We evaluated the PEDSnet clinical research network for study enrollment of juvenile spondyloarthritis, a rare rheumatic disease that includes enthesitis-related arthritis (ERA) and psoriatic arthritis (PsA). An electronic health record (EHR)-based typology was developed by an interdisciplinary team to query EHR data for a spectrum of pediatric rheumatic diseases (2009–2023) from 8 PEDSnet centers. The prevalence, characteristics and drug exposures for juvenile spondyloarthritis was explored to gauge feasibility of leveraging the network for study enrollment. Next, the typology was adapted to identify subjects for a clinical trial; the efficiency of EHR typology query was compared to standard screening efforts. Code sets for 35 pediatric rheumatology conditions were developed to identify potentially eligible subjects in the PEDSnet network. 2510 unique patients with juvenile spondyloarthritis across the PEDSnet health care systems over the years of study were identified. Median age at 1st rheumatology visit was 12.9 years, 50.4

Background Recurrence of focal segmental glomerulosclerosis (rFSGS) remains a major complication and a challenge to study treatment efficacy due to lack of granular data in a sufficient sample size. Aggregated data from electronic health records can provide such data. Methods We applied computational phenotypes to data from 11 large pediatric health systems in the USA, to identify treatments used and remission outcomes in children with rFSGS after renal transplantation. Additional data were collected by chart review. We performed both linear and non-linear multivariable Cox regression analyses with penalized splines to allow for time-varying predictors. Based on effect sizes from the hazard ratios, we then calculated a sample size needed for a future randomized clinical trial. Results Plasmapheresis was used in 101/107 (94%) patients, followed by anti-CD20 agents in 84 (78%), Low-Density-Lipoprotein (LDL)-apheresis in 22 (20%) and CTLA4Igs in 8 (7%). In linear multivariable models, complete remission was associated with more plasmapheresis sessions. In non-linear models, more doses or sessions of all the above treatments were associated with complete remission or any remission (partial or complete). Penalized spline curves for complete or any remission showed greatest yield within 5 doses of anti-CD20 agents but increasing yield with more doses/sessions of CTLA4Igs or LDL-apheresis. Based on observed hazard ratios, a prospective randomized trial of plasmapheresis vs LDL-apheresis would require 155 participants to have 80% power. Conclusions Increased doses/sessions or additional therapies for rFSGS associated with more favorable outcomes. Non-linear modelling identified when further increases did not improve outcomes.

OBJECTIVE:We discuss implications of potential ascertainment biases for studies examining diabetes risk following SARS-CoV-2 infection using electronic health records (EHRs). We quantitatively explore sensitivity of results to misclassification of COVID-19 status using data from the U.S.-based Diabetes in Children, Adolescents and Young Adults (DiCAYA) Network on children (≤17 years) and young adults (18-44 years). MATERIALS AND METHODS:In our retrospective case study from the DiCAYA Network, SARS-CoV-2 was identified using labs and diagnoses from June 1, 2020 to December 31, 2021. Patients were followed through December 31, 2022 for new diabetes diagnoses. Sites examined incident diabetes by COVID-19 status using Cox proportional hazards models. Results were pooled in meta-analyses. A bias analysis examined potential impact of COVID-19 misclassification scenarios on results, guided by hypotheses that sensitivity would be <50% and would be higher among those who developed diabetes. RESULTS:Prevalence of documented COVID-19 was low overall and variable across sites (children: 4.4%-7.7%, young adults: 6.2%-22.7%). Individuals with documented COVID-19 were at higher risk of incident diabetes compared to those with no documented infection, but results were heterogeneous across sites. Findings were highly sensitive to COVID-19 misclassification assumptions. Observed results could be biased away from the null under several differential misclassification scenarios. DISCUSSION:Although EHR-based documentation of COVID-19 was associated with incident diabetes, COVID-19 phenotypes likely had low sensitivity, with considerable variation across sites. Misclassification assumptions strongly impacted interpretation of results. CONCLUSION:Given the potential for low phenotype sensitivity and misclassification, caution is warranted when interpreting analyses of COVID-19 and incident diabetes using clinical or administrative databases.

