Management of Febrile Neonates in US Pediatric Emergency Departments
Recommended management of febrile neonates (≤28 days) includes blood, urine, and cerebrospinal fluid cultures with hospital admission for antibiotic therapy. No study has reported adherence to standard recommendations in the management of febrile neonates in US pediatric emergency departments.
There is wide variation in adherence to recommended management of febrile neonates. High rates of serious infections in admitted patients but low return rates for missed infections in discharged patients suggest additional studies needed to understand variation from current recommendations.
2010 Perinatal GBS Prevention Guideline and Resource Utilization
An algorithm for neonatal early-onset sepsis risk based on Centers for Disease Control and Prevention 2002 guidelines for prevention of perinatal Group B Streptococcus disease results in the evaluation of ∼12–15% of well-appearing term and late preterm infants.
A revised algorithm based on the Centers for Disease Control and Prevention 2010 guidelines eliminated 25% of all early-onset sepsis evaluations and resulted in significant cost savings, without short-term evidence of harm.
Antidepressants and Suicide Attempts in Children
Warnings of increased risk for suicidality have been placed on antidepressant medications. Because antidepressants differ in their characteristics, including effects on neurotransmitters, it is possible that the risk of suicidal behavior for individual medications may differ.
In a cohort of 36 842 children with review of medical records for confirmation of suicide attempts, we found no difference for risk of suicide attempts among individual medications compared with fluoxetine, the currently recommended antidepressant for treatment of depression.
Usefulness of Symptoms to Screen for Celiac Disease
Celiac disease (CD) often goes undiagnosed. Current guidelines suggest intensified active case-finding, with liberal testing of children with CD-associated symptoms and/or conditions. However, methods for also finding undiagnosed CD cases in the general population should be explored and evaluated.
In a population-based CD screening, information on CD-associated symptoms and conditions, obtained before knowledge of CD status, was not useful in discriminating undiagnosed CD cases from non-CD children. The majority of screening-detected CD cases had no CD-associated symptoms or conditions.
Hospitalizations Due to Firearm Injuries in Children and Adolescents
Firearm injuries are the second leading cause of death among American children. Previous estimates of nonfatal injuries have relied on small samples of emergency department visits and do not allow a detailed understanding of these injuries among children and adolescents.
In 2009, there were 7391 hospitalizations for firearm-related injuries in US children and adolescents; 89% of hospitalizations occurred in males. Hospitalization rates were highest for 15- to 19-year-olds and for black males. Deaths in the hospital occurred in 6.1% of children and adolescents.
Mortality and Morbidity of VLBW Infants With Trisomy 13 or Trisomy 18
Infants with trisomy 13 (T13) or trisomy 18 (T18) are known to have poor survival. Little is known about how very low birth weight (VLBW) impacts survival and morbidities among infants with T13 or T18.
We examined the risks of mortality and neonatal morbidities for VLBW infants with T13 or T18 compared with VLBW infants with trisomy 21 and VLBW infants without birth defects in a 16-year cohort from the Neonatal Research Network.
Changes in the Incidence of Candidiasis in Neonatal Intensive Care Units
The incidence of invasive candidiasis in hospitalized infants is related to postnatal exposures, but large-scale studies relating the incidence of invasive candidiasis to changes in exposures over time are not available.
This study describes the association between the incidence of invasive candidiasis and changes in use of antifungal prophylaxis, empirical antifungal therapy, and broad-spectrum antibacterial antibiotics over time.
Cost-effectiveness Analysis of the National Perinatal Hepatitis B Prevention Program
Infant postexposure prophylaxis prevents perinatal hepatitis B (HepB) virus transmission and mortality and morbidity caused by chronic HepB virus infection. The US Perinatal Hepatitis B Prevention Program (PHBPP) identifies and manages infants born to HepB surface antigen–positive women.
It presents the first estimates of the long-term costs and outcomes of postexposure prophylaxis with the PHBPP. It analyzes the effects of the PHBPP, and alternative immunization scenarios, on health and economic outcomes for the 2009 US birth cohort.
Emergency Department Visits Resulting From Intentional Injury In and Out of School
Injuries sustained by children in the school setting have a significant public health impact. A concerning subgroup of school injuries are due to intentional and violent etiologies. Several studies have identified a need for further research to understand intentional school-based injuries.
This study discusses national estimates and trends over time and risk factors of intentional injury–related emergency department visits due to injuries sustained in the school setting.
Disparities in Age-Appropriate Child Passenger Restraint Use Among Children Aged 1 to 12 Years
Age-appropriate child safety seat use in the United States is suboptimal, particularly among children older than 1 year. Minority children have higher rates of inappropriate child safety seat use based on observational studies. Explanations for observed differences include socioeconomic factors.
