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A retrospective, cross-sectional study of children with suspected urinary tract infections (UTIs) 3 months to 18 years of age who had a urinalysis and urine culture (UC) during an emergency department (ED) visit between 2019 and 2020 was performed. Chi-square, Fisher exact, and independent samples T tests were used as appropriate. Median age was 6.6 years (interquartile range = 3.3-12.4). Urinalysis positivity was 92.8%, of which 81.9% of children were prescribed a first-line antibiotic. First-line antibiotic use was 82.7%. Positive UC rate was 84.7%, with 84% receiving a first-line antibiotic (P =.025). The correlation between a positive urinalysis and a positive UC was 80.8% (P <.001). Change of antibiotics based on the uropathogen of positive UCs was 6.3% (P <.001). The urinalysis and UC guided the diagnosis and treatment of UTIs. First-line antibiotics can be safely administered in the ED and prescribed for positive urinalyses. Studies are needed to evaluate the discontinuation of antibiotics with negative UCs as part of antibiotic stewardship initiatives. [ABSTRACT FROM AUTHOR]

The article examines the relationship between age and obstructive sleep apnea (OSA) severity in infants under one year old who underwent polysomnography (PSG) due to sleep-related concerns. Topics discussed include age-related changes in OSA indices, the influence of comorbidities such as laryngomalacia, and variations in clinical outcomes among infants with different OSA severities.

Acute bronchiolitis is a leading cause of hospitalization in infants. In this retrospective study, 645 patients with acute bronchiolitis diagnosed as respiratory syncytial virus (RSV; n = 538) or human metapneumovirus (HMPV; n = 107) were compared in terms of demographic, clinical, and laboratory findings. The HMPV patients presented later in the winter, were older (20 vs 7.55 months; P <.001)), had higher levels of C-reactive protein (4.55 vs 3.03 mg/dL; P =.007), and a higher prevalence of complications (43.9% vs 32.7%; P =.03). This study highlights the similarities and differences between these 2 common respiratory viral pathogens and shows that HMPV has a slightly more severe disease course than RSV. These findings can help guide approaches to these 2 common viruses that cause bronchiolitis. [ABSTRACT FROM AUTHOR]

The article focuses on hospital's newborn falls and suffocation incidents associated with parental drug-related fatigue, highlighting the risks and lack of formal policies in neonatal intensive care units (NICUs) to address these situations. Topics discussed include the contributing factors, cases of newborn falls and near-suffocation events, and the need for standardized policies and education in NICUs to prevent such incidents.

To investigate effects of diaper-free times, elimination communication (EC) and early toilet training, a web-based survey was conducted for caregivers. The more diaper-free times an infant experienced during day, the earlier it was toilet trained (P <.001), which was enhanced by the usage of cloth diapers. The amount of diaper-free times significantly reduced the caregiver's continuous sleep, the occurrence of rashes and balm usage (P <.001) and lead to a more regular defecation frequency. Cloth diaper usage had no effect on rashes or balm usage, but on diaper change rate (P <.001). We could show that, although not as effective as full-time EC, part-time EC is more effective if cloth diapers are used, provided they are changed frequently. Furthermore, EC causes a more regular defecation in infants between 1 and 2 years. [ABSTRACT FROM AUTHOR]

The article discusses a study of the presentation of type 2 diabetes (T2D) in youth in the U.S. during the COVID-19 pandemic. The number of persons diagnosed with T2D increased to 34 in 2020 from 28 in 2019. It mentions the higher mean serum glucose in the 2020 cohort compared with the 2016 to 2019 cohort. It emphasizes the necessity for multisite collaborations to research impediments to optimal treatment of youth with T2D.

In this retrospective study of 319 children with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, we assessed whether age, asthma, obesity, diabetes, and socioeconomic status were associated with hospitalization for coronavirus disease 2019 (COVID-19). Demographic and clinical characteristics were assessed using univariate statistics, excluding incidental or unrelated positives. There was a bimodal distribution of age among hospitalized children. Obesity (P <.001) and a past medical history of diabetes (P =.001) were significantly more prevalent in hospitalized children, including cases of new-onset diabetes and diabetic ketoacidosis. Neither a past medical history of asthma nor lower socioeconomic status was associated with hospitalization. Although limited to a single center, the findings in this study may have important clinical implications. Targeted, proactive health outreach to children with obesity and diabetes, with prioritization of preventative efforts such as vaccination, may be important in preventing worse SARS-CoV-2 infection in this vulnerable group. [ABSTRACT FROM AUTHOR]

The article informs about barriers to infant preventive care during the covid-19 pandemic, which disrupted all aspects of life for Americans, including their access to health care. Topics include hospitals and medical clinics were declared essential by government entities and professional organizations; and risk of vaccine-preventable infections, missed identification of delayed development, and decreased ability to foster family child mental health.

