A cross-sectional analysis of otitis media with effusion in children with Down syndrome

Children with Down syndrome are at risk to develop otitis media with effusion (OME). We performed a retrospective and cross-sectional analysis to evaluate the prevalence of OME in children with Down syndrome (DS) for consecutive age categories between 6 months and 12 years. Clinical and audiometric data were available for 107 children followed in a multidisciplinary Down team. A high prevalence of OME was found at the age of 1 year (66.7 %), with a second peak prevalence of 60 % at 6–7 years. A declining trend was observed in children ≥8 years. Overall, 52.3 % of DS children had either OME or ventilation tubes at the time of evaluation. Hearing thresholds were significantly higher in children with bilateral OME (median 36.7 decibel hearing level (dB HL), range 26.7–46.1) compared to those with at least one normally ventilated middle ear (median 28.3 dB HL, range 22.8–3.3), p?=?0.013. Conclusion: We found a high prevalence of OME in children with Down syndrome, with a peak of ≥60 % around 1 and 6–7 years. A declining trend is seen in older children. Mild to moderate hearing loss was present in children with bilateral OME.     

High frequency hearing loss in Ullrich-Turner syndrome

A total of 38 patients with Ullrich-Turner syndrome underwent standard otological and audiometric evaluation as well as high frequency audiological tests. Some 26 (68.4%) patients had a history of middle ear infections, and ten (26.3%) had required otolaryngological surgery. Conventional audiometry (125–8000 Hz) demonstrated normal hearing in only 25 of the ears (33%); between 500–4000 Hz, 16 ears (21.0%) had a mixed type and eight ears (10.5%) had conductive hearing loss. High frequency audiometry (8–18 kHz) revealed sensorineural hearing loss in 98.7% of the ears. Our results for conventional audiometry are in accordance with the literature. Conclusion The detection of a high prevalence of hearing loss in the high frequency range brings a significant new perspective to the pursuit of the aetiology of ear and hearing problems in Ullrich-Turner syndrome. This pathology seems to be a premature variant of presbycusis and it may underlie future hearing impairment which will come to clinical attention only after it progresses to conventional testing frequencies. While further studies are underway to evaluate this aspect, routine otological and audiological follow-up of patients with Ullrich-Turner syndrome is warranted from the time of diagnosis. Received: 1 December 1999 and in revised form: 31 March 2000 / Accepted: 4 April 2000     

Hearing loss in children with osteogenesis imperfecta

Osteogenesis imperfecta (OI) is a genetic disorder of connective tissue. Progressive hearing loss is one of the principal symptoms of OI, affecting about 50% of adult patients. Hearing loss may also occur in childhood and results in additional disability in education and psychosocial adaptation and aggravates the physical handicap. This can be avoided by appropriate otological and audiological treatment. In a nationwide search, 254 Finnish patients with OI were identified indicating a prevalence of 4.9/100 000. Of the 60 children, 45 aged between 4 and 16 years accepting to participate the study on hearing, were evaluated by a questionnaire and clinical audiometry. Hearing loss was defined as pure tone average (PTA_{0.5–2 kHz}) more than 20 dB hearing level (HL). A clinical geneticist determined the type of OI among the 45 patients. Two sporadic OI cases with conductive hearing loss were ascertained (4.4%): An 11-year-old girl with type IV OI with a PTA_{0.5–2 kHz} of 35/40 dB HL and a 15-year-old boy with type IV OI with a PTA_{0.5–2 kHz} of 27/18 dB HL. In addition, a 6-year-old girl with familial OI type I had either a congenital sensorineural deafness or early progressive deafness with PTA_{0.5–2 kHz} of 97/103 dB HL, probably of unrelated aetiology. Conclusion Hearing loss in children with osteogenesis imperfecta is less frequent than generally suspected. Nevertheless, it is recommended that audiometry is performed in children with osteogenesis imperfecta even without symptoms of hearing loss at the age of 10 years, and repeated every 3 years thereafter. Received: 13 October 1999 and in revised forms: 20 December 1999, 13 January 2000 and 24 January 2000 / Accepted: 25 January 2000     

