Pub Date : 2026-03-01Epub Date: 2025-12-23DOI: 10.1016/j.jpeds.2025.114960
Peter M. Socha BSc , Jennifer A. Hutcheon PhD , Erin C. Strumpf PhD , Jessica Liauw MD, MHSc , Myriam Srour MD, PhD , Joseph Y. Ting MD, MPH , M. Amanda Skoll MD , Sam Harper PhD
Objective
To use a natural experiment to investigate the effect of antenatal corticosteroids on the risk of cerebral palsy.
Study design
We included singleton livebirths with a maternal admission for delivery from 31 + 0 through 36 + 6 weeks of gestation, in British Columbia, Canada, between 2000 and 2015. Guidelines recommended antenatal corticosteroids through 33 + 6 weeks, and we estimated the effect of the corresponding sharp drop in the proportion treated at 34 + 0 weeks on the risk of a composite of death before age 2 or cerebral palsy. We defined cerebral palsy using diagnostic codes in hospital and physician-billing records before age 5 years and corrected for misclassification using external estimates of the sensitivity and specificity. We used logistic regression to estimate marginal effects at 34 + 0 weeks.
Results
There were 20 009 children in our study sample. The crude and misclassification-corrected risks of cerebral palsy were 6.2 and 5.6 per 1000, respectively. The risk of death before age 2 or cerebral palsy declined with increasing gestational age at maternal admission for delivery, but we found no convincing evidence of an abrupt change just before vs just after 34 + 0 weeks (risk ratio: 0.98, 95% confidence interval: 0.50 to 1.98). Results were similar using a composite outcome of in-hospital newborn death or cerebral palsy, and using cerebral palsy alone.
Conclusions
We did not find evidence that the lower likelihood of being treated with antenatal corticosteroid at 34 + 0 weeks affected the risk of cerebral palsy, but the estimates were imprecise and compatible with benefits or harms.
{"title":"Antenatal Corticosteroids and Risk of Cerebral Palsy: A Regression Discontinuity Study","authors":"Peter M. Socha BSc , Jennifer A. Hutcheon PhD , Erin C. Strumpf PhD , Jessica Liauw MD, MHSc , Myriam Srour MD, PhD , Joseph Y. Ting MD, MPH , M. Amanda Skoll MD , Sam Harper PhD","doi":"10.1016/j.jpeds.2025.114960","DOIUrl":"10.1016/j.jpeds.2025.114960","url":null,"abstract":"<div><h3>Objective</h3><div>To use a natural experiment to investigate the effect of antenatal corticosteroids on the risk of cerebral palsy.</div></div><div><h3>Study design</h3><div>We included singleton livebirths with a maternal admission for delivery from 31 + 0 through 36 + 6 weeks of gestation, in British Columbia, Canada, between 2000 and 2015. Guidelines recommended antenatal corticosteroids through 33 + 6 weeks, and we estimated the effect of the corresponding sharp drop in the proportion treated at 34 + 0 weeks on the risk of a composite of death before age 2 or cerebral palsy. We defined cerebral palsy using diagnostic codes in hospital and physician-billing records before age 5 years and corrected for misclassification using external estimates of the sensitivity and specificity. We used logistic regression to estimate marginal effects at 34 + 0 weeks.</div></div><div><h3>Results</h3><div>There were 20 009 children in our study sample. The crude and misclassification-corrected risks of cerebral palsy were 6.2 and 5.6 per 1000, respectively. The risk of death before age 2 or cerebral palsy declined with increasing gestational age at maternal admission for delivery, but we found no convincing evidence of an abrupt change just before vs just after 34 + 0 weeks (risk ratio: 0.98, 95% confidence interval: 0.50 to 1.98). Results were similar using a composite outcome of in-hospital newborn death or cerebral palsy, and using cerebral palsy alone.</div></div><div><h3>Conclusions</h3><div>We did not find evidence that the lower likelihood of being treated with antenatal corticosteroid at 34 + 0 weeks affected the risk of cerebral palsy, but the estimates were imprecise and compatible with benefits or harms.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"290 ","pages":"Article 114960"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145835337","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 : 2026-03-01Epub Date: 2025-12-15DOI: 10.1016/j.jpeds.2025.114943
Paula M. Magee MD, MPH , Erin Paquette MD, JD, MBe , Latasha A. Daniels MA, MSW , L. Nelson Sanchez-Pinto MD, MBI, FAMIA , Nadir Yehya MD, MSCE
Objective
To explore potential associations between neighborhood-level factors and early organ dysfunction in children who are critically ill.
