PEDIATRICS SPECIAL ARTICLES http://pediatrics.aappublications.org PEDIATRICS RSS feed -- recent SPECIAL ARTICLES articles 1098-4275 PEDIATRICS 0031-4005 PEDIATRICS http://pediatrics.aappublications.org/icons/banner/title.gif http://pediatrics.aappublications.org <![CDATA[The Health and Obesity: Prevention and Education (HOPE) Curriculum Project--Curriculum Development]]> http://pediatrics.aappublications.org/cgi/content/abstract/124/5/1438?rss=1 The Health and Obesity: Prevention and Education (HOPE) project is a multidisciplinary, healthy living counseling curriculum to educate pediatric clinicians in training on how to recognize children who are at risk for obesity and its comorbidities and how to promote healthy weight among children and their families. Curriculum topics were selected by experts of nutrition, medicine, dentistry, behavioral counseling, and education and incorporate the recent 2007 Expert Committee recommendations regarding the prevention, assessment, and treatment of childhood and adolescent obesity. The HOPE curriculum instructs medical and dental clinicians on the health consequences of childhood obesity and screening techniques to identify children and families at risk, reviews the current evidence for health intervention recommendations, and teaches trainees regarding the theoretical rationale and art of constructive and culturally sensitive weight counseling for behavioral change. Although designed and tailored specifically for and currently available medical and dental trainees, the HOPE curriculum is Web-based and will also be made available to currently practicing clinicians across the United States beginning in winter 2009. This educational tool, grounded in understanding of relevant sciences, literature, and research methods, provides clinicians with the skills necessary to identify and counsel patients who are at risk to promote healthy weight among youth. This article discusses the approach and methods used for curriculum development. Future publications will discuss HOPE project implementation and outcomes.

]]> Mon, 26 Oct 2009 04:02:04 PDT info:doi/10.1542/peds.2009-0009 American Academy of Pediatrics 5 124 1446 2009-11-01 1438 SPECIAL ARTICLES <![CDATA[Consensus Statement on Diagnostic Criteria for PHACE Syndrome]]> http://pediatrics.aappublications.org/cgi/content/abstract/124/5/1447?rss=1 OBJECTIVES: A subgroup of patients with infantile hemangiomas have associated structural anomalies of the brain, cerebral vasculature, eyes, sternum, and/or aorta in the neurocutaneous disorder known as PHACE syndrome. The diagnosis has been broadly inclusive by using a case definition of a facial hemangioma plus ≥1 extracutaneous features, leading to numerous reports of potential associated disease features, many of uncertain significance. This consensus statement was thus developed to establish diagnostic criteria for PHACE syndrome.

METHODS: A multidisciplinary group of specialists with expertise in PHACE syndrome drafted initial diagnostic criteria on the basis of review of published, peer-reviewed medical literature and clinical experience. The group then convened in both executive and general sessions during the PHACE Syndrome Research Conference held in November 2008 for discussion and used a consensus method. All conflicting recommendations were subsequently reconciled via electronic communication and teleconferencing.

RESULTS: These criteria were stratified into 2 categories: (1) PHACE syndrome or (2) possible PHACE syndrome. Major and minor criteria were determined for the following organ systems: cerebrovascular, structural brain, cardiovascular, ocular, and ventral/midline. Definite PHACE requires the presence of a characteristic segmental hemangioma or hemangioma >5 cm on the face or scalp plus 1 major criterion or 2 minor criteria. Possible PHACE requires the presence of a hemangioma >5 cm on the face or scalp plus 1 minor criterion. The group recognized that it may be possible to have PHACE syndrome with a hemangioma affecting the neck, chest, or arm only or no cutaneous hemangioma at all. In such cases, fulfillment of additional required criteria would also lead to a possible PHACE diagnosis.

CONCLUSIONS: These criteria represent current knowledge and are expected to enhance future assessments of PHACE syndrome. It is understood that modifications are to be expected over time to incorporate new research findings.

]]> Mon, 26 Oct 2009 04:02:04 PDT info:doi/10.1542/peds.2009-0082 American Academy of Pediatrics 5 124 1456 2009-11-01 1447 SPECIAL ARTICLES <![CDATA[Recommendations for Screening, Monitoring, and Referral of Pediatric Chronic Hepatitis B]]> http://pediatrics.aappublications.org/cgi/content/abstract/124/5/e1007?rss=1 Most children with chronic hepatitis B virus infection (persistent hepatitis B surface antigen–positive for >6 months) are asymptomatic and do not generally require treatment. These children are, however, at increased risk for severe complications later in life, including advanced liver disease and liver cancer. On November 11, 2008, the Hepatitis B Foundation, a nonprofit research and disease advocacy organization, convened a panel of nationally recognized North American pediatric liver specialists to consider and recommend an approach for the screening, monitoring, initial management, and referral of children with chronic hepatitis B. The panel developed recommendations to provide guidance to practitioners on determining what additional tests to conduct, how often to monitor on the basis of test results, and when to refer to a pediatric liver specialist to build a partnership between the practitioner and liver specialist to enhance the success of management of children with this lifelong infection.

