2020 edition of the Rourke Baby Record: What is new in preventive care of children up to 5 years of age?

OBJECTIVE: To update primary care providers practising well-child and well-baby clinical care on the evidence that contributed to the recommendations of the 2020 edition of the Rourke Baby Record (RBR). QUALITY OF EVIDENCE: Pediatric preventive care literature was searched from June 2016 to May 2019, primary research studies were reviewed and critically appraised using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology, and recommendations were updated where there was support from the literature. MAIN MESSAGE: Notable changes in the 2020 edition of the RBR include the recommendations to limit or avoid consumption of highly processed foods high in dietary sodium, to ensure safe sleep (healthy infants should sleep on their backs and on a firm surface for every sleep, and should sleep in a crib, cradle, or bassinette in the parents' room for the first 6 months of life), to not swaddle infants after they attempt to roll, to inquire about food insecurity, to encourage parents to read and sing to infants and children, to limit screen time for children younger than 2 years of age (although it is accepted for videocalling), to educate parents on risks and harms associated with e-cigarettes and cannabis, to avoid pesticide use, to wash all fruits and vegetables that cannot be peeled, to be aware of the new Canadian Caries Risk Assessment Tool, to note new red flags for cerebral palsy and neurodevelopmental problems, and to pay attention to updated high-risk groups for lead and anemia screening. CONCLUSION: The RBR endeavours to guide clinicians in providing evidence-informed primary care to Canadian children. The revisions are rigorously considered and are based on appraisal of a growing, albeit still limited, evidence base for pediatric preventive care.

The 2020 Rourke Baby Record release: A time for reflection and looking forward.

The Rourke Baby Record (RBR) is a health supervision guide for providing care and anticipatory guidance to children aged 0 to 5 years in Canada. First developed in 1979, it has been revised regularly to ensure that it remains current and evidence-informed. The RBR has a longstanding relationship with the Canadian Paediatric Society (CPS), and relies on this organization for its expertise to inform the RBR guide's content. The 2020 edition of the RBR includes many recommendations based on evidence provided in current CPS position statements. The RBR Working Group is planning to develop app-based resources and an adapted RBR for clinical care provision in this challenging pandemic time to ensure that Canadian infants and children continue to receive high-quality care.

Édition 2020 du Relevé postnatal Rourke: Quoi de neuf en soins préventifs des enfants jusqu'à 5 ans?

OBJECTIF: Renseigner les fournisseurs de soins de première ligne qui dispensent des soins de médecine préventive durant l'enfance quant aux données ayant servi de fondement aux recommandations de l'édition 2020 du Relevé postnatal Rourke (RBR). QUALITÉ DES DONNÉES: Une recherche a effectuée parmi les publications sur les soins préventifs en pédiatrie entre les mois de juin 2016 et mai 2019, les principales études de recherche ont été revues et rigoureusement évaluées à l'aide de la méthode GRADE (Grading of Recommendations Assessment, Development and Evaluation) et les recommandations ont été actualisées là où les publications étayaient des changements. MESSAGE PRINCIPAL: Les changements notables de l'édition 2020 du RBR sont les recommandations de limiter ou d'éviter les aliments très transformés et riches en sodium alimentaire, de veiller au sommeil sécuritaire (les nourrissons en bonne santé doivent dormir sur le dos et sur une surface rigide à tous les dodos, et ils doivent dormir dans un moïse, un berceau ou une couchette dans la chambre des parents pendant les 6 premiers mois de vie), de ne pas emmailloter les nourrissons après qu'ils aient tenté de se retourner, de s'informer de l'insécurité alimentaire, d'encourager les parents à lire et à chanter aux nourrissons et aux enfants, de limiter le temps que les enfants de moins de 2 ans passent devant un écran (bien que ce soit accepté pour les appels vidéo), de renseigner les parents sur les risques et les torts associés aux cigarettes électroniques et au cannabis, d'éviter les pesticides, de laver tous les fruits et légumes ne pouvant être pelés, de connaître l'existence du nouvel Outil national d'évaluation du risque de caries, de noter les nouveaux symptômes alarmants de paralysie cérébrale et de problèmes neurodéveloppementaux et de porter attention aux nouveaux groupes à risque élevé pour le dépistage du plomb et de l'anémie. CONCLUSION: Le RBR s'efforce de guider les cliniciens pour leur permettre de dispenser des soins de première ligne factuels aux enfants canadiens. Les révisions sont rigoureusement étudiées, et sont basées sur l'évaluation d'une base de données probantes croissante, quoique toujours limitée, sur les soins préventifs en pédiatrie.

Carnitine/xenobiotics transporters in the human mammary gland epithelia, MCF12A.

The barrier function of the human mammary gland collapses if challenged with cationic drugs, causing their accumulation in milk. However, underlying molecular mechanisms are not well understood. To gain insight into the mechanism, we characterized transport of organic cations in the MCF12A human mammary gland epithelial cells, using carnitine and tetraethylammonium (TEA) as representative nutrient and xenobiotics probes, respectively. Our results show that the mammary gland cells express mRNA and proteins of human (h) novel organic cation transporters (OCTN) 1 and hOCTN2 (a Na+-dependent carnitine carrier with Na+-independent xenobiotics transport function), which belong to the solute carrier superfamily (SLC) of transporters. Other SLC OCTs such as hOCT1 and extraneuronal monoamine transporter (EMT)/hOCT3 are also expressed at mRNA levels, but hOCT2 was undetectable. We further showed mRNA expression of ATB0+ (an amino acid transporter with a Na+/Cl(-)-dependent carnitine transport activity), and Fly-like putative transporter 2/OCT6 (a splice variant of carnitine transporter 2: a testis-specific Na+-dependent carnitine transporter). TEA uptake was pH dependent. Carnitine uptake was dependent on Na+, and partly on Cl-, compatible with hOCTN2 and ATB0+ function. Modeling analyses predicted multiplicity of the uptake mechanisms with the high-affinity systems characterized by K(m) of 5.1 microM for carnitine and 1.6 mM for TEA, apparently similar to the reported hOCTN2 parameter for carnitine, and that of EMT/hOCT3 for TEA. Verapamil, cimetidine, carbamazepine, quinidine, and desipramine inhibited the carnitine uptake but required supratherapeutic concentrations, suggesting robustness of the carnitine uptake systems against xenobiotic challenge. Our findings suggest functional roles of a network of multiple SLC organic cation/nutrient transporters in human mammary gland drug transfer.