Pediatric Annals

Trend Watch 

Trend Watch

Abstract

Premature infants had a high rate of group B streptococcus infections, likely acquired from their mothers, according to results of a recent study.

Alberto Berardi, MD, of the Azienda Osspedaliero-Universitaria Proclinico in Italy, and colleagues evaluated group B streptococcus (GBS) late-onset disease in about 100 infants between 2003 and 2010. The researchers also collected cultures from the mothers’ breast milk and rectovaginal cultures to determine whether infected breast milk may have contributed to the babies’ GBS disease.

The rate of GBS late-onset disease in full-term neonates was 0.32 per 1,000 live births. The most common presentation of the late-onset disease was meningitis, sepsis, or focal infection. Sixty-four percent of 47 mothers were positive for GBS at the rectovaginal site, and 6% of 53 mothers had GBS mastitis, according to the researchers. In some cases, the mother’s breast milk was infected even when the mother did not have mastitis.

Although “ingestion of contaminated breast milk can be a route of LOD transmission … it is also possible that women with antenatal negative GBS cultures were colonized at delivery, vertically transmitted the GBS to the neonatal upper airway, and the mother’s milk ducts were colonized by the baby,” Morven S. Edwards MD, Professor of Pediatrics at Baylor College of Medicine, Houston told Pediatric Annals. “The authors’ finding that 68% of cases occurred among term and another 9% in near-term infants suggests that a GBS glycoconjugate vaccine would prevent most LOD, regardless of mode of acquisition and clinical presentation.”

Intrapartum antibiotic exposure also was “significantly associated with mild (12 of 22) rather than severe (11 of 45; P = .03) [late-onset disease],” the researchers wrote.

Berardi A. Pediatrics. 2013;doi:10.1542/peds.2012-1231.

Disclosure: Berardi reports no relevant financial disclosures.

Disclosure: Edwards is a consultant to and receives research funding from Novartis Vaccines & Diagnostics.

Pediatricians should advocate that there be a school physician in every school district, and a nurse in every school building, according to a recent policy statement from the American Academy of Pediatricians.

Such coverage would be “a wonderful way to develop effective alliances among the medical home, the educational home and the family home,” Cynthia DiLaura Devore, MD, chair of the AAP’s School Health Committee, told Pediatric Annals. “A school physician enhances the important integration of health and education for all children within the school setting and especially assists children with special health care needs by furthering the medical home’s goals.”

In the AAP policy statement, the council said community pediatricians should work in tandem with school health professionals to develop sound health policies, and to consider becoming the school’s physician. According to the Committee, a school physician should be board-certified in pediatrics or should be a physician with an expertise in pediatrics.

The Committee stated that school physicians can help to improve student attendance by assisting in the management of chronic medical conditions such as asthma and diabetes, and by monitoring chronic school absenteeism. School physicians also can help decrease district liability and improve safety by developing sound protocols to manage concussions, climate extremes, and emergent situations wrote the committee.

AAP Council on School Health. Pediatrics. 2013;131:178–182.

Disclosure: The researchers report no relevant financial disclosures.

Recipients of hepatitis B vaccination at infancy may lose their hepatitis B surface antigen immunological memories by adolescence, according to recently published data.

Researchers tested 8,733 Taiwanese high school students born between July 1987 and July 1991 for hepatitis B surface antigen (HBsAg) and antibodies to HBsAg (anti-HBs). Most participants (n = 7,914) had documented hepatitis B immunizations before age 3 years, including 381 who received hepatitis B immunoglobulin (HBIG).

HBsAg positivity was detected in 1.9%…

Mothers Common Infection Source of Premature Infant GBS

Premature infants had a high rate of group B streptococcus infections, likely acquired from their mothers, according to results of a recent study.

Alberto Berardi, MD, of the Azienda Osspedaliero-Universitaria Proclinico in Italy, and colleagues evaluated group B streptococcus (GBS) late-onset disease in about 100 infants between 2003 and 2010. The researchers also collected cultures from the mothers’ breast milk and rectovaginal cultures to determine whether infected breast milk may have contributed to the babies’ GBS disease.

The rate of GBS late-onset disease in full-term neonates was 0.32 per 1,000 live births. The most common presentation of the late-onset disease was meningitis, sepsis, or focal infection. Sixty-four percent of 47 mothers were positive for GBS at the rectovaginal site, and 6% of 53 mothers had GBS mastitis, according to the researchers. In some cases, the mother’s breast milk was infected even when the mother did not have mastitis.

Although “ingestion of contaminated breast milk can be a route of LOD transmission … it is also possible that women with antenatal negative GBS cultures were colonized at delivery, vertically transmitted the GBS to the neonatal upper airway, and the mother’s milk ducts were colonized by the baby,” Morven S. Edwards MD, Professor of Pediatrics at Baylor College of Medicine, Houston told Pediatric Annals. “The authors’ finding that 68% of cases occurred among term and another 9% in near-term infants suggests that a GBS glycoconjugate vaccine would prevent most LOD, regardless of mode of acquisition and clinical presentation.”

