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Journal of Pediatrics
Journal Prestige (SJR): 1.522
Citation Impact (citeScore): 2
Number of Followers: 171  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0022-3476
Published by Elsevier Homepage  [3185 journals]
  • Use of a Modified Early-Onset Sepsis Risk Calculator for Neonates Exposed
           to Chorioamnionitis
    • Abstract: Publication date: Available online 14 June 2019Source: The Journal of PediatricsAuthor(s): Amy J. Sloane, Cassandra Coleman, David L. Carola, Margaret A. Lafferty, Caroline Edwards, Jay Greenspan, Zubair H. AghaiObjectiveTo validate the recently modified Kaiser Permanente early-onset sepsis (EOS) calculator with a higher baseline incidence in chorioamnionitis exposed neonates.Study designThis is a retrospective study of chorioamnionitis-exposed neonates born at ≥35 weeks of gestation with a known EOS incidence of 4.3/1000. The risk and management categories were calculated using the calculator with an incidence of 4/1000. The results were compared with a previous analysis of the same cohort that used an EOS incidence of 0.5/1000.ResultsIn our sample, the EOS calculator recommends at least a blood culture in 834 of 896 (93.1%) and empiric antibiotics in 533 of 896 (59.5%) chorioamnionitis-exposed neonates when using an EOS incidence of 4/1000. This captures 5 of 5 neonates (100%) with EOS. When using a baseline EOS incidence of 0.5/1000, the calculator recommends at least a blood culture in only 289 of 896 (32.2%) and empiric antibiotics in only 209 of 896 (23.3%) neonates, but fails to recommend empiric antibiotics in 2 of 5 neonates with EOS (40%).ConclusionsWhen using an EOS risk of 4 of 1000 in infants exposed to mothers with chorioamnionitis, the EOS calculator has the ability to capture an increased number of neonates with culture-positive EOS. However, this change also leads to nearly a 3-fold increase in the use of empiric antibiotics and an evaluation with blood culture in almost all infants born to mothers with chorioamnionitis.
       
  • Larva Eruption: A Furuncle in a Returned Traveller
    • Abstract: Publication date: Available online 14 June 2019Source: The Journal of PediatricsAuthor(s): Daniel K. Yeoh, Coen Butters, Andrew J. Daley, Amanda Gwee
       
  • Short Sleep Duration and Later Overweight in Infants
    • Abstract: Publication date: Available online 14 June 2019Source: The Journal of PediatricsAuthor(s): Tuuli Tuohino, Isabel Morales-Muñoz, Outi Saarenpää-Heikkilä, Olli Kiviruusu, Tiina Paunio, Petteri Hovi, Kirsi H. Pietiläinen, E. Juulia PaavonenObjectiveTo provide further knowledge about the longitudinal association between sleep duration and overweight in infants.Study designThe data for this study are from the CHILD-SLEEP birth cohort (n = 1679). The sleep data are based on parent-reported total sleep duration collected at 3, 8, 18, and 24 months. For a subgroup of 8-month old participants (n = 350), an actigraph recording was also made. Growth data were derived from the child health clinic records. A logistic regression model was used to study the association between sleep duration and later weight development.ResultsShorter sleep duration in 3-month-old infants was cross-sectionally associated with lower weight-for-length/height (all P values ≤ .026) and body mass index (all P values ≤ .038). Moreover, short sleep duration at the age of 3 months was associated with greater weight-for-length/height z score at the age of 24 months (aOR 1.56; 95% CI 1.02-2.38) as well as with a predisposition to gain excess weight between 3 and 24 months of age (aOR 2.61; 95% CI 1.75-3.91). No significant associations were found between sleep duration at 8, 18, or 24 months and concurrent or later weight status. Actigraph-measured short night-time sleep duration at the age of 8 months was associated with greater weight-for-length at the age of 24 months (aOR 1.51; 95% CI 1.02-2.23).ConclusionsShort total sleep duration at the age of 3 months and short night-time sleep duration at the age of 8 months are associated with the risk of gaining excess weight at 24 months of age.
       
  • Seizure Rescue Medication Use among US Pediatric Epilepsy Providers: A
           Survey of the Pediatric Epilepsy Research Consortium
    • Abstract: Publication date: Available online 14 June 2019Source: The Journal of PediatricsAuthor(s): Adam Wallace, Elaine Wirrell, Eric PayneObjectiveTo assess how pediatric neurologists prescribe home seizure rescue medications to treat acute prolonged seizures and clusters of seizures in children.Study designA brief, email survey was sent to the members of the Pediatric Epilepsy Research Consortium assessing seizure rescue medication prescribing practices for patients of different age groups, cognitive abilities, and seizure type. Survey responses were anonymous.ResultsThirty-six respondents (of 76 surveyed; 47% response rate) completed the survey. Rectal diazepam was the most commonly chosen rescue medication for a prolonged convulsive seizure in a severely developmentally delayed 16-year-old (44%) and typical and delayed 7-year-old (44% and 61%, respectively), 3-year-old (78% and 86%, respectively), and 9-month-old (83%) patients. Most responders (69%) indicated that developmentally typical 16-year-olds would be prescribed intranasal midazolam. For clusters of seizures, clonazepam orally disintegrating tablets were the most frequent first-line option in all age groups, except developmentally delayed 3-year-old and 9-month-old children, for whom rectal diazepam was chosen more commonly. Medication dosing generally followed standard dosing guidelines with very few exceptions.ConclusionsRectal diazepam remains the most frequently used rescue medication for prolonged seizures for nearly all age groups, except in developmentally typical teenagers, for whom intranasal midazolam is used more often. Clonazepam orally disintegrating tablets are the most frequently used medication for treatment of clusters of seizures, except in younger patients. Further work is necessary to establish best practices for type and administration route of seizure rescue medications.
       
  • Gastroenteritis, Hepatitis, Encephalopathy, and Human Herpesvirus 6
           Detection in an Immunocompetent Child: Benefits and Risks of Syndromic
           Multiplex Molecular Panel Testing
    • Abstract: Publication date: Available online 14 June 2019Source: The Journal of PediatricsAuthor(s): Christina A. Olson, Samuel R. Dominguez, Steve Miller, Charles Y. Chiu, Kevin MessacarAn immunocompetent toddler came to medication attention with gastroenteritis, complicated by encephalopathy and hepatitis. Multiplexed testing using a polymerase chain reaction meningitis panel was positive for human herpesvirus 6 (HHV-6). Clinical correlation, quantitative HHV-6 polymerase chain reaction, and metagenomic next-generation sequencing supported a likely diagnosis of primary HHV-6B infection.
       
  • Assessing the Efficacy of Very Early Motor Rehabilitation in Children with
           Down Syndrome
    • Abstract: Publication date: Available online 14 June 2019Source: The Journal of PediatricsAuthor(s): Seigo Okada, Takahiro Uejo, Reiji Hirano, Haruka Nishi, Ikuko Matsuno, Takeshi Muramatsu, Mayu Fujiwara, Akiko Miyake, Yusuke Okada, Shinnosuke Fukunaga, Yuichi IshikawaAmong children with Down syndrome, the frequency of motor rehabilitation intervention and the age at the start of this intervention are independently related to the age at onset of independent walking. Early motor rehabilitation, before age 6 months, may be effective in reducing motor delay in children with Down syndrome.
       
  • Involuntary Movements with Abnormal Brain Imaging Led to the Diagnosis
    • Abstract: Publication date: Available online 14 June 2019Source: The Journal of PediatricsAuthor(s): William M. Webb, Philip R. Chapman, Victor W. Sung, Marissa N. Dean
       
  • Reply
    • Abstract: Publication date: Available online 14 June 2019Source: The Journal of PediatricsAuthor(s): Tracy N. Zembles, Glenn Bushee, Rodney E. Willoughby
       
  • More on the impact of American Academy of Pediatrics palivizumab guidance
           for infants with respiratory syncytial virus infection
    • Abstract: Publication date: Available online 14 June 2019Source: The Journal of PediatricsAuthor(s): Michela Silvestri, Oliviero Sacco, Giovanni A. Rossi
       
  • Myofibroma—A Common Congenital Lesion
    • Abstract: Publication date: Available online 11 June 2019Source: The Journal of PediatricsAuthor(s): Mario Diplomatico, Francesco Esposito, Ferdinando Aliberti, Pierluigi Marzuillo, Maria Elena Errico, Orsola Ametrano
       
  • Pustular Eruption in Kawasaki Disease
    • Abstract: Publication date: Available online 11 June 2019Source: The Journal of PediatricsAuthor(s): Sonia Kamath, Emily A. Gurnee, Olivia L. Schenck, Sarah L. Chamlin, Anthony J. Mancini
       
  • Association of Neonatologist Continuity of Care and Short-Term Patient
           Outcomes
    • Abstract: Publication date: Available online 11 June 2019Source: The Journal of PediatricsAuthor(s): Kerri Z. Machut, Ankur Datta, Jason Z. Stoller, Rakesh Rao, Amit Mathur, Theresa R. Grover, Zeenia Billimoria, Karna MurthyObjectivesTo describe neonatologist continuity of care and estimate the association between these transitions and selected patient outcomes.Study designWe linked Children's Hospitals Neonatal Database records with masked neonatologist daily schedules at 4 centers, which use 2- and 3-week and 1-month “on service” blocks to provide care. After describing the neonatologist transitions, we estimated associations between these transitions and selected short-term patient outcomes using multivariable Poisson, logistic, and linear regression analyses, independent of length of stay (LOS) and case-mix. We also completed analyses after stratifying the cohort by LOS, birthweight, age at admission categories, and selected diagnoses.ResultsStratified by LOS, patient transitions varied between centers in both unadjusted (P 
       
