The vitamin D concentration in breast milk of women taking 400 IU vitamin D per day is relatively low, leading to vitamin D deficiency in breastfeeding infants. As a result, the American Academy of Pediatrics recommends breastfeeding infant vitamin D supplementation within days after birth.

Maternal vitamin D supplementation alone with 6400 IU/day safely supplies breast milk with adequate vitamin D to satisfy the requirement of her nursing infant and offers an alternate strategy to direct infant supplementation. (Read the full article)

Urologic outcomes of prenatal myelomeningocele closure have previously been reported. This study, however, represents a large, prospectively followed cohort of these patients and presents detailed findings of urologic outcomes. To our knowledge, this is the largest study of this type.

Our study is the only trial to compare urologic outcomes in children with myelomeningocele having undergone prenatal closure with those who had postnatal repair in a prospective and systematic manner. We report our findings at 12 and 30 months. (Read the full article)

There are no validated claims-based algorithms for identifying children with disabilities (CWD) to facilitate larger-scale studies of care quality for CWD.

This study develops the CWD algorithm, a claims-based algorithm for identifying diagnostic codes with a ≥75% chance of indicating CWD, and triangulates the algorithm against parent report and physician chart abstraction. (Read the full article)

Adolescent vaccination rates lag behind other childhood vaccines. Text messaging to improve uptake of adolescent vaccines has been shown to be effective in academic centers but has not been studied in other settings.

This study, done in 5 private and 2 safety-net practices, used a bidirectional text message as a behavioral prompt and showed text messaging was effective at increasing uptake of all adolescent vaccines. Costs were similar to other reminder/recall methods. (Read the full article)

Deferral of consent avoids delaying emergency interventions while ensuring consent to ongoing participation and use of data. Deferred consent is particularly important for enabling trials in pediatric settings, where many medicines and devices are unlicensed and untested for use.

Approaches for seeking deferred consent should balance the potential burden of obtaining consent against risk of bias due to outcome-related attrition. Ethics committees could consider approving data use when best efforts to obtain deferred consent are met with no response. (Read the full article)

De novo mutations of the sodium channel gene SCN1A are the major cause of Dravet syndrome, an infantile-onset epileptic encephalopathy. The incidence of this genetic disorder in the United States is unclear.

Dravet syndrome due to SCN1A mutation is twice as common in the United States as previously thought. Genetic testing should be considered in children with ≥2 prolonged febrile seizures by 1 year of age. (Read the full article)

Children with medical complexity require a disproportionate amount of health services due to a multitude of chronic severe illness, and their impact on the health care system appears to be increasing.

This study provides one of the first comparisons of health care utilization patterns for children with medical complexity between medical centers in a population-based cohort. (Read the full article)

Glucose-6-phosphate dehydrogenase deficiency remains a global as well as a North American burden for extreme hyperbilirubinemia and kernicterus and is often unpredictable during the first few days after birth. Newborn screening for this enzyme deficiency is not universally available but debated.

Point-of-care screening, using digital microfluidics, provides accurate, low blood volume, and affordable technology for rapid newborn glucose-6-phosphate dehydrogenase enzyme screening that could guide clinicians before infants’ discharge from well-child nurseries and meet existing American Academy of Pediatrics’ recommendations. (Read the full article)

The frequency of cardiac arrest is significantly lower in children than in adults, rendering the delivery of high-quality cardiopulmonary resuscitation more difficult. Metronome-based studies in adults showed improvement in adequate compression rate, with a detrimental effect on the depth of chest compressions.

This is the first pediatric study to confirm that the use of a metronome during cardiopulmonary resuscitation significantly improves the delivery of adequate rate without affecting the compression depth. This effect was more prominent among medical students and pediatric residents and fellows than nurses. (Read the full article)

A number of studies have reported an association between birth by cesarean delivery and adverse childhood health outcomes such as obesity, asthma, atopy, and a number of neurodevelopmental abnormalities. However, these studies have had limited capacity to control for confounders.

