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IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2024-10-22 DOI: 10.1016/S0022-3476(24)00415-3

引用次数: 0

Substantiating the Need for Need for NICU “Follow Through” 证明新生儿重症监护室需要 "跟进"

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2024-10-22 DOI: 10.1016/j.jpeds.2024.114297

Raye-Ann deRegnier MD

引用次数: 0

Go Where the Money is in Antibiotic Stewardship – The Outpatient Clinics 抗生素管理中的资金去向 - 门诊诊所

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2024-10-22 DOI: 10.1016/j.jpeds.2024.114296

Sarah S. Long MD

引用次数: 0

Adverse Childhood Experiences and Socioemotional Outcomes of Children Born Very Preterm 极早产儿的不良童年经历和社会情感结果。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2024-10-21 DOI: 10.1016/j.jpeds.2024.114377

Callie L. Bishop MD , Rachel E. Lean PhD , Tara A. Smyser MSE , Christopher D. Smyser MD , Cynthia E. Rogers MD

Objective

To examine whether adverse childhood experiences (ACEs) confer risk for socioemotional problems in children born very preterm (VPT).

Study design

As part of a longitudinal study, 96 infants born VPT at 23-30 weeks of gestation were recruited from a level III neonatal intensive care unit and underwent follow-up at ages 2 and 5 years. Eighty-three full-term (FT) (37-41 weeks gestation) children were recruited from an adjoining obstetric service and the local community. ACEs were assessed with the Child Life Events Scale at age 2 and Preschool Age Psychiatric Assessment at age 5. At age 5, internalizing, externalizing, and attention deficit hyperactivity disorder (ADHD) symptoms were assessed with the Child Behavior Checklist and Conner's Rating Scale-Revised, respectively. Covariates including socioeconomic disadvantage, maternal distress, and parent ADHD symptoms were assessed at the 2- and/or 5-year follow-up. Mediation and moderation analysis, accounting for family clustering, examined associations between birth group, ACEs, and socioemotional outcomes.

Results

After covariate adjustment, children born VPT experienced more ACEs (P < .001), particularly medical ACEs (P < .01), and had worse ADHD and internalizing outcomes (P < .05) than full-term children. ACEs mediated the association between birth group and ADHD outcomes (95% CI, 0.11-4.08). There was no evidence of mediation for internalizing outcomes. Higher parent ADHD symptoms (P < .001) and maternal distress (P < .05) were associated with poorer internalizing outcomes.

Conclusions

Screening for childhood ACEs should be embedded in the follow-up care of children born VPT and their families. Strategies to screen for and address parent psychosocial functioning may be important to support children's socioemotional development.

目的：研究不良童年经历（ACE）是否会导致早产儿出现社会情感问题：研究设计：作为一项纵向研究的一部分，从一家三级新生儿重症监护病房招募了 96 名妊娠 23-30 周的早产儿，并对他们进行了 2 岁和 5 岁的随访。从邻近的产科服务机构和当地社区招募了 83 名足月（FT，妊娠 37-41 周）儿童。2 岁时使用儿童生活事件量表对 ACE 进行评估，5 岁时使用学龄前儿童精神病学评估对 ACE 进行评估。5岁时，分别使用儿童行为检查表（Child Behavior Checklist）和康纳尔评定量表（Conner's Rating Scale-Revised）对内化、外化和注意力缺陷/多动障碍（ADHD）症状进行评估。在 2 年和/或 5 年的随访中，对包括社会经济劣势、母亲痛苦和父母多动症症状在内的协变量进行了评估。在考虑家庭聚类的情况下，对出生组别、ACE和社会情感结果之间的关联进行了中介和调节分析：结果：经协变量调整后，VPT出生的儿童经历了更多的ACEs（p结论：儿童ACEs筛查应在儿童期进行：儿童 ACE 筛查应纳入对 VPT 出生儿童及其家庭的后续护理中。筛查和解决父母社会心理功能问题的策略可能对支持儿童的社会情感发展非常重要。

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引用次数: 0

Pediatric Acute Lymphangitis Manifesting as Skip Skin Lesions 表现为跳皮病变的小儿急性淋巴管炎

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2024-10-21 DOI: 10.1016/j.jpeds.2024.114373

