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Prevalence of Parental Misconceptions About
Antibiotic Use
Attitudes and knowledge about appropriate management of com-mon childhood illnesses may lead parents to mistakenly believe antibiotics are needed. Differences existed in antibiotic knowledge and attitudes between parents of Medicaid- and commercially in-sured children and according to other sociodemographic variables.
Despite efforts to decrease unnecessary antibiotic use, mis-conceptions about antibiotic use persist and continue to be more prevalent among parents of Medicaid-insured children. Tailored efforts for socioeconomically disadvantaged pop-ulations remain warranted to decrease parental drivers of unnecessary antibiotic prescribing.
Evaluation for Occult Fractures in Injured Children
Screening for occult fractures is a key component of the medical evaluation for young victims of suspected physical abuse. Little is known about adherence to occult fracture evaluation guidelines in children with suspected abuse cared for at non-pediatric-focused hospitals.
Occult fracture evaluations were performed in half of young children diagnosed with abuse or injuries concerning for abuse in a large cohort of hospitals. Evaluations were more common at hospitals caring for higher volumes of young, injured children.
Trends in Hospitalization for Pediatric Pulmonary
Hypertension
Although existing analyses of inpatient pediatric pulmonary hypertension (PH) care have established an association with
substantial morbidity and mortality, these investigations have been limited to small single-institution series or focused registries representative of selected patient subgroups.
This study provides thefirst contemporary, national trend analysis of inpatient care for children with PH. Pediatric PH is associated with a rapidly increasing number of hospital dis-charges and magnitude of resource utilization, and the makeup of this population is changing.
Recognizing Differences in Hospital Quality
Performance for Pediatric Inpatient Care
Hospital quality-of-care measures are publicly reported to in-form consumer choice and stimulate quality improvement. The number of hospitals and states with a sufficient number of pediatric hospital discharges to detect worse-than-average pediatric inpatient care quality remains unknown.
Most children are admitted to hospitals in which all-condition measures of inpatient quality are powered to show differences in performance from average, but most condition-specific measures are not. Policy on incentives for pediatric inpatient quality should take thesefindings into account.
Trends in Morbidity and Mortality of Extremely
Preterm Multiple Gestation Newborns
Studies on the risk of mortality and morbidities of extremely preterm infants of multiple gestation births have shown in-consistent results. Perinatal antecedents, admission status and severity of illness after birth can adversely affect outcomes of the extremely premature infants.
Preterm multiple gestation infants have increased risk of mortality but similar risk of major morbidities compared with singletons. Outcomes improved over time and all adverse outcomes, including mortality, were comparable between multiples and singletons in the most recent 5-year epoch.
Integrating a Parenting Intervention With Routine
Primary Health Care: A Cluster Randomized Trial
More than 200 million children,5 years are not reaching their developmental potential. Lack of stimulating caregiving is a major cause, and effective scalable interventions are needed. Integrating parenting with health services has been recommended, but there are few evaluations.
An innovative parenting intervention can be delivered at routine visits for primary health care, with benefits to child cognitive development and parenting knowledge. This approach usingfilms, discussion, and practice has the potential for delivery at scale.
A Tailored Family-Based Obesity Intervention:
A Randomized Trial
Although treatment programs for childhood obesity can demonstrate success, long-term outcomes have seldom been evaluated. The benefit of intervention when overweight is identified in a screening assessment and parental recognition of the problem is minimal is understudied.
A low-dose (sessions every 1–3 months), but long-term (2 years), family-based intervention was effective at reducing BMI compared with usual care in children recruited via a weight screening initiative in which many parents had been unaware their child was overweight.
Validation of a Prediction Tool for Abusive Head
Trauma
A previous multivariable statistical model, using individual patient data, estimated the probability of abusive head trauma based on the presence or absence of 6 clinical features: rib fracture, long-bone fracture, apnea, seizures, retinal hemor-rhage, and head or neck bruising.
The model performed well in this validation, with a sensitivity of 72.3%, specificity of 85.7%, and area under the curve of 0.88. In children,3 years old with intracranial injury plus$3 fea-tures, the estimated probability of abuse is.81.5%.
Home Foreclosure and Child Protective Services
Involvement
Prior studies have found a positive relationship between macro-level indicators of home foreclosure and child mal-treatment rates. The extent to which home foreclosure may be
associated with child protective services involvement at the micro level is largely unknown.
Foreclosurefilings are positively associated with child protective services involvement. However, this is true of the periods before and after afiling, which are characterized by economic and other stress, which may drive this association more than thefiling itself.
Psychosocial Factors Associated With Adolescent
Electronic Cigarette and Cigarette Use
Electronic cigarette (e-cigarette) use in adolescence is in-creasing. E-cigarette use has been associated with cigarette use, but there has been little study of other psychosocial risk factors for e-cigarette use and their relationship with cigarette use.
