In this commentary as part of our centennial celebration and the history of pediatrics in the United States, BakerArticle discusses the advances in neonatology in the 1970s, the challenges of coordinating obstetric and pediatric care, and the ethical and economic challenges associated with caring for ever-smaller infants. Since the 1970s, neonatal medicine has succeeded to a remarkable degree in both saving the lives of ever-smaller premature infants and doing so with fewer complications.
Peripartum asphyxia complicated by hypoxic-ischemic encephalopathy (HIE) remains an important worldwide cause of mortality and long-term disability. This randomized trial by Jacobs et alArticle of systemic hypothermia commencing within 6 hours of birth at the birth hospital and continuing for 72 hours in term and near-term infants with HIE reduced the combined rate of death or major sensorineural disability at age 2 years by 15%.
Wen et alArticle describe the first randomized controlled trial to test the effectiveness of an early childhood obesity intervention in the first 2 years. There were significant improvements in duration of breastfeeding, appropriate timing of introduction of solid foods, and practice of “tummy time” among those receiving the home-based intervention. The intervention also significantly decreased the proportion of mothers using food for reward.
Sheu et alArticle report that in Texas, between 1999 and 2007, the prevalence of plagiocephaly increased more than 9-fold from 3.0 cases per 10 000 live births to 28.8, a 21.2% increase per year. A small part of this might have been due to delayed compliance with the American Academy of Pediatrics recommendation for supine infant sleeping and a slight increase in preterm births.
An intensive primary care intervention by Taveras et alArticle based on the Chronic Care Model improved television and video viewing but did not affect change in body mass index in the overall group of 2- to 6-year-olds. Intervention effects were larger among girls and those living in lower-income households.
Field et alArticle report that during 7 years of follow-up, 3.9% of preadolescent and adolescent girls developed a stress fracture. Girls with later age at menarche and those engaged in running, basketball, and cheerleading/gymnastics were at greatest risk for fracture.
As described by McCabe et alArticle, use of controlled medications (pain, stimulant, antianxiety, and sleeping) in the past year was reported by 18% of adolescents, and 22% of these users reporting misusing these medications. Medical users of these substances are at substantially greater risk for misuse than are adolescents who do not use these medications.
Freeman et alArticle found that in this population recent methamphetamine use was reported by 10.8% of young men. Users had a higher risk of having sexually transmitted infections, a partner who was an intravenous drug abuser, and more sexual partners, all behaviors that place them at higher risk of human immunodeficiency virus infection.
Butz et alArticle report that use of air cleaners significantly diminished fine and coarse particulate matter concentrations compared with homes with no air cleaners. The addition of an intensive health coach intervention provided no additional benefit.
In this study by Glanz et alArticle of more than 66 000 children, gastrointestinal symptoms, gastrointestinal disorders, and fever were significantly associated with vaccination. None of these events were serious and no children had complications.
Wang et alArticle report that when combining the intervention's effect on prevention of both obesity and disordered weight control behaviors, the Planet Health program is cost-effective and cost-saving. The findings of this study provide additional argument for integrated prevention of obesity and eating disorders.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2011;165(8):687-688. doi:10.1001/archpediatrics.2011.126