Category Archives: Pediatrics

Pediatrics

Rehabilitation Following Above-Knee Amputation in a Pediatric Osteosarcoma Patient: A Case Report – Cureus

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Rehabilitation Following Above-Knee Amputation in a Pediatric Osteosarcoma Patient: A Case Report - Cureus

Pediatrics

Campbell chair of Pediatrics talks with WRAL about flu, respiratory illness – News | Campbell University – Campbell University News

Dr. Lori Langdon, chair of Pediatrics at the Campbell University School of Osteopathic Medicine, spoke with WRAL this week after the death of a Wilson girl who developed myocarditis after she was infected with the flu, WRAL reports.

Langdon also offered parents advice on when to see a doctor or to seek emergency care. She told the Raleigh station that its important to closely monitor children when theyre sick, particularly for fever and dehydration.

The height of the fever or number doesnt scare us. It scares us how they are handling the fever, said Langdon, who has more than 25 years experience in pediatric medicine. Really push fluids. I dont want you to be concerned if they are not eating solid foods.

Respiratory infections are now prevalent, she told WRAL.

Our top reason for seeking a higher level of care is if there is difficulty breathing, Langdon said. We are getting slammed with RSV right now.

Seek emergency care if a child is struggling to breathe, Langdon told WRAL.

If their belly muscles are working in and out to help them breathe, shoulders bobbing, head bobbing all are bad signs of respiratory distress, and they should be seen even if its the weekend, even if its the middle of the night, Langdon said.

Langdon also has nearly 1,000 subscribers on her YouTube channel, where she offers medical advice to children and parents.

Seasonal influenza activity is elevated in most parts of the country, with the Southeast, South-central, and West Coast areas of the country reporting the highest levels of activity, the Centers for Disease Control and Prevention reports, as of Dec. 15.

More than 7,000 people were admitted to hospitals over the past week. Nationally, 14 children this season have died of the flu, the CDC reports.

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Campbell chair of Pediatrics talks with WRAL about flu, respiratory illness - News | Campbell University - Campbell University News

Pediatrics

Democrats eye appropriations to protect pediatrician training – Roll Call

Corrected 3:46 p.m. | House Republicansattempting to tie the reauthorization of a critical pediatrician training program to efforts to limit gender-affirming care for transgender children acknowledge those efforts will collapse. Now lawmakers are lookingto fund the program as-is through the appropriations process.

Federal authorization for the Childrens Hospitals Graduate Medical Education Program, which trains more than half of pediatric specialists and almost half of general pediatricians nationwide, lapsed on Sept. 30.

Earlier this year, the Republican-led House Energy and Commerce Committee approved a reauthorization bill that bars any federal funds from going to hospitals that provide gender-affirming care. That provision was a nonstarter for Democrats, who wanted to see a clean reauthorization of the physician training program.

Both sides have refused to budge, and without congressional investment, hospitals might be forced to make cuts to fund their next classes of fellows and residents.

But in a last-minute bid to prevent more pediatrician shortages, some lawmakers hope to appropriate dollars for the Childrens Hospitals Graduate Medical Education program through the fiscal 2024 Labor-Health and Human Services-Education funding bill.

There are no actual consequences to not reauthorizing the program and just appropriating funding, a Senate Democratic aide said, unless lawmakers want to make changes to the program. Funding the training program through the appropriations process would sidestep GOP attempts to tie the training program to an anti-trans policy.

The Labor-HHS-Education funding deadline this year is Feb. 2, thanks to an unusual two-pronged approachthe Hill is taking to appropriations this year. So far the House has passed seven of its 12 appropriations bills, but the health funding bill is not on that list.

The proposed House Labor-HHS funding bill includes $400 million for the program, a $15 million boost above the 2023 enacted level but it includes the gender-affirming care restrictions. The Senate bill proposes $385 million flat fundingwithout restrictions.

The focus right now is ensuring the appropriations is as robust as possible to make sure the funding continues, a Childrens Hospital Association spokesperson said. The group is hopeful the gender-affirming care provisions will be stripped out in conference.

Rep. Kim Schrier, D-Wash., a pediatrician who led Democrats attempt to get a clean reauthorization of the program through the House, said shes hopeful this plan will get funds to childrens hospitals in the next year, though shes disappointed the usually bipartisan program has devolved to this.

Congress cannot afford to cut funding at a time when the US desperately needs to be training the next generation of pediatricians and pediatric subspecialists, Schrier said in a statement.

The standoff comes as pediatric hospitals face workforce shortages among physicians and nurses and many childrens hospitals have been forced to rely on temporary staffing agencies to fill workforce gaps, according to the Childrens Hospital Association.

