Medical Device-Associated Adverse Events: They Can and Do Happen

Our patients use a wide range of medical devices - ranging from contact lenses to wheel chairs to hypodermic needles. In an article released this week, Wang et al. (doi:10.1542/peds.2010-0528) used emergency department medical records from the National Electronic Injury Surveillance System to document the injuries attributed to medical devices used in 13 different specialties by type of device, type of injury, type of patient and outcome. Over a two year surveillance period, the authors estimate that the number of adverse events associated with these devices ranges from 113K to 183K –not a small number. This article is troubling and yet extremely informative, and reminds us to think about injury prevention for devices we do not usually associate with injury. Read this important injury article - I guarantee it won’t hurt a bit!

IVF and Cancer Risk for Progeny

Children born following in-vitro fertilization techniques (IVF) have been studied to understand whether or not they are at more risk for medical complications as they grow older than children conceived without IVF. Cancer risk has been studied, but until now no statistically significant risk has been identified, according to Källén et al. (doi:10.1542/peds.2009-3225) in an article we are releasing this week. Yet, in this new study, the authors do find a modest but statistically significant risk increase (1.42 with 95% Confidence Interval of 1.09-1.87). The authors studied more than 26000 children born after IVF over a 13 year period (1982-2005) using the Swedish Cancer Register to identify children with new onset of cancer. Of note, being born premature and experiencing birth asphyxia with low Apgar scores were identified as risk factors for cancer in the IVF population—thus making it difficult to truly prove cause and effect—but highlighting an association between increased risk of cancer and IVF that has not been reported prior to this study. We are sure that this article will generate responses from many experts in the field of cancer and reproductive endocrinology—so please give this article a read so you are familiar with just what this study says and doesn’t say about the risk of cancer in children born after IVF.

A Population-Based Look at Acellular Pertussis Vaccine and Risk of Seizures (or Lack Thereof)

While we are certainly familiar with reports of an association between whole-cell pertussis vaccine and rare but documented neurologic complications like seizures, Huang et al. (doi:10.1542/peds.2009-1496) study the association between acellular pertussis vaccine (DTaP) and seizures in an article released this week. Using a population-based methodology involving children age 6-23 months in seven managed care organizations, the authors find no increased risk of seizures in the four days surrounding a child getting the vaccine as well as in days outside of that time period. This information reassures us about the safety of this vaccine, in contrast to whole-cell pertussis vaccine, which was a major drawback to parents agreeing to have their child receive it. This study makes some great points that will be helpful to you in convincing families to consent for their child to receive this important series of vaccines.

A Presidential Look at Health Reform

This week we have asked our current AAP president, Dr. Judith (Judy) Palfrey, along with Mr. (esq!) Robert Hall (doi:10.1542/peds.2010-1600), to comment on what the new health reform legislation will mean to children and pediatricians. Their insight is well worth reading and calls for us all to become a part of the transformational changes in health care on behalf of the patients we serve. Read this commentary and then become a proactive part of the health reform process rather than have others do this in ways that are not beneficial to our patients or those of us who care for children.

As New Interns Start Their Residencies, Should Patients Worry? Not If They Are Newborns!

With summer here and the start of yet another academic year, residency training programs are welcoming new interns to their pediatric training programs. While some might think that having new interns covering patients after hours and weekends may mean more complications, Bell et al. (doi:10.1542/peds.2010-0456) prove otherwise in an interesting study of whether birth complications are higher in July and August. In addition, the authors look at the impact of resident-duty hours on morbidity and mortality of premature infants as well as whether birth at night or during the weekends makes a difference. The good news is that while trainees might be new and limited on experience by work-hour requirements, perhaps supervisors for these interns are well-experienced such that no effect of timing seems to be worsening outcomes for these very tiny infants. New house staff may enjoy reading this one and feel somewhat relieved, as will the attendings who supervise them, and most of all the parents fortunate enough to receive care from these enthusiastic rookies during the summer months.

Initiating Smoking in Early Adolescence: Corner Store Visits “Ad” Up

How often do you see cigarette advertising around the counters in neighborhood stores? Teenagers certainly do and Henriksen et al. (doi:10.1542/peds.2009-3021) decided to study whether the frequency of exposure to these stores and the amount of cigarette advertising in these stores leads to the onset of smoking in teens age 11 to 14 years. The results are disturbing and could lead to even more efforts to smoke out retail cigarette advertising in places that teens frequent—a task that is easier said than done. Start by educating your teen patients to be wary of what they don’t realize they are subconsciously seeing when they visit their local convenience stores.

Saying Good-bye to Bottles

How often do parents ask us about weaning their toddler from a bottle to a cup and how to speed up that process? This week, Maguire et al. (doi:10.1542/peds.2009-3583) report on the results of their office-based educational intervention for parents who bring their child in for a scheduled 9 month health maintenance visit. Parents were randomized to get either the intervention, which involved being given a sip cup and a 1 week protocol for bottle weaning or being given routine health maintenance. The results are quite striking: those that received the intervention had a 60% reduction in prolonged bottle use compared with children in the control group. For details on the intervention and other interesting results that derived from using this technique, check out this article so you are not bottle-necked the next time a parent needs a bottle-weaning plan that works.