Pediatrics Digest

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Wartime Military Deployment and Increased Pediatric Mental and Behavioral Health Complaints

Military deployment of a parent inﬂuences children’s behavior in a variety of settings. The clinical signiﬁcance of these deployment-associated behavior changes has not been determined.

Children experiencing separation from a parent due to wartime military deployment have an 11% increase in outpatient visits for mental and behavioral health complaints, which contrasts with a general deployment-associated decrease in health care visits in all other diagnostic categories.

Variability in Antibiotic Use at Children’s Hospitals

National organizations recommend the implementation of antimicrobial stewardship programs (ASPs) to help facilitate the judicious use of antibiotics within hospitals. Establishing guidelines for an ASP relies on the comparison of use across equivalent institutions to identify high-impact targets for improvement.

Both the quantity and type of antibiotic-prescribing ranged broadly across US children’s hospitals. These data will help establish benchmarks for the judicious use of antibiotics within children’s hospitals and help target research to identify reasons for such variability.

Febrile Infants With Urinary Tract Infections at Very Low Risk for Adverse Events and Bacteremia

Febrile infants aged 29 to 60 days who have urinary tract infections are typically hospitalized forⱖ48 hours. Previous study results have indicated that most patients have benign clinical courses, but small sample sizes have limited the ability to identify those at near-zero risk of adverse events.

We derived prediction models from a large sample of patients who identify infants at low risk for adverse events and at low risk for bacteremia. Shorter hospitalization or outpatient treatment with close follow-up may be feasible for selected patients.

Risk of Renal Scarring in Children With a First Urinary Tract Infection: A Systematic Review

The risk of renal scarring in children with a urinary tract infection has not been systematically studied.

The pooled prevalence values from this study provide a basis for an evidence-based approach to the management of children with urinary tract infections.

ARTICLE SUMMARIES – DECEMBER 2010

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A vapor rub combination of camphor, menthol, and eucalyptus oils provided nocturnal symptom relief for children with cold symptoms. Children treated with vapor rub had improved sleep, as did their parents, when compared with children given placebo or no treatment.

Adverse Events From Cough and Cold Medications After a Market Withdrawal of Products Labeled for Infants

A voluntary market withdrawal of orally administered, over-the-counter cough and cold medications (CCMs) labeled for infants was announced in October 2007 because of concerns regarding limited evidence of efﬁcacy and potential harmful effects of these products for young children.

This study assessed changes in CCM-related harm, as measured with national estimates of emergency department visits to CCM-related adverse events, among children after announcement of the withdrawal of orally administered, over-the-counter, infant CCMs.

Prescribing of Controlled Medications to Adolescents and Young Adults in the United States

The nonmedical use of prescription drugs by adolescents and young adults has surpassed all illicit drugs except marijuana and has become an increasing public health concern. Adolescents and young adults are in the most likely age groups to abuse prescription medications.

This study’s results demonstrate increasing rates of prescribing of controlled medications to adolescents and young adults across multiple settings, including ambulatory ofﬁces and emergency departments.

adolescents in primary care settings. However, there is limited information on the performance of depression-screening tools with adolescents in primary care settings.

This study is the first to examine the sensitivity and specificity of the PHQ-9 among adolescent populations. The PHQ-9 has good sensitivity and specificity for detecting major depression among adolescents in the primary care setting.

Late-Preterm Birth and Its Association With Cognitive and Socioemotional Outcomes at 6 Years of Age

Late-preterm birth (34 –36 weeks’ gestation) may be

associated with cognitive and socioemotional problems during childhood. It is unclear whether these associations are independent of fetal growth and other covariates such as neighborhood conditions and maternal IQ.

Late-preterm birth, on average, is associated with cognitive and socioemotional problems even after adjusting for important covariates. A greater proportion of late-preterm births fall within the category of borderline/clinical problems, but many are within the normal range.

