infants warranted a TSB and two were hospitalized for phototherapy. In both cases, residents did not recognize that the jaundice was significant while the attending correctly determined the need for hospitalization in one of the two cases. While the TcB and the TSB matched in one case, the TcB underestimated the TSB by 6 to 24% (5 cases). Conclusions: The data suggest that general pediatricians may not accurately predict bilirubin concentration based on physical examination, which underscores the importance of TcB measurement as a valuable screening tool. This study reaffirms the conclusions of other studies regarding the underestimation of TcB compared to TSB. Further studies are needed to test the validity of TcB measurements, especially in Hispanic infants. 362 IS THERE A NEUROBEHAVIORAL PROFILE ASSOCIATED WITH IN UTERO EXPOSURE TO SOLVENT ABUSE? M. Singal, A.N. Prasad, 1 V. Kamaya-Miyakawa, 2 T. Benoit, 3 A. Hanlon-Dearman, 3 C. Prasad, 1 University of British Columbia, Vancouver, BC; 1 University of Western Ontario, London, ON; 2 Clinical Health Psychology, University of Manitoba, Winnipeg, MB; 3 University of Manitoba, Winnipeg, MB. Background: Alcohol and solvent abuse are common in certain populations in Manitoba. Infants born to mothers with significant alcohol and/or solvent exposures are difficult to distinguish on the basis of dysmorphic features alone. Our experience at the Clinic for Alcohol and Drug Exposed Children (CADEC) led us to believe that solvent-exposed children may have a distinct neurobehavioral profile that has hitherto gone unrecognized in comparison with alcohol-exposed children. Objective: To identify differences in neurobehavioural profile following alcohol and/or solvent exposure using standardized psychometric tools. Methods: A prospective blinded design: 26 children (2–6 years) attending the CADEC underwent a neurologic examination and assessments for adaptive behavior (Vineland Adaptive Behavioural Scales [VABS]) and emotional and social functioning (Achenbach Child Behavioral Checklist [CBCL]). Results: Twenty-six children were assessed, 18 with alcohol + multiple exposures and 8 with exposure purely to solvents. Conclusions: Solvent-exposed children were less affected in motor and daily living skills in comparison with the alcohol and multiple- exposures group in a blinded assessment using VABS. However, both groups performed significantly lower than the standardized norms expected for their age. The solvent-exposed group showed more severe manifestations in several behavioral subdomains (emotion, withdrawn, internalizing behavior, and pervasive development) of the CBCL in comparison with alcohol-exposed children. Given their particular difficulties in communication and socialization on the VABS and propensity to internalize emotions, the solvent-exposed group may be at a great risk of secondary disabilities and psychiatric comorbid disorders and are deserving of funding support and early intervention. TABLE 1 Neurobehavioral Profile of Study Groups by Exposure Alcohol Solvent t-test Neurologic severity scores 10.4 6 6.1 5.6 6 4.5 NS VABS-Daily Living Skills 76.8 6 3.5 85.0 6 5.6 NS VABS-Motor Skills 82.1 6 4.1 90.8 6 6.8 NS VABS-Communication 71.9 6 3.0 72.6 6 4.6 NS VABS-Socialization 72.7 6 2.1 76.9 6 3.3 NS CBCL-Emotion 56.1 6 5.3 62.8 6 8.9 p , .05 CBCL-Withdrawn 62.4 6 7.4 71.1 6 8.0 p , .05 CBCL-Internalizing Behaviour 59.0 6 8.9 67.5 6 9.8 p , .05 CBCL-Pervasive Development 63.9 6 8.5 71.4 6 7.0 p , .05 363 ADHERENCE TO AMERICAN ACADEMY OF PEDIATRICS PRACTICE GUIDELINES FOR URINARY TRACT INFECTIONS AT OUR TEACHING INSTITUTION. L. Shah, N. Mandlik, P. Kumar, S. Andaya, P. Patamasucon, Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV. Introduction: Urinary tract infection (UTI) is becoming a more common cause of bacterial infection for febrile illness in children. The American Academy of Pediatrics (AAP) developed ‘‘practice guidelines’’ for the management of UTI in children in 1999. The aim of this study was to evaluate the uniformity of adherence to AAP guidelines at our teaching institution. Methods: The medical records of 405 patients (age 0–16 years) were retrospectively reviewed from the outpatient clinic, emergency room, and inpatient unit. Of these, 104 patients met the criteria. Data collected included age, gender, age of first UTI, presenting symptoms, method of urine collection, urinalysis, Gram stain, urine culture, repeat culture, imaging studies including renal ultrasonography (RUS), voiding cystourethrogram (VCUG), and treatment prescribed. UTI was defined as . 