Pediatrics Statement Research Articles

Current Patterns of Probiotic Use in U.S. Neonatal Intensive Care Units: A Multi-Institution Survey.

Probiotic supplementation is associated with health benefits in preterm infants. The 2021 American Academy of Pediatrics (AAP) statement on probiotic use advised caution, citing heterogeneity and absence of federal regulation. We assessed the impact of the AAP statement and current institution-wide patterns of probiotic use across neonatal intensive care units (NICU) across the United States. A cross-sectional web-based institutional survey using REDCap was emailed to 430 Children's Hospital Neonatal Consortium (CHNC) and Pediatrix Medical Group institutions. The survey captured data on probiotic formulations, supplementation, initiation and cessation criteria, reasons for discontinuation, interest in initiating, and AAP statement's impact. Ninety-five (22.1%) hospitals, including 42/46 (91%) CHNC and 53/384 (14%) Pediatrix institutions, completed the survey. Thirty-seven (39%) currently use probiotics. Fourteen different probiotic formulations were reported. The common criteria for initiation were birth weight <1,500 g and gestational age <32 weeks. Parental consent or assent was obtained at only 30% of institutions. Five hospitals (11%) with prior probiotic use discontinued solely due to the AAP statement. Overall, 23 (24%) of hospitals indicated that the AAP statement significantly influenced their decision regarding probiotic use. Nineteen of 51 nonusers (37%) are considering initiation. Probiotic use in preterm infants is likely increasing in NICUs across the United States, but significant variability exists. The 2021 AAP statement had variable impact on NICUs' decision regarding probiotic use. The growing interest in adopting probiotics and the significant interhospital variability highlight the need for better regulation and consensus guidelines to ensure standardized use. · Probiotic use in preterm infants is likely increasing in U.S. NICUs, but clinical variability exists.. · The AAP statement on probiotic use in preterm infants had a modest impact on current practices.. · There's a need for better product regulation and consensus guidelines to ensure standardized use..

Options Counseling for the Pregnant Adolescent Patient.

Although teenage pregnancy rates have decreased over the past 30 years, many adolescents become pregnant every year. It is important for pediatricians to have the ability and the resources to make a timely pregnancy diagnosis in their adolescent patients and provide them with nonjudgmental counseling that includes the full range of pregnancy options. Counseling includes an unbiased discussion of the adolescent's options to continue or terminate the pregnancy, supporting the adolescent in the decision-making process, and referring the adolescent to appropriate resources and services. It is important for pediatricians to be familiar with laws and policies impacting access to abortion care, especially for minor adolescents, as well as laws that seek to limit health care professionals' provision of unbiased pregnancy options counseling and referrals, either for abortion care or continuation of pregnancy in accordance with the adolescent's choice. Pediatricians who choose not to provide such discussions should promptly refer pregnant adolescent patients to a health care professional who will offer developmentally appropriate pregnancy options counseling that includes the full range of pregnancy options. Pediatricians should be aware of and oppose policies that restrict their ability to provide pregnant adolescents with unbiased counseling that includes the full range of pregnancy options. This approach to pregnancy options counseling has not changed since the original 1989 American Academy of Pediatrics statement on this issue.

Let's Talk about Dex: When do the Benefits of Dexamethasone for Prevention of Bronchopulmonary Dysplasia Outweigh the Risks?

Bronchopulmonary dysplasia (BPD) is the most common complication of extreme prematurity and carries increased respiratory morbidity into childhood and adulthood. Systemic administration of dexamethasone during the preterm period has been shown to decrease the incidence of BPD in this population. However, enthusiasm about its use has been tempered by early evidence that suggested potential adverse neurodevelopmental outcomes. More recent studies suggest that the timing, dosing, and duration of therapy may have a significant impact on the safety and efficacy of dexamethasone administration and that side effects and harms may be minimized if its use is appropriately targeted. Focusing on studies published since the 2010s American Academy of Pediatrics (AAP) statement on dexamethasone, this review seeks to examine the evidence from recent clinical trials to present the current state of knowledge regarding the systemic dexamethasone administration to prevent BPD in extremely premature infants and how dose, duration, and timing might impact its safety and efficacy in this vulnerable population.

