Pediatrics Digest

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Hypertension Screening During Ambulatory

Pediatric Visits in the United States, 2000

–

2009

The American Academy of Pediatrics and National Heart, Lung, and Blood Institute recommend routine blood pressure mea-surement in children. Little is known about the frequency with which blood pressure is currently measured in ambulatory pediatric settings in the United States.

Between 2000 and 2009, providers measured blood pressure during only one-third of ambulatory pediatric visits and two-thirds of pediatric preventive visits. The current rate of screening is especially low for children aged 3 to 7 years.

Sodium Intake and Blood Pressure Among US

Children and Adolescents

High blood pressure in childhood predisposes people to hy-pertension in adulthood and is associated with early de-velopment of cardiovascular disease and risk for premature death. High sodium intake and overweight/obesity are recog-nized as risk factors for hypertension in children.

These results show that usual sodium intake was positively associated with systolic blood pressure and risk for pre-high blood pressure and high blood pressure among US children. The data indicate a synergistic interaction between sodium intake and weight status on risk for high blood pressure.

Un

ﬁ

lled Prescriptions in Pediatric Primary Care

Filling a prescription is theﬁrst step in medication adherence. Unﬁlled prescriptions are a documented component of non-adherence in adult and pediatric emergency departments and

family practices. No one has reported the proportion of unﬁlled prescriptions in pediatric primary care.

This study identiﬁes the proportion of unﬁlled prescriptions in a large sample of primary care pediatric patients. It describes clinical and demographic factors associated with prescription

ﬁlling and suggests that electronic prescribing may improve adherence.

Communication During Pediatric Asthma Visits and

Self-Reported Asthma Medication Adherence

Little is known about how communication during pediatric asthma visits is associated with child control medication adherence 1 month after the visit.

When providers asked for caregiver input into the asthma treatment plan during the visit, caregivers reported signiﬁ -cantly higher child medication adherence to control medi-cations 1 month later.

Pediatric Sleep Disorders and Special Educational

Need at 8 Years: A Population-Based Cohort Study

Sleep disordered breathing (SDB) and behavioral sleep prob-lems (BSPs) affect cognitive, behavioral, and language de-velopment. No studies have examined associations between SDB and BSPs across early childhood, and later special edu-cation need (SEN), on a population basis.

A history of SDB through 5 years of age was associated with

∼40% increased odds of SEN at 8 years, among.11 000 children. BSPs were associated with 7% increased odds of SEN, for each additional∼12 months of reported BSPs.

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ness, theoretical concerns persist about long-term harm on children’s emotional development, stress regulation, mental health, and the child-parent relationship.

Behavioral sleep techniques did not cause long-lasting harms or beneﬁts to child, child-parent, or maternal outcomes. Parents and health professionals can feel comfortable about using these techniques to reduce the population burden of infant sleep problems and maternal depression.

Feasibility and Preliminary Outcomes of a Scalable,

Community-based Treatment of Childhood Obesity

Pediatric obesity is a prevalent public health issue that is associated with medical and physical consequences. Clinic-based interventions for pediatric obesity are effective, but they have limited reach and are costly.

This is theﬁrst examination of an empirically informed, scalable treatment of pediatric overweight and obesity de-livered in YMCAs. The results indicate that a scalable, com-munity-based pediatric obesity intervention can produce clinically meaningful changes in weight and quality of life.

Ef

ﬁ

cacy of Family-Based Weight Control Program

for Preschool Children in Primary Care

Overweight children are at risk for becoming obese adults, especially if they have an obese parent. Family-based behavioral interventions, largely implemented in specialized settings, have shown efﬁcacy in weight control in youth aged$8 years.

This study demonstrates the efﬁcacy of a family-based be-havioral weight control program translated to be implemented in the primary care setting. The work underscores the im-portance of pediatricians intervening early and shifting their focus from the child to the family.

