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The Journal of pediatrics
Mosby-Year Book
The Journal of pediatrics

Mosby-Year Book

0022-3476

The Journal of pediatrics/Journal The Journal of pediatrics
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    Archived! Intrauterine Transfusion and Exchange Transfusions for Hemolytic Disease of the Newborn

    Bansal, Satvik C.Gupta, Piyush
    1页
      原文链接:
    • NSTL

    The Trend in Costs of Tertiary-Level Neonatal Intensive Care for Neonates Born Preterm at 22(0/7)-28(6/7) Weeks of Gestation from 2010 to 2019 in Canada

    Zupancic, John A. F.Lee, Shoo K.Pechlivanoglou, PetrosShah, Prakesh S....
    9页
    查看更多>>摘要：Objective To describe the trend in costs over 10 years fortertiary-level neonatal care of infants born 22(0/7)-28(6/7) weeks of gestation during an ongoing Canadian national quality improvement project. Study design Clinical characteristics, outcomes, and third-party payor costs for the tertiary neonatal care of infants born 22(0/7)-28(6/7) weeks of gestation between the years 2010 and 2019 were analyzed from the Canadian Neonatal Network database. Costs were estimated using resource use data from the Canadian Neonatal Network and cost inputs from hospitals, physician billing, and administrative databases in Ontario, Canada. Cost estimates were adjusted to 2017 Canadian dollars (CAD). A generalized linear mixed-effects model with gamma regression was used to estimate trends in costs. Results Between 2010 and 2019, the number of infants born <24 weeks of gestation increased from 4.4% to 7.7%. The average length of stay increased from 68 days to 75 days. Unadjusted average +/- SD total costs per neonate were $120 717 +/- $93 062 CAD in 2010 and $132 774 +/- $93 161 CAD in 2019. After adjustment for year, center, and gestation, total costs and length of stay increased significantly, by $13 612 CAD (P < .01) and 8.1 days (P < .01) over 10 years, respectively; whereas costs accounting for LOS remained stable. Conclusions The total costs and length of stay for infants 22(0/7)-28(6/7) weeks of gestation have increased over the past decade in Canada during an ongoing national quality improvement initiative; however, there was an increase in the number and survival of neonates at the age of periviability.
      原文链接:
    • NSTL
    • Elsevier

    Temporal Differences in Concussion Symptom Factors in Adolescents following Sports-Related Concussion

    Manderino, LisaPreszler, JonathanWomble, Melissa N.Elbin, Robert J....
    6页
    查看更多>>摘要：Objective To evaluate temporal differences in concussion symptoms up to 30 days following a sports-related concussion. Study design Adolescent and young adult athletes (n = 782) were separated based on time since injury at presentation as Early (0-7 days; n = 321, age: 15.4 +/- 1.9 years, 51.7% female), Middle (8-14 days; n = 281, age: 15.8 +/- 2.2 years, 54.8% female), and Late (15-30 days; n = 180, age: 15.6 +/- 1.8 years, 52.8% female). All participants completed the 22-item Post-Concussion Symptom Scale at first visit. A confirmatory factor analysis was completed separately for each time since injury cohort using a 4-component model reported previously. Results The confirmatory factor analysis model fit was acceptable for Early, Middle, and Late (using cognitive-migraine-fatigue, affective, sleep, and somatic factors). Both affective (change = 0.30; P = .01; Cohen d = 0.30) and sleep (change = 0.51; P .001; Cohen d = 0.47) factors were significantly greater in the Late group compared with the Early, but not Middle, groups. The previously reported 4-factor symptom model, including cognitive- migraine-fatigue, affective, somatic, and sleep factors, was appropriate for adolescents up to 30 days' postinjury. However, adolescents who presented between 15 and 30 days' postinjury reported greater affective and sleep symptoms than those who presented within 1 week. Conclusions Clinicians should consider these temporal differences when evaluating concussion symptoms in adolescents, as greater affective and sleep symptoms can be predictive of prolonged recovery/persistent complications.
      原文链接:
    • NSTL
    • Elsevier

    Prescription Fluoride and Dental Caries for Children

    Ko, AliceChi, Donald L.
    1页
      原文链接:
    • NSTL

    Cardiac Magnetic Resonance Findings after Multisystem Inflammatory Syndrome in Children

