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Teaching Basic Life Support to 5- to 8-Year-Old Children: A Cluster Randomized Trial

Pediatrics - Vie, 01/10/2021 - 10:01
OBJECTIVE

We aimed to compare traditional basic life support (BLS) education with specific and innovative educative didactic material that has been previously designed and validated.

METHODS

Fifteen classes of schoolchildren aged 5 to 8 years (n = 237) were randomly assigned to 4 groups in which different didactic and complementary materials were used: (1) the Rescube tool with a cuddly toy (n = 61), (2) the Endless Book tool with a cuddly toy (n = 74), (3) traditional teaching with a cuddly toy (n = 46), and (4) traditional teaching with a manikin (n = 55). The BLS sequence was assessed at baseline (T0). After that, children took part in a one-hour theory and practice session in their assigned training modality. BLS sequence was assessed again within one week (T1) and after one month (T2).

RESULTS

The 4 modalities were successful in improving children’s skills when comparing T0 with both T1 and T2 (P < .05). At T2, more schoolchildren remembered the complete BLS sequence after using the Rescube (75%) compared with the number of schoolchildren who remember the complete BLS sequence after using the Endless Book (53%), a manikin (42%), or a cuddly toy (13%) (P < .05). A higher proportion of participants who used the Rescube correctly performed all the BLS steps analyzed compared with those who used only the manikin or a cuddly toy during the learning phase. The Endless Book was also more effective except for learning to check consciousness and breathing.

CONCLUSION

Better BLS learning and knowledge retention outcomes were achieved by using our specific and adapted didactic materials (Rescube and Endless Book). These new educational tools have the potential to substantially support BLS school education programs.

Collaborating to Advocate in Primary Care for Children During COVID-19

Pediatrics - Vie, 01/10/2021 - 10:01

The St Louis Regional Pediatric Learning Collaborative of pediatric primary care providers and infectious diseases specialists formed in March 2020 to address the needs of children and families during the coronavirus disease 2019 (COVID-19) pandemic. More than 400 pediatric primary care providers participated, using a listserv to discuss care and organize webinars to provide updates on local and national data and plan next steps. To inform local decision-making about care and testing for severe acute respiratory syndrome coronavirus 2, 95 providers from 26 practices partnered with the local practice-based research network to rapidly collect and share data about children with COVID-19–like symptoms. Of 2162 children tested for severe acute respiratory syndrome coronavirus 2, 9% had positive test results. Test result positivity was 33% if a patient was exposed to a confirmed case of COVID-19 and 4% if they had COVID-19–like symptoms and no exposure. School or day care attendance was associated with lower rates of positive test results. Although not originally planned, these findings drove local advocacy efforts by the Collaborative for increased access to testing and contact tracing and safe in-person school. Members communicated directly and collectively with local politicians, provided advice and resources for school boards and superintendent groups, and appeared on various media platforms. In these efforts, they shared local data, highlighting the lower rate of positive test results for children in school to support the idea that schools could be safely open. Outreach from trusted pediatricians sharing prospective, timely, local data sustained in-person school for some districts and aided in future in-person openings for other school districts.

Medical Admissions Among Adolescents With Eating Disorders During the COVID-19 Pandemic

Pediatrics - Vie, 01/10/2021 - 10:01
BACKGROUND AND OBJECTIVES

Emerging data suggest the coronavirus disease 2019 (COVID-19) pandemic has been associated with worsening symptoms of eating disorders (EDs) among both adults and adolescents. With this study, we sought to determine if medical admission patterns among adolescents admitted to our institution for restrictive EDs changed during the pandemic, relative to prepandemic counts of admissions per month.

METHODS

We performed a chart review of patients aged 10 to 23 years admitted to our children’s hospital for restrictive EDs from March 2017 through March 2021 and completed an interrupted time series analysis of admission counts per month. Demographic variables for admitted patients were compared by using 2, Fisher's exact, and 2-sample t tests.

RESULTS

ED-related medical admissions at our institution increased significantly during the COVID-19 pandemic. The total number of admissions during the first 12 months of the COVID-19 pandemic (April 1, 2020, through March 31, 2021, n = 125) was more than double the mean number of admissions per year for the same time frame (April 1 through March 31) for the previous 3 years (mean = 56). Patient demographics were similar before and during the pandemic, with the exception that patients admitted during the COVID-19 pandemic were less likely than those admitted before the pandemic to have public insurance.

CONCLUSIONS

Medical admissions related to restrictive EDs among adolescents increased significantly during the COVID-19 pandemic. Pediatric providers in a variety of settings should be prepared to care for adolescents with restrictive EDs during the pandemic.

Parents Intentions and Perceptions About COVID-19 Vaccination for Their Children: Results From a National Survey

Pediatrics - Vie, 01/10/2021 - 10:01
OBJECTIVES

Assess the degree to which US parents are likely to have their children get coronavirus disease 2019 (COVID-19) vaccines and identify parental concerns about the vaccines.

