5233 articles - 08.09.10
1: Pediatrics. 2010 Sep 6; [Epub ahead of print]
Dombkowski KJ, Hassan F, Wasilevich EA, Clark SJ.
Child Health Evaluation and Research Unit, Division of General Pediatrics, and.
Objective: This study explores the use of spirometry in primary care settings. Methods: A 4-page survey was mailed to a national, random sample of office-based family physicians and pediatricians. Survey items addressed knowledge, attitudes, and practices regarding spirometry and standardized clinical vignettes. Data were analyzed by using chi(2) tests and multivariate logistic regression. Results: Among the 360 respondents who provided care to children with asthma, 52% used spirometry in clinical practice, whereas 80% used peak flow meters and 10% used no lung function tests. Only 21% routinely used spirometry for all guideline-recommended clinical situations. More family physicians than pediatricians reported using spirometry (75% vs 35%; P < .0001), and family physicians were more comfortable in interpreting spirometric results (50% vs 25%; P < .0001). Only one-half of respondents interpreted correctly the spirometric results in a standardized clinical vignette, and the frequency of underrating asthma severity increased with the inclusion of spirometric results. The most common barriers to the use of spirometry, that is, time and training, were cited more often by physicians who did not use spirometry. Two-thirds of respondents agreed that they would want additional training regarding implementing spirometry in their clinical practices. Conclusions: The use of spirometry in primary care settings for children with asthma does not conform to national guidelines. Widespread implementation of national asthma guidelines likely would require a major educational initiative to address deficiencies in spirometry interpretation and other barriers.
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PMID: 20819894 [PubMed - as supplied by publisher]2: J Pediatr Gastroenterol Nutr. 2010 Aug 25; [Epub ahead of print]
Illueca M, Wernersson B, Henderson C, Lundborg P.
*AstraZeneca LP, Wilmington, Delaware, US daggerAstraZeneca R&D, Molndal, Sweden double daggerResearch Evaluation Unit, Oxford PharmaGenesis Ltd, Oxford, UK.
OBJECTIVES:: Short-term treatment with a proton pump inhibitor (PPI) is effective for healing reflux esophagitis and improving reflux symptoms in pediatric patients. Our aim was to assess the efficacy and tolerability of maintenance PPI treatment after healing of reflux esophagitis in pediatric patients. MATERIALS AND METHODS:: Systematic searches of MEDLINE, Excerpta Medica database, and recent conference abstracts. RESULTS:: Five studies evaluated the efficacy of PPI maintenance therapy (6- to 90-month follow-up) in pediatric patients after healing of reflux esophagitis. Three found no relapse of reflux esophagitis or reflux symptoms during PPI maintenance therapy; however, a low relapse rate (1/14) was also found in the placebo group of the only prospective controlled study. Two of the 5 studies (both prospective) reported relapse of reflux esophagitis at half the original healing dose of omeprazole (7 of 51 patients relapsed after 3 months; 8 of 32 within 21 months), which resolved again in most patients when the healing dose or higher was given. Four studies evaluated relapse of reflux esophagitis and/or reflux symptoms after stopping PPI therapy. Reflux symptoms recurred in 18% to 76% of patients across all 4 studies. In the 4 studies that assessed the safety of PPI maintenance therapy, adverse events were infrequent and of low severity. CONCLUSIONS:: Pediatric patients with gastroesophageal reflux disease and certain chronic comorbidities appear to have the greatest need of maintenance PPI treatment after healing of reflux esophagitis. In patients requiring maintenance therapy, PPIs appear to be well tolerated and effective in maintaining remission of reflux esophagitis and reflux symptoms.
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PMID: 20808247 [PubMed - as supplied by publisher]3: Pediatrics. 2010 Sep;126(3):e506-12. Epub 2010 Aug 23.
Field EJ, Vally H, Grimwood K, Lambert SB.
MBBS, Queensland Paediatric Infectious Diseases Laboratory, Queensland Children's Medical Research Institute, Royal Children's Hospital, Herston Road, Herston 4029 Queensland, Australia. sblambert@uq.edu.au.
