Pub Date : 2024-12-28DOI: 10.1016/j.jpeds.2024.114457
Myriam Casseus PhD, MPH, MA , Nancy E. Reichman PhD
Pediatric care coordination (PCC) has been shown to improve quality of care and health outcomes. This study documents trends and patterns in parent-reported receipt of PCC between 2016 and 2022 (n = 279 546). Rates of PCC declined throughout this period and were particularly low for children with special health care needs.
{"title":"Trends and Patterns in United States Pediatric Care Coordination, 2016-2022","authors":"Myriam Casseus PhD, MPH, MA , Nancy E. Reichman PhD","doi":"10.1016/j.jpeds.2024.114457","DOIUrl":"10.1016/j.jpeds.2024.114457","url":null,"abstract":"<div><div>Pediatric care coordination (PCC) has been shown to improve quality of care and health outcomes. This study documents trends and patterns in parent-reported receipt of PCC between 2016 and 2022 (n = 279 546). Rates of PCC declined throughout this period and were particularly low for children with special health care needs.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"279 ","pages":"Article 114457"},"PeriodicalIF":3.9,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904035","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 : 2024-12-28DOI: 10.1016/j.jpeds.2024.114458
Serena Yun-Chen Tsai MD, MMSc , Stephanie Hadley MD , Amanda S. Growdon MD , Kevin Sheng-Kai Ma DDS, FRSPH, FRSM , Jonathan M. Mansbach MD, MPH
There has been a significant, postpandemic increase in the incidence of serious head and neck infections among children aged <18 years since 2021, compared with the stable incidence of nontransmissible osteomyelitis and serious head and neck infections in adults from 2018 to 2023. The etiology of this increase requires further study.
{"title":"Increasing Incidence of Serious Head and Neck Infections among Children in the United States, 2018-2023","authors":"Serena Yun-Chen Tsai MD, MMSc , Stephanie Hadley MD , Amanda S. Growdon MD , Kevin Sheng-Kai Ma DDS, FRSPH, FRSM , Jonathan M. Mansbach MD, MPH","doi":"10.1016/j.jpeds.2024.114458","DOIUrl":"10.1016/j.jpeds.2024.114458","url":null,"abstract":"<div><div>There has been a significant, postpandemic increase in the incidence of serious head and neck infections among children aged <18 years since 2021, compared with the stable incidence of nontransmissible osteomyelitis and serious head and neck infections in adults from 2018 to 2023. The etiology of this increase requires further study.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"279 ","pages":"Article 114458"},"PeriodicalIF":3.9,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142906921","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 : 2024-12-26DOI: 10.1016/j.jpeds.2024.114456
Dinushan C. Kaluarachchi MBBS , Matthew A. Rysavy MD, PhD , Barbara T. Do MSPH , Valerie Y. Chock MD, Ms Epi , Matthew M. Laughon MD, MPH , Carl H. Backes MD , Tarah T. Colaizy MD, MPH , Edward F. Bell MD , Patrick J. McNamara MB BCh, BAO, MSc
Objective
To investigate the association between the secular decrease in treatment of patent ductus arteriosus (PDA) and trends in neonatal mortality and morbidity in infants born at 26 0/7-28 6/7 weeks’ gestation.
Study design
A retrospective cohort study including infants born between 2012 and 2021 in continually participating hospitals in the National Institute of Child Health and Human Development Neonatal Research Network. The primary composite outcome was defined as surgical necrotizing enterocolitis, grade 2-3 bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage, or death. Relationships of temporal trends in PDA treatment with the primary composite outcome and its components were analyzed using a multilevel model accounting for patient-level factors. A separate analysis assessed these relationships stratified by hospital changes in PDA treatment.
Results
The study included 7864 infants. There was a decrease in any PDA treatment from 21% to 16% (P < .01) and an increase in the primary composite outcome from 24% to 36% (P < .01). Change in the primary outcome was driven by increased grade 2-3 BPD (13%-26%, P < .01), with grade 2 BPD accounting for most of this increase (10%-22%, P < .01). Temporal decreases in PDA treatment were associated with increases in the primary outcome and grade 2-3 BPD after adjusting for patient-level factors (P < .01). However, stratified analyses showed that grade 2-3 BPD increased in all hospital groups, regardless of changes in PDA management.
