PedSPAM June 2001

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

In the News

Monday, June 4: Tattooing in commercial tattoo parlors is a major route of hepatitis C virus transmission, according to Robert Haley, M.D., chief of epidemiology at University of Texas Southwestern Medical Center in Dallas. Hepatitis C infection is incurable and can lead to liver cirrhosis and cancer. Children at an orthopedic spinal clinic were studied fro prevalence of HCV infection. One third of the adolescents who had a tattoo from a commercial parlor carried HCV, as opposed to 3.5% of patients with no tattoos. Infectious Diseases in Children, p.14, May 2001.

Tuesday, June 5: Nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) given to children with chickenpox do not increase the risk of necrotizing group A streptococcal (GAS) infections (necrotizing fasciitis). Previous studies suggested a link of ibuprofen use and this devastating infection, so we have routinely warned against using ibuprofen in chickenpox cases. That warning seems now to have been unfounded. Pediatrics 2001;107:1108-1115.

Wednesday, June 6: British researchers found that "probiotic" milk, which is milk containing the beneficial bacterium Lactobacillus GG, reduced respiratory infections in the daycare setting as well as reducing diarrheal illness. Additionally, there was a relative 19% reduction in antibiotic use among children who consumed the probiotic milk. British Medical Journal 2001;322:1318-1319,1327-1329.

Recall that probiotic organisms given in a hospital study to patients on antibiotics reduced antibiotic-induced diarrhea. Children with diarrhea or on antibiotics can always use a little active culture yogurt which contains this beneficial bacterium - it has been shown to reduce the length and severity of diarrhea.

Thursday, June 7: Researchers have reported that infant primates reared under constant light exposure are no more susceptible to myopia than those reared in a more circadian rhythm of ambient light. "Parents should not worry," according to investigator Dr. Dolores V. Bradley of Emory University. "Having lights on at night does not cause myopia." Investigational Ophthalmology and Vision Science 2001;42:1146-1152. See also PedSPAM for June 1999, April 2000.

Friday, June 8: Newborns with low antibody levels to pneumococcus (a common causative bacteria for otitis media) in their cord blood have a higher incidence of otitis media episodes in the first year of life. This finding might eventually lead to prenatal immunization of mothers to protect their babies in the first months of life from ear infections. Archives of Otolaryngology Head and Neck Surgery 2001;127:517-522.

Monday, June 11: Researchers at the National Institute of Neurological Disorders and Stroke have found that levels of certain neuronal growth factors in the blood of newborns are markedly elevated in children who later develop autism or mental retardation. This may eventually lead to predictive tests for autism and retardation and enable study of ways to perhaps treat or prevent autism. Annals of Neurology 2001; 49(5):597-606.

Tuesday, June 12: Babies who are breast feeding while they receive immunization injections exhibit significantly lower pain and distress scores - crying, facial activity and flushing. Breast feeding during the administration of the injection was much more effective in reducing stress than nursing right after the immunization. Infectious Diseases in Children May p. 22.

Wednesday, June 13: Mothers attempting to initiate breast feeding are often told to pump their breasts to hasten the onset of effective milk production. A study at the University of Connecticut of mothers trying to establish nursing after C-section delivery found that contrary to widespread belief and perhaps intuition, pumping does not increase milk transfer to the baby in the first 72 hours of life. Pediatrics Vol. 107 No. 6 June 2001, p. e94

I have several points at issue with this study:
The amount of pumping was six 10-15 minute pumping sessions in 48 hours. Not much pumping.
The measured outcome was "milk transfer," determined by weighing the baby before and after nursing. The article implied that the pumped colostrum and milk were discarded. If it was not given to the baby via bottle, then it is almost guaranteed that milk transfer will be reduced - part of the milk is being discarded.
So in my mind it is not established that pumping is actually ineffective. My experience over the years has been much more positive.

Thursday, June 14: In the I-kid-you-not department: high licorice consumption by pregnant women is linked with a slightly increased risk of preterm birth in a study in Finland. Consumption of at least 250 grams (about 9 ounces) of licorice candy a week was associated with delivery which was on average 2.5 days earlier. American Journal of Epidemiology 2001;153:1085-1088.

Licorice must be more popular in Finland than in the US.

Friday, June 15: First seizures in children often last more than 10 minutes, according to findings reported this month. Researchers found

92% of first seizures stopped spontaneously
however, if the seizure lasted more than 7 minutes, there was a 95% chance that medical intervention would be needed to stop it.

Annals of Neurology 2001;49:659-664.

I have yet to meet parents who when confronted with a seizure of any duration do not call for assistance, or rush to the emergency department, or both. But for the inordinately calm parent, the guideline is, if the seizure lasts longer than 5 minutes, seek immediate assistance.

