Monday, September 22, 2014

Two Pertussis Vaccine Studies Shed More Light on Benefits vs. Risks

By: Lewis First, MD, MS; Editor-in-Chief 
Photo via the National Institute for Health

It seems that no matter how many studies we publish on the advantages of vaccinating children against pertussis with the Tdap vaccine, some families ask for even more evidence—so this week, we provide two studies to add to the published benefits of this vaccine.

The first by Quinn et al. (doi:10.1542/peds.2014-1105) focuses on the benefits of “cocooning”, the process of vaccinating close adult contacts of newborn infants against pertussis during a pertussis epidemic in Australia. This was especially effective if parents were vaccinated pre-pregnancy.

The second by Vogt et al. (doi:10.1542/peds.2014-0723) debunks the belief that pertussis immunization in infancy may increase the chances of developing asthma by adolescence as measured by asthma medication use in adolescence. Again, the data convincingly shows no association between pertussis vaccine administered in 1993-1994 and asthma medication prescribed for the study cohort of more than 80,000 children 2008-2010.

If you are looking for two nice studies to further provide vaccine-hesitant parents of your patients with added reassurance that their infant should receive this important vaccine (and parents should get a booster if they haven’t gotten one recently), then take a deep breath. The findings these two studies cough up should help you make your case.

Related Reading:

Friday, September 19, 2014

Dosing Out Knowledge on the Medications Children Commonly Ingest Unsupervised

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by Charles Williams via Flickr
We know we try hard to encourage families to secure medications, both prescription and non-prescription, from their children—but ingestions can and do occur when children are unsupervised.

Just what gets ingested most commonly forms the focus of a study by Lovegrove et al. (doi: 10.1542/peds.2014-0840) reporting on adverse drug events recorded in a national surveillance database in regard to emergency hospitalizations. The high number of hospitalizations recorded in children under 6-years-old over the five years studied will make you then want to learn the specifics of what is being ingested to cause these inpatient admissions.

While certainly opioids and benzodiazepines lead the list, the high number more specifically of buprenorphine and clonidine ingestions also got our attention and should make you think about what you are doing to specifically inquire about these medications and what can be done to prevent unsupervised access to them by infants, toddlers, and preschoolers.

If I could write a prescription to insure you read about the findings in this study, I would—but since I cannot, I hope you will just take the initiative and link to this study to learn more. It’s an important study but also a bitter pill to swallow.

Related Reading:

Thursday, September 18, 2014

Delivering High-Quality Care to All Children Under the Affordable Care Act

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by 401(k)2013 via Flickr
If you’re practicing in the United States, chances are, you've wondered how the far-reaching requirements of the Affordable Care Act (ACA) will impact your patients’ health. This week we are fortunate to publish two very topical special articles worth your attention.

The first by Cheng et al. (doi: 10.1542/peds.2014-0881) focuses on the potential risks to children caused by the ACA’s turning over child and adolescent healthcare delivery decision making to individual states. The authors suggest the changes in the insurance market need to be careful not to worsen child health outcomes just because they don’t return the same immediate savings that some of the adult metrics and changes proposed by the ACA are intended to do—thus putting children at risk.

The second special article by Limper et al. (doi: 10.1542/peds.2014-1339) looks at the benefits of school-located vaccination programs for teens. To accommodate the ACA’s mandates to maintain quality and healthy outcomes while reducing costs of care, schools could be an ideal location to improve vaccination rates in our adolescent population.

So how concerned are you with the implications of the Affordable Care Act for children? Would you consider helping to establish a school-based vaccination program, or is that something your department of health should undertake. What effect would a school-based vaccination program have on your practice?

Read both of these timely articles and then inject your comments via response to this blog or on Facebook or Twitter.

Related Reading:

Wednesday, September 17, 2014

Psychological Health of Transgender Adolescents After Puberty Suppression, Gender Reassignment

Pediatrics Editorial Board Member Joann Schulte, DO, MPH, shares her expert perspective on a new article from our October issue. To learn more about Dr. Schulte, check out her bio on our Contributors page.

By: Joann Schulte, DO, MPH
Photo by Purple Sherbert Photography via Flickr

When I spent a year in Boston doing an editorial fellowship at a medical journal, I also saw adolescents at the Sidney Borum Clinic, on the edge of Chinatown. The clinic's location near the Boston Commons was one reason it had such a diverse patient population. Some were college students enrolled in the expensive, private colleges that surround the Commons. Others were the runaways and street kids who slept near the Boston’s Central Burying Ground, located alongside Boylston Street at the edge of Boston Common.

More than a few of the runaways were transgender adolescents who'd become estranged from their families. All adolescents face the tasks of figuring out who they are, but I thought the transgender adolescents had especially tough challenges. By definition, such adolescents have an assigned gender, but their experienced gender is different. Some of the adolescents can be diagnosed with gender dysphoria (GD). That means that a trans adolescent born a male considers himself to be of female gender and would be called a trans-woman. Likewise, a trans-man would have been considered female at birth but consider himself to be a man.

