Pediatri

Martin Ward Platt The last week of July has seen some very sad news. Our great friend, senior editor, and inspirational colleague, Martin Ward Platt, has died after a long illness. Martin, who was also interim Editor in Chief in

Martin Ward Platt The last week of July has seen some very sad news. Our great friend, senior editor, and inspirational colleague, Martin Ward Platt, has died after a long illness. Martin, who was also interim Editor in Chief in 2017,

Type 1 diabetes is caused by the autoimmune destruction of insulin-producing beta cells in the islets of Langerhans, which leads to dependence on exogenous insulin for survival. Approximately 1 million to 1.5 million Americans have type 1 diabetes, which is

Sickle cell disease affects approximately 100,000 persons in the United States and reduces life expectancy by approximately 30 years. The disease is caused by a single amino acid substitution resulting in the production of sickle hemoglobin (HbS). HbS polymerizes when

Globally, 700 children are diagnosed with cancer every day. In high-income countries such as the USA, cancer remains the leading cause of death by disease in children younger than 19 years, despite survival rates having dramatically improved recently—80% of these

Yellow fever is a mosquito-borne viral disease endemic to tropical and subtropical regions in Africa and the Americas. Infection with yellow fever virus can result in subclinical to severe illness, characterized by fever, jaundice, and hemorrhage. There were an estimated

This randomized clinical trial assesses whether providing a drug disposal bag along with postoperative discharge instructions on opioid use, storage, and disposal affects the rate of proper opioid disposal compared with that for providing only the discharge instructions among families

Severe anemia (hemoglobin level In the Transfusion and Treatment of Severe Anemia in African Children Trial (TRACT), we compared four interventions. Here, we compare immediate transfusion with no immediate transfusion, in which transfusion was triggered by the development of new

Yellow fever is a mosquito-borne viral disease endemic to tropical and subtropical regions in Africa and the Americas. Infection with yellow fever virus can result in subclinical to severe illness, characterized by fever, jaundice, and hemorrhage. There were an estimated

Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors’ clinical recommendations. Stage.

Neural-tube defects occur by the end of the sixth week of pregnancy (i.e. the fourth week after fertilization) and have been associated with exposure to specific drugs early in pregnancy. Concerns about neural-tube defects among children exposed to efavirenz at

Case A: London. Twenty-year-old Ms. Z. presented to the emergency department (ED) of a hospital in London, anxious and hyperventilating after 4 days sheltering on night buses. She was brought in by an elderly couple whom she had approached when

Global health: Charges to migrant children’s families In a hard-hitting salvo, Russell and colleagues argue that recent changes to charging regulations in the NHS, both undermine child health and represent a departure from the founding principles of the organisation. The

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The United States has been experiencing an increasing number of measles outbreaks, and more measles cases were reported in the first 5 months of 2019 than in any full year since 1992, which was 8 years before endemic transmission was

The establishment of June 13 as International Albinism Awareness Day by the UN General Assembly “as a response to the appeal by civil society organizations that advocate for individuals with albinism as a specific group with specific needs that require

Achondroplasia is the most common form of disproportionate short stature, with a prevalence of 1 in 25,000 live births. The condition is caused by an autosomal dominant mutation in the fibroblast growth factor receptor 3 gene (FGFR3) that constitutively activates

Heatstroke is the most hazardous condition in a spectrum of illnesses progressing from heat exhaustion to heatstroke, in which a shared finding is hyperthermia (i.e. the rise in core body temperature when heat accumulation overrides heat dissipation during exercise or

To the Editor: The rapid accrual of knowledge in genomic medicine has prompted the reanalysis of existing data. We clinically reanalyzed data from two patient series that had undergone diagnostic proband-only exome sequencing. The exome sequences of the first series

Vision: JAMA Pediatrics will be the most respected source of information for investigators, providers, and policy makers seeking the highest quality evidence to guide decision making.

