Pediatrics Digest

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Drinking Frequency as a Brief Screen for

Adolescent Alcohol Problems

The American Academy of Pediatrics recommends routine al-cohol screening for all adolescents. Problem-based substance use screens for adolescents exist, but have limitations. A consumption-based alcohol screen could provide an empiri-cally validated, very brief method to screen youth for alcohol-related problems.

National sample data indicate that frequency of alcohol use has high sensitivity and specificity in identifying youth with alcohol-related problems. A range of age-specific frequency cut scores perform well; specific cut points can be selected based on the screening context.

Hepatitis A Vaccination Coverage Among

Adolescents in the United States

Hepatitis A infection causes severe disease among adolescents and adults. Hepatitis A vaccination (HepA) is recommended universally at 1 year, with vaccination through 18 years based on risk or desire for protection.

This is theﬁrst study to evaluate adolescent HepA coverage in the United States using provider-reported vaccination data. HepA coverage was low among adolescents, leaving a large population susceptible to hepatitis A infection maturing into adulthood.

Cardiac Screening Prior to Stimulant Treatment of

ADHD: A Survey of US-Based Pediatricians

Over the past decade, drug oversight committees and pro-fessional organizations have debated the evidence regarding

cardiac screening to identify undiagnosed disorders associated with sudden cardiac death in youth with attention-deﬁ cit/hy-peractivity disorder before beginning treatment with stimulants.

How practicing pediatricians have responded to this contro-versy is not known. We present results from a national sample of pediatricians regarding current attitudes, barriers, and practices for cardiac screening in youth with attention-deﬁcit/ hyperactivity disorder before prescribing stimulants.

Public Attitudes Regarding the Use of Residual

Newborn Screening Specimens for Research

The retention and use of residual bloodspots is a practice of many state newborn screening programs. This practice has become controversial, and little is known about public attitudes on the retention and research use of newborn residual bloodspots.

This study offers a detailed analysis of public attitudes re-garding bloodspot retention and use for biomedical research. The results also offer insights on how education regarding this practice inﬂuences support for newborn screening and re-sidual bloodspot use.

Citizens

’

Values Regarding Research With Stored

Samples From Newborn Screening in Canada

Newborn screening (NBS) programs may store bloodspot samples and use them for secondary purposes, such as re-search. Recent public controversies and lawsuits over storage and secondary uses underscore the need to engage the public on these issues.

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After Vaccination in Children and Adolescents

Studies on vaccine safety are crucial to the ongoing success of our national immunization program. ITP has a known associ-ation with MMR in young children, occurring in 1 in 40 000 doses. The risk after other childhood vaccines is unknown.

This study found no increased risk of ITP after vaccines other than MMR in young children, conﬁrmed an association of ITP with MMR, and also found that ITP may occur after certain other vaccines in older children.

A National Pro

ﬁ

le of Childhood Epilepsy and Seizure

Disorder

Epilepsy/seizure disorder is known to be associated with a range of mental health and neurodevelopmental comorbid-ities, based on clinical studies, and on population studies largely conducted outside the United States.

In a nationally representative sample of US children, estimated prevalence of reported lifetime epilepsy/seizure disorder was 1%, and of current epilepsy/seizure disorder was 6.3/1000. Developmental, mental health, and physical comorbidities are common, warranting enhanced surveillance, and an integrated service approach.

Societal Values and Policies May Curtail Preschool

Children

’

s Physical Activity in Child Care Centers

Three-fourths of US preschool-age children are in child care; many are not achieving recommended levels of physical activity. Daily physical activity is essential for motor and socioemotional development and for the prevention of obesity. Little is known about physical-activity barriers in child care.

Injury and school-readiness concerns may inhibit children’s physical activity in child care. Fixed playground equipment that meets licensing codes is unchallenging and uninteresting to children. Centers may cut time and space for gross motor play to address concerns about school readiness.

Trends in US Pediatric Drowning Hospitalizations,

1993

–

2008

In the United States, drowning is the second leading cause of unintentional injury death among children (1–19), accounting for.1000 deaths per year. Total lifetime costs in 2000 were estimated to be $2.6 billion for children aged 0 to 14.

Assault

Although follow-up examinations are recommended for sus-pected victims of sexual abuse or assault, little is known about the potential beneﬁts of a second examination with regard to diagnosing trauma or sexually transmitted infections.

