PedSPAM January 1999

In the News

The American Academy of Pediatrics (AAP) now recommends that most US children receive the injectable inactivated poliovirus vaccine (IPV) for the first two doses of the immunization schedule. The third and fourth vaccine doses could be either more IPV injections, or doses of the oral vaccine (OPV) that contain live poliovirus. The new guidelines are aimed at reducing the rate of vaccine-associated paralytic poliomyelitis (VAPP) that has been linked to the oral vaccine. There are 4 or 5 of these cases annually in the US, out of perhaps 15,000,000 doses of vaccine given. The committee stopped short of going right to an all-injectable schedule, but that is understood to be a given within about two years. Arguments against this change include increased of the injectible vaccine, decreased "herd immunity."

A study group at the US Centers for Disease Control and Prevention in Atlanta, Georgia now recommends routine vaccination of all US children and adults for hepatitis A. This recommendation was made when the researchers determined that current outbreak control measures are inadequate to stop the spread of Hepatitis A during outbreaks. Gracious - yet another shot.

Feeding preterm infants in the first month after delivery with a nutrient-enriched diet improves IQ scores by about 10 points at follow-up during the elementary school years, at least for boys, reports a study in the British Medical Journal. This makes sense based on the fact that growth, including that of the brain, is very rapid in the last trimester of pregnancy - a time cut short by premature birth.

Pennies minted after 1982, when the US Mint began making pennies with a zinc core and a thin copper coating, can cause gastric irritation and ulceration if swallowed by a child. Dr. Sara M. O'Hara of Duke University stated that "The penny is only a problem while it is lodged in the stomach," Dr. O'Hara noted. She warned doctors to be suspicious if there are symptoms of gastrointestinal upset in a child who has swallowed a coin. She advised an xray in such cases to check for a coin lodged in the stomach. "And don't be surprised if the coin doesn't still look like a coin." This is because the stomach acid dissolves holes in the coin and eats away the edges creating a ragged appearance. How one tells the year in which the penny was minted - now that is another problem!

According to study findings published in the December issue of the Journal of the American College of Cardiology, sudden cardiac death occurs in only about 1 in 200,000 high-school athletes per year. This rate is very low. Of the three children who died out of 650,000 sports participants, only one had a condition that might conceivably have been diagnosed before the sudden event.

Researchers at the Centers for Disease Control and Prevention report that the incidence of Haemophilus influenzae b (Hib) invasive disease dropped from 34 cases per 100,000 children aged less than 5 years in 1989 to only 0.4 cases per 100,000 in 1997. While the disease still exists, primarily affecting children who are too young to have completed their primary HiB vaccination series, this particular immunization program has been no less than a stunning success.

Cephalohematoma is a blood collection of the scalp under the dura mater, the tough membrane covering the skull bones) the skull. Researchers report in the American Journal of Obstetrics and Gynecology that skull hematomas and caput succedaneum (boggy fluid swelling of the presenting part of the skull) can occur in utero before labor ever begins. They discovered seven such cases of cephalohematoma or caput succedaneum in fetuses documented on prenatal ultrasound exams. They theorized that abnormal head compression caused by loss of cushioning fluid with premature rupture of membranes was the most common cause of this phenomenon.

A study published in the journal Pediatrics this month confirmed what we have long observed clinically: that children with symptoms of gastroesophageal reflux (GERD) between 6 and 12 months of age all grew out of their problems by one year later. They had no greater than normal incidence of repiratory problems including ear, sinus, and upper respiratory infections, or wheezing episodes. Refluxers were more likely to be perceived by their parents as having minor feeding problems such as slow eating or food refusal.

Chronic headache in children and teens (particularly in girls) should raise high suspicion of psychiatric illnesses including depression, anxiety, and conduct disorder. When such psychiatric problems are confirmed in this age group, practitioners and caregivers should be particularly alert for signs of potential suicide attempts, especially in teenage patients who abuse alcohol and drugs. These cautions come from two unrelated studies published recently in the Journal of the American Academy of Child and Adolescent Psychiatry.

Migraine in children often can be successfully treated with acetominophen and ibuprofen, according to a pediatrician at the University of Helsinki in Finland. Those children resistant to over the counter medication can usually be helped by a single dose of sumatriptan (Immitrex®). About 3% of children will develop migraine headaches by age five.

The lost art of tympanocentesis may be revived. Typanocentesis refers to the insertion of a needle through the eardrum into the middle ear cavity to obtain a specimen of infected fluid for culture tests, to relieve pressure and thus pain, and to allow temporary drainage and ventilation of the middle ear cavity. It is performed regularly by fewer that 50 of the nation's 36,000 pediatricians, but with increased concern about antibiotic resistance, the procedure may make a comeback.

The safety of performance-enhancing dietary supplements is getting renewed scrutiny as a result of Mark McGwire and Sammy Sosa's headline-making pursuit of baseball's home run record. Observers worry that many children and adolescents will follow their lead and may face unforeseen adverse effects including shortened ultimate height. Many teenagers are taking androstenedione and creatine based on reports that the agents help build strength and stamina by allowing them to train for longer periods of time and to recover more rapidly from workouts. Most experts do agree that androstenedione is potentially dangerous, but the jury is still out on creatine.

