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Nutrition in children with sickle cell disease
On-time immunization of very low birth weight infants Pfister and colleagues have performed a meticulous study of adverse events associated with immunization with a DTaPcontaining vaccine of a most vulnerable group of very-low-birthweight premature infants. Although immunizing experiences with premature infants have been reported previously by others, the attention to detail and categorization of infants’ underlying characteristics, the careful monitoring over the 24 hours before and 48 hours after immunization, and delineation of severity of events make this study definitive. One can expect that: (1) approximately 50% of such infants overall will have resurgence or increase in cardiorespiratory events postimmunization, which peaks at 24 hours; (2) relative risk is predictable by severity of underlying conditions up to the time of immunization; and (3) postimmunization events may require transient increased monitoring or simple intervention, but will not have detrimental impact on infants’ clinical course. The glass is more than half full. The authors describe policy for immunization in their neonatal intensive care units that evolved from evidence of this study. Importantly, it applies to both infants being discharged and those staying in the hospital. With pertussis prevalent in all of our communities, their policies should become broad recommendations.
—Sarah S. Long, MD Page 58
Evidence of early lung involvement in CF Brody and colleagues studied chest high-resolution computerized tomography (HRCT) in cystic fibrosis (CF) patients with mild to moderate chest disease and relatively normal pulmonary function tests. The investigators identified a high incidence of regional bronchiectasis, air trapping, and mucous plugging in otherwise normal appearing lungs (Figure). These findings demonstrate that HRCT is a sensitive tool that will be valuable in understanding the natural history of this disease. In the accompanying editorial, McColley points out how these findings can be used in clinical trials that seek to alter the course of lung disease in its earliest stages.
Behavior, food, and obesity Clearly, dietary intake of calories is a major factor in the development of obesity in children. It seems likely that the interaction of a child and their parents around food is important, but the literature on this is not extensive. In this issue of The Journal, Agras et al examine factors that are related to the development of overweight. They followed children from birth to age 9 years and found that childhood overweight is strongly related to parental overweight. They also found evidence that persistent tantrums over food in preschool children is predictive of childhood overweight. This type of research may provide information on the children at highest risk to gain excess weight and also may help inform behavioral interventions that can prevent weight gain.
—Stephen R. Daniels, MD, PhD Page 20
Nutrition in children with sickle cell disease It is well known that vitamin A deficiency in children living in developing countries is associated with greater mortality and morbidity as well as poor growth and development. Unfortunately, growth failure and abnormalities in nutrient metabolism are also not uncommon in children with sickle cell disease in the United States. Schall et al have documented suboptimal vitamin A status (lower serum retinol levels) in a significant percentage of patients with sickle cell disease cared for in a tertiary care setting in Philadelphia. They further document that suboptimal vitamin A status in these children was associated with worse clinical status and outcomes—such as an increased number of hospitalizations, increased severity of anemia, and more frequent fever and pain events than children with sickle cell disease who had normal serum retinol levels. This data presents a compelling argument for us all to intensify our efforts to optimize the nutritional status of children with chronic disease to improve outcomes.
—William F. Balistreri, MD Page 99
—Thomas Green, MD Page 6 (editorial) Page 32 (article)
2A
July 2004
The Journal of Pediatrics
—Sarah S. Long, MD Page 58
Evidence of early lung involvement in CF Brody and colleagues studied chest high-resolution computerized tomography (HRCT) in cystic fibrosis (CF) patients with mild to moderate chest disease and relatively normal pulmonary function tests. The investigators identified a high incidence of regional bronchiectasis, air trapping, and mucous plugging in otherwise normal appearing lungs (Figure). These findings demonstrate that HRCT is a sensitive tool that will be valuable in understanding the natural history of this disease. In the accompanying editorial, McColley points out how these findings can be used in clinical trials that seek to alter the course of lung disease in its earliest stages.
Behavior, food, and obesity Clearly, dietary intake of calories is a major factor in the development of obesity in children. It seems likely that the interaction of a child and their parents around food is important, but the literature on this is not extensive. In this issue of The Journal, Agras et al examine factors that are related to the development of overweight. They followed children from birth to age 9 years and found that childhood overweight is strongly related to parental overweight. They also found evidence that persistent tantrums over food in preschool children is predictive of childhood overweight. This type of research may provide information on the children at highest risk to gain excess weight and also may help inform behavioral interventions that can prevent weight gain.
—Stephen R. Daniels, MD, PhD Page 20
Nutrition in children with sickle cell disease It is well known that vitamin A deficiency in children living in developing countries is associated with greater mortality and morbidity as well as poor growth and development. Unfortunately, growth failure and abnormalities in nutrient metabolism are also not uncommon in children with sickle cell disease in the United States. Schall et al have documented suboptimal vitamin A status (lower serum retinol levels) in a significant percentage of patients with sickle cell disease cared for in a tertiary care setting in Philadelphia. They further document that suboptimal vitamin A status in these children was associated with worse clinical status and outcomes—such as an increased number of hospitalizations, increased severity of anemia, and more frequent fever and pain events than children with sickle cell disease who had normal serum retinol levels. This data presents a compelling argument for us all to intensify our efforts to optimize the nutritional status of children with chronic disease to improve outcomes.
—William F. Balistreri, MD Page 99
—Thomas Green, MD Page 6 (editorial) Page 32 (article)
2A
July 2004
The Journal of Pediatrics