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Child Abuse and Neglect and Cognitive Function at Geographic Maldistribution of Primary Care for Children
14 Years of Age: Findings From a Birth Cohort Concerns about the sufficiency of the primary care workforce
Child abuse and neglect are associated with a range of have led to efforts to train more primary care physicians.
adverse outcomes including reduced academic performance. Inequitable distribution of the physician workforce, a long-
Both abuse and neglect are Independently associated with standing problem, has received less attention, particularly
reduced cognitive performance at 14 years of age. We used with respect to children.
prospective follow-up of a birth cohort, independent recording Despite pronounced growth of the primary care workforce for
of child-maltreatment reports and substantiation, and children, millions of children live in areas with insufficient
adjustment for multiple potential confounders. local supplies of primary care physicians. More-effective
policies targeting adequate geographic access to primary
care are needed.
Translation of a Pediatric Asthma-Management Program
Into a Community in Connecticut
Despite the initial release of the National Asthma Education National Trends in Visit Rates and Antibiotic Prescribing
and Prevention Program asthma guidelines in 1991, primary for Children With Acute Sinusitis
care clinicians do not adhere to the guidelines and continue to Streptococcus pneumoniae is a common cause of acute
underdiagnose and undertreat asthma in children. sinusitis and otitis media, and American Academy of
An asthma-management program was transferred to 5 Pediatrics guidelines recommend amoxicillin as the first-line
communities in Connecticut and resulted in reduced medical antibiotic therapy. Amoxicillin use for otitis media increased
services utilization. The study’s results demonstrate that after guideline publication, and visits decreased after vaccine
pediatricians can use guidelines, and, when used, guidelines introduction.
are effective in reducing medical services utilization for Office and emergency department visits for acute sinusitis
Medicaid-insured children. remained stable after vaccine introduction, whereas
amoxicillin use increased substantially, in accordance with the
guidelines. Despite the increase in amoxicillin use,
prescriptions for broad-spectrum agents, especially
macrolides, remain common and unnecessary.

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Clinical Prediction Rule for RSV Bronchiolitis in Healthy Early-Childhood Neurodevelopmental Outcomes Are
Newborns: Prognostic Birth Cohort Study Not Improving for Infants Born at <25 Weeks’
Hospitalized respiratory syncytial virus (RSV) lower Gestational Age
respiratory tract infection (LRTI) can be predicted by using Early-childhood neurodevelopmental outcomes seem to have
host and environmental factors. The impact of outpatient- improved over the last decade for some groups of preterm
treated RSV LRTI includes increased numbers of physician infants, but it is not known whether this trend applies to
visits, drug prescriptions, and parents’ missed work days. extraordinarily preterm infants who are born at ⬍25 weeks’
A simple prediction rule can identify infants at risk of estimated gestational age.
outpatient-treated RSV LRTI. The absolute risks of RSV LRTI Despite a dramatic reduction in postnatal steroid exposure,
range from 3% for children with the lowest prediction rule neurosensory and cognitive outcomes at 18 to 22 months’
score to 32% for children with all predictive factors. corrected age remain guarded and unchanged for infants who
are born at ⬍25 weeks’ estimated gestational age in the
NICHD Neonatal Research Network between 2 recent birth
Enhanced Monitoring Improves Pediatric Transport
epochs.
Outcomes: A Randomized Controlled Trial
There has been a limited amount of research in the pediatric
interfacility-transport environment. Effects of Serving High-Sugar Cereals on Children’s
Breakfast-Eating Behavior
This study is the first randomized controlled trial in the out-of-
hospital pediatric transport environment. There are positive health benefits for children who consume
ready-to-eat cereals for breakfast; however, cereal companies
market their high-sugar products extensively to children,
Criminal-Justice and School Sanctions Against which causes concern that eating these products contributes
Nonheterosexual Youth: A National Longitudinal Study to unhealthy levels of added sugar in children’s diets.
Nonheterosexual youth are vulnerable to a variety of health Results demonstrate the potential negative effects of serving
risks. In addition, anecdotal reports have suggested that they high-sugar cereal to children and how it affects their
may be overrepresented among adolescents who have consumption of cereal, added sugar, and fruit during
received a variety of institutional sanctions. breakfast. In addition, they demonstrate that children like and
This is the first study to use a nationally representative, will eat low-sugar cereals as an alternative.
population-based sample to document that nonheterosexual
youth, particularly girls, have greater odds than their peers of
Adherence to the HPV Vaccine Dosing Intervals and
experiencing school and criminal-justice sanctions.
Factors Associated With Completion of 3 Doses
Vaccination to prevent human papillomavirus infection is safe
The Tiniest Babies: A Registry of Survivors With Birth and effective. Rates of receiving all 3 doses after initiating
Weight Less Than 400 Grams vaccination range from 42% to 60%, according to early
There have been isolated reports of single infants surviving reports from managed health care organizations and the
after birth at ⬍400 g. However, these reports have not been Centers for Disease Control and Prevention.
compiled and summarized, and little is known about the early We determined that few female patients received the second
health and development of these infants. and third human papillomavirus vaccine doses early, and
We have created a Web-based registry of survivors who most girls received the second and third doses either late or
weighed ⬍400 g at birth. The Tiniest Babies Registry now not at all. Race, health care use, and insurance were
contains data on 110 infants. This report summarizes the associated with completion.
information submitted to the registry about this extraordinary
group of infants.

