Pub Date : 2024-11-02DOI: 10.1016/j.jpeds.2024.114385
Wendy M. Brunner PhD , Zhuang Han MS , Sharon Tennyson PhD , Peter C. Fiduccia PhD, MBA, MPA , Nicole Krupa BS , Chris Kjolhede MD, MPH
Objective
To test the hypothesis that students with asthma who have access to school-based health centers (SBHCs) receive more recommended preventive care and use less emergency care, we compared patterns of health care utilization among rural students with asthma by SBHC access.
Study design
Using a cross-sectional design, we analyzed encounters for all patients ages 4 through 19 living in 4 counties covered by a health care system that sponsors a network of SBHCs in rural upstate New York. Patient addresses for each encounter were geocoded to school districts, allowing us to determine whether students lived in districts with (n = 15) or without (n = 23) a SBHC. We measured utilization among students with asthma in 2016 and 2017, comparing measures by SBHC access. Students with asthma were identified using International Classification of Diseases diagnosis codes from visits in the 2 calendar years prior to each analysis year.
Results
Students in districts with SBHCs had greater odds of 2 or more asthma-related office visits (odds ratio [OR] = 2.23; 95% CI: 1.66-2.99) and 1 or more well-child visits (OR = 1.24; 95% CI: 1.03-1.50) than their peers in districts without SBHCs. Students in districts with SBHCs had lower odds of a respiratory-related convenient care or emergency department visit (OR = 0.45; 95% CI: 0.30-0.67). Across outcomes, differences were greatest when comparing students who utilized the SBHC in their district with students in districts who did not have access to a SBHC.
Conclusions
Rural students with asthma who have access to SBHCs have greater opportunities for preventive asthma care per national guidelines and use emergency departments and convenient care less.
{"title":"Impact of Rural School-Based Health Centers on Asthma Management","authors":"Wendy M. Brunner PhD , Zhuang Han MS , Sharon Tennyson PhD , Peter C. Fiduccia PhD, MBA, MPA , Nicole Krupa BS , Chris Kjolhede MD, MPH","doi":"10.1016/j.jpeds.2024.114385","DOIUrl":"10.1016/j.jpeds.2024.114385","url":null,"abstract":"<div><h3>Objective</h3><div>To test the hypothesis that students with asthma who have access to school-based health centers (SBHCs) receive more recommended preventive care and use less emergency care, we compared patterns of health care utilization among rural students with asthma by SBHC access.</div></div><div><h3>Study design</h3><div>Using a cross-sectional design, we analyzed encounters for all patients ages 4 through 19 living in 4 counties covered by a health care system that sponsors a network of SBHCs in rural upstate New York. Patient addresses for each encounter were geocoded to school districts, allowing us to determine whether students lived in districts with (n = 15) or without (n = 23) a SBHC. We measured utilization among students with asthma in 2016 and 2017, comparing measures by SBHC access. Students with asthma were identified using International Classification of Diseases diagnosis codes from visits in the 2 calendar years prior to each analysis year.</div></div><div><h3>Results</h3><div>Students in districts with SBHCs had greater odds of 2 or more asthma-related office visits (odds ratio [OR] = 2.23; 95% CI: 1.66-2.99) and 1 or more well-child visits (OR = 1.24; 95% CI: 1.03-1.50) than their peers in districts without SBHCs. Students in districts with SBHCs had lower odds of a respiratory-related convenient care or emergency department visit (OR = 0.45; 95% CI: 0.30-0.67). Across outcomes, differences were greatest when comparing students who utilized the SBHC in their district with students in districts who did not have access to a SBHC.</div></div><div><h3>Conclusions</h3><div>Rural students with asthma who have access to SBHCs have greater opportunities for preventive asthma care per national guidelines and use emergency departments and convenient care less.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114385"},"PeriodicalIF":3.9,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570369","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 : 2024-11-01DOI: 10.1016/j.jpeds.2024.114383
Haihao Sun MD, PhD , Norman Stockbridge MD, PhD , D. Dunbar Ivy MD , Jennifer Clark PhD , Angela Bates MD , Stephanie S. Handler MD , Usha S. Krishnan MD , Mary P. Mullen MD, PhD , Delphine Yung MD , Rachel K. Hopper MD , Nidhy P. Varghese MD , Catherine M. Avitabile MD , Jeff Fineman MD , Eric D. Austin MD , Grace Freire MD
Objective
To investigate the feasibility of using actigraphy to measure physical activity (pA) and heart rate variability (HRV) as study endpoints in pediatric pulmonary arterial hypertension (PAH) and to compare their performance to 6-minute-walk distance (6MWD), a common primary endpoint used in PAH clinical trials in adults and children who can walk and understand the test process.
