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In this interview, Cindy Jackson DO, FAAP, chief operating officer of The Institute for Advanced Clinical Trials for Children (I-ACT for Children) discusses the disparities in children's pharmaceutical drug development, and how the Spin to Save Kids challenge was created to address these issues.

According to Jackson, the Spin to Save Kids challenge was created to amplify awareness about clinical trials for children. Many drugs advertised for adults aren't approved for children, making them used in an off-label manner in the pediatric population. The time between a drug being approved in adults and that same drug being approved in children can reach up to 7 to 9 years on average, with Jackson seeing some take up to 20 years.

Jackson said the biggest reason for this disparity is that most drugs are being developed for use in adults. Most children don't have chronic conditions seen in adults, making the demand for these drugs in children low. Because of this, more public engagement can help improve the process of pediatric drug development.

COVID-19 also had an impact on pediatric drug development. While certain trials were slowed down by overrun hospitals and lockdowns, clinical trials were discussed publicly for the first time Jackson was aware of. Children were given conditional use for the COVID-19 vaccine about a year after the adult vaccine was made, showing that the "lag time" Jackson has seen can be avoided.

Jackson compared the Spin to Save Kids challenge to the ice bucket challenge, with people being able to post videos of themselves spinning anything. This makes the challenge an easy method of spreading awareness of clinical research for pediatric drugs.

I-ACT for Children was created officially in 2016, after a meeting sponsored by the American Academy of Pediatrics in 2014 discussing how to improve the process of pediatric drug development. The need for a nonprofit organization for guidance and the formation of a clinical trials network were analyzed during the meeting.

For more information on the Spin to Save Kids challenge, visit 

Articles

Cindy Jackson, DO, FAAP, discusses the creation of the Spin to Save Kids challenge for bringing awareness to the disparities in pediatric drug development.

Discussing the Spin to Save Kids challenge

Children with injuries and medical conditions have reduced mortality risk when treated in emergency departments (EDs) with high pediatric readiness, according to a recent study.

Over 30 million children visit EDs annually, but over 97% of EDs treating children are nonchildren’s hospitals. To improve ED pediatric readiness, the National Pediatric Readiness Project (NPRP) was created. 

Aspects of improved pediatric readiness include quality improvement, care coordination, personnel and competencies, policies and procedures, patient safety, and availability of key equipment and supplies.

High ED pediatric readiness has been associated with reduced mortality among children with critical illnesses, but the association among other pediatric groups is unknown. To determine the association between ED pediatric readiness and 1-year mortality among injured and medically ill children, investigators conducted a retrospective cohort study.

There were 983 EDs included in the study, all having been assessed by the NPRP. Inclusion criteria included having cared for at least 10 hospitalized children in a 6-year period. The first ED visit for each child aged under 18 years between January 1, 2012, and December 31, 2017, was recorded.

Participants included children requiring hospitalization, transfer to another hospital, or dying in the ED. Children were divided into groups based on whether they presented with injuries or medical illness based on hospital discharge records.

The weighted Pediatric Readiness Score (wPRS), used in the 2013 NPRP assessment, was used to determine ED pediatric readiness. A higher score from 0 to 100 indicated greater pediatric readiness.

Other variables included patient demographics, complex chronic conditions, health insurance payer, blood transfusion within 24 hours, Severity Classification System, hospital procedures, interhospital transfer, injury severity, and mechanism of injury. ED and hospital variables were measured using NPRP assessment, American Hospital Association data, and patient-level data.

In-hospital mortality was the primary outcome of the study. Additionally, 1-year mortality among patients was measured.

There were 796,937 children in the study cohort, 11.4% of which were hospitalized for injuries and 88.6% for medical conditions. Of the injured children, 2% died in the hospital. Of the children with medical conditions, 1.1% died in the hospital. The median ED wPRS was 73.

