Four million babies are born each year in the United States. AHRQ's current research focuses on improving the babies' health outcomes, preventing jaundice, and reducing racial and ethnic disparities in access to care.
Researchers are assessing the economic impact of breastfeeding promotions.
Description:
Using a randomized controlled trial, researchers are comparing the effects of pre- and postnatal breastfeeding promotions on child health care costs, breastfeeding practices, and outcomes.
Principal Investigator: Karen A. Bonuck (AHRQ grant HS10900).
Study will test the transferability of a simulation program.
Description:
Investigators will determine whether the skills acquired in a simulated environment can be practiced in delivery rooms. Findings will be used to improve the technical and behavioral performance of health professionals caring for mothers and babies.
Principal Investigator: Louis P. Halamek (AHRQ grant HS12022).
Two studies focus on racial/ethnic variations in managing prematurity and infant mortality.
Description:
In the first study, the researchers are using vital statistics to determine the relationship between newborn ethnicity, obstetric volume, and neonatal intensive care unit volume in the hospital of birth. Mark Chassin (AHRQ grant HS10859). In the second study, the researchers are using linked birth records, death records, and hospital discharge abstract data, to examine racial/ethnic differences in infant mortality.
Principal Investigator: Martin Shapiro (AHRQ grant HS10858).
Researchers seek to improve quality of care for newborns with jaundice.
Description:
The impact of a QI intervention on adherence to the American Academy of Pediatrics' guidelines for jaundice management is being assessed.
Principal Investigator: R. Heather Palmer (AHRQ grant HS09782).
Standardizing surfactant therapy for preterm infants.
Description:
One of the goals of this QI study is to reduce morbidity and mortality among preterm infants by standardizing use of surfactant therapy.
Principal Investigator: Jeffrey D. Horbar (AHRQ grant HS10528).
Study of neonatal intensive care addresses regionalization, market forces, and mortality.
Description:
Researchers are assessing differences in neonatal mortality over time, focusing on assessing the volume of newborns in high-risk groups, comparing insurance coverage with mortality, and assessing how competition affects the diffusion of units into community hospitals.
Principal Investigator: Ciaran S. Phibbs (NIH/AHRQ grant HD36914).
Quality of care measures for high-risk infants are being developed.
Description:
This project has three objectives: (1) develop new methods for measuring quality of care for very low birthweight infants, (2) apply the methods to estimating past and future quality of care, and (3) apply measures that summarize quality differences and economic performance across time and place.
Principal Investigator: Jeanette A. Rogowski (AHRQ grant HS10328).
Researchers examine outcomes for moderately premature newborns.
Description:
This study focuses on the epidemiology, treatment, and outcomes of moderately premature newborns who are admitted to an intensive care setting during the birth hospitalization.
Principal Investigator: Douglas K. Richardson (AHRQ grant HS10131).
Survival of low birthweight infants is linked to care in neonatal intensive care units (NICUs).
Description:
Birth certificates for 16,732 infants who weighed less than 4.2 pounds at birth were linked with hospital discharge abstracts and death certificates. Those who were born at hospitals with no NICUs or intermediate NICUs had almost twice the risk of dying of babies born at hospitals with regional NICUs.
Citation: Cifuentes, Bronstein, Phibbs, et al. Pediatrics 109(5):745-51, 2002 (AHRQ contract 290-92-0055).
Selective testing finds most urinary tract infections (UTIs).
Description:
A study of the urine testing practices of 573 pediatricians shows many test the urine of young febrile infants according to their clinical judgment rather than the recommended routine testing. Over half of the 3,066 infants had their urine tested, and 10 percent of those had UTIs. Of the 807 infants not initially tested, only 2 had subsequent documented UTIs.
Citation: Newman, Bernzweig, Takayama, et al. Arch Pediatr Adolesc Med 156:44-54, 2002 (AHRQ grant HS06485).
Market factors are not related to the offering of neonatal intensive care (NIC).
Description:
Researchers examined how strongly a hospital's decision to offer NIC is associated with teaching status and market factors. A high hospital market share of births is not associated with a higher likelihood of offering NIC, although the effect of market share is confounded with hospital teaching status (Intramural).
