PedSPAM August 2003

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 6: A survey by the US Centers for Disease Control (CDC) found that only 75% of U.S. children have received the full recommended course of vaccinations by their third birthday. One major barrier is the cost of vaccines, which are often not covered by health insurance. A panel of experts at the Institute of Medicine, an independent advisory board to the US government, says that health insurers should cover immunizations. The panel advises that if the insurers do not do this voluntarily, the government should require the coverage by all insurers. They further recommended that the government subsidize vaccine coverage so that insurers do not drop customers with children, with a voucher plan for uninsured children. Reuters Health.
Friday, August 8: PE tube insertion in children with persistent middle ear effusion (fluid), "MEE," who are younger than age 3 does not significantly improve developmental scores at age 4 years. This research group, led by Dr. Jack Paradise, one of the nation's leading authorities on the treatment of ear infections in children, concluded that "... persistent MEE within the duration limits that we studied is negligibly associated with and probably does not affect developmental outcomes at 4 years of age." Pediatrics 2003;112:265-277.
These findings would tend to argue against tube insertion solely on the basis of non-symptomatic middle ear fluid.

Monday, August 11: It will soon be RSV season again. This study confirms what most pediatricians know from experience, that serious bacterial infections in infants with fever and confirmed RSV infection is rare. The authors conclude that complete "septic workup" (lumbar puncture, blood cultures, and urine cultures) is thus usually not needed. They do note a need to check urine cultures in RSV positive infants with fever, because there was some increased incidence of urinary tract infection in these infants in their study. Pediatrics 2003;112:282-284.
Tuesday, August 12: This study was done in a private pediatric office which strongly encourages bicycle helmet use in general and counsels about this topic at well child visits. A helmet-inspection program was instituted to determine whether helmets were in proper condition and if they were correctly fitted. The results were somewhat disturbing! The authors write, "Ninety-six percent of the children and adolescents wore helmets in inadequate condition and/or with inadequate fit. This occurred despite a high acceptance of helmet use by this population. Initial evidence suggests that helmet assessment during well visits may be practical and valuable." Pediatrics 2003;112:320-323.
Helmet use makes wonderful sense, a fact that is unfortunately not always obvious until one sees a child with a severe preventable head injury from a bike accident (as I have). It is important for your child to wear a helmet when on a bike, scooter, or skates - it is equally important that the helmet fit properly.

Wednesday, August 13: Children with proven cow milk allergy can still safely drink soy formulas made with lactose (milk sugar), this study found. Other foods or drugs that contain lactose from cow sources are likewise safe. Pediatrics 2003;112:-362.
Thursday, August 14: The rate of deaths in children younger than 13 due to HIV infection has declined significantly since 1994. Both the advent of "highly active antiretroviral therapy" (HAART) and prevention of HIV transmission during delivery have contributed to this decrease, according to a study by the Centers for Disease Control and Prevention (CDC). Pediatric Infectious Disease Journal 2003;22:635-641.
Friday, August 15: Short courses of oral steroids for acute exacerbations of childhood asthma reduce the risk of subsequent flareups, shorten the course of the worsening, improve symptoms, and make hospitalization less likely. Pediatrics 2003;112:382-383.
This article is interesting in that physicians are often reluctant to use oral steroids; this survey of published research found that not only did kids get better sooner if treated with oral steroids (the earlier the better), but their subsequent risk of flaring up again was reduced by judicious use of oral steroid.

Tuesday, August 19: A 30 year follow-up study of 856 children who survived acute lymphoblastic leukemia (ALL) for at least 10 years found that while they were at risk for some complications of therapy (notably those related to radiation treatment) and some risk of late relapse, those children who made the 10 year mark without disease recurrence could be considered cured. Their subsequent survival is about equal to the general population. One important result from the study is the discovery that second cancers related to radiation treatment can appear more than 20 years later. This will lead to careful rethinking of which patients should have radiation treatments. New England Journal of Medicine 2003;349:640-649.
Wednesday, August 20: Preschool children who regularly snore are more likely to have asthma and night cough than those who do not snore, this study found. In the survey, about 10% of preschoolers of both sexes snored at least four nights a week. Snorers were twice as likely to have asthma, and three times as likely to have night cough as non-snoring children. Chest 2003;124:587-593.
Thursday, August 21: Two counties in Colorado have declared public health emergencies because of West Nile virus infections. Colorado leads the US in confirmed cases of the mosquito-borne West Nile virus infection. This year there have already been 599 reported cases in the United States. Reuters Health
We should be reminded that the only prevention for West Nile infection - as with all mosquito-borne viral illnesses - is do not get bitten. This means using effective repellants.

Tuesday, August 26: The world faces a "diabetes catastrophe" over the next 20 years, according to a report from the International Diabetes Federation conference in Paris. Changing lifestyles and diet worldwide are causing an epidemic of Type II diabetes. The report predicts that the worldwide impact of diabetes will be greater than of AIDS. They foresee a tremendous impact on the healthcare and social services system of the developed countries due to this rapid increase in diabetes incidence. Reuters Health
Childhood obesity is the silent but deadly epidemic in all the western countries. This report underscores what the stakes are.

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