{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T21:57:33Z","timestamp":1792015053932,"version":"4.4.0"},"reference-count":44,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,1]]},"abstract":"<jats:sec>\n                  <jats:title\/>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>We sought to improve utilization of a sepsis care bundle and decrease 3- and 30- day sepsis-attributable mortality, as well as determine which care elements of a sepsis bundle are associated with improved outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Children\u2019s Hospital Association formed a QI collaborative to Improve Pediatric Sepsis Outcomes (IPSO) (January 2017\u2013March 2020 analyzed here). IPSO Suspected Sepsis (ISS) patients were those without organ dysfunction where the provider \u201cintended to treat\u201d sepsis. IPSO Critical Sepsis (ICS) patients approximated those with septic shock. Process (bundle adherence), outcome (mortality), and balancing measures were quantified over time using statistical process control. An original bundle (recognition method, fluid bolus &amp;lt; 20 min, antibiotics &amp;lt; 60 min) was retrospectively compared with varying bundle time-points, including a modified evidence-based care bundle, (recognition method, fluid bolus &amp;lt; 60 min, antibiotics &amp;lt; 180 min). We compared outcomes using Pearson \u03c7-square and Kruskal Wallis tests and adjusted analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Reported are 24\u2009518 ISS and 12\u2009821 ICS cases from 40 children\u2019s hospitals (January 2017\u2013March 2020). Modified bundle compliance demonstrated special cause variation (40.1% to 45.8% in ISS; 52.3% to 57.4% in ICS). The ISS cohort\u2019s 30-day, sepsis-attributable mortality dropped from 1.4% to 0.9%, a 35.7% relative reduction over time (P &amp;lt; .001). In the ICS cohort, compliance with the original bundle was not associated with a decrease in 30-day sepsis-attributable mortality, whereas compliance with the modified bundle decreased mortality from 4.75% to 2.4% (P &amp;lt; .01).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Timely treatment of pediatric sepsis is associated with reduced mortality. A time-liberalized care bundle was associated with greater mortality reductions.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2022-059938","type":"journal-article","created":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T08:08:51Z","timestamp":1689149331000},"source":"Crossref","is-referenced-by-count":34,"title":["Bundled Care to Reduce Sepsis Mortality: The Improving Pediatric Sepsis Outcomes (IPSO) Collaborative"],"prefix":"10.1542","volume":"152","author":[{"given":"Raina","family":"Paul","sequence":"first","affiliation":[{"name":"aDivision of Emergency Medicine, Children\u2019s Hospital of Orange County, University of California Irvine, Orange California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Niedner","sequence":"additional","affiliation":[{"name":"bUnaffiliated"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Riggs","sequence":"additional","affiliation":[{"name":"cChildren\u2019s Hospital Association, Lenexa, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troy","family":"Richardson","sequence":"additional","affiliation":[{"name":"cChildren\u2019s Hospital Association, Lenexa, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi Gruhler","family":"DeSouza","sequence":"additional","affiliation":[{"name":"cChildren\u2019s Hospital Association, Lenexa, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffery J.","family":"Auletta","sequence":"additional","affiliation":[{"name":"dNationwide Children\u2019s Hospital, The Ohio State University College of Medicine, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frances","family":"Balamuth","sequence":"additional","affiliation":[{"name":"eDepartment of Pediatrics, University of Pennsylvania, The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Campbell","sequence":"additional","affiliation":[{"name":"fKentucky Hospital Association, Louisville, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly","family":"Depinet","sequence":"additional","affiliation":[{"name":"gDepartments of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leslie","family":"Hueschen","sequence":"additional","affiliation":[{"name":"hUniversity of Missouri-Kansas City, Children\u2019s Mercy Hospital, Kansas City, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Charles","family":"Huskins","sequence":"additional","affiliation":[{"name":"iMayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah B.","family":"Kandil","sequence":"additional","affiliation":[{"name":"jDepartment of Pediatrics, Yale University School of Medicine, Yale New Haven Children\u2019s Hospital, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gitte","family":"Larsen","sequence":"additional","affiliation":[{"name":"kPrimary Children\u2019s Hospital, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth H.","family":"Mack","sequence":"additional","affiliation":[{"name":"lMedical University of South Carolina Children\u2019s Health, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory P.","family":"Priebe","sequence":"additional","affiliation":[{"name":"mDepartment of Anesthesiology, Critical Care and