PedSPAM September 2002
Welcome to the PedSPAM archive for September. Here are the month's daily SPAMlets from my update reading that you might have missed:
In the News
Tuesday, September 3: A study finds that motor tics are more common among children than previously thought. Almost a quarter of all elementary school children have motor tics at some point, but in general these tics are benign and self-limited.
Previous estimates of the incidence of tics in children ranged from 5-20%. This study examined a large representative sample of children, evaluated by experts for the presence of tics. Pediatrics 2002;110:331-336.
One interesting finding was the increased incidence of tics during the winter months. This may relate to the known association of strep infections with tic disorders and other neurologic problems.
Wednesday, September 4: This study is a turnabout in thinking about seizures in the newborn period. The researchers found that seizures in newborns are only rarely the result of oxygen deprivation during labor and delivery. Study of a series of infants who had experienced seizures in the immediate newborn period showed that 70% of the babies with seizures had normal blood oxygen levels at birth, indicating that the seizures were not due to low oxygen during delivery. Only one infant in the study who had a seizure had a low blood oxygen and low Apgar score. Journal of Maternal Fetal and Neonatal Medicine 2002;12:123-127.
This finding is particularly relevant in the field of medical malpractice litigation, a growing crisis in the United States.
Thursday, September 5: A detailed 7 year review of babies born at home or whose mothers unsuccessfully attempted home delivery before emergent transfer to a hospital have a death rate twice that of babies delivered in-hospital. For the home births studied, a midwife, nurse, or physician had to be listed on the birth certificate as the birth attendant or certifier. The statistics were compiled from Washington state birth records. Nulliparous women (first pregnancy and delivery) who planned to give birth at home were at significantly increased risk of prolonged labor and postpartum, and their infants were at almost three times the risk of respiratory distress. Obstetrics and Gynecology 2002;100:253-259.
Friday, September 6: A study of young children with eczema (atopic dermatitis) finds that topical pimecrolimus (Elidel®, Novartis) is safe for infants as young as 3 months of age. Pimecrolimus is a nonsteroid selective inhibitor of inflammatory hormones that activate eczema. The drug was compared to standard steroid treatment. It significantly reduced the number of eczema flare-ups by a two to one margin. Skin absorption of the drug was found to be very low, contributing to an excellent safety profile in the study. Journal of Allergy and Clinical Immunology 2002, 110:277-284.
Monday, September 9: Infants belong in baby beds, not adult beds. The US Consumer Product Safety Commission (CPSC) said that more than 100 infants under 2 years of age died between 1999 and 2001 while sleeping in a bed made for adults. The majority were under 3 months of age. Pushing a bed against a wall or surrounding a napping baby with pillows does not make a safe place for infants to sleep, because of the risk from suffocation, according to the CPSC. Babies wiggle around and move in sleep, and have been found fatally wedged between mattress and wall, as well as suffocated on clothing or plastic bags left on the bed. Parents are advised to only use the mattress that came with baby's crib, and to be sure the sheet fits tightly and securely on the mattress. Reuters Health
Tuesday, September 10: Although the results have varied, some studies have suggested that early exposure to pets reduces the risk of wheezing and asthma later in childhood. This study however found that for the subgroup of children whose mothers - not fathers - have a history of asthma, exposure to cats increased the subsequent risk of wheezing. The current study found that in general, exposure to a cat or cat dander at two to three months of age was protective against wheezing between the ages of one and five years, unless the mother had a history of asthma. In that case, exposure increased the risk of wheezing at or beyond three years of age. Lancet 2002;360:781-782.
Wednesday, September 11: It was once a dictum of medicine that a single case of chickenpox gave lifelong immunity. This study finds that a second case of chickenpox (varicella) is more common than once thought. Interestingly, the tendency seems to be familial, since 45% of the children who had more than one infection had a relative who had also experienced two or more bouts of chickenpox. The authors conclude that otherwise healthy children who have a second case of chickenpox are probably quite normal and do not require any workup for immune deficiency. It also seems from their study that with the dramatic reduction of the number of chickenpox cases due to the availability of the varicella vaccine - about an 80% drop - a proportionally greater number of cases in the childhood population are now second cases. Pediatrics 2002;109:1068-1073.
Thursday, September 12: A controlled trial in children from 6 months to 6 years old with fever of at least 102¡F was conducted to determine whether acetaminophen given by rectal suppository was as effective as the oral route for bringing down fever. The study found that there was no difference in effectiveness between oral and rectal acetaminophen, and that doubling the dose of rectal acetaminophen was no more effective than the standard dose. The dosage for acetaminophen, by the way, is 7 mg per US pound (15 mg per kilogram) of body weight. Pediatrics 2002;110:553-556.
Friday, September 13: Children with transient synovitis of the hip ("toxic synovitis," "irritable hip") get better significantly faster - in less than half the time in this sample - if given ibuprofen, according to this Australian study. Annals of Emergency Medicine 2002;40:294-299.
