Pediatrics Digest Pediatrics 2013;132;D1 DOI: 10.1542/peds.

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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright 2013 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

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Pediatrics Digest Pediatrics 2013;132;D1 DOI: 10.1542/peds.digest1325

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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright 2013 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

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ARTICLE SUMMARIES NOVEMBER 2013

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Inuenza-Associated Pediatric Deaths in the United States, 20042012

Inuenza-associated deaths in children occur every year among children of all ages. Young children and those with high-risk medical conditions are at higher risk of inuenza-related complications. This study describes inuenza-associated pediatric deaths over 8 inuenza seasons in the United States and compares characteristics of deaths in children with high-risk medical conditions with those in children without high-risk medical conditions.

wheezing has been suggested by many studies. Only a few studies conducted from Europe and North America have addressed this causal association. In a prospective, multicenter, case-control study of 440 children with high follow-up rate of 98.4%, palivizumab prophylaxis administered to preterm Japanese infants (3335 weeks gestational age) in their rst respiratory season reduced the incidence of subsequent recurrent wheezing up to 3 years.

Approval and Perceived Impact of Duty Hour Regulations: Survey of Pediatric Program Directors
Several studies have been published evaluating the impact of 2011 Accreditation Council for Graduate Medical Education duty hour regulations. Although resident quality of life may be improved, it appears that resident education and patient care may be worse. This is the rst study to evaluate pediatric program director approval of 2011 Accreditation Council for Graduate Medical Education Common Program Requirements and the perceived impact of the regulations on patient care, resident education, and quality of life.

Athlete Endorsements in Food Marketing

Food marketing can lead to increases in food intake, purchase intentions, and brand preferences. Food companies use athlete endorsements as 1 form of food marketing. One study revealed that parents perceive athlete-endorsed food products as healthier than nonendorsed products. This study assessed the (1) prevalence of athlete endorsements of food, (2) nutritional prole of foods endorsed by athletes, and (3) youth exposure to athlete endorsements of foods. This study reveals that adolescents saw more athlete-endorsement food commercials than adults.

Nonmedical Prescription Opioid and Sedative Use Among Adolescents in the Emergency Department
Unintentional overdose and emergency department visits secondary to nonmedical use of prescription drugs are on the rise with peak age of onset in midadolescence for these risk behaviors. Also, risk behaviors, such as substance use and violence, tend to cluster.

Effect of Palivizumab Prophylaxis on Subsequent Recurrent Wheezing in Preterm Infants

Palivizumab prophylaxis prevents respiratory syncytial virus lower respiratory tract infection. An association between respiratory syncytial virus infection and subsequent recurrent

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Approximately 1 in 10 adolescents or young adults using the emergency department endorse nonmedical prescription opioid or sedative use in the past year. Rates of current opioid or sedative prescriptions are low among this group.

Using a large national administrative dataset, this study revealed that general hospitals were associated with higher rates of intubation and longer lengths of stay compared with childrens hospitals for adolescents and young adults with SCD admitted with acute chest syndrome.

Psychotropic Medication Use and Polypharmacy in Children With Autism Spectrum Disorders
Psychotropic use is common and increasing in children with mental disorders but little is known about the long-term patterns of psychotropic use and polypharmacy among commercially insured children with autism spectrum disorders. Among 33 565 children with autism spectrum disorders, 64% used psychotropic medications and 35% had evidence of polypharmacy. Older children and those who had seizures, attention-decit disorders, anxiety, bipolar disorder, or depression had increased risk of psychotropic use and polypharmacy.

Gunshot Injuries in Children Served by Emergency Services

Gunshot injuries are an important cause of preventable injury and mortality in children, with emergency services often providing the initial care for patients. However, there is little recent population-based research to guide public health, injury prevention, and health policy efforts. Gunshot injuries are uncommon in children, but cause greater injury severity, need for major surgery, mortality, and costs compared with other injury mechanisms. There is also large variation in the population-adjusted incidence of pediatric gunshot injuries between regions.

Active Versus Passive Cooling During Neonatal Transport

Cooling infants with hypoxic-ischemic encephalopathy shortly after birth improves survival and neurodevelopmental outcome. The optimal way to cool infants during transfer to regional NICUs is unclear. Data from a regional neonatal transfer team, using rst passive and subsequently active cooling for these infants, suggest that active cooling results in improved thermal control and a reduction in stabilization time.