Temperature-Adjusted Respiratory Rate for the Prediction of Childhood Pneumonia

ObjectivesAs both fever and pneumonia can be associated with tachypnea, we investigated the relationship between body temperature and respiratory rate (RR) in young children and whether temperature-adjusted RR enhances the prediction of pneumonia.MethodsIn this retrospective cross-sectional analysis of 91,429 children < 5 years of age presenting to an urban pediatric emergency department, the relationship between triage RR and temperature was analyzed using regression analysis. We assessed the predictive value of temperature-adjusted RR for the diagnosis of pneumonia; diagnostic performance was evaluated for continuous RR as well as World Health Organization (WHO) age-based RR thresholds.ResultsThe mean RR increased 2.6 breaths/minute for each 1°C increase in temperature. Interpatient variability was comparatively large; at any temperature, the interquartile range (75th percentile minus 25th percentile) varied from 4 to 16 breaths/minute. For predicting pneumonia, temperature- and age-adjusted RR was superior to age-adjusted RR: area under the curve (AUC) = 0.76 (95% confidence interval [CI], 0.75–0.78) versus AUC = 0.73 (95% CI, 0.72–0.75), respectively. Using WHO RR criteria, temperature-adjusted RR improved diagnostic discrimination, as the AUC increased from 0.58 (95% CI, 0.57–0.59) to 0.72 (95% CI, 0.70–0.73).ConclusionsThe effects of temperature on respiratory rate are modest, with a mean increase of 2.6 breaths/minute for each 1°C rise in temperature. Despite considerable interpatient variability in respiratory rates by temperature, temperature adjustment improves the diagnostic value of respiratory rate for pneumonia.     

Use and Utility of Skeletal Surveys to Evaluate for Occult Fractures in Young Injured Children

ObjectiveTo describe the percentage and characteristics of children aged <24 months with non-motor vehicle crash (MVC)-related injuries who undergo a skeletal survey and have occult fractures.MethodsWe performed a retrospective chart review of a stratified, systematic random sample of 1769 children aged<24 months with non-MVC–related bruises, burns, fractures, abdominal injuries, and head injuries at 4 children's hospitals between 2008 and 2012. Sampling weights were assigned to each child to allow for representative hospital-level population estimates. Logistic regression models were used to test for associations between patient characteristics with outcomes of skeletal survey completion and occult fracture identification.ResultsSkeletal surveys were performed in 46.3% of children aged 0 to 5 months, in 21.1% of those aged 6 to 11 months, in 8.0% of those aged 12 to 17 months, and in 6.2% of those aged 18 to 24 months. Skeletal surveys were performed most frequently in children with traumatic brain injuries (64.7%) and rib fractures (100%) and least frequently in those with burns (2.1%) and minor head injuries (4.4%). In adjusted analyses, older age, private insurance, and reported history of accidental trauma were associated with decreased skeletal survey use (P ≤ .001 for all). The prevalence of occult fractures on skeletal surveys ranged from 24.6% in children aged 0 to 5months to 3.6% in those aged 18 to 24 months, and varied within age categories based on the presenting injury (P < .001).ConclusionsThe high rate of occult fractures in infants aged 0 to 5 months underscores the importance of increasing the use of skeletal surveys in this population. Further research is needed to identify the injury characteristics of older infants and toddlers most at risk for occult fractures.     

Comparison of different growth curves in the assessment of extrauterine growth restriction in very low birth weight preterm infants

