Pub Date : 2024-10-18DOI: 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.
{"title":"Long-Term Mental Health Outcomes of Bronchopulmonary Dysplasia in Neonates: An 18-Year National Cohort Study","authors":"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","doi":"10.1016/j.jpeds.2024.114341","DOIUrl":"10.1016/j.jpeds.2024.114341","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the association between neonatal bronchopulmonary dysplasia and the subsequent development of mental health conditions in children and adolescents.</div></div><div><h3>Study design</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"276 ","pages":"Article 114341"},"PeriodicalIF":3.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481230","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 : 2024-10-18DOI: 10.1016/j.jpeds.2024.114355
Jennifer O. Lambert MD, MHS , Melissa R. Lutz MD, MHS , Colin J. Orr MD, MPH , Jonathan S. Schildcrout PhD , Aihua Bian MPH , Kori B. Flower MD, MS, MPH , H. Shonna Yin MD, MSc , Lee M. Sanders MD, MPH , William J. Heerman MD, MPH , Russell L. Rothman MD, MPP , Alan M. Delamater PhD , Charles T. Wood MD, MPH , Michelle J. White MD, MPH , Eliana M. Perrin MD, MPH
Objective
To examine the association between social capital and household food insecurity among US families with newborns.
Study design
This cross-sectional analysis used enrollment data from 881 newborn-caregiver dyads at 6 geographically-diverse US academic sites enrolled in the Greenlight Plus Trial, a comparative effectiveness trial to prevent childhood obesity. Ordinal proportional-odds models were used to characterize the associations of 2 self-reported measures of social capital: (1) caregiver social support and (2) neighborhood social cohesion, with household food insecurity after controlling for sociodemographic characteristics.
Results
Among 881 newborn-caregiver dyads (49% Hispanic, 23% non-Hispanic White, 17% non-Hispanic Black; 49% with annual household income <$50 000), food security was high for 75%, marginal for 9%, low for 11% and very low for 4%. In covariate-adjusted analyses, caregivers with a low social support score of 18 had 5 times the odds (aOR = 5.03 95% CI = 3.28-7.74) of greater food insecurity compared with caregivers with a high social support score of 30. Caregivers with a low neighborhood social cohesion score of 10 had nearly 3 times the odds (aOR = 2.87 95% CI 1.61-5.11) of greater food insecurity compared with caregivers with a high neighborhood social cohesion score of 20. These associations remained robust when both social capital measures were included in one model.
Conclusions
Caregiver social support and neighborhood social cohesion each appear to be inversely associated with food insecurity among US families with newborns. Longitudinal research is needed to determine the directionality of these relationships and whether improving social capital for families with young children reduces household food insecurity.
{"title":"Good Friends and Good Neighbors: Social Capital and Food Insecurity in Families with Newborns","authors":"Jennifer O. Lambert MD, MHS , Melissa R. Lutz MD, MHS , Colin J. Orr MD, MPH , Jonathan S. Schildcrout PhD , Aihua Bian MPH , Kori B. Flower MD, MS, MPH , H. Shonna Yin MD, MSc , Lee M. Sanders MD, MPH , William J. Heerman MD, MPH , Russell L. Rothman MD, MPP , Alan M. Delamater PhD , Charles T. Wood MD, MPH , Michelle J. White MD, MPH , Eliana M. Perrin MD, MPH","doi":"10.1016/j.jpeds.2024.114355","DOIUrl":"10.1016/j.jpeds.2024.114355","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the association between social capital and household food insecurity among US families with newborns.</div></div><div><h3>Study design</h3><div>This cross-sectional analysis used enrollment data from 881 newborn-caregiver dyads at 6 geographically-diverse US academic sites enrolled in the Greenlight Plus Trial, a comparative effectiveness trial to prevent childhood obesity. Ordinal proportional-odds models were used to characterize the associations of 2 self-reported measures of social capital: (1) caregiver social support and (2) neighborhood social cohesion, with household food insecurity after controlling for sociodemographic characteristics.</div></div><div><h3>Results</h3><div>Among 881 newborn-caregiver dyads (49% Hispanic, 23% non-Hispanic White, 17% non-Hispanic Black; 49% with annual household income <$50 000), food security was high for 75%, marginal for 9%, low for 11% and very low for 4%. In covariate-adjusted analyses, caregivers with a low social support score of 18 had 5 times the odds (aOR = 5.03 95% CI = 3.28-7.74) of greater food insecurity compared with caregivers with a high social support score of 30. Caregivers with a low neighborhood social cohesion score of 10 had nearly 3 times the odds (aOR = 2.87 95% CI 1.61-5.11) of greater food insecurity compared with caregivers with a high neighborhood social cohesion score of 20. These associations remained robust when both social capital measures were included in one model.</div></div><div><h3>Conclusions</h3><div>Caregiver social support and neighborhood social cohesion each appear to be inversely associated with food insecurity among US families with newborns. Longitudinal research is needed to determine the directionality of these relationships and whether improving social capital for families with young children reduces household food insecurity.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"276 ","pages":"Article 114355"},"PeriodicalIF":3.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481227","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 : 2024-10-18DOI: 10.1016/j.jpeds.2024.114363
Kerri Z. Machut MD , Christine E. Bishop MD , Emily R. Miller MD , Christiane E.L. Dammann MD , Milenka Cuevas Guaman MD
Objective
To describe neonatology leaders’ perspectives on ideal staffing practices, including clinical work, nonclinical roles, shift characteristics, and flexibility. Although the current state of neonatology staffing issues is reported in the literature, a description of ideal, recommended staffing practices is lacking.
