Pediatrics Digest

Child Abuse and Neglect and Cognitive Function at 14 Years of Age: Findings From a Birth Cohort

Child abuse and neglect are associated with a range of adverse outcomes including reduced academic performance.

Both abuse and neglect are Independently associated with reduced cognitive performance at 14 years of age. We used prospective follow-up of a birth cohort, independent recording of child-maltreatment reports and substantiation, and adjustment for multiple potential confounders.

Translation of a Pediatric Asthma-Management Program Into a Community in Connecticut

Despite the initial release of the National Asthma Education and Prevention Program asthma guidelines in 1991, primary care clinicians do not adhere to the guidelines and continue to underdiagnose and undertreat asthma in children.

An asthma-management program was transferred to 5 communities in Connecticut and resulted in reduced medical services utilization. The study’s results demonstrate that pediatricians can use guidelines, and, when used, guidelines are effective in reducing medical services utilization for Medicaid-insured children.

Geographic Maldistribution of Primary Care for Children

Concerns about the sufficiency of the primary care workforce have led to efforts to train more primary care physicians. Inequitable distribution of the physician workforce, a long-standing problem, has received less attention, particularly with respect to children.

Despite pronounced growth of the primary care workforce for children, millions of children live in areas with insufficient local supplies of primary care physicians. More-effective policies targeting adequate geographic access to primary care are needed.

National Trends in Visit Rates and Antibiotic Prescribing for Children With Acute Sinusitis

Streptococcus pneumoniaeis a common cause of acute sinusitis and otitis media, and American Academy of Pediatrics guidelines recommend amoxicillin as the first-line antibiotic therapy. Amoxicillin use for otitis media increased after guideline publication, and visits decreased after vaccine introduction.

Office and emergency department visits for acute sinusitis remained stable after vaccine introduction, whereas

amoxicillin use increased substantially, in accordance with the guidelines. Despite the increase in amoxicillin use,

prescriptions for broad-spectrum agents, especially

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digest

visits, drug prescriptions, and parents’ missed work days.

A simple prediction rule can identify infants at risk of outpatient-treated RSV LRTI. The absolute risks of RSV LRTI range from 3% for children with the lowest prediction rule score to 32% for children with all predictive factors.

Enhanced Monitoring Improves Pediatric Transport Outcomes: A Randomized Controlled Trial

There has been a limited amount of research in the pediatric interfacility-transport environment.

This study is the first randomized controlled trial in the out-of-hospital pediatric transport environment.

Criminal-Justice and School Sanctions Against Nonheterosexual Youth: A National Longitudinal Study

Nonheterosexual youth are vulnerable to a variety of health risks. In addition, anecdotal reports have suggested that they may be overrepresented among adolescents who have received a variety of institutional sanctions.

This is the first study to use a nationally representative, population-based sample to document that nonheterosexual youth, particularly girls, have greater odds than their peers of experiencing school and criminal-justice sanctions.

The Tiniest Babies: A Registry of Survivors With Birth Weight Less Than 400 Grams

There have been isolated reports of single infants surviving after birth at⬍400 g. However, these reports have not been compiled and summarized, and little is known about the early health and development of these infants.

We have created a Web-based registry of survivors who weighed⬍400 g at birth. The Tiniest Babies Registry now contains data on 110 infants. This report summarizes the information submitted to the registry about this extraordinary group of infants.

extraordinarily preterm infants who are born at⬍25 weeks’ estimated gestational age.

Despite a dramatic reduction in postnatal steroid exposure, neurosensory and cognitive outcomes at 18 to 22 months’ corrected age remain guarded and unchanged for infants who are born at⬍25 weeks’ estimated gestational age in the NICHD Neonatal Research Network between 2 recent birth epochs.

Effects of Serving High-Sugar Cereals on Children’s Breakfast-Eating Behavior

There are positive health benefits for children who consume ready-to-eat cereals for breakfast; however, cereal companies market their high-sugar products extensively to children, which causes concern that eating these products contributes to unhealthy levels of added sugar in children’s diets.

Results demonstrate the potential negative effects of serving high-sugar cereal to children and how it affects their consumption of cereal, added sugar, and fruit during

breakfast. In addition, they demonstrate that children like and will eat low-sugar cereals as an alternative.

Adherence to the HPV Vaccine Dosing Intervals and Factors Associated With Completion of 3 Doses

Vaccination to prevent human papillomavirus infection is safe and effective. Rates of receiving all 3 doses after initiating vaccination range from 42% to 60%, according to early reports from managed health care organizations and the Centers for Disease Control and Prevention.

Tobacco-Smoke Exposure in Children Who Live in Multiunit Housing

Exposure to secondhand tobacco smoke is an important cause of morbidity and mortality among children, even at low levels of exposure. In a recent national sample, 54% of children who did not live with a smoker showed measurable amounts of cotinine.

