Pub Date : 2026-02-01DOI: 10.1542/peds.2025-072578
Abigail L Salthouse, Ayzsa Tannis, Rachel E Rutkowski, Geoffrey A Weinberg, Peter G Szilagyi, Mary A Staat, Elizabeth Schlaudecker, Natasha B Halasa, Laura S Stewart, Julie A Boom, Leila C Sahni, Marian G Michaels, Jennifer E Schuster, Rangaraj Selvarangan, Eileen J Klein, Janet A Englund, John V Williams, Ariana Toepfer, Heidi L Moline, Fatimah S Dawood
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.
{"title":"Hospitalization Outcomes of Full-Term and Premature Children Aged Less Than 2 Years Hospitalized With RSV.","authors":"Abigail L Salthouse, Ayzsa Tannis, Rachel E Rutkowski, Geoffrey A Weinberg, Peter G Szilagyi, Mary A Staat, Elizabeth Schlaudecker, Natasha B Halasa, Laura S Stewart, Julie A Boom, Leila C Sahni, Marian G Michaels, Jennifer E Schuster, Rangaraj Selvarangan, Eileen J Klein, Janet A Englund, John V Williams, Ariana Toepfer, Heidi L Moline, Fatimah S Dawood","doi":"10.1542/peds.2025-072578","DOIUrl":"10.1542/peds.2025-072578","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-29DOI: 10.1542/peds.2025-072830
Elyse N Portillo,Melissa R Ponce,Shaquita Bell,Angela M Ellison,Monika K Goyal,Nia Heard-Garris,Tiffani J Johnson,Joseph L Wright
Healthcare inequities and resultant disparities in health outcomes can be influenced by clinical guidelines and organization policies. This guidance may be implicitly or explicitly embedded with bias, discrimination, and racist ideologies which have the potential to cause harm, not only for historically marginalized and minoritized communities, but also at a broader population health-level. The American Academy of Pediatrics (AAP) is a professional society responsible for the creation and dissemination of many clinical practice guidelines (CPGs) and clinical reports (CRs) to promote child health. Recognizing the importance of ensuring that these CPGs and CRs promote health equity, the AAP convened a group of health services researchers to develop and pilot an evidence-informed instrument to assess for the inappropriate use of race and/or ethnicity. This article describes the methodological approach to developing and applying the evidence-informed instrument to the compendium of active AAP CPGs and CRs. We also present an approach for prioritizing CPGs and CRs most urgently in need of revision and describe a process to achieve buy-in within AAP leadership, and among the authoring groups and other partners. The process described here may be utilized by other professional societies and healthcare organizations to assess their own clinical guidelines.
{"title":"Operationalizing Equity: A Methodologic Framework for Revising Pediatric Clinical Guidances.","authors":"Elyse N Portillo,Melissa R Ponce,Shaquita Bell,Angela M Ellison,Monika K Goyal,Nia Heard-Garris,Tiffani J Johnson,Joseph L Wright","doi":"10.1542/peds.2025-072830","DOIUrl":"https://doi.org/10.1542/peds.2025-072830","url":null,"abstract":"Healthcare inequities and resultant disparities in health outcomes can be influenced by clinical guidelines and organization policies. This guidance may be implicitly or explicitly embedded with bias, discrimination, and racist ideologies which have the potential to cause harm, not only for historically marginalized and minoritized communities, but also at a broader population health-level. The American Academy of Pediatrics (AAP) is a professional society responsible for the creation and dissemination of many clinical practice guidelines (CPGs) and clinical reports (CRs) to promote child health. Recognizing the importance of ensuring that these CPGs and CRs promote health equity, the AAP convened a group of health services researchers to develop and pilot an evidence-informed instrument to assess for the inappropriate use of race and/or ethnicity. This article describes the methodological approach to developing and applying the evidence-informed instrument to the compendium of active AAP CPGs and CRs. We also present an approach for prioritizing CPGs and CRs most urgently in need of revision and describe a process to achieve buy-in within AAP leadership, and among the authoring groups and other partners. The process described here may be utilized by other professional societies and healthcare organizations to assess their own clinical guidelines.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"13 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1542/peds.2025-074507
Craig Authement,Poyyapakkam Srivaths
In 2011, the American Academy of Pediatrics (AAP) published a clinical practice guideline for urinary tract infections (UTI) in which voiding cysto-urethrogram (VCUG) would no longer be the first-line imaging study after first febrile urinary tract infection in children.1 Instead, VCUG would be indicated if a renal bladder ultrasound (RBUS) reveals hydronephrosis, scarring, or other findings suggestive of high-grade vesico-ureteral reflux (VUR) or obstructive uropathy. RBUS was recommended for all febrile infants and could be done in the acute period if suppurative complications (eg, renal abscesses) were suspected. The guideline acknowledged that RBUS would not identify all children with high-grade VUR, but the risk of a missed case was low and balanced by the avoidance of a painful procedure that also involves radiation exposure. Subsequently, and as expected, the use of VCUGs has decreased. Even though the 2011 guideline was retired in 2021 as part of the AAP's work to eliminate race-based medicine, the proportion of children who receive a VCUG after a febrile UTI remains low. The question is whether this decrease in VCUG has led to any harm.
