bluuebunny/crossref_metadata_2025 huggingface dataset:
Twelve-Month Neurofunctional Assessment and Cognitive Performance at 36 Months of Age in Extremely Low Birth Weight Infants
Authors: Giannì Maria Lorella , Picciolini Odoardo , Vegni Chiara , Gardon Laura , Fumagalli Monica , Mosca Fabio
Published: November 2007

OBJECTIVE. The objective of this study was to investigate whether an early neurofunctional assessment (at 12 months’ corrected age) is predictive of cognitive outcome at 36 months of age in extremely low birth weight infants.

METHODS. We conducted an observational longitudinal study. Neurodevelopmental outcome by means of a neurofunctional assessment was evaluated at 12 months’ corrected age and 36 months’ chronological age in 141 extremely low birth weight children. Cognitive outcome was assessed with use of the Griffiths Mental Developmental Scale.

RESULTS. A significant association was found between the 12-month neurofunctional status and cognitive performance at 36 months. A higher general quotient on the Griffiths Mental Developmental Scale at 36 months was observed in infants who exhibited normal (score: ≤1) neurodevelopment compared with children who exhibited minor (score: 2) and major (score: ≥3) dysfunctions at the 12-month neurofunctional evaluation (99 ± 6.8 vs 85.3 ± 16.3 vs 57.3 ± 22.0). A score of ≥2 at the 12-month neurofunctional assessment, abnormal brain MRI results at term, and chronic lung disease remained predictive of cognitive delay at 36 months of age and also after adjustment for confounders.

CONCLUSIONS. The 12-month neurofunctional evaluation may be an additional useful clinical tool in predicting later cognitive outcome in extremely low birth weight children.
Out-of-Pocket Costs of Childhood Immunizations: A Comparison by Type of Insurance Plan
Authors: Molinari Noëlle-Angélique M. , Kolasa Maureen , Messonnier Mark L. , Schieber Richard A.
Published: November 2007

BACKGROUND. The “Guide to Community Preventive Services” strongly recommends reducing out-of-pocket costs to increase vaccination rates among children. Nevertheless, out-of-pocket expenses are still incurred during the receipt of childhood vaccines, vaccine administration, and associated well-child visits.

OBJECTIVE. Our goal was to estimate total and out-of-pocket costs of childhood immunization.

METHODS. We used the 2003 benefit-plan data for all 1217 private and public health plans registered in Georgia and the 2003 Advisory Committee on Immunization Practices recommended vaccine schedule to calculate costs to vaccinate children aged 0 to 5 years in 2003 dollars. By applying published estimates of health insurance enrollment of Georgia children, we calculated the total and out-of-pocket costs per child according to insurance status and race/ethnicity. Immunization coverage according to payer type was based on National Immunization Survey data.

RESULTS. Out-of-pocket costs ranged between $0 (Medicaid/Peachcare) and $652 (uninsured/Medicare). Most out-of-pocket costs were incurred during the first year of life. Up-to-date immunization status ranged from 63.7% for uninsured persons to 83.2% for privately insured persons. Up-to-date status was negatively correlated with out-of-pocket costs and the proportion of the population below 250% of the federal poverty level.

CONCLUSIONS. For most Georgia families, out-of-pocket expenses for childhood immunizations were low, favoring compliance with the recommended immunization schedule. However, families least able to afford the expense faced disproportionately high out-of-pocket costs. Out-of-pocket costs were inversely correlated with immunization coverage levels. Uninsured children whose families lived below 250% of the federal poverty level experienced the lowest immunization coverage levels. Immunization coverage through the Vaccines for Children Program and Medicaid/State Children's Health Insurance Programs should be promoted to minimize or eliminate out-of-pocket costs related to childhood immunizations, especially among children of low-income families.
Effect of Vaccine Shortages on Timeliness of Pneumococcal Conjugate Vaccination: Results From the 2001–2005 National Immunization Survey
Authors: Smith Philip J. , Nuorti J. Pekka , Singleton James A. , Zhao Zhen , Wolter Kirk M.
Published: November 2007

BACKGROUND. In September 2001 and again in February 2004, the Centers for Disease Control and Prevention announced shortages in the supply of the pneumococcal conjugate vaccine. We describe the effects of the pneumococcal conjugate vaccine shortages in 2001–2003 and 2004 on the timeliness of vaccination uptake for quarterly birth cohorts affected by the shortages.

METHODS. A total of 102478 19- to 35-month-old children were sampled by the National Immunization Survey between 2001 and 2005. Provider-reported vaccination histories were used to evaluate whether children had been administered ≥4 doses of pneumococcal conjugate vaccine by 16 months of age.

RESULTS. Among successive birth cohorts affected by the first shortage, estimated coverage of ≥4 doses of pneumococcal conjugate vaccine by 16 months declined significantly from 28.8% to 18.2%. As the first shortage ended, estimated coverage of ≥4 doses of pneumococcal conjugate vaccine by 16 months increased steadily with each successive birth cohort to 40.2%. From the onset of the second shortage, estimated coverage of ≥4 doses of pneumococcal conjugate vaccine by 16 months declined steadily and significantly to 13.7%. As many as 27% of parents whose child was affected by the first shortage reported that their child's vaccination provider had delayed the administration of pneumococcal conjugate vaccine doses. Of those parents who said that a pneumococcal conjugate vaccine dose was delayed and whose child was not administered ≥4 doses, 2.9% received a reminder notice from the provider to schedule administration of those delayed doses, and 0.2% had an appointment to receive those delayed or missed doses.