Heatstroke is the most hazardous condition in a spectrum of illnesses progressing from heat exhaustion to heatstroke, in which a shared finding is hyperthermia (i.e. the rise in core body temperature when heat accumulation overrides heat dissipation during exercise or

To the Editor: The rapid accrual of knowledge in genomic medicine has prompted the reanalysis of existing data. We clinically reanalyzed data from two patient series that had undergone diagnostic proband-only exome sequencing. The exome sequences of the first series

Global health: tuberculosisDiagnosis Though the WHO endorsed gold standard for diagnosing tuberculosis in all age groups is positive microbiology, this is notoriously difficult to achieve in children. If all else fails and the infrastructure allows, bronchoscopy is an option, but

Automated FiO2 adjustment In an issue bursting with great content the Editor’s choice this month is closed-loop automated FiO2 control. The potential for this technology to improve clinical outcomes of high-risk preterm infants is obvious and most manufacturers are working

The gravity of gender inequality seems to have, at last, reached all sectors of society. A watershed on dangerously permissive attitudes to sexual assaults, outrage at gender-oriented discrimination, and a refusal to accept socially constructed gender roles are aired daily

This analysis of the Global Disease Burden data estimates mortality and morbidity in children and adolescents from 1990 to 2017 by age and sex in 195 countries and territories worldwide.

Global child healthAntibiotics in non-bloody diarrhoea Managing infectious diarrhoea is essentially uncomplicated. In only a small proportion of children, those with bloody diarrhoea (shigella, cholera amoebiasis) and associated toxicity or sepsis are antibiotics indicated. In other situations, they can prolong

While primary school enrolment rate in developing regions reached 91% at the end of the Millennium Development Goal era, 60% of children and adolescents worldwide (617 million) are not achieving basic proficiency in reading and mathematics expected of their school

Vision: JAMA Pediatrics will be the most respected source of information for investigators, providers, and policy makers seeking the highest quality evidence to guide decision making.

As we continue our plan to make the journal fatter in terms of articles per issue, it becomes increasingly difficult to choose which articles to highlight in Fantoms without leaving out lots of interesting content. Nutrition There is a strong nutritional

Milestones Like many words with an implicit sense of drama, ‘milestones’ has become something of an overused term, a ‘millstone’, if you will. There are occasions, though, where it is fully justified and, by chance, this month’s issue describes events

Vaccine hesitancy, which is defined by WHO as a “delay in acceptance or refusal of vaccines despite availability of vaccination services”, has been reported in more than 90% of countries in the world. In many areas, immunisation for measles, a

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Attention deficit–hyperactivity disorder (ADHD) is one of the most commonly diagnosed conditions in child and adolescent mental health services. Stimulants, including methylphenidate and amphetamines, are recommended for ADHD treatment. Methylphenidate is the most frequently prescribed stimulant in…

In Kipling’s seminal novel ‘Kim’, the central premise (literal and metaphorical) is the wresting for power in fin de (19th) siècle South Asia. This attritional confrontation became popularly known as the Great Game and, though ostensibly a children’s book, is really

Poverty disproportionately affects the young. Worldwide, one in five children—a staggering 385 million—survive on less than US$1·90 per day. Such extreme poverty affects 21% of children aged 0–9 years and 15–19% of adolescents (10–17 years), compared with 10% of adults,

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Vision: JAMA Pediatrics will be the most respected source of information for investigators, providers, and policy makers seeking the highest quality evidence to guide decision making.

Measuring growth One might have thought that something as basic as charting the growth of preterm babies might have been a settled issue by now, but as we all know, this is far from the case. We carried an important

Global child healthVitamin A The history of the vitamin A supplementation studies from the initial excitement of the reduction in measles related mortality trials in West Africa 25 years ago has been a chequered one. The routine population supplementation from

Objective Significant haemodynamic changes occur at delivery impacting organ blood flow distribution. We aimed to characterise Doppler indices patterns over time in three different organs (brain, gut and kidney) and test them as measures of vascular resistance. Design Observational cohort

In Australia, in the first month of 2019 alone, five Aboriginal girls, aged 12–15 years, have taken their own lives and a 12-year-old boy is critically ill after attempt suicide. Indigenous children (5–17 years old) in Australia die from suicide

Vision: JAMA Pediatrics will be the most respected source of information for investigators, providers, and policy makers seeking the highest quality evidence to guide decision making.

