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Journal Cover Pediatrics
  [SJR: 3.226]   [H-I: 263]   [284 followers]  Follow
   Full-text available via subscription Subscription journal
   ISSN (Print) 0031-4005 - ISSN (Online) 1098-4275
   Published by American Academy of Pediatrics Homepage  [4 journals]
  • Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I.
           Practice Preparation, Identification, Assessment, and Initial Management
    • Authors: Zuckerbrot, R. A; Cheung, A, Jensen, P. S, Stein, R. E. K, Laraque, D, GLAD-PC STEERING GROUP
      Abstract: OBJECTIVES:To update clinical practice guidelines to assist primary care (PC) clinicians in the management of adolescent depression. This part of the updated guidelines is used to address practice preparation, identification, assessment, and initial management of adolescent depression in PC settings.METHODS:By using a combination of evidence- and consensus-based methodologies, guidelines were developed by an expert steering committee in 2 phases as informed by (1) current scientific evidence (published and unpublished) and (2) draft revision and iteration among the steering committee, which included experts, clinicians, and youth and families with lived experience.RESULTS:Guidelines were updated for youth aged 10 to 21 years and correspond to initial phases of adolescent depression management in PC, including the identification of at-risk youth, assessment and diagnosis, and initial management. The strength of each recommendation and its evidence base are summarized. The practice preparation, identification, assessment, and initial management section of the guidelines include recommendations for (1) the preparation of the PC practice for improved care of adolescents with depression; (2) annual universal screening of youth 12 and over at health maintenance visits; (3) the identification of depression in youth who are at high risk; (4) systematic assessment procedures by using reliable depression scales, patient and caregiver interviews, and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria; (5) patient and family psychoeducation; (6) the establishment of relevant links in the community, and (7) the establishment of a safety plan.CONCLUSIONS:This part of the guidelines is intended to assist PC clinicians in the identification and initial management of adolescents with depression in an era of great clinical need and shortage of mental health specialists, but they cannot replace clinical judgment; these guidelines are not meant to be the sole source of guidance for depression management in adolescents. Additional research that addresses the identification and initial management of youth with depression in PC is needed, including empirical testing of these guidelines.
      Keywords: Developmental/Behavioral Pediatrics, Psychosocial Issues, Adolescent Health/Medicine
      PubDate: 2018-03-01T01:01:30-08:00
      DOI: 10.1542/peds.2017-4081
      Issue No: Vol. 141, No. 3 (2018)
  • Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part II.
           Treatment and Ongoing Management
    • Authors: Cheung, A. H; Zuckerbrot, R. A, Jensen, P. S, Laraque, D, Stein, R. E. K, GLAD-PC STEERING GROUP
      Abstract: OBJECTIVES:To update clinical practice guidelines to assist primary care (PC) in the screening and assessment of depression. In this second part of the updated guidelines, we address treatment and ongoing management of adolescent depression in the PC setting.METHODS:By using a combination of evidence- and consensus-based methodologies, the guidelines were updated in 2 phases as informed by (1) current scientific evidence (published and unpublished) and (2) revision and iteration among the steering committee, including youth and families with lived experience.RESULTS:These updated guidelines are targeted for youth aged 10 to 21 years and offer recommendations for the management of adolescent depression in PC, including (1) active monitoring of mildly depressed youth, (2) treatment with evidence-based medication and psychotherapeutic approaches in cases of moderate and/or severe depression, (3) close monitoring of side effects, (4) consultation and comanagement of care with mental health specialists, (5) ongoing tracking of outcomes, and (6) specific steps to be taken in instances of partial or no improvement after an initial treatment has begun. The strength of each recommendation and the grade of its evidence base are summarized.CONCLUSIONS:The Guidelines for Adolescent Depression in Primary Care cannot replace clinical judgment, and they should not be the sole source of guidance for adolescent depression management. Nonetheless, the guidelines may assist PC clinicians in the management of depressed adolescents in an era of great clinical need and a shortage of mental health specialists. Additional research concerning the management of depressed youth in PC is needed, including the usability, feasibility, and sustainability of guidelines, and determination of the extent to which the guidelines actually improve outcomes of depressed youth.
      Keywords: Developmental/Behavioral Pediatrics, Psychosocial Issues, Adolescent Health/Medicine
      PubDate: 2018-03-01T01:01:30-08:00
      DOI: 10.1542/peds.2017-4082
      Issue No: Vol. 141, No. 3 (2018)
  • Learning From National and State Trends in Sudden Unexpected Infant Death
    • Authors: Carlin, R; Moon, R. Y.
      Keywords: Fetus/Newborn Infant, SIDS
      PubDate: 2018-03-01T01:01:30-08:00
      DOI: 10.1542/peds.2017-4083
      Issue No: Vol. 141, No. 3 (2018)
  • Revisiting the Viability of the Developmental-Behavioral Health Care
    • Authors: Leslie, L. K; Baum, R, Turner, A.
      Keywords: Medical Education, Workforce, Developmental/Behavioral Pediatrics
      PubDate: 2018-03-01T01:01:30-08:00
      DOI: 10.1542/peds.2017-4132
      Issue No: Vol. 141, No. 3 (2018)
  • AAP Publication Reaffirmed
    • Keywords: Nutrition, Sports Medicine/Physical Fitness
      PubDate: 2018-03-01T01:01:30-08:00
      DOI: 10.1542/peds.2017-4173
      Issue No: Vol. 141, No. 3 (2018)
  • Inhaled Nitric Oxide for Preterm Infants: What Can Change Our
    • Authors: Soll R. F.
      Keywords: Pulmonology, Respiratory Tract
      PubDate: 2018-03-01T01:01:30-08:00
      DOI: 10.1542/peds.2017-4214
      Issue No: Vol. 141, No. 3 (2018)
  • Carrying Forward a Legacy: A Tribute to Jerold F. Lucey, MD, Pediatrics
           Editor-in-Chief (1974-2008)
    • Authors: First, L. R; Kemper, A. R.
      Keywords: Medical Education
      PubDate: 2018-03-01T01:01:30-08:00
      DOI: 10.1542/peds.2017-4216
      Issue No: Vol. 141, No. 3 (2018)
  • Failure Is an Option: Using Errors as Teaching Opportunities
    • Authors: Beck, J. B; McGrath, C, Toncray, K, Rooholamini, S. N.
      Keywords: Medical Education, Teaching/Curriculum Development
      PubDate: 2018-03-01T01:01:30-08:00
      DOI: 10.1542/peds.2017-4222
      Issue No: Vol. 141, No. 3 (2018)
  • Recommended Childhood and Adolescent Immunization Schedules: United
           States, 2018
      Keywords: Infectious Disease, Vaccine/Immunization
      PubDate: 2018-03-01T01:01:30-08:00
      DOI: 10.1542/peds.2018-0083
      Issue No: Vol. 141, No. 3 (2018)
  • Neonatal Jaundice: Improved Quality and Cost Savings After Implementation
           of a Standard Pathway
    • Authors: Romero, H. M; Ringer, C, Leu, M. G, Beardsley, E, Kelly, K, Fesinmeyer, M. D, Haaland, W. L, Johnson, J. B, Migita, D.