Spanking and Child Development Across the First Decade of Life

A large and growing literature has demonstrated signicant associations between the use of spanking and later child aggression, but we know less about paternal spanking, effects of spanking on cognitive development, and longer-term effects. Accounting for a broad array of risk factors, spanking predicts both aggression and receptive vocabulary across the rst decade of life. Importantly, we include paternal spanking, cognitive outcomes, and a longitudinal span longer than that of much of the literature.

Health Outcomes Associated With Transition From Pediatric to Adult Cystic Fibrosis Care
Transition from pediatric to adult care is often reported to be unsuccessful. Little evidential research has examined the actual proportion of youth in pediatric versus adult care or impact on health status outcomes after transferring from pediatric to adult care. Our article extends the literature by providing health transition outcome data, something that has been recognized as a critical gap to developing evidence-based programming and health care transition policy.

Measles in Children Vaccinated With 2 Doses of MMR

School outbreak investigation in Quebec, Canada suggested that adolescents previously vaccinated with 2 doses of measles vaccine beginning at 12 months of age were at greater measles risk than those whose rst dose was given at $15 months of age. Greater measles risk among earlier rst-of-2-dose vaccine recipients was replicated as a generalized provincial nding during the 2011 epidemic in Quebec, Canada. The mechanism remains unknown, but the ndings warrant additional evaluation in the context of measles elimination efforts.

Association of Hospital and Provider Types on Sickle Cell Disease Outcomes

As more children with sickle cell disease survive into adulthood, they are increasingly hospitalized in both childrens and general hospitals and managed by different provider specialists. But it is unknown if hospital type and provider specialty affect patient outcomes.

Impact of a Routine Two-Dose Varicella Vaccination Program on Varicella Epidemiology

The 1-dose childhood varicella vaccination program in the United States resulted in dramatic declines in varicella

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incidence, hospitalizations, and deaths. There is little information on the impact of the 2006 recommendation for 2-dose varicella vaccination of children on varicella epidemiology. In the rst 5 years of the 2-dose varicella vaccination program, declines in varicella incidence were seen in all age groups, including infants who are not eligible for varicella vaccination, providing evidence of the benet of high population immunity.

Cognitive Behavior Therapy for Pediatric Functional Abdominal Pain: A Randomized Controlled Trial
Pediatric functional abdominal pain is common and costly. Cognitive behavior therapy (CBT) is a promising treatment for these complaints, but solid evidence for its effectiveness is lacking. This randomized controlled trial shows that CBT reduces abdominal pain in 60% of children 1 year after treatment. Six sessions of CBT delivered by trained masters students in psychology were equally effective as 6 visits to an experienced pediatrician.

Narrow Vs Broad-spectrum Antimicrobial Therapy for Children Hospitalized With Pneumonia

Recent guidelines for the management of childhood pneumonia recommend narrow-spectrum antimicrobial agents (eg, ampicillin) for most children; however, few studies have directly compared the effectiveness of narrow-spectrum agents to the broader spectrum third-generation cephalosporins commonly used among children hospitalized with pneumonia. By using data from 43 childrens hospitals in the United States, we demonstrate equivalent outcomes and costs for children hospitalized with pneumonia and treated empirically with either narrow- (ampicillin/penicillin) or broad-spectrum (ceftriaxone/cefotaxime) antimicrobial therapy.

Complementary and Conventional Medicine Use Among Youth With Recurrent Headaches
Use of complementary and alternative medicine (CAM) is increasingly common among American youth; however, information on use of CAM among youth with recurrent headache (HA) is limited. Youth across a range of chronic conditions experience HA. These youth are more likely to use CAM. Use and expenditures for conventional medical care, and increased difculties in activity and functioning are greater for youth with HA who use CAM.

Infant Hospitalizations for Pertussis Before and After Tdap Recommendations for Adolescents
Pertussis rates are on the rise in the United States. Infants often require hospitalization for pertussis. Vaccination can change hospitalization patterns for vaccine-preventable diseases. It is unknown if vaccinating adolescents for pertussis (recommended in 2006) might change infant hospitalization utilization. Universal vaccination policy among adolescents against pertussis appears to have been effective in 3 of the 4 years we examined postvaccination. Further vaccination efforts among adolescents and adults are needed to prevent infantile hospitalization on a more consistent basis.

Changes in Bedtime Schedules and Behavioral Difculties in 7 Year Old Children

Links between clinically diagnosed sleep problems and adverse behavioral outcomes are well documented. However, in nonclinical populations, causal links between disrupted sleep and the development of behavioral difculties are far from clear. Seven-year-old children with nonregular bedtimes had more behavioral difculties than children who had regular bedtimes. There were clear doseresponse relationships, and the effects of not having regular bedtimes appeared to be reversible.