  • Neonatal Antibiotics and Prematurity Are Associated with an Increased Risk
           of Functional Gastrointestinal Disorders in the First Year of Life
    • Abstract: Publication date: Available online 11 June 2019Source: The Journal of PediatricsAuthor(s): Silvia Salvatore, Maria Elisabetta Baldassarre, Antonio Di Mauro, Nicola Laforgia, Silvio Tafuri, Francesco Paolo Bianchi, Enzo Dattoli, Lucia Morando, Licia Pensabene, Fabio Meneghin, Dario Dilillo, Valentina Mancini, Valentina Talarico, Francesco Tandoi, Gianvincenzo Zuccotti, Massimo AgostiObjectiveTo assess the prevalence of functional gastrointestinal disorders (FGIDs) in the first year of life and the influence of different neonatal factors on development of FGIDs.Study designA prospective cohort multicenter study including neonates, consecutively enrolled at birth, and followed up until 1 year. Gestational age, neonatal antibiotic administration, duration of hospitalization, mode of delivery, birth weight, and feeding pattern were recorded. FGIDs were classified according to Rome III criteria and assessed at 1, 3, 6, and 12 months of life.ResultsAmong 1152 newborns enrolled, 934 (81.1%) completed the study, 302 (32%) were newborns born preterm, 320 (34%) had neonatal antibiotics, and 718 (76.9%) had at least 1 FGID according to Rome III criteria (443 [47.4%] infantile colic, 374 [40.0%] regurgitation, 297 [31.8%] infant dyschezia, 248 [26.6%] functional constipation, and 34 [3.6%] functional diarrhea) throughout the first year of life. The proportion of infants born preterm presenting with FGIDs (86%) was significantly greater compared with infants born full term (72.5%) (χ2 = 21.3, P = .0001). On multivariate analysis, prematurity and neonatal use of antibiotics was significantly associated with at least 1 FGID.ConclusionsWe found a high rate FGIDs in infants, likely related to the population recruited, the long observation period, the diagnosis based on Rome III criteria, and parental reports. Preterm delivery and neonatal use of antibiotics in the first months of life are associated with an increased incidence of FGIDs, particularly infantile colic and regurgitation. In our population, cesarean delivery and feeding pattern at 1 month of life emerged as additional risk factors for infant dyschezia and functional diarrhea. Other neonatal factors associated with FGIDs need to be further explored.
       
  • Reply
    • Abstract: Publication date: Available online 11 June 2019Source: The Journal of PediatricsAuthor(s): Yaron Finkelstein, Teresa To
       
  • Free Vitamin D: Relationship to Insulin Sensitivity and Vascular Health in
           Youth
    • Abstract: Publication date: Available online 11 June 2019Source: The Journal of PediatricsAuthor(s): Fida Bacha, Sara Klinepeter Bartz, Anca Tomsa, Susan SharmaObjectiveTo evaluate the relationship of free 25 hydroxy vitamin D [free 25(OH)D] or bioavailable vitamin D (BioD) concentrations to insulin sensitivity and cardiovascular disease risk markers in normal weight and overweight youth.Study designCross-sectional study of 79 adolescents 15.4 ± 0.2 years, 18 normal weight, 30 overweight, and 31 overweight with prediabetes who underwent peripheral arterial tonometry, dual-energy x-ray absorptiometry, and hyperinsulinemic-euglycemic clamp in subset (n = 71) for determination of reactive hyperemia index (RHI), body composition, and insulin sensitivity. 25(OH)D and vitamin D binding protein were measured; free 25(OH)D and BioD were calculated.ResultsAcross tertiles of free 25(OH)D concentrations (4.0 ± 0.2, 7.5 ± 0.3, and 17.0 ± 2.1 pg/mL, P 
       
  • Dieulafoy Lesion: An Unusual Cause of Excessive Gastric Bleeding in a
           Neonate
    • Abstract: Publication date: Available online 11 June 2019Source: The Journal of PediatricsAuthor(s): Alison Kirse Coit, Uma Pisharody, Michael Kamitsuka
       
  • Cross-Sectional Study of Arterial Stiffness in Adolescents with Down
           Syndrome
    • Abstract: Publication date: Available online 11 June 2019Source: The Journal of PediatricsAuthor(s): Andrea Kelly, Sheela N. Magge, Rachel Walega, Claire Cochrane, Mary E. Pipan, Babette S. Zemel, Meryl S. Cohen, Samuel S. Gidding, Ray TownsendObjectivesTo test whether youth with Down syndrome have aortic stiffness indices, as measured by pulse wave velocity (PWV), that differ from youth without Down syndrome and to compare reference-based age-adjusted (age-PWV-Z) and height-adjusted (Ht-PWV-Z) in youth with and without Down syndrome.Study designCross-sectional study of PWV in 129 adolescents with Down syndrome and 97 youth of comparable age, sex, race/ethnicity, and body mass index (BMI). PWV, age-PWV-Z, and Ht-PWV-Z were compared. Regression models were developed to test for associations with PWV.ResultsYouth with Down syndrome and controls were comparable in BMI-Z (1.4 [−1.5 to 2.8] vs 1.2 [−2.0 to 2.8], P = .57) but not Ht-Z (−2.3 [−4.7 to 0.8] vs 0.4 [−2.0 to 2.6], P 
       
  • Neuropsychiatric side effects of montelukast
    • Abstract: Publication date: Available online 8 June 2019Source: The Journal of PediatricsAuthor(s): Thomas Kovesi
       
  • Transition Readiness in Adolescents and Young Adults with Heart Disease:
           Can We Improve Quality of Life'
    • Abstract: Publication date: Available online 8 June 2019Source: The Journal of PediatricsAuthor(s): Karen Uzark, Katherine Afton, Sunkyung Yu, Ray Lowery, Cynthia Smith, Mark D. NorrisObjectivesWe previously reported common knowledge deficits and lack of transition readiness in 13- 25-year-olds with congenital or acquired heart disease. The aims of this study were to re-evaluate transition readiness in this cohort at follow-up and to examine the relationship between changes in transition readiness and quality of life (QOL).Study designIn this prospective cohort study, patients completed the Transition Readiness Assessment and the Pediatric Quality of Life Inventory using an e-tablet, web-based format at a routine follow-up visit. Changes from initial to follow-up scores were evaluated.ResultsSixty-five percent of patients (106 of 164) completed follow-up assessments at a median age of 18.7 years (IQR, 16.5-21.2 years) at a median follow-up of 1 year. The average perceived knowledge deficit score (percent of items with no knowledge) at follow-up was 18.0 ± 15.2%, which decreased from 24.7 ± 16.5% (P 
       
  • Challenges to Eating, Swallowing, and Aerodigestive Functions in Infants:
           A Burning Platform That Needs Attention!
    • Abstract: Publication date: Available online 5 June 2019Source: The Journal of PediatricsAuthor(s): Sudarshan R. Jadcherla
       
  • Neonatal Intensive Care Variation in Medicaid-Insured Newborns: A
           Population-Based Study
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): David C. Goodman, Cecilia Ganduglia-Cazaban, Luisa Franzini, Therese A. Stukel, Jared R. Wasserman, Megan A. Murphy, Youngran Kim, Meredith E. Mowitz, Jon E. Tyson, Julie R. Doherty, George A. LittleObjectiveTo assess the contribution of maternal and newborn characteristics to variation in neonatal intensive care use across regions and hospitals.Study designThis was a retrospective population-based live birth cohort of newborn infants insured by Texas Medicaid in 2010-2014 with 2 subcohorts: very low birth weight (VLBW) singletons and late preterm singletons. Crude and risk-adjusted neonatal intensive care unit (NICU) admission rates, intensive and intermediate special care days, and imaging procedures were calculated across Neonatal Intensive Care Regions (n = 21) and hospitals (n = 100). Total Medicaid payments were calculated.ResultsOverall, 11.5% of live born, 91.7% of VLBW, and 37.6% of infants born late preterm were admitted to a NICU, receiving an average of 2 days, 58 days, and 5 days of special care with payments per newborn inpatient episode of $5231, $128 075, and $10 837, respectively. There was little variation across regions and hospitals in VLBW NICU admissions but marked variation for NICU admissions in late preterm newborn infants and for special care days and imaging rates in all cohorts. The variation decreased slightly after health risk adjustment. There was moderate substitution of intermediate for intensive care days across hospitals (Pearson r VLBW −0.63 P 
       
  • Reply
    • Abstract: Publication date: Available online 31 May 2019Source: The Journal of PediatricsAuthor(s): Megan H. Pesch, Sarah Tomlinson, Kanakadurga Singer, Heather L. Burrows
       
  • Support for breastfeeding physicians
    • Abstract: Publication date: Available online 31 May 2019Source: The Journal of PediatricsAuthor(s): Jennifer M. Nelson, Ngozi Onyema-Melton, Lauren E. Hanley, Joan Younger Meek, Julie K. Wood
       
