Journal of Pediatrics最新文献

{"title":"Evaluating Diagnostic Strategies for Pediatric Traumatic Brain Injury: A Literature-Based Clinical Decision Analysis","authors":"Rebekah Mannix MD, MPH ,&nbsp;Megan Hannon MD ,&nbsp;Kara Hennelly MD ,&nbsp;Christina Master MD ,&nbsp;Daniel Corwin MD, MSCE ,&nbsp;Mohamed Badawy MD ,&nbsp;Ashley A. Foster MD ,&nbsp;Danny Thomas MD, MPH ,&nbsp;Laura Blackwell PhD ,&nbsp;Andrew Reisner MD ,&nbsp;Geoff Manley MD, PhD","doi":"10.1016/j.jpeds.2025.114880","DOIUrl":"10.1016/j.jpeds.2025.114880","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the role of blood-based biomarkers in pediatric traumatic brain injury (TBI) using a clinical decision analysis (CDA) framework, with the goal of determining whether biomarker integration improves diagnostic accuracy, reduces unnecessary imaging, and supports clinical decision-making.</div></div><div><h3>Study design</h3><div>We developed a CDA model to compare standard clinical assessment strategies/decision rules for children with suspected mild TBI vs strategies incorporating biomarker measurement. Model inputs included published estimates of biomarker test performance (sensitivity, specificity), rates of clinically important TBI, and imaging utilization. Outcomes included diagnostic yield, false-positive and false-negative rates, and projected reductions in neuroimaging. Sensitivity analyses explored the robustness of findings across a range of disease prevalences.</div></div><div><h3>Results</h3><div>Biomarker-enhanced strategies consistently reduced unnecessary head computed tomography utilization compared with clinical assessment alone. Decision-analytic modeling indicated that its integration into assessment strategies could meaningfully decrease radiation exposure at a population level. Sensitivity analyses demonstrated that findings were robust across plausible ranges of injury prevalence.</div></div><div><h3>Conclusions</h3><div>Application of CDA to pediatric TBI demonstrates the potential value of biomarker integration in improving diagnostic accuracy and optimizing computed tomography utilization. Biomarker-augmented strategies may enhance patient safety by reducing unnecessary radiation exposure, while maintaining sensitivity for clinically important injuries. Prospective validation and real-world implementation studies are needed to confirm clinical effectiveness and cost-effectiveness.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114880"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433018","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}

{"title":"Kernicterus Case Incidence Unchanged Since the 2022 American Academy of Pediatrics Hyperbilirubinemia Guideline Revision","authors":"Aisha Jameel MD,&nbsp;Troy Richardson PhD,&nbsp;Jonathan L. Slaughter MD, MPH","doi":"10.1016/j.jpeds.2025.114927","DOIUrl":"10.1016/j.jpeds.2025.114927","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114927"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589539","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}

{"title":"Shifts in Pediatric Acute Mastoiditis: Unexplored Drivers and Management Implications","authors":"Hai Wang MD","doi":"10.1016/j.jpeds.2025.114894","DOIUrl":"10.1016/j.jpeds.2025.114894","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114894"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477079","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}

{"title":"Entering Subspecialties in Pediatrics: More Than Just a Matter of Mentoring","authors":"Ángela Milena Díaz Díaz MD,&nbsp;Daniela Hernández Quiñones MD,&nbsp;Paul Anthony Camacho López MD, MSc","doi":"10.1016/j.jpeds.2025.114892","DOIUrl":"10.1016/j.jpeds.2025.114892","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114892"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477094","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}

