To determine the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in infants hospitalized for a serious bacterial infection (SBI) evaluation and clinically characterize young infants with SARS-CoV-2 infection.METHODS
A retrospective chart review was conducted on infants <90 days of age hospitalized for an SBI evaluation. The study was conducted at 4 inpatient facilities in New York City from March 15, 2020, to December 15, 2020.RESULTS
We identified 148 SBI evaluation infants who met inclusion criteria. A total of 22 infants (15%) tested positive for SARS-CoV-2 by nasopharyngeal reverse transcription polymerase chain reaction; 31% of infants admitted during periods of high community SARS-CoV-2 circulation tested positive for SARS-CoV-2, compared with 3% when community SARS-CoV-2 circulation was low (P < .001). The mean age of infants with SARS-CoV-2 was higher than that of SARS-CoV-2–negative infants (33 [SD: 17] days vs 23 [SD: 23] days, respectively; P = .03), although no age difference was observed when analysis was limited only to febrile infants. An isolated fever was the most common presentation of SARS-CoV-2 (n = 13; 59%). Admitted infants with SARS-CoV-2 were less likely to have positive urine culture results (n = 1 [5%] versus n = 25 [20%], respectively; P = .002), positive cerebrospinal culture results (n = 0 [0%] versus n = 5 [4%], respectively; P = .02), or be admitted to intensive care (n = 2 [9%] versus n = 47 [37%]; P < .001), compared with infants without SARS-CoV-2.CONCLUSIONS
SARS-CoV-2 was common among young infants hospitalized for an SBI evaluation during periods of high but not low community SARS-CoV-2 circulation in New York City, although most infants did not require intensive care admission.
Canada legalized nonmedical cannabis possession and sale in October 2018. In the United States, state legalization has been tied to an increase in cannabis-related emergency department (ED) visits; however, little research exists on provincial changes in pediatric visits after nationwide legislation. We compared pre- and postlegalization trends in pediatric cannabis-related ED visits and presentation patterns in urban Alberta EDs.METHODS
Retrospective National Ambulatory Care Reporting System data were queried for urban Alberta cannabis-related ED visits among patients aged <18 years from October 1, 2013, to February 29, 2020. Population subgroups included children (aged 0–11 years), younger adolescents (12 to 14 years), and older adolescents (15 to 17 years). We calculated interrupted time series, incident rate ratios (IRRs), and relative risk (RR) ratios to identify trend change. IRRs identified changes against growth-adjusted Alberta population, while RRs measured presentation pattern changes against prelegalization ED visits.RESULTS
Pediatric visit volume did not change postlegalization when accounting for preexisting volume trends. Unintentional ingestions increased in children (IRR: 1.77, 95% confidence interval [CI]: 1.42 to 2.20 and RR: 1.24, 95% CI: 1.05 to 1.47, respectively) and older adolescents (IRR: 1.36, 95% CI: 1.07 to 1.71 and RR: 1.48, 95% CI: 1.21 to 1.81, respectively). Presentation patterns remained similar, although older adolescent co-ingestant use decreased (RR: 0.77, 95% CI: 0.67 to 0.88), whereas hyperemesis cases increased (RR: 1.64, 95% CI: 1.13 to 2.37).CONCLUSIONS
Cannabis legalization has increased child and older adolescent unintentional cannabis ingestions, increasing child cannabis-related ED visits. Changes highlight need for public health interventions targeting pediatric exposures.
A comparative effectiveness trial tested 2 parent-based interventions in improving the psychosocial recovery of hospitalized injured children: (1) Link for Injured Kids (Link), a program of psychological first aid in which parents are taught motivational interviewing and stress-screening skills, and (2) Trauma Education, based on an informational booklet about trauma and its impacts and resources.METHODS
A randomized controlled trial was conducted in 4 children’s hospitals in the Midwestern United States. Children aged 10 to 17 years admitted for an unintentional injury and a parent were recruited and randomly assigned to Link or Trauma Education. Parents and children completed questionnaires at baseline, 6 weeks, 3 months, and 6 months posthospitalization. Using an intent-to-treat analysis, changes in child-reported posttraumatic stress symptoms, depression, quality of life, and child behaviors were compared between intervention groups.RESULTS
Of 795 injured children, 314 children and their parents were enrolled into the study (40%). Link and Trauma Education was associated with improved symptoms of posttraumatic stress, depression, and pediatric quality of life at similar rates over time. However, unlike those in Trauma Education, children in the Link group had notable improvement of child emotional behaviors and mild improvement of conduct and peer behaviors. Compared with Trauma Education, Link was also associated with improved peer behaviors in rural children.CONCLUSION
Although children in both programs had reduced posttrauma symptoms over time, Link children, whose parents were trained in communication and referral skills, exhibited a greater reduction in problem behaviors.