{"title":"End-Stage Kidney Disease Following Reflux Nephropathy Since the 2011 AAP Guidelines.","authors":"Craig Authement,Poyyapakkam Srivaths","doi":"10.1542/peds.2025-074507","DOIUrl":"https://doi.org/10.1542/peds.2025-074507","url":null,"abstract":"In 2011, the American Academy of Pediatrics (AAP) published a clinical practice guideline for urinary tract infections (UTI) in which voiding cysto-urethrogram (VCUG) would no longer be the first-line imaging study after first febrile urinary tract infection in children.1 Instead, VCUG would be indicated if a renal bladder ultrasound (RBUS) reveals hydronephrosis, scarring, or other findings suggestive of high-grade vesico-ureteral reflux (VUR) or obstructive uropathy. RBUS was recommended for all febrile infants and could be done in the acute period if suppurative complications (eg, renal abscesses) were suspected. The guideline acknowledged that RBUS would not identify all children with high-grade VUR, but the risk of a missed case was low and balanced by the avoidance of a painful procedure that also involves radiation exposure. Subsequently, and as expected, the use of VCUGs has decreased. Even though the 2011 guideline was retired in 2021 as part of the AAP's work to eliminate race-based medicine, the proportion of children who receive a VCUG after a febrile UTI remains low. The question is whether this decrease in VCUG has led to any harm.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"3 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1542/peds.2025-072092
Alexander J Wolf,Sai Liu,Margaret Stedman,Paul Grimm,Abanti Chaudhuri,David S Hains,Michelle C Starr,Kathleen Kan,Scott M Sutherland,Alan R Schroeder
BACKGROUND AND OBJECTIVESUp to 50% of children with urinary tract infections (UTIs) have vesicoureteral reflux (VUR). Severe VUR can lead to reflux nephropathy (RN) and end-stage kidney disease (ESKD). In 2011, the American Academy of Pediatrics UTI guidelines suggested selective voiding cystourethrogram (VCUG), departing from previous recommendations to obtain VCUG after all febrile UTIs in children aged less than 2 years. It is unknown whether the subsequent decrease in VCUG has led to increased preventable kidney damage. This study's objective is to evaluate recent trends in the US incidence of pediatric ESKD owing to RN.METHODSThis retrospective cohort study used the US Renal Data System, a database that includes all US patients with ESKD. We identified patients aged 24 years and younger with ESKD attributed to RN from 2002 to 2021 as well as diagnoses that may overlap with RN. We used the US Census Bureau data to ascertain population incidence and a Poisson regression model for average annual percentage change (AAPC).RESULTSThere were 46 000 cases of ESKD. The all-cause incidence of ESKD decreased (AAPC of -1.0%; 95% CI, -1.4% to -0.7%) as did the incidence of ESKD owing to RN (AAPC of -4.4%; 95% CI, -5.8% to -3.0%). The incidence of ESKD from obstructive uropathies and renal dysplasia also decreased; however, the incidence of other nonspecific congenital anomalies of the kidney and urinary tract increased.CONCLUSIONSThe declining use of VCUG over the last decade has not resulted in a measurable worsening of ESKD related to identified RN at the population level. Continued surveillance over time and investigations into shorter-term kidney outcomes are needed.
