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Edwards B, Schaefer EW, Murray-Kolb LE, Daymont C. Evaluation of Income and Food Insecurity as Risk Factors for Failure to Thrive: An Analysis of National Survey Data. Clin Pediatr (Phila) 2023; 62:862-870. [PMID: 36661103 PMCID: PMC10411026 DOI: 10.1177/00099228221150705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Limited data exist regarding the relationship between socioeconomic risk factors and failure to thrive (FTT). Using data from the National Health and Nutrition Examination Survey (NHANES) from years 1999 to 2014, we sought to determine whether there was a higher prevalence of underweight (<5th percentile weight-for-age [WFA], weight-for-length [WFL], or body mass index-for-age [BFA]), and, therefore, likely a higher risk of FTT, in US children <3 years with low household income or food insecurity compared with children without these factors. Among 7356 evaluated children, there were no significant differences in the prevalence of underweight by adjusted household income quintile, food security, household Women, Infants, and Children (WIC) status, or federal poverty income ratio. These findings do not support a link between low income or food security and underweight in children and, therefore, do not provide support for an association between low income or food security and FTT.
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Affiliation(s)
- Bathai Edwards
- Penn State College of Medicine, Hershey, PA, USA
- Department of Medicine, Lehigh Valley Health Network, Allentown, PA, USA
| | - Eric W. Schaefer
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Laura E. Murray-Kolb
- Department of Nutritional Sciences, The Pennsylvania State University, State College, PA, USA
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Carrie Daymont
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
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Nelson A, Stuckey H, Snyder B, Van Scoy LJ, Daymont C, Irvin C, Wasserman E, Beck M. Provider Perspectives of Transitions of Care at a Tertiary Care Children's Hospital With a Hospitalist-Run Discharge Clinic. Clin Pediatr (Phila) 2023; 62:926-934. [PMID: 36726290 PMCID: PMC10986183 DOI: 10.1177/00099228221149279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Children's hospitals are discharging patients to home with increasingly complex outpatient needs, making safe transitions of care (ToCs) of vital importance. Our study involved a survey of both outpatient providers and pediatric hospitalists associated with our medical center to better describe providers' views on the ToC process. The survey included questions assessing views on patient care responsibilities, resource availability, our hospitalist-run postdischarge clinic (PDC), and comfort with telemedicine. Our hospitalists generally believed that primary care providers (PCPs) did not have adequate access to important ToC elements, whereas PCPs felt their access was adequate. Both provider types felt it was the inpatient team's responsibility to manage patient events between discharge and PCP follow-up and that a hospitalist-run PDC may reduce interim emergency room visits. This study challenges perceptions about the ToC process in children and describes a generalizable approach to assessing provider perceptions surrounding the ToC within individual health systems.
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Affiliation(s)
- Abigail Nelson
- Penn State Children’s Hospital, Department of Pediatrics
| | - Heather Stuckey
- Penn State Hershey College of Medicine; Department of Medicine
| | - Bethany Snyder
- Penn State Hershey College of Medicine; Department of Medicine
| | | | - Carrie Daymont
- Penn State Children’s Hospital, Department of Pediatrics
- Penn State Hershey College of Medicine, Department of Public Health Sciences
| | | | - Emily Wasserman
- Penn State Hershey College of Medicine, Department of Public Health Sciences
| | - Michael Beck
- Penn State Children’s Hospital, Department of Pediatrics
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Shur N, Tigranyan A, Daymont C, Regier DS, Raturi S, Roshan Lal T, Cleary K, Summar M. The past, present, and future of child growth monitoring: A review and primer for clinical genetics. Am J Med Genet A 2023; 191:948-961. [PMID: 36708136 DOI: 10.1002/ajmg.a.63102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 01/29/2023]
Abstract
Child growth measurements are critical vital signs to track, with every individual child growth curve potentially revealing a story about a child's health and well-being. Simply put, every baby born requires basic building blocks to grow and thrive: proper nutrition, love and care, and medical health. To ensure that every child who is missing one of these vital aspects is identified, growth is traditionally measured at birth and each well-child visit. While the blue and pink growth curves appear omnipresent in pediatric clinics, it is surprising to realize that their use only became standard of care in 1977 when the National Center for Health Statistics (NCHS) adopted the growth curve as a clinical tool for health. Behind this practice lies a socioeconomically, culturally, and politically complex interplay of individuals and institutions around the world. In this review, we highlight the often forgotten past, current state of practice, and future potential of this powerful clinical tool: the growth reference chart, with a particular focus on clinical genetics practice. The goal of this article is to understand ongoing work in the field of anthropometry (the scientific study of human measurements) and its direct impact on modern pediatric and genetic patient care.
