August 2012, VOLUME 130 / ISSUE 2 - مركز مديريت دانش بيماريهاي كودكان

پنجشنبه 4 بهمن 1403 - 22 رجب 1446

English | فارسی

جستجو :

شما اینجا هستید صفحه اصلیAugust 2012, VOLUME 130 / ISSUE 2

مطالب آموزشی

August 2012, VOLUME 130 / ISSUE 2

· Abstract 1 of 61Article

Vaccine-Type Human Papillomavirus and Evidence of Herd Protection After Vaccine Introduction

OBJECTIVES: The aims of this study were to compare prevalence rates of human papillomavirus (HPV) in young women before and after HPV vaccine introduction to determine the following: (1) whether vaccine-type HPV infection decreased, (2) whether there was evidence of herd protection, and (3) whether there was evidence for type-replacement (increased prevalence of nonvaccine-type HPV).

METHODS: Young women 13 to 26 years of age who had had sexual contact were recruited from 2 primary care clinics in 2006–2007 for a prevaccination surveillance study (N = 368, none were vaccinated) and 2009–2010 for a postvaccination surveillance study (N = 409, 59% were vaccinated). Participants completed a questionnaire and were tested for cervicovaginal HPV DNA. HPV prevalence rates were compared in the pre- versus postsurveillance studies by using χ² tests. Propensity score weighting was used to balance differences in covariates between the 2 surveillance studies.

RESULTS: The mean age was ∼19 years for both groups of participants and most were African American and non-Hispanic. After propensity score weighting, the prevalence rate for vaccine-type HPV decreased substantially (31.7%–13.4%, P < .0001). The decrease in vaccine-type HPV not only occurred among vaccinated (31.8%–9.9%, P < .0001) but also among unvaccinated (30.2%–15.4%, P < .0001) postsurveillance study participants. Nonvaccine-type HPV increased (60.7%–75.9%, P < .0001) for vaccinated postsurveillance study participants.

CONCLUSIONS: Four years after licensing of the quadrivalent HPV vaccine, there was a substantial decrease in vaccine-type HPV prevalence and evidence of herd protection in this community. The increase in nonvaccine-type HPV in vaccinated participants should be interpreted with caution but warrants further study.

KEY WORDS

human papillomavirus vaccines
herd protection
adolescent
prevalence

Accepted April 18, 2012.

· Abstract 2 of 61Article

Academic Achievement Varies With Gestational Age Among Children Born at Term

OBJECTIVE: The goal of this study was to examine the degree to which children born within the “normal term” range of 37 to 41 weeks’ gestation vary in terms of school achievement.

METHODS: This study analyzed data from 128 050 singleton births born between 37 and 41 weeks’ gestation in a large US city. Data were extracted from city birth records to assess a number of obstetric, social, and economic variables, at both the individual and community levels. Birth data were then matched with public school records of standardized city-wide third-grade reading and math tests. Specifically, we assessed (1) whether children born within the normal term range of 37 to 41 weeks’ gestation show differences in reading and/or math ability 8 years later as a function of gestational age, and (2) the degree to which a wide range of individual- and community-level social and biological factors mediate this effect.

RESULTS: Analyses revealed that gestational age within the normal term range was significantly and positively related to reading and math scores in third grade, with achievement scores for children born at 37 and 38 weeks significantly lower than those for children born at 39, 40, or 41 weeks. This effect was independent of birth weight, as well as a number of other obstetric, social, and economic factors.

CONCLUSIONS: Earlier normal term birth may be a characteristic considered by researchers, clinicians, and parents to help identify children who may be at risk for poorer school performance.

KEY WORDS

gestational age
developmental outcomes
risk factors
school performance
reading achievement

Accepted March 27, 2012.

· Abstract 3 of 61Article

Neonatal Morbidities and Developmental Delay in Moderately Preterm-Born Children

BACKGROUND AND OBJECTIVE: Children born moderately preterm (32–35^6/7 weeks’ gestation) are at increased risk of both neonatal morbidities and developmental delays in early childhood. It is unknown whether neonatal morbidities contribute to the increased risk of developmental delay. The objective of this study was to determine the effect of neonatal morbidities after moderately preterm birth on development at preschool age.

METHODS: In a community-based, stratified cohort, parents of 832 moderately preterm children born in 2002 or 2003 completed the Ages and Stage Questionnaire when their child was 43 to 49 months old. Data on Apgar scores, asphyxia, tertiary NICU admission, hospital transfer, circulatory insufficiency, hypoglycemia, septicemia, mechanical ventilation, continuous positive airway pressure, apneas, caffeine treatment, and hyperbilirubinemia were obtained from medical records. We assessed associations of neonatal characteristics with developmental delay, adjusted for gender, small-for-gestational-age status, gestational age, and maternal education.

RESULTS: Hypoglycemia and asphyxia were associated with developmental delay; odds ratios (ORs) were 2.42 (95% confidence interval [CI]: 1.23–4.77) and 3.18 (95% CI: 1.01–10.0), respectively. Tertiary NICU admission and hyperbilirubinemia had positive but statistically borderline nonsignificant associations with developmental delay: ORs were 1.74 (95% CI: 0.96–3.15) and 1.52 (95% CI: 0.94–2.46), respectively. No other neonatal morbidities were associated with developmental delay. In multivariate analyses, only hypoglycemia was associated with developmental delay (OR: 2.19; 95% CI: 1.08–4.46).

CONCLUSIONS: In moderately preterm-born children, only hypoglycemia increased the risk of developmental delay at preschool age. A concerted effort to prevent hypoglycemia might enhance developmental outcome in this group.

KEY WORDS

moderately preterm
late preterm
neurodevelopment
Ages and Stages Questionnaire
neonatal morbidity
hypoglycemia
follow-up

Accepted April 20, 2012.

· Abstract 4 of 61Article

Adherence to PALS Sepsis Guidelines and Hospital Length of Stay

BACKGROUND AND OBJECTIVES: Few studies have evaluated sepsis guideline adherence in a tertiary pediatric emergency department setting. We sought to evaluate (1) adherence to 2006 Pediatric Advanced Life Support guidelines for severe sepsis and septic shock (SS), (2) barriers to adherence, and (3) hospital length of stay (LOS) contingent on guideline adherence.

METHODS: Prospective cohort study of children presenting to a large urban academic pediatric emergency department with SS. Adherence to 5 algorithmic time-specific goals was reviewed: early recognition of SS, obtaining vascular access, administering intravenous fluids, delivery of vasopressors for fluid refractory shock, and antibiotic administration. Adherence to each time-defined goal and adherence to all 5 components as a bundle were reviewed. A detailed electronic medical record analysis evaluated adherence barriers. The association between guideline adherence and hospital LOS was evaluated by using multivariate negative binomial regression.

RESULTS: A total of 126 patients had severe sepsis (14%) or septic shock (86%). The median age was 9 years (interquartile range, 3–16). There was a 37% and 35% adherence rate to fluid and inotrope guidelines, respectively. Nineteen percent adhered to the 5-component bundle. Patients who received 60 mL/kg of intravenous fluids within 60 minutes had a 57% shorter hospital LOS (P = .039) than children who did not. Complete bundle adherence resulted in a 57% shorter hospital LOS (P = .009).

CONCLUSIONS: Overall adherence to Pediatric Advanced Life Support sepsis guidelines was low; however, when patients were managed within the guideline’s recommendations, patients had significantly shorter duration of hospitalization.

KEY WORDS

sepsis
septic shock
PALS
adherence
guidelines

Accepted March 27, 2012.

· Abstract 5 of 61Article

Two-Year Follow-up of an Adolescent Behavioral Weight Control Intervention

OBJECTIVE: This study examined the 24-month outcomes of a randomized controlled trial of a group-based behavioral weight control (BWC) program combined with either activity-based peer intervention or aerobic exercise.

METHODS: At baseline, 118 obese adolescents (68% female; BMI = 31.41 ± 3.33) ages 13 to 16 years (mean = 14.33; SD = 1.02) were randomized to receive 1 of 2 weight loss interventions. Both interventions received the same 16-week group-based cognitive-behavioral treatment, combined with either aerobic exercise or peer-based adventure therapy. Eighty-nine adolescents (75% of original sample) completed the 24-month follow-up. Anthropometric and psychosocial measures were obtained at baseline, at the end of the 16-week intervention, and at 12 and 24 months following randomization.

RESULTS: An intent-to-treat mixed factor analysis of variance indicated a significant effect for time on both percent over 50th percentile BMI for age and gender and standardized BMI score, with no differences by intervention group. Post hoc comparisons showed a significant decrease in percent overweight at 4 months (end of treatment), which was maintained at both 12- and 24-month follow-up visits. Significant improvements on several dimensions of self-concept were noted, with significant effects on physical appearance self-concept that were maintained through 24 months.

CONCLUSIONS: Both BWC conditions were effective at maintaining reductions in adolescent obesity and improvements in physical appearance self-concept through 24-month follow-up. This study is one of the first to document long-term outcomes of BWC intervention among adolescents.

KEY WORDS

adolescents
overweight
weight management
behavioral weight control

Accepted April 5, 2012.

· Abstract 6 of 61Article

Prospective Association of Common Eating Disorders and Adverse Outcomes

OBJECTIVE: Anorexia nervosa and bulimia nervosa (BN) are rare, but eating disorders not otherwise specified (EDNOS) are relatively common among female participants. Our objective was to evaluate whether BN and subtypes of EDNOS are predictive of developing adverse outcomes.

METHODS: This study comprised a prospective analysis of 8594 female participants from the ongoing Growing Up Today Study. Questionnaires were sent annually from 1996 through 2001, then biennially through 2007 and 2008. Participants who were 9 to 15 years of age in 1996 and completed at least 2 consecutive questionnaires between 1996 and 2008 were included in the analyses. Participants were classified as having BN (≥weekly binge eating and purging), binge eating disorder (BED; ≥weekly binge eating, infrequent purging), purging disorder (PD; ≥weekly purging, infrequent binge eating), other EDNOS (binge eating and/or purging monthly), or nondisordered.

