Prevalence of Parental Misconceptions About Antibiotic Use
Attitudes and knowledge about appropriate management of common childhood illnesses may lead parents to mistakenly believe antibiotics are needed. Differences existed in antibiotic knowledge and attitudes between parents of Medicaid- and commercially insured children and according to other sociodemographic variables.
Despite efforts to decrease unnecessary antibiotic use, misconceptions about antibiotic use persist and continue to be more prevalent among parents of Medicaid-insured children. Tailored efforts for socioeconomically disadvantaged populations remain warranted to decrease parental drivers of unnecessary antibiotic prescribing.
Evaluation for Occult Fractures in Injured Children
Screening for occult fractures is a key component of the medical evaluation for young victims of suspected physical abuse. Little is known about adherence to occult fracture evaluation guidelines in children with suspected abuse cared for at non-pediatric-focused hospitals.
Occult fracture evaluations were performed in half of young children diagnosed with abuse or injuries concerning for abuse in a large cohort of hospitals. Evaluations were more common at hospitals caring for higher volumes of young, injured children.
Trends in Hospitalization for Pediatric Pulmonary Hypertension
Although existing analyses of inpatient pediatric pulmonary hypertension (PH) care have established an association with substantial morbidity and mortality, these investigations have been limited to small single-institution series or focused registries representative of selected patient subgroups.
This study provides the first contemporary, national trend analysis of inpatient care for children with PH. Pediatric PH is associated with a rapidly increasing number of hospital discharges and magnitude of resource utilization, and the makeup of this population is changing.
Recognizing Differences in Hospital Quality Performance for Pediatric Inpatient Care
Hospital quality-of-care measures are publicly reported to inform consumer choice and stimulate quality improvement. The number of hospitals and states with a sufficient number of pediatric hospital discharges to detect worse-than-average pediatric inpatient care quality remains unknown.
Most children are admitted to hospitals in which all-condition measures of inpatient quality are powered to show differences in performance from average, but most condition-specific measures are not. Policy on incentives for pediatric inpatient quality should take these findings into account.
Trends in Morbidity and Mortality of Extremely Preterm Multiple Gestation Newborns
Studies on the risk of mortality and morbidities of extremely preterm infants of multiple gestation births have shown inconsistent results. Perinatal antecedents, admission status and severity of illness after birth can adversely affect outcomes of the extremely premature infants.
Preterm multiple gestation infants have increased risk of mortality but similar risk of major morbidities compared with singletons. Outcomes improved over time and all adverse outcomes, including mortality, were comparable between multiples and singletons in the most recent 5-year epoch.
Integrating a Parenting Intervention With Routine Primary Health Care: A Cluster Randomized Trial
More than 200 million children <5 years are not reaching their developmental potential. Lack of stimulating caregiving is a major cause, and effective scalable interventions are needed. Integrating parenting with health services has been recommended, but there are few evaluations.
An innovative parenting intervention can be delivered at routine visits for primary health care, with benefits to child cognitive development and parenting knowledge. This approach using films, discussion, and practice has the potential for delivery at scale.
A Tailored Family-Based Obesity Intervention: A Randomized Trial
Although treatment programs for childhood obesity can demonstrate success, long-term outcomes have seldom been evaluated. The benefit of intervention when overweight is identified in a screening assessment and parental recognition of the problem is minimal is understudied.
A low-dose (sessions every 1–3 months), but long-term (2 years), family-based intervention was effective at reducing BMI compared with usual care in children recruited via a weight screening initiative in which many parents had been unaware their child was overweight.
Validation of a Prediction Tool for Abusive Head Trauma
A previous multivariable statistical model, using individual patient data, estimated the probability of abusive head trauma based on the presence or absence of 6 clinical features: rib fracture, long-bone fracture, apnea, seizures, retinal hemorrhage, and head or neck bruising.
The model performed well in this validation, with a sensitivity of 72.3%, specificity of 85.7%, and area under the curve of 0.88. In children <3 years old with intracranial injury plus ≥3 features, the estimated probability of abuse is >81.5%.
Home Foreclosure and Child Protective Services Involvement
Prior studies have found a positive relationship between macro-level indicators of home foreclosure and child maltreatment rates. The extent to which home foreclosure may be associated with child protective services involvement at the micro level is largely unknown.
Foreclosure filings are positively associated with child protective services involvement. However, this is true of the periods before and after a filing, which are characterized by economic and other stress, which may drive this association more than the filing itself.
Psychosocial Factors Associated With Adolescent Electronic Cigarette and Cigarette Use
Electronic cigarette (e-cigarette) use in adolescence is increasing. E-cigarette use has been associated with cigarette use, but there has been little study of other psychosocial risk factors for e-cigarette use and their relationship with cigarette use.
