Tuesday, July 22, 2014

Jaundice in Breastfed Infants: How Long Can It Last?

Photo by Cheryl via Flickr
By: Lewis First, MD, MS; Editor-in-Chief 

We certainly see babies coming into offices at 3 and even 4 weeks of age still looking somewhat
yellow, prompting us to check a bilirubin level and finding an unconjugated level still over 5 mg/dL. Is this prolonged level normal? Should we worry and keep checking levels or reassure parents that all is well?

Maisels et al. (doi: 10.1542/peds.2013-4299) looked into this issue of the natural history of hyperbilirubinemia and jaundice in newborns by measuring transcutaneous bilirubin levels in predominantly breastfed infants over 35 weeks gestation.

The results suggest that almost a third of breastfed infants will stay jaundiced for their first month of life. As to whether a particular level of bilirubin correlates with the color or location of the jaundice, the authors looked into this as well. Their findings were interesting confirming the lack of accuracy of predicting bilirubin by distribution of visible jaundice, but reassuring in that the wide range of levels obtained by severity of color do not appear to be high enough to be worrisome.

The brief summary in this post just begins to skin the surface on a nice study well worth reading in its entirety to have a better understanding of when to worry and not to worry about persistent unconjugated jaundice in breastfed infants.

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Thursday, July 17, 2014

Sleep-Related Deaths: Do Risk Factors Differ by Age?

By: Lewis First, MD, MS; Editor-in-Chief 
Photo by Flickr user Liz

We certainly recognize the importance of counseling families against bed-sharing and to avoid putting objects in the crib in hope of reducing the risk of sudden unexpected infant death (SUID). Yet do some risk factors in sleep environment appear to play a more prevalent role at some ages in infants relative to others when it comes to a SUID occurring?

Colvin et al. (doi: 10.1542/peds.2014-0401) performed a cross-sectional study of sleep-related infant deaths using data obtained from death reports in 24 states during 2004 through 2012. The authors discovered that at different times during infancy, different risk factors play a role in increasing the chance of unexpected death.

For example, bed-sharing is more likely to play a role in a death of an infant in the first three months of life, whereas having an object in the crib or moving from a back to a prone sleep position worsens SUID chances for an older infant (4 months to 1 year).

When it comes to anticipatory guidance on sleep environment for infants, this study will help you further refine instructions to parents to insure that more emphasis is paid to certain risks based on the age of the infant.

Read this study and see if it doesn't help you better educate your families on proper sleep environment for babies.

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Wednesday, July 16, 2014

Dosing Out Some Concerning Information on Parent Errors in Administering Medications to Children

By: Lewis First, MD, MS; Editor-in-Chief 

Illustration by Nemo via Pixabay
If you have ever looked at instructions for medications to be administered to children, you will find dosage amounts listed in every unit from milliliters to teaspoon or tablespoons or droppers-full. Sadly, when one varies the dosing measurement scale, errors are prone to happen, especially if well-meaning parents use non-standardized kitchen spoons instead of the recommended spoon size on a package.

To determine just how serious the frequency of dosing errors might be, Yin et al. (doi: 10.1542/ peds.2014-0395) did a cross-sectional analysis of almost 300 parents whose children were prescribed liquid medications in two different emergency departments and identified a high percentage (39.4 percent) of errors in measuring the correct dose, either by not understanding the amount in the prescribed dose or using a nonstandard instrument to measure out what they thought was the correct dose.

When milliliters were used instead of spoon size, the rate of errors decreased. The authors identify subgroups of parents and types of measurements that increased the chance of dosing errors, and my prescription is to read the article in detail so you might be better able to recognize risk factors for doing errors before they actually occur.

This article is a bitter pill to swallow—especially when we hope parents are giving their children just what the doctor ordered and in a number of cases—are not.

Do you have any tips you use to reduce dosing errors in your patients? Why not share them with us by commenting below, via an eLetter or by posting on Facebook or Twitter.