Children who live in homes in which no one smokes inside have a 45% increase in cotinine levels if they live in apartments compared with detached homes. Multiunit housing may be a significant source of secondhand tobacco-smoke exposure for children, at levels associated with morbidity.

Effects of HEPA Air Cleaners on Unscheduled Asthma Visits and Asthma Symptoms for Children Exposed to Secondhand Tobacco Smoke

Exposure to secondhand smoke (SHS) is associated with asthma exacerbations in children. Anticipatory guidance has failed to reduce SHS in controlled trials. It is not known whether high-efficiency, particle-arresting (HEPA) air cleaners can reduce SHS or improve asthma symptoms in children.

HEPA air cleaners led to reductions in unscheduled asthma visits and fine airborne particle levels but not asthma symptoms or cotinine levels. HEPA air cleaners may be useful as part of a multifaceted strategy to reduce asthma morbidity among children.

Smoke-Free Air Laws and Asthma Prevalence, Symptoms, and Severity Among Nonsmoking Youth

Smoke-free laws reduce exposure to secondhand smoke, as measured by cotinine, in both adults and children. In adults, smoke-free laws have been associated with reductions in health outcomes such as respiratory symptoms and acute myocardial infarctions, as well.

This study examined the association between smoke-free laws and health in children and adolescents. Health outcomes that have been associated with exposure to secondhand smoke in children include prevalence of asthma, asthmatic symptoms, asthma severity, and ear infection.

Differential Growth Patterns Among Healthy Infants Fed Protein Hydrolysate or Cow-Milk Formulas

The different classes of formulas, and different brands within each class, vary in composition and flavor profiles, both of which may influence feeding and growth patterns. Because recent evidence suggests that, relative to intact proteins, hydrolyzed proteins are absorbed and metabolized in a way that promotes greater satiation, we conducted a randomized study on healthy, formula-fed infants to determine whether growth patterns and feeding behaviors differ on the basis of formula type.

Not all formulas are alike. On the basis of World Health Organization standards,z-score trajectories indicate that cow-milk formula-fed infants’ weight gain was accelerated, whereas protein-hydrolysate formula-fed infants’ weight gain was normative.

Incidence of Neonatal Herpes Simplex Virus Infections in the United States, 2006

Neonatal herpes simplex virus infections, although relatively rare, cause significant morbidity and mortality. Incidence estimates for neonatal herpes simplex virus from studies conducted throughout the United States since the early 1980s have ranged from 4.0 to 76.2 per 100 000 live births.

This report describes neonatal herpes simplex virus incidence rates specific to regions and demographic groups across the United States and provides important new information on the extent of this potentially devastating disease.

Diarrhea-Associated Hospitalizations Among US Children Over 2 Rotavirus Seasons After Vaccine Introduction

Before 2006, rotavirus was a significant cause of morbidity among US children⬍5 years of age. After the introduction of rotavirus vaccine, many studies documented decreases in the burden of severe diarrhea among US children during the 2007–2008 rotavirus season.

The reductions in diarrhea-associated hospitalizations observed among US children in 2007–2008 were sustained in 2008 –2009. The consistency of the reductions over 2 rotavirus seasons indicates that these changes likely are attributable to the new rotavirus vaccination program.

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of human and animal pediatric defibrillation suggest that 2 J/kg is ineffective.

Two J/kg as the initial shock dose for in-hospital VF/pVT arrest was substantially less effective than previously reported. Four J/kg was not associated with increased termination of VF/pVT or improved survival rates. The optimal pediatric defibrillation dose remains unknown.

Longitudinal Study of Physical Activity and Sedentary Behavior in Children

Levels of physical activity during childhood are expected to be quite stable with age. Physical activity is believed to decline markedly at adolescence, particularly for girls.

Physical activity declines before adolescence in both boys and girls. Strategies to prevent the decline in physical activity should be considered and started for both sexes before adolescence.

Comparing the Tuberculin Skin Test and T-SPOT.TBBlood Test in Children

Interferon-␥–release assays are blood tests that offer more specificity for tuberculosis than the tuberculin skin test. The performance of this test in children still is being studied.

This study adds more information on the utility of

interferon-␥–release assays for children with tuberculosis disease and children in varying risk categories for latent tuberculosis infection.

Prevalence of Noise-Induced Hearing-Threshold Shifts and Hearing Loss Among US Youths

Voluntary exposure to loud noise may cause hearing loss and increase the prevalence of hearing impairment among adolescents. However, cross-sectional surveys of military conscripts and young adults entering the work force have revealed no differences in auditory thresholds between cohorts.

Use of Skeletal Surveys to Evaluate for Physical Abuse: Analysis of 703 Consecutive Skeletal Surveys

The skeletal survey (SS) is part of the evaluation of suspected physical abuse. Previous studies focused on the use of the SS for children whom the diagnosis of abuse was strongly suspected before completion of the SSs.