A randomized, blinded pilot clinical study was conducted to assess gastrointestinal (GI) tolerance in healthy, full-term infants (2-9 weeks old), whose pediatricians recommended a formula change due to perceived cow's milk formula intolerance. Infants were randomized and exclusively fed either a commercial control soy formula (SF; n = 22), an experimental partially hydrolyzed SF (10% hydrolyzed, n = 23), or a 5% hydrolyzed SF (n = 26) for 2 weeks. Age-matched reference cohorts (n = 72) with no GI intolerance on milk-based formula were assessed in parallel. Results indicated that all SF-fed groups contributed to reduction (P <.05) in common GI tolerance symptoms to levels not different from the non-symptomatic reference cohort at study end. The control SF group had more reduced fussiness, gas, and crying and higher formed stools versus hydrolyzed SF groups. In conclusion, the study suggests that SFs reduced GI intolerance symptoms in otherwise healthy infants with poor tolerance on milk-based formulas. [ABSTRACT FROM AUTHOR]

The article presents a study which compare the influence of demographic, clinical, and environmental factors and interventions during initial hospitalization on rehospitalization within 30 days of discharge of children with bronchiolitis. It mentions that the study identifies passive smoke exposure as a major risk factor for readmission. It mentions that the American Academy of Pediatrics recommends clinicians should ask about tobacco smoke and counsel caregivers to quit.

Background. Acute kidney injury (AKI) is common in critically ill children and develops in association with organ system dysfunction, with acute respiratory failure (ARF) one of the most common. We aim to study AKI in the pediatric ARF population. Methods. Data were retrospectively collected on children aged 1 day to 18 years admitted to the pediatric intensive care unit (PICU) with ARF between 2010 and 2013. Descriptive statistics and multivariate analyses utilizing Mann-Whitney U, Wilcoxon signed rank, χ2, or Fisher’s exact tests were performed to identify risk factors associated with AKI. Results. A total of 186 patients, with median age of 36 months (interquartile range 4-120 months) met the inclusion criteria. ARF was related to pulmonary disease in 49%. AKI was noted in 53% of patients. Patients with AKI had significantly higher serum creatinine (P < .001) and lower estimated creatinine clearance (P < .001) compared with those without AKI. Among patients with moderate and severe acute respiratory distress syndrome (ARDS), 64% had AKI versus 46% with mild or no ARDS (P = .02). Patients with AKI had significantly lower PaO2/FiO2 ratio (P = .03), longer PICU (P = .03), and longer hospital length of stay (P = .01). ARDS patients were less likely to be AKI free on day 7 of hospitalization, as compared with those without ARDS. Multivariate analysis revealed positive end expiratory pressure (odds ratio [OR] = 1.2, confidence interval [CI] = 1.0-1.4; P = .03) and admission serum creatinine (OR = 27.9, CI = 5.2-148.5; P < .001) to be independently associated with AKI. Conclusions. AKI is common in children with ARF. In patients with ARF and AKI, AKI is associated with ARDS and longer PICU and hospital length of stay. Positive end expiratory pressure and serum creatinine are independently associated with AKI. [ABSTRACT FROM AUTHOR]

Personal health records (PHRs) have the potential to improve incomplete health records. However, internet access through traditional methods may be limited for populations most at risk for fragmented care. A convenience sample of postpartum women at a community hospital and tertiary-care academic center in New York City completed a self-administered survey. Most (75.2%, n = 200) women approached participated. The majority (70.0%) were Latina, 53.5% were Spanish speakers, 23.4% were uninsured, and 41.6% were publicly insured. Smartphone ownership (85.6%) including a data plan (80.0%) was high. While insurance and educational level were associated with decreased odds of internet access at home, access via cellphone only differed by age. Nearly all (94%) women wanted PHR access and interest only differed by language. Even the minority (20.0%) of women with concerns, reported high (93.8%) interest. High smartphone ownership, use of phone for internet access, and interest in PHR access, suggest the potential of optimizing PHR use via mobile technologies. [ABSTRACT FROM AUTHOR]

Term infants with hypertrophic pyloric stenosis (HPS) typically present between 4 and 6 weeks. There is limited consensus, however, regarding age of presentation of premature infants. We aim to determine if there is an association between the degree of prematurity and chronological age of presentation of HPS. A total of 2988 infants who had undergone a pyloromyotomy for HPS were identified from the 2012 and 2013 NSQIP-P Participant Use Files. Two hundred seventeen infants (7.3%) were born prematurely. A greater degree of prematurity was associated with an older chronological age of presentation (P < .0001). Prematurity was significantly associated with an increase in overall postoperative morbidity, reintubation, readmission, and postoperative length of stay. When clinicians evaluate an infant with nonbilious emesis with a history of prematurity, they should consider pyloric stenosis if the calculated postconceptional age is between 44 and 50 weeks. When counseling families of premature infants, surgeons should discuss the increased incidence of postpyloromyotomy morbidity. [ABSTRACT FROM AUTHOR]

To assess adherence to symptom-based studies recommended in the health supervision guidelines for Down syndrome from the American Academy of Pediatrics (AAP), 24 pediatric care sites participated in retrospective chart review. Symptom-based screening and 4 associated recommendations, including cervical spine radiograph, video swallow study, celiac study with tissue transglutaminase and sleep study were analyzed by reviewing well-child visit notes of 264 children with Down syndrome. Given trends toward symptom-based screens, Pearson's chisquare test and Fisher's exact test were used to determine the association between symptom presence and receiving corresponding symptom-based screens. Adherence rates were widely variable ranging from 0% to 79% completion. Symptom-based studies were performed in 22% to 36% of patients. Symptom screens were documented positive in many patients, but the presence of symptoms did not correlate with completion of symptom-based screens. Symptom-based screening is low; associated studies were performed in patients without documented symptoms contrary to AAP recommendation. [ABSTRACT FROM AUTHOR]

