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Background: There are limited studies on educational outcomes of children born with esophageal atresia (EA) with or without tracheoesophageal fistula (TEF). We aimed to compare 3rd to 5th grade academic proficiency among children born with EA/TEF versus unaffected children. Methods: Children born with EA/TEF (2000–2005) were identified from the Arkansas Reproductive Health Monitoring System. For each child born with EA/TEF, up to two unaffected children were selected from birth certificates and matched on hospital and month of birth, sex, and race and ethnicity. Data on NICU hospitalization were abstracted from medical records at Arkansas' only pediatric specialty hospital. The study outcomes were 3rd to 5th grade proficiency on literacy and mathematic standardized achievement tests, referral to special education, and days of school absence. Regression models were used to assess the association of outcome measures with diagnosis of EA/TEF, after adjusting for differences in covariates between EA/TEF and unaffected children and accounting for paired correlations using the generalized estimating equation method. Results: The final cohort included 20 surviving children born with EA/TEF and 31 unaffected children. There was no significant difference in literacy (3rd: 70% vs. 71%; 4th: 83% vs. 81%; 5th: 94% vs. 87%, p > 0.05) or mathematics proficiency (3rd: 80% vs. 87%; 4th: 83% vs. 78%; 5th: 75% vs. 78%, p > 0.05), referral to special education (20% vs. 19%, p = 0.65), or total days of school absence (47 vs. 26 days, p = 0.07) between EA/TEF and unaffected children. Conclusions: Children born with EA/TEF had comparable academic proficiency to unaffected children. [ABSTRACT FROM AUTHOR]

Background: We examined prevalence, incidence, and trajectory of obesity from kindergarten through grade 8 in one of the first states to implement annual surveillance. Methods: Participants included 16,414 children enrolled in kindergarten in Arkansas in 2004 with complete body mass index (BMI) measurements in kindergarten and eighth grade. Repeated measures of weight status were entered in multiple linear and logistic regression models with demographics and family poverty status. Results: The prevalence of obesity (BMI = 95th percentile) was lowest in kindergarten (14.9%), with subsequent incidence rates consistent at 4%. Prevalence and incidence peaked in eighth grade (24.5% and 4.9%, respectively), with 33.8% of children measuring obese at least once by eighth grade. Kindergarten obesity was a significant predictor of eighth grade obesity (odds ratio, 17.5; 95% confidence interval, 15.8-19.3). We found statistically significant 3-way interactions for sex, race, and time, suggesting unique patterns for Hispanic boys and black girls. Conclusions: Our study documents unique longitudinal patterns of obesity from kindergarten through eighth grade that expand our understanding of risk. It demonstrates the value of public school health systems that collect routine administrative data about student BMI that is integrated with education records to foster program and policy discussions.

Previous machine learning approaches fail to consider race and ethnicity and social determinants of health (SDOH) to predict childhood asthma exacerbations. A predictive model for asthma exacerbations in children is developed to explore the importance of race and ethnicity, rural-urban commuting area (RUCA) codes, the Child Opportunity Index (COI), and other ICD-10 SDOH in predicting asthma outcomes. Insurance and coverage claims data from the Arkansas All-Payer Claims Database were used to capture risk factors. We identified a cohort of 22,631 children with asthma aged 5–18 years with 2 years of continuous Medicaid enrollment and at least one asthma diagnosis in 2018. The goal was to predict asthma-related hospitalizations and asthma-related emergency department (ED) visits in 2019. The analytic sample was 59% age 5–11 years, 39% White, 33% Black, and 6% Hispanic. Conditional random forest models were used to train the model. The model yielded an area under the curve (AUC) of 72%, sensitivity of 55% and specificity of 78% in the OOB samples and AUC of 73%, sensitivity of 58% and specificity of 77% in the training samples. Consistent with previous literature, asthma-related hospitalization or ED visits in the previous year (2018) were the two most important variables in predicting hospital or ED use in the following year (2019), followed by the total number of reliever and controller medications. Predictive models for asthma-related exacerbation achieved moderate accuracy, but race and ethnicity, ICD-10 SDOH, RUCA codes, and COI measures were not important in improving model accuracy. [ABSTRACT FROM AUTHOR]

Introduction A very small number of all children (0.4-0.7%) are recognized as extreme health care resource utilizers by incurring 11-33% of total pediatric health care costs [1, 2]. The vast [...], Children with medical complexity (CMC) have multiple specialty need, technology dependence, and high health care utilization. The objective of this study is to profile types of pediatric health care utilization and costs by increasing levels of medical complexity. This is a cross-sectional study of the 2007, 2008 and 2009 Full-Year Data Sets from the Medical Expenditure Panel Survey. Medical complexity was defined by a higher number of positive items from the five question children with special health care needs (CSHCN) Screener. CMC were defined by [greater than or equal to]4 positive screener items. Outcomes included the number of inpatient, outpatient, and emergency department visits, associated costs and diagnoses, and reported satisfaction. ICD-9 codes were grouped by Clinical Classifications Software. Of 27,755 total study subjects [less than or equal to]17 years, 4,851 had special needs and 541 were CMC. Older age, male gender, white/non-Hispanic race/ethnicity, and public insurance were all associated with medical complexity (all p < 0.001). CMC had an annual mean of 19 annual outpatient visits ($616) and 0.26 inpatient visits ($3,308), with other significant cost drivers including home health ($2,957) and prescriptions ($2,182). The most common reasons for non-CSHCN and less-complex CSHCN outpatient visits were viral illnesses, while the main reasons for CMC visits were for mental health. Compared to families without CSHCN, those with CMC have, on average, lower satisfaction with health care (8.4 vs. 8.9 out of 10, p < 0.001). Health care models for CMC should account for mental health conditions that may be driving high numbers of outpatient encounters. Keywords Children with special health care needs * Complex care * Complex chronic conditions * Health care disparities * Medical home

The magnitude of stress and associated health consequences experienced by caregivers compromises their ability to effectively provide care to children, especially children with disability. We used latent class analysis of [...]

Background: To compare academic proficiency among children with congenital diaphragmatic hernia (CDH) versus controls and identify predictors of academic performance among children with CDH. Methods: Infants born with CDH in Arkansas, 2000–2005, were identified from the Arkansas Reproductive Health Monitoring System. For each case, two controls were selected from birth certificate data and matched for hospital and month of birth, sex, and race/ethnicity. Data on re‐hospitalization within the first 5 years and payer data were collected from the Arkansas Hospital Inpatient Discharge database. Surviving cases and controls were linked to the Arkansas Department of Education database. Primary outcomes were odds of proficiency on fourth grade literacy and mathematics achievement tests. Multivariable logistic regression models evaluated the association between study characteristics and academic proficiency. Results: The final study cohort included 25 surviving CDH cases and 31 controls who were linked to their education data. After adjusting for differences in characteristics (5‐min Apgar score and associated congenital anomalies) between cases and controls, there were no statistically significant differences in literacy (72% vs. 84%, p =.93) or mathematics (64% vs. 81%, p =.98) test proficiency between the two groups. In multivariable analyses, among CDH cases, oxygen at discharge and Medicaid payer/longer hospital stay were associated with worse fourth grade literacy and mathematics proficiency, respectively. Conclusions: Oxygen at discharge, Medicaid payer, and longer hospital stay were associated with lower academic performance among CDH cases. [ABSTRACT FROM AUTHOR]