The Journal of Pediatrics

IntroductionBronchopulmonary dysplasia (BPD) remains a major complication among extremely low gestational age (ELGA) infants, with long-term respiratory and neurodevelopmental consequences. Despite advances in neonatal care, effective therapies to prevent BPD are lacking. Mesenchymal stromal cells (MSC), particularly those derived from umbilical cord (UC-MSC), offer promise due to their pleiotropic effects. Preclinical and early-phase clinical studies have demonstrated safety and potential effic...

BackgroundTranslocation of bacteria across the intestinal barrier has been postulated to contribute to mortality among severely malnourished children. Pancreatic enzymes (PE) and bile acids (BA) have anti-bacterial properties in the small intestine, but severe malnutrition is associated with impaired exocrine pancreatic and hepatobiliary functions. We evaluated whether ancillary treatment with PE and BA improves survival in hospitalized, acutely ill, severely malnourished children. Methods and ...

Background and ObjectivesPatient portals allow adolescents and caregivers of pediatric patients to better engage with health care, improving their medication adherence, health knowledge, self-efficacy, and receipt of preventive care. However, disparities in access to and comfort with using these portals persist. Hospitalization represents a promising opportunity to address these disparities among a high-risk population. Design/MethodsWe conducted a cross-sectional analysis to identify dispariti...

OBJECTIVETo develop a parsimonious, interpretable, and accurate model for predicting discharge for premature infants in the NICU that is suitable for prospective evaluation and integration into clinical workflows. STUDY DESIGNUsing routinely available electronic health record data, we developed and validated NEOnatal Reliable Estimation of Approaching Discharge in Young infants (NEO-READY), a daily-updating model that predicts likelihood of discharge within 5 days for premature infants. RESULT...

Fortification of human milk (HM) is essential to meet the nutritional needs of very low birthweight infants (VLBWI). Most available fortifiers are derived from cows milk, raising concerns about tolerability, immunogenicity and access in low-resource settings. LioNeo is a novel multinutrient fortifier produced exclusively from freeze-dried donor HM by a certified Human Milk Bank in Brazil. Preclinical and Phase 1 testing demonstrated safety and tolerability. This Phase 2 trial evaluated the effic...

ImportanceWhole genome sequencing (WGS) is increasingly used to diagnose severely ill children, yet the long-term impact of a genetic diagnosis on healthcare utilization and resource allocation remains poorly understood. ObjectiveTo determine the influence of a genetic diagnosis via WGS on long-term healthcare utilization metrics in severely ill children. DesignA retrospective cohort study using data from the Next Generation Children study (2016-2020) with record linkage and analysis of primar...

Patient portals are designed to enhance patient and caregiver engagement by providing access to health information, communication with care teams, and telehealth services, yet their impact on health care utilization among hospitalized children is not well understood. In this cross-sectional study, we examined associations between patient portal enrollment and use and hospitalization outcomes among 40,377 children admitted to an urban quaternary or suburban tertiary pediatric hospital between 202...

BackgroundPediatric long COVID is associated with substantial symptom burden, yet evidence-based pharmacologic treatments remain limited. Low-dose naltrexone (LDN) has been proposed as a potential symptomatic therapy, but data in pediatric populations is lacking. MethodsWe conducted a retrospective analysis of pediatric and young adult patients ([≤]25 years) with a clinical diagnosis of long COVID who were prescribed LDN between July 2020 and July 2025 at three multidisciplinary pediatric lo...

IntroductionPediatric acute appendicitis (PAA) remains challenging to diagnose despite existing diagnostic scores. The BIDIAP index is a three-item diagnostic tool with very high discriminative performance in a derivation cohort. This study aimed to prospectively and externally validate the BIDIAP index in a multicenter pediatric population. Material and MethodsWe conducted a prospective, multicenter observational study across four tertiary pediatric centers, enrolling children presenting with ...

ImportanceBowel ultrasound (BUS) offers real-time assessment of bowel integrity and perfusion, but its clinical impact on diagnosis and management of necrotizing enterocolitis (NEC) remains unclear. ObjectiveTo evaluate whether adding BUS to standard abdominal radiography (AXR) improves diagnostic decision-making and clinical outcomes in infants evaluated for suspected NEC. DesignRandomized clinical trial. SettingLevel IV neonatal intensive care unit (NICU) of a freestanding childrens hospita...