Study design
This retrospective, ecological cohort study assessed the association between neighborhood factors and early organ dysfunction in 8289 encounters for children who were critically ill from January 2013 to December 2019 at a quaternary pediatric hospital in an urban setting. The exposures were neighborhood factors, which were measured using 3 composite indices: Child Opportunity Index (COI), Social Vulnerability Index (SVI), and Neighborhood Disorder Index (NDI). Peak Pediatric Logistic Organ Dysfunction [PELOD]-2 scores in the first 72 hours measured early organ dysfunction as the primary outcome. An adjusted Poisson regression with robust modeling was used to measure the association.
Results
Most encounters were for patients from very low opportunity (28%), very high vulnerability (29%), and very high physical disorder neighborhoods (27%). Median peak PELOD-2 score was 3 (interquartile range 2-5). No association was identified for COI or NDI with peak PELOD-2 scores; however, there was an association between a very high SVI and greater peak PELOD-2 scores (P = .004).
Conclusions
No association was found among COI or NDI with worse early organ dysfunction. Very high SVI was associated with worse early organ dysfunction. Further studies should assess whether specific aspects of neighborhoods drive critical illness in organ-specific diseases.
{"title":"The Association Between Neighborhood Factors and Early Organ Dysfunction in Children Who Are Critically Ill: A Retrospective Cohort Study","authors":"Paula M. Magee MD, MPH , Erin Paquette MD, JD, MBe , Latasha A. Daniels MA, MSW , L. Nelson Sanchez-Pinto MD, MBI, FAMIA , Nadir Yehya MD, MSCE","doi":"10.1016/j.jpeds.2025.114943","DOIUrl":"10.1016/j.jpeds.2025.114943","url":null,"abstract":"<div><h3>Objective</h3><div>To explore potential associations between neighborhood-level factors and early organ dysfunction in children who are critically ill.</div></div><div><h3>Study design</h3><div>This retrospective, ecological cohort study assessed the association between neighborhood factors and early organ dysfunction in 8289 encounters for children who were critically ill from January 2013 to December 2019 at a quaternary pediatric hospital in an urban setting. The exposures were neighborhood factors, which were measured using 3 composite indices: Child Opportunity Index (COI), Social Vulnerability Index (SVI), and Neighborhood Disorder Index (NDI). Peak Pediatric Logistic Organ Dysfunction [PELOD]-2 scores in the first 72 hours measured early organ dysfunction as the primary outcome. An adjusted Poisson regression with robust modeling was used to measure the association.</div></div><div><h3>Results</h3><div>Most encounters were for patients from very low opportunity (28%), very high vulnerability (29%), and very high physical disorder neighborhoods (27%). Median peak PELOD-2 score was 3 (interquartile range 2-5). No association was identified for COI or NDI with peak PELOD-2 scores; however, there was an association between a very high SVI and greater peak PELOD-2 scores (<em>P</em> = .004).</div></div><div><h3>Conclusions</h3><div>No association was found among COI or NDI with worse early organ dysfunction. Very high SVI was associated with worse early organ dysfunction. Further studies should assess whether specific aspects of neighborhoods drive critical illness in organ-specific diseases.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"290 ","pages":"Article 114943"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776758","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 : 2026-02-26DOI: 10.1016/j.jpeds.2026.115048
Xiong Ping, Mei Zhaojun
{"title":"Does Necrotizing Enterocolitis Severity and Timing, Rather than Necrotizing Enterocolitis Itself, Drive Shunt Failure in Premature Infants with Posthemorrhagic Hydrocephalus?","authors":"Xiong Ping, Mei Zhaojun","doi":"10.1016/j.jpeds.2026.115048","DOIUrl":"10.1016/j.jpeds.2026.115048","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115048"},"PeriodicalIF":3.5,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147322500","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 : 2026-02-26DOI: 10.1016/j.jpeds.2026.115049
Vijay M Ravindra, Jay Riva-Cambrin
{"title":"Reply.","authors":"Vijay M Ravindra, Jay Riva-Cambrin","doi":"10.1016/j.jpeds.2026.115049","DOIUrl":"10.1016/j.jpeds.2026.115049","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115049"},"PeriodicalIF":3.5,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147322498","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 : 2026-02-18DOI: 10.1016/j.jpeds.2026.115045
Patrick J Peebles, Joseph G Reiter, Paul J Wildenhain, Justine Shults, Heidi M Herrick, Ivana Brajkovic, Cassandra DeMartino, Stephen D DeMeo, Kristen M Glass, Kate A Hodgson, Sabine Iben, Philipp Jung, Jae H Kim, Lim Alicia May, Julie McKanna, Ahmed Moussa, Michael Narvey, Nicole Pouppirt, Mihai Puia-Dumitrescu, Jennifer A Rumpel, Rebecca L M Shay, Michelle D Tyler, Michael Wagner, Akira Nishisaki, Elizabeth E Foglia
Objectives: To compare procedural safety and success outcomes between catheter placement for minimally invasive surfactant therapy (MIST) and tracheal intubation (TI) for surfactant, and to identify characteristics associated with improved procedural outcomes among patients treated with MIST.