Injured children cared for in high-readiness EDs had a 60% reduced chance of in-hospital death, compared to a 76% reduction among those with medical conditions. Investigators estimated that an additional 288 lives could have been saved through increasing all lower-readiness EDs to high-readiness.

Outcomes to 1 year were measured in 545,921 children. There were 1316 deaths in the injury cohort during this time, 693 of which occurred in the ED, 477 as inpatients, and 146 after hospital discharge. In comparison, there were 6635 deaths in the medical cohort during this time, 4150 in the ED, 759 as inpatients, and 1726 after discharge. 

Children cared for in low-readiness EDs had a shorter time to death, making up 90.6% of quartile 1 injury deaths and 88.5% of quartile 1 medical deaths. Children treated in high-readiness EDs had the lowest risk of death to 1 year.

Both short- and long-term mortality were reduced in pediatric patients treated in high-readiness EDs. This indicates pediatric deaths can be reduced through increasing pediatric readiness in all EDs.

Newgard CD, Lin A, Malveau S, Cook JNB, Smith M, Kuppermann N, et al. Emergency department pediatric readiness and short-term and long-term mortality among children receiving emergency care. 

2023;6(1):e2250941. doi:10.1001/jamanetworkopen.2022.50941

In a recent study, children had improved short- and long-term mortality when treated in emergency departments with high pediatric readiness.

High pediatric readiness among EDs reduces mortality rates

Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.

The sudden cardiac arrest of Buffalo Bills safety Damar Hamlin, 24, on January 2 shocked the public, but the condition believed to have triggered his collapse is one that is more common in young athletes than any other group.

Although there have been no official statements on the exact cause of Hamlin’s sudden cardiac arrest (SCA) after taking a hit in the January 2 football game, many are speculating that commotio cordis is to blame.

Commotio cordis is a condition that develops when blunt force to the chest wall leads to a disruption in the heart’s normal rhythm. The impact of the blow at a specific time in the cardiac cycle can disrupt the normal electrical signals in the heart and trigger arrhythmias like atrial or ventricular fibrillation.

While this phenomenon can really develop in anyone, it’s most common in young competitive athletes. About 95% of cases of commotio cordis happens in adolescent males, according to a report in Circulation, and the mean age at the time of SCA was 14.5 years.

Studies have found that an impact equivalent to around 40 mph of force that strikes directly perpendicular over the left chest wall can trigger commotio cordis.

The collapse of the athlete can happen instantaneously, but the effects of the blow can also appear as long as 24 hours after a hit. Immediate resuscitation efforts with cardiopulmonary resuscitation and defibrillation are key to managing this condition, improving survival rates following commotion cordis from about 15% in 2002 to more than 50% today. Increased awareness, and improved availability of automated external defibrillators in the community have been credited for these improved survival rates.

Although this condition often develops in young athletes with no previously known cardiac history, the American Academy of Pediatrics released guidance in 2021 to help pediatricians recognize patients who may be at risk of commotio cordis.

Multiple conditions can contribute to an increased risk of sudden cardiac arrest, and primary care providers and pediatricians should refer any young athletes with known risk factors to a pediatric cardiologist or electrophysiologist for further evaluation and management.

Some conditions that are believed to increase the risk of developing commotio cordis include:

Regular wellness exams may uncover some of these issues, but the American Heart Association recommends a 14-point history and physical screening for young athletes.

Assessments of personal and family history include:

· A history of chest pain, tightness, or discomfort during exertion

· Excessive shortness of breath, fatigue, or palpitations with exercise

· Prior restrictions for sports participation

· A family history or sudden or unexpected premature death

· Disability from heart disease in close relatives under 50 years of age

· A family history of hypertrophic or dilated cardiomyopathy, clinically significant arrhythmias, genetic cardiac conditions, long QT syndrome, Marfan syndrome, or other ion channelopathies

Physical assessments are also part of the screening and include examination of:

Patients whose screenings generate any concern should undergo additional evaluations, including an electrocardiogram, the guidance states.

