Pediatrics最新文献

Background: Febrile young infants are at risk of invasive bacterial infections (IBIs; bacteremia or bacterial meningitis). American Academy of Pediatrics (AAP) guidelines recommend that when procalcitonin testing is unavailable, C-reactive protein (CRP), absolute neutrophil count (ANC) and temperature should be used to identify low-risk infants. We sought to determine the optimal combination of these inflammatory markers to predict IBI when procalcitonin is unavailable.

Methods: This was a secondary analysis of prospectively collected data for all febrile infants aged 60 days or younger evaluated at a tertiary pediatric emergency department (January 2018 to July 2023). Previously healthy term infants aged 8 to 60 days with rectal temperatures of 38.0°C or greater meeting AAP inclusion/exclusion criteria were analyzed. A decision rule was derived by classification and regression tree analysis with 10-fold cross-validation then compared to AAP-recommended thresholds of ANC ≤ 5200/mm3, CRP ≤ 20 mg/L, and temperature ≤ 38.5°C.

Results: Among 1987 infants, 38 (1.9%) had IBIs. The AAP-recommended thresholds missed no IBIs (sensitivity: 100.0% [95% CI, 88.6%-100.0%]; negative predictive value (NPV): 100.0% [95% CI, 99.5%-100.0%]; specificity: 50.7% [95% CI, 48.5%-53.0%]). Optimal derived thresholds were CRP ≤ 22.2mg/L, temperature ≤ 39.0°C, and ANC ≤ 4500/mm3; urinalysis and age were not selected. The derived rule also missed no IBIs (sensitivity: 100.0% [95% CI, 88.6%-100.0%]; NPV: 100.0% [95% CI, 99.7%-100.0%]); however, specificity improved to 83.8% (95% CI, 82.1%-85.4%). Area under the receiver operating curve for the cross-validated rule (91.9% [95% CI, 91.1%-92.7%]) was higher than at AAP-recommended thresholds (75.4% (95% CI, 74.3%-76.5%]).

Conclusions: The combination of ANC, CRP, and temperature at statistically derived thresholds improved diagnostic accuracy for identifying infants at low risk of IBIs compared to AAP-recommended thresholds.

In response to a record number of immigrant families arriving in the United States through the southern border, a multidisciplinary team at a tertiary care children's hospital developed an inpatient asylum protocol (IAP) whose goals were to identify, screen, and support hospitalized asylum-seeking patients and their families. Identified patients were provided with specialized social work, case management, and legal support and were longitudinally followed after hospital discharge to ensure successful engagement with community resources. A total of 47 patients were enrolled over 2.5 years. Our patient population demonstrated significant food, housing, and legal needs. Medical complexity was also substantial, with half of our patients requiring both inpatient subspecialty consultations and outpatient follow-up and 13% qualifying for our institution's complex care program. As a result of the IAP, all families received social work support that continued after discharge, 93% of families without legal aid on admission were connected with legal resources, and 96% of our patients without a primary care physician on arrival had established one on discharge. At the time of this review, half of our patients and families had graduated from the program, whereas the rest continued to require monthly follow-up because of ongoing needs. This novel program was successful in evaluating and addressing the needs of newly arrived asylum-seeking patients and their families in the inpatient setting. We hope that our protocol will aid other institutions in adopting similar interventions.

This case report describes a boy aged 8 years with autism spectrum disorder who was diagnosed with electrical status epilepticus in sleep (ESES) and found to have a likely pathogenic variant in the SEMA6B gene. The patient presented with developmental regression and cognitive decline. An electroencephalogram demonstrated continuous spike-and-wave discharges during sleep, a hallmark of ESES. Genetic testing identified a De Novo likely pathogenic variant in SEMA6B, a gene implicated in neurodevelopmental disorders and epilepsy. Although the association between SEMA6B mutations and ESES is not well established, this case suggests that the genetic variant may have contributed to the patient's clinical presentation. This is the first reported instance of ESES being linked to a SEMA6B gene variant, highlighting the importance of genetic testing in similar cases. The findings could have significant implications for the understanding and management of ESES in autistic patients with behavioral difficulties. They also underscore the need for further research into the role of SEMA6B in epilepsy and neurodevelopmental disorders.