In∼23% of pediatric patients evaluated for sexual abuse or assault, a second examination by a specialist changed the interpretation of trauma likelihood or results in the detection of a sexually transmitted infection.

Carpooling and Booster Seats: A National Survey of

Parents

Booster seat use improves seat belt ﬁt and reduces risk of injury for children,57 in tall. Booster seat use decreases between ages 4 and 8 years. Children observed riding with other children frequently do not use booster seats.

In this national survey of parents, we found that a majority of parents of 4- to 8-year-old children carpool, and when they carpool booster seat use is inconsistent. Social norms and self-efﬁcacy appear to inﬂuence booster seat use when carpooling.

Oral Sucrose and

“

Facilitated Tucking

”

for

Repeated Pain Relief in Preterms: A Randomized

Controlled Trial

Preterm infants are exposed to inadequately managed painful procedures during their NICU stay, which can lead to altered pain responses. Nonpharmacologic approaches are estab-lished for the treatment of single painful procedures, but ev-idence for their effectiveness across time is lacking.

Oral sucrose with or without the added technique of facilitated tucking has a pain-relieving effect even in extremely premature infants undergoing repeated pain exposures; facilitated tucking alone seems to be less effective for repeated pain exposures over time.

Prospective Study of Sunburn and Sun Behavior

Patterns During Adolescence

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To date, most studies in this age group have been cross sectional in nature. This is theﬁrst prospective study of sunburn and sun behaviors in this age group.

Predictors of Cognitive Function and Recovery 10

Years After Traumatic Brain Injury in Young

Children

Previous research has demonstrated that young children with traumatic brain injury are at elevated risk of poor outcomes, particularly following severe injuries. These deﬁcits persist until at least 5 years postinsult. Factors predicting outcomes in this age group have not been established.

This study follows survivors of very early traumatic brain injury into adolescence. Results indicate that severe injury is asso-ciated with poorest outcome, but after 3 years, the gap between children with severe traumatic brain injury and peers sta-bilizes.

Intellectual, Behavioral, and Social Outcomes of

Accidental Traumatic Brain Injury in Early

Childhood

Traumatic brain injury in school-aged children is associated with intellectual, behavioral, and social deﬁcits. Research into outcomes of children injured before 3 years of age is limited despite data suggesting a high incidence of injury in this age group.

Results show that a moderate to severe traumatic brain injury before 3 years of age is associated with lowered cognitive function. Furthermore, this study highlights the link between social disadvantage and poor outcomes after traumatic brain injury in early childhood.

Randomized Trial of Oral Versus Sequential IV/Oral

Antibiotic for Acute Pyelonephritis in Children

The standard initial management for infants and children with acute pyelonephritis is intravenous antibiotic treatment.

Our results support the use of an oral ceﬁxime treatment of initial episodes of acute pyelonephritis involving a gram-negative bacteria strain in children aged 1 month to 3 years who are without urological abnormalities and without clinical hemodynamic impairment.

Prevalence, Patterns, and Persistence of Sleep

Problems in the First 3 Years of Life

Sleep problems are common during childhood, but screening for sleep problems in the clinic setting is often cursory. Moreover, there are few longitudinal studies examining the

prevalence and persistence of sleep problems in young chil-dren.

Patterns of sleep problems vary across early development, but sleep problems arising in infancy persist in 21% of children through 36 months of age. Parent response to a nonspeciﬁc query about sleep problems may overlook relevant sleep symptoms and behaviors.

RCT of Montelukast as Prophylaxis for Upper

Respiratory Tract Infections in Children

Upper respiratory tract infections (URIs) are very common in children. Currently, there are no effective preventive measures for URI. There are no studies on the effect of montelukast for prevention of URI.

In a randomized, double-blind, placebo-controlled study of preschool-aged children, 12-week prophylactic treatment with montelukast did not reduce the incidence of URI.

Late Intravenous Immunoglobulin Treatment in

Patients With Kawasaki Disease

The effectiveness of intravenous immunoglobulin treatment of patients with Kawasaki disease within 9 days of illness has been established. However, the effectiveness of such treatment$10 days after illness onset has not yet been clariﬁed.

Intravenous immunoglobulin treatment$10 days after illness onset was observed to be effective for achieving inﬂammation resolution. Patients who are strongly suspected to have Kawasaki disease and demonstrate ongoing inﬂammation should therefore be treated as soon as possible.

