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Two-step UTI screening cuts catheterization rate in half
After implementation of a quality improvement initiative to more effectively screen febrile children for urinary tract infections (UTIs) in the emergency department, catheterization rates dropped from 63% to 30% over a 6-month period, a study found.
The sustained drop prevented more than 350 young children from catheterization without increasing revisit rates or missing UTIs in the 39% of children who were followed in the care network. This was in a study that compared catheterization rates in 1,520 children aged 6-24 months in the year before the intervention and 828 children in the 6 months during the intervention.
“Although urine catheterization remains the gold standard in diagnosing UTIs, it is an invasive procedure that may be avoided in most patients who are being screened,” wrote Dr. Jane M. Lavelle of Children’s Hospital of Philadelphia (CHOP) and her associates. UTI screening by this method can be “painful, time consuming, and costly,” they added (Pediatrics. 2016 June 2. doi: 10.1542/peds.2015-3023).
An alternative method to automatic catheterization is a two-step process already included as an option in American Academy of Pediatrics guidelines: Instead of collecting urine through catheterization just once for screening and culture, an emergency department first noninvasively collects urine with a urine bag for screening in those indicated with evidence-based risk factors, and then catheterizes only those who screen positive (Pediatrics. 2011;128[3]:595-610).
“Due to the predictive models’ higher sensitivity than specificity for screening, most urine samples will have a negative screen for pyuria or bacteriuria by urine dipstick or microscopy,” the authors wrote.
At baseline, CHOP’s ED was screening 63% of febrile children under age 24 months using catheterization, but screens were most commonly negative and only 4.3% had positive cultures. The authors therefore initiated a switch to the two-step method as a pilot run in one ED area before educating all ED personnel and expanding to the full department in the second month, using three cycles of Plan-Do-Study-Act protocol.
Children aged 6-24 months comprised approximately 20% of the ED’s more than 90,000 annual patients, and about 22% of these children presented with fever as the primary concern. Children with a history of genitourinary problems or immune deficiency were excluded.
The pilot ran in an “urgent care section of ED where there are typically more children with less complex medical histories and where ‘fever’ is a common complaint,” the investigators said. The staff completed a learning module with assessment and then received in-person and visual reminders of the procedure. Nurse feedback was then used to develop a nursing-specific educational module before expanding the intervention to all ED areas.
While 69% of 828 febrile young children still underwent screening during the 6-month intervention period, only 16% still underwent urethral catheterization as the initial screening step, typically because of strong clinical indications for a UTI. Another 14% underwent catheterization only after a positive urine screen from an initial noninvasive urine collection or because of an inability to get an adequate urine specimen with the bag. The reduction in catheterization dropped to 55% within 2 weeks of the intervention’s start and spread to other hospital departments. The drop to a 30% catheterization rate remained throughout 18 additional months of monitoring.
“Through online education modules, staff meetings, printed and EHR reminders, family involvement, team review of weekly data, individual and group feedback, and nurse scripting, the ED was able to achieve our aim of reducing catheterization rates among febrile young children ages 6-24 months by half over a 6-month period with sustained results,” Dr. Lavelle and her associates reported.
The research did not use external funding, and the researchers reported they had no financial disclosures.
When children are febrile and younger than 24 months old and they go to a pediatric emergency department, a pretty big work-up can be anticipated, taking several hours and including a test for possible UTI.
 |
Dr. Michael E. Pichichero |
In this report from investigators at Children’s Hospital of Philadelphia, we learn the results of a study undertaken to reduce the frequency of bladder catheterization by using a urine bag collection as a screening tool. It worked! Before the study, 63% of 1,520 young children got catheterized, and 4.3% had a UTI. With the screening method, only those with a positive screen for a possible UTI (16% of 828) proceeded to be catheterized, reducing catheterization rates significantly. Only 4.4% of the 69% of children screened by either method had a UTI. So by screening with a bag urine specimen first, many of the children who would have been catheterized did not undergo the procedure.
A hidden gem of information in the study was the length of a visit to the emergency department. The kids were there an average of 4.7 hours whether the provider waited for the bag urine and then catheterized or went straight to the procedure! If only they had gone to their primary care provider, I wonder how much time could have been saved?
Dr. Michael E. Pichichero, a specialist in pediatric infectious diseases, is director of the Research Institute, Rochester (N.Y.) General Hospital. He is also a pediatrician at Legacy Pediatrics in Rochester. Dr. Pichichero said he had no relevant financial disclosures.
When children are febrile and younger than 24 months old and they go to a pediatric emergency department, a pretty big work-up can be anticipated, taking several hours and including a test for possible UTI.
|
Dr. Michael E. Pichichero |
In this report from investigators at Children’s Hospital of Philadelphia, we learn the results of a study undertaken to reduce the frequency of bladder catheterization by using a urine bag collection as a screening tool. It worked! Before the study, 63% of 1,520 young children got catheterized, and 4.3% had a UTI. With the screening method, only those with a positive screen for a possible UTI (16% of 828) proceeded to be catheterized, reducing catheterization rates significantly. Only 4.4% of the 69% of children screened by either method had a UTI. So by screening with a bag urine specimen first, many of the children who would have been catheterized did not undergo the procedure.
A hidden gem of information in the study was the length of a visit to the emergency department. The kids were there an average of 4.7 hours whether the provider waited for the bag urine and then catheterized or went straight to the procedure! If only they had gone to their primary care provider, I wonder how much time could have been saved?
Dr. Michael E. Pichichero, a specialist in pediatric infectious diseases, is director of the Research Institute, Rochester (N.Y.) General Hospital. He is also a pediatrician at Legacy Pediatrics in Rochester. Dr. Pichichero said he had no relevant financial disclosures.
When children are febrile and younger than 24 months old and they go to a pediatric emergency department, a pretty big work-up can be anticipated, taking several hours and including a test for possible UTI.
|
Dr. Michael E. Pichichero |
In this report from investigators at Children’s Hospital of Philadelphia, we learn the results of a study undertaken to reduce the frequency of bladder catheterization by using a urine bag collection as a screening tool. It worked! Before the study, 63% of 1,520 young children got catheterized, and 4.3% had a UTI. With the screening method, only those with a positive screen for a possible UTI (16% of 828) proceeded to be catheterized, reducing catheterization rates significantly. Only 4.4% of the 69% of children screened by either method had a UTI. So by screening with a bag urine specimen first, many of the children who would have been catheterized did not undergo the procedure.
A hidden gem of information in the study was the length of a visit to the emergency department. The kids were there an average of 4.7 hours whether the provider waited for the bag urine and then catheterized or went straight to the procedure! If only they had gone to their primary care provider, I wonder how much time could have been saved?
Dr. Michael E. Pichichero, a specialist in pediatric infectious diseases, is director of the Research Institute, Rochester (N.Y.) General Hospital. He is also a pediatrician at Legacy Pediatrics in Rochester. Dr. Pichichero said he had no relevant financial disclosures.
After implementation of a quality improvement initiative to more effectively screen febrile children for urinary tract infections (UTIs) in the emergency department, catheterization rates dropped from 63% to 30% over a 6-month period, a study found.
The sustained drop prevented more than 350 young children from catheterization without increasing revisit rates or missing UTIs in the 39% of children who were followed in the care network. This was in a study that compared catheterization rates in 1,520 children aged 6-24 months in the year before the intervention and 828 children in the 6 months during the intervention.
“Although urine catheterization remains the gold standard in diagnosing UTIs, it is an invasive procedure that may be avoided in most patients who are being screened,” wrote Dr. Jane M. Lavelle of Children’s Hospital of Philadelphia (CHOP) and her associates. UTI screening by this method can be “painful, time consuming, and costly,” they added (Pediatrics. 2016 June 2. doi: 10.1542/peds.2015-3023).
An alternative method to automatic catheterization is a two-step process already included as an option in American Academy of Pediatrics guidelines: Instead of collecting urine through catheterization just once for screening and culture, an emergency department first noninvasively collects urine with a urine bag for screening in those indicated with evidence-based risk factors, and then catheterizes only those who screen positive (Pediatrics. 2011;128[3]:595-610).
“Due to the predictive models’ higher sensitivity than specificity for screening, most urine samples will have a negative screen for pyuria or bacteriuria by urine dipstick or microscopy,” the authors wrote.
At baseline, CHOP’s ED was screening 63% of febrile children under age 24 months using catheterization, but screens were most commonly negative and only 4.3% had positive cultures. The authors therefore initiated a switch to the two-step method as a pilot run in one ED area before educating all ED personnel and expanding to the full department in the second month, using three cycles of Plan-Do-Study-Act protocol.
Children aged 6-24 months comprised approximately 20% of the ED’s more than 90,000 annual patients, and about 22% of these children presented with fever as the primary concern. Children with a history of genitourinary problems or immune deficiency were excluded.
The pilot ran in an “urgent care section of ED where there are typically more children with less complex medical histories and where ‘fever’ is a common complaint,” the investigators said. The staff completed a learning module with assessment and then received in-person and visual reminders of the procedure. Nurse feedback was then used to develop a nursing-specific educational module before expanding the intervention to all ED areas.
While 69% of 828 febrile young children still underwent screening during the 6-month intervention period, only 16% still underwent urethral catheterization as the initial screening step, typically because of strong clinical indications for a UTI. Another 14% underwent catheterization only after a positive urine screen from an initial noninvasive urine collection or because of an inability to get an adequate urine specimen with the bag. The reduction in catheterization dropped to 55% within 2 weeks of the intervention’s start and spread to other hospital departments. The drop to a 30% catheterization rate remained throughout 18 additional months of monitoring.
“Through online education modules, staff meetings, printed and EHR reminders, family involvement, team review of weekly data, individual and group feedback, and nurse scripting, the ED was able to achieve our aim of reducing catheterization rates among febrile young children ages 6-24 months by half over a 6-month period with sustained results,” Dr. Lavelle and her associates reported.
The research did not use external funding, and the researchers reported they had no financial disclosures.
After implementation of a quality improvement initiative to more effectively screen febrile children for urinary tract infections (UTIs) in the emergency department, catheterization rates dropped from 63% to 30% over a 6-month period, a study found.
The sustained drop prevented more than 350 young children from catheterization without increasing revisit rates or missing UTIs in the 39% of children who were followed in the care network. This was in a study that compared catheterization rates in 1,520 children aged 6-24 months in the year before the intervention and 828 children in the 6 months during the intervention.
“Although urine catheterization remains the gold standard in diagnosing UTIs, it is an invasive procedure that may be avoided in most patients who are being screened,” wrote Dr. Jane M. Lavelle of Children’s Hospital of Philadelphia (CHOP) and her associates. UTI screening by this method can be “painful, time consuming, and costly,” they added (Pediatrics. 2016 June 2. doi: 10.1542/peds.2015-3023).
An alternative method to automatic catheterization is a two-step process already included as an option in American Academy of Pediatrics guidelines: Instead of collecting urine through catheterization just once for screening and culture, an emergency department first noninvasively collects urine with a urine bag for screening in those indicated with evidence-based risk factors, and then catheterizes only those who screen positive (Pediatrics. 2011;128[3]:595-610).
“Due to the predictive models’ higher sensitivity than specificity for screening, most urine samples will have a negative screen for pyuria or bacteriuria by urine dipstick or microscopy,” the authors wrote.
At baseline, CHOP’s ED was screening 63% of febrile children under age 24 months using catheterization, but screens were most commonly negative and only 4.3% had positive cultures. The authors therefore initiated a switch to the two-step method as a pilot run in one ED area before educating all ED personnel and expanding to the full department in the second month, using three cycles of Plan-Do-Study-Act protocol.
Children aged 6-24 months comprised approximately 20% of the ED’s more than 90,000 annual patients, and about 22% of these children presented with fever as the primary concern. Children with a history of genitourinary problems or immune deficiency were excluded.
The pilot ran in an “urgent care section of ED where there are typically more children with less complex medical histories and where ‘fever’ is a common complaint,” the investigators said. The staff completed a learning module with assessment and then received in-person and visual reminders of the procedure. Nurse feedback was then used to develop a nursing-specific educational module before expanding the intervention to all ED areas.
While 69% of 828 febrile young children still underwent screening during the 6-month intervention period, only 16% still underwent urethral catheterization as the initial screening step, typically because of strong clinical indications for a UTI. Another 14% underwent catheterization only after a positive urine screen from an initial noninvasive urine collection or because of an inability to get an adequate urine specimen with the bag. The reduction in catheterization dropped to 55% within 2 weeks of the intervention’s start and spread to other hospital departments. The drop to a 30% catheterization rate remained throughout 18 additional months of monitoring.
“Through online education modules, staff meetings, printed and EHR reminders, family involvement, team review of weekly data, individual and group feedback, and nurse scripting, the ED was able to achieve our aim of reducing catheterization rates among febrile young children ages 6-24 months by half over a 6-month period with sustained results,” Dr. Lavelle and her associates reported.
The research did not use external funding, and the researchers reported they had no financial disclosures.
FROM PEDIATRICS
Key clinical point: Use of a two-step UTI screening process reduced unnecessary catheterizations by half.
Major finding: The ED catheterization rate in febrile children suspected of a UTI dropped from 63% to 30% over a 6-month period.
Data source: An assessment of a quality improvement initiative in the Children’s Hospital of Philadelphia ED that compared catheterization rates in 1,520 children aged 6-24 months in the year before the intervention and 828 children in the 6 months during the intervention.
Disclosures: The research did not use external funding, and the researchers reported they had no financial disclosures.
Advocate for RNs in schools, AAP says in policy statement
Advocate for having full-time registered nurses (RNs) in local schools, and work to establish ongoing two-way communication and a more collaborative partnership between patients’ schools and medical homes: This is what the American Academy of Pediatrics wants pediatricians to do, according to its recommendations in a new policy statement.
“School nurses, working with pediatric patient-centered medical homes, school physicians, and families, are in a critical position to identify unmet health needs of large populations of children and adolescents in the school setting,” wrote the AAP Council on School Health Executive Committee. “Promoting the presence of a qualified school nurse in every school and a school physician in every district fosters the close interdependent relationship between health and education” (Pediatrics. 2016 May; 137(6):e20160852).
The Council noted that academic achievement, attendance, and graduation rates all can improve when children’s medical, family, and educational homes work together and recognize the inseparable link between good health and learning. Since the first U.S. school nurse appointment in 1902 dramatically reduced absenteeism, the position has become more common and even standard throughout most of the United States. Along with the increase of school nurses has been growth in their responsibilities, ranging from chronic disease management and emergency preparedness to behavioral health assessment and ongoing health education.
“I think as a society that having kids with lots and lots of different chronic health conditions in schools without medical care is horrifying,” said Dr. Breena Welch Holmes, a clinical associate professor of pediatrics at the University of Vermont, Burlington, and one of the lead authors of the statement. One goal of the policy statement is to ensure educators, administrators, and pediatricians recognize the role they can play in improving school health. “It’s the first time in a long time in my career that health has something to offer education that’s concrete,” she said.
The need for a school nurse in each school has become especially critical now that legal changes guarantee access to education for all students, including those with disabilities who often need ongoing case management. In addition, survival rates of extremely preterm infants have increased dramatically, and chronic illnesses such as food allergies, obesity, and type 1 and type 2 diabetes, have been increasing.
“As the number of students with chronic conditions grows, the need for health care at school has increased,” the Council wrote. “The rise in enrollment of students with special health care needs increases the need for school nurses and school health services.”
In addition, school has become a safety net for students with chronic illnesses, said Anne Sheetz, MPH, RN, former director of School Health Services at the Massachusetts Department of Public Health, Boston, and the other lead author of the policy statement. Even for students without chronic illnesses, the implications of not having a registered nurse on site are troubling, she said.
“Children don’t schedule their emergencies when the nurse is there,” she said, adding that it really needs to be a registered nurse, not simply a licensed practical nurse or aide.