OBJECTIVE: A publicly funded, universal infant pentavalent rotavirus vaccine (RV5) program was implemented in Queensland, Australia, in mid-2007. We sought to assess vaccine effectiveness (VE) of 3 doses of RV5 at preventing rotavirus and nonrotavirus acute gastroenteritis (AGE) hospitalizations in the first birth cohort and impact on hospitalizations in all age groups. METHODS: Hospitalization rates for rotavirus and nonrotavirus AGE in all age groups before and after RV5 introduction were compared. Population vaccine coverage, hospitalization data, and individual vaccination status were obtained from routinely collected, publicly funded state- and nationally based data sets. Data linkage was performed to calculate 3-dose VE for preventing hospitalization in the eligible age group. RESULTS: RV5 coverage in the first eligible birth cohort was 89.6% for at least 1 dose and 73.1% for 3 doses. Three-dose VE for preventing nonrotavirus AGE hospitalization was 62.3% to 63.9% (any/primary diagnosis) and 89.3% to 93.9% (any/primary diagnosis) for rotavirus hospitalizations. After program implementation, there were immediate and sustained reductions in rotavirus hospitalizations for those who were younger than 20 years and nonrotavirus AGE-coded hospitalizations for those who were younger than 5 years. CONCLUSIONS: RV5 is highly effective at preventing rotavirus hospitalizations in a developed country setting, confirming efficacy figures from the pivotal clinical trial. Additional direct and indirect effects are substantial and include reductions in nonrotavirus AGE hospitalizations in vaccinated age groups and rotavirus and nonrotavirus AGE hospitalization rates in older age groups.
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PMID: 20732946 [PubMed - in process]4: Clin Pediatr (Phila). 2010 Aug 19; [Epub ahead of print]
Bourgeois FC, Linder J, Johnson SA, T Co JP, Fiskio J, Ferris TG.
Background. Computerized decision support (CDS) can potentially improve patient safety and guideline adherence. The authors developed an acute respiratory illness interactive template (ARI-IT) within an electronic health record (EHR) to manage pediatric ARIs and assessed the impact on antibiotic prescribing. Methods. They randomized 12 practices either to receive the ARI-IT or to the control group. Antibiotic rates among all eligible ARI diagnoses were compared among control and intervention ARI visits, controlling for clustering by clinician. Results. There was no difference in total antibiotic prescriptions between control and intervention clinics. Use of the ARI-IT significantly reduced antibiotic prescriptions (31.7% vs 39.9%; P = .02) and use of macrolides (6.2% vs 9.5%; P = .02) among visits compared with those eligible visits where it was not used. Conclusion. Use of the CDS reduced antibiotic prescribing and macrolide prescriptions among children with an ARI. Nonetheless, the low overall use resulted in an ineffective intervention.
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PMID: 20724348 [PubMed - as supplied by publisher]5: Clin Pediatr (Phila). 2010 Aug 19; [Epub ahead of print]
Ponnapakkam TP, Bradford E, Gensure R.
This study was conducted to determine if vitamin D supplementation is required to prevent rickets in breast-fed infants. Breast-feeding rates are increasing, and there are concerns about whether the vitamin D content of breast milk is sufficient. There are a few treatment trials of vitamin D supplementation in breast-fed infants; these were conducted in northern climates. The authors therefore performed a prospective clinical trial comparing vitamin D supplementation with placebo as control in southern Louisiana. Blood samples and questionnaires were collected at birth, 2, 4, and 6 months of age. There were no cases of rickets observed, and no differences in alkaline phosphatase levels between groups. Thus, there was no evidence that vitamin D supplementation reduced rickets risk in the authors' study population. This suggests that the current recommendations for universal vitamin D supplementation of breast-fed infants throughout the United States may need to be revised.
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PMID: 20724336 [PubMed - as supplied by publisher]6: Pediatrics. 2010 Sep;126(3):e651-6. Epub 2010 Aug 9.
Zecca E, Corsello M, Priolo F, Tiberi E, Barone G, Romagnoli C.
University Hospital "A. Gemelli," Catholic University of the Sacred Heart, Department of Pediatrics, Division of Neonatology, Largo Agostino Gemelli 8, 00168 Rome, Italy. enrizecca@rm.unicatt.it.
