Pediatric Hospital Medicine: A Proposed New Subspecialty.

Over the past 20 years, hospitalists have emerged as a distinct group of pediatric practitioners. In August of 2014, the American Board of Pediatrics (ABP) received a petition to consider recommending that pediatric hospital medicine (PHM) be recognized as a distinct new subspecialty. PHM as a formal subspecialty raises important considerations related to: (1) quality, cost, and access to pediatric health care; (2) current pediatric residency training; (3) the evolving body of knowledge in pediatrics; and (4) the impact on both primary care generalists and existing subspecialists.

Trends and factors associated with infant bed sharing, 1993-2010: the National Infant Sleep Position Study.

Importance: A strong association between infant bed sharing and sudden infant death syndrome or unintentional sleep-related death in infants has been established. Occurrences of unintentional sleep-related deaths among infants appear to be increasing.

Objectives: To determine the trends and factors associated with infant bed sharing from 1993 through 2010, including the association of physician advice on bed sharing.

2011 Joseph W. St Geme Jr lecture: five things I'd like to see changed in American pediatrics, five lessons I've learned.

Objective: In response to limitations in access to subspecialty care, I present personal observations and suggestions related to education of future pediatricians regarding development of critical thinking skills, care of complex and chronically ill patients, development of empathy, and restoration of responsibility that may help ameliorate this serious problem. Toward this end, I also offer 1 approach, a 24/7 telephone consultation network, for enriching interaction of primary care providers (PCPs) and subspecialists who can potentially provide rapid access to needed advice, reduce demand for subspecialty appointments, bolster decision-making and expertise, and realign resources with need.

Methods: Data were obtained from 579 requests by PCPs for telephone consultation by subspecialists in 8 areas (including child psychiatry).

Relationship between sleep position and risk of extreme cardiorespiratory events.

Objective: To determine whether infants at sleep in the prone side positions are at higher risk for an extreme cardiorespiratory event compared with infants at sleep in the supine position.

Study Design: We used a case-control study to compare sleep position, determined with an accelerometer, in 116 infants during an extreme cardiorespiratory event with that in 231 matched control subjects (2 per case) who did not experience any extreme events during monitoring.

Results: From calculation of adjusted ORs and 95% CIs, infants placed in the prone or side position were no more likely to experience an extreme cardiorespiratory event compared with infants at sleep in the supine position.

Sowing the seeds for a career in medicine: reflections and projections.

Dr. George Lister delivered the following presentation as the Lee E. Farr Lecturer on May 8, 2011, which served as the culmination of the annual Student Research Day at Yale School of Medicine.

Longitudinal assessment of hemoglobin oxygen saturation in preterm and term infants in the first six months of life.

Objective: To report longitudinal home recordings of hemoglobin O(2) saturation by pulse oximetry (Spo(2)) during unperturbed sleep in preterm and term infants.

Study Design: We recorded continuous pulse oximetry during the first 3 minutes of each hour of monitor use (nonevent epochs) for 103 preterm infants born at <1750 g and ≤ 34 weeks postmenstrual age (PMA), and 99 healthy term infants.

Results: Median baseline Spo(2) was approximately 98% for both the preterm and term groups.

Maternal assessment of physician qualification to give advice on AAP-recommended infant sleep practices related to SIDS.

Objective: The American Academy of Pediatrics (AAP) strongly recommends the supine-only sleep position for infants and issued 2 more sudden infant death syndrome (SIDS) reduction recommendations: avoid bed sharing and use pacifiers during sleep. In this study, we investigated the following: 1) if mothers from at risk populations rate physicians as qualified to give advice about sleep practices and 2) if these ratings were associated with reports of recommended practice.

Methods: A cross-sectional survey of mothers (N=2355) of infants aged <8 months was conducted at Women, Infants, and Children (WIC) Program centers in 6 cities from 2006 to 2008.

Influence of prior advice and beliefs of mothers on infant sleep position.