Study design
We performed a qualitative study, using purposive sampling to interview 26 neonatology leaders. Semi-structured interviews included open-ended questions on ideal staffing practices in 4 categories: clinical and nonclinical aspects of work, shift characteristics, and flexibility in the work environment. We conducted a directed content qualitative analysis of interview transcripts.
Results
Leaders described their perspectives of ideal staffing practices. All clinical hours should count toward total clinical time and clinical full-time equivalent, and many nonclinical efforts should be compensated with time or money. Most stated varying workloads reflective of team structures and patient factors should be considered. Maximum in-house shift length should be ≤ 24 hours and weekend assignments should be equitable, irrespective of career track. Most endorsed flexibility at the individual physician level with a clear plan for covering variable staffing acute and chronic needs.
Conclusions
Neonatology leaders recognize current staffing challenges and the need to evolve toward more ideal staffing practices. However, competing interests and complexities drive maintenance of the status quo and make change difficult for healthcare organizations and academic departments. Future work needs to create and measure optimal, standardized, and transparent staffing practices with appropriate adjustments for clinical, administrative, teaching, and scholarly obligations.
{"title":"Neonatology Staffing Practices: An In-Depth Exploration of Leaders’ Perspectives","authors":"Kerri Z. Machut MD , Christine E. Bishop MD , Emily R. Miller MD , Christiane E.L. Dammann MD , Milenka Cuevas Guaman MD","doi":"10.1016/j.jpeds.2024.114363","DOIUrl":"10.1016/j.jpeds.2024.114363","url":null,"abstract":"<div><h3>Objective</h3><div>To describe neonatology leaders’ perspectives on ideal staffing practices, including clinical work, nonclinical roles, shift characteristics, and flexibility. Although the current state of neonatology staffing issues is reported in the literature, a description of ideal, recommended staffing practices is lacking.</div></div><div><h3>Study design</h3><div>We performed a qualitative study, using purposive sampling to interview 26 neonatology leaders. Semi-structured interviews included open-ended questions on ideal staffing practices in 4 categories: clinical and nonclinical aspects of work, shift characteristics, and flexibility in the work environment. We conducted a directed content qualitative analysis of interview transcripts.</div></div><div><h3>Results</h3><div>Leaders described their perspectives of ideal staffing practices. All clinical hours should count toward total clinical time and clinical full-time equivalent, and many nonclinical efforts should be compensated with time or money. Most stated varying workloads reflective of team structures and patient factors should be considered. Maximum in-house shift length should be ≤ 24 hours and weekend assignments should be equitable, irrespective of career track. Most endorsed flexibility at the individual physician level with a clear plan for covering variable staffing acute and chronic needs.</div></div><div><h3>Conclusions</h3><div>Neonatology leaders recognize current staffing challenges and the need to evolve toward more ideal staffing practices. However, competing interests and complexities drive maintenance of the status quo and make change difficult for healthcare organizations and academic departments. Future work needs to create and measure optimal, standardized, and transparent staffing practices with appropriate adjustments for clinical, administrative, teaching, and scholarly obligations.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"276 ","pages":"Article 114363"},"PeriodicalIF":3.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481240","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 examine outcomes and associated risk factors for children who undergo surgery for lung hydatidosis (LH).
Study design
Through a retrospective and analytical-aim-study, over a period of 35 years in 2 surgical departments, we reported all operative cases for LH in children, regardless of cyst number, location, and aspect. Univariate and multivariable analyses were used to assess variables potentially predictive of postoperative morbidity.
Results
In total, 456 children with a mean age of 10.3 years were included. We performed 544 surgical procedures for 704 cysts with a median size of 60 mm (range 10–200 mm). Thirty-six percent of cysts were complicated. Conservative surgery was performed in 98.5% of cases and anatomical lung resection was required for 1.47% of children. Postoperative complications occurred in 24.4% of children and one death was recorded (0.2%). After multivariable analysis, the independent-associated morbidity risk factors for postoperative morbidity were anatomical lung resection, intensive care unit stay, complicated cyst, a cyst size ≥60 mm, ≥3 bronchial fistulas, associated liver hydatidosis, and the presence or occurrence of empyema during surgery.