Apnea, bradycardia, and oxygen desaturation events are a common in neonatal intensive care units, with relevant literature to date largely focusing on very low birth weight and extremely low birth weight infants. We conducted a retrospective review of infants born at ≥34 weeks gestational age at 2 tertiary neonatal intensive care units in Boston, MA, between January 2009 and December 2013. Our objectives included (1) describing the diagnostic evaluations performed in late preterm to term infants with discharge-delaying apnea, bradycardia, or oxygen desaturation events and (2) identifying variables associated with home monitor use. Of the 741 eligible infants identified, diagnostic evaluations were variable and infrequent with blood culture, blood glucose, and head ultrasound performed most commonly. The likelihood of home monitor use was greater in infants with either a prolonged inpatient stay or greater gestational age at birth. [ABSTRACT FROM AUTHOR]

The 2013 US Preventive Services Task Force report found insufficient evidence for pediatric blood pressure screening. This retrospective study evaluated the reliability of successive annual blood pressure screening of children for hypertension at the 3-, 4-, and 5-year-old health maintenance visits (January 1, 2010 to June 18, 2014). Of 328 patients, 290 (88%) were normotensive at all 3 visits. All elevated blood pressures (≥95th percentile) were stage 1. No patient was hypertensive (3 elevated measures). The extended concordance correlation coefficient indicated poor agreement for systolic (0.19, 95% CI −0.49 to 0.72) and diastolic (0.11, 95% CI −0.39 to 0.56) measurements. Blood pressure at the 3-year (κ −0.008, 95% CI −0.11 to 0.09), 4-year (κ 0.09, 95% CI −0.06 to 0.24), or 5-year (κ 0.08, 95% CI −0.05 to 0.20) visit was not associated with elevated blood pressures at the other 2 time points. In the preschool years, stage 1 elevated blood pressures do not correlate with hypertension and may be better managed by watchful waiting and parental reassurance. [ABSTRACT FROM AUTHOR]

We compared demographic and clinical characteristics of pneumonia with and without pleural fluid (PF and Pn, respectively) in hospitalized children younger than 5 years in southern Israel, between 2002 and 2011. Overall, 108 PF and 5811 Pn episodes were recorded. Children with PF were older. Prematurity (6.6% vs 14.0%) and asthma (9.9% vs 23.5%) were less common in PF. Mean temperature and saturation were higher in PF while hemoglobin and sodium levels were lower in PF compared with Pn. Nasal washes were obtained in 30.6% and 39.9% of PF and Pn episodes, respectively, with respiratory syncytial virus identified more commonly in Pn (24.2% vs 42.3%). Streptococcus pneumoniae was identified in 5.2% and 0.9% of blood cultures in PF and Pn, respectively. In conclusion, PF differed from Pn in demographic and clinical characteristics, possibly due to differences in etiology. Although both diseases are considered bacterial, a high proportion of viral etiology was found in both, especially in Pn. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the impact of a client-centered behavioral intervention (Brief Negotiated Interviewing) on mothers’ human papillomavirus (HPV) vaccine knowledge and vaccination initiation for their adolescent daughters. Methods. We randomized mothers to intervention (n = 100) and control (n = 100) groups, and followed them over 12 months. Electronic medical records were reviewed to determine vaccination status. The primary outcome was receipt of the first vaccine. The secondary outcome was HPV vaccine knowledge among mothers. Results. Brief Negotiated Interviewing intervention mothers demonstrated increased knowledge about HPV (pre/post mean score of 5 to 10 out of a possible 11; P < .001) and significantly higher mean knowledge scores (10 vs 6, P < .001) than control mothers. However, initiation and completion rates of the vaccine were not significantly different between groups. Conclusions. Increasing HPV vaccine knowledge did not translate into increased vaccine uptake or completion of vaccination series. Future intervention must explore vaccine reminders to increase HPV vaccination rates. [ABSTRACT FROM AUTHOR]

Background. Annual vaccination of children against seasonal influenza with trivalent inactivated influenza vaccine (TIV) has shown to be beneficial. However, this yearly practice may have unintended effect. Studies have shown that infection with wild type influenza A viruses can stimulate protective heterotypic immunity against unrelated or new influenza subtypes. We hypothesized that a consequence of yearly TIV vaccination is lack of induction of heterotypic immunity against the recent H1N1 pandemic. Methods. This was a retrospective case-control study. We reviewed the medical records of polymerase chain reaction–confirmed cases of 2009 H1N1 influenza infection in children 6 months to 18 years and a matched control group seen during the pandemic. Results. We identified 353 polymerase chain reaction–confirmed H1N1 cases and 396 matching control subjects. Among the H1N1 group, 202/353 (57%) cases received a total of 477 doses of seasonal TIV compared with 218/396 (55%) in the control group who received a total of 435 doses. Seasonal TIV uptake was significantly higher in the H1N1 group 477/548 (87%) than in the control group, 435/532 (81%) (P = .017). Conclusion. Seasonal TIV uptake was significantly higher in H1N1-infected group. The finding suggests that the practice of yearly vaccination with TIV might have negatively affected the immune response against the novel pandemic H1N1 strain. Given the rarity of pandemic novel influenza viruses, and the high predictability of seasonal influenza occurrence, the practice of yearly influenza vaccination should be continued. However, the use of live attenuated intranasal vaccine, as opposed to TIV, may allow for the desirable development of a vigorous heterotypic immune response against future pandemics. [ABSTRACT FROM AUTHOR]