CONCLUSIONS. Vaccine shortages can result in delayed or missed doses and can have a dramatic impact on the vaccine coverage of children. Vaccination providers need to communicate effectively with parents so that doses that are delayed or missed during a vaccine shortage are administered when the shortage is resolved.
Current Definitions of Hypotension Do Not Predict Abnormal Cranial Ultrasound Findings in Preterm Infants
Authors: Limperopoulos Catherine , Bassan Haim , Kalish Leslie A. , Ringer Steven A. , Eichenwald Eric C. , Walter Gene , Moore Marianne , Vanasse Matthew , DiSalvo Donald N. , Soul Janet S. , Volpe Joseph J. , du Plessis Adré J.
Published: November 2007

OBJECTIVE. Hypotension is a commonly treated complication of prematurity, although definitions and management guidelines vary widely. Our goal was to examine the relationship between current definitions of hypotension and early abnormal cranial ultrasound findings.

METHODS. We prospectively measured mean arterial pressure in 84 infants who were ≤30 weeks’ gestational age and had umbilical arterial catheters in the first 3 days of life. Sequential 5-minute epochs of continuous mean arterial pressure recordings were assigned a mean value and a coefficient of variation. We applied to our data 3 definitions of hypotension in current clinical use and derived a hypotensive index for each definition. We examined the association between these definitions of hypotension and abnormal cranial ultrasound findings between days 5 and 10. In addition, we evaluated the effect of illness severity (Score for Neonatal Acute Physiology II) on cranial ultrasound findings.

RESULTS. Acquired lesions as shown on cranial ultrasound, present in 34 (40%) infants, were not predicted by any of the standard definitions of hypotension or by mean arterial pressure variability. With hypotension defined as mean arterial pressure < 10th percentile (<33 mmHg) for our overall cohort, mean value for mean arterial pressure and hypotensive index predicted abnormal ultrasound findings but only in infants who were ≥27 weeks’ gestational age and those with lower illness severity scores.

CONCLUSIONS. Hypotension as diagnosed by currently applied thresholds for preterm infants is not associated with brain injury on early cranial ultrasounds. Blood pressure management directed at these population-based thresholds alone may not prevent brain injury in this vulnerable population.
Is There Differential Retention of Children With Special Health Care Needs in the State Children's Health Insurance Program?
Authors: Macon Tamarie , Miller Jane E. , Gaboda Dorothy , Simpson Theresa , Cantor Joel C.
Published: November 2007

OBJECTIVE. The purpose of this work was to determine whether children with special health care needs in New Jersey's State Children's Health Insurance Program are less likely to become uninsured than children without special health care needs.

PATIENTS AND METHODS. We used the 2003 New Jersey FamilyCare Supplement to the New Jersey Family Health Survey. Children were randomly selected from the universe of children enrolled in New Jersey FamilyCare as of May 2002, and their families were surveyed during 2003 (N = 675). The Children With Special Health Care Needs Screener was used to identify 5 types of special health care needs. We estimated multinomial logistic regression models of final enrollment status according to the presence of ≥1 special health care need, controlling for demographic characteristics.

RESULTS. Roughly 1 of every 5 children in New Jersey FamilyCare had ≥1 special health care need. Older children and boys had greater odds of having special health care needs than others. Children with special health care needs had only one fourth the odds of becoming disenrolled and uninsured compared with children without special health care needs, even when controlling for age, gender, race/ethnicity, and insurance plan level. There was no difference in likelihood of finding other health insurance according to children with special health care needs status.

CONCLUSIONS. Children with special health care needs were more likely than children without such needs to be covered by health insurance at the time of the survey, either by retaining State Children's Health Insurance Program coverage or by finding other insurance. The higher retention of children with special health care needs in New Jersey FamilyCare is good news for families of these children and their advocates. However, higher health care costs for these children should be considered in federal and state budget planning for the State Children's Health Insurance Program.
Lipolysis and Insulin Sensitivity at Birth in Infants Who Are Large for Gestational Age
Authors: Ahlsson Fredrik S.E. , Diderholm Barbro , Ewald Uwe , Gustafsson Jan
Published: November 2007

OBJECTIVE. In addition to neonatal hypoglycemia, infants who are born large for gestational age are at risk for developing obesity, cardiovascular disease, and diabetes later in life. The aim of this study was to investigate glucose production, lipolysis, and insulin sensitivity in infants who were born large for gestational age to mothers without diabetes. The effect of glucagon administration on production of energy substrates was also investigated.

METHODS. Ten healthy term infants who were born large for gestational age to mothers without diabetes were studied 16 ± 8 hours postnatally after a 3-hour fast. Rates of glucose production and lipolysis were analyzed by gas chromatography–mass spectrometry following constant rate infusion of [6,6-2H2]glucose and [2-13C]glycerol. Insulin sensitivity was assessed by the Homeostasis Assessment Model. In 8 of the infants, the effect of an intravenous injection of 0.2 mg/kg glucagon was also analyzed.