BackgroundPreterm infants are at risk of extrauterine growth restriction (EUGR) and associated complications in the long term. Growth curves are important in assessing postnatal growth in these infants. The aim of this study was to determine the prevalence of EUGR in preterm infants and the factors associated with EUGR using two different growth curves.MethodsWe retrospectively evaluated 596 preterm infants with birth weight ≤1500 g. Small for gestational age (SGA) was defined as birth weight <10th percentile for gestational age. EUGR was defined as discharge weight z score <?2. All z scores were determined using both the Fenton 2013 and Intergrowth-21st (IG-21) growth curves.ResultsThe infants’ median gestational age was 28 weeks (27–29) and median birth weight was 1080 g (900–1243). The prevalence of SGA was 9.2% with IG-21 curves and 5% with Fenton curves (p < 0.001). The median discharge weight was 2060 g (1860–2363). The prevalence of EUGR was significantly higher with the Fenton curves than with the IG-21 curves (38% vs. 31.7%, p < 0.001). The mean discharge weight z score was ?1.82±1.29 with Fenton and ?1.44±1.49 with IG-21 curves. In multivariate analysis, significant risk factors for EUGR according to the Fenton curves were SGA (odds ratio [OR]: 19.15, 95% confidence interval [CI]: 4.4–82.59), respiratory distress syndrome (RDS) (OR 1.64, 95% CI 1.12–2.4), late neonatal sepsis (LNS) (OR: 2.27, 95% CI: 1.5–3.44), and >16 days to full enteral feeding (OR: 1.8, 95% CI: 1.22–2.68). Similarly, independent risk factors for EUGR according to the IG-21 curve were SGA (OR: 16.3, 95% CI: 7.23–36.9), RDS (OR: 1.81, 95% CI: 1.16–2.83), LNS (OR: 2.29, 95% CI: 1.43–3.68), and >16 days to full enteral feeding (OR: 2.11, 95% CI: 1.38–3.23).ConclusionThe growth curves used for diagnosis may lead to differences in EUGR rates in intensive care units and the factors identified as associated with EUGR. At-risk infants should be evaluated for EUGR and their weight and nutritional support should be monitored carefully. Comparisons of long-term outcomes are needed to assess the suitability of growth curves used for EUGR follow-up.     

Trends in Visits and Costs for Mental Health Emergencies in a Pediatric Emergency Department, 2010–2016

ObjectiveAnalyze trends in visit numbers, length of stay (LOS), and costs of pediatric mental health emergency department (ED) visits over time.MethodsWe conducted a cross-sectional, time-series analysis from 2010 to 2016 of mental health visits, identified by billing diagnosis codes, among children 5 to 18years old in a tertiary pediatric ED. We used Poisson regression to analyze trends in rates of mental health visits, patient-hours, and visits with LOS ≥ 24hours. We used time-series analysis to trend median costs per visit.ResultsFrom 2010 to 2016, there were 197,982 ED visits and 13,367 (6.7%) mental health visits. Mental health visits increased by 45% (from 1462 to 2119), compared to a 13% increase in non–mental health visits. The rate of mental health visits increased from 5.6 to 7.1 per 100 ED visits and increased 5.5% annually, compared to –0.4% annually for non–mental health visits (incidence rate ratio [IRR], 1.06; 95% confidence interval [CI], 1.05–1.07). Mental health patient-hours increased 186%, compared to an 18% increase in non–mental health patient-hours. The rate of mental health visits with LOS ≥ 24hours increased from 4.3 to 18.8 per 100 mental health visits and increased 22% annually (IRR, 1.22; 95% CI, 1.19–1.26). Median costs per visit increased by $38 per quarter (95% CI, $28–$48).ConclusionsRates of mental health visits, patient-hours, visits with LOS ≥ 24hours, and visit costs are increasing over time. Additional hospital and community resources are needed to address rising ED utilization for mental illness in children.     

Associations of Passive and Mentally Active Screen Time With Perceived School Performance of 197,439 Adolescents Across 38 Countries

