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Utility of Jaundice Surveillance and Bilirubin Screening in Identifying Neonates Who Qualify for Phototherapy ≤24 Hours after Birth 黄疸监测和胆红素筛查在确定出生后 24 小时内符合光疗条件的新生儿方面的实用性。
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2024-10-16 DOI: 10.1016/j.jpeds.2024.114362
Gysella B. Muniz MD, MBA , Rebecca Saliga MD , Hui Liu MS , Jon F. Watchko MD , Abeer Azzuqa MD

Objective

To assess the utility of jaundice surveillance and routine 24 hour bilirubin screening in identifying neonates who qualify for phototherapy (PT) at ≤24 hours after birth.

Study design

In this retrospective, single-center observational study, records of neonates ≥350/7 weeks gestation born to O+, antibody negative mothers (n = 6098) were screened to identify who received PT at ≤24 hours after birth. The hour specific TSB at which neonates qualified for PT, blood type, direct antiglobulin test (DAT), and whether treatment was triggered by jaundice detection at <24 hours or the 24-hour bilirubin screen were determined.

Results

59 neonates (1.0%) qualified for PT ≤ 24 hours after birth; 10 (17%) were identified by jaundice detection at <24 hours, whereas 49 (83%) were identified on 24-hour bilirubin screening. Forty-eight of the 59 (81%) were ABO incompatible and DAT+; 11 were DAT negative, one of whom had glucose-6-phosphate dehydrogenase deficiency. Among the ≤24 hour PT group, 17 had a PT qualifying TSB within 3 mg/dL of exchange transfusion (ET); 14 of whom were only identified first on 24-hour bilirubin screening. Six exceeded ET thresholds, 4 of whom were identified on 24-hour bilirubin screening.

Conclusions

Neonates who qualified for PT at ≤24 hours were identified mostly by 24-hour bilirubin screening, a fraction of whom had a TSB that approached or exceeded ET thresholds. Our findings support routine birth hospitalization bilirubin screening and suggest screening no later than 24 hours after birth may be beneficial.
目的:评估黄疸监测和 24 小时胆红素常规筛查在确定新生儿出生后 24 小时内是否符合光疗条件方面的作用:评估黄疸监测和 24 小时胆红素常规筛查在识别出生后 24 小时内符合光疗(PT)条件的新生儿方面的作用:在这项回顾性单中心观察研究中,对 O+、抗体阴性母亲所生妊娠≥ 350/7 周的新生儿(n=6098)的记录进行了筛查,以确定哪些新生儿在出生后≤ 24 小时时接受了光疗。新生儿符合 PT 条件的具体 TSB 时间、血型、直接抗球蛋白试验(DAT)以及治疗是否由《结果》中的黄疸检测触发:59 名新生儿(1.0%)在出生后 24 小时内符合 PT 条件;10 名新生儿(17%)在出生后 24 小时内发现黄疸,而 49 名新生儿(83%)在 24 小时胆红素筛查时发现黄疸。59人中有48人(81%)ABO血型不合且DAT+;11人DAT阴性,其中一人患有葡萄糖-6-磷酸脱氢酶缺乏症。在 PT≤24 小时组中,有 17 人在交换输血(ET)前的 PT 合格 TSB 在 3 毫克/分升以内;其中 14 人是在 24 小时胆红素筛查中才首先发现的。6 人超过了 ET 临界值,其中 4 人是在 24 小时胆红素筛查中发现的:结论:通过 24 小时胆红素筛查确定了≤24 小时符合 PT 的新生儿,其中一部分新生儿的 TSB 接近或超过了 ET 临界值。我们的研究结果支持常规出生住院胆红素筛查,并建议在出生后 24 小时内进行筛查可能会有益处。
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引用次数: 0
Development and Evaluation of Pediatric Acute Care Hospital Referral Regions in Eight States 八个州儿科急症医院转诊区域的发展与评估。
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2024-10-16 DOI: 10.1016/j.jpeds.2024.114371
Allan M. Joseph MD, MPH , John S. Minturn MAS , Kristen S. Kurland BA , Billie S. Davis PhD , Jeremy M. Kahn MD, MS

Objective

To develop a set of pediatric acute care hospital referral regions for use in studying pediatric acute care delivery and test their utility relative to other regional systems.

Study design

We used state-level administrative databases capturing all pediatric acute care in 8 states to construct novel referral regions. We first constructed pediatric hospital service areas (PHSAs) based on 5 837 464 pediatric emergency department encounters. We then aggregated these PHSAs to pediatric hospital referral regions (PHRRs) based on 344 440 pediatric hospitalizations. Finally, we used 3 measures of spatial accuracy (localization index, market share index, and net patient flow) to compare this novel region system with the Dartmouth Atlas, designed originally to study adult specialty care, and the Pittsburgh Atlas, designed originally to study adult acute care.