RESULTS: BN affected ∼1% of adolescent girls; 2% to 3% had PD and another 2% to 3% had BED. Girls with BED were almost twice as likely as their nondisordered peers to become overweight or obese (odds ratio [OR]: 1.9 [95% confidence interval: 1.0–3.5]) or develop high depressive symptoms (OR: 2.3 [95% confidence interval: 1.0–5.0]). Female participants with PD had a significantly increased risk of starting to use drugs (OR: 1.7) and starting to binge drink frequently (OR: 1.8).

CONCLUSIONS: PD and BED are common and predict a range of adverse outcomes. Primary care clinicians should be made aware of these disorders, which may be underrepresented in eating disorder clinic samples. Efforts to prevent eating disorders should focus on cases of subthreshold severity.

KEY WORDS

adolescents
eating disorders
epidemiology
obesity
substance use

Accepted April 5, 2012.

· Abstract 7 of 61Article

Influence of Sports, Physical Education, and Active Commuting to School on Adolescent Weight Status

OBJECTIVE: To compare the associations between weight status and different forms of physical activity among adolescents.

METHODS: We conducted telephone surveys with 1718 New Hampshire and Vermont high school students and their parents as part of a longitudinal study of adolescent health. We surveyed adolescents about their team sports participation, other extracurricular physical activity, active commuting, physical education, recreational activity for fun, screen time, diet quality, and demographics. Overweight/obesity (BMI for age ≥ 85th percentile) and obesity (BMI for age ≥ 95 percentile) were based on self-reported height and weight.

RESULTS: Overall, 29.0% (n = 498) of the sample was overweight/obese and 13.0% (n = 223) were obese. After adjustments, sports team participation was inversely related to overweight/obesity (relative risk [RR] = 0.73 [95% confidence interval (CI): 0.61, 0.87] for >2 sports teams versus 0) and obesity (RR = 0.61 [95% CI: 0.45, 0.81] for >2 sports teams versus 0). Additionally, active commuting to school was inversely related to obesity (RR = 0.67 [95% CI: 0.45, 0.99] for >3.5 days per week versus 0). Attributable risk estimates suggest obesity prevalence would decrease by 26.1% (95% CI: 9.4%, 42.8%) if all adolescents played on 2 sports teams per year and by 22.1% (95% CI: 0.1%, 43.3%) if all adolescents walked/biked to school at least 4 days per week.

CONCLUSIONS: Team sport participation had the strongest and most consistent inverse association with weight status. Active commuting to school may reduce the risk of obesity, but not necessarily overweight, and should be studied further. Obesity prevention programs should consider strategies to increase team sport participation among all students.

KEY WORDS

overweight
obesity
exercise
sports
team sports
physical education
active travel
walking
bicycling
commuting
adolescent
body weight
secondary school

Accepted March 23, 2012.

· Abstract 8 of 61Article

Caffeine Intake During Pregnancy and Risk of Problem Behavior in 5- to 6-Year-Old Children

BACKGROUND AND OBJECTIVE: Human studies that have investigated the association between caffeine intake during pregnancy and offspring’s behavioral outcomes are scant and inconclusive. We prospectively investigated the association between maternal caffeine intake during pregnancy and children’s problem behavior at age 5 to 6 years. Mediation by fetal growth restriction and gestational age as well as effect modification by the child’s gender and maternal smoking was tested.

METHODS: In a community based multiethnic birth cohort, dietary caffeine intake (coffee, caffeinated tea, and cola) was measured (maternal self-report, n = 8202) around the 16th week of gestation. At age 5, children’s overall problem behavior, emotional problems, conduct problems, hyperactivity/inattention problems, peer relationship problems, and prosocial behavior were rated by both mother and teacher (n = 3439) with the Strengths and Difficulties Questionnaire. Analyses were adjusted for maternal age, ethnicity, cohabitant status, education, smoking and alcohol consumption during pregnancy, child’s gender, family size, and prenatal maternal anxiety.

RESULTS: Caffeine intake was not associated with a higher risk for behavior problems or with suboptimal prosocial behavior. No evidence was found for mediation by fetal growth restriction or gestational age, nor for effect modification by the child’s gender.

CONCLUSIONS: Results did not provide evidence for developmental programming influences of intrauterine exposure to caffeine on offspring’s problem behavior at age 5. Present results give no indication to advise pregnant women to reduce their caffeine intake to prevent behavior problems in their children.

KEY WORDS

pregnancy
caffeine
prenatal exposure
preschool age
behavior problems

Accepted March 27, 2012.

· Abstract 9 of 61Article

Early Growth of Infantile Hemangiomas: What Parents’ Photographs Tell Us

BACKGROUND AND OBJECTIVES: Infantile hemangiomas (IH) are recognized as growing rapidly during the first months of life, but details of early growth before 3 months of age have not been well-characterized. Our goal was to study early IH growth by using parental photographs of infant children with facial IHs to better understand early hemangioma growth, with the aim of improving guidance for physicians and parents of infants with high-risk IH.

METHODS: Serial images of 30 infants showing IH at intervals of 1 to 2 weeks up to 6 months were analyzed for characteristics of color, thickness, and distortion of anatomic landmarks. The presence or absence of an IH precursor at birth was noted. Mean scores per age interval were compiled. Results were analyzed by using signed rank test. An assessment of “optimal time for referral” was made.

RESULTS: IH growth was nonlinear; most rapid growth occurred between 5.5 and 7.5 weeks of age. The mean “optimal age for referral” was 4 weeks of age. Hemangioma precursors were present at birth in 65% of patients.

CONCLUSIONS: The most rapid hemangioma growth occurs before 8 weeks of age, much earlier than previously appreciated. Specialty evaluation and initiation of treatment, however, typically occur after the age of most rapid growth. Our findings suggest a need for a paradigm shift in the timing of referral and initiation of treatment of high-risk IH so that therapy can be initiated before or early in the course of most rapid growth, rather than after it is already completed.

KEY WORDS

infantile hemangioma
strawberry hemangioma
high-risk
referral practice

Accepted April 16, 2012.

· Abstract 10 of 61Article

The HEADS-ED: A Rapid Mental Health Screening Tool for Pediatric Patients in the Emergency Department

BACKGROUND AND OBJECTIVE: The American Academy of Pediatrics called for action for improved screening of mental health issues in the emergency department (ED). We developed the rapid screening tool home, education, activities/peers, drugs/alcohol, suicidality, emotions/behavior, discharge resources (HEADS-ED), which is a modification of “HEADS,” a mnemonic widely used to obtain a psychosocial history in adolescents. The reliability and validity of the tool and its potential for use as a screening measure are presented.

METHODS: ED patients presenting with mental health concerns from March 1 to May 30, 2011 were included. Crisis intervention workers completed the HEADS-ED and the Child and Adolescent Needs and Strengths-Mental Health tool (CANS MH) and patients completed the Children’s Depression Inventory (CDI). Interrater reliability was assessed by using a second HEADS-ED rater for 20% of the sample.

RESULTS: A total of 313 patients were included, mean age was 14.3 (SD 2.63), and there were 182 females (58.1%). Interrater reliability was 0.785 (P < .001). Correlations were computed for each HEADS-ED category and items from the CANS MH and the CDI. Correlations ranged from r = 0.17, P < .05 to r = 0.89, P < .000. The HEADS-ED also predicted psychiatric consult and admission to inpatient psychiatry (sensitivity of 82% and a specificity of 87%; area under the receiver operator characteristic curve of 0.82, P < .01).

CONCLUSIONS: The results provide evidence to support the psychometric properties of the HEADS-ED. The study shows promising results for use in ED decision-making for pediatric patients with mental health concerns.

KEY WORDS

mental health
emergency department
psychosocial screening

Accepted March 27, 2012.

· Abstract 11 of 61Article

Dental Composite Restorations and Psychosocial Function in Children

BACKGROUND AND OBJECTIVE: Resin-based dental materials may intraorally release their chemical components and bisphenol A. The New England Children’s Amalgam Trial found that children randomized to amalgam had better psychosocial outcomes than those assigned to composites for posterior tooth restorations. The objective of this study was to examine whether greater exposure to dental composites is associated with psychosocial problems in children.

METHODS: Analysis of treatment-level data from the New England Children’s Amalgam Trial, a 2-group randomized safety trial comparing amalgam with the treatment plan of bisphenol A-glycidyl methacrylate (bisGMA)-based composite and urethane dimethacrylate–based polyacid-modified composite (compomer), among 534 children aged 6 to 10 years at baseline. Psychosocial function at follow-up (n = 434) was measured by using the self-reported Behavior Assessment System for Children (BASC-SR) and parent-reported Child Behavior Checklist (CBCL).

RESULTS: Children with higher cumulative exposure to bisGMA-based composite had poorer follow-up scores on 3 of 4 BASC-SR global scales: Emotional Symptoms (β = 0.8, SE = 0.3, P = .003), Clinical Maladjustment (β = 0.7, SE = 0.3, P = .02), and Personal Adjustment (β = –0.8, SE = 0.2, P = .002). Associations were stronger with posterior-occlusal (chewing) surfaces, where degradation of composite was more likely. For CBCL change, associations were not statistically significant. At-risk or clinically significant scores were more common among children with greater exposure for CBCL Total Problem Behaviors (16.3% vs 11.2%, P-trend = .01) and numerous BASC-SR syndromes (eg, ≥13 vs 0 surface-years, Interpersonal Relations 13.7% vs 4.8%, P-trend = .01). No associations were found with compomer, nor with amalgam exposure levels among children randomized to amalgam.

CONCLUSIONS: Greater exposure to bisGMA-based dental composite restorations was associated with impaired psychosocial function in children, whereas no adverse psychosocial outcomes were observed with greater urethane dimethacrylate–based compomer or amalgam treatment levels.