Conclusions
Conservative surgery sparing the lung parenchyma is the treatment of choice for lung hydatidosis and is associated with a low mortality rate. Knowledge of independent risk factors for morbidity may help clinicians to manage children with LH more adequately and improve postoperative outcomes.
{"title":"Outcomes and Risk Factors for Morbidity After Lung Hydatidosis Surgery in Children","authors":"Zied Chaari MD , Saloua Ammar MD , Aymen Ben Ayed MD , Emna Krichen MD , Aymen Dammak MD , Jihen Jdidi MD , Abdessalem Hentati MD , Riadh Mhiri MD , Faiza Safi MD , Imed Frikha MD","doi":"10.1016/j.jpeds.2024.114367","DOIUrl":"10.1016/j.jpeds.2024.114367","url":null,"abstract":"<div><h3>Objective</h3><div>To examine outcomes and associated risk factors for children who undergo surgery for lung hydatidosis (LH).</div></div><div><h3>Study design</h3><div>Through a retrospective and analytical-aim-study, over a period of 35 years in 2 surgical departments, we reported all operative cases for LH in children, regardless of cyst number, location, and aspect. Univariate and multivariable analyses were used to assess variables potentially predictive of postoperative morbidity.</div></div><div><h3>Results</h3><div>In total, 456 children with a mean age of 10.3 years were included. We performed 544 surgical procedures for 704 cysts with a median size of 60 mm (range 10–200 mm). Thirty-six percent of cysts were complicated. Conservative surgery was performed in 98.5% of cases and anatomical lung resection was required for 1.47% of children. Postoperative complications occurred in 24.4% of children and one death was recorded (0.2%). After multivariable analysis, the independent-associated morbidity risk factors for postoperative morbidity were anatomical lung resection, intensive care unit stay, complicated cyst, a cyst size ≥60 mm, ≥3 bronchial fistulas, associated liver hydatidosis, and the presence or occurrence of empyema during surgery.</div></div><div><h3>Conclusions</h3><div>Conservative surgery sparing the lung parenchyma is the treatment of choice for lung hydatidosis and is associated with a low mortality rate. Knowledge of independent risk factors for morbidity may help clinicians to manage children with LH more adequately and improve postoperative outcomes.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"276 ","pages":"Article 114367"},"PeriodicalIF":3.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481241","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 : 2024-10-18DOI: 10.1016/j.jpeds.2024.114370
Harrison Wilde BSc , Christopher Tomlinson MD, PhD , Bilal A. Mateen MD, PhD , David Selby PhD , Hari Krishnan Kanthimathinathan MD , Spiros Denaxas PhD , Seth Flaxman PhD , Sebastian Vollmer PhD , Christina Pagel PhD , Katherine Brown MD, MPH , CVD-COVID-UK/COVID-IMPACT Consortium
Objective
To investigate the changing characteristics of SARS-CoV-2–related pediatric hospital admissions over time.
Study design
This was a national, observational cohort study from July 1, 2020, to August 31, 2023, using English population-linked electronic health records. We identified 45 203 children younger than 18 years old in whom SARS-CoV-2 either caused or contributed to hospitalization, excluding those admitted with “incidental” infection. Studied outcomes were types of hospitalization and severe hospitalizations involving either critical care or pediatric inflammatory multisystem syndrome-temporally associated with SARS-CoV-2 (PIMS-TS).
Results
There were 45 920 SARS-CoV-2–related hospitalizations in children: 34 870 (75.9%) attributable to COVID-19; 1845 (4.0%) attributable to PIMS-TS; 8330 (18.1%) with SARS-CoV-2 as contributor to admission; and 875 (1.9%) acquired nosocomial SARS-CoV-2 infection. The most notable changes between the first 3 waves (March 2020 through November 2021) and the Omicron era (December 2021 onwards) were a decrease in PIMS-TS from 1575 of 14 020 (11.2%) to 270 of 31 905 (0.8%); a reduction in critical care use from 1175 of 14 020 (8.4%) to 1390 of 31 905 (4.4%); a decreased in mortality rate among those hospitalized from 521 per 100 000 to 249 per 100 000; and a decrease in the median age of hospitalized children from 4.7 (IQR 0.6,12.3) to 1.1 (IQR 0.3,6.4) years. Of children hospitalized, infants, 10.2% of whom had a recorded underlying health condition, comprised 4225 of 14 020 (30.1%) admissions 2020 through 2021 and 15 555 of 31 900 (48.8%) since 2022. (P < .001 for all comparisons).
Conclusions
Infants are now the pediatric age group most affected by SARS-CoV-2, at least partially because they have the least immunity to the virus, and are most vulnerable to respiratory illnesses.
