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Sexual Activity
–
Related Outcomes After Human
Papillomavirus Vaccination of 11- to 12-Year-Olds
Concerns persist about sexual disinhibition after human papillomavirus (HPV) vaccination of preteenage girls. Self-reported surveys have indicated few anticipated behavior changes after HPV vaccination. Little is known about sexual activity–related clinical outcomes after HPV vaccination.
Utilizing managed care organization electronic data, we evaluated the incidence of adverse outcomes of sexual activity among vaccinated preteenage girls and found little difference between those who received HPV vaccine and those who did not.
Prevalence and Correlates of Exergaming in Youth
Exergaming offers a physical activity (PA) alternative for youth that may be attractive in our increasingly technophilic society. Exergaming increases PA and decreases sedentary time, but most exergame studies are clinically based and focus on measuring energy expenditure during exergaming.
One-quarter of adolescents exergamed at intensity levels that could help them achieve PA recommendations. Exergamers were more likely to be female, play nonactive video games, watch$2 hours of television per day, be stressed about weight, and be nonsmokers.
Diagnostic Value of Procalcitonin in Well-Appearing
Young Febrile Infants
Procalcitonin is a better marker than white blood cell count and overall comparable to C-reactive protein for identifying children at higher risk of having a serious bacterial infection. However,
its value in well-appearing young febrile infants is not clearly defined.
In well-appearing young febrile infants, procalcitonin is a better marker than C-reactive protein for identifying patients with an invasive bacterial infection.
In
fl
uence of Hospital Guidelines on Management of
Children Hospitalized With Pneumonia
There are limited data on current testing and treatment patterns for children hospitalized with pneumonia, and on whether institutional guidelines affect care.
The use of institutional clinical practice guidelines was not associated with changes in diagnostic testing, hospital length of stay, or costs for children hospitalized with pneumonia, but was associated with increased use of narrow-spectrum antibiotics.
Identifying and Treating a Substandard Housing
Cluster Using a Medical-Legal Partnership
Social and environmental risks related to substandard housing contribute to adverse health outcomes. Partnerships between the health care and legal systems can help families address such risks and help clinicians understand the legal context of health.
A medical-legal partnership colocated in a pediatric primary care setting identified and treated a large cluster of poor quality, substandard housing. Housing improvements were possible because of strong collaboration between clinicians, attorneys, community partners, and families.
African American children are exposed to more background television. Family behaviors associated with background television are offered.
Incidence of Serious Injuries Due to Physical Abuse
in the United States: 1997 to 2009
National data from child protective services agencies have shown a 55% decrease in the incidence of substantiated cases of physical abuse from 1992 to 2009, but no study has tracked the occurrence of serious injuries due to physical abuse.
Using national data from hospitalized children, we found a statistically significant increase in the incidence of serious injuries due to physical abuse from 1997 to 2009. These results are in sharp contrast to data from child protective services.
Variation in Occult Injury Screening for Children
With Suspected Abuse in Selected US Children
’
s
Hospitals
Clinical guidelines for the evaluation of suspected physical abuse in young children emphasize performing radiologic imaging to screen for occult fractures. Little is known about the degree of adherence to guidelines for screening for occult fractures among pediatric hospitals.
Adherence to guidelines related to screening for occult fractures in young children diagnosed with physical abuse varies significantly among pediatric hospitals. Use of screening in infants who have injuries associated with a high likelihood of abuse also varies among pediatric hospitals.
Mental Health Services Use by Children
Investigated by Child Welfare Agencies
Children investigated for alleged maltreatment have consid-erable physical, mental health (MH), developmental, and educational needs and often do not receive services to address these needs. The prevalence/correlates of MH services use in the current challengingfinancial environment is unknown.
This study demonstrates the importance of medical providers and schools for receipt of MH services for these children, but shows disparities in MH service use between white and non-white children. Unlike earlierfindings, MH service use declined over the follow-up.
Nearly half of children with an ASD elope, and more than half of these“go missing.”Elopement is associated with autism severity, and is often goal-directed. Addressing elopement behavior is an important aspect of intervention for many individuals with ASDs.
Antecedents of Neonatal Encephalopathy in the
Vermont Oxford Network Encephalopathy Registry
Most term and late preterm infants with neonatal encepha-lopathy have not had recognized asphyxial birth events. Several nonasphyxial risk factors for neonatal encephalopathy have been identified in previous studies.
In a large sample, we confirm the association of several nonasphyxial factors with neonatal encephalopathy, including markers of intrauterine exposure to infection or inflammation, intrauterine fetal growth restriction, and birth defects. We identify steps that would improve studies of neonatal encephalopathy.
