Pediatrics Digest

(1)

Long-term Results of an Obesity Program in an Ethnically Diverse Pediatric Population

Long-term pediatric weight management studies have been predominantly carried out with afﬂuent, white populations. Thus, evidence on successful management of childhood obesity is limited, especially in inner-city, ethnically diverse populations.

This randomized controlled trial bridges the gap in the pediatric obesity treatment literature by revealing a sustained treatment effect on anthropometric and metabolic markers after a family-based lifestyle intervention versus traditional clinical care in inner-city, ethnically diverse populations.

Ambulatory Visit Rates and Antibiotic Prescribing for Children With Pneumonia, 1994 –2007

Pneumococcus is the most commonly identiﬁed bacterial cause of community-acquired pneumonia. Pediatric pneumonia hospitalizations have decreased since the introduction of the pneumococcal conjugate vaccine in 2000. However, few data exist on national trends in the incidence of pediatric outpatient pneumonia.

This study provides the ﬁrst comprehensive national

estimates of pediatric outpatient pneumonia incidence. Rates of outpatient pediatric pneumonia have not changed despite introduction of the pneumococcal conjugate vaccine, and broad-spectrum antibiotic prescribing for outpatient

Nosocomial Infection Reduction in VLBW Infants With a Statewide Quality-Improvement Model

Quality-improvement techniques are increasingly effective as they move from passive dissemination to interactive

techniques between those authoring practice change packages and their audiences. However, resource constraints and the many potential topics mitigate against prescribing intense collaboratives for every topic.

Efﬁcient progress in decreasing neonatal nosocomial infection rates can be achieved when statewide quality-improvement collaboratives using structured interventions (“toolkits”) are augmented with brief interactions that introduce, orient, and motivate potential users.

Ohio Statewide Quality-Improvement Collaborative to Reduce Late-Onset Sepsis in Preterm Infants

Late-onset infections cause signiﬁcant morbidity and mortality in preterm infants. Quality-improvement interventions focused on catheter care have reduced nosocomial infections in adult and pediatric patients but have yet to be proven effective in preterm neonates.

This study extended previous work, and the results showed that increased application of evidence-based catheter care as part of a state-based quality-improvement collaborative can reduce infections in preterm neonates. It also highlights the important role of reliability principles in evidence

ARTICLE SUMMARIES – MARCH 2011

P E D I AT R I C S

威

digest

(2)

NICU quality-improvement network has not been studied.

Statewide adoption of standardized, evidence-based central-line insertion and maintenance bundles substantially reduced NICU CLABSI. Increased use of maintenance checklists was associated with fewer CLABSIs. We also measured the impact of the 2008 Centers for Disease Control and Prevention CLABSI deﬁnition change.

Outcomes of a Universal Shared Reading Intervention by 2 Years of Age: The Let’s Read Trial

Literacy acquisition is an important developmental milestone and key to educational success. Interest in early literacy promotion has led to trials with some success in improving language and literacy activities; these trials have yet to demonstrate improved literacy outcomes.

This ﬁrst population-based cluster randomized trial demonstrates how the key messages and corresponding activities of an early literacy-promotion program relate to the number of literacy activities in the home and infants’ communication and language development at age 2 years.

Literacy Promotion for Families Participating in the Women, Infants and Children Program

Large social class differences exist in children’s exposure to experiences that support the development of literacy skills. Pediatric clinic-based literacy promotion programs have demonstrated effects in promoting reading activities at home and accelerating children’s language acquisition.

This study describes the impact of a Special Supplemental Nutrition Program for Women, Infants and Children– based intervention on the school readiness of low-income children. The study examines the impact of the intervention on English-and Spanish-speaking children’s readiness for school.

functioning and service use at the population level investigated has not been found in previous studies.

Two-thirds of US children with ADHD have comorbid conditions. Social and educational functioning declines with more comorbidities and cross-sector service use and need for care coordination increase. Management of ADHD should be tailored to each child’s neurodevelopmental proﬁle.

Racial Bias in Child Protection? A Comparison of Competing Explanations Using National Data

Black children are involved in reported and substantiated cases of child abuse and neglect at approximately twice the rate of white children. It is unknown if this disproportionality is attributable to higher risk or to bias in reporting or assessment.

