The Journal of Pediatrics

Down syndrome increases risk of hospitalization for RSV

Sarah S. Long — 2012-05-01

Zachariah et al in Colorado used three retrospective administrative databases and study designs to investigate hospitalizations of children with Down syndrome (DS) due to respiratory synctial virus lower respiratory tract infection (RSV LRTI) during the approximate years of 1995 to 2006. They were able to show that population-based incidence of RSV LRTI in DS was approximately 6-fold higher than in children without DS (67 versus 12 per 1000 child-years during the first 2 years of life, respectively). Children with DS without other underlying conditions (such as congenital heart disease, pulmonary hypertension, chronic lung disease or prematurity) still had higher incidence of RSV LRTI hospitalization (42 per 1000 child-years; OR 3.5, 95% CI 3.10-4.12) than children without DS. Severity scores, clinical features of fever, pulmonary consolidation, bronchodilator use, and durations of hospitalization also were higher in patients with DS.

Should we resuscitate newborn infants in developing countries?

Terrie E. Inder — 2012-05-01

There has been concern among primary caregivers in developing countries that the need for resuscitation after birth indicates brain injury and high risk for subsequent neurodevelopmental impairment. These beliefs have impaired widespread uptake of newborn resuscitation procedures. The study by Carlo et al in this issue of The Journal provides important information to negate that belief. They demonstrate that resuscitation of the newborn, without severe encephalopathy, is not associated with an increased risk for adverse neurodevelopmental outcome. These findings will greatly assist in supporting appropriate training for resuscitation of the term born infant resulting in increased survival without major neurodevelopmental impairment.

Vertical transmission of HPV

Sarah S. Long — 2012-05-01

In a prospective longitudinal study of mother–infant pairs conducted in Finland, investigators have added specificity to our knowledge of transmission of human papillomavirus (HPV). Vertical transmission was confirmed. The majority of mothers were HPV seropositive. HPV DNA was detected in approximately 18% of oral samples of newborn infants and 16% of cervical samples of mothers. There was almost 100% concordance of maternal–infant genotypes at birth. Oral HPV carriage at birth was most strongly associated with the detection of HPV in the placenta (OR = 14.0, 95% CI 13.7 to 52.2). Oral HPV carriage of infants fell over the first 2 months of age, as did concordance with maternal genotype. Maternal genotype-specific antibody did not appear to protect infants from colonization or persistence. The authors discuss the possible meaning of their findings within the complex relationships of HPVs and the host, relationships in which the viruses seem to have more tricks than the host.

Is post-term birth associated with increased risk of obesity?

Stephen R. Daniels — 2012-05-01

Studies have shown that babies born small are at increased risk for type 2 diabetes, obesity, hypertension, and cardiovascular disease. Most studies have focused on infants who were small for gestational age and born at term or premature. Post-term birth is relatively common and it has been speculated that post-term gestation may produce a suboptimal environment for the fetus. Life course risks for chronic disease have not been extensively studied for children who were born post-term. In this issue of The Journal, Beltrand et al evaluated whether post-term birth is associated with obesity in adolescents. Their results show that even though body mass index (BMI) is similar for term and post-term infants until age 2 years, after that they start to diverge, with post-term infants having significantly greater BMI and an increasing separation in BMI, especially after age 12 years. These results suggest that pediatricians should counsel parents of infants born post-term on diet, physical activity, and other lifestyle factors.

Variations in performance of outpatient tonsillectomy in the US

Sarah S. Long — 2012-05-01

Using a 2006 National Survey of Ambulatory Surgery database and population estimates from the 2006 Census Bureau and the National Health Interview Survey, Boss et al queried geographic and demographic variations in performance of tonsillectomy in US children. More than half a million tonsillectomies were performed in outpatient settings (where >95% of such procedures currently are performed) in 2006. Seeming differences from earlier reported ages and indications for tonsillectomy were that younger children (0 through 6 years) underwent tonsillectomies more often than older children (7 through 12 years) (rates per 10 000 of 102.9 versus 91.3 versus 33.8, respectively), and obstructive symptoms alone (sleep-disordered breathing and obstructive sleep apnea) trumped infection alone (61% versus 52%) as declared indication for surgery. Rate of tonsillectomy was lower in the Western US compared with other regions, and higher in small/medium metropolitan areas compared with large central metropolitan areas.

Helping babies breathe

Alan H. Jobe — 2012-05-01

Since the introduction of ventilators designed for infants in the 1970s, there have been multiple innovations to better deliver mechanical breaths. Ventilators that synchronize with spontaneous breathing and deliver operator-selected tidal volumes are now routinely used. Flow sensors are used to synchronize breaths and deliver tidal volumes. A new wrinkle is the recent development of an esophageal catheter that can detect the amount of neural signaling to the diaphragm. This vagal nerve signal can be used to synchronize mechanical breaths with spontaneous breaths of the infant and vary volume/pressure with the size of the neural signal. In this issue of The Journal, Stein et al report that the use of neutrally adjusted ventilatory assistance (NAVA) seems to provide better ventilatory assistance than conventional ventilators for intubated infants with respiratory distress syndrome or bronchopulmonary dysplasia. Many clinicians are now using various devices to provide noninvasive (no endotracheal tube) ventilation via nasal devices. Synchronization of these ventilatory assists using flow sensors is most difficult because of the large and variable leaks. Adaptation of technology such as NAVA may allow for synchronization of noninvasive ventilation.

Growth hormone treatment of skeletal dysplasia

Thomas R. Welch — 2012-05-01

It seems that recombinant human growth hormone (rhGH) therapy can lead to increased growth in just about any child with (or without) chronic disease. An exception to this has been one of the more common skeletal dysplasias achondroplasia. Attempts at achieving enhanced growth in children with this disorder have not been successful.

Rheumatic fever: Down but not gone

Sarah S. Long — 2012-05-01

Authors from the well-industrialized area of Abruzzo, in Central Italy document the population-based incidence of acute rheumatic fever and prevalence of rheumatic heart disease in children from 2000 through 2009. The observed rates are lower than those in developing countries but higher than those in most of the United States. Of the 88 cases identified, 75% were 5-14 years of age (with 14% younger than 5 years), 59% had arthritis, and 49% had carditis.

2012-05-01

Masthead

2012-05-01

Information for Readers

2012-05-01

Are Pediatric Grand Rounds Dead?

Donald W. Lewis — 2012-05-01

EDITOR’S NOTE: We note, with great sadness, the untimely passing of Dr Lewis on February 17, 2012, shortly after his final review of this manuscript. Don was loved by his students and faculty as a mentor, teacher, advocate, and leader. We will miss him as a colleague and friend. Our most sincere condolences to his family and faculty.–Paul H. Dworkin, MD

Obesity, Asthma, and Sleep-Disordered Breathing

Leila Kheirandish-Gozal, David Gozal — 2011-12-26

In a busy clinical practice, asthma, obesity, and sleep-disordered breathing (SDB) are frequent occurrences, many times overlapping in the same patient. Is this just a coincidence, or do these 3 medical problems share pathophysiological mechanisms that may explain their concurrence beyond randomness?

