Pediatrics最新文献

Objectives: We assessed the prevalence of neurodevelopmental disabilities (NDDs; cognition, cerebral palsy, vision/hearing, epilepsy), attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), developmental coordination disorder (DCD), behavior problems, and multimorbidity in a national cohort of children born extremely preterm (EPT, <27-week gestation) to provide a comprehensive understanding of the challenges faced by children born EPT in early adolescence.

Methods: All infants born EPT in Sweden from April 2004 through March 2007 were enrolled in the Extremely Preterm Infants in Sweden Study (EXPRESS). Of 492 survivors at age 12 years, 462 were assessed alongside 373 term-born controls. Standard instruments were used to assess cognition, motor function, and behavior. Parents completed a structured health questionnaire. Diagnoses were obtained from national health registers.

Results: Compared with controls, children born EPT exhibited significantly higher rates of moderate/severe NDD (37.4% vs 4.6%), ASD (14.9% vs 2.41%), ADHD (21.2% vs 8.9%), DCD (29.4% vs 5.7%), and behavioral problems (35.3% vs 8.13%; all P < .001). Of children born EPT with no/mild NDD, 8.3% (24/289) were diagnosed with ASD and 14.5% (24/289) with ADHD, and of those with moderate/severe NDD, 26.0% (42/289) were diagnosed with ASD and 32.4% (56/173) with ADHD. Of children born EPT with moderate/severe NDD, 59% exhibited at least 2 co-occurring disabilities/disorders, and in those with no/mild disabilities, comorbidity was 24.9%. In the total EPT cohort, 57.4% were free from moderate/severe NDD and ASD, and 42.0% were free from ASD, ADHD, and DCD.

Conclusions: By age 12 years, a large proportion of children born EPT faced challenges because of NDD, ASD, ADHD, DCD, multimorbidity, and behavioral problems, necessitating multidisciplinary follow-up.

Objectives: To examine (1) differences in low-value care (LVC) for common emergency conditions by race and ethnicity in US children's hospitals and (2) the association between hospital characteristics, including LVC rate, and the magnitude of within-hospital LVC differences by race and ethnicity. We hypothesized smaller LVC differences in hospitals with lower overall LVC rates.

Methods: We performed a cross-sectional study of children younger than 18 years discharged from the emergency department with asthma, bronchiolitis, headache, or minor head injury in the Pediatric Health Information System (PHIS) from January 2021 to June 2023. Exposures were patient race and ethnicity (non-Hispanic Black, "Black"; non-Hispanic white, "white"; Hispanic) and deidentified PHIS hospital. Outcomes were LVC by race and ethnicity within and across hospitals. We used multivariable logistic regression, reporting adjusted odds ratios (aORs) and 95% CI, to estimate hospital-level and condition-specific LVC differences and linear regression to examine the association between LVC differences and LVC rates.

Results: Among 314 138 eligible encounters, overall LVC rates were as follows: asthma 18%, bronchiolitis 32%, headache 24%, and minor head injury 26%. White compared with Black and Hispanic patients had higher odds of LVC across multiple conditions in pooled and within-hospital analyses. The largest pooled differences were for white vs Black: asthma aOR (95% CI) = 1.51 (1.18-1.95) and headache 1.57 (1.43-1.72). Hospital LVC rate was not associated with magnitude of within-hospital LVC difference for any condition.

Conclusions: Lower hospital LVC rates were not associated with reduced LVC differences. Intentional focus on LVC differences is important when designing LVC reduction efforts.

Here, we present a unique case of a 17-year-old boy who presented with progressive lower extremity weakness, functional decline, and mood changes and was ultimately found to have a new diagnosis of AIDS from perinatally acquired HIV infection. This case demonstrates the discovery of a delayed diagnosis of HIV with important lessons for all pediatricians. It highlights the need for pediatricians to maintain a high index of suspicion and consider broad differentials and appropriate workup for at-risk youth with known psychiatric conditions. It is essential to identify at-risk youth early to prevent progression and severity of illness.

This technical report on Medicaid and the Children's Health Insurance Program (CHIP), the cornerstones of the entire children's health care delivery system, complements the 2023 American Academy of Pediatrics policy statement "Medicaid and the Children's Health Insurance Program: Optimization to Promote Equity in Child and Young Adult Health." The origin and intent of both the Medicaid and CHIP programs are outlined, and a current summary of issues related to enrollment, eligibility, funding, benefits, payments, quality assurance, and reporting in these programs that pertain to all children, including children with special health care needs (CYSHCN), is provided. Opportunities and drawbacks associated with states contracting with Medicaid managed care organizations are highlighted. This report also details mechanisms by which Medicaid can be modified through executive and legislative actions and summarizes past proposals (many recently resurrected) that would have degraded Medicaid's ability to provide quality care for children. Special issues of interest for specific populations are explored, including children with special health care needs, adolescents, immigrant children, children in foster care, and adopted children, and the role of Medicaid and CHIP in addressing specific health care needs in the arenas of mental and behavioral health and dental care are discussed. Finally, the following 3 themes are emphasized: (1) the criticality of these programs to the current needs of children and the necessity to resolve operational factors that cause inequities; (2) the strategic importance of these programs to the well-being of the country's future; and (3) the crisis with attracting, training, and retaining pediatric generalists and subspecialty physicians to lead the care of children in future generations.

