Child Outcomes Research Articles

Family Socioeconomic Status and Neurodevelopment Among Patients With Dextro-Transposition of the Great Arteries

Data are limited on the longitudinal implications of socioeconomic status (SES) for neurodevelopmental outcomes among persons with complex congenital heart disease (CHD). To examine the association of family SES, maternal educational level, and maternal IQ with the neurodevelopment of individuals with dextro-transposition of the great arteries (d-TGA) from age 1 to 16 years and to identify how SES-related disparities change with age. This cohort study analyzed data of participants enrolled in the Boston Circulatory Arrest Study, a randomized clinical trial conducted in Boston, Massachusetts, from 1988 to 1992. Participants were infants with d-TGA who underwent arterial switch operation and, after operation, underwent in-person neurodevelopmental status evaluations at ages 1, 4, 8, and 16 years. Analyses were conducted from April 2021 to August 2024. Mean Hollingshead scores at birth, age 1 year, and age 4 years were used to assign participants to SES tertiles (lowest, middle, or highest). Age-appropriate neurodevelopmental outcomes assessed at 4 study time points (ages 1, 4, 8, and 16 years) via in-person administration of a range of well-validated measures. Standardized neurodevelopmental composite scores from each evaluation were derived from principal component analysis and compared across SES tertiles, adjusting for birth and medical characteristics. These scores were used to categorize the sample into latent classes; patient and medical factors for a 3-class model were used to estimate latent class using multinomial regression. The sample included 164 patients with d-TGA (123 males [75%]; mean [SD] gestational age at birth, 39.8 [1.2] weeks; 3 with Asian [2%], 6 with Black [4%], 5 with Hispanic [3%], and 146 with White [89%] race and ethnicity) and their mothers (mean [SD] age at birth, 28.5 [5.2] years). Lower SES tertile was associated with worse scores on most individual neurodevelopmental tests and worse neurodevelopmental composite scores at ages 4, 8, and 16 years. For example, mean (SD) neurodevelopmental composite scores at age 4 years were -0.49 [0.83] for lowest, 0.00 [0.81] for middle, and 0.47 [1.10] for highest SES tertile (F2 = 15.5; P < .001). When measured at consecutive time points, differences between SES tertiles were of similar magnitude. A latent class analysis produced 2- and 3-class models representing patients with stable (103 [64%] and 85 [53%]), improving (20 [13%]), and declining (57 [36%] and 55 [34%]) neurodevelopmental status. Those experiencing declines in neurodevelopmental status were more likely to have younger maternal age at childbirth (26.6 [5.1] vs 29.6 [4.9] and 29.1 [5.1] years; P = .002), lower maternal IQ (91.0 [14.1] vs 100.1 [11.1] and 96.2 [11.0]; P < .001), and lower SES (35.2 [10.8] vs 40.9 [9.9] and 35.8 [10.1]; P = .003) compared with those with stable or improving status. This cohort study of individuals with d-TGA found an association between lower family SES and worse neurodevelopmental outcomes in childhood and continuing throughout adolescence as well as greater decline in neurodevelopmental status over time. Effective strategies are needed to improve access to neurodevelopmental monitoring and intervention services for children with CHD from lower socioeconomic backgrounds.

Clinical outcomes in febrile children with a positive urine culture without pyuria: Implications for antibiotics.

This study aimed to investigate whether antibiotics should be administered to patients aged <2 years with a positive urine culture without pyuria by identifying their clinical characteristics and outcomes in the absence of antibiotic treatment. This retrospective, observational study included children aged <2 years with positive findings on a culture of urine obtained using a catheter in the paediatric emergency department between 2016 and 2021. The primary outcome was the spontaneous resolution of fever without antibiotics in patients with a positive urine culture without pyuria. The clinical characteristics of the patients with and without pyuria were also compared. Of 391 patients, 86 (22%) were negative for pyuria. Of these, 63 (73%) received no antibiotics, and 56 (89%) had spontaneous defervescence and no symptom recurrence. The patients without pyuria had a higher proportion of other possible causes of fever, lower inflammatory markers, fewer cultured bacteria, and a higher proportion of multiple, bacterial species in their culture than the patients with pyuria. Most of the patients with a positive urine culture without pyuria may not require antibiotics if their fever resolves spontaneously.