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Background and objectives Adverse childhood experiences (ACEs) have been associated with a range of poorer health and social outcomes throughout the life course; however, to date they have primarily been conducted retrospectively in adulthood. This paper sets out to determine

Objective To establish the incidence of road transport collision (RTC) fatalities in the Irish paediatric population, examining trends in fatality rates over a period of 25 years, during which several national road safety interventions were implemented. Study design Retrospective review

Pragmatism Pragmatism is generally taken to mean ‘practical’, a means of operation which is both user and subject friendly. We are all bound to an extent by pragmatism as this defines the world we inhabit, simultaneously adhering to certain rules

Since August, 2018, an outbreak of Ebola virus disease has been ongoing in the North Kivu province in the Democratic Republic of the Congo. This is the tenth outbreak of the disease in the country since 1976, but what makes

To the Editor: A rapid increase in the prevalence of vaping among adolescents has aroused public health concern. Adolescents who “vape” use a device such as an electronic cigarette to inhale a heated aerosol, which typically contains nicotine. In 2017,

This multicenter cohort study describes the natural progression of symptom change by age group (5-7, 8-12, and 13-18 years) and sex and develops centile curves to inform families about children after concussion recovery.

On June 26, 2018, a federal judge ordered the Trump administration to reunite families that it had separated at the U.S.–Mexico border. As of mid-October, however, an analysis by the American Civil Liberties Union showed that 245 children were still

The arrival of a newborn is a highly anticipated occasion. But for families with preterm and ill babies, the associated health challenges and psychological burden can make the occasion a stressful one. Each year in Europe, an estimated 500 000 babies—roughly

Recipe for success The editor’s choice this month would make a great choice for your journal club. When you have read it and the accompanying editorial by Lamia Soghier and Billie Lou Short you will want plenty of your colleagues

Parsimony Parsimony, ‘the quality of frugality in the use of resources’, is an unusual term. Unusual in that it has both pejorative (personal—meanness) and complimentary connotations. A parsimonious statistical model, for example, makes fewer assumptions, has fewer variables and has

This cohort study assesses whether echocardiographic imaging of pediatric patients with Kawasaki diseaes 6 weeks after onset of illness adds value for patients whose earlier examinations showed no coronary artery abnormalities.

Variable rates of diagnosis and treatment of attention deficit–hyperactivity disorder (ADHD) across the United States have aroused concern about overdiagnosis, underdiagnosis, and appropriate treatment. Over the past two decades, rates of diagnosis and treatment of ADHD have increased. Among…

The prevalence of peanut allergy among children in the United States and other industrialized countries is on the rise. Peanut allergy usually persists into adulthood, is occasionally life-threatening, and accounts for the majority of deaths related to food allergy. Because

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Evolving… I’ve always had a fear (and I accept it might be irrational) of becoming fixed in any set way of thinking, the ‘that’s how it’s done’ stance. Practices from 25 years ago, are now looked at (affectionately) as historical

Children with severe allergies, and their parents, remain in a state of anxiety as an international shortage of life-saving medication continues. EpiPens, the leading brand of epinephrine autoinjectors used to treat anaphylaxis, have been in short supply since November, 2017.

Over the past 20 years, medical professionals and the general public have gained clearer understanding that mild traumatic brain injury (mTBI), or concussion, is often not a benign, self-limited condition as once thought. Rather, it may result in persistent physical,

The hemoglobinopathies, disorders that are caused by mutations in genes that encode the “adult” globins, exert a devastating toll on patients and their families. Worldwide, approximately 300,000 babies are born with sickle cell disease and 60,000 are born with β-thalassemia

World Cup winners… Hugo Lagercrantz’s editorial (see page 1005) based on the recent Lancet paper by Zylberszteyn examining relative child mortality in Sweden and England reinforces some home truths. Unsurprisingly, as the largest contributor to the numerator, the greatest difference

Summary The 1960s heralded an era when rapid advances in technology led to tremendous advances in medicine. We describe how the European Society for Paediatric Nephrology (ESPN) marked its 50th anniversary by creating an oral video archive from early pioneers

The UK has a higher mortality for children from birth to 5 years old compared with most other countries in Western Europe,1 and this has been recognised as a national priority by the Royal College of Paediatrics and Child Health.

