Long-term Results of an Obesity Program in an Ethnically Diverse Pediatric Population
Long-term pediatric weight management studies have been predominantly carried out with affluent, white populations. Thus, evidence on successful management of childhood obesity is limited, especially in inner-city, ethnically diverse populations.
This randomized controlled trial bridges the gap in the pediatric obesity treatment literature by revealing a sustained treatment effect on anthropometric and metabolic markers after a family-based lifestyle intervention versus traditional clinical care in inner-city, ethnically diverse populations.
Ambulatory Visit Rates and Antibiotic Prescribing for Children With Pneumonia, 1994–2007
Pneumococcus is the most commonly identified bacterial cause of community-acquired pneumonia. Pediatric pneumonia hospitalizations have decreased since the introduction of the pneumococcal conjugate vaccine in 2000. However, few data exist on national trends in the incidence of pediatric outpatient pneumonia.
This study provides the first comprehensive national estimates of pediatric outpatient pneumonia incidence. Rates of outpatient pediatric pneumonia have not changed despite introduction of the pneumococcal conjugate vaccine, and broad-spectrum antibiotic prescribing for outpatient pneumonia is commonplace.
Nosocomial Infection Reduction in VLBW Infants With a Statewide Quality-Improvement Model
Quality-improvement techniques are increasingly effective as they move from passive dissemination to interactive techniques between those authoring practice change packages and their audiences. However, resource constraints and the many potential topics mitigate against prescribing intense collaboratives for every topic.
Efficient progress in decreasing neonatal nosocomial infection rates can be achieved when statewide quality-improvement collaboratives using structured interventions (“toolkits”) are augmented with brief interactions that introduce, orient, and motivate potential users.
Ohio Statewide Quality-Improvement Collaborative to Reduce Late-Onset Sepsis in Preterm Infants
Late-onset infections cause significant morbidity and mortality in preterm infants. Quality-improvement interventions focused on catheter care have reduced nosocomial infections in adult and pediatric patients but have yet to be proven effective in preterm neonates.
This study extended previous work, and the results showed that increased application of evidence-based catheter care as part of a state-based quality-improvement collaborative can reduce infections in preterm neonates. It also highlights the important role of reliability principles in evidence implementation.
Statewide NICU Central-Line-Associated Bloodstream Infection Rates Decline After Bundles and Checklists
Evidence-based care bundles for inserting and maintaining central lines can reduce central-line–associated bloodstream infection (CLABSI) rates. The impact of adopting standardized bundle elements and related checklists across a statewide NICU quality-improvement network has not been studied.
Statewide adoption of standardized, evidence-based central-line insertion and maintenance bundles substantially reduced NICU CLABSI. Increased use of maintenance checklists was associated with fewer CLABSIs. We also measured the impact of the 2008 Centers for Disease Control and Prevention CLABSI definition change.
Outcomes of a Universal Shared Reading Intervention by 2 Years of Age: The Let's Read Trial
Literacy acquisition is an important developmental milestone and key to educational success. Interest in early literacy promotion has led to trials with some success in improving language and literacy activities; these trials have yet to demonstrate improved literacy outcomes.
This first population-based cluster randomized trial demonstrates how the key messages and corresponding activities of an early literacy-promotion program relate to the number of literacy activities in the home and infants' communication and language development at age 2 years.
Literacy Promotion for Families Participating in the Women, Infants and Children Program
Large social class differences exist in children's exposure to experiences that support the development of literacy skills. Pediatric clinic-based literacy promotion programs have demonstrated effects in promoting reading activities at home and accelerating children's language acquisition.
This study describes the impact of a Special Supplemental Nutrition Program for Women, Infants and Children–based intervention on the school readiness of low-income children. The study examines the impact of the intervention on English- and Spanish-speaking children's readiness for school.
Patterns of Comorbidity, Functioning, and Service Use for US Children With ADHD, 2007
Attention-deficit/hyperactivity disorder (ADHD) is known to be associated with a range of mental health and neurodevelopmental comorbidities, but the pattern of these comorbidities and their relationship to child and family functioning and service use at the population level investigated has not been found in previous studies.
Two-thirds of US children with ADHD have comorbid conditions. Social and educational functioning declines with more comorbidities and cross-sector service use and need for care coordination increase. Management of ADHD should be tailored to each child's neurodevelopmental profile.
Racial Bias in Child Protection? A Comparison of Competing Explanations Using National Data
Black children are involved in reported and substantiated cases of child abuse and neglect at approximately twice the rate of white children. It is unknown if this disproportionality is attributable to higher risk or to bias in reporting or assessment.
Results based on national child abuse and neglect and child health data indicated that racial disproportionality in black children is attributable to higher risk rather than reporting bias. Our findings also suggest that in Hispanic children cultural protective factors apply to child maltreatment (the “Hispanic Paradox”).
