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In This Issue of JAMA Pediatrics
December 2017


JAMA Pediatr. 2017;171(12):1133. doi:10.1001/jamapediatrics.2016.3147


Given the high prevalence of obesity in the United States, the search for feasible and effective treatments that can be used in the community is critical. Wilfley et al conducted a randomized clinical trial of a family-based intervention for children who were overweight or obese aged 7 to 11 years and their parents. Intensive behavioral intervention programs with enhanced social facilitation maintenance, especially at higher doses, improved weight outcomes. There is a need to translate these types of effective family-based weight management interventions into routine clinical care.

While the association of adverse childhood experiences with poor health outcomes is well known, the mechanism of this effect is poorly understood. This prospective longitudinal study by Luby and colleagues followed up patients from ages 3 to 15 years. Magnetic resonance imaging results at age 9 years revealed that smaller inferior frontal gyrus volumes mediated the association between early adverse childhood experiences and poor general health and higher depression severity in adolescence.

The inability to manage type 1 diabetes effectively during the adolescent and young adult years is associated with poor glycemic control and complications from diabetes and later life. This study used financial incentives for 3 months to improve adherence to glucose monitoring goals. There was no significant difference between the groups in change in hemoglobin A1c levels from baseline at 3 or 6 months, and no improvement in adherence during the follow-up period. The Editorial by Mulvaney and Lee discusses the potential implications of these negative results.


Continuing Medical Education

β-lactam monotherapy and β-lactam plus macrolide combination therapy are common treatment strategies for children hospitalized with pneumonia. Williams and colleagues collected data on 1418 children who were hospitalized for pneumonia in 1 of 3 children’s hospitals. There was no significant difference in the length of hospital stay between children who received β-lactam monotherapy and and those who received combination therapy, nor any difference in intensive care unit admission or the need for rehospitalization. Smith’s Editorial states that the time for routine use of macrolides for community-acquired pneumonia may be coming to an end.


While congenital malformations and genetic diseases are the leading causes of early infant death, the contribution of single-gene disorders is undetermined. Meng at al conducted clinical exome sequencing on 278 infants within 100 days of life. A molecular diagnosis was achieved in 37% by clinical exome sequencing, affecting treatment for 52% of infants. Critical trio-exome sequencing yielded a diagnosis for 51% of infants at a mean of 33 days of life with a turnaround time of 13 days and change in clinical care in 72%. The accompanying Editorial by Baxter and King discusses the implications of this study for current medical care.


Author Audio Interview