Pain Medicine, Boston Children\u2019s Hospital, Department of Anesthesia, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lori E.","family":"Rutman","sequence":"additional","affiliation":[{"name":"nUniversity of Washington, Seattle Children\u2019s Hospital, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Schafer","sequence":"additional","affiliation":[{"name":"oState University of New York Upstate Medical Center, Syracuse, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Halden","family":"Scott","sequence":"additional","affiliation":[{"name":"pDepartment of Pediatrics, University of Colorado School of Medicine, Children\u2019s Hospital Colorado, Denver, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pete","family":"Silver","sequence":"additional","affiliation":[{"name":"qCohen Children\u2019s Medical Center of New York, Queens, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika L.","family":"Stalets","sequence":"additional","affiliation":[{"name":"gDepartments of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth A.","family":"Wathen","sequence":"additional","affiliation":[{"name":"rChildren\u2019s Hospital Colorado, Denver, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles G.","family":"Macias","sequence":"additional","affiliation":[{"name":"sDivision of Pediatric Emergency Medicine, Rainbow Babies and Children\u2019s Hospital, Case Western Reserve University, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Brilli","sequence":"additional","affiliation":[{"name":"tNationwide Children\u2019s Hospital, Division of Pediatric Critical Care Medicine, Department of Pediatrics, Columbus, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the IPSO COLLABORATIVE INVESTIGATORS","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2023,7,12]]},"reference":[{"issue":"9730","key":"2023111414345801100_B1","doi-asserted-by":"crossref","first-page":"1969","DOI":"10.1016\/S0140-6736(10)60549-1","article-title":"Global, regional, and national causes of child mortality in 2008: a systematic analysis","volume":"375","author":"Black","year":"2010","journal-title":"Lancet"},{"issue":"7","key":"2023111414345801100_B2","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1097\/PCC.0b013e3182917fad","article-title":"Trends in the epidemiology of pediatric severe sepsis","volume":"14","author":"Hartman","year":"2013","journal-title":"Pediatr Crit Care Med"},{"issue":"9","key":"2023111414345801100_B3","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1097\/PCC.0000000000000225","article-title":"Pediatric severe sepsis in U.S. children\u2019s hospitals","volume":"15","author":"Balamuth","year":"2014","journal-title":"Pediatr Crit Care Med"},{"issue":"5","key":"2023111414345801100_B4","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1097\/CCM.0b013e31827c09f8","article-title":"Benchmarking the incidence and mortality of severe sepsis in the United States","volume":"41","author":"Gaieski","year":"2013","journal-title":"Crit Care Med"},{"issue":"5","key":"2023111414345801100_B5","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1097\/PCC.0000000000001502","article-title":"Hospital variation in risk-adjusted pediatric sepsis mortality","volume":"19","author":"Ames","year":"2018","journal-title":"Pediatr Crit Care Med"},{"key":"2023111414345801100_B6","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.jpeds.2018.03.056","article-title":"Children with chronic disease bear the highest burden of pediatric sepsis","volume":"199","author":"Prout","year":"2018","journal-title":"J Pediatr"},{"key":"2023111414345801100_B7","volume-title":"Sepsis: Recognition, Diagnosis and Early Management","author":"National Institute for Health and Care Excellence (NICE)","year":"2016"},{"issue":"6","key":"2023111414345801100_B8","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1097\/CCM.0000000000002425","article-title":"American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock","volume":"45","author":"Davis","year":"2017","journal-title":"Crit Care Med"},{"issue":"2","key":"2023111414345801100_B9","doi-asserted-by":"crossref","first-page":"e52","DOI":"10.1097\/PCC.0000000000002198","article-title":"Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children","volume":"21","author":"Weiss","year":"2020","journal-title":"Pediatr Crit Care Med"},{"issue":"1","key":"2023111414345801100_B10","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1097\/01.CCM.0000298158.12101.41","article-title":"Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008","volume":"36","author":"Dellinger","year":"2008","journal-title":"Crit Care Med"},{"key":"2023111414345801100_B11","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.resuscitation.2021.02.015","article-title":"European Resuscitation Council Guidelines 2021: paediatric life support","volume":"161","author":"Van de Voorde","year":"2021","journal-title":"Resuscitation"},{"key":"2023111414345801100_B12","doi-asserted-by":"crossref","first-page":"S591","DOI":"10.1097\/01.CCM.0000145904.97821.0D","article-title":"Pediatric considerations","volume":"32","author":"Parker","year":"2004","journal-title":"Crit Care Med"},{"issue":"12","key":"2023111414345801100_B13","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1097\/PEC.0b013e31818e9f3a","article-title":"Time- and