White parents reported greater use of age-appropriate child safety seats for 1- to 7-year-old children than nonwhite parents. Race remained a significant predictor of age-appropriate restraint use after adjusting for parental education, family income, and information sources.
Shoulder Injuries Among US High School Athletes, 2005/2006–2011/2012
Shoulder injuries are common among high school athletes. These injuries, both traumatic and overuse, contribute to significant time loss from athletic activity. Understanding sport-specific injury patterns is critical for development of targeted injury prevention programs.
This study is the most comprehensive analysis of high school shoulder injuries to date, providing national injury estimates while examining injury rates, diagnoses, severity, and mechanisms of injury in 9 interscholastic sports.
Variation in Quality of Tonsillectomy Perioperative Care and Revisit Rates in Children’s Hospitals
Tonsillectomy is one of the most commonly performed surgeries in children and is one of the most cumulatively expensive conditions in pediatric hospital care. Little is known about how the quality of tonsillectomy care varies across hospitals.
In a large cohort of low-risk children undergoing same-day tonsillectomy, there was substantial variation in quality measures of process, dexamethasone and antibiotic use, and outcome, revisits to the hospital within the first 30 days after surgery.
Xylitol Syrup for the Prevention of Acute Otitis Media
Xylitol given as a gum or syrup 5 times daily has been shown to reduce the incidence of acute otitis media in children, but this dosing schedule is unlikely to be feasible for many families.
A regimen of viscous xylitol syrup in a dose of 5 g 3 times daily was ineffective in preventing recurrences of acute otitis media in otitis-prone children.
Sexting and Sexual Behavior in At-Risk Adolescents
Sending sexual messages and/or pictures (sexting) has been associated with sexual intercourse among high school–age students.
This study is the first to examine sexting’s prevalence among at-risk middle school students and its associations with a range of sexual behaviors. It also examines differences in sexual risk between sending sexual messages and sexual photos.
Adherence to Label and Device Recommendations for Over-the-Counter Pediatric Liquid Medications
Due to reports of unintentional overdoses, in 2011 the US Food and Drug Administration finalized voluntary recommendations for dosing devices included with over-the-counter (OTC) liquid medications. The Consumer Healthcare Products Association previously endorsed similar recommendations for devices and dosing directions.
This study assessed dosing directions and devices for national brand name OTC liquid medications, available after a voluntary FDA guidance, and found high levels of adherence to most recommendations. Further improvement efforts should prioritize recommendations directly addressing potential dosing errors.
Association of Maternal Self-Medication and Over-the-Counter Analgesics for Children
Self-medication with over-the-counter (OTC) analgesics, particularly paracetamol (PCM), among children is widespread and increasing. Parents often administer the medicine. The health care system has little knowledge or possibility to regulate OTC medication, and use of PCM for children may be partly unjustified.
Maternal frequent self-medication with OTC analgesics is associated with frequent use of OTC analgesics, particularly PCM, among 6- to 11-year-old schoolchildren, even when the child’s frequency of pain is accounted for.
Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms
Cognitive rest is recommended for the management of sport-related concussions. There are limited data to support this recommendation.
This study adds empirical data supporting the recommendation for cognitive rest after a sport-related concussion.
Long-term Cardiovascular Outcomes in Survivors of Kawasaki Disease
Kawasaki disease (KD) results in coronary aneurysm formation and an increased risk of cardiovascular complications. Modern treatment of acute KD with intravenous immunoglobulin substantially reduces the rate of acute aneurysm formation.
This study reveals that long-term cardiovascular outcomes for KD patients in the current era are not significantly different than matched controls without KD. Late cardiovascular complications are almost exclusively seen in patients with persistent coronary aneurysms.
Human Rhinovirus and Disease Severity in Children
Human rhinovirus has been known as the common cold agent. Recently, studies have reported that this virus is responsible for severe infections of the lower respiratory tract in children. Reports of factors that increase disease severity have been contradictory.
This study identifies some of the factors involved in disease severity in HRV infections in children. We expect that children at risk for developing severe disease could be identified sooner and appropriate measures could be taken.
Risk Factors and Outcomes for Multidrug-Resistant Gram-Negative Bacteremia in the NICU
There is a perception that Gram-negative bacilli (GNB) bloodstream infection is increasing in the NICU, and those infections caused by a multidrug-resistant (MDR) strain are a growing threat to hospitalized patients.
Exposure to broad-spectrum antibiotics is the most important risk factor for MDR GNB bacteremia, which is associated with higher mortality. Neonates with risk factors for bacteremia caused by a MDR GNB strain may benefit from empirical antimicrobial therapy with carbapenem.
Diagnostic Performance of BMI Percentiles to Identify Adolescents With Metabolic Syndrome
The Centers for Disease Control and FITNESSGRAM BMI percentile thresholds are commonly used for obesity screening in youth. It is assumed that these thresholds are predictive of metabolic health risk, but little diagnostic data are available.