      Abstract: OBJECTIVES:Seattle Children’s Hospital sought to optimize the value equation for neonatal jaundice patients by creating a standard care pathway.METHODS:An evidence-based pathway for management of neonatal jaundice was created. This included multidisciplinary team assembly, comprehensive literature review, creation of a treatment algorithm and computer order sets, formulation of goals and metrics, roll-out of an education program for end users, and ongoing pathway improvement. The pathway was implemented on May 31, 2012. Quality metrics before and after implementation were compared. External data were used to analyze cost impacts.RESULTS:Significant improvements were achieved across multiple quality dimensions. Time to recovery decreased: mean length of stay was 1.30 days for 117 prepathway patients compared with 0.87 days for 69 postpathway patients (P < .001). Efficiency was enhanced: mean time to phototherapy initiation was 101.26 minutes for 14 prepathway patients compared with 54.67 minutes for 67 postpathway patients (P = .03). Care was less invasive: intravenous fluid orders were reduced from 80% to 44% (P < .001). Inpatient use was reduced: 66% of prepathway patients were admitted from the emergency department to inpatient care, compared with 50% of postpathway patients (P = .01). There was no increase in the readmission rate. These achievements translated to statistically significant cost reductions in total charges, as well as in the following categories: intravenous fluids, laboratory, room cost, and emergency department charges.CONCLUSIONS:An evidence-based standard care pathway for neonatal jaundice can significantly improve multiple dimensions of value, including reductions in cost and length of stay.
      Keywords: Administration/Practice Management, Quality Improvement, Fetus/Newborn Infant, Hyperbilirubinemia
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2016-1472
      Issue No: Vol. 141, No. 3 (2018)
  • Angiomatoid Fibrous Histiocytoma With Paraneoplastic Platelet Storage Pool
    • Authors: Morgan, L. M; Miller, E. R, Raj, A. B, Coventry, S. C, Elster, J. D.
      Abstract: Angiomatoid fibrous histiocytoma is a rare soft tissue tumor usually discovered in young individuals. This tumor is often mistaken for a hematoma and typically misdiagnosed. It is commonly found in the extremities and may be associated with a site of recent or previous trauma. Characteristic histology includes nodules of histiocytoid spindle cells with pseudoangiomatoid spaces, fibrous pseudocapsules, and lymphoid cuffing. We describe the case of an 8-year-old girl who presented after incision and drainage of a superficial thigh lesion and experienced subsequent chronic bleeding of her wound. Her initial presentation was concerning for an underlying bleeding disorder, and laboratory analysis uncovered a paraneoplastic platelet function disorder that resolved with therapy of the primary tumor.
      Keywords: Hematology/Oncology, Hospital Medicine
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2016-2065
      Issue No: Vol. 141, No. 3 (2018)
  • When Lightning Strikes Twice in Pediatrics: Case Report and Review of
           Recurrent Myocarditis
    • Authors: Floyd, A; Lal, A, Molina, K, Puchalski, M, Miller, D, May, L.
      Abstract: Myocarditis is an important but incompletely understood cause of cardiac dysfunction. Children with fulminant myocarditis often require inotropic or mechanical circulatory support, and researchers in some studies suggest that up to 42% of children who die suddenly have evidence of myocarditis. Recurrent myocarditis is extremely rare, and the vast majority of reported cases involve adult patients. Pediatric providers who suspect a recurrence of myocarditis have limited evidence to guide patient management because the literature in this domain is sparse. Here we present a unique, illustrative pediatric case of recurrent myocarditis. A 14-year-old boy presented for the second time in 2 years with a clinical history strongly suggestive of myocarditis. Although myocarditis was suggested in the results of cardiac MRI, no pathogen was identified during his first presentation. During his second episode of myocarditis, parvovirus was confirmed by polymerase chain reaction testing of an endomyocardial specimen that also met Dallas criteria for myocarditis. With each presentation, he had decreased ventricular function that subsequently normalized. To the best of our knowledge, there are no reports of recurrent myocarditis in children in whom the diagnosis was confirmed by using MRI and/or biopsy data. Reviewing this distinctive case and the existing literature may help characterize this entity and raise awareness among care providers.
      Keywords: Cardiology
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2016-4096
      Issue No: Vol. 141, No. 3 (2018)
  • Airway Autoimmune Inflammatory Response (AAIR) Syndrome: An
           Asthma-Autoimmune Overlap Disorder'
    • Authors: Spencer, C. Y; Millman, J, Veiga, K, Vicencio, A. G.
      Abstract: Asthma encompasses numerous phenotypes that may require alternate approaches to diagnosis and therapy, particularly for patients whose symptoms remain poorly controlled despite escalating treatment. We describe 3 patients with apparent asthma who demonstrated unusual findings on cryobiopsy by flexible bronchoscopy and responded to therapy directed against autoimmune disease.
      Keywords: Pulmonology, Respiratory Tract, Allergy/Immunology, Asthma
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-0138
      Issue No: Vol. 141, No. 3 (2018)
  • Well-Appearing Newborn With a Vesiculobullous Rash at Birth
    • Authors: Stewart, S. E; Lin, J. L, Everhart, J. L, Pham, T. H, Marqueling, A. L, Rieger, K. E, Hilgenberg, S. L.
      Abstract: A term, appropriate-for-gestational-age, male infant born via normal spontaneous vaginal delivery presented at birth with a full-body erythematous, vesiculobullous rash. He was well-appearing with normal vital signs and hypoglycemia that quickly resolved. His father had a history of herpes labialis. His mother had an episode of herpes zoster during pregnancy and a prolonged rupture of membranes that was adequately treated. The patient underwent a sepsis workup, including 2 attempted but unsuccessful lumbar punctures, and was started on broad-spectrum antibiotics and acyclovir, given concerns about bacterial or viral infection. The rash evolved over the course of several days. Subsequent workup, with particular attention to his history and presentation, led to his diagnosis.
      Keywords: Dermatology, Infectious Disease
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-0236
      Issue No: Vol. 141, No. 3 (2018)
  • Beckwith-Wiedemann Syndrome: Partnership in the Diagnostic Journey of a
           Rare Disorder
    • Authors: Davlin, A. S; Clarkin, C. M, Kalish, J. M.
