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In This Issue of JAMA Pediatrics
October 2016


JAMA Pediatr. 2016;170(10):919. doi:10.1001/jamapediatrics.2015.2557

Zika virus continues to infect pregnant women across a large portion of the Americas. Ellington and coauthors develop models to predict the number of pregnant women infected with Zika virus in Puerto Rico and the resultant number of infants with congenital microcephaly. Using available data, they estimated that 5900 to 10 300 pregnant women might be infected during the initial Zika virus outbreak in Puerto Rico, resulting in 100 to 270 cases of congenital microcephaly. The study underscores the urgent need for both public health control of the outbreak and research to develop a vaccine.

Prior research suggests that acetaminophen use in pregnancy is associated with abnormal fetal development. Stergiakouli and coauthors seek to determine whether this could be due to unmeasured confounding, using data on 7796 mothers in the Avon Longitudinal Study of Parents and Children. Children exposed to prenatal use of acetaminophen were at higher risk for multiple behavioral difficulties, not explained by mother’s postnatal use or partner’s use of acetaminophen. Given the widespread use of this drug, this has important implications for public health advice.

Author Audio Interview

While the Institute of Medicine described emergency care for children in the United States as uneven a decade ago, no data exist on the current quality of such care in the United States. Auerbach and coauthors study the quality of care for children in 8 pediatric emergency departments and 22 general emergency departments using care of 3 simulated critically ill patients. Higher quality of care was associated with higher pediatric volume, not with the pediatric vs general emergency department distinction. This has important implications for developing health systems in which children receive the highest quality of care.

Mothers with poor dietary intake of thiamine produce breast milk low in thiamine, placing their infants at risk for beriberi. Whitfield and coauthors conduct a randomized clinical trial in rural Cambodia in which fish sauce used in cooking was supplemented with thiamine. Women in the intervention group had higher thiamine levels in their breast milk and their infants had higher blood levels of thiamine. In their editorial, Wake and Neal discuss the policy implications of this trial of vitamin fortification through food reformulation.



Clinical Review & Education

Advances in biology are providing deeper insights into how early experiences are built into the body with lasting effects on learning, behavior, and health. Shonkoff discusses how new research on interventions during early development suggests 4 shifts in thinking about policy and practice: (1) early experiences affect lifelong health; (2) healthy brain development requires protection from toxic stress; (3) best outcomes for children requires supporting adults who care for them; and (4) more effective interventions are needed for the most vulnerable children and families.