Obesity and a higher body mass index (BMI) have been hypothesized to be linked to cardiometabolic risks. An 

 examines whether overweight and obesity as well as BMI patterns can serve as a predictor for future cardiometabolic risks.

Researchers used a population-based sample of 5107 infants who were measured for BMI every 2 years between 2 years to 11 years. Five BMI trajectories were found using growth curve models. At 11 and 12 years of age, 1811 underwent assessments for metabolic syndrome risk scores, carotid intima-media thickness, and carotid-femoral pulse wave velocity.

They found that overweight and obesity that went from early childhood onward were strongly linked with higher cardiometabolic risks when the child was aged 11 to 12 years. At 6 or 7 years of age, when compared with a healthy weight child, children who were overweight had higher metabolic syndrome risk scores by 0.23 standard deviation (SD) units and children with obesity saw higher risk scores by 0.76 SD units. The links nearly doubled by the time a child was aged 10 to 11 years. Children who were obese had higher outcome pulse wave velocity from the age of 6 years and also had slightly higher outcome carotid intima-media thickness at all ages studied. Overall, a cumulative exposure to a high BMI from 2 years of age was linked to the greatest cardiometabolic risk.

The investigators concluded that a high BMI, particularly one that started in early childhood, was linked to cardiometabolic risk as young as 11 years of age. This connection underscores the need to reduce and prevent overweight and obesity in early childhood.

1. Lycett K, Juonala M, Magnussen CG, et al. Body mass index from early to late childhood and cardiometabolic measurements at 11 to 12 years. 

. 2020;146(1):e20193666. doi:10.1542/peds.2019-3666

Articles

Overweight and obesity issues have been suspected of increasing cardiometabolic risk in children. A new study investigates.

What body mass index can mean for cardiometabolic risk

 in female patients aged <25 years and sexually active, the Centers for Disease Control and Prevention recommends using nucleic-acid amplification tests (NAAT) from a vaginal swab sample. A 

 examined whether a quality improvement program would increase the number of clinicians using the vaginal swab NAAT instead of the less sensitive urine NAAT.

The investigators utilized 3 different interventions in 3 pediatric practices over the course of 12 months. The interventions included cross-training, education, and process standardization. The primary outcome for the study was the percentage of urogenital 

Over the course of the study, 818 urogenital 

 tests were performed. Two hundred eighty-nine tests were run before the first intervention and 529 were run after the intervention. In the preintervention period, 1.4% of the 

 tests were performed by vaginal swab. Within 6 weeks of the first intervention, investigators had exceeded the aim of 25%. Following the second intervention, they found sustained improvement with an average of 68.3% of the tests being performed by vaginal swabs in the postintervention period. No difference in the overall number of 

 tests run before and after the intervention.

The researchers concluded that the quality improvement program had led to a significant increase in the use of vaginal swabs. They noted that the intervention that standardized processes were linked with more impact than the education intervention.

1. Brigham KS, Peer MJ, Ghoshhajra BB, Co JP. Increasing vaginal 

 testing in adolescent and young adults. 

s. 2020:146(1):e20193028. doi:10.1542/peds.2019-3028

Clinicians may still use urine nucleic-acid amplification tests, despite the recommendation to use a more sensitive vaginal swab to test for Chlamydia trachomatis. A report looks at whether a quality improvement program could change that.

Using an improvement program to improve Chlamydia trachomatis testing

Dr Farber is a pediatrician in Woodbridge, Virginia.

A limited abdominal ultrasound (US) is a safe and e­ffective way to assess for intestinal malrotation (IM) with or without midgut volvulus (MGV), according to a retrospective study. An upper gastrointestinal (UGI) series has long been considered the imaging gold standard for making this assessment.

Investigators searched radiology reports at a children’s hospital for patients who were evaluated for MGV using US during 2016 and 2017 and examined the relevant charts for any events that happened in the month following the US. Of the 195 patients who received a US evaluation, the most common presentations were vomiting (44%) followed by abdominal pain and suspected malrotation. Median age was 77 days, with 91% of patients aged younger than 1 year, half of whom were aged younger than 1 month.