KEY WORDS

composite dental resin
composite resins
bisphenol A-glycidyl methacrylate
compomers
child behavior
behavioral symptoms
affective symptoms

Accepted April 10, 2012.

· Abstract 12 of 61Article

The Impact of Macromastia on Adolescents: A Cross-Sectional Study

OBJECTIVE: To determine the physical and psychosocial impact of macromastia on adolescents considering reduction mammaplasty in comparison with healthy adolescents.

METHODS: The following surveys were administered to adolescents with macromastia and control subjects, aged 12 to 21 years: Short-Form 36v2, Rosenberg Self-Esteem Scale, Breast-Related Symptoms Questionnaire, and Eating-Attitudes Test-26 (EAT-26). Demographic variables and self-reported breast symptoms were compared between the 2 groups. Linear regression models, unadjusted and adjusted for BMI category (normal weight, overweight, obese), were fit to determine the effect of case status on survey score. Odds ratios for the risk of disordered eating behaviors (EAT-26 score ≥20) in cases versus controls were also determined.

RESULTS: Ninety-six subjects with macromastia and 103 control subjects participated in this study. Age was similar between groups, but subjects with macromastia had a higher BMI (P = .02). Adolescents with macromastia had lower Short-Form 36v2 domain, Rosenberg Self-Esteem Scale, and Breast-Related Symptoms Questionnaire scores and higher EAT-26 scores compared with controls. Macromastia was also associated with a higher risk of disordered eating behaviors. In almost all cases, the impact of macromastia was independent of BMI category.

CONCLUSIONS: Macromastia has a substantial negative impact on health-related quality of life, self-esteem, physical symptoms, and eating behaviors in adolescents with this condition. These observations were largely independent of BMI category. Health care providers should be aware of these important negative health outcomes that are associated with macromastia and consider early evaluation for adolescents with this condition.

KEY WORDS

macromastia
adolescent
quality-of-life
self-esteem
eating disorder
reduction mammaplasty

Accepted April 5, 2012.

· Abstract 13 of 61Article

Misclassification of Newborns Due to Systematic Error in Plotting Birth Weight Percentile Values

OBJECTIVES: Higher than expected small for gestational age (SGA) rates and lower than expected large for gestational age (LGA) rates have been observed. A possible explanation is a leftward shift of percentile curves for birth weight due to a systematic error in plotting birth weight values in charts (ie, plotting weekly mean birth weight data at the beginning of the weeks). Our objectives were to assess how common this plotting error is and to analyze the effect of this error on SGA and LGA classification based on data from the German perinatal survey.

METHODS: First, a systematic literature search for birth weight charts was performed, and the charts were analyzed for the plotting error. Second, percentile values (10th, 50th, and 90th) for 25 to 42 completed weeks of gestation were calculated from the data of 1 181 200 male singleton newborns (German perinatal survey, 1995–2000). Birth weight percentile curves were calculated with and without the plotting error, and the resulting SGA and LGA rates were analyzed.

RESULTS: Fourteen of the 16 identified publications contained the systematic error in plotting. Using our calculated percentile curves, a leftward shift caused by the plotting error led to an SGA rate of 12.5% and an LGA rate of 7.7%; ∼5% of newborns were misclassified.

CONCLUSIONS: Percentile charts should be examined for the described systematic error and, if necessary, corrected.

KEY WORDS

percentile charts
somatic classification of neonates

Accepted April 16, 2012.

· Abstract 14 of 61Article

Dose-Response Relationship of Phototherapy for Hyperbilirubinemia

BACKGROUND AND OBJECTIVE: Using light-emitting diodes during conventional phototherapy, it is possible to reduce the distance from light source to infant, thus increasing light irradiance. The objective of this study was to search for a “saturation point” (ie, an irradiation level above which there is no further decrease in total serum bilirubin [TsB]). This was a prospective randomized study performed in the NICU of Aalborg Hospital, Denmark.

METHODS: One hundred fifty-one infants (gestational age ≥33 weeks) with uncomplicated hyperbilirubinemia were randomized to 1 of 4 distances from the phototherapy device to the mattress (20, 29, 38, and 47 cm). TsB was measured before and after 24 hours of phototherapy and irradiance every eighth hour. Main outcome was 24-hour decrease of TsB expressed in percent, (∆ TsB_0–24, difference between TsB₀ and TsB₂₄ [%]).

RESULTS: A highly significant linear relation was seen between light irradiance and ∆ TsB_0–24 (%) (P < .001): when the irradiance increased from 20 to 55 μW/cm²/nm, ∆ TsB_0–24 (%) increased from approximately 30% to 50%. In addition, smooth regression showed no tendency for ∆ TsB_0–24 (%) to level off as irradiance increased. ∆ TsB_0–24 (%) was negatively correlated to birth weight and positively to formula volume. Average weight gain during phototherapy was 1%, independent of light irradiance.

CONCLUSIONS: By using light-emitting diodes, we found a linear relation between light irradiance in the range of 20 to 55 μW/cm²/nm and a decrease in TsB after 24 hours of therapy, with no evidence of a saturation point.

KEY WORDS

neonates
hyperbilirubinemia
phototherapy
light irradiance
saturation point

Accepted April 16, 2012.

· Abstract 15 of 61Article

Local Macroeconomic Trends and Hospital Admissions for Child Abuse, 2000–2009

OBJECTIVE: To examine the relationship between local macroeconomic indicators and physical abuse admission rates to pediatric hospitals over time.

METHODS: Retrospective study of children admitted to 38 hospitals in the Pediatric Hospital Information System database. Hospital data were linked to unemployment, mortgage delinquency, and foreclosure data for the associated metropolitan statistical areas. Primary outcomes were admission rates for (1) physical abuse in children <6 years old, (2) non-birth, non-motor vehicle crash-related traumatic brain injury (TBI) in infants <1 year old (which carry high risk for abuse), and (3) all-cause injuries. Poisson fixed-effects regression estimated trends in admission rates and associations between those rates and trends in unemployment, mortgage delinquency, and foreclosure.

RESULTS: Between 2000 and 2009, rates of physical abuse and high-risk TBI admissions increased by 0.79% and 3.1% per year, respectively (P ≤ .02), whereas all-cause injury rates declined by 0.80% per year (P < .001). Abuse and high-risk TBI admission rates were associated with the current mortgage delinquency rate and with the change in delinquency and foreclosure rates from the previous year (P ≤ .03). Neither abuse nor high-risk TBI rates were associated with the current unemployment rate. The all-cause injury rate was negatively associated with unemployment, delinquency, and foreclosure rates (P ≤ .007).

CONCLUSIONS: Multicenter hospital data show an increase in pediatric admissions for physical abuse and high-risk TBI during a time of declining all-cause injury rate. Abuse and high-risk TBI admission rates increased in relationship to local mortgage delinquency and foreclosure trends.

KEY WORDS

child safety
maltreatment
abuse
head trauma
head injuries

Accepted April 5, 2012.

· Abstract 16 of 61Article

Duration of Protection of Pentavalent Rotavirus Vaccination in Nicaragua

OBJECTIVE: To evaluate the duration of protection of pentavaent rotavirus vaccine (RV5) against rotavirus hospitalizations in Nicaragua, a developing country in Central America.

METHODS: We conducted a case-control study at 4 hospitals from 2007 through 2010, including 1016 children hospitalized with laboratory-confirmed rotavirus diarrhea, 4930 controls with nonrotavirus diarrhea (ie, “test-negative”), and 5627 controls without diarrhea. All cases and controls were aged ≥6 months and born after August 2006. Outcomes included odds of antecedent vaccination between case-patients and controls, and effectiveness of vaccination (1 – adjusted odds ratio [OR] × 100). Duration of protection was assessed by comparing effectiveness among children aged <1 year compared with ≥1 year.

RESULTS: Indicators of socioeconomic conditions and nonrotavirus vaccination (oral polio vaccine and diphtheria/tetanus/pertussis/hepatitis A/hepatitis B) for test-negative controls were more comparable to the rotavirus case-patients than nondiarrhea controls. RV5 vaccination was associated with a significantly lower risk of rotavirus hospitalization by using test-negative controls (OR: 0.55; 95% confidence interval [CI]: 0.41–0.74) and nondiarrhea controls (OR: 0.30; 95% CI: 0.22–0.40). Risk of rotavirus hospitalization was twofold lower among RV5 vaccinated children aged <1 year (OR: 0.36; 95% CI: 0.22–0.57) compared with RV5 vaccinated children aged ≥1 year (OR: 0.70; 95% CI: 0.47–1.05).

CONCLUSIONS: RV5 provided good protection against severe rotavirus disease in Nicaragua during the first year of life, when most severe and fatal rotavirus disease in developing countries occurs. However, the decline in protection with age warrants monitoring of disease among older children and consideration of a booster dose evaluation at the end of infancy.

KEY WORDS

rotavirus
vaccine
diarrhea
vaccine effectiveness

Accepted March 30, 2012.

· Abstract 17 of 61Article

Risk Factors for In-Hospital Mortality Among Children With Tuberculosis: The 25-Year Experience in Peru

OBJECTIVE: We examined factors associated with in-hospital death among children with tuberculosis (TB). We hypothesized that a negative response to tuberculin skin testing (TST) would predict decreased survival.

METHODS: This retrospective cohort comprised 2392 children ages 0 to 14 years hospitalized with TB at a Peruvian referral hospital over the 25-year study period. Detailed chart abstraction captured clinical history including TB contacts, physical examination findings, diagnostic data, treatment regimen, and hospitalization outcome. We used Cox proportional hazards regression analyses to determine risk factors for mortality.

