PedSPAM January 2003
Welcome to the PedSPAM archive for January. Here are the month's daily SPAMlets from my update reading that you might have missed:
In the News
Thursday, January 2: A doctor from the US Centers for Disease Control says that the polyvalent pneumococcal vaccine now routinely given to infants at 2, 4, and 6 months has led to a dramatic two-thirds drop in life-threatening invasive pneumococcal disease in children under 2 years. Pneumococcal disease caused by serotypes contained in the vaccine also dropped in elderly adults, suggesting a herd immunity effect. ePediatric News 2002;36:12.
Monday, January 6: The asthma drug Singulair (montelukast) has received FDA approval for treatment of hay fever - seasonal allergic rhinitis. The drug was approved in 1998 for use in the treatment of asthma, and is approved for use down to age 2 years. It is available only in pill form - younger children use a chewable form. Singulair works via a different mechanism than antihistamines, blocking inflammatory hormones called leukotrienes. It has no side effects of drowsiness. Reuters Health.
Tuesday, January 7: It is known that smoking lowers vitamin C levels in smokers. Now it has been shown that vitamin C levels are lower as well in children aged 2-12 years exposed to secondhand cigaret smoke. These researchers found that even very low levels of smoke exposure led to significant reductions in vitamin C levels, the effect was most pronounced in girls. American Journal of Clinical Nutrition 2003;77:167-172.
Wednesday, January 8: Another study confirms what 11 earlier research studies had established: that stimulant use for ADHD treatment in childhood does not predispose to drug abuse in adulthood. Neither the fact of stimulant use nor the duration of ADHD treatment influenced the risk of subsequent drug abuse. These findings "indicate that clinicians probably need not fear that the stimulant treatment of children with ADHD is predisposing those children to later drug use, dependence, or abuse," the team leader concluded. Pediatrics 2003;111:97-109.
I think there is good reason to believe that untreated ADHD carries a significantly higher risk of substance abuse and other problems in adulthood.
Thursday, January 9: The autoimmune process that leads to diabetes may be triggered by enterovirus (intestinal virus) infections, this Finnish study found. A study of 41 children observed from birth who became positive for diabetes-associated autoantibodies compared them to 196 closely matched control children who remained autoantibody-negative. All children in the study had blood testing for exposure to viral diseases. The group of children that developed diabetes were twice as likely to have had an enterovirus infection in the 6 months prior to the onset of diabetes. Journal of Medical Virology 2003;69:91-98.
Friday, January 10: Prozac® (fluoxetine) has been approved by the US Food and Drug Administration for use in children from 7-17 years of age with depression or obsessive-compulsive disorder (OCD). The National Institute of Mental Health estimates that depression affects up to 2.5% of children and 8% of adolescents in the US. OCD affects roughly 2% of the population and typically begins during adolescence or childhood. Reuters Health.
Monday, January 13: This study found that breast feeding has analgesic effect in newborn infants undergoing painful procedures. A research group in France randomized 180 term newborns undergoing blood drawing into 4 groups, receiving either breast feeding, holding in the mother's arms without nursing, 1 ml of sterile water, or 1 ml of 30% sugar solution. Pain was rated by independent observers working from videotapes. Pain scores (0-10 range, 10 being highest pain level) ranged from 1 for the breast fed infants, to 3 for the sugar solution infants, and 10 for babies held by mother or given sterile water. British Medical Journal 2003; 326:13-15.
Wednesday, January 15: Children who have new onset seizures with fever do not need emergency CT or MRI scans unless they fall into one of several predisposing groups, this study of almost 500 children found. The investigators at Scottish Rite Hospital in Atlanta found such scans were overwhelmingly likely to be normal unless the child was less than 33 months old or had one of these conditions:The research team suggests that unless children fall into one of these two categories, and they are otherwise "well-appearing," the patients can be "safely discharged from the ED, without neuroimaging, if follow-up can be assured." Pediatrics 2003;111:1-5.
Thursday, January 16: In sharp contrast to current American practice, Britain's Department of Health recently advised continued use of thimerosal-containing vaccines. This move was based on the findings first that there was no evidence thimerosal containing vaccines harmed children and second, that alternative thimerosal-free vaccines are less effective. In contrast, the US Senate moved to strike a provision blocking US lawsuits by families who blame their children's autism on thimerosal. This paves the way for lawsuits against manufacturers such as Eli Lilly and Co. who deny liability. Reuters Health.
