Publisher: American Academy of Pediatrics   (Total: 4 journals)   [Sort by number of followers]

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AAP Grand Rounds     Full-text available via subscription   (Followers: 20)
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Pediatrics     Full-text available via subscription   (Followers: 378, SJR: 3.337, CiteScore: 5)
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Journal Prestige (SJR): 3.337
Citation Impact (citeScore): 5
Number of Followers: 378  
  Full-text available via subscription Subscription journal
ISSN (Print) 0031-4005 - ISSN (Online) 1098-4275
Published by American Academy of Pediatrics Homepage  [4 journals]
  • Tobacco Retail Licensing and Youth Product Use
    • Authors: Astor, R. L; Urman, R, Barrington-Trimis, J. L, Berhane, K, Steinberg, J, Cousineau, M, Leventhal, A. M, Unger, J. B, Cruz, T, Pentz, M. A, Samet, J. M, McConnell, R.
      Abstract: BACKGROUND:Restricting youth access to tobacco is a central feature of US tobacco regulatory policy, but impact of local tobacco retail licensing (TRL) regulation on cigarette smoking rates remains uncertain. Effects of TRL on other tobacco product use and use as adolescents reach the age to legally purchase tobacco products has not been investigated.METHODS:Prevalences of ever and past 30-day cigarette, electronic cigarette (e-cigarette), cigar, and hookah use were assessed in a survey of a cohort of 1553 11th- and 12th-grade adolescents (mean age: 17.3 years); rates of initiation were evaluated 1.5 years later. An American Lung Association (2014) youth access grade was assigned to each of 14 political jurisdictions in which participants lived on the basis of the strength of the local TRL ordinance.RESULTS:At baseline, participants living in 4 jurisdictions with "A" grades (ie, with most restrictive ordinances) had lower odds of ever cigarette use (odds ratio [OR] 0.61; 95% confidence interval [CI] 0.41–0.90) and of past 30-day use (OR 0.51; 95% CI 0.29–0.89) than participants in 10 D- to F-grade jurisdictions. At follow-up at legal age of purchase, lower odds of cigarette use initiation (OR 0.67; 95% CI 0.45–0.99) occurred in jurisdictions with stronger TRL policy. Lower odds of e-cigarette initiation at follow-up (OR 0.74; 95% CI 0.55–0.99) and of initiation with past 30-day use (OR 0.45; 95% CI 0.23–0.90) were also associated with better regulation.CONCLUSIONS:Strong local TRL ordinance may lower rates of cigarette and e-cigarette use among youth and young adults.
      Keywords: Substance Use, Smoking, Public Health
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2017-3536
      Issue No: Vol. 143, No. 2 (2019)
  • Adolescent Mental Health and the Choking Game
    • Authors: Michel, G; Garcia, M, Aubron, V, Bernadet, S, Salla, J, Purper-Ouakil, D.
      Abstract: OBJECTIVES:To examine the demographic and health risk factors associated with participation in the choking game (CG), a dangerous and potentially fatal strangulation activity in which pressure is applied to the carotid artery to temporarily limit blood flow and oxygen.METHODS:We obtained data from 2 cross-sectional studies realized respectively in 2009 and 2013 among French middle school students. The 2009 (n = 746) and 2013 (n = 1025) data sets were merged (N = 1771), and multivariate modeling was conducted to examine demographic and clinical characteristics of youth reporting a lifetime participation in the CG. The 2 studies included questions about risk-taking behaviors and substance use, and standardized assessments were used to collect conduct disorder symptoms and depressive symptoms.RESULTS:In the merged 2009 and 2013 data set, the lifetime prevalence of CG participation was 9.7%, with no statistically significant differences between boys and girls. A multivariate logistic regression revealed that higher levels of conduct disorder symptoms (odds ratio: 2.33; P < .001) and greater rates of depressive symptoms (odds ratio: 2.18; P < .001) were both significantly associated with an increased likelihood of reporting CG participation.CONCLUSIONS:The significant relationship between elevated levels of depressive symptoms and participation in the CG sheds new light on the function of self-asphyxial activities. However, with the finding that higher rates of conduct disorder symptoms were the most important predictor of CG participation, it is suggested that the profile and the underlying motivations of youth who engage in this activity should be reexamined.
      Keywords: Adolescent Health/Medicine
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2017-3963
      Issue No: Vol. 143, No. 2 (2019)
  • Quality Improvement Project to Decrease Delivery Room Intubations in
           Preterm Infants
    • Authors: Kakkilaya, V; Jubran, I, Mashruwala, V, Ramon, E, Simcik, V. N, Marshall, M, Brown, L. S, Jaleel, M. A, Kapadia, V. S.
      Abstract: BACKGROUND AND OBJECTIVES: Avoidance of delivery room intubation (DRI) reduces death or bronchopulmonary dysplasia (BPD) in preterm neonates. Our objective with this quality improvement project was to decrease DRI rates by improving face mask positive pressure ventilation (Fm-PPV) among infants born ≤29 weeks’ gestation.METHODS:Key drivers of change were identified from a retrospective review of resuscitation records. A resuscitation bundle to optimize Fm-PPV including the use of a small round mask and end-tidal CO2 detectors, increasing peak inspiratory pressure when indicated, and debriefing after each intubation were implemented in consecutive plan-do-study-act cycles. The DRI rate was tracked by using a control chart. Resuscitation practice and outcomes of pre–quality improvement cohort (QIC) (January 2014–September 2015) were compared with post-QIC (October 2015–December 2016).RESULTS:Of the 314 infants who were resuscitated, 180 belonged to the pre-QIC and 134 to the post-QIC. The antenatal steroid administration rate was higher in the post-QIC (54% vs 88%). More infants in the post-QIC had resolution of bradycardia after Fm-PPV (56% vs 77%, P = .02). Infants in the post-QIC had lower DRI rates (58% vs 37%, P < .01), lower need for mechanical ventilation (85% vs 70%, P < .01), lower rates of BPD (26% vs 13%, P < .01), and severe retinopathy of prematurity (14% vs 5%, P = .01). Rates of DRI, BPD, and severe retinopathy of prematurity remained lower even after controlling for the potential confounders.CONCLUSIONS:Implementation of a resuscitation bundle decreased the DRI rate and improved outcomes of preterm infants.
      Keywords: Administration/Practice Management, Quality Improvement, Fetus/Newborn Infant, Neonatology
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-0201
      Issue No: Vol. 143, No. 2 (2019)
  • Priorities for Pediatric Patient Safety Research
    • Authors: Hoffman, J. M; Keeling, N. J, Forrest, C. B, Tubbs-Cooley, H. L, Moore, E, Oehler, E, Wilson, S, Schainker, E, Walsh, K. E.
      Abstract: BACKGROUND:Developing a research agenda that is focused on the priorities of key stakeholders may expedite implementation and dissemination. Our objective was to identify the highest-priority patient-safety research topics among pediatric clinicians, health care leaders, and families.METHODS:The Children’s Hospitals Solutions for Patient Safety Network is a network of>100 children’s hospitals working together to eliminate harm due to health care. Parents and site leaders responded to an open-ended, anonymous e-mail survey used to elicit research topics. A key stakeholder panel winnowed related topics and prioritized topics using Likert scale ratings. Site leaders and parents responded to a second anonymous e-mail survey and rated the importance of each topic. Health system executive interviews were used to elicit their opinions regarding top priorities for patient-safety research.RESULTS:The elicitation survey had 107 respondents who produced 49 unique research topics. The key stakeholder panel developed a final list of 24 topics. The prioritization survey had 74 respondents. Top-priority research topics concerned high reliability, safety culture, open communication, and early detection of patient deterioration and sepsis. During 7 qualitative interviews, health system executives highlighted diagnostic error, medication safety, deterioration, and ambulatory patient safety as priority areas.CONCLUSIONS:With this study, we take a first step toward a stakeholder-driven research agenda on the basis of the assumption that stakeholders are best positioned to determine what research will be used to address the problems of most concern to them.
      Keywords: Administration/Practice Management, Quality Improvement
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-0496
      Issue No: Vol. 143, No. 2 (2019)
  • Syrian Children in Turkey: A Model of Action for National Pediatric
    • Authors: Özmert, E. N; Derman, O, Bideci, A, Okumus, N, Boduroglu, K, Bakkaloglu, S, Hasanoglu, E, Alden, E.
      Keywords: International Child Health, Immigration
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-0539
      Issue No: Vol. 143, No. 2 (2019)
  • Promoting Enrollment in Parenting Programs Among a Filipino Population: A
           Randomized Trial
    • Authors: Javier, J. R; Coffey, D. M, Palinkas, L. A, Kipke, M. D, Miranda, J, Schrager, S. M.
      Abstract: BACKGROUND AND OBJECTIVES:Evidence-based parenting programs prevent the onset and escalation of youth conduct problems. However, participation rates in such programs are low among hard-to-reach populations, including Filipino individuals. Compared with other ethnic groups, Filipino adolescents have significant mental health disparities. We evaluated the effectiveness of a theory-based, culturally tailored video versus a usual-care mainstream video on enrollment in an evidence-based parenting program among Filipino caregivers of children ages 6 to 12 years and tested theoretical mediators of intervention effect.METHODS:We randomly assigned 215 Filipino participants to view either a theory-based, culturally tailored video based on the Health Belief Model and Theory of Planned Behavior or a control video. The primary outcome was actual enrollment in an evidence-based parenting intervention. Mediators (knowledge and perceived susceptibility) were modeled as latent variables in a structural equation model.RESULTS:After the intervention, participants in the intervention group had significantly higher knowledge of Filipino adolescent behavioral health disparities and higher perceived susceptibility to adolescent risky sexual activity and illegal drug use. Controlling for child sex, parents in the intervention group had significantly greater odds of actual enrollment in the Incredible Years program (odds ratio = 2.667; 95% confidence interval: 1.328–5.354; P = .006). The intervention effects were mediated by increased knowledge and perceived susceptibility.CONCLUSIONS:Results demonstrated the effectiveness of a theory-based, culturally tailored intervention aimed at increasing participation of a hard-to-engage population in parenting interventions. Videos that include parents and health professionals with whom audiences can identify can be used to produce shifts in knowledge and behavior.
