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Recent work has raised questions about the uniformity of criteria for admission to a neonatal intensive care unit (NICU) and possible overuse of this resource. In this large study in California, 10% of infants born at 34 or more weeks were admitted to a NICU, accounting for 79% of all NICU admissions. Admission rates varied 34-fold across NICUs and there was a 40-fold variation in the reported percentage of high illness acuity. The accompanying Editorial by Goodman and Little discusses the implications of this variation and the need for appropriate population-based data to track variations in care.
While maternal obesity is associated with birth weight and later overweight, the timing of the differences in fetal growth is unknown. Using data from the National Institute of Child Health and Human Development Fetal Growth Studies–Singletons study, Zhang et al collected ultrasonographic data on weekly growth in a sample of pregnant women with and without obesity. Femur and humerus lengths in the fetuses of women who were obese were significantly longer than those of woman who were not, starting from 21 weeks’ gestation and extending through the rest of pregnancy. At delivery, neonates of woman who were obese were significantly heavier and more likely to be large for their gestational age.
Rates of adolescent preventive care visits were lower than what is recommended and needed to achieve optimal health in this age group. Adams and colleagues used national data to examine the rates of well visits from the pre–Affordable Care Act (ACA) to the post–ACA period. While there was a 7% increase in well-visit rates after ACA implementation, there was little to no change in the receipt of most preventive services. The Editorial by English and Perkins discusses the issues of confidentiality, increasing awareness, and changing beliefs about the importance of preventive services for this age group.
The influenza vaccine is an effective method to prevent disease, but the level of vaccination is still suboptimal in the population. Hart et al modelled the cost-effectiveness of 4 different strategies for administering the influenza vaccine in pediatric emergency departments. Offering the influenza vaccine to all eligible patients had the lowest cost per case of influenza averted, resulting in 27 fewer cases of influenza per 1000 patients. Routine vaccination in the emergency department results in a net societal monetary benefit and should be considered as an important strategy to decrease cases of influenza.
Will breastfeeding reduce the risk of asthma and atopic eczema in children? Flohr and colleagues conducted a 16-year follow-up of the Promotion of Breastfeeding Intervention Trial in 30 Belarusian maternity hospitals and clinics. This study represents the closest approximation to a randomized clinical trial of breastfeeding. Adolescents born to mothers in the intervention group had half the risk of flexural eczema on skin examination but no significant difference in wheezing in the past year or pulmonary function test results indicative of asthma compared with children born to mothers in the control group.
Highlights. JAMA Pediatr. 2018;172(1):1. doi:10.1001/jamapediatrics.2017.1568
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