Search

Opinion. Focuses on the occurrence of sudden infant death syndrome (SIDS) and the risks for subsequent siblings. Pathophysiology; Consideration of filicide in cases of infant death; Recurrence rate of SIDS in subsequent siblings; Effectiveness of home infant monitoring; Cost effectiveness of documented home infant monitoring.

One of the most complex areas in perinatal/neonatal medicine is the use of oxygen in neonatal therapies. To address the knowledge gaps that preclude optimal, evidence-based care in this critical field of perinatal medicine, the National Institute of Child Health and Human Development organized a workshop, Oxygen in Neonatal Therapies: Controversies and Opportunities for Research, in August 2005. The information presented at the workshop included basic and translational oxygen research; a review of completed, ongoing, and planned clinical trials; oxygen administration for neonatal resuscitation; and a review of the collaborative home infant monitoring evaluation study. This article provides a summary of the discussions, focusing on major knowledge gaps, with prioritized suggestions for studies in this area. [ABSTRACT FROM AUTHOR]

Parental assessment of the development of their high-risk infant does not appear to agree well enough with professional assessment to allow parental assessment to be used as an inexpensive screening tool. A group of parents of 196 developmentally high-risk infants completed a developmental assessment questionnaire at periodic visits up to one year corrected age at which their infant was also evaluated by professionals. Evaluating parents were almost all white and married, and most had at least completed high school. Infants were high risk by virtue of prematurity or other complications potentially affecting the nervous system. Parents and professionals agreed on only 52% of normal infants, 60% of suspect infants, and 44% of abnormal infants. If professional assessment is considered 100% accurate, one in five developmentally delayed children would be missed by using parental assessment as a screening tool, and half of normal children would unnecessarily undergo further evaluation., Objectives. To examine the degree of agreement between parental reporting of the development of high-risk infants and professional assessment by a multidisciplinary team. Methods. The developmental status of 196 infants discharged from neonatal intensive care units (NICUs) was assessed by their parents using the Infant Monitoring Questionnaire (IMQ) at 4, 8, or 12 months' corrected age. On the same day, a clinical assessment was done by a multidisciplinary team consisting of a developmental pediatrician, physical therapist, and psychologist. The K statistic was used to measure agreement between the assessments. Logistic regression was used to investigate factors that might influence agreement. Results. Both the IMQ and the multidisciplinary team classified infants as developing normally ("normal"), being at risk for abnormal development ("suspect"), or developing abnormally ("abnormal"). Although the same proportion of children fell into the three categories by both assessments, parents and the multidisciplinary team showed poor agreement with respect to the classification of individual infants (K = 0.276). No infant or family characteristic was found to have an influence on agreement. Conclusions. For a group of high-risk infants discharged from NICUs, the agreement between parental assessment of developmental status using the IMQ and the professional assessment by a multidisciplinary team is poor in the first year of life. We do not recommend the use of this questionnaire as a substitute for clinical assessment of biologically at-risk infants discharged from NICUS. However, it may be useful for those groups of infants for whom no other information is available or as an adjunct to clinical assessment when infants are not behaving practically because of an unfamiliar setting or concurrent illness., Pediatrics 1996,97:676-681; parent report, high-risk infants, infant monitoring questionnaire, child development. ABBREVIATIONS. NICU, neonatal intensive care unit; IMQ, Infant Monitoring Questionnaire. The past two decades have witnessed the increased survival [...]

Abstract. Public Law 99-457 amends the Education of the Handicapped Act to include services for children from birth through 3 years. Inasmuch as detection and referral of children with developmental delays continues to reside largely with pediatricians and other health care professionals, developmental screening, using standardized tests, is increasingly important. To help physicians select from the array of instruments, 19 different screening tests were administered by a pediatrician and rated by a panel of pediatricians and a special educator. While the panel found few tests that fit within the time constraints of pediatric practice, several tests approached standards for educational and psychologic tests. These included the Battelle Developmental Inventory Screening Test, Infant Monitoring System, Developmental Indicators for Assessment of Learning-Revised, Screening Children for Related Early Educational Needs, and the Developmental Profile II. Pediatrics 1990;86:547-554; developmental screening tests. INSET: EFFICACY OF PRIOR-REVIEW PROGRAMS. [ABSTRACT FROM AUTHOR]

