infant, newborn

In many countries clinical examination is the primary screening tool to identify dislocated hips in newborns, with a positive screening examination typically triggering an ultrasound assessment of the hips. However, the condition is rare and the examination can be difficult to perform. We explore the key components of the examination - symmetry of limb length, symmetry of abduction and consider the ’special tests’ of instability, known as the ‘Barlow’ and ‘Ortolani’ maneuvre. However, given the rarity of the disease, even in expert hands for every 1000 newborn hips screened with the clinical examination, relying on the Barlow and Ortolani maneuvres will identify 5 dislocations, result in 13 “unnecessary” ultrasound scans and 4 missed diagnoses. For every 1000 newborn hips screened with limited hip abduction, the system would identify 1 dislocation, result in 33 “unnecessary” ultrasound scans and 8 missed diagnoses per 1000 newborn hips.

What Is Perinatal Depression?

Erin Blanchette — Tue, 26 Mar 2024 16:36:41 +0000

Date Added:

March 26, 2024

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

March 14, 2024

URL:

What Is Perinatal Depression?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jama.2024.0434

Keywords

Depressive Disorders

Psychiatry and Behavioral Health

Patient Information

Reproductive Health

Pregnancy

Postpartum Depression

Perinatal Depression

PMID (1):

38483381

MeSH

Information for patients about perinatal depression. James W. Mold, MD, MPH

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Perinatal depression can occur during pregnancy and the first 12 months after childbirth.

Perinatal depression, also called postpartum depression, affects about 1 in 7 perinatal individuals. More than 75% of these individuals receive no treatment for perinatal depression. Onset of perinatal depression may occur prepregnancy or may develop over the course of pregnancy and the postpartum period. Untreated perinatal depression is associated with an increased risk of suicide and has additional negative effects on the perinatal individual, the fetus (preterm birth, low birth weight), and the child (impaired attachment, which may affect neurodevelopment) and may negatively affect relationships with partners and other family members.

Author/s:

Rebecca Voelker

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

Perinatal Depression: A Guide to Detection and Management in Primary Care

Linda Fowler — Fri, 19 Jan 2024 17:34:34 +0000

Date Added:

January 19, 2024

Journal/Publication:

Journal of the American Board of Family Medicine

Publication Date:

January 5, 2024

Issue:

Volume:

Pages:

1071-1086

URL:

Perinatal Depression: A Guide to Detection and Management in Primary Care

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.3122/jabfm.2023.230061R1

Keywords

breast feeding

Interpersonal Psychotherapy

Lactation

Postpartum

Postpartum Depression

Pregnancy

Psychiatry

Psychosocial Intervention

selective serotonin reuptake inhibitors

Surveys and Questionnaires

PMID (1):

37704392

MeSH

Depression / drug therapy

Sertraline / therapeutic use

Depressive Disorder, Major*

An evidence-based summary of the recognition and treatment of patients with peripartum depression. James W. Mold, MD, MPH

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Introduction: Existing guidelines for primary care clinicians (PCCs) on the detection and management of perinatal depression (PD) contain important gaps. This review aims to provide PCCs with a summary of clinically relevant evidence in the field.

Methods: A narrative literature review was conducted by searching PubMed and PsycINFO for articles published between 2010 to 2023. Guidelines, systematic reviews, clinical trials, and/or observational studies were all examined.

Results: Screening with the Edinburgh Postnatal Depression Scale or Patient Health Questionnaire-9 followed by a diagnostic evaluation for major depressive disorder in probable cases can enhance PD detection. At-risk individuals and mild to moderate PD should be referred for cognitive behavioral therapy or interpersonal psychotherapy when available. Selective serotonin reuptake inhibitors should be used for moderate to severe PD, with sertraline, escitalopram, or citalopram being preferred first. Using paroxetine or clomipramine in pregnancy, and fluoxetine or doxepin during lactation is generally not preferred. Gestational antidepressant use is associated with a small increase in risk of reduced gestational age at birth, low birth weight, and lower APGAR scores, though whether these links are causal is unclear. Sertraline and paroxetine have the lowest rate of adverse events during lactation. Consequences of untreated PD can include maternal and offspring mortality, perinatal complications, poor maternal-infant attachment, child morbidity and maltreatment, less breastfeeding, and offspring developmental problems.