The Cost of Opportunity: Anti-Black Discrimination in High Resource Settings.

Inequalities exist in children's educational outcomes-including reading proficiency, school discrimination, and school disciplinary actions-across zip codes with different levels of educational childhood opportunity index (COI). This study examines the interaction between race and educational environment on children's educational outcomes. We hypothesize that race, parental education, and their interaction are associated with perceived school discrimination, which in turn reduces their cognitive, academic, and emotional wellbeing. We also hypothesize that Black children with high socioeconomic status (SES) report high perceived school discrimination in high-COI settings. Data were drawn from the Adolescent Brain Cognitive Development (ABCD) study, which measures a wide range of educational, cognitive, and emotional outcomes. At the same time, the ABCD children are sampled across areas with vast differences in COI rankings, that can be classified into these five categories: very high, high, average, low, and very low educational COIs. Our structural equation models (SEM) tested the additive and interactive effects of race and educational attainment on perceived school discrimination, and the effects of school discrimination on various cognitive abilities (reading proficiency, picture vocabulary, and list sorting working memory), school suspension, as well as depressed mood. Our multi-group SEM assessed how these relationships vary across educational COI levels. Our findings showed that high SES Black children report highest school discrimination in residential areas with highest COIs. This is based on the observation that the interaction between race and parental education on experiences of school discrimination were only significant in areas with highest COI. Across residential areas with different COI levels, students who experienced higher school discrimination had higher suspension, worse depression, and worse cognitive performance. While higher COIs are associated with better academic outcomes, Black-White gaps exist in the role of increased COI through increased racial bias that children perceive. These findings underscore the complexity of educational equity, suggesting that improving COI alone is insufficient for eliminating racial disparities in school experiences. Policies should be in place to reduce school-based discrimination against Black students in high COI settings.

Parental engagement and transformation as a marker of quality in Early Childhood Education and Care

Despite the extensive research evidence about the importance of high-quality Early Childhood Education and Care (ECEC), English policy makers continue to promote nurseries for the ‘childcare’ they provide, rather than the transformational effects they can have in areas of socio-economic challenge. The aim of this study was to investigate if and how access to early years provision impacted on parents/carers and their children during the Covid pandemic in a newly established early years community research centre, situated in an area of economic and social challenge. Group analysis of interview data by a team of researchers and stakeholders suggests that access to nursery provision and the positive and trusting relationships within the nursery had a transformative impact on children and their parents/carers. Drawing on the data, we adopt an ecological perspective to theorise quality provision as holistic and relational and challenge policy makers to reconceptualise quality as a holistic endeavour. Specifically, this paper offers a new lens for policy makers to revisit existing evidence about the value of integrated care and education centres for improving child outcomes.

In utero exposure to per - and polyfluoroalkyl substances (PFAS) associates with altered human infant T helper cell development.

Environmental exposures to chemical toxicants during gestation and infancy can dysregulate multiple developmental processes, causing lifelong effects. There is compelling evidence of PFAS-associated immunotoxicity in adults and children. However, the effect of developmental PFAS exposure on infant T-cell immunity is unreported, and, if present, could be implicated in immune-related health outcomes. We seek to model longitudinal changes in CD4+ T-cell subpopulations from birth through 12 months and their association with in-utero PFAS exposure and postnatal CD4+ T-cell frequencies and functions. Maternal-infant dyads were recruited as part of the UPSIDE-ECHO cohort during the first trimester between 2015 and 2019 in Rochester, New York; dyads were followed through the infant's first birthday. Maternal PFAS concentrations (PFOS, PFOA, PFNA, and PFHXS) were quantified in serum during the second trimester using high-performance liquid chromatography and tandem mass spectrometry. Infant lymphocyte frequencies were assessed at birth, 6- and 12-months using mass cytometry and high-dimensional clustering methods. Linear mixed-effects models were employed to analyze the relationship between maternal PFAS concentrations and CD4+ T-cell subpopulations (n=200). All models included a PFAS and age interaction and were adjusted for parity, infant sex, and pre-pregnancy body mass index. In-utero PFAS exposure correlated with multiple CD4+ T-cell subpopulations in infants. The greatest effect sizes were seen in T-follicular helper (Tfh) and T-helper 2 (Th2) cells at 12 months. A log 2 -unit increase in PFOS was associated with lower Tfh [0.17% (95%CI: -0.30, -0.40)] and greater Th2 [0.27% (95%CI: 0.18, 0.35)] cell percentages at 12 months. Similar trends were observed for PFOA, PFNA, and PFHXS. Maternal PFAS exposures correlate with cell-specific changes in the infant T-cell compartment, including key CD4+ T-cell subpopulations that play central roles in coordinating well-regulated, protective immunity. Future studies into the role of PFAS-associated T-cell distribution and risk of adverse immune-related health outcomes in children are warranted.