Objective: To discuss the value of general movements assessment in predicting the neurological disorders. Methods: Using PubMed as the search engine, we searched to identify relevant studies in English and Chinese language published up to November 2014 and 19 studies were selected. Standard methods in meta-analyses were used to provide diagnostic accuracy by Meta-DiSc 1.4. Results: For non–cerebral palsy (non-CP) as outcome for writhing period, the results suggested a good sensitivity and a specificity of 0.74, the Q-value was 0.80. The area under the curve (AUC) was 0.87. For non-CP as outcome for fidgety period, the results suggested both high level for sensitivity and specificity. And the Q-value was 0.914, the AUC was 0.9664. For CP as outcome for writhing and fidgety periods, good sensitivity and specificity were found in the analysis, and the Q-value was 0.9034 while the AUC was 0.9592. Conclusion: General movements assessment is a good predictor for diagnosing neurological disorders. [ABSTRACT FROM AUTHOR]

Objectives. Primary immunodeficiency diseases (PIDDs) are caused by inherent deficits in immune defenses that result in abnormal susceptibility to infection. In most cases, early and appropriate diagnosis can improve patient outcomes. The objective of this study was to evaluate understanding, recognition, and diagnosis of PIDD among pediatricians. Methods. A mail survey sent to a sample of pediatricians obtained from the American Medical Association and American Osteopathic Association. Results were compared with a similar survey of specialists who are members of the American Academy of Asthma, Allergy and Immunology. Results. More than a third (35%) of pediatricians were uncomfortable with the recognition and diagnosis of PIDD despite 95% having ordered screening tests or referring patients to specialists to be evaluated for PIDD, and 77% having followed at leastone patient with PIDD. In all, 84% of pediatricians were unaware that professional guidelines for PIDD exist. Conclusions. Patients with PIDD would benefit from improved recognition of the diseases by pediatricians in order to facilitate earlier diagnosis and optimize ongoing therapy. [ABSTRACT FROM AUTHOR]

The article discusses a study investigating implications for engaging minority parents in weight-related discussions. It used identical survey components comparing Latino and African American samples. It reveals higher risk of misperceiving obese child's weight among low-income Latino parents as compared to low-income African American parents.

Objective. To examine food and beverage depictions in books for preschoolers. Methods. Books for preschoolers from Reach Out and Read (ROR; n = 42), public library (n = 27), and Publisher's Weekly booklists (n = 31) were examined for nutritive and empty-calorie food and beverage depictions. Results. It was found that 66% of books depicted at least 1 food or beverage. More books depicted nutritive items than empty-calorie items (87.5% vs 54.7%, P < .001). There was a trend toward fewer empty-calorie depictions in ROR books than in other booklists. Yet nearly half of ROR books depicted at least 1 empty-calorie item. ROR books also accounted for 5 of 10 books with the most empty-calorie item depictions and 3 of 4 books with branding. With regard to messaging, approximately a third of books with the most empty-calorie depictions promoted unhealthy foods. Conclusions. When selecting books for ROR, it may be important to consider food and beverage depictions and messages. [ABSTRACT FROM AUTHOR]

Objective: Current guidelines for Kawasaki disease (KD) recommend intravenous immunoglobulin infusion and echocardiography. However, no previous studies have evaluated the relationship between the treating hospital’s concordance with guidelines and the prevention of coronary artery aneurysm in patients with KD. Study Design: KD patients between 2010 and 2013 were identified in a Japanese national inpatient database. Guideline concordance was defined as the proportions of patients who received echocardiography as well as treatment with both immunoglobulin and aspirin, which were divided into quartiles. Multivariable logistic regression analysis was conducted to examine the association between the guideline concordance and the occurrence of coronary artery aneurysm with adjustment for patient backgrounds. Results: In sum, 20 156 patients with KD were identified. The very high (>83.3%) concordance group had a lower rate of coronary artery aneurysm than the very low (<59.0%) concordance group (4.9% vs 9.9%; odds ratio, 0.45; 95% CI, 0.27 to 0.74; P = .002). Conclusion: All patients with KD should be treated according to the guidelines. [ABSTRACT FROM AUTHOR]

Background. We compared the variability of bone age (BA) rating between clinicians and an automated system in children with congenital adrenal hyperplasia (CAH). Method. A total of 126 radiographs assessed by 3 clinicians blinded to patient details using Greulich and Pyle (GP) (readers 1, 2, and 3) and BoneXpert (BX). Results. Comparing BA rating with each other, the mean of the absolute differences varied from 0.42 ± 0.53 years (reader 1 and BX) to 0.57 ± 0.58 years (reader 2 and reader 3), P = .368. Comparing ratings that were consistent with all 4 methods (within 1 year of each other, 93/126, 74%) and the remaining, “outliers” (33/126, 26%), the outliers were younger (P = .003), smaller (height, P = .011, weight, P = .000), and prepubertal (P = .001). Conclusion. The variability of BA rating in CAH children is similar whether performed by clinicians or an automated system. The greatest variability was in prepubertal children. [ABSTRACT FROM AUTHOR]

Background. Missed appointments complicate primary care services. Objective. To determine factors associated with missed pediatric appointments. Design/Methods. A convenience sample of 1537 patients who missed appointments were called and 386 (25%) families completed the 26-item survey. Those with high no-show rates were compared with the rest using χ2 and Fisher’s exact tests. Initial covariates with P < .2 were included in a multivariate logistic regression model. Results. Common reasons for missing appointments were the following: forgot (27%), transportation problems (21%), and time off of work (14%). The high no-show group had more African Americans (P = .030) and older patients (P = .003). Higher no-show rates correlated with well child visits (P = .029) and perception of “excellent health” (P = .022). In the logistic regression model, well child appointments (odds ratio = 2.56) and increasing age in years (odds ratio = 1.11) were associated with higher no-show rates. Conclusions. Efforts to decrease no-show rates should target older patients and well child visits. [ABSTRACT FROM AUTHOR]