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Affiliation(s)
- Natasha Shur
- Rare Disease Institute, Children's National Research and Innovation Campus, Washington, District of Columbia, USA.,The Sheikh Zayed Institute for Pediatric Surgical Innovation Children's National Hospital, Washington, District of Columbia, USA
| | - Annie Tigranyan
- The Sheikh Zayed Institute for Pediatric Surgical Innovation Children's National Hospital, Washington, District of Columbia, USA
| | - Carrie Daymont
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Debra S Regier
- Rare Disease Institute, Children's National Research and Innovation Campus, Washington, District of Columbia, USA
| | - Sumant Raturi
- The Sheikh Zayed Institute for Pediatric Surgical Innovation Children's National Hospital, Washington, District of Columbia, USA
| | - Tamanna Roshan Lal
- The Sheikh Zayed Institute for Pediatric Surgical Innovation Children's National Hospital, Washington, District of Columbia, USA
| | - Kevin Cleary
- The Sheikh Zayed Institute for Pediatric Surgical Innovation Children's National Hospital, Washington, District of Columbia, USA
| | - Marshall Summar
- The Sheikh Zayed Institute for Pediatric Surgical Innovation Children's National Hospital, Washington, District of Columbia, USA
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Brawley AM, Schaefer EW, Lucarelli E, Ural SH, Chuang CH, Hwang W, Paul IM, Daymont C. Differing prevalence of microcephaly and macrocephaly in male and female fetuses. Front Glob Womens Health 2023; 4:1080175. [PMID: 36911049 PMCID: PMC9998507 DOI: 10.3389/fgwh.2023.1080175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/01/2023] [Indexed: 03/14/2023] Open
Abstract
Objective To compare the proportion of female and male fetuses classified as microcephalic (head circumference [HC] < 3rd percentile) and macrocephalic (>97th percentile) by commonly used sex-neutral growth curves. Methods For fetuses evaluated at a single center, we retrospectively determined the percentile of the first fetal HC measurement between 16 and 0/7 and 21-6/7 weeks using the Hadlock, Intergrowth-21st, and NICHD growth curves. The association between sex and the likelihood of being classified as microcephalic or macrocephalic was evaluated with logistic regression. Results Female fetuses (n = 3,006) were more likely than male fetuses (n = 3,186) to be classified as microcephalic using the Hadlock (0.4% male, 1.4% female; odds ratio female vs. male 3.7, 95% CI [1.9, 7.0], p < 0.001), Intergrowth-21st (0.5% male, 1.6% female; odds ratio female vs. male 3.4, 95% CI [1.9, 6.1], p < 0.001), and NICHD (0.3% male, 1.6% female; odds ratio female vs. male 5.6, 95% CI [2.7, 11.5], p < 0.001) curves. Male fetuses were more likely than female fetuses to be classified as macrocephalic using the Intergrowth-21st (6.0% male, 1.5% female; odds ratio male vs. female 4.3, 95% CI [3.1, 6.0], p < 0.001) and NICHD (4.7% male, 1.0% female; odds ratio male vs. female 5.1, 95% CI [3.4, 7.6], p < 0.001) curves. Very low proportions of fetuses were classified as macrocephalic using the Hadlock curves (0.2% male, < 0.1% female; odds ratio male vs. female 6.6, 95% CI [0.8, 52.6]). Conclusion Female fetuses were more likely to be classified as microcephalic, and male fetuses were more likely to be classified as macrocephalic. Sex-specific fetal head circumference growth curves could improve interpretation of fetal head circumference measurements, potentially decreasing over- and under-diagnosis of microcephaly and macrocephaly based on sex, therefore improving guidance for clinical decisions. Additionally, the overall prevalence of atypical head size varied using three growth curves, with the NICHD and Intergrowth-21st curves fitting our population better than the Hadlock curves. The choice of fetal head circumference growth curves may substantially impact clinical care.
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Affiliation(s)
- Amalia M Brawley
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, United States
| | - Eric W Schaefer
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Elizabeth Lucarelli
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, United States
| | - Serdar H Ural
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, PA, United States
| | - Cynthia H Chuang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States.,Department of Medicine, Penn State College of Medicine, Hershey, PA, United States
| | - Wenke Hwang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Ian M Paul
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States.,Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States
| | - Carrie Daymont
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States.,Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States
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Hahn T, Daymont C, Beukelman T, Groh B, Hays K, Bingham CA, Scalzi L. Correction: Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2022; 20:116. [PMID: 36517887 PMCID: PMC9749320 DOI: 10.1186/s12969-022-00775-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Timothy Hahn
- Department of Pediatrics, Penn State Children's Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA, 17033-0855, USA.
| | - Carrie Daymont
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Timothy Beukelman
- grid.265892.20000000106344187Department of Pediatrics, University of Alabama at Birmingham, CPPN G10, 1600 7th Ave South, Birmingham, AL 35233 USA
| | - Brandt Groh
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Kimberly Hays
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Catherine April Bingham
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Lisabeth Scalzi
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
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Hahn T, Daymont C, Beukelman T, Groh B, Hays K, Bingham CA, Scalzi L, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2022; 20:107. [PMID: 36434731 PMCID: PMC9701017 DOI: 10.1186/s12969-022-00770-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months. METHODS We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed. RESULTS We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05). CONCLUSION While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.
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Affiliation(s)
- Timothy Hahn
- Department of Pediatrics, Penn State Children's Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA, 17033-0855, USA.
| | - Carrie Daymont
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Timothy Beukelman
- grid.265892.20000000106344187Department of Pediatrics, University of Alabama at Birmingham, CPPN G10, 1600 7th Ave South, Birmingham, AL 35233 USA
| | - Brandt Groh
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | | | - Catherine April Bingham
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Lisabeth Scalzi
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
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Freedman DS, Kompaniyets L, Daymont C, Zhao L, Blanck HM. Weight gain among US adults during the COVID-19 pandemic through May 2021. Obesity (Silver Spring) 2022; 30:2064-2070. [PMID: 35822832 PMCID: PMC9349426 DOI: 10.1002/oby.23511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/19/2022] [Accepted: 06/03/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVE There have been conflicting reports concerning weight gain among adults during the COVID-19 epidemic. Although early studies reported large weight increases, several of these analyses were based on convenience samples or self-reported information. The objective of the current study is to examine the pandemic-related weight increase associated with the pandemic through May 2021. METHODS A total of 4.25 million adults (18 to 84 years) in an electronic health record database who had at least two weight measurements between January 2019 and February 2020 and one after June 2020 were selected. Weight changes before and after March 2020 were contrasted using mixed-effects regression models. RESULTS Compared with the pre-pandemic weight trend, there was a small increase (0.1 kg) in weight in the first year of the pandemic (March 2020 through March 2021). Weight changes during the pandemic varied by sex, age, and initial BMI, but the largest mean increase across these characteristics was < 1.3 kg. Weight increases were generally greatest among women, adults with BMI of 30 or 35 kg/m2 , and younger adults. CONCLUSIONS The results indicate that the mean weight gain among adults during the COVID-19 pandemic may be small.
