The Journal Of Pediatrics[JOURNAL]
Sun
200 papers
Guideline-Discordant Bronchiolitis Care in Community Emergency Departments.
Casey SD, Perry RM, Somers MJ … +7 more , DiLena DD, Luna D, Greenhow TL, Ballard DW, Nguyen THP, Dalziel SR, Reed ME
J Pediatr · 2026 Jun · PMID 42297338 · Publisher ↗
OBJECTIVES: To determine demographic and clinical predictors of guideline discordant care (GDC) that children with uncomplicated bronchiolitis receive in community emergency departments (EDs) and to explore the associati...
OBJECTIVES: To determine demographic and clinical predictors of guideline discordant care (GDC) that children with uncomplicated bronchiolitis receive in community emergency departments (EDs) and to explore the association between GDC and ED length (LOS) for children who meet criteria for supportive care alone. STUDY DESIGN: We conducted a retrospective observational study from 2017-2024 of ED patients 28 days -2 years old lacking comorbidities with bronchiolitis. All children were discharged home from the 21 community EDs in our Northern California health system. Our primary outcome was GDC, which was defined as receipt of ≥1 test or intervention discordant with guidelines from the American Academy of Pediatrics (AAP) and included bronchodilators, chest radiography, steroids, or antibiotics. A secondary outcome was ED LOS. We analyzed patient and clinical characteristics associated with GDC and its association with ED LOS using multivariable regression. RESULTS: We included 6,083 patient encounters in which AAP guideline application would be justified; most had normal triage vital signs (86%), and all were discharged home. Most patients (62%) received ≥1 measure of GDC; chest radiography (41%) and albuterol (37%) were most common. GDC was associated with longer median ED LOS (142 min, 95% CI: 140-145 min) compared with no GDC (84 min, 95% CI: 82-86 min). After adjustment, abnormal vital signs, older age, male sex, and past albuterol exposurewere associated with increased likelihood of GDC. CONCLUSIONS: GDC is prevalent among children with uncomplicated bronchiolitis, even though most patients meet eligibility criteria for the application of AAP guidelines. GDC is associated with prolonged ED LOS and may have a significant impact on ED overcrowding. These findings suggest that AAP guidelines have had a limited effect on GDC in community EDs.
Naloxone Co-Prescribing Across a Pediatric Health System: A Quality Improvement Initiative.
Bythrow M, Devine K, Linstead R … +3 more , Schellenberger T, Scott M, Sutherland TN
J Pediatr · 2026 Jun · PMID 42297337 · Publisher ↗
OBJECTIVE: To increase naloxone co-prescribing to ≥80% among patients prescribed opioids as outpatients by December 31, 2024, regardless of gender, race, or preferred language. STUDY DESIGN: We conducted a quality improv...
OBJECTIVE: To increase naloxone co-prescribing to ≥80% among patients prescribed opioids as outpatients by December 31, 2024, regardless of gender, race, or preferred language. STUDY DESIGN: We conducted a quality improvement initiative at the Children's Hospital of Philadelphia (CHOP) from October 2023 to June 2025. In 3 phases, we implemented an electronic health record (EHR)-based automated alert to co-prescribe naloxone, combined with education for providers, nurses, patients/families, and pharmacists. The primary outcome was the proportion of patients with an outpatient opioid prescription who were co-prescribed naloxone ("coverage"). We also tracked naloxone dispensing from CHOP pharmacies (outcome measure) and provider engagement with the alert (process measure). Balancing measures included provider-reported ease of prescribing naloxone and comfort offering naloxone. RESULTS: Compared with a 1-year baseline period, average monthly naloxone coverage increased from 3.0% to 84.1% enterprise-wide. Although early feedback revealed that perceived stigma and naloxone cost were barriers to dispensing, the proportion of orders for naloxone dispensed at our internal pharmacy during the initiative was 59.1%. Most providers reported that naloxone was easy to prescribe (81.8%, 36/44) and reported high levels of comfort with offering naloxone to families (86.4%, 38/44). CONCLUSIONS: EHR-based prompts, combined with education for providers, nurses, patients/families and pharmacists, increased naloxone co-prescribing across a diverse population of patients in a large pediatric health system.
Ambulatory Blood Pressure Thresholds and Left Ventricular Hypertrophy in Children Aged 6-12 Years: A Pediatric Nephrology Research Consortium Study.
Jahan A, Schuchman M, Abdullah M … +16 more , McLaughlin M, Cadiz EM, Manchanda E, Chishti A, Murphy M, Twichell S, Mazo A, Samsonov D, Maniar A, Kim H, Lomanta F, Patibandla AC, Frank R, Srivastava T, Yamaguchi I, Sethna C
J Pediatr · 2026 Jun · PMID 42297336 · Publisher ↗
OBJECTIVE: To evaluate the diagnostic performance of ambulatory blood pressure monitoring (ABPM) thresholds for predicting left ventricular hypertrophy (LVH) in children aged 6-12 years. STUDY DESIGN: A retrospective, mu...