Public Law 99-457, passed in 1986, expanded the Education of the Handicapped Act to include services for children between birth and three years with delayed development. Agencies that are responsible for administering services to handicapped children are currently planning how to implement this law. Developmental screening with standardized tests will assist pediatricians and other health care professionals in identifying young children with delayed development. Various test can be used to screen for developmental delays in five areas: cognition or intellectual awareness; gross and fine motor function; speech and language; adaptive behavior; and psychosocial characteristics. Nineteen different screening tests, given by a pediatrician, were assessed by a panel of pediatricians and a special educator. Although most of the tests were too lengthy for routine pediatric examinations, many tests fulfilled the requirements for educational and psychologic tests. The screening tests included the Battelle Developmental Inventory Screening Test, Infant Monitoring System, Developmental Indicators for Assessment of Learning-Revised, Screening Children for Related Early Educational Needs, and the Developmental Profile II. (Consumer Summary produced by Reliance Medical Information, Inc.)

OBJECTIVE. The goal was to identify criteria that would allow low-risk infants presenting with an apparent life-threatening event to be discharged safely from the emergency department. METHODS. We completed data forms prospectively on all previously healthy patients < 12 months of age presenting to the emergency department of an urban tertiary care children&apos;s hospital with an apparent life-threatening event over a 3-year period. These patients were then observed for subsequent events, significant interventions, or final diagnoses that would have mandated their admission (eg, sepsis). RESULTS. In our population of 59 infants, all 8 children who met the aforementioned outcome measures, thus requiring admission, either had experienced multiple apparent life-threatening events before presentation or were in their first month of life. In our study group, the high-risk criteria of age of CONCLUSIONS. Our study suggests that >30-day-old infants who have experienced a single apparent life-threatening event may be discharged safely from the hospital, which would decrease admissions by 38%. Key Words apnea, apparent life-threatening event, emergency department, AN APPARENT LIFE-THREATENING event (ALTE) is defined as "an episode that is frightening to the observer and that is characterized by some combination of apnea (central or occasionally obstructive), color [...]

Bronchiolitis is a disorder most commonly caused in infants by viral lower respiratory tract infection. It is the most common lower respiratory infection in this age group. It is characterized by acute inflammation, edema, and necrosis of epithelial cells lining small airways, increased mucus production, and bronchospasm. The American Academy of Pediatrics convened a committee composed of primary care physicians and specialists in the fields of pulmonology, infectious disease, emergency medicine, epidemiology, and medical informatics. The committee partnered with the Agency for Healthcare Research and Quality and the RTI International-University of North Carolina Evidence-Based Practice Center to develop a comprehensive review of the evidence-based literature related to the diagnosis, management, and prevention of bronchiolitis. The resulting evidence report and other sources of data were used to formulate clinical practice guideline recommendations. This guideline addresses the diagnosis of bronchiolitis as well as various therapeutic interventions including bronchodilators, corticosteroids, antiviral and antibacterial agents, hydration, chest physiotherapy, and oxygen. Recommendations are made for prevention of respiratory syncytial virus infection with palivizumab and the control of nosocomial spread of infection. Decisions were made on the basis of a systematic grading of the quality of evidence and strength of recommendation. The clinical practice guideline underwent comprehensive peer review before it was approved by the American Academy of Pediatrics. This clinical practice guideline is not intended as a sole source of guidance in the management of children with bronchiolitis. Rather, it is intended to assist clinicians in decision-making. It is not intended to replace clinical judgment or establish a protocol for the care of all children with this condition. These recommendations may not provide the only appropriate approach to the management of children with bronchiolitis. Key Word bronchiolitis Abbreviations CAM--complementary and alternative medicine LRTI--lower respiratory tract infection AHRQ--Agency for Healthcare Research and Quality RSV--respiratory syncytial virus AAP--American Academy of Pediatrics AAEP--American Academy of Family Physicians RCT--randomized, controlled trial CLD--chronic neonatal lung disease SBI--serious bacterial infection UTI--urinary tract infection AOM--acute otitis media Sp[O.sub.2]--oxyhemoglobin saturation LRTD--lower respiratory tract disease, INTRODUCTION THIS GUIDELINE EXAMINES the published evidence on diagnosis and acute management of the child with bronchiolitis in both outpatient and hospital settings, including the roles of supportive therapy, oxygen, [...]

