PAS Annual Meeting 2014

VANCOUVER – The long-standing practice of endotracheal suctioning in nonvigorous neonates born with meconium-stained amniotic fluid does not reduce adverse outcomes, finds an open-label, randomized trial conducted among 175 term singleton neonates at a tertiary care hospital in India.

Although this practice has been used since the 1970s, it has not been rigorously tested in randomized trials, noted lead investigator Dr. Sushma Nangia, a neonatologist and professor of pediatrics at Lady Hardinge Medical College in New Delhi.

In a statement addressing neonatal resuscitation, the American Academy of Pediatrics and American Heart Association found "insufficient evidence to recommend a change in the current practice" (Pediatrics. 2010;126:e1400-13).

Trial results showed that 26% of the neonates who were not intubated and suctioned developed meconium aspiration syndrome, compared with 32% of their intubated and suctioned counterparts, a nonsignificant difference, researchers reported at the annual meeting of the Pediatric Academic Societies. The distribution of syndrome severity was also statistically indistinguishable.

Additionally, 5% of the neonates in the nonsuctioned group and 10% in the suctioned group died, another nonsignificant difference.

Rates of other adverse outcomes also were essentially the same, except that the nonsuctioned neonates actually had significantly shorter durations of respiratory distress (19 vs. 43 hours) and mechanical ventilation (25 vs. 43 hours).

"In nonvigorous full-term neonates born to mothers with meconium-stained amniotic fluid, our study demonstrated that not performing endotracheal suction to clear the airway during neonatal resuscitation did not increase the incidence of meconium aspiration syndrome or predispose to death," Dr. Nangia commented.

Session attendee Dr. Martin Keszler of Brown University, Providence, R.I., said, "Congratulations for having the courage to do this important study. All of us have been wondering about it, but it’s a practice so deeply ingrained that at least in our litigious environment, it would be very difficult to do. ... I think that this is a very important study because it can reassure future investigators to get the courage up to do this very important work."

"Certainly, it was encouraging that [no endotracheal suctioning] was no worse than control. It even seems that it was better. ... I wonder if you could speculate ..., is the intervention truly harmful and are we really better off leaving them alone?" he asked.

"We really don’t have the numbers that are required to do kind of an equivalence study," Dr. Nangia replied. "So this is just the pilot where we have 175 babies."

Another attendee asked, "With these results, can you give us an idea of the sample size you need to prove [the findings] particularly in the babies with thick meconium? How many babies will you need to test the hypothesis?"

Given the incidence of meconium aspiration syndrome, "from a national perinatal database, we think we would require about 480 babies to study the difference," said Dr. Nangia.

Dr. Nangia disclosed no relevant conflicts of interest.

VANCOUVER – The long-standing practice of endotracheal suctioning in nonvigorous neonates born with meconium-stained amniotic fluid does not reduce adverse outcomes, finds an open-label, randomized trial conducted among 175 term singleton neonates at a tertiary care hospital in India.

Although this practice has been used since the 1970s, it has not been rigorously tested in randomized trials, noted lead investigator Dr. Sushma Nangia, a neonatologist and professor of pediatrics at Lady Hardinge Medical College in New Delhi.

In a statement addressing neonatal resuscitation, the American Academy of Pediatrics and American Heart Association found "insufficient evidence to recommend a change in the current practice" (Pediatrics. 2010;126:e1400-13).

Trial results showed that 26% of the neonates who were not intubated and suctioned developed meconium aspiration syndrome, compared with 32% of their intubated and suctioned counterparts, a nonsignificant difference, researchers reported at the annual meeting of the Pediatric Academic Societies. The distribution of syndrome severity was also statistically indistinguishable.

Additionally, 5% of the neonates in the nonsuctioned group and 10% in the suctioned group died, another nonsignificant difference.

Rates of other adverse outcomes also were essentially the same, except that the nonsuctioned neonates actually had significantly shorter durations of respiratory distress (19 vs. 43 hours) and mechanical ventilation (25 vs. 43 hours).

"In nonvigorous full-term neonates born to mothers with meconium-stained amniotic fluid, our study demonstrated that not performing endotracheal suction to clear the airway during neonatal resuscitation did not increase the incidence of meconium aspiration syndrome or predispose to death," Dr. Nangia commented.

Session attendee Dr. Martin Keszler of Brown University, Providence, R.I., said, "Congratulations for having the courage to do this important study. All of us have been wondering about it, but it’s a practice so deeply ingrained that at least in our litigious environment, it would be very difficult to do. ... I think that this is a very important study because it can reassure future investigators to get the courage up to do this very important work."

"Certainly, it was encouraging that [no endotracheal suctioning] was no worse than control. It even seems that it was better. ... I wonder if you could speculate ..., is the intervention truly harmful and are we really better off leaving them alone?" he asked.

"We really don’t have the numbers that are required to do kind of an equivalence study," Dr. Nangia replied. "So this is just the pilot where we have 175 babies."

Another attendee asked, "With these results, can you give us an idea of the sample size you need to prove [the findings] particularly in the babies with thick meconium? How many babies will you need to test the hypothesis?"

Given the incidence of meconium aspiration syndrome, "from a national perinatal database, we think we would require about 480 babies to study the difference," said Dr. Nangia.

