This report provides a practical guide and algorithm for the screening and subsequent management of neonatal hypoglycemia. Current evidence does not support a specific concentration of glucose that can discriminate normal from abnormal or can potentially result in acute or chronic irreversible neurologic damage. Early identification of the at-risk infant and institution of prophylactic measures to prevent neonatal hypoglycemia are recommended as a pragmatic approach de-spite the absence of a consistent definition of hypoglycemia in the literature. Pediatrics 2011;127:575–579 use of regulatory mechanisms.

"Kangaroo mother care" was first described as an alternative method of caring for low birth weight infants in resource-limited countries, where neonatal mortality and infection rates are high because of overcrowded nurseries, inadequate staffing, and lack of equipment. Intermittent skin-to-skin care (SSC), a modified version of kangaroo mother care, is now being offered in resource-rich countries to infants needing neonatal intensive care, including those who require ventilator support or are extremely premature. SSC significantly improves milk production by the mother and is associated with a longer duration of breastfeeding. Increased parent satisfaction, better sleep organization, a longer duration of quiet sleep, and decreased pain perception during procedures have also been reported in association with SSC. Despite apparent physiologic stability during SSC, it is prudent that infants in the NICU have continuous cardiovascular monitoring and that care be taken to verify correct head positioning for airway patency as well as the stability of the endotracheal tube, arterial and venous access devices, and other life support equipment.

Immersion in water has been suggested as a beneficial alternative for labor, delivery, or both and over the past decades has gained popularity in many parts of the world. Immersion in water during the first stage of labor may be associated with decreased pain or use of anesthesia and decreased duration of labor. However, there is no evidence that immersion in water during the first stage of labor otherwise improves perinatal outcomes, and it should not prevent or inhibit other elements of care. The safety and efficacy of immersion in water during the second stage of labor have not been established, and immersion in water during the second stage of labor has not been associated with maternal or fetal benefit. Given these facts and case reports of rare but serious adverse effects in the newborn, the practice of immersion in the second stage of labor (underwater delivery) should be considered an experimental procedure that only should be performed within the context of an appropriately designed clinical trial with informed consent. Facilities that plan to offer immersion in the first stage of labor need to establish rigorous protocols for candidate selection, maintenance and cleaning of tubs and immersion pools, infection control procedures, monitoring of mothers and fetuses at appropriate intervals while immersed, and immediately and safely moving women out of the tubs if maternal or fetal concerns develop.

Palivizumab was licensed in June 1998 by the Food and Drug Administration for the reduction of serious lower respiratory tract infection caused by respiratory syncytial virus (RSV) in children at increased risk of severe disease. Since that time, the American Academy of Pediatrics has updated its guidance for the use of palivizumab 4 times as additional data became available to provide a better understanding of infants and young children at greatest risk of hospitalization attributable to RSV infection. The updated recommendations in this policy statement reflect new information regarding the seasonality of RSV circulation, palivizumab pharmacokinetics, the changing incidence of bronchiolitis hospitalizations, the effect of gestational age and other risk factors on RSV hospitalization rates, the mortality of children hospitalized with RSV infection, the effect of prophylaxis on wheezing, and palivizumab-resistant RSV isolates. This policy statement updates and replaces the recommendations found in the 2012 Red Book.

This guideline is a revision of the clinical practice guideline, “Diagnosis and Management of Bronchiolitis,” published by the American Academy of Pediatrics in 2006. The guideline applies to children from 1 through 23 months of age. Other exclusions are noted. Each key action statement indicates level of evidence, benefit-harm relationship, and level of recommendation. Key action statements are as follows:

Health care–associated infections in the NICU result in increased morbidity and mortality, prolonged lengths of stay, and increased medical costs. Neonates are at high risk of acquiring health care– associated infections because of impaired host-defense mechanisms, limited amounts of protective endogenous flora on skin and mucosal surfaces at time of birth, reduced barrier function of their skin, use of invasive procedures and devices, and frequent exposure to broadspectrum antibiotic agents. This clinical report reviews management and prevention of health care–associated infections in newborn infants. Pediatrics 2012;129:e1085–e1093

Inguinal hernia repair in infants is a routine surgical procedure. However, numerous issues, including timing of the repair, the need to explore the contralateral groin, use of laparoscopy, and anesthetic approach, remain unsettled. Given the lack of compelling data, consideration should be given to large, prospective, randomized controlled trials to determine best practices for the management of inguinal hernias in infants.