Objectives: To determine the relationship between the advice mothers receive about infant sleep position and the actual position they place their infants in to sleep and to understand modifiers of that relationship, especially beliefs about infant comfort and safety.

Design: Cross-sectional, face-to-face interviews.

Setting: Women, Infants, and Children centers in the United States from 2006 to 2008.

Trends and factors associated with infant sleeping position: the national infant sleep position study, 1993-2007.

Objective: To determine trends and factors associated with choice of infant sleeping position.

Design: Annual nationally representative telephone surveys from 1993 through 2007.

Setting: Forty-eight contiguous states of the United States.

Report of colloquium I: the future of pediatric health care delivery and education--pondering imponderables to create an ideal residency in a world of critical uncertainties.

Participants of the first colloquium of the Residency Review and Redesign in Pediatrics (R(3)P) Project considered possible scenarios affecting pediatric practice over the next 15 to 20 years and speculated about the knowledge and skills that pediatricians would need to care for children, adolescents, and young adults in the future. They concluded that the imponderables and complexity of that undertaking fell into the category of a "wicked problem" with no unique solutions. The specifics of the future cannot be predicted, but the themes important to thinking about the future are clear and must be incorporated into thinking about pediatric residency education.

Precursors of cardiorespiratory events in infants detected by home memory monitor.

In 1,079 infants monitored for >700,000 hr at home for apnea or bradycardia, we found an association between infants having multiple events exceeding conventional or a priori defined more extreme thresholds and less favorable developmental outcome at 1 year of age than infants with few or no events. If it is necessary to prevent such events to minimize risk for developmental morbidity, there is reason to determine whether there are disturbances in advance of the apnea or bradycardia that herald their onset. In the 85 infants with at least 1 extreme event and 1 conventional event, we hypothesized that apnea and bradycardia do not occur de novo but rather are preceded by cardiorespiratory and hemoglobin O2 saturation changes.

Barriers to following the supine sleep recommendation among mothers at four centers for the Women, Infants, and Children Program.

Objectives: The risk for sudden infant death syndrome in black infants is twice that of white infants, and their parents are less likely to place them in the supine position for sleep. We previously identified barriers for parents to follow recommendations for sleep position. Our objective with this study was to quantify these barriers, particularly among low-income, primarily black mothers.

Barriers to following the back-to-sleep recommendations: insights from focus groups with inner-city caregivers.

Background: African American infants have a higher incidence of SIDS and increased risk of being placed in the prone position for sleep.

Objective: To determine new barriers and more information about previously identified barriers that interfere with adherence to the Back-to-Sleep recommendations among inner-city, primarily African Americans.

Design/methods: We conducted 9 focus groups with caregivers of infants and young children from women, infants, and children centers and clinics in New Haven and Boston.

Factors that influence use of a home cardiorespiratory monitor for infants: the collaborative home infant monitoring evaluation.

Background: As part of the Collaborative Home Infant Monitoring Evaluation, a home monitor was developed to record breathing, heart rate, other physiologic variables, and the time the monitor was used.

Objective: To determine the frequency of monitor use, factors that influence use, and validity of a model developed to predict use.

Design: We developed a model to predict monitor use using multiple linear regression analysis; we then tested the validity of this model to predict adherence for the first week of monitoring and for the subsequent 4-week period (weeks 2-5).

Brain death in children.

In 1981, the Report of the Medical Consultants on the Diagnosis of Death established guidelines for the diagnosis of brain death and, in 1995, the American Academy of Neurology published practice parameters to standardize determination of brain death. In 1987, the American Academy of Pediatrics established guidelines for determining brain death in children. Despite the establishment of these guidelines, the declaration of "death" based on the cessation of brain function remains complex and controversial.

Outcome of coma in children.

Coma following a hypoxic-ischemic event is a serious condition and common reason for admission to the pediatric intensive care unit. Because coma has a high rate of mortality and morbidity in children, and the clinician may be unsure of the outcome very early in the course, it is important to have strategies to define prognosis. Although most studies have been conducted in adults, we review factors predicting outcome from coma of nontraumatic causes in infants and children.