Citation: Friedman, Dever, Steiner, et al. J Health Polit Policy Law 27(3):441-64, 2002 (AHRQ Publication No. 02-R078)
Available from: AHRQ Publications Clearinghouse.
Authors urge the discontinuation of a biased index.
Description:
The Adequacy of Prenatal Care Utilization (APNCU) Index, used to measure resource use, demonstrates bias with the finding that more intensive resource use is associated with poorer birth outcomes. Investigators recommend discontinuing use of the APNCU index because it yields misleading results.
Citation: Koroukian and Rimm. J Clin Epidemiol 55:296-305, 2002 (NRSA training grant T32 HS00059).
The long-term health of low birthweight survivors may be compromised.
Description:
The physical growth and health status of 154 adolescents who were extremely low birthweight (ELBW) infants were examined and compared with 125 sociodemographically matched controls. Despite some catch-up growth, fewer acute health problems, and less use of medical services, the former group's physical growth continues to be compromised.
Citation: Saigal, Stoskoph, Streiner, et al. Pediatrics 108(2):407-15, 2001 (AHRQ grant HS08385).
Method of delivery affects bleeding problems.
Description:
Researchers studied the incidence of neonatal thrombocytopenia (NT); incidence of intraventricular hemorrhage (IVH); and method of delivery for 1,283 low birthweight infants. Vaginal delivery involved nearly three times the risk of IVH and 11 times the risk of severe NT during an infant's first day in the neonatal intensive care unit.
Citation: Kahn, Richardson, and Billett. Amer J Obstet Gynecol 186:109-16, 2002 (AHRQ grant HS07015).
Ventilation increases risk of disabling cerebral palsy (DCP) in some low birthweight infants.
Description:
With a population of 1,105 low birthweight newborns, researchers examined ventilatory practices as risks for cerebral palsy. Results show that ventilated newborns with low levels of carbon dioxide in the blood, high levels of oxygen in the blood, or unusually prolonged duration of ventilation support have a two- to three-fold increased risk of being diagnosed with DCP by age 2.
Citation: Collins, Lorenz, Jetton, et al. Pediatr Res 50(6):712-19, 2001 (AHRQ grant HS08385).
Use of intensive care can pose a moral dilemma.
Description:
Researchers examined two groups of extremely premature infants in New Jersey and the Netherlands. Near universal care in New Jersey (versus selective initiation of intensive care in the Netherlands) was associated with an additional 24.1 survivors, 7.2 cases of disabling cerebral palsy, and 1,372 ventilator days per 100 live births.
Citation: Lorenz, Paneth, Jetton, et al. Pediatrics 108(6):1269-1274, 2001 (AHRQ grant HS08385).
Prevalence of hypotension and vasopressor use varies.
Description:
Researchers evaluated differences in the prevalence of hypotension and hypertension among 1,288 very low birthweight infants at six neonatal intensive care units (NICUs). Hypotensive prevalence ranged from 24 to 45 percent, and NICUs varied nine-fold in their use of vasopressors.
Citation: Al-Aweel, Pursley, Rubin, et al. J Perinatol 21:272-8, 2001 (AHRQ grant HS07015).
Care differs widely despite similarity of illness.
Description:
Researchers used the Pediatric Comprehensive Severity Index and patient charts of 601 infants less than a year old with viral lower respiratory illness (VLRI) to examine practice variations in 10 medical centers. They found that infants with similar illness severity receive very different care at different hospitals. A more conservative approach to treatment of VLRI in hospitalized infants would not affect recovery but could reduce resource use and related costs.
Citation: Wilson, Horn, Hendley, et al. Pediatrics 108(4):851-5, 2001 (AHRQ contract 290-95-0042).
Study associates maternal fever with death of newborns.
Description:
Investigators retrospectively analyzed data from more than 11 million single live births from 1995 to 1997. The data show that maternal fever during labor is strongly associated with neonatal and infant death.
Citation: Petrova, Demissie, Rhoads, et al. Obstet Gynecol 98:20-27, 2001 (AHRQ grant HS09788).
