Journal of Pediatrics最新文献_第6页

Knowledge and Barriers to Safe Sleep Counseling Among Pediatric Emergency Department Clinicians and Trainees 儿科急诊科临床医生和培训生对安全睡眠咨询的知识和障碍。

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2026-03-01 Epub Date: 2025-12-09 DOI: 10.1016/j.jpeds.2025.114937

Mary Beth Howard MD, MSc , Leticia M. Ryan MD, MPH , Kevin J. Psoter PhD , Barry S. Solomon MD, MPH , Olivia A. Wilson-Lall BS , Rachel Moon MD

Objectives

To assess knowledge of the American Academy of Pediatrics (AAP) safe sleep recommendations, identify barriers to education, and explore strategies to improve education delivery in the acute care setting among pediatric emergency department (ED) clinicians and trainees.

Study design

We conducted a cross-sectional survey of pediatric ED clinicians and trainees at a tertiary care children's hospital. The survey assessed knowledge of AAP safe sleep recommendations, current counseling practices, perceived barriers, and suggested interventions. Descriptive statistics and stratified analyses were performed.

Results

Of 226 eligible clinicians and trainees, 182 responded (80.5%). Most were pediatric residents (47.5%) or nurses (33.9%). Knowledge was high (mean score: 5.5/6, standard deviation: 0.7), with no significant differences across roles or experience levels. Major barriers to counseling included time constraints (86.3%) and competing clinical priorities (77.6%), followed by language or cultural barriers (38.3%). Although 71.0% provided education when observing unsafe sleep practices, only 29.5% documented counseling. Clinician and trainees endorsed system-level supports such as multilingual resources (65.0%), provision of cribs or sleep sacks (56.3%), electronic medical record prompts (53.0%), and referral pathways for safe sleep resources (53.6%).

Conclusions

Although pediatric ED clinicians and trainees demonstrate strong knowledge of AAP recommendations, system-level barriers limit consistent counseling. Addressing these barriers represents a critical opportunity to reduce the heightened risk of sleep-related infant death during illness. Embedding safe sleep education into ED workflows may strengthen sudden unexpected infant death prevention efforts and reduce infant mortality.

目的：评估美国儿科学会（AAP）安全睡眠建议的知识，确定教育障碍，并探讨在儿科急诊科（ED）临床医生和培训生中改善急性护理环境教育的策略。研究设计：我们对一家三级儿童医院的儿科急诊科临床医生和实习生进行了横断面调查。该调查评估了美国儿科学会安全睡眠建议的知识、当前的咨询实践、感知到的障碍和建议的干预措施。进行描述性统计和分层分析。结果：226名符合条件的临床医生和培训生中，182人（80.5%）回应。大多数是儿科住院医师（47.5%）或护士（33.9%）。知识水平较高（平均得分5.5/6，标准差0.7），不同角色或经验水平之间无显著差异。咨询的主要障碍包括时间限制（86.3%）和临床优先事项竞争（77.6%），其次是语言或文化障碍（38.3%）。尽管71.0%的人在观察不安全睡眠习惯时提供了教育，但只有29.5%的人记录了咨询。临床医生和学员支持系统级支持，如多语言资源（65.0%）、提供婴儿床或睡袋（56.3%）、电子病历提示（53.0%）和安全睡眠资源转诊途径（53.6%）。结论：尽管儿科急诊科临床医生和受训者对AAP建议有很强的了解，但系统层面的障碍限制了咨询的一致性。解决这些障碍是降低疾病期间与睡眠有关的婴儿死亡风险的关键机会。将安全睡眠教育纳入ED工作流程可以加强sud预防工作并降低婴儿死亡率。

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引用次数: 0

Failure to Wean: Predictors and Adverse Outcomes Associated with Pediatric Postextubation Noninvasive Respiratory Support 断奶失败：与儿科拔管后无创呼吸支持相关的预测因素和不良后果。

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2026-03-01 Epub Date: 2025-12-10 DOI: 10.1016/j.jpeds.2025.114939

Samer Abu-Sultaneh MD, FAAP, FCCM , Colin M. Rogerson MD, MPH , Jeremy M. Loberger MD

Objectives

To describe postextubation noninvasive respiratory support (NRS) use, and its variation based on clinical variables and institution, to identify factors associated with failure to liberate from NRS ≤ 48 hours postextubation, and to explore the association between postextubation NRS use and patient-centered outcomes.

