Pediatrics Digest

(1)

Receive summaries of articles in each

month

’

s issue of

_Pediatrics

when

you sign up at www.pediatrics.org.

Vaccine Financing From the Perspective of Primary

Care Physicians

Because of high costs of newer vaccines,ﬁnancial risk to private vaccination providers has increased. Previous studies have shown general dissatisfaction with payment for the cost of vaccines and administration fees, with some providers con-sidering no longer providing childhood vaccines.

We show that many providers are dissatisﬁed with payment for vaccine purchase and administration from all types of payers and that, for new vaccines, providers are using a variety of strategies with parents to handle uncertainty about insurance coverage.

Recent Trends in Outpatient Antibiotic Use in

Children

Antibiotic use for children has decreased dramatically over the last 20 years. Programs encouraging judicious antibiotic use have focused both on decreasing overall antibiotic use and appropriate prescribing of broad-spectrum agents.

Large declines in antibiotic rates were prominent in the early 2000s. This trend has attenuated, and use has leveled off in some age groups and locales; continued improvement in the use of broad-spectrum agents is possible.

Trends in Caffeine Intake Among US Children and

Adolescents

The majority of caffeine intake among children and adolescents is due to soda and tea consumption. Energy drinks, which provide a potent source of caffeine, have increased in avail-ability in the United States in recent years.

This analysis presents trends in caffeine intake between 1999 and 2010, which have previously not been described in the United States, and reveals the impact of increasing energy drink use, also previously not described, on these trends among children and adolescents.

Ultrasound as a Screening Test for Genitourinary

Anomalies in Children With UTI

Current guidelines recommend renal ultrasound as a screening test after febrile urinary tract infection, with voiding cys-tourethrogram (VCUG) only if the ultrasound is abnormal. Few studies have evaluated the accuracy of ultrasound as a screening test for VCUG-identiﬁed abnormalities.

This study shows that ultrasound is a poor screening test for genitourinary abnormalities identiﬁed on VCUG, such as ves-icoureteral reﬂux. Neither positive nor negative ultrasounds reliably identify or rule out such abnormalities. Ultrasound and VCUG provide different, but complementary, information.

Risk Perceptions and Subsequent Sexual Behaviors

After HPV Vaccination in Adolescents

Concerns have been raised that human papillomavirus (HPV) vaccination could lead to riskier behaviors in vaccinated adolescents, but it is unknown whether changes in risk per-ceptions after vaccination lead to riskier sexual behaviors.

Risk perceptions following HPV vaccination were not associated with subsequent riskier sexual behaviors in sexually experi-enced and inexperiexperi-enced young women. These data contribute to the growing evidence that HPV vaccination does not lead to changes in sexual behaviors among adolescents.

(2)

Altered myelination at school age is associated with greater numbers of invasive procedures during hospitalization in very preterm children without severe brain injury or neurosensory impairment. Greater numbers of invasive procedures and altered brain microstructure interact to predict lower IQ.

Local Food Prices and Their Associations With

Children

’

s Weight and Food Security

A growing body of research suggests that the food environment affects children’s weight. Speciﬁcally, living in areas with higher-priced fast foods and soda is associated with lower weight and BMI, whereas higher fruit and vegetable prices demonstrate the opposite association.

Using longitudinal data on lower-income young children, this studyﬁnds that higher-priced fruits and vegetables are asso-ciated with higher child BMI, but not food insecurity, and that this relationship is driven by the prices of fresh fruits and vegetables.

Role of Financial and Social Hardships in Asthma

Racial Disparities

Asthma morbidity disproportionately affects racial minorities and disadvantaged children. Differences in socioeconomic status and genetics have been offered as explanations but an in-depth understanding of differences in hardships may better explain disparities and also help to identify intervention targets.

Among children admitted for asthma, African Americans were twice as likely to be readmitted as whites. Nearly half the disparity was explained by socioeconomic status and hard-ships. Community-based interventions targeting hardships may be more feasible given emerging health care payment reform.

Peer Victimization in Fifth Grade and Health in

Tenth Grade

Research indicates that bullying, a type of peer victimization, is related to worse mental and physical health. Most previous studies have been cross-sectional and have not examined effects of bullying over time.

This analysis examined longitudinal effects of bullying on mental and physical health from middle school to high school. Experiencing chronic bullying, especially in both the past and

however, these interventions are not broadly implemented. There is little evidence to inform decision-makers of the costs associated with preventing violence.

