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Journal Cover Pediatrics
  [SJR: 3.226]   [H-I: 263]   [263 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]
  • Obesogenic Behavior and Weight-Based Stigma in Popular Childrens Movies,
           2012 to 2015
    • Authors: Howard, J. B; Skinner, A. C, Ravanbakht, S. N, Brown, J. D, Perrin, A. J, Steiner, M. J, Perrin, E. M.
      Abstract: BACKGROUND:Obesity-promoting content and weight-stigmatizing messages are common in child-directed television programming and advertisements, and 1 study found similar trends in G- and PG-rated movies from 2006 to 2010. Our objective was to examine the prevalence of such content in more recent popular children’s movies.METHODS:Raters examined 31 top-grossing G- and PG-rated movies released from 2012 to 2015. For each 10-minute segment (N = 302) and for movies as units, raters documented the presence of eating-, activity-, and weight-related content observed on-screen. To assess interrater reliability, 10 movies (32%) were coded by more than 1 rater.RESULTS:The result of Cohen’s test of agreement among 3 raters was 0.65 for binary responses (good agreement). All 31 movies included obesity-promoting content; most common were unhealthy foods (87% of movies, 42% of segments), exaggerated portion sizes (71%, 29%), screen use (68%, 38%), and sugar-sweetened beverages (61%, 24%). Weight-based stigma, such as a verbal insult about body size or weight, was observed in 84% of movies and 30% of segments.CONCLUSIONS:Children’s movies include much obesogenic and weight-stigmatizing content. These messages are not shown in isolated incidences; rather, they often appear on-screen multiple times throughout the entire movie. Future research should explore these trends over time, and their effects.
      Keywords: Media, Obesity
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-2126
      Issue No: Vol. 140, No. 6 (2017)
  • Urinary Tract Infection Antibiotic Trial Study Design: A Systematic Review
    • Authors: Basmaci, R; Vazouras, K, Bielicki, J, Folgori, L, Hsia, Y, Zaoutis, T, Sharland, M.
      Abstract: CONTEXT:Urinary tract infections (UTIs) represent common bacterial infections in children. No guidance on the conduct of pediatric febrile UTI clinical trials (CTs) exist.OBJECTIVE:To assess the criteria used for patient selection and the efficacy end points in febrile pediatric UTI CTs.DATA SOURCES:Medline, Embase, Cochrane central databases, and were searched between January 1, 1990, and November 24, 2016.STUDY SELECTION:We combined Medical Subject Headings terms and free-text terms for "urinary tract infections" and "therapeutics" and "clinical trials" in children (0–18 years), identifying 3086 articles.DATA EXTRACTION:Two independent reviewers assessed study quality and performed data extraction.RESULTS:We included 40 CTs in which a total of 4381 cases of pediatric UTIs were investigated. Positive urine culture results and fever were the most common inclusion criteria (93% and 78%, respectively). Urine sampling method, pyuria, and colony thresholds were highly variable. Clinical and microbiological end points were assessed in 88% and 93% of the studies, respectively. Timing for end point assessment was highly variable, and only 3 studies (17%) out of the 18 performed after the Food and Drug Administration 1998 guidance publication assessed primary and secondary end points consistently with this guidance.LIMITATIONS:Our limitations included a mixed population of healthy children and children with an underlying condition. In 6 trials, researchers studied a subgroup of patients with afebrile UTI.CONCLUSIONS:We observed a wide variability in the microbiological inclusion criteria and the timing for end point assessment. The available guidance for adults appear not to be used by pediatricians and do not seem applicable to the childhood UTI. A harmonized design for pediatric UTIs CT is necessary.
      Keywords: Infectious Disease
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-2209
      Issue No: Vol. 140, No. 6 (2017)
  • Growth Tracking in Severely Obese or Underweight Children
    • Authors: Chambers, M; Tanamas, S. K, Clark, E. J, Dunnigan, D. L, Kapadia, C. R, Hanson, R. L, Nelson, R. G, Knowler, W. C, Sinha, M.
      Abstract: OBJECTIVES:To illustrate the difficulties in optimal growth monitoring of children with severe obesity or underweight by using the Centers for Disease Control and Prevention (CDC) 2000 age- and sex-specific BMI percentile growth charts. We also aimed to examine the utility of a new modified CDC BMI z score chart to monitor growth in children with normal and extreme BMI percentiles by using real-life clinical scenarios.METHODS:Modified BMI z score charts were created by using the 2000 CDC algorithm. Three cases of children with extreme BMI values and abnormal growth patterns were plotted by using the standard CDC 2000 clinical growth chart, the modified BMI z score chart, and the CDC BMI percentile chart, modified to include the percentage of the 95th percentile (%BMIp95) curves.RESULTS:Children with severe obesity could not be plotted on the standard CDC BMI percentile chart because their BMI points lay above the chart cutoff. Children with a low BMI (
      Keywords: Developmental/Behavioral Pediatrics, Growth/Development Milestones, Obesity
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-2248
      Issue No: Vol. 140, No. 6 (2017)
  • Physical and Sexual Dating Violence and Nonmedical Use of Prescription
    • Authors: Clayton, H. B; Lowry, R, Basile, K. C, Demissie, Z, Bohm, M. K.
      Abstract: BACKGROUND:Little information is available on the associations between nonmedical use of prescription drugs (NMUPD) and dating violence victimization (DVV) among high school students and how associations vary by sex.METHODS:We used data from the 2015 national Youth Risk Behavior Survey, a cross-sectional survey of a nationally representative sample of students in grades 9 to 12. The sample was restricted to students who dated during the 12 months before the survey, resulting in a sample of 5136 boys and 5307 girls. Sex-stratified logistic regression models estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations between lifetime NMUPD and DVV. In our analyses, we examined a 4-level DVV measure: no DVV, physical only, sexual only, and both physical and sexual. RESULTS:Male students had a significantly lower prevalence of DVV compared with female students. By using the 4-level measure of DVV, after adjusting for covariates, sexual DVV only (aPR = 1.61, 95% CI: 1.21–2.12) and both physical and sexual DVV (aPR = 1.65, 95% CI: 1.26–2.17) were positively associated with NUMPD among boys, whereas among girls, physical DVV only (aPR = 1.42, 95% CI: 1.16–1.75) and both physical and sexual DVV (aPR = 1.43, 95% CI: 1.03–1.99) were positively associated with NMUPD.CONCLUSIONS:NMUPD was associated with experiences of DVV among both male and female students. Community- or school-based adolescent violence and substance use prevention efforts would be enhanced by considering the association between DVV and substance use, particularly NMUPD among both male and female adolescents, to address these public health problems.
      Keywords: Injury, Violence & Poison Prevention, Substance Use
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-2289
      Issue No: Vol. 140, No. 6 (2017)
  • Momentary Parental Stress and Food-Related Parenting Practices
    • Authors: Berge, J. M; Tate, A, Trofholz, A, Fertig, A. R, Miner, M, Crow, S, Neumark-Sztainer, D.
      Abstract: BACKGROUND:Research suggests that stress and depressed mood are associated with food-related parenting practices (ie, parent feeding practices, types of food served at meals). However, current measures of parental stress, depressed mood, and food-related parenting practices are typically survey-based and assessed as static/unchanging characteristics, failing to account for fluctuations across time and context. Identifying momentary factors that influence parent food-related parenting practices will facilitate the development of effective interventions aimed at promoting healthy food-related parenting practices. In this study, we used ecological momentary assessment to examine the association between momentary factors (eg, stress, depressed mood) occurring early in the day and food-related parenting practices at the evening meal.METHODS:Children aged 5 to 7 years and their families (N = 150) from 6 racial and/or ethnic groups (n = 25 each African American, Hispanic/Latino, Hmong, American Indian, Somali, and white families) were recruited for this mixed-methods study through primary care clinics.RESULTS:Higher stress and depressed mood earlier in the day predicted pressure-to-eat feeding practices and fewer homemade foods served at meals the same night. Effect modification was found for certain racial and/or ethnic groups with regard to engaging in pressure-to-eat feeding practices (ie, America Indian, Somali) or serving fewer homemade meals (ie, African American, Hispanic/Latino) in the face of high stress or depressed mood.CONCLUSIONS: Clinicians may want to consider discussing with parents the influence stress and depressed mood can have on everyday food-related parenting practices. Additionally, future researchers should consider using real-time interventions to reduce parental stress and depressed mood to promote healthy parent food-related parenting practices.
      Keywords: Obesity, Public Health
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-2295
      Issue No: Vol. 140, No. 6 (2017)
  • Ethics Rounds: Death After Pediatric Dental Anesthesia: An Avoidable
    • Authors: Lee, H; Milgrom, P, Huebner, C. E, Weinstein, P, Burke, W, Blacksher, E, Lantos, J. D.
      Abstract: Early childhood caries (ECC) is the single most common chronic childhood disease. In the treatment of ECC, children are often given moderate sedation or general anesthesia. An estimated 100 000 to 250 000 pediatric dental sedations are performed annually in the United States. The most common medications are benzodiazepines, opioids, local anesthetics, and nitrous oxide. All are associated with serious adverse events, including hypoxemia, respiratory depression, airway obstruction, and death. There is no mandated reporting of adverse events or deaths, so we don’t know how often these occur. In this article, we present a case of a death after dental anesthesia and ask experts to speculate on how to improve the quality and safety of both the prevention and treatment of ECC.
      Keywords: Dentistry/Oral Health, Ethics/Bioethics
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-2370
      Issue No: Vol. 140, No. 6 (2017)
  • Ring Block of the Penis: A Proven Addition to Multimodal Pain Relief for
           Newborn Circumcision
    • Authors: Rosen, D. A; Broadman, L. M.
      Keywords: Fetus/Newborn Infant, Circumcision, Neonatology
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-2678
      Issue No: Vol. 140, No. 6 (2017)
  • Clinical Variability in Neonatology: Context Matters
    • Authors: Gagliardi L.
      Keywords: Evidence-Based Medicine, Fetus/Newborn Infant, Neonatology
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-2808
      Issue No: Vol. 140, No. 6 (2017)
  • Early Child Care and Education: A Key Component of Obesity Prevention in
    • Authors: Hassink S. G.
      Keywords: Nutrition, Obesity
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-2846
      Issue No: Vol. 140, No. 6 (2017)
  • Care Management for Children With Medical Complexity: Integration Is
    • Authors: Antonelli, R. C; Turchi, R. M.
      Keywords: Children With Special Health Care Needs
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-2860
      Issue No: Vol. 140, No. 6 (2017)
  • Defang ACEs: End Toxic Stress by Developing Resilience Through
           Physician-Community Partnerships
    • Authors: Jichlinski A.
      Keywords: Advocacy, Public Health
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-2869
      Issue No: Vol. 140, No. 6 (2017)
  • An Interdisciplinary Approach to Toxic Stress: Learning the Lingo
    • Authors: Livaditis L. V.
      Keywords: Advocacy
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-2916
      Issue No: Vol. 140, No. 6 (2017)
  • Re: Confusing Recommendations Regarding Timing of Peanut-Based Foods to
           Low-risk Infants
    • Authors: Eidelman, A. I; Meek, J. Y, Schanler, R. J.