Study design

A retrospective cohort study of patients aged ≤ 18 years exposed to invasive mechanical ventilation (IMV) via endotracheal tube for ≥ 24 hours between January 1, 2013 and December 31, 2022, in the Virtual Pediatric Systems multicenter quality improvement database. Failure to liberate from NRS ≤ 48 hours postextubation was the primary outcome. Mixed-effects logistic regression models were developed for patient-centered outcomes.

Results

A total of 132,712 encounters from 158 institutions were included. High-flow nasal cannula was the most common NRS modality followed by bilevel positive airway pressure (BiPAP) and continuous positive airway pressure (CPAP) with rescue deployment more common than planned. Older age, later study year, high-risk primary diagnostic category, use of BiPAP or CPAP, and IMV duration ≥ 7 days were associated with higher odds of failure to liberate from NRS ≤ 48 hours. Patients who failed to be liberated from NRS ≤ 48 hours postextubation had longer NRS duration, longer intensive care unit and hospital lengths of stay, and higher pediatric intensive care unit all-cause mortality. Younger age, high-risk primary diagnostic category, use of rescue CPAP, use of planned as well as rescue BiPAP, and IMV duration ≥ 7 days were associated with higher odds of extubation failure ≤ 48 hours and 7 days.

Conclusions

Postextubation NRS use is highly prevalent and most commonly deployed as a rescue strategy. Failure to liberate from NRS ≤ 48 hours postextubation is associated with worse patient-centered outcomes. Optimizing the postextubation NRS deployment and titration is an important gap in need of research and quality improvement interventions which may lead to improved patients’ outcomes.

目的：描述拔管后无创呼吸支持（NRS）的使用及其基于临床变量和机构的变化，确定拔管后≤48小时未能摆脱NRS的相关因素，并探讨拔管后NRS使用与以患者为中心的结局之间的关系。研究设计：在2013年1月1日至2022年12月31日期间，在Virtual Pediatric Systems多中心质量改善数据库中，对≤18岁的患者进行回顾性队列研究，这些患者通过气管插管接受有创机械通气(IMV)≥24小时。拔管后≤48小时未从NRS中解脱是主要结局。为以患者为中心的结果建立了混合效应logistic回归模型。结果：共纳入来自158个机构的132,712次就诊。高流量鼻插管（HFNC）是最常见的NRS方式，其次是双水平气道正压（BiPAP）和持续气道正压（CPAP），救援部署比计划更常见。年龄较大、研究年份较晚、高危初级诊断类别、BiPAP或CPAP的使用以及IMV持续时间≥7天与NRS≤48小时未能解放的较高几率相关。拔管后≤48小时未能摆脱NRS的患者NRS持续时间更长，重症监护病房（ICU）和住院时间（LOS）更长，儿科ICU全因死亡率更高。年龄较小、高危主要诊断类别、使用抢救性CPAP、使用计划性和抢救性BiPAP、IMV持续时间≥7天与拔管失败的较高几率相关（≤48小时和7天）。结论：拔管后NRS的使用非常普遍，最常作为一种抢救策略。拔管后≤48小时未能摆脱NRS与较差的以患者为中心的结局相关。优化拔管后NRS的部署和滴定是研究和质量改善干预措施的重要空白，可能会改善患者的预后。

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引用次数: 0

Corrigendum to ‘Circadian Variability in Pediatric Arterial Ischemic Stroke’ The Journal of Pediatrics, Volume 289 (2026), 114875 《儿科杂志》289卷（2026），114875，“儿童动脉缺血性中风的昼夜变化”的勘误表

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2026-03-01 Epub Date: 2026-01-03 DOI: 10.1016/j.jpeds.2025.114936

Sarah Lee MD , Anirudh Sreekrishnan MD , Michael Mlynash MD, MS , Fernanda Balut MD , Rachel Pearson MD , Dana B. Harrar MD PhD , Sahar Hassanein MBBS, MSc, MD, PhD , Taryn L. Surtees MD , Janette Mailo MD PhD , Nomazulu Dlamini MD, MBBS, PhD