Dr. Nangia disclosed no relevant conflicts of interest.

VANCOUVER – The long-standing practice of endotracheal suctioning in nonvigorous neonates born with meconium-stained amniotic fluid does not reduce adverse outcomes, finds an open-label, randomized trial conducted among 175 term singleton neonates at a tertiary care hospital in India.

Although this practice has been used since the 1970s, it has not been rigorously tested in randomized trials, noted lead investigator Dr. Sushma Nangia, a neonatologist and professor of pediatrics at Lady Hardinge Medical College in New Delhi.

In a statement addressing neonatal resuscitation, the American Academy of Pediatrics and American Heart Association found "insufficient evidence to recommend a change in the current practice" (Pediatrics. 2010;126:e1400-13).

Trial results showed that 26% of the neonates who were not intubated and suctioned developed meconium aspiration syndrome, compared with 32% of their intubated and suctioned counterparts, a nonsignificant difference, researchers reported at the annual meeting of the Pediatric Academic Societies. The distribution of syndrome severity was also statistically indistinguishable.

Additionally, 5% of the neonates in the nonsuctioned group and 10% in the suctioned group died, another nonsignificant difference.

Rates of other adverse outcomes also were essentially the same, except that the nonsuctioned neonates actually had significantly shorter durations of respiratory distress (19 vs. 43 hours) and mechanical ventilation (25 vs. 43 hours).

"In nonvigorous full-term neonates born to mothers with meconium-stained amniotic fluid, our study demonstrated that not performing endotracheal suction to clear the airway during neonatal resuscitation did not increase the incidence of meconium aspiration syndrome or predispose to death," Dr. Nangia commented.

Session attendee Dr. Martin Keszler of Brown University, Providence, R.I., said, "Congratulations for having the courage to do this important study. All of us have been wondering about it, but it’s a practice so deeply ingrained that at least in our litigious environment, it would be very difficult to do. ... I think that this is a very important study because it can reassure future investigators to get the courage up to do this very important work."

"Certainly, it was encouraging that [no endotracheal suctioning] was no worse than control. It even seems that it was better. ... I wonder if you could speculate ..., is the intervention truly harmful and are we really better off leaving them alone?" he asked.

"We really don’t have the numbers that are required to do kind of an equivalence study," Dr. Nangia replied. "So this is just the pilot where we have 175 babies."

Another attendee asked, "With these results, can you give us an idea of the sample size you need to prove [the findings] particularly in the babies with thick meconium? How many babies will you need to test the hypothesis?"

Given the incidence of meconium aspiration syndrome, "from a national perinatal database, we think we would require about 480 babies to study the difference," said Dr. Nangia.

Dr. Nangia disclosed no relevant conflicts of interest.

VANCOUVER, B.C. – Motivational interviewing in the primary care setting promotes weight loss among overweight and obese children, according to results from a randomized trial reported at the annual meeting of the Pediatric Academic Societies.

Investigators conducted the trial, Brief Motivational Interviewing to Reduce Child Body Mass Index (BMi2), in 42 practices across the United States belonging to the Pediatric Research in Office Settings (PROS) research network.

Participants were 645 racially/ethnically and socioeconomically diverse children aged 2-8 years with a body mass index (BMI) in the 85th-97th percentile, and their parents.

©moodboard/thinkstockphotos.com

The practices were randomized into three even groups assigned to deliver usual care (assessment and health education materials), four sessions of motivational interviewing by pediatricians only, or four sessions by pediatricians plus six sessions by registered dietitians, generally by telephone.

Motivational interviewing entails rolling with patient/parent resistance to change, building a discrepancy between their current health status/behaviors and their values and goals, supporting their autonomy, and energizing them to change, explained lead author Ken Resnicow, Ph.D., professor of health behavior and health education, University of Michigan School of Public Health in Ann Arbor.

"When we train clinicians to do motivational interviewing, we want to move them from asking to reflecting, from counterpunching to rolling with resistance, and from informing and advising to eliciting autonomous change talk," he elaborated. If the technique is used properly, patients/parents should be talking more than half the time.

Main trial results showed that at the 2-year mark, all groups had a lower adjusted BMI percentile than the baseline average of about 92. However, the children who received motivational interviewing from both a pediatrician and dietitian had a significantly lower value than the children who received usual care (87.1 vs. 90.3) and a significantly greater reduction in that value from baseline (4.9 vs. 1.8). The findings were similar for raw BMI.

In addition, children in that intervention group consumed more servings of fruits and vegetables daily than their usual-care peers (4.3 vs. 3.8), and had fewer hours of screen time per day (2.2 vs. 2.5). Daily servings of sweet beverages and daily hours of physical activity did not differ significantly.

There were intermediate but generally nonsignificant benefits among the children who received motivational interviewing only from pediatricians.

Pediatricians were highly satisfied with their training, and parents were highly satisfied with pediatrician-delivered motivational interviewing.

"This is actually the first large-scale randomized controlled trial to show that motivational interviewing delivered by primary care providers significantly reduced BMI percentile and raw BMI, and with the effect size, I think most of our colleagues agree that these are clinically significant," Dr. Resnicow commented.

