Pediatrics
28 Sep Pre-exposure Prophylaxis Use by Breastfeeding HIV-Uninfected Women
MedicalResearch.com Interview with: [caption id="attachment_28422" align="alignleft" width="145"]
Dr. Kenneth K. Mugwanya[/caption]
Kenneth K. Mugwanya MBChB, MS
Department of Epidemiology andDepartment of Global Health
University of Washington, Seattle, Washington, USA
Division of Disease Control, School of Public Health
Makerere University
Kampala, Uganda
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Women living in regions with high HIV prevalence are at high risk of HIV acquisition in pregnancy and postpartum because they infrequently use condoms, do not know their partner's HIV status, and have biologic changes or changes in their partner's sexual partnerships that increase susceptibility. Moreover, acute HIV infection during pregnancy or breastfeeding period is associated with high rates of mother-to child HIV transmission because of high circulating level of HIV virus in blood. Oral antiretroviral pre-exposure prophylaxis (PrEP) is a powerful HIV prevention strategy recommended by both the World Health organization and US Centers for Diseases Control and Prevention. PrEP is an attractive prevention strategy for women as it can be used discreetly and independent of sexual partners. However, there is limited research about the safety of PrEP in HIV-uninfected pregnant or breastfeeding mothers and their infants.
27 Sep Isolated Cleft Palate, But Not Cleft Lip, Linked to Increased Health Risks
MedicalResearch.com Interview with: Erik Berg, MD Department of Global Public Health and Primary Care University of Bergen Bergen, Norway MedicalResearch.com: What is the background for this study? What are the main findings? Response: Parents regularly express concern about long term health outcomes for children born with oral cleft. In this study we used population-based long-term follow-up data from multiple national registries to focus on the future health outcomes of cleft cases without additional chronic medical conditions or congenital anomalies. The study cohort consisted of all individuals born in Norway between 1967 and 1992. All patients treated for clefts in Norway during the study period were invited to participate. 2 337 cases with isolated clefts and 1 413 819 unaffected individuals were followed until 2010. The main outcome variables were conditions diagnosed in childhood or early adulthood, need for social security benefits, and risk of death.21 Sep Collaborative Care is Effective and Cost-Effective For Adolescent Depression
MedicalResearch.com Interview with: [caption id="attachment_28010" align="alignleft" width="173"]
Dr. Laura Richardson[/caption]
Laura P. Richardson, MD, MPH
Interim Chief | Division of Adolescent Medicine
Director | UW Leadership Education in Adolescent Health (LEAH) Program
Professor | UW Department of Pediatrics
Seattle Children's | University of Washington
MedicalResearch.com: What is the background for this study?
Response: Adolescent depression is one of the most common mental health conditions during adolescence. Up to one in five adolescents experience an episode of major depression by age 18. Depressed youth are at greater risk of suicide, dropping out of school and poor long-term health. Treatments, including medications and psychotherapy, have been proven to be effective but most depressed teens don’t receive any treatment.
Two years ago, we showed that the Reaching Out to Adolescents in Distress (ROAD) collaborative care model (a.k.a. Reach Out 4 Teens) designed to increase support and the delivery of evidence-based treatments in primary care was effective in treating depression in teens, significantly improving outcomes. We ran a randomized clinical trial at nine of Group Health’s primary care clinics and reported effectiveness results in JAMA.
The current paper represents the next step in this work, examining the cost-effectiveness of collaborative care for adolescent depression in our intervention sample of 101 adolescents with depression, ages 13-17 years.
21 Sep Early Introduction May Reduce Peanut and Egg, But Not Gluten, Allergies in Children
MedicalResearch.com Interview with: [caption id="attachment_28127" align="alignleft" width="200"]
Dr. Robert Boyle[/caption]
Dr Robert Boyle
Senior lecturer in paediatric allergy
honorary consultant, Paediatric allergist
Imperial College Healthcare NHS Trust
MedicalResearch.com: What is the background for this study? What are the main findings?
Editors' note: Please discuss food introduction with your child's pediatrician before embarking on any new foods.
Response: Food allergy is a common problem which may be getting more common.
