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  • 1
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    Online Resource
    Outpatient Opioid Prescriptions for Children and Opioid-Related Adverse Events
    American Academy of Pediatrics (AAP) ; 2018
    In:  Pediatrics Vol. 142, No. 2 ( 2018-08-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 142, No. 2 ( 2018-08-01)
    Abstract: Little is known about opioid prescribing for children without severe conditions. We studied the prevalence of and indications for outpatient opioid prescriptions and the incidence of opioid-related adverse events in this population. METHODS: This retrospective cohort study between 1999 and 2014 included Tennessee Medicaid children and adolescents aged 2 to 17 without major chronic diseases, prolonged hospitalization, institutional residence, or evidence of a substance use disorder. We estimated the annual prevalence of outpatient opioid prescriptions and incidence of opioid-related adverse events, defined as an emergency department visit, hospitalization, or death related to an opioid adverse effect. RESULTS: There were 1 362 503 outpatient opioid prescriptions; the annual mean prevalence of opioid prescriptions was 15.0%. The most common opioid indications were dental procedures (31.1% prescriptions), outpatient procedure and/or surgery (25.1%), trauma (18.1%), and infections (16.5%). There were 437 cases of opioid-related adverse events confirmed by medical record review; 88.6% were related to the child’s prescription and 71.2% had no recorded evidence of deviation from the prescribed regimen. The cumulative incidence of opioid-related adverse events was 38.3 of 100 000 prescriptions. Adverse events increased with age (incidence rate ratio = 2.22; 95% confidence interval, 1.67–2.96; 12–17 vs 2–5 years of age) and higher opioid doses (incidence rate ratio = 1.86 [1.45–2.39]; upper versus lower dose tertiles). CONCLUSIONS: Children without severe conditions enrolled in Tennessee Medicaid frequently filled outpatient opioid prescriptions for acute, self-limited conditions. One of every 2611 study opioid prescriptions was followed by an opioid-related adverse event (71.2% of which were related to therapeutic use of the prescribed opioid).
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2017-2156
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2018
    detail.hit.zdb_id: 1477004-0
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  • 2
    Online Resource
    Online Resource
    Double-Blind Study of the Effectiveness of a Broad Spectrum Antibiotic in Status Asthmaticus
    American Academy of Pediatrics (AAP) ; 1974
    In:  Pediatrics Vol. 54, No. 4 ( 1974-10-01), p. 428-428
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 54, No. 4 ( 1974-10-01), p. 428-428
    Abstract: The dosage of 1:1,000 aqueous epinephrine is incorrectly given in the article by Shapiro et al. in the June issue (Pediatrics, 53:867, 1974). The cor- rect dosage is 0.01 cc/kilo instead of 0.1 cc/kilo as given. The patient's serum IgE level in the article by Albrecht et al. in the June issue (Pediatrics, 53:907, 1974) is incorrect. It should be given as 205 nanograms per milliliter instead of 205 mg/ml.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.54.4.428
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 1974
    detail.hit.zdb_id: 1477004-0
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  • 3
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    Online Resource
    Double-Blind Study of the Effectiveness of a Broad Spectrum Antibiotic in Status Asthmaticus
    American Academy of Pediatrics (AAP) ; 1974
    In:  Pediatrics Vol. 53, No. 6 ( 1974-06-01), p. 867-872
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 53, No. 6 ( 1974-06-01), p. 867-872
    Abstract: Forty-four children and adolescents with status asthmaticus and without signs of bacterial infection, such as otitis media, purulent pharyngitis or lobular pulmonary infiltrate and fever were treated identically except that one group received hetacillin, whose active form is ampicillin, and one group received placebo in a prerandomized double-blind fashion. The groups were similar in terms of age, size and severity of asthma. Hospital course, complications and duration of hospitalization were similar for the two groups. The incidence of viral and mycoplasma infection was 20%. History, physical examination and chest x-ray were poor predictors of those with nonbacterial infection. There was no culture evidence that bacterial disease had been missed. It appears that the use of broad spectrum antibiotics such as hetacillin or ampicillin in children and adolescents with status asthmaticus and without clinical evidence of bacterial disease is of no benefit. The need for close observation of these patients is stressed.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.53.6.867
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 1974
    detail.hit.zdb_id: 1477004-0
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  • 4
    Online Resource
    Online Resource
    Trends in Invasive Methicillin-Resistant Staphylococcus aureus Infections
    American Academy of Pediatrics (AAP) ; 2013
    In:  Pediatrics Vol. 132, No. 4 ( 2013-10-01), p. e817-e824
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 132, No. 4 ( 2013-10-01), p. e817-e824
