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Intermittent vs Continuous Pulse Oximetry in Bronchiolitis
Despite studies asserting the importance of monitoring the oxygen saturation level of patients with a respiratory infection, no study has yet linked routine use of pulse oximetry to improved outcomes for patients with bronchiolitis. McCulloh and colleagues randomize 161 hospitalized infants with bronchiolitis to either continuous oximetry or intermittent assessment along with other vital signs. Intermittent pulse oximetry monitoring of nonhypoxemic patients did not shorten length of stay and was not associated with any difference in rate of escalation of care or use of diagnostic or therapeutic measures. Cunningham’s editorial underscores the importance of the findings and discusses how these results should change clinical care.
Continuing Medical Education and Journal Club
Transient Hypoglycemia and Achievement Test Proficiency
This cohort study examines whether transient hypoglycemia 3 hours after birth is associated with poor academic performance at age 10 years. Kaiser and colleagues link neonatal data to state student achievement test scores. Transient hypoglycemia was associated with a decreased probability of proficiency on literacy and mathematics fourth-grade achievement tests, with the strongest effects in those with transient glucose levels less than 35 mg/dL. Establishing associations between transient hypoglycemia and childhood achievement is important in informing future newborn hypoglycemia recommendations.
Integrated Child/Adolescent Medical-Behavioral Primary Care
Integrating primary medical care with behavioral health care has the potential to improve access to and rates of care for behavioral health problems. The meta-analysis by Asarnow and colleagues examines whether integrated behavioral health and primary medical care for children and adolescents leads to improved behavioral health outcomes. Benefits of integrated medical-behavioral treatment were observed for interventions that target diverse mental health problems.
Author Audio Interview
Effect of Childhood Adversity on Brain Structure in Young Men
The effects of early adversity on children and adult outcomes are well known. The extent to which brain structure variation typically associated with depression may also relate to early experiences of stress was examined by Jensen and colleagues within a large (n = 494) longitudinal birth cohort. Early adverse experiences predicted lower gray matter volume in the anterior cingulate cortex and greater gray matter volume in the precuneus in adolescence. These results indicate that early childhood adversity is associated with altered brain structure, and the effects of depression on the brain may partly relate to early adversity.
Antibullying Policies and Bullying in 25 states
To address school bullying, 49 states have passed antibullying statutes. Hatzenbuehler and colleagues link data on legislation to high school students from 25 states. Students in states with at least 1 of the 16 Department of Education legislative components in their antibullying law had 24% reduced odds of reporting bullying and 20% reduced odds of cyberbullying compared with students in states whose laws had no such components. Although antibullying policies by themselves cannot completely eradicate bullying, these data suggest that such policies represent an important part of a comprehensive strategy for preventing bullying among youth.
Highlights. JAMA Pediatr. 2015;169(10):883. doi:10.1001/jamapediatrics.2014.2154
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