*"It doesn't matter if the cat is black or white as long as it catches
mice."*

Deng Hsaio P'ing 1904-1997

This a page for sharing "what works" as seen in the published literature
as well as what is done at sites that care for American Indian/Alaskan
Native children. If you have any suggestions, comments or questions
please contact Steve Holve, MD, Chief Clinical Consultant in Pediatrics
at sholve@tcimc.ihs.gov

IHS Child Health Notes

January 2005

# Quote of the month

"*Less is more."*

Robert Browning

**Articles of Interest**

Managing Acute Gastroenteritis Among Children: Oral Rehydration,
Maintenance and Nutritional Therapy

MMWR November 21, 2003/52(RR16);1-16

<http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5216a1.htm>

-   A terrific summary of the development, physiology and clinical use
    of oral rehydration solution (ORS)

Oral rehydration therapy for diarrhea: an example of reverse transfer of
technology.\
Pediatrics. 1997 Nov;100(5):E10.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9347004>

-   Summary of a symposium held at Johns Hopkins in 1996

-   Reviewed demonstrated efficacy of ORS

-   Reviewed widespread and successful use of ORS around the world

-   Pointed out that ORS is still grossly underused in the United States
    because it is seen as too simple compared to intravenous fluid

Barriers to use of oral rehydration therapy.\
Pediatrics. 1994 May;93(5):708-11.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8165066>

-   Pointed out that barrier to use of ORS was often related not only to
    MD but to staff reluctance

-   Staff perceived frequent, small feedings of ORS as too time
    consuming

A comparison of rice-based oral rehydration solution and \"early
feeding\" for the treatment of acute diarrhea in infants.

J Pediatr. 1990 Jun;116(6):868-7

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2112187>

-   Feeding of milk and solids in the first 24 hours of illness was
    associated with decreased stool output and decreased length of
    illness

Oral rehydration therapy of infantile diarrhea: a controlled study of
well-nourished children hospitalized in the United States and Panama.\
N Engl J Med. 1982 May 6;306(18):1070-6.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7040950>

-   The first use of ORS in the United States was done in the Indian
    Health Service on the Whiteriver Apache Reservation in Arizona

-   Demonstrated that the "simpler technology" of ORS was effective and
    far easier and cheaper than intravenous therapy

# Editorial Comment

The development of ORS has probably saved more lives worldwide than any
other medical device in the past 30 years. It was rapidly adopted
overseas but there was initial resistance to its use in the United
States. Much of the resistance was based on the assumption that
intravenous fluid (more sophisticated and intensive technology) must be
better than something so simple as drinking salt and sugar water.
Numerous studies in the past thirty years have shown not only the
safety, but the superiority of ORS over intravenous therapy except in
cases of severe diarrhea or children with decreased levels of
consciousness.

The CDC article is a great summary for anyone not familiar with ORS; its
development, scientific rationale and clinical use. I would like to
point out that much of the early work on the use of ORS in this country
was done by Dr. Matu Santosham of Johns Hopkins University. Much of his
work was done with the Indian Health Service on the Whiteriver Apache
reservation in Arizona. Dr. Santosham has also done many other studies
of tremendous benefit to American Indians and Alaskan Natives through
his work on development of vaccines against Hemophilus influenza type B
and pneumococcus

**Recent literature on American Indian/Alaskan Native Health**

Racial/Ethnic Disparities in Neonatal Mortality -- United States, 1989
-- 2001

MMWR July 30, 2004;53:655-658

<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5329a2.htm>

-   Neonatal mortality accounts for two thirds of infant deaths in the
    U.S.

-   Neonatal mortality of AI/AN in 2001 was 4.1/1,000 which is equal to
    that of whites and below the US average of 4.5/1,000

-   AI/AN showed the greatest annual decrease in neonatal mortality of
    all ethnic groups during this time period with a decrease of 5% per
    year.

-   This improvement may be related to better access to neonatal
    intensive care for rural populations such as AI/AN

-   

# Meetings of Interest for Child Health

April 29-May 1, 2005\
Seattle, WA

Join the American Academy of Pediatrics and the Canadian Paediatric
Society, in cooperation with the Indian Health Service, for the first
International Meeting on Inuit and Native American Child Health.
Pediatricians, family physicians, residents, other health care
professionals, clinical researchers, state and federal public health
employees, child advocates, and other professionals and family
representatives dedicated to working with First Nations, Inuit, and
American Indian/Alaska Native (AI/AN) children should attend.
Participants will have the opportunity to share ideas on culturally
effective health care delivery models, present research findings, and
dialogue about strategies to improve the health of First Nations, Inuit,
and AI/AN children and communities.

<http://www.aap.org/nach/InternationalMeeting.htm>

This is the first international meeting on Indian/Inuit health with
sponsorship by both countries pediatric societies. It should be an
excellent forum for education and sharing of ideas.