Children taking high doses of systemic steroids should not receive live virus vaccines, Dr. Larry K. Pickering, professor of pediatrics and director of the center for pediatric research at Eastern Virginia Medical School, Norfolk said at a meeting on clinical pediatrics. Children taking more than 2 mg/kg per day of prednisone or an equivalent amount of another steroid run the risk of disseminated infection from live virus vaccines. Live virus vaccines include oral polio, measles, mumps, and rubella, varicella, and BCG¹. This is not a risk with killed virus vaccines. Dr. Pickering says it is probably safe to begin immunizations with the live virus vaccine 4 weeks after high doses of steroids have been tapered down. In most cases, children taking oral pulsed steroids, inhaled steroids, or topical steroids may receive live virus vaccines. To be prudent, he recommended that children on an oral pulsed-dose schedule be immunized during the period when they are not taking the medication.

¹Not strictly a viral vaccine, but a live bacterium... you get the picture.

A study reported in The Lancet reported that the protective effect of circumcision against urinary tract infection in boys was less than previously believed. A Toronto group found that uncircumcised boys had a 3.7 times higher risk for UTIs during follow-up compared with circumcised infants. A previous large study had shown the incidence to be 20 times greater in uncircumcised boys.

A British study likewise reported in The Lancet found a significant association between domestic water hardness and the prevalence of eczema in younger school-aged children. No association was seen in older children, which the authors speculated may be due to their greater exposure to varying degrees of water hardness outside the home.

A jump among U.S. children between 1973 and 1994 in the reported incidence rate of pediatric brain tumors may be simply attributable to the introduction of the MRI scanner, according to a recent article in the Journal of the National Cancer Institute.

A large survey of sixth, seventh, and eighth graders in North Carolina schools indicates that most young adolescents have tried to lose weight and that "many use potentially harmful strategies to do so," concluded authors of the study in the December Archives of Pediatric and Adolescent Medicine. Many - 51% of girls and 31% of boys - were trying to lose weight, while another 23% were trying to maintain their weight. Of those trying to lose weight, over 90% exercised, almost 65% dieted, 13% vomited or used laxatives, and nearly 13% used diet pills. A word to the wise, parents of teens...

Low-income children in third through eighth grades whose participation in a school breakfast program increased over 4 months had significant improvements in math grades, school absence, and tardiness rates and had fewer psychosocial problems like hyperactivity, depression, and anxiety, compared with those whose participation in the program dropped or did not change. Archives of Pediatric and Adolescent Medicine. Like your Mom told you - eat a good breakfast!

Children with previously untreatable immunodeficiency syndromes and inborn metabolic disorders may respond to umbilical cord blood transplantation, Duke University researchers told attendees at the American Society of Hematology annual meeting. Unrelated donor cord blood harvested at the time of birth can be effectively transplanted in these children, the investigators said. According to lead the researcher, while the incidence of infection and toxicity was high, "...those who survive the early stages do well."

A study in the British Medical Journal confirms earlier findings that events during labor and delivery were in general not associated with cerebral palsy in the newborn. Many factors during the pregnancy increased the risk for CP, including low socioeconomic status; family history of neurologic disease, including seizures; infertility treatment; maternal thyroid disease; severe pre-eclampsia; bleeding during pregnancy; viral illness; placental abnormalities; intrauterine growth restriction; and postmaturity.

Members of the American College of Allergy, Asthma and Immunology (ACAAI) are recommending a change in terminology from "immunotherapy" to allergy "vaccination." "The term 'vaccination' is recommended as opposed to 'immunotherapy,' which some people confuse with cancer treatment,' according to Dr. Ira Finegold, past president of the ACAAI.

Apricot kernels, marketed as a "health food," can cause potentially fatal cyanide poisoning, according to a report in the December issue of the Annals of Emergency Medicine. A 41-year-old woman who began to have difficulty breathing shortly after chewing about 30 apricot kernels was being rushed to the emergency room and diagnosed with cyanide poisoning. The woman was treated with cyanide antidote and other medications, and recovered. A toxic dose in a child would be much less. Keep children away from faddy health foods.

A woman with Rh-negative blood develops antibodies to a fetus with Rh-positive blood because the baby's blood carries a protein that the mother's immune system recognizes as foreign. These antibodies can cross the placental and cause serious problems for the unborn fetus. Determining fetal Rh blood type to initiate treatment before birth previously required invasive and potentially risky techniques such as amniocentesis. A new test will eliminate this risk. Doctors extracted the fetal DNA from samples of women's blood plasma and were able to determine fetal Rh type. The test was 100% reliable beginning in the second trimester. This method may one day help clinicians diagnose genetic disorders such as cystic fibrosis and beta-thalassemia prenatally as well. New England Journal of Medicine Dec. 10, 1998

TB screening is recommended for children who have traveled to or had visitors from a country having a high tuberculosis prevalence. Risks linked to foreign travel were highest when the children had traveled to countries with high rates of tuberculosis infection, including Mexico, China, Hong Kong, Taiwan, and Central America. Other high-risk countries include the Philippines, Vietnam, India, Haiti and South Korea. From the December issue of the American Journal of Respiratory and Critical Care Medicine.

Children and adolescents with asthma appear significantly more likely to be overweight than do healthy controls, according to researchers at the State University of New York at Buffalo. This association may imply a relationship of obesity with reduced physical activity. Asthmatic children were twice as likely to be either in the categories of "very obese" or "overweight." There was no relationship between obesity and asthma severity. From the December issue of the Archives of Pediatric and Adolescent Medicine

A British study has found that grandmothers have profound effects on child health. Children younger than 5 years with grandmothers involved in their care were less likely to visit the emergency room for minor problems than those without grandmother involvement. The study leader concluded that "the absence of an involved grandmother in a child's care is one of the markers of family vulnerability..." December 18th issue of the British Medical Journal.

Site Information/Disclaimer