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Esophageal swallowing reflexes in preterms
This Month in
THE JOURNAL OF
PEDIATRICS July 2006 • Volume 149 • Number 1 Copyright © 2006 by Mosby, Inc.
THE EDITORS’ PERSPECTIVES Inactivity and risk of overweight There has been a dramatic increase in the prevalence of obesity in childhood. There are multiple reasons for this but one is decreased physical activity. In The Journal this month, two articles highlight this relationship. Davison et al report that TV watching is associated with increased BMI over time. This was true even for children who started at normal weight. This is probably due to the fact that time watching television is sedentary time with reduced energy expenditure. Dencker et al used accelerometers to measure physical activity. They found that children who were less active were more likely to be overweight. In his editorial, Washington emphasizes that current AAP and CDC guidelines should be followed for children. These guidelines include no more than 2 hours of television watching per day and 60 minutes or more of physical activity daily.
Stephen R. Daniels, MD, PhD page 32 (Davison) page 38 (Dencker) page 5 (editorial)
Esophageal swallowing reflexes in preterms Gastro-esophageal reflux disease is frequent at all ages and multiple medications are used to treat symptoms. Most preterm infants will have swallowing problems as they develop feeding skills and will have reflux that may or may not be “symptomatic.” The frequency of diagnosis of symptomatic reflux varies widely between physicians and neonatal units. Similarly, the use of drug therapy that is unvalidated for efficacy or safety varies widely in this patient population. Jadcheria, Hoffman, and Shaker report an elegant study of the mechano- and chemo-sensitive stimuli of persistalsis and upper esophageal sphincter reflexes in preterm infants. With more studies like this, we may learn the physiologic basis for reflux in the preterm, which would be desirable to better direct drug therapies.
Alan H. Jobe, MD, PhD page 77
Risk of hyperbilirubinemia in newborn African American boys The occurrence of idiopathic hyperbilirubinemia in normal newborn populations is higher in Asians than in Caucasians and African American infants are at the lowest risk. Even though all newborns need to be evaluated for elevated bilirubin levels, the infrequent occurrence of bilirubin levels high enough to require treatment in the African American population may decrease the vigilance of health care providers. Kaplan et al report that about 9% of African American newborns developed hyperbilirubinemia. Predictive factors were exclusive breast-feeding, an elevated pre-discharge bilirubin, and G-6-PD deficiency. The authors suggest that screening male African American infants for G-6-PD deficiency will identify a sub-group of these infants at high risk for hyperbilirubinemia.
Alan H. Jobe, MD, PhD page 83
Earlier diagnosis of multiple sclerosis in children using multimodal evoked potentials Diagnostic criteria for multiple sclerosis (MS) in children with demyelinating brain disease require clinical or imaging findings of disease affecting multiple areas of the brain or spinal cord, and of disease occurring at more than one point in time. These criteria are referred to as requirements for evidence of “dissemination in time and space.” Children frequently lack dissemination in space early in the disease. Pohl et al collected their experience with multimodal evoked potential (EP) study results in 85 children with MS before their second episodes (confirming dissemination in space) and found that EP study abnormalities, especially in visual EPs, revealed clinically silent, and MRI- and ophthalmologic examination-negative, pathology. Multimodal EPs confirmed dissemination in space in almost one-half of patients.
Sarah S. Long, MD page 125 (article) page 8 (editorial)
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
July 2006
1A
THE JOURNAL OF
PEDIATRICS July 2006 • Volume 149 • Number 1 Copyright © 2006 by Mosby, Inc.
THE EDITORS’ PERSPECTIVES Inactivity and risk of overweight There has been a dramatic increase in the prevalence of obesity in childhood. There are multiple reasons for this but one is decreased physical activity. In The Journal this month, two articles highlight this relationship. Davison et al report that TV watching is associated with increased BMI over time. This was true even for children who started at normal weight. This is probably due to the fact that time watching television is sedentary time with reduced energy expenditure. Dencker et al used accelerometers to measure physical activity. They found that children who were less active were more likely to be overweight. In his editorial, Washington emphasizes that current AAP and CDC guidelines should be followed for children. These guidelines include no more than 2 hours of television watching per day and 60 minutes or more of physical activity daily.
Stephen R. Daniels, MD, PhD page 32 (Davison) page 38 (Dencker) page 5 (editorial)
Esophageal swallowing reflexes in preterms Gastro-esophageal reflux disease is frequent at all ages and multiple medications are used to treat symptoms. Most preterm infants will have swallowing problems as they develop feeding skills and will have reflux that may or may not be “symptomatic.” The frequency of diagnosis of symptomatic reflux varies widely between physicians and neonatal units. Similarly, the use of drug therapy that is unvalidated for efficacy or safety varies widely in this patient population. Jadcheria, Hoffman, and Shaker report an elegant study of the mechano- and chemo-sensitive stimuli of persistalsis and upper esophageal sphincter reflexes in preterm infants. With more studies like this, we may learn the physiologic basis for reflux in the preterm, which would be desirable to better direct drug therapies.
Alan H. Jobe, MD, PhD page 77
Risk of hyperbilirubinemia in newborn African American boys The occurrence of idiopathic hyperbilirubinemia in normal newborn populations is higher in Asians than in Caucasians and African American infants are at the lowest risk. Even though all newborns need to be evaluated for elevated bilirubin levels, the infrequent occurrence of bilirubin levels high enough to require treatment in the African American population may decrease the vigilance of health care providers. Kaplan et al report that about 9% of African American newborns developed hyperbilirubinemia. Predictive factors were exclusive breast-feeding, an elevated pre-discharge bilirubin, and G-6-PD deficiency. The authors suggest that screening male African American infants for G-6-PD deficiency will identify a sub-group of these infants at high risk for hyperbilirubinemia.
Alan H. Jobe, MD, PhD page 83
Earlier diagnosis of multiple sclerosis in children using multimodal evoked potentials Diagnostic criteria for multiple sclerosis (MS) in children with demyelinating brain disease require clinical or imaging findings of disease affecting multiple areas of the brain or spinal cord, and of disease occurring at more than one point in time. These criteria are referred to as requirements for evidence of “dissemination in time and space.” Children frequently lack dissemination in space early in the disease. Pohl et al collected their experience with multimodal evoked potential (EP) study results in 85 children with MS before their second episodes (confirming dissemination in space) and found that EP study abnormalities, especially in visual EPs, revealed clinically silent, and MRI- and ophthalmologic examination-negative, pathology. Multimodal EPs confirmed dissemination in space in almost one-half of patients.
Sarah S. Long, MD page 125 (article) page 8 (editorial)
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
July 2006
1A