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}
Pub Date : 2026-01-23DOI: 10.1542/peds.2025-073588
Jennifer L Rosenthal,Kristin R Hoffman,Daniel J Tancredi,James P Marcin,Audriana Ketchersid,Elva T Horath,Erika N Zerda,Trevor R Bushong,Daniel S Merriott,Heather M Young,Patrick S Romano
BACKGROUND AND OBJECTIVEThe use of telehealth to bring a family member virtually to the bedside for family-centered rounds (FCR) is a promising strategy to increase family members' access. We aimed to evaluate the impact of offering families the option to use virtual FCR in the neonatal intensive care unit (NICU) on parental and neonatal outcomes.METHODSThis 2-arm cluster randomized controlled trial assigned families of hospitalized infants to the option of using virtual FCR (intervention) or to usual care (control). Intervention families could also attend FCR in person (usual care). All eligible families of infants who were admitted to this single-site neonatal intensive care unit during the study period were included. Outcomes included FCR attendance, parent experience, family-centered care, parent activation, parent health-related quality of life, length of stay, breastmilk feeding, and neonatal growth.RESULTSFrom March 2023 to 2024, 486 families were randomized (325 intervention, 161 control). Infants in the intervention arm were estimated to have 4.81 (95% CI 3.65-6.32) times the parent attendance rate of infants in the control arm (unadjusted incidence rate ratio: 4.62 [95% CI 3.40-6.28]). The intervention arm had 0.37 (95% CI 0.18-0.75) times the adjusted odds of a 30-day emergency department revisit compared with the control arm (unadjusted odds ratio: 0.48 [95% CI 0.25-0.91]). No statistically significant positive intervention effects were observed for other secondary outcomes.CONCLUSIONSOffering virtual FCR increased parent attendance and reduced 30-day emergency department revisits among NICU infants.
背景与目的利用远程医疗将家庭成员虚拟带到床边进行以家庭为中心的查房（FCR）是增加家庭成员访问的一种有前途的策略。我们的目的是评估在新生儿重症监护病房（NICU）为家庭提供虚拟FCR的选择对父母和新生儿结局的影响。方法该双组随机对照试验将住院婴儿家庭分为虚拟FCR（干预）和常规护理（对照组）两组。干预家庭也可以亲自参加FCR（常规护理）。所有在研究期间入住单点新生儿重症监护病房的符合条件的婴儿家庭均被纳入研究。结果包括FCR出席率、父母经验、以家庭为中心的护理、父母激活、父母健康相关生活质量、住院时间、母乳喂养和新生儿生长。结果从2023年3月至2024年3月，共纳入486个家庭，其中干预325个，对照组161个。据估计，干预组婴儿的父母出勤率是对照组婴儿的4.81倍（95% CI 3.65-6.32）（未调整的发病率比：4.62 [95% CI 3.40-6.28]）。与对照组相比，干预组30天急诊重访的调整后几率为0.37倍（95% CI 0.18-0.75）（未调整的优势比：0.48 [95% CI 0.25-0.91]）。其他次要结果未观察到统计学上显著的积极干预效果。结论虚拟FCR提高了新生儿重症监护病房患儿的家长出勤率，减少了患儿30天急诊科就诊次数。
{"title":"NICU Virtual Family-Centered Rounds: A Cluster Randomized Controlled Trial.","authors":"Jennifer L Rosenthal,Kristin R Hoffman,Daniel J Tancredi,James P Marcin,Audriana Ketchersid,Elva T Horath,Erika N Zerda,Trevor R Bushong,Daniel S Merriott,Heather M Young,Patrick S Romano","doi":"10.1542/peds.2025-073588","DOIUrl":"https://doi.org/10.1542/peds.2025-073588","url":null,"abstract":"BACKGROUND AND OBJECTIVEThe use of telehealth to bring a family member virtually to the bedside for family-centered rounds (FCR) is a promising strategy to increase family members' access. We aimed to evaluate the impact of offering families the option to use virtual FCR in the neonatal intensive care unit (NICU) on parental and neonatal outcomes.METHODSThis 2-arm cluster randomized controlled trial assigned families of hospitalized infants to the option of using virtual FCR (intervention) or to usual care (control). Intervention families could also attend FCR in person (usual care). All eligible families of infants who were admitted to this single-site neonatal intensive care unit during the study period were included. Outcomes included FCR attendance, parent experience, family-centered care, parent activation, parent health-related