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Pediatrics
Journal Prestige (SJR): 3.337
Citation Impact (citeScore): 5
Number of Followers: 409  
 
  Full-text available via subscription Subscription journal
ISSN (Print) 0031-4005 - ISSN (Online) 1098-4275
Published by American Academy of Pediatrics Homepage  [4 journals]
  • Decreasing Continuous Positive Airway Pressure Failure in Preterm Infants

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      Authors: Kakkilaya, V. B; Weydig, H. M, Smithhart, W. E, Renfro, S. D, Garcia, K. M, Brown, C. M, He, H, Wagner, S. A, Metoyer, G. C, Brown, L. S, Kapadia, V. S, Savani, R. C, Jaleel, M. A.
      Abstract: BACKGROUND AND OBJECTIVESMany preterm infants stabilized on continuous positive airway pressure (CPAP) at birth require mechanical ventilation (MV) during the first 72 hours of life, which is defined as CPAP failure. Our objective was to decrease CPAP failure in infants ≤29 weeks’ gestational age (GA).METHODSA quality improvement bundle named OPTISURF was implemented for infants ≤29 weeks’ GA admitted on CPAP, consisting of stepwise escalation of CPAP and less invasive surfactant administration guided by fractional inspired oxygen concentration ≥0.3. The CPAP failure rate was tracked by using control charts. We compared practice and outcomes of a pre–OPTISURF cohort (January 2017 to September 2018) to a post-OPTISURF cohort (October 2018 to December 2019).RESULTSOf the 216 infants ≤29 weeks’ GA admitted to NICU on CPAP, 125 infants belonged to the pre-OPTISURF cohort (OSC) and 91 to the post-OSC. Compared with the pre-OSC, a higher proportion of infants in the post-OSC received CPAP 7 cm H2O within 4 hours of life (7% vs 32%; P < .01). The post-OSC also had lower rates of CPAP failure (54% vs 11%; P < .01), pneumothoraces (8% vs 1%; P < .03), need for MV (58% vs 31%; P < .01), and patent ductus arteriosus treatment (21% vs 9%; P = .02). Additionally, in a subgroup analysis, CPAP failure was lower in the post-OSC among infants 23 to 26 weeks (79% vs 27%; P < .01) and 27 to 29 weeks’ GA (46% vs 3%; P < .01).CONCLUSIONSImplementation of a quality improvement bundle including CPAP optimization and less invasive surfactant administration decreased CPAP failure and need for MV in preterm infants.
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2020-014191
      Issue No: Vol. 148, No. 4 (2021)
       
  • Optimizing Situation Awareness to Reduce Emergency Transfers in
           Hospitalized Children

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      Authors: Sosa, T; Sitterding, M, Dewan, M, Coleman, M, Seger, B, Bedinghaus, K, Hawkins, D, Maddock, B, Hausfeld, J, Falcone, R, Brady, P. W, Simmons, J, White, C. M.
      Abstract: BACKGROUND AND OBJECTIVESInterventions to improve care team situation awareness (SA) are associated with reduced rates of unrecognized clinical deterioration in hospitalized children. By addressing themes from recent safety events and emerging corruptors to SA in our system, we aimed to decrease emergency transfers (ETs) to the ICU by 50% over 10 months.METHODSAn interdisciplinary team of physicians, nurses, respiratory therapists, and families convened to improve the original SA model for clinical deterioration and address communication inadequacies and evolving technology in our inpatient system. The key drivers included the establishment of a shared mental model, psychologically safe escalation, and efficient and effective SA tools. Novel interventions including the intentional inclusion of families and the interdisciplinary team in huddles, a mental model checklist, door signage, and an electronic health record SA navigator were evaluated via a time series analysis. Sequential inpatient-wide testing of the model allowed for iteration and consensus building across care teams and families. The primary outcome measure was ETs, defined as any ICU transfer in which the patient receives intubation, inotropes, or ≥3 fluid boluses within 1 hour.RESULTSThe rate of ETs per 10 000 patient-days decreased from 1.34 to 0.41 during the study period. This coincided with special cause improvement in process measures, including risk recognition before medical response team activation and the use of tools to facilitate shared SA.CONCLUSIONSAn innovative, proactive, and reliable process to predict, prevent, and respond to clinical deterioration was associated with a nearly 70% reduction in ETs.
      Keywords: Quality Improvement, Safety, Hospital Medicine
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2020-034603
      Issue No: Vol. 148, No. 4 (2021)
       
  • Sexual Minority Status and Age of Onset of Adolescent Suicide Ideation and
           Behavior

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      Authors: Luk, J. W; Goldstein, R. B, Yu, J, Haynie, D. L, Gilman, S. E.
      Abstract: OBJECTIVESTo determine if sexual minority adolescents have earlier onset of suicidality and faster progressions from ideation to plan and attempt than heterosexual adolescents.METHODSA population-based longitudinal cohort of 1771 adolescents participated in the NEXT Generation Health Study. Participants reported sexual minority status (defined by sexual attraction) in 2010–2011 and retrospectively reported age at onset of suicidality in 2015–2016.RESULTSSexual minority adolescents (5.8% of weighted sample) had higher lifetime risk of suicide ideation (26.1% vs 13.0%), plan (16.6% vs 5.4%), and attempt (12.0% vs 5.4%) than heterosexual adolescents. Survival analyses adjusted for demographic characteristics and depressive symptoms revealed positive associations of sexual minority status with time to first onset of suicide ideation (hazard ratio [HR] = 1.77; 95% confidence interval [CI] 1.03–3.06) and plan (HR = 2.69; 95% CI 1.30–5.56). The association between sexual minority status and age at onset of suicide attempt was stronger at age
      Keywords: Epidemiology, Psychiatry/Psychology, LGBTQ+
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2020-034900
      Issue No: Vol. 148, No. 4 (2021)
       
  • Reducing Severe Tracheal Intubation Events Through an Individualized
           Airway Bundle

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      Authors: Herrick, H. M; Pouppirt, N, Zedalis, J, Cei, B, Murphy, S, Soorikian, L, Matthews, K, Nassar, R, Napolitano, N, Nishisaki, A, Foglia, E. E, Ades, A, Nawab, U.
      Abstract: BACKGROUNDNeonatal tracheal intubation (TI) is a high-risk procedure associated with adverse safety events. In our newborn and infant ICU, we measure adverse tracheal intubation–associated events (TIAEs) as part of our participation in National Emergency Airway Registry for Neonates, a neonatal airway registry. We aimed to decrease overall TIAEs by 10% in 12 months.METHODSA quality improvement team developed an individualized approach to intubation using an Airway Bundle (AB) for patients at risk for TI. Plan-do-study-act cycles included AB creation, simulation, unit roll out, interprofessional education, team competitions, and adjusting AB location. Outcome measure was monthly rate of TIAEs (overall and severe). Process measures were AB initiation, AB use at intubation, video laryngoscope (VL) use, and paralytic use. Balancing measure was inadvertent administration of TI premedication. We used statistical process control charts.RESULTSData collection from November 2016 to August 2020 included 1182 intubations. Monthly intubations ranged from 12 to 41. Initial overall TIAE rate was 0.093 per intubation encounter, increased to 0.172, and then decreased to 0.089. System stability improved over time. Severe TIAE rate decreased from 0.047 to 0.016 in June 2019. AB initiation improved from 70% to 90%, and AB use at intubation improved from 18% to 55%. VL use improved from 86% to 97%. Paralytic use was 83% and did not change. The balancing measure of inadvertent TI medication administration occurred once.CONCLUSIONSWe demonstrated a significant decrease in the rate of severe TIAEs through the implementation of an AB. Next steps include increasing use of AB at intubation.
      Keywords: Quality Improvement, Neonatology
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2020-035899
      Issue No: Vol. 148, No. 4 (2021)
       
  • Pubertal Suppression, Bone Mass, and Body Composition in Youth With Gender
           Dysphoria

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      Authors: Navabi, B; Tang, K, Khatchadourian, K, Lawson, M. L.
      Abstract: BACKGROUND AND OBJECTIVESPuberty onset and development contribute substantially to adolescents’ bone mass and body composition. Our objective with this study was to examine the effects of gonadotropin-releasing hormone agonists (GnRHa) on these puberty-induced changes among youth with gender dysphoria (GD).METHODSMedical records of the endocrine diversity clinic in an academic children’s hospital were reviewed for youth with GD seen from January 2006 to April 2017 with at least 1 baseline dual-energy radiograph absorptiometry measurement.RESULTSAt baseline, transgender females had lower lumbar spine (LS) and left total hip (LTH) areal bone mineral density (aBMD) and LS bone mineral apparent density (BMAD) z scores. Only 44.7% of transgender youth were vitamin D sufficient. Baseline vitamin D status was associated with LS, LTH aBMD, and LS BMAD z scores. Post-GnRHa assessments revealed a significant drop in LS and LTH aBMD z scores (transgender males and transgender females) without fractures and LS BMAD (transgender males), an increase in gynoid (fat percentage), and android (fat percentage) (transgender males and transgender females), and no changes in BMI z score.CONCLUSIONSGnRHa monotherapy negatively affected bone mineral density of youth with GD without evidence of fractures or changes in BMI z score. Transgender youth body fat redistribution (android versus gynoid) were in keeping with their affirmed gender. The majority of transgender youth had vitamin D insufficiency or deficiency with baseline status associated with bone mineral density. Vitamin D supplementation should be considered for all youth with GD.
      Keywords: Endocrinology, Puberty, Adolescent Health/Medicine
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2020-039339
      Issue No: Vol. 148, No. 4 (2021)
       
  • Health Care Insurance Adequacy for Children and Youth With Special Health
           Care Needs

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      Authors: Berry, J. G; Perrin, J. M, Hoover, C, Rodean, J, Agrawal, R. K, Kuhlthau, K. A.
      Keywords: Child Health Financing
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2020-039891
      Issue No: Vol. 148, No. 4 (2021)
       
  • SARS-CoV-2 Among Infants <90 Days of Age Admitted for Serious Bacterial
           Infection Evaluation

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      Authors: Paret, M; Lalani, K, Hedari, C, Jaffer, A, Narayanan, N, Noor, A, Lighter, J, Madan, R. P, Shust, G. F, Ratner, A. J, Raabe, V. N.
      Abstract: OBJECTIVESTo determine the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in infants hospitalized for a serious bacterial infection (SBI) evaluation and clinically characterize young infants with SARS-CoV-2 infection.METHODSA retrospective chart review was conducted on infants
      Keywords: Infectious Disease
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2020-044685
      Issue No: Vol. 148, No. 4 (2021)
       