Monday, June 18: Researchers at the National Institute of Neurological Disorders and Stroke have found that levels of certain neuronal growth factors in the blood of newborns are markedly elevated in children who later develop autism or mental retardation. This may eventually lead to predictive tests for autism and retardation and enable study of ways to perhaps treat or prevent autism. Annals of Neurology 2001; 49(5):597-606.

These excess growth factors are thought to cause disorganized growth of brain tissue by overstimulation, causing a structural basis for the brain dysfunction of autism or retardation. If it pans out, this concept could explain a lot.

Wednesday, June 20: Children seen in the Emergency Department for asthma receive very poor follow-up care and have a high rate of complications of their asthma in the two weeks following an ED visit for asthma. The authors of this study found that

45% of children missed two or more days of school or daycare following the visit
17% spent at least three days in bed and 7% spent at least five days in bed
at two weeks, 23% were still coughing and 15% were still wheezing
only half of the children had an office followup visit during the two week followup period

Pediatrics 2001;107:1357-1362.

An emergency department visit for asthma should be a signal to parents that things are not working - your child's doctor should be consulted about his or her care plan. Neglected asthma does more than just cause unnecessary school absences; it means significant lung damage that eventually becomes irreversible and will likely have significant health consequences in adulthood. Work with your doctor or asthma specialist closely. Do not neglect childhood asthma.

Thursday, June 21: Stubbed great toes - a common injury for kids going barefoot in the summer - are sometimes much more serious than parents or physicians appreciate. Because of the anatomy of the toe and toenail, a significant number of more complex injuries to the toe can occur. These include fractures, which are at risk for bone infection (osteomyelitis) because germs can get into the fracture site through the torn nailbed. The authors recommend aggressive cleaning of wounds caused by stubbed toes, with antibiotic coverage to prevent infection of the bone. Journal of Pediatric Orthopedics 2001;21:31-34.

Friday, June 22: Something of a breakthrough for diabetic children may be in the offing in the next few years. It has long been known (since the 1920's) that insulin is absorbed well when sprayed in the nose. Purity and potency of insulin preparations - the sticking point up until this time - has come light years since that time. A study reported in Britain found that adults could be maintained with a single shot of long acting insulin in the evening and short-acting insulin by nasal spray before each meal. Diabetes control was the same as with the standard regimen of multiple injections during the day. Potentially welcome news for children with diabetes. Lancet 2001;357:331.

Monday, June 25: Steroids have often been used in the past in an attempt to aid clearing of middle ear effusion ("fluid in the ear," "serous otitis," or "OME"). This effectiveness of this treatment has been somewhat controversial. This study finds that use of steroids for middle ear fluid is not recommended, because while the steroids did show some faster improvement initially, there was no evidence of any long term benefit from their use. There were no harmful effects of steroid use in the study, by the way. Archives of Pediatric and Adolescent Medicine 2001;155:641-647.

Tuesday, June 26: A study suggests that children with sleep deprivation may exhibit partial-arousal parasomnias such as sleep walking, sleep talking, and night terrors. Dr. Brett Kuhn at the University of Nebraska Medical Center Pediatric Sleep Clinic in Omaha found that increasing total daily sleep by as little as a half an hour quickly produced significant reductions in night arousal attacks. Reuters Health

Wednesday, June 27: We have taught parents for years to estimate the amount of medication left in a metered dose inhaler (MDI) by floating it is water. An empty canister floats high, a full one is partially submerged. This does not work, said Dr. John J. Oppenheimer at the annual meeting of the American Academy of Allergy, Asthma, and Immunology. He stated that it is better to count doses: 2 puffs twice a day will exhaust a 120 puff canister in a month, for example. Reuters Health

Thursday, June 28: In the past, it has been fairly standard practice for surgeons to explore for and possibly repair inguinal (groin) hernias found on the other side of the body from the hernia that prompted surgical repair. A study from Britain, where this practice has long been less popular than in the US, finds that this practice is not justified, based on their findings that recurrence of hernia on the other side is uncommon (about 8% risk in the 5 years after surgery. British Journal of Surgery 2001;88:720-723.

Friday, June 29: Jaundiced neonates require prompt attention to prevent kernicterus, warns the US Centers for Disease Control and Prevention. A report on four breast fed male infants who developed brain damage from excessive jaundice found a common theme: jaundice was recognized, but ignored or discounted as a normal part of breast feeding. In each case, this caused delay in beginning therapy and ultimately, severe brain damage. "Jaundice needs to be recognized and treated in otherwise healthy full-term infants in order to prevent brain damage and permanent disability from kernicterus," said Dr. Rachel Nonkin Avchen of the CDC. She reminds physicians that some of the early warning signs of kernicterus are very yellow or orange skin tones (beginning at the head and spreading to the toes); increased sleepiness, so much that it is hard to wake the infant; a high-pitched cry; poor sucking or nursing; weakness, limpness, or floppiness in body tone; and arching of the baby's body. Morbidity and Mortality Weekly Report 2001;50:491-496.

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