1. Buffalo General releases latest update on Damar Hamlin. Buffalo Bills. January 10, 2023. Accessed on January 16, 2023. https://www.buffalobills.com/news/buffalo-general-releases-latest-update-on-damar-hamlin

2. Commotio cordis in athletes. The Sports Medicine Review. January 8, 2023. Accessed January 15, 2023. https://www.sportsmedreview.com/blog/commotio-cordis-athletes/

3. Understanding cardiac arrest and emergency response following Damar Hamlin’s collapse during Monday Night Football. American Heart Association. January 3, 2023. Accessed on January 10, 2023. https://newsroom.heart.org/news/understanding-cardiac-arrest-and-emergency-response-following-damar-hamlins-collapse-during-monday-night-football#:~:text=Commotio%20cordis%20is%20a%20rare,absence%20of%20apparent%20cardiac%20damage

4. Ota K, Bratincsak A. Atrial fibrillation induced by commotio cordis secondary to a blunt chest trauma in a teenage boy. 

2015;135(1):e199-e201. doi:10.1542/peds.2014-1972

5. Link MS, et al. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task force 13: Commotio cordis. 

. 2015;132(22):e339-e342. doi:10.1161/CIR.0000000000000249

6. Erickson CC, et al. Sudden death in the young: Information for the primary care provider. 

 2021;148(1):e2021052044. doi:10.1542/peds.2021-052044

The sudden cardiac arrest of Buffalo Bills safety Damar Hamlin on January 2 shocked the public, but the condition believed to have triggered his collapse is one that is more common in young athletes than any other group.

Red flags in pediatric practice

In this interview, Colleen Kraft, MD, senior medical director of clinical adoption at Cognoa, discussed the hurdles many children with autism spectrum disorder (ASD) face, and the benefits these children and their families can experience from early diagnosis and treatment.

Kraft started the discussion by noting how most expulsions from school occur in preschool-aged children. Differences in behavior, speech, and language, along with failing to understand social contexts, leads to these children being expelled. According to Kraft, pediatricians should work with parents on regulating children's behavior in a way that is developmentally appropriate.

An example Kraft gave was that a 4-year-old with ASD may not understand the social cues which could get them into trouble, meaning they may not understand why they are being punished. This leads to poor performance and expulsion in preschool for many children with ASD.

With this in mind, Kraft believes that early diagnosis is vital for kids to be successful academically and socially. The American Academy of Pediatrics has recommended early screening and evaluation for ASD, and steps have been made to help pediatricians understand the differences in these children's development.

Kraft remembers a time when ASD diagnosis was seen as a "death sentence." Now, however, treatment is available, with data showing that children are less likely to show signs of ASD in kindergarten if they begin treatment early.

"For any developmental disability, parents have 2 fears. First, they think they caused it. Second, they think there's nothing they can do about it," Kraft said. Kraft believes that changing this rhetoric could help decrease the stigma surrounding ASD.

In a message to parents of children with ASD, Kraft said their children will have slightly different pathways than children without ASD, but they can still find success and thrive. These children have skills and talents they can harness once they get past the core deficits they may face at a young age.

Videos

Colleen Kraft, MD, senior medical director of clinical adoption at Cognoa, discusses how autism spectrum disorder (ASD) development affects children and families, along with how early diagnosis and treatment can improve the lives of children with ASD.

The value of early diagnosis of autism spectrum disorder 

Young children with severe traumatic brain injury (TBI) will experience little recovery, according to a recent study.

Some of the highest rates of pediatric TBI are seen in preschool-aged children, but the long-term outcomes of TBI in this age group are unclear. As skills in very young children undergo rapid development, concerns have arisen over the effects of injury on this development.

Severe TBI has been associated with lower cognition and academic performance in children injured as infants and toddlers. Studies have also recorded slight difference in intelligence and behavior for very young children with mild TBI.

To evaluate longitudinal outcomes in very young children with mild and severe TBI, investigators examined outcomes in the first 3 years following TBI in children aged under 31 months.