Approval and use of e-cigarettes and cigarettes among friends and family were strongly associated with cigarette and e-cigarette use in a cohort of adolescents in southern California.
Positive Parenting Practices, Health Disparities,
and Developmental Progress
Interactive activities and routines promote early childhood language skills and subsequent educational achievement. Population studies describing parent-child participation in interactive activities and their associations with early child development among vulnerable populations are needed.
Significant disparities exist in parenting practices that promote child development between economically advantaged and disad-vantaged parents. Participating in less interactive activities was associated with increased risk of developmental delay among low-income families, suggesting a need to enrich parenting practices.
Use of Temporary Names for Newborns and
Associated Risks
Because there can be no delay in providing newborns with identification wristbands, some hospitals assign newborns temporaryfirst names such as Babyboy or Babygirl. These nondistinct naming conventions result in a large number of patients with similar identifiers in NICUs.
We performed an intervention study to determine if assigning distinctfirst names at birth would result in a reduction in wrong-patient errors. We used the Retract-and-Reorder tool, an established, automated tool to detect the outcome measure of wrong-patient electronic orders.
Statewide Medicaid Enhanced Prenatal Care
Programs and Infant Mortality
Medicaid made substantial investments in enhanced prenatal and postnatal care programs to address maternal and infant
health, including infant mortality. Evaluations of population-based programs are few, and although some have reported reductions in infant mortality, they have methodological limitations. A population-based home visitation program can be a suc-cessful approach to reduce infant mortality. The reduced risk of infant death is consistent with previousfindings on the effects of the program on health care utilization and birth outcomes.
Maternal Report of Advice Received for Infant Care
Parental adherence to recommended infant care practices (eg, breastfeeding; safe sleep) is below targeted goals. Adherence to practice recommendations increases when parents receive appro-priate advice from multiple sources such as family and physicians. Using a nationally representative sample, this study explores the advice mothers receive about safe sleep, immunization, breastfeeding, and pacifier use; thefindings suggest infant care practices about which mothers receive little or inappropriate advice, suggesting possible targets for intervention.
Immunogenicity, Safety, and Tolerability of
a Hexavalent Vaccine in Infants
The routine childhood immunization schedule is crowded during thefirst 2 years, leading to deferred doses and limiting the addition of new vaccines. Combination vaccines can reduce the“shot burden”and improve coverage rates and timeliness. Antibody response rates to antigens contained in an in-vestigational hexavalent vaccine (DTaP5-IPV-Hib-HepB) were noninferior to licensed comparator vaccines when given as a 3-dose infant series. The safety profile was similar to control except for increased rates of mild-to-moderate, self-limited fever.
Antibiotic Exposure and Juvenile Idiopathic
Arthritis: A Case
–
Control Study
The etiology of juvenile idiopathic arthritis (JIA) is poorly un-derstood. A recent study suggested a link between antibiotics and JIA but did not examine the potential for confounding from infections or the role of antibiotic timing.
Antibiotics were associated with newly diagnosed JIA in a dose-and time-dependent manner after adjusting for infection dose-and other confounders. Antibiotics may play a role in the pathogenesis of JIA.
Identifying Priorities for Mental Health Interventions
in War-Affected Youth: A Longitudinal Study
War-affected youth often suffer from multiple co-occurring mental health problems. The relationship of these conditions to later mental health has yet to be thoroughly investigated. There is a need to explore potential targets for mental health interventions.
After controlling for preexisting conditions and contemporary confounders, internalizing (depression and anxiety) remained the major predictor of future mental health symptoms (in-ternalizing symptoms, prosocial attitudes/behaviors, and posttraumatic stress symptoms). Interventions targeting in-ternalizing in war-affected youth hold promise.
Prevalence of and Risk Factors for Intracranial
Abnormalities in Unprovoked Seizures
Weak recommendations exist to guide emergent neuroimaging decisions in children withfirst, unprovoked seizures. The prevalence of and risk factors associated with clinically relevant abnormalities on neuroimaging have not been well defined in prospective studies. Clinically relevant intracranial abnormalities on neuroimaging occur in 11% of children withfirst, unprovoked seizures. Emer-gent/urgent abnormalities, however, occur in,1%, suggesting that most of these children do not require emergent neuro-imaging. Specific clinicalfindings identify patients at higher risk.
Thrombocytopenia in Small-for-Gestational-Age Infants
Small-for-gestational-age neonates are at risk for thrombo-cytopenia during thefirst days and weeks after birth. However, the incidence, duration, severity, responsible mechanism, value of platelet transfusions, and risk of death from this variety of neonatal thrombocytopenia are unknown.
Ten percent of thrombocytopenic small-for-gestational-age neonates have a recognized cause for low platelets (aneuploidy, extracorporeal membrane oxygenation, disseminated in-travascular coagulation); they have a high mortality rate (65%). Ninety percent have a moderate, transient (2 weeks), hypo-regenerative thrombocytopenia with a low mortality rate (2%).