Researchers examine attitudes on treating extremely premature newborns.
Description:
Researchers examined the attitudes of parents of ELBW children and doctors about the desirability of saving ELBW children. Findings underscore the importance of parent-doctor decisionmaking.
Citation: Steiner, Saigal, Burrows, et al. Pediatrics 108(1):152-7, 2001 (AHRQ grant HS08385).
Hospital sepsis evaluations for infants vary substantially.
Description:
Researchers analyzed medical records of 303 infants. After controlling for illness severity, infant age, and pediatric ICU stay, 10 hospitals were found to vary 46-fold in the likelihood that an infant would undergo a sepsis evaluation.
Citation: Antonow, Smout, Gassaway, et al. J Nurs Care Qual 15(3):39-49, 2001 (AHRQ contract 290-95-0042).
Biological mechanisms contribute to behavioral problems.
Description:
A four-country study of ELBW babies reveals that 8 to 10 years after birth, these children suffer from behavioral difficulties. Central nervous system insult due to prenatal or neonatal complications can explain some of the problems.
Citation: Hille, den Ouden, Saigal, et al. Lancet 357:1641-43, 2001 (AHRQ grant HS08385).
Similar patterns of disorders are found in LBW infants internationally.
Description:
Researchers examined cohorts of very low birthweight infants in the United States, Canada, Holland, Germany, and Jamaica. At school age, all groups had high rates of disabling cerebral palsy, mental retardation, school problems, and behavioral difficulties.
Citation: Nigel S. Paneth (AHRQ grant HS08385), Strategies for Care of the Very Low Birthweight Infant (Final Report NTIS Accession No. PB2001-105904).
Available from: The National Technical Information Service
Relationship between method of infant feeding and health care costs and use depends on several factors.
Description:
A study of 1,374 infants enrolled in Medicaid found no specific relationship between method of feeding—breastfeeding or formula feeding—and use of health care services. Although breastfeeding initially appeared to lower costs and use of care, preexisting illnesses and more severe conditions affected this relationship.
Citation: Aylin A. Riedel (AHRQ grant HS10163), Impact of Infant Feeding Method on Health Services Costs and Utilization in a Medicaid Population (Final Report, NTIS Accession No. PB2000-107824)
Available from: The National Technical Information Service.
Many low birthweight babies have learning and behavioral problems in adolescence.
Description:
A review of studies of six cohorts of infants born in the United States, Canada, Australia, and the United Kingdom found that adolescents who weighed only 2 pounds or less at birth (very low birthweight) suffer from more school difficulties and behavioral problems than their normal birthweight peers. Extremely low birthweight (less than 1.6 pounds at birth) adolescents fared the worst.
Citation: Saigal. Semin Neonatology 5:107-18, 2000 (AHRQ grant HS08385).
Children with very low birthweight remain smaller than their normal-birthweight peers.
Description:
Researchers found that adolescents who weighed 2 pounds or less at birth, even if they survived without major neurodevelopmental disability, continued to be smaller in height, weight, and head circumference than peers of normal birthweight.
Citation: Peralta-Carcelen, Jackson, Goran, et al. J Pediatr 136:633-40, 2000 (PORT contract 290-92-0055).
Home visits to low-risk mothers and newbor
ns cost more than clinic visits but are equally effective and increase mother's satisfaction.
Description:
In a randomized study of 1,163 medically and socially low-risk mother-newborn pairs, researchers assigned the pairs to receive either 70-minute home visits by nurses or 20-minute clinic visits with nurse practitioners or physicians on the third or fourth postpartum day. No significant differences were seen in clinical outcomes between the groups, but the mothers were much more satisfied with the home visits.
Citation: Lieu, Braveman, Escobar, et al. Pediatrics 105(5):1058-65, 2000 (AHRQ grant HS07910).
Increasing postpartum hospital stays may reduce newborn readmissions and deaths.
