Epidemiology of Bacteremia in Febrile Infants in the United States
Bacteremia occurs in 2.2% of febrile infants who have a blood culture drawn. Regional data suggest that Escherichia coli, group B Streptococcus, and Staphylococcus aureus are leading causes; however, the geographic boundaries of these data limit universal applicability.
This is the first national study examining epidemiology of bacteremia in febrile infants admitted to a general inpatient unit. The most common pathogens were Escherichia coli (42%), group B Streptococcus (23%), and Streptococcus pneumoniae (6%). No Listeria monocytogenes was identified.
Pediatricians' Involvement in Community Child Health From 2004 to 2010
Although community engagement is considered an important professional role of physicians, there has been declining involvement of pediatricians in community child health activities. Whether enhanced training is associated with increased involvement is unclear.
This study reveals a continued decline in pediatricians’ involvement in community child health activities and is the first national study to identify a link between formal training and pediatricians’ community involvement.
Incidence of Obesity Among Young US Children Living in Low-Income Families, 2008–2011
One study examined the incidence of obesity among low-income children aged <5 years who participated in federally funded child health and nutrition programs during 1985–1990. The study examined the variations by baseline age but not by gender or race/ethnicity.
This study provides most recent data on incidence and reversing of obesity and variations across gender, baseline age, and racial/ethnic subgroups among young low-income children. We conducted multivariable analyses to examine the relative risk of obesity in population subgroups.
Gun Violence Trends in Movies
Previous research has shown the following: the mere presence of weapons can increase aggression, dubbed the “weapons effect”; violence in films has increased over time; and violent films can increase aggression.
This study examines a potential source of the “weapons effect”: the presence of guns in films. In just 20 years, gun violence in PG-13 films (age 13+) has increased from the level in films rated G/PG to the point where it exceeds the level in R films.
Onset of Breast Development in a Longitudinal Cohort
Several studies have documented earlier onset of pubertal maturation in girls, with several potential factors attributed to the earlier onset.
This study demonstrates earlier maturation in white non-Hispanic girls, with greater BMI linked as a major factor. The entire distribution of pubertal timing has shifted to a younger age, suggesting redefinition of ages for both early and late maturation.
Age at Menarche and Age at First Sexual Intercourse: A Prospective Cohort Study
Young age at first sexual intercourse (FSI) is related to risk-taking behaviors and negative outcomes. Previous studies using a cohort or cross-sectional design have concluded that younger age at menarche (AAM) is related to younger age at FSI.
This large birth cohort study is the first to address the temporal relationship between AAM and FSI. We found that younger AAM does not confer higher risk of early FSI, whether in terms of calendar age or time since menarche.
The Architecture of Provider-Parent Vaccine Discussions at Health Supervision Visits
An increasing number of parents have concerns about childhood vaccines. Parents consistently cite their child’s provider as influential in their vaccine decision-making. Little is known about how providers communicate with parents about vaccines and which communication strategies are important.
How providers initiate the vaccine recommendation at health supervision visits appears to be an important determinant of parent resistance. Also, when providers pursue their original vaccine recommendations in the face of parental resistance, many parents subsequently agree to vaccination.
Cough and Cold Medication Adverse Events After Market Withdrawal and Labeling Revision
In 2007, manufacturers voluntarily withdrew over-the-counter (OTC) infant cough and cold medications (CCMs) from the US market. A year later, manufacturers announced OTC CCM labeling would be revised to warn against OTC CCM use by children aged <4 years.
Among children aged <2 and 2 to 3 years, emergency department visits for CCM adverse events declined nationally after the withdrawal and labeling revision announcement relative to all adverse drug event visits. Unsupervised ingestions caused most CCM adverse events after each intervention.
Probiotic Effects on Late-onset Sepsis in Very Preterm Infants: A Randomized Controlled Trial
Late-onset sepsis is a frequent complication of prematurity, contributing to morbidity and mortality. Although evidence is accumulating that administration of probiotics to very preterm infants reduces necrotizing enterocolitis (NEC) and all-cause mortality, the effect on late-onset sepsis is less clear.
The probiotic combination Bifidobacterium infantis, Streptococcus thermophilus, and Bifidobacterium lactis reduced NEC in very preterm infants, but not mortality or late-onset sepsis. Probiotics may be of greatest global value in neonatal settings with high rates of NEC.
Pediatric Palliative Care Programs in Children’s Hospitals: A Cross-Sectional National Survey
Over the past 10 years, children’s hospitals increasingly have established pediatric palliative care programs, but little is known about the prevalence of these programs or their geographic distribution, range of services offered, staff composition, or funding.
Among the 162 hospitals that responded to this survey (71.7% response rate), 69% have a pediatric palliative care program, with substantial variation across programs in terms of how they are staffed and funded and what services they provide.