    Dove, Matthew L.Oster, Matthew E.Hashemi, SassanSlesnick, Timothy C....
    7页
    查看更多>>摘要：Objective To describe the cardiac magnetic resonance (MR) findings of children recovered from multisystem inflammatory syndrome in children (MIS-C) longer than 3 months after acute illness. Study design We performed a retrospective cohort study of children hospitalized with MIS-C at a single institution receiving cardiac MR imaging between July 2020 and May 2021. Patient demographics, echocardiogram data from diagnosis through follow-up, and cardiac MR data obtained at approximately 3 months after hospitalization were recorded. Results In total, 51 children with a median age of 11.3 years were included; 80% of patients had left ventricular ejection fraction <55%, 65% of patients developed valvular regurgitation, and 20% of patients developed coronary artery dilation during acute illness. Cardiac MR was performed at a median time of 105 days after diagnosis; 8% of patients had left ventricular ejection fraction <55%; 1 patient had residual valvular regurgitation; and 2 patients had residual coronary artery dilation. Two of 51 patients were found to have late gadolinium enhancement, T1 mapping abnormalities, and abnormal or borderline extracellular volume calculations suggesting myocardial fibrosis. No patient had T2 mapping abnormalities corresponding with edema, and no patient met the modified Lake Louise criteria for acute myocarditis; 10 of 51 patients had isolated elevated T1 values. Conclusions At 3-5 months following diagnosis, cardiac MR reveals no evidence of acute myocarditis as described by the modified Lake Louise criteria in patients with MIS-C. Two patients were observed to have myocardial fibrosis without regional wall motion abnormalities, and 10 had isolated imaging changes (elevated T1 values) in the absence of macroscopic fibrosis.
      原文链接:
    • NSTL
    • Elsevier

    The Multiple Personalities of Epstein-Barr Virus

    Long, Sarah S.
    1页
      原文链接:
    • NSTL

    Comorbidities Associated with Hospitalization and Progression Among Adolescents with Symptomatic Coronavirus Disease 2019

    Campbell, Jeffrey, IDubois, Melanie M.Savage, Timothy J.Hood-Pishchany, M. Indriati...
    9页
    查看更多>>摘要：Objective To identify subgroups likely to benefit from monoclonal antibody and antiviral therapy by evaluating the relationship between comorbidities and hospitalization among US adolescents with symptomatic coronavirus disease 2019 (COVID-19). Study design We analyzed the relationship between presence of comorbidities and need for hospitalization within 28 days of COVID-19 diagnosis for adolescents aged 12-17 years listed in the Pediatric COVID-19 US registry, a multicenter retrospective cohort of US pediatric patients with COVID-19. Comorbidities assessed included obesity, chronic kidney disease (CKD), diabetes, immunosuppressive disease or treatment, sickle cell disease (SCD), heart disease, neurologic disease/neurodevelopmental disorders, and pulmonary disease (excluding patients with mild asthma). We used multivariable logistic regression to determine race/ethnicity-adjusted associations between comorbidities and hospitalization. Results A total of 1877 patients met our inclusion criteria, of whom 284 (15%) were hospitalized within 28 days of their COVID-19 diagnosis. In a race/ethnicity-adjusted model, the following comorbidities were independently associated with increased odds of hospitalization: SCD (aOR, 6.9; 95% CI, 3.0-15.9), immunocompromising condition (aOR, 6.4; 95% CI, 3.8-10.8), obesity (aOR, 3.2; 95% CI, 2.1-4.9), diabetes (aOR, 3.0; 95% CI, 1.4-6.2), neurologic disease (aOR, 2.8; 95% CI, 1.8-4.3), and pulmonary disease (excluding mild asthma) (aOR, 1.9; 95% CI, 1.2-3.1). Heart disease and CKD were not independently associated with hospitalization. Conclusions SCD, immunocompromising conditions, obesity, diabetes, neurologic disease, and pulmonary disease (excluding mild asthma) were associated with hospitalization for symptomatic COVID-19. Adolescents with acute COVID-19 and these comorbidities should be prioritized for consideration of therapy to avert hospitalization.
      原文链接:
    • NSTL
    • Elsevier

