Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis.

This guideline is a revision of the clinical practice guideline, "Diagnosis and Management of Bronchiolitis," published by the American Academy of Pediatrics in 2006. The guideline applies to children from 1 through 23 months of age. Other exclusions are noted. Each key action statement indicates level of evidence, benefit-harm relationship, and level of recommendation. Key action statements are as follows:

Hypothermia and neonatal encephalopathy.

Data from large randomized clinical trials indicate that therapeutic hypothermia, using either selective head cooling or systemic cooling, is an effective therapy for neonatal encephalopathy. Infants selected for cooling must meet the criteria outlined in published clinical trials. The implementation of cooling needs to be performed at centers that have the capability to manage medically complex infants. Because the majority of infants who have neonatal encephalopathy are born at community hospitals, centers that perform cooling should work with their referring hospitals to implement education programs focused on increasing the awareness and identification of infants at risk for encephalopathy, and the initial clinical management of affected infants.

Longitudinal predictors of maternal stress and coping after very low-birth-weight birth.

OBJECTIVE: To determine longitudinal outcomes and contributors to parental stress and coping in mothers of very low-birth-weight (VLBW) children. DESIGN: Prospective cohort follow-up of high-risk VLBW children (n = 113), low-risk VLBW children (n = 80), and term children (n = 122) and their mothers from birth to 14 years. SETTING: Recruitment from level III neonatal intensive care and term nurseries in a large Midwestern region with follow-up at an academic medical center. PARTICIPANTS: A total of 315 mother-infant dyads enrolled from November 8, 1989, to February 22, 1992. MAIN EXPOSURES: High-risk VLBW infants had bronchopulmonary dysplasia. Comparison groups were demographically similar low-risk VLBW children (without bronchopulmonary dysplasia) and term children. MAIN OUTCOME MEASURES: Child IQ and self-report measures of parenting stress, family impact, maternal coping, education, and social support. RESULTS: After VLBW birth, mothers attained fewer additional years of education than term mothers (P = .04). Mothers of high-risk VLBW children felt more personal stress (P = .006) and family stress (P = .009) under conditions of low social support and had greater child-related stress than term mothers; however, they also expressed the highest levels of parenting satisfaction at 14 years. They became less likely to use denial (P = .02) and mental disengagement (P = .03) as coping mechanisms over time. Except for education attainment, mothers of low-risk VLBW infants did not differ from mothers of term children and at 14 years reported the lowest stress. CONCLUSIONS: Parenting a VLBW child had both positive and negative outcomes, dependent on child medical risk, child IQ, social support, and maternal coping mechanisms, suggesting that mothers experience posttraumatic growth and resilience after significant distress post partum.

Parenting very low birth weight children at school age: maternal stress and coping.

OBJECTIVE: To compare severity and determinants of stress and coping in mothers of 8-year-old very low birth weight (VLBW) and term children varying in medical and developmental risk. STUDY DESIGN: Three groups of mothers/infants were prospectively compared in a longitudinal study from birth to 8 years (110 high-risk VLBW, 80 low-risk VLBW, and 112 term). Maternal psychological distress, coping, parenting/marital stress, child health, and family impact were measured in the children at age 8 years. RESULTS: Mothers of VLBW children differed from term mothers, reporting less consensus with partners, more concern for their children's health, less parent-child conflict, and fewer years of education attained. Mothers of high-risk VLBW children experienced the greatest family and personal strains and used less denial and disengagement coping. The groups exhibited no differences in the sense of parenting competence, divorce rate, parenting/marital satisfaction, family cohesion, and psychological distress symptoms. Multiple birth, low socioeconomic status, and lower child IQ added to maternal stress. CONCLUSIONS: VLBW birth has long-term negative and positive impacts on maternal/family outcomes related to the infant's medical risk.

Neonatal candidiasis: ophthalmologic infection.

Endophthalmitis results from hematogenous seeding of the eye in preterm infants with candidiasis. Early systemic therapy decreases the frequency of eye involvement, now only about 6% in infants with systemic candidiasis. Eye disease can occur on the first day, but is more likely with prolonged candidemia. Candida albicans and C tropicalis predominate in newborns. Indirect ophthalmoscopy will identify the characteristic unilateral or bilateral, yellow-white, fluffy, retinal or vitreal balls with frequent hemorrhage or inflammatory vitreous haze. Systemic antifungal therapy alone usually results in good visual outcome, but unresponsive or recurrent lesions are reported. Lens abscesses presenting as cataracts may be seeded before regression of the tunica vasculosa lentis, leaving an infection nidus in a subsequently avascular structure that is poorly reached by antifungal drugs. Lensectomy may be required to clear the visual field and the infection. Candidemia is also implicated in progression of retinopathy of prematurity to stage 3 or beyond, possibly due to induction of cytokines or angiogenic factors.

Effects of infant risk status and maternal psychological distress on maternal-infant interactions during the first year of life.

The associations of infant medical risk, prematurity, and maternal psychological distress with the quality of maternal-infant interactions during the first year of life were evaluated in a prospective, longitudinal follow-up from birth. A total of 103 high-risk very low birth weight (VLBW) infants with bronchopulmonary dysplasia, 68 low-risk VLBW infants without bronchopulmonary dysplasia, and 117 healthy term infants were seen at 1, 8, and 12 months of age. Videotaped feedings at each age were rated using the Nursing Child Assessment Feeding Scale, and mothers completed the Brief Symptom Inventory as a measure of psychological distress. VLBW infant status was related to both maternal and infant behaviors as well as to maternal distress, and these relationships varied with infant age. Overall, VLBW infants displayed fewer responsive, clear interactions, with differences from term infants increasing over time. Maternal distress was related to less cognitive growth fostering for all mothers. Because maternal distress is more prevalent in mothers of VLBW infants postpartum, intervention efforts should focus on assessment of maternal distress and the challenges posed by the interactive behaviors of VLBW infants.

Coping and Psychological Distress in Mothers of Very Low Birth Weight Young Children.

OBJECTIVE: This study sought to increase understanding of relations among coping strategies, sociodemographic variables, and psychological distress in mothers of high-risk (HR) and low-risk (LR) very low birth weight (VLBW; < 1,500g) infants. DESIGN: The sample (N = 199) consisted of 77 mothers of HR VLBW infants, 43 mothers of LR VLBW infants, and a control group of 79 mothers of healthy, term infants. Data were collected with self-report questionnaires at birth and at 24 months postpartum. Relations among infant medical risk, multiple birth, maternal race, social class, and maternal coping were investigated. Hierarchical regression analyses were used to identify predictors of maternal psychological distress and to determine whether coping differentially moderated maternal psychological distress across groups. RESULTS: Infant medical risk, social support, and maternal coping independently predicted maternal psychological distress. Mothers of HR VLBW infants reported significantly greater psychological distress than mothers of LR VLBW or term infants. Greater use of avoidant and express emotions coping predicted higher psychological distress for all mothers. Greater use of humor coping had a buffering effect, reducing distress only for mothers of HRVLBW infants. Maternal coping scores were related to maternal race and social class, rather than to severity of infant medical risk. CONCLUSIONS: Sociocultural sources of resiliency, as well as biological risk factors, should be considered when developing strategies to enhance coping and parenting in HR populations.