Journal of Pediatrics最新文献

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The Association of Opioid Prescriptions to Children after Discharge from Surgery and New Opioid Prescription Fills in Family Members.

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-05 DOI: 10.1016/j.jpeds.2025.114505

Erica Langnas, Andrew Lin, Yanting Luo, Rosa Rodriguez-Monguio, Mark Bicket, Sara Cairo, Mathijs De Vaan, Catherine L Chen

Objective: To determine whether family members of pediatric surgical patients who filled a discharge opioid prescription would have higher rates of new opioid prescription fills compared with family members of patients who did not fill a pediatric surgical discharge opioid prescription.

Study design: Using OptumLabs Data Warehouse administrative claims, we performed a retrospective cohort study of pediatric surgery patients aged 5 through18 and their family members, based on whether an opioid prescription for the child was filled after surgery. Neither patients nor family members had any history of prior opioid use. We calculated the frequency of new opioids filled among family members in the 12 months following the date of surgery. We created a hierarchical logistic regression model to determine the association between having a discharge opioid prescription filled for a pediatric surgical patient and a new opioid prescription filled by family members within the same household.

Results: There were a total of 206,598 family members within 76,569 households in our study. 73.75% of pediatric surgery patients had a prescription filled after surgery, resulting in 151,693 total family members within 56,456 households exposed to a new discharge opioid prescription. 7.3% of exposed family members and 19.6% exposed households then filled a new opioid prescription within 12 months, compared with 5.2% of family members and 13.3% of households (p<0.001 for both) unexposed to a filled opioid prescription after pediatric surgical discharge . After adjusting for demographic factors, clinical attributes, and surgical factors, we found an increased risk of new opioid prescription fills among exposed family members compared with unexposed family members (OR 1.28 [95% CI 1.217, 1.352, p<0.001]).

Conclusions: Introducing a discharge opioid prescription after pediatric surgery to an opioid-naïve household is associated with increased rates of opioid prescriptions in opioid-naïve family members in the year following surgery.

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引用次数: 0

Quantitative Magnetic Resonance Cerebrospinal Fluid Flow Properties and Neurocognitive Outcomes in Congenital Heart Disease

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-03 DOI: 10.1016/j.jpeds.2025.114494

Vincent Kyu Lee BS , William T. Reynolds BS , Rebecca R. Hartog MD , Julia Wallace BA , Nancy Beluk RT , Jodie K. Votava-Smith MD , Daryaneh Badaly PhD , Cecilia W. Lo PhD , Rafael Ceschin PhD , Ashok Panigrahy MD

Objectives

To determine whether there are differences in pulsatile cerebrospinal fluid (CSF) flow between children and adolescents with congenital heart disease (CHD) and healthy, age-matched peers, and to determine if abnormal CSF flow is associated with abnormal CSF volumes and whether it predicts executive function outcomes.

Study design

CSF flow was measured across the lumen of the aqueduct of Sylvius using cardiac-gated phase-contrast MRI at 3.0 T on 60 children and adolescents (CHD = 22, healthy controls = 38). CSF flow modeled as standard pulsatility characteristics (anterograde and retrograde peak velocities, mean velocity, and velocity variance measurements) and dynamic pulsatility characteristics (each participant's CSF flow deviation from study cohort's consensus flow quantified using the root mean squared deviation) were measured. Participants underwent neurocognitive assessments for executive function, focused on inhibition, cognitive flexibility, and working memory domains.

Results

Compared with controls, the CHD group demonstrated greater dynamic pulsatility over the entire cardiac cycle (higher overall flow root mean squared deviation: P = .0353 for the study cohort fitted; P = .0292 for the control only fitted), but no difference in standard pulsatility measures. However, a lower mean velocity (P = .0323) and lower dynamic CSF flow pulsatility (root mean squared deviation P = .0181 for the study cohort fitted; P = .0149 for the control only fitted) predicted poor inhibitory executive functional outcomes.

Discussion

Although the whole CHD group exhibited higher dynamic CSF flow pulsatility compared with controls, the subset of patients with CHD with relatively reduced static and dynamic CSF flow pulsatility had the worst inhibitory domain executive functioning. These findings suggest that altered CSF flow pulsatility may be related to not only brain compensatory mechanisms, but also to cognitive impairment in CHD.

