In this issue we published 2 studies that examined genetic testing in diagnosing serious illnesses in children. In the first, Tan and colleagues examined 61 ambulatory children at a mean age of 28 months and provided 23 (52%) with diagnoses through singleton whole-exome sequencing. Eight diagnoses (35%) were unexpected and the sequencing was cost-saving.. The Editorial by Lemke discusses the use of high-throughput sequencing early in the diagnostic workup of children with early-onset disorders.
Editorial and Related Article
CME and Journal Club
In the second article on genetic testing, Berg et al studied 327 children younger than 3 years with newly diagnosed epilepsy with various forms of genetic testing and identified pathogenic variants in 131 (40%). The Editorial by Lemke also discusses these conclusions.
In the United States, more than 26 000 infants, children, and adolescents are discharged annually from acute care hospitals into postacute care facilities. Saiman and colleagues studied the infection risk among 717 residents of pediatric long-term care facilities over 3 years. Most children had at least 1 infection, most commonly viral respiratory tract and skin/soft tissue infections. The Editorial by Thomson and Shah discusses the clinical and research questions raised in light of the growing number of children with medical complexities.
Vaccination of children is declining in areas of the United States where state laws allow for personal belief and other nonmedical exemptions to childhood vaccination requirements. Lo and Hotez modeled county-level measles, mumps, and rubella vaccine coverage for children aged 2 to 11 years. A 5% decline in vaccine coverage would result in a 3-fold increase in measles cases for children aged 2 to 11 years, with an additional $2.1 million in public sector costs. The results support a need to address vaccine hesitancy in policy dialogues at state and national levels and to consider removing personal belief exemptions.
With changes in the health insurance marketplace, it is important to determine the regionalization of care for children and the availability of specialized care in different locales. Franca and McManus used data from Massachusetts from 2004 to 2014 to examine emergency department visits and hospital admissions for 34 million encounters in 66 acute care hospitals. The number of children who required care in more than 1 hospital increased by 36%, and the care of more than 75% of pediatric conditions was highly regionalized by 2014.
While there has been a call for states to remove their nonmedical exemption vaccine policies, the likelihood of potential outcomes, such as policy enforcement, confidence in vaccine safety, and the policy precedent created for other public health contexts, is uncertain. Opel and colleagues call for a neutral forum, such as workshops hosted by the National Academies of Sciences, Engineering, and Medicine, to foster a dialogue about these issues.
Highlights. JAMA Pediatr. 2017;171(9):823. doi:10.1001/jamapediatrics.2016.3129