Pediatrics Digest

Routine human papillomavirus (HPV) vaccination is recommended for girls 11 or 12 years of age (catch-up vaccination through the age of 26 years). Vaccine coverage rates are low but increasing.This report describes associations between sociodemographic characteristics and HPV vaccination series initiation and completion, information useful for targeted public health interventions to increase adolescent coverage rates. It is the first study to use a national sample with provider-reported vaccination data.Urinary tract infections (UTIs) are among the most common bacterial infections in childhood, and 2% to 5% of children experience ≥1 of them before puberty. Childhood UTIs cause kidney scarring and are claimed to increase the risk of chronic kidney disease (CKD).In the absence of structural abnormalities evident in imaging studies after the first childhood UTI, the significance of recurrent childhood UTIs as a cause of CKD is small. Ultrasonography could be sufficient for identification of such abnormalities.Increasing numbers of parents are following alternative vaccination schedules that differ from the recommended vaccination schedule for their young children. Following an alternative schedule leads to undervaccination and increases the risk of contracting vaccine-preventable diseases.This is one of the first studies to detail alternative vaccination schedule use among parents of young children nationally and to delineate the “malleability” of parent's attitudes regarding their vaccination schedule choices.The role of hypotonic parenteral solutions in the pathogenesis of hospital-acquired hyponatremia in children has been much debated for almost 2 decades, but there has been a paucity of prospective trials evaluating the safety of common maintenance solutions for children.The results confirm that hypotonic solutions increase the risk of postoperative hyponatremia in children, whereas this risk is significantly reduced with isotonic fluids. The number needed to treat with isotonic maintenance solutions to prevent 1 case of hyponatremia is 6.Exposure to profanity in the media is a problem acknowledged by society, parents, and the industry. However, research has not examined the relationship between exposure to profanity in the media and subsequent behavior in adolescents.This study is the first of its kind to reveal any harmful relationship between exposure to profanity in media and attitudinal and behavioral outcomes among adolescents.Virtually all persons in industrialized countries are exposed to bisphenol A (BPA), and early-life BPA exposure might be associated with behavior problems. Few human studies have been conducted, and the impact of gestational versus childhood BPA exposures is unclear.BPA exposure during pregnancy, but not childhood, was associated with worse behavior at 3 years of age, especially among girls. Domains related to behavioral and emotional regulation were most affected by gestational BPA exposure.Low birth weight and/or prematurity are considered to be risk factors for autism spectrum disorders, largely on the basis of retrospective studies or prospective studies that have used screening rather than diagnostic instruments.This is the first study of the prevalence of autism spectrum disorders in a prospectively followed low birth weight population using validated diagnostic instruments. The 5% estimated prevalence rate found was ∼5 times the rate reported in the general population.Families whose children with special needs receive health care in a medical home setting are less likely to report financial stress attributable to medical expenses incurred on behalf of those children. Financial stress is measured subjectively through parents' perceptions.Families whose children with special needs receive health care in a medical home setting incur significantly lower out-of-pocket costs per $1000 of household income compared with similar families without a medical home. This study used objective measures of financial stress.Provider elicitation of parents' developmental concerns is a critical first step in developmental surveillance, and linguistic disparities have been described for provider elicitation of parents' developmental concerns.This is the first study to document racial/ethnic disparities in provider elicitation of parents' developmental concerns. This study also explores the association of the medical home with provider elicitation of parents' developmental concerns.It is known that adult language input is important to healthy language development and that preterm infants are at risk for language delay.This is the first study to provide evidence that very preterm infants begin making vocalizations as early as 8 weeks before their projected due date and make significantly more vocalizations when a parent is present in the NICU.Psychiatry and the pharmaceutical industry have been criticized for publicizing social phobia to increase pharmaceutical sales, particularly among youth. Moreover, there has been open debate regarding whether the diagnostic entity of social phobia “medicalizes” normal human shyness.This is the first general population study of youth to demonstrate that social phobia is a disabling psychiatric disorder beyond normal human shyness. In addition, this study provides novel information concerning the plausibility of the medicalization hypothesis for social phobia.Most adolescent smokers want to quit and make serious attempts to quit. However, few seek medical assistance, and most are unsuccessful in their efforts to stop. Therefore, accessible, effective treatment approaches are needed for adolescents who want to quit smoking.Results demonstrate that a brief smoking-cessation intervention delivered by school nurses in the school health setting is feasible and moderately effective in helping adolescents to stop smoking.A large proportion of preschool children spend significant amounts of time in sedentary behavior, but evidence regarding factors associated with objectively measured sedentary behavior in preschool children has been limited.Objectively measured sedentary behavior in preschool children is influenced by multiple factors. Different correlates were identified for boys and girls. Such information will be helpful for future interventions to reduce sedentary behavior in preschool children.Traumatic brain injury (TBI) is a major cause of disability among US children. Population-based data on TBI incidence are rare, especially for mild TBIs.TBI incidence rates for King County, Washington, were well below recent national estimates. Because mechanisms of injury varied greatly according to age, prevention strategies almost certainly must be customized to each age group for greatest impact.Exposure to