Abstract:
Importance:Pneumonia is the leading infectious killer of children. Rigorous evidence supporting antibiotic treatment of children with nonsevere fast-breathing pneumonia in low-resource African settings is lacking. Objective:To assess whether treatment with placebo for nonsevere fast-breathing pneumonia is substantively less effective than 3 days of treatment with amoxicillin. Design, Setting, and Participants:This double-blind, 2-arm, randomized clinical noninferiority trial with follow-up of 14 days screened 1343 HIV-uninfected children aged 2 to 59 months with nonsevere fast-breathing pneumonia at outpatient departments of hospitals in Lilongwe, Malawi, Africa, between June 2016 and June 2017. Interventions:Placebo or amoxicillin dispersible tablets administered twice daily for 3 days. Main Outcomes and Measures:The primary end point was the proportion of children failing treatment by day 4 with a relative noninferiority margin of 1.5 times the failure rate in the amoxicillin group. Primary analyses were performed based on the intention-to-treat principle. Planned secondary analyses included treatment failure or relapse by day 14. Results:In total, 1126 children were randomized to 3 days of amoxicillin (n = 564) or placebo (n = 562) therapy. Baseline demographic and clinical characteristics were similar between the groups. For the entire study population, the mean (SD) age was 21.3 (15.1) months, and 601 (53.4%) were female. After an interim analysis, the data safety monitoring board stopped the study because children receiving amoxicillin had a 4.0% (22 of 552 with outcome data) treatment failure rate by day 4, whereas children receiving placebo had a 7.0% (38 of 543) treatment failure rate (adjusted relative risk, 1.78; 95% CI, 1.07%-2.97%; adjusted absolute difference, 3.0%; 95% CI, 0.4%-5.7%). Among children with known day 14 outcomes, 56 of 552 (10.1%) receiving amoxicillin and 64 of 543 (11.8%) receiving placebo had either treatment failure by day 4 or relapse by day 14 (relative risk, 1.16; 95% CI, 0.83%-1.63%; absolute difference, 1.6%; 95% CI, -2.1% to 5.4%). There were no deaths. Conclusions and Relevance:In HIV-uninfected children aged 2 to 59 months in a malaria-endemic region of Malawi, placebo treatment of nonsevere fast-breathing pneumonia was significantly inferior to treatment with amoxicillin. However, by day 4, approximately 93% of children receiving placebo were without treatment failure, and there was no significant difference between groups in treatment failure or relapse by day 14. The number of children with nonsevere fast-breathing pneumonia that needed amoxicillin treatment for 1 child to benefit was 33. Trial Registration:ClinicalTrials.gov Identifier: NCT02760420.
journal_name
JAMA Pediatrjournal_title
JAMA pediatricsauthors
Ginsburg AS,Mvalo T,Nkwopara E,McCollum ED,Ndamala CB,Schmicker R,Phiri A,Lufesi N,Izadnegahdar R,May Sdoi
10.1001/jamapediatrics.2018.3407subject
Has Abstractpub_date
2019-01-01 00:00:00pages
21-28issue
1eissn
2168-6203issn
2168-6211pii
2714280journal_volume
173pub_type
杂志文章,随机对照试验相关文献
JAMA Pediatrics文献大全abstract:Importance:The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) uses the Sequential Organ Failure Assessment (SOFA) score to grade organ dysfunction in adult patients with suspected infection. However, the SOFA score is not adjusted for age and therefore not suitable for children. Objec...
journal_title:JAMA pediatrics
pub_type: 杂志文章
doi:10.1001/jamapediatrics.2017.2352
更新日期:2017-10-02 00:00:00
abstract:IMPORTANCE:Late-term gestation (defined as the 41st week of pregnancy) is associated with increased risk of perinatal health complications. It is not known to what extent late-term gestation is associated with long-term cognitive and physical outcomes. Information about long-term outcomes may influence physician and pa...
journal_title:JAMA pediatrics
pub_type: 杂志文章
doi:10.1001/jamapediatrics.2016.0238
更新日期:2016-08-01 00:00:00
abstract:Importance:Posthospitalization follow-up visits are prescribed frequently for children with bronchiolitis. The rationale for this practice is unclear, but prior work has indicated that families value these visits for the reassurance provided. The overall risks and benefits of scheduled visits have not been evaluated. ...
