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Journal Cover Journal of Pediatrics
  [SJR: 1.849]   [H-I: 163]   [182 followers]  Follow
    
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 0022-3476
   Published by Elsevier Homepage  [3043 journals]
  • What are the benefits of molecular testing of cerebrospinal fluid of young
           febrile infants for enteroviruses'
    • Authors: Sarah S. Long
      First page: 1
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Sarah S. Long


      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.08.019
      Issue No: Vol. 189 (2017)
       
  • Secondhand tobacco smoke exposure: perhaps the most important
           cardiovascular risk factor for toddlers
    • Authors: Reginald Washington
      Pages: 1 - 2
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Reginald Washington


      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.08.020
      Issue No: Vol. 189 (2017)
       
  • Online Master of Education Program: Academic Outcomes
    • Authors: Robert Harper; Lea Alaee; Jeanne R. Spaulding; Thomas DeWitt; Melissa Klein
      Pages: 3 - 4
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Robert Harper, Lea Alaee, Jeanne R. Spaulding, Thomas DeWitt, Melissa Klein


      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.06.067
      Issue No: Vol. 189 (2017)
       
  • Amoxicillin Is the Most Cost-Effective Therapy for Acute Otitis Media: The
           Culmination of 40 Years of Research
    • Authors: Christopher J. Harrison
      Pages: 5 - 8.e1
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Christopher J. Harrison


      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.06.070
      Issue No: Vol. 189 (2017)
       
  • High Flow Nasal Cannula Flow Rates: New Data Worth the Weight
    • Authors: Steven L. Shein; Katherine N. Slain; Alexandre T. Rotta
      Pages: 9 - 10
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Steven L. Shein, Katherine N. Slain, Alexandre T. Rotta


      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.06.077
      Issue No: Vol. 189 (2017)
       
  • Down Syndrome and Pediatric Nonalcoholic Fatty Liver Disease: A Causal or
           Casual Relationship'
    • Authors: Antonia De Matteo; Pietro Vajro
      Pages: 11 - 13
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Antonia De Matteo, Pietro Vajro


      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.07.011
      Issue No: Vol. 189 (2017)
       
  • Treatment and Nontreatment of the Patent Ductus Arteriosus: Identifying
           Their Roles in Neonatal Morbidity
    • Authors: Ronald I. Clyman; Melissa Liebowitz
      Pages: 13 - 17
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Ronald I. Clyman, Melissa Liebowitz


      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.06.054
      Issue No: Vol. 189 (2017)
       
  • Solving the Extubation Equation: Successfully Weaning Infants Born
           Extremely Preterm from Mechanical Ventilation
    • Authors: Brett J. Manley; Peter G. Davis
      Pages: 17 - 18
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Brett J. Manley, Peter G. Davis


      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.06.015
      Issue No: Vol. 189 (2017)
       
  • Primary Hemophagocytic Lymphohistiocytosis and Macrophage Activation
           Syndrome: The Importance of Timely Clinical Differentiation
    • Authors: Alexei A. Grom
      Pages: 19 - 21.e1
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Alexei A. Grom


      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.07.025
      Issue No: Vol. 189 (2017)
       
  • Pediatric Anticoagulation: Time for a New Paradigm'
    • Authors: Masato Takahashi; Guy Young
      Pages: 21 - 23
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Masato Takahashi, Guy Young


      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.06.036
      Issue No: Vol. 189 (2017)
       
  • Adolescents at Risk for Sexually Transmitted Infection Need More Than the
           Right Medicine
    • Authors: Melissa K. Miller; Michelle L. Pickett; Jennifer L. Reed
      Pages: 23 - 25
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Melissa K. Miller, Michelle L. Pickett, Jennifer L. Reed


      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.06.072
      Issue No: Vol. 189 (2017)
       
  • Can We Prevent Bronchopulmonary Dysplasia'
    • Authors: Judy L. Aschner; Eduardo H. Bancalari; Cindy T. McEvoy
      Pages: 26 - 30
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Judy L. Aschner, Eduardo H. Bancalari, Cindy T. McEvoy


      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.08.005
      Issue No: Vol. 189 (2017)
       
  • Biologic Agents in the Treatment of Childhood-Onset Rheumatic Disease
    • Authors: Jay Mehta; Timothy Beukelman
      Pages: 31 - 39
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Jay Mehta, Timothy Beukelman


      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.06.041
      Issue No: Vol. 189 (2017)
       
  • The Microbiome and Biomarkers for Necrotizing Enterocolitis: Are We Any
           Closer to Prediction'
    • Authors: Brigida Rusconi; Misty Good; Barbara B. Warner
      Pages: 40 - 47.e2
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Brigida Rusconi, Misty Good, Barbara B. Warner


      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.05.075
      Issue No: Vol. 189 (2017)
       
  • Sensitivity and Specificity of Empiric Treatment for Sexually Transmitted
           Infections in a Pediatric Emergency Department
    • Authors: Kristen Breslin; Lisa Tuchman; Katie L. Hayes; Gia Badolato; Monika K. Goyal
      Pages: 48 - 53
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Kristen Breslin, Lisa Tuchman, Katie L. Hayes, Gia Badolato, Monika K. Goyal
      Objective To determine test characteristics of provider judgment for empiric antibiotic provision to patients undergoing testing for a sexually transmitted infection. Study design We conducted a retrospective cross-sectional electronic health record review of all patients aged 13-19 years who had Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) testing sent from an urban, academic pediatric emergency department in 2012. We abstracted data, including patient demographics, chief complaint, sexually transmitted infection test results, and treatment. We calculated test characteristics comparing clinician judgment for presumptive treatment for a sexually transmitted infection with the reference standard of the actual results of testing for a sexually transmitted infection. Results Of 1223 patient visits meeting inclusion criteria, 284 (23.2%) had a positive GC and/or CT test result. Empiric treatment was provided in 615 encounters (50.3%). Provider judgment for presumptive treatment had an overall sensitivity of 67.6% (95% CI, 61.8-73.0) and a specificity of 55% (95% CI, 51.7-58.2) for accurate GC and/or CT detection. Conclusions Many adolescents tested for GC and CT receive empiric treatment at the initial emergency department visit. Provider judgment may lack sufficient sensitivity and specificity for identifying infected patients, resulting in the potential for undertreatment of true disease, overtreatment of uninfected patients, or both.

