March 5, 2014 Vol. V, Issue 10

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Maternity hospital "discharge bags" & breast feeding at 6 months.

Data from the Infant Feeding Practice Study II (IFPSII) was utilized to evaluate the effect of breast feeding at six months of age of 4 different "discharge bags" ("formula bag"; "coupon bag"; "breast feeding supply bag"; and "no bag"). In this study of 1,868 women, 81.4% received "formula bags", 4.2% received "coupon bags", 2.0% received "breast feeding supply bags", and 12.4% received "no bag".

There is a positive association (approximately 58%) between women who on discharge receive either "breast feeding supply bags" or "no bag" with exclusive breast feeding at 10 weeks and 6 months of age. "Formula bag" receipt on discharge leads to reduced breast feeding.

Journal of Human Lactation

Childhood effects of polycyclic aromatic hydrocarbon (PAH's - byproducts of fuel burning) inhalation during pregnancy & early childhood.

Natural crude oil and coal deposits contain significant amounts of PAH's and are among the most wide spread organic pollutants. High prenatal exposure appears, in the child, to be associated with a lower IQ, and childhood asthma.

A study of 257 children followed to age 4 years, who were exposed in utero transplacentally, and postnatally to airborne concentrations of 9 PAH compounds indicates that prenatal PAH exposure may precipitate and intensify early wheezing symptoms in young children exposed to PAH pollutants during childhood. Reducing childhood respiratory problems may require (among other strategies) reducing pre- and post-natal exposure to PAH's.

Pediatric Pulmonology

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-James Joyce

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Maternal diet during pregnancy & allergy/asthma in childhood.

1277 mother-child pairs were utilized to examine the associations between maternal intake of common childhood food allergens during the first and second trimester of pregnancy, and childhood allergy and asthma. At 7.9 years (mean) of age, childhood food allergy, asthma, allergic rhinitis and atopic dermatitis was assessed by questionnaire and serum-specific IgE levels.

Food allergies are common in childhood (5.6%) as is sensitization to at least 1 food allergen (28.0%). Increased maternal first trimester intake of peanuts results in a 47% reduction in the risk of childhood peanut allergy, while an increase in milk consumption significantly reduces the likelihood of asthma and allergic rhinitis. The chance of atopic dermatitis is reduced by an increased second trimester intake of wheat.

The Journal of Allergy and Clinical Immunology

Video Feature

Tympanocentesis in Children with Acute Otitis Media

via YouTube

Ear drops most effective for tympanostomy-tube ("Grommets") ottorrhea.

"Acute otitis media (AOM) is the most common childhood condition in the USA requiring medical treatment". Recurrent AOM appears to occur in the 20%-30% of the <10 year old pediatric population. Predominant organisms involved are antibiotic-resistant Strep. Pneumoniae and beta-lactamase-producing Hemophilus influenza.

In recurrent/chronic cases with effusions (>3 episodes of AOM in 3 months, or 4 per year) tympanostomy tubes appear to reduce recurrence rates. When acute ottorrhea occurs in these children, a 2 week course of antibiotic-glucocorticoid ear drops as opposed to oral antibiotics significantly improves the ottorrhea.

New England Journal of Medicine

White blood count (WBC) & negative appendectomy (NA) rate.

"NA rates in children remain above 3% nationwide".

A retrospective analysis of 847 appendectomies in which 2.6% were found to be pathologically normal, indicates that the absence of a high WBC (<9,000 uL) reduces the NA rate. Ongoing observation of children with acute appendicitis symptoms who have normal WBC's can reduce the likelihood of missing the diagnosis.

Pediatrics

Isotonic vs. Hypotonic maintenance IV fluids in hospitalized children.

An extensive search of a number of databases on the serum sodium effects of hypotonic vs. isotonic maintenance IV fluids, indicates (in 10 randomized control studies) that there is a significantly greater risk for hyponatremia in children receiving hypotonic maintenance fluids; - with no differences found in the risk for hypernatremia.

Pediatrics

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