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Journal Cover Pediatrics
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   ISSN (Print) 0031-4005 - ISSN (Online) 1098-4275
   Published by American Academy of Pediatrics Homepage  [4 journals]
  • NCE Abstracts 2015
    • Abstract:
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-000a
      Issue No: Vol. 140, No. 4 (2017)
  • Dietary Supplements, Isotretinoin, and Liver Toxicity in Adolescents: A
           Retrospective Case Series
    • Authors: DeKlotz, C. M. C; Roby, K. D, Friedlander, S. F.
      Abstract: Isotretinoin is the most effective acne therapy available, but has the potential for a number of adverse side effects, including transaminitis. The iPLEDGE isotretinoin program recommends avoiding some herbals and supplements due to potential side effects. However, little is known about the effects of protein supplements on the liver, particularly in patients taking isotretinoin. We designed a retrospective chart review to evaluate the symptoms, diagnosis, treatment, and outcome of patients on or preparing to take isotretinoin therapy who were concurrently ingesting protein or herbal supplementation and who developed transaminitis. In 100% (8/8) of cases, dietary supplementation was determined to be at least a possible cause of elevated liver transaminases. In 75% (6/8) of cases, dietary supplement appears to be the most likely cause at some point in their evaluation. Most of our patients’ elevations in aspartate aminotransferase and/or alanine aminotransferase were likely caused by supplementation with protein, creatine, or herbal extracts, rather than prescribed isotretinoin or tetracycline antibiotics for acne. Hence, dietary supplementation may cause liver function abnormalities. As supplement usage appears common in teenagers, clinicians should consider counseling their patients to avoid these products, particularly when prescribing known hepatotoxic drugs.
      Keywords: Dermatology, Adolescent Health/Medicine
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2015-2940
      Issue No: Vol. 140, No. 4 (2017)
  • Case Report of Clitoral Hypertrophy in 2 Extremely Premature Girls With an
           Ovarian Cyst
    • Authors: Nerre, A.-L; Betremieux, P, Nivot-Adamiak, S.
      Abstract: Neonatal clitoromegaly is mainly attributed to in utero androgen exposure secondary to congenital adrenal hyperplasia. We report on 2 extremely premature girls with clitoromegaly, increased androgen levels, no salt wasting syndrome, and ovarian cyst. In case 1, the cyst liquid was aspired during ovarian hernia surgery and revealed high androgen levels. After aspiration, serum androgen levels decreased, as did clitoral size. In case 2, an ovarian cyst was seen on pelvic ultrasound. Aspiration was not indicated. The cyst regressed spontaneously on iterative pelvic ultrasounds, and her clitoromegaly decreased. Case 1 demonstrates the ovarian origin of this transient virilization. Cyst formation seems to be linked to the physiologic maturation of the hypothalamic-pituitary-ovarian axis. Thirteen cases of clitoromegaly with hyperandrogenism, without salt wasting syndrome, have been reported in extremely premature infants. In the context of clitoromegaly, we recommend ruling out in utero androgen exposure, adrenal hyperandrogenism, and disorders of sex development. We further recommend affirming hyperandrogenism by androgen assay and confirming ovarian origin with gonadotrophin assays and pelvic ultrasound. Drug therapy abstention and clinical and ultrasound monitoring are recommended because spontaneous regression of clitoral hypertrophy seems to be the most common outcome in the literature, as it was in our 2 observations.
      Keywords: Endocrinology, Fetus/Newborn Infant, Neonatology
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2016-1807
      Issue No: Vol. 140, No. 4 (2017)
  • Fibrous Arthropathy Associated With Morphea: A New Cause of Diffuse
           Acquired Joint Contractures
    • Authors: Merlin, E; Breton, S, Fraitag, S, Stephan, J.-L, Wouters, C, Bodemer, C, Bader-Meunier, B.
      Abstract: Etiologies for childhood-onset diffuse joint contractures encompass a large group of inherited disorders and acquired diseases, in particular a subtype of juvenile idiopathic arthritis called "dry polyarthritis," dermatomyositis, and systemic sclerosis. We report on 2 boys, aged 5 and 8 years, who developed acquired symmetric painless joint contractures preceding the development of superficial plaques of morphea by 7 to 13 months. There was no other clinical involvement, biological inflammation, or autoantibodies. No urinary mucopolysaccharidosis was seen. In both patients, wrist MRI showed no joint effusion, no bone erosion, and no or mild synovial thickening with slight enhancement after gadolinium infusion. One patient underwent a synovial biopsy, which showed dense fibrosis with a sparse inflammatory infiltrate, similar to the pathologic pattern observed in the skin biopsy. With methotrexate and systemic steroids, joint contractures slowly improved in the first patient and remained stable in the second. These 2 cases suggest that fibrous synovitis should be considered in children with acquired diffuse, symmetric, painless contractures and without elevation of acute-phase reactants, even in the absence of cutaneous manifestations. Articular MRI with gadolinium and careful cutaneous examination at onset and during follow-up should provide clues for diagnosing this entity.
      Keywords: Rheumatology/Musculoskeletal Disorders
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2016-1899
      Issue No: Vol. 140, No. 4 (2017)
  • Sudden Cardiac Arrest While Eating a Hot Dog: A Rare Presentation of
           Brugada Syndrome in a Child
    • Authors: Ozyilmaz, I; Akyol, B, Ergul, Y.
      Abstract: Patients who are diagnosed with Brugada syndrome (BS) usually experience sudden cardiac arrest (SCA) and arrhythmia when they have a high fever, consume alcohol, and, more frequently, during their night sleep. In some rare cases, an SCA can be seen depending on a possible vagal stimulus, such as eating a large bite of food. We describe a 9-year-old patient who had a sudden cardiac attack while he was eating a large hot dog. After successful resuscitation, a suspicious ST elevation in V2 was seen in his electrocardiographic evaluation. He was diagnosed with BS after the ajmaline test and an implantable cardioverter defibrillator was implanted. Vagal stimulus–dependent SCA after eating a large bite of food may be the first symptom of BS. For this reason, the electrocardiographic results of the children who had a cardiac arrest after eating a large meal with big bites should be evaluated in detail.
      Keywords: Cardiology, Cardiovascular Disorders
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2016-2485
      Issue No: Vol. 140, No. 4 (2017)
  • Rapid Targeted Genomics in Critically Ill Newborns
    • Authors: van Diemen, C. C; Kerstjens-Frederikse, W. S, Bergman, K. A, de Koning, T. J, Sikkema-Raddatz, B, van der Velde, J. K, Abbott, K. M, Herkert, J. C, Löhner, K, Rump, P, Meems-Veldhuis, M. T, Neerincx, P. B. T, Jongbloed, J. D. H, van Ravenswaaij-Arts, C. M, Swertz, M. A, Sinke, R. J, van Langen, I. M, Wijmenga, C.