Its become more difficult to fill pediatric residency positions in recent years, and several pediatric specialties are seeing 20 to 40 percent fewer applicants, according to the American Academy of Pediatrics.

The Childrens Hospitals Graduate Medical Education program is, at its core, a workforce program and has historically been a bipartisan, feel-good issue. In 2018 Texas Republican Michael C. Burgess co-led the reauthorization.

But House Republicans are making gender-affirming care a hallmark social issue of this Congress. So far theyve added riders to seven of 12 government funding bills to limit access to hormone therapy, surgery and other, similar care.

Most of the bills have little chance of passing the Democrat-controlled Senate, but thats not the point for conservatives, who want to amplify the issue ahead of the 2024 election.

This is the issue of our time. This is the hill were going to die on, Rep. Daniel Crenshaw, R-Texas, who led the legislative push in committee to tie pediatric physician training to gender-affirming care bans, said of gender-affirming care during a summer legislative hearing on his bill.

But asked this week whether hed hold up the appropriations process over the policy rider, Crenshaw, who is still advocating for his legislation with riders blocking gender-affirming care, acknowledged the House needs to get a bill to the floor.

Im weighing my options as the funding process moves, he said.

This story has been corrected to reflect the correct date the Labor-HHS-Education spending bill expires.

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Democrats eye appropriations to protect pediatrician training - Roll Call

Pediatrics

Discussing epilepsy’s initial signs and treatments in the pediatric population – Contemporary Pediatrics

In this Contemporary Pediatrics interview, William Gallentine, DO, clinical professor of neurology, interim chief, Pediatric Neurology, Stanford Medicine Children's Health, discusses what to look for when suspecting epilepsy in children, who to refer to, and how to break down seizures to worried parents.

Interview transcript (edited for clarity):

Contemporary Pediatrics:

What signs can the general pediatrician look for suspecting epilepsy?

William Gallentine, DO:

So seizures really are behaviors that occur whenever we have abnormal electrical discharges occurring within the brain. They can occur within many areas and depending on where those seizures are coming from, oftentimes, the behaviors that you can see in association with those can vary quite dramatically. Because of that, seizures can have a varied appearance in terms of how they may look.

The appearance of them, sometimes the child can be confused, and not behaving appropriately with repetitive type of movements on one side of the body. Other times, they actually may be more what people more traditionally think of as kind of generalized convulsions where the entire body may stiff and, and shake. Those are things that seizures that are more readily recognized by providers, and are not quite as subtle, and the ones that oftentimes quickly become presented to emergency departments, and brought in as acute level of care. So depending upon the nature of the seizure, oftentimes they may be determined to be seizures easier.

A hallmark of things that would kind of highlight them being seizures, would be seizures oftentimes look the same. So they have the same appearance when they occur. If they are occurring in the same area of the brain, that same area of the brain is involved, oftentimes, you'll have this appearance, that will look the same over and over again. So if you're having repetitive behaviors, that kind of look the same for short periods of time, that's kind of the hallmark of seizures.

The other things that you can also kind of look to are the events that occur out of sleep, that are also repetitive, can oftentimes be a clue that this could be something that's potentially related to epilepsy.

Contemporary Pediatrics:

Who should a child be seeing once epilepsy is suspected after a primary visit?

Gallentine:

Making sure that they're seeing an epilepsy provider, someone with it with expertise in that area, and that certainly could be a child neurologist or an epilepsy specialist. The majority of children that we take care of seizures can be well controlled with our typical anti-seizure medications, and really can go about their normal lives and do all the things that we wished for them to do.

But there is a smaller subset of patients that make up about 20% or 30% of patients with epilepsy, that the seizures become very difficult to control and are resistant to the medications. In those scenarios, even if they are seeing a child neurologist, if they haven't been seen at a tertiary medical center with expertise in epilepsy, it's really important to advocate for the patient being evaluated in a program like that, because there are different types of therapies, there are different approaches in the centers that we'll be taking will be very aggressive in terms of trying to get the seizures under better control.

That may be with further medications, but oftentimes that may be going a different route with our treatments. That may be including surgical interventions, where we're actually trying to render a patient seizure-free by doing a specific surgery to eliminate epileptic focus, that may actually be offering dietary therapies where we're using specific things like ketogenic diet to try to help control seizures, or it could even be implanting nerve stimulators, where were actually putting in stimulators, either on the periphery, or actually even into the brain that may help decrease the frequency and improve overall seizures.

All this is extraordinarily important, because we know that the longer children go with very difficult to control seizures, the worse their outcomes ultimately are. This could have an impact on their overall cognition, and their overall long term potential within their lives to do the things that they ultimately want to do.

Contemporary Pediatrics:

What can the general pediatrician do during initial visits to not only help the child, but also reassure the parents?