To investigate trends in population-level school-aged reading scores among students with hearing loss in an urban Colorado school district after implementation of universal newborn hearing screening (UNHS) and Early Hearing Detection and Intervention.METHODS
The final sample included 1422 assessments conducted during the 2000–2001 through 2013–2014 school years for 321 children with hearing loss in grades 3 through 10. Longitudinal hierarchical linear modeling analyses were used to examine reading proficiency (controlling for birth year, grade in school, free and reduced lunch status, additional disability services, and English not spoken in the home). The Colorado Student Assessment Program was administered to students in third through 10th grades throughout the state. The test years chosen included children born before and after implementation of UNHS.RESULTS
After implementation of UNHS, significant longitudinal reading proficiency improvements were observed by birth year and grade overall and for all subgroups. However, gains in reading proficiency were substantially less for children eligible for free and reduced lunch and those with moderate-severe to profound hearing loss. With each succeeding birth cohort and grade, increased numbers of children participated in testing because of improved language skills, with higher proportions identified as proficient or advanced readers.CONCLUSIONS
Notable improvements in reading proficiency after Early Hearing Detection and Intervention implementation were demonstrated, as all groups of children with hearing loss became more likely to achieve proficient and advanced reading levels. On the other hand, some disparities increased, with greater improvements in reading proficiency for children in economically advantaged families.
Conventional timing of newborn pulse oximetry screening is not ideal for infants born out-of-hospital. We implemented a newborn pulse oximetry screen to align with typical midwifery care and measure its efficacy at detecting critical congenital heart disease.METHODS
Cohort study of expectant mothers and infants mainly from the Amish and Mennonite (Plain) communities with limited prenatal ultrasound use. Newborns were screened at 1 to 4 hours of life ("early screen") and 24 to 48 hours of life ("late screen"). Newborns were followed up to 6 weeks after delivery to report outcomes. Early screen, late screen, and combined results were analyzed on the basis of strict algorithm interpretation ("algorithm") and the midwife’s interpretation in the field ("field") because these did not correspond in all cases.RESULTS
Pulse oximetry screening in 3019 newborns (85% Plain; 50% male; 43% with a prenatal ultrasound) detected critical congenital heart disease in 3 infants. Sensitivity of combined early and late screen was 66.7% (95% confidence interval [CI] 9.4% to 99.2%) for algorithm interpretation and 100% (95% CI 29.2% to 100%) for field interpretation. Positive predictive value was similar for the field interpretation (8.8%; 95% CI 1.9% to 23.7%) and algorithm interpretation (5.4%; 95% CI 0.7% to 18.2%). False-positive rates were ≤1.2% for both algorithm and field interpretations. Other pathologies (noncritical congenital heart disease, pulmonary issues, or infection) were reported in 12 of the false-positive cases.CONCLUSIONS
Newborn pulse oximetry can be adapted to the out-of-hospital setting without compromising sensitivity or prohibitively increasing false-positive rates.