Use of Serum Bicarbonate to Substitute for Venous
pH in New-Onset Diabetes
Diabetic ketoacidosis (DKA) is a common and seriousfirst manifestation of diabetes mellitus in children. During initial evaluation, the venous blood pH is frequently used to make the diagnosis and classify the severity of DKA.
This study demonstrates that the serum bicarbonate concentration is a simple and accurate predictor of DKA and its severity and can be used in lieu of venous pH measurement, especially in resource-poor settings where access to pH measurement is limited.
Variation in Prenatal Diagnosis of Congenital Heart
Disease in Infants
Prenatal diagnosis may lead to benefits in outcomes for certain forms of critical congenital heart disease. Despite recognized
ARTICLE SUMMARIES
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AUGUST 2015
P E D I AT R I C S
ÒS U M M A RY
benefits, single-center studies and focused regional efforts suggest that prenatal detection rates for congenital heart disease remain low in the United States.
We describe prenatal detection rates for a large cohort of neonates and infants undergoing heart surgery across a range of congenital heart defects. Additionally, this study adds new information by demonstrating geographic variability of pre-natal detection rates across the United States.
Outbreak of
Mycoplasma pneumoniae
–
Associated
Stevens-Johnson Syndrome
Stevens-Johnson syndrome (SJS) is a rare and severe im-munologic phenomenon characterized by rash and mucous membrane disease. SJS may be triggered by medications and, less commonly, by infections such asMycoplasma pneumoniae (Mp). Outbreaks of SJS are exceedingly rare.
We describe the largest SJS outbreak reported in children, which was also Mp-associated. In thefirst case-control study of this disease, we identify predictors of Mp-associated SJS versus non–Mp-associated SJS, including fewer skin lesions, pneu-monia, and elevated erythrocyte sedimentation rate.
Predicting Discharge Dates From the NICU Using
Progress Note Data
Discharge from the NICU requires coordination and may be delayed for nonmedical reasons. Predicting when patients will be medically ready for discharge can avoid these delays and result in cost savings for the hospital.
We developed a supervised machine learning approach using real-time patient data from the daily neonatology progress note to predict when patients will be medically ready for discharge.
Late Diagnosis of Coarctation Despite Prenatal
Ultrasound and Postnatal Pulse Oximetry
Neonatal coarctation of the aorta (CoA) is a life-threatening cardiac defect, but because symptoms may be lacking initially, newborns with this defect are frequently discharged from the hospital undiagnosed. Delayed diagnosis of CoA is associated with increased morbidity and mortality.
This population-based study analyzes the contribution of pre-natal ultrasound and postpre-natal pulse oximetry screening to the timely diagnosis of neonatal CoA. Both screening methods had low sensitivity for CoA. Nearly half of all newborns with isolated CoA were discharged undiagnosed.
Public Perceptions of the Bene
fi
ts and Risks of
Newborn Screening
Infant screening is valued by members of the lay public, but how different benefits are independently valued, and whether harms are disvalued, is not known. Public expectations of screening can inform decisions about what diseases to screen for. The public values clinical benefits of screening and disvalues harms, with tolerance for harm proportional to clinical benefit. Thesefindings support newborn screening policies prioritizing clinical benefits over solely informational benefits, coupled with concerted efforts to avoid or minimize harms.
Cost-Effectiveness Analysis of a National Newborn
Screening Program for Biotinidase De
fi
ciency
Biotinidase deficiency (BD) might cause severe and permanent consequences. Cases detected through newborn screening and under treatment are shown to remain asymptomatic. However, some countries, including Spain, do not provide universal BD screening within their national newborn screening programs.
It provides afirst estimate of the lifetime costs and health outcomes of a Spanish birth cohort with and without neonatal screening for BD. It shows that newborn screening for BD is likely to be a cost-effective use of resources.
Maternal Consequences of the Detection of Fragile
X Carriers in Newborn Screening
Parents generally adapt well to newborn screening results, but reactions to carrier status for X-linked conditions are unknown.
Results suggest that detection and disclosure ofFMR1newborn carrier status may not result in significant adverse events for mothers.
Trisomy 21 and Risk of Retinopathy of Prematurity
It is known that trisomy 21 decreases the risk of (nonocular) angiogenic-mediated disorders, such as solid tumors. It is not known whether trisomy 21 decreases the risk of ocular angiogenic-mediated disorders such as retinopathy of pre-maturity.
This study shows that trisomy 21 decreases the risk of reti-nopathy of prematurity (ROP), thus unmasking a potentially identifiable genetic component to ROP risk. This study paves the way for the future development of a laboratory-based ROP screening tool.
See the table of contents of this issue to learn more about these articles.
DOI: 10.1542/peds.digest1362
2015;136;D1
Pediatrics
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DOI: 10.1542/peds.digest1362
2015;136;D1
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