OBJECTIVE: The goal was to assess the feasibility of earlier weaning from the incubator for preterm infants. METHODS: This was a prospective, randomized study with preterm infants with birth weights of <1600 g who were admitted to a neonatal subintensive ward. Findings for 47 infants who were transferred from an incubator to an open crib at >1600 g (early transition group) were compared with those for 47 infants who were transferred from an incubator to an open crib at >1800 g (standard transition [ST] group). The primary outcome of the study was length of stay. Secondary outcomes were the number of infants returned to an incubator, the growth velocity in an open crib and during the first week at home, the proportions of breastfeeding at discharge and during the first week at home, and the hospital readmission rate. RESULTS: The length of stay was significantly shorter in the early transition group than in the standard transition group (23.5 vs 33 days; P = .0002). No infants required transfer back to the incubator. Only 1 infant in the standard transition group was readmitted to the hospital during the first week after discharge. Growth velocities and individual amounts of breastfeeding were similar between the 2 groups. CONCLUSION: In this study, weaning of moderately preterm infants from incubators to open cribs at 1600 g was safe and resulted in earlier discharge.
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PMID: 20696729 [PubMed - in process]7: Pediatrics. 2010 Sep;126(3):e557-64. Epub 2010 Aug 9.
Shaikh N, Leonard E, Martin JM.
Children's Hospital of Pittsburgh, General Academic Pediatrics, 3414 Fifth Ave, Pittsburgh, PA 15213-2583. nader.shaikh@chp.edu.
OBJECTIVES: Prevalence estimates can help clinicians make informed decisions regarding diagnostic testing of children who present with symptoms of pharyngitis. We conducted a meta-analysis to determine the (1) prevalence of streptococcal infection among children who presented with sore throat and (2) prevalence of streptococcal carriage among asymptomatic children. METHODS: We searched Medline for articles on pediatric streptococcal pharyngitis. We included articles in our review when they contained data on the prevalence of group A Streptococcus (GAS) from pharyngeal specimens in children who were younger than 18 years. Two evaluators independently reviewed, rated, and abstracted data from each article. Prevalence estimates were pooled in a meta-analysis and stratified according to age group. RESULTS: Of the 266 articles retrieved, 29 met all inclusion criteria. Among children of all ages who present with sore throat, the pooled prevalence of GAS was 37% (95% confidence interval [CI]: 32%-43%). Children who were younger than 5 years had a lower prevalence of GAS (24% [95% CI: 21%-26%]). The prevalence of GAS carriage among well children with no signs or symptoms of pharyngitis was 12% (95% CI: 9%-14%). CONCLUSIONS: Prevalence rates of GAS disease and carriage varied by age; children who were younger than 5 years had lower rates of throat cultures that were positive for GAS.
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PMID: 20696723 [PubMed - in process]8: Pediatrics. 2010 Sep;126(3):538-45. Epub 2010 Aug 2.
Finsterer J, Ramaciotti C, Wang CH, Wahbi K, Rosenthal D, Duboc D, Melacini P.
Postfach 20, 1180 Vienna, Austria. fifigs1@yahoo.de.
Cardiac involvement (CI) in congenital muscular dystrophies (CMDs) has been only rarely investigated so far. By means of a systematic literature search we reviewed the literature about CI in CMD and found that CI is apparently absent in Ullrich CMD or CMD with integrin deficiency and only mild in Bethlem CMD. CI in merosin deficiency includes dilated cardiomyopathy and systolic dysfunction. CI in dystroglycanopathies seems most prevalent among all CMDs and includes dilated cardiomyopathy, systolic dysfunction, and myocardial fibrosis in Fukuyama CMD. Among the nonspecified dystroglycanopathies, CI manifests as dilated cardiomyopathy, hypertrophic cardiomyopathy (CMP) or systolic dysfunction. With CMD type 1C, as well as with limb-girdle muscular dystrophy 2I, up to half of the patients develop dilated cardiomyopathy. In rigid-spine syndrome, predominantly the right heart is affected secondary to thoracic deformity. In patients who carry LMNA mutations, CI may manifest as dilated cardiomyopathy, hypertrophic cardiomyopathy, or fatal ventricular arrhythmias. Overall, CI in patients with CMD varies considerably between the different CMD types from absent or mild CI to severe cardiac disease, particularly in merosin deficiency, dystroglycanopathies, and laminopathies. Patients with CMD with CI require regular cardiologic surveillance so that severe, treatable cardiac disease is not overlooked.
