Journal of Pediatrics最新文献

Objective: To evaluate the risks of incident dyslipidemia and abnormal body mass index (BMI) during the 28-179-day postacute phase after documented SARS-CoV-2 infection in a large pediatric sample.

Study design: A retrospective cohort study using the Researching COVID to Enhance Recovery pediatric electronic health record datasets from 25 US children's hospitals and health institutions, from March 2020 to September 2023. This study included 384 289 COVID-19-positive patients aged 0-21 years for dyslipidemia analyses and 285 559 aged 2-21 years for BMI analyses, each with at least 6 months of follow-up. COVID-19-negative controls included 1 080 413 and 817 315 patients, respectively. SARS-CoV-2 infection was defined by a positive polymerase chain reaction, antigen, or serologic test; a clinical diagnosis of COVID-19; or a documented diagnosis of post-acute sequelae of SARS-CoV-2. Incident dyslipidemia and abnormal BMI were identified using age-specific laboratory or anthropometric thresholds. Adjusted relative risks (aRRs) were estimated using propensity-score-stratified modified Poisson regression with multiple sensitivity analyses.

Results: During the postacute phase, the COVID-19-positive cohort had higher rates of new-onset composite dyslipidemia (aRR 1.24; 95% CI 1.18-1.29) and abnormal BMI (aRR 1.15; 95% CI, 1.12-1.18). Results were robust to sensitivity and stratified analyses.

Conclusions: Children and adolescents with documented COVID-19 infection were associated with an increased risk of new-onset dyslipidemia and abnormal BMI during the postacute phase, highlighting the need for metabolic monitoring after infection.

Antimicrobial resistance is life-threatening to pediatric patients with medical complexity who receive multiple courses of broad-spectrum antibiotics. Bacteriophages offer a safe treatment alternative when our antibiotic armamentarium is no longer sufficient. We describe successful use of bacteriophage therapy on a patient with a recalcitrant Pseudomonasaeruginosa infection after receiving a multiorgan transplant.

Objective: To build a time-series machine learning (ML) model that improves BPD prediction compared with published online calculators.

Study design: We used a single-center, extremely low gestational age newborn cohort (ELGANs, inborn, birth year 2016-2021, N=438). The primary outcome was a 5-level class outcome for BPD as defined by the Neonatal Research Network (NRN) in 2019. Flowsheet data were extracted from the electronic medical record. Time-series data were generated from birth onward, with 14 static and 35 dynamic input attributes. Iterative static (regression) and dynamic (ML) modeling was performed, comparing model performance with the NRN BPD calculator at several time points (postnatal day [PND] 1, 3, 7, 14, and 28) and ranking feature leverage at each time point.

Results: Of the original cohort, 92 infants met all inclusion criteria (gestational age 25.6 ± 1.4 weeks). Static models performed comparably with the NRN BPD calculator (AUC=0.7460), improving to 0.7978 with forward/backward selection. In contrast, dynamic long short-term memory (LSTM) models outperformed static models at all time points, reaching a peak AUC of 0.8400 on PND 28. LSTM models performed best for no BPD and severe disease/death. Principal component analysis (PCA) revealed that respiratory support, ventilator settings, supplemental oxygen requirements, medications, and pre/postnatal growth were major factors driving BPD severity.

Conclusions: LSTM-based ML time-series analysis substantially outperformed static approaches for predicting BPD and death among ELGANs. Integrating ML methods into clinical applications holds promise for enhancing real-time BPD trajectory mapping.

Objective: To determine if newborns receiving morphine or methadone as the primary pharmacologic treatment for neonatal opioid withdrawal syndrome (NOWS) tolerate and receive fewer days of opioid using an accelerated wean protocol (15% decrements) compared with using a slower wean protocol (10% decrements).

Study design: Newborns ≥ 36 weeks of gestation receiving morphine or methadone for NOWS were enrolled in a pragmatic blinded, randomized multicenter trial. Newborns underwent protocol-driven weaning with decreasing opioid doses of either 15% or 10% decrements. Weaning was encouraged every 24 hours and if signs of NOWS worsened, the preceding dose was resumed. To maintain blinding, the last 3 dose levels of the 15% decrements were placebo. The primary outcome was the number of days of opioid treatment from the first weaning dose to cessation of opioids.

Results: Slow enrollment prompted early trial closure; 189 newborns were randomized, 98 (51.9%) to 15% decrements (mean ± standard deviation, 38.8±1.2 weeks gestation, 59.8% male) and 91 (48.1%) to 10% decrements (38.8±1.3 weeks gestation, 61.5% male). Morphine was used most commonly. Intention to treat analysis included all but 4 infants withdrawn in the 15% decrement group. The durations of opioid treatment during weaning were 8.2 (7.2, 9.5) (adjusted mean [95% confidence interval]) and 11.2 (9.7, 12.9) days for 15% and 10% decrement groups, respectively (p<0.001). Adverse events were few in both groups.

Conclusion: Pharmacologic treatment of NOWS using an accelerated wean protocol (15% decrements) was well tolerated with fewer days of opioid treatment compared with 10% decrements.

Objective: To evaluate psychosocial functioning among youth with hereditary polyposis syndromes (HPS) and their caregivers.

Study design: Data on health-related quality of life (HRQOL), illness uncertainty (CIUS/PIUS), caregiver psychological distress, and caregiver-perceived blame/fault were collected as part of standard care visits to a multidisciplinary polyposis clinic.

Results: Psychosocial data were obtained from 33 youth ages 8-18 and 63 caregivers. About 15% of youth and 13% of caregivers endorsed elevated illness uncertainty. HRQOL was poorest in emotional and school functioning. Mean (± SD) caregiver distress scores were 1.03 ± 1.59 and mean blame/fault scores were 2.56 ± 2.53, with 21% of caregivers feeling at fault for their child's HPS. Significant correlations were found between child- and caregiver-reported illness uncertainty (r = 0.52, p < 0.01) and caregiver perceived fault was significantly correlated with caregiver distress (r = 0.26, p = 0.04). Caregivers with a shared diagnosis endorsed feeling at fault for their child's HPS diagnosis and endorsed significantly greater distress. Caregivers of youth with minority status endorsed significantly greater distress (H(4) = 10.54, p = 0.03) and caregiver perceived fault was higher for male youth.

Conclusions: Findings suggest that youth with HPS are at risk of poor HRQOL and elevated illness uncertainty, and caregivers similarly show elevated risk for psychological distress, perceived fault for the youth's HPS diagnosis, and elevated illness uncertainty. Some socioeconomic factors also have significant implications for caregiver's overall functioning. These findings highlight the need for psychosocial functioning to be a primary target and consideration in HPS care.