      Keywords: Allergy/Immunology
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-2938A
      Issue No: Vol. 140, No. 6 (2017)
  • Authors Response
    • Authors: Sicherer S. H.
      Keywords: Allergy/Immunology
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-2938B
      Issue No: Vol. 140, No. 6 (2017)
  • Randomized Trials in Children With UTI
    • Authors: Schroeder, A. R; Newman, T. B.
      Keywords: Evidence-Based Medicine, Infectious Disease
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-2957
      Issue No: Vol. 140, No. 6 (2017)
  • Complexities in the Association Between Bullying Victimization and Weapon
    • Authors: Holt, M. K; Gini, G.
      Keywords: Injury, Violence & Poison Prevention, Bullying
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-3033
      Issue No: Vol. 140, No. 6 (2017)
  • Stigma Experienced by Children and Adolescents With Obesity
    • Authors: Pont, S. J; Puhl, R, Cook, S. R, Slusser, W, SECTION ON OBESITY, THE OBESITY SOCIETY
      Abstract: The stigmatization of people with obesity is widespread and causes harm. Weight stigma is often propagated and tolerated in society because of beliefs that stigma and shame will motivate people to lose weight. However, rather than motivating positive change, this stigma contributes to behaviors such as binge eating, social isolation, avoidance of health care services, decreased physical activity, and increased weight gain, which worsen obesity and create additional barriers to healthy behavior change. Furthermore, experiences of weight stigma also dramatically impair quality of life, especially for youth. Health care professionals continue to seek effective strategies and resources to address the obesity epidemic; however, they also frequently exhibit weight bias and stigmatizing behaviors. This policy statement seeks to raise awareness regarding the prevalence and negative effects of weight stigma on pediatric patients and their families and provides 6 clinical practice and 4 advocacy recommendations regarding the role of pediatricians in addressing weight stigma. In summary, these recommendations include improving the clinical setting by modeling best practices for nonbiased behaviors and language; using empathetic and empowering counseling techniques, such as motivational interviewing, and addressing weight stigma and bullying in the clinic visit; advocating for inclusion of training and education about weight stigma in medical schools, residency programs, and continuing medical education programs; and empowering families to be advocates to address weight stigma in the home environment and school setting.
      Keywords: Nutrition, Obesity
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-3034
      Issue No: Vol. 140, No. 6 (2017)
  • Flynn JT, Kaelber DC, Baker-Smith CM, et al; SUBCOMMITTEE ON SCREENING AND
           MANAGEMENT OF HIGH BLOOD PRESSURE IN CHILDREN. Clinical Practice Guideline
           for Screening and Management of High Blood Pressure in Children and
           Adolescents. Pediatrics. 2017; 140(3):e20171904
    • Keywords: Cardiology, Cardiovascular Disorders
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-3035
      Issue No: Vol. 140, No. 6 (2017)
  • Anorexia and Autoimmunity: Challenging the Etiologic Constructs of
           Disordered Eating
    • Authors: Hommer, R. E; Swedo, S. E.
      Keywords: Psychiatry/Psychology
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-3060
      Issue No: Vol. 140, No. 6 (2017)
  • Issues Related to Laboratory Screening for Children and Adolescents
           Entering Foster Care
    • Authors: Szilagyi, M; Schulte, E.
      Keywords: Adoption & Foster Care
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-3075
      Issue No: Vol. 140, No. 6 (2017)
  • Adolescent Hearing Loss: Rising or Not, It Remains a Concern
    • Authors: Sekhar D. L.
      Keywords: Community Pediatrics, Bright Futures, Ear, Nose & Throat Disorders
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-3084
      Issue No: Vol. 140, No. 6 (2017)
  • A Dream Deferred: Ending DACA Threatens Children, Families, and
    • Authors: Uwemedimo, O. T; Monterrey, A. C, Linton, J. M.
      Keywords: International Child Health, Immigration, Advocacy, Federal Policy
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-3089
      Issue No: Vol. 140, No. 6 (2017)
  • Applying Evidence From Clinical Trials: Need for Pediatric Learning Health
           System Research
    • Authors: Mistry, K. B; Forrest, C. B.
      Keywords: Medical Education, Research Methods & Statistics, Adolescent Health/Medicine
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-3098
      Issue No: Vol. 140, No. 6 (2017)
  • Sudden Cardiac Death Decreasing: Why Remains Unclear
    • Authors: Bratton, S. L; Chan, T.
      Keywords: Emergency Medicine, Cardiology, Cardiovascular Disorders
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-3122
      Issue No: Vol. 140, No. 6 (2017)
  • Rethinking the Definition of Evidence-Based Interventions to Promote Early
           Childhood Development
    • Authors: Shonkoff J. P.
      Keywords: Evidence-Based Medicine
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-3136
      Issue No: Vol. 140, No. 6 (2017)
  • Global Human Trafficking and Child Victimization
      Abstract: Trafficking of children for labor and sexual exploitation violates basic human rights and constitutes a major global public health problem. Pediatricians and other health care professionals may encounter victims who present with infections, injuries, posttraumatic stress disorder, suicidality, or a variety of other physical or behavioral health conditions. Preventing child trafficking, recognizing victimization, and intervening appropriately require a public health approach that incorporates rigorous research on the risk factors, health impact, and effective treatment options for child exploitation as well as implementation and evaluation of primary prevention programs. Health care professionals need training to recognize possible signs of exploitation and to intervene appropriately. They need to adopt a multidisciplinary, outward-focused approach to service provision, working with nonmedical professionals in the community to assist victims. Pediatricians also need to advocate for legislation and policies that promote child rights and victim services as well as those that address the social determinants of health, which influence the vulnerability to human trafficking. This policy statement outlines major issues regarding public policy, medical education, research, and collaboration in the area of child labor and sex trafficking and provides recommendations for future work.
      Keywords: Child Abuse and Neglect
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-3138
      Issue No: Vol. 140, No. 6 (2017)
  • Adolescent Dating Violence and Nonmedical Prescription Drug Use
    • Authors: Miller E.
      Keywords: Injury, Violence & Poison Prevention, Substance Use
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-3162
      Issue No: Vol. 140, No. 6 (2017)
  • Understanding the Highs and Lows of Adolescent Marijuana Use
    • Authors: Chadi, N; Levy, S.
      Keywords: Adolescent Health/Medicine, Substance Use
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-3164
      Issue No: Vol. 140, No. 6 (2017)
  • RE: Statistical Interpretation Error in Metformin Trial Article
    • Authors: Allison D. B.
      Keywords: Obesity
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-3231A
      Issue No: Vol. 140, No. 6 (2017)
  • Authors Response
    • Authors: Pastor-Villaescusa, B; Plaza-Diaz, J, Aguilera, C. M.
      Keywords: Obesity
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-3231B
      Issue No: Vol. 140, No. 6 (2017)
  • Pastor-Villaescusa B, Canete MD, Caballero-Villarraso J, et al. Metformin
           for Obesity in Prepubertal and Pubertal Children: A Randomized Controlled
           Trial. Pediatrics. 2017;140(1):e20164285
    • Keywords: Obesity
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-3232
      Issue No: Vol. 140, No. 6 (2017)
  • Evidence for a Uniform Medicaid Eligibility Threshold for Children and
    • Authors: Davis M. M.
      Keywords: Administration/Practice Management, Billing & Coding
      PubDate: 2017-12-01T01:02:10-08:00
      DOI: 10.1542/peds.2017-3236
      Issue No: Vol. 140, No. 6 (2017)
  • Diagnosing Infection in a Neonate Using Whole-Body Screening Magnetic
           Resonance Imaging
    • Authors: Fu, T. T; Kingma, P. S.
      Abstract: The location of invasive infections is difficult to detect in infants, in part due to their inability to localize signs and symptoms. However, identifying the location often significantly alters clinical management by extending the duration of antibiotic therapy or revealing a source requiring surgical intervention. Compared with commonly used first-line imaging techniques such as radiographs and ultrasounds, MRI has higher sensitivity for identifying invasive infections and allows for simultaneous evaluation of multiple foci. We present 2 cases in which whole-body screening MRI was used in neonates to identify invasive sources of infection, including one in which traditional modalities failed to detect multiple clinically significant sources. We posit that whole-body screening MRI merits consideration as a potential first-line imaging method when investigating invasive infections in infants.
      Keywords: Fetus/Newborn Infant, Neonatology
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2016-0732
      Issue No: Vol. 140, No. 6 (2017)
  • Generalizability of Clinical Trial Results for Adolescent Major Depressive
    • Authors: Blanco, C; Hoertel, N, Franco, S, Olfson, M, He, J.-P, Lopez, S, Gonzalez-Pinto, A, Limosin, F, Merikangas, K. R.
      Abstract: BACKGROUND:Although there have been a number of clinical trials evaluating treatments for adolescents with major depressive disorder (MDD), the generalizability of those trials to samples of depressed adolescents who present for routine clinical care is unknown. Examining the generalizability of clinical trials of pharmacological and psychotherapy interventions for adolescent depression can help administrators and frontline practitioners determine the relevance of these studies for their patients and may also guide eligibility criteria for future clinical trials in this clinical population.METHODS:Data on nationally representative adolescents were derived from the National Comorbidity Survey: Adolescent Supplement. To assess the generalizability of adolescent clinical trials for MDD, we applied a standard set of eligibility criteria representative of clinical trials to all adolescents in the National Comorbidity Survey: Adolescent Supplement with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of MDD (N = 592).RESULTS:From the overall MDD sample, 61.9% would have been excluded from a typical pharmacological trial, whereas 42.2% would have been excluded from a psychotherapy trial. Among those who sought treatment (n = 412), the corresponding exclusion rates were 72.7% for a pharmacological trial and 52.2% for a psychotherapy trial. The criterion leading to the largest number of exclusions was "significant risk of suicide" in both pharmacological and psychotherapy trials.CONCLUSIONS:Pharmacological and, to a lesser extent, psychotherapy clinical trials likely exclude most adolescents with MDD. Careful consideration should be given to balancing eligibility criteria and internal validity with applicability in routine clinical care while ensuring patient safety.
      Keywords: Psychiatry/Psychology, Public Health
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2016-1701
      Issue No: Vol. 140, No. 6 (2017)
  • Computer-Aided Recognition of Facial Attributes for Fetal Alcohol Spectrum
    • Authors: Valentine, M; Bihm, D. C. J, Wolf, L, Hoyme, H. E, May, P. A, Buckley, D, Kalberg, W, Abdul-Rahman, O. A.
