Pediatrics Digest

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Pediatric Nurse Practitioners: Roles and Scope of Practice

There are⬃13 000 pediatric nurse practitioners (PNPs) in the United States. PNPs have been suggested as professionals who could provide care to the growing cadre of children with chronic illnesses and expand the pool of subspecialty care providers.

Little is known about the current roles of PNPs in primary or subspecialty care. Results of this study help us gain a better understanding of the roles, focus of practice, professional setting, and professional responsibilities of PNPs.

Pediatric Physician Assistants: Distribution and Scope of Practice

Physician assistants (PAs) are licensed to practice medicine with physician supervision. As of 2009, there were⬃72 000 PAs in clinical practice in the United States.

The authors provide information regarding the current distribution and scope of practice of PAs who work within the ﬁeld of pediatrics.

Neonatal Nurse Practitioners: Distribution, Roles and Scope of Practice

Neonatal nurse practitioners are registered nurses who have completed a master’s degree and advanced training program, including extensive supervised practice in the specialized care of newborns and their families.

The greatest concentrations of NNPs per capita were in the Midwest, South, and Mid-Atlantic regions. Fifty-four percent of NNPs reported that they spend the majority of their time in community hospitals, while 37% reported that they spend most of their time in academic health centers.

Family Nurse Practitioners: Roles and Scope of Practice in the Care of Pediatric Patients

Health care workforce planning efforts are increasingly incorporating the roles of nurse practitioners and physician assistants. Recent trends that highlight signiﬁcant

implications for future workforce planning across the age spectrum have emerged.

This study characterizes the pediatric roles and scope of practice of family nurse practitioners, to determine variations in states that do or do not allow independent practice of nurses.

ARTICLE SUMMARIES – NOVEMBER 2010

P E D I AT R I C S

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universal VUR screening among siblings are unknown.

Prevention of a single febrile urinary tract infection (fUTI) would require screening of 30 to 430 siblings, costing $56 000 to $820 000 per averted fUTI. These estimates are heavily dependent on screening age and the effectiveness of antibiotic prophylaxis.

Neonatal Jaundice, Autism, and Other Disorders of Psychological Development

Little and inconclusive evidence has been published regarding the association between neonatal jaundice and autistic disorders.

With this study, the authors conﬁrm a positive association between neonatal jaundice and autistic disorders, as well as possibly disorders of psychological development in general. Gestational age, parity, and season of birth play important roles in this association.

Sexual Behaviors and Sexual Violence: Adolescents With Opposite-, Same-, or Both-Sex Partners

High rates of risky sexual behaviors among youth with same-sex partners have been documented that may predispose this group to high rates of sexually transmitted infections, including HIV.

This is the ﬁrst report of sexual risk behaviors and identities in a population-based sample of sexually active male and female adolescents, analyzed according to reported sex of partner.

Just Say “I Don’t”: Lack of Concordance Between Teen Self-report and Biological Measures of Illicit Drug Use

With few exceptions, previous information on the prevalence of teen drug use in nonclinical samples has been derived exclusively from conﬁdential or anonymous self-reported surveys and suggests that few US teens use cocaine or opiates.

Analgesic Effects of Sweet-Tasting Solutions for Infants: Current State of Equipoise

Evidence from RCTs and systematic reviews supports the use of sweet solutions for pain reduction during painful

procedures for infants in medically stable condition. However, RCTs with placebo groups continue to be conducted.

A state of clinical equipoise regarding analgesic effects of small volumes of sweet-tasting solutions no longer exists. Therefore, there is no justiﬁcation for conducting additional RCTs with placebo or no-treatment groups for infants in medically stable condition.

Interpreting Complete Blood Counts Soon After Birth in Newborns at Risk for Sepsis

Components of the complete blood count (CBC) provide information about the likelihood of sepsis in newborns, but previous studies have used varying deﬁnitions of abnormal and yielded inconsistent results.

White blood cell counts and absolute neutrophil counts increase the probability of sepsis only when they are low. The informativeness of the CBC increases with age and when interval likelihood ratios are used rather than a “normal” range.

The Effects of Gestational Age and Birth Weight on False-Positive Newborn-Screening Rates

Newborn-screening false-positive rates are increased in preterm infants. However, the speciﬁc contribution of birth weight and gestational age to newborn-screening false-positive rates has not been fully reported.

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Referral to the Emergency Department by a Primary Care Provider Predicts Severity of Illness

ED overcrowding necessitates an accurate triage process. It is unclear whether referral to the ED by a PCP is a predictor of illness severity and should be included in triage decisions.

Referral to a PED by a PCP was signiﬁcantly and independently associated with greater severity of illness and resource utilization. Referral status should be considered in algorithms used to triage cases for evaluation in the PED.

Reliability of Clinical Examinations for Pediatric Skin and Soft-Tissue Infections

Studies have demonstrated fair to moderate reliability of clinical examinations for several diagnoses. Skin and soft-tissue infections represent a common reason for acute care visits, and physicians rely on clinical acumen to determine the need for drainage of these lesions.

