Pediatrics最新文献

Background and objectives: Humans use storytelling to create meaning from suffering, including after the death of a child. The elicitation of and response to stories remains underused in medicine, and in particular, within parental bereavement. Thus, we sought to explore how bereaved parents choose to share the story of their child.

Methods: This is a secondary analysis of a dual site, survey-based study of parents' experiences following their child's death from cancer 6 to 24 months earlier. Our qualitative inquiry focuses on inductive, iterative analysis of free-text responses to the following question: "If you would be willing to share, please tell us about your child. What would you like us to know about him/her?"

Results: A total of 128 parents completed the survey; 101 parents (79%) representing 81 children shared stories about their child. Responses took the form of narratives that varied in terms of structure (eg, verb tense, subject, narrative arc) and content (eg, character development, narration/voice). Parents highlighted their child's appearance, traits, and passions. Most did not detail cancer history or death. Parent narratives progressed through themes of medicalization, humanization, and supernaturalization in the "character development" of their child, who was frequently characterized as "otherworldly."

Conclusions: Bereaved parents whose child died of cancer have a desire to tell their child's story. When given the opportunity, nearly 80% of parents in this study chose to share. Thematic progression may be a framework for narrative repair. Parental narratives of their deceased child provide new insights into their bereavement experience and may help to develop novel supportive interventions.

Objective: Prognostic communication is vital to high-quality care for children with serious illness. Yet clinicians often struggle to balance honesty with preservation of hope-especially when prognosis is poor or uncertain. Patients and parents cite hope and uncertainty as central themes in their communication needs, but guidance for clinicians is lacking. This study aimed to characterize patient, parent, and oncologist recommendations for strategies to navigate hope and uncertainty during prognostic discussions.

Methods: Semistructured interviews were conducted with pediatric patients with poor-prognosis cancer (n = 25), parents of patients on therapy (n = 30), bereaved parents (n = 10), and pediatric oncologists (n = 20) from 6 institutions across 5 US states. Participants were asked whether oncologists could support hope while discussing poor prognosis and how oncologists should discuss uncertain prognostic information. Rapid analysis yielded themes in participant recommendations.

Results: Nearly all participants agreed that oncologists can support hope while discussing poor prognosis. Participants emphasized that honesty-about prognosis and uncertainty-can support, rather than diminish, hope. Most participants described recommended strategies for how to navigate hope and uncertainty during prognostic communication. Four themes were identified in recommendations: (1) prioritize honesty, (2) provide leadership, guidance, and expertise, (3) provide compassionate, individualized support, and (4) acknowledge inherent uncertainty as space for hope.

Conclusion: Providing honest, individualized communication can foster hope and manage uncertainty for children with cancer and their families. Results will guide development of communication tools to strengthen education and bedside care, equipping clinicians to meet the diverse needs and preferences of families facing childhood cancer.

Background: Prematurity may place young children at increased risk for severe respiratory syncytial virus (RSV) disease because of differences in lung development. We describe characteristics of children aged less than 2 years hospitalized with RSV by prematurity and bronchopulmonary dysplasia (BPD) status and examine both as risk factors for severe in-hospital outcomes.

Methods: During 2016-2023, population-based surveillance was conducted at 7 medical centers for hospitalizations with RSV-associated acute respiratory illness in children. Poisson regression with robust variance was used to estimate adjusted relative risks (aRRs) of prolonged hospitalization (≥3 days), intensive care unit (ICU) admission, and assisted ventilation by age in children with prematurity without and with BPD compared with term children after adjustment for surveillance site and palivizumab receipt.

Results: Among 5844 children, 4626 (79.2%) were term and 1218 (20.8%) were premature, including 1138 (93.4%) without BPD and 80 (6.6%) with BPD. Compared with term children, all premature children had greater risks for prolonged hospitalization (aRR = 1.3; 95% CI, 1.2-1.5), ICU admission (aRR = 1.4; 95% CI, 1.2-1.6), and assisted ventilation (aRR = 2.0; 95% CI, 1.4-2.8) at chronological age less than 6 months. Premature children with BPD also had greater risk for prolonged hospitalization at all ages through 23 months.

Conclusions: Premature children accounted for 1 in 5 hospitalizations among children aged less than 2 years hospitalized with RSV. Compared with term children, all premature children had increased risk for severe in-hospital outcomes in early infancy, and those with BPD remained at increased risk of prolonged hospitalization through age 23 months.

The 2026 recommended childhood and adolescent immunization schedule has been published by the American Academy of Pediatrics (AAP). The schedule is revised annually to reflect current recommendations for the use of vaccines licensed by the US Food and Drug Administration. At this time, the AAP no longer endorses the recommended childhood and adolescent immunization schedule from the Centers for Disease Control and Prevention.