As any adolescent tries to figure out life and issues, he or she often finds their families are unable or unwilling to deal with the issues. To me, those stresses seemed worse for many of the transgender adolescents.

Some transgender adolescents have a better journey toward adulthood. Research published in the October issue of Pediatrics (doi: 10.1542/peds.2013-2958) describes one such group of 55 transgender adolescents followed and their successful transition to adulthood.

Dr. Annelou de Vies and her colleagues at VU University Medical Center in Amsterdam, Netherlands, assessed the psycho-social outcomes of adolescents who underwent treatment for puberty suppression followed by cross-sex hormones and gender reassignment surgery. The authors used the "Dutch model" for their treatment protocol. Under that protocol, adolescents undergo a comprehensive psychological evaluation with many sessions over a longer period of time. Those who are compliant with the protocol undergo puberty suppression, cross-sex hormones and gender reassignment surgery at the respective ages of 12, 16 and 18 years. Puberty suppression is only started when the adolescent reaches Tanner Stage 2 or 3.

Boston's Central Burying Ground, near where author
Joann Schulte's homeless, transgender teen patients
often slept. Photo by Joann Schulte. 
The researchers assessed the outcomes of the 55 subjects enrolled in the study and found they were functioning well as young adults. The study, while limited to one clinic, is considered important because it is the first long-term follow-up of a group that often has a tough, unsatisfactory transition to their adult years. The authors suggested that clinicians involved in the care of transgender adolescents need to realize both early medical intervention and a multi-disciplinary approach are needed for such a program.

The issue of transgender adolescents is one that many pediatricians are unfamiliar with and yet these adolescents represent a population who would be well-served by appropriate care. Finding that care and support can be difficult, but hopefully articles like this one by Dr. de Vies and colleagues can help.

Further Reading:

Tuesday, September 16, 2014

Acute Respiratory Tract Infections: Prevalence of Bacterial Etiology & Rates of Antibiotic Prescribing

Photo by Ajay Suresh via Flickr
By: Lewis First, MD, MS; Editor-in-Chief 

In this era of antimicrobial stewardship to prevent bacterial resistance, we are certainly cautious about empiric usage of antibiotics in a child with respiratory symptoms and signs, especially given the predominant viral etiology of these acute infections. Yet, are we actually being good stewards?

Kronman et al. (doi: 10.1542/ peds.2014-0605) ventured into answering this interesting question using a meta-analysis of prior studies on this question to determine acute respiratory tract infection (ARTI) rates for children, and a retrospective cohort as well, to determine antimicrobial prescribing rates. The study shares condition specific-prevalence rates and then antimicrobial prescriptions ordered. It will be no surprise that the use of antimicrobials exceeds the prevalence—but just how much is worth your attention.

So give this study your attention. You’ll find nothing to sneeze at when it comes to being an even better steward of antibiotic usage in your patients.

Related Reading:

Monday, September 15, 2014

Post-Vaccination Seizures: Though Infrequent, Why do They Occur?

Photo by the World Health Organization
By: Lewis First, MD, MS; Editor-in-Chief 

Much anti-vaccine spin has been attributed to the risk of seizures and subsequent epilepsy occurring after administration of some vaccines, and while ongoing epilepsy has not been proven to be a common complication after a post-vaccine seizure, one wonders why epilepsy occurs.

Is it something about the vaccine or is it something about the wiring of a child’s brain that predisposes it to an increased risk of ongoing seizure activity? As it turns out, the latter appears to be true—at least according to an article by Verbeek et al. (doi:10.1542/ peds.2014-0690) being early released online this week.

The investigators studied a cohort of almost 1,000 children in the Netherlands who experienced seizure activity 24 hours after getting an inactivated vaccine or five to 12 days after a live attenuated vaccine and followed those who were given the diagnosis of epilepsy to see if an etiology is found other than the vaccine for ongoing seizures. As it turns out, genetic and anatomic structural defects are identified in the majority of these children, thus making those without such predisposing factors at minimal if any risk for ongoing epilepsy after receiving a vaccine.

This study can be very useful in helping convince families to vaccinate their children in the absence of neurologic underlying abnormalities—but don’t take our word—read this study yourself and see if you don’t agree.

Related Reading:

Thursday, September 11, 2014

Do Your Food Allergic Patients Have Health Management Plans at School?

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by US Dept. of Agriculture
With the increasing prevalence of asthma and food allergies in our patients nowadays, the need for a health management plan in school is critical to insure their health and well-being. Yet how good are our schools at making sure health management plans are in place for asthma and food allergic patients? A new study we published this week is itching to tell you more.

Gupta et al. (doi:10.1542/peds.2014-0402) share with us the results of some demographic and health data from the Chicago Public School database. The results are disappointing and indicate only one in four students has an asthma action plan, and about 50 percent of students with food allergy had school management plans. Just who are the students with and without plans, and why are so few getting these plans instituted in schools are topics included in the Results and Discussion sections of this interesting paper.

Read it in detail and learn more so you can insure that your patients do have asthma and food allergy action plans in place as we enter a new school year.

Related Reading: