PedSPAM June 2003

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

In the News

Monday, June 2: Mothers who smoke during pregnancy may counteract the effects of cigaret smoking on their babies if they breast feed. This study found that at 9 years of age, children of mothers who breast fed at least 3 weeks had scores in reading, math and spelling similar to scores of as children whose mothers did not smoke during pregnancy. Bottle fed children of mothers who smoked in pregnancy scored lower on these tests than those whose mothers did not smoke. Journal of Epidemiology & Community Health 2003;57:403-404.
Tuesday, June 3: Giving pregnant women probiotic therapy in the period before and after delivery the may avert allergic disease in their babies up to 4 years old. Pregnant women were given capsules of either Lactobacillus (a harmless, normal inhabitant of the human digestive tract, found for example in active culture yogurt) or a placebo. If the mother was nursing, this continued until the baby was 6 months old. If the baby was bottle fed, the baby received the probiotics or placebo directly. All the babies had a family history of allergic disease. By 4 years of age, half of the children in the placebo group had developed allergic eczema, compared with one fourth of the children in the probiotic group - a 43% reduction in risk, according to the report. Lancet 2003;361:1869-1870.
Wednesday, June 4: A new respiratory virus has been identified as a possibly significant disease causing entity in US children. Human metapneumovirus (hMPV) has been identified circulating in the United States. Blood antibody tests for children who had suffered viral respiratory illness and had negative tests for respiratory syncytial virus (RSV), influenza and parainfluenza viruses, and adenovirus were studied. Of those studied, 6.4% had evidence of hMPV infection. Infections with hMPV infection mimic RSV infection and include wheezing and abnormal findings on chest x-ray. There is as yet no widespread test for the virus. Pediatrics 2003;111:1407-1410.
Monday, June 9: Tacrolimus (Protopic®) has been shown to be effective in the treatment of childhood vitiligo. This is a condition of progressive depigmentation of the skin in sharply demarcated areas. The cause is unknown, but many theorize it is an auto-immune phenomenon. The success of tacrolimus in restoring normal skin pigment would tend to support that supposition. Archives of Dermatology 2003;139:581-585.
Tuesday, June 10: Oral amoxicillin is better for curing strep throat (group A beta-hemolytic streptococcal tonsillopharyngitis) than plain penicillin, which has been the standard therapy for many years. Several hundred children were randomized into amoxicillin or penicillin treatment groups; the cure rate for amoxicillin was better both clinically (the patient got better) and bacteriologically (repeat throat culture showed clearing of the germ). Clinical Pediatrics 2003;42:219-25.
Another advantage of amoxicillin is better flavor and once-daily dosing.

Wednesday, June 11: Not surprisingly, children who are bullied, especially adolescent girls, have a higher rate of depression and even suicidal thoughts than other children. In a large survey, about 40% of girls who were directly hit, kicked, threatened or called names were depressed and 25% had suicidal thoughts. The rates for children indirectly bullied by ignoring, excluding and backbiting were actually comparable: 35% were depressed, and 20% had suicidal thoughts. The rates of such thoughts in boys who were bullied were lower than for girls; 22% of those directly bullied and 28% of those indirectly bullied were depressed. Pediatrics 2003;111:1312-1317.
These findings would implicate bullying as a major source of childhood depression. The researchers remarked that teachers need to be more sensitive to the effects of bullying, especially the less obvious forms such as social exclusion.

Thursday, June 12: Eight years after introduction, the chickenpox (varicella) vaccine is now widely used in the United States. It has been successful in reducing the death rate from varicella significantly. Varicella deaths declined from 61 in 1994 to 8 in 2000. ePediatric News June 2003;37:6.
Tuesday, June 17: Parents of children who undergo transplant procedures often report symptoms of posttraumatic stress disorder (PTSD). The investigators in this study found that the overall level of the child's health as well as the impact on the family of the transplant process and the attitudes of the medical staff were correlated with level of PTSD symptoms. Pediatrics 2003;111:e725-e731.
Wednesday, June 18 A study which followed over a thousand preadolescent girls over ten years found that those girls who begin puberty with breast development before pubic hair growth are at increased risk for obesity and possibly also breast cancer. Half of the girls studied began breast and pubic hair development at about the same time. Of the remainder, about a third began puberty with pubic hair development, and two thirds with breast development. These girls began their menstrual periods a few months earlier than those who began puberty with pubic hair development. The early breast development group also had a greater percentage of body fat throughout puberty. Increased body fat (BMI) in women is known to be a risk factor for breast cancer. Journal of Pediatrics 2003;142:000-000.
Monday, June 23: The US Food and Drug Administration (FDA) has advised that children and adolescents under 18 years old not be given Paxil® for major depressive disorder. The drug has been associated with a possible increased risk of suicidal thinking in this age group, there is no scientific evidence the drug is effective for major depressive disorder in children and adolescents, and the drug is not approved for use in this age range. MD Consult
Note: "The FDA advises that caretakers of pediatric patients already receiving treatment with Paxil for MDD talk to their doctor before stopping use of the drug. Patients should not discontinue use of Paxil without first consulting their physicians, and it is important that Paxil not be abruptly discontinued."

Tuesday, June 24: Pediatric residents (doctors in specialty training after medical school) are not well informed about prospects for survival and good neurologic outcome in extremely premature babies (defined as those less than 28 weeks gestation). This Canadian study found that the residents underestimated chances for survival and overestimated the risk of cerebral palsy for the tiniest babies. Actual survival rates now for 25-week gestation infants now exceed 80%, with a 9% rate of cerebral palsy. The investigators attribute this to educational goals that focus on management of equipment and day-to-day life support for the babies and very little on long term outcome prospects. MD Consult
Wednesday, June 25: A program of two different interventions to increase multivitamin use by pregnant women was a failure. Women in a California health maintenance organization received either a starter kit or counseling by their doctor or nurse practitioner about the importance of prenatal vitamins to prevent birth defects. Compared with multivitamin use in a control group, neither intervention increased vitamin usage. American Journal of Preventive Medicine 2003;25:17-24.
Thursday, June 26: Children who receive cochlear implants to restore hearing are at high risk of developing bacterial meningitis and should be fully immunized against this disease, especially Haemophilus influenzae type B (the HiB immunization) and Streptococcus pneumoniae (Prevnar®). A Canadian study found a high rate of bacterial meningitis among cochlear implant recipients, and that the recipients studied had a disappointingly low rate of immunization - only about half were immunized against the two main forms of meningitis. Reuters Health
Friday, June 27: The US birth rate is at its lowest level in history.

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