Objectives To assess the prevalence, characteristics, and risk of sensorineural hearing loss (SNHL) through 18 years of age in children with congenital CMV infection identified through hospital-based newborn screening who were asymptomatic at birth compared to uninfected children. Methods We included 92 case-patients and 51 controls assessed using auditory brainstem response and behavioral audiometry. We used Kaplan-Meier survival analysis to estimate prevalence of SNHL, defined as ≥25 dB hearing level (HL) at any frequency, and Cox proportional hazards regression analyses to compare SNHL risk between groups. Results At the end of follow-up, SNHL prevalence was 25% (95% CI: 17–36%) among case-patients and 8% (95% CI: 3–22%) in controls (hazard ratio (HR): 4.0; 95% CI: 1.2–14.5; p-value=0.02). Among children without SNHL by age 5 years, the risk of delayed-onset SNHL was not significantly greater for case-patients than for controls (HR: 1.6; 95% CI: 0.4–6.1; P=0.5). Among case-patients, the risk of delayed-onset SNHL was significantly greater among those with unilateral congenital/early-onset loss than those without (hazard ratio: 6.9; 95% CI: 2.5–19.1; P<0.01). At the end of follow-up, the prevalence of severe to profound bilateral SNHL among case-patients was 2% (95% CI: 1–9%). Conclusions Delayed-onset and progression of SNHL among children with asymptomatic congenital CMV infection continued to occur throughout adolescence. However, the risk of developing SNHL after age 5 years among case-patients was not different than in uninfected children. An estimated 2% of case-patients developed SNHL severe enough to be candidates for cochlear implantation.

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OBJECTIVE. Many children are brought to the pediatric emergency department (ED) with acute asthma symptoms. Emergency asthma care is costly, and many ED visits may be preventable. Families often do not have written asthma action plans and lack asthma self-managment skills. This study tests a tailored self-managment intervention delivered in the ED for families of children with asthma. The primary hypotheses were that the intervention group would have greater confidence to manage asthma 14 days postintervention and more well-asthma visits and fewer urgent care/ED visits at 9 and 12 months.METHODS. This randomized intervention/usual-care study was part of a larger ED asthma surveillance project in 4 urban pediatric ED sites. Asthma educators used a computer-based resource to tailor the intervention messages and provide a customized asthma action plan and educational summary. Children with acute asthma were enrolled during an ED visit, and follow-up telephone interviews were conducted during the next 9 months. The ED clinician classified the child's acute and chronic severity.RESULTS. To date, 464 subjects aged 1 to 18 years have been enrolled. The ED clinicians reported that 46% had intermittent and 54% had persistent chronic severity with 51% having mild acute severity episodes. The confidence level to prevent asthma episodes and keep them from getting worse was significantly higher in the intervention group at 14 days postintervention. More subjects in the intervention group reported well-asthma visits by 9 months. Return ED visits were significantly lower in the intervention group in those with intermittent asthma. Twelve-month follow-up is in process.CONCLUSIONS. The tailored ED self-management intervention demonstrates significant effects on caregiver self-confidence and well-visit follow-up. Additional evaluation is needed to determine what impact this intervention has long-term. A N ESTIMATED 9 million (12.5%) children Ͻ18 years of age in the United States have had asthma diagnosed at some time in their lives. 1 Asthma morbidity and mortality have increased dramatically in the United States in the last 2 decades. The economic burden of asthma is increasing, with hospitalizations accounting for 46% to 50% of costs and emergency department (ED) visits accounting for ϳ8%. 2 Emergency care visits cost 5 times more than primary care visits. 3 Every year, 1 of 3 children with asthma visit an ED because of an asthma-related event. 3 These ED visits and hospitalizations may be preventable through either better chronic asthma control or early recognition of acute symptoms and intervention in the primary care setting.Children with asthma may lack a primary medical provider and may depend on ED services for their care. Routine primary medical care is hampered by a lack of medical insurance and by other barriers such as access to transportation. There are disparities in asthma severity and access to care with respect to ethnicity and socioeconomic status, and minority children and those with low socioeconomic s...

Despite challenges associated with pediatric ART in developing countries, low mortality and good treatment outcomes can be achieved. However, outcomes are worse in younger patients and those with advanced disease at the time of ART initiation, highlighting the importance of early diagnosis and treatment.