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PMID: 20679303 [PubMed - in process]9: J Neurosurg Pediatr. 2010 Aug;6(2):115-22.
Souweidane MM, Fraser JF, Arkin LM, Sondhi D, Hackett NR, Kaminsky SM, Heier L, Kosofsky BE, Worgall S, Crystal RG, Kaplitt MG.
Department of Neurological Surgery, Weill Cornell Medical College, Cornell University, New York, New York 10021, USA. mmsouwei@med.cornell.edu
OBJECT: The authors conducted a phase I study of late infantile neuronal ceroid lipofuscinosis using an adenoassociated virus serotype 2 (AAV2) vector containing the deficient CLN2 gene (AAV2(CU)hCLN2). The operative technique, radiographic changes, and surgical complications are presented. METHODS: Ten patients with late infantile neuronal ceroid lipofuscinosis disease each underwent infusion of AAV2(CU)hCLN2 (3 x 10(12) particle units) into 12 distinct cerebral locations (2 depths/bur hole, 75 minutes/infusion, and 2 microl/minute). Innovative surgical techniques were developed to overcome several obstacles for which little or no established techniques were available. Successful infusion relied on preoperative stereotactic planning to optimize a parenchymal target and diffuse administration. Six entry sites, each having 2 depths of injections, were used to reduce operative time and enhance distribution. A low-profile rigid fixation system with 6 integrated holding arms was utilized to perform simultaneous infusions within a practical time frame. Dural sealant with generous irrigation was used to avoid CSF egress with possible subdural hemorrhage or altered stereotactic registration. RESULTS: Radiographically demonstrated changes were seen in 39 (65%) of 60 injection sites, confirming localization and infusion. There were no radiographically or clinically defined complications. CONCLUSIONS: The neurosurgical considerations and results of this study are presented to offer guidance and a basis for the design of future gene therapy or other clinical trials in children that utilize direct therapeutic delivery.
Publication Types: Clinical Trial, Phase I Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't
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PMID: 20672930 [PubMed - indexed for MEDLINE]10: Pediatrics. 2010 Aug;126(2):392-403. Epub 2010 Jul 26.
Frankowski BL, Bocchini JA Jr; Council on School Health and Committee on Infectious Diseases.
Head lice infestation is associated with limited morbidity but causes a high level of anxiety among parents of school-aged children. Since the 2002 clinical report on head lice was published by the American Academy of Pediatrics, patterns of resistance to products available over-the-counter and by prescription have changed, and additional mechanical means of removing head lice have been explored. This revised clinical report clarifies current diagnosis and treatment protocols and provides guidance for the management of children with head lice in the school setting.
Publication Types: Practice Guideline
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PMID: 20660553 [PubMed - indexed for MEDLINE]11: J Pediatr Gastroenterol Nutr. 2010 May;50(5):551-4.
Panahi Y, Falahi G, Falahpour M, Moharamzad Y, Khorasgani MR, Beiraghdar F, Naghizadeh MM.
Research Center of Chemical Injuries, Baqiyatallah Medical Sciences University, Tehran, Iran. yunespanahi@yahoo.com
OBJECTIVE: The objective of the study was to evaluate the clinical efficacy of oral bovine colostrum in the management of nonorganic failure to thrive (FTT). MATERIALS AND METHODS: In a randomized clinical trial, 120 children (1-10 years of age) of either sex with mild or moderate nonorganic FTT were divided into 2 groups. Both groups were matched with regard to age, sex, weight, and height. One group (control) received routine treatments for FTT and the other group (case), besides routine treatments, received supplementary bovine colostrum at the dose of 40 mg . kg . day for a 3-month period. Following the initial visit, subsequent visits were completed following 1, 2, and 3 months of supplementation. For quantitative measurements, Waterlow I (height for age) and Gomez (weight for age) indices were used. RESULTS: The mean value of Gomez index in the case group (81.72) was significantly higher than the control group (77.12) at the end of the third month of supplementation (P = 0.003). Such a difference was not reported based on Waterlow I index between the case and control groups (92.91 vs 91.71; P = 0.094). According to Gomez index 12 patients (20%) who received colostrum became healthy at the end of the third month, which was significantly higher than the control group (2 cases, 3.3%); P = 0.006. CONCLUSIONS: Bovine colostrum supplementation for a 3-month period is a useful method without any side effects, in addition to known medical and psychological treatments, to increase the weight of children with nonorganic FTT.
