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Does Mediterranean diet protect against wheezing in preschool children?
Exercise and hemophilia The prognosis has been improving in adults with severe hemophilia who participate in sports activities at the same levels as healthy controls. In this issue of The Journal, Engelbert et al from the Netherlands found that boys with hemophilia compared with healthy controls had significantly reduced peak oxygen consumptions, heart rates, and work loads. Total muscle strength was normal, and there was virtually no impairment of joint function. Interestingly, 30% of the boys were overweight, although their self-reported physical activity was normal. Clearly, there is room for further studies of physical activity and obesity in this patient population.
–Robert W. Wilmott, MD page 833
Pertussis among American Indian and Alaska Native infants Collaborators from the Centers for Disease Control and Prevention and other public health programs report the substantially increased burden of hospitalization for pertussis among American Indian and Alaska Native (AI/AN) infants compared with the general U.S. infant population. Cases occur primarily in infants too young to be afforded protection from the current pertussis immunization schedule that begins at two months of age and despite vaccination coverage rates similar to or just slightly lower than national coverage levels. Additional strategies will be required to reduce the burden. Because the Alaska and Southwest regions, among seven regions, account for the majority of the differences between AI/AN children and the general U.S. population, it is likely that ethnicity per se is one contributing factor among others such as geography, environment, and social factors.
–Sarah S. Long, MD page 839
Does Mediterranean diet protect against wheezing in preschool children? Castro-Rodriguez et al from Spain have tested the hypothesis that Mediterranean diet can be a protective factor for wheezing in 784 preschool children. Questionnaires were completed by the parents and the children were stratified according to whether or not they had wheezed in the previous year. A Mediterranean diet score was created according to the frequency of intake of several foods such as fruit, grains, fish, vegetables, and pasta. Eating a Mediterranean diet protected against current wheezing in preschool children. In an accompanying editorial by Brown, many interesting suggestions are made concerning future research in the area of Mediterranean diet and lung disease.
A “jaundiced” eye toward clinical assessments of bilirubin Elevated bilirubin levels are normal in term newborn infants. The risk of very high bilirubin levels can be predicted by clinical factors such as gestational age, growth, and feeding practices. Recently, nomograms were developed for screening infants prior to discharge to identify the infants at risk and to arrange for closer follow-up. These assessments require bilirubin measurements on blood, which are time-consuming and expensive. In this issue of The Journal, Riskin et al evaluated the ability of physicians and nurses to visually assess bilirubin levels. Although the overall correlations between the clinical estimates and laboratory assessments were quite good, 62% of infants in a high-risk zone were misclassified as lower risk. The problem was most evident for infants scheduled for early discharge or for near-term infants. The clinical assessments of bilirubin were made under optimal conditions with consistent lighting. Therefore, in practice, clinical estimates of bilirubin levels are likely to be more problematic. Surprisingly, in 2008, the management of bilirubin in newborn infants remains an area of active research.
–Alan H. Jobe, MD, PhD page 782
Pneumococcal serotype matters The development of pneumococcal conjugate vaccines requires knowledge of specific serotypes causing disease. The implementation and universal use of 7-valent conjugate pneumococcal vaccine in children in the United States in 2000 has taught us that we need to continue to monitor the relative importance as well as the population-based incidence of disease caused by specific serotypes of Streptococcus pneumoniae. Both have shifted in surprising ways in less than a decade of conjugate vaccine use in the United States. Specific serotypes and relevant pneumococcal diseases vary by demography and geography. In this issue of The Journal, Hortal et al provide difficult-to-obtain serotype data on 387 culture-proven cases of pneumococcal pneumonia in Uruguayan children. They show that universal implementation of the 7-valent conjugate pneumococcal vaccination in Uruguay, even if 100% effective, would be expected to prevent only 60% of cases of pneumococcal pneumonia requiring hospitalization. The more we learn, the more we realize that disease due to S. pneumoniae—with at least 90 serotypes and a niche in the normal flora of the respiratory tract—will be far more difficult to prevent using protein-conjugate polysaccharide vaccines than was and still is disease due to Haemophilus influenzae type b.