Sexually Explicit Cell Phone Messaging Associated

With Sexual Risk Among Adolescents

Sending and receiving sexually explicit picture and text mes-sages via cell phone (ie,“sexting”) among adolescents is publicized as a societal and public health concern, yet it is unknown whether sexting is associated with physical sexual activity or sexual risk behavior.

This study is theﬁrst to examine sexting among a probability sample of adolescents and found that sexting is associated with

Declining dietary omega 3 polyunsaturated fatty acids has been associated with rising allergy prevalence andﬁsh oil is therefore of interest in allergy prevention. Supplementation during pregnancy, but not after the age of 6 months, has achieved some allergy reductions.

We assessed the effect offish oil supplementation from birth to 6 months, which has not been investigated previously. Our results, together with previousfindings, will likely help define a“window of opportunity”for allergy intervention usingfish oil supplements.

Erythropoietin for Neuroprotection in Neonatal

Encephalopathy: Safety and Pharmacokinetics

Infants with hypoxic-ischemic encephalopathy suffer a high rate (.40%) of death or moderate to severe disability, even after therapeutic hypothermia. High-dose erythropoietin (Epo) reduces brain injury and improves neurologic function in animal models of neonatal hypoxic-ischemic brain injury.

Multiple doses of Epo (up to 2500 U/kg intravenously) given in conjunction with hypothermia are well tolerated in newborns with HIE. Epo doses of 1000 U/kg intravenously in cooled infants produce plasma concentrations that are neuroprotective in animal studies.

Views of Adolescents and Parents on Pediatric

Research Without the Potential for Clinical Bene

ﬁ

t

Critics argue that pediatric research without the potential for clinical beneﬁt treats children as mere means to beneﬁt others. Yet, there are no data to assess whether adolescents who participate in research, or their parents, agree with this view.

Respondents felt that by participating in research the ado-lescents were making important contributions to help others, and the adolescents felt proud to be doing so. Theseﬁndings support the view that nonbeneﬁcial pediatric research involves a type of charitable activity.

Resident Work Hour Changes in Children

’

s

Hospitals: Impact on Staf

ﬁ

ng Patterns and

Workforce Needs

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This study provides an understanding of the impact of changes in resident work hours on the stafﬁng strategies of children’s hospitals.

Pediatric Residents

’

Knowledge, Use, and Comfort

With Expedited Partner Therapy for STIs

Expedited partner therapy (EPT) is an effective method of partner treatment of sexually transmitted infections but is not used frequently. There are limited data on provider knowledge, practices, and comfort with EPT use in adolescents.

California pediatric residents have knowledge gaps and dis-comfort providing EPT and presence of an adolescent medicine fellowship is associated with increased EPT knowledge, use, and comfort among residents. Ourﬁndings support the need to improve EPT education in pediatric residencies.

Pediatric Residency Training Director Tobacco

Survey II

A 2001 survey of pediatric residency training directors in-dicated that few programs prepared residents to intervene on tobacco. A decade later, it is not known whether programs are doing more to prepare residents to intervene effectively with patients and parents.

Despite the need for pediatricians to play a leadership role in tobacco prevention and control, most pediatric residency training programs focus more on health effects of tobacco use and smoke exposure than on how to intervene with patients and parents.

Medical Errors in US Pediatric Inpatients With

Chronic Conditions

Iatrogenic medical errors are an important medical care issue in the United States. Errors may be particularly important in children with chronic health conditions, especially as the prevalence of chronic conditions is increasing in children.

In a nationally representative sample, we found that pediatric inpatients with chronic conditions were at a signiﬁcantly higher risk for medical errors than inpatient children without chronic conditions, controlling for severity of illness, length of stay, and other potential confounders.

Antibiotic Exposure and IBD Development Among

Children: A Population-Based Cohort Study

Inﬂammatory bowel disease pathogenesis is incompletely understood. Previous pediatric studies suggested associations between antibiotic use and inﬂammatory bowel disease de-velopment but were limited by recall bias, lack of controls,

incomplete antibiotic capture, or included exposures between symptom onset and diagnosis.

