A2

These results suggest that screening for increased risk of sudden death with ECGs isstill problematic. In an accompanying editorial,Washington puts this in a broader con-text, including other reasons why such screening would not be a cost-effective strategyin theUnited States. He recommends a staged approach that begins with family history,symptoms, and physical examination, with further testing being done based on thoseresults. Nevertheless, we must continue to strive to do better in the prediction ofincreased risk for sudden death in athletes, whether that is via new screening strategiesor improving old ones. Further research will be important.

Article page 783<Editorial page 712<

Early preterm birthincreases mortality in

congenital heartdisease

—Samuel S. Gidding, MD

The morbidity associated with late preterm/early full term delivery in infants withnormal hearts is well known. In this issue of The Journal, Cnota et al show that chil-

dren born between 34 and 40 weeks gestation have an incremental increase in mortal-ity associated with the degree of prematurity, which is consistent with other work(Pediatrics 2010;126:277-84). The current report supports the importance of waitingas close to term as possible before delivering an infant with in utero diagnosis ofcongenital heart disease. Too often, the presence of a cardiac defect in the womb cre-ates unnecessary medical anxiety. In most cases, the fetal circulation compensates forthe congenital defect. It is only after birth and after the ductus arteriosus closes thatemergency intervention is required. The vast majority of babies born with congenitalheart disease requires urgent, rather than emergent, care, particularly with the generalavailability of prostaglandin treatment to maintain ductal patency. Another argumentfor waiting as close to term as possible is the observation that the brain in certain con-genital heart defects may have delayed development, a potential explanation for thepoorer developmental outcome relative to the general population seen in congenitalheart disease (Circulation 2010;121:26-33). Although fetal diagnosis probably iden-tifies most serious congenital heart disease in the United States, the benefit on out-comes of this expensive technology has never been demonstrated; earlier deliverymay be an unintended adverse consequence.

Article page 761<

Maternal metabolism,birth weight, andpostnatal growth

—Stephen R. Daniels, MD, PhD

Maternal metabolism, including the maternal lipid profile, may have an impact onfetal growth and longer term outcomes. Most studies of the maternal lipid profile

during pregnancy have focused on the third trimester. In this issue of The Journal,Vrijkotte et al report on results of the Amsterdam Born Children and their Develop-ment (ABCD) Study, in which the maternal lipid profile was measured during the firsttrimester of pregnancy and birth weight and postnatal growth were followed in theinfant. The authors found that maternal triglyceride levels, but not total cholesterollevels, were associated with birth weight and a higher prevalence of large for gestationalage infants. Lower triglyceride levels in the first trimester were associated with morerapid postnatal growth.

Although this is an observational study, the results suggest that triglyceride levelsmay be a marker for metabolic pathways that influence fetal and postnatal growth.Further research may suggest methods of intervention that could promote optimalfetal growth and, ultimately, postnatal growth.

Article page 736<

And the glucosewas low?

—Alan H. Jobe, MD, PhD

For most physiological variables, continuous monitoring will detect abnormalvalues that would be missed by intermittent or symptom-directed monitoring. It

is now possible to continually measure tissue interstitial glucose in infants, but issuch monitoring useful in clinical practice? As a research tool, such measurementsdemonstrate that infants at risk of hypoglycemia often have low glucose values thatare not detected clinically. In this issue of The Journal, Harris et al demonstrate that

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