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Affiliation(s)
- David S. Freedman
- Division of Nutrition, Physical Activity, and ObesityCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Lyudmyla Kompaniyets
- Division of Nutrition, Physical Activity, and ObesityCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Carrie Daymont
- Departments of Pediatrics and Public Health SciencePenn State College of MedicineHersheyPennsylvaniaUSA
| | - Lixia Zhao
- Division of Nutrition, Physical Activity, and ObesityCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Heidi M. Blanck
- Departments of Pediatrics and Public Health SciencePenn State College of MedicineHersheyPennsylvaniaUSA
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8
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Petrovich J, Reimherr M, Daymont C. Highly irregular functional generalized linear regression with electronic healthrecords. J R Stat Soc Ser C Appl Stat 2022. [DOI: 10.1111/rssc.12556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Daymont C, Ross ME, Localio AR, Fiks AG, Wasserman RC, Grundmeier RW. Corrigendum to: Automated identification of implausible values in growth data from pediatric electronic health records. J Am Med Inform Assoc 2021; 29:223. [PMID: 34791265 DOI: 10.1093/jamia/ocab250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Batra EK, Lewis M, Saravana D, Corr TE, Daymont C, Miller JR, Hackman NM, Mikula M, Ostrov BE, Fogel BN. Improving Hospital Infant Safe Sleep Compliance by Using Safety Prevention Bundle Methodology. Pediatrics 2021; 148:183392. [PMID: 34851414 DOI: 10.1542/peds.2020-033704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Sudden unexpected infant death often results from unsafe sleep environments and is the leading cause of postneonatal mortality in the United States. Standardization of infant sleep environment education has been revealed to impact such deaths. This standardized approach is similar to safety prevention bundles typically used to monitor and improve health outcomes, such as those related to hospital-acquired conditions (HACs). We sought to use the HAC model to measure and improve adherence to safe sleep guidelines in an entire children's hospital. METHODS A hospital-wide safe sleep bundle was implemented on September 15, 2017. A safe sleep performance improvement team met monthly to review data and discuss ideas for improvement through the use of iterative plan-do-study-act cycles. Audits were performed monthly from March 2017 to October 2019 and monitored safe sleep parameters. Adherence was measured and reviewed through the use of statistical process control charts (p-charts). RESULTS Overall compliance improved from 9% to 72%. Head of bed flat increased from 62% to 93%, sleep space free of extra items increased from 52% to 81%, and caregiver education completed increased from 10% to 84%. The centerline for infant in supine position remained stable at 81%. CONCLUSIONS Using an HAC bundle safety prevention model to improve adherence to infant safe sleep guidelines is a feasible and effective method to improve the sleep environment for infants in all areas of a children's hospital.
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Affiliation(s)
- Erich K Batra
- Departments of Family and Community Medicine.,Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Mary Lewis
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Deepa Saravana
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Tammy E Corr
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Carrie Daymont
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Jennifer R Miller
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Nicole M Hackman
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
| | - Margaret Mikula
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania.,Samaritan Health Services, Corvallis, Oregon
| | - Barbara E Ostrov
- Department of Pediatrics, Bernard & Millie Duker Children's Hospital, Albany Medical Center, Albany, New York
| | - Benjamin N Fogel
- Pediatrics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
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11
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Freedman DS, Daymont C. Response to Rolland-Cachera et al., "Early Adiposity Rebound Predicts Later Overweight and Provides Useful Information on Obesity Development" (DOI: chi-2021-0087). Child Obes 2021; 17:429-430. [PMID: 33978468 PMCID: PMC8834404 DOI: 10.1089/chi.2021.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- David S. Freedman
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carrie Daymont
- Departments of Pediatrics and Public Health Science, Penn State College of Medicine, Hershey, PA, USA
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Abstract
OBJECTIVE The aim of this study was to identify emergency department (ED) heart rate (HR) values that identify children at elevated risk of ED revisit with admission. METHODS We performed a retrospective cohort study of patients 0 to 18 years old discharged from a tertiary-care pediatric ED from January 2013 to December 2014. We created percentile curves for the last recorded HR for age using data from calendar year 2013 and used receiver operating characteristic (ROC) curves to characterize the performance of the percentiles for predicting ED revisit with admission within 72 hours. In a held-out validation data set (calendar year 2014 data), we evaluated test characteristics of last-recorded HR-for-age cut points identified as promising on the ROC curves, as well as those identifying the highest 5% and 1% of last recorded HRs for age. RESULTS We evaluated 183,433 eligible ED visits. Last recorded HR for age had poor discrimination for predicting revisit with admission (area under the curve, 0.61; 95% confidence interval, 0.58-0.63). No promising cut points were identified on the ROC curves. Cut points identifying the highest 5% and 1% of last recorded HRs for age showed low sensitivity (10.1% and 2.5%) with numbers needed to evaluate of 62 and 50, respectively, to potentially prevent 1 revisit with admission. CONCLUSIONS Last recorded ED HR discriminates poorly between children who are and are not at risk of revisit with admission in a pediatric ED. The use of single-parameter HR in isolation as an automated trigger for mandatory reevaluation prior to discharge may not improve revisit outcomes.
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Affiliation(s)
- Carrie Daymont
- Departments of Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Fran Balamuth
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Halden F Scott
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christopher P Bonafide
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Patrick W Brady
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Holly Depinet
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Elizabeth R Alpern
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Abstract
Objective: The beginning of postinfancy increase in BMI has been termed the adiposity rebound, and an early rebound increases the risk for obesity in adolescence and adulthood. We examined whether the relation of the age at BMI rebound (agerebound) to subsequent BMI is independent of childhood BMI. Design: From the electronic health records of 2.8 million children, we selected 17,077 children examined at least once each year between ages 2 and <8 years, and who were reexamined between age 10 and <16 years. The mean age at the last visit was 12 years (SD = 1). We identified agerebound for each child using lowess, a smoothing technique. Results: Children who had an agerebound <3 years were, on average, 6.8 kg/m2 heavier after age 10 years than were children with an agerebound >7 years. However, BMI after age 10 years was more strongly associated with BMI at the rebound (BMIrebound) than with agerebound (r = 0.63 vs. -0.49). Although the relation of agerebound to BMI at the last visit was mostly independent of the BMIrebound, adjustment for age-5 BMI reduced the association's magnitude by about 55%. Conclusions: Both agerebound and the BMIrebound are independently related to BMI and obesity after age 10 years. However, a child's BMIrebound and at ages 5 and 7 years accounts for more of the variability in BMI levels after age 10 years than does agerebound.
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Affiliation(s)
- David S Freedman
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alyson B Goodman
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Raymond J King
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lyudmyla Kompaniyets
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carrie Daymont
- Department of Pediatrics and Penn State College of Medicine, Hershey, PA, USA.,Department of Public Health Science, Penn State College of Medicine, Hershey, PA, USA
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14
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Freedman DS, Goodman AB, King RJ, Daymont C. The Longitudinal Relation of Childhood Height to Subsequent Obesity in a Large Electronic Health Record Database. Obesity (Silver Spring) 2020; 28:1742-1749. [PMID: 32638501 DOI: 10.1002/oby.22901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Several cross-sectional studies have shown that height in childhood is correlated with BMI and with body fatness, and two longitudinal studies have reported that childhood height is associated with adult BMI. This study explored this longitudinal association in an electronic health record database of 2.8 million children. METHODS Children were initially examined between the ages of 2 and 13.9 years and, on average, were reexamined 4 years later. RESULTS As expected, there was a cross-sectional correlation between height-for-age z score and BMI that increased from r = -0.06 (age of 2 years) to r = 0.37 (age of 9-10 years). In addition, height-for-age at the first visit was related to subsequent BMI and obesity, with the prevalence of subsequent obesity increasing about fourfold over six categories of height-for-age at the first visit. About 40% of this longitudinal association was independent of initial BMI, but its magnitude decreased with initial age. For example, the initial height-for-age of children who were 12 years of age or older was only weakly associated with subsequent BMI. CONCLUSIONS Health professionals should recognize that greater childhood height-for-age before 12 years of age may be a marker for increased risk of subsequent obesity.
