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NEWS FLASH
By Dawn Drennan Nahlen High-risk Infants May Benefit From Early Aeroallergen Testing
M
ore than one quarter of 1-year-old children born to atopic parents with percutaneous sensitization to aeroallergens tested positive on a skin-prick test for one or more aeroallergens and/or food, the results of a large, ongoing study show. According to a Family Practice News article, the findings suggest that children at high risk for aeroallergen sensitization could undergo skin-prick testing at earlier than 2 years old, a group of researchers led by Grace K LeMasters, PhD, reported in the October issue of the Journal of Pediatrics. In current clinical practice, they noted, most children do not undergo aeroallergen sensitization evaluation until they reach the age of 4 or 5 years. For the Cincinnati Childhood Allergy and Air Pollution Study, LeMasters and her associates at the University of Cincinnati performed skin-prick testing on 680 1-year-old children of 1134 parents who had at least one allergy or asthma symptom and had tested positive on skin-prick testing for at least one of 15 aeroallergens (J Pediatr. 2006;149:505-511). The researchers found that 28.4% of 1-year-old children tested positive to any aeroallergen or food, whereas 18% were positive for one or more aeroallergen. The most common allergens by category were pollen (9.7%), mold (7.5%), dust mites and/or cockroaches (4.3%), and dogs or cats (3.5%). Only 589 infants were available to undergo a subsequent skin-prick test at age 2 years. Of those who had tested positive at age 1 year, 67.5% remained positive to an allergen. The study was supported by a grant from the National Institute of Environmental Health Sciences.
Lung Function at Birth Portends Asthma
I
From the Elsevier, Little Rock, AR. Address correspondences to Dawn Drennan Nahlen, 34 Barbara Dr., Little Rock, AR 72204. n 2007 Published by Elsevier Inc. 1527-3369/07/0701-0186$10.00/0 doi:10.1053/j.nainr.2007.01.002
nfants who have reduced lung function a few days after birth are at elevated risk for developing asthma by 10 years of age, reported Dr Geir H3land of Ulleval University Hospital, Oslo, and associates. The findings suggest that airway dysfunction associated with later asthma may be present and detectable a few days after birth. They assessed the predictive value of lung function using data from the Environment and Childhood Asthma study, a prospective study of 3754 healthy term infants born in Oslo over a 15-month period beginning in 1992. Tidal breathing flow-volume loops and passive respiratory mechanics were evaluated using a face mask while the newborns were calm and awake. At 10-years’ follow-up, 614 of these subjects were found to have a history of asthma or current asthma. Infants whose tidal breathing values were at or below the median were significantly more likely to develop asthma over the intervening years than were those whose values were above the median. They also were more likely to develop severe bronchial hyperresponsiveness and use inhaled corticosteroids. Children whose values for respiratory system compliance were at or below the median were significantly more likely to develop asthma by age 10 years than were those whose values were above the median. Newborn and Infant Nursing Reviews, Vol 7, No 1 (March), 2007: pp e1-e3
e1
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Dawn Drennan Nahlen
In the subset of 33 children whose values for both measures of lung function were below the median at birth, the prevalence of a history of asthma was 46% and the prevalence of current asthma was 28%, significantly higher than the rates of 19% and 10%, respectively, seen in the other subjects. The strength of these associations was equivalent to that of a family history of asthma, Dr H3land and associates noted (N Engl J Med. 2006;355:1682-1689). Family Practice News, November 15, 2006, Volume 36, Issue 22, Page 51
Dentists Warn Against Fluoride for Infants
T
o prevent tooth damage, the American Dental Association (ADA) warned its members that fluoridated water should not be mixed into concentrated formula or foods intended for babies 1 year and younger in a November 9 ADA e-mail alert (available at www.ada.org/ prof/resources/pubs/epubs/egram/egram_061109.pdf). Two thirds of US public water suppliers add fluoride chemicals, based on a disproved theory that fluoride ingestion prevents cavities. Bottled water with added fluoride is now sold with specific instructions to mix into formula. The ADA reports that b. . . infants could receive a greater than optimal amount of fluoride through liquid concentrate or powdered baby formula that has been mixed with water containing fluoride during a time that their developing teeth may be susceptible to enamel fluorosis.Q The ADA recommends using fluoride-free water. For more information, go to www.orgsites.com/ny/ nyscof or www.fluorideaction.net.
