PedSPAM February 2002
Welcome to the PedSPAM archive for February. Here are the month's daily SPAMlets from my update reading that you might have missed:
In the News
Friday, February 1: Early breast development can be a perplexing problem in preadolescent girls. While the vast majority of these early bloomers are normal and go on to have normal sexual development, in a few patients the precocious breast development is a sign of abnormal hormone release from a benign brain tumor. French researchers found that measuring one hormone, plasma estradiol, predicted the presence of a tumor on MRI scan 100% of the time. In related commentary in the same journal, an American expert cautioned that for girls in the age range of 6 to 8 with no other signs than simple breast development, simple watching without lab work or MRI scanning was perfectly sound practice. Breast development before the age of six would however be much more predictive of an abnormality on MRI scan, and would justify more aggressive evaluation. Pediatrics 2002;109:61-67,139-141.
Monday, February 4: Aspirin has been implicated in the past as an aggravating factor for asthma, because a significant number of asthmatics have aspirin allergy. Ibuprofen is chemically related to aspirin, leading to speculation that ibuprofen use might increase the risk for or severity of asthma attacks. Far from supporting the idea that ibuprofen (Motrin®, Advil®) use by asthmatic children increases risk of attacks or makes them worse, a study from the School of Public Health, Boston University School of Medicine, Boston, Massachusetts finds that hospitalizations and office or ER visits for asthma were actually lower in children given ibuprofen for fever versus acetaminophen (Tylenol®). Pediatrics 2002; 109: e20.
Tuesday, February 5: The risk of testicular cancer in Danish males was found to not be related to disposable diaper use in childhood. This connection had been proposed after the observation that the rate of testicular malignancy in Danish men had risen threefold in the 50 years from 1945 to 1995. This study found no relation between the use of disposable diapers and testicular cancer risk. Archives of Diseases of Childhood 2002;86:28-29.
Wednesday, February 6: A study in England of the effectiveness of education for parents of asthmatic preschoolers has yielded disappointing results. Parents of hospitalized children in the test group were given "a booklet on asthma, a written self-management plan and two individual 20-minute sessions with a specialist respiratory nurse." However, over the next year of followup there was no reduction in doctor or emergency department visits or subsequent hospitalizations. Thorax 2002;57:39-44.
Thursday, February 7: After six years of use, vaccination for chickenpox has reduced the incidence of the disease by about 80%. The greatest reduction has been in the age range of 1 to 4 years, but there have been significant declines in disease in all age groups, from infants to adults.
Before the vaccine, there were about 100 deaths and 11,000 hospitalizations for chickenpox in the US. Hospitalizations for chickenpox have dropped by about 2/3. Journal of the American Medical Association 2002;287:606-611.
Friday, February 8: The tallest children are at a much increased risk of adult obesity compared to the shortest children. This finding comes from a study by an epidemiologist at the Centers for Disease Control and Prevention in Atlanta, Georgia. Tall children tend to mature earlier, and he thinks that this is the reason for this newly discovered association of childhood height with adult obesity. Pediatrics 2002;109:e23
Monday, February 11: British researchers find little to like about over-the-counter (OTC) cough medicines for adults. They reviewed 15 clinical trials that compared OTC cough medicines with placebo1. They found that in nine of the trials, OTC cough preparations were no better than placebo, meaning worthless. In the remainder of the trials, the sample sizes or study designs left room for doubt about their validity. The researchers concluded that while there is little evidence that these medicines do any harm, they may also not have any benefits. In fact, OTC cough medicines probably act more as a placebo. British Medical Journal 2002;324:329-331.
Doctors are forever telling patients this; the patients continue to take the medicines and feel better. Some things never change. I took some OTC cough medicine this weekend, and do you know what? It worked.
1. See also the discussion in the same article of the nocebo effect, which I will wager you have never heard of - I certainly had not.