Gallentine:

The big thing is one, recognize that this is a very scary situation. These are some of the most scary situations that parents can go through and so sort of recognizing that our property yes, this can be very scary, but the reality of it is, that the majority of children who are having a seizure, once the seizure is over, the emergency is over. In the acute period, and that period with the seizures occur, really the sole job is this kind of support the child, make sure that the child is safe. In that scenario, [it] is recommend basic seizure first aid. One, look at your watch so you know how long the seizure is lasting, and then two, just making sure the patient is safe.

Most seizures in most individuals are only going to last 1 to 2 minutes in duration and following that, like I said, the emergency is over. Where the bigger problem comes, is when the seizure lasts more than 5 minutes, then the likelihood of that seizure ending on its own without medical intervention really begins to drop off. Oftentimes, you're going to require a medication to actually get that to seizure to stop. That's a scenario where one, activating 911, if the seizure is clearly going to be a prolonged seizure, and number two, hopefully those patients will have rescue medications. Medications that have been either provided by their primary care doctor, at the emergency department, or if they've already seen a neurologist in that particular setting, and administering a rescue medication at that 5-minute mark, really trying to avoid prolonged seizures.

Seizures that last more than 30 minutes, which then potentially result in injury to the brain. Usually, a lot of the time is spent on that initial visit with a first time or second time seizure patient. One, trying to have the parents understand kind of what's an emergency and what is not. And realizing that in most circumstances, the seizures are going to be brief. They're going to get through them, and really, we just want to make sure that things are safe. We don't want [the child] putting things into their mouths, we want to roll them in a rescue position so that they're safe. But really, just getting them through that and then supporting them. So that's kind of the acute portion of that. And then the next question that's always on the mind, of all the families was 'why is this happening?' And in that situation, it's going to come down to their evaluation in terms of what's the underlying cause. In most circumstances that evaluation is going to be led by the neurologist. So getting them in with those appointments, getting them in to see the neurologist and kind of move forward with those evaluations can be very helpful in expediting those things.

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Discussing epilepsy's initial signs and treatments in the pediatric population - Contemporary Pediatrics

Pediatrics

Pediatric obesity during COVID-19: the role of neighborhood social vulnerability and collective efficacy | International … – Nature.com

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Pediatric obesity during COVID-19: the role of neighborhood social vulnerability and collective efficacy | International ... - Nature.com

Pediatrics

Pediatric Drugs Market Size Expected to Reach USD 363.86 Billion by 2032 – GlobeNewswire

Ottawa, Dec. 21, 2023 (GLOBE NEWSWIRE) -- The global pediatric drugs market size accounted for USD 129.13 billion in 2023 and grew to USD 144.36 billion in 2024, expanding at a healthy CAGR of 12.2% between 2023 and 2032.

In March 2023, WHO released the first list of priority pediatric antibiotic compositions, enabling more concentrated research and development activities that tackle the specific requirements of infants and children.

Pharmaceutical companies are now working more on making medicines specifically for pediatrics, considering age, weight, and how their bodies develop. This is because children have unique traits that can affect how medicines work for them. The market for these pediatric drugs is growing because more kids are getting sick, and there are better ways to design drugs. But there are challenges, like figuring out the right amount of medicine for different ages and dealing with smaller groups of patients, which can make the drugs more expensive. Organizations like the European Medical Agency (EMA) and the Food and Drug Administration (FDA) are making rules to encourage research and ensure that medicines for children are safe and work well.

The market for pediatric drugs is growing because kids often face health issues like stomach, allergy, and respiratory problems due to their weaker immune systems. This market includes drugs for conditions like breathing disorders, autoimmune diseases, stomach issues, heart-related problems, and others. Medicines can be taken orally, applied on the skin, injected, or through other ways. This market spans North America, Europe, Asia-Pacific, the Middle East, Africa, and Latin America, with specific data for 17 countries.

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Individuals aged 2 to 12 receive pharmaceutical interventions specifically designed for pediatric use. The approach to pediatric therapy is fundamentally different from that of adults, primarily stemming from the imperative to tailor dosage regimens to the unique requirements of pediatric patients. Additionally, differentiation is imperative because the physiological response of a child to a given drug may diverge significantly from that observed in an adult population. Thus, the distinct nature of pediatric therapy is essential for ensuring optimal efficacy and safety in this specific age group. Furthermore, the market experiences a positive impetus due to the expanding landscape of clinical trials aimed at introducing novel pediatric pharmaceutical products. This multifaceted synergy of elements substantiates the robust growth trajectory observed in the pediatric drugs market.