journal_title:JAMA pediatrics
pub_type: 杂志文章
doi:10.1001/jamapediatrics.2020.1937
更新日期:2020-09-01 00:00:00
abstract:IMPORTANCE:Chronic fatigue syndrome (CFS) is a disabling condition with unknown disease mechanisms and few treatment options. OBJECTIVE:To explore the pathophysiology of CFS and assess clonidine hydrochloride pharmacotherapy in adolescents with CFS by using a hypothesis that patients with CFS have enhanced sympathetic...
journal_title:JAMA pediatrics
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamapediatrics.2013.4647
更新日期:2014-04-01 00:00:00
abstract:Importance:Acute kidney injury (AKI) occurs commonly in preterm neonates and is associated with increased morbidity and mortality. Objectives:To examine the association between caffeine citrate administration and AKI in preterm neonates in the first 7 days after birth and to test the hypothesis that caffeine administr...
journal_title:JAMA pediatrics
pub_type: 杂志文章,多中心研究
doi:10.1001/jamapediatrics.2018.0322
更新日期:2018-06-04 00:00:00
abstract:IMPORTANCE:Policy makers and practitioners need rigorous evaluations of state-based Medicaid enhanced prenatal care programs that provide home visiting to guide improvements and inform future investments. Effects on adverse birth outcomes are of particular interest. OBJECTIVE:To test if participation in the Michigan s...
journal_title:JAMA pediatrics
pub_type: 杂志文章
doi:10.1001/jamapediatrics.2013.4347
更新日期:2014-03-01 00:00:00
abstract:Clinical Question:Do dietary interventions, such as probiotics, improve pain in children with recurrent abdominal pain? Clinical Application:Compared with placebo, children who were treated with probiotic preparations were more likely to experience improvement in pain in the short term (odds ratio, 1.63; 95% CI, 1.07-...
journal_title:JAMA pediatrics
pub_type: 杂志文章
doi:10.1001/jamapediatrics.2018.4575
更新日期:2019-02-01 00:00:00
abstract:Importance:After initial resuscitation, critically ill children may accumulate fluid and develop fluid overload. Accruing evidence suggests that fluid overload contributes to greater complexity of care and worse outcomes. Objective:To describe the methods to measure fluid balance, define fluid overload, and evaluate t...
journal_title:JAMA pediatrics
pub_type: 杂志文章,meta分析
doi:10.1001/jamapediatrics.2017.4540
更新日期:2018-03-01 00:00:00
abstract:Importance:Pediatric chronic conditions have become a major public health challenge, and behavioral change plays an important role in overcoming this problem. Many health behavior interventions are described as theory-based, but evidence that such programs properly use theoretical constructs is scant. Objective:To ide...
journal_title:JAMA pediatrics
pub_type: 杂志文章
doi:10.1001/jamapediatrics.2018.3039
更新日期:2018-12-01 00:00:00
abstract:Importance:In 2005, the US Advisory Committee on Immunization Practices recommended routine quadrivalent meningococcal conjugate (MenACWY) vaccine for all adolescents aged 11 to 12 years, and in 2010, a booster dose for adolescents aged 16 years. Measuring the association between MenACWY vaccination and the incidence o...
journal_title:JAMA pediatrics
pub_type: 杂志文章
doi:10.1001/jamapediatrics.2020.1990
更新日期:2020-09-01 00:00:00
abstract:IMPORTANCE:Short-term impacts of breakfast consumption on diet quality and cognitive functioning have been reported, but more evidence is needed to draw causal inferences about long-term impacts of school breakfast on indicators of school engagement and academic achievement. OBJECTIVE:To estimate the impact of a Break...
journal_title:JAMA pediatrics
pub_type: 杂志文章,多中心研究
doi:10.1001/jamapediatrics.2014.2042
更新日期:2015-01-01 00:00:00
abstract::OBJECTIVES To determine the effect of modifiable dietary intake variables (current vitamin D supplementation and daily cow's milk intake) on 25-hydroxyvitamin D level in early childhood and to evaluate the relationship between these modifiable dietary factors and other largely nonmodifiable determinants of vitamin D s...
