BACKGROUND AND OBJECTIVE: Respiratory syncytial virus (RSV) is a common cause of pediatric hospitalization, but the mortality rate and estimated annual deaths are based on decades-old data. Our objective was to describe contemporary RSV-associated mortality in hospitalized infants and children aged ,2 years.

Objective Extracorporeal membrane oxygenation, an accepted rescue therapy for refractory cardiopulmonary failure, requires a complex multidisciplinary approach and advanced technology. Little is known about the relationship between a center’s case volume and patient mortality. The purpose of this study was to analyze the relationship between hospital extracorporeal membrane oxygenation annual volume and in-hospital mortality and assess if a minimum hospital volume could be recommended. Design Retrospective cohort study Setting A retrospective cohort admitted to children’s hospitals in the Pediatric Health Information System database from 2004-2011 supported with extracorporeal membrane oxygenation was identified. Indications were assigned based on patient age (neonatal vs. pediatric), diagnosis, and procedure codes. Average hospital annual volume was defined as 0-19, 20-49, or ≥50 cases per year. Maximum likelihood estimates were used to assess minimum annual case volume. Patients A total of 7322 pediatric patients aged 0-18 years of age were supported with extracorporeal membrane oxygenation and had an indication assigned. Interventions None Measurements and Main Results Average hospital extracorporeal membrane oxygenation volume ranged from 1-58 cases per year. Overall mortality was 43% but differed significantly by indication. After adjustment for case-mix, complexity of cardiac surgery, and year of treatment, patients treated at medium (OR 0.86, 95% CI 0.75-0.98) and high (OR 0.75, 95% CI 0.63-0.89) volume centers had significantly lower odds of death compared to those treated at low volume centers. The minimum annual case load most significantly associated with lower mortality was 22 (95% CI 22-28). Conclusion Pediatric centers with low extracorporeal membrane oxygenation average annual case volume had significantly higher mortality and a minimum volume of 22 cases per year was associated with improved mortality. We suggest this threshold be evaluated by additional study.

OBJECTIVES:To describe the proportion of children screened by the Modified Checklist for Autism in Toddlers (M-CHAT), identify characteristics associated with screen completion, and examine associations between autism spectrum disorder (ASD) screening and later ASD diagnosis. METHODS:We examined data from children attending 18-and 24-month visits between 2013 and 2016 from 20 clinics within a health care system for evidence of screening with the M-CHAT and subsequent coding of ASD diagnosis at age .4.75 years. We interviewed providers for information about usual methods of M-CHAT scoring and ASD referral.RESULTS: Of 36 233 toddlers, 73% were screened and 1.4% were later diagnosed with ASD. Hispanic children were less likely to be screened (adjusted prevalence ratio [APR]: 0.95, 95% confidence interval [CI]: 0.92-0.98), and family physicians were less likely to screen (APR: 0.12, 95% CI: 0.09-0.15). Compared with unscreened children, screen-positive children were more likely to be diagnosed with ASD (APR: 10.3, 95% CI: 7.6-14.1) and were diagnosed younger (38.5 vs 48.5 months, P , .001). The M-CHAT's sensitivity for ASD diagnosis was 33.1%, and the positive predictive value was 17.8%. Providers routinely omitted the M-CHAT follow-up interview and had uneven referral patterns.CONCLUSIONS: A majority of children were screened for ASD, but disparities exist among those screened. Benefits for screen-positive children are improved detection and younger age of diagnosis. Performance of the M-CHAT can be improved in real-world health care settings by administering screens with fidelity and facilitating timely ASD evaluations for screen-positive children. Providers should continue to monitor for signs of ASD in screen-negative children.WHAT'S KNOWN ON THIS SUBJECT: Universal autism screening in toddlers is recommended, but it is unknown how frequently this occurs, what factors are associated with screening, and the performance characteristics of the most commonly used screening instrument in real-world health care settings.WHAT THIS STUDY ADDS: Autism screening was completed in the majority of toddlers but was less likely to occur in Hispanic children. Children who screened positive were more likely to be diagnosed with autism and were diagnosed earlier, but falsenegative screens were common.

WHAT'S KNOWN ON THIS SUBJECT: Urinary tract infection (UTI) is the most common bacterial infection in febrile infants aged 1 to 90 days. It is unclear if urine microscopy offers significant benefit beyond urine dipstick as a screening test for UTI in this population.WHAT THIS STUDY ADDS: Dipstick may be an adequate screening test for UTI in infants aged 1 to 90 days with a negative predictive value (NPV) of 98.7%. Adding microscopy increases the NPV to 99.2% but results in 8 false-positives for every UTI missed by dipstick.abstract OBJECTIVE: This study compares the performance of urine dipstick alone with urine microscopy and with both tests combined as a screen for urinary tract infection (UTI) in febrile infants aged 1 to 90 days. METHODS:We queried the Intermountain Healthcare data warehouse to identify febrile infants with urine dipstick, microscopy, and culture performed between 2004 and 2011. UTI was defined as .50 000 colonyforming units per milliliter of a urinary pathogen. We compared the performance of urine dipstick with unstained microscopy or both tests combined ("combined urinalysis") to identify UTI in infants aged 1 to 90 days. RESULTS:Of 13 030 febrile infants identified, 6394 (49%) had all tests performed and were included in the analysis. Of these, 770 (12%) had UTI. Urine culture results were positive within 24 hours in 83% of UTIs. The negative predictive value (NPV) was .98% for all tests. The combined urinalysis NPV was 99.2% (95% confidence interval: 99.1%-99.3%) and was significantly greater than the dipstick NPV of 98.7% (98.6%-98.8%). The dipstick positive predictive value was significantly greater than combined urinalysis (66.8% [66.2%-67.4%] vs 51.2% [50.6%-51.8%]). These data suggest 8 febrile infants would be predicted to have a false-positive combined urinalysis for every 1 infant with UTI initially missed by dipstick screening.CONCLUSIONS: Urine dipstick testing compares favorably with both microscopy and combined urinalysis in febrile infants aged 1 to 90 days. The urine dipstick test may be an adequate stand-alone screen for UTI in febrile infants while awaiting urine culture results. Pediatrics 2014;133:e1121-e1127 UTI screening methods may include dipstick urinalysis and/or microscopy of centrifuged urine, as well as other methods. 3,4,[9][10][11] Urine dipstick is an inexpensive and rapid screening test that can be performed in office settings and other laboratories and is waived by the Clinical Laboratory Improvement Amendment (CLIA). 12 Dipstick has been shown to perform well in children $2 years old as a screening test for UTI. 13 Microscopic examination of urine requires technicians with special training in laboratories using CLIA-certified methods. 12 Previous studies have questioned the additional benefit of microscopy over dipstick urinalysis in children; however, these studies included few infants 1 to 90 days of age. [14][15][16][17][18][19][20] Although dipstick is rapid, inexpensive, and does not require special training, there currently are insufficient data t...

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