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引用次数: 0

Reconsidering Initial Respiratory Support Strategies in Infants Born Preterm 重新考虑早产儿的初始呼吸支持策略。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2024.114394

Yinfang Wu MM, Weixing Xu MM

引用次数: 0

The Association of the Child Opportunity Index with Emergency Department Presentations for Pediatric Poisonings: A Case-Control Study 儿童机会指数与儿科中毒急诊就诊率的关系：病例对照研究

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2024.114410

Michael S. Toce MD, MS , Claire Narang BS , Michael C. Monuteaux ScD , Florence T. Bourgeois MD, MPH

Objective

To examine the relationship between the Child Opportunity Index (COI) and unintentional poisonings in a geographically diverse pediatric population.

Study design

We conducted a retrospective, case-control study of children ≤ 6 years of age who had emergency department encounters for poisonings from January 1, 2016, to December 31, 2021. Data were obtained from the Pediatric Health Information System database. Poisonings were categorized as related to prescription medications, over-the-counter medications, drugs of misuse, or nonmedicinal substances. We estimated multivariable conditional logistic regression models to examine the association of the COI with each poisoning type.

Results

Among 49 789 emergency department encounters for poisonings, the most common poisoning category was prescription medications (28.3%). Compared with patients with very low COI, patients with very high COI were more likely to present for prescription medication (aOR 1.15 [95% CI, 1.01-1.31]) or over-the-counter medication poisoning (aOR 1.37 [95% CI, 1.18-1.59]). Conversely, patients with very high COI were less likely to have poisonings secondary to drugs of misuse (aOR 0.82 [95% CI, 0.67-0.99]). Patients with high COI were also less likely to have poisonings due to a nonmedicinal substance compared with patients with very low COI (aOR 0.83 [95% CI, 0.73-0.93]).

Conclusions

Different pediatric poisoning types were associated with a patient's COI, possibly reflecting socioeconomic characteristics of a child's environment. While poison prevention strategies should be employed uniformly to maximize impact, our findings highlight variation in poisoning risks related to a child's environment and support the use of the COI for future research into mechanisms to strengthen further poisoning prevention strategies.

研究目的研究设计：研究设计：我们对 2026 年 1 月 1 日至 2021 年 12 月 31 日期间因中毒而在急诊科（ED）就诊的 6 岁以下儿童进行了一项回顾性病例对照研究。数据来自儿科健康信息系统数据库。中毒事件分为与处方药、非处方药 (OTC)、滥用药物或非药用物质有关的中毒事件。我们估计了多变量条件逻辑回归模型，以检验 COI 与每种中毒类型的关联：在 49789 例急诊室中毒事件中，最常见的中毒类别是处方药（28.3%）。与 COI 很低的患者相比，COI 很高的患者更有可能因处方药中毒（aOR 1.15 [95% CI, 1.01-1.31]）或 OTC 药物中毒（aOR 1.37 [95% CI, 1.18-1.59]）而就诊。相反，COI 非常高的患者因滥用药物而中毒的可能性较低（aOR 0.82 [95% CI, 0.67-0.99]）。与 COI 很低的患者相比，COI 很高的患者因非药用物质中毒的可能性也较低（aOR 0.83 [95% CI, 0.73-0.93]）：不同的儿科中毒类型与患者的 COI 有关，这可能反映了儿童所处环境的社会经济特征。虽然预防中毒的策略应统一采用以达到最大效果，但我们的研究结果突显了与儿童所处环境有关的中毒风险的差异，并支持在未来的研究中使用COI来加强进一步预防中毒策略的机制。

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引用次数: 0

Why the Negative? A Reflective Analysis on the Impact of Weekly Vitamin D Supplementation on Acute Respiratory Infections in Young Children 为什么是负面的？每周补充维生素 D 对幼儿急性呼吸道感染影响的反思性分析》。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2024.114417

Yahong Wang MSc, Yupeng Ruan MBBS

引用次数: 0

Corrigendum to “Cognitive Bias in an Infant with Constipation” J Pediatrics 270 (2024): 113996 “婴儿便秘的认知偏差”[J] .儿科学270(2024):113996。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2024.114406