      Keywords: Administration/Practice Management, Interpersonal & Communication Skills, Genetics
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-0475
      Issue No: Vol. 141, No. 3 (2018)
  • Cost-Effectiveness of Supplemental Donor Milk Versus Formula for Very Low
           Birth Weight Infants
    • Authors: Trang, S; Zupancic, J. A. F, Unger, S, Kiss, A, Bando, N, Wong, S, Gibbins, S, OConnor, D. L, on behalf of the GTA DoMINO Feeding Group
      Abstract: OBJECTIVES:To determine the cost-effectiveness of supplemental donor human milk (DHM) versus preterm formula (PTF) for very low birth weight (VLBW,
      Keywords: Fetus/Newborn Infant, Neonatology, Nutrition
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-0737
      Issue No: Vol. 141, No. 3 (2018)
  • Epilepsy in Children After Pandemic Influenza Vaccination
    • Authors: Haberg, S. E; Aaberg, K. M, Suren, P, Trogstad, L, Ghaderi, S, Stoltenberg, C, Magnus, P, Bakken, I. J.
      Abstract: OBJECTIVES:To determine if pandemic influenza vaccination was associated with an increased risk of epilepsy in children.METHODS:Information from Norwegian registries from 2006 through 2014 on all children
      Keywords: Infectious Disease, Influenza, Vaccine/Immunization
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-0752
      Issue No: Vol. 141, No. 3 (2018)
  • A Quality-Improvement Initiative to Reduce NICU Transfers for Neonates at
           Risk for Hypoglycemia
    • Authors: LeBlanc, S; Haushalter, J, Seashore, C, Wood, K. S, Steiner, M. J, Sutton, A. G.
      Abstract: BACKGROUND AND OBJECTIVE:Neonatal hypoglycemia is a common problem, often requiring management in the NICU. Nonpharmacologic interventions, including early breastfeeding and skin-to-skin care (SSC), may prevent hypoglycemia and the need to escalate care. Our objective was to maintain mother-infant dyads in the mother-infant unit by decreasing hypoglycemia resulting in NICU transfer.METHODS:Inborn infants ≥35 weeks’ gestation with at least 1 risk factor for hypoglycemia were included. Using quality-improvement methodology, a bundle for at-risk infants was implemented, which included a protocol change focusing on early SSC, early feeding, and obtaining a blood glucose measurement in asymptomatic infants at 90 minutes. The primary outcome was the overall transfer rate of at-risk infants to the NICU. Secondary outcomes were related to protocol adherence. Balancing measures, including the rate of symptomatic hypoglycemia and sepsis evaluations, were monitored. Statistical process control charts using standard interpretation rules were used to monitor for improvement in key aims.RESULTS:For infants at risk for hypoglycemia, the NICU transfer rate decreased from 17% to 3% overall. Documented early feeding and SSC in at-risk newborns increased. The percent of at-risk infants transferred to the NICU who did not require intravenous dextrose decreased from 5% at baseline to 0.7% after intervention. There were no adverse outcomes observed in the period before or after the intervention.CONCLUSIONS:The implementation of a quality-improvement intervention promoting SSC and early feeding in at-risk infants was associated with a decreased rate of transfer to the NICU for hypoglycemia.
      Keywords: Administration/Practice Management, Quality Improvement, Fetus/Newborn Infant, Neonatology
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-1143
      Issue No: Vol. 141, No. 3 (2018)
  • Quality-Improvement Effort to Reduce Hypothermia Among High-Risk Infants
           on a Mother-Infant Unit
    • Authors: Andrews, C; Whatley, C, Smith, M, Brayton, E. C, Simone, S, Holmes, A. V.
      Abstract: BACKGROUND AND OBJECTIVE:Neonatal hypothermia is common in low birth weight (LBW) (
      Keywords: Administration/Practice Management, Quality Improvement
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-1214
      Issue No: Vol. 141, No. 3 (2018)
  • Health and Care Utilization of Transgender and Gender Nonconforming Youth:
           A Population-Based Study
    • Authors: Rider, G. N; McMorris, B. J, Gower, A. L, Coleman, E, Eisenberg, M. E.
      Abstract: BACKGROUND:Transgender and gender nonconforming (TGNC) adolescents have difficulty accessing and receiving health care compared with cisgender youth, yet research is limited by a reliance on small and nonrepresentative samples. This study's purpose was to examine mental and physical health characteristics and care utilization between youth who are TGNC and cisgender and across perceived gender expressions within the TGNC sample.METHODS:Data came from the 2016 Minnesota Student Survey, which consisted of 80 929 students in ninth and 11th grade (n = 2168 TGNC, 2.7%). Students self-reported gender identity, perceived gender expression, 4 health status measures, and 3 care utilization measures. Chi-squares and multiple analysis of covariance tests (controlling for demographic covariates) were used to compare groups.RESULTS:We found that students who are TGNC reported significantly poorer health, lower rates of preventive health checkups, and more nurse office visits than cisgender youth. For example, 62.1% of youth who are TGNC reported their general health as poor, fair, or good versus very good or excellent, compared with 33.1% of cisgender youth (2 = 763.7, P < .001). Among the TGNC sample, those whose gender presentation was perceived as very congruent with their birth-assigned sex were less likely to report poorer health and long-term mental health problems compared with those with other gender presentations.CONCLUSIONS:Health care utilization differs between TGNC versus cisgender youth and across gender presentations within TGNC youth. With our results, we suggest that health care providers should screen for health risks and identify barriers to care for TGNC youth while promoting and bolstering wellness within this community.
      Keywords: Adolescent Health/Medicine
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-1683
      Issue No: Vol. 141, No. 3 (2018)
  • Structure and Functions of Pediatric Aerodigestive Programs: A Consensus
    • Authors: Boesch, R. P; Balakrishnan, K, Acra, S, Benscoter, D. T, Cofer, S. A, Collaco, J. M, Dahl, J. P, Daines, C. L, DeAlarcon, A, DeBoer, E. M, Deterding, R. R, Friedlander, J. A, Gold, B. D, Grothe, R. M, Hart, C. K, Kazachkov, M, Lefton-Greif, M. A, Miller, C. K, Moore, P. E, Pentiuk, S, Peterson-Carmichael, S, Piccione, J, Prager, J. D, Putnam, P. E, Rosen, R, Rutter, M. J, Ryan, M. J, Skinner, M. L, Torres-Silva, C, Wootten, C. T, Zur, K. B, Cotton, R. T, Wood, R. E.
