PedSPAM October 2002
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
Tuesday, October 1: Specific immunotherapy (allergy shots directed at a specific antigen) against dust mite antigen are effective in reducing not only allergy and asthma symptoms in asthmatic children sensitive to mites, but reduce the likelihood of the development of new allergies. The children receiving specific allergy immunization therapy in this study had improvement in respiratory symptoms and a reduction in drug intake. Children in the study who received therapy directed against the dust mite antigen had significantly fewer asthma flare-ups than control subjects, and required significantly less bronchial dilator medication and systemic steroids than control subjects. Measures of bronchial hyperreactivity were improved as well. Allergy 2002;57:785-790.
Wednesday, October 2: On a positive note, the rate of sexual activity and risky sexual behaviors among US teens has dropped over the last decade. A report from the US Centers for Disease Control and Prevention (CDC) states that the percentage of high school students who had ever had sex fell from 54% to less than 46%. Condom use was higher among students in 2001 than in 1991, and the number of students in 2001 who reported having four or more lifetime sex partners dropped in comparison to findings in 1991. Morbidity and Mortality Weekly Report 2002;51:856-859.
Thursday, October 3: There has been debate over the years about the effects of minor head injuries on young children. A New Zealand study compared long term outcomes in children who sustained mild head injuries to children who had not. The researchers further broke the head injury group down into those whose injuries required hospital observation or those who were watched at home. The findings showed that some psychosocial problems are indeed more common in children who sustain a head injury, especially if the injury was more severe and happened during the preschool years. Children in the group that required hospitalization, in particular those under 5 years at the time of the injury, had a higher incidence of attention deficit or hyperactivity, as well as conduct disorders. However, the more severe head injuries were not related to poor performance on cognitive and academic tests. Journal of Neurology, Neurosurgery and Psychiatry 2002;73:281-288.
Friday, October 4: A large study of 167,000 children tracked over the first six years of life examined a previously suspected association of common childhood vaccinations and the development of asthma. No correlation was found, refuting several previous studies. Pediatric Infectious Disease Journal 2002:21(6);498-504.
Monday, October 7: It is time for all children 6 months and older to get their flu shots. The US Centers for Disease Control and Prevention (CDC) is encouraging flu shots for healthy children 6 to 23 months of age, their household contacts and out-of-home caretakers. The vaccine is available in ample amounts this year. Health care workers should be vaccinated now; vaccination of other healthy adults should begin in November. Any child with asthma, diabetes, kidney disease or a weakened immune system should be vaccinated, as well as women who will be more than 3 months pregnant during the flu season, according to the CDC. Morbidity and Mortality Weekly Report 2002;51:880-882.
Tuesday, October 8: A nationwide survey of 1,000 parents found that 64 percent of parents of children aged 4-12 years don't vaccinate their children against chickenpox, mostly because of misconceptions about the disease's seriousness. Fewer than half the surveyed parents knew that chickenpox can cause pneumonia, encephalitis, skin infections, and death. While 97% of parents surveyed knew about the availability of a vaccine for chickenpox, only half of them responded that they would vaccinate their at-risk children. Physicians play a key role in educating parents about the benefits of the varicella vaccination, according to the survey findings:
ePediatric News 2002:36.
- 90% of parents who had their children vaccinated were urged to do so by their physician.
- 62% of parents said that their physician's recommendation was the primary factor in deciding to vaccinate their child.
- 57% of parents who didn't vaccinate their child did not discuss the varicella vaccine with their physician.
Wednesday, October 9: A study of sudden infant death syndrome (SIDS) found that the rate of SIDS was more than twice as high for African American babies as compared to Caucasian babies, and that a large portion of the increased risk could be attributed to prone (tummy) sleeping. Overall, The study showed that SIDS risk was four times higher for babies placed on their stomachs to sleep. Pediatrics 2002;110:772-780.
Thursday, October 10: Untreated moderate jaundice in newborns has detectable effects upon behavior, find these Italian researchers. Fifty term newborns with jaundice were matched with a like number of control subjects with lower bilirubin levels. Behavioral assessments were performed at about 3 days, 5 days, and 3 weeks of age. Jaundiced babies had significant reductions in their initial behavioral scores, especially with respect to vision and hearing abilities. Social-interactive scores were especially affected. These scores improved at the 5 day evaluation, and by three weeks the test and control groups showed no differences. Pediatrics 2002:110;e50.