Daily outdoor play is encouraged by the American Academy of Pediatrics. Existing evidence is unclear on the independent effect of nature exposures on child health.OBJECTIVE
We systematically evaluated evidence regarding the relationship between nature contact and children’s health.DATA SOURCES
The database search was conducted by using PubMed, Cumulative Index to Nursing and Allied Health Literature, PsychInfo, ERIC, Scopus, and Web of Science in February 2021.STUDY SELECTION
We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In all searches, the first element included nature terms; the second included child health outcome terms.DATA EXTRACTION
Of the 10 940 studies identified, 296 were included. Study quality and risk of bias were assessed.RESULTS
The strongest evidence for type of nature exposure was residential green space studies (n = 147, 50%). The strongest evidence for the beneficial health effects of nature was for physical activity (n = 108, 32%) and cognitive, behavioral, or mental health (n = 85, 25%). Physical activity was objectively measured in 55% of studies, and 41% of the cognitive, behavioral, or mental health studies were experimental in design.LIMITATIONS
Types of nature exposures and health outcomes and behaviors were heterogenous. Risk of selection bias was moderate to high for all studies. Most studies were cross-sectional (n = 204, 69%), limiting our ability to assess causality.CONCLUSIONS
Current literature supports a positive relationship between nature contact and children’s health, especially for physical activity and mental health, both public health priorities. The evidence supports pediatricians in advocating for equitable nature contact for children in places where they live, play, and learn.
Children entering kindergarten ready to learn are more likely to thrive. Inequitable access to high-quality, early educational settings creates early educational disparities. TipsByText, a text-message–based program for caregivers of young children, improves literacy of children in preschool, but efficacy for families without access to early childhood education was unknown.METHODS
We conducted a randomized controlled trial with caregivers of 3- and 4-year-olds in 2 public pediatric clinics. Intervention caregivers received TipsByText 3 times a week for 7 months. At pre- and postintervention, we measured child literacy using the Phonological Awareness Literacy Screening Tool (PALS-PreK) and caregiver involvement using the Parent Child Interactivity Scale (PCI). We estimated effects on PALS-PreK and PCI using multivariable linear regression.RESULTS
We enrolled 644 families, excluding 263 because of preschool participation. Compared with excluded children, those included in the study had parents with lower income and educational attainment and who were more likely to be Spanish speaking. Three-quarters of enrollees completed pre- and postintervention assessments. Postintervention PALS-PreK scores revealed an unadjusted treatment effect of 0.260 (P = .040); adjusting for preintervention score, child age, and caregiver language, treatment effect was 0.209 (P = .016), equating to ~3 months of literacy gains. Effects were greater for firstborn children (0.282 vs 0.178), children in 2-parent families (0.262 vs 0.063), and 4-year-olds (0.436 vs 0.107). The overall effect on PCI was not significant (1.221, P = .124).CONCLUSIONS
The health sector has unique access to difficult-to-reach young children. With this clinic-based texting intervention, we reached underresourced families and increased child literacy levels.
Antivirals are recommended for children hospitalized with influenza but are underutilized. We describe antiviral prescribing during influenza admissions in Canadian pediatric centers and identify factors associated with antiviral use.METHODS
We performed active surveillance for laboratory-confirmed influenza hospitalizations among children ≤16 years old at the 12 Canadian Immunization Monitoring Program Active hospitals, from 2010–2011 to 2018–2019. Logistic regression analyses were used to identify factors associated with antiviral use.RESULTS
Among 7545 patients, 57.4% were male; median age was 3 years (interquartile range: 1.1–6.3). Overall, 41.3% received antiviral agents; 72.8% received antibiotics. Antiviral use varied across sites (range, 10.2% to 81.1%) and influenza season (range, 19.9% to 59.6%) and was more frequent in children with ≥1 chronic health condition (52.7% vs 36.7%; P < .001). On multivariable analysis, factors associated with antiviral use included older age (adjusted odds ratio [aOR] 1.04 [95% confidence interval (CI), 1.02–1.05]), more recent season (highest aOR 9.18 [95% CI, 6.70–12.57] for 2018–2019), admission during peak influenza period (aOR 1.37 [95% CI, 1.19–1.58]), availability of local treatment guideline (aOR 1.54 [95% CI, 1.17–2.02]), timing of laboratory confirmation (highest aOR 2.67 [95% CI, 1.97–3.61] for result available before admission), presence of chronic health conditions (highest aOR 4.81 [95% CI, 3.61–6.40] for cancer), radiographically confirmed pneumonia (aOR 1.39 [95% CI, 1.20–1.60]), antibiotic treatment (aOR 1.51 [95% CI, 1.30–1.76]), respiratory support (1.57 [95% CI, 1.19–2.08]), and ICU admission (aOR 3.62 [95% CI, 2.88–4.56]).CONCLUSIONS
Influenza antiviral agents were underused in Canadian pediatric hospitals, including among children with high-risk chronic health conditions. Prescribing varied considerably across sites, increased over time, and was associated with patient and hospital-level characteristics. Multifaceted hospital-based interventions are warranted to strengthen adherence to influenza treatment guidelines and antimicrobial stewardship practices.