RESULTS. Plasma glucose and glycerol averaged 3.8 ± 0.5 mmol/L and 384 ± 183 μmol/L, respectively. The glycerol production rate, reflecting lipolysis, was 12.7 ± 2.9 μmol/kg per min. Mean rate of glucose production was 30.2 ± 4.6 μmol/kg per min. Homeostasis Assessment Model insulin sensitivity corresponded to 82% ± 19%, β-cell function to 221% ± 73%, and insulin resistance to 1.3 ± 0.3. After glucagon administration, rate of glucose production increased by 13.3 ± 8.3 μmol/kg per min and blood glucose by 1.4 ± 0.5 mmol/L. Glycerol production decreased from 12.8 ± 3.0 to 10.7 ± 2.9 μmol/kg per min. Mean insulin concentration increased from 10.9 ± 3.0 to 30.9 ± 10.3 mU/L. There was a strong inverse correlation between the decrease in lipolysis and increase in insulin after glucagon administration.

CONCLUSIONS. Infants who are born large for gestational age show increased lipolysis and a propensity for decreased insulin sensitivity already at birth. The simultaneous increase in plasma insulin correlated strongly with the noted decrease in lipolysis, indicating an antilipolytic effect of insulin in these infants.
Hearing Loss, Quality of Life, and Academic Problems in Long-term Neuroblastoma Survivors: A Report From the Children's Oncology Group
Authors: Gurney James G. , Tersak Jean M. , Ness Kirsten K. , Landier Wendy , Matthay Katherine K. , Schmidt Mary Lou
Published: November 2007

OBJECTIVES. Among a cohort of long-term neuroblastoma survivors, our aims were to (1) assess the association between treatment intensity and parent-reported hearing loss in the child, (2) evaluate the strength of the association between hearing loss and parent-reported academic and psychosocial difficulties in the child, and (3) examine the association between parent-reported academic and psychosocial difficulties in the child and the child's self-reported quality of life.

PATIENTS AND METHODS. Through a mailed survey that included the Pediatric Quality of Life Inventory 4.0 and an outcomes questionnaire for parents, we evaluated 137 children (aged 8–17 years) who were previously enrolled in 1 of 2 Children's Cancer Group neuroblastoma clinical studies.

RESULTS. Childhood survivors of neuroblastoma who had prevalent hearing loss, as reported by their parents, had at least twice the risk of an identified problem with reading skills, math skills, and/or attention and a similarly higher risk of a general learning disability and/or special educational needs than did neuroblastoma survivors without hearing loss. Consistent with this finding, hearing loss was associated with a 10-point-lower mean score in the school-functioning scale of the Pediatric Quality of Life Inventory 4.0. We also observed a clear pattern of poorer self-reported quality-of-life scores among children with parent-reported academic and psychosocial problems compared with those without such problems, particularly with school functioning, even after controlling for reported hearing loss.

CONCLUSIONS. We found evidence that long-term neuroblastoma survivors, especially those with hearing loss, are at elevated risk for academic learning problems and psychosocial difficulties. We also found strong concordance between parent-reported learning problems in the child and indications of distress in the child's self-reported quality of life.
Does Current Asthma Control Predict Future Health Care Use Among Black Preschool-aged Inner-City Children?
Authors: Sharma Hemant P. , Matsui Elizabeth C. , Eggleston Peyton A. , Hansel Nadia N. , Curtin-Brosnan Jean , Diette Gregory B.
Published: November 2007

OBJECTIVES. Factors predictive of future asthma must be identified among young inner-city children, who suffer disproportionately from asthma. We investigated whether current asthma control predicts future asthma-related health care use among inner-city preschool-aged children with asthma.

METHODS. A total of 150 inner-city preschool-aged children with asthma were followed prospectively for 6 months. At baseline, symptom frequency and reliever-medication use were assessed to classify children into National Asthma Education and Prevention Program–derived control categories. Long-term controller-medication use was also assessed, as well as asthma-related health care use at baseline and at 3 and 6 months.

RESULTS. The mean age was 4.4 years, 92% were black, and 39% reported long-term controller use. At baseline, 37% were classified as having mild-intermittent, 17% had mild-persistent, 21% had moderate-persistent, and 25% had severe-persistent asthma control. Significant changes in asthma control were observed over time, including 46% of children originally categorized with mild-intermittent asthma who had worsened asthma control by 3 months. Asthma control significantly predicted future health care use 3 months later but not 6 months later. Multivariate analyses showed that, once control status was known, reported use of long-term controller medication added little additional predictive value.

CONCLUSIONS. Among inner-city preschool-aged children, significant fluctuations in asthma control occur as early as 3 months after assessment. Poor control but not long-term controller-medication use is an independent predictor of future asthma-related health care use at 3 months but is not significantly predictive of 6-month outcomes. Therefore, clinicians caring for inner-city children with asthma should consider reassessing asthma control at least every 3 months to identify those at highest future risk and to provide early interventions.
Obesity Is a Common Comorbidity in Children With Congenital and Acquired Heart Disease
Authors: Pinto Nelangi M. , Marino Bradley S. , Wernovsky Gil , de Ferranti Sarah D. , Walsh Amy Z. , Laronde Meena , Hyland Kristen , Dunn Stanley O. , Cohen Meryl S.
Published: November 2007

OBJECTIVES. Obesity may pose additional cardiovascular risk to children with acquired and congenital heart disease. Many children with heart disease are sedentary as a result of physician-, parent-, and/or self-imposed restrictions. The aim of this study was to evaluate the impact of the epidemic of obesity on children with heart disease.

