Pediatrics最新文献

The changing field of academic medicine presents unique challenges for physician-scientists, who intricately weave the complexities of research and patient care. These challenges have significantly lengthened the time needed for scientific discoveries to be applied in clinical practice. In response to these escalating demands, the training trajectory for physician-scientists has notably expanded over recent decades. In anticipation of and preparation for future training requirements, the National Pediatrician-Scientist Collaborative Workgroup facilitated a series of convenings with a diverse array of stakeholders vested in physician-scientist training. The framework Strategic Foresight was used to explore possible future scenarios and develop strategic plans. Seven pivotal themes, termed "performance zones," emerged from this endeavor: (1) revolution in education through technology-enhanced learning, (2) educational outcomes beyond content mastery, (3) artificial intelligence-empowered research portfolios and expansive networks, (4) evolution of high-performance inclusive, equitable, distributed, and agile teams, (5) evolution of antifragile systems, (6) a multiparadigmatic program of research, and (7) interdependence and commitments to a common agenda for collective impact. These identified zones underscore the imperative for physician-scientists to acquire novel skill sets essential for navigating the impending shifts in the health care landscape. These findings are poised to steer policy initiatives and educational advancements, fortifying the foundation for future physician-scientist training needs.

Objectives: There is little understanding of the circumstances behind fatal pediatric opioid poisonings. Our objective was to characterize opioid fatalities according to child, family, and household factors.

Methods: We used data from the National Fatality Review-Case Reporting System to describe the circumstances behind the deaths of children 0 to 17 years of age who died of an opioid poisoning (ie, prescription opioid, heroin, illicit fentanyl) between 2004 and 2020. Decedents were stratified into age groups: 0-4, 5-9, 10-14, and 15-17 years.

Results: The majority (65.3%) of the 1696 fatal opioid poisonings occurred in the child's own home. Prescription opioids contributed to 91.8% of deaths, heroin contributed to 5.4%, and illicit fentanyl to 7.7%. Co-poisonings with nonopioid substances occurred in 43.2% of deaths. Among 0- to 4-year-olds, 33.9% died of homicide and 45.0% had a primary caregiver with a history of substance use/abuse. Among 10- to 14-year-olds and 15- to 17-year-olds, respectively, 42.0% and 72.8% of decedents had a history of substance use/abuse. In each age group, at least 25.0% of children were victims of previous child maltreatment.

Conclusions: A history of maltreatment and substance use-whether on the part of the caregiver or the child-are common factors surrounding fatal pediatric opioid poisonings, the majority of which occur in the child's own home. Families with children of all ages would benefit from interventions focused on opioid prescribing, storage, disposal, and misuse. These findings also underscore the urgency of ensuring that access to naloxone becomes universal for families with a history of maltreatment and/or substance use.

Sudden unexpected infant death (SUID) is a major contributor to infant death and a persistent public health issue. After an initial decline after the 1994 "Back to Sleep" campaign, SUID numbers plateaued. Currently, ∼10 infants die suddenly and unexpectedly each day in the United States. In 2019, we established a surveillance system for SUID in Cook County, Illinois, partnering our academic medical center, the Cook County Medical Examiner's Office, and child death review to create the Cook County SUID Case Registry. Our data show that, in Cook County, including the city of Chicago, ∼1 infant dies unexpectedly during sleep every week. Of these SUID, ∼25% were because of suffocation/possible suffocation. SUID peaks at 30 to 60 days old. SUID rates are 15 times higher in non-Hispanic Black infants and 3 times higher in Hispanic infants, compared with white infants. Nearly all involved 1 or more unsafe sleep factors. SUID are concentrated in community areas experiencing high hardship. Through our Community Partnership Approaches for Safe Sleep-Chicago team, we have developed collaborative prevention approaches in affected communities, allowing for conversations with families and those who support them to better understand barriers to safe sleep that they experience. These partnerships and our data allow for tailoring of informed prevention approaches to address upstream factors driving disproportionate infant mortality in historically disinvested communities, as well as optimizing the immediate risks posed by the infant sleep environment. Data from our system show the number of SUID declining modestly since our prevention work began.

Objectives: Significant inequities in pediatric injury outcomes exist. We aim to develop a process to assist child death review (CDR) teams in identifying upstream factors that lead to inequitable outcomes in pediatric injuries.