Provision of risk-appropriate care for newborn infants and mothers was first proposed in 1976. This updated policy statement provides a review of data supporting evidence for a tiered provision of care and reaffirms the need for uniform, nationally applicable definitions and consistent standards of service for public health to improve neonatal outcomes. Facilities that provide hospital care for newborn infants should be classified on the basis of functional capabilities, and these facilities should be organized within a regionalized system of perinatal care.

The Centers for Disease Control and Prevention (CDC) guidelines for the prevention of perinatal group B streptococcal (GBS) disease were initially published in 1996. The American Academy of Pediatrics (AAP) also published a policy statement on this topic in 1997. In 2002, the CDC published revised guidelines that recommended universal antenatal GBS screening; the AAP endorsed these guidelines and published recommendations based on them in the 2003 Red Book. Since then, the incidence of early-onset GBS disease in neonates has decreased by an estimated 80%. However, in 2010, GBS disease remained the leading cause of early-onset neonatal sepsis. The CDC issued revised guidelines in 2010 based on evaluation of data generated after 2002. These revised and comprehensive guidelines, which have been endorsed by the AAP, reaffirm the major prevention strategy--universal antenatal GBS screening and intrapartum antibiotic prophylaxis for culture-positive and high-risk women--and include new recommendations for laboratory methods for identification of GBS colonization during pregnancy, algorithms for screening and intrapartum prophylaxis for women with preterm labor and premature rupture of membranes, updated prophylaxis recommendations for women with a penicillin allergy, and a revised algorithm for the care of newborn infants. The purpose of this policy statement is to review and discuss the differences between the 2002 and 2010 CDC guidelines that are most relevant for the practice of pediatrics.

The hospital stay of the mother and her healthy term newborn infant should be long enough to allow identification of early problems and to ensure that the family is able and prepared to care for the infant at home. The length of stay should also accommodate the unique characteristics of each mother-infant dyad, including the health of the mother, the health and stability of the infant, the ability and confidence of the mother to care for her infant, the adequacy of support systems at home, and access to appropriate follow-up care. Input from the mother and her obstetrician should be considered before a decision to discharge a newborn is made, and all efforts should be made to keep mothers and infants together to promote simultaneous discharge. Pediatrics 2010; 125:405-409

Objective: To determine longitudinal outcomes and contributors to parental stress and coping in mothers of very low-birth-weight (VLBW) children.Design: Prospective cohort follow-up of high-risk VLBW children (n=113), low-risk VLBW children (n=80), and term children (n=122) and their mothers from birth to 14 years.Setting: Recruitment from level III neonatal intensive care and term nurseries in a large Midwestern region with follow-up at an academic medical center.Participants: A total of 315 mother-infant dyads enrolled from November 8, 1989, to February 22, 1992.Main Exposures: High-risk VLBW infants had bronchopulmonary dysplasia. Comparison groups were demographically similar low-risk VLBW children (without bronchopulmonary dysplasia) and term children.Main Outcome Measures: Child IQ and self-report measures of parenting stress, family impact, maternal coping, education, and social support.Results: After VLBW birth, mothers attained fewer additional years of education than term mothers (P=.04). Mothers of high-risk VLBW children felt more personal stress (P=.006) and family stress (P=.009) under conditions of low social support and had greater child-related stress than term mothers; however, they also expressed the highest levels of parenting satisfaction at 14 years. They became less likely to use denial (P=.02) and mental disengagement (P=.03) as coping mechanisms over time. Except for education attainment, mothers of low-risk VLBW infants did not differ from mothers of term children and at 14 years reported the lowest stress.Conclusions: Parenting a VLBW child had both positive and negative outcomes, dependent on child medical risk, child IQ, social support, and maternal coping mechanisms, suggesting that mothers experience post-traumatic growth and resilience after significant distress post partum.

The purpose of this revised statement is to review current information on the use of postnatal glucocorticoids to prevent or treat bronchopulmonary dysplasia in the preterm infant and to make updated recommendations regarding their use. High-dose dexamethasone (0.5 mg/kg per day) does not seem to confer additional therapeutic benefit over lower doses and is not recommended. Evidence is insufficient to make a recommendation regarding other glucocorticoid doses and preparations. The clinician must use clinical judgment when attempting to balance the potential adverse effects of glucocorticoid treatment with those of bronchopulmonary dysplasia.