METHODS

In February 2021 to March 2021, we surveyed parent members of a nationally representative probability-based Internet panel of ~9000 adults regarding their intent to have their children receive a COVID-19 vaccination, perceptions of COVID-19 vaccines for children, and trust in sources of information about COVID-19 vaccines for children. We used descriptive and multivariate analyses to evaluate parent-stated likelihood of having their children get a COVID-19 vaccine and to assess the association between likelihood of child COVID-19 vaccination and child age, parent demographics, and parental perceptions about COVID-19 vaccines.

RESULTS

Altogether, 1745 parents responded (87% of eligible parents, 3759 children). Likelihood of child COVID-19 vaccination was as follows: very likely (28%), somewhat likely (18%), somewhat unlikely (9%), very unlikely (33%), and unsure (12%). The stated likelihood of child vaccination was greater among parents of older children (P < .001) as well as among parents who had a bachelor’s degree or higher education (P < .001), had already received or were likely to receive a COVID-19 vaccine (P < .001), or had Democratic affiliation (P < .001); variations existed by race and ethnicity (P = .04). Parental concerns centered around vaccine safety and side effects. A key trusted source of information about COVID-19 vaccines for children was the child’s doctor.

CONCLUSIONS

Less than one-half of US participants report that they are likely to have their child receive a COVID-19 vaccine. Pediatric health care providers have a major role in promoting and giving COVID-19 vaccination for children.

Early-Onset Sepsis Among Very Preterm Infants

Pediatrics - Vie, 01/10/2021 - 10:01
OBJECTIVES

To determine the epidemiology and microbiology of early-onset sepsis (EOS) among very preterm infants using a nationally representative cohort from academic and community hospitals to inform empirical antibiotic guidance, highlight risk factors for infection, and aid in prognostication for infected infants.

METHODS

Prospective observational study of very preterm infants born weighing 401 to 1500 g or at 22 to 29 weeks’ gestational age from January 2018 to December 2019 in 753 Vermont Oxford Network centers. EOS was defined as a culture-confirmed bacterial infection of the blood or cerebrospinal fluid in the 3 days after birth. Demographics, clinical characteristics, and outcomes were compared between infants with and without EOS.

RESULTS

Of 84 333 included infants, 1139 had EOS for an incidence rate of 13.5 per 1000 very preterm births (99% confidence interval [CI] 12.5–14.6). Escherichia coli (538 of 1158; 46.5%) and group B Streptococcus (218 of 1158; 18.8%) were the most common pathogens. Infected infants had longer lengths of stay (median 92 vs 66 days) and lower rates of survival (67.5% vs 90.4%; adjusted risk ratio 0.82 [95% CI 0.79–0.85]) and of survival without morbidity (26.1% vs 59.4%; adjusted risk ratio 0.66 [95% CI 0.60–0.72]).

CONCLUSIONS

In a nationally representative sample of very preterm infants with EOS from 2018 to 2019, approximately one-third of isolates were neither group B Streptococcus nor E coli. Three-quarters of all infected infants either died or survived with a major medical morbidity. The profoundly negative impact of EOS on very preterm infants highlights the need for novel preventive strategies.

Screening for Anxiety in Pediatric Primary Care: A Systematic Review

Pediatrics - Vie, 01/10/2021 - 10:01
CONTEXT

Anxiety is common, screening tools are available, and treatment can be effective. Recently, anxiety screening has been recommended for adolescent girls beginning at 13 years of age.

OBJECTIVE

To evaluate the evidence regarding anxiety screening test accuracy in primary care for children and adolescents and assess the effectiveness of treatment of individuals identified through screening.

DATA SOURCES

We searched PubMed, the Cochrane library, and references to potentially eligible studies cited in other articles.

STUDY SELECTION

Screening studies were included if they were conducted in primary care or a similar population and employed a reference standard based on DSM criteria. Treatment studies were included if subjects were identified through screening and there was at least 1 comparator intervention or a placebo arm.

DATA EXTRACTION

At least 2 reviewers evaluated each identified reference.

RESULTS

Two screening studies (1 with low risk of bias and 1 with high risk of bias) and 1 treatment study with a low risk of bias were included. The screening study with a low risk of bias reported a sensitivity of 56% and specificity of 80%. The treatment study found individual cognitive behavioral therapy to be effective for screen-detected adolescents with social phobia.

LIMITATIONS

This review only included screening or treatment studies with clear evidence that the study populations were derived from an unselected population reflective of typical primary care. Relevant studies not indexed in PubMed or the Cochrane library could have been missed.

CONCLUSIONS

There are significant gaps in evidence related to anxiety screening in the primary care setting.

Community SARS-CoV-2 Surge and Within-School Transmission

Pediatrics - Vie, 01/10/2021 - 10:01
OBJECTIVES

When the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic began, experts raised concerns about in-person instruction in the setting of high levels of community transmission. We describe secondary transmission of SARS-CoV-2 within North Carolina kindergarten through 12th-grade school districts during a winter surge to determine if mitigation strategies can hinder within-school transmission.