Participants were recruited from Primary Children’s Hospital in Salt Lake City, Utah, and the University of Texas Health Science Center at Houston. Severe developmental delay and very preterm birth were exclusion criteria for the study.

Data analysis occurred from May 12 to October 20, 2021. Children were categorized into a TBI group and comparison group. TBI severity was measured for children in the TBI group through the lowest emergency department pediatric Glasgow Coma Scale. Mild, moderate, and severe levels of TBI were recorded.

In the comparison group, children had an upper or lower extremity long bone fracture, with no clinical signs of TBI. The comparison group was implemented into the study to determine that the effects of TBI are not related to general injuries.

Data on demographic characteristics, developmental outcomes, and family function and support were collected through a survey administered to parents. This data was collected as soon as possible following injury, with follow-ups occurring at 3, 12, 24, and 36 months.

Parents reported communication, gross motor, fine motor, problem-solving, and personal social skills in their children aged 1 to 60 months through the Ages & Stages Questionnaire-3 (ASQ-3), with a higher score indicating more advanced development. The mean score in a reference population was 50.

There were 168 children in the study who completed at least 1 follow-up assessment, 160 of which completed a 12-month follow-up and 134 a 36-month follow-up. Mild TBI was seen in 48 children in the study cohort, while complicated mild or moderate TBI was seen in 54 and severe TBI in 21. Finally, 45 participants presented with orthopedic injury (OI).

Family function, social capital, and income were similar across injury groups preinjury. However, mean ASQ-3 scores were significantly worse in children with severe TBI for all domains compared to other groups. 

During follow-ups, children with mild or moderate TBI performed similarly to those with OI, while children with severe TBI showed deficits in all domains. While there was a slight decrease in score for children with mild or moderate TBI, the differences were not statistically significant.

As children with severe TBI showed little recovery, investigators recommended early childhood intervention to manage longitudinal developmental outcomes.

Keenan HT, Clark A, Holubkov R, Ewing-Cobbs L. Longitudinal developmental outcomes of infants and toddlers with traumatic brain injury. 

. 2023;6(1):e2251195. doi:10.1001/jamanetworkopen.2022.51195

In a recent study, young children with severe traumatic brain injury (TBI) showed significantly worse cognition and academic scores than children with mild TBI or other injury.

Developmental outcomes found after traumatic brain injury in young children

All but 4 states in the US have legalized some form of cannabis use and 19 states have fully legalized it for adult recreational use.

 While providers and national organizations recommend against prenatal cannabis use, the frequency and rate at which pregnant women are using cannabis continues to increase in the US. Most pregnant women use cannabis to prevent nausea and vomiting.

Prenatal cannabis use may result in adverse fetal outcomes, including low birth weight and neurodevelopmental issues in childhood.

 Understanding the impact of cannabis legalization and its role in prenatal cannabis use from the perspective of pregnant women is crucial for ob-gyns to offer effective, personalized care and counsel to patients. It can also contribute to educational materials, public health campaigns, and policy adaptations in the future.

Findings from a study from Kaiser Permanente Northern California (KPNC)—a large integrated health care delivery system with more than 4 million members—were published recently in 

, revealing valuable insight into how women who use cannabis during pregnancy perceive the impacts of cannabis legalization.

In general, the study found that women perceived legalization to mean greater access and exposure to cannabis, increased acceptance, and greater trust in cannabis retailers. Perhaps the most important finding, however, was the idea that legalization gave them greater confidence and willingness to discuss cannabis use during pregnancy with their provider. One woman said legalization empowered her to have an honest discussion with her doctor that ultimately led to her quitting use for the duration of her pregnancy.

Researchers from KPNC conducted the qualitative study using data from the system’s universal prenatal screening questionnaire that women are given on entrance to prenatal care, at approximately 8 week’s gestation. They prioritized women who reported daily or weekly prenatal cannabis use and focused their efforts primarily on non-Hispanic Black and non-Hispanic White pregnant women—the 

 with the highest prevalence of prenatal cannabis use in KPNC in recent years.

