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High School Students
’
Use of Electronic Cigarettes
to Vaporize Cannabis
Electronic cigarette use among youth is rising exponentially. Among other concerns, modified electronic cigarettes can be used to vaporize cannabis. However, no scientific data have been published on the rates of using electronic cigarettes to vaporize cannabis among youth.
This study presents rates of vaporizing cannabis among a sample of high school students (N= 3847). Rates of vaporizing cannabis were high among lifetime e-cigarette users (18.0%), lifetime cannabis users (18.4%), and lifetime dual cannabis and e-cigarette users (26.5%).
Parental Supervision and Alcohol Abuse Among
Adolescent Girls
Minimal parent supervision and early pubertal maturation independently forecast alcohol misuse among adolescent girls. It is not known if pubertal timing amplifies risks associated with inadequate supervision during the formative years when youth arefirst exposed to alcohol.
Early maturing girls who enter secondary school with high levels of behavioral autonomy report a dramatic increase in alcohol abuse. The etiology of their problems with alcohol can be traced, in part, to heightened risks arising from low parent supervision.
Maternal Versus Infant Vitamin D Supplementation
During Lactation: A Randomized Controlled Trial
The vitamin D concentration in breast milk of women taking 400 IU vitamin D per day is relatively low, leading to vitamin D
deficiency in breastfeeding infants. As a result, the American Academy of Pediatrics recommends breastfeeding infant vitamin D supplementation within days after birth.
Maternal vitamin D supplementation alone with 6400 IU/day safely supplies breast milk with adequate vitamin D to satisfy the requirement of her nursing infant and offers an alternate strategy to direct infant supplementation.
Sources of Infant Pertussis Infection in the United
States
The source of infant pertussis infection is typically identified
∼50% of the time. Historically, mothers have been identified as the most common source of pertussis transmission to infants.
This analysis of 8 years of enhanced pertussis surveillance data has uncovered a shift in the most common source of infant pertussis infection in the United States from mothers to siblings.
Lung Function in Very Low Birth Weight Adults
Children born preterm at very low birth weight have reduced lung function. Reduced lung function may extend to adult life, but to what extent this outcome is attributable to broncho-pulmonary dysplasia and other prenatal and neonatal con-ditions is not known.
Young adults born preterm at very low birth weight had im-paired airflow. Thisfinding suggests an increased risk of later obstructive airways disease and was observed also among those with no bronchopulmonary dysplasia, regardless of other prenatal and neonatal complications.
Interpregnancy Interval and Risk of Autism
Spectrum Disorders
Both short and long interpregnancy intervals are associated with increased risk of autism in second-born children. However, it is not known if the association is explained by unfavorable birth outcomes of the previous siblings.
Both short and long interpregnancy intervals increase risk of autism in second-born children independently of previous siblings being born premature, having low birth weight, or being born by cesarean delivery and independently of maternal antidepressant use 3 months before pregnancy.
Tricycle Injuries Presenting to US Emergency
Departments, 2012
–
2013
Tricycle riding is a common activity in children. In calendar year 2012, tricycle accidents were the most common cause of reported toy-related deaths in children. Little research has been conducted regarding tricycle-related injuries and how to counsel parents appropriately.
This study uses nationally representative data to investigate various characteristics of tricycle-related injuries in children to better counsel parents. This study highlights the importance of helmet and elbow pad use and parental supervision.
Fruit Consumption by Youth in the United States
Although whole fruit intake has increased among US youth from 2003 to 2010, little is known about the specific types of fruits youth consume and whether consumption varies by age, poverty status, gender, and race or Hispanic origin.
Twelve discrete fruits and fruit juices contribute almost 90% of total fruit consumed by US youth. Consumption of specific fruits and 100% fruit juices was associated with age and race or Hispanic origin but not gender or poverty status.
Early Career Experiences of Pediatricians Pursuing
or Not Pursuing Fellowship Training
Choosing career paths can be a difficult decision for residents contemplating fellowship training. Limited resources are available to residents to help guide their choices.
This article provides additional descriptions and insight into actual lifestyle and workplace environments for pediatric residents who choose fellowship training compared with those who do not.
Reentry to Pediatric Residency After Global Health
Experiences
Although nonphysician reentry transitions have been charac-terized in the literature, little is known about the reentry of
residents after either short-term (1-month elective) or long-term (12-month training) global health experiences abroad.
Reverse culture shock may be a useful conceptual framework for understanding the range of emotions felt by pediatric residents when they reenter residency after global health experiences, particularly if these experiences were long term.
