Teaching About Human Milk, Teen Depression

Improving exclusive human milk feedings for NICU infants is a major public health issue in India, where Diane Spatz, PhD, RN-BC, FAAN, director of The Children’s Hospital of Philadelphia’s Breastfeeding and Lactation Program, spent two weeks teaching nurses and physicians about human milk and implementation of her 10 Step Model for Human Milk and Breastfeeding in Vulnerable Hospitals.

Dr. Spatz visited nine NICUs throughout Delhi and Jaipur, both private and government-run, and noticed that exclusive human milk feeds are nonexistent, despite breastfeeding being the cultural norm in India. In Jaipur alone, the four government hospitals she worked with deliver more than 50,000 infants each year, with 25 percent going to the NICU.

Research by doctors at CHOP has shown the impact breast milk can have on the health of babies in the NICU.

Task Force Guidelines Recommend Screening for Teen Depression

About 8 percent of U.S. adolescents experience major depression each year, according to the U.S. Preventive Services Task Force (USPSTF), a government-backed panel of prevention experts. In a new report, the USPSTF updated its recommendations released in 2009 for screening adolescents and children for major depressive disorder in primary care and similar settings, such as school-based clinics.

“Because primary care providers are often the first point of professional contact for children and their families during times of distress, they can facilitate early identification of mental health issues; begin initial management; and refer children, as necessary, for further mental health assessment and treatment,” the report states. It reaffirmed USPSTF guidelines that adolescents between 12 and 18 years old in the U.S. should be screened for depression.

"Treating someone early on can change the trajectory of what happens later," said Rhonda Boyd, PhD, a CHOP psychologist interviewed in a Reuters article about the report. She said those treated early will likely have less severe bouts of depression and a less chronic course going forward.

The report pointed out that more evidence is needed to determine if screening children younger than 12 years is beneficial.

"Hopefully with these recommendations, more people will be doing more research on how to best screen for depression in the younger children," said O’Nisha Lawrence, MD, a CHOP psychiatrist also interviewed by Reuters.

Dr. Boyd and Dr. Lawrence were not involved in the new recommendation.

Research Team Pinpoints Malfunction in High Risk Form of Acute Lymphoblastic Leukemia

"These findings expand the number of ALL patients who should be amenable to precision medicine therapies that add targeted inhibitors to chemotherapy for ALL patents with specific genetic changes in the leukemia cells," stated Stephen Hunger, MD, chief of the Division of Oncology and the director of the Center for Childhood Cancer Research at CHOP, in a press release announcing results of a study led by St. Jude Children’s Research Hospital scientists. The findings appeared in the Feb. 8 issue of the journal Cancer Cell. Dr. Hunger was a co-author.

The research team discovered details of how the abnormal breakage and rearrangement of chromosomes in white blood cells triggers a particularly aggressive form of ALL called “Ph-like ALL.” In analysis of cells from patients with ALL, the scientists found the characteristic rearrangements in all the leukemic cells, suggesting these changes were fundamental to the development of cancer. The chromosomal rearrangements in the leukemia resulted in a truncated version of a gene called the erythropoietin receptor (EPOR) gene, driving the white blood cells to proliferate out of control.

Ruxolitinib, a drug already available to treat other cancers, may inhibit the over-activated biological pathway in the leukemia. Based on the results of this St. Jude-led study, Dr. Hunger said, a clinical trial developed by the Children’s Oncology Group (COG) to test this strategy with ruxolitinib will include children with ALL and EPOR rearrangements. COG is a federally supported clinical trials group focused exclusively on childhood cancer.

PHA Awards Grant to Pulmonary Hypertension Researcher

The Pulmonary Hypertension Association (PHA) announced in a news release that David Frank, MD, PhD, an attending physician at CHOP and an instructor in the department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, received a $50,000 research and mentoring grant. The grant was made possible through a generous donation by Betty Lou Wojciechowski in honor of her two late sons, Matthew and Michael, who lost their battles to PH. Dr. Frank’s research on mice may lead to an understanding of whether reactivated cells following lung injury can regenerate lost lung tissue, including lung blood vessels, to prevent the development of PH for infants with a chronic lung disorder.

Editorial Discusses Behavioral Nudges to Improve Outpatient Antibiotic Prescribing

In an editorial written for JAMA, Jeffrey Gerber, MD, PhD, commented on the results of a simple 18-month behavioral intervention that aimed to reduce inappropriate antibiotic prescribing in 47 primary care offices in Boston or Los Angeles. Physicians received immediate feedback in the form of pop-up messages from the electronic health record (EHR) when an antibiotic was not indicated, and it provided suggestions for nonantibiotic alternatives. Clinicians also were prompted to enter free-text justifications for prescribing antibiotics into patients’ EHRs. If they were among those with the lowest inappropriate prescribing rates, they received emails stating that they were a “top performer.”

“This report highlights the promise of various types of immediate feedback to improve antibiotic prescribing and justifies further investigation to devise the most effective, generalizable, and sustainable interventions,” wrote Dr. Gerber, an attending physician in the Division of Infectious Diseases at CHOP and a senior scholar within the Penn Center for Clinical Epidemiology and Biostatistics. “This might require tailoring the intervention to specific practice, practitioner, or patient characteristics. Future work should also expand to focus on the most common infections for which antibiotics are sometimes (but often not) indicated, such as acute pharyngitis and sinusitis (although these conditions triggered the nudge in this intervention, prescribing rates for pharyngitis and sinusitis were not measured), and to optimize guideline-concordant antibiotic choice (narrower) and duration of therapy (shorter) for common bacterial infections.”