背景与目的高达50%的儿童尿路感染（uti）有膀胱输尿管反流（VUR）。严重的VUR可导致反流性肾病（RN）和终末期肾病（ESKD）。2011年，美国儿科学会（American Academy of Pediatrics）的尿路感染指南建议选择性排尿膀胱输尿管造影（VCUG），而不是之前的建议，即在2岁以下儿童的所有发热性尿路感染后进行VCUG检查。目前尚不清楚随后的VCUG减少是否会导致可预防肾损害的增加。本研究的目的是评估美国因RN引起的儿童ESKD发病率的最新趋势。方法：本回顾性队列研究使用美国肾脏数据系统，该数据库包括所有美国ESKD患者。我们确定了2002年至2021年24岁及以下的患者，这些患者的ESKD归因于RN，以及可能与RN重叠的诊断。我们使用美国人口普查局的数据来确定人口发病率和平均年百分比变化（AAPC）的泊松回归模型。结果ESKD共4.6万例。全因ESKD发病率下降（AAPC为-1.0%,95% CI, -1.4%至-0.7%），因RN引起的ESKD发病率也下降（AAPC为-4.4%,95% CI, -5.8%至-3.0%）。梗阻性尿路病变和肾发育不良引起的ESKD发生率也有所下降；然而，其他非特异性肾脏和泌尿道先天性异常的发生率增加。结论：在过去十年中，VCUG使用的减少并未导致人群水平上与已确定的RN相关的ESKD的可测量恶化。需要持续监测一段时间并对短期肾脏结果进行调查。
{"title":"Trends in End-Stage Kidney Disease Due to Reflux Nephropathy in Children and Young Adults.","authors":"Alexander J Wolf,Sai Liu,Margaret Stedman,Paul Grimm,Abanti Chaudhuri,David S Hains,Michelle C Starr,Kathleen Kan,Scott M Sutherland,Alan R Schroeder","doi":"10.1542/peds.2025-072092","DOIUrl":"https://doi.org/10.1542/peds.2025-072092","url":null,"abstract":"BACKGROUND AND OBJECTIVESUp to 50% of children with urinary tract infections (UTIs) have vesicoureteral reflux (VUR). Severe VUR can lead to reflux nephropathy (RN) and end-stage kidney disease (ESKD). In 2011, the American Academy of Pediatrics UTI guidelines suggested selective voiding cystourethrogram (VCUG), departing from previous recommendations to obtain VCUG after all febrile UTIs in children aged less than 2 years. It is unknown whether the subsequent decrease in VCUG has led to increased preventable kidney damage. This study's objective is to evaluate recent trends in the US incidence of pediatric ESKD owing to RN.METHODSThis retrospective cohort study used the US Renal Data System, a database that includes all US patients with ESKD. We identified patients aged 24 years and younger with ESKD attributed to RN from 2002 to 2021 as well as diagnoses that may overlap with RN. We used the US Census Bureau data to ascertain population incidence and a Poisson regression model for average annual percentage change (AAPC).RESULTSThere were 46 000 cases of ESKD. The all-cause incidence of ESKD decreased (AAPC of -1.0%; 95% CI, -1.4% to -0.7%) as did the incidence of ESKD owing to RN (AAPC of -4.4%; 95% CI, -5.8% to -3.0%). The incidence of ESKD from obstructive uropathies and renal dysplasia also decreased; however, the incidence of other nonspecific congenital anomalies of the kidney and urinary tract increased.CONCLUSIONSThe declining use of VCUG over the last decade has not resulted in a measurable worsening of ESKD related to identified RN at the population level. Continued surveillance over time and investigations into shorter-term kidney outcomes are needed.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"1 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1542/peds.2025-075754
Sean T O'Leary
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.