      Keywords: Community Pediatrics, Community Health Services, Developmental/Behavioral Pediatrics, Psychosocial Issues
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-0553
      Issue No: Vol. 143, No. 2 (2019)
  • Ethical Implications for Providers Regarding Cannabis Use in Children With
           Autism Spectrum Disorders
    • Authors: Duvall, S. W; Lindly, O, Zuckerman, K, Msall, M. E, Weddle, M.
      Abstract: Children with autism spectrum disorder (ASD) are at risk for self-injurious behaviors that can be difficult to treat in the context of co-occurring low IQ and adaptive skills. Increased prevalence and decriminalization of cannabis in some states have led to more frequent questions for pediatricians about the use of cannabis for difficult-to-treat developmental and behavioral conditions. What do we know about the possible benefits and risks of cannabis use in children with ASD' How should the clinician respond to a parent who expresses interest in cannabis to manage behavior in a child with ASD' Ethical analysis that includes harm reduction, health concerns, and information sharing will be discussed. We present commentary on the ethical implications of cannabis use in children with ASD and severe self-harm behaviors.
      Keywords: Developmental/Behavioral Pediatrics, Autism/ASD, Ethics/Bioethics
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-0558
      Issue No: Vol. 143, No. 2 (2019)
  • Barriers and Stigma Experienced by Gay Fathers and Their Children
    • Authors: Perrin, E. C; Hurley, S. M, Mattern, K, Flavin, L, Pinderhughes, E. E.
      Abstract: BACKGROUND:Gay men have become fathers in the context of a heterosexual relationship, by adoption, by donating sperm to 1 or 2 lesbian women and subsequently sharing parenting responsibilities, and/or by engaging the services of a surrogate pregnancy carrier. Despite legal, medical, and social advances, gay fathers and their children continue to experience stigma and avoid situations because of fear of stigma. Increasing evidence reveals that stigma is associated with reduced well-being of children and adults, including psychiatric symptoms and suicidality.METHODS:Men throughout the United States who identified as gay and fathers completed an online survey. Dissemination of the survey was enhanced via a "snowball" method, yielding 732 complete responses from 47 states. The survey asked how the respondent had become a father, whether he had encountered barriers, and whether he and his child(ren) had experienced stigma in various social contexts.RESULTS:Gay men are increasingly becoming fathers via adoption and with assistance of an unrelated pregnancy carrier. Their pathways to fatherhood vary with socioeconomic class and the extent of legal protections in their state. Respondents reported barriers to becoming a father and stigma associated with fatherhood in multiple social contexts, most often in religious institutions. Fewer barriers and less stigma were experienced by fathers living in states with more legal protections.CONCLUSIONS:Despite growing acceptance of parenting by same-gender adults, barriers and stigma persist. States’ legal and social protections for lesbian and gay individuals and families appear to be effective in reducing experiences of stigma for gay fathers.
      Keywords: Community Pediatrics, Developmental/Behavioral Pediatrics
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-0683
      Issue No: Vol. 143, No. 2 (2019)
  • Survival and Impairment of Extremely Premature Infants: A Meta-analysis
    • Authors: Myrhaug, H. T; Brurberg, K. G, Hov, L, Markestad, T.
      Abstract: CONTEXT:Survival of infants born at the limit of viability varies between high-income countries.OBJECTIVE:To summarize the prognosis of survival and risk of impairment for infants born at 22 + 0/7 weeks’ to 27 + 6/7 weeks’ gestational age (GA) in high-income countries.DATA SOURCES:We searched 9 databases for cohort studies published between 2000 and 2017 in which researchers reported on survival or neurodevelopmental outcomes.STUDY SELECTION:GA was based on ultrasound results, the last menstrual period, or a combination of both, and neurodevelopmental outcomes were measured by using the Bayley Scales of Infant Development II or III at 18 to 36 months of age.DATA EXTRACTION:Two reviewers independently extracted data and assessed the risk of bias and quality of evidence.RESULTS:Sixty-five studies were included. Mean survival rates increased from near 0% of all births, 7.3% of live births, and 24.1% of infants admitted to intensive care at 22 weeks’ GA to 82.1%, 90.1%, and 90.2% at 27 weeks’ GA, respectively. For the survivors, the rates of severe impairment decreased from 36.3% to 19.1% for 22 to 24 weeks’ GA and from 14.0% to 4.2% for 25 to 27 weeks’ GA. The mean chance of survival without impairment for infants born alive increased from 1.2% to 9.3% for 22 to 24 weeks’ GA and from 40.6% to 64.2% for 25 to 27 weeks’ GA.LIMITATIONS:The confidence in these estimates ranged from high to very low.CONCLUSIONS:Survival without impairment was substantially lower for children born at
      Keywords: Children With Special Health Care Needs, Fetus/Newborn Infant
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-0933
      Issue No: Vol. 143, No. 2 (2019)
  • Neurodevelopmental Impairments 1 Year After Cerebral Malaria
    • Authors: Langfitt, J. T; McDermott, M. P, Brim, R, Mboma, S, Potchen, M. J, Kampondeni, S. D, Seydel, K. B, Semrud-Clikeman, M, Taylor, T. E.
      Abstract: BACKGROUND AND OBJECTIVES:Cerebral malaria (CM) causes significant mortality and morbidity in sub-Saharan African children. Reliable morbidity estimates are scarce because of methodological variability across studies. We describe the incidence, course, and severity of neurodevelopmental impairments in survivors of CM and the associated patient characteristics to inform epidemiologic estimates of malaria morbidity rates and prevention and treatment efforts.METHODS:We conducted an exposure-control study of 85 survivors of CM and 100 age-matched patients in a control group who were enrolled at hospital discharge and assessed after 1, 6, and 12 months using caregiver interviews and standardized developmental, cognitive, and behavioral measures.RESULTS:Developmental or cognitive impairment (
      Keywords: Developmental/Behavioral Pediatrics, Infectious Disease
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-1026
      Issue No: Vol. 143, No. 2 (2019)
  • Antibiotic Prescribing for Children in United States Emergency
           Departments: 2009-2014
    • Authors: Poole, N. M; Shapiro, D. J, Fleming-Dutra, K. E, Hicks, L. A, Hersh, A. L, Kronman, M. P.
      Abstract: OBJECTIVES:To characterize and compare ambulatory antibiotic prescribing for children in US pediatric and nonpediatric emergency departments (EDs).METHODS:A cross-sectional retrospective study of patients aged 0 to 17 years discharged from EDs in the United States was conducted by using the 2009–2014 National Hospital Ambulatory Medical Care Survey ED data. We estimated the proportion of ED visits resulting in antibiotic prescriptions, stratified by antibiotic spectrum, class, diagnosis, and ED type ("pediatric" defined as>75% of visits by patients aged 0–17 years, versus "nonpediatric"). Multivariable logistic regression was used to determine factors independently associated with first-line, guideline-concordant prescribing for acute otitis media, pharyngitis, and sinusitis.RESULTS:In 2009–2014, of the 29 million mean annual ED visits by children, 14% (95% confidence interval [CI]: 10%–20%) occurred at pediatric EDs. Antibiotics overall were prescribed more frequently in nonpediatric than pediatric ED visits (24% vs 20%, P < .01). Antibiotic prescribing frequencies were stable over time. Of all antibiotics prescribed, 44% (95% CI: 42%–45%) were broad spectrum, and 32% (95% CI: 30%–34%, 2.1 million per year) were generally not indicated. Compared with pediatric EDs, nonpediatric EDs had a higher frequency of prescribing macrolides (18% vs 8%, P < .0001) and a lower frequency of first-line, guideline-concordant prescribing for the respiratory conditions studied (77% vs 87%, P < .001).CONCLUSIONS:Children are prescribed almost 7 million antibiotic prescriptions in EDs annually, primarily in nonpediatric EDs. Pediatric antibiotic stewardship efforts should expand to nonpediatric EDs nationwide, particularly regarding avoidance of antibiotic prescribing for conditions for which antibiotics are not indicated, reducing macrolide prescriptions, and increasing first-line, guideline-concordant prescribing.
      Keywords: Emergency Medicine, Pharmacology, Therapeutics
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-1056
      Issue No: Vol. 143, No. 2 (2019)
  • Family Firearm Ownership and Firearm-Related Mortality Among Young
           Children: 1976-2016
    • Authors: Prickett, K. C; Gutierrez, C, Deb, S.
      Abstract: BACKGROUND:Firearm-related fatalities are a top 3 cause of death among children in the United States. Despite historical declines in firearm ownership, the firearm-related mortality rate among young children has risen over the past decade. In this study, we examined changes in firearm ownership among families with young children from 1976 to 2016, exploring how such changes relate to recent increases in firearm-related mortality among 1- to 5-year-olds.METHODS:Individual-level data from the National Vital Statistics System were merged with household-level data from the General Social Survey to create national-level estimates of firearm-related child mortality and family firearm ownership from 1976 to 2016 (n = 41 years). Vector autoregression models were used to examine the association between firearm ownership and child mortality.RESULTS:The proportion of non-Hispanic white families with young children who owned firearms declined from 50% in 1976 to 45% in 2016 and from 38% to 6% among non-Hispanic African American families. The proportion of white families with young children who owned handguns, however, increased from 25% to 32%; 72% of firearm-owning families with young children now own a handgun. Increases in handgun ownership partially explained the recent rise in firearm-related white child mortality (B = 0.426), net of economic conditions, and sociodemographic characteristics of firearm-owning families.CONCLUSIONS:Changes in the types of firearms in the homes of US families may partially explain recently rising firearm-related mortality among young white children. These findings hold relevance for pediatricians and policy makers aiming to reduce firearm-related mortality and promote firearm safety in children’s homes.