  • Emergency Department Pediatric Visits in Alberta for Cannabis After
           Legalization

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      Authors: Yeung, M. E. M; Weaver, C. G, Hartmann, R, Haines-Saah, R, Lang, E.
      Abstract: BACKGROUND AND OBJECTIVESCanada legalized nonmedical cannabis possession and sale in October 2018. In the United States, state legalization has been tied to an increase in cannabis-related emergency department (ED) visits; however, little research exists on provincial changes in pediatric visits after nationwide legislation. We compared pre- and postlegalization trends in pediatric cannabis-related ED visits and presentation patterns in urban Alberta EDs.METHODSRetrospective National Ambulatory Care Reporting System data were queried for urban Alberta cannabis-related ED visits among patients aged
      Keywords: Emergency Medicine, Toxicology, Federal Policy
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2020-045922
      Issue No: Vol. 148, No. 4 (2021)
       
  • Comparative Effectiveness of Parent-Based Interventions to Support Injured
           Children

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      Authors: Ramirez, M. R; Flores, J. E, Woods-Jaeger, B, Cavanaugh, J. E, Peek-Asa, C, Branch, C, Bolenbaugh, M, Chande, V, Pitcher, G, Ortega, H. W, Randell, K. A, Wetjen, K, Roth, L, Kenardy, J.
      Abstract: OBJECTIVESA comparative effectiveness trial tested 2 parent-based interventions in improving the psychosocial recovery of hospitalized injured children: (1) Link for Injured Kids (Link), a program of psychological first aid in which parents are taught motivational interviewing and stress-screening skills, and (2) Trauma Education, based on an informational booklet about trauma and its impacts and resources.METHODSA randomized controlled trial was conducted in 4 children’s hospitals in the Midwestern United States. Children aged 10 to 17 years admitted for an unintentional injury and a parent were recruited and randomly assigned to Link or Trauma Education. Parents and children completed questionnaires at baseline, 6 weeks, 3 months, and 6 months posthospitalization. Using an intent-to-treat analysis, changes in child-reported posttraumatic stress symptoms, depression, quality of life, and child behaviors were compared between intervention groups.RESULTSOf 795 injured children, 314 children and their parents were enrolled into the study (40%). Link and Trauma Education was associated with improved symptoms of posttraumatic stress, depression, and pediatric quality of life at similar rates over time. However, unlike those in Trauma Education, children in the Link group had notable improvement of child emotional behaviors and mild improvement of conduct and peer behaviors. Compared with Trauma Education, Link was also associated with improved peer behaviors in rural children.CONCLUSIONAlthough children in both programs had reduced posttrauma symptoms over time, Link children, whose parents were trained in communication and referral skills, exhibited a greater reduction in problem behaviors.
      Keywords: Psychosocial Issues, Trauma
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2020-046920
      Issue No: Vol. 148, No. 4 (2021)
       
  • Reading Proficiency Trends Following Newborn Hearing Screening
           Implementation

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      Authors: Yoshinaga-Itano, C; Mason, C. A, Wiggin, M, Grosse, S. D, Gaffney, M, Gilley, P. M.
      Abstract: OBJECTIVESTo investigate trends in population-level school-aged reading scores among students with hearing loss in an urban Colorado school district after implementation of universal newborn hearing screening (UNHS) and Early Hearing Detection and Intervention.METHODSThe final sample included 1422 assessments conducted during the 2000–2001 through 2013–2014 school years for 321 children with hearing loss in grades 3 through 10. Longitudinal hierarchical linear modeling analyses were used to examine reading proficiency (controlling for birth year, grade in school, free and reduced lunch status, additional disability services, and English not spoken in the home). The Colorado Student Assessment Program was administered to students in third through 10th grades throughout the state. The test years chosen included children born before and after implementation of UNHS.RESULTSAfter implementation of UNHS, significant longitudinal reading proficiency improvements were observed by birth year and grade overall and for all subgroups. However, gains in reading proficiency were substantially less for children eligible for free and reduced lunch and those with moderate-severe to profound hearing loss. With each succeeding birth cohort and grade, increased numbers of children participated in testing because of improved language skills, with higher proportions identified as proficient or advanced readers.CONCLUSIONSNotable improvements in reading proficiency after Early Hearing Detection and Intervention implementation were demonstrated, as all groups of children with hearing loss became more likely to achieve proficient and advanced reading levels. On the other hand, some disparities increased, with greater improvements in reading proficiency for children in economically advantaged families.
      Keywords: Children With Special Health Care Needs, Fetus/Newborn Infant, Birth Defects
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2020-048702
      Issue No: Vol. 148, No. 4 (2021)
       
  • Newborn Pulse Oximetry for Infants Born Out-of-Hospital

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      Authors: Williams, K. B; Horst, M, Hollinger, E. A, Freedman, J, Demczko, M. M, Chowdhury, D.
      Abstract: BACKGROUND AND OBJECTIVESConventional timing of newborn pulse oximetry screening is not ideal for infants born out-of-hospital. We implemented a newborn pulse oximetry screen to align with typical midwifery care and measure its efficacy at detecting critical congenital heart disease.METHODSCohort study of expectant mothers and infants mainly from the Amish and Mennonite (Plain) communities with limited prenatal ultrasound use. Newborns were screened at 1 to 4 hours of life ("early screen") and 24 to 48 hours of life ("late screen"). Newborns were followed up to 6 weeks after delivery to report outcomes. Early screen, late screen, and combined results were analyzed on the basis of strict algorithm interpretation ("algorithm") and the midwife’s interpretation in the field ("field") because these did not correspond in all cases.RESULTSPulse oximetry screening in 3019 newborns (85% Plain; 50% male; 43% with a prenatal ultrasound) detected critical congenital heart disease in 3 infants. Sensitivity of combined early and late screen was 66.7% (95% confidence interval [CI] 9.4% to 99.2%) for algorithm interpretation and 100% (95% CI 29.2% to 100%) for field interpretation. Positive predictive value was similar for the field interpretation (8.8%; 95% CI 1.9% to 23.7%) and algorithm interpretation (5.4%; 95% CI 0.7% to 18.2%). False-positive rates were ≤1.2% for both algorithm and field interpretations. Other pathologies (noncritical congenital heart disease, pulmonary issues, or infection) were reported in 12 of the false-positive cases.CONCLUSIONSNewborn pulse oximetry can be adapted to the out-of-hospital setting without compromising sensitivity or prohibitively increasing false-positive rates.
      Keywords: Fetus/Newborn Infant, Neonatology, Cardiology
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2020-048785
      Issue No: Vol. 148, No. 4 (2021)
       
  • Nature and Childrens Health: A Systematic Review

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      Authors: Fyfe-Johnson, A. L; Hazlehurst, M. F, Perrins, S. P, Bratman, G. N, Thomas, R, Garrett, K. A, Hafferty, K. R, Cullaz, T. M, Marcuse, E. K, Tandon, P. S.
      Abstract: CONTEXTDaily outdoor play is encouraged by the American Academy of Pediatrics. Existing evidence is unclear on the independent effect of nature exposures on child health.OBJECTIVEWe systematically evaluated evidence regarding the relationship between nature contact and children’s health.DATA SOURCESThe database search was conducted by using PubMed, Cumulative Index to Nursing and Allied Health Literature, PsychInfo, ERIC, Scopus, and Web of Science in February 2021.STUDY SELECTIONWe followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In all searches, the first element included nature terms; the second included child health outcome terms.DATA EXTRACTIONOf the 10 940 studies identified, 296 were included. Study quality and risk of bias were assessed.RESULTSThe strongest evidence for type of nature exposure was residential green space studies (n = 147, 50%). The strongest evidence for the beneficial health effects of nature was for physical activity (n = 108, 32%) and cognitive, behavioral, or mental health (n = 85, 25%). Physical activity was objectively measured in 55% of studies, and 41% of the cognitive, behavioral, or mental health studies were experimental in design.LIMITATIONSTypes of nature exposures and health outcomes and behaviors were heterogenous. Risk of selection bias was moderate to high for all studies. Most studies were cross-sectional (n = 204, 69%), limiting our ability to assess causality.CONCLUSIONSCurrent literature supports a positive relationship between nature contact and children’s health, especially for physical activity and mental health, both public health priorities. The evidence supports pediatricians in advocating for equitable nature contact for children in places where they live, play, and learn.
      Keywords: Community Pediatrics, Environmental Health, Public Health
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2020-049155
      Issue No: Vol. 148, No. 4 (2021)
       
  • A Text-Based Intervention to Promote Literacy: An RCT

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      Authors: Chamberlain, L. J; Bruce, J, De La Cruz, M, Huffman, L, Steinberg, J. R, Bruguera, R, Peterson, J. W, Gardner, R. M, He, Z, Ordaz, Y, Connelly, E, Loeb, S.
      Abstract: BACKGROUND AND OBJECTIVESChildren entering kindergarten ready to learn are more likely to thrive. Inequitable access to high-quality, early educational settings creates early educational disparities. TipsByText, a text-message–based program for caregivers of young children, improves literacy of children in preschool, but efficacy for families without access to early childhood education was unknown.METHODSWe conducted a randomized controlled trial with caregivers of 3- and 4-year-olds in 2 public pediatric clinics. Intervention caregivers received TipsByText 3 times a week for 7 months. At pre- and postintervention, we measured child literacy using the Phonological Awareness Literacy Screening Tool (PALS-PreK) and caregiver involvement using the Parent Child Interactivity Scale (PCI). We estimated effects on PALS-PreK and PCI using multivariable linear regression.RESULTSWe enrolled 644 families, excluding 263 because of preschool participation. Compared with excluded children, those included in the study had parents with lower income and educational attainment and who were more likely to be Spanish speaking. Three-quarters of enrollees completed pre- and postintervention assessments. Postintervention PALS-PreK scores revealed an unadjusted treatment effect of 0.260 (P = .040); adjusting for preintervention score, child age, and caregiver language, treatment effect was 0.209 (P = .016), equating to ~3 months of literacy gains. Effects were greater for firstborn children (0.282 vs 0.178), children in 2-parent families (0.262 vs 0.063), and 4-year-olds (0.436 vs 0.107). The overall effect on PCI was not significant (1.221, P = .124).CONCLUSIONSThe health sector has unique access to difficult-to-reach young children. With this clinic-based texting intervention, we reached underresourced families and increased child literacy levels.
      Keywords: Community Pediatrics, Growth/Development Milestones
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2020-049648
      Issue No: Vol. 148, No. 4 (2021)
       