Rebecca A. Carson DNP, APRN, CPNP, PC/AC , John L. Lyles MD

引用次数: 0

Advancing Very Early Intervention for Infants with Cerebral Palsy

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2025.114466

Alicia J. Spittle PhD

引用次数: 0

Congenital Goiter due to Inborn Error in Synthesis with Treatment Response 先天性合成错误导致的先天性甲状腺肿大及治疗反应。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2024.114387

Ankush Patel BS, Rekha Krishnasarma MD

引用次数: 0

The Pittsburgh Study: A Tiered Model to Support Parents during Early Childhood 匹兹堡研究：支持幼儿期父母的分层模式。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2024.114396

Chelsea Weaver Krug PhD , Alan L. Mendelsohn MD , Jordan Wuerth MS , Erin Roby PhD , Daniel S. Shaw PhD

Objective

To test the feasibility of implementing The Pittsburgh Study's (TPS) Early Childhood Collaborative, a population-level, community-partnered initiative to promote relational health by offering accessible preventive parenting program options for families with young children.

Study design

TPS partnered with healthcare and community agencies serving families in Allegheny County, Pennsylvania, to enroll and screen 878 parents of 1040 children 4-years-old and under. Participants were assigned to 1 of 4 tiered groups based on identified needs: (1) universal, (2) targeted/universal, (3) secondary/tertiary, or (4) tertiary programs. Parents were offered choices in empirically supported parenting programs within group ranging from texting programs to intensive home visiting. Program selection was optional. Chi-square tests were conducted to examine the likelihood of selecting a program by group.

Results

About 25% of participants were assigned to each tiered group; 78% of parents chose to enroll in a parenting program. In general, parents with higher levels of adversity were more likely to select a parenting program compared with those reporting less adversity, including secondary/tertiary vs targeted/universal groups (81.4% vs 72.8%), and tertiary vs universal and targeted/universal groups (83% vs 74.1% and 72.8%, respectively; P < .001).

Conclusions

Our high program enrollment rate supports the feasibility of TPS. TPS successfully engaged families in the study by offering choices in, and optimizing accessibility to, parenting programs. TPS is highly aligned with recent recommendations by the American Academy of Pediatrics for tiered approaches as part of a broad public health strategy for supporting early relational health.

Trial Registration

The Pittsburgh Study Early Childhood (TPS-ECC): NCT05444205.

目的测试实施匹兹堡研究（TPS）儿童早期协作项目的可行性。该项目是一项人口层面的社区合作计划，旨在通过为有年幼子女的家庭提供方便的预防性育儿项目选择来促进关系健康：研究设计：TPS 与宾夕法尼亚州阿勒格尼县为家庭提供服务的医疗保健和社区机构合作，招募并筛选了 878 名有 1040 名 4 岁及以下儿童的家长。根据已确定的需求，参与者被分配到四个分层组中的一个：（1）普及组；（2）目标/普及组；（3）二级/三级组；或（4）三级组。家长可在组内选择经验支持的育儿计划，包括短信计划和强化家访。项目选择是非强制性的。结果显示，约有 25% 的参与者被分配到了不同的项目组：结果：约 25% 的参与者被分配到各分层小组；78% 的家长选择参加亲职教育项目。一般来说，与逆境程度较轻的家长相比，逆境程度较高的家长更有可能选择亲职教育项目，包括二级/三级组与目标/普及组（81.4%对72.8%），以及三级组与普及组和目标/普及组（分别为83%对74.1%和72.8%；P < .001）：我们的高计划注册率证明了 TPS 的可行性。TPS 通过提供育儿计划的选择并优化其可及性，成功地让家庭参与到研究中来。TPS 与美国儿科学会（American Academy of Pediatrics）最近提出的分层方法建议高度一致，是支持早期关系健康的广泛公共卫生战略的一部分。

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引用次数: 0

Markers of Environmental Enteric Dysfunction are Associated with Poor Growth and Developmental Outcomes among Young Children in Lusaka, Zambia 环境肠道功能紊乱的标志物与赞比亚卢萨卡幼儿生长发育不良有关。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2024.114408

Jacqueline M. Lauer PhD, MPH , Juha Pyykkö PhD , Mpela Chembe BA , Tamara Billima-Mulenga MA , Dorothy Sikazwe MPH , Bertha Chibwe MPH , Savanna Henderson MA , Doug Parkerson MA , Jukka M. Leppänen PhD , Günther Fink PhD , Lindsey M. Locks ScD, MPH , Peter C. Rockers ScD

Objective

To examine cross-sectional relationships between biomarkers of environmental enteric dysfunction (EED), an acquired subclinical condition of the small intestine, and anthropometric and developmental outcomes among children in Lusaka, Zambia.