This is the first study to describe the use of SSs in a large, consecutive population of children being evaluated because of concerns regarding physical abuse.

Variation in Diagnosis of Apnea in Moderately Preterm Infants Predicts Length of Stay

Apnea of prematurity is expected to be uncommon in

moderately preterm infants. Variation in its diagnosis because of different monitoring or documentation practices may affect length of stay in moderately preterm infants.

Using hospital-specific criteria for its diagnosis, we demonstrated significant intrahospital variability in the proportion of moderately premature infants diagnosed with apnea. The proportion of infants diagnosed with apnea had a substantial impact on site variability in length of stay.

Serum Dioxins and Polychlorinated Biphenyls Are Associated With Growth Among Russian Boys

The disruption of childhood growth has been linked with deleterious effects on health in both childhood and adulthood. There is limited evidence from epidemiological studies that prenatal and postnatal exposure to dioxins and

polychlorinated biphenyls affects childhood growth.

In this study serum dioxins and polychlorinated biphenyls were measured in a cohort of Russian boys, who then underwent follow-up examinations for 3 years. The results showed that higher levels of serum dioxins and

Earliest Appropriate Time for Administering Neurobehavioral Assessment in Newborn Infants

The recommended time for assessing infant neurobehavior varies. For early-newborn examinations in hospitals, current practice requires that the infant be examined within⬃48 hours. It is not known how the amount of time since delivery may affect the results.

We recommend 20 hours after delivery as the earliest appropriate time for assessing newborn neurobehavior, because it allows accurate assessment of newborn

neurobehavior that is less contaminated by the acute effects of delivery.

Multicenter Crossover Study of Automated Inspired Oxygen for Mechanically Ventilated Preterm Infants

Many extremely preterm infants spend considerable time outside the intended arterial oxygen saturation range because of their respiratory instability and often insufficient or excessive oxygen supplementation, which increases the risk of complications associated with hypoxemia and hyperoxemia.

The results show that, under routine conditions, automatic adjustment of the fraction of inspired oxygen improves maintenance of pulse oxygen saturation (SpO₂) within an intended range, primarily by avoiding high SpO₂levels, and reduces oxygen concentration and staff workload.

Integrative Pediatric Care: Parents’ Attitudes Toward Communication of Physicians and CAM Practitioners

The use of complementary and alternative medicine (CAM) among children is prevalent in different countries. There have been limited data on parents’ perspectives toward pediatric CAM use and its meaning in terms of parent-doctor and doctor–CAM-practitioner communication.

The study revealed that parents referred to conventional and CAM clinics expressed distinctive attitudes toward CAM integration in pediatric care and perceived physician–CAM-practitioner communication as highly important in promoting their children’s health and safety.

Association of Smoking Onset With R-Rated Movie Restrictions and Adolescent Sensation Seeking

Evidence has shown that sensation seeking is positively related and parental restrictions on R-rated movies are

The current study revealed that, beyond direct influences, the relationship between adolescents’ sensation seeking and parental R-rated movie restrictions in explaining smoking onset is bidirectional in nature.

Intercenter Differences in Bronchopulmonary Dysplasia or Death Among Very Low Birth Weight Infants

Bronchopulmonary dysplasia is a major cause of morbidity in premature infants. Outcomes of most neonatal disorders, including bronchopulmonary dysplasia, vary in incidence across neonatal centers even after adjustment for demographic and antenatal characteristics. The factors responsible for such variation have not been systematically evaluated.

Bronchopulmonary dysplasia/death rates were found to demonstrate a moderate clustering effect according to center, as did clinical variables associated with the outcome.

Persistent center differences after clustered variables were corrected indicated the presence of as-yet unmeasured center variables.

Tuberous Sclerosis Complex: Diagnostic Challenges, Presenting Symptoms, and Commonly Missed Signs

Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disorder that is clinically diagnosed. Diagnosis of TSC may be difficult because no single symptom is present in all patients, and none are absolutely

pathognomonic.

Presenting symptoms and signs of TSC according to age group, missed symptoms, and signs that did not lead to diagnosis are described. Early diagnosis may reduce morbidity and mortality in patients with TSC.

Prospective Validation of a Novel Strategy for Assessing Risk of Significant Hyperbilirubinemia

Different risk assessment strategies have been developed to determine which infants are at greater risk for developing significant hyperbilirubinemia. Further refinement of such strategies is needed to provide safe, cost-effective treatment and follow-up care for these patients.

The present study has validated prospectively a novel strategy for significant hyperbilirubinemia risk assessment, which combines predischarge bilirubin percentile and gestational

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alanine transaminase/aspartate transaminase to muscle alone.

With this mathematical-modeling tool clinicians are provided with a practical method to assist in interpretation of high serum transaminase levels in patients with dystrophinopathy.