{"title":"Antenatal Exposure to Medication for Opioid Use Disorder and Infant Outcomes in the Eat, Sleep, Console for Neonatal Opioid Withdrawal Randomized Controlled Trial","authors":"Sandra G.S. Beauman MSN, RNC-NIC ,&nbsp;Zhuopei Hu MS ,&nbsp;Ward Rice MD, PhD ,&nbsp;Lori Devlin DO ,&nbsp;Stephanie L. Merhar MD ,&nbsp;Camille M. Fung MD ,&nbsp;Jaime Brown MD ,&nbsp;Ahmed Osman MD ,&nbsp;Adrienne Pahl MD ,&nbsp;Kara Wong Ramsey MD ,&nbsp;Bonny Whalen MD ,&nbsp;Kathryn Dee L. MacMillan MD, MPH ,&nbsp;Song T. Ounpraseuth PhD ,&nbsp;Abhik Das PhD ,&nbsp;Margaret M. Crawford BS ,&nbsp;Lillian Trochinski BSN, RN ,&nbsp;Rachel G. Greenberg MD ,&nbsp;P. Brian Smith MD ,&nbsp;Leslie W. Young MD ,&nbsp;Jessie R. Maxwell MD, MBA","doi":"10.1016/j.jpeds.2025.114859","DOIUrl":"10.1016/j.jpeds.2025.114859","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate associations between care approach (usual care vs Eat, Sleep, Console [ESC]) on infant outcomes, and how these associations were modified by medication (buprenorphine or methadone) for opioid use disorder (MOUD).</div></div><div><h3>Study design</h3><div>A <em>post hoc</em>, subgroup analysis was conducted on infants with antenatal exposure to MOUD enrolled in Eat, Sleep, Console for Neonatal Opioid Withdrawal (ESC-NOW), a multicenter, stepped-wedge, cluster-randomized controlled trial.</div></div><div><h3>Results</h3><div>There were 949 infants enrolled in the Eat, Sleep, Console for Neonatal Opioid Withdrawal trial and exposed to MOUD (604 buprenorphine, 345 methadone). Infants managed with ESC vs usual care were less likely to receive pharmacologic treatment for NOWS (57.4% vs 18.0%; absolute difference 39.4%; 95% CI: 30.6-48.2; <em>P</em> &lt; .001). Length of hospital stay was 5.4 days shorter (95% CI: 1.9, 8.8; <em>P</em> = .003) in the ESC group. Stratified by MOUD type, infants exposed to methadone managed with ESC had a 9.5 day (95% CI: 4.8-14.2) shorter length of treatment than those managed with usual care (11.1 vs 20.6 days). No significant difference was found between care approaches in length of treatment for buprenorphine-exposed infants (12.3 vs 13.1 days; 95% CI: −4.4 to 6.1).</div></div><div><h3>Conclusions</h3><div>Use of the ESC care approach was associated with a decrease in pharmacologic treatment for NOWS and a shorter hospital stay for infants with antenatal MOUD exposure. Methadone exposure was associated with a shorter length of pharmacologic treatment for infants cared for with ESC when compared with usual care, whereas such an association was not seen for buprenorphine exposed infants.</div></div><div><h3>Trial registration</h3><div><span><span>https://clinicaltrials.gov/study/NCT04057820</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114859"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330692","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}