Childhood Anemia at High Altitude: Risk Factors for Poor Outcomes in Severe Pneumonia
Pneumonia is the leading cause of death in young children worldwide. Anemia, widely prevalent globally, is not routinely assessed when treating pneumonia. The effect of anemia and high altitude on outcome of pneumonia is not well described. Anemia at high altitude increases the risk of poor outcome with severe pneumonia. Children with severe pneumonia at high altitude present with more severe hypoxemia and have a longer time to recovery than children at low altitude.

Apnea in Children Hospitalized With Bronchiolitis

Apnea is a life-threatening complication of bronchiolitis and has been associated with younger age, prematurity, and a parental report of apnea. Apnea is classically attributed to the respiratory syncytial virus, but little is known about the role of other viruses. Among hospitalized children, low or high respiratory rates or low oxygen saturation on presentation were associated with subsequent apnea in the hospital. Several bronchiolitis pathogens were associated with apnea, with similar apnea risk across the major viral pathogens.

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Early Feeding and Risk of Celiac Disease in a Prospective Birth Cohort

Lower risk of early celiac disease (CD) has been observed with breastfeeding and low dose of gluten at introduction. Gluten introduction before 4 or after 6 months has been associated with increased risk. For CD diagnosed after 2 years, the association is unclear. Gluten introduction delayed to .6 months as well as breastfeeding .12 months was associated with a modest increase in CD in this rst population-based birth cohort study, and gluten introduction under continued breastfeeding was not protective.

Pediatrician-led Motivational Interviewing to Treat Overweight Children: An RCT

Obesity and overweight can seriously affect health outcomes. Many obesity prevention interventions have been proposed, but few have been effective. Motivational interviewing in primary care seems promising, but results in BMI control are controversial and require further investigation. This is the rst study to demonstrate the effectiveness of pediatrician-led motivational interviewing for BMI control in overweight children aged 4 to 7 years. Nevertheless, no effect was observed in boys or when the mothers education level was low.

Association of Constipation and Fecal Incontinence With Attention-Decit/Hyperactivity Disorder

Several studies have shown that behavioral problems can be associated with defecation and voiding disorders, although few studies have looked directly at a link between a diagnosis of attention-decit/hyperactivity disorder (ADHD) and constipation or fecal incontinence. We identied an increased risk for both constipation and fecal incontinence in children with ADHD. In patients with concomitant ADHD and defecation disorders, more aggressive medical and behavioral treatment of the constipation or fecal incontinence may be warranted.

Neonatal ECMO Study of Temperature (NEST): A Randomized Controlled Trial

Although providing improved survival for infants with very severe cardiorespiratory problems, the use of neonatal extracorporeal membrane oxygenation has high rates of disability in survivors. Mild hypothermia has been shown to limit brain injury in a range of patient groups, including newborns. Infants who received extracorporeal membrane oxygenation and mild hypothermia did not show an improved neurodevelopmental outcome, and nonsignicant trends in the data suggested a small adverse effect. Use of hypothermia in other potential patient groups should be thoroughly tested.

Hypospadias and Residential Proximity to Pesticide Applications

Some studies suggest a contribution of environmental exposures such as pesticides to risk of hypospadias, whereas others do not. One of the challenges that has limited current knowledge is the lack of detailed exposure data. This study examined a more detailed assessment of exposure to pesticides than previous studies. Exposure assignments, whether to groups of chemicals, specic chemicals, or a composite involving a number of chemicals, showed a general lack of association with hypospadias.

Clinical Utility of the Colorado Learning Difculties Questionnaire

Caregiver behavioral symptom ratings are frequently used to assist in diagnosing childhood behavioral disorders. Although behavioral disorders are highly comorbid with learning disabilities (LDs), little work has examined the utility of caregiver ratings of learning concerns for screening of comorbid LD. The validity of a time- and cost-efcient caregiver rating of academic concerns (Colorado Learning Difculties Questionnaire) was examined. The screening measure accurately predicted children without LD, suggesting that the absence of parentreported difculties may be adequate to rule out overt LD.

Microbial Contamination of Human Milk Purchased Via the Internet

Sharing human milk between those with an abundant supply and those seeking milk for their child may be growing in popularity, facilitated by Web sites recently established to link providers and recipients. This study documents the potential for human milk shared via the Internet to cause infectious disease by estimating the extent of microbial contamination among samples purchased via a leading Internet Web site.