ObjectiveTo examine the associations of passive (ie, television) and active (ie, electronic games, computer use) screen time (ST) with perceived school performance of adolescents across gender.MethodsData were from the 2014 Health Behaviour in School-aged Children survey conducted across 38 European countries and Canada. Perceived school performance was assessed using an item and dichotomized as high (good/very good) versus the remainder (average/below-average as reference). Participants reported hours per day of time spent watching television, playing electronic games, and using a computer in their free time. Multilevel logistic regression was used to estimate the associations.ResultsA total of 197,439 adolescents (average age 13.6 [standard deviation 1.63] years; 51% girls) were analyzed. Multivariable modeling showed that engaging in >2 h/d of ST was progressively and adversely associated with high performance in both boys and girls. Adolescents reporting >4 h/d of television time (≤1 h/d as reference) had 32% lower odds in boys (odds ratio [OR] 0.68; 95% confidence interval [CI]: 0.65–0.71) and 39% lower odds in girls (OR 0.61; 95% CI, 0.58–0.65) of reporting high performance. Playing electronic games for >4 h/d was associated with high performance with odds being 38% lower in boys (OR 0.62; 95% CI, 0.59–0.66) and 45% lower in girls (OR 0.55; 95% CI, 0.52–0.57). Sex differences in the estimates were mixed.ConclusionsHigh screen use, whether active or passive, was adversely associated with perceived high school performance, with association estimates being slightly stronger in girls than boys, and for mentally active than passive screen use. Discouraging high levels of screen use of any type could be beneficial to school performance.     

Perceived barriers to care and attitudes towards shared decision-making among low socioeconomic status parents: role of health literacy

ObjectiveAlthough low parent health literacy (HL) has been linked to poor child health outcomes, it is not known whether differences in perceptions related to access to care and provider–parent partnership in care are potential contributing factors. We sought to assess whether parent HL is associated with differences in perceived barriers to care and attitudes regarding participatory decision-making with the provider.MethodsThis was a cross-sectional analysis of data collected from parents presenting with their child to an urban public hospital pediatric clinic in New York City. Dependent variables were caregiver-reported barriers to care (ability to reach provider at night/on weekends, difficult travel to clinic) and attitudes towards participatory decision-making (feeling like a partner, relying on doctor’s knowledge, leaving decisions up to the doctor, being given choices/asked opinion). The primary independent variable was caregiver HL (Short Test of Functional Health Literacy in Adults [S-TOHFLA]).ResultsA total of 823 parents were assessed; 1 in 4 (27.0%) categorized as having low HL. Parents with low HL were more likely to report barriers to care than those with adequate HL: trouble reaching provider nights/weekends, 64.9% vs. 49.6%, (p < 0.001, adjusted odds ratio [AOR] 1.7, 95% confidence interval [95% CI] 1.2–2.4); difficult travel, 15.3% vs. 8.0%, (p = 0.004, AOR 1.8, 95% CI 1.1–3.0). Low HL was also associated with not feeling like a partner (28.8% vs. 17.1%; AOR 2.0; 95% CI 1.4–3.0), preference for relying on the doctor's knowledge (68.9% vs. 52.2%; AOR 1.7; 95% CI 1.2–2.4), and preference for leaving decisions up to the doctor (57.7% vs. 33.3%; AOR 2.2; 95% CI 1.6–3.1).ConclusionsAddressing issues of parent HL may be helpful in ameliorating barriers to care and promoting provider-parent partnership in care.     

Prevalence of childhood obesity in Brazil: systematic review and meta-analysis

ObjectiveTo estimate the prevalence of childhood obesity in Brazil by means of a systematic review of representative studies.SourcesWe searched for population-based studies that assessed obesity in Brazilian children aged < 10 years in MEDLINE, EMBASE, Scopus and other sources up to September, 2019. Paired researchers selected studies, extracted data and assessed the quality of these studies. Meta-analysis of prevalence and confidence interval (95% CI) was calculated, weighted by the population sizes using Freeman-Tukey double-arccosine transformation. Heterogeneity (I²) and publication bias were investigated by meta-regression and Egger’s test, respectively.Summary of the findings53 studies were included (n = 122,395), which were held from 1986 to 2015 and limited mainly due to inadequate response rates. Prevalence of obesity in the three-decade period was of 8.2% ([95% CI]: 8.1–8.4%, I² = 98.5%). Higher prevalence was observed in boys (9.7% [9.4–9.9%], I² = 97.4%) than girls (7.3% [7.1−7.5%], I² = 96.1%). Prevalence increased according to the decade (1990: 6.5% [6.0–7.0 %], I² = 96.8%; 2000: 7.9% [7.7–8.0 %], I² = 98.8%; 2010: 12.0% [11.5–12.6 %], I² = 95.8%), and Brazilian region (Northeast: 6.4% [6.2−6.7%], I² = 98.1%; North: 6.7% [6.3−7.2%], I² = 98.8%; Southeast:10.6% [10.2−11.0%], I² = 98.2%; South: 10.1 [9.7−10.4%], I² = 97.7%). Heterogeneity was affected by age and region (p < 0.05) and publication bias was discarded (p = 0.746).ConclusionFor every 100 Brazilian children, over eight had obesity in the three-decade period and 12 in each 100 had childhood obesity in more recent estimates. Higher prevalence occurred in boys, recent decades and more developed Brazilian regions.     

