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}
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}
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