23.5.06

Should pacifiers be recommended to prevent sudden infant death syndrome?

Justito lo que concluíamos en Valencia

Pediatrics. 2006 May;117(5):1755-8.
Should pacifiers be recommended to prevent sudden infant death syndrome?
Mitchell EA, Blair PS, L'Hoir MP.

Department of Paediatrics, University of Auckland, Auckland, New Zealand. e.mitchell@auckland.ac.nz

OBJECTIVES: Our aim was to review the evidence for a reduction in the risk of sudden infant death syndrome (SIDS) with pacifier ("dummy" or "soother") use, to discuss possible mechanisms for the reduction in SIDS risk, and to review other possible health effects of pacifiers. RESULTS: There is a remarkably consistent reduction of SIDS with pacifier use. The mechanism by which pacifiers might reduce the risk of SIDS is unknown, but several mechanisms have been postulated. Pacifiers might reduce breastfeeding duration, but the studies are conflicting. CONCLUSIONS: It seems appropriate to stop discouraging the use of pacifiers. Whether it is appropriate to recommend pacifier use in infants is open to debate.

22.5.06

Screening for iron deficiency anemia - including iron supplementation for children and pregnant women.

Screening for iron deficiency anemia - including iron supplementation for children and pregnant women.

  • Screening Children and Pregnant Women for Iron Deficiency Anemia
    1. The USPSTF concludes that evidence is insufficient to recommend for or against routine screening for iron deficiency anemia in asymptomatic children aged 6 to 12 months. I recommendation
    2. The USPSTF recommends routine screening for iron deficiency anemia in asymptomatic pregnant women. B recommendation

The USPSTF was unable to determine the balance between the benefits and harms of routine screening for iron deficiency anemia in asymptomatic children aged 6 to 12 months. The USPSTF concludes that the benefits of routine screening for iron deficiency anemia in asymptomatic pregnant women outweigh the potential harms.

  • Iron Supplementation for Children and Pregnant Women
  1. The USPSTF recommends routine iron supplementation for asymptomatic children aged 6 to 12 months who are at increased risk for iron deficiency anemia (see Clinical Considerations below for a discussion of increased risk). B recommendation
  2. The USPSTF concludes that evidence is insufficient to recommend for or against routine iron supplementation for asymptomatic children aged 6 to 12 months who are at average risk for iron deficiency anemia. I recommendation
  3. The USPSTF concludes that evidence is insufficient to recommend for or against routine iron supplementation for non-anemic pregnant women. I recommendation

19.5.06

Reunión PAPPS Infancia
20-21 de Mayo de 2006
Sala de juntas del decanato
Facultad de Medicina
Avenida Blasco Ibáñez 15
46010 Valencia

Hypertension in Children and Adolescents

GREGORY B. LUMA, M.D., and ROSEANN T. SPIOTTA, M.D., Jamaica Hospital Medical CenterFamily Medicine Residency Program, New York, New York
The development of a national database on normative blood pressure levels throughout childhood has contributed to the recognition of elevated blood pressure in children and adolescents. The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make the detection of and intervention in childhood hypertension important to reduce long-term health risks; however, supporting data are lacking. Secondary hypertension is more common in preadolescent children, with most cases caused by renal disease. Primary or essential hypertension is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension. Evaluation involves a thorough history and physical examination, laboratory tests, and specialized studies. Management is multifaceted. Nonpharmacologic treatments include weight reduction, exercise, and dietary modifications. Recommendations for pharmacologic treatment are based on symptomatic hypertension, evidence of end-organ damage, stage 2 hypertension, stage 1 hypertension unresponsive to lifestyle modifications, and hypertension with diabetes mellitus. (Am Fam Physician 2006;73:1158-68. Copyright © 2006 American Academy of Family Physicians.)

2.5.06

Evaluation of a Learning Collaborative to Improve the Delivery of Preventive Services by Pediatric Practices.

Paul C. Young, MDa, Gordon B. Glade, MDa, Gregory J. Stoddard, MPHd and Chuck Norlin, MDa,
OBJECTIVE. Effective delivery of preventive services is an essential component of high-quality pediatric health care. However, both variation in and deviation from accepted guidelines have been reported. Learning collaboratives (LCs) have been shown to result in improvement in several aspects of pediatric care. The objective of this study was to determine whether pediatric practices that participated in a preventive services LC would improve their delivery of preventive services.
METHODS. After conducting an initial audit of the medical records of twenty 2-year-olds and twenty 4-year-olds for documentation of preventive services on the basis of national standards, practice teams attended a quality improvement workshop. They were presented with evidence to support the value of preventive services and the results of their audits and taught quality improvement methods, eg, rapid cycles of change. Each team developed plans to improve 1 or more services. Brief audits with feedback and monthly conference calls were used to support practices to conduct rapid cycles of change, to discuss barriers and solutions, and to monitor progress. The results of final chart audits of twenty 2-year-olds and 4-year-olds were compared with the initial chart audits. A Preventive Service Score (PSS) was assigned to each practice on the basis of the number of services provided, and initial to final comparisons were made.
RESULTS. Fourteen practices participated. PSSs improved for all practices after the LC. Mean PSS for 2-year-olds increased from 4.0 ± 1.1 to 4.9 ± 1.2 and for 4-year-olds increased from 3.8 ± 1.8 to 5.6 ± 1.9. The proportions of children who received 9 of the 10 individual preventive services also improved significantly.
CONCLUSION. LCs are a potentially effective method of improving the quality of care that is delivered by pediatric practices.