RESULTS: Of 2392 children, 2 (0.1%) were known to be HIV-positive, 5 (0.2%) had documented multidrug-resistant TB, and 266 (11%) died. The median time from hospitalization to death was 16 days (interquartile range: 4–44 days). Reaction of <5 mm induration on TST predicted death in a multivariable analysis (hazard ratio [HR]: 3.01; 95% confidence interval [CI]: 2.15–4.21; P < .0001). Younger age, period of admission, alteration of mental status (HR: 3.25; 95% CI: 2.48–4.27; P < .0001), respiratory distress (HR: 1.40; 95% CI: 1.07–1.83; P = .01), peripheral edema (HR: 1.97; 95% CI: 1.42–2.73; P < .0001), and hemoptysis (HR: 0.57; 95% CI: 0.32–1.00; P = .05) were associated with mortality. Treatment regimens that contained rifampicin (HR: 0.47; 95% CI: 0.33–0.68; P < .0001) were associated with improved survival.

CONCLUSIONS: Negative reaction to TST is highly predictive of death among children with active TB. In children with clinical and radiographic findings suggestive of TB, a negative TST should not preclude or delay anti-TB therapy.

KEY WORDS

pediatrics
childhood tuberculosis
tuberculin skin testing
mortality
global health

Accepted March 30, 2012.

· Abstract 18 of 61Article

Economic Evaluation of Strategies to Reduce Sudden Cardiac Death in Young Athletes

OBJECTIVE: There is controversy about appropriate methods to reduce sudden cardiac death (SCD) in young athletes, but there is limited evidence on costs or consequences of alternative strategies. The objective of this study was to evaluate the cost-effectiveness of adding electrocardiogram (ECG) screening to the currently standard practice of preparticipation history and physical examination (H&P) to reduce SCD.

METHODS: Decision analysis modeling by using a societal perspective, with annual Markov cycles from age 14 until death. Three screening strategies were evaluated: (1) H&P, with cardiology referral if abnormal (current standard practice); (2) H&P, plus ECG after negative H&P, and cardiology referral if either is abnormal; and (3) ECG only, with cardiology referral if abnormal. Children identified with SCD-associated cardiac abnormalities were restricted from sports and received cardiac treatment. Main outcome measures were costs of screening and treatment, quality-adjusted life years (QALYs), and premature deaths averted.

RESULTS: Relative to strategy 1, incremental cost-effectiveness is $68 800/QALY for strategy 2 and $37 700/QALY for strategy 3. Monte Carlo simulation revealed the chance of incremental cost-effectiveness compared with strategy 1 was 30% for strategy 2 and 66% for strategy 3 (assumed willingness to pay ≤$50 000/QALY). Compared with strategy 1, strategy 2 averted 131 additional SCDs at $900 000 per case, and strategy 3 averted 127 SCDs at $600 000 per case.

CONCLUSIONS: Under a societal willingness to pay threshold of $50 000/QALY, adding ECGs to current preparticipation evaluations for athletes is not cost-effective, with costs driven largely by false-positive findings.

KEY WORDS

cost-effectiveness
ECG screening
sudden death

Accepted March 23, 2012.

· Abstract 19 of 61Article

Prevalence and Correlates of Low Fundamental Movement Skill Competency in Children

OBJECTIVE: To describe the demographic and health-related characteristics of school-aged children with low competency in fundamental movement skills (FMS).

METHODS: Cross-sectional representative school-based survey of Australian elementary and high school students (n = 6917) conducted in 2010. Trained field staff measured students’ height, weight, and assessed FMS and cardiorespiratory endurance (fitness). Information on students’ demographics and physical activity was collected by questionnaire.

RESULTS: Overall, the prevalence of students with low motor skill competency was high. Girls with low socioeconomic status (SES) were twice as likely to be less competent in locomotor skills compared with high SES peers. Among boys, there was a strong association between low competency in FMS and the likelihood of being from non–English-speaking cultural backgrounds. There was a clear and consistent association between low competency in FMS and inadequate cardiorespiratory fitness. For boys, there was a clear association between low competency in object-control skills and not meeting physical activity recommendations. Conversely, the odds of being inactive were double among girls who had low competency in locomotor skills.

CONCLUSIONS: Low competency in FMS is strongly associated with lower cardiorespiratory fitness and physical activity levels in children and adolescents. The characteristics of students with competency in FMS differ by gender and skills types and show that interventions need to target girls from low SES backgrounds and boys from non–English-speaking cultural backgrounds. The high prevalence of low competency in FMS among Grade 4 students indicates that FMS interventions need to start during the preschool and early school years.

KEY WORDS

fundamental movement skills
fitness
physical activity
ethnicity
BMI

Accepted April 5, 2012.

· Abstract 20 of 61Article

Physical Punishment and Mental Disorders: Results From a Nationally Representative US Sample

BACKGROUND: The use of physical punishment is controversial. Few studies have examined the relationship between physical punishment and a wide range of mental disorders in a nationally representative sample. The current research investigated the possible link between harsh physical punishment (ie, pushing, grabbing, shoving, slapping, hitting) in the absence of more severe child maltreatment (ie, physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, exposure to intimate partner violence) and Axis I and II mental disorders.

METHODS: Data were from the National Epidemiologic Survey on Alcohol and Related Conditions collected between 2004 and 2005 (N = 34 653). The survey was conducted with a representative US adult population sample (aged ≥20 years). Statistical methods included logistic regression models and population-attributable fractions.

RESULTS: Harsh physical punishment was associated with increased odds of mood disorders, anxiety disorders, alcohol and drug abuse/dependence, and several personality disorders after adjusting for sociodemographic variables and family history of dysfunction (adjusted odds ratio: 1.36–2.46). Approximately 2% to 5% of Axis I disorders and 4% to 7% of Axis II disorders were attributable to harsh physical punishment.

CONCLUSIONS: Harsh physical punishment in the absence of child maltreatment is associated with mood disorders, anxiety disorders, substance abuse/dependence, and personality disorders in a general population sample. These findings inform the ongoing debate around the use of physical punishment and provide evidence that harsh physical punishment independent of child maltreatment is related to mental disorders.

KEY WORDS

child abuse
child neglect
mental disorders
mental health
personality disorders

Accepted April 2, 2012.

· Abstract 21 of 61Article

Prevalence of Abusive Injuries in Siblings and Household Contacts of Physically Abused Children

OBJECTIVE: Siblings and other children who share a home with a physically abused child are thought to be at high risk for abuse, but rates of injury in these contact children are unknown and screening of contacts is highly variable. Our objective was to determine the prevalence of abusive injuries identified by a common screening protocol among contacts of physically abused children.

METHODS: This is an observational, multicenter cross-sectional study of children evaluated for physical abuse, and their contacts, by 20 US child abuse teams who used a common screening protocol for the contacts of physically abused children with serious injuries. Contacts underwent physical examination if they were <5 years old, physical examination and skeletal survey (SS) if they were <24 months old, and physical examination, SS, and neuroimaging if they were <6 months old.

RESULTS: Protocol-indicated SS identified at least 1 abusive fracture in 16 of 134 contacts (11.9%, 95% confidence interval [CI] 7.5–18.5) <24 months of age. None of these fractures had associated findings on physical examination. No injuries were identified by neuroimaging in 19 of 25 eligible contacts (0.0%, 95% CI 0.0–13.7). Twins were at substantially increased risk of fracture relative to nontwin contacts (odds ratio 20.1, 95% CI 5.8–69.9).

CONCLUSIONS: SS should be obtained in the contacts of injured, abused children for contacts who are <24 months old, regardless of physical examination findings. Twins are at higher risk of abusive fractures relative to nontwin contacts.

KEY WORDS

abuse
siblings
skeletal survey
screening

Accepted March 27, 2012.

· Abstract 22 of 61Article

Adolescent Dating Violence: A National Assessment of School Counselors’ Perceptions and Practices

BACKGROUND AND OBJECTIVES: Adolescent dating violence (ADV) is a significant public health problem that, according to various estimates, affects 9% to 34% of adolescents in the United States. Schools can play an important role in preventing ADV. However, little is known about school personnel\x{2019}s practices and perceptions regarding ADV. This study assessed high school counselors' knowledge, training, perceptions, and practices on dealing with ADV incidents.

METHODS: A national random sample (n = 550) of high school counselors who were members of the American School Counselors Association were sent a valid and reliable questionnaire on ADV. A 3-wave mailing procedure was used to increase the response rate, which was 58%. Statistically significant differences (P < .05) were calculated by using t tests, χ² tests, analysis of variance, and logistic regression.

RESULTS: A majority of the school counselors reported that they did not have a protocol in their schools to respond to an incident of ADV (81.3%). Additionally, the majority (90%) of counselors reported that in the past 2 years, training to assist survivors of teen dating abuse has not been provided to personnel in their schools, their school did not conduct periodic student surveys that include questions on teen dating abuse behaviors (83%), and their school did not have a committee that meets periodically to address health and safety issues that include teen dating abuse (76%).

CONCLUSIONS: The results of this study indicate that schools do not find ADV a high-priority issue to be addressed in their student populations.

KEY WORDS

adolescent
dating
violence
school
prevention

Accepted April 10, 2012.

· Abstract 23 of 61Article

Respiratory Tract Illnesses During the First Year of Life: Effect of Dog and Cat Contacts

OBJECTIVES: To investigate the effect of dog and cat contacts on the frequency of respiratory symptoms and infections during the first year of life.

METHODS: In this birth cohort study, 397 children were followed up from pregnancy onward, and the frequency of respiratory symptoms and infections together with information about dog and cat contacts during the first year of life were reported by using weekly diaries and a questionnaire at the age of 1 year. All the children were born in eastern or middle Finland between September 2002 and May 2005.

RESULTS: In multivariate analysis, children having dogs at home were healthier (ie, had fewer respiratory tract symptoms or infections) than children with no dog contacts (adjusted odds ratio, [aOR]: 1.31; 95% confidence interval [CI]: 1.13–1.52). Furthermore, children having dog contacts at home had less frequent otitis (aOR: 0.56; 95% CI: 0.38–0.81) and tended to need fewer courses of antibiotics (aOR: 0.71; 95% CI: 0.52–0.96) than children without such contacts. In univariate analysis, both the weekly amount of contact with dogs and cats and the average yearly amount of contact were associated with decreased respiratory infectious disease morbidity.

