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This Month in Archives of Pediatrics and Adolescent Medicine
November 2, 2009

This Month in Archives of Pediatrics & Adolescent Medicine

Author Affiliations

Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2009

Arch Pediatr Adolesc Med. 2009;163(11):975. doi:10.1001/archpediatrics.2009.208
Antibacterial Medication Use During Pregnancy and Risk of Birth Defects: National Birth Defects Prevention Study

Although it appears that some classes of antibiotics have been used relatively safely during pregnancy, there have not been large-scale studies that addressed safety or risk for many classes of antibacterial drugs. This study used data from the National Birth Defects Prevention Study to assess the risks of different classes of antibiotics taken during pregnancy. The study lends support to the established safety profiles for certain classes of antibacterials, like penicillins, erythromycins, and cephalosporins. However, several increased odds ratios were observed among women who took sulfonamides and nitrofurantoins. Sulfonamides were associated with an increased risk of anencephaly, hypoplastic left heart syndrome, coarctation of the aorta, transverse limb deficiency, and diaphragmatic hernia, while nitrofurantoins were associated with anophthalmos/microphthalmos, hypoplastic left heart syndrome, atrial septal defects, and cleft lip with cleft palate. These associations warrant further study because of the common use of these drugs.

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Percentage of case mothers and control mothers who reported antibiotic use during the period from 3 months before conception through the end of pregnancy.

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A Randomized Trial of Nebulized 3% Hypertonic Saline With Epinephrine in the Treatment of Acute Bronchiolitis in the Emergency Department

Although up to 1% of healthy infants and 2% to 3% of high-risk infants are hospitalized for bronchiolitis annually, its optimal treatment remains unclear. In this randomized controlled trial, infants treated in an emergency department for viral bronchiolitis were randomized to nebulized racemic epinephrine in either hypertonic or normal saline. There was no difference in the amount of respiratory distress at 2 hours after treatment nor in oxygen saturations between infants in the 2 groups. While there was no difference in the proportion returning later to the emergency department for care, the group treated with hypertonic saline and racemic epinephrine had 22% fewer children admitted to the hospital, though this was not statistically significant. Given the frequency of children with bronchiolitis who are brought to medical care, this finding would indicate the need for additional, larger studies.

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Physical Activity Opportunities Associated With Fitness and Weight Status Among Adolescents in Low-Income Communities

Environment is 1 potentially changeable factor in the fight against obesity. This study sought to identify physical activity opportunities most strongly associated with student health (cardiorespiratory fitness and weight status) among adolescents in low-income communities and to determine if associations were different in middle and high schools. Almost half of the students from these low-income communities were overweight or obese, and over half did not meet recommended physical fitness standards. As the proportion of students who reported liking school physical education classes, walking to school, and spending 20 minutes or more in exercise during physical education classes increased from 0% to 100%, physical fitness improved. Each additional day that students reported being active on school grounds outside school was associated with decreased time on a mile run. Active transport to school was associated with poorer weight status and greater odds of purchasing food while in transit. These findings point to potential policy opportunities to improve student health in low-income communities.

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Television Exposure as a Risk Factor for Aggressive Behavior Among 3-Year-Old Children

Given the potential importance of household television (TV) use and the need to account for multiple nonmedia factors that can influence aggression, the current study was designed to assess the unique contribution of household TV use to aggression among 3-year-old children. Despite American Academy of Pediatrics recommendations, about two-thirds (65%) of mothers in this study reported that their 3-year-old child watched more than 2 hours of TV per day. Higher levels of TV exposure for the child and for household TV use were associated with maternal depression, regular bedtime, witnessing violence, and neighborhood disorder. The level of aggression in the child increased for each additional hour he or she directly watched TV as well as for each additional hour the TV was on in the household. There were no threshold effects for the relationship between both TV variables and aggression score.

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