Publication Types: Research Support, Non-U.S. Gov't
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PMID: 20639714 [PubMed - in process]12: BMC Pediatr. 2010 Jul 15;10:50.
Barnard K, Thomas S, Royle P, Noyes K, Waugh N.
National Institute for Health Research Health Technology Assessment Programme, University of Southampton, Southampton SO16 7NS, UK. k.barnard@soton.ac.uk
BACKGROUND: Many children with type 1 diabetes have poor glycaemic control. Since the Diabetes Control and Complications Trial (DCCT) showed that tighter control reduces complication rates, there has been more emphasis on intensified insulin therapy. We know that patients and families are afraid of hypoglycaemia. We hypothesised that fear of hypoglycaemia might take precedence over concern about long-term complications, and that behaviour to avoid hypoglycaemia might be at the cost of poorer control, and aimed to evaluate the effectiveness of any interventions designed to prevent that. The objective of this review was to systematically review studies concerning the extent and consequences of fear of hypoglycaemia in parents of children under 12 years of age with type 1 diabetes, and interventions to reduce it. METHODS: Data Sources: MEDLINE, EMBASE, PsycINFO, The Cochrane Library, Web of Science, meeting abstracts of EASD, ADA and Diabetes UK, Current Controlled Trials, ClinicalTrials.gov, UK CRN, scrutiny of bibliographies of retrieved papers and contact with experts in the field.Inclusions: Relevant studies of any design of parents of children under 12 years of age with Type 1 diabetes were included. The key outcomes were the extent and impact of fear, hypoglycaemia avoidance behaviour in parents due to parental fear of hypoglycaemia in their children, the effect on diabetes control, and the impact of interventions to reduce this fear and hypoglycaemia avoidance behaviour. RESULTS: Eight articles from six studies met the inclusion criteria. All were cross sectional studies and most were of good quality. Parental fear of hypoglycaemia, anxiety and depression were reported to be common. There was a paucity of evidence on behaviour to avoid hypoglycaemia, but there were some suggestions that higher than desirable blood glucose levels might be permitted in order to avoid hypoglycaemia. No studies reporting interventions to reduce parental fear of hypoglycaemia were found. CONCLUSIONS: The evidence base was limited. Parents of children with Type 1 diabetes reported considerable parental fear of hypoglycaemia, affecting both parental health and quality of life. There is some suggestion that hypoglycaemia avoidance behaviours by parents might adversely affect glycaemic control. Trials of interventions to reduce parental anxiety and hypoglycaemia avoidance behaviour are needed. We suggest that there should be a trial of structured education for parents of young children with Type 1 diabetes.
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PMID: 20633252 [PubMed - in process]13: Pediatrics. 2010 Aug;126(2):260-5. Epub 2010 Jul 12.
Ritchie SK, Murphy EC, Ice C, Cottrell LA, Minor V, Elliott E, Neal W.
Department of Pediatrics, Robert C. Byrd Health Science Center, West Virginia University, Morgantown, WV 26506-9214, USA. sritchie@hsc.wvu.edu
OBJECTIVES: The goal was to determine the sensitivity and specificity of family history in identifying children with severe or genetic hyperlipidemias in a rural, predominantly white population. METHODS: A total of 20,266 fifth-grade children in West Virginia, from the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project, who completed a family history and fasting lipid profile were used in analyses. The relationship between hyperlipidemia and family history was determined, and the use of family history to predict the need for pharmacologic treatment among children with dyslipidemia was evaluated. RESULTS: A total of 71.4% of children met the National Cholesterol Education Program (NCEP) guidelines for cholesterol screening on the basis of positive family history. Of those, 1204 (8.3%) were considered to have dyslipidemia (low-density lipoprotein > or =130 mg/dL), and 1.2% of these children with dyslipidemia warranted possible pharmacologic treatment (low-density lipoprotein > or =160 mg/dL). Of the 28.6% who did not have a positive family history (did not meet NCEP guidelines), 548 (9.5%) had dyslipidemia, 1.7% of whom warranted pharmacologic treatment. Sensitivity and specificity data demonstrated that family history does not provide a strong indication as to whether pharmacologic treatment may be warranted. CONCLUSIONS: Results indicate that the use of family history to determine the need for cholesterol screening in children would have (1) missed many with moderate dyslipidemia and (2) failed to detect a substantial number with likely genetic dyslipidemias that would require pharmacologic treatment. The use of universal cholesterol screening would identify all children with severe dyslipidemia, allowing for proper intervention and follow-up and leading to the prevention of future atherosclerotic disease.