      Abstract: OBJECTIVES:To compare the detection of facial attributes by computer-based facial recognition software of 2-D images against standard, manual examination in fetal alcohol spectrum disorders (FASD).METHODS:Participants were gathered from the Fetal Alcohol Syndrome Epidemiology Research database. Standard frontal and oblique photographs of children were obtained during a manual, in-person dysmorphology assessment. Images were submitted for facial analysis conducted by the facial dysmorphology novel analysis technology (an automated system), which assesses ratios of measurements between various facial landmarks to determine the presence of dysmorphic features. Manual blinded dysmorphology assessments were compared with those obtained via the computer-aided system.RESULTS:Areas under the curve values for individual receiver-operating characteristic curves revealed the computer-aided system (0.88 ± 0.02) to be comparable to the manual method (0.86 ± 0.03) in detecting patients with FASD. Interestingly, cases of alcohol-related neurodevelopmental disorder (ARND) were identified more efficiently by the computer-aided system (0.84 ± 0.07) in comparison to the manual method (0.74 ± 0.04). A facial gestalt analysis of patients with ARND also identified more generalized facial findings compared to the cardinal facial features seen in more severe forms of FASD.CONCLUSIONS:We found there was an increased diagnostic accuracy for ARND via our computer-aided method. As this category has been historically difficult to diagnose, we believe our experiment demonstrates that facial dysmorphology novel analysis technology can potentially improve ARND diagnosis by introducing a standardized metric for recognizing FASD-associated facial anomalies. Earlier recognition of these patients will lead to earlier intervention with improved patient outcomes.
      Keywords: Genetics, Dysmorphology, Substance Use
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2016-2028
      Issue No: Vol. 140, No. 6 (2017)
  • Eating Disorders, Autoimmune, and Autoinflammatory Disease
    • Authors: Zerwas, S; Larsen, J. T, Petersen, L, Thornton, L. M, Quaranta, M, Koch, S. V, Pisetsky, D, Mortensen, P. B, Bulik, C. M.
      Abstract: OBJECTIVES:Identifying factors associated with risk for eating disorders is important for clarifying etiology and for enhancing early detection of eating disorders in primary care. We hypothesized that autoimmune and autoinflammatory diseases would be associated with eating disorders in children and adolescents and that family history of these illnesses would be associated with eating disorders in probands.METHODS:In this large, nationwide, population-based cohort study of all children and adolescents born in Denmark between 1989 and 2006 and managed until 2012, Danish medical registers captured all inpatient and outpatient diagnoses of eating disorders and autoimmune and autoinflammatory diseases. The study population included 930 977 individuals (48.7% girls). Cox proportional hazards regression models and logistic regression were applied to evaluate associations.RESULTS:We found significantly higher hazards of eating disorders for children and adolescents with autoimmune or autoinflammatory diseases: 36% higher hazard for anorexia nervosa, 73% for bulimia nervosa, and 72% for an eating disorder not otherwise specified. The association was particularly strong in boys. Parental autoimmune or autoinflammatory disease history was associated with significantly increased odds for anorexia nervosa (odds ratio [OR] = 1.13, confidence interval [CI] = 1.01–1.25), bulimia nervosa (OR = 1.29; CI = 1.08–1.55) and for an eating disorder not otherwise specified (OR = 1.27; CI = 1.13–1.44).CONCLUSIONS:Autoimmune and autoinflammatory diseases are associated with increased risk for eating disorders. Ultimately, understanding the role of immune system disturbance for the etiology and pathogenesis of eating disorders could point toward novel treatment targets.
      Keywords: Psychiatry/Psychology, Allergy/Immunology, Immunologic Disorders
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2016-2089
      Issue No: Vol. 140, No. 6 (2017)
  • Mental Health Screening Quality Improvement Learning Collaborative in
           Pediatric Primary Care
    • Authors: Beers, L. S; Godoy, L, John, T, Long, M, Biel, M. G, Anthony, B, Mlynarski, L, Moon, R, Weissman, M.
      Abstract: BACKGROUND:In the United States, up to 20% of children experience a mental health (MH) disorder in a given year, many of whom remain untreated. Routine screening during annual well visits is 1 strategy providers can use to identify concerns early and facilitate appropriate intervention. However, many barriers exist to the effective implementation of such screening.METHODS:A 15-month quality improvement learning collaborative was designed and implemented to improve screening practices in primary care. Participating practices completed a survey at 3 time points to assess preparedness and ability to promote and support MH issues. Monthly chart reviews were performed to assess the rates of screening at well visits, documentation of screening results, and appropriate coding practices.RESULTS:Ten practices (including 107 providers) were active participants for the duration of the project. Screening rates increased from 1% at baseline to 74% by the end of the project. For the 1 practice for which more comprehensive data were available, these screening rates were sustained over time. Documentation of results and appropriate billing for reimbursement mirrored the improvement seen in screening rates.CONCLUSIONS:The learning collaborative model can improve MH screening practices in pediatric primary care, an important first step toward early identification of children with concerns. More information is needed about the burden placed on practices and providers to implement these changes. Future research will be needed to determine if improved identification leads to improved access to care and outcomes.
      Keywords: Community Pediatrics, Medical Home, Administration/Practice Management, Quality Improvement
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2016-2966
      Issue No: Vol. 140, No. 6 (2017)
  • Laboratory Screening for Children Entering Foster Care
    • Authors: Greiner, M. V; Beal, S. J, Nause, K, Staat, M. A, Dexheimer, J. W, Scribano, P. V.
      Abstract: OBJECTIVES:To determine the prevalence of medical illness detected by laboratory screening in children entering foster care in a single, urban county.METHODS:All children entering foster care in a single county in Ohio were seen at a consultation foster care clinic and had laboratory screening, including testing for infectious diseases such as HIV, hepatitis B, hepatitis C, syphilis, and tuberculosis as well as for hemoglobin and lead levels.RESULTS:Over a 3-year period (2012–2015), laboratory screening was performed on 1977 subjects entering foster care in a consultative foster care clinic. The prevalence of hepatitis B, hepatitis C, syphilis, and tuberculosis were all found to be
      Keywords: Infectious Disease, Epidemiology, Adoption & Foster Care
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2016-3778
      Issue No: Vol. 140, No. 6 (2017)
  • Successful Reversal of Furosemide-Induced Secondary Hyperparathyroidism
           With Cinacalcet
    • Authors: Srivastava, T; Jafri, S, Truog, W. E, Sebestyen VanSickle, J, Manimtim, W. M, Alon, U. S.
      Abstract: Secondary hyperparathyroidism (SHPT) is a rare complication of furosemide therapy that can occur in patients treated with the loop diuretic for a long period of time. We report a 6-month-old 28-weeks premature infant treated chronically with furosemide for his bronchopulmonary dysplasia, who developed hypocalcemia and severe SHPT, adversely affecting his bones. Discontinuation of the loop diuretic and the addition of supplemental calcium and calcitriol only partially reversed the SHPT, bringing serum parathyroid hormone level down from 553 to 238 pg/mL. After introduction of the calcimimetic Cinacalcet, we observed a sustained normalization of parathyroid hormone concentration at 27 to 63 pg/mL and, with that correction, of all biochemical abnormalities and healing of the bone disease. No adverse effects were noted. We conclude that in cases of SHPT due to furosemide in which traditional treatment fails, there may be room to consider the addition of a calcimimetic agent.
      Keywords: Nephrology
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2016-3789
      Issue No: Vol. 140, No. 6 (2017)
  • Capsaicin Cream for Treatment of Cannabinoid Hyperemesis Syndrome in
           Adolescents: A Case Series
    • Authors: Graham, J; Barberio, M, Wang, G. S.
      Abstract: Cannabinoid hyperemesis syndrome (CHS) is an underrecognized diagnosis among adolescents. In the adult literature, it is characterized as nausea, vomiting, and abdominal pain in patients with chronic marijuana use. CHS is often refractory to the standard treatment of nausea and vomiting. Unconventional antiemetics, such as haloperidol, have been successful in alleviating symptoms; however, even 1 dose of haloperidol can lead to grave adverse effects, such as dystonia, extrapyramidal reactions, and neuroleptic malignant syndrome. The use of topical capsaicin cream to treat CHS has been well described in the adult literature. This treatment is cost-effective and is associated with few serious side effects. Here, we describe 2 adolescent patients with nausea, vomiting, and abdominal pain in the setting of chronic cannabis use whose symptoms were not relieved by standard antiemetic therapies, but who responded well to topical capsaicin administration in our pediatric emergency department. We also discuss the pathophysiology behind capsaicin’s efficacy. These are the first reported cases in which capsaicin was successfully used to treat CHS in pediatric patients.
      Keywords: Emergency Medicine, Pharmacology, Toxicology
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2016-3795
      Issue No: Vol. 140, No. 6 (2017)
  • 4-Valent Human Papillomavirus (4vHPV) Vaccine in Preadolescents and
           Adolescents After 10 Years
    • Authors: Ferris, D. G; Samakoses, R, Block, S. L, Lazcano-Ponce, E, Restrepo, J. A, Mehlsen, J, Chatterjee, A, Iversen, O.-E, Joshi, A, Chu, J.-L, Krick, A. L, Saah, A, Das, R.
      Abstract: OBJECTIVES:We describe the final 10-year data for the long-term follow-up study of the 4-valent human papillomavirus (4vHPV) vaccine in preadolescents and adolescents.METHODS:In the base study (V501-018), 1661 sexually inactive boys and girls received the 4vHPV vaccine (early vaccination group [EVG], managed for 9.9 years) or a placebo at day 1, month 2, and month 6. Thereafter, at month 30, the placebo group (catch-up vaccination group [CVG], managed for 7.4 years) received the 4vHPV vaccine by using the same dosing schedule. Long-term anti-HPV type 6, 11, 16, and 18 immune responses were assessed. Effectiveness was estimated by calculating the incidence rate of the primary endpoints (HPV types 6, 11, 16, and 18–related disease or persistent infection).RESULTS:For HPV types 6, 11, and 16, 89% to 96% of subjects remained seropositive through 10-years postvaccination. The preadolescents had 38% to 65% higher geometric mean titers at month 7, which remained 16% to 42% higher at 10 years compared with adolescents. No cases of HPV type 6, 11, 16, and 18–related diseases were observed. Ten subjects had a persistent infection of ≥6 months duration with vaccine-type HPV and 2 subjects had persistent infection for ≥12 months. No new serious adverse events were reported through 10 years.CONCLUSIONS:A 3-dose regimen of the 4vHPV vaccine was immunogenic, clinically effective, and generally well tolerated in preadolescents and adolescents during 10 years of follow-up. These long-term findings support efforts to vaccinate this population against HPV before exposure.