Survival and Morbidity Outcomes for Very Low Birth Weight Infants With Down Syndrome

Infants with very low birth weight (VLBW) are at increased risk of neonatal death and complications of prematurity. Down syndrome carries its own risks, but little is known about how this syndrome affects the risks associated with VLBW.

This study examines the risks of death and complications of prematurity for VLBW infants with and without Down syndrome in a 15-year cohort from the National Institute of Child Health and Human Development Neonatal Research Network.

Youth Motorcycle-Related Hospitalizations and Traumatic Brain Injuries in the United States in 2006

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Our findings describe the burden of motorcycle-related injuries and TBIs in both traffic and non-traffic domains and describe the TBI burden on the basis of a very large sample, with the most-precise national estimates ever reported.

Youth Motorcycle-Related Brain Injury by State Helmet Law Type: United States, 2005–2007

Youth fatality rates from motorcycle crashes are higher in states with partial-age helmet laws, but whether this difference is traumatic brain injury–related has not been determined. This study focused on TBI by using hospital morbidity data from states with different helmet laws.

Study results highlight and quantify the head-injury risks of different partial-age helmet laws for young riders and offer caution for the many states that have or are considering replacement of universal all-age laws with age-speciﬁc laws.

Inﬂuence of Birth Hospital on Outcomes of Ductal-Dependent Cardiac Lesions

It is not known whether birth at a pediatric cardiac specialty center or at a hospital with a higher neonatal level of care affects mortality for infants with ductal-dependent congenital heart disease.

For infants with ductal-dependent congenital heart disease, there is no difference in 90-day mortality for those born at specialty centers versus other centers in the state of Washington.

Impact of Income and Income Inequality on Infant Health Outcomes in the United States

The relationship between income inequality and health outcomes has been explored extensively for adults. However, relatively little is known about the impact of income inequality on infant health outcomes in the United States in the past decade.

This study demonstrates that both income and income inequality affect infant health in the United States. Also, the study documents that the health of the poorest infants in our country is affected more by absolute income than by relative income.

Food Insecurity: Could School Food Supplementation Help Break Cycles of Intergenerational Transmission of Social Inequalities?

Food insecurity is associated with poverty and poor scholastic achievement among children. School food supplementation programs are controversial.

Food assistance in high schools in underprivileged areas had a moderating effect on the association between household food insecurity and scholastic difﬁculties among adolescents.

Video-Gaming Among High School Students: Health Correlates, Gender Differences, and Problematic Gaming

The effects of video-gaming have been found to be mixed. There is little evidence that recreational play has poor consequences; however, problematic gaming has been recognized as a potential area of concern.

This study examined the correlates of recreational gaming and revealed few poor consequences but important health consequences of problematic gaming, particularly externalizing behaviors such as smoking, drug use, and ﬁghting.

Learning and Attention Problems Among Children With Pediatric Primary Hypertension

Children with sustained primary hypertension exhibit neuropsychological impairments in attention, working memory, and parent ratings of executive function skills. Previous studies excluded children with learning disabilities or attention-deﬁcit/hyperactivity disorder, which precluded examination of associations between hypertension and academic problems.

This study found increased prevalence of learning problems among children with sustained primary hypertension, irrespective of attention-deﬁcit/hyperactivity disorder history, in comparison with children without hypertension.

Therapeutic Acetaminophen Is Not Associated With Liver Injury in Children: A Systematic Review

Although case reports have described liver injury after therapeutic dosing of acetaminophen in children, no previous study has attempted to estimate the risk to a given patient.

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A Randomized Controlled Trial ofLactobacillusGG in Children With Functional Abdominal Pain

Chronic abdominal pain is one of the most common reasons for referral to a specialist. Effective measures for the treatment of recurrent abdominal pain are lacking. Data on the use of probiotics in adults with irritable bowel syndrome (IBS) have demonstrated their efﬁcacy.