Considerations in the development of the International Multicenter Pediatric Portal Hypertension Registry

AbstractPortal hypertension, a common sequela of chronic liver disease, is complicated by variceal hemorrhage, one of its most serious complications. Evidence‐based approaches to managing variceal hemorrhage are limited by the scarcity of data related to this rare entity. Multicenter international registries are increasingly utilized to garner critical information about rare diseases. The International Multicenter Pediatric Portal Hypertension Registry (IMPPHR) was developed to acquire pediatric data about the mortality of first variceal hemorrhage and approaches to primary and second prophylaxis of variceal hemorrhage with a goal of improving outcomes in children with portal hypertension. IMPPHR evolved from pediatric portal hypertension symposia at the Baveno V and VI meetings in 2010 and 2015, with a formal executive committee initiating the development of IMPPHR in 2019. The registry opened in 2020, with data closure in 2024, including information from 44 centers and &gt;700 subjects. The complexities and approaches to developing IMPPHR are described.

Speech Outcomes in Children with Robin Sequence Treated with a Pre-Epiglottic Baton Plate

Objective To analyze speech outcomes and cleft shape changes in children diagnosed with Robin sequence (RS) treated with a customized pre-epiglottic baton plate (PEBP). Design Single-surgeon retrospective analysis. Setting Tertiary care institution. Patients and Participants Twenty-five patients with RS who were treated with PEBP and primary cleft palate repair between 2010 and 2019. Interventions Postnatal use of a PEBP. Main Outcome Measures Speech assessment at the age of 3.5 to 4.5 years documenting hypernasality, nasal emission, nasal turbulence, voice quality, and consonant production, and analysis of digitally scanned cast models before and after the use of PEBP to quantify changes in cleft shape and width. Results The study cohort ( N = 25) consisted of 19 patients with hard and soft cleft palates and 6 patients with soft cleft palate only and postnatal use of PEBP. The mean reduction in cleft width following PEBP treatment prior to cleft palate repair in 19 infants with hard and soft cleft palates was 41.30% (standard deviation, 13.25). Speech assessments were conducted at a mean age of 48.5 months in all 25 children treated with PEBP. Most children presented with absent or mild hypernasality (96%), a rate of 8% of nasal emission and 4% of nasal turbulence was found. The most frequent findings were articulation errors in 14 children (56%), of whom 2 presented with cleft-type characteristics. Conclusions Children with RS and cleft palate treated with PEBP demonstrated a narrowing of the cleft palate prior to a timely surgical repair, and favorable speech outcomes already at a young age during childhood.

An Analysis of Hearing Outcomes in Children with Hutchinson-Gilford Progeria Syndrome

Aims/Background Few hearing loss studies have been conducted in patients with progeria, and only the possibility of low-frequency conductive hearing loss has been mentioned. The primary objective of this study is to perform a comprehensive analysis of the clinical audiological characteristics of children with Hutchinson-Gilford progeria syndrome (HGPS), and the secondary objective is to analyse the causes of their hearing loss and what can be done to enable them to hear as well as possible. Methods Ten children with HGPS underwent impedance audiometry (tympanogram), otoacoustic emissions, and pure-tone audiometry tests. Otoscopic examination and imaging were also performed in the patients with abnormal hearing. Results Five patients had normal hearing, while the other five had varying degrees of hearing impairment manifesting as mild to moderate low-frequency or full-frequency conductive hearing loss. Otoscopic examination of those patients with abnormal hearing showed a narrowing of the external auditory canal, a thinning of the tympanic membrane, and a distorted cone of light. Further, computed tomography of one patient showed a poorly defined temporal bone morphology with scant pneumatization of the mastoid process. Conclusion Patients with HGPS differ from normally aging individuals with a predominant conductive pattern of hearing loss as opposed to sensorineural deafness, with more lower-frequency hearing impairment due to poor pneumatization of the mastoid process and the possible formation of osteophytes in the temporal bone.