Friday, October 11: The risk of allergic conditions in children may be increased if their mothers take antibiotics during pregnancy, this study found. In a large review of the medical records of 25,000 children in the UK, those children exposed to antibiotics in utero had a 68%, 56% and 17% increased risk of developing asthma, hay fever, and eczema, respectively. The type of antibiotic or which trimester it was given in did not change these effects. American Journal of Respiratory and Critical Care Medicine 2002;166:827-832.
Monday, October 14: Patients who have severe oral steroid-dependent asthma - who have reached the limits of conventional therapy regimens - can be helped considerably by treatment with high-dose intravenous immunoglobulin (IVIG). In this small series of five patients, monthly infusions of intravenous gamma globulin reduced steroid requirements by half. Two of the five patients were able to be weaned off oral steroids entirely. Pulmonary function tests seemed to be improved as well, but the study was too small to draw conclusions with statistical significance. Pediatric Asthma Allergy and Immunology 2002;15:187-194.
Tuesday, October 15: Simple duct tape treatment is more effective than liquid nitrogen freezing for common warts. This study of 51 patients compared standard liquid nitrogen freezing (cryotherapy) to a treatment which consisted of covering the wart with duct tape. In the liquid nitrogen group, 60% of the warts were cured, but duct tape treatment eliminated 85% of the warts within the two month limit of the study. The warts that responded to treatment usually did so within the first month of either therapy. Archives of Pediatric and Adolescent Medicine 2002;156:971-974.
The duct tape treatment is done in this manner: the wart is covered with duct tape (chosen for its sticky qualities) for 6 days. On the seventh day the tape is removed, the wart soaked in water and gently abraded with a course emery board or pumice stone. The wart is allowed to dry overnight, then the duct tape reapplied for another 6 days. If the tape comes off before the sixth day, it is reapplied.
This treatment is not new (we call duct tape "special magic wart tape") but this article provides the first official scientific support for the treatment.
Wednesday, October 16: The US Centers for Disease Control and Prevention (CDC) have reported a second case of Staphylococcus aureus infection in the United States resistant to the antibiotic vancomycin. A Pennsylvania man had a foot infection which proved to be due to the drug resistant bacteria. The infection was cured with other antibiotics. Genetic analysis of the staphyloccus germ showed that it had acquired the trait of vancomycin resistance from another species of bacteria, enterococcus. This bacterium has shown vancomycin resistance for the past 14 years. Morbidity and Mortality Weekly Report 2002;51:902.
Friday, October 18: In this long term controlled study, children experiencing divorce of their parents were shown to have a lower incidence of mental disorders if they receive intervention with group and individual sessions. The researchers found that there was a lower incidence of substance abuse and sexual activity in the intervention group. An active parenting class for mothers that stressed listening and communication skills, consistent discipline, and other key parenting skills produced the best results over the long term. Journal of the American Medical Association 2002;288(15):1874-1881
Monday, October 21: Mist therapy is worthless for childhood croup in the emergency room setting. It provided no improvement whatsoever in the treatment group versus controls. Academic Emergency Medicine 2002;9:873-879.
This article is perhaps most noteworthy in that it appeared at all; it is old news. The experimentally documented effective treatments for croup in the ER include dexamethasone by oral or injection route, and racemic epinephrine by nebulizer. Home mist therapy - take the child into the shower or running a vaporizer - has not been shown to be effective, either.
Tuesday, October 22: When healthy preterm twins sleep together in the same crib, they have significantly fewer episodes of apnea. Eleven sets of preterm twins (mean gestational age of 32 weeks) were monitored for apnea for twelve hours before and then 12 hours during cobedding. Apnea episodes were fewer during the cobedding phase of testing. The investigators surmised that cobedding twins might wake each other periodically, stimulating more regular breathing patterns and resulting in fewer incidents of apnea. Clinical Pediatrics 2002;41:425-31.