  • Attributable Delay of Discharge for Children with Long-Term Mechanical
           Ventilation
    • Abstract: Publication date: Available online 29 May 2019Source: The Journal of PediatricsAuthor(s): Sarah A. Sobotka, Carolyn Foster, Emma Lynch, Lindsey Hird-McCorry, Denise M. GoodmanObjectiveTo assess the reasons for discharge delays for children with long-term mechanical ventilation.Study designCharts of children (0-18 years of age) with a new tracheostomy in the Pulmonary Habilitation Program at the Ann and Robert H. Lurie Children's Hospital of Chicago were retrospectively reviewed for demographic information, medical diagnoses, medical stability, discharge to home, reasons for discharge delay, and hours of staffed home nursing. All patients were discharged on mechanical ventilation. Discharge delay was defined as>10 days after medical stability. Hospital charges were analyzed and excess charges quantified beginning with the date of delay. Descriptive statistics and Pearson χ2 tests were used to compare nursing hours and demographics.ResultsOf 72 patients, 55% were male with mean age 1.8 years (SD 3.8) at tracheostomy placement. The most common long-term mechanical ventilation indication was chronic lung disease (n = 47, 65%); 54% had discharge delays, the majority were primarily due to lack of home nursing (62%), followed by delay of caregiver training (18%), caregiver health and social issues (8%), and delay in a transitional care facility bed (8%). Of the 39 delayed patients, 10% ($13 217 889) of hospital charges occurred during excess days with a median of $186 061 (IQR $117 661-$386 905) per patient.ConclusionsOver one-half of children discharged to the community from a large inpatient pediatric long-term mechanical ventilation program had a nonmedical delay of discharge home, most commonly because of home nurse staffing. This case series provides further evidence that limited availability of home nursing impedes efficient discharge and prolongs hospitalizations.
       
  • The North Carolina Experience with Mucopolysaccharidosis Type I Newborn
           Screening
    • Abstract: Publication date: Available online 24 May 2019Source: The Journal of PediatricsAuthor(s): Jennifer L. Taylor, Kristin Clinard, Cynthia M. Powell, Catherine Rehder, Sarah P. Young, Deeksha Bali, Sara E. Beckloff, Lisa M. Gehtland, Alex R. Kemper, Stacey Lee, David Millington, Hari S. Patel, Scott M. Shone, Carol Woodell, Scott J. Zimmerman, Donald B. Bailey, Joseph MuenzerObjectiveTo evaluate the performance of a 2-tiered newborn screening method for mucopolysaccharidosis type I (MPS I) in North Carolina.Study designThe screening algorithm included a flow injection analysis-tandem mass spectrometry assay as a first-tier screening method to measure α-L-iduronidase (IDUA) enzyme activity and Sanger sequencing of the IDUA gene on dried blood spots as a second-tier assay. The screening algorithm was revised to incorporate the Collaborative Laboratory Integrated Reports, an analytical interpretive tool, to reduce the false-positive rate. A medical history, physical examination, IDUA activity, and urinary glycosaminoglycan (GAG) analysis were obtained on all screen-positive infants.ResultsA total of 62 734 specimens were screened with 54 screen-positive samples using a cut-off of 15% of daily mean IDUA activity. The implementation of Collaborative Laboratory Integrated Reports reduced the number of specimens that screened positive to 19 infants. Of the infants identified as screen-positive, 1 had elevated urinary GAGs and a homozygous pathogenic variant associated with the severe form of MPS I. All other screen-positive infants had normal urinary GAG analysis; 13 newborns had pseudodeficiency alleles, 3 newborns had variants of unknown significance, and 2 had heterozygous pathogenic variants.ConclusionsAn infant with severe MPS I was identified and referred for a hematopoietic stem cell transplant. Newborn IDUA enzyme deficiency is common in North Carolina, but most are due to pseudodeficiency alleles in infants with normal urinary GAG analysis and no evidence of disease. The pilot study confirmed the need for second-tier testing to reduce the follow-up burden.
       
  • Pediatric Hospital Medicine Board Certification: A Solution, but to Which
           Problem'
    • Abstract: Publication date: Available online 24 May 2019Source: The Journal of PediatricsAuthor(s): David I. Rappaport, Jane Ierardi, Jay S. Greenspan
       
  • Association between Policy Changes for Oxygen Saturation Alarm Settings
           and Neonatal Morbidity and Mortality in Infants Born Very Preterm
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Elizabeth E. Foglia, Benjamin Carper, Marie Gantz, Sara B. DeMauro, Satyan Lakshminrusimha, Michele Walsh, Barbara Schmidt, Michael S. Caplan, Abbott R. Laptook, Martin Keszler, Angelita M. Hensman, Andrea M. Knoll, Emilee Little, Elisa Vieira, Kristin M. Basso, Jennifer A. Keller, Anna Maria Hibbs, Avroy A. Fanaroff, Nancy S. Newman, Allison H. PayneObjectiveTo determine the impact of policy changes for pulse oximetry oxygen saturation (SpO2) alarm limits on neonatal mortality and morbidity among infants born very preterm.Study designThis was a retrospective cohort study of infants born very preterm in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants were classified based on treatment at a hospital with an SpO2 alarm policy change and study epoch (before vs after policy change). We used a generalized linear mixed model to determine the effect of hospital group and epoch on the primary outcomes of mortality and severe retinopathy of prematurity (ROP) and secondary outcomes of necrotizing enterocolitis, bronchopulmonary dysplasia, and any ROP.ResultsThere were 3809 infants in 10 hospitals with an SpO2 alarm policy change and 3685 infants in 9 hospitals without a policy change. The nature of most policy changes was to narrow the SpO2 alarm settings. Mortality was lower in hospitals without a policy change (aOR 0.63; 95% CI 0.50-0.80) but did not differ between epochs in policy change hospitals. The odds of bronchopulmonary dysplasia were greater for hospitals with a policy change (aOR 1.65; 95% CI 1.36-2.00) but did not differ for hospitals without a policy change. Severe ROP and necrotizing enterocolitis did not differ between epochs for either group. The adjusted odds of any ROP were lower in recent years in both hospital groups.ConclusionsChanging SpO2 alarm policies was not associated with reduced mortality or increased severe ROP among infants born very preterm.
       
  • The State of Children's Health in Europe
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Paolo Biasci, Angel Carrasco Sanz, Tudor Lucian Pop, Massimo Pettoello-Mantovani, Antonio D'Avino, Luigi Nigri
       
  • Reply
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): R. Thomas Collins, Robert E. Lyle, Patrick H. Casey
       
  • Dichotomizing the spectrum of ductal shunt places long-term outcomes
           research at risk
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Timothy G. Elgin, Patrick J. McNamara, Regan E. Giesinger
       
  • Persisting Isolated Metacarpal Swelling and Pain in Adolescence: Consider
           Osteochondrosis
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Luisa Cortellazzo Wiel, Giulia Gortani, Serena Pastore, Daniela Sanabor, Egidio Barbi
       
  • Silvery Gray Hair: A Clue to Diagnosing Chédiak–Higashi
           Syndrome
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Zhaoyang Wang, Yuan Liang, Zigang Xu
       
  • Crusts on the Eyelashes
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Muriel Ouedraogo, Sarah Ventéjou, Sophie Leducq, Guillaume Desoubeaux, Annabel Maruani
       
  • Norwegian Scabies in a Patient with Down Syndrome
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Karen Lee, Gloria Heresi, Roukaya Al Hammoud
       
  • Von Hippel Lindau Disease
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Deniz Hos, Claus Cursiefen, Claudia Dahlke
       
  • Promoting Cardiovascular Health in Early Childhood and Transitions in
           Childhood through Adolescence: A Workshop Report
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Stephen R. Daniels, Charlotte A. Pratt, Emily B. Hollister, Darwin Labarthe, Deborah A. Cohen, Jenelle R. Walker, Bettina M. Beech, P. Babu Balagopal, Dean W. Beebe, Matthew W. Gillman, Jaclyn M. Goodrich, Cashell Jaquish, Brian Kit, Alison L. Miller, David Olds, Emily Oken, Kumaravel Rajakumar, Nancy E. Sherwood, Donna Spruijt-Metz, Julia Steinberger
       
  • Pediatrician Beliefs about Juvenile Idiopathic Arthritis May Result in
           Referral Delays: A Spanish National Survey
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): María Rosa Pavo, Jaime de InocencioWe explored, through a national survey, pediatrician beliefs and misconceptions that could interfere with early referral of patients with juvenile idiopathic arthritis. A total of 831 pediatricians participated. Approximately one-half of the respondents underestimated the incidence of the disease and thought that pain was the leading symptom of oligoarticular forms.
       
  • Musculoskeletal Manifestations as Presenting Symptoms of Inflammatory
           Bowel Disease in Children and Adolescents
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Rachel Levy, Gil Amarilyo, Rotem Tal, Jacob Amir, Amit Assa, Firas Rinawi, Liora HarelA comparison of 23 children with inflammatory bowel disease presenting with musculoskeletal symptoms and 46 children with arthritis of other causes yielded significantly higher rates in the inflammatory bowel disease group of sacroiliitis, arthralgia, additive and recurrent arthritis, microcytic anemia, elevated inflammatory markers, and hypoalbuminemia. Clinical awareness of these findings could expedite diagnosis and treatment.
       