quality of life, length of stay, breastmilk feeding, and neonatal growth.RESULTSFrom March 2023 to 2024, 486 families were randomized (325 intervention, 161 control). Infants in the intervention arm were estimated to have 4.81 (95% CI 3.65-6.32) times the parent attendance rate of infants in the control arm (unadjusted incidence rate ratio: 4.62 [95% CI 3.40-6.28]). The intervention arm had 0.37 (95% CI 0.18-0.75) times the adjusted odds of a 30-day emergency department revisit compared with the control arm (unadjusted odds ratio: 0.48 [95% CI 0.25-0.91]). No statistically significant positive intervention effects were observed for other secondary outcomes.CONCLUSIONSOffering virtual FCR increased parent attendance and reduced 30-day emergency department revisits among NICU infants.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"42 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021359","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 : 2026-01-23DOI: 10.1542/peds.2025-073306
Michael J Feldman,William J Hereford,Regan Gaskin,Garrett W Thrash,Honour M Hill,Sana Jaffery,Betsy Hopson,Brandon G Rocque,Anastasia Arynchyna-Smith,Jeffrey P Blount
Neural tube defects (NTDs), such as myelomeningocele, are serious birth defects preventable with adequate maternal folate intake. In the United States, Hispanic populations have disproportionately high NTD rates. Mandatory fortification of enriched cereal grains in the 1990s significantly reduced NTDs but excluded corn masa flour (CMF), a staple in many Hispanic diets. This shortcoming may contribute to persistent disparities in NTD rates. We pursued a state legislative mandate for folic acid fortification of CMF to reduce NTDs. We also developed a legislative model that can be replicated nationwide to encourage broader fortification of CMF. A task force engaged the Hispanic community through bilingual outreach to understand dietary habits and the role of CMF to optimize the impact and cultural utility of resulting legislation. Based on these conversations, legislation was drafted with consultation from fortification experts ensuring scientific and policy viability. A legislative sponsor was secured through targeted engagement and lobbying. In June 2025, HB384 was signed into law by the governor of Alabama, mandating folic acid fortification of CMF and tortilla products. Opposition cited concerns about genetic variation in folic acid metabolism, prenatal care access, and governmental overreach. Alabama's legislative success demonstrates a model for addressing sources of disparity in health care access and outcomes. Additional states replicating this approach may promote national CMF fortification policy or incentivize industry adoption of CMF fortification, potentially preventing up to 120 NTD cases per year in the Hispanic community, saving up to $100 million in annual health care spending.
{"title":"Fortify Alabama: Corn Masa Fortification for Spina Bifida Prevention.","authors":"Michael J Feldman,William J Hereford,Regan Gaskin,Garrett W Thrash,Honour M Hill,Sana Jaffery,Betsy Hopson,Brandon G Rocque,Anastasia Arynchyna-Smith,Jeffrey P Blount","doi":"10.1542/peds.2025-073306","DOIUrl":"https://doi.org/10.1542/peds.2025-073306","url":null,"abstract":"Neural tube defects (NTDs), such as myelomeningocele, are serious birth defects preventable with adequate maternal folate intake. In the United States, Hispanic populations have disproportionately high NTD rates. Mandatory fortification of enriched cereal grains in the 1990s significantly reduced NTDs but excluded corn masa flour (CMF), a staple in many Hispanic diets. This shortcoming may contribute to persistent disparities in NTD rates. We