In 2003, 12.3% of births in the United States were preterm ( Key Words prematurity, low birth weight, preterm birth, near-term infant, late-preterm infant, seizures, kernicterus, respiratory distress syndrome, apnea, sudden infant death Abbreviations TTN--transient tachypnea of the newborn RDS--respiratory distress syndrome, THE RATE OF preterm births in the United States increased from 9.1% in 1981 to 12.3% in 2003, (1) an increase of 31%, most of which was caused by increases [...]

OBJECTIVE. The objective of this study was to compare the respiratory physiologic features of healthy term infants placed in either a car bed or a car safety seat. METHODS. Within the first 1 week of life, 67 healthy term infants were recruited and assigned randomly to be monitored in either a car bed (33 infants) or a car safety seat (34 infants). Physiologic data, including oxygen saturation and frequency and type of apnea, were obtained and analyzed in a blinded manner. RESULTS. The groups spent similar amounts of time in the devices (car bed: 71.6 minutes; car seat: 74.2 minutes). The mean oxygen saturation values were not different between the groups (car bed: 97.1%; car seat: 97.3%). The percentages of time with oxygen saturation of CONCLUSIONS. The respiratory physiologic features of infants in the 2 car safety devices were observed to be similar. Of note, substantial periods of time with oxygen saturation of Key Words apnea, car seats, car beds Abbreviation AAP--American Academy of Pediatrics, INFANT CAR SEATS play a critical role in the safe transportation of young infants and have reduced the rates of deaths and injuries during motor vehicle accidents. As with all [...]

Objective. Compared with in utero transport, incubator transport for preterm infants has several disadvantages including instability during transport with increased mortality and morbidity, lack of adequate systems for securing the infant in the event of an accident, and separation of mother and infant. As a new kind of postnatal transportation that bears some analogy to in utero transport and may be safer than incubator transport, we investigated kangaroo transport, transporting the infant on the mother&apos;s or other caregiver&apos;s chest. This article presents a description and preliminary data for kangaroo transport. Design. We conducted kangaroo transports of 31 stable preterm and term infants in different settings and recorded data regarding transport conditions and cardiorespiratory stability. Eighteen transports were back transfers, and 13 were transfers in. Twenty-seven transports were conducted by the mother, 1 by the father, 2 by nurses, and I by a doctor. Transport distance was 2 to 400 km. Results. Heart rate, respiratory rate, oxygen saturation, and rectal temperature remained stable during all kangaroo transports lasting 10 to 300 minutes. Weight at transport was 1220 to 3720 g. Parents felt very comfortable and safe and appreciated this method of transport. Conclusions. Kangaroo transport promotes mother-infant closeness and might ameliorate several of the risks associated with incubator transport. Pediatrics 2004;113: 920-923; kangaroo, transport, incubator, preterm, back transfer., Very low birth weight infants who are transported directly after birth have an increased risk of intraventricular bleeding compared with infants who are not transported. This may be explained by [...]

Objectives. To test prospectively the hypothesis that an infant car seat modification to allow the infant&apos;s head to rest in a neutral position on the trunk would prevent narrowing of the upper airway and thus reduce oxygen desaturation in preterm infants who are restrained in car seats. Methods. Seventeen preterm infants who were approved for discharge were evaluated in a car seat for newborns, with and without a foam insert that provided a slot for the back of the infants&apos; head. Respiration timed inspiratory radiographs for assessment of upper airway dimensions were taken during quiet sleep in each position. Infants were monitored in each position for 30 minutes with continuous polygraphic recording of respiratory, cardiac, and nasal airflow activity and pulse oximetry. Results. Placement of the insert in the car seat was associated with a larger upper airway space (mean [+ or -] standard deviation, 5.2 [+ or -] 1.3 vs 3.6 [+ or -] 1.4 mm). This radiologic improvement was associated with a significant reduction in the frequency of episodes of oxygen desaturation to Conclusions. The cause of oxygen desaturation in preterm infants who are restrained in car seats is multi-factorial. The present data strongly support the hypothesis that flexion of the head on the body is a significant contributor to these episodes and that the mechanism is posterocephalic displacement of the mandible, leading to narrowing of the upper airway. Critically, this pilot study demonstrates that the frequency of episodes of desaturation in a standard newborn car seat can be substantially reduced by placement of a simple foam insert that allows the infant to maintain the head in a neutral position on the trunk during sleep. Pediatrics 2003;112:907-913; newborn, premature; apnea of prematurity; infant car seat; infant safety., Premature infants are now widely recognized to be at high risk of oxygen desaturation and secondary central apnea while restrained infant car seats. (1,2) The American Academy of Pediatrics recommends [...]