      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.05.050
      Issue No: Vol. 189 (2017)
       
  • 50 Years Ago in The Journal of Pediatrics
    • Authors: Stephanie L. Bourque; Paul J. Rozance; William W. Hay
      First page: 53
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Stephanie L. Bourque, Paul J. Rozance, William W. Hay


      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.03.059
      Issue No: Vol. 189 (2017)
       
  • A Cost-Utility Analysis of 5 Strategies for the Management of Acute Otitis
           Media in Children
    • Authors: Nader Shaikh; Emily E. Dando; Mark L. Dunleavy; Dorothy L. Curran; Judith M. Martin; Alejandro Hoberman; Kenneth J. Smith
      Pages: 54 - 60.e3
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Nader Shaikh, Emily E. Dando, Mark L. Dunleavy, Dorothy L. Curran, Judith M. Martin, Alejandro Hoberman, Kenneth J. Smith
      Objective To assess whether antimicrobial therapy in young children with acute otitis media reduces time to resolution of symptoms, overall symptom burden, and persistence of otoscopic evidence of infection. We used a cost-utility model to evaluate whether immediate antimicrobial treatment seems to be worthwhile, and if so, which antimicrobial agent is most cost effective. Study design We compared the cost per quality-adjusted life-day of 5 treatment regimens in children younger than 2 years of age with acute otitis media: immediate amoxicillin/clavulanate, immediate amoxicillin, immediate cefdinir, watchful waiting, and delayed prescription (DP) for antibiotic. Results The 5 treatment regimens, listed in order from least effective to most effective were DP, watchful waiting, immediate cefdinir, immediate amoxicillin, and immediate amoxicillin/clavulanate. Listed in order from least costly to most costly, the regimens were DP, immediate amoxicillin, watchful waiting, immediate amoxicillin/clavulanate, and immediate cefdinir. The incremental cost-utility ratio of immediate amoxicillin compared with DP was $101.07 per quality-adjusted life-day gained. The incremental cost-utility ratio of immediate amoxicillin/clavulanate compared with amoxicillin was $2331.28 per quality-adjusted life-day gained. Conclusions In children younger than 2 years of age with acute otitis media and no recent antibiotic exposure, immediate amoxicillin seems to be the most cost-effective initial treatment.

      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.05.047
      Issue No: Vol. 189 (2017)
       
  • Safety and Efficacy of Warfarin Therapy in Kawasaki Disease
    • Authors: Annette L. Baker; Christina Vanderpluym; Kimberly A. Gauvreau; David R. Fulton; Sarah D. de Ferranti; Kevin G. Friedman; Jenna M. Murray; Loren D. Brown; Christopher S. Almond; Margaret Evans-Langhorst; Jane W. Newburger
      Pages: 61 - 65
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Annette L. Baker, Christina Vanderpluym, Kimberly A. Gauvreau, David R. Fulton, Sarah D. de Ferranti, Kevin G. Friedman, Jenna M. Murray, Loren D. Brown, Christopher S. Almond, Margaret Evans-Langhorst, Jane W. Newburger
      Objective To describe the safety and efficacy of warfarin for patients with Kawasaki disease and giant coronary artery aneurysms (CAAs, ≥8 mm). Giant aneurysms are managed with combined anticoagulation and antiplatelet therapies, heightening risk of bleeding complications. Study design We reviewed the time in therapeutic range; percentage of international normalization ratios (INRs) in range (%); bleeding events, clotting events; INRs ≥6; INRs ≥5 and <6; and INRs <1.5. Results In 9 patients (5 male), median age 14.4 years (range 7.1-22.8 years), INR testing was prescribed weekly to monthly and was done by home monitor (n = 5) or laboratory (n = 3) or combined (1). Median length of warfarin therapy was 7.2 years (2.3-13.3 years). Goal INR was 2.0-3.0 (n = 6) or 2.5-3.5 (n = 3), based on CAA size and history of CAA thrombosis. All patients were treated with aspirin; 1 was on dual antiplatelet therapy and warfarin. The median time in therapeutic range was 59% (37%-85%), and median percentage of INRs in range was 68% (52%-87%). INR >6 occurred in 3 patients (4 events); INRs ≥5 <6 in 7 patients (12 events); and INR <1.5 in 5 patients (28 events). The incidence of major bleeding events and clinically relevant nonmajor bleeding events were each 4.3 per 100 patient-years (95% CI 0.9-12.6). New asymptomatic coronary thrombosis was detected by imaging in 2 patients. Conclusions Bleeding and clotting complications are common in patients with Kawasaki disease on warfarin and aspirin, with INRs in range only two-thirds of the time. Future studies should evaluate the use of direct oral anticoagulants in children as an alternative to warfarin.

      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.04.051
      Issue No: Vol. 189 (2017)
       
  • The Relationship between High Flow Nasal Cannula Flow Rate and Effort of
           Breathing in Children
    • Authors: Thomas Weiler; Asavari Kamerkar; Justin Hotz; Patrick A. Ross; Christopher J.L. Newth; Robinder G. Khemani
      Pages: 66 - 71.e3
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Thomas Weiler, Asavari Kamerkar, Justin Hotz, Patrick A. Ross, Christopher J.L. Newth, Robinder G. Khemani
      Objective To use an objective metric of effort of breathing to determine optimal high flow nasal cannula (HFNC) flow rates in children <3 years of age. Study design Single-center prospective trial in a 24-bed pediatric intensive care unit of children <3 years of age on HFNC. We measured the percent change in pressure∙rate product (PRP) (an objective measure of effort of breathing) as a function of weight-indexed flow rates of 0.5, 1.0, 1.5, and 2.0 L/kg/minute. For a subgroup of patients, 2 different HFNC delivery systems (Fisher & Paykel [Auckland, New Zealand] and Vapotherm [Exeter, New Hampshire]) were compared. Results Twenty-one patients (49 titration episodes) were studied. The most common diagnoses were bronchiolitis and pneumonia. Overall, there was a significant difference in the percent change in PRP from baseline (of 0.5 L/kg/minute) with increasing flow rates for the entire cohort (P < .001) with largest change at 2.0 L/kg/min (−21%). Subgroup analyses showed no significant difference in percent change in PRP from baseline when comparing the 2 different HFNC delivery systems (P = .12). Patients ≤8 kg experienced a larger percent change in PRP as HFNC flow rates were increased (P = .001) than patients >8 kg. Conclusions The optimal HFNC flow rate to reduce effort of breathing in infants and young children is approximately 1.5-2.0 L/kg/minute with more benefit seen in children ≤8 kg.