Methods: We spent 6 months (November 2021-April 2022) working with 3 CDR teams in Massachusetts to understand their tools and processes for CDR. During that time, we began to iteratively develop a pediatric injury equity review process and tools. Between May and October 2022, acceptability and adaptability of the resulting Massachusetts Pediatric Injury Equity Review (MassPIER) process and tools were evaluated through focus groups and a Research Electronic Data Capture survey of participants. We compared the prevention recommendations of the CDR teams before the implementation of MassPIER with those generated using MassPIER. A χ2 and Fisher's exact test assessed whether the 2 sets of recommendations differed with regard to equity.

Results: A 7-step process was developed, along with 2 tools for use during the MassPIER process. From an acceptability and adaptability standpoint, 100% of participants strongly agreed or agreed that the MassPIER process was simple to follow and adaptable to any type of injury. Ninety-five percent of participants agreed or strongly agreed that the approach could be replicated by other teams. Furthermore, the MassPIER process increased the likelihood of generating equity-focused recommendations in general (P < .05), and particularly recommendations focusing on economic inequities (P < .05).

Conclusions: MassPIER is effective in facilitating equity-focused discussion and recommendation development. It is acceptable to team members, and adaptable to other types of injury.

Background: Sudden unexpected postnatal collapse (SUPC) is a category of sudden unexpected infant death (SUID), limited to previously well infants born at ≥34 weeks' gestation who die suddenly and unexpectedly at ≤6 days of age. We compared SUPC risk factors to SUID at older ages.

Methods: We conducted a retrospective cross-sectional study of 2010-2020 SUID deaths in the National Fatality Review Case Reporting System, excluding SUPC occurring in the birth hospital. Our main outcome was age at death: ≤6 days (SUPC) versus occurring from 7 days old but not having reached their first birthday. We performed multivariable logistic regression using stepwise selection.

Results: Of 6051 SUID deaths, 98 (1.6%) were SUPC. The median SUPC age was 4 days. A higher percentage of SUPC deaths occurred with surface sharing (73.5% versus 59.6%; odds ratio, 2.74 [1.59-4.73]). Infants who died of SUPC had higher odds of a mother ≥40 years (adjusted odds ratio [aOR], 13.1 [95% confidence interval [CI], 3.3-51.4]), being the first live birth (aOR, 4.0 [95% CI, 2.4-6.9]), being swaddled (aOR, 2.7 [95% CI, 1.7-4.1]), and of dying after their caregiver fell asleep while feeding (aOR, 2.6 [95% CI, 1.6-4.4]).

Conclusions: Common SUID risk factors, including surface sharing and prone position, were present in SUPC deaths. However, compared with SUID at older ages, SUPC was associated with older and primiparous mothers, swaddling, and the caregiver falling asleep while feeding the infant. Clinicians should reinforce all American Academy of Pediatrics' safe sleep recommendations and provide guidance regarding situations when parents may fall asleep during a feeding.

The fetal and infant mortality review (FIMR) process is a community-oriented strategy focused on improving the health services systems for pregnant persons, infants, and their families. FIMR helps communities to understand and change systems that contribute to racial disparities in birth outcomes. FIMR equally values the medical and social services delivery records and the personal narratives of families who have suffered a fetal or infant loss when creating the de-identified case summaries to be reviewed by teams. A two-tiered process, FIMR uses a multidisciplinary Case Review Team (CRT) as the information processor and the Community Action Team (CAT) as the action arm of the process. Pediatricians are vital to both teams, helping to bring about systems change to improve maternal and child health. This paper examines how the well-established FIMR team serving Indianapolis (Marion County, IN) worked to build the capacity of its CAT to address racial disparities in birth outcomes through 5 distinct steps: focus on the primary causes of local fetal or infant mortality, focus on neighborhoods with the highest stable fetal or infant mortality rates, designation of a CAT leader, creation of a culture of regular CAT meetings inclusive of a health-equity skill building curriculum, and inclusion of Grassroots Maternal and Child Health Leaders on the CAT. This paper demonstrates how the synergy between local organizations and community members can effectively address racial disparities in birth outcomes.

There have been significant advances in the medical and surgical options available for contraception and management of menses for individuals, including those with intellectual developmental disorder. This new statement frames the ethical, legal, and medical issues of permanent contraception in children, adolescents, and young adults with intellectual developmental disorder, emphasizing the importance of utilizing long-acting reversible and minimally invasive treatments, whenever possible. The historical use and abuse of permanent contraception is briefly reviewed, providing the foundation for ongoing ethical and legal considerations, including issues of informed consent. The authors then discuss medical decision-making and patient preferences that should be considered and make recommendations to providers who are contemplating permanent contraception therapies in this population.