In vitro fertilization and long-term child health and development: nationwide birth cohort study in Japan

The aim of this study is to compare long-term health outcomes between IVF-conceived children and non-IVF-conceived children in Japan, in the context of strong recommendation for single embryo transfer. Using data from a nationwide birth cohort linked with perinatal database, this study analyzed 2140 children born in Japan in May 2010. It compared child health and development outcomes up to 9 years of age between IVF-conceived and non-IVF-conceived children (binary exposure). A Poisson regression with robust variance to estimate the risk ratios for the association between IVF and various long-term child health and developmental outcomes. After adjusting for confounding factors, no significant differences were observed between IVF-conceived and naturally conceived children for most outcomes, including hospitalization, obesity, and developmental milestones. IVF-conceived children showed a slightly lower risk of attention problems at 8 years (adjusted Risk Ratio [aRR]: 0.73, 95% CI: 0.53–1.00). In subgroup analyses, IVF-conceived term children and singletons demonstrated reduced risk of cognitive delays at 5.5 years (aRR: 0.31, 95% CI: 0.10–0.96 and aRR: 0.37, 95% CI: 0.14–0.98, respectively).Conclusion: In this Japanese cohort, IVF conception was not associated with adverse long-term health or developmental outcomes. These findings provide reassurance about the safety of IVF, particularly in the context of single embryo transfer policies. Further research is needed to explore specific IVF protocols and subgroups.What is known:• Long-term health and developmental outcomes of IVF-conceived children remain inconsistent across studies and populations, despite the widespread use of this technology.What is new:• A nationwide population-based cohort study in Japan did not show adverse effects of IVF on long-term child health and development through age 9.• These findings provide reassurance about the safety of IVF, while indicating the need for careful monitoring in specific subgroups such as preterm and multiple births.

Craniofacial anatomical determinants of pediatric sleep-disordered breathing: A comprehensive review.

This narrative review aims to elucidate the anatomical features of sleep-disordered breathing (SDB) in children. By identifying key structures and intervening proactively, we seek to alter craniofacial growth patterns and improve functional outcomes for SDB children. The literature on pediatric sleep-disordered breathing (PSDB), pediatric obstructive sleep apnea (OSA), anatomical predispositions, and the relationship between skeletal deformity and PSDB was examined using PubMed and Google Scholar databases, covering studies from 2006 to 2024. Forty relevant articles were reviewed, focusing on craniofacial characteristics associated with PSDB. The etiology of PSDB is multifactorial, with adenoid and palatal tonsil enlargement being the most common cause. While adenotonsillectomy is recommended as the primary treatment, residual SDB may result in craniofacial skeletal deformities contributing to upper airway constriction. Typical craniofacial phenotypes of SDB include excessive vertical growth and constriction of the maxilla, a retruded mandible, and posterior rotation, known as a Class II hyperdivergent pattern. Conversely, Class III with an underdeveloped maxilla shows a relatively lower risk for SDB due to reduced nasal cavity and nasopharyngeal airway volumes. Transverse maxillary constriction with a high, deep palatal vault is a significant risk factor. Additionally, nasal obstruction and low tongue posture, with or without a short lingual frenulum, are identified as craniofacial risk factors for SDB development in children. Early diagnosis and intervention are critical in managing PSDB. Dentists, through screening and early treatment, can significantly influence craniofacial growth and health outcomes. A multidisciplinary approach is essential for effective management, improving the quality of life and long-term health of affected children.