    Abstract: To describe trends in the incidence of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in children during 2005–2010. METHODS: We evaluated reports of invasive MRSA infections in pediatric patients identified from population-based surveillance during 2005–2010. Cases were defined as isolation of MRSA from a normally sterile site and classified on the basis of the setting of the positive culture and presence or absence of health care exposures. Estimated annual changes in incidence were determined by using regression models. National age- and race-specific incidences for 2010 were estimated by using US census data. RESULTS: A total of 876 pediatric cases were reported; 340 (39%) were among infants. Overall, 35% of cases were hospital-onset, 23% were health care–associated community-onset, and 42% were community-associated (CA). The incidence of invasive CA-MRSA infection per 100 000 children increased from 1.1 in 2005 to 1.7 in 2010 (modeled yearly increase: 10.2%; 95% confidence interval: 2.7%–18.2%). No significant trends were observed for health care–associated community-onset and hospital-onset cases. Nationally, estimated invasive MRSA incidence in 2010 was higher among infants aged & lt;90 days compared with older infants and children (43.9 vs 2.0 per 100 000) and among black children compared with other races (6.7 vs 1.6 per 100 000). CONCLUSIONS: Invasive MRSA infection in children disproportionately affects young infants and black children. In contrast to reports of declining incidence among adults, there were no significant reductions in health care–associated MRSA infections in children. Concurrently, the incidence of CA-MRSA infections has increased, underscoring the need for defining optimal strategies to prevent MRSA infections among children with and without health care exposures.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2013-1112
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2013
    detail.hit.zdb_id: 1477004-0
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  • 5
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    Online Resource
    Passive Immunization for Infection With Haemophilus influenzae Type b
    American Academy of Pediatrics (AAP) ; 1990
    In:  Pediatrics Vol. 85, No. 4 ( 1990-04-01), p. 662-666
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 85, No. 4 ( 1990-04-01), p. 662-666
    Abstract: Haemophilus influenzae type b is the leading cause of meningitis in children younger than 5 years of age in the United States.1 The incidence of infection with H influenzae type b in certain populations, such as Apache and Navajo Indians and Alaskan Eskimos, is 10 to 20 times higher than in the general US population.2-4 Another important feature of H influenzae type b infections in these populations is that more than 80% of the cases occur during the first year of life, with 35% to 45% occurring during the first 6 months. One of the currently licensed vaccines that contains the capsular polysaccharide of the H influenzae type b organism is not reliably immunogenic in infants younger than 18 months of age.5,6 A number of new H influenzae type b vaccines prepared by covalently coupling the H influenzae type b capsular polysaccharide with a protein carrier antigen are undergoing clinical evaluation.7-13 One of these conjugate vaccines was shown to be efficacious in preventing disease caused by H influenzae type b in Finnish infants when they were immunized at 3, 4, and 6 months of age.14 Unfortunately, in a recently concluded trial, the same vaccine was not found to be efficacious in preventing such disease in infants younger than 1 year of age among the Alaskan Eskimo population.15 We have evaluated an alternative approach for protecting high-risk infants. A human hyperimmune globulin called bacterial polysaccharide immune globulin (BPIG) was prepared from the pooled plasma of adult blood donors immunized with H influenzae type b, pneumococcal, and meningococcal capsular polysaccharide.16
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.85.4.662
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 1990
    detail.hit.zdb_id: 1477004-0
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  • 6
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    Online Resource
    Antidepressants and Suicide Attempts in Children
    American Academy of Pediatrics (AAP) ; 2014
    In:  Pediatrics Vol. 133, No. 2 ( 2014-02-01), p. 204-210
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 133, No. 2 ( 2014-02-01), p. 204-210
    Abstract: Recent data showing possible increased risk for suicidal behavior among children and adolescents treated with selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) antidepressants have created significant concern among patients, families, and providers, including concerns about the risk of individual antidepressants. This study was designed to compare the risk for medically treated suicide attempts among new users of sertraline, paroxetine, citalopram, escitalopram, and venlafaxine to risk for new users of fluoxetine. METHODS: A retrospective cohort study included 36 842 children aged 6 to 18 years enrolled in Tennessee Medicaid between 1995 and 2006 who were new users of 1 of the antidepressant medications of interest (defined as filling no prescriptions for antidepressants in the preceding 365 days). Medically treated suicide attempts were identified from Medicaid files and vital records and confirmed with medical record review. RESULTS: Four hundred nineteen cohort members had a medically treated suicide attempt with explicit or inferred attempt to die confirmed through medical record review, including 4 who completed suicide. The rate of confirmed suicide attempts for the study drugs ranged from 24.0 per 1000 person-years to 29.1 per 1000 person-years. The adjusted rate of suicide attempts did not differ significantly among current users of SSRI and SNRI antidepressants compared with current users of fluoxetine. Users of multiple antidepressants concomitantly had increased risk for suicide attempt. CONCLUSIONS: In this population-based study of children recently initiating an antidepressant, there was no evidence that risk of suicide attempts differed for commonly prescribed SSRI and SNRI antidepressants.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2013-0923
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2014
    detail.hit.zdb_id: 1477004-0
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