Mortality, ADHD, and Psychosocial Adversity in Adults With Childhood ADHD: A Prospective Study
Attention-deficit/hyperactivity disorder (ADHD) has been viewed as a neurodevelopmental disorder, adversely affecting behavior and school performance, with studies suggesting increased risk for poor adult outcomes. However, no prospective studies have examined long-term outcomes of childhood ADHD in an epidemiologic sample.
Our epidemiologic study indicates that adults with childhood ADHD are at increased risk for death from suicide. ADHD persists into adulthood in 29.3% of childhood ADHD cases, and 56.9% have ≥1 psychiatric disorder other than ADHD.
Reasons for Not Vaccinating Adolescents: National Immunization Survey of Teens, 2008–2010
The reasons why teens are not immunized are related to parental lack of knowledge and the need for provider recommendations.
The reasons for vaccine refusal for human papillomavirus vaccine differ from other teen vaccines, and concerns about its safety are increasing over time.
A Parent-Focused Intervention to Reduce Infant Obesity Risk Behaviors: A Randomized Trial
While obesity-promoting eating, sedentary and physical activity behaviors, and increased prevalence of adiposity are evident from early life, few high-quality studies have evaluated interventions that seek to influence the development of these behaviors in very early childhood.
This study highlights the receptivity of first-time parents to interventions focused on their new infant’s eating and active play and provides evidence of effectiveness on some obesity-promoting behaviors in very early childhood.
Heliox Therapy in Bronchiolitis: Phase III Multicenter Double-Blind Randomized Controlled Trial
Bronchiolitis, a leading cause of infant hospitalization, has few proven treatments. A few small studies have reported the beneficial effects of a mixture of 21% oxygen + 79% helium (Heliox). The 2010 Cochrane Review concluded that additional large randomized controlled trials were needed to determine the therapeutic role of Heliox in bronchiolitis.
The Bronchiolitis Randomized Controlled Trial Emergency-Assisted Therapy with Heliox—An Evaluation (BREATHE) trial is the largest multicenter randomized controlled trial to date to investigate the efficacy of Heliox in acute bronchiolitis. The delivery method for Heliox therapy was found to be crucial to its efficacy.
Trends in the Management of Viral Meningitis at United States Children’s Hospitals
In the era of widespread conjugate vaccine use, the prevalence of bacterial meningitis has declined. However, the impact of this decline on the rate of emergency department visits for viral meningitis and cost of caring for these children is unknown.
There was a decline in the rate of diagnosis of viral meningitis in US children’s hospitals between 2005 and 2011. Most children diagnosed with viral meningitis are treated with antibiotics and are hospitalized, accounting for considerable health care costs.
Racial Differences in Antibiotic Prescribing by Primary Care Pediatricians
Racial disparities in health care have been reported in multiple settings, but not thoroughly examined at the clinician level. The frequent occurrence of respiratory tract infections allows the evaluation of differences in the management of children seen by the same clinician.
Racial differences in the management of common pediatric infections occur among children treated by the same clinician. Given persistent concerns about nonjudicious antibiotic use, examining racial differences may inform our understanding of prescribing practices and identify opportunities for intervention.
Baby-Friendly Hospital Accreditation, In-Hospital Care Practices, and Breastfeeding
Baby-Friendly Hospital Initiative (BFHI) accreditation can have a positive effect on breastfeeding initiation and continuation rates; however, little is known about the effect of BFHI accreditation in populations with high breastfeeding-initiation rates and where infant-friendly practices are common.
BFHI accreditation per se does not improve breastfeeding rates at 1 and 4 months when breastfeeding-initiation rates are high and accredited and nonaccredited hospitals have infant-friendly practices. Baby-friendly practices are more important than accreditation.
Perinatal Origins of First-Grade Academic Failure: Role of Prematurity and Maternal Factors
Extreme prematurity is a well-established cause of cognitive and motor impairment. There is some evidence that late prematurity and modifiable maternal attributes may negatively influence scholastic achievement, including standardized test performance.
We found that preterm birth significantly increases risk of first-grade failure rate even when the birth is just a few weeks before term gestation. Low maternal education status compounds the effect of prematurity.
Sentinel Injuries in Infants Evaluated for Child Physical Abuse
Although it is known that relatively minor abusive injuries sometimes precede more severe physical abuse, the prevalence of these previous injuries in infants evaluated for abuse was not known.
A history of bruising or oral injury in a precruising infant evaluated for abuse should heighten the level of suspicion because these injuries are common in abused infants and rare in infants found not to be abused.
Chlorhexidine Cleansing of the Umbilical Cord and Separation Time: A Cluster-Randomized Trial
Chlorhexidine cleansing of the cord can reduce mortality in high-risk settings. Time to separation may increase with topical applications of chlorhexidine; 1 previous community trial quantified this increase and did not measure whether caretakers perceived the delay.