Pediatricians completed an average of 3.4 of their four planned motivational interviewing sessions, and dietitians completed 2.7 of their six planned sessions. Findings showed a dose-response whereby improvements in BMI were greater the more sessions a family completed.

"Of course, there are confounders here, and maybe families that are doing better are more likely to continue therapy, so we have to be careful not to infer causality. But it certainly suggests that our next couple of studies might want to focus on improving the dose of the motivational interviewing delivery," Dr. Resnicow commented. "We do feel that the dose of 4 and 10 sessions that we shot for is something that can be replicated in practice."

Attendee Dr. James M. Perrin, professor of pediatrics at Harvard Medical School, Boston, and president of the American Academy of Pediatrics, asked why results were better with motivational interviewing from both pediatricians and dietitians when the number of sessions delivered by dietitians was so low.

"I would just have to conclude that those additional three contacts, although only around 50% of what was prescribed, were still important. The dietitians did address different content, so it may be that the docs were very good at approaching the topics and setting goals, but the dietitians were able to get into more of the nutrition therapy, so even at that low dose, it seemed to add to what the docs were doing as sort of the background intervention," Dr. Resnicow speculated.

The pediatricians in the trial showed high competence and fidelity in their ability to deliver the motivational interviewing intervention, he noted. "They were handpicked in some ways; we had just an amazing group of pediatricians participating in the study. The next question is, can the average clinician do it – that’s a very important next step."

The investigators plan to disseminate the intervention more widely among PROS practices and to boost the dose of dietitian counseling through use of a disease management telephonic system, according to Dr. Resnicow.

Also, clinicians in the study were paid $50 per completed motivational interviewing session, but those in future studies will not be paid. "As long as fee-for-service is still around, they want to get reimbursed for this. ... For the two dissemination projects we are putting in..., we are going to help them maximize reimbursement, [using] 99214 and beyond," he said, referring to the CPT code for a visit by an established outpatient that includes moderate-complexity medical decision making.

Finally, the investigators plan to integrate the intervention with electronic health records to maximize its effectiveness. "Perhaps when the child comes in, many of you have electronic health record systems that may prompt you if you see an elevated BMI, but to take that one step further and have a motivational interviewing script pop up when you have a child who’s eligible for this type of counseling" should increase its use, he explained.

More information about motivational interviewing to address pediatric obesity is available online at the University of Michigan’s Center for Health Communications Research website, including DVDs about the project generally and about the intervention.

Dr. Resnicow had no relevant financial disclosures.

VANCOUVER, B.C. – Motivational interviewing in the primary care setting promotes weight loss among overweight and obese children, according to results from a randomized trial reported at the annual meeting of the Pediatric Academic Societies.

Investigators conducted the trial, Brief Motivational Interviewing to Reduce Child Body Mass Index (BMi2), in 42 practices across the United States belonging to the Pediatric Research in Office Settings (PROS) research network.

Participants were 645 racially/ethnically and socioeconomically diverse children aged 2-8 years with a body mass index (BMI) in the 85th-97th percentile, and their parents.

©moodboard/thinkstockphotos.com

The practices were randomized into three even groups assigned to deliver usual care (assessment and health education materials), four sessions of motivational interviewing by pediatricians only, or four sessions by pediatricians plus six sessions by registered dietitians, generally by telephone.

Motivational interviewing entails rolling with patient/parent resistance to change, building a discrepancy between their current health status/behaviors and their values and goals, supporting their autonomy, and energizing them to change, explained lead author Ken Resnicow, Ph.D., professor of health behavior and health education, University of Michigan School of Public Health in Ann Arbor.

"When we train clinicians to do motivational interviewing, we want to move them from asking to reflecting, from counterpunching to rolling with resistance, and from informing and advising to eliciting autonomous change talk," he elaborated. If the technique is used properly, patients/parents should be talking more than half the time.

Main trial results showed that at the 2-year mark, all groups had a lower adjusted BMI percentile than the baseline average of about 92. However, the children who received motivational interviewing from both a pediatrician and dietitian had a significantly lower value than the children who received usual care (87.1 vs. 90.3) and a significantly greater reduction in that value from baseline (4.9 vs. 1.8). The findings were similar for raw BMI.

In addition, children in that intervention group consumed more servings of fruits and vegetables daily than their usual-care peers (4.3 vs. 3.8), and had fewer hours of screen time per day (2.2 vs. 2.5). Daily servings of sweet beverages and daily hours of physical activity did not differ significantly.

There were intermediate but generally nonsignificant benefits among the children who received motivational interviewing only from pediatricians.

Pediatricians were highly satisfied with their training, and parents were highly satisfied with pediatrician-delivered motivational interviewing.

"This is actually the first large-scale randomized controlled trial to show that motivational interviewing delivered by primary care providers significantly reduced BMI percentile and raw BMI, and with the effect size, I think most of our colleagues agree that these are clinically significant," Dr. Resnicow commented.

Pediatricians completed an average of 3.4 of their four planned motivational interviewing sessions, and dietitians completed 2.7 of their six planned sessions. Findings showed a dose-response whereby improvements in BMI were greater the more sessions a family completed.