Intrapartum antibiotic exposure also was “significantly associated with mild (12 of 22) rather than severe (11 of 45; P = .03) [late-onset disease],” the researchers wrote.

Berardi A. Pediatrics. 2013;doi:10.1542/peds.2012-1231.

Disclosure: Berardi reports no relevant financial disclosures.

Disclosure: Edwards is a consultant to and receives research funding from Novartis Vaccines & Diagnostics.

AAP: Pediatricians Should be in Every School District

Pediatricians should advocate that there be a school physician in every school district, and a nurse in every school building, according to a recent policy statement from the American Academy of Pediatricians.

Such coverage would be “a wonderful way to develop effective alliances among the medical home, the educational home and the family home,” Cynthia DiLaura Devore, MD, chair of the AAP’s School Health Committee, told Pediatric Annals. “A school physician enhances the important integration of health and education for all children within the school setting and especially assists children with special health care needs by furthering the medical home’s goals.”

In the AAP policy statement, the council said community pediatricians should work in tandem with school health professionals to develop sound health policies, and to consider becoming the school’s physician. According to the Committee, a school physician should be board-certified in pediatrics or should be a physician with an expertise in pediatrics.

The Committee stated that school physicians can help to improve student attendance by assisting in the management of chronic medical conditions such as asthma and diabetes, and by monitoring chronic school absenteeism. School physicians also can help decrease district liability and improve safety by developing sound protocols to manage concussions, climate extremes, and emergent situations wrote the committee.

AAP Council on School Health. Pediatrics. 2013;131:178–182.

Disclosure: The researchers report no relevant financial disclosures.

Infant HBV Vaccine May Affect Surface Antigen Protection in Adolescence

Recipients of hepatitis B vaccination at infancy may lose their hepatitis B surface antigen immunological memories by adolescence, according to recently published data.

Researchers tested 8,733 Taiwanese high school students born between July 1987 and July 1991 for hepatitis B surface antigen (HBsAg) and antibodies to HBsAg (anti-HBs). Most participants (n = 7,914) had documented hepatitis B immunizations before age 3 years, including 381 who received hepatitis B immunoglobulin (HBIG).

HBsAg positivity was detected in 1.9% of the evaluable cohort, and anti-HBs was observed in 48.3%. Investigators noted an association between dosage and HBsAg positivity (P = .0085 for trend). Those who received either one, two, or three doses of vaccine were more likely to test positive for HBsAg than those who received four doses (OR = 2.38; 95% CI, 1.74–4.84 for one to two doses; OR = 1.40; 95% CI, 0.92–2.14 for three doses).

Similar trends were observed among the 7,537 patients who did not receive HBIG (OR = 2.85; 95% CI, 1.39–5.81 for one to two doses; OR = 1.52; 95% CI, 0.91–2.53 for three doses), but not among the patients who did. HBIG recipients were more likely to be HBsAg-positive than those who did not receive HBIG (15.4% vs. 1.3%, adjusted OR = 15.63; 95% CI, 10.99–22.22).

Patients whose mothers were HBeAg-positive (n = 162) had higher rates of HBsAg positivity than those with negative maternal HBeAg status (17.8% vs. 11.1%; P = .014). Within this subgroup, fewer participants vaccinated on their birth date were HBsAg-positive than those vaccinated the next day (14.9% vs. 29.0%, P = .032).

Researchers administered a booster vaccination to 1,974 HBsAg- and anti-HBs-negative participants, including 1,252 recipients with pre-booster anti-HBs titers less than 1.0 mIU/mL and 722 with titers between 1 mIU/mL and 9.9 mIU/mL. Anti-HBs seropositivity increased from 48.3% to an estimated 84.3% after the booster.

“A significant proportion of adolescents who had received primary infantile HB vaccination may have lost their immunological memories against HBsAg,” the researchers wrote. “Routine use of anti-HBV treatment during pregnancy might be an option, if safety and efficacy are proven by further large-scale studies. Booster HB vaccination in subjects aged 15 years or more should be considered, especially in subjects born to HBsAg-positive mothers or who have a high risk of HBV exposure.”

Wu T-W. Hepatology. 2013;57:37–45.

Disclosure: The researchers report no relevant financial disclosures.

Children with Prader-Willi Syndrome at Increased Risk for Congenital Defects

In a recent study, researchers found that children with Prader-Willi syndrome displayed an increased prevalence of heart defects, renoureteral malformations, vertebral anomalies, hip dysplasia, clubfoot, agenesis/hypoplasia of the corpus callosum, and other congenital defects.

Maria Torrado, MD, of the department of genetics at Hospital de Pediatria in Buenos Aires, Argentina, and colleagues followed 180 children with Prader-Willi syndrome for 13 years. Using national and international registries of congenital defects in the general population, the researchers compared the patients’ prevalence of defects. Overall, children with Prader-Willi syndrome were 5.4 to 18.7 times more likely at risk for developing a congenital birth defect compared with patients in the general population.

“Based on the general population registries consulted, the prevalence of these defects was significantly higher than expected,” Torrado and colleagues wrote. Data indicated congenital defects were discovered in 40 children; cardiac anomalies being the most common (4.4%), followed by renoureteral malformations (2.8%) and abnormalities of the corpus callosum (2.8%). Vascular anomalies occurred in 1.11% of patients, the researchers wrote.

