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The car seat challenge - What makes sense
This Month in
THE JOURNAL OF
PEDIATRICS March 2007 • Volume 150 • Number 3 Copyright © 2007 by Mosby, Inc.
THE EDITORS’ PERSPECTIVES “Bad to the Bone” Regular readers of The Journal cannot have missed the explosion of interest in bone mineralization studies in children with various chronic disorders. Our understanding of this topic has deepened, and it is recognized that the different modalities employed in the measurement of bone density (DEXA, qualitative CT, and speed of sound [SOS]) do not measure exactly the same thing; each has its advantages and disadvantages, depending upon the situation. A nice example of this is found in a study by DiVasta et al in Boston in this issue of The Journal. These workers examined a cohort of teenagers with anorexia nervosa, a condition known to be associated with abnormalities in bone mineralization. The short version of their conclusions is that SOS is not the appropriate modality for this population. The reason for this is not clear, but may relate to the effect of changes in other tissue compartments (e.g. fat) in the measurement. —Thomas R. Welch, MD page 286
The car seat challenge - What makes sense The standard of care prior to discharge of a preterm infant is a test of cardiorespiratory stability in the car seat to be used for transporting the infant home. Some infants do have cardiorespiratory events when placed in car seats. The car bed, which allows the infant to be flat, is viewed as a good alternative for discharge. Salhab et al performed a high quality randomized-control trial comparing predischarge respiratory events for preterm infants placed in car seats or car beds. They found no differences in events. In an editorial, Greenberg points out that there is no evidence of the validity of the “car seat challenge,” even though the evaluation is endorsed by the American Academy of Pediatrics. Perhaps it is time to evaluate the utility of car seat assessments prior to discharge of preterms. It may be more effective to simply recommend limited automobile travel for preterms in car seats, along with continual observation during travel to protect the infant from cardiorespiratory events. —Alan H. Jobe, MD, PhD page 224 (article) page 215 (editorial)
The Journal of Pediatrics (ISSN 0022-3476) is published monthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010. Business and Editorial Offices: 1600 John F. Kennedy Blvd., Suite 1800, Philadelphia, PA 19103-2899. Accounting and Circulation Offices: 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Periodicals postage paid at New York, NY, and additional mailing offices. POSTMASTER: Send address changes to The Journal of Pediatrics, Elsevier Periodicals Customer Service, 6277 Sea Harbor Drive, Orlando, FL 32887-4800.
The Journal of Pediatrics
March 2007
1A
THE JOURNAL OF
PEDIATRICS March 2007 • Volume 150 • Number 3 Copyright © 2007 by Mosby, Inc.
THE EDITORS’ PERSPECTIVES “Bad to the Bone” Regular readers of The Journal cannot have missed the explosion of interest in bone mineralization studies in children with various chronic disorders. Our understanding of this topic has deepened, and it is recognized that the different modalities employed in the measurement of bone density (DEXA, qualitative CT, and speed of sound [SOS]) do not measure exactly the same thing; each has its advantages and disadvantages, depending upon the situation. A nice example of this is found in a study by DiVasta et al in Boston in this issue of The Journal. These workers examined a cohort of teenagers with anorexia nervosa, a condition known to be associated with abnormalities in bone mineralization. The short version of their conclusions is that SOS is not the appropriate modality for this population. The reason for this is not clear, but may relate to the effect of changes in other tissue compartments (e.g. fat) in the measurement. —Thomas R. Welch, MD page 286
The car seat challenge - What makes sense The standard of care prior to discharge of a preterm infant is a test of cardiorespiratory stability in the car seat to be used for transporting the infant home. Some infants do have cardiorespiratory events when placed in car seats. The car bed, which allows the infant to be flat, is viewed as a good alternative for discharge. Salhab et al performed a high quality randomized-control trial comparing predischarge respiratory events for preterm infants placed in car seats or car beds. They found no differences in events. In an editorial, Greenberg points out that there is no evidence of the validity of the “car seat challenge,” even though the evaluation is endorsed by the American Academy of Pediatrics. Perhaps it is time to evaluate the utility of car seat assessments prior to discharge of preterms. It may be more effective to simply recommend limited automobile travel for preterms in car seats, along with continual observation during travel to protect the infant from cardiorespiratory events. —Alan H. Jobe, MD, PhD page 224 (article) page 215 (editorial)
The Journal of Pediatrics (ISSN 0022-3476) is published monthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010. Business and Editorial Offices: 1600 John F. Kennedy Blvd., Suite 1800, Philadelphia, PA 19103-2899. Accounting and Circulation Offices: 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Periodicals postage paid at New York, NY, and additional mailing offices. POSTMASTER: Send address changes to The Journal of Pediatrics, Elsevier Periodicals Customer Service, 6277 Sea Harbor Drive, Orlando, FL 32887-4800.
The Journal of Pediatrics
March 2007
1A