Incidence and Timing of Presentation of Necrotizing

Enterocolitis in Preterm Infants

Necrotizing enterocolitis (NEC) can present within theﬁrst week of life in term infants. In preterm infants, NEC usually appears after commencement of feeds and can occur between 2 and 3 weeks of life.

Among infants,33 weeks’gestation, NEC appears to occur at mean age of 7 days in more mature infants, whereas onset of NEC is delayed to 32 days of age in smaller, lower gestational age infants.

Co-occurring Conditions and Change in Diagnosis

in Autism Spectrum Disorders

Mixed prevalence rates of co-occurring psychiatric and neu-rodevelopmental conditions have been reported in children diagnosed with an autism spectrum disorder (ASD). ASD di-agnoses remain fairly stable within a continuum, but some do

ARTICLE SUMMARIES

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Selected Birth Defects

Asthma is a common obstructive pulmonary disease experi-enced during pregnancy. Clinical guidelines recommend women with asthma maintain asthma medication use during pregnancy. Epidemiologic studies suggest an association be-tween several types of defects and asthma or asthma medi-cation use during pregnancy.

Data from a large, population-based, multicenter, case-control study was used. This provides the opportunity to study speciﬁc birth defects with minimal heterogeneity in case groups, as well as control for a variety of potential confounders.

Multicenter Analysis of Quality Indicators for

Children Treated in the Emergency Department for

Asthma

Studies of the association between process and outcome measures of the quality of acute asthma care for children have been mixed. These studies are limited by small, single-institution settings or by examining the association at the aggregate level.

Thisﬁrst multicenter analysis of the process-outcome associa-tion in acute asthma care for children revealed no associaassocia-tion. Because the validity of process measures depends on associ-ation with outcomes, further study is needed before imple-menting existing process measures as performance metrics.

Nasal Continuous Positive Airway Pressure With

Heliox in Preterm Infants With Respiratory Distress

Syndrome

Nasal continuous positive airway pressure (NCPAP) is a non-invasive ventilatory support that may reduce the need for mechanical ventilation in preterm infants with respiratory distress syndrome. Heliox, a helium-oxygen mixture, has shown positive effects, especially in obstructive diseases.

NCPAP with heliox reduces the need for mechanical ventilation in preterm infants with respiratory distress syndrome in comparison with NCPAP with medical air.

A Decision-Tree Approach to Cost Comparison of

Newborn Screening Strategies for Cystic Fibrosis

Although it has been shown that cysticﬁbrosis newborn screening is beneﬁcial, the strategies vary widely, and there has

noreactive trypsinogen/DNA, by using a decision-tree framework allowing variation in the model parameters.

Comparison of the US and Australian Cystic

Fibrosis Registries: The Impact of Newborn

Screening

Registries have been established in a number of countries to monitor the health of patients with cysticﬁbrosis. Few in-ternational comparisons have been made between registries. International data registry comparisons may be useful for informing best practice and benchmarking.

Registry comparisons are feasible but are limited by factors such as nonstandardization of data collection. Lung function was lower in Australian children with cysticﬁbrosis compared with their US counterparts after adjusting for the beneﬁts of diagnosis after newborn screening.

Urinary Proteome Analysis to Exclude Severe

Vesicoureteral Re

ﬂ

ux

High-grade vesicoureteral reﬂux is a risk factor for impaired renal function. Diagnosis by voiding cystourethrography is invasive and highly uncomfortable. As only a minority of children show high-grade vesicoureteral reﬂux, this exposes the majority to unnecessary distress.

This case-control study proved that high-grade vesicoureteral reflux is identifiable with high sensitivity using urinary pro-teome analysis, based on capillary electrophoresis coupled to mass spectrometry in a cohort suspected of having ves-icoureteral reflux, thus sparing the majority of children from invasive diagnostics.

Bronchoscopic Findings in Children With Chronic

Wet Cough

Chronic wet cough is a common symptom well recognized by pediatricians. Protracted bacterial bronchitis is deﬁned as more than 4 weeks of wet cough that responds to antibiotic treatment. Diagnosis of protracted bacterial bronchitis is not readily accepted by pediatricians

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chronic wet cough frequently have a bacterial infection of the lower airway.

Association of Center Volume With Mortality and

Complications in Pediatric Heart Surgery

Previous analyses have suggested that center volume is as-sociated with outcome in children undergoing heart surgery. There are limited data regarding factors that may mediate this volume–outcome relationship.