BackgroundAnti-seizure medications (ASMs) are widely used in neonatal intensive care, but there is limited evidence for their safety and long-term outcomes. Phenobarbital is the only ASM generally recommended for use in neonates, but it has been linked with adverse effects in infants. Other anti-seizure medications, such as fosphenytoin, levetiracetam, and midazolam are used off-label in this population. MethodsWe performed a retrospective observational study of 18,548 infants in intensive care...

Background and ObjectivesAnnual tuberculosis (TB) screening is recommended for all children and adolescents in the United States, but gaps remain in the diagnosis and treatment of latent TB infection (LTBI). We utilized the electronic health record (EHR) to examine the pediatric LTBI care cascade and assessed if an EHR note template could increase risk factor screening. MethodsWe extracted EHR data from well-child and -adolescent visits at a federally qualified health center in Northern Califor...

IntroductionCentral line-associated bloodstream-infection (CLA-BSI) and catheter-related bloodstream infections (CR-BSI) remain a significant concern in pediatric inpatient units. ObjectiveTo analyze a case series of CLA-BSI and CR-BSI in hospitalized pediatric patients in hospitals with rigorous infection prevention measures. Materials and MethodsThis was an analytical, descriptive, and retrospective study conducted in patients aged 0 to 18 years, admitted between August 2023 and March 2025, ...

BackgroundPediatric eczema is a highly prevalent condition that often causes substantial suffering among affected children and their families. Numerous modifiable lifestyle and environmental risk factors for the condition have been identified, although these risk factors and related interventions have generally been studied in isolation. The goal of this study was to evaluate the effects of an integrative program for parents of children with eczema that simultaneously addressed multiple lifestyl...

ImportanceCurrent guidelines from the World Health Organization, Centers for Disease Control and Prevention, and Academy of Breastfeeding Medicine recommend discarding all milk remaining in bottles immediately after infant feeding. However, these recommendations lack supporting microbiological evidence from studies of actual infant feeding, imposing substantial financial and emotional burden on the 78 million families worldwide who bottle-feed their infants. ObjectiveTo determine (1) the financ...

BackgroundEarly relational health (ERH) is thought to buffer the association between early life stress (ELS) and child psychopathology, but limited work has directly tested this hypothesis. ObjectiveWe evaluate mother-infant emotional connection, a facet of ERH, as a buffer of combined and individual impacts of specific ELS exposures (maternal mental health and interpartner conflict) on child psychopathology. MethodsParticipants included mother-infant dyads (n=100) followed longitudinally in t...

Background and ObjectivesDecision-making about resuscitating a critically ill child is complex yet common. We aimed to study the survival thresholds at which physicians, compared to parents, decide to treat or withhold resuscitating a child. Moreover, we aimed to compare physicians survival estimates with those from a nationwide registry. MethodsWe conducted a cross-sectional survey-based study in the United States. Clinical vignettes based on hypothetical survival probabilities were used to st...

Background and ObjectivesCurrent potassium reference intervals for neonates fail to account for sampling method differences and prematurity-related factors, leading to unnecessary resampling and interventions. We aimed to establish sampling-specific potassium reference intervals for term and preterm neonates using comprehensive electronic health record data. MethodsWe analyzed 195 606 blood gas measurements from 10 290 neonates (2007-2024) at a tertiary neonatal intensive care unit. After ex-cl...

BackgroundLinked administrative data covering whole populations are fundamental resources for longitudinal studies of children with rare conditions (cases) and unaffected peers (comparators). Data minimisation regulations sometimes limit the number of comparators per case (sampled comparators, SC), with unknown impact on study findings. MethodsUsing Monte Carlo draws, we simulated 100 000 children with and without an exemplar condition, congenital hypothyroidism (CHT), with covariates (sex and ...

BackgroundChildren with tracheostomies experience frequent and recurrent acute respiratory infections (ARIs). While cultured respiratory pathogens can inform ARI diagnosis, it is unknown if their presence in the airway affects future ARI risk. ObjectiveTo identify predictors of frequent (3+) ARIs within 36 months of tracheostomy. MethodsWe conducted a single-center, retrospective cohort study of children with tracheostomies placed between 2010-2016. Medical records were reviewed for each encou...