Study design: We conducted a retrospective, multi-center, observational, matched cohort study from an international airway registry from 2016-2024. Patients treated with MIST and patients who received TI for surfactant without paralytic premedication, were matched 1:1 on gestational age, procedure location, and laryngoscope type. The primary outcome was severe oxygen desaturation (>20% SpO2 decrease). Secondary outcomes included SpO2 <80%, any adverse event, and first attempt success. Using conditional logistic regression, the association between procedure type and outcomes was assessed. Among patients who received MIST, a multiple logistic regression model assessed the association between procedural characteristics and outcomes.
Results: There were 383 patients treated with MIST matched to 383 patients who underwent TI for surfactant. Compared with TI, MIST procedures were associated with lower adjusted odds of severe oxygen desaturation (aOR 0.66, 95% CI 0.45-0.97) and SpO2 <80% (aOR 0.59 95% CI: 0.40-0.85) and higher odds of first attempt success (aOR 2.93 95% CI 1.94-4.43). Odds of adverse events did not differ (aOR 0.88 95% CI 0.50-1.56). Factors associated with improved MIST outcomes included video laryngoscopy, first airway provider, commercial catheter type, and patient weight.
Conclusions: MIST is associated with improved procedural safety and success compared with TI for surfactant. Several factors are associated with improved MIST procedural outcomes.
目的：比较导管置入微创表面活性剂治疗（MIST）和气管插管（TI）治疗表面活性剂的手术安全性和成功结果，并确定与MIST治疗患者手术结果改善相关的特征。研究设计：我们进行了一项回顾性、多中心、观察性、匹配队列研究，研究对象来自2016-2024年的国际气道登记处。在胎龄、手术部位和喉镜类型上，经MIST治疗的患者与未进行麻痹前用药的表面活性剂TI治疗的患者按1:1匹配。主要结局是严重的氧饱和度降低（SpO2降低20%）。结果：383例接受MIST治疗的患者与383例接受表面活性剂TI治疗的患者相匹配。与TI相比，MIST手术与较低的严重氧去饱和调整几率（aOR 0.66, 95% CI 0.45-0.97）和SpO2相关。结论：与表面活性剂的TI相比，MIST手术安全性和成功率更高。有几个因素与MIST手术结果的改善有关。
{"title":"Procedural Outcomes of Minimally Invasive Surfactant Therapy (MIST): An International Matched Cohort Study.","authors":"Patrick J Peebles, Joseph G Reiter, Paul J Wildenhain, Justine Shults, Heidi M Herrick, Ivana Brajkovic, Cassandra DeMartino, Stephen D DeMeo, Kristen M Glass, Kate A Hodgson, Sabine Iben, Philipp Jung, Jae H Kim, Lim Alicia May, Julie McKanna, Ahmed Moussa, Michael Narvey, Nicole Pouppirt, Mihai Puia-Dumitrescu, Jennifer A Rumpel, Rebecca L M Shay, Michelle D Tyler, Michael Wagner, Akira Nishisaki, Elizabeth E Foglia","doi":"10.1016/j.jpeds.2026.115045","DOIUrl":"https://doi.org/10.1016/j.jpeds.2026.115045","url":null,"abstract":"<p><strong>Objectives: </strong>To compare procedural safety and success outcomes between catheter placement for minimally invasive surfactant therapy (MIST) and tracheal intubation (TI) for surfactant, and to identify characteristics associated with improved procedural outcomes among patients treated with MIST.</p><p><strong>Study design: </strong>We conducted a retrospective, multi-center, observational, matched cohort study from an international airway registry from 2016-2024. Patients treated with MIST and patients who received TI for surfactant without paralytic premedication, were matched 1:1 on gestational age, procedure location, and laryngoscope type. The primary outcome was severe oxygen desaturation (>20% SpO2 decrease). Secondary outcomes included SpO2 <80%, any adverse event, and first attempt success. Using conditional logistic regression, the association between procedure type and outcomes was assessed. Among patients who received MIST, a multiple logistic regression model assessed the association between procedural characteristics and outcomes.</p><p><strong>Results: </strong>There were 383 patients treated with MIST matched to 383 patients who underwent TI for surfactant. Compared with TI, MIST procedures were associated with lower adjusted odds of severe oxygen desaturation (aOR 0.66, 95% CI 0.45-0.97) and SpO2 <80% (aOR 0.59 95% CI: 0.40-0.85) and higher odds of first attempt success (aOR 2.93 95% CI 1.94-4.43). Odds of adverse events did not differ (aOR 0.88 95% CI 0.50-1.56). Factors associated with improved MIST outcomes included video laryngoscopy, first airway provider, commercial catheter type, and patient weight.