very low birth weight infants need an MRI at term or some later time?

And what will

the clinician do with that information? In this issue of The Journal, Brown et al report
that clinical neurobehavioral assessments at term correlate with MRI abnormalities at
term. Perhaps this result justifies screening of infants to decide which infant is likely to
have MRI abnormalities.
Article page 32 <

Improving on quality
adjusted life years
measurements for
health outcomes
Sarah S. Long, MD

Hyperglycemia
during induction of
acute lymphocytic
leukemia
Robert W. Wilmott, MD

Nephrosis and clots

Thomas R. Welch, MD

A2

he general academic pediatrician has become familiar with quality adjusted life
years as a measure of health outcomes and data points in the equations of cost-effectiveness. We now need to get up to speed on more complex cost-utility analysis
measures, especially so that healthcare reform will be informed and childrens costutility tools will not be smaller versions of adult measures. In this issue of The Journal,
Carroll and Downs provide a robust assessment of utility values for a variety of pediatric health outcomes based on parental preferences. Researchers and policy makers
now will have this resource of citizen preferences for children, which can be shared
and compared.
In the accompanying editor, Prosser brings into focus the limitations of currently
available approaches for valuing child health, potential issues of using parents as proxy
respondents to these questions, and how the results of Carroll and Downs study
should and should not be used.
Article page 21 <
Editorial page 7 <

yperglycemia is a well recognized complication during induction therapy for acute

lymphocytic leukemia (ALL), and recent studies have shown that it is a risk factor
in several other acute illnesses. In this issue of The Journal, Sonabend et al from Baylor
College of Medicine have investigated whether children with ALL who develop hyperglycemia during induction have worse clinical outcomes. They have shown that
34% of their patients developed overt hyperglycemia and these children had poorer
relapse-free and overall survival. It appears that overt hyperglycemia is an independent
predictor of survival in children with ALL, and there is a place to study whether tighter
control of blood sugars would improve outcomes.
Article page 73 <

n the days before steroids and other drugs made childhood nephrotic syndrome
(NS) controllable, thromboembolic disease was one of the major causes of death.
Although older pediatric textbooks discuss this complication extensively, the association is often forgotten today, especially by primary care providers.
In the current issue of The Journal, Kerlin et al mined the records of two major
pediatric centers in Columbus, Ohio and Ann Arbor, Michigan, to establish how
much of a problem thromboembolic complications present to patients with NS today.
Although, fortunately and commendably, there was no mortality in their series of 326
children, nearly 10% of them had some evidence of thromboembolic disease during
their course. Risk factors included older (>12 years) age, severe proteinuria, and prior
history of thrombosis. Primary care providers should be aware that many of these
complications occurred very early in the course of the NSpotentially before
nephrology consultation had been obtained. This is certainly the case for the 4
children, in whom thromboembolic complications were present at the time of diagnosis of NS.
Article page 105 <
Vol. 155, No. 1