{"title":"Trends in Pediatric Hospital Admissions Caused or Contributed by SARS-CoV-2 Infection in England","authors":"Harrison Wilde BSc , Christopher Tomlinson MD, PhD , Bilal A. Mateen MD, PhD , David Selby PhD , Hari Krishnan Kanthimathinathan MD , Spiros Denaxas PhD , Seth Flaxman PhD , Sebastian Vollmer PhD , Christina Pagel PhD , Katherine Brown MD, MPH , CVD-COVID-UK/COVID-IMPACT Consortium","doi":"10.1016/j.jpeds.2024.114370","DOIUrl":"10.1016/j.jpeds.2024.114370","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the changing characteristics of SARS-CoV-2–related pediatric hospital admissions over time.</div></div><div><h3>Study design</h3><div>This was a national, observational cohort study from July 1, 2020, to August 31, 2023, using English population-linked electronic health records. We identified 45 203 children younger than 18 years old in whom SARS-CoV-2 either caused or contributed to hospitalization, excluding those admitted with “incidental” infection. Studied outcomes were types of hospitalization and severe hospitalizations involving either critical care or pediatric inflammatory multisystem syndrome-temporally associated with SARS-CoV-2 (PIMS-TS).</div></div><div><h3>Results</h3><div>There were 45 920 SARS-CoV-2–related hospitalizations in children: 34 870 (75.9%) attributable to COVID-19; 1845 (4.0%) attributable to PIMS-TS; 8330 (18.1%) with SARS-CoV-2 as contributor to admission; and 875 (1.9%) acquired nosocomial SARS-CoV-2 infection. The most notable changes between the first 3 waves (March 2020 through November 2021) and the Omicron era (December 2021 onwards) were a decrease in PIMS-TS from 1575 of 14 020 (11.2%) to 270 of 31 905 (0.8%); a reduction in critical care use from 1175 of 14 020 (8.4%) to 1390 of 31 905 (4.4%); a decreased in mortality rate among those hospitalized from 521 per 100 000 to 249 per 100 000; and a decrease in the median age of hospitalized children from 4.7 (IQR 0.6,12.3) to 1.1 (IQR 0.3,6.4) years. Of children hospitalized, infants, 10.2% of whom had a recorded underlying health condition, comprised 4225 of 14 020 (30.1%) admissions 2020 through 2021 and 15 555 of 31 900 (48.8%) since 2022. (<em>P</em> < .001 for all comparisons).</div></div><div><h3>Conclusions</h3><div>Infants are now the pediatric age group most affected by SARS-CoV-2, at least partially because they have the least immunity to the virus, and are most vulnerable to respiratory illnesses.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"276 ","pages":"Article 114370"},"PeriodicalIF":3.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481245","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 : 2024-10-18DOI: 10.1016/j.jpeds.2024.114364
Benjamin Africk MD , Ingrid Luo MS , Andrew Silverman MD, MHS , Prathyusha Teeyagura MSBI , Karla Jackson MSN , Jeilo Gauna BA , Elizabeth Mayne MD, PhD , Sarah Lee MD
Objective
To assess for improvement in diagnostic efficiency following implementation of an institutional pediatric stroke alert protocol at a quaternary children's hospital, and to compare characteristics of in-hospital (IH) and out-of-hospital (OH) stroke alert activations.
Study design
We retrospectively reviewed data from pediatric stroke alerts called for children between age 1 month and 21 years of age at our quaternary children's hospital between October 2016 and October 2022 after implementation of an institutional stroke alert protocol. Generalized linear models assessed code-to-image (CTI) time over the study period, with and without interaction terms for alert location. Demographic, clinical, and imaging characteristics between IH and OH alerts were compared using Fisher's exact test or Mann–Whitney U test.
Results
Of 206 total stroke activations, 129 (62.6%) occurred IH and 77 (37.4%) occurred OH. Overall mean CTI time decreased by 4.56 minutes per year (P = .007) after adjusting for confounders. The association between year and mean CTI time was significantly stronger for IH alerts (decrease of 8.33 minutes/year) compared with OH alerts (increase of 1.90 minutes/year). Subgroup analyses showed that CTI for computed tomography (CT) ± CT angiography and magnetic resonance imaging (MRI) without sedation improved, although CTI time for MRI with sedation did not change over time. IH/OH divergent trends were consistent for CT ± CTA and nonsedated MRI.
Conclusions
After implementation of a pediatric stroke alert protocol, we observed a steady and significant improvement in CTI times for IH, but not OH alerts.
