Vulnerable Child Syndrome and Its Variants

Green, Morris

doi:10.1542/pir.8-3-75

Cited by 43 publications

(31 citation statements)

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“…Yet, the perceived potential for recurring events or a serious underlying disorder often provokes concern in caregivers and clinicians. 2,4,5 This concern can compel testing or admission to the hospital for observation, which can increase parental anxiety and subject the patient to further risk and does not necessarily lead to a treatable diagnosis or prevention of future events. A more precise definition could prevent the overuse of medical interventions by helping clinicians distinguish infants with lower risk.…”

Section: Change In Terminology and Diagnosismentioning

confidence: 99%

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Tieder¹,

Bonkowsky²,

Etzel³

et al. 2016

Pediatrics

139

154

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This is the fi rst clinical practice guideline from the American Academy of Pediatrics that specifi cally applies to patients who have experienced an apparent life-threatening event (ALTE). This clinical practice guideline has 3 objectives. First, it recommends the replacement of the term ALTE with a new term, brief resolved unexplained event (BRUE). Second, it provides an approach to patient evaluation that is based on the risk that the infant will have a repeat event or has a serious underlying disorder. Finally, it provides management recommendations, or key action statements, for lower-risk infants. The term BRUE is defi ned as an event occurring in an infant younger than 1 year when the observer reports a sudden, brief, and now resolved episode of ≥1 of the following: (1) cyanosis or pallor; (2) absent, decreased, or irregular breathing; (3) marked change in tone (hyper-or hypotonia); and (4) altered level of responsiveness. A BRUE is diagnosed only when there is no explanation for a qualifying event after conducting an appropriate history and physical examination. By using this defi nition and framework, infants younger than 1 year who present with a BRUE are categorized either as (1) a lower-risk patient on the basis of history and physical examination for whom evidence-based recommendations for evaluation and management are offered or (2) a higher-risk patient whose history and physical examination suggest the need for further investigation and treatment but for whom recommendations are not offered. This clinical practice guideline is intended to foster a patient-and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient outcomes, support implementation, and provide direction for future research. Each key action statement indicates a level of evidence, the benefi t-harm relationship, and the strength of recommendation.

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Section: Change In Terminology and Diagnosismentioning

confidence: 99%

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Tieder¹,

Bonkowsky²,

Etzel³

et al. 2016

Pediatrics

139

154

View full text Add to dashboard Cite

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“…This case conforms to what is known regarding the undue concern some parents experience on receiving carrier or false-positive results from NBS programs, 11,17 leading to excess health service utilization 18 and the 'vulnerable child' phenomenon. 19 Uncertainty with regard to SCD carrier status was also aired as conjecture among those with little knowledge: as an expectation that carrier results might prove clinically helpful and that clinicians might now, or in the future, be able to manage individual patients better because of it. Some providers shared this optimistic conjecture, which provided perverse support for result disclosure.…”

Section: Discussionmentioning

confidence: 99%

Understanding sickle cell carrier status identified through newborn screening: a qualitative study

et al. 2009

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The expansion of newborn screening (NBS) is increasing the generation of incidental results, notably carrier results. Although carrier status is generally understood to be clinically benign, concerns persist that parents may misunderstand its meaning, with deleterious effects on children and their families. Expansion of the NBS panel in Ontario, Canada in 2006 to include sickle cell disorders drew attention to the policy challenge of incidental carrier results. We conducted a study of consumer and provider attitudes to inform policy on disclosure. In this paper, we report the results of (i) qualitative interviews with health-care providers, advocates and parents of carrier infants and (ii) focus groups with new parents and individuals active with the sickle cell community. Lay and provider participants generally believed that carrier results were clinically insignificant. However, some uncertainty persisted among lay consumers in the form of conjecture or doubt. In addition, consumers and advocates who were most informed about the disease articulated insistent yet dissonant claims of clinical significance. Meanwhile, providers referenced research knowledge to offer an equivocal assessment of the possibility and significance of clinically symptomatic carrier status. We conclude that many interpretations of carrier status are in circulation, failing to fit neatly into the categories of 'clinically significant' or 'benign.' This creates challenges for communicating clearly with parents -challenges exacerbated by inconsistent messages from screening programs regarding the significance of sickle cell carrier status. Disclosure policy related to incidentally generated infant carrier results needs to account for these complex realities.

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“…Among the plausible explanations for unevenness in the distribution of pediatric morbidity is the possibility that some children sustain disproportionate rates of illness and injury as a consequence of greater exposure to psychologic stressors (2,8). This explanation has been supported in recent years both by epidemiologic evidence for reliable stress-morbidity associations (9-1 1) and by psychobiologic evidence that pathophysiologic changes can accompany emotional stress (12)(13)(14).…”

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confidence: 99%

Adrenocortical and Behavioral Predictors of Immune Responses to Starting School

Adams

et al. 1995

Pediatr Res

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Associations between major psychologic stressors and immune function have been documented in previous research, but few studies have investigated immune changes attending minor, normative stressors. This study examined adrenocortical and behavioral predictors of immune responses to starting kindergarten in 39 five-year-old children, who completed laboratory visits for venipunctures 1 wk before (time 1) and 1 wk after (time 2) school entry. At time 1, children were also immunized with pneumococcal vaccine. Immune responses were measured as change scores for T (CD4+ and CD8+) cells, B (CD19+) cells, lymphoproliferative responses to pokeweed mitogen (PWM), and type-specific pneumococcal antibody responses (ABR). Adrenocortical response was assessed as the change in salivary cortisol level, and behavioral difficulty with school adjustment was scored using parental ratings of behavior problems, stress due to changes in routines, and degree of adaptive challenge. Salivary cortisol rose after lundergarten entry (means = 0.39 ? 0.28 to 0.49 ? 0.36 pg/dL, p = 0.03) and was unrelated to behavioral difficulties. CD4+ cells increased in number, whereas PWM declined, and ~D 1 9 + cells showed a borderline increase. Change in salivary cortisol was positively associated with change in ~~1 9~ (ACD19+) and inversely related to ABR. Scores for behavioral difficulty were inversely associated with A C D~+ and Among the most striking and reliable epidemiologic features of disease in childhood populations is the uneven, nonrandom character of morbidity distributions. Approximately 15-20% of children incur the majority of illness visits in primary care settings and sustain over 50% of the overall population morbidity (1, 2). This maldistribution of pediatric morbidity and

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Vulnerable Child Syndrome and Its Variants

Cited by 43 publications

References 0 publications

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Understanding sickle cell carrier status identified through newborn screening: a qualitative study

Adrenocortical and Behavioral Predictors of Immune Responses to Starting School

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