PATIENTS AND METHODS. A cross-sectional review was performed of children evaluated in 2004 at 2 cardiology outpatient clinics. Differences in the prevalence of obese (BMI ≥ 95%) and overweight (BMI 85%–95%) children were compared with national data and healthy control subjects. Dictated letters were reviewed to determine whether obesity was discussed with referring practitioners.

RESULTS. Of 2921 patients assessed, 1523 had heart disease. Diagnostic subgroups included “mild” heart disease (n = 401), arrhythmia (n = 447), biventricular repair (n = 511), univentricular palliation (Fontan; n = 108), and heart transplantation (n = 56). More than 25% of the patients with heart disease were obese or overweight; the prevalence of obese and overweight children was significantly lower only in the Fontan group (15.9%). Pediatric cardiologists failed to document obesity or weight counseling in the majority of clinic letters.

CONCLUSIONS. Obesity is common in children with congenital and acquired heart disease. Pediatric cardiologists demonstrate inadequate communication regarding this problem to referring practitioners. Healthy-lifestyle counseling and routine exercise in children with heart disease may be underemphasized.
Aerobic Fitness Attenuates the Metabolic Syndrome Score in Normal-Weight, at-Risk-for-Overweight, and Overweight Children
Authors: DuBose Katrina D. , Eisenmann Joey C. , Donnelly Joseph E.
Published: November 2007

OBJECTIVE. The purpose of this study was to examine the combined influence of aerobic fitness and BMI on the metabolic syndrome score in children.

METHODS. A total of 375 children (193 girls and 182 boys) aged 7 to 9 years were categorized as being normal weight, at risk for overweight, and overweight on the basis of BMI and aerobic fitness (high or low based on median split) via a submaximal physical working capacity test. Participants were cross-tabulated into 6 BMI fitness categories. High-density lipoprotein cholesterol and triglyceride levels, homeostasis assessment model of insulin resistance, mean arterial pressure, and waist circumference were used to create a continuous metabolic syndrome score.

RESULTS. Both BMI and fitness were associated with the metabolic syndrome score. In general, the metabolic syndrome score increased across the cross-tabulated groups with the normal-weight, high-fit group possessing the lowest metabolic syndrome score and the overweight, unfit group possessing the highest metabolic syndrome score. Children who were at risk for overweight and had high fitness had a lower metabolic syndrome score compared with those at-risk-for-overweight, less-fit children, and the score was similar to that of the less-fit, normal-weight children. Furthermore, a high fitness level resulted in a lower metabolic syndrome score in overweight children compared with overweight children with low fitness.

CONCLUSIONS. High fitness levels modified the impact that BMI had on the metabolic syndrome score in children. Increasing a child's fitness level could be one method for reducing the risk of obesity-related comorbidities.
Treating Attention-Deficit/Hyperactivity Disorder With a Stimulant Transdermal Patch: The Clinical Art
Authors: Arnold L. Eugene , Lindsay Ronald L. , López Frank A. , Jacob Sharon E. , Biederman Joseph , Findling Robert L. , Ramadan Yaser
Published: November 2007

Stimulant medications (amphetamine and methylphenidate) are the best-documented treatments for attention-deficit/hyperactivity disorder, but their short pharmacokinetic and behavioral half-lives have historically produced irksome time-course effects. New drug-delivery systems designed to eliminate the need for frequent dosing include the methylphenidate transdermal system, in which the matrix acts as both the drug reservoir and the skin adhesive. The methylphenidate transdermal system patch, in contrast to long-acting oral preparations, requires a paradigmatic shift in clinical thinking, as well as refinement of clinical management skills. For dosing with the methylphenidate transdermal system patch, clinicians must think in terms of a retrievable form of drug delivery (in milligrams per hour) rather than a fixed nonretrievable dose (in milligrams per dose or milligrams per day). Clinicians and patients can determine the optimal clinical dose by controlling 2 variables: (1) patch size (controlling milligrams per hour) and (2) duration of patch wear. The new paradigm is worth learning, because the patch offers several advantages over oral preparations for some patients, chiefly individualized control over effect duration (determined by when the patch is applied in the morning and removed in the afternoon/evening). Taking full advantage of this treatment option requires educating the patient and parents regarding practical elements of daily use. These elements include patch-site selection, application techniques, management of wear time to optimize the daily time course of clinical benefits, and skin hygiene. This article summarizes clinical principles that physicians may find useful in managing this new addition to the attention-deficit/hyperactivity disorder treatment armamentarium.
Effects of Corticosteroid on Henoch-Schönlein Purpura: A Systematic Review
Authors: Weiss Pamela F. , Feinstein James A. , Luan Xianqun , Burnham Jon M. , Feudtner Chris
Published: November 2007

OBJECTIVE. No consensus exists among general pediatricians or pediatric rheumatologists regarding whether corticosteroid therapy ameliorates the acute manifestations of Henoch-Schönlein purpura or mitigates renal injury. Therefore, we sought to synthesize the reported experimental and observational data regarding corticosteroid use.

METHODS. We performed a meta-analysis based on a comprehensive review of the literature in the Medline database (1956 to January 2007) and the Cochrane Controlled Trials Register. On the basis of reported outcomes among patients with Henoch-Schönlein purpura who were treated at diagnosis with corticosteroids compared with patients treated with supportive care only, we calculated odds ratios for the resolution of abdominal pain, the need for surgical intervention secondary to severe pain or intussusception, the likelihood of Henoch-Schönlein purpura recurrence, and the development of transient or persistent renal disease.

