Rotavirus in the healthcare setting and in the community: Opportunities for prevention

Rotavirus in the healthcare setting and in the community: Opportunities for prevention

This Month in THE JOURNAL OF PEDIATRICS October 2006 • Volume 149 • Number 4 Copyright © 2006 by Mosby, Inc. THE EDITORS’ PERSPECTIVES Prospective ...

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This Month in

THE JOURNAL OF

PEDIATRICS October 2006 • Volume 149 • Number 4 Copyright © 2006 by Mosby, Inc.

THE EDITORS’ PERSPECTIVES Prospective study on two continents implicates respiratory adenovirus but not rotavirus in intussusception

Rotavirus in the healthcare setting and in the community: Opportunities for prevention

Investigators from Australia and Vietnam performed a concurrent, prospective case-control study of intussusception in children ⬍2 years of age, and the results are published in this issue of The Journal. They used strict criteria for diagnosis and multiple tests on stool samples to identify bacteria, bacterial toxin, viruses, and protozoa. They documented incidence of intussusception in infants ⬍1 year of age in Vietnam (302/100,000) that was 4-fold higher than in Australia (71/100,000). Odds ratio for identifying a respiratory tract adenovirus in stool was 8.2 in cases vs. controls in Hanoi and 44 in Melbourne. Thirty-four percent of children with intussusception in Hanoi and 40% in Melbourne had adenovirus isolated from stool sample. On the other hand, rotavirus infection was not common in cases or controls and was not associated with intussusception at either site. This exquisite study answers one question soundly: natural rotavirus infection is not associated with intussusception in these developing and developed countries. What it doesn’t answer is why intussusception is more common in some countries (usually developing) than in others. Rate of adenovirus infection does not explain the difference. The incidence of adenovirus infection in Vietnamese infants was not greater than in Australian infants.

In this issue, Chandran et al provide results of the systematic review of published studies on nosocomial rotavirus infection, concluding that the burden is probably substantial but the studies are disappointing in design. O’Ryan and Matson provide a primer on incidence of rotavirus infection across countries, the safety and efficacy trials necessary for licensure of novel rotavirus vaccines and their results to date, and the cost-benefit of implementing universal vaccination.

—Sarah S. Long, MD page 452

—Sarah S. Long, MD page 441 (Chandran) page 448 (O’Ryan)

Apgar score imprecision The Apgar score is used worldwide to assess the newborn clinically and to document for the medical record the status of infants at birth. The limitations of the Apgar score to predict outcomes and the poor reproducibility of the score in clinical practice has been noted previously. Yet, the Apgar score is a rite of passage for the infant and a standard of care for the provider. O’Donnell et al have rigorously evaluated Apgar scoring using videos of infants taken at 5 minutes of age. Personnel from a tertiary neonatal unit scored the infant videos inconsistently, and the scores assigned clinically to the infants were at striking variance from the video scores. The simple truth is that Apgar scores are as often “influenced” by subjective factors as objective assessments. In an editorial, Keenan hopes that improved training will improve the consistency of Apgar scoring. Apgar scores at best force caregivers to “look at” the newborn at about 1 and 5 minutes to assess two essential physiological functions: heart rate and breathing. That is good for the infants.

—Alan H. Jobe, MD, PhD page 486 (article) page 440 (editorial)

The Journal of Pediatrics (ISSN 0022-3476) is published monthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010. Business and Editorial Offices: 1600 John F. Kennedy Blvd., Suite 1800, Philadelphia, PA 19103-2899. Accounting and Circulation Offices: 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Periodicals postage paid at New York, NY, and additional mailing offices. POSTMASTER: Send address changes to The Journal of Pediatrics, Elsevier Periodicals Customer Service, 6277 Sea Harbor Drive, Orlando, FL 32887-4800.

The Journal of Pediatrics

October 2006

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