Identification Of High-risk Children Research Articles

MUC5AC: A potential biomarker of severity in pediatric patients infected with influenza.

Numerous factors can increase the risk of severe influenza; however, a majority of severe cases occur in previously healthy children. Identification of high-risk children is important for targeted preventive interventions and prompt treatment. The aim of this study was to evaluate MUC5AC as a biomarker for influenza disease severity in children. For this, aprospective cohort study was conducted in 2019. Children hospitalized with acute respiratory infection (ARI) with confirmed positive influenza infection were enrolled. Influenza cases were identified by reverse transcriptase-polymerase chain reaction. Life-threatening disease (LTD) was defined by the need for intensive care and ventilatory support. MUC5AC, epidemiologic, and clinical risk factors were assessed. Three hundred and forty-two patients were hospitalized with ARI, of which 49 (14%) had confirmed influenza infection and 6 (12%) of them developed LTD. MUC5AC levels were higher in those patients with mild diseasecompared to cases with poorer outcomes. Our results show that the severity of influenza infection in children is significantly associated with low levels of MUC5AC. These findings suggest its potential as a suitable biomarker for predicting disease severity.

997-P: TG/HDL Ratio as a Predictor of Insulin Resistance in U.S. Adolescents: Do Age and Sex Percentiles Matter?

Identifying children with insulin resistance (IR) is difficult due to insulin assay reliability/reproducibility. We examined if the triglyceride/high-density lipoprotein ratio (TG/HDL) can identify children with IR and if it is important to use age- & sex-specific cutoffs. In a representative sample of 3,464 US adolescents 12-18 yrs participating in NHANES (2003-2020) , we calculated the fasting TG/HDL ratio & homeostasis model assessment-insulin resistance level (HOMA-IR) . We established age- & sex-specific & universal percentiles (10th, 25th, 50th, 75th, 95th) for TG/HDL ratio based on a subset of normal weight adolescents; IR was defined as having a HOMA-IR >4.39. We created receiver operating characteristic (ROC) curves predicting IR comparing age- & sex-specific, universal TG/HDL ratios, and raw TG/HDL cutpoints. Half were female, 14% were black, 13% were Mexican-American, and 24% had IR. AUC was similar for age-,sex-specific (0.69 (SE 0.01)) , universal (0.69 (SE 0.01)) percentiles and raw TG/HDL ratios (0.69 (SE 0.01)) (p=0.22) . Age and sex cutoffs did not provide further discrimination for identifying adolescents with IR. A universal TG/HDL ratio cutoff of 1.0 conferred a sensitivity of 84% and specificity of 42%. A TG/HDL ratio of 1.0 may be a reasonable test cutoff for identifying adolescents with IR, given that higher detection rates may improve identification of high risk children. Disclosure D.Eng: None. B.Gregg: None. K.Singer: None. J.M.Lee: Advisory Panel; GoodRx, Consultant; Tandem Diabetes Care, Inc. Funding Caswell Diabetes Institute at the University of Michigan

Cardiac Screening: An Important Diagnostic Tool in the Early Identification of High-Risk Children with Post-COVID-19 Multisystem Inflammatory Syndrome in Children.

Cardiac Screening: An Important Diagnostic Tool in the Early Identification of High-Risk Children with Post-COVID-19 Multisystem Inflammatory Syndrome in Children.

Prediction of Clinically Important Traumatic Brain Injury in Pediatric Minor Head Trauma; proposing Pediatric Traumatic Brain Injury (PTBI) Prognostic Rule

Background: The present study assesses independent predictors of clinically important traumatic brain injury (ciTBI) in order to design a prognostic rule for identification of high risk children with mild head injury. Materials and Methods: In a retrospective cross-sectional study, 3,199 children with mild traumatic brain injury (TBI) brought to emergency ward of three hospitals in Tehran, Iran were gathered, from April 2014 to April 2016. The associations between probable predictors of ciTBI in children with mild TBI were assessed and a prediction rule for identification of high risk children in need of computed tomography (CT) scan was designed based on a stepwise multivariate logistic regression. Results: 592 (18.5%) children had ciTBI. History of loss of conciseness (odds ratio [OR]=3.0; p<0.0001), underlying disease (OR=3.6; p=0.002), Glasgow coma scale (GCS) score equal to 14 (OR=40.6; p<0.0001), altered mental status (OR=19.1; p<0.0001), need for intubation (OR=27.4; p<0.0001), presence of vomiting (OR=7.3; p=0.001), and sign of basilar skull fracture (OR=25.9; p=0.007), were the most important prognostic factors of ciTBI in children. Pediatric traumatic brain injury prognostic rule (PTBI prognostic rule) was designed based on these predictors. PTBI prognostic rule had an area under the curve of 0.93, a sensitivity of 100.0%, a specificity of 73.0% and a proper calibration (slope=0.97 and intercept=0.006) in identification of ciTBI. Conclusion: The present study showed that a few of children with mild TBI have ciTBI. Therefore, CT scans are not necessary in all of these children. Using PTBI prognostic rule can reduce the number of unnecessary CT scans.

