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pages in future issues, as well as a historical piece about the EPA’s growth and devel-opment by Ehrich et al.

The Journalwelcomes themembers of the EPA as readers, and encourages all readersto find out more about EPA (http://www.epa-unepsa.org/).

Article page 373<Article page 374<

Hyponatremia inInfants with

cystic fibrosis— Robert W. Wilmott, MD

Hyponatremia can be a presenting symptom of cystic fibrosis in infancy, especiallyin countries with hot climates. In this issue of The Journal, Guimar~aes et al from

the Universidade Federal de Minas Gerais, Brazil, have evaluated hyponatremia atdiagnosis and then longitudinally in 20 infants with cystic fibrosis. They demonstratedthat 95% of the patients had hyponatremia at the time of diagnosis, and the serumsodium levels had normalized within the first year. Factors associated with variationsin serum sodium were diet and ambient temperature. Their findings indicate thatinfants with cystic fibrosis in hot countries are still at risk for developing hyponatremiaeven when receiving an increased salt intake.

Article page 285<

Maternal postpartumdepression andintimate partner

violence— Sarah S. Long, MD

In a study of socioeconomically disadvantaged urban mothers attending routineclinic appointments for their infants, questionnaires were used to screen for symp-

toms of postpartum depression and intimate partner violence. Questionnaires usingvalidated tools were administered at visits through 6 months of age; children’s atten-dance at scheduled and unscheduled visits, as well as emergency department visits,were assessed until the age of 2 years. Postpartum depression and intimate partnerviolence were reported frequently (26% and 7% of women, respectively). An impor-tant novel finding was the presence of both problems concurrently. For example, 58%ofmothers reporting intimate partner violence also reported symptoms of postpartumdepression, and 16% who reported postpartum depression had symptoms of intimatepartner violence. Most positive screens occurred at the first screening (usually at theinfant’s 2-month visit). Although children of women with postpartum depressionhad similar rates of attending well-child clinic visits, they were more likely to havemultiple emergency department visits.

It behooves pediatric providers to consider maternal problems of postpartumdepression and intimate partner violence concurrently, and to consider mothers’health and well being as central to that of their children. Studies of interventionsshould take into account the linking of these problems.

Article page 348<

NEC withthickened feeds

— Alan H. Jobe, MD, PhD

Neonatologists seem determined to treat the poorly defined reflux that frequentlyoccurs in preterm infants with something—preferably drugs that are off-label

and have no proven efficacy. Popular choices are prokinetic agents and protonpump inhibitors. Another unvalidated strategy is to thicken feeds. In this issue ofThe Journal, Beal et al report a series of 22 cases of necrotizing enterocolitis (NEC)that were associated with a commercial xanthan gum-containing food thickener.These cases of NEC are quite unique in the time of onset of the disease after birth.Most of the 22 infants were preterm, but the onset of NEC was at a mean of about40 weeks gestational age, with a number of infants developing NEC at home after dis-charge—a most unusual timing for the onset of NEC. Although this case series doesnot prove cause and effect, the disease presentation strongly implicates this food thick-ener as a risk for NEC. Perhaps clinicians should restrain their enthusiasm for otherthickeners for the feeding of preterm infants as well. The proven treatments for refluxin otherwise normal preterm infants are time and patience.

Article page 354<

Vol. 161, No. 2