Child Health Conference Research Articles

P.U.R.E. (purposeful, unambiguous, respectful, and effective) Conversations and electronic fetal monitoring: gaining consensus and collaboration

A revised nomenclature regarding electronic fetal heart rate monitoring was accepted at a National Institute of Child Health and Human Development consensus conference in 2008. At the heart of patient safety are communication strategies that enhance teamwork and collaboration between health care professionals. Communications is a complex 2-way process that involves more than transfer of factual information. P.U.R.E. (purposeful, unambiguous, respectful, and effective) Conversations in Obstetrics is an acronym that helps facilitate this communication process in perinatal care. P.U.R.E. stands for purposeful, unambiguous, respectful, and effective. The P.U.R.E. Conversations approach involves refinement of the mental processes associated with delivering the message, delivery of the message with data, accuracy, and direct requests for action, attention to relationships and behaviors between the communicating parties, and real-time assessment of the effectiveness of the communication. When the new electronic monitoring nomenclature is combined with an effective communication tool, one could expect to see a reduction in communication failures that could lead to adverse perinatal outcomes.

Prevalence of polycystic ovary syndrome in reproductive-aged women with type 2 diabetes

Background. Women with polycystic ovary syndrome (PCOS) are at higher risk of type 2 diabetes and cardiovascular disease. The present study was conducted to investigate the prevalence of PCOS in type 2 diabetic patients.Methods. Type 2 diabetic women (n = 157) of reproductive age were selected by a convenience sampling method. PCOS was confirmed using the clinical diagnosis criteria proposed in 1990 by the National Institute of Child Health and Human Development Conference of PCOS. The diabetic patients were divided into two groups according to the presence of PCOS. Baseline demographic characteristics were obtained by questionnaire, and body weight, height, waist circumference, blood pressure and some biochemical indices were measured in both groups.Results. The prevalence of PCOS was high (8.3%, 95% confidence interval 4.5–13.4%) in these type 2 diabetic women. The onset of diabetes occurred at a lower age in the PCOS group, who also displayed significantly greater waist circumference and body mass index (p<0.05). No difference in lipid profile, glycosylated hemoglobin or blood pressure was observed between the two groups.Conclusions. PCOS is highly prevalent in type 2 diabetic patients. Hence, focusing the treatment on insulin sensitizers in these patients should improve both the metabolic and non-metabolic complications of PCOS.

Commentary: Perspectives on Funding Community Pediatrics

The 5 panelists on the funders' session, “′Show Me the Money' (Part 2): Private and Public Foundations,” at the July 2004 American Academy of Pediatrics Community Access to Child Health and Medical Home National Conference could have changed the title of the session from “Show Me the Money” to “Show Me the Project, Passion, Your Partnerships, and Existing Relationships With the Community, Data, Logic of Your Model, and Sustainability of Your Proposed Project.” They emphasized that funding for community-pediatrics issues can be obtained for a project that is carefully planned and meets a funder's priorities. What the … Address correspondence to Bill Isler, Family Communications, Inc, 4802 5th Ave, Pittsburgh, PA 15213. E-mail: isler{at}fci.org

Prevention of Kernicterus: A Lesson From the Past: In Reply

In Reply .— We appreciate the opportunity to respond to the thoughtful letter from Dr Rosefsky regarding our summary of the recent National Institute of Child Health and Human Development conference on prevention of …

2003 C. Anderson Aldrich award lecture: enhancing developmental services in child health supervision--an idea whose time has truly arrived.

In 1938, in his famous Babies Are Human Beings , C. Anderson Aldrich was cautious in describing the feasibility of enhancing children's developmental potential: “Every human being, as he grows into childhood, must inevitably be hampered and opposed by the restrictions of his environment, and the best we can hope for is to modify somewhat the urgency of this conflict. The degree to which we are considerate of our baby's early needs, however, may be the measure of his later ability to feel secure in a world of change and to adapt himself to the necessities of circumstance.”1(p xi) Aldrich's contributions occurred at a crucial transitional period for child health. In the early 20th century, child health services were almost exclusively focused on the treatment of the sick child, with the modest exception of cursory examinations to detect signs of contagion, milk stations for feeding and weighing, and urban child health conferences for examining and later immunizing children. Subsequent control of infection through improved sanitation, public health measures, the introduction of antibiotic agents, and effective immunization profoundly influenced the scope of child health care, with the founding of the American Academy of Pediatrics in 1930 heralding a shift of emphasis to include health promotion and disease prevention.2 In 1944, Aldrich helped to pioneer this shift through the founding of the Rochester (Minnesota) Child Health Institute, devoted to research on the development of normal infants and children and to a program of delivering child health care to an entire community. Contemporary efforts to enhance the effectiveness of developmental services similarly occur within the context of a profound transition in children's health services. In the mid-1970s, the recognition of developmental, behavioral, and psychosocial problems as the “new morbidity” of pediatric practice by Haggerty et al3 reinforced an emphasis … Reprint requests to (P.H.D.) Connecticut Children's Medical Center, 282 Washington St, Hartford, CT 06106. E-mail: pdworki{at}ccmckids.org