Many families face barriers to health care access on their own, and increased awareness about behavioral and mental health issues among children and adolescents means school nurses can play a critical role in screening and referrals.
“School nurse offices and school nurses are a social and emotional support for the students,” Dr. Holmes noted. “It’s the place you go without stigma when you can’t quite get yourself to your next class or you’re an elementary school kid who has experienced all sorts of trauma or chaos or doesn’t have a coat for recess.”
Four recommendations
The policy statement emphasizes four recommendations, starting with pediatricians’ advocacy for having at least one full-time professional school nurse in every community school, as well as a school physician assigned to the overall district to provide medical oversight for the nurses.
“We’ve already established that school nurses can save schools money,” Ms. Sheetz said. One study found “for every $1 spent on school nurses, $2.20 was saved in teacher time, parent loss of work time, and treatments done in the school setting versus the clinical setting.”
The second recommendation encourages pediatricians to ask their patients about issues related to school at each visit, such as whether a health or medical problem is causing them to miss school. Pediatricians can then provide this information to the school under the Meaningful Use guidelines for sharing electronic health records. Some doctors and school nurses may hesitate to share information that could inadvertently violate Health Insurance Portability and Accountability Act (HIPAA) or Family Educational Rights and Privacy Act (FERPA) laws. Dr. Holmes recommends getting the necessary permission forms signed at the start of the year.
“As part of the obtaining school health information from parents, school nurses get parental permission for information sharing,” she said. “Also, pediatricians have parents sign consent [forms] to talk with school nurses about children with chronic health conditions.”
The first and second recommendations lead to the third: establish a working relationship with school nurses to help manage students’ chronic health conditions. Such a relationship would include standardized communication, permission, and information forms, which can help when developing Individualized Health Care Plans.
Finally, the AAP recommends that pediatricians include nurses as part of the health care delivery team for children and teens, working toward designing integrated health systems with school-based health centers.
Intimidated by the idea of community advocacy or implementing these other recommendations? Dr. Holmes said the first step is to learn about the community.
“We want pediatricians to know where their patients go to school, and then we want them to know if that school has a nurse,” Dr. Holmes said. “Then they can decide where their advocacy best fits, but it often best fits at the school board.”
One next step might be asking the district to form a school health advisory committee, with at least one local pediatrician member, if one doesn’t exist, Ms. Sheetz said. She described a variety of ways that communication systems could be set up and listed the various tasks that school nurses can do to help pediatricians understand what’s happening at local schools, such as in-school screenings.
“The best model is for a school district to have a school physician who coordinates with school nurses to assure communication with community pediatricians, including creating communication expectations,” Dr. Holmes added. “Since this model is not common, we encourage pediatricians to know who the nurses are in their district, and to treat them as part of the team.”
Funding or other models
Funding is definitely a serious concern for many districts, but pediatricians can investigate other successful models, such as hospitals or the Department of Health paying for nurses in schools, university programs who “lend” nurses to schools, and programs where pediatric nurses in physician offices share time in schools.
Ms. Sheetz also recommended joining forces with parents who can pressure the district to address health in schools. Parents of children with chronic illnesses often are especially motivated to advocate for better care availability in the school setting.
“The parents have the biggest stake in all of this,” Ms. Sheetz said. “If there’s no school nurse there for an emergency or to manage chronic illnesses or to respond to an emotional issue, it’s the parent and child that gets hurt.”
I look at this policy statement as representing the ideal situation, and the ideal situation would be absolutely the best scenario, to have a registered nurse in each school. I view the school nurse as a very important part of the team, but there is the theoretical perspective and then there is the real perspective when it comes to school boards and administrators finding ways to include registered nurses into annual budgets. In the ideal, this is great, but in reality, it cannot be achieved across the board, so it’s important to look at what’s economically feasible within each community.
Whether or not pediatricians can be visible, vocal advocates would depend on the community size, structure, the number of schools in a district or the number of school districts within a system, and the number of community pediatricians available and willing to be advocate for such. It may work in some communities, and in others, it would be like throwing a pebble into the ocean. Most active pediatricians must consider time and productivity in caring for and keeping well the patients coming into their offices. Sadly, many school systems have inadequate funds for teachers, technologies, and supplies, and too many school administrators are focused on test scores.
 |
Dr. Lillian M. Beard |
It is, however, very important that schools think more about student health and how it aligns with student achievement, and for every school to have a trained person on staff to handle students’ health needs. An RN would be ideal, but cost alone may make that requirement infeasible in large metro areas. It depends on the economics of a school or school district or in the community. Many alternatives that can fill that role, such as a licensed practical nurse or a certified medical assistant. In addition, telemedicine has made it easier for a well-trained school health aide to report to and get direct guidance from a physician. Physicians also can make rounds at schools using telemedicine.
Dr. Lillian M. Beard made these comments in a phone conversation that has been condensed. Dr. Beard is a private practice pediatrician in Silver Spring, Md., and an associate clinical professor of pediatrics at George Washington University in Washington. Dr. Beard said she has no relevant disclosures.
I look at this policy statement as representing the ideal situation, and the ideal situation would be absolutely the best scenario, to have a registered nurse in each school. I view the school nurse as a very important part of the team, but there is the theoretical perspective and then there is the real perspective when it comes to school boards and administrators finding ways to include registered nurses into annual budgets. In the ideal, this is great, but in reality, it cannot be achieved across the board, so it’s important to look at what’s economically feasible within each community.
Whether or not pediatricians can be visible, vocal advocates would depend on the community size, structure, the number of schools in a district or the number of school districts within a system, and the number of community pediatricians available and willing to be advocate for such. It may work in some communities, and in others, it would be like throwing a pebble into the ocean. Most active pediatricians must consider time and productivity in caring for and keeping well the patients coming into their offices. Sadly, many school systems have inadequate funds for teachers, technologies, and supplies, and too many school administrators are focused on test scores.
|
Dr. Lillian M. Beard |
It is, however, very important that schools think more about student health and how it aligns with student achievement, and for every school to have a trained person on staff to handle students’ health needs. An RN would be ideal, but cost alone may make that requirement infeasible in large metro areas. It depends on the economics of a school or school district or in the community. Many alternatives that can fill that role, such as a licensed practical nurse or a certified medical assistant. In addition, telemedicine has made it easier for a well-trained school health aide to report to and get direct guidance from a physician. Physicians also can make rounds at schools using telemedicine.
Dr. Lillian M. Beard made these comments in a phone conversation that has been condensed. Dr. Beard is a private practice pediatrician in Silver Spring, Md., and an associate clinical professor of pediatrics at George Washington University in Washington. Dr. Beard said she has no relevant disclosures.
I look at this policy statement as representing the ideal situation, and the ideal situation would be absolutely the best scenario, to have a registered nurse in each school. I view the school nurse as a very important part of the team, but there is the theoretical perspective and then there is the real perspective when it comes to school boards and administrators finding ways to include registered nurses into annual budgets. In the ideal, this is great, but in reality, it cannot be achieved across the board, so it’s important to look at what’s economically feasible within each community.
Whether or not pediatricians can be visible, vocal advocates would depend on the community size, structure, the number of schools in a district or the number of school districts within a system, and the number of community pediatricians available and willing to be advocate for such. It may work in some communities, and in others, it would be like throwing a pebble into the ocean. Most active pediatricians must consider time and productivity in caring for and keeping well the patients coming into their offices. Sadly, many school systems have inadequate funds for teachers, technologies, and supplies, and too many school administrators are focused on test scores.
|
Dr. Lillian M. Beard |
It is, however, very important that schools think more about student health and how it aligns with student achievement, and for every school to have a trained person on staff to handle students’ health needs. An RN would be ideal, but cost alone may make that requirement infeasible in large metro areas. It depends on the economics of a school or school district or in the community. Many alternatives that can fill that role, such as a licensed practical nurse or a certified medical assistant. In addition, telemedicine has made it easier for a well-trained school health aide to report to and get direct guidance from a physician. Physicians also can make rounds at schools using telemedicine.
Dr. Lillian M. Beard made these comments in a phone conversation that has been condensed. Dr. Beard is a private practice pediatrician in Silver Spring, Md., and an associate clinical professor of pediatrics at George Washington University in Washington. Dr. Beard said she has no relevant disclosures.
Advocate for having full-time registered nurses (RNs) in local schools, and work to establish ongoing two-way communication and a more collaborative partnership between patients’ schools and medical homes: This is what the American Academy of Pediatrics wants pediatricians to do, according to its recommendations in a new policy statement.
“School nurses, working with pediatric patient-centered medical homes, school physicians, and families, are in a critical position to identify unmet health needs of large populations of children and adolescents in the school setting,” wrote the AAP Council on School Health Executive Committee. “Promoting the presence of a qualified school nurse in every school and a school physician in every district fosters the close interdependent relationship between health and education” (Pediatrics. 2016 May; 137(6):e20160852).
The Council noted that academic achievement, attendance, and graduation rates all can improve when children’s medical, family, and educational homes work together and recognize the inseparable link between good health and learning. Since the first U.S. school nurse appointment in 1902 dramatically reduced absenteeism, the position has become more common and even standard throughout most of the United States. Along with the increase of school nurses has been growth in their responsibilities, ranging from chronic disease management and emergency preparedness to behavioral health assessment and ongoing health education.
“I think as a society that having kids with lots and lots of different chronic health conditions in schools without medical care is horrifying,” said Dr. Breena Welch Holmes, a clinical associate professor of pediatrics at the University of Vermont, Burlington, and one of the lead authors of the statement. One goal of the policy statement is to ensure educators, administrators, and pediatricians recognize the role they can play in improving school health. “It’s the first time in a long time in my career that health has something to offer education that’s concrete,” she said.
The need for a school nurse in each school has become especially critical now that legal changes guarantee access to education for all students, including those with disabilities who often need ongoing case management. In addition, survival rates of extremely preterm infants have increased dramatically, and chronic illnesses such as food allergies, obesity, and type 1 and type 2 diabetes, have been increasing.
“As the number of students with chronic conditions grows, the need for health care at school has increased,” the Council wrote. “The rise in enrollment of students with special health care needs increases the need for school nurses and school health services.”
In addition, school has become a safety net for students with chronic illnesses, said Anne Sheetz, MPH, RN, former director of School Health Services at the Massachusetts Department of Public Health, Boston, and the other lead author of the policy statement. Even for students without chronic illnesses, the implications of not having a registered nurse on site are troubling, she said.
“Children don’t schedule their emergencies when the nurse is there,” she said, adding that it really needs to be a registered nurse, not simply a licensed practical nurse or aide.
Many families face barriers to health care access on their own, and increased awareness about behavioral and mental health issues among children and adolescents means school nurses can play a critical role in screening and referrals.
“School nurse offices and school nurses are a social and emotional support for the students,” Dr. Holmes noted. “It’s the place you go without stigma when you can’t quite get yourself to your next class or you’re an elementary school kid who has experienced all sorts of trauma or chaos or doesn’t have a coat for recess.”
Four recommendations
The policy statement emphasizes four recommendations, starting with pediatricians’ advocacy for having at least one full-time professional school nurse in every community school, as well as a school physician assigned to the overall district to provide medical oversight for the nurses.
“We’ve already established that school nurses can save schools money,” Ms. Sheetz said. One study found “for every $1 spent on school nurses, $2.20 was saved in teacher time, parent loss of work time, and treatments done in the school setting versus the clinical setting.”
The second recommendation encourages pediatricians to ask their patients about issues related to school at each visit, such as whether a health or medical problem is causing them to miss school. Pediatricians can then provide this information to the school under the Meaningful Use guidelines for sharing electronic health records. Some doctors and school nurses may hesitate to share information that could inadvertently violate Health Insurance Portability and Accountability Act (HIPAA) or Family Educational Rights and Privacy Act (FERPA) laws. Dr. Holmes recommends getting the necessary permission forms signed at the start of the year.
“As part of the obtaining school health information from parents, school nurses get parental permission for information sharing,” she said. “Also, pediatricians have parents sign consent [forms] to talk with school nurses about children with chronic health conditions.”
The first and second recommendations lead to the third: establish a working relationship with school nurses to help manage students’ chronic health conditions. Such a relationship would include standardized communication, permission, and information forms, which can help when developing Individualized Health Care Plans.
Finally, the AAP recommends that pediatricians include nurses as part of the health care delivery team for children and teens, working toward designing integrated health systems with school-based health centers.
Intimidated by the idea of community advocacy or implementing these other recommendations? Dr. Holmes said the first step is to learn about the community.
“We want pediatricians to know where their patients go to school, and then we want them to know if that school has a nurse,” Dr. Holmes said. “Then they can decide where their advocacy best fits, but it often best fits at the school board.”
One next step might be asking the district to form a school health advisory committee, with at least one local pediatrician member, if one doesn’t exist, Ms. Sheetz said. She described a variety of ways that communication systems could be set up and listed the various tasks that school nurses can do to help pediatricians understand what’s happening at local schools, such as in-school screenings.
“The best model is for a school district to have a school physician who coordinates with school nurses to assure communication with community pediatricians, including creating communication expectations,” Dr. Holmes added. “Since this model is not common, we encourage pediatricians to know who the nurses are in their district, and to treat them as part of the team.”
Funding or other models
Funding is definitely a serious concern for many districts, but pediatricians can investigate other successful models, such as hospitals or the Department of Health paying for nurses in schools, university programs who “lend” nurses to schools, and programs where pediatric nurses in physician offices share time in schools.
Ms. Sheetz also recommended joining forces with parents who can pressure the district to address health in schools. Parents of children with chronic illnesses often are especially motivated to advocate for better care availability in the school setting.
“The parents have the biggest stake in all of this,” Ms. Sheetz said. “If there’s no school nurse there for an emergency or to manage chronic illnesses or to respond to an emotional issue, it’s the parent and child that gets hurt.”
Advocate for having full-time registered nurses (RNs) in local schools, and work to establish ongoing two-way communication and a more collaborative partnership between patients’ schools and medical homes: This is what the American Academy of Pediatrics wants pediatricians to do, according to its recommendations in a new policy statement.
“School nurses, working with pediatric patient-centered medical homes, school physicians, and families, are in a critical position to identify unmet health needs of large populations of children and adolescents in the school setting,” wrote the AAP Council on School Health Executive Committee. “Promoting the presence of a qualified school nurse in every school and a school physician in every district fosters the close interdependent relationship between health and education” (Pediatrics. 2016 May; 137(6):e20160852).
The Council noted that academic achievement, attendance, and graduation rates all can improve when children’s medical, family, and educational homes work together and recognize the inseparable link between good health and learning. Since the first U.S. school nurse appointment in 1902 dramatically reduced absenteeism, the position has become more common and even standard throughout most of the United States. Along with the increase of school nurses has been growth in their responsibilities, ranging from chronic disease management and emergency preparedness to behavioral health assessment and ongoing health education.
“I think as a society that having kids with lots and lots of different chronic health conditions in schools without medical care is horrifying,” said Dr. Breena Welch Holmes, a clinical associate professor of pediatrics at the University of Vermont, Burlington, and one of the lead authors of the statement. One goal of the policy statement is to ensure educators, administrators, and pediatricians recognize the role they can play in improving school health. “It’s the first time in a long time in my career that health has something to offer education that’s concrete,” she said.
The need for a school nurse in each school has become especially critical now that legal changes guarantee access to education for all students, including those with disabilities who often need ongoing case management. In addition, survival rates of extremely preterm infants have increased dramatically, and chronic illnesses such as food allergies, obesity, and type 1 and type 2 diabetes, have been increasing.
“As the number of students with chronic conditions grows, the need for health care at school has increased,” the Council wrote. “The rise in enrollment of students with special health care needs increases the need for school nurses and school health services.”
