Pub Date : 2025-02-01DOI: 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.
{"title":"The Pittsburgh Study: A Tiered Model to Support Parents during Early Childhood","authors":"Chelsea Weaver Krug PhD , Alan L. Mendelsohn MD , Jordan Wuerth MS , Erin Roby PhD , Daniel S. Shaw PhD","doi":"10.1016/j.jpeds.2024.114396","DOIUrl":"10.1016/j.jpeds.2024.114396","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Study design</h3><div>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.</div></div><div><h3>Results</h3><div>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; <em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>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.</div></div><div><h3>Trial Registration</h3><div>The Pittsburgh Study Early Childhood (TPS-ECC): NCT05444205.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114396"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 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.
{"title":"Markers of Environmental Enteric Dysfunction are Associated with Poor Growth and Developmental Outcomes among Young Children in Lusaka, Zambia","authors":"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","doi":"10.1016/j.jpeds.2024.114408","DOIUrl":"10.1016/j.jpeds.2024.114408","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Study design</h3><div>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 log<sub>2</sub>-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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div><div><h3>Clinical Trial Registry</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> identifier for parent trial: <span><span>NCT05120427</span><svg><path></path></svg></span>. <span><span>https://clinicaltrials.gov/ct2/show/NCT05120427</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114408"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649549","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jpeds.2024.114395
Ayman Abou Mehrem MD, MSc, Marc Beltempo MD, MSc
{"title":"Noninvasive Respiratory Support for Stabilization After Birth is a Safe Approach in Infants Who are Micropreterm","authors":"Ayman Abou Mehrem MD, MSc, Marc Beltempo MD, MSc","doi":"10.1016/j.jpeds.2024.114395","DOIUrl":"10.1016/j.jpeds.2024.114395","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114395"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632526","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jpeds.2024.114380
Tandy Aye MD , David A. Turner MD , Angela S. Czaja MD, MSc, PhD , Cynthia M. Holland-Hall MD, MPH , Mary E. Moffatt MD , Patrick J. Myers MD , Jill J. Fussell MD , Council of Pediatric Subspecialties (CoPS)
{"title":"Subspecialty Perspectives on the Education Needs for Pediatrics Residency Training","authors":"Tandy Aye MD , David A. Turner MD , Angela S. Czaja MD, MSc, PhD , Cynthia M. Holland-Hall MD, MPH , Mary E. Moffatt MD , Patrick J. Myers MD , Jill J. Fussell MD , Council of Pediatric Subspecialties (CoPS)","doi":"10.1016/j.jpeds.2024.114380","DOIUrl":"10.1016/j.jpeds.2024.114380","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114380"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548995","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jpeds.2024.114414
Alan M. Groves MBChB , Monica M. Bennett PhD , John Loyd MD , Reese H. Clark MD , Veeral N. Tolia MD
Objective
To describe the trends in percentage oxygen requirement and mode of respiratory support delivered to extremely premature infants in the 12 weeks after birth.
Study design
This is a retrospective study of extremely premature infants (≤276/7 weeks) discharged from neonatal intensive care units managed by Pediatrix Medical Group between January 1, 2016, and December 31, 2021. Demographic and daily clinical data (mode of respiratory support and fraction of inspired oxygen [FiO2]) were extracted from the Pediatrix Clinical Data Warehouse.
Results
A total of 16 386 infants with a median gestational age of 25 weeks and birthweight of 765 g were included. There were 3808 (23.2%) infants who died. Of the cohort, 6019 (43.1%) infants who survived to 36 weeks’ gestation had bronchopulmonary dysplasia. Median FiO2 at all gestations followed a biphasic pattern with a peak on day of life 1, reduction to a nadir by day 4 to 5, and an increase to a second peak around day 14. Infants born at lower gestational ages had a higher median FiO2 at each time point. At lower gestations, there were higher proportions of infants receiving mechanical ventilation and a later introduction of noninvasive modes.
Conclusions
Extremely premature infants show a consistent biphasic pattern in percentage of supplemental oxygen required after birth.