We have known for over 100 years that feeding egg to animals such as guinea pigs can prevent egg allergy. However randomised trials of allergenic food introduction for preventing food allergy in human infants have not been done until the past 5 years, and have so far yielded mixed results. One trial for peanut allergy was positive, with less peanut allergy in infants who were fed the food from early in life compared with infants who avoided it for 5 years. Other trials have yielded null findings, but may have been too small to yield a conclusive result. We used a technique called meta-analysis to combine the results of all previous trials of timing of allergenic food introduction and risk of food allergy. We also evaluated other allergic and autoimmune diseases.
Our analysis yielded conclusive results for both egg and peanut – that early introduction of these foods into an infant’s diet might reduce their risk of egg and peanut allergy by around 40-70%. We were surprised to see null findings in our meta-analysis of timing of gluten or wheat introduction and risk of coeliac disease (gluten intolerance) which is a different type of allergy to egg and peanut allergy. This suggests that early introduction of allergenic foods does not reduce risk of all types of food allergy.
21 Sep BDNF Is Potential Biomarker For Autism Spectrum Disorder
MedicalResearch.com Interview with: [caption id="attachment_28240" align="alignleft" width="150"]
Dr. Yong Cheng[/caption]
Dr. Yong Cheng, PhD
Postdoctoral Fellow
NIH
MedicalResearch.com: What is the background for this study?
Response: Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders which affect about 1 in 68 children in the United States, according to data from the Centers for Disease Control and Prevention. Brain-derived neurotrophic factor (BDNF) is an important moderator in neurodevelopment and neuroplasticity, and studies have suggested the involvement of BDNF in ASD. Although some clinical studies show abnormal expression of BDNF in children with ASD, findings have been inconsistent. Therefore, we undertook a systematic review of the scientific literature, using a meta-analysis to quantitatively summarize clinical data on blood BDNF levels in children with ASD, compared with healthy peers.
21 Sep Intestinal Microbiome Linked to Obesity and Fat Storage in Children
MedicalResearch.com Interview with: [caption id="attachment_28185" align="alignleft" width="133"]
Dr. Nicola Santoro[/caption]
Nicola Santoro, MD, PhD
Associate Research Scientist in Pediatrics (Endocrinology)
Yale University
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The study start from previous observations showing an association between the gut microbiota and obesity.
Similarly to what previously described in adults and in children, we found an association between the gut microbiota and obesity. We took a step further and also observed that the gut flora is associated to body fat partitioning (amount of fat in the abdomen). Moreover, we observed that the effect of microbiota could be mediated by the short chain fatty acids a product of gut flora.
17 Sep Healthy Eating in Adolescence Sets Pattern For Less Weight Gain As Young Adult
MedicalResearch.com Interview with: [caption id="attachment_28058" align="alignleft" width="133"]
Dr. David R. Jacobs, Jr.[/caption]
David R. Jacobs, Jr., PhD
Mayo Professor of Public Health
Division of Epidemiology and Community Health, School of Public Health
University of Minnesota
Minneapolis MN 55454-1075
MedicalResearch.com: What is the background for this study?
Response: Project EAT (Eating and Activity in Teens and Young Adults) is on ongoing longitudinal study which began by screening middle and secondary school students in the Minneapolis and St Paul Metropolitan are. Students were the 11-18 years old (average age 15), then followed up at average ages 20 and 25. We had devised an eating pattern in about 2006, which
a) predicts a lot of things in several different studies (including total mortality in the Iowa Women's Health Study) and b) looks a great deal like the recently released 2015 Dietary Guidelines for Americans (DGA).
We call our diet pattern A Priori Diet Quality Score (APDQS) and think of it as close to or in the style of a Mediterranean/prudent/healthy diet.
We hypothesized that this pattern would be associated with lower weight (in general with better long term health, but the focus in Project EAT was weight and BMI), probably least so at age 15. The minimal hypothesized effect in adolescence relates to the very large energy expenditure in adolescent growth years; we thought that diet composition would be less important for body weight at that time than energy intake (and APDQS is about diet composition).
17 Sep Children Living In HUD Housing Had Lower Blood Lead Levels Than Those Not Receiving Housing Assistance
MedicalResearch.com Interview with: [caption id="attachment_28039" align="alignleft" width="151"]
Dr. Katherine Ahrens[/caption]
Dr. Katherine Ahrens PhD
Office of Population Affairs
Rockville, MD 20852
MedicalResearch.com: What is the background for this study?