      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.06.006
      Issue No: Vol. 189 (2017)
       
  • Development and Initial Validation of the Macrophage Activation
           Syndrome/Primary Hemophagocytic Lymphohistiocytosis Score, a Diagnostic
           Tool that Differentiates Primary Hemophagocytic Lymphohistiocytosis from
           Macrophage Activation Syndrome
    • Authors: Francesca Minoia; Francesca Bovis; Sergio Davì; Antonella Insalaco; Kai Lehmberg; Susan Shenoi; Sheila Weitzman; Graciela Espada; Yi-Jin Gao; Jordi Anton; Toshiyuki Kitoh; Ozgur Kasapcopur; Helga Sanner; Rosa Merino; Itziar Astigarraga; Maria Alessio; Michael Jeng; Vyacheslav Chasnyk; Kim E. Nichols; Zeng Huasong; Caifeng Li; Concetta Micalizzi; Nicolino Ruperto; Alberto Martini; Randy Q. Cron; Angelo Ravelli; AnnaCarin Horne; Mario Abinun; Amita Aggarwal; Jonathan Akikusa; Sulaiman Al-Mayouf; Maria Alessio; Jordi Anton; Maria Teresa Apaz; Itziar Astigarraga; Tadej Avcin; Nuray Aktay Ayaz; Patrizia Barone; Bianca Bica; Isabel Bolt; Francesca Bovis; Luciana Breda; Vyacheslav Chasnyk; Rolando Cimaz; Fabrizia Corona; Randy Q. Cron; Ruben Cuttica; Sergio Davì; Zane Davidsone; Carmen De Cunto; Jaime De Inocencio; Erkan Demirkaya; Eli M. Eisenstein; Sandra Enciso; Graciela Espada; Michel Fischbach; Michael Frosch; Romina Gallizzi; Maria Luz Gamir; Yi-Jin Gao; Thomas Griffin; Alexei Grom; Soad Hashad; Teresa Hennon; Jan-Inge Henter; AnnaCarin Horne; Gerd Horneff; Zeng Huasong; Adam Huber; Norman Ilowite; Antonella Insalaco; Maka Ioseliani; Michael Jeng; Agneza Marija Kapović; Ozgur Kasapcopur; Raju Khubchandani; Toshiyuki Kitoh; Isabelle Koné-Paut; Sheila Knupp Feitosa de Oliveira; Bianca Lattanzi; Kai Lehmberg; Loredana Lepore; Caifeng Li; Jeffrey M. Lipton; Silvia Magni-Manzoni; Despoina Maritsi; Alberto Martini; Deborah McCurdy; Rosa Merino; Concetta Micalizzi; Paivi Miettunen; Francesca Minoia; Velma Mulaosmanovic; Kim E. Nichols; Susan Nielsen; Seza Ozen; Priyankar Pal; Sampath Prahalad; Angelo Ravelli; Donato Rigante; Ingrida Rumba-Rozenfelde; Nicolino Ruperto; Ricardo Russo; Claudia Saad Magalhães; Helga Sanner; Wafaa Mohamed Saad Sewairi; Susan Shenoi; Clovis Artur Silva; Valda Stanevicha; Gary Sterba; Kimo C. Stine; Gordana Susic; Flavio Sztajnbok; Syuji Takei; Ralf Trauzeddel; Elena Tsitsami; Erbil Unsal; Yosef Uziel; Olga Vougiouka; Carol A. Wallace; Lehn Weaver; Jennifer E. Weiss; Sheila Weitzman; Carine Wouters; Nico Wulffraat; Mabruka Zletni; Maurizio Arico; R. Maarten Egeler; Alexandra H. Filipovich; Helmut Gadner; Shinsaku Imashuku; Gritta Janka; Stephan Ladisch; Ken L. McClain; David Webb
      Pages: 72 - 78.e3
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Francesca Minoia, Francesca Bovis, Sergio Davì, Antonella Insalaco, Kai Lehmberg, Susan Shenoi, Sheila Weitzman, Graciela Espada, Yi-Jin Gao, Jordi Anton, Toshiyuki Kitoh, Ozgur Kasapcopur, Helga Sanner, Rosa Merino, Itziar Astigarraga, Maria Alessio, Michael Jeng, Vyacheslav Chasnyk, Kim E. Nichols, Zeng Huasong, Caifeng Li, Concetta Micalizzi, Nicolino Ruperto, Alberto Martini, Randy Q. Cron, Angelo Ravelli, AnnaCarin Horne
      Objective To develop and validate a diagnostic score that assists in discriminating primary hemophagocytic lymphohistiocytosis (pHLH) from macrophage activation syndrome (MAS) related to systemic juvenile idiopathic arthritis. Study design The clinical, laboratory, and histopathologic features of 362 patients with MAS and 258 patients with pHLH were collected in a multinational collaborative study. Eighty percent of the population was assessed to develop the score and the remaining 20% constituted the validation sample. Variables that entered the best fitted model of logistic regression were assigned a score, based on their statistical weight. The MAS/HLH (MH) score was made up with the individual scores of selected variables. The cutoff in the MH score that discriminated pHLH from MAS best was calculated by means of receiver operating characteristic curve analysis. Score performance was examined in both developmental and validation samples. Results Six variables composed the MH score: age at onset, neutrophil count, fibrinogen, splenomegaly, platelet count, and hemoglobin. The MH score ranged from 0 to 123, and its median value was 97 (1st-3rd quartile 75-123) and 12 (1st-3rd quartile 11-34) in pHLH and MAS, respectively. The probability of a diagnosis of pHLH ranged from <1% for a score of <11 to >99% for a score of  ≥123. A cutoff value of ≥60 revealed the best performance in discriminating pHLH from MAS. Conclusion The MH score is a powerful tool that may aid practitioners to identify patients who are more likely to have pHLH and, thus, could be prioritized for functional and genetic testing.

      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.06.005
      Issue No: Vol. 189 (2017)
       
  • The Prevalence of Rome IV Nonerosive Esophageal Phenotypes in Children
    • Authors: Lisa B. Mahoney; Samuel Nurko; Rachel Rosen
      Pages: 86 - 91
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Lisa B. Mahoney, Samuel Nurko, Rachel Rosen
      Objectives To assess the prevalence of Rome IV nonerosive esophageal phenotypes in children using multichannel intraluminal impedance testing and to describe the rates of proton pump inhibitor (PPI) responsiveness and the frequency of microscopic esophagitis in these patients. Study design We conducted a retrospective review of all children ≥5 years of age who underwent esophagogastroduodenoscopy and multichannel intraluminal impedance testing off PPI therapy for evaluation of typical gastroesophageal reflux symptoms. Only children with symptoms during the multichannel intraluminal impedance testing were included. Children were categorized into the following nonerosive esophageal phenotypes using Rome IV criteria: nonerosive reflux disease, reflux hypersensitivity, and functional heartburn. Rates of esophagitis and responsiveness to acid suppression therapy were assessed. Results Forty-five children were included: 27% were categorized as having nonerosive reflux disease, 29% with reflux hypersensitivity (27% acid and 2% nonacid), and 44% with functional heartburn. Older children reported significantly more heartburn (P < .001) than younger children, whereas younger children were more likely to report nonspecific pain (P = .047). There were no differences between groups in other reflux symptoms, rates of responsiveness to PPIs, or the presence of microscopic esophagitis on biopsy. Conclusions Functional heartburn is the most common Rome IV nonerosive esophageal phenotype in children. Neither microscopic esophagitis nor PPI responsiveness can predict phenotype in pediatric patients.