Tuesday, February 12: The incidence of pertussis (whooping cough) among American infants has increased over the last 20 years, especially in infants too young to have received a full course of three pertussis vaccine doses, according to the US Centers for Disease Control and Prevention (CDC). This means that the pertussis germ is silently present in greater numbers in the population. In the early 80's there were about 2,000 cases of pertussis nationwide per year. From 1997 to 2000 the rate has climbed to over 7,000 cases per year. Dr. Kris Bisgard is a medical epidemiologist with the CDC's National Immunization Program, warns: "Pertussis remains an endemic disease," and that adolescents and adults likely play an important role in transmitting pertussis to very young infants. Mortality and Morbidity Weekly Report 2002;51:73-76.
Wednesday, February 13: A new formula has been introduced for the treatment of inflammatory bowel disease. Known as "Modulen IBD," it was introduced last year. The formula contains a biologically active substance known as transforming growth factor (TGF) which is found in cow's milk and human breast milk. This polypeptide promotes lining cell growth and is a regulator of the immune system within the bowel. It can replace steroids, commonly used in the United States for Crohn's disease, as first line therapy. ePediatric News, January 2002, Vol. 36 No. 1.
Thursday, February 14: Gastroesophageal reflux could be a major cause of chronic otitis media with effusion (OME, serous otitis, "glue ear"). Researchers found increased levels of stomach proteins in the middle ear fluid of most children with chronic disease. They were able to determine that pepsin and pepsinogen enzyme proteins found in middle ear fluid were coming from the stomach rather than through the bloodstream. They felt that their results suggest that antireflux therapy might be an effective method of preventing chronic "glue ear." Lancet 2002;359:493.
Friday, February 15: Use of a spray furniture polish when dusting significantly reduces airborne dust and allergens in this British study. Compared to dry dusting, spray polish use greatly reduces the amount of dust particles stirred up into the air environment of a room. Spraying the polish on the dust cloth was very effective, but spraying the material directly onto the furniture surfaces was the best method. Direct application to furniture surfaces before dusting reduced allergens in the air by more than 90%. Journal of Allergy and Clinical Immunology 2002;109:63-67.
Monday, February 18: German health officials are studying a program of universal mass spectrometry screening for more than 20 congenital metabolic disorders in newborns. Results of a three-year trial demonstrated that more than 170 children in Bavaria alone were saved from serious disability or death by such screening. Nationwide in Germany, Currently, German infants are only tested for galactosemia, phenylketonuria and hypothyroidism, for reasons of expense. Mass spectrometry allows effective screen for much lower cost. The tests are all performed on a single drop of blood, taken on the third day of life. Reuters Health
Tuesday, February 19: Tooth decay might largely become a thing of the past if a new strategy to prevent it pans out. Scientists at the University of Florida have developed a genetically modified strain of the Streptococcus mutans bacteria which can be artificially introduced into the mouth with an oral rinse. The new bacteria do not produce enamel-destroying acid, and thus do not cause tooth decay. A single application leads to these more "friendly" bacteria crowding out the acid-producing S. mutans strains. It is thought this protection will be life-long. The mouthwash would be most ideally suited to infants cutting their first teeth, but the method will be tested in adult volunteers first. Clinical trials will start this year; the technique has received favorable comment from the National Institutes of Health.
Wednesday, February 20: Rapid weight gain in the first four months of infancy is associated with childhood overweight at 7 years. This risk was found to be independent of an infant's birth weight or weight at a year of age. Each 3 ounces of weight gain per month over the norms carried a 38% increase in the risk of overweight at 7 years. The investigators hope this finding will increase our understanding of the problem of childhood obesity. Pediatrics 2002;109:194-199.