Twenty-first century parents want to be assured that their newborn infant is ‘normal’. But how reliable is the routine newborn examination procedure? Should parents trust us as health professionals when we say, or imply, that they have a normal, healthy

Sweden lost its World Cup quarter final to England in summer 2018, but it has certainly met its goals for infant survival. Child mortality is almost twice as high in England as Sweden, according to a study by Zylbersztejn et

Objective To determine the comparative efficacy and safety of corticosteroids in the prevention of bronchopulmonary dysplasia (BPD) in preterm infants. Study design We systematically searched PubMed, EMBASE and the Cochrane Library. Two reviewers independently selected randomised controlled trials (RCTs) of

Congenital diaphragmatic hernia (CDH) remains one of the most challenging conditions to manage in neonatology and neonatal surgery. Despite significant advances in antenatal detection, antenatal therapy, neonatal intensive care and neonatal surgery, there is a significant mortality rate due to

Twin and higher order multiples have a natural frequency of

Some historical aspects Corticosteroids, in the form of hydrocortisone, were first used in neonatal medicine in the 1970s to try to modify the course of respiratory distress syndrome.1 No clinical benefit was shown but the treatment appeared to be without

Postnatal steroids for bronchopulmonary dysplasia While there are many strategies for reducing the risk of BPD, the place of corticosteroids remains uncertain in spite of its long history. This month we publish a network meta-analysis by Zhang et al which

In The Lancet Child & Adolescent Health, Bernadeta Patro Golab and colleagues1 report a meta-analysis combining data sets from 34 prospective pregnancy and birth cohorts from Europe and North America to examine an important public health question: how do maternal

Physical abuse of children is all too common, but often difficult to detect. Although we as physicians usually trust caretaker histories, with cases of abuse those histories are often partial, minimised, or intended to misdirect clinical evaluations. Thus, we usually

Anxiety disorders are among the most common mental health conditions in childhood, and are ranked by WHO as the sixth-largest contributor to non-fatal health loss globally.1 Early-onset anxiety disorders tend to be chronic and can relapse, and are associated with

Healthy lifestyle behaviours are the primary modifiable risk factors for prevention of chronic disease.1 Recognition of the interdependence between various lifestyle behaviours has grown and investigation of their potentially synergistic benefits has increased.2 In The Lancet Child & Adolescent Health,

Alcohol is one of the most commonly used legal, addictive substances in adolescence. Consumption by peers heavily influences initiation of use, and most young people drink alcohol in social situations to enhance existing friendships and make new ones. Adolescents might

Adolescents’ use of electronic cigarettes initially took the public health community by surprise. In 2011, less than 2% of U.S. high school students reported having used e-cigarettes in the previous month. But by 2015, the percentage had jumped to 16%.

The overall prevalence of childhood obesity remains very high, and the prevalence of very high levels of body-mass index (BMI) for age in children is still rising. Most adolescents who are obese remain so in adulthood. The early onset of

The body-fat content of a healthy full-term infant rises sharply from 10 to 14% at birth to 25 to 30% at 6 months of age, with a consequent 30% increase in the body-mass index (BMI). The accrual of body fat

Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations. Stage.