Introduction and Objective: Childhood-onset diabetes is associated with costly care and reduced life expectancy. In US surveillance data, prevalence rose by ~50% from 2001 to 2017. EHRs may offer a scalable approach for timely surveillance. Our objective was to use EHR networks to estimate diabetes prevalence by type and demographic subgroup in US children in index years 2018 and 2022. Methods: We used data from 5 centers (Table 1) in the DiCAYA Network: 3 health system centers (HS) and 2 geographic-based centers (GBC) in two US states. Validated computable phenotypes identified children <18y with type 1 (T1D) or type 2 (T2D) diabetes in the index year or up to several preceding years. We used bias correction to adjust HS denominator estimates. We calculated a 3-year period prevalence for HS and a 1-year point prevalence for GBC. Results: In 2018, T1D prevalence was 3.8 per 1000 children <18y (95% CI: 3.7, 3.9) in the HS and 2.3 (2.2, 2.3) in the GBC. T2D prevalence was 1.5 (1.4, 1.5) in the HS and 0.4 (0.4, 0.4) in the GBC. Table 1 shows results for 2018 and 2022 by type and subgroup. T1D was most prevalent among non-Hispanic (NH) White and T2D among NH Black and Hispanic children. Prevalence increased with age. T2D was more prevalent in girls than in boys. Conclusion: In this large EHR-based study of children, diabetes prevalence findings by type and demographic subgroup were consistent with recent population-based surveillance. Disclosure L. Zhang: None. A.G. Hirsch: None. T. Crume: None. A.D. Liese: None. R. Anthopolos: None. H. Shao: None. Y. Guo: None. B.E. Dixon: None. D. Dabelea: None. S. Conderino: None. E.A. Mendonca: None. M. Mefford: Research Support; Current; Merck & Co., Inc. M. Maltenfort: None. C. Bailey: None. L. Knight: None. J. Divers: None. L. Thorpe: None. M. Rosenman: None. Funding CDC and NIH (NIDDK):U18DP006521; U18DP006512; U18DP006509; U18DP006500; U18DP006513; U18DP006506; U18DP006693; U18DP006694; U18DP006517; U18DP006518; and U18DP006633.

BACKGROUND:One hypothesis for the respiratory syncytial virus (RSV) surge in 2022 was suppression of immune responses following SARS-CoV-2 infection. Our objective was to compare the risk of subsequent RSV and other infections among children with and without SARS-CoV-2 infection. METHODS:We conducted a retrospective cohort study using electronic health record data from 27 US health systems analyzing children aged under 5 years with SARS-CoV-2 infection (test/coded) between March and July 2022. The comparison groups were children with (a) influenza infection and (b) respiratory tract infection with no evidence of SARS-CoV-2/influenza infection. The primary and secondary outcomes were RSV infection and respiratory or any infection in the subsequent 15 to 180 days, respectively. We applied inverse probability of treatment weighting and performed weighted logistic regression modeling. RESULTS:Our primary and secondary cohorts consisted of 18 767 and 114 414 children with SARS-CoV-2 infection, and 6697 and 30 424 with influenza infection, respectively, and 46 697 with another acute respiratory tract infection. The odds of subsequent RSV were lower in the SARS-CoV-2 group compared with the influenza group (adjusted odds ratio [aOR] 0.73, 95% CI 0.61-0.86) and compared with the group with any respiratory tract infection (aOR 0.78, 95% CI 0.7-0.87). The odds of a respiratory tract infection and any infection were lower in the SARS-CoV-2 group than the influenza group (aOR 0.62, 95% CI 0.59-0.64 and aOR 0.67, 95% CI 0.65-0.7, respectively). CONCLUSIONS:We did not find an increased risk of RSV or a respiratory or any type of infection within 6 months of SARS-CoV-2 infection, compared with influenza and other respiratory illnesses.