pursued a state legislative mandate for folic acid fortification of CMF to reduce NTDs. We also developed a legislative model that can be replicated nationwide to encourage broader fortification of CMF. A task force engaged the Hispanic community through bilingual outreach to understand dietary habits and the role of CMF to optimize the impact and cultural utility of resulting legislation. Based on these conversations, legislation was drafted with consultation from fortification experts ensuring scientific and policy viability. A legislative sponsor was secured through targeted engagement and lobbying. In June 2025, HB384 was signed into law by the governor of Alabama, mandating folic acid fortification of CMF and tortilla products. Opposition cited concerns about genetic variation in folic acid metabolism, prenatal care access, and governmental overreach. Alabama's legislative success demonstrates a model for addressing sources of disparity in health care access and outcomes. Additional states replicating this approach may promote national CMF fortification policy or incentivize industry adoption of CMF fortification, potentially preventing up to 120 NTD cases per year in the Hispanic community, saving up to $100 million in annual health care spending.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"47 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021361","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 : 2026-01-23DOI: 10.1542/peds.2025-073458
Renée A Shellhaas,Fauziya Hassan,Thornton A Mason,Jagruti Anadkat,Ellen Bendel-Stenzel,Stephanie Eyerly-Webb,Cindy K Jon,Robin M Lloyd,Julie S Moldenhauer,Ramesha Papanna,John E Pascoe,Stefanie Riddle,Regina Reynolds,Brandon G Rocque,Narong Simakajornboon,Marjorie C Treadwell,R Bradley Troxler,Lydia S Youmans,Niko A Kaciroti,Harlan McCaffery,Hemant A Parmar,Lora Merley,Stephanie Md Rau,Ronald D Chervin,John D E Barks
BACKGROUND & OBJECTIVESleep-disordered breathing (SDB) may be a remediable contributor to abnormal cognitive outcomes for children with myelomeningocele. We investigated the frequency of SDB among neonates with fetal vs postnatal myelomeningocele repair.METHODSIn this nine-center, prospective, observational study, neonates with myelomeningocele born at more than 30 weeks gestational age underwent a 10-hour bedside polysomnogram at at least 35 weeks postmenstrual age, before hospital discharge. The primary outcome was SDB severity, reflected by the apnea-hypopnea index (AHI; number of respiratory events per hour of sleep). Decisions regarding surgical timing (fetal vs postnatal), technique (open fetal vs fetoscopic approach), and SDB treatment were made by the clinical teams.RESULTSAmong 173 infants, 92/173 (53%) had SDB (median AHI 22.5, IQR 12.2-44.2). In unadjusted analysis, AHI was higher among the 90 neonates with fetal repair vs 83 with postnatal surgery (median 29, IQR 14-49, vs 19, IQR 10-36, P = .008). In propensity-adjusted multivariable models, prematurity was independently associated with AHI, whereas surgical timing (fetal vs postnatal) was not. Hindbrain herniation, myelomeningocele level, and clinical need for ventriculoperitoneal shunt did not predict AHI in adjusted models. Supplemental oxygen was commonly prescribed, for 44% of fetal vs 39% of postnatal myelomeningocele repair infants (P = .5).CONCLUSIONSSDB affects more than half of neonates with myelomeningocele. The higher AHI after fetal surgery could stem from the elevated incidence of prematurity in this group. As SDB is treatable and has a potential impact on neurodevelopment, routine screening could become an integral part of a strategy to optimize long-term medical and neurodevelopmental outcomes.