      Keywords: Infectious Disease, Vaccine/Immunization, Public Health
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2016-3947
      Issue No: Vol. 140, No. 6 (2017)
  • Presentation and Diagnosis of Tuberous Sclerosis Complex in Infants
    • Authors: Davis, P. E; Filip-Dhima, R, Sideridis, G, Peters, J. M, Au, K. S, Northrup, H, Bebin, E. M, Wu, J. Y, Krueger, D, Sahin, M, on behalf of the Tuberous Sclerosis Complex Autism Center of Excellence Research Network
      Abstract: OBJECTIVES:Tuberous sclerosis complex (TSC) is a neurocutaneous genetic disorder with a high prevalence of epilepsy and neurodevelopmental disorders. TSC can be challenging to diagnose in infants because they often do not show many clinical signs early in life. In this study, we describe the timing and pattern of presenting and diagnostic features in a prospective longitudinal study of infants with TSC.METHODS:Two multicenter, prospective studies enrolled 130 infants with definite TSC by clinical or genetic criteria and followed them longitudinally up to 36 months of age. Periodic study visits included medical and seizure histories, physical and neurologic examinations, and developmental assessments. Ages at which major and minor features of TSC and seizures were first identified were analyzed.RESULTS:The most common initial presenting features of TSC were cardiac rhabdomyomas (59%) and hypomelanotic macules or other skin findings (39%), and 85% of infants presented with either or both. Ultimately, the most prevalent diagnostic TSC features were hypomelanotic macules (94%), tubers or other cortical dysplasias (94%), subependymal nodules (90%), and cardiac rhabdomyomas (82%). Thirty-five percent of infants presented prenatally, 41% presented at birth or within the first month of life, and 74% met criteria for TSC diagnosis at or within 30 days of presentation. Seizure onset occurred before or at initial presentation in only 15% of infants, but 73% developed epilepsy within the first year of life.CONCLUSIONS:Infants with TSC can often be identified early, before the onset of neurologic sequelae, enabling earlier diagnosis, surveillance, and possibly disease-modifying treatment.
      Keywords: Genetics, Neurology, Neurologic Disorders
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2016-4040
      Issue No: Vol. 140, No. 6 (2017)
  • Two-Year Neurodevelopmental Outcome of an Infant Born at 21 Weeks 4 Days
    • Authors: Ahmad, K. A; Frey, C. S, Fierro, M. A, Kenton, A. B, Placencia, F. X.
      Abstract: Recent literature confirms that, at the lower limit of extrauterine survival, substantial intercenter variability exists in resuscitation practice. The reasons for this variability are unclear, but may be related to disagreement on how to apply the best interests standard to extremely premature infants. Currently, both obstetric and pediatric societies recommend against assessing for viability or attempting resuscitation before 22 weeks’ gestation. In this context, we report the unimpaired 2-year outcome of a female infant resuscitated after delivery at 21 weeks’ 4 days’ gestation and 410 g birth weight. She may be the most premature known survivor to date. This infant had multiple risk factors for adverse outcome, including prolonged mechanical ventilation, bronchopulmonary dysplasia, and threshold retinopathy of prematurity. She achieved discharge from the hospital on low-flow oxygen at 39 weeks’ 4 days’ gestation and 2519 g. At 24 months’ and 8 days’ chronological age, she achieved cognitive, motor, and language Bayley III scores of 90, 89, and 88, equivalent to 105, 100, and 103 at 20 months 2 days corrected age. It is known that active intervention policies at 22 weeks’ gestation improves the outcome for those infants and it may be reasonable to infer that these benefits would extend, if to a lesser degree, into the 21st week. Ultimately, such limited data exist at this gestational age that the time may have arrived for obstetrical centers to begin systematically reporting fetal outcomes in the 21st week.
      Keywords: Fetus/Newborn Infant, Neonatology, Gynecology, Obstetrics
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-0103
      Issue No: Vol. 140, No. 6 (2017)
  • Lessons From History: Parents Anonymous and Child Abuse Prevention Policy
    • Authors: Raz M.
      Keywords: Advocacy, Federal Policy, Child Abuse and Neglect
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-0340
      Issue No: Vol. 140, No. 6 (2017)
  • Weapon Carrying Among Victims of Bullying
    • Authors: Pham, T. B; Schapiro, L. E, John, M, Adesman, A.
      Abstract: OBJECTIVES:To examine, in a large, nationally representative sample of high school students, the association between bullying victimization and carrying weapons to school and to determine to what extent past experience of 1, 2, or 3 additional indicators of peer aggression increases the likelihood of weapon carrying by victims of bullying (VoBs).METHODS:National data from the 2015 Youth Risk Behavior Survey were analyzed for grades 9 to 12 (N = 15 624). VoB groups were determined by self-report of being bullied at school and additional adverse experiences: fighting at school, being threatened or injured at school, and skipping school out of fear for one’s safety. Weapon carrying was measured by a dichotomized (ie, ≥1 vs 0) report of carrying a gun, knife, or club on school property. VoB groups were compared with nonvictims with respect to weapon carrying by logistic regression adjusting for sex, grade, and race/ethnicity.RESULTS:When surveyed, 20.2% of students reported being a VoB in the past year, and 4.1% reported carrying a weapon to school in the past month. VoBs experiencing 1, 2, or 3 additional risk factors were successively more likely to carry weapons to school. The subset of VoBs who experienced all 3 additional adverse experiences were more likely to carry weapons to school compared with nonvictims (46.4% vs 2.5%, P < .001).CONCLUSIONS:Pediatricians should recognize that VoBs, especially those who have experienced 1 or more indicators of peer aggression in conjunction, are at substantially increased risk of weapon carrying.
      Keywords: Adolescent Health/Medicine, Injury, Violence & Poison Prevention, Bullying
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-0353
      Issue No: Vol. 140, No. 6 (2017)
  • Weighing the Social and Ethical Considerations of Maternal-Fetal Surgery
    • Authors: Antiel, R. M; Flake, A. W, Collura, C. A, Johnson, M. P, Rintoul, N. E, Lantos, J. D, Curlin, F. A, Tilburt, J. C, Brown, S. D, Feudtner, C.
      Abstract: OBJECTIVES:The ethics of maternal-fetal surgery involves weighing the importance of potential benefits, risks, and other consequences involving the pregnant woman, fetus, and other family members. We assessed clinicians’ ratings of the importance of 9 considerations relevant to maternal-fetal surgery.METHODS:This study was a discrete choice experiment contained within a 2015 national mail-based survey of 1200 neonatologists, pediatric surgeons, and maternal-fetal medicine physicians, with latent class analysis subsequently used to identify groups of physicians with similar ratings.RESULTS:Of 1176 eligible participants, 660 (56%) completed the discrete choice experiment. The highest-ranked consideration was of neonatal benefits, which was followed by consideration of the risk of maternal complications. By using latent class analysis, we identified 4 attitudinal groups with similar patterns of prioritization: "fetocentric" (n = 232), risk-sensitive (n = 197), maternal autonomy (n = 167), and family impact and social support (n = 64). Neonatologists were more likely to be in the fetocentric group, whereas surgeons were more likely to be in the risk-sensitive group, and maternal-fetal medicine physicians made up the largest percentage of the family impact and social support group.CONCLUSIONS:Physicians vary in how they weigh the importance of social and ethical considerations regarding maternal-fetal surgery. Understanding these differences may help prevent or mitigate disagreements or tensions that may arise in the management of these patients.
      Keywords: Ethics/Bioethics, Fetus/Newborn Infant
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-0608
      Issue No: Vol. 140, No. 6 (2017)
  • Trends in Hearing Loss Among Adolescents
    • Authors: Barrett, T. S; White, K. R.
      Abstract: OBJECTIVES:Our aim with this article is to evaluate whether the prevalence of hearing loss is increasing among adolescents living in the United States.METHODS:All available data about hearing loss among adolescents from the large, federally funded National Health and Nutrition Examination Survey (NHANES) were analyzed. By using the 4 data releases between 1994 and 2010 (a total of 6891 adolescents), the prevalence of adolescent hearing loss >15 and ≥25 dB at low frequencies (0.5, 1, and 2 kHz) and high frequencies (3, 4, 6, and 8 kHz) for bilateral, unilateral, and any loss were calculated.RESULTS:Only 13 of 90 comparisons of prevalence across combinations of degree, frequency, and laterality of hearing loss revealed a statistically significant increase at P < .05. Among the 18 subgroups of degree, frequency, and laterality, 61% had a lower prevalence of hearing loss in 2010 than in 1994, and 100% of the subgroups had a lower prevalence in 2010 than in 2006.CONCLUSIONS:With previous analyses of NHANES data from 1994 to 2006, researchers showed that hearing loss among US adolescents was increasing. Based on the NHANES data from 1994 to 2010 that are now available, there is no consistent evidence that hearing loss among adolescents in the United States is increasing. Results reveal that conclusions about trends using data from 2 time points can be misleading. NHANES should resume collecting audiometric data as part of their data collection protocol so that trends in the prevalence of childhood hearing loss can be documented.
      Keywords: Ear, Nose & Throat Disorders, Adolescent Health/Medicine
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-0619
      Issue No: Vol. 140, No. 6 (2017)
  • Oropharyngeal Dysphagia and Cerebral Palsy
    • Authors: Benfer, K. A; Weir, K. A, Bell, K. L, Ware, R. S, Davies, P. S. W, Boyd, R. N.
      Abstract: OBJECTIVES:To determine the progression of oropharyngeal dysphagia (OPD) in preschool-aged children with cerebral palsy (CP) according to gross motor function. It was hypothesized that fewer children would have OPD at 60 months compared with 18 to 24 months (predominately Gross Motor Function Classification System [GMFCS] I–II).METHODS:Longitudinal population-based cohort of 179 children (confirmed CP diagnosis, born in Queensland in 2006–2009, aged 18–60 months at study entry [mean = 34.1 months ± 11.9; 111 boys; GMFCS I = 46.6%, II = 12.9%, III = 15.7%, IV = 10.1%, and V = 14.6%]). Children had a maximum of 3 assessments (median = 3, total n = 423 assessments). OPD was classified by using the Dysphagia Disorders Survey part 2 and rated from video by a certified pediatric speech pathologist. GMFCS was used to classify children’s gross motor function.RESULTS:OPD prevalence reduced from 79.7% at 18 to 24 months to 43.5% at 60 months. There were decreasing odds of OPD with increasing age (odds ratio [OR] = 0.92 [95% confidence interval (CI) 0.90 to 0.95]; P < .001) and increasing odds with poorer gross motor function (OR = 6.2 [95% CI 3.6 to 10.6]; P < .001). This reduction was significant for children with ambulatory CP (GMFCS I–II, OR = 0.93 [95% CI 0.90 to 0.96]; P < .001) but not significant for children from GMFCS III to V (OR [III] = 1.0 [95% CI 0.9 to 1.1]; P = .897; OR [IV–V] = 1.0 [95% CI 1.0 to 1.1]; P = .366).CONCLUSIONS:Half of the OPD present in children with CP between 18 and 24 months resolved by 60 months, with improvement most common in GMFCS I to II. To more accurately detect and target intervention at children with persisting OPD at 60 months, we suggest using a more conservative cut point of 6 out of 22 on the Dysphagia Disorders Survey for assessments between 18 and 48 months.
      Keywords: Children With Special Health Care Needs, Nutrition
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-0731
      Issue No: Vol. 140, No. 6 (2017)
  • Perinatal Outcomes After Treatment With ADHD Medication During Pregnancy
    • Authors: Nörby, U; Winbladh, B, Källen, K.