Friday, January 17: New practice guidelines soon to be released by the American Academy of Neurology and the Child Neurology Society reinforces recent trends away from treating first nonfebrile unprovoked seizures. While between 4% and 10% of children will have a seizure of some kind by age 20, only about 1% progress to epilepsy (defined as two or more seizures without known cause). Because treatment with anticonvulsants does not prevent the development of epilepsy, the risks of daily antiepileptic medication outweigh any potential benefits in most of these cases. ePediatric News December 2002;36:12.
Monday, January 20: About 30 gene therapy experiments in the United States have been halted by the Food and Drug Administration following a second case of leukemia in a child undergoing gene therapy. The new case of leukemia was diagnosed in a boy undergoing gene therapy in France to correct X-linked severe combined immunodeficiency (SCID-X1). A similar case was diagnosed last September. A leading French scientist said that this development shows the risks of the treatment are greater than had been first estimated. The gene therapy had until the emergence of the two leukemia cases worked well in the 10 children being treated for SCID in France. Reuters Health
Tuesday, January 21: An unusual number of cases of infant botulism have been reported in Staten Island, New York in the past 18 months. Four cases in that area represent a rate 34 times the national average. The source of the infection remains a mystery. All of the babies lived within 6 miles of each other. The parents of all 4 babies reported construction activity near their homes around the time of the infections, leading to speculation that dust stirred up during construction carried the spores. All four babies recovered fully. Morbidity and Mortality Weekly Report 2003;52:21-26.
Wednesday, January 22: The anticonvulsant lamotrigine (Lamictal®, GlaxoSmithKline) has received FDA approval as an add-on therapy for the treatment of partial seizures in children two years and older. It had previously been approved for adults with partial seizures as well as a type of generalized seizure of Lennox-Gastaut Syndrome in children, also from age two years and older. Side effects were similar to placebo. Reuters Health
Thursday, January 23: An Australian study comparing pairs of twins, one of whom smoked marijuana at an early age and one who did not, finds that early marijuana use dramatically increases the likelihood of later drug or alcohol addiction problems. In this study, a twin who smoked marijuana before the age of 17 had a fourfold increase in the likelihood of other drug abuse and a sixfold increase in risk of drug and alcohol abuse. Other risk factors for drug abuse, including depression, childhood sexual abuse, or a parent's separation or divorce, did not affect the findings. Journal of the American Medical Association 2003;289:427-433,482-483.
Monday, January 27: In recent years, omphalitis - infection around the umbilical has become a rare disease. Some have advocated dry cord care - no disinfectant dyes applied. Untreated umbilical cord stumps are at increased risk of infection, this Canadian study found, and the researchers cautioned that babies given dry cord care should be monitored closely for signs of infection. Pediatrics 2003;111:15-20.
Wednesday, January 29: The FDA has approved a new 5-in-1 vaccine combination that can reduce the number of shots in the primary immunization series for infants by 6 injections. The new vaccine, Pediarix® (GlaxoSmithKline), is a DTaP-HBV-IPV vaccine containing pertussis (whooping cough), tetanus, and diphtheria vaccines as well as hepatitis B and polio. It is administered as a three-dose series to babies at 2, 4, and 6 months of age. The potential for an extra hepatitis B vaccine dose also has caused concern, because babies who receive a birth dose of hepatitis B vaccine in the newborn nursery and the series of Pediarix injections end up having an extra dose of the vaccine. This extra dose does not cause any problems, however (Pediatric Infectious Disease Journal 2002;21:854-59). ePediatric News 2003;37:1.
Sounds good. We will probably adopt this vaccine in our office soon, pending insurance company approvals.
Thursday, January 30: Adolescents with type 1 (juvenile onset) diabetes may show signs of coronary artery disease as early as their teens, especially if they are smokers or have high levels of a certain blood lipoprotein. Highly sensitive CT scanning of the coronary arteries of a series of young diabetics between the ages of 17 and 28 found evidence of arterial disease in about 10% of them. Young diabetics who said they smoked were five times as likely as non-smokers to have coronary artery calcification, which indicates disease. Diabetes Care 2003;26:433-436.