背景与目的：睡眠呼吸障碍（SDB）可能是脊髓脊膜膨出儿童认知结果异常的可补救因素。我们调查了脊髓脊膜膨出修复的新生儿中发生SDB的频率。方法：在这项9个中心的前瞻性观察性研究中，出生在孕周超过30周的脊髓脊膜膨出新生儿在月经后至少35周出院前接受了10小时床边多导睡眠图检查。主要结局是SDB严重程度，由呼吸暂停低通气指数（AHI，每小时睡眠呼吸事件数）反映。关于手术时机（胎儿vs产后）、技术（开放胎儿vs胎儿镜）和SDB治疗的决定由临床团队做出。结果173例患儿中，92/173例（53%）患有SDB （AHI中位数22.5，IQR中位数12.2-44.2）。在未经校正的分析中，90例胎儿修复新生儿的AHI高于83例产后手术新生儿（中位数29，IQR 14-49，对19，IQR 10-36, P = 0.008）。在倾向调整的多变量模型中，早产与AHI独立相关，而手术时机（胎儿vs产后）与AHI无关。在调整后的模型中，后脑疝、脊髓脊膜膨出水平和脑室-腹膜分流术的临床需要不能预测AHI。44%的胎儿和39%的产后脊髓脊膜膨出修复婴儿（P = 0.5）通常需要补充氧气。结论ssdb影响超过一半的新生儿脊髓脊膜膨出。胎儿手术后较高的AHI可能源于该组早产儿的发生率升高。由于SDB是可治疗的，并且对神经发育有潜在影响，因此常规筛查可以成为优化长期医疗和神经发育结果的策略的组成部分。
{"title":"Sleep-Disordered Breathing in Newborns After Myelomeningocele Repair.","authors":"Renée A Shellhaas,Fauziya Hassan,Thornton A Mason,Jagruti Anadkat,Ellen Bendel-Stenzel,Stephanie Eyerly-Webb,Cindy K Jon,Robin M Lloyd,Julie S Moldenhauer,Ramesha Papanna,John E Pascoe,Stefanie Riddle,Regina Reynolds,Brandon G Rocque,Narong Simakajornboon,Marjorie C Treadwell,R Bradley Troxler,Lydia S Youmans,Niko A Kaciroti,Harlan McCaffery,Hemant A Parmar,Lora Merley,Stephanie Md Rau,Ronald D Chervin,John D E Barks","doi":"10.1542/peds.2025-073458","DOIUrl":"https://doi.org/10.1542/peds.2025-073458","url":null,"abstract":"BACKGROUND & OBJECTIVESleep-disordered breathing (SDB) may be a remediable contributor to abnormal cognitive outcomes for children with myelomeningocele. We investigated the frequency of SDB among neonates with fetal vs postnatal myelomeningocele repair.METHODSIn this nine-center, prospective, observational study, neonates with myelomeningocele born at more than 30 weeks gestational age underwent a 10-hour bedside polysomnogram at at least 35 weeks postmenstrual age, before hospital discharge. The primary outcome was SDB severity, reflected by the apnea-hypopnea index (AHI; number of respiratory events per hour of sleep). Decisions regarding surgical timing (fetal vs postnatal), technique (open fetal vs fetoscopic approach), and SDB treatment were made by the clinical teams.RESULTSAmong 173 infants, 92/173 (53%) had SDB (median AHI 22.5, IQR 12.2-44.2). In unadjusted analysis, AHI was higher among the 90 neonates with fetal repair vs 83 with postnatal surgery (median 29, IQR 14-49, vs 19, IQR 10-36, P = .008). In propensity-adjusted multivariable models, prematurity was independently associated with AHI, whereas surgical timing (fetal vs postnatal) was not. Hindbrain herniation, myelomeningocele level, and clinical need for ventriculoperitoneal shunt did not predict AHI in adjusted models. Supplemental oxygen was commonly prescribed, for 44% of fetal vs 39% of postnatal myelomeningocele repair infants (P = .5).CONCLUSIONSSDB affects more than half of neonates with myelomeningocele. The higher AHI after fetal surgery could stem from the elevated incidence of prematurity in this group. As SDB is treatable and has a potential impact on neurodevelopment, routine screening could become an integral part of a strategy to optimize long-term medical and neurodevelopmental outcomes.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"263 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021373","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 : 2026-01-22DOI: 10.1542/peds.2025-072525
Carrie L Byington,Lisa Stellwagen,Lars Bode,Mitra Hooshmand,Donald P Pizzo,Hana Russo,Steven L Gonias
Highly pathogenic avian influenza A (H5N1) (H5N1 hereafter) is an emerging pathogen in mammals. The recent recognition of H5N1 in dairy cattle increases opportunities for human exposure and infection and may accelerate a trajectory toward sustained human-to-human transmission. Furthermore, the presence of virus at high concentration in unpasteurized milk raises new risks for humans, especially infants and children. Milk has been identified as a vehicle for viral transmission in and between mammalian species, including humans. Sialic acids (SAs) found on cell surfaces are important mediators of species susceptibility to specific influenza strains and play an important role in viral tropism. New data demonstrate that SA receptors with α2,3 linkages capable of binding avian influenza strains are present in human mammary tissue. The presence of SA receptors that can bind avian influenza and a comparative analysis of viral transmission risk of raw and pasteurized milk in several mammalian species have implications for human milk feeding. During this period of sporadic human infections with H5N1, further research and collaboration is warranted to address the potential risk of human milk contamination. Infants and children are particularly vulnerable to emerging infections during pandemics and have unique needs that may be overlooked. Pandemic preparedness must address the needs of all populations at all life stages, including pregnancy and infancy, and must include support for the safety of human milk.