Impact of Guidelines Regarding Brief Resolved Unexplained Events on Care of Patients in a Pediatric Emergency Department.

This study aimed to determine if the 2016 clinical practice guidelines regarding brief resolved unexplained events (BRUE) impacted our institutional approach to infants with BRUE. We sought to determine the statement's impact on admission rates, emergency department (ED) length of stay, and return ED visits or readmissions. We conducted a retrospective chart review of patients who presented to the ED at a tertiary pediatric hospital from January 2014 to June 2019. Diagnostic workup (laboratory testing, imaging, monitoring) in the ED was recorded. Cohorts of patients presenting pre- and post-2016 guideline were compared using χ2 and t tests. Subanalysis of higher-risk and lower-risk infant groups was also performed. The demographics of the 2 cohorts were not significantly different. Comparison showed significant reductions in invasive testing after the guideline, both overall (P = 0.005), and specifically regarding comprehensive metabolic panel, blood culture, urine culture, and chest x-ray. Infants meeting higher-risk criteria also showed decreases in invasive testing (P = 0.02). Admission to the hospital and ED lengths of stay decreased in the post-American Academy of Pediatrics statement cohort (P < 0.001 and P = 0.007, respectively). There were no increases in readmissions or repeat ED visits. This study revealed significant reduction in invasive testing, shorter lengths of ED stays, and lower admission rates at a tertiary care children's hospital after the release of the American Academy of Pediatrics BRUE guideline with no increase in return ED visits or readmissions.

Navigating Privacy Laws to Deliver STI Health Services in High Schools.

* Abbreviations: FERPA — : Family Educational Rights and Privacy Act HIPAA — : Health Insurance Portability and Accountability Act PHI — : protected health information STI — : sexually transmitted infection In the American Academy of Pediatrics statement “Role of the School Nurse in Providing School Health Services,” the authors acknowledge that misinformation about federal privacy laws can be problematic,1 creating misunderstandings among pediatricians and school nurses that impact student care. Confusion arises when clinicians, covered by the Health Insurance Portability and Accountability Act (HIPAA), work collaboratively with school nurses, covered by the Family Educational Rights and Privacy Act (FERPA), to conduct health programs. The majority of school nurses report working with their local health department2 but are unsure about what procedures to follow for documenting and communicating health information, and existing federal guidance does not speak adequately to the complications arising from cross-sector collaboration.3 In this article, we use an example of a school-based sexually transmitted infection (STI) screening program to highlight the 2 main federal privacy laws that impact school and health provider collaboration: FERPA and HIPAA. State privacy laws and institutional policies impose restrictions beyond federal law. These local laws and policies vary, as does their intersection with federal law. School and health department collaborators must negotiate this complex web when they plan joint projects. Passed in 1974, FERPA is designed to protect students’ educational records.4 Any educational institution receiving funding from the US Department of Education must allow parents or an eligible student (>18 years of age or has begun postsecondary education) to access the student’s … Address correspondence to Patricia A. Elliott, DrPH, Department of Community Health Sciences, School of Public Health, Boston University, 801 Massachusetts Ave, Room 440, Boston, MA 02118. E-mail: pelliott{at}bu.edu

Medicaid Transformation From the Independent Practice Perspective: Opportunities and Obstacles.

The importance of independent primary care practices as North Carolina approaches Medicaid transformation cannot be overstated. Forty-four percent of the state's pediatricians remain in independent practice and more than a quarter of family physicians maintain an equity stake in their practice, with

Physical Punishment and Child Externalizing Behavior: Comparing American Indian, White, and African American Children.