Using a prospective cohort while controlling for birth factors, social vulnerability, maternal BMI, and breastfeeding, we found few differences between children delivered by cesarean delivery and those born vaginally. Higher child BMI was explained by maternal BMI. (Read the full article)

Seven percent of children in the United States receive mental health services each year. There are more pediatric outpatient mental health care visits to primary care physicians (PCPs) than to psychiatrists. Mental health utilization patterns regarding different conditions and medication prescribing are unknown.

One-third of children with mental health conditions see PCPs only. A greater proportion of children with attention-deficit/hyperactivity disorder see PCPs for this than do those with anxiety/mood disorders. Children seeing PCPs are prescribed psychotropic medications more often than those seeing psychiatrists. (Read the full article)

Strictly-defined pediatric bipolar I disorder (BP-I) is a serious condition. Although lithium is a benchmark treatment and has shown effectiveness in adults for decades, no definitive efficacy or long-term safety studies had been performed in pediatric patients with BP-I.

This study provides evidence to support the efficacy of lithium in the acute treatment of youths with BP-I who are currently in a manic or mixed state. Lithium had an adverse effect profile that was acceptable for most patients. (Read the full article)

Many families share genetic cancer risk information with their children, and some parents and providers believe BRCA1/2 testing should be permitted in adolescence. The psychosocial effects and impact on health and risk behaviors of this knowledge is unknown.

In our cohort of 869 mother-daughter pairs, we found no differences in general adjustment, but 10- to 13-year-old girls with breast cancer family histories reported higher breast cancer–specific distress and perceived breast cancer risk. Mother distress was associated with daughter distress. (Read the full article)

Children with Down syndrome (DS) grow differently from other children. Advances in medical care, access to care, and improved life expectancy suggest that contemporary growth patterns may have improved over recent decades for children with DS in the United States.

New growth charts are presented for length/height, weight, head circumference, and BMI for children with DS (birth to 20 y). Weight gain in children <36 months, and stature for males are improved compared with older growth charts. (Read the full article)

Communication between parents and providers is an important driver of parent experience of care. The impact of nighttime communication, which has become increasingly relevant after changes in resident physician duty hours, on parent experience is unknown.

Parent communication with nighttime doctors and nurses, and parent perceptions of communication and teamwork between these providers, may be important drivers of parent experience. Efforts to improve nighttime communication, both with parents and between team members, may improve parent experience. (Read the full article)

The impact of neonatal abstinence syndrome is of concern because the number of newborns showing symptoms of withdrawal after intrauterine drug exposure is increasing worldwide. Newborns developing neonatal abstinence syndrome require prolonged medical treatment and longer hospital admission after birth.

This first randomized controlled trial presents data on newborns with neonatal abstinence syndrome treated with laser acupuncture. The findings suggest that adjuvant laser acupuncture has the potential to reduce duration of morphine therapy and length of hospital stay. (Read the full article)

National guidelines recommend testing and prophylaxis for chlamydia, gonorrhea, and pregnancy for adolescent sexual assault victims. Little is known about rates of testing and prophylaxis in adolescent victims of sexual assault evaluated in pediatric emergency departments.

There is significant variation in testing and prophylaxis practices in the pediatric emergency department evaluation of adolescent victims of sexual assault. Adolescents cared for in emergency departments with clinical pathways are more likely to receive recommended prophylaxis. (Read the full article)

Receiving primary care in a high-quality medical home may lead to reductions in hospital or emergency department (ED) utilization; however, the relationship between the medical home and postdischarge hospitalizations and ED visits is poorly understood.

Readmission rates vary markedly based on data source and definition. Unplanned readmissions were associated with absence of a usual source of well and sick care but not other medical home components. Lack of parent confidence at discharge identified patients at high risk for readmissions and ED visits shortly after discharge. (Read the full article)

Interactive mobile media devices have revolutionized children’s access to and experience of media, but research is lagging behind its adoption. A critical first step is to understand when and how young children adopt mobile media devices.

Our study found almost universal exposure, early adoption, and use of mobile media devices among young children in an urban, low-income, minority community. Studies are needed to update guidelines on the use of mobile media by young children. (Read the full article)

Apple is thought to be planning a merger of its app platforms, which means a developer can develop an app once and have it automatically run on iPhone, iPad, and Mac without any extra work. The initiative is called 'Marzipan.'