Both thresholds are predictive of metabolic syndrome, more so for boys than for girls, although with differing sensitivity and specificity. The diagnostic details of the thresholds can inform clinicians and practitioners about how these standards perform in practice.
Preterm Infant’s Early Crying Associated With Child’s Behavioral Problems and Parents’ Stress
Preterm infants are at an increased risk of regulatory difficulties during infancy and of behavioral problems in childhood. In the full-term population, persistent crying problems that last beyond 3 months of age have been related to later behavioral problems.
Excessive crying by a preterm infant may reflect an increased risk for later behavioral problems and higher parenting stress even years later. Therefore, it is clinically relevant to assess systematically the crying behavior of preterm infants.
Preventing Early Infant Sleep and Crying Problems and Postnatal Depression: A Randomized Trial
Infant sleep and crying problems are common and associated with postnatal depression. No programs aiming to prevent all 3 issues have been rigorously evaluated.
A prevention program targeting these issues improves caregiver mental health, behaviors, and cognitions around infant sleep. Implementation at a population level may be best restricted to infants who are frequent feeders because they experience fewer crying and daytime sleep problems.
Cotinine in Children Admitted for Asthma and Readmission
Serum and salivary cotinine have previously been identified as reliable biomarkers for exposure to tobacco smoke.
We found that detectable serum and salivary cotinine is common among children admitted for asthma and is associated with readmission. This finding may inform clinical care for children at increased risk of asthma morbidity.
Diagnostic and Prognostic Value of Procalcitonin and C-Reactive Protein in Malnourished Children
Biomarkers such as C-reactive protein (CRP) and procalcitonin are elevated in children with severe bacterial infections. Children with severe malnutrition are at increased risk of bacterial infections and early markers for the diagnosis of infection in these children are needed.
Despite elevated values in severely malnourished children with invasive bacterial infection or infectious diarrhea, CRP and procalcitonin have limited diagnostic value. CRP could predict death in these children with a good negative predictive value.
School-Based Health Promotion and Physical Activity During and After School Hours
The effects of previous school-based physical activity promotion interventions have been modest, and none have demonstrated significant or meaningful increases in children’s physical activity outside of school, a period characterized by disproportionally low levels of physical activity in youth.
This study adds to the evidence-base for the effectiveness of comprehensive school health programs by demonstrating that such novel interventions lead to statistically significant, meaningful increases in the amount of physical activity children achieved on weekends and after school hours.
Closed-Loop Automatic Oxygen Control (CLAC) in Preterm Infants: A Randomized Controlled Trial
In preterm infants receiving supplemental oxygen, manual control of the inspired oxygen fraction is often difficult and time consuming, which may increase the risk of complications. We developed a system for automatic oxygen control and proved its efficacy in the past.
A multicenter study adds evidence for the proposed automatic oxygen control system to significantly improve oxygen administration to preterm infants receiving mechanical ventilation or nasal continuous positive airway pressure while reducing workload compared with routine manual oxygen control.
Uppsala Longitudinal Study of Childhood Obesity: Protocol Description
Childhood obesity poses a serious threat to human health. Obesity is caused by genetic and environmental factors and linked to type 2 diabetes and cardiovascular disease. Pediatric obesity cohorts aim at understanding early events in the pathophysiology of obesity-related complications.
Cohort subjects are examined at consecutive visits, including measurements of glucose tolerance and hormones regulating nutrient handling (enhanced glucose tolerance tests) and body composition (MRI and bioimpedance). Mechanisms causing obese children to progress to type 2 diabetes are delineated.
Sibship Size, Sibling Cognitive Sensitivity, and Children’s Receptive Vocabulary
Sibship size has been negatively associated with children’s language, cognitive, and academic outcomes. This phenomenon is often explained in terms of resource dilution, wherein more children in the home is associated with fewer parental resources allocated to each child.
The current study identifies a moderator of this relationship. Specifically, if children’s next-in-age older siblings exhibit high levels of cognitive sensitivity then sibship size is not significantly related to children’s vocabulary.
Patient Health Questionnaire for School-Based Depression Screening Among Chinese Adolescents
Major depression is common among adolescents. The PHQ-9 has good sensitivity and specificity for detecting depression among adolescents in primary care settings. However, no study has examined the psychometric properties of the PHQ-9 among Chinese adolescents in school settings.
This is the first study to validate the use of the PHQ-9, Patient Health Questionnaire–2 item, and Patient Health Questionnaire–1 item among Chinese adolescents in Taiwan. The PHQ-9 and its 2 subscales have good sensitivity and specificity for detecting depression among school adolescents.
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- Copyright © 2014 by the American Academy of Pediatrics