Response: Lead exposure among children is linked to many adverse effects on health and cognitive development, which can be irreversible. The National Center for Health Statistics (NCHS) has linked 1999 to 2012 National Health and Nutrition Examination Survey (NHANES) data to administrative data for the Department of Housing and Urban Development’s (HUD) largest rental assistance programs (1999 through 2014), and these linked data allow calculation of the first-ever national blood lead level estimates among children living in HUD-assisted housing. Here we compare blood lead levels among children 1 to 5 years of age in 2005 to 2012 who received housing assistance during 1999 to 2014 with levels among children who did not receive housing assistance during that period.
16 Sep Cause and Preventative Treatment of Most Preterm Births Remains Unknown
MedicalResearch.com Interview with: [caption id="attachment_27981" align="alignleft" width="104"]
Dr. Joseph Leigh Simpson[/caption]
Joseph Leigh Simpson, MD FACOG, FACMG
President at International Federation of Fertility Societies
March of Dimes Foundation
White Plains, NY
MedicalResearch.com: What is the background for this study?
Response: Preterm birth (PTB) is the most common single cause of perinatal and infant mortality, affecting 15 million infants worldwide each year with global rates increasing. A total of 1.1 million infants die each year. Preterm births and their complications are the leading cause of deaths in children under age 5.
The biological basis of preterm birth remains poorly understood, and for that reason, preventive interventions are often empiric and have only limited benefit. Large differences exist in preterm birth rates across high income countries: 5.5 percent in Sweden and at present 9.6 percent in the U.S. The International Federation of Gynecologists and Obstetricians (FIGO)/March of Dimes Working Group on Preterm Birth Prevention hypothesized that identifying the risk factors underlying these wide variations could lead to interventions that reduce preterm birth in countries having high rates.
14 Sep Some Pediatric Acute Otitis Media Can Be Managed With Close Parental Supervision, Without Antibiotics
MedicalResearch.com Interview with: Johanna M. Uitti, MD Department of Paediatrics and Adolescent Medicine Turku University Hospital Turku, Finland MedicalResearch.com: What is the background for this study? What are the main findings? Response: According to several national guidelines, close follow-up is required if initial observation without antimicrobial agents is chosen for the management of acute otitis media (AOM) in children. The aim of this study was to examine whether close follow-up with reexamination is needed for children with AOM initially managed without antimicrobial agents who have symptomatic improvement during the first week after diagnosis, as assessed by their parents. Of the 104 children with symptomatic improvement, 3 (2.9%) developed worse signs or perforation of the tympanic membrane as seen on otoscopy. In contrast, of the 54 children with symptomatic failure, 16 (29.6%) developed worse signs or perforation of the tympanic membrane as seen on otoscopy.14 Sep Adolescent Girls Not Adequately Screened For Pregnancy Before Chemo or CT Scans
MedicalResearch.com Interview with: [caption id="attachment_27794" align="alignleft" width="144"]
Dr. Pooja Rao[/caption]
Pooja Rao, MD, MSCE
Assistant Professor
Division of Pediatric Hematology/Oncology
Milton S. Hershey Medical Center
Penn State College of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Although many chemotherapy drugs can cause birth defects, no standardized guidelines exist for pregnancy screening in adolescent female patients with cancer. Additionally, little is known about how often they are screened prior to receiving treatment.
Our study found that adolescent girls are not adequately screened for pregnancy prior to receiving chemotherapy or CT scans that could potentially harm a developing fetus. Adolescents with acute lymphoblastic leukemia, the most common childhood cancer, had the lowest pregnancy screening rates of the patients studied.
14 Sep Playing Video Games By Children May Be Helpful In Moderation
MedicalResearch.com Interview with: [caption id="attachment_27906" align="alignleft" width="200"]
Dr. Jesus Pujol[/caption]
Jesus Pujol, MD
Director of the MRI Research Unit.
Department of Radiology. Hospital del Mar
Barcelona
MedicalResearch.com: What is the background for this study?
Response: The pros and cons of video gaming in children have been extensively debated. There are relevant amounts of data indicating both the positive and negative effects of video games. Nevertheless, a key question for many parents remains unanswered: How long should children play? To provide some clarity, we have investigated the relationship between weekly video game use and certain cognitive abilities and conduct-related problems.
