PedSPAM July 2003
Welcome to the PedSPAM archive for July. Here are the month's daily SPAMlets from my update reading that you might have missed:
In the News
Tuesday, July 1: While more than half of extremely low birth weight children have "neurobehavioral" impairments by school age, as a group they advance in school at the normal rate without major educational problems. Their IQs are within the normal range (although about 9 points lower than normal birth weight children). Measures of verbal comprehension, perceptual organization, distractibility and processing speed were all significantly lower in the extremely low birth weight group. Journal of the American Medical Association 2003;289;3264-3272.
Wednesday, July 2: A new, broader spectrum pneumococcal vaccine has been shown to be effective against 11 strains of the bacteria (the present vaccine is active against 7 strains). Testing in the Philippines found that the vaccine produced not just high levels of antibodies, but antibodies that are measurably effective in killing the germ. Journal of Infectious Disease 2003;197:1704-1708.
Tuesday, July 8: Epinephrine, a bronchial dilator, has no beneficial effect when given by inhalation to babies with bronchiolitis. In fact, the sickest patients may actually be made worse by bronchodilator therapy, this study determined. A family history of asthma, eczema or hay fever did not increase the chance of a favorable response to inhalation treatment with epinephrine. New England Journal of Medicine 2003;349:27-35,82-83.
Bronchodilators such as albuterol and Xopenex® are regularly used in treatment of hospitalized infants with bronchiolitis. This is not the first study to show no benefit from nebulization treatments. The finding that they may be harmful in the sicker children should give pause. Bronchiolitis is sometimes difficult to manage, and there really is no really effective treatment.
Wednesday, July 9: Rapid influenza tests given in the emergency room can be cost-effective in reducing the number of blood tests, chest xrays, antibiotic prescriptions, and hospital admissions in children with influenza-like illness. This study compared the management of almost a thousand children with flu-like symptoms in an ER setting, and found significant differences in the way children were managed based on the results of the rapid influenza test. Archives of Diseases of Childhood 2003;88:525-526.
Friday, July 11: While very low birth weight males never completely catch up by adulthood with normal birth weight babies, very low birth weight girls catch up by age 20. Low birth weight girls (the mean birth weight in this study was 2-1/2 pounds - 1190 grams) studied at age 8 and then at age 20 showed normalization of weight, height, and body mass index (BMI) between 8 and 20 years. Menarche - onset of menstrual cycle - was the same in both VLBW and control groups. Pediatrics 2003;112:e30-e38.
Tuesday, July 15: Newborns exposed in utero to selective serotonin reuptake inhibitors (SSRI's) such as fluoxetine (Prozac®) are more likely to have what the researchers termed "adaptation problems" during the first few days after birth while the infant experiences drug withdrawal. Use of SSRI's in pregnancy has not been shown to cause major fetal malformations, but they may cause neonatal neurologic problems such as restlessness, tremor and rigidity. One treated infant had abnormal muscle twitching and exaggerated reflexes. Archives of General Psychiatry 2003;60:720-726.
Thursday, July 24: A group of dermatological researchers set out to prove that the common belief that stress worsens acne was a myth. What they found out was the reverse. Their study of 22 college students found that emotional stress was directly linked to acne severity. They suggested that doctors consider adjusting medications during their patients' stressful times, and remind them as well of the importance of keeping on their treatment during stressful times such as exams. Archives of Dermatology 2003;139:897-900.
Monday, July 28: Another study has absolved the measles, mumps, and rubella (MMR) vaccine from any association with autistic spectrum disorder (ASD). Twelve epidemiological studies from five countries were analysed, and no study showed any association of the vaccine with either autism or any of the milder autism spectrum disorders. Archives of Pediatric and Adolescent Medicine 2003;157:628-634.
Tuesday, July 29: Montelukast (Singulair®) is effective in reducing requirements for inhaled steroids in children with mild-to-moderate persistent asthma in whom steroids are being tapered. This study showed no reduction in inhaled steroid requirement for children based on maintaining a stable state, but there were significant reductions in steroid requirements during times when steroids were being weaned. Annals of Allergy, Asthma and Immunology 2003;91:49-54
Wednesday, July 30: High levels of fungal spores in homes place infants at increased risk of croup, pneumonia, and bronchitis. Both wheezing and non-wheezing lower respiratory tract diseases were increased by high fungal levels in the home. When fungal levels were found to exceed the 90th percentile level, the risk of lower tract disease was almost doubled. American Journal of Respiratory and Critical Care Medicine 2003;168:232-237.
Thursday, July 31: The U.S. Food and Drug Administration (FDA) has approved Eli Lilly's synthetic human growth hormone Humatrope® for the long-term treatment of children with non–growth hormone deficient short stature (also known as idiopathic short stature. The therapy is restricted to the shortest 1.2% of children - for 10 year old boys and girls, for example, heights of less than 4'1". That height at age ten would normally result in an adult height of about 5'3" for men, 4'11" for women. The distribution of the drug will be strictly limited to pediatric endocrinologists and not advertised to the general public. Reuters Health.