引用次数: 0

Children with Medical Complexity and Their Families: Addressing Social Risks and Advancing Integrated Care Models 儿童与医疗复杂性及其家庭：解决社会风险和推进综合护理模式。

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2026-03-01 Epub Date: 2025-12-11 DOI: 10.1016/j.jpeds.2025.114951

Maria Pastore MD , Tudor Lucian Pop MD , Esra Sevketoglu MD , Donjeta Bali MD , Ida Giardino MD , Mehmet Vural MD , Massimo Pettoello-Mantovani MD, PhD

引用次数: 0

Maternal and Paternal Impulsivity and Adolescent Epigenetic Age Acceleration 父母冲动与青春期表观遗传年龄加速。

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2026-03-01 Epub Date: 2025-12-12 DOI: 10.1016/j.jpeds.2025.114946

Michael V. Cataluna MS, Rachel A. Brown PhD, Kalsea J. Koss PhD

Objective

To test whether cumulative parental impulsivity exposure across childhood is associated with greater accelerated epigenetic age across adolescence.

Study design

Data were drawn from the Future of Families and Child Wellbeing Study, a population-based birth cohort (1998-2000) study of 4898 families across 20 major US cities. We analyzed data from families who provided self-reported survey data on maternal and paternal impulsivity when children were in early childhood (between the ages of 1 and 5 years); scores of parental impulsivity were created for each parent. Youth provided saliva samples to assess adolescent accelerated epigenetic age at ages 9 and 15 years old using 3 epigenetic clocks: PhenoAge, GrimAge, and DunedinPACE (n = 1971). Analyses jointly modeled the associations between maternal and paternal impulsivity during childhood and longitudinal change in accelerated epigenetic age using a latent variable constructed from these clocks in the structural equation modeling framework. We also conducted analyses using the individual clocks as the dependent variables. The autoregressive effect of age 9 accelerated epigenetic age was included to model residualized change from age 9 to 15.

Results

Maternal impulsivity during early childhood, but not paternal impulsivity, was significantly associated with greater residualized change in the latent factor of accelerated epigenetic age (β = 0.06, P = .03) at age 15 years. Maternal impulsivity was also associated with greater residualized change in accelerated aging using the individual clocks (GrimAge: β = 0.06, P < .001, PhenoAge: β = 0.04, P = .06, DunedinPACE: β = 0.05, P = .01).

Conclusions

Maternal impulsivity may constitute an environmental stressor that is correlated with greater accelerated epigenetic aging across adolescence. Variations in maternal impulsivity should be considered within the broader constellation of social and ecological factors as parental behavior may reflect adaptations to the broader contexts in which both parents and children reside.

目的：检验童年时期父母冲动暴露的累积是否与青春期表观遗传年龄的加速有关。研究设计：数据来自未来家庭和儿童福利研究，这是一项基于人口的出生队列研究（1998-2000），研究了美国20个主要城市的4898个家庭。我们分析了来自家庭的数据，这些家庭在儿童早期（1至5岁）提供了关于父母冲动的自我报告调查数据；每个父母都有冲动的分数。Youth提供唾液样本，使用三种表观遗传时钟：PhenoAge、GrimAge和DunedinPACE （n = 1971）来评估9岁和15岁的青少年加速表观遗传年龄。在结构方程建模框架中，使用由这些时钟构建的潜在变量，共同建模了童年时期母亲和父亲冲动与加速表观遗传年龄纵向变化之间的关联。我们还使用单个时钟作为因变量进行了分析。将9岁加速表观遗传年龄的自回归效应纳入9岁至15岁的残差变化模型。结果：母亲在儿童早期的冲动与15岁时表观遗传年龄加速潜在因素的残留变化显著相关，而父亲的冲动与此无关（ß= 0.06， P= 0.03）。使用个体时钟，母亲冲动也与加速衰老的更大残余变化相关（Grim Age: β= 0.06, p）。结论：母亲冲动可能构成一种环境压力源，与青春期加速的表观遗传衰老有关。母亲冲动的变化应该在更广泛的社会和生态因素中加以考虑，因为父母的行为可能反映了对父母和孩子所处的更广泛环境的适应。

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引用次数: 0

Neonatal Multimorbidity is a Poor Predictor of Health and Developmental Outcomes after Preterm Birth 新生儿多病是早产后健康和发育结局的不良预测因子。

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2026-03-01 Epub Date: 2025-12-12 DOI: 10.1016/j.jpeds.2025.114948

Jonathan S. Litt MD, MPH, ScD , Mandy B. Belfort MD, MPH , Erika M. Edwards PhD, MPH , Henning Tiemeier MD, PhD

Objective

To test and compare the capability of 3 multimorbidity-based models to predict outcomes in early childhood among infants born with extremely low birth weight (<1000 g, ELBW).

