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In This Issue of JAMA Pediatrics
May 2017


JAMA Pediatr. 2017;171(5):407. doi:10.1001/jamapediatrics.2016.3105

Antibiotic therapy for uncomplicated appendicitis is effective among adult patients, but its application among pediatric patients remains controversial. Huang and coauthors conducted a meta-analysis of 5 randomized clinical trials of children ages 5 to 18 years with acute uncomplicated appendicitis. Nonoperative treatment was successful in 90.5% of patients, but the risk of treatment failure was 10.4-fold higher in children with appendicolith. The accompanying Editorial by Lopez and Wesson emphasizes the need for high-quality clinical trials with longer follow-up periods and for greater attention to be paid toward patient-centered outcomes and cost utility.


While mobile phones are ubiquitous and mobile health interventions are increasingly popular, it is unclear how effective these interventions are in improving health outcomes. This meta-analysis by Fedele and coauthors included 37 studies among approximately 30 000 participants examining health outcomes from various mobile health interventions. The average effect of these interventions was small, but there was significant heterogeneity in the effect size across the studies with mobile health interventions including caregiver involvement that was more effective than those that only targeted youth. Mobile health interventions appear to be a promising and potentially effective tool for pediatric health care professionals to use with parents and caregivers.

Continuing Medical Education and Journal Club

Diabetic ketoacidosis is the leading cause of hospitalization, morbidity, and mortality among children with type 1 diabetes. In this cohort study of 165 children with type 1 diabetes hospitalized for diabetic ketoacidosis, Hursh and coauthors found that 64% met criteria for acute kidney injury. Serum bicarbonate levels less than 10 mEq/L (for millimoles per liter, multiply by 1.0) and an elevated heart rate were associated with an increased risk of severe kidney injury. The Editorial by Laskin and Goebel discusses the need for careful fluid management in these patients to avoid acute kidney injury and a potentially catastrophic cerebral edema.



Clinical Review & Education

More than 70 countries have reported evidence of Zika virus transmission and 20 countries have cumulatively reported more than 2000 newborns with microcephaly and other brain abnormalities associated with Zika infection. In September 2016, the Eunice Kennedy Shriver National Institute of Child Health and Human Development and partner National Institutes of Health institutes held a workshop to develop a research agenda on congenital Zika infection. This report by Kapogiannis and coauthors outlines the consequences of congenital Zika infection and discusses the research needs to address gaps in knowledge and inform practices.