Pediatric Annals

Trend Watch 

Trend Watch

Abstract

Rick factors in infancy and early childhood may influence racial and ethnic disparities in children who are overweight and obese, according to recent study results published in JAMA Pediatrics.

“Many early life risk factors for childhood obesity are more prevalent among blacks and Hispanics than among whites and may explain the higher prevalence among racial/ethnic minority children,” researchers wrote.

The prospective prebirth cohort study included 1,116 mother-child pairs (63% white, 17% black, 4% Hispanic). Researchers analyzed which racial and ethnic disparities were explained by factors during pregnancy (gestational diabetes and depression), infancy (rapid infant weight gain, feeding other than exclusive breast-feeding and early introduction of solid foods), and early childhood (sleep less than 12 hours per day, a television in the room where the child sleeps and any intake of sugar-sweetened beverages or fast food).

Researchers found higher BMI z scores in black and Hispanic participants. They also had higher total fat mass index and overweight/obesity prevalence than white participants.

After adjustment for socioeconomic confounders and parental BMI, differences in BMI z scores decreased for black and Hispanic participants.

Adjustment for pregnancy risk factors did not reveal substantial changes. However, only small differences were found between whites, blacks and Hispanic participants after adjustment for infancy and childhood risk factors.

“Our findings suggest that modifiable risk factors throughout the life course, including infancy and early childhood, as well as social conditions in childhood and transgenerational obesity, are critical to understanding how disparities in childhood obesity arise,” researchers wrote. “Our findings also imply that efforts to eliminate ethnic/racial disparities in childhood obesity should focus on preventing these early life risk factors with their socio-environmental context.”

Taveras EM. JAMA Pediatr. 2013;doi:10.1001/jamapediatrics.2013.85.

Disclosure: The study was supported by a grant from the National Institute on Minority Health and Health Disparities.

Internationally adopted children are reaching puberty at young ages and have a high risk for early puberty, including very early or precocious puberty, according to an editorial that was recently published in Pediatrics.

“However, there can be uncertainty over the chronological age of adopted children, raising the possibility that the seemingly elevated risk of early puberty is due to some children having a significantly under-recorded age, perhaps of up to 2 years or more,” Peter Hayes, PhD, of the University of Sunderland in the United Kingdom, said in the editorial.

Hayes said underestimates of age are more likely than overestimates because people are more willing to adopt younger children, and neglected and malnourished children will be smaller and less advanced than typical children the same age.

“Nonetheless, most researchers have tended to discount under-recorded age as a systemic explanation of the elevated risk of early puberty in favor of theories that assume that, in most cases at least, they are dealing with a genuine diagnosis,” Hayes wrote.

According to Hayes, past studies show that the older the recorded age of a child, the higher the risk for early puberty. When adopted, malnourished children whose height has been affected with catch up to their height potential, and early puberty has been associated with those children who catch up the fastest.

Other researchers attribute early puberty to nutritional deprivation before adoption, Hayes wrote. He added that the theory gained some support from a study on male rats, but it did not extend to nonadopted children who recovered from postnatal under-nutrition.

“All of these investigations required transdisciplinary research,” Hayes wrote. “The research to date, however, has been largely driven by the effort to come to a better understanding of the onset of puberty rather than the context of adoption, with a notable absence of curiosity over how…

Racial, Ethnic Disparities Increased Obesity Risk in Children

Rick factors in infancy and early childhood may influence racial and ethnic disparities in children who are overweight and obese, according to recent study results published in JAMA Pediatrics.

“Many early life risk factors for childhood obesity are more prevalent among blacks and Hispanics than among whites and may explain the higher prevalence among racial/ethnic minority children,” researchers wrote.

The prospective prebirth cohort study included 1,116 mother-child pairs (63% white, 17% black, 4% Hispanic). Researchers analyzed which racial and ethnic disparities were explained by factors during pregnancy (gestational diabetes and depression), infancy (rapid infant weight gain, feeding other than exclusive breast-feeding and early introduction of solid foods), and early childhood (sleep less than 12 hours per day, a television in the room where the child sleeps and any intake of sugar-sweetened beverages or fast food).

Researchers found higher BMI z scores in black and Hispanic participants. They also had higher total fat mass index and overweight/obesity prevalence than white participants.

After adjustment for socioeconomic confounders and parental BMI, differences in BMI z scores decreased for black and Hispanic participants.

Adjustment for pregnancy risk factors did not reveal substantial changes. However, only small differences were found between whites, blacks and Hispanic participants after adjustment for infancy and childhood risk factors.

“Our findings suggest that modifiable risk factors throughout the life course, including infancy and early childhood, as well as social conditions in childhood and transgenerational obesity, are critical to understanding how disparities in childhood obesity arise,” researchers wrote. “Our findings also imply that efforts to eliminate ethnic/racial disparities in childhood obesity should focus on preventing these early life risk factors with their socio-environmental context.”

Taveras EM. JAMA Pediatr. 2013;doi:10.1001/jamapediatrics.2013.85.

Disclosure: The study was supported by a grant from the National Institute on Minority Health and Health Disparities.

Internationally Adopted Children Found to Reach Puberty Earlier

Internationally adopted children are reaching puberty at young ages and have a high risk for early puberty, including very early or precocious puberty, according to an editorial that was recently published in Pediatrics.

“However, there can be uncertainty over the chronological age of adopted children, raising the possibility that the seemingly elevated risk of early puberty is due to some children having a significantly under-recorded age, perhaps of up to 2 years or more,” Peter Hayes, PhD, of the University of Sunderland in the United Kingdom, said in the editorial.

