Evaluation and Management of Well-Appearing Febrile Infants 8 to 60 Days Old.

This guideline addresses the evaluation and management of well-appearing, term infants, 8 to 60 days of age, with fever ≥38.0°C. Exclusions are noted.

Chlamydia and Gonorrhea Prevalence and Treatment in Detained Youths: Strategies for Improvement.

Purpose: Adolescents and young adults have the highest prevalence of sexually transmitted infections (STIs), accounting for more than 50% of all reported infections. An especially high-risk group includes adolescents in juvenile or correctional facilities.

Methods: This retrospective analysis was conducted at the only juvenile detention facility in the State of Hawai'i from 2014 to 2017.

The Child Witness in the Courtroom.

Beginning in the 1980s, children have increasingly served as witnesses in the criminal, civil, and family courts; currently, >100 000 children appear in court each year. This statement updates the 1992 American Academy of Pediatrics (AAP) policy statement "The Child as a Witness" and the subsequent 1999 "The Child in Court: A Subject Review." It also builds on existing AAP policy on adverse life events affecting children and resources developed to understand and address childhood trauma.

Management and Outcomes of Previously Healthy, Full-Term, Febrile Infants Ages 7 to 90 Days.

Background: There is considerable variation in the approach to infants presenting to the emergency department and outpatient clinics with fever without a source. We set out to describe the current clinical practice regarding culture acquisition on febrile young infants and review the outcomes of infants with and without cultures obtained.

Methods: This study analyzed Kaiser Permanente Northern California's electronic medical record to identify all febrile, full term, previously healthy infants born between July 1, 2010, and June 30, 2013, presenting for care between 7 and 90 days of age.

The changing epidemiology of serious bacterial infections in young infants.

Background: Management of febrile young infants suspected of having serious bacterial infections has been a challenge for decades. The impact of changes in prenatal screening for Group B Streptococcus and of infant immunizations has received little attention in population-based studies.

Methods: This study analyzed all cultures of blood, urine and cerebrospinal fluid obtained from full-term infants 1 week to 3 months of age, who presented for care at Kaiser Permanente Northern California during a 7-year period utilizing electronic medical records.

Office-based treatment and outcomes for febrile infants with clinically diagnosed bronchiolitis.

Objectives: The goals were to describe the (1) frequency of sepsis evaluation and empiric antibiotic treatment, (2) clinical predictors of management, and (3) serious bacterial illness frequency for febrile infants with clinically diagnosed bronchiolitis seen in office settings.

Methods: The Pediatric Research in Office Settings network conducted a prospective cohort study of 3066 febrile infants (<3 months of age with temperatures >or=38 degrees C) in 219 practices in 44 states. We compared the frequency of sepsis evaluation, parenteral antibiotic treatment, and serious bacterial illness in infants with and without clinically diagnosed bronchiolitis.

Forgone health care among U.S. adolescents: associations between risk characteristics and confidentiality concern.

Purpose: To examine risk characteristics associated with citing confidentiality concern as a reason for forgone health care, among a sample of U.S. adolescents who reported having forgone health care they believed was necessary in the past year.

Does clinical presentation explain practice variability in the treatment of febrile infants?

Background: Previous studies documented considerable variability in the treatment of febrile infants, despite the existence of practice guidelines for this condition. None of those studies documented the extent to which this variability is accounted for by differences in clinical severity.

Objective: To quantify the individual effects of the patient's clinical presentation, demographic, provider, and practice characteristics, and regional variables on practice variability in the evaluation and treatment of febrile infants.

Examination of the treatment and follow-up care for adolescents who test positive for Chlamydia trachomatis infection.

Objective: To document the comprehensive management of Chlamydia trachomatis infections in sexually active 14- to 19-year-old adolescents.

Design: A chart review of both paper and electronic records to examine documentation of treatment and follow-up of adolescents who tested positive for C. trachomatis infection.

Choice of urine collection methods for the diagnosis of urinary tract infection in young, febrile infants.

Background: The optimal method of urine collection in febrile infants is debatable; catheterization, considered more accurate, is technically difficult and invasive.

Objectives: To determine predictors of urethral catheterization in febrile infants and to compare bag and catheterized urine test performance characteristics.

Design: Prospective analysis of infants enrolled in the Pediatric Research in Office Settings' Febrile Infant Study.

Screening sexually active adolescents for Chlamydia trachomatis: what about the boys?

Objectives: We sought to determine the effectiveness of a systems-based intervention designed to increase Chlamydia trachomatis (CT) screening among adolescent boys.

Methods: An intervention aimed at increasing CT screening among adolescent girls was extended to adolescent boys (14-18 years). Ten pediatric clinics in a health maintenance organization with an ethnically diverse population were randomized.

Impact of pulse oximetry and oxygen therapy on length of stay in bronchiolitis hospitalizations.

Background: Infants hospitalized with bronchiolitis are frequently monitored with a pulse oximeter. However, there is little consensus on an acceptable lower limit of oxygenation. No previous studies have examined how the use of pulse oximetry and supplemental oxygen therapy affects length of stay.

Management and outcomes of care of fever in early infancy.

Context: Fever in infants challenges clinicians in distinguishing between serious conditions, such as bacteremia or bacterial meningitis, and minor illnesses. To date, the practice patterns of office-based pediatricians in treating febrile infants and the clinical outcomes resulting from their care have not been systematically studied.

Objectives: To characterize the management and clinical outcomes of fever in infants, develop a clinical prediction model for the identification of bacteremia/bacterial meningitis, and compare the accuracy of various strategies.

To screen or not to screen: prevalence of C. trachomatis among sexually active asymptomatic male adolescents attending health maintenance pediatric visits.

This study estimated the prevalence of Chlamydia trachomatis (CT) among sexually active, asymptomatic, multiethnic adolescent males attending preventive health maintenance visits at pediatric clinics within a large health maintenance organization. First-void urines of sexually active 14-18-year-old males were screened for CT. The CT infection rate was 4% (27/711), 95% CI = 2.

Effect of a clinical practice improvement intervention on Chlamydial screening among adolescent girls.

Context: Chlamydia trachomatis infection is a serious public health concern that disproportionately affects adolescent girls. Although annual C trachomatis screening of sexually active adolescent girls is recommended by health professional organizations and is a Health Employer Data and Information Set (HEDIS) performance measure, this goal is not being met.

Objective: To test the effectiveness of a system-level, clinical practice improvement intervention designed to increase C trachomatis screening by using urine-based tests for sexually active adolescent girls identified during their routine checkups at a pediatric clinic.

Urine testing and urinary tract infections in febrile infants seen in office settings: the Pediatric Research in Office Settings' Febrile Infant Study.

Objective: To determine the predictors and results of urine testing of young febrile infants seen in office settings.

Design: Prospective cohort study.

Setting: Offices of 573 pediatric practitioners from 219 practices in the American Academy of Pediatrics Pediatric Research in Office Settings' research network.