fluid-sensitive resuscitation for hemodynamic support of children in septic shock: barriers to the implementation of the American College of Critical Care Medicine\/pediatric advanced life support guidelines in a pediatric intensive care unit in a developing world","volume":"24","author":"Oliveira","year":"2008","journal-title":"Pediatr Emerg Care"},{"issue":"4","key":"2023111414345801100_B14","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1542\/peds.112.4.793","article-title":"Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome","volume":"112","author":"Han","year":"2003","journal-title":"Pediatrics"},{"issue":"5","key":"2023111414345801100_B15","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.annemergmed.2007.06.482","article-title":"Rapid fluid resuscitation in pediatrics: testing the American College of Critical Care Medicine guideline","volume":"50","author":"Stoner","year":"2007","journal-title":"Ann Emerg Med"},{"issue":"5","key":"2023111414345801100_B16","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1136\/adc.2008.153064","article-title":"Emergency management of children with severe sepsis in the United Kingdom: the results of the Paediatric Intensive Care Society sepsis audit","volume":"94","author":"Inwald","year":"2009","journal-title":"Arch Dis Child"},{"issue":"2","key":"2023111414345801100_B17","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1542\/peds.2008-1967","article-title":"Mortality and functional morbidity after use of PALS\/APLS by community physicians","volume":"124","author":"Carcillo","year":"2009","journal-title":"Pediatrics"},{"issue":"3","key":"2023111414345801100_B18","doi-asserted-by":"crossref","first-page":"e758","DOI":"10.1542\/peds.2010-2895","article-title":"Implementation of goal-directed therapy for children with suspected sepsis in the emergency department","volume":"127","author":"Cruz","year":"2011","journal-title":"Pediatrics"},{"issue":"4","key":"2023111414345801100_B19","doi-asserted-by":"crossref","first-page":"e20154153","DOI":"10.1542\/peds.2015-4153","article-title":"High reliability pediatric septic shock quality improvement initiative and decreasing mortality","volume":"138","author":"Lane","year":"2016","journal-title":"Pediatrics"},{"issue":"2","key":"2023111414345801100_B20","doi-asserted-by":"crossref","first-page":"e273","DOI":"10.1542\/peds.2012-0094","article-title":"Adherence to PALS sepsis guidelines and hospital length of stay","volume":"130","author":"Paul","year":"2012","journal-title":"Pediatrics"},{"issue":"5","key":"2023111414345801100_B21","doi-asserted-by":"crossref","first-page":"e1358","DOI":"10.1542\/peds.2013-3871","article-title":"Improving adherence to PALS septic shock guidelines","volume":"133","author":"Paul","year":"2014","journal-title":"Pediatrics"},{"issue":"4","key":"2023111414345801100_B22","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1001\/jama.2018.9071","article-title":"Association between the New York sepsis care mandate and in-hospital mortality for pediatric sepsis","volume":"320","author":"Evans","year":"2018","journal-title":"JAMA"},{"issue":"9","key":"2023111414345801100_B23","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1097\/PCC.0000000000000858","article-title":"Protocolized treatment is associated with decreased organ dysfunction in pediatric severe sepsis","volume":"17","author":"Balamuth","year":"2016","journal-title":"Pediatr Crit Care Med"},{"issue":"7","key":"2023111414345801100_B24","doi-asserted-by":"crossref","first-page":"e0181160","DOI":"10.1371\/journal.pone.0181160","article-title":"Clinical outcomes and mortality before and after implementation of a pediatric sepsis protocol in a limited resource setting: a retrospective cohort study in Bangladesh","volume":"12","author":"Kortz","year":"2017","journal-title":"PLoS One"},{"issue":"10","key":"2023111414345801100_B25","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1136\/archdischild-2015-310234","article-title":"A prospective quality improvement study in the emergency department targeting paediatric sepsis","volume":"101","author":"Long","year":"2016","journal-title":"Arch Dis Child"},{"issue":"10","key":"2023111414345801100_B26","doi-asserted-by":"crossref","first-page":"e451","DOI":"10.1097\/PCC.0000000000000906","article-title":"Treatment of pediatric septic shock with the surviving sepsis campaign guidelines and PICU patient outcomes","volume":"17","author":"Workman","year":"2016","journal-title":"Pediatr Crit Care Med"},{"issue":"6","key":"2023111414345801100_B27","doi-asserted-by":"crossref","first-page":"e1585","DOI":"10.1542\/peds.2010-3513","article-title":"An emergency department septic shock protocol and care guideline for children initiated at triage","volume":"127","author":"Larsen","year":"2011","journal-title":"Pediatrics"},{"issue":"7","key":"2023111414345801100_B28","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1177\/0009922815601984","article-title":"\u201cBeat the shock clock\u201d: an interprofessional team improves pediatric septic shock care","volume":"55","author":"Tuuri","year":"2016","journal-title":"Clin Pediatr (Phila)"},{"issue":"1","key":"2023111414345801100_B29","doi-asserted-by":"crossref","first-page":"e051","DOI":"10.1097\/pq9.0000000000000051","article-title":"A quality