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A Learning Health Care System for Pediatrics

from ArchPedi - 01 Apr 14

A learning health care system (LHCS) continuously gathers data, evaluates them, and implements change to improve quality, health outcomes, and save costs. LHCSs have been discussed for adult health care but could also be important in the improvement of pediatrics. However, the mission of a pediatric LHCS should be driven by the distinctive goals of child well-being.



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Extracorporeal Membrane Oxygenation and an Angel

from ArchPedi - 01 Apr 14

“We have a baby who needs ECMO,” says a voice on the other end of the line. I recognize the sound of his adrenaline rush, just as my own occurs. We often take calls from other neonatal intensive care units requesting a transfer to our center. The calls for extracorporeal membrane oxygenation (ECMO) are usually the worst.



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Antenatal Acetaminophen Use and Attention-Deficit/Hyperactivity Disorder An Interesting Observed Association But Too Early to Infer Causality

from ArchPedi - 01 Apr 14

Attention-deficit/hyperactivity disorder (ADHD) is the most common childhood-onset neurodevelopmental disorder. Although it is highly heritable, ADHD has a complex etiology, and noninherited factors also contribute. Early environmental exposures that may cause neurobiological dysfunction and confer risk for ADHD (eg, lead and other toxins) have been gaining increased attention of late.



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Ondansetron for Acute Gastroenteritis A Failure of Knowledge Translation

from ArchPedi - 01 Apr 14

Acute gastroenteritis (AGE) is one of the most common reasons for children seeking care in the emergency department (ED), accounting for nearly 2 million visits in the United States each year. For children with AGE and mild to moderate dehydration, oral rehydration therapy (ORT) is effective and recommended by the Centers for Disease Control and Prevention and American Academy of Pediatrics as first-line therapy. However, vomiting is common in children with AGE and may prevent the success of ORT



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Appetite for Prevention Genetics and Developmental Epidemiology Join Forces in Obesity Research

from ArchPedi - 01 Apr 14

The obesogenic environment does not affect all children equally. Diminished opportunities for physical activity in daily life and increasing availability and declining cost of calorie-dense foods are primary culprits in the obesity epidemic. But there is more to obesity than the environment. Even children raised together in the same family may experience diverging trajectories of body mass. The fact that children confronted with similar environmental circumstances experience disparate outcomes h



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Potential—and Potential Pitfalls—of Screening Newborns for Critical Congenital Heart Disease

from ArchPedi - 01 Apr 14

Before discharge from a newborn nursery, most US infants undergo screening for a diverse list of medical conditions. In addition to the newborn metabolic screen, recommended screening in each newborn includes testing for hearing loss, a serum or transcutaneous measurement of bilirubin level for jaundice, and, for infants born at less than 37 weeks’ gestation, a 90-minute “car seat challenge” to evaluate for possible hypoxia. The most recent addition to this menu is the recommendation that newbor



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Acetaminophen Use During Pregnancy, Behavioral Problems, and Hyperkinetic Disorders

from ArchPedi - 01 Apr 14

ImportanceAcetaminophen (paracetamol) is the most commonly used medication for pain and fever during pregnancy in many countries. Research data suggest that acetaminophen is a hormone disruptor, and abnormal hormonal exposures in pregnancy may influence fetal brain development.ObjectiveTo evaluate whether prenatal exposure to acetaminophen increases the risk for developing attention-deficit/hyperactivity disorder (ADHD)–like behavioral problems or hyperkinetic disorders (HKDs) in children.Design



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Impact of Increasing Ondansetron Use on Clinical Outcomes in Children With Gastroenteritis

from ArchPedi - 01 Apr 14

ImportanceOndansetron hydrochloride use in children with gastroenteritis is increasing rapidly; however, little is known about its impact on outcomes.ObjectiveTo determine whether increasing emergency department ondansetron use has resulted in a reduction in intravenous rehydration rates.Design, Setting, and ParticipantsRetrospective observational analysis of eligible visits included in the Pediatric Health Information System administrative database. Eligible institutions included 18 emergency d