      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.06.019
      Issue No: Vol. 189 (2017)
       
  • Nonalcoholic Fatty Liver Disease in Italian Children with Down Syndrome:
           Prevalence and Correlation with Obesity-Related Features
    • Authors: Diletta Valentini; Anna Alisi; Chiara di Camillo; Maria Rita Sartorelli; Annalisa Crudele; Andrea Bartuli; Valerio Nobili; Alberto Villani
      Pages: 92 - 97.e1
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Diletta Valentini, Anna Alisi, Chiara di Camillo, Maria Rita Sartorelli, Annalisa Crudele, Andrea Bartuli, Valerio Nobili, Alberto Villani
      Objective To assess the prevalence of overweight/obesity in a cohort of Italian children with Down syndrome (DS) and to investigate the correlation of both obesity and DS with nonalcoholic fatty liver disease (NAFLD). Study design We enrolled 280 children with DS (age range 5-18 years), who were referred to the DS outpatient clinic of the Bambino Gesù Children's Hospital in Rome. For all children, we collected the clinical history and measured anthropometric variables. Eighty-four of 280 children with DS were selected to undergo liver ultrasound scanning to evaluate the presence of NAFLD. Results Italian children with DS exhibited a prevalence of 19.64% for overweight and 12.14% for obesity. The prevalence of NAFLD in nonobese (45%) and overweight/obese (82%) children with DS is greater than in the European pediatric nonobese (5.7%) or obese population (33%). Moreover, the severity of liver brightness on ultrasound scan correlated positively with body mass index, triglycerides, low-density lipoprotein-cholesterol, and leptin levels and negatively with adiponectin. Conclusions We demonstrated that, independently from the obese phenotype, children with DS display a greater risk to develop NAFLD than the general pediatric population.

      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.05.077
      Issue No: Vol. 189 (2017)
       
  • Caregiver-Reported Quality of Life in Youth with Down Syndrome
    • Authors: Melissa S. Xanthopoulos; Rachel Walega; Rui Xiao; Divya Prasad; Mary M. Pipan; Babette S. Zemel; Robert I. Berkowitz; Sheela N. Magge; Andrea Kelly
      Pages: 98 - 104.e1
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Melissa S. Xanthopoulos, Rachel Walega, Rui Xiao, Divya Prasad, Mary M. Pipan, Babette S. Zemel, Robert I. Berkowitz, Sheela N. Magge, Andrea Kelly
      Objectives To describe caregiver-reported quality of life (QOL) in youth with Down syndrome (DS) and to examine the role of obesity on QOL. Study design Caregivers of youth with and without DS aged 10 through 20 years completed questionnaires examining QOL (Pediatric Quality of Life Questionnaire) and weight-related QOL (Impact of Weight on Quality of Life – Kids). Age- and sex-specific z scores were generated for body mass index. Obesity was defined as a body mass index ≥95th percentile for age and sex. Results Caregiver-reported Total QOL, Physical Health, and Psychosocial Health summary scores were all lower in the DS group compared with the non-DS controls (P < .001). Social and School Functioning were also lower (P < .001), but Emotional Functioning did not differ between DS and non-DS groups (P = .31). Physical Functioning (P = .003) and Total scores (P = .03) differed between youth without DS with and without obesity, but no differences were reported between youth with DS with and without obesity. On the Impact of Weight on Quality of Life – Kids, caregivers of youth with DS reported greater Body Esteem (P = .020) and Social Life scores (P = .03) than caregivers of non-DS youth. Caregivers of youth with obesity, regardless of DS status, reported significantly lower weight-specific QOL scores than caregivers of youth without obesity. Conclusion Caregivers reported lower QOL in youth with DS compared with youth without DS with the exception of emotional functioning. Obesity influences most domains of weight-related QOL in youth with and without DS; therefore, providers should address weight concerns in youth with obesity even in the presence of DS. Clinical Trial Registration NCT01821300.

      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.06.073
      Issue No: Vol. 189 (2017)
       
  • Maternal Caffeine Consumption during Pregnancy and Behavioral Disorders in
           11-Year-Old Offspring: A Danish National Birth Cohort Study
    • Authors: Susanne Hvolgaard Mikkelsen; Carsten Obel; Jørn Olsen; Janni Niclasen; Bodil Hammer Bech
      Pages: 120 - 127.e1
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Susanne Hvolgaard Mikkelsen, Carsten Obel, Jørn Olsen, Janni Niclasen, Bodil Hammer Bech
      Objective To examine the association between maternal caffeine consumption from coffee and tea during pregnancy and offspring behavioral disorders. Study design We studied 47 491 children enrolled in the Danish National Birth Cohort between 1996 and 2002. Data on maternal coffee and tea consumption was collected at 15 and 30 weeks of gestation. When the child was 11 years old, the Strength and Difficulties Questionnaire was filled in by children, parents, and teachers. We estimated risk ratios (RRs) for offspring behavioral disorders. Results At 15 weeks of gestation 3% and 4% of the pregnant women consumed ≥8 cups/d of coffee or tea, respectively. Maternal coffee consumption ≥8 cups/d at 15 weeks of gestation was associated with increased risk of hyperactivity-inattention disorder (RR 1.47; 95% CI 1.18-1.83), conduct-oppositional disorders (RR 1.22; 95% CI 1.01-1.48), and any psychiatric disorder (RR 1.23; 95% CI 1.08-1.40). Maternal tea consumption ≥8 cups/d at 15 weeks of gestation was associated with increased risk of anxiety-depressive disorders (RR 1.28; 95% CI 1.09-1.52) and any psychiatric disorder (RR 1.24; 95% CI 1.11-1.40). An increased risk of hyperactivity-inattention disorder was observed with increasing daily caffeine consumption at 15 weeks of gestation. Conclusion High maternal caffeine consumption from coffee and tea at 15 weeks of gestation was associated with behavioral disorders in 11-year-old offspring. We hypothesize that caffeine exposure may affect the fetal brain and program for behavioral disorders later in life. The fetal brain seems to be more sensitive to caffeine exposure at 15 weeks of pregnancy compared with 30 weeks of gestation.

