Pediatrics Digest

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The National Perinatal Hepatitis B Prevention

Program, 1994

–

2008

Infants born to women who are hepatitis B surface antigen– positive have a 90% risk of chronic hepatitis B virus infection, which may cause premature death from liver failure or cancer. Postexposure prophylaxis in infancy prevents 85% to 95% of perinatal infections.

The Perinatal Hepatitis B Prevention Program was created to identify and manage infants born to women who are hepatitis B surface antigen–positive. We provide, for theﬁrst time since 1996, national-level data on the outcomes of the Perinatal Hepatitis B Prevention Program.

Implications of Childhood Autism for Parental

Employment and Earnings

Previous research on the cost of childhood autism has been restricted primarily to studying direct costs (money outlays) incurred by publicly and privately funded service systems.

This study estimates the economic impact on the family and examines indirect costs to families in the form of parental labor market productivity losses.

Pharmacy Communication to Adolescents and Their

Physicians Regarding Access to Emergency

Contraception

Emergency contraception is a safe and effective method of pregnancy prevention after unprotected intercourse.

Pharmacies commonly communicate misinformation, both to adolescents and to physicians, concerning who is able

to access emergency contraception and through what means.

Risk Factor Changes for Sudden Infant Death

Syndrome After Initiation of Back-to-Sleep

Campaign

Prone sleep, bed-sharing, maternal smoking during pregnancy, and prematurity increase the risk of sudden infant death syndrome. The sudden infant death syndrome rate initially declined dramatically after the initiation of the US Back-to-Sleep campaign in 1994, but subsequently plateaued.

The risk proﬁle has changed since the Back-to-Sleep campaign; the prevalence of simultaneous risks has remained consistent. Intrinsic and extrinsic risks provide uniﬁcation into 1 un-derlying triple-risk model and insights into potential unun-derlying mechanisms.

Tight Glycemic Control With Insulin in

Hyperglycemic Preterm Babies: A Randomized

Controlled Trial

Insulin is commonly used to treat neonatal hyperglycemia, but there are few data to support its use. Tight glycemic control with insulin improves outcome in diabetic patients, but it is not known whether it is effective in hyperglycemic preterm infants.

Tight glycemic control with insulin in hyperglycemic preterm neonates decreases the rate of linear growth despite increased weight and occipitofrontal head circumference gain and increases the risk of hypoglycemia. Insulin may not be a safe and effective treatment in hyperglycemic preterm neonates.

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and useful (“is this child due for catch-up immunizations?”) information is unclear.

Overall, HEDIS childhood immunization measures are accurate and useful. Users of HEDIS data should be aware, however, that certain immunizations (eg, hepatitis B, pneumococcal conju-gate) and children (eg, those with a single overdue immuni-zation) are more prone to HEDIS misclassiﬁcation.

Analgesic Effect of Breast Milk Versus Sucrose for

Analgesia During Heel Lance in Late Preterm

Infants

Breastfeeding and oral sucrose have shown an analgesic effect in premature newborn infants for minor painful procedures. Studies suggest that the analgesic properties of breast milk are superior to oral sucrose in term neonates.

For premature infants from 32 to 37 weeks, there is no sig-niﬁcant difference in analgesic effect between breast milk and oral sucrose. Breast milk is a safe and natural method for pain relief in late preterm infants.

Breast Milk and Glucose for Pain Relief in Preterm

Infants: A Noninferiority Randomized Controlled

Trial

Numerous late preterm infants undergo repetitive heel lancing procedures during theirﬁrst hours of life to evaluate glycemic control. Heel lances are painful and 25% glucose solution is effective on reducing procedural neonatal pain scores and crying behavior.

This noninferiority randomized controlled trial demonstrated that compared with breast milk, 25% glucose provided lower pain scores and reduced duration of cry. Further research is necessary to clarify breast milk’s mechanisms and efﬁcacy on neonatal pain relief.

