Adjunct corticosteroids
in children hospitalized with community-acquired pneumonia.
Pediatrics. 2011;
127(2):e255-63 (ISSN: 1098-4275)
Weiss AK; Hall M; Lee GE;
Kronman MP; Sheffler-Collins S; Shah SS
Division of Infectious Diseases, Children's Hospital of Philadelphia, Room 1526, North Campus, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
Division of Infectious Diseases, Children's Hospital of Philadelphia, Room 1526, North Campus, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
OBJECTIVE: To determine if systemic
corticosteroid therapy is associated with improved outcomes for children
hospitalized with community-acquired pneumonia (CAP).
METHODS: In this multicenter, retrospective
cohort study we used data from 36 children's hospitals for children aged 1 to
18 years with CAP. Main outcome measures were length of stay (LOS),
readmission, and total hospitalization cost. The primary exposure was the use
of adjunct systemic corticosteroids. Multivariable regression models and
propensity scores were used to adjust for confounders.
RESULTS: The 20 703 patients whose data were
included had a median age of 4 years. Adjunct corticosteroid therapy was
administered to 7234 patients (35%). The median LOS was 3 days, and 245
patients (1.2%) required readmission. Systemic corticosteroid therapy was
associated with shorter LOS overall (adjusted hazard ratio [HR]: 1.24 [95%
confidence interval (CI): 1.18-1.30]). Among children who received treatment
with β-agonists, the LOS was shorter for children who had received
corticosteroids compared with children who had not (adjusted HR: 1.36 [95% CI:
1.28-1.45]). Among children who did not receive β-agonists, the LOS was longer
for those who received corticosteroids compared with those who did not
(adjusted HR: 0.85 [95% CI: 0.75-0.96]). Corticosteroids were associated with
readmission of patients who did not receive concomitant β-agonist therapy
(adjusted odds ratio: 1.97 [95% CI: 1.09-3.57]).
CONCLUSIONS: For children hospitalized with CAP,
adjunct corticosteroids were associated with a shorter hospital LOS among
patients who received concomitant β-agonist therapy. Among patients who did not
receive this therapy, systemic corticosteroids were associated with a longer
LOS and a greater odds of readmission. If β-agonist therapy is considered a
proxy for wheezing, our findings suggest that among patients admitted to the
hospital with a diagnosis of CAP, only those with acute wheezing benefit from
adjunct systemic corticosteroid therapy.
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CAS Registry / EC Numbers
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PreMedline Identifier:
21220397
2.
Adjunct corticosteroids
in children hospitalized with community-acquired pneumonia.
Pediatrics. 2011;
127(2):e255-63 (ISSN: 1098-4275)
Weiss AK; Hall M; Lee GE; Kronman MP;
Sheffler-Collins S; Shah SS
Division of Infectious Diseases, Children's Hospital of Philadelphia, Room 1526, North Campus, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
Division of Infectious Diseases, Children's Hospital of Philadelphia, Room 1526, North Campus, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
OBJECTIVE: To determine if systemic corticosteroid therapy is
associated with improved outcomes for children hospitalized with
community-acquired pneumonia (CAP).
METHODS: In this multicenter, retrospective cohort study we used
data from 36 children's hospitals for children aged 1 to 18 years with CAP.
Main outcome measures were length of stay (LOS), readmission, and total
hospitalization cost. The primary exposure was the use of adjunct systemic
corticosteroids. Multivariable regression models and propensity scores were
used to adjust for confounders.
RESULTS: The 20 703 patients whose data were included had a median
age of 4 years. Adjunct corticosteroid therapy was administered to 7234
patients (35%). The median LOS was 3 days, and 245 patients (1.2%) required
readmission. Systemic corticosteroid therapy was associated with shorter LOS
overall (adjusted hazard ratio [HR]: 1.24 [95% confidence interval (CI):
1.18-1.30]). Among children who received treatment with β-agonists, the LOS was
shorter for children who had received corticosteroids compared with children
who had not (adjusted HR: 1.36 [95% CI: 1.28-1.45]). Among children who did not
receive β-agonists, the LOS was longer for those who received corticosteroids
compared with those who did not (adjusted HR: 0.85 [95% CI: 0.75-0.96]).
