Pediatrics

Chung, J. R., B. Flannery, R. K. Zimmerman, M. P. Nowalk, M. L. Jackson, L. A. Jackson, J. G. Petrie, E. T. Martin, A. S. Monto, H. Q. McLean, E. A. Belongia, M. Gaglani and A. M. Fry (2017). “Prior season vaccination and risk of influenza during the 2014-2015 season in the U.S.” J Infect Dis: 2017 Jun [Epub ahead of print].

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The US Flu VE Network conducts annual studies of VE using the test-negative study design that is also used in Canada. In the Canadian study, current and prior-season vaccination status is based on a combination of patient self-report and sentinel practitioner documentation. In the US Flu VE Network, current season vaccination status is also based on a combination of patient self-report and electronic immunization records; however, prior-season vaccination is based on immunization records only. Misclassification of vaccine history may result from inaccurate self-report or incomplete immunization records. One study that compared self-reported influenza vaccination to an immunization registry found that patients overreported vaccination by approximately 10% [5]; recall of prior seasons’ vaccination may be less accurate. To minimize misclassification of vaccination history in 2 prior seasons, we considered documented doses only among patients aged ≥9 years with medical records available for at least 2 years prior to enrollment, and excluded patients who reported 2014–2015 influenza vaccination that was not documented. After adjusting for age and other potential confounding variables, we found no statistically significant association between vaccination in 3 consecutive seasons and A(H3N2)-related illness during 2014–2015 (Table 1). However, we observed the highest point estimate among persons vaccinated in 2014–2015 only. A sensitivity analysis restricted to the main genetic group (clade 3C.2a) of antigenically drifted A(H3N2) and influenza negatives resulted in similar estimates (data not shown). Although the higher point estimate for vaccination only in 2014–2015 is consistent with potential negative interference from prior vaccination [1], our results do not support evidence of increased likelihood of influenza due to A(H3N2) viruses among repeatedly vaccinated individuals compared to those unvaccinated in 3 consecutive seasons.

Arpitha Chiruvolu, MD; Kimberly K. Miklis, MSN, NNP-BC; Karen C. Stanzo, MSN; Barbara Petrey, MSN; Chelsey G. Groves, MSN; Kari McCord, BSN; Huanying Qin, MS; Sujata Desai, PhD; Veeral N. Tolia, MD (2017). “Effects of Skin-to-Skin Care on Late Preterm and Term Infants At-Risk for Neonatal Hypoglycemia.” Pediatric Quality and Safety (2017) 2:4;e030.

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Objective: The objective of this study was to evaluate the effects of prolonged skin-to-skin care (SSC) during blood glucose monitoring (12–24 hours) in late preterm and term infants at-risk for neonatal hypoglycemia (NH). Study design: We conducted a retrospective pre- and postintervention study. We compared late preterm and term infants at-risk for NH born in a 1-year period before the SSC intervention, May 1, 2013, to April 30, 2014 (pre-SSC) to at-risk infants born in the year following the implementation of SSC intervention, May 1, 2014, to April 30, 2015 (post-SSC). Results: The number of hypoglycemia admissions to neonatal intensive care unit among at-risk infants for NH decreased significantly from 8.1% pre-SSC period to 3.5% post-SSC period (P = 0.018). The number of infants receiving intravenous dextrose bolus in the newborn nursery also decreased significantly from 5.9% to 2.1% (P = 0.02). Number of infants discharged exclusively breastfeeding increased from 36.4% to 45.7%, although not statistically significant (P = 0.074). Conclusion: This SSC intervention, as implemented in our hospital, was associated with a significant decrease in newborn hypoglycemia admissions to neonatal intensive care unit. The SSC intervention was safe and feasible with no adverse events.

McLean, H. Q., H. Caspard, M. R. Griffin, K. A. Poehling, M. Gaglani, E. A. Belongia, H. K. Talbot, T. R. Peters, K. Murthy and C. S. Ambrose (2017). “Effectiveness of live attenuated influenza vaccine and inactivated influenza vaccine in children during the 2014-2015 season.” Vaccine 35(20): 2685-2693.