Lactobacillus rhamnosusstrain GG (LGG) is effective for reducing the frequency and severity of pain in children with IBS. The beneﬁcial effect of LGG persists beyond the cessation of the administration and represents a valid therapeutic option. Small intestinal permeability is signiﬁcantly increased in children with IBS.

Risk Factors in Children Hospitalized With RSV Bronchiolitis Versus Non–RSV Bronchiolitis

Respiratory syncytial virus (RSV) is the leading cause of hospitalization in infants.

Hospitalization for respiratory syncytial virus increased signiﬁcantly from 2002 to 2007. The majority of children with RSV bronchiolitis were previously healthy, but they had more severe disease than did children with non-RSV bronchiolitis.

Iatrogenic Events in Neonates: Beneﬁcial Effects of Prevention Strategies and Continuous Monitoring

Iatrogenic events have been increasingly recognized as a major problem in NICUs. Incident-reporting systems are widely used to monitor iatrogenic events.

Prospective, continuous incident-reporting systems associated with subsequent prevention initiatives are key tools for decreasing iatrogenic events and, thus, improving quality of care and patient safety.

Adolescents expect and value all aspects of health care privacy. Informational privacy (or conﬁdentiality) is most salient, but psychological, social, and physical privacy also affect adolescents’ experience of and willingness to participate in care.

Redeﬁning Outcome of First Seizures by Acute Illness

Febrile seizures are the most common childhood seizures and are considered to have a good prognosis. Reports have suggested another category of provoked seizures, nonfebrile-illness seizures, which are not associated with fever but occur with other illness symptoms.

This study’s results conﬁrm the role of gastrointestinal illness as a distinguishing factor in childhood seizures, and

demonstrate that children who suffer a ﬁrst-time seizure associated with an acute gastrointestinal illness have a good prognosis and low risk of seizure recurrence.

Effects of Traditional Swaddling on Development: A Randomized Controlled Trial

Swaddling is a child care method that has been practiced over thousands of years in numerous cultures, and is still used to care for millions of infants annually. Its effects on motor and mental development remain uncertain and have only been investigated in small ethnographic studies.

Traditional, tight, and prolonged swaddling has no deleterious effects on child psychomotor and mental development scores at 13 months of age, as assessed by the Bayley Scales of Infant Development in a randomized controlled trial.

Aerosol Inhalation From Spacers and Valved Holding Chambers Requires Few Tidal Breaths for Children

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The breathing patterns of young children differ markedly from usual patterns when they use spacers/valved holding

chambers. When using these devices, 2 or 3 tidal breaths are adequate for drug delivery in young children .

Pentavalent Rotavirus Vaccine in Developing Countries: Safety and Health Care Resource Utilization

Two rotavirus vaccines are available globally. The safety and efﬁcacy of the pentavalent vaccine were established primarily in industrialized countries and have not been documented as extensively in developing countries, where the burden of rotavirus-attributable morbidity and death is greatest.

This study reports on the effectiveness of the pentavalent rotavirus vaccine in reducing hospitalizations and emergency department visits attributable to rotavirus gastroenteritis, without increased risk of acute infant intussusception, death, or other serious adverse events, in a developing country.

Effects of Current Size, Postnatal Growth, and Birth Size on Blood Pressure in Early Childhood

Blood pressure has been related inversely to birth weight, but this relationship comes to the fore only with adjustment for current size.

This study suggests that early postnatal growth, rather than birth weight, affects blood pressure at 3 years of age. This implies the presence of potentially modiﬁable factors in the postnatal period.

Educational Outreach to Reduce Immunization Pain in Ofﬁce Settings

Many strategies have been developed to address the pain and anxiety associated with immunizations, but these often are underutilized by pediatric providers. An educational outreach strategy known as “academic detailing” has been effective in changing health provider practices.

In this study, an academic detailing strategy featuring a single teaching visit to the ofﬁces of pediatric practitioners in our community, focusing on reduction of injection pain, had demonstrable effects on practice behaviors up to 6 month after application.