 Researchers also reviewed electronic health records for any documented pregnancy loss to confirm that the women were still pregnant. Eligible women were contacted with an invitation to participate or opt-out, asked to consent and then schedule a focus group. More than 60% of the eligible women did not schedule focus group participation for various reasons, including those who opted out, had time conflicts and incomplete consent processes.

Over the course of 4 weeks (November 17 to December 17, 2021), 51% of women scheduled (104) participated in 1 of 18 virtual focus groups, each with 1 to 6 participants per group and a duration of 90 minutes. Researchers grouped women and focus group leaders together based on race and ethnicity for congruency and to recognize the role race and ethnicity play in the experiences of pregnant women. The focus groups were made up of 43% non-Hispanic Black women and 57% non-Hispanic White women with a mean age of 30.3 (5.2) years. At the time of recruitment, most women (70%) reported daily prenatal cannabis use, 25% (13) reported weekly use, and 6% (3) participants reported monthly or less use.

Many women described ubiquitous cannabis retailers in their areas and believed that the easy access and convenience increased their desire to use cannabis. Several women reported cannabis retailers as accessible as liquor and corner stores, comparing the ease of accessibility to buying cigarettes or alcohol. Experiences with cannabis marketing and advertising varied among women, with many who had quit or cut down on use during pregnancy recalling that billboards and advertisements made them miss using or think about cannabis more often. Other women, however, reported little impact from cannabis marketing and advertising.

Evident among most women was the perception of reduced stigma around cannabis use, in general and during pregnancy. Such reduction may also be the reason they reported being more comfortable and open with their doctors. “I think that if it wasn’t legal and I didn’t feel comfortable speaking about it in the beginning with my doctor… I may still be smoking because

if I didn’t say anything and didn’t have those conversations with my doctor, I probably would have just kept doing it,” said a woman during one of the focus groups.

Women expressed mixed concerns regarding Child Protective Services (CPS) investigations. Something for ob-gyns to consider may be reassuring patients that CPS would not be called because of her prenatal cannabis use. Several women, however, reported continued strong concerns about potential CPS involvement after delivery. “I actually had a friend who has a CPS case out on her because she had tested positive for weed when she gave birth. So, that’s definitely a worry because some people are so against it. I don’t know if that’s in every case if that would happen. It’s kind of scary, you know?”

Another recurring theme among focus groups was the idea that cannabis retailer staff are knowledgeable, caring, and nonjudgmental. Most women viewed budtenders in retail outlets as experts on the benefits of cannabis use, including during pregnancy, with one woman likening them to a doctor of sorts. One woman said that budtenders “show you what’s best for

you… it’s kind of like the doctor, but not really.” A few other women, however, noticed that advice may vary in quality and suggested to go to a dispensary where “they know what they’re talking about.”

Ob-gyns and other prenatal care providers should leverage these findings, especially the notion that legalization gave women greater confidence and willingness to discuss cannabis use during pregnancy with their doctors. Ob-gyns should be trained and empowered to screen for and initiate conversations about prenatal cannabis use, provide nonjudgmental counseling and information about potential health risks, and refer women to alternative medicines or supplements that have been proven safe for pregnancy-related symptoms.

The issue regarding CPS involvement is also critical for ob-gyns to be aware of so they can provide accurate information to patients that is relevant in their state of practice.

In California, ob-gyns are not required to contact CPS or law enforcement when pregnant women screened positive for cannabis use and a positive toxicology test result at the time of delivery is not sufficient basis for reporting child abuse or neglect.

 However, prenatal cannabis use is still included in definitions of child abuse or neglect that can lead to termination of parental rights in many states

According to researchers and study authors, this implication further highlights the need to reform antiquated policies in states that criminalize prenatal substance use. Doing so, they concluded, may help avoid unintended negative public health consequences such as fewer patient-provider conversations, missed opportunities for education and referrals for alternative treatments.