Pediatric Sedation with Propofol—Continuing Evolution of Procedural Sedation Practice

Joseph P. Cravero — 2012-02-10

Propofol is a highly effective yet politically charged sedative-hypnotic. Disagreement over where it may be administered and by whom continues to generate attention, whether in a celebrity bedroom or in the magnetic resonance image scanner. The rapid onset and recovery kinetics of propofol, together with the absence of nausea or other emergence phenomena, create a highly desirable pharmacologic profile. On the other hand, the potency of propofol has lead to safety concerns over which specialists should be granted sedation privileges for its use. In this issue of The Journal, Srinivasan et al describe the adverse events and interventions recorded during propofol procedural sedation delivered by pediatric hospitalists over almost 4 years. The authors should be complimented for reporting the outcomes of their practice and adding to the collected literature on propofol sedation. The data from this study are worth comment and discussion, both as an example of difficulties encountered with most pediatric sedation studies and as a reflection of the current status of propofol sedation administered by providers other than anesthesiologists.

Tonsillectomy: A Procedure in Search of Evidence

David C. Goodman, Greg J. Challener — 2012-02-16

In this issue of The Journal, Boss et al report on the epidemiology of outpatient tonsillectomies in children using recent data from the National Survey of Ambulatory Surgery. Procedure rates varied almost 5-fold across the 4 Census regions, dwarfing the variation observed for urban versus rural residence or insurance status. What can we learn from the current regional variation in tonsillectomies, a phenomenon first reported decades ago?

Comparative Effectiveness Research Using the Electronic Medical Record: An Emerging Area of Investigation in Pediatric Primary Care

2012-02-27

Previous research demonstrated that as many as one-half of all clinical decisions are reached without adequate medical evidence to inform choices. In contrast to other areas of investigation, comparative effectiveness research (CER) directly addresses this problem. Specifically, CER uses varied study designs to generate and synthesize evidence demonstrating the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor clinical conditions or improve the delivery of care. The need for CER is especially urgent in pediatrics, a field in which clinicians and families frequently depend on the generalization of medical knowledge from adult trials despite limited evidence to support the use of these treatments. To close these knowledge gaps, the American Recovery and Reinvestment Act of 2009 (ARRA) allocated $1.1 billion for CER.

50 Years Ago in The Journal of Pediatrics: Leprechaunism in a Male Infant

Alan D. Rogol — 2012-05-01

Patterson JH, Watkins WL. J Pediatr 1962;60:730-9 The authors describe a male infant with a syndrome that matches another previously described. It was called leprechaunism and featured anorexia, mental retardation, abnormal facies and ears, masculinization of the external genitalia, severe malnutrition, muscle wasting, severe bony abnormalities, and markedly delayed bone age with early death. This patient had a moderate disorder of insulin action.

Moving from PANDAS to CANS

2011-12-26

Encountering a previously healthy child with the acute, sudden onset of obsessive-compulsive behaviors, tics, abnormal movements, or other neuropsychiatric symptoms poses a dilemma for most physicians. The differential diagnosis is broad (infectious, post-infectious, drug-induced, autoimmune, metabolic, traumatic, psychogenic, etc), and the selection of rational therapeutic agents is dependent on the identification of a specific etiology or symptom complex. One entity in particular, pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) is frequently considered because of its apparent association with a highly prevalent bacterial infection. This report reviews each of the required clinical criteria for PANDAS. On the basis of inconclusive and conflicting scientific support for this diagnosis, a broader concept of childhood acute neuropsychiatric symptoms (CANS) is proposed. Although inclusion in CANS requires only the acute dramatic onset of symptoms, we mandate a comprehensive history and examination, consideration of a differential diagnosis, an active search for a specific etiology through appropriate laboratory testing, and treatment with the most appropriate therapy.

Relationships among Obstructive Sleep Apnea, Anthropometric Measures, and Neurocognitive Functioning in Adolescents with Severe Obesity

2011-12-05

Objective: To explore associations between measures of obstructive sleep apnea (OSA) and sleep quality, anthropometrics, and neurocognitive functioning in severely obese adolescents.Study design: This was a cross-sectional pilot study performed at an academic medical center in 37 severely obese (body mass index [BMI] >97th percentile) adolescents. Study evaluations included polysomnography, BMI, waist circumference, and standardized neurocognitive tests to assess memory, executive functioning, psychomotor efficiency, academic achievement, and an approximation of full-scale IQ. Outcome data were evaluated categorically, based on clinical criteria for the diagnosis of OSA, and continuously to quantify associations between sleep parameters, anthropometrics, and neurocognitive test results.Results: Sleep fragmentation and poorer sleep quality were associated with reduced psychomotor efficiency, poorer memory recall, and lower scores on standardized academic tests. Having evidence of OSA was associated with lower math scores, but not with other neurocognitive measures. BMI and waist circumference were negatively associated with oxygen saturation.Conclusion: Our pilot study findings suggest that sleep fragmentation and poorer sleep quality have implications for neurocognitive functioning in obese adolescents. The epidemic of childhood obesity has dire implications, not only for increasing cardiometabolic pathology, but also for possibly promoting less readily apparent neurologic alterations associated with poor sleep quality.

50 Years Ago in The Journal of Pediatrics: Auscultation in the Diagnosis of Intracardiac Acyanotic Congenital Heart Disease

Samuel S. Gidding — 2012-05-01

Kaplan S, Daoud G. J Pediatr 1961;60:746-53 In an article as true today, with some minor exceptions, as it was in 1961, Kaplan and Daoud describe the auscultatory findings in atrial septal defect, ventricular septal defect, endocardial cushion defect, aortic stenosis, and pulmonic stenosis. These descriptions are based on precise correlations of cardiac catheterization pressure recordings with phonocardiograms. At the time, the emerging technical advances related to both cardiac surgery and catheterization made accurate diagnosis of congenital heart disease in youth critically important. Studies of school-based screening for congenital defects with tape recordings were conducted in the 1960s. In the 1980s, skilled auscultation was determined to have a sensitivity and specificity for distinguishing children with normal hearts from children with congenital heart defects <95% to 98%, test characteristics rarely achieved in clinical medicine today.

Sleep-Disordered Breathing is Associated with Asthma Severity in Children

2011-12-02

Objective: To examine the relationships among obesity, sleep-disordered breathing (SDB, defined as intermittent nocturnal hypoxia and habitual snoring), and asthma severity in children. We hypothesized that obesity and SDB are associated with severe asthma at a 1- year follow-up.Study design: Children aged 4-18 years were recruited sequentially from a specialty asthma clinic and underwent physiological, anthropometric, and biochemical assessment at enrollment. Asthma severity was determined after 1 year of follow-up and guideline-based treatment, using a composite measure of level of controller medication, symptom burden, and health care utilization. Multivariate logistic regression was used to examine adjusted associations of SDB and obesity with asthma severity at 12-month follow-up.Results: Among 108 subjects (mean age, 9.1±3.4 years; 45.4% African-American; 67.6% male), obesity and SDB were common, affecting 42.6% and 29.6% of subjects, respectively. After adjusting for obesity, race, and sex, children with SDB had a 3.62-fold increased odds of having severe asthma at follow-up (95% CI, 1.26-10.40). Obesity was not associated with asthma severity.Conclusion: SDB is a modifiable risk factor for severe asthma after 1 year of specialty asthma care. Further studies are needed to determine whether treating SDB improves asthma morbidity.

Occurrence and Timing of Childhood Overweight and Mortality: Findings from the Third Harvard Growth Study

Aviva Must, Sarah M. Phillips, Elena N. Naumova — 2011-12-19

Objective: To assess the mortality experience of participants in the Third Harvard Growth Study (1922-1935) who provided ≥8 years of growth data.Study design: A total of 1877 participants provided an average of 10.5 body mass index measurements between age 6 and 18 years. Based on these measurements, the participants were classified as ever overweight or ever >85th percentile for height in childhood. Age at peak height velocity was used to indicate timing of overweight relative to puberty. Relative risks of all-cause and cause-specific mortality according to measures of childhood growth were estimated using Cox proportional hazards survival analysis.Results: For women, ever being overweight in childhood increased the risks of all-cause and breast cancer death; the risk of death from ischemic heart disease was increased in men. Men with a first incidence of overweight before puberty were significantly more likely to die from ischemic heart disease; women in the same category were more likely to die from all causes and from breast cancer.Conclusion: We find evidence of long-term effects of having ever been overweight, with some evidence that incidence before puberty influences the pattern of risk.