RESULTS. Of 201 articles retrieved from the initial literature search, 15 were eligible for inclusion. Corticosteroid treatment did not reduce the median time to resolution of abdominal pain but did significantly reduce the mean resolution time and increased the odds of resolution within 24 hours. Early corticosteroid treatment significantly reduced the odds of developing persistent renal disease. In addition, although the results were not statistically significant, the prospective data suggest reduced odds of both surgical intervention and recurrence.

CONCLUSIONS. Corticosteroids, given early in the course of illness, seem to produce consistent benefits for several major clinically relevant Henoch-Schönlein purpura outcomes.
Infant-Feeding Methods and Childhood Sleep-Disordered Breathing
Authors: Montgomery-Downs Hawley Evelyn , Crabtree Valerie McLaughlin , Capdevila Oscar Sans , Gozal David
Published: November 2007

OBJECTIVE. Childhood sleep-disordered breathing has an adverse impact on cognitive development, behavior, quality of life, and use of health care resources. Early viral infections and other immune-mediated responses may contribute to development of the chronic inflammation of the upper airway and hypertrophic upper airway lymphadenoid tissues underlying childhood sleep-disordered breathing. Breastfeeding provides immunologic protection against such early exposures. Therefore, we sought to explore whether sleep-disordered breathing severity would differ for children who were breastfed as infants.

METHODS. The parents or guardians of 196 habitually snoring children (mean ± SD: 6.7 ± 2.9 years old) who were undergoing overnight polysomnography at Kosair Children's Hospital Sleep Medicine and Apnea Center completed a retrospective survey on the method(s) used to feed the child as an infant.

RESULTS. Among habitually snoring children, those who were fed breast milk for at least 2 months had significantly reduced sleep-disordered breathing severity on every measure assessed, including apnea-hypopnea index, oxyhemoglobin desaturation nadir, and respiratory arousal index. Breastfeeding for longer than 5 months did not contribute additional benefits.

CONCLUSIONS. Our findings support the notion that breastfeeding may provide long-term protection against the severity of childhood sleep-disordered breathing. Future research should explore mechanism(s) whereby infant-feeding methods may affect the pathophysiology of development of childhood sleep-disordered breathing.
Pediatricians’ Perspectives Regarding Community Child Health: Training, Involvement, and Expectations According to Age
Authors: Minkovitz Cynthia S. , O'Connor Karen G. , Grason Holly , Palfrey Judith S. , Chandra Anita , Tonniges Thomas F.
Published: November 2007

OBJECTIVE. There are increasing opportunities for pediatricians to promote children's health through community involvement during and after residency training. Little is known about whether younger relative to established pediatricians have different experiences regarding community activities. In this study we examined whether pediatricians’ training, perspectives, and involvement in community activities vary by age.

METHODS. Eight hundred seventy-six pediatricians participated in a national, random-sample, mailed periodic survey of US members of the American Academy of Pediatrics in 2004 (response rate: 58%). χ2 statistics and median tests were used to measure associations of age (≤34, 35–39, 40–50, and ≥51 years) with training, perspectives, and involvement.

RESULTS. Younger pediatricians reported more training in community child health during and before residency but were less likely to be involved currently (37.9% for ≤34 years, 44.4% for 35–39 years, 46.2% for 40–50 years, 48.3% for ≥51 years). They were more likely to report that their current involvement was too little versus just right or too much (81.3%, 73.5%, 60.7%, and 47.1%, respectively). Younger pediatricians were more willing to spend ≥1 hour/month on community child health activities (95.0%, 91.2%, 89.7%, and 85.4%, respectively). Younger versus older pediatricians were more likely to sense moderate or greater responsibility for improving children's health in their community (83.6%, 77.2%, 76.7%, and 70.2%, respectively) and expected their community work to increase during the next 5 years (80.0%, 67.5%, 59.7%, and 40.1%, respectively). Age findings persisted when adjusted for gender.

CONCLUSIONS. Although practice constraints may limit community involvement, younger pediatricians anticipated growing participation in community activities. Longitudinal studies are needed to determine whether such expectations are realized.
Racial Disparities in Childhood Asthma in the United States: Evidence From the National Health Interview Survey, 1997 to 2003
Authors: Virnig Christine , Gern James E.
Published: November 2007

McDaniel M, Paxson C, Waldfogel J. Pediatrics. 2006;117(5). Available at: www.pediatrics.org/cgi/content/full/117/5/e868

PURPOSE OF THE STUDY. To evaluate the differences in asthma prevalence and emergency department (ED) visits between non-Hispanic black and white children, as well as the factors that might explain those differences.

STUDY POPULATION. Cross-sectional study of 14 487 non-Hispanic black children and 49 042 non-Hispanic white children interviewed from 1997 to 2003 as part of a large, nationally representative sample.

METHODS. Information was collected as part of the National Health Interview Survey, a cross-sectional, in-person, household interview administered annually by the Centers for Disease Control and Prevention. Data were obtained on lifetime asthma, current asthma, ED visits in the previous year, age, gender, birth weight, family income, rural versus urban environment, type of health insurance, accessibility of routine medical care, and maternal history of asthma, smoking, depression, and BMI.