Objectives: To identify opportunities for improvement in quality of care, we explore Black families' experiences of family support in the neonatal intensive care unit (NICU) during their infant's hospital stay.

Methods: Semistructured qualitative interviews or focus groups (FGs) were conducted to explore Black families' experiences of NICU hospitalization. Inclusion criteria were self-identification as a Black family member and infant admission to our NICU between January 2020 and February 2022. We conducted reflexive thematic analysis of recorded transcripts using Dedoose software.

Results: Three interviews and 2 FGs were conducted with 9 unique families (n = 13 individuals). We organized 10 key themes into "Experiences" and "Recommendations." Experience themes included distrust and fear of the medical setting, hypervigilance and trauma trajectory formation, the myth of "Black hardiness," policing and surveillance, and undermining of Black parenting. Recommendation themes implored NICU staff to earn rather than assume trust, respect family concerns, improve mental health support, provide compassionate care, and support the parenting role.

Conclusions: In this single-center qualitative study of Black families' NICU encounters, families continue to experience differential treatment, which reinforces an untrustworthy medical system perpetuating structural racism. Family recommendations for improving care through transparent communication, advocacy and mental health support, increased engagement in their parental role, and decreasing biased treatment and provision of resources may improve their experience and mitigate hypervigilance and trajectory formation in our NICU.

Objective: Our institutional data revealed high pneumothorax rates in term neonates resuscitated in the delivery room (DR). Other studies have reported that high rates of continuous positive airway pressure (CPAP) in the DR are associated with increased pneumothorax rates. We sought to test the hypothesis that quality improvement efforts to reduce the use of CPAP in the DR would be associated with a reduced incidence of pneumothorax.

Methods: We performed a series of interventions to make minor revisions to our DR respiratory care algorithm focusing on optimizing CPAP use by providing education to the DR team to the revisions. For neonates born at 36 weeks of gestation or beyond, we evaluated the use of CPAP in the DR and the number of births between pneumothorax events before and after the algorithm was implemented. We used statistical process control charts to assess improvement.

Results: CPAP utilization in the DR for infants 36 weeks or older decreased from 3.4% to 1.0%. Frequency of pneumothorax decreased, with births between pneumothorax events increasing from 293 to 530. We found no increase in the number of neonates requiring a higher level of care with respiratory distress.

Conclusion: We found that a reduction in the use of CPAP in DR was associated with a decrease in the rate of pneumothorax without an increase in neonates requiring additional care with respiratory distress.

Background and objectives: Research on conversations between caregivers and their children about how to prepare or conduct themselves when stopped by police (ie, "the talk") has grown in recent years. However, little is known about how having "the talk" may influence youths' stress about future experiences of police brutality (ie, anticipatory stress of police brutality). The objective of the present study is to examine how youths' anticipatory stress regarding police brutality varies by whether they have had "the talk" with their caregivers.

Methods: Data come from the Survey of Police-Adolescent Contact Experiences (SPACE), a cross-sectional survey of a community-based sample of Black youth aged 12 to 21 years in Baltimore, Maryland (n = 339), collected from August 2022 to July 2023. Multivariable ordinary least squares regressions were conducted to (1) examine associations between "the talk" and anticipatory stress of police brutality among a sample of Black youth in Baltimore and (2) examine the associations between messages in "the talk" and anticipatory stress of police brutality among youth who received "the talk."

Results: Findings indicate that having "the talk" was associated with lower anticipatory stress of police brutality. Moreover, among youth who received "the talk," certain messages from parents during "the talk" were associated with significant increases in anticipatory stress of police brutality compared with other messages.

Conclusions: Findings underscore the need for a nuanced understanding of "the talk's" broader implications on youth well-being and may be used to expand opportunities for youth to encounter affirmative racial socialization messages.