      Abstract: Aerodigestive programs provide coordinated interdisciplinary care to pediatric patients with complex congenital or acquired conditions affecting breathing, swallowing, and growth. Although there has been a proliferation of programs, as well as national meetings, interest groups and early research activity, there is, as of yet, no consensus definition of an aerodigestive patient, standardized structure, and functions of an aerodigestive program or a blueprint for research prioritization. The Delphi method was used by a multidisciplinary and multi-institutional panel of aerodigestive providers to obtain consensus on 4 broad content areas related to aerodigestive care: (1) definition of an aerodigestive patient, (2) essential construct and functions of an aerodigestive program, (3) identification of aerodigestive research priorities, and (4) evaluation and recognition of aerodigestive programs and future directions. After 3 iterations of survey, consensus was obtained by either a supermajority of 75% or stability in median ranking on 33 of 36 items. This included a standard definition of an aerodigestive patient, level of participation of specific pediatric disciplines in a program, essential components of the care cycle and functions of the program, feeding and swallowing assessment and therapy, procedural scope and volume, research priorities and outcome measures, certification, coding, and funding. We propose the first consensus definition of the aerodigestive care model with specific recommendations regarding associated personnel, infrastructure, research, and outcome measures. We hope that this may provide an initial framework to further standardize care, develop clinical guidelines, and improve outcomes for aerodigestive patients.
      Keywords: Administration/Practice Management, Interdisciplinary Teams, System-Based Practice
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-1701
      Issue No: Vol. 141, No. 3 (2018)
  • Families Experiences With Pediatric Family-Centered Rounds: A Systematic
    • Authors: Rea, K. E; Rao, P, Hill, E, Saylor, K. M, Cousino, M. K.
      Abstract: CONTEXT:Family-centered rounding (FCR) is of increasing importance in pediatric medicine. Although researchers have begun to understand the effect of FCR on providers and systematic health care outcomes, we provide a systematic review of the literature regarding families’ experiences with FCR.OBJECTIVE:To systematically review patient and family experiences with pediatric FCR.DATA SOURCES:Our data sources included PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Scopus, and Embase.STUDY SELECTION:Inclusion criteria included publication in a peer-reviewed journal between January 2007 and February 2017, written in the English language, pediatric population (patients 0–21 years), and specific measurement of a families' experience with FCR.DATA EXRACTIONData extracted were sample size, participating medical unit, measures of family experience, and overall results of family experience.RESULTS:Twenty-eight studies were included. It is unclear whether participation in FCR increases family satisfaction compared with standard rounds; however, families report a strong desire to participate in FCR. Family benefits of FCR included increased understanding of information and confidence in the medical team, as well as reduced parental anxiety.LIMITATIONS:There were only 2 studies in which researchers examined pediatric patients’ experiences with FCR, and literature on the communication needs of non–English-speaking families was also limited.CONCLUSIONS:Overall, it is suggested that families positively perceive their experience with FCR, although more research is needed to determine if satisfaction is greater in FCR versus standard rounds as well as to better understand different perspectives of adolescent patients and non–English-speaking families.
      Keywords: Administration/Practice Management, Interpersonal & Communication Skills, System-Based Practice
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-1883
      Issue No: Vol. 141, No. 3 (2018)
  • Left Axis Deviation in Children Without Previously Known Heart Disease
    • Authors: Schneider, A. E; Cannon, B. C, Johnson, J. N, Ackerman, M. J, Wackel, P. L.
      Abstract: BACKGROUND:Left axis deviation (LAD) discovered in children via electrocardiogram (ECG) is uncommon but can be associated with heart disease (HD). The optimal diagnostic approach in a seemingly healthy child with LAD is unclear. We sought to better stratify which patients with LAD but without previously known HD may warrant additional workup.METHODS:A retrospective chart review was performed to identify patients ≥1 to
      Keywords: Cardiology, Cardiovascular Disorders
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-1970
      Issue No: Vol. 141, No. 3 (2018)
  • Parents Refusing Dialysis for a 3-Month-Old With Renal Failure
    • Authors: Willig, L; Paquette, E, Hester, D. M, Warady, B. A, Lantos, J. D.
      Abstract: A 3-month-old boy with failure to thrive was referred to a nephrology clinic after a diagnostic workup for failure to thrive revealed a serum urea nitrogen level of 95 mg/dL and creatinine level of 3.6 mg/dL. A renal ultrasound revealed marked bilateral hydronephrosis with little remaining renal cortex in either kidney. A voiding cystourethrogram revealed evidence of posterior urethral valves. The child had no evident comorbidities. Fulguration of the valves was successfully performed but did not lead to improvement in kidney function. The nephrologists recommended the initiation of dialysis with the hope that the child would be able to receive a kidney transplant in the future. After careful consideration, the family stated that they did not want this child to suffer with a lifetime of dialysis and transplant care. They were also concerned about the impact of this child’s illness on their other 2 children and their family. They requested that their son be provided with palliative care only. Experts in nephrology, bioethics, and critical care discuss the ethical issues raised by this parental request.
      Keywords: Ethics/Bioethics, Nephrology
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-2096
      Issue No: Vol. 141, No. 3 (2018)
  • A Workforce Survey on Developmental-Behavioral Pediatrics
    • Authors: Bridgemohan, C; Bauer, N. S, Nielsen, B. A, DeBattista, A, Ruch-Ross, H. S, Paul, L. B, Roizen, N.
      Abstract: BACKGROUND AND OBJECTIVES:Developmental-behavioral conditions are common, affecting ~15% of US children. The prevalence and complexity of these conditions are increasing despite long wait times and a limited pipeline of new providers. We surveyed a convenience sample of the developmental-behavioral pediatric (DBP) workforce to determine current practices, workforce trends, and future needs.METHODS:An electronic survey was e-mailed to 1568 members of the American Academy of Pediatrics Section on Developmental and Behavioral Pediatrics and Council on Children with Disabilities, the Society for Developmental and Behavioral Pediatrics, and the National Association of Pediatric Nurse Practitioners Developmental and Behavioral Mental Health Special Interest Group.RESULTS:The response rate was 48%. There were 411 fellowship-trained physicians, 147 nonfellowship-trained physicians, and 125 nurse practitioners; 61% were women, 79% were white, and 5% were Hispanic. Physicians had a mean of 29 years since medical school graduation, and one-third planned to retire in 3 to 5 years. Nurse practitioners were earlier in their careers. Respondents reported long wait times for new appointments, clinician burnout, increased patient complexity and up to 50% additional time spent per visit in nonreimbursed clinical-care activities. Female subspecialists spent more time per visit in billable and nonbillable components of clinical care.CONCLUSIONS:The DBP workforce struggles to meet current service demands, with long waits for appointments, increased complexity, and high volumes of nonreimbursed care. Sex-based practice differences must be considered in future planning. The viability of the DBP subspecialty requires strategies to maintain and expand the workforce, improve clinical efficiency, and prevent burnout.
      Keywords: Medical Education, Workforce, Developmental/Behavioral Pediatrics
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-2164
      Issue No: Vol. 141, No. 3 (2018)
  • Nutrient Intake in the First Two Weeks of Life and Brain Growth in Preterm
    • Authors: Schneider, J; Fischer Fumeaux, C. J, Duerden, E. G, Guo, T, Foong, J, Graz, M. B, Hagmann, P, Chakravarty, M. M, Hüppi, P. S, Beauport, L, Truttmann, A. C, Miller, S. P.