50 Years Ago in The Journal of Pediatrics: Observations on Skin Resistance to Electricity and Sweat Chloride Content: A Preliminary Report

Neil B. Sweezey — 2012-05-01

Batson R, Young WC, Shepard FM. J Pediatr 1962;60:716-20 Batson et al sought to develop a simple test for cystic fibrosis (CF) by measuring the electrical resistance of the skin. Their method distinguished between CF and non-CF groups, but in individual patients with borderline results it did not discriminate as well as sweat chloride content, at that time a new test for CF. The authors suggested improving their test for screening or diagnosis.

Hemoglobin A1c above Threshold Level is Associated with Decreased β-Cell Function in Overweight Latino Youth

Claudia M. Toledo-Corral, Lisa G. Vargas, Michael I. Goran, Marc J. Weigensberg — 2011-12-06

Objective: To examine whether a hemoglobin A1c (HbA1c)-identified prediabetic state (HbA1c ≥6.0%-6.4%) is associated with decreased insulin sensitivity (SI) and β-cell dysfunction, known factors in the pathogenesis of type 2 diabetes, in an overweight pediatric population.Study design: A total of 206 healthy overweight Latino adolescents (124 males and 82 females; mean age, 13.1±2.0 years) were divided into 2 groups: lower risk (n=179), with HbA1c <6.0%, and higher risk (n=27), with HbA1c 6.0%-6.4%. Measurements included HbA1c, oral glucose tolerance testing, fasting and 2-hour glucose and insulin, SI, acute insulin response, and disposition index (an index of β-cell function) by the frequently sampled intravenous glucose tolerance test with minimal modeling. Body fat was determined by dual-energy X-ray absorptiometry.Results: Compared with the lower risk group, the higher risk group had 21% lower SI (1.21±0.06 vs 1.54±0.13; P<.05), 30% lower acute insulin response (928±102 vs 1342±56; P<.01), and a 31% lower disposition index (1390±146 vs 2023±83; P=.001) after adjusting for age and total percent body fat.Conclusion: These data provide clear evidence of greater impairment of β-cell function in overweight Latino children with HbA1c 6.0%-6.4%, and thereby support the adoption of the International Expert Committee’s HbA1c-determined definition of high-risk state for overweight children at risk for type 2 diabetes.

50 Years Ago in The Journal of Pediatrics: A Decade with Agammaglobulinemia

Nathan R. York, M. Teresa de la Morena — 2012-05-01

Bruton OC. J Pediatr 1962:60:672-6 In 1952, Ogden Bruton reported the first case of a boy with X-linked agammaglobulinemia (XLA), now recognized as Bruton’s XLA. Fifty years ago in The Journal, he provided a progress report on the same child. Bruton described how gammaglobulin treatment allowed for normal growth, lack of serious illnesses, and how the boy was able to lead a normal life. This is followed by a summary of how study of these children advanced the young field of clinical immunology.

Prevalence of Persistent Prehypertension in Adolescents

Alisa A. Acosta, Joshua A. Samuels, Ronald J. Portman, Karen M. Redwine — 2011-12-08

Objective: To measure the prevalence of persistent prehypertension in adolescents.Study design: We collected demographic and anthropometric data and 4 oscillometric blood pressure (BP) measurements on 1020 students. The mean of the second, third, and fourth BP measurements determined each student’s BP status per visit, with up to 3 total visits. Final BP status was classified as normal (BP <90th percentile and 120/80 mm Hg at the first visit), variable (BP ≥90th percentile or 120/80 mm Hg at the first visit and subsequently normal), abnormal (BP ≥90th percentile or 120/80 mm Hg at 3 visits but not hypertensive), or hypertensive (BP ≥95th percentile at 3 visits). The abnormal group included those with persistent prehypertension (BP ≥90th percentile or 120/80 mm Hg and <95th percentile on 3 visits). Statistical analysis allowed for comparison of groups and identification of characteristics associated with final BP classification.Results: Of 1010 students analyzed, 71.1% were classified as normal, 15.0% as variable, 11.5% as abnormal, and 2.5% as hypertensive. The prevalence of persistent prehypertension was 4.0%. Obesity similarly affected the odds for variable BP (OR, 3.9; 95% CI, 2.5-6.0) and abnormal BP (OR, 3.4; 95% CI, 2.0-5.9), and dramatically increased the odds for hypertension (OR, 38.4; 95% CI, 9.4-156.6).Conclusion: Almost 30% of the students had at least one elevated BP measurement significantly influenced by obesity. Treating obesity may be essential to preventing prehypertension and/or hypertension.

Eighty-Year Trends in Infant Weight and Length Growth: The Fels Longitudinal Study

2011-12-19

Objectives: To investigate secular trends in weight and length growth from birth to 3 years of age in infants born from 1930 to 2008, and to assess whether these trends were associated with concurrent trends in pace of infant skeletal maturation and maternal body mass index.Study design: Longitudinal weight and length data from 620 infants (302 girls) were analyzed with mixed effects modeling to produce growth curves and predicted anthropometry for infants born from 1930 to 1949, 1950 to 1969, 1970 to 1989, and 1990 to 2008.Results: The most pronounced differences in growth occurred in the first year of life. Infants born after 1970 were approximately 450 g heavier and 1.4 cm longer at birth, but demonstrated slower growth to 1 year of age than infants born before 1970. Growth trajectories converged after 1 year of age. There was no evidence that relative skeletal age, maternal body mass index, or maternal age together mediated associations between cohort and growth.Conclusions: Recent birth cohorts may be characterized not only by greater birth size, but also by subsequent catch-down growth. Trends over time in human growth do not increase monotonically, and growth velocity in the first year may have declined compared with preceding generations.

Post-Term Birth is Associated with Greater Risk of Obesity in Adolescent Males

2011-12-08

Objective: To test the hypothesise that post-term birth (>42 weeks gestation) adversely affects longitudinal growth and weight gain throughout childhood.Study design: A total of 525 children (including 17 boys and 20 girls born post-term) were followed from birth to age 16 years. Weight and height were recorded prospectively throughout childhood, and respective velocities from birth to end of puberty were calculated using a mathematical model.Results: At birth, post-term girls were slimmer than term girls (ponderal index, 27.7±2.6 kg/m3 vs 26.3±2.8 kg/m3; P<.05). At age 16 years, post-term boys were 11.8 kg heavier than term subjects (body mass index [BMI], 25.4±5.5 kg/m2 vs 21.7±3.1 kg/m2; P<.01). The rate of obesity was 29% in post-term boys and 7% in term boys (P<.01), and the combined rate of overweight and obesity was 47% in post-term boys and 13% in term boys (P<.01). Weight velocity, but not height velocity, was higher in post-term boys at age 1.5-7 years (P<.05) and again at age 11.5-16 years (P<.05). BMI was higher in post-term boys at age 3 years, with the difference increasing thereafter. BMI and growth were similar in post-term and term girls.Conclusion: In this post-term birth cohort, boys, but not girls, demonstrated accelerated weight gain during childhood, leading to greater risk of obesity in adolescence.