CONCLUSIONS: These results suggest that dog contacts may have a protective effect on respiratory tract infections during the first year of life. Our findings support the theory that during the first year of life, animal contacts are important, possibly leading to better resistance to infectious respiratory illnesses during childhood.

KEY WORDS

cat
dog
pets
respiratory infections

Accepted April 5, 2012.

· Abstract 24 of 61Article

Influence of Smoking Cues in Movies on Children’s Beliefs About Smoking

OBJECTIVE: Experimental research has revealed that short exposure to movie smoking affects beliefs about smoking in adolescents. In this study, we tested that association in children.

METHODS: In 2 experiments, participants were exposed to either a cartoon or family-oriented movie and randomly assigned to 20-minute segments with or without smoking characters. Data collection took place at elementary schools. A total of 101 children (8–10 years; 47.5% boys) were exposed to a cartoon, and in a second experiment, 105 children (8–11 years; 56.2% boys) were exposed to a family-oriented movie. Beliefs about smoking (assessed by questionnaire) and implicit associations toward smoking (single target implicit association task) were assessed after watching the movie.

RESULTS: The majority of both samples of children viewed smoking unfavorably. Exposure to movie smoking had no effect on implicit associations toward smoking when experiments were analyzed separately or if the results were combined. For smoking beliefs, effects were again small and only statistically significant for social norms regarding smoking.

CONCLUSIONS: Short-term exposure to smoking in cartoon and family-oriented movies had little immediate impact on beliefs about smoking in preadolescent children, but a significant cumulative impact on norms cannot be ruled out.

KEY WORDS

children
smoking beliefs
implicit associations toward smoking
movie
smoking

Accepted April 16, 2012.

· Abstract 25 of 61Article

Influence of Motion Picture Rating on Adolescent Response to Movie Smoking

OBJECTIVE: To examine the association between movie smoking exposure (MSE) and adolescent smoking according to rating category.

METHODS: A total of 6522 US adolescents were enrolled in a longitudinal survey conducted at 8-month intervals; 5503 subjects were followed up at 8 months, 5019 subjects at 16 months, and 4575 subjects at 24 months. MSE was estimated from 532 recent box-office hits, blocked into 3 Motion Picture Association of America rating categories: G/PG, PG-13, and R. A survival model evaluated time to smoking onset.

RESULTS: Median MSE in PG-13–rated movies was ∼3 times higher than median MSE from R-rated movies, but their relation with smoking was essentially the same, with adjusted hazard ratios of 1.49 (95% confidence interval [CI]: 1.23–1.81) and 1.33 (95% CI: 1.23–1.81) for each additional 500 occurrences of MSE respectively. MSE from G/PG-rated movies was small and had no significant relationship with adolescent smoking. Attributable risk estimates showed that adolescent smoking would be reduced by 18% (95% CI: 14–21) if smoking in PG-13–rated movies was reduced to the fifth percentile. In comparison, making all parents maximally authoritative in their parenting would reduce adolescent smoking by 16% (95% CI: 12–19).

CONCLUSIONS: The equivalent effect of PG-13-rated and R-rated MSE suggests it is the movie smoking that prompts adolescents to smoke, not other characteristics of R-rated movies or adolescents drawn to them. An R rating for movie smoking could substantially reduce adolescent smoking by eliminating smoking from PG-13 movies.

KEY WORDS

adolescent smoking
motion picture rating
movie smoking

Accepted April 16, 2012.

· Abstract 26 of 61Article

Hypoxic and Hypercapnic Events in Young Infants During Bed-sharing

OBJECTIVES: To identify desaturation events (arterial oxygen saturation [Sao₂] <90%) and rebreathing events (inspired carbon dioxide (CO₂) >3%), in bed-sharing (BS) versus cot-sleeping (CS) infants.

METHODS: Forty healthy, term infants, aged 0 to 6 months who regularly bed-shared with at least 1 parent >5 hours per night and 40 age-matched CS infants were recruited. Overnight parent and infant behavior (via infrared video), Sao₂, inspired CO₂ around the infant’s face, and body temperature were recorded during sleep at home.

RESULTS: Desaturation events were more common in BS infants (risk ratio = 2.17 [95% confidence interval: 1.75 to 2.69]), associated partly with the warmer microenvironment during BS. More than 70% of desaturations in both groups were preceded by central apnea of 5 to 10 seconds with no accompanying bradycardia, usually in active sleep. Apnea >15 seconds was rare (BS infants: 3 events; CS infants: 6 events), as was desaturation <80% (BS infants: 3 events; CS infants: 4 events). Eighty episodes of rebreathing were identified from 22 BS infants and 1 CS infant, almost all preceded by head covering. During rebreathing, Sao₂ was maintained at the baseline of 97.6%.

CONCLUSIONS: BS infants experienced more oxygen desaturations preceded by central apnea, partly related to the warmer microenvironment. Rebreathing occurred mainly during bed-sharing. Infants were at low risk of sudden infant death syndrome and maintained normal oxygenation. The effect of repeated exposure to oxygen desaturation in vulnerable infants is unknown as is the ability of vulnerable infants to respond effectively to rebreathing caused by head covering.

KEY WORDS

co-sleeping
infant
oxygen desaturation
rebreathing
thermoregulation
sudden infant death syndrome
sleep

Accepted April 20, 2012.

· Abstract 27 of 61Article

Child and Adolescent Abuse in Relation to Obesity in Adulthood: The Black Women’s Health Study

OBJECTIVE: To investigate the association of physical and sexual abuse in childhood and adolescence with risk of adult obesity among black women in the United States.

METHODS: Participants were women enrolled in the Black Women’s Health Study, an ongoing prospective cohort study begun in 1995. In 2005, 33 298 participants completed a self-administered questionnaire on early life experiences of abuse. Log-binomial regression models were used to derive risk ratios (RRs) and 95% confidence intervals (CIs) for the relation of child/teenager abuse with obesity (BMI ≥30) and central adiposity (waist circumference >35 inches) reported in 2005.

RESULTS: The RR for BMI ≥30, a measure of overall obesity, was 1.29 (95% CI 1.20–1.38) for the highest severity of exposure to child/teenager physical and sexual abuse relative to no abuse. After controlling for postulated intermediates, including reproductive history, diet, physical activity, depressive symptoms, and socioeconomic status, the RR was 1.14 (95% CI 1.08–1.21). The RR for waist circumference >35 inches, which measures central obesity, for severe physical and sexual abuse relative to no abuse was 1.29 (95% CI 1.19–1.38) before adjustment for intermediates and 1.18 (95% CI 1.10–1.27) after adjustment.

CONCLUSIONS: Early life sexual and physical abuse was associated with an increased risk of overall and central obesity in adulthood. Although the association between abuse and obesity was explained to some extent by health behaviors, reproductive history, and mental health, these factors did not fully account for the associations. Our data suggest that early life adversity is related to adult body size and weight distribution.

KEY WORDS

obesity
violence
adversity
child abuse
African American

Accepted March 27, 2012.

· Abstract 28 of 61Article

Food Insecurity and Obesogenic Maternal Infant Feeding Styles and Practices in Low-Income Families

OBJECTIVES: We explored the relationship between household food insecurity and maternal feeding styles, infant feeding practices, and perceptions and attitudes about infant weight in low-income mothers.

METHODS: Mothers participating in the Special Supplemental Food Program for Women, Infants, and Children with infants aged between 2 weeks and 6 months were interviewed. By using regression analyses, the following relationships were examined between food insecurity and: (1) controlling feeding styles (restrictive and pressuring); (2) infant feeding practices, including breastfeeding, juice consumption, and adding cereal to the bottle; and (3) perceptions and attitudes about infant weight. Path analysis was used to determine if perceptions and attitudes about infant weight mediated the relationships between food insecurity and controlling feeding styles.

RESULTS: The sample included 201 mother–infant pairs, with 35% reporting household food insecurity. Food-insecure mothers were more likely to exhibit restrictive (B [SE]: 0.18 [0.08]; 95% confidence interval [CI]: 0.02–0.34) and pressuring (B [SE]: 0.11 [0.06]; 95% CI: 0.001–0.22) feeding styles compared with food-secure mothers. No associations were found with feeding practices. Concern for their infant becoming overweight in the future was associated with food insecurity (adjusted odds ratio: 2.11 [95% CI: 1.02–4.38]). This concern mediated the relationship between food insecurity and both restrictive (P = .009) and pressuring (P = .01) feeding styles.

CONCLUSIONS: Increased concern about future overweight and controlling feeding styles represent potential mechanisms by which food insecurity could be related to obesity. Obesity prevention should aim to decrease food insecurity and to reduce controlling feeding styles in families who remain food insecure.

KEY WORDS

feeding
food insecurity
Hispanic
infant
pressure to eat
restriction

Accepted March 27, 2012.

· Abstract 29 of 61Article

Long-term Clinical Outcome After Lyme Neuroborreliosis in Childhood

OBJECTIVES: To determine long-term clinical outcome in children with confirmed Lyme neuroborreliosis (LNB) and to evaluate persistent subjective symptoms compared with a control group.

METHODS: After a median of 5 years, 84 children with confirmed LNB underwent a neurologic re-examination, including a questionnaire. Medical records were analyzed, and a control group (n = 84) was included.

RESULTS: The total recovery rate was 73% (n = 61). Objective neurologic findings, defined as “definite sequelae,” were found in 16 patients (19%). The majority of these children had persistent facial nerve palsy (n = 11), but other motor or sensory deficits occurred (n = 5). Neurologic signs and/or symptoms defined as “possible sequelae” were found in another 7 patients (8%), mainly of sensory character. Nonspecific subjective symptoms were reported by 35 patients (42%) and 32 controls (38%) (nonsignificant). Affected daily activities or school performance were reported to the same extent in both groups (23% vs 20%, nonsignificant).