Description:
In the first of two studies, researchers compared the probability of readmission for newborns who had 39-hour stays with those who had 51-hour stays. They found that the 12-hour increase in length of hospital stay could reduce the newborn readmission rate by 0.6 percentage point. In the second study, the researchers examined birth, death, and hospital discharge records of 47,879 newborns and found a significant association between early discharge and newborn death. Delayed diagnosis of curable but life-threatening conditions was a major factor in their finding that infants discharged within 30 hours of birth were at greater risk of death than those discharged within 30 to 78 hours.
Citations: Malkin, Broder, and Keeler. Health Serv Res 35:1071-91, 2000; and Malkin, Garber, Broder, et al. Obstet Gynecol 96:183-8, 2000 (AHRQ grant HS09342).
Clinicians should give high priority to parents' wishes in decisions about neonatal care.
Description:
A study of ELBW adolescents and their parents found that despite severe disabilities, parents—and ELBW adolescents themselves—believe these young people have a decent quality of life.
Citation: Saigal. Clin Perinatology 27(2):403-19, 2000 (AHRQ grant HS08385).
Physicians may underestimate preterm infants' outcomes.
Description:
Pediatricians and obstetricians who are pessimistic about the outcomes of premature infants tend to underestimate their actual chances of survival and freedom from serious handicap and may be less likely to use potentially lifesaving therapies.
Citation: Morse, Haywood, Goldenberg, et al. Pediatrics 105(5):1046-50, 2000 (PORT contract 290-92-0055).
Comprehensive followup care reduces life-threatening illnesses and improves outcomes.
Description:
When high-risk inner-city infants received comprehensive followup care, 47 percent fewer of them died or developed life-threatening illnesses that required admission for pediatric intensive care, compared with infants who did not receive comprehensive followup care.
Citation: Broyles, Tyson, Heyne, et al. JAMA 284:2070-6, 2000 (AHRQ grant HS06837).
Longer hospital stays for newborns may not affect readmission rates for jaundice.
Description:
This study found that current laws mandating insurance coverage for 48-hour maternal and infant stays may not be the most effective way to prevent hospital readmission for jaundice and its complications.
Citation: Grupp-Phelan, Taylor, Liu, et al. Arch Pediatr Adolesc Med 153:1283-8, 1999 (NRSA training grant T32 HS00034).
Researchers develop model for treating infants with high fevers.
Description:
These researchers documented clinical practices and costs of care for infants with fever, and developed an optimal clinical prediction model. They used data collected by 577 pediatricians on 3,066 infants less than 3 months old who had a fever of at least 100.2ºF.
Citation: Robert H. Pantell (AHRQ grant HS06485), PROs Febrile Infant Study (Final Report, NTIS Accession No. PB2000-100683).
Available from: The National Technical Information Service.
To reverse trends of under use and disparities in oral care for children, researchers are studying incentives to improve access to and delivery of care.
Study assesses effects of public insurance on use of pediatric dental services.
Description:
This researcher is studying the dental health status, use of dental services, and effectiveness of established pediatric oral health performance measures for children enrolled in the North Carolina Medicaid or State Children's Health Insurance Program.
Principal Investigator: Tegwyn L. Hughes (AHRQ grant HS11514).
How do Federal programs affect use and cost of services?
Description:
This dissertation research project involves costs to the Medicaid program and use of dental health services for children and the role of the Women, Infants, and Children's (WIC) Supplemental Food Program in helping to help increase oral health access for Medicaid children.
Principal Investigator: Jessica Y. Lee (AHRQ grant HS11607).
Dental expenses of poor and minority children are low compared with other population groups.
Description:
Data from the 1996 Medical Expenditure Panel Survey show that white children make up to 66 percent of the child population and incur 86 percent of dental expenditures. Black and Hispanic children each make up 17 percent of the population and incur about 6 and 8 percent of dental expenditures, respectively. Dental expenses for poor, middle-income, and high-income children account for 8, 43, and 41 percent respectively (Intramural).
Citation: Edelstein, Manski, and Moeller. Pediatr Dent 24(2):11-17, 2002 (AHRQ Publication No. 02-R062)
Available from: AHRQ Publications Clearinghouse.