Corticosteroids were associated with readmission of patients who did not
receive concomitant β-agonist therapy (adjusted odds ratio: 1.97 [95% CI:
1.09-3.57]).
CONCLUSIONS: For children hospitalized with CAP, adjunct
corticosteroids were associated with a shorter hospital LOS among patients who
received concomitant β-agonist therapy. Among patients who did not receive this
therapy, systemic corticosteroids were associated with a longer LOS and a
greater odds of readmission. If β-agonist therapy is considered a proxy for
wheezing, our findings suggest that among patients admitted to the hospital
with a diagnosis of CAP, only those with acute wheezing benefit from adjunct
systemic corticosteroid therapy.
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Major Subject Heading(s)
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Minor Subject Heading(s)
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CAS Registry / EC Numbers
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PreMedline Identifier:
21220397
From MEDLINE®/PubMed®,
a database of the U.S. National Library of Medicine.
3.
Randomized controlled
trial of cephalexin versus clindamycin for uncomplicated pediatric skin
infections.
Pediatrics. 2011;
127(3):e573-80 (ISSN: 1098-4275)
Chen AE; Carroll KC; Diener-West M; Ross T;
Ordun J; Goldstein MA; Kulkarni G; Cantey JB;
Siberry GK
Johns Hopkins University, Department of Pediatrics, Division of Pediatric Emergency Medicine, CMSC 144, 600 N Wolfe St, Baltimore, MD 21287, USA. achen33@jhmi.edu
Johns Hopkins University, Department of Pediatrics, Division of Pediatric Emergency Medicine, CMSC 144, 600 N Wolfe St, Baltimore, MD 21287, USA. achen33@jhmi.edu
OBJECTIVE: To compare clindamycin and cephalexin for treatment of
uncomplicated skin and soft tissue infections (SSTIs) caused predominantly by
community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA).
We hypothesized that clindamycin would be superior to cephalexin (an antibiotic
without MRSA activity) for treatment of these infections.
PATIENTS AND METHODS: Patients aged 6 months to 18 years with
uncomplicated SSTIs not requiring hospitalization were enrolled September 2006
through May 2009. Eligible patients were randomly assigned to 7 days of
cephalexin or clindamycin; primary and secondary outcomes were clinical improvement
at 48 to 72 hours and resolution at 7 days. Cultures were obtained and tested
for antimicrobial susceptibilities, pulsed-field gel electrophoresis type, and
Panton-Valentine leukocidin status.
RESULTS: Of 200 enrolled patients, 69% had MRSA cultured from
wounds. Most MRSA were USA300 or subtypes, positive for Panton-Valentine
leukocidin, and clindamycin susceptible, consistent with CA-MRSA. Spontaneous
drainage occurred or a drainage procedure was performed in 97% of subjects. By
48 to 72 hours, 94% of subjects in the cephalexin arm and 97% in the
clindamycin arm were improved (P = .50). By 7 days, all subjects were improved,
with complete resolution in 97% in the cephalexin arm and 94% in the
clindamycin arm (P = .33). Fevers and age less than 1 year, but not initial
erythema > 5 cm, were associated with early treatment failures, regardless
of antibiotic used.
CONCLUSIONS: There is no significant difference between cephalexin
and clindamycin for treatment of uncomplicated pediatric SSTIs caused predominantly
by CA-MRSA. Close follow-up and fastidious wound care of appropriately drained,
uncomplicated SSTIs are likely more important than initial antibiotic choice.
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CAS Registry / EC Numbers
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PreMedline Identifier:
21339275
From MEDLINE®/PubMed®,
a database of the U.S. National Library of Medicine.
4.
Efficacy of neonatal
release of ankyloglossia: a randomized trial.
Pediatrics. 2011;
128(2):280-8 (ISSN: 1098-4275)
Buryk M; Bloom D; Shope T
Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA. melissa.buryk@gmail.com
Naval Medical Center Portsmouth, Portsmouth, VA 23708, USA. melissa.buryk@gmail.com
BACKGROUND: Ankyloglossia has been associated with a variety of
infant-feeding problems. Frenotomy commonly is performed for relief of
ankyloglossia, but there has been a lack of convincing data to support this
practice.