OBJECTIVE: To evaluate the diagnostic performance of ambulatory blood pressure monitoring (ABPM) thresholds for predicting left ventricular hypertrophy (LVH) in children aged 6-12 years. STUDY DESIGN: A retrospective, multicenter study was conducted across 11 Pediatric Nephrology Research Consortium (PNRC) sites and included children aged 6-12 years who underwent ABPM and two-dimensional (2D) echocardiography for diagnostic assessment of elevated blood pressure (BP). Diagnostic accuracy of fixed ABPM thresholds and the current 95th percentile for sex and height were assessed using area under the receiver operating characteristic (AUROC), sensitivity, specificity, and Youden index. Multivariable logistic regression models, adjusted for age, sex, and body mass index (BMI) z-score, were used to evaluate associations of ABPM thresholds with LVH. RESULTS: Among 279 children, hypertension was present in 51%, and LVH in approximately 20%. Across all systolic and diastolic ABPM thresholds tested, AUROC values ranged from 0.5 to 0.6, indicating poor discriminatory performance, including analyses restricted to children without chronic kidney disease or obesity. Although daytime and 24-hour BP thresholds were not significantly associated with LVH, nighttime systolic BP ≥110 mmHg and nighttime diastolic BP ≥70 mmHg both increased odds of LVH approximately twofold (OR for nighttime SBP 1.93; 95% CI, 1.07-3.50; p=0.03; and OR for nighttime DBP 2.27; 95% CI, 1.08-4.76; p=0.03). CONCLUSIONS: In this multicenter cohort of US children aged 6-12 years, percentile-based and fixed ABPM thresholds demonstrated limited ability to discriminate LVH. Nighttime systolic and diastolic BP showed the strongest associations with LVH, underscoring the importance of nocturnal BP assessment.
Values in the Neonatal Intensive Care Unit: Insights into Caregiver Priorities.
Cyrus KE, Creel AM, Fang Z … +2 more , Autrey AK, Surcouf JW
J Pediatr · 2026 Jun · PMID 42297335 · Publisher ↗
OBJECTIVES: To identify and prioritize caregiver values related to high-quality care for infants hospitalized in the neonatal intensive care unit (NICU) and to examine variation in these values by caregiver and clinical...
OBJECTIVES: To identify and prioritize caregiver values related to high-quality care for infants hospitalized in the neonatal intensive care unit (NICU) and to examine variation in these values by caregiver and clinical characteristics. STUDY DESIGN: Sixteen domains of high-value NICU care were adapted for the neonatal, critical care setting from the National Consensus Project's Guidelines for Quality Palliative Care, neonatology literature, and a stakeholder panel. Using a discrete choice experiment, we recruited caregivers to provide their ratings of the most and least valued NICU care domains. RESULTS: Forty-five caregivers of 39 infants participated. Overall, caregivers ranked "Care team members have the necessary education and training to provide high quality care for infants and families," as most important with domains relating to communication and symptom management also ranked highly. Cultural, spiritual, and religious aspects of care were among the lowest ranked. Differences in highest ranked values were also noted based on the patient's length of stay, clinical status, and caregiver's relationship to the patient. CONCLUSIONS: Among caregivers of infants in the NICU, values emphasizing care team knowledge, communication, and symptom management were consistently prioritized. Identification of caregiver priorities during NICU hospitalization may help clinicians better understand the perspectives that shape families' experiences of care and support efforts toward value-concordant communication and shared decision-making.
Demographic Shifts in Pediatric Emergency Department Visits for Homelessness During State and Federal Policy Changes.
Donohue KJ, Gabbay JM, Guyol GG … +3 more , Chang L, Belenky CC, Stewart AM
J Pediatr · 2026 Jun · PMID 42297334 · Publisher ↗
OBJECTIVE: To evaluate trends, demographics, and visit characteristics in pediatric emergency department (ED) visits for homelessness in relation to state and federal policies before and during the COVID-19 pandemic. STU...
