PedSPAM November 1999

Welcome to PedSPAM for November. Here are some more things from my update reading that might interest you.

In the News

The long awaited new 7-serotype pneumococcal vaccine will be licensed soon, and when it is, it will be recommended for use in all children up to age 5, with priority given to 1 to 2 year olds and other high risk groups. Because of possible shortage of the vaccine initially, the Advisory Committee on Immunization Practices (ACIP) will recommend that the vaccine initially be given to groups based upon the following priority scheme:

High Priority
  • All children aged 23 months and younger. These children have a rate of invasive pneumococcal disease (pneumonia, meningitis, sepsis) over 8 times the general population. The vaccination schedule will be at 2, 4, and 6 months, with a booster at 15 months, similar to the Hemophilus Influenza type B (HiB) vaccine currently standard.
  • Children 24-59 months with certain conditions such as sickle cell disease, HIV infection, chemotherapy-induced immune suppression, or organ transplant recipients. These children will receive 2 doses 2 months apart.
  • Native American or Alaskan Native children aged 24-59 months. These children have the highest rate of invasive pneumococcal disease of any ethnic groups, over 10 times the national average.
Moderate Priority
  • All healthy children aged 24-35 months
  • Children aged 36-59 months who are
    • socially or economically disadvantaged, especially those living in crowed homes
    • children in day care
    • children who have experienced repeated or complicated cases of otitis media during the past year
Low Priority
  • Other children aged 36-59 months who are not included in the above groups.

Breast feeding is linked to a reduced risk of childhood leukemia according to a multicenter study just reported. The large multicenter study found a 21% reduction in leukemia risk, greatest in children breast fed for more than 6 months. Journal of the National Cancer Institute 1999;91:1765-1772.

Identifying and treating thyroid deficient mothers early in pregnancy may lead to improved IQ for their children, according to a study by researchers in Maine. Followup at 7 and 9 years of age showed significant correlations of low maternal thyroid levels (as determined in a mass screening program for pregnant women) and later IQ scores. Treatment of the hypothyroidism during pregnancy produced essentially normal intelligence scores at followup. The researchers conclude routine screening for hypothyroidism in pregnant women may be warranted. New England Journal of Medicine, 1999;341:549-55

 Diagnosis and treatment of ADHD in very young children (three and under) may be inappropriate. More than half of those very young children diagnosed with ADHD are being treated with medication. Dr. Marsha D. Rappley from Michigan State University in East Lansing, warned that very young children were sometimes being treated for attention deficit disorder with multiple medications, often with no clear guidelines for diagnosis and treatment, and in the presence of developmental disabilities in language and cognition (which might explain some of their behavioral difficulties). Archives of Pediatric and Adolescent Medicine 1999;153:1039-1045.

The desire to help these children is understandable, but physicians must guard against administering potentially harmful treatments and applying inaccurate labels in their desire to help the patients and their families.

The "Mozart effect" is a supposed temporary increase in spatial reasoning performance after listening to a Mozart piano sonata. Researchers originally reported 8-9 point increases in IQ test scores after college undergraduates listened to 10 minutes of a Mozart piano sonata. Sorry - no one has been able to reproduce these results. No such effect has been found by anyone, and in a report in Psychological Science, the investigators found that just doing the test again (after no music) improved the scores. Psychological Science, 1999:10:366-69.

According to researchers in New Zealand, hot tumble drying of comforters using a clothes dryer is effective in killing the %great majority% of allergenic house dust mites. However, this process alone did not reduce the mite allergen levels in the bedding. Journal of Allergy and Clinical Immunology, 1999;104:499-500.

I suppose it remains to be determined what the optimum approach would be to reduce the overall allergenicity of household bedding infested with dust mites.

A recent study finds that school-based scoliosis screening is ineffective. It does not reduce the need for surgery, which is the stated goal of the program, and has significant costs in terms of doctor visits for positive screening tests, xrays, and parental worry. Journal of the American Medical Association, 1999;282:1427-1432,1472-1474.

Amen. These programs were all the rage years ago; they continue on, required by law in many states, diverting resources from other, more effective uses.

