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Real Doctors (Life Makers)  |  Clinical  |  Pediatrics  |  Updates & Articles  |  New in Pediatrics « previous next »
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cleo_md
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New in Pediatrics
« on: /September/ 30, 2005, 08:01:55 AM »

ALLERGY

Insect stings

Venom immunotherapy for children with moderate to severe systemic reaction to insect stings reduces the risk of a similar reaction upon reexposure [1] and the effect appears to last for 10 to 20 years.

ENDOCRINOLOGY

Growth hormone therapy

A common polymorphism of the growth hormone receptor may explain some of the variability in response to growth hormone therapy in short children who are not growth hormone deficient [2].

In a controlled trial, mean adult height of peripubertal children with idiopathic stature who were treated with growth hormone was 3.7 cm greater than that of controls [3].

GASTROENTEROLOGY

Short bowel syndrome

Intestinal adaptation in children with short bowel syndrome is related to small bowel length, presence of the ileocecal valve, colonic resection, and whether or not primary anastomosis could be performed [4].

GENERAL PEDIATRICS

Thimerosal

A prospective population based cohort study in the United Kingdom found no convincing evidence of an association between exposure to thimerosal and neurologic or psychologic outcome [5].

Antidepressants

An FDA advisory panel has recommended that antidepressants carry a black box warning that antidepressant medications can increase suicidal tendencies among children and adolescents.

INFECTIOUS DISEASE

Giardiasis

Tinidazole, a nitroimidazole congener of metronidazole, and highly effective for the treatment of giardiasis has been approved by the FDA for treatment of giardiasis in children older than three years and adults [6].

Influenza virus

Although resistance of influenza virus to neuraminidase inhibitors has been uncommon, a report from Japan found that nine of 50 children (18 percent) who were treated with oseltamivir for seven days had drug-resistant viruses [7].
Methicillin-resistant Staphylococcus aureus

In 2001, 57 percent of Staphylococcus aureus isolates in 49 hospitals in the United States were resistant to methicillin [8].

Occult bacteremia

Approximately one year after the routine use of pneumococcal conjugate vaccine, the prevalence of occult bacteremia in febrile children (2 to 36 months) in one emergency department was <1 percent [9].

NEONATOLOGY

Unconjugated hyperbilirubinemia

The American Academy of Pediatrics has issued a new clinical practice guideline for the management of unconjugated hyperbilirubinemia in term and near term infants [10].
Neonatal cholestasis

The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition has issued a guideline for the evaluation of cholestatic jaundice in infants [11].

NEPHROLOGY

Hypertension

The National Heart, Lung, and Blood Institute has issued the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents, including new definitions of hypertension [12].
NEUROLOGY

Duchenne muscular dystrophy

A myostatin mutation in a child with gross muscle hypertrophy has been identified [13], suggesting that myostatin inactivation could be a therapeutic target to increase muscle bulk and strength in muscle wasting diseases such as Duchenne muscular dystrophy [14].

Epilepsy surgery

In a large series of hemispherectomy for pediatric epilepsy of various etiologies, 58 percent of patients were seizure free five years after surgery [15]. Shorter seizure duration before surgery, better seizure control after surgery, and higher presurgery developmental attainment predicted higher postsurgery developmental gains regardless of pathologic substrate. These results support early rather than later surgical evaluation of children who have severe refractory seizures [16].

NUTRITION

Obesity

The Bogulusa Heart Study provides information correlating BMI and waist circumference with cardiovascular risk factors in children [17].

PULMONOLOGY

Bronchiolitis

The risk for bacteremia or meningitis among febrile infants 60 days of age with RSV bronchiolitis is low. The risk for UTI is less than that for febrile infants without RSV infection, but it is not negligible [18].

VACCINES

Influenza

The total number of doses of influenza vaccine for the 2004-2005 season are expected to exceed the number of doses released during the 2003-2004 season. However, vaccine delivery may be delayed because of production problems related to sterility of several lots (4 million doses) of Fluvirin? [19]. Updates on the influenza vaccine supply are available on the CDC website (www.cdc.gov/flu).

Pneumococcal

After the introduction of the pneumococcal conjugate vaccine to the routine childhood immunization schedule, invasive pneumococcal disease declined by greater than 90 percent in Northern California children younger than two years of age [20].

The pneumococcal conjugate vaccine shortage has resolved, permitting return to the standard recommended four-dose schedule for healthy children [21].

Varicella

Varicella-related hospitalizations in the United States have decreased from 0.5 to 0.13 per 10,000 population (by 74 percent) after the introduction of the varicella vaccine to the routine childhood immunization schedule [22].