Prevalence and determinant factors of anemia in children aged 6–12 months after starting an iron supplement in the east of Iran

ObjectiveAnemia in infants is a common problem, with regular iron supplementation the suggested policy for prevention and control of anemia. The aim of this study was to determine the prevalence and the determining factors of anemia as well as the benefits of regular iron supplementation in 6- to 12-month-old children.Design/setting/subjectsIn this cross-sectional study, 897 children aged from 6 to 12 months cared for at the Tabas Health Centers, affiliated with Birjand University of Medical Sciences, South Khorasan, Iran, were enrolled in the study. Demographic and anthropometric data as well as the level of hemoglobin were collected through interviews and laboratory tests, respectively. Data analysis was performed using SPSS-22 and stata-13. Chi², polychromic PCA, and logistic regression were used. The statistical significance level was 0.05.ResultThe prevalence of anemia, according to the WHO criterion for hemoglobin, was 36.8% (95% CI, 33.6–40.0). Its prevalence showed a decreasing trend as age and duration of iron supplement increased. Each 1-month increase in infant age was associated with a decreased risk of anemia [OR = 0.88 (95% CI, 0.80–0.98)]. Anemia was not significantly different between genders. Individuals in the highest category for parity (≥3) were at a 2.3-fold greater risk of anemia compared with the lowest category [OR = 2.35 (95% CI, 1.43–3.84)]. In contrast, individuals in the highest category for maternal age (>35 years) had a 62% lower risk of anemia compared with the reference category (<25 years) [OR = 0.38 (95% CI, 0.20–0.72)].ConclusionImplementation of an iron supplementation plan in Iran has decreased anemia among 6- to 12-month-old children.     

Rezeptiver Wortschatzumfang bilateral schallempfindungsgestörter Kinder im Verlauf

Objective

The aim of this study was to assess receptive vocabulary development in children with aided residual hearing, but without major co-morbidities.

Patients and Methods

A total of 26 boys and 27 girls (t1: 2.0–7.4 years old) with bilateral sensorineural hearing loss (average at frequencies of 0.5, 1, 2, 4 kHz >21 dB in the better hearing ear) were recruited out of the 1994 implemented Göttinger Hör-Sprachregister (Gö HSR). The mean age at diagnosis was 51.4 months (SD 19.6; min. 14; max. 85), the mean hearing aiding age: 51.9 months (SD 19.6). The children had an average nonverbal intelligence in Raven’s Coloured Progressive Matrices and in CMMS respectively. The individual assessment of receptive vocabulary was carried out at three time points using standardized test measures. The raw test scores were converted to T-scores (M=50; SD=10; normed for hearing children). The first psychometric examination took place after the ascertainment of the hearing loss (t1). Two follow-ups (t2, t3) were performed at 6–9 month time intervals.

Results

No child with a hearing loss >61 dB HL obtained an age appropriate receptive vocabulary score. On average, the study group exhibited an age-delayed lexical performance at t1 (M=38.7; SD=14.7) which significantly improved over time reaching the lower norm level at t3 (M=44.7; SD=18.0; p<0.001). The number of children with below norm performance did not change (t1=53%, t3=47%). The mildly hearing impaired children (21–40 dB) exhibited an age adequate receptive test score at t1 (except for three children). These three children with delayed results scored normally by t3. The children with moderate hearing loss (41–70 dB) improved significantly (t1–t3; p<0.001). The mean vocabulary performance of severe, bilaterally impaired children (>70 dB HL) did not increase.