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Effectiveness of Peer-Based Healthy Living Lesson Plans on Anthropometric Measures and Physical Activity in Elementary School Students A Cluster Randomized Trial

from ArchPedi - 01 Apr 14

ImportanceSchools are considered an attractive setting to promote healthy living behaviors in children, but previous school-based interventions aimed at preventing weight gain in children have yielded mixed results. Novel school-based approaches are needed to modify healthy living behaviors and attenuate weight gain in children.ObjectiveTo assess the effectiveness of a peer-led healthy living program called Healthy Buddies on weight gain and its determinants when disseminated at the provincial l



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Satiety Mechanisms in Genetic Risk of Obesity

from ArchPedi - 01 Apr 14

ImportanceA better understanding of the cause of obesity is a clinical priority. Obesity is highly heritable, and specific genes are being identified. Discovering the mechanisms through which obesity-related genes influence weight would help pinpoint novel targets for intervention. One potential mechanism is satiety responsiveness. Lack of satiety characterizes many monogenic obesity disorders, and lower satiety responsiveness is linked with weight gain in population samples.ObjectiveTo test the



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Appetite and Growth A Longitudinal Sibling Analysis

from ArchPedi - 01 Apr 14

ImportanceIdentifying early markers of future obesity risk can help target preventive interventions. Several studies have shown that a heartier appetite in infancy is a risk factor for more rapid weight gain, but to date no investigations have been able to rule out familial confounding.ObjectivesTo use a sibling design (data from same-sex, dizygotic twin pairs) to test the hypothesis that sibling differences in infant appetite predicted differential weight gain during childhood.Design, Setting,



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Disease Mechanisms and Clonidine Treatment in Adolescent Chronic Fatigue Syndrome A Combined Cross-sectional and Randomized Clinical Trial

from ArchPedi - 01 Apr 14

ImportanceChronic fatigue syndrome (CFS) is a disabling condition with unknown disease mechanisms and few treatment options.ObjectiveTo explore the pathophysiology of CFS and assess clonidine hydrochloride pharmacotherapy in adolescents with CFS by using a hypothesis that patients with CFS have enhanced sympathetic activity and that sympatho-inhibition by clonidine would improve symptoms and function.Design, Setting, and ParticipantsParticipants were enrolled from a single referral center recrui



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Late Detection of Critical Congenital Heart Disease Among US Infants Estimation of the Potential Impact of Proposed Universal Screening Using Pulse Oximetry

from ArchPedi - 01 Apr 14

ImportanceCritical congenital heart disease (CCHD) was added to the Recommended Uniform Screening Panel for Newborns in the United States in 2011. Many states have recently adopted or are considering requirements for universal CCHD screening through pulse oximetry in birth hospitals. Limited previous research is directly applicable to the question of how many US infants with CCHD might be identified through screening.ObjectivesTo estimate the proportion of US infants with late detection of CCHD



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Genetic Epidemiology and Nonsyndromic Structural Birth Defects From Candidate Genes to Epigenetics

from ArchPedi - 01 Apr 14

Birth defects are a leading cause of infant morbidity and mortality worldwide. The vast majority of birth defects are nonsyndromic, and although their etiologies remain mostly unknown, evidence supports the hypothesis that they result from the complex interaction of genetic, epigenetic, environmental, and lifestyle factors. Since our last review published in 2002 describing the basic tools of genetic epidemiology used to study nonsyndromic structural birth defects, many new approaches have becom




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CD4 Counts of Nonperinatally HIV–Infected Youth and Young Adults Presenting for HIV Care Between 2002 and 2010

from ArchPedi - 01 Apr 14

Human immunodeficiency virus (HIV) incidence is increasing among youth, particularly young men who have sex with men and racial/ethnic minorities. Earlier presentation to care, a goal of public health initiatives, can limit immune deterioration and HIV transmission. We determined if fewer nonperinatally HIV (nPHIV)–infected youth are presenting for care at lower CD4 counts.



