Journal of Pediatrics最新文献

英文中文

How Neonatologists Use Genetic Information

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-12 DOI: 10.1016/j.jpeds.2025.114508

Katharine Press Callahan MD, MSME , Rebecca Mueller LCGC, PhD, MPH , Steven Joffe MD, MPH , Cara Skraban MD , Nancy B. Spinner PhD , Karen Crew BSc , K. Taylor Wild MD , Justin T. Clapp PhD, MPH , Chris Feudtner MD, PhD, MPH

Objective

To delineate specific ways in which neonatologists integrate genetic information into their clinical decision making.

Study design

We employed chart-stimulated recall, in which neonatologists described how they used genetic tests in specific patient cases, as well as semi-structured questioning about genetic information.

Results

Based on 28 interviews with neonatologists, we document 6 uses of genetic information: making a diagnosis, categorizing/stereotyping as “genetic,” informing prognosis, influencing treatment, informing goals of care, and supporting accountability. Both specific genetic diagnoses as well as a general categorization as “genetic” help neonatologists make sense of unusual clinical situations and calibrate their predictions about the future. Predictions, in turn, inform goals of care decisions, the timing of medical technology placement, and neonatologists' self-evaluations. Diagnoses rarely influence day-to-day treatment directly. Neonatologists assign great value to improved prognostication, but simultaneously feel a responsibility to ensure that genetic information is not applied in ways that are overly deterministic or reflect ableism.

Conclusions

Frameworks for measuring successes and failures of genetic information in the neonatal intensive care unit need to be aligned with the ways neonatologists use this information. Understanding neonatologists’ use creates opportunity to maximize benefit and reduce bias in applying this complex information.

{"title":"How Neonatologists Use Genetic Information","authors":"Katharine Press Callahan MD, MSME , Rebecca Mueller LCGC, PhD, MPH , Steven Joffe MD, MPH , Cara Skraban MD , Nancy B. Spinner PhD , Karen Crew BSc , K. Taylor Wild MD , Justin T. Clapp PhD, MPH , Chris Feudtner MD, PhD, MPH","doi":"10.1016/j.jpeds.2025.114508","DOIUrl":"10.1016/j.jpeds.2025.114508","url":null,"abstract":"<div><h3>Objective</h3><div>To delineate specific ways in which neonatologists integrate genetic information into their clinical decision making.</div></div><div><h3>Study design</h3><div>We employed chart-stimulated recall, in which neonatologists described how they used genetic tests in specific patient cases, as well as semi-structured questioning about genetic information.</div></div><div><h3>Results</h3><div>Based on 28 interviews with neonatologists, we document 6 uses of genetic information: making a diagnosis, categorizing/stereotyping as “genetic,” informing prognosis, influencing treatment, informing goals of care, and supporting accountability. Both specific genetic diagnoses as well as a general categorization as “genetic” help neonatologists make sense of unusual clinical situations and calibrate their predictions about the future. Predictions, in turn, inform goals of care decisions, the timing of medical technology placement, and neonatologists' self-evaluations. Diagnoses rarely influence day-to-day treatment directly. Neonatologists assign great value to improved prognostication, but simultaneously feel a responsibility to ensure that genetic information is not applied in ways that are overly deterministic or reflect ableism.</div></div><div><h3>Conclusions</h3><div>Frameworks for measuring successes and failures of genetic information in the neonatal intensive care unit need to be aligned with the ways neonatologists use this information. Understanding neonatologists’ use creates opportunity to maximize benefit and reduce bias in applying this complex information.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"280 ","pages":"Article 114508"},"PeriodicalIF":3.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426744","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}

引用次数: 0

Infantile Granular Parakeratosis

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-12 DOI: 10.1016/j.jpeds.2025.114507

Samantha Epstein BS, Sarah Williamson MD, Lisa Gelles MD

引用次数: 0

Effects of the COVID-19 Pandemic on Children's Body Mass Index Trajectories in Sweden

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-10 DOI: 10.1016/j.jpeds.2025.114500

Jonas Englund MSc , Niclas Olofsson PhD

Objectives

To examine the effects of societal and public health changes during the COVID-19 pandemic in Sweden on children's body mass index (BMI) and to determine whether the effect persisted and differed between the sexes.