  • Blood Utilization and Transfusion Reactions in Pediatric Patients
           Transfused with Conventional or Pathogen Reduced Platelets
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Wade L. Schulz, Jacob McPadden, Eric A. Gehrie, Burak Bahar, Amit Gokhale, Rebecca Ross, Nathaniel Price, Bryan R. Spencer, Edward SnyderObjectivesTo assess the safety and efficacy of a Food and Drug Administration-approved pathogen-reduced platelet (PLT) product in children, as ongoing questions regarding their use in this population remain.Study designWe report findings from a quality assurance review of PLT utilization, associated red blood cell transfusion trends, and short-term safety of conventional vs pathogen-reduced PLTs over a 21-month period while transitioning from conventional to pathogen-reduced PLTs at a large, tertiary care hospital. We assessed utilization in neonatal intensive care unit (NICU) patients, infants 0-1 year not in the NICU, and children age 1-18 years (PED).ResultsIn the 48 hours after an index conventional or pathogen-reduced platelet transfusion, respectively, NICU patients received 1.0 ± 1.4 (n = 91 transfusions) compared with 1.2 ± 1.3 (n = 145) additional platelet doses (P = .29); infants 0-1 year not in the NICU received 2.8 ± 3.0 (n = 125) vs 2.6 ± 2.6 (n = 254) additional platelet doses (P = .57); and PEDs received 0.9 ± 1.6 (n = 644) vs 1.4 ± 2.2 (n = 673) additional doses (P < .001). Time to subsequent transfusion and red cell utilization were similar in every group (P > .05). The number and type of transfusion reactions did not significantly vary based on PLT type and no rashes were reported in NICU patients receiving phototherapy and pathogen-reduced PLTs.ConclusionsConventional and pathogen-reduced PLTs had similar utilization patterns in our pediatric populations. A small, but statistically significant, increase in transfusions was noted following pathogen-reduced PLT transfusion in PED patients, but not in other groups. Red cell utilization and transfusion reactions were similar for both products in all age groups.
       
  • Anti-Factor Xa–Based Monitoring of Unfractionated Heparin: Clinical
           Outcomes in a Pediatric Cohort
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Surbhi Saini, Ashley N. Folta, Katherine L. Harsh, Joseph R. Stanek, Amy L. Dunn, Sarah H. O'Brien, Riten KumarObjectivesTo assess clinical outcomes in children treated with unfractionated heparin and monitored using an anti-factor Xa (Anti-FXa)-based nomogram. We also sought to assess the correlation between activated partial thromboplastin time (APTT) and Anti-FXa.Study designThis was a single-center, observational cohort study conducted over a 20-month period that included all pediatric patients (
       
  • he +J ournal+of +P ediatrics :+Intrauterine+Growth+of+Live-Born+Caucasian+Infants+at+Sea+Level:+Standards+Obtained+from+Measurements+in+7+Dimensions+of+Infants+Born+between+25+and+44 Weeks+of+Gestation&rft.title=Journal+of+Pediatrics&rft.issn=0022-3476&rft.date=&rft.volume=">50 Years Ago in T he J ournal of P ediatrics : Intrauterine Growth of
           Live-Born Caucasian Infants at Sea Level: Standards Obtained from
           Measurements in 7 Dimensions of Infants Born between 25 and 44 Weeks of
           Gestation
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Jannicke H. Andresen, Ola Didrik Saugstad
       
  • Prenatal Omega-6:Omega-3 Ratio and Attention Deficit and Hyperactivity
           Disorder Symptoms
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Mónica López-Vicente, Núria Ribas Fitó, Natalia Vilor-Tejedor, Raquel Garcia-Esteban, Sílvia Fernández-Barrés, Payam Dadvand, Mario Murcia, Marisa Rebagliato, Jesús Ibarluzea, Aitana Lertxundi, Ana Fernández-Somoano, Adonina Tardón, M. Carmen López-Sabater, Dora Romaguera, Martine Vrijheid, Jordi Sunyer, Jordi JulvezObjectiveTo evaluate whether higher omega-6:omega-3 (n-6:n-3) long-chain polyunsaturated fatty acid ratio in cord plasma is associated with more symptoms of attention deficit and hyperactivity disorder (ADHD) at 4 and 7 years of age.Study designThis study was based on a population-based birth cohort in Spain. N-6 arachidonic acid and n-3 eicosapentaenoic and docosahexaenoic acid concentrations were measured in cord plasma. At 4 years old, ADHD symptoms were reported by teachers through the ADHD Diagnostic and Statistical Manual of Mental Disorders, 4th ed checklist (n = 580). At 7 years old, ADHD symptoms were reported by parents through the Conners’ Rating Scale-Revised (short form; n = 642). The ADHD variable was treated as continuous (score) and as dichotomous (symptom diagnostic criteria). Child and family general characteristics were prospectively collected through questionnaires. We applied pooled zero-inflated negative binomial and logistic regressions adjusted for covariates.ResultsA higher omega-6:omega-3 long-chain polyunsaturated fatty acid ratio in cord plasma was associated with a higher ADHD index (incidence rate ratio, 1.13; 95% CI, 1.03, 1.23) at 7 years old. The association was not observed at 4 years old (incidence rate ratio, 1.04; 95% CI, 0.92-1.18). No associations were found using ADHD symptom diagnostic criteria.ConclusionsHigh prenatal omega-6:omega-3 long-chain polyunsaturated fatty acid ratio preceded the appearance of subclinical ADHD symptoms during mid-childhood. Our findings suggest that maternal diet during pregnancy may modulate the risk to develop long-term ADHD symptoms in the offspring.
       
  • Psychiatric Disorders and Gun Carrying among Adolescents in the United
           States
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Rose M.C. Kagawa, Dahsan S. Gary, Garen J. Wintemute, Kara E. Rudolph, Veronica A. Pear, Katherine Keyes, Magdalena CerdáObjectivesTo estimate associations between psychiatric disorders and gun carrying among adolescents and to estimate the total number of adolescents in the US who have psychiatric disorders and report carrying guns.Study designWe used cross-sectional data from the National Comorbidity Survey – Adolescent Supplement, a nationally representative sample of adolescents age 13-18 years (N = 10 123; response rate = 75.6%). Psychiatric disorders were assessed using the Composite International Diagnostic Interview. Gun carrying in the 30 days prior to the interview was assessed by self-report. We used multivariable Poisson regression to test for associations.ResultsThe analytic sample included 10 112 adolescents, 2.4% of whom reported carrying a gun in the prior 30 days. The prevalence of gun carrying was greater among adolescents with conduct disorder (adjusted prevalence ratio [APR] = 1.88, 95% CI 1.38, 2.57), drug use disorders (APR = 1.91, 95% CI 1.05, 3.45), and specific phobias (APR = 1.54, 95% CI 1.07, 2.22) compared with adolescents without these disorders. We estimated that 1.1% (95% CI 0.77, 1.48) of adolescents with a disorder associated with self- or other-directed violence also carry guns. Nationally, that is approximately 272 000 adolescents with both risk factors.ConclusionsSpecific psychiatric disorders are associated with an increased risk of gun carrying among adolescents, but the vast majority of adolescents with psychiatric disorders did not report gun carrying. Targeted efforts to assess access to and use of firearms in mental healthcare and other clinical settings are important, as are efforts to identify population approaches to prevention.
       
  • Day-Night Activity in Hospitalized Children after Major Surgery: An
           Analysis of 2271 Hospital Days
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Sapna R. Kudchadkar, Othman Aljohani, Jordan Johns, Andrew Leroux, Eman Alsafi, Ebaa Jastaniah, Allan Gottschalk, Nehal J. Shata, Ahmad Al-Harbi, Daniel Gergen, Anisha Nadkarni, Ciprian CrainiceanuObjectivesTo characterize the day-night activity patterns of children after major surgery and describe differences in children's activity patterns between the pediatric intensive care unit (PICU) and inpatient floor setting.Study designIn this prospective observational study, we characterized the daytime activity ratio estimate (DARE; ratio between mean daytime activity [08:00-20:00] and mean 24-hour activity [00:00-24:00]) for children admitted to the hospital after major surgery. The study sample included 221 infants and children ages 1 day to 17 years admitted to the PICU at a tertiary, academic children's hospital. Subjects were monitored with continuous accelerometry from postoperative day 1 until hospital discharge. The National Health and Nutrition Examination Survey accelerometry data were utilized for normative data to compare DARE in a community sample of US children to hospitalized children.ResultsThe mean DARE over 2271 hospital days was 57.8%, with a significant difference between the average DARE during PICU days and inpatient floor days (56% vs 61%, P 
       
  • Postconcussion Academic Support in Children Who Attend a Primary Care
           Provider Follow-up Visit after Presenting to the Emergency Department
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Traci R. Snedden, Lauren A. Pierpoint, Dustin W. Currie, R. Dawn Comstock, Joseph A. GrubenhoffObjectiveTo examine whether a primary care provider (PCP) follow-up visit after emergency department evaluation of concussion improved the children's likelihood of receiving academic support.Study designThis was a prospective cohort study. Concussed children, aged 8-18 years, presenting to a regional pediatric trauma center emergency department (n = 160) were contacted 7 and 30 days after injury to gather data on PCP follow-up, symptoms, quality of life, and receipt of academic support instituted after and because of the concussion. Bivariate comparisons of demographics, concussion characteristics, quality of life, and symptoms were made between children who did and did not receive support using independent samples t tests, Wilcoxon rank sum tests, or χ2 tests. ORs and 95% CIs were calculated using multivariable logistic regression with backwards elimination to test the association between attending an outpatient follow-up visit and the receipt of academic support for variables where P 
       