More than 25 years have elapsed since continuous cardiorespiratory monitoring at home was suggested to decrease the risk of sudden infant death syndrome (SIDS). In the ensuing interval, multiple studies have been unable to establish the alleged efficacy of its use. In this statement, the most recent research information concerning extreme limits for a prolonged course of apnea of prematurity is reviewed. Recommendations regarding the appropriate use of home cardiorespiratory monitoring after hospital discharge emphasize limiting use to specific clinical indications for a predetermined period, using only monitors equipped with an event recorder, and counseling parents that monitor use does not prevent sudden, unexpected death in all circumstances. The continued implementation of proven SIDS prevention measures is encouraged., ABBREVIATIONS. SIDS, sudden infant death syndrome; ALTE, apparent life-threatening event. INTRODUCTION Significant new information has been forthcoming in recent decades on sudden infant death syndrome (SIDS) and apnea during early [...]

Pediatricians may better identify children with developmental or behavioral problems by asking their parents if they have concerns about their child. A review of research about the kinds of information parents can provide revealed that asking parents about any concerns they may have about their child and having parents complete questionnaires related to child behavior and development are useful methods that increase detection of potential problem areas. Doctors should follow up by obtaining more information when parents describe problem areas for their child. Using parent-provided information may save pediatricians' time and improve early diagnosis of behavioral and developmental problems., Objective. The success of early identification of children with developmental and behavioral problems is influenced by the manner in which pediatricians elicit, recognize, and select clinical information and derive appropriate impressions. Parents are ready sources of clinical information, and they can be asked to provide two broad types of data: appraisals, including concerns, estimations, and predictions; and descriptions, including recall and report. The purpose of this article is to help pediatricians make optimal use of clinical information from parents to increase the accuracy of clinical judgment in detecting children with developmental and behavoral problems. Design. Review of 78 research articles and tests relying on parent information from pediatric, psychological, and education literature. Results and Conclusion. There are several formats for eliciting parental information that are superior in terms of accuracy and ease of evocation. Specifically, parents&apos; concerns and good-quality standardized parent report measures such as the Child Development Inventories capitalize best on parents&apos; observations and insights into their children. In combination, these two types of parental information offer an effective method for the early detection of behavioral and developmental problems in primary-care settings. Pediatrics 1995; 95:829 -- 836; parents&apos; concerns, developmental screening, developmental surveillance, behavior problems., The Committee on Children with Disabilities of the American Academy of Pediatrics recently has emphasized the importance of the early identification of children with developmental disabilities.(1) In addition to leading [...]

To the Editor.-- I am deeply perturbed by Dr Frankenburg's commentary. (1) His assertions are erroneous and troubling: 1. Developmental delays cannot be quantified. False! Every state, under the Individuals [...]

Documented home monitoring is cost-effective in some infants who are at risk for sudden infant death syndrome (SIDS) and will help determine whether home monitors can prevent SIDS. Documented home monitors record the electrical activity in infants' bodies when they stop breathing or have abnormally slow heart rates. Researchers believe that SIDS is caused by a brain abnormality that interferes with the body's ability to regulate the heart and breathing rates. An infant's risk of SIDS is approximately 1.3 per 1,000 live births. Subsequent siblings of SIDS infants, premature babies, and infants who stop breathing periodically have an increased risk of SIDS. Research published in 1995 revealed that documented monitoring of subsequent siblings of SIDS infants would reduce the duration of home monitoring and would decrease the the number of unnecessary diagnostic studies. It is unclear whether documented home monitoring reduces the risk of SIDS., Major uncertainties still exist in regard to mechanisms for sudden infant death syndrome (SIDS) and proposed strategies for prospective identification and intervention. Beginning in part with the report by Steinschneider [...]