Chondroblastoma of the femoral head: curettage without dislocation

BackgroundChondroblastoma (CBL) of the femoral head is a rare disease, typically encountered in the epiphysis of long bones, with its occurrence in the femoral head being particularly uncommon. The unique location and aggressive nature of this tumor pose substantial challenges in its treatment, leading to ongoing controversies regarding the therapeutic approaches. In this study, we introduce a technique of curettage without surgical dislocation as a treatment option for CBL in this challenging location.MethodsA total of 6 children diagnosed with chondroblastoma of the femoral head underwent a surgical procedure consisting of curettage, the application of anhydrous alcohol as an adjuvant therapy, followed by bone grafting. The epiphyseal plate status of the femoral head was classified as open, closing, or closed. To evaluate the children's postoperative functional outcome, the Musculoskeletal Tumour Society (MSTS) scoring system was utilized. Additionally, the Lodwick classification was employed to assess the extent of bone destruction. Furthermore, the kappa coefficient was calculated to quantify the level of inter-observers agreement in assessing the status of the epiphyseal plate.ResultsThe epiphyseal plate status was closing in two patients and closed in four patients. According to the Lodwick classification, one patient was classified as IA, one as IB, and four as IC. The mean MSTS score was 28. Notably, one patient developed a femoral neck fracture three months post-curettage.ConclusionsCurettage without surgical dislocation, combined with the use of anhydrous alcohol as an adjuvant therapy, followed by bone grafting, constitutes an effective treatment technique for femoral head chondroblastoma.

Delineating Trajectories of Social-Emotional Competence in Infants and Toddlers.

The acquisition of social-emotional competence (SEC) in early childhood has implications for critical child and adult outcomes, such as school readiness, educational and occupational attainment, and mental health. To elucidate this developmental process, normative trajectories of social-emotional competence in infants and toddlers were modeled using longitudinal mixed effects modeling, including the evaluation of child and family characteristics as moderators. The SEC of 12-36-month-old children (N=256, 83% White, 51% female) was assessed in a cohort-sequential design using the Infant Toddler Social-Emotional Assessment Competence scale. Trajectories were modeled using linear, quadratic, exponential, and logistic mean forms. Following base model selection, child sex, maternal education, parental occupation, family income, and number of siblings were separately added to the model to assess their effect on trajectories. Results show that infants and toddlers SEC follows a quadratic pattern of growth. Additionally, girls had higher scores than boys at 12months with similar slopes. Number of siblings was also significant at 12months such that children with fewer siblings had higher scores than those with more with similar slopes. This suggests a female advantage in early SEC acquisition exists even before 12months and that sibling number may moderate SEC in infancy and toddlerhood.

Long-Term Outcome of Children With Steroid-Resistant Nephrotic Syndrome: A Single Center Experience From Pakistan

Objective: To determine the long-term outcome of children with steroid-resistant nephrotic syndrome at a single center in Pakistan. Study Design: Retrospective, observational study. Place and Duration of Study: Pediatric Nephrology Department, Sindh Institute of Urology and Transplantation, Karachi, Pakistan from July 2008 to June 2014. Methodology: The study included 153 children aged 4 months-12 years with steroid-resistant nephrotic syndrome. We collected data at the time of diagnosis and the last follow-up. The data was entered and analyzed by SPSS version 20. Results: Among 153 children, 84(55%) were males and 69(45%) females. At the time of diagnosis, 118(77%) were hypertensive and 65 (42.5%) had microscopic hematuria. Histopathological spectrum included focal segmental glomerulosclerosis, 63(41%); minimal change disease, 33(22%); IgM nephropathy, 9 (6%); mesangioproliferative glomerulonephritis, 26(17%), membranous glomerulonephritis, 13(8%) and membranoproliferative glomerulonephritis, 9(6%). Complete remission with cyclosporine was seen in 53(34.6%), partial remission in 36(23.5%), while 53(35%) developed chronic kidney disease, of which 26(78.8%) needed renal replacement therapy. Mortality was 21(13.7 %) and 11(7.2%) were lost to follow-up. Calcineurin inhibitors’ toxicity was seen in 52(34%). One patient received renal transplant but lost the graft 6 years post-transplant due to disease recurrence. Conclusion: Steroid-resistant nephrotic syndrome has significant long-term morbidity and mortality. Recurrence of disease in transplanted kidney is common and can result in graft loss.

Sinus node dysfunction in children: different aetiologies, similar clinical course in two-centre experience.

