Children’s Doctor News and Updates: Winter 2019

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Children's Doctor

Study: Toddlers may sleep better in cribs until age 3

Parents who wait to start the crib-to-bed transition until toddlers are 3 years old may find that both they and their children get better sleep, says CHOP’s Ariel Williamson, PhD, who led a study that included a survey of parents from 5 countries.

The results, published in Sleep Medicine, showed that across age groups and countries crib sleeping was connected with an earlier bedtime, falling asleep faster, fewer night awakenings, longer stretches of time asleep, and decreased bedtime resistance and sleep problems.

Read more about the study from CHOP's PolicyLab: "Caregiver-Perceived Sleep Outcomes in Toddlers Sleeping in Cribs versus Beds."

Be alert for type 1 diabetes in kids younger than 5

Since 1990, the incidence of type 1 diabetes has doubled in children under the age of 5, according to Terri H. Lipman, PhD, CRNP, FAAN, nurse practitioner in the Diabetes Center. Making a timely diagnosis is critical since young children have the highest risk for morbidity and mortality at the time of diagnosis. Diabetic ketoacidosis is the No. 1 cause of death in children with diabetes.

Lipman has maintained the Philadelphia Pediatric Diabetes Registry, a participating center in the World Health Organization’s 10-year Multinational Project for Childhood Diabetes — the DIAMOND (Diabetes Mondiale) project, a consortium of 150 centers in 70 countries.

Lipman, who spoke at a press conference at the Pennsylvania state capitol in November to promote diabetes awareness, encourages primary care pediatricians to be alert to the signs and symptoms of type 1 diabetes and keep it in mind as a differential diagnosis when evaluating very young children who come in sick.

CHOP researchers develop screening tool for retinopathy in premature infants

CHOP led a multihospital collaboration that found a simple method to determine which premature infants should be screened for retinopathy of prematurity (ROP). The recommendations, published in JAMA Ophthalmology, have the potential to significantly reduce the number of eye examinations being done.

Of the approximately 70000 babies deemed at risk for ROP who have repeated diagnostic eye examinations in the United States each year, only about 6% actually require laser surgery to try to prevent loss of vision.

The researchers analyzed 7483 premature infants at risk for developing ROP across 29 U.S. and Canadian hospitals between 2006 and 2012. They identified 6 key criteria that could be used to determine whether a child should receive an exam for ROP: birthweight <1051 grams, gestational age <28 weeks, and hydrocephalus, or slow weight gain during 3 time periods between ages 10 and 40 days. Using these criteria, researchers correctly predicted 100% of infants with “type 1 ROP,” which requires treatment, while reducing the number of premature infants who would require examinations by 30.3%.

“The criteria we developed were highly sensitive; in fact, they were slightly more sensitive that the current screening guidelines, and yet they were much more accurate than the current guidelines,” says lead author Gil Binenbaum, MD, MSCE. “The next step is to validate these encouraging results in a second large clinical study before actually using the new criteria in practice.”

Study: Primary care physicians missed chances for HIV testing

In the year prior to diagnosis, there were high rates of missed opportunities for recommended routine HIV testing and sexual history taking, according to a retrospective study of youth with HIV aged 14 to 26 years who were treated at CHOP’s HIV clinic. The study was published in the Journal of Adolescent Health by Nellie Riendeau Lazar, MSN, MPH, CRNP-BC, AAHIVS, and Nadia Dowshen, MD, MSHP, of CHOP’s Adolescent Initiative (AI) Program.

Of the 301 subjects who met study criteria, a total of 58 (19%) had at least 1 visit in the care network in the year prior to diagnosis. Among the total cohort, 183 of 301 had never had an HIV test prior to their first positive test, even though 26% had been seen in the care network in the 3 years prior to their diagnosis. Among the 58 who had prior visits in the network, only 48% were tested for HIV, even though 88% (51) had documented symptoms in their visits that may have been consistent with acute infection. AI is partnering with pediatric primary care practices throughout the region to improve HIV screening rates as recommended by the CDC.

CHOP physicians help write new mTBI guideline

CHOP’s James M. Callahan, MD, associate medical director in the Division of Emergency Medicine, and Cindy W. Christian, MD, a child abuse pediatrician, were on the team that authored the new Centers for Disease Control Pediatric mTBI (mild traumatic brain injury) Guideline, released in September.

“More than 650000 children are seen in emergency departments each year for traumatic brain injury, including concussions,” says Callahan. “Although many mTBI cases are sports-related, over half result from falls from bicycles, monkey bars, and down stairs—in addition to injuries from motor vehicle crashes and other causes of trauma.”

CHOP recognized as Center of Excellence for Bladder Exstrophy

Children’s Hospital is now officially recognized as a Center of Excellence in the treatment and care of patients with bladder and cloacal exstrophy by the Association for the Bladder Exstrophy Community (A-BE-C).

The A-BE-C launched its Centers of Excellence program with the goal of shortening the time it takes families to find complete, effective care for children born with bladder or cloacal exstrophy.

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