Conclusion

Even a hearing loss <40 dB may negatively affect receptive vocabulary development. Receptive vocabulary outcome was not highly variable.     

Hearing improvement in patients with Fabry disease treated with agalsidase alfa

Aim : To describe the nature and prevalence of hearing loss in Fabry disease, and its response to enzyme replacement therapy (ERT) with agalsidase alfa. Methods : Fifteen male patients with Fabry disease were enrolled in a randomized, double-blind study and received placebo ( n = 8) or ERT ( n = 7) with agalsidase alfa for 6 months. This was followed by an open-label extension of 36 months thus far. Alongside this trial, an additional eight men and two women have so far received open-label ERT for between 6 and 30 months. Pure-tone audiometry, impedance audio-metry and otoacoustic emission testing were performed at 0 (baseline), 6, 18, 30 and 42 months. Results : Nine patients (36%) had bilateral and ten (40%) had unilateral high-frequency sensorineural hearing loss (SNHL). Three (12%) had unilateral middle ear effusions with conductive losses persisting beyond 6 months. Only five patients (20%) had normal hearing. The high-frequency SNHL deteriorated over the first 6 months in both placebo and active treatment groups by a median 6.3 dB ( p < 0.0001, Wilcoxon matched-pairs). This hearing loss subsequently improved above baseline by 1.5 dB at 18 months (p = 0.07), by 5.0 dB at 30 months ( p = 0.006) and by 4.0 dB at 42 months ( p = 0.01).
Conclusion : Significant hearing loss, usually high-frequency SNHL, is a common manifestation of Fabry disease in adults. α-Galactosidase A replacement therapy with agalsidase alfa appears to reverse the hearing deterioration in these patients. This improvement, however, is gradual, suggesting the need for long-term ERT.     

Association of women's empowerment with anaemia and haemoglobin concentration in children in sub‐Saharan Africa: A multilevel analysis

We assessed the associations between women''s empowerment and anaemia and haemoglobin concentration among children (6–59 months) in 31 sub‐Saharan African (SSA) countries. We included 72,032 mother–child pairs from Demographic and Health Surveys conducted between 2006 and 2019. A three‐dimensional women''s empowerment index (attitude towards violence, decision making and social independence) was constructed using principal components analysis, and associations between the index and any anaemia and Hb concentration were assessed using multilevel regression. The mean (standard deviation) haemoglobin concentration was 102.3 (16.0 g/L) and 65.8% of the children were anaemic. The odds of anaemia reduced with increasing empowerment in the dimensions of attitude towards violence [quintile (Q5) versus Q1, OR 0.77; 95% confidence interval [CI] 0.65–0.89, p _trend = 0.006], decision making (Q5 vs. Q1, OR 0.72; 95% CI 0.61–0.84, p _trend < 0.001) and social independence (Q5 vs. Q1, OR 0.86; 95% CI 0.76–0.97, p _trend = 0.015). The mean Hb concentration increased with increasing women''s empowerment in the dimensions of attitude towards violence (Q5 vs. Q1, mean difference [MD] 1.40 g/L; 95% CI 0.63–2.17, p _trend < 0.001) and social independence (Q5 vs. Q1, MD 1.32 g/L; 95% CI 0.36–2.28, p _trend = 0.001). There was no evidence for a linear trend in the association between decision making and haemoglobin concentration (p _trend = 0.051). Women''s empowerment was associated with reduced odds of any anaemia and higher haemoglobin concentration in children. The promotion of women''s empowerment may play a role in reducing the burden of childhood anaemia in SSA.     