Prenatal Methamphetamine Exposure and

Childhood Behavior Problems at 3 and 5 Years

of Age

Prenatal methamphetamine exposure has been related to deﬁcits in fetal growth, changes in infant neurobehavior, and

ﬁne motor deﬁcits, but little is known about its developmental effects on behavior problems in early childhood.

Bilirubin Measurements

Transcutaneous bilirubinometry was originally developed as a potential replacement for invasive blood sampling, but its clinical application is still limited to a screening method for hyperbilirubinemia. Reasons for this limited clinical value may be diverse.

This study provides insight into the reasons for the limited clinical value of transcutaneous bilirubinometry. This aids to both better interpretation of the measured TcB value from a patient and to possible improvement of the clinical value of the technique.

Interrater Reliability of Clinical Findings in Children

With Possible Appendicitis

Few studies have examined the reliability of clinicalﬁndings in pediatric appendicitis. Clinical prediction rules are most useful if the included variables are reliable across practice settings and practitioners.

Among children who present with possible appendicitis, the interrater reliability varied considerably for patient history and physical examination variables. Those variables with the highest degree of reliability may be best suited for inclusion in appendicitis clinical prediction rules.

A Randomized Controlled Trial of Zinc as Adjuvant

Therapy for Severe Pneumonia in Young Children

Pneumonia is still a significant problem in young children from developing countries where zinc deficiency is prevalent. Al-though zinc supplementation reduces the risk of childhood pneumonia, the effect of adjunct zinc on severe pneumonia is unclear with conflicting results.

The overall effect, if any, of zinc as adjuvant therapy for World Health Organization–deﬁned severe pneumonia in young chil-dren is small.

Alcohol Consumption in Movies and Adolescent

Binge Drinking in 6 European Countries

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Exposure to alcohol consumption in movies is associated with youth binge drinking, is little inﬂuenced by cultural differences between countries (Germany, Iceland, Italy, Netherlands, Poland, and Scotland), and is speciﬁc to movie alcohol, not movie smoking, depictions.

Stair-Related Injuries to Young Children Treated in

US Emergency Departments, 1999

–

2008

Stairs are a common source of injury to children. Most injuries are minor soft tissue injuries, with the head and neck region being injured most commonly.

This is theﬁrst nationally representative study of stair-related injuries to young children in the United States. A child aged,5 years is treated in a US emergency department, on average, every 6 minutes for a stair-related injury.

Incidence and Cost of Injury Among Youth in

Agricultural Settings, United States, 2001

–

2006

Several studies have analyzed fatal or nonfatal youth injury incidence in US agricultural settings, but none have combined those estimates to form an overall picture. The only detailed study of costs related to such injuries is restricted to nonfatal injury.

This study provides a comprehensive analysis of the annual incidence and cost of agricultural youth injuries in the United States. It analyzes them from different perspectives: fatal versus nonfatal, at work versus not at work, and requiring hospitalization versus not requiring hospitalization.

Sleep-Disordered Breathing in a Population-Based

Cohort: Behavioral Outcomes at 4 and 7 Years

Sleep-disordered breathing is associated with neurobehavioral morbidity in children. Prior related research has generally been cross-sectional or short (ie, 1–2 years) follow-up studies of a single symptom (ie, snoring, obstructive sleep apnea, mouth breathing), with limited control for confounders.

Sleep-disordered breathing was assessed as a trajectory of combined symptoms from 6 months to 69 months, in more than 11 000 children. Sleep-disordered breathing was associated with 40% and 60% more behavioral difﬁculties at 4 and 7 years, respectively.

Clinic-Integrated Behavioral Intervention for

Families of Youth With Type 1 Diabetes: Randomized

Clinical Trial

Strategies to assist patients in achieving optimal chronic disease self-management are critical. The complex family and

regimen issues surrounding pediatric type 1 diabetes man-agement suggest the need to integrate such strategies into routine clinical care.

This study demonstrates the efﬁcacy of a practical, low-intensity behavioral intervention delivered during routine care for im-proving glycemic outcomes. Findings indicate that the approach may offer a potential model for integrating medical and be-havioral sciences to improve health care.