OBJECTIVES: Our primary objective was to determine whether
frenotomy for infants with ankyloglossia improved maternal nipple pain and
ability to breastfeed. A secondary objective was to determine whether frenotomy
improved the length of breastfeeding.
METHODS: Over a 12-month period, neonates who had difficulty
breastfeeding and significant ankyloglossia were enrolled in this randomized,
single-blinded, controlled trial and assigned to either a frenotomy (30
infants) or a sham procedure (28 infants). Breastfeeding was assessed by a
preintervention and postintervention nipple-pain scale and the Infant
Breastfeeding Assessment Tool. The same tools were used at the 2-week follow-up
and regularly scheduled follow-ups over a 1-year period. The infants in the
sham group were given a frenotomy before or at the 2-week follow-up if it was
desired.
RESULTS: Both groups demonstrated statistically significantly
decreased pain scores after the intervention. The frenotomy group improved
significantly more than the sham group (P < .001). Breastfeeding scores
significantly improved in the frenotomy group (P = .029) without a significant
change in the control group. All but 1 parent in the sham group elected to have
the procedure performed when their infant reached 2 weeks of age, which
prevented additional comparisons between the 2 groups.
CONCLUSIONS: We demonstrated immediate improvement in nipple-pain
and breastfeeding scores, despite a placebo effect on nipple pain. This should
provide convincing evidence for those seeking a frenotomy for infants with
signficant ankyloglossia.
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Minor Subject Heading(s)
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PreMedline Identifier:
21768318
From MEDLINE®/PubMed®,
a database of the U.S. National Library of Medicine.
5.
ADHD drugs and serious
cardiovascular events in children and young adults.
N Engl J Med.
2011; 365(20):1896-904 (ISSN: 1533-4406)
Cooper WO; Habel LA; Sox CM; Chan KA;
Arbogast PG; Cheetham TC; Murray KT; Quinn VP;
Stein CM; Callahan ST; Fireman BH; Fish FA;
Kirshner HS; O'Duffy A; Connell FA; Ray WA
Division of General Pediatrics, Vanderbilt University, Nashville, TN 37232-4313, USA. william.cooper@vanderbilt.edu
Division of General Pediatrics, Vanderbilt University, Nashville, TN 37232-4313, USA. william.cooper@vanderbilt.edu
BACKGROUND: Adverse-event reports from North America have raised
concern that the use of drugs for attention deficit-hyperactivity disorder
(ADHD) increases the risk of serious cardiovascular events.
METHODS: We conducted a retrospective cohort study with automated
data from four health plans (Tennessee Medicaid, Washington State Medicaid,
Kaiser Permanente California, and OptumInsight Epidemiology), with 1,200,438
children and young adults between the ages of 2 and 24 years and 2,579,104
person-years of follow-up, including 373,667 person-years of current use of
ADHD drugs. We identified serious cardiovascular events (sudden cardiac death,
acute myocardial infarction, and stroke) from health-plan data and vital
records, with end points validated by medical-record review. We estimated the
relative risk of end points among current users, as compared with nonusers,
with hazard ratios from Cox regression models.
RESULTS: Cohort members had 81 serious cardiovascular events (3.1
per 100,000 person-years). Current users of ADHD drugs were not at increased
risk for serious cardiovascular events (adjusted hazard ratio, 0.75; 95%
confidence interval [CI], 0.31 to 1.85). Risk was not increased for any of the
individual end points, or for current users as compared with former users
(adjusted hazard ratio, 0.70; 95% CI, 0.29 to 1.72). Alternative analyses
addressing several study assumptions also showed no significant association
between the use of an ADHD drug and the risk of a study end point.
CONCLUSIONS: This large study showed no evidence that current use
of an ADHD drug was associated with an increased risk of serious cardiovascular
events, although the upper limit of the 95% confidence interval indicated that
a doubling of the risk could not be ruled out. However, the absolute magnitude
of such an increased risk would be low. (Funded by the Agency for Healthcare
Research and Quality and the Food and Drug Administration.).
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Major Subject Heading(s)
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Minor Subject Heading(s)
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CAS Registry / EC Numbers
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PreMedline Identifier:
22043968
From MEDLINE®/PubMed®,
a database of the U.S. National Library of Medicine.
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