Of the 40 congenital birth defects demonstrated in this study, 28 were found in the first 4 weeks of life; 17.5% of birth defects were discovered after the diagnosis of Prader-Willi syndrome.

“I don’t think these findings will come as a surprise to those providers. However, I think the documentation of the magnitude of the effect is maybe a little surprising,” Shawn E. McCandless MD, Director of the Center for Human Genetics at University Hospitals, Case Medical Center, in Cleveland, told Pediatric Annals.

“In the past, we’ve tended to think of Prader-Willi syndrome being primarily a hypothalamic abnormality that then leads to downstream endocrine and neuroendocrine signaling abnormalities, which lead to the specific defects,” said McCandless. “This study suggests that there may be many more fundamental effects of whatever the underlying processes in Prader-Willi syndrome are that impact the development of a variety of organ systems.”

The researchers wrote that infants with Prader-Willi syndrome should undergo abdominal, renal and hip ultrasounds, cardiologic evaluations, spine X-ray, and at least one cerebral ultrasound to personalize clinical management of this syndrome.

Torrado M. Pediatrics. 2013;doi:10.1542/peds.2012-1103.

Disclosure: The researchers report no relevant financial disclosures.

Father’s Prenatal Mental Health Impacts Children's Behavior

The psychological distress of expectant fathers was associated with emotional and behavioral problems in their children, according to data published in Pediatrics.

“Expectant fathers’ mental health should be addressed both in research and clinical practice,” Anne Lise Kvalevaag, a PhD candidate at Haugesund Hospital in Norway, told Pediatric Annals. “This epidemiological study, based on a large population cohort, investigated the transmission of psychological difficulties over the generation gap. The findings point to the fact that the expectant fathers’ mental health represents a risk factor for child development, whereas the traditional view has been that this risk in large is represented by the mother.”

Kvalevaag and colleagues examined data on 31,663 children who were enrolled in the Norwegian Mother and Child Cohort Study. The researchers relied on information from self-reports and questionnaires to determine the fathers’ perinatal mental health statuses — primarily symptoms of depression and anxiety — the mothers’ pre-and postnatal mental health, and their children’s behavioral and emotional outcomes at the age of 36 months.

Results indicated that at week 17 or 18 of gestation, 3% of the fathers had high levels of psychological distress. The researchers found a small but positive relationship between the fathers’ psychological distress and their children’s behavioral difficulties (beta = 0.19; 95% CI, 0.15–0.23), emotional difficulties (beta = 0.22; 95% CI, 0.18–0.26) and social functioning (beta = 0.12; 95% CI, 0.07–0.16). The association between the fathers’ perinatal psychosocial distress and their children’s emotional and behavioral problems later on did not change when accounting for relevant confounders, such as the father’s age, education and marital status, or the mother’s mental health.

“The findings from this study suggest that some risk for future child emotional and behavioral problems can be identified during pregnancy, and, as such, the results are of importance for health professionals and policymakers in their planning of health care in the perinatal period,” the researchers wrote.

Kvalevaag AL. Pediatrics. 2013;doi:10.1542/peds.2012-0804.

Disclosure: The researchers report no relevant financial disclosures.

Check List ☑

Simple Screening Tool Created for Suicide Prevention in Adolescents

Suicide is the second-leading cause of death in persons between 10 and 24 years of age, according to the US Centers for Disease Control and Prevention. Because many individuals who die by suicide saw a health care provider – typically someone in the emergency department (ED) – between 3 months and 1 year before their deaths, Lisa M. Horowitz, PhD, MPH, a clinician and researcher at the National Institute of Mental Health (NIMH), and colleagues developed a simple, evidence-based, survey for ED personnel to use.

“Most people don’t show up to the emergency department and say, ‘I want to kill myself.’ Rather, they show up with physical complaints and do not discuss their suicidal thoughts,” said Horowitz. “But studies have shown that if you ask directly, the majority will tell you. Nurses and physicians need to know what questions to ask.”

The four-question survey, “Ask Suicide-Screening Questions,” which according to Horowitz takes 2 minutes to complete, is published in the December 2012 issue of Archives of Pediatrics and Adolescent Medicine and available at the NIMH website ( www.nimh.nih.gov). The questions are:

  • □ In the past few weeks, have you wished you were dead?

    ___ yes  ___ no  ___ no response

  • □ In the past few weeks, have you felt that you or your family would be better off if you were dead?

    ___ yes  ___ no  ___ no response

  • □ In the past week, have you been having thoughts about killing yourself?

    ___ yes  ___ no   ___ no response

  • □ Have you ever tried to kill yourself?

    ___ yes  ___ no  ___ no response

Horowitz LM. Arch Pediatr Adolesc Med.2012;166(12):1170–1176.

Disclosure: The researcher reports no relevant financial disclosures

Authors
Trend Watch written by Whitney McKnight, Cassandra Richards, John Schoen, and Colleen Zacharyczuk.

10.3928/00904481-20130128-02

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