Childhood-onset systemic lupus erythematosus (SLE) poses unique challenges compared to adult-onset SLE, with higher rates of kidney involvement, tissue damage, and mortality. Despite this, data on the effectiveness of immunomodulatory therapies, particularly for lupus nephritis (LN), in pediatric populations are limited. We leveraged a U.S. national learning health system to describe induction treatment in children with LN. A previously validated LN case-finding algorithm was used to identify patients. Index date was the date of the first LN diagnosis code or the date of the first kidney biopsy, whichever came first. Induction medications included corticosteroids (IV and PO), cytotoxic agents (cyclophosphamide, IV), antimetabolites (mycophenolate mofetil, mycophenolic acid) and biologics (rituximab, belimumab). 575 children with LN were identified. Median age at entry was 15.1 years, 78.6

Real -world evidence synthesis through integration of data from distributed research networks has gained increasing attention in recent years. Due to privacy concerns and restrictions of sharing patient -level data, distributed algorithms that do not require sharing patient level information are in great need for facilitating multisite collaborations. On the other hand, data collected at multiple sites often come from diverse populations, and there exists a substantial amount of heterogeneity across sites in patient characteristics. Most of the existing distributed algorithms have ignored such betweensite heterogeneity. In this paper we aim to fill this methodological gap by proposing a general distributed algorithm. We develop our distributed algorithm based on a general semiparametric model, namely, the proportional likelihood ratio model (Biometrika 99 (2012) 211-222), which is a semiparametric extension of generalized linear model. We devise the proportional likelihood ratio model with site -specific baseline function, to account for between -site heterogeneity, and shared regression parameters to borrow information across sites. Under this flexible formulation, our distributed algorithm is designed to be privacy -preserving and communication -efficient (i.e., only one round of communication across sites is needed). We validate our method via simulation studies and demonstrate the utility of our method via a multisite study of pediatric avoidable hospitalization based on electronic health record data from a total of 354,672 patients across 26 different clinical sites within the Children's Hospital of Philadelphia health system.

Importance A first step toward understanding whether pediatric medical subspecialists are meeting the needs of the nation’s children is describing rates of use and trends over time. Objectives To quantify rates of outpatient pediatric medical subspecialty use. Design, Setting, and Participants This repeated cross-sectional study of annual subspecialist use examined 3 complementary data sources: electronic health records from PEDSnet (8 large academic medical centers [January 1, 2010, to December 31, 2021]); administrative data from the Healthcare Integrated Research Database (HIRD) (14 commercial health plans [January 1, 2011, to December 31, 2021]); and administrative data from the Transformed Medicaid Statistical Information System (T-MSIS) (44 state Medicaid programs [January 1, 2016, to December 31, 2019]). Annual denominators included 493 628 to 858 551 patients younger than 21 years with a general pediatric visit in PEDSnet; 5 million beneficiaries younger than 21 years enrolled for at least 6 months in HIRD; and 35 million Medicaid or Children’s Health Insurance Program beneficiaries younger than 19 years enrolled for any amount of time in T-MSIS. Exposure Calendar year and type of medical subspecialty. Main Outcomes and Measures Annual number of children with at least 1 completed visit to any pediatric medical subspecialist in an outpatient setting per population. Use rates excluded visits in emergency department or inpatient settings. Results Among the study population, the proportion of girls was 51.0% for PEDSnet, 51.1% for HIRD, and 49.3% for T-MSIS; the proportion of boys was 49.0% for PEDSnet, 48.9% for HIRD, and 50.7% for T-MSIS. The proportion of visits among children younger than 5 years was 37.4% for PEDSnet, 20.9% for HIRD, and 26.2% for T-MSIS; most patients were non-Hispanic Black (29.7% for PEDSnet and 26.1% for T-MSIS) or non-Hispanic White (44.9% for PEDSnet and 43.2% for T-MSIS). Annual rates for PEDSnet ranged from 18.0% to 21.3%, which were higher than rates for HIRD (range, 7.9%-10.4%) and T-MSIS (range, 7.6%-8.6%). Subspecialist use increased in the HIRD commercial health plans (annual relative increase of 2.4% [95% CI, 1.6%-3.1%]), but rates were essentially flat in the other data sources (PEDSnet, −0.2% [95% CI, −1.1% to 0.7%]; T-MSIS, −0.7% [95% CI, −6.5% to 5.5%]). The flat PEDSnet growth reflects a balance between annual use increases among those with commercial insurance (1.2% [95% CI, 0.3%-2.1%]) and decreases in use among those with Medicaid (−0.9% [95% CI, −1.6% to −0.2%]). Conclusions and Relevance The findings of this cross-sectional study suggest that among children, 8.6% of Medicaid beneficiaries, 10.4% of those with commercial insurance, and 21.3% of those whose primary care is received in academic health systems use pediatric medical subspecialty care each year. There was a small increase in rates of subspecialty use among children with commercial but not Medicaid insurance. These data may help launch innovations in the primary-specialty care interface.