OBJECTIVE:To investigate the relationship between the severity-based definition of bronchopulmonary dysplasia (BPD), choice of treatment, and neurocognitive outcomes at age 3 and 8 years.DESIGN:This is a secondary analysis of data collected from a prospective, longitudinal sample of 99 children with a history of BPD.SETTING:Children born with BPD admitted to 3 hospitals from February 1, 1989, to November 31, 1991.PARTICIPANTS:Ninety-nine children with BPD were longitudinally assessed at age 3 and 8 years. Three severity groups (mild, moderate, and severe) were formed based on gestational age and need for supplemental oxygen therapy.MAIN EXPOSURES:Supplemental oxygen therapy for 28 days or longer, birth weight less than 1500 g, and radiographic evidence of lung disease.MAIN OUTCOME MEASURES:Neurologic and medical outcomes; type of medical management; and language, achievement, and cognitive functioning were compared among the 3 severity groups.RESULTS:Severity classification of BPD was associated with poorer outcomes. Compared with children with mild or moderate BPD, children with severe BPD performed more poorly on IQ tests (Mental Development Index, 90 vs 76.4; and Psychomotor Development Index, 92.5 vs 73.9) and language measures (total, 95 vs 82) at age 3 years and performance IQ (86 vs 75) and perceptual organization (86 vs 76) at age 8 years. Severity of BPD was not associated with choice of medical management but was related to educational interventions. Children with severe BPD received more special education services (69% vs 44%) than did children with mild BPD.CONCLUSIONS:The severity-based classification clarifies the relationship between BPD and developmental sequelae. Children with severe BPD required more interventions at age 8 years than did children with mild or moderate BPD.

American Journal of Medical Genetics Part AVolume 143A, Issue 17 p. 2070-2074 Research Letter A longitudinal case study of a child with mosaic trisomy 22: Language, cognitive, behavioral, physical, and dental outcomes† Barbara Lewis, Corresponding Author Barbara Lewis bxl@case.edu Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OhioBehavioral Pediatrics and Psychology 6038, Rainbow Babies and Children's Hospital, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106-6038.Search for more papers by this authorSarah Fulton, Sarah Fulton Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OhioSearch for more papers by this authorElizabeth Short, Elizabeth Short College of Arts and Sciences, Department of Psychology, Case Western Reserve University, Cleveland, OhioSearch for more papers by this authorSuchitra Nelson, Suchitra Nelson Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, OhioSearch for more papers by this authorGiuseppina Lombardi, Giuseppina Lombardi Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, OhioSearch for more papers by this authorDaniel Rosenbaum, Daniel Rosenbaum Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OhioSearch for more papers by this authorCarolyn Kercsmar, Carolyn Kercsmar Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OhioSearch for more papers by this authorJill Baley, Jill Baley Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OhioSearch for more papers by this authorLynn T. Singer, Lynn T. Singer Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio College of Arts and Sciences, Department of Psychology, Case Western Reserve University, Cleveland, Ohio Department of General Medical Sciences, School of Medicine, Case Western Reserve University, Cleveland, OhioSearch for more papers by this author Barbara Lewis, Corresponding Author Barbara Lewis bxl@case.edu Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OhioBehavioral Pediatrics and Psychology 6038, Rainbow Babies and Children's Hospital, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106-6038.Search for more papers by this authorSarah Fulton, Sarah Fulton Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OhioSearch for more papers by this authorElizabeth Short, Elizabeth Short College of Arts and Sciences, Department of Psychology, Case Western Reserve University, Cleveland, OhioSearch for more papers by this authorSuchitra Nelson, Suchitra Nelson Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, OhioSearch for more papers by this authorGiuseppina Lombardi, Giuseppina Lombardi Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, OhioSearch for more papers by this authorDaniel Rosenbaum, Daniel Rosenbaum Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OhioSearch for more papers by this authorCarolyn Kercsmar, Carolyn Kercsmar Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OhioSearch for more papers by this authorJill Baley, Jill Baley Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, OhioSearch for more papers by this authorLynn T. Singer, Lynn T. Singer Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio College of Arts and Sciences, Department of Psychology, Case Western Reserve University, Cleveland, Ohio Department of General Medical Sciences, School of Medicine, Case Western Reserve University, Cleveland, OhioSearch for more papers by this author First published: 30 July 2007 https://doi.org/10.1002/ajmg.a.31866Citations: 5 † How to cite this article: Lewis B, Fulton S, Short E, Nelson S, Lombardi G, Rosenbaum D, Kercsmar C, Baley J, Singer LT. 2007. A longitudinal case study of a child with mosaic trisomy 22: Language, cognitive, behavioral, physical, and dental outcomes. Am J Med Genet Part A 143A:2070–2074. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume143A, Issue171 September 2007Pages 2070-2074 RelatedInformation

Objective To compare severity and determinants of stress and coping in nil of 8-year-old very low birth weight (VLBW) and term children varying in medical and developmental risk.Study design Three groups of mothers/infants were prospectively compared in a longitudinal study from birth to 8 years (110 high-risk VLBW, 80 low-risk VLBW, and 112 term). Maternal psychological distress, coping, parenting/marital stress, child health, and family impact were measured in the children at age 8 years.Results Mothers of VLBW children differed from term mothers, reporting less consensus with partners, more concern for their children's health, less parent-child conflict, and fewer years of education attained. Mothers of high-risk VI BW children experienced the greatest family and personal strains and used less denial and disengagement coping. The groups exhibited no differences in the,sense of parenting competence, divorce rate, parenting/matital satisfaction, family cohesion, and psychological distress symptoms. Multiple birth, low socioeconomic status, and lower child IQ added to maternal stress.Conclusions VLBW birth has long-term negative and positive impacts on maternal/family outcomes related to the infant's medical risk.

