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In this population-based study in Norway, Berg and coauthors follow up 2337 patients with cleft lip only, cleft palate only, and cleft lip and palate until they reached 18 years of age. No increased risk for morbidity or mortality was found for individuals with isolated cleft palate only, while patients with both cleft lip and palate were at increased risk for intellectual disability and cerebral palsy. Those with cleft palate only had the greatest risk for intellectual and motor disorders as well as a 3.4 increased risk for mortality. Heike and Evans discuss the implications for craniofacial disease research.
Qin and coauthors conduct a meta-analysis of 19 studies with 2986 unique participants that examined the peripheral blood levels of brain-derived neurotrophic factor. Children with autism had elevated levels of brain-derived neurotrophic factor in serum specimens taken later in life but not in those collected during the neonatal period. This study strengthens the clinical evidence of an abnormal neurotrophic factor profile in children with autism spectrum disorder.
Social adversities affect child health, but no studies have examined whether social interventions can improve children’s health status. Gottlieb and coauthors conduct a randomized clinical trial in 2 safety-net hospitals in which the intervention group received in-person help from trained volunteers to access services. The intervention decreased the number of social needs over the following 4 months and resulted in greater improvement in child health compared with the control group. Halfon’s editorial discusses the need to conduct cost-effectiveness analyses of interventions such as this that address social determinants of health.
Opipari and coauthors report on a set of principles of lifelong learning endorsed by the Association of Medical School Pediatric Department Chairs and the results of a survey of its members. Six of 7 principles were endorsed by 84% to 96% of pediatric department chairs. While 62% agreed that the American Board of Pediatrics should have a role in assessing lifelong learning and competence in clinical practice, 90% endorsed a need to revise the current board requirements for recertification. Keller and Wells discuss the professional conundrum about lifelong learning and continuous quality improvement faced by pediatricians.
Continuing Medical Education and Journal Club
In the 50 years since Tomisaku Kawasaki first reported a new mucocutaneous lymph node syndrome, much has been learned about diagnosing and treating this disease. Cohen and Sundel review what is known about the pathophysiology of this disease and its diagnosis. Current treatment with intravenous immunoglobulin is discussed as well as augmented treatment with corticosteroids, other anti-inflammatory agents, and antithrombotic therapy.
Highlights. JAMA Pediatr. 2016;170(11):1033. doi:10.1001/jamapediatrics.2015.2564