Physician Attitudes Regarding School-Located
Vaccinations
Implementing expanded vaccination recommendations has challenged primary care providers, who administer the ma-jority of vaccines in the United States. School-located vacci-nation has been proposed as a means of increasing vaccivacci-nation rates while reducing the burden on primary care providers.
This study assesses physicians’support for their patients’ receipt of vaccines in school. Additionally, it compares physi-cians’support for adolescent versus influenza vaccination and compares support by insurance status of their patient.
Allowing Adolescents and Young Adults to Plan
Their End-of-Life Care
Discussing end-of-life (EoL) care with adolescents and young adults (AYAs) is difficult. Often, such conversations are delayed or avoided, but AYAs contemplate EoL issues and want to make decisions about their care. Few established resources exist to help this process.
choices about EoL care and how they would like to be remembered in the future.
Depressive Symptoms and Neurocardiogenic
Syncope in Children: A 2-Year Prospective Study
Adult patients with neurocardiogenic syncope have shown high rates of depression. Patients with more severe depressive symptoms have higher rates of syncope recurrence. Psychiatric interventions improve quality of life and decrease syncope recurrence rates.
Children with neurocargiogenic syncope presented a 2.6-fold higher rate of clinically significant depressive symptoms compared to healthy controls. No recurrent syncope was noted during follow-up which along with improvement in family functioning predicted depressive symptoms improvement.
Internet Access and Attitudes Toward Online
Personal Health Information Among Detained Youth
Detained youth represent a vulnerable pediatric population with worse health outcomes than their nondetained peers. To date, little work has been done to determine whether health information technologies may be effectively used to improve the health of this underserved population.
The Internet is accessible to youth involved in the juvenile justice system. A securely accessible online system to store detained youth’s health information may be both feasible and acceptable for engaging these adolescents more actively in their health care.
Secondary Sexual Characteristics in Boys: Data
From the Pediatric Research in Of
fi
ce Settings
Network
Recent investigations of pubertal onset in US girls suggest earlier maturation. The situation for US boys is unknown, and existing investigations are outdated and lack information on a key physical marker of male puberty: testicular enlargement.
US boys appear to be developing secondary sexual charac-teristics and achieving testicular enlargement 6 months to 2 years earlier than commonly used norms, with African American boys entering Tanner stages 2 to 4 earlier than white or Hispanic boys.
Computed Tomography Use Among Children
Presenting to Emergency Departments With
Abdominal Pain
Increased computed tomography (CT) use among adults and children presenting to emergency departments has spawned
concern about associated radiation exposure. The risks and benefits of CT use for certain conditions, such as abdominal pain, among general pediatric populations remains unclear.
This study analyzes emergency department radiology trends between 1998 and 2008 among children with abdominal pain, highlighting a dramatic increase in CT use. Factors associated with CT ordering include older age, non-black race, and hospital admission.
Prevention of Invasive
Cronobacter
Infections in
Young Infants Fed Powdered Infant Formulas
InvasiveCronobacterinfection is a rare but devastating disease known to affect hospitalized premature or immuno-compromised infants fed powdered infant formulas (PIFs). PIF labels imply that powdered formulas are safe for healthy, term infants if the label instructions are followed.
Cronobactercan also infect healthy, term infants in thefirst months of life, even if PIF label instructions are followed. In-vasive Cronobacter infection is extremely rare in exclusively breastfed infants or those fed commercially sterile, ready-to-feed formulas.
Clinical Utility of Chromosomal Microarray Analysis
Chromosomal microarray analysis offers a superior diagnostic yield over karyotyping for the evaluation of individuals with developmental disabilities. Many third-party payers, however, do not reimburse for microarray testing, citing a lack of evi-dence that patients benefit from testing.
This study demonstrates that microarray testing frequently identifies conditions that include features requiring specific medical follow-up and that referring physicians respond to abnormal test results with appropriate clinical actions. Microarray testing, therefore, provides direct benefits to patients.
In
fl
uence of Stress in Parents on Child Obesity and
Related Behaviors
Stress in parents has been shown to be related to child obesity.
The presence of multiple parent stressors was related to child obesity, and parent perception of stress was related to child fast-food consumption. Stress in parents may be an important risk factor for child obesity and related behaviors.
Impact of Neonatal Intensive Care on Late Preterm
Infants: Developmental Outcomes at 3 Years
Children born late preterm (34–36 weeks’gestation) are at increased risk of adverse early childhood outcomes compared
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not receive this care.
Prophylactic Probiotics to Prevent Death and
Nosocomial Infection in Preterm Infants
Several meta-analyses evaluating probiotics in preterm infants suggest a beneficial effect for the prevention of necrotizing enterocolitis and death, but less for nosocomial infection.Lactobacillus reuteri may reduce these outcomes because of its immunomodulation and bactericidal properties.