Thursday, February 21: In a surprise finding, one-third of cases of Group A streptococcus - causative germ of streptococcal throat infections - in Pittsburgh are highly resistant to antibiotics in the class known as macrolides - azithrocin (Zithromax¨), clarithrocin (Biaxin¨), and erythromycin. Ordinarily, we do not test for sensitivities on throat cultures, since the germ is 100% sensitive to penicillin. However, macrolides are sometimes prescribed for "strep throat" in penicillin allergic patients and for other reasons as well - for example, Zithromax¨ is only given once a day for five days, which appeals to parents. Resistance to the macrolide family of antibiotics is increasing around the country, with reduced susceptibility also being reported among pneumococcal and group B streptococcal strains. ePediatric News February 2002;36:2.
Friday, February 22: Children with asthma are often undermedicated, according to this report, and the problem seems to lie in correctly judging the severity of disease. Only about 40% of children followed in this study had been accurately assessed with respect to the severity of their disease. About 85% of those who had been accurately assessed for severity of their asthma were on the right maintenance anti-inflammatory medicines; only 28% of those whose assessment was incorrect were on the right medications. Archives of Pediatric and Adolescent Medicine 2002;156:141-146.
Monday, February 25: A panel convened by the Institute of Medicine recently found little or no scientific evidence that the total number of vaccinations young children receive or giving them at the same visit increases risks for diabetes or infections. The panel also concluded that there is not enough evidence either way to accept or reject the notion that shots may trigger allergies or asthma. The panel continued to stress the idea that while there can never be absolute knowledge about possible or purported side effects of vaccines, the overall benefits of immunization against infections are clear and convincing. Reuters Health.
Tuesday, February 26: Head lice in the United States are resistant to most common treatments. Researchers exposed head lice collected from a number of children and adults to several commonly used anti-louse agents ("pediculicides"). In descending order of effectiveness:
Archives of Dermatology 2002;138:220-224.
- Ovide lotion (0.5% malathion)
- A-200 shampoo (a natural pyrethrin product synergized with piperonyl butoxide)
- undiluted Nix (1% permethrin)
- diluted Nix
- RID (a natural pyrethrin product synergized with piperonyl butoxide)
- 1% lindane shampoo
Wednesday, February 27: A study of almost 5,000 adolescent girls in junior high and high school who are very overweight finds that they often may resort to extreme and unhealthy weight-control measures such as diet pills, laxatives, diuretics or vomiting. The authors emphasize that physicians should address not just weight itself and needed changes in eating and physical activity, but they should discuss body image issues and talk about unhealthy dieting behaviors. While healthy measures such as reducing dietary fat were most common, unhealthy measures such as skipping meals, self-induced vomiting, diet pills or laxatives were reported by about a fifth of the adolescents. The unhealthy activities were about three times more prevalent in overweight girls as compared to boys. Archives of Pediatric and Adolescent Medicine 2002;156:171-178.
Thursday, February 28: A review of available scientific studies finds that the traditional methods of dealing with gastroesophageal reflux are not proved to work. In light of these findings, the authors advise caution in using these interventions that really are not shown convincingly to work. The reviewers only found ten studies out of 35 that they reviewed which met their criteria for scientific validity of the results.
- Two studies showed that neither positioning babies upright in an infant seat, nor elevating the head of the crib reduced reflux
- Thickened formula did not significantly reduce reflux as measured by acid-monitoring pH probes, but did somewhat reduce outright vomiting; carob bean gum was significantly more successful in reducing reflux than adding rice flour
- No good study evaluated whether smaller feeding volumes or more frequent feedings helped reduce reflux
- There was no evidence pacifier use had anything to do with reflux, and formula changes were not shown to be beneficial
The authors cautioned that while the studies did not prove the therapies work, they also did not prove they do not work. But without more convincing evidence of efficacy, it is wise not to push potentially interventions that may cause more trouble for child and parents than beneficial effects. They reminded that "Nearly all cases will get better without any therapy at all... If the problem is severe, other treatments besides the ones we studied should be considered." Archives of Pediatric and Adolescent Medicine 2002;156:109-113.