OBJECTIVE:This study sought to increase understanding of relations among coping strategies, sociodemographic variables, and psychological distress in mothers of high-risk (HR) and low-risk (LR) very low birth weight (VLBW; < 1,500g) infants.DESIGN:The sample (N = 199) consisted of 77 mothers of HR VLBW infants, 43 mothers of LR VLBW infants, and a control group of 79 mothers of healthy, term infants. Data were collected with self-report questionnaires at birth and at 24 months postpartum. Relations among infant medical risk, multiple birth, maternal race, social class, and maternal coping were investigated. Hierarchical regression analyses were used to identify predictors of maternal psychological distress and to determine whether coping differentially moderated maternal psychological distress across groups.RESULTS:Infant medical risk, social support, and maternal coping independently predicted maternal psychological distress. Mothers of HR VLBW infants reported significantly greater psychological distress than mothers of LR VLBW or term infants. Greater use of avoidant and express emotions coping predicted higher psychological distress for all mothers. Greater use of humor coping had a buffering effect, reducing distress only for mothers of HRVLBW infants. Maternal coping scores were related to maternal race and social class, rather than to severity of infant medical risk.CONCLUSIONS:Sociocultural sources of resiliency, as well as biological risk factors, should be considered when developing strategies to enhance coping and parenting in HR populations.

There is little information detailing how families adapt to the experience of VLBW birth and subsequent caregiving demands. Mothers of high risk (HR) VLBW infants with BPD (n = 122), low risk (LR) VLBW infants without BPD (n = 84), and term (T) infants were folowed longitudinally from birth at 8, 12, 24, and 36 months (corrected ages). At each visit standardized normative measures of child development (Bayley Scales), maternal psychological distress (Brief Symptom Inventory), parenting stress (Parenting Stress Index), and (at 2 and 3 years) family impact (Impact on Family Scale) were given to assess the relationship of high/low risk VLBW birth on maternal and family stress. Groups did not differ in sex, race, socioeconomic status, or age. Group differences over time were assessed using repeated measures MANOVAS, with significant group and time (all F's 3.5, p's <.05) effects found on all outcomes. Maternal psychological symptoms were elevated for both HR and LR groups neonatally but by 2 and 3 years, LR mothers had the lowest levels of symptoms, while HR mothers reported greater distress. Parenting stress did not differ until 3 years when HR mothers reported greater stress related to child characteristics. After the neonatal period, LR mothers did not differ from T mothers on any measure except for financial stress at 2 years, while HR mothers reported higher stress in family impact domains. Severity of maternal mental health symptoms was inversely related to child developmental outcome at all ages for HR mothers. These findings indicate that the psychosocial impact of VLBW birth varies with the medical risk, developmental outcome, and age of the infant.

A randomized multicenter study compared the routine hepatitis B vaccine schedule of 0, 1, 6 months with an accelerated schedule of 0, 1, 2 months in newborns. Two hundred ninety-nine infants whose mothers were seronegative for hepatitis B were enrolled in the study and randomized to either the routine or accelerated schedule. All infants had blood drawn for antibody titers to hepatitis B at 2, 3, 6 and 7 months of age. For 222 infants data were evaluable, at least for safety; 193 of these 22 had antibody titers that were evaluable. The infants vaccinated on the accelerated schedule developed seroprotective concentrations of antibody more quickly than the infants vaccinated on the routine schedule; 92.6% vs. 66.1% had seroprotective concentrations (> or = 10 mIU/ml) at 3 months of age (P < 0.001). However, infants in the accelerated schedule had lower geometric mean antibody titers at 7 months, 420.0 vs. 3141.8. We conclude that the accelerated vaccination schedule resulted in the more rapid development of seroprotective concentrations of antibody, but levels of antibodies were not as high as in the routinely vaccinated infants at 7 months. These data suggest that an accelerated vaccine schedule can be used in the newborn period. The effectiveness of the accelerated schedule in preventing perinatal infections compared to the standard schedule and the necessity for booster doses of vaccine remain to be studied.