RESULTS. Being black was associated with a 20% greater likelihood of having current asthma as well as a greater likelihood of having gone to the ED for asthma treatment in the past year. Furthermore, this increased asthma risk was greatest in younger children and remained even after child and family characteristics were controlled for.

CONCLUSIONS. Black children were more likely to have asthma and to have experienced ED visits in the past year than were otherwise comparable white children; these racial disparities could not be completely explained by differences in child or family characteristics.

REVIEWER COMMENTS. It has long been recognized that asthma, while affecting individuals of all ages, races, ethnicities, and incomes, disproportionately afflicts black and poor children. Past studies have identified multiple contributors to asthma prevalence and severity, including environmental factors, birth weight, socioeconomic and demographic differences, access to medical care and health insurance, and parental history. Because many of these factors are closely associated with race, especially in inner-city environments, it has been difficult to determine if race is independently associated with asthma. This study used a nationally representative sample of children to determine which, if any, of these social and environmental influences could explain the discrepancy in asthma prevalence between black and white children. The results indicate that the difference in asthma prevalence between black and white children remains significant, even when possible confounding variables are taken into account. This study will provide a baseline for tracking asthma trends in the future and should stimulate research aimed at determining the reasons for this increased asthma susceptibility.
Allergy Immunotherapy as an Early Intervention in Patients With Child-Onset Atopic Asthma
Authors: Wang Julie
Published: November 2007

Nagaya H, Maren S, Nagaya N. Int Arch Allergy Immunol. 2006;139:9–15

PURPOSE OF THE STUDY. In patients with bronchial asthma, an effective treatment is required at early stages of the disease to prevent irreversible structural changes of the airways. The objective of this study was to evaluate the beneficial effects of routine immunotherapy as an early intervention on forced expiratory volume in 1 second (FEV1) in patients with childhood-onset atopic asthma.

STUDY POPULATION. Forty-three patients with child-onset atopic asthma who had received regular immunotherapy injections and periodic FEV1 measurements.

METHODS. Beneficial effects of successful immunotherapy on FEV1 were analyzed retrospectively in 43 unselected patients who received standard subcutaneous immunotherapy with periodic FEV1 measurements and became asymptomatic.

RESULTS. Although there was no significant correlation between the duration of asthma symptoms before immunotherapy and the changes in FEV1 before and after immunotherapy in the 43 unselected patients, there was a significant inverse correlation between these 2 parameters in 23 patients whose asthma duration was <20 years. Because the FEV1 increased after immunotherapy in all 14 patients whose asthma duration was <5 years, the 43 patients were divided into group, 1 including these 14 patients, and group 2, including 29 patients whose asthma duration was >5 years. The FEV1 decreased in 7 of the 29 asymptomatic patients in group 2. There was no difference in the initial FEV1 between the 2 groups, but the final FEV1 and the mean of the average increase in FEV1 per year during immunotherapy were significantly higher in group 1 than in group 2.

CONCLUSIONS. Immunotherapy should be started as early as possible at the youngest age to increase a beneficial effect of successful immunotherapy on FEV1.

REVIEWER COMMENTS. Specific immunotherapy has demonstrated clinical benefits for allergic asthma in double-blind, placebo-controlled trials. The results from this study indicate that immunotherapy can modify the natural progression of asthma by improving lung function. Furthermore, early intervention leads to a greater improvement in FEV1, which suggests that early use of immunotherapy should be considered in allergic asthmatic patients. Additional studies will be needed to assess whether this improvement in lung function persists after the discontinuation of immunotherapy.
Accidental Ingestions in Children With Peanut Allergy
Authors: Davis Karla L. , Mikita Cecilia P.
Published: November 2007

Yu JA, Kagan R, Verreault N, et al. J Allergy Clin Immunol. 2006;118:466–472

PURPOSE OF THE STUDY. To determine the current frequency of accidental exposures occurring in peanut-allergic children and identify factors associated with exposure.

STUDY POPULATION. Children 4 years of age and older, who were diagnosed with peanut allergy at the Montreal Children's Hospital Allergy Clinic (Quebec, Canada) between January 2000 and February 2005.

METHODS. Parents of children with peanut allergy completed questionnaires about accidental exposure to peanut occurring over the preceding year. Details of the accidental exposure requested included age of the child, quantity and type of food ingested, location of ingestion, allergic symptoms, onset and duration of reaction, and treatment administered. Medical charts were reviewed to confirm eligibility criteria, demographic information, atopic history, family history, details of the initial and most severe accidental reaction, number of previous accidental reactions, and previous use of epinephrine.

RESULTS. A total of 252 (57.7%) of 437 parents of children with peanut allergy completed a questionnaire. Chart review allowed comparison between participants and nonparticipants. Of participants, 62% were boys and the mean age was 8.1 years. The mean age at diagnosis was 2 years. There were 35 accidental exposures among 29 children over a period of 244 patient-years (annual incidence rate: 14.3%). Reactions were mild (15), moderate (16), and severe (4). Of the 20 children with reactions that were moderate to severe, only 4 received epinephrine. Eighty percent of children attended schools that prohibit peanut; only 1 accidental exposure occurred at school. Neither univariate nor multivariate logistic regression analyses identified any clinically important associations with inadvertent exposure to peanut.

