PedSPAM May 2002
Welcome to the PedSPAM archive for May. Here are the month's daily SPAMlets from my update reading that you might have missed:
In the News
Wednesday, May 1: Metadate CD®, an extended release form of methylphenidate used for attention deficit disorder, can be sprinkled on food without altering its effectiveness, find these researchers. Because the beads within the capsule rather than the capsule structure itself provide the timed-release feature of absorption, the beads themselves may be removed from the capsule and still deliver smooth medication release. This may be of value for children who have trouble swallowing the common capsule forms of many ADD medications. Journal of the American Academy of Child and Adolescent Psychiatry 2002;41:443-449.
Thursday, May 2: Dyslexia may not be a permanent brain disorder after all, but a variation of normal brain development that can be reversed by therapy. This study finds that intensive reading instruction may reverse the abnormal brain activity that occurs in children with dyslexia. Why the structures of the brain that are involved in reading fail to develop normally in dyslexic children is not known. It has been thought in the past that these changes are permanent. This data shows this not to be the case - brain function as measured by special scans in the areas associated with reading improved remarkably over the course of an intensive remedial program. Neurology 2002;58:189-1190,1203-1213.
Monday, May 6: An Institute of Medicine study concludes that while soccer is not 100% safe, it is too soon to require changes such as helmets for players. There has been considerable concern in recent years about the effect of repeated blows to the head with the soccer ball, either accidental, or deliberate by the child (heading). No published research to date gives direct or conclusive evidence that heading a soccer ball causes long-term deficits in mental functions. However, tests in the Netherlands found that soccer players scored significantly lower on tests that measured visual and verbal memory, visual analysis and planning, and mental flexibility. The American Youth Soccer Organization recommends that children under 10 should not head the ball, although the organization sill supports the practice of purposeful heading for older soccer players. Pediatrics 2000;105:659-61.
Tuesday, May 7: Maternal depression, which affects up to 10% of postpartum mothers, may affect infant learning. A mother's normal, animated "baby talk" helps stimulate young infants to foster learning. This small study suggests that a depressed mother's "flat" speech patterns may not evoke the proper responses from her infant to foster learning. The authors speculate that this may explain the observation that children of depressed mothers tend to lag in school readiness. The study also found that exposure to non-depressed caregivers might lessen the effects on learning of maternal depression. Psychological Science 2002;13:268-271.
Wednesday, May 8: Celiac disease, an intestinal disorder, is rare in the general population but has now been found to be very common in diabetic children. In Italian children with type 1 diabetes, the disease is about 20 times higher than seen in the general population. In the study, about 3-1/2 percent of children with newly diagnosed diabetes had celiac disease, and this percentage almost doubled over the next few years. Most of the cases of celiac disease were non-symptomatic and there were no outward signs of malnutrition. The researchers recommended that all newly diagnosed diabetics be tested for the disease, and yearly thereafter for several years. Pediatrics 2002;109:833-838.
Thursday, May 9: This study is the first to document a long-standing expert recommendation that hospitals without neonatal intensive care units (NICU) transfer high-risk mothers and infants that weigh <2000 g to a regional NICU. This standard was based on expert opinion and had not been validated formally. This study looked at outcomes for babies less than 2000g born at different types of hospitals. It found that mortality was 2.4 times higher for babies born in hospitals with no NICU; 1.9 times higher for hospitals with intermediate sized NICU units, and 1.4 times higher for babies born in hospitals with small NICU's. The authors call for greater efforts be ensure that babies smaller than 2000 g are delivered at hospitals with regional NICUs. Pediatrics 2002;109:745-751.
Friday, May 10: High school athletes often have undiagnosed and undertreated asthma, finds this large study. A group of 800 high school athletes was tested for exercise-induced asthma symptoms. about 40 had previously diagnosed asthma, and a like number had undiagnosed disease. 85% of the athletes known to have asthma were found to be undertreated, failing a simple running test for exercise-induced symptoms even while on their recommended medication. Annals of Allergy, Asthma, and Immunology 2002;88:380-384.
Monday, May 13: The World Health Organization has unveiled a new reformulation of the oral rehydrating solution used for the past 25 years to prevent dehydration from diarrhea in children. Because of the wide use of this solution, childhood deaths from serious diarrhea have fallen from 5 million per year to 1.3 million a year. The new formulation is less concentrated, and causes fewer side effects. It is effective in children from earliest infancy to reduce the severity of diarrhea and vomiting and the need for intravenous fluids and hospital admission. Reuters Health
Tuesday, May 14: If mothers continue to breast feed while they are introducing foods that contain gluten - a protein found in wheat and other grains - they may significantly reduce the risk of their babies developing celiac disease. Swedish researchers found that the way solid foods were introduced in relation to breast feeding may influence the body's immune response, resulting in tolerance or intolerance of particular foods. There was a 40% lower risk of celiac disease if gluten-containing foods were introduced while the baby was still being breast fed. "It is tempting to speculate that this dietary pattern also reduces the lifetime risk of celiac disease; however, further studies are needed to confirm this notion," the team's lead researcher commented. American Journal of Clinical Nutrition 2002;75:914-921.
Another reason to introduce non-gluten containing rice cereal into the diet first.