12 Sep Low-Intensity Interventions Addressing Social Needs In Pediatric Settings Can Improve Child Health
MedicalResearch.com Interview with: Laura M. Gottlieb, MD, MPH Department of Family and Community Medicine, 2Center for Health and Community University of California, San Francisco MedicalResearch.com: What is the background for this study? What are the main findings? Response: Numerous studies have demonstrated that childhood exposures to social adversities, like family financial insecurity, food insecurity, and housing instability, lead to poorer health outcomes across the life course. These social adversities disproportionately affect low-income and racial minority populations. In response to this evidence there have been calls to address social needs in pediatric clinical care settings. For example, recently the American Academy of Pediatrics’ Task Force on Childhood Poverty endorsed the promotion of evidenced-based strategies to reduce the negative health effects of poverty on low-income children, including by increasing the availability of clinic-based interventions addressing social risks. In response to these calls to action, a growing number of pediatric health care organizations are screening for and address families’ social needs. There is a critical need for more evidence on the effectiveness of these types of interventions. Many of the studies conducted so far have focused primarily on assessing program process outcomes or impacts on families’ social needs, but have not evaluated actual health outcomes resulting from program participation. To our knowledge, this study was the first randomized clinical trial evaluating the impacts of a pediatric social needs navigation program on child health. The reported number of social needs identified at baseline ranged from 0 to 11 out of 14 possible items, with a mean [SD] of 2.7[2.2] needs identified by participating families. Family participation in the navigation program intervention significantly decreased families’ reports of social needs by a mean (SE) of .39(0.13) vs. an increase of a mean (SE) of .22(0.13) in the active control arm. Participation in the navigation program also significantly improved parent-reported overall child health, with a mean (SE) change of -.036(0.05), compared to the active control arm with a mean (SE) change of -0.12(0.05). At 4 months post enrollment, the number of social needs reported by those that participated in the navigation program decreased by a mean (SE) of .39(0.13).08 Sep Breastfeeding May Protect Against Genetic Tendency Toward Pediatric Asthma
MedicalResearch.com Interview with: Olga Gorlanova Wissenschaftliche Assistenzärztin Paediatric Pneumology Research Group Universitäts-Kinderspital beider Base MedicalResearch.com: What is the background for this study? Response: Previous research has investigated how childhood asthma and early wheeze can develop as the result of a complex interaction between environmental exposures, such as tobacco exposure, older siblings and an individual’s genetic profile. Genes associated with childhood asthma risk are located on chromosome 17, called 17q21. Our study asked the question: could the effect of 17q21 on respiratory symptoms in infants be modified by breastfeeding?07 Sep Food Allergies May Be Higher In Children Who Receive Antibiotics During First Year
MedicalResearch.com Interview with: [caption id="attachment_27718" align="alignleft" width="125"]
Dr. Bryan Love[/caption]
Bryan L. Love, PharmD, BCPS-AQ ID
Associate Professor
Department of Clinical Pharmacy & Outcomes Sciences
South Carolina College of Pharmacy
University of South Carolina
Columbia, South Carolina 29208-0001
MedicalResearch.com: What is the background for this study?
Response: In the US, food allergy has become one of the more common childhood medical conditions diagnosed in young children. Antibiotics are frequently prescribed in young children, and research continues to reveal that as many as 30% of antibiotic prescriptions are not appropriate.* We sought to examine if there was an association between antibiotic prescription and food allergy diagnosis.
07 Sep Over the Counter Lice Remedies Unlikely to Be Effective
MedicalResearch.com Interview with: [caption id="attachment_27707" align="alignleft" width="120"]
Head Louse[/caption]
William Ryan B.V.Sc.
Ryan Mitchell Associates LLC
Westfield, NJ and
Bernard Cohen, MD
Professor Dermatology and
Ellen Koch, MD
Division of Pediatric Dermatology
Johns Hopkins Medicine, Baltimore, Maryland
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: As a group we were concerned about the misinformation that continues to be promulgated on the internet and through other sites. Importantly, the group consisted of experts with specific experience in the management of head louse infestations, from pediatric dermatology, pediatrics, school nursing and head louse research fields. Even information sources that we would have expected to be credible are outdated, unreliable or both, often continuing myths about head louse infestations and how they can be controlled. We wanted to provide a balanced and informed perspective that would help physicians and parents recognize that head louse infestations do not present a serious problem, and can be well managed with an informed approach to treatment.