virtually all anesthetic drugs has been shown to cause neurodegeneration in young animals. Studies of learning and cognition in children exposed to anesthesia and surgery have been few, have relied on single outcome measures, and have not controlled for comorbidity.In this study of children exposed to anesthesia/surgery before the age of 2, multiple group and individual measures of learning and behavior are examined by using a matched design with adjustment for comorbidity using 2 separate methods.Chest pain in children is an extremely frequent complaint, with generally benign causes. Referrals to cardiologists are increasing in volume, although the frequency of cardiac causes is exceedingly low.This study demonstrates that thorough history assessments, physical examinations, and electrocardiograms can be used effectively in initial screening to determine when higher-level care and testing are needed. This technique allowed for no cardiac deaths over a 10-year period.Intubation with prophylactic surfactant administration protects preterm infants from the complications of respiratory distress syndrome. From recent studies it was suggested that initial respiratory support with continuous positive airway pressure and later selective surfactant treatment might be an acceptable alternative.Preterm neonates managed with early nasal CPAP or prophylactic surfactant with rapid extubation to nasal CPAP had outcomes similar to those treated with prophylactic surfactant followed by mechanical ventilation. Early CPAP might obviate the need for mechanical ventilation and/or surfactant.Pediatric central line–associated bloodstream infections (CLA-BSIs) are common, are costly (up to $45 000 per event), cause considerable morbidity, and are the focus of significant research and quality improvement efforts.This is the first study to show sustained and continually decreasing PICU CLA-BSI rates over an extended period of 3 years and across multiple PICUs.In Canada, children 6 months to 9 years old were recommended to receive 2 half-adult (0.25 mL) doses of AS03-adjuvanted pandemic influenza A/H1N1 vaccine. A single dose was highly immunogenic and protective against infection in children, but protection against hospitalization is unknown.Results indicate that a single half-adult dose of AS03-adjuvanted pandemic influenza A/H1N1 vaccine is highly protective against hospitalization in children aged 6 months to 9 years. Protection was substantial 10 days after a single dose (additional marginal increase at 14 days).Vaccination of adolescents is important to reduce the transmission of influenza in households and communities. Vaccination in schools is 1 strategy to reach this population. School-based influenza vaccination intervention studies have been predominantly conducted in elementary schools comprising nonminority populations.In this study the efficacy of school-based influenza education to improve vaccination rates among adolescents regardless of location of vaccination is demonstrated. School-based influenza vaccination intervention was associated with higher levels of vaccination coverage compared with provider-based influenza vaccination intervention.Immunization reminder/recall usually relies on mail or telephone methods. Little is known about whether parents would accept the use of e-mail or cell phone calls/text messaging for immunization reminders and whether parents' contact information for these technologies is stable.Results of this national study indicate that a sizable proportion of parents would accept e-mail or cell phone-based immunization reminders and that parents' e-mail and cell phone information is at least as stable as home address and telephone information.Inpatient care for patients with bronchiolitis is highly variable and often without measurable benefit. Contextual factors, including the prevalence of a condition in the community, might affect care delivery.The adjusted risk of receiving several types of unnecessary care seems to be lower when a hospital is caring for greater numbers of patients with bronchiolitis. Hospitals should consider disseminating information about the prevalence of bronchiolitis to care providers.Real-time polymerase chain reaction (RT-PCR) testing is a sensitive specific method for detecting respiratory pathogens. Information is needed on the impact of RT-PCR testing on clinical management, antibiotic use, and hospital stays for children with respiratory infections.This study was primarily focused on effects on clinical management when RT-PCR results for respiratory samples are reported to clinicians within 12 to 36 hours. Rapid reporting does not change patient care.Osgood-Schlatter disease symptoms may wax and wane until maturity and affect sport confidence and participation periodically. Chronic sequelae may include anterior knee pain, kneeling discomfort, or sports limitation. Symptom reduction parallels resolution of patellar tendinopathy by MRI/ultrasound, although ossicles may persist radiographically.Small-needle injection of the patellar tendon enthesis/tibial apophysis with 12.5% dextrose was safe and well tolerated in adolescents with recalcitrant Osgood-Schlatter disease. Dextrose injection resulted in more rapid and frequent achievement of unaltered sport and asymptomatic sport than did usual care.Significant impairments have been found in many domains of neuropsychological functioning after TBI, although the degree to which these impairments affect quality of life and activities is not clear.Children with moderate or severe TBI and children with mild TBI who had intracranial hemorrhage had substantial reduction in their quality of life, participation in activities, and ability to communicate and care for themselves.The prevalence of noise-induced hearing loss in pediatric populations is increasing. In response to this trend, educational initiatives directed toward hearing conservation are being widely promoted for school-aged children, but few randomized trials have examined the efficacy of these initiatives.Comprehensive follow-up assessment of participants in a randomized trial of a hearing conservation intervention revealed a limited, long-term increase in the reported use of hearing protection but failed to demonstrate efficacy with respect to objective measures of hearing loss.Two randomized controlled safety trials found that long-acting β-adrenergic receptor agonists (LABAs) were associated with three- to fourfold risks for asthma-related death. A meta-analysis later revealed that the greatest risks for severe asthma outcomes associated with LABAs were among children.Results of this study substantiate the risks of LABAs for children and indicate that simultaneous use of inhaled corticosteroids might mitigate those