      Abstract: OBJECTIVES:To analyze perinatal outcomes after maternal use of attention-deficit/hyperactivity disorder (ADHD) medication during pregnancy.METHODS:The study included singletons born between 2006 and 2014 in Sweden. Data on prescription drug use, pregnancies, deliveries, and the newborn infants’ health were obtained from the Swedish Medical Birth Register, the Prescribed Drug Register, and the Swedish Neonatal Quality Register. We compared infants exposed to ADHD medication during pregnancy with infants whose mothers never used these drugs and infants whose mothers used ADHD medication before or after pregnancy. Analyses were performed with logistic regression.RESULTS:Among 964 734 infants, 1591 (0.2%) were exposed to ADHD medication during pregnancy and 9475 (1.0%) had mothers treated before or after pregnancy. Exposure during pregnancy increased the risk for admission to a NICU compared with both no use and use before or after pregnancy (adjusted odds ratio [aOR], 1.5; 95% confidence interval [CI], 1.3–1.7; and aOR, 1.2; 95% CI, 1.1–1.4, respectively). Infants exposed during pregnancy had more often central nervous system–related disorders (aOR, 1.9; 95% CI, 1.1–3.1) and were more often moderately preterm (aOR, 1.3; 95% CI, 1.1–1.6) than nonexposed infants. There was no increased risk for congenital malformations or perinatal death.CONCLUSIONS:Treatment with ADHD medication during pregnancy was associated with a higher risk for neonatal morbidity, especially central nervous system–related disorders such as seizures. Because of large differences in background characteristics between treated women and controls, it is uncertain to what extent this can be explained by the ADHD medication per se.
      Keywords: Fetus/Newborn Infant, Gynecology, Maternal and Fetal Medicine
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-0747
      Issue No: Vol. 140, No. 6 (2017)
  • Practice Variation in Acute Bronchiolitis: A Pediatric Emergency Research
           Networks Study
    • Authors: Schuh, S; Babl, F. E, Dalziel, S. R, Freedman, S. B, Macias, C. G, Stephens, D, Steele, D. W, Fernandes, R. M, Zemek, R, Plint, A. C, Florin, T. A, Lyttle, M. D, Johnson, D. W, Gouin, S, Schnadower, D, Klassen, T. P, Bajaj, L, Benito, J, Kharbanda, A, Kuppermann, N, the Pediatric Emergency Research Networks (PERN)
      Abstract: BACKGROUND AND OBJECTIVES:Studies characterizing hospitalizations in bronchiolitis did not identify patients receiving evidence-based supportive therapies (EBSTs). We aimed to evaluate intersite and internetwork variation in receipt of ≥1 EBSTs during the hospital management of infants diagnosed with bronchiolitis in 38 emergency departments of pediatric emergency research networks in Canada, the United States, Australia, New Zealand, the United Kingdom, Ireland, Spain, and Portugal. We hypothesized that there would be significant variation, adjusted for patient characteristics.METHODS:Retrospective cohort study of previously healthy infants aged
      Keywords: Pulmonology, Bronchiolitis
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-0842
      Issue No: Vol. 140, No. 6 (2017)
  • Infant Neuromotor Development and Childhood Problem Behavior
    • Authors: Serdarevic, F; Ghassabian, A, van Batenburg-Eddes, T, Tahirovic, E, White, T, Jaddoe, V. W. V, Verhulst, F. C, Tiemeier, H.
      Abstract: BACKGROUND:Research of adults and school-aged children suggest a neurodevelopmental basis for psychiatric disorders. We examined whether infant neuromotor development predicted internalizing and externalizing problems in young children.METHODS:In Generation R, a population-based cohort in the Netherlands (2002–2006), trained research assistants evaluated the neuromotor development of 4006 infants aged 2 to 5 months by using an adapted version of Touwen’s Neurodevelopmental Examination (tone, responses, and senses and other observations). We defined nonoptimal neuromotor development as scores in the highest tertile. Mothers and fathers rated their children’s behavior at ages 1.5, 3, 6, and 10 years with the Child Behavior Checklist (n = 3474, response: 86.7%). The associations were tested with generalized linear mixed models.RESULTS:Overall, neuromotor development predicted internalizing scores, but no association was observed with externalizing scores. Nonoptimal muscle tone was associated with higher internalizing scores (mothers’ report: β = .07; 95% confidence interval [CI]: 0.01 to 0.13; fathers’ report: β = .09, 95% CI: 0.00 to 0.16). In particular, nonoptimal low muscle tone was associated with higher internalizing scores (mothers’ report: β = .11; 95% CI: 0.05 to 0.18; fathers’ report: β = .13; 95% CI: 0.04 to 0.22). We also observed an association between senses and other observations with internalizing scores. There was no relationship between high muscle tone or reflexes and internalizing scores.CONCLUSIONS:Common emotional problems in childhood have a neurodevelopmental basis in infancy. Neuromotor assessment in infancy may help identify vulnerability to early internalizing symptoms and offer the opportunity for targeted interventions.
      Keywords: Developmental/Behavioral Pediatrics, Growth/Development Milestones, Psychiatry/Psychology
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-0884
      Issue No: Vol. 140, No. 6 (2017)
  • Spillover Effects of Adult Medicaid Expansions on Childrens Use of
           Preventive Services
    • Authors: Venkataramani, M; Pollack, C. E, Roberts, E. T.
      Abstract: BACKGROUND:Since the passage of the Affordable Care Act, Medicaid enrollment has increased by ~17 million adults, including many low-income parents. One potentially important, but little studied, consequence of expanding health insurance for parents is its effect on children’s receipt of preventive services.METHODS:By using state Medicaid eligibility thresholds linked to the 2001–2013 Medical Expenditure Panel Surveys, we assessed the relationship between changes in adult Medicaid eligibility and children’s likelihood of receiving annual well-child visits (WCVs). In instrumental variable analyses, we used these changes in Medicaid eligibility to estimate the relationship between parental enrollment in Medicaid and children’s receipt of WCVs.RESULTS:Our analytic sample consisted of 50 622 parent-child dyads in families with incomes
      Keywords: Advocacy, Federal Policy
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-0953
      Issue No: Vol. 140, No. 6 (2017)
  • Prevalence and Attitudes Regarding Marijuana Use Among Adolescents Over
           the Past Decade
    • Authors: Miech, R; Johnston, L, OMalley, P. M.
      Abstract: BACKGROUND:Adolescent marijuana prevalence has not increased since 2005 despite a substantial decrease in the percentage of adolescents who believe marijuana use leads to great risk of harm. This finding calls into question the long-standing, inverse connection between marijuana prevalence and perceived risk of use, a connection central to many arguments opposing marijuana legalization. We tested 2 hypotheses for why marijuana prevalence did not increase after 2005: (1) decreases in adolescent use of cigarettes and alcohol reduced risk for marijuana use and counteracted the expected risk in marijuana prevalence, and/or (2) perceived risk of harm now plays a smaller role in marijuana use.METHODS:Data came from the annual, nationally-representative Monitoring the Future study from 1991 to 2016, in which 1 100 000 US students in eighth, 10th, and 12th grade were surveyed.RESULTS:The entire sample was stratified into 3 mutually exclusive and exhaustive groups on the basis of cigarette and alcohol use. Within each of the 3 groups, marijuana prevalence increased from 2005 to 2016. Paradoxically, when the 3 groups were combined into 1 analysis pool, overall marijuana prevalence did not increase. The seeming paradox results from a decline in the percentage of adolescents who used cigarettes; as this group grew smaller, so too did its disproportionately large contribution to overall marijuana prevalence. Perceived risk of harm from marijuana remained a strong indicator of use throughout 2005 to 2016.CONCLUSIONS:Perceived risk of marijuana remains tightly associated with use, and adolescent marijuana prevalence today would be at or near record highs if cigarette use had not declined since 2005, according to study projections.
      Keywords: Substance Use, Public Health
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-0982
      Issue No: Vol. 140, No. 6 (2017)
  • Trends in Intravenous Antibiotic Duration for Urinary Tract Infections in
           Young Infants
    • Authors: Lewis-de los Angeles, W. W; Thurm, C, Hersh, A. L, Shah, S. S, Smith, M. J, Gerber, J. S, Parker, S. K, Newland, J. G, Kronman, M. P, Lee, B. R, Brogan, T. V, Courter, J. D, Spaulding, A, Patel, S. J.
      Abstract: OBJECTIVES:To assess trends in the duration of intravenous (IV) antibiotics for urinary tract infections (UTIs) in infants ≤60 days old between 2005 and 2015 and determine if the duration of IV antibiotic treatment is associated with readmission.METHODS:Retrospective analysis of infants ≤60 days old diagnosed with a UTI who were admitted to a children’s hospital and received IV antibiotics. Infants were excluded if they had a previous surgery or comorbidities, bacteremia, or admission to the ICU. Data were analyzed from the Pediatric Health Information System database from 2005 through 2015. The primary outcome was readmission within 30 days for a UTI.RESULTS:The proportion of infants ≤60 days old receiving 4 or more days of IV antibiotics (long IV treatment) decreased from 50% in 2005 to 19% in 2015. The proportion of infants ≤60 days old receiving long IV treatment at 46 children’s hospitals varied between 3% and 59% and did not correlate with readmission (correlation coefficient 0.13; P = .37). In multivariable analysis, readmission for a UTI was associated with younger age and female sex but not duration of IV antibiotic therapy (adjusted odds ratio for long IV treatment: 0.93 [95% confidence interval 0.52–1.67]).CONCLUSIONS:The proportion of infants ≤60 days old receiving long IV treatment decreased substantially from 2005 to 2015 without an increase in hospital readmissions. These findings support the safety of short-course IV antibiotic therapy for appropriately selected neonates.
      Keywords: Hospital Medicine, Infectious Disease
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1021
      Issue No: Vol. 140, No. 6 (2017)
  • Urinary Neutrophil Gelatinase-Associated Lipocalin for the Diagnosis of
           Urinary Tract Infections
    • Authors: Lubell, T. R; Barasch, J. M, Xu, K, Ieni, M, Cabrera, K. I, Dayan, P. S.
      Abstract: OBJECTIVES:To determine the accuracy of the novel biomarker urinary neutrophil gelatinase–associated lipocalin (uNGAL) to diagnose urinary tract infections (UTIs) in febrile infants and young children.METHODS:Prospective cross-sectional study of febrile infants
      Keywords: Emergency Medicine, Infectious Disease
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1090
      Issue No: Vol. 140, No. 6 (2017)
  • Web-based Social Media Intervention to Increase Vaccine Acceptance: A
           Randomized Controlled Trial
    • Authors: Glanz, J. M; Wagner, N. M, Narwaney, K. J, Kraus, C. R, Shoup, J. A, Xu, S, OLeary, S. T, Omer, S. B, Gleason, K. S, Daley, M. F.
      Abstract: BACKGROUND:Interventions to address vaccine hesitancy and increase vaccine acceptance are needed. This study sought to determine if a Web-based, social media intervention increases early childhood immunization.METHODS:A 3-arm, randomized controlled trial was conducted in Colorado from September 2013 to July 2016. Participants were pregnant women, randomly assigned (3:2:1) to a Web site with vaccine information and interactive social media components (VSM), a Web site with vaccine information (VI), or usual care (UC). Vaccination was assessed in infants of participants from birth to age 200 days. The primary outcome was days undervaccinated, measured as a continuous and dichotomous variable.RESULTS:Infants of 888 participants were managed for 200 days. By using a nonparametric rank-based analysis, mean ranks for days undervaccinated were significantly lower in the VSM arm versus UC (P = .02) but not statistically different between the VI and UC (P = .08) or between VSM and VI arms (P = .63). The proportions of infants up-to-date at age 200 days were 92.5, 91.3, and 86.6 in the VSM, VI, and UC arms, respectively. Infants in the VSM arm were more likely to be up-to-date than infants in the UC arm (odds ratio [OR] = 1.92; 95% confidence interval [CI], 1.07–3.47). Up-to-date status was not statistically different between VI and UC arms (OR = 1.62; 95% CI, 0.87–3.00) or between the VSM and VI arms (OR = 1.19, 95% CI, 0.70–2.03).CONCLUSIONS:Providing Web-based vaccine information with social media applications during pregnancy can positively influence parental vaccine behaviors.