AlthoughL reuteri did not appear to decrease the rate of death or nosocomial infection, the trends suggest a protective role consistent with the literature. Feeding intolerance and duration of hospitalization were significantly decreased in premature infants#1500 g.
Effects of Glutamine on Brain Development in Very
Preterm Children at School Age
Brain maturation processes of very premature children are adversely affected by serious neonatal infections. Differences in brain development persist into childhood and adolescence, and underpin widespread neurocognitive and behavioral deficits in very preterm children.
We present evidence for long-term beneficial effects of early nutritional intervention with glutamine in very preterm infants on brain development at 8 years of age, mediated by a decrease in the number of serious neonatal infections.
Cord Blood 25-Hydroxyvitamin D
3and Allergic
Disease During Infancy
The rising burden of allergy is most evident in infancy, indicating the importance of early exposures. Reduced vitamin D status in pregnancy has been associated with atopy and respiratory outcomes, but there is less information on other early allergic outcomes.
Cord blood 25-hydroxyvitamin D3concentrations,50 nmol/L
were highly prevalent in an Australian population. Lower vi-tamin D levels were associated with increased risk of eczema at 12 months of age, whereas there was no association with sensitization or food allergy.
States. Previous research has shown positive effects on school climate and school-level discipline problems.
This study reports multilevel results on data from a 4-year randomized controlled effectiveness trial of SWPBIS in 37 el-ementary schools. Results indicate significant impacts on children’s aggressive behavior problems, concentration problems, office discipline referrals, emotion regulation, and prosocial behavior.
Sleep Duration and Adiposity During Adolescence
Some epidemiologic evidence suggests an inverse association between sleep duration and obesity in various age groups. However, in the case of adolescents, inconsistent results have been reported, which can be partly explained by methodologic options.
Our study supports an effect of sleep duration in adiposity during adolescence and found gender differences in this as-sociation. The results are consistent by using either the tra-ditional longitudinal approach or cross-lagged modeling.
Impact of Sleep Extension and Restriction on
Children
’
s Emotional Lability and Impulsivity
Healthy sleep is essential for supporting alertness and other key functional domains required for academic success. Research involving the impact of modest changes in sleep duration on children’s day-to-day behavior in school is limited.
This study shows that modest changes in sleep duration have significant impact on the behavior of typically developing children in school. Modest sleep extension resulted in de-tectable improvement in behavior, whereas modest sleep restriction had the opposite effect.
Carnitine Palmitoyltransferase I and Sudden
Unexpected Infant Death in British Columbia First
Nations
TheCPT1Ap.P479L variant is common to northern aboriginal populations, leads to reduced enzyme activity, and may be associated with increased infant mortality rates.
Randomized Trial of Prongs or Mask for Nasal
Continuous Positive Airway Pressure in Preterm
Infants
Nasal continuous positive airway pressure (NCPAP) is com-monly given to premature infants with nasal prongs and nasal masks. Prongs and masks appear to injure the nose of preterm infants with equal frequency.
Nasal masks are more effective than nasal prongs for pre-venting intubation and mechanical ventilation in premature infants within 72 hours of starting NCPAP.
Electrocardiogram Provides a Continuous Heart
Rate Faster Than Oximetry During Neonatal
Resuscitation
Heart rate continues to be the single most important indicator of well-being in a newborn. Availability of a reliable method to determine heart rate in thefirst minute would help determine resuscitation interventions, particularly for the extremely premature infant.
Electrocardiograms can provide a reliable, continuous heart rate in the most premature infants in thefirst minute of re-suscitation compared with pulse oximeters.
Variations in Children
’
s Dental Service Use Based
on Four National Health Surveys
Oral health researchers and policy makers primarily use 4 national surveys to examine use of dental services among US children. Estimates from the surveys may vary, posing a challenge to pop-ulation-based monitoring.
The authors of this study compared estimates of dental service use and delayed dental care obtained from 4 commonly used health surveys to appraise their utility for guiding pediatric oral health research and policy.
Pediatric Chronic Nonbacterial Osteomyelitis
Chronic nonbacterial osteomyelitis (CNO) is a sterile
in-flammatory bone disorder of presumed autoimmune or autoinflammatory etiology predominantly affecting children. There are limited data on the characteristics and optimal treatment of CNO in the United States.
A US-based cohort of pediatric CNO patients revealed high rates of personal and familial autoimmunity. Coexisting autoimmu-nity was a risk factor for widespread involvement. Response to nonsteroidal antiinflammatory drugs was inferior to that with immunosuppressive and biologic agents.
Factors In
fl
uencing Participation in
a Population-based Biorepository for Childhood
Heart Disease
Understanding human disease genomics requires large population-based studies. There is lack of standardization, as well as social and ethical concerns surrounding the consent process for pediatric participation in a biorepository.