Daisuke Matsubara MD, Megumi Akutsu MD, Tomoyuki Ota MD

引用次数: 0

Impact of COVID-19 Pandemic Interventions on Sudden Unexpected Death in Infancy Incidence in France COVID-19 大流行干预措施对法国婴儿意外猝死发生率的影响。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2024-10-19 DOI: 10.1016/j.jpeds.2024.114369

Pauline Scherdel PhD , Adeline Ricard MD , Christèle Gras-le Guen MD, PhD , Bérengère Jarry RN , Léa Ferrand MSc , Karine Levieux MD , Naïm Ouldali MD , Sophie de Visme MSc , Camille Aupiais MD, PhD

Objective

To study the impact of nonpharmaceutical interventions implemented during the COVID-19 pandemic on the monthly incidence of sudden unexpected death in infancy (SUDI) cases overall and those with a viral or bacterial identification.

Study design

We conducted an interrupted time-series analysis using seasonally adjusted Poisson regression models from the French national prospective and multicenter SUDI registry, that included all SUDI cases below the age of 1 year who died from 2016 to 2021 in mainland France.

Results

Of 998 SUDI cases analyzed, 750 were recorded during the prepandemic period (January 2016 through March 2020) and 248 during the NPI period (April 2020 through December 2021). We found a significant seasonal pattern of overall monthly SUDI incidence, with a peak observed periodically from November to February. The monthly SUDI incidence decreased significantly from the prepandemic to NPI periods (adjusted incidence rate ratio 0.83 [95% CI 0.72-0.96]). In particular, the monthly incidence of SUDI cases with a viral or bacterial identification decreased significantly, while no significant difference was found for SUDI cases without a viral or bacterial identification.

Conclusions

Nonpharmaceutical interventions were associated with a significant change in the incidence of SUDI cases with a viral or bacterial identification. Further investigations are needed to analyze the pathophysiologic role of viruses and bacteria in the SUDI.

目的研究设计：研究在COVID-19大流行期间实施的非药物干预措施（NPIs）对婴儿意外猝死（SUDI）病例总数以及病毒或细菌鉴定病例的月发病率的影响：我们利用法国国家前瞻性多中心SUDI登记处的季节调整泊松回归模型进行了间断时间序列分析，其中包括2016年至2021年期间在法国本土死亡的所有1岁以下SUDI病例：在分析的998例SUDI病例中，750例记录在大流行前（2016年1月至2020年3月），248例记录在NPI期间（2020年4月至2021年12月）。我们发现，SUDI 的月总体发病率具有明显的季节性特征，11 月至次年 2 月为周期性高峰。从大流行前到非大流行期间，SUDI 的月发病率明显下降（调整后的发病率比值为 0.83 [95% 置信区间为 0-72-0-96]）。特别是，经病毒或细菌鉴定的 SUDI 病例的月发病率有所下降，而未经病毒或细菌鉴定的 SUDI 病例的发病率则无明显差异：结论：NPI 与经病毒或细菌鉴定的 SUDI 病例发生率的显著变化有关。需要进一步调查分析病毒和细菌在 SUDI 中的病理生理作用。

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引用次数: 0

Caregiver Values and Preferences Related to Surgical Decision-Making for Children with Medical Complexity 护理人员对医疗复杂儿童手术决策的价值观和偏好。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2024-10-19 DOI: 10.1016/j.jpeds.2024.114366

Jody L. Lin MD, MS , Tsivya Devereaux MD , Tamara D. Simon MD, MSPH , Kimberly A. Kaphingst ScD , Angela Zhu BA , Unni Narayanan MBBS , Andrew B.L. Berry PhD , Kaleb G. Eppich MS , Greg Stoddard PhD , John T. Smith MD , Lindsay Andras MD , John Heflin MD , Heather T. Keenan MDCM, PhD , Steven M. Asch MD , Angela Fagerlin PhD

Objective

To uncover the values and preferences of the caregivers for children with medical complexity using the test case of surgical treatment decision-making for pediatric neuromuscular scoliosis that will inform the future development of a decision support tool in this population.

