On social media, people are expected to disclose any sponsored content. However, celebrities who own alcohol brands and make posts promoting their brands may circumvent these disclosure policies, potentially exposing young audiences to alcohol marketing. This study examined the extent to which celebrities promoted their own alcohol brands on Instagram, whether they disclosed the content as sponsored, and whether the posts were visible to underage users. Through systematic Google searches, we identified 112 celebrities who own alcohol brands. We retrieved 85 673 of their Instagram posts published between January 1, 2020, and December 31, 2023. Alcohol-brand posts were identified through text-pattern matching. We checked the accessibility of alcohol-brand posts to underage users using a simulated 15-year-old account. Among 112 celebrities (mean age = 50.8years; 72.3% male), 42 (37.5%) explicitly mentioned their brand in their Instagram bio, and 84 (75%) referenced their own alcohol brand in at least 1 post during the study period. Of the 85 673 total posts, 3.4% mentioned a celebrity's alcohol brand. Concerningly, only 1.7% of these alcohol-brand posts included a clear disclosure in the caption and 98% (646/660) of sampled alcohol-brand posts were visible to a simulated 15-year-old account. Celebrities' posts about their own alcohol brands were common and accessible to underage users. Policymakers should implement stricter regulations on alcohol promotions on social media to protect adolescents from exposure to alcohol-related content.

We assessed the prevalence of neurodevelopmental disabilities (NDDs; cognition, cerebral palsy, vision/hearing, epilepsy), attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), developmental coordination disorder (DCD), behavior problems, and multimorbidity in a national cohort of children born extremely preterm (EPT, <27-week gestation) to provide a comprehensive understanding of the challenges faced by children born EPT in early adolescence. All infants born EPT in Sweden from April 2004 through March 2007 were enrolled in the Extremely Preterm Infants in Sweden Study (EXPRESS). Of 492 survivors at age 12years, 462 were assessed alongside 373 term-born controls. Standard instruments were used to assess cognition, motor function, and behavior. Parents completed a structured health questionnaire. Diagnoses were obtained from national health registers. Compared with controls, children born EPT exhibited significantly higher rates of moderate/severe NDD (37.4% vs 4.6%), ASD (14.9% vs 2.41%), ADHD (21.2% vs 8.9%), DCD (29.4% vs 5.7%), and behavioral problems (35.3% vs 8.13%; all P < .001). Of children born EPT with no/mild NDD, 8.3% (24/289) were diagnosed with ASD and 14.5% (24/289) with ADHD, and of those with moderate/severe NDD, 26.0% (42/289) were diagnosed with ASD and 32.4% (56/173) with ADHD. Of children born EPT with moderate/severe NDD, 59% exhibited at least 2 co-occurring disabilities/disorders, and in those with no/mild disabilities, comorbidity was 24.9%. In the total EPT cohort, 57.4% were free from moderate/severe NDD and ASD, and 42.0% were free from ASD, ADHD, and DCD. By age 12years, a large proportion of children born EPT faced challenges because of NDD, ASD, ADHD, DCD, multimorbidity, and behavioral problems, necessitating multidisciplinary follow-up.

Since 1991, the CDC has recommended screening for hepatitis B virus (HBV) infection in pregnancy and universal hepatitis B vaccination of all medically stable infants at birth, serving as a core strategy to prevent perinatal and postnatal infection and eliminate HBV transmission nationwide. On December 5, 2025, the Advisory Committee on Immunization Practices (ACIP) voted (1) among women who screen negative in pregnancy, parents decide, in consultation with providers, when or if to vaccinate their child for hepatitis B, and if not at birth, then no earlier than 2 months of age, and (2) consider collection of infant immune titers to guide decision-making for completing the vaccine series. We conducted a comprehensive review of the evidence of the safety, immunogenicity, efficacy, and effectiveness of the birth dose and a delayed first dose, and of the potential role of serology for clinical decision making. We analyzed studies of the epidemiology of HBV infection, clinical trials, systematic reviews, vaccine safety from surveillance and clinical studies, and potential impact of revised guidelines on individual and public health. We synthesized the history of ACIP recommendations and resulting trends in HBV incidence. The review found strong evidence for the safety and effectiveness of the birth dose, and no improved safety or effectiveness with a delayed first dose. We found no evidence to support use of post-vaccination serology. Infant vaccination has resulted in a 99% reduction in pediatric HBV infections; we found no evidence to support a change in vaccine recommendations but identified potential health consequences.

The American Academy of Pediatrics recommends immediate referral of children screening at elevated likelihood of autism for diagnostic evaluation, early intervention, and audiology. However, most children screening at elevated autism likelihood are not referred. We aimed to synthesize decision-making processes related to generalist referrals to specialists for children with increased autism likelihood in the United States. We examined (i) rates of referral from generalist to specialist providers across medical and geographic settings, (ii) child/family factors that influence provider referrals, and (iii) facilitators and barriers to timely referral. We searched PubMed, PsycINFO, and Embase for studies that discussed autism likelihood in young children, discussed generalist to specialist referral, used empirical methods, and were set in the United States. We extracted the setting, study design, referral rates, child and family factors associated with referrals, and facilitators and barriers to referral. A total of 38 articles were included. In studies with no intervention elements, providers refer children to evaluations and early intervention services at rates ranging from 20% to 58.4%. In intervention studies, referral rates ranged from 45% to 98% after intervention. Perceived symptom severity and greater caregiver concern were associated with increased referral rates. Barriers to referral included providers' lack of confidence in screening tools and lack of local diagnostic and intervention sites. Interventions to facilitate rates of referral varied widely in their characteristics and outcomes. This review was restricted to the United States and included few high-quality experimental interventions. Increased research efforts should focus on increasing referral rates to early intervention, which is appropriate even for children with false positive results screening at elevated autism likelihood. Rigorous studies that optimize referral processes across providers and settings are needed.

