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This Month in Archives of Pediatrics and Adolescent Medicine
July 07, 2008

This Month in Archives of Pediatrics & Adolescent Medicine

Author Affiliations

Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2008

Arch Pediatr Adolesc Med. 2008;162(7):601. doi:10.1001/archpedi.162.7.601
Complementary Feeding With Fortified Spread to Reduce Severe Stunting Among Malawian Infants

The very high incidence and serious consequences of childhood undernutrition in sub-Saharan Africa and some parts of southern Asia necessitate emphasis on early prevention. One feasible low-priced option is fortified spreads. In this randomized trial in Malawai, 182 6-month-old infants received either supplements of maize–soy flour or 25 or 50 g daily of a ready-to-use fortified spread for 1 year. By the 12-month follow-up, 10 infants had died. There were similar gains in weight and length in all groups. However, there was a greater gain in length in the group given 50 g of fortified spread daily in infants who were below the median for length at baseline. Severe stunting did not develop in any of the infants receiving 50 g/d of the spread compared with stunting developing in 3.5% of infants receiving 25 g of the spread daily and 12.5% of those receiving the maize–soy flour. Fortified spread appeared to boost linear growth and thus decreased the incidence of severe stunting in these high-risk infants.

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Cumulative incidence functions of severe stunting in children in the likuni phala (LP), fortified spread, 25 g/d (FS25), and fortified spread, 50 g/d (FS50) groups.

See page 619

Impact of Maternal and Birth Attendant Hand Washing on Neonatal Mortality in Southern Nepal

More than 99% of the nearly 4 million global neonatal deaths each year occur in low- and middle-income countries. About half of these deaths occur at home where mothers receive little or no perinatal care. One of the clear interventions to decrease risk of infection is hand washing by the birth attendant and mother. The authors observed 23 662 newborns through their first 28 days of life. Hand washing by the birth attendant was associated with a 19% lower risk of neonatal mortality, and hand washing by the mother was associated with a 44% lower risk of mortality. In infants who survived the first few days of life, the population attributable risk percentage associated with maternal hand washing with soap and water or antiseptic before handling the neonate was 55.8%.

See page 603

Pediatricians' Involvement in Community Child Health From 1989 to 2004

Pediatricians have long been leaders for professional involvement in communities and in community child health. However, changing demographics, increased medical school debt, and demands by large group practices to generate income may conflict with desires to become involved. This study took advantage of the American Academy of Pediatrics Periodic Surveys to examine changes in reported involvement from 1989 to 2004. The proportion of pediatricians involved in community child health decreased from 56.6% in 1989 to 45.1% in 2004, and these activities were increasingly volunteer rather than paid (48.6% in 1989 to 79.6% in 2004). There was decreased involvement of pediatricians in schools, neighborhood health centers, child care centers, child protection agencies, and child advocacy organizations. More pediatricians in 2004 believed that their current level of activity was inadequate.

See page 658

Primary Early Thoracoscopy in Children With Complicated Pneumonia

Approaches to treat children with pneumonia complicated by pleural effusion include chest tube placement, thoracotomy, and video-assisted thoracoscopic surgery (VATS). Shah and colleagues used data from 27 children's hospitals to examine the variation in care and subsequent length of stay for 2862 children with complicated pneumonia. One-third of these children had early pleural fluid drainage, primarily through chest tube placement. The median length of stay was 10 days and 31% of patients required at least 1 additional drainage procedure. Children undergoing primary VATS had a 24% shorter length of stay than patients undergoing primary chest tube placement and an 84% reduction in the need for additional pleural fluid drainage.

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Distribution of procedure type by hospital. The y-axis shows the percentage of patients undergoing specific pleural fluid drainage procedures. Each bar on the x-axis represents 1 hospital. VATS indicates video-assisted thoracoscopic surgery.

See page 675