      Keywords: Injury, Violence & Poison Prevention, Firearms, Home Safety
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-1171
      Issue No: Vol. 143, No. 2 (2019)
  • Retinal Findings in Young Children With Increased Intracranial Pressure
           From Nontraumatic Causes
    • Authors: Shi, A; Kulkarni, A, Feldman, K. W, Weiss, A, McCourt, E. A, Schloff, S, Partington, M, Forbes, B, Geddie, B. E, Bierbrauer, K, Phillips, P. H, Rogers, D. L, Abed Alnabi, W, Binenbaum, G, Levin, A. V.
      Abstract: OBJECTIVES:Increased intracranial pressure (ICP) has been suggested in legal settings as an alternative cause of retinal hemorrhages (RHs) in young children who may have sustained abusive head trauma. We assessed the prevalence and characteristics of RHs in children with increased ICP.METHODS:We conducted a prospective, multicenter study of children
      Keywords: Neurology, Neurological Surgery, Ophthalmology
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-1182
      Issue No: Vol. 143, No. 2 (2019)
  • The Pivotal Role of the International Medical Graduate
    • Authors: Chakraborty, R; Rathore, M. H, Dreyer, B. P, Stein, F.
      Keywords: Medical Education, Workforce, International Child Health
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-1189
      Issue No: Vol. 143, No. 2 (2019)
  • Discussion of Potentially Sensitive Topics With Young People
    • Authors: Santelli, J. S; Klein, J. D, Song, X, Heitel, J, Grilo, S, Wang, M, Yan, H, Kaseeska, K, Gorzkowski, J, Schneider, M, Dereix, A. E, Catallozzi, M.
      Abstract: OBJECTIVES:To identify modifiable factors that facilitate discussion of potentially sensitive topics between health care providers and young people at preventive service visits after Patient Protection and Affordable Care Act implementation.METHODS:We used data from a national internet survey of adolescents and young adults (13–26 years old) in the United States. Questionnaire construction was guided by formative research and Fisher’s Information-Motivation-Behavioral Skills model. Those who had seen a regular health care provider in the past 2 years were asked about 11 specific topics recommended by national medical guidelines. Four multivariable regression models were used to identify independent predictors of discussions of (1) tobacco use, (2) drug and/or alcohol use, (3) sexually transmitted infections or HIV, and (4) the number of topics discussed.RESULTS:Fewer than half of young people reported having discussed 10 of 11 topics at their last visit. Predictors were similar across all 4 models. Factors independently associated with health discussions included the following: ever talked with a provider about confidentiality (4/4 models; adjusted odds ratio [aOR] = 1.85–2.00), ever had private time with a provider (1 model; aOR = 1.50), use of health checklist and/or screening questionnaire at last visit (4 models; aOR = 1.78–1.96), and time spent with provider during last visit (4 models). Number of years that young men had seen their regular provider was significant in 1 model. Other independent factors were positive youth attitudes about discussing specific topics (3/3 models) and youth involvement in specific health risk behaviors (3/3 models).CONCLUSIONS:Discussions about potentially sensitive topics between health care providers and young people are associated with modifiable factors of health care delivery, particularly provider explanations of confidentiality, use of screening and/or trigger questionnaires, and amount of time spent with their provider.
      Keywords: Adolescent Health/Medicine, Preventive Medicine
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-1403
      Issue No: Vol. 143, No. 2 (2019)
  • Development and Validation of a Cellulitis Risk Score: The Melbourne ASSET
    • Authors: Ibrahim, L. F; Hopper, S. M, Donath, S, Salvin, B, Babl, F. E, Bryant, P. A.
      Abstract: BACKGROUND:The evidence is unclear about the optimal route of treatment for children with cellulitis, specifically how to assess the risk of moderate-to-severe cellulitis requiring intravenous (IV) antibiotics. We aimed to derive and validate a cellulitis risk assessment scoring system to guide providers as to which patients require IV antibiotics.METHODS:This was a prospective cohort study of children presenting to the emergency department aged 6 months to 18 years diagnosed with cellulitis from January 2014 to August 2017. Patients were divided into 2 groups based on route of antibiotics at 24 hours (the predetermined gold standard). Demographics and clinical features were compared. Clinicians were surveyed about which features they used to decide whether to start IV antibiotics. Combinations of differentiating features were plotted on receiver operating characteristic curves.RESULTS:There were 285 children in the derivation cohort used to create the Melbourne Area, Systemic features, Swelling, Eye, Tenderness (ASSET) Score, which has a maximum score of 7. The area under the curve was 0.86 (95% confidence interval 0.83–0.91). Using a cutoff score of 4 to start IV antibiotics yielded the highest correct classification of 80% of patients (sensitivity 60%; specificity 93%). This score was validated in 251 children and maintained a robust area under the curve of 0.83 (95% confidence interval 0.78–0.89).CONCLUSIONS:The Melbourne ASSET Score was derived and validated for cellulitis in children to guide clinicians regarding when to start IV antibiotics. Although intended for widespread use, if limitations exist in other settings, it is designed to allow for refinement and is amenable to local impact analysis.
      Keywords: Emergency Medicine, Infectious Disease
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-1420
      Issue No: Vol. 143, No. 2 (2019)
  • Perinatal Risk Factors and Outcome Coding in Clinical and Administrative
    • Authors: Tawfik, D. S; Gould, J. B, Profit, J.
      Abstract: BACKGROUND AND OBJECTIVES:Administrative databases may allow true population-based studies and quality improvement endeavors, but the accuracy of billing codes for capturing key risk factors and outcomes needs to be assessed. We sought to describe the performance of a statewide administrative database and the clinical database from the California Perinatal Quality Care Collaborative (CPQCC).METHODS:This population-based retrospective cohort study linked key perinatal risk factors and outcomes from the 133-unit CPQCC database to relevant billing codes from administrative maternal and newborn inpatient discharge records, for 50 631 infants born from 2006 to 2012. Using the CPQCC record as the gold standard, we calculated the positive predictive value, negative predictive value, and Matthews correlation coefficient for each item, then evaluated comparative performance across units.RESULTS:The Matthews correlation coefficient was highest (>0.7; strong positive correlation) for multiple delivery, Cesarean delivery, very low birth weight, maternal hypertension, maternal diabetes, patent ductus arteriosus, in-hospital death, patent ductus arteriosus and retinopathy of prematurity surgeries, extracorporeal life support, and intraventricular hemorrhage. Maternal chorioamnionitis, fetal distress, retinopathy of prematurity staging, chronic lung disease, and pneumothorax were the least reliably coded. Maternal factors and delivery details were more reliably coded in the maternal inpatient record than the newborn inpatient record.CONCLUSIONS:Several important perinatal risk factors and outcomes are highly congruent between these administrative and clinical databases. Several subjective risk factors and outcomes are appropriate targets for data improvement initiatives. The ability for timely extraction of administrative inpatient data will be key to their usefulness in quality metrics.
      Keywords: Administration/Practice Management, Quality Improvement, Fetus/Newborn Infant, Neonatology
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-1487
      Issue No: Vol. 143, No. 2 (2019)
  • Bifidobacterium Abundance in Early Infancy and Vaccine Response at 2 Years
           of Age
    • Authors: Huda, M. N; Ahmad, S. M, Alam, M. J, Khanam, A, Kalanetra, K. M, Taft, D. H, Raqib, R, Underwood, M. A, Mills, D. A, Stephensen, C. B.
      Abstract: BACKGROUND:The intestinal microbiome in early infancy affects immunologic development and thus may affect vaccine memory, though few prospective studies have examined such associations. We examined the association of Bifidobacterium levels in early infancy with memory responses to early vaccination measured at 2 years of age.METHODS:In this prospective observational study, we examined the association of Bifidobacterium abundance in the stool of healthy infants at 6 to 15 weeks of age, near the time of vaccination, with T-cell and antibody responses measured at 6 weeks, 15 weeks, and 2 years of age. Infants were vaccinated with Bacillus Calmette-Guérin (BCG) (at birth), oral polio virus (at birth and at 6, 10, and 14 weeks), tetanus toxoid (TT) (at 6, 10, and 14 weeks), and hepatitis B virus (at 6, 10, and 14 weeks). Fecal Bifidobacterium was measured at 6, 11, and 15 weeks. Bifidobacterium species and subspecies were measured at 6 weeks.RESULTS:Mean Bifidobacterium abundance in early infancy was positively associated with the CD4 T-cell responses to BCG, TT, and hepatitis B virus at 15 weeks, with CD4 responses to BCG and TT at 2 years, and with plasma TT-specific immunoglobulin G and stool polio-specific immunoglobulin A at 2 years. Similar associations were seen for the predominant subspecies, Bifidobacterium longum subspecies infantis.CONCLUSIONS:Bifidobacterium abundance in early infancy may increase protective efficacy of vaccines by enhancing immunologic memory. This hypothesis could be tested in clinical trials of interventions to optimize Bifidobacterium abundance in appropriate populations.
      Keywords: International Child Health, Allergy/Immunology
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-1489
      Issue No: Vol. 143, No. 2 (2019)
  • Mutation in ITCH Gene Can Cause Syndromic Multisystem Autoimmune Disease
           With Acute Liver Failure
    • Authors: Kleine-Eggebrecht, N; Staufner, C, Kathemann, S, Elgizouli, M, Kopajtich, R, Prokisch, H, Lainka, E.