We report the costs of a brief violence prevention intervention in the ED. We highlight the economic impact of implementation, showing that brief interventions in the ED are an inexpensive way the health care system can prevent violence in adolescents.

Income Inequality and Child Maltreatment in the

United States

Income inequality is positively associated with several adverse child health and well-being outcomes. There is no existing research investigating the relationship between income in-equality and child maltreatment rates.

This study is theﬁrst to demonstrate that increases in income inequality are associated with increases in child maltreatment rates at the county level.

A Paci

ﬁ

er-Activated Music Player With Mother

’

s

Voice Improves Oral Feeding in Preterm Infants

Preterm infants must develop oral feeding skills before success-fully transitioning to home. Paciﬁer-activated devices playing se-lected music can improve nonnutritive sucking in preterm infants. A mother’s voice is a positive auditory stimulus for infants.

A brief intervention with a paciﬁer-activated music player using mother’s voice can decrease tube feeding duration without adverse effects on stress or growth. Operant conditioning with positive reinforcement is an effective developmental strategy to improve preterm infants’feeding skills.

Sexual Orientation and Anabolic-Androgenic

Steroids in US Adolescent Boys

Anabolic-androgenic steroid misuse is not uncommon among adolescent boys, and initial use in adolescence is associated with a host of maladaptive outcomes, including cardiovascular, endocrine, and psychiatric complications.

(3)

Pulse Oximeter Sensor Application During Neonatal

Resuscitation: A Randomized Controlled Trial

Pulse oximeter is better than skin color assessment in the initial minutes of life. After sensor application, a delay occurs in the display of reliable saturation and heart rate. An appropriate method of sensor placement can minimize the delay.

Attaching sensorﬁrst to oximeter and then to neonate picked up signal faster than attaching it to the neonateﬁrst and then to the equipment. However, the time from birth to display of reliable signal was similar between the methods.

In-School Neurofeedback Training for ADHD:

Sustained Improvements From a Randomized

Control Trial

An estimated 9.5% of children are diagnosed with attention-deﬁcit/hyperactivity disorder (ADHD), which affects academic and social outcomes. We previously found signiﬁcant improvements in ADHD symptoms immediately after neuro-feedback training at school.

This randomized controlled trial included a large sample of elementary school students with ADHD who received in-school computer attention training with neurofeedback or cognitive training. Students who received neurofeedback were reported to have fewer ADHD symptoms 6 months after the intervention.

Epidemiology of Tuberculosis in Young Children in

the United States

More than 60% of all US tuberculosis cases occur among foreign-born persons, but∼90% of cases in young children occur among US-born; many of these children have foreign-born parents, suggesting that this is an important population for prevention.

This is theﬁrst study to calculate tuberculosis rates in US-born children by parental nativity. Compared with US-born children with US-born parents, rates were 32 times higher in foreign-born children and 6 times higher in US-born children with foreign-born parents.

Effectiveness of Nebulized Beclomethasone in

Preventing Viral Wheezing: An RCT

Viral wheezing is common in preschool-aged children. The efﬁcacy of inhaled steroids in preventing viral wheezing is de-bated. Despite this debate, nebulized beclomethasone is widely prescribed (particularly in a few countries) to children with upper respiratory tract infections.

Findings from this study conﬁrm that inhaled steroids are not effective in preventing viral wheezing. Moreover, no differences

were found in the persistence of symptoms (eg, runny nose, sore throat) or in the parental perception of asthma-like symptom severity.

Duration of Protection After First Dose of Acellular

Pertussis Vaccine in Infants

Waning effectiveness of 5 doses of acellular pertussis vaccines is well documented after 6 years of age, but data are lacking for fewer doses in younger children.

In 2- to 3-month-old infants, 1 dose of the diphtheria–tetanus– acellular pertussis vaccine gave signiﬁcant protection against hospitalized pertussis. The effectiveness of 3 doses decreased from 84% between 6 and 11 months to 59% after 3 years.

Economic Burden of Childhood Autism Spectrum

Disorders

Previous analyses have documented increased health care costs for children with autism spectrum disorders but have not provided comprehensive estimates of the total economic burden.

There are substantial additional costs associated with caring for children with autism spectrum disorders, amounting to.$17 000 per child annually. Costs accrued outside of the health care system account for the majority of theﬁnancial burden.

