infants

RPR Commentary: In infants 60 - 90 days old presenting the emergency room with a fever, the probability of serious invasive bacterial infection is apparently about 1%. James W. Mold, MD, MPH

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Abstract
Importance The prevalence of invasive bacterial infections (IBIs), specifically bacteremia and bacterial meningitis, is not well established among febrile infants in the third month of life. International guidelines exclude or vary in management recommendations for this age group.

Objective To assess the prevalence of IBIs among febrile infants aged 60 to 90 days.

Data Sources MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Scopus were searched with deliberate limitation to studies between January 1, 2000, to October 2, 2025, and analyzed in December 2025.

Study Selection Studies were included that reported on previously healthy, well-appearing febrile infants 60 to 90 days old evaluated in emergency department or outpatient settings and for whom patient-level IBI status could be ascertained.

Data Extraction and Synthesis Data were extracted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, and risk of bias was assessed using the Joanna Briggs Institute critical appraisal Checklist for Prevalence Studies. Pooled prevalences were calculated using random-effects generalized linear mixed models of logit-transformed single proportions of cases.

Main Outcomes and Measures The primary outcome was the prevalence of IBI. Secondary outcomes included the prevalence of bacteremia and bacterial meningitis separately.

Results The search yielded 13 130 records; 59 studies were included (20 distinct datasets of 34 835 infants). The pooled prevalence of IBI was 1.11% (95% CI, 0.84%-1.47%), bacteremia was 1.01% (95% CI, 0.76%-1.34%), and bacterial meningitis was 0.11% (95% CI, 0.08%-0.16%). Results were consistent across multiple sensitivity analyses excluding (1) retrospective cohorts; (2) cohorts of only infants with fever without source; (3) cohorts with shorter clinical follow-up of less than 7 days; and (4) the largest study (66% of all included patients).

Conclusions and Relevance In this systematic review and meta-analysis, the pooled prevalence of IBI among well-appearing febrile infants in the third month of life was 1.11%; bacteremia accounted for most cases, whereas bacterial meningitis was rare. These contemporary prevalence estimates should inform guideline development and shared parent and clinician decision-making for the management of these infants.

Author/s:

Dionisopoulos, Zachary, Sabhaney, Vikram, D'Arienzo, David

Prenatal Cannabis Use and Neonatal Outcomes A Systematic Review and Meta-Analysis

Hope Smashey — Tue, 08 Jul 2025 16:15:44 +0000

Date Added:

July 8, 2025

Journal/Publication:

JAMA Pediatrics

Publication Date:

May 5, 2025

Issue:

179

Volume:

URL:

Prenatal Cannabis Use and Neonatal Outcomes A Systematic Review and Meta-Analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamapediatrics.2025.0689

Keywords

PMID (1):

40323610

MeSH

Evidence-Based Medicine

Maternal marijuana use during pregnancy is bad for babies. James W. Mold, MD, MPH.

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Importance: Prenatal cannabis use continues to increase, and cannabis remains the most commonly used illegal substance in pregnancy. Accumulating evidence suggests potential adverse effects on fetal and neonatal outcomes following cannabis use in pregnancy.

Objective: To update a living systematic review and meta-analysis to provide a timely understanding regarding cannabis use in pregnancy and fetal and neonatal outcomes.

Data sources: The previous review was updated by searching bibliographic databases MEDLINE, CINAHL, PsycInfo, Global Health, and Evidence-Based Medicine Reviews Cochrane Database of Systematic Reviews from November 1, 2021, through April 4, 2024.

Study selection: Cohort or case-control studies comparing pregnancies with and without prenatal cannabis use on prespecified fetal or neonatal outcomes with adjustment for confounders, such as co-use of tobacco products, were included. Two independent reviewers screened studies, with disagreements resolved through discussion.

