Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial

Maternal Versus Infant Vitamin D Supplementation During Lactation: A Randomized Controlled Trial

Bruce W. Hollis, Carol L. Wagner, Cynthia R. Howard, Myla Ebeling, Judy R. Shary, Pamela G. Smith, Sarah N. Taylor, Kristen Morella, Ruth A. Lawrence, Thomas C. Hulsey.
PEDIATRICS Volume 136, number 4, October 2015


Compare effectiveness of maternal vitamin D3 supplementation with 6400 IU per day alone to maternal and infant supplementation with 400 IU per day.


Exclusively lactating women living in Charleston, SC, or Rochester, NY, at 4 to 6 weeks postpartum were randomized to either 400, 2400, or 6400 IU vitamin D3/day for 6 months.
Breastfeeding infants in 400 IU group received oral 400 IU vitamin D3/day; infants in 2400 and 6400 IU groups received 0 IU/day (placebo). Vitamin D de ficiency was defined as 25-hydroxy-vitamin D (25(OH)D) < 50 nmol/L.  2400 IU group ended in 2009 as greater infant deficiency occurred. Maternal serum vitamin D, 25(OH)D, calcium, and phosphorus concentrations and urinary calcium/creatinine ratios were measured at baseline then monthly, and infant blood parameters were measured at baseline and months 4 and 7.


Of the 334 mother-infant pairs in 400 IU and 6400 IU groups at enrollment, 216 (64.7%) were still breastfeeding at visit 1; 148 (44.3%) continued full breastfeeding to 4 months and 95 (28.4%) to 7 months. Vitamin D deficiency in breastfeeding infants was greatly affected by race. Compared with 400 IU vitamin D3 per day, 6400 IU/day safely and significantly increased maternal vitamin D and 25(OH)D from baseline (P < 0.0001). Compared with breastfeeding infant 25(OH)D in the 400 IU group receiving supplement, infants in the 6400 IU group whose mothers only received supplement did not differ.


Maternal vitamin D supplementation with 6400 IU/day safely supplies breast milk with adequate vitamin D to satisfy her nursing infant’s requirement and offers an alternate strategy to direct infant supplementation.



Screening Recommendations Referenced in Treatment Guidelines and Original Recommendation Sources

El 5 de junio de 2015, el CDC (Centro para el control de enfermedades, por sus siglas en inglés) publicó una revisión de las guías para el tratamiento de enfermedades de transmisión sexual (ETS).

El documento muestra las recomendaciones diagnósticas y las estrategias de prevención más adecuadas. Con esta publicación, se actualiza la última guía publicada en el año 2010. 
Resumen de recomendaciones ( Guía rápida de recomendaciones)


Systematic review of physical activity and exercise interventions on body mass indices, subsequent physical activity and psychological symptoms in overweight and obese adolescents.

Ruotsalainen H1Kyngäs H2,3Tammelin T4Kääriäinen M2.
 J Adv Nurs. 2015 May 29. doi: 10.1111/jan.12696. (Review) PMID: 26031309



To examine the effects of physical activity and exercise interventions on body mass index, subsequent physical activity and psychological symptoms for overweight and obese adolescents (12-18 years).


Overweight and obesity have increased among adolescents globally and physical activity has decreased. Healthcare systems face challenges promoting physical activity and in treating obesity. Promotion of physical activity must be effective and school nurses should be equipped with the information and resources required to implement counselling for overweight and obese adolescents.


A systematic review of randomized controlled trials was conducted according to procedures by the Centre for Reviews and Dissemination and the Joanna Briggs Institute.


Research studies published between 1950-2013 were identified from the following databases. CINAHL, MEDLINE (Ovid) and PsycINFO.


Selected studies were reviewed for quality and a risk-of-bias assessment was conducted for the included studies. A narrative synthesis was used to report results, while a fixed-effect meta-analysis was used to analyse the interventions effects on physical activity and body mass index.


