PedSPAM February 2003

Welcome to the PedSPAM archive for February. It is much abbreviated due to the recent heavy patient load - I have been in the office until 7 - 8 p.m. with patients every night for the past 6 weeks. Here are the month's daily SPAMlets from my update reading that you might have missed:

In the News

Monday, February 3: Infants of mothers who do not receive enough vitamin B12 in their diets (usually due to strict vegetarianism) are at risk for neurologic damage, potentially permanent. A report in this weeks Morbidity and Mortality Weekly Report from the US Centers for Disease Control highlighted two cases in which mothers who were strict vegetarians delivered infants who suffered from B-12 deficiency and neurologic impairment. One child recovered completely with vitamin B-12 supplementation; the other apparently has some more permanent impairment. Morbidity and Mortality Weekly Report 2003;52:61-64.
Wednesday, February 5: A study published in The Lancet last November examined blood mercury levels at 2 and 6 months in babies who received either thimerosal containing or thimerosal free vaccines. The levels in thimerosal exposed infants after vaccinations were approximately 1/5 the level generally accepted as safe in umbilical cord blood collected from the baby at birth. The Lancet 2002;360(9347):1737-1741.
A reassuring study. We need vaccines and we certainly need the facts about them.

Thursday, February 6: Despite laws requiring insurance payment coverage for newborn hospital care, newborns are often discharged early, with inadequate follow-up care. Early discharge in this study was defined as after no more than a one-night stay for a vaginal birth and a three-night stay or less after a cesarean delivery. The most common complications associated with early discharge are jaundice, poor feeding habits or birth defects. Often these are not detectable until the third to fifth day of life. The authors of this study point out that, "The risk for these potential complications of early discharge could be reduced if infants received follow-up from a healthcare provider sometime between days three to five of life when many of the complications arise." In the California based study, babies of mothers on Medicaid and those from low-income, Latino and non-English speaking homes - those least likely to have access to followup care - were more likely to be discharged early and less likely to receive follow-up care within two days after discharge. Pediatrics 2003;111:364-370.
Monday, February 10: Children with congenital hereditary spherocytosis usually require removal of the spleen to cure their anemia. This procedure is effective, but carries with it a subsequent life-long risk of sepsis (overwhelming bacterial infection), because removal of bacteria from the bloodstream is one of the chief functions of the spleen. This study found that partial removal of 80-90% of the organ was effective in stopping the excessive breakdown of red blood cells without compromising the spleen's ability to cleanse the blood of bacteria. Annals of Surgery 2003;237.
Friday, February 15: Very low-birth-weight premature infants who do not have intraventricular brain hemorrhage at birth experience significant improvements in word recognition and intelligence during the first years of life, according to a new study. These investigators found that verbal skills and intelligence scores of VLBW infants were within normal limits by the age of eight years. They suspect that in some cases, early environment may help young children in overcoming the developmental disadvantages of prematurity. Journal of the American Medical Association 2003;289:705-711,752-753.
Tuesday, February 18: A once-daily methylphenidate transdermal patch system (MethyPatch®) has been shown effective in treatment of attention-deficit hyperactivity disorder (ADHD). The patches deliver four different doses of medication, calculated on a milligrams-per-hour basis. The patches were found to be effective, especially when combined with behavior modification therapy. Side effects were few, including minor skin irritation and the usual side effects of methylphenidate, including tics in the highest doses. ePediatric News 2003;37:1.
Patches, patches. Our pharmacists are now dispensing Phenergan® (promethazine) gel for nausea and vomiting as a patch preparation, and it seems to work as well as the dreaded suppositories - much to the delight of the children.

Friday, February 21: It is known that children who are inappropriately graduated from car and booster seats into adult seat belts are 3.5 times more likely to suffer significant injuries in a motor vehicle crash, especially head injuries, than children who are correctly restrained. Children should stay in auto booster seats until they reach proper size. Children between 4 and 8 years of age who weigh between 40 and 80 pounds transition to booster seats once they are too big for their car seats, with the final transition to adult seat belt use only made once a child weighs 80 pounds and is at least 4 feet 9 inches tall. A recent community education program to increase the use of child booster seats in Seattle, Washington led to a doubling of booster seat use in 15 months. Journal of the American Medical Association 2003;289:879-884.
Monday, February 24: A Columbia University study found that while 90% of parents believe that they would know if their teenager were depressed, two thirds of teenage depression is missed. These depressed adolescents are at increased risk for suicide. A child psychiatrist involved in the study stated that about 4% to 5% of adolescents in the US are depressed, meaning about 750,000 adolescents at any one time. About 500,000 make serious suicide attempts, and tragically 1,700 succeed every year. Symptoms of depression can be very subtle, and teenagers will go to great lengths to conceal their distress, the psychiatrist added. As one result of the study, a self-administered screening questionnaire is being released by the researchers to help schools screen for depression in teenagers. Reuters Health
Tuesday, February 25: A study that confirms what I have been preaching for years appeared in the February issue of the Archives of Diseases in Childhood, finding that frequently fed infants are more prone to sleep problems. Specifically in this study, 1-week old infants who are fed more than 11 times over 24-hours have an increased risk of disrupted night sleep at 12 weeks. The study involved a three-step behavioral program: reducing light and social interaction at night; placing a sleeping infant in a crib and not feeding or cuddling at night; and gradually delaying feedings when the infant wakes up at night after 3 weeks of age. The mothers also kept behavior diaries for up to 12 weeks. Frequently fed infants were half as likely to sleep through the night by 3 months of age, and also experienced more fussing and crying episodes at night. There were no differences between breast-fed and bottle-fed infants. Archives of Diseases in Childhood 2003;88:108-111.
Wednesday, February 26: Previous studies have already demonstrated that fruit consumption in adulthood may reduce the risk of certain cancers. Now a 60-year study of diet in childhood found that fruit consumption reduced the risk of cancer later in life. A total of 1,352 families in England and Scotland were followed from the initial data gathering in 1937-39 to the year 2000. Full data on health outcomes and diet were available for 3,878 subjects. Adults who as children had eaten 3 ounces of fruit a day were 40% less likely to have cancer over the study span of 60 years. Journal of Epidemiology and Community Health 2003;57:218-225.

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