A multicenter analysis of 35 776 children revealed that the higher mortality observed at lower volume centers may be related to a higher rate of mortality in those with post-operative complications, rather than a higher rate of compli-cations alone.

Social-Emotional Screening for Infants and

Toddlers in Primary Care

Recommendations in pediatrics call for general developmental screening of young children; however, research suggests social-emotional development, in particular, is important as an initial indicator of general well-being versus risk, and may warrant inclusion in screening protocols.

Via a social-emotional screening program, signiﬁcant per-centages of children can be identiﬁed as being at risk for social-emotional problems, and colocation of an early childhood psychologist promotes the ability to effectively address young children’s social-emotional development within their medical home.

Perioperative Methylprednisolone and Outcome in

Neonates Undergoing Heart Surgery

Recent studies have called into question the beneﬁt of peri-operative corticosteroids in children undergoing heart surgery, but have been limited by small sample size, the lack of placebo control, and the grouping of various steroid regimens together in analysis.

We evaluated outcomes across methylprednisolone regimens versus no steroids in a large cohort of neonates and found no mortality or length-of-stay beneﬁt associated with any regimen, and a higher risk of infection in certain subgroups.

Lead Poisoning in United States-Bound Refugee

Children: Thailand-Burma Border, 2009

Refugee children arriving in the United States have had higher rates of elevated blood lead levels than US-born children. The Centers for Disease Control and Prevention recommends blood lead screening of all refugee children within 3 months after their arrival in the United States.

This is theﬁrst investigation we are aware of to examine and identify risk factors for lead poisoning among US-bound ref-ugee children living in camps overseas, before their arrival in the United States.

Fetal and Maternal Candidate Single Nucleotide

Polymorphism Associations With Cerebral Palsy: A

Case-Control Study

Candidate genes involved in thrombophilia, inﬂammation, and preterm birth have previously been associated with cerebral palsy. Most studies to date have included small cohorts, did not allow for multiple testing, and require replication.

This study of children with cerebral palsy and their mothers did not conﬁrm previously reported candidate gene associations. Prothrombin gene mutation was associated with hemiplegia in children born at term to mothers with a reported infection during pregnancy.

Pertussis Pseudo-outbreak Linked to Specimens

Contaminated by

_{Bordetella pertussis}

DNA From

Clinic Surfaces

Pertussis is a poorly controlled vaccine-preventable disease. Verifying outbreaks is challenging owing to nonspeciﬁc clinical presentations and imperfect diagnostic tests. Exclusive reliance on highly sensitive polymerase chain reaction has been as-sociated with pseudo-outbreaks.

Contamination of specimens with vaccine derived_Bordetella pertussisDNA from pediatric clinic surfaces likely resulted in misdiagnoses. Standard practices, liquid transport medium, and lack of polymerase chain reaction cutoffs for discerning weakly positive (contaminant) DNA are contributory, but modiﬁable factors.

Genetic Causes of Macroglossia: Diagnostic

Approach

Macroglossia is a clinical feature of several disorders and a common reason for additional diagnostic investigations during infancy. Limited research has been done on the eval-uation of macroglossia when other features are not suggestive of Beckwith-Wiedemann syndrome.

All patients with apparently isolated macroglossia should have at least initial evaluation with abdominal ultrasounds and molecular studies for Beckwith-Wiedemann syndrome before aﬁnal diagnosis is given. Other common diagnoses included isolated macroglossia, chromosomal abnormalities, hypothy-roidism, and mucopolysaccharidoses.

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The McLaren and Moore methods present with several limi-tations when calculating EBW for adolescents with eating disorders. A commonly agreed upon method for EBW calcu-lation such as the BMI percentile method is recommended for clinical and research purposes.

Intrapartum Temperature Elevation, Epidural Use,

and Adverse Outcome in Term Infants

Previous observational studies and randomized trials have reported an association between the use of epidural analgesia for pain relief in labor and intrapartum maternal fever. Studies

ated with adverse neonatal outcomes.

Genetic and Environmental Components of

Neonatal Weight Gain in Preterm Infants

Several studies have focused on birth weight heritability, reporting results that range between 40% and 80%. Few studies have focused on the process of weight gain and were mainly based on heterogeneous samples of infants.

The present work looks at a uniform set of healthy preterm newborn twins. The resulting high heritability estimate could suggest using the inclusion criteria to identify genes that regulate postnatal weight gain or failure.

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DOI: 10.1542/peds.digest1292

2012;129;D1

Pediatrics

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