Antibiotic Prescribing During Pediatric Ambulatory Care Visits for Asthma
There have been several recent trials evaluating the efficacy of antibiotics as an asthma therapy, but to date national guidelines do not recommend them as an asthma therapy. Inappropriate antibiotic prescribing may lead to avoidable adverse events and bacterial resistance.
Antibiotics are prescribed during nearly 1 million US asthma visits annually when antibiotic need is undocumented. The frequent coprescription of systemic corticosteroids suggests that greater symptom severity increases this practice. Conversely, asthma education delivery is associated with decreased antibiotic prescribing.
Coprescription of Antibiotics and Asthma Drugs in Children
Antibiotics and asthma drugs are the most frequently prescribed drugs in most age categories and in most countries.
In this study, antibiotic use was found to be 1.9 times more frequent in children who were treated with asthma drugs than those who were not. Among children who received an asthma drug, 35.6% were dispensed an antibiotic on the same day.
National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007
Urinary tract infections represent a significant source of exposure to antibiotics in the pediatric population and often physicians must select the antibiotic treatment empirically. No examination of ambulatory antibiotic prescribing patterns in the United States for children with urinary tract infections has been performed.
Ambulatory care physicians commonly prescribe broad-spectrum antibiotics, especially third-generation cephalosporins, for the treatment of pediatric urinary tract infections. Given that narrower-spectrum alternatives are frequently appropriate options for the treatment of these infections, efforts are necessary to promote more judicious antibiotic prescribing for pediatric urinary tract infections.
Trends in the Prevalence of Developmental Disabilities in US Children, 1997–2008
US data on the changes in the prevalence of developmental disabilities are scarce. Although there are a few studies on individual disabilities, data examining the impact of the full range of developmental disabilities are unavailable.
Developmental disabilities make a significant contribution to overall childhood health. We show the health disparities that exist for specific populations and how selected conditions have increased over the past 10 years.
Early Diagnoses of Autism Spectrum Disorders in Massachusetts Birth Cohorts, 2001–2005
Early identification of autism spectrum disorders and early initiation of developmental services can improve outcomes. The Centers for Disease Control and Prevention estimates that an average of 1 in 110 children aged 8 years have an autism spectrum.
A total of 1 in 129 children in Massachusetts born between 2001 and 2005 were enrolled in early intervention with an autism spectrum disorder by the age of 36 months. Early autism spectrum disorder diagnoses increased between 2001 and 2005.
Preterm Birth and Inhaled Corticosteroid Use in 6- to 19-Year-Olds: A Swedish National Cohort Study
Preterm birth is associated with respiratory morbidity later in life, including asthma. Previous studies have mainly focused on asthma in early childhood in children born extremely preterm.
Moderate preterm (33–36 weeks' gestation) and early term (37–38 weeks' gestation) births are associated with increased risk of asthma medication at 6 to 19 years of age. Gestational age per se seems to be the most important factor responsible for this effect.
Feeding of Dietary Botanical Supplements and Teas to Infants in the United States
Dietary botanical supplement and tea use among infants as a separate group from children has not been studied.
Our study is the first to examine prevalence of dietary botanical supplement and tea use among US infants. We found that ∼9% of infants were given these supplements in their first year of life, although usually only for short periods.
The Effect of Observation on Cranial Computed Tomography Utilization for Children After Blunt Head Trauma
Emergency-department observation of children with minor blunt head trauma for symptom progression before making a decision regarding computed tomography may decrease computed tomography use. The actual impact of this strategy on computed tomography use and clinical outcomes, however, is unknown.
Clinicians currently observe some children with head trauma before deciding whether to obtain a cranial computed tomography scan. Patients who were observed had a significantly lower rate of overall cranial computed tomography use after adjusting for markers of head injury severity.
Association of Interpersonal Violence With Self-reported History of Head Injury
Traumatic brain injury can cause functional short- or long-term changes in cognition, language, and emotion. These changes can include irritability, impulsivity, aggression, and violence. To date, most studies on effects of head injury have focused on clinical or prison-based samples.
Using longitudinal data, we provide insight into the relationship between head injury and violence in an urban community–based sample of youth and young adults. Understanding head injury during adolescence may provide insight into cognitive issues and problem behaviors.
Prospective Evaluation of Residents on Call: Before and After Duty-Hour Reduction
Duty-hour regulation is used as a mechanism to reduce resident fatigue and improve patient safety. Although the link between patient safety and reduced duty hours is questioned, experts articulate concerns that duty-hour reduction will reduce resident education and direct patient exposure.
Before duty-hour reduction, workload had increased and rest had decreased. After duty-hour reduction, supervision and direct patient care decreased. Education time remained similar. Evaluation of preregulation changes provides important context to improve our understanding of the impact of duty-hour regulation.