Conclusions
From 2012 to 2021, temporal decreases in PDA treatment for infants 26-28 weeks were associated with an increase in grade 2-3 BPD. However, caution is warranted in determining causality. Reasons for increased grade 2-3 BPD during the past decade warrant investigation.
{"title":"Changes in Patent Ductus Arteriosus Management and Outcomes in Infants Born at 26-28 Weeks’ Gestation","authors":"Dinushan C. Kaluarachchi MBBS , Matthew A. Rysavy MD, PhD , Barbara T. Do MSPH , Valerie Y. Chock MD, Ms Epi , Matthew M. Laughon MD, MPH , Carl H. Backes MD , Tarah T. Colaizy MD, MPH , Edward F. Bell MD , Patrick J. McNamara MB BCh, BAO, MSc","doi":"10.1016/j.jpeds.2024.114456","DOIUrl":"10.1016/j.jpeds.2024.114456","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the association between the secular decrease in treatment of patent ductus arteriosus (PDA) and trends in neonatal mortality and morbidity in infants born at 26 0/7-28 6/7 weeks’ gestation.</div></div><div><h3>Study design</h3><div>A retrospective cohort study including infants born between 2012 and 2021 in continually participating hospitals in the National Institute of Child Health and Human Development Neonatal Research Network. The primary composite outcome was defined as surgical necrotizing enterocolitis, grade 2-3 bronchopulmonary dysplasia (BPD), severe intraventricular hemorrhage, or death. Relationships of temporal trends in PDA treatment with the primary composite outcome and its components were analyzed using a multilevel model accounting for patient-level factors. A separate analysis assessed these relationships stratified by hospital changes in PDA treatment.</div></div><div><h3>Results</h3><div>The study included 7864 infants. There was a decrease in any PDA treatment from 21% to 16% (<em>P</em> < .01) and an increase in the primary composite outcome from 24% to 36% (<em>P</em> < .01). Change in the primary outcome was driven by increased grade 2-3 BPD (13%-26%, <em>P</em> < .01), with grade 2 BPD accounting for most of this increase (10%-22%, <em>P</em> < .01). Temporal decreases in PDA treatment were associated with increases in the primary outcome and grade 2-3 BPD after adjusting for patient-level factors (<em>P</em> < .01). However, stratified analyses showed that grade 2-3 BPD increased in all hospital groups, regardless of changes in PDA management.</div></div><div><h3>Conclusions</h3><div>From 2012 to 2021, temporal decreases in PDA treatment for infants 26-28 weeks were associated with an increase in grade 2-3 BPD. However, caution is warranted in determining causality. Reasons for increased grade 2-3 BPD during the past decade warrant investigation.</div></div><div><h3>Trial registration</h3><div>Generic Database: NCT00063063.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"279 ","pages":"Article 114456"},"PeriodicalIF":3.9,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899727","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 : 2024-12-24DOI: 10.1016/j.jpeds.2024.114446
Massimo Pettoello-Mantovani, Donjeta Bali, Ida Giardino, Mehmet Vural, Flavia Indrio, Giuseppe Buonocore, Maria Pastore
{"title":"Navigating Resistance and Adaptation in Health Care: How Pediatricians Can Balance Transformation and Children's Needs.","authors":"Massimo Pettoello-Mantovani, Donjeta Bali, Ida Giardino, Mehmet Vural, Flavia Indrio, Giuseppe Buonocore, Maria Pastore","doi":"10.1016/j.jpeds.2024.114446","DOIUrl":"10.1016/j.jpeds.2024.114446","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114446"},"PeriodicalIF":3.9,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900106","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}
To investigate the feasibility of cut-umbilical cord milking (C-UCM) during stabilization of preterm infants after birth.