Review Finds Pediatric Vaccines Do Not Increase Brain Disease Risk
A
report published last fall in Pediatric Infectious Disease Journal asserts that childhood vaccination against whooping cough (pertussis) and measles is not associated with an increased risk for encephalopathy, a disease of the brain. According to a Reuters article, although encephalopathy or encephalitis have been reported to occur more often after whole-cell pertussis (diphtheriatetanus-pertussis; DTP) or combined measles-mumps-rubella (MMR) vaccination, the connection is debated. Paula Ray and colleagues from the Kaiser Permanente Vaccine Study Center in Oakland, CA, reviewed the records of more than two million children and used data from four study sites to reevaluate whether DTP and measles vaccinations are associated with encephalopathy or encephalitis. In all, 452 cases of encephalopathy were identified.
bAt no time period studied were patients with encephalopathy more likely than controls to have received DTP or MMR vaccine,Q the authors report. bIn fact, patients with encephalopathy were significantly less likely than controls to have received DTP vaccine in the prior 60 or 90 days. When only the patients without a known cause of encephalopathy were considered, there was a slightly but insignificantly higher likelihood of having received DTP.Q Likewise, the researchers found that children with neurologic disease of unknown or unverified origin were numerically (but not significantly) more likely to have received MMR vaccine in the previous 90 days. As quoted by Reuters, the investigators said, bAlthough this study is large, encephalopathy is rare, and thus it is not possible to exclude completely a small increase in the risk of encephalopathy after DTP or MMR vaccination. However, if such an increased risk exists, the absolute risk is extremely small and it is much lower after vaccination than after pertussis or measles.Q
Federal Child Development Campaign Targets Child Care Facilities
T
he Centers for Disease Control and Prevention (CDC), in collaboration with a coalition of national partners, is launching a new phase of the bLearn the Signs. Act EarlyQ public awareness campaign. This childhood development campaign aims to increase awareness of the importance of tracking a child’s social and emotional development, including the potential early warning signs of autism and other developmental disabilities. The new phase targets more than 407 000 child care facilities and provides free materials to help child care providers and preschool teachers educate parents about child development and autism. bMore than 8.7 million children younger than 5 years of age are in some type of child care arrangement,Q said Alison Johnson, acting director of CDC’s National Center on Birth Defects and Developmental Disabilities. bChild care providers and preschool teachers are in a special position to watch for delays and to promote early identification and action when a delay is suspected. In fact, because they see children interact in peer groups, child care providers can be the first to observe early warning signs of a developmental delay such as autism.Q The campaign has developed a free resource kit of materials on child development and autism for day care providers and teachers to share with parents. The kit, available in English and Spanish, includes a CD containing fact sheets on age-specific developmental milestones and disabilities such as autism, a growth chart that allows
News Flash
parents to track specific developmental milestones along with child height and weight, and educational posters. The CDC campaign also encourages parents to ask their child’s health care professional about any developmental concerns they might have. Parents can also call 1-800CDC-INFO or visit www.cdc.gov/actearly for additional information. The following groups collaborated on the campaign: US Department of Health and Human Services, CDC, American Academy of Pediatrics, Autism Speaks/ National Alliance for Autism Research, Autism Society of America, Cure Autism Now, First Signs, Interagency Autism Coordinating Council, and Organization for Autism Research.