Malnutrition and Helminth Infection Affect Performance of an Interferon␥–Release Assay

The use of interferon␥-release assays, including the QuantiFERON-TB Gold In-Tube assay (QFT-IT), is hampered by insufﬁcient data regarding performance among high-risk pediatric subpopulations, including children with immunomodulating conditions such as malnutrition and intestinal helminth infection.

Interferon␥responses were blunted in the setting of malnutrition and helminth infection, leading to more indeterminate QFT-IT results. QFT-IT results should be

interpreted with caution when performed on children affected by such conditions.

Predicting Language Outcomes at 4 Years of Age: Findings From Early Language in Victoria Study

Children with language impairment have less-than-optimal outcomes later in childhood, in adolescence, and in adulthood. Little is known about early-life environmental, social, and family risk factors for language impairment at 4 years.

Family history of speech/language problems and low maternal education levels and socioeconomic status helped explain more variation in adverse language outcomes at 4 years than at 2 years, but ability to predict impairment remained limited.

Trends in Cause-Speciﬁc Mortality at a Canadian Outborn NICU

There have been important changes in the causes of death in NICU patients in the postsurfactant era. Outborn neonates have higher mortality rates, but it is unclear whether there have been changes in their speciﬁc causes of death.

Although mortality rates were stable over the last decade, a larger proportion of outborn premature infants admitted to our center seemed to survive the early problems of prematurity, only to succumb to late complications.

Hyperglycemia and Adverse Pregnancy Outcome Study: Neonatal Glycemia

Newborn infants of mothers with preexisting overt diabetes mellitus are at risk for hypoglycemia that is associated with fetal hyperinsulinemia.

For newborn infants of mothers who do not have overt diabetes, neonatal glucose concentrations are associated with cord blood C-peptide levels but are relatively stable during the ﬁrst 5 hours of life.

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in school.

Moderate preterm birth was associated with school difﬁculties persisting through basic school. The risk of not completing basic school increased with decreasing

gestational age. The absolute increase was minimal above 32 weeks’ gestation but more pronounced below 31 weeks’ gestation.

Infant Feeding Methods and Maternal Sleep and Daytime Functioning

Breastfed infants are reported to awaken more often and to sleep less. Because of its well-established beneﬁts for both infants and mothers, any perceived disadvantage of

breastfeeding should be evaluated carefully. Feeding method effects on maternal sleep are relatively unknown.

We did not ﬁnd any objective, subjective, or sleepiness/fatigue differences among women who used different feeding methods. The risks of not breastfeeding should be weighed against the cumulative lack of evidence of any beneﬁt of formula feeding on maternal sleep.

Left Vocal Cord Paralysis After Extreme Preterm Birth, a New Clinical Scenario in Adults

Injury to the left recurrent laryngeal nerve may occur during surgical ligation of a patent ductus arteriosus (PDA), resulting in left vocal cord paralysis (LVCP). Neonatal symptoms include respiratory difﬁculties, aspiration, and feeding disorders. Consequences beyond early childhood are unknown.

Incidence of Morbidity From Penetrating Palate Trauma

Reports of previous studies of oropharyngeal injury in children have described wound characteristics, injury vectors, and results from radiologic studies. The true risk of stroke and infection is unknown. Providers face decisions regarding which patients require computed tomographic angiography, an otorhinolaryngologist consultation, or hospitalization.

This study’s results reveal an incidence of 0% for stroke and 0.9% for infection and conﬁrm a wide variation in testing and treatment and an increase in the rate of computed

tomographic angiography and hospitalization over time. Positive computed tomographic angiography results did not lead to signiﬁcant interventions.

Ingestion ofLantana camaraIs Not Associated With Signiﬁcant Effects in Children

Ingestion of the plantLantana camara(particularly the unripe berries) has been reported to result in serious toxicity and even death; however, evidence to support this is sparse.

We reviewed 641 cases of pediatricLantana camara

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DOI: 10.1542/peds.digest1266

2010;126;D1

Pediatrics