Incidence of Chronic Bilirubin Encephalopathy in Canada, 2007–2008

BACKGROUND AND OBJECTIVES:Despite the implementation of screening guidelines to identify infants at risk for hyperbilirubinemia, chronic bilirubin encephalopathy (CBE) continues to be reported worldwide in otherwise healthy infants. The incidence of CBE in Canada is unknown. The objectives of this study were to establish the incidence of CBE in Canada and identify epidemiological and medical risk factors associated with its occurrence.METHODS:Data on infants were collected prospectively through the Canadian Pediatric Surveillance Program. Infants born between January 1, 2007 and December 31, 2008 were included if they either had symptoms of CBE and a history of hyperbilirubinemia, or if they presented in the newborn period with severe hyperbilirubinemia and an abnormal MRI finding as per the reporting physician.RESULTS:During the study period, 20 cases were identified; follow-up data were available for 14 of these. The causes for the hyperbilirubinemia included glucose-6-phosphate dehydrogenase deficiency (n = 5), sepsis (n = 2), ABO incompatibility and other red blood cell antibodies (n = 7). Fifteen infants had abnormal brain MRI findings during the neonatal period. At follow-up, 5 infants developed classic choreoathetoid cerebral palsy, 6 had spectrum of neurologic dysfunction and developmental delay (as described by the reporting physician), and 3 were healthy.CONCLUSIONS:CBE continues to occur in Canada at an incidence that appears to be higher than previously reported.</jats:sec

The Relationship Between Cow’s Milk and Stores of Vitamin D and Iron in Early Childhood

OBJECTIVE:To examine the association between cow’s milk intake on both vitamin D and iron stores in healthy urban preschoolers.METHODS:Healthy children 2 to 5 years of age were recruited from December 2008 through December 2010 through the TARGet Kids! practice-based research network. Cow’s milk intake was measured by parental report. Vitamin D and iron stores were measured by using serum 25-hydroxyvitamin D and ferritin. Bivariate multivariable linear regression was used to examine the effect of cow’s milk intake simultaneously on 25-hydroxyvitamin D and serum ferritin. Analyses were stratified by important clinical variables including skin pigmentation, bottle feeding, vitamin D supplementation, and season.RESULTS:Among 1311 children, increasing cow’s milk consumption was associated with decreasing serum ferritin (P &amp;lt; .0001) and increasing 25-hydroxyvitamin D (P ≤ .0001). Two cups (500 mL) of cow’s milk per day maintained 25-hydroxyvitamin D &amp;gt;75 nmol/L with minimal negative effect on serum ferritin for most children. Children with darker skin pigmentation not receiving vitamin D supplementation during the winter required 3 to 4 cups of cow’s milk per day to maintain 25-hydroxyvitamin D &amp;gt;75 nmol/L. Cow’s milk intake among children using a bottle did not increase 25-hydroxyvitamin D and resulted in more dramatic decreases in serum ferritin.CONCLUSIONS:There is a trade-off between increasing 25-hydroxyvitamin D and decreasing serum ferritin with increasing milk intake. Two cups of cow’s milk per day appears sufficient to maintain healthy vitamin D and iron stores for most children. Wintertime vitamin D supplementation was particularly important among children with darker skin pigmentation.</jats:sec

Association between Vitamin D and Circulating Lipids in Early Childhood.

Vitamin D is associated with established cardiovascular risk factors such as low density lipoprotein (LDL) in adults. It is unknown whether these associations are present in early childhood. To determine whether serum 25-hydroxyvitamin D (25(OH)D) is associated with serum non-high density lipoprotein (non-HDL) cholesterol during early childhood we conducted a cross-sectional study of children aged 1 to 5 years. Healthy children were recruited through the TARGet Kids! practice based research network from 2008-2011 (n=1,961). The associations between 25(OH)D and non-fasting non-HDL cholesterol (the primary endpoint), total cholesterol, triglycerides, HDL, and low density lipoprotein (LDL) cholesterol, were evaluated using multiple linear regression adjusted for age, sex, skin pigmentation, milk intake, vitamin D supplementation, season, body mass index, outdoor play, and screen time. Each 10 nmol/L increase in 25(OH)D was associated with a decrease in non-HDL cholesterol concentration of -0.89 mg/dl (95% CI: -1.16,-0.50), total cholesterol of -1.08 mg/dl (95%CI: -1.49,-0.70), and triglycerides of -2.34 mg/dl (95%CI: -3.23,-1.45). The associations between 25(OH)D and LDL and HDL were not statistically significant. 25(OH)D concentrations were inversely associated with circulating lipids in early childhood, suggesting that vitamin D exposure in early life may be an early modifiable risk factor for cardiovascular disease

Characteristics of Participants With and Without Blood in TARGet Kids!, 2008–2011.

<p>^aTo convert from mg/dL to SI units (mmol/L) divide the results for non-HDL, Total Cholesterol, LDL and HDL by 38.6, and divide by 88.6 for triglycerides.</p><p>^bAbnormal cut-point values for plasma lipid levels are from the National Cholesterol Education Program (NCEP) Expert Panel on Cholesterol Levels in Children. Non-HDL cholesterol values from the Bogalusa Heart Study are equivalent to the NCEP Pediatric Panel cut points for LDL cholesterol. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0131938#pone.0131938.ref014" target="_blank">14</a>]</p><p>^cTriglyceride cut-point is from fasting sample recommendations.</p><p>Characteristics of Participants With and Without Blood in TARGet Kids!, 2008–2011.</p

Adjusted Association Between 25-Hydroxyvitamin D (per 10 nmol/L increase) and Non-HDL (mg/dL) Among Children 1 to 5 Years of Age in TARGet Kids!, 2008–2011.

<p>^aTo convert from mg/dL to SI units divide the results for non-HDL, Total Cholesterol, LDL and HDL by 38.6, and divide by 88.6 for triglycerides.</p><p>Adjusted Association Between 25-Hydroxyvitamin D (per 10 nmol/L increase) and Non-HDL (mg/dL) Among Children 1 to 5 Years of Age in TARGet Kids!, 2008–2011.</p

Unadjusted and Adjusted Association Between 25-Hydroxyvitamin D (per 10 nmol/L increase) and Non-Fasting Serum Lipids (mg/dL) Among Children 1 to 5 Years of Age in TARGet Kids!, 2008–2011.

<p>^aAdjusted for age, sex, season, vitamin D supplementation, daily volume of cow’s milk intake, daily minutes of outdoor play, daily minutes of screen time, zBMI, and skin pigmentation.</p><p>^bP-values for secondary objectives adjusted for multiple testing using a false discovery rate controlling procedure correction. Statistical significance is defined as an adjusted P-value <0.05.</p><p>^cTriglyceride values were log transformed for analysis and back transformed results are presented.</p><p>Unadjusted and Adjusted Association Between 25-Hydroxyvitamin D (per 10 nmol/L increase) and Non-Fasting Serum Lipids (mg/dL) Among Children 1 to 5 Years of Age in TARGet Kids!, 2008–2011.</p

psri_supplemental_material_march_20 – Supplemental material for Development of the Pediatric Social Risk Instrument Using a Structured Panel Approach

<p>Supplemental material, psri_supplemental_material_march_20 for Development of the Pediatric Social Risk Instrument Using a Structured Panel Approach by Justine Cohen-Silver, Sherri Adams, Rishi Agrawal, Catherine Birken, Eyal Cohen, Geoffrey Dougherty, Amy Houtrow, Thivia Jegathesan, Sharmilaa Kandasamy, Barbara Muskat, Nikhil Pai and Jonathon L. Maguire in Clinical Pediatrics</p