Creating Flexibility in Pediatric Resident Education
Pediatric residents desire flexibility in their pediatric training program. With the requirements of pediatric residency training, it is often difficult to meet this desire and provide quality training at the same time.
Implementation of a 2 half day continuity clinic program can provide enhanced clinical opportunities for residents entering practice, and advocacy and research opportunities for residents anticipating subspecialty careers. All residents are still able to acquire core knowledge in general pediatrics.
Pediatric Palliative Care Patients: A Prospective Multicenter Cohort Study
During the past decade, pediatric palliative care (PPC) has become an established area of medical expertise. Although the number of hospital-based PPC teams is increasing, scant information exists regarding the patients referred for PPC consultations or their subsequent survival pattern.
Compared with adult patients, pediatric patients who received hospital-based PPC services had a greater diversity of medical conditions and duration of survival, which underscores the need for PPC teams to be properly resourced to meet the needs of these patients and families.
Cardiovascular Events and Death in Children Exposed and Unexposed to ADHD Agents
Attention-deficit/hyperactivity disorder agents increase systolic and diastolic blood pressure and heart rate. Case reports of sudden death in children and adolescents receiving these agents have led to the concern that they might increase the risk of cardiovascular events.
Low rates of validated cardiovascular events and of all-cause death, nonsuicide, and non–accidental death were found in children and adolescents receiving attention-deficit/hyperactivity disorder medications.
Physician Communication Regarding Smoking and Adolescent Tobacco Use
Previous research has shown that physician advice against smoking has sufficient impact among adults to be ranked as a high-priority, evidence-based preventive service. However, little research has explored the potential benefits of physician advice against smoking among adolescents.
This study examines the relationship between physician communications regarding smoking and adolescent tobacco use. The study is unique in that (1) it examines a range of tobacco use behaviors; and (2) it explores potential benefits for young nonsmokers as well as smokers.
Immunogenicity and Safety of H influenzae Type b–N meningitidis C/Y Conjugate Vaccine in Infants
Infants and toddlers have the highest rate of meningococcal disease, but no vaccine is available in the United States for the protection of this age group.
Novel combined HibMenCY conjugate vaccine could provide an incremental public health benefit to monovalent Hib vaccines by protecting US infants against meningococcal serogroups C and Y and by providing an additional source of Hib conjugate vaccine.
Self-Embedding Behavior: A New Primary Care Challenge
Self-embedding behavior is an extreme form of self-injury involving the insertion of inanimate objects into the soft tissues, either under the skin or into muscle. To date, no case series data on this behavior among adolescents has been described in the pediatric medical literature.
Goals of this study are to begin to develop a clinical picture of adolescents who engage in self-embedding behavior, resulting in an understanding that allows practitioners to pursue rapid and targeted intervention to interrupt the cycle of self-harm and institute appropriate long-term therapy.
Fermented Milk Containing Bifidobacterium lactis DN-173 010 in Childhood Constipation: A Randomized, Double-Blind, Controlled Trial
Chronic constipation is a common problem in childhood. In two randomized trials in adults with irritable bowel syndrome and constipation, and 1 in constipated women with a defecation frequency <3 times per week, a significant increase was shown in stool frequency in the probiotic group who used Bifidobacterium lactis DN-173 010 compared with the control group in subjects who had <3 stools per week.
In constipated children, the fermented dairy product that contained B lactis strain DN-173 010 increased stool frequency, but this increase was comparable to that of the control group. There is currently insufficient evidence to recommend fermented dairy products that contain B lactis strain DN-173 010 for these patients.
Outcomes for Children Hospitalized With Abusive Versus Noninflicted Abdominal Trauma
Data from pediatric trauma centers suggest that children with abusive abdominal trauma have higher mortality, longer hospitalizations, and higher hospitalization costs compared with children with noninflicted abdominal trauma.
This study included children hospitalized for abdominal trauma at all types of acute care hospitals across the country. It therefore provides a more representative sample of children hospitalized with abdominal trauma than previous studies.
Clonidine Extended-Release Tablets as Add-on Therapy to Psychostimulants in Children and Adolescents With ADHD
Two small studies have evaluated the safety and efficacy of immediate-release clonidine plus stimulant medication to treat attention-deficit/hyperactivity disorder (ADHD). No previous studies have evaluated the US Food and Drug Administration - approved extended-release formulation of clonidine plus stimulants.
In this study information on the safety and efficacy of extended-release clonidine combined with stimulant medication for the treatment of ADHD is provided. The combination of the 2 medications works well to reduce the symptoms of ADHD and is generally well tolerated.