Publication Types: Clinical Trial
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PMID: 20624798 [PubMed - indexed for MEDLINE]14: Arch Dis Child. 2010 Jul 6; [Epub ahead of print]
Hunt K, Ernst E.
Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK.
Background The use of complementary and alternative medicine (CAM) in paediatric populations is common yet, to date, there has been no synthesis of the evidence of its effectiveness in that population. This overview of systematic review evaluates the evidence for or against the effectiveness of CAM for any childhood condition. Methods Medline, AMED and Cochrane were searched from inception until September 2009. Reference lists of retrieved articles were hand-searched. Experts in the field of CAM were contacted. No language restrictions were applied. Results 17 systematic reviews were included in this overview, covering acupuncture, chiropractic, herbal medicine, homeopathy, hypnotherapy, massage and yoga. Results were unconvincing for most conditions although there is some evidence to suggest that acupuncture may be effective for postoperative nausea and vomiting, and that hypnotherapy may be effective in reducing procedure-related pain. Most of the reviews failed to mention the incidence of adverse effects of CAMs. Conclusions Although there is some encouraging evidence for hypnosis, herbal medicine and acupuncture, there is insufficient evidence to suggest that other CAMs are effective for the treatment of childhood conditions. Many of the systematic reviews included in this overview were of low quality, as were the randomised clinical trials within those reviews, further reducing the weight of that evidence. Future research in CAM for children should conform to the reporting standards outlined in the CONSORT and PRISMA guidelines.
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PMID: 20605859 [PubMed - as supplied by publisher]15: J Pediatr. 2010 Jun 3; [Epub ahead of print]
Tosounidis T, Stengel D, Kontakis G, Scott B, Templeton P, Giannoudis PV.
Academic Department of Trauma and Orthopaedics, Leeds General Infirmary, University of Leeds, Leeds, UK (); Academic Department of Trauma and Orthopedics, University of Crete, Greece (); and Center for Clinical Research, Department of Trauma and Orthopedics, Unfallkrankenhaus Berlin and University of Greifswald, Germany ().
OBJECTIVE: To examine associations of major complications after surgical treatment of slipped upper femoral epiphysis (SUFE) with condition- and treatment-related risk factors. STUDY DESIGN: This systematic review and meta-analysis of observational studies used an electronic literature search of Embase and Medline supplemented by a manual search of bibliographies. The studies enrolled children and adolescents with SUFE, defined stable and unstable disease, and reported at least 3 primary endpoints: avascular necrosis (AVN), chondrolysis, and reoperation. Random-effects meta-regression analysis was performed when possible. RESULTS: The weighted risk for AVN, derived from intercept-only meta-regression, was estimated as 5.3% (95% confidence interval [CI], 3.4%-7.2%). Patients with unstable slips had a 9.4-fold greater risk of developing AVN. Instability proved to be an independent predictor for AVN. The weighted risk of chondrolysis was 0.8% (95% CI, 0.2%-1.4%), associated with unstable slips and osteotomies. The risk of reoperation was estimated at 5.5% (95% CI, 1.7%-9.3%). Loss of fixation was the primary reason for reoperation. CONCLUSIONS: Current evidence indicates that unstable slips are at a significantly higher risk for AVN than stable slips, regardless of the attempted surgical approach. Little clinical information is available regarding chondrolysis and reoperation in relation to the stability of the physis. Copyright (c) 2010 Mosby, Inc. All rights reserved.
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PMID: 20605166 [PubMed - as supplied by publisher]16: Pediatrics. 2010 Aug;126(2):323-32. Epub 2010 Jul 5.
Bruijn J, Locher H, Passchier J, Dijkstra N, Arts WF.