Wednesday, October 23: A large long term study confirms that Synagis (palivizumab) - a monoclonal antibody preparation directed against the respiratory syncytial virus (RSV) is effective in reducing hospitalizations for children with serious congenital heart defects. There was a 45% reduction in the number of hospital admissions, and there were fewer RSV-related hospital days and fewer days of increased oxygen usage for the treatment group compared with placebo. Reuters Health
Thursday, October 24: The policy of the American Academy of Pediatrics has been to recommend immunization of premature infants at the normal ages, without correcting for prematurity. That is, a baby born 3 months premature still receives immunizations at 2 months chronological age. Some studies have recommended delaying immunizations in these children due to a suspected increase in apnea and bradycardia spells. A study announced at the Academy's recent meeting found that there was no need to delay immunizations because the incidence of apnea and bradycardia spells was not increased in prematures immunized at the usual chronological age. Reuters Health
Friday, October 25: Bedwetting, daytime voiding accidents, and bowel problems are more common in children with ADHD, according to a study presented this week at the American Academy of Pediatrics National Conference. Children with ADHD were two to three times more likely to report bedwetting, painful voiding, incontinence, urgency, infrequent voiding and constipation than control children.
This connection had been suspected by pediatric urologists before, but never confirmed in a controlled study. Computerized biofeedback training was found in a companion study to be an effective, non-threatening therapy for these problems. Reuters Health
Monday, October 28: Levels of the vitamin folic acid are significantly depressed in pregnant women who smoke. This finding may explain the higher incidence of obstetric and fetal complications. Whether high dose folate supplementation can overcome this deficiency is not yet known. American Journal of Gynecology 2002;187:620-625.
Tuesday, October 29: The Committee on School Health of the American Academy of Pediatrics states in a new position paper that healthy children should not miss school because of head lice. It discourages "no nit" policies as unwarranted. Lice are not painful or a health hazard. They are however responsible for many lost days of school attendance. The AAP had specific recommendations for in-school handling of head lice. Specifically, the paper said that:
The committee recommended permethrin 1% (Nix®, Pfizer) because of its low toxicity for humans and because it is unlikely to cause allergic reactions. Nix® is a cream rinse applied to hair that is first shampooed with a nonconditioning shampoo and then towel-dried. Retreatment is recommended in seven to 10 days if live lice are seen. No currently available medication is 100% effective at eliminating head lice. Treatment failure may mean louse resistance to the medication, but may also reflect improper application. Removal of all nits is not necessary to prevent spread.
- Head lice screening programs in schools do not have a significant effect on the incidence of head lice, and are not cost-effective. Parent education programs may be more appropriate management tools.
- School personnel responsible for detecting head lice in symptomatic children should be appropriately trained, as it can be difficult to diagnose.
- Because a child with active head lice infestation has likely had the infestation for a month or more by the time it is discovered, and because the child poses no health risk to others and does not have a resulting health problem, he or she should remain in class, but be discouraged from close direct head contact with others.
Wednesday, October 30: Even moderate jaundice in newborns at levels we do not ordinarily treat with phototherapy produces subtle behavioral changes in babies.
Behavioral tests done at about 3 days of age and repeated at 3 weeks of age showed differences in all areas, especially reductions in the visual and auditory capabilities of jaundiced babies. Decreased bilirubin levels was correlated with improvement in the behavioral scores. By three weeks of age, however, there was no difference in behavior between the low bilirubin and moderate level groups. Pediatrics 2002;110:e50.
What does this mean? We don't know how important this might be, if it is at all. Mild to moderate jaundice is so common as to be considered normal. We know that there are definite dangers in high levels of bilirubin, but we are unsure just what levels are truly dangerous, so many babies receive phototherapy to prevent moderate levels from rising further. The finding of clear behavioral changes - that is, nervous system effects - in moderately jaundiced infants is slightly troubling.
Thursday, October 31: Asthmatic children who experience night waking are signaling increasing severity of their disease, this study found. Children who had an asthma-related night waking had increased use of rescue inhalers in the days following the event, and were more likely to have more night waking on subsequent nights. The researchers pointed out that night waking due to asthma should prompt parents to watch for further night waking and worsening asthma symptoms. Journal of Allergy and Clinical Immunology 2002;110:395-403.