PedSPAM October 2001

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

In the News

Monday, October 1: Once again, researchers find that fears associating any increased risk of inflammatory bowel disease or autism with the MMR immunization (measles, mumps, and rubella) are unwarranted. They specifically state that the combination vaccine is known to be safe based upon many good studies, and that giving the three vaccines separately is inadvisable in light of the fact that this method of immunization has not received the intense experimental scrutiny to which the MMR shot has been subjected. Archives of Disease in Childhood 2001;85:27-274.
Tuesday, October 2: Sumatriptan nasal spray seems to be effective and well tolerated in children between the ages of 5 and 12 who suffer from migraine headaches. The researchers in this small study concluded that while the medication does not have FDA approval for this age group, it is another option for therapy for children with difficult to treat migraines. Headache 2001;41:693-697.
Wednesday, October 3: An analysis of dust and air samples at a number of day care centers finds high levels of dust mite allergens. Allergen exposure in early childhood is a risk factor for the later development of asthma. Most of the day care centers studied had wall-to-wall carpeting, which is known to harbor the human dust mite. The authors endorse the recommendation that day care centers remove carpeting. Annals of Allergy, Asthma and Immunology 2001;87:196-200.
Thursday, October 4: A survey of sudden infant death cases in Alaska found that 98% of the cases involved one or more of three risk factors: Sleeping with a parent was not a significant risk factor in itself if Only one case of SIDS was identified in a infant who slept supine (on the back) with a non-drug using parent. Pediatrics 2001;108:923-927.
Friday, October 5: Children with difficult to control seizures respond so well to a ketogenic diet that it should be considered after a child fails to be controlled on two or even one seizure medication, say theses researchers. The rigorous diet supplies most calories as fat, restricting protein and carbohydrate. It is often unpalatable for children over 2-3 years old because of the high fat content, but can produce dramatic reductions in seizure frequency. Pediatrics 2001;108:898-905.
Monday, October 7: Overall, United States children have a very high rate of completed vaccinations, according to a recent study done by the US Centers for Disease Control. They found that at least 95% of American children have their basic vaccinations in the 70% of states that reported to the CDC. Morbidity and Mortality Weekly Report Weekly Report 2001;50:847-855.
Tuesday, October 9: Children who grow up on a farm and are exposed to stables and farm milk have a lower incidence of developing asthma, hay fever and eczema. Data gathered on children in Austria, Germany, and Switzerland showed a significantly lower incidence of these diseases if children had lived on a farm and been exposed specifically to stables and farm milk. Mothers who continued to farm and worked around stables during pregnancy also conferred protection on their babies independently of whether the babies subsequently had farm exposure. Lancet 2001;358:1129-1133.
I have heard of similar findings before - most recently in a program on television. There is growing interest in the study of the interaction of our immune systems with the microbial "flora" we encounter in early life. Exposure to ordinary germs at an early age seems to be quite beneficial, and protects us from allergies. This is a field just beginning to be studied.

Wednesday, October 10: Very young infants given the antibiotic erythromycin, especially in the first two weeks of life, are at higher risk of developing pyloric stenosis. There may additionally be an association with maternal use of erythromycin and closely related antibiotics in the last 10 weeks of pregnancy, but the correlation was not confirmed. The risk of pyloric stenosis in infancy is normally about 3 per 1,000 babies. Erythromycin treated babies had a rate of 26 per 1,000 - considerably higher but still reasonably low. Erythromycin would ordinarily be given to a newborn for chlamydia eye or lung infection. Topical erythromycin eye ointment, commonly used in the newborn nursery after delivery, was not implicated in any problems. Journal of Pediatrics 2001;139:380-384.
Thursday, October 11: A new formulation of the combination antibiotic amoxicillin-clavulanate, Augmentin ES®, has been recently approved and has arrived in pharmacies. This study finds it very effective for treatment of otitis media (middle ear infection). Side effects were mild to moderate, most commonly diaper rash, diarrhea, and vomiting. Diarrhea has been the main complaint with Augmentin®; the new formulation increases only the amoxicillin component, while leaving the clavulanate at the level found in the older Augmentin 400. Pediatric Infectious Disease Journal 2001;20:829-837.
The advantage of increasing the amoxicillin component is better coverage of so-called intermediate penicillin sensitive pneumococci (a common middle ear disease-causing germ - or pathogen). These germs are resistant to many of the new antibiotics.

