Time Interval Between Concussions and Symptom Duration
Although concussion is increasingly being diagnosed in the pediatric population, little is known about what factors lead to prolonged postconcussive symptoms in children. In particular, the effect of previous history of concussion on recovery from a repeat injury is unclear.
Children with a history of previous concussion, particularly recent or multiple concussions, are at increased risk for prolonged symptoms after concussion. This suggests that repeat concussion, particularly within a vulnerable time window, may lead to longer duration of symptoms.
Adult Prescription Drug Use and Pediatric Medication Exposures and Poisonings
Medication ingestions are increasing among children despite a number of public health interventions. The majority of these poisonings are related to prescription as opposed to over-the-counter medications.
Rising rates of poisonings in children are strongly correlated with rising use of hypoglycemics, antihyperlipidemics, β-blockers, and opioids among adults. These events are associated with considerable health care utilization, both in terms of emergency department visits and hospital admissions.
Trends in Bronchiolitis Hospitalizations in the United States, 2000–2009
Bronchiolitis is often cited as the leading cause of hospitalization for young children in the United States Previous studies reported increases in bronchiolitis hospitalizations through the 1990s. There are no recent efforts to assess national trends in bronchiolitis incidence and health care utilization.
Between 2000 and 2009, we found a significant decline in bronchiolitis hospitalizations among US children. By contrast, use of mechanical ventilation and hospital charges for bronchiolitis significantly increased over this same period.
Religious Exemptions for Immunization and Risk of Pertussis in New York State, 2000–2011
Exemption rates for immunization requirements have until recently been stable in states permitting religious exemptions. States with easy exemption processes have seen higher rates of vaccine-preventable diseases.
In New York, the rate of religious exemptions has increased. Counties with higher rates of exemption have a greater incidence of pertussis.
Sick-Visit Immunizations and Delayed Well-Baby Visits
Parent or provider reluctance to immunize infants during sick visits is a common reason why infants fall behind on the recommended schedule. One previous study suggested that immunizations at sick visits discouraged parents from making up missed well-baby visits.
Delaying immunizations at sick visits can lower immunization rates without improving rates of well-baby visits. Many infants will not return to makeup well-baby visits missed because of a sick visit, regardless of whether immunizations were delayed or given.
Ten-Year Review of Major Birth Defects in VLBW Infants
Infants with birth defects are more likely to be born preterm or with low birth weight and are at higher risk of death.
This study describes the prevalence of birth defects in a cohort of very low birth weight infants and evaluates in-hospital surgical procedures, morbidity, and mortality.
Outcomes of Infants Born at 22 and 23 Weeks’ Gestation
The remarkable improvement in the survival of extremely premature infants has been well documented. However, there have been few cohort studies large enough to determine the neurodevelopmental outcomes of survivors born at 22 or 23 weeks.
The proportions of unimpaired or minimally impaired were 12.0% at 22 weeks (n = 75) and 20.0% at 23 weeks (n = 245). The outcomes were inferior compared with those for infants born at 24 and 25 weeks, but were improved compared with those in previous studies.
Differences in Characteristics of Dying Children Who Receive and Do Not Receive Palliative Care
Pediatric palliative care (PC) can be beneficial to children with life-threatening conditions and their families by providing symptom management and control, sibling support, bereavement services, spiritual guidance, support in decision-making about limiting burdensome medical interventions, and advance directives.
Little is known about actual receipt of PC by dying children. This study compares characteristics of dying children by receipt of PC and highlights underserved patient groups who could be targeted to improve access.
Association of Sibling Aggression With Child and Adolescent Mental Health
Popular press and research show that sibling aggression is common. Too often, however, it is dismissed as benign, and other forms of child aggression, such as peer aggression, are considered more serious. Peer aggression is linked to poorer mental health.
Using a national probability sample, we show that the nature and severity of sibling aggression have negative links to children’s and adolescents’ mental health. We demonstrate that sibling and peer aggression are comparable their links to symptoms of distress.
Racial and Ethnic Disparities in ADHD Diagnosis From Kindergarten to Eighth Grade
Minority children are less likely than white children to be diagnosed and treated with attention-deficit/hyperactivity disorder. However, diagnosis patterns over time in early and middle childhood and whether confounding factors explain these disparities are not currently well understood.
Racial/ethnic disparities in attention-deficit/hyperactivity disorder diagnosis occur by kindergarten and continue until eighth grade. Racial/ethnic disparities among diagnosed children in medication use occur in both fifth and eighth grades. These disparities are not attributable to confounding factors.
Racial and Ethnic Differences in Subspecialty Service Use by Children With Autism
Racial and ethnic differences exist in age at diagnosis and early access to mental and behavioral health services among children with autism spectrum disorders (ASDs). ASDs are also associated with increased rates of other medical comorbidities that may require specialty care.
Significant racial and ethnic differences in use of specialty care and specialty procedures exist among children with documented ASD.
Discharge Timing, Outpatient Follow-up, and Home Care of Late-Preterm and Early-Term Infants
Infants born late-preterm and early-term are at higher risk of morbidity and mortality compared with term infants. Home care practices recommended for all infants include supine sleep position, no smoke exposure, and breastfeeding to optimize health outcomes.
Our study provides new findings on the timing of hospital discharge, outpatient follow-up, and home care of late-preterm and early-term infants compared with term infants in the United States.
Implementation of a Parental Tobacco Control Intervention in Pediatric Practice
Young adult smokers frequently encounter the health care system as parents coming in for their child’s medical visit. Child health care clinicians, however, do not typically provide smoking cessation assistance to parents.
This national cluster-randomized trial demonstrates that a tobacco dependence intervention for parents can be effectively implemented in routine pediatric outpatient practice.
Using Otoacoustic Emissions to Screen Young Children for Hearing Loss in Primary Care Settings
The incidence of permanent hearing loss doubles between birth and school age. Otoacoustic emissions screening has been used successfully in early childhood educational settings to identify children with losses not found through newborn screening.
Using otoacoustic emissions to screen the hearing of young children during routine health care visits is feasible and can lead to the identification of permanent hearing loss overlooked by providers relying solely on subjective methods.
Mortality Risks in New-Onset Childhood Epilepsy
Seizure-related death, including sudden death, is a frightening prospect. In part because risk and prevention are poorly understood, neurologists tend to avoid discussions of sudden death with families and young patients.
Most deaths in children with epilepsy are not seizure related. Relative to the population, however, sudden and seizure-related deaths alone double overall mortality. In uncomplicated epilepsy, such deaths occur at rates comparable to individual leading causes of death in young people.
CT Scan Utilization Patterns in Pediatric Patients With Recurrent Headache
Although unnecessary for children with headache and normal history, computed tomography (CT) scans are widely used. Fewer than 1% of pediatric brain abnormalities present with headache as the only symptom. Furthermore, repeated CT scans may increase lifetime risk of cancer.
CT scans continue to be used to diagnose isolated pediatric headaches despite existing practice parameters. Although emergency department visits were correlated with greater likelihood of CT scan use, these scans were widely used across a variety of clinical settings.
Incidence and Risk Factors of Chronic Daily Headache in Young Adolescents: A School Cohort Study
Several studies have investigated the prevalence of chronic daily headache (CDH) and analyzed the risk factors for its persistence. However, the etiologic factors that lead to new-onset CDH remain unsettled in adolescents.
This study was the first incidence study of CDH conducted in young adolescents. We reported the incidence rates and found that some risk factors for incident chronic migraine and chronic tension-type headache were different.
Invasive Pneumococcal Disease in Infants Younger Than 90 Days Before and After Introduction of PCV7
Introduction of the pneumococcal conjugate vaccine was associated with decreased invasive pneumococcal disease (IPD) in children. Few data exist on the impact in infants aged 1 to 90 days, who are too young to be fully immunized.
The incidence and proportion of IPD in Utah infants aged 1–90 days remained stable after vaccine introduction. IPD caused by PCV7 serotypes decreased significantly in the post-vaccine period. Serotype 7F emerged as the predominant serotype and commonly resulted in meningitis.
Effectiveness of Monovalent and Pentavalent Rotavirus Vaccine
Monovalent rotavirus vaccine was introduced for infants in the United States in 2008. Previous US evaluations have not specifically assessed the performance of this vaccine under routine use.
Using the same methodology and covering the same time period, high effectiveness (∼90%) was demonstrated for the monovalent and the pentavalent rotavirus vaccine series against rotavirus disease resulting in emergency department/inpatient care, in children up to 2 years of age.
The RIVUR Trial: Profile and Baseline Clinical Associations of Children With Vesicoureteral Reflux
The ideal management of children with vesicoureteral reflux (VUR) remains a source of debate. There is little evidence to support many of the current management practices for children with VUR who have had 1 or 2 urinary tract infections.