      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.06.051
      Issue No: Vol. 189 (2017)
       
  • The Impact of Routine Evaluation of Gastric Residual Volumes on the Time
           to Achieve Full Enteral Feeding in Preterm Infants
    • Authors: Arieh Riskin; Keren Cohen; Amir Kugelman; Arina Toropine; Waseem Said; David Bader
      Pages: 128 - 134
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Arieh Riskin, Keren Cohen, Amir Kugelman, Arina Toropine, Waseem Said, David Bader
      Objective To evaluate the time to full enteral feedings in preterm infants after a practice change from routine evaluation of gastric residual volume before each feeding to selective evaluation of gastric residual volume , and to evaluate the impact of this change on the incidence of necrotizing enterocolitis (NEC). Study design Data were collected on all gavage-fed infants born at ≤34 weeks gestational age (GA) for 2 years before (n = 239) and 2 years after the change (n = 233). Results The median GA was 32.0 (IQR: 29.7-33.0) weeks before and 32.4 (30.4-33.4) weeks after the change (P = .02). Compared with historic controls, infants with selective evaluations of gastric residual volumes weaned from parenteral nutrition 1 day earlier (P < .001) and achieved full enteral feedings (150 cc/kg/day) 1 day earlier (P = .002). The time to full oral feedings and lengths of stay were similar. The rate of NEC (stage ≥ 2) was 1.7% in the selective gastric residual volume evaluation group compared with 3.3% in the historic control group (P = .4). Multiple regression analyses showed that the strongest predictor of time to full enteral feedings was GA. Routine evaluation of gastric residual volume and increasing time on noninvasive ventilation both prolonged the attainment of full enteral feedings. Findings were consistent in the subgroup with birth weights of <1500 g. Increased weight at discharge was most strongly associated with advancing postmenstrual, age but avoidance of routine evaluations of gastric residual volume also was a significant factor. Conclusions Avoiding routine evaluation of gastric residual volume before every feeding was associated with earlier attainment of full enteral feedings without increasing risk for NEC.

      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.05.054
      Issue No: Vol. 189 (2017)
       
  • Leisure Time Physical Activity in Young Adults Born Preterm
    • Authors: Marjaana Tikanmäki; Nina Kaseva; Tuija Tammelin; Marika Sipola-Leppänen; Hanna-Maria Matinolli; Johan G. Eriksson; Marjo-Riitta Järvelin; Marja Vääräsmäki; Eero Kajantie
      Pages: 135 - 142.e2
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Marjaana Tikanmäki, Nina Kaseva, Tuija Tammelin, Marika Sipola-Leppänen, Hanna-Maria Matinolli, Johan G. Eriksson, Marjo-Riitta Järvelin, Marja Vääräsmäki, Eero Kajantie
      Objective To evaluate the amount of self-reported physical activity in young adults born prematurely compared with those born at term. Study design Unimpaired participants of the Preterm Birth Study (Preterm Birth and Early Life Programming of Adult Health and Disease) birth cohort study were studied at age 23.3 ± 1.2 (SD) years: 118 born early preterm (<34 weeks), 210 late preterm (34-36 weeks), and 311 born at term (≥37 weeks, controls). The participants completed a validated 30-item, 12-month physical activity questionnaire. The annual frequency and total volume of conditioning and nonconditioning leisure time physical activity and commuting physical activity were calculated and the data analyzed by means of linear regression. Results Adults born early preterm reported a 31.5% (95% CI, 17.4-43.2) lower volume of leisure time physical activity (in metabolic equivalents [MET] h/year) and had a 2.0-fold increased OR (1.2-3.3) of being in the least active quintile than controls. Lower amounts of conditioning, nonconditioning, and commuting physical activity all contributed to the difference. In addition, early preterm participants undertook less vigorous physical activity (≥6 MET). No differences in physical activity were found between the late preterm and control groups. Adjustments for potential early life confounders and current mediating health characteristics did not change the results. Conclusions Young adults born early preterm engage less in leisure time physical activities than peers born at term. This finding may in part underlie the increased risk factors of cardiometabolic and other noncommunicable diseases in adults born preterm. Low physical activity is a risk factor for several noncommunicable diseases and amenable to prevention.

      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.06.068
      Issue No: Vol. 189 (2017)
       
  • Validity and Reliability of the Brazilian Version of the Weight Control
           Behaviors Scale
    • Authors: Karin Louise Lenz Dunker; Angelica Medeiros Claudino
      Pages: 143 - 148.e1
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Karin Louise Lenz Dunker, Angelica Medeiros Claudino
      Objective To develop and validate the weight-control behaviors (WCBs) scale and to evaluate its psychometric properties. Study design We made use of data from a cluster-randomized trial assessing the effectiveness of the Brazilian New Moves Program. The Brazilian New Moves Program was a multicomponent intervention aimed at preventing weight-related problems among adolescent girls in public schools in São Paulo, Brazil. Results Healthy and unhealthy WCBs were strongly associated. A 2-factor solution was the best model to explain the correlation across items, including following constructs: (1) healthy WCB: exercising, eating more fruits and vegetables, drinking less regular soda or sweetened drinks, eating fewer sweets, and paying attention to portion sizes; and (2) unhealthy WCB: skipping meals and the presence of any other, combined unhealthy weight-control behaviors, including fasting, eating little, going on a diet, vomiting, taking diet pills, using diuretics (water pills), using laxatives, using food substitutes (powder/special drinks), and smoking more cigarettes. The WCB scale was determined to be reliable (internally consistent) and valid, with high scores positively associated with body dissatisfaction and high body mass index values. Individual reliability values were high for factors representing healthy and unhealthy WCBs. Conclusions Our findings support the use of the WCB scale as a screening tool for overall weight control behaviors among female adolescents. This assessment tool should be considered in future observational and experimental prospective studies. Trial registration Brazilian Registry of Clinical Trials: RBR-6ddpb3.

      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.06.037
      Issue No: Vol. 189 (2017)
       
  • Longitudinal Association between Obesity and Dental Caries in Adolescents
    • Authors: Ling-Wei Li; Hai Ming Wong; Colman P. McGrath
      Pages: 149 - 154.e5
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Ling-Wei Li, Hai Ming Wong, Colman P. McGrath
      Objective To investigate the longitudinal association between obesity and dental caries among adolescents. Study design The present cohort study was conducted among a random sample of 12-year-old adolescents in Hong Kong. Two rounds of follow-up were performed when the participants were aged 15 and 18 years. A total of 668 participants were included at age 12 years, and 282 of them completed all 3 phases of data collection. Body mass index, waist circumference, waist-to-hip (WHR) ratio, waist-to-height ratio, and triceps skinfold thickness were measured as indices of obesity. Dental caries were assessed by the number of decayed, missing, and filled permanent teeth (DMFT). Results The percentage of underweight adolescents increased significantly from 6.0% to 23.8% during the observation period (P < .001). Body mass index, waist circumference, waist-to-hip ratio, and waist-to-height ratio were related to frequency of tooth brushing at age 15 and 18 years. The prevalence of dental caries was 25.5%, 53.2%, and 62.1% at 12, 15 and 18 years, respectively. At age 18 years, mean DMFT of participants whose WHR at age 15 years was below the median value was 0.707 times (ie, 29.3%) lower than the DMFT of those whose WHR was above the median (P = .028). Participants with greater DMFT at age 15 demonstrated significantly increased probability of having WHR above the median (OR 1.135; 95% CI 1.01-1.28; P = .041) at age 18 years. Conclusion There is longitudinal association between central obesity and dental caries experience among adolescents aged 15-18 years.