      Abstract: BACKGROUND:Optimizing early nutritional intake in preterm neonates may promote brain health and neurodevelopment through enhanced brain maturation. Our objectives were (1) to determine the association of energy and macronutrient intake in the first 2 weeks of life with regional and total brain growth and white matter (WM) maturation, assessed by 3 serial MRI scans in preterm neonates; (2) to examine how critical illness modifies this association; and (3) to investigate the relationship with neurodevelopmental outcomes.METHODS:Forty-nine preterm neonates (21 boys, median [interquartile range] gestational age: 27.6 [2.3] weeks) were scanned serially at the following median postmenstrual weeks: 29.4, 31.7, and 41. The total brain, basal nuclei, and cerebellum were semiautomatically segmented. Fractional anisotropy was extracted from diffusion tensor imaging data. Nutritional intake from day of life 1 to 14 was monitored and clinical factors were collected.RESULTS:Greater energy and lipid intake predicted increased total brain and basal nuclei volumes over the course of neonatal care to term-equivalent age. Similarly, energy and lipid intake were significantly associated with fractional anisotropy values in selected WM tracts. The association of ventilation duration with smaller brain volumes was attenuated by higher energy intake. Brain growth predicted psychomotor outcome at 18 months’ corrected age.CONCLUSIONS:In preterm neonates, greater energy and enteral feeding during the first 2 weeks of life predicted more robust brain growth and accelerated WM maturation. The long-lasting effect of early nutrition on neurodevelopment may be mediated by enhanced brain growth. Optimizing nutrition in preterm neonates may represent a potential avenue to mitigate the adverse brain health consequences of critical illness.
      Keywords: Fetus/Newborn Infant, Neonatology, Nutrition
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-2169
      Issue No: Vol. 141, No. 3 (2018)
  • Antibiotic Prophylaxis for Children With Sickle Cell Anemia
    • Authors: Reeves, S. L; Tribble, A. C, Madden, B, Freed, G. L, Dombkowski, K. J.
      Abstract: BACKGROUND:Children with sickle cell anemia (SCA) are at increased risk for invasive pneumococcal disease; antibiotic prophylaxis significantly reduces this risk. We calculated the proportion of children with SCA who received ≥300 days of antibiotic prophylaxis and identified predictors of such receipt.METHODS:Children aged 3 months to 5 years with SCA were identified by the presence of 3 or more Medicaid claims with a diagnosis of SCA within a calendar year (2005–2012) in Florida, Illinois, Louisiana, Michigan, South Carolina, and Texas. Receipt of antibiotics was identified through claims for filled prescriptions. The outcome, receipt of ≥300 days of antibiotics, was assessed annually by using varying classifications of antibiotics. By using logistic regression with generalized estimating equations, we estimated the odds of receiving ≥300 days of antibiotics, with potential predictors of age, sex, year, state, and health services use.RESULTS:A total of 2821 children contributed 5014 person-years. Overall, only 18% of children received ≥300 days of antibiotics. Each additional sickle cell disease-related outpatient visit (odds ratio = 1.01, 95% confidence interval: 1.01–1.02) and well-child visit (odds ratio = 1.08, 95% confidence interval: 1.02–1.13) was associated with incrementally increased odds of receiving ≥300 days of antibiotics.CONCLUSIONS:Despite national recommendations and proven lifesaving benefit, antibiotic prophylaxis rates are low among children with SCA. Numerous health care encounters may offer an opportunity for intervention; in addition, such interventions likely need to include social factors that may affect the ability for a child to receive and adhere to antibiotic prophylaxis.
      Keywords: Hematology/Oncology, Blood Disorders, Infectious Disease
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-2182
      Issue No: Vol. 141, No. 3 (2018)
  • Variation in Anthropometric Status and Growth Failure in Low- and
           Middle-Income Countries
    • Authors: Mejia-Guevara, I; Corsi, D. J, Perkins, J. M, Kim, R, Subramanian, S. V.
      Abstract: BACKGROUND:Addressing anthropometric failure in low- and middle-income countries can have 2 targets of inference: addressing differences between individuals within populations (Wpop) or differences between populations (Bpop). We present a multilevel framework to apply both targets of inference simultaneously and quantify the extent to which variation in anthropometric status and growth failure is reflective of undernourished children or undernourished populations.METHODS:Cross-sectional data originated from the Demographic and Health Surveys program, covering children under age 5 from 57 countries surveyed between 2001 and 2015.RESULTS:A majority of variation in child anthropometric status and growth failure was attributable to Wpop-associated differences, accounting for 89%, 83%, and 85% of the variability in z scores for height for age, weight for age, and weight for height. Bpop-associated differences (communities, regions, and countries combined) were associated with 11%, 17%, and 15% of the variation in height-for-age z score, weight-for-age z score, and weight-for-height z score. Prevalence of anthropometric failure was closely correlated with mean levels of height and weight. Approximately 1% of Wpop variability, compared with 30% to 50% of the Bpop variability, was explained by mean values of maternal correlates of anthropometric status and failure. Although there is greater explanatory power Bpop, this varied because of modifiability of what constitutes population.CONCLUSIONS:Our results suggest that universal strategies to prevent future anthropometric failure in populations combined with targeted strategies to address both the impending and existing burden among children are needed.
      Keywords: Developmental/Behavioral Pediatrics, Growth/Development Milestones, Infectious Disease, Epidemiology
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-2183
      Issue No: Vol. 141, No. 3 (2018)
  • The Current Pediatric Telehealth Landscape
    • Authors: Olson, C. A; McSwain, S. D, Curfman, A. L, Chuo, J.
      Abstract: The growth and evolution of telehealth are opening new avenues for efficient, effective, and affordable pediatric health care services in the United States and around the world. However, there remain several barriers to the integration of telehealth into current practice. Establishing the necessary technical, administrative, and operational infrastructure can be challenging, and there is a relative lack of rigorous research data to demonstrate that telehealth is indeed delivering on its promise. That being said, a knowledge of the current state of pediatric telehealth can overcome many of these barriers, and programs are beginning to collaborate through a new pediatric telehealth research network called Supporting Pediatric Research on Outcomes and Utilization of Telehealth (SPROUT). In this report, we provide an update on the landscape of pediatric telehealth and summarize the findings of a recent SPROUT study in which researchers assessed pediatric telehealth programs across the United States. There were >50 programs representing 30 states that provided data on their implementation barriers, staffing resources, operational processes, technology, and funding sources to establish a base understanding of pediatric telehealth infrastructure on a national level. Moving forward, the database created from the SPROUT study will also serve as a foundation on which multicenter studies will be developed and facilitated in an ongoing effort to firmly establish the value of telehealth in pediatric health care.
      Keywords: Administration/Practice Management, Health Information Technology, Telehealth Care
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-2334
      Issue No: Vol. 141, No. 3 (2018)
  • Seeking Professional Resilience
    • Authors: Rosenberg A. R.