Study design

We used growth curve models applied to retrospective cohorts of children in preschool, grade 4, grade 7, and the first year of high school between the years 2014 and 2023. The data include information on the BMI of individuals in these grades.

Results

The results indicate that the pandemic in Sweden was associated with a very small weight gaining effect among children, with no substantial differences between the sexes. The effect peaked approximately 2 years after the beginning of the pandemic, following which the BMI began trending back toward levels that would be expected had the pandemic not affected children's body weight.

Conclusions

These study findings from Sweden partially align with those of international studies, although the effect is smaller in magnitude compared with international estimates. The results of this study suggest that more liberal restrictions, compared with stricter ones, are associated with a smaller excess increase in body weight among children.

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引用次数: 0

Corrigendum to “Relationship Between Urine Serotonin and Persistent Pulmonary Hypertension of the Newborn”. J Pediatr 2025; 276:114290

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-08 DOI: 10.1016/j.jpeds.2025.114462

Jamie L. Archambault MD , Teri L. Hernandez PhD, RN , Eva S. Nozik MD , Claire Palmer MS , Mairead Dillon MB , Ravinder J. Singh PhD , Csaba Galambos MD, PhD , Cassidy A. Delaney MD

引用次数: 0

Hemodynamic Risk Factors for Cerebellar Hemorrhage Presence and Volume in Infants Born Very Preterm

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-06 DOI: 10.1016/j.jpeds.2025.114503

Marta Ybarra MD , Thiviya Selvanathan MD, PhD , Ting Guo PhD , Vann Chau MD , Helen M. Branson BSc, MBBS , Linh G. Ly MD, MEd , Anne R. Synnes MDCM, MHSc , Edmond Kelly MB, BCh, BAO , Ruth E. Grunau PhD , Steven P. Miller MDCM, MAS , Emily W.Y. Tam MDCM, MAS

Objective

To examine among infants born very preterm the role of hemodynamic disturbances in the occurrence of cerebellar hemorrhage (CbH) and whether cardiovascular instability is associated with larger CbH volume.

Study design

Prospective, longitudinal, multisite cohort study. Early-life and/or term-equivalent age brain magnetic resonance imaging were performed in 309 very preterm infants admitted to 3 tertiary-level neonatal intensive care units. A cut-off of 4 mm was used to distinguish punctate vs large CbH. CbH volumes were obtained by manual segmentation. As a measure of hemodynamic stability, Score for Neonatal Acute Physiology, patent ductus arteriosus requiring treatment, and hypotension treated with inotropes were recorded.

Results

Sixty patients (18.3%) were diagnosed with CbH, classified as punctate in 43 infants (71.3%). Hypotension requiring treatment with inotropes was an independent risk factor for CbH (OR 3.07, 95% CI 1.15-8.21, P = .02) and was associated with larger CbH volume (0.36 log mm³, 95% CI 0.17-0.54, P < .001).

Conclusions

Hypotension treated with inotropes is shown to be an independent risk factor for the presence of CbH as well as for larger CbH volume. These results reinforce the importance of hemodynamics stability, especially an appropriate management of hypotension to prevent CbH and therefore improve neurodevelopmental outcomes among infants born very preterm.