{"title":"Recommended Childhood and Adolescent Immunization Schedule: United States, 2026: Policy Statement.","authors":"Sean T O'Leary","doi":"10.1542/peds.2025-075754","DOIUrl":"https://doi.org/10.1542/peds.2025-075754","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1542/peds.2025-073627
Santina A Zanelli,Courtney J Wusthoff,Ashley M Lucke,David A Kaufman, ,
Therapeutic hypothermia to a temperature of 33.5 to 34.5 °C initiated within 6 hours of birth and continued for 72 hours reduces the risk of death or moderate-to-severe neurodevelopmental impairments in neonates with moderate-to-severe hypoxic-ischemic encephalopathy (HIE) born at ≥36 0/7 weeks of gestation. This specialized therapy requires neuromonitoring, neuroimaging, and plans for follow-up of neurodevelopmental outcomes. Any center or practitioner involved in newborn deliveries should have action plans for prompt recognition and initiation of therapeutic hypothermia or transfer of infants with possible HIE to a center providing therapeutic hypothermia. Because many neonates with HIE are born at places that do not provide therapeutic hypothermia, therapeutic hypothermia centers should work with their referring hospitals, birthing centers and practitioners to implement educational programs that focus on the identification, initial clinical management of affected neonates, and prompt transfer of neonates with moderate-to-severe HIE.
{"title":"Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy: Clinical Report.","authors":"Santina A Zanelli,Courtney J Wusthoff,Ashley M Lucke,David A Kaufman, , ","doi":"10.1542/peds.2025-073627","DOIUrl":"https://doi.org/10.1542/peds.2025-073627","url":null,"abstract":"Therapeutic hypothermia to a temperature of 33.5 to 34.5 °C initiated within 6 hours of birth and continued for 72 hours reduces the risk of death or moderate-to-severe neurodevelopmental impairments in neonates with moderate-to-severe hypoxic-ischemic encephalopathy (HIE) born at ≥36 0/7 weeks of gestation. This specialized therapy requires neuromonitoring, neuroimaging, and plans for follow-up of neurodevelopmental outcomes. Any center or practitioner involved in newborn deliveries should have action plans for prompt recognition and initiation of therapeutic hypothermia or transfer of infants with possible HIE to a center providing therapeutic hypothermia. Because many neonates with HIE are born at places that do not provide therapeutic hypothermia, therapeutic hypothermia centers should work with their referring hospitals, birthing centers and practitioners to implement educational programs that focus on the identification, initial clinical management of affected neonates, and prompt transfer of neonates with moderate-to-severe HIE.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"16 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1542/peds.2025-072885
Sean C Rose,Dominique Dupont,Ken Tang,Keith Owen Yeates,Fanny Dégeilh,Isabelle Gagnon,Jocelyn Gravel,Kelly McNally,Brett Burstein,Antonia Stang,Rachel M Stanley,Roger Leonard Zemek,Miriam H Beauchamp,
OBJECTIVESConcussion is common in early childhood, yet the rate of persisting symptoms after concussion (PSaC) is unknown. We sought to determine the frequency of PSaC after early childhood concussion and identify potential predictors of PSaC.METHODSWe conducted a cohort study enrolling children aged 6 months to younger than 6 years presenting to Canadian and US emergency departments (EDs) with concussion or orthopedic injury (OI) and uninjured children from the community (community controls [CCs]). The primary outcome was PSaC at 1 month after injury determined by reliable change analysis. PSaC were also tracked through 12 months after injury. Potential predictors of PSaC were analyzed using multivariable logistic regression.RESULTSWe enrolled 418 children: 235 with concussion, 108 with OI, and 75 CCs. Median age was 2.8 years, and 50.7% were male. At 1 month, PSaC were documented in 28% of children with concussion, higher than in the OI group (10%, P = .006) and the CC group (2%, P < .001). After concussion, PSaC were documented in 24% of children at 3 months and 16% at 12 months. Total symptom burden in the ED predicted PSaC at 1 month (odds ratio, 1.108; 95% CI, 1.004-1.223; P = .04). Age, loss of consciousness, receiving brain imaging in the ED, attending daycare or school, and parent education did not predict PSaC.CONCLUSIONSPSaC are common after early childhood concussion. Acute symptom burden in the ED predicts PSaC at 1 month. Greater focus on research in this age group and the development of clinical infrastructure is necessary to address these ongoing symptoms.