Neuroblastoma is a childhood cancer of the sympathetic nervous system, with a propensity for widespread metastasis and aggressive clinical behavior. For patients with so-called high-risk disease (typically patients 18 months of age or older who present with metastatic disease), standard

Respect for the individual is a fundamental ethical principle of human subjects research. While informed consent is an essential component of clinical research, it remains unclear how to ensure that consent for study participation is truly informed. Many studies have

Videolaryngoscopy Two papers and an accompanying editorial discuss videolaryngoscopy. Changes in staffing and in clinical practice mean that trainees get precious few opportunities to intubate and are frequently unsuccessful. In a randomised controlled trial videolaryngoscopy improved trainee success rate. Now

Objective This study aimed to test the applicability and effectiveness of the enhanced informed consent form (ICF) methodology, proposed by the Strategic Initiative for Developing Capacity in Ethical Review (SIDCER), in neonatal research requiring maternal consent. Design A single-centre open-label

Intubation is a technically challenging but important skill for neonatal trainees to master. Trainees’ opportunities to perform neonatal intubation have decreased over time, due to less use of invasive ventilation, limited duty hours and changes in practice for infants born

Preterm birth occurs during a critical period of brain development. For babies born before 26 weeks’ gestational age, neurons have just completed migration to the cortex and are starting to form a network of connections. Cortical surface area is expanded

Objective The epidemiology of violence against children is likely to differ substantially by sex and age of the victim and the perpetrator. Thus far, investment in effective prevention strategies has been hindered by lack of clarity in the burden of

Objective To compare the anthropometric measurements of newborns in a tertiary care hospital in Sri Lanka, with WHO standards. Methods Birth weight, length and occipitofrontal circumference (OFC) of 400 consecutive, term newborns of healthy mothers were measured in a tertiary

Objective To assess the contribution of the severity of bronchopulmonary dysplasia (BPD) and the time point of its diagnosis to the prediction of neurodevelopmental impairment (NDI) at corrected age of 2 years in preterm infants. Design Retrospective cohort study. Setting

Introduction Cyclists have a high mortality and morbidity per mile travelled compared with car occupants, a figure that is likely to increase if campaigns to increase active travel are successful. Concerns about safety is the leading factor limiting cycling for

Background Preterm birth causes long-term problems, even for infants born 1 or 2 weeks early. However, less is known about infants born after their due date and over a quarter of infants are born over 1 week late, and many

The global burden of obesity is increasing in children and adolescents.1 The incidence of type 2 diabetes and its precursor, prediabetes, is burgeoning in this young population, particularly among some ethnic groups. Youth-onset type 2 diabetes is a more aggressive

The human papillomavirus (HPV) vaccine provides an extraordinary opportunity to mitigate the burden of HPV-related diseases, including cervical intraepithelial neoplasia (CIN) and cancer. However, the ideal vaccine schedule to maximise cervical cancer prevention continues to be debated and refined. In

Type 1 diabetes, an autoimmune disease characterised by deficiency and resultant hyperglycaemia, is the second most common chronic disease of childhood. The associated complications are manifold, ranging from acute and potentially life-threatening events such as hypoglycaemia and ketoacidosis to chronic

Introduction Decades of research unequivocally demonstrates that no matter the society, socioeconomic resources are perhaps the most fundamental determinants of health throughout the life course, including during its very earliest stages. As a result, societies have implemented ‘cash transfer’ programmes,

Children’s use of hospital services in the UK has been increasing rapidly since the late 1990s.1–6 Findings from the latest QualityWatch report show significant increases in emergency hospital admissions for infants (23%) and young children aged 1–4 years (11%) between

Coon et al,1 who have published on other areas of putative overdiagnosis, bring us the example of coronary artery abnormalities in Kawasaki disease in children. Across 48 participating hospitals, they noted that over some 15 years the rate of diagnosis

‘Happiness does not depend on outward things, but on the way we see them.’ Leo Tolstoy, Childhood, Boyhood and Youth. Can we ever know the mind of another? A few years ago, the Study of Participation of Children with Cerebral

Diagnosing normality… Our medical school graduation year book opened with the apocryphal quote that ‘There’s no such thing as a well patient, merely one who hasn’t been investigated enough’. Partially tongue in cheek, it nonetheless resonated with me even then.

More than 50 years ago, an epidemic of serious birth defects caused by prenatal exposure to thalidomide shattered the prevailing notion that the placenta served as a barrier against damaging influences and led to recognition that exposures during pregnancy can

To the Editor: Since August 2014, the Botswana Harvard AIDS Institute Partnership has conducted birth outcome surveillance at eight government hospitals throughout Botswana. A primary ongoing aim of the surveillance is to evaluate the prevalence of neural-tube defects associated with

This Viewpoint discusses the issue of tracking and storing data on nonverbal behavior that is collected through the use of virtual reality devices.