Study design

Participants included 8332 surviving ELBW infants born 2010-2020 in North America who contributed follow-up data at 24-months corrected age to the Vermont Oxford Network. Neonatal morbidities included bronchopulmonary dysplasia, grade 3-4 intraventricular hemorrhage, periventricular leukomalacia, stage 3-4 retinopathy of prematurity, late infection, necrotizing enterocolitis, and spontaneous intestinal perforation. Outcomes included: 1) developmental delay (Bayley score <70 in ≥1 domain), 2) rehospitalization, and 3) therapeutic service use. We compared 3 gestational age-adjusted risk models with the following predictors: 1) morbidity count, 2) count of 3 morbidities (bronchopulmonary dysplasia, intraventricular hemorrhage, and retinopathy of prematurity), and 3) multimorbidity-based latent classes.

Results

Thirty five percent of the study sample had ≥2 neonatal morbidities. Most (64%) received ≥2 therapeutic services, 36% were re-hospitalized, and 19% had developmental delay at 24-months. Morbidity counts and multimorbidity-based latent classes were associated with increased risk for poor 24-month outcomes compared with no morbidity. However, the predictive ability of all 3 models was modest (area under the receiver operating curve = 0.66).

Conclusions

Neonatal multimorbidity is common among ELBW infants and associated with later health and developmental outcomes. However, diagnosis-based multimorbidity risk models have poor prognostic ability. More robust characterization of multimorbidity symptom severity, physiologic impact, and environmental correlates may improve the clinical utility of future risk models.

目的：测试和比较三种基于多发病率的模型预测极低出生体重婴儿早期预后的能力(研究设计：参与者包括8332名2010-2020年在北美出生的存活的ELBW婴儿，他们在校正年龄24个月时向佛蒙特牛津网络提供随访数据。新生儿发病率包括：支气管肺发育不良（BPD）、3-4级脑室内出血（IVH）、脑室周围白质软化、3-4期早产儿视网膜病变（ROP）、晚期感染、坏死性小肠结肠炎和自发性肠穿孔。结果包括：1)发育迟缓（Bayley评分）结果：35%的研究样本有≥2种新生儿发病率。大多数（64%）接受了≥2种治疗服务，36%再次住院，19%在24个月时出现发育迟缓。与无发病相比，发病计数和基于多发病的潜在分类与24个月不良预后的风险增加相关。然而，这三种模型的预测能力一般（受试者工作曲线下面积=0.66）。结论：新生儿多病在低体重婴儿中很常见，并与后来的健康和发育结局有关。然而，基于诊断的多病风险模型预后能力较差。对多病症状严重程度、生理影响和环境相关因素的更强有力的描述可能会改善未来风险模型的临床应用。