{"title":"Hemodynamic Risk Factors for Cerebellar Hemorrhage Presence and Volume in Infants Born Very Preterm","authors":"Marta Ybarra MD , Thiviya Selvanathan MD, PhD , Ting Guo PhD , Vann Chau MD , Helen M. Branson BSc, MBBS , Linh G. Ly MD, MEd , Anne R. Synnes MDCM, MHSc , Edmond Kelly MB, BCh, BAO , Ruth E. Grunau PhD , Steven P. Miller MDCM, MAS , Emily W.Y. Tam MDCM, MAS","doi":"10.1016/j.jpeds.2025.114503","DOIUrl":"10.1016/j.jpeds.2025.114503","url":null,"abstract":"<div><h3>Objective</h3><div>To examine among infants born very preterm the role of hemodynamic disturbances in the occurrence of cerebellar hemorrhage (CbH) and whether cardiovascular instability is associated with larger CbH volume.</div></div><div><h3>Study design</h3><div>Prospective, longitudinal, multisite cohort study. Early-life and/or term-equivalent age brain magnetic resonance imaging were performed in 309 very preterm infants admitted to 3 tertiary-level neonatal intensive care units. A cut-off of 4 mm was used to distinguish punctate vs large CbH. CbH volumes were obtained by manual segmentation. As a measure of hemodynamic stability, Score for Neonatal Acute Physiology, patent ductus arteriosus requiring treatment, and hypotension treated with inotropes were recorded.</div></div><div><h3>Results</h3><div>Sixty patients (18.3%) were diagnosed with CbH, classified as punctate in 43 infants (71.3%). Hypotension requiring treatment with inotropes was an independent risk factor for CbH (OR 3.07, 95% CI 1.15-8.21, <em>P</em> = .02) and was associated with larger CbH volume (0.36 log mm<sup>3</sup>, 95% CI 0.17-0.54, <em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>Hypotension treated with inotropes is shown to be an independent risk factor for the presence of CbH as well as for larger CbH volume. These results reinforce the importance of hemodynamics stability, especially an appropriate management of hypotension to prevent CbH and therefore improve neurodevelopmental outcomes among infants born very preterm.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"280 ","pages":"Article 114503"},"PeriodicalIF":3.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374977","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}

引用次数: 0

Rural-Urban Differences in Patient-Sharing by Clinicians Caring for Children with Medical Complexity: Network Analysis of the Pediatric Workforce in Three States

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-06 DOI: 10.1016/j.jpeds.2025.114506

Erika L. Moen PhD, MS , Seneca D. Freyleue MS , Mary Arakelyan MPH , Andrew P. Schaefer PhD , A. James O'Malley PhD , David C. Goodman MD, MS , JoAnna K. Leyenaar MD, PhD, MPH

Objective

To examine rural-urban differences in the clinician workforce caring for children with medical complexity (CMC) in ambulatory settings and to determine how measures of clinician patient-sharing differ for rural- and urban-residing CMC.

Study design

We analyzed Massachusetts, New Hampshire, and Colorado all-payer claims data from 2012 through 2017 to identify CMC and their clinicians. We assembled patient-sharing networks in which clinicians were connected on the basis of having encounters with common pediatric patients. We evaluated rural-urban differences in CMC care team size, composition (ie, which specialists were included), and care density (ie, extent to which a CMC's care team shared patients) and network measures of primary care clinician (PCC) centrality (eg, number of patient-sharing relationships).

Results

Analysis included 107 692 CMC, of whom 7065 (7.0%) were rural-residing and 100 627 (93.0%) were urban-residing. Rural-residing CMC had lower relative risk of having a PCC specialized in pediatrics (relative risk 0.81, 95% CI 0.73-0.89) compared with urban-residing CMC. Despite having similarly sized care teams, rural-residing CMC had substantially lower care density (median [IQR] = 21.6 [7.9, 72.8]) compared with urban-residing CMC (median [IQR] = 48.3 [13.0, 158.7]). Rural PCC were less central in the networks and had a greater percentage of connections with advanced practice providers compared with their urban counterparts (median [IQR] = 19.2 [14.3, 24.5] vs 14.3 [7.5, 23.4]).

Conclusions

Our study provides new insight into the clinicians and teams caring for CMC. Rural-residing CMC were more likely to receive care from clinicians with fewer connections and lower care density, reflecting fewer shared patients within the team. Programs supporting care of CMC may benefit from recognizing rural-urban differences in team composition and relationships between clinicians.