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Affiliation(s)
- David S Freedman
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alyson B Goodman
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Raymond J King
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carrie Daymont
- Departments of Pediatrics and Public Health Science, Penn State College of Medicine, Hershey, Pennsylvania, USA
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15
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Kennedy T, Rodd C, Daymont C, Grant CG, Mittermuller BA, Pierce A, Moffatt MEK, Schroth RJ. The association of body mass index and severe early childhood caries in young children in Winnipeg, Manitoba: A cross-sectional study. Int J Paediatr Dent 2020; 30:626-633. [PMID: 32057150 DOI: 10.1111/ipd.12629] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/23/2019] [Accepted: 02/09/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Associations between body mass index (BMI) and caries have been reported. AIM To evaluate the direction of the relationship between BMI and severe early childhood caries (S-ECC). DESIGN Children were recruited as part of a larger prospective cohort study assessing changes in nutritional status following dental rehabilitation under general anaesthetic. Pre-operative anthropometric measurements were used to calculate BMI z-scores (BMIz). Operative reports were reviewed to calculate caries scores based on treatment rendered. Analysis included descriptive statistics, bivariate analyses, and simple and multiple linear regression. RESULTS Overall, 150 children were recruited with a mean age of 47.7 ± 14.2 (SD) months; 52% female. Over 42% were at risk for overweight, overweight or obese. Although simple linear regression demonstrated a significant positive association between dmfs score and BMIz, adjusted multiple linear regression found no significant relationship between BMIz and dmfs, but highlighted a relationship between BMI z-score and family income, Registered First Nations Status and physical activity. CONCLUSIONS Although a significant relationship between BMI and S-ECC was not found, poverty was a key confounding variable. As both S-ECC and obesity are known predictors of future disease, it is important for healthcare professionals to identify children at risk. Diet and behaviour modification may play a role in disease prevention.
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Affiliation(s)
- Tara Kennedy
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Dentistry Department, The Royal Children's Hospital Melbourne, Melbourne, VIC, Australia
| | - Celia Rodd
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Carrie Daymont
- Penn State Pediatric Hospital Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Philadelphia
| | - Cameron G Grant
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Betty-Anne Mittermuller
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Andrew Pierce
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Michael E K Moffatt
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Robert J Schroth
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.,Section of Pediatric Dentistry, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
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16
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Affiliation(s)
- Carrie Daymont
- Departments of Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
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17
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Daymont C, Hoffman N, Schaefer E, Fiks AG. Clinician Diagnoses of Failure to Thrive Before and After Switch to World Health Organization Growth Curves. Acad Pediatr 2020; 20:405-412. [PMID: 31128383 PMCID: PMC6874747 DOI: 10.1016/j.acap.2019.05.126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/06/2019] [Accepted: 05/18/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate change in the incidence of failure to thrive (FTT) based on selected growth percentile criteria and diagnostic codes before and after a switch in growth curves. METHODS We performed a retrospective cohort study of children 2 to 24 months of age in a large primary care network that switched its default growth curve from the Centers for Disease Control and Prevention (CDC) reference to the World Health Organization (WHO) standards in 2012. We compared the incidence of FTT defined by growth percentile criteria (using the default growth curve at the time of each measurement) and by International Classification of Diseases, Ninth Revision, codes in the 3 years before and after the CDC-WHO switch using an interrupted time series analysis. We performed these analyses stratified by age group (≤6 months and >6-24 months). RESULTS We evaluated 83,299 children. Among those ≤6 months, increases in FTT incidence were found in both growth-percentile and clinician-diagnosis criteria at the CDC-WHO switch (P < .05). Among those >6 to 24 months, decreases in FTT incidence were found by growth-percentile criteria at the CDC-WHO switch (P < .05), but no significant changes were found in FTT incidence by diagnostic codes. CONCLUSIONS When switching from the CDC to the WHO growth curves, changes in the incidence of FTT by growth-percentile and clinician-diagnosis criteria differed for younger versus older infants. Factors beyond growth likely influence the decision to diagnose a child as having FTT and may differ in younger compared to older infants.
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Affiliation(s)
- Carrie Daymont
- Departments of Pediatrics (C Daymont) and Public Health Sciences (C Daymont and EW Schaefer), Penn State College of Medicine, Hershey.
| | - Noah Hoffman
- Department of Pediatrics, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102
| | - Eric Schaefer
- Department of Public Health Sciences, 500 University Drive, Penn State College of Medicine, Hershey, PA, 17033
| | - Alexander G. Fiks
- Department of Pediatrics, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104,Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104,PolicyLab, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104
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18
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Butto A, Mercer-Rosa L, Teng C, Daymont C, Edelson J, Faerber J, Mejia E, Ravishankar C, Cohen MS. Longitudinal growth in patients with single ventricle cardiac disease receiving tube-assisted feeds. CONGENIT HEART DIS 2019; 14:1058-1065. [PMID: 31917526 PMCID: PMC9784686 DOI: 10.1111/chd.12843] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/04/2019] [Accepted: 08/29/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Children with single ventricle cardiac disease (SVCD) have poor growth in early life. Tube-assisted feeding (TF) is used to improve weight gain, but its impact on long-term growth remains unknown. We sought to compare the longitudinal growth of SVCD patients receiving TF after initial cardiac surgery with those fed entirely by mouth. DESIGN We conducted a retrospective cohort study of SVCD patients who underwent initial surgical palliation between 1999 and 2009. We defined TF as the use of nasogastric, gastrostomy, or jejunostomy TF. We compared maximal attained growth z-scores for each year of life between TF and non-TF patients. A secondary analysis compared surgical and clinical factors between groups. RESULTS A total of 134 patients were included; 64% were male and 68% underwent the Norwood operation. One third of patients (44) received TF. Adjusting for age, TF patients had an average of 0.56 lower weight-for-age z-score (WAZ) than non-TF patients (P = 0.007) through the age of 6 years. Longitudinal height was not affected by TF status (P = 0.15). In a subanalysis of Norwood patients, TF patients had lower WAZ at initial hospital discharge despite longer LOS. TF patients had diminished WAZ after adjusting for complications, interstage hospitalizations, and timing of subsequent operations. CONCLUSIONS In this single-center study, patients with SVCD requiring TF at discharge from initial surgical palliation had diminished WAZ at discharge and on long-term follow-up, despite controlling for other identifiable risk factors. Further investigation is needed to understand the mechanisms underlying this phenomenon and to risk stratify infants who go home on TF.