Child Immunization Charts to Split by Age
B
eginning in 2007–2008, the annual harmonized childhood and adolescent immunization schedule will be split in two, with a chart on one page devoted to children 0 to 6 years old and another on a separate page for those 7 to 18 years old. The catch-up schedule also will be divided by age in the same way, but those two charts will both appear on one page. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted unanimously for the new format at its fall meeting. The American Academy of Family Physicians supports it as well. The decisions about whether and how to split the schedule were based in part on results from focus group sessions involving 69 immunization providers, including pediatricians, family physicians, nurse practitioners, physician assistants, registered nurses, and licensed practical nurses. They came from private and public settings and from urban, suburban, and rural areas. bWe wanted to capture the real world out there,Q said Sarah J Clark, associate director for research at the Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, which conducted the focus group. Overall, there was a general preference for two schedules rather than one. The group disagreed, however, on where to make the split. The majority who chose 0 to 6
e3
and 7 to 18 years did so primarily because it places the focus on preparing children for entering kindergarten or first grade. However, some participants wanted the split at 0 to 10 and 11 to 18 years, noting that if a clinician were only going to post one page, the younger age range chart would contain more information. Family Practice News, November 15, 2006, Volume 36, Issue 22, Page 2
Colorado Children’s Hospital Plans High-tech Facility
T
he Children’s Hospital of Denver is implementing advanced technology at its new $600 million facility in Aurora, CO, to improve care and staff communication. As reported by the Denver Post, the 1.44 million-squarefoot hospital, scheduled to open this fall, will feature campus-wide wireless access and a communications network connecting more than 5000 phones and 800 wireless access points. The newest facility will be outfitted with a single communications architecture capable of supporting the converged delivery of data, voice, and video. The $25 million communications network eventually will link all 11 Children’s facilities, two campus centers, and more than 400 outreach clinics to improve communication among staff and the transfer of patient data. The integrated pediatric care network has been designed to optimize health care delivery based on recommended best practices for real-time collaboration, resiliency, security, responsiveness, and connectivity. Plans for patient rooms call for handheld bedside devices that allow nurses to check medication levels, ondemand television programming, and a two-way nurse call system through which patients can directly contact the nursing desk. The article said the hospital complex is being erected on the Fitzsimons campus in Aurora. It includes a 270-bed inpatient hospital, a six-story outpatient center, and a 250,000-square-foot office building. Read the complete article at www.denverpost.com/ business/ci_4519437.
By Dawn Drennan Nahlen High-risk Infants May Benefit From Early Aeroallergen Testing
M
ore than one quarter of 1-year-old children born to atopic parents with percutaneous sensitization to aeroallergens tested positive on a skin-prick test for one or more aeroallergens and/or food, the results of a large, ongoing study show. According to a Family Practice News article, the findings suggest that children at high risk for aeroallergen sensitization could undergo skin-prick testing at earlier than 2 years old, a group of researchers led by Grace K LeMasters, PhD, reported in the October issue of the Journal of Pediatrics. In current clinical practice, they noted, most children do not undergo aeroallergen sensitization evaluation until they reach the age of 4 or 5 years. For the Cincinnati Childhood Allergy and Air Pollution Study, LeMasters and her associates at the University of Cincinnati performed skin-prick testing on 680 1-year-old children of 1134 parents who had at least one allergy or asthma symptom and had tested positive on skin-prick testing for at least one of 15 aeroallergens (J Pediatr. 2006;149:505-511). The researchers found that 28.4% of 1-year-old children tested positive to any aeroallergen or food, whereas 18% were positive for one or more aeroallergen. The most common allergens by category were pollen (9.7%), mold (7.5%), dust mites and/or cockroaches (4.3%), and dogs or cats (3.5%). Only 589 infants were available to undergo a subsequent skin-prick test at age 2 years. Of those who had tested positive at age 1 year, 67.5% remained positive to an allergen. The study was supported by a grant from the National Institute of Environmental Health Sciences.
