How to detect lung inflammation in preterms?

Television watching and obesity The prevalence of overweight is increasing in adolescents at a rate of about 0.5% per year. It is clear that this results from population changes in energy balance. However, the specific contributors to this obesigenic environment have not been clarified. An area of concern is that the time spent on sedentary pursuits, specifically time spent watching television, may be a contributing factor. There have been few prospective, longitudinal studies that have examined this relationship. In this issue of The Journal, Kaur et al report on results drawn from the California Teen Longitudinal Survey. They assessed the associations between hours of television watched at baseline and body mass index (BMI) at baseline and after 3 years of follow-up. They found that television viewing leads to a subsequent increase in BMI percentile rank and overweight. These results confirm that interventions directed at reducing time spent watching television could help to prevent the development of obesity. —Stephen R. Daniels, MD, PhD Page 506

An ‘‘eye’’ out for trauma Retinal hemorrhages have long been recognized as a clue to the presence of inflicted head injury in children. The precise mechanism by which this occurs has not been totally understood. A step in this direction is reported in this issue of The Journal by Gilles and associates from Children’s Hospital in Los Angeles. These workers used a database containing serial fundus photographs and brain imaging in 14 children with inflicted head injury, 10 of whom had retinal hemorrhages. In most cases, there was good correlation between the laterality of the initial fundus findings and the localization of injury on computed tomography (CT) imaging. In some cases, it was a matter of time before the lateralization became evident on CT, although it could be predicted by the initial appearance of the fundus. This observation supports the hypothesis that retinal findings in children with inflicted head injury are consequent to the transmission of intracranial pressure gradients to the retinal sheath and vessels. In addition to providing the practitioner with a nice review of the effects of these injuries in children, the paper is an example of the use of careful clinical examinations in testing complex physiologic hypotheses. —Thomas R. Welch, MD Page 494

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October 2003

Opportunity for better protection of children with sickle hemoglobinopathy Adamkiewicz et al provide data from 8 regional pediatric sickle cell programs on invasive episodes of Staphylococcus pneumoniae for the 3 years leading up to universal use of the 7-serotype pneumococcal conjugate vaccine (PCV7). They highlight opportunities for combined use of PCV7 with booster dose(s) of the 23-serotype pneumococcal polysaccharide vaccine (PPV23) to especially increase protection against penicillin nonsusceptible strains, serotypes not included in PCV7, and risks occurring across all age groups. The authors concur with recommending bodies that suggest that until we know more, penicillin prophylaxis should be used in all children with sickle hemoglobinopathy until age 5 years. They also suggest that continued prophylaxis beyond 5 years should be given to certain children with increased risk, eg, those with previous invasive infection and those who have undergone surgical splenectomy. —Sarah S. Long, MD Page 438

How to detect lung inflammation in preterms? Much perinatal research is now focused on the relationships between antenatal infection/inflammation, preterm labor, and adverse outcomes of prematurity such as neurodevelopmental abnormalities and bronchopulmonary dysplasia. The primary mediators of these adverse outcomes are thought to be pro-inflammatory cytokines produced by activated granulocytes. Andersen et al used positron emission tomography to detect the accumulation of 18fluorodeoxyglucose in the lungs of infants as a noninvasive way to measure inflammation. Their hypothesis was that infants born of mothers with chorioamnionitis would have more granulocytes in their lungs. A positive correlation would be consistent with cytokine measurements and would offer investigators in the field a quantitative technique to measure lung inflammation. Unfortunately, because several infants not exposed to chorioamnionitis had very high 18fluorodeoxyglucose uptakes, no relationship between this measure of granulocyte activity in the lungs and chorioamnionitis was apparent. The study demonstrates the likely complexity of inflammatory relationships in the lungs of ventilated preterm infants. Techniques such as this must be pursued for the experimental information about lung injury to be evaluated in a clinical setting. —Alan H. Jobe, MD, PhD Page 470

The Journal of Pediatrics