Reducing Children’s Exposure to Secondhand Smoke at Home: A Randomized Trial
The World Health Organization estimates that ∼700 million children breathe tobacco smoke polluted air, particularly at home. Educational strategies either directly or indirectly targeting household decision-makers through other family members are effective in reducing children's exposure in private homes.
Intensive intervention was effective in decreasing children’s personal exposure to secondhand smoke (SHS), educating mothers about SHS, and promoting smoking restrictions at home. However, superiority over minimal intervention to decrease children’s personal exposure to SHS was not statistically significant.
Media Use and Sleep Among Boys With Autism Spectrum Disorder, ADHD, or Typical Development
Children with autism spectrum disorders (ASD) or attention-deficit/hyperactivity disorder (ADHD) are at increased risk for sleep disturbances and excessive media use. However, the relationship between media use and sleep in children with ASD or ADHD has not been studied.
In-room access to screen-based media and video game hours were associated with less sleep among boys with ASD. The relationships between media use and sleep were much more pronounced among boys with ASD than among boys with ADHD or typical development.
Telemedicine Consultations and Medication Errors in Rural Emergency Departments
Medication errors occur frequently among pediatric patients, particularly those treated in rural emergency departments (EDs). Although telemedicine has been proposed as a potential solution, there are few data supporting its clinical effectiveness and its effect on medication errors.
The use of telemedicine to provide pediatric critical care consultations to rural EDs is associated with less frequent physician-related ED medication errors among seriously ill and injured children. Therefore, this model of care may improve patient safety in rural hospital EDs.
The Effect of Obesity in Adolescence on Adult Health Status
Adverse effects of excess weight are likely related to both obesity severity and duration. Little is known about the contribution of adolescent weight status to development of specific comorbid conditions in adults.
Severe obesity at age 18 was independently associated with increased risk of lower extremity venous edema, walking limitation, kidney dysfunction, polycystic ovary syndrome, respiratory conditions, diabetes, and hypertension in adulthood.
Strength Training and Physical Activity in Boys: a Randomized Trial
Levels of daily physical activity in children are decreasing worldwide. This implies risk factors for cardiovascular and metabolic diseases.
Strength training makes children not only stronger but significantly increases their daily spontaneous physical activity outside the training intervention.
Frequency and Variety of Inpatient Pediatric Surgical Procedures in the United States
Pediatric surgery is performed in a variety of hospital types. General surgeons as well as fellowship-trained pediatric surgeons and surgical subspecialists perform inpatient operative procedures on infants and children. The distribution of procedures between specialists is not well characterized.
This study describes the demographics of pediatric surgery: the hospital type, the surgical procedures, and the quantity of inpatient pediatric surgery in the U.S. today. By implication, the data has much to inform health care about hospital and practitioner workforce.
Changes in Children’s Sleep Duration on Food Intake, Weight, and Leptin
Epidemiologic studies have documented that children’s sleep duration is associated with obesity risk. Experimental studies with adults suggest that short sleep may lead to changes in appetite-regulating hormones and food intake, which could lead to weight gain over time.
This controlled experimental study demonstrates that compared to sleeping less, when children increase sleep, they report decreased caloric intake, have lower fasting leptin levels, and weigh less. Such changes, if maintained, could help prevent excess weight gain over time.
Sexual Risk Taking and Bullying Among Adolescents
Bullying involvement is associated with deleterious psychological, educational, and health effects. However, little is known about relations between bullying involvement and sexual risk-taking behaviors or whether similar patterns hold for heterosexual and gay, lesbian, bisexual, transgendered, or questioning adolescents.
Among adolescents, bullies and bully-victims engaged in more casual sex and sex under the influence than their peers. Controlling for demographic characteristics and other victimization exposures, bully and bully-victim status predicted sexual risk taking but primarily for heterosexual adolescents.
Resuscitation of Preterm Neonates With Limited Versus High Oxygen Strategy
Preterm infants can be successfully resuscitated with <100% oxygen (O2); however, initiation with room air remains controversial. Current Neonatal Resuscitation Program (NRP) guidelines suggest using air or blended O2 to titrate O2 to meet target preductal saturation goals.
This is the first trial to compare a limited O2 strategy to target NRP–recommended transitional goal saturations versus a high O2 strategy in preterm infants. The limited O2 strategy decreased integrated excess oxygen and oxidative stress and improved respiratory outcomes.
Adiposity and Different Types of Screen Time
Screen time has risen to unprecedented levels among youth. Greater television time is known to be associated with gains in pediatric adiposity, but few studies have examined the longitudinal relations of other forms of screen-based media with weight gain.