Department of Pediatrics, Vlietland Hospital, Schiedam, The Netherlands. jbruijn@ssvz.nl
BACKGROUND: In past decades, numerous population- and hospital-based studies have revealed a relationship between migraine or headache and psychopathology in children. OBJECTIVE: To describe and assess all clinical studies on the prevalence and manifestations of psychological functioning and psychiatric comorbidity in children with migraine and to provide recommendations for its diagnosis and treatment. METHODS: A literature search was performed in Medline, Embase, PsycINFO, and the Cochrane Database to identify clinical studies that assessed psychological functioning and/or psychiatric comorbidity in children with migraine. Trial quality was assessed according to a standardized and validated set of criteria. RESULTS: Seven studies met our inclusion criteria. Evidence assessment was performed by using the best-evidence synthesis method of Slavin. On the basis of this method, we found strong evidence that children with migraine in a clinical setting do not exhibit more withdrawn behavior, do not have more thought problems, do not have more social problems, and do not exhibit more delinquent or aggressive behavior than healthy children. Furthermore, there is strong evidence that children with migraine have more somatic complaints and exhibit internalizing behavior which is, given the construct of the outcome measure used, a consequence of the nature of their disease rather than a sign of psychological dysfunctioning. Finally, compared with healthy children, there is limited evidence that children with migraine in a clinical setting are more frequently diagnosed with oppositional defiant disorder, and they are not more frequently diagnosed with attention-deficit/hyperactivity disorder, conduct disorder, dysthymia, or depression. CONCLUSIONS: On the basis of this review, we conclude that children with migraine at referral to a specialist do not exhibit more psychological dysfunctioning and (to a lesser extent) do not exhibit more psychiatric comorbidity compared with healthy controls.
Publication Types: Research Support, Non-U.S. Gov't Review
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PMID: 20603260 [PubMed - indexed for MEDLINE]17: Pediatrics. 2010 Aug;126(2):e451-8. Epub 2010 Jul 5.
Wilkinson D.
Department of Public Health and Primary Health Care, Ethox Centre, University of Oxford, Badenoch Building, Headington, UK. dominic.wilkinson@ethox.ox.ac.uk
The majority of deaths in infants with hypoxic-ischemic encephalopathy (HIE) follow decisions to withdraw life-sustaining treatment. Clinicians use prognostic tests including MRI to help determine prognosis and decide whether to consider treatment withdrawal. A recently published meta-analysis provided valuable information on the prognostic utility of magnetic resonance (MR) biomarkers in HIE and suggested, in particular, that proton MR spectroscopy is the most accurate predictor of neurodevelopmental outcome. How should this evidence influence treatment-limitation decisions? In this article I outline serious limitations in existing prognostic studies of HIE, including small sample size, selection bias, vague and overly inclusive outcome assessment, and potential self-fulfilling prophecies. Such limitations make it difficult to answer the most important prognostic question. Reanalysis of published data reveals that severe abnormalities on conventional MRI in the first week have a sensitivity of 71% (95% confidence interval: 59%-91%) and specificity of 84% (95% confidence interval: 68%-93%) for very adverse outcome in infants with moderate encephalopathy. On current evidence, MR biomarkers alone are not sufficiently accurate to direct treatment-limitation decisions. Although there may be a role for using MRI or MR spectroscopy in combination with other prognostic markers to identify infants with very adverse outcome, it is not possible from meta-analysis to define this group clearly. There is an urgent need for improved prognostic research into HIE.
Publication Types: Meta-Analysis Research Support, Non-U.S. Gov't
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PMID: 20603255 [PubMed - indexed for MEDLINE]18: Arch Dis Child. 2010 Jun 24; [Epub ahead of print]
Joseph J, Saroha V, Payne H, Paul P, Didi M, Isherwood D, Blair J.
Department of Diabetes and Endocrinology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
Background National guidelines recommend that thyroid function is assessed at diagnosis of type I diabetes (TIDM) and annually thereafter. This paper reports an audit of thyroid surveillance in accordance with this guideline. Patients 110 patients (66 males), median age 11.3 (1.2-15.7) years at diagnosis of TIDM, were monitored for 2.3 (0.7-4.2) years. Results 21/110 (19.0%) patients had abnormal thyroid function at diagnosis of TIDM. Of these, 16 had normal thyroid function on reassessment after 45 (3-540) days. Abnormalities of thyroid function occurred more commonly in children with diabetic ketoacidosis (DKA) than those who did not have DKA (9/29, 31.0% vs 12/81, 14.8%, p<0.025). At the end of the observation period, five (4.5%) patients had minor abnormalities of thyroid function not requiring treatment and three (2.7%) were treated. Conclusions Transient abnormalities of thyroid function are common at diagnosis of TIDM, and therefore, thyroid hormones should not be measured at this time.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20576659&dopt=ExternalLink
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PMID: 20576659 [PubMed - as supplied by publisher]19: Arch Dis Child. 2010 Jun 24; [Epub ahead of print]
Peters M, Fijnvandraat K, van den Tweel XW, Garre FG, Giordano PC, van Wouwe JP, Pereira RR, Verkerk PH.