This study aims to evaluate the clinical characteristics and outcomes of children diagnosed with sinus node dysfunction. This was a retrospective review of patients diagnosed with sinus node dysfunction in two tertiary paediatric cardiology centres in Turkey from January 2011 to June 2022. In all, 77 patients (50, 64.9% males) were included, with a mean age of 8.2 ± 6.3 years and a mean weight of 28.2 ± 18.8 kg. While age-incompatible bradycardia and pauses were the most common rhythm disturbances, syncope, presyncope, and dizziness (n:33, 43%) were the most frequent initial symptoms. Structural heart disease was present in 58 (75.3%) of the 77 patients, 47 (61%) of whom were congenital. The most commonly associated CHDs were transposition of the great arteries (n:8), atrial septal defect (n:7), and atrioventricular septal defect (n:5). Seven of them also had left atrial isomerism. The remaining 19 patients were isolated. Four patients had SCN5A mutation (two of them were siblings) and two of them had Emery-Dreifuss muscular dystrophy. Although sinus node dysfunction is rare in children, it has been diagnosed with increasing frequency with structural heart disease, especially in patients who have undergone corrective cardiac surgery related to atrial tissue. Since sinus node dysfunction can occur at any time postoperatively, these patients should be kept under constant control. If symptomatic sinus node dysfunction is confirmed, permanent pacing is an effective therapeutic modality.

Perspective on the Influence of Biopsy on the Survival of Pediatric Patients with Diffuse Brainstem Gliomas: A Literature Review

Abstract Introduction Diffuse brainstem gliomas (DBG) represent the most common subtype of pediatric brainstem tumors, characterized by a systematically grim prognosis with a median survival rate of 10% two years post-diagnosis. Unlike other brain tumors, diffuse brainstem gliomas have traditionally relied on cranial magnetic resonance imaging (MRI) as a sufficient diagnostic tool, rendering surgical biopsies deemed unnecessary. Objectives To conduct a literature review aiming to assess whether the performance of surgical biopsies has influenced the survival outcomes of children with diffuse brainstem gliomas. Materials and Methods A comprehensive literature review was conducted using electronic databases PubMed, Embase, and LILACS. The search terms included “glioma” or “diffuse glioma” in conjunction with “pediatric” or “childhood,” combined with “biopsy” or “stereotactic,” and further combined with “brainstem,” “pons,” “pontine,” or “mesencephalon,” along with “survival.” The searches were limited to studies involving pediatric patients (age &lt;18 years) published between 1980 and 2021. Results The analysis of the presented data revealed morbidity ranging from 0% to 33.3% and mortality from 0% to 2.2%. Transfrontal access was predominantly favored by most authors, followed by transcerebellar approaches. The rate of inconclusive biopsies varied from 0% to 30%. Conclusion Given the infiltrative nature of diffuse brainstem gliomas; surgical resection is generally deemed impractical. Radiation therapy remains the standard treatment, providing a marginal survival benefit of ∼3 months. There is currently no established chemotherapy protocol for this pathology.

Exploring the Knowledge, Attitudes, and Practise of Healthy Eating Among Lactating Mothers in a Poor Rural Setting in North‐Western Ghana

ABSTRACTIntroductionRecognised as one of the most effective ways to guarantee positive maternal and child health outcomes, optimal nutrition for lactating mothers has received significant attention and investment both globally and locally. Despite this recognition, studies on maternal and child nutrition in Ghana have revealed that adherence to prescribed healthy eating regimens among lactating mothers in deprived settings has not received adequate scholarly attention. Thus, this study explores lactating mothers knowledge, attitudes, and practices regarding healthy eating to better understand the barriers to optimal nutritional outcomes for mothers and children, especially when chronic poverty is widespread.MethodsThis was a case study to explore the knowledge, attitudes, and practise of healthy eating among lactating mothers in the Wa West District. Convenience and purposive sampling procedures were followed to select lactating mothers and healthcare providers, respectively. Semi‐structured interviews were used to collect the data. The data were analysed using Anderson's behavioural model. The model offers a comprehensive analysis of factors—predisposition, enabling factors, and need for care—potentially influencing lactating mothers' knowledge, attitudes, and practise of healthy eating.ResultsThe findings show that while lactating mothers in the district were aware of the importance of optimal nutrition for their health and wellbeing; food insecurity and pervasive poverty limit their opportunities to adhere to a balanced eating regimen.ConclusionAn integrated development approach is needed to expand and sustain awareness of the importance of optimal nutrition for maternal and child health, improve local food production, and promote household economic empowerment.

Functional outcomes in children and adolescents with neurodisability accessing music therapy: A scoping review.

https://onlinelibrary.wiley.com/doi/10.1111/dmcn.16135

Association of Antibiotic Route and Outcomes in Children with Methicillin-Resistant Staphylococcus aureus Bacteremic Osteomyelitis.