      Keywords: Medical Education, Workforce
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-2388
      Issue No: Vol. 141, No. 3 (2018)
  • Disparities in Outcomes and Resource Use After Hospitalization for Cardiac
           Surgery by Neighborhood Income
    • Authors: Anderson, B. R; Fieldston, E. S, Newburger, J. W, Bacha, E. A, Glied, S. A.
      Abstract: BACKGROUND:Significant disparities exist between patients of different races and with different family incomes; less is understood regarding community-level factors on outcomes.METHODS:In this study, we used linked data from the Pediatric Health Information System database and the US Census Bureau to examine associations between median annual household income by zip code and mortality, length of stay, inpatient standardized costs, and costs per day, over and above the effects of race and payer, first for children undergoing cardiac surgery (2005–2015) and then for all pediatric discharges (2012–2015). Median community-level income was examined as continuous and categorical (by quartile) predictors. Hierarchical logistic and censored linear regression models were constructed. To these models, patient and surgical characteristics, year, race, payer, state, urban or rural designation, and center fixed effects were added.RESULTS:We identified 101 013 cardiac surgical (and 857 833 total) hospitalizations from 46 institutions. Children from the lowest-income neighborhoods who were undergoing cardiac surgery had 1.18 times the odds of mortality (95% confidence interval [CI]: 1.03 to 1.35), 7% longer lengths of stay (CI: 1% to 14%), and 7% higher standardized costs (CI: 1% to 14%) than children from the highest-income neighborhoods. Results for all children were similar, both with and without any major chronic conditions. The effects of neighborhood were only partially explained by differences in race, payer, or the centers at which patients received care. There were no differences in costs per day.CONCLUSIONS:Children from lower-income neighborhoods are at increased risk of mortality and use more resource intensive care than children from higher-income communities, even after accounting for disparities between races, payers, and centers.
      Keywords: Public Health, Cardiology, Cardiac Surgery
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-2432
      Issue No: Vol. 141, No. 3 (2018)
  • Child Health Outcomes After Presumptive Infection Treatment in Pregnant
           Women: A Randomized Trial
    • Authors: Hallamaa, L; Cheung, Y. B, Maleta, K, Luntamo, M, Ashorn, U, Gladstone, M, Kulmala, T, Mangani, C, Ashorn, P.
      Abstract: BACKGROUND AND OBJECTIVES:We showed earlier that presumptive infection treatment in pregnancy reduced the prevalence of neonatal stunting in a rural low-income setting. In this article, we assess how these gains were sustained and reflected in childhood growth, development, and mortality.METHODS:We enrolled 1320 pregnant Malawian women in a randomized trial and treated them for malaria and other infections with either 2 doses of sulfadoxine-pyrimethamine (SP) (control), monthly SP, or monthly sulfadoxine-pyrimethamine and 2 doses of azithromycin (AZI-SP). Child height or length and mortality were recorded at 1, 6, 12, 24, 36, 48, and 60 months and development at 60 months by using Griffith’s Mental Development Scales.RESULTS:Throughout follow-up, the mean child length was 0.4 to 0.7 cm higher (P < .05 at 1–12 months), the prevalence of stunting was 6 to 11 percentage points lower (P < .05 at 12–36 months), and the 5-year cumulative incidence of stunting was 13 percentage points lower (hazard ratio: 0.70, 95% confidence interval [CI]: 0.60 to 0.83, P < .001) in the AZI-SP group than in the control group. The mean developmental score was 3.8 points higher in the AZI-SP group than in the control group (95% CI: 1.1 to 6.4, P = .005). Total mortality during pregnancy and childhood was 15.3%, 15.1%, and 13.1% (P = .60) in the control, monthly SP, and AZI-SP groups, respectively. Postneonatal mortality (secondary outcome) was 5.5%, 3.3%, and 1.9%, respectively (risk ratio of AZI-SP versus control: 0.34, 95% CI: 0.15 to 0.76, P = .008).CONCLUSIONS:Provision of AZI-SP rather than 2 doses of SP during pregnancy reduced the incidence of stunting in childhood. AZI-SP during pregnancy also had a positive effect on child development and may have reduced postneonatal mortality.
      Keywords: Developmental/Behavioral Pediatrics, Growth/Development Milestones
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-2459
      Issue No: Vol. 141, No. 3 (2018)
  • Firearm Storage in Homes With Children With Self-Harm Risk Factors
    • Authors: Scott, J; Azrael, D, Miller, M.
      Abstract: OBJECTIVES:To describe firearm storage practices in homes with children who have versus do not have self-harm risk factors.METHODS:A cross-sectional analysis of a nationally representative probability-based online survey of US adults conducted in 2015 (n = 3949; response rate 55%). Respondents self-reported whether they lived with children and were a caretaker/health care decision-maker for a child. Household firearm ownership was ascertained for all respondents; how firearms were stored in homes with guns was asked of gun owning respondents only; all respondents were asked whether their child had a history of the following self-harm risk factors: depression, mental health conditions other than depression, or attention-deficit/hyperactivity disorder.RESULTS:Household firearms were present in 43.5% (95% confidence interval [CI]: 34.4–64.7) of homes with children who had a history of self-harm risk factors (n = 52), compared with 42.3% (95% CI: 35.2–49.7) of homes in which no child had self-harm risk factors (n = 411). Among parents or caretakers with firearms, 34.9% (95 % CI: 20.2–53.2) stored all guns locked and unloaded when they had a child with a history self-harm risk factors, compared with 31.8% (95% CI: 25.9–38.3) when none of their children had such a history.CONCLUSIONS:Millions of US children live in homes in which firearms are left loaded or unlocked or both. A child’s history of depression, mental health conditions other than depression, or attention-deficit/hyperactivity disorder does not appear to appreciably influence caretaker decisions about whether to (1) have firearms in the home, or (2) store all household firearms in accordance with American Academy of Pediatrics recommendations (ie, locked and unloaded).
      Keywords: Injury, Violence & Poison Prevention, Firearms
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-2600
      Issue No: Vol. 141, No. 3 (2018)
  • Television Format and Childrens Executive Function
    • Authors: Scarf, D; Hinten, A. E.
      Keywords: Media, Screen Time
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-2674
      Issue No: Vol. 141, No. 3 (2018)
  • Inhaled Nitric Oxide in Extremely Premature Neonates With Respiratory
           Distress Syndrome
    • Authors: Carey, W. A; Weaver, A. L, Mara, K. C, Clark, R. H.