Results based on national child abuse and neglect and child health data indicated that racial disproportionality in black children is attributable to higher risk rather than reporting bias. Our ﬁndings also suggest that in Hispanic children cultural protective factors apply to child maltreatment (the “Hispanic Paradox”).

Injuries Associated With Cribs, Playpens, and Bassinets Among Young Children in the US, 1990 –2008

Previous research has focused on infant mortality attributed to suffocation and strangulation in the crib environment. No studies have investigated both fatal and nonfatal crib-related injuries.

(3)

Increasing VLBW Deliveries at Subspecialty Perinatal Centers via Perinatal Outreach

The American Academy of Pediatrics Guidelines for Perinatal Care recommends delivery of infants⬍32 weeks’ gestation at subspecialty perinatal centers (SPCs). Infants born with very low birth weights (VLBW) at SPCs have decreased perinatal morbidity and mortality.

Perinatal outreach education to providers at non-SPCs is an effective strategy to promote transfer of all pregnant mothers with⬍32 weeks’ gestation to SPCs for delivery. The Healthy People 2010 objective to deliver 90% of infants born with VLBW in SPCs is achievable.

Timing of Solid Food Introduction and Risk of Obesity in Preschool-Aged Children

Limited, conﬂicting data suggest that the timing of solid food introduction in infancy may be associated with an increased risk of obesity in childhood.

Among infants who were never breastfed or those who stopped breastfeeding before the age of 4 months, the introduction of solids before the age of 4 months was associated with a sixfold increase in the odds of obesity at the age of 3 years.

The Scope of Nonsuicidal Self-Injury on YouTube

Given its high rates (14 –24%) and co-occurrence with psychiatric difﬁculties, nonsuicidal self-injury among youth is worrisome. With more youth using video-sharing Web sites, such as YouTube, nonsuicidal self-injury–themed videos may be normalized and reinforced among youth who self-injure.

Examination of nonsuicidal self-injury material on YouTube revealed favorably and frequently viewed videos that were accessible and graphic and that often were creative, with an informational, melancholic, or hopeless message. The possible impact of this material on viewers is worrisome.

Cerebral Oxygenation Is Depressed During Sleep in Healthy Term Infants When They Sleep Prone

Prone sleeping is a major risk factor for the sudden infant death syndrome. In the prone position blood pressure is often lower and arousability is depressed.

Normative data on the effects of sleeping position, sleep state, and postnatal age on cerebral oxygenation were collected. Infants sleeping in the prone position had lower cerebral oxygenation, which may contribute to the decreased arousability and increased risk for sudden infant death syndrome associated with this sleeping position.

Microbiology and Antibiotic Management of Orbital Cellulitis

Recent reports suggest thatStaphylococcus aureusmay be an increasing cause of pediatric orbital infections. However, the risk of methicillin-resistant infections and current antibiotic management practices in these patients are unclear.

TheStreptococcus anginosusgroup is an emerging cause of pediatric orbital infections. Although cases caused by methicillin-resistantStaphylococcus aureusseem uncommon, vancomycin and combination antibiotics are frequently used. A more simpliﬁed antibiotic regimen may be warranted in many patients.

Randomized Controlled Trial of Cephalexin Versus Clindamycin for Uncomplicated Pediatric Skin Infections

Community-associated methicillin-resistantStaphylococcus aureus(MRSA) causes the majority of purulent skin infections in children. The choice of adjuvant antibiotic varies widely in clinical practice, with a recent trend toward the empiric use of antibiotics with activity against MRSA.

This randomized controlled trial of cephalexin versus clindamycin for uncomplicated, purulent skin infections showed equally high rates of improvement at 48 to 72 hours and 7 days, which suggests that using antibiotics with in vitro MRSA activity may not be critical for successful treatment.

Injection Site and Risk of Medically Attended Local Reactions to Acellular Pertussis Vaccine

In a study of 1315 children aged 4 through 6 years who received their ﬁfth dose of the diphtheria and tetanus toxoids and acellular pertussis vaccine, children vaccinated in the thigh had less redness and swelling at the injection site than children vaccinated in the arm.

Medically attended local reactions to the ﬁfth dose of the diphtheria and tetanus toxoids and acellular pertussis vaccine are signiﬁcantly less common when the vaccine is injected in the thigh versus the arm.

P E D I AT R I C S

威

(4)

PICU.

This is the largest national study to show that race/ethnicity is not clearly associated with mortality disparities in the PICU.

