Tuesday, December 16, 2014

The Down Side of Adolescent Obesity: Don't Miss an Eating Disorder

With all the emphasis on curbing overweight and obesity, have we missed opportunities to identify eating disorders in such individuals. These authors provide some evidence for this, with some suggestions to identify such individuals.

Source: Lebow J, Smith LA, Kransdorf LN. Prevalence of a history of overweight and obesity in adolescents with restrictive eating disorders [published online ahead of print]. J Adolesc Health; 2014; in press. doi:10.1016/j.jadohealth.2014.06.005. See AAP Grand Rounds commentary by Dr. Charlene Wong (subscription required). 

PICO Question: Among treatment-seeking adolescents with restrictive eating disorders, what is the prevalence of a history of overweight or obesity?
Question type: Descriptive
Study design: Retrospective cohort 

Tuesday, December 9, 2014

Bronchiolitis - Tricking the Doctors Exposes the Dark Side of Technology

This might be my favorite article of the year. It used a bit of trickery to expose our over-reliance on pulse oximetry for bronchiolitis management.

Source: Schuh S, Freedman S, Coates A, et al. Effect of oximetry on hospitalization in bronchiolitis a randomized clinical trial. JAMA. 2014;312(7):712-718; doi:10.1001/jama.2014.8637. See AAP Grand Rounds commentary by Dr. Matthew Garber (subscription required). 

PICO Question: Among infants 1 to 12 months old presenting to an emergency department with nonsevere bronchiolitis, does artificially raising the pulse oximeter values by 3 percentage points, compared to unaltered oximetry values, decrease the rate of hospital admission?
Question type: Intervention
Study Design: Randomized controlled

Tuesday, December 2, 2014

The Complex Relationship Between BMI and Scoliosis

How many of us pediatricians have had occasion to read an article in the Journal of Bone and Mineral Research? I think it's a first for me, and it's a gem of an article. AAP Grand Rounds expands my horizons once again.

Source: Clark EM, Taylor HJ, Harding I, et al. Association between components of body composition and scoliosis: a prospective cohort study reporting differences identifiable before the onset of scoliosis. J Bone Miner Res.2014;29(8):1729-1736; doi:10.1002/jbmr.2207. See AAP Grand Rounds commentary by Dr. William Hennrikus (subscription required).

PICO Question: Among children without scoliosis at age 10, are measures of fat and lean mass related to the development of scoliosis by age 15?
Question type: Descriptive
Study design: Prospective cohort

Monday, December 1, 2014

Wrapping Up 2014

AAP Grand Rounds for December has several thought-provoking reviews, including subjects such as concussions in high school football players, association of "successful" schools with risky behaviors in adolescents, adolescent predictors of end-stage renal disease in adulthood, and many more.

Over the next 4 weeks, I'll be commenting on bronchiolitis care, including the new palivizumab guideline, and 2 cohort studies, one looking at predictors of scoliosis and the other at eating disorder predictors of obesity.

Also, it's another month with 5 Tuesdays, bringing you the infamous 5th Tuesday wild card rant, just in time for New Year's eve. Please join me!

Tuesday, November 25, 2014

Suicide and Black Boxes - A Large Controversy

I love a controversy, but the problem at the end of the day, particularly in medicine, is that we need to move forward and continue to provide care for our patients. So, we're in a bit of a quandry with a new study that blames the FDA Black Box warning on antidepressants for an increase in suicide attempts among adolescents and young adults. Read on.

Source: Lu CY, Zhang F, Lakoma MD, et al. Changes in antidepressant use by young people and suicidal behavior after FDA warnings and media coverage: quasi-experimental study. BMJ.2014;348:g3596; doi:10.1136/bmj.g3596. See AAP Grand Rounds commentary by Dr. Justin Schreiber (subscription required). 

PICO Question: Among adolescents and young adults, what was the effect of the FDA warning of an increased risk of suicidality with antidepressant use on suicidal behavior and antidepressant use?
Question type: Harm
Study design: Interrupted time series

Tuesday, November 18, 2014

Adenotonsillectomy for Sleep Apnea: A Mixed Bag

Congratulations to the investigators in the Childhood Adenotonsillectomy Trial (CHAT) group. We now have a pretty good idea of risks and benefits of early adenotonsillectomy (AT) versus watchful waiting (WW) for children with mild to moderate obstructive sleep apnea.

Source: Katz ES, Moore RH, Rosen CL, et al. Growth after adenotonsillectomy for obstructive sleep apnea: an RCT. Pediatrics. 2014;134(2):282-289; doi:10.1542/peds.2014-0591. See AAP Grand Rounds commentary by Dr. Daniel Lesser (subscription required). 

PICO Question: Among children with obstructive sleep apnea syndrome aged 5.0-9.9 years, does treatment with adenotonsillectomy compared to watchful waiting result in increased weight gain?
Question type: Intervention
Study design: Randomized controlled

Tuesday, November 11, 2014

Mothers Receiving Epilepsy Medication: Is Breastfeeding Safe?

This study addresses a very important, and difficult to answer, question about safety of breastfeeding for infants whose mothers receive anti-epileptic drugs (AEDs). The answer still isn't clear cut, but this study offers a bit of reassurance plus some instructive points about interpreting prospective observational studies.

Source: Meador KJ, Baker GA, Browning N, et al for the Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) Study Group. Breastfeeding in children of women taking antiepileptic drugs: cognitive outcomes at age 6 years. JAMA Pediatr. 2014;168(8):729-736; doi:10.1001/jamapediatrics.2014.118. See AAP Grand Rounds commentary by Dr. Lawrence Noble (subscription required).

PICO Question: Among children of women taking antiepileptic drugs, are cognitive outcomes at age 6 years different between those who were breastfed and those who were not?
Question type: Causation
Study design: Prospective observational

Tuesday, November 4, 2014

The Febrile Infant: More Data, No Closer to a Definitive Solution

Management of the febrile infant in the first few months of life strikes me as a throwback to the mid-20th century. It frustrates me to see so many infants subjected to tests and treatments when only a few ultimately need intervention. We need a breakthrough, but a retrospective study design won't get us there very fast.

Source: Biondi EA, Mischler M, Jerardi KE, et al. Blood culture time to positivity in febrile infants with bacteremia. JAMA Pediatr.2014;168(9):844-849; doi:10.1001/jamapediatrics.2014.895. See AAP Grand Rounds commentary by Dr. Matthew Garber (subscription required).

PICO Question: Among febrile bacteremic infants younger than 91 days of age on a general inpatient unit, what is the blood culture time to positivity and what proportion of positive blood cultures become positive after 24 hours?
Question type: Descriptive

Study design: Retrospective cohort

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