This article was published by our sister publication Contemporary OB/GYN.

Marijuana Legality By State. DISA. Published 2023. Accessed January 17, 2023. 

https://disa.com/maps/marijuana-legality-by-state

Skelton KR, Hecht AA, Benjamin-Neelon SE. Women’s cannabis use before, during, and after pregnancy in New Hampshire. 

. 2020;20:101262. doi:10.1016/j.pmedr.2020.101262

Young-Wolff KC, Foti TR, Green A, et al. Perceptions About Cannabis Following Legalization Among Pregnant Individuals With Prenatal Cannabis Use in California. 

. 2022;5(12):e2246912. doi:10.1001/jamanetworkopen.2022.46912

Young-Wolff KC, Sarovar V, Tucker LY, et al. Trends in Cannabis Polysubstance Use During Early Pregnancy Among Patients in a Large Health Care System in Northern California. 

. 2022;5(6):e2215418. doi:10.1001/jamanetworkopen.2022.15418

Child Welfare Information Gateway. Parental drug use as child abuse. Accessed October 18, 2022. 

https://www.childwelfare.gov/topics/systemwide/laws-policies/statutes/parentalsubstanceuse/

Guttmacher Institute. Substance use during pregnancy. Accessed October 18, 2022. 

https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy

Findings from a study in JAMA Network Open reveal valuable insight into the way cannabis legalization has impacted the perceptions of pregnant women who use cannabis in the US.

Impact of cannabis legalization on prenatal marijuana use

The US Department of Health and Human Services (HHS) has awarded almost $245 million to support health care workers helping families meet mental health needs.

The funding came from the Bipartisan Safer Communities Act, with $185.7 million from the Substance Abuse and Mental Health Services Administration (SAMHSA) and almost $60 million from the Health Resources and Services Administration (HRSA).

In June 2022, President Joe Biden signed President Biden’s Unity Agenda as part of the administration’s efforts to manage the ongoing mental health crisis in children. This has given vital resources to the HHS for supporting children and families nationwide.

There were 5 awards given from SAMHSA. The first of these was given to Project Advancing Wellness and Resiliency in Education, so that health programs and services may be created and managed in schools.

The second award was given to Mental Health Awareness Training, so that law enforcement, school personnel, and emergency first responders could be trained to recognize signs and symptoms of mental health issues, promoting early intervention.

The third award was given to School Based Trauma-Informed Support Services and Mental Health Care for Children and Youth, so that students may have improved access to trauma support services and mental health care that is culturally relevant and evidence-based.

The fourth award was given to the National Child Traumatic Stress Initiative, so that children, adolescents, and families who have experienced traumatic events may receive improved treatment and services.

The final award was given to Resiliency in Communities after Stress and Trauma, to prevent violence in communities facing civil unrest, community violence, or collective trauma through the promotion of resilience and equity.

Almost $60,000 was given by the HRSA into supporting an initiative for mental health training to be given to primary care clinicians. In particular, the training would focus on mental health in children and adolescents.

HHS awards nearly $245 million to support youth mental health and help the health care workforce meet families’ mental health needs. HHS. January 9, 2023. Accessed January 18, 2023. 

https://www.hhs.gov/about/news/2023/01/09/hhs-awards-nearly-245-million-support-youth-mental-health-and-help-health-care-workforce-meet-families-mental-health-needs.html

Nearly $245 million was awarded in Bipartisan Safer Communities Act funding from the US Department of Health and Human Services to help health care workers support mental health in youths and families.

HHS offers awards for supporting mental health in youths

The risk of juvenile idiopathic arthritis (JIA) is greater among children with familial autoimmune diseases (AD), according to a recent study published in 

There are 7 subtypes of arthritis under JIA, all of which appear in patients before they are aged 16 years, and last for over 6 weeks. Of these, 6 arthritis subtypes are considered ADs, with the exception being systemic JIA. 