The US studies were evaluated for 2 abnormalities: twisting of the small bowel and vasculature around the superior mesenteric artery (SMA), indicative of IM; and occlusion of the SMA, indicating MGV. Of the 195 US studies, 179 were diagnostic; that is, they could include or exclude MGV. (Sixteen studies were not diagnostic because of overlying bowel gas.) Of the diagnostic studies, 14 were found to be positive for MGV, which was confirmed at surgery. For the 164 patients with a negative US who did not have surgery, no negative outcomes were reported. In other words, US was diagnostic in 92% of patients, and in those individuals, it had a sensitivity and specificity of 100%.

Seven of the 16 patients with nondiagnostic US studies were evaluated further with UGI exams, and all tested negative for MGV or malrotation, although 1 patient later was confirmed surgically to have malrotation without volvulus. The remaining 6 patients did not receive further imaging, and either were followed clinically (their symptoms resolved) or underwent surgical exploration that revealed other causes of abdominal pain.

The authors noted that unlike UGI, US does not expose the child to radiation or fill his or her stomach with contrast. In addition, US offers portability and repeatability (

. 2020;S0022- 3468(20)30295-5. Online ahead of print.

Anything that can be done noninvasively at the bedside is a tremendous boon, both in terms of minimizing risk and getting a child to the operating room sooner when needed. The ultrasound is taking on more of the functions of a Star Trek tricorder every day.

A retrospective study examines whether limited abdominal ultrasound is a safe and e­ffective way to assess for intestinal malrotation with or without midgut volvulus.

Ultrasound accurately diagnoses midgut volvulus

What is COVID-19's association with conjunctivitis? John D. Sheppard, MD, discusses steps that pediatricians and primary care providers can take to appropriately triage and manage patients with suspected cases of bacterial or viral conjunctivitis — as well as the importance of rapid, point-of-care testing as an everyday resource.

Presented By: John D. Sheppard, MD
Bio: John D. Sheppard, MD, is an internationally recognized expert in the diagnosis and treatment of ophthalmologic disease, immunology, and preclinical science. His background provides a broad base for development of ophthalmologic drugs and devices, as well as translational research bringing preclinical studies into practice.

Podcasts

COVID-19 and Its Association with Conjunctivitis

Opioids and corticosteroids are sometimes prescribed to children suffering from pneumonia or sinusitis. A 

 examines the frequency of the prescriptions as well as whether location of care had an impact.

The investigators used 2016 South Carolina Medicaid claims data for patient aged 5 to 18 years who had been diagnosed with either pneumonia or sinusitis. The visits for care were linked to 3 different locations: the ambulatory setting, urgent care, or the emergency department (ED). The inclusion criteria for the study were met by 31,838 children.

They found that visits for pneumonia were more likely to result in an opioid prescription in the ED (34 of 542 visits) than the ambulatory setting (24 of 1590 visits). They were also most likely to result in a steroid prescription in the ED (106 of 542 visits) than in the ambulatory settings (196 of 1590 visits). In cases of sinusitis, opioids (202 of 2705 visits) and steroids (510 of 2705 visits) were more likely in ED visits than in ambulatory settings (opioid: 568 of 26,866 visits, steroids: 1922 of 26,866 visits). Following logistic regression, visits to the ED were linked to increased odds of being prescribed opioids or steroids for the treatment of pneumonia and sinusitis.

Researchers concluded that location of care did impact whether a child was given a prescription when treated for certain conditions.

1. Phang KG, Roberts JR, Ebeling M, Garner SS, Basco WT. Opioids or steroids for pneumonia or sinusitis. 

. 2020:146(1):e20193690. doi:10.1542/peds.2019-3690

The location where care is received can impact how medication is prescribed. A report examines how location impacts care for pneumonia and sinusitis.

How location of care impacts prescriptions for pneumonia and sinusitis

Over the past several years, the effect of obesity on morbidity and mortality on a number of diseases has become apparent. An 

 explores whether obesity leads to worse outcomes in children who are critically ill.