Major Chromosomal Anomalies among Very Low Birth Weight Infants in the Vermont Oxford Network

2011-12-19

Objective: To examine prevalence, characteristics, interventions, and mortality of very low birth weight (VLBW) infants with trisomy 21 (T21), trisomy 18 (T18), trisomy 13 (T13), or triploidy.Study design: Infants with birth weight 401-1500 g admitted to centers of the Vermont Oxford Network during 1994-2009 were studied. A majority of the analyses are presented as descriptive data. Median survival times and their 95% CIs were estimated using the Kaplan-Meier approach.Results: Of 539 509 VLBW infants, 1681 (0.31%) were diagnosed with T21, 1416 (0.26%) with T18, 435 (0.08%) with T13, and 116 (0.02%) with triploidy. Infants with T18 were the most likely to be growth restricted (79.7%). Major surgery was reported for 30.4% of infants with T21, 9.2% with T18, 6.4% with T13, and 4.8% with triploidy. Hospital mortality occurred among 33.1% of infants with T21, 89.0% with T18, 92.4% with T13, and 90.5% with triploidy. Median survival time was 4 days (95% CI, 3-4) among infants with T18 and 3 days (95% CI, 2-4) among both infants with T13 and infants with triploidy.Conclusion: In this cohort of VLBW infants, survival among infants with T18, T13, or triploidy was very poor. This information can be used to counsel families.

Neurodevelopmental Outcomes in Infants Requiring Resuscitation in Developing Countries

2011-11-21

Objective: To determine whether resuscitation of infants who failed to develop effective breathing at birth increases survivors with neurodevelopmental impairment.Study design: Infants unresponsive to stimulation who received bag and mask ventilation at birth in a resuscitation trial and infants who did not require any resuscitation were randomized to early neurodevelopmental intervention or control groups. Infants were examined by trained neurodevelopmental evaluators masked to both their resuscitation history and intervention group. The 12-month neurodevelopmental outcome data for both resuscitated and non-resuscitated infants randomized to the control groups are reported.Results: The study provided no evidence of a difference between the resuscitated infants (n = 86) and the non-resuscitated infants (n = 115) in the percentage of infants at 12 months with a Mental Developmental Index <85 on the Bayley Scales of Infant Development-II (primary outcome; 18% versus 12%; P = .22) and in other neurodevelopmental outcomes.Conclusions: Most infants who received resuscitation with bag and mask ventilation at birth have 12-month neurodevelopmental outcomes in the reference range. Longer follow-up is needed because of increased risk for neurodevelopmental impairments.

Neurally Adjusted Ventilatory Assist in Neonates Weighing <1500 Grams: A Retrospective Analysis

Howard Stein, Diane Howard — 2011-12-06

Objective: To report our experience using neurally adjusted ventilatory assist (NAVA), which allows a patient to synchronize spontaneous respiratory effort with mechanical ventilation, in the neonatal intensive care unit in neonates weighing <1500 g.Study design: This was a retrospective review performed between May 2008 and May 2009. A total of 52 neonates on conventional ventilation were converted to NAVA. We compared ventilatory parameters and blood gas values during conventional ventilation and then at various time intervals during NAVA and evaluated for complications. Statistical analyses were performed using the 2-tailed Student t-test and the Z-test for proportions for demographic data and Hotelling’s T2 test to compare repeated measures (P < .05).Results: Peak inspiratory pressure and fraction of inspired oxygen decreased, and pH and partial pressure of carbon dioxide improved during use of NAVA. These changes were sustained for 24 hours.Conclusion: Compared with standard conventional ventilation, in preterm neonates NAVA appears to provide better blood gas regulation with lower peak inspiratory pressure and oxygen requirements.

A Randomized, Masked Study of Weekly Erythropoietin Dosing in Preterm Infants

Robin K. Ohls, Mashid Roohi, Hannah M. Peceny, Ronald Schrader, Ryann Bierer — 2011-12-05

Objective: To compare reticulocyte responses of once-per-week erythropoietin (EPO) dosing with 3-times-a-week dosing in preterm infants.Study design: Infants weighing ≤1500 g and ≥7 days of age were randomized to once-per-week EPO, 1200 U/kg/dose, or 3-times-a-week EPO, 400 U/kg/dose, subcutaneously for 4 weeks, along with iron and vitamin supplementation. Complete blood counts, absolute reticulocyte counts (ARCs), transfusions, phlebotomy losses, and adverse events were recorded.Results: Twenty preterm infants (962±55 g, 27.9±0.4 weeks, 17±3 days of age) were enrolled. Groups were similar at baseline. Infants in both groups had increased ARCs, which were similar between treatment groups at the start and end of 4 weeks. Hematocrit remained stable, and similar numbers of transfusions were administered. No adverse effects of either dosing schedule were noted.Conclusions: Preterm infants respond to weekly EPO by increasing ARCs and maintaining hematocrit. We speculate that once-per-week EPO dosing might be beneficial to preterm infants requiring increased erythropoiesis.

Total Serum Bilirubin Exceeding Exchange Transfusion Thresholds in the Setting of Universal Screening

2011-12-02

Objective: To describe the incidence and predictors of total serum bilirubin (TSB) levels that meet or exceed American Academy of Pediatrics (AAP) exchange transfusion (ET) thresholds in the setting of universal screening.Study design: We conducted a retrospective cohort analysis of electronic data on 18 089 newborns ≥35 weeks gestation born at Northern California Kaiser Permanente Medical Care Program hospitals implementing universal TSB screening in 2005 to 2007, with chart review for subjects with TSB levels reaching the AAP threshold for ET.Results: The outcome developed in 22 infants (0.12%); 14 (63.6%) were <38 weeks gestation. Only one infant received an ET; none of the infants had documented sequelae. The first TSB was at least high-intermediate risk on the AAP risk-nomogram for all 22 infants and high-risk for those ≥38 weeks, but was less than the phototherapy level in 15 infants (68%). Of these 15 infants, 2 failed phototherapy and 13 did not have a TSB repeated in <24 hours. However, re-testing all infants at high-intermediate risk or greater would have required 2166 additional bilirubin tests.Conclusion: Screening was sensitive but not specific for predicting exchange threshold.

Procedural Sedation for Diagnostic Imaging in Children by Pediatric Hospitalists using Propofol: Analysis of the Nature, Frequency, and Predictors of Adverse Events and Interventions

2011-12-19

Objective: To evaluate the nature, frequency, and predictors of adverse events during the use of propofol by pediatric hospitalists.Study design: We reviewed 1649 charts of patients sedated with propofol by pediatric hospitalists at St Louis Children’s Hospital between January 2005 and September 2009.Results: Hospitalists were able to complete 1633 of the 1649 sedations reviewed (99%). Major complications included 2 patients with aspiration and 1 patient intubated to complete the study. We observed a 74% reduction in the number of patients with respiratory events and airway interventions from 2005 to 2009. Predictors of respiratory events were history of snoring (OR, 2.40; 95% CI, 1.52-3.80), American Society of Anesthesiologists (ASA) physical status classification of ASA 3 (OR, 2.30; 95% CI, 1.22-4.33), age >12 years (OR, 4.01; 95% CI, 2.02-7.98), premedication with midazolam (OR, 1.85; 95% CI, 1.15-2.98), and use of adjuvant glycopyrrolate (OR, 4.70; 95% CI, 2.35-9.40). All except ASA 3 status were also predictors for airway intervention. There was a decline in the prevalence of all of these predictors over the study years (P < .05) except for use of glycopyrrolate.Conclusion: Our pediatric hospitalists implemented a successful propofol sedation program that realized a 74% reduction in respiratory events and airway interventions between 2005 and 2009. Decreased prevalence of the predictors of adverse events that we identified likely contributed to this reduction.