journal_title:JAMA pediatrics
pub_type: 杂志文章
doi:10.1001/2013.jamapediatrics.226
更新日期:2013-03-01 00:00:00
abstract:Importance:Sudden infant death syndrome remains the leading cause of death in infants aged 1 month to 1 year in the United States. Observations:While its exact cause is unknown, sudden infant death syndrome is believed to be multifactorial, ie, occurs in infants with underlying biological vulnerability who experience ...
journal_title:JAMA pediatrics
pub_type: 杂志文章,评审
doi:10.1001/jamapediatrics.2016.3345
更新日期:2017-02-01 00:00:00
abstract:Importance:Prenatal and neonatal cystic kidney diseases are a group of rare disorders manifesting as single, multiple unilateral, or bilateral cysts or with increased echogenicity of the renal cortex without macroscopic cysts. They may be accompanied by grossly enlarged kidneys, renal oligohydramnios, pulmonary hypopla...
journal_title:JAMA pediatrics
pub_type: 共识发展会议,杂志文章
doi:10.1001/jamapediatrics.2017.3938
更新日期:2018-01-01 00:00:00
abstract:IMPORTANCE:The quadrivalent human papillomavirus (HPV) vaccine was licensed for use in 9- through 26-year-old females in 2006. Postlicensure studies in Australia, Denmark, and Canada have demonstrated vaccine effectiveness against abnormal cervical cytology results. However, there are limited data describing postlicens...
journal_title:JAMA pediatrics
pub_type: 杂志文章,多中心研究
doi:10.1001/jamapediatrics.2015.3926
更新日期:2016-05-01 00:00:00
abstract:IMPORTANCE:Most patients with asthma take fewer than half of prescribed doses of controller medication. Interventions to improve adherence have typically been costly, impractical, and at best only minimally successful. OBJECTIVE:To test a speech recognition (SR) intervention to improve adherence to pediatric asthma co...
journal_title:JAMA pediatrics
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamapediatrics.2014.3280
更新日期:2015-04-01 00:00:00
abstract:Importance:Studies of cranial ultrasonography and early childhood outcomes among cohorts of extremely preterm neonates have linked periventricular-intraventricular hemorrhage and cystic periventricular leukomalacia with adverse neurodevelopmental outcomes. However, the association between nonhemorrhagic ventriculomegal...
journal_title:JAMA pediatrics
pub_type: 杂志文章,多中心研究
doi:10.1001/jamapediatrics.2017.3545
更新日期:2018-01-01 00:00:00
abstract:Importance:Home aeroallergen exposure is associated with increased asthma morbidity in children, yet little is known about the contribution of school aeroallergen exposures to such morbidity. Objective:To evaluate the effect of school-specific aeroallergen exposures on asthma morbidity among students, adjusting for ho...
journal_title:JAMA pediatrics
pub_type: 杂志文章,多中心研究
doi:10.1001/jamapediatrics.2016.2543
更新日期:2017-01-01 00:00:00
abstract:IMPORTANCE:Smaller cerebral volumes at hospital discharge in very preterm (VPT) infants are associated with poor neurobehavioral outcomes. Brain growth from the newborn period to middle childhood has not been explored because longitudinal data have been lacking. OBJECTIVES:To examine the pattern of growth of cerebral ...
journal_title:JAMA pediatrics
pub_type: 杂志文章
doi:10.1001/jamapediatrics.2016.0781
更新日期:2016-08-01 00:00:00
abstract:IMPORTANCE:Efforts to transform primary care through the medical home model may have limited effectiveness if they do not incorporate families' preferences for different primary care services. OBJECTIVE:To assess parents' relative preferences for different categories of enhanced access services in primary care. DESIG...
journal_title:JAMA pediatrics
pub_type: 杂志文章
doi:10.1001/jamapediatrics.2014.3534
更新日期:2015-04-01 00:00:00
abstract:IMPORTANCE:There has been a significant expansion in the number of low-level and midlevel neonatal intensive care units (NICUs) in recent decades. Infants with necrotizing enterocolitis represent a high-risk subgroup of the very low-birth-weight (VLBW) (<1500 g) population that would benefit from focused regionalizatio...