The main findings are that over the counder products (permethrin/pyrethrins) are unlikely to be effective, and that that there are safe and effective products that are available by prescription.
Interestingly, head lice do affect Indian and African children in their home countries, but virtually nonexistent in African Americans in North America. There has been speculation about hair grooming regimen or structure of African American hair but the cause is unknown. In a study we performed assessing resistance to over the counter pediculicide components over a decade ago in Baltimore, we were not able to find a single African American child with head lice. We were not able to recruit any patients from the Baltimore City Schools.
07 Sep Which Come First? Atopic Dermatitis or Staph Aureus Colonisation?
MedicalResearch.com Interview with: [caption id="attachment_27696" align="alignleft" width="125"]
Prof. Alan Irvine[/caption]
Prof. Alan Irvine DSc
Consultant Dermatologist Our Lady’s Children’s Hospital
Associate Professor of Dermatology
Trinity College Dublin
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The background is that atopic dermatitis (AD) has a close relationship with staphylococcus aureus (SA) colonisation, and this is known to drive flares or exacerbations of AD but before our report it was not known which came first-AD colonisation or atopic dermatitis?
By following a cohort pf patients very carefully over a 1 year period and regularly sampling their skin microbiome we were able to show that SA colonisation did not precede development of AD and in fact that several non SA species of staphylococcus actually appeared to be protective for developing atopic dermatitis.
This is an important new finding in the complex relationship between the microbiome and skin inflammation, suggesting that some commensal bacterial are anti-inflammatory or protective.
06 Sep Overweight Girls, Underweight Boys May Be At Greater Risk of Adult Asthma
MedicalResearch.com Interview with: Professor Charlotte Suppli Ulrik MD DMSc et al. Dept. of Respiratory Medicine Hvidovre Hospital Copenhagen, Denmark MedicalResearch.com: What is the background for this study? Response: Obesity is a risk factor for new-onset asthma, but the association is incompletely understood. Our aim was, therefore, to investigate the association between body mass index (BMI) BMI in childhood and asthma admissions in early adulthood (until age 45 years). We used data on BMI measured annually (age 7-13 years) in 321,830 children enrolled in the Copenhagen School Health Records Registry. During the 36-years of follow-up, a total of 2,059 first-time ever hospital admissions for asthma were observed.06 Sep Origins of Childhood Asthma Can Be Traced To Very Early in Pregnancy
MedicalResearch.com Interview with: [caption id="attachment_27674" align="alignleft" width="132"]
Dr. Stephen Turner[/caption]
Dr Steve Turner MD MBBS
Lead investigator of the study team and
Respiratory paediatrician
Royal Aberdeen Children’s Hospital
MedicalResearch.com: What is the background for this study?
Response: For almost thirty years there has been evidence that we are all born with a certain predisposition to what are called non communicable diseases (NCD) such as high blood pressure, type II diabetes and heart disease.
The evidence comes from studies which have linked reduced birth weight with increased risk for these NCDs in later life. The question which arises, and which has been more difficult to answer, is “when during pregnancy is the predisposition to for NCDs first seen?”
This is important to any attempt to reduce the unborn baby’s risk for NCD. We and other researchers have used fetal ultrasound data to link size before birth to non communicable diseases outcomes. In childhood, NCDs include asthma.
06 Sep Uncertainty Persists About Benefits of Delayed Cord Clamping In Extremely Premature Infants
MedicalResearch.com Interview with: [caption id="attachment_27700" align="alignleft" width="138"]
Dr. David Osborn[/caption]
David Osborn MB BS MM PhD FRACP
Clinical Associate Professor, University of Sydney
Senior Neonatologist, Royal Prince Alfred Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: In an analysis of trials of placental transfusion at delivery by either delayed umbilical cord clamping or cord milking in infants born before 30 weeks gestation, placental transfusion was associated with short term benefits including increased hemoglobin, fewer blood transfusions, improved blood pressure and reduced late onset sepsis, with no significant effect on other outcomes. There were insufficient data regarding effects of placental transfusion on survival and long term disability.
The Australian Placental Transfusion Study (APTS) is a randomised controlled trial that aims to determine if delayed cord clamping (≥ 60 seconds) compared to early cord clamping (≤10 seconds) in 1600 infants born before 30 weeks gestation results in improved newborn outcomes and disability free survival.