National Institute of Child Health and Human Development (NICHD) conference on kernicterus: a population perspective on prevention of kernicterus.

This paper reviews barriers to the prevention of kernicterus. Reports of kernicterus cases persist. We do not know why kernicterus continues to occur or how best to prevent it. We need evidence for key recommendations that make clinical guidelines usable by practitioners caring for newborns, especially for practitioners providing ambulatory care in the first week of life. Data on prevalence and incidence, mortality and morbidity are essential for launching a kernicterus public health campaign. Modeling cost-effectiveness requires data on costs and benefits of alternative strategies for managing hyperbilirubinemia and preventing kernicterus and on parental preferences concerning follow-up in the first days of life. Understanding how existing patterns of care obstruct preventive care involves exploration of the roles of clinicians, health-care organizations, parents, and payers and purchasers of health care. Lastly, discovering how to motivate change in existing practices can provide the guidance needed to prevent kernicterus in the US.

Altering the perceptions of WIC health professionals about childhood obesity using video with facilitated group discussion

Objective To determine if viewing a documentary video, followed by facilitated group discussion, could alter the perceptions of those providing public health nutrition services about the barriers and solutions to addressing the problem of obesity in low-income preschoolers. Design Before-after trial to determine how often study participants could identify any of the 17 barriers and seven solutions targeted in the video and during the facilitated group discussion. Subjects/setting One hundred fifty-five attendees of the 2001 Kentucky Maternal and Child Health Conference participated in the study. Sixty percent were nurses, 24% were dietitians or nutritionists, and 64% had Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) counseling experience. Intervention Participants first viewed a 20-minute documentary video about three families enrolled in WIC. A 40-minute facilitated group discussion followed to highlight the 17 barriers (eg, WIC families are struggling with many demands in their lives that make nutrition a low priority and WIC health professionals “lecture” clients on what they “need to know”) and seven solutions (eg, adjusting WIC counseling to assess parenting skills and to increase sensitivity to clients’ life context and stresses). Main outcome measures/analyses Participants responded before and after the intervention to the same two open-ended questions, one about barriers and one about solutions. Participant responses were coded to count instances of identifying any of the 17 barriers and seven solutions. Results At baseline, 51% of participants were unable to record any of the barriers, and 91% could not identify any of the solutions. After the intervention, 37% could identify at least one more of the target barriers than they did at baseline, and 24% could identify at least one more of the target solutions. Conclusions A documentary-style video, used with facilitated group discussion, can produce a short-term change in the perceptions of those providing public health nutrition services about addressing the problem of obesity in low-income preschool children.

Biological implications of bi-directional fetomaternal cell traffic: a summary of a National Institute of Child Health and Human Development-sponsored conference

Objective: The National Institute of Child Health and Human Development (NICHD) held a workshop on 27-28 July 2000 to bring together investigators working in the field of fetomaternal cellular and nucleic acid trafficking with the hope that this would stimulate further research into the biological implications of such phenomena. Methods: Invited speakers from all over the world presented their latest (unpublished) data. The conference proceedings were delayed until the present time to allow independent publication of the primary data. Results and conclusions: Bi-directional fetomaternal trafficking of cells and nucleic acids during pregnancy is now well established, through the use of molecular techniques including conventional and real-time polymerase chain reaction, as well as fluorescence in situ hybridization. In addition, human leukocyte antigen (HLA) is deposited in the skin of pregnant women. Feto-maternal trafficking is increased in some complications of pregnancy, such as pre-eclampsia, polyhydramnios, polymorphic eruption of pregnancy, preterm labor and specific fetal chromosome aneuploidies. Maternal cells and nucleic acids have been documented in umbilical cord blood and in autopsy tissue of non-transfused neonates. Fetal cells persist postpartum and may be associated with the development of disorders such as scleroderma, lichen planus, lupus and thyroid disease. The extent of fetomaternal trafficking may be affected by three generational HLA relationships. Thus, the consequences of pregnancy extend beyond gestation.