Among adolescents aged 9 to 19 years, television viewing was the type of screen time most consistently associated with gains in BMI. However, time with digital versatile discs/videos and video/computer games was also associated with gains in BMI among girls.
Overweight Adolescents and Life Events in Childhood
Psychosocial stress in childhood has been associated with a greater risk of future overweight, although the associations have not always been consistent, the types of psychosocial stressors have often been somewhat extreme, and moderators of the association have rarely been examined.
Experiencing many negative life events in childhood, particularly with chronicity or events that are family health related, increases risk of overweight by age 15 years. Maternal obesity and greater delay of gratification for food each intensify this risk.
Bidirectional Associations Between Mothers’ and Fathers’ Parenting Consistency and Child BMI
Parents influence their child’s overweight development through lifestyle-related parenting practices. Although broader parenting dimensions may also affect children’s BMI, reverse causality is possible and there have been calls to examine the possible impacts of fathers.
More consistent parenting prospectively predicted lower child BMI with effects equally strong for fathers and mothers. There was little evidence of child BMI influencing parenting. Improved child BMI could be among the benefits of promoting parenting consistency of both parents.
Psychosocial Outcomes of Young Adults Born Very Low Birth Weight
Several studies have suggested that very low birth weight young adults have increased risks of physical and health problems, educational underachievement, and poorer social functioning than their peers, but there are limited population-based and longitudinal data.
Former VLBW young adults in this national cohort scored as well as term controls on many measures of health and social functioning, including quality-of-life scores, with some differences largely confined to those with disability at age 7 to 8 years.
Introduction of Complementary Foods and the Relationship to Food Allergy
Breast milk is protective against many conditions, but its role in allergy has not been established. Infant-feeding recommendations support exclusive breastfeeding for 26 weeks, whereas allergy prevention recommendations advise exclusive breastfeeding for 4 to 6 months with continued breastfeeding thereafter.
Evidence that continued breastfeeding while solids are introduced into the diet and delaying the introduction of solids until at least 17 weeks of age are associated with fewer food allergies.
Neuraminidase Inhibitors for Critically Ill Children With Influenza
Few data on treating children hospitalized for influenza with neuraminidase inhibitors are available, contributing to uncertainty regarding the benefits of treatment.
This study of nearly 800 critically ill children suggests that treatment with neuraminidase inhibitors improves survival from influenza. This message needs additional emphasis, given that in the past 2 seasons over one-third of cases did not receive antiviral treatment.
National, Regional, and State Abusive Head Trauma: Application of the CDC Algorithm
Abusive head trauma (AHT) is a rare phenomenon that results in devastating injuries to children. It is necessary to analyze large samples to examine changes in rates over time.
This is the first study to examine rates of AHT at the national, regional, and state level. The results provide a more detailed description of AHT trends than has been previously available.
Longitudinal Validation of a Tool for Asthma Self-Monitoring
To prevent asthma exacerbations, asthma guidelines recommend ongoing monitoring of patients’ asthma symptoms to promote timely adjustments of therapy to achieve and maintain optimal control. Existing tools, validated for ongoing monitoring, have significant limitations in children.
Our study established longitudinal validation of the Asthma Symptom Tracker, a novel tool designed for use by children or their parents to facilitate ongoing monitoring of patients’ asthma symptoms and proactive medical decision-making to prevent acute exacerbations.
Gestational Age, Birth Weight, and Risk of Respiratory Hospital Admission in Childhood
Preterm birth is associated with increased morbidity during childhood. Many studies have focused on outcomes for preterm births before 32 weeks’ gestation, but there are few follow-up data for late preterm infants (34–36 weeks’ gestation).
The risk of respiratory admission during childhood decreased with each successive week in gestation up to 40 to 42 weeks. The increased risk is small for late preterm infants, but the number affected is large and has an impact on health care services.
Development and Evaluation of Global Child Health Educational Modules
Global health is of increasing interest and relevance to North American pediatric trainees. Opportunities for resident global health training and exposure are most often limited to electives or trainees in dedicated global health tracks.
A series of short, structured, participatory global child health modules improved knowledge and were well received and integrated within academic programs. Such modules enable global health learning for all residents, including those who never intend to practice overseas.
Child Exposure to Parental Violence and Psychological Distress Associated With Delayed Milestones
It has previously been shown that exposure to intimate partner violence and/or parental depression or anxiety may increase a child’s risk for specific adverse health outcomes.
By using a large pediatric primary care sample, this study examined associations of child exposure to intimate partner violence and parental psychological distress with developmental milestone attainment by analyzing their combined and separate effects while adjusting for other family factors.
