PedSPAM April 2000

Welcome to PedSPAM for April. Here are some more things from my update reading that might interest you:

In the News

The risk of nearsightedness is not higher in children who sleep in rooms with night lights. The journal Nature published an article refuting its earlier article claiming an association of night light use with childhood nearsightedness. A study of 1,220 school children found that

20% of children who slept with no night light were nearsighted
17% of those who slept with a night light were nearsighted
22% of those who slept in a fully lit room were nearsighted

Thank goodness this study appeared. It restores my faith in common sense. I am quite puzzled why Nature even printed the first article, with its pretty glaring statistical flaws.

Nature 404(6773):143-144, 2000.

"Vaccinating Your Child: Questions and Answers for the Concerned Parent (Peachtree Publishers, 2000), by Sharon Humiston, MD, MPH, and Cynthia Good, is written for parents who want reliable medical information about why and when to vaccinate their children against childhood diseases.

"Vaccinating Your Child addresses the medical, ethical, and legal issues related to immunization to help parents make informed decisions about individual vaccines. Humiston and Good provide the most up-to-date information available about vaccines, and the benefits and risks of each vaccine for the individual and the community. The authors also provide an evaluation of medical reasons not to vaccinate and an overview of parental rights. Finally, the book reviews the vaccines that children may need as they grow older, and the vaccines that family members may need as they travel outside of the United States.

"The cost of the book Vaccinating Your Child is $14.95 (paperback). To purchase this book, check your local bookstore or call Peachtree Publishers at (800) 241-0113 and ask for the sales department."

Quoted from the Immunization Action Coalition electronic newsletter #155. You can subscribe to this newsletter at http://www.immunize.org/

This winter marked the occurrence of something unusual: nationwide shortages of a number of antibiotics, most notably intravenous penicillin G. A very old drug - one of the first widely used antibiotics - it remains the first line drug of choice for several important and dangerous infections. Among these are congenital syphilis, neurosyphilis, invasive Group A streptococcal disease, pneumococcal meningitis, meningococcemia, and intrapartum Group B strep prophylaxis. Shortages apparently arose when production problems cropped up at several generic drug suppliers, and this was compounded by so-called "just-in-time" production and delivery systems that keep inventories as low as possible for cost control.

DaimlerChrysler Corporation now provides free child safety seat inspections at over 400 Five Star DaimlerChrysler dealerships across the US. One survey showed that only 20% of children were buckled in correctly.

The teen birth rate dropped for the seventh straight year in 1998, due to increased use of contraception and a lower rate of teenagers having sex. Greatest drops were among black teenagers, girls ages 15-17, and those girls who had already had one pregnancy.

There is an increased risk for local reactions to the fifth dose of acellular pertussis vaccine (DTaP) which can involve swelling of the entire limb, either thigh or upper arm. The reactions occur in about 2% of children receiving a 5th dose of DTaP within about 2 days; all reactions so far have resolved in 1-4 days with no lasting ill effects. The reactions are believed due to sensitivity to the diphtheria toxoid in the vaccine, not the pertussis component. All DTaP vaccines licensed in the US exhibit this phenomenon.

US children are still getting taller. The Bogalusa Heart Study found that the average height of children in Bogalusa, Louisiana increased about 0.7 cm per decade, and among children in the 9-12 year age range, average heights increased 1.1 cm per decade. National data also support this finding. Archives of Pediatric and Adolescent Medicine 154:155-61.

A simple treatment for tension headaches that seems to work and costs nothing is the hot towel treatment described by Dr. Carter Snead, Professor of Pediatrics and Neurology at the University of Toronto. A towel is soaked in water as hot as the child can stand, wrung out, and wrapped around the head. The application of heat to the cramped muscles of the scalp causes increased blood flow by dilating constricted scalp blood vessels, breaks the cycle of cramping, and relieves the headache.

A study of alternative medicine providers found that up to a third of visits to homeopathic and naturopathic practitioners were made by children and adolescents. The most troubling findings were that fewer than half the practitioners had any pediatric training, most did not actively recommend immunizations, and that fewer than half would refer a two week old infant with fever (a medical emergency) to a medical facility. Archives of Pediatrics and Adolescent Medicine 154:75-80. Caveat emptor.

According to a report from the Honolulu Heart Program, high consumption of tofu in midlife causes poor cognitive function, brain atrophy and decreased brain weight in later years. This effect is hypothesized to result from either the presence of phytoestrogens (plant substances that mimic natural estrogen hormones) or other substances that interfere with brain chemistry. The effect held true for men and women in the study. Journal of the American College of Nutrition 2000;19:242-255.

I knew there was a reason I don't eat tofu.

Good news on the child abuse and neglect front: the US Department of Health and Human Services (HHS) announced that the number of children neglected or abused has fallen for the fifth straight year. The incidence of child abuse declined to the lowest rate in over 10 years.

Italian researchers report a striking connection between absence of the mandibular frenulum (that piece of tissue that connects the gum and the inner lip) and the development of pyloric stenosis. The specificity (predictive value) of hypoplastic or absent mandibular frenulum to identify infants with pyloric stenosis was 98.4% Journal of Pediatrics 2000;136:408-410.