Researchers characterize 10 years of dental expenditures for children.
A comparison of data from the 1987 National Medical Expenditure Survey and the 1996 Medical Expenditure Panel Survey indicates that disparities in dental care expenses between poor and higher income children and among minority and white children are shrinking (Intramural).
Citation: Wall, Brown, and Manski. J Am Dent Assoc 133:474-82, 2002 (AHRQ Publication No. 02-R069)
Available from: AHRQ Publications Clearinghouse.
School-based dental sealant program reduces decay and tooth loss among poor children.
Description:
A cost-effectiveness analysis was conducted on a school-based dental sealant program for low-socioeconomic-status children in New York. Despite having more untreated cavities than the control group (78 vs. 66 percent), the sealant group experienced fewer cavities (2.2 vs. 6.8), no loss of permanent teeth (0 vs. 6), and fewer decayed and filled surfaces (62 vs. 159).
Citation: Zabos, Glied, Tobin, et al. J Health Care Poor Underserved 13(1):38-48, 2002 (AHRQ and HRSA interagency agreement).
Caregivers recount barriers to obtaining care.
Description:
Researchers examined comments about dental care from an ethnically diverse group of 77 caregivers who participated in 11 focus groups. Participants identified barriers to making appointments for their Medicaid-insured children, as well as barriers at the dental setting, such as long waiting times and judgmental, disrespectful, and discriminatory behavior from staff and providers.
Citation: Mofidi, Rozier, and King. Am J Public Health 92(1):53-8, 2002 (NRSA training grant T32 HS00032).
Poor and minority children experience substantial service disparities in dental care.
Description:
Investigators analyzed dental visits among U.S. children by category of service and sociodemographic factors using 1996 Medical Expenditure Panel Survey data. For every type of dental service, use was higher among white children than among black and Hispanic children and among non-poor children than among poor children (Intramural).
Citation: Macek, Edelstein, and Manski. Pediatr Dent 23(5):383-9, 2002 (AHRQ Publication No. 02-R045)
Available from: AHRQ Publications Clearinghouse.
Consuming sugared soda does not increase cavities in children and teens.
Description:
Using data from the 1988-1994 Third National Health and Nutrition Examination Survey, researchers examined associations between dental cavities and soda consumption. Children aged 12 to 16 drank an average of 9 to 12 ounces of soda a day, those aged 6 to 11 drank about 6.5 ounces a day, and those aged 2 to 5 drank an average of 2.3 ounces a day. No differences in decayed, missing, and filled permanent tooth surfaces were found.
Citation: Heller, Burt, and Eklund. J Dent Res 80(10):1949-53, 2001 (AHRQ grant HS09554).
Income affects the number of preventive dental visits made.
Description:
These researchers calculated national estimates for preventive dental visits by poor and near-poor youths. Such visits were only about half as likely among poor and near-poor youngsters as they were among young people in middle or high income families across racial/ethnic groups (Intramural).
Citation: Watson, Manski, and Macek. J Am Dent Assoc 132:1580-7, 2001 (AHRQ grant HS10129) (AHRQ Publication No. 02- R034)
Available from: AHRQ Publications Clearinghouse.
Sealants save Medicaid money for children prone to cavities.
Description:
Researchers assessed dental experiences of 15,438 children enrolled in the North Carolina Medicaid program from 1985 to 1992. They found savings in Medicaid expenditures related to sealant use within 2 years of application for children with two or more prior caries-related services involving the occlusal surface.
Citation: Weintraub, Stearns, Rozier, et al. Am J Public Health 91(11):1877-81, 2001 (AHRQ grant HS06993).
Study reveals the impact of insurance on dental visits.
Description:
Using data from the 1996 Medical Expenditure Panel Survey, researchers found that Medicaid-insured children are more likely than uninsured children to visit a dentist but not as likely as privately insured children (Intramural).
Citation: Manski, Edelstein, and Moeller. J Am Dent Assoc 132:1137-45, 2001 (AHRQ Publication No. 01-R083)
Available from: AHRQ Publications Clearinghouse.
Age and sociodemographic differences exist in dental visits.