{"title":"Milk as a Transmission Vehicle for Highly Pathogenic Avian Influenza A (H5N1).","authors":"Carrie L Byington,Lisa Stellwagen,Lars Bode,Mitra Hooshmand,Donald P Pizzo,Hana Russo,Steven L Gonias","doi":"10.1542/peds.2025-072525","DOIUrl":"https://doi.org/10.1542/peds.2025-072525","url":null,"abstract":"Highly pathogenic avian influenza A (H5N1) (H5N1 hereafter) is an emerging pathogen in mammals. The recent recognition of H5N1 in dairy cattle increases opportunities for human exposure and infection and may accelerate a trajectory toward sustained human-to-human transmission. Furthermore, the presence of virus at high concentration in unpasteurized milk raises new risks for humans, especially infants and children. Milk has been identified as a vehicle for viral transmission in and between mammalian species, including humans. Sialic acids (SAs) found on cell surfaces are important mediators of species susceptibility to specific influenza strains and play an important role in viral tropism. New data demonstrate that SA receptors with α2,3 linkages capable of binding avian influenza strains are present in human mammary tissue. The presence of SA receptors that can bind avian influenza and a comparative analysis of viral transmission risk of raw and pasteurized milk in several mammalian species have implications for human milk feeding. During this period of sporadic human infections with H5N1, further research and collaboration is warranted to address the potential risk of human milk contamination. Infants and children are particularly vulnerable to emerging infections during pandemics and have unique needs that may be overlooked. Pandemic preparedness must address the needs of all populations at all life stages, including pregnancy and infancy, and must include support for the safety of human milk.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"396 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015162","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 : 2026-01-22DOI: 10.1542/peds.2025-070779
Christopher J Hammond,Lindsey Webb,Chae Young Lee,Ayisat Adegbindin,Grace Park,Rachael Lebo,Julie Nanavati,Erica Sibinga
CONTEXTGiven the large treatment gap and modest response to contemporary drug treatment approaches for adolescents, interest in mindfulness-based interventions (MBI) for this population is growing.OBJECTIVETo systematically review the extant literature on the efficacy of MBIs in reducing alcohol/drug use and improving psychological functioning in youth who use substances (YWUS) using PRISMA guidelines.DATA SOURCESPubMed, EMBASE, Cochrane Library, PsycINFO, and Web of Science.STUDY SELECTIONSelected studies used randomized controlled trial (RCT) designs to compare the efficacy of an MBI to a comparator intervention on substance-related outcomes in samples of YWUS (12-21 years).DATA EXTRACTIONExtracted data included design features, sample characteristics, outcome variables, source measures, and characteristics of MBI and control conditions.RESULTSAfter reviewing 2090 citations, we identified 23 eligible studies reporting results from 21 trials with 2297 participants. There was a high degree of heterogeneity across designs, analytic approaches, MBI types, and populations studied. Over two-thirds of studies reported positive results favoring MBI over comparator conditions for postintervention substance use reductions and pooled substance use outcomes. Subgroup results provided preliminary evidence that MBI may reduce impulsivity and alter responses to stress and craving, and that these changes may mediate the relationship between MBI receipt and substance outcomes in YWUS.LIMITATIONSFew studies examined intervention impacts on illicit substances, and heterogeneity of interventions and outcomes limited the ability to generalize findings.CONCLUSIONSOur results indicate that MBIs can produce small to moderate reductions in alcohol/drug use and may improve impulsivity and stress reactivity in YWUS.