OBJECTIVE: To evaluate trends, demographics, and visit characteristics in pediatric emergency department (ED) visits for homelessness in relation to state and federal policies before and during the COVID-19 pandemic. STUDY DESIGN: We conducted a retrospective cohort study of pediatric ED visits for homelessness from 2019-2021 at an urban tertiary care children's hospital. Visit rates were analyzed in relation to the 2019 repeal of a restrictive shelter eligibility state policy and the implementation and expiration of state and federal COVID-19 eviction moratoria. Demographic and clinical characteristics were compared before and during the pandemic. RESULTS: Among 1,045 visits, the rate of pediatric ED visits for homelessness per 1,000 total visits declined modestly after the 2019 policy repeal, then spiked in January 2021 following the end of COVID-19 eviction moratoria. During the pandemic, children presenting for homelessness were more likely to be Hispanic (72.5% vs 53.4%, P<0.001), have Spanish-speaking caregivers (59.1% vs 40.1%, P<0.001), and have chronic medical conditions (25.2% vs 14.6%, P<0.001), compared with before the pandemic. Families were less likely to have eviction as the reason for their homelessness (6.2% vs 11.4%, P=0.010) during the pandemic, and were more likely to cite loss of job or income (11.2% vs 4.9%, P=0.001). CONCLUSIONS: Pediatric ED visits for homelessness persisted throughout the pandemic, with notable demographic shifts and changing causes of homelessness. These findings demonstrate the inequitable impact of the pandemic on different groups of children, underscore the limitations of temporary housing protections, and highlight the need for durable, equity-driven housing policies.
Embracing Our Humanity: Building a Physician Well-Being Champion Program.
Fahey LM, Boldizar L, DeRusso PA … +2 more , St Geme JW, Stewart MT
J Pediatr · 2026 Jun · PMID 42285285 · Publisher ↗
Abstract loading — click title to view on PubMed.
An Introduction to Classification and Regression Trees for Risk Assessment in Pediatric Research.
Selvaraj N, Chen S
J Pediatr · 2026 Jun · PMID 42285284 · Publisher ↗
Abstract loading — click title to view on PubMed.
Association Between Primary Care Access and Emergency Department Utilization.
Gaffney LK, Lyons TW, Monuteaux MC … +1 more , Hudgins J
J Pediatr · 2026 Jun · PMID 42259470 · Publisher ↗
OBJECTIVES: To examine the association between primary care pediatrician (PCP) access and emergency department (ED) utilization and reliance for children, and to determine whether lack of PCP, limited after hour availabi...
OBJECTIVES: To examine the association between primary care pediatrician (PCP) access and emergency department (ED) utilization and reliance for children, and to determine whether lack of PCP, limited after hour availability, and greater distance to care would be associated with higher ED utilization and reliance. STUDY DESIGN: We performed a retrospective, cross-sectional study of nonelective visits for children <18 years old in 2021-2022, utilizing the nationally representative Medical Expenditure Panel Survey. Primary outcomes were frequent ED utilization (>2 emergency visits annually) and high ED reliance (one-third or more of all medical visits occurring in the ED). We assessed the relationship between PCP access and the outcomes using logistic regression, adjusting for age, sex, race and ethnicity, and special health care need. RESULTS: We included 9878 surveyed children, who were representative of 72 549 476 children nationally. A total of 60 353 592 (83.2%) children had identified PCP. Lack of PCP was associated with high ED reliance (aOR 1.78, 95% CI 1.26-2.50) but showed no significant association with frequent ED utilization (aOR 0.60, 95% CI 0.34-1.08). Among children with identified PCP, neither travel time to PCP, ease of contact with phone or email, ease of contact after hours, nor night-time and weekend availability was associated with either outcome. CONCLUSIONS: Lack of PCP is strongly associated with greater reliance on the ED as a source of medical care, but not with frequent ED utilization. Policymakers can use these data to tailor programs to the needs of specific groups that would most benefit from improved access to care.
The MIND Randomized Controlled Trial: An Intervention to Improve Neural Speech Processing and 2-Year Language Outcomes of Infants Born Preterm.
Maitre NL, Kjeldsen CP, Jeanvoine A … +3 more , Lukemire J, Slaughter JL, Key AP
J Pediatr · 2026 Jun · PMID 42250747 · Publisher ↗
OBJECTIVES: To assess whether contingently administered caregivers' infant-directed voice in a multisensory intervention would have a larger effect than standard care on preterm neural speech-sound differentiation and to...