]]> Mon, 26 Oct 2009 04:02:05 PDT info:doi/10.1542/peds.2009-0567 American Academy of Pediatrics 5 124 e1013 2009-11-01 e1007 SPECIAL ARTICLES <![CDATA[Screening of Infants for Hyperbilirubinemia to Prevent Chronic Bilirubin Encephalopathy: US Preventive Services Task Force Recommendation Statement]]> http://pediatrics.aappublications.org/cgi/content/abstract/124/4/1172?rss=1 DESCRIPTION: Recommendation on screening newborn infants, based on a recent supplemental review of a 2003 Agency for Healthcare Research and Quality evidence report on the effectiveness of various screening strategies for preventing the development of chronic bilirubin encephalopathy, performed at the request of the US Preventive Services Task Force (USPSTF). This topic has not been previously considered by the USPSTF.

METHODS: The USPSTF reviewed experimental and observational studies that included comparison groups. For harms associated with phototherapy, case reports or case series were also included.

CONCLUSION: The evidence is insufficient to assess the balance of benefits and harms of screening for hyperbilirubinemia to prevent chronic bilirubin encephalopathy (I statement).

]]> Mon, 28 Sep 2009 04:02:15 PDT info:doi/10.1542/peds.2009-0128 American Academy of Pediatrics 4 124 1177 2009-10-01 1172 SPECIAL ARTICLES <![CDATA[Closing the Quality Gap: Promoting Evidence-Based Breastfeeding Care in the Hospital]]> http://pediatrics.aappublications.org/cgi/content/abstract/124/4/e793?rss=1 Evidence shows that hospital-based practices affect breastfeeding duration and exclusivity throughout the first year of life. However, a 2007 CDC survey of US maternity facilities documented poor adherence with evidence-based practice. Of a possible score of 100 points, the average hospital scored only 63 with great regional disparities. Inappropriate provision and promotion of infant formula were common, despite evidence that such practices reduce breastfeeding success. Twenty-four percent of facilities reported regularly giving non–breast milk supplements to more than half of all healthy, full-term infants. Metrics available for measuring quality of breastfeeding care, range from comprehensive Baby-Friendly Hospital Certification to compliance with individual steps such as the rate of in-hospital exclusive breastfeeding. Other approaches to improving quality of breastfeeding care include (1) education of hospital decision-makers (eg, through publications, seminars, professional organization statements, benchmark reports to hospitals, and national grassroots campaigns), (2) recognition of excellence, such as through Baby-Friendly hospital designation, (3) oversight by accrediting organizations such as the Joint Commission or state hospital authorities, (4) public reporting of indicators of the quality of breastfeeding care, (5) pay-for-performance incentives, in which Medicaid or other third-party payers provide additional financial compensation to individual hospitals that meet certain quality standards, and (6) regional collaboratives, in which staff from different hospitals work together to learn from each other and meet quality improvement goals at their home institutions. Such efforts, as well as strong central leadership, could affect both initiation and duration of breastfeeding, with substantial, lasting benefits for maternal and child health.

]]> Mon, 28 Sep 2009 04:02:16 PDT info:doi/10.1542/peds.2009-0430 American Academy of Pediatrics 4 124 e802 2009-10-01 e793 SPECIAL ARTICLES <![CDATA[Failure to Thrive: When to Suspect Inborn Errors of Metabolism]]> http://pediatrics.aappublications.org/cgi/content/abstract/124/3/972?rss=1 Failure to thrive (FTT) is a common symptom, not a diagnosis, of a wide range of childhood diseases. Although FTT is usually caused by inadequate energy intake in diet or constitutional small size, organic pathology should be considered in some cases of FTT. This article is intended to guide primary care physicians for when to suspect inborn errors of metabolism in children who present with FTT.

]]> Mon, 31 Aug 2009 04:01:39 PDT info:doi/10.1542/peds.2008-3724 American Academy of Pediatrics 3 124 979 2009-09-01 972 SPECIAL ARTICLES