PEDIATRIC CARE
Late bedtimes associated with childhood weight problems
Bell JF, Zimmerman FJ. Shortened nighttime sleep duration in early life and subsequent childhood obesity. Arch Pediatr Adolesc Med. 2010;164(9):840-845.
Recent research supports the theory that too little sleep is associated with childhood overweight and obesity. A study published in the Archives of Pediatrics & Adolescent Medicine takes it one step further, stating that too little nighttime sleep is the cause of the problem. Daytime sleep such as naps is not sufficient.
The National Science Foundation's longitudinal Panel Survey of Income Dynamics Child Development Supplements examined two groups of children and their sleep habits, and whether they became overweight or obese. One group had 822 children in the United States ages 0 to 4, and the other had 1,108 ages 5 to 13. The study began in 1997 and follow-up occurred in 2002.
At baseline, the children in the younger group generally got 10 hours of nighttime sleep, with a 1-hour nap during the day. This was the same for this group at the 5-year follow-up. However, the group of older children started with approximately 9.7 hours of nighttime sleep, which decreased to 9.2 after 5 years.
After 5 years, 33% of the younger group and 36% of the older group were overweight or obese. The body mass index was at the 85th percentile for the younger children and 95th for the older. After factoring in the variables of age, sex, birth weight, presence of a father, hours of daily TV watching, birth order, and urban residence, it was determined that children in the bottom quartile for nighttime sleep duration were at a higher risk for significant weight increase.
Less daytime sleep did not appear to have any effect on weight at any age. This is because napping does not serve the same physiologic functions as nighttime sleep, and does not have any impact on the primary hormones that regulate weight and metabolism.
Pre- and postterm babies at higher risk for cerebral palsy
Moster D, Wilcox AJ, Vollset SE, Markestad T, Lie RT. Cerebral palsy among term and postterm births. JAMA. 2010;304(9):976-982.
Results from a large, Norwegian population-based study suggest that babies born either preterm or postterm are more likely to be diagnosed with cerebral palsy (CP).
This study analyzed the Medical Birth Registry of Norway from 1967 to 2001, identifying 1,682,441 singleton births of at least 37 weeks' gestation. Follow-up data were available through 2005. The data showed that the prevalence of children later diagnosed with CP was 1.25/1,000 for babies born at 38 weeks and 1.36/1,000 for those born at 42 weeks. These children were more likely to be males, with APGAR scores lower than 4, in addition to having:
* Less educated parents
* Complications during labor and delivery
* Single mother
* Lower mean birth weight
* Smaller head circumference.
In contrast, children born at 40 weeks had the lowest CP prevalence of 0.99/1,000.
One suggested explanation of these findings is that the presence of cerebral damage in the fetus actually causes pre- or postterm births because children with trisomy 18 are often born either early or late, and those with Down syndrome are typically born early.
PREOPERATIVE CARE
Children with respiratory issues at increased risk with anesthesia
Lerman J. Perioperative respiratory complications in children. Lancet. 2010;376(9743):745-746.
Findings from an Australian study support the practice of preanesthesia assessments to screen for preexisting respiratory conditions in children.
The intention of this research was to identify risk factors for perioperative respiratory adverse events in children. Data were collected via questionnaire on all children who underwent general anesthesia for surgical or medical interventions at a children's hospital in Australia from February 1, 2007 to January 31, 2008.
During the study period, approximately 15% of the children had perioperative respiratory adverse events. The incidences of complications were slightly higher in urgent procedures (17%) and slightly lower in elective procedures (14%). The questionnaires obtained at baseline revealed that a history of dry nocturnal coughing and wheezing during exercise, in addition to present or past eczema, increased the risk of respiratory adverse events during and after general anesthesia. Other noted risk factors included upper respiratory tract infection less than 2 weeks before the procedure, or having at least two family members with asthma or atopy, or who are smokers.
Because the study took place in only a single facility, its validity might be challenged and further, more widespread studies may be warranted.
Antibiotics should be given before C-section
ACOG Committee on Obstetric Practice. ACOG Committee opinion no. 465: antimicrobial prophylaxis for cesarean delivery: timing of administration. Obstet Gynecol. 2010;116:791-792.
Antimicrobial prophylaxis to reduce postoperative maternal infections is already commonly administered during C-sections. However, the timing of the start of the drug is crucial to the best preventive outcomes. A report in Obstetrics & Gynecology gives the most recent recommendation from the writing committee of the American Congress of Obstetricians and Gynecologists (ACOG). It is now strongly suggested that the antibiotics be administered 60 minutes before delivery, rather than the common practice of waiting until after clamping the umbilical cord to administer them.
The previous concern was that administering the drugs too early could have a negative effect on the neonate. However, after extensive research, the committee has determined that these concerns are unfounded. Additionally, administering the antibiotics at least 60 minutes before incision was found to result in significantly lower rates of endometriosis and much lower total maternal postoperative infection rates.
The ACOG recommends starting the antibiotics within 60 minutes of the start of the delivery. The only exceptions to this new recommendation are women who are already on appropriate antibiotics, as well as emergency cases. For emergency deliveries, the antibiotics should be administered as soon as possible.
ONCOLOGY
Telemonitoring cancer patients has many benefits
Kroenke K, Theobald D, Wu J, et al. Effect of telecare management on pain and depression in patients with cancer: a randomized trial. JAMA. 2010;304(2):163-171.
Cancer treatments are very taxing not just on the body, but also on the mental well-being of the patients who have to endure them. These patients often suffer with lingering physical pain, insecurities, and depression. A recent report in the Journal of the American Medical Association suggests that regular telemonitoring with a nurse-physician team, along with home symptom monitoring, can significantly reduce pain and depression.
Even though pain and depression are two of the most common cancer-related ailments, they often go undiagnosed and untreated, which negatively affects both the recovery and the quality of life of the patient. To determine whether the use of telemonitoring teams would alleviate these maladies, researchers conducted the randomized controlled Indiana Cancer Pain and Depression trial at 16 community-based urban and rural oncology practices in Indiana from March 2006 to August 2008, with follow-up through August 2009.
About half the patients were assigned to the telemonitoring team intervention, and the other half received usual care. After the first 12 months, the patients in the intervention group saw significant improvements in pain, depression, and health-related quality of life.
INFECTIOUS DISEASE
Prophylactic medication reduces corneal disease
Young RC, Hodge DO, Liesegang TJ, Baratz KH. Incidence, recurrence, and outcomes of herpes simplex virus eye disease in Olmsted County, Minnesota, 1976-2007: the effect of oral antiviral prophylaxis. Arch Ophthalmol. 2010;128(9):1178-1183.
Herpes simplex is a common cause of corneal disease, and is the leading infectious cause of corneal blindness in developed nations. To determine whether the use of oral prophylactic antiviral drugs would lower the instances of herpes-related corneal disease, researchers conducted a retrospective study of 32 years of patient data from Olmsted, Minnesota. The findings are reported in the Archives of Ophthalmology.
Over the 32 years of records, the researchers found records of 394 patients with ocular herpes infection. Oral antiviral medication was prescribed for 175 (44%) of these patients, who were then treated for approximately 2.8 years. The patients who did not take antiviral medication had a higher risk of recurrence:
* 9.4 times more likely to have a recurrence of epithelial keratitis
* 8.4 times more likely to have a recurrence of stromal keratitis
* 34.5 times more likely to have a recurrence of blepharitis or conjunctivitis.
Of these patients, 20 experience adverse outcomes such as vision loss or corneal perforation. It is the conclusion of the researchers that these serious adverse outcomes could have been prevented if the patients had taken oral antiviral medication.