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Mortality and Neonatal Morbidity Among Infants

501 to 1500 Grams From 2000 to 2009

Infants weighing 501 to 1500 g are at high risk for mortality and for neonatal morbidities associated with both short- and long-term adverse consequences.

Mortality and major neonatal morbidity in survivors decreased for infants 501 to 1500 g between 2000 and 2009. However, in 2009, a high proportion of these infants still either died or survived after experiencing$1 major neonatal morbidity.

Missed Opportunities in the Referral of High-Risk

Infants to Early Intervention

Neonatal follow-up programs are designed in part to identify developmental delays among high-risk infants after NICU hospitalization and make referrals to state-funded early in-tervention. Early intervention has been shown to benefit chil-dren with developmental delays.

Many high-risk infants demonstrating developmental delays at neonatal follow-up programs are not referred to early in-tervention. Subspecialty clinics share responsibility with the medical home in referring children from birth through three years with developmental problems to early intervention services.

Prevalence of Cardiovascular Disease Risk Factors

Among US Adolescents, 1999

2

2008

Overweight and obese children have a higher prevalence of several cardiovascular disease (CVD) risk factors. There is

growing evidence demonstrating that CVD risk factors present during childhood persist into adulthood.

US adolescents had no significant change in prehypertension/ hypertension and borderline-high/ high low-density lipoprotein cholesterol prevalence from 1999-2000 to 2007-2008; however, prediabetes/diabetes increased by 12%.

Postsecondary Education and Employment Among

Youth With an Autism Spectrum Disorder

Previous research has identified low rates of employment and postsecondary education for youth with autism, but general-izability has been limited by small samples.

Using national data, the authors of this study found that youth with autism are at high risk for no postsecondary education or employment, especially in thefirst 2 years after high school. Findings highlight the need for improved transition planning.

Oral Dimenhydrinate Versus Placebo in Children

With Gastroenteritis: A Randomized Controlled Trial

Dimenhydrinate, an antihistaminic agent, is a widely used drug in Canada and Europe. It limits stimulation of the vomiting center via the vestibular system. Multiple studies have shown its effectiveness in the treatment of vertigo and postoperative nausea and vomiting.

Dimenhydrinate, when given orally, did not significantly de-crease the frequency of vomiting in children with acute gas-troenteritis compared with placebo. The reported adverse effect proportions were similar for the dimenhydrinate and placebo groups.

whereas education-only requirements appear not to have an impact at this time.

The Distribution of Physical Activity in an

After-school Friendship Network

New, effective approaches to obesity prevention are urgently needed. Social network interventions warrant our attention. Social networks play a significant role in adult and adolescent obesity. The role of social networks in pediatric obesity has not been examined.

Afterschool friendship ties play a critical role in setting physical activity patterns in children as young as 5 to 12 years. Children’s activity levels can be changed by the activity level of their social network during a 12-week afterschool program.

Computer-Facilitated Substance Use Screening and

Brief Advice for Teens in Primary Care: An

International Trial

Primary care settings provide an important venue for early detection of substance use and intervention, but adolescent screening rates need improvement. Screening and brief inter-ventions appear effective in reducing adult problem drinking but evidence for effectiveness among adolescents is needed.

A computer-facilitated system for screening, feedback, and provider brief advice for primary care can increase adolescent receipt of substance use screening across a variety of practice settings, and shows promise for reducing adolescents’use of alcohol and cannabis.

Brief Motivational Interviewing Intervention for

Peer Violence and Alcohol Use in Teens: One-Year

Follow-up

Youth violence and alcohol misuse are a preventable public health problem. Previous studies have demonstrated the effi -cacy of brief interventions in the emergency department (ED) in reducing alcohol misuse and related consequences among older adolescents and adults.

This study supports the efficacy of brief interventions in the ED in reducing peer aggression and victimization 12 months after ED visit. The previous reductions in alcohol consequences noted at 6 months follow-up were not sustained at 12 months.

In the largest pediatric study to date, we demonstrate that the shared environment strongly influences sleep behavior in infants, with no gender differences in the results. This research provides strong impetus to future work identifying the key modifiable environmental drivers.

