March 8, 2017
Volume VIII |  Issue No. 10

Circulating antibody 1 and 2 years after vaccination with the 13-valent pneumococcal conjugate vaccine (PCV13) in preterm vs. term infants     
PCV13 is a 13-valent pneumococcal polysaccharide-protein conjugate given for the prevention of invasive pneumococcal disease and increases by 6 the serotypes previously covered by PCV7. It is recommended for infants/children 6 weeks to 71 months.

A study of the immune responses to PCV13 was undertaken in previously preterm (including subgroups) and term infants 1-2 years after vaccination. Data indicates that all preterm infant groups appear capable of generating an immune response likely to protect against invasive pneumococcal disease, and subsequent levels are not significantly different to those of the full term infant.

"Timely vaccination of infants against S. pneumoniae starting at the chronological age of 2 months" is needed regardless of gestational age or weight at birth. "A routine vaccination schedule should include a 3-dose primary series followed by a toddler dose at approximately 12 months".

Transfer of Montelukast into breast milk during lactation
Milk samples analyzed over a 12 hour period from 7 breast feeding mothers following the ingestion of 10mg Montelukast indicates that milk levels are low and infant exposure is well below therapeutic ranges. "Montelukast is probably safe to use in breast feeding mother".

Cardiac arrest and azithromycin
Azithromycin (an azalide-type of macrolide) is an antibiotic widely used to treat a number of bacterial infections. Common side effects include nausea (3%), vomiting, abdominal pain (3%) and diarrhea (5%), etc., few patients need to discontinue the drug because of them.

An increased cardiac arrest rate with azithromycin use has been described in adults; a study 82,986 children (median age 2.6 years) which examined cardiac arrest in children receiving azithromycin, penicillin or cephalosporin indicates no differences noted between the three antibiotics studied.

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Pertussis in young infants and children 

"Pertussis infection can be severe in unvaccinated infants". In spite of effective vaccines, reported pertussis cases in the USA continue to increase. Infant-specific risk and geographic data is limited.

Two large USA data bases were utilized to create a geographically diverse population to study pertussis in infants from birth to 12 months of age. The incidence rate appears to be 117.7 cases per 100,000 person-years, with infants 2-3 months old having the highest rates. Fall/winter, cough, apnea, acute upper respiratory tract infection and a wheezing-related illness are all associated with a greater likelihood of infant pertussis in the first year of life.

Most infant pertussis cases occur before DTaP has been started or completed. A reduced-antigen Tdap vaccine is recommended for all pregnant woman between 27-36 weeks gestation, during each gestation, as well as for all people in close contact with the infant.

Exclusive breast feeding does not appear to decrease the risk of pertussis in the infant.

Video Feature
5 Things You Should Know About Whooping Cough
5 Things You Should Know About Whooping Cough
Upper airway viruses and bacteria and clinical outcomes in children with acute cough 

A cohort study of 817 children <15 years (media age 27.7 months) followed for 28-days after presenting to Pediatric Emergency Department (ED) with an acute respiratory illness (ARI) where cough was a symptom, indicates that hospitalized children are more likely to have RSV A or B on nasal swab and N. catarrhalis is the only significant bacterium that is associated with persistent cough post-ARI.

The Cape Town Clinical Decision rule (CDR) for streptococcal pharyngitis (GAS) in children

A prospective cohort study of 997 children (of whom 21% had a positive GAS culture), 3-15 years of age, presenting to a Primary Care clinic with a complaint of sore throat examined the signs, symptoms of pharyngitis and their relationship to a positive GAS throat culture.

A 4-variable clinical decision rule of tonsillar swelling, and one of tonsillar exudate, no cough, no rhinorrhea is
Strep Throat in Kids
Strep Throat in Kids
associated with positive GAS cultures wit 83.7% sensitivity and 32.2% specificity. This appears to be better than any existing CDR for GAS Pharyngitis.

Risk factors, protective factors and current recommendations to reduce Sudden Infant Death Syndrome (SIDS)
In the USA, SIDS is the leading cause of death in infants 1 month-1 year of life ( highest risk period 2-4 months of age). Etiology appears multi-factorial; apparently it occurs in infants who have a genetic mediated impaired arousal response to hypercarbia and hypoxia during a critical developmental period, and are exposed to a negative external environment.

Known risk factors include: Prone and side-sleeping, soft-bedding, bed-sharing, inappropriate sleep surfaces, exposure to tobacco smoke and prematurity.

Protective factors include: Breast feeding, pacifier use, room sharing, and immunizations.

Recommendations include: Brest feeding, placing baby to sleep on his/her back, no pillows, blankets, stuffed animals or bumpers in the crib, avoid overheating, pacifier use, avoid cigarette smoking during and after pregnancy and the non-use of home monitors of other commercial devices marketed to prevent SIDS

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