Prevalence and Characteristics of Fetal Alcohol Spectrum Disorders
Most studies of fetal alcohol syndrome and fetal alcohol spectrum disorders (FASD) prevalence in the general population of the United States have been carried out using passive methods (surveillance or clinic-based studies), which underestimate rates of FASD.
Using active case ascertainment methods among children in a representative middle class community, rates of fetal alcohol syndrome and total FASD are found to be substantially higher than most often cited estimates for the general US population.
Out-of-Hospital Medication Errors Among Young Children in the United States, 2002–2012
Medication errors involving children represent a frequently occurring public health problem. Since 2003, >200 000 out-of-hospital medication errors have been reported to US poison control centers annually, and ∼30% of these involve children <6 years of age.
During 2002–2012, an average of 63 358 children <6 years experienced out-of-hospital medication errors annually, or 1 child every 8 minutes. There was a significant increase in the number and rate of non–cough and cold medication errors during the study period.
Parental Desensitization to Violence and Sex in Movies
Movie ratings designed to warn parents about violence and sexual content have permitted increasing amounts of each in popular films. One potential explanation for this “ratings creep” is parental desensitization to this content as it becomes more prevalent in movies.
This study adds experimental evidence that parents become desensitized to movie violence and sex and are more willing to allow children to view such content.
College Health Service Capacity to Support Youth With Chronic Medical Conditions
The population of youth with chronic medical conditions is growing and many attend college. Yet we know little about US colleges’ capacity to identify and care for these youth, nor how transition guidelines and financing models should incorporate college health.
This is the first study to find that although many colleges can provide some clinical care for youth with chronic conditions, few colleges have systems to identify and track these students, elucidating gaps that pediatricians and institutions need to address.
Pediatricians’ Communication About Weight With Overweight Latino Children and Their Parents
Little is known about how pediatricians communicate with overweight Latino children and their parents regarding overweight and obesity.
Findings suggest that many overweight Latino children and their parents do not receive direct communication that the child is overweight, weight-management plans, culturally relevant dietary recommendations, or follow-up visits.
Transition Care for Children With Special Health Care Needs
More children with special health care needs are surviving to adulthood and entering the adult health care system. Effective transition of care can promote continuity of developmental and age-appropriate care for these individuals.
Existing studies provide modest transition care support. Methods for providing transition care warrant attention, and future research needs are wide ranging. Consistent and accepted measures of transition success are critical to establishing an adequate body of literature to affect practice.
Use of and Regional Variation in Initial CT Imaging for Kidney Stones
Professional organizations recommend ultrasound as the initial diagnostic imaging modality for children with suspected nephrolithiasis. Computed tomography utilization for children with nephrolithiasis treated at freestanding children’s hospitals is common and varies substantially by hospital.
The high prevalence and regional variability of CT as the first imaging study for children with nephrolithiasis who presented to emergency departments, outpatient clinics, and hospitals throughout the United States indicate that current imaging practices deviate substantially from guidelines.
Prenatal and Newborn Screening for Critical Congenital Heart Disease: Findings From a Nursery
The detection of critical congenital heart disease by fetal echocardiography or neonatal physical examination can have limitations. The addition of pulse oximetry screening in the newborn nursery increases the rate of diagnosis of these conditions before hospital discharge.
In a tertiary-care center with comprehensive fetal echocardiography, nearly all newborns with critical congenital heart disease are diagnosed prenatally. Pulse oximetry will identify more infants from settings with lower prenatal detection. Improving access to and training in fetal echocardiography should also improve detection of these conditions.
Childhood Obesity and Interpersonal Dynamics During Family Meals
Family meals are protective for child health, but there are inconsistent findings in relation to child weight status. More research is needed examining why family meals are protective for child health and whether there are differences by child weight status.
The current mixed-methods study used direct observational methods to examine family dynamics during family meals and child weight status. Results indicated that positive family interpersonal and food-related dynamics during family meals were associated with reduced prevalence of childhood obesity.
Sustainability of a Parental Tobacco Control Intervention in Pediatric Practice
Parental smoking cessation helps eliminate children’s exposure to tobacco smoke. A child’s visit to the doctor provides a teachable moment for parental smoking cessation. Effective strategies to help parents quit smoking are available for implementation.
Evidence-based outpatient intervention for parents who smoke can be delivered successfully after the initial implementation. Maximizing parental quit rates in the pediatric context will require more complete and sustained systems-level integration.