This study examined if, compared to White and African American children, maternal spanking of American Indian children was associated with child externalizing behavior problems. Using a community-based sample of 3,632 children (1,183 White, 2,183 African American, 266 American Indian), multiple-group autoregressive cross-lagged models examined the associations between maternal spanking and child externalizing behavior across the first 5 years of life. Rates of spanking for American Indian and White children were similar at all three time points (age 1, age 3, and age 5). When comparing White and American Indian groups, maternal spanking at age 1 predicted child externalizing behavior at age 3 (White: β = .10, p < .001; American Indian: β = .08, p < .01), and maternal spanking at age 3 predicted child externalizing behavior at age 5 (White: β = .09, p < .05; American Indian: β = .08, p < .01). When comparing African American and American Indian groups, maternal spanking at age 1 predicted child externalizing behavior at age 3 (African American: β = .08, p < .01; American Indian: β = .06, p < .001), and maternal spanking at age 3 predicted child externalizing behavior at age 5 (African American: β = .08, p < .001; American Indian: β = .07, p < .001). Structural invariance tests suggested that the associations observed among American Indian children were not distinguishable from those observed among White and African American children. Results of this study can be interpreted in light of the recent American Academy of Pediatrics statement that encourages pediatricians to counsel parents against the use of physical punishment. Similar to White and African American families, American Indian families may benefit from reducing or eliminating the use of physical punishment.

Why we still spank our children in the US: Is there a role for corporal punishment in raising children?

In last month's CABL, our managing editor Alison Knopf reviewed the most recent American Academy of Pediatrics (AAP) statement about spanking/corporal punishment. Notably, there are no benefits associated with corporal punishment, and many disadvantages. These include negative effects on the parent‐child relationship, increased aggression in children, increased risk of mental health disorders, and cognitive problems. Further, in families that are already experiencing stress, these risks are increased. As professionals working with children, we know this in a way that we know few other things about child rearing. And yet, most American parents (65%) still spank their children. Some research even suggests that for parents that utilize corporal punishment, they probably do it more often than they report to therapists.

Options Counseling for the Pregnant Adolescent Patient.

Each year, more than 500 000 girls and young women younger than 20 years become pregnant. It is important for pediatricians to have the ability and the resources in their offices to make a timely pregnancy diagnosis in their adolescent patients and provide them with nonjudgmental pregnancy options counseling. Counseling includes an unbiased discussion of the adolescent's legal options to either continue or terminate her pregnancy, supporting the adolescent in the decision-making process, and referring the adolescent to appropriate resources and services. Pediatricians who choose not to provide such discussions should promptly refer pregnant adolescent patients to a health care professional who will offer developmentally appropriate pregnancy options counseling. This approach to pregnancy options counseling has not changed since the original 1989 American Academy of Pediatrics statement on this issue.

Depression Is a Deadly Growing Threat to Our Youth: Time to Rally.

In this month’s issue of Pediatrics , Mojtabai and colleagues1 sound an alarm with 2 critical public health updates; depression is significantly on the rise in adolescents, with a 12-month prevalence of 11.3% in 2014 versus 8.7% in 2005. Furthermore, despite this disturbing development, the percentage of young people with a history of past-year major depressive episodes seen by primary care providers for depression care is only ∼10% and has not appreciably budged in the past decade. The second point is disappointing because it occurs despite a 2007 American Academy of Pediatrics statement,2 which could have possibly had an impact on the comparison between 2005 and 2014. This statement strongly encouraged all pediatricians to recognize and identify the risk factors for suicide, then the third leading cause of death for adolescents 15 to 19 years old, of which depression was and remains … Address correspondence to Anne Glowinski, MD, MPE, Department of Psychiatry, Division of Child and Adolescent Psychiatry, Washington University in St Louis, 4444 Forest Park Ave, St Louis, MO 63108. E-mail: glowinsa{at}wustl.edu

The Current and Ideal State of Mental Health Training: Pediatric Resident Perspectives