Results

The development procedure resulted in 717 novel PHSAs, which were then aggregated to 55 PHRRs across the included states. Relative to hospital referral regions in the Dartmouth and Pittsburgh Atlases, PHRRs were fewer in number and larger in area and population. PHRRs more accurately captured patterns of pediatric hospitalizations, (eg, mean localization index: 69.1 out of 100, compared with a mean of 58.1 for the Dartmouth Atlas and 62.4 for the Pittsburgh Atlas).

Conclusions

The use of regional definitions designed specifically to study pediatric acute care better captures contemporary pediatric acute care delivery than the use of existing regional definitions. Future work should extend these definitions to all US states to enable national analyses of pediatric acute care delivery.
研究目的研究设计:研究设计:我们利用州一级的行政数据库,收集了八个州的所有儿科急症护理信息,构建了新的转诊区域。我们首先根据 5,837,464 次儿科急诊就诊记录构建了儿科医院服务区(PHSAs)。然后,我们根据 344,440 例儿科住院病例,将这些 PHSA 聚合为儿科医院转诊区域 (PHRR)。最后,我们使用三种空间精确度测量方法(定位指数、市场份额指数和净病人流量)将这一新型区域系统与达特茅斯地图集(最初设计用于研究成人专科医疗)和匹兹堡地图集(最初设计用于研究成人急诊医疗)进行比较:结果:开发过程产生了 717 个新型 PHSA,然后将其汇总到所包含州的 55 个 PHRR。与达特茅斯地图集和匹兹堡地图集中的 HRRs 相比,PHRRs 的数量更少,面积更大,人口更多。PHRRs 更准确地反映了儿科住院治疗的模式(例如,平均定位指数为 69.1(满分 100),而 HRRs 为 69.1(满分 100)):结论:结论:使用专为研究儿科急症护理而设计的地区定义比使用现有的地区定义更能反映当代儿科急症护理的提供情况。未来的工作应将这些定义扩展到美国所有州,以便对儿科急症护理服务进行全国性分析。
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引用次数: 0
Demodicosis in an Immunocompetent Child 免疫力低下儿童的脱皮症
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2024-10-10 DOI: 10.1016/j.jpeds.2024.114336
Arezki Izri MD, PhD, Sophie Brun MD, PhD, Gérôme Bohelay MD, PhD, Mohammad Akhoundi PhD
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引用次数: 0
The Academic Pediatrician-Advocate: A View from Government Relations Officials of United States Freestanding Children's Hospitals. 儿科医生学术代言人:美国独立儿童医院政府关系官员的观点。
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2024-10-09 DOI: 10.1016/j.jpeds.2024.114335
Eimaan Anwar, Richard J Chung, Diana Bautista, Lisa J Chamberlain, Debra L Best
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引用次数: 0
Esophageal Atresia with Tracheoesophageal Fistula Is Associated with Consanguinity in the Bedouins of the Negev. 内盖夫贝都因人食道闭锁伴气管食道瘘与近亲结婚有关。
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2024-10-05 DOI: 10.1016/j.jpeds.2024.114334
Raouf Nassar, Baruch Yerushalmi
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引用次数: 0
Corrigendum to “A Randomized Trial of Baby Triple P for Preterm Infants: Child Outcomes at 2 Years of Corrected Age”. J Pediatr. 2019;210:48-54 早产儿婴儿三P随机试验:2岁矫正年龄时的儿童结果 "的更正。J Pediatr.
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2024-10-05 DOI: 10.1016/j.jpeds.2024.114293
Paul B. Colditz DPhil (Oxon) , Roslyn N. Boyd PhD , Leanne Winter PhD , Margo Pritchard PhD , Peter H. Gray MD , Koa Whittingham PhD , Michael O’Callaghan MSc , Luke Jardine MClinEpid , Peter O’Rourke PhD , Louise Marquart PhD , Kylee Forrest DClinPsych , Carmen Spry PhD , Matthew R. Sanders PhD
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引用次数: 0
Infants Born at Late Preterm Gestation: Management during the Birth Hospitalization 晚期早产儿:分娩住院期间的管理。
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2024-10-05 DOI: 10.1016/j.jpeds.2024.114330
Neha S. Joshi MD, MS , Jochen Profit MD, MPH , Adam Frymoyer MD , Valerie J. Flaherman MD, MPH , Yuan Gu PhD , Henry C. Lee MD, MS

Objective

To examine the admission practices, frequency of common clinical morbidities, and rates of medical intervention in infants born at 34-36 weeks gestational age (GA, late preterm).