In addition, school has become a safety net for students with chronic illnesses, said Anne Sheetz, MPH, RN, former director of School Health Services at the Massachusetts Department of Public Health, Boston, and the other lead author of the policy statement. Even for students without chronic illnesses, the implications of not having a registered nurse on site are troubling, she said.
“Children don’t schedule their emergencies when the nurse is there,” she said, adding that it really needs to be a registered nurse, not simply a licensed practical nurse or aide.
Many families face barriers to health care access on their own, and increased awareness about behavioral and mental health issues among children and adolescents means school nurses can play a critical role in screening and referrals.
“School nurse offices and school nurses are a social and emotional support for the students,” Dr. Holmes noted. “It’s the place you go without stigma when you can’t quite get yourself to your next class or you’re an elementary school kid who has experienced all sorts of trauma or chaos or doesn’t have a coat for recess.”
Four recommendations
The policy statement emphasizes four recommendations, starting with pediatricians’ advocacy for having at least one full-time professional school nurse in every community school, as well as a school physician assigned to the overall district to provide medical oversight for the nurses.
“We’ve already established that school nurses can save schools money,” Ms. Sheetz said. One study found “for every $1 spent on school nurses, $2.20 was saved in teacher time, parent loss of work time, and treatments done in the school setting versus the clinical setting.”
The second recommendation encourages pediatricians to ask their patients about issues related to school at each visit, such as whether a health or medical problem is causing them to miss school. Pediatricians can then provide this information to the school under the Meaningful Use guidelines for sharing electronic health records. Some doctors and school nurses may hesitate to share information that could inadvertently violate Health Insurance Portability and Accountability Act (HIPAA) or Family Educational Rights and Privacy Act (FERPA) laws. Dr. Holmes recommends getting the necessary permission forms signed at the start of the year.
“As part of the obtaining school health information from parents, school nurses get parental permission for information sharing,” she said. “Also, pediatricians have parents sign consent [forms] to talk with school nurses about children with chronic health conditions.”
The first and second recommendations lead to the third: establish a working relationship with school nurses to help manage students’ chronic health conditions. Such a relationship would include standardized communication, permission, and information forms, which can help when developing Individualized Health Care Plans.
Finally, the AAP recommends that pediatricians include nurses as part of the health care delivery team for children and teens, working toward designing integrated health systems with school-based health centers.
Intimidated by the idea of community advocacy or implementing these other recommendations? Dr. Holmes said the first step is to learn about the community.
“We want pediatricians to know where their patients go to school, and then we want them to know if that school has a nurse,” Dr. Holmes said. “Then they can decide where their advocacy best fits, but it often best fits at the school board.”
One next step might be asking the district to form a school health advisory committee, with at least one local pediatrician member, if one doesn’t exist, Ms. Sheetz said. She described a variety of ways that communication systems could be set up and listed the various tasks that school nurses can do to help pediatricians understand what’s happening at local schools, such as in-school screenings.
“The best model is for a school district to have a school physician who coordinates with school nurses to assure communication with community pediatricians, including creating communication expectations,” Dr. Holmes added. “Since this model is not common, we encourage pediatricians to know who the nurses are in their district, and to treat them as part of the team.”
Funding or other models
Funding is definitely a serious concern for many districts, but pediatricians can investigate other successful models, such as hospitals or the Department of Health paying for nurses in schools, university programs who “lend” nurses to schools, and programs where pediatric nurses in physician offices share time in schools.
Ms. Sheetz also recommended joining forces with parents who can pressure the district to address health in schools. Parents of children with chronic illnesses often are especially motivated to advocate for better care availability in the school setting.
“The parents have the biggest stake in all of this,” Ms. Sheetz said. “If there’s no school nurse there for an emergency or to manage chronic illnesses or to respond to an emotional issue, it’s the parent and child that gets hurt.”
FROM PEDIATRICS
Insulin timing of diabetic mothers influences preemie outcomes
Extremely preterm infants born to diabetic mothers starting insulin before pregnancy faced a greater risk of microcephaly, birth defects, necrotizing enterocolitis (NEC), and late-onset sepsis, compared with extremely preterm infants whose mothers started insulin during pregnancy or who didn’t need insulin, found a recent study.
“Importantly, however, no differences in neurodevelopmental outcomes at 18-22 months were observed between the groups,” reported Nansi S. Boghossian, Ph.D., of the University of South Carolina, Columbia, and her associates online (Pediatrics. 2016 May 13. doi: 10.1542/peds.2015-3424).
The researchers compared outcomes among 10,781 infants born at 22-28 weeks’ gestation and either born or cared for at any one of 24 Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers between 2006 and 2011. Of these infants, 5% had mothers with insulin-dependent diabetes, who were divided based on when they began insulin treatment. After excluding the 29 cases lacking data on insulin initiation, 58% of the infants had mothers who began taking insulin before pregnancy, and 36% began insulin treatment during pregnancy.
Among the 26% of infants who died, the risk of death was similar between those born to mothers without insulin-dependent diabetes and those born to mothers who started insulin before pregnancy. Compared with the 18% mortality in infants born to mothers starting insulin during pregnancy, however, the 27% whose mothers started before pregnancy had a narrowly significant 33% greater risk of death (relative risk = 1.33; P = .054).
The researchers also assessed morbidity for the 89% of infants who survived at least 12 hours after birth. Children of mothers starting insulin before pregnancy had a 55% greater likelihood of necrotizing enterocolitis and a 26% greater risk of late-onset sepsis (RR = 1.55, RR = 1.26), compared with newborns of mothers not needing insulin. The increased NEC risk “might be due to higher polycythemia rates among these infants,” the authors suggested. Compared with babies whose mothers started insulin during pregnancy, increased risk of NEC or late-onset sepsis among those born to mothers who took insulin before pregnancy did not reach significance. However, results were significant for the latter’s 45% greater risk of death within 12 hours or NEC, and 35% greater risk for death within 3 days or late-onset sepsis.
Within the first 28 days of hospitalization, retinopathy of prematurity occurred in 57% of infants whose mothers began insulin pre-pregnancy and in 49% of those whose mothers started insulin during pregnancy, translating to a 23% increased risk for the former group. However, incidence of patent ductus arteriosus, early-onset sepsis, intraventricular hemorrhage, periventricular leukomalacia, or bronchopulmonary dysplasia was not significantly different across all three groups, nor was a composite risk of morbidity and death.
Average head circumference z scores at 36 weeks post-menstrual age were greater for those born to mothers starting insulin before pregnancy, compared with the other two groups. Similarly, microcephaly occurred among 25% of the former and 18% of mothers not needing insulin (P = .003). At 18-22 months corrected age, 7% of children whose mothers started insulin before pregnancy had birth defects, compared with none of those whose mothers started during pregnancy and 2% of those whose mothers didn’t need insulin.
“The etiology of diabetes might differ based on the timing of insulin use,” the authors noted, pointing out that women starting insulin before pregnancy likely had type 1 or type 2 diabetes whereas only type 2 diabetes or gestational diabetes would probably occur among those starting insulin during pregnancy.
The research was funded by the National Institutes of Health. The authors reported they had no disclosures.
Extremely preterm infants born to diabetic mothers starting insulin before pregnancy faced a greater risk of microcephaly, birth defects, necrotizing enterocolitis (NEC), and late-onset sepsis, compared with extremely preterm infants whose mothers started insulin during pregnancy or who didn’t need insulin, found a recent study.
“Importantly, however, no differences in neurodevelopmental outcomes at 18-22 months were observed between the groups,” reported Nansi S. Boghossian, Ph.D., of the University of South Carolina, Columbia, and her associates online (Pediatrics. 2016 May 13. doi: 10.1542/peds.2015-3424).
The researchers compared outcomes among 10,781 infants born at 22-28 weeks’ gestation and either born or cared for at any one of 24 Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers between 2006 and 2011. Of these infants, 5% had mothers with insulin-dependent diabetes, who were divided based on when they began insulin treatment. After excluding the 29 cases lacking data on insulin initiation, 58% of the infants had mothers who began taking insulin before pregnancy, and 36% began insulin treatment during pregnancy.
Among the 26% of infants who died, the risk of death was similar between those born to mothers without insulin-dependent diabetes and those born to mothers who started insulin before pregnancy. Compared with the 18% mortality in infants born to mothers starting insulin during pregnancy, however, the 27% whose mothers started before pregnancy had a narrowly significant 33% greater risk of death (relative risk = 1.33; P = .054).
The researchers also assessed morbidity for the 89% of infants who survived at least 12 hours after birth. Children of mothers starting insulin before pregnancy had a 55% greater likelihood of necrotizing enterocolitis and a 26% greater risk of late-onset sepsis (RR = 1.55, RR = 1.26), compared with newborns of mothers not needing insulin. The increased NEC risk “might be due to higher polycythemia rates among these infants,” the authors suggested. Compared with babies whose mothers started insulin during pregnancy, increased risk of NEC or late-onset sepsis among those born to mothers who took insulin before pregnancy did not reach significance. However, results were significant for the latter’s 45% greater risk of death within 12 hours or NEC, and 35% greater risk for death within 3 days or late-onset sepsis.
Within the first 28 days of hospitalization, retinopathy of prematurity occurred in 57% of infants whose mothers began insulin pre-pregnancy and in 49% of those whose mothers started insulin during pregnancy, translating to a 23% increased risk for the former group. However, incidence of patent ductus arteriosus, early-onset sepsis, intraventricular hemorrhage, periventricular leukomalacia, or bronchopulmonary dysplasia was not significantly different across all three groups, nor was a composite risk of morbidity and death.
Average head circumference z scores at 36 weeks post-menstrual age were greater for those born to mothers starting insulin before pregnancy, compared with the other two groups. Similarly, microcephaly occurred among 25% of the former and 18% of mothers not needing insulin (P = .003). At 18-22 months corrected age, 7% of children whose mothers started insulin before pregnancy had birth defects, compared with none of those whose mothers started during pregnancy and 2% of those whose mothers didn’t need insulin.
“The etiology of diabetes might differ based on the timing of insulin use,” the authors noted, pointing out that women starting insulin before pregnancy likely had type 1 or type 2 diabetes whereas only type 2 diabetes or gestational diabetes would probably occur among those starting insulin during pregnancy.
The research was funded by the National Institutes of Health. The authors reported they had no disclosures.
Extremely preterm infants born to diabetic mothers starting insulin before pregnancy faced a greater risk of microcephaly, birth defects, necrotizing enterocolitis (NEC), and late-onset sepsis, compared with extremely preterm infants whose mothers started insulin during pregnancy or who didn’t need insulin, found a recent study.
“Importantly, however, no differences in neurodevelopmental outcomes at 18-22 months were observed between the groups,” reported Nansi S. Boghossian, Ph.D., of the University of South Carolina, Columbia, and her associates online (Pediatrics. 2016 May 13. doi: 10.1542/peds.2015-3424).
The researchers compared outcomes among 10,781 infants born at 22-28 weeks’ gestation and either born or cared for at any one of 24 Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network centers between 2006 and 2011. Of these infants, 5% had mothers with insulin-dependent diabetes, who were divided based on when they began insulin treatment. After excluding the 29 cases lacking data on insulin initiation, 58% of the infants had mothers who began taking insulin before pregnancy, and 36% began insulin treatment during pregnancy.
Among the 26% of infants who died, the risk of death was similar between those born to mothers without insulin-dependent diabetes and those born to mothers who started insulin before pregnancy. Compared with the 18% mortality in infants born to mothers starting insulin during pregnancy, however, the 27% whose mothers started before pregnancy had a narrowly significant 33% greater risk of death (relative risk = 1.33; P = .054).
The researchers also assessed morbidity for the 89% of infants who survived at least 12 hours after birth. Children of mothers starting insulin before pregnancy had a 55% greater likelihood of necrotizing enterocolitis and a 26% greater risk of late-onset sepsis (RR = 1.55, RR = 1.26), compared with newborns of mothers not needing insulin. The increased NEC risk “might be due to higher polycythemia rates among these infants,” the authors suggested. Compared with babies whose mothers started insulin during pregnancy, increased risk of NEC or late-onset sepsis among those born to mothers who took insulin before pregnancy did not reach significance. However, results were significant for the latter’s 45% greater risk of death within 12 hours or NEC, and 35% greater risk for death within 3 days or late-onset sepsis.
Within the first 28 days of hospitalization, retinopathy of prematurity occurred in 57% of infants whose mothers began insulin pre-pregnancy and in 49% of those whose mothers started insulin during pregnancy, translating to a 23% increased risk for the former group. However, incidence of patent ductus arteriosus, early-onset sepsis, intraventricular hemorrhage, periventricular leukomalacia, or bronchopulmonary dysplasia was not significantly different across all three groups, nor was a composite risk of morbidity and death.
Average head circumference z scores at 36 weeks post-menstrual age were greater for those born to mothers starting insulin before pregnancy, compared with the other two groups. Similarly, microcephaly occurred among 25% of the former and 18% of mothers not needing insulin (P = .003). At 18-22 months corrected age, 7% of children whose mothers started insulin before pregnancy had birth defects, compared with none of those whose mothers started during pregnancy and 2% of those whose mothers didn’t need insulin.
“The etiology of diabetes might differ based on the timing of insulin use,” the authors noted, pointing out that women starting insulin before pregnancy likely had type 1 or type 2 diabetes whereas only type 2 diabetes or gestational diabetes would probably occur among those starting insulin during pregnancy.
The research was funded by the National Institutes of Health. The authors reported they had no disclosures.
FROM PEDIATRICS
Key clinical point: Mortality and morbidity, excluding poor neurodevelopment outcomes, were greater among extremely preterm infants whose mothers started insulin before pregnancy.
Major finding: Extremely preterm infants whose mothers began insulin pre-pregnancy had a 33% greater risk of death, compared with those of mothers starting insulin during pregnancy.
Data source: The findings are based on prospectively gathered data on a cohort of 10,781 infants born at 22-28 weeks between 2006 and 2011 and cared for at any of 24 National Institutes of Health network centers.
Disclosures: The research was funded by the National Institutes of Health. The authors reported they had no disclosures.
Study Reaffirms That Maternal Flu Immunization Reduces Infants’ Risk for Flu
Infants born to mothers who received flu immunization during pregnancy were 70% less likely to contract lab-confirmed influenza and 81% less likely to be hospitalized for flu before age 6 months, compared with infants of unimmunized mothers, a study reaffirmed.
Yet just one in ten pregnant women received the vaccine, a proportion that has steadily risen since the 2009-2010 H1N1 flu season.
“The results of this large retrospective study support the conclusions of prospective studies regarding the protective benefit of maternal influenza immunization during pregnancy,” reported Dr. Julie H. Shakib of the University of Utah, Salt Lake City, and her associates (Pediatrics. 2016 May 3. doi: 10.1542/peds.2015-2360). “Interventions that target both healthy pregnant women and those with chronic conditions are needed to increase vaccine uptake,” they wrote.
The researchers analyzed self-reported seasonal influenza immunization uptake in the 245,386 women who gave birth between December 2005 and March 2014 in the Intermountain Healthcare facilities in Utah and Idaho. Although 10% of the women overall received flu vaccinations, just 2.2% of the women who delivered before the 2009-2010 H1N1 pandemic had received them. That number rose after the pandemic to 21% (P < .001). More than half (52%) of the women giving birth during the 2013-2014 flu season reported getting the seasonal flu vaccine.
Among the women’s 249,387 infants, 866 had at least one influenza-like illness (ILI), including 32 born to vaccinated women and 834 born to unvaccinated women. The infants born to women receiving the flu vaccine during pregnancy were 64% less likely to develop an ILI, with illnesses in 1.34 per 1,000 born to vaccinated women and 3.7 per 1,000 born to unvaccinated women (relative risk, 0.36).