      Abstract: BACKGROUND:Inhaled nitric oxide (iNO) is increasingly prescribed to extremely premature neonates with respiratory distress syndrome (RDS). Most of this off-label use occurs during the first week of life. We studied this practice, hypothesizing that it would not be associated with improved survival.METHODS:We queried the Pediatrix Medical Group Clinical Data Warehouse to identify all neonates born at 22 to 29 weeks’ gestation from 2004 to 2014. In our study sample, we included singletons who required mechanical ventilation for treatment of RDS and excluded those with anomalies. The primary outcome was death before discharge. Through a sequential risk set approach, each patient who received iNO during the first 7 days of life ("case patient") was matched by using propensity scores to a patient who had not received iNO at a chronological age before the case patient’s iNO initiation age (defined as the index age for the matched pair). The association between iNO status and in-hospital mortality was evaluated in a Cox proportional hazards regression model by using age as the time scale with patients entering the risk set at their respective index age.RESULTS:Among 37 909 neonates in our study sample, we identified 993 (2.6%) who received iNO. The 2 matched cohorts each contained 971 patients. We did not observe a significant association between iNO exposure and mortality (hazard ratio, 1.08; 95% confidence interval, 0.94–1.25; P = .29).CONCLUSIONS:Off-label prescription of iNO is not associated with reduced in-hospital mortality among extremely premature neonates with RDS.
      Keywords: Fetus/Newborn Infant, Neonatology, Pharmacology, Therapeutics
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-3108
      Issue No: Vol. 141, No. 3 (2018)
  • Characteristics of Children 2 to 5 Years of Age With Severe Obesity
    • Authors: Tester, J. M; Phan, T.-L. T, Tucker, J. M, Leung, C. W, Dreyer Gillette, M. L, Sweeney, B. R, Kirk, S, Tindall, A, Olivo-Marston, S. E, Eneli, I. U.
      Abstract: BACKGROUND AND OBJECTIVES:As a distinct group, 2- to 5-year-olds with severe obesity (SO) have not been extensively described. As a part of the Expert Exchange Workgroup on Childhood Obesity, nationally-representative data were examined to better characterize children with SO.METHODS:Children ages 2 to 5 (N = 7028) from NHANES (1999–2014) were classified as having normal weight, overweight, obesity, or SO (BMI ≥120% of 95th percentile). Sociodemographics, birth characteristics, screen time, total energy, and Healthy Eating Index 2010 scores were evaluated. Multinomial logistic and linear regressions were conducted, with normal weight as the referent.RESULTS:The prevalence of SO was 2.1%. Children with SO had higher (unadjusted) odds of being a racial and/or ethnic minority (African American: odds ratio [OR]: 1.7; Hispanic: OR: 2.3). They were from households with lower educational attainment (OR: 2.4), that were single-parent headed (OR: 2.0), and that were in poverty (OR: 2.1). Having never been breastfed was associated with increased odds of obesity (OR: 1.5) and higher odds of SO (OR: 1.9). Odds of >4 hours of screen time were 1.5 and 2.0 for children with obesity and SO. Energy intake and Healthy Eating Index 2010 scores were not significantly different in children with SO.CONCLUSIONS:Children ages 2 to 5 with SO appear to be more likely to be of a racial and/or ethnic minority and have greater disparities in social determinants of health than their peers and are more than twice as likely to engage in double the recommended screen time limit.
      Keywords: Media, Screen Time, Obesity
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-3228
      Issue No: Vol. 141, No. 3 (2018)
  • Infant Hospitalizations and Mortality After Maternal Vaccination
    • Authors: Sukumaran, L; McCarthy, N. L, Kharbanda, E. O, Vazquez-Benitez, G, Lipkind, H. S, Jackson, L, Klein, N. P, Naleway, A. L, McClure, D. L, Hechter, R. C, Kawai, A. T, Glanz, J. M, Weintraub, E. S.
      Abstract: BACKGROUND:The Advisory Committee on Immunization Practices currently recommends pregnant women receive influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines. There are limited studies of the long-term safety in infants for vaccines administered during pregnancy. We evaluate whether maternal receipt of influenza and Tdap vaccines increases the risk of infant hospitalization or death in the first 6 months of life.METHODS:We included singleton, live birth pregnancies in the Vaccine Safety Datalink between 2004 and 2014. Outcomes were infant hospitalizations and mortality in the first 6 months of life. We performed a case-control study matching case patients and controls 1:1 and used conditional logistic regression to estimate odds ratios for maternal exposure to influenza and/or Tdap vaccines in pregnancy.RESULTS:There were 413 034 live births in our population. Of these, 25 222 infants had hospitalizations and 157 infants died in the first 6 months of life. We found no association between infant hospitalization and maternal influenza (adjusted odds ratio: 1.00; 95% confidence interval [CI]: 0.96–1.04) or Tdap (adjusted odds ratio: 0.94; 95% CI: 0.88–1.01) vaccinations. We found no association between infant mortality and maternal influenza (adjusted odds ratio: 0.96; 95% CI: 0.54–1.69) or Tdap (adjusted odds ratio: 0.44; 95% CI: 0.17–1.13) vaccinations.CONCLUSIONS:We found no association between vaccination during pregnancy and risk of infant hospitalization or death in the first 6 months of life. These findings support the safety of current recommendations for influenza and Tdap vaccination during pregnancy.
      Keywords: Gynecology, Maternal and Fetal Medicine, Infectious Disease, Vaccine/Immunization
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-3310
      Issue No: Vol. 141, No. 3 (2018)
  • Cerebrospinal Fluid Reference Values for Young Infants Undergoing Lumbar
    • Authors: Thomson, J; Sucharew, H, Cruz, A. T, Nigrovic, L. E, Freedman, S. B, Garro, A. C, Balamuth, F, Mistry, R. D, Arms, J. L, Ishimine, P. T, Kulik, D. M, Neuman, M. I, Shah, S. S, for the Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC) HSV Study Group
      Abstract: OBJECTIVES:To determine age-specific reference values and quantify age-related changes for cerebrospinal fluid (CSF) white blood cell (WBC) counts and protein and glucose concentrations in infants ≤60 days of age.METHODS:This multicenter, cross-sectional study included infants ≤60 days old with CSF cultures and complete CSF profiles obtained within 24 hours of presentation. Those with conditions suspected or known to cause abnormal CSF parameters (eg, meningitis) and those with a hospital length of stay of >72 hours were excluded. Reference standards were determined for infants ≤28 days of age and 29 to 60 days of age by using the third quartile +1.5 interquartile range for WBC and protein and the first quartile –1.5 interquartile range for glucose. CSF parameter centile curves based on age were calculated by using the LMST method.RESULTS:A total of 7766 patients were included. CSF WBC counts were higher in infants ≤28 days of age (upper bound: 15 cells/mm3) than in infants 29 to 60 days of age (upper bound: 9 cells/mm3; P < .001). CSF protein concentrations were higher in infants ≤28 days of age (upper bound: 127 mg/dL) than in infants 29 to 60 days of age (upper bound: 99 mg/dL; P < .001). CSF glucose concentrations were lower in infants ≤28 days of age (lower bound: 25 mg/dL) than in infants 29 to 60 days of age (lower bound: 27 mg/dL; P < .001).CONCLUSIONS:The age-specific CSF WBC count, protein concentration, and glucose concentration reference values identified in this large, multicenter cohort of infants can be used to interpret the results of lumbar puncture in infants ≤60 days of age.