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BACKGROUND: A clinical study found that live attenuated influenza vaccine (LAIV) was superior to inactivated influenza vaccine (IIV) against drifted A(H3N2) viruses in children. During the 2014-2015 influenza season, widespread circulation of antigenically and genetically drifted A(H3N2) viruses provided an opportunity to evaluate subtype-specific vaccine effectiveness (VE) of quadrivalent LAIV (LAIV4) and IIV in children. METHODS: Children (2-17years) with febrile acute respiratory illness <5days' duration were enrolled at 4 outpatient sites in the United States during the 2014-2015 influenza season. Nasal swabs were tested for influenza by reverse transcription polymerase chain reaction; vaccination dates were obtained from medical records or immunization registries. VE was estimated using a test-negative design comparing odds of vaccination among influenza cases and test-negative controls with adjustment for potential confounders. RESULTS: Among 1696 children enrolled, 1511 (89%) were included in the analysis. Influenza was detected in 427 (28%) children; 317 had influenza A(H3N2) and 110 had influenza B. Most influenza isolates were characterized as a drifted strain of influenza A(H3N2) or a drifted strain of B/Yamagata. For LAIV4, adjusted VE was 50% (95% confidence interval [CI], 27-66%) against any influenza, 30% (95% CI, -6% to 54%) against influenza A(H3N2), and 87% (95% CI, 63-96%) against type B. For IIV, adjusted VE was 39% (95% CI, 18-54%) against any influenza, 40% (95% CI, 16-58%) against A(H3N2), and 29% (95% CI, -15% to 56%) against type B. Odds of influenza for LAIV4 versus IIV recipients were similar against influenza A(H3N2) (odds ratio [OR], 1.17; 95% CI, 0.73-1.86) and lower against influenza B (OR, 0.18; 95% CI, 0.06-0.55). CONCLUSIONS: LAIV4 and IIV provided similar protection against a new antigenic variant A(H3N2). LAIV4 provided significantly greater protection than IIV against a drifted influenza B strain.

Ahmad, K. A., S. J. Desai, M. M. Bennett, S. F. Ahmad, Y. T. Ng, R. H. Clark and V. N. Tolia (2017). “Changing antiepileptic drug use for seizures in us neonatal intensive care units from 2005 to 2014.” J Perinatol 37(3): 296-300.

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OBJECTIVE: Neonatal seizures are a common problem in the neonatal intensive care unit and are frequently treated with antiepileptic drugs. Limited data exist on current or changing antiepileptic drug use for seizures in the neonatal intensive care unit.We sought to describe trends of antiepileptic drug exposure in a large volume of US neonatal intensive care unit from 2005 to 2014 and we hypothesized increasing levetiracetam exposure over the 10-year study period. STUDY DESIGN: Retrospective cohort study of infants from the Pediatrix Medical Group Clinical Data Warehouse, a large, multicenter, deidentified data set. Data were analyzed for trends in 2-year time periods. Our cohort included infants with a diagnosis of seizures who received an antiepileptic drug that were discharged from the neonatal intensive care unit from 1 January 2005 to 31 December 2014. RESULTS: Among 778 395 infants from 341 facilities, we identified 9134 infants with a seizure diagnosis who received an antiepileptic drug. Phenobarbital was used in 98% of the cohort. From 2005-2006 to 2013-2014 phenobarbital exposure declined from 99 to 96% (P<0.001), phenytoin exposure decreased from 15 to 11% (P<0.001) and levetiracetam exposure increased 10-fold from 1.4 to 14% (P<0.001). Overall, <1% of infants were exposed to carbamazepine, lidocaine or topiramate. CONCLUSIONS: Infants with seizures were overwhelmingly exposed to phenobarbital, despite a significant increase in levetiracetam exposure. The use of phenytoin declined and has been surpassed by levetiracetam as the second most widely used antiepileptic in the neonatal intensive care unit. These changes in antiepileptic drug usage patterns have occurred in the absence of novel efficacy data in neonates.

Downey, L. C., C. M. Cotten, C. P. Hornik, M. M. Laughon, V. N. Tolia, R. H. Clark and P. B. Smith (2017). “Association of in utero magnesium exposure and spontaneous intestinal perforations in extremely low birth weight infants.” J Perinatol: 2017 Jan [Epub ahead of print].

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OBJECTIVE: The objective of this study is to determine whether antenatal exposure to magnesium is associated with spontaneous intestinal perforation (SIP) in extremely low birth weight (ELBW) infants (1000 g). STUDY DESIGN: We identified all ELBW infants admitted to 1 of 323 neonatal intensive care units from 2007 to 2013. We used multivariable conditional logistic regression to compare outcomes in the first 21 days after birth between infants exposed and unexposed to magnesium in utero. RESULTS: Of the 28 035 infants, 11 789 (42%) were exposed to antenatal magnesium (AM). There was no difference in the risk of SIP, odds ratio=1.08 (95% confidence interval; 0.91 to 1.29), between infants exposed and unexposed to AM. Mortality in the first 21 days after birth was lower in the magnesium-exposed infants, odds ratio=0.76 (0.70 to 0.83). CONCLUSION: AM exposure in ELBW infants was not associated with increased risk of SIP.