As a poorly reliable method for determining management of skin and soft-tissue infections, clinical examinations should not be the sole means through which physicians evaluate these lesions, and more-objective methods should be investigated.

Racial Differences Among Children With Primary Hypertension

Race is a known risk factor for hypertension and overall cardiovascular risk in adults. In children, the normal blood pressure increases seen with age and height are also inﬂuenced by race and ethnicity.

This study of children with primary hypertension reveals differences in cardiovascular risk factors among children of different racial groups not previously described in the pediatric population.

Variation in Methods of Predicting Adult Height for Children With Idiopathic Short Stature

Predicted adult height often is used in evaluations of children with short stature, because treatment may not be indicated for children whose growth is consistent with attainment of a height above the 1.2nd percentile.

We demonstrated wide variation in adult heights predicted with 3 commonly used height prediction algorithms. Because the 3 algorithms led to profoundly discrepant predicted heights, future studies are necessary to determine which is most accurate for children with short stature.

Evidence for an Association Between Infant Mortality and a Carnitine Palmitoyltransferase 1A Genetic Variant

For unknown reasons circumpolar indigenous populations such as Alaska Native people have historically experienced high infant mortality rates.

Infants homozygous for the c.1436C_¡T variant in the gene coding for carnitine palmitoyltransferase type 1A (CPT1A) had higher infant mortality rates, primarily attributable to infectious diseases, than did other infants. Regions with the highest infant mortality rates had the highest gene

frequencies.

Association Between Medicaid Reimbursement and Child Inﬂuenza Vaccination Rates

Although experts have suggested that provider

reimbursement rates may affect childhood vaccination levels, this relationship is not well understood.

This is the ﬁrst study, to our knowledge, estimating the association between Medicaid provider reimbursement rates (for vaccine administration) and childhood inﬂuenza

vaccination rates.

Children’s Screen Viewing is Related to Psychological Difﬁculties Irrespective of Physical Activity

It is not known whether use of speciﬁc electronic media (computer use or television viewing) or total sedentary time is most strongly related to psychological difﬁculties and the extent to which objectively measured physical activity moderates this relationship.

Greater television or computer use was related to greater psychological distress for 10- to 11-year-old children, irrespective of objectively measured physical activity or sedentary time. Limiting computer use and television viewing may be important for optimal well-being for young people.

Trends in the Prevalence of Autism on the Basis of Special Education Data

The numbers of children receiving special education and other services because of autism have increased steadily in the United States since the early 1990s. It is unclear how long this trend will continue or whether it is leveling off.

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Maternal or Paternal Suicide and Offspring’s Psychiatric and Suicide-Attempt Hospitalization Risk

The evidence on parental suicide and offspring risk is equivocal, because most of the research in this area is from short-term prospective or cross-sectional studies of referred samples. Most studies compared offspring of suicide decedents with offspring of living parents.

Although others suggested that offspring of suicide decedents were more similar than different, compared with offspring of accident decedents, our study suggests that their cumulative risks may be different.

Clinical Utility of the Vanderbilt ADHD Rating Scale for Ruling Out Comorbid Learning Disorders

Approximately 30% of children with ADHD also meet the criteria for a comorbid learning disorder. Determining when to refer children for LD evaluations can be difﬁcult, and data-driven approaches are needed to facilitate these decisions.

The authors evaluate the utility of the Vanderbilt ADHD Rating Scale performance items for identifying children with ADHD who are unlikely to meet the criteria for an LD. The authors use these data to make recommendations about when children should be referred.

Hepatitis A in Internationally Adopted Children: Screening for Acute and Previous Infections

Transmission of hepatitis A virus infection to family members and close contacts of internationally adopted children has been reported. The birth countries of internationally adopted children have endemic HAV; however, the prevalence rates of infection and immunity are not known.

HAV immunity prevalence was 29%, increased with age, and varied according to birth country. Acute HAV infection prevalence was 1%. Screening children for HAV may be useful for infection prevention and immunization decisions.

the children.

This study was able to show that repeated courses of prenatal corticosteroid therapy did not contribute to improved outcomes. Although growth parameters at birth were signiﬁcantly different with repeated courses, there was no signiﬁcant difference at 2 years of age.

Physiologic and Clinical Beneﬁts of Noninvasive Ventilation in Infants With Pierre Robin Sequence

Infants with a Pierre Robin sequence may present with severe upper airway obstruction. Numerous treatments and surgical techniques have been reported but are not always able to prevent a tracheotomy.

This study is the ﬁrst to show the tremendous increase in respiratory effort for some infants with severe upper airway obstruction attributable to a Pierre Robin sequence and the efﬁcacy of nasal noninvasive respiratory support.

Newborn Care Training of Midwives and Neonatal and Perinatal Mortality Rates in a Developing Country

The majority of infant deaths occur during the neonatal period. Educational programs available to train neonatal health care workers are effective in improving knowledge and skills, but there are limited data on their effects on neonatal mortality rates.

Training midwives in neonatal care reduces early neonatal mortality rates for infants born in low-risk, ﬁrst-level facilities.