      Keywords: Infectious Disease, Vaccine/Immunization, Media, Social Media
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1117
      Issue No: Vol. 140, No. 6 (2017)
  • Effectiveness of a Kindergarten-Based Intervention for Preventing
           Childhood Obesity
    • Authors: Hu, Y; He, J.-R, Liu, F.-H, Li, W.-D, Lu, J.-H, Xing, Y.-F, Lin, S.-F, Liu, X, Bartington, S, Feng, Q, Xia, H.-M, Lam, K. B. H, Cheng, K. K, Qiu, X.
      Abstract: BACKGROUND AND OBJECTIVES:Interventions to prevent childhood obesity targeting school age children have mostly reported limited effectiveness, suggesting such prevention programs may need to start at an earlier age, but evidence has been scarce. We reported a pilot study aiming to demonstrate the feasibility of a multifaceted intervention for preschool children and to provide a preliminary assessment of the effectiveness.METHODS:This nonrandomized controlled trial recruited children aged 3 to 6 years from 6 kindergartens in Guangzhou, China. Based on the preference of the School and Parents Committees, 4 kindergartens (648 children) received a 3-component intervention (training of kindergarten staff, initiating healthy curriculum for children, and close collaboration between families and kindergartens) over 12 months, while the other 2 kindergartens (336 children), serving as controls, received routine health care provision. Outcome measures were the changes in BMI z score between baseline and the end of 12 months, and the prevalence of postintervention children who were overweight or obese. RESULTS:By 12 months, children within the intervention group had a smaller BMI z score increase (0.24) compared to the control (0.41), with a difference of –0.31 (95% CI –0.47 to –0.15). The prevalence of overweight or obesity was also lower among the intervention group at the end of the study (OR: 0.43, 95% CI 0.19 to 0.96), adjusted for baseline status. CONCLUSIONS:Our results indicated a multicomponent health behavior intervention might be effective in reducing the prevalence of obesity, but the longer term effects will need confirmation from randomized controlled trials.
      Keywords: Obesity, Public Health
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1221
      Issue No: Vol. 140, No. 6 (2017)
  • Hand and Wrist Injuries Among US High School Athletes: 2005/06-2015/16
    • Authors: Johnson, B. K; Brou, L, Fields, S. K, Erkenbeck, A. N, Comstock, R. D.
      Abstract: BACKGROUND:The risk of hand/wrist injuries is present across various sports. Little is known about the epidemiology of such injuries. The objective of this study was to calculate the rates of hand/wrist injuries and investigate injury patterns among high school athletes.METHODS:Athlete exposure (AE) and hand/wrist injury data were collected during 11 academic years, 2005/06 through 2015/16, from a large sample of US high schools as part of the National High School Sports-Related Injury Surveillance Study.RESULTS:There were 6723 hand/wrist injuries sustained during 40 195 806 AEs, a rate of 1.7 per 10 000 AEs. The rate of injury in competition (3.3) was higher than in practice (1.1) (95% confidence interval: 2.8–3.1). Rates of hand/wrist injuries varied by sport, with the highest rates in football (4.3), boys’ lacrosse (1.9), girls’ softball (1.9), wrestling (1.8), girls’ field hockey (1.7), boys’ ice hockey (1.7), and girls’ basketball (1.7). The most common injuries were fracture (45.0%), contusion (11.6%), and ligament sprain (9.0%). Athletes most frequently returned to play in
      Keywords: Injury, Violence & Poison Prevention, Sports Medicine/Physical Fitness
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1255
      Issue No: Vol. 140, No. 6 (2017)
  • Survival in Very Preterm Infants: An International Comparison of 10
           National Neonatal Networks
    • Authors: Helenius, K; Sjörs, G, Shah, P. S, Modi, N, Reichman, B, Morisaki, N, Kusuda, S, Lui, K, Darlow, B. A, Bassler, D, Hakansson, S, Adams, M, Vento, M, Rusconi, F, Isayama, T, Lee, S. K, Lehtonen, L, on behalf of the International Network for Evaluating Outcomes (iNeo) of Neonates
      Abstract: OBJECTIVES:To compare survival rates and age at death among very preterm infants in 10 national and regional neonatal networks.METHODS:A cohort study of very preterm infants, born between 24 and 29 weeks’ gestation and weighing
      Keywords: Fetus/Newborn Infant, Neonatology
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1264
      Issue No: Vol. 140, No. 6 (2017)
  • Diagnostic Accuracy of Neonatal Assessment for Gestational Age
           Determination: A Systematic Review
    • Authors: Lee, A. C; Panchal, P, Folger, L, Whelan, H, Whelan, R, Rosner, B, Blencowe, H, Lawn, J. E.
      Abstract: CONTEXT:An estimated 15 million neonates are born preterm annually. However, in low- and middle-income countries, the dating of pregnancy is frequently unreliable or unknown.OBJECTIVE:To conduct a systematic literature review and meta-analysis to determine the diagnostic accuracy of neonatal assessments to estimate gestational age (GA).DATA SOURCES:PubMed, Embase, Cochrane, Web of Science, POPLINE, and World Health Organization library databases.STUDY SELECTION:Studies of live-born infants in which researchers compared neonatal signs or assessments for GA estimation with a reference standard.DATA EXTRACTION:Two independent reviewers extracted data on study population, design, bias, reference standard, test methods, accuracy, agreement, validity, correlation, and interrater reliability.RESULTS:Four thousand nine hundred and fifty-six studies were screened and 78 included. We identified 18 newborn assessments for GA estimation (ranging 4 to 23 signs). Compared with ultrasound, the Dubowitz score dated 95% of pregnancies within ±2.6 weeks (n = 7 studies), while the Ballard score overestimated GA (0.4 weeks) and dated pregnancies within ±3.8 weeks (n = 9). Compared with last menstrual period, the Dubowitz score dated 95% of pregnancies within ± 2.9 weeks (n = 6 studies) and the Ballard score, ±4.2 weeks (n = 5). Assessments with fewer signs tended to be less accurate. A few studies showed a tendency for newborn assessments to overestimate GA in preterm infants and underestimate GA in growth-restricted infants.LIMITATIONS:Poor study quality and few studies with early ultrasound-based reference.CONCLUSIONS:Efforts in low- and middle-income countries should focus on improving dating in pregnancy through ultrasound and improving validity in growth-restricted populations. Where ultrasound is not possible, increased efforts are needed to develop simpler yet specific approaches for newborn assessment through new combinations of existing parameters, new signs, or technology.
      Keywords: Fetus/Newborn Infant, Neonatology, International Child Health
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1423
      Issue No: Vol. 140, No. 6 (2017)
  • Trends of Out-of-Hospital Sudden Cardiac Death Among Children and Young
    • Authors: El-Assaad, I; Al-Kindi, S. G, Aziz, P. F.
      Abstract: BACKGROUND AND OBJECTIVES:Previous estimates of sudden cardiac death in children and young adults vary significantly, and population-based studies in the United States are lacking. We sought to estimate the incidence, causes, and mortality trends of sudden cardiac death in children and young adults (1–34 years).METHODS:Demographic and mortality data based on death certificates for US residents (1–34 years) were obtained (1999–2015). Cases of sudden death and sudden cardiac death were retrieved by using the International Classification of Diseases, 10th Revision codes.RESULTS:A total of 1 452 808 subjects aged 1 to 34 years died in the United States, of which 31 492 (2%) were due to sudden cardiac death. The estimated incidence of sudden cardiac death is 1.32 per 100 000 individuals and increased with age from 0.49 (1–10 years) to 2.76 (26–34 years). During the study period, incidence of sudden cardiac death declined from 1.48 to 1.13 per 100 000 (P < .001). Mortality reduction was observed across all racial and ethnic groups with a varying magnitude and was highest in children aged 11 to 18 years. Significant disparities were found, with non-Hispanic African American individuals and individuals aged 26 to 34 years having the highest mortality rates. The majority of young children (1–10 years) died of congenital heart disease (n = 1525, 46%), whereas young adults died most commonly from ischemic heart disease (n = 5075, 29%).CONCLUSIONS:Out-of-hospital sudden cardiac death rates declined 24% from 1999 to 2015. Disparities in mortality exist across age groups and racial and ethnic groups, with non-Hispanic African American individuals having the highest mortality rates.
      Keywords: Cardiology
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1438
      Issue No: Vol. 140, No. 6 (2017)
  • Childhood Sports Participation and Adolescent Sport Profile
    • Authors: Gallant, F; OLoughlin, J. L, Brunet, J, Sabiston, C. M, Belanger, M.
      Abstract: OBJECTIVES:We aimed to increase understanding of the link between sport specialization during childhood and adolescent physical activity (PA). The objectives were as follows: (1) describe the natural course of sport participation over 5 years among children who are early sport samplers or early sport specializers and (2) determine if a sport participation profile in childhood predicts the sport profile in adolescence.METHODS:Participants (n = 756, ages 10–11 years at study inception) reported their participation in organized and unorganized PA during in-class questionnaires administered every 4 months over 5 years. They were categorized as early sport samplers, early sport specializers, or nonparticipants in year 1 and as recreational sport participants, performance sport participants, or nonparticipants in years 2 to 5. The likelihood that a childhood sport profile would predict the adolescent profile was computed as relative risks. Polynomial logistic regression was used to identify predictors of an adolescent sport profile.RESULTS:Compared with early sport specialization and nonparticipation, early sport sampling in childhood was associated with a higher likelihood of recreational participation (relative risk, 95% confidence interval: 1.55, 1.18–2.03) and a lower likelihood of nonparticipation (0.69, 0.51–0.93) in adolescence. Early sport specialization was associated with a higher likelihood of performance participation (1.65, 1.19–2.28) but not of nonparticipation (1.01, 0.70–1.47) in adolescence. Nonparticipation in childhood was associated with nearly doubling the likelihood of nonparticipation in adolescence (1.88, 1.36–2.62).CONCLUSIONS:Sport sampling should be promoted in childhood because it may be linked to higher PA levels during adolescence.
      Keywords: Public Health
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1449
      Issue No: Vol. 140, No. 6 (2017)
  • Bone Age: A Handy Tool for Pediatric Providers
    • Authors: Creo, A. L; Schwenk, W. F.