Need and Unmet Need for Care Coordination Among

Children With Mental Health Conditions

Although care coordination has been associated with lower health care costs and improved outcomes for vulnerable children, little is known about the extent of need and factors associated with unmet need for care coordination among children with mental health conditions.

Children with mental health conditions have substantial need and unmet need for care coordination. Unmet need is more likely for families with children with anxiety disorder and less likely for those who report social support and family-centered care.

Clinical Utility of PCR for Common Viruses in Acute

Respiratory Illness

Quantitative real-time polymerase chain reaction allows sensitive detection of respiratory viruses. The clinical signiﬁcance of detection of speciﬁc viruses is not fully understood, however, and several viruses have been detected in the respiratory tract of asymptomatic children.

Our results indicate that quantitative real-time polymerase chain reaction is limited at distinguishing acute infection from

ARTICLE SUMMARIES

–

MARCH 2014

P E D I AT R I C S

Ò

S U M M A RY

(4)

reported data are based mostly on questionnaires and clinical assessments.

Significant cognitive impairment, attention-deficit/hyperactivity disorder, and learning disabilities are common after childhood encephalitis. Even children who were considered fully re-covered may be significantly affected. Identifiable pathogens, abnormal neuroimaging, and abnormal neurologic examination on discharge are risk factors of poor outcome.

Variation in Congenital Heart Surgery Costs Across

Hospitals

Congenital heart disease is known to be a commonly treated and resource-intense condition across children’s hospitals, yet knowledge regarding the degree of cost variation across hospitals and associated factors is lacking.

Using a linked clinical and administrative data set, we establish benchmarks for hospital costs for common congenital heart operations, and demonstrate wide variation in cost between hospitals related in part to differences in length of stay and complications.

Feasibility of Critical Congenital Heart Disease

Newborn Screening at Moderate Altitude

The American Academy of Pediatrics (AAP) and other organ-izations have recommended critical congenital heart disease (CCHD) pulse oximetry screening. Small studies have revealed lower saturations at higher altitude, but this effect on CCHD screening is unknown. The AAP requested additional studies at altitude to help clarify the dilemma.

The AAP has endorsed higher-altitude studies of CCHD screening. This observational prospective study revealed a higher positive screen rate at moderate altitude than at sea level. Theseﬁndings suggest that current national recommendations may result in increased screening failures at moderate altitude.

Risk and Prevalence of Developmental Delay in

Young Children With Congenital Heart Disease

Children with congenital heart disease demonstrate a high prevalence of low-severity developmental problems in the areas of language, motor skills, attention, and executive function. Systematic evaluation has been recommended to

Adult Talk in the NICU With Preterm Infants and

Developmental Outcomes

It is known that adult language input is important to healthy language development and that preterm infants are at risk for language delay.

This is theﬁrst study to provide evidence that preterm infants’ exposure to adult words in the NICU before the mother’s due date are associated with better cognitive and language out-comes at 7 and 18 months’corrected age.

Fertility Rate Trends Among Adolescent Girls With

Major Mental Illness: A Population-Based Study

Although fertility rates among adolescents have declined in recent years, certain groups of adolescent girls remain at risk. Whereas adolescents with major mental illness have many risk factors for teenage pregnancy, their fertility rates have not been yet to be examined.

Fertility rates among adolescent girls with major mental illness are almost 3 times higher than among unaffected adolescents and are not decreasing to the same extent. Mental health considerations are highly important for pregnancy prevention and for perinatal interventions targeting adolescents.

Long-Term Outcomes of Adolescents With

Juvenile-Onset Fibromyalgia in Early Adulthood

Juvenile-onsetfibromyalgia (JFM) is a poorly understood chronic pain condition, typically identified in adolescence and accompanied by physical and social impairment and mood difficulties. There are no long-term studies on the prognosis of adolescents with JFM into adulthood.

This prospective study demonstrated that pain and other symptoms persisted into adulthood for.80% of JFM patients, with associ-ated impairments in physical functioning and mood. At follow-up, one-half of the sample met full criteria for adultﬁbromyalgia.

Ophthalmic Outcomes of Congenital Toxoplasmosis

Followed Until Adolescence

(5)

treatment. Long-term ocular outcome beyond puberty and associated prognostic factors are unknown due to limited follow-up.

Our study in 477 patients with treated congenital toxoplasmosis who were followed up to 22 years indicated that new ocular lesions can be detected well into adolescence (with a cumulative probability at 18 years of almost 50%), but they rarely cause severe visual impairment.