Babys First Years: Design of a Randomized Controlled Trial of Poverty Reduction in the United States
Childhood economic disadvantage is associated with lower cognitive and social-emotional skills, reduced educational attainment, and lower earnings in adulthood. Despite these robust correlations, it is unclear whether family income is the cause of differences observed between children growing up in poverty and their more fortunate peers or whether these differences are merely due to the many other aspects of family life that co-occur with poverty. Baby’s First Years is the first randomized controlled trial in the United States designed to identify the causal impact of poverty reduction on children’s early development. A total of 1000 low-income mothers of newborns were enrolled in the study and began receiving a monthly unconditional cash gift for the first several years of their children’s lives. Mothers were randomly assigned to receive either a large monthly cash gift or a nominal monthly cash gift. All monthly gifts are administered via debit card and can be freely spent with no restrictions. Baby’s First Years aims to answer whether poverty reduction in early childhood (1) improves children’s developmental outcomes and promotes healthier brain functioning, and (2) improves family functioning and better enables parents to support child development. Here we present the rationale and design of the study as well as potential implications for science and policy.
The New York City (NYC) Department of Education is the largest public school system in the United States, with an enrollment of >1.1 million students. Students who participate in school meal programs can have higher dietary quality than nonparticipating students. Historically, family income documentation qualifying students in the NYC Department of Education for free or reduced-price meals reimbursed by the National School Lunch Program perpetuated poverty stigma. Additionally, National School Lunch Program qualification paperwork was a deterrent to many vulnerable families to participate and impeded all eligible children’s access to nutritious meals, potentially magnifying food insecurity. The Healthy, Hunger-Free Kids Act of 2010 provided a viable option for schools to serve free meals to all students, regardless of income status, as a universal free lunch (UFL) through a Community Eligibility Provision if ≥40% of students already participated in another means-based program, such as the Supplemental Nutrition Assistance Program. In this case study, we describe the processes of (1) strategic coalition building of the Lunch 4 Learning campaign (a coalition of students, parents, school-based unions, teachers, pediatricians, community leaders, and children’s advocacy organizations) to bring UFL to all NYC public schools, (2) building political support, (3) developing a media strategy, and (4) using an evidence-based strategy to overcome political, administrative, and procedural challenges. The Lunch 4 Learning campaign successfully brought UFL to all NYC public schools in 2017. This case study informs further advocacy efforts to expand UFL in other school districts across the country and national UFL advocacy.
Factorial design of a natural experiment was used to quantify the benefit of individual and combined bundle elements from a 4-element discharge transition bundle (checklist, teach-back, handoff to outpatient providers, and postdischarge phone call) on 30-day readmission rates (RRs).METHODS
A 24 factorial design matrix of 4 bundle element combinations was developed by using patient data (N = 7725) collected from January 2014 to December 2017 from 4 hospitals. Patients were classified into 3 clinical risk groups (CRGs): no chronic disease (CRG1), single chronic condition (CRG2), and complex chronic condition (CRG3). Estimated main effects of each bundle element and their interactions were evaluated by using Study-It software. Because of variation in subgroup size, important effects from the factorial analysis were determined by using weighted effect estimates.RESULTS
RR in CRG1 was 3.5% (n = 4003), 4.1% in CRG2 (n = 1936), and 17.6% in CRG3 (n = 1786). Across the 3 CRGs, the number of subjects in the factorial groupings ranged from 16 to 674. The single most effective element in reducing RR was the checklist in CRG1 and CRG2 (reducing RR by 1.3% and 3.0%) and teach-back in CRG3 (by 4.7%) The combination of teach-back plus a checklist had the greatest effect on reducing RR in CRG3 by 5.3%.CONCLUSIONS
The effect of bundle elements varied across risk groups, indicating that transition needs may vary on the basis of population. The combined use of teach-back plus a checklist had the greatest impact on reducing RR for medically complex patients.