"Of course, there are confounders here, and maybe families that are doing better are more likely to continue therapy, so we have to be careful not to infer causality. But it certainly suggests that our next couple of studies might want to focus on improving the dose of the motivational interviewing delivery," Dr. Resnicow commented. "We do feel that the dose of 4 and 10 sessions that we shot for is something that can be replicated in practice."

Attendee Dr. James M. Perrin, professor of pediatrics at Harvard Medical School, Boston, and president of the American Academy of Pediatrics, asked why results were better with motivational interviewing from both pediatricians and dietitians when the number of sessions delivered by dietitians was so low.

"I would just have to conclude that those additional three contacts, although only around 50% of what was prescribed, were still important. The dietitians did address different content, so it may be that the docs were very good at approaching the topics and setting goals, but the dietitians were able to get into more of the nutrition therapy, so even at that low dose, it seemed to add to what the docs were doing as sort of the background intervention," Dr. Resnicow speculated.

The pediatricians in the trial showed high competence and fidelity in their ability to deliver the motivational interviewing intervention, he noted. "They were handpicked in some ways; we had just an amazing group of pediatricians participating in the study. The next question is, can the average clinician do it – that’s a very important next step."

The investigators plan to disseminate the intervention more widely among PROS practices and to boost the dose of dietitian counseling through use of a disease management telephonic system, according to Dr. Resnicow.

Also, clinicians in the study were paid $50 per completed motivational interviewing session, but those in future studies will not be paid. "As long as fee-for-service is still around, they want to get reimbursed for this. ... For the two dissemination projects we are putting in..., we are going to help them maximize reimbursement, [using] 99214 and beyond," he said, referring to the CPT code for a visit by an established outpatient that includes moderate-complexity medical decision making.

Finally, the investigators plan to integrate the intervention with electronic health records to maximize its effectiveness. "Perhaps when the child comes in, many of you have electronic health record systems that may prompt you if you see an elevated BMI, but to take that one step further and have a motivational interviewing script pop up when you have a child who’s eligible for this type of counseling" should increase its use, he explained.

More information about motivational interviewing to address pediatric obesity is available online at the University of Michigan’s Center for Health Communications Research website, including DVDs about the project generally and about the intervention.

Dr. Resnicow had no relevant financial disclosures.

VANCOUVER, B.C. – Motivational interviewing in the primary care setting promotes weight loss among overweight and obese children, according to results from a randomized trial reported at the annual meeting of the Pediatric Academic Societies.

Investigators conducted the trial, Brief Motivational Interviewing to Reduce Child Body Mass Index (BMi2), in 42 practices across the United States belonging to the Pediatric Research in Office Settings (PROS) research network.

Participants were 645 racially/ethnically and socioeconomically diverse children aged 2-8 years with a body mass index (BMI) in the 85th-97th percentile, and their parents.

©moodboard/thinkstockphotos.com

The practices were randomized into three even groups assigned to deliver usual care (assessment and health education materials), four sessions of motivational interviewing by pediatricians only, or four sessions by pediatricians plus six sessions by registered dietitians, generally by telephone.

Motivational interviewing entails rolling with patient/parent resistance to change, building a discrepancy between their current health status/behaviors and their values and goals, supporting their autonomy, and energizing them to change, explained lead author Ken Resnicow, Ph.D., professor of health behavior and health education, University of Michigan School of Public Health in Ann Arbor.

"When we train clinicians to do motivational interviewing, we want to move them from asking to reflecting, from counterpunching to rolling with resistance, and from informing and advising to eliciting autonomous change talk," he elaborated. If the technique is used properly, patients/parents should be talking more than half the time.

Main trial results showed that at the 2-year mark, all groups had a lower adjusted BMI percentile than the baseline average of about 92. However, the children who received motivational interviewing from both a pediatrician and dietitian had a significantly lower value than the children who received usual care (87.1 vs. 90.3) and a significantly greater reduction in that value from baseline (4.9 vs. 1.8). The findings were similar for raw BMI.

In addition, children in that intervention group consumed more servings of fruits and vegetables daily than their usual-care peers (4.3 vs. 3.8), and had fewer hours of screen time per day (2.2 vs. 2.5). Daily servings of sweet beverages and daily hours of physical activity did not differ significantly.

There were intermediate but generally nonsignificant benefits among the children who received motivational interviewing only from pediatricians.

Pediatricians were highly satisfied with their training, and parents were highly satisfied with pediatrician-delivered motivational interviewing.

"This is actually the first large-scale randomized controlled trial to show that motivational interviewing delivered by primary care providers significantly reduced BMI percentile and raw BMI, and with the effect size, I think most of our colleagues agree that these are clinically significant," Dr. Resnicow commented.

Pediatricians completed an average of 3.4 of their four planned motivational interviewing sessions, and dietitians completed 2.7 of their six planned sessions. Findings showed a dose-response whereby improvements in BMI were greater the more sessions a family completed.

"Of course, there are confounders here, and maybe families that are doing better are more likely to continue therapy, so we have to be careful not to infer causality. But it certainly suggests that our next couple of studies might want to focus on improving the dose of the motivational interviewing delivery," Dr. Resnicow commented. "We do feel that the dose of 4 and 10 sessions that we shot for is something that can be replicated in practice."