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Tobacco-Smoke Exposure in Children Who Live in Differential Growth Patterns Among Healthy Infants Fed
Multiunit Housing Protein Hydrolysate or Cow-Milk Formulas
Exposure to secondhand tobacco smoke is an important cause The different classes of formulas, and different brands within
of morbidity and mortality among children, even at low levels each class, vary in composition and flavor profiles, both of
of exposure. In a recent national sample, 54% of children who which may influence feeding and growth patterns. Because
did not live with a smoker showed measurable amounts of recent evidence suggests that, relative to intact proteins,
cotinine. hydrolyzed proteins are absorbed and metabolized in a way
Children who live in homes in which no one smokes inside that promotes greater satiation, we conducted a randomized
have a 45% increase in cotinine levels if they live in study on healthy, formula-fed infants to determine whether
apartments compared with detached homes. Multiunit growth patterns and feeding behaviors differ on the basis of
housing may be a significant source of secondhand tobacco- formula type.
smoke exposure for children, at levels associated with Not all formulas are alike. On the basis of World Health
morbidity. Organization standards, z-score trajectories indicate that cow-
milk formula-fed infants’ weight gain was accelerated,
whereas protein-hydrolysate formula-fed infants’ weight gain
Effects of HEPA Air Cleaners on Unscheduled Asthma
was normative.
Visits and Asthma Symptoms for Children Exposed to
Secondhand Tobacco Smoke
Exposure to secondhand smoke (SHS) is associated with Incidence of Neonatal Herpes Simplex Virus Infections in
asthma exacerbations in children. Anticipatory guidance has the United States, 2006
failed to reduce SHS in controlled trials. It is not known Neonatal herpes simplex virus infections, although relatively
whether high-efficiency, particle-arresting (HEPA) air cleaners rare, cause significant morbidity and mortality. Incidence
can reduce SHS or improve asthma symptoms in children. estimates for neonatal herpes simplex virus from studies
HEPA air cleaners led to reductions in unscheduled asthma conducted throughout the United States since the early 1980s
visits and fine airborne particle levels but not asthma have ranged from 4.0 to 76.2 per 100 000 live births.
symptoms or cotinine levels. HEPA air cleaners may be useful This report describes neonatal herpes simplex virus incidence
as part of a multifaceted strategy to reduce asthma morbidity rates specific to regions and demographic groups across the
among children. United States and provides important new information on the
extent of this potentially devastating disease.
Smoke-Free Air Laws and Asthma Prevalence, Symptoms,
and Severity Among Nonsmoking Youth Diarrhea-Associated Hospitalizations Among US Children
Smoke-free laws reduce exposure to secondhand smoke, as Over 2 Rotavirus Seasons After Vaccine Introduction
measured by cotinine, in both adults and children. In adults, Before 2006, rotavirus was a significant cause of morbidity
smoke-free laws have been associated with reductions in among US children ⬍5 years of age. After the introduction of
health outcomes such as respiratory symptoms and acute rotavirus vaccine, many studies documented decreases in the
myocardial infarctions, as well. burden of severe diarrhea among US children during the
This study examined the association between smoke-free laws 2007–2008 rotavirus season.
and health in children and adolescents. Health outcomes that The reductions in diarrhea-associated hospitalizations
have been associated with exposure to secondhand smoke in observed among US children in 2007–2008 were sustained in
children include prevalence of asthma, asthmatic symptoms, 2008 –2009. The consistency of the reductions over 2 rotavirus
asthma severity, and ear infection. seasons indicates that these changes likely are attributable to
the new rotavirus vaccination program.