A study showed that handheld metal detector can locate suspected swallowed coins or coin shaped objects in the esophagus in the emergency room. Inexperienced hands were as good as the experienced examiners at picking up the objects. The investigators advocated wider use of this tool - it is cheap, safe (no radiation) and effective. Archives of Pediatric and Adolescent Medicine, 1999:153:853-857

Vaginal douching is practiced by about 15% of adolescent girls and young women. While there is apparently no official position by any of the professional organizations on this practice, it has been found to be associated with an increased risk for vaginal infections, pelvic inflammatory disease, and ectopic pregnancy. Adolescent girls should be discouraged from douching. Archives of Pediatric and Adolescent Medicine, 1999: 153:834-837

Another study on tympanic thermometry (the ear thermometer) in hospitalized children ages 0-2 years old found no significant differences between tympanic and rectal temperatures. Clinical Pediatrics, 38:463-466

You will have trouble convincing some doctors of this, but these results are not new. Properly done, tympanic thermometry is sufficiently accurate and significantly faster. I have used these thermometers in my office since day one and would never consider going back to rectal temperatures. The reduction in crying in the office alone is justification enough.

Nurses who wear artificial nails are more likely to carry germs from one patient to another despite handwashing with soap and water or antibacterial hand cleansing gels, when compared to nurses with natural nails. Infectious Diseases in Children, October 1999.

A mother's intake of soy may affect the development of her fetus, say study results announced at the Third International Symposium on the Role of Soy in Preventing and Treating Chronic Disease in Washington, DC.

Apparently they will have a symposium for just about anything 8-)
Certain substances normally present in soybeans, known as phytoestrogens, affect the development of rats when fed to their mothers during gestation. Both sexes of young rats had lowered birth weights, and the males rats had earlier puberty, when compared to controls whose mothers were fed a soy free diet. Whether these findings will be significant for humans remains to be examined. The lead researcher stated, "There is no reason to assume that there will be gross malformations of fetuses but there may be subtle changes, such as neurobehavioral attributes, immune function, and sex hormone levels." Reuters

Antiepileptic drugs taken during pregnancy are again linked to major congenital defects in a large retrospective group study in the Netherlands. Carbamazepine or valproate as single drug therapy, or multiple drug therapies that include benzodiazepines with carbamazepine or valproate, can significantly increase the risk of congenital heart defects, hypospadias, polydactyly (extra digits), spina bifida and facial clefts. Drinking caffeine while taking these drugs, especially phenobarbital, increases this risk, especially when combined with phenobarbital. Annals of Neurology, 1999;46:739-746.

The use of folic acid by women in China dramatically reduces the rate of neural tube birth defects by up to 85% as reported in a recent study. The women took the same amount of folate as is recommended for American women in pregnancy. The lead investigator, Dr. Robert J. Berry, said "Women need to know about folic acid. They are getting their information from newspapers and magazines but not from their healthcare providers....Physicians need to be very proactive about this....Women of childbearing age should be taking this amount daily." New England Journal of Medicine 1999;341:1485-1490.

Use of sunscreen reduced the number of new moles developing on children in a study of children in Canada. Children given SPF-30 sunscreen and told to apply it whenever they went outside for more than 30 minutes developed 4 to 17 fewer moles over a three year period. Pediatric News, September 1999.

Two new anti-influenza drugs, zanamivir (Relenza®) and oseltamivir (Tamiflu®) are a major step forward in the fight against the annual plague of influenza; they significantly shorten the course and severity of influenza infections of all types. Both drugs work by blocking the release of newly made virus by infected cells. They should be given at the earliest sign of symptoms, and preferably within the first 48 hours of illness. Zanamivir treatment of family members can cut the rate of second cases in the household by 79%. The downside for these drugs: oseltamivir has a 10% rate of nausea and vomiting; zanamivir must be inhaled from an inhaler. Zanamivir is approved down to age 12. Pediatric News, November 1999.

Pork or beef derived pet chews can cause Salmonella infections in people who handle them. This alert was issued by the Food and Drug Administration when 68 persons - half under 10 years of age and 1/3 under the age of two - contracted Salmonella infantis infections after handling pig ear dog chews sold in Canada. Pediatric News, November 1999.

Secretin, an intestinal hormone previously mentioned in PedSPAM as a possible treatment for autism, failed to show any benefit over placebo in its first randomized, placebo-controlled, double-blind trial. The head of the research team remarked that the negative results did not reduce the hopes of the parents, which he says reflects a growing public suspicion of science.

That is a sad thing to hear. Modern Western medicine is as wonderful as it is because of the benefits of science and scientific thinking. We must always be on guard against the forces of darkness: ignorance, quackery, and the perverse anti-technological "Green" mentality that would throw us all back to the "simpler, more natural times" when great suffering and early death were the rule for humanity.

As a physician, I am always offended and saddened by the apparent convictions that so many people hold that somehow some evil conspiracy of scientists and businessmen suppress the truth about supposed miracle cures and withhold them from the market for reasons of profit.

The truth - that we cannot cure every disease and correct every condition - is apparently too much for these people to handle. In the final analysis, what they do is project their anger on others and are often consumed by it, rather than living life as it is in the here and now. How sad.

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