Clinical Pediatrics

Intrauterine growth restriction (IUGR) is associated with various prenatal risks and postnatal adverse outcomes. The aim of this study is to choose the most sensitive newborn anthropometric measure, which is closely associated with IUGR-related risks and outcomes, to substitute IUGR after delivery. Data were obtained from the Collaborative Perinatal Project, a multicenter prospective cohort study in the United States from 1959 to 1976. Maternal heavy smoking and severe hypertensive disorders during pregnancy, neonatal polycythemia and hypothermia, low intelligence quotient (<70) at age 7 years were chosen as IUGR-related risks and outcomes. Eight anthropometric measures at birth were tested by logistic regression model. Birth weight-to-head circumference (W/HC) had the largest odds ratio (OR) for neonatal polycythemia (OR = 1.8, 95% confidence interval [CI] = 1.5-2.0), severe hypertensive disorders (OR = 1.9, 95% CI = 1.5-2.2), and maternal heavy smoking (OR = 1.9, 95% CI = 1.7-2.1) during pregnancy. It also had the highest summary OR (9.3). Thus, W/HC may be a good measure for IUGR.

Increased public awareness of autism spectrum disorders (ASD) and routine screening in primary care have contributed to increased requests for diagnostic ASD evaluations. However, given the scarcity of subspecialty autism diagnostic resources, overreferral of children suspected of having ASD may be contributing to long waiting lists at tertiary care autism centers and delaying diagnosis for those children who truly have ASD. To determine whether children are being excessively referred to ASD-specific diagnostic clinics, our objective was to determine the prevalence of true ASD diagnoses in children referred for diagnostic ASD evaluation. Charts of all patients referred to a regional autism center between April 2011 and August 2012 for suspicion of a possible ASD were retrospectively reviewed and demographic and clinical diagnoses abstracted. Only 214 of 348 patients evaluated (61%) received an ASD diagnosis. Thus, concerns about autism are not confirmed by an ASD diagnosis in a significant number of children.

Objective. To examine correlates of vaccine series completion among young adolescent US girls who initiated the human papillomavirus (HPV) vaccine. Methods. We analyzed National Immunization Survey–Teens 2012 provider-verified data to examine correlates of HPV vaccine completion among 13- to 17-year-old girls who initiated HPV vaccine in 2012 (N = 4548). Results. The weighted vaccine series completion rate among 13- to 17-year-old girl initiators was 66.7% (95% confidence interval [CI], 64.0-69.3). Adolescent girls who were older, residents of the Northeast (adjusted prevalence ratio [aPR], 1.36; 95% CI, 1.07-1.73), and had provider-verified seasonal influenza vaccination in the past year (aPR, 1.67; 95% CI, 1.32-2.11) and provider recommendation (aPR, 1.40; 95% CI, 1.10-1.77) were more likely to complete the 3-dose vaccine series. Conclusions. Parents of younger adolescent girls need to be educated about the importance of completing the 3-dose HPV vaccine series. Provider recommendation for the vaccine would also facilitate series completion.

The goal of this study was to evaluate how epilepsy affected the health-related quality of life (HRQOL) in children with epilepsy, as well as the risk factors for poor HRQOL. Parents of epileptic children (n = 223) and parents of healthy children (n = 216) were enrolled. The Child Epilepsy Questionnaire–Parental form was given to all parents. Children with epilepsy had significantly lower HRQOL scores for overall QOL and all subscales. Seizure types were not associated with HRQOL, but the age of the child with epilepsy, disease courses and seizure frequency did influence the quality of life. Epilepsy has a severe impact on children’s HRQOL, and age, increased seizure frequency and longer duration of epilepsy are associated with poor HRQOL.

Background. Extremely low birth weight (ELBW; <1000 g) children may be at risk for experiencing peer victimization. We examined retrospectively reported peer victimization in ELBW and control children in the oldest known, prospectively followed, population-based birth cohort of ELBW survivors. Method. We compared levels of verbal and physical peer victimization in ELBW and control children. We also predicted peer victimization in the ELBW sample from child characteristics. Results. ELBW children, especially girls, were at an increased risk for verbal, but not physical victimization. In addition, ELBW children with a higher IQ reported higher levels of verbal victimization, although ELBW females who had a lower body mass index in childhood reported higher levels of physical victimization. Conclusion. Findings highlight the need for parents and clinicians to be aware that ELBW girls, especially those with a lower body mass index in childhood, may be at increased risk of peer victimization, as are ELBW children with a higher IQ.