Study design
We conducted a prospective, multicenter, noninterventional study in pediatric PAH patients and healthy children. Actiheart and Fitbit Charge 2 recorded pA and heart rate data. HRV was defined as SD of daily heart rate. Actigraphy pA and HRV and 6MWD from the same subjects were analyzed to compare children with PAH with controls, and Panama functional classification (FC) III vs II. Power/sample size simulations were conducted to detect hypothetical treatment effect equivalent to differences seen between FC III and FC II.
Results
We enrolled 116 children: 90 and 98 adhered with Actiheart and Fitbit, respectively. Actigraphy daily pA was ∼36% lower (P < .05) and daily HRV was ∼18% lower (P < .05) in children with PAH (n = 62) than healthy controls (n = 54). Daily pA and daily HRV trended ∼17% lower in FC III than FC II, whereas 6MWD showed little difference. Simulation at 80% power showed that pA required 175 subjects per group and HRV required 40 per group to detect the difference/effect, whereas 6MWD required over our maximum sample size of 200.
Conclusions
Actigraphy is a feasible measure in pediatric PAH. Compared with 6MWD, pA and HRV may be more sensitive in differentiating Panama FC III from II. HRV may improve actigraphy's utility in pediatric PAH.
目的研究设计：我们对小儿肺动脉高压（PAH）患者和健康儿童进行了前瞻性多中心非介入性研究：我们对小儿 PAH 患者和健康儿童进行了一项前瞻性、多中心、非干预性研究。Actiheart™ 和 Fitbit Charge 2™ 记录了 pA 和心率 (HR) 数据。心率变异定义为每日心率的标准偏差。对同一受试者的动图 pA 和 HRV 以及 6MWD 进行了分析，以比较 PAH 儿童和对照组，以及巴拿马功能分类 (FC) III 和 II。进行了功率/样本大小模拟，以检测相当于 FC III 和 FC II 之间差异的假定治疗效果：我们招募了 116 名儿童，其中分别有 90 名和 98 名儿童坚持使用 Actiheart 和 Fitbit。Actigraphy每日pA降低了36%（PC结论：Actigraphy是一种可行的治疗方法：在小儿 PAH 中，Actigraphy 是一种可行的测量方法。与 6MWD 相比，pA 和 HRV 在区分巴拿马 FC III 和 II 方面可能更敏感。心率变异可提高动图在小儿 PAH 中的实用性。
{"title":"Actigraphy Study Endpoints to Reduce Sample Size and Facilitate Drug Development for Pediatric Pulmonary Arterial Hypertension","authors":"Haihao Sun MD, PhD , Norman Stockbridge MD, PhD , D. Dunbar Ivy MD , Jennifer Clark PhD , Angela Bates MD , Stephanie S. Handler MD , Usha S. Krishnan MD , Mary P. Mullen MD, PhD , Delphine Yung MD , Rachel K. Hopper MD , Nidhy P. Varghese MD , Catherine M. Avitabile MD , Jeff Fineman MD , Eric D. Austin MD , Grace Freire MD","doi":"10.1016/j.jpeds.2024.114383","DOIUrl":"10.1016/j.jpeds.2024.114383","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the feasibility of using actigraphy to measure physical activity (pA) and heart rate variability (HRV) as study endpoints in pediatric pulmonary arterial hypertension (PAH) and to compare their performance to 6-minute-walk distance (6MWD), a common primary endpoint used in PAH clinical trials in adults and children who can walk and understand the test process.</div></div><div><h3>Study design</h3><div>We conducted a prospective, multicenter, noninterventional study in pediatric PAH patients and healthy children. Actiheart and Fitbit Charge 2 recorded pA and heart rate data. HRV was defined as SD of daily heart rate. Actigraphy pA and HRV and 6MWD from the same subjects were analyzed to compare children with PAH with controls, and Panama functional classification (FC) III vs II. Power/sample size simulations were conducted to detect hypothetical treatment effect equivalent to differences seen between FC III and FC II.</div></div><div><h3>Results</h3><div>We enrolled 116 children: 90 and 98 adhered with Actiheart and Fitbit, respectively. Actigraphy daily pA was ∼36% lower (<em>P</em> < .05) and daily HRV was ∼18% lower (<em>P</em> < .05) in children with PAH (n = 62) than healthy controls (n = 54). Daily pA and daily HRV trended ∼17% lower in FC III than FC II, whereas 6MWD showed little difference. Simulation at 80% power showed that pA required 175 subjects per group and HRV required 40 per group to detect the difference/effect, whereas 6MWD required over our maximum sample size of 200.</div></div><div><h3>Conclusions</h3><div>Actigraphy is a feasible measure in pediatric PAH. Compared with 6MWD, pA and HRV may be more sensitive in differentiating Panama FC III from II. HRV may improve actigraphy's utility in pediatric PAH.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114383"},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570368","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 : 2024-11-01DOI: 10.1016/j.jpeds.2024.114386
Shawn R. Eagle PhD, ATC , Aaron J. Zynda PhD , Lindsey Sandulli BSN, RN , Robert W. Hickey MD , Nathan E. Kegel PhD , Lindsay Nelson PhD , Michael McCrea PhD , Michael W. Collins PhD , David O. Okonkwo MD, PhD , Danny G. Thomas MD, MPH , Anthony P. Kontos PhD
Objective
To determine the step count and self-reported activity levels for obese and nonobese pediatric patients following concussion and predict self-reported symptoms, quality of life, and psychological health over time.