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引用次数: 0

Overlapping Clinical Phenotypes in Patients with Primary Ciliary Dyskinesia or Activated Phosphoinositide 3-Kinase Delta Syndrome

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-06 DOI: 10.1016/j.jpeds.2025.114499

Adam J. Shapiro MD , Eveline Y. Wu MD , Deborah J. Morris-Rosendahl PhD , Kenneth N. Olivier MD , Sharon D. Dell MD , Scott D. Sagel MD , Cullen M. Dutmer MD , Ricardo A. Mosquera MD , Markus Rose MD , Michael G. O'Connor MD , Chi A. Ma PhD , Gulbu Uzel MD , Timothy J. Vece MD , Maimoona A. Zariwala PhD , Michael R. Knowles MD , Margaret W. Leigh MD , Stephanie D. Davis MD , Thomas W. Ferkol MD

Primary ciliary dyskinesia and activated phosphoinositide 3-kinase delta syndrome type 1 present similarly, with recurrent respiratory infections and reduced nasal nitric oxide levels. When diagnostic confirmation of primary ciliary dyskinesia with genetic testing and/or ciliary electron microscopy is inconclusive, activated phosphoinositide 3-kinase delta syndrome type 1 and other inborn errors of immunity must be investigated.

引用次数: 0

Assessing Racial and Ethnic Health Disparities in a Diverse Cohort with Pediatric Inflammatory Bowel Disease

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-06 DOI: 10.1016/j.jpeds.2025.114504

Ashleigh Watson MD, Chelsea Young MD, Faith D. Ihekweazu MD, MS

Objective

To identify racial and ethnic disparities in disease phenotype, treatment, and outcome in a diverse cohort of children with pediatric inflammatory bowel disease (IBD).

Study design

Patients aged 7 through 18 with IBD diagnosed at a single institution between March 2020 and June 2021 with self- or parent-identified race and ethnicity of non-Hispanic (NH) Black, NH-White, or Hispanic were included. Demographics, Centers for Disease Control/Agency for Toxic Substances and Disease Registry Social Vulnerability Index, Childhood Opportunity Index, disease phenotype, time to diagnosis, treatment, and health care utilization were compared between the racial and ethnic groups.

Results

Ninety-seven patients were included. A total of 18.6% of the cohort self- or parent-identified as NH-Black, 53.6% as NH-White, and 27.8% as Hispanic. Ulcerative colitis was found to be significantly more common in Hispanic patients. Hispanic patients were also significantly more likely to be hospitalized at time of diagnosis and have more emergency department visits within 2 years of diagnosis compared with non-Hispanic White patients.

Conclusions

Race and ethnicity may affect the diagnosis and treatment of pediatric IBD, and these findings should serve as a foundation for establishing equitable care. Larger cohorts are needed to validate these findings.

{"title":"Assessing Racial and Ethnic Health Disparities in a Diverse Cohort with Pediatric Inflammatory Bowel Disease","authors":"Ashleigh Watson MD, Chelsea Young MD, Faith D. Ihekweazu MD, MS","doi":"10.1016/j.jpeds.2025.114504","DOIUrl":"10.1016/j.jpeds.2025.114504","url":null,"abstract":"<div><h3>Objective</h3><div>To identify racial and ethnic disparities in disease phenotype, treatment, and outcome in a diverse cohort of children with pediatric inflammatory bowel disease (IBD).</div></div><div><h3>Study design</h3><div>Patients aged 7 through 18 with IBD diagnosed at a single institution between March 2020 and June 2021 with self- or parent-identified race and ethnicity of non-Hispanic (NH) Black, NH-White, or Hispanic were included. Demographics, Centers for Disease Control/Agency for Toxic Substances and Disease Registry Social Vulnerability Index, Childhood Opportunity Index, disease phenotype, time to diagnosis, treatment, and health care utilization were compared between the racial and ethnic groups.</div></div><div><h3>Results</h3><div>Ninety-seven patients were included. A total of 18.6% of the cohort self- or parent-identified as NH-Black, 53.6% as NH-White, and 27.8% as Hispanic. Ulcerative colitis was found to be significantly more common in Hispanic patients. Hispanic patients were also significantly more likely to be hospitalized at time of diagnosis and have more emergency department visits within 2 years of diagnosis compared with non-Hispanic White patients.</div></div><div><h3>Conclusions</h3><div>Race and ethnicity may affect the diagnosis and treatment of pediatric IBD, and these findings should serve as a foundation for establishing equitable care. Larger cohorts are needed to validate these findings.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"280 ","pages":"Article 114504"},"PeriodicalIF":3.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374973","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}

