Pediatrics Digest

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State of Dental Care Among Medicaid-Enrolled

Children in the United States

Numerous studies report disparate use of dental services among poor children. National estimates vary based on the data source, and little is known about how age, race, and health plan affect use of dental services among Medicaid-enrolled children. Based on of Medicaid claims, dental services improved since 2002 but varied substantially by state, age, and type of in-surance. Children entering school had the highest prevalence of care as did children in primary care case management and health maintenance organizations.

Trends in Antibiotic Use in Massachusetts Children,

2000

–

2009

Overall antibiotic prescribing rates for children declined throughout the 1990s and early 2000s. These declines were concurrent with changes in practice related to acute otitis media, the most common reason for antibiotic treatment in young children.

The downward trend in antibiotic-dispensing rates to young children in 16 Massachusetts communities ended by 2004–2005 and remained stable thereafter. This trend was driven by a declining otitis media diagnosis rate. Antibiotic treatment of diagnosed otitis media remained constant.

Trends of Outpatient Prescription Drug Utilization

in US Children, 2002

–

2010

A wide variety of prescription drugs are prescribed to US children. Although one of the steps in assessing the risk/beneﬁt

of therapies in the pediatric population is to understand how they are used, pediatric drug utilization is not well characterized. By using large prescription databases, this study examines the frequency and patterns of national outpatient drug utilization (acute and chronic medications) in US infants, children, and adolescents for 2002 through 2010.

Frequency of Alternative Immunization Schedule

Use in a Metropolitan Area

Parents are increasingly following alternative immunization schedules. Current studies suggest up to 21% of parents in the United States are intentionally delaying or refusing some or all of the recommended early-childhood vaccines.

This is theﬁrst study to use Immunization Information System data to quantify the proportion of children consistently delaying receipt of vaccines. Consistent-limiting children were found to have lower levels of recommended vaccines.

Rates of Nonsuicidal Self-Injury in Youth: Age, Sex,

and Behavioral Methods in a Community Sample

Known rates of nonsuicidal self-injury, hurting oneself without the intent to die, are between ∼7% and 24% in samples of early adolescents and older adolescents, yet research has not reported rates for youth younger than 11 years old.

Children as young as 7 years old report engaging in non-suicidal self-injury. There is a grade by gender interaction for nonsuicidal self-injury, such that ninth-grade girls report

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have assessed their health status similar to that of normal birth weight controls.

Extremely low birth weight adolescents born in the 1990s assess their health similar to controls but report less risk taking. Extremely low and normal birth weight children rate their health to be poorer at 8 than at 14 years.

Baby-Friendly Hospital Practices and Meeting

Exclusive Breastfeeding Intention

Most mothers in the United States do not meet recom-mendations for exclusive breastfeeding; however, little is known about how long mothers intend to exclusively breastfeed or how hospital practices affect achieving these intentions. Most mothers who want to exclusively breastfeed intend to do so for$3 months, but the majority are not meeting their intended duration. Mothers are more likely to achieve their intended duration when their infant is not supplemented in the hospital.

Follow-up of Neonates With Total Serum Bilirubin

Levels

‡

25 mg/dL: A Danish Population-Based Study

Neonatal hyperbilirubinemia may progress to bilirubin en-cephalopathy. Findings from previous studies on long-term development of neonatal hyperbilirubinemia are conﬂicting. Using Ages and Stages Questionnaire, we observed no asso-ciation between bilirubin exposure and overall development in 1- to 5-year-old children who in the neonatal period had total serum bilirubin level$25 mg/dL and no or only minor neuro-logic symptoms.

Obesity Counseling by Pediatric Health

Professionals: An Assessment Using Nationally

Representative Data

The rapidly rising prevalence of overweight and obesity among children and adolescents over the past 4 decades is a signiﬁ -cant public health concern. Experts urge pediatric health care providers to provide routine obesity screening and counseling. We provide theﬁrst nationally representative estimates of the rate of screening and counseling for adolescent obesity by pediatric health professionals. We also examine how socio-economic factors and access to health care affect whether adolescents receive these services.

of NEC. Through a case-control design we determined that maternal smoking predisposes infants to the development of NEC. Our results highlight the importance of smoking cessation in pregnancy.

Interfacility Transfers of Noncritically Ill Children to

Academic Pediatric Emergency Departments

Although many children are treated in general emergency departments, many such facilities have limited pediatric capabilities. Transfer to academic centers improves outcomes for critically ill patients, but transfers of noncritically ill children have not been well studied.

