Pediatricians' views of postpartum depression: a self-administered survey.

OBJECTIVE: To assess pediatricians' knowledge and views about postpartum depression (PPD). METHOD: Self-administered survey of a nationwide random sample of general pediatricians. RESULTS: Of 1200 eligible pediatricians sampled, 389 responded (32%). Half of pediatricians (49%) reported little or no education about PPD. Many respondents (51%) underestimated the overall incidence of PPD. Most pediatricians (80%) estimated the incidence in their practice as less than the published incidence. Few pediatricians felt confident they would recognize PPD (31%). Pediatricians were rarely familiar with available screening tools (7%). Many pediatricians (51%) felt screening was feasible in their practices. In logistic regression analysis, intent to begin screening was independently associated with <6 years in practice, positive view of feasibility and greater awareness of PPD. CONCLUSIONS: Pediatricians sampled have limited awareness of PPD and are unfamiliar with screening tools. Efforts to involve pediatricians in screening should address these knowledge barriers.

Nursery practices and detection of jaundice after newborn discharge.

OBJECTIVE: To investigate nursery practices regarding outpatient recognition of neonatal jaundice. DESIGN: Descriptive survey. PARTICIPANTS: Random sample of nursery head nurses and pediatricians from national lists. SETTING: Nurseries with more than 100 births per year and pediatricians responsible for newborn discharges. RESULTS: Head nurses from 204 nurseries and 200 pediatricians were surveyed, with 62% of head nurses and 55% of pediatricians responding. Almost half of the head nurses (45%) reported lack of a written neonatal jaundice protocol. Twenty-seven percent of head nurses and pediatricians reported that no system is in place to track jaundiced newborns after discharge. Forty percent of head nurses and 26% of pediatricians reported from higher-risk nurseries, defined as nurseries where more than 25% of mothers did not have a high school diploma or more than 50% of infants were born to single-parent families. These nurseries were no more likely to have a protocol for jaundice management or to use a system to track newborns after discharge. Discharge of most newborns before 36 hours of age was common (70% of head nurses, 62% of pediatricians) and some respondents discharged most newborns before 24 hours of age (16% of head nurses, 12% of pediatricians). For newborns discharged before 24 hours of age, more than half of the nurseries surveyed scheduled follow-up within 2 to 3 days (53% of head nurses, 62% of pediatricians). The likelihood of such follow-up did not differ by type of health care insurance, level of maternal education, percentage of single-parent families, predominance of minority patients, or higher risk as defined above. CONCLUSIONS: In our sample, many nurseries lack parent education, neonatal jaundice protocols, and neonatal jaundice tracking systems. Newborns discharged before 48 hours of age are often not scheduled to be seen by a health care provider within 2 to 3 days, despite American Academy of Pediatrics guidelines recommending such follow-up.

Pediatric benzodiazepine ingestion resulting in hospitalization.

OBJECTIVE: To characterize the clinical findings in children hospitalized for benzodiazepine ingestion. METHOD: Retrospective case series in two urban children's hospitals, with no intervention. Suicide attempts and polypharmacy ingestions were excluded. RESULTS: Forty-six children (67% male) with a mean age of 36 months (range 14-127 months) were hospitalized from January 1987 through September 1994. Lorazepam was most frequently ingested (13/41 identified drugs, 32%). The most prevalent symptoms were ataxia (87%), lethargy (57%), coma (Glasgow coma score < 15, 35%; Reed coma score > 0, 22%), and respiratory depression (9%). Duration of symptoms was less than 24 hours in 88% of patients. Isolated ataxia occurred in eight patients; in five of these patients, benzodiazepine ingestion was unsuspected by the physicians. Three parents intentionally administered the benzodiazepine to their child. Only 50% of 32 toxicology screens were positive for benzodiazepines. One child required endotracheal intubation. Flumazenil administration preceded clinical improvement in two other children. The remaining patients received activated charcoal administration and supportive care. CONCLUSION: Children hospitalized for benzodiazepine overdose occasionally had life-threatening symptoms. Ataxia was the most common clinical finding following benzodiazepine ingestion in this series. Flumazenil appeared beneficial for the treatment of severe benzodiazepine toxicity in only two patients. Most children recovered from their overdose uneventfully after receiving activated charcoal and supportive care.

Rebound severe methemoglobinemia from ingestion of a nitroethane artificial-fingernail remover.

We describe life-threatening methemoglobinemia in a child who ingested a nitroethane artificial-fingernail remover initially mistaken to be an acetone-based polish remover. Nitroethane-induced methemoglobinemia may be delayed and recurrent; patients ingesting this substance may warrant close observation for at least 24 hours. Care givers are cautioned to determine the precise substance involved in ingestions of potentially toxic fingernail products.

Family experiences, attitudes, and household safety practices regarding firearms.

To assess families' experiences with shootings and firearm ownership and attitudes, 208 children aged 5 to 12 years were interviewed and 242 parents filled out a questionnaire, all at an urban hospital. Forty-three percent of the parents and 25% of the children had personal knowledge of shootings. Of the parents, 10% owned guns, of which only 21% were stored safely. Gun ownership was more common in homes with resident adult males (14%) than in those with no adult males (3%). Most children (81%) played with guns, and 20% to 25% preferred violent TV shows, games, and toys. Parents' and children's attitudes toward firearms and children's gun play did not differ by level of mother's education; method of payment for, or site of, health care; income; or exposure to shootings. Children with personal knowledge of shootings more often expressed fears of being shot than did other children (52% vs 31%). The children in our study population were similar in their gun play and attitudes about gun use despite disparate socioeconomic backgrounds and exposure to shootings.

Cardiotoxic effects of astemizole overdose in children.

Astemizole, a nonsedating antihistamine, caused a prolonged corrected QT interval, ventricular dysrhythmias, and atrioventricular heart block after overdose in five children. Cardiotoxic effects lasted an average of 2 1/2 days. Children poisoned with astemizole need emergent medical evaluation, a 12-lead electrocardiogram with calculation of the corrected QT interval, and continuous cardiac monitoring for 24 hours.

Clonidine poisoning in young children.

We reviewed 47 consecutive inpatient records to determine the clinical course, role of supportive measures, and response to naloxone in children with clonidine poisoning. Severity of illness was assigned by means of the "pediatric risk of mortality" (PRISM) score. The children's ages ranged from 9 to 84 months. Central nervous system effects were noted in 44 patients; bradycardia occurred in 25, and apnea or depressed respiration was seen in 18. Thirty-four patients had symptoms within 1 hour of presentation, but no patient had further clinical deterioration more than 4 hours after presentation. Six patients required endotracheal intubation and mechanical ventilation. There was no difference in PRISM score or duration of symptoms between those patients who received naloxone and those who did not. More patients receiving naloxone required intubation, and only three patients had definite improvement after naloxone administration. We conclude that (1) young children who ingest clonidine have a wide spectrum of serious findings, (2) delayed progression of symptoms after clonidine poisoning is unlikely in a young child with normal renal function, and (3) naloxone is an inconsistent antidote for clonidine poisoning.