{"title":"Neonatal Multimorbidity is a Poor Predictor of Health and Developmental Outcomes after Preterm Birth","authors":"Jonathan S. Litt MD, MPH, ScD , Mandy B. Belfort MD, MPH , Erika M. Edwards PhD, MPH , Henning Tiemeier MD, PhD","doi":"10.1016/j.jpeds.2025.114948","DOIUrl":"10.1016/j.jpeds.2025.114948","url":null,"abstract":"<div><h3>Objective</h3><div>To test and compare the capability of 3 multimorbidity-based models to predict outcomes in early childhood among infants born with extremely low birth weight (<1000 g, ELBW).</div></div><div><h3>Study design</h3><div>Participants included 8332 surviving ELBW infants born 2010-2020 in North America who contributed follow-up data at 24-months corrected age to the Vermont Oxford Network. Neonatal morbidities included bronchopulmonary dysplasia, grade 3-4 intraventricular hemorrhage, periventricular leukomalacia, stage 3-4 retinopathy of prematurity, late infection, necrotizing enterocolitis, and spontaneous intestinal perforation. Outcomes included: 1) developmental delay (Bayley score <70 in ≥1 domain), 2) rehospitalization, and 3) therapeutic service use. We compared 3 gestational age-adjusted risk models with the following predictors: 1) morbidity count, 2) count of 3 morbidities (bronchopulmonary dysplasia, intraventricular hemorrhage, and retinopathy of prematurity), and 3) multimorbidity-based latent classes.</div></div><div><h3>Results</h3><div>Thirty five percent of the study sample had ≥2 neonatal morbidities. Most (64%) received ≥2 therapeutic services, 36% were re-hospitalized, and 19% had developmental delay at 24-months. Morbidity counts and multimorbidity-based latent classes were associated with increased risk for poor 24-month outcomes compared with no morbidity. However, the predictive ability of all 3 models was modest (area under the receiver operating curve = 0.66).</div></div><div><h3>Conclusions</h3><div>Neonatal multimorbidity is common among ELBW infants and associated with later health and developmental outcomes. However, diagnosis-based multimorbidity risk models have poor prognostic ability. More robust characterization of multimorbidity symptom severity, physiologic impact, and environmental correlates may improve the clinical utility of future risk models.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"290 ","pages":"Article 114948"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145758290","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

Magnetic Resonance Imaging Reveals an Important Role for Brain Ischemia Across Injury Severity in Abusive Head Trauma in Infants and Young Children 创伤性脑损伤严重程度的脑缺血及其与虐待性头部创伤的关系。

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2026-03-01 Epub Date: 2025-11-19 DOI: 10.1016/j.jpeds.2025.114901

Caitlin R. McNamara MD , Sean Lee MD , Isha Atre MD , Rachel P. Berger MD, MPH , Ericka L. Fink MD, MS , Robert SB. Clark MD , Patrick M. Kochanek MD, MCCM , Subramanian Subramanian MD , Dennis W. Simon MD

Objective

To determine the prevalence and associations of ischemia with injury severity and discharge outcomes in pediatric traumatic brain injury (TBI).

Study design

All imaging interpretations (head computed tomography [CT] and brain magnetic resonance imaging [MRI]) during hospitalization were reviewed in a retrospective cohort of children aged < 3 years admitted with TBI to our pediatric intensive care unit from 2011-2024. Initial TBI severity was defined by presenting Glasgow Coma Scale score as mild 13-15, moderate 9-12, or severe 3-8. Impairment was defined as an increase in Functional Status Score > 1 (preinjury to discharge). Data analysis used nonparametric tests.

Results

Of 946 children, 560/946 (59%) had only head CT, 52/946 (5%) had only brain MRI, and 334/946 (35%) had both. Ischemia was identified in 107/946 (14%) children (95 by MRI and 12 by CT) with 56 (52%) and 13 (12%) children with severe and moderate TBI, respectively. In mild TBI, ischemia was present in 35/232 (15%) cases of abusive head trauma (AHT) vs only 3/479 (0.3%) children with accidental TBI (P < .001). Children with ischemia had more impairment at discharge (80/107 [75%] vs 121/839 [14%], P < .001).

Conclusions

Ischemia was associated with AHT and unfavorable outcomes. Ischemia in mild AHT suggests an unrecognized injury. Further work is needed to determine whether early MRI may be an important tool to detect ischemia and AHT.

目的：了解儿童创伤性脑损伤（TBI）中缺血的发生率及其与损伤严重程度和出院结局的关系。研究设计：回顾性分析儿童住院期间的所有影像学解释（头部计算机断层扫描[CT]和脑磁共振成像[MRI]） 1（损伤前至出院）。数据分析采用非参数检验。结果：946例患儿中，560/946[59%]只做头部CT检查，52/946[5%]只做脑部MRI检查，334 /946[35%]两者都做。107/946例（14%）患儿（MRI 95例，CT 12例）中发现缺血，重度和中度脑损伤患儿分别为56例（52%）和13例（12%）。在轻度脑损伤中，35/232例（15%）患儿出现脑缺血，而意外脑损伤患儿只有3/479例（0.3%）。结论：缺血与AHT和不良预后相关。轻度AHT的缺血提示存在未被识别的损伤。早期MRI是否可能是检测缺血和AHT的重要工具还需要进一步的研究。