Phenomenon: Mental health (MH) problems are prevalent in the pediatric population, and in a setting of limited resources, pediatricians need to provide MH care in the primary medical home yet are uncomfortable doing so citing a lack of training during residency as one barrier. Approach: The purpose of this study is to describe pediatric residents’ experiences and perspectives on the current and ideal states of MH training and ideas for curriculum development to bridge this gap. A qualitative study using focus groups of pediatric residents from an urban academic medical center was performed. Audio recordings were transcribed and analyzed using a grounded theory approach. Findings: Twenty-six residents participated in three focus groups, which is when thematic saturation was achieved. The team generated five major themes: capabilities, comfort, organizational capacity, coping, and education. Residents expressed uncertainty at every step of an MH visit. Internal barriers identified included low levels of comfort and negative emotional responses. External barriers included a lack of MH resources and mentorship in MH care, or an inadequate organizational capacity. These internal and external barriers resulted in a lack of perceived capability in handling MH issues. In response, residents reported inadequate coping strategies, such as ignoring MH concerns. To build knowledge and skills, residents prefer educational modalities including didactics, experiential learning through collaborations with MH specialists, and tools built into patient care flow. Insights: Pediatric residency programs need to evolve in order to improve resident training in MH care. The skills and knowledge requested by residents parallel the American Academy of Pediatrics statement on MH competencies. Models of collaborative care provide similar modalities of learning requested by residents. These national efforts have not been operationalized in training programs yet may be useful for curriculum development and dissemination to enhance trainees’ MH knowledge and skills to provide optimal MH care for children.

Pediatricians Transitioning Practices, Youth With Special Health Care Needs in New York State.

To assess current practices of New York State pediatricians as they transition youth with special health care needs to adult-oriented medical care. A survey of New York State pediatricians included 6 critical steps from 2002 consensus statement, 11 essential steps adapted from recent literature, and questions targeting age of starting transition and availability of transition policy. Of 181 respondents, only 11% have a transition policy. Most assist patients in transition process; identify an adult provider (92%); and create portable medical summary (57%). Only 3% start planning process at recommended age. No respondents are compliant with all 6 critical steps; subspecialists were more likely to report compliance to more than 4 steps. Participating pediatricians are making gains, yet effort is needed, to incorporate the essential steps into practice for transitioning youth with special health care needs. Recognition of barriers, use of electronic tools, and clarifying subspecialist's approach, may improve compliance with transition recommendations.

Not just little adults: a review of 102 paediatric ethics consultations.

The American Academy of Pediatrics statement on institutional ethics committees highlights the importance of paediatric ethics consultation. However, little has been published on actual experience with ethics consultation in paediatrics. The objective of this study was to review and describe topics covered by a large retrospective sample of clinical ethics consultations in paediatric medicine. We reviewed ethics consultations involving patients of <18years of age from January 2005 to July 2013 at one institution. Descriptive statistics of the patient population, the reason for the ethics consultation and the consultant's perceived contribution to the case were generated. Subgroups of patients were compared based on demographic and clinical characteristics using Wilcoxon's rank sum tests, chi-square tests and logistic regression models. Most of the 102 eligible consultations originated from intensive care units and were requested by attending physicians. The most frequent topic leading to consultation was end-of-life issues. Both younger age and male sex were associated with consults for end-of-life issues (p<0.001 and p=0.010). This analysis provides important information describing the type of consults requested in paediatric medicine, which is necessary given the movement towards professionalising clinical ethics consultation. Further empirical research is needed on ethics consultation in paediatrics.

AAP Principles Concerning Retail-Based Clinics

The American Academy of Pediatrics views retail-based clinics (RBCs) as an inappropriate source of primary care for pediatric patients, as they fragment medical care and are detrimental to the medical home concept of longitudinal and coordinated care. This statement updates the original 2006 American Academy of Pediatrics statement on RBCs, which flatly opposed these sites as appropriate for pediatric care, discussing the shift in RBC focus and comparing attributes of RBCs with those of the pediatric medical home.

Pediatricians' Perspectives on Indoor Tanning

This report presents results from an online survey of New York State pediatricians regarding their counseling habits and attitudes toward indoor tanning among adolescents, as well as their awareness of current legislation that restricts youth access to tanning beds.

1762 Current Resuscitation Practices among Pediatricians in Gujarat, India - Effect of 2010 Resuscitation Guidelines

Background and AimsNeonatal Resuscitation Guidelines are updated by international societies every five years. India does not have mandatory certification and hence many pediatricians may not change their practices which may...