目的：脑震荡在儿童早期很常见，但脑震荡后持续症状（PSaC）的发生率尚不清楚。我们试图确定早期儿童脑震荡后PSaC的频率，并确定PSaC的潜在预测因素。方法：我们进行了一项队列研究，纳入了来自加拿大和美国急诊科（ed）的6个月至6岁以下的脑震荡或骨科损伤（OI）儿童和来自社区的未受伤儿童（社区对照[cc]）。主要终点是损伤后1个月的PSaC，通过可靠的变化分析确定。PSaC也在受伤后的12个月内被追踪。采用多变量logistic回归分析PSaC的潜在预测因素。结果：我们招募了418名儿童：235名脑震荡，108名成骨不全，75名cc。中位年龄为2.8岁，50.7%为男性。1个月时，28%的脑震荡儿童出现PSaC，高于成骨不全组(10%,P =。006)和CC组（2%,P < 0.001）。脑震荡后，24%的3个月儿童和16%的12个月儿童出现PSaC。ED的总症状负担预测1个月时的PSaC（优势比1.108;95% CI, 1.004-1.223; P = 0.04）。年龄、意识丧失、在急诊科接受脑成像、是否参加日托或上学以及父母的教育程度与PSaC无关。结论spsac在儿童早期脑震荡后较为常见。急诊科的急性症状负担预测1个月的PSaC。需要更多地关注这一年龄组的研究和临床基础设施的发展，以解决这些持续的症状。
{"title":"Frequency and Predictors of Persisting Symptoms 1 Year After Early Childhood Concussion.","authors":"Sean C Rose,Dominique Dupont,Ken Tang,Keith Owen Yeates,Fanny Dégeilh,Isabelle Gagnon,Jocelyn Gravel,Kelly McNally,Brett Burstein,Antonia Stang,Rachel M Stanley,Roger Leonard Zemek,Miriam H Beauchamp, ","doi":"10.1542/peds.2025-072885","DOIUrl":"https://doi.org/10.1542/peds.2025-072885","url":null,"abstract":"OBJECTIVESConcussion is common in early childhood, yet the rate of persisting symptoms after concussion (PSaC) is unknown. We sought to determine the frequency of PSaC after early childhood concussion and identify potential predictors of PSaC.METHODSWe conducted a cohort study enrolling children aged 6 months to younger than 6 years presenting to Canadian and US emergency departments (EDs) with concussion or orthopedic injury (OI) and uninjured children from the community (community controls [CCs]). The primary outcome was PSaC at 1 month after injury determined by reliable change analysis. PSaC were also tracked through 12 months after injury. Potential predictors of PSaC were analyzed using multivariable logistic regression.RESULTSWe enrolled 418 children: 235 with concussion, 108 with OI, and 75 CCs. Median age was 2.8 years, and 50.7% were male. At 1 month, PSaC were documented in 28% of children with concussion, higher than in the OI group (10%, P = .006) and the CC group (2%, P < .001). After concussion, PSaC were documented in 24% of children at 3 months and 16% at 12 months. Total symptom burden in the ED predicted PSaC at 1 month (odds ratio, 1.108; 95% CI, 1.004-1.223; P = .04). Age, loss of consciousness, receiving brain imaging in the ED, attending daycare or school, and parent education did not predict PSaC.CONCLUSIONSPSaC are common after early childhood concussion. Acute symptom burden in the ED predicts PSaC at 1 month. Greater focus on research in this age group and the development of clinical infrastructure is necessary to address these ongoing symptoms.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"7 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1542/peds.2025-074113
Mary E O'Connor,Judith Groner,Larry Wissow,Rebecca Cantu,James Scibilia, , , ,
Pediatricians may be asked or choose to provide care for parents during a child's visit. This care may include treatment of infectious diseases; immunization; screening, referral, or treatment for mental health issues; and assessment and management of breastfeeding problems. By providing medical care to parents, pediatricians can reduce barriers to care and improve the timeliness of needed interventions. This policy statement describes some practical and medical-legal issues associated with caring for parents and provides guidance about when and how pediatricians can provide care in a way that minimizes liability risk, even when a physician-patient relationship may be established. Common situations when pediatricians may consider providing care for parents are reviewed, and recommendations considering the pediatrician's personal preferences, training, and medical-legal considerations are provided.