Description:
An analysis of data on the civilian, community-based U.S. population during 1977, 1987, and 1996 was conducted. Children aged 6 to 18 had higher dental use rates than any other age group (Intramural).
Citation: Manski, Moeller, and Maas. J Am Dent Assoc 132:655-64, 2001 (AHRQ Publication No. 01-R068)
Available from: AHRQ Publications Clearinghouse.
Review demonstrates benefits of preventive oral care in children.
Description:
Studies show that by mid-childhood, more than 50 percent of children have dental caries; by late adolescence about 80 percent have caries. Researchers say the infectious nature of dental caries, their early onset, and the potential of early interventions require an emphasis on preventive oral care in primary pediatric care to complement existing dental services.
Citation: Mouradian, Wehr, and Crall. JAMA 284(20):2625-31, 2000 (AHRQ purchase order R40281601D).
Applying fluoride during dental checkups does not affect restorative care.
Description:
Researchers correlated the application of topical fluoride with dental fillings and found that children who receive topical fluoride most frequently are at least as likely to receive fillings as children who receive little or no topical fluoride.
Citation: Eklund, Pittman, and Heller. J Public Health Dent 60(1):33-8, 2000 (AHRQ grant HS09554).
Study suggests that increasing reimbursement will not substantially improve access to dental care for children.
Description:
Expanding Medicaid eligibility in North Carolina between 1985 and 1991 and increasing payments to providers between 1988 and 1991 only marginally increased access to dental services for Medicaid-insured children in the State. Pediatric dentists were more likely to participate in Medicaid than general dentists, as were dentists in solo rather than group practices.
Citation: Mayer, Stearns, Norton, et al. Inquiry 37:33-44, 2000 (AHRQ grant HS09330).
Data reveal disparities in dental care.
Description:
Data from AHRQ's Medical Expenditure Panel Survey were analyzed to determine the percentage of children who made a dental visit and the number of visits they made. Low income, low education, and minority race were associated with lower odds of visiting the dentist and a lower number of visits per child (Intramural).
Citation: Edelstein, Manski, and Moeller. Pediatr Dent 22(1):17-20, 2000 (AHRQ Publication No. 00-R024)
Available from: AHRQ Publications Clearinghouse.
Half of Medicaid-insured children do not use dental services.
Description:
Despite Federal law requiring dental care for Medicaid-eligible children, researchers found that half of such children never used dental services.
Citation: Robison, Rozier, and Weintraub. Am J Public Health 88(11):1669-73, 1998 (AHRQ grant HS06993 and NRSA training grant T32 HS00032).
Otitis media (middle ear infection) is a common childhood illness that affects more than half of children under age 5 each year. Current debate revolves around antibiotic use and the long-term effects of ear infection on functioning, behavioral problems, and parental stress.
Conference attendees focused on the effects of otitis media on language and learning.
Description:
Aims of this interdisciplinary conference included addressing research and controversies on the linkage of otitis media in early childhood with hearing, speech and language development, behavior, and academic achievement.
Principal Investigator: Joanne Roberts (AHRQ grant HS12072).
Investigators are developing and validating quality measures related to insertion of tympanostomy tubes.
Description:
Researchers are assessing the usefulness of tympanostomy tubes in children with recurring otitis media with effusion and developing quality measures and evidence-based criteria to identify appropriate candidates for tube placement.
Principal Investigator: Mark R. Chassin (AHRQ grant HS10302).
Study focuses on use of nonantibiotic treatments for otitis media.
Description:
These researchers are examining the safety, effectiveness, cost, and acceptability of withholding antibiotics from children with mild acute otitis media (AOM). They are using nonantibiotic symptomatic treatment, parent education, and followup to manage the condition.
Principal Investigator: David P. McCormick (AHRQ grant HS10613).
Parents influence pediatricians' treatment decisions.
Description:
An analysis of audiotapes and videotapes of 295 acute care visits reveals that parents often pressure pediatricians to prescribe antibiotics for their children. The doctors prescribed antibiotics in 15 of the 31 cases involving overt pressure.