Our population-based cohort study suggests that certain childhood antibiotic exposures are associated with an in-creased risk of developing inﬂammatory bowel disease. Our

ﬁndings have implications for understanding the condition’s pathogenesis and provide additional stimulus for reducing unnecessary childhood antibiotic use.

Increased Expression of the Glucocorticoid

Receptor

b

in Infants With RSV Bronchiolitis

Most studies on corticoid treatment of respiratory syncytial virus (RSV) respiratory diseases have revealed no beneﬁcial effect. The mechanism by which RSV respiratory-infected patients are insensitive to the antiinﬂammatory effect of cor-ticosteroids is unknown.

This study helps to understand how a respiratory syncytial viral infection may alter the normal antiinﬂammatory response to cortisol and the insensitivity to glucocorticoid treatment. The increase expression ofbglucocorticoid receptor could be a marker of disease severity.

Trends in Venous Thromboembolism-Related

Hospitalizations, 1994

–

2009

Findings from 3 studies suggest that the diagnosis of venous thromboembolism in hospitalized US children has increased in recent years.

This study provides additional evidence of an increasing trend in the rate of venous thromboembolism-associated hospitalization in US children, as well as a concurrent increase in the prevalence of venous catheter

procedures.

Acute Bacterial Osteoarticular Infections:

Eight-Year Analysis of C-Reactive Protein for Oral

Step-Down Therapy

Pediatric osteoarticular infections can be treated with suc-cessful microbiologic and clinical outcomes with a transition from parenteral to oral therapy. The best way to determine the timing of this transition is neither well studied nor stan-dardized.

A total of 193 (99.5%) of 194 pediatric patients with acute bacterial osteoarticular infections were successfully transitioned to oral therapy, determined by using

a combination of clinicalﬁndings and C-reactive protein levels, representing the largest single-center data set analyzed.

ARTICLE SUMMARIES

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OCTOBER 2012

P E D I AT R I C S

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(4)

By using population-based data, we found that PTB associated with CHDs was due to spontaneous PTB. Associated anomalies accounted for a small part of this increase, and there were speciﬁc associations between categories of CHDs and PTB.

Functioning of 7-Year-Old Children Born at 32 to 35

Weeks

’

Gestational Age

Approximately 80% of all preterm children are born moderately preterm (32–36 weeks’gestation). Moderately preterm chil-dren are at increased risk for developmental delays, but the speciﬁc neuropsychological functions that may underlie these delays are unknown.

Moderately preterm birth is associated with poorer perfor-mance in intelligence, attention, visuospatial reasoning, and executive functioning. Using gender-speciﬁc norms, our data suggest that preterm boys catch up, whereas preterm girls lag behind their peers at 7 years of age.

Impact of Maternal Depressive Symptoms on

Growth of Preschool- and School-Aged Children

Few longitudinal studies from developing countries have assessed the relation between early maternal depressive symptoms and child growth beyond age 2. The results of these studies have been inconclusive.

Early maternal depressive symptoms were related to higher odds of deﬁcits in stature but not to deﬁcits in weight among preschool- and school-aged children. Well-child care provides opportunities to identify maternal depressive symptoms to prevent future child growth delays.

Obesity and Metabolic Syndrome and Functional

and Structural Brain Impairments in Adolescence

Despite the dramatic rise in prevalence of metabolic syndrome (MetS) among children and adolescents, and that MetS is associated with cognitive and brain impairments among adults, no data on the impact of MetS on the brain exist in children.

It provides theﬁrst data on the impact of MetS on brain in adolescence. We show reductions in cognitive function and brain structural integrity in nondiabetic adolescents with MetS, thus suggesting that even pre-clinical metabolic illness may give rise to brain complications.