Breastfeeding Duration and Academic Achievement at 10 Years

It is not clear whether the benefits of breastfeeding on cognitive development reflect nutritional or socioeconomic advantages associated with breastfeeding. Some studies have revealed no differences after adjusting for socioeconomic status, and maternal verbal ability, whereas others have shown the benefits.

Predominant breastfeeding forⱖ6 months was positively associated with numeracy and literacy achievement independent of maternal and demographic factors and cognitive stimulation at home. However, the effectiveness of breastfeeding differed according to gender; benefits were only evident for boys.

Economic Evaluation of Caffeine for Apnea of Prematurity

The Caffeine for Apnea of Prematurity Trial demonstrated that caffeine-treated infants had improved survival rates without neurodevelopmental impairment at 18 to 21 months’

corrected age compared with those in the placebo group. The cost implications of this therapy have not been explored.

Caffeine is a cost-saving therapy compared with placebo, despite the various underlying assumptions regarding unit prices for medical services and caffeine in sensitivity

analyses. This effect is, in large part, attributed to the reduced number of days on positive-pressure ventilation.

Pandemic H1N1 in Children Requiring Intensive Care in Australia and New Zealand During Winter 2009

Pandemic influenza A H1N1-09 had a major and unexpected impact on critical care worldwide. The Australia and New Zealand influenza investigators previously reported the effect of H1N1-09 on critical care in this region.

Predictors of Participant Dropout at Various Stages of a Pediatric Lifestyle Program

It has been shown that children who drop out of a weight-management program are more likely to be older, to have an ethnic minority status, to self-report more depressive symptoms, and to have lower self-concept scores.

The results of this study indicate that the predictors of dropping out of treatment are different at various stages. Some characteristics seem to require attention at an earlier stage in the treatment to reduce dropout rates.

Excess Weight Loss in First-Born Breastfed Newborns Relates to Maternal Intrapartum Fluid Balance

Excess weight loss is relatively common in term breastfed infants, occurring in up to 16% of first-born infants in previous studies. Delayed onset of lactogenesis and suboptimal infant breastfeeding behavior were associated with excess weight loss in multivariate analyses.

This study describes an independent association between excess weight loss among breastfed infants and maternal intrapartum fluid balance. The prevalence of excess weight loss—19% of exclusively breastfed, demographically diverse, first-born, term infants—was higher than previously reported.

Cord-Blood 25-Hydroxyvitamin D Levels and Risk of Respiratory Infection, Wheezing, and Asthma

Recent study results have suggested that higher maternal intake of vitamin D during pregnancy may lower the risk of wheezing in offspring. The relationship between cord-blood levels of 25-hydroxyvitamin D and risk of childhood respiratory outcomes is unknown.

Contrasting Parents’ and Pediatricians’ Perspectives on Shared Decision-Making in ADHD

Shared decision-making (SDM) is recommended when multiple evidence-based treatments exist and families value options differently. Although national guidelines prioritize SDM in attention-deficit/hyperactivity disorder, little is known regarding how parents and clinicians understand and implement SDM in practice.

We found that practical barriers limit the consideration of evidence-based options in SDM, key participants often are excluded from the process, and, although parents and clinicians view SDM favorably, they understand SDM differently. Implications for clinical practice are discussed.

Testosterone Levels in Umbilical-Cord Blood and Risk of Pyloric Stenosis

Infantile hypertrophic pyloric stenosis is⬃5 times more common in male infants. The male hormone testosterone is known to induce muscle hypertrophy, and the testosterone levels are several-fold higher in male infants than female infants.

This study is the first of its kind, and the results add new insight to the etiology of pyloric stenosis. No evidence was found to support the hypothesis that high testosterone levels at birth are associated with an increased risk of pyloric stenosis.

Intrauterine Effects of Maternal Prepregnancy

Overweight on Child Cognition and Behavior in 2 Cohorts

Maternal prepregnancy overweight may be associated with child behavioral problems, such as inattention-hyperactivity, and lower intellectual function in offspring. However, few studies have explored this issue, and it is unclear whether associations, if replicated, reflect biological intrauterine mechanisms.

In this study, maternal prepregnancy overweight was not consistently associated with child behavioral problems or measures of cognitive abilities. We found no strong evidence of biological intrauterine mechanisms for these associations.

Adverse Events After the Use of Benznidazole in Infants and Children With Chagas Disease

Treatment of Chagas disease with benznidazole in adults leads to a high incidence of severe drug reactions. However, benznidazole seems to lead to less frequent and less severe adverse drug reactions (ADRs) in children, but there are scarce data on this subject.

A cohort of children with Chagas disease treated with benznidazole is described. A lower incidence of ADRs was observed in smaller children and adults. All ADRs observed were mild, and treatment response was excellent.

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