Bacteremia Risk and Outpatient Management of Febrile Patients With Sickle Cell Disease
Before the introduction of conjugate pneumococcal vaccines and routine penicillin prophylaxis, febrile patients with sickle cell disease were known to have a 3% to 5% risk of bacteremia. Consequently, hospitalization rates for febrile episodes are >70%.
We observed no mortality or morbidity among those managed completely as outpatients, and bacteremia occurred in <1%. Physicians should strongly consider outpatient management of febrile children with sickle cell disease if there are no other indications for admission.
Intussusception After Rotavirus Vaccines Reported to US VAERS, 2006–2012
A low-level risk of intussusception after rotavirus vaccines, ∼1 to 2 cases per 100 000 vaccinees, exists in some settings. In the United States, a risk of 1 in 65 000 was excluded, but lower risk could exist.
A persistent clustering of intussusception events 3 to 6 days after dose 1 indicates the possibility of a low-level risk of intussusception of ∼0.8 cases per 100 000 vaccinees. The documented benefits of rotavirus vaccine far outweigh this low-level risk of intussusception.
Resource Utilization for Observation-Status Stays at Children’s Hospitals
Hospitalizations under observation status are presumed to be shorter and less resource-intensive, but utilization for pediatric observation-status stays has not been studied.
Children’s hospitals use observation status with great variation. Resource utilization for pediatric patients under observation status overlaps substantially with inpatient-status utilization, calling into question the utility of segmenting pediatric patients according to billing status.
Effect of Early Limited Formula on Duration and Exclusivity of Breastfeeding in At-Risk Infants: An RCT
Public health policy focuses on reducing formula use for breastfed infants during the birth hospitalization. Observational evidence supports this approach, but no previous studies have examined the effect of early use of small volumes of formula on eventual breastfeeding duration.
Use of limited volumes of formula during the birth hospitalization may improve breastfeeding duration for newborns with high early weight loss. Reducing the use of formula during the birth hospitalization could be detrimental for some subpopulations of healthy term newborns.
Prevalence of Use of Human Milk in US Advanced Care Neonatal Units
The American Academy of Pediatrics recommends that all preterm infants receive human milk; however, little is known about the use of human milk in US advanced care neonatal units.
Routine use of human milk and use of donor milk in neonatal advanced care units increased from 2007 to 2011, particularly among units providing intensive care. There is geographic variation in the use of human milk in these units.
General Pediatric Attending Physicians’ and Residents’ Knowledge of Inpatient Hospital Finances
Physicians have little knowledge of health care costs and charges. Studies suggest that education and awareness of hospital finances can decrease unnecessary utilization of resources. Little is known about pediatricians’ awareness of the economics of health care delivery in the inpatient setting.
Both general pediatric attending physicians and trainees acknowledged a limited understanding of hospital finances, and they demonstrated a lack of awareness of costs, charges, and reimbursements for inpatient care.
Elevated Blood Lead Levels and Reading Readiness at the Start of Kindergarten
Blood lead levels well below 10 µg/dL are now recognized as causing adverse cognitive effects, including lower scores on standardized reading and math tests.
This is the first study to show that reading readiness early in kindergarten is independently associated with blood lead levels well below 10 µg/dL. Results suggest that lead exposure may have a larger impact on urban education than national estimates suggest.
Current Status of Transition Preparation Among Youth With Special Needs in the United States
The importance of transition from pediatric to adult health care for youth with special health care needs has gained increasing attention over the past decade, but fewer than half of this population received needed transition preparation in 2005–2006.
This study reports on transition findings from the 2009–2010 National Survey of Children with Special Health Care Needs and finds no discernible improvements since 2005–2006. New clinical recommendations and care processes should help to accelerate transition improvements in the future.
Race and Acute Abdominal Pain in a Pediatric Emergency Department
Abdominal pain is a frequent complaint in pediatric emergency departments, with a broad differential diagnosis. The impact of demographic and clinical characteristics of patients on the evaluation and management of these children is not well known.
The most common cause of abdominal pain is constipation, which rarely requires hospital admission. Demographic factors, in particular race, do not seem to affect evaluation and management.
Effectiveness of Preventive Dental Visits in Reducing Nonpreventive Dental Visits and Expenditures
Early preventive pediatric dental visits are widely recommended. However, the effectiveness of pediatric preventive dental visits in reducing the need for subsequent, more expensive oral health treatment has not been well established.
Using an econometric method that accounts for time-invariant differences between children, and thus helps mitigate selection bias, we found a positive impact of preventive dental visits on oral health. However, there is less evidence regarding the cost-effectiveness of preventive visits.