In an article sure to arouse the ire of anti-circumcision partisans, Dr. Edgar J. Schoen and colleagues from Kaiser Permanente Medical Center, report in the April issue of Pediatrics that newborn circumcision significantly decreases urinary tract infections and medical costs. Dr. Schoen concludes, "Newborn circumcision during the first year of life is, thus, a valuable preventative health measure, particularly in the first 3 months of life, when uncircumcised males are most likely to be hospitalized with severe UTI," Dr. Schoen's group concludes. Dr. Thomas E. Wiswell of Thomas Jefferson University in Philadelphia, Pennsylvania, notes that because the study did not address longer-term costs such as assessment for scarring or screening for subsequent infection, "the true cost of UTI among uncircumcised male infants is considerably higher than what is described in the current report." Pediatrics 2000;105:789-793,860-862.

A Dutch study finds that early and adequate treatment of congenital hypothyroidism leads to normal mental development in afflicted babies. Aggressive, high dose therapy begun early - before the 13th day of life - led to the best outcomes. Journal of Pediatrics 2000;136:273-274, 292-297.

All newborns are screened in the hospital for hypothyroidism - this is the reason why. This study addressed the concern that infants might be overtreated and suffer harmful effects. Quite the opposite conclusion was found - early and aggressive treatment with higher doses led to better outcomes.

Smoking during pregnancy increases the odds that the child will exhibit negative behavior in the toddler years. Toddlers whose mothers smoked during pregnancy were four times likelier to manifest negative behavior than toddlers whose mothers did not smoke. Archives of Pediatric and Adolescent Medicine 2000;154:381-385.

Pediatricians' knowledge or ignorance of emergency contraception, not their attitudes, is responsible for limiting its use. Pediatricians who knew about the timing of the "morning after pill" now approved for use in adolescents were more than 10 times as likely to prescribe it as those who did not. Pediatrics 2000;105:954-956.

A new synthetic antibiotic, linezolid (Zyvox®), has been approved by the FDA for use against resistant bacterial infections, specifically vancomycin resistant Staphylococcus and Enterococcus. It is approved for pneumonia and skin infections in addition to resistant "superbugs." Reuters.

A study finds that teenage girls who diet, exercise, and pursue other weight-control efforts are significantly more likely to gain weight and to become obese than are those who do not. The findings, which seem to contradict common sense, are explained by the investigators. They conclude that weight-reduction efforts can lead to the "dysregulation of the normal appetite system," resulting in weight gain from erratic eating behaviors and "increased metabolic efficiency." Clinician Reviews 10(2):39-52, 2000.

A single injection of dexamethasone appears to be as safe and effective as a 5-day course of oral prednisone in the treatment of young children with mild-to-moderate asthma exacerbation. The shot replaces the often prescribed five-day course of rather bad-tasting prednisolone syrup. In the study, either a single dose of 1.7 mg/kg of dexamethasone was administered, or a standard 5 day course of oral prednisone at 2 mg/kg. There were no significant differences in improvement rates between groups. A number of children in the study group who received the oral prednisone either totally refused to take the medicine or missed a third or more of the doses. Journal of Pediatrics 2000;136:298-303.

Soft drinks are not responsible for increases in childhood obesity, find researchers reporting at the Experimental Biology 2000 meeting in San Diego, California. Based on government nutritional survey information, overweight children consumed only 2 ounces more of soft drinks per day than non-obese children. The idea that soft drinks have replaced milk in the diet is also unfounded. Milk intake in the 1 to 5 year age range has actually increased. Reuters.

We call patients who react to the blood pressure cuff by becoming nervous and raising their blood pressure "cuff reactors." Physicians generally think this is a harmless phenomenon. It turns out that, according to a recent study, teens who react this way are more likely to develop true hypertension. Journal of Pediatrics 2000;136:359-364.

The measles, mumps, and rubella (MMR) vaccine can be safely given to most children who are allergic to eggs, according to an extensive survey of medical reports by British researchers. The authors note that "only children with a history of life-threatening reactions to eggs, or who have an allergy to eggs and coexisting asthma, had life-threatening reactions after being vaccinated against measles." These children should receive the MMR vaccine under hospital supervision, the reviewers recommend. Egg protein in the vaccine can possibly cause allergies, but the authors note that the MMR vaccine contains a maximum of 1 ng per dose, which "seems to be far too small to cause an allergic reaction in the majority of individuals." Other constituents of the vaccine, including tiny amounts of neomycin and gelatin, were more likely to be responsible for allergic reactions than egg white. British Medical Journal 2000;320:929-932.

Childhood urinary tract infection with scarring requires long-term monitoring well into adulthood, find Swedish researchers. Infants and young children who have urinary tract infection with kidney scarring show decreased kidney function when studied 16 to 26 years later. Those children with scarring of only one kidney show normal overall kidney function because the unaffected kidney compensates; children with scarring of both kidneys show decreased kidney function and "a more serious prognosis can be expected" in patients with scarring of both kidneys. Archives of Pediatric and Adolescent Medicine 2000;154:339-345.

Preterm infants undergoing surgery for inguinal hernia repair can be safely anesthetized with spinal anesthesia. The spinal anesthetic was effective in almost all babies, and there was a much lower risk of postoperative apnea in infants anesthetised by spinal than those receiving general anesthesia. Archives of Surgery 2000;135:445-451.

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