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Variation in Prenatal Diagnosis of Congenital Heart Disease in Infants

Prenatal diagnosis may lead to benefits in outcomes for certain forms of critical congenital heart disease. Despite recognized benefits, single-center studies and focused regional efforts suggest that prenatal detection rates for congenital heart disease remain low in the United States.

We describe prenatal detection rates for a large cohort of neonates and infants undergoing heart surgery across a range of congenital heart defects. Additionally, this study adds new information by demonstrating geographic variability of prenatal detection rates across the United States. (Read the full article)




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Congenital Heart Defects and Receipt of Special Education Services

Poor neurocognitive outcomes are associated with some types of congenital heart defects (CHDs). Guidelines for developmental screening for children with CHDs have been published. Population-based information on special education services needed among children with CHDs is limited.

Children in metropolitan Atlanta with congenital heart defects (CHDs) received special education services more often than children without birth defects. These findings highlight the need for special education services and the importance of developmental screening for all children with CHDs. (Read the full article)




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Infection-Related Hospitalization in Childhood and Adult Metabolic Outcomes

Childhood inflammatory mediators are associated with adult obesity, but the stimuli that initiate and perpetuate chronic inflammation start in early life are largely unknown.

Childhood infection-related hospitalization was independently associated with adverse adult metabolic variables, which suggests that infections and/or their treatment in childhood may contribute to causal pathways leading to adult cardiometabolic diseases. (Read the full article)




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Computed Tomography and Shifts to Alternate Imaging Modalities in Hospitalized Children

Concern of the risk of malignancy from ionizing radiation has prompted many to advocate for judicious use of computed tomography (CT) and as low as necessary radiation doses administered per scan. Recent analysis has shown a decline in CT utilization.

We identified decreases in CT utilization between 2004 and 2012 for the 10 most common diagnostic groups receiving CT. Decreases were typically associated with increases in alternate imaging modalities. We provide a possible reason for the decrease in CT utilization. (Read the full article)




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Disorders in Children With Congenital Cytomegalovirus Infection

Congenital cytomegalovirus infection is the leading infectious cause of neurologic disabilities and sensorineural hearing loss in children. Little is known concerning the frequency and impact of vestibular disorders induced by cytomegalovirus infection.

This study reports on the largest cohort of vestibular assessment of children congenitally infected with cytomegalovirus, demonstrating vestibular damages, and analyzes the correlations between vestibular dysfunction and hearing impairment or severity of infection. Cytomegalovirus infection affects postural development in children. (Read the full article)




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Reasons for Rehospitalization in Children Who Had Neonatal Abstinence Syndrome

Infants with neonatal abstinence syndrome are hospitalized for longer after birth and are more likely to be from highly vulnerable families. Determining long-term outcomes is difficult because this is a large and chaotic population.

(Read the full article)




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Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial

The vitamin D concentration in breast milk of women taking 400 IU vitamin D per day is relatively low, leading to vitamin D deficiency in breastfeeding infants. As a result, the American Academy of Pediatrics recommends breastfeeding infant vitamin D supplementation within days after birth.

Maternal vitamin D supplementation alone with 6400 IU/day safely supplies breast milk with adequate vitamin D to satisfy the requirement of her nursing infant and offers an alternate strategy to direct infant supplementation. (Read the full article)




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Hospital Use in the Last Year of Life for Children With Life-Threatening Complex Chronic Conditions

Children with life-threatening complex chronic conditions (LT-CCCs) experience high hospital use.

Hospital use in the last year of life for these children varies by type and number of LT-CCCs. Most children with ≥3 LT-CCCs are admitted to the hospital for more than 2 months in the last year of life. (Read the full article)




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Hospital Variation in Health Care Utilization by Children With Medical Complexity

Children with medical complexity require a disproportionate amount of health services due to a multitude of chronic severe illness, and their impact on the health care system appears to be increasing.

This study provides one of the first comparisons of health care utilization patterns for children with medical complexity between medical centers in a population-based cohort. (Read the full article)




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Point-of-Care Quantitative Measure of Glucose-6-Phosphate Dehydrogenase Enzyme Deficiency

Glucose-6-phosphate dehydrogenase deficiency remains a global as well as a North American burden for extreme hyperbilirubinemia and kernicterus and is often unpredictable during the first few days after birth. Newborn screening for this enzyme deficiency is not universally available but debated.

Point-of-care screening, using digital microfluidics, provides accurate, low blood volume, and affordable technology for rapid newborn glucose-6-phosphate dehydrogenase enzyme screening that could guide clinicians before infants’ discharge from well-child nurseries and meet existing American Academy of Pediatrics’ recommendations. (Read the full article)




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Use of a Metronome in Cardiopulmonary Resuscitation: A Simulation Study

The frequency of cardiac arrest is significantly lower in children than in adults, rendering the delivery of high-quality cardiopulmonary resuscitation more difficult. Metronome-based studies in adults showed improvement in adequate compression rate, with a detrimental effect on the depth of chest compressions.