</p><p><strong>Conclusions: </strong>MIST is associated with improved procedural safety and success compared with TI for surfactant. Several factors are associated with improved MIST procedural outcomes.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115045"},"PeriodicalIF":3.5,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146260102","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 : 2026-02-09DOI: 10.1016/j.jpeds.2026.115025
Robert S Tepper, Brandie D Wagner, Jeffrey Bjerregaard, Christina Tiller, Laura Amos, Greg Sokol, Dominic Adducci, Steven H Abman
Objectives: To evaluate whether preterm birth is associated with impaired airway and parenchymal lung function and whether early physiological phenotypes change or are sustained during follow-up during infancy.
Study design: We included125 infants born preterm who underwent forced expiratory flow at 75% (FEF75), expired forced vital capacity, lung diffusion (DL), and alveolar volume measured longitudinally after discharge from the neonatal intensive care unit.
Results: The average gestational age of the cohort was 31 weeks (range, 25-36), 52% were female, and 36% were diagnosed with bronchopulmonary dysplasia. Length and lung function were evaluated at mean corrected ages of 5.4 and 13.6 months, visit 1 and visit 2, respectively. Significant increases occurred in body length (11.82 cm), FEF75 (94.3 mL/s), forced vital capacity (149 mL), DL (147 mL/min/mm Hg), and alveolar volume (254 mL) (P < .01 for each parameter). When quantified by z-scores based on full-term infants, the Δz-length increased significantly (P < .01); however, there were significant decreases in Δz-FEF75 and Δz-DL (P < .01). Lower FEF75 and DL values at visit 1 were associated with lower values at visit 2, but were not associated with gestational age or bronchopulmonary dysplasia.
Conclusions: After preterm birth, absolute values for lung function increased during infancy; however, when expressed as z-scores, values were persistently impaired and became more negative relative to full-term infants. Airway and parenchymal function may be established early after preterm birth and may contribute to impaired trajectories or dysanapsis later in life.
{"title":"Differential Trajectories of Airway and Parenchymal Function in Infants Born Preterm.","authors":"Robert S Tepper, Brandie D Wagner, Jeffrey Bjerregaard, Christina Tiller, Laura Amos, Greg Sokol, Dominic Adducci, Steven H Abman","doi":"10.1016/j.jpeds.2026.115025","DOIUrl":"10.1016/j.jpeds.2026.115025","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether preterm birth is associated with impaired airway and parenchymal lung function and whether early physiological phenotypes change or are sustained during follow-up during infancy.</p><p><strong>Study design: </strong>We included125 infants born preterm who underwent forced expiratory flow at 75% (FEF<sub>75</sub>), expired forced vital capacity, lung diffusion (D<sub>L</sub>), and alveolar volume measured longitudinally after discharge from the neonatal intensive care unit.</p><p><strong>Results: </strong>The average gestational age of the cohort was 31 weeks (range, 25-36), 52% were female, and 36% were diagnosed with bronchopulmonary dysplasia. Length and lung function were evaluated at mean corrected ages of 5.4 and 13.6 months, visit 1 and visit 2, respectively. Significant increases occurred in body length (11.82 cm), FEF<sub>75</sub> (94.3 mL/s), forced vital capacity (149 mL), D<sub>L</sub> (147 mL/min/mm Hg), and alveolar volume (254 mL) (P < .01 for each parameter). When quantified by z-scores based on full-term infants, the Δz-length increased significantly (P < .01); however, there were significant decreases in Δz-FEF<sub>75</sub> and Δz-D<sub>L</sub> (P < .01). Lower FEF<sub>75</sub> and D<sub>L</sub> values at visit 1 were associated with lower values at visit 2, but were not associated with gestational age or bronchopulmonary dysplasia.