  • Antiviral Use in Canadian Children Hospitalized for Influenza

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      Authors: Mehta, K; Morris, S. K, Bettinger, J. A, Vaudry, W, Jadavji, T, Halperin, S. A, Bancej, C, Sadarangani, M, Dendukuri, N, Papenburg, J, for the Canadian Immunization Monitoring Program Active (IMPACT) Investigators
      Abstract: OBJECTIVESAntivirals are recommended for children hospitalized with influenza but are underutilized. We describe antiviral prescribing during influenza admissions in Canadian pediatric centers and identify factors associated with antiviral use.METHODSWe performed active surveillance for laboratory-confirmed influenza hospitalizations among children ≤16 years old at the 12 Canadian Immunization Monitoring Program Active hospitals, from 2010–2011 to 2018–2019. Logistic regression analyses were used to identify factors associated with antiviral use.RESULTSAmong 7545 patients, 57.4% were male; median age was 3 years (interquartile range: 1.1–6.3). Overall, 41.3% received antiviral agents; 72.8% received antibiotics. Antiviral use varied across sites (range, 10.2% to 81.1%) and influenza season (range, 19.9% to 59.6%) and was more frequent in children with ≥1 chronic health condition (52.7% vs 36.7%; P < .001). On multivariable analysis, factors associated with antiviral use included older age (adjusted odds ratio [aOR] 1.04 [95% confidence interval (CI), 1.02–1.05]), more recent season (highest aOR 9.18 [95% CI, 6.70–12.57] for 2018–2019), admission during peak influenza period (aOR 1.37 [95% CI, 1.19–1.58]), availability of local treatment guideline (aOR 1.54 [95% CI, 1.17–2.02]), timing of laboratory confirmation (highest aOR 2.67 [95% CI, 1.97–3.61] for result available before admission), presence of chronic health conditions (highest aOR 4.81 [95% CI, 3.61–6.40] for cancer), radiographically confirmed pneumonia (aOR 1.39 [95% CI, 1.20–1.60]), antibiotic treatment (aOR 1.51 [95% CI, 1.30–1.76]), respiratory support (1.57 [95% CI, 1.19–2.08]), and ICU admission (aOR 3.62 [95% CI, 2.88–4.56]).CONCLUSIONSInfluenza antiviral agents were underused in Canadian pediatric hospitals, including among children with high-risk chronic health conditions. Prescribing varied considerably across sites, increased over time, and was associated with patient and hospital-level characteristics. Multifaceted hospital-based interventions are warranted to strengthen adherence to influenza treatment guidelines and antimicrobial stewardship practices.
      Keywords: Infectious Disease, Influenza, Therapeutics
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2020-049672
      Issue No: Vol. 148, No. 4 (2021)
       
  • Babys First Years: Design of a Randomized Controlled Trial of Poverty
           Reduction in the United States

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      Authors: Noble, K. G; Magnuson, K, Gennetian, L. A, Duncan, G. J, Yoshikawa, H, Fox, N. A, Halpern-Meekin, S.
      Abstract: Childhood economic disadvantage is associated with lower cognitive and social-emotional skills, reduced educational attainment, and lower earnings in adulthood. Despite these robust correlations, it is unclear whether family income is the cause of differences observed between children growing up in poverty and their more fortunate peers or whether these differences are merely due to the many other aspects of family life that co-occur with poverty. Baby’s First Years is the first randomized controlled trial in the United States designed to identify the causal impact of poverty reduction on children’s early development. A total of 1000 low-income mothers of newborns were enrolled in the study and began receiving a monthly unconditional cash gift for the first several years of their children’s lives. Mothers were randomly assigned to receive either a large monthly cash gift or a nominal monthly cash gift. All monthly gifts are administered via debit card and can be freely spent with no restrictions. Baby’s First Years aims to answer whether poverty reduction in early childhood (1) improves children’s developmental outcomes and promotes healthier brain functioning, and (2) improves family functioning and better enables parents to support child development. Here we present the rationale and design of the study as well as potential implications for science and policy.
      Keywords: Cognition/Language/Learning Disorders, Psychosocial Issues, Public Health
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2020-049702
      Issue No: Vol. 148, No. 4 (2021)
       
  • The Campaign for Universal Free Lunch in New York City: Lessons Learned

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      Authors: Watts; A., Araiza, A. L., Fernandez, C. R., Rosenthal, L., Vargas-Rodriguez, I., Duroseau, N., Accles, L., Rieder, J., on behalf of the American Academy of Pediatrics New York Chapter 3 Committee on Nutrition the Community Food Advocates
      Abstract: The New York City (NYC) Department of Education is the largest public school system in the United States, with an enrollment of >1.1 million students. Students who participate in school meal programs can have higher dietary quality than nonparticipating students. Historically, family income documentation qualifying students in the NYC Department of Education for free or reduced-price meals reimbursed by the National School Lunch Program perpetuated poverty stigma. Additionally, National School Lunch Program qualification paperwork was a deterrent to many vulnerable families to participate and impeded all eligible children’s access to nutritious meals, potentially magnifying food insecurity. The Healthy, Hunger-Free Kids Act of 2010 provided a viable option for schools to serve free meals to all students, regardless of income status, as a universal free lunch (UFL) through a Community Eligibility Provision if ≥40% of students already participated in another means-based program, such as the Supplemental Nutrition Assistance Program. In this case study, we describe the processes of (1) strategic coalition building of the Lunch 4 Learning campaign (a coalition of students, parents, school-based unions, teachers, pediatricians, community leaders, and children’s advocacy organizations) to bring UFL to all NYC public schools, (2) building political support, (3) developing a media strategy, and (4) using an evidence-based strategy to overcome political, administrative, and procedural challenges. The Lunch 4 Learning campaign successfully brought UFL to all NYC public schools in 2017. This case study informs further advocacy efforts to expand UFL in other school districts across the country and national UFL advocacy.
      Keywords: School Health, Nutrition, Advocacy
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2020-049734
      Issue No: Vol. 148, No. 4 (2021)
       
  • Factorial Analysis Quantifies the Effects of Pediatric Discharge Bundle on
           Hospital Readmission

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      Authors: Osorio, S. N; Gage, S, Mallory, L, Soung, P, Satty, A, Abramson, E. L, Provost, L, Cooperberg, D, ON BEHALF OF THE IMPACT STUDY GROUP
      Abstract: BACKGROUND AND OBJECTIVESFactorial design of a natural experiment was used to quantify the benefit of individual and combined bundle elements from a 4-element discharge transition bundle (checklist, teach-back, handoff to outpatient providers, and postdischarge phone call) on 30-day readmission rates (RRs).METHODSA 24 factorial design matrix of 4 bundle element combinations was developed by using patient data (N = 7725) collected from January 2014 to December 2017 from 4 hospitals. Patients were classified into 3 clinical risk groups (CRGs): no chronic disease (CRG1), single chronic condition (CRG2), and complex chronic condition (CRG3). Estimated main effects of each bundle element and their interactions were evaluated by using Study-It software. Because of variation in subgroup size, important effects from the factorial analysis were determined by using weighted effect estimates.RESULTSRR in CRG1 was 3.5% (n = 4003), 4.1% in CRG2 (n = 1936), and 17.6% in CRG3 (n = 1786). Across the 3 CRGs, the number of subjects in the factorial groupings ranged from 16 to 674. The single most effective element in reducing RR was the checklist in CRG1 and CRG2 (reducing RR by 1.3% and 3.0%) and teach-back in CRG3 (by 4.7%) The combination of teach-back plus a checklist had the greatest effect on reducing RR in CRG3 by 5.3%.CONCLUSIONSThe effect of bundle elements varied across risk groups, indicating that transition needs may vary on the basis of population. The combined use of teach-back plus a checklist had the greatest impact on reducing RR for medically complex patients.
      Keywords: Quality Improvement, Continuity of Care Transition & Discharge Planning
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-049926
      Issue No: Vol. 148, No. 4 (2021)
       
  • Parenthood and Parental Leave Decisions in Pediatric Residency

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      Authors: Dundon, K. M; Powell, W. T, Wilder, J. L, King, B, Schwartz, A, McPhillips, H, Best, J. A, for the APPD LEARN Parenthood in Pediatric Residency Study Consortium
      Abstract: OBJECTIVESThe demands of residency training may impact trainees’ decision to have children. We examined characteristics of pediatric residents’ decisions regarding childbearing, determinants of resident parental leave, and associations with well-being.METHODSA survey of 845 pediatric residents at 13 programs was conducted between October 2019 and May 2020. Survey items included demographics, desire for future children, and logistics of parental leave. Outcomes included parental leave length, burnout and depression screening results, satisfaction with duration of breastfeeding, and satisfaction with parental leave and parenthood decisions.RESULTSSeventy-six percent (639 of 845) of residents responded to the survey. Fifty-two percent (330) of respondents reported delaying having children during residency, and 29% (97) of those were dissatisfied with their decision to do so. Busy work schedule (89.7%), finances (50.9%), and a desire not to extend residency (41.2%) were the most common reasons for delay. Of respondents, 16% were parents and 4% were pregnant or had pregnant partners. Sixty-one parental leaves were reported, and 67% of parents reported dissatisfaction with leave length. The most frequently self-reported determinant of leave duration was the desire not to extend residency training (74%). Program mean leave length was negatively associated with burnout, measured as a dichotomous outcome (odds ratio = 0.81 [95% confidence interval 0.68–0.98]; P = .02).CONCLUSIONSMany pediatric trainees delay parenthood during residency and are not satisfied with their decision to do so. Pediatric resident parental leave remains short and variable in duration, despite the positive association between longer leaves and overall well-being.
      Keywords: Medical Education, Workforce
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-050107
      Issue No: Vol. 148, No. 4 (2021)
       