{"title":"Use of a Stroke Alert Protocol and Outcomes at a Quaternary Children’s Hospital","authors":"Benjamin Africk MD , Ingrid Luo MS , Andrew Silverman MD, MHS , Prathyusha Teeyagura MSBI , Karla Jackson MSN , Jeilo Gauna BA , Elizabeth Mayne MD, PhD , Sarah Lee MD","doi":"10.1016/j.jpeds.2024.114364","DOIUrl":"10.1016/j.jpeds.2024.114364","url":null,"abstract":"<div><h3>Objective</h3><div>To assess for improvement in diagnostic efficiency following implementation of an institutional pediatric stroke alert protocol at a quaternary children's hospital, and to compare characteristics of in-hospital (IH) and out-of-hospital (OH) stroke alert activations.</div></div><div><h3>Study design</h3><div>We retrospectively reviewed data from pediatric stroke alerts called for children between age 1 month and 21 years of age at our quaternary children's hospital between October 2016 and October 2022 after implementation of an institutional stroke alert protocol. Generalized linear models assessed code-to-image (CTI) time over the study period, with and without interaction terms for alert location. Demographic, clinical, and imaging characteristics between IH and OH alerts were compared using Fisher's exact test or Mann–Whitney U test.</div></div><div><h3>Results</h3><div>Of 206 total stroke activations, 129 (62.6%) occurred IH and 77 (37.4%) occurred OH. Overall mean CTI time decreased by 4.56 minutes per year (<em>P</em> = .007) after adjusting for confounders. The association between year and mean CTI time was significantly stronger for IH alerts (decrease of 8.33 minutes/year) compared with OH alerts (increase of 1.90 minutes/year). Subgroup analyses showed that CTI for computed tomography (CT) ± CT angiography and magnetic resonance imaging (MRI) without sedation improved, although CTI time for MRI with sedation did not change over time. IH/OH divergent trends were consistent for CT ± CTA and nonsedated MRI.</div></div><div><h3>Conclusions</h3><div>After implementation of a pediatric stroke alert protocol, we observed a steady and significant improvement in CTI times for IH, but not OH alerts.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"276 ","pages":"Article 114364"},"PeriodicalIF":3.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481246","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 : 2024-10-18DOI: 10.1016/j.jpeds.2024.114372
Banu Ahtam MSc, DPhil , Julie Meadows BA , Laura F. Berto , Christina Lildharrie BS , Marina Solti MD , Justin M. Doo BS , Henry A. Feldman PhD , Rutvi Vyas MS , Fan Zhang PhD , Lauren J. O'Donnell PhD , Yogesh Rathi PhD , Jeffrey Stout PhD , Edward R. Smith MD , Darren B. Orbach MD, PhD , Alfred P. See MD , P. Ellen Grant MSc, MD , Laura L. Lehman MD, MPH
Objective
To assess whether white matter injuries differ in symptomatic vs asymptomatic moyamoya-affected hemispheres using diffusion magnetic resonance imaging since there is controversy regarding when or if to revascularize children with asymptomatic moyamoya.
Study design
We conducted a cross-sectional study of children with moyamoya who underwent diffusion magnetic resonance imaging before revascularization surgery as well as controls without moyamoya. We measured the fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity of white matter tracts in the watershed regions. Moyamoya-affected hemispheres were included if they did not have any visible stroke or infarct. Moyamoya-affected hemispheres were labeled “symptomatic” if transient ischemic attack, seizure, or movement disorder were localizable to that hemisphere, or if the child experienced headaches. Moyamoya-affected hemispheres were “asymptomatic” if the child did not have symptoms attributable to that hemisphere. Asymptomatic and symptomatic hemispheres were compared with each other and control children using ANOVA.
Results
We included 17 children with moyamoya with 26 moyamoya-affected hemispheres and 27 control children. Compared with controls, mean diffusivity, radial diffusivity, and axial diffusivity were greater in both symptomatic and asymptomatic moyamoya-affected hemispheres but were not significantly different from each other.
Conclusions
Children with moyamoya without stroke or silent infarct have unrecognized white matter injury that is similar in both symptomatic and asymptomatic moyamoya-affected hemispheres, suggesting that symptoms do not accurately reflect moyamoya severity.