50,000 cfu/mL for catheterized specimens and . 10 5 cfu/mL for clean catch specimens. Results: Overall, adherence to guidelines was as high as 97.1% in performance of urinalysis and 61% in imaging studies and 51% in urine Gram stains. The majority of patients who were tested for UTI presented with fever and 70% of urine specimens were collected by transurethral catheterization. The route of antibiotic administration for treatment of UTIs was exclusively parenteral in 12.5% of patients (mostly neonates , 1 month old), and 87.5% received a combination of parenteral and oral antibiotics at some point during the course of therapy. There was 70% adherence to the recommendations for the method of urine collection and 97% adherence to performance of urinalysis. In contrast, there was only 61% adherence for renal imaging. Reasons for the lower adherence rate for renal imaging included the following: 27% never came for follow-up and 7% did not get imaging due to lack of financial coverage. The attending physician did not order imaging studies in 24 patients, which occurred more frequently with community physicians than academic faculty. Escherichia coli was found to be the cause of UTI in 82.7% of patients, followed by Enterococcus spp, Staphylococcus spp, and then Proteus mirabilis/Klebsiella/Streptococcus. Conclusion: We conclude that there is great adherence to AAP guidelines for diagnosis of UTI, but there was less adherence to recommendations for renal imaging. Future studies to improve patient follow-up, financial coverage to improve access to care, and education of primary care providers to adherence of guidelines may increase the quality of care for children with UTI. 364 PEDIATRIC ASTHMA PREVALENCE AND CARE AMONG NATIVE AMERICAN YOUTH IN SOUTHEASTERN MONTANA. M. Roberts, 1 D. Mark, 21 University of Washington Medical School, Seattle, WA; 2 Crow/Northern Cheyenne IHS Hospital, Crow Agency, MT. Objective: To determine the period prevalence of asthma in youth accessing care at the Crow Service Unit in southeastern Montana during the years 1995–2005 and to evaluate adherence to national care guidelines. Setting: The Crow Service Unit, an Indian Health Service area that includes one hospital and two satellite clinics and serves a user population of 11,400, approximately 5,200 of whom are less than 21 years old. Methods: Retrospective electronic and manual chart review to identify pediatric patients (age less than 21 years old) with a diagnosis of asthma (ICD 493) who had at least one clinic visit during the given calendar year. Care given to pediatric patients during 2005 was evaluated by examining six discrete variables from the National Asthma Education and Prevention Program (NAEPP) guidelines. Results: The prevalence rate for pediatric asthma from 1995 to 2005 was 8.3%. The period prevalence ranged from 6.94 to 10.38% (see Figure). Of the pediatric patients with asthma in 2005 (N 5 454), assessment to describe the severity of the patient’s condition was performed in 29.7% (n 5 135) of cases; spirometry was performed in 7.9% (n 5 36) of cases; a written self- management plan was given or updated in 53.5% (n 5 243) of cases; patient’s metered dose inhaler or nebulizer technique was assessed in 5.3% (n 5 24) of cases; and a follow-up plan was generated in 56.2% (n 5 255) of cases. Of the pediatric patients over age 5 years who had documented persistent asthma in 2005 (n 5 14), 71% (n 5 10) were treated with inhaled corticosteroids. Conclusion: Although the prevalence rate of asthma among Native American youth at the Crow Service Unit is similar to the general US pediatric population rate for all races in 2001 (8.7%), adherence to national standards of asthma care is suboptimal. 