      Abstract: Pediatric intractable autoimmune hepatitis is rare and may be responsible for acute liver failure. Mutations in the itchy E3 ubiquitin protein ligase (ITCH) gene (located on chromosome 20q11.22) can lead to a deficiency of the encoded protein, resulting in increased T-cell activity with lack of immune tolerance and manifestation of a complex systemic autoimmune disease. A 1-year-old girl of consanguineous parents received a liver transplant (LT) because of acute liver failure attributed to a drug-induced hypereosinophilic syndrome with positive liver-kidney-mikrosome-2 antibodies. Notable findings were syndromic features, dystrophy, short stature, psychomotor retardation, and muscular hypotonia. Later, we saw corticosteroid-sensitive rejections as well as a systemic autoimmune disease with detection of specific antibodies (de novo autoimmune hepatitis, thyroiditis with exophthalmos, diabetes mellitus type 1, and immune neutropenia). Histologically, liver cirrhosis with lobular inflammatory infiltrates, giant-cell hepatitis, and ductopenia was verified in chronic cholestasis. Shortly after a second LT, a comparable liver histology could be detected, and viral, bacterial, and mycotic infections deteriorated the general health condition. Because of refractory pancytopenia related to portal hypertension and hypersplenism, a posttransplant lymphoproliferative disorder was excluded. One year after the second LT, epidural and subdural bleeding occurred. Three months afterward, the girl died of sepsis. Postmortem, whole-exome sequencing revealed a homozygous mutation in the ITCH gene. A biallelic mutation in ITCH can cause a severe syndromic multisystem autoimmune disease with the above phenotypic characteristics and acute liver failure because of autoimmune hepatitis. This case reveals the importance of ubiquitin pathways for regulation of the immune system.
      Keywords: Gastroenterology, Hepatology
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-1554
      Issue No: Vol. 143, No. 2 (2019)
  • Methemoglobinemia in an Infant After Sclerotherapy With High-Dose
    • Authors: Coughlin, K; Flibotte, J, Cahill, A. M, Osterhoudt, K, Hedrick, H, Vrecenak, J.
      Abstract: Methemoglobinemia occurs when the heme moiety of hemoglobin (Hb) is oxidized from the ferrous to ferric state, leading to impairments in oxygen transport and delivery. Methemoglobinemia is rare in pediatric patients but has been described in the setting of congenital abnormalities in the Hb structure, inherited enzyme deficiencies, oxidative Hb injury in response to illness, and oxidative Hb injury due to toxicants. We present a 1-week-old infant born with a cervical lymphangioma who developed persistent desaturations that were unresponsive to oxygen after sclerotherapy with doxycycline. Arterial blood gas revealed a high Pao2 despite low saturations being found on pulse oximetry and a methemoglobin level that was found to be elevated. Further sclerotherapy was discontinued, the saturations eventually normalized, and the methemoglobin level decreased. This is a novel report of sclerotherapy with doxycycline associated with the development of methemoglobinemia.
      Keywords: Fetus/Newborn Infant, Neonatology, Hematology/Oncology, Blood Disorders
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-1642
      Issue No: Vol. 143, No. 2 (2019)
  • Acceptance and Commitment Therapy for Parental Management of Childhood
           Asthma: An RCT
    • Authors: Chong, Y.-y; Mak, Y.-w, Leung, S.-p, Lam, S.-y, Loke, A. Y.
      Abstract: BACKGROUND:Few trials have been conducted to address the psychological difficulties of parents in managing their child’s asthma. Fostering parental psychological flexibility through Acceptance and Commitment Therapy (ACT) may help parents to accept these psychological difficulties and improve their management of childhood asthma.METHODS:In this randomized controlled trial, a 4-session, group-based ACT plus asthma education (ACT group) was compared with an asthma education talk plus 3 telephone follow-ups (control group) to train parents of children diagnosed with asthma. The use of health care services due to asthma exacerbations in children and the psychological well-being of their parents were assessed before, immediately after, and at 6 months after the intervention.RESULTS:A total of 168 parents and their children aged 3 to 12 years with asthma were consecutively recruited in a public hospital in Hong Kong. When compared with the control group, children whose parents were in the ACT group made significantly fewer emergency department visits (adjusted 6-month incidence rate ratio = 0.20; confidence interval [CI] 0.08 to 0.53; P = .001) due to asthma exacerbations at 6 months postintervention. These parents also reported a decrease in psychological inflexibility (mean difference = –5.45; CI –7.71 to –3.30; P = .014), less anxiety (mean difference = –2.20; CI –3.66 to –0.73; P = .003), and stress (mean difference = –2.50; CI –4.54 to –0.47; P = .016). CONCLUSIONS:Integrating ACT into parental asthma education was effective at decreasing parental anxiety and stress and reducing the asthma-related emergency department visits of children at 6 months postintervention.
      Keywords: Psychiatry/Psychology, Allergy/Immunology, Asthma
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-1723
      Issue No: Vol. 143, No. 2 (2019)
  • Parent-Adolescent Agreement About Adolescents Suicidal Thoughts
    • Authors: Jones, J. D; Boyd, R. C, Calkins, M. E, Ahmed, A, Moore, T. M, Barzilay, R, Benton, T. D, Gur, R. E.
      Abstract: OBJECTIVES:To examine agreement between parent and adolescent reports of adolescents’ suicidal thoughts and explore demographic and clinical factors associated with agreement in a large community sample.METHODS:Participants included 5137 adolescents 11 to 17 years old (52.1% girls; 43.0% racial minority) and a collateral informant (97.2% parent or stepparent) from the Philadelphia Neurodevelopmental Cohort. Families were recruited from a large pediatric health care network. Adolescents and parents completed a clinical interview that included questions about adolescents’ lifetime suicidal thoughts.RESULTS:Agreement was moderate for thoughts of killing self ( = 0.466) and low for thoughts of death or dying ( = 0.171). Discrepancies stemmed from both parental unawareness of suicidal thoughts reported by adolescents and adolescent denial of suicidal thoughts reported by parents. Fifty percent of parents were unaware of adolescents’ thoughts of killing themselves, and 75.6% of parents were unaware of adolescents’ recurrent thoughts of death. Forty-eight percent of adolescents denied thoughts of killing themselves, and 67.5% of adolescents denied thoughts of death reported by parents. Several demographic (eg, age) and clinical (eg, treatment history) characteristics were associated with agreement.CONCLUSIONS:Early identification and intervention hinge on reliable and valid assessment of suicide risk. The high prevalence of parental unawareness and adolescent denial of suicidal thoughts found in this study suggests that many adolescents at risk for suicide may go undetected. These findings have important clinical implications for pediatric settings, including the need for a multi-informant approach to suicide screening and a personalized approach to assessment based on empirically derived risk factors for unawareness and denial.
      Keywords: Adolescent Health/Medicine, Psychiatry/Psychology
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-1771
      Issue No: Vol. 143, No. 2 (2019)
  • Factors Associated With Rotavirus Vaccine Coverage
    • Authors: Aliabadi, N; Wikswo, M. E, Tate, J. E, Cortese, M. M, Szilagyi, P. G, Staat, M. A, Weinberg, G. A, Halasa, N. B, Boom, J. A, Selvarangan, R, Englund, J. A, Azimi, P. H, Klein, E. J, Moffatt, M. E, Harrison, C. J, Sahni, L. C, Stewart, L. S, Bernstein, D. I, Parashar, U. D, Payne, D. C.
      Abstract: BACKGROUND:Rotavirus vaccines (RVVs) were included in the US immunization program in 2006 and are coadministered with the diphtheria-tetanus-acellular pertussis (DTaP) vaccine, yet their coverage lags behind DTaP. We assessed timing, initiation, and completion of the RVV series among children enrolled in active gastroenteritis surveillance at 7 US medical institutions during 2014–2016.METHODS:We compared coverage and timing of each vaccine series and analyzed characteristics associated with RVV initiation and completion. We report odds ratios (ORs) and 95% confidence intervals (CIs) from multivariable logistic regression models.RESULTS:We enrolled 10 603 children. In 2015, ≥1 dose coverage was 91% for RVV and 97% for DTaP. Seven percent of children received their first DTaP vaccine at age ≥15 weeks versus 4% for RVV (P ≤ .001). Recent birth years (2013–2016) were associated with higher odds of RVV initiation (OR = 5.72; 95% CI 4.43–7.39), whereas preterm birth (OR = 0.32; 95% CI 0.24–0.41), older age at DTaP initiation (OR 0.85; 95% CI 0.80–0.91), income between $50 000 and $100 000 (OR = 0.56; 95% CI 0.40–0.78), and higher maternal education (OR = 0.52; 95% CI 0.36–0.74) were associated with lower odds. Once RVV was initiated, recent birth years (2013–2016; OR = 1.57 [95% CI 1.32–1.88]) and higher maternal education (OR = 1.31; 95% CI 1.07–1.60) were associated with higher odds of RVV completion, whereas preterm birth (OR = 0.76; 95% CI 0.62–0.94), African American race (OR = 0.82; 95% CI 0.70–0.97) and public or no insurance (OR = 0.75; 95% CI 0.60–0.93) were associated with lower odds. Regional differences existed.CONCLUSIONS:RVV coverage remains lower than that for the DTaP vaccine. Timely DTaP administration may help improve RVV coverage.
      Keywords: Infectious Disease, Epidemiology, Vaccine/Immunization
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-1824
      Issue No: Vol. 143, No. 2 (2019)
  • Questions and Concerns About HPV Vaccine: A Communication Experiment
    • Authors: Shah, P. D; Calo, W. A, Gilkey, M. B, Boynton, M. H, Alton Dailey, S, Todd, K. G, Robichaud, M. O, Margolis, M. A, Brewer, N. T.