Data extraction and synthesis: Included studies were extracted by 1 reviewer and confirmed by a second. Risk of bias was assessed with the Newcastle-Ottawa Scale. Random-effects meta-analyses of unadjusted and adjusted odds ratios (ORs) were performed for all primary outcomes. Results were synthesized using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Main outcomes and measures: Primary outcomes were preterm birth (PTB; <37 weeks of gestation), small for gestational age (SGA), low birth weight (LBW; <2500 g), and perinatal mortality.

Results: For this update, 8 new studies with 1 709 998 participants were added, for a total of 51 studies synthesized (N = 21 146 938). From meta-analyses of adjusted effect sizes, moderate-certainty evidence indicated that cannabis use in pregnancy was associated with increased odds of LBW (20 studies; OR, 1.75; 95% CI, 1.41-2.18), PTB (20 studies; OR, 1.52; 95% CI, 1.26-1.83), and SGA (12 studies; OR, 1.57; 95% CI, 1.36-1.81), and low-certainty evidence indicated that it was associated with greater odds of perinatal mortality (6 studies; OR, 1.29; 95% CI, 1.07-1.55). Previously, the evidence was rated as very low or low certainty.

Conclusions and relevance: Cannabis use in pregnancy was associated with greater odds of PTB, SGA, and LBW even after adjusting for co-use of tobacco products, and confidence in these findings increased from low in the prior review to moderate in the current meta-analysis. The findings of this study may help inform patient counseling and future public health policies.

Author/s:

Jamie O Lo, Chelsea K Ayers, Snehapriya Yeddala, Beth Shaw, Shannon Robalino, Rachel Ward, Devan Kansagara

Age and Probability of Spontaneous Umbilical Hernia Closure

Erin Blanchette — Tue, 19 Mar 2024 17:51:29 +0000

Date Added:

March 19, 2024

Journal/Publication:

JAMA Pediatrics

Publisher:

American Medical Association

Publication Date:

March 11, 2024

URL:

Age and Probability of Spontaneous Umbilical Hernia Closure

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamapediatrics.2024.0087

Keywords

PMID (1):

38466296

MeSH

referral and consultation

A concise report on the probability of spontaneous umbilical hernia closure across ages 0 to 5 years. The figure is particularly helpful. James W. Mold, MD, MPH

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This cohort study of children younger than 6 years uses electronic health records to investigate whether a child’s age is associated with the probability of spontaneous umbilical hernia closure and to refine guidelines for surgical repair.

Author/s:

Katherine He, Dionne A Graham, Louis Vernacchio, Jonathan Hatoun, Laura Patane, Shannon L Cramm, Shawn J Rangel

Ankyloglossia (tongue tie) in infants

Rowan Hutchins — Sun, 15 Oct 2023 05:00:00 +0000

Date Added:

October 15, 2023

Journal/Publication:

CMAJ

Publisher:

CMA

Publication Date:

October 10, 2023

Issue:

Volume:

195

Pages:

E1349

URL:

Ankyloglossia (tongue tie) in infants

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.230151

Keywords

infants

Clinical Guideline

PMID (1):

37816524

MeSH

A concise review of the management of ankyloglossia (tongue tie) in infants. James W. Mold, MD, MPH

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The lingual frenulum is a tissue fold created by tongue elevation. In ankyloglossia, oral examination may reveal a short, tight frenulum that inserts either toward the tongue tip or onto the mandibular alveolus (the tooth-bearing surface of the lower jaw). Clinicians should evaluate range of motion of the infant’s tongue (elevation and protrusion) and breastfeeding, as the diagnosis is functional. The incidence of ankyloglossia is roughly 4%

Author/s:

Josdalyne Anderson, Pooja Prabhu, M. Elise Graham

Routine Childhood Vaccines Given in the First 11 Months After Birth

John Bayhi — Thu, 02 Jan 2020 20:22:28 +0000

Date Added:

January 2, 2020

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Elsevier Inc.

Publication Date:

December 23, 2019

URL:

Routine Childhood Vaccines Given in the First 11 Months After Birth

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.mayocp.2019.06.007

Keywords

vaccines

infants

immunizations

PMID (1):

31879133

MeSH

Haemophilus influenzae type b

Influenza

Human

Rotavirus

Strepococcus pneumoniae

Poliovirus

Advisory Committees

Vaccine-Preventable Diseases

This is a nice review from Mayo of the vaccines recommended for children under the age of one including rationale, effectiveness, and concerns.