ADs have been observed to cluster in families, sharing certain pathogenic mechanisms and genetic factors, but the association between ADs and JIA is unclear. In 1 study, 32% of patients with JIA had at least 1 first-degree relative with an AD. Family history of AD has also been associated with greater disease activity in individuals with JIA.

To understand the association between JIA in children and ADs in parents, investigators gathered and analyzed data from the international observational Pharmachild registry. Since 2011, Pharmachild has studied the safety and efficacy of drug therapies against JIA.

Patients with JIA being treated with nonsteroidal anti-inflammatory drugs were included in the registry. If family history of AD was not available, then the patient was excluded from the study.

Reported ADs in first-degree relatives were evaluated by 3 investigators and put into the following categories: psoriasis, autoimmune thyroid disease, rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel disease, JIA, asthma, insulin-dependent diabetes mellitus, systemic lupus erythematosus, vitiligo, celiac disease, multiple sclerosis, uveitis, sarcoidosis, reactive arthritis, Sjögren’s syndrome, rheumatic fever, vasculitis, Still’s disease, familial Mediterranean fever, other autoimmune arthritis, other connective tissue diseases, and other AD.

Demographic and disease characteristics of participants were also gathered. There were 8673 patients with JIA in the final analysis, most of which were treated in European centers.

The time from disease onset until entry in the study for patients was a median 139 days. A family history of AD was seen in 1231 patients, about 90% of which had a family history of 1 AD, about 9% a history of 2 ADs, and about 1% a history of 3 or more ADs.

Enthesitis-related arthritis, psoriatic arthritis, and undifferentiated arthritis were seen more often in patients with a family history of AD. These patients were often also older at JIA onset.

In parents of the included JIA patients, 1366 ADs were reported, with psoriasis and ankylosing spondylitis being the most common diseases. Several other ADs were also more common in these individuals compared to a general population.

These results indicated increased risks in JIA development in children with a familial history of AD. Investigators concluded that AD history should be noted when diagnosing JIA.

van Straalen JW, de Roock S, Giancane G,Alexeeva E, Koskova E, Mesa-del-Castillo Bermejo P, et al. Prevalence of familial autoimmune diseases in juvenile idiopathic arthritis: results from the international Pharmachild registry. 

A recent study found that a family history of autoimmune diseases increased risk factors in juvenile idiopathic arthritis development.

Familial autoimmune diseases linked to pediatric juvenile idiopathic arthritis

An association was identified between emergency cesarean section (C-section) and childhood 

, according to recent data. This relationship has been investigated before, however, previous results have yielded conflicting evidence.

While some studies showed the absence of a connection, others have indicated the disruption of infant intestinal flora that occurs during C-section can facilitate the development of allergens.

The aim of this study was to explore how the mode of delivery related to asthma development at 7, 11, or 14 years. Additionally, investigators examined persistent asthma and adolescent onset asthma by analyzing data acquired from the UK Millennium Cohort Study.

Does the Mode of Delivery Determine Asthma Risk?

In a research letter regarding the UK Millennium Cohort Study, Amy O’Connor, School of Public Health, University College Cork, Cork, Ireland, and a team of investigators hypothesized that if the disruption of infant intestinal microflora was responsible for the link between C-section and asthma, an association would be observed between planned C-section and asthma in this study.

The mode of delivery was categorized as one of the following: ‘spontaneous vaginal delivery’, ‘assisted vaginal delivery’, ‘induced vaginal delivery’, ‘emergency C-section’, ‘planned C-section’ and ‘C-section after induction of labor’. Investigators defined the variable as the effect of any intervention during labor, as opposed to no intervention.

One of the principal findings was the link between emergency C-section and asthma at ages 7, 11, and 14 years. According to results, few associations were observed between assisted and induced vaginal delivery and asthma at the age of 11 and induced vaginal delivery and wheezing at 7 years.

The other principal finding came from assessing the relationship between planned C-section and asthma–after crude and adjusted model analyses, investigators observed no associations.

