Predictors of blood pressure in newborns

Evidence for reduction of antibiotic use across all outpatient care settings for young children The manuscript by Halasa et al provides convincing evidence from population-based data for a reduction in antibiotic prescribing practices across all three patient-care settings (hospital-based clinics, emergency departments, and office-based clinics/practices) during the period from 1994 to 2000. The data also expose several areas where targeted education of prescribing physicians and parents could have a major impact. For example, in 1998 to 2000, 21% of children with the diagnosis of undifferentiated upper respiratory illness were prescribed an antibiotic. —Sarah S. Long, MD Page 200

Prognostic factors for multiple sclerosis and disability Mikaeloff et al have studied the prognostic factors for second attacks and for disability in children presenting with acute CNS inflammatory demyelination. In this issue of The Journal, they show that 57% had a diagnosis of MS on followup after a mean time of 2.9 years, 29% had monophasic acute disseminated encephalomyelitis, and 14% had a single focal episode of demyelination. The rate of a second attack was higher in patients with an age of onset greater than 10 years, patients with an initial MRI suggestive of multiple sclerosis, and in those with optic nerve lesions. Occurrence of severe disability was associated with a polysymptomatic onset, sequelae after the first attack, further relapses, and progressive MS. Interestingly, they found that the risk of a second attack of CNS demyelination was reduced in children with mental status change and those with myelitis. —Robert W. Wilmott, MD Page 246

The Journal of Pediatrics

Quadrivalent human-bovine rotavirus vaccine Rotavirus continues to loom annually as a major contributor to childhood morbidity in the United States and mortality worldwide. With discontinuance of tetravalent rhesus reassortant rotavirus vaccine, there is a resurgence of research and development of additional vaccines. Clark et al report a randomized, double-blind, placebocontrolled trial of safety, immunogenicity, and single-season efficacy of a quadrivalent human-bovine reassortant rotavirus vaccine in ;400 infants administered three doses. In this small study, safety and immunogenicity were good. Vaccine efficacy against prevalent rotavirus strains was modest (74%) for moderate-to-severe gastroenteritis and good (100%) for severe disease, with wide confidence intervals (lower limits for both ;45%) around point estimates. Interestingly, the study also documents at least a low level of viral replication in the human host. —Sarah S. Long, MD Page 184

Predictors of blood pressure in newborns There has been interest in intrauterine factors that may affect long-term risk of cardiovascular disease. In this issue, Gillman et al evaluate pre- and perinatal factors that might influence blood pressure in newborns. They found that higher maternal age, maternal blood pressure, and birth weight were associated with higher systolic blood pressure in newborns. It is not currently known the extent to which these factors may influence blood pressure later in life and, ultimately, the risk of cardiovascular disease. These results, however, emphasize that maternal blood pressure and age, as well as other intrauterine factors, may adversely affect the cardiovascular system of the developing fetus. More studies will be important to better understand the mechanisms underlying these finding. —Stephen R. Daniels, MD, PhD Page 240

February 2004 3A