Journal of Pediatrics最新文献

英文中文

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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引用次数: 0

Noninvasive Respiratory Support for Stabilization After Birth is a Safe Approach in Infants Who are Micropreterm 为稳定微早产儿出生后的状况而提供无创呼吸支持是一种安全的方法。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2024.114395

Ayman Abou Mehrem MD, MSc, Marc Beltempo MD, MSc

引用次数: 0

Subspecialty Perspectives on the Education Needs for Pediatrics Residency Training 亚专科对儿科住院医师培训教育需求的看法。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-01 DOI: 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)

引用次数: 0

Trajectory of Postnatal Oxygen Requirement in Extremely Preterm Infants 极早产儿出生后的需氧量轨迹。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-01 DOI: 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 (≤27^6/7 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.

研究目的描述极早产儿出生后 12 周内的氧气需求百分比和呼吸支持方式的变化趋势：这是一项回顾性研究，研究对象为 2016 年 1 月 1 日至 2021 年 12 月 31 日期间从 Pediatrix 医疗集团管理的新生儿重症监护病房出院的极早产儿（≤27+6 周）。人口统计学和日常临床数据（呼吸支持模式和吸氧分数 [FiO2]）均从 Pediatrix 临床数据仓库中提取：共纳入 16,386 名婴儿，中位胎龄为 25 周，出生体重为 765 克。3808名（23.2%）婴儿死亡。6,019名（43.1%）妊娠36周以内的存活婴儿患有支气管肺发育不良（BPD）。所有妊娠期的血氧饱和度中值均呈双相模式，在出生后第 1 天达到峰值，第 4 至 5 天降至最低点，第 14 天左右升至第二个峰值。低胎龄出生的婴儿在每个时间点的 FiO2 中位数都较高。胎龄越小的婴儿接受机械通气的比例越高，采用无创通气模式的时间也越晚：结论：极早产儿出生后需要补充氧气的比例呈现出一致的双相模式。

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引用次数: 0

The Pressing Issue of Food Safety for Infants and the Role of the Pediatrician 婴儿食品安全的紧迫问题和儿科医生的作用。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-01 DOI: 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

引用次数: 0

Characteristics of Fentanyl Toxicity in Very Young Children 年幼儿童的芬太尼毒性特征

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-01 DOI: 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.

接触非法芬太尼的儿童往往会出现严重中毒，需要反复服用纳洛酮并接受长时间的气道支持。本回顾性研究介绍了四例病例的临床过程和处理方法，强调了及时识别和干预的迫切需要，以应对非法芬太尼暴露对年幼儿童造成的长期严重影响。

引用次数: 0

Step Up After Concussion

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2025.114467

Paul G. Fisher MD

引用次数: 0

Information for Readers

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-01 DOI: 10.1016/S0022-3476(24)00554-7

引用次数: 0

One of the Most Common Diseases You May Never Have Heard About

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-02-01 DOI: 10.1016/j.jpeds.2025.114468

Thomas R. Welch MD

引用次数: 0

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