Neighborhood Influences on Girls’ Obesity Risk Across the Transition to Adolescence
The built environment may affect weight status by presenting opportunities or barriers for exercise and nutritious eating. Although there is substantial cross-sectional evidence linking neighborhood factors and childhood obesity, causal uncertainty remains, owing to conceptual and methodological challenges.
This prospective study examined neighborhood influences on obesity during the transition to adolescence, a sensitive period for excess weight gain. Girls living in neighborhoods characterized by physical disorder or increased access to food and service retailers exhibited higher obesity risk.
Circumcision of Privately Insured Males Aged 0 to 18 Years in the United States
Neonatal circumcision in the United States has been estimated to be performed in ∼58% of all neonates, and varies by US geographic region.
This study estimates neonatal and postneonatal circumcision rates among commercially insured males aged 0 to 18 years that were performed in both inpatient and outpatient settings. This study also estimates indications and payments for the procedure.
School-Based Health Centers as Patient-Centered Medical Homes
School-based health centers (SBHCs) are known to increase access to medical care and mental health services for at-risk adolescents. Policymakers have suggested that SBHCs could function as patient-centered medical homes, but SBHCs have not been evaluated in that context.
Using the constructs of the patient-centered medical home as defined by the American Academy of Pediatrics (accessibility, continuity, comprehensiveness, family-centeredness, coordination, and compassion), this study shows that SBHCs have the potential to function as medical homes from the perspective of adolescents and parents.
Feedback on Oral Presentations During Pediatric Clerkships: A Randomized Controlled Trial
Delivering competent oral case presentations is an important clinical communication skill, yet effective means of improving trainees’ presentations have not been identified.
Oral presentation feedback sessions facilitated by faculty by using an 18-item competency-based evaluation form early in pediatric clerkships improved medical students’ subsequent oral presentations. Medical schools should consider implementing this evidence-supported practice.
Longitudinal Association Between Teen Sexting and Sexual Behavior
Cross-sectional research indicates that teen sexting is common, may be associated with other adolescent behaviors such as substance use, does not appear to be a marker of mental well being, and is probably an indicator of actual sexual behaviors.
Although mounting evidence links teen sexting to sexual behavior, little is known about the temporal sequencing of these 2 behaviors. Knowing which comes first will aid tween- and teen-focused health care providers in their interaction with patients and patients’ parents.
Sofas and Infant Mortality
Sleeping on a sofa increases the risk of sudden and unexpected infant death.
Infant deaths on sofas are associated with nonsupine placement, being found in side position, surface sharing, changing sleep location, and experiencing prenatal tobacco exposure. These results may help explain why sofa sleeping is hazardous for infants.
Urokinase Versus VATS for Treatment of Empyema: A Randomized Multicenter Clinical Trial
There are discrepancies regarding which treatment is best in clinical practice for children with parapneumonic empyema, with some authors favoring video-assisted thoracoscopy and others favoring intrapleural fibrinolytic agents.
This study is one of the few randomized clinical trials on this subject in children and the first multicenter trial. It exclusively included patients with septated empyema. Thoracoscopy and fibrinolysis with urokinase were equally effective for this condition.
Adherence to Guidelines for Glucose Assessment in Starting Second-Generation Antipsychotics
In 2003, the US Food and Drug Administration issued warnings about hyperglycemia and diabetes with second-generation antipsychotics (SGAs). Since 2004, hyperglycemic and diabetes risk with SGAs has been stated in product labels, and published guidelines have recommended baseline metabolic screening.
Between 2006 and 2011, 11% of children 2 to 18 years starting an SGA had baseline glucose assessed. Youth at risk for diabetes may not be identified. Further, lack of screening impedes determining the contribution of SGAs to hyperglycemia.
Perinatal Complications and Aging Indicators by Midlife
Perinatal complications predict increased risk for morbidity and early mortality. Evidence of perinatal programming of adult mortality raises the question of what mechanisms embed this long-term effect. Telomere length and perceived facial age are 2 indicators of accelerated aging.
Perinatal complications predicted greater signs of accelerated aging “inside,” as measured objectively by leukocyte telomere length, an indicator of cellular aging, and “outside,” as measured subjectively by perceived age, an indicator of declining integrity of tissues.
Transcutaneous Bilirubin After Phototherapy in Term and Preterm Infants
Phototherapy decreases bilirubin concentration in skin more rapidly than in blood. During and after phototherapy, transcutaneous bilirubin measurements are considered unreliable and therefore discouraged.
Transcutaneous bilirubin underestimates total serum bilirubin by 2.4 mg/dL (SD, 2.1 mg/dL) during the first 8 hours after phototherapy. This gives a safety margin of ∼7 mg/dL below the treatment threshold to omit confirmatory blood sampling.