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Parathyroid Hormone as a Functional Indicator of Vitamin D Sufficiency in Children

from ArchPedi - 01 Apr 14

There has been debate on what constitutes physiologically normal 25-hydroxyvitamin D serum levels in children. The Institute of Medicine and the American Academy of Pediatrics have recommended that 25-hydroxyvitamin D levels in children be more than 50 nmol/L. The Canadian Paediatric Society has suggested that 25-hydroxyvitamin D levels be more than 75 nmol/L. Given the long time course for the development of chronic health outcomes that may be related to low vitamin D levels in children, physio



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Transportation Barriers to Child Health Care Access Remain After Health Reform

from ArchPedi - 01 Apr 14

The Affordable Care Act will improve access to pediatric care by expanding health insurance coverage. The law has provisions to increase primary care provider supply to meet increased demand but not to improve access for families without resources to travel to health care providers. Lack of transportation is a known barrier to children attending well care visits and receiving preventive health services.



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Parent-Infant Bedsharing Is Not Recommended

from ArchPedi - 01 Apr 14

To the Editor The recently published study by Colson et al on the increasing trends of bedsharing highlights the challenges faced by the pediatric community in preventing sudden and unexpected infant deaths (SUIDs). Unfortunately, the accompanying editorial by Bergman undermines the message and importance of the article. Bergman cites his work from the early 1990s to question epidemiological risk factors, noting that there was no difference between the control group and the “classic sudden infan



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Parent-Infant Bedsharing Is Not Recommended

from ArchPedi - 01 Apr 14

To the Editor The Bergman editorial, “Bed Sharing per se Is Not Dangerous,” admonishes the American Academy of Pediatrics (AAP) for recommending against bedsharing to reduce sudden infant death syndrome (SIDS) risk. He states that the studies supporting this position had “nonuniform and unverifiable information on the causes of death,” because medical examiners and coroners are moving away from classifying sudden and unexpected infant deaths (SUIDs) as SIDS, instead classifying these as accident



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Parent-Infant Bedsharing Is Not Recommended—Reply

from ArchPedi - 01 Apr 14

In Reply Krugman’s letter illustrates the imprecise thinking underlying the American Academy of Pediatrics (AAP) admonition against bedsharing. He lumps the terms sudden infant death syndrome (SIDS), sudden unexpected death in infancy, undetermined, asphyxia, accidental suffocation, and strangulation under the rubric of “unsafe sleep environment.” He also touts the accomplishments of Child Fatality Review teams in uncovering risk factors for sleep-related deaths without reference to peer-reviewe



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Methods to Estimate Gestational Age Can Significantly Affect Study Results—Reply

from ArchPedi - 01 Apr 14

In Reply Ambrose et al raise 2 important points. First, we did not calculate gestational age (GA) from the last menstrual period (LMP) but assumed that the provided estimate on the state birth certificates was derived following the Centers for Disease Control and Prevention algorithm that is used for the US natality file and that defaults to LMP. We contacted both Florida and Texas Vital Statistics offices and verified that recorded (GA) estimates are indeed the clinical estimate and not solely



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Methods to Estimate Gestational Age Can Significantly Affect Study Results

from ArchPedi - 01 Apr 14

To the Editor In their analysis of respiratory syncytial virus (RSV) hospitalization risk among preterm infants born at 32 to 34 weeks’ gestational age (GA) with siblings relative to full-term infants with siblings in Florida and Texas, Winterstein et al estimated infants’ GA by calculating weeks between the last menstrual period (LMP) date on the birth certificate and the date of birth. Although this method is still used to estimate GA in US natality statistics, it is not widely appreciated tha



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More Evidence That Unnecessary Antenatal Treatments Cause Harm

from ArchPedi - 01 Apr 14

To the Editor We read with interest the article “Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study: Outcomes in Children at 5 Years of Age (MACS-5).” Asztalos et al, as well as the supporting funding bodies, must be congratulated on ensuring long-term follow-up of the participants in this important trial. No benefit was conferred by multiple doses of antenatal corticosteroids on the primary outcome, a composite of death or neurodevelopmental disability at 5 years of age. Inde


 

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