The rates of laboratory-confirmed influenza in the 658 children who contracted it were 0.84 per 1,000 children born to vaccinated mothers and 2.83 per 1,000 children born to unvaccinated mothers, translating to a 70% lower risk of flu in those born to vaccinated mothers (RR, 0.30). Similarly, infants born to vaccinated mothers were 81% less likely to be hospitalized for lab-confirmed influenza (RR, 0.19, P = .005). Just 3 of 151 hospitalized infants had been born to mothers who received the flu vaccine, for a rate of 0.13 per 1,000 for children of vaccinated mothers and 0.66 per 1,000 for children of unvaccinated mothers.
Pregnant women with public insurance or no insurance were less likely to report getting the seasonal vaccine than were privately insured women, but those with chronic conditions were more likely to be vaccinated. Uptake also was lower among women with incomes below the federal poverty level and among women living in either rural or frontier areas or in the Urban South or Southwest Intermountain regions.
“The Intermountain Urban South region includes Utah County, 1 of 30 U.S. counties with the largest estimated numbers of unvaccinated children from 1995-2001 CDC National Immunization Surveys (NIS) data,” the authors wrote. “It is possible that factors leading to parental vaccine hesitancy in children may similarly affect pregnant women considering maternal immunization during pregnancy.”
Because of widespread testing for respiratory viruses at Intermountain facilities, the researchers also could determine that flu vaccine receipt among the mothers did not affect incidence of RSV.
“Our study strengthens the evidence that maternal immunization provides passive protection against influenza to infants during the vulnerable period before they are old enough to receive active immunization,” Dr. Shakib and her associates wrote.
The research was funded by the National Institutes of Health, the University of Utah Children’s Health Research Center and the Pediatric Clinical and Translational Scholar Program, the H.A. and Edna Benning Presidential Endowment, and the University of Utah Center for Clinical and Translational Science through the National Center for Research Resources and the National Center for Advancing Translational Sciences. The authors reported no disclosures.
Infants born to mothers who received flu immunization during pregnancy were 70% less likely to contract lab-confirmed influenza and 81% less likely to be hospitalized for flu before age 6 months, compared with infants of unimmunized mothers, a study reaffirmed.
Yet just one in ten pregnant women received the vaccine, a proportion that has steadily risen since the 2009-2010 H1N1 flu season.
“The results of this large retrospective study support the conclusions of prospective studies regarding the protective benefit of maternal influenza immunization during pregnancy,” reported Dr. Julie H. Shakib of the University of Utah, Salt Lake City, and her associates (Pediatrics. 2016 May 3. doi: 10.1542/peds.2015-2360). “Interventions that target both healthy pregnant women and those with chronic conditions are needed to increase vaccine uptake,” they wrote.
The researchers analyzed self-reported seasonal influenza immunization uptake in the 245,386 women who gave birth between December 2005 and March 2014 in the Intermountain Healthcare facilities in Utah and Idaho. Although 10% of the women overall received flu vaccinations, just 2.2% of the women who delivered before the 2009-2010 H1N1 pandemic had received them. That number rose after the pandemic to 21% (P < .001). More than half (52%) of the women giving birth during the 2013-2014 flu season reported getting the seasonal flu vaccine.
Among the women’s 249,387 infants, 866 had at least one influenza-like illness (ILI), including 32 born to vaccinated women and 834 born to unvaccinated women. The infants born to women receiving the flu vaccine during pregnancy were 64% less likely to develop an ILI, with illnesses in 1.34 per 1,000 born to vaccinated women and 3.7 per 1,000 born to unvaccinated women (relative risk, 0.36).
The rates of laboratory-confirmed influenza in the 658 children who contracted it were 0.84 per 1,000 children born to vaccinated mothers and 2.83 per 1,000 children born to unvaccinated mothers, translating to a 70% lower risk of flu in those born to vaccinated mothers (RR, 0.30). Similarly, infants born to vaccinated mothers were 81% less likely to be hospitalized for lab-confirmed influenza (RR, 0.19, P = .005). Just 3 of 151 hospitalized infants had been born to mothers who received the flu vaccine, for a rate of 0.13 per 1,000 for children of vaccinated mothers and 0.66 per 1,000 for children of unvaccinated mothers.
Pregnant women with public insurance or no insurance were less likely to report getting the seasonal vaccine than were privately insured women, but those with chronic conditions were more likely to be vaccinated. Uptake also was lower among women with incomes below the federal poverty level and among women living in either rural or frontier areas or in the Urban South or Southwest Intermountain regions.
“The Intermountain Urban South region includes Utah County, 1 of 30 U.S. counties with the largest estimated numbers of unvaccinated children from 1995-2001 CDC National Immunization Surveys (NIS) data,” the authors wrote. “It is possible that factors leading to parental vaccine hesitancy in children may similarly affect pregnant women considering maternal immunization during pregnancy.”
Because of widespread testing for respiratory viruses at Intermountain facilities, the researchers also could determine that flu vaccine receipt among the mothers did not affect incidence of RSV.
“Our study strengthens the evidence that maternal immunization provides passive protection against influenza to infants during the vulnerable period before they are old enough to receive active immunization,” Dr. Shakib and her associates wrote.
The research was funded by the National Institutes of Health, the University of Utah Children’s Health Research Center and the Pediatric Clinical and Translational Scholar Program, the H.A. and Edna Benning Presidential Endowment, and the University of Utah Center for Clinical and Translational Science through the National Center for Research Resources and the National Center for Advancing Translational Sciences. The authors reported no disclosures.
Infants born to mothers who received flu immunization during pregnancy were 70% less likely to contract lab-confirmed influenza and 81% less likely to be hospitalized for flu before age 6 months, compared with infants of unimmunized mothers, a study reaffirmed.
Yet just one in ten pregnant women received the vaccine, a proportion that has steadily risen since the 2009-2010 H1N1 flu season.
“The results of this large retrospective study support the conclusions of prospective studies regarding the protective benefit of maternal influenza immunization during pregnancy,” reported Dr. Julie H. Shakib of the University of Utah, Salt Lake City, and her associates (Pediatrics. 2016 May 3. doi: 10.1542/peds.2015-2360). “Interventions that target both healthy pregnant women and those with chronic conditions are needed to increase vaccine uptake,” they wrote.
The researchers analyzed self-reported seasonal influenza immunization uptake in the 245,386 women who gave birth between December 2005 and March 2014 in the Intermountain Healthcare facilities in Utah and Idaho. Although 10% of the women overall received flu vaccinations, just 2.2% of the women who delivered before the 2009-2010 H1N1 pandemic had received them. That number rose after the pandemic to 21% (P < .001). More than half (52%) of the women giving birth during the 2013-2014 flu season reported getting the seasonal flu vaccine.
Among the women’s 249,387 infants, 866 had at least one influenza-like illness (ILI), including 32 born to vaccinated women and 834 born to unvaccinated women. The infants born to women receiving the flu vaccine during pregnancy were 64% less likely to develop an ILI, with illnesses in 1.34 per 1,000 born to vaccinated women and 3.7 per 1,000 born to unvaccinated women (relative risk, 0.36).
The rates of laboratory-confirmed influenza in the 658 children who contracted it were 0.84 per 1,000 children born to vaccinated mothers and 2.83 per 1,000 children born to unvaccinated mothers, translating to a 70% lower risk of flu in those born to vaccinated mothers (RR, 0.30). Similarly, infants born to vaccinated mothers were 81% less likely to be hospitalized for lab-confirmed influenza (RR, 0.19, P = .005). Just 3 of 151 hospitalized infants had been born to mothers who received the flu vaccine, for a rate of 0.13 per 1,000 for children of vaccinated mothers and 0.66 per 1,000 for children of unvaccinated mothers.
Pregnant women with public insurance or no insurance were less likely to report getting the seasonal vaccine than were privately insured women, but those with chronic conditions were more likely to be vaccinated. Uptake also was lower among women with incomes below the federal poverty level and among women living in either rural or frontier areas or in the Urban South or Southwest Intermountain regions.
“The Intermountain Urban South region includes Utah County, 1 of 30 U.S. counties with the largest estimated numbers of unvaccinated children from 1995-2001 CDC National Immunization Surveys (NIS) data,” the authors wrote. “It is possible that factors leading to parental vaccine hesitancy in children may similarly affect pregnant women considering maternal immunization during pregnancy.”
Because of widespread testing for respiratory viruses at Intermountain facilities, the researchers also could determine that flu vaccine receipt among the mothers did not affect incidence of RSV.
“Our study strengthens the evidence that maternal immunization provides passive protection against influenza to infants during the vulnerable period before they are old enough to receive active immunization,” Dr. Shakib and her associates wrote.
The research was funded by the National Institutes of Health, the University of Utah Children’s Health Research Center and the Pediatric Clinical and Translational Scholar Program, the H.A. and Edna Benning Presidential Endowment, and the University of Utah Center for Clinical and Translational Science through the National Center for Research Resources and the National Center for Advancing Translational Sciences. The authors reported no disclosures.
FROM PEDIATRICS
Study reaffirms that maternal flu immunization reduces infants’ risk of flu
Infants born to mothers who received flu immunization during pregnancy were 70% less likely to contract lab-confirmed influenza and 81% less likely to be hospitalized for flu before age 6 months, compared with infants of unimmunized mothers, a study reaffirmed.
Yet just one in ten pregnant women received the vaccine, a proportion that has steadily risen since the 2009-2010 H1N1 flu season.
“The results of this large retrospective study support the conclusions of prospective studies regarding the protective benefit of maternal influenza immunization during pregnancy,” reported Dr. Julie H. Shakib of the University of Utah, Salt Lake City, and her associates (Pediatrics. 2016 May 3. doi: 10.1542/peds.2015-2360). “Interventions that target both healthy pregnant women and those with chronic conditions are needed to increase vaccine uptake,” they wrote.
The researchers analyzed self-reported seasonal influenza immunization uptake in the 245,386 women who gave birth between December 2005 and March 2014 in the Intermountain Healthcare facilities in Utah and Idaho. Although 10% of the women overall received flu vaccinations, just 2.2% of the women who delivered before the 2009-2010 H1N1 pandemic had received them. That number rose after the pandemic to 21% (P < .001). More than half (52%) of the women giving birth during the 2013-2014 flu season reported getting the seasonal flu vaccine.
Among the women’s 249,387 infants, 866 had at least one influenza-like illness (ILI), including 32 born to vaccinated women and 834 born to unvaccinated women. The infants born to women receiving the flu vaccine during pregnancy were 64% less likely to develop an ILI, with illnesses in 1.34 per 1,000 born to vaccinated women and 3.7 per 1,000 born to unvaccinated women (relative risk, 0.36).
The rates of laboratory-confirmed influenza in the 658 children who contracted it were 0.84 per 1,000 children born to vaccinated mothers and 2.83 per 1,000 children born to unvaccinated mothers, translating to a 70% lower risk of flu in those born to vaccinated mothers (RR, 0.30). Similarly, infants born to vaccinated mothers were 81% less likely to be hospitalized for lab-confirmed influenza (RR, 0.19, P = .005). Just 3 of 151 hospitalized infants had been born to mothers who received the flu vaccine, for a rate of 0.13 per 1,000 for children of vaccinated mothers and 0.66 per 1,000 for children of unvaccinated mothers.
Pregnant women with public insurance or no insurance were less likely to report getting the seasonal vaccine than were privately insured women, but those with chronic conditions were more likely to be vaccinated. Uptake also was lower among women with incomes below the federal poverty level and among women living in either rural or frontier areas or in the Urban South or Southwest Intermountain regions.
“The Intermountain Urban South region includes Utah County, 1 of 30 U.S. counties with the largest estimated numbers of unvaccinated children from 1995-2001 CDC National Immunization Surveys (NIS) data,” the authors wrote. “It is possible that factors leading to parental vaccine hesitancy in children may similarly affect pregnant women considering maternal immunization during pregnancy.”
Because of widespread testing for respiratory viruses at Intermountain facilities, the researchers also could determine that flu vaccine receipt among the mothers did not affect incidence of RSV.
“Our study strengthens the evidence that maternal immunization provides passive protection against influenza to infants during the vulnerable period before they are old enough to receive active immunization,” Dr. Shakib and her associates wrote.
The research was funded by the National Institutes of Health, the University of Utah Children’s Health Research Center and the Pediatric Clinical and Translational Scholar Program, the H.A. and Edna Benning Presidential Endowment, and the University of Utah Center for Clinical and Translational Science through the National Center for Research Resources and the National Center for Advancing Translational Sciences. The authors reported no disclosures.
Infants born to mothers who received flu immunization during pregnancy were 70% less likely to contract lab-confirmed influenza and 81% less likely to be hospitalized for flu before age 6 months, compared with infants of unimmunized mothers, a study reaffirmed.
Yet just one in ten pregnant women received the vaccine, a proportion that has steadily risen since the 2009-2010 H1N1 flu season.
“The results of this large retrospective study support the conclusions of prospective studies regarding the protective benefit of maternal influenza immunization during pregnancy,” reported Dr. Julie H. Shakib of the University of Utah, Salt Lake City, and her associates (Pediatrics. 2016 May 3. doi: 10.1542/peds.2015-2360). “Interventions that target both healthy pregnant women and those with chronic conditions are needed to increase vaccine uptake,” they wrote.
The researchers analyzed self-reported seasonal influenza immunization uptake in the 245,386 women who gave birth between December 2005 and March 2014 in the Intermountain Healthcare facilities in Utah and Idaho. Although 10% of the women overall received flu vaccinations, just 2.2% of the women who delivered before the 2009-2010 H1N1 pandemic had received them. That number rose after the pandemic to 21% (P < .001). More than half (52%) of the women giving birth during the 2013-2014 flu season reported getting the seasonal flu vaccine.
Among the women’s 249,387 infants, 866 had at least one influenza-like illness (ILI), including 32 born to vaccinated women and 834 born to unvaccinated women. The infants born to women receiving the flu vaccine during pregnancy were 64% less likely to develop an ILI, with illnesses in 1.34 per 1,000 born to vaccinated women and 3.7 per 1,000 born to unvaccinated women (relative risk, 0.36).
The rates of laboratory-confirmed influenza in the 658 children who contracted it were 0.84 per 1,000 children born to vaccinated mothers and 2.83 per 1,000 children born to unvaccinated mothers, translating to a 70% lower risk of flu in those born to vaccinated mothers (RR, 0.30). Similarly, infants born to vaccinated mothers were 81% less likely to be hospitalized for lab-confirmed influenza (RR, 0.19, P = .005). Just 3 of 151 hospitalized infants had been born to mothers who received the flu vaccine, for a rate of 0.13 per 1,000 for children of vaccinated mothers and 0.66 per 1,000 for children of unvaccinated mothers.
Pregnant women with public insurance or no insurance were less likely to report getting the seasonal vaccine than were privately insured women, but those with chronic conditions were more likely to be vaccinated. Uptake also was lower among women with incomes below the federal poverty level and among women living in either rural or frontier areas or in the Urban South or Southwest Intermountain regions.
“The Intermountain Urban South region includes Utah County, 1 of 30 U.S. counties with the largest estimated numbers of unvaccinated children from 1995-2001 CDC National Immunization Surveys (NIS) data,” the authors wrote. “It is possible that factors leading to parental vaccine hesitancy in children may similarly affect pregnant women considering maternal immunization during pregnancy.”
Because of widespread testing for respiratory viruses at Intermountain facilities, the researchers also could determine that flu vaccine receipt among the mothers did not affect incidence of RSV.
“Our study strengthens the evidence that maternal immunization provides passive protection against influenza to infants during the vulnerable period before they are old enough to receive active immunization,” Dr. Shakib and her associates wrote.
The research was funded by the National Institutes of Health, the University of Utah Children’s Health Research Center and the Pediatric Clinical and Translational Scholar Program, the H.A. and Edna Benning Presidential Endowment, and the University of Utah Center for Clinical and Translational Science through the National Center for Research Resources and the National Center for Advancing Translational Sciences. The authors reported no disclosures.
