Clinical Pediatrics

This cross-sectional study examines the relationship between parenting stress and concerns identified by developmental screening and their effects on parents' decisions to seek medical care for their children. A total of 182 parents completed both the Parenting Stress Index (PSI) and the Parents' Evaluation of Developmental Status (PEDS) when their children were admitted to a sick child care program that provides parents the option of requesting medical evaluations for their children with mild acute illnesses. Although 31.6% of parents (N = 62) requested medical evaluations, neither PSI nor PEDS scores were associated with these requests. However, PEDS scores indicating significant parental concerns about their child's development or behavior predicted clinically significant levels of parenting stress on the PSI (odds ratio 4.9; 95% confidence interval, 1.5-15.9; P = .007). Primary pediatric health care providers who routinely perform developmental screening need to consider this relationship when interpreting developmental screening results and offer supportive and referral services to families as needed.

Objective To determine the effect of the revised guidelines on incidence of neonatal early-onset group B streptococcal disease (EoGBS) via retrospective analysis of births in a military population.

Methods Information from records of all live births within military hospitals from 1993 to 2007 was obtained. The data were divided into three time frames, representing the evolution of identifying and managing at-risk deliveries for GBS transmission.

Results Incidence of EoGBS decreased from 1.95 to 0.72 per 1000 live births following institution of the 1996 Centers for Disease Control and Prevention recommendations and continued to fall to 0.47 per 1000 since the adoption of universal screening in 2002.

Conclusions Universal culture-based screening is more effective than risk-based screening in preventing EoGBS in term infants. Cases of EoGBS continue to occur, however, at a baseline rate of nearly 0.5 per 1000 births, thus emphasizing the need for rapid diagnostics and ultimately a vaccine.

This survey study provides pediatricians the opportunity to hear directly from surviving parents and caretakers and is an initial step in developing training curricula for doctors and other health care professionals who wish to improve the effectiveness of their interactions with grieving families. A privately maintained listserve, originating in Kentucky, of bereaved parents and guardians was used to send written surveys via the U.S. Postal Service to those individuals living in Kentucky. Survey results include thematic concerns identified by the bereaved parents about physician interaction and actions at the time of a child's death. Although published guidelines are available for physicians attending to bereaved parents at the time of a child's death, these results suggest that the availability of guidelines alone may be insufficient and that more in-depth physician training and education are needed.

This article describes the short-term outcomes of late preterm neonates born between 34 and 36 (6/7) weeks gestational age (GA) in a 4-year period. A total of 1381/ 20554 (6.7%) births were between 34 and 36 weeks of GA and were predominantly Caucasian (87%). In all, 697/1381 (51%) were admitted to nursery whereas 684/1381 (49%) remained with their mothers. Of the babies born at 34, 35, and 36 weeks GA, 97%, 53%, and 32%, respectively, required admission and of these 30%, 33%, and 23%, respectively, required respiratory support. Air leaks developed in <4% infants. Median length of stay and age at full enteral feeds were 11, 6, and 4 days and 10, 6, and 3 days for 34, 35, and 36 weeks GA, respectively. It is concluded that late preterms have significant morbidity in the neonatal period.

Objective. To determine national estimates of computerized physician order entry (CPOE) use for 2003 in hospitals that care for children. Design. Retrospective cohort analysis. Results. Six percent of the hospitals used CPOE (119 out of 2145). Children's hospitals are more likely to use CPOE than a children's unit (odds ratio [OR] = 6; 95% confidence interval [CI] = 1.5-23.9). Private for-profit hospitals are more likely to use CPOE than public hospitals (OR = 26.5; 95% CI = 3.1-224.8). Urban teaching hospitals are more likely to use CPOE than rural hospitals (OR = 3.9; 95% CI = 1.7-8.8). Hospitals in the Northeast, Midwest, and South are more likely to use CPOE than hospitals in the West (OR = 11.2, 95% CI = 4.8-26.5; OR = 4.2, 95% CI = 1.7-10.5; OR = 3.1, 95% CI = 1.5-6.3, respectively). Conclusions. In 2003, 6% of the hospitals that care for children reported using CPOE. Early adoption of CPOE was associated with children's hospitals, private hospitals, urban-teaching hospitals, and hospitals outside of the western region.

The objective of this study was to train pediatric providers to address weight, body mass index (BMI), diet, and physical activity with parents. Children aged 8 to 12 years with BMI of ≥85th percentile were eligible if accompanied by a parent. The intervention was a family-based, 11-session behavioral program focusing on healthy eating and physical activity. Outcome measures were weight and BMI. Seventy-three child—parent dyads enrolled. Children who attended at least 6 of 8 intervention sessions and 1 of 3 follow-up sessions (completers) lost an average of 2.84 lb; change in BMI z scores was statistically significant at 5 months (P < .001). Primary care providers can acquire skills to increase their confidence in approaching children and parents regarding weight and BMI. Parents and children will attend an intervention targeting healthy weight in the pediatric practice. Professional office staff can be trained to provide an evidence-informed intervention that promotes healthy weight.