Friday, October 12: Women who breast feed their infants should be concerned but not become alarmed about reports of environmental pollutants in their breast milk, say experts at the Center for Children's Health and the Environment. Despite the fact that some pollutants - among them DDT, PCB's and dioxins - are appearing in trace amounts in breast milk, the clear benefits of breast feeding still outweigh any concerns about chemicals in mothers' milk. Further long term studies are needed to ascertain what if any adverse effects these chemicals cause. Reuters Health
Monday, October 15: A one-time "loading dose" (an increased, one time only starting dose) of twice the standard dose of acetaminophen (Tylenol® and others) brings fevers down significantly faster than starting and then maintaining the standard 15 mg/kg (about 7 mg/lb) dose. The incidence of complications was the same in both loading dose and standard dose groups. Pediatrics 2001;108:e73.
The obvious danger with this report is that a few parents will inevitably misunderstand the loading dose - maintenance dose concept and wind up forgetting to reduce the dose to the maintenance (normal) level. This could be very dangerous, because acetaminophen in overdose can be fatal. I would be very cautious about recommending this to patients.

Tuesday, October 16: The rotavirus vaccine may have been unjustly accused of causing an increased risk of intussusception, leading to its withdrawal from the market in 1999. so finds a study published in the British journal Lancet. There was actually a 4% decrease in admissions for intussusception during the time the vaccine was being administered. Lancet 2001;358:1197-1198,1224-1229.
While this study may lead to reinvestigation of the vaccine, do not hold your breath. In our legal climate, when it comes to drugs - once withdrawn, never again seen.