OBJECTIVES: To assess whether contingently administered caregivers' infant-directed voice in a multisensory intervention would have a larger effect than standard care on preterm neural speech-sound differentiation and to determine if effects of the intervention causally mediated differences in 2-year language outcomes. STUDY DESIGN: A randomized controlled trial of the MIND (Multisensory support to Improve Neural processing and Development) intervention (contingent caregiver's recorded voice, scent cloth, holding by therapist in kangaroo binder; 20 sessions, 20 minutes each, over 2-3 weeks) compared with an enhanced standard care control (passive listening to recorded caregiver's voice, same dose) starting at 32-36 weeks of corrected gestational age (GA) among infants in the neonatal intensive care unit. Speech-sound differentiation was measured by auditory time-locked electroencephalogram (EEG) pre- and post-intervention and language outcomes using Bayley Scales of Infant and Toddler Development and Preschool Language Scales at 2 years. Analyses were conducted through ANCOVA and causal mediation modeling. RESULTS: Of enrolled infants (mean GA 28.8 weeks), 100 completed MIND and 98 completed enhanced standard care, with usable EEG data pre- and post-intervention. Infants receiving MIND had greater neural speech-sound differentiation compared with controls (F ranging 5.33-7.87; P ranging .03 to .04). MIND effects included small-to-medium size effects on language outcomes that were mediated by EEG with total effects model R ranging 0.39-0.57 (P ranging .05 to <.001), all adjusting for GA and maternal education. CONCLUSIONS: MIND, a parent-supported, therapist-implemented intervention, can improve preterm speech-sound differentiation in the neonatal intensive care unit and 2-year language outcomes. Efficacious parent-engaging neuropromotive interventions can change neurodevelopment, even without bedside presence. TRIAL REGISTRATION: ClinicalTrials.gov NCT03232931.
Role of Home Monitoring in Reducing Disparities in the Interstage Mortality of Infants with Single Ventricle.
El-Magharbel Y, Goldberg CS, Yu S … +8 more , Valentini A, Uzark K, Romano JC, Fifer CG, Afton KM, Lowery R, Duimstra A, Balasubramanian S
J Pediatr · 2026 Jun · PMID 42250746 · Publisher ↗
OBJECTIVE: To determine whether the interstage (between Norwood and stage 2 palliation) home monitoring program (IHMP) has reduced disparities in interstage survival and growth outcomes in patients with single-ventricle...
OBJECTIVE: To determine whether the interstage (between Norwood and stage 2 palliation) home monitoring program (IHMP) has reduced disparities in interstage survival and growth outcomes in patients with single-ventricle heart disease. STUDY DESIGN: A single-center, retrospective study was performed on patients with single-ventricle lesions who underwent a Norwood operation between January 2000 and December 2020. Data were collected from the institutional electronic medical record, the Pediatric Cardiac Critical Care Consortium and National Pediatric Cardiology Quality Improvement Collaborative registries, and the US census. The National Pediatric Cardiology Quality Improvement Collaborative's NEONATE risk score was used as the representative clinical variable. Primary outcomes were interstage mortality (ISM) and interstage growth (ISG), assessed by change in weight-for-age z scores. Multivariable logistic and linear regressions were used to examine the impact of IHMP, initiated in 2012 to address clinical and sociodemographic contributors of ISM, on the independent associations of patient clinical and sociodemographic factors with ISM and ISG, respectively. RESULTS: Post-IHMP, ISM decreased (12.7% vs 6.7%, P = .04) and average ISG z scores increased (-0.15 [0.97] vs 0.14 [0.84)] P = .01). Multivariable analyses showed that lower birth weight, public insurance, and high NEONATE risk score were independently associated with ISM (all P < .05). Birth weight, feeding at discharge, and NEONATE risk score were independently associated with ISG (all P < .05). Both results remained significant after adjusting for IHMP. CONCLUSIONS: In the current era, with a robust IHMP, ISG and ISM improved whereas sociodemographic disparities persisted, suggesting the need for a tailored approach for vulnerable patient groups.
Institutional Variation in Cervical Spine Imaging among Children with Blunt Trauma: A Multicenter Prospective Observational Cohort Study.
Chaudhari PP, Rogers A, Burger RK … +11 more , Harding M, Cook LJ, Adelgais K, Browne LR, Corwin D, Delgado C, Lee LK, Riney L, Ward C, Leonard JC, PECARN C-Spine Study Team
J Pediatr · 2026 Jun · PMID 42250745 · Publisher ↗
OBJECTIVE: To describe institutional variation in use of cervical spine radiographs (x-ray) and computed tomography (CT) among children evaluated following blunt trauma. STUDY DESIGN: We conducted a planned secondary ana...