Objective. Personal health records (PHRs) may address the needs of children with attention deficit hyperactivity disorder. Among parents, we assessed acceptance, barriers, and intentions regarding use of PHR for their children with attention deficit hyperactivity disorder. Methods. Survey of parents from 3 practices in Rochester, NY. Stepwise logistic regression analysis explored factors predicting respondents’ intentions for future use of PHR, accounting for care coordination needs, caregiver education, socioeconomic status, and satisfaction with providers. Results. Of 184 respondents, 23% had used the PHR for their child, 82% intended future use. No difference was observed between users and nonusers regarding gender, age, race, or education. Users were more likely than nonusers to reside in the suburbs (P = .03). Caregivers were more likely to plan future use of the PHR if they felt engaged as partners in their child’s care (adjusted odds ratio = 2.3, 95% confidence interval = 1.2, 4.5). Conclusions. Parents are enthusiastic about PHRs. Future work should focus on engaging them as members of the health care team. [ABSTRACT FROM PUBLISHER]

The evaluation for children with bruising may be affected by the specialty to which they are referred. We conducted a 3-year retrospective review of subjects referred for bruising to Child Abuse Pediatrics (CAP) or Pediatric Hematology to identify characteristics associated with referral to each specialty and to compare the diagnostic evaluations and diagnoses based on specialty. Of 369 subjects, 275 were referred to CAP and 94 to Hematology. Clinical exam findings were similar in both groups. Hematology referrals were significantly more likely to have laboratory evaluations. Among those referred to CAP, 9.5% had head computed tomography scans and 27.3% had skeletal surveys. No children referred to Hematology had these imaging studies performed. Hematology never diagnosed child physical abuse, and CAP never diagnosed bleeding disorders. Pediatric hematologists and CAPs perform different evaluations and reach different diagnostic conclusions for similar patients with bruising. Further investigation of these practice patterns is warranted. [ABSTRACT FROM AUTHOR]

Background. The current specialty-centric hypertension paradigm is unsustainable given the high prevalence of primary hypertension in adolescents. Objective. To describe specialists’ perspectives on referral and comanagement for adolescents with hypertension. Methods. Cross-sectional mailed survey of a national sample of 397 pediatric cardiologists and 389 pediatric nephrologists, conducted January to May 2014. Results. Response rate was 61%. Both specialties agreed that primary care providers can make the hypertension diagnosis, try lifestyle changes, and comanage monitoring of patient blood pressure control and medication side effects, but they felt antihypertensive medication use should mainly occur in the specialty setting. Conclusions. Our study suggests specialist support for changing the hypertension paradigm to encourage primary care providers, in collaboration with specialists, to diagnose hypertension, initiate lifestyle changes, and monitor progress and side effects. Future work should focus on supporting primary care physician comanagement of adolescents with hypertension. [ABSTRACT FROM AUTHOR]

Urinary tract infection (UTI) is common in infants and children, and Escherichia coli is the leading pathogen. The aims of this study were to compare first episode of UTI with recurrent infection, reveal organisms that cause UTI, uropathogen resistance, and presence of bacteria producing extended-spectrum β-lactamase (ESBL). The first-UTI group included 456 children. E coli was the leading pathogen (80.5%), and Pseudomonas aeruginosa was found in 1.5%. The uropathogens were resistant to gentamicin (3.41%) and cefuroxime (5.71%), and highly resistant to cefamezin (37.39%). The recurrent-infection group included 106 children. E coli was also the leading pathogen, but 7.5% of the isolates were P aeruginosa (P = .002 compared with first-episode group); 6.6% were ESBL-producing bacteria compared with 1.1% in the first-episode group (P = .002). E coli is the leading pathogen in both groups. P aeruginosa and ESBL-producing bacteria were more common in the recurrent infection group. [ABSTRACT FROM PUBLISHER]

Sexual harassment can be physical interaction and touching, as well as, psychological, environmental, or via Internet and text messaging. An online survey in an urban clinic asked children, aged 12 to 18 years the following: demographic data, height and weight, chronic medical conditions, healthcare use, questions concerning sexual harassment—witnessed and exposure, and finally questions from the Pediatric Symptom Checklist (PSC-35). Overall, 124 of 210 (59%) of the 12- to 18-year-olds surveyed had experienced sexual harassment, with the predominance being female 69% (80/116) versus 48% (49/92) male. Participants who had experienced sexual harassment were significantly more likely to score positive for psychological impairment than those who had not experienced sexual harassment (chi-square test P < .001; odds ratio: 4.7 (95% confidence interval, 1.9-11.8). There was a borderline significant association between elevated body mass index and having experienced sexual harassment (2-sample t test P = .08). Sexual harassment has a direct correlation to psychological impairment in adolescents, especially females. [ABSTRACT FROM PUBLISHER]