Recurrence of focal segmental glomerulosclerosis (FSGS) or steroid-resistant nephrotic syndrome (SRNS) after kidney transplant leads to significant morbidity and potentially earlier allograft loss. To date however, reported rates, risk factors and treatment outcomes have varied widely. We applied computational phenotypes to a multicenter aggregation of electronic health records data from 7 large pediatric health systems in the USA, to identify recurrence rates, risk factors, and treatment outcomes. We refined the data collection by chart review. From > 7 million patients, we compared children with primary FSGS/SRNS who received a kidney transplant between 2009 and 2020 and who either developed recurrence (n = 67/165; 40.6

OBJECTIVES:To evaluate temporal trends and identify patient characteristics associated with otitis media (OM) surgery. METHODS:A retrospective cohort study performed using electronic health record data from seven large pediatric medical networks from January 1, 2009, to December 31, 2022. Children <6 months old cohort entrance time and OM history were included and followed longitudinally. RESULTS:The database included 1,448,390 children entering at age <6 months of which 5.3% underwent tympanostomy tube insertion (TTI). Inclusion criteria was met by 454,924 children. Age at first OM was 1.6 years (standard deviation [SD]: 1.1), with mean follow-up of 6.3 years (SD 3.7), and 249,818 (54.9%) were male. Among children with OM 64,950 (14.3%) underwent only TTI, and 13,188 (2.9%) had TTI with adenoidectomy (TTI-A). Over time, TTI only rates exhibited seasonal fluctuations with a drop in 2020, TTI-A rates were flat. The following patient characteristics greatly increased TTI: sensorineural hearing loss (adjusted hazard ratio, aHR 4.0, [95% confidence interval, CI] 3.9-4.1), chronic adenoiditis (aHR 3.4 [95% CI 3.0-3.5]), and cleft palate (aHR 1.9 [95% CI 1.8-2.0]). Children 4-8 years old (aHR >11.7 [95% CI 10.6-16.4]), history of chronic adenoiditis (aHR 6.4 [95% CI 5.4-7.7]), or sleep disorders (aHR 4.9 [95% CI 4.7-5.2]) greatly increased TTI-A odds. CONCLUSIONS:Overall TTI rate was 5.3%, which increased to approximately 20% in children with OM. Aside from the COVID-19 pandemic, surgical rates have been stable. Though multiple characteristics increase the risk of TTI, sensorineural hearing loss for TTI only, and older age in the TTI-A subset carried the highest risk. LEVEL OF EVIDENCE:3 Laryngoscope, 135:1821-1829, 2025.

Background:Outdoor aeroallergens, such as pollens and molds, are known triggers of asthma exacerbation; however, few studies have examined children's aeroallergen response based on sensitization. Objective:Our aim was to compare the relative impact of aeroallergen levels on asthma exacerbation between pediatric patients with asthma who tested positive or negative for sensitization to particular allergens. Methods:A case-crossover design study was conducted to examine associations between outdoor aeroallergen levels and asthma exacerbation events among children living in Philadelphia, Pennsylvania, who were treated within a large pediatric care network. Sensitization to common allergens was characterized in a subset of patients with asthma exacerbation who had undergone skin prick testing (5.5%). Odds ratios (ORs) and 95% CIs were estimated in all patients with asthma exacerbation and in those sensitized or not sensitized to aeroallergens. Results:Children who were sensitized to a particular allergen had higher odds of asthma exacerbation with exposure to the allergen (ie, early-season tree pollen, oak tree pollen, early-season weed pollen, and late-season molds) than did all patients with asthma or nonsensitized patients. For example, the association between early-season tree pollen and asthma exacerbation among sensitized children (>90th percentile vs ≤25th, OR = 2.28 [95% CI = 1.23-4.22]) was considerably stronger than that estimated among all patients (OR = 1.34 [95% CI = 1.19-1.50]), and it was also substantially different from the lack of association seen among nonsensitized children (OR = 0.89 [95% CI = 0.51-1.55] [P value for heterogeneity = .03]). Conclusion:More prevalent allergy testing may be useful for prevention of asthma exacerbation by informing interventions targeted to sensitized children and tailored for particular aeroallergens.