      Abstract: OBJECTIVES:We sought to identify effective responses to parents’ questions and concerns about human papillomavirus (HPV) vaccine.METHODS:In 2017–2018, we surveyed a national sample of 1196 US parents of children aged 9 to 17 years. We recorded brief videos of a pediatrician providing messages that addressed 7 HPV vaccination topics that commonly elicit questions or concerns (eg, recommended age). We randomly assigned parents to 1 of the message topics; parents then viewed 4 videos on that topic in random order and evaluated the messages.RESULTS:Parents were more confident in HPV vaccine when they were exposed to messages that addressed lack of knowledge about HPV vaccine (b = 0.13; P = .01), messages that included information about cancer prevention (b = 0.11; P < .001), messages that required a higher reading level (b = 0.02; P = .01), and messages that were longer (b = 0.03; P < .001). Parents were less confident in HPV vaccine when exposed to messages in which urgency was expressed (b = –0.06; P = .005). Analyses conducted by using HPV vaccine motivation as an outcome revealed the same pattern of findings.CONCLUSIONS:We provide research-tested messages that providers can use to address parents’ HPV vaccination questions and concerns about 7 common topics. Important principles for increasing message effectiveness are to include information on the benefits of vaccination (including cancer prevention) and avoid expressing urgency to vaccinate when addressing parents' questions or concerns. Additionally, providers may need to be prepared to have longer conversations with parents who express concerns about HPV vaccine, especially regarding safety and side effects.
      Keywords: Infectious Disease, Vaccine/Immunization, Preventive Medicine
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-1872
      Issue No: Vol. 143, No. 2 (2019)
  • Leveraging Evidence-Based Public Policy and Advocacy to Advance Newborn
           Screening in California
    • Authors: Bronstein, M. G; Pan, R. J, Dant, M, Lubin, B.
      Abstract: In 2016, the EveryLife Foundation for Rare Diseases, in partnership with Dr Pan, who is a pediatrician and state senator in California, launched legislation to advance and expand newborn screening. Researchers have shown that newborn screening can be cost-effective and can greatly improve health outcomes for patients with rare diseases. However, adding additional diseases in newborn screening is a long process, requiring legislative approval in addition to new state funding. Such process delays can lead to protracted diagnostic odysseys for patients, especially those with rare diseases. These delays can result in irreversible morbidity and, in some cases, early mortality for patients. To improve this process, legislation known as Senate Bill 1095 was introduced to require California to adhere to the latest federal recommendations for newborn screening within 2 years. We provide insight and describe the process of advancing state legislation, coalition building, and managing opposition. Senate Bill 1095 would become law in 2016, requiring California to screen for 2 new rare diseases by August 2018: mucopolysaccharidosis type I and Pompe disease. This case study can serve as a model for advocates looking to expand state newborn-screening programs.
      Keywords: Fetus/Newborn Infant, Advocacy, Legislation
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-1886
      Issue No: Vol. 143, No. 2 (2019)
  • Addressing Racial Inequities in Breastfeeding in the Southern United
    • Authors: Merewood, A; Bugg, K, Burnham, L, Krane, K, Nickel, N, Broom, S, Edwards, R, Feldman-Winter, L.
      Abstract: BACKGROUND:Race is a predictor of breastfeeding rates in the United States, and rates are lowest among African American infants. Few studies have assessed changes in breastfeeding rates by race after implementing the Ten Steps to Successful Breastfeeding (hereafter referred to as the Ten Steps), and none have assessed the association between implementation and changes in racial disparities in breastfeeding rates. Our goal was to determine if a hospital- and community-based initiative in the Southern United States could increase compliance with the Ten Steps, lead to Baby-Friendly designation, and decrease racial disparities in breastfeeding.METHODS:Hospitals in Mississippi, Louisiana, Tennessee, and Texas were enrolled into the Communities and Hospitals Advancing Maternity Practices initiative from 2014 to 2017 and received an intensive quality improvement and technical assistance intervention to improve compliance with the Ten Steps. Community partners and statewide organizations provided parallel support. Hospitals submitted monthly aggregate data stratified by race on breastfeeding, skin-to-skin care, and rooming in practices.RESULTS:The disparity in breastfeeding initiation between African American and white infants decreased by 9.6 percentage points (95% confidence interval 1.6–19.5) over the course of 31 months. Breastfeeding initiation increased from 66% to 75% for all races combined, and exclusivity increased from 34% to 39%. Initiation and exclusive breastfeeding among African American infants increased from 46% to 63% (P < .05) and from 19% to 31% (P < .05), respectively. Skin-to-skin care after cesarean delivery was significantly associated with increased breastfeeding initiation and exclusivity in all races; rooming in was significantly associated with increased exclusive breastfeeding in African American infants only.CONCLUSIONS:Increased compliance with the Ten Steps was associated with a decrease in racial disparities in breastfeeding.
      Keywords: Administration/Practice Management, Quality Improvement, Nutrition, Breastfeeding
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-1897
      Issue No: Vol. 143, No. 2 (2019)
  • Human Papillomavirus Vaccine Effectiveness and Herd Protection in Young
    • Authors: Spinner, C; Ding, L, Bernstein, D. I, Brown, D. R, Franco, E. L, Covert, C, Kahn, J. A.
      Abstract: BACKGROUND:Clinical trials of the 4-valent human papillomavirus (HPV) vaccine demonstrate high efficacy, but surveillance studies are essential to examine the long-term impact of vaccine introduction on HPV prevalence in community settings. The aims of this study were to determine during the 11 years after vaccine introduction the prevalence of (1) vaccine-type HPV in adolescent and young adult women who were vaccinated (to assess vaccine effectiveness) and (2) vaccine-type HPV in women who were unvaccinated (to assess herd protection).METHODS:Young women 13 to 26 years of age were recruited from hospital-based and community health clinics for 4 surveillance studies from 2006 to 2017. We determined the proportion of vaccinated and unvaccinated women who were positive for vaccine-type HPV across the studies, and the odds of positivity for vaccine-type HPV using logistic regression; all analyses were propensity score–adjusted to control for between-wave differences in participant characteristics.RESULTS:Vaccination rates increased from 0% to 84.3% (97% of study participants received the 4-valent vaccine). Among women who were vaccinated, 4-valent vaccine–type HPV detection decreased from 35% to 6.7% (80.9% decline; odds ratio 0.13, 95% confidence interval 0.08 to 0.22). Among women who were unvaccinated, 4-valent vaccine–type HPV detection decreased from 32.4% to 19.4% (40% decline; odds ratio 0.50, 95% confidence interval 0.26 to 0.97). Estimated vaccine effectiveness was 90.6% in wave 3 and 80.1% in wave 4.CONCLUSIONS:In this study in which trends in HPV in a US community>10 years after 4-valent HPV vaccine introduction and after 9-valent vaccine introduction were examined, we found evidence of vaccine effectiveness and herd protection. Further research is needed to examine trends in 9-valent vaccine–type HPV after higher rates of vaccination are achieved.
      Keywords: Infectious Disease, Vaccine/Immunization, Sexually Transmitted Infections
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-1902
      Issue No: Vol. 143, No. 2 (2019)
  • Trends in Pediatric Hospitalizations and Readmissions: 2010-2016
    • Authors: Bucholz, E. M; Toomey, S. L, Schuster, M. A.
      Abstract: BACKGROUND:Health reform and policy initiatives over the last 2 decades have led to significant changes in pediatric clinical practice. However, little is known about recent trends in pediatric hospitalizations and readmissions at a national level.METHODS:Data from the 2010–2016 Healthcare Cost and Utilization Project Nationwide Readmissions Database and National Inpatient Sample were analyzed to characterize patient-level and hospital-level trends in annual pediatric (ages 1–17 years) admissions and 30-day readmissions. Poisson regression was used to evaluate trends in pediatric readmissions over time.RESULTS:From 2010 to 2016, the total number of index admissions decreased by 21.3%, but the percentage of admissions for children with complex chronic conditions increased by 5.7%. Unadjusted pediatric 30-day readmission rates increased over time from 6.26% in 2010 to 7.02% in 2016 with a corresponding increase in numbers of admissions for patients with complex chronic conditions. When stratified by complex or chronic conditions, readmission rates declined or remained stable across patient subgroups. Mean risk-adjusted hospital readmission rates increased over time overall (6.46% in 2010 to 7.14% in 2016) and in most hospital subgroups but decreased over time in metropolitan teaching hospitals.CONCLUSIONS:Pediatric admissions declined from 2010 to 2016 as 30-day readmission rates increased. The increase in readmission rates was associated with greater numbers of admissions for children with chronic conditions. Hospitals serving pediatric patients need to account for the rising complexity of pediatric admissions and develop strategies for reducing readmissions in this high-risk population.
      Keywords: Hospital Medicine
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-1958
      Issue No: Vol. 143, No. 2 (2019)
  • Live Attenuated and Inactivated Influenza Vaccine Effectiveness
    • Authors: Chung, J. R; Flannery, B, Ambrose, C. S, Begue, R. E, Caspard, H, DeMarcus, L, Fowlkes, A. L, Kersellius, G, Steffens, A, Fry, A. M, for the Influenza Clinical Investigation for Children Study Team, the Influenza Incidence Surveillance Project, the US Influenza Vaccine Effectiveness Network
      Abstract: BACKGROUND:Researchers in observational studies of vaccine effectiveness (VE) in which they compared quadrivalent live attenuated vaccine (LAIV4) and inactivated influenza vaccine (IIV) among children and adolescents have shown inconsistent results, and the studies have been limited by small samples.METHODS:We combined data from 5 US studies from 2013–2014 through 2015–2016 to compare the VE of LAIV4 and IIV against medically attended, laboratory-confirmed influenza among patients aged 2 to 17 years by influenza season, subtype, age group, and prior vaccination status. The VE of IIV or LAIV4 was calculated as 100% x (1 – odds ratio), comparing the odds of vaccination among patients who were influenza-positive to patients who were influenza-negative from adjusted logistic regression models. Relative effectiveness was defined as the odds of influenza comparingLAIV4 and IIV recipients.RESULTS:Of 17 173 patients aged 2 to 17 years, 4579 received IIV, 1979 received LAIV4, and 10 615 were unvaccinated. Against influenza A/H1N1pdm09, VE was 67% (95% confidence interval [CI]: 62% to 72%) for IIV and 20% (95% CI: –6% to 39%) for LAIV4. Results were similar when stratified by vaccination in the previous season. LAIV4 recipients had significantly higher odds of influenza A/H1N1pdm09 compared with IIV recipients (odds ratio 2.66; 95% CI: 2.06 to 3.44). LAIV4 and IIV had similar effectiveness against influenza A/H3N2 and B. Our overall findings were consistent when stratified by influenza season and age group.CONCLUSIONS:From this pooled individual patient–level data analysis, we found reduced effectiveness of LAIV4 against influenza A/H1N1pdm09 compared with IIV, which is consistent with published results from the individual studies included.