Baseline associations, including bladder and bowel dysfunction and imaging studies, from the largest randomized, controlled trial conducted to date aimed at assessing the value of antimicrobial prophylaxis in children with urinary tract infection and VUR are presented.
Short-Course Prophylactic Zinc Supplementation for Diarrhea Morbidity in Infants of 6 to 11 Months
Randomized controlled trials have shown that zinc supplementation during diarrhea substantially reduces the incidence and severity. However, the effect of short-course prophylactic zinc supplementation has been observed only in children >12 months of age.
The current study was able to show that short-course prophylactic zinc supplementation significantly reduced diarrhea morbidity in apparently healthy infants of 6 to 11 months even after 5 months of follow-up.
Impact of Neonatal Growth on IQ and Behavior at Early School Age
Feeding difficulties often emerge during the neonatal period and affect neonatal growth. Growth throughout the first years of life is associated with children’s IQ scores and risk of behavioral problems.
Among infants born full term (≥37 weeks’ gestation) with birth weight ≥2500 g, gain in weight and head circumference during the neonatal period is associated with higher IQ, but not with behavior at 6.5 years of age.
Enrollment in Early Intervention Programs Among Infants Born Late Preterm, Early Term, and Term
Infants born late preterm and early term are at increased risk for short-term morbidities compared with term infants. Longer-term morbidity and disability in this group of infants is not well established.
Massachusetts infants born late preterm and early term are at increased risk of early intervention program enrollment than term infants. Boys and children whose mothers were less educated, older, and with public insurance were most affected.
Simplified Definitions of Elevated Pediatric Blood Pressure and High Adult Arterial Stiffness
Elevated blood pressure (BP) has long-term influence on the atherosclerotic process. The relative predictive ability of the standard BP definition endorsed by the National High Blood Pressure Education Program and the recently proposed 2 simplified definitions has not been studied.
Simplified pediatric BP tables predict risk of high adult arterial stiffness as well as the complex table does. These simple screening tools could be used for identifying pediatric subjects at risk and for intervening to improve adult cardiovascular outcomes.
Association of Fitness With Vascular Intima-Media Thickness and Elasticity in Adolescence
Atherosclerotic cardiovascular diseases are rooted in childhood. Vascular intima-media thickness (IMT) and elasticity are early surrogate markers of atherosclerosis. In adults, cardiorespiratory fitness is associated with enhanced arterial elasticity and decreased IMT.
Fitness was favorably associated with aortic IMT and elasticity in adolescents. The association was independent of several cardiometabolic risk factors. In fit adolescents, the increase in IMT during the preceding 6 years was smaller compared with low-fit peers.
Cardiorespiratory Fitness and Adiposity in Metabolically Healthy Overweight and Obese Youth
Obesity is associated with cardiometabolic risk factors and chronic conditions, such as type 2 diabetes. However, a proportion of overweight and obese youth remain free from cardiometabolic risk factors and are considered metabolically healthy.
This study provides insight into the determinants of cardiometabolic risk factors and the concept in health promotion of “fitness versus fatness.” Hepatic lipid accumulation and not fitness level appears to drive cardiometabolic risk factor clustering among overweight and obese youth.
Serum Uric Acid and Blood Pressure in Children at Cardiovascular Risk
Uric acid (UA) is associated with hypertension in children, after body weight adjustment. Whether the whole spectrum of variables, such as visceral adiposity, insulin resistance, puberty, and renal function, influence the relationship between UA and blood pressure is unknown.
In a cohort of children at relatively high cardiovascular risk, the association between UA and blood pressure levels is independent of several well-known factors implicated in the development of hypertension, such as insulin resistance, pubertal status, and renal function.
Childhood Obesity: Knowledge, Attitudes, and Practices of European Pediatric Care Providers
Health care professionals face problems managing obesity and often fail to follow guidelines for its management in practice. Only a few single-country reports are available describing delivery of primary care to children with obesity.
Nearly all primary pediatric care providers from 4 European countries recognize the importance of obesity in pediatric practice, but only half use BMI clinically, and many lack the confidence and the infrastructure needed for providing care to patients with obesity.
Outcomes of an Early Feeding Practices Intervention to Prevent Childhood Obesity
About one in five 2-year-olds are overweight, with potential adverse outcomes. Early feeding practices lay the foundation for food preferences and eating behavior and may contribute to future obesity risk. High-quality obesity prevention trials commencing in infancy are rare.