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Affiliation(s)
- Arene Butto
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Laura Mercer-Rosa
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Christopher Teng
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Carrie Daymont
- Departments of Pediatrics and Public Health Sciences. Penn State College of Medicine, Hershey, PA
| | - Jonathan Edelson
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Jennifer Faerber
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Erika Mejia
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Chitra Ravishankar
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Meryl S. Cohen
- Division of Cardiology, The Children’s Hospital of Philadelphia, Philadelphia, PA
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19
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Grant CG, Daymont C, Rodd C, Mittermuller BA, Pierce A, Kennedy T, Singh S, Moffatt MEK, Schroth RJ. Oral Health-Related Quality of Life of Canadian Preschoolers with Severe Caries After Dental Rehabilitation Under General Anesthesia. Pediatr Dent 2019; 41:221-228. [PMID: 31171075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose: The purpose was to determine changes in the oral health-related quality-of-life (OHRQoL) of children with severe early childhood caries (S-ECC) following dental rehabilitation under general anesthesia (DRGA). Methods: This prospective cohort study involved caregivers completing questionnaires, including the Early Childhood Oral Health Impact Scale (ECOHIS). Data analysis included descriptive statistics, bivariate analyses, effect size, and multiple linear regression. Results: Initially, 150 children were enrolled, mean age of 47.7±14.2 (SD) months. The baseline mean total ECOHIS score was 6.3±5.3. Higher baseline ECOHIS scores were associated with single-parent families, low-income house-holds, higher decayed, missing, and filled primary teeth (dmft) scores, and having extractions (P ≤ 0.05). Multiple linear regression results showed low household income (P=0.01) and the child not having Registered First Nation status (a specific population of Indigenous Canadians; P=0.03) were significantly and independently associated with higher total baseline ECOHIS scores. At follow-up, 103 children had a mean total ECOHIS score of 3.5±2.9 versus a baseline score of 6.3±5.4. Change in total ECOHIS and three of four Child Impact Section domains showed significant improvement (P<0.001) post-DRGA. Worse follow-up ECOHIS scores were only associated with the child being male (P=0.02). Conclusions: Improvements in oral health-related quality of life were observed following DRGA. Consideration should be given for using the Early Childhood Oral Health Impact Scale to help prioritize children waiting for DRGA. (Pediatr Dent 2019;41(3):221-8) Received November 22, 2018 | Last Revision February 28, 2019 | Accepted April 1, 2019.
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Affiliation(s)
- Cameron G Grant
- is a pediatric dentist in private practice, Red Deer, Alberta, Canada
| | - Carrie Daymont
- is an assistant professor, Departments of Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, Pa., USA, and is an assistant professor, Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba. Winnipeg, Manitoba, Canada.,
| | - Celia Rodd
- is a professor, Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, and is a research scientist, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Betty-Anne Mittermuller
- is a research coordinator, Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, and is research coordinator, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew Pierce
- research assistants, Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tara Kennedy
- is a pediatric dentistry resident, Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarbjeet Singh
- research assistants, Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael E K Moffatt
- is a professor, Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, and is a research scientist, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert J Schroth
- is a professor and clinician scientist, Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, and is a research scientist, Children's Hospital Research Institute of Manitoba, and is section head, Section of Pediatric Dentistry, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
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20
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Lazzara A, Daymont C, Ladda R, Lull J, Ficicioglu C, Cohen JL, Aprile J. Failure to Thrive: An Expanded Differential Diagnosis. J Pediatr Genet 2018; 8:27-32. [PMID: 30775051 DOI: 10.1055/s-0038-1669445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
The patient is a term 6-month-old male, who presented with failure to thrive since birth. History was remarkable for suspected milk and soy protein allergy, gastroesophageal reflux, constipation, and abdominal distension that was present since birth. He was losing weight despite oral intake of over 100 kcal/kg per day. Prior workup including laboratory studies, abdominal X-ray, upper gastrointestinal series with fluoroscopy, barium enema, and abdominal ultrasound were all within normal limits. The patient's history, diagnostic evaluation, and final diagnosis are revealed. This case highlights a rare condition presenting as failure to thrive, a common problem with a wide differential diagnosis.
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Affiliation(s)
- Alexandra Lazzara
- Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pennsylvania, United States.,Department of Pediatrics, Johns Hopkins Children's Center, Baltimore, Maryland, United States
| | - Carrie Daymont
- Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pennsylvania, United States
| | - Roger Ladda
- Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pennsylvania, United States
| | - Jordan Lull
- Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pennsylvania, United States
| | - Can Ficicioglu
- Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Jennifer L Cohen
- Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Justen Aprile
- Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pennsylvania, United States
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Daymont C, Ross ME, Russell Localio A, Fiks AG, Wasserman RC, Grundmeier RW. Automated identification of implausible values in growth data from pediatric electronic health records. J Am Med Inform Assoc 2018; 24:1080-1087. [PMID: 28453637 DOI: 10.1093/jamia/ocx037] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 03/17/2017] [Indexed: 11/14/2022] Open
Abstract
Objective Large electronic health record (EHR) datasets are increasingly used to facilitate research on growth, but measurement and recording errors can lead to biased results. We developed and tested an automated method for identifying implausible values in pediatric EHR growth data. Materials and Methods Using deidentified data from 46 primary care sites, we developed an algorithm to identify weight and height values that should be excluded from analysis, including implausible values and values that were recorded repeatedly without remeasurement. The foundation of the algorithm is a comparison of each measurement, expressed as a standard deviation score, with a weighted moving average of a child's other measurements. We evaluated the performance of the algorithm by (1) comparing its results with the judgment of physician reviewers for a stratified random selection of 400 measurements and (2) evaluating its accuracy in a dataset with simulated errors. Results Of 2 000 595 growth measurements from 280 610 patients 1 to 21 years old, 3.8% of weight and 4.5% of height values were identified as implausible or excluded for other reasons. The proportion excluded varied widely by primary care site. The automated method had a sensitivity of 97% (95% confidence interval [CI], 94-99%) and a specificity of 90% (95% CI, 85-94%) for identifying implausible values compared to physician judgment, and identified 95% (weight) and 98% (height) of simulated errors. Discussion and Conclusion This automated, flexible, and validated method for preparing large datasets will facilitate the use of pediatric EHR growth datasets for research.