Study design

We conducted a qualitative study of semistructured interviews of English- and Spanish-speaking caregivers of children with neuromuscular scoliosis from 2 geographically distinct children's hospitals. We used purposive sampling of language and treatment options selected to capture diverse experiences. Analysis was on the basis of grounded theory with synthesized caregiver values and preferences themes.

Results

From 47 participants, we completed 41 interviews (9 in Spanish). Caregivers had a mean age of 43.2 years, were mostly White (66%), and had children with a mean age of 15.6. In total, 64% chose surgery. The following values and preferences were important to many caregivers: reducing scoliosis-related pain, minimizing mobility limitations to optimize socioemotional quality of life, limiting the impact of comorbidities on overall quality of life, information provided by peer support, the uncertainty of outcomes due to underlying comorbidities, and the uncertainty related to the anticipated progression of their child's scoliosis curve. Caregivers experienced immense uncertainty related to treatment outcomes due to their child's comorbidities.

Conclusions

Caregivers of children with medical complexity may benefit from decision support that includes both values clarification exercises to help caregivers identify what of the many possible values and preferences are important to them and novel methods to communicate uncertainty in the care of CMC.

目的以小儿神经肌肉性脊柱侧凸（NMS）的手术治疗决策为测试案例，揭示医疗复杂性（CMC）患儿护理人员的价值观和偏好，为今后开发该人群的决策支持工具提供参考：研究设计：我们对来自两家地理位置不同的儿童医院、讲英语和西班牙语的 NMS 患儿护理人员进行了半结构化访谈的定性研究。我们采用有目的的语言和治疗方案取样，以获取不同的经验。分析以基础理论为基础，综合了护理人员的价值观和偏好主题：在 47 名参与者中，我们完成了 41 次访谈（9 次为西班牙语访谈）。照顾者的平均年龄为 43.2 岁，大部分为白人（66%），其子女的平均年龄为 15.6 岁。64%的人选择了手术治疗。以下价值观和偏好对许多照顾者来说非常重要：减少脊柱侧弯相关疼痛、尽量减少活动限制以优化社会情感生活质量、限制合并症对整体生活质量的影响、同伴支持提供的信息、潜在合并症导致的结果不确定性，以及与孩子脊柱侧弯的预期进展相关的不确定性。由于孩子的合并症，照护者在治疗结果方面经历了巨大的不确定性：结论：CMC 的护理者可能会从决策支持中获益，决策支持包括价值澄清练习，以帮助护理者确定在众多可能的价值和偏好中哪些对他们是重要的，以及在 CMC 护理中沟通不确定性的新方法。

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引用次数: 0

Association of Allergy Specialty Care and Asthma Outcomes for Medicaid-Enrolled Children 过敏专科护理与参加医疗补助计划儿童的哮喘治疗效果之间的关系。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2024-10-19 DOI: 10.1016/j.jpeds.2024.114361

Melanie Boyd MS , Arina Eyimina MA , Clare C. Brown PhD, MPH , Anthony Goudie PhD , Erhan Ararat MD , Mandana Rezaeiahari PhD , Tamara T. Perry MD , J. Mick Tilford PhD , Akilah A. Jefferson MD, MSc

Objective

To evaluate the comparative effectiveness of allergy specialist care for children with asthma enrolled in the Arkansas Medicaid program.

Study design

We used the Arkansas All-Payers Claims Database to identify Medicaid-enrolled children with asthma who had an allergy specialist visit in 2018. These children were propensity score matched to children without an allergy specialist visit to evaluate differences in asthma-related adverse events (AAEs), specifically emergency department visits and/or hospitalizations in 2019. Multivariable logistic regression was used to assess the association between allergy specialist care in 2018 and AAEs in 2019.

Results

Prior to matching, a higher percentage of children with an allergy specialist visit had persistent asthma, were atopic, and received influenza vaccination. In the matched sample, 10.1% of identified patients experienced an AAE in 2019. Adjusted analysis showed 21.0% lower odds of AAEs (aOR: 0.79; 95% CI: 0.63, 0.98) in 2019 for children with an allergy specialist visit (n = 2964) in 2018 compared with those without an allergy specialist visit (ME: 9.1% vs 11.0%; P = .04).