</p><p><strong>Conclusions: </strong>After preterm birth, absolute values for lung function increased during infancy; however, when expressed as z-scores, values were persistently impaired and became more negative relative to full-term infants. Airway and parenchymal function may be established early after preterm birth and may contribute to impaired trajectories or dysanapsis later in life.</p>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":" ","pages":"115025"},"PeriodicalIF":3.5,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12961765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168124","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 : 2026-02-01Epub Date: 2025-10-31DOI: 10.1016/j.jpeds.2025.114881
Daniel J. Benedetti MD, MA , Esther Knapp MD, MA
{"title":"Navigating the Crossroads of Pediatric Cancer Predisposition: Pitfalls and Limitations of Commercial Genetic Testing","authors":"Daniel J. Benedetti MD, MA , Esther Knapp MD, MA","doi":"10.1016/j.jpeds.2025.114881","DOIUrl":"10.1016/j.jpeds.2025.114881","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114881"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433177","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 : 2026-02-01Epub Date: 2025-11-13DOI: 10.1016/j.jpeds.2025.114902
Alexandra Seabury MD, MS , Mary Pipan MD , Nathan J. Blum MD , Kathleen Campbell MD, MHSc
{"title":"Optimizing Inpatient Care for Children with Neurodevelopmental Disabilities","authors":"Alexandra Seabury MD, MS , Mary Pipan MD , Nathan J. Blum MD , Kathleen Campbell MD, MHSc","doi":"10.1016/j.jpeds.2025.114902","DOIUrl":"10.1016/j.jpeds.2025.114902","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114902"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145531021","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 : 2026-02-01Epub Date: 2025-11-13DOI: 10.1016/j.jpeds.2025.114904
Deborah J. Rinehart PhD, MA , Aiden Gilbert MPA , Leisha M. Andersen MD, MPH , Tom W. Gray MSW, MPH , Sonja O'Leary MD , Holly M. Frost MD, PhD , DISAPEAR Study Group
Objective
To assess facilitators and barriers to watchful waiting for nonsevere acute otitis media (AOM), as recommended by the American Academy of Pediatrics, rather than immediate antibiotic initiation.
Study design
In a qualitative study, purposeful sampling was used in to recruit clinicians and clinician administrators from three health care systems for semistructured interviews and convenience sampling was used to recruit parents of children aged 6 months or older with a recent diagnosis of AOM for focus groups. The Practical Robust Implementation and Sustainability Model guided the study. Interviews were analyzed using the Rapid Assessment Process.
Results
Forty-four participants (23 clinicians/administrators and 21 parents) engaged in interviews and focus groups. Barriers to watchful waiting included lack of standard workflows and systems to support the process, time constraints, bidirectional trust, unclear instructions and processes for parents, fear of complications, parental misconceptions about antibiotics, and parental concerns about pain management. Patient-level obstacles included social factors, such as access to transportation, communication limitations, and finances. Facilitators included a strong stewardship culture, family/clinician rapport, and parent desire to participate in decision-making.
Conclusions
Our findings suggest clinicians, administrators, and parents are receptive to watchful waiting for management of AOM in children. Several modifiable factors were identified that could support the utilization of watchful waiting and reduce unneeded antibiotic use among children.