–Sarah S. Long, MD page 850
–Robert W. Wilmott, MD page 823 (article) page 749 (editorial)
The Journal of Pediatrics
June 2008
A3
–Robert W. Wilmott, MD page 833
Pertussis among American Indian and Alaska Native infants Collaborators from the Centers for Disease Control and Prevention and other public health programs report the substantially increased burden of hospitalization for pertussis among American Indian and Alaska Native (AI/AN) infants compared with the general U.S. infant population. Cases occur primarily in infants too young to be afforded protection from the current pertussis immunization schedule that begins at two months of age and despite vaccination coverage rates similar to or just slightly lower than national coverage levels. Additional strategies will be required to reduce the burden. Because the Alaska and Southwest regions, among seven regions, account for the majority of the differences between AI/AN children and the general U.S. population, it is likely that ethnicity per se is one contributing factor among others such as geography, environment, and social factors.
–Sarah S. Long, MD page 839
Does Mediterranean diet protect against wheezing in preschool children? Castro-Rodriguez et al from Spain have tested the hypothesis that Mediterranean diet can be a protective factor for wheezing in 784 preschool children. Questionnaires were completed by the parents and the children were stratified according to whether or not they had wheezed in the previous year. A Mediterranean diet score was created according to the frequency of intake of several foods such as fruit, grains, fish, vegetables, and pasta. Eating a Mediterranean diet protected against current wheezing in preschool children. In an accompanying editorial by Brown, many interesting suggestions are made concerning future research in the area of Mediterranean diet and lung disease.
A “jaundiced” eye toward clinical assessments of bilirubin Elevated bilirubin levels are normal in term newborn infants. The risk of very high bilirubin levels can be predicted by clinical factors such as gestational age, growth, and feeding practices. Recently, nomograms were developed for screening infants prior to discharge to identify the infants at risk and to arrange for closer follow-up. These assessments require bilirubin measurements on blood, which are time-consuming and expensive. In this issue of The Journal, Riskin et al evaluated the ability of physicians and nurses to visually assess bilirubin levels. Although the overall correlations between the clinical estimates and laboratory assessments were quite good, 62% of infants in a high-risk zone were misclassified as lower risk. The problem was most evident for infants scheduled for early discharge or for near-term infants. The clinical assessments of bilirubin were made under optimal conditions with consistent lighting. Therefore, in practice, clinical estimates of bilirubin levels are likely to be more problematic. Surprisingly, in 2008, the management of bilirubin in newborn infants remains an area of active research.
–Alan H. Jobe, MD, PhD page 782
Pneumococcal serotype matters The development of pneumococcal conjugate vaccines requires knowledge of specific serotypes causing disease. The implementation and universal use of 7-valent conjugate pneumococcal vaccine in children in the United States in 2000 has taught us that we need to continue to monitor the relative importance as well as the population-based incidence of disease caused by specific serotypes of Streptococcus pneumoniae. Both have shifted in surprising ways in less than a decade of conjugate vaccine use in the United States. Specific serotypes and relevant pneumococcal diseases vary by demography and geography. In this issue of The Journal, Hortal et al provide difficult-to-obtain serotype data on 387 culture-proven cases of pneumococcal pneumonia in Uruguayan children. They show that universal implementation of the 7-valent conjugate pneumococcal vaccination in Uruguay, even if 100% effective, would be expected to prevent only 60% of cases of pneumococcal pneumonia requiring hospitalization. The more we learn, the more we realize that disease due to S. pneumoniae—with at least 90 serotypes and a niche in the normal flora of the respiratory tract—will be far more difficult to prevent using protein-conjugate polysaccharide vaccines than was and still is disease due to Haemophilus influenzae type b.
–Sarah S. Long, MD page 850
–Robert W. Wilmott, MD page 823 (article) page 749 (editorial)
The Journal of Pediatrics
June 2008
A3