Study design

Serum samples were collected from 240 children aged 27 to 35 months enrolled in a cluster-randomized trial assessing the effects of growth charts and small-quantity lipid-based nutrient supplements on linear growth. Samples were analyzed using the 11-plex Micronutrient and EED Assessment Tool, which incorporates 2 biomarkers of EED, namely intestinal fatty acid-binding protein (I-FABP), a marker of epithelial damage, and soluble CD14 (sCD14), a marker of microbial translocation. Associations between log₂-transformed biomarker concentrations and anthropometric (height-for-age z-score [HAZ], weight-for-height z-score, and weight-for-age z-score) and developmental (Global Scales of Early Development development for age z-score and saccadic reaction time [SRT]) outcomes were assessed using linear regression analyses adjusted for background characteristics.

Results

Mean ± SD HAZ was −1.94 ± 1.10. Higher sCD14 and I-FABP concentrations were significantly associated with lower HAZ (β: −0.21, 95% CI: −0.41, −0.01 and β: −0.20, 95% CI: −0.32, −0.08, respectively). Higher I-FABP concentrations were significantly associated with lower development-for-age z-score (β: −0.22, 95% CI: −0.40, −0.03) and slower SRT (β: 7.37 ms, 95% CI: 2.02, 12.72) as were higher alpha-1-acid glycoprotein concentrations (HAZ β: −0.38, 95% CI: −0.72, −0.03; SRT β: 11.14 ms, 95% CI: 0.94, 21.72).

Conclusions

In children in Lusaka, biomarkers of EED were associated with poor anthropometric and developmental outcomes, underscoring the need for interventions to address EED to improve child health globally.

Clinical Trial Registry

ClinicalTrials.gov identifier for parent trial: NCT05120427. https://clinicaltrials.gov/ct2/show/NCT05120427.

目的研究设计：研究赞比亚卢萨卡儿童环境肠道功能障碍（EED）生物标志物（一种后天性小肠亚临床症状）与人体测量和发育结果之间的横断面关系：研究设计：研究人员收集了 240 名 27 至 35 个月大的儿童的血清样本，这些儿童参加了一项分组随机试验，评估生长图表和小量脂质营养补充剂对线性生长的影响。样本采用 11 种微量营养素和 EED 评估工具进行分析，该工具包含两种 EED 生物标记物，即肠道脂肪酸结合蛋白 (I-FABP) 和可溶性 CD14 (sCD14)，前者是上皮损伤的标记物，后者是微生物转移的标记物。采用线性回归分析评估了对数2转换的生物标记物浓度与人体测量（身高与年龄Z值[HAZ]、体重与身高Z值、体重与年龄Z值0）和发育（全球早期发育量表[GSED]年龄发育Z值[DAZ]和眼动反应时间[SRT]）结果之间的关系，并对背景特征进行了调整：HAZ 的平均值（± SD）为 -1.94 ± 1.10。较高的 sCD14 和 I-FABP 浓度与较低的 HAZ 显著相关（β：-0.21，95% CI：-0.41，-0.01；β：-0.20，95% CI：-0.32，-0.08）。I-FABP浓度越高，DAZ越低（β：-0.22，95% CI：-0.40，-0.03），SRT越慢（β：7.37 ms，95% CI：2.02，12.72），α-1酸糖蛋白浓度越高（HAZ β：-0.38，95% CI：-0.72，-0.03；SRT β：11.14 ms，95% CI：0.94，21.72）：在卢萨卡的儿童中，EED 的生物标志物与不良的人体测量和发育结果有关，这表明需要采取干预措施来解决 EED 问题，以改善全球儿童的健康状况。

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