Study design
This was a pilot randomized controlled trial of initial resuscitation. Infants born to eligible, consenting women presenting in preterm labor at <32 weeks’ gestation were randomized to receive either the standard practice of deferred cord clamping (DCC) for 30-60 seconds at birth or C-UCM while supporting breathing and following 30 seconds of DCC. The primary outcome was feasibility in terms of percentage recruitment, intervention compliance, safety, and study completion. Short-term clinical outcomes were collected. Analysis was by intention to treat.
Results
Of the 133 pregnant women approached, 93 consented to participate (70%). Fifty infants delivered <32 weeks’ gestation were randomized to either C-UCM (25) or DCC (25). Baseline characteristics of infants were similar. All participants completed the study. One infant in the C-UCM group and 5 infants in the DCC group did not receive the allocated intervention. Median (IQR) time to cord milking was 62 (54, 99) seconds and median (IQR) length of the cut-cord milked was 20 (14, 29) cm. C-UCM was not associated with increased adverse effects compared with DCC.
Conclusion
Milking of the long-cut cord after 30 seconds of DCC while supporting breathing was feasible and not associated with significant adverse effects. A larger randomized controlled trial is required to assess the efficacy and safety of this approach on clinical outcomes. C-UCM may be especially useful in situations when DCC is not feasible.
{"title":"Milking of the Cut Cord During Stabilization of Infants Born Very Premature: A Randomized Controlled Trial","authors":"Walid El-Naggar MD , Souvik Mitra MD , Jayani Abeysekera MD , Tim Disher PhD , Christy Woolcott PhD , Tara Hatfield RN , Douglas McMillan MD , Jon Dorling MD","doi":"10.1016/j.jpeds.2024.114444","DOIUrl":"10.1016/j.jpeds.2024.114444","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the feasibility of cut-umbilical cord milking (C-UCM) during stabilization of preterm infants after birth.</div></div><div><h3>Study design</h3><div>This was a pilot randomized controlled trial of initial resuscitation. Infants born to eligible, consenting women presenting in preterm labor at <32 weeks’ gestation were randomized to receive either the standard practice of deferred cord clamping (DCC) for 30-60 seconds at birth or C-UCM while supporting breathing and following 30 seconds of DCC. The primary outcome was feasibility in terms of percentage recruitment, intervention compliance, safety, and study completion. Short-term clinical outcomes were collected. Analysis was by intention to treat.</div></div><div><h3>Results</h3><div>Of the 133 pregnant women approached, 93 consented to participate (70%). Fifty infants delivered <32 weeks’ gestation were randomized to either C-UCM (25) or DCC (25). Baseline characteristics of infants were similar. All participants completed the study. One infant in the C-UCM group and 5 infants in the DCC group did not receive the allocated intervention. Median (IQR) time to cord milking was 62 (54, 99) seconds and median (IQR) length of the cut-cord milked was 20 (14, 29) cm. C-UCM was not associated with increased adverse effects compared with DCC.</div></div><div><h3>Conclusion</h3><div>Milking of the long-cut cord after 30 seconds of DCC while supporting breathing was feasible and not associated with significant adverse effects. A larger randomized controlled trial is required to assess the efficacy and safety of this approach on clinical outcomes. C-UCM may be especially useful in situations when DCC is not feasible.</div></div><div><h3>Trial registration</h3><div><span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>: <span><span>NCT03852134</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"278 ","pages":"Article 114444"},"PeriodicalIF":3.9,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900099","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 : 2024-12-24DOI: 10.1016/j.jpeds.2024.114445
Sunah S. Hwang MD, MPH, PhD , Stephanie L. Bourque MD, MSCS , Kathleen E. Hannan MD, MSCS , Molly Passarella MS , Joshua Radack , Brielle Formanowski , Scott A. Lorch MD, MSCE
Objective
To investigate individual-, hospital-, and community-level factors associated with sudden unexpected infant death (SUID) among infants born preterm.
Study design
The following linked dataset from 5 states (California, Michigan, Oregon, Pennsylvania, and South Carolina) from 2005 through 2020 was used: (1) infant birth and death certificates; (2) maternal and infant birth hospitalization discharge records; (3) birthing hospital data from the American Hospital Association; and (4) community-level data from the Social Vulnerability Index (SVI).) Multivariable models were used to assess the independent association between these multilevel factors and SUID, adjusting for several maternal and infant characteristics.