Investigators ran a secondary analysis of the Assessment of Worldwide Acute Kidney Injury, Renal Angina, and Epidemiology study, which was a prospective, multinational observational study. Participants in the study were aged from 3 months to 25 years and had been recruited across North America, Europe, Asia, and Australia. They were divided into 4 groups: underweight, normal weight, overweight, and obese.

Of the 3719 patients included in the study, 542 were given a primary diagnosis of sepsis. In the cohort, 1059 were underweight; 1649 were normal weight; 423 were overweight; and 588 were obese. In the main cohort, the 28-day mortality rate was 3.6%. Within the sepsis cohort, the overall mortality rate was 9.1% and was found to vary significantly by weight status (15.4% in underweight, 6.6% in normal weight, 3.6% in overweight, and 4.7% in obese). In a fully adjusted model, the 28-day mortality risk was 2.9-fold higher in the underweight group versus the normal weight group in the sepsis cohort and 1.8-fold higher in the overall cohort. They also found that children who were underweight had a longer stay in the intensive care unit (ICU), higher frequency of fluid overload, and an increased need for mechanical ventilation support.

The researchers concluded that children who are underweight make up a significant proportion of patients in the pediatric ICU. They also have a more complicated course during their ICU stay.

1. Ayalon I, Woo JG, Basu RK, Kaddourah A, Goldstein SL, Kaplan JM. Weight as a risk factor for mortality in critically ill patients. 

. 2020;146(1):e20192829. doi:10.1542/peds.2019-2829

It’s been hypothesized that obesity can lead to worse outcomes in critical illness and an investigation provides some answers.

Impact of weight in outcomes for critically ill kids

A recent case report describes how appendicitis in a 9-year-old child with sickle cell disease was handled effectively with nonsurgical treatment.

The child, who has sickle beta zero thalassemia and moderate persistent asthma, visited an emergency department because of lower back, chest, and abdominal pain that had not responded to ibuprofen. Doctors diagnosed vasoocclusive crisis, and the child was given intravenous fluids and analgesia. Abdominal ultrasound did not visualize the appendix, and results of abdominal computerized tomography were consistent with acute appendicitis without perforation.

Considered a high surgical risk, the child was given medical therapy, including ciprofloxacin and metronidazole, and after a day of not eating was transitioned to a full liquid diet. By the fifth day of hospitalization his respiration had improved significantly, and he was discharged on day 6. A year later, his abdominal pain had not returned (

Although rarely discussed in pediatric literature, using medical therapy with early introduction of antibiotics for acute appendicitis is not a new concept. Given how easily and relatively risk free appendectomy is to perform (especially laparoscopically), surgery is still the standard of care. However, keep an open mind about medical treatment if a surgeon believes that operating might be the greater risk.

A case report examines whether a high-risk child with appendicitis will need surgery.

Appendectomy successfully averted in child considered at high surgical risk

The drive to reduce antibiotic resistance has led to reduce the use of commonly prescribed antibiotics such as vancomycin. A 

 examines whether a quality improvement initiative could change how 1 neonatal intensive care unit (NICU) prescribed vancomycin.

Investigators created a quality improvement framework that included physician education that involved benchmarking for antibiotic prescribing rates; pharmacy-initiated 48-hour antibiotic time-outs on rounds; developing clinical pathways to standardize empirical antibiotic choices for certain situations such as necrotizing enterocolitis; and a daily audit that included feedback from an antimicrobial stewardship program. The program was deployed in a 60-bed level IV NICU in an academic referral center.

Statistical process u-charts were used to indicate that the use of vancomycin had declined from 112 to 38 days of therapy per 1000 patient-days. Following education, development of clinical pathways, and pharmacy-initiated 48-hour time-outs, the use of vancomycin declined by 29%. It declined by an additional 52% when it implemented the daily audit. They also found that acute kidney injury associated with vancomycin declined from 1.4 to 0.1 events per 1000 patient-days.

The researchers concluded that the implemented quality improvement program led to a decline in the use of vancomycin over a year and the decline was maintained over another year.