In this echocardiographic sub study, the aim was to determine the effect of placental transfusion on systemic blood flow in the first day after birth in 266 infants randomly allocated to delayed versus early cord clamping (133 infants in each group). The primary outcome was superior vena cava (SVC) flow (cardiac input) which overcomes the problem of shunts across the adapting heart which affect the usefulness of measuring ventricular outputs in the first days after birth.
In infants born <30 weeks gestation, delayed cord clamping had no effect on the principle measure of systemic blood flow (SVC flow) during the first 24 hours compared to immediate cord clamping. However, right ventricular output (RVO) was lower in the delayed cord clamping group. This was not predicted and may be a chance finding. Further analysis suggests the effect of cord clamping on RVO could be mediated by its effect on hemoglobin. This may be a positive or negative adaptive change. There was no evidence of an increase in right to left ductal shunting suggestive of high pulmonary blood pressure to explain the difference in RVO. Delayed cord clamping resulted in a 8.9g/L greater increase in hemoglobin to 6 hours but had no effect on ductus arteriosus size, shunt direction or treatment, no effect on blood pressure or its treatment, and no effect on blood gas parameters and other cardiovascular variables in the first 24 hours.
06 Sep Iron Chelator Can Reduce Cardiac Toxicity From Some Pediatric Chemotherapy
MedicalResearch.com Interview with: [caption id="attachment_27606" align="alignleft" width="133"]
Dr. Steven Lipshultz[/caption]
Steven E. Lipshultz, MD, FAAP, FAHA
Schotanus Family Endowed Chair of Pediatrics / Carman and Ann Adams Endowed Chair in Pediatric Research / Professor, Carman and Ann Adams Department of Pediatrics / Professor of Medicine (Cardiology), Oncology, Obstetrics/Gynecology, Molecular Biology/Genetics, Family Medicine/Public Health Sciences, & Pharmacology /Professor in the Center for Molecular Medicine and Genetics
Wayne State University School of Medicine
President, University Pediatricians & Interim Director, Children’s Research Center of Michigan
Pediatrician-in-Chief, Children’s Hospital of Michigan
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Surviving childhood cancer has dramatically and increasing improved to the point where more than 80% will achieve a 5-year event free survival. Many of these survivors look forward to decades of active productive life.
More than half of these survivors have been treated with therapies know to be associated with late cardiotoxicity that can be pervasive, persistent, and progressive and associated with cardiovascular morbidity and mortality. In this article we review both the course and prevention of this cardiotoxicity. We focus in part on anthracycline chemotherapy that is widely used and known to be cardiotoxicity.
We further review studies we and others have conducted to examine the effectiveness of dexrazoxane, an iron chelator, that when given before each anthracycline dose results in anthracycline cardioprotection for long term survivors. In some reported studies this has allowed for higher cumulative anthracycline doses to be safely given. In other cases this has allowed for simultaneously being able to safely treat children with malignancies that would be refractory to conventional therapy more potent therapies that would normally have additive cardiotoxicity.
01 Sep Most Childhood Asthma Responds To Evidenced Based Therapy
MedicalResearch.com Interview with: [caption id="attachment_27559" align="alignleft" width="125"]
Prof. Francine Ducharme[/caption]
Francine M. Ducharme, MD, FRCPC
Professor, Departments of Paediatrics and Social and Preventive Medicine
University of Montreal
Associate Director of Clinical Research and Knowledge Transfer, Research Centre, CHU Ste-Justine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The management of asthma attacks in preschoolers has been the subject of much recent debate. The results of a study published in 2009 had shaken the pediatric world. The study reported that preschool children with viral-triggered flare-ups did not respond to standard treatment and, suggesting that this was due to their young age. Such finding was particularly worrisome as the majority of asthma-related emergency room visits and hospitalizations involve preschool children.
We conducted this large cohort study in which children aged 1 to 17 years with a moderate or severe asthma attack were treated using the established evidence-based therapy adjusted to the severity of exacerbation assessed by the Pediatric Respiratory Assessment Measure (PRAM), administered rapidly. We explored the determinants of the failure of emergency therapy. Age was not a factor. Instead, in addition to attack severity and symptoms between attacks, it was rather the presence of respiratory viral infection or fever triggering the attack that was more often associated with treatment failure, i.e., higher hospitalization rates, more returns to the emergency room, and reduced speed of recovery over the 10 days after discharge. Viral detection occurred more frequently in preschoolers (67%) than in older children (46%) with asthma.