The Effect of Maternity Leave Length and Time of Return to Work on Breastfeeding
It is known that breastfeeding behavior is affected by maternity leave length and time of return to work. However, previous studies have mainly been conducted among subgroups of women and limited to small sample sizes.
This study adds to the literature by using recent, nationally representative data. In addition, breastfeeding duration was followed longitudinally for up to 2 years compared with previous studies that have looked at breastfeeding duration for ≤1 year.
Disparities in Child Access to Emergency Care for Acute Oral Injury
Traumatic injuries to permanent front teeth impact 1 in 7 preadolescent children, but more than 10% of significant dental fractures go untreated. Medicaid and CHIP are designed to provide access to care, but there is underutilization of dental services by low-income children.
The current study directly measures dentists' willingness to provide emergency oral health care in the second-largest US urban county and finds significant disparities in access for children covered by Medicaid or CHIP versus private insurance, controlling for all non–insurance-related access barriers.
Young Maternal Age and Poor Child Development: Predictive Validity From a Birth Cohort
Teen-aged mothers and their children are targeted by policies and programs aimed at improving child development. Teenage motherhood may be a risk factor for poor childhood development, but it may be an inaccurate criterion for predicting risk of developmental outcomes.
To reach the goal of improving child development outcomes across the population, factors such as maternal education level, financial difficulties, smoking, and depression during pregnancy should be considered in addition to young maternal age when recruiting women to preventive programs.
Reproducibility of Acute Mountain Sickness in Children and Adults: A Prospective Study
Although a history of previous acute mountain sickness is often used for providing advice and recommending its prophylaxis during subsequent exposure, the intraindividual reproducibility of acute mountain sickness during repeated high-altitude exposure has never been examined in a controlled study.
A history of acute mountain sickness strongly predicts future illness in adults but not in children. Advice to avoid reexposure to high altitude or prescription of prophylactic medications is not indicated for children.
Pain Reduction on Insertion of a Feeding Tube in Preterm Infants: A Randomized Controlled Trial
Insertion of a feeding tube is commonly done in preterm infants, but the degree of pain and discomfort—as well any measures to reduce pain—have not been well investigated.
Insertion of a feeding tube leads to brief but measurable pain and discomfort. Pain relief was best achieved by combining a pacifier with 30% sucrose in these preterm infants.
Parents' Decisions to Screen Newborns for FMR1 Gene Expansions in a Pilot Research Project
Fragile X syndrome is not diagnosed until patients are aged 3 years or older. Although parents of affected children support newborn screening, public acceptance of a screening test that would identify both affected children and carriers is unknown.
In the context of a prospective, longitudinal study in which parents are offered voluntary newborn screening for FMR1 gene expansions, this article reports uptake rates of parents offered screening shortly after birth and their reasons for accepting or declining.
Equimolar Nitrous Oxide/Oxygen Versus Placebo for Procedural Pain in Children: A Randomized Trial
The most frequent cause of pain in children is diagnostic or therapeutic procedure–related pain. Inhalation of nitrous oxide in oxygen is a well-known effective analgesia, without major adverse effects and widely used in pediatric settings for minimally invasive procedures.
We determined through a randomized, placebo-controlled, double-blind clinical assay that nitrous oxide inhalation was notably more effective than placebo in decreasing pain by nearly half for minor pediatric procedures in patients aged 3 to 18 years.
Decision-Making Around Gastrostomy-Feeding in Children With Neurologic Disabilities
Consensus statements recommend the effective involvement of parents in decision-making around gastrostomy-feeding in children with a neurologic disability. It is important to understand parental experiences and views in order to design and implement interventions to improve the decision-making-process.
Parents of children with a neurologic disability experience decisional conflict around gastrostomy-feeding. Conflict in values associated with gastrostomy-feeding and feeding by mouth, inadequacies in the process of decision-making and the context of child and family shape experiences and decisional conflict.
Care Models and Associated Outcomes in Congenital Heart Surgery
Recently, there has been a shift toward care of patients undergoing congenital heart surgery in dedicated pediatric cardiac ICUs. The impact of this trend on patient outcomes is unclear.
In an analysis of 20 922 patients from 47 centers we were unable to detect a difference overall in postoperative morbidity or mortality associated with a dedicated cardiac ICU. There may be a survival benefit in certain subgroups.
Quality Measures for the Care of Children With Otitis Media With Effusion
Many performance measures are under development for use in quality improvement, program monitoring, public reporting, and value-based purchasing. A measure of the care of children with otitis media with effusion is included in an initial set of national pediatric core measures.
This study emphasizes the importance of testing proposed performance measures in “real-world” settings. Coding, case finding, and evaluating appropriateness of treatment are some of the issues that will need to be considered to assess the care of children with otitis media with effusion.