      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.06.050
      Issue No: Vol. 189 (2017)
       
  • Secondhand Smoke Exposure and Preclinical Markers of Cardiovascular Risk
           in Toddlers
    • Authors: Judith A. Groner; Hong Huang; Mandar S. Joshi; Nicholas Eastman; Lisa Nicholson; John Anthony Bauer
      Pages: 155 - 161
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Judith A. Groner, Hong Huang, Mandar S. Joshi, Nicholas Eastman, Lisa Nicholson, John Anthony Bauer
      Objective To investigate relationships between secondhand smoke exposure in young children and several preclinical markers of cardiovascular risk that have been established as relevant to adult populations. Study design There were 139 children, 2-5 years of age, enrolled in a cross-sectional study. Secondhand smoke exposure was objectively determined by hair nicotine level; a comprehensive panel of clinical markers (morning blood pressure, fasting glucose and insulin, lipid profiles, inflammation) and research markers (markers of oxidation, endothelial stress, and endothelial repair) of cardiovascular risk status were assessed. Univariate and multivariate linear regression were used to evaluate relationships between secondhand smoke exposure and cardiovascular risk markers. Results Hair nicotine levels were correlated directly with blood pressure and serum C-reactive protein, and inversely correlated with serum high-density lipoprotein cholesterol and endothelial cell progenitor cell prevalence. In multivariate analyses, these relationships remained when controlled for age, sex, body mass index z-score, maternal education, and method of payment. Additionally, in multivariate analyses, hair nicotine level was significantly negatively correlated with total antioxidant capacity. Conclusions These results support the view that secondhand smoke exposure in the very young has a detectable relationship with several markers of cardiovascular risk, long before the emergence of clinical disease. Further studies to define mechanisms and strategies to prevent and mitigate these risks early in life are warranted.

      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.06.032
      Issue No: Vol. 189 (2017)
       
  • Exercise Performance and 22q11.2 Deletion Status Affect Quality of Life in
           Tetralogy of Fallot
    • Authors: Elizabeth Goldmuntz; Amy Cassedy; Laura Mercer-Rosa; Mark A. Fogel; Stephen M. Paridon; Bradley S. Marino
      Pages: 162 - 168
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Elizabeth Goldmuntz, Amy Cassedy, Laura Mercer-Rosa, Mark A. Fogel, Stephen M. Paridon, Bradley S. Marino
      Objective To identify mediators of health status and quality of life (QOL) in children and adolescents aged 8-18 years old following surgical repair for tetralogy of Fallot (TOF), including resource use, exercise performance, and 22q11.2 deletion status. Study design We performed a corollary study to a cross-sectional analysis of subjects following repair for TOF that completed cardiac magnetic resonance imaging, cardiopulmonary exercise tests, and instruments assessing health status and QOL. General linear models were used to test for mediation. Results A total of 29 of 151 (19%) patients carried a 22q11.2 deletion. Parents of children with a deletion compared with those without a deletion reported worse physical and psychosocial functioning on the Child Health Questionnaire. The patients with a 22q11.2 deletion and their parents reported lower total and Disease Impact scores compared with the group without a deletion on the Pediatric Cardiac Quality of Life Inventory. Medical care use negatively correlated with measures of health status/QOL. Greater maximum work correlated with better patient health status and QOL, regardless of deletion status. Exercise performance mediated the association between deletion status and parent-reported outcomes (unstandardized effects ranging from 2.4 to 4.2) and patient-reported Disease Impact (0.99; 95% CI 0.02-2.70). Conclusion Children and adolescents following repair for TOF seem to suffer significant challenges to their health status and QOL, which is amplified markedly in the context of the 22q11.2 deletion syndrome, and related to exercise performance.

      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.06.049
      Issue No: Vol. 189 (2017)
       
  • Subclinical Kidney Injury in Children Receiving Nonsteroidal
           Anti-Inflammatory Drugs After Cardiac Surgery
    • Authors: Edward Nehus; Ahmad Kaddourah; Michael Bennett; Olivia Pyles; Prasad Devarajan
      Pages: 175 - 180
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Edward Nehus, Ahmad Kaddourah, Michael Bennett, Olivia Pyles, Prasad Devarajan
      Objective To investigate the association of nonsteroidal anti-inflammatory drug (NSAID) administration with urinary neutrophil gelatinase-associated lipocalin (NGAL) levels in children following cardiopulmonary bypass (CPB) who did not develop acute kidney injury (AKI). Study design In this prospective observational study, urinary NGAL levels were investigated in 210 children who underwent cardiothoracic surgery requiring CPB. Children with clinical AKI (defined as an increase in serum creatinine ≥50% from baseline within 72 hours of CPB) were excluded from the analysis. NSAIDs were administered no sooner than 24 hours after CPB. NGAL levels were compared between children who received NSAIDs (n = 146) and those who did not receive NSAIDs (n = 64). Results The median age was 3.2 years in the children who received NSAIDs and 2.5 years in those who did not receive NSAIDs (P = .05). Before NSAID administration at 24 hours following CPB, the median NGAL level was 15 ng/mL in both groups (P = .92). Following NSAID administration, the median urinary NGAL level increased to 83 ng/mL (IQR, 45-95 ng/mL) at 72 hours after CPB in those receiving NSAIDs (P < .001). In contrast, the median NGAL level decreased to 10 ng/mL (IQR, 5.4-15.9 ng/mL) at 72 hours after CPB in those who did not receive NSAIDs (P = .01). In multivariable analysis, children receiving NSAIDs demonstrated a 5-fold elevation of urinary NGAL levels at 60-72 hours following CPB compared with those who did not receive NSAIDs (P < .001). Conclusion NSAID administration was associated with a significant increase in urinary NGAL in children who did not develop clinical AKI following CPB. This indicates that NGAL can detect NSAID-induced subclinical kidney injury in this population.