Injuries Associated With Cribs, Playpens, and Bassinets Among Young Children in the US, 1990–2008
Previous research has focused on infant mortality attributed to suffocation and strangulation in the crib environment. No studies have investigated both fatal and nonfatal crib-related injuries.
This study is the first to use a nationally representative sample to investigate injuries among young children associated with cribs, playpens, and bassinets.
Increasing VLBW Deliveries at Subspecialty Perinatal Centers via Perinatal Outreach
The American Academy of Pediatrics Guidelines for Perinatal Care recommends delivery of infants <32 weeks' gestation at subspecialty perinatal centers (SPCs). Infants born with very low birth weights (VLBW) at SPCs have decreased perinatal morbidity and mortality.
Perinatal outreach education to providers at non-SPCs is an effective strategy to promote transfer of all pregnant mothers with <32 weeks' gestation to SPCs for delivery. The Healthy People 2010 objective to deliver 90% of infants born with VLBW in SPCs is achievable.
Timing of Solid Food Introduction and Risk of Obesity in Preschool-Aged Children
Limited, conflicting data suggest that the timing of solid food introduction in infancy may be associated with an increased risk of obesity in childhood.
Among infants who were never breastfed or those who stopped breastfeeding before the age of 4 months, the introduction of solids before the age of 4 months was associated with a sixfold increase in the odds of obesity at the age of 3 years.
The Scope of Nonsuicidal Self-Injury on YouTube
Given its high rates (14–24%) and co-occurrence with psychiatric difficulties, nonsuicidal self-injury among youth is worrisome. With more youth using video-sharing Web sites, such as YouTube, nonsuicidal self-injury–themed videos may be normalized and reinforced among youth who self-injure.
Examination of nonsuicidal self-injury material on YouTube revealed favorably and frequently viewed videos that were accessible and graphic and that often were creative, with an informational, melancholic, or hopeless message. The possible impact of this material on viewers is worrisome.
Cerebral Oxygenation Is Depressed During Sleep in Healthy Term Infants When They Sleep Prone
Prone sleeping is a major risk factor for the sudden infant death syndrome. In the prone position blood pressure is often lower and arousability is depressed.
Normative data on the effects of sleeping position, sleep state, and postnatal age on cerebral oxygenation were collected. Infants sleeping in the prone position had lower cerebral oxygenation, which may contribute to the decreased arousability and increased risk for sudden infant death syndrome associated with this sleeping position.
Microbiology and Antibiotic Management of Orbital Cellulitis
Recent reports suggest that Staphylococcus aureus may be an increasing cause of pediatric orbital infections. However, the risk of methicillin-resistant infections and current antibiotic management practices in these patients are unclear.
The Streptococcus anginosus group is an emerging cause of pediatric orbital infections. Although cases caused by methicillin-resistant Staphylococcus aureus seem uncommon, vancomycin and combination antibiotics are frequently used. A more simplified antibiotic regimen may be warranted in many patients.
Randomized Controlled Trial of Cephalexin Versus Clindamycin for Uncomplicated Pediatric Skin Infections
Community-associated methicillin-resistant Staphylococcus aureus (MRSA) causes the majority of purulent skin infections in children. The choice of adjuvant antibiotic varies widely in clinical practice, with a recent trend toward the empiric use of antibiotics with activity against MRSA.
This randomized controlled trial of cephalexin versus clindamycin for uncomplicated, purulent skin infections showed equally high rates of improvement at 48 to 72 hours and 7 days, which suggests that using antibiotics with in vitro MRSA activity may not be critical for successful treatment.
Injection Site and Risk of Medically Attended Local Reactions to Acellular Pertussis Vaccine
In a study of 1315 children aged 4 through 6 years who received their fifth dose of the diphtheria and tetanus toxoids and acellular pertussis vaccine, children vaccinated in the thigh had less redness and swelling at the injection site than children vaccinated in the arm.
Medically attended local reactions to the fifth dose of the diphtheria and tetanus toxoids and acellular pertussis vaccine are significantly less common when the vaccine is injected in the thigh versus the arm.
Race/Ethnicity Is Not Associated With Mortality in the PICU
Racial/ethnic disparities in health care outcomes are well documented in the adult literature, but evidence for racial/ethnic disparities in pediatric critical care is limited. It is unclear whether race/ethnicity plays a role in mortality in the PICU.
This is the largest national study to show that race/ethnicity is not clearly associated with mortality disparities in the PICU.
A New Risk-Based Screening Criterion for Treatment-Demanding Retinopathy of Prematurity in Denmark
Efforts are made worldwide to determine the most effective and safe criterion for retinopathy of prematurity screening. Combining gestational age at delivery and birth weight limits is the preferred method to effectiveness and safety measured by the capability to detect advanced retinopathy of prematurity cases.