Preschool Weight and Body Mass Index in Relation to Central Obesity and Metabolic Syndrome in Adulthood

BackgroundIf preschool measures of body size routinely collected at preventive health examinations are associated with adult central obesity and metabolic syndrome, a focused use of these data for the identification of high risk children is possible. The aim of this study was to test the associations between preschool weight and body mass index (BMI) and adult BMI, central obesity and metabolic alterations.MethodsThe Northern Finland Birth Cohort 1966 (NFBC1966) (N = 4111) is a population-based cohort. Preschool weight (age 5 months and 1 year) and BMI (age 2–5 years) were studied in relation to metabolic syndrome as well as BMI, waist circumference, lipoproteins, blood pressure, and fasting glucose at the age of 31 years. Linear regression models and generalized linear regression models with log link were used.ResultsThroughout preschool ages, weight and BMI were significantly linearly associated with adult BMI and waist circumference. Preschool BMI was inversely associated with high-density lipoprotein levels from the age of 3 years. Compared with children in the lower half of the BMI range, the group of children with the 5% highest BMI at the age of 5 years had a relative risk of adult obesity of 6.2(95% CI:4.2–9.3), of adult central obesity of 2.4(95% CI:2.0–2.9), and of early onset adult metabolic syndrome of 2.5(95% CI:1.7–3.8).ConclusionsHigh preschool BMI is consistently associated with adult obesity, central obesity and early onset metabolic syndrome. Routinely collected measures of body size in preschool ages can help to identify children in need of focused prevention due to their increased risk of adverse metabolic alterations in adulthood.

Comparing the Tuberculin Skin Test and T-SPOT.TB Blood Test in Children

Interferon-γ-release assays (IGRAs) have been developed for the diagnosis of tuberculosis infection, but few data are available for children. There currently is no reference standard for the diagnosis of tuberculosis infection. To compare the performance of 1 IGRA, the T-SPOT.TB assay with the tuberculin skin test (TST) in children with different epidemiologic risk factors for tuberculosis. We conducted a prospective study of 210 patients referred to 3 pediatric tuberculosis clinics, including those with no risk factors for tuberculosis (low risk, n = 27), risk factors but no identifiable source case (intermediate risk, n = 78), contact with a known source case (high risk, n = 74), and active disease (n = 31). Children were tested with TST and T-SPOT.TB. Concordance analyses were performed, and assay outcomes were modeled by multivariate logistic regression. For 13 children with culture-confirmed tuberculosis disease, sensitivity of TST and T-SPOT.TB was 77% and 92%, respectively, and concordance was 69%. For high-risk children, concordance was 94% for BCG-unimmunized children and 88% for BCG-immunized children. For intermediate-risk children, concordance was 74% for BCG-unimmunized children and 33% for BCG-immunized children. For low-risk children, concordance was 74% for BCG-unimmunized children and 20% for BCG-immunized children. Multivariate analysis revealed that contact with a source case was associated with T-SPOT.TB result, but age and BCG immunization were not. T-SPOT.TB is comparable to the TST in the diagnosis of tuberculosis disease and identification of high-risk children with tuberculosis infection and is more specific than the TST in children who have received the BCG vaccine.

A rapid review of key strategies to improve the cognitive and social development of children in Scotland

Inequalities in health and educational outcomes in Scotland show a strong and persistent socioeconomic status gradient. Our aims were to provide policy-makers with a synthesis of international research evidence that assesses the effectiveness of early childhood interventions aimed at equitably promoting cognitive and social development and suggest potential areas for action in Scotland. A rapid review was conducted of review level studies of early childhood interventions with outcome measures relating to child cognitive-language or social-emotional development, subsequent academic and life achievement. Websites were searched and interviews were conducted to identify relevant interventions, policies and programmes delivered in Scotland. : Early childhood intervention programmes can reduce disadvantage due to social and environmental factors. Scottish health policy demonstrates a clear commitment to early childhood development but much work remains in terms of detail of policy implementation, identification of high risk children and families, and early childhood monitoring systems. Programmes should provide a universal seamless continuum of care and support from pregnancy through to school entry with the intensity of support graded according to need. The current information systems in Scotland would be inadequate for monitoring the effects of early childhood interventions especially in relation to cognitive-language and social-emotional development.

Advances and challenges in biomarker development for type 1 diabetes prediction and prevention using ‘omic’ technologies

IMPORTANCE OF THE FIELD: Biomarkers are essential for the identification of high risk children as well as monitoring of prevention outcomes for type 1 diabetes (T1D). AREAS COVERED IN THIS REVIEW: This review discusses progress, opportunities and challenges in biomarker discovery and validation using high throughput genomic, transcriptomic and proteomic technologies. The authors also suggest potential solutions to deal with the current challenges. WHAT THE READER WILL GAIN: Readers will gain an overview of the current status on T1D biomarkers, an integrated review of three omic technologies, their applications and limitations for biomarker discovery and validation, and a critical discussion of the major issues encountered in biomarker development. TAKE HOME MESSAGE: Better biomarkers are still urgently needed for T1D prediction and prevention. The high throughput omic technologies offer great opportunities but also face significant challenges that have to be solved before their potential for biomarker development is fully realized.

