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  • 1
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    Online Resource
    Evidence Assessment of Management of Acute Otitis Media: I. The Role of Antibiotics in Treatment of Uncomplicated Acute Otitis Media
    American Academy of Pediatrics (AAP) ; 2001
    In:  Pediatrics Vol. 108, No. 2 ( 2001-08-01), p. 239-247
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 108, No. 2 ( 2001-08-01), p. 239-247
    Abstract: In 1995, & gt;5 million episodes of acute otitis media (AOM) accounted for $3 billion in health care expenditures. Objectives. To synthesize the literature on the natural history of AOM, the effectiveness of antibiotic treatment in uncomplicated AOM, and the relative effectiveness of specific antibiotic regimens. Data Sources. Seven electronic databases for articles published between 1966 and March 1999 and reference lists in proceedings, published articles, reports, and guidelines. Study Selection. Two physicians independently assessed each article. Studies addressing AOM in children 4 weeks to 18 years old were included; those addressing children with immunodeficiencies or craniofacial abnormalities were excluded. Randomized, controlled trials (RCTs) were used to assess antibiotic effectiveness, and RCTs and cohort studies were used to assess the natural history of AOM. Among the 3491 citations identified, 80 (2.3%) met our inclusion criteria. Data Extraction. Two physicians independently abstracted data and assessed the quality of studies using a validated scale for RCTs and 8 quality components for cohort studies. Data Synthesis. Random-effects estimates of pooled absolute rate differences of outcomes were derived, and heterogeneity of both the rates and rate differences was assessed. Children with AOM not treated with antibiotics experienced a 1- to 7-day clinical failure rate of 19% (95% confidence interval: 0.10–0.28) and few suppurative complications. When patients were treated with amoxicillin, the 2- to 7-day clinical failure rate was reduced to 7%, a 12% (95% confidence interval: 0.04–0.20) reduction. Adverse effects, primarily gastrointestinal, were more common among children on cefixime than among those on ampicillin or amoxicillin. They were also more common among children on amoxicillin-clavulanate than among those on azithromycin. Conclusions. The majority of uncomplicated cases of AOM resolve spontaneously without apparent suppurative complications. Ampicillin or amoxicillin confers a limited therapeutic benefit. There is no evidence to support any particular antibiotic regimens as more effective at relieving symptoms. Certain antibiotics are more likely than others to cause diarrhea and other adverse events.
    Type of Medium: Online Resource
    ISSN: 1098-4275 , 0031-4005
    URL: Article
    DOI: 10.1542/peds.108.2.239
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2001
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  • 2
    Online Resource
    Online Resource
    Evidence Assessment of Management of Acute Otitis Media: II. Research Gaps and Priorities for Future Research
    American Academy of Pediatrics (AAP) ; 2001
    In:  Pediatrics Vol. 108, No. 2 ( 2001-08-01), p. 248-254
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 108, No. 2 ( 2001-08-01), p. 248-254
    Abstract: To report research gaps and priorities of future research identified during an evidence assessment process on the management of acute otitis media (AOM). Methods. A conceptual framework for management of AOM was developed to guide the evidence assessment. An 11-member technical expert panel guided the selection of key questions, prioritization of influencing factors, development of scope, definition of AOM, and search strategy through polling processes and conference calls. Quality of clinical trials was evaluated using established scales. Outcome measures were abstracted from each study. Results. A total of 3461 titles and abstracts were screened, and 760 full-length articles were reviewed. Of the 760 articles, 80 studies addressed the key questions. In defining AOM, 42 (52.5%) of the 80 studies included the middle-ear effusion component, only 2 (2.5%) included the rapid onset component, and 26 (32.5%) included the signs/symptoms of inflammation component. None of the 80 studies used all 3 components. Of the 74 controlled trials, 39 (53%) were of acceptable quality (Jadad score of 3 or higher). The technical experts did not agree in the ranking of the importance of the 41 influencing factors (Kendall's coefficient of concordance was 0.0022). Another poll also indicated diverse opinions of the experts on the importance of 7 key questions derived from the conceptual framework (Kendall coefficient of concordance is 0.21). Furthermore, our review found that the type and definition of outcome measure varied. Conclusions. Despite the large body of literature on AOM, its quality is uneven and its findings are not generalizable. Future research should try to answer all key questions and investigate all risk factors in well-designed, scientific studies.