The following factors propel the pediatric drugs market growth

Innovation in Pediatric Drugs Expands Market Growth

The expansion of the pediatric drugs market is driven by several factors, such as advancements in pediatric research, the broadening range of clinical trials, and increased investment in developing medications personalised for children. This trend creates substantial business prospects for pharmaceutical and biotechnology companies specialising in pediatric drug formulations. For instance, in August 2023,Aurobindo Pharma Ltd announced the release of their HIV triple combination medicine to pediatric patients in around 123 low- and middle-income countries.

Additionally, companies offering contract manufacturing services for pediatric pharmaceuticals stand to benefit. Collaborative research ventures, innovative drug delivery methods, and strategic partnerships with healthcare providers further facilitate market growth. Overall, these developments present promising opportunities for growth in the pediatric drugs market.

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Some of the Recent Pediatric Oncology Drug Approvals by FDA:

Specialised Pharmaceutical Drugs is the Driving Force behind the Growth of the Pediatric Drugs Market

The wider utilization of off-label drugs in the pediatric population underscores the need for specialised pharmaceuticals customised to pediatric drug requirements, fueling innovation and expansion in the pediatric drug market. The expansion of the pediatric drug market is primarily driven by the increasing prevalence of health issues in children, including obesity, diabetes, asthma, and neurological disorders.

This has led to a rising demand for specialised pharmaceuticals personalised to the unique needs of the pediatric population. Recognising children's distinct physiological and developmental characteristics, the pharmaceutical industry increasingly focuses on research and developing drugs specifically designed for them.

The heightened awareness among parents, caregivers, and healthcare practitioners regarding the importance of addressing children's healthcare needs has fueled the demand for pediatric medications. This advocacy has prompted governments and regulatory bodies to introduce incentives, such as market exclusivity and extended patent protection for pediatric drugs, encouraging research in this field. Consequently, these initiatives have attracted pharmaceutical investments and fostered innovation. The surge in pediatric health issues is propelling the growth of the pediatric drug market, underscoring its crucial role in safeguarding and improving the well-being of children globally.

Respiratory Disorders Dominate Pediatric Drugs Market

The pediatric drugs market is anticipated to be predominantly influenced by the respiratory disorder drugs segment, which holds the largest market share. This is primarily attributed to factors such as compromised immunity, heightened pollution levels, and increased exposure to various allergens, leading to chronic respiratory disorders like Chronic Obstructive Pulmonary Disease (COPD). COPD, a significant contributor to the global pediatric healthcare burden, has seen a surge in demand for effective treatments. According to the World Health Organization (2021),COPD ranked as the third leading cause of global mortality in 2019, causing 3.23 million deaths.

The segments growth is driven by the escalating prevalence of rare autoimmune disorders linked to various cancers, genetic disorders, and other autoimmune conditions. The market is further propelled by initiatives to develop drugs for rare diseases, exemplified by the FDA's approval of RUZURGI (amifampridine) tablets from Jacobus Pharmaceutical Company in May 2019. These prescription drugs, though associated with high costs, are contributing to the rapid growth of the global pediatric drugs market.

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Rising Prevalence of Diseases in the Pediatric Population Expands the Pediatric Drugs Market Growth

The variance between the high rate of childhood illness, roughly 60%, and the narrow focus of pharmacological trials, about 12%, highlights the unrealized potential in the pediatric medication market. This disparity, coupled with a greater understanding of the particular healthcare requirements of children, has spurred more focus and funding for pediatric medication research. The growth of the pediatric medication business has also been aided by regulatory incentives, including pediatric exclusivity and an understanding of the moral need to address children's health. As a result, pharmaceutical companies are working harder on research and development projects to close this gap and satisfy the unique therapeutic needs of the diseases. They are mostly prevalent with childhood cancer in North America.

According to the Nationwide Childrens Hospitals May 2023 estimates,in the U.S., around 90% of 17,000 paediatrics are diagnosed with cancer every year. 1,000+ Medical research grants at 150 institutions, 240+ Ongoing clinical trials funded each year. The increasing incidence of chronic disorders, encompassing conditions such as anorexia, asthma, congenital disabilities, growth deficiencies, diabetes, childhood cancer, juvenile diabetes, and attention deficit hyperactivity, is projected to positively impact the growth trajectory of the market. This surge in chronic disorders is a primary factor contributing to heightened demand for pediatric drugs, consequently influencing the market dynamics throughout the forecast period from 2022 to 2032.

Obesity is one of the most prevalent conditions among children. For instance, according to data from the 2020-2021 National Survey of Children's Health (NSCH),17% of children aged 10 to 17 in the United States are obese. Obesity is a major problem that leads to several diseases like Type 2 Diabetes, Hypertension, Hyperlipidemia, Liver and kidney diseases, Hypertension, Cancer Risk and others.