    Association Between Neonatal Phototherapy Exposure and Childhood Neoplasm

    Bugaiski-Shaked, AdvaShany, EilonMesner, OdedSergienko, Ruslan...
    6页
    查看更多>>摘要：Objective To study the association between phototherapy for the treatment of neonatal jaundice and the risk of childhood neoplasms. Study design This population-based retrospective cohort study included all infants born at >= 32 weeks of gestation at a single medical center between 1988 and 2018. The incidence of neoplastic diseases was compared between infants exposed to phototherapy and those unexposed. Kaplan-Meier curves and log-rank tests were used for cumulative incidence comparison, and multivariable Cox and Weibull survival analysis were used to adjust for confounding or clinically significant variables. Results The study population included 342 172 infants, of whom 18 797 (5.5%) were exposed to phototherapy. The median duration of follow-up was 9.5 years (range, birth to 18 years). Phototherapy was associated with a significantly increased risk for childhood malignancies and benign tumors (preterm birth and maternal age- adjusted hazard ratio, 1.89 [95% CI, 1.35-2.67] for malignancies and 1.27 [95% CI, 1.02-1.57] for benign tumors) Specifically, phototherapy was associated with hematopoietic cancers and leukemia (hazard ratio, 2.29 [95% CI, 1.48-3.54; P < .01] for hematopoietic cancers and 2.51 [95% CI, 1.52-4.14; P < .001] for leukemia), but not with solid tumors and lymphoma. Conclusions Phototherapy may be associated with a slightly increased childhood risk of neoplasm. It is important to strictly follow phototherapy treatment guidelines to minimize unnecessary exposure.
      原文链接:
    • NSTL
    • Elsevier

    Characterizing Pediatric Familial Adenomatous Polyposis in Patients Undergoing Colectomy in the United States

    Flahive, Colleen B.Onwuka, AmandaBass, Lee M.MacFarland, Suzanne P....
    6页
    查看更多>>摘要：Objective To characterize a multi-institutional cohort of pediatric patients who underwent colectomy for familial adenomatous polyposis (FAP). Study design In this retrospective cohort study, diagnosis and procedure codes were used to identify patients who underwent colectomy for FAP within the Pediatric Health Information System (PHIS). The inclusion criteria were validated at 3 children's hospitals and applied to PHIS to generate a cohort of patients with FAP between 2 and 21 years who had undergone colectomy between 2009 and 2019. Demographics, clinical and surgical characteristics, and endoscopic procedu re trends as identified through PHIS are described. Descriptive and comparative statistics were used to analyze data. Results Within the PHIS, 428 pediatric patients with FAP who underwent colectomy were identified. Median age at colectomy was 14 years (range 2-21 years); 264 patients (62%) received an ileal pouch anal anastomosis and 13 (3%) underwent ileorectal anastomosis. Specific anastomotic surgical procedure codes were not reported for 151 patients (35%). Endoscopic assessment at the surgical institution occurred in 40% of the cohort before colectomy and in 22% of the cohort following colectomy. Conclusions In this cohort, colectomy took place at an earlier age than suggested in published guidelines. Ileal pouch anal anastomosis is the predominant procedure for pediatric patients with FAP who underwent colectomy in US pediatric centers. Endoscopic assessment trends before and after surgery suggest that the surgical institution plays a limited role in the care of this population.
      原文链接:
    • NSTL
    • Elsevier

    Relationship Between Food Insecurity and Neighborhood Child Opportunity Index

    Ho, Brandon J.Rucker, AlexandraBoyle, Meleah D.Badolato, Gia M....
    6页
    查看更多>>摘要：Objectives To evaluate the association between the Child Opportunity Index (C01) and food insecurity. Study design This was a secondary analysis of a comprehensive screening instrument for social determinants of health and behavioral health risks. It was administered in 2 urban pediatric emergency departments to adolescents aged 13-21 years and caregivers of children aged 0-17 years. Food insecurity was assessed using the 2-item Hunger Vital Sign. Residential addresses were geocoded and linked with COI data. Bivariable and multivariable logistic regression models were developed to measure the relationship between COI and food insecurity. Results Of the 954 participants (384 adolescents, 570 caregivers) who underwent screening, 15.7% identified food insecurity (14.3% of adolescent and 16.7% of caregiver participants). The majority of participants were non-Hispanic Black (overall, 62.3%; food secure, 60.9%; food insecure, 72.0%), were publicly insured (overall, 56.6%; food secure, 53.1%; food insecure, 73.3%), and lived in neighborhoods of low/very low opportunity (overall, 76.9%; food secure, 74.7%; food insecure, 88.3%). In adjusted analyses, participants living in neighborhoods of low/very low child opportunity had 3-fold greater odds of being food insecure compared with children living in neighborhoods of high child opportunity (aOR, 3.0; 95% CI, 1.4-6.3). Conclusion We demonstrate that food insecurity is associated with lower neighborhood opportunity. Our results could inform future screening initiatives and support the development of novel, place-based interventions to tackle the complex issue of food insecurity.
      原文链接:
    • NSTL
    • Elsevier