      Keywords: Infectious Disease
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-3405
      Issue No: Vol. 141, No. 3 (2018)
  • Strengthening the Connection of Medical Education to the Vision of
           Improving Child Health
    • Authors: Carraccio C.
      Keywords: Medical Education, Teaching/Curriculum Development
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-3427
      Issue No: Vol. 141, No. 3 (2018)
  • Prevalence of Obesity and Severe Obesity in US Children, 1999-2016
    • Authors: Skinner, A. C; Ravanbakht, S. N, Skelton, J. A, Perrin, E. M, Armstrong, S. C.
      Abstract: OBJECTIVES:To provide updated prevalence data on obesity trends among US children and adolescents aged 2 to 19 years from a nationally representative sample.METHODS:We used the NHANES for years 1999 to 2016. Weight status was determined by using measured height and weight from the physical examination component of the NHANES to calculate age- and sex-specific BMI. We report the prevalence estimates of overweight and obesity (class I, class II, and class III) by 2-year NHANES cycles and compared cycles by using adjusted Wald tests and linear trends by using ordinary least squares regression.RESULTS:White and Asian American children have significantly lower rates of obesity than African American children, Hispanic children, or children of other races. We report a positive linear trend for all definitions of overweight and obesity among children 2–19 years old, most prominently among adolescents. Children aged 2 to 5 years showed a sharp increase in obesity prevalence from 2015 to 2016 compared with the previous cycle.CONCLUSIONS:Despite previous reports that obesity in children and adolescents has remained stable or decreased in recent years, we found no evidence of a decline in obesity prevalence at any age. In contrast, we report a significant increase in severe obesity among children aged 2 to 5 years since the 2013–2014 cycle, a trend that continued upward for many subgroups.
      Keywords: Obesity
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-3459
      Issue No: Vol. 141, No. 3 (2018)
  • National and State Trends in Sudden Unexpected Infant Death: 1990-2015
    • Authors: Erck Lambert, A. B; Parks, S. E, Shapiro-Mendoza, C. K.
      Abstract: BACKGROUND:Sharp declines in sudden unexpected infant death (SUID) in the 1990s and a diagnostic shift from sudden infant death syndrome (SIDS) to unknown cause and accidental suffocation and strangulation in bed (ASSB) in 1999–2001 have been documented. We examined trends in SUID and SIDS, unknown cause, and ASSB from 1990 to 2015 and compared state-specific SUID rates to identify significant trends that may be used to inform SUID prevention efforts.METHODS:We used data from US mortality files to evaluate national and state-specific SUID rates (deaths per 100 000 live births) for 1990–2015. SUID included infants with an underlying cause of death, SIDS, unknown cause, or ASSB. To examine overall US rates for SUID and SUID subtypes, we calculated the percent change by fitting Poisson regression models. We report state differences in SUID and compared state-specific rates from 2000–2002 to 2013–2015 by calculating the percent change.RESULTS:SUID rates declined from 154.6 per 100 000 live births in 1990 to 92.4 in 2015, declining 44.6% from 1990 to 1998 and 7% from 1999 to 2015. From 1999 to 2015, SIDS rates decreased 35.8%, ASSB rates increased 183.8%, and there was no significant change in unknown cause rates. SUID trends among states varied widely from 41.5 to 184.3 in 2000–2002 and from 33.2 to 202.2 in 2013–2015.CONCLUSIONS:Reductions in SUID rates since 1999 have been minimal, and wide variations in state-specific rates remain. States with significant declines in SUID rates might have SUID risk-reduction programs that could serve as models for other states.
      Keywords: Fetus/Newborn Infant, SIDS
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-3519
      Issue No: Vol. 141, No. 3 (2018)
  • Reducing Youth Firearm Suicide Risk: Evidence for Opportunities
    • Authors: Grossman D. C.
      Keywords: Adolescent Health/Medicine, Injury, Violence & Poison Prevention, Firearms
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-3884
      Issue No: Vol. 141, No. 3 (2018)
  • Tikanma╠łki et al. Physical Fitness in Young Adults Born Preterm.
           Pediatrics. 2016;137(1):e20151289
    • Keywords: Sports Medicine/Physical Fitness
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-3993
      Issue No: Vol. 141, No. 3 (2018)
  • RE: Global Initiatives for Early Childhood Development Should Be
           Disability Inclusive
    • Authors: Olusanya, B. O; Krishnamurthy, V, Wertlieb, D.
      Keywords: International Child Health
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-4055
      Issue No: Vol. 141, No. 3 (2018)
  • Pediatric Medication Safety in the Emergency Department
    • Authors: Benjamin, L; Frush, K, Shaw, K, Shook, J. E, Snow, S. K, AMERICAN ACADEMY OF PEDIATRICS Committee on Pediatric Emergency Medicine, AMERICAN COLLEGE OF EMERGENCY PHYSICIANS Pediatric Emergency Medicine Committee, EMERGENCY NURSES ASSOCIATION Pediatric Emergency Medicine Committee
      Abstract: Pediatric patients cared for in emergency departments (EDs) are at high risk of medication errors for a variety of reasons. A multidisciplinary panel was convened by the Emergency Medical Services for Children program and the American Academy of Pediatrics Committee on Pediatric Emergency Medicine to initiate a discussion on medication safety in the ED. Top opportunities identified to improve medication safety include using kilogram-only weight-based dosing, optimizing computerized physician order entry by using clinical decision support, developing a standard formulary for pediatric patients while limiting variability of medication concentrations, using pharmacist support within EDs, enhancing training of medical professionals, systematizing the dispensing and administration of medications within the ED, and addressing challenges for home medication administration before discharge.
      Keywords: Emergency Medicine
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-4066
      Issue No: Vol. 141, No. 3 (2018)
  • Kaur R, Morris M, Pichichero ME. Epidemiology of Acute Otitis Media in the
    • Keywords: Infectious Disease
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-4067
      Issue No: Vol. 141, No. 3 (2018)
  • Epidemic Childhood Obesity: Not Yet the End of the Beginning
    • Authors: Ludwig D. S.
      Keywords: Obesity
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-4078
      Issue No: Vol. 141, No. 3 (2018)
  • Health Disparities Facing Transgender and Gender Nonconforming Youth Are
           Not Inevitable
    • Authors: Shumer D.
      Keywords: Developmental/Behavioral Pediatrics, Endocrinology
      PubDate: 2018-03-01T01:01:29-08:00
      DOI: 10.1542/peds.2017-4079
      Issue No: Vol. 141, No. 3 (2018)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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