Study design

This retrospective, single institution, cohort study analyzed electronic health records of infants born late preterm from 2019 through 2021. Infants with known congenital anomalies necessitating neonatal intensive care unit admission were excluded. Analysis included descriptive and inferential statistics.

Results

The study included 1022 infants: 209 (21%) 34 weeks GA, 263 (26%) 35 weeks GA, and 550 (54%) 36 weeks GA. Sixty-three percent of infants at 35 weeks GA and 78% of infants of 36 weeks GA remained in well newborn care throughout the birth hospitalization; infants born at 34 weeks GA were ineligible for well newborn care. The need for respiratory support was 32%, 18%, and 11% in infants of 34, 35, and 36 weeks GA, respectively. Supplemental tube feeds were administered in 55%, 24%, and 8% of infants of 34, 35, and 36 weeks GA, respectively. Most infants born at 34 weeks GA (91%) were placed in an incubator; this was less frequent in infants at 35 (37%) and 36 weeks (16%). Tachypnea, hypoglycemia, and hypothermia were noted in 40%, 61%, and 57% of infants, respectively. A subset of these infants (30% with tachypnea, 23% with hypoglycemia, and 46% with hypothermia) required medical intervention for these abnormalities.

Conclusions

This single-center study provides an outlook on the care of infants born late preterm. Multicenter studies can contextualize these findings in order to develop clinical benchmarks and quality markers for this large population of infants.
研究目的研究设计:这项回顾性、单一机构、队列研究分析了 2019 年至 2021 年晚期早产儿的电子健康记录。不包括因畸形而必须入住新生儿重症监护室的婴儿。分析包括描述性和推论性统计:研究包括 1022 名婴儿:209 名(21%)34 周龄;263 名(26%)35 周龄;550 名(54%)36 周龄。63%怀孕 35 周的婴儿和 78% 怀孕 36 周的婴儿在出生住院期间一直接受新生儿护理;怀孕 34 周的婴儿没有资格接受新生儿护理。34周、35周和36周新生儿需要呼吸支持的比例分别为32%、18%和11%。体重 34 周、35 周和 36 周的婴儿中,分别有 55%、24% 和 8% 需要使用补充管喂养。大多数出生日期为 34 周的婴儿(91%)都被安置在保温箱中,而 35 周(37%)和 36 周(16%)的婴儿则较少出现这种情况。分别有 40%、61% 和 57% 的婴儿出现呼吸过速、低血糖和体温过低。这些婴儿中的一部分(30%呼吸过速、23%低血糖、46%低体温)需要对这些异常情况进行医疗干预:这项单中心研究为晚期早产儿的护理提供了一个前景。多中心研究可将这些发现与实际情况相结合,从而为这一庞大的婴儿群体制定临床基准和质量标准。
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引用次数: 0
Juvenile Spring Eruption: Twice is Not Nice 青少年春季爆发:两次都不好
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2024-10-01 DOI: 10.1016/j.jpeds.2024.114331
Michelle L. Wang BA, Hayley S. Goldbach MD, Indi Trehan MD, MPH, DTM&H
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引用次数: 0
Liberal Fluid Resuscitation is Associated with Improved Outcomes in Pediatric Acute Pancreatitis 通畅的液体复苏可改善小儿急性胰腺炎的预后。
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2024-09-30 DOI: 10.1016/j.jpeds.2024.114329
Nicholas Norris MD , Peter Farrell MD, MS , Sherif Ibrahim MD , Lin Fei PhD , Qin Sun MPH , David S. Vitale MD , Maisam Abu-El-Haija MD, MS

Objective

To evaluate outcomes of children from an observational cohort registry of index acute pancreatitis (AP) admissions managed with different types and rates of intravenous fluid therapy.

Study design

Patients with index admission of AP between 2013 and 2023 were included. Those who received >1.5x the maintenance intravenous fluid rate were assigned to the liberal fluid group, and patients who received <1.5x maintenance fluids were assigned to the conservative group. Outcomes including intensive care unit admission rate, organ dysfunction, local pancreatic complications, and AP severity were evaluated. Influence of early enteral feeding and fluid composition on outcomes and clinical course were also analyzed.

Results

Patients who received liberal fluids were less likely to be admitted or transferred to the intensive care unit compared with those receiving conservative management (OR, 0.32; 95% CI, 0.12-0.80; P = .015). The liberal fluid group with early feeding had the lowest rate of moderate/severe manifestations of AP compared with other combinations of diet and fluid orders. Patients within the liberal fluid group who received the highest fluid rates (>2x maintenance) did not have higher rates of organ dysfunction or severe disease.