{"title":"Symptoms Do Not Predict White Matter Injury in the Watershed Regions in Children with Moyamoya","authors":"Banu Ahtam MSc, DPhil , Julie Meadows BA , Laura F. Berto , Christina Lildharrie BS , Marina Solti MD , Justin M. Doo BS , Henry A. Feldman PhD , Rutvi Vyas MS , Fan Zhang PhD , Lauren J. O'Donnell PhD , Yogesh Rathi PhD , Jeffrey Stout PhD , Edward R. Smith MD , Darren B. Orbach MD, PhD , Alfred P. See MD , P. Ellen Grant MSc, MD , Laura L. Lehman MD, MPH","doi":"10.1016/j.jpeds.2024.114372","DOIUrl":"10.1016/j.jpeds.2024.114372","url":null,"abstract":"<div><h3>Objective</h3><div>To assess whether white matter injuries differ in symptomatic vs asymptomatic moyamoya-affected hemispheres using diffusion magnetic resonance imaging since there is controversy regarding when or if to revascularize children with asymptomatic moyamoya.</div></div><div><h3>Study design</h3><div>We conducted a cross-sectional study of children with moyamoya who underwent diffusion magnetic resonance imaging before revascularization surgery as well as controls without moyamoya. We measured the fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity of white matter tracts in the watershed regions. Moyamoya-affected hemispheres were included if they did not have any visible stroke or infarct. Moyamoya-affected hemispheres were labeled “symptomatic” if transient ischemic attack, seizure, or movement disorder were localizable to that hemisphere, or if the child experienced headaches. Moyamoya-affected hemispheres were “asymptomatic” if the child did not have symptoms attributable to that hemisphere. Asymptomatic and symptomatic hemispheres were compared with each other and control children using ANOVA.</div></div><div><h3>Results</h3><div>We included 17 children with moyamoya with 26 moyamoya-affected hemispheres and 27 control children. Compared with controls, mean diffusivity, radial diffusivity, and axial diffusivity were greater in both symptomatic and asymptomatic moyamoya-affected hemispheres but were not significantly different from each other.</div></div><div><h3>Conclusions</h3><div>Children with moyamoya without stroke or silent infarct have unrecognized white matter injury that is similar in both symptomatic and asymptomatic moyamoya-affected hemispheres, suggesting that symptoms do not accurately reflect moyamoya severity.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"276 ","pages":"Article 114372"},"PeriodicalIF":3.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481243","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 : 2024-10-18DOI: 10.1016/j.jpeds.2024.114368
Holly M. Frost MD , Timothy C. Jenkins MD , Jennifer C. Meece PhD , Connie Savor-Price MD , Michael L. Wilson MD , Amy Keith MPH , Amy Stein PhD , Theresa Morin MA , Shaun Cosgrove MS , Melanie Kiernan BS , Thresia Sebastian MD , Samuel R. Dominguez MD
Objective
To determine the causes of conjunctivitis and whether clinical presentations and outcomes differ by pathogen.
Study design
This multicenter, case-control study enrolled 390 children (194 cases, 196 controls) whose conjunctival samples were tested for bacterial and viral pathogens. Caregivers completed surveys tracking symptoms, antibiotic use, school attendance, and adverse events. The outcomes analyzed included the prevalence of microorganisms detected by polymerase chain reaction in cases vs controls, symptoms, rate of resolution by day 5, school/childcare attendance, and parent-reported antibiotic-related adverse incidents.
Results
Most cases (148, 76%) and controls (112, 57%) had bacteria identified, although only detection of Haemophilus influenzae was associated with conjunctivitis (aOR 4.59, 95% CI 2.86, 7.37). Purulent discharge was associated with H influenzae (aOR 2.47, 95% CI 1.23, 5.01) and occurred in 92 (77%) cases in which H influenzae was detected and 39 (53%) in which H influenzae was not detected. Improvement (186, 96%) and resolution (166, 86%) were observed by day 5 for most children and did not differ on the basis of ophthalmic antibiotic use. Caregivers reported antibiotic-associated adverse events for 21 (20%) children, with 8 (8%) requiring a medical visit.
Conclusions
Only H influenzae was significantly associated with conjunctivitis. Symptoms did not differ in children with or without bacteria detected by polymerase chain reaction. Independent of antibiotic use, most children experienced resolution by day 5, but parents reported adverse events in 20% of children treated with topical antibiotics, underscoring the importance of judicious prescribing.
