Your Voice

Dear Editor,
I thought the article by David C. Stockwell, MD, entitled, "Handheld computing in pediatric practice: Is it for you?" in the September 2006 issue, targeted many of the key advantages of using PDAs at the hospital or office: point of care access to information, drug and text references, patient education, and personal organizer.

However, I feel he neglected one area which can be greatly improved upon: Continuing Medical Education. There are a few current applications that will allow you to complete CME credit, such as Epocrates MobileCME. First, an article within your selected areas of interest can be downloaded to your handheld when it is synchronized with your computer. You can then read the article and answer the questions at your leisure. When your PDA or handheld is synchronized again, your answers are sent to the Web site for scoring and awarding CME credit.

This can be helpful to busy physicians who suddenly have a lull in their schedule, or are otherwise unoccupied, while waiting in line at the store, bank, etc. However, I think that mobile versions of popular pediatric publications, such as Contemporary Pediatrics, set up for CME quizzes to be downloaded and scored through their online Web site would be extremely convenient. Frequently I'm stuck waiting somewhere with my handheld, but not the latest edition of CP. It would be nice to use those ten or fifteen minutes to catch up on some journal reading, which many of us find difficult to do. If more pediatric journals offered this service, I believe physicians would use these opportunities for improving their knowledge base.

Multiple births rate

Dear Editor,
The article on multiple births in the January 2007 issue (and the accompanying parent page) contains seemingly contradictory claims on the frequency of multiple births. First it is stated that "one in every 250 American deliveries is a multiple birth." Then "for every 1,000 live births in 2003, 32 sets of twins and two sets of triplets were delivered..." The first statement indicates four multiple births for every 1,000 deliveries, while the second indicates 34 multiple births for every 1,000 live births (live births and deliveries should not differ significantly). Did I misunderstand these statistics or is there a discrepancy?

Robert Wiskind, MDPeachtree Park PediatricsAtlanta, Ga.

Author John E. Moore's response: I rechecked my sources and re-did the math myself. Let me explain the apparent contradiction. The prevalence of twins in America is 1/125. That means that one out of every 125 new babies statistically will be a twin, so the figure is correct as far as it goes. That figure is a statistical number, rather than an actual number, and it probably should be written that way rather than "one out of every 250 deliveries."

The actual birth rate for twins, from the Centers for Disease Control and Prevention (CDC) analysis of birth certificates, is 32 per 1,000. That means that 32 actual twin babies were born per 1,000 deliveries, or 16 deliveries out of 1,000 were for twins. The apparent discrepancy comes because twins have an incredibly elevated rate of infant mortality. Approximately one out of every five neonatal deaths was from a multiple, and about 35% of extremely low birth weight babies in America in 2003 are multiples. I believe that is why the CDC's numbers do not match up with the prevalence data, and also with the clinical picture most of us see in our daily practices.

Sincerely,John E. Moore, MD