Conclusions

Children with asthma enrolled in Arkansas Medicaid who saw an allergy specialist were less likely to have an AAE. Asthma quality metrics developed using guideline-based recommendations for allergy specialist care should be considered for asthma health management programs.

目的：评估阿肯色州医疗补助计划中的哮喘患儿接受过敏专科护理的比较效果：评估阿肯色州医疗补助计划中的哮喘患儿接受过敏专科护理的比较效果：我们使用阿肯色州所有支付者索赔数据库（APCD）来识别2018年接受过过敏专科就诊的哮喘病医保参保儿童。将这些儿童与未接受过敏专科就诊的儿童进行倾向评分匹配，以评估2019年哮喘相关不良事件（AAE）的差异，特别是急诊就诊和/或住院治疗。多变量逻辑回归用于评估 2018 年过敏专科就诊与 2019 年 AAE 之间的关联：在匹配之前，接受过过敏专科就诊的儿童中，患有持续性哮喘、特应性疾病和接种过流感疫苗的比例较高。在匹配样本中，10.1% 的已识别患者在 2019 年经历了 AAE。调整后的分析表明，与没有过敏专科医生就诊的儿童相比（ME：9.1% vs 11.0%；P=0.04），2018 年有过敏专科医生就诊的儿童（n=2964）在 2019 年发生 AAE 的几率降低了 21.0%（aOR：0.79；95%CI：0.63，0.98）：参加阿肯色州医疗补助计划的哮喘儿童中，接受过敏专科医生诊治的儿童发生 AAE 的可能性较低。哮喘健康管理计划应考虑使用基于指南的过敏专科护理建议制定哮喘质量指标。

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引用次数: 0

Outpatient Infant Botulism in the United States, 1976-2021 1976-2021 年美国婴儿肉毒中毒门诊情况。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2024-10-18 DOI: 10.1016/j.jpeds.2024.114365

Jessica M. Khouri MD, Haydee A. Dabritz PhD, Jessica R. Payne MPH , Jennifer S. Read MD, Connie H. Chung MPH

Objective

To characterize cases of outpatients with infant botulism (IB) in the US identified by the Infant Botulism Treatment and Prevention Program at the California Department of Public Health from 1976 through 2021.

Study design

Outpatient IB cases were defined as patients presenting with an illness consistent with the known paralyzing action of botulinum neurotoxin and with laboratory confirmation. Outpatient cases were distinguished from the majority of patients with IB by the atypical fact that they did not require hospitalization throughout the course of their illness.

Results

Of the 4372 cases of IB identified by the Infant Botulism Treatment and Prevention Program over a 45-year period (1976-2021), 17 (0.4%) were outpatient cases. Most (11/17; 65%) cases occurred in California. The median age at disease onset was 20 weeks (range = 6 to 55 weeks). The most common symptom among cases was constipation (16/17; 94%). Most patients (16/17; 94%) had at least one cranial nerve palsy, manifested as decreased head control, ptosis, weak cry, or poor suck.

Conclusions

Outpatient IB occurs nationwide, although clinical diagnosis may be difficult because the severity of symptoms do not necessitate hospitalization or more comprehensive clinical intervention. Identification of outpatient cases requires an astute clinician and a capable, willing diagnostic testing laboratory. It is likely that more outpatient cases of IB are occurring than are presently recognized in infants mildly affected by this disease. Healthcare providers should consider the possibility of IB when presented with a previously well infant with failure to thrive, poor feeding, constipation, mild hypotonia, or cranial nerve palsy.

