PedSPAM August 2002

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

In the News

Thursday, August 1: Skin prick allergy testing, when combined with a blood test, is very accurate in the diagnosis of peanut allergy, according to French researchers. This can reduce or eliminate the need for elaborate and potentially dangerous food challenge tests. When the skin prick was performed with raw peanut extract, a negative test had a perfect predictive value of no allergy to peanuts. When specific IgE antibody concentrations were above a specified level, the predictive value for peanut allergy was 100%. Thus the skin prick test combined with specific antibody testing gave 100% certainty that a given child was peanut allergic. Journal of Allergy and Clinical Immunology 2002;109:1027-1033.
Friday, August 2: Children whose environment is too clean have a higher risk of asthma and eczema, finds this British study. A survey of parents found that for children between 30 and 42 months, higher hygiene scores for their home environment meant increased risk of allergic disease. This risk did not show up in the first 6 months of life. While "the importance of hygiene in public health should not be dismissed;" they add, "the creation of a sterile environment through excessive cleanliness may potentially be harmful to the immune system." Archives of Disease in Childhood 2002;87:26-29.

PedSPAM was on vacation Monday, August 5.

Tuesday, August 6: There does not seem to be any relation of exposure to antibiotics early in life and the development of asthma and allergies in childhood. This study refuted an association found in several earlier studies. A longitudinal study of about 450 children followed from birth showed no significant association between antibiotic use in the first year of life and asthma, recurrent wheezing, allergic rhinitis (hay fever), or eczema at age 5 years. American Journal of Respiratory and Critical Care Medicine 2002;166:72-75.
Wednesday, August 7: Scientists are a step closer to understanding the origin of Kawasaki disease, a potentially devastating autoimmune phenomenon that causes widespread damage to small blood vessels. It affects about 10,000 children a year in the US. The exact cause of the syndrome is not known, but the disease can cause coronary artery aneurysms and serious or fatal damage to the heart. Now, antigens have been discovered in the upper respiratory tract of some children that react with synthetic anti-Kawasaki antibodies. These studies may lead to a diagnostic test; so far there is none. Kawasaki disease is diagnosed by the clinical course and appearance of the disease. ePediatric News July 2002:36.
Thursday, August 8: Water birth - birthing during which the mother is immersed in water - has been promoted as a safe and improved method of delivery. This study reported on four cases in 18 months at one hospital in New Zealand of serious complications of water birth. These infants suffered near-drowning effects, requiring intensive care. All recovered without long term effects. The authors caution that water birth is not without increased risk both to infant and mother. Pediatrics 2002;110:411-413.
Friday, August 9: Children who are abused in early childhood manifest effects years later in adolescence. They miss one and a half times more school, are less likely to go on to college, and have more emotional and behavioral problems than other children, according to this report. The abused children had higher levels of aggression, anxiety, depression, post traumatic stress disorder symptoms, social problems and social withdrawal compared with children who were not physically abused. Archives of Pediatric and Adolescent Medicine 2002;156:824-830.
Monday, August 12: This study found that girls who develop anorexia before they begin to menstruate do not reach their full potential for height, even if they resume normal eating. Of 16 girls studied who developed anorexia before puberty, 13 never reached their genetic potential for height, calculated according to the height of their parents. On average, the girls were 1.5 inches shorter than they could have been. The girls had their first periods when they were an average of 15 years old, which is significantly later than the average age of first menstruation among US teens. The researchers believe that without any nutritional intervention, the girls would have experienced an even stronger growth suppression. Journal of Adolescent Health 2002;31:162-165.
Tuesday, August 13: Previous studies has shown that administration of an annual flu shot to children reduces their incidence of ear infections (otitis media) A trial involving 133 children in Italy with recurrent otitis media demonstrated a 50% reduction in the number of recurrent ear infections if the vaccine was administered before flu season began. The vaccine would necessarily be given each year before flu season. A nasal influenza vaccine is in final approval stages now. Clinical Infectious Disease 2002;35:168-174.
This is a very encouraging report. I would think this vaccine could reduce the number of tube insertion operations needed significantly, and save a lot of money as well as a lot of misery from recurrent ear aches.

Wednesday, August 14: Treatment of first-time, uncomplicated bladder infections in children can be accomplished in 2-4 days of oral antibiotics, according to this study. Previous guidelines for treatment recommended 7-14 days of therapy. This study found no significant difference in outcome for short treatment protocols versus longer duration oral therapy. Archives of Diseases in Childhood 2002;87:118-123.
Thursday, August 15: The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) has released new recommendations for the use of influenza vaccine for healthy children ages 6-23 months old. For the 2002-'03 flu season, the ACIP encourages influenza vaccination of all children 6 months through 23 months of age when feasible, and of household contacts and out-of-home caretakers of children younger than 2 years of age. Yearly influenza vaccination is already recommended for the following groups of children and adolescents:

American Academy of Pediatrics News, August 2002.
Friday, August 16: The long acting bronchodilator formoterol (Foradil®, Novartis) has anti-inflammatory effects as well, finds a Polish study. In a four week blinded1 study, those in the treatment group showed a significant improvement in lung function and asthma symptoms. There was also a significant reduction in inflammation in the lung, but not sufficient to make it suitable for use alone in asthma. Annals of Allergy Asthma and Immunology 2002;89:67-73.