365 TELEMEDICINE IN PEDIATRIC SEXUAL ASSAULT. K.J. MacLeod, C. Boyle, S. Miyamoto, J.P. Marcin, K.K. Rogers, University of California, Davis, Children’s Hospital, Sacramento, CA. Rates of child abuse are high in rural Northern California, where the hospitals have fewer resources and less experienced pediatric sexual assault examiners. Without access to a complete, accurate examination, child sexual abuse victims face unnecessary admission or transfer and may not receive the quality of care that they deserve, putting them at risk for inadequate protection and continued abuse. The goal of this research project is to use live telemedicine consultations to improve the quality of care provided to child sexual assault victims in rural areas. We hypothesize that telemedicine will increase the ability of the rural provider to perform a complete and accurate sexual assault examination. The University of California, Davis (UCD), Children’s Hospital, CAARE Center, and the UCD Center for Health and Technology joined forces to provide telemedicine consultations to clinicians in two rural hospitals. Child abuse experts from UCD provide 24-hour-a-day live, pediatric sexual assault consultations, assisting in both the examiantion and the interpretation of the findings. Rural provider education and training are included. We designed and implemented quality of care surveys to assess patient history, physical examination, colposcopic and manual manipulation techniques, interpretation of findings, and treatment plans for these children. Data from the first 25 cases of live, telemedicine consultation showed that the mean duration for completing the consults was 58.89 minutes; with a range of 25 to 90 minutes. These consultations also showed that the telemedicine intervention produced the following: 44% positive change in history and data gathering; 77% changed their examination to include the use of the multimethod examination technique; and 52% changed their methods to include the use of adjunct techniques. The use of the multimethod and adjunct techniques during sexual assault examination has been shown, in previous studies, to improve the accuracy and completeness of these examinations. There were four acute sexual assault examination consultations that required additional methods in the collection of forensically defensible evidence. In these cases, the telemedicine consultation resulted in the UCD child abuse experts assisting the rural providers in the use of the Woods lamp (instrument with ultraviolet light to illuminate bodily secretions), as well as the proper collection and packaging of secretions and hair for possible DNA analysis. In conclusion, the use of telemedicine in cases of pediatric sexual assault increases the quality of care offered by rural health care providers to young victims in isolated communities. 366 MISUSE OF CHILD RESTRAINT SEATS IN MANITOBA: RESULTS OF A 2004 SURVEY. J. Blair, A. Perdios, S. Babul, P. Cripton, I. Pike, K. Mulpuri, E. Desapriya, BC Children’s Hospital, Vancouver, BC. Introduction: Child passenger restraints, including rear-facing infant seats, forward-facing toddler seats, and booster seats, provide protection for pediatric passengers traveling in motor vehicles. Objective: To investigate the use and misuse rate of child restraint seats in Manitoba. Methods: Characteristics of child restraint seat use were assessed at 10 child safety seat inspection surveys held between May 2004 and August 2004 in Manitoba. The sample of convenience included (1) rear-facing infant seat: for infants until they are at least 20 pounds and 1 year old (n 5 49); (2) forward-facing toddler seat: for toddlers 20 to 40 pounds and 1 to 4 years old (n 5 175); and (3) booster seats: for children 40 to 80 pounds and 4 to 8 years old (n 5 118). In all, MCSC child safety seats specialists inspected a total of 342 child restraint seats. Results: The overall rate of misuse was 63%, with 73% of infant carriers used inappropriately. The most common type of misuse found in infant carriers was loosely fitted seats (91%) followed by chest clips in the wrong position (86%). Seventy-four percent of forward-facing seats were incorrectly used. The most common type of misuse found in forward-facing child restraints was harness straps placed through the wrong slot (95%) followed by seats too loosely fitted (66%). Forty-three percent of booster seats were used incorrectly. The most common misuse found in booster seat was no head and neck protection offered (46%) followed by seat belts not crossing the child’s chest over the shoulder (37%). The risks of misuse of infant carriers compared with booster seats were nearly four times higher (odds ratio 3.63; confidence interval 1.75–7.55). The risks of volume 55 supplement 1 N January 2007 S135