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Affiliation(s)
- Carrie Daymont
- Departments of Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Michelle E Ross
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - A Russell Localio
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexander G Fiks
- Department of Biomedical and Health Informatics
- Pediatric Research Consortium
- Center for Pediatric Clinical Effectiveness
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove, IL, USA
| | - Richard C Wasserman
- Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove, IL, USA
- Department of Pediatrics, University of Vermont, Burlington, VT, USA
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Affiliation(s)
- Christopher P. Bonafide
- Division of General Pediatrics, The Children’s Hospital of
Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia,
PA, USA
| | - Patrick W. Brady
- Division of Hospital Medicine, Cincinnati Children’s Hospital
Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine,
Cincinnati, OH, USA
| | - Carrie Daymont
- Children’s Hospital Research Institute of Manitoba, Winnipeg,
Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg,
Manitoba, Canada
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23
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Daymont C. Growing our knowledge about head circumference. Paediatr Int Child Health 2016; 36:81-3. [PMID: 27116892 DOI: 10.1080/20469047.2016.1162393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Carrie Daymont
- a University of Manitoba and Children's Hospital Research Institute of Manitoba , Winnipeg , Manitoba , Canada
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Gerber JS, Bryan M, Ross RK, Daymont C, Parks EP, Localio AR, Grundmeier RW, Stallings VA, Zaoutis TE. Antibiotic Exposure During the First 6 Months of Life and Weight Gain During Childhood. JAMA 2016; 315:1258-65. [PMID: 27002447 DOI: 10.1001/jama.2016.2395] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Early-life antibiotic exposure has been associated with increased adiposity in animal models, mediated through the gut microbiome. Infant antibiotic exposure is common and often inappropriate. Studies of the association between infant antibiotics and childhood weight gain have reported inconsistent results. OBJECTIVE To assess the association between early-life antibiotic exposure and childhood weight gain. DESIGN AND SETTING Retrospective, longitudinal study of singleton births and matched longitudinal study of twin pairs conducted in a network of 30 pediatric primary care practices serving more than 200,000 children of diverse racial and socioeconomic backgrounds across Pennsylvania, New Jersey, and Delaware. PARTICIPANTS Children born between November 1, 2001, and December 31, 2011, at 35 weeks' gestational age or older, with birth weight of 2000 g or more and in the fifth percentile or higher for gestational age, and who had a preventive health visit within 14 days of life and at least 2 additional visits in the first year of life. Children with complex chronic conditions and those who received long-term antibiotics or multiple systemic corticosteroid prescriptions were excluded. We included 38,522 singleton children and 92 twins (46 matched pairs) discordant in antibiotic exposure. Final date of follow-up was December 31, 2012. EXPOSURE Systemic antibiotic use in the first 6 months of life. MAIN OUTCOMES AND MEASURES Weight, measured at preventive health visits from age 6 months through 7 years. RESULTS Of 38,522 singleton children (50% female; mean birth weight, 3.4 kg), 5287 (14%) were exposed to antibiotics during the first 6 months of life (at a mean age of 4.3 months). Antibiotic exposure was not significantly associated with rate of weight change (0.7%; 95% CI, -0.1% to 1.5%; P = .07, equivalent to approximately 0.05 kg; 95% CI, -0.004 to 0.11 kg of added weight gain between age 2 years and 5 years). Among 92 twins (38% female; mean birth weight, 2.8 kg), the 46 twins who were exposed to antibiotics during the first 6 months of life received them at a mean age of 4.5 months. Antibiotic exposure was not significantly associated with a weight difference (-0.09 kg; 95% CI, -0.26 to 0.08 kg; P = .30). CONCLUSIONS AND RELEVANCE Exposure to antibiotics within the first 6 months of life compared with no exposure was not associated with a statistically significant difference in weight gain through age 7 years. There are many reasons to limit antibiotic exposure in young, healthy children, but weight gain is likely not one of them.
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Affiliation(s)
- Jeffrey S Gerber
- Center for Pediatric Clinical Effectiveness, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania2Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Matthew Bryan
- Division of Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rachael K Ross
- Center for Pediatric Clinical Effectiveness, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Carrie Daymont
- Department of Pediatrics and Child Health, University of Manitoba, and Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Elizabeth P Parks
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia5Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - A Russell Localio
- Division of Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Robert W Grundmeier
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia6Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Virginia A Stallings
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia5Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Theoklis E Zaoutis
- Center for Pediatric Clinical Effectiveness, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania2Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Abstract
BACKGROUND AND OBJECTIVES Heart rate (HR) is frequently used by clinicians in the hospital to assess a patient's severity of illness and make treatment decisions. We sought to develop percentiles that characterize the relationship of expected HR by age and body temperature in hospitalized children and to compare these percentiles with published references in both primary care and emergency department (ED) settings. METHODS Vital sign data were extracted from electronic health records of inpatients <18 years of age at 2 large freestanding children's hospitals from July 2011 to June 2012. We selected up to 10 HR-temperature measurement pairs from each admission. Measurements from 60% of patients were used to derive the percentile curves, with the remainder used for validation. We compared our upper percentiles with published references in primary care and ED settings. RESULTS We used 60,863 observations to derive the percentiles. Overall, an increase in body temperature of 1°C was associated with an increase of ∼ 10 beats per minute in HR, although there were variations across age and temperature ranges. For infants and young children, our upper percentiles were lower than in primary care and ED settings. For school-age children, our upper percentiles were higher. CONCLUSIONS We characterized expected HR by age and body temperature in hospitalized children. These percentiles differed from references in primary care and ED settings. Additional research is needed to evaluate the performance of these percentiles for the identification of children who would benefit from further evaluation or intervention for tachycardia.