目的研究设计：门诊 IB 病例是指出现与已知的肉毒杆菌神经毒素（BoNT）麻痹作用一致的疾病并经实验室确认的患者。门诊病例与大多数 IB 患者的区别在于，他们在整个病程中不需要住院治疗：结果：45年间（1976-2021 年），IBTPP 共发现 4372 例 IB 病例，其中 17 例（0.4%）为门诊病例。大多数病例（11/17；65%）发生在加利福尼亚州。发病年龄中位数为 20 周（范围 = 6 至 55 周）。病例中最常见的症状是便秘（16/17；94%）。大多数患者（16/17；94%）至少有一个颅神经麻痹，表现为头部控制能力下降、眼睑下垂、哭声微弱或吸吮不畅：门诊 IB 患者遍布全国，但临床诊断可能比较困难，因为症状的严重程度并不需要住院治疗或更全面的临床干预。门诊病例的识别需要精明的临床医生和有能力、有意愿的诊断检测实验室。IB 的门诊病例很可能比目前发现的轻度患儿病例还要多。医护人员在接诊出现发育不良、喂养不良、便秘、轻度肌张力低下或颅神经麻痹等症状的婴儿时，应考虑 IB 的可能性。

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引用次数: 0

Long-Term Mental Health Outcomes of Bronchopulmonary Dysplasia in Neonates: An 18-Year National Cohort Study 新生儿支气管肺发育不良的长期心理健康后果：一项为期 18 年的全国队列研究。

IF 3.9 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2024-10-18 DOI: 10.1016/j.jpeds.2024.114341

Ga Won Jeon MD , Jaeho Shin MD , Ju Hee Kim MD , Eun Kyo Ha MD , Bo Eun Han BS , Ha Na Yoo MS , Soonchul Lee MD , Man Yong Han MD

Objective

To evaluate the association between neonatal bronchopulmonary dysplasia and the subsequent development of mental health conditions in children and adolescents.

Study design

This was a retrospective cohort study, utilizing data from individuals born in South Korea between 2002 and 2005 and followed up until 2021, using the National Health Insurance Database. The cohort included 1 893 314 participants born during that period, with 927 diagnosed with bronchopulmonary dysplasia during the neonatal period (the exposed cohort). They were matched 1:10 with 9270 unexposed individuals (the unexposed cohort) based on key demographic factors.

Results

The median age at the first mental health disorder diagnosis was 9 years (IQR, 5-15 years), with 5698 individuals (55.9%) being male. During an average follow-up of 15.2 years, the incidence rate was 481/10 000 person-years in the exposed and 138 of 10 000 person-years in the unexposed cohort. By the age of 18 years, the cumulative incidence in the exposed cohort was 54% (95% CI; 50%-57%), with an adjusted hazard ratio of 3.18 (95% CI; 2.81-3.60) compared with the unexposed cohort, and adjusted hazard ratios for early- and late-onset mental health disorders of 4.48 (95% CI; 3.84-5.22) and 1.89 (95% CI; 1.61-2.22), respectively. Sensitivity analyses confirmed these findings, and a subgroup analysis revealed a higher risk among individuals with bronchopulmonary dysplasia who required prolonged respiratory support or oxygen.

Conclusions

Half of children with bronchopulmonary dysplasia in our cohort developed mental health disorders by the age of 18 years, emphasizing the need for interventions and support for such individuals.

研究目的研究设计：这是一项回顾性队列研究，利用国民健康保险数据库中 2002 年至 2005 年间在韩国出生并随访至 2021 年的个体数据。该队列包括 1,893,314 名在此期间出生的参与者，其中 927 人在新生儿期被诊断为支气管肺发育不良（暴露队列）。根据主要人口统计学因素，他们与 9,270 名未暴露者（未暴露队列）进行了 1:10 匹配：首次诊断出精神障碍的中位年龄为 9 岁（四分位数间距为 5-15 岁），其中 5,698 人（55.9%）为男性。在平均 15.2 年的随访期间，暴露人群的发病率为 481/10,000人年，未暴露人群的发病率为 138/10,000人年。到18岁时，暴露人群的累积发病率为54%（95%置信区间[CI]；50%-57%），与未暴露人群相比，调整后的危险比为3.18（95% CI；2.81-3.60），早期和晚期精神疾病的调整后危险比分别为4.48（95% CI；3.84-5.22）和1.89（95% CI；1.61-2.22）。敏感性分析证实了这些结果，一项亚组分析显示，需要长期呼吸支持或氧气的支气管肺发育不良患者的风险更高：结论：在我们的队列中，半数患有支气管肺发育不良的儿童在18岁时出现了心理健康障碍，这强调了对这些儿童进行干预和提供支持的必要性。

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