Excellence in Paediatrics - 2011

Risk of Bottle-feeding for Rapid Weight Gain During the First Year of Life

admin — Wed, 30 May 2012 09:50:03 +0000

Arch Pediatr Adolesc Med. 2012;166(5):431-436. doi:10.1001/archpediatrics.2011.1665

COMMENTARY
With the rate of obesity and overweight ever increasing, many are trying to turn to prevention as a better means of confronting the epidemic than treatment. And, as more and more children are becoming overweight and obese at younger and younger ages, preventing its occurrence must also occur at younger and younger ages. Some studies have shown that breastfeeding may be protective against rapid weight gain in infancy, and may be linked to lower rates of obesity and overweight later in childhood. This study took things a step further. It sought to tease out the relative contributions of the mechanism of feeding as opposed to the type of milk being fed. The study followed infants through their first year and recorded not only the type of milk they were being fed, but also whether they got it by bottle or from the breast. Infants who were fed nonhuman milk by bottle gained, on average, 71g more per month above those who were exclusively breastfed. But even infants who were fed human breast milk only by bottle gained 89g more per month than infants who were exclusively breastfed. In other words, it appears that the feeding by bottle is more likely associated with increased weight gain as opposed to the type of milk given. For those infants who received only breast milk by a variety of sources, those with more bottle feedings gained more weight. This may be because infants are less able to self-regulate with the bottle, or because those fed at the breast receive less milk in general. Regardless, there is something different about bottle feeding as opposed to breastfeeding when it come s to weight gain, and we should be cognizant of this when advising mothers against allowing their children to become too heavy.

Measles-Containing Vaccines and Febrile Seizures in Children Age 4 to 6 Years

admin — Wed, 30 May 2012 09:38:05 +0000

PEDIATRICS Vol. 129 No. 5 May 1, 2012, pp. 809 -814 (doi: 10.1542/peds.2011-3198)

COMMENTARY
As with the preceding study, monitoring for rare sequela after vaccine administration requires surveillance studies conducted after vaccines have been approved and started to be given in large numbers. In the US, children receive two doses each of the MMR and varicella vaccines, one between 1-2 years and another between 4-6 years. Parents can opt for their children to receive two separate shots, or a formulation that combines both of these vaccines into one shot. Previous studies, however, have shown that the risk of a febrile seizure 7 to 10 days after receiving both these vaccines in one shot that of receiving them separately. This study sought to confirm if this same finding occurred in children 4-6 years old who received the vaccine. The study used the Vaccine Safety Datalink to identify seizures in emergency departments and hospitals occurring up to 6 weeks after receiving the vaccines, whether together or separate. Over a two year study period, data were available for over 86,000 children who received the two vaccines in one shot, and these were compared to more than 67,000 children who received the shots separately over an 8 year period. Seizures were rare in this age group for the entire study period, and they did not peak 7 to 10 days after vaccine administration. Overall, there was one febrile seizure 7 to 10 days in the 86,750 kids who received the combined formulation. There were no children who had a febrile seizure 7 to 10 days after the administration of the shots separately. Because of the low numbers, a relative risk could not be calculated, but there seems to be no increased risk of the combined formulation leading to more febrile seizures in 4-6 year olds as it does in 1-2 year olds. The CDC continues to recommend that parents of 1-2 year olds receiving their first doses of these vaccines who don’t have a strong preference for the combined formulation should have their children receive separate shots. It seems unlikely they will make the same recommendation for 4-6 year olds.

