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In This Issue of JAMA |

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JAMA. 2014;311(17):1707-1709. doi:10.1001/jama.2013.279472.
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Edited by Jody Zylke, MD, and Howard Bauchner, MD


Invasive candidiasis is associated with impaired neurodevelopment and mortality in premature infants. Benjamin and colleagues assessed the effect of fluconazole prophylaxis (twice weekly for 42 days) in a multicenter, randomized, placebo-controlled trial involving 361 premature infants with birth weight less than 750 g. The authors report that compared with placebo, fluconazole prophylaxis did not result in a lower incidence of a composite outcome of death or invasive candidiasis.

Controversy exists as to whether use of steroids after hepatoportoenterostomy improves clinical outcomes in infants with biliary atresia. To explore this question, Bezerra and colleagues randomly assigned 140 infants with biliary atresia to receive high-dose steroid therapy or placebo following hepatoportoenterostomy. The authors report steroid treatment did not result in a statistically significant improvement in biliary drainage 6 months after surgery.

Munoz and colleagues assessed the safety and immunogenicity of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) immunization during pregnancy in a randomized, placebo-controlled study involving 48 pregnant women. The authors found no increased risk of adverse events among the women who received antepartum Tdap or their infants; high levels of pertussis antibodies in the infants; and no significant alteration in infant response to routine DTaP vaccination. In an Editorial, Jiménez-Truque and Edwards discuss maternal pertussis immunization to protect young infants.

In an analysis of longitudinal data from more than 2 million Swedish children—including identification of twin, sibling, and cousin pairs—Sandin and colleagues assessed the familial aggregation of autism spectrum disorders. The authors found that the individual risk of autism spectrum disorder and autistic disorder increased with increasing genetic relatedness, with an estimated heritability of approximately 50%. In an Editorial, Schendel and colleagues discuss genetic and environmental contributions to autism spectrum disorders.

To examine trends in prevalence of type 1 and type 2 diabetes among youth, Dabelea and colleagues analyzed medical record data from more than 3 million youth from birth to 19 years in 5 areas of the United States. The authors report that between 2001 and 2009 the prevalence of both type 1 diabetes and type 2 diabetes increased.


Short stature—a height that is more than 2 SDs below the mean for age, sex, and population—occurs in approximately 2% of children. Cohen reviews the evaluation and differential diagnosis of short stature and summarizes the evidence relating to efficacy and safety of recombinant human growth hormone therapy for children with idiopathic short stature.

Prenatal exposure to antiepileptic drugs is associated with adverse effects; however, effects of antiepileptic drug exposure from breast milk are not clear. A recent article in JAMA Neurology reported no adverse developmental effects among children of mothers taking antiepileptic drugs while breastfeeding. In this From The JAMA Network article, Meador discusses the need to balance beneficial effects of breastfeeding with possible risks of postnatal antiepileptic drug exposure among children of mothers taking antiepileptic drugs.

A healthy 4-year-old girl presents for evaluation of a white pupillary reflex in the left eye. On examination, the left eye does not follow an object. What would you do next?



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