Conclusions: These clinically relevant data can support the delivery of high-quality care by PCCs. Risks and benefits of PD treatments and the consequences of untreated PD should be discussed with patients to support informed decision making.

Author/s:

Manish H Dama, Ryan J Van Lieshout

Diagnosis and Treatment of Pulmonary Arterial Hypertension: A Review

Saige Blanchard — Thu, 14 Apr 2022 05:00:00 +0000

Date Added:

April 14, 2022

Journal/Publication:

Journal of the American Medical Association

Publisher:

American Medical Association

Publication Date:

April 12, 2022

Issue:

327

Volume:

Pages:

1379-1391

URL:

Diagnosis and Treatment of Pulmonary Arterial Hypertension: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2022.4402

Keywords

Pulmonary Arterial Hypertension

diagnosis

treatment

PAH

PMID (1):

35412560

MeSH

Humans

infant, newborn

Hypertension, Pulmonary

treprostinil

Epoprostenol

A review of the management of patients with pulmonary hypertension. James W. Mold, MD, MPH

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Importance: Pulmonary arterial hypertension (PAH) is a subtype of pulmonary hypertension (PH), characterized by pulmonary arterial remodeling. The prevalence of PAH is approximately 10.6 cases per 1 million adults in the US. Untreated, PAH progresses to right heart failure and death.

Observations: Pulmonary hypertension is defined by a mean pulmonary artery pressure greater than 20 mm Hg and is classified into 5 clinical groups based on etiology, pathophysiology, and treatment. Pulmonary arterial hypertension is 1 of the 5 groups of PH and is hemodynamically defined by right heart catheterization demonstrating a mean pulmonary artery pressure greater than 20 mm Hg, a pulmonary artery wedge pressure of 15 mm Hg or lower, and a pulmonary vascular resistance of 3 Wood units or greater. Pulmonary arterial hypertension is further divided into subgroups based on underlying etiology, consisting of idiopathic PAH, heritable PAH, drug- and toxin-associated PAH, pulmonary veno-occlusive disease, PAH in long-term responders to calcium channel blockers, and persistent PH of the newborn, as well as PAH associated with other medical conditions including connective tissue disease, HIV, and congenital heart disease. Early presenting symptoms are nonspecific and typically consist of dyspnea on exertion and fatigue. Currently approved therapy for PAH consists of drugs that enhance the nitric oxide-cyclic guanosine monophosphate biological pathway (sildenafil, tadalafil, or riociguat), prostacyclin pathway agonists (epoprostenol or treprostinil), and endothelin pathway antagonists (bosentan and ambrisentan). With these PAH-specific therapies, 5-year survival has improved from 34% in 1991 to more than 60% in 2015. Current treatment consists of combination drug therapy that targets more than 1 biological pathway, such as the nitric oxide-cyclic guanosine monophosphate and endothelin pathways (eg, ambrisentan and tadalafil), and has shown demonstrable improvement in morbidity and mortality compared with the previous conventional single-pathway targeted monotherapy.

Conclusions and relevance: Pulmonary arterial hypertension affects an estimated 10.6 per 1 million adults in the US and, without treatment, typically progresses to right heart failure and death. First-line therapy with drug combinations that target multiple biological pathways are associated with improved survival.

Author/s:

Ruopp, N. F., Cockrill, B. A.

The effect of high-dose vitamin D supplementation on serum vitamin D levels and milk calcium concentration in lactating women and their infants

Bethie Seay — Fri, 03 Sep 2021 05:00:00 +0000

Date Added:

September 3, 2021

Type:

Clinical Research Results

DOI (1):

10.1089/bfm.2006.1.27

PMID (1):

17661558

MeSH

Adult

Bone Density Conservation Agents

calcium

dietary supplements

Dose-Response Relationship

Infant Nutritional Physiological Phenomena

infant, newborn

Lactation

Maternal Nutritional Physiological Phenomena

Milk, Human

Nutritional Requirements

Nutritional Status

prospective studies

vitamin D

This study provides guidance on Vitamin D supplementation in lactating women and their babies.

