Journal of Pediatrics最新文献

Objective: To study pediatric inpatient hospital capacity and resources, characterizing differences according to Social Determinants of Health (SDoH) using market share techniques.

Study design: This cross-sectional study uses nonelective inpatient discharges (≥1 month to ≤19 years) from Healthcare Cost and Utilization Project and American Hospital Association surveys to derive hospital capacity and resources/capability. We include US hospitals with ≥1 pediatric bed and ≥1 pediatric discharge and calculate per bed capital, expenditure, and staffing, transfer rates, payer-mix, and adjusted central line-associated blood stream infection rate. We utilize actual discharge data to improve upon traditional geospatial access analyses that assume all patients receive care close to home. SDoH are derived from American Community Survey measures (family income, race and ethnicity, and urban vs rural) and Child Opportunity Index (COI).

Results: Using 1 118 502 discharges across 1404 hospitals, mean pediatric bed capacity was 3.26 beds per 10 000 pediatric-aged residents (95% CI: 3.24-3.29). Capacity was similar across racial and ethnic groups, although socially disadvantaged (low income or COI) areas had higher capacity. Hospitals serving non-Hispanic/Latino Black and Hispanic/Latino children, children from socially disadvantaged communities, and rural areas had lower capital, expenditure, and staff per bed; higher transfer rates; and served more Medicaid enrollees. Hospitals serving very-high COI areas had $284 000 greater expenditure per bed (vs very low) and a 16% lower proportion of Medicaid patients. Central line-associated blood stream infection rates did not substantively differ by SDoH.

Conclusions: Although pediatric bed capacity was evenly distributed according to SDoH, hospitals serving under-represented, disadvantaged, and rural communities had less capability and resource availability. Future work is required to guide equity-oriented resource allocation.

Objectives: To determine incidence and risk factors for hypertension in childhood nephrotic syndrome.

Study design: Using data from the Insight into Nephrotic Syndrome (INSIGHT) study, a prospective observational childhood nephrotic syndrome cohort from Toronto, Canada, we evaluated hypertension incidence and time-to-hypertension overall and stratified by 1) steroid-resistance or steroid-sensitivity, and 2) frequently-relapsing, steroid dependent, or infrequently-relapsing. Hypertension was defined as stage 1-2 hypertensive blood pressure on two consecutive visits or anti-hypertensive medication initiation.

Results: We included 748 children with nephrotic syndrome from 1996 to 2023. Median (quartile 1-3 [Q1-3]) age at diagnosis was 4 (2.8-6) years, 473 (63%) children were male, and 240 (32%) were of South Asian ethnicity. Forty (5%) children were steroid-resistant, 177 (24%) steroid-dependent, 113 (15%) frequently-relapsing, and 418 (56%) infrequently-relapsing. Median follow-up was 5.2 years (Q1-3 3.0-9.3). During follow-up, 393 (53%) children developed hypertension or were initiated on an anti-hypertensive medication (incidence rate 8.2 per 100 person-years, 95%CI 7.4-9.1). Hypertension was more common among children steroid-resistance than steroid-sensitivity (70% vs. 52%; adjusted HR 1.47, 95%CI 1.00-2.17). Hypertension was also more common in children who were steroid-dependent (67%; adjusted HR 1.81, 95%CI 1.43-2.30) and frequently-relapsing (63%; adjusted HR 1.64, 95%CI 1.23-2.18), than infrequently-relapsing (42%). Among steroid-sensitive patients, higher BMI Z-score and academic center were also significant hypertension risk factors.

Conclusions: Half of children with nephrotic syndrome develop hypertension. Children who are steroid-resistant, steroid-dependent, frequently-relapsing or have obesity are at greatest risk. Close blood pressure surveillance is justified to identify and treat hypertension.

Objective: To explore perceptions, concerns, and enthusiasm from a diverse group of parents regarding early childhood research that involves home monitoring technologies for collecting environmental exposure data.

Study design: A diverse group of new and expecting parents participated in semi-structured interviews. A single interviewer conducted all sessions and introduced a hypothetical longitudinal early childhood research study, which included the following novel home monitoring approaches: (1) wearable devices, (2) audio monitoring, and (3) environmental sampling. Interviews were audio-recorded, transcribed, and coded. Qualitative description guided the study, and a constant comparative approach was used to identify themes from transcripts.

Results: Twenty-four interviews were completed. Emerging themes included the following: (1) Ready and Willing to Participate; (2) Helping Others, Helping Ourselves: Motivation for Participation; (3) Trust and Transparency: Understanding the "What?" and the "Why?;" (4) Data Privacy and Security: "What If It Gets into the Wrong Hands?;" and (5) It's a Lot to Juggle: Logistical Realities. Perceptions were similar across racial, ethnic, and socioeconomic groups. Perceptions were positive, and participants desired additional information about study feasibility and purpose. Many had concerns related to wearable device safety and data privacy; a trusting relationship with the research team was a priority.

Conclusion: Participants had positive sentiments regarding longitudinal observational studies involving pregnancy and infancy yet expressed concerns about safety, privacy, feasibility, and transparency. These findings can inform future early childhood research study design to ensure protocols are transparent, inclusive, and appealing to parents.

Objective: To evaluate the accuracy of various point-of-care device methodologies for measuring blood glucose concentrations in babies at risk of neonatal hypoglycemia.

Study design: This systematic review and meta-analysis included studies from Ovid MEDLINE, Ovid Embase, and Web of Science up to May 20, 2024. Studies comparing point-of-care testing methods for neonatal blood glucose to a standard laboratory method were included, excluding those on continuous glucose monitoring or conducted before 1990. Two researchers independently assessed inclusion and evaluated risk of bias using QUADAS-2. Sensitivity and specificity were calculated using contingency tables, and diagnostic accuracy was analyzed using hierarchical random-effects modelling. Studies with insufficient data were summarized by estimation direction.