Dexamethasone Therapy for Septic Arthritis in
Children
Two prospective studies of children with septic arthritis have shown that the addition of dexamethasone to antibiotic therapy contributes to clinical and laboratory improvement. Never-theless, the mainstay of treatment remains antibiotics alone.
This study, which was conducted outside a randomized con-trolled trial, demonstrates that children with septic arthritis treated early with a short course of adjuvant dexamethasone show earlier improvement in clinical and laboratory param-eters than children treated with antibiotics alone.
Alcohol Interventions Among Underage Drinkers in
the ED: A Randomized Controlled Trial
Intervention strategies are needed to reduce underage drinking. Meta-analyses of youth alcohol brief interventions (BIs) conclude that therapist-delivered BIs are efficacious; however, to maximize public health impact, recommendations include using technology to streamline intervention delivery, for which evidence is lacking.
A single-session BI, delivered by a computer or therapist in the emergency department, shows promise for underage drinkers. Findings for the stand-alone computer BI are particularly appealing given the ease of future implementation.
Preterm Infant Attendance at Health Supervision
Visits
Premature infants are at risk for medical and neurodevelopmental sequelae. Close monitoring is an important role for primary care providers. Premature infants have high use of health care services; however, little is known about the role of health supervision visits.
This study explores the utilization and value of health super-vision visits for premature infants. Fewer than half were found to be fully adherent to the health supervision visit schedule, resulting in preventive care gaps and immunization delays.
Implementation of a Neonatal Abstinence Syndrome
Weaning Protocol: A Multicenter Cohort Study
Use of a standard treatment protocol with stringent weaning guidelines for infants with neonatal abstinence syndrome
supports improved outcomes including shorter duration of opioid exposure and length of hospital stay.
We demonstrate generalizability of a protocol-driven weaning strategy for improvement in hospital outcomes for neonatal abstinence syndrome. After adoption, adherent protocol-adopting centers improved outcomes and eliminated differ-ences in outcomes compared with centers with preexisting stringent weaning protocols.
Reasons for Rehospitalization in Children Who Had
Neonatal Abstinence Syndrome
Infants with neonatal abstinence syndrome are hospitalized for longer after birth and are more likely to be from highly vul-nerable families. Determining long-term outcomes is difficult because this is a large and chaotic population.
After neonatal abstinence syndrome, children are twice as likely to require hospitalization, to die in hospital, and be admitted for maltreatment, visual, mental, and behavioral problems. Strategies to reduce these risks will improve safety and outcomes of these vulnerable children.
Trends in Emergency Department Visits for
Unsupervised Pediatric Medication Exposures,
2004
–
2013
Unsupervised medication exposures increased during the previous decade, despite child-resistant packaging and care-giver education. To achieve the Healthy People 2020 objective of reducing emergency department visits for unintentional pe-diatric medication overdoses, targeted interventions including improved safety packaging may be needed.
Since 2010, emergency department visits for unsupervised medication exposures started to decrease. Most visits involved solid dose medications, typically for adult use. Most liquid medication exposure visits involved 4 over-the-counter pediatric products and may be more readily amenable for interventions.
Timing of the Diagnosis of Attention-De
fi
cit/
Hyperactivity Disorder and Autism Spectrum Disorder
Many studies have suggested that autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are commonly co-occuring neurodevelopmental conditions.
In children with co-occurring ASD and ADHD, an initial ADHD diagnosis may be associated with delayed ASD diagnosis and a higher likelihood of ASD diagnosis older than 6 years of age. Clinicians should consider ASD when evaluating young children presenting with ADHD symptoms.
Two-Year Outcomes of a Population-Based
Intervention for Preschool Language Delay: An RCT
Preschool language delay predicts poorer academic performance, employment opportunities, and social relationships. Language for Learning, a systematic, population-based intervention for 4-year-olds with low language, is feasible, acceptable and has short-term benefits, but long-term benefits are unknown.
Population ascertainment at age 4 followed by a yearlong, one-on-one home program benefited phonological skills (an im-portant literacy determinant) at age 6, but not the primary language outcomes. To be cost-effective, future follow-up would need to demonstrate lasting academic benefits.
Febrile Seizures After 2010
–
2011 Trivalent
Inactivated In
fl
uenza Vaccine
Previous studies found that 2010–2011 trivalent inactivated influenza vaccine (TIV) and 13-valent pneumococcal conjugate vaccine (PCV13) were associated with statistically significant increased risks of febrile seizures (FS) in the United States.
Estimated FS relative risks after TIV or PCV13 adjusted for DTaP were.1, although not statistically significant and lower than previous estimates. Same-day administration of TIV and PCV13 did not result in more FS compared with separate-day vaccination.