Risky Music-Listening Behaviors and Associated

Health-Risk Behaviors

Traditional health-risk behaviors, such as problem drinking, smoking, marijuana use, and unsafe sexual behavior are in-terrelated and not isolated events in the life of adolescents. New health-risk behaviors are emerging: risky music-listening behaviors, which may induce hearing loss.

Risky music-listening behaviors are highly associated with traditional health-risk behaviors. Risky MP3-player listeners are often cannabis users. Frequent visitors of music venues are less often cannabis users, but are often binge drinkers and have sexual intercourse without using a condom.

Injuries Associated With Bottles, Paci

fi

ers, and

Sippy Cups in the United States, 1991

–

2010

Previous research on injuries related to bottle, pacifier, and sippy cup use has largely focused on case reports of infant injuries or fatalities attributed to pacifiers or pacifier parts causing asphyxiation or to bottle warming causing burns.

This study is thefirst to use a nationally representative sample to investigate the range of injuries requiring emergency de-partment visits associated with bottles, pacifiers, and sippy cups among children aged,3 years.

Pediatric Battery-Related Emergency Department

Visits in the United States, 1990

–

2009

Batteries, especially button batteries, are an important source of pediatric injury. Recent reports suggest that fatal and severe button battery ingestions are increasing.

Effect of Acculturation and Distance From Cardiac

Center on Congenital Heart Disease Mortality

Disparities in outcomes of ethnic minority children have been reported, and have been ascribed to having barriers to access to health care. Minority parents have indicated that difficulties in access are because of problems with transportation and being non-English speaking.

This population-based study of Texas infants with severe congenital heart disease reports that neither home distance from a cardiac center nor Hispanic children having a Latin American–born parent were risk factors forfirst-year mortality.

Childhood Cancer Incidence Trends in Association

With US Folic Acid Forti

fi

cation (1986

–

2008)

The hypothesis that maternal prenatal folic acid lowers risk for childhood malignancy in offspring is supported by experi-mental and epidemiologic evidence, including 2 Canadian ecologic studies that showed inverse associations for some cancer types in the very young.

Examining Surveillance Epidemiology and End Results Program data, a decrease in the incidence of some childhood cancers (Wilms tumor, primitive neuroectodermal tumors) was ob-served in those,5 years after mandatory US folic acid for-tification, with stronger effects detected in infants.

Developmental Status of 1-Year-Old Infants Fed

Breast Milk, Cow

’

s Milk Formula, or Soy Formula

Although soy protein–based infant formula is known to support physical growth equal to that of infants fed cow’s milk–based formula, data are lacking on developmental status of infants fed soy formula compared with breast milk or milk formula.

Infants fed soy protein–based formula scored within normal limits on standardized developmental testing and did not dif-fer from infants fed cow’s milk–based formula. Breastfed infants have a slight advantage on cognitive development compared with formula-fed infants.

Predictors of Survival in Children Born With Down

Syndrome: A Registry-Based Study

Survival of children born with Down syndrome has been im-proving, but few studies have used population-based data to examine the influence of fetal and maternal characteristics on survival.

This study examined predictors of survival for children born with Down syndrome using population-based data from the UK Northern Congenital Abnormality Survey and shows that year of

birth, gestational age, birth weight, and presence of additional anomalies influence survival status.

Lipid Pro

fi

les of Children With Down Syndrome

Compared With Their Siblings

Some researchers have suggested that individuals with Down syndrome (DS) are protected from atherosclerotic disease; however, recent data from 2 large cohort studies of individuals with DS are significant for increased mortality from ischemic heart disease and cerebrovascular disease.

This study compares lipid profiles among children with DS and their siblings, highlighting the presence of a less favorable lipid profile in this high-risk population.

Prevalence of Retinal Hemorrhages in Critically Ill

Children

The association of retinal hemorrhages (RHs) with abusive head trauma (AHT) is robust; 46% to 100% RHs are reported in AHT. There is potential selection bias with risk of circular reasoning because the majority of studies describing RH focus on AHT.

This is thefirst prospective observational study defining prevalence and distribution of RH in critically ill children ex-cluding those with AHT. Severe multilayered RH were rare and observed in children with accidental fatal head injury, severe coagulopathy, severe sepsis, or a combination of these factors.