    Type of Medium: Online Resource
    ISSN: 1098-4275 , 0031-4005
    URL: Article
    DOI: 10.1542/peds.108.2.248
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2001
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  • 3
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    Online Resource
    Evidence Assessment of the Accuracy of Methods of Diagnosing Middle Ear Effusion in Children With Otitis Media With Effusion
    American Academy of Pediatrics (AAP) ; 2003
    In:  Pediatrics Vol. 112, No. 6 ( 2003-12-01), p. 1379-1387
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 112, No. 6 ( 2003-12-01), p. 1379-1387
    Abstract: Objectives. We report the findings of an evidence assessment on the accuracy of methods of diagnosing middle ear effusion in children with otitis media with effusion (OME). Methods. We searched Medline (1966–January 2000), the Cochrane Library (through January 2000), and Embase (1980–January 2000) and identified additional articles from reference lists in proceedings, published articles, reports, and guidelines. Excluded were nonhuman studies; case reports; editorials; letters; reviews; practice guidelines; non–English-language publications; and studies on patients with immunodeficiencies, craniofacial anomalies (including cleft palate), primary mucosal disorders, or genetic conditions. From each eligible study, we calculated the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and prevalence of OME in the cohort. We determined the number of studies for each comparison of a diagnostic method and a reference standard listed within the scope of our assessment. For comparisons with 3 or more studies, we derived random effects estimates of sensitivity, specificity, and prevalence rate. Using the pooled estimates, we plotted the performance of each diagnostic test in terms of sensitivity and (1 − specificity) and identified the best performer among the tests included in the comparison. Results. Among 8 diagnostic methods, pneumatic otoscopy had the best apparent performance with a sensitivity of 94% (95% confidence interval: 92%–96%) and a specificity of 80% (95% confidence interval: 75%–86%). However, examiner qualifications were reported inconsistently, and training was not specified. Conclusions. The finding that pneumatic otoscopy can do as well as or better than tympanometry and acoustic reflectometry has significant practical implications. For the typical clinician, pneumatic otoscopy should be easier to use than other diagnostic methods. The important question may be what degree of training will be needed for the clinician to be as effective with pneumatic otoscopy as were the examiners in the studies reviewed in this report.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.112.6.1379
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2003
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  • 4
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    Online Resource
    Sudden Infant Death Syndrome in Infants Evaluated by Apnea Programs in California
    American Academy of Pediatrics (AAP) ; 1986
    In:  Pediatrics Vol. 77, No. 4 ( 1986-04-01), p. 451-458
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 77, No. 4 ( 1986-04-01), p. 451-458
    Abstract: Home apnea/bradycardia monitoring is frequently used in the management of infants at increased risk for sudden infant death syndrome (SIDS). However, some infants have died despite evaluation by infant apnea programs, and the benefits of home monitoring remain unproven. To determine the SIDS rate and risk factors of infants evaluated by infant apnea programs, 31 apnea programs and ten home monitor vendors in California were surveyed. Eleven (35%) of the apnea programs and four (40%) of the vendors responded. Information was obtained on 26 infants who died. Thirteen (50%) deaths were due to SIDS. Abnormal sleep studies did not predict death. Fifteen infants died despite a recommendation for home monitoring. Seven deaths occurred in association with technical errors or noncompliance with monitoring. Four deaths were due to nonaccidental trauma. The apnea programs evaluated 3,406 infants during a 5-year period; 1,841 had monitoring recommended. Term infants with apnea, subsequent siblings of SIDS victims, and infants evaluated at referral centers were more likely to have monitoring recommended than premature infants with apnea or infants evaluated at nonreferral centers (P & lt; .0001). Infants who had monitoring recommended were at equal risk of dying of SIDS as those who did not.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.77.4.451
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 1986
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  • 5
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    Online Resource
    Maternal and Newborn Hospital Outcomes of Perinatal SARS-CoV-2 Infection: A National Registry
    American Academy of Pediatrics (AAP) ; 2023
    In:  Pediatrics Vol. 151, No. 2 ( 2023-02-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 151, No. 2 ( 2023-02-01)