      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.06.045
      Issue No: Vol. 189 (2017)
       
  • Salivary Cortisol Levels Predict Therapeutic Response to a Sleep-Promoting
           Method in Children with Postural Tachycardia Syndrome
    • Authors: Jing Lin; Huacai Zhao; Jie Shen; Fuyong Jiao
      Abstract: Publication date: Available online 13 October 2017
      Source:The Journal of Pediatrics
      Author(s): Jing Lin, Huacai Zhao, Jie Shen, Fuyong Jiao
      Objective To determine the value of salivary cortisol concentrations in predicting the efficacy of sleep-promoting treatment in children with postural tachycardia syndrome (POTS). Study design This prospective study involved 40 children with POTS and 20 healthy children (controls). POTS was diagnosed using the head-up or head-up tilt test. Patients with POTS received a sleep-promoting treatment: >8 hours of sleep every night and a midday nap in an appropriate environment; no drinking water or exercising before bedtime; and urination before bedtime. The Pittsburgh Sleep Quality Index was used to evaluate sleep quality, and symptom scores were used to assess POTS severity. Salivary samples were collected upon awakening, 30 minutes after awakening, at 12:00 p.m., 4:00 p.m., and 8:00 p.m., and at bedtime before treatment. Enzyme-linked immunosorbent assay was used to measure salivary cortisol concentrations. Results Cortisol concentrations were significantly higher in patients with POTS than in the controls at all time points (P < .05 for all). PSQI scores were significantly higher in patients with POTS (7.2 ± 3.0) than in the controls (1.35 ± 1.39; t = -10.370, P < .001). Salivary cortisol concentrations at awakening were significantly higher in responders than in nonresponders (4.83 ± 0.73 vs 4.05 ± 0.79 ng/mL, t = -3.197, P = .003). The area under the receiver operating characteristic curve was 75.8%, (95% CI 59.3%-92%). Cut-off at-awakening salivary cortisol concentrations of >4.1 ng/mL yielded 83.3% sensitivity and 68.7% specificity in predicting therapeutic efficacy. Conclusions At-awakening salivary cortisol concentrations may predict the efficacy of sleep-promoting treatment in patients with POTS

      PubDate: 2017-10-15T01:15:04Z
      DOI: 10.1016/j.jpeds.2017.08.039
       
  • The Benefits of Early Oral Nutrition in Mild Acute Pancreatitis
    • Authors: Kate M. Ellery; Soma Kumar; Wallace Crandall; Cheryl Gariepy
      Abstract: Publication date: Available online 12 October 2017
      Source:The Journal of Pediatrics
      Author(s): Kate M. Ellery, Soma Kumar, Wallace Crandall, Cheryl Gariepy
      Objective To determine whether early patient-directed oral nutrition in children with mild acute pancreatitis decreases the length of hospitalization without increasing complications. Study design Hospitalized patients aged 2-21 years of age who met the criteria for acute pancreatitis based on the Revised Atlanta Classification were enrolled prospectively and allowed to eat by mouth at their discretion (patient-directed nutrition [PDN]). These patients were compared with a retrospective cohort of children who were allowed to eat based on traditional practices (treatment team-directed nutrition [TTDN]). Outcomes included length of hospitalization, time nil per os (NPO), and complications within 30 days of discharge. Results The study included 30 patients in the PDN group and 92 patients in the TTDN group. Patients in the PDN group had a median length of stay of 48.5 hours (IQR 37-70 hours) compared with 93 hours (IQR 52-145 hours) in the TTDN group (P < .0001). Patients were NPO for a median of 14 hours (IQR 7-19.5 hours) in the PDN group compared with 34 hours (IQR 19.3-55 hours) in the TTDN group (P < .0001). No patients in the PDN group developed complications within 30 days of discharge. Conclusion Early patient-directed oral nutrition in mild acute pancreatitis was well tolerated and resulted in decreased length of NPO status and hospitalization with no obvious complications. Clinical Trial Registration ClinicalTrials.gov: NCT01423786.

      PubDate: 2017-10-15T01:15:04Z
      DOI: 10.1016/j.jpeds.2017.08.032
       
  • PFAPA Syndrome in a Population with Endemic Familial Mediterranean Fever
    • Authors: Esra Pehlivan; Amra Adrovic; Sezgin Sahin; Kenan Barut; Ovgu Kul Cınar; Ozgur Kasapcopur
      Abstract: Publication date: Available online 12 October 2017
      Source:The Journal of Pediatrics
      Author(s): Esra Pehlivan, Amra Adrovic, Sezgin Sahin, Kenan Barut, Ovgu Kul Cınar, Ozgur Kasapcopur
      We reviewed the medical records of patients with periodic fever, aphthosis, pharyngitis, and adenitis (PFAPA) to investigate the clinical course, treatment response, and association with MEFV gene mutation. Familial Mediterranean fever should be considered in patients with PFAPA who do not respond to adenotonsillectomy.

      PubDate: 2017-10-15T01:15:04Z
      DOI: 10.1016/j.jpeds.2017.08.078
       
  • Children as Biomarker Orphans: Progress in the Field of Pediatric
           Biomarkers
    • Authors: Darla R. Shores; Allen D. Everett
      Abstract: Publication date: Available online 12 October 2017
      Source:The Journal of Pediatrics
      Author(s): Darla R. Shores, Allen D. Everett


      PubDate: 2017-10-15T01:15:04Z
      DOI: 10.1016/j.jpeds.2017.08.077
       
  • Neuroprotective Strategies in Neonatal Brain Injury
    • Authors: Pratik Parikh; Sandra E. Juul
      Abstract: Publication date: Available online 12 October 2017
      Source:The Journal of Pediatrics
      Author(s): Pratik Parikh, Sandra E. Juul


      PubDate: 2017-10-15T01:15:04Z
      DOI: 10.1016/j.jpeds.2017.08.031
       
  • Characteristics and Changes of Pediatric Therapeutic Trials under the Best
           Pharmaceuticals for Children Act
    • Authors: Debbie Avant; Gerold T. Wharton; Dianne Murphy
      Abstract: Publication date: Available online 10 October 2017
      Source:The Journal of Pediatrics
      Author(s): Debbie Avant, Gerold T. Wharton, Dianne Murphy