      Keywords: Infectious Disease, Influenza, Vaccine/Immunization
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-2094
      Issue No: Vol. 143, No. 2 (2019)
  • Caregiver Experience in Pediatric Dialysis
    • Authors: Wightman, A; Zimmerman, C. T, Neul, S, Lepere, K, Cedars, K, Opel, D.
      Abstract: BACKGROUND AND OBJECTIVES:Pediatric dialysis is thought to be burdensome on caregivers given their need to assume dual responsibilities of parental and medical management of their child’s chronic illness. In this study, we seek to describe the experience of parental caregivers of children receiving chronic dialysis for end-stage kidney disease.METHODS:We performed semistructured interviews of primary caregivers of children with end-stage kidney disease receiving chronic peritoneal dialysis or hemodialysis for at least 8 weeks from March 2016 to April 2017 at 3 pediatric dialysis centers in the United States. We performed a thematic analysis to inductively derive and identify themes and subthemes related to positive and negative caregiver experiences.RESULTS:Thirty-five caregivers completed interviews. Four major themes were identified, each with several subthemes: (1) caregiver medicalization (subthemes: diagnosis and initiation, disease management, and the future), (2) emotional adjustment (initial and/or acute phase, acceptance, personal growth, and medical stress and psychological burden), (3) pragmatic adaptation (disruption, adaptation of life goals and/or sense of self, and financial impact), and (4) social adjustment (relationship opportunity, relationship risk, advocacy, family functioning, and intimate relationships). These themes and subthemes reflected a broad range of experiences from positive to severely burdensome.CONCLUSIONS:Caregivers of patients on dialysis report a broad range of positive and burdensome experiences. These results reveal a need for continued advocacy to support families with a child on dialysis and can be used to develop targeted measures to study and improve caregiver experience in this population.
      Keywords: Community Pediatrics, Nephrology
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-2102
      Issue No: Vol. 143, No. 2 (2019)
  • Newborn Risk Factors for Subsequent Physical Abuse Hospitalizations
    • Authors: Puls, H. T; Anderst, J. D, Bettenhausen, J. L, Clark, N, Krager, M, Markham, J. L, Hall, M.
      Abstract: OBJECTIVES:To describe the prevalence of risk factors for abuse and newborns’ risks for physical abuse hospitalizations during early infancy.METHODS:We created a nationally representative US birth cohort using the 2013 and 2014 Nationwide Readmissions Databases. Newborns were characterized by demographics, prematurity or low birth weight (LBW), intrauterine drug exposure, and medical complexity (including birth defects). Newborns were tracked for 6 months from their birth hospitalization, and subsequent abuse hospitalizations were identified by using International Classification of Diseases, Ninth Revision codes. We calculated adjusted relative risks (aRRs) with multiple logistic regression, and we used classification and regression trees to identify newborns with the greatest risk for abuse on the basis of combinations of multiple risk factors.RESULTS:There were 3 740 582 newborns in the cohort. Among them, 1247 (0.03%) were subsequently hospitalized for abuse within 6 months. Among infants who were abused, 20.4% were premature or LBW, and 4.1% were drug exposed. Premature or LBW newborns (aRR 2.16 [95% confidence interval (CI): 1.87–2.49]) and newborns who were drug exposed (aRR 2.86 [95% CI: 2.15–3.80]) were independently at an increased risk for an abuse hospitalization, but newborns with medical complexity or noncardiac birth defects were not. Publicly insured preterm or LBW newborns from rural counties had the greatest risk for abuse hospitalizations (aRR 9.54 [95% CI: 6.88–13.23]). Publicly insured newborns who were also preterm, LBW, or drug exposed constituted 5.2% of all newborns, yet they constituted 18.5% of all infants who were abused.CONCLUSIONS:Preterm or LBW newborns and newborns who were drug exposed, particularly those with public insurance and residing in rural counties, were at the highest risk for abuse hospitalizations. Effective prevention directed at these highest-risk newborns may prevent a disproportionate amount of abuse.
      Keywords: Child Abuse and Neglect
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-2108
      Issue No: Vol. 143, No. 2 (2019)
  • Continuous Versus Intermittent Vancomycin Infusions in Infants: A
           Randomized Controlled Trial
    • Authors: Gwee, A; Cranswick, N, McMullan, B, Perkins, E, Bolisetty, S, Gardiner, K, Daley, A, Ward, M, Chiletti, R, Donath, S, Hunt, R, Curtis, N.
      Abstract: BACKGROUND:In adults, continuous infusions of vancomycin (CIV) are associated with earlier attainment of target drug concentrations, require fewer blood samples for monitoring, and may reduce drug toxicity. We aimed to determine, in young infants, if CIV or intermittent infusions of vancomycin (IIV) better achieves target vancomycin concentrations at the first steady-state level and to compare the frequency of drug-related adverse effects.METHODS:In a multicenter randomized controlled trial in 2 tertiary neonatal units over a 40-month period, young infants aged 0 to 90 days requiring vancomycin therapy for at least 48 hours were randomly assigned to CIV and IIV.RESULTS:Of 111 infants randomized, 104 were included in the intention-to-treat analysis. Baseline characteristics were similar for both groups. The proportion of infants achieving target concentrations at the first steady-state level was higher for CIV compared with IIV (45 in 53 [85%] vs 21 in 51 [41%]; P < .001). Fewer dose adjustments were required in the CIV group (median 0; range 0–1) compared with the IIV group (median 1; range 0–3; P < .001). The mean daily dose required to achieve target concentrations was lower with CIV compared with IIV (40.6 [SD 10.7] vs 60.6 [SD 53.0] mg/kg per day, respectively; P = .01). No drug-related adverse effects occurred in either group.CONCLUSIONS:In young infants, CIV is associated with earlier and improved attainment of target concentrations compared with IIV. Lower total daily doses are required to achieve target levels with CIV. There is no difference in the rate of drug-related adverse effects.
      Keywords: Fetus/Newborn Infant, Neonatology, Infectious Disease
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-2179
      Issue No: Vol. 143, No. 2 (2019)
  • Newborn Screening for Severe Combined Immunodeficiency and T-cell
           Lymphopenia in California, 2010-2017
    • Authors: Amatuni, G. S; Currier, R. J, Church, J. A, Bishop, T, Grimbacher, E, Nguyen, A. A.-C, Agarwal-Hashmi, R, Aznar, C. P, Butte, M. J, Cowan, M. J, Dorsey, M. J, Dvorak, C. C, Kapoor, N, Kohn, D. B, Markert, M. L, Moore, T. B, Naides, S. J, Sciortino, S, Feuchtbaum, L, Koupaei, R. A, Puck, J. M.
      Abstract: OBJECTIVES:Newborn screening for severe combined immunodeficiency (SCID) was instituted in California in 2010. In the ensuing 6.5 years, 3 252 156 infants in the state had DNA from dried blood spots assayed for T-cell receptor excision circles (TRECs). Abnormal TREC results were followed-up with liquid blood testing for T-cell abnormalities. We report the performance of the SCID screening program and the outcomes of infants who were identified.METHODS:Data that were reviewed and analyzed included demographics, nursery summaries, TREC and lymphocyte flow-cytometry values, and available follow-up, including clinical and genetic diagnoses, treatments, and outcomes.RESULTS:Infants with clinically significant T-cell lymphopenia (TCL) were successfully identified at a rate of 1 in 15 300 births. Of these, 50 cases of SCID, or 1 in 65 000 births (95% confidence interval 1 in 51 000–1 in 90 000) were found. Prompt treatment led to 94% survival. Infants with non-SCID TCL were also identified, diagnosed and managed, including 4 with complete DiGeorge syndrome who received thymus transplants. Although no cases of typical SCID are known to have been missed, 2 infants with delayed-onset leaky SCID had normal neonatal TREC screens but came to clinical attention at 7 and 23 months of age.CONCLUSIONS:Population-based TREC testing, although unable to detect immune defects in which T cells are present at birth, is effective for identifying SCID and clinically important TCL with high sensitivity and specificity. The experience in California supports the rapid, widespread adoption of SCID newborn screening.
      Keywords: Fetus/Newborn Infant, Allergy/Immunology, Immunologic Disorders
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-2300
      Issue No: Vol. 143, No. 2 (2019)
  • Cognitive Outcomes and Positional Plagiocephaly
    • Authors: Collett, B. R; Wallace, E. R, Kartin, D, Cunningham, M. L, Speltz, M. L.