{"title":"Magnetic Resonance Imaging Reveals an Important Role for Brain Ischemia Across Injury Severity in Abusive Head Trauma in Infants and Young Children","authors":"Caitlin R. McNamara MD , Sean Lee MD , Isha Atre MD , Rachel P. Berger MD, MPH , Ericka L. Fink MD, MS , Robert SB. Clark MD , Patrick M. Kochanek MD, MCCM , Subramanian Subramanian MD , Dennis W. Simon MD","doi":"10.1016/j.jpeds.2025.114901","DOIUrl":"10.1016/j.jpeds.2025.114901","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the prevalence and associations of ischemia with injury severity and discharge outcomes in pediatric traumatic brain injury (TBI).</div></div><div><h3>Study design</h3><div>All imaging interpretations (head computed tomography [CT] and brain magnetic resonance imaging [MRI]) during hospitalization were reviewed in a retrospective cohort of children aged < 3 years admitted with TBI to our pediatric intensive care unit from 2011-2024. Initial TBI severity was defined by presenting Glasgow Coma Scale score as mild 13-15, moderate 9-12, or severe 3-8. Impairment was defined as an increase in Functional Status Score > 1 (preinjury to discharge). Data analysis used nonparametric tests.</div></div><div><h3>Results</h3><div>Of 946 children, 560/946 (59%) had only head CT, 52/946 (5%) had only brain MRI, and 334/946 (35%) had both. Ischemia was identified in 107/946 (14%) children (95 by MRI and 12 by CT) with 56 (52%) and 13 (12%) children with severe and moderate TBI, respectively. In mild TBI, ischemia was present in 35/232 (15%) cases of abusive head trauma (AHT) vs only 3/479 (0.3%) children with accidental TBI (<em>P</em> < .001). Children with ischemia had more impairment at discharge (80/107 [75%] vs 121/839 [14%], <em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>Ischemia was associated with AHT and unfavorable outcomes. Ischemia in mild AHT suggests an unrecognized injury. Further work is needed to determine whether early MRI may be an important tool to detect ischemia and AHT.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"290 ","pages":"Article 114901"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145574967","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

Risk of Celiac Disease Before and After Nationwide Infant Rotavirus Vaccination: A Population-Based Study 全国婴儿轮状病毒疫苗接种前后乳糜泻的风险：一项基于人群的研究

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2026-03-01 Epub Date: 2025-12-10 DOI: 10.1016/j.jpeds.2025.114938

Maria Östman , Lars C. Stene PhD , German Tapia PhD , Laura Kivelä MD, PhD , Kalle Kurppa MD, PhD , Ketil Størdal MD, PhD , The Human Exposomic Determinants of Immune Mediated Diseases (HEDIMED) Investigator Group

Objective

To study the association between rotavirus vaccination and risk of celiac disease, which remains debated.

Study design

We conducted a nationwide register-based study including 740 744 children born during 2007-2019 from the Norwegian Birth Registry individually linked to the Norwegian Patient Registry for celiac disease diagnosis. With follow-up until 5 years of age, 2795 were diagnosed with celiac disease. The main analysis was an interrupted time series analysis to assess break in trend of celiac disease incidence before compared with after vaccine introduction in September 2014. Furthermore, we linked the cohort to the Norwegian Immunization Register and compared the risk of celiac disease between fully vaccinated and nonvaccinated children. In sensitivity analyses, we excluded children born 1 year before to 1 year after vaccine introduction to mitigate the effect of herd immunity.

Results

There was no significant break in trend after rotavirus vaccine introduction (P = .46). Hazard ratio (HR) of celiac disease was 0.96 (95% CI 0.89-1.04) if born after compared with before vaccination started, and 1.00 (95% CI 0.92-1.09) when excluding children born in 2013-2015. In fully vaccinated compared with nonvaccinated the HR was 0.99 (95% CI 0.92-1.07), consistent in robustness analyses. Including a requirement for gluten-free diet support in the celiac disease case definition gave similar results (HR 1.06, 95% CI 0.98-1.15).

