PedSPAM April 2003

Welcome to the PedSPAM archive for April. Here are the month's daily SPAMlets from my update reading that you might have missed:

In the News

Tuesday, April 1: The Food and Drug Administration (FDA) has toughened the warnings on lotions and shampoos for the treatment of lice and scabies that contain the insecticide lindane. This substance is known potentially to cause toxicity to the nervous systems of young children. The new warnings state that the products are only to be used as second line treatment in individuals who have failed treatment with the preferred agents. Inappropriate reapplication of the lotions or shampoos is often the reason for excess absorption of the substance and toxic reactions, therefore the package size will be limited to 1 or 2 ounces. Reuters Health

Thursday, April 3: The Agency for Healthcare Research and Quality has released a study done at the request of the American Academy of Pediatrics that addresses several key questions regarding the diagnosis, treatment, and long-term impact of newborn jaundice. The review of 138 scientific articles made several conclusions:

A single bilirubin level is inadequate in predicting brain injury from jaundice (kernicterus).
Further studies are still needed to answer the questions of how gestational age, accelerated breakdown of red blood cells (hemolysis), serum protein levels, and other factors influence the link between elevated bilirubin levels and poor neurologic outcomes.
Between 6 and 10 infants receive phototherapy to prevent one child from exceeding the accepted upper limit of 20 mg/dL blood level of bilirubin.
The most efficient treatment for healthy term or near-term infants was found to be phototherapy combined with temporary substitution of formula feeding for breastfeeding.
Newer electronic skin color measuring devices such as the SpectRx Bilicheck and the Colormate III perform well in monitoring bilirubin levels.

Reuters Health

Friday, April 4: It has been known for some time that bronchodilator therapy for wheezing in young infants is of limited value at best. This study finds that the use of inhaled bronchodilators such as albuterol may actually worsen lung function in children under two who have non-asthmatic wheeze. The 60% of infants with recurrent wheeze but not asthma can be made worse with treatment with inhaled bronchodilators. The investigators suggested that young children whose wheeze is not improved by bronchodilator inhalation treatment need not have more such treatments. Archives of Diseases of Childhood 2003;88:246-249.

Tuesday, April 8: Most recurrent ear infections occurring within a month of completing antibiotic treatment are in fact new infections, this study found. Most of the true relapses (acute infection, not just old fluid) occur within 14 days after completion of therapy. However, even during this time interval most of the recurrences are caused by new pathogens. Pediatric Infectious Disease Journal 2003;22:209-216.

Wednesday, April 9: Increased total body fat in girls at age 5 is linked to earlier puberty, this study found, and large increases in body fat between the ages of 5 and 9 tend likewise to accelerate the beginning of female puberty. The researchers suggest that weight control efforts may thus need to start as early as preschool. Average age for first signs of breast development is now 8 or 9 for US girls, and this age has dropped by about 1 year earlier over the last 20 years. This finding seems to have paralleled the increase in childhood obesity over the same period. Pediatrics 2003;111:815-821.

Friday, April 11 Children with asthma flareups who have sinusitis as well do better if the sinusitis is treated and cured. This study lends support to the common observation that children with asthma often have coexistent sinus infections, and the asthma may not be fully controlled until the sinus infection is cleared. The research showed that bronchial hyperreactivity - how sensitive the lungs are to asthma triggers - is greatly increased when there is also a sinus infection present. Chest 2003;123:757-764.

Tuesday, April 15: Frequent throat-clearing may be the first sign of asthma in some children, this study maintains. Researchers in Crete tested children whose parents complained of their frequent throat-clearing for asthma, and found that frequent throat clearing was highly indicative of mild asthma. Treatment directed at the asthma also improved the throat-clearing behavior. New England Journal of Medicine 2003;348:1502-1503.

Wednesday, April 16: Children with cerebral palsy can received sustained benefit when treated with botulinum toxin (BoTox®). While BoTox® injections do not replace physical therapy, occupational therapy, and bracing, they can provide both immediate improvement and long term benefits in treating spasticity and uncoordinated movements. These beneficial effects persisted for several months after treatment, and repeated treatment had similar positive benefits without the development of "immunity" to the beneficial effects of BoTox®, as was once feared would happen. Reuters Health

Friday, April 18: The simple expedient of fortification of flour with the vitamin folic acid has led to significant reductions in childhood neuroblastoma, a form of cancer. Folate fortification was mandated in Canada in 1998. Since then there has been a 62% decline in the incidence of neuroblastoma and also a drop of about half in the incidence of more severe metastatic neuroblastomas at diagnosis. In other words, the rate of disease has fallen dramatically, and the disease that occurs is on average less severe. Reuters Health

Tuesday, April 22: Low blood levels of lead up to now considered safe have been found to have deleterious effects on development of the nervous system and hormonal system. Furthermore, the effects of lead on brain development are even more pronounced at low levels than at higher levels. Additionally, blood lead concentrations were related to delays in puberty, which might indicate eventual linkage to other disturbances of the glandular and other body systems. New England Journal of Medicine 2003;348:1515-1536.

Thursday, April 24: Finnish researchers found that children born to mothers with preeclampsia (elevated blood pressure) during pregnancy have elevated blood pressures 12 years later. Children born to preeclamptic mothers were smaller at birth, and the higher the maternal blood pressure, the smaller the baby. The researchers speculate that maternal preeclampsia may "program" the baby's glandular system in a way that leads to elevated blood pressure in the older child and perhaps into adulthood. Journal of Clinical Endocrinology and Metabolism 2003;88:1217-1222.

Monday, April 28: Motor-vehicle crashes are currently the leading cause of death among 4- to 8-year-old children in the US. The American Academy of Pediatrics recommends that children under 4 feet, 9 inches or between 40 and 80 pounds (generally children between the ages of 4 and 8 years) use belt-positioning booster seats to reduce their risk of injury and death in motor vehicle crashes. An observational study of parent practices found that only 16% of children who should properly have been riding in booster seats were correctly restrained. The children were more likely to be using seat belts, and those incorrectly, with the shoulder belt pushed behind their backs. Pediatrics 2003;111:e323-e327.

Wednesday, April 30: Meningitis in infancy may have lasting effects upon survivors even in adolescence. A British study found that teenagers who survived meningitis as infants have more difficulties with behavior in the realms of emotional problems, behavior, hyperactivity, peer problems and social skills than their peers. The researchers suggest that even uncomplicated meningitis has subtle, permanent effects that were not previously appreciated. Long term followup of these children is warranted to ensure possible behavioral problems are addressed. Archives of Disease in Childhood 88:395-398.

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