Prevalence and independent risk factors for hearing loss in NICU infants

AIM: To determine the prevalence and independent relationship between hearing loss and risk factors in a representative neonatal intensive care unit (NICU) population. METHODS: Automated auditory brainstem response (AABR) hearing screening has been introduced since 1998 in the Dutch NICUs. After a second AABR failure, diagnostic ABR was used to establish diagnosis of hearing loss. Newborns who died before the age of 3 months were excluded. In the present study only the NICU infants who were born with a gestational age <30 weeks and/or a birth weight <1000 g between October 1, 1998 and January 1, 2002 were included. Risk factors included in the study were familial hearing loss, in utero infections, craniofacial anomalies, birth weight <1500 g, hyperbilirubinemia, ototoxic medications, cerebral complications, severe birth asphyxia, assisted ventilation > or =5 days and syndromes. RESULTS: A nationwide cohort of 2186 newborns were included. Mean gestational age was 28.5 weeks (SD 1.6) and mean birth weight was 1039 g (SD 256). Prevalence of uni- or bilateral hearing loss was 3.2% (71/2186; 95% CI 2.6-4.1). Multivariate analysis revealed that the only independent risk factors for hearing loss were severe birth asphyxia (OR 1.7; 95% CI 1.0-2.7) and assisted ventilation > or =5 days (OR 3.6; 95% CI 2.1-6.0). CONCLUSION: The prevalence of hearing loss in a representative NICU population was 3.2%. Independent risk factors for hearing loss were severe birth asphyxia and assisted ventilation > or =5 days.     

Social Epidemiology of Early Adolescent Cyberbullying in the United States

ObjectiveTo determine the prevalence and sociodemographic correlates of cyberbullying victimization and perpetration among a racially, ethnically and socioeconomically diverse population-based sample of 11–12-year-old early adolescents.MethodsWe analyzed cross-sectional data from the Adolescent Brain Cognitive Development (ABCD) Study (Year 2; N = 9429). Multiple logistic regression analyses were used to estimate associations between sociodemographic factors (sex, race/ethnicity, sexual orientation, country of birth, household income, parental education) and adolescent-reported cyberbullying victimization and perpetration.ResultsIn the overall sample, lifetime prevalence of cyberbullying victimization was 9.6%, with 65.8% occurring in the past 12 months, while lifetime prevalence of cyberbullying perpetration was 1.1%, with 59.8% occurring in the past 12 months. Boys reported higher odds of cyberbullying perpetration (AOR 1.71, 95% CI 1.01–2.92) but lower odds of cyberbullying victimization (AOR 0.80, 95% CI 0.68–0.94) than girls. Sexual minorities reported 2.83 higher odds of cyberbullying victimization (95% CI 1.69–4.75) than nonsexual minorities. Lower household income was associated with 1.64 (95% CI 1.34–2.00) higher odds of cyberbullying victimization than higher household income, however household income was not associated with cyberbullying perpetration. Total screen time, particularly on the internet and social media, was associated with both cyberbullying victimization and perpetration.ConclusionsNearly one in 10 early adolescents reported cyberbullying victimization. Pediatricians, parents, teachers, and online platforms can provide education to support victims and prevent perpetration for early adolescents at the highest risk of cyberbullying.     

Design,Validity, and Reliability of a Pediatric Resident JumpSTART Disaster Triage Scoring Instrument

ObjectiveTo design an instrument for scoring residents learning pediatric disaster triage (PDT), and to test the validity and reliability of the instrument.MethodsWe designed a checklist-based scoring instrument including PDT knowledge and skills and performance, as well as a global assessment. Learners' performance in a 10-patient school bus crash simulation was video recorded and scored with the instrument. Learners triaged the patients with a color-coded algorithm (JumpSTART, Simple Triage and Rapid Treatment). Three evaluators observed the recordings and scored triage performance for each learner. Internal and construct validity of the instrument were established via comparison of resident performance by postgraduate year (PGY) and correlating instrument items with overall score. Validity was assessed with analysis of variance and the D statistic. We calculated evaluators' intraclass correlation coefficient (ICC) for each patient, skill, triage decision, and global assessment.ResultsThere were 37 learners and 111 observations. There was no difference in total scores by PGY (P = .77), establishing internal validity. Regarding construct validity, most instrument items had a D statistic of >0.5. The overall ICC among scores was 0.83 (95% confidence interval [CI] 0.74–0.89). Individual patient score reliability was high and was greatest among patients with head injury (ICC 0.86; 95% CI 0.79–0.91). Reliability was low for an ambulatory patient (ICC 0.29; 95% CI 0.07–0.48). Triage skills evaluation showed excellent reliability, including airway management (ICC 0.91; 95% CI 0.86–0.94) and triage speed (ICC 0.81; 95% CI 0.72–0.88). The global assessment had moderate reliability for skills (ICC 0.63; 95% CI 0.47–0.75) and knowledge (ICC 0.64; 95% CI 0.49–0.76).ConclusionsWe report the validity and reliability testing of a PDT-scoring instrument. Validity was confirmed with no performance differential by PGY. Reliability of the scoring instrument for most patient-level triage, knowledge, and specific skills was high.     