Nevertheless, the results confirm the overall effectiveness of standard treatment, adjusted to the severity of the attack and administered early, in the vast majority of children, regardless of age and viral detection. Indeed, although a failure rate of nearly 40% was expected in this group of children with moderate to severe attack, only 17% of the participants did not respond to standard treatment. This rate was significantly higher (19%) in children with viral infection compared to uninfected children (13%).
01 Sep Long-Acting Beta-Agonists-Steroid Combination in Pediatric Asthma
MedicalResearch.com Interview with: David A Stempel, MD Medical Affairs Lead US Medical Affairs GlaxoSmithKline MedicalResearch.com: What is the background for this study? What are the main findings? Response: Long-acting beta-agonists (LABAs) have been shown to increase the risk of asthma-related death among adults and the risk of asthma-related hospitalization among children. It is unknown whether the concomitant use of inhaled glucocorticoids with LABAs mitigates those risks. This trial prospectively evaluated the safety of the LABA salmeterol, added to fluticasone propionate, in a fixed-dose combination in children.31 Aug Maternal High Dose Monthly Vitamin D May Be Useful During Breastfeeding
MedicalResearch.com Interview with: [caption id="attachment_27553" align="alignleft" width="125"]
Dr. Ben Wheeler[/caption]
Dr. Ben Wheeler MB ChB(Otago) DCH CCE FRACP
Senior Lecturer / Paediatrician / Paediatric Endocrinologist
Department of Women’s & Children’s Health : Te Tari Hauora Wāhine me te Tamariki
Dunedin School of Medicine
MedicalResearch.com: What is the background for this study?
Response: Vitamin D is essential for calcium and bone metabolism. It is unique among vitamins in that it is mainly derived from synthesis in the
skin after exposure to UV-B radiation. In the absence of fortification, few foods are rich in vitamin D, including human milk, which contains very low amounts. Breastfeeding infants in higher latitude countries such as New Zealand, much of North America and
Central/Northern Europe are at risk of vitamin D deficiency.
The most profound manifestation of vitamin D deficiency in growing children is rickets, characterized by bone deformities, impaired growth, biochemical abnormalities, and depending on the severity of deficiency, seizures. Studies also identified a number of common factors that potentially affect the risk of rickets, including darker pigmented skin, maternal vitamin D deficiency during pregnancy, season of birth, and age.
A potential alternative strategy to improve the vitamin D status of breastfed infants is high-dose vitamin D supplementation to pregnant and lactating women. This would be attractive from a compliance perspective, promote exclusive breastfeeding, and treat both the mother and her infant.
Thus, the primary aim of this randomized, placebo-controlled study was to determine the effect of two different monthly doses of maternal vitamin D supplementation on the vitamin D status of non–vitamin D–supplemented breastfed infants and their mothers.
31 Aug Parents Likely To Use Food To Soothe Fussy Infants
MedicalResearch.com Interview with: [caption id="attachment_27521" align="alignleft" width="133"]
Dr. Kai Ling Kong[/caption]
Kai Ling Kong, PhD, MS
Assistant Professor
Division of Behavioral Medicine
Department of Pediatrics
School of Medicine and Biomedical Sciences
State University of New York at Buffalo
MedicalResearch.com: What is the background for this study?
Response: Infant temperament, or individual behavior styles, can be reliably measured and is related to weight status. However, we know very little about the association of infants’ temperament and their motivation to eat versus engage in other activities (relative food reinforcement). Examining such associations is an important step given the need to use behavioral strategies in obesity prevention in early life. The purpose of our study was to determine if infant temperament, specifically the factors that have been linked with obesity risk, are associated with infant relative food reinforcement.