Study design
Participants completed the Post-Concussion Symptom Scale (PCSS), Pediatric Quality of Life (PedsQL), and Behavioral Symptom Inventory-18 (BSI-18) at an initial visit (<72 hours), 3-5 days postinjury, 10-18 days postinjury, and 1 and 2 months postinjury. Physical activity data (eg, step count) were collected via a commercial actigraph. Participants were categorized into obese and nonobese body mass index (BMI) groups based on age- and sex-adjusted growth standards. Mann-Whitney U tests compared groups while nonparametric series regression models examined the effect of obese BMI and average daily step count on PCSS, PedsQL, and BSI-18 outcomes at 1 and 2 months postinjury.
Results
One hundred ninety-four participants were included: 153 (78.9%; M = 14.6 ± 2.4 years; 50% female) in the nonobese group and 41 (21.1%; M = 14.2 ± 2.0 years; 44% female) in the obese group. The obese group had a 22.8% lower average daily step count in the week postinjury (P = .02). At 2 months, there was a significant association between obese BMI and worse PCSS total score (P = .042), PedsQL (P = .017), and BSI-18 anxiety (P = .046). Average daily step count in the first week postinjury was associated with a higher PCSS total score at 2 months (P = .031).
Conclusions
Pediatric patients following concussion with an obese BMI had a lower daily average step count in the week after injury and exhibited worse concussion symptoms, quality of life, and anxiety at 2 months compared with those with a nonobese BMI.
Trial registration
Active Injury Management (AIM) after Pediatric Concussion: NCT03869970
{"title":"The Role of Body Mass Index on Physical Activity, Symptoms, and Related Outcomes Following Pediatric Concussion","authors":"Shawn R. Eagle PhD, ATC , Aaron J. Zynda PhD , Lindsey Sandulli BSN, RN , Robert W. Hickey MD , Nathan E. Kegel PhD , Lindsay Nelson PhD , Michael McCrea PhD , Michael W. Collins PhD , David O. Okonkwo MD, PhD , Danny G. Thomas MD, MPH , Anthony P. Kontos PhD","doi":"10.1016/j.jpeds.2024.114386","DOIUrl":"10.1016/j.jpeds.2024.114386","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the step count and self-reported activity levels for obese and nonobese pediatric patients following concussion and predict self-reported symptoms, quality of life, and psychological health over time.</div></div><div><h3>Study design</h3><div>Participants completed the Post-Concussion Symptom Scale (PCSS), Pediatric Quality of Life (PedsQL), and Behavioral Symptom Inventory-18 (BSI-18) at an initial visit (<72 hours), 3-5 days postinjury, 10-18 days postinjury, and 1 and 2 months postinjury. Physical activity data (eg, step count) were collected via a commercial actigraph. Participants were categorized into obese and nonobese body mass index (BMI) groups based on age- and sex-adjusted growth standards. Mann-Whitney <em>U</em> tests compared groups while nonparametric series regression models examined the effect of obese BMI and average daily step count on PCSS, PedsQL, and BSI-18 outcomes at 1 and 2 months postinjury.</div></div><div><h3>Results</h3><div>One hundred ninety-four participants were included: 153 (78.9%; M = 14.6 ± 2.4 years; 50% female) in the nonobese group and 41 (21.1%; M = 14.2 ± 2.0 years; 44% female) in the obese group. The obese group had a 22.8% lower average daily step count in the week postinjury (<em>P</em> = .02). At 2 months, there was a significant association between obese BMI and worse PCSS total score (<em>P</em> = .042), PedsQL (<em>P</em> = .017), and BSI-18 anxiety (<em>P</em> = .046). Average daily step count in the first week postinjury was associated with a higher PCSS total score at 2 months (<em>P</em> = .031).</div></div><div><h3>Conclusions</h3><div>Pediatric patients following concussion with an obese BMI had a lower daily average step count in the week after injury and exhibited worse concussion symptoms, quality of life, and anxiety at 2 months compared with those with a nonobese BMI.</div></div><div><h3>Trial registration</h3><div>Active Injury Management (AIM) after Pediatric Concussion: NCT03869970</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114386"},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570370","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 : 2024-10-30DOI: 10.1016/j.jpeds.2024.114376
J. Wells Logan MD , Xiaodan Tang PhD , Rachel G. Greenberg MD , Brian Smith MD , Lisa Jacobson ScD , Courtney K. Blackwell PhD , Mark Hudak MD , Judy L. Aschner MD , Barry Lester PhD , T. Michael O'Shea MD
Objectives
To evaluate positive health outcomes among children born at < 32 weeks of gestation and to determine whether children with three common neonatal morbidities and 2 neurodevelopmental impairments would have similar positive health outcomes to children and adolescents without these exposures and impairments.