Weekend Versus Weekday Asthma-Related Emergency Department Utilization

ObjectiveTo assess variation in asthma-related emergency department (ED) use between weekends and weekdays.MethodsCross-sectional administrative claims-based analysis using California 2016 Medicaid data and Vermont 2016 and Massachusetts 2015 all-payer claims databases. We defined ED use as the rate of asthma-related ED visits per 100 child-years. A weekend visit was a visit on Saturday or Sunday, based on date of ED visit claim. We used negative binomial regression and robust standard errors to assess variation between weekend and weekday rates, overall and by age group.ResultsWe evaluated data from 398,537 patients with asthma. The asthma-related ED visit rate was slightly lower on weekends (weekend: 18.7 [95% confidence interval (CI): 18.3–19.0], weekday: 19.6 [95% CI, 19.3–19.8], P < .001). When stratifying by age group, 3- to 5-year-olds had higher rates of asthma-related ED visits on weekends than weekdays (weekend: 33.7 [95% CI, 32.6–34.7], weekday: 29.8 [95% CI, 29.1–30.5], P < .001) and 12- to 17-year-olds had lower rates of ED visits on weekends than weekdays (weekend: 13.0 [95% CI: 12.5–13.4], weekday: 16.3 [95% CI: 15.9–16.7], P < .001). In the other age groups (6–11, 18–21 years) there were not statistically significant differences between weekend and weekday rates (P > .05).ConclusionsIn this multistate analysis of children with asthma, we found limited overall variation in pediatric asthma-related ED utilization on weekends versus weekdays. These findings suggest that increasing access options during the weekend may not necessarily decrease asthma-related ED use.     

Evaluation of the prevalence and factors associated with acute kidney injury in a pediatric intensive care unit

ObjectiveTo assess the prevalence of acute kidney injury in pediatric intensive care unit according to diagnostic criteria – pediatric risk, injury, failure, loss, end-stage renal disease, Acute Kidney Injury Network and Acute Kidney Injury Work Group, or Kidney Disease: Improving Global Outcomes –, and determining factors associated with acute kidney injury as well as its outcome.MethodologyThis was a cross-sectional monocentric observational study, including patients aged between 29 days and 17 years who were admitted to the pediatric intensive care unit between January 1, 2012 and December 31, 2016. To evaluate the association between the study variables and acute kidney injury, the log-binomial generalized univariate and multivariate linear models were adjusted.ResultsThe study included 1131 patients, with prevalence of acute kidney injury according to the Acute Kidney Injury Network and Kidney Disease: Improving Global Outcomes criteria of 12.6% and of 12.9% according to the pediatric risk, injury, failure, loss, end-stage renal disease. In the multivariate analysis of older children (PR 1.007, 95% CI: 1.005–1.009), sepsis (PR 1.641, 95% CI: 1.128–2.387), demand for ventilatory support (PR 1.547, 95% CI: 1.095–2.186), and use of vasoactive amines (PR 2.298, 95% CI: 1.681–3.142) constituted factors associated with statistical significance to the development of acute kidney injury. The mortality rate among those with acute kidney injury was 28.7%.ConclusionOlder children, diagnosis of sepsis, demand for ventilatory support, and use of vasoactive amines were correlated with a higher risk of developing acute kidney injury. The mortality associated with acute kidney injury was elevated; it is crucial that all measures that ensure adequate renal perfusion are taken for patients with risk factors, to avoid the installation of the disease.