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In This Issue of JAMA Pediatrics |

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JAMA Pediatr. 2016;170(8):723. doi:10.1001/jamapediatrics.2015.2543.
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Much attention has been given to the importance of the intestinal microbiota and the effects of early exposure to antibiotics. In this longitudinal cohort study, Korpela and coauthors examine whether the positive metabolic effects of breastfeeding are affected by antibiotic use. The protective effects of breastfeeding against infections were found to be weakened or completely eliminated by early-life antibiotic use. The accompanying editorial by Paolella and Vajro discusses methods to potentially avoid or repair changes to the intestinal microbiota in breastfed children who need antibiotics.

While health care apps in low-income countries are common and have the potential to improve quality and outcomes of care, few have been rigorously evaluated. In this cluster-randomized clinical trial by Lund and coauthors, 73 health care facilities were randomized to usual care or to receive a mobile phone app for training in emergency obstetrical and neonatal care. The app improved and sustained health care workers’ skills in neonatal resuscitation and resulted in a nonsignificant change in perinatal mortality. Pagliari’s editorial discusses the role for digital support in improving children’s health in the developing world.

Folate insufficiency during pregnancy can have powerful effects on the developing infant. This large cohort study by Wang and coauthors examines whether sufficient maternal folate levels can alleviate prepregnancy obesity effects on the child. The study found that the risk for child overweight and obesity was reduced by nearly half if obese mothers had adequate folate concentrations. This points to the need to establish and ensure optimal rather than minimal maternal folate concentrations for pregnant women.


As Zika virus infection spreads across the Latin American and Caribbean region and then into the southern United States, we can expect to see thousands of additional children born with microcephaly and potentially many more with more subtle but significant neurological damage. In this Special Communication, Hotez discusses the history of the current epidemic and the risk factors supporting its spread. The potential of up to 4 million people infected by Zika virus by the end of 2016 will affect pediatric practice both in the near future and for years to come.

Management of febrile infants younger than 90 days has evolved considerably over the last few decades. With effective vaccines against Haemophilus influenza type b and Streptococcus pneumonia, occult bacteremia has largely disappeared. In this review, Cioffredi and Jhaveri note that urinary tract infection is the most prevalent serious bacterial infection without localizing signs of infection in vaccinated children. For children with fever without localizing signs of infection, given that the odds of identifying a contaminant is 100 times more likely than identifying a true pathogen, management has moved away from evaluation of complete blood cell counts, blood cultures, and empirical antibiotics of any kind.





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