Background and objectives: On social media, people are expected to disclose any sponsored content. However, celebrities who own alcohol brands and make posts promoting their brands may circumvent these disclosure policies, potentially exposing young audiences to alcohol marketing. This study examined the extent to which celebrities promoted their own alcohol brands on Instagram, whether they disclosed the content as sponsored, and whether the posts were visible to underage users.

Methods: Through systematic Google searches, we identified 112 celebrities who own alcohol brands. We retrieved 85 673 of their Instagram posts published between January 1, 2020, and December 31, 2023. Alcohol-brand posts were identified through text-pattern matching. We checked the accessibility of alcohol-brand posts to underage users using a simulated 15-year-old account.

Results: Among 112 celebrities (mean age = 50.8 years; 72.3% male), 42 (37.5%) explicitly mentioned their brand in their Instagram bio, and 84 (75%) referenced their own alcohol brand in at least 1 post during the study period. Of the 85 673 total posts, 3.4% mentioned a celebrity's alcohol brand. Concerningly, only 1.7% of these alcohol-brand posts included a clear disclosure in the caption and 98% (646/660) of sampled alcohol-brand posts were visible to a simulated 15-year-old account.

Conclusions: Celebrities' posts about their own alcohol brands were common and accessible to underage users. Policymakers should implement stricter regulations on alcohol promotions on social media to protect adolescents from exposure to alcohol-related content.

Background and objectives: Children with medical complexity are caregiver dependent because of complex, chronic health conditions; functional limitations; technology dependence; and high health care use. Their parental caregivers have suboptimal mental health, yet little is known about the psychiatric profiles of this group. We aimed to describe the clinical and demographic characteristics of parents of children with medical complexity seen by an integrated psychiatry service.

Methods: This is a descriptive case series using retrospective medical record review of electronic medical records from 2020 to 2023. We developed a novel psychiatry service in partnership with a pediatric complex care program for diagnostic assessment and treatment of parental caregivers of children with medical complexity in Toronto, Ontario. We included all parents of children with medical complexity who were seen by the psychiatry service for assessment and treatment of suspected mental illness (n = 57).

Results: Most parents received a new diagnosis (79%); the most common diagnoses were depressive disorders (67%), anxiety disorders (65%), and trauma- and stressor-related disorders (56%). Common treatment recommendations included psychotherapy (95%) and medication (75%). The sample was 84% female with a mean age of 42 years (SD 6 years). All consultations occurred virtually.

Conclusions: We identified a high number of treatable psychiatric illnesses in the referred parents. Partnerships between pediatric complex care teams and psychiatry services and using virtual care may help with timely and accessible mental health care for this at-risk population. Future research could investigate adherence to and efficacy of treatment recommendations for this caregiver population.

Opioid overdose deaths are a leading cause of death for adolescents and young adults in the United States. Many young people, however, are not aware of basic harm reduction principles like overdose recognition, naloxone administration, and protections provided by Good Samaritan laws. This article describes advocacy efforts to create peer-to-peer opioid education and naloxone distribution (OEND) in a high school setting. Through the recruitment of multidisciplinary partners, the team created a novel student-led initiative in a high school setting to provide peer education. The high school students leveraged their existing relationships with teachers and peers to promote their classroom didactics, and they were able to provide overdose prevention education to 46 classes. In a focus group at the end of the school year, the peer educators stated that they were prepared to teach about overdose prevention, the student-led design was appreciated by their peers, and they planned to spread their model for OEND programming to local high schools. There was an increase in naloxone distribution following the student-led initiatives, with 94 kits distributed, a 247% increase from baseline distribution efforts at the beginning of the year. Ultimately, the high school health center was able to distribute 150 kits of free naloxone throughout the school year. This model serves as an example for using existing school resources, and particularly partnering with school-based health centers, to create a model for youth-led programs addressing overdose awareness in adolescents.

Retinal astrocytic hamartoma (RAH) is a rare benign retinal tumor most commonly associated with tuberous sclerosis complex and is typically stable. RAH may also rarely occur in neurofibromatosis type 1 (NF1), an autosomal dominant disorder characterized by skin pigmentation abnormalities and multiple neurofibromas. We present a case of a child with NF1 and symptomatic, inoperable plexiform neurofibromas, for which selumetinib was initiated. Incidentally, the patient also had a progressive RAH involving the optic disc, leading to severe exudative retinal detachment. Following selumetinib therapy, the RAH showed measurable reduction in size (from 5.51 × 10.69 mm to 5.46 × 5.23 mm on ocular ultrasonography) and resolution of associated retinal detachment This case highlights a novel observation of selumetinib-associated RAH regression in an a patient with NF1. Although selumetinib was not prescribed for ocular disease, these findings suggest a potential off-target benefit and support further exploration of mitogen-activated protein kinase inhibitors in managing vision-threatening RAH in NF1.

The American Academy of Pediatrics proposes guidance for the pediatric periprocedural anesthesia environment. Essential components are identified to optimize the periprocedural anesthesia environment for the anesthetic care of infants and children. Such an environment promotes the safety and well-being of infants and children by reducing the risk of adverse events.