Wednesday, October 17: Surprise, surprise. Swedish researchers find that adults who were exposed to tobacco smoke in childhood are more likely to develop asthma in adulthood than children of non-smokers. They admitted that getting parents to stop smoking was difficult given its addictive nature, but at least smoking outdoors is a start in the right direction. Chest 2001;120:711-717.
Thursday, October 18: In addition to medical or religious exemptions, sixteen states now allow "philosophical" or "personal" reasons for exemption from childhood immunization requirements, and may require that parents simply check a box on an immunization form to exempt their children from vaccination. The CDC is watching the growing trend of these laws with some concern. Unimmunized children are at much higher risk of preventable and sometime serious illness, and may expose other young children to these diseases as well. Journal of the American Medical Association 284[24]:3171-73, 2000.
Friday, October 19: More that 80% of children who contract acute lymphocytic leukemia are alive 10 years after diagnosis. A German researcher has used a new method of analysis for survival data, and found that the outlook for childhood leukemia is even better than previously thought. Survival rates for acute lymphocytic leukemia are still better than those for other leukemias, with 77% 15 year survival rates versus 57% 15 year survival for other acute nonlymphocytic leukemias. Cancer 2001;92:1977-1983.
Monday, October 22: The popular teen "rave" drug known as "ecstasy" (MDMA) causes permanent reduction of verbal memory in users. The effect is dose related - the more the individual uses, the greater the permanent impairment. These researchers say it is urgent that the public understand that "MDMA may cause long-term damage and dysfunction in the human brain." Archives of General Psychiatry 2001;58:901-908.
Tuesday, October 23: Ordinary laundry washing with common household detergents at lower temperatures is sufficient to remove dust mite and cat allergens from the dust found in bed linens. The commonly published recommendation is for laundry to be washed at 130° F or higher to kill dust mites, but whether these higher temperatures are necessary to remove allergens has not been well studied until now. Almost all allergens were removed from bedding within 5 minutes of washing at 80° F. with any of the ordinary commercial household detergents used in the tests. Only slightly more of both allergens were removed at a temperature of 140° F. Enzyme containing detergents were no better at allergen removal. Higher-temperature washing can only be justified if the objective is to kill dust mites, the researchers conclude. Journal of Allergy and Clinical Immunology 2001;108:369-374.
Wednesday, October 24: Patients with chronic Lyme disease symptoms do not respond to long term therapy with intravenous and oral antibiotics. Patients with known Lyme disease and chronic symptoms of persisting muscle or joint pains, fatigue, memory and thinking problems were first treated with 30 days of intravenous antibiotics, followed by 60 days of oral antibiotics. This regimen was useless for alleviating the symptoms. The lack of response leads the investigators to suggest an autoimmune basis rather than persistent infection for these symptoms. New England Journal of Medicine 2001:345(2):85-92.
Thursday, October 25: Local side effects - cough, rash around the mouth, or hoarseness - are common in children who use inhaled corticosteroids for asthma. The most influential factor is the type of device used. The use of spacer devices increases cough during inhalation. Nebulizer use is associated with hoarseness, rash around the mouth, and tongue thickening. The investigators caution that while these side effects are for the most part minor, they may adversely effect patient compliance with treatments. Allergy 2001;56:925-927,944-948.
Friday, October 26: About 6% of all infants younger than 1 year of age in the United States are hospitalized annually for lower respiratory tract disease such as bronchiolitis and pneumonia. Lower respiratory tract disease so early in life increases the risk for later respiratory illnesses such as asthma. Infants who are breast fed for at least 4 months are only one third as likely to be hospitalized with respiratory tract disease such as bronchiolitis or pneumonia. Presented at the annual meeting of the American Academy of Pediatrics.
Monday, October 29: Genetic factors are much more responsible for determining whether a child will develop asthma, find these researchers. They compared asthma rates in large numbers of identical twins, and both same sex and different sex non-identical twins. The overall rate of asthma was 18%, which even I find high (and I am probably quicker to diagnose asthma than many other physicians). Genetic factors isolated in this study accounted for 68% of asthma prevalence. Environmental factors accounted for less than 20% of cases. Archives of Disease in Childhood 2001;85:398-400.
Tuesday, October 30: Tic disorders are much more common than has been recognized in the past, and they are even more common in children with school problems such as attention deficit disorder, handwriting problems, and learning disabilities. The incidence of minor tics in normal school aged children in this study was 18.5%. For children in special education classes, the percentage was 25%. This led the researchers to the idea that tics may represent a sign of an underlying disturbance of brain development which in turn can lead to obsessive-compulsive disorder, attention deficit-hyperactivity disorder (ADHD), and other neuropsychological conditions that can interfere with school performance. Early recognition of tic disorders and Tourette syndrome might lead to better academic and social outcomes for affected children. Neurology 2001;57:1383-1388.
Wednesday, October 31: Harvard researchers reported at the annual meeting of the Infectious Diseases Society of America that parents of young children still hold many incorrect notions about the common cold. All of the following statements are false; the percentage that believed them to be true is given:

Bacteria cause some common colds 60%
Colds should be treated with antibiotics 50%
Colds can be caused by not wearing enough clothes 46%
Colds can be caused by cold weather 57%
A child could catch a cold by going outside with wet hair 37%

74% of parents knew that frequent hand washing can prevent colds, but only 14% know about alcohol-based gels for water-free hand cleansing (a real boon when your hands get as chapped as mine in the winter from endless hand washing between patients). The scientists reminded parents that these gels can be even better than soap and water for stopping the spread of the common cold virus (rhinovirus). They also emphasized that colds are more easily transmitted through contact with nose and eye secretions than through the mouth. Shaking hands is a common way to catch a cold. Reuters Health

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