Biologic Limits of Viability

After completing this article, readers should be able to: 1. Define the gestational range for extremely preterm birth. 2. Explain the difference between possibility and probability in reference to survival following extremely preterm birth. 3. Describe the key lung development required for adequacy of gas exchange. 4. Describe the renal functional limitations for water, sodium, and creatinine homeostasis in the first postnatal week of the extremely preterm infant. 5. List at least one structural and/or functional limitation of at least five organ systems that increases mortality risks for the extremely preterm infant. With the advent of neonatal intensive care in the 1960s, preterm infants born at progressively lower gestational ages began to survive. The progression of the decrement did not follow a recognizable relationship; rather, it was erratic as the knowledge base of neonatal physiology and pathology expanded and new technical capabilities for life support were developed. The most dramatic increase in survival of extremely preterm birth (<26 completed weeks’ gestation) came with the introduction of surfactant replacement therapy in the late 1980s. The increased use of maternal antenatal corticosteroid therapy for induction of lung maturation with threatened preterm delivery following the National Institute of Child Health and Human Development Consensus Conference recommendations in 1994 also contributed to improved survival. Since that time, the survival of infants of gestational ages as low as 22 weeks’ has been reported. The purpose of this article is to review the current understanding of the biologic factors limiting survival potential, particularly as they inform clinical decision-making. Viability or survival potential, when used in reference to a fetus, frequently is used to indicate the possibility for a fetus to be live born and capable of living to a specified endpoint of either a designated time, reaching a certain age or a landmark event, admission to a neonatal intensive care unit, …

Biological implications of bi-directional fetomaternal cell traffic: a summary of a National Institute of Child Health and Human Development-sponsored conference

Objective: The National Institute of Child Health and Human Development (NICHD) held a workshop on 27-28 July 2000 to bring together investigators working in the field of fetomaternal cellular andnucleic acid trafficking with the hope that this would stimulate further research into the biological implications of such phenomena.Methods: Invited speakers from all over the world presentedtheir latest (unpublished) data. The conference proceedings were delayed until the present time to allow independent publication of the primary data.Results and conclusions: Bi-directionalfetomaternal trafficking of cells and nucleic acids during pregnancy is now well established, through the use of molecular techniques including conventional and real-time polymerase chain reaction, as wellas fluorescence in situ hybridization. In addition, human leukocyte antigen (HLA) is deposited in the skin of pregnant women. Feto-maternal trafficking is increased in some complications of pregnancy, suchas pre-eclampsia, polyhydramnios, polymorphic eruption of pregnancy, preterm labor and specific fetal chromosome aneuploidies. Maternal cells and nucleic acids have been documented in umbilical cord bloodand in autopsy tissue of non-transfused neonates. Fetal cells persist postpartum and may be associated with the development of disorders such as scleroderma, lichen planus, lupus and thyroid disease. Theextent of fetomaternal trafficking may be affected by three generational HLA relationships. Thus, the consequences of pregnancy extend beyond gestation.

National Institute of Child Health and Development Conference summary: Amniotic fluid biology - basic and clinical aspects

National Institute of Child Health and Development Conference summary: Amniotic fluid biology - basic and clinical aspects

Compassion: Our True Vocation?

I went to collect a Kenyan friend from the Pan African Federation for Mother and Child Health (PAFMACH) conference held recently in Midrand. While waiting for him to sort out some minor details with the reception, I bumped into a family physician colleague. I was distressed to hear from her that throughout the week, the delegates (from all over Africa and other parts of the world) had emphasised the role of paediatricians, obstetricians and nurses in meeting the needs of mother and child health care. The general practitioner / family physician was either ignored or seen as irrelevant.

Necrotizing enterocolitis: research agenda for a disease of unknown etiology and pathogenesis.

