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Hypotension After Cardiac Arrest Survival
More than 6000 children annually in the United States experience out-of-hospital cardiac arrest, with survival rates of less than 10%. In a secondary analysis of data from the Therapeutic Hypothermia After Cardiac Arrest clinical trial, 27% of patients had at least 1 episode of hypotension in the first 6 hours after arrest. Children who had early hypotension had a 61% lower odds of survival to hospital discharge than those without early hypotension. The Editorial by Joffe discusses the implications of this study for future research as well as current care for children with out-of-hospital cardiac arrest.
Nasal Continuous Positive Airway Pressure in Infants
A meconium staining of amniotic fluid occurs in 10% to 15% of deliveries and increases the risk of respiratory distress 100-fold. Pandita et al conducted a randomized clinical trial comparing bubble nasal continuous positive pressure with usual care in infants with respiratory distress. There was a 91% lower odds of needing mechanical ventilation, a 76% reduced odds of needing surfactant, and a 58% lower odds of persistent pulmonary hypertension in the nasal continuous positive pressure group. This study has far-reaching implications, especially for infants born in low-income and middle-income countries.
Effect of Financial Incentives on Breastfeeding
While the benefits of breastfeeding are well known, the methods to increase the prevalence of breastfeeding have not been well studied. Relton et al conducted a cluster randomized trial in 92 electoral wards in England in which participants were given shopping vouchers worth $50 each 5 times over the first 6 months after birth to promote breastfeeding. There was no difference in the prevalence of breastfeeding initiation, but there was a 6% difference in breastfeeding prevalence at 6 to 8 weeks. Using behavioral economics to encourage breastfeeding should be further explored.
Clinical Review & Education
Nusinersen Treatment for Spinal Muscular Atrophy
The US Food and Drug Administration approved nusinersen in 2016 for treating patients with spinal muscular atrophy. Burgart and colleagues discuss the ethical challenges associated with this drug, including the $750 000 cost for the first year and the $375 000 annual cost thereafter for life, the uncertainty on the magnitude of potential benefits of treatment across spinal muscular atrophy subtypes and diseases stages, treatment allocation, and the geographic distribution of treatment centers. The Editorial by Prasad discusses the cost-benefit issues for this and other drugs for rare diseases.
Author Audio Interview
Highlights. JAMA Pediatr. 2018;172(2):105. doi:10.1001/jamapediatrics.2017.3327
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