Showing posts with label infants. Show all posts
Showing posts with label infants. Show all posts

Friday, May 29, 2015

Taking a Peek at the Accuracy of the Urinalysis for Diagnosing UTIs in Infants

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

      The gold standard for diagnosis of a urinary tract infection (UTI) is the urine culture, but just how accurate is the urinalysis itself, especially in young infants?  Schroeder et al. (doi:10.1542/peds.2015-0012) tackled this question through a cross-sectional look at a cohort of 276 infants under three months of age who had a documented UTI based on a urine culture.  The authors then looked at the sensitivity and specificity of the urinalysis findings for infection.    
     More specifically, the authors report on the sensitivity of leukocyte esterase (LE) and of pyuria in the urines studied and the results may surprise you in terms of the accuracy achieved just with the urinalysis.   
     To add more import to this study, we asked Dr. Ken Roberts who chaired the AAP committee that produced the recently revised UTI guidelines to add his perspective on the findings with a commentary (doi:10.1542/peds.2015-0884) also being released this week.  
      If you wonder whether to use the urinalysis findings to help decide whether or not to get a urine culture, go with the flow and read both this study and commentary and see if you want to pay even more attention to the urinalysis results as a diagnostic indicator. 

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Wednesday, April 1, 2015

Antibiotic Usage in Infancy and Being Overweight: Weighing in on an Unexpected Association

By: Lewis First, MD, MS; Editor-in-Chief  
     How often have you considered that antibiotics given in infancy might predispose your patient to being overweight by age 2 years?  We certainly did not until we read the study by Saari et al. (doi: 10.1542/peds.2014-3407) and realized that the intestinal microbiome might be the culprit responsible for such an association. 
     The authors studied a population-based cohort of approximately 6 thousand boys and a similar number of girls in the first 24 months of life and looked at antibiotic purchase data as well as body mass index and height at 2 years of age. Since antibiotics can change the human microbiome, especially in infancy, doing so may trigger additional weight gain. 
      Why this happens is the subject of a provocative discussion section of this study, making this article well worth your attention. 

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Thursday, February 5, 2015

Are You Seeing Infants for Their First Well-child Visit Early Enough to Prevent Readmission?

 German Tenirio @Flickr
          It is recommended that the first well-child visit following discharge from the well-baby nursery occur within 48 hours for infants discharged in less than 48 hours and within 3-5 days for those who do stay more than 48 hours.  How effective are these guidelines in preventing unintended readmissions to the hospital? 
Shakib et al. (doi:10.1542/peds.2014-2329) opted to study this question using a large data-set in Utah that tracked both well child visits and readmission rates for a population of over 79,000 newborns. While 63% of these babies went home in less than 48 hours post-birth, only 15% had a well-child visit in 72 hours (and less in the recommended 48 hours).  To no surprise, those infants who were seen shortly after discharge had a 15% lower readmission rate than those with a later visit. 
          How strictly do you adhere to seeing early discharged babies for a visit within 48-72 hours?  Do you agree seeing babies shortly after birth has helped you prevent a readmission and if so, what type of readmission are you finding your can prevent? We would love to hear your take on this study, and whether or not you feel a 48 hour office visit does help reduce readmissions by sharing your comments via a response to this blog, an e-letter or our Facebook or Twitter sites.

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Tuesday, December 2, 2014

Two Breastfeeding Studies Provide New Information Worth Sharing with Parents

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

Breastfeeding icon.
Public domain via Wikimedia Commons
There are many evidence-based reasons to exclusively breastfeed newborns and infants. Yet despite the evidence, mothers opt to not exclusively breastfeed for the recommended one-year duration, let alone six months or even a shorter time period. Yet each addition to the body of breastfeeding literature hopefully further convinces an expectant mother or one that has just given birth to choose exclusive breastfeeding as the best way to ensure the growth and development of her newborn.

Thus this week, we provide two additional studies that we found well worth sharing in our journal.

The first, by Abbass-Dick et al. (doi: 10.1542/peds.2014-1416), involved a randomized controlled trial to see if co-parenting breastfeeding support resulted in increases in breastfeeding duration and mothers feeling more supported by paternal partners.

The study involved more than 100 couples randomized to get either usual care or an intervention involving both parents’ involvement in understanding and supporting breastfeeding. The results of the co-parenting intervention are most impressive and may further enhance a mothers desire to continue to exclusively breastfeed for as long as she can.

The second study by Carling et al. (doi: 10.1542/peds.2014-1392) was a prospective observational study of mothers in rural and central New York of weight gain trajectories for the first two years of life in almost 600 infants.