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Tuesday, July 15, 2014

Covering the Topic of Weighted Blankets & Sleep in Autistic Children

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by Yogendra Joshi via Flickr (cropped)
Sleep problems in children with autism spectrum disorders (ASD) have been identified and well-studied in prior articles published in Pediatrics. Of course, parents have sought solutions to these sleep problems, and one of those solutions readily offered online via the Internet is the use of weighted blankets to allegedly provide a better quality of sleep.

Yet studies on the effectiveness of weighted blankets compared to regular ones have been limited until this week when Gingras et al. (doi: 10.1542/peds.2013-4285) offer us a randomized placebo-controlled phase three trial of weighted blankets in 67 children with ASD between 5 and 16 years of age.

If you are a fan of using weighted blankets to improve sleep in autistic children (and a number of children and parents are), you will find the results of this study surprising and perhaps disappointing.

Are your patients with ASD using weighted blankets? Do they tell you they work? Would you still recommend one after reading this study? Share your thoughts with us via response to this blog, an eLetter or on Facebook and Twitter.

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Monday, July 14, 2014

Two Studies on the Benefits of Delayed Cord Clamping

By: Lewis First, MD, MS; Editor-in-Chief 

Early (less than 30 seconds) versus delayed (greater than 30-60 seconds) cord clamping has been the subject of a number of recent studies in our journal and others, and this week, we share two more that are worth your attention.

Photo by Mamma Loves via Flickr
The first by Diaz-Castro et al. (doi: 10.1542/ peds.2013-3798) looks at the influence of early versus late cord clamping relative to oxidative stress and inflammation signaling. The delay in clamping may reduce the amount of oxidative stress and inflammation and improve outcomes without other adverse complications—at least according to data shared by these authors.

To lend further support to delayed clamping, Ersdal et al. (doi: 10.1542/peds.2014-0467) looked at the timing of cord clamping relative to spontaneous respiration. The authors studied more than 15,500 infants born in Tanzania and looked at neonatal outcomes and found benefit in reducing risk of death when spontaneous respirations preceded cord clamping.

To better understand the pathophysiologic mechanisms that result in beneficial outcomes to newborns by delayed cord clamping, read both studies and you’re likely to be in accord if you aren't already in seeing even more benefit to this practice when a baby is born.

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Friday, July 11, 2014

Which Colonoscopy Cleanout Preparation Works Best in Children?

By: Lewis First, MD, MS -- Editor-in-Chief

Photo by cheryl via Flickr
Preparing a child’s bowel for a colonoscopy is easier said than done, since available bowel preparation solutions often don’t taste good, require children to consume a high volume of the solution, and necessitate compliance with tricky dietary restrictions.

Multiple preparations for colonoscopy do exist, but have not been compared with each other for efficacy, safety, tolerability and acceptance—at least not until Di Nardo et al. (doi: 10.1542/peds.2014-0131) performed a randomized controlled trial using four different bowel preparation methods.

The study does a nice job of coming clean with some useful results that will flush out what you need to know and consider using (if you’re not using them already) the next time you need to have one of your patients undergo colonoscopy.

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Thursday, July 10, 2014

The Microbiome and Vaccine Responsiveness

By: Editor-in-Chief Lewis First, MD, MS
Bifidobacterium adolescentis by YTambe via Wikimedia Commons

It seems that almost every recent issue of our journal has had an article on the microbiome and the role of probiotics in cultivating the composition of this environment to reduce the incidence and prevalence of common childhood illnesses like upper respiratory and gastrointestinal infections.

This month, we share a study by Huda et al. (doi: 10.1542/ peds.2013-3937) noting how the composition of the stool microbiome might indicate a better or worse response to oral and parenteral infant vaccines. For example, when the stool microbiota composition is rich in Bifidobacterium, thymic development and response to vaccines is enhanced. Other microbiome organism predominance appears to do just the opposite—again suggesting that what organisms predominate in the microbiome of the intestines can influence a child’s health and well-being.

Are you using probiotics in your patients? Are they getting fewer infections as a result? Share your opinion on this topic via a response to our blog, an eLetter, or by way of Facebook or Twitter.

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