    Abstract: The American Academy of Pediatrics National Registry for the Surveillance and Epidemiology of Perinatal coronavirus disease 2019 (COVID-19) (NPC-19) was developed to provide information on the effects of perinatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS National Registry for the Surveillance and Epidemiology of Perinatal COVID-19 participating centers entered maternal and newborn data for pregnant persons who tested positive for SARS-CoV-2 infection between 14 days before and 10 days after delivery. Incidence of and morbidities associated with maternal and newborn SARS-CoV-2 infection were assessed. RESULTS From April 6, 2020 to March 19, 2021, 242 centers in the United States centers reported data for 7524 pregnant persons; at the time of delivery, 78.1% of these persons were asymptomatic, 18.2% were symptomatic but not hospitalized specifically for COVID-19, 3.4% were hospitalized for COVID-19 treatment, and 18 (0.2%) died in the hospital of COVID-related complications. Among 7648 newborns, 6486 (84.8%) were tested for SARS-CoV-2, and 144 (2.2%) were positive; the highest rate of newborn infection was observed when mothers first tested positive in the immediate postpartum period (17 of 125, 13.6%). No newborn deaths were attributable to SARS-CoV-2 infection. Overall, 15.6% of newborns were preterm: among tested newborns, 30.1% of polymerase chain reaction-positive and 16.2% of polymerase chain reaction-negative were born preterm (P & lt; .001). Need for mechanical ventilation did not differ by newborn SARS-CoV-2 test result, but those with positive tests were more likely to be admitted to a NICU. CONCLUSIONS Early in the pandemic, SARS-CoV-2 infection was acquired by newborns at variable rates and without apparent short-term effects. During a period that preceded widespread availability of vaccines, we observed higher than expected numbers of preterm births and maternal in-hospital deaths.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2022-059595
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2023
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  • 6
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    Online Resource
    The Effects of Armed Conflict on Children
    American Academy of Pediatrics (AAP) ; 2018
    In:  Pediatrics Vol. 142, No. 6 ( 2018-12-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 142, No. 6 ( 2018-12-01)
    Abstract: More than 1 in 10 children worldwide are affected by armed conflict. The effects are both direct and indirect and are associated with immediate and long-term harm. The direct effects of conflict include death, physical and psychological trauma, and displacement. Indirect effects are related to a large number of factors, including inadequate and unsafe living conditions, environmental hazards, caregiver mental health, separation from family, displacement-related health risks, and the destruction of health, public health, education, and economic infrastructure. Children and health workers are targeted by combatants during attacks, and children are recruited or forced to take part in combat in a variety of ways. Armed conflict is both a toxic stress and a significant social determinant of child health. In this Technical Report, we review the available knowledge on the effects of armed conflict on children and support the recommendations in the accompanying Policy Statement on children and armed conflict.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2018-2586
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2018
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  • 7
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    Online Resource
    The Effects of Armed Conflict on Children
    American Academy of Pediatrics (AAP) ; 2018
    In:  Pediatrics Vol. 142, No. 6 ( 2018-12-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 142, No. 6 ( 2018-12-01)
    Abstract: Children are increasingly exposed to armed conflict and targeted by governmental and nongovernmental combatants. Armed conflict directly and indirectly affects children’s physical, mental, and behavioral health. It can affect every organ system, and its impact can persist throughout the life course. In addition, children are disproportionately impacted by morbidity and mortality associated with armed conflict. A children’s rights–based approach provides a framework for collaboration by the American Academy of Pediatrics, child health professionals, and national and international partners to respond in the domains of clinical care, systems development, and policy formulation. The American Academy of Pediatrics and child health professionals have critical and synergistic roles to play in the global response to the impact of armed conflict on children.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2018-2585
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2018
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  • 8
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    The Role of Pediatricians in Global Health
    American Academy of Pediatrics (AAP) ; 2018
    In:  Pediatrics Vol. 142, No. 6 ( 2018-12-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 142, No. 6 ( 2018-12-01)
    Abstract: Ninety percent of the world’s children live in low- and middle-income countries, where barriers to health contribute to significant child morbidity and mortality. The American Academy of Pediatrics is dedicated to the health and well-being of all children. To fulfill this promise, this policy statement defines the role of the pediatrician in global health and provides a specific set of recommendations directed to all pediatricians, emphasizing the importance of global health as an integral function of the profession of pediatrics.
    Type of Medium: Online Resource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2018-2997
    Language: English
    Publisher: American Academy of Pediatrics (AAP)
    Publication Date: 2018
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