背景考虑到青少年的治疗差距很大，对当代药物治疗方法的反应不大，对这一人群的正念干预（MBI）的兴趣正在增长。目的采用PRISMA指南系统回顾mbi在减少青少年酒精/药物使用和改善青少年心理功能方面的有效性。数据来源pubmed， EMBASE, Cochrane Library, PsycINFO, Web of Science。研究选择选定的研究使用随机对照试验（RCT）设计来比较MBI和比较物干预对YWUS样本（12-21岁）物质相关结局的疗效。数据提取提取的数据包括设计特征、样本特征、结果变量、源测量、MBI特征和控制条件。在回顾了2090篇引用后，我们确定了23篇符合条件的研究，报告了21项试验的结果，共有2297名受试者。在设计、分析方法、MBI类型和研究人群之间存在高度异质性。超过三分之二的研究报告了在干预后物质使用减少和综合物质使用结果方面，MBI优于比较条件的积极结果。亚组结果提供了初步证据，表明MBI可以减少冲动性，改变对压力和渴望的反应，这些变化可能介导了YWUS中MBI接收和物质结果之间的关系。局限性：很少有研究检查干预对非法药物的影响，干预措施和结果的异质性限制了推广研究结果的能力。结论mbi可减少酒精/药物使用，并可改善YWUS患者的冲动性和应激反应性。
{"title":"Mindfulness-Based Interventions for Adolescent Substance Use and Substance Use Disorders: A Systematic Review.","authors":"Christopher J Hammond,Lindsey Webb,Chae Young Lee,Ayisat Adegbindin,Grace Park,Rachael Lebo,Julie Nanavati,Erica Sibinga","doi":"10.1542/peds.2025-070779","DOIUrl":"https://doi.org/10.1542/peds.2025-070779","url":null,"abstract":"CONTEXTGiven the large treatment gap and modest response to contemporary drug treatment approaches for adolescents, interest in mindfulness-based interventions (MBI) for this population is growing.OBJECTIVETo systematically review the extant literature on the efficacy of MBIs in reducing alcohol/drug use and improving psychological functioning in youth who use substances (YWUS) using PRISMA guidelines.DATA SOURCESPubMed, EMBASE, Cochrane Library, PsycINFO, and Web of Science.STUDY SELECTIONSelected studies used randomized controlled trial (RCT) designs to compare the efficacy of an MBI to a comparator intervention on substance-related outcomes in samples of YWUS (12-21 years).DATA EXTRACTIONExtracted data included design features, sample characteristics, outcome variables, source measures, and characteristics of MBI and control conditions.RESULTSAfter reviewing 2090 citations, we identified 23 eligible studies reporting results from 21 trials with 2297 participants. There was a high degree of heterogeneity across designs, analytic approaches, MBI types, and populations studied. Over two-thirds of studies reported positive results favoring MBI over comparator conditions for postintervention substance use reductions and pooled substance use outcomes. Subgroup results provided preliminary evidence that MBI may reduce impulsivity and alter responses to stress and craving, and that these changes may mediate the relationship between MBI receipt and substance outcomes in YWUS.LIMITATIONSFew studies examined intervention impacts on illicit substances, and heterogeneity of interventions and outcomes limited the ability to generalize findings.CONCLUSIONSOur results indicate that MBIs can produce small to moderate reductions in alcohol/drug use and may improve impulsivity and stress reactivity in YWUS.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"66 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015183","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 : 2026-01-22DOI: 10.1542/peds.2025-073145
Aaron Kleinertz,Tracy Geoffrion
Osteomyelitis is a rarely encountered diagnosis in children. It typically occurs due to hematogenous inoculation following transient bacteremia, with bacterial infection ultimately establishing in areas of microtrauma. Prevalence is highest in long bones due to active marrow, and the most common organism isolated from affected tissue is Staphylococcus aureus. Patients with hemoglobinopathies, however, are more susceptible to unusual pathogens, particularly Salmonella species. This report summarizes the successful management of a unique presentation of primary Salmonella osteomyelitis of the sternum in a patient heterozygous for the hemoglobin E trait and opens the discussion for a potential biological basis of disease.