CONCLUSIONS. Children with peanut allergy residing in Quebec had an annual incidence rate of accidental exposure to peanut of 14.3%. This finding is substantially lower than previously reported incidence rates. Predictors of accidental exposure could not be identified.

REVIEWER COMMENTS. In this study, only 1 of 35 accidental exposures occurred in school. Coupled with the lower incidence of accidental exposures reported in this study, these data may suggest that enhanced education about and awareness of peanut allergy in the public sector have been effective. The majority of accidental exposures occurred at the patient's home (14) or the home of a friend or relative (12), which underscores the critical importance of education of the family, friends, and caregivers of children with peanut allergy.
Grass Pollen Immunotherapy as an Effective Therapy for Childhood Seasonal Allergic Asthma
Authors: Andrews Timothy , Banks James R.
Published: November 2007

Roberts G, Hurley C, Turcanu V, Lack G. J Allergy Clin Immunol. 2006;117:263–268

PURPOSE OF THE STUDY. There is abundant evidence to support the use of specific immunotherapy (SIT) in the treatment of allergic rhinoconjunctivitis. Studies that have looked at the role of SIT for the treatment of seasonal allergic asthma are lacking. This study evaluated the safety and effectiveness of SIT for the treatment of seasonal allergic asthma in children.

STUDY POPULATION. A total of 39 of 161 screened subjects 3 to 16 years old were enrolled onto the study from the allergy clinic at St Mary's Hospital (London, United Kingdom). All of them had history of grass-pollen–induced asthma that required 200 μg of inhaled beclomethasone (or equivalent) daily. All subjects had a positive skin-prick–test response: a positive specific immunoglobulin E level (Pharmacia CAP) to a relevant grass pollen (Phleum pratense). Subjects also had a positive conjunctival provocation test. Subjects were excluded if they previously had been treated with grass-pollen immunotherapy or had a history of perennial asthma requiring inhaled corticosteroids, significant perennial allergic rhinitis, or sensitization to a pet present in the household.

METHODS. The study was a single-center, randomized, double-blind, placebo-controlled study over 2 successive pollen seasons. Subjects were randomly assigned to receive SIT or placebo. The primary outcome was the asthma-symptom–medication score during the second pollen season. Secondary outcome measures included lung function, cutaneous, conjunctival, and bronchial allergen reactivity, and both exhaled nitric oxide and sputum eosinophil levels.

RESULTS. The use of SIT was associated with a substantial reduction in asthma-symptom–medication score as compared with placebo (P = .04). There was significant reduction in cutaneous (P = .002), conjunctival (P = .02), and bronchial (P = .01) reactivity to allergen after SIT compared with placebo. Children in the 2 groups had similar levels of airway inflammation, although less inhaled steroids were required for those in the active group. No serious adverse events were reported, and no subjects withdrew because of adverse events.

CONCLUSIONS. SIT is effective and well tolerated in children with seasonal allergic asthma to grass pollen.

REVIEWER COMMENTS. There are limited studies that have demonstrated the efficacy of immunotherapy for treatment of asthma. On the basis of the complex nature of asthma and realizing that multiple phenotypes exist, it is understandable that there is difficulty in evaluating SIT for asthma. This study provided encouraging evidence for the role of SIT in the treatment of seasonal allergic asthma. Unfortunately, the majority of allergic patients are sensitized to multiple allergens, and symptoms are typically triggered by several different allergens.
Peanut Allergen Exposure Through Saliva: Assessment and Interventions to Reduce Exposure
Authors: Nowak-Wegrzyn Anna
Published: November 2007

Maloney JM, Chapman MD, Sicherer SH. J Allergy Clin Immunol. 2006;118:719–724

PURPOSE OF THE STUDY. To determine the time course of major peanut allergen (Arah1) persistence in saliva after ingestion of peanut butter and to evaluate mouth-cleansing interventions to reduce salivary peanut allergen.

STUDY POPULATION. A convenient sample of adults without peanut allergy.

METHODS. Thirty-eight individuals ingested 2 tablespoons of peanut butter, and saliva was collected at various time points. At another time, samples were collected after 5 interventions (brushing teeth, brushing and rinsing, rinsing, waiting then brushing, waiting then chewing gum). Detection of Arah1 was performed by a monoclonal-based enzyme-linked immunosorbent assay (detection limit: 15–20 ng/mL).

RESULTS. Salivary peanut allergen Arah1 varied considerably immediately after ingestion but included levels expected to invoke reactions (as much as 40 μg/mL). Most (87%) subjects with detectable peanut after a meal had undetectable levels by 1 hour with no interventions. None had detectable levels several hours later after a peanut-free lunch. This result indicates (with 95% confidence) that 90% would have undetectable Arah1 in saliva under these circumstances. All of the immediate interventions reduced salivary Arah1, in some cases by >95%, but Arah1 remained detectable in ∼40% of the samples (although typically below thresholds reported to induce reactions).

CONCLUSIONS. Patients with peanut allergy require counseling regarding the risks of kissing or sharing utensils, even if their partners have brushed their teeth or chewed gum. Advice to reduce risks, although not as ideal as total avoidance, includes waiting a few hours plus eating a peanut-free meal.