Single and multiple cleansing of the umbilical cord increases time to separation by ∼50%, or an average of 2 to 2.5 days. Caretakers were able to detect this difference and expressed dissatisfaction, while still accepting the intervention.
Variation in the Use of Diuretic Therapy for Infants With Bronchopulmonary Dysplasia
Diuretics are used in preterm infants to treat the symptoms of bronchopulmonary dysplasia (BPD), although there is little evidence of their effectiveness in improving long-term outcomes. Prescribing patterns and frequency of diuretic use in patients with BPD are unknown.
The use of diuretics in infants with BPD, including the specific medications used and length of treatment, varies widely by institution. Long-term diuretic administration to patients with BPD is commonly practiced despite minimal evidence regarding effectiveness and safety.
US Outbreak of Human Salmonella Infections Associated With Aquatic Frogs, 2008–2011
Although amphibians are known Salmonella carriers, aquatic African dwarf frogs are specifically marketed toward children, who are especially vulnerable to Salmonella infections. Both direct animal contact and indirect contact with animal habitats can lead to human Salmonella infections.
This is the first reported outbreak of human Salmonella infections associated with African dwarf frogs, particularly among young children. Parents should be aware of the risk of Salmonella infections from both direct and indirect animal contact. Pediatricians should regularly inquire about animal contact and advise families about risks.
Quality of Reporting and Evidence in American Academy of Pediatrics Guidelines
In the only previous cross-sectional study, the quality of pediatric guidelines was rated low on the AGREE-II (Appraisal of Guidelines for Research and Evaluation II) scale. The levels of evidence used in pediatric clinical practice guidelines have never been described.
American Academy of Pediatrics guidelines score low on the AGREE-II scale. Approximately one-quarter of recommendations are based on expert opinion or no reference. These findings support the adoption of standards for guideline development and research targeted toward unsupported recommendations.
Waning Immunity to Pertussis Following 5 Doses of DTaP
Despite high coverage with acellular pertussis vaccine (DTaP), rates of pertussis have increased substantially in 7- to 10-year-olds in recent years. Duration of protection with 5 doses of DTaP may wane earlier than expected and is currently not well described.
This evaluation reports increasing risk of pertussis in the 6 years after receipt of the fifth DTaP dose, suggesting that waning of vaccine-induced immunity is occurring before the recommended adolescent booster dose at 11 to 12 years of age.
School-age Outcomes of Extremely Preterm or Extremely Low Birth Weight Children
Although it is known that extremely preterm children are at increased risk for cognitive deficits, academic underachievement, and behavioral problems, the frequency and severity of these impairments may decline with advances in neonatal care.
Despite recent changes in obstetric and neonatal management of extremely preterm infants, the rate of neurobehavioral impairments at school age is still too high.
Transition From Pediatric to Adult Care for Youth Diagnosed With Type 1 Diabetes in Adolescence
Most children with type 1 diabetes get care from pediatric-trained providers, and must transfer care to adult providers once in adulthood. The timing of this change in providers and its relationship to glycemic control is not well understood.
In this cohort, the estimated median age to transition to adult care was 20.1 years and 77% had left pediatric care by age 21. Leaving pediatric care was associated with a 2.5-fold increase in odds of having poor glycemic control.
Improving Adherence to Otitis Media Guidelines With Clinical Decision Support and Physician Feedback
Expectations are high that electronic health record–based clinical decision support and performance feedback will improve adherence to guidelines by delivering relevant and actionable information to clinicians. Few studies have evaluated these assertions or examined the combined effects of decision support and feedback.
Clinical decision support customized to a patient’s history and presentation and performance feedback are both effective for improving adherence to guidelines for otitis media. However, the combination of the 2 interventions is no better than either delivered alone.
Triglyceride to HDL-C Ratio and Increased Arterial Stiffness in Children, Adolescents, and Young Adults
The triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) estimates atherogenic small, dense low-density lipoprotein cholesterol and predicts arterial stiffness and hard cardiovascular events in adults. Whether TG/HDL-C predicts intermediate noninvasive end points (arterial stiffness) in youth is not known.
This study is the first to document stiffer vessels in youth with higher cardiovascular risk factor–adjusted TG/HDL-C, with the effect especially strong in obese subjects. Evaluating TG/HDL-C may be helpful in identifying young subjects at risk for obesity-related atherosclerosis.
Evidence of Small-Fiber Polyneuropathy in Unexplained, Juvenile-Onset, Widespread Pain Syndromes
Acquired widespread pain syndromes of youth are prevalent, disabling, usually unexplained, and untreatable. Small-fiber polyneuropathy causes widespread pain and multisystem complaints in older adults. Some causes are treatable. Neurodiagnostic skin biopsy, autonomic function testing, and nerve biopsy permit objective diagnosis.