We have calculated the population-based relevance of deter-minants of childhood overweight by using attributable risks, which can be interpreted as maximum success rates of pre-ventive measures. New concepts were applied to estimate the relative contribution of each risk factor.

Decline in Gastroenteritis-Related Triage Calls After

Rotavirus Vaccine Licensure

Rotavirus is a major cause of acute gastroenteritis among children worldwide. Vaccines targeting rotavirus have been demonstrated to be highly efﬁcacious against severe disease in clinical trials and postlicensure studies. Vaccine impact on mild gastroenteritis has not been well studied.

We used a novel surveillance platform consisting of telephone triage data to capture mild gastroenteritis not detected in other surveillance systems. Since rotavirus vaccine licensure, gas-troenteritis-related call proportions have declined, and peak gastroenteritis-related calls are correlated with community norovirus circulation.

Electronic Cigarette Use Among Teenagers and

Young Adults in Poland

Electronic cigarettes are battery-powered devices that simulate tobacco cigarettes by vaporizing nicotine and other chemicals into an inhalable mist. They have gained popularity around the world, but little is known about their safety and addictive properties.

Among Polish youth, electronic cigarettes are the fourth most common source of nicotine after cigarettes, waterpipes, and snuff. For those aged between 15 and 24 years, ever use of an electronic cigarette was 20.9%, and 30-day use was 6.9%.

Incidence of Chronic Bilirubin Encephalopathy in

Canada, 2007

–

2008

Severe neonatal hyperbilirubinemia can lead to acute bilirubin encephalopathy and, subsequently, chronic bilirubin enceph-alopathy (CBE). This condition is preventable through routine identiﬁcation and proper treatment; therefore, it is rare for permanent neurologic complications to occur.

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it describes the underlying causes of CBE and the spectrum of neurologic disease.

EEG for Predicting Early Neurodevelopment in

Preterm Infants: An Observational Cohort Study

Previous studies suggest that abnormalﬁndings on conven-tional EEG during the neonatal period are associated with death or severe brain injury in preterm infants. However, large cohort studies on preterm EEG for predicting later

neuro-developmental outcome remain scarce.

This study demonstrates precise prognostic values of con-ventional EEG for predicting neurodevelopmental outcome in the current perinatal care setting. Additionally, its prognostic values are independent of severe injury on neuroimaging and clinical risk factors.

Trends of Transcutaneous Bilirubin in Neonates

Who Develop Signi

ﬁ

cant Hyperbilirubinemia

Although the natural course of bilirubin levels has been ex-tensively studied in general neonatal populations, there is a paucity of data regarding bilirubin trends in neonates before the development of signiﬁcant hyperbilirubinemia.

This study provides data on the natural course of trans-cutaneous bilirubin before the development of signiﬁcant hyperbilirubinemia, and on the effect of different demographic and perinatal risk factors on the rate of bilirubin increase in neonates with borderline bilirubin values.

Beliefs and Expectations of Canadian Parents Who

Bring Febrile Children for Medical Care

Fever phobia is a ubiquitous problem throughout the world. As a result, fever is pharmacologically overtreated, and medical attention is frequently sought by worried parents.

Most Canadian parents fear their child’s fever, resulting in aggressive surveillance and treatment. Parents expect in-formation about fever etiology and how to care for their ill child. Few parents expect antibiotics and satisfaction with care is high.

Circulating 25-Hydroxyvitamin D

3

in Pregnancy and

Infant Neuropsychological Development

Adequate vitamin D status in mothers during pregnancy may inﬂuence the health status of offspring later in life. Growing evidence based on animal studies is linking vitamin D to brain development and functioning, but studies in humans are lacking.

This large-scale prospective pregnancy cohort study examines the association between maternal circulating

25-hydrox-yvitamin D3concentrations in pregnancy and offspring

neu-ropsychological development. Higher circulating concentration of 25-hydroxyvitamin D3in pregnancy was associated with

improved mental and psychomotor development in infants.

