The potentially negative side of newborn screening is the detection of heterozygous infants and false-positive results. Posttest counseling and communication with families is critical in reducing possible harm caused by these results. Farrell et al's survey of state programs found that less than half the programs in the United States provide counseling after false-positive results or for the families of heterozygous infants. Few states track the quality of their counseling, and the best practices for postscreening counseling are not yet evident.
Febrile urinary tract infections in children are common and have the potential for long-term sequelae. In a randomized controlled trial of children between the ages of 6 months and 12 years with febrile urinary tract infections, Baker and colleagues examined the benefit of adding a single dose of ceftriaxone to a 10-day course of oral trimethoprim-sulfamethoxazole compared with oral therapy alone. After 48 hours, there was no difference in urine sterilization rate, degree of clinical improvement, or subsequent admission rate. Parenteral ceftriaxone appears to add little to the effectiveness of oral therapy.
Cervical spine injuries, although rare in the pediatric trauma population, are nevertheless catastrophic. Consequently, trauma protocol generally includes cervical spine radiography on many patients to detect the rare child with an unstable fracture. Omran and colleagues surveyed emergency department physicians across the country to determine care patterns for low-risk patients. The variability of care found in the survey documents the need for definitive guidelines based on evidence, and indicates the importance of a large study of cervical spine radiography in injured children.
Newborn infants routinely experience pain associated with invasive procedures such as blood sampling and circumcision. Management of pain in the newborn is hampered by the lack of awareness among health care professionals of both the neonate's capability of experiencing pain and the means to prevent and treat it. Experts from 14 countries and several disciplines used systematic reviews, data synthesis, and open discussion to develop a consensus on clinical practices to prevent and treat pain in the newborn. From these guidelines, individualized care plans and analgesic protocols can be created for specific clinical situations, patients, and health care settings.
Addressing barriers to health care among adolescents is a prerequisite to ensuring appropriate use of care in this age group. This study of more than 1600 high school students in rural Appalachia found that 1 in 5 youths had no regular source of medical care and two thirds had received no preventive health care in the previous year. Those without a regular source of care were 4 times less likely to receive preventive health care and were more likely to seek care in the emergency department. Economic resources alone are not sufficient to ensure appropriate and timely access to medical care.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2001;155(2):115. doi:10.1001/archpedi.155.2.115