In the research letter, it was speculated that the positive associations could potentially include a disruption in the infant intestinal microflora following C-section. However, investigators emphasized that in that case, the expectation was related to planned C-section.

Some limitations noted by investigators included the possible role of recall bias for self-reported potential confounders, and that the data was collected before asthma status of the child was known. In instances of any misclassification, the letter stated this could bias results toward the null due to the likelihood of it being non-differential.

By confounding by indication, investigators didn’t have any information regarding the reasoning for planned or emergency C-section scenarios, which they explained could have influenced results.

The large, population-based cohort nationally represented children born in the UK between 2000-2002, which strengthened this research. Additionally, the outcome measure was determined by a validated questionnaire that exhibited a specificity of 93%, and is widely used to measure childhood asthma.

Unlike previous investigations, this one categorically distinguished planned C-section, and emergency C-section. Complications of pregnancy, maternal asthma, and several maternal and socio-economic factors were considered when controlling for potential confounders.

“In conclusion, children born by emergency CS, but not planned CS had an increased likelihood of asthma diagnosis,” investigators wrote. “These results suggest that the association may be due to confounding by indication or other residual confounding factors, and unlikely to be causal based on the microbiome theory.”

Mode of delivery and asthma in childhood and adolescence: Findings from the Millennium Cohort Study

This article was published by our sister publication HCP Live.

The relationship between C-section and childhood asthma has been investigated before, however, previous results have yielded conflicting evidence.

From C-section to childhood asthma: new evidence sheds light on the relationship

Telehealth treatment is a potential method of providing intervention to children with developmental delay (DD), according to a recent study published in 

DD leads to early behavior problems in children which can be prevalent and impairing, and there is little data on the efficacy of telehealth intervention in treating children with DD. To evaluate the impact of telehealth on parenting intervention for behavioral problems in children with DD, investigators conducted a randomized clinical trial.

The trial took place from March 17, 2017, to December 15, 2020. Children present with DD and early behavior problems were recruited from early intervention. There was a telehealth parenting intervention group and a control group in the study. Children were randomly assigned to 1 of these 2 groups, then analyzed through a 12-month follow-up.

Intervention included internet-delivered parent-child interaction therapy (iPCIT), providing guidance on interactions between caregivers and children through video conferencing. There were 20 weeks of iPCIT given to families. Many of these families were low wealth, with over half of children in extreme poverty or low income-need ratio categories.

Behaviors and caregiving stress between child and caregiver were analyzed at preintervention, midtreatment, postintervention, and during 6-month and 12-month follow-ups. There were 150 children in the sample, 74% of which were male. Children were assigned to one of the groups randomly with their caregivers.

In families receiving iPCIT, the rate of externalizing problems was significantly lower than families in the control group, which received referrals as usual. Post treatment, children in the iPCIT group were also significantly more likely to follow caregiver directions.

A clinically significant change was seen in 74% of the iPCIT group analyzed postintervention, compared to 42% of the control group. Positive parenting skills were also more often seen in caregivers from the iPCIT group, along with a decrease in controlling or critical behaviors.

These results indicated positive outcomes from telehealth treatment in maintaining improvements for young children with DD and their caregivers. Investigators hypothesized telehealth could expand the scope and reach of care for low-income families.

Bagner DM, Berkovits MD, Coxe S, Frech N, Garcia D, Golik A, et al. Telehealth treatment of behavior problems in young children with developmental delay: arandomized clinical trial. 

2023.doi:10.1001/jamapediatrics.2022.5204

In a recent study, young children with developmental delay saw improvements in behavior after receiving treatment through telehealth.

Impact of cannabis legalization on prenatal marijuana use

HHS offers awards for supporting mental health in youths

Familial autoimmune diseases linked to pediatric juvenile idiopathic arthritis

From C-section to childhood asthma: new evidence sheds light on the relationship

Telehealth treatment effective in managing developmental delay