  • Gender Dysphoria and Chronic Pain in Youth

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      Authors: Sayeem, M; Carter, B, Phulwani, P, Zempsky, W. T.
      Abstract: Chronic pain in youth with gender dysphoria (GD) is poorly understood. The aim of our study was to review the clinical presentation of 8 youth with GD in a multidisciplinary chronic pain clinic. A single center retrospective chart review was conducted to obtain information on demographics, clinical care, previous diagnoses, and validated clinical measures. We present the trajectory of pain in this population with treatment of GD. Recognition and treatment of GD in youth with pain may improve pain outcomes.
      Keywords: Endocrinology, Adolescent Health/Medicine, Anesthesiology/Pain Medicine
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-050128
      Issue No: Vol. 148, No. 4 (2021)
       
  • Disclosure of Self-Injurious Thoughts and Behaviors Across Sexual and
           Gender Identities

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      Authors: Burke, T. A; Bettis, A. H, Barnicle, S. C, Wang, S. B, Fox, K. R.
      Abstract: OBJECTIVESEvidence suggests that sexual minority (SM) and gender minority (GM) youth are more likely to experience self-injurious thoughts and behaviors (SITBs) than heterosexual and cisgender youth. A major barrier to identifying and treating SITBs is nondisclosure. In this study, we explored differences in SITB disclosure patterns between SM and GM youth and their heterosexual and cisgender peers. In this study, we further examined the association between discrimination experiences and SITB disclosure.METHODSAdolescents (N = 931) completed questionnaires assessing demographics, SITBs, disclosure history, disclosure barriers, future intentions to disclose SITBs, and discrimination history.RESULTSFew differences in SITB disclosure patterns emerged between SM and GM youth and heterosexual and cisgender youth (P > .05). SM and GM youth endorsed greater rates of fear of disclosure to and worrying parents, two parent-related barriers ( = 8.11, P = .017; = 7.25, P = .027). GM youth reported greater discrimination experiences than SM youth (F = 6.17, P = .002); discrimination experiences impacted their willingness to disclose future SITBs more so than their SM and heterosexual and cisgender peers (F = 11.58, P
      Keywords: Adolescent Health/Medicine, Psychiatry/Psychology
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-050255
      Issue No: Vol. 148, No. 4 (2021)
       
  • Opioid Use Disorder and Perinatal Outcomes

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      Authors: Piske, M; Homayra, F, Min, J. E, Zhou, H, Marchand, C, Mead, A, Ng, J, Woolner, M, Nosyk, B.
      Abstract: OBJECTIVESEvidence on the perinatal health of mother-infant dyads affected by opioids is limited. Elevated risks of opioid-related harms for people with opioid use disorder (OUD) increase the urgency to identify protective factors for mothers and infants. Our objectives were to determine perinatal outcomes after an OUD diagnosis and associations between opioid agonist treatment and birth outcomes.METHODSWe conducted a population-based retrospective study among all women with diagnosed OUD before delivery and within the puerperium period in British Columbia, Canada, between 2000 and 2019 from provincial health administrative data. Controlling for demographic and clinical characteristics, we determined associations of opioid agonist treatment on birth weight, gestational age, infant disorders related to gestational age and birth weight, and neonatal abstinence syndrome via logistic regression.RESULTSThe population included 4574 women and 6720 live births. Incidence of perinatal OUD increased from 166 in 2000 to 513 in 2019. Compared with discontinuing opioid agonist treatment during pregnancy, continuous opioid agonist treatment reduced odds of preterm birth (adjusted odds ratio: 0.6; 95% confidence interval: 0.4–0.8) and low birth weight (adjusted odds ratio: 0.4; 95% confidence interval: 0.2–0.7). Treatment with buprenorphine-naloxone (compared with methadone) reduced odds of each outcome including neonatal abstinence syndrome (adjusted odds ratio: 0.6; 95% confidence interval: 0.4–0.9).CONCLUSIONSPerinatal OUD in British Columbia tripled in incidence over a 20-year period. Sustained opioid agonist treatment during pregnancy reduced the risk of adverse birth outcomes, highlighting the need for expanded services, including opioid agonist treatment to support mothers and infants.
      Keywords: Maternal and Fetal Medicine, Addiction, Public Health
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-050279
      Issue No: Vol. 148, No. 4 (2021)
       
  • Metronidazole-Induced Hepatitis in a Teenager With Xeroderma Pigmentosum
           and Trichothiodystrophy Overlap

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      Authors: Abiona, A; Cordeiro, N, Fawcett, H, Tamura, D, Khan, S. G, DiGiovanna, J. J, Lehmann, A. R, Fassihi, H.
      Abstract: A teenage girl had the rare combined phenotype of xeroderma pigmentosum and trichothiodystrophy, resulting from mutations in the XPD (ERCC2) gene involved in nucleotide excision repair (NER). After treatment with antibiotics, including metronidazole for recurrent infections, she showed signs of acute and severe hepatotoxicity, which gradually resolved after withdrawal of the treatment. Cultured skin fibroblasts from the patient revealed cellular sensitivity to killing by metronidazole compared with cells from a range of other donors. This reveals that the metronidazole sensitivity was an intrinsic property of her cells. It is well recognized that patients with Cockayne syndrome, another NER disorder, are at high risk of metronidazole-induced hepatotoxicity, but this had not been reported in individuals with other NER disorders. We would urge extreme caution in the use of metronidazole in the management of individuals with the xeroderma pigmentosum and trichothiodystrophy overlap or trichothiodystrophy phenotypes.
      Keywords: Dermatology, Hepatology, Genetics
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-050360
      Issue No: Vol. 148, No. 4 (2021)
       
  • Burnout and Perceptions of Stigma and Help-Seeking Behavior Among
           Pediatric Fellows

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      Authors: Weiss, A. K; Quinn, S. M, Danley, A. L, Wiens, K. J, Mehta, J. J.
      Abstract: BACKGROUND AND OBJECTIVESAlthough burnout has been studied extensively among students and residents, in few studies have researchers examined burnout among fellowship trainees. We measured burnout among fellows in our freestanding children’s hospital and evaluated fellows' perceptions of stigma around (and willingness to seek treatment for) psychological distress. The objectives are as follows: to (1) measure burnout among pediatric fellows, (2) assess fellows' perceptions of stigma around help seeking for mental illness, and (3) examine the relationship between burnout and willingness to seek behavioral health counseling.METHODSWe distributed a 48-item inventory to all 288 fellows in our pediatric center. Items included the Maslach Burnout Inventory and Likert-type matrices to assess attitudes toward behavioral health treatment and associated stigma. We used 2-sampled t-tests to associate burnout with willingness to seek mental health treatment.RESULTSA total of 152 fellows (52%) responded, of whom 53% met the threshold for burnout. Most reported believing that their program directors (78%), attending physicians (72%), and patients (82%) hold negative attitudes about mental illness and its treatment; 68% believed that employers would reject their application if they knew they sought counseling. Fellows with burnout were more likely to believe that others in the clinical learning environment hold negative views of help seeking for behavioral health (odds ratio 1.2–1.9).CONCLUSIONSJust over one-half of the pediatric fellows in our center meet the threshold for burnout. They also experience significant workplace-based stigma around help seeking for psychological distress. Fellows with burnout are more likely than their peers to perceive significant stigma around help seeking for their distress, making them a particularly at-risk learner population.
      Keywords: Medical Education, Workforce, Professionalism
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-050393
      Issue No: Vol. 148, No. 4 (2021)
       
  • Comparative Effectiveness of Clinical and Community-Based Approaches to
           Healthy Weight

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      Authors: Fiechtner, L; Perkins, M, Biggs, V, Langhans, N, Sharifi, M, Price, S, Luo, M, Locascio, J. J, Hohman, K. H, Hodge, H, Gortmaker, S, Torres, S, Taveras, E. M.
      Abstract: OBJECTIVESThe objective was to evaluate if 2 pediatric weight management interventions delivered to Hispanic, low-income children (one in a health center the other in a Young Men’s Christian Association) were effective in reducing BMI. We hypothesized that they would be equally effective.METHODSA total 407 children aged 6 to 12 years with BMI ≥ 85th percentile receiving care at 2 health centers were randomly assigned to a healthy weight clinic (HWC) at the health center or to a modified Healthy Weight and Your Child (M-HWYC) intervention delivered in Young Men’s Christian Associations. A total of 4037 children served as the comparison group. We completed a noninferiority test comparing the M-HWYC with the HWC, which was supported if the bounds of the 90% confidence interval (CI) for the difference in percentage of the 95th percentile (%BMIp95) change did not contain what we considered a minimally clinically important difference, on the basis of previous data (0.87). Then, using linear mixed models, we assessed yearly changes in BMI among intervention participants compared with the comparison sites.RESULTSThe mean difference in %BMIp95 between the M-HWYC and the HWC was 0.75 (90% CI: 0.07 to 1.43), which did not support noninferiority. Compared with the comparison sites, per year, children in the HWC had a –0.23 (95% CI: –0.36 to –0.10) decrease in BMI and a –1.03 (95% CI –1.61 to –0.45) %BMIp95 decrease. There was no BMI effect in the M-HWYC.CONCLUSIONSWe were unable to establish noninferiority of the M-HWYC. The HWC improved BMI, offering an effective treatment of those disproportionately affected.
      Keywords: Community Pediatrics, Obesity
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-050405
      Issue No: Vol. 148, No. 4 (2021)
       
  • Neonatal Stress, Health, and Development in Preterms: A Systematic Review

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      Authors: van Dokkum, N. H; de Kroon, M. L. A, Reijneveld, S. A, Bos, A. F.
      Abstract: CONTEXTAn overview of the full range of neonatal stressors and the associated clinical, laboratory, and imaging outcomes regarding infants’ health and development may contribute to the improvement of neonatal care.OBJECTIVETo systematically review existing literature on the associations between all kinds of neonatal stressors and the health and development of preterm infants.DATA SOURCESData sources included Embase, Medline, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and reference lists.STUDY SELECTIONStudies were eligible if they included a measure of neonatal stress during the NICU stay, reported clinical, laboratory, and/or imaging outcomes regarding health and/or development on discharge from the NICU or thereafter, included preterm infants, and were written in English or Dutch.DATA EXTRACTIONTwo reviewers independently screened the sources and extracted data on health and development. Study quality was assessed by using the Newcastle-Ottawa Quality Assessment Scale.RESULTSWe identified 20 articles that reported on neonatal stress associated negatively with clinical outcomes, including cognitive, motor, and emotional development, and laboratory and imaging outcomes, including epigenetic alterations, hypothalamic-pituitary-adrenal axis functioning, and structural brain development. We found no evidence regarding associations with growth, cardiovascular health, parent-infant interaction, the neonatal immune system, and the neonatal microbiome.LIMITATIONSThe studies were all observational and used different definitions of neonatal stress.CONCLUSIONSNeonatal stress has a profound impact on the health and development of preterm infants, and physicians involved in their treatment and follow-up should be aware of this fact.
      Keywords: Developmental/Behavioral Pediatrics, Neonatology, Epigenetics
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-050414
      Issue No: Vol. 148, No. 4 (2021)
       