Although more than half of these patients are seriously ill, many transferred patients are discharged directly from the emergency department or are admitted for less than 24 hours. Orthopedic problems, gastrointestinal conditions, and traumatic head injury are the most common complaints.

Dynamic Evolution of Practice Guidelines: Analysis

of Deviations From Assessment and Management

Plans

Adherence to guidelines has generally been shown to improve patient care and reduce the cost of care. Current understanding of the varying reasons why clinicians deviate from guidelines is based on surveys and retrospective reviews.

We examined clinician deviations from guidelines in a pro-spective fashion and attempted to categorize those deviations. Better elucidation of clinician reasoning behind deviations may inform care improvement and help deﬁne strategies to eliminate unjustiﬁable deviations.

Pediatric Residents

’

Perspectives on Reducing

Work Hours and Lengthening Residency: A National

Survey

In 2011, the Accreditation Council on Graduate Medical Edu-cation increased restrictions on resident duty-hours. Further changes have been considered, including greater work-hour restrictions and lengthening residency. Residents’views about these policies are unclear.

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pediatric residents support than oppose reduced hours, and a minority would add a year to residency to achieve them.

Socioeconomic Outcomes in Adults Malnourished in

the First Year of Life: A 40-Year Study

Infant malnutrition is known to be associated with behavioral and cognitive impairment throughout childhood, adolescence, and young adulthood. However, controlled studies addressing adult outcomes in middle life, including earning potential, educational attainment, and standard of living, are limited. A discrete episode of moderate to severe malnutrition in in-fancy, with good rehabilitation thereafter, is associated with lower adult social status and a widening income gap relative to healthy controls, partially attributable to cognitive impairment in the previously malnourished.

Long-term Outcomes of Group B Streptococcal

Meningitis

Group B_{Streptococcus}(GBS) is a common cause of meningitis in young infants. Studies from the 1980s revealed that GBS meningitis resulted in substantial mortality and reported that survivors of the infection had a high likelihood of adverse neurodevelopmental outcome.

Contemporary long-term outcomes for children surviving GBS meningitis reveal that 56% are functioning normally. The re-mainder sustained mild-to-moderate (25%) or severe (19%) neurodevelopmental impairment, highlighting the need for GBS prevention and for ongoing developmental follow-up for GBS meningitis survivors.

Costs and Infant Outcomes After Implementation of

a Care Process Model for Febrile Infants

Febrile infants in theﬁrst 90 days may have life-threatening serious bacterial infection. Well-appearing febrile infants with serious bacterial infections cannot be distinguished from those without by examination alone. Variation in care resulting in both undertreatment and overtreatment is common. The systemwide implementation of an evidence-based care process model for the care of febrile infants in Intermountain Healthcare was associated with increased delivery of evidence-based care, improved infant outcomes, and lower costs. This model adopted nationally can improve value.

Allergic Reactions to Foods in Preschool-Aged

Children in a Prospective Observational Food

Allergy Study

Infants and children with diagnosed food allergy are at risk for acute, potentially life-threatening symptoms. Limited data

are available on the frequency, severity, and circumstances of reactions and caretaker medical response.

This study describes food allergy reaction frequency, cir-cumstances, and response. Pitfalls that may inform improved anticipatory guidance included lack of vigilance, misreading ingredient labels, allergen cross-contact, nonaccidental al-lergen feeding, and underutilization of epinephrine for severe reactions.

RCT of a Mentoring and Skills Group Program:

Placement and Permanency Outcomes for Foster

Youth

Children in foster care are at elevated risk for adverse out-comes. Placement instability and failure to achieve timely permanence exacerbate that risk. A handful of studies have found that parent-management training is effective in pro-moting placement stability and timely permanence. Unlike parent-management training, youth focused inter-ventions have not been systematically evaluated for their im-pact on placement and permanency outcomes. A mentoring and skills group intervention for preadolescents in foster care demonstrated better placement and permanency outcomes, especially for high-risk subgroups.

Sport-Related Kidney Injury Among High School

Athletes

Children with a single kidney are often counseled to avoid contact/collision sports based on the concern of injury to the kidney; however, the incidence of kidney injury during sport is not well understood.

Based on this multiyear, prospective injury surveillance system of varsity-level high school athletes, sport-related kidney injury is rare. Reevaluation of American Academy of Pediatrics rec-ommendations regarding sport participation by children with a single kidney is indicated.

Trends in

_Candida

Central Line-Associated

Bloodstream Infections Among NICUs, 1999

–

2009

Emphasis on preventing central line-associated bloodstream infections (CLABSIs) in US health care facilities and prophylactic antifungal medication use in neonates may impact incidence of

Candidaspp. CLABSIs. However, data on trends in incidence of neonatal_Candida spp. CLABSIs are lacking.