A New Risk-Based Screening Criterion for Treatment-Demanding Retinopathy of Prematurity in Denmark

Efforts are made worldwide to determine the most effective and safe criterion for retinopathy of prematurity screening. Combining gestational age at delivery and birth weight limits is the preferred method to effectiveness and safety measured by the capability to detect advanced retinopathy of

prematurity cases.

This study shows how advanced statistical models are helpful tools for evaluating of the suitability of screening criteria for implementation. It also presents a criterion based on the estimated risk of developing treatment-demanding

retinopathy of prematurity. This criterion is more effective and safer than any conventional screening criteria.

A Clinical Prediction Model to Stratify Retinopathy of Prematurity Risk Using Postnatal Weight Gain

Most infants screened for retinopathy of prematurity (ROP) under current criteria do not require treatment. Slow postnatal growth is a surrogate for low serum insulin-like growth factor 1 and a marker for severe ROP. A complex ROP surveillance model using weights has been developed.

A simple predictive model that uses postnatal weight gain to accurately predict risk of severe ROP reduced the number of infants requiring exams among a high-risk population. Nomograms potentially make it easy to apply the model clinically.

behavioral insomnia and problematic feeding behaviors.

Problematic sleep and feeding behaviors tend to coexist in early childhood. Increased awareness of clinicians involved in the treatment of pediatric sleep or feeding disorders to this coexistence may allow early intervention and improve outcome.

Late Preterm Infants Have Worse 24-Month Neurodevelopmental Outcomes Than Term Infants

Data suggest that late preterm infants have worse

neurodevelopmental outcomes and academic performance at school age and require special education more frequently.

It is important to know whether late preterm infants with worse neurodevelopmental outcomes can be identiﬁed before school age, permitting them to have earlier interventions to limit the need for later special education.

Prediction of Neurodevelopmental and Sensory Outcome At 5 Years in Norwegian Children Born Extremely Preterm

Extreme prematurity is associated with poor functional outcome.

The prognosis is much poorer for gestational ages less than 26 weeks compared with gestational ages between 26 and 27 weeks. Gestational age has minor predictive signiﬁcance for cognitive and motor function for those with no major disability.

Executive and Memory Function in Adolescents Born Very Preterm

Very preterm children display signiﬁcant school problems that persist into adolescence. Executive functioning and memory play important roles in learning and school attainment.

(5)

Maternal Smoking and Congenital Heart Defects in the Baltimore-Washington Infant Study

Maternal smoking during pregnancy has been implicated as a possible risk factor for birth defects, but the evidence is mixed, and when identiﬁed as a risk factor, the magnitude of the estimates has been typically modest.

Results of this study, based on a population-based design with high-quality case ascertainment and defect classiﬁcation, add to the existing body of evidence that implicates ﬁrst-trimester maternal cigarette smoking as a modest risk factor for select congenital heart defect phenotypes.

Neurodevelopmental Outcomes of Triplets or Higher-Order Extremely Low Birth Weight Infants

The incidence of cerebral palsy is higher in multiple births than in singleton infants. Twin extremely low birth weight (ELBW) infants have a higher incidence of death or

neurodevelopmental impairment compared to ELBW singleton infants.

This study evaluates the risk of death or neurodevelopmental impairment in triplet or higher-order ELBW infants compared with twins and singleton infants. A similar study using such a large cohort of infants has not been previously performed.

Newborns With Sonographically Dysplastic and Potentially Unstable Hips: 6-Year Follow-up of an RCT

A total of 1% to 2% of all newborns have mildly dysplastic and potentially unstable hips and are thus thought to be in need of immediate abduction treatment.

Newborns with mildly dysplastic and potentially unstable hips randomly assigned to either immediate abduction treatment or active sonographic surveillance have radiographically normal hips at 6 years of age with no evidence of avascular necrosis, despite one-third showing residual dysplasia at 1 year of age.

Population Case-Control Study of Cerebral Palsy: Neonatal Predictors for Low-Risk Term Singletons

Term infants account for the majority of cases of cerebral palsy (CP). The strongest risk factor for term infants is admission to the NICU with newborn encephalopathy. Little research has focused on infants not admitted to a NICU.

Two-thirds of term infants with CP were not admitted to the NICU but contributed one-half of severe cases. Six neonatal factors were identiﬁed as predictors of CP for this group, but 60% of the subjects had none of these factors.