{"title":"Providing Medical Care for Parents During the Pediatric Visit: Policy Statement.","authors":"Mary E O'Connor,Judith Groner,Larry Wissow,Rebecca Cantu,James Scibilia, , , , ","doi":"10.1542/peds.2025-074113","DOIUrl":"https://doi.org/10.1542/peds.2025-074113","url":null,"abstract":"Pediatricians may be asked or choose to provide care for parents during a child's visit. This care may include treatment of infectious diseases; immunization; screening, referral, or treatment for mental health issues; and assessment and management of breastfeeding problems. By providing medical care to parents, pediatricians can reduce barriers to care and improve the timeliness of needed interventions. This policy statement describes some practical and medical-legal issues associated with caring for parents and provides guidance about when and how pediatricians can provide care in a way that minimizes liability risk, even when a physician-patient relationship may be established. Common situations when pediatricians may consider providing care for parents are reviewed, and recommendations considering the pediatrician's personal preferences, training, and medical-legal considerations are provided.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"50 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1542/peds.2025-074668
Hanna Heintz,Robert W Hickey,Danny G Thomas
{"title":"Rethinking \"Mild\" Concussion in Early Childhood.","authors":"Hanna Heintz,Robert W Hickey,Danny G Thomas","doi":"10.1542/peds.2025-074668","DOIUrl":"https://doi.org/10.1542/peds.2025-074668","url":null,"abstract":"","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"4 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-26DOI: 10.1542/peds.2025-074114
Tim Jancelewicz,Ashley Lucke,Charleta Guillory, ,
This clinical report provides an updated evidence-based set of recommendations for the long-term follow-up of patients with congenital diaphragmatic hernia (CDH) after discharge from initial hospitalization. Since the last American Academy of Pediatrics report was published over 15 years ago, there have been significant advances in our understanding of the manifestations, diagnostic and surveillance approaches, and therapies for the cardiopulmonary, neurodevelopmental, gastrointestinal/nutritional, and surgical adverse outcomes that are commonly encountered in patients with CDH. Consideration is also given to patient and caregiver quality of life, which has been a relatively overlooked component of this disease in previous CDH guidance. Because CDH severity and the prevalence of adverse outcomes are not only variable but also change with patient age, differential guidance is provided based on low-risk and high-risk status and are presented in a timeline format. Providers may use the guidance in this clinical report to develop an individualized long-term plan that balances care with available resources to support quality of life through the lifespan.
{"title":"Postdischarge Follow-Up of Infants With Congenital Diaphragmatic Hernia: Clinical Report.","authors":"Tim Jancelewicz,Ashley Lucke,Charleta Guillory, , ","doi":"10.1542/peds.2025-074114","DOIUrl":"https://doi.org/10.1542/peds.2025-074114","url":null,"abstract":"This clinical report provides an updated evidence-based set of recommendations for the long-term follow-up of patients with congenital diaphragmatic hernia (CDH) after discharge from initial hospitalization. Since the last American Academy of Pediatrics report was published over 15 years ago, there have been significant advances in our understanding of the manifestations, diagnostic and surveillance approaches, and therapies for the cardiopulmonary, neurodevelopmental, gastrointestinal/nutritional, and surgical adverse outcomes that are commonly encountered in patients with CDH. Consideration is also given to patient and caregiver quality of life, which has been a relatively overlooked component of this disease in previous CDH guidance. Because CDH severity and the prevalence of adverse outcomes are not only variable but also change with patient age, differential guidance is provided based on low-risk and high-risk status and are presented in a timeline format. Providers may use the guidance in this clinical report to develop an individualized long-term plan that balances care with available resources to support quality of life through the lifespan.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"17 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146044676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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