Post-Discharge Adverse Events following Pediatric Sedation with High Doses of Oral Medication

2011-12-02

Objective: To compare the occurrence of post-discharge adverse events in children having received a high dose of either chloral hydrate (CH) or midazolam (MZ) during outpatient dental treatment.Study design: A repeated-measures study design was carried out with 42 children treated at a sedation center. The sample comprised 103 dental sedation sessions among 22 male and 20 female patients, 1-8 years old, receiving either MZ (1.0-1.5 mg/kg) or CH (70.0-100.0 mg/kg). During treatment, a single observer recorded intraoperative adverse events. Twenty-four hours later, the observer called the child’s main caregiver seeking information on further adverse events. Data analysis involved descriptive and bivariate statistics and the general estimating equation for repeated measures.Results: The most common intraoperative and post-discharge adverse events were hallucination (3.9%) and excessive sleep (41.9%), respectively. The chance of the occurrence of an adverse event following oral pediatric sedation was lesser among the children who received MZ than those who received CH (OR: 0.09; 95% CI: 0.01-0.88).Conclusions: High doses of CH were associated with post-discharge adverse events in children having undergone pediatric dental sedation, whereas high doses of MZ were not associated with these events in pediatric patients.

Outpatient Tonsillectomy in Children: Demographic and Geographic Variation in the United States, 2006

Emily F. Boss, Jill A. Marsteller, Alan E. Simon — 2011-12-19

Objectives: To examine geographic and demographic variation for outpatient tonsillectomy in children nationally.Study design: The 2006 National Survey of Ambulatory Surgery was analyzed to describe outpatient tonsillectomy in children. Rates by age, sex, region, urban/rural residence, and payment source were calculated with 2006 population estimates from the Census Bureau and the National Health Interview Survey as denominators. Rates were compared with Z tests.Results: In 2006, approximately 583 000 (95% CI, 370 000-796 000) outpatient tonsillectomy procedures were performed in children in the United States. Rates per 10 000 children were lower in children 13 to 17 years old (33.8 per 10 000) than in both children 7 to 12 years old (91.3; P < .05) and children 0 to 6 years old (102.9; P < .001). Compared with the South, tonsillectomy rates were lower in the West (29 per 10 000 versus 125 per 10 000; P < .01) and not significantly different in other regions. Compared with large central metropolitan areas, tonsillectomy rates were higher in small/medium metropolitan areas (118 per 10 000 versus 42 per 10 000; P < .05), and not significantly different in large fringe or non-metropolitan areas. Tonsillectomy rates were similar for children insured by Medicaid compared with those insured by private sources. Compared with older children (13-17 years), children in the younger age groups (0-6 years, 7-12 years) underwent tonsillectomy more commonly for airway obstruction (69.5% and 59.2% versus 34.3%, P < .05 for both). Compared with older children, younger children (0-6 years) underwent tonsillectomy less commonly for infection (40.4% versus 61.0% [7-12 years] and 72.2% [13-17 years], P < .001 for both).Conclusions: Use of tonsillectomy in the ambulatory setting varies across age groups, geographic regions, levels of urbanization, and indication. Further research is warranted to examine these differences.

Health Status of Children Alive 10 Years after Pediatric Liver Transplantation Performed in the US and Canada: Report of the Studies of Pediatric Liver Transplantation Experience

2011-12-22

Objectives: To determine clinical and health-related quality of life outcomes, and to derive an “ideal” composite profile of children alive 10 years after pediatric liver transplantation (LT) performed in the US and Canada.Study design: This was a multicenter cross-sectional analysis characterizing patients enrolled in the Studies of Pediatric Liver Transplantation database registry who have survived >10 years from LT.Results: A total of 167 10-year survivors were identified, all of whom received daily immunosuppression therapy. Comorbidities associated with the post-LT course included post-transplantation lymphoproliferative disease (in 5% of patients), renal dysfunction (9%), and impaired linear growth (23%). Health-related quality of life, as assessed by the PedsQL 4.0 Generic Core Scales, revealed lower patient self-reported total scale scores for 10-year survivors compared with matched healthy children (77.2±12.9 vs 84.9±11.7; P<.001). At 10 years post-LT, only 32% of patients achieved an ideal profile of a first allograft stable on immunosuppression monotherapy, normal growth, and absence of common immunosuppression-induced sequelae.Conclusion: Success after pediatric LT has moved beyond patient survival. Availability of an ideal composite profile at follow-up provides opportunities for patients, families, and healthcare providers to identify broader sets of outcomes at earlier stages, ultimately contributing to improved outcomes after pediatric LT.

Down Syndrome and Hospitalizations due to Respiratory Syncytial Virus: A Population-Based Study

Philip Zachariah, Margaret Ruttenber, Eric A.F. Simões — 2011-12-19

Objective: To assess the risk estimates for respiratory syncytial virus (RSV) hospitalization in children with Down syndrome (DS) and the clinical features and severity of RSV lower respiratory tract infection (LRTI) in hospitalized children.Study design: Statewide hospitalization data for children with DS for 1995 through 2006 from the Colorado Health and Hospital Association database were combined with birth data from the Colorado Department of Public Health and Environment to obtain population-based estimates of RSV LRTI hospitalization for children with DS in the first 2 years of life. RSV hospitalization data for children with DS at the Children’s Hospital Colorado for 2000 through 2006 were used to compare the course and severity of hospitalization of DS LRTI admissions with those of matched control subjects.Results: There were 85 RSV LRTI hospitalizations in 630 children born with DS in Colorado, with 50 having no concurrent underlying conditions identified. Children with DS had a significantly higher risk than did those without DS for being hospitalized with RSV LRTI (OR, 5.99; 95% CI, 6.68-5.38), even in the absence of other underlying conditions (OR 3.5; 95% CI, 3.10-4.12). In the case-control study, children with DS hospitalized for RSV presented more frequently with fever (P = .005), had consolidation reported more often on chest radiography (P = .003), and were given bronchodilator therapy more often during the hospital stay (P = .002).Conclusions: Children with DS have a higher risk of being hospitalized with RSV LRTI even in the absence of coexisting risk factors. They present more often with fever and more often have radiographic consolidation detected on chest radiography.

Population-Based Study of Incidence and Clinical Characteristics of Rheumatic Fever in Abruzzo, Central Italy, 2000-2009

2011-11-21

Objective: To investigate the incidence and describe the characteristics of acute rheumatic fever (ARF) in the pediatric population in a community-based healthcare delivery system of the central Italy region of Abruzzo during 2000-2009.Study design: A retrospective study was conducted in Abruzzo to identify patients aged <18 years with a diagnosis of ARF between January 1, 2000, and December 31, 2009. Each patient’s age, sex, date of diagnosis, age at disease presentation, and fulfilled Jones criteria were recorded.Results: A total of 88 patients meeting the Jones criteria for the diagnosis of ARF were identified, with arthritis in 59.1% of the patients, carditis in 48.9%, erythema marginatum in 11.4%, 5.7% with chorea, and 4.6% with subcutaneous nodules. Residual chronic rheumatic heart disease was present in 44.3% of the children. Age at diagnosis ranged from 2.5 to 17 years (average, 8.7 ± 4.0 years). Twelve children (13.6%) were under age 5 years. The overall incidence rate of ARF was 4.1/100 000. The lowest incidence rate was documented in the year 2000 (2.26/100 000), and the highest in 2006 (5.58/100 000).Conclusion: Our data indicate that ARF has not disappeared in industrialized countries and still causes significant residual rheumatic heart disease. Pediatricians should routinely consider the diagnoses of streptococcal pharyngitis and ARF to reduce long-term morbidity and mortality.