Study design
In this secondary analysis of prospectively acquired data derived from 3 multicenter cohorts of children born very preterm (the Extremely Low Gestational Age Newborn cohort [birth years 2001 to 2004], the Neurobehavior And Outcomes in Very Preterm Infants cohort [birth years 2014 to 2016], and the Developmental Impact of Neurobehavior And Outcomes in Very Preterm Infants Exposures cohort [birth years 2010 to 2020]), we examined associations between the 3 common neonatal morbidities (bronchopulmonary dysplasia, necrotizing enterocolitis, and intraventricular hemorrhage, diagnosed before hospital discharge), 2 neurodevelopmental impairments (developmental delays and cerebral palsy, diagnosed at preschool age follow-up), and perceptions of physical, mental, and social well-being (in either early childhood or adolescence), using the Patient-Reported Outcomes Measurement Information System scales for positive health.
Results
After adjusting for confounders, bronchopulmonary dysplasia, intraventricular hemorrhage, and cerebral palsy were associated with lower positive health scores, reported by parent-proxy during early childhood. None of the exposures or impairments were associated with lower positive health scores at adolescence, reported by the children themselves.
Conclusion
Parents of children born very preterm with bronchopulmonary dysplasia, intraventricular hemorrhage, or cerebral palsy rated their children's positive health lower than did parents of children without these morbidities. However, adolescents' own reports of positive health outcomes were not associated with either neonatal pre-discharge morbidities or preschool neurodevelopmental impairments.
{"title":"Neonatal Morbidities, Neurodevelopmental Impairments, and Positive Health among Children Surviving Birth before 32 Weeks of Gestation","authors":"J. Wells Logan MD , Xiaodan Tang PhD , Rachel G. Greenberg MD , Brian Smith MD , Lisa Jacobson ScD , Courtney K. Blackwell PhD , Mark Hudak MD , Judy L. Aschner MD , Barry Lester PhD , T. Michael O'Shea MD","doi":"10.1016/j.jpeds.2024.114376","DOIUrl":"10.1016/j.jpeds.2024.114376","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate positive health outcomes among children born at < 32 weeks of gestation and to determine whether children with three common neonatal morbidities and 2 neurodevelopmental impairments would have similar positive health outcomes to children and adolescents without these exposures and impairments.</div></div><div><h3>Study design</h3><div>In this secondary analysis of prospectively acquired data derived from 3 multicenter cohorts of children born very preterm (the Extremely Low Gestational Age Newborn cohort [birth years 2001 to 2004], the Neurobehavior And Outcomes in Very Preterm Infants cohort [birth years 2014 to 2016], and the Developmental Impact of Neurobehavior And Outcomes in Very Preterm Infants Exposures cohort [birth years 2010 to 2020]), we examined associations between the 3 common neonatal morbidities (bronchopulmonary dysplasia, necrotizing enterocolitis, and intraventricular hemorrhage, diagnosed before hospital discharge), 2 neurodevelopmental impairments (developmental delays and cerebral palsy, diagnosed at preschool age follow-up), and perceptions of physical, mental, and social well-being (in either early childhood or adolescence), using the Patient-Reported Outcomes Measurement Information System scales for positive health.</div></div><div><h3>Results</h3><div>After adjusting for confounders, bronchopulmonary dysplasia, intraventricular hemorrhage, and cerebral palsy were associated with lower positive health scores, reported by parent-proxy during early childhood. None of the exposures or impairments were associated with lower positive health scores at adolescence, reported by the children themselves.</div></div><div><h3>Conclusion</h3><div>Parents of children born very preterm with bronchopulmonary dysplasia, intraventricular hemorrhage, or cerebral palsy rated their children's positive health lower than did parents of children without these morbidities. However, adolescents' own reports of positive health outcomes were not associated with either neonatal pre-discharge morbidities or preschool neurodevelopmental impairments.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114376"},"PeriodicalIF":3.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559479","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 : 2024-10-29DOI: 10.1016/j.jpeds.2024.114382
Mengyi Zha MD, Delaney D. Ding BS
{"title":"Erythrasma with Id Reaction in a Healthy 13-Year-Old Boy","authors":"Mengyi Zha MD, Delaney D. Ding BS","doi":"10.1016/j.jpeds.2024.114382","DOIUrl":"10.1016/j.jpeds.2024.114382","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114382"},"PeriodicalIF":3.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559478","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 : 2024-10-29DOI: 10.1016/j.jpeds.2024.114381
Roslyn N. Boyd MSc PT, PhD , Susan Greaves BSc OT, PhD , Jenny Ziviani BSc OT, PhD , Iona Novak BSc OT, PhD , Nadia Badawi MD, PhD , Kerstin Pannek PhD , Catherine Elliott BSc OT, PhD , Margaret Wallen BSc OT, PhD , Catherine Morgan BSc PT, PhD , Jane Valentine MD, PhD , Lisa Findlay BSc OT , Andrea Guzzetta MD, PhD , Koa Whittingham PhD , Robert S. Ware PhD , Simona Fiori MD, PhD , Nathalie L. Maitre MD, PhD , Jill Heathcock PhD PT , Kimberley Scott PhD PT , Ann-Christin Eliasson BSc OT, PhD , Leanne Sakzewski BSc OT, PhD
Objective
To compare efficacy of constraint-induced movement therapy (Baby-CIMT) with bimanual therapy (Baby-BIM) in infants at high risk of unilateral cerebral palsy.