In this large randomized controlled trial, anticipatory guidance on the “when, what, and how” of complementary feeding was associated with increased maternal “protective” feeding practices. Differences in anthropometric indicators were in the expected direction but did not achieve statistical significance.
A Randomized, Masked, Placebo-Controlled Study of Darbepoetin Alfa in Preterm Infants
Preterm infants in the NICU receive the greatest number of transfusions of any patient population. The administration of the long-acting erythropoiesis stimulating agent (ESA) darbepoetin to reduce or eliminate transfusions in preterm infants has not been evaluated.
Infants receiving ESAs received half the number of transfusions and were exposed to approximately half the donors compared with the placebo group. More than half of the ESA recipients (59% darbepoetin recipients, 52% erythropoietin recipients) remained untransfused during their hospitalization.
Plastic Bags for Prevention of Hypothermia in Preterm and Low Birth Weight Infants
Preterm neonates in resource-poor settings frequently develop hypothermia. Plastic bags or wraps are a low-cost intervention for the prevention of hypothermia in infants in developed countries.
For preterm infants born in a resource-poor health facility, placement in a plastic bag at birth can reduce the incidence of hypothermia at 1 hour after birth.
A Randomized Trial of Exothermic Mattresses for Preterm Newborns in Polyethylene Bags
Wrapping very preterm newborns in polyethylene bags in the delivery room reduces hypothermia on admission to the NICU, but many infants remain cold despite their use. Placing polyethylene-wrapped infants on exothermic mattresses may reduce hypothermia but increase hyperthermia.
Placing polyethylene-wrapped very preterm infants on exothermic mattresses in the delivery room results in more infants with abnormal temperature and more hyperthermia on admission to the NICU.
Access to Digital Technology Among Families Coming to Urban Pediatric Primary Care Clinics
Internet, smartphones, and online social media offer new platforms for health promotion and disease management. Few studies have evaluated the use of digital technology among families receiving care in an urban pediatric primary care setting.
Caregivers in an urban pediatric primary care setting have access to and frequently use the Internet, smartphones, and online social media. These technologies may help reach a traditionally hard-to-reach population.
“Eczema Coxsackium” and Unusual Cutaneous Findings in an Enterovirus Outbreak
Coxsackievirus A6 (CVA6) was identified as an important cause of “severe” hand, foot, and mouth disease (HFMD) during the 2011–2012 outbreak in North America. The atypical cutaneous features in this outbreak have not been well documented.
The cutaneous manifestations of CVA6-associated HFMD may be more extensive and variable than classic HFMD. Four distinct morphologies characterize this exanthem: (1) widespread vesiculobullous and erosive lesions, (2) “eczema coxsackium,” (3) an eruption similar to Gianotti-Crosti, and (4) purpuric lesions.
Online Problem-Solving Therapy for Executive Dysfunction After Child Traumatic Brain Injury
Cognitive and behavioral problems after pediatric traumatic brain injury lead to poor functioning across multiple settings and can persist long-term after injury. Executive dysfunction is particularly common; however, there is a paucity of evidence-based interventions to guide treatment.
This study is among the largest randomized controlled trials performed in pediatric traumatic brain injury. It demonstrates the ability to use an online problem-solving-based intervention to improve caregiver ratings of executive dysfunction within 12 months after injury.
Risk Factors for Urolithiasis in Gastrostomy Tube Fed Children: A Case-Control Study
Patients who are fed via gastrostomy tube represent a heterogeneous, complex group of patients who may be at increased risk for kidney stones. To date, no previous studies have examined risk factors for kidney stone development in this population.
This case-control study of risk factors for urolithiasis in patients fed via gastrostomy suggests that topiramate use, urinary infections, and shorter length of time with a gastrostomy tube (possibly a marker for dehydration) are all associated with stone development.
Individual and Center-Level Factors Affecting Mortality Among Extremely Low Birth Weight Infants
Significant variation in the mortality of preterm infants has been observed among NICUs. Factors explaining this variation have been difficult to identify.
Sizable center differences in mortality exist, even among similarly sized NICUs in academic centers. Patient characteristics and center treatment rates explain some of the center effect, especially for the youngest infants, but a significant portion of these differences remains unexplained.
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- Copyright © 2013 by the American Academy of Pediatrics