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Affiliation(s)
- Carrie Daymont
- Department of Pediatrics and Child Health, and The Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; The George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada;
| | - Christopher P. Bonafide
- Division of General Pediatrics, and,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,Department of Pediatrics, Perelman School of Medicine, and,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia Pennsylvania
| | - Patrick W. Brady
- Division of Hospital Medicine, and,James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Daymont C, McDonald PJ, Wittmeier K, Reed MH, Moffatt M. Variability of physicians' thresholds for neuroimaging in children with recurrent headache. BMC Pediatr 2014; 14:162. [PMID: 24957861 PMCID: PMC4079181 DOI: 10.1186/1471-2431-14-162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 06/19/2014] [Indexed: 11/23/2022] Open
Abstract
Background We sought to determine the extent to which physicians agree about the appropriate decision threshold for recommending magnetic resonance imaging in a clinical practice guideline for children with recurrent headache. Methods We surveyed attending physicians in Canada practicing in community pediatrics, child neurology, pediatric radiology, and pediatric neurosurgery. For children in each of six risk categories, physicians were asked to determine whether they would recommend for or against routine magnetic resonance imaging of the brain in a clinical practice guideline for children with recurrent headache. Results Completed surveys were returned by 114 physicians. The proportion recommending routine neuroimaging for each risk group was 100% (50% risk), 99% (10% risk), 93% (4% risk), 54% (1% risk), 25% (0.4% risk), 4% (0.01% risk). Community pediatricians, physicians in practice >15 years, and physicians who believed they ordered neuroimaging less often than peers were less likely to recommend neuroimaging for the 1% risk group (all p < 0.05). Conclusions There is no consensus among pediatric specialists regarding the appropriate decision threshold for neuroimaging in a clinical practice guideline for children with recurrent headache. Because of the impact that individual threshold preferences may have on guidelines, these findings support the need for careful composition of guideline committees and consideration of the role of patient and family preferences. Our findings also support the need for transparency in guidelines regarding how evidence was translated into recommendations and how conflicts were resolved.
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Affiliation(s)
- Carrie Daymont
- Department of Pediatrics and Child Health, The University of Manitoba, Winnipeg, MB, Canada.
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Abstract
OBJECTIVE To develop and validate heart and respiratory rate percentile curves for hospitalized children and compare their vital sign distributions to textbook reference ranges and pediatric early warning score (EWS) parameters. METHODS For this cross-sectional study, we used 6 months of nurse-documented heart and respiratory rates from the electronic records of 14,014 children on general medical and surgical wards at 2 tertiary-care children's hospitals. We developed percentile curves using generalized additive models for location, scale, and shape with 67% of the patients and validated the curves with the remaining 33%. We then determined the proportion of observations that deviated from textbook reference ranges and EWS parameters. RESULTS We used 116,383 heart rate and 116,383 respiratory rate values to develop and validate the percentile curves. Up to 54% of heart rate observations and up to 40% of respiratory rate observations in our sample were outside textbook reference ranges. Up to 38% of heart rate observations and up to 30% of respiratory rate observations in our sample would have resulted in increased EWSs. CONCLUSIONS A high proportion of vital signs among hospitalized children would be considered out of range according to existing reference ranges and pediatric EWSs. The percentiles we derived may serve as useful references for clinicians and could be used to inform the development of evidence-based vital sign parameters for physiologic monitor alarms, inpatient electronic health record vital sign alerts, medical emergency team calling criteria, and EWSs.
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Affiliation(s)
- Christopher P. Bonafide
- Division of General Pediatrics, and,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,Department of Pediatrics, Perelman School of Medicine, and,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Patrick W. Brady
- Division of Hospital Medicine,,James M. Anderson Center for Health Systems Excellence, and,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Ron Keren
- Division of General Pediatrics, and,Center for Pediatric Clinical Effectiveness, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,Department of Pediatrics, Perelman School of Medicine, and,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Patrick H. Conway
- Division of Hospital Medicine,,James M. Anderson Center for Health Systems Excellence, and,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Keith Marsolo
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Carrie Daymont
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada; and,Manitoba Institute of Child Health, Winnipeg, Manitoba, Canada
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Abstract
OBJECT Enlargement of the subarachnoid spaces has been theorized as a risk factor for the development of subdural hemorrhage (SDH). As the finding of unexplained SDH in children often raises suspicion for nonaccidental trauma, the possibility of increased risk of SDH in children with enlargement of the subarachnoid spaces has important clinical, social, and legal implications. Therefore, the authors evaluated the frequency of SDH in a cohort of children with enlargement of the subarachnoid spaces. METHODS The authors identified children younger than 2 years of age who were diagnosed with enlargement of the subarachnoid spaces on MRI or CT scanning in a large primary care network between July 2001 and January 2008. The authors excluded children who had enlargement of the subarachnoid spaces diagnosed on imaging performed for trauma or developmental delay, as well as children with a history of prematurity, diagnosis of intracranial pathology, or metabolic or genetic disorders. Chart review recovered the following data: patient demographics, head circumference, history of head trauma, and head imaging results. For the subset of children with SDH, information regarding evaluation for other injuries, including skeletal survey, ophthalmological examination, and child protection team evaluation, was abstracted. RESULTS There were 177 children with enlargement of the subarachnoid spaces who met the inclusion criteria. Subdural hemorrhage was identified in 4 (2.3%) of the 177 children. All of the children with SDH underwent evaluations for suspected nonaccidental trauma, which included consultation by the child protection team, skeletal survey, and ophthalmological examination. Additional injuries (healing rib fractures) were identified in 1 of 4 patients. None of the 4 children had retinal hemorrhages. Only the child with rib fractures was reported to child protective services due to concerns for abuse. CONCLUSIONS Only a small minority of the patients with enlargement of the subarachnoid spaces had SDH. Evidence of additional injuries concerning for physical abuse were identified in a quarter of the children with enlargement of the subarachnoid spaces and SDH, suggesting that an evaluation for suspected nonaccidental trauma including occult injury screening should be performed in cases of SDH with enlargement of the subarachnoid spaces. In the absence of additional injuries, however, the presence of an unexplained SDH in the setting of enlargement of the subarachnoid spaces may be insufficient to support a diagnosis of nonaccidental trauma.
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Affiliation(s)
- Heather McKeag
- Department of Pediatrics, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts, USA.