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Effect of Defibrillation Energy Dose During In-Hospital The overall prevalence of exposure to loud noise or listening
Pediatric Cardiac Arrest to music through headphones increased among adolescent
Cardiac arrest from ventricular fibrillation/pulseless National Health and Nutrition Examination Survey participants
ventricular tachycardia (VF/pVT) cardiac arrest is an in 2005–2006, compared with 1988 –1994; the prevalence of
important pediatric in-hospital problem. Historically, 2 J/kg noise-induced threshold shifts among female youths
was effective for termination of VF/pVT, but recent case series increased.
of human and animal pediatric defibrillation suggest that 2
J/kg is ineffective. Use of Skeletal Surveys to Evaluate for Physical Abuse:
Two J/kg as the initial shock dose for in-hospital VF/pVT arrest Analysis of 703 Consecutive Skeletal Surveys
was substantially less effective than previously reported. The skeletal survey (SS) is part of the evaluation of suspected
Four J/kg was not associated with increased termination of physical abuse. Previous studies focused on the use of the SS
VF/pVT or improved survival rates. The optimal pediatric for children whom the diagnosis of abuse was strongly
defibrillation dose remains unknown. suspected before completion of the SSs.
This is the first study to describe the use of SSs in a large,
Longitudinal Study of Physical Activity and Sedentary consecutive population of children being evaluated because of
Behavior in Children concerns regarding physical abuse.
Levels of physical activity during childhood are expected to be
quite stable with age. Physical activity is believed to decline Variation in Diagnosis of Apnea in Moderately Preterm
markedly at adolescence, particularly for girls. Infants Predicts Length of Stay
Physical activity declines before adolescence in both boys and Apnea of prematurity is expected to be uncommon in
girls. Strategies to prevent the decline in physical activity moderately preterm infants. Variation in its diagnosis because
should be considered and started for both sexes before of different monitoring or documentation practices may affect
adolescence. length of stay in moderately preterm infants.
Using hospital-specific criteria for its diagnosis, we
Comparing the Tuberculin Skin Test and T-SPOT.TB Blood demonstrated significant intrahospital variability in the
Test in Children proportion of moderately premature infants diagnosed with
Interferon-␥–release assays are blood tests that offer more apnea. The proportion of infants diagnosed with apnea had a
specificity for tuberculosis than the tuberculin skin test. The substantial impact on site variability in length of stay.
performance of this test in children still is being studied.
This study adds more information on the utility of interferon- Serum Dioxins and Polychlorinated Biphenyls Are
␥–release assays for children with tuberculosis disease and Associated With Growth Among Russian Boys
children in varying risk categories for latent tuberculosis The disruption of childhood growth has been linked with
infection. deleterious effects on health in both childhood and adulthood.
There is limited evidence from epidemiological studies that
Prevalence of Noise-Induced Hearing-Threshold Shifts prenatal and postnatal exposure to dioxins and
and Hearing Loss Among US Youths polychlorinated biphenyls affects childhood growth.
Voluntary exposure to loud noise may cause hearing loss and In this study serum dioxins and polychlorinated biphenyls
increase the prevalence of hearing impairment among were measured in a cohort of Russian boys, who then
adolescents. However, cross-sectional surveys of military underwent follow-up examinations for 3 years. The results
conscripts and young adults entering the work force have showed that higher levels of serum dioxins and
revealed no differences in auditory thresholds between polychlorinated biphenyls were associated with lower BMI and
cohorts. linear growth.