Advancement in Healthcare Infrastructure Foster the Pediatric Drugs Market Growth

The escalation of healthcare investment plays a pivotal role in shaping the trajectory of the pediatric drug market. A substantial determinant contributing to market growth is the surge in healthcare expenditure, facilitating the enhancement of healthcare infrastructure. Notably, government bodies are proactively augmenting this development by allocating increased funding to bolster healthcare facilities, exerting a profound impact on market dynamics.

Moreover, the concerted efforts of both public and private entities to raise awareness, coupled with a notable uptick in childhood obesity cases, are poised to further propel the pediatric drugs market. This phenomenon is further accentuated by evolving lifestyle patterns and a burgeoning population, collectively fostering the expansive growth of the pediatric drugs sector. The convergence of these factors delineates a landscape where healthcare investments, governmental initiatives, and societal changes converge to drive advancements in pediatric pharmaceuticals.

Challenges Posed by Limited Market Exclusivity in Pediatric Drug Development

The abbreviated duration of market exclusivity poses a significant obstacle to the growth of the pediatric drugs market. In contrast to pharmaceuticals customised for adults, pediatric medications often face shorter market exclusivity and patent protection periods. This diminishes the financial allure for pharmaceutical companies to invest in pediatric drug development, as they are inclined towards markets where research and development investments can be recouped with substantial profits. The pediatric sector encounters challenges due to smaller patient populations and limited exclusivity periods, making it more difficult to justify allocating resources for research and development. This limitation mainly affects the development of drugs for rare pediatric diseases, where patient numbers are exceptionally restricted.

Consequently, a considerable number of children resort to off-label use of medications intended for adults, posing potential risks to safety and effectiveness. Addressing this constraint necessitates policy and regulatory reforms that offer enhanced incentives for pediatric drug development, ensuring children can access secure and efficacious treatments.

Drug Type Segment Holds a Substantial Market Share

The paediatrics drugs market is categorized by type, encompassing analgesic and antipyretic, central nervous system drugs, especially antibiotics, gastrointestinal drugs, respiratory drugs, and vaccines. The segment held a significant market share, driven by children's lower immunity, increasing pollution, and allergen exposure leading to chronic respiratory disorders, including Chronic obstructive pulmonary disease. Montelukast is notably employed for asthma prevention in children 2 years and older, particularly for exercise-induced bronchoconstriction. The Autoimmune Disorders segment is anticipated to exhibit substantial growth, attributed to the rising incidence of genetic disorders, cancers, and cystic fibrosis. In addition, mental health problems sucg as anxiety, depression, ADHD, and behavioural problems are also common among children aged 5-27 years.

Fig. Percentage of Children and Adolescents Aged 5-17 Years Who Received Mental Health Medication Counselling or Therapy from a Mental Health Professional Between 2019 and 2022 in the U.S.

Additionally, the Pediatrics Medicine Market growth is further fueled by the inclusion of antibiotics, analgesics, antipyretics, respiratory drugs, gastrointestinal drugs, central nervous system drugs, vaccines, and others in the pediatric disease treatment spectrum. This comprehensive range contributes significantly to the overall market expansion.

The Route of Administration Segment brings Substantial Growth in the Pediatric Drugs Market

The Pediatrics Medicine Market is categorized based on the route of administration, namely topical, oral, parental, and others. In 2020, the Oral segment dominated with the highest revenue share. This is attributed to the preference for non-invasive oral delivery in pediatric patients, minimizing pain and enhancing parental comfort, resulting in improved medication compliance.

This growth is driven by the minimal risk of adverse reactions and drug interactions, along with the ease of administration to children. Additionally, factors such as cost-effectiveness, lower drug quantities, and the concentrated application of antibiotics in affected areas contribute to the growth of this route of administration.

The Distribution Channel Segment expands the Pediatric Drugs Market Growth

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Geographical Landscape:

North America dominates the pediatric drugs market due to rising healthcare spending, supportive regulatory framework, and quick adoption of advanced technologies across the U.S. and Canada. The growth in this region is primarily attributed to its robust healthcare infrastructure, substantial research and development capabilities, and a significant pediatric patient demographic. The region's dominance is further bolstered by favourable regulatory frameworks and government incentives, fostering the development and accessibility of pediatric medications. For instance, in 2021, US FDA approved the Rethymic drug for pediatric patients and used it to treat rare immune disorders. Rethymic is the 1st thymus tissue that is approved in the United States.

The market benefits from North America's dedicated focus on pediatric healthcare heightened awareness among parents and healthcare professionals, and the region's economic strength. Additionally, the presence of leading pharmaceutical companies further solidifies North America's prominent position in the global pediatric drugs market. During the forecast period, the Asia-Pacific region is poised for significant pediatric drug market growth. This expansion is driven by various vital factors, including the region's substantial and expanding pediatric population, leading to an increased demand for specialized healthcare solutions for children. The economic prosperity and expanding middle-class demographic in Asia-Pacific also enhance affordability and accessibility to pediatric medications.