Effectiveness of Decision Support for Families, Clinicians, or Both on HPV Vaccine Receipt
Despite proven health benefits, human papillomavirus (HPV) vaccination rates are among the lowest of all routine immunizations. No previous large-scale trial has compared the benefit of automated decision support directed at clinicians, families, or both in any context.
We found that a clinician-focused intervention was most effective for initiating the HPV vaccine series, whereas a family-focused intervention supported completion. Decision support directed at both clinicians and families most effectively promotes HPV vaccine series receipt.
Analysis of Pediatric Clinical Drug Trials for Neuropsychiatric Conditions
Neuropsychiatric conditions comprise a substantial and growing disease burden among children. Pharmacotherapy represents an important treatment option for these conditions, although most drugs are not approved for use in children.
Very few drug trials studying neuropsychiatric conditions focus on children. Furthermore, these trials examine and provide pediatric evidence for only a fraction of all available drugs in the treatment of common neuropsychiatric conditions.
A Qualitative Study of the Day-to-Day Lives of Obese Mexican-American Adolescent Females
Obesity is a growing concern for Mexican-American adolescents, with both behavioral and cultural variables that are related to the increasing trend.
These results highlight a patient-centered view of the emotional and physical burden of obesity in female Mexican-American adolescents, the families’ personal struggles with weight-related conditions, and the challenge of balancing family needs with those specific to the adolescent.
Pediatric Hydrocarbon-Related Injuries in the United States: 2000–2009
Hydrocarbons are dangerous household products commonly found in homes with young children. Unintentional ingestion continues to be a problem despite existing prevention efforts. Aspiration is often associated with ingestion of hydrocarbons by children.
The National Poison Database System and National Electronic Injury Surveillance System data sets demonstrate similar rates of hydrocarbon-related injuries in children. Rates of hydrocarbon exposure were highest in summer. Gasoline was the product most associated with hydrocarbon injuries.
Malpractice Risk Among US Pediatricians
Despite evidence on how malpractice risk varies according to physician specialty, there is growing but still limited evidence about malpractice among US pediatricians. The frequency of malpractice claims against pediatricians is low among specialties, but payments are among the highest.
This study describes malpractice risk among US pediatricians using data from a nationwide liability insurer covering 1630 pediatricians from 1991 to 2005. It compares pediatric malpractice experience with other specialties and studies patient factors associated with pediatric malpractice claims.
Texting While Driving and Other Risky Motor Vehicle Behaviors Among US High School Students
Distracted driving due to texting while driving (TWD) has emerged as an important teenage safety issue. Previous studies have shown that the self-reported prevalence of TWD among teenagers varies widely.
In 2011, 45% of US high school students aged ≥16 years reported TWD during the past 30 days. TWD was positively associated with other risky motor vehicle behaviors; this association strengthened as frequency of TWD increased.
Comparative Effectiveness of Acellular Versus Whole-Cell Pertussis Vaccines in Teenagers
The United States switched from whole-cell to acellular pertussis vaccines during the 1990s. Whether pertussis risk during a California outbreak differed between teenagers who previously received whole-cell or acellular pertussis vaccines early in life has not been reported.
We evaluated pertussis risk in 10 to 17 year olds at Kaiser Permanente Northern California during a recent pertussis outbreak. Those given whole-cell pertussis vaccines in childhood were more protected than those given acellular pertussis vaccines.
Pediatric Organ Donation and Transplantation
The gap between organ availability and need continues to grow, and infants are among the most vulnerable candidates on the wait-list. The scarcity of donor organs has led the transplant community to look for alternative donor sources.
Children are receiving more grafts from pediatric donors, but they also continue to receive adult donor grafts. Donation after circulatory determination of death increases organ availability. Allocation changes have also helped increase pediatric transplantation and decrease wait-list deaths.
Obesity in Men With Childhood ADHD: A 33-Year Controlled, Prospective, Follow-up Study
Cross-sectional studies in children and adults have reported a significant positive association between attention-deficit/hyperactivity disorder (ADHD) and obesity.
This controlled, prospective, follow-up study of boys with ADHD found significantly higher BMI and obesity rates in adulthood, compared with men without childhood ADHD, regardless of socioeconomic status and other lifetime mental disorders.
RCT of Timolol Maleate Gel for Superficial Infantile Hemangiomas in 5- to 24-Week-Olds
The systemic nonselective β-blocker propranolol hydrochloride is increasingly used as first-line management for infantile hemangiomas. Superficial nonulcerating lesions do not require systemic medications. Case series have suggested the efficacy of timolol; however, its safety has been questioned.
This randomized controlled trial indicates that timolol maleate 0.5% gel is a well-tolerated, safe, and effective treatment of superficial infantile hemangiomas.