CONCLUSIONS: The long-term clinical recovery rate was 73% in children with confirmed LNB. Persistent facial nerve palsy occurred in 13%, whereas other motor or sensory deficits were found in another 14%. Neurologic deficits did not affect daily activities or school performance more often among patients than controls and should be considered as mild. Furthermore, nonspecific subjective symptoms such as headache, fatigue, or memory or concentration problems were reported as often among patients as controls and should not be considered as sequelae after LNB.

KEY WORDS

Lyme borreliosis
neuroborreliosis
children
clinical outcome
sequelae
facial nerve palsy
persistent symptoms

Accepted April 13, 2012.

· Abstract 30 of 61Article

The Differential Impact of Delivery Hospital on the Outcomes of Premature Infants

BACKGROUND: Because greater percentages of women deliver at hospitals without high-level NICUs, there is little information on the effect of delivery hospital on the outcomes of premature infants in the past 2 decades, or how these effects differ across states with different perinatal regionalization systems.

METHODS: A retrospective population-based cohort study was constructed of all hospital-based deliveries in Pennsylvania and California between 1995 and 2005 and Missouri between 1995 and 2003 with a gestational age between 23 and 37 weeks (N = 1 328 132). The effect of delivery at a high-level NICU on in-hospital death and 5 complications of premature birth was calculated by using an instrumental variables approach to control for measured and unmeasured differences between hospitals.

RESULTS: Infants who were delivered at a high-level NICU had significantly fewer in-hospital deaths in Pennsylvania (7.8 fewer deaths/1000 deliveries, 95% confidence interval [CI] 4.1–11.5), California (2.7 fewer deaths/1000 deliveries, 95% CI 0.9–4.5), and Missouri (12.6 fewer deaths/1000 deliveries, 95% CI 2.6–22.6). Deliveries at high-level NICUs had similar rates of most complications, with the exception of lower bronchopulmonary dysplasia rates at Missouri high-level NICUs (9.5 fewer cases/1000 deliveries, 95% CI 0.7–18.4) and higher infection rates at high-level NICUs in Pennsylvania and California. The association between delivery hospital, in-hospital mortality, and complications differed across the 3 states.

CONCLUSIONS: There is benefit to neonatal outcomes when high-risk infants are delivered at high-level NICUs that is larger than previously reported, although the effects differ between states, which may be attributable to different methods of regionalization.

KEY WORDS

perinatal regionalization
premature infant
delivery hospital

Accepted April 2, 2012.

· Abstract 31 of 61Article

The Prevalence and Course of Idiopathic Toe-Walking in 5-Year-Old Children

BACKGROUND: Children walking on their toes instead of with a typical gait, without evidence of an underlying medical condition, are defined as idiopathic toe-walkers. The prevalence of idiopathic toe-walking is unknown.

METHODS: A cross-sectional prevalence study of 5.5-year-old children (n = 1436) living in Blekinge County, Sweden, was performed at the regular 5.5-year visit to the local child welfare center. Children were assessed for a history of toe-walking or whether they still walked on their toes. Additionally, all 5.5-year-old children (n = 35) admitted to the clinic for children with special needs in the county were assessed.

RESULTS: Of the 1436 children in the cohort (750 boys, 686 girls), 30 children (2.1%, 20 boys and 10 girls) still walked on their toes at age 5.5 years and were considered as active toe-walkers. Forty children (2.8%, 22 boys and 18 girls) had previously walked on their toes but had stopped before the 5.5-year visit and were considered as inactive toe-walkers. At age 5.5 years, the total prevalence of toe-walking was 70 (4.9%) of 1436. For children with a neuropsychiatric diagnosis or developmental delay, the total prevalence for active or inactive toe-walking was 7 (41.2%) of 17.

CONCLUSIONS: This study establishes the prevalence and- early spontaneous course of idiopathic toe-walking in 5.5-year-old children. At this age, more than half of the children have spontaneously ceased to walk on their toes. The study confirms earlier findings that toe-walking has a high prevalence among children with a cognitive disorder.

KEY WORDS

idiopathic toe-walking
prevalence
children
natural course
cognitive disorder

Accepted April 13, 2012.

· Abstract 32 of 61Article

Pediatric Versus Adult Drug Trials for Conditions With High Pediatric Disease Burden

BACKGROUND AND OBJECTIVE: Optimal treatment decisions in children require sufficient evidence on the safety and efficacy of pharmaceuticals in pediatric patients. However, there is concern that not enough trials are conducted in children and that pediatric trials differ from those performed in adults. Our objective was to measure the prevalence of pediatric studies among clinical drug trials and compare trial characteristics and quality indicators between pediatric and adult drug trials.

METHODS: For conditions representing a high burden of pediatric disease, we identified all drug trials registered in ClinicalTrials.gov with start dates between 2006 and 2011 and tracked the resulting publications. We measured the proportion of pediatric trials and subjects for each condition and compared pediatric and adult trial characteristics and quality indicators.

RESULTS: For the conditions selected, 59.9% of the disease burden was attributable to children, but only 12.0% (292/2440) of trials were pediatric (P < .001). Among pediatric trials, 58.6% were conducted without industry funding compared with 35.0% of adult trials (P < .001).

Fewer pediatric compared with adult randomized trials examined safety outcomes (10.1% vs 16.9%, P = .008). Pediatric randomized trials were slightly more likely to be appropriately registered before study start (46.9% vs 39.3%, P = .04) and had a modestly higher probability of publication in the examined time frame (32.8% vs 23.2%, P = .04).

CONCLUSIONS: There is substantial discrepancy between pediatric burden of disease and the amount of clinical trial research devoted to pediatric populations. This may be related in part to trial funding, with pediatric trials relying primarily on government and nonprofit organizations.

KEY WORDS

clinical trials
evidence-based medicine
pediatrics
medication use
research subjects

Accepted April 5, 2012.

· Abstract 33 of 61Article

The Experience of Families With Children With Trisomy 13 and 18 in Social Networks

BACKGROUND: Children with trisomy 13 and trisomy 18 (T13-18) have low survival rates and survivors have significant disabilities. For these reasons, interventions are generally not recommended by providers. After a diagnosis, parents may turn to support groups for additional information.

METHODS: We surveyed parents of children with T13-18 who belong to support groups to describe their experiences and perspectives.

RESULTS: A total of 503 invitations to participate were sent and 332 questionnaires were completed (87% response rate based on site visits, 67% on invitations sent) by parents about 272 children. Parents reported being told that their child was incompatible with life (87%), would live a life of suffering (57%), would be a vegetable (50%), or would ruin their family (23%). They were also told by some providers that their child might have a short meaningful life (60%), however. Thirty percent of parents requested “full” intervention as a plan of treatment. Seventy-nine of these children with full T13-18 are still living, with a median age of 4 years. Half reported that taking care of a disabled child is/was harder than they expected. Despite their severe disabilities, 97% of parents described their child as a happy child. Parents reported these children enriched their family and their couple irrespective of the length of their lives.

CONCLUSIONS: Parents who engage with parental support groups may discover an alternative positive description about children with T13-18. Disagreements about interventions may be the result of different interpretations between families and providers about the experiences of disabled children and their quality of life.

KEY WORDS

trisomy 13
trisomy 18
life-sustaining interventions
quality of life
parental opinions
ethics
end of life decision-making

Accepted April 17, 2012.

· Abstract 34 of 61Article

Family Experiences and Pediatric Health Services Use Associated With Family-Centered Rounds

BACKGROUND: Family-centered rounds (FCR) are defined as interdisciplinary bedside teaching rounds with active family participation. The objective of this study was to examine the association of FCR with family experiences and health services use.

METHODS: Prospective study comparing families with a child admitted to general pediatric inpatient services with and without FCR. The presence of FCR elements was assessed before study enrollment. Study data were obtained by an in-person interview, a follow-up phone interview <1 week after discharge, and medical record review. Family outcomes were informed by Consumer Assessment of Healthcare Providers and Systems measures. Health service use outcomes included hour of discharge, number of medications, and overall charges. Primary analyses included χ² and multivariate regression. Secondary analyses by using propensity score matching were performed to account for differences on observed variables.

RESULTS: A total of 140 of 203 eligible families were enrolled; 97 completed follow-up surveys (49 on FCR team). Compared with non-FCR, FCR families were more likely to report consistent medical information (P < .001), the option of discussing care plan (P < .001), doctors listening carefully (P < .01), and doctors showing respect (P < .001). No differences were found in number of medications (mean 2.4 vs 2.9, P = .26) or discharge time (mean 3:06 pm versus 2:43 pm, P = .39). No difference was found for hospital charges after adjusting for length of stay outliers.

CONCLUSIONS: FCR are associated with higher parent satisfaction, consistent medical information, and care plan discussion, with no additional burden to health service use. Additional studies should assess FCR under different settings of care.

KEY WORDS

family-centered care
family-centered rounds

Accepted April 2, 2012.

· Abstract 35 of 61Article

Racial Disparity Trends in Children’s Dental Visits: US National Health Interview Survey, 1964–2010

BACKGROUND AND OBJECTIVE: Research that has repeatedly documented marked racial/ethnic disparities in US children’s receipt of dental care at single time points or brief periods has lacked a historical policy perspective, which provides insight into how these disparities have evolved over time. Our objective was to examine the im-pact of national health policies on African American and white children’s receipt of dental care from 1964 to 2010.

METHODS: We analyzed data on race and dental care utilization for children aged 2 to 17 years from the 1964, 1976, 1989, 1999, and 2010 National Health Interview Survey. Dependent variables were as follows: child’s receipt of a dental visit in the previous 12 months and child’s history of never having had a dental visit. Primary independent variable was race (African American/white). We calculated sample prevalences, and χ² tests compared African American/white prevalences by year. We age-standardized estimates to the 2000 US Census.

RESULTS: The percentage of African American and white children in the United States without a dental visit in the previous 12 months declined significantly from 52.4% in 1964 to 21.7% in 2010, whereas the percentage of children who had never had a dental visit declined significantly (P < .01) from 33.6% to 10.6%. Pronounced African American/white disparities in children’s dental utilization rates, whereas large and statistically significant in 1964, attenuated and became nonsignificant by 2010.