Health-related social needs (HRSN) affect a wide range of short- and long-term outcomes, health care use, functioning, and quality of life. Although HRSN screening is valuable, it is likely ineffective unless coupled with interventions. This project integrated HRSN screening and intervention(s) across 9 inpatient and outpatient divisions, varied in composition, patient populations, process flows, and resource availability. A quality improvement team with a standardized change package facilitated a multimodal initiative for divisions spanning hospital medicine, newborn nurseries, and specialty outpatient clinics at an urban, quaternary pediatric hospital system. We aimed for 80% of patient encounters to be screened for HRSN and that each positive screen receive an agreed upon resource intervention using a centralized resource bank. From January 2021 to October 2023, 31 834 screenings were conducted across 9 divisions. Performance increased to a mean 92%, with positive screens receiving interventions. The last 7months of the project were sustained at 92% or higher. Food insecurity was identified in 17.6% of encounters (n = 10 007, 1765 positive), with a 56% decrease in prevalence on repeat screening after identification/intervention. A centralized quality team and change package can facilitate successful implementation of HRSN screening and connection to resources across multiple disciplines and sites. These interventions may lead to a decrease in subsequent HRSN positivity. Rescreening patients over time is important to capture the full spectrum of HRSN needs of a family.

Evidence on the association between maternal diabetes and neurodevelopmental disorders in offspring, particularly epilepsy, remains limited and heterogeneous. Moreover, most studies have not distinguished among diabetes subtypes-type 1 (T1DM), type 2 (T2DM), and gestational diabetes mellitus (GDM)-which have distinct etiologies. This study examines the association among these diabetes subtypes and epilepsy in offspring. In a retrospective birth cohort of all in-hospital live births between 2002 and 2018 in Ontario, Canada's most populous province, linked with population maternal and child health records up until March 2020, we estimated the crude and adjusted association among T1DM, T2DM, and GDM and epilepsy in children aged younger than 18years using Cox proportional hazards models. We examined the robustness of results using quantitative bias analyses. Among 2 105 553 children, 160 644 (7.6%) were exposed to maternal diabetes (0.3% T1DM, 1.2% T2DM, and 6.1% GDM). Over a median follow-up of 10.2years, 17 853 epilepsy cases were diagnosed. After adjusting for maternal socioeconomic and clinical characteristics, children exposed to maternal diabetes had an increased risk of epilepsy in all subcategories of diabetes compared with those unexposed (adjusted HR [aHR] for T2DM, 1.40; 95% CI, 1.24-1.58; aHR for T1DM, 1.32; 95% CI, 1.03-1.69; and aHR for GDM, 1.14; 95% CI, 1.07-1.22). A longer duration of T1DM or T2DM was associated with an increased risk. These results were consistent in our quantitative bias analyses. Maternal diabetes, particularly T1DM and T2DM, is associated with an increased epilepsy risk in offspring, with longer disease duration not significantly amplifying this risk. These findings suggest that prenatal metabolic and inflammatory exposures may contribute to the development of epilepsy.

Here, we present a unique case of a 17-year-old boy who presented with progressive lower extremity weakness, functional decline, and mood changes and was ultimately found to have a new diagnosis of AIDS from perinatally acquired HIV infection. This case demonstrates the discovery of a delayed diagnosis of HIV with important lessons for all pediatricians. It highlights the need for pediatricians to maintain a high index of suspicion and consider broad differentials and appropriate workup for at-risk youth with known psychiatric conditions. It is essential to identify at-risk youth early to prevent progression and severity of illness.

Therapeutic hypothermia within 6hours of birth is critical for newborns with hypoxic-ischemic encephalopathy (HIE) but is often delayed by transfers to appropriate facilities. Telemedicine (TM) based hypothermia evaluation could expedite these assessments. There is limited evidence on the efficacy of TM compared with the in-person (IP) Sarnat examination. In this study, we aim to compare the TM with the IP examination in infants with suspected HIE. Newborns were enrolled from March 2022 to December 2023. All infants underwent IP and TM assessments using the modified Sarnat examination within 6hours after birth. Data included neurologic examination scores for both IP and TM, decisions for hypothermia qualification, and TM technology metrics. Cohen's kappa statistic (κ) was used to measure the interrater agreement between IP and TM examination findings. 170 Sarnat assessments (IP and TM) were performed on 85 enrolled infants. The results show almost perfect agreement between IP and TM regarding signs of moderate or severe HIE (κ = 0.82) and the decision for hypothermia intervention (κ = 0.82). We report fair to moderate agreement (κ = 0.33-0.58) for individual categories of the neurologic examination. 93% of TM examinations were completed within 15minutes, and 79% of the TM encounters had no technology issues. This study compares IP and TM assessments in infants requiring hypothermia evaluation. Findings show that TM is feasible and not significantly different from IP for making hypothermia decisions in suspected HIE. This could enhance remote Sarnat evaluations and initiate earlier therapeutic interventions.