Government initiatives and increased regional healthcare investments are pivotal in fostering market growth. The pharmaceutical industry in Asia-Pacific is channelling more resources towards developing medications tailored for pediatric patients. This concerted effort has positioned the region as a significant influencer in the pediatric drugs market, emerging as a central hub for research, development, and distribution of pharmaceuticals for children.

Competitive Landscape

The pediatric drugs are competitive, with a few big companies leading the way. Some of these companies have a larger share of the market. To stay ahead, some introduce new medicines to tackle existing problems, while others ensure they reach the people needing them.

In the past 10 years, pharmaceutical companies have increasingly chosen external organisations known as CROs, i.e. Contract Research Organisations, for their clinical trial and clinical research. A Tufts University and ICON PLC study predicts that by 2022, about 72% of global clinical trials will be handled by CROs. The combination of research and accessibility strategy allows these companies to stay ahead in the competitive landscape of pediatric medication.

Key Market Players:

Pediatric Drugs Market Segmentation:

By Drug Type:

By Route of Administration:

By Distribution Channel

By Geography

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Pediatric Drugs Market Size Expected to Reach USD 363.86 Billion by 2032 - GlobeNewswire

Pediatrics

Maternal Flu Shot Protects Infants Against Severe Disease – Medpage Today

Maternal influenza vaccination was effective at protecting infants under 6 months against severe disease, a case-control study showed.

While overall effectiveness was 34% (95% CI 12-50) against markers of severe disease -- hospitalizations and emergency department (ED) visits combined -- effectiveness was significant for hospitalizations (39%, 95% CI 12-58) but not for ED visits in secondary analyses, according to Leila Sahni, PhD, MPH, of Baylor College of Medicine and Texas Children's Hospital in Houston, and colleagues.

Effectiveness was also greater for infants less than 3 months of age (53%, 95% CI 30-68) and when mom was vaccinated during the third trimester (52%, 95% CI 30-68), they reported in JAMA Pediatrics, though they noted that secondary analyses should be considered exploratory.

"Infants younger than 6 months are at high risk of influenza-associated complications but are not eligible for vaccination given the absence of licensed influenza vaccines for this age group," Sahni and colleagues wrote. "Maternal influenza vaccination is safe, immunogenic, and can prevent laboratory-confirmed influenza and its complications in both mothers and infants."

However, "recent evidence, particularly from the U.S. after the H1N1 pandemic and data on maternal effectiveness by timing during pregnancy are limited," they added. "Updated data are needed on maternal vaccine effectiveness and data to determine optimal timing of vaccination to benefit the pregnant person and their infant."

Further results from secondary analyses showed that effectiveness of maternal influenza vaccination wasn't significant when mothers were vaccinated during their first or second trimesters.

"These findings, particularly the timing of maternal vaccination, weren't surprising to us," Sahni told MedPage Today in an email. "However, this speaks to the complexity of maternal vaccination timing, and the need to balance benefit to the mother who should ideally be vaccinated before influenza season begins, which may occur early in pregnancy, against benefit to the infant, which we found was greatest when vaccination occurs later in pregnancy."

"Additional studies should investigate the timing of vaccination during pregnancy and the benefit to the mother and infant," Sahni added.

Vaccine effectiveness was 47% against influenza B (95% CI 13-68) but it wasn't significant against influenza A, the researchers found; nor was it effective against influenza A subtypes H1N1 or H3N2 in those secondary endpoint analyses.

Sensitivity analyses excluding infants with positive test results for A/H3N2 and mothers with prior season vaccination yielded vaccine effectiveness of 43% (95% CI 17-60) and 42% (95% CI 20-58), respectively, the researchers added.

The study "strengthens the evidence that infants benefit when persons receive the quadrivalent-inactivated influenza vaccine during pregnancy," Katherine Poehling, MD, MPH, of Atrium Health Wake Forest Baptist, in Winston-Salem, North Carolina, and colleagues wrote in an accompanying editorial, noting that guidelines from the CDC and the American College of Obstetricians and Gynecologists recommend that pregnant patients receive the inactivated influenza vaccination during the flu season. "With only half of pregnant persons receiving the influenza vaccine in this study and nationally, there is a huge opportunity to improve vaccine coverage and health outcomes for all pregnant persons and newborns."

Opportunities to optimize the health of mothers and their babies include expanding vaccine registries from children to persons of all ages, having all clinicians who see pregnant persons strongly recommend flu vaccination during pregnancy, and having obstetric and pediatric clinicians collaborate on approaches to improve access to, confidence in, and coverage of vaccines and preventive care, they added.