Attendee Dr. James M. Perrin, professor of pediatrics at Harvard Medical School, Boston, and president of the American Academy of Pediatrics, asked why results were better with motivational interviewing from both pediatricians and dietitians when the number of sessions delivered by dietitians was so low.

"I would just have to conclude that those additional three contacts, although only around 50% of what was prescribed, were still important. The dietitians did address different content, so it may be that the docs were very good at approaching the topics and setting goals, but the dietitians were able to get into more of the nutrition therapy, so even at that low dose, it seemed to add to what the docs were doing as sort of the background intervention," Dr. Resnicow speculated.

The pediatricians in the trial showed high competence and fidelity in their ability to deliver the motivational interviewing intervention, he noted. "They were handpicked in some ways; we had just an amazing group of pediatricians participating in the study. The next question is, can the average clinician do it – that’s a very important next step."

The investigators plan to disseminate the intervention more widely among PROS practices and to boost the dose of dietitian counseling through use of a disease management telephonic system, according to Dr. Resnicow.

Also, clinicians in the study were paid $50 per completed motivational interviewing session, but those in future studies will not be paid. "As long as fee-for-service is still around, they want to get reimbursed for this. ... For the two dissemination projects we are putting in..., we are going to help them maximize reimbursement, [using] 99214 and beyond," he said, referring to the CPT code for a visit by an established outpatient that includes moderate-complexity medical decision making.

Finally, the investigators plan to integrate the intervention with electronic health records to maximize its effectiveness. "Perhaps when the child comes in, many of you have electronic health record systems that may prompt you if you see an elevated BMI, but to take that one step further and have a motivational interviewing script pop up when you have a child who’s eligible for this type of counseling" should increase its use, he explained.

More information about motivational interviewing to address pediatric obesity is available online at the University of Michigan’s Center for Health Communications Research website, including DVDs about the project generally and about the intervention.

Dr. Resnicow had no relevant financial disclosures.

VANCOUVER, B.C. – The evidence is strong. Having guns at home increases the risk of accidental injury, suicide, and homicide among youth. Nearly 20,600 youths between the ages of 1 and 24 years sustain firearm injuries each year, and 6,570 of them die.

Firearm injuries cause twice as many deaths as cancer, five times as many as heart disease, and 20 times as many as infections in this age group, according to presenters who spoke during a symposium about firearm injury prevention at the annual meeting of the Pediatric Academic Societies.

"We must continue to raise awareness about the public health and social consequences of firearm injury in children," symposium cochair Dr. Barbara J. Stoll, chair of the pediatrics department at Emory University in Atlanta, noted in a written statement. "We hope to focus the discussion on up-to-date evidence, rather than politics or personal opinion, and to identify gaps in knowledge and build the case for expanded research. Firearm injury has not gone away. We must address the tragedy of these preventable injuries and deaths," Dr. Stoll said.

But because the issue is highly politicized, pediatricians might hesitate to bring it up in conversation during routine office visits. 

Dr. Robert Sege, director of the division of family and child advocacy at Boston Medical Center, shared his advice during this video interview on how to approach the topic without creating tension or push-back.

Dr. Sege had no relevant conflicts of interest. 

nmiller@frontlinemedcom.com

On Twitter @naseemsmiller

VANCOUVER, B.C. – The evidence is strong. Having guns at home increases the risk of accidental injury, suicide, and homicide among youth. Nearly 20,600 youths between the ages of 1 and 24 years sustain firearm injuries each year, and 6,570 of them die.

Firearm injuries cause twice as many deaths as cancer, five times as many as heart disease, and 20 times as many as infections in this age group, according to presenters who spoke during a symposium about firearm injury prevention at the annual meeting of the Pediatric Academic Societies.

"We must continue to raise awareness about the public health and social consequences of firearm injury in children," symposium cochair Dr. Barbara J. Stoll, chair of the pediatrics department at Emory University in Atlanta, noted in a written statement. "We hope to focus the discussion on up-to-date evidence, rather than politics or personal opinion, and to identify gaps in knowledge and build the case for expanded research. Firearm injury has not gone away. We must address the tragedy of these preventable injuries and deaths," Dr. Stoll said.

But because the issue is highly politicized, pediatricians might hesitate to bring it up in conversation during routine office visits. 

Dr. Robert Sege, director of the division of family and child advocacy at Boston Medical Center, shared his advice during this video interview on how to approach the topic without creating tension or push-back.

Dr. Sege had no relevant conflicts of interest. 

nmiller@frontlinemedcom.com

On Twitter @naseemsmiller

VANCOUVER, B.C. – The evidence is strong. Having guns at home increases the risk of accidental injury, suicide, and homicide among youth. Nearly 20,600 youths between the ages of 1 and 24 years sustain firearm injuries each year, and 6,570 of them die.

Firearm injuries cause twice as many deaths as cancer, five times as many as heart disease, and 20 times as many as infections in this age group, according to presenters who spoke during a symposium about firearm injury prevention at the annual meeting of the Pediatric Academic Societies.

"We must continue to raise awareness about the public health and social consequences of firearm injury in children," symposium cochair Dr. Barbara J. Stoll, chair of the pediatrics department at Emory University in Atlanta, noted in a written statement. "We hope to focus the discussion on up-to-date evidence, rather than politics or personal opinion, and to identify gaps in knowledge and build the case for expanded research. Firearm injury has not gone away. We must address the tragedy of these preventable injuries and deaths," Dr. Stoll said.