Hypertonic Saline and Acute Wheezing in Preschool

Children

Most acute wheezing episodes in preschool children are asso-ciated with rhinovirus, which decreases extracellular adenosine triphosphate levels, leading to airway surface liquid dehydration and submucosal edema, which cause failure of mucus clearance. These children respond poorly to available treatments.

Hypertonic saline inhalation, a pro–airway surface liquid hy-dration therapy, significantly decreases both length of stay by 33% (1 day) and the absolute risk of hospitalization by 30% in preschool children presenting with acute wheezing episode to the emergency department.

Medication Adherence Among Latino and

Non-Latino White Children With Asthma

Asthma disparities exist, with Latino children of Caribbean descent at risk for poor disease control. Controller medications reduce symptoms; however, medication adherence remains suboptimal. Identifying what factors predict poor medication adherence in at-risk groups could identify important treatment targets.

ARTICLE SUMMARIES

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JUNE 2012

P E D I AT R I C S

Sodium Combination in Adolescent Migraine

Treatment of adolescent migraine remains a significant unmet medical need. In adults, the combination of sumatriptan and naproxen sodium has demonstrated superior efficacy, with similar tolerability, to its components in the acute treatment of migraine.

This study constitutes thefirst large-scale, placebo-controlled evidence for the acute relief of adolescent migraine pain and associated symptoms with an oral medication.

Low Rates of In

fl

uenza Immunization in Young

Children Under Ontario

’

s Universal In

fl

uenza

Immunization Program

Despite recommendations and a universal immunization pro-gram, a recent survey reported suboptimal influenza vacci-nation coverage in children aged 6 to 23 months in Ontario. Little is known about predictors of coverage in young children to target immunization strategies.

Full influenza vaccination coverage in young children in Ontario is,10% and declining since the 2006–2007 season. Medically high-risk children including low birth weight infants are more likely to be immunized, but maternal and health services characteristics remain important.

Effect of a Single Inhalation of Laninamivir

Octanoate in Children With In

fl

uenza

A single inhalation of laninamivir octanoate has previously been shown to be as effective as repeated doses of zanamivir in vitro and in vivo, but it is not known whether this is also the case for children.

Median time to fever resolution was not significantly different between laninamivir octanoate and zanamivir for pediatric patients with influenza. The severity of influenza symptoms and the frequency of complications were similar in the 2 groups.

Effectiveness and Net Cost of Reminder/Recall for

Adolescent Immunizations

Rates of coverage for recommended vaccinations in adoles-cents are substantially lower than Healthy People 2010 goals. Reminder/recall is an evidence-based strategy that is proven to increase immunization rates in both adults and young children.

School-Based Health Centers

The National Vaccine Advisory Committee highlighted the importance of settings complementary to the medical home for immunization delivery among adolescents, including school-based health centers (SBHCs). The effectiveness and cost of recall for immunizations in SBHC settings has not been studied.

SBHC-based recall was effective in improving immunization rates among adolescents, with effects sizes exceeding those achieved in practice settings. Average costs per child who was immunized ranged from $1.12 to $2.34 in 3 schools, but was $6.87 in 1 school.

How Children With Speci

fi

c Language Impairment

View Social Situations: An Eye Tracking Study

Children with specific language impairment are at risk for social difficulties. However, whether this occurs adaptively as a result of language impairment or occurs as a result of an underlying deficit in social cognition remains unclear. We used eye tracking to explore how children with specific language impairment view social scenes. The overall gaze behavior resembled that of typically developing children. Significant attention to the speaker’s mouth may result in receiving less social-emotional information from the eyes.

Transient Neonatal Hypocalcemia: Presentation and

Outcomes

Late-onset hypocalcemia is common in neonates, often pres-ents with seizures or tetany, and is often attributed to transient hypoparathyroidism.

Late-onset hypocalcemia in neonates is often a sign of coex-isting vitamin D deficiency and hypomagnesemia and is readily managed with therapy of limited duration, and neonates pre-senting with tetany or seizures due to hypocalcemia are un-likely to benefit from neuroimaging studies.

A 4-Year Exercise Program in Children Increases

Bone Mass Without Increasing Fracture Risk

accrual of bone mass and size during growth; however, fracture risk has not been evaluated.

This study reports the long-term results of a prospective in-tervention with increased physical activity at a population-based level and for thefirst time evaluated the clinical relevant end point, fracture risk.