  • Virtual Reality for Pediatric Needle Procedural Pain: Two Randomized
           Clinical Trials
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Evelyn Chan, Michael Hovenden, Emma Ramage, Norman Ling, Jeanette H. Pham, Ayesha Rahim, Connie Lam, Linly Liu, Samantha Foster, Ryan Sambell, Kasthoori Jeyachanthiran, Catherine Crock, Amanda Stock, Sandy M. Hopper, Simon Cohen, Andrew Davidson, Karin Plummer, Erin Mills, Simon S. Craig, Gary DengObjectiveTo assess the efficacy and safety of a virtual reality distraction for needle pain in 2 common hospital settings: the emergency department (ED) and outpatient pathology (ie, outpatient laboratory). The control was standard of care (SOC) practice.Study designIn 2 clinical trials, we randomized children aged 4-11 years undergoing venous needle procedures to virtual reality or SOC at 2 tertiary Australian hospitals. In the first study, we enrolled children in the ED requiring intravenous cannulation or venipuncture. In the second, we enrolled children in outpatient pathology requiring venipuncture. In the ED, 64 children were assigned to virtual reality and 59 to SOC. In pathology, 63 children were assigned to virtual reality and 68 to SOC; 2 children withdrew assent in the SOC arm, leaving 66. The primary endpoint was change from baseline pain between virtual reality and SOC on child-rated Faces Pain Scale-Revised.ResultsIn the ED, there was no change in pain from baseline with SOC, whereas virtual reality produced a significant reduction in pain (between-group difference, −1.78; 95% CI, −3.24 to −0.317; P = .018). In pathology, both groups experienced an increase in pain from baseline, but this was significantly less in the virtual reality group (between-group difference, −1.39; 95% CI, −2.68 to −0.11; P = .034). Across both studies, 10 participants experienced minor adverse events, equally distributed between virtual reality/SOC; none required pharmacotherapy.ConclusionsIn children aged 4-11 years of age undergoing intravenous cannulation or venipuncture, virtual reality was efficacious in decreasing pain and was safe.Trial registrationAustralia and New Zealand Clinical Trial Registry: ACTRN12617000285358p
       
  • he +J ournal+of +P ediatrics :+Esophageal+Injury+by+Liquid+Chlorine+Bleach:+Experimental+Study&rft.title=Journal+of+Pediatrics&rft.issn=0022-3476&rft.date=&rft.volume=">50 Years Ago in T he J ournal of P ediatrics : Esophageal Injury by
           Liquid Chlorine Bleach: Experimental Study
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Peter R. Farrell, Michael K. Farrell
       
  • Classic Metaphyseal Lesions among Victims of Abuse
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Catherine Adamsbaum, Paul De Boissieu, Jean Paul Teglas, Caroline Rey-SalmonObjectiveTo use legal statements by perpetrators to gain new insights into the causative mechanism of classic metaphyseal lesion (CML). The CML, so called “corner fracture,” is considered a highly specific marker for abuse in infants. However, the precise correlation between CMLs and abusive head trauma is still unknown.Study designIn this retrospective observational study, we selected 67 cases with at least 1 CML from a 15-year cohort of legally prosecuted child abuse cases. Their clinical, radiologic, and forensic records were analyzed. In 27 cases, the perpetrator confessed to abusing the child and described the events. Potential associations with subdural hematoma and with confession were evaluated using 2 separate binary logistic regression models.ResultsAll 67 infants showed other signs of abuse. Median age was 3.4 months. Over 65% had multiple CMLs. Knees and ankles were predominantly involved (64%). Only CMLs of the shoulder were significantly associated with subdural hematoma (P = .03). Different-age fractures were more common in the nonsubdural hematoma group (P = .01). In the group with confessions, perpetrators admitted inflicting violent indirect skeletal forces (torsion, traction, compression, and forced movements). The most common circumstance was diapering (44%), reported by male perpetrators only (P = .03) followed by dressing/undressing (30%). The violence was habitual in 67% of cases.ConclusionsThis unique forensic case series shows that CMLs are caused by violent acts inflicted most during physical care of infants. The frequency of habitual violence responsible for CMLs deserves greater attention.
       
  • Host and Bacterial Markers that Differ in Children with Cystitis and
           Pyelonephritis
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Nader Shaikh, Judith M. Martin, Alejandro Hoberman, Megan Skae, Linette Milkovich, Andrew Nowalk, Christi McElheny, Robert W. Hickey, Diana Kearney, Massoud Majd, Eglal Shalaby-Rana, George Tseng, John F. Alcorn, Jay Kolls, Marcia Kurs-Lasky, Zhiguang Huo, William Horne, Greg Lockhart, Hans Pohl, Timothy R. ShopeObjectiveTo determine whether treatment for urinary tract infections in children could be individualized using biomarkers for acute pyelonephritis.Study designWe enrolled 61 children with febrile urinary tract infections, collected blood and urine samples, and performed a renal scan within 2 weeks of diagnosis to identify those with pyelonephritis. Renal scans were interpreted centrally by 2 experts. We measured inflammatory proteins in blood and urine using LUMINEX or an enzyme-linked immunosorbent assay. We evaluated serum RNA expression using RNA sequencing in a subset of children. Finally, for children with Escherichia coli isolated from urine cultures, we performed a polymerase chain reaction for 4 previously identified virulence genes.ResultsUrinary markers that best differentiated pyelonephritis from cystitis included chemokine (C-X-C motif) ligand (CXCL)1, CXCL9, CXCL12, C-C motif chemokine ligand 2, INF γ, and IL-15. Serum procalcitonin was the best serum marker for pyelonephritis. Genes in the interferon-γ pathway were upregulated in serum of children with pyelonephritis. The presence of E coli virulence genes did not correlate with pyelonephritis.ConclusionsImmune response to pyelonephritis and cystitis differs quantitatively and qualitatively; this may be useful in differentiating these 2 conditions.
       
  • High-Dose Vitamin D Supplementation Does Not Prevent Allergic
           Sensitization of Infants
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Jenni Rosendahl, Anna S. Pelkonen, Otto Helve, Helena Hauta-alus, Elisa Holmlund-Suila, Saara Valkama, Maria Enlund-Cerullo, Heli Viljakainen, Timo Hytinantti, Outi Mäkitie, Sture Andersson, Mika J. MäkeläObjectiveTo investigate the effect of vitamin D supplementation dose on allergic sensitization and allergic diseases in infants, and to evaluate whether vitamin D status in pregnancy and at birth are associated with infant allergy outcomes.Study designAltogether, 975 infants participated in a randomized, controlled trial of daily vitamin D supplementation of 10 μg (400 IU) or 30 μg (1200 IU) from the age of 2 weeks. At 12 months of age, food and aeroallergen IgE antibodies were measured, and the occurrence of allergic diseases and wheezing were evaluated.ResultsWe found no differences between the vitamin D supplementation groups in food (OR, 0.98; 95% CI, 0.66-1.46) or aeroallergen sensitization at 12 months (OR, 0.76; 95% CI,0.34-1.71). Allergic diseases or wheezing did not differ between groups, except for milk allergy which occurred more often in infants administered 30 μg vitamin D compared with the 10 μg dose (OR, 2.23; 95% CI, 1.00-4.96). Infants with high cord blood 25-hydroxyvitamin D (≥100 nmol/L) had a higher risk of food allergen sensitization compared with those with lower 25(OH)D concentration (75-99.9 nmol/L; OR, 2.00; 95% CI, 1.19-3.39).ConclusionsHigh-dose vitamin D supplementation did not prevent allergic sensitization, allergic diseases, or wheezing during the first year of life. In contrast, we observed an increased risk of milk allergy in infants randomized to higher vitamin D supplementation, and an increased risk of allergic sensitization in infants with high cord blood vitamin D status, indicating a possible adverse effect of high concentrations of vitamin D.
       
  • A Validated Scale for Assessing the Severity of Acute Infectious
           Mononucleosis
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Ben Z. Katz, Caroline Reuter, Yair Lupovitch, Kristen Gleason, Damani McClellan, Joseph Cotler, Leonard A. JasonObjectivesTo develop a scale for the severity of mononucleosis.Study designOne to 5 percent of college students develop infectious mononucleosis annually, and about 10% meet criteria for chronic fatigue syndrome (CFS) 6 months following infectious mononucleosis. We developed a severity of mononucleosis scale based on a review of the literature. College students were enrolled, generally when they were healthy. When the students developed infectious mononucleosis, an assessment was made as to the severity of their infectious mononucleosis independently by 2 physicians using the severity of mononucleosis scale. This scale was correlated with corticosteroid use and hospitalization. Six months following infectious mononucleosis, an assessment is made for recovery from infectious mononucleosis or meeting 1 or more case definitions of CFS.ResultsIn total, 126 severity of mononucleosis scales were analyzed. The concordance between the 2 physician reviewers was 95%. All 3 hospitalized subjects had severity of mononucleosis scores ≥2. Subjects with severity of mononucleosis scores of ≥1 were 1.83 times as likely to be given corticosteroids. Students with severity of mononucleosis scores of 0 or 1 were less likely to meet more than 1 case definition of CFS 6 months following infectious mononucleosis.ConclusionsThe severity of mononucleosis scale has interobserver, concurrent and predictive validity for hospitalization, corticosteroid use, and meeting criteria for CFS 6 months following infectious mononucleosis.
       
