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This Month in Archives of Pediatrics & Adolescent Medicine
Arch Pediatr Adolesc Med. 2005;159:105.
With typically short postpartum stays, outpatient follow-up is needed to identify the minority of infants in whom bilirubin levels will be high enough to require treatment. Prediction of the infants at risk of significant hyperbilirubinemia is thus important. In this study, the authors tested a risk index at the time of hospital discharge for predicting subsequent significant jaundice; the risk factors examined included exclusive breastfeeding, bruising or cephalhematoma, Asian race, mothers older than 24 years, male sex, and gestational age. Approximately 2% of the 5706 newborns developed bilirubin levels of 20 mg/dL (342 µmol/L) or higher. A combination of the risk index and the bilirubin levels within the first 48 hours of life were the best predictors of subsequent hyperbilirubinemia needing treatment.
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In recent years, there have been increasing challenges to laws allowing minors to obtain certain health services, especially reproductive health care, on a confidential basis. Eisenberg and colleagues examined parents’ views on proposed legislation that would require physicians to notify parents in writing when their minor adolescents seek to obtain prescription birth control methods. Although more than half of responding parents thought that such parent notification laws were a good idea, 96% of parents expected at least 1 negative consequence from such laws. In addition, 86% of parents agreed with at least 1 exception to these laws and one third agreed with 5 to 6 exceptions. Many parents hold complex views on the need for confidentiality and the appropriate involvement of parents in adolescent health care services.
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Bone mineral density in adult women is highly dependent on bone mineral density during adolescence. The effect of contraceptives on bone mineral density during use and after discontinuation is unclear. In this prospective study of 170 adolescents, bone mineral density was compared among users of depot medroxyprogesterone acetate (DMPA) and nonusers. During use of DMPA, bone mineral density decreased in the hip and spine by nearly 2% per year, with greater decreases among new users of DMPA. After discontinuation of use, bone mineral density rebounded back to levels equivalent to those of nonusers of DMPA.
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Figure. Mean percentage change in bone mineral density (BMD) from baseline by depot medroxyprogesterone acetate (DMPA) exposure status, adjusted for baseline covariates (BMD, ethnicity, pregnancy, age at menarche) and time-dependent covariates (age, smoking status, calcium intake, percentage body fat). Error bars represent 1 SE from the mean. New users (n = 17, 9, and 8 at 12, 18, and 24 months, respectively) received 1 DMPA injection; prevalent users (n = 26, 18, and 14 at 12, 18, and 24 months, respectively) received more than 1 DMPA injection. For DMPA discontinuers (n = 26, 14, and 5 at 12, 18, and 24 months, respectively), the intervals refer to the length of time participants were followed up after becoming discontinuers. The number of nonusers at 12, 18, and 24 months was 69, 69, and 59, respectively. A, Total hip BMD. B, Spine BMD. C, Whole body BMD.
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Children with human immunodeficiency virus (HIV)–infected parents, even when not infected themselves, may be greatly affected by the disease. One concern is that parents fear transmitting HIV to their children; another is fear of contracting a communicable illness from their children when they are sick. In this nationally representative sample of 344 HIV-infected parents, 42% reported fearing catching an infection from their child, and more than one third feared transmitting HIV to their children. Consequently, more than one quarter of parents avoided at least 1 type of normal interaction with their children, such as kissing, hugging, and sharing utensils. This may represent an important need for physicians to provide education to HIV-infected parents and reassurance about HIV transmission and the safety of various activities.
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