risks. However, additional study of this question is needed.Risk factors for neonatal early-onset sepsis are based on results of studies performed before widespread use of group B Streptococcus intrapartum antibiotic prophylaxis. Algorithms to rule out sepsis on the basis of risk-factor threshold values result in antibiotic treatment of large numbers of uninfected newborns.An accurate multivariate predictive model of sepsis risk can be developed for infants born at ≥34 weeks' gestation. This model uses only objective clinical data available at the time of birth and performs better than currently recommended algorithms.Approximately 20 per 100 000 infants per year experience abusive head injuries resulting from shaking, typically triggered by a caregiver's inability to stop the infant's crying. Hospital-based parent education immediately after the infant's birth has shown promise as a prevention strategy.Results of this study provide strong corroborating evidence that a low-cost prevention program delivered by maternity nurses can substantially reduce newborns' risk of sustaining an abusive head injury resulting from shaking during the first year of life.Outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) are a concern in NICUs. Efforts to decrease rates of both colonization and infection are commonly undertaken in such units.Although infection-control efforts seem effective in reducing the overall colonization risk, siblings remain at increased risk. Strategies addressing this issue and attempting to minimize episodes of staff members caring for colonized and uncolonized infants may help reduce MRSA spread.Hypoplastic left heart syndrome (HLHS) is a serious congenital heart defect that requires 3 staged palliative operations or cardiac transplantation. Mortality rates have improved significantly over the past decade, but patients continue to consume extensive inpatient hospital resources.Improved survival rates for patients born with HLHS have led to increased hospital stays and costs. Whether treated with 3 staged palliative operations or transplantation, patients require resources similar to those needed for prematurity or other major birth defects.Early-preterm-born children often show growth restraint, and studies on small groups of moderately preterm-born children have found that they, too, are at risk. Both poor somatic growth and excessive weight gain can lead to long-term complications.This study of 1123 children revealed that at age 4, growth regarding height and weight of moderately preterm-born children was restricted twice as often as that of term-born children. Being born small for gestational age and short mothers were identified as predictors of growth restraint.Adult patients are frequently hyperventilated during performance of cardiopulmonary resuscitation. Animal studies have revealed that similar excessive ventilation rates increase intrathoracic pressure, decrease coronary perfusion pressure, and lower survival rates. No data exist regarding the prevalence of hyperventilation in pediatric resuscitation.This study revealed that in simulated pediatric emergencies, hyperventilation is common. This tendency does not vary according to ventilation provider type or with increasing code leader seniority.Although evidence-based guidelines for pediatric attention-deficit/hyperactivity disorder (ADHD) care exist, adherence to the guidelines in community-based settings has been problematic. Effective interventions that improve the quality of pediatricians' ADHD care and are ready for widespread dissemination do not currently exist.By using a cluster-randomized trial design, results of this study provide evidence that a quality improvement intervention that is conducive to widespread dissemination improves the ADHD assessment and treatment behaviors of community-based pediatricians.The Kasai operation is regarded as the gold standard of treatment for biliary atresia, and early operation is associated with a better outcome. Using stool color cards have been described as a cost-effective, simple, and convenient screening method.Stool color card screening was associated with a decline in the proportion of late referral. Improvements in the speed of workup and the operation should be the focus of education and training in the future.Extremely low birth weight infants are at high risk of rehospitalization in infancy, often for respiratory illnesses. Few studies have evaluated which prematurely born infants will need rehospitalization or will have persistent respiratory problems after discharge.Scoring systems and classification and regression-tree analysis models were developed to identify extremely low birth weight infants at higher risk of rehospitalization and might help target interventions to infants at higher risk and assist in planning quality improvement initiatives.High rates of mental health problems among youth in residential treatment are well documented; however, research in which the prevalence of physical health problems among this potentially vulnerable population is examined has been limited.This study is among the first to show that youth in residential treatment have high rates of physical health problems, which suggests that systematic medical evaluation, program planning, and follow-up should be integral components of effective interdisciplinary treatment for these youth.GM2 gangliosidosis is an autosomal recessive inherited condition of the nervous system with a heterogeneous clinical spectrum. Infants are affected most severely, but the pace and characteristics of neurologic decline and factors that affect survival have not been systematically described.This is the largest cohort of infantile GM2 gangliosidosis studied to date. This article presents the first survival estimates and quantifies the gain and loss of specific developmental milestones in these patients.Extrapolation of efficacy, an approach first proposed in 1994, can increase the efficiency of pediatric drug development. Little has been published on its practical application and whether it can achieve the objectives of increased efficiency and increased pediatric drug labeling.Extrapolation can be used successfully to decrease the number of pediatric patients and studies required for pediatric drug development. Approaches have changed over time with growing knowledge and experience regarding the assumptions underlying extrapolation for particular therapeutic classes and indications.Fetal growth predicts the risk for disorders associated with in the including in However, studies often are performed with very low birth weight samples and information on between birth and in childhood were found across the population and were by and the affected children in the of birth had lower