Monday, September 16: The FDA has cleared a preservative-free influenza vaccine for children 6-35 months old. Aventis produces Fluzone®, and will have limited quantities of the mercury free vaccine this fall. Full production will be online for next year's 2003-2004 flu season. The influenza vaccine is one of the last major childhood vaccines to contain traces of mercury as the preservative thimerosal. Reuters Health
Tuesday, September 17: An Australian study finds that infants of mothers who smoked during pregnancy have significant impairment of their normal arousal patterns when they sleep on their backs. Both spontaneous arousals and those caused by a stimulus (a puff of compressed air on the infant's face) were blunted. This effect is most prominent at the age of 2 to 3 months, which is a peak age of incidence of sudden infant death syndrome (SIDS). This may be a clue to the basis of the observed increase in SIDS incidence in babies of mothers who smoke during pregnancy. Archives of Disease in Childhood, Fetal and Neonatal Edition 2002;87:F100-F105.
Wednesday, September 18: High dose growth hormone therapy for short children produces a significant increase in ultimate height, but the benefits are limited by the fact that bone maturation is accelerated and puberty begins sooner. Growth in height ceases when ceases when the skeleton is mature; this occurs several years after puberty. Since growth hormone advances the onset of puberty to a younger age, the researchers caution that hormone therapy for young children may not be appropriate. They will gain height faster in the short run, but may not benefit very much with respect to their ultimate adult height. Archives of Disease in Childhood 2002;87:215-220.
Friday, September 21: Resistant head lice are a well documented phenomenon in the US and in other countries, and cause a significant amount of missed school days. Treatment failures are common, and usually are due to true resistance to anti-louse medications, although incomplete killing of eggs, errors in applying the medications, or reinfection cause some failures. Permethrin 1% (Nix®, Pfizer) is still recommended as first line treatment by the American Academy of Pediatrics. It as well as other pediculicides work best when applied to a dry scalp, because wet hair tends to dilute the product and decreases penetration into the louse or the eggs. Eggs that survive will hatch into mature lice in 9 days. The CDC recommends treating all family members at the same time, as well as disinfecting anything the patient touches by dry cleaning, hot washing, or sealing in plastic for two weeks. Malathion is a prescription drug approved by the FDA for treating head lice. It should be applied to dry hair until the scalp and hair are soaked and allowed to dry naturally, leaving it on for eight to 12 hours. More information on lice can be found on the CDC's Web site.
Monday, September 23: In a reversal from findings of earlier studies, this group finds in a very long term followup study (which began in 1973) that breast feeding is not protective against asthma or allergies in children. In fact, this long term study suggests breast feeding may even increase the risk. Whether the parents suffered from allergies was found to be irrelevant in this study. "Breastfeeding could be promoted for many reasons, including optimum nutrition and reduction of risk of infant infections," the investigators conclude. "However, the role of breastfeeding in protection of children against atopy and asthma cannot be supported on the basis of the present balance of evidence." Lancet 2002;360:887-888,901-907.
Tuesday, September 24: A large British study suggests that children exposed to measles or influenza around the time of birth may be at increased risk for brain tumors. The researchers correlated general infection levels in one English county over a 17 year period with childhood cancer rates in children born around times of outbreaks of viral diseases. They found that children born around the times of measles or influenza outbreaks were significantly more likely to develop brain tumors. British Journal of Cancer 2002:87.
Wednesday, September 25: A study of nationwide access to mental health services for children finds that three fourths of those children who need help do not receive it. Latino children, uninsured children and preschoolers are most likely to have unmet mental health service needs. Earlier studys have indicated that about 20 percent of children between the ages of 3 and 17 years has a mental health disorder. In this nationwide survey of over 50,000 children, only about 20% of children identified as needing services were receiving them. American Journal of Psychiatry 2002;159:1548-1555.
I am not surprised by these findings. Arranging for mental health services, even for children with supposedly good insurance coverage, is a recurrent problem in my practice.
Thursday, September 26: A study of over 1600 children over two seasons of sports participation found these injury rates per 100 children:
These figures do not paint a full picture, however. Severity of injuries was skewed. Serious injury rates (fracture, dislocation, concussion) were:
- baseball, 1.7
- softball, 1.0
- soccer, 2.1
- football, 1.5
- baseball, 3%
- soccer, 1%
- football, 14%
Friday, September 27: The one remaining vaccine for children containing mercury-containing thimerosal - the influenza shot - will soon be mercury-free. Aventis Pasteur has received approval from the U.S. Food and Drug Administration for Fluzone®, a preservative free influenza vaccine. Limited quantities of the vaccine will be available in early to mid-November. The Centers for Disease Control recently suggested that infants ages 6 to 35 months should now receive annual flu shots, and will likely push for universal yearly immunization of children. This new vaccine will allay fears that some parents have about thimerosal preservatives in vaccines by removing the substance from the last vaccine to contain it. Reuters Health
Of course, we are all waiting impatiently for the nasal flu vaccine to appear on the market. No shot!
Monday, September 30: Untreated urinary tract infection (UTI) in pregnancy appears to be a risk factor for mental retardation in the newborn, according to information released recently at the first annual Centers for Disease Control and Prevention Conference on Birth Defects, Developmental Disabilities, and Disability and Health. About 10-15% of pregnant women experience at least one UTI during pregnancy. This study found that nearly a fourth of the women with diagnosed UTI did not fill their antibiotic prescriptions, often out of concern that the antibiotic would harm their babies in some way. Among these women, the subsequent relative risk of mental retardation in their offspring rose significantly. Untreated UTI was also a significant risk factor for fetal death. Reuters Health