OBJECTIVE: To describe institutional variation in use of cervical spine radiographs (x-ray) and computed tomography (CT) among children evaluated following blunt trauma. STUDY DESIGN: We conducted a planned secondary analysis of a multicenter, observational cohort study of children 0-17 years old evaluated for possible cervical spine injury (CSI) in 18 emergency departments (EDs) from December 2018-October 2021. Our primary outcome was any ED cervical spine x-ray or CT, and our secondary outcome was use of CT only. We performed univariable logistic regression, reporting ED-level unadjusted and injury severity-adjusted proportions of children with any cervical spine imaging and CT only, stratified by presenting ED type (referring general ED vs pediatric ED). Severity adjustment was based on Pediatric Emergency Care Applied Research Network high-risk predictors (Glasgow Coma Scale 3-8, unresponsiveness, abnormal airway/breathing/circulation, and focal neurologic deficits). RESULTS: We enrolled 22 430 eligible children, of whom 17.9% (n = 4008) were referred from a general ED. Cervical spine x-ray or CT was performed in 52.9% (n = 11 865) and 1.9% (n = 433) were diagnosed with a CSI. After adjusting for severity, imaging proportions were similar within each ED type (referring general EDs and pediatric EDs). Among children whose initial evaluation occurred in a referring general ED, 71.3% underwent any cervical spine imaging and 32.3% underwent CT as the sole modality. Among children presenting directly to a pediatric ED, the corresponding proportions were 48.9% and 7.9%. CONCLUSIONS: In this observational study of children with potential CSI, those managed in referring general EDs and transferred to pediatric EDs more frequently underwent cervical spine imaging, including CT as the sole modality, than those presenting directly to pediatric EDs. These data can inform future benchmarking to assess concordance after implementation of the PECARN CSI decision rule.
Sudden Acute Liver Failure in Citrullinemia Type 1: An Argument for Earlier Liver Transplantation?
Eldredge JA, Dhawan A, Deheragoda M … +5 more , Heaton ND, Cortes-Cerisuelo M, Grünewald S, Hadžić N, Vara R
J Pediatr · 2026 Jun · PMID 42235881 · Publisher ↗
Acute liver failure has been described at initial presentation of citrullinemia type 1, but recurrent hepatic decompensations during medical treatment have not been reported. We describe 5 children developing episodes of...
Acute liver failure has been described at initial presentation of citrullinemia type 1, but recurrent hepatic decompensations during medical treatment have not been reported. We describe 5 children developing episodes of acute liver failure, including one who required emergency liver transplantation. Our findings expand the citrullinemia type 1 phenotype and support early liver transplant referral in selected cases.
Temporal Association Between Viral Infections and Intussusception: Comparing SARS-CoV-2 and Adenovirus Using Self-Controlled and Case-Control Designs.
Miyamori D, Ito M
J Pediatr · 2026 Jun · PMID 42229729 · Publisher ↗
OBJECTIVE: To investigate the short-term risk of intussusception following SARS-CoV-2 and adenovirus infections in children. STUDY DESIGN: Using Japan's health insurance claims database from January 2015 to December 2022...
OBJECTIVE: To investigate the short-term risk of intussusception following SARS-CoV-2 and adenovirus infections in children. STUDY DESIGN: Using Japan's health insurance claims database from January 2015 to December 2022, a self-controlled risk interval design and a nested case-control analysis with conditional logistic regression were employed to adjust for individual confounders and assess the robustness of the findings. RESULTS: The study included 3.6 million children aged <10 years, with 1069 intussusception events identified by procedure codes. The self-controlled risk interval analysis revealed a 4-fold increased incidence of intussusception within 0-1 months of SARS-CoV-2 infection (incidence rate ratio 4.27, 95% CI 2.11-8.67) and a 6-fold increased incidence for adenovirus infection (incidence rate ratio 6.09, 95% CI 3.18-11.66). The nested case-control analysis yielded consistent results, with odds ratios of 4.43 (95% CI 2.94-6.66) for SARS-CoV-2 and 8.21 (95% CI 6.12-11.02) for adenovirus. Monte Carlo resampling confirmed the stability of the estimates. Negative control windows showed no increased risk, supporting the validity of the observed associations. CONCLUSIONS: This study provides population-scale evidence that both SARS-CoV-2 and adenovirus infections are associated with the risk of pediatric intussusception, with adenovirus demonstrating a stronger effect. The findings have implications for clinical vigilance and understanding the impact of viral infections on gastrointestinal disorders in children.
Newborn Screening for Familial Hypercholesterolemia Using Liquid Chromatography Tandem Mass Spectrometry-Based Free Cholesterol Measurements.
Hannemann A, Winter T, Steinhagen-Thiessen E … +10 more , Giżewska M, Ołtarzewski M, Klein J, Blankenstein O, Henning AK, Zylla S, Petersmann A, Friedrich N, Ceglarek U, Nauck M
J Pediatr · 2026 Jun · PMID 42229728 · Publisher ↗
OBJECTIVE: To describe the feasibility of free cholesterol (FC) measurement from dried blood spots (DBS) obtained during regular newborn screening in a pilot project in the Euroregion Pomerania, aimed ultimately to enhan...