This is the first pediatric study to confirm that the use of a metronome during cardiopulmonary resuscitation significantly improves the delivery of adequate rate without affecting the compression depth. This effect was more prominent among medical students and pediatric residents and fellows than nurses. (Read the full article)




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Physician and Nurse Nighttime Communication and Parents' Hospital Experience

Communication between parents and providers is an important driver of parent experience of care. The impact of nighttime communication, which has become increasingly relevant after changes in resident physician duty hours, on parent experience is unknown.

Parent communication with nighttime doctors and nurses, and parent perceptions of communication and teamwork between these providers, may be important drivers of parent experience. Efforts to improve nighttime communication, both with parents and between team members, may improve parent experience. (Read the full article)




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Variation in Utilization of Computed Tomography Imaging at Tertiary Pediatric Hospitals

Given the efforts to decrease the use of ionizing radiation in pediatric patients, there is significant variability in head computed tomography (CT) scan use in pediatric emergency departments for minor head trauma.

This study characterized variability in CT scan rates for all body regions in emergency department, observation, and inpatient encounters across 30 tertiary pediatric hospitals. Two-fold variation remained after case-mix adjustment, with higher volume hospitals having lower rates of CT scanning. (Read the full article)




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The Medical Home and Hospital Readmissions

Receiving primary care in a high-quality medical home may lead to reductions in hospital or emergency department (ED) utilization; however, the relationship between the medical home and postdischarge hospitalizations and ED visits is poorly understood.

Readmission rates vary markedly based on data source and definition. Unplanned readmissions were associated with absence of a usual source of well and sick care but not other medical home components. Lack of parent confidence at discharge identified patients at high risk for readmissions and ED visits shortly after discharge. (Read the full article)




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Teachers' Content Chops Are Vital to Teach Early Algebra

An educator's experience teaching math is important, but performance on math-content-certification tests is the best predictor of how well a teacher's students will perform in early algebra, finds a new study by the Regional Educational Laboratory Central at Marzano Research.




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Understanding the impacts of unexpected shift to digital learning

The unexpected transition to online classes due to the COVID-19 pandemic has prompted many changes for undergraduate students and their instructors. To understand the magnitude of these impacts and potentially improve digital learning, researchers in the Penn State School of Engineering Design and Professional Programs have received a $196,136 grant from the National Science Foundation.




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Free dental services for veterans, active military and dependents

Pennsylvania College of Technology dental hygiene students and volunteer dental professionals will provide free dental hygiene services to veterans, members of the armed services, and their dependents on Saturday, April 4.




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Study: Digital Summer Learning Boosts Achievement

The report suggests programs delivering instruction through multiple media platforms can lead to significant improvement in students' mathematics, numeracy, and phonics skills.




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Public Libraries Add Multimedia Learning to Digital Mission

Public libraries are moving deeper into digital learning, often in partnership with schools and other institutions, to help prepare students for the skills they'll need for college and careers.




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The Best Digital Cameras for 2020

Want better photos than your phone can provide? We test and rate hundreds of cameras and lenses each year, ranging from pocket-friendly shooters to high-end medium format systems. Here's everything you need to know to pick the best digital camera for you.




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Congo Crisis: Military Intervention in Ituri




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After MONUC, Should MONUSCO Continue to Support Congolese Military Campaigns?

For more than a year and a half, UN peacekeepers have continuously supported military operations conducted by the Congolese armed forces (FARDC) against the Rwandan rebels of the Democratic Forces for the Liberation of Rwanda (FDLR) in North and South Kivu.




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Imaginación para salvar República Centroafricana. Cómo actuar con rapidez y eficacia para evitar la somalización del país.

Los conflictos en los países pequeños suelen agravarse debido a la indiferencia internacional. Sin embargo, en el caso de la República Centroafricana (RCA), el problema es ligeramente distinto. Hay una importante presencia internacional en este Estado, pero los actores principales han decidido mantenerse al margen y esperar en vez de intervenir activamente en la crisis.




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Prediction of antibiotic susceptibility for urinary tract infection in a hospital setting [Epidemiology and Surveillance]

Objectives: Empiric antibiotic prescribing can be supported by guidelines and/or local antibiograms, but these have limitations. We sought to use data from a comprehensive electronic health record to use statistical learning to develop predictive models for individual antibiotics that incorporate patient-, and hospital-specific factors. This paper reports on the development and validation of these models on a large retrospective cohort.