Pregnancy Dose Tdap and Postpartum Cocooning to Prevent Infant Pertussis: A Decision Analysis
Infants aged <2 months are at highest risk for pertussis morbidity and mortality but are too young to receive pertussis vaccines. To protect young infants, the Advisory Committee on Immunization Practices recommends mothers receive 1 dose of Tdap during pregnancy.
This article evaluates the effect of Tdap during pregnancy compared with postpartum Tdap and cocooning in preventing infant pertussis cases, hospitalizations, and deaths, as well as their relative cost-effectiveness.
Accuracy of Point-of-Care Ultrasound for Diagnosis of Skull Fractures in Children
Head injuries and concern for skull fracture are common in pediatrics. Point-of-care ultrasound is an imaging tool that can be used to diagnose fractures. However, there are scant data regarding the accuracy of point-of-care ultrasound in skull fracture diagnosis.
Clinicians with focused point-of-care ultrasound training are able to diagnose skull fractures in children with high specificity. Ultrasound may be valuable to diagnose skull fractures in children at the point of care.
Usefulness of Routine Head Ultrasound Scans Before Surgery for Congenital Heart Disease
Routine head ultrasound scans (HUSs) are frequently performed in the preoperative evaluation of the infants with congenital heart disease, and brain MRI is being increasingly used in the research setting. The utility of HUSs in this population has not yet been established.
This is the first study to prospectively evaluate the utility of routine HUSs compared with MRIs in asymptomatic newborns and young infants undergoing cardiac surgery. Our findings suggest that routine HUS is not indicated in asymptomatic term or near-term neonates undergoing surgery for CHD.
Factors Affecting Caregivers’ Use of Antibiotics Available Without a Prescription in Peru
Self-medication with antibiotics available without prescription is among the main causes of antibiotic misuse in the developing world and is associated with antibiotic resistance. Inappropriate antibiotic prescription is common in children. Patient expectations seem to influence physicians’ advice.
This study demonstrates that even in places where antibiotics are unregulated, improving physician prescribing habits could reduce irrational use overall and also future caregiver-driven misuse. Physician training in adequate antibiotic prescription could be a cost-effective intervention in these settings.
Health of Children Classified as Underweight by CDC Reference but Normal by WHO Standard
Many US children aged 6 to 24 months who would be classified as low weight-for-age by the Centers for Disease Control and Prevention 2000 reference will be classified as normal weight-for-age by the World Health Organization 2006 standard.
Children who will be reclassified from low to normal weight-for-age using the World Health Organization growth standard are at higher risk of adverse health outcomes than children who are not low weight-for-age by the Centers for Disease Control and Prevention reference.
Internet-Based Therapy for Adolescents With Chronic Fatigue Syndrome: Long-term Follow-up
Cognitive behavioral therapy is an effective and safe treatment of chronic fatigue syndrome in children and adolescents. After 6 months, Internet-based cognitive behavioral therapy in the form of FITNET led to an 8 times higher chance of recovery compared with usual care.
The positive effects of FITNET were maintained at long-term follow-up (>2.5 years).Patients following usual-care treatment achieve similar recovery rates at long-term follow-up.
Trends in Hospitalization Rates and Severity of Injuries From Abuse in Young Children, 1997–2009
Child welfare data show declines in child physical abuse since the early 1990s, but analysis of national data from hospitalized children in the Kids’ Inpatient Database showed an increased incidence of serious physical abuse in children from 1997 to 2009.
We found no significant change in hospitalization rates for injury from abuse in young children and increases in injury severity using the National Inpatient Sample from 1997 to 2009. This data helps provide a more complete perspective of the problem.
Oxygen Saturation Nomogram in Newborns Screened for Critical Congenital Heart Disease
Universal oxygen saturation screening by pulse oximetry is now recommended for early detection of critical congenital heart disease. The distribution of saturations in asymptomatic newborns in a large population has not been described.
Our study is the largest to date to establish simultaneous pre- and postductal oxygen saturation nomograms in asymptomatic newborns at ∼24 hours after birth. The mean postductal saturation is higher than preductal during this time.
Safety and Utilization of Influenza Immunization in Children With Inflammatory Bowel Disease
Yearly influenza immunization is recommended in patients with inflammatory bowel disease (IBD). However, concern regarding vaccine-related adverse events may limit uptake, and case reports in the literature detail disease flares after immunization.
Influenza immunization rates in children with IBD are low but immunization did not result in increased outpatient visits, hospitalizations or emergency visits. Immunization was associated with fewer IBD-related visits in the post-vaccine period, which may indicate protection against IBD symptoms.
