Lessons from hospitalization for seasonal influenza over five seasons

help raise awareness around the world that children can contract this serious disease and they can die from a delay in its diagnosis. Perhaps someday routine diabetes antibody screening at the time of the preschool physical examination will alert physicians and families to children at high risk for type 1 diabetes. Until then, working together during World Diabetes Month, November 2010, will enable us to focus the world on a simple message—No Child Should Die of Diabetes.

Lessons from hospitalization for seasonal influenza over five seasons —Sarah S. Long, MD

The associations of infantile hemangiomas —Robert W. Wilmott, MD

Inter-alpha inhibitor proteins—biomarker for NEC? —Alan H. Jobe, MD, PhD

A2

U

sing the Emerging Infections Program of surveillance in 10 states, which covers a population of more than 5 million children under 18 years of age, Dawood et al report hospitalization incidence for seasonal influenza over 5 seasons by age and patient characteristics, as well as clinical course of disease. Besides providing reliable incidence figures that estimate burden of disease, several findings are noteworthy. The highest incidence of influenza hospitalization (seasonal range, 9-30/10 000 children) is in infants under 6 months of age—too young to be immunized. Prevention, therefore, depends on immunization of older individuals in order to decrease exposure. Another finding is the vulnerability of children with underlying conditions, such children accounting for 40% of seasonal influenza hospitalizations. Finally, although all cases included in the dataset were proved to have influenza (usually by rapid assays), fewer than one-half of patients aged 1 year or older were treated with an antiviral agent. We should do much better, with both prevention and treatment. Article page 808 <

R

ecently there has been a flurry of articles about large cutaneous hemangiomas in infancy, much of it prompted by the apparent efficacy of propranolol therapy. There also has been interest in cutaneous infantile hemangiomas and their associated congenital anomalies. In this issue of The Journal, Iacobas et al examined the association of cutaneous infantile hemangiomas of the lower body and regional congenital anomalies in 24 new patients and 29 published cases. They report on the associated urogenital, ulceration, spinal cord, and anorectal, arterial, and renal anomalies and have proposed the acronym LUMBAR to describe this association. The PHACE syndrome has many similarities, although it applies to the associations with segmental infantile hemangioma to the face. Time will show whether the LUMBAR acronym is a useful term. Article page 795 <

P

otential biomarkers for infection and inflammatory disease are continually being identified, tested, and usually discarded as not being of sufficient resolution for general clinical use. A good biomarker for necrotizing entercolitis (NEC) would distinguish the infant developing NEC from the many infants with non-specific gastrointestinal findings that do not progress to NEC. The inter-alpha inhibitor proteins are a family of structurally related serine protease inhibitors that are present in plasma. These proteins decrease with sepsis, and Chaaban et al now show that the proteins also are decreased at the time of evaluation for NEC. Although the magnitude of decrease was just 50%, this decreased level separated the population of infants with NEC from the infants without NEC almost completely. Although the prospective, further larger studies will be required to demonstrate whether decreased inter-alpha inhibitor proteins can predict NEC with sufficient precision to be useful for patient management. Article page 757 <

Vol. 157, No. 5