Methods: This is a retrospective cohort study including hospitalized patients with positive urine cultures in the first 48 hours of hospitalization at a 1500 bed, tertiary care hospital over a 4.5 year period. All first urine cultures with susceptibilities were included. Statistical learning techniques, including penalized logistic regression, were used to create predictive models for cefazolin, ceftriaxone, ciprofloxacin, cefepime, and piperacillin-tazobactam. These were validated on a held-out cohort.

Results: The final dataset used for analysis included 6,366 patients. Final model covariates included demographics, comorbidity score, recent antibiotic use, recent antimicrobial resistance, and antibiotic allergies. Models had acceptable to good discrimination in the training dataset and acceptable performance in the validation dataset, with a point estimate for area under the receiver operating characteristic curve (AUC) that ranged from 0.65 for ceftriaxone to 0.69 for cefazolin. All models had excellent calibration.

Conclusion: In this study we used electronic health record data to create predictive models to estimate antibiotic susceptibilities for UTIs in hospitalized patients. Our models had acceptable performance in a held-out validation cohort.




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Validation of a Prediction Rule for Mortality in Congenital Diaphragmatic Hernia

BACKGROUND:

Congenital diaphragmatic hernia (CDH) is a rare congenital anomaly with a mortality of ~27%. The Congenital Diaphragmatic Hernia Study Group (CDHSG) developed a simple postnatal clinical prediction rule to predict mortality in newborns with CDH. Our aim for this study is to externally validate the CDHSG rule in the European population and to improve its prediction of mortality by adding prenatal variables.

METHODS:

We performed a European multicenter retrospective cohort study and included all newborns diagnosed with unilateral CDH who were born between 2008 and 2015. Newborns born from November 2011 onward were included for the external validation of the rule (n = 343). To improve the prediction rule, we included all patients born between 2008 and 2015 (n = 620) with prenatally diagnosed CDH and collected pre- and postnatal variables. We build a logistic regression model and performed bootstrap resampling and computed calibration plots.

RESULTS:

With our validation data set, the CDHSG rule had an area under the curve of 79.0%, revealing a fair predictive performance. For the new prediction rule, prenatal herniation of the liver was added, and absent 5-minute Apgar score was taken out. The new prediction rule revealed good calibration, and with an area under the curve of 84.6%, it had good discriminative abilities.

CONCLUSIONS:

In this study, we externally validated the CDHSG rule for the European population, which revealed fair predictive performance. The modified rule, with prenatal liver herniation as an additional variable, appears to further improve the model’s ability to predict mortality in a population of patients with prenatally diagnosed CDH.




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Continuous Albuterol With Benzalkonium in Children Hospitalized With Severe Asthma

BACKGROUND AND OBJECTIVES:

The albuterol dropper bottle used to prepare solutions for continuous nebulization contains the preservative benzalkonium chloride (BAC). BAC, by itself, has been shown to cause bronchospasm. We hypothesized that BAC would decrease the therapeutic efficacy of albuterol in patients with acute asthma exacerbations.

METHODS:

We performed a retrospective cohort study comparing the clinical outcomes of patients <18 years of age receiving continuous nebulized albuterol with and without BAC. For the primary end point (duration of continuous albuterol nebulization), we compared the 2 groups with Kaplan-Meier estimate of survival curves, conducted a log-rank test of difference, and adjusted for baseline characteristics using multivariable Cox regression. A P value <.05 was considered significant.

RESULTS:

A total of 477 patients were included in the analysis (236 exposed to BAC and 241 controls). The duration of continuous nebulization was significantly longer in the BAC group than in the control group (median of 9 vs 6 hours; 15.7% required continuous nebulization compared to 5.8% of controls at 24 hours). The control group was 79% more likely to stop continuous nebulization at any particular point in time (hazard ratio 1.79; 95% confidence interval: 1.45 to 2.22; P < .001) and 43% more likely to stop additional respiratory support (hazard ratio 1.43; 95% confidence interval: 1.16 to 1.75; P < .001).

CONCLUSIONS:

BAC is a functional albuterol antagonist associated with a longer duration of continuous albuterol nebulization treatment and additional respiratory support, suggesting that preservative-free albuterol formulations are safer for use in continuous nebulization.




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Educational Technology Has Limitations

Deep and lasting learning can best come from the relationship between teachers and their students.




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Digital Technology Is Gambling With Children's Minds

Writing, reading, focusing, and remembering have all been transformed in ways we don't yet fully understand, writes psychologist Elias Aboujaoude.




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Penn State Health hospitals use recovered patients' plasma as COVID-19 treatment

Penn State Health has enrolled its first COVID-19 patient into an experimental treatment program called convalescent plasma therapy.