Low-cost, translatable interventions to promote adherence in adolescents with type 1 diabetes are needed. This study evaluated a brief physician-delivered intervention designed to increase parent–adolescent communication about blood glucose monitoring. Thirty adolescent–parent dyads completed baseline questionnaires and received the physician-delivered intervention. Participants completed follow-up questionnaires at 12 weeks; HbA1c and glucometer data were abstracted from medical charts. Parent-reported conflict surrounding diabetes management decreased from pre- to postintervention. Participants who reported adhering to the intervention plan (n = 15) demonstrated an increase in blood glucose monitoring frequency and trends in improved HbA1c and parental diabetes collaboration from pre- to postintervention. Participants and physicians reported overall satisfaction with the program. Results demonstrate initial feasibility as well as a trend toward improvement in diabetes-specific health indicators for parent–adolescent dyads who adhered to program components. Frequent joint review of glucometer data can be a useful strategy to improve type 1 diabetes–related health outcomes and parent–adolescent communication.

Objective. To evaluate the influence of hip dysfunction on quality of life of pediatric patients with sickle cell disease (SCD). Methods. Clinical demographic, Charnley hip score, Barthel scale and Pediatric Quality of Life Inventory (PedsQL 4.0) questionnaires were used. Results. Seventeen patients were placed into the group “with hip dysfunction,” and 54 into the group “without hip dysfunction.” The group “with hip dysfunction” had a higher average age (P = .026), weight (P = .029), and height (P = .019) than the group “without hip dysfunction.” There was also a higher prevalence of hip trauma (P = .05) and pain (P = .00). The study demonstrated that hip dysfunction negatively influenced quality of life in the physical activity (P = .11) and psychosocial (P = .003) domains. Conclusion. Hip dysfunction and previous hip trauma negatively influenced quality of life, especially in the physical activity and psychosocial domains.

Purpose. To determine if a guideline-based electronic health record (EHR) template and staff education would increase diagnosis and treatment of overweight and obese children. Method. At a large pediatric office, a minitemplate was customized to pediatric obesity evidence-based practice guidelines. Staff were educated regarding current guidelines and instructed to merge minitemplate to EHR encounters in which body mass indexes (BMIs) were greater than the 85th percentile, thus integrating assessment questions, overweight or obese diagnoses, and triggered treatment order sets. Results. A total of 9701 charts of 2- to 18-year-old patients presenting over 6 months were reviewed. Preintervention, 52% with BMIs greater than the 85th percentile had diagnoses of overweight or obese in problem lists; 86% received treatment when diagnosed. Postintervention, 75% had diagnoses in problem lists, and 96% received treatment. Conclusion. This initiative illustrated how EHR customization and staff education improved the diagnosis and treatment of pediatric overweight and obesity.

Objective. It is uncertain whether children of all weight classifications receive the recommended screening and counseling and if these affect weight status in the subsequent year. Methods. Data from the 2008-2011 Medical Expenditures Panel Survey were used to examine associations between weight classification and receipt of weight-related screening and counseling from the pediatric provider (n = 9835). Body mass index (BMI) z-score in the subsequent year was modeled as a function of the BMI z-score in year 1. Results. Normal and overweight children have lower odds than obese children of receiving counseling regarding diet (adjusted odds ratio [AOR] = 0.58, 95% confidence interval [CI] = 0.50-0.68; AOR = 0.75, 95% CI = 0.63-0.89, respectively) and exercise (AOR = 0.56, 95% CI = 0.48-0.65; AOR = 0.75, 95% CI = 0.64-0.89, respectively). Counseling was associated with a small increase in BMI z-score in the subsequent year (β = 0.06, 95% CI = 0.01-0.11), as was maternal weight class. Conclusions. Recommendations to focus prevention on the family unit may reduce childhood overweight and obesity.

Objective. To compare the accuracy of pulse oximetry oxygen saturation (SpO₂) measured on the right wrist and right ankle in relation to the ipsilateral palm and sole, respectively. Study Design. A prospective observational study carried out on neonates and infants admitted to intensive care units. SpO₂ was measured at the right palm and wrist and the right sole and ankle. Sensitivity and specificity tests were performed. Results. Ninety-four patients, mean postnatal age of 29.9 days, were included in our study. Sensitivity and specificity tests for right wrist SpO₂ in comparison to right palm SpO₂ revealed sensitivity of 100% and specificity of 80.4%. Sensitivity and specificity tests for right ankle SpO₂ in comparison to right sole SpO₂ revealed sensitivity of 100% and specificity of 77.4%. Conclusion. The results of the current study revealed that the wrist and ankle can be alternative placement sites for the measurement of SpO₂ in newborn and infants instead of the routinely used palm or sole.