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    <recommendedItem id="20090101_19_481"
                     title="Early Oral Antimicrobial Therapy Reduces Complications in Pediatric Osteomyelitis"
                     score="-0.005"
                     href="http://www.medpagetoday.com/CriticalCare/InfectionControl/tb/12903?impressionId=1265773838588"
                     
      PHILADELPHIA, Feb. 16 -- Children with acute osteomyelitis can be safely switched to oral antimicrobial therapy early in the course of treatment to avoid prolonged use of central venous catheters, researchers found. 
              &lt;br&gt; 
              &lt;br&gt;Treatment failure rates were similar whether children transitioned to oral antimicrobials after a short intravenous course or stayed on prolonged IV therapy (4% versus 5%, &lt;em&gt;P&lt;/em&gt;=NS), Theoklis Zaoutis, M.D., of the Children&apos;s Hospital of Philadelphia, and colleagues reported in the February issue of &lt;em&gt;Pediatrics&lt;/em&gt;.
              &lt;br&gt; 
              &lt;br&gt;But in the large retrospective cohort study, an early transition to oral therapy was associated with significantly fewer rehospitalizations for complications.
              &lt;p&gt; 
              &lt;p&gt;Other potential advantages of sending children home on oral therapy include lower cost and increased convenience, Dr. Zaoutis said in an interview. 
              &lt;p&gt; 
              &lt;p&gt;These findings validate the safety of the oral approach seen in smaller pediatric studies, he noted. &quot;In the adult world there&apos;s been a move toward switching to oral therapy for a while now, my sense is we may be moving toward that in children as well.&quot;
              &lt;p&gt; 
              &lt;p&gt;Dr. Zaoutis cautioned, though, that the study included only uncomplicated osteomyelitis cases. &quot;Physicians should be careful about applying this paradigm to other conditions.&quot;
              &lt;p&gt; 
              &lt;p&gt;The study included children age two months to 17 years being treated for uncomplicated acute osteomyelitis from 2000 through 2005 at 29 children&apos;s hospitals participating in the Pediatric Health Information System administrative database. 
              &lt;p&gt; 
              &lt;p&gt;Of those children, 1,021 received prolonged intravenous therapy indicated by diagnostic codes for placement of a central venous catheter and 948 received oral therapy. 
              &lt;p&gt; 
              &lt;p&gt;There was wide variation between centers in the proportion of pediatric patients who had a central venous catheter placed for prolonged intravenous therapy (10% to 95%, &lt;em&gt;P&lt;/em&gt;&lt;0.001).
              &lt;p&gt; 
              &lt;p&gt;An early transition to oral therapy did not increase the risk of treatment failure after adjustment for propensity score and clustering within hospitals compared with intravenous therapy alone (odds ratio 0.77, 95% confidence interval 0.49 to 1.22).
              &lt;p&gt; 
              &lt;p&gt;Treatment failure -- defined as rehospitalization within six months for acute or chronic osteomyelitis, potential complications of osteomyelitis, or musculoskeletal surgery -- did not occur any sooner in the early oral therapy group either (median time to failure 14.0 versus 16.5 days, &lt;em&gt;P&lt;/em&gt;=0.65).
              &lt;p&gt; 
              &lt;p&gt;Despite the variation among hospitals in use of early oral antimicrobial therapy in these patients, the mode of antimicrobial administration did not show a significant within-hospital effect (OR 0.73, 95% CI 0.39 to 1.35) or among-hospital association with outcome (OR 0.98, 95% CI 0.93 to 1.04). 
              &lt;p&gt; 
              &lt;p&gt;However, complication rates did differ significantly between groups. 
              &lt;p&gt; 
              &lt;p&gt;Children transitioned to early oral therapy were significantly less likely to be readmitted to the hospital over the subsequent six months for antimicrobial complications (0.4% versus 1.6%, &lt;em&gt;P&lt;/em&gt;&lt;0.005) or for any reason (6.0% versus 10.0%, &lt;em&gt;P&lt;/em&gt;=0.017).
              &lt;p&gt; 
              &lt;p&gt;More than 3% of children on a full four to six weeks of IV therapy had to return to the hospital for complications related to the indwelling catheter, such as breakage or infections, including catheter-related sepsis.
              &lt;p&gt; 
              &lt;p&gt;Prior studies have documented central venous catheter-associated complication rates ranging from 29% to 41% in pediatric outpatient antimicrobial therapy, Dr. Zaoutis&apos; group noted.
              &lt;p&gt; 
              &lt;p&gt;The study may have been limited by misclassification in the administrative database or by late failures not captured by the six-month data.
              &lt;p&gt; 
              &lt;p&gt;Since patient characteristics and outcomes were identical between groups, &quot;it seems that institutional culture and tradition, rather than patient characteristics, are driving therapeutic choices,&quot; the researchers said.
              &lt;p&gt; 
              &lt;p&gt;They suggested that clinical practice guidelines outlining parameters and a protocol for switching to oral therapy need to be implemented across hospitals.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; The researchers reported support by grants from the National Institutes of
              &lt;p&gt;Health, Agency for Healthcare Research and Quality, and the National Institute of Child Health and Human Development, but no conflicts of interest. &lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
    <recommendedItem id="20090101_19_2271"
                     title="Social Status Predicts Preemie&apos;s School Readiness"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb/15145?impressionId=1265773838588"
                     