Using Electronic Health Records to Conduct Children’s Health Insurance Surveillance
Stable health insurance coverage facilitates access to health care. Despite expanded coverage options for children, parents report barriers to accessing insurance programs for their children, including uncertainty about a child’s coverage status and eligibility.
Electronic health records can be used as an emerging data source for conducting health insurance surveillance to track trends in patients’ insurance coverage status, and to identify patients who may benefit from outreach and support to obtain and maintain coverage.
Community Household Income and Resource Utilization for Common Inpatient Pediatric Conditions
Socioeconomic status is known to influence health and health care utilization, but few studies have explored the relationship between community-level income and inpatient resource utilization for children.
In a large sample of pediatric hospitalizations, lower community-level household income is associated with higher inpatient costs of care for common conditions. These findings highlight the need to consider socioeconomic status in health care system design and reimbursement.
Accuracy of Triage for Children With Chronic Illness and Infectious Symptoms
Children with chronic illnesses tend to be sicker during infections than previously healthy children but are triaged in the same way, even though the validity of triage systems has not yet been evaluated in these chronically sick children.
The performance of the Manchester Triage System was lower for children with a chronic illness than for previously healthy children. Children with cardiovascular illnesses, respiratory illnesses, gastrointestinal illnesses, or other congenital or genetic defects were especially at risk of being undertriaged.
Catheter Dwell Time and CLABSIs in Neonates With PICCs: A Multicenter Cohort Study
Peripherally inserted central catheters (PICCs) are essential to deliver life-saving treatment to neonates. Longer PICC dwell times may increase the risk of central line–associated bloodstream infections (CLABSIs) in neonates, but previous studies have yielded inconsistent results, likely due to different study designs, analytic methods, and small sample sizes.
The risk of CLABSIs increases during the 2 weeks after PICC insertion and remains elevated for the catheter duration. These data support daily review of PICC necessity, optimization of catheter maintenance practices, and consideration of novel strategies to prevent CLABSIs.
Potential Asphyxia and Brainstem Abnormalities in Sudden and Unexpected Death in Infants
Certain characteristics of the sleep environment increase the risk for sleep-related, sudden, and unexplained infant death. These characteristics have the potential to generate asphyxia. The relationship between the deaths occurring in these environments and neurochemical abnormalities in the brainstem that may impair protective responses to asphyxia is unknown.
We report neurochemical brainstem abnormalities underlying cases of sudden infant death that are associated with and without potential asphyxial situations in the sleep environment at death. The means to detect and treat these abnormalities in infants at risk are needed.
Serum Tocopherol Levels in Very Preterm Infants After a Single Dose of Vitamin E at Birth
Preterm infants are born with low serum levels and low body stores of tocopherol. Serum levels ≥0.5 mg/dL are required for protection against lipid peroxidation. Previous studies have shown good intestinal absorption of vitamin E given intragastrically to preterm infants.
Serum α-tocopherol increases after a single 50-IU/kg dose of vitamin E as dl-α-tocopheryl acetate given intragastrically to very preterm infants soon after birth; however, 30% of infants still have serum α-tocopherol level <0.5 mg/dL 24 hours after dosing.
Intravenous Magnesium Sulfate for Vaso-occlusive Episodes in Sickle Cell Disease
Vaso-occlusive episodes (VOEs) are a common complication of sickle cell disease, resulting in morbidity. Magnesium is a vasodilator and has been shown to improve red blood cell hydration. Previous small studies have suggested that treatment with magnesium may decrease VOEs.
Intravenous magnesium sulfate is well tolerated in relatively high doses but had no effect on the length of stay in hospital, pain scores, or cumulative analgesia used in children admitted with painful VOEs in sickle cell disease.
Neurofibromatosis Type 1 and Autism Spectrum Disorder
NF1 is the commonest single-gene neurodevelopmental disorder with known neurobiology and developmental impact on attention and cognition. Its impact on social functioning is described but poorly understood, with no population-based study of autism spectrum disorder (ASD) prevalence in the disorder.
This epidemiological study shows high prevalence of 25% ASD in NF1 not explained by learning difficulties. ASD should be considered during clinical practice with NF1. Further research into NF1 as a single-gene model of ASD is warranted.
Acetylcholinesterase Activity and Neurodevelopment in Boys and Girls
Prenatal and postnatal organophosphate (cholinesterase inhibitor) pesticide exposure has been associated with delays in attention, memory, intelligence, and inhibitory control. Two recent studies reported decreased attention and working memory with greater exposure to organophosphates in boys but not in girls.
This is the first study to report associations between decreased acetylcholinesterase activity, a stable marker of cholinesterase inhibitor pesticide exposure, and lower overall neurodevelopment, attention, inhibitory control, and memory. These associations were present in boys but not in girls.
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- Copyright © 2013 by the American Academy of Pediatrics