      Abstract: BACKGROUND:Studies have revealed an association between positional plagiocephaly and/or brachycephaly (PPB) and development, although little is known about long-term outcomes. We examined cognition and academic achievement in children with and without PPB, testing the hypothesis that children who had PPB as infants would score lower than controls.METHODS:We enrolled 187 school-aged children with a history of PPB and 149 controls. Exposures were the presence or absence and severity of infancy PPB (mild, moderate to severe). Cognitive and academic outcomes were assessed by using the Differential Ability Scales, Second Edition and Wechsler Individual Achievement Test, Third Edition, respectively.RESULTS:Children with PPB scored lower than controls on most scales of the Differential Ability Scales, Second Edition (standardized effect sizes [ESs] = –0.38 to –0.20) and the Wechsler Individual Achievement Test, Third Edition (ESs = –0.22 to –0.17). Analyses by PPB severity revealed meaningful differences among children with moderate to severe PPB (ESs = –0.47 to –0.23 for 8 of 9 outcomes), but few differences in children with mild PPB (ESs = –0.28 to 0.14).CONCLUSIONS:School-aged children with moderate to severe PPB scored lower than controls on cognitive and academic measures; associations were negligible among children with mild PPB. The findings do not necessarily imply that these associations are causal; rather, PPB may serve as a marker of developmental risk. Our findings suggest a role for assessing PPB severity in clinical practice: providing developmental assessment and intervention for infants with more severe deformation and reassurance and anticipatory guidance for patients with mild deformation.
      Keywords: Developmental/Behavioral Pediatrics, Cognition/Language/Learning Disorders
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-2373
      Issue No: Vol. 143, No. 2 (2019)
  • Patterns of Prenatal Alcohol Use That Predict Infant Growth and
    • Authors: Bandoli, G; Coles, C. D, Kable, J. A, Wertelecki, W, Yevtushok, L, Zymak-Zakutnya, N, Wells, A, Granovska, I. V, Pashtepa, A. O, Chambers, C. D, the CIFASD
      Abstract: BACKGROUND:Previous studies have had inconsistent findings regarding the quantity and frequency of prenatal alcohol exposure (PAE) that lead to deficits in growth and neurodevelopment. This may be due to imprecise methods of exposure classification. Our objective in this study was to employ longitudinal trajectory modeling of maternal drinking patterns associated with infant growth or neurodevelopmental deficits to a homogenous sample of mothers and infants.METHODS:From a sample of 471 pregnant women prospectively enrolled in a longitudinal study in the Ukraine, we performed a longitudinal cluster analysis of drinking patterns across gestation. We employed multivariable regression analyses to determine if each trajectory group was associated with infant weight, length, or head circumference at birth or psychomotor or mental deficits in infancy.RESULTS:We identified 5 distinct PAE trajectory groups: minimal or no PAE throughout gestation, low-to-moderate PAE with discontinuation early in gestation, low-to-moderate PAE sustained across gestation, moderate-to-high PAE with reduction early in gestation, and high PAE sustained across gestation. The highest-trajectory group was associated with deficits in infant weight and length at birth and deficits in psychomotor and mental performance at 6 to 12 months of age. Although confidence intervals overlapped, low-to-moderate sustained use was more strongly associated with most negative infant outcomes than moderate-to-high PAE with early reduction.CONCLUSIONS:With these findings, we confirm that high, sustained PAE confers the highest risk for adverse infant outcomes but demonstrate that even low-to-moderate PAE continued across gestation is associated with certain deficits. This approach may be used to help clinicians identify high-risk infants for targeted early intervention.
      Keywords: Developmental/Behavioral Pediatrics, Cognition/Language/Learning Disorders, Growth/Development Milestones
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-2399
      Issue No: Vol. 143, No. 2 (2019)
  • Ranitidine-Induced Delirium in a 7-Year-Old Girl: A Case Report
    • Authors: Castro, R. E. V. d; Sousa, C. d. C, de Magalhaes-Barbosa, M. C, Prata-Barbosa, A, Cheniaux, E.
      Abstract: Ranitidine is a histamine-2 blocker commonly prescribed in PICUs for the prophylaxis of gastrointestinal bleeding and stress ulcers. However, it can be associated to central nervous system side effects, such as delirium, in adults. We present the first case of a child presenting delirium possibly caused by anticholinergic toxidrome secondary to the use of ranitidine, resolving after drug discontinuation. With this case report, we reinforce that a wide variety of clinical conditions can trigger delirium and that the best therapeutic approach is to minimize risk factors.
      Keywords: Critical Care, Developmental/Behavioral Pediatrics, Cognition/Language/Learning Disorders
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-2428
      Issue No: Vol. 143, No. 2 (2019)
  • Effects of Feedback on Chest Compression Quality: A Randomized Simulation
    • Authors: Wagner, M; Bibl, K, Hrdliczka, E, Steinbauer, P, Stiller, M, Gröpel, P, Goeral, K, Salzer-Muhar, U, Berger, A, Schmölzer, G. M, Olischar, M.
      Abstract: OBJECTIVES:Our aim for this study was to test whether visual and verbal feedback compared with instructor-led feedback improve the quality of pediatric cardiopulmonary resuscitation (CPR).METHODS:There were 653 third-year medical students randomly assigned to practice pediatric CPR on 1 of 2 manikins (infant and adolescent; n = 344 and n = 309, respectively). They were further randomly assigned to 1 of 3 feedback groups: The instructor feedback (IF) group (n = 225) received traditional, instructor-led feedback without any additional feedback device. The device feedback (DF) group (n = 223) received real-time visual feedback from a feedback device. The instructor and device feedback (IDF) group (n = 205) received verbal feedback from an instructor who continuously reviewed the trainees’ performance using the feedback device. After the training, participants’ CPR performance was assessed on the same manikin while no feedback was being provided.RESULTS:For the primary outcome of total compression score, participants in the DF and IDF groups performed similarly, with both groups showing scores significantly (P < .001) better than those of the IF group. The same findings held for correct hand position and the proportion of complete release. For compression rate, the DF group was at the higher end of the guideline for 100 to 120 chest compressions per minute compared with the IF and IDF groups (both P < .001). No effect of feedback on compression depth was found.CONCLUSIONS:Chest compression performance significantly improved with both visual and verbal feedback compared with instructor-led feedback. Feedback devices should be implemented during pediatric resuscitation training to improve resuscitation performance.
      Keywords: Medical Education, Teaching/Curriculum Development, Critical Care
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-2441
      Issue No: Vol. 143, No. 2 (2019)
  • Contraceptive Initiation Among Women in the United States: Timing, Methods
           Used, and Pregnancy Outcomes
    • Authors: Murray Horwitz, M. E; Ross-Degnan, D, Pace, L. E.
      Abstract: BACKGROUND:Timely contraceptive initiation is increasingly common, yet population trends by method and among subgroups with increased risk of unintended pregnancy are not well described. The impact of timing and type of contraceptive initiation on risk of unwanted pregnancy is unknown.METHODS:We used nationally representative cross-sectional data from 4 cycles of the National Survey of Family Growth, 2002–2015. We calculated outcomes from self-reported dates of sexual debut, contraceptive initiation, and unwanted pregnancy. We compared trends in timely contraceptive initiation (within 1 month of sexual debut) by method and by race and/or ethnicity and income. Using multivariable regression, we identified predictors of delayed contraceptive initiation. We compared the risk of unwanted pregnancy for delayed versus timely contraceptive initiation.RESULTS:We analyzed responses from 26 359 women with sexual debuts in 1970–2014. One in 5 overall and 1 in 4 African American, Hispanic, or low-income respondents reported delayed contraceptive initiation, which was associated with unwanted pregnancy within 3 months of sexual debut (adjusted risk ratio 3.7 versus timely contraceptive initiation; 99.9% confidence interval: 2.3–5.9; P < .001). Timely contraceptive initiation with less effective versus effective methods was not associated with unwanted pregnancy within 3 months.CONCLUSIONS:Delayed contraceptive initiation is more common among African American, Hispanic, and low-income women and is strongly associated with short-term risk of unwanted pregnancy. Pediatricians play a key role in making timely contraception available to adolescents at or before sexual debut. More research is needed to understand the importance of early contraceptive methods on pregnancy risk.
      Keywords: Adolescent Health/Medicine, Contraception, Teen Pregnancy
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-2463
      Issue No: Vol. 143, No. 2 (2019)
  • Youth and the Opioid Epidemic
    • Authors: Levy; S.
      Abstract: The current epidemic of opioid addiction has arguably been the most recalcitrant in the nation’s history and the first to involve substantial numbers of adolescents. The country has embarked on a public health response, including increasing access to addiction treatment. However, the treatment infrastructure, which was initially created in the 1970s, is ill equipped for meeting the needs of adolescents and young adults, who are often cared for in pediatric primary care. In this article, I review the development of the current treatment system, examine shortfalls in regard to youth-specific needs, and propose suggestions for addressing the current crisis while simultaneously preparing to address future epidemics of addiction by enabling pediatricians to better manage substance use disorders in primary care.
      Keywords: Adolescent Health/Medicine, Substance Use, Addiction
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-2752
      Issue No: Vol. 143, No. 2 (2019)
  • Survival and Health Care Use After Feeding Tube Placement in Children With
           Neurologic Impairment
    • Authors: Nelson, K. E; Rosella, L. C, Mahant, S, Cohen, E, Guttmann, A.
      Abstract: BACKGROUND AND OBJECTIVES:Children with neurologic impairment (NI) often undergo feeding tube placement for undernutrition or aspiration. We evaluated survival and acute health care use after tube placement in this population.METHODS:This is a population-based exposure-crossover study for which we use linked administrative data from Ontario, Canada. We identified children aged 13 months to 17 years with a diagnosis of NI undergoing primary gastrostomy or gastrojejunostomy tube placement between 1993 and 2015. We determined survival time from procedure until date of death or last clinical encounter and calculated mean weekly rates of unplanned hospital days overall and for reflux-related diagnoses, emergency department visits, and outpatient visits. Rate ratios were estimated from negative binomial generalized estimating equation models adjusting for time and age.RESULTS:Two-year survival after feeding tube placement was 87.4% (95% confidence interval [CI]: 85.2%–89.4%) and 5-year survival was 75.8% (95% CI: 72.8%–78.4%). The adjusted rate ratio comparing weekly rates of unplanned hospital days during the 2 years after versus before tube placement was 0.92 (95% CI: 0.57–1.48). Similarly, rates of reflux-related hospital days, emergency department visits, and outpatient visits were unchanged. Unplanned hospital days were stable within subgroups, although rates across subgroups varied.CONCLUSIONS:Mortality is high among children with NI after feeding tube placement. However, the stability of health care use before and after the procedure suggests that the high mortality may reflect underlying fragility rather than increased risk from nonoral feeding. Further research to inform risk stratification and prognostic accuracy is needed.