{"title":"Examining Clinic-Based Health Care Use Patterns in a Specialty Concussion Care Setting","authors":"Kayla Covert PT, DPT ,&nbsp;Brittany Davis MS ,&nbsp;Kendall Hammonds MPH ,&nbsp;Taylor Gilliland MS ,&nbsp;Nicholas Douville MD ,&nbsp;Simon Driver PhD ,&nbsp;Morgan O'Neil PhD","doi":"10.1016/j.jpeds.2025.114887","DOIUrl":"10.1016/j.jpeds.2025.114887","url":null,"abstract":"<div><h3>Objective</h3><div>To examine clinic-based health care use (HU) patterns (prolonged use, accessibility continuity, comprehensiveness, and intensity) in children with acute and subacute concussion.</div></div><div><h3>Study design</h3><div>This retrospective cohort study included patients aged 5-17 years receiving specialty care at an interdisciplinary sports concussion clinic. Patients were dichotomized on the basis of index visit chronicity: acute (≤3 days) and subacute (&gt;3 days) postinjury. Prolonged HU, the primary outcome, was defined as having any follow-up visit &gt;28 days from the index visit. Other measures of HU (accessibility [distance from clinic, insurance status], continuity [visit pacing], comprehensiveness [number and type of referrals], and intensity [number of follow-up visits]) as well as recovery and treatment time were obtained. Multivariable regressions were completed using confounders based upon established literature.</div></div><div><h3>Results</h3><div>Of 622 patients, 362 (58.2%) presented acutely and 260 (41.8%) subacutely. The acute group was more likely to have a history of motion sickness (<em>P</em> = .02), a sport-related mechanism of injury (<em>P</em> = .006), and migrainous presentation (<em>P</em> = .0005), whereas the subacute group was slightly older (<em>P</em> = .002). Despite differences in presentation timing, no significant differences were observed in prolonged HU (<em>P</em> = .17), distance from clinic (<em>P</em> = .41), or insurance status (<em>P</em> = .36). However, patients in the acute group had significantly lower pacing of visits (ie, continuity; <em>P</em> &lt; .001) with greater number of follow-ups (ie, intensity; <em>P</em> &lt; .001) but were less likely to receive interdisciplinary referrals (<em>P</em> &lt; .001). After adjusting for confounding clinical variables, no significant differences in treatment duration were observed between the two groups (<em>P</em> = .90).</div></div><div><h3>Conclusions</h3><div>Initiation of concussion care within 1 week of injury demonstrates comparable effectiveness regardless of exact timing, although early presentation favors single-provider management whereas later presentation requires enhanced interdisciplinary coordination.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114887"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433039","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}

{"title":"Changes in Suicidality among Transgender Adolescents Following Hormone Therapy: An Extended Study","authors":"Luke R. Allen PhD ,&nbsp;Cody G. Dodd PhD ,&nbsp;Christine N. Moser PsyD ,&nbsp;Michelle M. Knoll MD","doi":"10.1016/j.jpeds.2025.114883","DOIUrl":"10.1016/j.jpeds.2025.114883","url":null,"abstract":"<div><h3>Objective</h3><div>To examine changes in suicidality following hormone therapy (HT) among transgender and gender-diverse adolescents and young adults.</div></div><div><h3>Study design</h3><div>A retrospective chart review was conducted at a multidisciplinary gender health clinic with 432 patients (mean follow-up = 679 days) completing the Ask Suicide-Screening Questions before and after treatment initiation. A repeated-measures ANCOVA assessed within-person changes in suicidality over time, adjusting for age at treatment and treatment duration.</div></div><div><h3>Results</h3><div>Suicidality significantly declined from pretreatment to post-treatment (<em>F</em>[1, 426] = 34.63, <em>P</em> &lt; .001, partial η² = 0.075). This effect was consistent across sex assigned at birth, age at start of therapy, and treatment duration.</div></div><div><h3>Conclusions</h3><div>HT was associated with clinically meaningful reductions in suicidality over time, extending prior findings with a larger sample and longer follow-up. These study findings provide clinical evidence supporting the mental health benefits of timely access to HT in this population.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114883"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433101","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}