High Mortality Rates for Very Low Birth Weight Infants in Developing Countries Despite Training

Perinatal and/or neonatal mortality rates for infants born in community settings in developing countries can be decreased with implementation of a package of neonatal health care interventions. VLBW infants born in these settings have high mortality risk.

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Sleeping Through the Night: The Consolidation of Self-regulated Sleep Across the First Year of Life

The majority of infants met conventional deﬁnitions for sleeping through the night by 12 months of age. Changes in infants’ self-regulated sleep, as judged by developmentally and socially valid criteria for sleeping through the night, are unknown.

This study is the ﬁrst to investigate infants’ sleep-regulation capabilities by comparing 3 criteria for sleeping through the night. Longitudinal data provide an empirical foundation for infants’ self-regulated sleep. A new criterion for sleeping through the night is presented.

Early Intervention Improves Cognitive Outcomes for Preterm Infants: Randomized Controlled Trial

Knowledge regarding the beneﬁcial effects of early intervention programs on cognitive outcomes for preterm infants and their families is limited. There are few randomized controlled trials, and long-term results are conﬂicting.

The authors demonstrate that a modiﬁed version of a sensitizing parental intervention program (the Mother-Infant Transaction Program) showed beneﬁcial effects on cognitive outcomes for preterm infants with birth weights of⬍2000 g at corrected age of 5 years.

The Effect of Intrauterine Growth on Verbal IQ Scores in Childhood: A Study of Monozygotic Twins

Undernutrition during the fetal period affects future cognition, and nutritional interventions affect brain structure. Birth weight is correlated with later cognitive ability, but a number of variables can confound this link, including parental IQ and education, social background, genes, and gestational age.

We used a study design with monozygotic twins to reduce the effect of confounding variables. Our results suggest that suboptimal intrauterine growth is related to impaired cognitive outcome in both children born small and those with birth weights across the spectrum.

Economic Outcomes in Young Adulthood for Extremely Low Birth Weight Survivors

Extremely small and extremely preterm infants are known to experience signiﬁcant rates of neurosensory impairment, and large proportions have difﬁculties in school. Only a few studies have evidence on adult outcomes such as educational attainment and earnings.

This study compares educational and labor market outcomes for a cohort of extremely low birth weight survivors and a normal birth weight control group, with controlling for family background. Survivors experience some deﬁcits, but deﬁcits typically are not large.

The Association Between Developmental Coordination Disorder and Other Developmental Traits

Previous clinic-based samples have shown an overlap between developmental coordination disorder and ADHD, autism, and dyslexia. However, there has been limited population-based work on the association of DCD with other developmental traits that account for potential confounding factors.

Using data from the ALSPAC (N⫽6902 maximum), these study results show that children with probable DCD have an increased risk of difﬁculties in attention, short-term memory, and academic and social skills, after controlling for

confounding factors including IQ and other developmental traits.

Relationship Between Bed Sharing and Breastfeeding: Longitudinal, Population-Based Analysis

Bed sharing is a widespread practice, but it has been implicated in rare accidental or sudden deaths. Before advising against such a practice, we need to understand better the different groups that share beds and the potential association with breastfeeding.

An analysis of bed sharing and breastfeeding over time suggests an interdependent temporal relationship, with demographic differences between families that share beds mainly in infancy and those that share beds later in childhood.

Isolation of Tracheal Aspirate Mesenchymal Stromal Cells Predicts Bronchopulmonary Dysplasia

Mesenchymal stem cells were isolated from the tracheal aspirates of premature infants with respiratory distress syndrome. These cells may differentiate to myoﬁbroblasts, the number of which is increased in the lungs of patients with bronchopulmonary dysplasia.

Isolation of lung MSCs within the ﬁrst week of life predicts the development of BPD. MSCs may play an important role in the pathogenesis of BPD and serve as a biomarker for the development of this disease.

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cognitive problems.

In term-born children, stability of motor development from birth until school age was found to be low. Maternal SES and verbal intelligence rather than the infants’ scores on early motor tests signiﬁed added value for complex cognitive functions at school age.

The Effect of Protein and Glycemic Index on Children’s Body Composition: The DiOGenes Randomized Study

The potential of high protein and low glycemic index diets to promote weight loss in adults has resulted in research to investigate the effect of these diets on weight control in children; results have been promising but still conﬂicting.

In the DiOGenes study, a European family-based, randomized, controlled, multicenter, 6-month energy ad libitum dietary intervention study, the LP/HGI diet increased body fat, whereas overweight/obesity decreased in those on the HP/LGI diet.

An Observational Study of an Employer Intervention for Children’s Healthy Weight Behaviors

Although evidence exists for childhood obesity-prevention interventions that target families, such efforts in employer settings have been limited. However, employers have

demonstrated success in adult employee health improvement, and there is evidence that collaboration between pediatricians and employers can be powerful.

Neurocognitive and Endothelial Dysfunction in Children With Obstructive Sleep Apnea

Obstructive sleep apnea syndrome (OSAS) is associated with neuropsychological deﬁcits and cardiovascular morbidity. However, not all children are affected, and it is unknown whether those children with 1 of these morbidities are at risk for the other.

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DOI: 10.1542/peds.digest1265

2010;126;D1

Pediatrics