{"title":"Trajectory of Postnatal Oxygen Requirement in Extremely Preterm Infants","authors":"Alan M. Groves MBChB , Monica M. Bennett PhD , John Loyd MD , Reese H. Clark MD , Veeral N. Tolia MD","doi":"10.1016/j.jpeds.2024.114414","DOIUrl":"10.1016/j.jpeds.2024.114414","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the trends in percentage oxygen requirement and mode of respiratory support delivered to extremely premature infants in the 12 weeks after birth.</div></div><div><h3>Study design</h3><div>This is a retrospective study of extremely premature infants (≤27<sup>6/7</sup> weeks) discharged from neonatal intensive care units managed by Pediatrix Medical Group between January 1, 2016, and December 31, 2021. Demographic and daily clinical data (mode of respiratory support and fraction of inspired oxygen [FiO<sub>2</sub>]) were extracted from the Pediatrix Clinical Data Warehouse.</div></div><div><h3>Results</h3><div>A total of 16 386 infants with a median gestational age of 25 weeks and birthweight of 765 g were included. There were 3808 (23.2%) infants who died. Of the cohort, 6019 (43.1%) infants who survived to 36 weeks’ gestation had bronchopulmonary dysplasia. Median FiO<sub>2</sub> at all gestations followed a biphasic pattern with a peak on day of life 1, reduction to a nadir by day 4 to 5, and an increase to a second peak around day 14. Infants born at lower gestational ages had a higher median FiO<sub>2</sub> at each time point. At lower gestations, there were higher proportions of infants receiving mechanical ventilation and a later introduction of noninvasive modes.</div></div><div><h3>Conclusions</h3><div>Extremely premature infants show a consistent biphasic pattern in percentage of supplemental oxygen required after birth.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114414"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692945","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jpeds.2024.114088
Massimo Pettoello-Mantovani MD, PhD , Donjeta Bali MD , Maria Pastore MD , Ida Giardino MD , Leyla Namazova-Baranova MD, PhD , Georgios Konstantinidis MD , Mehmet Vural MD
{"title":"The Pressing Issue of Food Safety for Infants and the Role of the Pediatrician","authors":"Massimo Pettoello-Mantovani MD, PhD , Donjeta Bali MD , Maria Pastore MD , Ida Giardino MD , Leyla Namazova-Baranova MD, PhD , Georgios Konstantinidis MD , Mehmet Vural MD","doi":"10.1016/j.jpeds.2024.114088","DOIUrl":"10.1016/j.jpeds.2024.114088","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114088"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140904356","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jpeds.2024.114409
Courtney Temple MD, Emma Cassidy MD, Robert G. Hendrickson MD
Children exposed to illicit fentanyl often experience severe toxicity and receive repeated naloxone doses and prolonged airway support. This retrospective study presents the clinical course and management of 4 cases, emphasizing the urgent need for prompt recognition and intervention to address the severe, extended effects of illicit fentanyl exposure in very young children.
{"title":"Characteristics of Fentanyl Toxicity in Very Young Children","authors":"Courtney Temple MD, Emma Cassidy MD, Robert G. Hendrickson MD","doi":"10.1016/j.jpeds.2024.114409","DOIUrl":"10.1016/j.jpeds.2024.114409","url":null,"abstract":"<div><div>Children exposed to illicit fentanyl often experience severe toxicity and receive repeated naloxone doses and prolonged airway support. This retrospective study presents the clinical course and management of 4 cases, emphasizing the urgent need for prompt recognition and intervention to address the severe, extended effects of illicit fentanyl exposure in very young children.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114409"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649545","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jpeds.2025.114467
Paul G. Fisher MD
{"title":"Step Up After Concussion","authors":"Paul G. Fisher MD","doi":"10.1016/j.jpeds.2025.114467","DOIUrl":"10.1016/j.jpeds.2025.114467","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114467"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143147602","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}
Pub Date : 2025-02-01DOI: 10.1016/S0022-3476(24)00554-7
{"title":"Information for Readers","authors":"","doi":"10.1016/S0022-3476(24)00554-7","DOIUrl":"10.1016/S0022-3476(24)00554-7","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114451"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143147599","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}
Pub Date : 2025-02-01DOI: 10.1016/j.jpeds.2025.114468
Thomas R. Welch MD
{"title":"One of the Most Common Diseases You May Never Have Heard About","authors":"Thomas R. Welch MD","doi":"10.1016/j.jpeds.2025.114468","DOIUrl":"10.1016/j.jpeds.2025.114468","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114468"},"PeriodicalIF":3.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143147603","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}