Objectives. This randomized controlled trial evaluated the effectiveness, feasibility, and acceptability of parent participation (PP) in an evidence-based method to reduce the pain of prekindergarten immunizations. Methods. Healthy children aged 4 to 6 years were randomized to a multimodal distraction method during administration of routine vaccines with PP and 1 medical assistant (experimental group) or 2 medical assistants (standard-of-care comparison group). Children and parents rated the pain after injections, and a blinded observer coded children’s pain from videotapes. Results. In all, 76 children participated. Despite group randomization, more children in the medical assistant–only group received a 3-injection series (25; 68%) than in the PP group (6 [15%], P = .001). After adjustment for this imbalance, child-reported pain was higher in the PP group compared with the medical assistant–only group (2.95 vs 1.75; F = 5.87; df = 1.66; d = 0.64; P < .02). There were no differences between groups for parent-reported and observer-rated measures of pain or in intervention fidelity, duration of procedure, or child or parent satisfaction. Conclusions. Although child-reported pain was higher for the PP group, the magnitude of the difference may not be clinically significant. PP was feasible and acceptable to both parents and children, did not take any longer, and reduced the need for additional medical personnel. Together, these data provide preliminary support for PP for prekindergarten immunization pain management. [ABSTRACT FROM PUBLISHER]

Background. The extent to which pediatricians inform parents about gestation-adjusted age growth plotting is unclear. Uninformed parents may have decreased satisfaction of infant growth. Subsequent early introduction of solid foods may lead to avoidant feeding behaviors and poor parental perception of infant feeding patterns. Methods. Questionnaires regarding infant growth and feeding behaviors were given to parents (n = 76) of premature infants. The Wilcoxon rank-sum and χ2/Fisher’s exact tests were used. Results. Uninformed parents were less satisfied with their infant’s growth (P < .002). Uninformed parents had more developmentally unready infants at the time of solid food introduction compared with informed parents (P = .03). Significant differences were found in avoidant feeding behaviors and parental perception of infant feeding patterns between developmentally ready and unready infants. Conclusion. Pediatricians should adjust for gestational age when plotting growth and assess for developmental readiness for premature infants when recommending solid foods. [ABSTRACT FROM PUBLISHER]

The article discusses a study on the association between Interferon Gamma Release Assays (IGRAs) and Tuberculin Skin Test (TST) among children referred by pediatricians and clinics who did not participate in health department contact investigations. Topics discussed include an evaluation if IGRA results in children being seen for suspected latent tuberculosis infection (LTBI) and the option of a tiered approach for immunocompetent children with positive TSTs and an IGRA.

Background. Ethanol lock therapy (ELT) with systemic antimicrobial therapy (SAT) is a treatment for catheter-associated bloodstream infections (CABSI). However, its impact on hospital length of stay (LOS) is unknown. Objectives. Assess the impact of ELT on LOS, LOS attributable to CABSI (ALOS), and catheter salvage in pediatric hematology, oncology, stem cell transplant (HOSCT) CABSI. Methods. Retrospective review of HOSCT CABSI from January 2009 to July 2011. Results. A total of 124 CABSI episodes were reviewed in 66 patients. Mean LOS with ELT after 1 positive blood culture (BC) was 7.1 versus 12.3 days after ≥2 positive BC (P = .014). Mean ALOS was 1.6 days with ELT versus 2.9 days without ELT (P = .018). Mean ALOS with ELT after 1 positive BC was 3.75 days versus 5.8 days after ≥2 positive BC (P = .022). Catheter salvage rate: 41 of 48 (85%) with ELT versus 49 of 68 (72%) without ELT (P = .169). Conclusion. Earlier initiation of ELT may decrease ALOS. [ABSTRACT FROM PUBLISHER]

Background. Current data are limited on compliance with guidelines for the treatment of attention deficit/hyperactivity disorder (ADHD). Methods. A survey assessing compliance with ADHD guidelines for diagnosis and management was distributed to pediatricians in a practice research network. Comparisons were made by practitioner characteristics. Results. In all, 42/76 surveys were returned (55%). Respondents largely adhered to American Academy of Pediatrics (AAP) guidelines. A lower percentage reported compliance for rescreening with a standardized tool (80%), use of electrocardiograms (78% rarely use), and the use of routine additional testing (80% rarely use). Academic practitioners were more likely to rescreen (100% vs 79%, P < .05). Private practitioners more often used newer therapeutic agents (7% vs 44%, P < .01). Older graduates were more comfortable diagnosing at a young age (93% vs 56%, P < .01) and were more comfortable using sleep agents (60% vs 15%, P < .01). Conclusion. Pediatricians largely adhered to AAP guidelines. These findings support changes made to the guidelines in 2011. Differences in practice patterns exist by practitioner experience, location, and practice type. [ABSTRACT FROM PUBLISHER]

Background. To evaluate if a severity score could differentiate the severity of children with nontyphoid salmonellosis; clinical outcomes of antimicrobial therapy in nontyphoid salmonellosis children with different severities. Methods. Admitted children with nontyphoid salmonellosis from 1996 to 2009 were monitored. Enrolled patients were divided into no antibiotics, concordant, and discordant therapies. Besides, the patients were classified into mild, moderate, and severe group according to the severity score. Clinical outcomes were compared among them. Results. A total of 558 patients were enrolled. In no therapy subset, compared with mild group, patients had worse clinical outcomes and more complications in severe group. Patients receiving no therapy had better clinical outcomes in mild group. However, patients receiving concordant therapy (ceftriaxone) had better clinical outcomes in severe group. Conclusions. The severity score and local antibiotic susceptibility could serve as guides for antibiotic prescription for severe nontyphoid salmonellosis in children. Inappropriate antibiotic use would worsen clinical outcomes in children with mild nontyphoid salmonellosis. [ABSTRACT FROM PUBLISHER]