Development of a Pragmatic Measure for

Evaluating and Optimizing Rapid Response Systems

The availability of rapid response systems to assist de-teriorating patients is the standard of care in children’s hos-pitals. Metrics for evaluating their effectiveness include cardiac and respiratory arrest rates, rare events that require years of data to show signiﬁcant improvements.

A proximate outcome for in-hospital mortality among patients receiving rapid response system assistance was developed. This“critical deterioration”metric was eightfold more com-mon than arrests and decom-monstrated criterion and construct validity, facilitating meaningful evaluation over shorter periods of time.

Mental Health Dif

ﬁ

culties in Children With

Developmental Coordination Disorder

Cross-sectional studies have shown an increased risk of mental health difﬁculties in children with developmental coordination disorder. However, there has been limited longitudinal research in this area controlling for confounding factors and assessing the role of potential mediators.

Children with"probable"developmental coordination disorder at 7 years had a signiﬁcantly increased risk mental health difﬁculties at 10 years. Protective factors for self-reported depression included high IQ, high self-esteem, good social communication skills, and the absence of bullying.

Motor Coordination and Psychosocial Correlates in

a Normative Adolescent Sample

Research has highlighted an important relationship between motor coordination and emotional functioning in children and adolescents. Few studies have provided support for this idea; research is therefore needed to further understand the re-lationship between the motor and emotional domains.

The results suggest that the relationship between motor co-ordination and emotional functioning (anxious and depressive symptoms) in an adolescent sample may be understood in terms of a mechanism whereby motor coordination has an indirect impact on emotional functioning via self-perceptions.

ARTICLE SUMMARIES

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APRIL 2012

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valuable.

A decline in the incidence of infantile hypertrophic pyloric stenosis in Germany from 2000 to 2008 was noted but with wide regional variations. The regional distribution of infantile hy-pertrophic pyloric stenosis was different from that of sudden infant death syndrome.

Impact of Rotavirus Vaccine on Diarrhea-Associated

Disease Burden Among American Indian and Alaska

Native Children

In the prerotavirus vaccine era, diarrhea-associated hospital-ization and outpatient rates among American Indian and Alaska Native children were higher than those among the general US population. Routine rotavirus vaccination has dramatically de-creased rotavirus diarrhea burden in the general US population.

Decreases in diarrhea-associated hospitalization and out-patient rates among American Indian and Alaska Native chil-dren in postvaccine years were observed in all Indian Health Service regions, with declines greater in each subsequent year after vaccine introduction.

Methicillin-Resistant and Susceptible

Staphylococcus aureus

Bacteremia and Meningitis

in Preterm Infants

There is a perception among clinicians that methicillin-resistant_{Staphylococcus aureus}(MRSA) bacteremia and/or meningitis result in a greater burden of disease than invasive infections attributed to methicillin-susceptible_{Staphylococcus} aureus(MSSA) among very low birth weight (VLBW) infants. VLBW infants with MRSA and MSSA bacteremia and/or men-ingitis have equivalent morbidity and mortality. Theseﬁndings suggest that allocation of resources for prevention and treatment of both MRSA and MSSA infections among VLBW infants should be comparable.

Rising National Prevalence of Life-Limiting

Conditions in Children in England

For children and young people with life-limiting conditions, pal-liative care services should be available, but few national or local data are available to estimate the burden of these conditions.

an Adapted Instrument

Survival takes precedence for adolescent patients with cancer and their families. Patients may not discuss their treatments’ potential to damage their reproductive capacity, which has signiﬁcant psychological late effects in survivorship.

Strong reproductive concerns of adolescents with cancer may not be captured on current health-related quality of life instruments and may be neglected by parents’unawareness. Parent-proxy reports of adolescent reproductive concerns are not suitable for capturing speciﬁc emotions and feelings.