      Abstract: Pediatricians have relied on methods for determining skeletal maturation for >75 years. Bone age continues to be a valuable tool in assessing children’s health. New technology for bone age determination includes computer-automated readings and assessments obtained from alternative imaging modalities. In addition, new nonclinical bone age applications are evolving, particularly pertaining to immigration and children’s rights to asylum. Given the significant implications when bone ages are used in high-stake decisions, it is necessary to recognize recently described limitations in predicting accurate age in various ethnicities and diseases. Current methods of assessing skeletal maturation are derived from primarily white populations. In modern studies, researchers have explored the accuracy of bone age across various ethnicities in the United States. Researchers suggest there is evidence that indicates the bone ages obtained from current methods are less generalizable to children of other ethnicities, particularly children with African and certain Asian backgrounds. Many of the contemporary methods of bone age determination may be calibrated to individual populations and hold promise to perform better in a wider range of ethnicities, but more data are needed.
      Keywords: Developmental/Behavioral Pediatrics, Growth/Development Milestones, Endocrinology, Puberty
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1486
      Issue No: Vol. 140, No. 6 (2017)
  • Academic Achievement and Physical Activity: A Meta-analysis
    • Authors: Alvarez-Bueno, C; Pesce, C, Cavero-Redondo, I, Sanchez-Lopez, M, Garrido-Miguel, M, Martinez-Vizcaino, V.
      Abstract: CONTEXT:The effect of physical activity (PA) on different areas of academic achievement and classroom behaviors and how different characteristics of PA interventions could modify the effect remain unclear.OBJECTIVE:The objective was twofold: (1) to assess the effect of PA interventions on academic achievement and classroom behaviors in childhood and (2) to determine the characteristics of individuals and PA programs that enhance academic performance.DATA SOURCES:We identified studies from the database inception to October 16, 2016.STUDY SELECTION:We selected intervention studies aimed at examining the effect of exercise on academic achievement and classroom behaviors at developmental age.DATA EXTRACTION:Random-effects models were used to calculate pooled effect size for all primary outcomes (language- and mathematics-related skills, reading, composite score, and time in on-task behavior). Positive values represent a direct relationship between PA programs and academic achievement scores or on-task behaviors.RESULTS:A total of 26 studies (10 205 children, aged from 4 to 13) were included. Pooled effect size (95% confidence interval) estimates were as follows: (1) 0.16 (–0.06 to 0.37) for language-related skills; (2) 0.21 (0.09 to 0.33) for mathematics-related skills; (3) 0.13 (0.02 to 0.24) for reading; (4) 0.26 (0.07 to 0.45) for composite scores; and (5) 0.77 (0.22 to 1.32) for time in on-task behaviors.LIMITATIONS:Limitations included the variety of tools used to measure academic achievement and the limited number of studies that reported the effect of after-school PA interventions.CONCLUSIONS:PA, especially physical education, improves classroom behaviors and benefits several aspects of academic achievement, especially mathematics-related skills, reading, and composite scores in youth.
      Keywords: Community Pediatrics, School Health, Developmental/Behavioral Pediatrics
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1498
      Issue No: Vol. 140, No. 6 (2017)
  • Revisiting Our Professional Oath Amid Shifts in the American Political
    • Authors: Beck A. F.
      Keywords: Advocacy
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1522
      Issue No: Vol. 140, No. 6 (2017)
  • Readmission After Pediatric Mental Health Admissions
    • Authors: Feng, J. Y; Toomey, S. L, Zaslavsky, A. M, Nakamura, M. M, Schuster, M. A.
      Abstract: BACKGROUND AND OBJECTIVES:Reducing readmissions is a major health care system goal. There is a gap in our understanding of pediatric readmission patterns after mental health (MH) admissions. With this study, we aimed to characterize the prevalence of readmissions after MH admissions, to identify patient-level factors and costs associated with readmissions, and to assess variation in readmission rates across hospitals.METHODS:Using the 2014 Healthcare Cost and Utilization Project all-payer Nationwide Readmissions Database, we conducted a retrospective cohort analysis of 253 309 admissions for 5- to 17-year-olds at acute-care hospitals in 22 states. We calculated 30-day unplanned readmission rates, lengths of stay, and costs by primary admission diagnosis. We used hierarchical regression models to assess differences in readmission rates by patient characteristics, primary diagnoses, and comorbid chronic conditions, and to estimate the variation in case mix–adjusted rates across hospitals.RESULTS:MH stays accounted for 18.7% (n = 47 397) of index admissions. The 30-day readmission rate for MH admissions was higher than for non-MH admissions (8.0% vs 6.2%; P < .001). Children who were ≤14 years old, had non-MH chronic conditions, and/or had public insurance were more likely to be readmitted than their peers (P
      Keywords: Administration/Practice Management, Quality Improvement, Psychiatry/Psychology
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1571
      Issue No: Vol. 140, No. 6 (2017)
  • Effectiveness of a Comprehensive Case Management Service for Children With
           Medical Complexity
    • Authors: Simon, T. D; Whitlock, K. B, Haaland, W, Wright, D. R, Zhou, C, Neff, J, Howard, W, Cartin, B, Mangione-Smith, R.
      Abstract: OBJECTIVES:To assess whether children with medical complexity (CMC) exposed to a hospital-based comprehensive case management service (CCMS) experience improved health care quality, improved functional status, reduced hospital-based utilization, and/or reduced overall health care costs.METHODS:Eligible CMC at Seattle Children’s Hospital were enrolled in a cluster randomized controlled trial between December 1, 2010, and September 29, 2014. Participating primary care providers (PCPs) were randomly assigned, and CMC either had access to an outpatient hospital-based CCMS or usual care directed by their PCP. The CCMS included visits to a multidisciplinary clinic ≥ every 6 months for 1.5 years, an individualized shared care plan, and access to CCMS providers. Differences between control and intervention groups in change from baseline to 12 months and baseline to 18 months (difference of differences) were tested.RESULTS:Two hundred PCPs caring for 331 CMC were randomly assigned. Intervention group (n = 181) parents reported more improvement in the Consumer Assessment of Healthcare Providers and Systems version 4.0 Child Health Plan Survey global health care quality ratings than control group parents (6.7 [95% confidence interval (CI): 3.5–9.8] vs 1.3 [95% CI: 1.9–4.6] at 12 months). We did not detect significant differences in child functional status and most hospital-based utilization between groups. The difference in change of overall health care costs was higher in the intervention group (+$8233 [95% CI: $1701–$16 937]) at 18 months). CCMS clinic costs averaged $3847 per child-year.CONCLUSIONS:Access to a CCMS generally improved health care quality, but was not associated with changes in child functional status or hospital-based utilization, and increased overall health care costs among CMC.
      Keywords: Children With Special Health Care Needs
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1641
      Issue No: Vol. 140, No. 6 (2017)
  • Primary Care Interventions for Early Childhood Development: A Systematic
    • Authors: Peacock-Chambers, E; Ivy, K, Bair-Merritt, M.
      Abstract: CONTEXT:The pediatric primary care setting offers a platform to promote positive parenting behaviors and the optimal development of young children. Many new interventions have been developed and tested in this setting over the past 2 decades.OBJECTIVE:To summarize the recent published evidence regarding the impact of primary care–based interventions on parenting behaviors and child development outcomes; to provide recommendations for incorporation of effective interventions into pediatric clinics.DATA SOURCES:A literature search of PubMed and PsycINFO was conducted from January 1, 1999, to February 14, 2017.STUDY SELECTION:Publications in which primary care–based interventions and reported outcomes regarding the child’s development or parenting behaviors associated with the promotion of optimal child development are described.DATA EXTRACTION:Forty-eight studies in which 24 interventions were described were included. Levels of evidence and specific outcome measures are reported.RESULTS:Included interventions were categorized as general developmental support, general behavioral development, or topic-specific interventions. Two interventions resulted in reductions in developmental delay, 4 improved cognitive development scores, and 6 resulted in improved behavioral intensity or reduction in behavioral problems. Interventions used a variety of theory-based behavior change strategies such as modeling, group discussion, role play, homework assignment, coaching, and video-recorded interactions. Three interventions report the cost of the intervention.LIMITATIONS:Community or home-based interventions were excluded.CONCLUSIONS:Although several interventions resulted in improved child development outcomes for children aged 0 to 3 years, comparison across studies and interventions is limited by use of different outcome measures, time of evaluation, and variability of results.
      Keywords: Developmental/Behavioral Pediatrics, Growth/Development Milestones
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1661
      Issue No: Vol. 140, No. 6 (2017)
  • Counseling on Sun Protection and Indoor Tanning
    • Authors: Balk, S. J; Gottschlich, E. A, Holman, D. M, Watson, M.
      Abstract: BACKGROUND:The US Preventive Services Task Force recommends clinical counseling for individuals ages 10 to 24 years to decrease skin cancer risk.METHODS:A national, random sample of US American Academy of Pediatrics members practicing primary care in 2002 (response rate 55%) and 2015 (response rate 43%). Surveys explored attitudes and experiences regarding sun protection counseling; indoor tanning questions were added in 2015. 2 tests compared demographics and counseling responses across years, and multivariable logistic regression models examined counseling predictors.RESULTS:More pediatricians in 2015 (34%) than in 2002 (23%) reported discussing sun protection during recent summer months with ≥75% of patients. This pattern held across all patient age groups (each P
      Keywords: Environmental Health, Preventive Medicine
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1680
      Issue No: Vol. 140, No. 6 (2017)
  • Implementation of a Guideline to Decrease Use of Acid-Suppressing
           Medications in the NICU
    • Authors: Angelidou, A; Bell, K, Gupta, M, Tropea Leeman, K, Hansen, A.
      Abstract: BACKGROUND AND OBJECTIVES:Acid-suppressing medications are used extensively in term and preterm newborns despite limited efficacy data and increasing evidence for potential harm. We sought to reduce nonindicated use of proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) in our level III/IV NICU by developing and implementing a guideline for their use. Our specific aim was to reduce prescriptions among infants
      Keywords: Administration/Practice Management, Quality Improvement, Fetus/Newborn Infant
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1715
      Issue No: Vol. 140, No. 6 (2017)
  • Effect of FDA Investigation on Opioid Prescribing to Children After
    • Authors: Chua, K.-P; Shrime, M. G, Conti, R. M.
      Abstract: BACKGROUND:In August 2012, the Food and Drug Administration investigated the safety of codeine use by children after tonsillectomy and/or adenoidectomy, culminating in a black box warning in February 2013. The objective of this study was to evaluate the association between the investigation and opioid prescribing to children undergoing these surgeries.METHODS:We identified 362 992 privately insured children in the 2010–2015 Truven MarketScan Commercial Claims and Encounters database who underwent tonsillectomy and/or adenoidectomy. Using an interrupted time series design, we estimated level and slope changes in the proportion of children with ≥1 prescription fills for codeine and ≥1 fills for an alternative opioid, such as hydrocodone, within 7 days of surgery.RESULTS:The investigation was associated with a significant –13.3 (95% confidence interval: –14.5 to –12.1) percentage point level change in the proportion of children with ≥1 prescription fills for codeine after tonsillectomy and/or adenoidectomy. Despite this drop, 5.1% of children had ≥1 prescription fills for codeine in December 2015. The investigation was not associated with significant level changes in alternative opioid prescribing, although the proportion of children receiving alternative opioids increased during the study period because of other factors.CONCLUSIONS:The Food and Drug Administration investigation substantially decreased codeine prescribing to children after tonsillectomy and/or adenoidectomy. However, 1 in 20 children undergoing these surgeries were still prescribed codeine in December 2015 despite its well-documented safety and efficacy issues.