The authors controlled for a number of possible confounders and found that the trajectories most worrisome for obesity risk were associated with the shortest duration of breastfeeding—especially if an infant breastfed for less than two months.

Since other studies have demonstrated that an overweight or obese younger child means increased risk of obesity up the road, this study should weigh heavily in your discussion with families of the importance of breastfeeding –especially if that family has a history of being overweight or obese.

Check out both studies—and then share what you learned with families of your infant patients. If they were on the fence about breastfeeding, these two studies may tip the balance in support of this important method of feeding.

Related Reading:

Monday, December 1, 2014

Uncovering Some Concerning Trends in Infant Bedding Use in the US

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

Photo by Janine via Flickr
Since the onset of the “Back to Sleep” campaign for infants in the early 1990s, one would think that the use of dangerous bedding materials in cribs would be much less 20 years later—but how much less?

Shapiro-Mendoza et al. (doi: 10.1542/peds.2014-1793) elected to review almost two decades of data from the National Sleep Position Study and although the use of blankets, pillows and other dangerous bedding materials declined, they were still being used at a prevalence of over 50 percent of those surveyed in this national database as of 2010.

So why is that, and who is not complying with a safe sleep environment for their babies so as to reduce the risk of sudden infant death? The authors reveal some important demographic predictors that will allow us to better educate some populations of parents even more than we are when it comes to making sure bedding is not hazardous for babies.

This is a study that will not put you or parents of infants to sleep. And if the data as presented is not a wake-up call, then read the commentary by safe sleep experts Dr. Rachel Moon and Fern Hauck (doi: 10.1542/peds.2014-3218) also released this week.

You may want to blanket your office (rather than baby’s crib) with copies of these materials with the hope we can do even more to reduce the risk of an unintended unsafe sleeping situation.

Related Reading:

Monday, November 24, 2014

Postnatal Growth Following Prenatal Lead Exposure and Calcium Intake

By: Assistant Editor Lydia Furman, MD

Photo by F. Lamiot via Wikimedia Commons (edited)
Lead is a ubiquitous environmental toxin, with well appreciated deleterious effects on the neurodevelopment of young children. But what do we know about the physical growth of lead-exposed infants and children? Dr. Hong and colleagues prospectively examine the effect of maternal lead levels during early and late pregnancy on postnatal growth at birth and at 6, 12 and 24 months (doi: 10.1542./peds.2014-1658).

Lead does cross the placenta, so prenatal exposure clearly has potential to reach the developing fetus; however there is limited evidence to date of any impact on postnatal growth beyond the neonatal period (Schell et al, Am J Human Bio, 2009).

Certainly no lead level is considered “safe.” With a new focus on primary prevention, the CDC has established 5.0 micrograms/dL or greater as the lead level that identifies children who are in the highest 2.5 percent of US children based on the National Health and Nutrition Examination survey (NHANES) data on blood lead levels in children.

Previously the CDC used a “level of concern” of 10 micrograms/dL; however it became clear that even at these “low” levels there were negative effects on neurodevelopment as assessed at 24 months with the Bayley Scales of Infant Development (Tellez-Rojo et al, Pediatrics, 2006), on intelligence as assessed at age 6 years (Canfield et al, New England Journal of Medicine, 2003 and Jusko et al, Environmental Health Perspectives, 2007), and on reading readiness at kindergarten entry (McLaine et al, Pediatrics, 2013). With the new population-based 2.5 percentile level of 5.0 micrograms/dL, clinicians, public health departments and parents hope to have the opportunity to intervene earlier and prevent deleterious effects.

But with less than 5.0 micrograms/dL as a non-actionable level for children, any direct effect of prenatal lead levels higher than this on child growth would be surprising. Hong and colleagues studied a cohort of 1,150 pregnant women whose mean lead level of 1.25 micrograms/dL was actually much lower.  Their unexpected results are a call to action for public health servants, policy makers and child advocates.

The authors further asked whether dietary intake of calcium has any impact on lead’s effects, and measured women’s diets carefully using dietary interviewers and 24 hour recall. Mothers’ mean daily calcium intake at study entry was 541 mg/24 hours; when pregnancy dietary intake of calcium was below the mean, this intensified the negative effect of maternal lead levels on infant growth, particularly birth weight.

The authors make a convincing case for biological plausibility of both the interrelationship between maternal dietary calcium intake during pregnancy and maternal blood lead levels, and the consequent demonstrated effect on infant growth. This article sets the stage for additional public health work, both to promote increased dietary calcium during pregnancy, and to continue the fight to reduce exposure of mothers and children to environmental toxins, including lead.