Approval and use of e-cigarettes and cigarettes among friends and family were strongly associated with cigarette and e-cigarette use in a cohort of adolescents in southern California.
Positive Parenting Practices, Health Disparities, and Developmental Progress
Interactive activities and routines promote early childhood language skills and subsequent educational achievement. Population studies describing parent-child participation in interactive activities and their associations with early child development among vulnerable populations are needed.
Significant disparities exist in parenting practices that promote child development between economically advantaged and disadvantaged parents. Participating in less interactive activities was associated with increased risk of developmental delay among low-income families, suggesting a need to enrich parenting practices.
Use of Temporary Names for Newborns and Associated Risks
Because there can be no delay in providing newborns with identification wristbands, some hospitals assign newborns temporary first names such as Babyboy or Babygirl. These nondistinct naming conventions result in a large number of patients with similar identifiers in NICUs.
We performed an intervention study to determine if assigning distinct first names at birth would result in a reduction in wrong-patient errors. We used the Retract-and-Reorder tool, an established, automated tool to detect the outcome measure of wrong-patient electronic orders.
Statewide Medicaid Enhanced Prenatal Care Programs and Infant Mortality
Medicaid made substantial investments in enhanced prenatal and postnatal care programs to address maternal and infant health, including infant mortality. Evaluations of population-based programs are few, and although some have reported reductions in infant mortality, they have methodological limitations.
A population-based home visitation program can be a successful approach to reduce infant mortality. The reduced risk of infant death is consistent with previous findings on the effects of the program on health care utilization and birth outcomes.
Maternal Report of Advice Received for Infant Care
Parental adherence to recommended infant care practices (eg, breastfeeding; safe sleep) is below targeted goals. Adherence to practice recommendations increases when parents receive appropriate advice from multiple sources such as family and physicians.
Using a nationally representative sample, this study explores the advice mothers receive about safe sleep, immunization, breastfeeding, and pacifier use; the findings suggest infant care practices about which mothers receive little or inappropriate advice, suggesting possible targets for intervention.
Immunogenicity, Safety, and Tolerability of a Hexavalent Vaccine in Infants
The routine childhood immunization schedule is crowded during the first 2 years, leading to deferred doses and limiting the addition of new vaccines. Combination vaccines can reduce the “shot burden” and improve coverage rates and timeliness.
Antibody response rates to antigens contained in an investigational hexavalent vaccine (DTaP5-IPV-Hib-HepB) were noninferior to licensed comparator vaccines when given as a 3-dose infant series. The safety profile was similar to control except for increased rates of mild-to-moderate, self-limited fever.
Antibiotic Exposure and Juvenile Idiopathic Arthritis: A Case–Control Study
The etiology of juvenile idiopathic arthritis (JIA) is poorly understood. A recent study suggested a link between antibiotics and JIA but did not examine the potential for confounding from infections or the role of antibiotic timing.
Antibiotics were associated with newly diagnosed JIA in a dose- and time-dependent manner after adjusting for infection and other confounders. Antibiotics may play a role in the pathogenesis of JIA.
Identifying Priorities for Mental Health Interventions in War-Affected Youth: A Longitudinal Study
War-affected youth often suffer from multiple co-occurring mental health problems. The relationship of these conditions to later mental health has yet to be thoroughly investigated. There is a need to explore potential targets for mental health interventions.
After controlling for preexisting conditions and contemporary confounders, internalizing (depression and anxiety) remained the major predictor of future mental health symptoms (internalizing symptoms, prosocial attitudes/behaviors, and posttraumatic stress symptoms). Interventions targeting internalizing in war-affected youth hold promise.
Prevalence of and Risk Factors for Intracranial Abnormalities in Unprovoked Seizures
Weak recommendations exist to guide emergent neuroimaging decisions in children with first, unprovoked seizures. The prevalence of and risk factors associated with clinically relevant abnormalities on neuroimaging have not been well defined in prospective studies.
Clinically relevant intracranial abnormalities on neuroimaging occur in 11% of children with first, unprovoked seizures. Emergent/urgent abnormalities, however, occur in <1%, suggesting that most of these children do not require emergent neuroimaging. Specific clinical findings identify patients at higher risk.
Thrombocytopenia in Small-for-Gestational-Age Infants
Small-for-gestational-age neonates are at risk for thrombocytopenia during the first days and weeks after birth. However, the incidence, duration, severity, responsible mechanism, value of platelet transfusions, and risk of death from this variety of neonatal thrombocytopenia are unknown.