This study shows how advanced statistical models are helpful tools for evaluating of the suitability of screening criteria for implementation. It also presents a criterion based on the estimated risk of developing treatment-demanding retinopathy of prematurity. This criterion is more effective and safer than any conventional screening criteria.
A Clinical Prediction Model to Stratify Retinopathy of Prematurity Risk Using Postnatal Weight Gain
Most infants screened for retinopathy of prematurity (ROP) under current criteria do not require treatment. Slow postnatal growth is a surrogate for low serum insulin-like growth factor 1 and a marker for severe ROP. A complex ROP surveillance model using weights has been developed.
A simple predictive model that uses postnatal weight gain to accurately predict risk of severe ROP reduced the number of infants requiring exams among a high-risk population. Nomograms potentially make it easy to apply the model clinically.
Coexistence of Sleep and Feeding Disturbances in Young Children
Behavioral insomnia and problematic feeding behaviors are 2 prevalent conditions in young children. Interaction between caregiver characteristics, child temperament, and parent-child interaction factors substantially contribute to both behavioral insomnia and problematic feeding behaviors.
Problematic sleep and feeding behaviors tend to coexist in early childhood. Increased awareness of clinicians involved in the treatment of pediatric sleep or feeding disorders to this coexistence may allow early intervention and improve outcome.
Late Preterm Infants Have Worse 24-Month Neurodevelopmental Outcomes Than Term Infants
Data suggest that late preterm infants have worse neurodevelopmental outcomes and academic performance at school age and require special education more frequently.
It is important to know whether late preterm infants with worse neurodevelopmental outcomes can be identified before school age, permitting them to have earlier interventions to limit the need for later special education.
Prediction of Neurodevelopmental and Sensory Outcome At 5 Years in Norwegian Children Born Extremely Preterm
Extreme prematurity is associated with poor functional outcome.
The prognosis is much poorer for gestational ages less than 26 weeks compared with gestational ages between 26 and 27 weeks. Gestational age has minor predictive significance for cognitive and motor function for those with no major disability.
Executive and Memory Function in Adolescents Born Very Preterm
Very preterm children display significant school problems that persist into adolescence. Executive functioning and memory play important roles in learning and school attainment.
This study confirms that adolescents born very preterm exhibit deficits in executive functioning and memory in a large contemporary sample. Severe brain injury and maternal education are strong predictors of performance on executive function and memory tasks.
Maternal Smoking and Congenital Heart Defects in the Baltimore-Washington Infant Study
Maternal smoking during pregnancy has been implicated as a possible risk factor for birth defects, but the evidence is mixed, and when identified as a risk factor, the magnitude of the estimates has been typically modest.
Results of this study, based on a population-based design with high-quality case ascertainment and defect classification, add to the existing body of evidence that implicates first-trimester maternal cigarette smoking as a modest risk factor for select congenital heart defect phenotypes.
Neurodevelopmental Outcomes of Triplets or Higher-Order Extremely Low Birth Weight Infants
The incidence of cerebral palsy is higher in multiple births than in singleton infants. Twin extremely low birth weight (ELBW) infants have a higher incidence of death or neurodevelopmental impairment compared to ELBW singleton infants.
This study evaluates the risk of death or neurodevelopmental impairment in triplet or higher-order ELBW infants compared with twins and singleton infants. A similar study using such a large cohort of infants has not been previously performed.
Newborns With Sonographically Dysplastic and Potentially Unstable Hips: 6-Year Follow-up of an RCT
A total of 1% to 2% of all newborns have mildly dysplastic and potentially unstable hips and are thus thought to be in need of immediate abduction treatment.
Newborns with mildly dysplastic and potentially unstable hips randomly assigned to either immediate abduction treatment or active sonographic surveillance have radiographically normal hips at 6 years of age with no evidence of avascular necrosis, despite one-third showing residual dysplasia at 1 year of age.
Population Case-Control Study of Cerebral Palsy: Neonatal Predictors for Low-Risk Term Singletons
Term infants account for the majority of cases of cerebral palsy (CP). The strongest risk factor for term infants is admission to the NICU with newborn encephalopathy. Little research has focused on infants not admitted to a NICU.
Two-thirds of term infants with CP were not admitted to the NICU but contributed one-half of severe cases. Six neonatal factors were identified as predictors of CP for this group, but 60% of the subjects had none of these factors.
Racial, Ethnic, and Socioeconomic Disparities in the Prevalence of Cerebral Palsy
Black infants have an increased risk of cerebral palsy when compared with white infants. The reason for this racial disparity is unclear. Lower socioeconomic status may be associated with an increased risk of cerebral palsy.
