Pediatrics最新文献

Objective: To evaluate changes in prescription stimulant dispensing to children aged 5 to 17 years associated with the COVID-19 pandemic and the shortage of immediate-release mixed amphetamine salts (Adderall), which was announced in October 2022.

Methods: We analyzed the 2017 to 2023 IQVIA Longitudinal Prescription Database, which captures 92% of US prescriptions. Using an interrupted time series design, we evaluated level and slope changes in the monthly stimulant-dispensing rate (number of children with stimulant dispensing per 100 000 children) in March 2020 and October 2022.

Results: In March 2020, the monthly stimulant-dispensing rate to children declined -454.9 children per 100 000 (95% CI, -572.6 to -337.2), an 18.8% decrease relative to January 2017. After March 2020, this rate increased to 12.7 children per 100 000 per month (95% CI, 6.6-18.8). In October 2022, there was no level change (-39.7 children per 100 000; 95% CI, -189.9 to 110.5) or slope change (-12.1 children per 100 000 per month; 95% CI, -27.5 to 3.3), although estimates were negative. During October 2022, there was a level decrease in the monthly dispensing rate for immediate-release mixed amphetamine salts and a level increase in the monthly dispensing rate for dexmethylphenidate.

Conclusions: Stimulant dispensing to children declined after the pandemic began. Dispensing may also have declined after October 2022, but estimates were not significant, partly because decreased dispensing of immediate-release mixed amphetamine salts was offset by increased dispensing of other stimulants. Findings suggest the shortage may have prompted children to switch to alternative stimulants. Future research should evaluate whether any switches led to adverse events.

Pleural tuberculoma is often observed during treatment for tuberculous pleurisy; however, this condition is rarely found as a solitary pleural nodule in patients without a history of tuberculosis treatment, and no cases have been reported in children. We report a case of a 12-year-old boy with pleural tuberculoma presenting as a solitary mass. He had a fever and cough that prompted chest radiography, which revealed a mass in the right lung. Symptoms improved with antibacterial medication; however, computed tomography (CT) revealed a 4.5-cm pleural mass that partially bordered the ribs. CT-guided biopsy revealed a necrotizing granuloma, but the real-time polymerase chain reaction result for Mycobacterium tuberculosis was negative. Malignant diseases, such as osteosarcoma, could not be ruled out; thus, surgical resection was performed, and pleural tuberculoma was diagnosed. The patient was treated with antituberculosis drugs for 6 months, and no recurrence was observed in the following 2 years. Pleural tuberculomas should be considered in the differential diagnosis of solitary pleural tumors, especially in countries where tuberculosis is endemic.

Background and objectives: Human papillomavirus (HPV) vaccination rates are suboptimal, and missed vaccination opportunities are common. We hypothesized that a bundled intervention improves missed HPV vaccination opportunities.

Methods: We used a pre-post design to assess differences in HPV vaccine missed opportunities (visits when vaccine-eligible adolescents are not vaccinated). We compared rates for a 12-month period before vs those for a 6-month period (February 23, 2022, to August 9, 2022) during a bundled intervention. We implemented the bundled intervention in 24 primary care pediatric practices that had been usual care controls for a prior randomized trial. The bundled intervention involved 3 components: online clinician training on HPV vaccine communication, performance feedback on missed HPV vaccination opportunities, and clinician prompts for HPV vaccination. As a secondary analysis, we compared missed opportunities for these 24 practices vs 48 contemporaneous comparison group practices identified retrospectively.

Results: For well-child care (WCC) visits, missed HPV vaccination opportunities were improved during vs before the intervention by 4.8 percentage points (95% CI, -7.2% to -2.4%) for initial HPV vaccine doses and a modest 2.2 percentage points (95% CI, -4.4% to -0.0%) for subsequent doses. For other visit types, findings ruled out changes beyond minimal improvements. Missed vaccination opportunity rates for initial HPV vaccination at WCC visits were similar for the 24 intervention practices vs the 48 comparison practices for a 4.5-year period before the intervention, but they improved for intervention practices and worsened for comparison practices during the intervention period (difference, -6.6%; 95% CI, -9.3% to -3.8%).

Conclusions: This bundled intervention appeared to improve HPV vaccination during WCC visits.

Background and objectives: Vaccine doses provided outside the Advisory Committee on Immunization Practices for minimum and maximum ages of vaccination and minimum intervals between doses are considered invalid. Our objective was to quantify the prevalence of and factors associated with invalid doses among US children aged 0 to 35 months.

Methods: We analyzed provider-verified vaccination records from the nationally representative 2011-2020 National Immunization Survey-Child. We quantified the number of children with at least 1 invalid vaccine dose overall, by survey year, and by vaccine type. Among children who received vaccine doses before the minimum age or minimum dose interval, we quantified the prevalence of receiving extra doses such that series were completed with the recommended number of valid doses. We used logistic regression models to identify factors associated with receipt of an invalid vaccination.

Results: Of 161 187 children, 22 209 (weighted percent: 15.4%, 95% CI, 15.0%-15.8%) had an invalid vaccine dose. Of children with a minimum age or minimum interval invalid dose, 44.9% (95% CI, 43.2%-46.6%) received extra doses and completed the series. The highest prevalence of invalid doses was for 3-dose rotavirus (n = 5733, 4.4%), with the first dose being administered after the maximum age (n = 3996, 3.1%). Overall, the percentage of children with an invalid dose decreased from 2011 (16.9%) to 2020 (12.5%). Children who moved across state lines vs not (adjusted odds ratio: 1.5 [95% CI, 1.4-1.6]) had higher odds of an invalid vaccine dose.

Conclusions: Although invalid vaccine doses have decreased over time, many children with invalid doses lacked the doses necessary to complete a vaccine series.

Background and objectives: The likelihood and severity of neurodevelopmental impairment (NDI) affects critical health care decisions. NDI definitions were developed without parental perspectives. We investigated the agreement between parental vs medical classification of NDI among children born preterm.

Methods: In this multicenter study, parents of children born preterm (<29 weeks) evaluated at 18 to 21 months corrected age (CA) were asked whether they considered their child as developing normally, having mild/moderate impairment, or having severe impairment. Medical categorization was based on hearing, vision, cerebral palsy status, and Bayley Scales of Infant and Toddler Development Third Edition (Bayley-III) scores. Agreement was analyzed using Cohen's weighted κ. Discrepancies in categorization by NDI components and parental demographics were examined using the Pearson χ2 test, Fisher exact test, or Wilcoxon signed-rank test.

Results: Children (n = 1098, gestational age 26.1 ± 1.5 weeks, birthweight 919 ± 247 g) were evaluated at 19.6 ± 2.6 months CA at 13 clinics. Agreement between parental and medical NDI classification was poor (κ = 0.30; 95% CI: 0.26-0.35). Parents described their child's development as normal or less impaired. Only 12% of parents of children classified as having a severe NDI according to the medical definition agreed. There were significant disagreements between classification for children based on Bayley-III cognitive, language, and motor scores but not for cerebral palsy. Discrepancies varied by parental education and ethnicity but not by single caregiver status.

Conclusions: Parent perception of NDI differs from medical categorization, creating a risk of miscommunication. This indicates an overestimation of the impact of disability by clinicians, which may affect life-and-death decisions. Parental perspectives should be considered when reporting and discussing neurodevelopmental outcomes.