  • Influenza Antiviral Treatment and Length of Stay

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      Authors: Campbell, A. P; Tokars, J. I, Reynolds, S, Garg, S, Kirley, P. D, Miller, L, Yousey-Hindes, K, Anderson, E. J, Oni, O, Monroe, M, Kim, S, Lynfield, R, Smelser, C, Muse, A. T, Felsen, C, Billing, L. M, Thomas, A, Mermel, E, Lindegren, M. L, Schaffner, W, Price, A, Fry, A. M.
      Abstract: BACKGROUNDAntiviral treatment is recommended for hospitalized patients with suspected and confirmed influenza, but evidence is limited among children. We evaluated the effect of antiviral treatment on hospital length of stay (LOS) among children hospitalized with influenza.METHODSWe included children
      Keywords: Infectious Disease, Influenza
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-050417
      Issue No: Vol. 148, No. 4 (2021)
       
  • Sharing Stories Through Art: Promoting Resident Connection During and
           After the COVID-19 Pandemic

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      Authors: Korus, R. E; Rabinowitz, D. G.
      Keywords: Career Development, Workforce
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-050636
      Issue No: Vol. 148, No. 4 (2021)
       
  • Concurrent Use of E-cigarettes, Combustible Cigarettes, and Marijuana

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      Authors: Wills, T. A; Leventhal, A. M, Sargent, J. D, Pagano, I.
      Abstract: OBJECTIVESubgroups of adolescent single and dual e-cigarette and cigarette users have been identified, but usage patterns have changed in recent years, and there has been an increase in marijuana use. Research is needed with current data to identify subgroups of use including marijuana and determine their behavioral correlates.METHODSWe cross classified ever and recent use of e-cigarettes, combustible cigarettes, and marijuana among US high school students in the 2019 Youth Risk Behavior Survey (YRBS), providing 8 different groups. Levels of 14 risk and protective factors were compared across groups in general linear models with demographic covariates using omnibus tests, pairwise comparisons, and planned contrasts. Replicability was tested through identical analyses for 2017 YRBS data.RESULTSThe nonuser group was 43.9% of the sample. The most frequent user groups were triple users (ever-use proportion: 16.9%), dual (e-cigarette and marijuana) users (15.8%), and exclusive e-cigarette users (13.2%). For risk profiles on levels of psychosocial variables, the triple-user group was typically elevated above all other groups. Exclusive e-cigarette users were above nonusers in risk profile but below dual users (both cigarettes and marijuana). Results were similar for ever use and recent use. The patterning of results in 2019 YRBS data were closely replicated in 2017 YRBS data.CONCLUSIONSCo-occurrence of e-cigarette, cigarette, and marijuana use is currently substantial among adolescents and is associated with an elevated psychosocial risk profile. This has implications for both epidemiology and prevention studies. Further research is needed to study prevalence and identify pathways to triple use.
      Keywords: Adolescent Health/Medicine, Epidemiology
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-050749
      Issue No: Vol. 148, No. 4 (2021)
       
  • High-Intensity Interval Training and Cardiometabolic Risk Factors in
           Children: A Meta-analysis

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      Authors: Solera-Martinez, M; Herraiz-Adillo, A, Manzanares-Dominguez, I, De La Cruz, L. L, Martinez-Vizcaino, V, Pozuelo-Carrascosa, D. P.
      Abstract: CONTEXTHigh-intensity interval training (HIIT) has been widely used to prevent and treat cardiovascular risk factors in adolescents and adults; nevertheless, the available evidence in children is scarce.OBJECTIVETo synthesize evidence regarding the effectiveness of HIIT interventions on improving cardiovascular risk factors and cardiorespiratory fitness (CRF) in children from 5 to 12 years old.DATA SOURCESWe searched 5 databases, Medline, Embase, SPORTDiscus, the Cochrane Library, and Web of Science.STUDY SELECTIONRandomized controlled trials (RCTs) evaluating the effectiveness of HIIT interventions on cardiometabolic risk factors and CRF in children were included.DATA EXTRACTIONMeta-analyses were conducted to determine the effect of HIIT on body composition, cardiometabolic and CRF variables in comparison with nontraining control groups.RESULTSA total of 11 RCTs and 512 participants were included. The results of the meta-analysis revealed a significant improvement in peak oxygen uptake (standardized mean difference [SMD] = 0.70, 95% confidence interval [CI] = 0.28 to 1.12; P = 0.001], in total cholesterol [SMD = –1.09, 95% CI = –1.88 to –0.30; P = 0.007], in low-density lipoprotein cholesterol [SMD = –1.28, 95% CI = –2.34 to –0.23; P = 0.017] and triglycerides [SMD = –0.71, 95% CI = –1.15 to –0.28; P = 0.001) levels.LIMITATIONSBecause of the small number of available RCTs, it was not possible to conduct a subgroup analysis or a linear meta-regression analysis.CONCLUSIONSHIIT is a feasible and time-efficient approach for improving CRF, total cholesterol, low-density lipoprotein cholesterol, and triglycerides levels in children.
      Keywords: Sports Medicine/Physical Fitness, Public Health
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-050810
      Issue No: Vol. 148, No. 4 (2021)
       
  • Cognitive and Executive Function in Congenital Heart Disease: A
           Meta-analysis

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      Authors: Feldmann, M; Bataillard, C, Ehrler, M, Ullrich, C, Knirsch, W, Gosteli-Peter, M. A, Held, U, Latal, B.
      Abstract: CONTEXTCognitive function and executive function (EF) impairments contribute to the long-term burden of congenital heart disease (CHD). However, the degree and profile of impairments are insufficiently described.OBJECTIVETo systematically review and meta-analyze the evidence on cognitive function and EF outcomes in school-aged children operated for CHD and identify the risk factors for an unfavorable outcome.DATA SOURCESCochrane, Embase, Medline, and PsycINFO.STUDY SELECTIONOriginal peer-reviewed studies reporting cognitive or EF outcome in 5- to 17-year old children with CHD after cardiopulmonary bypass surgery.DATA EXTRACTIONResults of IQ and EF assessments were extracted, and estimates were transformed to means and SE. Standardized mean differences were calculated for comparison with healthy controls.RESULTSAmong 74 studies (3645 children with CHD) reporting total IQ, the summary estimate was 96.03 (95% confidence interval: 94.91 to 97.14). Hypoplastic left heart syndrome and univentricular CHD cohorts performed significantly worse than atrial and ventricular septum defect cohorts (P = .0003; P = .027). An older age at assessment was associated with lower IQ scores in cohorts with transposition of the great arteries (P = .014). Among 13 studies (774 children with CHD) reporting EF compared with controls, the standardized mean difference was –0.56 (95% confidence interval: –0.65 to –0.46) with no predilection for a specific EF domain or age effect.LIMITATIONSHeterogeneity between studies was large.CONCLUSIONSIntellectual impairments in CHD are frequent, with severity and trajectory depending on the CHD subtype. EF performance is poorer in children with CHD without a specific EF profile. The heterogeneity in studied populations and applied assessments is large. A uniform testing guideline is urgently needed.
      Keywords: Developmental/Behavioral Pediatrics, Cognition/Language/Learning Disorders, Cardiology
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-050875
      Issue No: Vol. 148, No. 4 (2021)
       
  • Six Month Follow-up of Patients With Multi-System Inflammatory Syndrome in
           Children

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      Authors: Capone, C. A; Misra, N, Ganigara, M, Epstein, S, Rajan, S, Acharya, S. S, Hayes, D. A, Kearney, M. B, Romano, A, Friedman, R. A, Blaufox, A. D, Cooper, R, Schleien, C, Mitchell, E.
      Abstract: BACKGROUND AND OBJECTIVESMyocardial dysfunction and coronary abnormalities are prominent features of multisystem inflammatory syndrome in children (MIS-C). In this study we aim to evaluate the early and midterm outcomes of MIS-C.METHODSThis is a longitudinal 6-month cohort study of all children admitted and treated for MIS-C from April 17 to June 20, 2020. Patients were followed ~2 weeks, 8 weeks, and 6 months postadmission, with those with coronary aneurysms evaluated more frequently.RESULTSAcutely, 31 (62%) patients required intensive care with vasoactive support, 26 (52%) had left ventricular (LV) systolic dysfunction, 16 (32%) had LV diastolic dysfunction, 8 (16%) had coronary aneurysms (z score ≥2.5), and 4 (8%) had coronary dilation (z score
      Keywords: Cardiovascular Disorders
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-050973
      Issue No: Vol. 148, No. 4 (2021)
       
  • Should a Healthcare System Facilitate Racially Concordant Care for Black
           Patients'

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      Authors: Taylor, L. A; Udeagbala, O, Biggs, A, Lekas, H.-M, Ray, K.
      Abstract: Addressing racial disparities in health outcomes is an urgent priority for many health care organizations, leading health care managers to explore the potential for organization-level interventions to yield substantive health gains. In recent literature, it is suggested that Black patients who are treated by Black physicians may achieve superior health outcomes in some settings. In this case discussion, we consider a case in which a medical director considers implementing a voluntary program to promote racially concordant care for Black patients. Commentators consider the precedent for such a program, both in current informal care networks and 20th century medical history, as well as the burden such a program may place on Black physicians and the risks of reducing patients’ intersectional identities to be solely about race. A subset of commentators suggest that these risks are mitigated by the voluntary nature of the program, whereas others offer caution about relying solely on Black physicians to remedy health disparities. Others view multiple paths as morally defensible but emphasize the need for managers to take proactive steps to communicate and evaluate their choices in the face of such a complex social challenge.
      Keywords: Administration/Practice Management, Ethics/Bioethics
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-051113
      Issue No: Vol. 148, No. 4 (2021)
       
  • Bone Health Among Transgender Youth: What Is a Clinician to Do'

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      Authors: Bachrach, L. K; Gordon, C. M.
      Keywords: Orthopaedic Medicine, LGBTQ+
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-051137
      Issue No: Vol. 148, No. 4 (2021)
       
  • Six Stages of Engagement in ADHD Treatment Described by Diverse, Urban
           Parents

