A2

Oral treatmentfor PDA?

—Alan H. Jobe, MD, PhD

Indomethacin to close the patent ductus arteriosus (PDA) is one of the few drugs de-veloped specifically for preterm infants. More recently, a related drug, ibuprofen, was

approved for the indication of PDA closure in preterm infants. The unique aspect isthat both of these are in a solution for intravenous use. Oral indomethacin and ibu-profen are widely available as very inexpensive pills and liquids worldwide. However,the intravenous preparations of indomethacin and ibuprofen are available only insome medically resource-rich countries and at exorbitant prices. Physicians caringfor preterm infants in the developing world have used oral ibuprofen or indomethacinto treat preterm infants with PDA because they have no alternatives. Several small tri-als demonstrated that the oral preparations can close the PDA. This month in TheJournal, Gokmen et al from Turkey report a randomized controlled trial demonstrat-ing that oral ibuprofen more effectively closed the PDA than did intravenous ibupro-fen. There were no complications associated with the oral treatment. However,because only 102 patients were randomized, this trial was underpowered to detectcomplications. The infants had mean birth weights of about 1200 g and, thus, werelarger than many of the extremely preterm infants treated with these drugs in theUS. The results are most intriguing and hopefully will stimulate a large trial in lessmature infants.

Article page 549<

Missed opportunitiesfor mental

and behavioralhealth care

—Sarah S. Long, MD

In an urban comprehensive healthcare system (Cambridge Health Alliance,Cambridge, Massachusetts), investigators performed a longitudinal study of

children and adolescents who received behavioral and mental health screening inorder to assess adherence to returning for subsequent preventive care visits. For thosenon-adherent patients, the authors sought to determine why they were ‘‘lost’’ fromtheir medical home or whether they were actually seen in another medical home set-ting (ie, acute care visit) or system venue (ie, emergency department). In fact, 85% of461 non-adherent children and adolescents subsequently returned for acute care ordelayed preventive care or emergency care in the same medical system. Since mentalhealth/behavioral health risk characteristics were one predictor of non-adherence withscheduled preventive health visits, it behooves pediatricians not to miss opportunitiesduring unscheduled visits to re-connect with patients and continue preventive mentalhealth care. This approach has worked toward keeping a vulnerable population fordelayed immunizations up-to-date.

Article page 666<

Mental, motor, andlanguage difficultiesin neurofibromatosis

type 1—Robert W. Wilmott, MD

The mental, motor, and language development of toddlers with neurofibromatosistype 1 (NF1) was studied in 39 infants by Lorenzo et al from The Children’s

Hospital at Westmead, New South Wales, Australia, and Children’s National MedicalCenter, Washington, DC. The children were compared with 42 age-matched controlson several instruments for developmental assessment. The results showed that thetoddlers with NF1 had significantly poorer mental and motor development comparedwith controls, and the parents indicated that most of them had delayed language skills.There were no differences in terms of behavior and executive functioning. Given thatthese abnormalities were present at 30 months, the authors suggest that 24 monthsmight be the best time to perform an initial developmental assessment to identifychildren with NF1 with impaired development.

Article page 660<

Vol. 158, No. 4