Journal of Pediatrics最新文献

英文中文

Application of the Target Trial Emulation Framework to Studies in the Pediatric Population 目标试验模拟框架在儿科人群研究中的应用。

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-12-13 DOI: 10.1016/j.jpeds.2025.114941

Jenny W. Sun PhD , Daniel B. Horton MD, MSCE , Timothy J. Savage MD, MPH, MSc , Mehmet Burcu PhD , Sonia Hernandez-Diaz MD, DrPH

引用次数: 0

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

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-12-12 DOI: 10.1016/j.jpeds.2025.114946

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

Objective

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

Study design

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

Results

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

Conclusions

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

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

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引用次数: 0

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

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-12-12 DOI: 10.1016/j.jpeds.2025.114948

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

Objective

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

Study design

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

Results

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

Conclusions

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

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

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引用次数: 0

Corrigendum to Therapeutic Hypothermia in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis (J Pediatr. 2025;288:114793. doi:10.1016/j.jpeds.2025.114793) 治疗性低温治疗在低收入和中等收入国家的纠正：系统评价和荟萃分析[J]儿科学，2015;28:114793。doi: 10.1016 / j.jpeds.2025.114793)

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-12-12 DOI: 10.1016/j.jpeds.2025.114923

H.C. Lee , D.T. Costa-Nobre , A.C. Katheria , R. Mausling , F.L. Nakwa , G.M. Schmölzer , G.M. Weiner , H.G. Liley , ILCOR NLS Task Force

引用次数: 0

Upholding Our PROMISE: National Survey of Pediatrics Residents’ Experiences with Discrimination, Burnout, Belonging, Professional Fulfillment, and Career Plans 坚持我们的承诺：全国儿科住院医师在歧视、倦怠、归属感、专业成就感和职业规划方面的经历调查。

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-12-12 DOI: 10.1016/j.jpeds.2025.114957

Audrea M. Burns PhD , Laura Kester Prakash MD, MPH , Lahia Yemane MD , Oriaku Kas-Osoka MD, MEd , Rebecca Blankenburg MD, MPH , Jyothi Marbin MD, MPH , Patricia Poitevien MD, Msc , Alan Schwartz PhD, JD , Candice Taylor Lucas MD, MPH

Objective

To explore associations between pediatrics residents’ experiences with discrimination, burnout, belonging, professional fulfillment, and career plans, including interest in remaining at their training institution.

Study design

Between October 2020 and January 2021, a national, cross-sectional study titled PROMISE (PROmoting Med-Ed Insight into Supportive Environments) used a 23-item survey of pediatrics residents through the Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network. Descriptive, association, and mediation analyses were conducted for underrepresented in medicine (UIM), Asian and Asian American (AAA), and White residents using multilevel regression and structural equation models.

Results

The study included 799 pediatrics residents (20% UIM) from 24 residency programs. UIM and AAA residents experienced higher discrimination. Among UIM residents, staff discrimination was associated with greater interpersonal disengagement (P = .02), work exhaustion (P < .01), and lower professional fulfillment (P = .04). UIM (P < .01) and AAA (P = .01) residents reported lower belonging even after adjusting for discrimination. Greater belonging was associated with higher likelihood of wanting to remain at one's institution (B = 0.46, 95% CI 0.34-0.57; P < .001). Belonging and professional fulfillment mediated associations between discrimination and intent to stay among UIM residents; for AAA residents, only belonging was a significant mediator.

Conclusions

UIM and AAA pediatric residents reported disproportionately higher discrimination, which was associated with increased burnout and reduced belonging. Institutional efforts to address discrimination are critical for promoting resident well-being and retention in academic medicine.

目的：探讨儿科住院医师歧视经历、职业倦怠、归属感、职业成就感和职业规划（包括留在培训机构的兴趣）之间的关系。研究设计：在2020年10月至2021年1月期间，一项名为PROMISE（促进医学教育对支持环境的洞察）的全国性横断面研究通过儿科项目主任协会纵向教育评估研究网络对儿科居民进行了23项调查。采用多水平回归和结构方程模型对医学（UIM）、亚裔和亚裔美国人（AAA）和白人居民的代表性不足进行了描述性、相关性和中介分析。结果：本研究包括来自24个住院医师项目的799名儿科住院医师（20%为UIM）。UIM和AAA的居民受到的歧视更高。在UIM住院医师中，员工歧视与较高的人际脱离（P = .02）、工作疲惫（P < .01）和较低的职业成就感（P = .04）相关。UIM （P < 0.01）和AAA （P = 0.01）的居民即使在调整歧视后也报告了较低的归属感。更大的归属感与更大的希望留在自己所在机构的可能性相关（B = 0.46, 95% CI 0.34-0.57; P < 0.001）。归属感和职业成就感在大学居民歧视与逗留意向之间的中介作用对于AAA级居民，只有归属感是显著的中介。结论：UIM和AAA儿科住院医师报告了不成比例的高歧视，这与倦怠增加和归属感减少有关。解决歧视问题的机构努力对于促进居民福利和保留学术医学至关重要。

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引用次数: 0

Prevalence of Food Insufficiency Across Subgroups of Children with Special Health-Care Needs 有特殊保健需要的儿童亚群中食物不足的发生率

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-12-12 DOI: 10.1016/j.jpeds.2025.114950

Claire E. Branley BS , Anne E. Fuller MD, MS , Jessica Caouette BS , Alon Peltz MD, MBA, MHS , Arvin Garg MD, MPH , Stephenie C. Lemon PhD

Objective

To determine the association between subgroups of children with special health care needs (SHCN) and food insufficiency, and assess whether this association varies by income level, and to evaluate how food insufficiency trends have changed over the time.