Weight Gain in Infancy and Vascular Risk Factors in Later Childhood
Excessive weight gain over the first 18 months of life may have consequences for later body size. However, the relationship of weight gain in this period to atherogenic risk factors in later childhood is not well characterized.
Early postnatal weight gain from birth to 18 months is independently associated with childhood overweight and obesity, excess central adiposity, and greater arterial wall thickness at age 8 years.
Pacifier Cleaning Practices and Risk of Allergy Development
Infants with a diverse gut microbial flora are less likely to develop eczema and allergy.
Parental sucking of their infant’s pacifier is associated with a reduced risk of allergy development and an altered oral flora in their child. Transfer of oral microbes from parent to infant via the pacifier might be used in primary prevention.
Honey Pacifier Use Among an Indigent Pediatric Population
Botulinum spores are ubiquitous, found in the soil of most countries worldwide, and also in honey. It is well established that ingestion of honey by children aged <1 year can lead to infant botulism.
This study examines the prevalence of honey pacifier use among a pediatric population aged <1 year. We also assessed parental knowledge of the dangers of giving honey to children in this age group.
Etiology of Ethnic Differences in Childhood Spirometry
There are ethnic differences in lung function, with white people generally having higher values of FVC and FEV1 than people of South Asian origin, whereas differences in forced expiratory flows are absent or less marked. The underlying reasons are unknown.
Lung function differences were not explained by cultural, socioeconomic, or perinatal factors, nor by environmental exposures or wheezing illness. This suggests that genetic factors are responsible, and supports the use of ethnicity-specific prediction equations for children of South Asian origin.
Disparities in Disability After Traumatic Brain Injury Among Hispanic Children and Adolescents
Previous studies report Hispanic adults have lower access to rehabilitation services, especially among those who only speak Spanish, and higher disability after traumatic brain injury (TBI) compared with non-Hispanic white subjects. No studies have examined disparities in disability after TBI for Hispanic children.
Hispanic children experience disparities in long-term disability after TBI. Compared with non-Hispanic white children, Hispanic children report significantly larger reductions in health-related quality of life, participation in activities, and ability to communicate and care for themselves 3 years after injury.
Inconsolable Infant Crying and Maternal Postpartum Depressive Symptoms
Studies reveal that mothers of infants with colic (defined by Wessel’s criteria of >3 hours per day of distress) are more likely to develop depression. No studies have examined whether the consolability of infant crying predicts maternal depression risk.
Prolonged inconsolable infant crying has a stronger association with maternal depressive symptoms than overall daily duration of fussing and crying, suggesting that a mother’s report of inability to soothe her infant may be a powerful indicator of her depression risk.
Use of Antihypotensive Therapies in Extremely Preterm Infants
Extremely preterm infants who receive antihypotensive therapy have worse outcomes than untreated infants. The reasons for this are not clear. High-quality randomized trials have not been performed to date because of logistical challenges, thereby necessitating alternative methods of investigation.
Antihypotensive therapy administration was not associated with improved in-hospital outcomes for any of the 15 definitions of low blood pressure investigated. Alternative methods of deciding who to treat are needed to maximize patient benefit and minimize harm.
Genetic and Environmental Influences on Daytime and Nighttime Sleep Duration in Early Childhood
Sleep patterns of adult monozygotic twins are more similar than those of dizygotic twins, showing moderate heritability and little effects of environmental influences. There have been very few genetically informative studies of sleep in preschool children and results appear inconsistent.
From previous studies, we investigated daytime and nighttime continuous sleep duration longitudinally. This is the first time that the etiologies of daytime and nighttime continuous sleep duration trajectories were studied in early childhood.
Long-term Follow-up and Outcome of Phenylketonuria Patients on Sapropterin: A Retrospective Study
Pharmacologic treatment with sapropterin dihydrochloride (6R-tetrahydrobiopterin; BH4) has been an effective option for some phenylketonuria patients since its approval by the US Food and Drug Administration in 2007 and the European Medicines Agency in 2008.
This retrospective multicenter study revealed the long-term effects of sapropterin on metabolic control, dietary tolerance, and the outcome of BH4-responsive phenylketonuria patients harboring specific phenotypes and genotypes. It also confirmed that the minor adverse events disappeared by lowering the dose.
Neonatal End-of-Life Care: A Single-Center NICU Experience in Israel Over a Decade
Neonatal mortality rate and causes of death have been relatively stable in recent years. Decision-making practices preceding death of sick neonates affect the circumstances of death. These practices vary worldwide according to the team approach and local population background.
Although our population is mostly religious, we observed a decline in maximal intensive care along with increasing redirection of care over a decade. Changes in the team approach and increasing level of parental involvement influence type and duration of treatment.
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- Copyright © 2013 by the American Academy of Pediatrics