1. Hamdy R, Bhattarai S, Basu S et al. Reducing vancomycin use in a level IV NICU. 

. 2020:145(6):e20192963. doi:10.1542/peds.2019-2963

Reducing antibiotic resistance has been a high priority for quality improvement programs. How well did one program do in reducing vancomycin use?

Quality improvement program tries to reduce vancomycin use

Previous research has shown that children who are insured through their state’s Medicaid program frequently have higher hospital readmission rates than children who are privately insured. An 

 into whether the disparity has changed has been published in 

Investigators used data from the 2010 to 2017 Healthcare Cost and Utilization Project Nationwide Readmissions Database to compare the trends in 30-day readmission rates for children insured by private insurance and Medicaid

They found that roughly 60% of pediatric hospital admissions were covered by Medicaid. Between 2010 to 2017, the number of children who had a complex or chronic condition increased in both the privately insured population and among those covered by Medicaid. There was a slight decline in readmission rates in both populations, but the rate of readmission declined more rapidly in the privately insured group. Following an adjustment for risks, the readmission rates were found to decline at a similar rate. Within-hospital difference in readmission rates for privately insured patients versus Medicaid patients was found to be stable over the study period.

The researchers concluded that although readmission rates had declined across the board, but the rate remained higher among children insured by Medicaid, there could be a continuing disparity because of insurance status.

1. Bucholz EM, Schuster MA, Toomey SL. Trends in 30-day readmission for medicaid and privately insured pediatric patients: 2010–2017. 

. 2020:145(6):e20200270. doi:10.1542/peds.2020-0270

The risk of hospital readmission has been linked to insurance status in previous research. A new investigation examines if the disparity still exists.

Impact of insurance status on hospital readmission

A study in postmenarchal youngsters aged from 8 to 19 years found that the levonorgestrel intrauterine device (IUD) is successful in controlling abnormal uterine bleeding and in suppressing menses.

Investigators reviewed the charts of 166 patients who had the devices inserted at some point during a 6-year period for whom follow-up data (from 3 to 60 months after insertion) were available. Some of these patients used the 52-mg IUD and others the 13.5-mg IUD. The IUDs were inserted for contraception, management of heavy menstrual bleeding, and menstrual suppression. Researchers collected data on menstrual history and demographics before and after the devices were inserted.

The overall rate of amenorrhea among participants was 39.8%, with no difference between the patients having the 52-mg IUD and those with the 13.5-mg device. Preinsertion menstrual characteristics, such as regularity and flow of the menstrual cycle or a history of bleeding or of developmental delay, did not have a significant effect on the rate of amenorrhea or bleeding patterns after insertion.

Of the 100 patients who did not experience amenorrhea, 32% reported light vaginal bleeding and 35% reported moderate or heavy vaginal bleeding. Among users who described their cycle as regular before insertion, 28.6% reported spotting, 26.8% said they had light vaginal bleeding, and 44.6% had moderate to heavy bleeding after insertion. These proportions were not significantly different among those who described their cycle as irregular before IUD insertion, although only 23.3% in this group reported moderate to heavy vaginal bleeding later. Complications were rare; no uterine perforations were reported; and only 5.4% expelled the IUD (

. 2020; S1083-3188(20)30223-0. Online ahead of print.

Intrauterine devices have been demonstrated to be safe and effective with results comparable to, or better than, hormone therapy. They are underutilized in teenagers but should be considered an option. If you are uncomfortable placing the device yourself, refer the patient to a gynecologist.

A study finds that the levonorgestrel intrauterine device (IUD) is successful in controlling abnormal uterine bleeding and in suppressing menses in teenagers.

Levonorgestrel IUDs are safe and effective in adolescents

A 16-year-old girl presents for evaluation of a rash on her left forearm (Figure). Two days earlier, she was volunteering in the community, cleaning up a park by clearing plants and placing them in recycling bags, when she experienced sudden onset of a burning sensation on her left forearm associated with 2 enlarging red areas that became increasingly pruritic and edematous. The following day, she developed black macules on her forearm that she was unable to wash off.