引用次数: 0

Growth Characteristics at Time of Fontan Procedure and Their Association with Long-Term Outcomes

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-05 DOI: 10.1016/j.jpeds.2025.114501

Yanxu Yang DrPH , Jackie Luong MPH , Divya Suthar MD , Jessica H. Knight PhD , Matthew E. Oster MD, MPH , Alvaro Alonso MD, PhD , Lazaros Kochilas MD, MSCR

Objective

To assess whether somatic growth may predict long-term success after a Fontan procedure.

Study design

The National Death Index was used to track outcomes of Fontan procedures from 1982 through 2011, using data from the Pediatric Cardiac Care Consortium, a US-based registry. Kaplan-Meier plots and Cox models were used to compare outcomes by growth characteristics, adjusting for sex, dominant ventricle, and era.

Results

Among 1461 patients (median age 3.12 years at Fontan evaluation), median z-scores indicated delayed growth: height-for-age z-score (HAZ) −0.66, weight-for-age z-score (WAZ) −0.81, and weight-for-height z-score (WHZ) −0.50. Systemic left ventricle (LV) patients had higher WAZ vs those with right (−0.66 vs −0.93, P < .01). Over 21.2 years of median follow-up through 2022, 78 in-hospital and 184 postdischarge deaths occurred. High WAZ tertile was associated with decreased in-hospital mortality or takedown (aOR vs low tertile: 0.54; 95% CI: 0.31-0.95, P = .03). Long-term survival was not universally linked to growth, but systemic LV patients with higher HAZ tertile had better 25-year survival (high 93.8% vs middle 92.2% and low 82.2%, P = .02). High HAZ and middle WAZ tertiles were associated with lower mortality (adjusted hazard ratio vs low tertiles: 0.42; 95% CI: 0.20-0.87, P = .02 and .52; 95% CI: 0.28-0.97, P = .04). Overweight (WHZ > 2) was associated with increased mortality (adjusted hazard ratio vs normal WHZ: 2.43; 95% CI: 1.15-5.14, P = .02).

Conclusions

Suboptimal growth is prevalent after Fontan procedure. Higher weight correlates with improved perioperative outcomes, and taller height and balanced growth are associated with improved long-term survival, particularly in patients with a systemic LV.