{"title":"Primary Salmonella Osteomyelitis of the Sternum.","authors":"Aaron Kleinertz,Tracy Geoffrion","doi":"10.1542/peds.2025-073145","DOIUrl":"https://doi.org/10.1542/peds.2025-073145","url":null,"abstract":"Osteomyelitis is a rarely encountered diagnosis in children. It typically occurs due to hematogenous inoculation following transient bacteremia, with bacterial infection ultimately establishing in areas of microtrauma. Prevalence is highest in long bones due to active marrow, and the most common organism isolated from affected tissue is Staphylococcus aureus. Patients with hemoglobinopathies, however, are more susceptible to unusual pathogens, particularly Salmonella species. This report summarizes the successful management of a unique presentation of primary Salmonella osteomyelitis of the sternum in a patient heterozygous for the hemoglobin E trait and opens the discussion for a potential biological basis of disease.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"5 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146015212","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 : 2026-01-21DOI: 10.1542/peds.2025-073229
Shizuko Takahashi,Jerry Menikoff
Despite longstanding ethical consensus on the importance of pediatric assent, documentation of how assent is obtained, waived, or overridden remains sparse and inconsistent in clinical research. This article examines the systemic underreporting of assent practices in pediatric trials, drawing on a review of trial registries, informed consent forms, and published studies in pediatric oncology. Our findings reveal that assent is often embedded within parental consent processes, rarely documented in detail, and inconsistently interpreted across studies. Without minimal reporting standards, it is impossible to evaluate whether children were informed, involved in decisions, or given opportunities to dissent. This lack of transparency compromises ethical accountability and prevents researchers, ethics committees, and policymakers from learning from prior practice. Drawing on international examples, we propose a practical recommendation for change: that trial registries and journals adopt minimal reporting requirements to include who assented, whether disagreement occurred, and how it was addressed. Better documentation-through standardized, developmentally appropriate practices-can help ensure that children's voices are respected and their participation in research is ethically sound. Importantly, documenting assent is not only relevant to research but also extends to pediatric clinical care, in which everyday care decisions offer opportunities to engage children, foster trust, and respect their voices.
{"title":"Standardizing Reporting of Pediatric Assent in Clinical Trials.","authors":"Shizuko Takahashi,Jerry Menikoff","doi":"10.1542/peds.2025-073229","DOIUrl":"https://doi.org/10.1542/peds.2025-073229","url":null,"abstract":"Despite longstanding ethical consensus on the importance of pediatric assent, documentation of how assent is obtained, waived, or overridden remains sparse and inconsistent in clinical research. This article examines the systemic underreporting of assent practices in pediatric trials, drawing on a review of trial registries, informed consent forms, and published studies in pediatric oncology. Our findings reveal that assent is often embedded within parental consent processes, rarely documented in detail, and inconsistently interpreted across studies. Without minimal reporting standards, it is impossible to evaluate whether children were informed, involved in decisions, or given opportunities to dissent. This lack of transparency compromises ethical accountability and prevents researchers, ethics committees, and policymakers from learning from prior practice. Drawing on international examples, we propose a practical recommendation for change: that trial registries and journals adopt minimal reporting requirements to include who assented, whether disagreement occurred, and how it was addressed. Better documentation-through standardized, developmentally appropriate practices-can help ensure that children's voices are respected and their participation in research is ethically sound. Importantly, documenting assent is not only relevant to research but also extends to pediatric clinical care, in which everyday care decisions offer opportunities to engage children, foster trust, and respect their voices.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"1 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005472","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 : 2026-01-21DOI: 10.1542/peds.2025-072700