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      Authors: Spencer, A. E; Sikov, J, Loubeau, J. K, Zolli, N, Baul, T, Rabin, M, Hasan, S, Rosen, K, Buonocore, O, Lejeune, J, Dayal, R, Fortuna, L, Borba, C, Silverstein, M.
      Abstract: BACKGROUNDAttention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition in children. Although ADHD is treatable, barriers remain to engagement in treatment, especially among socioeconomically disadvantaged and racial and ethnic minority families. Our goal was to examine the process by which families engage in ADHD treatment and to identify targets for an intervention to improve engagement in care.METHODSWe conducted in-depth semistructured qualitative interviews with 41 parents of diverse youth aged 3 to 17 years old in treatment of ADHD at an urban safety net hospital. Parents were asked about their journey through diagnosis and treatment, community attitudes about ADHD, and other factors influencing treatment access and decision-making. Transcripts were analyzed by using thematic analysis.RESULTSOf children with ADHD, 69.2% were male, 57.7% were Black or African American, and 38.5% were of Hispanic, Latino, or Spanish origin. Parents were 92.7% female, were 75.6% English speaking, and had a median income of $20 000. Parents described 6 stages to the process of engaging in care for their child’s ADHD, which unfolded like a developmental process: (1) normalization and hesitation, (2) fear and stigmatization, (3) action and advocacy, (4) communication and navigation, (5) care and validation, and (6) preparation and transition. Barriers often occurred at points of stage mismatch between parents and providers and/or systems. Difficulty resolving an earlier stage interfered with the progression through subsequent stages.CONCLUSIONSThe 6 stages framework could be used to develop new strategies to measure engagement and to design family-centered interventions to facilitate engagement in ADHD treatment.
      Keywords: Attention-Deficit/Hyperactivity Disorder (ADHD)
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-051261
      Issue No: Vol. 148, No. 4 (2021)
       
  • Economic Trends of Racial Disparities in Pediatric Postappendectomy
           Complications

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      Authors: Mpody, C; Willer, B, Owusu-Bediako, E, Kemper, A. R, Tobias, J. D, Nafiu, O. O.
      Abstract: BACKGROUNDDespite unparalleled advances in perioperative medicine, surgical outcomes remain poor for racial minority patients relative to their white counterparts. Little is known about the excess costs to the health care system related to these disparities.METHODSWe performed a retrospective analysis of data from the Nationwide Inpatient Sample between 2001 and 2018. We included children younger than 18 years admitted with appendicitis who underwent an appendectomy during their hospital stay. We examined the inflation-adjusted hospital costs attributable to the racial disparities in surgical complications and perforation status, focusing on differences between non-Hispanic white patients and non-Hispanic Black patients.RESULTSWe included 100 639 children who underwent appendectomy, of whom 89.9% were non-Hispanic white and 10.1% were non-Hispanic Black. Irrespective of perforation status at presentation, surgical complications were consistently higher for Black compared with white children, with no evidence of narrowing of the racial disparity gap over time. Black children consistently incurred higher hospital costs (median difference: $629 [95% confidence interval: $500–$758; P < .01). The total inflation-adjusted hospital costs for Black children were $518 658 984, and $59 372 044 (11.41%) represented the excess because of the racial disparities in perforation rates.CONCLUSIONSAlthough all patients had a progressive decline in post appendectomy complications, Black children consistently had higher rates of complications and perforation, imposing a significant economic burden. We provide an empirical economic argument for sustained efforts to reduce racial disparities in pediatric surgical outcomes, notwithstanding that eliminating these disparities is simply the right thing to do.
      Keywords: Surgery
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-051328
      Issue No: Vol. 148, No. 4 (2021)
       
  • IgA Nephropathy as the Initial Presentation of Celiac Disease in an
           Adolescent

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      Authors: Slavin S. F.
      Abstract: Immunoglobulin A (IgA) nephropathy (Berger’s disease) is the most common glomerulonephritis worldwide. The disease typically is chronic and lifelong and eventually progresses to impaired renal function in a substantial proportion of cases. It has been known for some time that there is a correlation between IgA nephropathy and celiac disease, but until now it has remained unclear whether treatment of the underlying celiac disease has any meaningful impact on the progression of the renal disease. Therefore, until now, screening for celiac disease in patients presenting with IgA nephropathy has not been universally recommended in the absence of suggestive gastrointestinal symptoms. This report describes a case of IgA nephropathy in an adolescent boy that turned out to be the initial presentation of celiac disease. More importantly, it documents the complete laboratory normalization of his renal anomalies at 5-year follow-up after treatment of his celiac disease with implementation of a gluten-free diet. This case highlights the importance of awareness that suspected IgA nephropathy, even in the absence of gastrointestinal symptoms, should prompt screening for underlying celiac disease as a potential, and possibly treatable, cause.
      Keywords: Gastroenterology, Nephrology
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-051332
      Issue No: Vol. 148, No. 4 (2021)
       
  • Patient, Provider, and Health Care System Characteristics Associated With
           Overuse in Bronchiolitis

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      Authors: Wolf, E. R; Richards, A, Lavallee, M, Sabo, R. T, Schroeder, A. R, Schefft, M, Krist, A. H.
      Abstract: BACKGROUND AND OBJECTIVESThe American Academy of Pediatrics recommends against the routine use of β-agonists, corticosteroids, antibiotics, chest radiographs, and viral testing in bronchiolitis, but use of these modalities continues. Our objective for this study was to determine the patient, provider, and health care system characteristics that are associated with receipt of low-value services.METHODSUsing the Virginia All-Payers Claims Database, we conducted a retrospective cross-sectional study of children aged 0 to 23 months with bronchiolitis (code J21, International Classification of Diseases, 10th Revision) in 2018. We recorded medications within 3 days and chest radiography or viral testing within 1 day of diagnosis. Using Poisson regression, we identified characteristics associated with each type of overuse.RESULTSFifty-six percent of children with bronchiolitis received ≥1 form of overuse, including 9% corticosteroids, 17% antibiotics, 20% β-agonists, 26% respiratory syncytial virus testing, and 18% chest radiographs. Commercially insured children were more likely than publicly insured children to receive a low-value service (adjusted prevalence ratio [aPR] 1.21; 95% confidence interval [CI]: 1.15–1.30; P < .0001). Children in emergency settings were more likely to receive a low-value service (aPR 1.24; 95% CI: 1.15–1.33; P < .0001) compared with children in inpatient settings. Children seen in rural locations were more likely than children seen in cities to receive a low-value service (aPR 1.19; 95% CI: 1.11–1.29; P < .0001).CONCLUSIONSOveruse in bronchiolitis remains common and occurs frequently in emergency and outpatient settings and rural locations. Quality improvement initiatives aimed at reducing overuse should include these clinical environments.
      Keywords: Quality Improvement, Hospital Medicine, Bronchiolitis
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-051345
      Issue No: Vol. 148, No. 4 (2021)
       
  • When Fentanyl Finds an Outlier: Talking With Teenagers About the Danger

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      Authors: Cook-Sather, S. D; Urban, E, Romano, V. A, Romano, M. A.
      Keywords: Pharmacology, Substance Use, Anesthesiology/Pain Medicine
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-051368
      Issue No: Vol. 148, No. 4 (2021)
       
  • Educational Priorities for Providing End-of-Life Care: Parent Perspectives

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      Authors: Arora, G; Caliboso, M, Baird, J, Rusch, R, Greenman, J, Obregon, D, Serwint, J. R.
      Abstract: OBJECTIVESPartnership with parents is a tenet of pediatric medicine; however, initiatives to include parents in education and research have been limited. Through focus groups, we included parents at the beginning of curriculum development by asking them to identify the priorities, existing supports, and opportunities for improvement in their child’s end-of-life (EOL) care.METHODSEnglish and Spanish-speaking bereaved parents whose child had been cared for by the palliative care team and had died >18 months before the study initiation were invited to participate. In-person focus groups and a follow-up phone call were used to elicit opinions and capture a diversity of viewpoints. Themes were identified and clustered through an iterative analytic process.RESULTSTwenty-seven parents of 17 children participated, with the total sample size determined by thematic saturation. Four themes were identified as important to parents in their child’s EOL care: (1) honoring the role of the parent, (2) having confidence in the care team, (3) receiving gestures of love and caring, and (4) navigating logistic challenges.CONCLUSIONSWe asked parents to be partners in guiding priorities for health care education and professional development to improve pediatric EOL care. In addition to strengthening skills in communication, confidence in the team, and compassion, parents in this study identified a need for hospital staff to anticipate financial and social stressors and provide supportive resources more readily. Additionally, parents described clinical and nonclinical staff as providing support, suggesting that a multidisciplinary and interdisciplinary curriculum be developed to improve pediatric EOL care.
      Keywords: Medical Education, Interpersonal & Communication Skills, Hospice/Palliative Medicine
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-051379
      Issue No: Vol. 148, No. 4 (2021)
       
  • Teaching Basic Life Support to 5- to 8-Year-Old Children: A Cluster
           Randomized Trial

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      Authors: Varela-Casal, C; Abelairas-Gomez, C, Otero-Agra, M, Barcala-Furelos, R, Rodriguez-Nunez, A, Greif, R.
      Abstract: OBJECTIVEWe aimed to compare traditional basic life support (BLS) education with specific and innovative educative didactic material that has been previously designed and validated.METHODSFifteen classes of schoolchildren aged 5 to 8 years (n = 237) were randomly assigned to 4 groups in which different didactic and complementary materials were used: (1) the Rescube tool with a cuddly toy (n = 61), (2) the Endless Book tool with a cuddly toy (n = 74), (3) traditional teaching with a cuddly toy (n = 46), and (4) traditional teaching with a manikin (n = 55). The BLS sequence was assessed at baseline (T0). After that, children took part in a one-hour theory and practice session in their assigned training modality. BLS sequence was assessed again within one week (T1) and after one month (T2).RESULTSThe 4 modalities were successful in improving children’s skills when comparing T0 with both T1 and T2 (P < .05). At T2, more schoolchildren remembered the complete BLS sequence after using the Rescube (75%) compared with the number of schoolchildren who remember the complete BLS sequence after using the Endless Book (53%), a manikin (42%), or a cuddly toy (13%) (P < .05). A higher proportion of participants who used the Rescube correctly performed all the BLS steps analyzed compared with those who used only the manikin or a cuddly toy during the learning phase. The Endless Book was also more effective except for learning to check consciousness and breathing.CONCLUSIONBetter BLS learning and knowledge retention outcomes were achieved by using our specific and adapted didactic materials (Rescube and Endless Book). These new educational tools have the potential to substantially support BLS school education programs.
      Keywords: Medical Education, Teaching/Curriculum Development, School Health
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-051408
      Issue No: Vol. 148, No. 4 (2021)
       
