Newborn Screening for G6PD Deficiency- Why is it Important for India?

Neonatal screening, the most important preventive public health programme of the 21st century, is implemented in majority of the developed countries. The Asia-Pacific region has a long history—the late Emeritus Professor Wong Hock Boon in 1965 initiated cord blood G6PD screening in Singapore, which virtually eliminated kernicterus. In India currently there is no government funded neonatal screening programme for the masses, but most private hospitals have started screening for disorders which the pediatrician there thinks is relevant in that part of the country. Indian Council of Medical Research has established a task force to look into these and there have been numerous updates from them including an updated website where a pediatrician or a hospital can download information. The authors present this study, which reveals that G6PD in India is a high priority for public screening.     

Screening for developmental disorders of infants and young children in the primary care clinics--is there a need for standardized tools implementation?

Early identification of children with developmental delay is an important task for the primary care physicians. Different screening tests are used to detect developmental disorders in infants and young children. The authors describe screening tools currently available in Poland in the primary care setting. The review of the standardized developmental screening tests available in other countries is given: parent report instruments, such as Ages and Stages Questionnaires (ASQ), Parent's Evaluation of Developmental Status (PEDS) and instruments that require direct examination as the Denver-ll Developmental Screening Test (DDST) and Bayley Infant Neurodevelopmental Screener (BINS). The authors describe a proposed standardized developmental screening instrument of infants and young children for primary care pediatricians and family doctors in Poland.     

Doppler Flow Parameters of Left Ventricular Filling in Infants: How Long Does It Take for the Maturation of the Diastolic Function in a Normal Left Ventricle to Occur?

Objective To study the impact of the maturational process of diastolic left ventricular function on trans-mitral Doppler flow parameters.Methods and Participants In a survey we examined pulsed-wave Doppler signals and diastolic time intervals from 238 healthy neonates and infants. Using multiple linear regression analysis, we evaluated the impact of physiological determinants on parameter expression.Results Early-filling and atrial-filling peak velocities, early-filling acceleration and deceleration rates, and the atrial-filling time velocity integral reached a climax within 2 months after birth, while early-filling time velocity integral followed increasing throughout the study period. The isovolumic relaxation time was found to be significantly longer for neonates than for infants older than 2 months. The observed parameter movements could be attributed to changes of stroke volume and mitral valve area for early filling-time velocity integral (R² = 0.93), and of heart rate, stroke volume, and mitral valve area for early filling peak velocity (R² = 0.84), and atrial-filling time velocity integral (R² = 0.65). Isovolumic relaxation time and atrial-filling peak velocity became heart rate dependent not before 3 months after birth.Conclusions The observed parameter changes are powerful indicators for the maturational process in diastolic function. This process is mainly completed by 3 months of age.     

Measuring the effectiveness of a collaborative for quality improvement in pediatric asthma care: does implementing the chronic care model improve processes and outcomes of care?

OBJECTIVE: To examine whether a collaborative to improve pediatric asthma care positively influenced processes and outcomes of that care. METHODS: Medical record abstractions and patient/parent interviews were used to make pre- and postintervention comparisons of patients at 9 sites that participated in the evaluation of a Breakthrough Series (BTS) collaborative for asthma care with patients at 4 matched control sites. SETTING: Thirteen primary care clinics. PATIENTS: Three hundred eighty-five asthmatic children who received care at an intervention clinic and 126 who received care at a control clinic (response rate = 76%). INTERVENTION: Three 2-day educational sessions for quality improvement teams from participating sites followed by 3 "action" periods over the course of a year. RESULTS: The overall process of asthma care improved significantly in the intervention group but remained unchanged in the control group (change in process score +13% vs 0%; P < .0001). Patients in the intervention group were more likely than patients in the control group to monitor their peak flows (70% vs 43%; P < .0001) and to have a written action plan (41% vs 22%; P = .001). Patients in the intervention group had better general health-related quality of life (scale score 80 vs 77; P = .05) and asthma-specific quality of life related to treatment problems (scale score 89 vs 85; P < .05). CONCLUSIONS: The intervention improved some important aspects of processes of care that have previously been linked to better outcomes. Patients who received care at intervention clinics also reported higher general and asthma-specific quality of life.