      Abstract: BACKGROUND:Rapid diagnostic whole-genome sequencing has been explored in critically ill newborns, hoping to improve their clinical care and replace time-consuming and/or invasive diagnostic testing. A previous retrospective study in a research setting showed promising results with diagnoses in 57%, but patients were highly selected for known and likely Mendelian disorders. The aim of our prospective study was to assess the speed and yield of rapid targeted genomic diagnostics for clinical application.METHODS:We included 23 critically ill children younger than 12 months in ICUs over a period of 2 years. A quick diagnosis could not be made after routine clinical evaluation and diagnostics. Targeted analysis of 3426 known disease genes was performed by using whole-genome sequencing data. We measured diagnostic yield, turnaround times, and clinical consequences.RESULTS:A genetic diagnosis was obtained in 7 patients (30%), with a median turnaround time of 12 days (ranging from 5 to 23 days). We identified compound heterozygous mutations in the EPG5 gene (Vici syndrome), the RMND1 gene (combined oxidative phosphorylation deficiency-11), and the EIF2B5 gene (vanishing white matter), and homozygous mutations in the KLHL41 gene (nemaline myopathy), the GFER gene (progressive mitochondrial myopathy), and the GLB1 gene (GM1-gangliosidosis). In addition, a 1p36.33p36.32 microdeletion was detected in a child with cardiomyopathy.CONCLUSIONS:Rapid targeted genomics combined with copy number variant detection adds important value in the neonatal and pediatric intensive care setting. It led to a fast diagnosis in 30% of critically ill children for whom the routine clinical workup was unsuccessful.
      Keywords: Critical Care, Genetics
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2016-2854
      Issue No: Vol. 140, No. 4 (2017)
  • Sustaining SLUG Bug CLABSI Reduction: Does Sterile Tubing Change Technique
           Really Work'
    • Authors: Pallotto, E. K; Piazza, A. J, Smith, J. R, Grover, T. R, Chuo, J, Provost, L, Mingrone, T, Holston, M, Moran, S, DNP, Morelli, L, LNCC, Zaniletti, I, Brozanski, B, Brozanski, B.
      Abstract: OBJECTIVES:To evaluate the ability to sustain and further reduce central line–associated bloodstream infection (CLABSI) rates in NICUs participating in a multicenter CLABSI reduction collaborative and to assess the impact of the sterile tubing change (TC) technique as an important component in CLABSI reduction.METHODS:A multi-institutional quality improvement collaborative lowered CLABSI rates in level IV NICUs over a 12-month period. During the 19-month sustain phase, centers were encouraged to monitor and report compliance measures but were only required to report the primary outcome measure of the CLABSI rate. Four participating centers adopted the sterile TC technique during the sustain phase as part of a local Plan-Do-Study-Act cycle.RESULTS:The average aggregate baseline NICU CLABSI rate of 1.076 CLABSIs per 1000 line days was sustained for 19 months across 17 level IV NICUs from January 2013 to July 2014. Four centers transitioning from the clean to the sterile TC technique during the sustain phase had a 64% decrease in CLABSI rates from the baseline (1.59 CLABSIs per 1000 line days to 0.57 CLABSIs per 1000 line days).CONCLUSIONS:Sustaining low CLABSI rates in a multicenter collaborative is feasible with team engagement and ongoing collaboration. With these results, we further demonstrate the positive impact of the sterile TC technique in CLABSI reduction efforts.
      Keywords: Administration/Practice Management, Quality Improvement, Fetus/Newborn Infant, Neonatology
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2016-3178
      Issue No: Vol. 140, No. 4 (2017)
  • Validation of a Novel Assay to Distinguish Bacterial and Viral Infections
    • Authors: Srugo, I; Klein, A, Stein, M, Golan-Shany, O, Kerem, N, Chistyakov, I, Genizi, J, Glazer, O, Yaniv, L, German, A, Miron, D, Shachor-Meyouhas, Y, Bamberger, E, Oved, K, Gottlieb, T. M, Navon, R, Paz, M, Etshtein, L, Boico, O, Kronenfeld, G, Eden, E, Cohen, R, Chappuy, H, Angoulvant, F, Lacroix, L, Gervaix, A.
      Abstract: BACKGROUND:Reliably distinguishing bacterial from viral infections is often challenging, leading to antibiotic misuse. A novel assay that integrates measurements of blood-borne host-proteins (tumor necrosis factor-related apoptosis-inducing ligand, interferon -induced protein-10, and C-reactive protein [CRP]) was developed to assist in differentiation between bacterial and viral disease.METHODS:We performed double-blind, multicenter assay evaluation using serum remnants collected at 5 pediatric emergency departments and 2 wards from children ≥3 months to ≤18 years without (n = 68) and with (n = 529) suspicion of acute infection. Infectious cohort inclusion criteria were fever ≥38°C and symptom duration ≤7 days. The reference standard diagnosis was based on predetermined criteria plus adjudication by experts blinded to assay results. Assay performers were blinded to the reference standard. Assay cutoffs were predefined.RESULTS:Of 529 potentially eligible patients with suspected acute infection, 100 did not fulfill infectious inclusion criteria and 68 had insufficient serum. The resulting cohort included 361 patients, with 239 viral, 68 bacterial, and 54 indeterminate reference standard diagnoses. The assay distinguished between bacterial and viral patients with 93.8% sensitivity (95% confidence interval: 87.8%–99.8%) and 89.8% specificity (85.6%–94.0%); 11.7% had an equivocal assay outcome. The assay outperformed CRP (cutoff 40 mg/L; sensitivity 88.2% [80.4%–96.1%], specificity 73.2% [67.6%–78.9%]) and procalcitonin testing (cutoff 0.5 ng/mL; sensitivity 63.1% [51.0%–75.1%], specificity 82.3% [77.1%–87.5%]).CONCLUSIONS:Double-blinded evaluation confirmed high assay performance in febrile children. Assay was significantly more accurate than CRP, procalcitonin, and routine laboratory parameters. Additional studies are warranted to support its potential to improve antimicrobial treatment decisions.
      Keywords: Emergency Medicine, Infectious Disease
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2016-3453
      Issue No: Vol. 140, No. 4 (2017)
  • Adolescent and Young Adult Tattooing, Piercing, and Scarification
    • Authors: Breuner, C. C; Levine, D. A, THE COMMITTEE ON ADOLESCENCE
      Abstract: Tattoos, piercing, and scarification are now commonplace among adolescents and young adults. This first clinical report from the American Academy of Pediatrics on voluntary body modification will review the methods used to perform the modifications. Complications resulting from body modification methods, although not common, are discussed to provide the pediatrician with management information. Body modification will be contrasted with nonsuicidal self-injury. When available, information also is presented on societal perceptions of body modification.
      Keywords: Adolescent Health/Medicine
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-1962
      Issue No: Vol. 140, No. 4 (2017)
  • Association Between Insurance and Transfer of Injured Children From
           Emergency Departments
    • Authors: Huang, Y; Kissee, J. L, Dayal, P, Wang, N. E, Sigal, I. S, Marcin, J. P.
      Abstract: OBJECTIVES:To determine if injured children presenting to nondesignated trauma centers are more or less likely to be transferred relative to being admitted based on insurance status.METHODS:We conducted a cross-sectional study by using the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample. Pediatric trauma patients receiving care in emergency departments (EDs) at nontrauma centers who were either admitted locally or transferred to another hospital were included. We performed logistic regression analysis adjusting for injury severity and other confounders and incorporated nationally representative weights to determine the association between insurance and transfer or admission.RESULTS:Nine thousand four hundred and sixty-one ED pediatric trauma events at 386 nontrauma centers met inclusion criteria. EDs that treated a higher proportion of patients with Medicaid had higher odds of transfer relative to admission (odds ratio [OR]: 1.2 per 10% increase in Medicaid; 95% confidence interval [CI]: 1.1–1.4), resulting in overall higher odds of transfer among patients with Medicaid compared with patients with private insurance (OR: 1.3; 95% CI: 1.0–1.5). A patient’s insurance status was not associated with different odds of transfer relative to admission within individual EDs after adjusting for the ED’s proportion of patients with Medicaid (Medicaid OR: 1.0; 95% CI: 0.8–1.1).CONCLUSIONS:Injured pediatric patients presenting to nondesignated trauma centers are slightly more likely to be transferred than admitted when the ED treats a higher proportion of Medicaid patients. In this study, ongoing concerns about inequities in the delivery of care among hospitals treating high proportions of children with Medicaid are reinforced.