Conclusions

This study did not find an association between rotavirus vaccine and the risk of early-onset celiac disease.

目的：研究轮状病毒疫苗接种与乳糜泻风险之间的关系，这一点仍有争议。研究设计：我们进行了一项全国性的基于登记的研究，包括2007-2019年出生的740,744名儿童，这些儿童来自挪威出生登记处，与挪威患者登记处的乳糜泻诊断相关联。随访至5岁2,795人被诊断为乳糜泻。主要分析是中断时间序列分析，以评估2014年9月引入疫苗前与引入疫苗后乳糜泻发病率趋势的中断。此外，我们将队列与挪威免疫登记联系起来，比较了完全接种疫苗和未接种疫苗的儿童患乳糜泻的风险。在敏感性分析中，我们排除了接种疫苗前1年至接种疫苗后1年出生的儿童，以减轻群体免疫的影响。结果：轮状病毒疫苗接种后，该趋势无明显中断（P=0.46）。与接种疫苗前相比，接种疫苗后出生的乳糜泻风险比（HR）为0.96 (95% CI 0.89-1.04)，排除2013-2015年出生的儿童时为1.00 （95% CI 0.92-1.09）。与未接种疫苗相比，完全接种疫苗的风险比为0.99 (95% CI 0.92-1.07)，与鲁棒性分析一致。在乳糜泻病例定义中包括对无谷蛋白饮食支持的要求也得到了类似的结果（HR 1.06, 95% C: 0.98-1.15）。结论：本研究未发现轮状病毒疫苗与早发性乳糜泻风险之间的关联。

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引用次数: 0

Predicting Failure of Ventricular Shunts in the Emergency Department: The SMaRT (Shunt Malfunction and Revision Triage) Score 在急诊科预测心室分流失败：SMaRT评分

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2026-03-01 Epub Date: 2025-12-20 DOI: 10.1016/j.jpeds.2025.114969

Kurt R. Lehner MD , Anita L. Kalluri BA , Kelly Jiang MS , Rama J. Alawneh MD , Ryan P. Lee MD , Foad Kazemi MD , Joan Yea MHS , Sai Chandan Reddy BS , Jacob Shaw BS , Ann Kane MD , Eric M. Jackson MD

Objective

To create a simple scoring system to stratify likelihood of shunt failure in the emergency department.

Study design

We conducted a retrospective cohort study of all children presenting to the pediatric emergency department with concern for ventricular shunt failure from 2017 to 2022. A separate dataset from 2022 to 2023 was used for validation. The main predictors of shunt revision were determined using univariate and multivariable regression models, and a scoring system utilizing the top predictors of ventricular shunt malfunction was created.

Results

There were 1167 neurosurgical consultations for shunt malfunction during the study period which resulted in 285 shunt revisions. Utilizing the 10 variables most associated with revision (increased ventricle size, abnormal shunt series, bradycardia, lethargy, altered mental status, vomiting, headache, shorter time interval from last shunt surgery, seizure, and the presence of upper respiratory symptoms), a SMaRT score was developed. For Shunt Malfunction and Revision Triage (SMaRT) score <4, we achieved a receiver-operating characteristic area under the curve of 0.87 with sensitivity of 0.93, specificity of 0.58, positive predictive value of 0.42, and negative predictive value of 0.96. This was confirmed in a separate validation set of 119 patients. A similar analysis excluding imaging data yielded a significant decrease in the discrimination of the scoring system, dropping the receiver-operating characteristic area under the curve to 0.71.

Conclusions

The SMaRT score provides a data-driven tool to determine the utility of a neurosurgical consult for shunt malfunction with a high negative predictive value for shunt malfunction in its lowest tier. Use of this tool has the potential to improve triage and resource utilization in the emergency department.