Department of Paediatric Haematology, Academic Medical Center, Emma Children's Hospital, Amsterdam, The Netherlands.
Objectives To estimate the prevalence of children with sickle cell disease (SCD) in The Netherlands. To estimate the annual number of children newly diagnosed as having SCD and the proportion with diagnoses through neonatal screening To estimate the proportion of children with SCD receiving paediatric care in a comprehensive care setting. Design Data from two sources, a survey of paediatric practices (n=107) and a laboratory database (n=20), were analysed by the capture-recapture method. Participants Children with SCD aged <18 years, either born before 2003 or newly diagnosed as having SCD between 2003 and 2007. Main outcome measures Prevalence, annual number of children newly diagnosed as having SCD, proportion of children with diagnoses through neonatal screening, proportion of children receiving paediatric care. Results The prevalence of SCD in children living in The Netherlands on 1 January 2003 was 1:5152 (95% CI 1:4513 to 1:6015). In the next 4 years, the annual incidence was 1:2011 (95% CI 1:1743 to 1:2376). Nearly one-third (27%) of the children newly diagnosed as having SCD immigrated to The Netherlands after birth and would, therefore, be missed by the neonatal screening programme. Approximately 60% of all children with SCD were not reported by paediatricians. Conclusion The number of children with SCD in The Netherlands is much higher than previously estimated, and the majority of these children seem not to be reviewed regularly by a paediatrician. Children born abroad (27% of new cases) do not benefit from neonatal screening and are at high risk of life-threatening complications before SCD is diagnosed. As this introduces disparities in healthcare, the initiation of adequate measures should be considered.
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20576657&dopt=ExternalLink
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PMID: 20576657 [PubMed - as supplied by publisher]20: Arch Dis Child. 2010 Sep;95(9):745-8. Epub 2010 Jun 22.
Kalikstad B, Skjerdal A, Hansen TW.
Institute of Clinical Medicine, University of Oslo, Norway. betty.kalikstad@medisin.uio.no
OBJECTIVES: The majority of drugs used in sick newborns receiving intensive care are unlicensed and off-label, exposing infants to greater risk of adverse drug reactions (ADRs). Our aim was to study the compatibility of co-infusions for a selected group of drugs and nutrition solutions as part of our quality assurance programme in the neonatal intensive care unit. METHODS: The authors reviewed drug studies in the literature. Documented compatibility or the lack thereof was the main end point for the 1042 co-infusions investigated. The results of searches were reviewed against predetermined criteria for co-infusion of 13 intensive care drugs with 66 other drugs and two nutrition solutions and albumin. RESULTS: 33/820 (4%) co-infusions were documented as compatible without any restrictions. 212/820 (26%) drug co-infusions were compatible, but 196 of the 212 (93%) had restrictions on infusion fluid, concentration or contact time. 608/820 (74%) drug co-infusions in neonates have either been shown to be incompatible or have not been tested. Among those not tested, 163/486 (34%) entailed major differences in pH level which could cause co-infusion instability. CONCLUSION: There is a lack of data on compatibility for the majority of drugs used for co-infusions in neonates. Caregivers therefore need to pay special attention to infusion lines when drugs are co-administered. Our results suggest that further studies on drug compatibility are needed to reduce possible ADRs and toxicity, and avoid precipitation and occlusion of infusion lines in critically ill neonates.
Publication Types: Research Support, Non-U.S. Gov't
Links http://www.ncbi.nlm.nih.gov/entrez/queryd.fcgi?cmd=Retrieve&db=PubMed&list_uids=20570841&dopt=ExternalLink
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PMID: 20570841 [PubMed - in process]