Daniel S Farrar,Rachel L Knowles,Carlos Nunez,Gareth Baynam,Ari Bitnun,Mavis Duncanson,Richard M Lynn,Charlotte Moore Hepburn,Anne Morris,Clarissa Oeser,Richard Pebody,Ameenat Lola Solebo,Elizabeth J Elliott,Shaun K Morris
BACKGROUND AND OBJECTIVESSevere microcephaly, or head circumference at least 3 standard deviations below the mean for age and sex, is a rare condition with diverse etiology, making diagnosis challenging. Following the 2015 to 2016 Zika virus outbreak, surveillance studies in Australia, Canada, New Zealand, and the United Kingdom and Ireland were conducted to monitor severe microcephaly. We describe the etiology, clinical features, and diagnostic investigations of severe microcephaly among children aged younger than 1 year.METHODSWe pooled reports of patients with severe microcephaly detected through 4 national active surveillance studies, through the International Network of Paediatric Surveillance Units. Incident cases were reported voluntarily between June 2016 and October 2018 by networks of pediatricians totaling more than 8000 members. Etiology was categorized as genetic (confirmed/suspected), acquired (infection, ischemia/hypoxia, prenatal alcohol exposure, placental insufficiency), or unknown. Anonymized data were pooled and analyzed using descriptive statistics.RESULTSOverall, the cases of 118 patients with severe microcephaly were analyzed, including 59 from the United Kingdom and Ireland, 34 from Canada, and 25 from Australia (n < 5 cases from New Zealand were not analyzed). Median age at diagnosis was 17 days (IQR 1-119), and mean head circumference-for-age Z-score was -4.0 (SD 1.1). Genetic causes were determined for 50% (n = 59) vs 18% acquired (n = 21) and 32% unknown (n = 38). Common investigations included brain magnetic resonance imaging (70%), DNA microarray (69%), brain ultrasonography (53%), and cytomegalovirus screening (48%).CONCLUSIONSAt least one-half of severe microcephaly cases are attributable to genetic causes. One-third had unknown etiology, highlighting a need for a systematic approach to diagnostic investigation, including genomic sequencing and brain imaging for all children with severe microcephaly.
{"title":"Etiology of Severe Microcephaly in Infants: A Multinational Surveillance Study.","authors":"Daniel S Farrar,Rachel L Knowles,Carlos Nunez,Gareth Baynam,Ari Bitnun,Mavis Duncanson,Richard M Lynn,Charlotte Moore Hepburn,Anne Morris,Clarissa Oeser,Richard Pebody,Ameenat Lola Solebo,Elizabeth J Elliott,Shaun K Morris","doi":"10.1542/peds.2025-072700","DOIUrl":"https://doi.org/10.1542/peds.2025-072700","url":null,"abstract":"BACKGROUND AND OBJECTIVESSevere microcephaly, or head circumference at least 3 standard deviations below the mean for age and sex, is a rare condition with diverse etiology, making diagnosis challenging. Following the 2015 to 2016 Zika virus outbreak, surveillance studies in Australia, Canada, New Zealand, and the United Kingdom and Ireland were conducted to monitor severe microcephaly. We describe the etiology, clinical features, and diagnostic investigations of severe microcephaly among children aged younger than 1 year.METHODSWe pooled reports of patients with severe microcephaly detected through 4 national active surveillance studies, through the International Network of Paediatric Surveillance Units. Incident cases were reported voluntarily between June 2016 and October 2018 by networks of pediatricians totaling more than 8000 members. Etiology was categorized as genetic (confirmed/suspected), acquired (infection, ischemia/hypoxia, prenatal alcohol exposure, placental insufficiency), or unknown. Anonymized data were pooled and analyzed using descriptive statistics.RESULTSOverall, the cases of 118 patients with severe microcephaly were analyzed, including 59 from the United Kingdom and Ireland, 34 from Canada, and 25 from Australia (n < 5 cases from New Zealand were not analyzed). Median age at diagnosis was 17 days (IQR 1-119), and mean head circumference-for-age Z-score was -4.0 (SD 1.1). Genetic causes were determined for 50% (n = 59) vs 18% acquired (n = 21) and 32% unknown (n = 38). Common investigations included brain magnetic resonance imaging (70%), DNA microarray (69%), brain ultrasonography (53%), and cytomegalovirus screening (48%).CONCLUSIONSAt least one-half of severe microcephaly cases are attributable to genetic causes. One-third had unknown etiology, highlighting a need for a systematic approach to diagnostic investigation, including genomic sequencing and brain imaging for all children with severe microcephaly.","PeriodicalId":20028,"journal":{"name":"Pediatrics","volume":"63 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005471","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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