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The US Advisory Committee on Immunization Practices recommends that infants beginning at birth receive several vaccines directed against a variety of infectious diseases that currently pose threats of morbidity and mortality to infants and those around them, including the 3-dose hepatitis B (HepB) series. The first dose is due at birth. This series protects against maternal-infant transmission of the HepB virus and against exposure the rest of the infant's life. At age 2 months infants are to receive not only their second dose of HepB vaccine but also a series of vaccines directed against diphtheria, tetanus, pertussis, pneumococcus, rotavirus, poliovirus, and Haemophilus influenzae type b. At 4 months, infants are to repeat those vaccines except for the HepB vaccine. At age 6 months infants are to finish the HepB series and receive the third doses of the other vaccines received at 2 and 4 months except for the rotavirus vaccine, depending on the brand used. Also, starting at 6 months, depending on the time of year, infants are to begin a 2-dose series against influenza separated by 28 days. Each of these vaccines is due at a time when the vaccine works to protect against an immediate risk and to provide long-term protection. These vaccine-preventable diseases vary in terms of the nature of exposure, the form of the morbidity, the risk of mortality, and the ability of routine vaccination to prevent or ameliorate harm.

Author/s:

Jacobson, RM

Randomized Controlled Trial of Iron-Fortified versus Low-Iron Infant Formula: Developmental Outcomes at 16 Years

Brian Desmarais — Mon, 19 Aug 2019 15:00:24 +0000

Date Added:

August 19, 2019

Journal/Publication:

Journal of Pediatrics

Publication Date:

June 25, 2019

URL:

Randomized Controlled Trial of Iron-Fortified versus Low-Iron Infant Formula: Developmental Outcomes at 16 Years

Type:

Clinical Research Results

Format:

Article

Keywords

MeSH

Anemia, Iron-Deficiency

infants

Perhaps we are overprescribing iron fortified formulas for infants without iron deficiency anemia. James W. Mold, MD, MPH

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OBJECTIVES:

To test differences in cognitive outcomes among adolescents randomly assigned previously as infants to iron-fortified formulaor low-iron formula as part of an iron deficiency anemia prevention trial.

STUDY DESIGN:

Infants were recruited from community clinics in low- to middle-income neighborhoods in Santiago, Chile. Entrance criteria included term, singleton infants; birth weight of ≥3.0 kg; and no major congenital anomalies, perinatal complications, phototherapy, hospitalization >5 days, chronic illness, or iron deficiency anemia at 6 months. Six-month-old infants were randomized to iron-fortified(12 mg/L) or low-iron (2.3 mg/L) formula for 6 months. At 16 years of age, cognitive ability, visual perceptual ability, visual memory, and achievement in math, vocabulary, and comprehension were assessed, using standardized measures. We compared differences in developmental test scores according to randomization group.

RESULTS:

At the follow-up assessment, the 405 participants averaged 16.2 years of age and 46% were male. Those randomized to iron-fortified formula had lower scores than those randomized to low-iron formula for visual memory, arithmetic achievement, and reading comprehension achievement. For visual motor integration, there was an interaction with baseline infancy hemoglobin, such that the iron-fortified group outperformed the low-iron group when 6-month hemoglobin was low and underperformed when 6-month hemoglobin was high.

CONCLUSIONS:

Adolescents who received iron-fortified formula as infants from 6 to 12 months of age at levels recommended in the US had poorer cognitive outcomes compared with those who received a low-iron formula. The prevention of iron deficiency anemia in infancy is important for brain development. However, the optimal level of iron supplementation in infancy is unclear.

TRIAL REGISTRATION:

Clinicaltrials.gov: NCT01166451.

Author/s:

Gahagan, S., Delker, E., Blanco, E., Burrows, R., Lozoff, B.