METHODS

From October 26, 2020, to February 28, 2021, 13 North Carolina school districts participating in The ABC Science Collaborative were open for in-person instruction, adhered to basic mitigation strategies, and tracked community- and school-acquired SARS-CoV-2 cases. Public health officials adjudicated each case. We combined these data with that from August 2020 to evaluate the effect of the SARS-CoV-2 winter surge on infection rates as well as weekly community- and school-acquired cases. We evaluated the number of secondary cases generated by each primary case as well as the role of athletic activities in school-acquired cases.

RESULTS

More than 100 000 students and staff from 13 school districts attended school in person; of these, 4969 community-acquired SARS-CoV-2 infections were documented by molecular testing. Through contact tracing, North Carolina local health department staff identified an additional 209 infections among >26 000 school close contacts (secondary attack rate <1%). Most within-school transmissions in high schools (75%) were linked to school-sponsored sports. School-acquired cases slightly increased during the surge; however, within-school transmission rates remained constant, from presurge to surge, with ~1 school-acquired case for every 20 primary cases.

CONCLUSIONS

With adherence to basic mitigation strategies, within-school transmission of SARS-CoV-2 can be interrupted, even during a surge of community infections.

National Pediatric Experience With Virtual Interviews: Lessons Learned and Future Recommendations

Pediatrics - Vie, 01/10/2021 - 10:01

The coronavirus disease 2019 pandemic significantly impacted undergraduate and graduate medical education and created challenges that prevented a traditional approach to residency and fellowship recruitment and interviews. Early in the pandemic, the pediatric education community came together to support applicants and training programs and to foster an equitable recruitment process. We describe many of our community’s innovations, including the use of virtual cafés to educate programs and highlight best practices for virtual recruitment and the use of regional webinars to highlight residency programs and provide information to applicants. Surveys of applicants and programs suggest that the virtual interview process worked well overall, with applicants and programs saving both time and money and programs maintaining a high rate of filling their positions. On the basis of this experience, we highlight the strengths and weaknesses of 3 potential models for future interview seasons. We close with a series of questions that need further investigation to create an effective and equitable recruitment process for the future.

Authors Response

Pediatrics - Vie, 01/10/2021 - 10:01

Social Determinants Do Not Determine Me

Pediatrics - Vie, 01/10/2021 - 10:01

The following is the winning submission from the fifth annual Section on Pediatric Trainees Monthly Feature essay competition. For this year’s competition, we asked trainees to reflect on and share how their unique identity, or identities, informs their advocacy work on behalf of children and families. We asked writers to consider how their personal histories and backgrounds, including sex, sexual orientation, race, ethnicity, religion, geographic area, and life experiences improve equity in pediatric health care. We were impressed by the broad variety of important topics addressed in the pieces submitted by trainees from around the country. The winning essay by Dr Haleigh Prather highlights her experiences as a Hispanic woman raised by a single, working-class mother; the obstacles that she faced in her life and how she surmounted them; and how her strength and resilience shaped her approach to health care delivery. In this piece, she underscores how the lessons learned by trainees from challenges in their own lives promote advocacy for the health and welfare of patients.

Recommendations for Prevention and Control of Influenza in Children, 2021-2022

Pediatrics - Vie, 01/10/2021 - 10:01

This technical report accompanies the recommendations of the American Academy of Pediatrics for the routine use of the influenza vaccine and antiviral medications in the prevention and treatment of influenza in children during the 2021–2022 season. Influenza vaccination is an important intervention to protect vulnerable populations and reduce the burden of respiratory illnesses during circulation of severe acute respiratory syndrome coronavirus 2, which is expected to continue during this influenza season. In this technical report, we summarize recent influenza seasons, morbidity and mortality in children, vaccine effectiveness, vaccination coverage, and detailed guidance on storage, administration, and implementation. We also provide background on inactivated and live attenuated influenza vaccine recommendations, vaccination during pregnancy and breastfeeding, diagnostic testing, and antiviral medications for treatment and chemoprophylaxis.

Half Century Since SIDS: A Reappraisal of Terminology

Pediatrics - Vie, 01/10/2021 - 10:01

After a sudden infant death, parents and caregivers need accurate and open communication about why their infant died. Communicating tragic news about a child’s death to families and caregivers is difficult. Shared and consistent terminology is essential for pediatricians, other physicians, and nonphysician clinicians to improve communication with families and among themselves. When families do not have complete information about why their child died, pediatricians will not be able to support them through the process and make appropriate referrals for pediatric specialty and mental health care. Families can only speculate about the cause and may blame themselves or others for the infant’s death. The terminology used to describe infant deaths that occur suddenly and unexpectedly includes an assortment of terms that vary across and among pediatrician, other physician, or nonphysician clinician disciplines. Having consistent terminology is critical to improve the understanding of the etiology, pathophysiology, and epidemiology of these deaths and communicate with families. A lack of consistent terminology also makes it difficult to reliably monitor trends in mortality and hampers the ability to develop effective interventions. This report describes the history of sudden infant death terminology and summarizes the debate over the terminology and the resulting diagnostic shift of these deaths. This information is to assist pediatricians, other physicians, and nonphysician clinicians in caring for families during this difficult time. The importance of consistent terminology is outlined, followed by a summary of progress toward consensus. Recommendations for pediatricians, other physicians, and nonphysician clinicians are proposed.

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