Long-term Effectiveness of Maternal Dietary

Counseling in a Low-Income Population:

A Randomized Field Trial

Recent systematic reviews revealed that educational dietary interventions were effective in improving nutritional status and food consumption in thefirst year after birth. We are not aware, however, of studies in developing countries that have evaluated their long-term effectiveness.

This randomized trial revealed that, in a low-income population, the delivery of home-based maternal counseling focusing on breastfeeding and complementary feeding during thefirst year of children’s lives significantly improved the lipid profile at 7 to 8 years old.

Characteristics of Pediatric Traditional Chinese

Medicine Users in Taiwan: A Nationwide Cohort

Study

More than one-tenth pediatric patients use complementary and alternative medicines (CAM) for their medial conditions in the United States. Traditional Chinese medicine (TCM) is the most commonly used CAM in East Asia but large-scale epidemiologic studies are lacking.

In comparing TCM and non-TCM users among children in Tai-wan, children’s age and parental TCM use were strongly as-sociated with TCM use. Additionally, dyspepsia and allergic rhinitis were positively related to increasing TCM use.

A Double-Blind, Placebo-Controlled Trial of Omega-3

Fatty Acids in Tourette

’

s Disorder

Omega-3 fatty acids (O3FA) are commonly used as comple-mentary treatments in pediatric psychiatric disorders, including Tourette’s disorder (TD), and are well known to have anti-inflammatory properties. However, no studies to date have examined the effects of O3FA on pediatric TD.

This is thefirst double-blind, placebo-controlled clinical trial of O3FA in pediatric TD. The results indicate that O3FA supple-mentation may be beneficial in the reduction of tic-related impairment for some children and adolescents with TD, but not tics per se.

Developmental Outcome at 6.5 Years After Acidosis

in Term Newborns: A Population-Based Study

Conflicting results exist concerning long-term outcome in healthy infants with metabolic acidosis at birth.

Neonates who appear well after perinatal metabolic acidosis do not have an increased risk of neurologic or behavioral prob-lems in need of referral actions or pedagogic arrangements at the age of 6.5 years.

Approach to Infants Born at 22 to 24 Weeks

’

Gestation: Relationship to Outcomes of

More-Mature Infants

Although morbidity-free survival for preterm infants has remained constant in US NICUs when assessed collectively, morbidity-free survival differs among centers. Center-specific practices before, at, or after delivery might affect outcomes of the most premature infants.

Ourfindings suggest that the approach taken to infants at the limits of viability is associated with outcomes of more-mature infants. Identifying centers with higher survival and lower morbidity might lead to identification of key practices to im-prove morbidity-free survival.

Preliminary Development of a Rapid Assessment of

Supervision Scale for Young Children

Assessing for adequacy of supervision in the clinical setting is challenging and may result in significant variability in care. Clinicians must quickly decide if a child and family necessitate direct counseling, further intervention, or require reporting to state agencies.

This study identified the most important characteristics for the evaluation of the adequacy of supervision of a young child. A standardized scale using these characteristics may result in an efficient means to reduce variability in care.

Infant Outcomes After Maternal Antiretroviral

Exposure in Resource-Limited Settings

Information on infant safety after exposure to maternal anti-retroviral regimens during pregnancy in international clinical trials is lacking. As antiretroviral drugs are

released to populations in resource-limited settings through clinical trials, it becomes critical to collect pediatric outcome data.

The study demonstrates the feasibility of reporting infant outcomes following adult antiretroviral trials in developing countries, provides HIV-free infant survival and prospective growth data in association with maternal parameters, and

ARTICLE SUMMARIES

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JUNE 2012

P E D I AT R I C S

Data on the use of off-label rFVIIa, including safety and efficacy, are mostly limited to case reports or small case series.

This is the largest reported case series of off-label rFVIIa in pediatric patients from a well-designed, representative, and rigorously audited registry of rFVIIa use and describes the indications for use, dose administered, adverse events, and outcomes in 388 patients.

described.

This research defines the neurocognitive phenotype of isolated methylmalonic acidemia and identifies processing speed as a specific impairment. Clinical, biochemical, and molecular genetic covariates were explored. A history of hyper-ammonemia at diagnosis was found to correlate with poorer cognitive outcomes.

DOI: 10.1542/peds.digest1296

2012;129;D1

Pediatrics

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