But because the issue is highly politicized, pediatricians might hesitate to bring it up in conversation during routine office visits. 

Dr. Robert Sege, director of the division of family and child advocacy at Boston Medical Center, shared his advice during this video interview on how to approach the topic without creating tension or push-back.

Dr. Sege had no relevant conflicts of interest. 

nmiller@frontlinemedcom.com

On Twitter @naseemsmiller

VANCOUVER, B.C. – Motivational interviewing in the primary care setting promotes weight loss among overweight and obese children, according to a randomized trial, which is the first of its kind. The study was reported at the annual meeting of the Pediatric Academic Societies.

Motivational interviewing is not new. It got its start in addiction medicine several decades ago, and only in the past decade has the technique made its way to chronic disease management. Lead author Ken Resnicow, Ph.D., professor of health behavior and health education, University of Michigan School of Public Health in Ann Arbor, explains the method and how it’s finding its place in pediatrics and primary care.

Vidyard Video

VANCOUVER, B.C. – Motivational interviewing in the primary care setting promotes weight loss among overweight and obese children, according to a randomized trial, which is the first of its kind. The study was reported at the annual meeting of the Pediatric Academic Societies.

Motivational interviewing is not new. It got its start in addiction medicine several decades ago, and only in the past decade has the technique made its way to chronic disease management. Lead author Ken Resnicow, Ph.D., professor of health behavior and health education, University of Michigan School of Public Health in Ann Arbor, explains the method and how it’s finding its place in pediatrics and primary care.

Vidyard Video

VANCOUVER, B.C. – Motivational interviewing in the primary care setting promotes weight loss among overweight and obese children, according to a randomized trial, which is the first of its kind. The study was reported at the annual meeting of the Pediatric Academic Societies.

Motivational interviewing is not new. It got its start in addiction medicine several decades ago, and only in the past decade has the technique made its way to chronic disease management. Lead author Ken Resnicow, Ph.D., professor of health behavior and health education, University of Michigan School of Public Health in Ann Arbor, explains the method and how it’s finding its place in pediatrics and primary care.

Vidyard Video

VANCOUVER, B.C. – Motivational interviewing in the primary care setting promotes weight loss among overweight and obese children, according to a randomized trial, which is the first of its kind. The study was reported at the annual meeting of the Pediatric Academic Societies.

Motivational interviewing is not new. It got its start in addiction medicine several decades ago, and only in the past decade has the technique made its way to chronic disease management. Lead author Ken Resnicow, Ph.D., professor of health behavior and health education, University of Michigan School of Public Health in Ann Arbor, explains the method and how it’s finding its place in pediatrics and primary care.

VANCOUVER, B.C. – Motivational interviewing in the primary care setting promotes weight loss among overweight and obese children, according to a randomized trial, which is the first of its kind. The study was reported at the annual meeting of the Pediatric Academic Societies.

Motivational interviewing is not new. It got its start in addiction medicine several decades ago, and only in the past decade has the technique made its way to chronic disease management. Lead author Ken Resnicow, Ph.D., professor of health behavior and health education, University of Michigan School of Public Health in Ann Arbor, explains the method and how it’s finding its place in pediatrics and primary care.

VANCOUVER, B.C. – Motivational interviewing in the primary care setting promotes weight loss among overweight and obese children, according to a randomized trial, which is the first of its kind. The study was reported at the annual meeting of the Pediatric Academic Societies.

Motivational interviewing is not new. It got its start in addiction medicine several decades ago, and only in the past decade has the technique made its way to chronic disease management. Lead author Ken Resnicow, Ph.D., professor of health behavior and health education, University of Michigan School of Public Health in Ann Arbor, explains the method and how it’s finding its place in pediatrics and primary care.

VANCOUVER – Two years of low-dose trimethoprim-sulfamethoxazole prophylaxis halved the risk of recurrent urinary tract infections, but did not prevent renal scarring in a trial of 607 children with vesicoureteral reflux that was published online May 4 in the New England Journal of Medicine, and presented concurrently at the annual meeting of the Pediatric Academic Societies.

Within 112 days of their first or second febrile or symptomatic urinary tract infection (UTI), 302 young children diagnosed with vesicoureteral reflux (VUR) by voiding cystourethrogram were randomized to 3 mg of trimethoprim plus 15 mg of sulfamethoxazole per kilogram; and 305 other VUR children were randomized to placebo.

Alexander Otto/Frontline Medical News

Thirty-nine (13%) children who received antimicrobial prophylaxis developed a recurrent febrile or symptomatic UTI, compared with 72 (24%) who received a placebo (hazard ratio for risk of recurrence, 0.50; 95% confidence interval, 0.34-0.74). Prophylaxis was particularly effective in children whose index UTI was febrile (HR, 0.41; 95% CI, 0.26-0.64) and in those with baseline bladder and bowel dysfunction (HR, 0.21; 95% CI, 0.08-0.58).