{"title":"Etiology and Outcomes of Acute Infectious Conjunctivitis in Children","authors":"Holly M. Frost MD , Timothy C. Jenkins MD , Jennifer C. Meece PhD , Connie Savor-Price MD , Michael L. Wilson MD , Amy Keith MPH , Amy Stein PhD , Theresa Morin MA , Shaun Cosgrove MS , Melanie Kiernan BS , Thresia Sebastian MD , Samuel R. Dominguez MD","doi":"10.1016/j.jpeds.2024.114368","DOIUrl":"10.1016/j.jpeds.2024.114368","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the causes of conjunctivitis and whether clinical presentations and outcomes differ by pathogen.</div></div><div><h3>Study design</h3><div>This multicenter, case-control study enrolled 390 children (194 cases, 196 controls) whose conjunctival samples were tested for bacterial and viral pathogens. Caregivers completed surveys tracking symptoms, antibiotic use, school attendance, and adverse events. The outcomes analyzed included the prevalence of microorganisms detected by polymerase chain reaction in cases vs controls, symptoms, rate of resolution by day 5, school/childcare attendance, and parent-reported antibiotic-related adverse incidents.</div></div><div><h3>Results</h3><div>Most cases (148, 76%) and controls (112, 57%) had bacteria identified, although only detection of <em>Haemophilus influenzae</em> was associated with conjunctivitis (aOR 4.59, 95% CI 2.86, 7.37). Purulent discharge was associated with <em>H influenzae</em> (aOR 2.47, 95% CI 1.23, 5.01) and occurred in 92 (77%) cases in which <em>H influenzae</em> was detected and 39 (53%) in which <em>H influenzae</em> was not detected. Improvement (186, 96%) and resolution (166, 86%) were observed by day 5 for most children and did not differ on the basis of ophthalmic antibiotic use. Caregivers reported antibiotic-associated adverse events for 21 (20%) children, with 8 (8%) requiring a medical visit.</div></div><div><h3>Conclusions</h3><div>Only <em>H influenzae</em> was significantly associated with conjunctivitis. Symptoms did not differ in children with or without bacteria detected by polymerase chain reaction. Independent of antibiotic use, most children experienced resolution by day 5, but parents reported adverse events in 20% of children treated with topical antibiotics, underscoring the importance of judicious prescribing.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"276 ","pages":"Article 114368"},"PeriodicalIF":3.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481226","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 : 2024-10-16DOI: 10.1016/j.jpeds.2024.114357
Jeffrey D. Zampi MD , Dawn L. Ilardi PhD, ABPP-CN , Courtney E. McCracken PhD , Yun Zhang PhD , Andrew C. Glatz MD, MSCE , Bryan H. Goldstein MD , Christopher J. Petit MD , Athar M. Qureshi MD , Caren S. Goldberg MD, MS , Mark A. Law MD , Jeffery J. Meadows MD , Shabana Shahanavaz MD , Sarosh P. Batlivala MD, MSCI , Shiraz A. Maskatia MD , Michael L. O'Byrne MD, MSCE , R. Allen Ligon MD , Joelle A. Pettus MPH, MS , Asaad Beshish MD , Jennifer C. Romano MD , Kathryn O. Stack MD , George T. Nicholson MD
Objective
To assess the association between primary and staged repair of neonatal symptomatic tetralogy of Fallot (sTOF) and neurodevelopmental outcomes in preschool through school-age children.
Study design
Multicenter cohort (n = 9 sites) study of patients with sTOF who underwent neonatal intervention between 2005 and 2017. The neurodevelopmental outcomes measures included caregivers’ ratings of executive function with the Behavior Rating Inventory of Executive Function, and psychosocial functioning with the Behavior Assessment System for Children – third Edition (BASC-3). Results were compared with normative data and by treatment strategy (primary repair vs staged repair). A parent survey assessed history of disabilities and access to services related to neurodevelopment.
Results
Although the majority of patients (median age 8.3 years, IQR 5.7-11.2) had median Behavior Rating Inventory of Executive Function and BASC-3 scores within the normal range, a proportion had clinically elevated (abnormal) scores, especially in the school-age patient subgroup (Behavior Rating Inventory of Executive Function 24%-30% and BASC 20%-37%). There were no statistically significant differences based on treatment strategy for either the Behavior Rating Inventory of Executive Function or BASC-3. However, lower birth weight, genetic syndrome, and medical complexity were significantly associated with worse executive function, and lower maternal education was associated in school-age children with lower executive and psychosocial functioning. Ongoing disabilities were relatively common (learning disability 35%, speech delay 33%, developmental delay 31%), although up to 50% of children were not receiving educational or developmental services.
Conclusions
Elevated executive and psychosocial concerns are present in the patient population with sTOF. Although initial treatment strategy appears unrelated to neurodevelopmental outcomes, lower birth weight, genetic syndrome, and medical complexity and lower maternal education are risk factors. Early recognition of neurodevelopmental concerns can facilitate access to appropriate neurodevelopmental services in this high-risk group.
