Objective To determine if the current body of evidence describes specific threshold values of concern for modifiable societal-level risk factors for pediatric hearing loss, with the overarching goal of providing actionable guidance for the prevention and screening of audiological deficits in children. Data Sources Three related systematic reviews were performed. Computerized PubMed, Embase, and Cochrane Library searches were performed from inception through October 2013 and were supplemented with manual searches. Review Methods Inclusion/exclusion criteria were designed to determine specific threshold values of societal-level risk factors on hearing loss in the pediatric population. Searches and data extraction were performed by independent reviewers. Results There were 20 criterion-meeting studies with 29,128 participants. Infants less than 2 standard deviations below standardized weight, length, or body mass index were at increased risk. Specific nutritional deficiencies related to iodine and thiamine may also increase risk, although data are limited and threshold values of concern have not been quantified. Blood lead levels above 10 μg/dL were significantly associated with pediatric sensorineural loss, and mixed findings were noted for other heavy metals. Hearing loss was also more prevalent among children of socioeconomically disadvantaged families, as measured by a poverty income ratio less than 0.3 to 1, higher deprivation category status, and head of household employment as a manual laborer. Conclusions Increasing our understanding of specific thresholds of risk associated with causative factors forms the foundation for preventive and targeted screening programs as well as future research endeavors.

Background: Women whose offspring have congenital heart disease (CHD) have higher risk of cardiovascular (CV) disease and mortality later in life. The mechanism is not well-understood and may be related to angiogenic imbalance, genetic predisposition, or stress-related pathways. We aimed to describe the prevalence of CV disease and traditional and sex-specific risk factors among women with a child with CHD at 18-23 years after delivery. Methods: We conducted an online survey among mothers whose infants had undergone cardiac surgery before six months of age and enrolled in a prospective observational study at the Children’s Hospital of Philadelphia. Maternal surveys investigated sociodemographic characteristics and self-reported health behaviors and medical history. We described the prevalence of baseline characteristics. Results: 531 women were contacted and 220 (41%) completed the survey and are included in this analysis. Child and maternal characteristics are presented in Table. Mean maternal age was 52 years, 86% were White, and 68% completed college. Regarding sex-specific risk factors, 10% had preeclampsia and 32% had history of preterm delivery. The most common traditional CV risk factors were high cholesterol (32%) and hypertension (27%). Overall, 4.6% of women reported a history of atherosclerotic cardiovascular disease (ASCVD) and 15% reported any cardiac disease, as defined by arrhythmia, structural heart disease, or ASCVD. Of the 6 women with prior myocardial infarction (2.7%), mean age at onset was 44 years. Complexity of the child’s CHD was significantly associated with prevalence of ASCVD but not other types of CV disease (p=0.008) Conclusion: Having a child with CHD is a potentially important sex-specific CV risk factor that is not well-studied. Understanding how this maternal characteristic interacts with other traditional and sex-specific risk factors is critical to understanding mechanistic pathways leading to CV disease in these women.

A 5-WEEK-OLD BOY PRESENTED WITH A MASS on the right side of his neck noted immediately at birth, with no subsequent reported change in size or shape. He had no respiratory distress, breastfeeding difficulties, or systemic infectious or inflammatory manifestations. The child was born full term by cesarean delivery following an uncomplicated pregnancy with normal results on fetal ultrasonography (US).On physical examination, the infant appeared healthy, was breathing comfortably, and had a normal cry. The mass on the right side of his neck measured approximately 2 cm in diameter, was nontender, somewhat compressible but firm, with no discoloration of the overlying skin. Findings from the otolaryngology assessment were otherwise normal with the exception of the laryngeal examination, which revealed an immobile right true vocal fold and compensatory movement of the left true vocal fold.Cervical US demonstrated a heterogeneous mass that was inseparable from the right lobe of the thyroid gland (Figure 1). The mass consisted of several complex cystic as well as solid components with some vascularity. Cervical magnetic resonance imaging (MRI) confirmed a predominantly right-sided 3ϫ4ϫ 3-cm mass containing both solid and cystic components with heterogeneous enhancement (Figure 2 and Figure 3). The superior aspect of the mass extended to the level of the submandibular triangle, and the inferior aspect extended to the supraclavicular space. The mass abutted but did not compress the trachea. Results from additional tests, including a complete blood cell count, thyroid function studies, and tests for ␣-fetoprotein and ␤-human chorionic gonadotropin tumor markers, were all normal. Complete mass excision, including a hemithyroidectomy, was performed.