Infants born to mothers who received flu immunization during pregnancy were 70% less likely to contract lab-confirmed influenza and 81% less likely to be hospitalized for flu before age 6 months, compared with infants of unimmunized mothers, a study reaffirmed.
Yet just one in ten pregnant women received the vaccine, a proportion that has steadily risen since the 2009-2010 H1N1 flu season.
“The results of this large retrospective study support the conclusions of prospective studies regarding the protective benefit of maternal influenza immunization during pregnancy,” reported Dr. Julie H. Shakib of the University of Utah, Salt Lake City, and her associates (Pediatrics. 2016 May 3. doi: 10.1542/peds.2015-2360). “Interventions that target both healthy pregnant women and those with chronic conditions are needed to increase vaccine uptake,” they wrote.
The researchers analyzed self-reported seasonal influenza immunization uptake in the 245,386 women who gave birth between December 2005 and March 2014 in the Intermountain Healthcare facilities in Utah and Idaho. Although 10% of the women overall received flu vaccinations, just 2.2% of the women who delivered before the 2009-2010 H1N1 pandemic had received them. That number rose after the pandemic to 21% (P < .001). More than half (52%) of the women giving birth during the 2013-2014 flu season reported getting the seasonal flu vaccine.
Among the women’s 249,387 infants, 866 had at least one influenza-like illness (ILI), including 32 born to vaccinated women and 834 born to unvaccinated women. The infants born to women receiving the flu vaccine during pregnancy were 64% less likely to develop an ILI, with illnesses in 1.34 per 1,000 born to vaccinated women and 3.7 per 1,000 born to unvaccinated women (relative risk, 0.36).
The rates of laboratory-confirmed influenza in the 658 children who contracted it were 0.84 per 1,000 children born to vaccinated mothers and 2.83 per 1,000 children born to unvaccinated mothers, translating to a 70% lower risk of flu in those born to vaccinated mothers (RR, 0.30). Similarly, infants born to vaccinated mothers were 81% less likely to be hospitalized for lab-confirmed influenza (RR, 0.19, P = .005). Just 3 of 151 hospitalized infants had been born to mothers who received the flu vaccine, for a rate of 0.13 per 1,000 for children of vaccinated mothers and 0.66 per 1,000 for children of unvaccinated mothers.
Pregnant women with public insurance or no insurance were less likely to report getting the seasonal vaccine than were privately insured women, but those with chronic conditions were more likely to be vaccinated. Uptake also was lower among women with incomes below the federal poverty level and among women living in either rural or frontier areas or in the Urban South or Southwest Intermountain regions.
“The Intermountain Urban South region includes Utah County, 1 of 30 U.S. counties with the largest estimated numbers of unvaccinated children from 1995-2001 CDC National Immunization Surveys (NIS) data,” the authors wrote. “It is possible that factors leading to parental vaccine hesitancy in children may similarly affect pregnant women considering maternal immunization during pregnancy.”
Because of widespread testing for respiratory viruses at Intermountain facilities, the researchers also could determine that flu vaccine receipt among the mothers did not affect incidence of RSV.
“Our study strengthens the evidence that maternal immunization provides passive protection against influenza to infants during the vulnerable period before they are old enough to receive active immunization,” Dr. Shakib and her associates wrote.
The research was funded by the National Institutes of Health, the University of Utah Children’s Health Research Center and the Pediatric Clinical and Translational Scholar Program, the H.A. and Edna Benning Presidential Endowment, and the University of Utah Center for Clinical and Translational Science through the National Center for Research Resources and the National Center for Advancing Translational Sciences. The authors reported no disclosures.
FROM PEDIATRICS
Key clinical point: Young infants born to mothers receiving the flu vaccine were less likely to develop the flu and serious complications.
Major finding: Infants under 6 months old were 64% less likely to develop influenza-like illness, 70% less likely to develop lab-confirmed flu, and 81% less likely to be hospitalized for flu if born to vaccinated mothers.
Data source: The findings are based on a retrospective cohort study of 245,386 women who gave birth to 249,387 infants between December 2005 and March 2014 in the Intermountain Healthcare facilities in Utah and Idaho.
Disclosures: The research was funded by the National Institutes of Health, the University of Utah Children’s Health Research Center and the Pediatric Clinical and Translational Scholar Program, the H.A. and Edna Benning Presidential Endowment, and the University of Utah Center for Clinical and Translational Science through the National Center for Research Resources and the National Center for Advancing Translational Sciences. The authors reported no disclosures.
No increased suicide risk from atomoxetine in youths with ADHD
Youths who take atomoxetine for attention-deficit/hyperactivity disorder or other mental health conditions do not appear any more likely to attempt or complete suicide than those treated with stimulants alone, a recent study found.
“Our real-world findings should be integrated in treatment decisions that weigh stimulant and atomoxetine effectiveness against their respective side effect profiles, especially considering the demonstrated risk for injury and potential self-harm associated with untreated ADHD itself,” Stephan Linden, Ph.D., of the University of Florida, Gainesville, and his associates reported online (Pediatrics 2016 Apr 26. doi: 10.1542/peds.2015-3199). “Even if general concerns about bias are considered, the observed incidence rates provide assurance regarding a limited potential for clinically significant risk differences.”
The researchers analyzed pediatric administrative health care claims from 26 states using data from the Centers for Medicare & Medicaid Services between 1999 and 2006. The 499,530 patients, aged 5-18 years, were divided into two cohorts based on whether they received atomoxetine as a first-line or second-line treatment for ADHD or a mental health condition commonly treated with atomoxetine or stimulants.
In the first-line cohort of 279,315 patients from 2003 to 2006, the researchers compared the 20% treated with atomoxetine to the 80% who received stimulants. The second-line cohort of 220,215 youths included 26% of patients who initially received stimulants and then switched to or added atomoxetine, each of whom was matched to three patients in the cohort who remained on stimulants alone.
Of the 140 suicide attempts and/or completions in the first-line treatment group, 50 occurred during current stimulant exposure and 47 during former stimulant exposure, compared with 18 during current atomoxetine use and 25 during former atomoxetine use. These numbers translated to rates of 26, 33, 38 and 53 per 100,000 person-years, respectively. No significant increased risk of suicidal events occurred among those receiving atomoxetine, both before and after adjusting for age, calendar year, gender, race/ethnicity, state of residence, reasons for Medicaid eligibility, comorbid diagnoses (mental and nonmental), and number of hospitalizations for any reason.
In the second-line cohort, the 90 suicidal events that occurred included 46 during current stimulant use, 17 during former stimulant use, 11 during current atomoxetine use, and 16 during former atomoxetine use. The unadjusted rates were 32, 22, 29, and 37 per 100,000 person-years, respectively. Again, the hazard ratios before and after adjustment for confounders were not significant (P = .74 and P = .43).
“Statistical power limited our ability to stratify analyses to high-risk groups or long-term users of atomoxetine,” the researchers noted as one limitation, but “the overall small suicidal event rates indicate a small absolute risk increase potential in typical clinical practice.”
The research was supported by the Agency for Healthcare Research and Quality, the National Institutes of Health, and the Mary Kay Owens Healthcare Innovation and the DuBow Family fellowships. The data came from the Centers for Medicaid & Medicare Services. One investigator has previously received research funding from Otsuka and Pfizer and has consulted for Pfizer. No other authors reported relevant financial disclosures.
Youths who take atomoxetine for attention-deficit/hyperactivity disorder or other mental health conditions do not appear any more likely to attempt or complete suicide than those treated with stimulants alone, a recent study found.
“Our real-world findings should be integrated in treatment decisions that weigh stimulant and atomoxetine effectiveness against their respective side effect profiles, especially considering the demonstrated risk for injury and potential self-harm associated with untreated ADHD itself,” Stephan Linden, Ph.D., of the University of Florida, Gainesville, and his associates reported online (Pediatrics 2016 Apr 26. doi: 10.1542/peds.2015-3199). “Even if general concerns about bias are considered, the observed incidence rates provide assurance regarding a limited potential for clinically significant risk differences.”
The researchers analyzed pediatric administrative health care claims from 26 states using data from the Centers for Medicare & Medicaid Services between 1999 and 2006. The 499,530 patients, aged 5-18 years, were divided into two cohorts based on whether they received atomoxetine as a first-line or second-line treatment for ADHD or a mental health condition commonly treated with atomoxetine or stimulants.
In the first-line cohort of 279,315 patients from 2003 to 2006, the researchers compared the 20% treated with atomoxetine to the 80% who received stimulants. The second-line cohort of 220,215 youths included 26% of patients who initially received stimulants and then switched to or added atomoxetine, each of whom was matched to three patients in the cohort who remained on stimulants alone.
Of the 140 suicide attempts and/or completions in the first-line treatment group, 50 occurred during current stimulant exposure and 47 during former stimulant exposure, compared with 18 during current atomoxetine use and 25 during former atomoxetine use. These numbers translated to rates of 26, 33, 38 and 53 per 100,000 person-years, respectively. No significant increased risk of suicidal events occurred among those receiving atomoxetine, both before and after adjusting for age, calendar year, gender, race/ethnicity, state of residence, reasons for Medicaid eligibility, comorbid diagnoses (mental and nonmental), and number of hospitalizations for any reason.
In the second-line cohort, the 90 suicidal events that occurred included 46 during current stimulant use, 17 during former stimulant use, 11 during current atomoxetine use, and 16 during former atomoxetine use. The unadjusted rates were 32, 22, 29, and 37 per 100,000 person-years, respectively. Again, the hazard ratios before and after adjustment for confounders were not significant (P = .74 and P = .43).
“Statistical power limited our ability to stratify analyses to high-risk groups or long-term users of atomoxetine,” the researchers noted as one limitation, but “the overall small suicidal event rates indicate a small absolute risk increase potential in typical clinical practice.”
The research was supported by the Agency for Healthcare Research and Quality, the National Institutes of Health, and the Mary Kay Owens Healthcare Innovation and the DuBow Family fellowships. The data came from the Centers for Medicaid & Medicare Services. One investigator has previously received research funding from Otsuka and Pfizer and has consulted for Pfizer. No other authors reported relevant financial disclosures.
Youths who take atomoxetine for attention-deficit/hyperactivity disorder or other mental health conditions do not appear any more likely to attempt or complete suicide than those treated with stimulants alone, a recent study found.
“Our real-world findings should be integrated in treatment decisions that weigh stimulant and atomoxetine effectiveness against their respective side effect profiles, especially considering the demonstrated risk for injury and potential self-harm associated with untreated ADHD itself,” Stephan Linden, Ph.D., of the University of Florida, Gainesville, and his associates reported online (Pediatrics 2016 Apr 26. doi: 10.1542/peds.2015-3199). “Even if general concerns about bias are considered, the observed incidence rates provide assurance regarding a limited potential for clinically significant risk differences.”
The researchers analyzed pediatric administrative health care claims from 26 states using data from the Centers for Medicare & Medicaid Services between 1999 and 2006. The 499,530 patients, aged 5-18 years, were divided into two cohorts based on whether they received atomoxetine as a first-line or second-line treatment for ADHD or a mental health condition commonly treated with atomoxetine or stimulants.
In the first-line cohort of 279,315 patients from 2003 to 2006, the researchers compared the 20% treated with atomoxetine to the 80% who received stimulants. The second-line cohort of 220,215 youths included 26% of patients who initially received stimulants and then switched to or added atomoxetine, each of whom was matched to three patients in the cohort who remained on stimulants alone.
Of the 140 suicide attempts and/or completions in the first-line treatment group, 50 occurred during current stimulant exposure and 47 during former stimulant exposure, compared with 18 during current atomoxetine use and 25 during former atomoxetine use. These numbers translated to rates of 26, 33, 38 and 53 per 100,000 person-years, respectively. No significant increased risk of suicidal events occurred among those receiving atomoxetine, both before and after adjusting for age, calendar year, gender, race/ethnicity, state of residence, reasons for Medicaid eligibility, comorbid diagnoses (mental and nonmental), and number of hospitalizations for any reason.
In the second-line cohort, the 90 suicidal events that occurred included 46 during current stimulant use, 17 during former stimulant use, 11 during current atomoxetine use, and 16 during former atomoxetine use. The unadjusted rates were 32, 22, 29, and 37 per 100,000 person-years, respectively. Again, the hazard ratios before and after adjustment for confounders were not significant (P = .74 and P = .43).
“Statistical power limited our ability to stratify analyses to high-risk groups or long-term users of atomoxetine,” the researchers noted as one limitation, but “the overall small suicidal event rates indicate a small absolute risk increase potential in typical clinical practice.”
The research was supported by the Agency for Healthcare Research and Quality, the National Institutes of Health, and the Mary Kay Owens Healthcare Innovation and the DuBow Family fellowships. The data came from the Centers for Medicaid & Medicare Services. One investigator has previously received research funding from Otsuka and Pfizer and has consulted for Pfizer. No other authors reported relevant financial disclosures.
FROM PEDIATRICS
Key clinical point: Atomoxetine treatment in youths with ADHD or other mental disorders does not increase suicide risk.
Major finding: Risks of suicide attempts or completions were not significantly different between youths taking atomoxetine, compared with those taking only stimulants.
Data source: The findings are based on a retrospective cohort study of 499,530 youths aged 5-18 years who were treated with either atomoxetine or only stimulants for ADHD or other mental health conditions.
Disclosures: The research was supported by the Agency for Healthcare Research and Quality, the National Institutes of Health, and the Mary Kay Owens Healthcare Innovation and the DuBow Family fellowships. The data came from the Centers for Medicaid & Medicare Services. One investigator has previously received research funding from Otsuka and Pfizer and has consulted for Pfizer. No other authors reported relevant financial disclosures.
Chronic illness associated with lower developmental readiness for school entry
Chronic illnesses such as otitis media, respiratory disease, and epilepsy increase the likelihood that children will be developmentally at risk for difficulties at school entry, a study showed.
The authors’ findings indicated “that chronically poor health in early childhood is a risk for school readiness, over and above the disadvantage conferred by socioeconomic factors,” Megan F. Bell of the University of Western Australia in Perth and her associates reported online (Pediatrics. 2016 April 13. doi: 10.1542/peds.2015-2475). “This increased risk was particularly evident for social and emotional capacities.”
The researchers analyzed developmental school readiness among 22,890 children (average age, 5 years), within the context of having chronic illness. The children were born in Western Australia in 2003-2004, underwent an early development assessment for school readiness in 2009, and did not have special needs, cerebral palsy, or a diagnosed developmental disorder. The assessments’ five domains included physical health and well-being, social competence, emotional maturity, language and cognitive skills, and communication skills and general knowledge. Children were designated “developmentally vulnerable” if they scored in the bottom 10% of a domain and “at risk” if they scored in the bottom 10%-25%. The top 75% were classified as “on track.”
Among 2,879 children with chronic illness, involving 13% of the overall sample, 93% of these children had one chronic illness diagnosis, and 7% had at least two. The most common illnesses were chronic otitis media (71%), chronic respiratory disease (27%), and epilepsy (3%).
Using health and demographic data for 19,227 mothers and 19,030 fathers of the children, the researchers accounted for sociodemographic characteristics of each child, their community, and their parents, including parental chronic illness. After these adjustments, children with a chronic illness were approximately 20%-35% more likely to fall within the vulnerable or at-risk categories in all five developmental domains, compared with their healthier peers. Children with multiple diagnoses, however, were not significantly more likely to be less developmentally ready for school in any of the five domains than their peers with one diagnosis, suggesting that “just one chronic illness is enough to increase a child’s risk for lower school readiness,” the authors wrote.
