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In This Issue of JAMA Pediatrics
January 2015


JAMA Pediatr. 2015;169(1):1. doi:10.1001/jamapediatrics.2014.2100


In the last decade, there has been an expansion in the number of low-level and mid-level neonatal intensive care units and an increase in the proportion of premature babies treated in nontertiary hospitals. Kastenberg and colleagues examine the effect of this transition on the outcomes of very low-birth-weight infants with necrotizing enterocolitis in California. By 2011, only 28.6% of such babies were born into high-level, high-volume hospitals, which had the lowest in-hospital mortality rates. The editorial by Lorch discusses these findings and emphasizes the need to both educate families and develop appropriate quality metrics to assess care.


Caffeine is now widely used in preterm infants to treat apnea of prematurity. In this cohort study, Lodha and colleagues examine the use of prophylactic caffeine (initiation within 2 days of birth) and whether it would provide similar benefits without evidence of short-term harm in neonates born at less than 31 weeks’ gestation. Neonates in the early group had decreased risk for a composite outcome of death or bronchopulmonary dysplasia and patent ductus arteriosus, without an increase in the risk for mortality, necrotizing enterocolitis, or severe retinopathy of prematurity. Long-term neurodevelopmental outcomes of patients who received early caffeine are important to identify any potential untoward consequences.

The prevalence of autism spectrum disorders has increased markedly in recent decades, which researchers have suggested could be caused in part by nonetiologic factors such as changes in diagnosis reporting practices. Using a population-based birth cohort that includes data on all residents of Denmark, Hansen and colleagues examine the effects of changes in diagnostic criteria in 1994 and the inclusion of outpatient diagnoses in 1995. For children born during the study, 60% of the increase in reported prevalence of autism spectrum disorder was explained by the changes in diagnostic criteria and database changes. Nevertheless, a substantial portion of the change in prevalence was not owing to reporting practices, and other causes for the increase should be investigated.

While Congress in 2010 mandated that lunches provided by schools meet the Dietary Guidelines for Americans, there has been little examination of lunches brought by children from home. Caruso and Cullen examine the lunches brought by students at 8 elementary and 4 intermediate schools as well as the amount eaten by the children. Compared with the national guidelines for school lunches, meals brought from home contained more sodium; fewer servings of fruits, vegetables, and whole grains; and nearly always foods such as desserts and chips not allowed to be provided by schools. The cost of the home-provided lunches was higher among students from low-income schools than those from middle-income schools. Stallings’ editorial discusses the role of schools in working with parents to improve the quality of children’s diets.