OBJECTIVE: To describe the feasibility of free cholesterol (FC) measurement from dried blood spots (DBS) obtained during regular newborn screening in a pilot project in the Euroregion Pomerania, aimed ultimately to enhance the rates of familial hypercholesterolemia diagnoses. STUDY DESIGN: DBS from 7973 babies born in 2019 and included in the "Innovative Polish-German Cross-Border Program for Early Diagnosis and Treatment of Rare Diseases in Newborns - RareScreen" project were analyzed. The FC concentration was measured in each DBS using liquid chromatography tandem mass spectrometry and the distribution was examined. RESULTS: The FC concentration determined in the study sample ranged between 0.005 and 1.521 mmol/L (0.19 and 58.89 mg/dL), with a median of 0.709 mmol/L (27.4 mg/dL). There was no strong appearance of effects attributable to the newborn's sex, gestational age, birth weight, or age at sampling on the FC concentration. The 99.5% percentile for the FC concentration was 1.159 mmol/L (44.8 mg/dL). CONCLUSIONS: Our study demonstrated the feasibility of large-scale measurements of FC in DBS from newborns using liquid chromatography tandem mass spectrometry in a central study laboratory. The FC concentration was similar across selected demographic and clinical conditions of the newborns. FC may represent a novel marker for screening of lipid abnormalities but needs to be validated in future studies.
Connecting the Dots: Network Analysis of the Concussion Clinical Profiles Screening among Adolescents.
Thomas G, Zynda AJ, Trbovich AM … +4 more , Phan L, Collins MW, Kontos AP, Reynolds E
J Pediatr · 2026 Jun · PMID 42229727 · Publisher ↗
OBJECTIVES: To examine the network structure and relationships between common postconcussion symptoms and to apply network analysis techniques to the Concussion Clinical Profiles Screening (CP Screen) in order to determi...
OBJECTIVES: To examine the network structure and relationships between common postconcussion symptoms and to apply network analysis techniques to the Concussion Clinical Profiles Screening (CP Screen) in order to determine whether the CP Screen items cluster together within the appropriate predefined profiles. STUDY DESIGN: Participants included 913 adolescents (mean age = 15.04 ± 1.60 years, 43.3% female) seen in a specialty clinic within 7.04 ± 18.54 days of a diagnosed concussion. Participants completed the 29-item CP Screen at their initial clinic visit, which were used to estimate networks and calculate centrality (strength, betweenness, expected influence) and bridge strength. Network stability was assessed via bootstrapped case-dropping procedures (1000 iterations). RESULTS: The most central symptoms were slow/wavy dizziness (vestibular; strength z score = 1.90), headache with cognitive exertion (cognitive/fatigue; strength z score = 1.50), eye strain (ocular; strength z score = 1.40), headache with light and noise (post-traumatic migraine; strength z score = 1.18), hyposomnia (sleep; strength z score = 1.02), and feeling more stressed than usual (mood/anxiety; strength z score = 0.89). Bridge analysis identified headache with cognitive exertion, difficulty in busy environments, post-traumatic migraine-related symptoms, and ocular-motor symptoms as key connectors across symptom clusters. Network stability was excellent (edge-weight correlation stability coefficient = 0.75; strength correlation stability coefficient = 0.67). Community analysis identified 4 communities: anxiety/mood, vestibular, ocular, and headache/migraine. Modularity was modest but indicative of meaningful community structure, and there was moderate agreement with the pre-defined clinical profiles. CONCLUSIONS: Network analysis supported the CP Screen's original clinical profile structure. Findings also identified key central symptoms that may be driving elevated symptom burden postconcussion, as well as those symptoms that connect across profiles. This symptom profile approach may inform more effective, and targeted interventions for adolescents following concussion.
Increased Risk of Heart Rhythm Abnormalities in Adolescents and Young Adults Who Vape.
Tsalatsanis A, Johnson J, Abou-Assali O … +3 more , Almeida S, Khalaf R, Noujaim SF
J Pediatr · 2026 Jun · PMID 42229726 · Publisher ↗
OBJECTIVE: To test the hypothesis that the risk of heart rhythm abnormalities is increased in adolescents and young adults (AYA) who vape. STUDY DESIGN: We used data from the TriNetX network to identify 2 groups of AYA (...