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Benign Neonatal Shudders, Shivers, Jitteriness, or Tremors: Early Signs of Vitamin D Deficiency

Millicent Collins
Aug 1, 2017; 140:e20160719-e20160719
CASE REPORTS




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Fin24.com | Investors struggling to find returns and protect their capital in unusual prevailing climate

Extremely low or negative yields in global markets make it challenging for investors to generate meaningful returns, says Brian McMillan of Investec Structured Products.




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Digital Fluency Project goes remote at Penn State Greater Allegheny

A signature program at Penn State Greater Allegheny, implemented to give students, faculty and staff the digital skills to communicate, solve problems and create new knowledge, is front and center in the University’s remote learning period.




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Spain, Italy, Russia among qualifiers as main round ends

Italy, Azerbaijan, Ukraine, Portugal, Spain, Kazakhstan and Russia joined hosts Slovenia in the finals by winning their main round groups while the eight play-off contenders are confirmed.




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Penn State degree is this military wife’s hardest but proudest achievement

Penn State World Campus student Julie Brubaker balanced her family, job, and earning her bachelor’s degree, all while her military husband was deployed.




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Resources Recommended for the Care of Pediatric Patients in Hospitals

It is crucial that all children are provided with high-quality and safe health care. Pediatric inpatient needs are unique in regard to policies, equipment, facilities, and personnel. The intent of this clinical report is to provide recommendations for the resources necessary to provide high-quality and safe pediatric inpatient medical care.




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The Digital Watch: A Brief History

Before there were smartwatches, digital watches were the most high-tech timepieces you could buy. We explore the evolution of the digital watch from 1972 to present day.




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10 Digital Comic Books You Need to Read Right Now

Superheroics. Crime capers. Historical fiction. Conspiracies. Put a world of wonderful stories in your pocket with these 10 excellent digital comics.




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Western Digital Launches 5 WD Black External Gaming Drives

Capacities range from 2TB right up to 12TB, with the P50 Game Drive boasting a 'first-to-industry' USB 3.2 gen 2x2 connection and 2,000MB/s read speeds.




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Teachers' Content Chops Are Vital to Teach Early Algebra

An educator's experience teaching math is important, but performance on math-content-certification tests is the best predictor of how well a teacher's students will perform in early algebra, finds a new study by the Regional Educational Laboratory Central at Marzano Research.




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Increasing Prevalence of Medically Complex Children in US Hospitals

Katherine H. Burns
Oct 1, 2010; 126:638-646
ARTICLES




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Longitudinal Growth of Hospitalized Very Low Birth Weight Infants

Richard A. Ehrenkranz
Aug 1, 1999; 104:280-289
ARTICLES




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Trends in Bronchiolitis Hospitalizations in the United States, 2000-2009

Kohei Hasegawa
Jul 1, 2013; 132:28-36
ARTICLES




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The EPICure Study: Outcomes to Discharge From Hospital for Infants Born at the Threshold of Viability

Kate Costeloe
Oct 1, 2000; 106:659-671
ARTICLES




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Children With Complex Chronic Conditions in Inpatient Hospital Settings in the United States

Tamara D. Simon
Oct 1, 2010; 126:647-655
ARTICLES




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Palivizumab, a Humanized Respiratory Syncytial Virus Monoclonal Antibody, Reduces Hospitalization From Respiratory Syncytial Virus Infection in High-risk Infants

The IMpact-RSV Study Group
Sep 1, 1998; 102:531-537
ARTICLES




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U19 ambassador Mkhitaryan's Armenian pride

Armenia's most famous footballing son, Henrikh Mkhitaryan is the U19 EURO ambassador and looks back at his own youth career.




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Invent Penn State Innovation Hub Network pivots to offer digital resources

Across Pennsylvania, the Invent Penn State innovation hub network has pivoted to deliver needed programming and services online, by providing online mentoring, webinars, virtual speaker series, and a Virtual Idea TestLab.




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Using data to maximize hospital resources

As a student in Penn State's College of Information Sciences and Technology, Steve Ney learned critical skills, from coding to data design and architecture. Today, he applies that foundation in his "dream job" as a healthcare data analyst for Geisinger Health, where he uses those skills to help produce visual outputs for doctors and staff to utilize in caring for patients.




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Odd but stellar undergrad research project vital to student’s education, future

When Kaylee Kishbaugh arrived at Penn State four years ago, she didn’t even know what prosciutto was, let alone that it could be made from duck. But now, looking back over her undergraduate experience and looking ahead to her career, she realizes the odd meat product was pivotal for her.




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How Digital Games Take the Stress Out of Formative Tests

Elementary school teachers in the Peach State are using "game-based" formative assessments to take a pulse on their students' learning.