{"title":"Barriers and Facilitators to Implementing Watchful Waiting for Pediatric Acute Otitis Media","authors":"Deborah J. Rinehart PhD, MA , Aiden Gilbert MPA , Leisha M. Andersen MD, MPH , Tom W. Gray MSW, MPH , Sonja O'Leary MD , Holly M. Frost MD, PhD , DISAPEAR Study Group","doi":"10.1016/j.jpeds.2025.114904","DOIUrl":"10.1016/j.jpeds.2025.114904","url":null,"abstract":"<div><h3>Objective</h3><div>To assess facilitators and barriers to watchful waiting for nonsevere acute otitis media (AOM), as recommended by the American Academy of Pediatrics, rather than immediate antibiotic initiation.</div></div><div><h3>Study design</h3><div>In a qualitative study, purposeful sampling was used in to recruit clinicians and clinician administrators from three health care systems for semistructured interviews and convenience sampling was used to recruit parents of children aged 6 months or older with a recent diagnosis of AOM for focus groups. The Practical Robust Implementation and Sustainability Model guided the study. Interviews were analyzed using the Rapid Assessment Process.</div></div><div><h3>Results</h3><div>Forty-four participants (23 clinicians/administrators and 21 parents) engaged in interviews and focus groups. Barriers to watchful waiting included lack of standard workflows and systems to support the process, time constraints, bidirectional trust, unclear instructions and processes for parents, fear of complications, parental misconceptions about antibiotics, and parental concerns about pain management. Patient-level obstacles included social factors, such as access to transportation, communication limitations, and finances. Facilitators included a strong stewardship culture, family/clinician rapport, and parent desire to participate in decision-making.</div></div><div><h3>Conclusions</h3><div>Our findings suggest clinicians, administrators, and parents are receptive to watchful waiting for management of AOM in children. Several modifiable factors were identified that could support the utilization of watchful waiting and reduce unneeded antibiotic use among children.</div></div><div><h3>Trial registration</h3><div><span><span>NCT06034080</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114904"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145531022","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 : 2026-02-01Epub Date: 2025-11-01DOI: 10.1016/j.jpeds.2025.114884
Lukas K. Gaffney MD, MPH , Kenneth A. Michelson MD, MPH , Michael C. Monuteaux ScD , John Porter MBA , Joel Hudgins MD, MPH
Objectives
To examine the association between social determinants of health and location of pediatric low-resource-intensity visits, and to quantify associated reimbursement.
Study design
We performed a cross-sectional, nationally representative survey study of nonelective visits for patients ≤18 years old in the 2019-2021 Medical Expenditure Panel Survey. The primary outcome was emergency department (ED) or outpatient location of low-resource-intensity visits (visits with no labs, imaging, procedures, or resultant hospitalization). The relationship between location and social determinants was determined with logistic regression. The secondary outcome was reimbursement related to these visits.
Results
A total of 23 231 observations representing 96 155 173 visits were included. Of these, 3.2% were to the ED. Among social determinants of health, lower education, public insurance, and lack of primary care were associated with ED presentation; family income and language were not. Reimbursement for ED visits was 544.3% higher than outpatient visits, accounting for $546 million in yearly excess health care costs.
Conclusions
Lower family educational attainment, public insurance status, and poor access to primary care demonstrated significant associations with ED presentation for low-resource-intensity visits. These results suggest that interventions to reduce these visits, which could improve disparities and reduce unnecessary medical spending, should address modifiable factors such as access to primary care.
{"title":"Individual Social Determinants of Health and Location of Pediatric Low-Resource-Intensity Care","authors":"Lukas K. Gaffney MD, MPH , Kenneth A. Michelson MD, MPH , Michael C. Monuteaux ScD , John Porter MBA , Joel Hudgins MD, MPH","doi":"10.1016/j.jpeds.2025.114884","DOIUrl":"10.1016/j.jpeds.2025.114884","url":null,"abstract":"<div><h3>Objectives</h3><div>To examine the association between social determinants of health and location of pediatric low-resource-intensity visits, and to quantify associated reimbursement.</div></div><div><h3>Study design</h3><div>We performed a cross-sectional, nationally representative survey study of nonelective visits for patients ≤18 years old in the 2019-2021 Medical Expenditure Panel Survey. The primary outcome was emergency department (ED) or outpatient location of low-resource-intensity visits (visits with no labs, imaging, procedures, or resultant hospitalization). The relationship between location and social determinants was determined with logistic regression. The secondary outcome was reimbursement related to these visits.</div></div><div><h3>Results</h3><div>A total of 23 231 observations representing 96 155 173 visits were included. Of these, 3.2% were to the ED. Among social determinants of health, lower education, public insurance, and lack of primary care were associated with ED presentation; family income and language were not. Reimbursement for ED visits was 544.3% higher than outpatient visits, accounting for $546 million in yearly excess health care costs.</div></div><div><h3>Conclusions</h3><div>Lower family educational attainment, public insurance status, and poor access to primary care demonstrated significant associations with ED presentation for low-resource-intensity visits. These results suggest that interventions to reduce these visits, which could improve disparities and reduce unnecessary medical spending, should address modifiable factors such as access to primary care.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114884"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433023","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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