There remains uncertainty about whether transitioning to oral antibiotic therapy is appropriate for the management of children with methicillin-resistant Staphylococcus aureus (MRSA) bacteremic osteomyelitis. We compared clinical outcomes for children with MRSA osteomyelitis with associated bacteremia who were transitioned to discharge oral antibiotic therapy to those discharged on outpatient parenteral antibiotic therapy (OPAT). We performed a retrospective, multicenter, cohort study of children ≤ 18 years hospitalized with MRSA bacteremic osteomyelitis across four children's hospitals from 2007 to 2018 discharged on oral antibiotic therapy versus OPAT. The primary outcome was treatment failure within 6 months of discharge, defined as any of the following: diagnosis of chronic osteomyelitis, conversion from oral to IV antibiotic route, an operative procedure after the index hospitalization (abscess drainage, bone biopsy, arthrocentesis, or pathologic fracture) and/or recrudescence of MRSA bacteremia. Outcomes were analyzed in an inverse propensity score weighted (IPW) cohort. A total of 106 cases of MRSA bacteremic osteomyelitis were included; 44 (42%) were discharged in the oral antibiotic therapy group and 62 (59%) patients were discharged in the OPAT group. In the IPW cohort, treatment failure within 6 months of discharge occurred in 3.4% of children in the discharge oral therapy group and 16.3% in the OPAT group (P = 0.03). The odds of 6-month composite treatment failure between discharge oral therapy and OPAT were 0.18 (95% CI 0.05-0.61). Discharge oral therapy was not associated with higher rates of treatment failure compared to OPAT for children with MRSA bacteremic osteomyelitis.

Preparing Early Interventionists/Early Childhood Special Educators with Knowledge and Practices to Collaborate with Families: A Mixed-Methods Systematic Review

Due to the important impact family-professional collaboration has on child outcomes for infants, toddlers, children, and students with disabilities, research in special education preservice personnel preparation has evaluated the impact of higher education programs and curricula geared towards improving preservice educators’ knowledge and practices regarding family-professional collaboration in inclusive settings. The resulting literature has provided the field with insights as to instructional strategies faculty have implemented to better prepare preservice special educators to collaborate with families. The purpose of this mixed-methods systematic review was to identify and synthesize the current state of knowledge behind these instructional strategies intended to increase preservice educators’ knowledge and practices to collaborate with families. A total of 15 peer-reviewed journal articles published between 1968-2024 were included in the study. Findings indicate that various instructional strategies and outcome measures were used to measure preservice educators' knowledge and practices. Implications for future research are described.

The Associations Between Parenting and Bullying Among Children and Adolescents: A Systematic Review and Meta-Analysis.

Parenting styles are closely related to bullying behavior in children and adolescents. However, differences in study design and inconsistent results create uncertainty regarding the relationship between parenting and bullying. This study aimed to evaluate the associations between four parenting styles and bullying perpetration/victimization through a meta-analysis, identifying sources of study heterogeneity by examining moderating effects. This meta-analysis included 107 studies with 624 effect sizes and 162203 participants (49.28% female, Mage = 13.51, SDage = 2.56). Results indicated that positive parenting was negatively correlated with bullying perpetration and victimization, while negative/harsh parenting and uninvolved parenting were positively correlated with bullying perpetration and victimization. A positive correlation was also found between psychologically controlling parenting and bullying victimization (not perpetration). Significant moderating variables included the identity of the caregiver, country of origin, ethnic group, reporter of parenting, reporter of bullying, and measure of bullying. Specifically, the mother's psychological control was more related to bullying perpetration and victimization than the father's. Compared to other countries and ethnic groups, the relationships between psychologically controlling parenting or negative/harsh parenting and bullying were more positive in studies of Chinese and Asians. The relationship between negative/harsh parenting and bullying demonstrated a greater effect size in self-reported measures of parenting and bullying. Finally, a stronger correlation was found between negative/harsh parenting and bullying victimization when using the Olweus Bully/Victim Questionnaire to measure bullying. The current study deepens the understanding of the relationship between different parenting styles and bullying, emphasizing that adopting appropriate parenting, particularly positive parenting behaviors, helps mitigate bullying issues and achieve positive developmental outcomes for children and adolescents.