  • he +J ournal+of +P ediatrics :+Funduscopic+Photography+and+Fluorescein+Angioretinography+in+Evaluation+of+Children+with+Neurologic+Handicaps&rft.title=Journal+of+Pediatrics&rft.issn=0022-3476&rft.date=&rft.volume=">50 Years Ago in T he J ournal of P ediatrics : Funduscopic Photography
           and Fluorescein Angioretinography in Evaluation of Children with
           Neurologic Handicaps
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Payal Gupta, Piyush Gupta
       
  • Natural History of Perinatal and Infantile Hypophosphatasia: A
           Retrospective Study
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Michael P. Whyte, Edward Leung, William R. Wilcox, Johannes Liese, Jesús Argente, Gabriel Á. Martos-Moreno, Amy Reeves, Kenji P. Fujita, Scott Moseley, Christine Hofmann, Michael Beck, Linda DiMeglio, Paul Wuh-Liang Hwu, Peter Simm, Jill Simmons, Joel Steelman, Robert D. Steiner, Andrea Superti-FurgaObjectiveTo report clinical characteristics and medical history data obtained retrospectively for a large cohort of pediatric patients with perinatal and infantile hypophosphatasia.Study designMedical records from academic medical centers known to diagnose and/or treat hypophosphatasia were reviewed. Patients born between 1970 and 2011 with hypophosphatasia and any of the following signs/symptoms at age 70% of patients between birth and age 5 years. Vitamin B6–dependent seizures and respiratory distress and failure were associated significantly (P 
       
  • Ultrasound Elastography to Quantify Liver Disease Severity in Autosomal
           Recessive Polycystic Kidney Disease
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Erum A. Hartung, Jessica Wen, Laura Poznick, Susan L. Furth, Kassa DargeObjectivesTo evaluate the diagnostic accuracy of ultrasound elastography with acoustic radiation force impulse (ARFI) to detect congenital hepatic fibrosis and portal hypertension in children with autosomal recessive polycystic kidney disease (ARPKD).Study designCross-sectional study of 25 children with ARPKD and 24 healthy controls. Ultrasound ARFI elastography (Acuson S3000, Siemens Medical Solutions USA, Inc, Malvern, Pennsylvania) was performed to measure shear wave speed (SWS) in the right and left liver lobes and the spleen. Liver and spleen SWS were compared in controls vs ARPKD, and ARPKD without vs with portal hypertension. Linear correlations between liver and spleen SWS, spleen length, and platelet counts were analyzed. Receiver operating characteristic analysis was used to evaluate diagnostic accuracy of ultrasound ARFI elastography.ResultsParticipants with ARPKD had significantly higher median liver and spleen SWS than controls. At a proposed SWS cut-off value of 1.56 m/s, the left liver lobe had the highest sensitivity (92%) and specificity (96%) for distinguishing participants with ARPKD from controls (receiver operating characteristic area 0.92; 95% CI 0.82-1.00). Participants with ARPKD with portal hypertension (splenomegaly and low platelet counts) had significantly higher median liver and spleen stiffness than those without portal hypertension. The left liver lobe also had the highest sensitivity and specificity for distinguishing subjects with ARPKD with portal hypertension.ConclusionsUltrasound ARFI elastography of the liver and spleen, particularly of the left liver lobe, is a useful noninvasive biomarker to detect and quantify liver fibrosis and portal hypertension in children with ARPKD.
       
  • he +J ournal+of +P ediatrics :+Parents+of+the+Mentally+Retarded+Child:+Emotionally+Overwhelmed+or+Informationally+Deprived'&rft.title=Journal+of+Pediatrics&rft.issn=0022-3476&rft.date=&rft.volume=">50 Years Ago in T he J ournal of P ediatrics : Parents of the Mentally
           Retarded Child: Emotionally Overwhelmed or Informationally Deprived'
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Sarah A. Sobotka, Lainie Friedman Ross
       
  • Chronic Cholangiopathy Associated with Primary Immune Deficiencies Can Be
           Resolved by Effective Hematopoietic Stem Cell Transplantation
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Nedim Hadžić, Zohreh Nademi, Maesha Deheragoda, Yoh Zen, Reem Elfeky, Austen Worth, Paul Veys, Giorgina Mieli-Vergani, E. Graham DaviesObjectivesTo investigate effects and outcome of hematopoietic stem cell transplantation (HSCT) on sclerosing cholangitis, in pediatric patients with different primary immunodeficiencies (PIDs).Study designFrom databases in 2 tertiary centers for immunodeficiencies and liver disease, we have identified children with PIDs and sclerosing cholangitis, who have paired clinical, radiologic, and histologic information before and after HSCT and studied their clinical progress and outcome.ResultsSeven of 13 children (53.8%) died at a median interval of 4 months (range, 3 months-5 years) after HSCT. However, 6 surviving children (46.2%) with different PIDs and less severe cholangiopathies showed an improvement in markers of liver injury within months of successful unrelated reduced intensity conditioning HSCT. The repeated native liver biopsy, performed in 4 patients at a median of 96 (range, 4-144) months post-HSCT, showed a considerable improvement. Biochemical markers of liver function in the survivors completely normalized after a median of 13 months (range, 2-48). All patients continue to have a mildly dilated extrahepatic biliary system on ultrasonography with no intrahepatic ductal changes on magnetic resonance cholangiography after a follow-up of median 18 years (range, 2-20).ConclusionsEffective HSCT has the potential to improve biochemical and histologic features of cholangiopathy in children with PIDs, presumably by clearance of chronic infection following establishment of immune competence. However, careful patient selection is critical as advanced liver injury is often associated with serious complications and mortality.
       
  • Ursodeoxycholic Acid Therapy in Pediatric Primary Sclerosing Cholangitis:
           Predictors of Gamma Glutamyltransferase Normalization and Favorable
           Clinical Course
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Mark Deneau, Emily Perito, Amanda Ricciuto, Nitika Gupta, Binita M. Kamath, Sirish Palle, Bernadette Vitola, Vratislav Smolka, Federica Ferrari, Achiya Z. Amir, Tamir Miloh, Alexandra Papadopoulou, Parvathi Mohan, Cara Mack, Kaija-Leena Kolho, Raffaele Iorio, Wael El-Matary, Veena Venkat, Albert Chan, Lawrence SaubermannObjectiveTo investigate patient factors predictive of gamma glutamyltransferase (GGT) normalization following ursodeoxycholic acid (UDCA) therapy in children with primary sclerosing cholangitis.Study designWe retrospectively reviewed patient records at 46 centers. We included patients with a baseline serum GGT level ≥50 IU/L at diagnosis of primary sclerosing cholangitis who initiated UDCA therapy within 1 month and continued therapy for at least 1 year. We defined “normalization” as a GGT level
       
  • Infant Psychosocial Environment Predicts Adolescent Cardiometabolic Risk:
           A Prospective Study
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Jenalee R. Doom, Brie M. Reid, Estela Blanco, Raquel Burrows, Betsy Lozoff, Sheila GahaganObjectiveTo prospectively assess whether the infant psychosocial environment was associated with cardiometabolic risk as early as adolescence.Study designParticipants were recruited in Santiago, Chile, and have been followed from infancy. Inclusion criteria included healthy infants with birth weight ≥3 kg and a stable caregiver. The psychosocial environment, including depressive symptoms, stressful life events, poor support for child development, father absence, and socioeconomic status, was reported by mothers at 6-12 months. Body mass index (BMI) z score was assessed at 5 and 10 years. BMI z score, waist-to-hip ratio, systolic and diastolic blood pressure, fat mass and body fat percentage, fasting glucose, total and high-density lipoprotein cholesterol, and homeostatic model of insulin resistance were tested in adolescence.ResultsAdolescents ranged from 16 to 18 years of age (n = 588; 48.1% female). A poorer infant psychosocial environment was associated with BMI z score at 10 years (β = 0.10, 95% CI = 0.00-0.19) and in adolescence (β = 0.15, 95% CI = 0.06-0.24) but not at 5 years. A poorer infant psychosocial environment was associated with higher blood pressure (β = 0.15, 95% CI = 0.05-0.24), greater anthropometric risk (β = 0.13, 95% CI = 0.03-0.22), greater biomarker (triglycerides, homeostatic model assessment of insulin resistance, total cholesterol) risk (β = 0.12, 95% CI = 0.02-0.22), and a higher likelihood of metabolic syndrome in adolescence (aOR = 1.50; 95% CI = 1.06-2.12).ConclusionsThese findings demonstrate that a poorer infant psychosocial environment was associated with greater adolescent cardiometabolic risk. The results support screening for infants’ psychosocial environments and further research into causality, mechanisms, prevention, and intervention.
       
  • The Protective Effect of Prenatal Social Support on Infant Adiposity in
           the First 18 Months of Life
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Michelle Katzow, Mary Jo Messito, Alan L. Mendelsohn, Marc A. Scott, Rachel S. GrossObjectiveTo determine whether prenatal social support was associated with infant adiposity in the first 18 months of life in a low-income, Hispanic sample, known to be at high risk of early child obesity.Study designWe performed a longitudinal analysis of 262 low-income, Hispanic mother-infant pairs in the control group of the Starting Early child obesity prevention trial. Prenatal social support was measured using an item from the Maternal Social Support Index. We used multilevel modeling to predict weight-for-length z-score trajectories from birth to age 18 months and logistic regression to predict macrosomia and overweight status at ages 6, 12, and 18 months.ResultsHigh prenatal social support was independently associated with lower infant adiposity trajectories from birth to age 18 months (B = −0.40; 95% CI, −0.63 to −0.16), a lower odds of macrosomia (aOR = 0.35; 95% CI, 0.15-0.80), and a lower odds of overweight at ages 12 (aOR = 0.28; 95% CI, 0.10-0.74) and 18 months (aOR = 0.35; 95% CI, 0.14-0.89). Prenatal social support was not significantly associated with overweight status at age 6 months.ConclusionsPrenatal social support may protect against excessive infant adiposity and overweight in low-income, Hispanic families. Further research is needed to elucidate mechanisms underlying these associations and to inform preventive strategies beginning in pregnancy.
       