Study design
This was a single-blind, randomized-comparison-trial that had the following inclusion criteria: (1) asymmetric brain lesion (2) absent fidgety General Movements, (3) Hammersmith Infant Neurological Examination below cerebral palsy cut-points, (4) entry at 3-9 months of corrected age, and (5) >3-point difference between hands on Hand Assessment Infants (HAI). Infants were randomized to Baby-CIMT or Baby-BIM, which comprised 6-9 months of home-based intervention. Daily dose varied from 20 to 40 minutes according to age (total 70-89.2 hours). Primary outcome measure was the HAI after intervention, with secondary outcomes Mini-Assisting Hand Assessment and Bayley III cognition at 24 months of corrected age.
Results
In total, 96 infants (51 male, 52 right hemiplegia) born median at 37-weeks of gestation were randomized to Baby-CIMT (n = 46) or Baby-BIM (n = 50) and commenced intervention at a mean 6.5 (SD 1.6) months corrected age. There were no between group differences immediately after intervention on HAI (mean difference [MD] 0.98 HAI units, 95% CI 0.94-2.91; P = .31). Both groups demonstrated significant clinically important improvements from baseline to after intervention (Baby-BIM MD 3.48, 95% CI 2.09-4.87; Baby-CIMT MD 4.42, 95% CI 3.07-5.77). At 24 months, 64 infants were diagnosed with unilateral cerebral palsy (35 Baby-CIMT, 29 Baby-BIM). Infants who entered the study between 3 and 6 months of corrected age had greater change in HAI Both Hands Sum Score compared with those who entered at ≥6 months of corrected age (MD 7.17, 95% CI 2.93-11.41, P = .001).
Conclusions
Baby-CIMT was not superior to Baby-BIM, and both interventions improved hand development. Infants commencing intervention at <6 months corrected age had greater improvements in hand function.
{"title":"Randomized Comparison Trial of Rehabilitation Very Early for Infants with Congenital Hemiplegia","authors":"Roslyn N. Boyd MSc PT, PhD , Susan Greaves BSc OT, PhD , Jenny Ziviani BSc OT, PhD , Iona Novak BSc OT, PhD , Nadia Badawi MD, PhD , Kerstin Pannek PhD , Catherine Elliott BSc OT, PhD , Margaret Wallen BSc OT, PhD , Catherine Morgan BSc PT, PhD , Jane Valentine MD, PhD , Lisa Findlay BSc OT , Andrea Guzzetta MD, PhD , Koa Whittingham PhD , Robert S. Ware PhD , Simona Fiori MD, PhD , Nathalie L. Maitre MD, PhD , Jill Heathcock PhD PT , Kimberley Scott PhD PT , Ann-Christin Eliasson BSc OT, PhD , Leanne Sakzewski BSc OT, PhD","doi":"10.1016/j.jpeds.2024.114381","DOIUrl":"10.1016/j.jpeds.2024.114381","url":null,"abstract":"<div><h3>Objective</h3><div>To compare efficacy of constraint-induced movement therapy (Baby-CIMT) with bimanual therapy (Baby-BIM) in infants at high risk of unilateral cerebral palsy.</div></div><div><h3>Study design</h3><div>This was a single-blind, randomized-comparison-trial that had the following inclusion criteria: (1) asymmetric brain lesion (2) absent fidgety General Movements, (3) Hammersmith Infant Neurological Examination below cerebral palsy cut-points, (4) entry at 3-9 months of corrected age, and (5) >3-point difference between hands on Hand Assessment Infants (HAI). Infants were randomized to Baby-CIMT or Baby-BIM, which comprised 6-9 months of home-based intervention. Daily dose varied from 20 to 40 minutes according to age (total 70-89.2 hours). Primary outcome measure was the HAI after intervention, with secondary outcomes Mini-Assisting Hand Assessment and Bayley III cognition at 24 months of corrected age.