  • Unintended but Hardly Unexpected Consequences of Cannabis Legalization

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      Authors: Ryan S. A.
      Keywords: Substance Use
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-051426
      Issue No: Vol. 148, No. 4 (2021)
       
  • Effective Screening and Treatment to Reduce Suicide Risk Among Sexual and
           Gender Minority Youth

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      Authors: Murray, P. J; Thoma, B. C.
      Keywords: LGBTQ+
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-051831
      Issue No: Vol. 148, No. 4 (2021)
       
  • Collaborating to Advocate in Primary Care for Children During COVID-19

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      Authors: Harrison, E; Garbutt, J, Sterkel, R, Dodd, S, Wang, R, Newland, J, Plax, K, ST LOUIS REGIONAL PEDIATRIC COVID-19 LEARNING COLLABORATIVE
      Abstract: The St Louis Regional Pediatric Learning Collaborative of pediatric primary care providers and infectious diseases specialists formed in March 2020 to address the needs of children and families during the coronavirus disease 2019 (COVID-19) pandemic. More than 400 pediatric primary care providers participated, using a listserv to discuss care and organize webinars to provide updates on local and national data and plan next steps. To inform local decision-making about care and testing for severe acute respiratory syndrome coronavirus 2, 95 providers from 26 practices partnered with the local practice-based research network to rapidly collect and share data about children with COVID-19–like symptoms. Of 2162 children tested for severe acute respiratory syndrome coronavirus 2, 9% had positive test results. Test result positivity was 33% if a patient was exposed to a confirmed case of COVID-19 and 4% if they had COVID-19–like symptoms and no exposure. School or day care attendance was associated with lower rates of positive test results. Although not originally planned, these findings drove local advocacy efforts by the Collaborative for increased access to testing and contact tracing and safe in-person school. Members communicated directly and collectively with local politicians, provided advice and resources for school boards and superintendent groups, and appeared on various media platforms. In these efforts, they shared local data, highlighting the lower rate of positive test results for children in school to support the idea that schools could be safely open. Outreach from trusted pediatricians sharing prospective, timely, local data sustained in-person school for some districts and aided in future in-person openings for other school districts.
      Keywords: Community Pediatrics, Infectious Disease, Advocacy
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-052106
      Issue No: Vol. 148, No. 4 (2021)
       
  • Medical Admissions Among Adolescents With Eating Disorders During the
           COVID-19 Pandemic

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      Authors: Otto, A. K; Jary, J. M, Sturza, J, Miller, C. A, Prohaska, N, Bravender, T, Van Huysse, J.
      Abstract: BACKGROUND AND OBJECTIVESEmerging data suggest the coronavirus disease 2019 (COVID-19) pandemic has been associated with worsening symptoms of eating disorders (EDs) among both adults and adolescents. With this study, we sought to determine if medical admission patterns among adolescents admitted to our institution for restrictive EDs changed during the pandemic, relative to prepandemic counts of admissions per month.METHODSWe performed a chart review of patients aged 10 to 23 years admitted to our children’s hospital for restrictive EDs from March 2017 through March 2021 and completed an interrupted time series analysis of admission counts per month. Demographic variables for admitted patients were compared by using 2, Fisher's exact, and 2-sample t tests.RESULTSED-related medical admissions at our institution increased significantly during the COVID-19 pandemic. The total number of admissions during the first 12 months of the COVID-19 pandemic (April 1, 2020, through March 31, 2021, n = 125) was more than double the mean number of admissions per year for the same time frame (April 1 through March 31) for the previous 3 years (mean = 56). Patient demographics were similar before and during the pandemic, with the exception that patients admitted during the COVID-19 pandemic were less likely than those admitted before the pandemic to have public insurance.CONCLUSIONSMedical admissions related to restrictive EDs among adolescents increased significantly during the COVID-19 pandemic. Pediatric providers in a variety of settings should be prepared to care for adolescents with restrictive EDs during the pandemic.
      Keywords: Eating Disorders
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-052201
      Issue No: Vol. 148, No. 4 (2021)
       
  • Raising the Bar for Evaluating Effectiveness of Early Childhood
           Interventions

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      Authors: Shonkoff, J. P; McCoy, D. C.
      Keywords: Research Methods & Statistics, Medical Home, Developmental/Behavioral Pediatrics
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-052326
      Issue No: Vol. 148, No. 4 (2021)
       
  • Parents Intentions and Perceptions About COVID-19 Vaccination for Their
           Children: Results From a National Survey

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      Authors: Szilagyi, P. G; Shah, M. D, Delgado, J. R, Thomas, K, Vizueta, N, Cui, Y, Vangala, S, Shetgiri, R, Kapteyn, A.
      Abstract: OBJECTIVESAssess the degree to which US parents are likely to have their children get coronavirus disease 2019 (COVID-19) vaccines and identify parental concerns about the vaccines.METHODSIn February 2021 to March 2021, we surveyed parent members of a nationally representative probability-based Internet panel of ~9000 adults regarding their intent to have their children receive a COVID-19 vaccination, perceptions of COVID-19 vaccines for children, and trust in sources of information about COVID-19 vaccines for children. We used descriptive and multivariate analyses to evaluate parent-stated likelihood of having their children get a COVID-19 vaccine and to assess the association between likelihood of child COVID-19 vaccination and child age, parent demographics, and parental perceptions about COVID-19 vaccines.RESULTSAltogether, 1745 parents responded (87% of eligible parents, 3759 children). Likelihood of child COVID-19 vaccination was as follows: very likely (28%), somewhat likely (18%), somewhat unlikely (9%), very unlikely (33%), and unsure (12%). The stated likelihood of child vaccination was greater among parents of older children (P < .001) as well as among parents who had a bachelor’s degree or higher education (P < .001), had already received or were likely to receive a COVID-19 vaccine (P < .001), or had Democratic affiliation (P < .001); variations existed by race and ethnicity (P = .04). Parental concerns centered around vaccine safety and side effects. A key trusted source of information about COVID-19 vaccines for children was the child’s doctor.CONCLUSIONSLess than one-half of US participants report that they are likely to have their child receive a COVID-19 vaccine. Pediatric health care providers have a major role in promoting and giving COVID-19 vaccination for children.
      Keywords: Infectious Disease, Vaccine/Immunization, Public Health
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-052335
      Issue No: Vol. 148, No. 4 (2021)
       
  • Early-Onset Sepsis Among Very Preterm Infants

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      Authors: Flannery, D. D; Edwards, E. M, Puopolo, K. M, Horbar, J. D.
      Abstract: OBJECTIVESTo determine the epidemiology and microbiology of early-onset sepsis (EOS) among very preterm infants using a nationally representative cohort from academic and community hospitals to inform empirical antibiotic guidance, highlight risk factors for infection, and aid in prognostication for infected infants.METHODSProspective observational study of very preterm infants born weighing 401 to 1500 g or at 22 to 29 weeks’ gestational age from January 2018 to December 2019 in 753 Vermont Oxford Network centers. EOS was defined as a culture-confirmed bacterial infection of the blood or cerebrospinal fluid in the 3 days after birth. Demographics, clinical characteristics, and outcomes were compared between infants with and without EOS.RESULTSOf 84 333 included infants, 1139 had EOS for an incidence rate of 13.5 per 1000 very preterm births (99% confidence interval [CI] 12.5–14.6). Escherichia coli (538 of 1158; 46.5%) and group B Streptococcus (218 of 1158; 18.8%) were the most common pathogens. Infected infants had longer lengths of stay (median 92 vs 66 days) and lower rates of survival (67.5% vs 90.4%; adjusted risk ratio 0.82 [95% CI 0.79–0.85]) and of survival without morbidity (26.1% vs 59.4%; adjusted risk ratio 0.66 [95% CI 0.60–0.72]).CONCLUSIONSIn a nationally representative sample of very preterm infants with EOS from 2018 to 2019, approximately one-third of isolates were neither group B Streptococcus nor E coli. Three-quarters of all infected infants either died or survived with a major medical morbidity. The profoundly negative impact of EOS on very preterm infants highlights the need for novel preventive strategies.
      Keywords: Neonatology, Infectious Disease, Epidemiology
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-052456
      Issue No: Vol. 148, No. 4 (2021)
       
  • Screening for Anxiety in Pediatric Primary Care: A Systematic Review

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      Authors: Kemper, A. R; Letostak, T. B, Hostutler, C. A, Stephenson, K. G, Butter, E. M.
      Abstract: CONTEXTAnxiety is common, screening tools are available, and treatment can be effective. Recently, anxiety screening has been recommended for adolescent girls beginning at 13 years of age.OBJECTIVETo evaluate the evidence regarding anxiety screening test accuracy in primary care for children and adolescents and assess the effectiveness of treatment of individuals identified through screening.DATA SOURCESWe searched PubMed, the Cochrane library, and references to potentially eligible studies cited in other articles.STUDY SELECTIONScreening studies were included if they were conducted in primary care or a similar population and employed a reference standard based on DSM criteria. Treatment studies were included if subjects were identified through screening and there was at least 1 comparator intervention or a placebo arm.DATA EXTRACTIONAt least 2 reviewers evaluated each identified reference.RESULTSTwo screening studies (1 with low risk of bias and 1 with high risk of bias) and 1 treatment study with a low risk of bias were included. The screening study with a low risk of bias reported a sensitivity of 56% and specificity of 80%. The treatment study found individual cognitive behavioral therapy to be effective for screen-detected adolescents with social phobia.LIMITATIONSThis review only included screening or treatment studies with clear evidence that the study populations were derived from an unselected population reflective of typical primary care. Relevant studies not indexed in PubMed or the Cochrane library could have been missed.CONCLUSIONSThere are significant gaps in evidence related to anxiety screening in the primary care setting.
      Keywords: Community Pediatrics, Bright Futures, Developmental/Behavioral Pediatrics
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-052633
      Issue No: Vol. 148, No. 4 (2021)
       
