PedSPAM December 2001

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

In the News

Monday, December 3: Compared to children who live on the coast of Mexico and breathe clean air, children who live in Mexico City's polluted atmosphere show changes on their chest xrays indicating excessive inflation (as is characteristic of asthma) and increased density of the tissues between the air sacs. While none of these findings indicate disease per se, according to the lead researcher, "The findings do suggest that these children are at risk for developing chronic lung diseases." Reuters Health

Tuesday, December 4: Doctors should remember (and you can remind yours) that when giving both the MMR and Varivax® (chickenpox) vaccines, the shots should be given either on the same day, or at least 30 days apart. When the two vaccines are given fewer than 30 days apart but not simultaneously, there is a 2.5-fold increased incidence of breakthrough varicella, which they define as a case of varicella that occurs more than 42 days after varicella vaccination. Mortality and Morbidity Weekly Report 2001;50:1038-1041.

Wednesday, December 5: Contrary to popular belief, most obese children do not become obese adults, and childhood obesity is not a predictor of adult health status, say these researchers. They found that there is very little evidence that fat children go on to become fat adults, and there is no evidence that being fat as a child increased the risk of ill health as an adult. The researchers also found that the thinnest children and fattest adults had the highest risk for health problems as adults. British Medical Journal 2001;323:1280-1284.

These researchers did not say that being fat as an adult was harmless - far from it. Fat adults have more health problems by far. But adult overweight is an adult problem, not caused by childhood obesity.

Thursday, December 6: Activated charcoal, which is preferred over syrup of ipecac for the initial treatment of most childhood poisonings, can be easily administered by parents at home, reducing the time that elapses before effective treatment is begun by about half. "We advise parents that they should have activated charcoal in the home, but they should not administer it unless they speak to either the poison center or their pediatrician," the lead investigator said. Pediatrics 2001; 108: e100.

Friday, December 7: American teenagers have the highest birth rate, lowest use of contraceptives, and least access to reproductive services in the wealthy Western nations. While the rates of sexual activity are similar for teens in Sweden, France, Great Britain, Canada and the US, American teen pregnancy, birth and abortion rates are much higher than those in any of the other countries, despite significant drops over the last decade. US teen birthrates are double those in Great Britain and Canada and five times as high as those in Sweden and France. This is attributed to lower rates of contraceptive use by teens in the United States (40%) compared to other countries (70%). Reuters Health

Monday, December 10: Breastfeeding for at least 9 months was found to protect against asthma in childhood in this study. A longer duration of breastfeeding appears to be protective against the development of asthma and wheezing in young children. Archives of Pediatrics and Adolescent Medicine 2001;155:1261-1265.

Thursday, December 13: Women who take supplemental folate during pregnancy may be protecting their children from leukemia, Australian researchers report. They found that the rate of acute lymphoblastic leukemia (ALL), the most common form of childhood leukemia, was significantly lower in children whose mothers took folic acid supplements during their pregnancy. The Lancet 2001;358:1935-1940.

We already know that folate supplementation during pregnancy lowers the risk of spina bifida and other spinal chord and brain defects. If this is confirmed in a larger study, it would support our efforts for universal provision of folate to pregnant mothers.

Friday, December 14: Hepatitis B vaccination in the first 21 days of life is safe, find these investigators. The vaccination is recommended at birth by the American Academy of Pediatrics, but only about 50% of pediatricians routinely administer it in the newborn period. Comparing 3302 infants vaccinated in the first 21 days of life with 2353 who were not, there was no difference in the incidence of fever, allergic reactions, seizures, or other neurologic problems. Pediatric Infectious Disease Journal 2001;20:1049-1054.

Monday, December 17: Use of the long-acting bronchial dilator salmeterol has been tied to gingivitis (gum inflammation) in asthmatic children. Mexican researchers found that alone or in combination with an inhaled steroid, gum injury resulted from use of salmeterol. They possibly relate this injury to reduced saliva flow. Annals of Allergy, Asthma, and Immunology 2001;87:420-423.

Tuesday, December 18: Vegetarianism in teenagers may be a "red flag" warning for possible eating disorders. Investigators found that teenage vegetarians may be at greater risk of eating disorders and suicide than their meat-eating peers. A large survey of Minnesota teens found that girls were more likely than boys to be vegetarians; that vegetarians of both sexes were likely to engage in unhealthy weight control measures such as vomiting after eating, using laxatives or diet pills. The researchers concluded that while a vegetarian diet is more healthy for adults, in adolescents it is likely to alert parents and healthcare professionals to the possibility of an eating disorder or depression. Journal of Adolescent Health 2001;29:406-416.