Data from a large sample of US NICUs was analyzed to assess trends in incidence over time. This analysis provides a description of the epidemiology of_Candidaspp. CLABSIs in a national health care-associated infections surveillance system.

ARTICLE SUMMARIES

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JULY 2012

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attention-deﬁcit/hyperactivity disorder is unclear. Long-term follow-up studies on the topic are scarce.

Our results indicate that earlier stimulant treatment of attention-deficit/hyperactivity disorder is associated with a lower risk of decline in academic performance. Girls show a definite benefit only in mathematics, whereas boys show marginal benefits in both mathematics and language arts.

Early Vaccinations Are Not Risk Factors for Celiac

Disease

Celiac disease is an immunologic disorder with autoimmune features. Sweden experienced an epidemic of celiac disease in infants (1984–1996). Early vaccinations might inﬂuence the risk for autoimmune diseases, and could potentially have contributed to celiac disease risk and the epidemic.

Early vaccinations within the national Swedish program are not risk factors for celiac disease, nor do changes over time contribute to explaining the Swedish epidemic. A protective effect by vaccination against tuberculosis (bacillus Calmette-Guérin) is suggested.

Chronic Disabling Fatigue at Age 13 and Association

With Family Adversity

Chronic fatigue syndrome (CFS) is a disabling illness. Some children with chronic disabling fatigue are housebound. Some primary care physiciansﬁnd making the diagnosis of CFS difﬁcult. Chronic disabling fatigue is more common in 13-year-olds than previously realized with a population prevalence of∼2.0%. Chronic disabling fatigue in teenagers is more common in those with higher levels of early family adversity.

Impact of Language Pro

ﬁ

ciency Testing on Provider

Use of Spanish for Clinical Care

Providers who speak Spanish, regardless of their proﬁciency level, may use Spanish for clinical care without seeking pro-fessional interpretation. Failure to use propro-fessional in-terpretation increases the risk for miscommunication and can lead to patient harm.

Providing residents with objective feedback on Spanish language proﬁciency decreased willingness to use Spanish in straight-forward clinical scenarios. Language proﬁciency testing, coupled

Preterm infants from 33 gestational weeks can detect speciﬁc shape features (prism and cylinder) by touch (without visual control), and remember them; however, nothing is known about such abilities earlier in development.

The preterm infant, even when very immature (from 28 ges-tational weeks), is endowed with tactile sensory abilities: the exploration and memorization of an object by touch, the dis-crimination of a novel object, and the recognition of a familiar object after interference.

Birth by Cesarean Delivery and Failure on First

Otoacoustic Emissions Hearing Test

Neonatal hearing screening occasionally fails because of several perinatal and neonatal factors. However, the effect of mode of delivery on hearing screening has not yet been established. We show signiﬁcantly more failures on hearing screening in cesarean delivery infants. Hence, the timing of screening after cesarean delivery should preferably be postponed beyond 48 hours to improve success rate, minimize maternal anxiety, and decrease costs.

Preeclampsia and Retinopathy of Prematurity in

Preterm Births

Preterm infants are at a high risk for retinopathy of pre-maturity (ROP). Several postnatal factors are well known to be associated with ROP. However, the relationships between an-tenatal or maternal risk factors and ROP are poorly understood. This study used a large cohort database to study the inﬂuence of maternal gestational hypertension and preeclampsia on ROP in preterm infants. The results showed that preeclampsia, but not gestational hypertension, was associated with a reduced risk of ROP in preterm births.

Concurrent Validity of Ages and Stages

Questionnaires in Preterm Infants

Preterm children born between 29 and 36 gestational weeks are at higher risk of developmental delay. The Ages and Stages Questionnaires (ASQ) have been recommended as a de-velopmental screening tool.

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the Bayley Scales of Infant Development but was accurate in detecting mental delay at CA of 24 months.

Outcome Trajectories in Extremely Preterm Infants

Death or neurodevelopmental impairment in extremely premature neonates can be predicted at birth by considering gender, an-tenatal steroids, multiple birth, birth weight, and gestational age. Prediction of death or neurodevelopmental impairment in extremely premature infants is improved by using information available later during the clinical course. The importance of birth weight declines, whereas that of respiratory illness se-verity increases with advancing postnatal age.

Abnormalities of Vascular Structure and Function

in Children With Perthes Disease

The causes of Perthes disease are unknown. There is con-siderable evidence that the disease has a vascular mechanism, although the nature of this is unknown. There is some sug-gestion that affected individuals may have a heightened car-diovascular risk in adulthood.