Results
Overall, we found that maternal demographic factors (race and ethnicity, education, insurance) and infant gestational age were significant predictors of SUID. There was no difference in SUID odds by state, urban influence code, and maternal complications of pregnancy. Compared with mothers who lived in areas with the lowest SVI, those who resided in the highest SVI were more likely to experience SUID. There was no difference in SUID odds between infants who did or did not experience one or more complications of prematurity. For hospital-level factors, there was no difference in SUID odds among infants cared for in teaching vs nonteaching hospitals or in low vs high volume preterm birth hospitals.
Conclusion
Individual- and community-level factors were associated with SUID among infants born preterm. The neonatal intensive care unit hospitalization may provide a critical window of opportunity to engage families about SUID-risk reducing practices.
{"title":"Individual-, Hospital-, and Community-Level Factors Associated with Sudden Unexpected Infant Death Among Infants Born Preterm in 5 US States","authors":"Sunah S. Hwang MD, MPH, PhD , Stephanie L. Bourque MD, MSCS , Kathleen E. Hannan MD, MSCS , Molly Passarella MS , Joshua Radack , Brielle Formanowski , Scott A. Lorch MD, MSCE","doi":"10.1016/j.jpeds.2024.114445","DOIUrl":"10.1016/j.jpeds.2024.114445","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate individual-, hospital-, and community-level factors associated with sudden unexpected infant death (SUID) among infants born preterm.</div></div><div><h3>Study design</h3><div>The following linked dataset from 5 states (California, Michigan, Oregon, Pennsylvania, and South Carolina) from 2005 through 2020 was used: (1) infant birth and death certificates; (2) maternal and infant birth hospitalization discharge records; (3) birthing hospital data from the American Hospital Association; and (4) community-level data from the Social Vulnerability Index (SVI).) Multivariable models were used to assess the independent association between these multilevel factors and SUID, adjusting for several maternal and infant characteristics.</div></div><div><h3>Results</h3><div>Overall, we found that maternal demographic factors (race and ethnicity, education, insurance) and infant gestational age were significant predictors of SUID. There was no difference in SUID odds by state, urban influence code, and maternal complications of pregnancy. Compared with mothers who lived in areas with the lowest SVI, those who resided in the highest SVI were more likely to experience SUID. There was no difference in SUID odds between infants who did or did not experience one or more complications of prematurity. For hospital-level factors, there was no difference in SUID odds among infants cared for in teaching vs nonteaching hospitals or in low vs high volume preterm birth hospitals.</div></div><div><h3>Conclusion</h3><div>Individual- and community-level factors were associated with SUID among infants born preterm. The neonatal intensive care unit hospitalization may provide a critical window of opportunity to engage families about SUID-risk reducing practices.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"278 ","pages":"Article 114445"},"PeriodicalIF":3.9,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899934","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 : 2024-12-21DOI: 10.1016/j.jpeds.2024.114447
Thomas A. Hegland PhD , R. Thomas Day MD , Katie M. Moynihan MBBS
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.
{"title":"Access to Pediatric Bed Capacity According to Social Determinants of Health: All Beds Are Not Created Equal","authors":"Thomas A. Hegland PhD , R. Thomas Day MD , Katie M. Moynihan MBBS","doi":"10.1016/j.jpeds.2024.114447","DOIUrl":"10.1016/j.jpeds.2024.114447","url":null,"abstract":"<div><h3>Objective</h3><div>To study pediatric inpatient hospital capacity and resources, characterizing differences according to Social Determinants of Health (SDoH) using market share techniques.</div></div><div><h3>Study design</h3><div>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).</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"278 ","pages":"Article 114447"},"PeriodicalIF":3.9,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883629","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 : 2024-12-20DOI: 10.1016/j.jpeds.2024.114443
Cal Robinson, Stéphanie Wagner, Nowrin Aman, Tonny H M Banh, Vaneet Dhillon, Valerie Langlois, Christoph Licht, Ashlene McKay, Damien Noone, Rachel Pearl, Seetha Radhakrishnan, Chia Wei Teoh, Jovanka Vasilevska-Ristovska, Rulan S Parekh
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.