      Keywords: Emergency Medicine
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2016-3640
      Issue No: Vol. 140, No. 4 (2017)
  • Language Matters: Identifying Medically Complex Children in Foster Care
    • Authors: Williams, E. P; Seltzer, R. R, Boss, R. D.
      Keywords: Adoption & Foster Care, Advocacy
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2016-3692
      Issue No: Vol. 140, No. 4 (2017)
  • Partnerships for Global Child Health
    • Authors: Steenhoff, A. P; Crouse, H. L, Lukolyo, H, Larson, C. P, Howard, C, Mazhani, L, Pak-Gorstein, S, Niescierenko, M. L, Musoke, P, Marshall, R, Soto, M. A, Butteris, S. M, Batra, M, on behalf of the GH Task Force of the American Board of Pediatrics
      Abstract: Child mortality remains a global health challenge and has resulted in demand for expanding the global child health (GCH) workforce over the last 3 decades. Institutional partnerships are the cornerstone of sustainable education, research, clinical service, and advocacy for GCH. When successful, partnerships can become self-sustaining and support development of much-needed training programs in resource-constrained settings. Conversely, poorly conceptualized, constructed, or maintained partnerships may inadvertently contribute to the deterioration of health systems. In this comprehensive, literature-based, expert consensus review we present a definition of partnerships for GCH, review their genesis, evolution, and scope, describe participating organizations, and highlight benefits and challenges associated with GCH partnerships. Additionally, we suggest a framework for applying sound ethical and public health principles for GCH that includes 7 guiding principles and 4 core practices along with a structure for evaluating GCH partnerships. Finally, we highlight current knowledge gaps to stimulate further work in these areas. With awareness of the potential benefits and challenges of GCH partnerships, as well as shared dedication to guiding principles and core practices, GCH partnerships hold vast potential to positively impact child health.
      Keywords: International Child Health
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2016-3823
      Issue No: Vol. 140, No. 4 (2017)
  • Chronic Auditory Toxicity in Late Preterm and Term Infants With
           Significant Hyperbilirubinemia
    • Authors: Amin, S. B; Saluja, S, Saili, A, Orlando, M, Wang, H, Laroia, N, Agarwal, A.
      Abstract: BACKGROUND AND OBJECTIVES:Significant hyperbilirubinemia (SHB) may cause chronic auditory toxicity (auditory neuropathy spectrum disorder and/or sensorineural hearing loss); however, total serum bilirubin (TSB) does not discriminate neonates at risk for auditory toxicity. Our objective was to compare TSB, bilirubin albumin molar ratio (BAMR), and unbound bilirubin (UB) for their association with chronic auditory toxicity in neonates with SHB (TSB ≥20 mg/dL or TSB that met criteria for exchange transfusion).METHODS:Infants ≥34 weeks’ gestational age (GA) with SHB during the first 2 postnatal weeks were eligible for a prospective longitudinal study in India. Comprehensive auditory evaluations were performed at 2 to 3 months of age by using auditory brainstem response, tympanometry, and an otoacoustic emission test and at 9 to 12 months of age by using audiometry. The evaluations were performed by an audiologist unaware of the degree of jaundice.RESULTS:A total of 93 out of 100 infants (mean GA of 37.4 weeks; 55 boys, 38 girls) who were enrolled with SHB were evaluated for auditory toxicity. Of those, 12 infants (13%) had auditory toxicity. On regression analysis controlling for covariates, peak UB (but not peak TSB or peak BAMR), was associated with auditory toxicity (odds ratio 2.41; 95% confidence interval: 1.43–4.07; P = .001). There was significant difference in the area under the receiver operating characteristic curves between UB (0.866), TSB (0.775), and BAMR (0.724) for auditory toxicity (P = .03) after controlling for covariates.CONCLUSIONS:Unconjugated hyperbilirubinemia indexed by UB (but not TSB or BAMR) is associated with chronic auditory toxicity in infants ≥34 weeks’ GA with SHB.
      Keywords: Fetus/Newborn Infant, Hyperbilirubinemia, Neurology, Neurologic Disorders
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2016-4009
      Issue No: Vol. 140, No. 4 (2017)
  • Respiratory Infections and the Risk of Celiac Disease
    • Authors: Auricchio, R; Cielo, D, de Falco, R, Galatola, M, Bruno, V, Malamisura, B, Limongelli, M. G, Troncone, R, Greco, L.
      Abstract: BACKGROUND AND OBJECTIVES:The increasing incidence of celiac disease (CD) suggests that common infections before the onset of autoimmune diseases could be an important factor in switching the immune response. We aimed to explore the relationship between early clinical events and the development of CD in genetically predisposed infants.METHODS:In this study, 373 newborns from families with at least 1 relative with CD were recruited, and human leukocyte antigen DQ2- or DQ8-positive infants were followed up with clinical and serological evaluations. Cross tabulation and odds ratios were used to explore the risk associated with single variables, and logistic regression analysis was performed to determine the variables that contributed to the risk of developing CD. Stepwise discriminant analysis was used to determine which variables could distinguish case patients from controls before diagnosis.RESULTS:The cumulative incidence of CD in this cohort was 6% at 3 years and 13.5% at 5 years of age, and l34 children (14%) developed CD before the sixth year of life. An analysis of adverse events showed a higher frequency of respiratory tract infections among CD patients during the first 24 months of life. In a stepwise discriminant analysis, which included sex and human leukocyte antigen risk class, only respiratory infections in the second and first years of life significantly contributed to discrimination of case patients versus controls.CONCLUSIONS:A multivariate model of discriminant analysis showed that the frequency of respiratory infections in the first 2 years of life could distinguish children who developed CD from those who did not.
      Keywords: Gastroenterology
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2016-4102
      Issue No: Vol. 140, No. 4 (2017)
  • Clinical Pathway Produces Sustained Improvement in Acute Gastroenteritis
    • Authors: Rutman, L; Klein, E. J, Brown, J. C.
      Abstract: BACKGROUND AND OBJECTIVES:Despite widespread use of the rotavirus vaccine in the last decade, dehydrating illnesses impact almost 2 billion children worldwide annually. Evidence supports oral rehydration therapy as a first-line treatment of mild to moderate dehydration. Ondansetron has proven to be a safe and effective adjunct in children with vomiting. We implemented a clinical pathway in our pediatric emergency department (ED) in January 2005 to improve care for this common condition. Our objective in this study was to determine the long-term impact of the pathway for acute gastroenteritis (AGE) on the proportion of patients receiving intravenous (IV) fluids and ED length of stay (LOS) for discharged patients.METHODS:Cases were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. We used statistical process control to analyze process and outcome measures for 2 years before and 10 years after pathway implementation.RESULTS:We included 30 519 patients. We found special cause variation with a downward shift in patients receiving IV fluids after initiation of the pathway and later with addition of ondansetron to the pathway from 48% to 26%. Mean ED LOS for discharged patients with AGE decreased from 247 to 172 minutes. These improvements were sustained over time.CONCLUSIONS:Implementation of a clinical pathway emphasizing oral rehydration therapy and ondansetron for children with AGE led to decreased IV fluid use and LOS in a pediatric ED. Improvements were sustained over a 10-year period. Our results suggest that quality-improvement interventions for AGE can have long-term impacts on care delivery.