The secondary attack rate of varicella in household contacts aged 1 to 14 years varies according to age, vaccination status of the primary case, vaccination status of the household contact, and number of lesions of the primary case [23].



REFERENCES
1. Golden, DB, Kagey-Sobotka, A, Norman, PS, et al. Outcomes of allergy to insect stings in children, with and without venom immunotherapy. N Engl J Med 2004; 351:668.
2. Dos Santos, C, Essioux, L, Teinturier, C, et al. A common polymorphism of the growth hormone receptor is associated with increased responsiveness to growth hormone. Nat Genet 2004; 36:720.
3. Leschek, EW, Rose, SR, Yanovski, JA, et al. Effect of growth hormone treatment on adult height in peripubertal children with idiopathic short stature: a randomized, double-blind, placebo-controlled trial. J Clin Endocrinol Metab 2004; 89:3140.
4. Quiros-Tejeira, RE, Ament, ME, Reyen, L, et al. Long-term parenteral nutritional support and intestinal adaptation in children with short bowel syndrome: A 25-year experience. J Pediatr 2004; 145:157.
5. Heron, J, Golding, J. Thimerosal exposure in infants and developmental disorders: a prospective cohort study in the United kingdom does not support a causal association. Pediatrics 2004; 114:577.
6. Presutti antiprotozoal agent Tindamax clears FDA; AWP is $18 per dose. In: "The Pink Sheet" vol 66, F-D-C Reports, Inc. Chevy Chase, MD 2004. p.10.
7. Kiso, M, Mitamura, K, Sakai-Tagawa, Y, et al. Resistant influenza A viruses in children treated with oseltamivir: descriptive study. Lancet 2004; 364:759.
8. Wisplinghoff, H, Bischoff, T, Tallent, SM, et al. Nosocomial bloodstream infections in US hospitals: Analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004; 39:309.
9. Stoll, ML, Rubin, LG. Incidence of occult bacteremia among highly febrile young children in the era of the pneumococcal conjugate vaccine: a study from a Children's Hospital Emergency Department and Urgent Care Center. Arch Pediatr Adolesc Med 2004; 158:671.
10. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 2004; 114:297.
11. Moyer, V, Freese, DK, Whitington, PF, et al. Guideline for the evaluation of cholestatic jaundice in infants: recommendations of the north american society for pediatric gastroenterology, hepatology and nutrition. J Pediatr Gastroenterol Nutr 2004; 39:115.
12. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 2004; 114:555.
13. Schuelke, M, Wagner, KR, Stolz, LE, et al. Myostatin mutation associated with gross muscle hypertrophy in a child. N Engl J Med 2004; 350:2682.
14. McNally, EM. Powerful genes--myostatin regulation of human muscle mass. N Engl J Med 2004; 350:2642.
15. Jonas, R, Nguyen, S, Hu, B, et al. Cerebral hemispherectomy: hospital course, seizure, developmental, language, and motor outcomes. Neurology 2004; 62:1712.
16. Duchowny, M. Hemispherectomy for epilepsy: when is one half better than two?. Neurology 2004; 62:1664.
17. Katzmarzyk, PT, Srinivasan, SR, Chen, W, et al. Body mass index, waist circumference, and clustering of cardiovascular disease risk factors in a biracial sample of children and adolescents. Pediatrics 2004; 114:e198.
18. Levine, DA, Platt, SL, Dayan, PS, et al. Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections. Pediatrics 2004; 113:1728.
19. Influenza Vaccine Supply Update. Centers for Disease Control and Prevention (www.cdc.gov/od/oc/media/transcripts/t040827.htm), accessed September 10, 2004.
20. Black, S, Shinefield, H, Baxter, R, et al. Postlicensure surveillance for pneumococcal invasive disease after use of heptavalent pneumococcal conjugate vaccine in Northern California Kaiser Permanente. Pediatr Infect Dis J 2004; 23:485.
21. Notice to readers: Pneumococcal conjugate vaccine shortage resolved. MMWR Morb Mortal Wkly Rep 2004; 53:851.
22. Davis, MM, Patel, MS, Gebremariam, A. Decline in varicella-related hospitalizations and expenditures for children and adults after introduction of varicella vaccine in the United States. Pediatrics 2004; 114:786.
23. Seward, JF, Zhang, JX, Maupin, TJ, et al. Contagiousness of varicella in vaccinated cases: a household contact study. JAMA 2004; 292:704.
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