The demands of residency training may impact trainees’ decision to have children. We examined characteristics of pediatric residents’ decisions regarding childbearing, determinants of resident parental leave, and associations with well-being.METHODS
A survey of 845 pediatric residents at 13 programs was conducted between October 2019 and May 2020. Survey items included demographics, desire for future children, and logistics of parental leave. Outcomes included parental leave length, burnout and depression screening results, satisfaction with duration of breastfeeding, and satisfaction with parental leave and parenthood decisions.RESULTS
Seventy-six percent (639 of 845) of residents responded to the survey. Fifty-two percent (330) of respondents reported delaying having children during residency, and 29% (97) of those were dissatisfied with their decision to do so. Busy work schedule (89.7%), finances (50.9%), and a desire not to extend residency (41.2%) were the most common reasons for delay. Of respondents, 16% were parents and 4% were pregnant or had pregnant partners. Sixty-one parental leaves were reported, and 67% of parents reported dissatisfaction with leave length. The most frequently self-reported determinant of leave duration was the desire not to extend residency training (74%). Program mean leave length was negatively associated with burnout, measured as a dichotomous outcome (odds ratio = 0.81 [95% confidence interval 0.68–0.98]; P = .02).CONCLUSIONS
Many pediatric trainees delay parenthood during residency and are not satisfied with their decision to do so. Pediatric resident parental leave remains short and variable in duration, despite the positive association between longer leaves and overall well-being.
Chronic pain in youth with gender dysphoria (GD) is poorly understood. The aim of our study was to review the clinical presentation of 8 youth with GD in a multidisciplinary chronic pain clinic. A single center retrospective chart review was conducted to obtain information on demographics, clinical care, previous diagnoses, and validated clinical measures. We present the trajectory of pain in this population with treatment of GD. Recognition and treatment of GD in youth with pain may improve pain outcomes.
Evidence suggests that sexual minority (SM) and gender minority (GM) youth are more likely to experience self-injurious thoughts and behaviors (SITBs) than heterosexual and cisgender youth. A major barrier to identifying and treating SITBs is nondisclosure. In this study, we explored differences in SITB disclosure patterns between SM and GM youth and their heterosexual and cisgender peers. In this study, we further examined the association between discrimination experiences and SITB disclosure.METHODS
Adolescents (N = 931) completed questionnaires assessing demographics, SITBs, disclosure history, disclosure barriers, future intentions to disclose SITBs, and discrimination history.RESULTS
Few differences in SITB disclosure patterns emerged between SM and GM youth and heterosexual and cisgender youth (P > .05). SM and GM youth endorsed greater rates of fear of disclosure to and worrying parents, two parent-related barriers ( = 8.11, P = .017; = 7.25, P = .027). GM youth reported greater discrimination experiences than SM youth (F = 6.17, P = .002); discrimination experiences impacted their willingness to disclose future SITBs more so than their SM and heterosexual and cisgender peers (F = 11.58, P < .001). Among the full sample, more discrimination experiences were associated with lower previous disclosure honesty to therapists and pediatricians (r = –0.09 to –0.10, P < .05). Among SM and GM youth, discrimination experiences were associated with lesser odds of disclosing suicide attempts in the future (r = –0.12, P < .05).CONCLUSIONS
Minority stress experiences may interfere with SITB disclosure, particularly among GM youth. Targeted interventions should be considered to reduce minority stress and support disclosure.
