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In This Issue of JAMA Pediatrics
January 2017


JAMA Pediatr. 2017;171(1):3. doi:10.1001/jamapediatrics.2016.3081


Earlier access to intensive behavioral intervention is associated with improved outcomes for children with autism spectrum disorder (ASD). Piccininni and coauthors conduct a cost-effectiveness analysis of reducing wait times for intensive behavioral intervention from the current 32 months in Ontario, Canada. Eliminating wait time resulted in more independence among these individuals and substantial savings to government and society. The editorial by the DiBonas, the parents of a child with ASD, reinforces the importance of such wait time reductions.


Asthma is the most common chronic illness in the United States and disproportionately affects inner-city children. Sheehan and coauthors examine allergens collected from 37 schools attended by 284 students. Mouse allergen was detected in 99.5% of schools, and children attending schools with the highest mouse allergen levels had more days per week with asthma symptoms. The editorial by Matsui and McCormack points out the need to be cognizant of allergens in children’s environments and the work to be done to ensure healthy schools.


Continuing Medical Education and Journal Club

Nearly 6000 hospitalized US children receive cardiopulmonary resuscitation (CPR) annually. This study by Bhanji and coauthors of CPR for children while hospitalized in 354 hospitals compares outcomes of CPR occurring during days/evenings vs nights as well as weekdays vs weekends. The rate of hospital survival was 12% lower for CPR at night than during day/evening and marginally lower on weekends.

Prior studies have provided conflicting evidence on whether anesthesia and surgery during early childhood affects long-term cognitive function. In this longitudinal cohort study by Glatz and coauthors, mean school grades at age 16 years and IQ test scores at military conscription at age 18 years were compared in children who had anesthesia and surgery before age 4 vs those who did not. The study found no difference in school grades and minimal difference in IQ between the 2 groups. The editorial by Hansen and coauthors puts these findings in perspective of the well-known environmental and societal factors affecting long-term outcomes.



Clinical Review & Education

Necrotizing enterocolitis (NEC) remains a major cause of morbidity and mortality in infants. This review by Frost and coauthors discusses the new findings on the importance of alterations of the intestinal microbiome to the etiology of this disease, and the still conflicting evidence about the role of probiotics in its prevention. Indications for surgery and types of surgery needed are described, and the optimal management of NEC is discussed. Children needing surgery for NEC have higher mortality than those who can be medically treated.