{"title":"Growth Characteristics at Time of Fontan Procedure and Their Association with Long-Term Outcomes","authors":"Yanxu Yang DrPH , Jackie Luong MPH , Divya Suthar MD , Jessica H. Knight PhD , Matthew E. Oster MD, MPH , Alvaro Alonso MD, PhD , Lazaros Kochilas MD, MSCR","doi":"10.1016/j.jpeds.2025.114501","DOIUrl":"10.1016/j.jpeds.2025.114501","url":null,"abstract":"<div><h3>Objective</h3><div>To assess whether somatic growth may predict long-term success after a Fontan procedure.</div></div><div><h3>Study design</h3><div>The National Death Index was used to track outcomes of Fontan procedures from 1982 through 2011, using data from the Pediatric Cardiac Care Consortium, a US-based registry. Kaplan-Meier plots and Cox models were used to compare outcomes by growth characteristics, adjusting for sex, dominant ventricle, and era.</div></div><div><h3>Results</h3><div>Among 1461 patients (median age 3.12 years at Fontan evaluation), median z-scores indicated delayed growth: height-for-age z-score (HAZ) −0.66, weight-for-age z-score (WAZ) −0.81, and weight-for-height z-score (WHZ) −0.50. Systemic left ventricle (LV) patients had higher WAZ vs those with right (−0.66 vs −0.93, <em>P</em> < .01). Over 21.2 years of median follow-up through 2022, 78 in-hospital and 184 postdischarge deaths occurred. High WAZ tertile was associated with decreased in-hospital mortality or takedown (aOR vs low tertile: 0.54; 95% CI: 0.31-0.95, <em>P</em> = .03). Long-term survival was not universally linked to growth, but systemic LV patients with higher HAZ tertile had better 25-year survival (high 93.8% vs middle 92.2% and low 82.2%, <em>P</em> = .02). High HAZ and middle WAZ tertiles were associated with lower mortality (adjusted hazard ratio vs low tertiles: 0.42; 95% CI: 0.20-0.87, <em>P</em> = .02 and .52; 95% CI: 0.28-0.97, <em>P</em> = .04). Overweight (WHZ > 2) was associated with increased mortality (adjusted hazard ratio vs normal WHZ: 2.43; 95% CI: 1.15-5.14, <em>P</em> = .02).</div></div><div><h3>Conclusions</h3><div>Suboptimal growth is prevalent after Fontan procedure. Higher weight correlates with improved perioperative outcomes, and taller height and balanced growth are associated with improved long-term survival, particularly in patients with a systemic LV.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"280 ","pages":"Article 114501"},"PeriodicalIF":3.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374974","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}

引用次数: 0

Prescription Trends of Medications Used to Treat Sleep Disturbances in School-Aged Children: An Interrupted Time-Series Analysis in France, 2016-2023

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-05 DOI: 10.1016/j.jpeds.2025.114502

Zaba Valtuille MsC , Eric Acquaviva PhD , Vincent Trebossen MD , Naim Ouldali PhD , Aurelie Bourmaud PhD , Stéphane Sclison MBA , Alexandre Gomez BSc , Alexis Revet PhD , Hugo Peyre MD , Richard Delorme MD , Florentia Kaguelidou PhD

Objective

To assess rates and trends of hypnotic medication prescriptions for children and adolescents.

Study design

Cross-sectional study of national dispensing data between January 1, 2016, and December 31, 2023, in France. Prescriptions of hypnotic medications (hydroxyzine, alimemazine, melatonin, and Z-drugs) dispensed to children aged 6-17 years were analyzed. Monthly rates of hypnotic prescriptions per 1000 children were modeled before and after the pandemic onset (March 2020) to assess rate and trend changes. Rate ratios (RRs) were calculated between estimated and expected prescription rates.

Results

Overall, 2 675 142 prescriptions were dispensed to an average yearly population of 9 963 497 children. In January 2016, prescription rate of hypnotic medications was estimated at 1.9 per 1000 and at 6.8 per 1000 in December 2023, with postpandemic onset rates exceeding the expected by 131% (RR: 2.31, 95% CI: 2.08; 2.54). Prescription trends increased for all medications from −0.1% (95% CI: −0.2; 0.1%) per month prepandemic to +1.4% (95% CI: 1.2; 1.6%) after the pandemic onset for hydroxyzine; +0.1% (95% CI: 0.0; 0.2%) to +0.9% (95% CI: 0.7; 1.0%) for alimemazine; +2.2% (95% CI: 2.0; 2.3%) to +4.4% (95% CI: 3.9; 4.9%) for melatonin; and −3.2% (95% CI: −3.6;−2.8%) to +1.8% (95% CI: 1.4; 2.2%) for Z-drugs. Monthly prescription rates exceeded the expected by 38% (RR: 1.38, 95% CI: 1.31; 1.46) for hydroxyzine; 19% (RR: 1.19, 95% CI: 1.15; 1.22) for alimemazine; 344% (RR: 4.44, 95% CI: 4.07; 4.80) for melatonin; and 419% (RR: 5.19, 95% CI: 4.24; 6.14) for Z-drugs.

Conclusions

Recent substantial increases in hypnotic medication prescribing for children are possibly related to their persistently deteriorating mental health, changes in prescribing strategies, and/or unmet pre-existing needs.

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