Children with Perthes disease have reduced vascular caliber, which is independent of body height, and abnormal functional vascular measures. Theseﬁndings may be important in the mechanism of disease and may have implications on long-term vascular morbidity.

Predicting Language Change Between 3 and 5 Years

and Its Implications for Early Identi

ﬁ

cation

Early speech and language delays are risk factors for later developmental and social difficulties. It is easier to identify them retrospectively than prospectively. Population charac-teristics and prevalence rates make screening problematic. Using data from a birth cohort, this study identifies predictors of language performance at 5 years and 4 patterns of change between 3 and 5 years, comparing those who change with those whose profile remains low across time points.

Serotonin Transporter Role in Identifying

Similarities Between SIDS and Idiopathic ALTE

Literature about polymorphic expression of an apparent life-threatening event (ALTE), particularly that concerning dis-crimination between ALTE with evident cause and idiopathic ALTE, is scarce. Relationships between SIDS and ALTEs have been supposed but data are still controversial and no genetic data are available.

Genetic analysis (_5HTTand_MAOA) on ALTEs and idiopathic ALTEs discriminated the 2 syndromes and found a link between the

idiopathic form and SIDS. Consequently, we hypothesized that the 2 latter syndromes could be different phenotype expres-sions of a common genetic base.

Cycled Light Exposure Reduces Fussing and Crying

in Very Preterm Infants

Previous studies show beneﬁcial effects of cycled lighting in neonatal care on infant day–night activity, sleep behavior, and postnatal growth. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recom-mend neonatal care under cycled lighting conditions. This study found that cycled lighting during neonatal care reduces infant’s fussing and crying behavior at 5 and 11 weeks’corrected age and improves growth during neonatal period. Theseﬁndings support the introduction of cycled lighting in neonatal care practice.

Autism Spectrum Disorder, ADHD, Epilepsy, and

Cerebral Palsy in Norwegian Children

Prevalence estimates for neurologic and neurodevelopmental disorders in children vary widely, and there is uncertainty as to what extent the individual disorders overlap. Most previous prevalence studies have been based on survey data and not on specialist-conﬁrmed diagnoses.

This study used nationwide register data to determine the proportions of Norwegian children diagnosed with autism spectrum disorder, attention-deﬁcit/hyperactivity disorder, epilepsy, and cerebral palsy and to study how the disorders overlap. All diagnoses were specialist-conﬁrmed.

Secular Trends in BMI and Blood Pressure Among

Children and Adolescents: The Bogalusa Heart Study

Although obesity is correlated with levels of systolic and di-astolic blood pressure, there is little evidence if the increases in obesity over the last 40 years have resulted in increased blood pressure levels.

Despite increases in obesity in Bogalusa, Louisiana between 1974 and 1993, there was no increase in systolic or diastolic blood pressure levels. It should not be assumed that trends in high blood pressure have paralleled those for obesity.

Physical Activity and Sedentary Behaviors and

Health-Related Quality of Life in Adolescents

There are limited cross-sectional data from observational studies of adolescents showing that regular participation in physical activity is associated with a higher quality of life status, whereas time spent in screen-based entertainment is asso-ciated with a poorer quality of life.

ARTICLE SUMMARIES

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Circumcision for HIV Prevention in Western Kenya

Male circumcision reduces risk of HIV acquisition in men by 60% and is associated with other health beneﬁts. Compared with adult circumcision, infant male circumcision is safer, less expensive, and represents a cost-saving intervention for HIV prevention in many settings.

IMC is little known in East Africa and is not routinely practiced. This is theﬁrst study to assess acceptability and uptake of IMC in East Africa among parents who were actually offered the procedure.

Integrated Personal Health Record Use: Association

With Parent-Reported Care Experiences

Regular use of an integrated personal health record (PHR) may lead to improved outcomes through improved care

disease.

Vitamin B

₆

Vitamer Concentrations in

Cerebrospinal Fluid Differ Between Preterm and

Term Newborn Infants

There is no literature on the concentrations of vitamin B6 vitamers in cerebrospinalﬂuid of preterm and term newborn infants. This knowledge, however, is highly important, because vitamin B6plays a pivotal role in brain development and functioning.

In cerebrospinalﬂuid of newborn infants, B6vitamer con-centrations are strongly dependent on postmenstrual age, indicating that vitamin B6homeostasis in brain differs be-tween preterm and term newborns. This has implications for the evaluation of epilepsy and vitamin B6deﬁciency.

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DOI: 10.1542/peds.digest1301

2012;130;D1

Pediatrics

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