      Keywords: Emergency Medicine, Administration/Practice Management, Quality Improvement
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2016-4310
      Issue No: Vol. 140, No. 4 (2017)
  • Ending the Culture of Culture-Negative Sepsis in the Neonatal ICU
    • Authors: Cantey, J. B; Baird, S. D.
      Keywords: Fetus/Newborn Infant, Neonatology
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-0044
      Issue No: Vol. 140, No. 4 (2017)
  • Post-Up Study: Postpartum Depression Screening in Well-Child Care and
           Maternal Outcomes
    • Authors: van der Zee-van den Berg, A. I; Boere-Boonekamp, M. M, Groothuis-Oudshoorn, C. G. M, IJzerman, M. J, Haasnoot-Smallegange, R. M. E, Reijneveld, S. A.
      Abstract: OBJECTIVES:Postpartum depression often remains unaddressed. Screening in well-child care (WCC) may improve early detection, promote maternal recovery, and reduce effects on child development. We assessed the effectiveness of screening for postpartum depression in WCC compared with care as usual (CAU) on outcomes at mother and child levels.METHODS:In a prospective, quasiexperimental, comparative design, mothers visiting Dutch WCC centers were exposed either to screening at 1, 3, and 6 months postpartum (n = 1843) or to CAU (n = 1246). Assessments were at 3 weeks (baseline), 9 months (the Mini International Neuropsychiatric Interview), and 12 months (the Spielberger State-Trait Anxiety Inventory, the Short-Form 12-Item Health Survey, the Maternal Self-Efficacy in the Nurturing Role questionnaire, and the Ages and Stages Questionnaire–Social Emotional) postpartum.RESULTS:Significantly fewer mothers in the intervention group were depressed at 9 months postpartum compared with the CAU group (0.6% vs 2.5% for major depression). The adjusted odds ratio was 0.28 (95% confidence interval, 0.12 to 0.63; Cohen’s d, 0.70). For minor and major depression, figures were 3.0% vs 8.4%, and the adjusted odds ratio was 0.40 (95% confidence interval, 0.27 to 0.58; Cohen’s d, 0.51). For parenting, anxiety symptoms, and mental health functioning, the intervention resulted in effect sizes ranging from 0.23 to 0.27. The effect on the child's socioemotional development was negligible.CONCLUSIONS:Implementation of screening for postpartum depression in WCC should be seriously considered given its positive effects on maternal mental health. The benefits of optimizing the trajectory after screening on maternal and child outcomes need further attention.
      Keywords: Developmental/Behavioral Pediatrics, Psychosocial Issues, Psychiatry/Psychology
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-0110
      Issue No: Vol. 140, No. 4 (2017)
  • Racial and Ethnic Differences in Antibiotic Use for Viral Illness in
           Emergency Departments
    • Authors: Goyal, M. K; Johnson, T. J, Chamberlain, J. M, Casper, T. C, Simmons, T, Alessandrini, E. A, Bajaj, L, Grundmeier, R. W, Gerber, J. S, Lorch, S. A, Alpern, E. R, for The Pediatric Care Applied Research Network (PECARN)
      Abstract: BACKGROUND AND OBJECTIVES:In the primary care setting, there are racial and ethnic differences in antibiotic prescribing for acute respiratory tract infections (ARTIs). Viral ARTIs are commonly diagnosed in the pediatric emergency department (PED), in which racial and ethnic differences in antibiotic prescribing have not been previously reported. We sought to investigate whether patient race and ethnicity was associated with differences in antibiotic prescribing for viral ARTIs in the PED.METHODS:This is a retrospective cohort study of encounters at 7 PEDs in 2013, in which we used electronic health data from the Pediatric Emergency Care Applied Research Network Registry. Multivariable logistic regression was used to examine the association between patient race and ethnicity and antibiotics administered or prescribed among children discharged from the hospital with viral ARTI. Children with bacterial codiagnoses, chronic disease, or who were immunocompromised were excluded. Covariates included age, sex, insurance, triage level, provider type, emergency department type, and emergency department site.RESULTS:Of 39 445 PED encounters for viral ARTIs that met inclusion criteria, 2.6% (95% confidence interval [CI] 2.4%–2.8%) received antibiotics, including 4.3% of non-Hispanic (NH) white, 1.9% of NH black, 2.6% of Hispanic, and 2.9% of other NH children. In multivariable analyses, NH black (adjusted odds ratio [aOR] 0.44; CI 0.36–0.53), Hispanic (aOR 0.65; CI 0.53–0.81), and other NH (aOR 0.68; CI 0.52–0.87) children remained less likely to receive antibiotics for viral ARTIs.CONCLUSIONS:Compared with NH white children, NH black and Hispanic children were less likely to receive antibiotics for viral ARTIs in the PED. Future research should seek to understand why racial and ethnic differences in overprescribing exist, including parental expectations, provider perceptions of parental expectations, and implicit provider bias.
      Keywords: Emergency Medicine, Infectious Disease
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-0203
      Issue No: Vol. 140, No. 4 (2017)
  • LGBTQ Bullying: Translating Research to Action in Pediatrics
    • Authors: Earnshaw, V. A; Reisner, S. L, Juvonen, J, Hatzenbuehler, M. L, Perrotti, J, Schuster, M. A.
      Abstract: Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth experience significant bullying that undermines their mental and physical health. National health organizations have called for the development of innovative strategies to address LGBTQ bullying. Pediatricians and other clinicians, medical and public health students, interdisciplinary researchers, government officials, school leaders, community members, parents, and youth from around the country came together at a national symposium entitled "LGBTQ Bullying: Translating Research to Action to Improve the Health of All Youth" in May 2016 to generate strategies to prevent LGBTQ bullying and meet the needs of LGBTQ youth experiencing bullying. This article describes key scientific findings on bullying, LGBTQ stigma, and LGBTQ bullying interventions that were shared at the symposium and provides recommendations for pediatricians to address LGBTQ bullying via clinical care, research, interventions, and policy. Symposium participants recommended that pediatricians engage in efforts to foster inclusive and affirming health care environments wherein LGBTQ youth feel comfortable discussing their identities and experiences, identify youth experiencing LGBTQ bullying, and prevent the negative health consequences of bullying among youth. Moreover, pediatricians can attend to how multiple identities (eg, sexual orientation, gender identity, race and/or ethnicity, disability, and others) shape youth experiences of bullying and expand intervention efforts to address LGBTQ bullying in health care settings. Pediatricians can further advocate for evidence-based, antibullying policies prohibiting bullying on the basis of sexual orientation and gender identity. Collaboration between pediatricians and diverse stakeholders can contribute to the development and implementation of lasting change in all forms of bullying, including LGBTQ bullying.