</div></div><div><h3>Results</h3><div>In total, 96 infants (51 male, 52 right hemiplegia) born median at 37-weeks of gestation were randomized to Baby-CIMT (n = 46) or Baby-BIM (n = 50) and commenced intervention at a mean 6.5 (SD 1.6) months corrected age. There were no between group differences immediately after intervention on HAI (mean difference [MD] 0.98 HAI units, 95% CI 0.94-2.91; <em>P</em> = .31). Both groups demonstrated significant clinically important improvements from baseline to after intervention (Baby-BIM MD 3.48, 95% CI 2.09-4.87; Baby-CIMT MD 4.42, 95% CI 3.07-5.77). At 24 months, 64 infants were diagnosed with unilateral cerebral palsy (35 Baby-CIMT, 29 Baby-BIM). Infants who entered the study between 3 and 6 months of corrected age had greater change in HAI Both Hands Sum Score compared with those who entered at ≥6 months of corrected age (MD 7.17, 95% CI 2.93-11.41, <em>P</em> = .001).</div></div><div><h3>Conclusions</h3><div>Baby-CIMT was not superior to Baby-BIM, and both interventions improved hand development. Infants commencing intervention at <6 months corrected age had greater improvements in hand function.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114381"},"PeriodicalIF":3.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548994","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 : 2024-10-28DOI: 10.1016/j.jpeds.2024.114380
Tandy Aye, David A Turner, Angela S Czaja, Cynthia M Holland-Hall, Mary E Moffatt, Patrick J Myers, Jill J Fussell
{"title":"Subspecialty Perspectives on the Education Needs for Pediatrics Residency Training.","authors":"Tandy Aye, David A Turner, Angela S Czaja, Cynthia M Holland-Hall, Mary E Moffatt, Patrick J Myers, Jill J Fussell","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":" ","pages":"114380"},"PeriodicalIF":3.9,"publicationDate":"2024-10-28","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 : 2024-10-23DOI: 10.1016/j.jpeds.2024.114378
Mattina A. Davenport PhD , Steven Berkley PhD , Shameka R. Phillips PhD , Rose Y. Hardy PhD , Andreas Teferra PhD , Kierra S. Barnett PhD , Kelly Kelleher MD , Deena J. Chisolm PhD
Objective
To examine the association between caregiver-report of their child's inadequate sleep and exposure to interpersonal racism within racially minoritized subpopulations.
Study design
We conducted cross-sectional analysis among racially minoritized 21 924 school-aged children and 27 142 adolescents using a National Survey of Children's Health sample from 2016 through 2021. Multivariable logistic regression models were fit to estimate predicted probabilities for the adjusted associations between caregiver-report of their child's inadequate sleep and prior exposure to interpersonal racism.
Results
In bivariate models, caregiver report of child exposure to interpersonal racism was significantly associated with a higher probability of inadequate sleep within non-Hispanic Asian American/Pacific Islander school-aged children, Hispanic adolescents, and non-Hispanic multiracial adolescents. After adjusting for covariates, only the association within Hispanic youth remained significant though attenuated. Unexpectedly, non-Hispanic Black school-age children exposed to racism had a lower probability of inadequate sleep than non-Hispanic Black children without exposure to racism after adjusting for covariates.
Conclusions
Nationally representative pooled data that showed caregiver-report of Hispanic adolescents’ inadequate sleep was associated with their exposure to interpersonal racism, although an association with inadequate sleep was not found in other racially minoritized subpopulations. Examining within-race associations helps to assess more accurately risk and target efforts that seek to address racism-related stress among racially minoritized subpopulations.