Wednesday, May 15: Seat belts save lives, but air bags are less effective, finds a report in the British Medical Journal. Analysis of data from 51,000 automobile crashes revealed that a driver-side air bag provided an 8% reduction in automobile deaths whether or not a seat belt was worn, but wearing a seat belt reduced deaths by about 65% whether a bag was in place or not. The study did not address the effectiveness of passenger or side-impact air bags.
A second study from researchers in Canada found that even though seat belts are designed for an adult passenger's anatomy, they appeared to offer at least as much protection to school-age children as they did to adults; the tragic finding was that about 40% of children involved in the accidents under study were not wearing their seat belts at the time of the crash.British Medical Journal 2002;324:1119-1122, 1123-1125, 1145-1148.
Friday, May 17: A large Danish study finds that he risk of febrile seizure was increased to 12% for children with a full-sibling who had a febrile convulsion, while the corresponding risk for half-siblings was 8%. Children whose older sibling had been hospitalized at least three times for febrile seizures had twice the risk of febrile seizures. Decreasing gestational age - preterm or premature birth - and low birthweight were independently associated with an increased risk of febrile convulsions, regardless of family history. Epidemiology 2002;13:282-287.
Monday, May 20: The nonsteroidal pimecrolimus (Elidel®; Novartis AG) shows significantly and safely reduces eczema (atopic dermatitis) in infants 3 to 23 months old. The medicine, first approved for use down to two years of age for children who have inadequate response or intolerance to standard therapy, gives better long term results than standard therapy of moisturizers and topical steroid preparations for flareups. The new cream reduced the requirement for steroid use by half in children enrolled in the study over the one-year clinical trial. Reuters Health
This medicine is the next generation product after the fairly recent introduction of tacrolimus (Protopic®). These drugs are "immune modulators" that were actually discovered as a beneficial side effect of cancer chemotherapy. I have been very favorably impressed with them. Elidel is also being studied for oral use - it is apparently a very safe drug. Elidel achieved its first European approval in Denmark in March, 2002 for treating patients as young as 3 months old.
Tuesday, May 21: In the US, it costs as much or more to treat children with ADHD as for children with asthma. On average, the annual cost of healthcare for a child with ADHD was $479 higher than for a child in the general population. Annual excess costs for children with asthma were $437 higher than those for healthy children. "The potential economic burden of ADHD is enormous," say the researchers. Based on an estimated prevalence in the child population of 3.5%, the researchers put the yearly healthcare cost of ADHD at $1 billion. Archives of Pediatric Adolescent Medicine 2002;156:504-511.
Wednesday, May 22: A miniature wireless video camera the size of a jellybean that can be swallowed allows an unprecedented visualization of the small intestine in children. Researchers reported on this new device at the 103rd annual meeting of the American Gastroenterological Association. The camera can be used to diagnose small bowel disorders in children as young as 10, weighing as little as 40 pounds. It is swallowed, and sends back real-time pictures of the bowel as it passes through. Results were very impressive. In the study presented, the camera confirmed a diagnosis of Crohn's disease in 9 of 11 children in whom standard colonoscopy and barium X-ray were negative. The detail is better than the best endoscopes. Reuters Health
Fantastic. I would like to see a picture of this device, or better yet, see it in action.
Thursday, May 23: The risk of developing asthma for adolescents with no prior history of disease whose home contains a furry pet is increased, finds this study. A similar effect was identified for the presence of a humidifier in the home. About a third of new cases of asthma in adolescents can be attributed to having pets in the home. Epidemiology 2002;13:288-295.
The key to asthma control has always to start with environmental control. Living with furry pets, especially cats and dogs, has its drawbacks.
Friday, May 24: We know that folate supplementation of a mother at the time of conception dramatically reduces the risk of her baby having a neural tube defect such as spina bifida. Now comes research that suggests that women who use multivitamins around the time of conception are less likely to have an infant with omphalocele - a defect of the abdominal wall in which internal organs lie outside the abdominal cavity at birth - than women who do not use them. Mothers who used multivitamin supplements on a regular basis at any time during the period around conception were 60% less likely to give birth to an infant with omphalocele. The authors cautioned that these results are based on small samples and are not definitive. Pediatrics 2002;109:904-908.
Thursday, May 30: Fetal alcohol syndrome - totally preventable birth defects and developmental disabilities associated with maternal alcohol use during pregnancy - remains a persistent and significant problem in the United States, according to a report from the Centers for Disease Control and Prevention. The rate of fetal alcohol syndrome in children born between 1995 and 1997 in Alaska, Arizona, Colorado, and New York ranged from 0.3 to 1.5 per 1000 live births and remains in line with past prevalence estimates. Morbidity and Mortality Weekly Report 2002;51:433-435.
Friday, May 31: There is a "global explosion" of type 2 diabetes, and doctors are not aggressive enough in managing the disease, warns the International Diabetes Foundation. Just because insulin shots are often not needed in type 2 diabetes, it is not a "mild" form of diabetes. An expert speaking for the Foundation warned that "It is terrible. It means that those (children with type 2 diabetes), unless they're dealt with meticulously, are going to die of heart disease or kidney failure in their thirties... Type 2 diabetes is largely a consequence of unhealthy lifestyle," he said. "And it is preventable ... but there is very poor awareness of diabetes among the public and we need to improve that. Affluent nations should be screening high-risk groups, such as people who are obese, have a family history, or are from ethnic groups pre-disposed to the condition." Reuters Health