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Catecholamines on SIDS
This Month in
THE JOURNAL OF
PEDIATRICS August 2008 • Volume 153 • Number 2 Copyright © 2008 by Mosby, Inc.
THE EDITORS’ PERSPECTIVES Let’s not increase the indomethacin dose for PDA A major advance in neonatology was the demonstration in the late 1970s that indomethacin would close the PDA of the preterm infant. The problem in 2008 is that indomethacin is not as effective in the very preterm infants as in larger infants. A concern has been that the dose may be inadequate because of an increased volume for distribution of indomethacin in very preterm infants. Higher doses and longer durations of treatment are being used without validation. In this issue of The Journal, Jegatheesan et al report a careful study comparing the efficacy and safety of a higher dose of indomethacin for infants whose PDA did not close with conventional doses. The results of this study are definitive—a higher dose of indomethacin results in higher plasma indomethacin levels but no better closure of the PDA than continuing the standard dose. Further, the higher dose resulted in higher plasma creatinine levels (impaired kidney function) and an increased incidence of retinopathy of prematurity. Yet again, more is not better for the preterm infant.
—Alan H. Jobe, MD, PhD page 183
Catecholamines on SIDS Reports of associations between genetic markers in populations and disease are now frequent. The problem is that many of these associations have no apparent biological relevance and often provide no useful hypothesis about pathophysiology. This month in The Journal, Klintschar et al report a strong association between a polymorphism in the tyrosine hydroxylases gene that regulates catecholamine gene expression and SIDS. The polymorphism results in tandem repeat that modulate gene activity and thus catecholamine synthesis. Catecholamines are central to the CHS regulation of respiration as well as stress responses. Thus, this association of a polymorphism with SIDS makes sense biologically and should stimulate further research in the field.
—Alan H. Jobe, MD, PhD page 190
The cost of caring for Down syndrome Boulet et al from the National Center on Birth Defects and Developmental Disabilities have studied the health care insurance claims data from a privately insured population to estimate health care use and expenses for infants and children with Down syndrome. The mean medical cost for children 0 to 4 years was 12 to 13 times higher than for children without Down syndrome. For infants with Down syndrome and a congenital heart defect, mean and median costs were 5 to 7 times higher than for infants with Down syndrome who did not have heart disease. These results will guide future planning for the care of children affected by Down syndrome.
—Robert W. Wilmott, MD page 241
The Journal of Pediatrics (ISSN 0022-3476) is published monthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010. Business and Editorial Offices: 1600 John F. Kennedy Blvd., Suite 1800, Philadelphia, PA 19103-2899. Accounting and Circulation Offices: 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Periodicals postage paid at New York, NY, and additional mailing offices. POSTMASTER: Send address changes to The Journal of Pediatrics, Elsevier Periodicals Customer Service, 6277 Sea Harbor Drive, Orlando, FL 32887-4800.
The Journal of Pediatrics
August 2008
A1
THE JOURNAL OF
PEDIATRICS August 2008 • Volume 153 • Number 2 Copyright © 2008 by Mosby, Inc.
THE EDITORS’ PERSPECTIVES Let’s not increase the indomethacin dose for PDA A major advance in neonatology was the demonstration in the late 1970s that indomethacin would close the PDA of the preterm infant. The problem in 2008 is that indomethacin is not as effective in the very preterm infants as in larger infants. A concern has been that the dose may be inadequate because of an increased volume for distribution of indomethacin in very preterm infants. Higher doses and longer durations of treatment are being used without validation. In this issue of The Journal, Jegatheesan et al report a careful study comparing the efficacy and safety of a higher dose of indomethacin for infants whose PDA did not close with conventional doses. The results of this study are definitive—a higher dose of indomethacin results in higher plasma indomethacin levels but no better closure of the PDA than continuing the standard dose. Further, the higher dose resulted in higher plasma creatinine levels (impaired kidney function) and an increased incidence of retinopathy of prematurity. Yet again, more is not better for the preterm infant.
—Alan H. Jobe, MD, PhD page 183
Catecholamines on SIDS Reports of associations between genetic markers in populations and disease are now frequent. The problem is that many of these associations have no apparent biological relevance and often provide no useful hypothesis about pathophysiology. This month in The Journal, Klintschar et al report a strong association between a polymorphism in the tyrosine hydroxylases gene that regulates catecholamine gene expression and SIDS. The polymorphism results in tandem repeat that modulate gene activity and thus catecholamine synthesis. Catecholamines are central to the CHS regulation of respiration as well as stress responses. Thus, this association of a polymorphism with SIDS makes sense biologically and should stimulate further research in the field.
—Alan H. Jobe, MD, PhD page 190
The cost of caring for Down syndrome Boulet et al from the National Center on Birth Defects and Developmental Disabilities have studied the health care insurance claims data from a privately insured population to estimate health care use and expenses for infants and children with Down syndrome. The mean medical cost for children 0 to 4 years was 12 to 13 times higher than for children without Down syndrome. For infants with Down syndrome and a congenital heart defect, mean and median costs were 5 to 7 times higher than for infants with Down syndrome who did not have heart disease. These results will guide future planning for the care of children affected by Down syndrome.
—Robert W. Wilmott, MD page 241
The Journal of Pediatrics (ISSN 0022-3476) is published monthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010. Business and Editorial Offices: 1600 John F. Kennedy Blvd., Suite 1800, Philadelphia, PA 19103-2899. Accounting and Circulation Offices: 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Periodicals postage paid at New York, NY, and additional mailing offices. POSTMASTER: Send address changes to The Journal of Pediatrics, Elsevier Periodicals Customer Service, 6277 Sea Harbor Drive, Orlando, FL 32887-4800.
The Journal of Pediatrics
August 2008
A1