31 Aug Opportunities for Improvement in Pediatric Resuscitation Across US EDs
MedicalResearch.com Interview with: Marc Auerbach, MD, FAAP, MSc Associate Professor of Pediatrics (Emergency Medicine) and of Emergency Medicine Co-chair INSPIRE (International Network for Simulation Based Pediatric Innovation Research and Education) Director, Pediatric Simulation Yale Center for Medical Simulation; MedicalResearch.com: What is the background for this study? What are the main findings? Response: Severely ill infants and children present to any of over 5000 United States Emergency Departments every day. A direct comparison of the quality of resuscitative care across EDs is challenging due to the low frequency of these high stakes events in individual EDs. This study utilized in-situ simulation-based measurement to compare the quality of resuscitative care delivered to two infants and one child by 58 distinct interprofessional teams across 30 EDs. Composite quality scores correlated with annual pediatric patient volume, with higher volume departments demonstrating higher scores. The pediatric readiness score measures compliance with guidelines created by the American Academy of Pediatrics, the American College of Emergency Physicians and the Emergency Nurses Association. The pediatric readiness score correlated with composite quality scores measured by simulation.29 Aug ICUs Might Consider Avoiding Tap Water To Limit Pseudomonas Infections from Faucets
MedicalResearch.com Interview with: [caption id="attachment_27441" align="alignleft" width="200"]
Dr. Cohen Regev[/caption]
Dr. Cohen Regev, M.D
Head of the infectious diseases and infection control units
Sanz Medical Center, Laniado hospital
Netanya, Israel
MedicalResearch.com: What is the background for this study?
Response: During 3 months in 2012 we had a number of clinical isolates of Pseudomonas aeruginosa (PA) in our neonatal intensive care unit (NICU) and a high incidence of colonization among ventilated patients in our medical-surgical intensive care unit (MSICU). The origin of PA may be from various environmental sources (‘exogenous’), from the patients’ own microbiome (‘endogenous’), or from both. Since in NICUs the origin is usually exogenous, we investigated the sources of the bacteria, focusing on the faucets of these units, as they were previously incriminated as causes of outbreaks in ICUs.
The study was conducted in Sanz medical center, a 400-bed community hospital located in central Israel. In the NICU we obtained several environmental cultures from faucets using a bacterial swab by rubbing the tip into the distal part of the faucet. Aerators were dismantled from all faucets, cultured from their inner part using a swab and were not repositioned. Contaminated faucets were occasionally replaced or treated with enzymatic fluid and sterilization by Ethylene Oxide. During the intervention and since, neonates were bathed only with warmed sterile water, and tap water was allowed only for hand hygiene practices.
In the MSICU tap water was used only for bathing the patients. All other uses of tap water, such as drinking, moistening and mouth treatments, were allowed using only sterile water. The units' faucets were sampled on two different days concurrently with surveillance cultures of pharyngeal, sputum and urine from the patients.
Bacteria were identified with VITEK 2 (Biomerieux®) and typing was done by Enterobacterial Repetitive Intergenic Consensus (ERIC) PCR.
25 Aug Children With Food Allergies More Likely To Develop Asthma and Allergic Rhinitis
MedicalResearch.com Interview with: David A. Hill, M.D., Ph.D. Fellow Physician Division of Allergy and Immunology The Children's Hospital of Philadelphia Philadelphia, PA 19104-3375 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Eczema, asthma, allergic rhinitis, and food allergies are among the most common childhood medical conditions in the United States. Importantly, disease rates for these conditions are thought to be changing, prompting the need for continued surveillance. In our study, we examined electronic medical record data of over 1 million children to measure incidence and prevalence rates of these conditions in our community. We found that 1 in 5 children seen in our network are diagnosed with asthma, a rate that is among the highest in the nation. Additionally, the large size of our study allowed us to measure the extent to which food allergies are associated with asthma or allergic rhinitis. In this analysis, we found that children with food allergies are 2 to 3 times more likely to develop asthma or allergic rhinitis, as compared with children without food allergy.19 Aug Most Childhood Atopic Dermatitis Lasts About Three Years
MedicalResearch.com Interview with: [caption id="attachment_24142" align="alignleft" width="128"]
Dr. Jonathan Silverberg[/caption]
Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois
MedicalResearch.com: What is the background for this study?
Response: Some children with atopic dermatitis may have disease activity persist into adolescence and adulthood, although most children are thought to “grow out of it.” There have been a number of studies with varied results about how commonly atopic dermatitis actually persists later in life. Moreover, the risk factors for persistence of atopic dermatitis are unclear. We sought to systematically analyze the extant literature of research studies to determine the rates and predictors of atopic dermatitis persistence over time.