A 15%-35% increase in the risk of developmental vulnerability was seen in all domains for 1,859 children with a single diagnosis of otitis media and a 24%-45% increase was seen for 618 children with a single diagnosis of respiratory disease. However, there was no significant increase in risk for the 63 children with a diagnosis of epilepsy; all probability values were greater than .05.
“School-based programs targeted at enhancing social and emotional abilities have been shown to lead to improvements in behavioral, social, and academic outcomes,” the authors wrote. “This may therefore be an important focus of intervention for chronically ill children.
“Our findings suggest there is a need to broaden the scope of health conditions eligible for additional support at school entry. For instance, the most prevalent diagnosis was chronic otitis media, a common childhood condition that is associated with delayed language development, reading and spelling difficulties, and auditory processing deficits. Although recurrent ear infections may not be associated with significant limitations in daily activities, our study demonstrated that children with this condition are at increased risk of poor school readiness, even without having a more severe comorbid condition,” Ms. Bell and her associates wrote.
The research was funded by the Australian Research Council Linkage Project. The authors reported no relevant financial disclosures.
Chronic illnesses such as otitis media, respiratory disease, and epilepsy increase the likelihood that children will be developmentally at risk for difficulties at school entry, a study showed.
The authors’ findings indicated “that chronically poor health in early childhood is a risk for school readiness, over and above the disadvantage conferred by socioeconomic factors,” Megan F. Bell of the University of Western Australia in Perth and her associates reported online (Pediatrics. 2016 April 13. doi: 10.1542/peds.2015-2475). “This increased risk was particularly evident for social and emotional capacities.”
The researchers analyzed developmental school readiness among 22,890 children (average age, 5 years), within the context of having chronic illness. The children were born in Western Australia in 2003-2004, underwent an early development assessment for school readiness in 2009, and did not have special needs, cerebral palsy, or a diagnosed developmental disorder. The assessments’ five domains included physical health and well-being, social competence, emotional maturity, language and cognitive skills, and communication skills and general knowledge. Children were designated “developmentally vulnerable” if they scored in the bottom 10% of a domain and “at risk” if they scored in the bottom 10%-25%. The top 75% were classified as “on track.”
Among 2,879 children with chronic illness, involving 13% of the overall sample, 93% of these children had one chronic illness diagnosis, and 7% had at least two. The most common illnesses were chronic otitis media (71%), chronic respiratory disease (27%), and epilepsy (3%).
Using health and demographic data for 19,227 mothers and 19,030 fathers of the children, the researchers accounted for sociodemographic characteristics of each child, their community, and their parents, including parental chronic illness. After these adjustments, children with a chronic illness were approximately 20%-35% more likely to fall within the vulnerable or at-risk categories in all five developmental domains, compared with their healthier peers. Children with multiple diagnoses, however, were not significantly more likely to be less developmentally ready for school in any of the five domains than their peers with one diagnosis, suggesting that “just one chronic illness is enough to increase a child’s risk for lower school readiness,” the authors wrote.
A 15%-35% increase in the risk of developmental vulnerability was seen in all domains for 1,859 children with a single diagnosis of otitis media and a 24%-45% increase was seen for 618 children with a single diagnosis of respiratory disease. However, there was no significant increase in risk for the 63 children with a diagnosis of epilepsy; all probability values were greater than .05.
“School-based programs targeted at enhancing social and emotional abilities have been shown to lead to improvements in behavioral, social, and academic outcomes,” the authors wrote. “This may therefore be an important focus of intervention for chronically ill children.
“Our findings suggest there is a need to broaden the scope of health conditions eligible for additional support at school entry. For instance, the most prevalent diagnosis was chronic otitis media, a common childhood condition that is associated with delayed language development, reading and spelling difficulties, and auditory processing deficits. Although recurrent ear infections may not be associated with significant limitations in daily activities, our study demonstrated that children with this condition are at increased risk of poor school readiness, even without having a more severe comorbid condition,” Ms. Bell and her associates wrote.
The research was funded by the Australian Research Council Linkage Project. The authors reported no relevant financial disclosures.
Chronic illnesses such as otitis media, respiratory disease, and epilepsy increase the likelihood that children will be developmentally at risk for difficulties at school entry, a study showed.
The authors’ findings indicated “that chronically poor health in early childhood is a risk for school readiness, over and above the disadvantage conferred by socioeconomic factors,” Megan F. Bell of the University of Western Australia in Perth and her associates reported online (Pediatrics. 2016 April 13. doi: 10.1542/peds.2015-2475). “This increased risk was particularly evident for social and emotional capacities.”
The researchers analyzed developmental school readiness among 22,890 children (average age, 5 years), within the context of having chronic illness. The children were born in Western Australia in 2003-2004, underwent an early development assessment for school readiness in 2009, and did not have special needs, cerebral palsy, or a diagnosed developmental disorder. The assessments’ five domains included physical health and well-being, social competence, emotional maturity, language and cognitive skills, and communication skills and general knowledge. Children were designated “developmentally vulnerable” if they scored in the bottom 10% of a domain and “at risk” if they scored in the bottom 10%-25%. The top 75% were classified as “on track.”
Among 2,879 children with chronic illness, involving 13% of the overall sample, 93% of these children had one chronic illness diagnosis, and 7% had at least two. The most common illnesses were chronic otitis media (71%), chronic respiratory disease (27%), and epilepsy (3%).
Using health and demographic data for 19,227 mothers and 19,030 fathers of the children, the researchers accounted for sociodemographic characteristics of each child, their community, and their parents, including parental chronic illness. After these adjustments, children with a chronic illness were approximately 20%-35% more likely to fall within the vulnerable or at-risk categories in all five developmental domains, compared with their healthier peers. Children with multiple diagnoses, however, were not significantly more likely to be less developmentally ready for school in any of the five domains than their peers with one diagnosis, suggesting that “just one chronic illness is enough to increase a child’s risk for lower school readiness,” the authors wrote.
A 15%-35% increase in the risk of developmental vulnerability was seen in all domains for 1,859 children with a single diagnosis of otitis media and a 24%-45% increase was seen for 618 children with a single diagnosis of respiratory disease. However, there was no significant increase in risk for the 63 children with a diagnosis of epilepsy; all probability values were greater than .05.
“School-based programs targeted at enhancing social and emotional abilities have been shown to lead to improvements in behavioral, social, and academic outcomes,” the authors wrote. “This may therefore be an important focus of intervention for chronically ill children.
“Our findings suggest there is a need to broaden the scope of health conditions eligible for additional support at school entry. For instance, the most prevalent diagnosis was chronic otitis media, a common childhood condition that is associated with delayed language development, reading and spelling difficulties, and auditory processing deficits. Although recurrent ear infections may not be associated with significant limitations in daily activities, our study demonstrated that children with this condition are at increased risk of poor school readiness, even without having a more severe comorbid condition,” Ms. Bell and her associates wrote.
The research was funded by the Australian Research Council Linkage Project. The authors reported no relevant financial disclosures.
FROM PEDIATRICS
Key clinical point: Chronic illness, including otitis media, is associated with lower developmental readiness for school entry among children.
Major finding: Preschool children with chronic conditions are 20%-35% more likely to be developmentally at risk.
Data source: The findings are based on a cross-sectional cohort analysis of chronic illnesses and developmental assessments for school readiness among 22,890 Western Australian children, with an average age of 5 years.
Disclosures: The research was funded by the Australian Research Council Linkage Project. The authors reported no relevant financial disclosures.
Acute otitis media rates have dropped, but tied to upper respiratory infections
Close to half of all infants have an episode of acute otitis media by age 1 year, but incidence appears to have dropped in the pneumococcal conjugate vaccine era, a recent study found.
“We clearly showed that frequent viral infections, bacterial colonization, and lack of breastfeeding are major acute otitis media (AOM) risk factors,” reported Dr. Tasnee Chonmaitree and her associates at the University of Texas Medical Branch in Galveston (Pediatrics 2016 March 28 doi: 10.1542/peds.2015-3555). “It is likely that medical interventions in the past few decades, such as the use of pneumococcal and influenza virus vaccines, higher breastfeeding rates and decreased smoking, helped reduce AOM incidence.”
Between October 2008 and March 2014, researchers began tracking 367 infants from birth until they experienced their first case of AOM (and then on to age 6 months) or until they reached age 12 months; 85% completed the study. Preterm infants and those with anatomic defects or major medical problems were not included. The researchers collected nasopharyngeal specimens once during each of the first 6 months, once in the child’s 9th month, and during any viral upper respiratory infections to conduct bacterial cultures and viral polymerase chain reactions for 13 respiratory viruses.
During the course of the study, 305 children experienced a total of 887 upper respiratory infections, and 143 children experienced a total of 180 AOM episodes. Upper respiratory infections occurred at a rate of 3.2 episodes per child per year, and lower respiratory infections occurred at a rate of 0.24 episodes per child per year. Clinical sinusitis complications followed 4.6% of the upper respiratory infections, and lower respiratory infections followed 7.6%.
The rate of AOM was 0.67 episodes per child per year. Although only 6% of the infants had experienced AOM by age 3 months, that rose to nearly a quarter (23%) of the children at age 6 months and nearly half (46%) at age 12 months. Still, it remained below the rates of 18% by 3 months and 30%-39% by 6 months that had been reported in the late 1980s and 1990s.
Children who had AOM experienced 4.7 upper respiratory infections per year, compared with 2.3 episodes per year in children without AOM (P less than .002). They also had significantly greater pathogenic bacterial colonization overall and for Haemophilus influenzae and Moraxella catarrhalis, in their monthly nasopharyngeal specimens, although Streptococcus pneumoniae rates were not significantly greater.
“Interestingly, we found that not only viruses increased upper respiratory infection risk; M. catarrhalis and S. pneumoniae also increased upper respiratory infection risk,” the authors wrote “On the other hand, we found better protection for S. pneumoniae (infants born after 2010) associated with decreased upper respiratory infection risk.”
Upper respiratory infections were 74% more likely among children attending day care, and 7% more likely among children with at least one sibling at home. These infections were 37% less likely in children exclusively breastfed at least 6 months, 16% less likely in children born after February 2010, and 4% less likely for each month of any breastfeeding.
Similarly, AOM episodes were 60% less likely in children exclusively breastfed at least 3 months, and 15% less likely for each month children were breastfed.
The research was funded by the National Institutes of Health. The authors reported no disclosures.
Otitis media, or middle ear infection, is one of the most common reasons for office visits to pediatricians, and for outpatient surgery. Indeed, operations to insert ear tubes are the most frequently performed surgical procedures in children in the United States, at more than 500,000 per year. Extensive use of broad-spectrum oral antibiotics in children selects for difficult-to-treat resistant strains of bacteria and alters the normal microbiome of children. Strategies to reduce otitis media in children hold substantial promise in improving child health and reducing the cost of medical care.
Against this backdrop, the data reported in the study by Chonmaitree et al. in the current issue of Pediatrics provide reassurance that we are, indeed, making progress in the fight against otitis media. This study shows that a number of simple interventions can decrease a child’s risk of otitis. Compared with studies of similar design in the late 1980s and early 1990s, the incidence of otitis media was appreciably lower in the current study – compatible with an impact of licensure and implementation of the conjugate pneumococcal vaccine in the 1990s. This study also confirms the risk conferred by cigarette smoke exposure on the incidence of otitis media in children. Finally, and perhaps most importantly, exclusivity of breastfeeding for the first 6 months of life, and total duration of breastfeeding, also had a substantial impact on otitis media. Thus, simple interventions such as ensuring compliance with routine immunization, avoiding cigarette smoke exposure, and encouraging breastfeeding can go a long way in reducing the risk of otitis media.
The study also points out important interactions between viruses that cause infections of the upper respiratory track and pathogenic bacteria that can lead to otitis media. Although we don’t think of otitis media as a viral infection, this study confirms that viruses in fact play a critical role in development of otitis, and antiviral vaccines, such as influenza vaccine, can decrease not only the risk of developing the flu, but also the risk of otitis media and its attendant complications. Future studies of antiviral vaccines will likely further contribute to the progress made in reducing otitis media that this interesting study nicely documents.
These comments were made by Mark R. Schleiss, M.D., professor and division director of pediatric infectious diseases and immunology and the American Legion Endowed Professor of Pediatrics at the University of Minnesota, Minneapolis. Dr. Schleiss had no disclosures.
Otitis media, or middle ear infection, is one of the most common reasons for office visits to pediatricians, and for outpatient surgery. Indeed, operations to insert ear tubes are the most frequently performed surgical procedures in children in the United States, at more than 500,000 per year. Extensive use of broad-spectrum oral antibiotics in children selects for difficult-to-treat resistant strains of bacteria and alters the normal microbiome of children. Strategies to reduce otitis media in children hold substantial promise in improving child health and reducing the cost of medical care.
Against this backdrop, the data reported in the study by Chonmaitree et al. in the current issue of Pediatrics provide reassurance that we are, indeed, making progress in the fight against otitis media. This study shows that a number of simple interventions can decrease a child’s risk of otitis. Compared with studies of similar design in the late 1980s and early 1990s, the incidence of otitis media was appreciably lower in the current study – compatible with an impact of licensure and implementation of the conjugate pneumococcal vaccine in the 1990s. This study also confirms the risk conferred by cigarette smoke exposure on the incidence of otitis media in children. Finally, and perhaps most importantly, exclusivity of breastfeeding for the first 6 months of life, and total duration of breastfeeding, also had a substantial impact on otitis media. Thus, simple interventions such as ensuring compliance with routine immunization, avoiding cigarette smoke exposure, and encouraging breastfeeding can go a long way in reducing the risk of otitis media.
The study also points out important interactions between viruses that cause infections of the upper respiratory track and pathogenic bacteria that can lead to otitis media. Although we don’t think of otitis media as a viral infection, this study confirms that viruses in fact play a critical role in development of otitis, and antiviral vaccines, such as influenza vaccine, can decrease not only the risk of developing the flu, but also the risk of otitis media and its attendant complications. Future studies of antiviral vaccines will likely further contribute to the progress made in reducing otitis media that this interesting study nicely documents.
These comments were made by Mark R. Schleiss, M.D., professor and division director of pediatric infectious diseases and immunology and the American Legion Endowed Professor of Pediatrics at the University of Minnesota, Minneapolis. Dr. Schleiss had no disclosures.
Otitis media, or middle ear infection, is one of the most common reasons for office visits to pediatricians, and for outpatient surgery. Indeed, operations to insert ear tubes are the most frequently performed surgical procedures in children in the United States, at more than 500,000 per year. Extensive use of broad-spectrum oral antibiotics in children selects for difficult-to-treat resistant strains of bacteria and alters the normal microbiome of children. Strategies to reduce otitis media in children hold substantial promise in improving child health and reducing the cost of medical care.
Against this backdrop, the data reported in the study by Chonmaitree et al. in the current issue of Pediatrics provide reassurance that we are, indeed, making progress in the fight against otitis media. This study shows that a number of simple interventions can decrease a child’s risk of otitis. Compared with studies of similar design in the late 1980s and early 1990s, the incidence of otitis media was appreciably lower in the current study – compatible with an impact of licensure and implementation of the conjugate pneumococcal vaccine in the 1990s. This study also confirms the risk conferred by cigarette smoke exposure on the incidence of otitis media in children. Finally, and perhaps most importantly, exclusivity of breastfeeding for the first 6 months of life, and total duration of breastfeeding, also had a substantial impact on otitis media. Thus, simple interventions such as ensuring compliance with routine immunization, avoiding cigarette smoke exposure, and encouraging breastfeeding can go a long way in reducing the risk of otitis media.
The study also points out important interactions between viruses that cause infections of the upper respiratory track and pathogenic bacteria that can lead to otitis media. Although we don’t think of otitis media as a viral infection, this study confirms that viruses in fact play a critical role in development of otitis, and antiviral vaccines, such as influenza vaccine, can decrease not only the risk of developing the flu, but also the risk of otitis media and its attendant complications. Future studies of antiviral vaccines will likely further contribute to the progress made in reducing otitis media that this interesting study nicely documents.