Serum Bilirubin and Bilirubin/Albumin Ratio as Predictors of Bilirubin Encephalopathy
Jaundiced newborns without additional risk factors rarely develop kernicterus if the total serum bilirubin is <25 mg/dL. Measuring the bilirubin/albumin ratio might improve risk assessment, but the relationships of both indicators to advancing stages of neurotoxicity are poorly documented.
Both total serum bilirubin and bilirubin/albumin ratio are strong predictors of advancing stages of acute and post-treatment auditory and neurologic impairment. However, bilirubin/albumin ratio, adjusted to the same sensitivity, does not improve prediction over total serum bilirubin alone.
Direct Antiglobulin Titer Strength and Hyperbilirubinemia
Direct antiglobulin titer (DAT) positive, blood group A or B newborns born to group O mothers have a high incidence of hyperbilirubinemia, attributable to increased hemolysis.
DAT ++ readings were associated with a higher incidence of hyperbilirubinemia and a greater degree of hemolysis than DAT ± or DAT + counterparts. DAT strength should be taken into consideration when planning treatment strategies or follow-up of ABO-heterospecific newborns.
Off-Hours Admission to Pediatric Intensive Care and Mortality
Admissions to the ICU during off-hours (nights and weekends) have been variably associated with increased mortality in both adults and children. Changes in staffing patterns, patient characteristics, or other factors may have influenced this relationship over time.
This study demonstrates in a large, current, multicenter database sample that off-hours admissions to PICUs are not associated with increased risk-adjusted mortality. Admissions in the morning from 6:00 am to 10:59 am are associated with increased mortality and warrant further attention.
Timing of Adiposity Rebound and Adiposity in Adolescence
Earlier adiposity rebound may increase fatness in later life; however, there is limited evidence from large cohorts of contemporary children with direct measures of fatness in adolescence or adulthood.
Early adiposity rebound is strongly associated with increased BMI and fatness in adolescence. Future preventive interventions should consider targeting early childhood to delay timing of adiposity rebound.
Neighborhood Poverty and Allostatic Load in African American Youth
Allostatic load (AL), a biomarker of cardiometabolic risk, predicts the onset of the chronic diseases of aging including cardiac disease, diabetes, hypertension, and stroke. Socioeconomic-related stressors, such as low family income, are associated with AL.
African American youth who grow up in neighborhoods in which poverty levels increase across adolescence evince high AL. The study also highlights the benefits of emotional support in ameliorating this association.
Prophylactic Indomethacin and Intestinal Perforation in Extremely Low Birth Weight Infants
Prophylactic indomethacin in extremely low birth weight infants decreases severe intraventricular hemorrhage and patent ductus arteriosus but it is unknown whether concurrent enteral feeding and prophylactic indomethacin is associated with increased risk of spontaneous intestinal perforation.
The combination of prophylactic indomethacin and enteral feeding during the first 3 days after birth does not increase the risk of spontaneous intestinal perforation.
Implementation Methods for Delivery Room Management: A Quality Improvement Comparison Study
Quality improvement (QI) studies generally do not account for concurrent trends of improvement and it is difficult to distinguish the impact of a multihospital collaborative QI project without a contemporary control group.
A multihospital collaborative QI model led to greater declines in hypothermia and invasive ventilation rates in the delivery room compared with an individual NICU QI model and NICUs that did not participate in formal QI activities.
Sociodemographic Differences and Infant Dietary Patterns
Despite breastfeeding recommendations by the World Health Organization and the American Academy of Pediatrics, there is less agreement on appropriate use of infant solid foods. There are currently no well-established dietary guidelines for US infants that are similar to the Dietary Guidelines for Americans (aged >2 years).
Distinct dietary patterns exist among US infants and have differential influences on growth. Use of “Infant guideline solids” (vegetables, fruits, baby cereal, and meat) with prolonged breastfeeding is a promising healthy dietary pattern for infants after age 6 months.
Differential Maternal Feeding Practices, Eating Self-Regulation, and Adiposity in Young Twins
Restrictive feeding by parents is associated with poorer eating self-regulation and increased child weight status. However, this association could be due to confounding home environmental or genetic factors that are challenging to control.
Differential maternal restrictive feeding is associated with differences in twins' caloric compensation and BMI z score. Controlling for the shared home environment and partially for genetics, these findings further support a true (ie, unconfounded) association between restriction and childhood obesity.
Receive summaries of articles in each month's issue of Pediatrics when you sign up at www.pediatrics.org.
- Copyright © 2014 by the American Academy of Pediatrics