      HOUSTON, July 20 -- Socioeconomic status was the most powerful predictor of a premature infant&apos;s readiness to start school at age 5 or 6, researchers found. 
              &lt;br&gt;
              &lt;br&gt;Sex and a handful of health issues also influenced school readiness, Michael D. Schreiber, MD, of the University of Chicago, and colleagues reported in the July issue of &lt;em&gt;Pediatrics&lt;/em&gt;, but to a lesser degree. 
              &lt;br&gt;
              &lt;br&gt;&quot;Our findings demonstrate the risk of neonatal morbidities in determining school readiness,&quot; the authors concluded. &quot;However, decreased socioeconomic status plays a far greater role in determining school readiness than these biomedical risks. 
              &lt;p&gt;
              &lt;p&gt;&quot;Consequently, interventions targeting neonatal morbidities are likely to be less effective at improving school readiness in the setting of an impoverished socioeconomic environment.&quot; 
              &lt;p&gt;
              &lt;p&gt;Compared with full-term babies, infants weighing less than 2,000 g (4.5 lbs) at birth have an increased risk of adverse neurodevelopmental outcomes. Some of the effects might not become manifest for several years. 
              &lt;p&gt;
              &lt;p&gt;To determine factors at premature birth that affect school readiness, the authors studied 135 children ages 5 and 6, all of whom were born prematurely, weighed less than 2,000 g at birth, and had respiratory distress syndrome requiring surfactant-replacement therapy. 
              &lt;p&gt;
              &lt;p&gt;Mean birth weight of the children was 1,016 g (2.24 lbs) and gestational age averaged 27.5 weeks. 
              &lt;p&gt;
              &lt;p&gt;The authors developed a school-readiness score based on results of standardized tests of basic concepts, perceptual skills, receptive vocabulary, daily living functional skills, and presence of sensory impairments or autism. A composite score of 3 or 4 qualified a child as ready for school.
              &lt;p&gt; 
              &lt;p&gt;Almost 60% of the children came from families who were in the lowest socioeconomic categories of the Hollingshead Index of Social Position. A little more than 10% were from families with the highest social position in the index. 
              &lt;p&gt;Two-thirds of the children had composite test scores that categorized them as ready to begin school. Of the remaining children, 28 (21%) had composite scores of 2, and 16 (12%) had scores of 1. 
              &lt;p&gt;
              &lt;p&gt;In a multivariate analysis, a child&apos;s Hollingshead score stood out as the strongest predictor of school readiness in the overall analysis (&lt;em&gt;P&lt;/em&gt;=0.008), in an analysis that did not include birth weight (&lt;em&gt;P&lt;/em&gt;=0.007), and in an analysis that excluded race and birth weight (&lt;em&gt;P&lt;/em&gt;=0.001). 
              &lt;p&gt;
              &lt;p&gt;Male sex, chronic lung disease, and severe intraventricular hemorrhage or periventricular leukomalacia also influenced school readiness, but to a lesser degree compared with the Hollingshead score. 
              &lt;p&gt;
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt;The authors reported no conflicts of interest relevant to the study.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
       
    </recommendedItem>
    <recommendedItem id="20090101_1_720"
                     title="AAP: MRSA Infections in Newborns Are On the Rise"
                     score="-0.006"
                     href="