improvement collaborative for pediatric sepsis: lessons learned","volume":"3","author":"Paul","year":"2017","journal-title":"Pediatr Qual Saf"},{"issue":"3","key":"2023111414345801100_B30","doi-asserted-by":"crossref","first-page":"e2020007369","DOI":"10.1542\/peds.2020-007369","article-title":"Pediatric Septic Shock Collaborative improves emergency department sepsis care in children","volume":"149","author":"Depinet","year":"2021","journal-title":"Pediatrics"},{"issue":"1","key":"2023111414345801100_B31","doi-asserted-by":"crossref","first-page":"e20201434","DOI":"10.1542\/peds.2020-1434","article-title":"Development of a quality improvement learning collaborative to improve pediatric sepsis outcomes","volume":"147","author":"Larsen","year":"2021","journal-title":"Pediatrics"},{"issue":"10","key":"2023111414345801100_B32","doi-asserted-by":"crossref","first-page":"e916","DOI":"10.1097\/CCM.0000000000004505","article-title":"Evaluating pediatric sepsis definitions designed for electronic health record extraction and multicenter quality improvement","volume":"48","author":"Scott","year":"2020","journal-title":"Crit Care Med"},{"issue":"5","key":"2023111414345801100_B33","doi-asserted-by":"crossref","first-page":"e2020017889","DOI":"10.1542\/peds.2020-017889","article-title":"Metric development for the multicenter improving pediatric sepsis outcomes (IPSO) collaborative","volume":"147","author":"Paul","year":"2021","journal-title":"Pediatrics"},{"issue":"6","key":"2023111414345801100_B34","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1097\/SLA.0000000000003592","article-title":"National Quality Forum guidelines for evaluating the scientific acceptability of risk-adjusted clinical outcome measures: a report from the National Quality Forum scientific methods panel","volume":"271","author":"Glance","year":"2020","journal-title":"Ann Surg"},{"issue":"11","key":"2023111414345801100_B35","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1136\/bmjqs-2017-007219","article-title":"Using a network organisational architecture to support the development of Learning Healthcare Systems","volume":"27","author":"Britto","year":"2018","journal-title":"BMJ Qual Saf"},{"key":"2023111414345801100_B36","volume-title":"The Improvement Guide: A Practical Approach to Enhancing Organizational Performance","author":"Langley","year":"2009","edition":"2nd ed."},{"issue":"1","key":"2023111414345801100_B37","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1097\/01.PCC.0000149131.72248.E6","article-title":"International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics","volume":"6","author":"Goldstein","year":"2005","journal-title":"Pediatr Crit Care Med"},{"issue":"3","key":"2023111414345801100_B38","doi-asserted-by":"crossref","first-page":"e113","DOI":"10.1097\/CCM.0000000000001730","article-title":"A framework for the development and interpretation of different sepsis definitions and clinical criteria","volume":"44","author":"Angus","year":"2016","journal-title":"Crit Care Med"},{"key":"2023111414345801100_B39","volume-title":"The Health Care Data Guide","author":"Provost","year":"2011"},{"issue":"26","key":"2023111414345801100_B40","doi-asserted-by":"crossref","first-page":"2483","DOI":"10.1056\/NEJMoa1101549","article-title":"Mortality after fluid bolus in African children with severe infection","volume":"364","author":"Maitland","year":"2011","journal-title":"N Engl J Med"},{"key":"2023111414345801100_B41","doi-asserted-by":"crossref","first-page":"375","DOI":"10.2147\/OAEM.S368442","article-title":"Intravenous fluid bolus rates associated with outcomes in pediatric sepsis: a multi-center analysis","volume":"14","author":"Mullan","year":"2022","journal-title":"Open Access Emerg Med"},{"issue":"1","key":"2023111414345801100_B42","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s12967-022-03228-7","article-title":"Ground truth labels challenge the validity of sepsis consensus definitions in critical illness","volume":"20","author":"Lindner","year":"2022","journal-title":"J Transl Med"},{"issue":"6","key":"2023111414345801100_B43","doi-asserted-by":"crossref","first-page":"R409","DOI":"10.1186\/cc2959","article-title":"An international sepsis survey: a study of doctors\u2019 knowledge and perception about sepsis","volume":"8","author":"Poeze","year":"2004","journal-title":"Crit Care"},{"issue":"1","key":"2023111414345801100_B44","first-page":"2","article-title":"Definitions for sepsis and organ dysfunction in pediatrics","volume":"6","author":"Goldstein","year":"2005","journal-title":"PCCM"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2022-059938\/1566895\/peds_2022059938.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2022-059938\/1566895\/peds_2022059938.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T14:35:33Z","timestamp":1699972533000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/152\/2\/e2022059938\/192529\/Bundled-Care-to-Reduce-Sepsis-Mortality-The"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,12]]},"references-count":44,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,7,12]]},"published-print":{"date-parts":[[2023,8,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2022-059938","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,12]]},"article-number":"e2022059938"}}