      Keywords: Injury, Violence & Poison Prevention, Bullying
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-0432
      Issue No: Vol. 140, No. 4 (2017)
  • Lessons From Pediatric HIV: A Case for Curative Intent in Pediatric Cancer
           in LMICs
    • Authors: Miller, H; Slone, J. S, Raabe, E, El-Mallawany, N. K, Mehta, P, Phelps, B. R.
      Keywords: Hematology/Oncology, Infectious Disease, HIV/AIDS
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-0525
      Issue No: Vol. 140, No. 4 (2017)
  • US Emergency Department Trends in Imaging for Pediatric Nontraumatic
           Abdominal Pain
    • Authors: Niles, L. M; Goyal, M. K, Badolato, G. M, Chamberlain, J. M, Cohen, J. S.
      Abstract: OBJECTIVES:To describe national emergency department (ED) trends in computed tomography (CT) and ultrasound imaging for the evaluation of pediatric nontraumatic abdominal pain from 2007 through 2014.METHODS:We used data from the National Hospital Ambulatory Medical Care Survey to measure trends in CT and ultrasound use among children with nontraumatic abdominal pain. We performed multivariable logistic regression to measure the strength of the association of ED type (pediatric versus general ED) with CT and ultrasound use adjusting for potential confounding variables.RESULTS:Of an estimated 21.1 million ED visits for nontraumatic abdominal pain, 14.6% (95% confidence interval [CI], 13.2%–16.0%) had CT imaging only, 10.9% (95% CI, 9.7%–12.1%) had ultrasound imaging only, and 1.9% (95% CI, 1.4%–2.4%) received both CT and ultrasound. The overall use of CT and ultrasound did not significantly change over the study period (P trend .63 and .90, respectively). CT use was lower among children treated in pediatric EDs compared with general EDs (adjusted odds ratio 0.34; 95% CI, 0.17–0.69). Conversely, ultrasound use was higher among children treated in pediatric EDs compared with general EDs (adjusted odds ratio 2.14; 95% CI, 1.29–3.55).CONCLUSIONS:CT imaging for pediatric patients with nontraumatic abdominal pain has plateaued since 2007 after the steady increase seen in the preceding 9 years. Among this population, an increased likelihood of CT imaging was demonstrated in general EDs compared with pediatric EDs, in which there was a higher likelihood of ultrasound imaging. Dissemination of pediatric-focused radiology protocols to general EDs may help optimize radiation exposure in children.
      Keywords: Emergency Medicine, Radiology
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-0615
      Issue No: Vol. 140, No. 4 (2017)
  • Disparities in the Intensity of End-of-Life Care for Children With Cancer
    • Authors: Johnston, E. E; Alvarez, E, Saynina, O, Sanders, L, Bhatia, S, Chamberlain, L. J.
      Abstract: BACKGROUND:Many adult patients with cancer who know they are dying choose less intense care; additionally, high-intensity care is associated with worse caregiver outcomes. Little is known about intensity of end-of-life care in children with cancer.METHODS:By using the California Office of Statewide Health Planning and Development administrative database, we performed a population-based analysis of patients with cancer aged 0 to 21 who died between 2000 and 2011. Rates of and sociodemographic and clinical factors associated with previously-defined end-of-life intensity indicators were determined. The intensity indicators included an intense medical intervention (cardiopulmonary resuscitation, intubation, ICU admission, or hemodialysis) within 30 days of death, intravenous chemotherapy within 14 days of death, and hospital death.RESULTS:The 3732 patients were 34% non-Hispanic white, and 41% had hematologic malignancies. The most prevalent intensity indicators were hospital death (63%) and ICU admission (20%). Sixty-five percent had ≥1 intensity indicator, 23% ≥2, and 22% ≥1 intense medical intervention. There was a bimodal association between age and intensity: ages
      Keywords: Hematology/Oncology, Cancer/Neoplastic, Hospice/Palliative Medicine
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-0671
      Issue No: Vol. 140, No. 4 (2017)
  • The Dilemma of Predicting Violent Radicalization
    • Authors: Rousseau, C; Ellis, B. H, Lantos, J. D.
      Abstract: Parents, educators, law enforcement officials, and health professionals are all concerned about the violent radicalization of adolescents. Health professionals may be called on to assess teenagers regarding the risk that they will become dangerous. We present a case in which a psychiatrist is asked to do a forensic evaluation of a young adolescent who said troubling things and had some concerning posts on his Facebook page. The evaluation reveals things about both the young boy and his community.
      Keywords: Ethics/Bioethics, Psychiatry/Psychology
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-0685
      Issue No: Vol. 140, No. 4 (2017)
  • Neurodevelopment of HIV-Exposed and HIV-Unexposed Uninfected Children at
           24 Months
    • Authors: Chaudhury, S; Williams, P. L, Mayondi, G. K, Leidner, J, Holding, P, Tepper, V, Nichols, S, Magetse, J, Sakoi, M, Moabi, K, Makhema, J, Mdluli, C, Jibril, H, Seage, G. R, Kammerer, B, Lockman, S.
      Abstract: BACKGROUND:We sought to determine if HIV-exposed uninfected (HEU) children had worse neurodevelopmental outcomes at 24 months compared with HIV-unexposed uninfected (HUU) children in Botswana.METHODS:HIV-infected and uninfected mothers enrolled in a prospective observational study ("Tshipidi") in Botswana from May 2010 to July 2012. Child neurodevelopment was assessed at 24 months with the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III: cognitive, gross motor, fine motor, expressive language, and receptive language domains) and the Development Milestones Checklist (DMC), a caregiver-completed questionnaire (locomotor, fine motor, language and personal-social domains). We used linear regression models to estimate the association of in-utero HIV exposure with neurodevelopment, adjusting for socioeconomic and maternal health characteristics.RESULTS:We evaluated 670 children (313 HEU, 357 HUU) with ≥1 valid Bayley-III domain assessed and 723 children (337 HEU, 386 HUU) with a DMC. Among the 337 HEU children with either assessment, 122 (36%) were exposed in utero to maternal 3-drug antiretroviral treatment and 214 (64%) to zidovudine. Almost all HUU children (99.5%) breastfed, compared with only 9% of HEU children. No domain score was significantly lower among HEU children in adjusted analyses. Bayley-III cognitive and DMC personal-social domain scores were significantly higher in HEU children than in HUU children, but differences were small.CONCLUSIONS:HEU children performed equally well on neurodevelopmental assessments at 24 months of age compared with HUU children. Given the global expansion of the HEU population, results suggesting no adverse impact of in-utero HIV and antiretroviral exposure on early neurodevelopment are reassuring.
      Keywords: Developmental/Behavioral Pediatrics, Cognition/Language/Learning Disorders, Infectious Disease, HIV/AIDS
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-0988
      Issue No: Vol. 140, No. 4 (2017)
  • Gestational Age and Outcomes in Critical Congenital Heart Disease
    • Authors: Steurer, M. A; Baer, R. J, Keller, R. L, Oltman, S, Chambers, C. D, Norton, M. E, Peyvandi, S, Rand, L, Rajagopal, S, Ryckman, K. K, Moon-Grady, A. J, Jelliffe-Pawlowski, L. L.