Nuclear imaging showed no significant between-group differences in the incidence of renal scarring (11.9% in the treated group vs. 10.2% in the placebo group; P = 0.55), severe renal scars (4.0% vs. 2.6%; P = 0.37), or new renal scars since baseline (8.2% vs. 8.4%; P = 0.94) at trial completion (N. Eng. J. Med. 2014 May 4 [doi: 10.1056/NEJMoa1401811]).

"This study showed unequivocal evidence that antimicrobial prophylaxis reduced at least in half the likelihood of children having recurrent UTIs. Rates of renal scarring ... were low and not reduced by prophylaxis, perhaps because most children were enrolled after their first infection and because parents, instructed to be vigilant, sought early medical attention," said Dr. Alejandro Hoberman, a professor of pediatrics at the University of Pittsburgh and lead investigator in the multicenter study, dubbed the RIVUR (Randomized Intervention for Children with Vesicoureteral Reflux) trial.

"As long as evidence supporting the benefit of prophylaxis was dubious, the recommendation of a watchful-waiting approach, without performance of a voiding cystourethrographic study, seemed reasonable, because the imaging findings would not affect the nature of treatment. However, our finding that antimicrobial prophylaxis was associated with a reduced risk of recurrence may warrant reconsideration of that recommendation," the investigators said.

Eight children would have had to be treated for 2 years to prevent one case of febrile or symptomatic UTI. Several audience members, after hearing the results, wondered if the benefits of prophylaxis outweighed the costs, given that there was no effect on the incidence of renal scarring in the short term, and the difficulty and expense of performing voiding cystourethrographic studies, among other concerns.

Dr. Hoberman plans to investigate the cost-effectiveness implications of the findings, and, in the meantime, he noted that the study offers proof that prophylaxis helps prevent recurrent UTIs, something that was uncertain in the past. Also, he noted, the study was not powered to detect a difference in renal scarring as a primary outcome.

The children were aged 2-71 months (median age, 12 months), and 92% were girls. Eighty percent had grade II or III vesicoureteral reflux, and 48% had bilateral reflux.

Among 87 children with a first recurrence caused by Escherichia coli, the proportion of isolates that were resistant to trimethoprim-sulfamethoxazole was 63% in the prophylaxis group and 19% in the placebo group. "Not unexpectedly, recurrences that did occur in children who received prophylaxis were more likely to have been caused by a resistant pathogen," the investigators said.

Parents of 77% of the children reported that they had given the study medication at least 75% of the time, and parents of 85% reported administering it at least 50% of the time. There was no significant difference in reported adherence between the study groups.

Dr. Hoberman had no disclosures. The work was funded by the National Institute of Diabetes and Digestive and Kidney Diseases.

aotto@frontlinemedcom.com

VANCOUVER – Two years of low-dose trimethoprim-sulfamethoxazole prophylaxis halved the risk of recurrent urinary tract infections, but did not prevent renal scarring in a trial of 607 children with vesicoureteral reflux that was published online May 4 in the New England Journal of Medicine, and presented concurrently at the annual meeting of the Pediatric Academic Societies.

Within 112 days of their first or second febrile or symptomatic urinary tract infection (UTI), 302 young children diagnosed with vesicoureteral reflux (VUR) by voiding cystourethrogram were randomized to 3 mg of trimethoprim plus 15 mg of sulfamethoxazole per kilogram; and 305 other VUR children were randomized to placebo.

Alexander Otto/Frontline Medical News

Thirty-nine (13%) children who received antimicrobial prophylaxis developed a recurrent febrile or symptomatic UTI, compared with 72 (24%) who received a placebo (hazard ratio for risk of recurrence, 0.50; 95% confidence interval, 0.34-0.74). Prophylaxis was particularly effective in children whose index UTI was febrile (HR, 0.41; 95% CI, 0.26-0.64) and in those with baseline bladder and bowel dysfunction (HR, 0.21; 95% CI, 0.08-0.58).

Nuclear imaging showed no significant between-group differences in the incidence of renal scarring (11.9% in the treated group vs. 10.2% in the placebo group; P = 0.55), severe renal scars (4.0% vs. 2.6%; P = 0.37), or new renal scars since baseline (8.2% vs. 8.4%; P = 0.94) at trial completion (N. Eng. J. Med. 2014 May 4 [doi: 10.1056/NEJMoa1401811]).

"This study showed unequivocal evidence that antimicrobial prophylaxis reduced at least in half the likelihood of children having recurrent UTIs. Rates of renal scarring ... were low and not reduced by prophylaxis, perhaps because most children were enrolled after their first infection and because parents, instructed to be vigilant, sought early medical attention," said Dr. Alejandro Hoberman, a professor of pediatrics at the University of Pittsburgh and lead investigator in the multicenter study, dubbed the RIVUR (Randomized Intervention for Children with Vesicoureteral Reflux) trial.

"As long as evidence supporting the benefit of prophylaxis was dubious, the recommendation of a watchful-waiting approach, without performance of a voiding cystourethrographic study, seemed reasonable, because the imaging findings would not affect the nature of treatment. However, our finding that antimicrobial prophylaxis was associated with a reduced risk of recurrence may warrant reconsideration of that recommendation," the investigators said.