Fourteen published studies were included to this review. Supervised exercise interventions most affected adolescents' body mass index. The interventions effect on adolescents' physical activity was small and heterogeneous. Two interventions positively affected psychological symptoms.


Interventions were complex, with more than one component and the aspect that effectively promotes physical activity in obese adolescents was not clear. However, it seems that exercise interventions affect the body mass index of overweight or obese adolescents. Interventions that include a component for promoting physical activity with or without supervised exercise can affect subsequent physical activity and body mass index.


Speech and Language Delay and Disorders in Children Age 5 and Younger: Screening.

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in children aged 5 years or younger.
To view the recommendation and the evidence on which it is based, please go to 

PopulationAsymptomatic children aged ≤5 years whose parents or clinicians do not have specific concerns about their speech, language, hearing, or development
RecommendationNo recommendation.
Grade: I statement (insufficient evidence)
Risk AssessmentRisk factors that have been reported to be associated with speech and language delay and disorders include male sex, family history of speech and language impairment, low parental education level, and perinatal risk factors (e.g., prematurity, low birth weight, and birth difficulties).
Screening TestsThe USPSTF found inadequate evidence on specific screening tests for use in primary care settings. Widely used screening tests in the United States include the Ages and Stages Questionnaire, the Language Development Survey, and the MacArthur-Bates Communicative Development Inventory.
Treatment and InterventionsInterventions for childhood speech and language disorders vary widely and can include speech-language therapy sessions and assistive technology (if indicated). Interventions are commonly individualized to each child's specific pattern of symptoms, needs, interests, personality, and learning style.
Balance of Benefits and HarmsThe current evidence is insufficient to assess the balance of benefits and harms of screening and interventions for speech and language delay and disorders in young children in primary care settings.
Other Relevant USPSTF RecommendationsThe USPSTF recommends screening for hearing loss in all newborn infants, and is developing a recommendation on screening for autism spectrum disorder in young children (available at www.uspreventiveservicestaskforce.org).


Primary prevention of childhood obesity, second edition.

Primary prevention of childhood obesity, second edition.

Registered Nurses' Association of Ontario (RNAO). Primary prevention of childhood obesity, second edition. Toronto (ON): Registered Nurses' Association of Ontario (RNAO); 2014 May. 140 p. [265 references]

Major Recommendations
The levels of evidence supporting the recommendations (Ia, Ib, IIa, IIb, III, IV) are defined at the end of the "Major Recommendations" field.
Practice Recommendations
Recommendation 1.1
Routinely assess children's nutrition, physical activity, sedentary behaviour, and growth according to established guidelines, beginning as early as possible in a child's lifespan.
(Level of Evidence = IV)
Recommendation 1.2
Assess the family environment for factors (e.g., parenting/primary caregiver influences and socio-cultural factors) that may increase children's risk of obesity.
(Level of Evidence = IV)
Recommendation 1.3
Collaborate with school leaders to assess elementary-school environments for risk and protective conditions that influence childhood obesity, including:
  • Student demographics
  • School policies
  • Food and physical activity environments
(Level of Evidence = IV)
Recommendation 1.4
Assess neighbourhoods for community-level risk and protective conditions that influence childhood obesity.
(Level of Evidence = IV)
Recommendation 2.1
Engage community stakeholders when planning primary-prevention interventions for childhood obesity.
(Level of Evidence = IIb)
Recommendation 2.2
Develop interventions that are:
  • Universally applied, as early as possible (Level of Evidence = IV)
  • Targeted toward multiple behaviours (Level of Evidence = IV)
  • Implemented using multiple approaches (Level of Evidence = IIa)
  • Inclusive of parents/primary caregivers and the family (Level of Evidence = IIa), and
  • Implemented simultaneously in multiple settings (Level of Evidence = IIa)
Recommendation 3.1
Support exclusive breastfeeding for the first six months of life followed by breastfeeding and complementary feeding up to two years of age or beyond.
(Level of Evidence = III)
Recommendation 3.2
Provide education and social support to help parents/primary caregivers to promote healthy eating and physical activity in infants and toddlers.
(Level of Evidence = Ib)
Recommendation 3.3
Collaborate with parents/primary caregivers, educators and support staff (e.g., teachers, child care providers, school leaders) to promote healthy eating and physical activity in all settings where preschool children gather.
(Level of Evidence = Ib)
Recommendation 3.4
Collaborate with school communities to promote regular physical activity among elementary-school children.
(Level of Evidence = IIb)
Recommendation 3.5
Facilitate and support the integration of health and nutrition education into elementary-school programs and support the improvement of the school food environment.
(Level of Evidence = IIa–III)
Recommendation 4.1
Monitor and evaluate the effectiveness of the family's approach to healthy eating and physical activity.
(Level of Evidence = IV)
Recommendation 4.2
Evaluate the effectiveness and sustainability of school- and community-based primary-prevention initiatives.
(Level of Evidence = IV)
Recommendation 4.3
Advocate and support the evaluation of an organization's compliance with healthy public policies, and the impact of such policies on childhood eating behaviours and physical activity.
(Level of Evidence = III)
Education Recommendations
Recommendation 5.1
Incorporate foundational primary-prevention curricula based on this Guideline into the undergraduate education of nurses and other health-care providers.
(Level of Evidence = IV)
Recommendation 5.2
Health-care professionals should participate in continuing education to enhance their ability to support the positive behavioural and environmental changes for children, families, and communities recommended in this Guideline.
(Level of Evidence = IV)