OBJECTIVES:To determine rates and risk factors of pediatric otitis media (OM) using real-world electronic health record (PEDSnet) data from January 2009 through May 2021.STUDY DESIGN:Retrospective cohort study.SETTING:Seven pediatric academic health systems that participate in PEDSnet.METHODS:Children <6 months-old at time of first outpatient, Emergency Department, or inpatient visit were included and followed longitudinally. A time-to-event analysis was performed using a Cox proportional hazards model to estimate hazard ratios for OM incidence based on sociodemographic factors and specific health conditions.RESULTS:The PEDSnet cohort included 910,265 children, 54.3% male, mean age (months) 1.3 [standard deviation (SD) 1.6] and mean follow up (years) 4.3 (SD 3.2). By age 3 years, 39.6% of children had evidence of one OM episode. OM rates decreased following pneumococcal-13 vaccination (PCV-13) and the COVID-19 pandemic. Along with young age, non-Hispanic Black/African American or Hispanic race/ethnicity, public insurance, higher family income, and male sex had higher incidence rates. Health conditions that increased OM risk included cleft palate [adjusted hazard ratio (aHR) 4.0 [95% confidence interval (CI) 3.9-4.2], primary ciliary dyskinesia [aHR 2.5 (95% CI 1.8-3.5)], trisomy 21 [aHR 2.0 (95% CI 1.9-2.1)], atopic dermatitis [aHR 1.4 (95% CI 1.4-1.4)], and gastroesophageal reflux [aHR1.5 (95% CI 1.5-1.5)].CONCLUSIONS:Approximately 20% of children by age 1 and 40% of children by age 3 years will have experienced an OM episode. OM rates decreased after PCV-13 and COVID-19. Children with abnormal ciliary function or craniofacial conditions, specifically cleft palate, carry the highest risk of OM.

Background:Multisystem inflammatory syndrome in children (MIS-C) is a severe post-acute sequela of SARS-CoV-2 infection. The highly diverse clinical features of MIS-C necessities characterizing its features by subphenotypes for improved recognition and treatment. However, jointly identifying subphenotypes in multi-site settings can be challenging. We propose a distributed multi-site latent class analysis (dMLCA) approach to jointly learn MIS-C subphenotypes using data across multiple institutions. Methods:We used data from the electronic health records (EHR) systems across nine U.S. children's hospitals. Among the 3,549,894 patients, we extracted 864 patients < 21 years of age who had received a diagnosis of MIS-C during an inpatient stay or up to one day before admission. Using MIS-C conditions, laboratory results, and procedure information as input features for the patients, we applied our dMLCA algorithm and identified three MIS-C subphenotypes. As validation, we characterized and compared more granular features across subphenotypes. To evaluate the specificity of the identified subphenotypes, we further compared them with the general subphenotypes identified in the COVID-19 infected patients. Findings:Subphenotype 1 (46.1%) represents patients with a mild manifestation of MIS-C not requiring intensive care, with minimal cardiac involvement. Subphenotype 2 (25.3%) is associated with a high risk of shock, cardiac and renal involvement, and an intermediate risk of respiratory symptoms. Subphenotype 3 (28.6%) represents patients requiring intensive care, with a high risk of shock and cardiac involvement, accompanied by a high risk of >4 organ system being impacted. Importantly, for hospital-specific clinical decision-making, our algorithm also revealed a substantial heterogeneity in relative proportions of these three subtypes across hospitals. Properly accounting for such heterogeneity can lead to accurate characterization of the subphenotypes at the patient-level. Interpretation:Our identified three MIS-C subphenotypes have profound implications for personalized treatment strategies, potentially influencing clinical outcomes. Further, the proposed algorithm facilitates federated subphenotyping while accounting for the heterogeneity across hospitals.