These comments were made by Mark R. Schleiss, M.D., professor and division director of pediatric infectious diseases and immunology and the American Legion Endowed Professor of Pediatrics at the University of Minnesota, Minneapolis. Dr. Schleiss had no disclosures.
Close to half of all infants have an episode of acute otitis media by age 1 year, but incidence appears to have dropped in the pneumococcal conjugate vaccine era, a recent study found.
“We clearly showed that frequent viral infections, bacterial colonization, and lack of breastfeeding are major acute otitis media (AOM) risk factors,” reported Dr. Tasnee Chonmaitree and her associates at the University of Texas Medical Branch in Galveston (Pediatrics 2016 March 28 doi: 10.1542/peds.2015-3555). “It is likely that medical interventions in the past few decades, such as the use of pneumococcal and influenza virus vaccines, higher breastfeeding rates and decreased smoking, helped reduce AOM incidence.”
Between October 2008 and March 2014, researchers began tracking 367 infants from birth until they experienced their first case of AOM (and then on to age 6 months) or until they reached age 12 months; 85% completed the study. Preterm infants and those with anatomic defects or major medical problems were not included. The researchers collected nasopharyngeal specimens once during each of the first 6 months, once in the child’s 9th month, and during any viral upper respiratory infections to conduct bacterial cultures and viral polymerase chain reactions for 13 respiratory viruses.
During the course of the study, 305 children experienced a total of 887 upper respiratory infections, and 143 children experienced a total of 180 AOM episodes. Upper respiratory infections occurred at a rate of 3.2 episodes per child per year, and lower respiratory infections occurred at a rate of 0.24 episodes per child per year. Clinical sinusitis complications followed 4.6% of the upper respiratory infections, and lower respiratory infections followed 7.6%.
The rate of AOM was 0.67 episodes per child per year. Although only 6% of the infants had experienced AOM by age 3 months, that rose to nearly a quarter (23%) of the children at age 6 months and nearly half (46%) at age 12 months. Still, it remained below the rates of 18% by 3 months and 30%-39% by 6 months that had been reported in the late 1980s and 1990s.
Children who had AOM experienced 4.7 upper respiratory infections per year, compared with 2.3 episodes per year in children without AOM (P less than .002). They also had significantly greater pathogenic bacterial colonization overall and for Haemophilus influenzae and Moraxella catarrhalis, in their monthly nasopharyngeal specimens, although Streptococcus pneumoniae rates were not significantly greater.
“Interestingly, we found that not only viruses increased upper respiratory infection risk; M. catarrhalis and S. pneumoniae also increased upper respiratory infection risk,” the authors wrote “On the other hand, we found better protection for S. pneumoniae (infants born after 2010) associated with decreased upper respiratory infection risk.”
Upper respiratory infections were 74% more likely among children attending day care, and 7% more likely among children with at least one sibling at home. These infections were 37% less likely in children exclusively breastfed at least 6 months, 16% less likely in children born after February 2010, and 4% less likely for each month of any breastfeeding.
Similarly, AOM episodes were 60% less likely in children exclusively breastfed at least 3 months, and 15% less likely for each month children were breastfed.
The research was funded by the National Institutes of Health. The authors reported no disclosures.
Close to half of all infants have an episode of acute otitis media by age 1 year, but incidence appears to have dropped in the pneumococcal conjugate vaccine era, a recent study found.
“We clearly showed that frequent viral infections, bacterial colonization, and lack of breastfeeding are major acute otitis media (AOM) risk factors,” reported Dr. Tasnee Chonmaitree and her associates at the University of Texas Medical Branch in Galveston (Pediatrics 2016 March 28 doi: 10.1542/peds.2015-3555). “It is likely that medical interventions in the past few decades, such as the use of pneumococcal and influenza virus vaccines, higher breastfeeding rates and decreased smoking, helped reduce AOM incidence.”
Between October 2008 and March 2014, researchers began tracking 367 infants from birth until they experienced their first case of AOM (and then on to age 6 months) or until they reached age 12 months; 85% completed the study. Preterm infants and those with anatomic defects or major medical problems were not included. The researchers collected nasopharyngeal specimens once during each of the first 6 months, once in the child’s 9th month, and during any viral upper respiratory infections to conduct bacterial cultures and viral polymerase chain reactions for 13 respiratory viruses.
During the course of the study, 305 children experienced a total of 887 upper respiratory infections, and 143 children experienced a total of 180 AOM episodes. Upper respiratory infections occurred at a rate of 3.2 episodes per child per year, and lower respiratory infections occurred at a rate of 0.24 episodes per child per year. Clinical sinusitis complications followed 4.6% of the upper respiratory infections, and lower respiratory infections followed 7.6%.
The rate of AOM was 0.67 episodes per child per year. Although only 6% of the infants had experienced AOM by age 3 months, that rose to nearly a quarter (23%) of the children at age 6 months and nearly half (46%) at age 12 months. Still, it remained below the rates of 18% by 3 months and 30%-39% by 6 months that had been reported in the late 1980s and 1990s.
Children who had AOM experienced 4.7 upper respiratory infections per year, compared with 2.3 episodes per year in children without AOM (P less than .002). They also had significantly greater pathogenic bacterial colonization overall and for Haemophilus influenzae and Moraxella catarrhalis, in their monthly nasopharyngeal specimens, although Streptococcus pneumoniae rates were not significantly greater.
“Interestingly, we found that not only viruses increased upper respiratory infection risk; M. catarrhalis and S. pneumoniae also increased upper respiratory infection risk,” the authors wrote “On the other hand, we found better protection for S. pneumoniae (infants born after 2010) associated with decreased upper respiratory infection risk.”
Upper respiratory infections were 74% more likely among children attending day care, and 7% more likely among children with at least one sibling at home. These infections were 37% less likely in children exclusively breastfed at least 6 months, 16% less likely in children born after February 2010, and 4% less likely for each month of any breastfeeding.
Similarly, AOM episodes were 60% less likely in children exclusively breastfed at least 3 months, and 15% less likely for each month children were breastfed.
The research was funded by the National Institutes of Health. The authors reported no disclosures.
FROM PEDIATRICS
Key clinical point: Acute otitis media rates have declined, but are associated with upper respiratory infections.
Major finding: 46% of children had AOM by age 1 year; rates of upper respiratory infections were 4.7 per year in children with AOM and 2.3 per year in children without it.
Data source: The findings are based on a longitudinal cohort study of 305 children between October 2008 and March 2014, and their incidence of upper and lower respiratory infections and acute otitis media.
Disclosures: The research was funded by the National Institutes of Health. The authors reported no disclosures.
New Zika case study fills some research gaps
A new case study adds yet more evidence to the link between congenital Zika virus infection and fetal brain damage while offering insights into how the virus affects brain development at different stages.
“Our study highlights the possible importance of [Zika virus] RNA testing of serum obtained from pregnant women beyond the first week after symptom onset, as well as a more detailed evaluation of the fetal intracranial anatomy by means of serial fetal ultrasonography or fetal brain MRI,” wrote Dr. Rita W. Driggers of Johns Hopkins University, Baltimore, and her associates (N Engl J Med. 2016 March 30. doi: 10.1056/NEJMoa1601824).
The study also continues to help fill in the gaps in research highlighted by Dr. Lyle R. Petersen and his associates at the Centers for Disease Control and Prevention, in an overview of the virus published in the same issue (N Engl J Med. 2016 March 30. doi: 10.1056/NEJMra1602113).
“These include a complete understanding of the frequency and full spectrum of clinical outcomes resulting from fetal Zika virus infection and of the environmental factors that influence emergence, as well as the development of discriminating diagnostic tools for flaviruses, animal models for fetal developmental effects due to viral infection, new vector control products and strategies, effective therapeutics, and vaccines to protect humans against the disease,” the CDC authors wrote.
In the case study, a 33-year-old Finnish woman developed an infection from Zika virus in her 11th week of pregnancy while on vacation in Mexico, Guatemala, and Belize. She experienced the common Zika virus symptoms of a mild fever, eye pain, rash, and muscle pain for 5 days and had evidence of Zika virus RNA in her blood between 16 and 21 weeks’ gestation.
Although the fetal head size remained within the normal range during the 16th and 17th weeks of pregnancy, fetal head circumference dropped from the 47th percentile at 16 weeks gestation to the 24th percentile at 20 weeks’ gestation. Ultrasound and MRI imagery found fetal brain abnormalities, including a thin cerebral mantle and potential agenesis of the corpus callosum at 19 and 20 weeks’ gestation, but neither microcephaly nor calcifications in the brain were seen.
“We suspect these reductions in brain growth would have eventually met the criteria for microcephaly,” the researchers wrote. “As this case shows, the latency period between Zika virus infection of the fetal brain and the detection of microcephaly and intracranial calcifications on ultrasonography is likely to be prolonged.”
Negative findings during this time could be “falsely reassuring and might delay critical time-sensitive decision making,” they added.
The woman chose to terminate the pregnancy at 21 weeks, and high viral loads of Zika were found in the fetal brain during a postmortem exam. The fetus also had lower amounts of Zika RNA in the muscle, liver, lung, and spleen, as did the mother’s amniotic fluid.
“Although the evidence of the association between the presence of Zika virus in pregnant women and fetal brain abnormalities continues to grow, the timing of infection during fetal development and other factors that may have an effect on viral pathogenesis and their effects on the appearance of the brain abnormalities are poorly understood,” the case study researchers wrote.
The CDC authors also note the challenges of differentiating Zika virus infections from dengue or other flavivirus infections. “Reliable testing regimens for the diagnosis of prenatal and antenatal Zika virus infection have not been established,” they wrote.
The CDC authors also predict millions more Zika cases in the Americas, given the incidence of dengue and chikungunya cases previously, but the burden of long-term effects is harder to predict. “The long-term outlook with regard to the current Zika outbreak in the Americas is uncertain,” they wrote. “Herd immunity sufficient to slow further transmission will undoubtedly occur, although this will not obviate the need for immediate and long-term prevention and control strategies.”
Researchers from the CDC and those who reported the case study reported having no financial disclosures.
We need research to clarify the best way to provide protection and to prevent serious consequences of Zika virus and other flaviviruses that were previously unknown. Until recently, Zika virus was believed to cause only mild disease, which it still does in the majority of cases. The main concern today is the growing body of evidence that Zika virus infection results in severe neurologic complications – Guillain-Barré syndrome in infected patients and microcephaly in unborn babies – combined with the very rapid spread of the virus.
Although vaccines may come too late for countries currently affected by the Zika virus epidemic, the development of a vaccine that can, above all, protect pregnant women and their babies remains an imperative for countries where the epidemic is expected to arrive in the foreseeable future. The goal would be to allow for medium- to long-term control of Zika virus analogous in some ways to the control of rubella. It is critical that we collaborate rather than compete to find answers to the questions that worry millions of women of child-bearing age in areas where Zika virus is spreading rapidly and may become endemic.
Dr. Charlotte J. Haug is an international correspondent for the New England Journal of Medicine; Marie-Paule Kieny, Ph.D., is assistant director-general for health systems and innovation at the World Health Organization; and Dr. Bernadette Murgue is the project manager of the WHO’s R&D Blueprint. They reported having no financial disclosures. These comments are adapted from an editorial (N Engl J Med. 2016 March 30. doi: 10.1056/NEJMp1603734).
We need research to clarify the best way to provide protection and to prevent serious consequences of Zika virus and other flaviviruses that were previously unknown. Until recently, Zika virus was believed to cause only mild disease, which it still does in the majority of cases. The main concern today is the growing body of evidence that Zika virus infection results in severe neurologic complications – Guillain-Barré syndrome in infected patients and microcephaly in unborn babies – combined with the very rapid spread of the virus.
Although vaccines may come too late for countries currently affected by the Zika virus epidemic, the development of a vaccine that can, above all, protect pregnant women and their babies remains an imperative for countries where the epidemic is expected to arrive in the foreseeable future. The goal would be to allow for medium- to long-term control of Zika virus analogous in some ways to the control of rubella. It is critical that we collaborate rather than compete to find answers to the questions that worry millions of women of child-bearing age in areas where Zika virus is spreading rapidly and may become endemic.
Dr. Charlotte J. Haug is an international correspondent for the New England Journal of Medicine; Marie-Paule Kieny, Ph.D., is assistant director-general for health systems and innovation at the World Health Organization; and Dr. Bernadette Murgue is the project manager of the WHO’s R&D Blueprint. They reported having no financial disclosures. These comments are adapted from an editorial (N Engl J Med. 2016 March 30. doi: 10.1056/NEJMp1603734).
We need research to clarify the best way to provide protection and to prevent serious consequences of Zika virus and other flaviviruses that were previously unknown. Until recently, Zika virus was believed to cause only mild disease, which it still does in the majority of cases. The main concern today is the growing body of evidence that Zika virus infection results in severe neurologic complications – Guillain-Barré syndrome in infected patients and microcephaly in unborn babies – combined with the very rapid spread of the virus.
Although vaccines may come too late for countries currently affected by the Zika virus epidemic, the development of a vaccine that can, above all, protect pregnant women and their babies remains an imperative for countries where the epidemic is expected to arrive in the foreseeable future. The goal would be to allow for medium- to long-term control of Zika virus analogous in some ways to the control of rubella. It is critical that we collaborate rather than compete to find answers to the questions that worry millions of women of child-bearing age in areas where Zika virus is spreading rapidly and may become endemic.
Dr. Charlotte J. Haug is an international correspondent for the New England Journal of Medicine; Marie-Paule Kieny, Ph.D., is assistant director-general for health systems and innovation at the World Health Organization; and Dr. Bernadette Murgue is the project manager of the WHO’s R&D Blueprint. They reported having no financial disclosures. These comments are adapted from an editorial (N Engl J Med. 2016 March 30. doi: 10.1056/NEJMp1603734).
A new case study adds yet more evidence to the link between congenital Zika virus infection and fetal brain damage while offering insights into how the virus affects brain development at different stages.
“Our study highlights the possible importance of [Zika virus] RNA testing of serum obtained from pregnant women beyond the first week after symptom onset, as well as a more detailed evaluation of the fetal intracranial anatomy by means of serial fetal ultrasonography or fetal brain MRI,” wrote Dr. Rita W. Driggers of Johns Hopkins University, Baltimore, and her associates (N Engl J Med. 2016 March 30. doi: 10.1056/NEJMoa1601824).
The study also continues to help fill in the gaps in research highlighted by Dr. Lyle R. Petersen and his associates at the Centers for Disease Control and Prevention, in an overview of the virus published in the same issue (N Engl J Med. 2016 March 30. doi: 10.1056/NEJMra1602113).
“These include a complete understanding of the frequency and full spectrum of clinical outcomes resulting from fetal Zika virus infection and of the environmental factors that influence emergence, as well as the development of discriminating diagnostic tools for flaviruses, animal models for fetal developmental effects due to viral infection, new vector control products and strategies, effective therapeutics, and vaccines to protect humans against the disease,” the CDC authors wrote.
In the case study, a 33-year-old Finnish woman developed an infection from Zika virus in her 11th week of pregnancy while on vacation in Mexico, Guatemala, and Belize. She experienced the common Zika virus symptoms of a mild fever, eye pain, rash, and muscle pain for 5 days and had evidence of Zika virus RNA in her blood between 16 and 21 weeks’ gestation.
Although the fetal head size remained within the normal range during the 16th and 17th weeks of pregnancy, fetal head circumference dropped from the 47th percentile at 16 weeks gestation to the 24th percentile at 20 weeks’ gestation. Ultrasound and MRI imagery found fetal brain abnormalities, including a thin cerebral mantle and potential agenesis of the corpus callosum at 19 and 20 weeks’ gestation, but neither microcephaly nor calcifications in the brain were seen.