| | - Cindy W. Christian
- Department of Pediatrics, The Children’s Hospital of Philadelphia;,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Rubin
- Department of Pediatrics, The Children’s Hospital of Philadelphia;,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carrie Daymont
- Department of Pediatrics and Child Health, University of Manitoba;,The Manitoba Institute of Child Health, Winnipeg, Manitoba, Canada
| | - Avrum N. Pollock
- Department of Radiology, The Children’s Hospital of Philadelphia;,Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joanne Wood
- Department of Pediatrics, The Children’s Hospital of Philadelphia;,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
OBJECTIVE We sought to describe growth in young children with congenital heart disease (CHD) over time. METHODS We performed a retrospective matched cohort study, identifying children with CHD in a large primary care network in Pennsylvania, New Jersey, and Delaware and matching them 10:1 with control subjects. The primary endpoint was the difference in mean World Health Organization z score for cases and controls for weight-for-age (WFAZ), length-for-age (LFAZ), weight-for-length (WFLZ), and head circumference-for-age (HCFAZ) at traditional ages for preventive visits, stratified by CHD category. RESULTS We evaluated 856 cases: 37 with single ventricle (SV) physiology, 52 requiring complex repair (CR), 159 requiring simple repair (SR), and 608 requiring no repair. For children in the SV, CR, and SR categories, large, simultaneous, and statistically significant (Student's t test P < .05) decreases in WFAZ and LFAZ appeared within the first month of life, peaked near 4 months, and persisted through 24 or 36 months. There were fewer and smaller decreases in the no-repair group between 2 and 18 months. HC data were available between 1 week and 24 months; at those ages, decreases in mean HCFAZ generally paralleled decreases in WFAZ and LFAZ in the SV, CR, and SR groups. CONCLUSIONS Children with CHD experience early, simultaneous decreases in growth trajectory across weight, length, and head circumference. The simultaneous decrease suggests a role for altered growth regulation in children with CHD.
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Affiliation(s)
- Carrie Daymont
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.
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Daymont C, Zabel M, Feudtner C, Rubin DM. The test characteristics of head circumference measurements for pathology associated with head enlargement: a retrospective cohort study. BMC Pediatr 2012; 12:9. [PMID: 22269214 PMCID: PMC3331824 DOI: 10.1186/1471-2431-12-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 01/23/2012] [Indexed: 11/12/2022] Open
Abstract
Background The test characteristics of head circumference (HC) measurement percentile criteria for the identification of previously undetected pathology associated with head enlargement in primary care are unknown. Methods Electronic patient records were reviewed to identify children age 3 days to 3 years with new diagnoses of intracranial expansive conditions (IEC) and metabolic and genetic conditions associated with macrocephaly (MGCM). We tested the following HC percentile threshold criteria: ever above the 95th, 97th, or 99.6th percentile and ever crossing 2, 4, or 6 increasing major percentile lines. The Centers for Disease Control and World Health Organization growth curves were used, as well as the primary care network (PCN) curves previously derived from this cohort. Results Among 74,428 subjects, 85 (0.11%) had a new diagnosis of IEC (n = 56) or MGCM (n = 29), and between these 2 groups, 24 received intervention. The 99.6th percentile of the PCN curve was the only threshold with a PPV over 1% (PPV 1.8%); the sensitivity of this threshold was only 15%. Test characteristics for the 95th percentiles were: sensitivity (CDC: 46%; WHO: 55%; PCN: 40%), positive predictive value (PPV: CDC: 0.3%; WHO: 0.3%; PCN: 0.4%), and likelihood ratios positive (LR+: CDC: 2.8; WHO: 2.2; PCN: 3.9). Test characteristics for the 97th percentiles were: sensitivity (CDC: 40%; WHO: 48%; PCN: 34%), PPV (CDC: 0.4%; WHO: 0.3%; PCN: 0.6%), and LR+ (CDC: 3.6; WHO: 2.7; PCN: 5.6). Test characteristics for crossing 2 increasing major percentile lines were: sensitivity (CDC: 60%; WHO: 40%; PCN: 31%), PPV (CDC: 0.2%; WHO: 0.1%; PCN: 0.2%), and LR+ (CDC: 1.3; WHO: 1.1; PCN: 1.5). Conclusions Commonly used HC percentile thresholds had low sensitivity and low positive predictive value for diagnosing new pathology associated with head enlargement in children in a primary care network.
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Affiliation(s)
- Carrie Daymont
- Department of Pediatrics and Child Health, The University of Manitoba, Winnipeg, Manitoba, Canada.
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Daymont C. Sometimes zero risk is not an option. Arch Pediatr Adolesc Med 2011; 165:574. [PMID: 21646595 DOI: 10.1001/archpediatrics.2011.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Abstract
OBJECTIVE To compare currently available head-circumference growth curves to curves constructed from clinical measurements from patients in a large US primary care network (PCN). PATIENTS AND METHODS We performed a retrospective cohort study of 75 412 patients in an urban-suburban PCN. Patients with a birth weight of <1500 g or gestational age of <33 weeks at birth were excluded. We compared percentile values and the proportion of head-circumference observations above the 95th percentile and below the 5th percentile for the existing and PCN curves. RESULTS The PCN curves were most similar to the National Center for Health Statistics (NCHS) curves and were substantially different from the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) curves. The overall proportion of observations above the 95th percentile was 4.9% (PCN), 6.2% (NCHS), 8.6% (CDC), and 14.0% (WHO). The proportion below the 5th percentile was 4.4% (PCN), 5.1% (NCHS), 2.9% (CDC), and 2.3% (WHO). When using the CDC curves, the proportion above the 95th percentile increased from 0.2% for children younger than 2 weeks to 11.8% for children 12 months old. When using the WHO curves, the proportion above the 95th percentile was >5% at all ages, with a maximum of 18.0% for children older than 24 months. CONCLUSIONS The CDC and WHO head-circumference curves describe different distributions than the clinical measurements in our PCN population, especially for children with larger heads. The resulting percentile misclassification may delay diagnosis in children with intracranial pathology in very young infants and spur unnecessary evaluation of healthy children older than 6 months.
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Affiliation(s)
- Carrie Daymont
- Department of Pediatrics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Udani M, Zen Q, Cottman M, Leonard N, Jefferson S, Daymont C, Truskey G, Telen MJ. Basal cell adhesion molecule/lutheran protein. The receptor critical for sickle cell adhesion to laminin. J Clin Invest 1998; 101:2550-8. [PMID: 9616226 PMCID: PMC508844 DOI: 10.1172/jci1204] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Sickle red cells bind significant amounts of soluble laminin, whereas normal red cells do not. Solid phase assays demonstrate that B-CAM/LU binds laminin on intact sickle red cells and that red cell B-CAM/LU binds immobilized laminin, whereas another putative laminin binding protein, CD44, does not. Ligand blots also identify B-CAM/LU as the only erythrocyte membrane protein(s) that binds laminin. Finally, transfection of murine erythroleukemia cells with human B-CAM cDNA induces binding of both soluble and immobilized laminin. Thus, B-CAM/LU appears to be the major laminin-binding protein of sickle red cells. Previously reported overexpression of B-CAM/LU by epithelial cancer cells suggests that this protein may also serve as a laminin receptor in malignant tumors.
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Affiliation(s)
- M Udani
- Division of Hematology, Department of Medicine, Duke University Medical Center, Duke University, Durham, North Carolina 27710, USA
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