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Objective: Improve vitamin D status in lactating women and their recipient infants, and measure breast milk calcium concentration [Ca] as a function of vitamin D regimen.

Design/methods: Fully breastfeeding mothers were randomized at 1 month postpartum to 2000 (n = 12) or 4000 (n = 13) IU/day vitamin D for 3 months to achieve optimal vitamin D status [serum 25(OH)D > or =32 ng/mL (80 nmol/L)]. Breast milk [Ca], maternal and infant serum 25(OH)D and serum Ca, and maternal urinary Ca/Cr ratio were measured monthly.

Results: Mothers were similar between groups for age, race, gestation, and birth weight. 25(OH)D increased from 1 to 4 months in both groups (mean +/- SD): +11.5 +/- 2.3 ng/mL for group 2000 (p = 0.002) and +14.4 +/- 3.0 ng/mL for group 4000 (p = 0.0008). The 4000 IU/day regimen was more effective in raising both maternal and infant serum levels and breast milk antirachitic activity than the 2000 IU/day regimen. Breast milk [Ca] fell with continued lactation through 4 months in the 2000 and 4000 IU groups. Decline in breast milk [Ca] was not associated with vitamin D dose (p = 0.73) or maternal 25(OH)D (p = 0.94). No mother or infant experienced vitamin D-related adverse events, and all laboratory parameters remained in the normal range.

Conclusion: High-dose vitamin D was effective in increasing 25(OH)D levels in fully breastfeeding mothers to optimal levels without evidence of toxicity. Breast milk [Ca] and its decline in both groups during 1 to 4 months were independent of maternal vitamin D status and regimen. Both the mother and her infant attained improved vitamin D status and maintained normal [Ca].

Author/s:

Basile, L. A., Taylor, S. N., Wagner, C. L., Horst, R. L., Hollis, B. W.

Screening for Gestational Diabetes: US Preventive Services Task Force Recommendation Statement

Saige Blanchard — Wed, 11 Aug 2021 05:00:00 +0000

Date Added:

August 11, 2021

Journal/Publication:

Journal of the American Medical Association

Publisher:

JAMA

Publication Date:

August 10, 2021

Issue:

Volume:

326

Pages:

531-538

URL:

Screening for Gestational Diabetes: US Preventive Services Task Force Recommendation Statement

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1001/jama.2021.11922

Keywords

Gestational Diabetes

US Preventative Task Force

Infancy

Pregnancy

Diagnostic Criteria

PMID (1):

34374716

MeSH

infant, newborn

female

Diabetes, Gestational

Fetal Macrosomia

Pre-Eclampsia

diabetes mellitus, type 2

Updated recommendation regarding screening for gestational diabetes from the USPSTF. James W. Mold, MD, MPH

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Importance: Gestational diabetes is diabetes that develops during pregnancy. Prevalence of gestational diabetes in the US has been estimated at 5.8% to 9.2%, based on traditional diagnostic criteria, although it may be higher if more inclusive criteria are used. Pregnant persons with gestational diabetes are at increased risk for maternal and fetal complications, including preeclampsia, fetal macrosomia (which can cause shoulder dystocia and birth injury), and neonatal hypoglycemia. Gestational diabetes has also been associated with an increased risk of several long-term health outcomes in pregnant persons and intermediate outcomes in their offspring.

Objective: The USPSTF commissioned a systematic review to evaluate the accuracy, benefits, and harms of screening for gestational diabetes and the benefits and harms of treatment for the pregnant person and infant.

Population: Pregnant persons who have not been previously diagnosed with type 1 or type 2 diabetes.

Evidence assessment: The USPSTF concludes with moderate certainty that there is a moderate net benefit to screening for gestational diabetes at 24 weeks of gestation or after to improve maternal and fetal outcomes. The USPSTF concludes that the evidence on screening for gestational diabetes before 24 weeks of gestation is insufficient, and the balance of benefits and harms of screening cannot be determined.

Recommendation: The USPSTF recommends screening for gestational diabetes in asymptomatic pregnant persons at 24 weeks of gestation or after. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for gestational diabetes in asymptomatic pregnant persons before 24 weeks of gestation. (I statement).