      PubDate: 2017-10-15T01:15:04Z
      DOI: 10.1016/j.jpeds.2017.08.048
       
  • Prospective Evaluation of Physical Contact with Critically Ill Child on
           Caregiver Spiritual Wellbeing
    • Authors: Brian D. Leland; Mara E. Nitu; Maureen Hancock; Karen Moody; Richard Gunderman; Elizabeth Moser; Courtney M. Rowan
      Abstract: Publication date: Available online 4 October 2017
      Source:The Journal of Pediatrics
      Author(s): Brian D. Leland, Mara E. Nitu, Maureen Hancock, Karen Moody, Richard Gunderman, Elizabeth Moser, Courtney M. Rowan
      Objectives To evaluate whether a pediatric intensive care unit initiative promoting physical contact between caregiver and patient improves caregiver spiritual wellbeing. The secondary objectives were to evaluate caregiver perceptions of care before and after the initiative and to follow unplanned extubation rate as a marker of safety of the initiative. We hypothesized that caregiver spiritual wellbeing and caregiver perceptions of care would improve with implementation of our physical contact initiative known as Project ROSE (Reach Out, Soothe, and Embrace). Study design Project ROSE was a practice change initiative promoting physical contact between caregiver and hospitalized child in an academic quaternary care pediatric intensive care unit. Caregivers' spiritual wellbeing and perceptions of care were surveyed at days 1 and 4, then compared pre- and postimplementation of the unit-wide initiative. Wilcoxon rank sum tests compared groups (pre- and post-Project ROSE). A total of 331 caregivers returned surveys. Results We analyzed 331 surveys (pre, n = 174/post, n = 157). Caregiver spiritual wellbeing at enrollment (day 1) was no different between groups (P = .47). Caregiver spiritual wellbeing on day 4 was greater in the postintervention group (pre 40.0 [32.0, 44.0] vs post 42.0 [37.5, 45.0] P = .03). Caregiver perceptions of care improved postintervention. There was no change in the unplanned extubation rate between groups. Conclusion Project ROSE improved caregiver spiritual wellbeing and perceptions of care, was implemented safely, addresses a need in family-centered care of critically ill pediatric patients, and merits consideration for integration into practice.

      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.08.022
       
  • Childhood Obesity and Physical Activity-Friendly School Environments
    • Authors: Patrick Ip; Frederick Ka-Wing Ho; Lobo Hung-Tak Louie; Thomas Wai-Hung Chung; Yiu-Fai Cheung; So-Lun Lee; Stanley Sai-Chuen Hui; Walter King-Yan Ho; Daniel Sai-Yin Ho; Wilfred Hing-Sang Wong; Fan Jiang
      Abstract: Publication date: Available online 4 October 2017
      Source:The Journal of Pediatrics
      Author(s): Patrick Ip, Frederick Ka-Wing Ho, Lobo Hung-Tak Louie, Thomas Wai-Hung Chung, Yiu-Fai Cheung, So-Lun Lee, Stanley Sai-Chuen Hui, Walter King-Yan Ho, Daniel Sai-Yin Ho, Wilfred Hing-Sang Wong, Fan Jiang
      Objective Childhood obesity may be related to school environment, but previous studies often focused on food environment only. This study aimed to examine the relationship between school physical activity environment and childhood obesity. Study design This is a cross-sectional study with multilevel data collected on school physical activity environment using teacher questionnaires, students' growth, and obesity status from electronic health records, and neighborhood socioeconomic status from census data. Results This study included 208 280 students (6-18 years of age) from 438 schools (45% of Hong Kong). Prevalence of obesity was 5.0%. After controlling for socioeconomic status and intraschool correlation, robust Poisson regression revealed a reduced obesity risk associated with higher teachers' perceived physical activity benefits (risk ratio 0.96, 95% CI 0.94-0.99, P = .02), physical activity teaching experience (0.93, 0.91-0.96, P < .001), school campus size (0.93, 0.87-0.99, P = .02), physical activity ethos (0.91, 0.88-0.94, P < .001), number of physical activity programs (0.93, 0.90-0.96, P < .001), and physical activity facilities (0.87, 0.84-0.90, P < .001). Students in schools with at least 3 physical activity-friendly environmental factors (11.7%) had a much lower risk of obesity (0.68, 0.62-0.75, P < .001) than those without (23.7%). Conclusions A physical activity-friendly school environment is associated with lower risk of obesity. School physical activity environment should be considered in future epidemiologic and intervention studies.

      PubDate: 2017-10-08T18:33:59Z
      DOI: 10.1016/j.jpeds.2017.08.017
       
  • Information for Readers
    • Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189


      PubDate: 2017-10-08T18:33:59Z
       
  • Expanding adolescent family planning beyond the walls of the family
           planning clinic
    • Authors: Mary Ott
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Mary A. Ott


      PubDate: 2017-10-08T18:33:59Z
       
  • Markers of Successful Extubation in Extremely Preterm Infants, and
           Morbidity After Failed Extubation
    • Authors: Sanjay Chawla; Girija Natarajan Seetha Shankaran Benjamin Carper Luc Brion
      Abstract: Publication date: October 2017
      Source:The Journal of Pediatrics, Volume 189
      Author(s): Sanjay Chawla, Girija Natarajan, Seetha Shankaran, Benjamin Carper, Luc P. Brion, Martin Keszler, Waldemar A. Carlo, Namasivayam Ambalavanan, Marie G. Gantz, Abhik Das, Neil Finer, Ronald N. Goldberg, C. Michael Cotten, Rosemary D. Higgins
      Objectives To identify variables associated with successful elective extubation, and to determine neonatal morbidities associated with extubation failure in extremely preterm neonates. Study design This study was a secondary analysis of the National Institute of Child Health and Human Development Neonatal Research Network's Surfactant, Positive Pressure, and Oxygenation Randomized Trial that included extremely preterm infants born at 240/7 to 276/7 weeks' gestation. Patients were randomized either to a permissive ventilatory strategy (continuous positive airway pressure group) or intubation followed by early surfactant (surfactant group). There were prespecified intubation and extubation criteria. Extubation failure was defined as reintubation within 5 days of extubation. Results Of 1316 infants in the trial, 1071 were eligible; 926 infants had data available on extubation status; 538 were successful and 388 failed extubation. The rate of successful extubation was 50% (188/374) in the continuous positive airway pressure group and 63% (350/552) in the surfactant group. Successful extubation was associated with higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within the first 24 hours of age and prior to extubation, lower partial pressure of carbon dioxide prior to extubation, and non-small for gestational age status after adjustment for the randomization group assignment. Infants who failed extubation had higher adjusted rates of mortality (OR 2.89), bronchopulmonary dysplasia (OR 3.06), and death/ bronchopulmonary dysplasia (OR 3.27). Conclusions Higher 5-minute Apgar score, and pH prior to extubation, lower peak fraction of inspired oxygen within first 24 hours of age, lower partial pressure of carbon dioxide and fraction of inspired oxygen prior to extubation, and nonsmall for gestational age status were associated with successful extubation. Failed extubation was associated with significantly higher likelihood of mortality and morbidities. Trial registration ClinicalTrials.gov: NCT00233324.

      PubDate: 2017-10-08T18:33:59Z
       
 
 
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