Conclusions

Children with AP may stand to benefit from liberal fluid therapy and continued diet compared with more conservative fluid resuscitation and nothing by mouth status.
目的评估急性胰腺炎(AP)入院观察性队列登记中采用不同类型和比例静脉输液治疗的患儿的治疗效果。研究设计 纳入 2013 年至 2023 年期间入院的急性胰腺炎患者。接受的静脉输液量大于维持量1.5倍的患者被分配到自由输液组,接受的维持量小于1.5倍的患者被分配到保守输液组。评估结果包括重症监护室入院率、器官功能障碍、胰腺局部并发症和 AP 严重程度。此外,还分析了早期肠内喂养和液体成分对预后和临床过程的影响:与接受保守治疗的患者相比,接受通畅输液的患者入院或转入重症监护室的几率较低(OR,0.32;95% CI,0.12-0.80;P = 0.015)。与其他饮食和输液指令组合相比,早期喂养的宽松输液组出现 AP 中度/重度表现的比例最低。自由输液组中输液量最高(>2 倍维持量)的患者并没有较高的器官功能障碍或严重疾病发生率:结论:与较为保守的液体复苏和口服无糖状态相比,AP 患儿可能会从自由输液治疗和持续饮食中获益。
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引用次数: 0
Trends in the Diagnosis of Pediatric Venous Thromboembolism and Arterial Ischemic Stroke during the COVID-19 Pandemic: An Administrative Database Study COVID-19 大流行期间小儿静脉血栓栓塞症和动脉缺血性中风的诊断趋势:行政数据库研究。
IF 3.9 2区 医学 Q1 PEDIATRICS Pub Date : 2024-09-30 DOI: 10.1016/j.jpeds.2024.114328
Riten Kumar MD, MSc , Nan Chen MS , Laura L. Lehman MD, MPH , Wendy B. London PhD

Objective

To investigate trends in the diagnosis of venous thromboembolism (VTE) and arterial ischemic stroke (AIS), and examine the use of pharmacological thromboprophylaxis during the COVID-19 pandemic.

Study design

This retrospective cohort study used the Pediatric Health Information Systems database to investigate patients admitted to a participating hospital between January 1, 2018, and December 31, 2021. International Classification of Diseases, 10th edition codes were used to identify VTE, AIS, and COVID-19. Pharmacy billing codes were used to investigate pharmacological thromboprophylaxis use.

Results

1 759 701 unique patients underwent 2 234 135 inpatient admissions. Rate of VTE increased from 84 cases per 10 000 admissions in 2018-2019 to 108 cases per 10 000 admissions in 2020-2021, representing a 28.6% increase (P < .001). In contrast, the rate of AIS remained stable through the study period. When compared with 2018-2019, children diagnosed with VTE during 2020-2021 had longer hospitalizations and were more likely to be admitted to the intensive care unit. When analysis was limited to 2020-2021, a diagnosis code of COVID-19 was associated with a 1.35-fold (95% CI: 1.24-1.45) increase in the odds of VTE diagnosis, but not AIS. Use of pharmacologic thromboprophylaxis increased from 1.5% of hospitalizations in 2018-2019 to 3.0% of hospitalizations in 2020-2021 (P < .001). When evaluating thromboprophylaxis during 2020-2021, a diagnosis code for COVID-19 was associated with an 11-fold (95% CI: 10.86-11.49; P < .001) increase in the utilization of pharmacological thromboprophylaxis.

Conclusions

This study found an increase in the rate of VTE among hospitalized children during the pandemic. A diagnosis of COVID-19 was associated with a modest increase in odds of VTE diagnosis, which occurred despite increased use of pharmacological thromboprophylaxis.
目的调查静脉血栓栓塞症(VTE)和缺血性中风(AIS)诊断的最新趋势,并研究COVID-19大流行期间药物血栓预防的使用情况:这项回顾性队列研究使用儿科健康信息系统(PHIS)数据库,调查2018年1月1日至2021年12月31日期间参与研究的医院收治的患者。ICD-10代码用于识别VTE、AIS和COVID-19。药房账单代码用于调查血栓预防药物的使用情况:1,759,701名患者接受了2,234,135次住院治疗。VTE 发生率从 2018-2019 年的每 10,000 例住院患者中 84 例增加到 2020-2021 年的每 10,000 例住院患者中 108 例,增加了 28.6%(pConclusions:本研究发现,大流行期间住院儿童的 VTE 发生率有所上升。COVID-19的诊断与VTE诊断几率的适度增加有关,尽管药物血栓预防措施的使用有所增加。
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引用次数: 0
期刊
Journal of Pediatrics
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