Human Papillomavirus Genotypes Present in the Oral Mucosa of Newborns and their Concordance with Maternal Cervical Human Papillomavirus Genotypes

2011-12-05

Objectives: To elucidate the concordance of human papillomavirus (HPV) genotypes between the mother and her newborn and to identify risk factors for the vertical transmission of HPV.Study design: HPV genotypes present in 329 pregnant women, their newborns, cord blood, and placenta samples were determined by molecular techniques, including using pure DNA for nested polymerase chain reaction. HPV antibodies were tested using multiplex HPV serology. Kappa statistics and the Wilcoxon test were used to assess concordance, and regression analysis was used to calculate ORs and 95% CIs.Results: HPV DNA was detected in 17.9% of oral samples from newborns and in 16.4% of the cervical samples of the mothers. At delivery, mother-newborn pairs had similar HPV-genotype profiles, but this concordance disappeared in 2 months. Oral HPV carriage in newborns was most significantly associated with the detection of HPV in the placenta (OR=14.0; 95% CI, 3.7-52.2; P=.0001). The association between status of the cord blood and oral HPV was also significant at delivery (OR=4.7; 95% CI, 1.4-15.9; P=.015) but disappeared within 1 month. HPV antibodies in infants were of maternal origin (OR=68; 95% CI, 20.1-230.9; P=.0001).Conclusions: HPV is prevalent in oral samples from newborns. The genotype profile of newborns was more restricted than that of the maternal cervical samples. The close maternal-newborn concordance could indicate that an infected mother transmits HPV to her newborn via the placenta or cord blood.

E-Selectin is Elevated in Cord Blood of South Asian Neonates Compared with Caucasian Neonates

2011-12-19

Objective: To test the hypothesis that the increased risk of type 2 diabetes mellitus and coronary artery disease in South Asian subjects could be caused by the presence of endothelial dysfunction in early life. We studied markers of endothelial dysfunction in umbilical cord blood of South Asian neonates and compared these with that of Caucasian control subjects.Study design: From South Asian (n = 57) and Caucasian (n = 21) neonates, cord blood was collected and levels of glucose, insulin, lipids, and markers of endothelial dysfunction (E-selectin, intercellular adhesion molecule 1, vascular cell adhesion molecule 1) and inflammation (C-reactive protein) were measured.Results: Plasma E-selectin levels were significantly higher in South Asian neonates (46.7 versus 33.5 ng/mL, P < .001), and levels of intercellular adhesion molecule 1 and vascular cell adhesion molecule 1 did not differ. Furthermore, South Asian neonates had hyperinsulinemia (P = .043), dyslipidemia (with significantly higher triglyceride and lower high-density lipoprotein cholesterol levels), and higher C-reactive protein levels (75.7 versus 43.8 ng/mL, P = .009).Conclusions: South Asian newborns are characterized by elevated E-selectin levels in line with the hypothesis that endothelial dysfunction is present early in life. In addition, hyperinsulinemia, dyslipidemia, and inflammation are present. Because many pathogenic variables for coronary artery disease and type 2 diabetes are already present at birth in South Asian patients, the question arises whether rigorous childhood lifestyle intervention could be beneficial.

50 Years Ago in The Journal of Pediatrics: Temporal Lobe Epilepsy in Children

Paul Graham Fisher — 2012-05-01

Chao D, Sexton JA, Pardo LSS. J Pediatr 1962;60:686-93 Was that a seizure? Fifty years ago in The Journal, Chao et al explored the nature of temporal lobe epilepsy in a cohort of 156 children. As the authors recount, the diagnosis of seizures from the temporal lobe, labeled today as complex partial seizures or localization-related epilepsy, can be elusive: “From the literature and from our analysis, the impression is gained that temporal lobe epilepsy has a wide range of complexity and severity.” As they describe, temporal lobe seizures may commence with an aura—for example, fear, gastric discomfort, unpleasant smell or taste—followed most often by ictal motor activity and sometimes sensory, autonomic, or psychic changes. There is often, but not always, some impairment of consciousness—a “brown out,” as they note—and frequently a postictal period lasting several minutes. A single electroencephalogram may or may not be diagnostic.

A Pilot Study of Discontinuous, Insulin-Like Growth Factor 1–Dosing Growth Hormone Treatment in Young Children with FGFR3 N540K-Mutated Hypochondroplasia

Anya Rothenbuhler, Agnès Linglart, Catherine Piquard, Pierre Bougnères — 2011-12-05

Objective: To assess the growth promoting effect of a recombinant growth hormone (rGH) treatment protocol adjusted on insulin-like growth factor 1 (IGF-1) dosing in children affected by the most severe forms of FGFR3 N540K-mutated hypochondroplasia.Study design: Midterm results of an open-label, single-center, nonrandomized, 2003-2020 pilot trial to final stature, including 6 children (mean age, 2.6±0.7 years; mean height SDS, −3.0±0.5) with the N540K mutation of FGFR3 gene who received an rGH dosage titrated to an IGF-1 level close to 1.5 SDS of the normal range. rGH therapy was interrupted 1 day per week, 1 month per year, and 6 months every 2 years.Results: The mean height SDS increased by 1.9 during the 6.1±0.9-year study period, reaching −0.8 to −1.3 at age 8.7±1 years. The mean±SDS baseline IGF-1 value was −1.6±0.5 before rGH treatment and 1.4±0.3 during the last year of observation. The average cumulative rGH dose was 0.075±0.018 mg/kg/day (range, 0.059-0.100 mg/kg/day). Trunk/leg disproportion was improved.Conclusion: IGF-1–dosing rGH treatment durably improves growth and reduces body disproportion in children with severe forms of hypochondroplasia.

Placenta-Imprinted Gene Expression Association of Infant Neurobehavior

2011-12-08

Objective: To identify links between altered gene imprinting in the placenta and infant neurobehavioral profiles.Study design: Quantitative reverse-transcription polymerase chain reaction was used to examine the expression of 22 imprinted candidate genes in a series of 106 term human primary placenta tissues. The expression pattern uncovered was associated with Neonatal Intensive Care Unit Network Neurobehavioral Scales summary scores in the corresponding infants. Clustering of the expression data was used to define distinct classes of expression.Results: Significant associations were identified between classes of expression and the Neonatal Intensive Care Unit Network Neurobehavioral Scales quality of movement (P = .02) and handling (P = .006) scores. Multivariate regression demonstrated an independent effect of imprinted gene expression profile on these neurobehavioral scores after controlling for confounders.Conclusion: These results suggest that alterations in imprinted gene expression in the placenta are associated with infant neurodevelopmental outcomes, and suggest a role for the placenta and genomic imprinting in the placenta beyond intrauterine growth regulation.

Impact of Type 1 Diabetes Mellitus on the Family is Reduced with the Medical Home, Care Coordination, and Family-Centered Care

Michelle L. Katz, Lori M. Laffel, James M. Perrin, Karen Kuhlthau — 2011-12-02

Objectives: To examine whether the medical home, care coordination, or family-centered care was associated with less impact of type 1 diabetes mellitus (T1D) on families’ work, finances, time, and school attendance.Study design: With the 2005 to 2006 National Survey of Children with Special Health Care Needs, we compared impact in children with T1D (n = 583) with that in children with other special health care needs (n = 39 944) and children without special health care needs (n = 4945). We modeled the associations of the medical home, care coordination, and family-centered care with family impact in T1D.Results: Seventy-five percent of families of children with T1D reported a major impact compared with 45% of families of children with special health care needs (P < .0001) and 17% of families of children without special health care needs (P < .0001). In families of children with T1D, 35% reported restricting work, 38% reported financial impact, 41% reported medical expenses >$1000/year, 24% reported spending ≥11 hours/week caring or coordination care, and 20% reported ≥11 school absences/year. The medical home, care coordination, and family-centered care were associated with less work and financial impact.Conclusions: In childhood T1D, most families experience major impact. Better systems of health care delivery may help families reduce some of this impact.