Objective. Despite increased recognition of the importance of development and growth of young children, formal developmental and behavioral screening often is not included in general pediatric practice. Barriers to the provision of developmental and behavioral screening are considerable; among them are the need for specialized training and uncertain reimbursement. This article develops a model for estimating the cost of providing pediatric developmental and behavioral screening that can be scaled to reflect a pediatric practice&apos;s patient population and choice of screening offered. Methods. The framework for our scaleable cost model was drawn from work done in estimating the Resource-Based Relative Value Scale (RBRVS). RBRVS provides estimates of the work effort involved in the provision of health care services for individual Current Procedural Terminology codes. The American Academy of Pediatrics has assigned descriptions of pediatric services, including developmental and behavioral screening, to the Current Procedural Terminology codes originally created for adult health care services. The cost of conducting a screen was calculated as a function of the time and staff required and was loaded for practice costs using the RBRVS valuation. The cost of the follow-up consultation was calculated as a function of the time and staff required and the number of relative value units assigned in the RBRVS scale. Results. The practice cost of providing developmental and behavioral screening is driven primarily by the time and staff required to conduct and evaluate the screens. Administration costs are lowest for parent-administered developmental screens ($0 if no assistance is required) and highest ($67) for lengthy, pediatric provider-administered screens, such as the Neonatal Behavioral Assessment Scale. The costs of 3 different groups of developmental and behavioral screening are estimated. The estimated per-member per-month cost per 0- to 3-year-old child ranges from $4 to [is greater than] $7 in our 3 examples. Conclusions. Cost remains a significant barrier to greater provision of formal developmental and behavioral screening. Our scaleable cost model may be adjusted for a given practice to account for the overall level of developmental risk. The model also provides an estimate of the time and cost of providing new screening services. This model allows pediatric practices to select the mix of developmental screens most appropriate for their particular patient population at an acceptable cost. Pediatrics 2001;108:913-922; developmental screening, RBRVS, CPT codes, cost., ABBREVIATIONS. RBRVS, Resource-Based Relative Value Scale; RVU, relative value units; CPT, Current Procedural Terminology; CF, conversion factor; PCPM, per child per month. Pediatric primary care providers are well positioned to [...]

ABBREVIATIONS. AAP, American Academy of Pediatrics; G-6-PD, glucose-6-phosphate dehydrogenase. OBJECTIVE The American Academy of Pediatrics (AAP) Subcommittee on Hyperbilirubinemia is currently revising the practice parameter (guidelines) on neonatal hyperbilirubinemia published [...]

Early identification of children with developmental delays is important in the primary care setting. The pediatrician is the best-informed professional with whom many families have contact during the first 5 years of a child&apos;s life. Parents look to the pediatrician to be the expert not only on childhood illnesses but also on development. Early intervention services for children from birth to 3 years of age and early childhood education services for children 3 to 5 years of age are widely available for children with developmental delays or disabilities in the United States. Developmental screening instruments have improved over the years, and instruments that are accurate and easy to use in an office setting are now available to the pediatrician. This statement provides recommendations for screening infants and young children and intervening with families to identify developmental delays and disabilities., ABBREVIATIONS. IDEA, Individuals With Disabilities Education Act; CHAT, Checklist for Autism in Toddlers. BACKGROUND Developmental and behavioral problems are commonly seen by pediatricians and other primary care practitioners. According to [...]

ABBREVIATION. SIDS, sudden infant death syndrome. The premature infant is at increased risk to die of sudden infant death syndrome (SIDS).[1] Although the overall risk in Los Angeles County in [...]

To the Editor.-- Recently, I had the opportunity to review my hospital's policy on safe transportation of newborns from the hospital. The recommendation of the American Academy of Pediatrics for [...]

To the Editor.-- We were pleased to see the article by Mallory et al (1) examining how pulse oximetry readings affect practitioners' decisions to admit infants with bronchiolitis. Their finding [...]