Author/s:

US Preventive Services Task Force, Davidson, K. W., Barry, M. J., Mangione, C. M., Cabana, M., Caughey, A. B., Davis, E. M., Donahue, K. E., Doubeni, C. A., Kubik, M., Li, L., Ogedegbe, G., Pbert, L., Silberstein, M., Stevermer, J., Tseng, C., Wong, J. B.

Glucocorticoids for croup in children

John Bayhi — Tue, 24 Sep 2019 22:49:32 +0000

Date Added:

September 24, 2019

Journal/Publication:

Cochrane Database of Systematic Reviews

Publisher:

The Cochrane Collaboration / John Wiley & Sons, Ltd.

Publication Date:

August 22, 2018

URL:

Glucocorticoids for croup in children

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1002/14651858.CD001955.pub4

Keywords

croup

children

randomized control trial

adolescent

PMID (1):

30133690

MeSH

Randomized Controlled Trials as Topic

Corticosteroids reduce symptoms of croup in children for at least 24 hours. The optimal dose and route have not been established. James W. Mold, MD, MPH

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BACKGROUND:

Glucocorticoids are commonly used for croup in children. This is an update of a Cochrane Review published in 1999 and previously updated in 2004 and 2011.

OBJECTIVES:

To examine the effects of glucocorticoids for the treatment of croup in children aged 0 to 18 years.

SEARCH METHODS:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, Issue 2, 2018), which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, Ovid MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Ovid MEDLINE (1946 to 3 April 2018), and Embase (Ovid) (1996 to 3 April 2018, week 14), and the trials registers ClinicalTrials.gov (3 April 2018) and the World Health Organization International Clinical Trials Registry Platform (ICTRP, 3 April 2018). We scanned the reference lists of relevant systematic reviews and of the included studies.

SELECTION CRITERIA:

We included randomised controlled trials (RCTs) that investigated children aged 0 to 18 years with croup and measured the effects of glucocorticoids, alone or in combination, compared to placebo or another pharmacologic treatment. The studies needed to report at least one of our primary or secondary outcomes: change in croup score; return visits, (re)admissions or both; length of stay; patient improvement; use of additional treatments; and adverse events.

DATA COLLECTION AND ANALYSIS:

One author extracted data from each study and another verified the extraction. We entered the data into Review Manager 5 for meta-analysis. Two review authors independently assessed risk of bias for each study using the Cochrane 'Risk of bias' tool and the certainty of the body of evidence for the primary outcomes using the GRADE approach.

MAIN RESULTS:

We added five new RCTs with 330 children. This review now includes 43 RCTs with a total of 4565 children. We assessed most (98%) studies as at high or unclear risk of bias. Compared to placebo, glucocorticoids improved symptoms of croup at two hours (standardised mean difference (SMD) -0.65, 95% confidence interval (CI) -1.13 to -0.18; 7 RCTs; 426 children; moderate-certainty evidence), and the effect lasted for at least 24 hours (SMD -0.86, 95% CI -1.40 to -0.31; 8 RCTs; 351 children; low-certainty evidence). Compared to placebo, glucocorticoids reduced the rate of return visits or (re)admissions or both (risk ratio 0.52, 95% CI 0.36 to 0.75; 10 RCTs; 1679 children; moderate-certainty evidence). Glucocorticoid treatment reduced the length of stay in hospital by about 15 hours (mean difference -14.90, 95% CI -23.58 to -6.22; 8 RCTs; 476 children). Serious adverse events were infrequent. Publication bias was not evident. Uncertainty remains with regard to the optimal type, dose, and mode of administration of glucocorticoids for reducing croup symptoms in children.

AUTHORS' CONCLUSIONS:

Glucocorticoids reduced symptoms of croup at two hours, shortened hospital stays, and reduced the rate of return visits to care. Our conclusions have changed, as the previous version of this review reported that glucocorticoids reduced symptoms of croup within six hours.

Author/s:

Gates, A, Gates, M, Vandermeer, B, Johnson, C, Hartling, L, Johnson, DW, Klassen, TP