Institutional rearing represents a profound violation of the expectable environment that children typically experience. In this randomized clinical trial, Bick and colleagues examine brain white matter development among Romanian infants reared in institutional settings compared with those placed in foster care and infants reared in biological families. Neglect in early life was associated with alterations in white matter microstructure throughout the brain. However, the study found that removal of children from a condition of severe neglect into a high-quality family environment supports more normal white matter growth.
Up-to-date estimates of the health outcomes of preterm children are needed for informing parents, making decisions about care, and providing evidence for clinical guidelines. In this report from the EPIPAGE-2 study cohort, 2205 births and terminations of pregnancy at 22 through 26 weeks’ gestation, 3257 at 27 through 31 weeks, and 1234 at 32 through 34 weeks were studied. A total of 0.7% of infants born before 24 weeks’ gestation survived compared with 31.2% at 24 weeks, 75.3% at 26 weeks, and 98.9% born at 32 through 34 weeks. The proportion of infants surviving without severe morbidity in 2011 increased by 14.4% compared with 1997 for births at 25 through 29 weeks. In his editorial, Marlow discusses the importance and uses of these longitudinal outcome studies of premature infants.
While exchange transfusion is recommended for newborns with serum bilirubin levels thought to place them at risk for cerebral palsy (CP), the excess risk for CP among these infants is unknown. Wu and colleagues examine the risk for CP in 1833 infants with at least 1 serum bilirubin measurement at or above the exchange threshold compared with a 20% random sample of 104 716 infants with bilirubin levels below the threshold. Cerebral palsy consistent with kernicterus occurred in 3 infants, all of whom had bilirubin levels of more than 5.0 mg/dL above the exchange threshold and at least 2 risk factors for neurotoxicity. These findings support the suggestion that infants with hyperbilirubinemia without risk factors for neurotoxicity may have a higher tolerance than recognized in current management guidelines.
Continuing Medical Education and Journal Club
Treatment of latent tuberculosis is effective but the long course of therapy presents a challenge for adherence. Villarino and colleagues with the International Maternal Pediatric and Adolescents AIDS Clinical Trials Group and the Tuberculosis Trials Consortium conducted a randomized trial of a once-weekly combination of rifapentine and isoniazid for 12 weeks compared with 9 months of daily isoniazid for treatment of latent tuberculosis infection in children 12 years or older. Treatment with the combination of rifapentine and isoniazid was as effective as isoniazid-only treatment, had a higher treatment completion rate, and was safe. The editorial by Marais discusses the implications of this study for the prevention of tuberculosis in both the United States and in low-resourced countries.
Highlights. JAMA Pediatr. 2015;169(3):199. doi:10.1001/jamapediatrics.2015.0190