{"title":"Links among Parental Incarceration, Food Insecurity, Household Adverse Childhood Experiences, and Disordered Eating in United States Youth","authors":"C. Blair Burnette PhD ,&nbsp;Luke Muentner PhD, MSW","doi":"10.1016/j.jpeds.2025.114870","DOIUrl":"10.1016/j.jpeds.2025.114870","url":null,"abstract":"<div><h3>Objective</h3><div>To examine whether parental incarceration is related to increased risk for disordered eating (ie, fasting, binge eating, purging, and compulsive exercise) among children and adolescents in the US.</div></div><div><h3>Study design</h3><div>We used data from the 2022 and 2023 National Survey of Children's Health, an annual cross-sectional, nationally representative survey of US children. Analyses were restricted to youth ages 6-17 with parental incarceration data (n = 65 321). Logistic regression models were conducted, adjusting for age, sex, race, ethnicity, parental education, and body mass index.</div></div><div><h3>Results</h3><div>Both food insecurity and parental incarceration were associated with increased risk of fasting, binge eating, and purging. Youth who experienced parental incarceration had 1.74 greater odds of reporting any disordered eating over the last year. Food insecurity was not a significant moderator in any model. The association between parental incarceration and disordered eating differed across levels of household adverse childhood experience exposure; parental incarceration was related to greater odds of disordered eating only at low household adverse childhood experience exposure and attenuated at higher exposure.</div></div><div><h3>Conclusions</h3><div>Results suggest that experiencing the incarceration of a parent heightens disordered eating risk independent of FI. However, it is unclear whether parental incarceration exerts unique effects among children with high trauma exposure, which should be explored in future research.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114870"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370563","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}

{"title":"Effect of the Telemedicine Enhanced Asthma Management–Uniting Providers (TEAM-UP) Program on Asthma Outcomes: A Randomized Clinical Trial","authors":"Jill S. Halterman MD, MPH ,&nbsp;Maria Fagnano MPH, MS ,&nbsp;Paul J. Tremblay RN, BSN/ME, AE-C ,&nbsp;Tamara T. Perry MD ,&nbsp;Hongyue Wang PhD ,&nbsp;S. Shahzad Mustafa MD ,&nbsp;Allison Ramsey MD ,&nbsp;Jessica Stern MD, MS","doi":"10.1016/j.jpeds.2025.114872","DOIUrl":"10.1016/j.jpeds.2025.114872","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate a school-based intervention for children with moderate-severe persistent/poorly controlled asthma, adding telemedicine consultations with specialists to school-based directly observed therapy of preventive asthma medications in order to optimize management.</div></div><div><h3>Study design</h3><div>From 2018 to 2024 children aged 4-12 years with moderate-severe/poorly controlled asthma were randomized to Telemedicine Enhanced Asthma Management–Uniting Providers (TEAM-UP) or enhanced usual care. TEAM-UP included daily school-based directly observed therapy and telemedicine visits with asthma specialists. The primary outcome was mean symptom-free days/2 weeks. Analyses used linear mixed and generalized estimating equation models.</div></div><div><h3>Results</h3><div>We enrolled 326 children (62% participation; mean age 8.4 years; 60% male; 58% Black; 35% Hispanic; 80% Medicaid). The majority (84%) of TEAM-UP participants had ≥1 specialist visit and 74% received school-based DOT (excluding the pandemic). We found that children in TEAM-UP vs enhanced usual care had more symptom-free days (mean difference: 1.32; 95% CI 0.58-2.05) and were less likely to miss school (odds ratio: 0.70; 95% CI 0.52-0.96) or require emergency department visits or hospitalizations for asthma (odds ratio: 0.54; 95% CI 0.31-0.96).</div></div><div><h3>Conclusions</h3><div>TEAM-UP significantly improved asthma symptoms and reduced health care use, offering a promising model for asthma care in underserved communities.</div></div><div><h3>Trial registration</h3><div>ClinicalTrials.gov number: NCT03545906 <span><span>https://clinicaltrials.gov/study/NCT03545906?term=NCT03545906&amp;rank=1</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114872"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145370596","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}

{"title":"Flaky Paint Dermatosis in a Preterm Newborn","authors":"Sarvani Sattiraju MD,&nbsp;Apoorva Jain MD,&nbsp;Deva Aravindan MD,&nbsp;Chetan Khare MD, DM,&nbsp;Avantika Gupta MS","doi":"10.1016/j.jpeds.2025.114890","DOIUrl":"10.1016/j.jpeds.2025.114890","url":null,"abstract":"","PeriodicalId":54774,"journal":{"name":"Journal of Pediatrics","volume":"289 ","pages":"Article 114890"},"PeriodicalIF":3.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453758","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}