      Abstract: BACKGROUND AND OBJECTIVES:It is unknown how gestational age (GA) impacts neonatal morbidities in infants with critical congenital heart disease (CCHD). We aim to quantify GA-specific mortality and neonatal morbidity in infants with CCHD.METHODS:Cohort study using a database linking birth certificate, infant hospital discharge, readmission, and death records, including infants 22 to 42 weeks’ GA without chromosomal anomalies (2005–2012, 2 988 925 live births). The International Classification of Diseases, Ninth Revision diagnostic and procedure codes were used to define CCHD and neonatal morbidities (intraventricular hemorrhage, retinopathy, periventricular leukomalacia, chronic lung disease, necrotizing enterocolitis). Adjusted absolute risk differences (ARDs) with 95% confidence intervals (CIs) were calculated.RESULTS:We identified 6903 out of 2 968 566 (0.23%) infants with CCHD. The incidence of CCHD was highest at 29 to 31 weeks’ GA (0.9%) and lowest at 39 to 42 weeks (0.2%). Combined neonatal morbidity or mortality in infants with and without CCHD was 82.8% and 57.9% at
      Keywords: Fetus/Newborn Infant, Neonatology, Cardiology
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-0999
      Issue No: Vol. 140, No. 4 (2017)
  • Employer-Sponsored Plan Expenditures for Infants Born Preterm
    • Authors: Grosse, S. D; Waitzman, N. J, Yang, N, Abe, K, Barfield, W. D.
      Abstract: BACKGROUND:Care for infants born preterm or with major birth defects is costly. Specific estimates of financial burden for different payers are lacking, in part because use of administrative data to identify preterm infants and costs is challenging.METHODS:We used private health insurance claims data and billing codes to identify live births during 2013 and calculated first-year expenditures for employer-sponsored health plans for infants born preterm, both overall and stratified by major birth defects.RESULTS:We conservatively estimated that 7.7% of insured infants born preterm accounted for 37% of $2.0 billion spent by participating plans on the care of infants born during 2013. With a mean difference in plan expenditures of ~$47 100 per infant, preterm births cost the included plans an extra $600 million during the first year of life. Extrapolating to the national level, we projected aggregate employer-sponsored plan expenditures of $6 billion for infants born preterm during 2013. Infants with major birth defects accounted for 5.8% of preterm births but 24.5% of expenditures during infancy. By using an alternative algorithm to identify preterm infants, it was revealed that incremental expenditures were higher: $78 000 per preterm infant and $14 billion nationally.CONCLUSIONPreterm births (especially in conjunction with major birth defects) represent a substantial burden on payers, and efforts to mitigate this burden are needed. In addition, researchers need to conduct studies using linked vital records, birth defects surveillance, and administrative data to accurately and longitudinally assess per-infant costs attributable to preterm birth and the interaction of preterm birth with major birth defects.
      Keywords: Fetus/Newborn Infant
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-1078
      Issue No: Vol. 140, No. 4 (2017)
  • Pulse Oximetry and Auscultation for Congenital Heart Disease Detection
    • Authors: Hu, X.-j; Ma, X.-j, Zhao, Q.-m, Yan, W.-l, Ge, X.-l, Jia, B, Liu, F, Wu, L, Ye, M, Liang, X.-c, Zhang, J, Gao, Y, Zhai, X.-w, Huang, G.-y.
      Abstract: OBJECTIVES:Pulse oximetry (POX) has been confirmed as a specific screening modality for critical congenital heart disease (CCHD), with moderate sensitivity. However, POX is not able to detect most serious and critical cardiac lesions (major congenital heart disease [CHD]) without hypoxemia. In this study, we investigated the accuracy and feasibility of the addition of cardiac auscultation to POX as a screening method for asymptomatic major CHD.METHODS:A multicenter prospective observational screening study was conducted at 15 hospitals in Shanghai between July 1, 2012, and December 31, 2014. Newborns with either an abnormal POX or cardiac auscultation were defined as screen positive. All screen-positive newborns underwent further echocardiography. False-negative results were identified by clinical follow-up, parents’ feedback, and telephone review. We assessed the accuracy of POX plus cardiac auscultation for the detection of major CHD.RESULTS:CHD screening was completed in all 15 hospitals, with a screening rate of 94.0% to 99.8%. In total, 167 190 consecutive asymptomatic newborn infants were screened, of which 203 had major CHD (44 critical and 159 serious). The sensitivity of POX plus cardiac auscultation was 95.5% (95% confidence interval 84.9%–98.7%) for CCHD and 92.1% (95% confidence interval 87.7%–95.1%) for major CHD. The false-positive rate was 1.2% for detecting CCHD and 1.1% for detecting major CHD.CONCLUSIONS:In our current study, we show that using POX plus cardiac auscultation significantly improved the detection rate of major CHD in the early neonatal stage, with high sensitivity and a reasonable false-positive rate. It provides strong evidence and a reliable method for neonatal CHD screening.
      Keywords: Fetus/Newborn Infant, Birth Defects, Cardiology, Cardiovascular Disorders
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-1154
      Issue No: Vol. 140, No. 4 (2017)
  • Continuous Glucose Monitoring in Very Preterm Infants: A Randomized
           Controlled Trial
    • Authors: Galderisi, A; Facchinetti, A, Steil, G. M, Ortiz-Rubio, P, Cavallin, F, Tamborlane, W. V, Baraldi, E, Cobelli, C, Trevisanuto, D.
      Abstract: BACKGROUND AND OBJECTIVES:Impaired glucose control in very preterm infants is associated with increased morbidity, mortality, and poor neurologic outcome. Strategies based on insulin titration have been unsuccessful in achieving euglycemia in absence of an increase in hypoglycemia and mortality. We sought to assess whether glucose administration guided by continuous glucose monitoring (CGM) is more effective than standard of care blood glucose monitoring in maintaining euglycemia in very preterm infants.METHODS:Fifty newborns ≤32 weeks’ gestation or with birth weight ≤1500 g were randomly assigned (1:1) within 48-hours from birth to receive computer-guided glucose infusion rate (GIR) with or without CGM. In the unblinded CGM group, the GIR adjustments were driven by CGM and rate of glucose change, whereas in the blinded CGM group the GIR was adjusted by using standard of care glucometer on the basis of blood glucose determinations. Primary outcome was percentage of time spent in euglycemic range (72–144 mg/dL). Secondary outcomes were percentage of time spent in mild (47–71 mg/dL) and severe (180 mg/dL) hyperglycemia; and glucose variability.RESULTS:Neonates in the unblinded CGM group had a greater percentage of time spent in euglycemic range (median, 84% vs 68%, P < .001) and decreased time spent in mild (P = .04) and severe (P = .007) hypoglycemia and in severe hyperglycemia (P = .04) compared with the blinded CGM group. Use of CGM also decreased glycemic variability (SD: 21.6 ± 5.4 mg/dL vs 27 ± 7.2 mg/dL, P = .01; coefficient of variation: 22.8% ± 4.2% vs 27.9% ± 5.0%; P < .001).CONCLUSIONS:CGM-guided glucose titration can successfully increase the time spent in euglycemic range, reduce hypoglycemia, and minimize glycemic variability in preterm infants during the first week of life.
      Keywords: Fetus/Newborn Infant, Neonatology
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-1162
      Issue No: Vol. 140, No. 4 (2017)
  • Age Legislation and Off-Road Vehicle Injuries in Children
    • Authors: Flaherty, M. R; Raybould, T, Kelleher, C. M, Seethala, R, Lee, J, Kaafarani, H. M. A, Masiakos, P. T.
