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In This Issue of JAMA Pediatrics |

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JAMA Pediatr. 2016;170(6):517. doi:10.1001/jamapediatrics.2015.2529.
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Therapy for bronchiolitis continues to be frustrating and confusing. Brooks and coauthors reanalyze 2 prior meta-analyses on randomized clinical trials of hypertonic saline use in acute bronchiolitis because of heterogeneity among the studies. One study was a significant outlier; once this was removed, the data showed little support for the use of hypertonic saline in infants hospitalized with bronchiolitis. Hypertonic saline cannot be expected to shorten the length of stay of infants hospitalized with bronchiolitis in typical US hospital settings.

There is a large focus on oximetry values in the care of children with bronchiolitis, despite the lack of evidence on the importance of transient desaturations. In this cohort study, Principi and coauthors study the effect of oxygen desaturations lower than 90% on risk of return visits to the emergency department within 72 hours of an emergency department discharge. Most infants had desaturations on home oximetry monitoring, but their occurrence had no effect on unscheduled return medical visits or delayed hospitalizations. The accompanying editorial by Bajaj and Zorc discusses the appropriate role of oximetry in the care of infants with bronchiolitis.

Infant rice cereal and other rice-containing foods may contain inorganic arsenic but the extent of infants’ exposure to arsenic is unknown. Using the New Hampshire Birth Cohort from 2011-2014, Karagas and coauthors measure urinary arsenic concentrations and obtain dietary data on more than 700 infants. Among 12-month-old infants who did not eat seafood, the mean total urinary arsenic concentrations were 2- to 3-fold higher among infants who ate rice cereal or rice snacks compared with those who did not eat foods containing rice. Regulation of arsenic content of rice products should be considered.

Approximately 1 of every 66 live births in the United States in 2012 were conceived using assisted reproductive technology (ART). Boulet and coauthors examine the prevalence of birth defects among liveborn infants in Florida, Massachusetts, and Michigan from 2000-2010, comparing those born with and without ART. There was a 28% increased risk of nonchromosomal birth defects among infants born through ART. Risks were marginally higher among infants born to mothers with ovulation disorders and in those born through use of assisted hatching. As use of ART continues to increase, careful evaluation of the long-term outcomes of children conceived using these technologies becomes increasingly important.

Up to 10% of children develop rashes while receiving antibiotics, and most are labeled as allergic without further evaluation. Mill and coauthors use a graded provocation challenge to examine children with suspected amoxicillin allergy. The graded provocative challenge had 100% specificity and a 100% positive predictive value for amoxicillin allergy, and found that all allergic children tolerated a subsequent challenge with cefixime. Kelso’s editorial discusses the need to evaluate children labeled as allergic to amoxicillin using appropriate tests in a safe setting.





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