P.6.a.005 Identification of high-risk children of future alcohol use

P.6.a.005 Identification of high-risk children of future alcohol use

Rate of palivizumab administration in accordance with current recommendations among hospitalized children

IntroductionThe American Academy of Pediatrics recommends palivizumab prophylaxis for children born premature or with chronic lung disease to reduce the severity of respiratory syncytial virus (RSV) infection. The purpose of the current study is to examine palivizumab administration among children hospitalized with RSV infection.MethodThis is a retrospective medical record review at a tertiary care children's hospital. The study included children <2 years of age hospitalized between October 1, 2000, and April 1, 2001, with the diagnosis of RSV infection.ResultsThe records of 264 children meeting inclusion criteria were reviewed. Forty children qualified for administration of palivizumab using American Academy of Pediatrics recommendations. Of these, 14 (35%) received palivizumab prior to admission. Palivizumab administration rate was not affected by age, race, or insurance coverage.DiscussionExact barriers to the administration of palivizumab remain unclear. The identification of high-risk children, prevention of RSV by use of palivizumab, and collaboration between hospital and community health care providers will help increase the use of palivizumab and decrease the incidence of RSV.

Rate of palivizumab administration in accordance with current recommendations among hospitalized children

Introduction The American Academy of Pediatrics recommends palivizumab prophylaxis for children born premature or with chronic lung disease to reduce the severity of respiratory syncytial virus (RSV) infection. The purpose of the current study is to examine palivizumab administration among children hospitalized with RSV infection. Method This is a retrospective medical record review at a tertiary care children's hospital. The study included children <2 years of age hospitalized between October 1, 2000, and April 1, 2001, with the diagnosis of RSV infection. Results The records of 264 children meeting inclusion criteria were reviewed. Forty children qualified for administration of palivizumab using American Academy of Pediatrics recommendations. Of these, 14 (35%) received palivizumab prior to admission. Palivizumab administration rate was not affected by age, race, or insurance coverage. Discussion Exact barriers to the administration of palivizumab remain unclear. The identification of high-risk children, prevention of RSV by use of palivizumab, and collaboration between hospital and community health care providers will help increase the use of palivizumab and decrease the incidence of RSV.

Identification of factors associated with deficient immunization coverage

One of the most important challenges in the management of childhood immunization programmes is the persistence of some population groups with deficient immunization coverage. In the present study we identify some factors associated with deficient immunization coverage in pre-school populations living in Murcia (Spain). The main purpose is to develop some instruments to help managers of immunization programmes in developing strategies directed at high risk groups. Case-control study was designed on the basis of pre-school population (8579 children) living in the city during 1989 and 1990. All of the 380 cases and a similar number of randomly chosen controls were studied. Multivariate logistic regression method was used for statistical analysis. Secondly, two nominal group techniques were conducted with health and social professionals, and, lastly, one group interview was conducted with some mothers of deficiently immunized children. Variables associated with a deficient immunization coverage included: a large number of children in the family, being born at public hospitals, a greater age of the child, and living in certain city zones. The most important problems detected by professionals are lack of social and health services coordination, poor functioning of administrative registers, lack of strategies to catch marginal groups, and missed opportunities for the immunization of high-risk children. Mothers identified some problems in services accessibility, inadequate information from health professionals, and special characteristics of marginal groups. Information from registers (case-control study), professionals, and consumers proves some useful in the management of preventive services. Early identification of high-risk children with deficient immunization coverage would make it possible to assign more resources to groups with greater needs.

Behavioral predictors of injury in school-age children.

The behavior of 10,394 British children was related prospectively to their injury history between ages 5 and 10 years, obtained from parents. Aggressive and overactive behaviors at age 5 years were measured by subscales of the Rutter Child Behavior Questionnaire completed by the parents. Multivariate techniques were used to assess the association between behavior and injuries while controlling for social, demographic, and psychological characteristics. Boys' behavior at age 5 years was more strongly predictive of injuries in the subsequent five years than was girls' behavior. The odds of experiencing injuries resulting in hospitalization in boys with high aggression scores was 2.4 times that of boys with low aggression scores. The identification of high-risk children provides the foundation for understanding the behavioral mechanisms that contribute to injuries and for developing preventive strategies tailored to the needs of these children.

The Identification of High-Risk Children: A Retrospective Look at Selection Criteria

Three-hundred kindergarten children were screened with a test battery in order to identify high-risk children. The main principle underlying the selection criteria was Myklebust's definition of a learning disability as a discrepancy between achievement (as measured by a readiness test and knowledge of letter names) and potential. Other selection criteria were a discrepancy between verbal and nonverbal ability, intratest scatter, and performance on a visual-motor copying test. Sixty-two children were selected as having probable learning disabilities. At the beginning of first grade, they were tested with the WISC and the ITPA and showed average abilities. At the end of first grade these "high-risk" children scored within the average range on the Metropolitan Achievement Test. It was concluded that the selection criteria in kindergarten were inadequate.