Background: There is growing evidence supporting the safety and effectiveness of lacosamide in older children. However, minimal data are available for neonates. We aimed to determine the incidence of adverse events associated with lacosamide use and explore the electroencephalographic seizure response to lacosamide in neonates. Methods: A retrospective cohort study was conducted using data from seven pediatric hospitals from January 2009 to February 2020. For safety outcomes, neonates were followed for <= 30 days from index date. Electroencephalographic response of lacosamide was evaluated based on electroencephalographic reports for <= 3 days. Results: Among 47 neonates, 98% received the first lacosamide dose in the intensive care units. During the median follow-up of 12 days, 19% of neonates died, and the crude incidence rate per 1000 patientdays (95% confidence interval) of the adverse events by diagnostic categories ranged from 2.8 (0.3, 10.2) for blood or lymphatic system disorders and nervous system disorders to 10.5 (4.2, 21.6) for cardiac disorders. Electroencephalographic seizures were observed in 31 of 34 patients with available electroencephalographic data on the index date. There was seizure improvement in 29% of neonates on day 1 and also in 29% of neonates on day 2. On day 3, there was no change in 50% of neonates and unknown change in 50% of neonates. Conclusions: The results are reassuring regarding the safety of lacosamide in neonates. Although some neonates had fewer seizures after lacosamide administration, the lack of a comparator arm and reliance on qualitative statements in electroencephalographic reports limit the preliminary efficacy results. (c) 2024 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Background Identification of abnormal blood pressure (BP) in children requires normative data. We sought to examine the feasibility of using "real-world" office BP data obtained from electronic health records (EHR) to generate age-, sex-and height-specific BP percentiles for children. Methods Using data collected 01/01/2009-8/31/2021 from eight large children's healthcare organisations in PEDSnet, we applied a mixed-effects polynomial regression model with random slopes to generate Z-scores and BP percentiles and compared them with currently used normative BP distributions published in the 2017 American Academy of Paediatrics (AAP) Clinical Practise Guidelines (CPG). Findings We identified a study sample of 292,412 children (1,085,083 BP measurements), ages 3-17 years (53% female), with no chronic medical conditions, who were not overweight/obese and who were primarily seen for general paediatric care in outpatient settings. Approximately 45,000-75,000 children contributed data to each age category. The PEDSnet systolic BP percentile values were 1-4 mmHg higher than AAP CPG BP values across age-sex-height groups, with larger differences observed in younger children. Diastolic BP values were also higher in younger children; starting with age 7 years, diastolic BP percentile values were 1-3 mmHg lower than AAP CPG values. Cohen's Kappa was 0.90 for systolic BP, 0.66 for diastolic BP, and 0.80 overall indicating excellent agreement between PEDSnet and 2017 AAP CPG data for systolic BP and substantial agreement for diastolic BP. Interpretation Our analysis indicates that real-word EHR data can be used to generate BP percentiles consistent with current clinical practise on BP management in children. 2023;98: Published November https://doi.org/10. 1016/j.ebiom.2023. 104885Copyright (c) 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Background The objectives of this study were to use electronic health record data from a US national multicenter pediatric network to identify a large cohort of children with CKD, evaluate CKD progression, and examine clinical risk factors for kidney function decline. Methods This retrospective cohort study identified children seen between January 1, 2009, to February 28, 2022. Data were from six pediatric health systems in PEDSnet. We identified children aged 18 months to 18 years who met criteria for CKD: two eGFR values <90 and ≥15 ml/min per 1.73 m 2 separated by ≥90 days without an intervening value ≥90. CKD progression was defined as a composite outcome: eGFR <15 ml/min per 1.73 m 2 , ≥50% eGFR decline, long-term dialysis, or kidney transplant. Subcohorts were defined based on CKD etiology: glomerular, nonglomerular, or malignancy. We assessed the association of hypertension (≥2 visits with hypertension diagnosis code) and proteinuria (≥1 urinalysis with ≥1+ protein) within 2 years of cohort entrance on the composite outcome. Results Among 7,148,875 children, we identified 11,240 (15.7 per 10,000) with CKD (median age 11 years, 50% female). The median follow-up was 5.1 (interquartile range 2.8–8.3) years, the median initial eGFR was 75.3 (interquartile range 61–83) ml/min per 1.73 m 2 , 37% had proteinuria, and 35% had hypertension. The following were associated with CKD progression: lower eGFR category (adjusted hazard ratio [aHR] 1.44 [95% confidence interval (95% CI), 1.23 to 1.69], aHR 2.38 [95% CI, 2.02 to 2.79], aHR 5.75 [95% CI, 5.05 to 6.55] for eGFR 45–59 ml/min per 1.73 m 2 , 30–44 ml/min per 1.73 m 2 , 15–29 ml/min per 1.73 m 2 at cohort entrance, respectively, when compared with eGFR 60–89 ml/min per 1.73 m 2 ), glomerular disease (aHR 2.01 [95% CI, 1.78 to 2.28]), malignancy (aHR 1.79 [95% CI, 1.52 to 2.11]), proteinuria (aHR 2.23 [95% CI, 1.89 to 2.62]), hypertension (aHR 1.49 [95% CI, 1.22 to 1.82]), proteinuria and hypertension together (aHR 3.98 [95% CI, 3.40 to 4.68]), count of complex chronic comorbidities (aHR 1.07 [95% CI, 1.05 to 1.10] per additional comorbid body system), male sex (aHR 1.16 [95% CI, 1.05 to 1.28]), and younger age at cohort entrance (aHR 0.95 [95% CI, 0.94 to 0.96] per year older). Conclusions In large-scale real-world data for children with CKD, disease etiology, albuminuria, hypertension, age, male sex, lower eGFR, and greater medical complexity at start of follow-up were associated with more rapid decline in kidney function.