1. Neither researchers nor subjects knew whether or not the patient received medicine or placebo until after the study.

Monday, August 19: Substituting a leukotriene modifier for an inhaled steroid in patients with asthma led to a seven-fold increased risk of hospitalization in this study in adults. The researchers stated that this study's finding confirm what has been found in controlled clinical trials. "Leukotriene modifiers should not be substituted for inhaled corticosteroids as a single-controller therapy for asthma," according to the lead investigator. Journal of Allergy and Clinical Immunology 2002;110:39-41.
Tuesday, August 20: Exposure to lead in childhood apparently is linked to increased blood pressure in early adulthood. A large group of young adults was studied by a sensitive measurement of lead exposure. The group included individuals who had lived near a lead smelter (a known cause of excessive lead exposure). Those subjects with the highest lead levels in their bones (where lead is deposited in the body) had the highest systolic and diastolic blood pressures. The researchers reason that reductions of childhood lead exposure might reduce the occurrence of diseases related to blood pressure as well as the known deleterious effects of lead on the brain. American Journal of Industrial Medicine 2002;42:98-106.
Wednesday, August 21: There was a vaccine against rotavirus available in the past. It was withdrawn in 1999 after it was associated with increased risk of intussusception. Now a new vaccine, derived from a different strain of the virus appears to give good immunity, preventing 100% of severe gastroenteritis, and even better, did not cause any intussusceptions. It also did not cause any increase in fever, irritability, vomiting, or diarrhea during the 15-day period after any dose. ePediatric News 2002:36;8.
The study numbers were still small, but the vaccine looks very good initially. More trials are planned. Rotavirus is the leading cause of hospitalization for childhood diarrheal illness in the US.

Thursday, August 22: Newborns who receive numerous heel stick blood tests for hypoglycemia (low blood sugar) quickly learn to anticipate the pain from the antiseptic scrub and develop more intense pain responses than other babies. The researchers stated, "We do not know the extent to which the anticipatory pain behaviors and heightened pain responses persist beyond the first days of life and what impact, if any, this early exposure might have on subsequent behavior, learning, and memory." Journal of the American Medical Association 2002;288:857-861.
Friday, August 23: A small study finds that a developmental maturity test based on drawing can predict which bedwetting children will respond to DDAVP (a synthetically produces hormone that causes the kidneys to retain water). The children were all problem bedwetters aged 7-13 years, with at least four wet nights each week. The test consists of having the child observe and then draw a figure from memory. Archives of Disease in Childhood 2002;87:188-191.
It is not surprising that a developmental test would link delayed nervous system maturation with bedwetting. The best explanation for bedwetting in my view is that it is a sleep disorder related to brain maturation.

Monday, August 26: West Nile virus infections are now of great concern to parents. Here are some points to remember, extracted from US Centers For Disease Control information for physicians:

The virus has been reported in animal hosts or in humans in the majority of States. Most infections with the virus are mild, and often unknown to the parents.

About one in 150 affected individuals develop severe nervous system disease. Old age seems to be the greatest risk factor for severe disease. Encephalitis is more commonly reported than meningitis. Hospitalized patients have exhibited fever, weakness, gastrointestinal symptoms, and change in mental status. A few patients develop a measles-like rash of the trunk, arms or legs. Severely affected patients may experience sever muscle weakness or paralysis, seizures or other severe neurologic manifestations.

The diagnosis of West Nile virus infection is made by clinical impression and confirmed by laboratory testing. It is chiefly suspected in adults over 50 who develop an encephalitis or meningitis in the summer or early fall. The presence of other cases in the community or history of travel also raises suspicion. However, the disease has been reported in all ages, and should be considered in all patients with unexplained encephalitis or meningitis.

Local and state health departments provide diagnostic testing. Samples of blood and spinal fluid are required.

There is as yet no approved specific treatment for this infection. Anti-viral agents are being tested, with some promise. Prevention of mosquito exposure and the use of repellants makes the best sense. Since the disease is so rare (even if hyped by the news media), and even more rare in children, a bit of common sense precautions ought to be about all parents concern themselves with West Nile virus.

Tuesday, August 27: Children whose mothers smoke during pregnancy are predisposed to obesity, according to researchers in Germany. The prevalence of obesity among children of mothers who smoked throughout pregnancy was 6.2%. Obesity in children of nonsmokers was 2.8%. Low birth weight deliveries were twice as common and breast-feeding rates less than half among mothers who smoked throughout pregnancy, when compared with non-smoking mothers. The researchers surmise that exposure to nicotine during pregnancy may affect the neurotransmitter systems in the growing fetus and lead to changes in the feeding and satiety reflexes. A suppression of satiety could lead to overeating and obesity. European Journal of Pediatrics 2002;161:445-448.
Wednesday, August 28: The diagnosis of fragile X syndrome, the most common inherited form of mental retardation in the US, is often delayed. The average age at diagnosis is 26 months. This occurs despite the availability of a test for the condition. By the time of diagnosis, half of the parents in this study had already had another child, and 43% of these children also had fragile X syndrome. According to the lead researcher in this study, the FRAXA Research Foundation is a good resource for clinical information about fragile X syndrome. Morbidity and Mortality Weekly Report 2002:51:740-742.
Thursday, August 29: The Food and Drug Administration has approved a "wristwatch" style non-invasive blood glucose monitor for use by diabetic children. The "GlucoWatch Biographer" is made by Cygnus, Inc. It is a blood glucose monitoring device worn like a watch. The device was approved for use by adults last year. It is thus far meant to be backed up by fingerstick glucose monitoring to ensure correct readings. The manufacturer are working on an enhanced version. Their goal is the eventual replacement of finger-stick tests altogether. Reuters Health.
Friday, August 30: Exposure to pet cats or dogs during the first year of life seems to protect infants from developing allergies later in childhood. The rate of skin reactions to dust mite, ragweed, and blue grass allergens was reduced by half in children exposed to pets from early infancy as compared to children not exposed to these animals. "These findings suggest that exposure to more than one dog or cat in the first year of life may reduce a child's risk of allergic disease," the team leader concludes. Journal of the American Medical Association 2002;288:963-972,1012-1013.

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