Neurodevelopmental Outcomes in Children With Congenital Heart Disease: Evaluation and Management

The goal of this statement was to review the available literature on surveillance, screening, evaluation, and management strategies and put forward a scientific statement that would comprehensively review the literature and create recommendations to optimize neurodevelopmental outcome in the pediatric congenital heart disease (CHD) population. A writing group appointed by the American Heart Association and American Academy of Pediatrics reviewed the available literature addressing developmental disorder and disability and developmental delay in the CHD population, with specific attention given to surveillance, screening, evaluation, and management strategies. MEDLINE and Google Scholar database searches from 1966 to 2011 were performed for English-language articles cross-referencing CHD with pertinent search terms. The reference lists of identified articles were also searched. The American College of Cardiology/American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. A management algorithm was devised that stratified children with CHD on the basis of established risk factors. For those deemed to be at high risk for developmental disorder or disabilities or for developmental delay, formal, periodic developmental and medical evaluations are recommended. A CHD algorithm for surveillance, screening, evaluation, reevaluation, and management of developmental disorder or disability has been constructed to serve as a supplement to the 2006 American Academy of Pediatrics statement on developmental surveillance and screening. The proposed algorithm is designed to be carried out within the context of the medical home. This scientific statement is meant for medical providers within the medical home who care for patients with CHD. Children with CHD are at increased risk of developmental disorder or disabilities or developmental delay. Periodic developmental surveillance, screening, evaluation, and reevaluation throughout childhood may enhance identification of significant deficits, allowing for appropriate therapies and education to enhance later academic, behavioral, psychosocial, and adaptive functioning.

Washington State Pediatricians' Attitudes Toward Alternative Childhood Immunization Schedules

To determine the frequency of parents' requests for alternative childhood immunization schedules (ACISs) and pediatricians' comfort with and willingness to use ACISs. Washington State primary care pediatricians were asked to complete an Internet-based survey on ACISs. The main outcome measures were the frequency of parents' requests for ACISs, pediatricians' comfort with their use, and pediatricians' willingness to use ACISs for individual vaccines. In addition, respondents were asked to characterize their practices and to provide demographic information. Of the 311 respondents (response rate: 65%), 209 met inclusion criteria and were included in analyses. Overall, 77% of eligible respondents reported that parents sometimes or frequently requested ACISs, and 61% were comfortable using an ACIS if requested by a parent. Pediatricians were least willing to consider using ACISs for diphtheria-tetanus toxoids-acellular pertussis vaccine, Haemophilus influenzae type b vaccine, and pneumococcal conjugate vaccine. Pediatricians who practiced in a neighborhood or community clinic were less comfortable using ACISs than were those in a 1- or 2-physician practice (odds ratio: 0.10). Washington State pediatricians are regularly being asked to use ACISs, and most of them are comfortable using them if requested. Pediatricians are least willing to delay H influenzae type b vaccine, diphtheria-tetanus toxoids-acellular pertussis vaccine, and pneumococcal conjugate vaccine, which suggests prioritization of immunizations that protect against potentially devastating bacterial infections of infancy and early childhood.

Washington State Pediatricians' Attitudes Toward Alternative Childhood Immunization Schedules

Washington State Pediatricians' Attitudes Toward Alternative Childhood Immunization Schedules

An Exploratory Study of Early Intervention in Gujarat State, India: Pediatricians' Perspectives

Because of improvements in neonatal care in India, there is an increase in the survival rate of high-risk newborns; however, subsequent developmental support systems are inadequate. There is minimal documented research that examines the role of pediatricians as key stakeholders in the early intervention (EI) process in India. The aim of this study was to document perceptions and practices of pediatricians in Gujarat state, India, regarding identification of children at risk for developmental problems, referral procedures, access to EI services in their community, and relevant educational needs. An exploratory survey was courier mailed to the entire population of pediatricians in Gujarat. Analyses were based on survey responses from 192 pediatricians. Pediatricians infrequently used developmental assessment tools to identify children with delays, even when a child had biological or established risk conditions. The top 3 barriers to screening were insufficient time, lack of treatment choices, and lack of knowledge regarding referral options. The main deterrent for making referrals was the paucity of EI services. Nearly half the pediatricians reported receiving inadequate training for early detection of childhood disabilities during their medical education. A key continuing education need was learning about developmental screening techniques. Although more research is needed, it is clear that Gujarat's pediatricians consider early identification of children with developmental concerns as their role. Findings underscore the importance of providing them with more resources and training to promote the developmental aspects of children's health.