Evidence on the perinatal health of mother-infant dyads affected by opioids is limited. Elevated risks of opioid-related harms for people with opioid use disorder (OUD) increase the urgency to identify protective factors for mothers and infants. Our objectives were to determine perinatal outcomes after an OUD diagnosis and associations between opioid agonist treatment and birth outcomes.METHODS
We conducted a population-based retrospective study among all women with diagnosed OUD before delivery and within the puerperium period in British Columbia, Canada, between 2000 and 2019 from provincial health administrative data. Controlling for demographic and clinical characteristics, we determined associations of opioid agonist treatment on birth weight, gestational age, infant disorders related to gestational age and birth weight, and neonatal abstinence syndrome via logistic regression.RESULTS
The population included 4574 women and 6720 live births. Incidence of perinatal OUD increased from 166 in 2000 to 513 in 2019. Compared with discontinuing opioid agonist treatment during pregnancy, continuous opioid agonist treatment reduced odds of preterm birth (adjusted odds ratio: 0.6; 95% confidence interval: 0.4–0.8) and low birth weight (adjusted odds ratio: 0.4; 95% confidence interval: 0.2–0.7). Treatment with buprenorphine-naloxone (compared with methadone) reduced odds of each outcome including neonatal abstinence syndrome (adjusted odds ratio: 0.6; 95% confidence interval: 0.4–0.9).CONCLUSIONS
Perinatal OUD in British Columbia tripled in incidence over a 20-year period. Sustained opioid agonist treatment during pregnancy reduced the risk of adverse birth outcomes, highlighting the need for expanded services, including opioid agonist treatment to support mothers and infants.
Metronidazole-Induced Hepatitis in a Teenager With Xeroderma Pigmentosum and Trichothiodystrophy Overlap
A teenage girl had the rare combined phenotype of xeroderma pigmentosum and trichothiodystrophy, resulting from mutations in the XPD (ERCC2) gene involved in nucleotide excision repair (NER). After treatment with antibiotics, including metronidazole for recurrent infections, she showed signs of acute and severe hepatotoxicity, which gradually resolved after withdrawal of the treatment. Cultured skin fibroblasts from the patient revealed cellular sensitivity to killing by metronidazole compared with cells from a range of other donors. This reveals that the metronidazole sensitivity was an intrinsic property of her cells. It is well recognized that patients with Cockayne syndrome, another NER disorder, are at high risk of metronidazole-induced hepatotoxicity, but this had not been reported in individuals with other NER disorders. We would urge extreme caution in the use of metronidazole in the management of individuals with the xeroderma pigmentosum and trichothiodystrophy overlap or trichothiodystrophy phenotypes.
Although burnout has been studied extensively among students and residents, in few studies have researchers examined burnout among fellowship trainees. We measured burnout among fellows in our freestanding children’s hospital and evaluated fellows' perceptions of stigma around (and willingness to seek treatment for) psychological distress. The objectives are as follows: to (1) measure burnout among pediatric fellows, (2) assess fellows' perceptions of stigma around help seeking for mental illness, and (3) examine the relationship between burnout and willingness to seek behavioral health counseling.METHODS
We distributed a 48-item inventory to all 288 fellows in our pediatric center. Items included the Maslach Burnout Inventory and Likert-type matrices to assess attitudes toward behavioral health treatment and associated stigma. We used 2-sampled t-tests to associate burnout with willingness to seek mental health treatment.RESULTS
A total of 152 fellows (52%) responded, of whom 53% met the threshold for burnout. Most reported believing that their program directors (78%), attending physicians (72%), and patients (82%) hold negative attitudes about mental illness and its treatment; 68% believed that employers would reject their application if they knew they sought counseling. Fellows with burnout were more likely to believe that others in the clinical learning environment hold negative views of help seeking for behavioral health (odds ratio 1.2–1.9).CONCLUSIONS
Just over one-half of the pediatric fellows in our center meet the threshold for burnout. They also experience significant workplace-based stigma around help seeking for psychological distress. Fellows with burnout are more likely than their peers to perceive significant stigma around help seeking for their distress, making them a particularly at-risk learner population.