The study identifies specific barriers to pediatric participation in biorepositories relative to adults, and proposes strategies to improve ethical and responsible participation of pediatric-aged patients in large-scale genomics and biorepository-driven re-search without significantly increasing research burden for affected families.
Measuring Adverse Events and Levels of Harm in
Pediatric Inpatients With the Global Trigger Tool
The Global Trigger Tool uses a sampling methodology to identify and measure harm rates. It has been shown to effectively detect adverse events when applied in the adult environment, but it has never been evaluated in a pediatric setting.
The Global Trigger Tool can be used in the pediatric inpatient environment to measure adverse safety events. We detected a 2 to 3 times higher harm rate than previously found with different metrics in this setting.
Growth and Fat-Free Mass Gain in Preterm Infants
After Discharge: A Randomized Controlled Trial
Postnatal growth restriction of preterm infants is a universal problem. Early“catch-up growth” has been associated with development of metabolic syndrome. In addition, preterm infants appear to be at major risk for developing increased adiposity and insulin resistance.
The consumption of a nutrient-enriched formula after hospital discharge may be beneficial in adequate for gestational age infants both in terms of head circumference growth and fat-free mass gain.
Metformin
’
s Effect on First-Year Weight Gain: A
Follow-up Study
The use of metformin in pregnancy is increasing in the treatment of both gestational diabetes and polycystic ovary syndrome. Metformin crosses the placenta. Teratogenicity is not reported. Possible long-term effects are undetermined.
Intrauterine metformin exposure seems to have long-term effects on infant weight. At 1 year of age, infants born to women and exposed to metformin weigh more than those exposed to placebo in utero.
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of ITBI in infants, but the predictive value has not been established.
This prospective retinal imaging study found that a diagnosis of ITBI in infants and children can be distinguished from other traumatic and nontraumatic causes by the presence of.25 dot-blot (intraretinal layer) hemorrhages (positive predictive value = 93%).
Genotype Prediction of Adult Type 2 Diabetes From
Adolescence in a Multiracial Population
Among middle-aged adults, genotype scores predict incident type 2 diabetes but do not improve prediction models based on clinical risk factors including family history and BMI. These clinical factors are more dynamic in adolescence, however.
A genotype score also predicts type 2 diabetes from adoles-cence over a mean 27 years of follow-up into adulthood but does not improve prediction models based on clinical risk factors assessed in adolescence.
Long-term Outcomes of Infant Behavioral
Dysregulation
Infant behavioral dysregulation is a common concern, involving irritability, excessive crying, and problems with feeding and sleep. Previous research into its behavioral outcomes has been limited by small cohorts and short follow-up, andfindings have been contradictory.
Long-term follow-up of a large cohort showed that infant behavioral dysregulation was a risk factor for maternal-reported behavior concerns at 5 and 14 years, but was un-related to young adult mental health outcomes.
Performance Metrics After Changes in Screening
Protocol for Congenital Hypothyroidism
Significant variation in congenital hypothyroidism screening operations/performance has been observed in the United States. The origin of this variation remains unknown, in part because of a lack of evaluation. Accordingly, debates persist
Comparison of One-Tier and Two-Tier Newborn
Screening Metrics for Congenital Adrenal
Hyperplasia
The false-positive rate of newborn screening for classic con-genital adrenal hyperplasia (CAH) remains high and has not been significantly improved by adjusting 17a-hydroxyprogesterone cutoff values for birth weight and/or gestational age. In re-sponse, 4 states have initiated second-tier steroid profile screening.
Under second-tier screening, the false-positive rate remains high, and classic CAH cases missed by screening (false-negatives) occur more frequently than reported. Physicians are cautioned that a negative screen does not necessarily rule out CAH.
Status of the Pediatric Clinical Trials Enterprise: An
Analysis of the US ClinicalTrials.gov Registry
There are limited data regarding the current status of the pediatric clinical trial enterprise.
Evaluation of the ClinicalTrials.gov data set allows description of the overall portfolio of clinical trials relevant to US children, which was previously not possible.
Trajectories of Autism Severity in Children Using
Standardized ADOS Scores
Autism spectrum disorders are characterized by heteroge-neous severity. Previous latent variable analyses of longitudinal data have focused on trajectories of related features such as IQ, and not on changes over time in standardized, observational measures of core autism symptoms.
Autism Diagnostic Observation Schedule–calibrated severity scores allow comparisons of observational data from tod-dlerhood to adolescence. Thisfirst report of latent autism severity trajectory classes indicates that most children show stability in core symptom severity over many years; small groups improved or worsened.
DOI: 10.1542/peds.digest1305
2012;130;D1
Pediatrics
Pediatrics Digest
Services
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