Diagnosis: Urushiol dermatitis/”Black-spot” poison ivy

Allergic contact dermatitis as a result of poison ivy, poison oak, and poison sumac is an exceedingly common cause of Type IV hypersensitivity reaction. It results from allergens contained in urushiol, the resinous sap found in the stems, roots, and leaves of plants belonging to the genus 

 This reaction is characterized by a pruritic, erythematous rash, with papules and vesicles often in a linear distribution.

“Black-spot” poison ivy is an uncommon presentation of this common reaction, and as such may cause diagnostic confusion and alarm. Black enamel-like deposits are often seen on the surface of the plants themselves in areas of trauma, and this can be used in the field to identify plants from the genus 

. Leaves crushed between sheets of white paper cause the paper to turn dark brown within minutes and black by 24 hours as a result of oxidation of the urushiol.

 It is thought that this reaction occurs due to oxidation of concentrated urushiol under certain conditions, and it is reproducible on application of this substance to the skin, initially with black discoloration and after several days developing a lacquer-like appearance. These spots are adherent and cannot be removed.

Interestingly, the resin has the potential to cause dermatitis indefinitely

 and cannot be removed from clothing by washing.

 Histologically, biopsied specimens demonstrate the resin on the surface of the stratum corneum with a neutrophilic infiltrate and areas of epidermal necrosis beneath it (in contrast to the typical presentation of poison-ivy dermatitis without black discoloration, in which biopsy reveals superficial perivascular infiltration with no evidence of resin and no associated necrosis). This suggests both an irritant and allergic contact dermatitis.

There have been several case series of such “black-spot” poison ivy dermatitis,

 with patients often initially presenting concerned about more serious pathology, including melanoma. Treatment mirrors that as for classic contact dermatitis and includes topical steroids and oral antihistamines with the addition of oral steroids only as needed in extensive cases or those that involve the face or groin.

The patient was advised of the diagnosis and treated with triamcinolone 0.1% topical ointment, with topical mupirocin for any open areas. The following day, after a swim meet, she re-presented to the emergency department with new red raised eruptions around her eyes and neck, likely from contact with her arm or a delayed eruption from the original contact. She was treated with oral prednisone and did not require further follow-up.

Kim Y, Flamm A, ElSohly MA, et al. Poison ivy, oak, and sumac dermatitis: What is known and what is new?. 

Guin JD. The black spot test for recognizing poison ivy and related species. 

Mallory SB, Miller OF 3dU, Tyler WB. Toxicodendron radicans dermatitis with black lacquer deposit on the skin. 

Goldstein N. The ubiquitous urushiols contact dermatitis from mango, poison ivy, and other "poison" plants. 1968. 

Kurlan JG, Lucky AW. Black spot poison ivy: a report of 5 cases and a review of the literature. 

Hurwitz RM, Rivera HP, Guin JD. Black-spot poison ivy dermatitis. An acute irritant contact dermatitis superimposed upon an allergic contact dermatitis. 

A 16-year-old girl presents for evaluation of a rash on her left forearm, which was 2 enlarging red areas that became increasingly pruritic and edematous. What's the diagnosis?

Itchy black spots: Poison ivy or something else?

Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

Few things seem more like typical childhood than time spent with a dog. Life with a dog has been shown to have a number of benefits for children and a new 

 suggests that time spent with a dog could improve social and emotion development.

Investigators asked 1646 parents with preschoolers if their families owned a dog as well as how frequently the child went on the family dog walk or played with the dog. A parent-report version of the Strengths and Difficulties Questionnaire measured the children’s social-emotional development.

They found that children who were in dog-owning households had a lower likelihood of peer problems, conduct problems, and total difficulties when compared to children who were in households that did not own a dog. Children growing up with dogs also had an increased likelihood of prosocial behavior. An increase in prosocial behaviors was found in households where the child engaged in family dog walking at least 1 time a week and when the child actively played with the dog at least 3 times a week. Additionally, family dog walking at least 1 time a week was linked to reduced likelihood of total difficulties.