  • An Age-Based Framework for Evaluating Genome-Scale Sequencing Results in
           Newborn Screening
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Laura V. Milko, Julianne M. O'Daniel, Daniela M. DeCristo, Stephanie B. Crowley, Ann Katherine M. Foreman, Kathleen E. Wallace, Lonna F. Mollison, Natasha T. Strande, Zahra S. Girnary, Lacey J. Boshe, Arthur S. Aylsworth, Muge Gucsavas-Calikoglu, Dianne M. Frazier, Neeta L. Vora, Myra I. Roche, Bradford C. Powell, Cynthia M. Powell, Jonathan S. BergObjectiveTo assess the performance of a standardized, age-based metric for scoring clinical actionability to evaluate conditions for inclusion in newborn screening and compare it with the results from other contemporary methods.Study designThe North Carolina Newborn Exome Sequencing for Universal Screening study developed an age-based, semiquantitative metric to assess the clinical actionability of gene–disease pairs and classify them with respect to age of onset or timing of interventions. This categorization was compared with the gold standard Recommended Uniform Screening Panel and other methods to evaluate gene–disease pairs for newborn genomic sequencing.ResultsWe assessed 822 gene–disease pairs, enriched for pediatric onset of disease and suspected actionability. Of these, 466 were classified as having childhood onset and high actionability, analogous to conditions selected for the Recommended Uniform Screening Panel core panel. Another 245 were classified as having childhood onset and low to no actionability, 25 were classified as having adult onset and high actionability, 19 were classified as having adult onset and low to no actionability, and 67 were excluded due to controversial evidence and/or prenatal onset.ConclusionsThis study describes a novel method to facilitate decisions about the potential use of genomic sequencing for newborn screening. These categories may assist parents and physicians in making informed decisions about the disclosure of results from voluntary genomic sequencing in children.
       
  • Cesarean Delivery and Healthcare Utilization and Costs in the Offspring: A
           Retrospective Cohort Study
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Alexander Nikolas MacLellan, Christy G. Woolcott, Mary Margaret Brown, Linda Dodds, Sarah D. McDonald, Stefan KuhleObjectiveTo examine the association between cesarean delivery and healthcare utilization and costs in offspring from birth until age 7 years.Study designA retrospective cohort study of singleton term births in the Canadian province of Nova Scotia between 2003 and 2007 followed until age 7 years was conducted using data from the Nova Scotia Atlee Perinatal Database and administrative health data. The main exposure was mode of delivery (cesarean delivery vs vaginal birth); the outcome was healthcare utilization and costs during the first 7 years of life. Associations were modeled using multiple regression adjusting for maternal prepregnancy weight and sociodemographic factors.ResultsIn total, 32 464 births were included in the analysis. Compared with children born by vaginal birth, children born by cesarean delivery had more physician visits (incidence rate ratio 1.06, 95% CI 1.05-1.08) and longer hospital stays (incidence rate ratio 1.12, 95% CI 1.03-1.21) and were more likely to be high utilizers of physician visits (OR 1.23, 95% CI 1.10-1.37). Physician and hospital costs were $775 higher for children born by cesarean delivery compared with vaginal birth.ConclusionsCesarean delivery compared with vaginal birth is associated with small but statistically significant increases in healthcare utilization and costs during the first 7 years of life.
       
  • Evaluating the Use of a Decision Aid for Parents Facing Extremely
           Premature Delivery: A Randomized Trial
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Úrsula Guillén, Amy Mackley, Naomi Laventhal, Stephanie Kukora, Lori Christ, Matthew Derrick, Jennifer Batza, Sarvin Ghavam, Haresh KirpalaniObjectiveTo assess decisional conflict and knowledge about prematurity among mothers facing extreme premature delivery when the counseling clinicians were randomized to counsel using a validated decision aid compared with usual counseling.Study designIn this randomized trial, clinicians at 5 level III neonatal intensive care units in the US were randomized to supplement counseling using the decision aid or to counsel mothers in their usual manner. We enrolled mothers with threatened premature delivery at 220/7 to 256/7 weeks of gestation within 7 days of their counseling. The primary outcome was the Decisional Conflict Scale (DCS) score. One hundred mothers per group were enrolled to detect a clinically relevant effect size of 0.4 in the Decisional Conflict Scale. Secondary outcomes included knowledge about prematurity; scores on the Preparedness for Decision Making scale; and acceptability.ResultsNinety-two clinicians were randomized and 316 mothers were counseled. Of these, 201 (64%) mothers were enrolled. The median gestational age was 24.1 weeks (IQR 23.7-24.9). In both groups, DCS scores were low (16.3 ± 18.2 vs 16.8 ± 17, P = .97) and Preparedness for Decision Making scores were high (73.4 ± 28.3 vs 70.5 ± 31.1, P = .33). There was a significantly greater knowledge score in the decision aid group (66.2 ± 18.5 vs 57.2 ± 18.8, P = .005). Most clinicians and parents found the decision aid useful.ConclusionsFor parents facing extremely premature delivery, use of a decision aid did not impact maternal decisional conflict, but it significantly improved knowledge of complex information. A structured decision aid may improve comprehension of complex information.Trial registrationClinicaltrials.gov: NCT01713894.
       
  • The+Journal+of+Pediatrics :+Epidemiology+of+Diphtheria—Role+of+Cutaneous+Infection&rft.title=Journal+of+Pediatrics&rft.issn=0022-3476&rft.date=&rft.volume=">50 Years Ago in The Journal of Pediatrics : Epidemiology of
           Diphtheria—Role of Cutaneous Infection
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Swati Kalra, Piyush Gupta
       
  • Associations of Preeclampsia with Expiratory Airflows in School-Age
           Children Born Either at
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Lex W. Doyle, Sarath Ranganathan, Anjali Haikerwal, Jeanie L.Y. Cheong, Carolyn Anderson, Peter Anderson, Merilyn Bear, Alice Burnett, Catherine Callanan, Elizabeth Carse, Margaret P. Charlton, Janet Courtot, Noni Davis, Julianne Duff, Leah Hickey, Marie Hayes, Elaine Kelly, Katherine Lee, Marion McDonald, Emma McInnesObjectivesTo assess whether preeclampsia was associated with expiratory airflow at school-age in children born either extremely preterm (
       
  • Meeting the World Health Organization Maternal Antenatal Care Guidelines
           Is Associated with Improved Early and Middle Childhood Cognition in
           Ethiopia
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): David B. Douglas, Reem Waziry, Ellen P. McCarthy, Amare Worku Tadesse, Mekdes Daba Feyssa, Michael Kawooya, Christopher R. SudfeldObjectiveTo assess the association between meeting the World Health Organization (WHO) maternal antenatal care attendance guidelines and early and middle childhood cognition among impoverished Ethiopian children.Study designA total of 1914 impoverished Ethiopian children from the Young Lives longitudinal cohort study were included. Childhood cognition was assessed via the Cognitive Development Assessment (CDA) and Peabody Picture Vocabulary Test (PPVT) at ages 4-5 years; PPVT, Early Grade Reading Assessment (EGRA), and Math Test at ages 7-8 years; and PPVT, Math Test, and Reading Test at ages 11-12 years. Linear regression models were used to examine the association between maternal antenatal care attendance and childhood academic achievement test scores.ResultsIn the univariable analysis, children of mothers who received the WHO recommended 4+ antenatal care visits or received the WHO recommended first antenatal care visit during the first trimester scored higher on all academic achievement tests. In the multivariable analysis, children of mothers who received 4+ antenatal care visits scored significantly higher on the CDA at ages 4-5 years and Math Test at ages 7-8 years. Children of mothers who received antenatal care in the first trimester scored higher on the CDA at ages 4-5 years and Math Test scores at ages 11-12 years. Children of mothers who received both antenatal care in the first trimester and 4+ antenatal care visits scored significantly higher on the CDA at ages 4-5 years and Math Test at both ages 7-8 and 11-12 years.ConclusionsChildren of mothers who received the WHO recommended number and timing of antenatal care visits had significantly higher academic achievement scores across multiple domains during early and middle childhood. Promotion of antenatal care visit attendance may improve cognition through middle childhood.
       