Citation: Stivers. Soc Sci Med 54(7):1111-30, 2002 (AHRQ grant HS10577).
Researchers describe complications associated with tympanostomy-tube placement.
Description:
Investigators prospectively monitored the middle ear status of 173 children who underwent bilateral tympanostomy tube placement. They found that tube otorrhea (discharge of pus through the tube) is a common and recurring complication in young children who undergo tube placement for persistent middle-ear effusion.
Citation: Ah-Tye, Paradise, and Colborn. Pediatrics 107(6):1251-1258, 2001 (AHRQ and NICHD grant HD26026).
Antibiotics offer only modest benefits to children with uncomplicated otitis media.
Description:
Data show that most children with uncomplicated AOM who were not initially treated with antibiotics (78 percent) no longer had pain or fever within 4 to 7 days and suffered no complications.
Citation: Takata, Chan, Shekelle, et al. Pediatrics 108(2): 239-47, 2001 (AHRQ contract 290-97-0001).
Expert panel labels literature on otitis media “uneven.”
Description:
Reviewers screened 3,461 abstracts and titles of AOM studies from 1966 to 1999, reviewed 760 full-length articles, and used 80 studies in 85 articles. The experts concluded that there is a large body of research literature; however, its quality is uneven and not generalizable.
Citation: Chan, Takata, Shekelle, et al. Pediatrics 108(2):248-54, 2001 (AHRQ contract 290-97-0001).
Ear tube placement in children with persistent otitis media does not measurably improve development at age 3.
Description:
Children under age 3 in this study did not have improved developmental outcomes—speech, language, cognitive, or psychosocial development—as a result of tympanostomy tube placement for persistent fluid in the middle ear, regardless of whether tube insertion was prompt or delayed.
Citation: Paradise, Feldman, Campbell, et al. N Engl J Med 344:1179-87, 2001 (AHRQ/NICHD grant HD26026).
Report summarizes available scientific evidence on managing AOM.
Description:
This report presents a synthesis of available scientific evidence on treating AOM. The researchers discuss the natural history of AOM, assess whether antibiotics are effective in treating the condition, and compare the effectiveness of specific antibiotic regimens.
Availability: The summary (AHRQ Publication No. 00-E008) and full report, Management of Acute Otitis Media (AHRQ Publication No. 00-E009), are available from the AHRQ Publications Clearinghouse. (AHRQ contract 290-97-0001).
Primary care physicians can use tympanometry to diagnose middle ear infections.
Description:
Primary care physicians who have been trained in using a hand-held tympanometer to diagnose otitis media can interpret tympanograms as accurately as experts, according to this study. In addition, their readings can provide high-quality data for research purposes.
Citation: Green, Culpepper, De Melker, et al. J Fam Pract 49(10):932-36, 2000 (AHRQ grant HS07035).
Researchers examine effects of persistent middle-ear inflammation in the first 3 years of life.
Description:
Two studies from the University of Pittsburgh School of Medicine involved 2,278 children to examine the effects of persistent otitis media in the first 3 years of life on later functioning and behavior. The first study found that problems with impaired hearing, language, speech, and cognitive development correlated more with socioeconomic status than with otitis media. The second study found no substantial relationship between parents' ratings of parent-child stress or children's behavioral problems and the duration of middle-ear effusion.
Citations: Paradise, Dollaghan, Campbell, et al. Pediatrics 105(5):1119-30, 2000 (AHRQ/NICHD grant HD26026) and Paradise, Feldman, Colborn, et al. Pediatrics 104(6):1264-73, 1999 (AHRQ grant HS07786).
Using less expensive antibiotics to treat children's ear infections could save money without compromising care.
Description:
Researchers found that more expensive antibiotics accounted for only 30 percent of the prescriptions written but up to 77 percent of the more than $2 million spent on medications for AOM in the Colorado Medicaid program. Less expensive antibiotics, which worked just as well, accounted for 67 percent of the prescriptions but only 21 percent of the costs.
Citation: Berman, Byrns, Bondy, et al. Pediatrics 100(4):585-92, 1997 (AHRQ grant HS07816).