The researchers concluded that dog ownership in early childhood was linked to both social-emotional development benefits as well as physical activity benefits. These positives could present in early childhood.

1. Wenden EJ, Lester L, Zubrick SR, Ng M, Christian HR. The relationship between dog ownership, dog play, family dog walking, and pre-schooler social–emotional development: findings from the PLAYCE observational study. 

. July 6, 2020. Epub ahead of print. doi:10.1038/s41390-020-1007-2

Dogs have many benefits for children. An investigation examines how life with a dog may improve emotional development.

Dogs could aid early emotional development

Humans do not have any natural immunity to COVID-19. We do not have an effective antiviral medication for nonhospitalized patients. We do not have a vaccine and may not for at least a year. Perhaps we should optimize the human body’s natural response to infections. To us, that means helping fever do its job.

When the body is invaded by a new germ, it mounts a fever. The fever ramps up our immune system, which is necessary to fight infections.

 All warm-blooded animals get fevers when they have infections. Every aspect of our immune system works better at a higher temperature. Was that a design flaw? Why would our bodies waste energy on something that isn’t helpful?

Dogs, rabbits, mice, ferrets, lizards, fish, and other species have been studied for what happens if we inject them with germs and suppress their fever. They have a higher death rate.

 Humans should be no different. Yet you ask: Are there similar studies on humans?

Research has shown that people with infections who are treated with fever-reducing medicines have symptoms that often are more severe and last longer than those who don’t take antifever medicines.

 These articles on rhinovirus, influenza, chickenpox, and other respiratory infections all showed improved outcomes if the associated fever was not treated. To date, there is no published research that shows treating fevers with antipyretics improves outcomes.

What about fever from vaccines? Two studies looked at what happens if we give prophylactic antipyretics to young children before or immediately after vaccines.

 Both found that antipyretics cause a lower antibody response when measured one month later.

Obviously, our views apply to all viral infections, not just the dangerous one that currently holds center stage. We would suggest health care professionals stop interfering with the human body’s attempt to cure itself. Here’s how we might do that:

Understand that the human body has a thermostat in the hypothalamus that keeps the fever in the optimal range for fighting infections.

Do not treat all fevers with antipyretics (acetaminophen or ibuprofen).

Never treat with combination (dual) antipyretics. It’s one of the main causes of fever phobia, mainly propagated by physicians and nurses.

Keep patients well hydrated so they can easily give off heat by sweating if they need to.

Teach the public that most fevers are good, not bad. Teach that reducing fevers may make you feel better but delay your recovery.

Teach the public that every time we give an antipyretic, we dampen the body’s natural immune response. That’s why the fever always returns when the medicine wears off.

In summary, there is evidence that fever improves outcomes for infections. Of note, there is no evidence to the contrary. Let’s be evidence based.

The human body wants to recover, to survive. Shouldn’t we support that?

Evans SS, Repasky EA, Fisher DT. Fever and the thermal regulation of immunity: The immune system feels the heat. 

Kluger MJ, Ringler DH, Anver MR. Fever and survival. 

Bernheim HA, Kluger MJ. Fever: effect of drug-induced antipyresis on survival. 

Rodbard D. The role of regional body temperature in the pathogenesis of disease. 

Stanley ED, Jackson GG, Panusarn C, Rubenis M, Dirda V. Increased virus shedding with aspirin treatment of rhinovirus infection. 

Doran TF, De Angelis C, Baumgardner RA, Mellits ED. Acetaminophen: more harm than good for chickenpox? 

Graham NM, Burrell CJ, Douglas RM, Debelle P, Davies L. Adverse effects of aspirin, acetaminophen, and ibuprofen on immune function, viral shedding, and clinical status in rhinovirus-infected volunteers. 

Sugimura T, Fujimoto T, Motoyama H, et al. Risks of antipyretics in young children with fever due to infectious disease. 

Schulman CI, Namias N, Doherty J, et al. The effect of antipyretic therapy upon outcomes in critically ill patients: a randomized, prospective study. 

Prymula R, Siegrist CA, Chilbek R, et al. Effect of prophylactic paracetamol administration at time of vaccination on febrile reactions and antibody responses in children: two open-label, randomised controlled trials. 