Wednesday, December 19: Canadian researchers report that by age 10, the majority of children with no history of chickenpox infection are immune to the disease as determined by antibody levels. Half of the children in their study had developed chickenpox by kindergarten, and over 90% by age 10. The study was undertaken to determine how many children would need catch-up vaccination. Pediatric Infectious Disease Journal 2001;20:1087-1088.

Now that the chickenpox vaccine is widely used and the incidence of naturally occurring chickenpox is falling, there is heightened concern that individuals will "fall through the cracks" and reach adulthood without immunity.

Thursday, December 20: Current methods of blood sugar monitoring of children with juvenile diabetes leave a lot to be desired, this study finds. A special method of continuous glucose monitoring in children with diabetes shows that they experience much wider swings in blood sugar than we have thought. Even with good periodic pre-meal blood sugar check results and good hemoglobin A1c levels (a measure of long-term control quality), children may experience very high blood sugar levels after meals as well as silent hypoglycemia episodes with very low blood sugar levels without reported symptoms. Diabetes Care 2001;24:1858-1862.

Friday, December 21: The United States Food and Drug Administration has approved Zithromax® (azithromycin) for one-dose treatment of childhood middle ear infections (otitis media). The previous dosing regimen was once a day for five days; newly approved dosing schedules are a single dose, and a three-day treatment regimen.

Monday, December 24: Repeated, untreated attacks of Group A streptococcal tonsillopharyngitis ("strep throat") can lead to the development of obsessive compulsive disorder (OCD) and Tourette syndrome, according to these researchers. Not only that, they find that antibiotic treatment can reverse the symptoms. They discovered that a group of children seen over a period of time for obsessive-compulsive symptoms had confirmed group A streptococcal pharyngitis. When treated appropriately with antibiotics for the infection, the symptoms resolved. Reappearance of the symptoms occurred in some of the children when they became reinfected with the germ; again, symptoms responded completely to antibiotic treatment. The co-author of the study, Dr. Michael Pichichero, from the University of Rochester Medical Center in New York, presented this data at the recent Interscience Conference on Antimicrobial Agents and Chemotherapy. A full study of this striking relationship is now planned, and may lead to prevention of many cases of OCD and Tourette syndrome.

Wednesday, December 26: Children who have surgical correction of patent ductus arteriosus generally have a complete cure and are advised that they need no long term followup. This long term study of 700 children found this to be almost totally true; a handful of cases - about one in a hundred - developed problems sufficient to require re-operation. Indian Heart Journal 2001:615-628.

Thursday, December 27: "Adverse life events," ranging from childhood abuse to incarceration of a family member, markedly increase the risk of suicide attempts throughout a person's life span. A questionnaire study of 17,000 adult members of Kaiser Permanente Health Plan found that 64% of surveyed members reported at least one of the life events included in the survey: frequent emotional abuse, frequent physical abuse, any sexual abuse, other domestic violence, a household member who abused drugs or alcohol, a household member with mental illness or depression, parental separation or divorce, or incarceration of a household member. Patients with no such events in their personal history had an overall 1.1% risk of suicide attempt. Those with 7 or 8 such events had a 50 times greater risk of suicide attempt in childhood or adolescence, and a 30 times greater risk of a suicide attempt as an adult. Journal of the American Medical Association 2001;286:3089-3096,3126-3127.

Friday, December 28: Gastroesophageal reflux disease (GERD) is associated with an increased risk of a variety of respiratory diseases, including sinusitis, laryngitis, asthma, pneumonia, and bronchiectasis. A comparison of 1980 children with GERD with 7920 normal control subjects found that children with GERD had more sinusitis (4% versus 1.4%) and laryngitis (0.7% versus 0.2%), more asthma (13% versus 7%), pneumonia (6% versus 2%), and bronchiectasis (1% versus 0.06%. children with GERD were however found to have less otitis media than controls (2% versus 4.6%. Gastroenterology 2001;121:1294-1299.

Monday, December 31: Now that croup season is in full swing again: children with mild croup respond better to an oral dose of the steroid dexamethasone (Decadron®) than to a treatment with nebulized dexamethasone. They are less likely to seek subsequent medical care and show more rapid resolution of symptoms compared with children who receive nebulized dexamethasone or placebo treatment. Archives of Pediatric and Adolescent Medicine 2001;155:1340-1345.

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