Eight children would have had to be treated for 2 years to prevent one case of febrile or symptomatic UTI. Several audience members, after hearing the results, wondered if the benefits of prophylaxis outweighed the costs, given that there was no effect on the incidence of renal scarring in the short term, and the difficulty and expense of performing voiding cystourethrographic studies, among other concerns.

Dr. Hoberman plans to investigate the cost-effectiveness implications of the findings, and, in the meantime, he noted that the study offers proof that prophylaxis helps prevent recurrent UTIs, something that was uncertain in the past. Also, he noted, the study was not powered to detect a difference in renal scarring as a primary outcome.

The children were aged 2-71 months (median age, 12 months), and 92% were girls. Eighty percent had grade II or III vesicoureteral reflux, and 48% had bilateral reflux.

Among 87 children with a first recurrence caused by Escherichia coli, the proportion of isolates that were resistant to trimethoprim-sulfamethoxazole was 63% in the prophylaxis group and 19% in the placebo group. "Not unexpectedly, recurrences that did occur in children who received prophylaxis were more likely to have been caused by a resistant pathogen," the investigators said.

Parents of 77% of the children reported that they had given the study medication at least 75% of the time, and parents of 85% reported administering it at least 50% of the time. There was no significant difference in reported adherence between the study groups.

Dr. Hoberman had no disclosures. The work was funded by the National Institute of Diabetes and Digestive and Kidney Diseases.

aotto@frontlinemedcom.com

VANCOUVER – Two years of low-dose trimethoprim-sulfamethoxazole prophylaxis halved the risk of recurrent urinary tract infections, but did not prevent renal scarring in a trial of 607 children with vesicoureteral reflux that was published online May 4 in the New England Journal of Medicine, and presented concurrently at the annual meeting of the Pediatric Academic Societies.

Within 112 days of their first or second febrile or symptomatic urinary tract infection (UTI), 302 young children diagnosed with vesicoureteral reflux (VUR) by voiding cystourethrogram were randomized to 3 mg of trimethoprim plus 15 mg of sulfamethoxazole per kilogram; and 305 other VUR children were randomized to placebo.

Alexander Otto/Frontline Medical News

Thirty-nine (13%) children who received antimicrobial prophylaxis developed a recurrent febrile or symptomatic UTI, compared with 72 (24%) who received a placebo (hazard ratio for risk of recurrence, 0.50; 95% confidence interval, 0.34-0.74). Prophylaxis was particularly effective in children whose index UTI was febrile (HR, 0.41; 95% CI, 0.26-0.64) and in those with baseline bladder and bowel dysfunction (HR, 0.21; 95% CI, 0.08-0.58).

Nuclear imaging showed no significant between-group differences in the incidence of renal scarring (11.9% in the treated group vs. 10.2% in the placebo group; P = 0.55), severe renal scars (4.0% vs. 2.6%; P = 0.37), or new renal scars since baseline (8.2% vs. 8.4%; P = 0.94) at trial completion (N. Eng. J. Med. 2014 May 4 [doi: 10.1056/NEJMoa1401811]).

"This study showed unequivocal evidence that antimicrobial prophylaxis reduced at least in half the likelihood of children having recurrent UTIs. Rates of renal scarring ... were low and not reduced by prophylaxis, perhaps because most children were enrolled after their first infection and because parents, instructed to be vigilant, sought early medical attention," said Dr. Alejandro Hoberman, a professor of pediatrics at the University of Pittsburgh and lead investigator in the multicenter study, dubbed the RIVUR (Randomized Intervention for Children with Vesicoureteral Reflux) trial.

"As long as evidence supporting the benefit of prophylaxis was dubious, the recommendation of a watchful-waiting approach, without performance of a voiding cystourethrographic study, seemed reasonable, because the imaging findings would not affect the nature of treatment. However, our finding that antimicrobial prophylaxis was associated with a reduced risk of recurrence may warrant reconsideration of that recommendation," the investigators said.

Eight children would have had to be treated for 2 years to prevent one case of febrile or symptomatic UTI. Several audience members, after hearing the results, wondered if the benefits of prophylaxis outweighed the costs, given that there was no effect on the incidence of renal scarring in the short term, and the difficulty and expense of performing voiding cystourethrographic studies, among other concerns.

Dr. Hoberman plans to investigate the cost-effectiveness implications of the findings, and, in the meantime, he noted that the study offers proof that prophylaxis helps prevent recurrent UTIs, something that was uncertain in the past. Also, he noted, the study was not powered to detect a difference in renal scarring as a primary outcome.

The children were aged 2-71 months (median age, 12 months), and 92% were girls. Eighty percent had grade II or III vesicoureteral reflux, and 48% had bilateral reflux.

Among 87 children with a first recurrence caused by Escherichia coli, the proportion of isolates that were resistant to trimethoprim-sulfamethoxazole was 63% in the prophylaxis group and 19% in the placebo group. "Not unexpectedly, recurrences that did occur in children who received prophylaxis were more likely to have been caused by a resistant pathogen," the investigators said.

Parents of 77% of the children reported that they had given the study medication at least 75% of the time, and parents of 85% reported administering it at least 50% of the time. There was no significant difference in reported adherence between the study groups.

Dr. Hoberman had no disclosures. The work was funded by the National Institute of Diabetes and Digestive and Kidney Diseases.

aotto@frontlinemedcom.com