Anaphylaxis as an adverse event following immunisation in the UK and Ireland

admin — Wed, 30 May 2012 09:33:53 +0000

Arch Dis Child 2012;97:487-490 doi:10.1136/archdischild-2011-301163

COMMENTARY
When doing prospective studies of vaccines, and all drugs for that matter, it is difficult to estimate how often they might lead to rare adverse events. Properly done surveillance after vaccine approval, however, can allow researchers to monitor large numbers of people receiving drugs or vaccines to see if adverse events are occurring at rates that might be significant. One sequela that might arise from vaccines is anaphylaxis. This study monitored all in the UK and Ireland who received vaccines for just over a one year period from 2008-2009. Any child who had anaphylaxis after receiving a vaccine was reported to the British Paediatric Surveillance Unit. Thankfully, anaphylaxis was very rare. Even though 15 children were reported as part of the study, fewer than half of them had true anaphylaxis. All of the children made a full recovery. So many vaccines are given, that the rates of these events were quite small overall. For the single component measles vaccine, the rate of anaphylaxis post-administration was 12 per 100,000 doses. For the HPV vaccine, it was 1.4 cases per 1,000,000 doses. Although there are no solid numbers on how many vaccines were given over this period, it is estimated that the number was more than 5,500,000. And, for all of those, only 7 children had true anaphylaxis following immunization. Of course, if a child has a history, they should always be monitored carefully after getting any medication or vaccination. They should also be monitored for more than 30 minutes, as many of the cases of anaphylaxis occurred after this amount of time. But we should rest assured that vaccines are safe, and that anaphylaxis after vaccine administration is very rare.

New medical update opportunity

admin — Thu, 26 Apr 2012 11:49:53 +0000

Read scientific reports from key sessions at the recent EiP 2011 conference in Istanbul, Turkey.

This section of our website contains short reviews of key sessions at EiP 2011. There are already many of them available for you to read and enjoy to stimulate and challenge your clinical thinking. As new reports become available, this section of the EiP website will be continuously updated. As such, it will constitute a valuable new educational resource for paediatricians who either seek to recapture key sessions once again, or who could not attend them due to other very attractive parallel sessions at EiP. Best of all, EiP has generously made this section available free of charge even for those paediatricians who missed the entire conference. Together we can develop.

Hospitalisation for bronchiolitis in infants is more common after elective caesarean delivery

admin — Mon, 30 Apr 2012 14:11:35 +0000

Arch Dis Child 2012;97:410-414 doi:10.1136/archdischild-2011-300607

COMMENTARY
The numbers of children delivered by elective caesarean section have been increasing over time. Previous studies have shown that children delivered this way have a significantly increased risk of being hospitalized for a respiratory infection in their first two years of life. This study takes their work a bit further by specifically seeing If children delivered by elective caesarean section are more likely to be hospitalized for bronchiolitis in their first two years. They found that they were. In their first year of life, even after controlling for other factors, children delivered by elective caesarean section were 11% more likely to be hospitalized for acute bronchiolitis than those delivered by spontaneously vaginal delivery. In the second year of life, this risk appeared to increase, but was no longer statistically significant. There were no significant relationships found between the mode of delivery and the risk of being hospitalized for pneumonia.

The authors posit that perhaps being delivered by elective caesarean section somehow results in children who have an impaired immune system that makes them more susceptible to infection. This is possible, but the study was not designed to determine causality. It might also be that families that are predisposed to seek an elective caesarean section might be more inclined to have their child hospitalized when ill. Unfortunately, we can’t tell from this study. But as more and more of these procedures are performed, it’s worth remembering that this association exists. There are, perhaps, unintended negative consequences of interfering with the normal birth process.

Management of MRSA

admin — Thu, 26 Apr 2012 12:23:41 +0000

MEET THE PROFESSOR: Management of MRSA

Speaker: Theoklis Zaoutis

Common dermatologic problems facing primary care paediatricians

admin — Thu, 26 Apr 2012 12:21:44 +0000

INTERACTIVE CASE STUDY: Common dermatologic problems facing primary care

paediatricians

Speakers: Eulalia Baselga, Peter H. Hoeger, Alain Taieb

Organised by EPA/UNEPSA and Cochrane Child Health Field

Introduction

Antimicrobial Stewardship

admin — Thu, 26 Apr 2012 12:20:04 +0000

INTERACTIVE CASE STUDY: Antimicrobial Stewardship

Speaker: Theoklis Zaoutis

LECTURE: Sun Protection as a Preventive Strategy in Children: Truths, Myths and Misconceptions

admin — Thu, 26 Apr 2012 12:19:11 +0000

Speaker: Ulrike Blume‐Peytavi

Lecture: The shift of mortality and morbidity burden from children to adolescents: A challenge for paediatricians

admin — Thu, 26 Apr 2012 12:19:10 +0000

Speaker: Russell Viner

Global attention has focused on mortality in children younger than 5 years but adolescents and young adults have benefited from the epidemiological transition less than children have, with a reversal of traditional mortality patterns over the past 50 years.