OBJECTIVE: To test the hypothesis that the risk of heart rhythm abnormalities is increased in adolescents and young adults (AYA) who vape. STUDY DESIGN: We used data from the TriNetX network to identify 2 groups of AYA (11-24 years old). The first group included individuals who vaped and the second group was a comparison of individuals who did not report vaping. Individuals in the vaping group were matched 1:1 with those in the comparison group using propensity scores. The primary outcome was the association between vaping and diagnoses of heart rhythm abnormalities. We analyzed data from 114 404 patients (57 202 in each group) with no significant differences in baseline characteristics. RESULTS: Patients who vaped had 82% greater odds of being diagnosed with heart rhythm abnormalities compared with those who did not vape (OR 1.82, 95% CI 1.74-1.91, P < .001). Furthermore, the hazard of developing heart rhythm abnormalities was approximately twice as high among those who vaped compared with those who did not (hazard ratio 1.97, 95% CI 1.88-2.06, P < .001). CONCLUSIONS: There is an association between e-cigarette use and an increased risk of heart rhythm abnormalities in AYA. These findings highlight the potentially harmful cardiac electrophysiological outcomes of vaping in this population and underscore the importance of health interventions and surveillance.
Neuroprotection Bundles and Intraventricular Hemorrhage Rates in Neonates <29 Weeks' Gestation.
Deshpande P, Goswami I, Mohammad K … +8 more , Ng E, Garfinkle J, Wintermark P, Mukerji A, Yoon E, Beltempo M, Shah PS, Canadian Neonatal Network and Canadian Preterm Birth Network Investigators
J Pediatr · 2026 May · PMID 42208756 · Publisher ↗
OBJECTIVE: To evaluate the association of intraventricular hemorrhage-neuroprotection bundle (IVH-NB) implementation on intraventricular hemorrhage (IVH) rates in infants born at <29 weeks' gestation. STUDY DESIGN: This...
OBJECTIVE: To evaluate the association of intraventricular hemorrhage-neuroprotection bundle (IVH-NB) implementation on intraventricular hemorrhage (IVH) rates in infants born at <29 weeks' gestation. STUDY DESIGN: This multicenter, retrospective, preimplantation and postimplementation cohort study included neonates of <29 weeks' gestation admitted to Canadian neonatal intensive care units (NICUs) participating in the Canadian Neonatal Network. Sites which implemented IVH-NB were identified via a survey. Data were collected for 36 months each for preimplantation and postimplementation periods per NICU, with 1-month washout. Infants with major anomalies or admitted >2 days after birth were excluded. Primary outcome was a composite of severe IVH (grade III/IV) or death ≤ first 7 days. Secondary outcomes included severe IVH, posthemorrhagic ventricular dilatation, and severe neurological injury (severe IVH or periventricular leukomalacia). RESULTS: Seventeen NICUs that implemented IVH-NB were included, contributing a total of 6522 infants (3216 preimplementation and 3306 postimplementation). Postimplementation, deferred cord clamping (56% vs 62%, P < .0001), prophylactic indomethacin (15% vs 19%, P < .0001), and normothermia (50% vs 56%, P < .0001) increased, and cardiopulmonary resuscitation (29% vs 25%, P < .0001) and endotracheal intubation at birth decreased (46% vs 41%, P < .0001). After implementation, aOR for the composite outcome (aOR 1.07, 95% CI 0.84, 1.35), severe IVH (aOR 1.02, 95% CI 0.80, 1.31), and posthemorrhagic ventricular dilatation (aOR 1.18 95% CI 0.78, 1.79) were unchanged. The only bundle component associated with improved outcomes was early patent ductus arteriosus treatment adopted by 2 sites (aOR 0.30, 95% CI 0.17, 0.55). No temporal trend in outcomes was identified. CONCLUSION: In this large multicenter cohort, IVH-NB implementation was associated with improved practices but not with improved outcomes.
Acute Intensification May Reduce Persistent Coronary Artery Damage from Kawasaki Disease in Infants Younger Than 6 Months.
Dummer KB, Dominguez SR, Grenier M … +5 more , Cole LD, Anderson MS, Shimizu C, Tremoulet AH, Burns JC
J Pediatr · 2026 May · PMID 42202942 · Publisher ↗
OBJECTIVE: To characterize outcomes in patients <6 months old with Kawasaki disease who did or did not receive intensification of initial therapy. STUDY DESIGN: A retrospective cohort study of infants <6 months admitted...
OBJECTIVE: To characterize outcomes in patients <6 months old with Kawasaki disease who did or did not receive intensification of initial therapy. STUDY DESIGN: A retrospective cohort study of infants <6 months admitted to Rady Children's Hospital San Diego (n = 48) and Children's Hospital Colorado (n = 23) between January 1, 2014, and January 12, 2023, with Kawasaki disease diagnosed by American Heart Association criteria within 10 days of fever onset. Data included demographics, laboratory values, treatment, and echocardiogram results. Intensified therapy was defined as at least 1 therapy in addition to intravenous immunoglobulin. RESULTS: Of 71 patients, 33 (46.5%) had an initial echocardiogram obtained within 24 hours of intravenous immunoglobulin that demonstrated coronary artery aneurysms (CAA) (z score of the left anterior descending or right coronary artery ≥+2.5). CAA subsequently developed in an additional 6 patients. In total, 79% of patients received intensified therapy, most commonly infliximab (98%). Ten patients who received intensified therapy developed medium or giant aneurysms of whom 6 remodeled completely during the study period. Of the 15 patients with initially normal findings on echocardiogram who did not receive intensification, 13 remained normal and 2 developed transient, mild CA dilatation (z score ≥+2 and <+2.5). Echocardiograms closest to 1-year follow-up demonstrated 5 (7%) patients with residual CAA, none with z score >+3. CONCLUSIONS: In this observational series, no infants <6 months treated within 10 days of fever onset with intensification of initial therapy had more than mild CAA by 1 year after illness onset. Larger, multicenter studies are needed to support causal inference.
