Transverse Aortic Arch to Descending Aorta Ratio: A New Echocardiographic Parameter for Management of Coarctation of the Aorta in the Infant

Objective. The purpose of this study was to establish an objective criterion to help assess adequacy of the transverse arch in newborns with coarctation and thereby optimize preoperative surgical decision making. Methods. Echocardiograms of 47 patients <6 months of age who underwent coarctation repair from September 2005 to November 2008 and 47 age‐matched healthy infants were reviewed. The proximal and distal transverse aortic arch to descending aorta ratios (TAA : DAO ratio) were calculated from the end‐systolic proximal and distal transverse aortic arch diameters and diameter of the descending aorta at the diaphragm. Results. Both the proximal and distal TAA : DAO ratios were significantly lower in the study vs. control group (P= .001) and in patients who underwent patch reconstruction of the aorta vs. extended end‐to‐end anastomosis (P= .014; P= .015). All patients who underwent patch reconstruction had a proximal and/or distal TAA : DAO <0.65. A cutoff of 0.65 was derived based on our analyses and an algorithm was developed to guide decision making. Forty‐six out of 47 patients were free from reintervention. Conclusion. The TAA : DAO ratio appears to be an accurate parameter by which the adequacy of the transverse arch can be assessed preoperatively using the proposed algorithm, and thus help determine the type of surgical intervention and approach.     

Changes in Nurse Practitioners' Knowledge and Behaviors Following Brief Training on the Healthy Eating and Activity Together (HEAT) Guidelines

IntroductionPrimary care providers, particularly pediatric nurse practitioners, are an integral force involved in tackling the obesity epidemic among youth. The majority of nurse practitioners, however, report low proficiency regarding their ability to adequately prevent and treat pediatric overweight. In response, the National Association of Pediatric Nurse Practitioners (NAPNAP) developed the evidence-based Healthy Eating and Activity Together (HEAT) Clinical Practice Guideline (CPG) to improve provider behavior and efficacy.MethodThirty-five nurse practitioners attending the NAPNAP Annual Conference participated in an intensive 4-hour HEAT CPG training session. Pre-training and post-training data were collected on provider knowledge, practice behaviors, and barriers in relation to the prevention of overweight among youth.ResultsPost-training results revealed significant improvements in (a) practitioner knowledge (assessment of patient growth, family history, psychosocial functioning, nutrition, and physical activity); (b) practitioners' intent to improve behavior (i.e., increased intent to use behavior modification and counseling aimed at patient and family behavior change); and (c) practitioners' report of increased confidence in ability to address barriers.DiscussionStudy findings demonstrate preliminary support for the HEAT CPG as an effective tool aimed at helping providers to improve their ability to maintain patients' healthy weight. Future research is needed to verify the effects of HEAT CPG on long-term improvements in care.     

Clinical Profile of Apparently Healthy Neonates With In Utero Drug Exposure

OBJECTIVE: To identify the characteristics of neonates exposed to drugs in utero but admitted to the normal newborn nursery because of apparent good health. DESIGN: Retrospective evaluation with chart review of toxicology screening tests sent from a normal newborn nursery. SETTING: Newborn service in an urban hospital. PARTICIPANTS: Fifty newborns with positive drug screening results. MAIN OUTCOMES: Frequency of positive results and assessment of demographic features and neonates' clinical features. RESULTS: 43 (86%) of the apparently healthy newborns tested positive for cocaine. The results of simultaneous or proximate drug testing of mothers and their newborns were discordant in 11 (22%) cases. CONCLUSIONS: Neonates with in utero drug exposure often are born with few or no signs of abnormality and are admitted to the normal newborn nursery.     

Disorders of Fatty Acid Oxidation in the Era of Tandem Mass Spectrometry in Newborn Screening

With MS/MS, the world of newborn screening has changed from the “one test-one disorder” system to “one test-many disorders.” Disorders of fatty acid oxidation can be rapidly identified with a dried newborn blood spot on filter paper that is used to detect many other inborn error of metabolism. MS/MS allows the opportunity to identify many newborns with a FAOD before a catastrophic insult, thus, decreasing morbidity and mortality. In addition, MS/MS allows improved understanding of the natural history of FAODs, such as CPT I, MCAD, and VLCAD deficiencies. With appropriate support for biochemical genetics expertise, MS/MS used in newborn screening programs can provide a positive impact on the health of infants with a FAOD and their families.