{"title":"Association of Exposure to Interpersonal Racism and Racial Disparities in Inadequate Sleep Risk","authors":"Mattina A. Davenport PhD , Steven Berkley PhD , Shameka R. Phillips PhD , Rose Y. Hardy PhD , Andreas Teferra PhD , Kierra S. Barnett PhD , Kelly Kelleher MD , Deena J. Chisolm PhD","doi":"10.1016/j.jpeds.2024.114378","DOIUrl":"10.1016/j.jpeds.2024.114378","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the association between caregiver-report of their child's inadequate sleep and exposure to interpersonal racism within racially minoritized subpopulations.</div></div><div><h3>Study design</h3><div>We conducted cross-sectional analysis among racially minoritized 21 924 school-aged children and 27 142 adolescents using a National Survey of Children's Health sample from 2016 through 2021. Multivariable logistic regression models were fit to estimate predicted probabilities for the adjusted associations between caregiver-report of their child's inadequate sleep and prior exposure to interpersonal racism.</div></div><div><h3>Results</h3><div>In bivariate models, caregiver report of child exposure to interpersonal racism was significantly associated with a higher probability of inadequate sleep within non-Hispanic Asian American/Pacific Islander school-aged children, Hispanic adolescents, and non-Hispanic multiracial adolescents. After adjusting for covariates, only the association within Hispanic youth remained significant though attenuated. Unexpectedly, non-Hispanic Black school-age children exposed to racism had a lower probability of inadequate sleep than non-Hispanic Black children without exposure to racism after adjusting for covariates.</div></div><div><h3>Conclusions</h3><div>Nationally representative pooled data that showed caregiver-report of Hispanic adolescents’ inadequate sleep was associated with their exposure to interpersonal racism, although an association with inadequate sleep was not found in other racially minoritized subpopulations. Examining within-race associations helps to assess more accurately risk and target efforts that seek to address racism-related stress among racially minoritized subpopulations.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"276 ","pages":"Article 114378"},"PeriodicalIF":3.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513183","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 : 2024-10-23DOI: 10.1016/j.jpeds.2024.114379
Kylie M. Bushroe MD , Mary C. Politi PhD , Isabella Zaniletti PhD , Michael A. Padula MD, MBI , Theresa R. Grover MD, MAS , Matthew J. Kielt MD , Joanne M. Lagatta MD , Karna Murthy MD, MSc , Rakesh Rao MD
Objective
To estimate the association of ZIP code-level social determinants of health (SDoH), specifically household income, education level, and unemployment rate, with postmenstrual age (PMA) at tracheostomy placement in patients with severe bronchopulmonary dysplasia.
Study design
This was a retrospective observational study of infants born <32 weeks' gestation and discharged from a Children's Hospitals Neonatal Consortium newborn intensive care unit. Patients were diagnosed with severe bronchopulmonary dysplasia and received tracheostomies before discharge. Maternal ZIP code at admission was linked to that ZIP code's SDoH via the 2021 US Census Bureau 5-year data. Unadjusted and adjusted analyses were completed with separate models fit for each SDoH marker.
Results
There were 877 patients who received tracheostomies at a median of 48 weeks PMA (IQR, 44-53 weeks PMA). In multivariable models, patients in the highest education groups received tracheostomies earlier (OR, 0.972; 95% CI, 0.947-0.997; P = .031), and non-Hispanic Black patients received tracheostomies later compared with non-Hispanic White patients (OR, 1.026; 95% CI, 1.005-1.048; P = .017). For household income and unemployment, the PMA at tracheostomy did not differ by SDoH or race. For all 3 models, male sex, small for gestation status, and later PMA at admission were associated with later PMA at tracheostomy. For each SDoH marker, significant intercenter variation was noted; several centers had independently increased PMA at tracheostomy.
Conclusions
Education at the ZIP code level influenced PMA at tracheostomy after adjusting for patient and clinical factors. Adjusted for each SDoH studied, significant differences were noted among centers. Factors leading to the decision and timing of neonatal tracheostomy need further evaluation.
目的估计邮政编码级别的健康社会决定因素（SDoH），特别是家庭收入、教育水平和失业率，与严重支气管肺发育不良（BPD）患者实施气管切开术时的月经后年龄（PMA）之间的关系：研究设计：这是一项对出生婴儿的回顾性观察研究：877名患者在PMA中位数（四分位间）为48（44-53）周时接受了气管造口术。在多变量模型中，受教育程度最高的患者接受气管造口术的时间较早（OR：95% CI = 0.972：0.947-0.997，P=0.031），与非西班牙裔白人患者相比，非西班牙裔黑人患者接受气管造口术的时间较晚（OR：1.026；95% CI =1.005-1.048，P=0.017）。在家庭收入和失业率方面，气管切开术时的 PMA 因 SDoH 或种族而异。在所有三个模型中，男性性别、小妊娠状态和入院时的 PMA 均与气管切开时的 PMA 相关。对于每个SDoH指标，由于几个中心在气管切开术时的PMA独立增加，因此中心间存在显著差异：结论：在对患者和临床因素进行调整后，邮政编码级别的教育程度会影响气管切开术时的PMA。结论：在对患者和临床因素进行调整后，邮政编码级别的教育影响了气管切开术的PMA。导致新生儿气管切开术的决定和时机的因素需要进一步评估。