Weight Gain, Executive Functioning, and Eating
Behaviors Among Girls
Executive functioning and excess weight have been associated in both cross-sectional and prospective studies, but mecha-nisms explaining this relationship are unclear.
Impulsivity and planning at age 10 predicted age 10 to 16 BMI changes, and age 12 binge-eating tendencies mediated the relation between impulsivity at age 10 and changes in BMI change through age 16.
Survival of Children With Hypoplastic Left Heart
Syndrome
Hypoplastic left heart syndrome (HLHS) is a critical congenital heart defect with high mortality. With advances in surgical intervention in recent years, survival of infants with HLHS has improved, but information on long-term survival using population-based data is limited.
In this population-based study, survival to adolescence of children with HLHS has significantly improved in recent years. Among infant survivors,.90% survived up to 18 years. Gestational age, birth weight, and neighborhood poverty may affect survival.
ARTICLE SUMMARIES
–
OCTOBER 2015
P E D I AT R I C S
ÒS U M M A RY
Development of the Children With Disabilities Algorithm
There are no validated claims-based algorithms for identifying children with disabilities (CWD) to facilitate larger-scale studies of care quality for CWD.
This study develops the CWD algorithm, a claims-based algo-rithm for identifying diagnostic codes with a$75% chance of indicating CWD, and triangulates the algorithm against parent report and physician chart abstraction.
Intraurethral Lidocaine for Urethral Catheterization
in Children: A Randomized Controlled Trial
Urethral catheterization is a painful, yet common procedure to obtain a sterile urine sample in young children. There are conflicting results regarding the effectiveness of lidocaine to reduce pain, and it is unclear if it should be routinely used.
In young children, combined topical and intraurethral lidocaine does not reduce pain during urethral catheterization and is associated with more pain than nonanesthetic lubricant during instillation. Clinicians should use noninvasive methods of an-algesia during this painful procedure.
Disorders in Children With Congenital
Cytomegalovirus Infection
Congenital cytomegalovirus infection is the leading infectious cause of neurologic disabilities and sensorineural hearing loss in children. Little is known concerning the frequency and impact of vestibular disorders induced by cytomegalovirus infection.
This study reports on the largest cohort of vestibular as-sessment of children congenitally infected with cytomegalovi-rus, demonstrating vestibular damages, and analyzes the correlations between vestibular dysfunction and hearing im-pairment or severity of infection. Cytomegalovirus infection affects postural development in children.
A Model for Predicting Signi
fi
cant
Hyperbilirubinemia in Neonates From China
Guidelines for postdischarge monitoring of hyperbilirubinemia for neonates of white descent are available from the American Academy of Pediatrics; however, such information for healthy term and late preterm Chinese neonates is lacking.
A classification model for predicting the risk of significant hyperbilirubinemia in Chinese neonates was developed that combines a transcutaneous bilirubin–based nomogram with clinical risk factors. It classified newborns into 6 risk groups, which can guide clinicians in planning appropriate follow-up strategies.
Bladder Function After Fetal Surgery for
Myelomeningocele
Urologic outcomes of prenatal myelomeningocele closure have previously been reported. This study, however, represents a large, prospectively followed cohort of these patients and presents detailedfindings of urologic outcomes. To our knowledge, this is the largest study of this type.
Our study is the only trial to compare urologic outcomes in children with myelomeningocele having undergone prenatal closure with those who had postnatal repair in a prospective and systematic manner. We report ourfindings at 12 and 30 months.
Effects of Genotype and Sleep on Temperament
Sleep disturbances in infants associate with individual differences in temperament. However, little is known about interindividual differences and potential moderating factors, such as genotype.
The results suggest that the cumulative effect of total sleep duration during thefirst 3 years of life on temperament is moderated by child 5-HTTLPR genotype following a differential susceptibility model.
Chronic Neuromotor Disability After Complex
Cardiac Surgery in Early Life
Neurodevelopmental outcomes after cardiac surgery in early life provide critical information for understanding and im-proving care. Studies show these children are at risk for ar-terial ischemic stroke and acquired brain injury; further characterization of motor impairment is needed.
This study focuses on the presence of chronic neuromotor disabilities including cerebral palsy and motor impairments after acquired brain injury in children surviving early complex cardiac surgery, providing information on the frequency, characteristics, and predictors that may assist in prevention.
See the table of contents of this issue to learn more about these articles.
DOI: 10.1542/peds.digest1364
2015;136;D1
Pediatrics
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2015;136;D1
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