      Keywords: Gastroenterology, Neurology, Neurologic Disorders
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-2863
      Issue No: Vol. 143, No. 2 (2019)
  • The 2018 Joseph W. St. Geme, Jr. Leadership Award Address: Reflections on
    • Authors: Schuster; M. A.
      Abstract: The following is an address given by the author in receipt of the Joseph W. St. Geme, Jr. Leadership Award, presented by the Federation of Pediatric Organizations at the Pediatric Academic Societies Meeting in Toronto, Canada, on May 5, 2018. Gary R. Fleisher, MD, Chairman of the Department of (Pediatric) Medicine and Physician-in-Chief at Boston Children’s Hospital, and the Egan Professor of Pediatrics at Harvard Medical School, introduced the author.
      Keywords: Medical Education, Career Development
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-2957
      Issue No: Vol. 143, No. 2 (2019)
  • Developing Pediatric Patient Safety Research Priorities
    • Authors: Miller, M. R; Mistry, K. B.
      Keywords: Administration/Practice Management, Quality Improvement, Safety
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-2970
      Issue No: Vol. 143, No. 2 (2019)
  • Improving Antimicrobial Stewardship in Pediatric Emergency Care: A Pathway
    • Authors: Mistry, R. D; May, L. S, Pulia, M. S.
      Keywords: Emergency Medicine, Infectious Disease
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-2972
      Issue No: Vol. 143, No. 2 (2019)
  • Parent-Adolescent Agreement About Adolescents Suicidal Thoughts: A
    • Authors: Brahmbhatt, K; Grupp-Phelan, J.
      Keywords: Psychiatry/Psychology
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-3071
      Issue No: Vol. 143, No. 2 (2019)
  • Live Attenuated Influenza Vaccine: Will the Phoenix Rise Again'
    • Authors: Piedra; P. A.
      Keywords: Infectious Disease, Influenza, Vaccine/Immunization
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-3290
      Issue No: Vol. 143, No. 2 (2019)
  • Repurposing of Administrative Data for Research: Still Useful but for How
           Much Longer'
    • Authors: Hebert, P. L; Katon, J. G.
      Keywords: Administration/Practice Management, Quality Improvement, Fetus/Newborn Infant, Neonatology
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-3293
      Issue No: Vol. 143, No. 2 (2019)
  • Freire G, Kuppermann N, Zemek R, et al; Pediatric Emergency Research
           Networks (PERN). Predicting Escalated Care in Infants With Bronchiolitis.
           Pediatrics. 2018;142(3):e20174253
    • Keywords: Emergency Medicine, Pulmonology, Bronchiolitis
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-3404
      Issue No: Vol. 143, No. 2 (2019)
  • AAP Publications Reaffirmed
    • Keywords: Administration/Practice Management
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-3413
      Issue No: Vol. 143, No. 2 (2019)
  • Three Important Findings From a Study on HPV "Real World" Effectiveness
    • Authors: Dempsey; A. F.
      Keywords: Infectious Disease, Vaccine/Immunization
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-3427
      Issue No: Vol. 143, No. 2 (2019)
  • Block JP, Bailey LC, Gillman MW, et al; PCORnet Antibiotics and Childhood
           Growth Study Group. Early Antibiotic Exposure and Weight Outcomes in Young
           Children. Pediatrics. 2018;142(6):e20180290
    • Keywords: Pharmacology, Therapeutics, Obesity
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-3555
      Issue No: Vol. 143, No. 2 (2019)
  • Sege RD, Siegel BS; Council on Child Abuse and Neglect; Committee on
           Psychosocial Aspects of Child and Family Health. Effective Discipline to
           Raise Healthy Children. Pediatrics. 2018;142(6):e20183112
    • Keywords: Developmental/Behavioral Pediatrics, Psychosocial Issues
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-3609
      Issue No: Vol. 143, No. 2 (2019)
  • White PH, Cooley WC; Transitions Clinical Report Authoring Group; American
           Academy of Pediatrics; American Academy of Family Physicians; American
           College of Physicians. Supporting the Health Care Transition From
           Adolescence to Adulthood in the Medical Home. Pediatrics.
    • Keywords: Adolescent Health/Medicine, Transition to Adult Care
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-3610
      Issue No: Vol. 143, No. 2 (2019)
  • "Smart" Choices: Shared Decision-making in Firearm Storage and
           Personalized Firearms
    • Authors: Patel, S. J; Goyal, M. K, Parikh, K.
      Keywords: Firearms, Advocacy, Federal Policy
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-3611
      Issue No: Vol. 143, No. 2 (2019)
  • New Directions to Improve Preventive Care Discussions for Adolescents and
           Young Adults
    • Authors: Van Cleave; J.
      Keywords: Adolescent Health/Medicine
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-3618
      Issue No: Vol. 143, No. 2 (2019)
  • Feeding Tubes in Children With Neurologic Impairment: An Opportunity for
           Shared Decision-making
    • Authors: Lee, K. J; Corden, T. E.
      Keywords: Children With Special Health Care Needs
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-3623
      Issue No: Vol. 143, No. 2 (2019)
  • Jackson SL, Yang EC, Zhang Z. Income Disparities and Cardiovascular Risk
           Factors Among Adolescents. Pediatrics. 2018;142(5):e20181089
    • Keywords: Obesity, Public Health
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-3644
      Issue No: Vol. 143, No. 2 (2019)
  • The Link Between School Attendance and Good Health
    • Authors: Allison, M. A; Attisha, E, COUNCIL ON SCHOOL HEALTH
      Abstract: More than 6.5 million children in the United States, approximately 13% of all students, miss 15 or more days of school each year. The rates of chronic absenteeism vary between states, communities, and schools, with significant disparities based on income, race, and ethnicity. Chronic school absenteeism, starting as early as preschool and kindergarten, puts students at risk for poor school performance and school dropout, which in turn, put them at risk for unhealthy behaviors as adolescents and young adults as well as poor long-term health outcomes. Pediatricians and their colleagues caring for children in the medical setting have opportunities at the individual patient and/or family, practice, and population levels to promote school attendance and reduce chronic absenteeism and resulting health disparities. Although this policy statement is primarily focused on absenteeism related to students’ physical and mental health, pediatricians may play a role in addressing absenteeism attributable to a wide range of factors through individual interactions with patients and their parents and through community-, state-, and federal-level advocacy.
      Keywords: Community Pediatrics, School Health
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-3648
      Issue No: Vol. 143, No. 2 (2019)
  • Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care
    • Authors: Mueller; B. U., Neuspiel, D. R., Fisher, E. R. S., COUNCIL ON QUALITY IMPROVEMENT AND PATIENT SAFETY Mueller, B. U., Neuspiel, D. R., Fisher, E. R. S., COUNCIL ON QUALITY IMPROVEMENT AND PATIENT SAFETY
      Abstract: Pediatricians render care in an increasingly complex environment, which results in multiple opportunities to cause unintended harm. National awareness of patient safety risks has grown since the National Academy of Medicine (formerly the Institute of Medicine) published its report "To Err Is Human: Building a Safer Health System" in 1999. Patients and society as a whole continue to challenge health care providers to examine their practices and implement safety solutions. The depth and breadth of harm incurred by the practice of medicine is still being defined as reports continue to reveal a variety of avoidable errors, from those that involve specific high-risk medications to those that are more generalizable, such as patient misidentification and diagnostic error. Pediatric health care providers in all practice environments benefit from having a working knowledge of patient safety language. Pediatric providers should serve as advocates for best practices and policies with the goal of attending to risks that are unique to children, identifying and supporting a culture of safety, and leading efforts to eliminate avoidable harm in any setting in which medical care is rendered to children. In this Policy Statement, we provide an update to the 2011 Policy Statement "Principles of Pediatric Patient Safety: Reducing Harm Due to Medical Care."
      Keywords: Administration/Practice Management, Quality Improvement, Safety
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-3649
      Issue No: Vol. 143, No. 2 (2019)
  • Spinal Motion Restriction in the Trauma Patient
    • Keywords: Emergency Medicine, Hospital Medicine
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-3650
      Issue No: Vol. 143, No. 2 (2019)
  • E-Cigarettes and Similar Devices
    • Authors: Jenssen, B. P; Walley, S. C, SECTION ON TOBACCO CONTROL
      Abstract: Electronic cigarettes (e-cigarettes) are the most commonly used tobacco product among youth. The 2016 US Surgeon General’s Report on e-cigarette use among youth and young adults concluded that e-cigarettes are unsafe for children and adolescents. Furthermore, strong and consistent evidence finds that children and adolescents who use e-cigarettes are significantly more likely to go on to use traditional cigarettes—a product that kills half its long-term users. E-cigarette manufacturers target children with enticing candy and fruit flavors and use marketing strategies that have been previously successful with traditional cigarettes to attract youth to these products. Numerous toxicants and carcinogens have been found in e-cigarette solutions. Nonusers are involuntarily exposed to the emissions of these devices with secondhand and thirdhand aerosol. To prevent children, adolescents, and young adults from transitioning from e-cigarettes to traditional cigarettes and minimize the potential public health harm from e-cigarette use, there is a critical need for e-cigarette regulation, legislative action, and counterpromotion to protect youth.
      Keywords: Substance Use, Smoking
      PubDate: 2019-02-01T01:01:03-08:00
      DOI: 10.1542/peds.2018-3652
      Issue No: Vol. 143, No. 2 (2019)
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