The objective was to evaluate if 2 pediatric weight management interventions delivered to Hispanic, low-income children (one in a health center the other in a Young Men’s Christian Association) were effective in reducing BMI. We hypothesized that they would be equally effective.METHODS
A total 407 children aged 6 to 12 years with BMI ≥ 85th percentile receiving care at 2 health centers were randomly assigned to a healthy weight clinic (HWC) at the health center or to a modified Healthy Weight and Your Child (M-HWYC) intervention delivered in Young Men’s Christian Associations. A total of 4037 children served as the comparison group. We completed a noninferiority test comparing the M-HWYC with the HWC, which was supported if the bounds of the 90% confidence interval (CI) for the difference in percentage of the 95th percentile (%BMIp95) change did not contain what we considered a minimally clinically important difference, on the basis of previous data (0.87). Then, using linear mixed models, we assessed yearly changes in BMI among intervention participants compared with the comparison sites.RESULTS
The mean difference in %BMIp95 between the M-HWYC and the HWC was 0.75 (90% CI: 0.07 to 1.43), which did not support noninferiority. Compared with the comparison sites, per year, children in the HWC had a –0.23 (95% CI: –0.36 to –0.10) decrease in BMI and a –1.03 (95% CI –1.61 to –0.45) %BMIp95 decrease. There was no BMI effect in the M-HWYC.CONCLUSIONS
We were unable to establish noninferiority of the M-HWYC. The HWC improved BMI, offering an effective treatment of those disproportionately affected.
An overview of the full range of neonatal stressors and the associated clinical, laboratory, and imaging outcomes regarding infants’ health and development may contribute to the improvement of neonatal care.OBJECTIVE
To systematically review existing literature on the associations between all kinds of neonatal stressors and the health and development of preterm infants.DATA SOURCES
Data sources included Embase, Medline, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and reference lists.STUDY SELECTION
Studies were eligible if they included a measure of neonatal stress during the NICU stay, reported clinical, laboratory, and/or imaging outcomes regarding health and/or development on discharge from the NICU or thereafter, included preterm infants, and were written in English or Dutch.DATA EXTRACTION
Two reviewers independently screened the sources and extracted data on health and development. Study quality was assessed by using the Newcastle-Ottawa Quality Assessment Scale.RESULTS
We identified 20 articles that reported on neonatal stress associated negatively with clinical outcomes, including cognitive, motor, and emotional development, and laboratory and imaging outcomes, including epigenetic alterations, hypothalamic-pituitary-adrenal axis functioning, and structural brain development. We found no evidence regarding associations with growth, cardiovascular health, parent-infant interaction, the neonatal immune system, and the neonatal microbiome.LIMITATIONS
The studies were all observational and used different definitions of neonatal stress.CONCLUSIONS
Neonatal stress has a profound impact on the health and development of preterm infants, and physicians involved in their treatment and follow-up should be aware of this fact.
Antiviral treatment is recommended for hospitalized patients with suspected and confirmed influenza, but evidence is limited among children. We evaluated the effect of antiviral treatment on hospital length of stay (LOS) among children hospitalized with influenza.METHODS
We included children <18 years hospitalized with laboratory-confirmed influenza in the US Influenza Hospitalization Surveillance Network. We collected data for 2 cohorts: 1 with underlying medical conditions not admitted to the ICU (n = 309, 2012–2013) and an ICU cohort (including children with and without underlying conditions; n = 299, 2010–2011 to 2012–2013). We used a Cox model with antiviral receipt as a time-dependent variable to estimate hazard of discharge and a Kaplan–Meier survival analysis to determine LOS.RESULTS
Compared with those not receiving antiviral agents, LOS was shorter for those treated ≤2 days after illness onset in both the medical conditions (adjusted hazard ratio: 1.37, P = .02) and ICU (adjusted hazard ratio: 1.46, P = .007) cohorts, corresponding to 37% and 46% increases in daily discharge probability, respectively. Treatment ≥3 days after illness onset had no significant effect in either cohort. In the medical conditions cohort, median LOS was 3 days for those not treated versus 2 days for those treated ≤2 days after symptom onset (P = .005).CONCLUSIONS
Early antiviral treatment was associated with significantly shorter hospitalizations in children with laboratory-confirmed influenza and high-risk medical conditions or children treated in the ICU. These results support Centers for Disease Control and Prevention recommendations for prompt empiric antiviral treatment in hospitalized patients with suspected or confirmed influenza.