Chronic functional constipation with or without encopresis is a common problem in the pediatric population, and the prevalence of encopresis may be underestimated. The aim of this study was to assess the prevalence and risk factors for overflow incontinence in patients with chronic constipation seen at a pediatric gastroenterology consultation. A retrospective study of 270 files of patients seen between 1997 and 2012 was conducted, and a classification according to Rome III criteria was done. Among 145 (53.7%) boys and 125 (46.2%) girls, 117 had overflow incontinence (43.3%) - 41 (35%) girls and 76 (65%) boys. The first symptoms of chronic constipation appeared at a median age of 30 and 33 months in encopretic and 16 and 12 months in nonencopretic girls and boys, respectively. The first specialized consultation took place after a median disease duration of 26.5 and 24 months in encopretic and 16 and 9 months in nonencopretic girls and boys, respectively. A history of stool retention and the presence of scybala at examination, but not of pain at defecation or anal fissure, were associated with encopresis. The onset of chronic constipation after the age of 2 years, a longer disease duration, male gender, and a history of stool retention were seen as risk factors for the development of encopresis in patients with chronic functional constipation. [ABSTRACT FROM PUBLISHER]

Objective. To describe parents’ experience with their child’s allergic rhinitis (AR) to inform management by the primary care provider (PCP). Study Design. Two hundred parents with a child 7 to 15 years old with AR symptoms within the past 12 months completed a paper survey. Results. The child’s AR was identified as a significant problem in spring (89.3%), fall (63.4%), summer (50.3%), and winter (21.4%); 51.3% had persistent disease. AR symptoms most commonly interfered with the child’s outdoor activities and sleeping, and frequently bothered the parent and other family members. Most parents (88.3%) wanted to know what their child was allergic to and had many concerns about treatment options. A total of 62.9% had sought AR care from the PCP in the past 12 months. Conclusions. Many families experience significant morbidity from their child’s AR and turn to their PCP for help. We identified opportunities for the PCP to reduce AR morbidity. [ABSTRACT FROM PUBLISHER]

Objective: To assess the status of pulse oximetry screening and barriers to implementing screening programs. Methods: This was a prospective pre-post intervention survey of nurse managers and medical directors of hospital-based birthing centers in Oregon, Idaho, and Southern Washington. The intervention was a 7-minute video demonstrating and discussing pulse oximetry screening for critical congenital heart disease. Results: Analysis of matched pairs showed a significant increase in the use of pulse oximetry screening during the study period from 52% to 73% (P < .0001). Following implementation of the video, the perception of all queried potential barriers decreased significantly among individuals from hospitals self-identified as nonscreening at baseline. Viewing the educational video was associated with an increase in the percentage of individuals from nonscreening hospitals that rated screening as “very beneficial” (45% vs 90%, P = .0001). Conclusions: An educational video was associated with improved opinions of pulse oximetry screening among hospitals not currently screening. [ABSTRACT FROM PUBLISHER]

The article discusses a study on the use of rapid plasma reagin (RPR) test in screening for syphilis in adolescents using the electronic medical records of patients at aacademic medical center in New York City. Topics covered include the vaccination of patients with true-positive (TP) and false-positive (FP) RPR tests, the number of patients with rheumatologic disorders, and laboratory bills for each RPR test, RPR titers and fluorescent treponemal antibody absorption (FTA-ABS).

Objectives. To assess primary care pediatric providers’ comfort with co-managing patients with rare conditions. Methods. A survey was sent via an electronic link to pediatricians and family practitioners. Chi-square test of significance and Fisher’s exact test were used for categorical variable comparisons and the Student’s t test was used for continuous variable comparisons. Results. Most of the providers believed that care decisions are most frequently made by the specialist with consultation with the primary care clinician. The most common source of information is direct communication from the specialist. The most effective tool to increase clarity and comfort about provider roles was an active care plan identifying current care needs, who will act on the plan, and when the action should be completed. Conclusions. Coordinated co-management in which caregiving roles are explicitly defined and tools are available for the timely exchange of information among all key participants warrants further study. [ABSTRACT FROM PUBLISHER]

Aim. The objective of this study is to compare head circumferences (HCs) measured on the day of delivery and on the third day after delivery. Method. A total of 499 children born in the maternity department were recruited for the study. HC was measured in centimeters immediately after birth and on the third day after delivery. Results. There are statistically significant differences between HC at the time of birth and on the third day. Presentation and method of delivery were significantly associated with differences in HC. For presentation, we found that breech newborns more commonly have smaller HC on day 3 measurements (P = .001). For method of delivery, we found that cesarean sections also were more commonly associated with having smaller HC on day 3 measurement (P = .02). Conclusion. Measuring HC on the third day is more clinically valuable because much of the effects of molding and birth injuries will have subsided in most newborns. [ABSTRACT FROM PUBLISHER]

Objective. This study discusses the impact of mental health screening in pediatric primary care on the management of mental health concerns. Methods. Youth aged 11 years and their parents completed the Pediatric Symptom Checklist and chart reviews were used to gather information about discussion of mental health concerns and connection with mental health services. The study design was a post-intervention study with a concurrent comparison group of youth aged 12 years who were not offered a screening. The χ2 or Fisher’s exact tests and logistic regression were used to compare groups on outcome variables. Results. Parents who completed a mental health screening for their child were more likely to be referred and attend mental health services, attend a psychiatrist appointment, and discuss their concerns with the primary care provider compared with the comparison group. Conclusions. Screening by parents improves detection of problems and fosters conversations with providers and subsequent connection with services. [ABSTRACT FROM PUBLISHER]