The increase in cerebral palsy among blacks is due to higher rates of low birth weight. Among low birth weight infants, blacks are less likely to have cerebral palsy than whites. Prenatal care and maternal education also impact cerebral palsy risk.
Effectiveness of Preventive Dental Treatments by Physicians for Young Medicaid Enrollees
Mixed evidence exists regarding the effectiveness of preventive dental services in medical settings. Physicians and nurses are willing to provide preventive dental services, parents are satisfied with the services their children receive, and programs that encourage physician participation increase access.
Despite declines in effectiveness since fluoride treatment and referrals to dentists to treat existing disease, this study reports that oral health services by non-dental health care providers for Medicaid preschool-aged children lead to reductions in caries-related treatments.
Effects of Ambient Particulate Matter and Fungal Spores on Lung Function in Schoolchildren
Epidemiologic studies examining the combined childhood health effects of both air pollutants and fungal spores have been relatively lacking.
Exposure to current levels of ambient particulate matter with an aerodynamic diameter of 2.5 μm or less, fungal spores, and O3 are associated with reduced childhood lung function. These adverse effects were observed in a longitudinal setting, more specifically, in a cohort of schoolchildren that included healthy children.
Impact of Prenatal Exposure to Piperonyl Butoxide and Permethrin on 36-Month Neurodevelopment
Pyrethroid insecticides and the pyrethroid synergist piperonyl butoxide are potential neurodevelopmental toxicants and have not been evaluated for developmental toxicity. In this study the effects of prenatal exposure to piperonyl butoxide and permethrin on neurodevelopment in children aged 36 months were examined.
A significant inverse association was observed between prenatal exposure to piperonyl butoxide, a pyrethroid synergist, and 36-month neurodevelopment. No significant association was observed between prenatal exposure to permethrin and adverse neurodevelopment.
Up-to-Date Haemophilus influenzae Type b Vaccination Coverage During a Vaccine Shortage
Vaccine shortages and provider noncompliance with interim recommendations can result in decreased vaccination coverage. During the 2008–2009 Haemophilus influenzae type b vaccine shortage, Haemophilus influenzae type b vaccination coverage was known to have decreased in 1 US state.
This study demonstrated decreased Haemophilus influenzae type b (Hib) vaccination coverage during the 2008-2009 Hib PRP-OMP shortage in 7 of 8 participating states, suggesting that the vaccine shortage had a more widespread impact on Hib vaccination coverage in the US.
Prenatal Factors for Childhood Blood Pressure: Mediated by Intrauterine and/or Childhood Growth
Inconsistent evidence reveals that some prenatal factors are associated with high blood pressure in later life. The biological mechanisms of these associations are unknown, which is a critical barrier for causal interpretation as well as safe and effective intervention.
Maternal heavy smoking during pregnancy, prepregnancy overweight-obesity, chronic hypertension, and preeclampsia-eclampsia are associated with higher offspring systolic blood pressure, which is independent of intrauterine growth restriction. Childhood BMI or weight trajectory may mediate the associations of heavy maternal smoking and prepregnancy BMI with systolic blood pressure.
Placental Pathology in Neonatal Stroke
Neonatal stroke is recognized as a cause of infant morbidity and neurodevelopmental disability. The placenta has become an organ of interest as a contributor to cerebral palsy and neurologic disability; however, placental pathology has not been systematically described in stroke.
This study reviews placental pathology in patients presenting with neonatal stroke near delivery and correlates this with clinical presentation, outcome, and risk factors. We suggest that multiple risk factors are involved in neonatal stroke, and placental pathology may be a contributor.
Timing of Excess Weight Gain in the Avon Longitudinal Study of Parents and Children (ALSPAC)
In a previous study, it was found that most excess weight gain in English children had taken place by age 5. The authors suggested that interventions to prevent obesity should focus only on children younger than 5 years of age.
From birth to 5 years of age was not characterized by the greatest excess weight gain in a larger sample of English children and adolescents. Greatest gains in weight and BMI z scores occurred during mid-childhood. Efforts to prevent obesity should not only focus on preschool children, but also include school-aged children and adolescents.
Longitudinal Validation of the Test for Respiratory and Asthma Control in Kids in Pediatric Practices
The 5 items in the Test for Respiratory and Asthma Control in Kids were identified and validated in a previous development study of caregivers and their children, younger than 5 years, who were primarily cared for by asthma specialists.
This study extends the psychometric properties and utility of the Test for Respiratory and Asthma Control in Kids tool by demonstrating its reliability, validity, and responsiveness to change in respiratory-control status over time in preschool-aged children with symptoms consistent with asthma who are treated by pediatricians.
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- Copyright © 2011 by the American Academy of Pediatrics