Journal Club: top 10 of 2008, pulse ox usefulness, and the dangers of teens on MySpace

Top 10 List

Dr. Michael G. Burke chose the 10 best articles he reviewed in Journal Club over the past 12 months. The list below is chronological by issue of Contemporary Pediatrics. Head to http://www.contemporarypediatrics.com/ to read the summary and commentary on all of the top 10, as well as all the other Journal Club inclusions.

1. Less TV/computer use lowers BMI in young children.
Epstein LH, et al: Arch Pediatr Adolesc Med 2008;162:239 (May 2008)

3. 2005-2007 data show rise in postvaccination syncope
Centers for Disease Control and Prevention: MMWR 2008;57:457 (July 2008)

4. Many healthy infants and toddlers are vitamin D–deficient
Gordon CM, et al: Arch Pediatr Adolesc Med 2008;162:505 (August 2008)

5. Detecting congenital heart defects with pulse oximetry
Meberg A, et al: J Pediatr 2008;152:761 (August 2008)

6. Patch protects against travelers diarrhea
Frech SA, et al: Lancet 2008;372:2019 (August 2008)

7. Intranasal steroid eases mild obstructive sleep apnea
Kheirandish-Gozal, L et al: Pediatrics 2008;122:e149 (September 2008)

8. Your stethoscope could harbor bacterial pathogens
Youngster I, et al: Acta Paediatrica 2008;97:1253 (October 2008)

9. Minocycline associated with autoimmunity
El Hallak M, et al: J Pediatr 2008;153:314 (November 2008)

10. Using a fan reduces SIDS risk
Coleman-Phox K, et al: Arch Pediatr Adolesc Med 2008;162:963 (December 2008)

Pulse ox screening helps detect duct-dependent circulation

Investigators compared the overall rate of detection of duct-dependent circulation in one region of Sweden that screened with pulse ox with other regions that used physical examination alone. The total number of infants with duct-dependent circulation was 60 in the screening region, and 100 in all the other regions combined.

The combination of neonatal physical examination plus pulse ox screening for duct-dependent heart disease had a detection rate of 82.8%, with a low false positive rate of 0.17% for pulse ox. This compares with a 62.5% detection rate for physical examination alone. Whereas undiagnosed critical heart disease was not associated with a single infant death in the region using pulse ox screening, it was responsible for five deaths in the region not using the screening. Furthermore, 92% of all babies with duct-dependent circulation were diagnosed before leaving the hospital in the screening region, a significantly higher proportion than among babies from other regions of Sweden (de-Wahl Granelli A, et al: BMJ 2009;338:3031).

Commentary

This study is similar to a Norwegian report of last year, with one important difference. In the earlier study, pulse ox was done on admission to the nursery, while here it was on the day of discharge (see #5 on the accompanying Top 10 for citation). The delay may explain why the false positive rate was lower in the current study-0.17% instead of 0.6%. This lower rate, when applied to large groups of newborns, results in many fewer echocardiograms, lower screening cost, and increased likelihood that pulse ox screening will be adopted. The authors found that referral of all cases with positive oximetry results for echos resulted in only 2.3 echos with normal cardiac findings for every true case of duct-dependent circulation.