Study design

This was a cross-sectional survey study using the 2016-2023 National Surveys of Children's Health. SHCN subgroups were defined as follows: no special health care needs, prescription medication use only, elevated use of services, and functional limitations. The association between SHCN subgroup and food insufficiency was measured using weighted multivariable logistic regression models. Effect modification by income was evaluated. In addition, linear models described significant changes in food insufficiency rates by SHCN subgroup from 2016 to 2023.

Results

Compared with children without SHCN, children with SHCN who used medications only (aOR = 1.31; 95% CI 1.21-1.41), had elevated use of services (aOR = 1.54; 95% CI 1.45-1.63), or had functional limitations (aOR 1.97; 95% CI 1.82-2.13) had higher odds of food insufficiency. Effect modification by income was significant for children with functional limitations. From 2016 to 2023, the associations between SHCN and food insufficiency were similar.

Conclusion

Children with functional limitations are an especially high-risk group who require attention in public health efforts to reduce food insufficiency.

目的：确定有特殊保健需要的儿童亚群（SHCN）与食物不足之间的关系，并评估这种关系是否因收入水平而异，以及食物不足趋势如何随时间变化。研究设计：这是一项使用2016-2023年全国儿童健康调查的横断面调查研究。SHCN亚组的定义如下：无特殊医疗需求、仅使用处方药、服务使用率较高和功能受限。使用加权多变量logistic回归模型测量SHCN亚组与食物不足之间的关联。评价了收入对效果的影响。此外，线性模型描述了2016-2023年SHCN亚组食物不足率的显著变化。结果：与没有SHCN的儿童相比，仅使用药物的SHCN儿童（aOR=1.31; 95% CI 1.21-1.41），服务使用增加（aOR=1.54; 95% CI 1.45-1.63），或有功能限制（aOR 1.97; 95% CI 1.82-2.13），食物不足的几率更高。贫困对功能障碍儿童的影响显著。从2016年到2023年，SHCN与食物不足之间的关联相似。结论：功能障碍儿童是一个特别的高危人群，需要在公共卫生工作中予以重视，以减少食物不足。

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引用次数: 0

Assessment of Oral Anticancer Medicines in Pediatric Patients before the Research to Accelerate Cures and Equity (RACE) Act, 2007-2021 2007-2021年RACE法案出台前儿科患者口服抗癌药物的评估

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-12-12 DOI: 10.1016/j.jpeds.2025.114949

Mahnum Shahzad PhD , Steven G. DuBois MD , Rebecca Costa MS , Stephanie Argetsinger MS, MPH , Dennis Ross-Degnan ScD , Florence T. Bourgeois MD, MPH , Anita K. Wagner PharmD, MPH, DrPH

Objective

To assess the relationship between availability of pediatric labeling information as well as on-label pediatric safety information and the use of oral targeted anticancer medications (OTAMs) by pediatric patients.

Study design

We identified all OTAMs first approved by the Food and Drug Administration from January 1, 2007, to September 31, 2021, and assessed their use by children with cancers on the basis of claims data in Optum's deidentified Clinformatics Data Mart from January 1, 2007, to September 31, 2021.

Results

Over the study period and across cancer types, 3.8% of patients with childhood cancer received at least 1 OTAM. The majority of OTAMs used (29.4% in 2008 and 51.7% to 88.6% in other years) did not have an indication for the diagnosed pediatric cancers. First OTAM treatment episodes lasted longer (ie, discontinuations happened later) for drugs with pediatric cancer indications and safety information compared with those without the information during the episode of use. From 2007 to 2021, median standard costs of 30-day supplies of OTAMs for patients <18 years old were $6714 and inflation-adjusted, out-of-pocket median spending for a 30-day supply of OTAMs was about $11.

Conclusions

Our results show relatively limited yet increasing pediatric OTAM use over time. We document a greater likelihood of earlier discontinuation and significant financial cost for drugs without on-label pediatric cancer indications and safety information. There is a need for a robust regulatory framework to mandate the timely generation of pediatric population-specific efficacy and safety evidence.

目的：评估儿科标签信息和标签上安全信息的可获得性与儿科患者口服靶向抗癌药物（OTAMs）的使用之间的关系。研究设计：我们确定了2007年1月1日至2021年9月31日期间首次获得美国食品和药物管理局批准的所有OTAMs，并根据Optum的去标识Clinformatics®数据集市（2007年1月1日至2021年9月31日）的索赔数据，评估了癌症儿童对OTAMs的使用情况。结果：在整个研究期间，所有癌症类型中，3.8%的儿童癌症患者至少接受了一次OTAM。大多数使用的otam（2008年为29.4%，其他年份为51.7%至88.6%）没有诊断出儿童癌症的指征。有儿童癌症适应症和安全信息的药物与在使用期间没有相关信息的药物相比，首次OTAM治疗持续时间更长（即停药时间较晚）。结论：我们的研究结果显示，随着时间的推移，儿科OTAM的使用相对有限，但仍在增加。我们记录了没有标签上的儿童癌症适应症和安全信息的药物早期停药的更高可能性和显著的财务成本。有必要建立一个强有力的监管框架，以强制要求及时生成针对儿科人群的有效性和安全性证据。

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引用次数: 0

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

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-12-11 DOI: 10.1016/j.jpeds.2025.114951

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

引用次数: 0

Intranasal Septal Hematoma: A Diagnosis Not to Miss 鼻中隔血肿：一个不容错过的诊断。

IF 3.5 2区医学 Q1 PEDIATRICS

Journal of Pediatrics

Pub Date : 2025-12-11 DOI: 10.1016/j.jpeds.2025.114947

Joana De Beir MD, Diana Valbom Gonçalves MD, Joana Miguéis MD, José Romão MD

引用次数: 0

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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