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In This Issue of JAMA Pediatrics
January 2014


Author Affiliations

Copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Pediatr. 2014;168(1):1. doi:10.1001/jamapediatrics.2013.3315

Previous pediatric rapid response system implementation studies have shown variable effectiveness in preventing rare, catastrophic outcomes such as cardiac arrest and death. Bonafide and colleagues examined 1810 unplanned transfers to the intensive care unit to examine the effect of a hospitalwide rapid response system including a medical emergency team and an early warning score. Implementation was associated with a significant downward change in the preintervention trajectory of critical deterioration. In an accompanying editorial, Alobaidi and Joffe emphasized the need to look for other, and potentially more effective, ways to prevent cardiac arrest and mortality from in-hospital clinical deterioration.

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Weight-loss surgery (WLS) is being used to treat severely obese adolescents, although with very limited data regarding surgical safety for currently used, minimally invasive procedures. Inge and colleagues reported on the initial results of a prospective, 5-site observational study of WLS in 242 adolescents aged 19 years and younger in whom the median body mass index was 50.5, and half had 4 or more major comorbid conditions. Major complications (eg, reoperation) were seen in 8% and minor complications (eg, readmission for dehydration) were noted in 15%. In an editorial, Michael G. Sarr, MD, discussed the psychosocial retardation accompanying severe obesity and the need to consider this comorbidity in examining the role of WLS for severe adolescent obesity.

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The role of milk consumption during adolescence in hip fracture prevention is not established, and high consumption may adversely influence risk by increasing height. Feskanich and colleagues examined the protective effect of milk in a prospective cohort over 22 years of follow-up in more than 96 000 white postmenopausal women from the Nurses’ Health Study and men aged 50 years and older from the Health Professionals Follow-up Study in the United States. After controlling for known risk factors and current milk consumption, each additional glass of milk per day during teenage years was associated with a significant 9% higher risk of hip fracture in men and was not related to hip fracture risk in women. Connie M. Weaver, PhD, provided a related editorial.

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Phthalate diesters are used extensively in a variety of consumer products worldwide, and consequently exposure in pregnant women is highly prevalent. Ferguson and colleagues’ nested case-control study aimed to assess the relationship between phthalate exposure during pregnancy and preterm birth. The results demonstrated a robust increase in the odds of preterm birth in association with urinary phthalate metabolite concentrations during pregnancy. These data provide strong support for taking action in the prevention or reduction of phthalate exposure during pregnancy. Shanna H. Swan, PhD, provided a related editorial.

Related Editorial, JAMA Pediatrics Patient Page