Highlights from the Pediatric Academic Societies meeting

Adolescent suicide risk and access to guns, teens' cognitive dissonance on football concussions and more presented May 4-7 in Washington, D.C.

Some children at risk of suicide have easy access to guns

Roughly one in six children deemed at risk of suicide say that there are firearms at home, a study in urban centers finds. Stephen Teach, a pediatric emergency medicine physician at Children’s National Medical Center in Washington, D.C., and his colleagues analyzed responses collected from 524 children and adolescents interviewed at several urban hospital emergency rooms in the United States. Of the patients, 180 were in the ER with psychiatric complaints and 344 were seen for other reasons.

Overall, 151 of the children were deemed at risk of suicide by a doctor after answering yes to one of four questions: Have you ever tried suicide, felt your family would be better off without you, had thoughts about suicide in the past week, or wished you were dead in the past week? While 65 percent of the children getting a psychiatric assessment answered yes to at least one question, so did nearly 10 percent of the children examined for nonpsychiatric problems.

What’s more, 26 of the at-risk kids said there were firearms at home, Teach reported May 6. Eight of them said they knew how to get access to a gun or ammunition, and four kids could get to both. Teach said that roughly 90 percent of people who attempt suicide with a gun kill themselves. “It’s a lethal means, much more than pills,” he said. Doctors in emergency rooms “are in a unique position to reduce access to firearms,” he said, by assessing kids’ risk and talking with parents.

Maximizing preemies’ umbilical cord blood

A newborn’s umbilical cord is typically clamped immediately, severing it as a conduit for blood from mother to baby. Researchers now find that for very preterm infants, keeping the cord unclamped shortly after birth and squeezing it with a few long strokes from mother toward the child delivers valuable blood to the infant. The process — called milking because it looks similar to the technique used for milking cows — appears to benefit these at-risk babies.

Neonatologist Anup Katheria of the University of California, San Diego and his colleagues randomly assigned 60 babies born an average of 11 weeks premature to get either standard immediate clamping or to receive delayed clamping while medical staff milked the cord with three strokes, a process that takes less than a minute.

Measurements of blood flow in the newborns conducted 6, 18 and 30 hours after birth showed that those who received the extra cord contents had greater blood flow in their tiny circulatory systems and were less likely to need a blood transfusion or oxygen. Katheria, who reported the findings May 6,  said that milking the cord seems to deliver more blood and might dislodge and deliver to the infant valuable stem cells that line the inside of the cord. The study is the largest randomized trial to test the procedure, Katheria said.

Bad attitude on concussions

One in four high school football players attending a competitive football summer camp said they had experienced a concussion, researchers reported May 6. Of the 120 players attending the camp in the summer of 2012, 70 percent said they had received education on symptoms of concussions and a higher percentage recognized symptoms of a concussion, such as headache, dizziness and difficulty remembering things.

But more than half of the players believed it would be safe to play football with a concussion, and about half said they wouldn’t tell their coach if they had a concussion during a game, physician Brit Anderson of Cincinnati Children’s Hospital Medical Center reported. Playing with a concussion risks exacerbating the injury.

The players had filled out a questionnaire at the start of camp. Adolescents with a good understanding of concussions showed no better judgment on these choices than did kids with poorer knowledge of the condition. Anderson concluded that education alone may not solve the problem of kids exposing themselves to further injury after concussions.

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