{"title":"Social Determinants of Health and Timing of Tracheostomy for Severe Bronchopulmonary Dysplasia","authors":"Kylie M. Bushroe MD , Mary C. Politi PhD , Isabella Zaniletti PhD , Michael A. Padula MD, MBI , Theresa R. Grover MD, MAS , Matthew J. Kielt MD , Joanne M. Lagatta MD , Karna Murthy MD, MSc , Rakesh Rao MD","doi":"10.1016/j.jpeds.2024.114379","DOIUrl":"10.1016/j.jpeds.2024.114379","url":null,"abstract":"<div><h3>Objective</h3><div>To estimate the association of ZIP code-level social determinants of health (SDoH), specifically household income, education level, and unemployment rate, with postmenstrual age (PMA) at tracheostomy placement in patients with severe bronchopulmonary dysplasia.</div></div><div><h3>Study design</h3><div>This was a retrospective observational study of infants born <32 weeks' gestation and discharged from a Children's Hospitals Neonatal Consortium newborn intensive care unit. Patients were diagnosed with severe bronchopulmonary dysplasia and received tracheostomies before discharge. Maternal ZIP code at admission was linked to that ZIP code's SDoH via the 2021 US Census Bureau 5-year data. Unadjusted and adjusted analyses were completed with separate models fit for each SDoH marker.</div></div><div><h3>Results</h3><div>There were 877 patients who received tracheostomies at a median of 48 weeks PMA (IQR, 44-53 weeks PMA). In multivariable models, patients in the highest education groups received tracheostomies earlier (OR, 0.972; 95% CI, 0.947-0.997; <em>P</em> = .031), and non-Hispanic Black patients received tracheostomies later compared with non-Hispanic White patients (OR, 1.026; 95% CI, 1.005-1.048; <em>P</em> = .017). For household income and unemployment, the PMA at tracheostomy did not differ by SDoH or race. For all 3 models, male sex, small for gestation status, and later PMA at admission were associated with later PMA at tracheostomy. For each SDoH marker, significant intercenter variation was noted; several centers had independently increased PMA at tracheostomy.</div></div><div><h3>Conclusions</h3><div>Education at the ZIP code level influenced PMA at tracheostomy after adjusting for patient and clinical factors. Adjusted for each SDoH studied, significant differences were noted among centers. Factors leading to the decision and timing of neonatal tracheostomy need further evaluation.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114379"},"PeriodicalIF":3.9,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513186","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 : 2024-10-22DOI: 10.1016/j.jpeds.2024.114375
David S. Freedman PhD , Babette S. Zemel PhD , David R. Weber MD , William H. Dietz MD, PhD
Objective
To assess the screening ability of a high body mass index (BMI) for high adiposity among 8- to 19-year-olds.
Study design
This cross-sectional study included 6454 National Health and Nutrition Survey participants from 2011 through 2018. Fat and lean mass were measured with dual-energy X-ray absorptiometry. We expressed adiposity as fat mass index (FMI, kg ÷ m2) and %fat.
Results
Based on the Centers for Disease Control and Prevention 95th percentile, a high BMI correctly classified a high FMI for about 95% of participants in each racial and ethnic group. About 81% (Blacks) to 90% (Hispanics) of participants with a high BMI also had a high FMI. Further, children with a high BMI were 17 (Hispanics) to 46 (Blacks) times more likely to have a high FMI than those with a “normal” BMI. The screening ability of high BMI for high %fat was weaker because levels of %fat are influenced by both fat mass (numerator) and lean mass (denominator).
Conclusions
Despite differences in body composition, a high BMI is a very good screening tool for identifying high FMI not only among White 8- to 19-year-olds but also among Asians, Blacks, and Hispanics. Compared with %fat, FMI is likely a better adiposity metric among children and adolescents.
{"title":"The Cross-Sectional Relation of Body Mass Index to Adiposity among 8- to 19-Year-Olds within Several Races and Ethnicities","authors":"David S. Freedman PhD , Babette S. Zemel PhD , David R. Weber MD , William H. Dietz MD, PhD","doi":"10.1016/j.jpeds.2024.114375","DOIUrl":"10.1016/j.jpeds.2024.114375","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the screening ability of a high body mass index (BMI) for high adiposity among 8- to 19-year-olds.</div></div><div><h3>Study design</h3><div>This cross-sectional study included 6454 National Health and Nutrition Survey participants from 2011 through 2018. Fat and lean mass were measured with dual-energy X-ray absorptiometry. We expressed adiposity as fat mass index (FMI, kg ÷ m<sup>2</sup>) and %fat.</div></div><div><h3>Results</h3><div>Based on the Centers for Disease Control and Prevention 95th percentile, a high BMI correctly classified a high FMI for about 95% of participants in each racial and ethnic group. About 81% (Blacks) to 90% (Hispanics) of participants with a high BMI also had a high FMI. Further, children with a high BMI were 17 (Hispanics) to 46 (Blacks) times more likely to have a high FMI than those with a “normal” BMI. The screening ability of high BMI for high %fat was weaker because levels of %fat are influenced by both fat mass (numerator) and lean mass (denominator).</div></div><div><h3>Conclusions</h3><div>Despite differences in body composition, a high BMI is a very good screening tool for identifying high FMI not only among White 8- to 19-year-olds but also among Asians, Blacks, and Hispanics. Compared with %fat, FMI is likely a better adiposity metric among children and adolescents.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"277 ","pages":"Article 114375"},"PeriodicalIF":3.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513187","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}
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