In a 5-4 decision, the Supreme Court sided with four iPhone owners who contend the company has been inflating the prices on the App Store. Current antitrust laws allow the plaintiffs to recover three times the amount of damages.

Sometimes your iPhone just isn't big enough to enjoy the best of iOS gaming. Grab your iPad and take advantage of the expanded screen real estate with these games.

The Olympic women's football final will be an all-European affair after Sweden ousted hosts Brazil on penalties and Germany beat Canada in Tuesday's semi-finals.

Forty-six teams have entered European qualifying for the 2019 FIFA Women's World Cup in France, with 16 involved in the preliminary round draw on 19 January.

Silvia Neid, who led Germany to Olympic gold in 2016, was named best coach at The Best FIFA Football Awards as Melanie Behringer just missed out on the top player gong.

Debutants Kosovo will make the short trip to Albania as the 16 FIFA Women's World Cup preliminary round entrants discovered their groups for April.

Former Scotland captain Shelley Kerr will replace Anna Signeul as coach after UEFA Women's EURO 2017, the ex-defender saying she is "extremely proud and honoured".

Kazakhstan, Albania, Israel, the Faroe Islands and best runners-up Moldova will progress to the qualifying group stage after coming through the preliminary round.

Two-time winners Germany will take on Iceland, the Czech Republic, Slovenia and the Faroe Islands in Group 5 following the qualifying group stage draw in Nyon.

As the 2019 FIFA Women's World Cup qualifying group stage kicks off, we explain how Europe's eight berths alongside hosts France will be decided with tight ties in prospect.

The FIFA Women's World Cup qualifying group stage has begun with the likes of England, Norway, Germany, Iceland and Austria all in goalscoring form.

European champions the Netherlands opened qualifying with a dramatic defeat of Norway as Iceland shocked Germany before being held themselves in October's fixtures.

England, Switzerland, Sweden, Italy, Spain and Finland maintained their perfect records but European champions the Netherlands were held by the Republic of Ireland.

Pernille Harder, Ada Hegerberg and Amandine Henry are shortlisted for the 2017/18 UEFA Women's Player of the Year award.

Scotland, Norway, Germany and Sweden have joined hosts France, England, Italy and Spain in the finals by winning their qualifying groups.

The United States beat the Netherlands to retain the trophy in Lyon while Sweden pipped England to bronze.

Lyon trio Lucy Bronze, Ada Hegerberg and Amandine Henry are the UEFA Women's Player of the Year nominees.

Lyon and England right-back Lucy Bronze is the first defender to win the poll of coaches and journalists.

At Battle High School in Columbia, Mo., students in geometry class have swapped their compasses and protractors for hammers and hard hats. And they're doing it for a good cause.

A Fin24 reader nearing retirement wants to know if he can access his retirement annuity now while still employed or only after officially retiring.

A health expert discusses what late joiner penalties are and how to avoid them.

Minister of Finance Tito Mboweni has announced a number of "exceptional tax measures as part of the fiscal package outlined by President Cyril Ramaphosa to fight the coronavirus pandemic.

Experts say if you can afford to continue repaying your debts, resist the temptation to take a payment holiday, even if you qualify for the relief.

Due to the spreading coronavirus pandemic and compounded by the lockdown, more South Africans have chosen to or have been forced to work from home.

There has been a distinct trend of consolidation among private medical schemes in South Africa, according to an actuarial specialist at Alexander Forbes.

A Fin24 reader currently under debt wants to know how lockdown will affect his monthly debt repayment order.

A South African working abroad, able to save R36 000 per month, hopeful that he will continue these earnings, seeks the best investment strategy. Investment expert Elian Wiener responds.

A Fin24 reader heading into retirement seeks the opinion of an expert on investing during the uncertainty of Covid-19.

Due to markets and festivals closing until the end of June, a Fin24 reader will have no source of income and wants to know if there will be a payment holiday period. A debt expert responds.

A Fin24 reader whose son is a student at Stellenbosch University and stays at a private residence near the campus wants to know what his options are in requesting a rental payment holiday.