      Keywords: Ear, Nose & Throat Disorders, Administration/Practice Management, Quality Improvement
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1765
      Issue No: Vol. 140, No. 6 (2017)
  • The Gender Reveal: Implications of a Cultural Tradition for Pediatric
    • Authors: Nahata L.
      Keywords: Developmental/Behavioral Pediatrics, Psychosocial Issues
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1834
      Issue No: Vol. 140, No. 6 (2017)
  • Mortality in Infants Affected by Preterm Birth and Severe
           Small-for-Gestational Age Birth Weight
    • Authors: Ray, J. G; Park, A. L, Fell, D. B.
      Abstract: BACKGROUND:Few researchers have evaluated neonatal mortality in the combined presence of preterm birth (PTB) and small-for-gestational age (SGA) birth weight. None differentiated between infants with and without anomalies, considered births starting at 23 weeks’ gestation, or defined SGA at a more pathologic cutpoint less than the fifth percentile.METHODS:We completed a population-based cohort study within the province of Ontario, Canada, from 2002 to 2015. Included were 1 676 110 singleton hospital live births of 23 to 42 weeks’ gestation. Modified Poisson regression compared rates and relative risks of neonatal mortality among those with (1) preterm birth at 23 to 36 weeks’ gestation and concomitant severe small for gestational age (PTB-SGA), (2) PTB at 23 to 36 weeks’ gestation without severe SGA, (3) term birth with severe SGA, and each relative to (4) neither. Relative risks were adjusted for maternal age and stratified by several demographic variables.RESULTS:Relative to a neonatal mortality rate of 0.6 per 1000 term infants without severe SGA, the rate was 2.8 per 1000 among term births with severe SGA (adjusted relative risk [aRR] 4.6; 95% confidence interval [CI] 4.0–5.4), 22.9 per 1000 for PTB without severe SGA (aRR 38.3; 95% CI 35.4–41.4) and 60.0 per 1000 for PTB-SGA (aRR 96.7; 95% CI 85.4–109.5). Stratification by demographic factors showed a persistence of this pattern of neonatal death. Restricting the sample to births at ≥24 weeks’ gestation, or newborns without a congenital or chromosomal anomaly, also demonstrated the same pattern.CONCLUSIONS:Methods to detect or prevent PTB or SGA should focus on PTB-SGA, which serves as a useful perinatal surveillance indicator.
      Keywords: Fetus/Newborn Infant, Neonatology
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1881
      Issue No: Vol. 140, No. 6 (2017)
  • Combination Analgesia for Neonatal Circumcision: A Randomized Controlled
    • Authors: Sharara-Chami, R; Lakissian, Z, Charafeddine, L, Milad, N, El-Hout, Y.
      Abstract: OBJECTIVES:There is no consensus on the most effective pain management for neonatal circumcision. We sought to compare different modalities.METHODS:This is a double-blinded randomized controlled trial comparing 3 combination analgesics used during circumcision (EMLA + sucrose; EMLA + sucrose + dorsal penile nerve block [DPNB]; EMLA + sucrose + ring block [RB]) with the traditional topical analgesic cream EMLA alone. The trial was set in the normal nursery of a teaching hospital. The sample included 70 healthy male newborns, randomly assigned to intervention and control groups at a 2:1 ratio. Infants were videotaped (face and torso) during the procedure for assessment of pain by 2 blinded, independent reviewers. The primary outcome measure is the Neonatal Infant Pain Scale score. Secondary outcomes include heart rate, oxygen saturation, and crying time.RESULTS:Neonatal Infant Pain Scale scores were significantly lower in the intervention groups (EMLA + sucrose, mean [SD]: 3.1 [1.33]; EMLA + sucrose + DPNB: 3 [1.33]; EMLA + sucrose + RB: 2.45 [1.27]) compared with the control (5.5 [0.53]). Between-group analyses showed RB + EMLA + sucrose to be significantly more effective than EMLA + sucrose; EMLA + sucrose + DPNB (P = .009 and P = .002, respectively). Interrater reliability was = 0.843. Significant increase in heart rate (139.27 [9.63] to 163 [13.23] beats per minute) and crying time (5.78 [6.4] to 45.37 [12.39] seconds) were noted in the EMLA group. CONCLUSIONS:During neonatal circumcision in boys, the most effective analgesia is RB combined with oral sucrose and EMLA cream.
      Keywords: Fetus/Newborn Infant, Circumcision, Anesthesiology/Pain Medicine
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1935
      Issue No: Vol. 140, No. 6 (2017)
  • Refusal of Treatment of Childhood Cancer: A Systematic Review
    • Authors: Caruso Brown, A. E; Slutzky, A. R.
      Abstract: CONTEXT:Refusal of treatment for childhood cancer engenders much discussion. No systematic study of this phenomenon exists in countries where access to treatment is readily available.OBJECTIVE:To identify and describe all published cases of treatment refusal for childhood cancer in the contemporary era.DATA SOURCES:We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, LexisNexis Academic, personal database, and secondary bibliographies.STUDY SELECTION:Eligible studies included at least 1 child
      Keywords: Ethics/Bioethics, Hematology/Oncology, Cancer/Neoplastic
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1951
      Issue No: Vol. 140, No. 6 (2017)
  • Accuracy of Clinician Suspicion of Lyme Disease in the Emergency
    • Authors: Nigrovic, L. E; Bennett, J. E, Balamuth, F, Levas, M. N, Chenard, R. L, Maulden, A. B, Garro, A. C, for Pedi Lyme Net
      Abstract: BACKGROUND:To make initial management decisions, clinicians must estimate the probability of Lyme disease before diagnostic test results are available. Our objective was to examine the accuracy of clinician suspicion for Lyme disease in children undergoing evaluation for Lyme disease.METHODS:We assembled a prospective cohort of children aged 1 to 21 years who were evaluated for Lyme disease at 1 of the 5 participating emergency departments. Treating physicians were asked to estimate the probability of Lyme disease (on a 10-point scale). We defined a Lyme disease case as a patient with an erythema migrans lesion or positive 2-tiered serology results in a patient with compatible symptoms. We calculated the area under the curve for the receiver operating curve as a measure of the ability of clinician suspicion to diagnose Lyme disease.RESULTS:We enrolled 1021 children with a median age of 9 years (interquartile range, 5–13 years). Of these, 238 (23%) had Lyme disease. Clinician suspicion had a minimal ability to discriminate between children with and without Lyme disease: area under the curve, 0.75 (95% confidence interval, 0.71–0.79). Of the 554 children who the treating clinicians thought were unlikely to have Lyme disease (score 1–3), 65 (12%) had Lyme disease, and of the 127 children who the treating clinicians thought were very likely to have Lyme disease (score 8–10), 39 (31%) did not have Lyme disease.CONCLUSIONS:Because clinician suspicion had only minimal accuracy for the diagnosis of Lyme disease, laboratory confirmation is required to avoid both under- and overdiagnosis.
      Keywords: Emergency Medicine, Infectious Disease, Epidemiology
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-1975
      Issue No: Vol. 140, No. 6 (2017)
  • Epidemiology of Pediatric Zika Virus Infections
    • Authors: Griffin, I; Zhang, G, Fernandez, D, Cordero, C, Logue, T, White, S. L, Llau, A, Thomas, L, Moore, E, Noya-Chaveco, P, Etienne, M, Rojas, M, Goldberg, C, Rodriguez, G, Mejia-Echeverry, A, Rico, E, Gillis, L. D, Cone, M, Jean, R, Rivera, L.
      Abstract: BACKGROUND AND OBJECTIVE:In July 2016, local transmission of Zika virus (ZIKV) was announced in Miami-Dade County, Florida. In this report, we describe the epidemiology of pediatric ZIKV infections in locally acquired and travel-associated cases.METHODS:All children aged 1 to 17 years tested for ZIKV between October 1, 2015, and March 29, 2017, were included. SAS 9.4 was used to analyze age, sex, race and/or ethnicity, origin of exposure, onset date, affiliation with a household cluster, clinical symptoms, hospitalizations, viremia, viruria, and antibody detection in specimens.RESULTS:Among 478 confirmed ZIKV cases in Miami-Dade County, 33 (6.9%) occurred in children (1–17 years). Twenty-seven (82.3%) cases were travel-associated. The median age of a pediatric Zika case patient was 11 years. Seventeen (51.5%) case patients were boys, and 23 (69.9%) were Hispanic. Among 31 symptomatic cases, all reported having rash, 25 (80.6%) reported fever, 9 (29.0%) reported conjunctivitis, and 7 (22.6%) reported arthralgia. Sixteen (48.5%) cases reported 2 of 4 and 8 (24.2%) reported 3 of 4 main symptoms.CONCLUSIONS:This report found that the majority of children identified during the 2016 ZIKV outbreak only presented with 2 of the 4 main symptoms. In addition, pediatric ZIKV cases were frequently associated with symptomatic household members.
      Keywords: Infectious Disease, Epidemiology
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-2044
      Issue No: Vol. 140, No. 6 (2017)
  • State Variations in Infant Feeding Regulations for Child Care
    • Authors: Benjamin-Neelon, S. E; Gonzalez-Nahm, S, Grossman, E, Davis, M. L, Neelon, B, Ayers Looby, A, Frost, N.
      Abstract: OBJECTIVES:Early care and education (ECE) settings have become primary targets for policy change in recent years. In our 2008 study, we assessed state and regional variation in infant feeding regulations for ECE and compared them to national standards. We conducted the same regulatory review to assess change over time. Because all but 2 states have updated their regulations, we hypothesized that states would have made substantial improvements in the number of regulations supporting infant feeding in ECE.METHODS:For this cross-sectional study, we reviewed infant feeding regulations for all US states for child care centers (centers) and family child care homes (homes). We compared regulations with 10 national standards and assessed the number of new regulations consistent with these standards since our previous review.RESULTS:Comparing results from 2008 and 2016, we observed significant improvements in 7 of the 10 standards for centers and 4 of the 10 standards for homes. Delaware was the only state with regulations meeting 9 of the 10 standards for centers in 2008. In 2016, Delaware and Michigan had regulations meeting 8 of the 10 standards. Previously, Arkansas, the District of Columbia, Minnesota, Mississippi, Ohio, and South Carolina had regulations consistent with 4 of the 10 standards for homes. In 2016, Delaware, Mississippi, and Vermont had regulations meeting 7 of the 10 standards.CONCLUSIONS:Evidence suggests that enacting new regulations may improve child health outcomes. Given that many states recently enacted regulations governing infant feeding, our findings point to the growing interest in this area.
      Keywords: Nutrition, Breastfeeding, Child Care
      PubDate: 2017-12-01T01:02:09-08:00
      DOI: 10.1542/peds.2017-2076
      Issue No: Vol. 140, No. 6 (2017)
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