REVIEWER COMMENTS. Passionate kissing was reported to cause allergic reactions to foods, including anaphylaxis. Waiting several hours and ingesting a peanut-free meal were more effective at reducing salivary peanut protein concentration than simple, immediate interventions. Teenagers with peanut and other food allergies need to be reminded that to stay safe, restraint and patience are necessary even in the most intimate situations.
Long-term Follow-up of Atopic Dermatitis: Retrospective Analysis of Related Risk Factors and Association With Concomitant Allergic Diseases
Authors: Spergel Jonathan M.
Published: November 2007

Ricci G, Patrizi A, Baldi E, Menna G, Tabanelli M, Masi M. J Am Acad Dermatol. 2006;55:765–771

PURPOSE OF THE STUDY. To examine the natural course of atopic dermatitis (AD), the factors influencing its persistence, and the appearance of other allergic diseases with particular focus on asthma and the presence of specific immunoglobulin E (IgE) at first observation.

STUDY POPULATION. The prospective study included 252 children between 6 and 36 months of age with AD noted on first clinical visit to a pediatric or dermatology department in Bologna, Italy.

METHODS. Patients were followed for 13 to 22 years. AD diagnosis was based on the criteria of Hanifin and Rajka. Allergic rhinitis and asthma were determined by physician diagnosis. AD severity was based on validated clinical score. Total IgE and specific IgE to various allergens (cow's milk, egg white, soybean, wheat, peanut, nut, codfish, tomato, grass pollens, house dust mites, cat dander, horse dander, dog dander, and Alternaria) were determined at baseline. For radioallergosorbent test (RAST) testing, ≥1 was considered positive for inhalant allergen and ≥2 was considered positive for food allergies.

RESULTS. AD had completely resolved in 124 cases (60.5%). Other allergic manifestations that appeared included asthma in 70 cases (34.1%) and rhinoconjunctivitis in 118 cases (57.6%). Generally, the average age of patients who recovered from AD was higher in severe AD (6.0 ± 3.5 years) than in its moderate or mild forms (5.8 ± 4.5 and 5.5 ± 3.9 years, respectively). This phenomenon was particularly evident in children with egg sensitization, who showed a longer persistence of the condition (P < .02). The initial severity score of AD (P < .001) or egg sensitization (P < .007) was significantly related to the later development of asthma. Egg sensitization also predicted rhinitis (P < .05). A retrospective analysis of related risks factors and their association with concomitant allergic diseases showed that the egg sensitization, severity of AD, and onset of allergic rhinitis were positively related to the occurrence of asthma.

CONCLUSIONS. AD severity and the course of AD are significantly related to egg sensitivity. AD severity and egg allergy are risk factors for asthma.

REVIEWER COMMENTS. This article provides further evidence of the “atopic march” of AD to asthma. However, it is important to realize that a positive IgE test is simply evidence for sensitization, not confirmed clinical allergy. Also, the diagnosis of asthma and allergic rhinitis was not clearly defined. Nevertheless, patients with severe AD, egg sensitization, and allergic rhinitis are at higher risk for progressing in the atopic march to asthma and allergic rhinitis.
Exhaled Nitric Oxide in Asthma: Variability, Relation to Asthma Severity, and Peripheral Blood Lymphocyte Cytokine Expression
Authors: Humayun Fawwaz , Leo Harvey L.
Published: November 2007

Shome GP, Starnes JD 3rd, Shearer M, et al. J Asthma. 2006;43:95–99

PURPOSE OF THE STUDY. To measure and compare exhaled nitric oxide (eNO) levels in patients with asthma and healthy volunteers, to study peripheral blood lymphocyte cytokine expression, and to study the relationship between eNO and intracellular cytokine expression.

STUDY POPULATION. A total of 36 subjects were enrolled onto the study, with 19 asthmatic patients and 17 healthy control subjects.

METHODS. At least once per week for 4 weeks, patients with asthma visited the clinic and underwent a detailed history, physical examination, spirometry, and eNO-level measurement. These patients were maintained on established pharmacologic therapy regimens. A blood sample was taken and analyzed by flow cytometry. eNO was measured by using an NO analyzer. Univariate linear regression analysis was used to determine correlations between continuous variables and eNO concentrations.

RESULTS. eNO levels were significantly elevated in patients with moderate-to-severe asthma compared with those in healthy subjects (18.53 ± 2.00 vs 5.90 ± 0.90 ppb). With treatment, eNO levels in patients with moderate-to-severe asthma decreased to levels near those of the healthy subjects by 4 weeks. Interferon γ expression was decreased in patients with moderate-to-severe asthma. An elevated eNO level was also associated with decreased interleukin 4 and interleukin 13 cytokine expression in CD8 lymphocytes.

CONCLUSIONS. eNO levels were elevated in patients with moderate-to-severe asthma. With 4 weeks of treatment, eNO levels in patients with moderate-to-severe asthma were no different from those in the control subjects. There was decreased interferon γ expression by the CD4- and CD8-positive peripheral blood lymphocytes of patients with moderate-to-severe asthma. Elevated eNO levels were associated with suppression of both T-helper 1 and 2 cytokine expression by the peripheral blood lymphocyte, suggesting a systemic immunomodulatory effect.

REVIEWER COMMENTS. This study adds to the growing information on the utility of eNO levels to monitor asthma-treatment response. It demonstrates how eNO can be used to measure the reduction in airway inflammation as a response to treatment primarily in patients with moderate-to-severe asthma. At this point, it is not clear what the implications are of the association between elevated eNO levels and cytokine suppression.