CONCLUSIONS: We demonstrate a dramatic narrowing of African American/white disparities in 2 measures of children’s receipt of dental services from 1964 to 2010. Yet, much more needs to be done before persistent racial disparities in children’s oral health status are eliminated.

KEY WORDS

children
racial disparities
dental care
NHIS

Accepted April 20, 2012.

· Abstract 36 of 61Review Article

Clinical and Radiographic Characteristics Associated With Abusive and Nonabusive Head Trauma: A Systematic Review

BACKGROUND AND OBJECTIVE: To systematically review the literature to determine which clinical and radiographic characteristics are associated with abusive head trauma (AHT) and nonabusive head trauma (nAHT) in children.

METHODS: We searched MEDLINE, EMBASE, PubMed, conference proceedings, and reference lists to identify relevant studies. Two reviewers independently selected studies that compared clinical and/or radiographic characteristics including historical features, physical exam and imaging findings, and presenting signs or symptoms in hospitalized children ≤6 years old with AHT and nAHT.

RESULTS: Twenty-four studies were included. Meta-analysis was complicated by inconsistencies in the reporting of characteristics and high statistical heterogeneity. Notwithstanding these limitations, there were 19 clinical and radiographic variables that could be meta-analyzed and odds ratios were determined for each variable. In examining only studies deemed to be high quality, we found that subdural hemorrhage(s), cerebral ischemia, retinal hemorrhage(s), skull fracture(s) plus intracranial injury, metaphyseal fracture(s), long bone fracture(s), rib fracture(s), seizure(s), apnea, and no adequate history given were significantly associated with AHT. Epidural hemorrhage(s), scalp swelling, and isolated skull fracture(s) were significantly associated with nAHT. Subarachnoid hemorrhage(s), diffuse axonal injury, cerebral edema, head and neck bruising, any bruising, and vomiting were not significantly associated with either type of trauma.

CONCLUSIONS: Clinical and radiographic characteristics associated with AHT and nAHT were identified, despite limitations in the literature. This systematic review also highlights the need for consistent criteria in identifying and reporting clinical and radiographic characteristics associated with AHT and nAHT.

KEY WORDS

abusive head trauma
head injury
children
abuse
systematic review

Accepted April 9, 2012.

· Abstract 37 of 61State-of-the-Art Review Article

Tonsillectomy Care for the Pediatrician

Pediatricians play an important role in the perioperative care of hospitalized children after tonsillectomy and are often called upon to manage posttonsillectomy problems in the outpatient setting. The tonsillectomy operation has changed in recent years. More children are operated upon for sleep disordered breathing and fewer for recurrent pharyngitis. New instruments now permit less invasive surgery. Systematic reviews by the Cochrane Collaboration and others have helped define best practices for preoperative assessment and postoperative care. This article will outline these practices as defined in the 2011 American Academy of Otolaryngology–Head and Neck Surgery Foundation clinical practice guideline “Tonsillectomy in Children.” It will describe the different tonsillectomy operations, discuss patterns of normal healing, and review management of pain and posttonsillectomy hemorrhage to form a foundation for improved pediatric care.

KEY WORDS

adenotonsillectomy
complications
pain management
tonsillectomy
wound healing

Accepted March 30, 2012.

· Abstract 38 of 61Special Article

Council of Pediatric Subspecialties (CoPS): The First Five Years

The Council of Pediatric Subspecialties (CoPS) was founded in September 2006 largely due to concerns about the nonuniformity of the fellowship application process. Working with the pediatric subspecialty community, CoPS has been successful in promoting a uniform process with many more pediatric fellowship programs now using a matching program and the Electronic Residency Application Service. More important, the organization has created a bidirectional network of communication among the pediatric subspecialties and has used this to accomplish a great deal more than improving the entry of residents into subspecialty training. CoPS has provided a united voice for the subspecialties in response to the Institute of Medicine’s Duty Hours report, participated in the development of educational conferences geared toward the subspecialist, promoted careers in the subspecialties, and worked with other pediatric organizations to advocate for improved health care for children. This article highlights CoPS’ many achievements and describes the methods it used to accomplish them, illustrating how pediatric subspecialists can develop a communication network and use this to work together to achieve common goals.

KEY WORDS

CoPS
Council of Pediatric Subspecialties
pediatrics
pediatric subspecialties

Accepted April 10, 2012.

· Abstract 39 of 61Special Article

Choriophobia: A 1-Act Play

The management of a newborn born to a mother with chorioamnionitis is controversial. By using data collected on neonates born in the era of routine maternal screening for Group B Streptococcus, we calculate that the risk of early-onset sepsis in a hypothetical infant born at term to a mother with chorioamnionitis, who has a normal physical examination at birth, is likely substantially <1% if the mother’s screen for Group B Streptococcus was negative. This low rate of sepsis calls into question current guidelines recommending treatment of all such newborns with intravenous antibiotics for 48 hours pending the results of a blood culture. Current guidelines for the management of infants born to mothers with chorioamnionitis also raise an important ethical issue; the recommendation to treat these infants with intravenous antibiotics is, in essence, a de facto determination of what constitutes unacceptable risk to the newborn. We argue that this determination is ultimately value-based and therefore requires broader deliberation than that which frequently occurs among medical experts who develop medical guidelines.

KEY WORDS

Streptococcus agalactiae
infant
newborn
chorioamnionitis
bioethics

Accepted March 27, 2012.

· Abstract 40 of 61Special Article

USPSTF Perspective on Evidence-Based Preventive Recommendations for Children

The development and use of evidence-based recommendations for preventive care by primary care providers caring for children is an ongoing challenge. This issue is further complicated by the fact that a higher proportion of recommendations by the US Preventive Services Task Force (USPSTF) for pediatric preventive services in comparison with adult services have insufficient evidence to recommend for or against the service. One important root cause for this problem is the relative lack of high quality screening and counseling studies in pediatric primary care settings. The paucity of studies limits the development of additional evidence-based guidelines to enhance best practices for pediatric and adolescent conditions. In this article, we describe the following: (1) evidence-based primary care preventive services as a strategy for addressing important pediatric morbidities, (2) the process of making evidence-based screening recommendations by the USPSTF, (3) the current library of USPSTF recommendations for children and adolescents, and (4) factors influencing the use of USPSTF recommendations and other evidence-based guidelines by clinicians. Strategies to accelerate the implementation of evidence-based services and areas of need for future research to fill key gaps in evidence-based recommendations and guidelines are highlighted.

KEY WORDS

clinical preventive services
children
adolescents
evidence-based practice
primary care
guidelines
research

Accepted May 3, 2012.

· Abstract 41 of 61Special Article

FDA’s Health Claim Review: Whey-protein Partially Hydrolyzed Infant Formula and Atopic Dermatitis

In this review, we explain how the US Food and Drug Administration (FDA) used its evidence-based review system to evaluate the scientific evidence for a qualified health claim for 100% whey-protein partially hydrolyzed infant formula (W-PHF) and reduced risk of atopic dermatitis (AD). The labeling of health claims, including qualified health claims, on conventional foods and dietary supplements require premarket approval by the FDA. Health claims characterize the relationship between a substance (food or food component) and disease (eg, cancer or cardiovascular disease) or health-related condition (eg, hypertension). To determine whether sufficient evidence exists to support the qualified health claim, the FDA evaluated human intervention studies that evaluated the role of W-PHF in reducing the risk of AD. The FDA concluded there is little to very little evidence, respectively, to support a qualified health claim concerning the relationship between intake of W-PHF and a reduced risk of AD in partially breastfed and exclusively formula-fed infants throughout the first year after birth and up to 3 years of age. In addition, the FDA required a warning statement be displayed along with the health claim to indicate to consumers that partially hydrolyzed infant formulas are not hypoallergenic and should not be fed to infants who are allergic to milk or to infants with existing milk allergy symptoms.

KEY WORDS

whey-protein partially hydrolyzed infant formula
atopic dermatitis
evidence-based review
qualified health claim

Accepted April 10, 2012.

· Abstract 42 of 61Commentary

· Abstract 43 of 61Commentary

· Abstract 44 of 61Commentary

· Abstract 45 of 61Quality Report

Improving Notification of Sexually Transmitted Infections: A Quality Improvement Project and Planned Experiment

BACKGROUND AND OBJECTIVE: Inadequate follow-up of positive sexually transmitted infection (STI) test results is a gap in health care quality that contributes to the epidemic of STIs in adolescent women. The goal of this study was to improve our ability to contact adolescent women with positive STI test results after an emergency department visit.

METHODS: We conducted an interventional quality improvement project at a pediatric emergency department. Phase 1 included plan-do-study-act cycles to test interventions such as provider education and system changes. Phase 2 was a planned experiment studying 2 interventions (study cell phone and patient activation card), using a 2 × 2 factorial design with 1 background variable and 2 replications. Outcomes were: (1) the proportion of women aged 14 to 21 years with STI testing whose confidential telephone number was documented in the electronic medical record; (2) the proportion of STI positive women successfully contacted within 7 days.

RESULTS: Phase 1 interventions increased the proportion of records with a confidential number from 24% to 58% and the proportion contacted from 45% to 65%, and decreased loss to follow-up from 40% to 24%. In phase 2, the proportion contacted decreased after the electronic medical record system changed and recording of the confidential number decreased. Study interventions (patient activation card and study cell phone) had a synergistic effect on successful contact, especially when confidential numbers were less reliably documented.

CONCLUSIONS: Feasible and sustainable interventions such as improved documentation of a confidential number worked synergistically to increase our ability to successfully contact adolescent women with their STI test results.

KEY WORDS

adolescent sexual behavior
outcomes research
quality improvement
sexually transmitted infection

Accepted March 19, 2012.