Lung Function at Birth Portends Asthma
I
From the Elsevier, Little Rock, AR. Address correspondences to Dawn Drennan Nahlen, 34 Barbara Dr., Little Rock, AR 72204. n 2007 Published by Elsevier Inc. 1527-3369/07/0701-0186$10.00/0 doi:10.1053/j.nainr.2007.01.002
nfants who have reduced lung function a few days after birth are at elevated risk for developing asthma by 10 years of age, reported Dr Geir H3land of Ulleval University Hospital, Oslo, and associates. The findings suggest that airway dysfunction associated with later asthma may be present and detectable a few days after birth. They assessed the predictive value of lung function using data from the Environment and Childhood Asthma study, a prospective study of 3754 healthy term infants born in Oslo over a 15-month period beginning in 1992. Tidal breathing flow-volume loops and passive respiratory mechanics were evaluated using a face mask while the newborns were calm and awake. At 10-years’ follow-up, 614 of these subjects were found to have a history of asthma or current asthma. Infants whose tidal breathing values were at or below the median were significantly more likely to develop asthma over the intervening years than were those whose values were above the median. They also were more likely to develop severe bronchial hyperresponsiveness and use inhaled corticosteroids. Children whose values for respiratory system compliance were at or below the median were significantly more likely to develop asthma by age 10 years than were those whose values were above the median. Newborn and Infant Nursing Reviews, Vol 7, No 1 (March), 2007: pp e1-e3
e1
e2
Dawn Drennan Nahlen
In the subset of 33 children whose values for both measures of lung function were below the median at birth, the prevalence of a history of asthma was 46% and the prevalence of current asthma was 28%, significantly higher than the rates of 19% and 10%, respectively, seen in the other subjects. The strength of these associations was equivalent to that of a family history of asthma, Dr H3land and associates noted (N Engl J Med. 2006;355:1682-1689). Family Practice News, November 15, 2006, Volume 36, Issue 22, Page 51
Dentists Warn Against Fluoride for Infants
T
o prevent tooth damage, the American Dental Association (ADA) warned its members that fluoridated water should not be mixed into concentrated formula or foods intended for babies 1 year and younger in a November 9 ADA e-mail alert (available at www.ada.org/ prof/resources/pubs/epubs/egram/egram_061109.pdf). Two thirds of US public water suppliers add fluoride chemicals, based on a disproved theory that fluoride ingestion prevents cavities. Bottled water with added fluoride is now sold with specific instructions to mix into formula. The ADA reports that b. . . infants could receive a greater than optimal amount of fluoride through liquid concentrate or powdered baby formula that has been mixed with water containing fluoride during a time that their developing teeth may be susceptible to enamel fluorosis.Q The ADA recommends using fluoride-free water. For more information, go to www.orgsites.com/ny/ nyscof or www.fluorideaction.net.
Review Finds Pediatric Vaccines Do Not Increase Brain Disease Risk
A
report published last fall in Pediatric Infectious Disease Journal asserts that childhood vaccination against whooping cough (pertussis) and measles is not associated with an increased risk for encephalopathy, a disease of the brain. According to a Reuters article, although encephalopathy or encephalitis have been reported to occur more often after whole-cell pertussis (diphtheriatetanus-pertussis; DTP) or combined measles-mumps-rubella (MMR) vaccination, the connection is debated. Paula Ray and colleagues from the Kaiser Permanente Vaccine Study Center in Oakland, CA, reviewed the records of more than two million children and used data from four study sites to reevaluate whether DTP and measles vaccinations are associated with encephalopathy or encephalitis. In all, 452 cases of encephalopathy were identified.