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Earliest Appropriate Time for Administering The current study revealed that, beyond direct influences, the
Neurobehavioral Assessment in Newborn Infants relationship between adolescents’ sensation seeking and
The recommended time for assessing infant neurobehavior parental R-rated movie restrictions in explaining smoking
varies. For early-newborn examinations in hospitals, current onset is bidirectional in nature.
practice requires that the infant be examined within ⬃48
hours. It is not known how the amount of time since delivery Intercenter Differences in Bronchopulmonary Dysplasia
may affect the results. or Death Among Very Low Birth Weight Infants
We recommend 20 hours after delivery as the earliest Bronchopulmonary dysplasia is a major cause of morbidity in
appropriate time for assessing newborn neurobehavior, premature infants. Outcomes of most neonatal disorders,
because it allows accurate assessment of newborn including bronchopulmonary dysplasia, vary in incidence
neurobehavior that is less contaminated by the acute effects across neonatal centers even after adjustment for
of delivery. demographic and antenatal characteristics. The factors
responsible for such variation have not been systematically
Multicenter Crossover Study of Automated Inspired evaluated.
Oxygen for Mechanically Ventilated Preterm Infants Bronchopulmonary dysplasia/death rates were found to
Many extremely preterm infants spend considerable time demonstrate a moderate clustering effect according to center,
outside the intended arterial oxygen saturation range because as did clinical variables associated with the outcome.
of their respiratory instability and often insufficient or Persistent center differences after clustered variables were
excessive oxygen supplementation, which increases the risk of corrected indicated the presence of as-yet unmeasured center
complications associated with hypoxemia and hyperoxemia. variables.
The results show that, under routine conditions, automatic
adjustment of the fraction of inspired oxygen improves Tuberous Sclerosis Complex: Diagnostic Challenges,
maintenance of pulse oxygen saturation (SpO2) within an Presenting Symptoms, and Commonly Missed Signs
intended range, primarily by avoiding high SpO2 levels, and Tuberous sclerosis complex (TSC) is an autosomal dominant
reduces oxygen concentration and staff workload. neurocutaneous disorder that is clinically diagnosed.
Diagnosis of TSC may be difficult because no single symptom
Integrative Pediatric Care: Parents’ Attitudes Toward is present in all patients, and none are absolutely
Communication of Physicians and CAM Practitioners pathognomonic.
The use of complementary and alternative medicine (CAM) Presenting symptoms and signs of TSC according to age
among children is prevalent in different countries. There have group, missed symptoms, and signs that did not lead to
been limited data on parents’ perspectives toward pediatric diagnosis are described. Early diagnosis may reduce
CAM use and its meaning in terms of parent-doctor and morbidity and mortality in patients with TSC.
doctor–CAM-practitioner communication.
The study revealed that parents referred to conventional and Prospective Validation of a Novel Strategy for Assessing
CAM clinics expressed distinctive attitudes toward CAM Risk of Significant Hyperbilirubinemia
integration in pediatric care and perceived physician–CAM- Different risk assessment strategies have been developed to
practitioner communication as highly important in promoting determine which infants are at greater risk for developing
their children’s health and safety. significant hyperbilirubinemia. Further refinement of such
strategies is needed to provide safe, cost-effective treatment
Association of Smoking Onset With R-Rated Movie and follow-up care for these patients.
Restrictions and Adolescent Sensation Seeking The present study has validated prospectively a novel strategy
Evidence has shown that sensation seeking is positively for significant hyperbilirubinemia risk assessment, which
related and parental restrictions on R-rated movies are combines predischarge bilirubin percentile and gestational
negatively related to smoking onset in adolescence. age data.

PEDIATRICS Volume 127, Number 1, January 2011

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Serum Transaminase Levels in Boys With Duchenne and This article details the impact of H1N1-09 in children who
Becker Muscular Dystrophy required intensive care during the Southern Hemisphere
Failure to consider muscle as the origin of persistently high winter of 2009 and reveals important data that relate to risk
serum transaminase levels has led to delayed diagnosis and factors, comorbidities, and outcome in children younger than
extensive testing. Even for patients with muscle disease 16.
clinicians have been reluctant to attribute high levels of
alanine transaminase/aspartate transaminase to muscle Predictors of Participant Dropout at Various Stages of a
alone. Pediatric Lifestyle Program
With this mathematical-modeling tool clinicians are provided It has been shown that children who drop out of a weight-
with a practical method to assist in interpretation of high management program are more likely to be older, to have an
serum transaminase levels in patients with dystrophinopathy. ethnic minority status, to self-report more depressive
symptoms, and to have lower self-concept scores.
Breastfeeding Duration and Academic Achievement at The results of this study indicate that the predictors of
10 Years dropping out of treatment are different at various stages.
It is not clear whether the benefits of breastfeeding on Some characteristics seem to require attention at an earlier
cognitive development reflect nutritional or socioeconomic stage in the treatment to reduce dropout rates.
advantages associated with breastfeeding. Some studies have
revealed no differences after adjusting for socioeconomic Excess Weight Loss in First-Born Breastfed Newborns
status, and maternal verbal ability, whereas others have Relates to Maternal Intrapartum Fluid Balance
shown the benefits.
Excess weight loss is relatively common in term breastfed
Predominant breastfeeding for ⱖ6 months was positively infants, occurring in up to 16% of first-born infants in previous
associated with numeracy and literacy achievement studies. Delayed onset of lactogenesis and suboptimal infant
independent of maternal and demographic factors and breastfeeding behavior were associated with excess weight
cognitive stimulation at home. However, the effectiveness of loss in multivariate analyses.
breastfeeding differed according to gender; benefits were only
This study describes an independent association between
evident for boys.
excess weight loss among breastfed infants and maternal
intrapartum fluid balance. The prevalence of excess weight
Economic Evaluation of Caffeine for Apnea of Prematurity loss—19% of exclusively breastfed, demographically diverse,
The Caffeine for Apnea of Prematurity Trial demonstrated that first-born, term infants—was higher than previously reported.
caffeine-treated infants had improved survival rates without
neurodevelopmental impairment at 18 to 21 months’ Cord-Blood 25-Hydroxyvitamin D Levels and Risk of
corrected age compared with those in the placebo group. The Respiratory Infection, Wheezing, and Asthma
cost implications of this therapy have not been explored.
Recent study results have suggested that higher maternal
Caffeine is a cost-saving therapy compared with placebo, intake of vitamin D during pregnancy may lower the risk of
despite the various underlying assumptions regarding unit wheezing in offspring. The relationship between cord-blood
prices for medical services and caffeine in sensitivity levels of 25-hydroxyvitamin D and risk of childhood respiratory
analyses. This effect is, in large part, attributed to the reduced outcomes is unknown.
number of days on positive-pressure ventilation.
In a population-based birth cohort with excellent 5-year follow-
up, cord-blood 25-hydroxyvitamin D levels had significant
Pandemic H1N1 in Children Requiring Intensive Care in inverse associations with the risk of respiratory infection and
Australia and New Zealand During Winter 2009 risk of childhood wheezing. In contrast, vitamin D had no
Pandemic influenza A H1N1-09 had a major and unexpected association with incident asthma.
impact on critical care worldwide. The Australia and New
Zealand influenza investigators previously reported the effect
of H1N1-09 on critical care in this region.