Results: Seventy-one studies were included. The quantitative analysis (n = 31) evaluated glucose oxidase (GO) + photometry (n = 8), glucose-1-dehydrogenase (GDH) + photometry (n = 6), GO + electrochemistry (n = 13), GDH + electrochemistry (n = 12), and hexokinase (HK) + electrochemistry (n = 2). All methods showed high specificity (≥93%), with GO + electrochemistry, GDH + electrochemistry, and HK + electrochemistry showing superior sensitivity. The summary receiver operating characteristic curve confirmed HK + electrochemistry as the most accurate.

Conclusion: Certain point-of-care device methodologies demonstrate greater accuracy in measuring neonatal blood glucose concentrations. Of the methods evaluated, HK + electrochemistry proved to be the most reliable. However, the limited number of studies using this method suggests the need for further research to confirm these findings across diverse settings and populations.

Systematic review registration: PROSPERO on December 29, 2023 (CRD42023488539).

Objective: To determine the accuracy of the Parent's Observation of Social Interactions (POSI) when deployed for universal autism screening within a large healthcare network.

Study design: Retrospective analysis of electronic health record data from children screened for autism spectrum disorder (ASD) using POSI at the 18- and 24- month pediatric well-child care (WCC) visits across Southern California Permanente Medical Group facilities throughout the 2022 calendar year. Data on ASD diagnoses placed in the electronic health record problem list were analyzed 1 year later (until the end of 2023) to calculate sensitivity, specificity, and positive/negative likelihood ratio (LR+ and LR-) values.

Results: At the 18-month WCC, 8014 of 30 375 children (26.4%) had elevated POSI scores of ≥3 (positive screen), and the sensitivity and specificity were 77.9% and 76.1%, respectively. At the 24-month WCC, 5988 children of 27 975 (21.4%) had positive POSI screens, and the sensitivity and specificity were 76.5% and 81.4%, respectively. The LR+ was 3.3 at 18 months and 4.2 at 24 months. The LR- was 0.29 at both the 18- and 24-month time points.

Conclusions: The POSI screen for ASD had adequate sensitivity and specificity (both >76%) when systematically deployed in a primary care setting at 18- and 24-month WCC visits. Children diagnosed with ASD were 3.3 and 4.2 times more likely to have screened positive at 18 and 24 months, compared with children who were not diagnosed with ASD. Conversely, children not diagnosed with ASD were 3.4 times more likely to have screened negative than children with ASD at 18 and 24 months.

This multi-institutional, descriptive study of 19 children with neurofibromatosis 1 examines the link between optic pathway gliomas (OPGs) and central precocious puberty (CPP). We report that CPP can arise without OPG chiasmal involvement and that prior OPG chemotherapy does not prevent the development of CPP.

Objective: To use a pre-COVID-19 birth cohort database to describe the clinical heterogeneity of severe acute respiratory infection (SARI) cases of the past seasons as a basis to investigate further distribution of clinical phenotypes in the era of immunization for respiratory syncytial virus (RSV).

Study design: Infants with RSV-SARI were identified from a 2014 through 2019 birth cohort in a tertiary care center in Lyon, France, and their medical records extensively reviewed. Using the criteria of the World Health Organization severity definitions, we classified SARI as having nutritional (inability to feed), respiratory (SpO₂ <93%), or neurological (failure to respond, apneas) impairments.

Results: We described 3 phenotypes: nutritional impairment, respiratory impairment, and neurological (with respiratory and nutritional) impairment. Respiratory impairment could overlap with nutritional impairment, or not. There was a significant difference in age categories distribution regarding nutritional impairment (greater proportion in 1.5- to 3.0-month-olds; P = .01) and neurological impairment (greater proportion in <1.5-month-olds; P = .002).

Conclusions: The present study highlights the presence of 3 potentially overlapping phenotypes as a new way to consider and describe RSV disease. To adapt care and healthcare policies in the RSV immunization era, it is necessary to investigate further and monitor the residual SARI burden of each phenotype.

Objective: To evaluate the associations between complex hip surgery and subsequent hospitalizations in children with intellectual disability, including a subset of children with cerebral palsy.

Study design: We conducted a retrospective cohort study using linked administrative, health, and disability data from Western Australia. Children born between 1983 and 2009 who underwent complex hip surgery by end 2014 were included (intellectual disability, n = 154; subset with cerebral palsy, n = 91). A self-controlled case series analysis using Poisson regression was used to estimate the age-adjusted associations of complex hip surgery on all-cause hospitalizations and when the principal diagnosis was lower respiratory tract infection or epilepsy, for periods following the individual's first major hip surgery, compared with the year before surgery.

Results: Age adjusted incidence of all-cause hospitalizations decreased after surgery (year 1: incidence rate ratio [IRR] 0.87 [95% CI, 0.74-1.02]; year 6: IRR 0.57 [95% CI, 0.46-0.72]). The incidence of hospitalizations for lower respiratory tract infection increased (year 1: IRR, 1.03 [95% CI, 0.72-1.51]; year 6: IRR 2.08 [95% CI, 1.18-3.68]). The incidence of hospitalizations for epilepsy decreased (year 1: IRR 0.93 [95% CI, 0.57, 1.54]; year>6: IRR 0.72 [95% CI, 0.34-1.55]) after surgery. A similar pattern was observed for the subset of children with or without cerebral palsy.

Conclusion: Complex hip surgeries are associated with fewer hospitalizations overall but not respiratory hospitalizations for children with intellectual disability. Fewer hospitalizations suggest benefits for better musculoskeletal alignment.