Seizures are common in critically ill children and neonates, and these patients would benefit from intravenous (IV) antiseizure medications with few adverse effects. We aimed to assess the safety profile of IV lacosamide (LCM) among children and neonates.

PURPOSE:Little is known about the impact of ureteral stents on youth having stone surgery. We evaluated the association of ureteral stent placement before or concurrent with ureteroscopy and shock wave lithotripsy with emergency department visits and opioid prescriptions among pediatric patients.MATERIALS AND METHODS:We conducted a retrospective cohort study of individuals aged 0-24 years who underwent ureteroscopy or shock wave lithotripsy from 2009-2021 at 6 hospitals in PEDSnet, a research network that aggregates electronic health record data from children's health systems in the United States. The exposure, primary ureteral stent placement, was defined as a stent placed concurrent with or within 60 days before ureteroscopy or shock wave lithotripsy. Associations between primary stent placement and stone-related ED visits and opioid prescriptions within 120 days of the index procedure were evaluated with mixed-effects Poisson regression.RESULTS:Two-thousand ninety-three patients (60% female; median age 15 years, IQR 11-17) had 2,477 surgical episodes; 2,144 were ureteroscopy and 333 were shock wave lithotripsy. Primary stents were placed in 1,698 (79%) ureteroscopy episodes and 33 (10%) shock wave lithotripsy episodes. Ureteral stents were associated with a 33% higher rate of emergency department visits (IRR 1.33; 95% CI 1.02-1.73) and a 30% higher rate of opioid prescriptions (IRR 1.30; 95% CI 1.10-1.53). The magnitudes of both associations were greater for shock wave lithotripsy. Results were similar for age <18 and were lost when restricted to concurrent stent placement.CONCLUSIONS:Primary ureteral stent placement was associated with more frequent emergency department visits and opioid prescriptions, driven by pre-stenting. These results support elucidating situations where stents are not necessary for youth with nephrolithiasis.