· Abstract 46 of 61Quality Report

Quality Improvement Initiative to Reduce Serious Safety Events and Improve Patient Safety Culture

BACKGROUND AND OBJECTIVE: Many thousands of patients die every year in the United States as a result of serious and largely preventable safety events or medical errors. Safety events are common in hospitalized children. We conducted a quality improvement initiative to implement cultural and system changes with the goal of reducing serious safety events (SSEs) by 80% within 4 years at our large, urban pediatric hospital.

METHODS: A multidisciplinary SSE reduction team reviewed the safety literature, examined recent SSEs, interviewed internal leaders, and visited other leading organizations. Senior hospital leaders provided oversight, monitored progress, and helped to overcome barriers. Interventions focused on: (1) error prevention; (2) restructuring patient safety governance; (3) a new root cause analysis process and a common cause database; (4) a highly visible lessons learned program; and (5) specific tactical interventions for high-risk areas. Our outcome measures were the rate of SSEs and the change in patient safety culture.

RESULTS: SSEs per 10 000 adjusted patient-days decreased from a mean of 0.9 at baseline to 0.3 (P < .0001). The days between SSEs increased from a mean of 19.4 at baseline to 55.2 (P < .0001). After a worsening of patient safety culture outcomes in the first year of intervention, significant improvements were observed between 2007 and 2009.

CONCLUSIONS: Our multifaceted approach was associated with a significant and sustained reduction of SSEs and improvements in patient safety culture. Multisite studies are needed to better understand contextual factors and the significance of specific interventions.

KEY WORDS

patient safety
quality improvement
safety culture

Accepted March 14, 2012.

· Abstract 47 of 61Case Report

Delayed-Onset Seizure and Cardiac Arrest After Amitriptyline Overdose, Treated With Intravenous Lipid Emulsion Therapy

In recent years, intravenous lipid emulsion (ILE) therapy has emerged as a new rescue antidote for treatment of certain toxicities, including cyclic antidepressants, and as the primary treatment of toxic manifestations after local anesthetic exposure. We present a case of a 13-year-old girl who developed delayed seizures and cardiac arrest after amitriptyline ingestion. As part of the treatment, she was treated with ILE therapy. The patient's laboratories were not interpretable for several hours after the lipid emulsion. The patient developed pancreatitis after the ILE therapy. This case is unique; not only is it one of the first reported cases of lipid emulsion being used in a pediatric patient, but in that the patient developed delayed toxicity and iatrogenic harm from the ILE.

KEY WORDS

amitriptyline
pancreatitis
TCA
lipid
cardiac arrest

Accepted March 8, 2012.

· Abstract 48 of 61Case Report

Primary Sex Headache in Adolescents

Primary headache associated with sexual activity is a rare headache disorder that has only been reported twice previously in adolescents. Although it can mimic life-threatening causes of thunderclap-onset headache, primary sex headache is benign, self-limited, and highly responsive to indomethacin. Given the sensitive nature of sexual development in adolescents, it is important that pediatric providers know when to ask about this symptom and how to proceed with diagnostics and therapy when it arises. We report 2 new adolescent cases and review the semiology, epidemiology, and treatment of primary sex headache.

KEY WORDS

migraine
primary sex headache
adolescent
sexual development

Accepted February 29, 2012.

· Abstract 49 of 61Case Report

Inhaled Prostacyclin and High-Frequency Oscillatory Ventilation in a Premature Infant With Respiratory Syncytial Virus–Associated Respiratory Failure

In a 29-day-old premature infant with respiratory syncytial virus (RSV) pneumonia, we have shown an additive effect of high-frequency oscillatory ventilation (HFOV) and continuous inhalation of prostacyclin (iPGI₂) with improvement of ventilation and oxygenation. The addition of continuous inhaled iPGI₂ to HFOV was beneficial in the treatment of hypoxemic respiratory failure owing to RSV-associated pneumonia. The improvement in alveolar recruitment by increasing lung expansion by HFOV along with less ventilation-perfusion mismatch by iPGI₂ appears to be responsible for the synergistic effect and favorable clinical outcome. We conclude that the combined therapy of HFOV and continuous inhaled iPGI₂ may be considered in RSV-associated hypoxemic respiratory failure in pediatric patients.

KEY WORDS

prostacyclin inhalation
respiratory failure
respiratory syncytial virus
premature infant

Accepted March 8, 2012.

· Abstract 50 of 61Case Report

Management of Plastic Bronchitis With Topical Tissue-type Plasminogen Activator

Plastic bronchitis or cast bronchitis is a rare disease of unclear etiology characterized by formation of airway casts that can lead to life-threatening airway obstruction. There is currently limited data regarding optimal treatment of plastic bronchitis. Several therapies have been suggested, but recurrences are common and mortality remains high. We report the case of a 6-year-old boy with refractory eosinophilic bronchial casts, unresponsive to low-dose systemic corticosteroids, inhaled corticosteroids, azithromycin, and dornase alfa, who was treated successfully and safely with direct instillation of tissue-type plasminogen activator (tPA) to the obstructing casts during flexible bronchoscopy and inhaled tPA. Our case illustrates that the current therapy for plastic bronchitis remains inadequate. To our knowledge, this case is the first to show that direct instillation of tPA can be used safely for treatment of this disease. The use of tPA via direct administration into the airways during bronchoscopy and via a nebulizer appeared to be a safe and effective therapy for plastic bronchitis and should be considered early in the course of the disease to prevent complications of severe airway obstruction.

KEY WORDS

cast bronchitis
plastic bronchitis
tissue plasminogen activator
bronchoscopy

Accepted February 29, 2012.

· Abstract 51 of 61Case Report

Recooling for Rebound Seizures After Rewarming in Neonatal Encephalopathy

Infants undergoing therapeutic hypothermia for hypoxic ischemic encephalopathy are at risk for rebound seizures during and after the rewarming phase. We report a term male infant who was cooled for hypoxic ischemic encephalopathy. He developed electrographic seizures for the first time during the warming phase, which continued in the hours after rewarming. The seizures stopped within 30 minutes of recooling to 33.5°C without anticonvulsant medication. He was uneventfully cooled for an additional 24 hours and then rewarmed with no recurrence of seizures. Hypothermia appeared to have an antiepileptic effect in this case and may be worthy of additional investigation as an adjunct to antiepileptic drug therapy in newborns.

KEY WORDS

seizure
therapeutic hypothermia
neonatal encephalopathy
hypoxia-ischemia

Accepted March 8, 2012.

· Abstract 52 of 61Case Report

Malonyl Coenzyme A Decarboxylase Deficiency: Early Dietary Restriction and Time Course of Cardiomyopathy

Malonyl coenzyme A (CoA) decarboxylase (MCD) deficiency is a rare autosomal recessive organic acidemia characterized by varying degrees of organ involvement and severity. MCD regulates fatty acid biosynthesis and converts malonyl-CoA to acetyl-CoA. Cardiomyopathy is 1 of the leading causes of morbidity and mortality in this disorder. It is unknown if diet alone prevents cardiomyopathy development based in published literature. We report a 10-month-old infant girl identified by newborn screening and confirmed MCD deficiency with a novel homozygous MLYCD mutation. She had normal echocardiogram measurements before transition to high medium-chain triglycerides and low long-chain triglycerides diet. Left ventricular noncompaction development was not prevented by dietary interventions. Further restriction of long-chain triglycerides and medium-chain triglycerides supplementation in combination with angiotensin-converting enzyme inhibitors helped to improve echocardiogram findings. Patient remained asymptomatic, with normal development and growth. Our case emphasizes the need for ongoing cardiac disease screening in patients with MCD deficiency and the benefits and limitations of current dietary interventions.

KEY WORDS

malonyl-CoA decarboxylase deficiency
left ventricular noncompaction
malonic acid
newborn screening
malonyl carnitine
medium-chain triglycerides
angiotensin-converting enzyme

Accepted February 29, 2012.

· Abstract 53 of 61Letter to the Editor

· Abstract 54 of 61Letter to the Editor

· Abstract 55 of 61Letter to the Editor

· Abstract 56 of 61Letter to the Editor

· Abstract 57 of 61Letter to the Editor

· Abstract 58 of 61Letter to the Editor

· Abstract 59 of 61From the American Academy of PediatricsClinical Report

Psychological Maltreatment

Psychological or emotional maltreatment of children may be the most challenging and prevalent form of child abuse and neglect. Caregiver behaviors include acts of omission (ignoring need for social interactions) or commission (spurning, terrorizing); may be verbal or nonverbal, active or passive, and with or without intent to harm; and negatively affect the child’s cognitive, social, emotional, and/or physical development. Psychological maltreatment has been linked with disorders of attachment, developmental and educational problems, socialization problems, disruptive behavior, and later psychopathology. Although no evidence-based interventions that can prevent psychological maltreatment have been identified to date, it is possible that interventions shown to be effective in reducing overall types of child maltreatment, such as the Nurse Family Partnership, may have a role to play. Furthermore, prevention before occurrence will require both the use of universal interventions aimed at promoting the type of parenting that is now recognized to be necessary for optimal child development, alongside the use of targeted interventions directed at improving parental sensitivity to a child’s cues during infancy and later parent-child interactions. Intervention should, first and foremost, focus on a thorough assessment and ensuring the child’s safety. Potentially effective treatments include cognitive behavioral parenting programs and other psychotherapeutic interventions. The high prevalence of psychological abuse in advanced Western societies, along with the serious consequences, point to the importance of effective management. Pediatricians should be alert to the occurrence of psychological maltreatment and identify ways to support families who have risk indicators for, or evidence of, this problem.

KEY WORDS

psychological maltreatment
child abuse
emotional maltreatment
neglect
verbal abuse
development

· Abstract 60 of 61From the American Academy of PediatricsPolicy Statement

· Abstract 61 of 61From the American Academy of Pediatrics

بازگشت

امروز

پنجشنبه

بهمن 1403

قمری:22 رجب 1446

میلادی:23 ژانویه 2025

آدرس پست الکترونیک :
info@ckmu.tbzmed.ac.ir

تمامی حقوق این سایت برای مرکز تحقیقات طب فیزیکی و توانبخشی محفوظ است