{"title":"Comparing Parent Perception of Neurodevelopment after Primary versus Staged Repair of Neonatal Symptomatic Tetralogy of Fallot","authors":"Jeffrey D. Zampi MD , Dawn L. Ilardi PhD, ABPP-CN , Courtney E. McCracken PhD , Yun Zhang PhD , Andrew C. Glatz MD, MSCE , Bryan H. Goldstein MD , Christopher J. Petit MD , Athar M. Qureshi MD , Caren S. Goldberg MD, MS , Mark A. Law MD , Jeffery J. Meadows MD , Shabana Shahanavaz MD , Sarosh P. Batlivala MD, MSCI , Shiraz A. Maskatia MD , Michael L. O'Byrne MD, MSCE , R. Allen Ligon MD , Joelle A. Pettus MPH, MS , Asaad Beshish MD , Jennifer C. Romano MD , Kathryn O. Stack MD , George T. Nicholson MD","doi":"10.1016/j.jpeds.2024.114357","DOIUrl":"10.1016/j.jpeds.2024.114357","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the association between primary and staged repair of neonatal symptomatic tetralogy of Fallot (sTOF) and neurodevelopmental outcomes in preschool through school-age children.</div></div><div><h3>Study design</h3><div>Multicenter cohort (n = 9 sites) study of patients with sTOF who underwent neonatal intervention between 2005 and 2017. The neurodevelopmental outcomes measures included caregivers’ ratings of executive function with the Behavior Rating Inventory of Executive Function, and psychosocial functioning with the Behavior Assessment System for Children – third Edition (BASC-3). Results were compared with normative data and by treatment strategy (primary repair vs staged repair). A parent survey assessed history of disabilities and access to services related to neurodevelopment.</div></div><div><h3>Results</h3><div>Although the majority of patients (median age 8.3 years, IQR 5.7-11.2) had median Behavior Rating Inventory of Executive Function and BASC-3 scores within the normal range, a proportion had clinically elevated (abnormal) scores, especially in the school-age patient subgroup (Behavior Rating Inventory of Executive Function 24%-30% and BASC 20%-37%). There were no statistically significant differences based on treatment strategy for either the Behavior Rating Inventory of Executive Function or BASC-3. However, lower birth weight, genetic syndrome, and medical complexity were significantly associated with worse executive function, and lower maternal education was associated in school-age children with lower executive and psychosocial functioning. Ongoing disabilities were relatively common (learning disability 35%, speech delay 33%, developmental delay 31%), although up to 50% of children were not receiving educational or developmental services.</div></div><div><h3>Conclusions</h3><div>Elevated executive and psychosocial concerns are present in the patient population with sTOF. Although initial treatment strategy appears unrelated to neurodevelopmental outcomes, lower birth weight, genetic syndrome, and medical complexity and lower maternal education are risk factors. Early recognition of neurodevelopmental concerns can facilitate access to appropriate neurodevelopmental services in this high-risk group.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"276 ","pages":"Article 114357"},"PeriodicalIF":3.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481224","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 : 2024-10-16DOI: 10.1016/j.jpeds.2024.114358
Russell R. Pate PhD , Marsha Dowda DrPH , Alexander C. McLain PhD , Edward A. Frongillo PhD , Ruth P. Saunders PhD , Nabila Inak MPH , Kerry L. Cordan PhD
Objective
To describe the developmental pattern for physical activity (PA) in children 6-36 months of age and to identify factors that are longitudinally associated with PA as children transition from infancy to preschool age.
Study design
The study employed a prospective longitudinal design with baseline data collected when children were approximately 6 months of age. Mothers and infants (n = 124) were recruited through community and educational settings in South Carolina. Data were collected at 6-month intervals from 6 to 36 months. PA was measured via accelerometry. Mothers completed questionnaires that assessed independent variables, including parent characteristics, the child's sex, race, and ethnicity, birth/delivery type, motor milestones, sleep habits, dietary practices, childcare setting, and home environmental factors. Trained research staff administered anthropometric measures and assessed motor developmental status. Growth curve models described the age-related pattern for PA and evaluated relationships between independent variables and change in PA.
Results
PA increased by approximately 45% between 6 and 36 months of age and followed a curvilinear pattern, with most of the increase occurring between 6 and 24 months. The child's exposure to television/electronic media was negatively associated with change in PA, and the presence of older siblings in the home was positively associated with change in PA.
Conclusions
As children develop from infancy to early childhood, their PA increases substantially, with most of the increase occurring by 24 months of age.
{"title":"Longitudinal Change in Physical Activity in Children 6 to 36 Months of Age","authors":"Russell R. Pate PhD , Marsha Dowda DrPH , Alexander C. McLain PhD , Edward A. Frongillo PhD , Ruth P. Saunders PhD , Nabila Inak MPH , Kerry L. Cordan PhD","doi":"10.1016/j.jpeds.2024.114358","DOIUrl":"10.1016/j.jpeds.2024.114358","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the developmental pattern for physical activity (PA) in children 6-36 months of age and to identify factors that are longitudinally associated with PA as children transition from infancy to preschool age.</div></div><div><h3>Study design</h3><div>The study employed a prospective longitudinal design with baseline data collected when children were approximately 6 months of age. Mothers and infants (n = 124) were recruited through community and educational settings in South Carolina. Data were collected at 6-month intervals from 6 to 36 months. PA was measured via accelerometry. Mothers completed questionnaires that assessed independent variables, including parent characteristics, the child's sex, race, and ethnicity, birth/delivery type, motor milestones, sleep habits, dietary practices, childcare setting, and home environmental factors. Trained research staff administered anthropometric measures and assessed motor developmental status. Growth curve models described the age-related pattern for PA and evaluated relationships between independent variables and change in PA.</div></div><div><h3>Results</h3><div>PA increased by approximately 45% between 6 and 36 months of age and followed a curvilinear pattern, with most of the increase occurring between 6 and 24 months. The child's exposure to television/electronic media was negatively associated with change in PA, and the presence of older siblings in the home was positively associated with change in PA.</div></div><div><h3>Conclusions</h3><div>As children develop from infancy to early childhood, their PA increases substantially, with most of the increase occurring by 24 months of age.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"276 ","pages":"Article 114358"},"PeriodicalIF":3.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481229","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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