Incidence and Impact of CMV Infection in Very Low

Birth Weight Infants

Congenital cytomegalovirus (CMV) infection is a leading cause of sensorineural hearing loss and neurodevelopmental im-pairment in full-term infants. The incidence of congenital CMV infection in preterm infants and the possible associations with developmental outcomes are unknown.

This study deﬁnes the incidence of congenital CMV infection in very low birth weight infants and identiﬁes strong associations of congenital CMV infection with hearing loss and adverse neurodevelopmental outcomes in this population.

Dental Caries and Growth in School-Age Children

There is conﬂicting evidence about the relationship between dental caries in primary teeth and children’s height and weight.

Findings reveal an inverse linear association between caries levels and children’s height and weight. Theﬁndings take the argument beyond the presence or absence of an associ-ation and provide a better understanding of the pattern of this association.

Epidemiology of Male Genital Abnormalities: A

Population Study

There are misconceptions regarding childhood phimosis. Textbooks still teach that male children should have retractable foreskin by age 3. Young children are referred for evaluation for phimosis, which is a commonly used diagnosis for post-neonatal circumcision.

We found a high prevalence of physiologic phimosis in kin-dergarten children, up to 44% at age 6. We also reviewed the incidence of other congenital abnormalities in this coastal Chinese city. The management and complications of these conditions were analyzed.

Trial of Daily Vitamin D Supplementation in Preterm

Infants

Despite widespread prevalence of vitamin D deﬁciency, there is a paucity of evidence on the appropriate supplemental dose in

preterm infants. Various professional organizations empirically recommend different doses of vitamin D, ranging from 400 to 1000 IU per day.

Daily vitamin D supplementation at a dose of 800 IU compared with 400 IU significantly reduces the prevalence of vitamin D deficiency in preterm infants. The clinical significance of achieving vitamin D sufficiency needs to be studied in larger trials.

Dietary Sodium, Adiposity, and In

ﬂ

ammation in

Healthy Adolescents

High sodium intake is considered an indirect cause of obesity because it is often accompanied by higher energy intake and sugar-sweetened soft drink consumption. High sodium intake is associated with increased inﬂammatory response in adult patients.

This study shows that high sodium intake is positively asso-ciated with adiposity, leptin, and tumor necrosis factor-a independent of total energy intake and sugar-sweetened soft drink consumption in healthy white and African American adolescents.

Growth Patterns of Large for Gestational Age

Children up to Age 4 Years

Preterm (PT) birth is negatively associated with growth. Par-ticularly small for gestational age PT infants are at risk for delays in growth, whereas knowledge about the consequences regarding growth of large for gestational age PT birth is lacking.

During infancy, growth in height, weight, and head circum-ference of large for gestational age PT infants was well balanced and sufﬁcient. Subsequently, however, weight gain accelerated and resulted in high BMIs compared with the World Health Organization Multicentre Growth Reference Study population.

Symmetrical and Asymmetrical Growth Restriction

in Preterm-Born Children

Fetal growth restriction, particularly in preterm children, is associated with delayed development and poor growth. Knowledge about the consequences of fetal growth restriction if classiﬁed by symmetry is lacking, especially in preterm children.

In preterm children, symmetric and asymmetric growth re-striction at birth results in poorer growth later in life. Both groups are at considerable risk of developmental delay be-cause their long-term development is independent of their head circumference at birth.

ARTICLE SUMMARIES

–

MARCH 2014

P E D I AT R I C S

Ò

S U M M A RY

(6)

This study suggests that placement in foster care reduces indiscriminate behaviors to an intermediate level between those in institutional care and community control subjects. It also demonstrates the importance of disorganized early at-tachment in predicting later indiscriminate behaviors.

Available evidence on the comparative safety of pharmacologic interventions in adults versus children is inconclusive. In a third of meta-analyses, twofold or greater differences were identiﬁed between adults and children, and some clinically important discrepancies were also found.

(7)

DOI: 10.1542/peds.digest1333

2014;133;D1

Pediatrics

Pediatrics Digest

Services

Updated Information &

http://pediatrics.aappublications.org/content/133/3/D1 including high resolution figures, can be found at:

Permissions & Licensing

http://www.aappublications.org/site/misc/Permissions.xhtml in its entirety can be found online at:

Information about reproducing this article in parts (figures, tables) or

Reprints

(8)