“We suspect these reductions in brain growth would have eventually met the criteria for microcephaly,” the researchers wrote. “As this case shows, the latency period between Zika virus infection of the fetal brain and the detection of microcephaly and intracranial calcifications on ultrasonography is likely to be prolonged.”
Negative findings during this time could be “falsely reassuring and might delay critical time-sensitive decision making,” they added.
The woman chose to terminate the pregnancy at 21 weeks, and high viral loads of Zika were found in the fetal brain during a postmortem exam. The fetus also had lower amounts of Zika RNA in the muscle, liver, lung, and spleen, as did the mother’s amniotic fluid.
“Although the evidence of the association between the presence of Zika virus in pregnant women and fetal brain abnormalities continues to grow, the timing of infection during fetal development and other factors that may have an effect on viral pathogenesis and their effects on the appearance of the brain abnormalities are poorly understood,” the case study researchers wrote.
The CDC authors also note the challenges of differentiating Zika virus infections from dengue or other flavivirus infections. “Reliable testing regimens for the diagnosis of prenatal and antenatal Zika virus infection have not been established,” they wrote.
The CDC authors also predict millions more Zika cases in the Americas, given the incidence of dengue and chikungunya cases previously, but the burden of long-term effects is harder to predict. “The long-term outlook with regard to the current Zika outbreak in the Americas is uncertain,” they wrote. “Herd immunity sufficient to slow further transmission will undoubtedly occur, although this will not obviate the need for immediate and long-term prevention and control strategies.”
Researchers from the CDC and those who reported the case study reported having no financial disclosures.
A new case study adds yet more evidence to the link between congenital Zika virus infection and fetal brain damage while offering insights into how the virus affects brain development at different stages.
“Our study highlights the possible importance of [Zika virus] RNA testing of serum obtained from pregnant women beyond the first week after symptom onset, as well as a more detailed evaluation of the fetal intracranial anatomy by means of serial fetal ultrasonography or fetal brain MRI,” wrote Dr. Rita W. Driggers of Johns Hopkins University, Baltimore, and her associates (N Engl J Med. 2016 March 30. doi: 10.1056/NEJMoa1601824).
The study also continues to help fill in the gaps in research highlighted by Dr. Lyle R. Petersen and his associates at the Centers for Disease Control and Prevention, in an overview of the virus published in the same issue (N Engl J Med. 2016 March 30. doi: 10.1056/NEJMra1602113).
“These include a complete understanding of the frequency and full spectrum of clinical outcomes resulting from fetal Zika virus infection and of the environmental factors that influence emergence, as well as the development of discriminating diagnostic tools for flaviruses, animal models for fetal developmental effects due to viral infection, new vector control products and strategies, effective therapeutics, and vaccines to protect humans against the disease,” the CDC authors wrote.
In the case study, a 33-year-old Finnish woman developed an infection from Zika virus in her 11th week of pregnancy while on vacation in Mexico, Guatemala, and Belize. She experienced the common Zika virus symptoms of a mild fever, eye pain, rash, and muscle pain for 5 days and had evidence of Zika virus RNA in her blood between 16 and 21 weeks’ gestation.
Although the fetal head size remained within the normal range during the 16th and 17th weeks of pregnancy, fetal head circumference dropped from the 47th percentile at 16 weeks gestation to the 24th percentile at 20 weeks’ gestation. Ultrasound and MRI imagery found fetal brain abnormalities, including a thin cerebral mantle and potential agenesis of the corpus callosum at 19 and 20 weeks’ gestation, but neither microcephaly nor calcifications in the brain were seen.
“We suspect these reductions in brain growth would have eventually met the criteria for microcephaly,” the researchers wrote. “As this case shows, the latency period between Zika virus infection of the fetal brain and the detection of microcephaly and intracranial calcifications on ultrasonography is likely to be prolonged.”
Negative findings during this time could be “falsely reassuring and might delay critical time-sensitive decision making,” they added.
The woman chose to terminate the pregnancy at 21 weeks, and high viral loads of Zika were found in the fetal brain during a postmortem exam. The fetus also had lower amounts of Zika RNA in the muscle, liver, lung, and spleen, as did the mother’s amniotic fluid.
“Although the evidence of the association between the presence of Zika virus in pregnant women and fetal brain abnormalities continues to grow, the timing of infection during fetal development and other factors that may have an effect on viral pathogenesis and their effects on the appearance of the brain abnormalities are poorly understood,” the case study researchers wrote.
The CDC authors also note the challenges of differentiating Zika virus infections from dengue or other flavivirus infections. “Reliable testing regimens for the diagnosis of prenatal and antenatal Zika virus infection have not been established,” they wrote.
The CDC authors also predict millions more Zika cases in the Americas, given the incidence of dengue and chikungunya cases previously, but the burden of long-term effects is harder to predict. “The long-term outlook with regard to the current Zika outbreak in the Americas is uncertain,” they wrote. “Herd immunity sufficient to slow further transmission will undoubtedly occur, although this will not obviate the need for immediate and long-term prevention and control strategies.”
Researchers from the CDC and those who reported the case study reported having no financial disclosures.
FROM THE NEW ENGLAND JOURNAL OF MEDICINE
C-reactive protein levels help predict bacterial meningitis outcomes
Measuring C-reactive protein (CRP) levels in children with bacterial meningitis can help determine those children’s prognoses, a study showed.
“A single CRP measurement on the 3rd or 4th day is the most informative, since it rather reliably identifies the patients with highest risk of seizures, slow recovery, hearing impairment, and low scoring in the Glasgow Outcome Scale,” wrote Dr. Heikki Peltola of Children’s Hospital and Helsinki University Hospital, both in Helsinki, and his associates. CRP determination is the fastest, simplest, cheapest, easiest yardstick to use for predicting outcomes in resource-poor settings, the authors said.
“The predictive capacity of CRP almost paralleled the child’s score on the Glasgow Coma Scale at presentation to hospital,” the authors wrote, and combining the two doubled the prognostic predictive power. They reported their findings online in the Pediatric Infectious Disease Journal (2016 Mar 15. doi: 10.1097/INF.0000000000001133).
The researchers measured CRP levels in fingerprick blood samples from 669 children on their 1st through 4th days after hospitalization for bacterial meningitis. The children were all participating in two separate prospective, randomized double-blind treatment studies. One trial, conducted in Argentina, Brazil, the Dominican Republic, Ecuador, Paraguay, and Venezuela, involved 654 children, aged 2 months to 16 years, who received ceftriaxone and either dexamethasone or oral glycerol, both, or neither. The other trial, in Luanda, Angola, included 723 children, aged 2 months to 13 years, who received cefotaxime either as a slow continuous infusion or in 6-hourly boluses for 24 hours, and either acetaminophen or placebo.
CRP levels from day 1 or 2 were a median 159 mg/L among 285 Latin American children and a median 161 mg/L among 384 Angolan children. Though no correlation existed between CRP levels and the children’s age or sex, children with meningococcal meningitis had the highest and lowest levels. Higher levels were associated with lower cerebrospinal fluid glucose concentrations.
Levels from day 3 or 4 were a median 62 mg/L among 218 Latin American children and 117 mg/L among 57 Angolan children. The Latin American children with CRP levels above 62 mg/L had 2.4 times greater odds of seizures, 2.3 times greater odds of a secondary fever, 2.1 times greater odds of a suboptimal clinical course, 3.4 times greater odds of any neurological sequelae, 2.9 times greater odds of any hearing impairment, and 3.1 times greater odds of a Glasgow Outcome Scale score below 5.
The Angolan children with CRP levels above 62 mg/L had 6 times greater odds of a Glasgow Coma score below 15 for 2 days, 9 times greater odds of a hospital stay longer than 8 days, 6.3 times greater odds of seizures, 5.1 times greater odds of a suboptimal clinical course, and 7 times greater odds of any hearing impairment.
“When the child showed both a CRP above median level and a Glasgow Coma score below 13, the odds for severe neurological sequelae, any neurological sequelae, or any hearing impairment increased to 25.4, 7.9, and 5.3, respectively,” the authors wrote. “Full deafness by itself was not predicted by either index.”
The research was funded by the Sigrid Jusélius Foundation and the Foundation for Paediatric Research of Finland. CRP analyzers were provided by Orion Diagnostica. Dr. Irmeli Roine owns a Chilean company that distributes laboratory equipment, including CRP reagents and the QuikRead instrument. No other authors reported disclosures.
Measuring C-reactive protein (CRP) levels in children with bacterial meningitis can help determine those children’s prognoses, a study showed.
“A single CRP measurement on the 3rd or 4th day is the most informative, since it rather reliably identifies the patients with highest risk of seizures, slow recovery, hearing impairment, and low scoring in the Glasgow Outcome Scale,” wrote Dr. Heikki Peltola of Children’s Hospital and Helsinki University Hospital, both in Helsinki, and his associates. CRP determination is the fastest, simplest, cheapest, easiest yardstick to use for predicting outcomes in resource-poor settings, the authors said.
“The predictive capacity of CRP almost paralleled the child’s score on the Glasgow Coma Scale at presentation to hospital,” the authors wrote, and combining the two doubled the prognostic predictive power. They reported their findings online in the Pediatric Infectious Disease Journal (2016 Mar 15. doi: 10.1097/INF.0000000000001133).
The researchers measured CRP levels in fingerprick blood samples from 669 children on their 1st through 4th days after hospitalization for bacterial meningitis. The children were all participating in two separate prospective, randomized double-blind treatment studies. One trial, conducted in Argentina, Brazil, the Dominican Republic, Ecuador, Paraguay, and Venezuela, involved 654 children, aged 2 months to 16 years, who received ceftriaxone and either dexamethasone or oral glycerol, both, or neither. The other trial, in Luanda, Angola, included 723 children, aged 2 months to 13 years, who received cefotaxime either as a slow continuous infusion or in 6-hourly boluses for 24 hours, and either acetaminophen or placebo.
CRP levels from day 1 or 2 were a median 159 mg/L among 285 Latin American children and a median 161 mg/L among 384 Angolan children. Though no correlation existed between CRP levels and the children’s age or sex, children with meningococcal meningitis had the highest and lowest levels. Higher levels were associated with lower cerebrospinal fluid glucose concentrations.
Levels from day 3 or 4 were a median 62 mg/L among 218 Latin American children and 117 mg/L among 57 Angolan children. The Latin American children with CRP levels above 62 mg/L had 2.4 times greater odds of seizures, 2.3 times greater odds of a secondary fever, 2.1 times greater odds of a suboptimal clinical course, 3.4 times greater odds of any neurological sequelae, 2.9 times greater odds of any hearing impairment, and 3.1 times greater odds of a Glasgow Outcome Scale score below 5.
The Angolan children with CRP levels above 62 mg/L had 6 times greater odds of a Glasgow Coma score below 15 for 2 days, 9 times greater odds of a hospital stay longer than 8 days, 6.3 times greater odds of seizures, 5.1 times greater odds of a suboptimal clinical course, and 7 times greater odds of any hearing impairment.
“When the child showed both a CRP above median level and a Glasgow Coma score below 13, the odds for severe neurological sequelae, any neurological sequelae, or any hearing impairment increased to 25.4, 7.9, and 5.3, respectively,” the authors wrote. “Full deafness by itself was not predicted by either index.”
The research was funded by the Sigrid Jusélius Foundation and the Foundation for Paediatric Research of Finland. CRP analyzers were provided by Orion Diagnostica. Dr. Irmeli Roine owns a Chilean company that distributes laboratory equipment, including CRP reagents and the QuikRead instrument. No other authors reported disclosures.
Measuring C-reactive protein (CRP) levels in children with bacterial meningitis can help determine those children’s prognoses, a study showed.
“A single CRP measurement on the 3rd or 4th day is the most informative, since it rather reliably identifies the patients with highest risk of seizures, slow recovery, hearing impairment, and low scoring in the Glasgow Outcome Scale,” wrote Dr. Heikki Peltola of Children’s Hospital and Helsinki University Hospital, both in Helsinki, and his associates. CRP determination is the fastest, simplest, cheapest, easiest yardstick to use for predicting outcomes in resource-poor settings, the authors said.
“The predictive capacity of CRP almost paralleled the child’s score on the Glasgow Coma Scale at presentation to hospital,” the authors wrote, and combining the two doubled the prognostic predictive power. They reported their findings online in the Pediatric Infectious Disease Journal (2016 Mar 15. doi: 10.1097/INF.0000000000001133).
The researchers measured CRP levels in fingerprick blood samples from 669 children on their 1st through 4th days after hospitalization for bacterial meningitis. The children were all participating in two separate prospective, randomized double-blind treatment studies. One trial, conducted in Argentina, Brazil, the Dominican Republic, Ecuador, Paraguay, and Venezuela, involved 654 children, aged 2 months to 16 years, who received ceftriaxone and either dexamethasone or oral glycerol, both, or neither. The other trial, in Luanda, Angola, included 723 children, aged 2 months to 13 years, who received cefotaxime either as a slow continuous infusion or in 6-hourly boluses for 24 hours, and either acetaminophen or placebo.
CRP levels from day 1 or 2 were a median 159 mg/L among 285 Latin American children and a median 161 mg/L among 384 Angolan children. Though no correlation existed between CRP levels and the children’s age or sex, children with meningococcal meningitis had the highest and lowest levels. Higher levels were associated with lower cerebrospinal fluid glucose concentrations.
Levels from day 3 or 4 were a median 62 mg/L among 218 Latin American children and 117 mg/L among 57 Angolan children. The Latin American children with CRP levels above 62 mg/L had 2.4 times greater odds of seizures, 2.3 times greater odds of a secondary fever, 2.1 times greater odds of a suboptimal clinical course, 3.4 times greater odds of any neurological sequelae, 2.9 times greater odds of any hearing impairment, and 3.1 times greater odds of a Glasgow Outcome Scale score below 5.
The Angolan children with CRP levels above 62 mg/L had 6 times greater odds of a Glasgow Coma score below 15 for 2 days, 9 times greater odds of a hospital stay longer than 8 days, 6.3 times greater odds of seizures, 5.1 times greater odds of a suboptimal clinical course, and 7 times greater odds of any hearing impairment.
“When the child showed both a CRP above median level and a Glasgow Coma score below 13, the odds for severe neurological sequelae, any neurological sequelae, or any hearing impairment increased to 25.4, 7.9, and 5.3, respectively,” the authors wrote. “Full deafness by itself was not predicted by either index.”
The research was funded by the Sigrid Jusélius Foundation and the Foundation for Paediatric Research of Finland. CRP analyzers were provided by Orion Diagnostica. Dr. Irmeli Roine owns a Chilean company that distributes laboratory equipment, including CRP reagents and the QuikRead instrument. No other authors reported disclosures.
FROM THE PEDIATRIC INFECTIOUS DISEASE JOURNAL
Key clinical point: C-reactive protein measurements provide reliable prognostic information for pediatric bacterial meningitis.
Major finding: The odds of hearing impairment were three to seven times greater, and the odds of secondary fever, neurological sequelae, a longer hospital stay, and poorer scores on the Glasgow Outcome and Coma scales were several times greater for children with CRP levels above the median 62 mg/L.
Data source: The findings are based on CRP measurements taken prospectively from a cohort of 669 children with bacterial meningitis, all of whom were enrolled in two treatment trials in Latin America or Angola between 1996 and 2003.
Disclosures: The research was funded by the Sigrid Jusélius Foundation and the Foundation for Paediatric Research of Finland. CRP analyzers were provided by Orion Diagnostica. Dr. Irmeli Roine owns a Chilean company that distributes laboratory equipment, including CRP reagents and the QuikRead instrument. No other authors reported disclosures.