Fetal Growth and Childhood Cancer: A Population-Based Study

The etiology of childhood cancers is largely unknown. However, excessive fetal growth has been associated with some childhood cancers. One of the most consistent ndings is that high birth weight is associated with an increased risk of childhood leukemia. Examining large, population-based birth and cancer registry data from 4 Nordic countries, high birth weight was the most strongly associated with risk of many childhood cancers among

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several measures of fetal growth that have not previously been extensively assessed. protocol enrolls children with the medical condition under study. The ethics of this distinction have been debated, but parental opinions have not been explored. We found that parental opinions support federal regulations. We discuss parental motivations for and against research participation and the extent to which enrolling a child in higher-hazard, nobenet research reects appropriate surrogate decision-making.

Maternal Prenatal Weight Gain and Autism Spectrum Disorders

Previous studies have found links between prepregnancy BMI and/or pregnancy weight gain and autism spectrum disorders (ASD) risk. Several contributing factors to BMI and pregnancy weight gain (ie, prematurity, advanced maternal age, parental education, and parity) overlap with established ASD risk factors. This study identies an association between ASD risk and prenatal weight gain, but not prepregnancy BMI, and accounts for important confounding variables excluded in previous analyses. It provides the rst within-mother comparison of these factors by including unaffected sibling controls.

Physical Activity in Children Attending Preschools

Physical activity (PA) levels in preschool children vary considerably between preschools, and are positively associated with the overall quality of the preschool. However, knowledge regarding specic characteristics of the preschool environment hypothesized to promote PA is inconsistent and lacking. This study tested multiple potential correlates of preschool childrens objectively measured moderate and vigorous PA level during preschool attendance, identifying size of indoor area per child and location of preschool building on the playground as new potentially modiable correlates.

Prenatal Exposure to Air Pollution, Maternal Psychological Distress, and Child Behavior
Prenatal exposures to diverse pollutants and psychosocial stressors have been shown independently to adversely affect child development. Less is known about the potential interactions between these factors, although they commonly cooccur, especially in disadvantaged populations. The combination of high prenatal exposure to environmental polycyclic aromatic hydrocarbons and maternal demoralization adversely affects child behavior, and maternal demoralization has a greater effect among children with high prenatal polycyclic aromatic hydrocarbon exposure for a majority of behavioral symptoms.

End-Stage Kidney Disease After Pediatric Nonrenal Solid Organ Transplantation

End-stage kidney disease (ESKD) causes signicant morbidity and mortality after solid organ transplantation. Adults commonly develop advanced kidney disease, particularly after liver and intestinal transplantation. Previous pediatric studies have not compared the relative incidence of ESKD by organ type. This national cohort study shows the highest risk of ESKD among pediatric lung and intestinal transplant recipients, reecting unique organ-specic causes of kidney injury. Our ndings have implications for screening for and treating early kidney disease in transplant recipients.

Parent Health and Functioning 13 Months After Infant or Child NICU/PICU Death
Research has focused on primarily white parents, months to years after their infant/child or adult child died of cancer, accidental injury, sudden infant death syndrome, or suicide. Many parents experience depression and/or posttraumatic stress disorder and greater risk for some physical health problems. Data on hospitalizations, changes in and management of chronic conditions, complexity of medication regimens, depression, and posttraumatic stress disorder were collected over 13 months from 249 Hispanic, black, and white parents in 188 families who experienced an infant/child NICU/PICU death.

Off-Label Topical Calcineurin Inhibitor Use in Children

In January 2006, a public health advisory and boxed warning for long-term safety and the risk of malignancies and a medication guide were issued for topical calcineurin inhibitors, tacrolimus and pimecrolimus. Evaluation of off-label use of topical calcineurin inhibitors in children before and after regulatory action by the Food and Drug Administration is important to understand the impact of regulatory action.

Higher-Hazard, No Benet Research Involving Children: Parental Perspectives

Higher-hazard, no-benet research involving children may be approved by local institutional review boards only when the

Maternal Inuence on Child HPA Axis: A Prospective Study of Cortisol Levels in Hair
Stress affects health of children, potentially persisting as a trajectory into adulthood. Earlier biological markers assess only momentary stress, making it difcult to investigate stress

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over longer periods of time. Cortisol in hair is a new biomarker of prolonged stress. Mother and child hair cortisol association suggests a heritable part or maternal calibration. Cortisol output gradually

stabilizes, has a stable trait, and is positively correlated to birth weight. Hair cortisol is a promising noninvasive biomarker of prolonged stress, especially applicable for children.

See the table of contents of this issue to learn more about these articles.
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