journal_title:JAMA pediatrics
pub_type: 杂志文章
doi:10.1001/jamapediatrics.2014.2085
更新日期:2015-01-01 00:00:00
abstract:Importance:This study was designed to determine whether a preventive intervention focused on enhancing supportive parenting could ameliorate the association between exposure to poverty and brain development in low socioeconomic status African American individuals from the rural South. Objective:To determine whether pa...
journal_title:JAMA pediatrics
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamapediatrics.2016.2988
更新日期:2017-01-01 00:00:00
abstract:Importance:Inflammatory bowel diseases (IBD), such as Crohn disease and ulcerative colitis, are chronic relapsing conditions that affect a growing number of children worldwide. The pathogenesis of these disorders is complex and thought to be mediated by the interplay between genetic susceptibility, microbial dysbiosis,...
journal_title:JAMA pediatrics
pub_type: 杂志文章,评审
doi:10.1001/jamapediatrics.2017.2571
更新日期:2017-10-01 00:00:00
abstract:Importance:Firearm injuries are the second leading cause of death among US children and adolescents. Because of the lack of resources allocated to firearm injury prevention during the past 25 years, research has lagged behind other areas of injury prevention. Identifying timely and important research questions regardin...
journal_title:JAMA pediatrics
pub_type: 杂志文章
doi:10.1001/jamapediatrics.2019.1494
更新日期:2019-06-10 00:00:00
abstract:Importance:Approximately 90% of adult smokers first tried a cigarette by 18 years of age, and even infrequent smoking in adolescence is associated with established adult smoking. Noncigarette tobacco use is increasing and could stimulate subsequent conventional cigarette smoking in youths. Objective:To estimate the lo...
journal_title:JAMA pediatrics
pub_type: 杂志文章
doi:10.1001/jamapediatrics.2017.4173
更新日期:2018-02-01 00:00:00
abstract:Importance:Maternally derived antibodies are a key element of neonatal immunity. Understanding the dynamics of maternal antibody responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy and subsequent transplacental antibody transfer can inform neonatal management as well as ...
journal_title:JAMA pediatrics
pub_type: 杂志文章
doi:10.1001/jamapediatrics.2021.0038
更新日期:2021-01-29 00:00:00
abstract:IMPORTANCE:Rape on college campuses has been addressed recently by a presidential proclamation, federal legislation, advocacy groups, and popular media. Many initiatives assume that most college men who perpetrate rape are serial rapists. The scientific foundation for this perspective is surprisingly limited. OBJECTIV...
journal_title:JAMA pediatrics
pub_type: 杂志文章
doi:10.1001/jamapediatrics.2015.0707
更新日期:2015-12-01 00:00:00
abstract:IMPORTANCE:Reminder/recall notifications used by primary care practices increase the rates of childhood immunizations, but fewer than 20% of primary care practitioners nationally deliver such reminders. A reminder/recall notification conducted centrally by health departments in collaboration with primary care practices...
journal_title:JAMA pediatrics
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamapediatrics.2014.3670
更新日期:2015-04-01 00:00:00
abstract:Importance:Breast milk substitutes (BMS) are important nutritional products evaluated in clinical trials. Concerns have been raised about the risk of bias in BMS trials, the reliability of claims that arise from such trials, and the potential for BMS trials to undermine breastfeeding in trial participants. Existing cli...
journal_title:JAMA pediatrics
pub_type: 杂志文章
doi:10.1001/jamapediatrics.2020.0578
更新日期:2020-09-01 00:00:00
abstract:IMPORTANCE:Obesity is associated with chronic musculoskeletal pain and is a risk factor for disability and osteoarthritis. OBJECTIVES:To describe the prevalence, sites, and intensity of musculoskeletal pain in adolescents with severe obesity; to evaluate associations between musculoskeletal pain and self-reported phys...
journal_title:JAMA pediatrics
pub_type: 杂志文章
doi:10.1001/jamapediatrics.2015.0378
更新日期:2015-06-01 00:00:00