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Articles			eLetters
	ARTICLES: Prevalence of Parent-Reported Diagnosis of Autism Spectrum Disorder Among Children in the US, 2007 Kogan et al. (1 November 2009) [Abstract] [Full text] [PDF]		Aluminium and Autism - finally in the same issue of Pediatrics Paul N Thomas   (17 November 2009) Read every eLetter to this article
	COMMENTARIES: Bilirubin Screening for Normal Newborns: A Critique of the Hour-Specific Bilirubin Nomogram Fay et al. (1 October 2009) [Full text] [PDF]		Evidence and Use of Hour-specific Bilirubin Nomogram Vinod K. Bhutani, et al.   (17 November 2009) Read every eLetter to this article

ARTICLES: Prevalence of Parent-Reported Diagnosis of Autism Spectrum Disorder Among Children in the US, 2007 Kogan et al. (1 November 2009) [Abstract] [Full text] [PDF] Prevalence of Parent-Reported Diagnosis of Autism Spectrum Disorder Among Children... Aluminium and Autism - finally in the same issue of Pediatrics 17 November 2009 Paul N Thomas, Pediatrician Integrative Pediatrics Send letter to journal: Re: Aluminium and Autism - finally in the same issue of Pediatrics Paulthomasmd{at}aol.com Paul N Thomas Autism was 1 - 2 per 10,000 in the early 1980's when I trained. We have seen the prevalence rise to 1:650 then 1:150 and now 1:91. When we got the mercury out of the vaccines in 2001 there was no change and in fact rates have continued to rise. Alas we moved the Hep B vaccine around that time from teens to newborns. Many Vaccines have a lot of aluminium (eg 330 micrograms in most DTaP's, 250 micrograms in the Hep B and Hep A etc.). The November issue has the article on Aluminium in preterm infants and later bone health. In this article there is mention of the FDA recommended limit of aluminium exposure to <5 micrograms/Kg per day. Clearly our Hep B vaccines in newborns exceed this exposure ten-fold or more. Is it not time we re-consider the routine Hep B vaccine to infants whose mothers are hep B - negative and or/immune and have no risk factors? Most babies in my practice are not sexually active or using IV drugs. The precuationary principle should be sufficient to prevent us from routinely injecting the known neurotoxin aluminium into every baby in this country. Conflict of Interest: None declared

COMMENTARIES: Bilirubin Screening for Normal Newborns: A Critique of the Hour-Specific Bilirubin Nomogram Fay et al. (1 October 2009) [Full text] [PDF] Bilirubin Screening for Normal Newborns: A Critique of the Hour-Specific Bilirubin... Evidence and Use of Hour-specific Bilirubin Nomogram 17 November 2009 Vinod K. Bhutani, Professor of Pediatrics Stanford University School of Medicine, Lois Johnson, Children's Hospital of Philadelphia Send letter to journal: Re: Evidence and Use of Hour-specific Bilirubin Nomogram bhutani{at}stanford.edu Vinod K. Bhutani, et al. The breakthrough and innovative contribution of predictive value of routine predischarge total serum bilirubin (TSB) measured at time of the universal metabolic screen is its use as an hour-specific (instead of day-specific) risk designation for developing post-discharge clinically significant hyperbilirubinemia (specifically: TSB levels ± 95th percentile for age in hours) during the first postnatal week rather than by dependence on visual assessment of jaundice [1]. Such levels of hyperbilirubinemia have been deemed significant and are generally considered to require close supervision, possible further evaluation, and sometimes intervention if brain damage is to be prevented without resort to exchange transfusion. Careful reading of this manuscript emphasizes that the risk designation does not predict kernicterus or the decision to use phototherapy. The designated risk zones guide post-discharge follow-up. In an attempt to anticipate risk of an errant experience for a newborn who unexpectedly develops significant hyperbilirubinemia, newborns who crosses percentile tracks required a closer supervision. As provided in legend of Table 3, the nomogram can be used at geographic sites with different prior probabilities of significant hyperbilirubinemia to calculate site-specific risk assessment. In independent studies, Stevenson et al have reported on the reliable performance of the nomogram in a large-scale multinational study [2]; Keren et al have addressed and argued against evidence of spectrum or verification biases in a re-analysis of the cohort from the population reported to construct the nomogram [3, 4]. Recently, Keren et al supported the predictive accuracy of alternative risk-assessment strategies used to screen for the risk of significant neonatal hyperbilirubinemia using transcutaneous measurements on the TSB nomogram [5]. The difficulties encountered by practitioners with “false negatives” in the low-risk zone (not designated as a “no-risk” zone) relate to the limitations of TcB measurements to substitute for TSB [6] and possibly due to tissue bilirubin dynamics; inappropriate use of bovine albumin serum during TSB assay [7] and its continued usage outside the US; poor calibrated performance of certain devices [8]. Thankfully, the College of American Pathologists has been diligent in ensuring a better inter- laboratory performance of TSB assay [9, 10]. Clearly, the answer is not to have sub-cohorts of predictive nomograms based on diet, race, gender, ethnicity, overt or covert hemolysis, altitude, geographical distance from the equator, season, assay or institution. Based on lessons learned and reported in our study and those to yet come, a better universal predictive bilirubin nomogram based on accurate TSB/TcB measurements would be welcome. References: 1. Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns Pediatrics. 1999;103:6-14. 2. Stevenson DK, Fanaroff AA, Maisels MJ, et al. Prediction of hyperbilirubinemia in near-term and term infants. Pediatrics. 2001; 108:31– 39 3. Keren R, Bhutani VK, Luan X, Nihtianova S, Cnaan A, Schwartz SJ. Identifying newborns at risk of significant hyperbilirubinemia. Arch Dis Child 90:415-21, 2005. 4. Keren R and Bhutani VK, Predischarge Risk Assessment for Severe Neonatal Hyperbilirubinemia. NeoReviews. 2007; 8(2): e68 5. Keren R, Luan X, Friedman S, Saddlemire S, Cnaan A, Bhutani VK. A comparison of alternative risk-assessment strategies for predicting significant neonatal hyperbilirubinemia in term and near-term infants. Pediatrics. 2008;121(1):e170-9. 6. Maisels MJ, Bhutani VK, Bogen D, Newman TB, Stark AR, Watchko JF. Hyperbilirubinemia in the newborn infant > or =35 weeks' gestation: an update with clarifications. Pediatrics. 2009;124(4):1193-8. 7. Lo SF, Doumas BT, Ashwood ER; College of American Pathologists. Bilirubin proficiency testing using specimens containing unconjugated bilirubin and human serum: results of a College of American Pathologists study. Arch Pathol Lab Med. 2004;128(11):1219-23 8. Lo SF, Jendrzejczak B, Doumas BT. Total or neonatal bilirubin assays in the Vitros 5,1 FS: hemoglobin interference, hemolysis, icterus index. Clin Chem. 2007;53(4):799-800 9. Lo SF, Jendrzejczak B, Doumas BT; College of American Pathologists. Laboratory performance in neonatal bilirubin testing using commutable specimens: a progress report on a College of American Pathologists study. Arch Pathol Lab Med. 2008;132(11):1781-5. 10. Lo SF, Kytzia HJ, Schumann G, Swartzentruber M, Vader HL, Weber F, Doumas BT. Interlaboratory comparison of the Doumas bilirubin reference method. Clin Biochem. 2009;42(12):1328-30. Conflict of Interest: None declared