  • Community SARS-CoV-2 Surge and Within-School Transmission

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      Authors: Zimmerman, K. O; Brookhart, M. A, Kalu, I. C, Boutzoukas, A. E, McGann, K. A, Smith, M. J, Maradiaga Panayotti, G. M, Armstrong, S. C, Weber, D. J, Moorthy, G. S, Benjamin, D. K, for The ABC Science Collaborative
      Abstract: OBJECTIVESWhen the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic began, experts raised concerns about in-person instruction in the setting of high levels of community transmission. We describe secondary transmission of SARS-CoV-2 within North Carolina kindergarten through 12th-grade school districts during a winter surge to determine if mitigation strategies can hinder within-school transmission.METHODSFrom October 26, 2020, to February 28, 2021, 13 North Carolina school districts participating in The ABC Science Collaborative were open for in-person instruction, adhered to basic mitigation strategies, and tracked community- and school-acquired SARS-CoV-2 cases. Public health officials adjudicated each case. We combined these data with that from August 2020 to evaluate the effect of the SARS-CoV-2 winter surge on infection rates as well as weekly community- and school-acquired cases. We evaluated the number of secondary cases generated by each primary case as well as the role of athletic activities in school-acquired cases.RESULTSMore than 100 000 students and staff from 13 school districts attended school in person; of these, 4969 community-acquired SARS-CoV-2 infections were documented by molecular testing. Through contact tracing, North Carolina local health department staff identified an additional 209 infections among >26 000 school close contacts (secondary attack rate
      Keywords: School Health, Infectious Disease, Public Health
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-052686
      Issue No: Vol. 148, No. 4 (2021)
       
  • National Pediatric Experience With Virtual Interviews: Lessons Learned and
           Future Recommendations

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      Authors: Frohna, J. G; Waggoner-Fountain, L. A, Edwards, J, Fussell, J. J, Wueste, B, Gigante, J, Vinci, R. J, Heitkamp, N. M, Neelakantan, M. K, Degnon, L. E, Blankenburg, R. L, Pediatrics Recruitment Study Team
      Abstract: The coronavirus disease 2019 pandemic significantly impacted undergraduate and graduate medical education and created challenges that prevented a traditional approach to residency and fellowship recruitment and interviews. Early in the pandemic, the pediatric education community came together to support applicants and training programs and to foster an equitable recruitment process. We describe many of our community’s innovations, including the use of virtual cafés to educate programs and highlight best practices for virtual recruitment and the use of regional webinars to highlight residency programs and provide information to applicants. Surveys of applicants and programs suggest that the virtual interview process worked well overall, with applicants and programs saving both time and money and programs maintaining a high rate of filling their positions. On the basis of this experience, we highlight the strengths and weaknesses of 3 potential models for future interview seasons. We close with a series of questions that need further investigation to create an effective and equitable recruitment process for the future.
      Keywords: Medical Education
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-052904
      Issue No: Vol. 148, No. 4 (2021)
       
  • RE: Intrapartum Group B Streptococcal Prophylaxis and Childhood Allergic
           Disorders

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      Authors: Carpay, N. C; Vlieger, A. M, van Elburg, R. M.
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-053008A
      Issue No: Vol. 148, No. 4 (2021)
       
  • Authors Response

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      Authors: Dhudasia, M. B; Spergel, J. M, Mukhopadhyay, S.
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-053008B
      Issue No: Vol. 148, No. 4 (2021)
       
  • Important Considerations for COVID-19 Vaccination of Children With
           Developmental Disabilities

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      Authors: Tinker, S. C; Cogswell, M. E, Peacock, G, Ryerson, A. B.
      Keywords: Developmental/Behavioral Pediatrics, Children With Special Health Care Needs, Vaccine/Immunization
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-053190
      Issue No: Vol. 148, No. 4 (2021)
       
  • Statement of Correction for Chua K-P, Fendrick A. M, Conti R M, et al.
           Out-of-Pocket Spending for Deliveries and Newborn Hospitalizations Among
           the Privately Insured. Pediatrics. 2021;148(1):e2021050552

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      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-053526
      Issue No: Vol. 148, No. 4 (2021)
       
  • Statement of Correction for Kisely S, Strathearn L, Najman JM. Risk
           Factors for Maltreatment in Siblings of Abused Children. Pediatrics.
           2021;147(5):e2020036004

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      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-053566
      Issue No: Vol. 148, No. 4 (2021)
       
  • Social Determinants Do Not Determine Me

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      Authors: Prather H.
      Abstract: The following is the winning submission from the fifth annual Section on Pediatric Trainees Monthly Feature essay competition. For this year’s competition, we asked trainees to reflect on and share how their unique identity, or identities, informs their advocacy work on behalf of children and families. We asked writers to consider how their personal histories and backgrounds, including sex, sexual orientation, race, ethnicity, religion, geographic area, and life experiences improve equity in pediatric health care. We were impressed by the broad variety of important topics addressed in the pieces submitted by trainees from around the country. The winning essay by Dr Haleigh Prather highlights her experiences as a Hispanic woman raised by a single, working-class mother; the obstacles that she faced in her life and how she surmounted them; and how her strength and resilience shaped her approach to health care delivery. In this piece, she underscores how the lessons learned by trainees from challenges in their own lives promote advocacy for the health and welfare of patients.
      Keywords: Community Pediatrics, Public Health
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-053626
      Issue No: Vol. 148, No. 4 (2021)
       
  • Recommendations for Prevention and Control of Influenza in Children,
           2021-2022

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      Authors: COMMITTEE ON INFECTIOUS DISEASES
      Keywords: Infectious Disease, Influenza, Vaccine/Immunization
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-053744
      Issue No: Vol. 148, No. 4 (2021)
       
  • Recommendations for Prevention and Control of Influenza in Children,
           2021-2022

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      Authors: COMMITTEE ON INFECTIOUS DISEASES
      Abstract: This technical report accompanies the recommendations of the American Academy of Pediatrics for the routine use of the influenza vaccine and antiviral medications in the prevention and treatment of influenza in children during the 2021–2022 season. Influenza vaccination is an important intervention to protect vulnerable populations and reduce the burden of respiratory illnesses during circulation of severe acute respiratory syndrome coronavirus 2, which is expected to continue during this influenza season. In this technical report, we summarize recent influenza seasons, morbidity and mortality in children, vaccine effectiveness, vaccination coverage, and detailed guidance on storage, administration, and implementation. We also provide background on inactivated and live attenuated influenza vaccine recommendations, vaccination during pregnancy and breastfeeding, diagnostic testing, and antiviral medications for treatment and chemoprophylaxis.
      Keywords: Infectious Disease, Influenza, Vaccine/Immunization
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-053745
      Issue No: Vol. 148, No. 4 (2021)
       
  • Half Century Since SIDS: A Reappraisal of Terminology

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      Authors: Shapiro-Mendoza; C. K., Palusci, V. J., Hoffman, B., Batra, E., Yester, M., Corey, T. S., Sens, M. A., AAP TASK FORCE ON SUDDEN INFANT DEATH SYNDROME, COUNCIL ON CHILD ABUSE AND NEGLECT, COUNCIL ON INJURY, VIOLENCE, AND POISON PREVENTION, SECTION ON CHILD DEATH REVIEW AND PREVENTION, NATIONAL ASSOCIATION OF MEDICAL EXAMINERS Shapiro-Mendoza, C. K., Palusci, V. J., Hoffman, B., Batra, E., Yester, M., Corey, T. S., Sens, M. A., AAP TASK FORCE ON SUDDEN INFANT DEATH SYNDROME, COUNCIL ON CHILD ABUSE AND NEGLECT, COUNCIL ON INJURY, VIOLENCE, AND POISON PREVENTION, SECTION ON CHILD DEATH REVIEW AND PREVENTION, NATIONAL ASSOCIATION OF MEDICAL EXAMINERS
      Abstract: After a sudden infant death, parents and caregivers need accurate and open communication about why their infant died. Communicating tragic news about a child’s death to families and caregivers is difficult. Shared and consistent terminology is essential for pediatricians, other physicians, and nonphysician clinicians to improve communication with families and among themselves. When families do not have complete information about why their child died, pediatricians will not be able to support them through the process and make appropriate referrals for pediatric specialty and mental health care. Families can only speculate about the cause and may blame themselves or others for the infant’s death. The terminology used to describe infant deaths that occur suddenly and unexpectedly includes an assortment of terms that vary across and among pediatrician, other physician, or nonphysician clinician disciplines. Having consistent terminology is critical to improve the understanding of the etiology, pathophysiology, and epidemiology of these deaths and communicate with families. A lack of consistent terminology also makes it difficult to reliably monitor trends in mortality and hampers the ability to develop effective interventions. This report describes the history of sudden infant death terminology and summarizes the debate over the terminology and the resulting diagnostic shift of these deaths. This information is to assist pediatricians, other physicians, and nonphysician clinicians in caring for families during this difficult time. The importance of consistent terminology is outlined, followed by a summary of progress toward consensus. Recommendations for pediatricians, other physicians, and nonphysician clinicians are proposed.
      Keywords: Fetus/Newborn Infant, SIDS
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-053746
      Issue No: Vol. 148, No. 4 (2021)
       
  • AAP Publications Reaffirmed or Retired

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      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-053747
      Issue No: Vol. 148, No. 4 (2021)
       
  • School-Based Health Centers and Pediatric Practice

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      Authors: Kjolhede, C; Lee, A. C, COUNCIL ON SCHOOL HEALTH
      Abstract: School-based health centers (SBHCs) are unique health care settings for our nation’s school-aged children and adolescents. SBHCs represent the collaboration between the health and school communities to support the health and mental health needs and the academic achievements of children and adolescents, particularly students with health disparities or poor access to health care. SBHCs improve access to health care services for students by decreasing financial, geographic, age, and cultural barriers. This policy statement provides an overview of SBHCs, including the scope of services as well as some of the documented benefits and challenges. This policy statement also reviews the role of SBHCs in working with the pediatric medical home and provides recommendations that support the coordination of SBHCs with pediatric primary care providers and the pediatric medical home.
      Keywords: School Health
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-053758
      Issue No: Vol. 148, No. 4 (2021)
       
  • AAP Perspective: Race-Based Medicine

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      Authors: American Academy of Pediatrics Board of Directors; Executive Committee
      Keywords: Standard of Care
      PubDate: 2021-10-01T01:01:28-07:00
      DOI: 10.1542/peds.2021-053829
      Issue No: Vol. 148, No. 4 (2021)
       
 
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