目的：建立一个简单的评分系统，对急诊科分流失败的可能性进行分层。研究设计：我们进行了一项回顾性队列研究，纳入了2017-2022年期间因心室分流衰竭就诊的所有儿童。使用2022-2023年的单独数据集进行验证。利用单变量和多变量回归模型确定分流管修复的主要预测因子，并利用心室分流管功能障碍的主要预测因子建立评分系统。结果：在研究期间，有1167例神经外科患者因分流管功能障碍就诊，其中285例进行了分流管修复。利用与改版最相关的10个变量（心室增大、分流术系列异常、心动过缓、嗜睡、精神状态改变、呕吐、头痛、离上次分流术时间间隔较短、癫痫发作和上呼吸道症状的存在），制定了SMaRT评分。结论：SMaRT评分提供了一个数据驱动的工具，以确定神经外科咨询对分流功能障碍的效用，其最低层次的分流功能障碍具有很高的负预测值。使用该工具有可能改善急诊科的分诊和资源利用。

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引用次数: 0

Prediction of Language Development in Neonates Born at Less than 32 Weeks of Gestation 妊娠32周以下新生儿语言发育的预测。

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2026-03-01 Epub Date: 2025-12-17 DOI: 10.1016/j.jpeds.2025.114959

Nadine Pointner MSc , Daniel Savran MD , Johannes Mader MSc , Philipp Steinbauer MD , Angelika Berger MD , Renate Fuiko PhD , David Steyrl PhD , Vito Giordano PhD

Objective

To evaluate neonatal risk factors and the predictive value of prior assessments for language development at age 3 in toddlers born before 32 weeks of gestation.

Study design

Data were acquired retrospectively from infants’ hospitalizations (level 3 perinatal center, Medical University of Vienna) and annual assessments (Bayley Scales of Infant and Toddler Development). We included children born in 2012-2020 at < 32 weeks of gestation, with annual follow-ups, at least one German-speaking parent, and unimpaired hearing. Predictors of 3-year language development were analyzed using Gradient Boost Decision Trees and interpreted through SHapely Additive exPlanations (SHAP) values.

Results

Conclusions

The identification of SHAP values allowed us to evaluate the additive effect of neonatal and sociodemographic risk factors predicting language impairments in this cohort of children born preterm. Replication in other cohorts will be important, but SHAP-based analyses may be useful for tailored monitoring and implementation of early language support.

{"title":"Prediction of Language Development in Neonates Born at Less than 32 Weeks of Gestation","authors":"Nadine Pointner MSc , Daniel Savran MD , Johannes Mader MSc , Philipp Steinbauer MD , Angelika Berger MD , Renate Fuiko PhD , David Steyrl PhD , Vito Giordano PhD","doi":"10.1016/j.jpeds.2025.114959","DOIUrl":"10.1016/j.jpeds.2025.114959","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate neonatal risk factors and the predictive value of prior assessments for language development at age 3 in toddlers born before 32 weeks of gestation.</div></div><div><h3>Study design</h3><div>Data were acquired retrospectively from infants’ hospitalizations (level 3 perinatal center, Medical University of Vienna) and annual assessments (Bayley Scales of Infant and Toddler Development). We included children born in 2012-2020 at < 32 weeks of gestation, with annual follow-ups, at least one German-speaking parent, and unimpaired hearing. Predictors of 3-year language development were analyzed using Gradient Boost Decision Trees and interpreted through SHapely Additive exPlanations (SHAP) values.</div></div><div><h3>Results</h3><div>The cohort comprised 476 children (202 [42.4%] females; mean [standard deviation] gestational age, 27.4 [2.0] weeks). Risk factors were multilingualism (mean|SHAP| = 3.93, <em>P</em> ≤ .001), lower maternal education (mean|SHAP| = 2.51, <em>P</em> ≤ .001), reduced birth weight (mean|SHAP| = 1.92, <em>P</em> = .003), shorter gestational age (mean|SHAP| = 1.64, <em>P</em> = .009), grade of intraventricular hemorrhage in the left hemisphere (mean|SHAP| = 1.07, <em>P</em> = .005), severe intraventricular hemorrhage (mean|SHAP| = 0.80, <em>P</em> = .011, surgical necrotizing enterocolitis (mean|SHAP| = 0.80, <em>P</em> = .018), and surgical retinopathy of prematurity (mean|SHAP| = 0.59, <em>P</em> = .045).</div></div><div><h3>Conclusions</h3><div>The identification of SHAP values allowed us to evaluate the additive effect of neonatal and sociodemographic risk factors predicting language impairments in this cohort of children born preterm. Replication in other cohorts will be important, but SHAP-based analyses may be useful for tailored monitoring and implementation of early language support.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"290 ","pages":"Article 114959"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795340","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