  • Hyperglycemia and Glucose Variability Are Associated with Worse Brain
           Function and Seizures in Neonatal Encephalopathy: A Prospective Cohort
           Study
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Elana F. Pinchefsky, Cecil D. Hahn, Daphne Kamino, Vann Chau, Rollin Brant, Aideen M. Moore, Emily W.Y. TamObjectivesTo investigate how glucose abnormalities correlate with brain function on amplitude-integrated electroencephalography (aEEG) in infants with neonatal encephalopathy.Study designNeonates born at full term with encephalopathy were enrolled within 6 hours of birth in a prospective cohort study at a pediatric academic referral hospital. Continuous interstitial glucose monitors and aEEG were placed soon after birth and continued for 3 days. Episodes of hypoglycemia (≤50 mg/dL; ≤2.8 mmol/L) and hyperglycemia (>144 mg/dL;>8.0 mmol/L) were identified. aEEG was classified in 6-hour epochs for 3 domains (background, sleep–wake cycling, electrographic seizures). Generalized estimating equations assessed the relationship of hypo- or hyperglycemia with aEEG findings, adjusting for clinical markers of hypoxia-ischemia (Apgar scores, umbilical artery pH, and base deficit).ResultsForty-five infants (gestational age 39.5 ± 1.4 weeks) were included (24 males). During aEEG monitoring, 16 episodes of hypoglycemia were detected (9 infants, median duration 77.5, maximum 220 minutes) and 18 episodes of hyperglycemia (13 infants, median duration 237.5, maximum 3125 minutes). Epochs of hypoglycemia were not associated with aEEG changes. Compared with epochs of normoglycemia, epochs of hyperglycemia were associated with worse aEEG background scores (B 1.120, 95% CI 0.501-1.738, P 
       
  • The+Journal+of+Pediatrics :+Intestinal+Obstruction+Complicating+Familial+Mediterranean+Fever&rft.title=Journal+of+Pediatrics&rft.issn=0022-3476&rft.date=&rft.volume=">50 Years Ago in The Journal of Pediatrics : Intestinal Obstruction
           Complicating Familial Mediterranean Fever
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Philip J. Hashkes
       
  • Testing umbilical cord tissue for drugs: Lower analytical limits, better
           concordance with meconium results
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Adam Negrusz, Joseph Jones
       
  • The Changing Concepts Regarding the Mediterranean Fever Gene: Toward a
           Spectrum of Pyrin-Associated Autoinflammatory Diseases with Variable
           Heredity
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Guilaine Boursier, Veronique Hentgen, Guillaume Sarrabay, Isabelle Koné-Paut, Isabelle Touitou
       
  • Juvenile Idiopathic Arthritis—Education, Knowledge, and Patient
           Outcomes
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Yosef Uziel
       
  • Large Scale Next Generation Sequencing and Newborn Screening: Are We
           Ready'
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Chanika Phornphutkul, James Padbury
       
  • Trends in Pediatric Chair Sex Distribution and Tenure over Time: A Survey
           of 714 Pediatric Chairs from the Association of Medical School Pediatric
           Department Chairs
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Edie Weller, Richard Jacobs, Valerie P. Opipari, Robert W. Wilmott, Gary Fleisher
       
  • Making the Consult Interaction More Than a Transaction: Helping Fellows Be
           Better Teachers and Residents Be Better Learners
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Ariel S. Winn, Diane E.J. Stafford, Eli M. Miloslavsky, Jakob I. McSparron, Amit S. Grover, Debra Boyer
       
  • Recovery and the family tree of Morpheus
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Denise M. Goodman
       
  • An important marker explained
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Thomas Welch
       
  • Early psychosocial environment and cardiometabolic risk
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Stephen R. Daniels
       
  • Disproving junk science
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Paul G. Fisher
       
  • Information for Readers
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s):
       
  • Reply
    • Abstract: Publication date: June 2019Source: The Journal of Pediatrics, Volume 209Author(s): Jennifer M. Colby, Stephen W. Patrick
       
  • Incidence of Thyroid Disease in Adolescent Females Presenting with Heavy
           Menstrual Bleeding
    • Abstract: Publication date: Available online 23 May 2019Source: The Journal of PediatricsAuthor(s): Angela C. Weyand, Elisabeth H. Quint, Gary L. FreedThe incidence of thyroid disease in adolescents with heavy menstrual bleeding is unknown. A retrospective cross-sectional study of 427 adolescents presenting with heavy menstrual bleeding found 0.23% (95% CI 0%-0.7%) had thyroid disease, lower than that expected in the general population. Thyroid testing should only be considered when other symptomatology is present.
       
  • Intrathoracic Kidney
    • Abstract: Publication date: Available online 23 May 2019Source: The Journal of PediatricsAuthor(s): Orli Megged, Ruth Cytter-Kuint
       
  • The Role of Genetic Predisposition, Programing During Fetal Life, Family
           Conditions, and Post-natal Diet in the Development of Pediatric Fatty
           Liver Disease
    • Abstract: Publication date: Available online 23 May 2019Source: The Journal of PediatricsAuthor(s): Antonella Mosca, Valentina De Cosmi, Fabio Parazzini, Massimiliano Raponi, Anna Alisi, Carlo Agostoni, Valerio NobiliObjectiveTo evaluate, in patients with nonalcoholic fatty liver disease (NAFLD), the role of lifetime exposures associated with genetic predisposition, family history (parental obesity, economic income), programming during fetal life (gestational age, birthweight), being breastfed or not, and later biomarkers of dietary habits and lifestyle in the development of fibrosis.Study designIn total, 182 children with overweight/obesity diagnosed with NAFLD proven by biopsy results were enrolled in our study and evaluated for liver fibrosis. We estimated prevalence ORs of fibrosis according to genetics, parental obesity, occupational socioeconomic status (SES), birth weight, breastfeeding, fructose intake (indicator of junk food consumption), and vitamin D status (inflammatory indicator) using logistic regression models, adjusted for age and children's body mass.ResultsOne hundred thirty-seven patients (75.3%) had liver fibrosis, and 45 patients (24.7%) did not have liver fibrosis. The ORs of fibrosis were significant (P 
       
  • A Neonate with Unexplained Hair Loss
    • Abstract: Publication date: Available online 23 May 2019Source: The Journal of PediatricsAuthor(s): Bin Zhang, Li Wei, Lin Ma
       
  • A Child with Hemorrhagic Bullous Lesions
    • Abstract: Publication date: Available online 18 May 2019Source: The Journal of PediatricsAuthor(s): Dharmagat Bhattarai, Himanshi Chaudhary, Revathi Deglurkar, Pandiarajan Vignesh
       
  • A Positive Association Between Dietary Intake of Higher Cow's Milk-Fat
           Percentage and Non−High-Density Lipoprotein Cholesterol in Young
           Children
    • Abstract: Publication date: Available online 17 May 2019Source: The Journal of PediatricsAuthor(s): Vincent C.H. Wong, Jonathon L. Maguire, Jessica A. Omand, David W.H. Dai, Gerald Lebovic, Patricia C. Parkin, Deborah L. O'Connor, Catherine S. Birken, Catherine S. Birken, Jonathon L. Maguire, Ronald Cohn, Eddy Lau, Andreas Laupacis, Patricia C. Parkin, Michael Salter, Peter Szatmari, Shannon Weir, Laura N. Anderson, Cornelia M. Borkhoff, Charles Keown-StonemanObjectivesTo determine the association between cow's milk-fat and non−high-density lipoprotein (non-HDL) cholesterol, a marker of cardiovascular disease (CVD) risk in young children, and whether this association is mediated by the typical volume of cow's milk consumed.Study designA longitudinal study in 2- to 8-year-old children (n = 2890) was conducted through The Applied Research Group for Kids (TARGet Kids!), a practice-based research network in Toronto, Canada. Generalized estimating equations were used to examine the relationship between parent-reported cow's milk-fat percentage intake and serum non-HDL cholesterol concentrations as well as having high non-HDL cholesterol (≥3.75 mmol/L [145 mg/dL]), adjusting for covariates including age, sex, body mass index z score, breastfeeding duration, mother's ethnicity, and parental history of CVD. Bootstrap resampling (10 000 repetitions) was used to assess whether typical volume consumed mediated the association between cow's milk-fat percentage and non-HDL cholesterol.ResultsIn total, 156 (5.4%) had high non-HDL cholesterol. Each percent increase in cow's milk-fat was associated with a 0.035 mmol/L (1.35 mg/dL) (P 
       
  • The Impact of the American Academy of Pediatrics Brief Resolved
           Unexplained Event Guidelines on Gastrointestinal Testing and Prescribing
           Practices
    • Abstract: Publication date: Available online 15 May 2019Source: The Journal of PediatricsAuthor(s): Daniel R. Duncan, Amanda S. Growdon, Enju Liu, Kara Larson, Madeline Gonzalez, Kerri Norris, Rachel L. RosenObjectivesTo determine if hospitalization, testing, diagnosis, and management of suspected gastroesophageal reflux, and follow-up visits decreased since introduction of American Academy of Pediatrics guidelines for brief resolved unexplained events (BRUEs).Study designWe performed a retrospective cohort study of infants with BRUE evaluated at Boston Children's Hospital in the year before and after guideline implementation to determine if practice patterns have changed. Outcomes included hospitalization rates, frequency of swallow assessments, other diagnostic testing, and reflux diagnoses, cost of care, and number of repeat visits. Groups were compared based on whether they presented before or after guideline implementation.ResultsIn total, 359 subjects (186 pre-, 173 post-guidelines) were identified. There were no significant differences in practice patterns or outcomes before or after guideline implementation. Subjects had mean age 2.53 ± 0.15 months, and 80% were hospitalized for 2.49 ± 0.26 days. Each subject had 2.47 diagnostic tests performed, and 89% were noncontributory. Despite only 13% having videofluoroscopic swallow study performed, 72% showed aspiration/penetration. No subject had gastroesophageal reflux testing, yet reflux was implicated as the cause for admission in 40% of subjects, resulting in increased odds of discharge on acid suppressing medications (OR 2.88, 95% CI 1.68-4.92, P = .0001). In follow-up, 28% of subjects had repeat hospitalizations or emergency department visits for persistent symptoms.ConclusionsInfants with BRUE continue to undergo low-yield diagnostic testing and after admission remain symptomatic and frequently re-present to medical care. Swallow testing remains infrequent despite its high-yield, reflux continues to be implicated and children are still being discharged on acid suppression despite lack of efficacy.
       
 
 
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