Long-term Impact of Poor Birth Condition on Social and Economic Outcomes in Early Adulthood
Severe perinatal asphyxia is known to have devastating effects on the newborn infant. The long-term outcome of perinatal asphyxia on social and economic outcomes is unknown.
Although the effect sizes were small, these study infants with brief perinatal compromise had measurably worse social outcomes. Infants who developed encephalopathy showed far greater impact, yet many of these infants attended university and gained employment in adulthood.
Epidemiology of 15-Day Readmissions to a Children's Hospital
Hospital readmissions are common and costly occurrences for adult patients. Our understanding of the full scope of readmissions for pediatric patients is incomplete, particularly for readmissions that occur within a short time after hospital discharge.
This study was the first investigation of the characteristics of all readmissions within 15 days of discharge of patients at a single children's hospital. The results serve as a basis for further analysis of the preventability of readmissions in the pediatric patient population.
Cord Blood Vitamin D Deficiency Is Associated With Respiratory Syncytial Virus Bronchiolitis
Respiratory syncytial virus is the most important pathogen that causes lower respiratory tract infections in infants. Cross-sectional studies in developing countries have show that vitamin D deficiency is associated with increased risk and severity of infant viral respiratory tract infections.
Results of this prospective birth cohort study demonstrated that vitamin D deficiency is highly prevalent among healthy newborns in Western countries, and that neonates who are vitamin D deficient at birth have an increased risk of developing respiratory syncytial virus respiratory tract infections during infancy.
Abnormal High-Density Lipoproteins in Overweight Adolescents With Atherogenic Dyslipidemia
Atherogenic dyslipidemia is a marker of qualitative and functional high-density lipoprotein (HDL) abnormalities in obese adults. Cholesterol efflux, an atheroprotective function of HDL, is inversely related to carotid intima-media thickness, independent of HDL cholesterol and apolipoprotein AI concentrations, suggesting it as a predictor of cardiovascular risk.
Atherogenic dyslipidemia identifies obese adolescents who, aside from a general adverse cardiovascular risk factor profile, show quantitative, qualitative, and cholesterol efflux abnormalities; therefore, these adolescents should be the target of aggressive prevention programs and lipid management guidelines.
Linezolid-Associated Peripheral and Optic Neuropathy in Children
The adverse events of peripheral neuropathy and optic neuropathy associated with linezolid use are well described in the adult literature; however, limited information is available in pediatrics.
This article summarizes pediatric cases of linezolid-associated peripheral and optic neuropathy to increase awareness of these neurologic adverse effects so that clinicians can most appropriately balance the benefits and risks of linezolid use in the pediatric population.
Inpatient Health Care Utilization for Children Dependent on Long-term Mechanical Ventilation
Children dependent on long-term mechanical ventilation are a diverse group who experience respiratory failure due to a variety of chronic conditions. Previous state-based analyses estimated a prevalence of 6 to 14 per 100 000 children but did not focus on age differences.
The rate of hospital discharges for children dependent on long-term mechanical ventilation has grown to 173.6 per 100 000 nonnewborn pediatric discharges in 2006. Young children and infants consume the highest proportion of health care resources and should be an area of additional study.
Development and Validation of a Pictorial Nausea Rating Scale for Children
A simple, reliable, validated pictorial scale for measuring nausea in children may help in its management. Current pictorial scales for nausea have limited construct and convergent validity and may lack specificity in the presence of pain.
This pictorial (Baxter Retching Faces) scale for measuring nausea severity has convergent and discriminant validity, and detected change after antiemetic treatment. Its use in the clinical and research setting may assist in nausea management in children.
Risk of Later Seizure After Perinatal Arterial Ischemic Stroke: A Prospective Cohort Study
Acute symptomatic seizures are common after perinatal arterial ischemic stroke, but published data regarding incidence and timing of seizures after hospital discharge are limited.
The Kaplan-Meier probability of remaining seizure-free at 3 years after acute perinatal arterial ischemic stroke was 73% in this study. Larger stroke size on MRI was significantly associated with development of later seizures.
Hypoglycemia in Pediatric Sulfonylurea Poisoning: An 8-Year Poison Center Retrospective Study
Pediatric sulfonylurea ingestions are known to cause profound and prolonged hypoglycemia. The optimum observation period for asymptomatic children remains controversial.
Either food or intravenous glucose can delay the onset of hypoglycemia in pediatric sulfonylurea poisonings. The conventional 8-hour observation period with free access to food for pediatric sulfonylurea exposures is an unreliable screening method.
Footnotes
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- Copyright © 2011 by the American Academy of Pediatrics