      Abstract: BACKGROUND AND OBJECTIVES:In 2010, the Massachusetts Legislature passed a comprehensive law that restricted off-road vehicle (ORV) use by children
      Keywords: Injury, Violence & Poison Prevention, Public Health
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-1164
      Issue No: Vol. 140, No. 4 (2017)
  • Assessing the Febrile Child for Serious Infection: A Step Closer to
           Meaningful Rapid Results
    • Authors: Kimberlin, D. W; Poole, C. L.
      Keywords: Infectious Disease
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-1210
      Issue No: Vol. 140, No. 4 (2017)
  • National Trends in Pediatricians Practices and Attitudes About
           Breastfeeding: 1995 to 2014
    • Authors: Feldman-Winter, L; Szucs, K, Milano, A, Gottschlich, E, Sisk, B, Schanler, R. J.
      Abstract: BACKGROUND AND OBJECTIVES:The American Academy of Pediatrics (AAP) has affirmed breastfeeding as the preferred method of infant feeding; however, there has been little systematic examination of how pediatricians’ recommendations, affiliated hospitals’ policies, counseling practices, and attitudes toward breastfeeding have shifted over the past 2 decades. These trends were examined from 1995 to 2014.METHODS:Data are from the Periodic Survey (PS) of Fellows, a nationally representative survey of AAP members. PS #30 (1995; response rate = 72%; N = 832), PS #57 (2004; response rate = 55%; N = 675), and PS #89 (2014; response rate = 51%; N = 620) collected demographics, patient and practice characteristics, and detailed responses on pediatricians’ recommendations, affiliated hospitals’ policies, counseling practices, and attitudes toward breastfeeding. By using bivariate statistics and logistic regression models, the analysis investigated changes over time with predicted values (PVs).RESULTS:From 1995 to 2014, more pediatricians reported their affiliated hospitals applied for "baby-friendly" designation (PV = 12% in 1995, PV = 56% in 2014; P < .05), and more reported that they recommend exclusive breastfeeding (65% to 76% [P < .05]). However, fewer respondents indicated that mothers can be successful breastfeeding (PV = 70% in 1995, PV = 57% in 2014; P < .05) and that the benefits outweigh the difficulties (PV = 70% in 1995, PV = 50% in 2014; P < .05). Younger pediatricians were less confident than older pediatricians in managing breastfeeding problems (P < .01).CONCLUSIONS:Pediatricians’ recommendations and practices became more closely aligned with AAP policy from 1995 to 2014; however, their attitudes about the likelihood of breastfeeding success have worsened. These 2 divergent trends indicate that even as breastfeeding rates continue to rise, continued efforts to enhance pediatricians’ training and attitudes about breastfeeding are necessary.
      Keywords: Administration/Practice Management, Standard of Care, Nutrition, Breastfeeding
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-1229
      Issue No: Vol. 140, No. 4 (2017)
  • Perioperative Spending on Spinal Fusion for Scoliosis for Children With
           Medical Complexity
    • Authors: Berry, J. G; Glotzbecker, M, Rodean, J, Leahy, I, Cox, J, Singer, S. J, ONeill, M, Hall, M, Ferrari, L.
      Abstract: BACKGROUND:Global payment is used with surgeries to optimize health, lower costs, and improve quality. We assessed perioperative spending on spinal fusion for scoliosis to inform how this might apply to children.METHODS:Retrospective analysis of 1249 children using Medicaid and aged ≥5 years with a complex chronic condition undergoing spinal fusion in 2013 from 12 states. From perioperative health services measured 6 months before and 3 months after spinal fusion, we simulated a spending reallocation with increased preoperative care and decreased hospital care.RESULTS:Perioperative spending was $112 353 per patient, with 77.9% for hospitalization, 12.3% for preoperative care, and 9.8% for postdischarge care. Primary care accounted for 0.2% of total spending; 15.4% and 49.2% of children had no primary care visit before and after spinal fusion, respectively. Compared with having no preoperative primary care visit, 1 to 2 visits were associated with a 12% lower surgery hospitalization cost (P = .05) and a 9% shorter length of stay (LOS) (P = .1); ≥3 visits were associated with a 21% lower hospitalization cost (P < .001) and a 14% shorter LOS (P = .01). Having ≥3 preoperative primary care visits for all children would increase total perioperative spending by 0.07%. This increased cost could be underwritten by a 0.1% reduction in hospital LOS or a 1.0% reduction in 90-day hospital readmissions.CONCLUSIONS:Hospital care accounted for most perioperative spending in children undergoing spinal fusion. Multiple preoperative primary care visits were associated with lower hospital costs and shorter hospitalizations. Modestly less hospital resource use could underwrite substantial increases in children’s preoperative primary care.
      Keywords: Hospital Medicine, Orthopaedic Medicine
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-1233
      Issue No: Vol. 140, No. 4 (2017)
  • Synthetic Cannabinoid Use Among High School Seniors
    • Authors: Palamar, J. J; Barratt, M. J, Coney, L, Martins, S. S.
      Abstract: OBJECTIVES:In this study, we examined the prevalence and correlates of current synthetic cannabinoid (SC) use among high school seniors in the United States.METHODS:Monitoring the Future, an annual nationally representative survey of high school seniors, began querying current (30-day) SC use in 2014. Data were examined from the 2 most recent cohorts (2014–2015; N = 7805). Prevalence of self-reported use was examined and differences in demographics and recency and frequency of other drug use was compared between current marijuana-only users and current SC (plus marijuana) users using 2 and generalized linear model using Poisson.RESULTS:We found that 2.9% of students reported current SC use; 1.4% of students (49.7% of users) reported using SCs on ≥3 days in the past month. SC users were more likely to report more recent (and often more frequent) use of lysergic acid diethylamide, cocaine, heroin, and/or nonmedical use of opioids compared with marijuana-only users. Compared with current marijuana-only users, SC users were more likely to report lower parent education (P < .05) and current use of a higher number of illegal drugs other than marijuana (Ps < .001). Students using SCs ≥10 times in the past month were more likely to be boys, frequent marijuana users (Ps < .01), African American, and users of multiple other illegal drugs (Ps < .001).CONCLUSIONS:SC use is typically part of a repertoire of polydrug use, and polydrug use is less prevalent among marijuana-only users. Current SC users are at risk for poisoning from use of the newest generation of SCs and from concurrent drug use.
      Keywords: Substance Abuse, Public Health
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-1330
      Issue No: Vol. 140, No. 4 (2017)
  • A Sports-Based Youth Development Program, Teen Mental Health, and Physical
           Fitness: An RCT
    • Authors: Ho, F. K. W; Louie, L. H. T, Wong, W. H.-s, Chan, K. L, Tiwari, A, Chow, C. B, Ho, W, Wong, W, Chan, M, Chen, E. Y. H, Cheung, Y. F, Ip, P.