Screening and routine supplementation for iron deficiency anemia: a systematic review.

Pediatrics. 2015 Apr;135(4):723-33.
McDonagh MS, Blazina I, Dana T, Cantor A, Bougatsos C.


Supplementation and screening for iron-deficiency anemia (IDA) in young children may improve growth and development outcomes. The goal of this study was to review the evidence regarding the benefits and harms of screening and routine supplementation for IDA for the US Preventive Services Task Force.


We searched Medline and Cochrane databases (1996-August 2014), as well as reference lists of relevant systematic reviews. We included trials and controlled observational studies regarding the effectiveness and harms of routine iron supplementation and screening in children ages 6 to 24 months conducted in developed countries. One author extracted data, which were checked for accuracy by a second author. Dual quality assessment was performed.


No studies of iron supplementation in young children reported on the diagnosis of neurodevelopmental delay. Five of 6 trials sparsely reporting various growth outcomes found no clear benefit of supplementation. After 3 to 12 months, Bayley Scales of Infant Development scores were not significantly different in 2 trials. Ten trials assessing iron supplementation in children reported inconsistent findings for hematologic measures. Evidence regarding the harms of supplementation was limited but did not indicate significant differences. No studies assessed the benefits or harms of screening or the association between improvement in impaired iron status and clinical outcomes. Studies may have been underpowered, and control factors varied and could have confounded results.


Although some evidence on supplementation for IDA in young children indicates improvements in hematologic values, evidence on clinical outcomes is lacking. No randomized controlled screening studies are available.


The Evaluation of Suspected Child Physical Abuse

The Evaluation of Suspected Child Physical Abuse

PEDIATRICS Volume 135, number 5, May 2015

The American Academy of Pediatrics (AAP) has updated its child physical abuse guideline to include new information on the lasting effects of abuse and on how pediatricians can protect children. The guideline highlights risk factors for abuse and abusive injuries that are frequently overlooked.
Child physical abuse is an important cause of pediatric morbidity and abstract mortality and is associated with major physical and mental health problems that can extend into adulthood. Pediatricians are in a unique position to identify and prevent child abuse, and this clinical report provides guidance to the practitioner regarding indicators and evaluation of suspected physical abuse of children. The role of the physician may include identifying abused children with suspicious injuries who present for care, reporting suspected abuse to the child protection agency for investigation, supporting families who are affected by child abuse, coordinating with other professionals and community agencies to provide immediate and long-term treatment to victimized children, providing court testimony when necessary, providing preventive care and anticipatory guidance in the office, and advocating for policies and programs that support families and protect vulnerable children