"These data are very encouraging and provide us with updated evidence supporting the benefit of influenza vaccination during pregnancy to protect both the pregnant person and their infant from serious influenza illness," Samantha Olson, MPH, co-first author of the study and epidemiologist with the CDC's Influenza Division, told MedPage Today in an email.

For this prospective, test-negative case-control study, Sahni and colleagues used data from the CDC's New Vaccine Surveillance Network from the 2016/2017 through the 2019/2020 influenza seasons. Infants younger than 6 months of age with an ED visit or hospitalization for acute respiratory illness were included from seven pediatric medical centers in the U.S. Infants with an influenza-negative molecular test were included as controls.

Among 3,764 infants included in the study, 53% were born to vaccinated mothers, including 94 of 223 (42%) infants with influenza and 1,913 of 3,541 (54%) control infants. Among the 2,007 vaccinated mothers, 54% had vaccination verified by immunization information systems or medical records and 46% had self-reported vaccination with timing.

Study limitations included that information about maternal influenza infection during or after pregnancy was not included, nor were data on influenza vaccination prior to conception or postpartum.

Jennifer Henderson joined MedPage Today as an enterprise and investigative writer in Jan. 2021. She has covered the healthcare industry in NYC, life sciences and the business of law, among other areas.

Disclosures

The study was supported in part by the CDC.

Authors reported relationships with the NIH, Sanofi, Quidel, Merck, AstraZeneca, Pfizer, GSK, Cepheid, Viracor, AbbVie, Ark Biopharma, Meissa, Moderna, and Shionogi.

Editorialists reported relationships with Optum, Organon Nexplanon, and DynaMed EBSCO Industries.

Primary Source

JAMA Pediatrics

Source Reference: Sahni LC, et al "Maternal vaccine effectiveness against influenza-associated hospitalizations and emergency department visits in infants" JAMA Pediatr 2023; DOI: 10.1001/jamapediatrics.2023.5639.

Secondary Source

JAMA Pediatrics

Source Reference: Zuber MJ, et al "Influenza vaccination in pregnancy -- rolling up sleeves for pregnant persons and infants" JAMA Pediatr 2023; DOI: 10.1001/jamapediatrics.2023.5630.

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Maternal Flu Shot Protects Infants Against Severe Disease - Medpage Today

Pediatrics

Missouri pediatricians provide holiday tips for families and children – Kirksville Daily Express and Daily News

Missouri American Academy of Pediatrics

The Missouri Chapter, American Academy of Pediatrics (MOAAP) is offering tips and resources on how families can remain safe this joyous holiday season.

The holidays can be really overwhelming when kids get off their routines and their schedules. It can make them feel a little anxious, said Dr. Maya Moody, MOAAP president. It's important to make sure that you keep mealtimes and bedtimes the same, to the extent you can, for both little kids and teenagers too. Sleep is really important for mental health, and so is making sure kids have those routines, their general schedule, and they know what to expect.

To help families keep holiday spirits high while avoiding ill-timed emergencies, the American Academy of Pediatrics (AAP) offers these 12 health and safety tips:

Stick to your child's usual sleep and mealtime schedules when you can. It's not always possible when you are juggling the demands of shopping, cooking and travel, but maintaining household routines will help ward off tantrums and maintain holiday cheer.

Take care of yourself, mentally and physically. Children sense the emotional wellbeing of their parents and caregivers, and if you cope with stress successfully, your children will learn how to do the same.

Don't feel pressured to overspend on gifts. Consider helping your child make one or two gifts. The chances are these will be the gifts most treasured by a parent, grandparent or special adult.

Participate in a volunteer activity and include your child, whether it's helping serve a holiday meal at a local food bank or shelter or writing letters to members of the armed forces who can't be home for the holidays.

Toys don't need to be expensive or electronic to make great gifts, but they should be suited to the child's age, abilities, skills and interest level. Be cautious about toys that contain button batteries or magnets, which can be swallowed by small children and cause serious internal damage. For more help with toy safety, go here.

Speaking of toys, if you are considering a digital device for a child or a teen, such as a tablet, smartphone or game system, think about the purpose of the device and the rules you want to set around its use. AAP offers a family media planning tool here.

Cooking with children can be a great way to bond over a family recipe and offer a sense of accomplishment to budding chefs. Be sure to follow food safety guidelines, wash hands frequently and keep hot foods and liquids away from the counter's edge. More kitchen safety tips are here.

When decorating, watch for fire hazards. If you have an artificial tree, make sure it's labeled "Fire Resistant," and if it's live, make sure it's fresh and not losing too many needles. Keep it away from fireplaces, radiators or portable heaters.

Keep trimmings with small removable parts out of reach of children to prevent them from swallowing or inhaling pieces. Find more tips on decorating safely here.