Necrotizing enterocolitis (NEC) is a significant neonatal public health problem that affects low-birth weight infants in neonatal intensive care units throughout the country. As the survival rate of low-birth weight infants continues to increase and as the number of low-birth weight births remains unchanged, we can anticipate that NEC will continue to be a cause of significant morbidity and mortality in the future. Despite many reports about NEC that describe demographic risk factors and short-term or long-term outcome, there is a paucity of basic science information about neonatal gastrointestinal physiology and pathophysiology in human preterm and even full-term infants. It has become increasingly evident that we need a much better understanding about the developmental aspects of gastrointestinal function in health and disease before we can achieve further advances in our understanding of and thus rational therapy for and prevention of NEC. The purpose of the National Institute of Child Health and Human Development conference "Necrotizing Enterocolitis: Basic Science Approaches to Gut Maturation and Pathogenesis" was to bring together basic science investigators, clinical epidemiologists, and clinical scientists to identify important areas of research that need to be applied to the problem of NEC. The concept of applying the "bench to bedside" type of collaborative research was emphasized and encouraged because many clinical neonatologists may have little scientific interaction with basic scientists. In addition, many basic scientists may be unaware of NEC and the implications for targeted research related to this disease.(ABSTRACT TRUNCATED AT 250 WORDS)

The 7th National Child Health Conference and Exhibition: Towards a better future? Controversies and new developments in child care

The 7th National Child Health Conference and Exhibition: Towards a better future? Controversies and new developments in child care

Suicide by physicians on probation

<h3>In Reply.—</h3> Comments in my communication alluding to Drs Banta and Thacker relate to reports in the Washington<i>Daily News</i>and other media after news release of their views of EFM based on "their extensive review of the literature." Opinions I express are the result of my involvement in the development and use of EFM since its inception nearly two decades ago. The list of references submitted by Banta and Thacker contains articles (1,4,5,6) that had not yet been published when my article was written or included among 253 references cited in a report of the National Institute of Child Health and Human Development Consensus Conference on Antenatal Diagnosis (March 1979). Drs Banta and Thacker failed to refer to the detailed critique of their unpublished manuscript, "Costs and Benefits of EFM: A review of the literature." That article is reviewed in depth in "The Fetal Monitoring Debate" (<i>Obstet Gynecol</i>1979;54:103-109).

Electronic Fetal Monitoring-Reply

In Reply.— Comments in my communication alluding to Drs Banta and Thacker relate to reports in the Washington Daily News and other media after news release of views of EFM based on their extensive review of the literature. Opinions I express are the result of my involvement in the development and use of EFM since its inception nearly two decades ago. list of references submitted by Banta and Thacker contains articles (1,4,5,6) that had not yet been published when my article was written or included among 253 references cited in a report of the National Institute of Child Health and Human Development Consensus Conference on Antenatal Diagnosis (March 1979). Drs Banta and Thacker failed to refer to the detailed critique of unpublished manuscript, Costs and Benefits of EFM: A review of the literature. That article is reviewed in depth in The Fetal Monitoring Debate ( Obstet Gynecol 1979;54:103-109).

How do Nurses Expand Their Roles in Well Child Care?

child oriented, and can more easily include psychological, social, and family needs, in her role behavior (1-10). However, there have been no systematic studies to document these beliefs, only job descriptions written by nurses functioning in expanded roles such as pediatric nurse practitioners or associates(11,12). When queried, mothers have consistently reported feeling more comfortable in approaching certain subjects with the nurse than with the physician(6). Also, reducing anxiety by means of reassurance and anticipatory guidance has traditionally been considered a basic function for the nurse(13). Nurses have reported that family orientation is their most important and gratifying contribution to the child health conference. Most articles

The Denver Developmental Screening Test Compared with the Stanford-Binet Test: Evaluation of 298 Preschool Children

SYSTEMATIC screening of patient populations to facilitate clinical services had its practical beginning with the KaiserPermanente Clinic (1) in the early 1950's. This approach had not been seriously applied to pediatric age groups, however, until Frankenburg and Dodds (2) introduced the Denver Developmental Screening Test (DDST) in 1967. In recent years, this test has become widely used by a variety of professional and nonprofessional workers in pediatric clinics, at maternal and child health conferences, and in children and youth projects.

How comprehensive are well child visits?

Most of the 450 child health conference visits documented were fairly stereotyped, with nurses as well as physicians focusing on physical examinations, immunizations, and feeding advice and with little attention to psychosocial content. Comprehensive patient care clearly is not yet expected by mothers attending well child clinics. Parents must learn that psychosocial concerns and behavioral problems are legitimate topics for discussion, and doctors and nurses must initiate and encourage this type of discussion explicitly in well child care.

477. Shaping preschoolersʼ play behaviour in the child health conference waiting area

477. Shaping preschoolersʼ play behaviour in the child health conference waiting area