Racial, Ethnic, and Socioeconomic Disparities in the Prevalence of Cerebral Palsy

Black infants have an increased risk of cerebral palsy when compared with white infants. The reason for this racial disparity is unclear. Lower socioeconomic status may be associated with an increased risk of cerebral palsy.

The increase in cerebral palsy among blacks is due to higher rates of low birth weight. Among low birth weight infants, blacks are less likely to have cerebral palsy than whites. Prenatal care and maternal education also impact cerebral palsy risk.

Effectiveness of Preventive Dental Treatments by Physicians for Young Medicaid Enrollees

Mixed evidence exists regarding the effectiveness of

preventive dental services in medical settings. Physicians and nurses are willing to provide preventive dental services, parents are satisﬁed with the services their children receive, and programs that encourage physician participation increase access.

Despite declines in effectiveness since ﬂuoride treatment and referrals to dentists to treat existing disease, this study reports that oral health services by non-dental health care providers for Medicaid preschool-aged children lead to reductions in caries-related treatments.

Effects of Ambient Particulate Matter and Fungal Spores on Lung Function in Schoolchildren

Epidemiologic studies examining the combined childhood health effects of both air pollutants and fungal spores have been relatively lacking.

Exposure to current levels of ambient particulate matter with an aerodynamic diameter of 2.5␮m or less, fungal spores, and O₃are associated with reduced childhood lung function. These adverse effects were observed in a longitudinal setting, more speciﬁcally, in a cohort of schoolchildren that included healthy children.

P E D I AT R I C S

威

(6)

permethrin on neurodevelopment in children aged 36 months were examined.

A signiﬁcant inverse association was observed between prenatal exposure to piperonyl butoxide, a pyrethroid synergist, and 36-month neurodevelopment. No signiﬁcant association was observed between prenatal exposure to permethrin and adverse neurodevelopment.

Up-to-DateHaemophilus inﬂuenzaeType b Vaccination Coverage During a Vaccine Shortage

Vaccine shortages and provider noncompliance with interim recommendations can result in decreased vaccination coverage. During the 2008 –2009Haemophilus inﬂuenzaetype b vaccine shortage,Haemophilus inﬂuenzaetype b vaccination coverage was known to have decreased in 1 US state.

This study demonstrated decreasedHaemophilus inﬂuenzae type b (Hib) vaccination coverage during the 2008-2009 Hib PRP-OMP shortage in 7 of 8 participating states, suggesting that the vaccine shortage had a more widespread impact on Hib vaccination coverage in the US.

Prenatal Factors for Childhood Blood Pressure: Mediated by Intrauterine and/or Childhood Growth

Inconsistent evidence reveals that some prenatal factors are associated with high blood pressure in later life. The biological mechanisms of these associations are unknown, which is a critical barrier for causal interpretation as well as safe and effective intervention.

Maternal heavy smoking during pregnancy, prepregnancy overweight-obesity, chronic hypertension, and preeclampsia-eclampsia are associated with higher offspring systolic blood pressure, which is independent of intrauterine growth restriction. Childhood BMI or weight trajectory may mediate the associations of heavy maternal smoking and

prepregnancy BMI with systolic blood pressure.

This study reviews placental pathology in patients presenting with neonatal stroke near delivery and correlates this with clinical presentation, outcome, and risk factors. We suggest that multiple risk factors are involved in neonatal stroke, and placental pathology may be a contributor.

Timing of Excess Weight Gain in the Avon Longitudinal Study of Parents and Children (ALSPAC)

In a previous study, it was found that most excess weight gain in English children had taken place by age 5. The authors suggested that interventions to prevent obesity should focus only on children younger than 5 years of age.

From birth to 5 years of age was not characterized by the greatest excess weight gain in a larger sample of English children and adolescents. Greatest gains in weight and BMIz scores occurred during mid-childhood. Efforts to prevent obesity should not only focus on preschool children, but also include school-aged children and adolescents.

Longitudinal Validation of the Test for Respiratory and Asthma Control in Kids in Pediatric Practices

The 5 items in the Test for Respiratory and Asthma Control in Kids were identiﬁed and validated in a previous development study of caregivers and their children, younger than 5 years, who were primarily cared for by asthma specialists.

(7)

DOI: 10.1542/peds.digest1273

2011;127;D1

Pediatrics