It identifies definite (in 59%) and probable (in 17%) small-fiber polyneuropathy among 41 young patients with otherwise-unexplained, childhood-onset widespread pain. It characterizes this new disease’s clinical features, diagnostic, and treatment options. Some cases appeared immune mediated and responded to immunomodulatory therapies.
Pacifier Restriction and Exclusive Breastfeeding
Pacifiers may interfere with breastfeeding and thus are discouraged until 3 to 4 weeks of life, when they are recommended for sudden infant death syndrome risk reduction. Hospitals are restricting pacifier distribution as part of the Baby-Friendly Hospital Initiative.
We describe a temporal association between reduced exclusive breastfeeding and pacifier restriction. This observation encourages research on breastfeeding promotion and the effects of pacifiers and pacifier restriction on breastfeeding.
Prevalence and Reasons for Introducing Infants Early to Solid Foods: Variations by Milk Feeding Type
Adherence to infant feeding recommendations in the United States is low. The prevalence of early introduction of solid foods (<4 months of age) in the United States has been estimated to range from 19% to 29%.
Mothers’ most commonly cited reasons for early solid food introduction include perception of readiness, hunger, wanting to feed something in addition to breast milk or formula, perception of interest in solids, advice from a clinician, and to improve infant’s sleep.
Effect of Rotavirus Vaccine on Diarrhea Mortality in Different Socioeconomic Regions of Mexico
In Mexico, substantial declines in childhood diarrhea deaths have been documented since the introduction of the rotavirus vaccine in 2007. However, there is concern of lower vaccine effectiveness in less developed regions of Mexico with higher diarrhea-related mortality.
We documented significant and comparable declines across all 3 regions of Mexico with different levels of development, indicating equitable vaccine distribution to children with varying risk of mortality and reaffirming the beneficial effects of rotavirus vaccination against fatal diarrheal disease.
Large-Scale Use of the Modified Checklist for Autism in Low-Risk Toddlers
Early detection for children with autism leads to better outcomes; early screening is critical. The Modified Checklist for Autism in Toddlers (M-CHAT) is a widely used instrument for early autism screening and is recommended by the American Academy of Pediatrics.
This large study provides empirical support for population screening for autism spectrum disorders and the use of the M-CHAT in primary care settings. This study provides updated results to facilitate use and scoring of the M-CHAT by clinical providers.
Predictors of Phrase and Fluent Speech in Children With Autism and Severe Language Delay
Autism is a disorder that significantly affects language/communication skills, with many children not developing fluent language. The rate of spoken language acquisition after severe language delay and predictors of functional language, beyond comorbid intellectual disability, is less clear.
This study uses the largest sample to date to examine the relationship between key deficits associated with autism and attainment of phrase and/or fluent speech after a severe language delay, providing information to guide therapeutic targets and developmental expectations.
Cost-effectiveness of Augmenting Universal Hepatitis B Vaccination With Immunoglobin Treatment
Universal hepatitis B virus (HBV) vaccination is a cost-effective strategy to control HBV infection. Giving hepatitis B immunoglobulin to neonates of HBV carrier mothers additionally reduces transmission but is not widely used because of its expense and infrastructure requirements.
Maternal screening for hepatitis B surface antigen and hepatitis B immunoglobulin treatment of neonates of hepatitis B virus carrier mothers could be a cost-effective addition to universal vaccination in settings in which health infrastructure can support such an intervention.
Oxygen Delivery Using a Neonatal Self-inflating Resuscitation Bag: Effect of Oxygen Flow
Excess tissue oxygenation should be avoided during neonatal resuscitation, especially in premature infants. Delivered oxygen concentrations when using a self-inflating bag (SIB) at oxygen flows <1 L/min remain to be established.
Low oxygen concentrations (30%– 40%) can be delivered with a SIB at an oxygen flow <1 L/min. A practical scheme has been developed correlating the oxygen flow rate and the corresponding delivered fraction of oxygen when using a neonatal SIB.
Development of Heart and Respiratory Rate Percentile Curves for Hospitalized Children
Accurately identifying ill hospitalized children with vital signs concerning for clinical deterioration is fundamental to inpatient pediatrics. Normal vital sign ranges for healthy children are useful for outpatient practice but have limited application to detecting deterioration in the hospital setting.
Percentile curves for heart and respiratory rate in hospitalized children were developed and validated. The distributions differed from existing reference ranges and early warning scores. They may be useful to identify vital signs deviating from ranges expected among hospitalized children.
New Reference Curves for Head Circumference at Birth, by Gestational Age
Head circumference (HC) at birth reflects brain development in utero. However, HC charts used in Canada are either dated, mixed-gender, nonrepresentative of lower gestational ages, or reflective of other populations in the world.