目的：了解儿童肾病综合征高血压的发病率及危险因素。研究设计：使用来自Insight肾病综合征研究（Insight）的数据，这是一项来自加拿大多伦多的前瞻性观察儿童肾病综合征队列研究，我们评估了高血压的发病率和高血压发生的时间，并按1)类固醇抵抗或类固醇敏感，2)频繁复发、类固醇依赖或罕见复发进行分层。高血压定义为连续两次就诊或开始服用降压药时出现1-2期高血压。结果：从1996年到2023年，我们纳入了748例肾病综合征患儿。诊断时的中位（四分位数1-3 [Q1-3]）年龄为4（2.8-6）岁，473（63%）名儿童为男性，240（32%）名儿童为南亚族裔。40例（5%）儿童为类固醇抵抗，177例（24%）为类固醇依赖，113例（15%）为频繁复发，418例（56%）为罕见复发。中位随访时间为5.2年（Q1-3为3.0-9.3年）。在随访期间，393名（53%）儿童出现高血压或开始服用抗高血压药物（发病率为8.2 / 100人年，95%CI为7.4-9.1）。高血压在类固醇抵抗儿童中比在类固醇敏感儿童中更常见(70% vs 52%；调整后的HR 1.47, 95%可信区间1.00-2.17)。高血压在类固醇依赖儿童中也更为常见(67%；调整后危险度1.81,95%CI 1.43-2.30)和频繁复发(63%；调整后的HR为1.64,95%CI为1.23-2.18)，而不频繁复发者（42%）。在类固醇敏感患者中，较高的BMI Z-score和学术中心也是显著的高血压危险因素。结论：半数儿童肾病综合征并发高血压。类固醇抵抗、类固醇依赖、频繁复发或肥胖的儿童风险最大。密切的血压监测是确定和治疗高血压的合理方法。
{"title":"Incidence and Risk Factors for Hypertension among Children with Nephrotic Syndrome.","authors":"Cal Robinson, Stéphanie Wagner, Nowrin Aman, Tonny H M Banh, Vaneet Dhillon, Valerie Langlois, Christoph Licht, Ashlene McKay, Damien Noone, Rachel Pearl, Seetha Radhakrishnan, Chia Wei Teoh, Jovanka Vasilevska-Ristovska, Rulan S Parekh","doi":"10.1016/j.jpeds.2024.114443","DOIUrl":"https://doi.org/10.1016/j.jpeds.2024.114443","url":null,"abstract":"<p><strong>Objectives: </strong>To determine incidence and risk factors for hypertension in childhood nephrotic syndrome.</p><p><strong>Study design: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"114443"},"PeriodicalIF":3.9,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878584","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 : 2024-12-14DOI: 10.1016/j.jpeds.2024.114437
Gabriella B. Smith BA , Mickayla D. Jones MPH , Mary J. Akel MPH , Leonardo Barrera MPH , Marie Heffernan PhD , Patrick Seed MD, PhD , Michelle L. Macy MD, MS , Stephanie A. Fisher MD, MPH , Leena B. Mithal MD, MSCI
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.
{"title":"Parental Perceptions of Early Childhood In-Home Research with Monitoring: A Qualitative Study","authors":"Gabriella B. Smith BA , Mickayla D. Jones MPH , Mary J. Akel MPH , Leonardo Barrera MPH , Marie Heffernan PhD , Patrick Seed MD, PhD , Michelle L. Macy MD, MS , Stephanie A. Fisher MD, MPH , Leena B. Mithal MD, MSCI","doi":"10.1016/j.jpeds.2024.114437","DOIUrl":"10.1016/j.jpeds.2024.114437","url":null,"abstract":"<div><h3>Objective</h3><div>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.</div></div><div><h3>Study design</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"278 ","pages":"Article 114437"},"PeriodicalIF":3.9,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830814","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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