Parental Psychological Well-Being and Behavioral

Outcome of Very Low Birth Weight Infants at 3 Years

Preterm infants are at increased risk of behavioral problems, which has been associated with maternal distress. Paternal psychological well-being is less studied. Parents’concerns may affect their perceptions or attitudes and have negative effects on the behavior of the child.

Parents report more behavior problems in VLBW children at age 3 if they themselves have had symptoms of depression, parenting stress, or weak sense of coherence. Also, the pa-ternal psychological well-being contributes to the behavioral development of a preterm child.

Hospital Variation in Nitric Oxide Use for Premature

Infants

Inhaled nitric oxide for premature infants has been evaluated in multiple studies; however, these trials differed in treatment initiation, duration of therapy, and inclusion criteria. Further-more, these trials reached differing conclusions regarding the beneﬁt of inhaled nitric oxide.

We used a large sample of infants from children’s hospitals and found that the use of inhaled nitric oxide in premature infants was variable even when controlling for demographic charac-teristics and disease.

The Outcome of ELBW Infants Treated With NCPAP

and InSurE in a Resource-Limited Institution

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care facilities. Nasal continuous positive airway pressure resulted in an increased survival of these infants, but many still require back-up ventilation.

Nasal continuous positive airway pressure and intubation, sur-factant, and extubation practiced in a neonatal high care ward with limited resources and limited back-up ventilatory facilities can improve the survival of extremely low birth weight infants.

Effect on Infant Illness of Maternal

Supplementation With 400 000 IU Vs 200 000 IU of

Vitamin A

Postpartum vitamin A supplementation is a strategy to combat vitamin A deﬁciency and seems to reduce maternal/infant morbidity and mortality. However, controversies exist re-garding which dose has a greater efﬁcacy, 200 000 IU (WHO protocol) or 400 000 IU (IVACG protocol).

In this study, postpartum maternal supplementation with 400 000 IU of vitamin A did not provide any additional beneﬁcial effect in reducing infant morbidity compared with the stan-dard dose of 200 000 IU.

Immune Status in Very Preterm Neonates

The very preterm neonate is more susceptible to bacterial infection; this is thought to be due to immaturity of the innate immune response.

Monocytes have an anti-inflammatory profile at birth and are hyporesponsive to inflammatory stimuli in fetuses born very prematurely. This reflects the response to the pro-inflammatory events leading to preterm birth as well as gestational immaturity.

Barriers to Conducting Advance Care Discussions

for Children With Life-Threatening Conditions

Previous studies have identiﬁed barriers to providing optimal pediatric palliative care, including general communication

issues between clinicians and family members. However, there is a paucity of data regarding the barriers speciﬁcally relating to advance care discussions.

This study identiﬁes signiﬁcant barriers to advance care dis-cussions for children with life-threatening conditions. Clinicians perceive parental issues as the most common impediments to these discussions. Furthermore, providers believe that advance care discussions happen too late in the course of illness.

Shifts in BMI Category and Associated

Cardiometabolic Risk: Prospective Results From

HEALTHY Study

Changes in BMI category appear to be common in young children and are associated with cardiometabolic risk in cross-sectional studies. However, there are few longitudinal studies and little information from multiethnic samples of US middle school children.

Findings demonstrate that shifts in BMI category are common in middle-school-aged children and associated with clinically meaningful changes in cardiometabolic risk factors. Programs to promote decreases in BMI, prevent increases, and moderate risk are indicated.

Cerebral Palsy Among Asian Ethnic Subgroups

Asian Americans have a reduced risk of cerebral palsy (CP) compared with whites. Whether this is true for all Asian ethnic subgroups is unknown. Differences in sociodemographic fac-tors may explain disparities in CP prevalence between Asians and whites.

East Asian, Filipino, Indian, Paciﬁc Islander, and Southeast Asian children were 13% to 38% less likely to have CP than white children. Differences in maternal age and education, gender, and birth weight did not explain these differences in CP rates.

See the table of contents of this issue to learn more about these articles.

ARTICLE SUMMARIES

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APRIL 2012

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