This study describes epidemiologic findings of pediatric cancer diagnosed in the emergency department (ED) setting. Medical records are retrospectively reviewed on all patients in the hospital's cancer database between 2000 and 2004 who were diagnosed as having cancer or whose oncologic diagnosis was missed during their ED presentation. Of 427 patients identified in the cancer database, 18% (77 of 427) are analyzed. Oncologic diagnosis was missed in 5% (4 of 77) of the eligible patients initially presenting to the ED. The incidence of cancer in the ED is 22.8 cases per 100 000 ED visits. The most prevalent cancer is related to the hematologic system (37.7%), followed by the central nervous system (31.2%) and the abdomen (22.1%). Hematologic, central nervous system, and abdominal cancers constitute approximately 90% of all childhood cancers. Cancer is diagnosed frequently in our ED patient population. Based on the prevalence of certain tumors, the diagnostic approach to children with hematologic, neurologic, or abdominal complaints should include evaluation for any underlying cancer.

This exploratory randomized, double-blind, double-dummy, placebo-controlled trial of 14 days duration conducted in 22 primary care practices in the United States was used to compare the efficacy of ibuprofen and pseudoephedrine, administered alone or in combination, to placebo for the treatment of primary nocturnal enuresis (PNE) in children aged 6 to 11 years. Ibuprofen (IBU) and pseudoephedrine (PSE) are not approved for the treatment of PNE. Three hundred eighteen children with PNE were enrolled. Eligible children had ≥ 8 wet nights during a 14-day baseline. Each child was randomly assigned to 1 of 4 treatment groups: IBU 12.5 mg/kg and PSE HCl 15 or 30 mg (depending on weight) (n = 82), IBU 12.5 mg/kg (n = 78), PSE HCl 15 or 30 mg (n = 76), or placebo (n = 82). Treatment was administered orally at bedtime for 14 days. Caregivers recorded whether the child was wet or dry each night in a daily diary. Children in the IBU alone and IBU and PSE combined groups had greater mean reductions from baseline in the number of wet nights (primary end point) compared to children receiving placebo (-2.9, -2.9, and -1.4, respectively, P < .005); PSE alone (-1.8) was not significantly different from placebo. Children in these groups also had greater mean percentage reductions in the number of wet nights compared to placebo-treated children (26%, 28%, and 12%, respectively). Although not always statistically significant, secondary end points improved in the IBU alone and IBU and PSE combined treatment groups, which included decreases in mean number of wet nights and decreases in the number and percentage of children with ≥ 50%, 40%, 30%, or 25% reductions in number of wet nights. Children responding to treatment had larger mean bladder capacities and larger mean percentage of predicted bladder capacities than children who did not respond in each treatment group. No significant differences in adverse events were found among treatment groups. In conclusion, in this exploratory study in children aged 6 through 11 years, IBU provided a beneficial effect in the treatment of PNE compared to placebo, whereas PSE did not. The addition of PSE to IBU did not enhance or diminish the efficacy of IBU. All treatments were well tolerated.

Purpose. The purpose of this study was to determine the association between iron deficiency and febrile seizures in a large cohort of children aged 6 to 36 months. Methods. A retrospective case control study with 361 patients who presented with febrile seizures to the emergency department and 390 otherwise healthy controls who presented with a febrile illness to the emergency department were reviewed to determine iron status using the MCV, RDW, and hemoglobin. Results. A total of 9% of cases had iron deficiency (ID) and 6% had iron deficiency anemia (IDA), compared to 5% and 4% of controls respectively. The conditional logistic regression odds ratio for ID in patients with febrile seizures was 1.84 (95% CI, 1.02-3.31). Conclusion. Children with febrile seizures were almost twice as likely to be iron deficient as those with febrile illness alone. The results suggest that screening for ID should be considered in children presenting with febrile seizure.

An 8-year-old girl who was recently diagnosed as having anaplastic large-cell lymphoma presented with atrial tachycardia and dilated cardiomyopathy, which is a contraindication for further treatment with cardio-toxic chemotherapy. After starting digoxin therapy, the dilated cardiomyopathy resolved. Repeated episodes of atrial tachycardia in this case were not caused by any common disorder but were due to mechanical stimulation by a central venous catheter. Central venous catheters are known to cause mainly ventricular arrhythmias. However, atrial tachycardia is a rare manifestation of arrhythmia due to mechanical stimulation of the heart by a central venous catheter, with potentially important cardiovascular consequences.