Li-Kim-Moy J, Wood N, Jones C, Macartney K, Booy R. Impact of fever and antipyretic use on influenza vaccine immune responses in children. 

Most fevers are good, not bad. Here’s why pediatricians should respect fever.

Could fever improve COVID-19 outcomes?

Running a car seat tolerance screening is recommended for every infant born prematurely, but data on the implementation of the screening is limited. An investigation 

 looks at implementation and any variations.

Investigators used the Better Outcomes through Research for Newborns network to reach out to newborn nurseries in 35 states. The staff at the nurseries were asked whether they performed car seat tolerance screenings, inclusion and failure criteria, provider attitudes toward car seat tolerance screenings, performance characteristics, and the follow-up of failed car seat tolerance screenings.

A total of 84 newborn nurseries responded. Roughly 90% of the nurseries did predischarge car seat tolerance screenings. Most common failure criteria included apnea >20 seconds, bradycardia <80 beats per minute, saturation 90%. Over 55% of the nurseries said that hypotonia was an additional inclusion criterion for testing and >34% said they tested any infant who had ever needed supplemental oxygen. Following an initial failed car seat tolerance screening, >93% of the nurseries would retest the car seat at some time in the future and only ~1% would automatically discharge an infant in a car bed. Survey respondents recommended that infants with hypotonia (83%), airway malformations (78%), hemodynamically significant congenital heart disease (63%), and prematurity (61%) as indications for receiving the screening when they were asked who should be given predischarge car seat tolerance screenings.

The researchers said that due to the large variability in implementing predischarge car seat tolerance screenings further guidelines for screening practices could improve the practice.

1. Davis NL, Hoffman BD, Eichenwald EC. Variation in car seat tolerance screen performance in newborn nurseries. 

. 2020:146(1):e20193593. doi:10.1542/peds.2019-3593

Newborn nurseries are supposed to run a car seat tolerance screening before discharging any infant born prematurely. An investigation examines how well nurseries follow this recommendation.

Examining how many nurseries do car seat tolerance screenings

A follow-up visit after hospitalization for bronchiolitis is a typical course of action, frequently because parents appreciate the assurance that a scheduled visit can provide. However, a 

 looks at whether an as-needed follow-up visit can work just as well as the typical scheduled visit.

Investigators ran an open-label noninferiority randomized clinical trial that ran from January 2018 to April 2019. The study assessed children aged younger than 24 months who had been hospitalized for bronchiolitis at either a children’s hospital (Primary Children’s Hospital, Salt Lake City, Utah, and Lucile Packard Children’s Hospital, Palo Alto, California) or a community hospital (Intermountain Riverton Hospital, Riverton, Utah, and Packard El Camino Hospital, Mountain View, California). Parental anxiety at 7 days postdischarge, as measured by the Hospital Anxiety and Depression Scale, was the primary outcome.

There were 304 children included in the study and the primary outcome was available for 269 patients. One hundred and six children in the scheduled follow-up group went to a scheduled posthospitalization visit where 26 children in the as-needed group had such a visit. The average 7-day parental anxiety score was 4.2 among parents with a scheduled visit and 3.9 among parents with as-needed visits. Other than the decreased average number of clinic visits in the as-needed group, no significant difference was seen between the groups in the secondary outcomes, which included symptom duration and hospital readmission.

The researchers concluded that as-needed follow-up visits were noninferior to scheduled follow-up visits when it came to reducing parental anxiety. They believe that their findings show that as-needed follow-up care for bronchiolitis can be an effective strategy for posthospital care.

1. Coon ER, Destino LA, Greene TH, Vukin E, Stoddard G, Schroeder AR. Comparison of as-needed and scheduled posthospitalization follow-up for children hospitalized for bronchiolitis. 

. July 6, 2020. Epub ahead of print. doi:10.1001/jamapediatrics.2020.1937

Scheduled follow-up following hospitalization for bronchiolitis is typical care, but a new report questions whether as-needed care can be just as effective.