bAt no time period studied were patients with encephalopathy more likely than controls to have received DTP or MMR vaccine,Q the authors report. bIn fact, patients with encephalopathy were significantly less likely than controls to have received DTP vaccine in the prior 60 or 90 days. When only the patients without a known cause of encephalopathy were considered, there was a slightly but insignificantly higher likelihood of having received DTP.Q Likewise, the researchers found that children with neurologic disease of unknown or unverified origin were numerically (but not significantly) more likely to have received MMR vaccine in the previous 90 days. As quoted by Reuters, the investigators said, bAlthough this study is large, encephalopathy is rare, and thus it is not possible to exclude completely a small increase in the risk of encephalopathy after DTP or MMR vaccination. However, if such an increased risk exists, the absolute risk is extremely small and it is much lower after vaccination than after pertussis or measles.Q
Federal Child Development Campaign Targets Child Care Facilities
T
he Centers for Disease Control and Prevention (CDC), in collaboration with a coalition of national partners, is launching a new phase of the bLearn the Signs. Act EarlyQ public awareness campaign. This childhood development campaign aims to increase awareness of the importance of tracking a child’s social and emotional development, including the potential early warning signs of autism and other developmental disabilities. The new phase targets more than 407 000 child care facilities and provides free materials to help child care providers and preschool teachers educate parents about child development and autism. bMore than 8.7 million children younger than 5 years of age are in some type of child care arrangement,Q said Alison Johnson, acting director of CDC’s National Center on Birth Defects and Developmental Disabilities. bChild care providers and preschool teachers are in a special position to watch for delays and to promote early identification and action when a delay is suspected. In fact, because they see children interact in peer groups, child care providers can be the first to observe early warning signs of a developmental delay such as autism.Q The campaign has developed a free resource kit of materials on child development and autism for day care providers and teachers to share with parents. The kit, available in English and Spanish, includes a CD containing fact sheets on age-specific developmental milestones and disabilities such as autism, a growth chart that allows
News Flash
parents to track specific developmental milestones along with child height and weight, and educational posters. The CDC campaign also encourages parents to ask their child’s health care professional about any developmental concerns they might have. Parents can also call 1-800CDC-INFO or visit www.cdc.gov/actearly for additional information. The following groups collaborated on the campaign: US Department of Health and Human Services, CDC, American Academy of Pediatrics, Autism Speaks/ National Alliance for Autism Research, Autism Society of America, Cure Autism Now, First Signs, Interagency Autism Coordinating Council, and Organization for Autism Research.
Child Immunization Charts to Split by Age
B
eginning in 2007–2008, the annual harmonized childhood and adolescent immunization schedule will be split in two, with a chart on one page devoted to children 0 to 6 years old and another on a separate page for those 7 to 18 years old. The catch-up schedule also will be divided by age in the same way, but those two charts will both appear on one page. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted unanimously for the new format at its fall meeting. The American Academy of Family Physicians supports it as well. The decisions about whether and how to split the schedule were based in part on results from focus group sessions involving 69 immunization providers, including pediatricians, family physicians, nurse practitioners, physician assistants, registered nurses, and licensed practical nurses. They came from private and public settings and from urban, suburban, and rural areas. bWe wanted to capture the real world out there,Q said Sarah J Clark, associate director for research at the Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, which conducted the focus group. Overall, there was a general preference for two schedules rather than one. The group disagreed, however, on where to make the split. The majority who chose 0 to 6
e3
and 7 to 18 years did so primarily because it places the focus on preparing children for entering kindergarten or first grade. However, some participants wanted the split at 0 to 10 and 11 to 18 years, noting that if a clinician were only going to post one page, the younger age range chart would contain more information. Family Practice News, November 15, 2006, Volume 36, Issue 22, Page 2
Colorado Children’s Hospital Plans High-tech Facility
T
he Children’s Hospital of Denver is implementing advanced technology at its new $600 million facility in Aurora, CO, to improve care and staff communication. As reported by the Denver Post, the 1.44 million-squarefoot hospital, scheduled to open this fall, will feature campus-wide wireless access and a communications network connecting more than 5000 phones and 800 wireless access points. The newest facility will be outfitted with a single communications architecture capable of supporting the converged delivery of data, voice, and video. The $25 million communications network eventually will link all 11 Children’s facilities, two campus centers, and more than 400 outreach clinics to improve communication among staff and the transfer of patient data. The integrated pediatric care network has been designed to optimize health care delivery based on recommended best practices for real-time collaboration, resiliency, security, responsiveness, and connectivity. Plans for patient rooms call for handheld bedside devices that allow nurses to check medication levels, ondemand television programming, and a two-way nurse call system through which patients can directly contact the nursing desk. The article said the hospital complex is being erected on the Fitzsimons campus in Aurora. It includes a 270-bed inpatient hospital, a six-story outpatient center, and a 250,000-square-foot office building. Read the complete article at www.denverpost.com/ business/ci_4519437.