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Contrasting Parents’ and Pediatricians’ Perspectives on Intrauterine Effects of Maternal Prepregnancy

Shared Decision-Making in ADHD Overweight on Child Cognition and Behavior in 2 Cohorts
Shared decision-making (SDM) is recommended when Maternal prepregnancy overweight may be associated with
multiple evidence-based treatments exist and families value child behavioral problems, such as inattention-hyperactivity,
options differently. Although national guidelines prioritize SDM and lower intellectual function in offspring. However, few
in attention-deficit/hyperactivity disorder, little is known studies have explored this issue, and it is unclear whether
regarding how parents and clinicians understand and associations, if replicated, reflect biological intrauterine
implement SDM in practice. mechanisms.
We found that practical barriers limit the consideration of In this study, maternal prepregnancy overweight was not
evidence-based options in SDM, key participants often are consistently associated with child behavioral problems or
excluded from the process, and, although parents and measures of cognitive abilities. We found no strong evidence
clinicians view SDM favorably, they understand SDM of biological intrauterine mechanisms for these associations.
differently. Implications for clinical practice are discussed.
Adverse Events After the Use of Benznidazole in Infants
Testosterone Levels in Umbilical-Cord Blood and Risk of and Children With Chagas Disease
Pyloric Stenosis Treatment of Chagas disease with benznidazole in adults
Infantile hypertrophic pyloric stenosis is ⬃5 times more leads to a high incidence of severe drug reactions. However,
common in male infants. The male hormone testosterone is benznidazole seems to lead to less frequent and less severe
known to induce muscle hypertrophy, and the testosterone adverse drug reactions (ADRs) in children, but there are
levels are several-fold higher in male infants than female scarce data on this subject.
infants. A cohort of children with Chagas disease treated with
This study is the first of its kind, and the results add new benznidazole is described. A lower incidence of ADRs was
insight to the etiology of pyloric stenosis. No evidence was observed in smaller children and adults. All ADRs observed
found to support the hypothesis that high testosterone levels were mild, and treatment response was excellent.
at birth are associated with an increased risk of pyloric
stenosis.

See the table of contents of this issue to learn more about these articles.
PEDIATRICS Volume 127, Number 1, January 2011
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 Pediatrics Digest
Pediatrics 2011;127;D1
DOI: 10.1542/peds.digest1271

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Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since . Pediatrics is owned, published, and trademarked by the
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois,
60007. Copyright © 2011 by the American Academy of Pediatrics. All rights reserved. Print ISSN:
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 Pediatrics Digest
Pediatrics 2011;127;D1
DOI: 10.1542/peds.digest1271

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/127/1/D1

Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since . Pediatrics is owned, published, and trademarked by the
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois,
60007. Copyright © 2011 by the American Academy of Pediatrics. All rights reserved. Print ISSN:
.

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