Vocal Cord Adduction Causing Obstructive Sleep Apnea from Vagal Nerve Stimulation: Case Report

Margaret Aron, Helen Vlachos-Mayer, Dominique Dorion — 2012-02-27

A recognized complication of vagal nerve stimulation is new or worsening sleep apnea. Its pathophysiology is not clearly understood. We report a patient with obstructive sleep apnea that was directly associated with vagal nerve stimulation causing recurring vocal cord adduction. Adjusting the stimulator settings resolved the problem.

Cirrhosis due to Chronic Hepatitis E Infection in a Child Post-Bone Marrow Transplant

2012-02-20

Chronic hepatitis E virus (HEV) infection occurs in immunosuppressed adults. We detected HEV ribonucleic acid in serum of an adolescent patient who had undergone bone marrow transplantation and subsequently presented with persistently increased aminotransferases and histologic chronic hepatitis, and eventually developed cirrhosis. Phylogenetic analysis revealed these HEV strains were similar to swine genotype 3a, suggesting a possible zoonosis.

Resistant Kawasaki Disease Treated with Anti-CD20

2012-02-20

We report the case of a 6-year-old boy who had Kawasaki disease resistant to intravenous immunoglobulin and systemic steroids. Because of an uncontrolled disease course, with significant lesions of the coronary arteries, anti-CD20 treatment was used. Rapid clinical, biological, and cardiac improvement was observed. The patient tolerated the treatment well.

Free-Running Disorder in a Sighted Adolescent

Andres Santiago Endara-Bravo, Supat Thammasitboon, David Thomas — 2012-01-09

An 11-year-old girl presented with sleepiness/insomnia of 2 years’ duration. On some days she slept from 3 p.m. to the next morning, whereas on other days she could not fall asleep until 3 a.m. but had to get up at 6 a.m. for school. On weekends she usually slept until noon. On some other days, she slept from 10 p.m. to 6 a.m. This irregular pattern repeated every few weeks.

Congenital Hemangiopericytoma

Laura Travan, Sergio Demarini, Giovanni Del Frate, Alberto Zacchi — 2011-12-19

The congenital/infantile form of hemangiopericytoma has more benign features than the adult form. Infantile hemangiopericytoma has a favorable outcome, even in cases of unresectable tumors, characterized by a high response to chemotherapy.

Crossed-Fused Testicular Ectopia: A Case for the Use of Laparoscopy to Evaluate Nonpalpable Testicles

Jack M. Zuckerman, Jyoti Upadhyay — 2012-01-09

A 1-year-old male was referred for evaluation of a nonpalpable right testicle. In children with nonpalpable testicles, it our practice to proceed with diagnostic laparoscopy in an attempt to identify an intra-abdominal testicle or blind-ending spermatic vessels regardless of ultrasound findings. In the operating room, we performed diagnostic laparoscopy through the umbilical stump. We identified a vas deferens passing from the right side to the left side, and what appeared to be a testicle in the area of the left internal inguinal ring ( and ). In the left groin, we found both testicles fused together with a common blood supply, but a separate vas deferens. We placed the right testicle transseptally into the right hemiscrotum.

Several neuroradiological features can help distinguish abusive and non-abusive head trauma

Tessa Sieswerda-Hoogendoorn — 2012-05-01

Kemp AM, Jaspan T, Griffiths J, Stoodley N, Mann MK, Tempest V, et al. Neuroimaging: what neuroradiological features distinguish abusive from non-abusive head trauma? A systematic review. Arch Dis Child 2011;96:1103-12.

Daily and intermittent corticosteroids have similar impact on recurrent wheezing in young children

Ixsy Ramirez, Carey N. Lumeng — 2012-05-01

Zeiger RS, Mauger D, Bacharier LB, Guilbert TW, Martinez FD, Lemanske RF, Jr., et al. Daily or intermittent budesonide in preschool children with recurrent wheezing. N Engl J Med 2011;365:1990-2001.

Hand sanitizer and cough hygiene can reduce the number of influenza A infections in school children

Thomas J. Sandora — 2012-05-01

Stebbins S, Cummings DAT, Stark JH, Vukotich C, Mitruka K, Thompson W, et al. Reduction in the incidence of influenza A but not influenza B associated with use of hand sanitizer and cough hygiene in schools: a randomized controlled trial. Pediatr Infect Disease J 2011;30:921-6.

Pure-tone threshold testing is better at detecting high-frequency hearing loss in adolescents

Deanna K. Meinke — 2012-05-01

Sekhar DL, Rhoades JA, Longenecker AL, Beiler JS, King TS, Widome MD, et al. Improving detection of adolescent hearing loss. Arch Pediatr Adolesc Med 2011;165:1094-100. Among adolescents, does a protocol for pure-tone threshold testing, capable of detecting high-frequency hearing loss as indicated by notched audiometric configurations, compared with the current school rapid hearing screen, improve the diagnosis of hearing loss?

Chest pain in children referred to cardiology clinic does not increase risk of sudden cardiac death

Katherine E. Bates, Kimberly Y. Lin — 2012-05-01

Saleeb SF, Li WY, Warren SZ, Lock JE. Effectiveness of screening for life-threatening chest pain in children. Pediatrics 2011;128:e1062-8. Of children who are evaluated for chest pain, how likely is sudden cardiac death among patients discharged from the cardiology clinic with presumed noncardiac chest pain (CP)?

Heliox is of minimal benefit in bronchiolitis but is more costly

Jean-Michel Liet — 2012-05-01

Kim IK, Phrampus E, Sikes K, Pendleton J, Saville A, Corcoran T, et al. Helium-oxygen therapy for infants with bronchiolitis: a randomized controlled trial. Arch Pediatr Adolesc Med 2011;165:1115-22.

Antibiotic exposure is associated with necrotizing enterocolitis in premature infants

Roger G. Faix — 2012-05-01

Alexander VN, Northrup V, Bizzarro MJ. Antibiotic exposure in the newborn intensive care unit and the risk of necrotizing enterocolitis. J Pediatr 2011;159:392-7. Among premature infants, is the duration of antibiotic exposure an independent risk factor for necrotizing enterocolitis (NEC)?

Rapid rehydration is not better than standard IV hydration in dehydrated pediatric patients with gastroenteritis

Benton R. Hunter, Rawle A. Seupaul — 2012-05-01

Freedman SB, Parkin PC, Willan AR, and Schuh S. Rapid versus standard intravenous rehydration in paediatric gastroenteritis: a pragmatic blinded randomised clinical trial. BMJ 2011;343:d6976.