The National Asthma Education and Prevention Program recommends that providers demonstrate and assess metered-dose inhaler–spacer (MDI-S) technique at each medical visit. To examine practice behaviors and perceived barriers to demonstrating and assessing MDI-S technique, we surveyed pediatric providers (n = 114) at an inner-city academic medical center. While 82% of providers demonstrated MDI-S technique, only 5% of providers demonstrate the technique at every visit. Although 67% of providers assessed MDI-S technique, only 13% assess the technique at every visit. None of the providers used MDI-S checklist for assessment. Attendings were more likely than residents to demonstrate with illustrations (24% vs 6%, P = .01) and when patient’s asthma was not well controlled (68% vs 47%, P = .05). Provider-identified barriers included limited access to MDI-S device, lack of time, and inadequate knowledge. Suggestions to address barriers include in-service training, device access, and nurse/health educators to alleviate the time constraints. Clinic modifications and education are needed. [ABSTRACT FROM PUBLISHER]

Purpose: To examine the attitudes toward human papillomavirus (HPV) vaccination among young men from African American, Haitian, Caucasian, and Latino backgrounds. Methods: We used in-person surveys at an urban teaching hospital from 2010 to 2012 to examine the racial and ethnic differences in the perceived benefits and barriers to HPV vaccination and vaccine mandate acceptance among 18- to 22-year-old African American, Haitian, Caucasian, and Latino men. Results: A total of 89 men participated (35% African American, 29% Haitian, 20% Latino, and 16% white). Participants from all ethnic groups perceived benefits to HPV vaccination but differed in their perceptions of barriers to vaccination as well as their acceptance of a vaccine mandate. Conclusions: Culturally competent educational messages may overcome ethnic differences in the attitudes, beliefs, and behaviors regarding vaccination among college-aged men from an urban population. [ABSTRACT FROM PUBLISHER]

Background. This study sought to determine if parents of males express concerns about vaccine-associated infertility (VAI) with the human papillomavirus (HPV) vaccine and to understand the impact of those concerns. Methods. Parents of sons were surveyed to determine VAI concerns. Logistic regression was used to find if parents worried about VAI had lower knowledge of HPV disease, more concern for side effects, lacked information about vaccination, or had lower intention to vaccinate. Results. In all, 39% of parents were worried about VAI. Parents worried about VAI had similar knowledge of HPV compared with other parents. Parents worried about VAI had twice the odds of agreeing the vaccine may cause side effects and agreeing they did not have enough information compared to their counterparts. Parents worried about VAI less often intended to vaccinate sons than other parents. Conclusions. These findings suggest many parents worry about VAI in sons with HPV vaccine. [ABSTRACT FROM PUBLISHER]

Objective. To examine feeding practices and factors associated with breast-feeding initiation (BFI) in women with pregestational diabetes mellitus (PGDM) and their infants. Methods. In all, 392 PGDM (135 late preterm and 257 term) pregnancies were studied. Infant feeding preference was ascertained on admission. Results. After birth, 166 (42%) of the infants received well-baby care, whereas 226 (58%) were admitted to the newborn intensive care unit (NICU). Hypoglycemia (blood glucose <40 mg/dL), which occurred in 128 (33%) of all infants, did not influence BFI. Of 257 women who intended to BF, 55% initiated BF. Also, 5% of 105 women who intended to feed formula and 13% of the 30 undecided later initiated BF. Conclusions. The BFI rate for women with PGDM is remarkably low even among those who intended to BF. Factors associated with BFI failure in this population were primiparity, African American race, lower education, smoking, lack of intention to BF, and NICU admission. [ABSTRACT FROM PUBLISHER]

Objective. To assess the interaction of parent and child characteristics with feeding practices and mealtime functioning. Design. Longitudinal, predictive study comparing baseline characteristics with follow-up assessments. Participants. The caregivers of 52 persistently obese youth and 32 nonoverweight comparison youth completed measurements of child temperament, parental feeding practices, parenting styles, and interactions during mealtimes. Results. Adolescents with persistent obesity were significantly more likely to be parented using problematic feeding practices when parents also reported difficult child temperaments. Additionally, adolescents with persistent obesity and difficult temperaments were significantly more likely to have lower levels of positive mealtime interactions. Conclusion. Persistently obese youth are at increased risk for problematic parental feeding practices and mealtime functioning, particularly when youth are described as having difficult temperaments. These results indicate that further investigations are needed to better understand the mechanisms linking parent and child characteristics with health-related behaviors for adolescents with obesity. [ABSTRACT FROM PUBLISHER]

Background. Rates of body mass index (BMI) calculation and plotting remain low. We examined whether providing a BMI wheel and brief education to pediatric residents and attendings would increase rates of “BMI recognition” and obesity-related counseling. Methods. A delayed-control design was used to evaluate a 20-minute intervention. A total of 1640 records of well-child visits were reviewed to determine the proportion of records in which BMI was calculated and plotted and counseling provided. Results. In clinic A, there was a significant increase in the proportion of records in which BMI was recognized from pre- to postintervention (P < .01). No changes in clinic B occurred until after the delayed intervention. Obesity-related counseling was more likely to occur if BMI was recognized. Conclusion. Brief education and BMI wheel increased rates of BMI recognition. BMI recognition was associated with increased obesity management. Additional efforts should be incorporated to further increase BMI recognition and assist providers in treating these children. [ABSTRACT FROM AUTHOR]