This Viewpoint describes a patient receiving gender-affirming hormonal therapy who chose to alter medication regimen after experiencing an identity shift.

This Viewpoint explains differences between attention-deficit/hyperactivity disorder symptoms and impairments and suggests that treatment approaches must address both aspects of the disorder.

This Viewpoint examines the assumptions made about pain in children with severe neurologic impairment.

A 4-year-old boy was brought by his father to the ophthalmology clinic with a 1-year history of enlarging white deposits in both eyes and decreased night vision. On examination, the conjunctivae of both the right eye (Panel A) and the

Additional effective antiviral agents are needed for the treatment and prevention of influenza virus infections. Two classes of agents, M2 ion-channel inhibitors and neuraminidase inhibitors, are widely available. However, circulating influenza viruses are now largely resistant to M2 ion-channel…

For many years, antiviral treatment of influenza has consisted of monotherapy with a neuraminidase inhibitor. The Food and Drug Administration (FDA) approved the neuraminidase inhibitors oseltamivir (oral administration) and zanamivir (oral inhalation) in 1999 and peramivir (intravenous…

Objective The epidemiology of violence against children is likely to differ substantially by sex and age of the victim and the perpetrator. Thus far, investment in effective prevention strategies has been hindered by lack of clarity in the burden of

Objective To compare the anthropometric measurements of newborns in a tertiary care hospital in Sri Lanka, with WHO standards. Methods Birth weight, length and occipitofrontal circumference (OFC) of 400 consecutive, term newborns of healthy mothers were measured in a tertiary

Objective To assess the contribution of the severity of bronchopulmonary dysplasia (BPD) and the time point of its diagnosis to the prediction of neurodevelopmental impairment (NDI) at corrected age of 2 years in preterm infants. Design Retrospective cohort study. Setting

Introduction Cyclists have a high mortality and morbidity per mile travelled compared with car occupants, a figure that is likely to increase if campaigns to increase active travel are successful. Concerns about safety is the leading factor limiting cycling for

Background Preterm birth causes long-term problems, even for infants born 1 or 2 weeks early. However, less is known about infants born after their due date and over a quarter of infants are born over 1 week late, and many

Type 1 diabetes, an autoimmune disease characterised by deficiency and resultant hyperglycaemia, is the second most common chronic disease of childhood. The associated complications are manifold, ranging from acute and potentially life-threatening events such as hypoglycaemia and ketoacidosis to chronic

The notion that an association exists between male reproductive disorders that manifest at birth (eg, cryptorchidism and hypospadias) and those that manifest in young adulthood (eg, testicular germ-cell cancer [TGCC] and reduced sperm count or fertility) might appear logical, but

The global burden of obesity is increasing in children and adolescents.1 The incidence of type 2 diabetes and its precursor, prediabetes, is burgeoning in this young population, particularly among some ethnic groups. Youth-onset type 2 diabetes is a more aggressive

Infantile spasms are characterised by runs of brief flexor or extensor spasms of the trunk and limbs with each spasm separated by several seconds. These epileptic seizures can vary in intensity, with some comprising a momentary subtle nod of the

The human papillomavirus (HPV) vaccine provides an extraordinary opportunity to mitigate the burden of HPV-related diseases, including cervical intraepithelial neoplasia (CIN) and cancer. However, the ideal vaccine schedule to maximise cervical cancer prevention continues to be debated and refined. In

This Viewpoint discusses the issue of tracking and storing data on nonverbal behavior that is collected through the use of virtual reality devices.

This Viewpoint describes a patient receiving gender-affirming hormonal therapy who chose to alter medication regimen after experiencing an identity shift.

This Viewpoint explains differences between attention-deficit/hyperactivity disorder symptoms and impairments and suggests that treatment approaches must address both aspects of the disorder.

This Viewpoint examines the assumptions made about pain in children with severe neurologic impairment.