Journal of Pediatrics最新文献

英文中文

Maternal-Fetal Environment and Neurodevelopment in Patients with Single Ventricle Heart Disease 单心室心脏病患者的母胎环境与神经发育。

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-12-11 DOI: 10.1016/j.jpeds.2025.114942

Samantha A. Holmes MD , Krista Young MD , Kelly R. Wolfe PhD , Camila Londono-Obregon MD , Bettina F. Cuneo MD , Emily M. Bucholz MD, PhD, MPH

Objective

To assess the role of the maternal-fetal environment (MFE) on early neurodevelopmental and clinical outcomes in children with single ventricle heart disease (SVHD).

Study design

We performed a retrospective, single-center study of patients with a prenatal diagnosis of SVHD from 2011-2022. Impaired MFE was defined as exposure to diabetes, pre-eclampsia, tobacco, or chronic or gestational hypertension in utero. Neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development-III and 4 between 12 and 36 months of age.

Results

Among 160 patients with SVHD (117 hypoplastic left heart and 43 hypoplastic right heart), 78 completed neurodevelopmental testing. Exposure to an impaired MFE was associated with lower cognitive scores (P = .030), although this association became nonsignificant after adjustment for clinical covariates. Impaired MFE was also associated with lower language and receptive communication scores after clinical adjustment (P = .023 and P = .040, respectively) but became nonsignificant after further adjustment for the Child Opportunity Index. No significant differences were observed in fine or gross motor scores, neonatal complications, hospital or intensive care unit stay, and 1-year mortality or transplantation between groups.

Conclusions

Among patients with SVHD, exposure to an impaired MFE was associated with lower cognitive and language outcomes, although these associations were attenuated after accounting for clinical and socioeconomic factors. These findings highlight the importance of early identification and monitoring of children with adverse prenatal exposures.

目的：探讨母胎环境（MFE）对单心室心脏病（SVHD）患儿早期神经发育及临床预后的影响。研究设计：我们对2011-2022年产前诊断为SVHD的患者进行了一项回顾性单中心研究。MFE受损定义为子宫内暴露于糖尿病、先兆子痫、烟草或慢性或妊娠期高血压。在12-36个月龄之间使用Bayley婴幼儿发育量表iii和4来评估神经发育结果。结果：160例SVHD患者（左心发育不全117例，右心发育不全43例）中，78例完成了神经发育测试。暴露于受损的MFE与较低的认知评分相关（P=0.030），尽管在调整临床协变量后，这种关联变得不显著。临床调整后，MFE受损也与较低的语言和接受性沟通得分相关（P分别=0.023和P=0.040），但在进一步调整儿童机会指数后，这一差异不显著。在精细或大运动评分、新生儿并发症、住院或重症监护病房时间、1年死亡率或移植方面，组间无显著差异。结论：在SVHD患者中，暴露于受损的MFE与较低的认知和语言结果相关，尽管在考虑了临床和社会经济因素后，这些关联减弱了。这些发现强调了早期识别和监测产前不良暴露儿童的重要性。

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引用次数: 0

Healthcare Decision-Making and Evolving Autonomy in Adolescents and Young Adults with Cerebral Palsy 青少年和青年脑瘫患者的医疗决策和自主性发展。

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-12-11 DOI: 10.1016/j.jpeds.2025.114953

Chelsey B. Anderson CPO, PhD , Michelle Gorecki MD, MPH , Amy Bailes PT, PhD , Jilda Vargus-Adams MD, MSc , Ellen A. Lipstein MD, MPH

Objective

To evaluate how adolescents and young adults with cerebral palsy (AYACP) make mobility-related health care decisions and seek their perspectives on making decisions about mobility-related health care interventions.

Study design

We purposively recruited AYACP ages 13-21 years from an academic medical center to participate in qualitative semistructured individual interviews. Interview questions explored mobility-related health care interventions and decision-making. We recorded, transcribed, coded, and analyzed interviews using thematic analysis.

Results

AYACP described multiple mobility-related health care decisions and cycling between testing out and choosing interventions. The research team identified four themes: balancing autonomy and support; connecting evolving knowledge and goals to intervention outcomes motivates decision participation; limited agency; and desire for options that effectively address AYACPs’ individual needs. AYACPs want to participate in decision-making about interventions to address their mobility-related goals but describe needing support from adults. AYACP also described their knowledge and goals as evolving throughout adolescence, which often motivated their participation in decisions and treatment plans. In contrast, some AYACP lacked agency in decision-making, which negatively influenced their participation. AYACP have a wide range of individual needs and struggle with finding mobility-related health care interventions that optimally address their individual needs.

Conclusions

AYACP need support in developing knowledge and decision-making skills about mobility-related health care interventions that address their goals. AYACP would benefit from decision support to develop skills for transitioning to adult health care and engaging in decision making.

目的：评价青少年和青壮年脑瘫患者（AYACP）如何做出与活动相关的医疗保健决策，并寻求他们对与活动相关的医疗保健干预决策的看法。研究设计：我们有目的地从一家学术医疗中心招募13-21岁的AYACP参加定性半结构化的个人访谈。访谈问题探讨了与流动性相关的医疗干预和决策。我们使用主题分析对访谈进行记录、转录、编码和分析。结果：AYACP描述了多种与流动性相关的医疗保健决策，以及在测试和选择干预措施之间的循环。研究团队确定了四个主题：平衡自主权和支持；将不断发展的知识和目标与干预结果联系起来，激励决策参与；有限的机构;以及对有效解决ayacp个人需求的选择的渴望。ayacp希望参与有关干预措施的决策，以解决他们与行动相关的目标，但表示需要成年人的支持。AYACP还描述了他们的知识和目标在整个青春期不断发展，这往往促使他们参与决策和治疗计划。相反，部分青年会在决策方面缺乏能动性，这对他们的参与产生了负面影响。AYACP有广泛的个人需求，并努力寻找与流动性相关的医疗干预措施，以最佳地满足他们的个人需求。结论：AYACP需要在发展知识和决策技能方面得到支持，这些知识和决策技能与实现其目标的流动性相关的医疗干预有关。AYACP将受益于决策支持，以发展向成人保健过渡和参与决策的技能。

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引用次数: 0

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

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-12-10 DOI: 10.1016/j.jpeds.2025.114939

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

Objectives

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

Study design

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

Results

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

Conclusions

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

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

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引用次数: 0

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

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-12-10 DOI: 10.1016/j.jpeds.2025.114938

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

Objective

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

Study design

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

Results

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

Conclusions

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

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

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引用次数: 0

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

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-12-09 DOI: 10.1016/j.jpeds.2025.114937

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

Objectives

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

Study design

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

Results

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

Conclusions

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

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

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Information for Readers 读者资讯

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