Parvovirus B19 and necrotizing enterocolitis in neonates

Orsolya Genzel-Boroviczény, Gundula Jäger, Hermann M. Schätzl — 2012-02-10

We read with interest the report by Blau et al regarding transfusion-related acute gut injury: A possible additional unexplored cause could be infection with parvovirus B through red blood cell transfusions. During an epidemic of necrotizing enterocolitis (NEC) lasting 8 weeks, we detected parvovirus B19 in blood and stool samples of 8 of 12 cases, whereas only 2 of the 32 healthy controls had a positive stool and none had a positive blood sample. The gestational age ranged from 27 to 32 weeks, with postnatal age from 4 days to 6 weeks. Six of the eight infants developed NEC within 1 week. Before the onset of symptoms, all infants had tolerated their enteral feedings well; one infant had never been fed. Stool and blood cultures were negative for other enteric pathogens and rotavirus. Subsequently, all blood transfusions were screened for parvovirus B19 DNA with polymerase chain reaction. Three of 36 transfusions were found to be positive for parvovirus B19. Blood transfusions from these 3 positive donors were given to 5 infants. One infant died of massive NEC 3 days after the transfusion; the other 4 infants did not develop any symptoms. We believe that there is evidence that parvovirus B19 infection can cause NEC in neonates and the virus can be transmitted via infected transfusions.

Reply

Jonathan Blau, Edmund F. La Gamma — 2012-02-27

We appreciate the opportunity to respond to the letter of Genzel-Boroviczény et al, which raises an intriguing hypothesis concerning yet another possible etiology in the multifactorial pathophysiological process resulting in necrotizing enterocolitis (NEC). Although there are reports in the literature implicating such pathogens as cytomegalovirus and Clostridium species in the pathogenesis of NEC, to our knowledge there are no reports or studies implicating parvovirus B19. As Genzel-Boroviczény et al point out, blood banks do not routinely screen for this pathogen. Additional work is needed to determine the prevalence of seropositivity to estimate the scope of the potential risk; it actually may be quite low due to the screening questions asked before blood donation.

Correction

2012-05-01

The following disclosures were inadvertently undeclared for the authors of the article, “Moving from PANDAS to CANS,” J Pediatr 2012;160:725-31. Harvey S. Singer, MD, receives research grant support from Psyadon (study of ecopipam for tic suppression), the National Institutes of Health (study of glutamate modulators for tic suppression and PET imaging studies in Tourette syndrome), and JAEB Center for Health Research (consultant for levodopa pilot study for pediatric eye disease). He serves on the Editorial Board of The Neurologist.

Correction

2012-05-01

In the article, “The Growing Impact of Pediatric Pharmaceutical Poisoning,” by Bond et al, J Pediatr 2012;160:265-70, the authors submitted incorrect versions of Tables I and II for publication. The corrected versions of and are below. Additionally, the number of significant injuries listed in the Abstract and Results section should be 18 192 (not 18 191).

The Journal of Pediatrics

Down syndrome increases risk of hospitalization for RSV

Should we resuscitate newborn infants in developing countries?

Vertical transmission of HPV

Is post-term birth associated with increased risk of obesity?

Variations in performance of outpatient tonsillectomy in the US

Helping babies breathe

Growth hormone treatment of skeletal dysplasia

Rheumatic fever: Down but not gone

Table of Contents

Masthead

Information for Readers

Are Pediatric Grand Rounds Dead?

Obesity, Asthma, and Sleep-Disordered Breathing

Pediatric Sedation with Propofol—Continuing Evolution of Procedural Sedation Practice

Tonsillectomy: A Procedure in Search of Evidence

Comparative Effectiveness Research Using the Electronic Medical Record: An Emerging Area of Investigation in Pediatric Primary Care

50 Years Ago in The Journal of Pediatrics: Leprechaunism in a Male Infant

Moving from PANDAS to CANS

Relationships among Obstructive Sleep Apnea, Anthropometric Measures, and Neurocognitive Functioning in Adolescents with Severe Obesity

50 Years Ago in The Journal of Pediatrics: Auscultation in the Diagnosis of Intracardiac Acyanotic Congenital Heart Disease

Sleep-Disordered Breathing is Associated with Asthma Severity in Children

Occurrence and Timing of Childhood Overweight and Mortality: Findings from the Third Harvard Growth Study

50 Years Ago in The Journal of Pediatrics: Observations on Skin Resistance to Electricity and Sweat Chloride Content: A Preliminary Report

Hemoglobin A1c above Threshold Level is Associated with Decreased β-Cell Function in Overweight Latino Youth

50 Years Ago in The Journal of Pediatrics: A Decade with Agammaglobulinemia

Prevalence of Persistent Prehypertension in Adolescents

Eighty-Year Trends in Infant Weight and Length Growth: The Fels Longitudinal Study

Post-Term Birth is Associated with Greater Risk of Obesity in Adolescent Males

Major Chromosomal Anomalies among Very Low Birth Weight Infants in the Vermont Oxford Network

Neurodevelopmental Outcomes in Infants Requiring Resuscitation in Developing Countries

Neurally Adjusted Ventilatory Assist in Neonates Weighing <1500 Grams: A Retrospective Analysis

A Randomized, Masked Study of Weekly Erythropoietin Dosing in Preterm Infants

Total Serum Bilirubin Exceeding Exchange Transfusion Thresholds in the Setting of Universal Screening

Procedural Sedation for Diagnostic Imaging in Children by Pediatric Hospitalists using Propofol: Analysis of the Nature, Frequency, and Predictors of Adverse Events and Interventions

Post-Discharge Adverse Events following Pediatric Sedation with High Doses of Oral Medication

Outpatient Tonsillectomy in Children: Demographic and Geographic Variation in the United States, 2006

Health Status of Children Alive 10 Years after Pediatric Liver Transplantation Performed in the US and Canada: Report of the Studies of Pediatric Liver Transplantation Experience

Down Syndrome and Hospitalizations due to Respiratory Syncytial Virus: A Population-Based Study

Population-Based Study of Incidence and Clinical Characteristics of Rheumatic Fever in Abruzzo, Central Italy, 2000-2009

Human Papillomavirus Genotypes Present in the Oral Mucosa of Newborns and their Concordance with Maternal Cervical Human Papillomavirus Genotypes

E-Selectin is Elevated in Cord Blood of South Asian Neonates Compared with Caucasian Neonates

50 Years Ago in The Journal of Pediatrics: Temporal Lobe Epilepsy in Children

A Pilot Study of Discontinuous, Insulin-Like Growth Factor 1–Dosing Growth Hormone Treatment in Young Children with FGFR3 N540K-Mutated Hypochondroplasia

Placenta-Imprinted Gene Expression Association of Infant Neurobehavior

Impact of Type 1 Diabetes Mellitus on the Family is Reduced with the Medical Home, Care Coordination, and Family-Centered Care

Vocal Cord Adduction Causing Obstructive Sleep Apnea from Vagal Nerve Stimulation: Case Report

Cirrhosis due to Chronic Hepatitis E Infection in a Child Post-Bone Marrow Transplant

Resistant Kawasaki Disease Treated with Anti-CD20

Free-Running Disorder in a Sighted Adolescent

Congenital Hemangiopericytoma

Crossed-Fused Testicular Ectopia: A Case for the Use of Laparoscopy to Evaluate Nonpalpable Testicles

Several neuroradiological features can help distinguish abusive and non-abusive head trauma

Daily and intermittent corticosteroids have similar impact on recurrent wheezing in young children

Hand sanitizer and cough hygiene can reduce the number of influenza A infections in school children

Pure-tone threshold testing is better at detecting high-frequency hearing loss in adolescents

Chest pain in children referred to cardiology clinic does not increase risk of sudden cardiac death

Heliox is of minimal benefit in bronchiolitis but is more costly

Antibiotic exposure is associated with necrotizing enterocolitis in premature infants

Rapid rehydration is not better than standard IV hydration in dehydrated pediatric patients with gastroenteritis

Parvovirus B19 and necrotizing enterocolitis in neonates

Reply

Correction

Correction