Developmental Care Practices for Infants with Grade 3 Bronchopulmonary Dysplasia While in the Neonatal Intensive Care Unit.
DiPrisco B, Brinker K, Coyle M … +10 more , DuPont T, Hanin M, House M, Lagoski M, Miller AN, Ransom MA, Sillers L, Wittwer C, Wood A, DeMauro SB
J Pediatr · 2026 May · PMID 42190905 · Publisher ↗
OBJECTIVE: To evaluate neurodevelopmental care practices for patients with grade 3 bronchopulmonary dysplasia (BPD), specifically the relationships between frequency of developmental therapies and types of developmentall...
OBJECTIVE: To evaluate neurodevelopmental care practices for patients with grade 3 bronchopulmonary dysplasia (BPD), specifically the relationships between frequency of developmental therapies and types of developmentally supportive equipment provided to patients and the patient's current level of respiratory support, while still in the neonatal intensive care unit (NICU). STUDY DESIGN: Cross-sectional study of 22 NICUs in the BPD Collaborative, including all eligible infants in each NICU with grade 3 BPD who had never been discharged home. We collected data about current respiratory support, neurodevelopmental therapies, and availability of developmentally supportive equipment in patients' rooms through the medical records and interviews with bedside nurses. RESULTS: For this study 141 infants were included (median postmenstrual age 49 weeks, IQR 43-60 weeks). The majority (65.2%) were receiving invasive ventilation. Respiratory support was significantly associated with any physical therapy (P = .008) or speech therapy (P < .001) and total number of completed therapy sessions in the prior 48 hours (P < .001). Availability of developmentally supportive equipment in an infant's room was also significantly associated with respiratory support. Patients with tracheostomies had a notably higher count of many different types of developmentally supportive equipment in their rooms than those infants with endotracheal tubes and those receiving noninvasive respiratory support. The majority of nurses reported having time to support their patients' development (80%), but fewer than half the infants regularly experienced reading (37%) or singing (46%). CONCLUSIONS: Developmental supports for infants with grade 3 BPD vary based on respiratory support and across institutions. Infants with tracheostomies have more opportunities for developmentally supportive activities. These data can be used to benchmark care practices across institutions and guide prospective studies to standardize developmental care and improve outcomes in infants with grade 3 BPD.
Geospatial Indices of Neighborhood Environment and Preadolescent Behavioral Health Screening in Primary Care.
Jones JD, Penney C, Davis M … +6 more , Figueroa J, Alexander E, Reagan S, Kelly S, Benton TD, Young JF
J Pediatr · 2026 May · PMID 42190904 · Full text
OBJECTIVES: To evaluate whether children living in more disadvantaged neighborhoods are less likely to be screened for behavioral health concerns and more likely to screen positive for symptoms at a well-child visit, and...
OBJECTIVES: To evaluate whether children living in more disadvantaged neighborhoods are less likely to be screened for behavioral health concerns and more likely to screen positive for symptoms at a well-child visit, and to examine whether the Child Opportunity Index (COI) and Area Deprivation Index (ADI) produce similar findings. STUDY DESIGN: We analyzed electronic health record data from 48 200 9-year-old well-child visits. Behavioral health risk was measured using the Pediatric Symptom Checklist-17. Patient addresses were geocoded to derive COI and ADI scores. RESULTS: Children living in more disadvantaged neighborhoods had significantly lower odds of behavioral health screening (ORs 0.62-0.88) and significantly greater odds of screening positive on the Pediatric Symptom Checklist-17 total, externalizing, and attention scales (ORs 1.23-1.78). Neighborhood disadvantage was not associated with internalizing risk in this sample. COI and ADI were highly correlated (r = -0.91) and yielded nearly identical results. CONCLUSIONS: Our findings underscore the importance of addressing structural barriers to behavioral health screening in childhood and support the use of geospatial measures to inform equitable screening implementation and mental health intervention efforts in pediatric primary care.
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