Vitamin D Status of Exclusively Breastfed

4-Month-Old Infants Supplemented During Different Seasons

Despite numerous preventive strategies including prophylaxis with 400 IU/day of vitamin D in recent years, the deﬁciency of vitamin D in infants is still a global health problem.

This study reveals that the risk of vitamin D deﬁciency is high in exclusively breastfed infants, especially in winter, despite vi-tamin D supplementation. Therefore, it is suggested that an adjustment of vitamin D dosage for seasonal variation might be necessary.

A New Liquid Human Milk Forti

ﬁ

er and Linear

Growth in Preterm Infants

Current human milk fortiﬁers fail to provide the higher protein intake that is now recommended for feeding human milk–fed infants. There is a desire to avoid the use of powdered products when feeding these infants.

A new ultraconcentrated liquid human milk fortifier that provides more protein than current powdered fortifiers is safe and supports better growth in human milk–fed infants than a powdered fortifier.

Self-Reported Energy Intake by Age in Overweight

and Healthy-Weight Children in NHANES, 2001

–

2008

The relationship between energy intake and obesity in children has yielded inconsistent results. Efforts to improve dietary intake as a means of improving weight status have largely yielded disappointing results.

Self-reported energy intake for younger, but not older, over-weight/obese children is higher than healthy-weight peers. In early childhood, higher (or excessive) energy intake may lead to onset of obesity, but other mechanisms may be important to maintain obesity through adolescence.

Bottle-feeding and the Risk of Pyloric Stenosis

Pyloric stenosis is the most common condition requiring surgery in infants. It is typically not present at birth but develops within theﬁrst weeks after birth. The etiology is largely unknown, but bottle-feeding has been suggested as a risk factor.

This study demonstrated that bottle-fed infants had a 4.6-fold increased risk of developing pyloric stenosis compared with

ARTICLE SUMMARIES

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OCTOBER 2012

P E D I AT R I C S

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Clinical diagnosis of motor disorder is tied to intellectual ability in theDiagnostic and Statistical Manual of Mental Disorders, Fourth Revision,and theInternational Classiﬁcation of Dis-eases, 10th Revision.

Overall, children with lower IQ scores had lower levels of motor skill, although motor skill at all levels of proﬁciency is seen across the IQ range, including in those with learning disability.

Comparison of Mortality and Morbidity of Very Low

Birth Weight Infants Between Canada and Japan

Mortality of very low birth weight infants varies widely between regions and countries; however, the variation in morbidities after adjusting for confounders has not been adequately studied.

Composite outcome of mortality or short-term morbidity for very low birth weight infants was lower in Japan than in Canada. However, marked variations in mortality and individual morbidity exist, revealing areas for improvement in each country.

Variability of Growth in Children Starting

Antiretroviral Treatment in Southern Africa

HIV-infected children on antiretroviral therapy in low-income settings show initial catch-up in weight and height growth

Tanner Stage 4 Breast Development in Adults:

Forensic Implications

There are no studies to support the clinical awareness of persistent Tanner stage (TS) 4 breast development in adult-hood, and forensic experts continue to use TS 4 as evidence of age,18 years in cases of alleged child pornography.

One-fourth of nonclinical images of women over 18 years of age could be considered by a single forensic expert to represent TS 4. This observation, and substantial discordance in in-terpretation by pediatric endocrinologists, renders testimony based on this distinction invalid.

Evaluation of Interobserver Agreement of Apgar

Scoring in Preterm Infants

The Apgar score is a convenient method to rapidly assess the clinical status of the newborn infant. Recent literature suggests Apgar scores vary widely in preterm infants.

The Apgar signs for respiratory effort, grimace, and muscle tone demonstrated considerable disagreement in preterm infants#28 weeks’gestation. Disagreement exists despite the level of respiratory intervention, continuous positive airway pressure, or intubation, and is likely independent of gesta-tional age.

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DOI: 10.1542/peds.digest1304

2012;130;D1

Pediatrics

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