We developed recent and gender-specific reference curves for HC at birth for singletons of 23 to 41 completed weeks’ gestational age, which included a large number of very prematurely born infants, reflecting the current geotemporal Canadian population and advances in obstetric care.
Weight Status of Children With Sickle Cell Disease
Children with sickle cell disease (SCD) have a higher basal metabolic rate, and have historically been underweight. In the general pediatric population, the average BMI percentile has been rising over the past 2 decades.
BMI percentiles for children with SCD in New England are higher than historically reported, mimicking the weight status in the general pediatric population. In children with SCD, higher hemoglobin levels increased the odds of being overweight and obese.
Growth of Spontaneously Descended and Surgically Treated Testes During Early Childhood
There are no published prospective studies on the natural course and testicular growth in early childhood of spontaneously descended testes after birth compared with scrotal or surgically treated testes in boys with congenital cryptorchidism.
Data collected from this prospective study on the natural course and growth of the spontaneously descended testes add evidence-based data and recommendations on how to clinically manage boys with congenital cryptorchidism.
Teen Birth Rates in Sexually Abused and Neglected Females
Despite downward trends, the US teen birth rate remains among the highest of developed nations. Childhood maltreatment may place teens at higher risk, but inferences are weak given a lack of prospective study and control for alternative explanations.
Results from the first controlled, prospective study of nulliparous teenagers confirm that victims of maltreatment are more than twice as likely as their nonmaltreated peers to experience a teen childbirth after controlling for demographic confounds and other known risk factors.
The Impact of Parental Incarceration on the Physical and Mental Health of Young Adults
Although a growing body of literature suggests links between parental incarceration and negative child outcomes, research that uses representative US samples and focuses on health outcomes is limited.
Using a nationally representative US sample, we examined the association between parental incarceration and young adult mental and physical health outcomes. Results suggest childhood exposure to parental incarceration is associated with increased risk of long-term health problems.
Efficacy of Psychosocial Group Intervention for Children With Chronic Illness and Their Parents
Children with chronic illnesses are at risk for emotional and behavioral problems. Therefore, interventions that focus on coping with the negative consequences of the disease are needed. Evidence-based interventions are limited and often focus on a single diagnosis group.
This study demonstrates the efficacy of a cognitive-behavioral group intervention for children with various chronic illnesses. The findings indicate that the involvement of parents is important to achieve long-term results.
Time and Risk Preferences and the Use of Asthma Controller Medication
College students with asthma tend to have worse health outcomes than their peers without asthma. Consistent use of controller medication could improve outcomes for these students, but a predictive model of appropriate use of controller medication is needed.
This study adds risk tolerance and time preference to previously studied factors of nonadherence with control medication. These preferences have substantial impacts on use of controller medication and the potential success of asthma education programs.
Biochemical Characteristics and Risk Factors for Insulin Resistance at Different Levels of Obesity
Although the metabolic syndrome is associated with obesity, not all obese children have insulin resistance and metabolic syndrome, and nonobese children may develop these abnormalities. Associated factors have not been well described.
There was a 6.6% prevalence of nonobese children who were insulin-resistant, associated with a family history of hypertension. There was a 21.3% prevalence of obese who were not insulin-resistant, associated with a low waist circumference.
Postpartum Anxiety and Maternal-Infant Health Outcomes
Guidelines encourage pediatric health care providers to aid in identifying women with postpartum depression but not postpartum anxiety, yet the major life event of childbirth can be anxiety provoking for many women.
During the postpartum hospital stay, anxiety was far more common than depression among breastfeeding women. Anxiety remained more common for the 6 months after childbirth, and was associated with increased health care use and reduced breastfeeding duration, particularly among primiparous women.
Prenatal Maternal Bereavement and Congenital Heart Defects in Offspring: A Registry-Based Study
The etiology of congenital heart defects (CHDs) is largely unknown. A few studies have suggested that maternal emotional stress around the time of conception may be related to the occurrence of CHDs.
Using a large registry-based data source from Denmark, we found that prenatal exposure to maternal bereavement, as a marker of severe stress exposure, may increase the prevalence of CHDs in offspring.
Neuropsychological Effects of Konzo: A Neuromotor Disease Associated With Poorly Processed Cassava
Konzo is an irreversible sudden-onset upper-motor neuron disorder affecting children dependent on bitter cassava for food. The neuroepidemiology of konzo is well characterized. Children subsisting on poorly processed bitter cassava without adequate dietary sulfur-based amino acids are especially at risk.
We found a pervasive subclinical neurocognitive effect in children with konzo. This study provides the first evidence we are aware of that a motor proficiency examination can effectively characterize konzo severity.
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- Copyright © 2013 by the American Academy of Pediatrics