Ten percent of thrombocytopenic small-for-gestational-age neonates have a recognized cause for low platelets (aneuploidy, extracorporeal membrane oxygenation, disseminated intravascular coagulation); they have a high mortality rate (65%). Ninety percent have a moderate, transient (2 weeks), hyporegenerative thrombocytopenia with a low mortality rate (2%).
Use of Serum Bicarbonate to Substitute for Venous pH in New-Onset Diabetes
Diabetic ketoacidosis (DKA) is a common and serious first manifestation of diabetes mellitus in children. During initial evaluation, the venous blood pH is frequently used to make the diagnosis and classify the severity of DKA.
This study demonstrates that the serum bicarbonate concentration is a simple and accurate predictor of DKA and its severity and can be used in lieu of venous pH measurement, especially in resource-poor settings where access to pH measurement is limited.
Variation in Prenatal Diagnosis of Congenital Heart Disease in Infants
Prenatal diagnosis may lead to benefits in outcomes for certain forms of critical congenital heart disease. Despite recognized benefits, single-center studies and focused regional efforts suggest that prenatal detection rates for congenital heart disease remain low in the United States.
We describe prenatal detection rates for a large cohort of neonates and infants undergoing heart surgery across a range of congenital heart defects. Additionally, this study adds new information by demonstrating geographic variability of prenatal detection rates across the United States.
Outbreak of Mycoplasma pneumoniae–Associated Stevens-Johnson Syndrome
Stevens-Johnson syndrome (SJS) is a rare and severe immunologic phenomenon characterized by rash and mucous membrane disease. SJS may be triggered by medications and, less commonly, by infections such as Mycoplasma pneumoniae (Mp). Outbreaks of SJS are exceedingly rare.
We describe the largest SJS outbreak reported in children, which was also Mp-associated. In the first case-control study of this disease, we identify predictors of Mp-associated SJS versus non–Mp-associated SJS, including fewer skin lesions, pneumonia, and elevated erythrocyte sedimentation rate.
Predicting Discharge Dates From the NICU Using Progress Note Data
Discharge from the NICU requires coordination and may be delayed for nonmedical reasons. Predicting when patients will be medically ready for discharge can avoid these delays and result in cost savings for the hospital.
We developed a supervised machine learning approach using real-time patient data from the daily neonatology progress note to predict when patients will be medically ready for discharge.
Late Diagnosis of Coarctation Despite Prenatal Ultrasound and Postnatal Pulse Oximetry
Neonatal coarctation of the aorta (CoA) is a life-threatening cardiac defect, but because symptoms may be lacking initially, newborns with this defect are frequently discharged from the hospital undiagnosed. Delayed diagnosis of CoA is associated with increased morbidity and mortality.
This population-based study analyzes the contribution of prenatal ultrasound and postnatal pulse oximetry screening to the timely diagnosis of neonatal CoA. Both screening methods had low sensitivity for CoA. Nearly half of all newborns with isolated CoA were discharged undiagnosed.
Public Perceptions of the Benefits and Risks of Newborn Screening
Infant screening is valued by members of the lay public, but how different benefits are independently valued, and whether harms are disvalued, is not known. Public expectations of screening can inform decisions about what diseases to screen for.
The public values clinical benefits of screening and disvalues harms, with tolerance for harm proportional to clinical benefit. These findings support newborn screening policies prioritizing clinical benefits over solely informational benefits, coupled with concerted efforts to avoid or minimize harms.
Cost-Effectiveness Analysis of a National Newborn Screening Program for Biotinidase Deficiency
Biotinidase deficiency (BD) might cause severe and permanent consequences. Cases detected through newborn screening and under treatment are shown to remain asymptomatic. However, some countries, including Spain, do not provide universal BD screening within their national newborn screening programs.
It provides a first estimate of the lifetime costs and health outcomes of a Spanish birth cohort with and without neonatal screening for BD. It shows that newborn screening for BD is likely to be a cost-effective use of resources.
Maternal Consequences of the Detection of Fragile X Carriers in Newborn Screening
Parents generally adapt well to newborn screening results, but reactions to carrier status for X-linked conditions are unknown.
Results suggest that detection and disclosure of FMR1 newborn carrier status may not result in significant adverse events for mothers.
Trisomy 21 and Risk of Retinopathy of Prematurity
It is known that trisomy 21 decreases the risk of (nonocular) angiogenic-mediated disorders, such as solid tumors. It is not known whether trisomy 21 decreases the risk of ocular angiogenic-mediated disorders such as retinopathy of prematurity.
This study shows that trisomy 21 decreases the risk of retinopathy of prematurity (ROP), thus unmasking a potentially identifiable genetic component to ROP risk. This study paves the way for the future development of a laboratory-based ROP screening tool.
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- Copyright © 2015 by the American Academy of Pediatrics