Maternal and Child Health Library

This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html

December 18, 2009

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Readers: The next issue of MCH Alert will be published on January 8, 2010. Happy holidays!

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1. WEB SITE OFFERS PEDIATRIC HEALTH INFORMATION FOR PARENTS

healthychildren.org is a new Web site designed for families seeking child and adolescent health information consistent with the American Academy of Pediatrics' (AAP's) policies and guidelines. The site contains information on more than 300 topics compiled from AAP parenting books, patient-education materials, and fact sheets. Content is organized into the following sections: Ages and Stages (prenatal to young adulthood), Healthy Living, Safety and Prevention, Family Life, Health Issues, News, and Tips and Tools. The site is also searchable by keyword, topic, age, or gender. An Ask the Pediatrician corner provides a searchable database of current health issues. The Hot Topics area presents news and guidance on medication safety alerts, product recalls, and information generated by AAP such as new policy statements and public-awareness campaigns. Parents may also opt to register with the site, customize the view, and receive information specific to their needs. The Web site is available at http://www.healthychildren.org.

• Thirty-three states define levels of hospital neonatal care services. The range of levels terminology is broad, with states using numbers, words, and combined designations. The defined levels of service range from two to six.
• Although all 33 states that have defined levels of care include language for increasing complexity of care, the descriptive language varies broadly. Twenty-five states stipulate newborn characteristics, restrictions on respiratory support, or specialized services such as neonatal and cardiac surgery as descriptive of the functional capabilities of the level of care.
• Nineteen states specify one or more use requirements for special care. These use requirements can be grouped into four categories: capacity, unit or service volume, unit occupancy, or case mix.
• For the 33 states with defined levels of neonatal services, the definitions appear in five types of operational documents: hospital licensure statutes and regulations, certificate of need application requirements, state health plans, state health department-sponsored program regulations, or affiliated nongovernmental program publications. In 9 states the definitions appear in two or more documents, and in 24 states they appear in one.
• States may use any of three options to regulate hospital perinatal services -- facility licensure; state health facility planning, expansion, or construction; and certification, in some instances linked to client care funding.
• Some degree of linkage through either levels designation for Medicaid coverage for NICU or MCH-funded services was confirmed for 11 states. Although many states reported MCH involvement in perinatal health activities, funding for regional outreach was confirmed for only three.
• AAP documents are cited as sources for state regulations or are incorporated by reference in 22 states.

• The overall MATPI incidence in St. Louis County for the 2007-2008 influenza season was 3.51 cases per 1,000 population. The 3,550 reported cases in St. Louis County were significantly greater than any of the totals for the previous nine seasons.
• An influenza morbidity curve revealed an apparent central peak in influenza incidence within the adolescent and young adult age groups.
• The 20-to-24-year-old age group had 4.4 times the number of MATPI cases during the 2007-2008 influenza season as the aggregate seasonal mean number of MATPI cases for the eight evaluable seasons, 1998-2004 and 2006-2008.
• Stratification by influenza type revealed that the central peak in the 20-to-24-year-old age group was primarily due to influenza type A.
• The influenza A MATPI incidence for the 20-to-24-year-old age group in the 2007-2008 influenza season remained significantly higher after adjustment for data source (hospital vs. nonhospital) in comparison with the 15-to-19-year-old age group and the 25-to-29-year-old age group within the 2007-2008 season.

• Children with ASD who displayed "extremely uncooperative" behavior and whose families' incomes were between $20,000 and $49,000 were least likely to have a regular dentist.
• Children with ASD who displayed "extremely uncooperative" behavior and whose families' incomes were between $20,000 and $49,000 were least likely to receive care when needed.
• There were no significant results found for the remaining dental care access issues, which included the following: (1) When was your child's last dental visit, (2) is your child currently scheduled for a checkup within the next 12 months, and (3) has your child ever been refused treatment.

• Between 1993 and 2000, there was a clear increase in use of the supine sleep position and a decrease in the prone position in each racial and ethnic group.
• Throughout the 15-year study period, African-Americans consistently had the lowest use of the supine sleep position and the highest use of the prone position, compared with whites. Hispanics did not significantly differ from whites regarding use of the prone position for sleep.
• Since 2001, there has been little change in sleep position practices. In the white and African-American populations, supine sleep position reached a plateau of approximately 75 percent and 58 percent, and prone sleep position reached a plateau of approximately 10 percent and 20 percent, respectively.
• Survey year is the strongest predictor of supine sleep position. Other characteristics associated with greater likelihood of reporting usual supine sleep position include older maternal age, race other than African-American, higher maternal educational level, higher maternal income level, mother not having other children, geographic region other than the Southern United States, older infant age, and infant being born after more than 37 weeks’ gestation.
• In 2007, there were statistically fewer infants placed in the supine position for sleep, compared with 2003.
• From 2003 to 2007, the difference in supine sleep position between African-American and white infants can be explained, at least in part, by caregiver concern about infant choking and comfort. While the prevalence of concern about choking decreased markedly over time, the relative importance of these attitudes as predictors of sleep position increased.