When visiting friends or family, remember that the homes you visit may not be childproofed. Keep an eye out for danger spots like unlocked cabinets, unattended purses, accessible cleaning or laundry products, stairways, or hot radiators. When visiting others or hosting guests, make sure that any medications are stored safely away from curious kids. Pay special attention to narcotics and other prescription medications.

After a holiday party, clean up immediately. A toddler could rise early and choke on leftover food or come into contact with alcohol, tobacco or vaping products.

Most important of all, enjoy the holidays for what they are- time to enjoy your family. Find ways to spend time together, whether it's on a sled outdoors or over a board game or good picture book.

We hope these tips help remove some stress for caregivers and help families remain safe and healthy this holiday season, said Dr. Heidi Sallee, MOAAP Vice President/President-Elect. Parents and caregivers need to take care of themselves and ensure our own emotional well-being as well because kids pick up on that.

The Missouri Chapter, American Academy of Pediatrics (MOAAP) represents more than 1,100 physicians, trainees, and pediatric-provider members throughout Missouri. Our mission is to promote the health of all Missouris children through advocacy, education, and collaboration. For more information, visit missouriaap.org.

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Missouri pediatricians provide holiday tips for families and children - Kirksville Daily Express and Daily News

Pediatrics

Brief Training Improves Counseling by Pediatricians on Social Media Safety – Physician’s Weekly

Training on social media safety for pediatricians improved rates of patient counseling on the topic and adolescents social media behavior.

This study arose, in part, from an enthusiasm among pediatricians wanting to understand how they could best support families in navigating social media for their kids, Megan Moreno, MD, MSEd, MPH, explains. We know that pediatricians can serve as a trusted source of information for families, and this study reflects that.

Dr. Moreno and colleagues tested a social media counseling intervention aimed at promoting safe social media use among youth through a randomized controlled trial. The researchers enrolled pediatric primary care practices between 2011 and 2013 and recruited youth participants during clinical visits. Study outcomes included media behaviors and caregiver communication. Multivariate regression models assessed associations between social media counseling and the pediatricians counseling score, and multivariate logistic regression evaluated four social media behavior outcomes.

This study was done as a randomized controlled trial, which can provide the very best level of evidence that an intervention does or does not work, and was conducted with pediatricians in their officesso it was as close to a real-world setting as possible, Dr. Moreno notes.

The study, published in The Journal of Adolescent Health, included 249 pediatricians representing 120 practices. More than half (53%) were independent pediatric group practices, and more practices were in suburban communities (46%) versus rural (19%), non-inner city urban (19%), and inner-city urban (16%) settings. Dr. Moreno and colleagues randomly assigned 58 practices to the social media intervention arm.

Could a brief training in social media lead to changes in how pediatricians counsel their patients? We found that the answer is YES! Dr. Moreno says. Training pediatricians in social media safety led to pediatricians consistently providing this counseling.

The greatest predictor of a clinician providing social media counseling was being trained on such counseling (adjusted OR, 4.94; 95% CI, 3.83-6.37), Dr. Moreno says (Table).

This may feel like an of course moment, she continues. However, when we were planning this intervention, we heard concerns from pediatricians that there could be generational barriers to learning this content or feeling comfortable providing counseling on this topic. There were no demographic differences among pediatricians willing to provide this counseling, and if they had training, they would provide the counseling, put those concerns to rest.

The researchers also reported positive findings for adolescent patients who received social media counseling from their pediatricians.

The intervention had a positive impact on reducing teens friending of strangers on social media and on teens communicating with their parents about social media, Dr. Moreno says. We did not find an impact on screen time, but, in recent years, the field has moved away from screen time as an accurate or meaningful measure of social media safety.

According to the study results, after 6 months, teens could recall receiving social media counseling, which aligns with previous findings that adolescents can accurately recall counseling from a clinician. Dr. Moreno and colleagues wrote that the counseling provided in the current study may have been more memorable given the relevance and significance of social media to youth.

The results underscore the role that pediatricians have in helping families navigate the use of media safely, says Dr. Moreno, who also serves as co-medical director of the Center of Excellence on Social Media and Youth Mental Health from the American Academy of Pediatrics. The organization is dedicated to creating a healthy digital ecosystem for children and adolescents, according to its website. Dr. Moreno notes that efforts are underway to expand the training opportunities for pediatricians to be part of this work.

Looking ahead to future studies, Dr. Moreno says research is needed to assess ways to incorporate specific tools, such as the Family Media Plan from the American Academy of Pediatrics, into the counseling that pediatricians provide families to see if this increases uptake and use of this family-centered tool.

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Brief Training Improves Counseling by Pediatricians on Social Media Safety - Physician's Weekly