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This Month in Archives of Pediatrics & Adolescent Medicine
Sep 2011

This Month in Archives of Pediatrics & Adolescent Medicine

Arch Pediatr Adolesc Med. 2011;165(9):781-782. doi:10.1001/archpediatrics.2011.160

As part of our centennial anniversary celebration, EvansArticle describes the evolution in the profession’s—and society’s—awareness of the problem of child sexual abuse and the duty to respond to the unique challenges posed by it. As he did for child physical abuse, C. Henry Kempe, MD, played a leading role in spurring interest and action on sexual abuse of children.

In this randomized controlled trial reported by Ekbom et alArticle, inhaled 50% nitrous oxide was found to be better than oral midazolam hydrochloride in facilitating intravenous line placement in anxious children. There were a greater rate of success and a shorter procedure time with the use of nitrous oxide, especially in obese children. Parents and nurses rated nitrous oxide to be a better choice than oral midazolam.

Skin-to-skin contact (kangaroo care) has been used as a pain-relieving strategy for infants. This randomized trial reported by Johnston et alArticle found that kangaroo care with mothers was more effective than with fathers in comforting premature infants undergoing heel-stick blood draws.

Problematic Internet use, also called Internet addiction, is a growing concern worldwide. This systematic review by Moreno et alArticle found no studies specifically on adolescents and a lack of consensus on the methods to measure the problem. Future large-scale studies in adolescent and young adult at-risk populations are urgently needed. If Internet use has potential to lead to addiction, this means that up to 93% of US adolescents and young adults are exposed to this risk.

During adolescence, weekend catch-up sleep is used to compensate for insufficient sleep on weekdays. This study of high school students by Kim et alArticle found that the amount of weekend catch-up sleep was a useful marker for performance on attention tasks. Weekday sleep duration did not correlate with ability to attend to the task.

Stokley et alArticle found that in the National Immunization Survey–Teen 2009, 54.9% of adolescents had at least 1 visit for vaccinations at ages 11 to 12 years. However, among those with a visit, 19.5% did not receive tetanus-diphtheria and/or tetanus-diphtheria-acellular pertussis vaccine and approximately two-thirds did not receive meningococcal-containing or human papillomavirus vaccines. Vaccines are the most effective health care interventions pediatricians can offer, yet missed opportunities for immunizing adolescents remain.

Current survival of extremely premature children has reached a level previously unsurpassed but with high rates of neonatal morbidity. This follow-up study by Taylor et alArticle revealed that such children born since 2000 performed more poorly on achievement tests, were making less learning progress, and had higher rates of special education needs than normal-birth-weight children. Many extremely premature children with learning problems are not receiving the interventions they need in kindergarten.

Garrison et alArticle report that daily adherence to controller medications is associated with a significant reduction in parent perception of problems falling asleep among children with asthma. Leukotriene inhibitor medications may be especially effective in this population. In addition to the clinical significance of improved sleep, the potential reduction in sleep onset problems may be a “selling point” for providers trying to increase parental motivation to initiate controller use or increase adherence.

Levas et alArticle show that among pediatric inpatients with infections requiring long-term antibiotics, having a primary caregiver with limited English proficiency was associated with a 60% longer length of stay and an 80% lower rate of referral for home health care than having an English-speaking primary caregiver. With the growth of families with limited English proficiency in the United States, this study has important implications for both quality of care and cost-containment.

In this meta-analysis by Shi et alArticle of 10 clinical controlled trials, there was no evidence that breastfeeding by mothers with hepatitis B virus with proper immunoprophylaxis contributed to mother-to-child transmission of infection. When mother-to-child transmission of hepatitis B virus does occur, it is usually transmitted during pregnancy or delivery.

Although several prior trials demonstrated eradication of Pseudomonas aeruginosa in patients with cystic fibrosis who have recently acquired the bacterium, this study by Treggiari et alArticle was the first to compare the effect of different therapeutic approaches. There was no significant difference in pulmonary exacerbation rates between cycled quarterly tobramycin inhaled solution compared with treatment based on microbiological findings. There were also no significant differences in clinical outcomes by adding a second antibiotic.

In this study by McLeod et alArticle of more than 12 000 children hospitalized at 280 US hospitals, higher admission volumes were associated with greater adherence to accepted indicators of quality in the management of children with acute gastroenteritis. However, misuse and overuse of blood tests, antibiotics, and nonrecommended antiemetic or antidiarrheal medications still occurred among high-volume hospitals.