      Abstract: OBJECTIVES:To assess the effectiveness of a positive youth development (PYD)-based sports mentorship program on the physical and mental well-being of adolescents recruited in a community setting.METHODS:This is a randomized controlled trial in which we recruited students from 12 secondary schools in Hong Kong, China. Participants were randomly assigned in a 1:1 ratio to an intervention or a control arm after stratification for school from October 2013 to June 2014. Participants were not blinded to allocation because of the nature of the intervention. Students in the intervention arm received an after-school, PYD-based sports mentorship for 18 weeks. Each weekly session lasted 90 minutes. Students in the control arm received exclusive access to a health education Web site.RESULTS:Six hundred and sixty-four students (mean age 12.3 years [SD 0.76]; 386 girls [58.1%]) completed baseline and postintervention assessments. The intervention improved students’ mental well-being (Cohen’s d, 0.25; 95% confidence interval [CI], 0.10 to 0.40; P = .001), self-efficacy (Cohen’s d, 0.22; 95% CI, 0.07 to 0.37; P = .01), resilience (Cohen’s d, 0.19; 95% CI, 0.03 to 0.34; P = .02), physical fitness (flexibility [Cohen’s d, 0.28; 95% CI, 0.13 to 0.43; P = .02], lower limb muscle strength [Cohen’s d, 0.18; 95% CI, 0.03 to 0.33; P = .03], and dynamic balance [Cohen’s d, 0.21; 95% CI, 0.06 to 0.37; P = .01]), and physical activity levels (Cohen’s d, 0.39; 95% CI, 0.24 to 0.55; P < .0001). The intervention did not significantly improve physical well-being (Cohen’s d, –0.01; 95% CI, –0.17 to 0.14; P = .86), BMI z scores (Cohen’s d, –0.03; 95% CI, –0.18 to 0.12; P = .69), body fat proportion (Cohen’s d, –0.15; 95% CI, –0.31 to 0.00; P = .051), and social connectedness (Cohen’s d, –0.03; 95% CI, –0.18 to 0.12; P = .72).CONCLUSIONS:A PYD-based sports mentorship intervention improved healthy adolescents’ mental well-being, psychological assets, physical fitness, and physical activity levels.
      Keywords: Community Pediatrics, School Health, Public Health
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-1543
      Issue No: Vol. 140, No. 4 (2017)
  • Disparities in Pediatric Palliative Care: An Opportunity to Strive for
    • Authors: Bona, K; Wolfe, J.
      Keywords: Hematology/Oncology, Hospice/Palliative Medicine
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-1662
      Issue No: Vol. 140, No. 4 (2017)
  • Doing More About Health Care Disparities: Moving Past Description to
    • Authors: Harper M. B.
      Keywords: Administration/Practice Management, Interpersonal & Communication Skills, Professionalism
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-2185
      Issue No: Vol. 140, No. 4 (2017)
  • Jan IA, Ramanathan R, Cayabyab RG. Chorioamnionitis and Management of
           Asymptomatic Infants>=35 Weeks Without Empiric Antibiotics. Pediatrics.
    • Keywords: Administration/Practice Management
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-2212
      Issue No: Vol. 140, No. 4 (2017)
  • Contribution of Cost of Preterm Infants to the Total Cost of Infant Health
           Care in the United States
    • Authors: Kirby R. S.
      Keywords: Fetus/Newborn Infant, Birth Defects, Health Information Technology, Electronic Health Records
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-2240
      Issue No: Vol. 140, No. 4 (2017)
  • Fowler KA, Dahlberg LL, Haileyesus T, et al. Childhood Firearm Injuries in
           the United States. Pediatrics. 2017;140(1):e20163486
    • Keywords: Injury, Violence & Poison Prevention, Firearms
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-2298
      Issue No: Vol. 140, No. 4 (2017)
  • Re: Fruit Juice and Child Health
    • Authors: Freedman, S. B; Tarr, P. I, Mahajan, P.
      Keywords: Administration/Practice Management
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-2301A
      Issue No: Vol. 140, No. 4 (2017)
  • Authors Response
    • Authors: Abrams, S. A; Daniels, S. R, Heyman, M. B.
      Keywords: Administration/Practice Management
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-2301B
      Issue No: Vol. 140, No. 4 (2017)
  • AAP Publications Retired and Reaffirmed
    • Keywords: Administration/Practice Management
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-2379
      Issue No: Vol. 140, No. 4 (2017)
  • Weighing All Patients in Kilograms
    • Keywords: Emergency Medicine, Endorsed Documents
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-2476
      Issue No: Vol. 140, No. 4 (2017)
  • Infectious Diseases Associated With Organized Sports and Outbreak Control
      Abstract: Participation in organized sports has a variety of health benefits but also has the potential to expose the athlete to a variety of infectious diseases, some of which may produce outbreaks. Major risk factors for infection include skin-to-skin contact with athletes who have active skin infections, environmental exposures and physical trauma, and sharing of equipment and contact with contaminated fomites. Close contact that is intrinsic to team sports and psychosocial factors associated with adolescence are additional risks. Minimizing risk requires leadership by the organized sports community (including the athlete’s primary care provider) and depends on outlining key hygiene behaviors, recognition, diagnosis, and treatment of common sports-related infections, and the implementation of preventive interventions.
      Keywords: Committee on Infectious Diseases, Council on Sports Medicine and Fitness, Infectious Disease
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-2477
      Issue No: Vol. 140, No. 4 (2017)
  • Pediatrician Competency in Breastfeeding Support Has Room for Improvement
    • Authors: Meek J. Y.
      Keywords: Medical Education, Nutrition, Breastfeeding
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-2509
      Issue No: Vol. 140, No. 4 (2017)
  • Recommendations for Prevention and Control of Influenza in Children, 2017
           - 2018
      Abstract: This statement updates the recommendations for routine use of the seasonal influenza vaccine and antiviral medications for the prevention and treatment of influenza in children. The American Academy of Pediatrics recommends annual seasonal influenza immunization for everyone 6 months and older, including children and adolescents. Highlights for the upcoming 2017–2018 season include the following:1. Annual universal influenza immunization is indicated with either a trivalent or quadrivalent (no preference) inactivated vaccine;2. The 2017–2018 influenza A (H1N1) vaccine strain differs from that contained in the 2016–2017 seasonal vaccines. The 2017–2018 influenza A (H3N2) vaccine strain and influenza B vaccine strains included in the trivalent and quadrivalent vaccines are the same as those contained in the 2016–2017 seasonal vaccines: a. trivalent vaccine contains an A/Michigan/45/2015 (H1N1)pdm09-like virus, an A/Hong Kong/4801/2014 (H3N2)-like virus, and a B/Brisbane/60/2008-like virus (B/Victoria lineage); and b. quadrivalent vaccine contains an additional B virus (B/Phuket/3073/2013-like virus [B/Yamagata lineage]);3. Quadrivalent live attenuated influenza vaccine (LAIV4) is not recommended for use in any setting in the United States during the 2017–2018 influenza season. This interim recommendation, originally made in 2016, followed observational data from the US Influenza Vaccine Effectiveness Network revealing that LAIV4 performed poorly against influenza A (H1N1)pdm09 viruses in recent influenza seasons;4. All children with an egg allergy of any severity can receive an influenza vaccine without any additional precautions beyond those recommended for any vaccine;5. All health care personnel should receive an annual seasonal influenza vaccine, a crucial step in preventing influenza and reducing health care–associated influenza infections, because health care personnel often care for individuals at high risk for influenza-related complications; and6. Pediatricians should attempt to promptly identify children suspected of having influenza infection for timely initiation of antiviral treatment, when indicated, to reduce morbidity and mortality. Best results are seen when treated within 48 hours of symptom onset.
      Keywords: Infectious Disease, Influenza
      PubDate: 2017-10-02T01:01:08-07:00
      DOI: 10.1542/peds.2017-2550
      Issue No: Vol. 140, No. 4 (2017)
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