Hayes said underestimates of age are more likely than overestimates because people are more willing to adopt younger children, and neglected and malnourished children will be smaller and less advanced than typical children the same age.

“Nonetheless, most researchers have tended to discount under-recorded age as a systemic explanation of the elevated risk of early puberty in favor of theories that assume that, in most cases at least, they are dealing with a genuine diagnosis,” Hayes wrote.

According to Hayes, past studies show that the older the recorded age of a child, the higher the risk for early puberty. When adopted, malnourished children whose height has been affected with catch up to their height potential, and early puberty has been associated with those children who catch up the fastest.

Other researchers attribute early puberty to nutritional deprivation before adoption, Hayes wrote. He added that the theory gained some support from a study on male rats, but it did not extend to nonadopted children who recovered from postnatal under-nutrition.

“All of these investigations required transdisciplinary research,” Hayes wrote. “The research to date, however, has been largely driven by the effort to come to a better understanding of the onset of puberty rather than the context of adoption, with a notable absence of curiosity over how either adoption practices or social, cultural and bureaucratic norms in different states of origin may impinge on the reliability of birth dates.”

Hayes P. Pediatrics. 2013;doi:10.1542/peds.2013-0232.

Disclosure: Hayes reports no relevant financial disclosures.

PCV13 Found to Be as Safe as PCV7

The new 13-valent pneumococcal conjugate vaccine appears to be as safe as the previous version used before 2010, the 7-valent pneumococcal conjugate vaccine, according to study results published in Vaccine.

“It is important that children receive the pneumococcal conjugate vaccine, as it provides protection against very serious and potentially fatal infections, including meningitis and bloodstream infections,” Hung Fu Tseng, PhD, MPH, of Kaiser Permanente Southern California Department of Research and Evaluation, said in a press release. “The new vaccine protects against an additional six types of pneumococcal bacteria.”

The cohort study included 599,229 children aged 1 month to 2 years to monitor the risk of prespecified events after receiving PCV13 (Prevnar 13, Pfizer) during a 90-week period. Children with febrile seizures, encephalopathy, urticaria and angioneurotic edema, asthma, anaphylaxis, thrombocytopenia and Kawasaki disease were identified using computerized data.

Researchers found a small but statistically insignificant increase in the risk for Kawasaki disease associated with PCV13 (seven diagnoses per 52,000 vs. 4.24 expected). When diagnoses were confirmed by medical record review, the risk for Kawasaki disease in the 28 days after receiving PCV7 (Prevnar 7, Pfizer) was one per 100,000 doses and two per 100,000 doses of PCV13. This difference was not significant.

They also found that there was no increased risk for febrile seizures, encephalopathy, hives/angioedema, asthma, low platelet counts or systemic allergic reactions.

“Based on 90 weeks of data including approximately 600,000 doses of PCV13 collected at the Vaccine Safety Datalink Project, we identified no significant increased risk of prespecified adverse events associated PCV13 vaccine comparing to PCV7 vaccine,” the researchers wrote.

Tseng HF. Vaccine. 2013;doi:10.1016/j.vaccine.2013.03.040

Disclosure: Tseng reports support from Novartis Vaccine.

Prophylactic Zinc Supplement Decreased Diarrheal Episodes in Normal Children

Diarrhea morbidity in populations of infants aged 6 to 11 months with high prevalence of wasting and stunting can be reduced with short-course prophylactic zinc supplementation for 2 weeks, according to recent study results published in Pediatrics.

“Zinc is required for multiple cellular tasks and the immune system depends on the sufficient availability of this essential trace element,” researchers wrote. “Zinc deficiency is common in several developing countries, including India. This is because the commonly consumed staple foods have low zinc contents and are high in phytates, which inhibit absorption and utilization of zinc.”

The randomized, double blind, placebo-controlled trial included 272 infants aged 6 to 11 months from an urban resettlement colony in Delhi, India, between Jan. 1, 2011, and Jan. 15, 2012. Participants were randomly assigned 20 mg zinc or a placebo orally every day for 2 weeks.

Researchers found a 39% (incident rate ratio = 0.61; 95% CI, 0.53–0.71) reduction in episodes of diarrhea in the zinc group compared with the placebo group.

There also were decreases in episodes of acute diarrhea (31%), episodes of persistent diarrhea (70%) and episodes of dysentery (>95%).

The zinc group also had a 39% decrease in overall days with diarrhea and a 36% decrease in duration per episode of diarrhea.

“Diarrhea continues to kill millions of children around the world and leaves several others malnourished,” Akash Malik, MBBS, of Maulana Azad Medical College and Associated Hospitals told Pediatric Annals. “Zinc has, up until now, been approved only as a therapeutic agent by WHO for diarrhea and even after being recommended its use in diarrhea still remains low. If the prophylactic effect of short course zinc supplementation in diarrhea as shown by this study can be validated and reproduced in other studies we will definitely have another tool to fight diarrhea with. Consider short course zinc prophylaxis especially in children from low socio-economic and other disadvantaged groups, likely to have under-nutrition and high incidence of diarrhea.”

Malik A. Pediatrics. 2013;doi:10.1542/peds.2012-2980.

Disclosure: The study was supported by the Indian Council of Medical Research, Department of Health Research.

ED Clinicians Do Not Always Follow PID Treatment Guidelines

Most clinicians in the ED were not treating adolescent girls who presented with pelvic inflammatory disease in accordance with CDC guidelines, according to findings in a report published online.

Monika Goyal, MD, of Children’s National Medical Center, George Washington University, and colleagues analyzed 2000–2009 data from the National Hospital Ambulatory Medical Care Survey.

The researchers reported that only 37.1% of girls with pelvic inflammatory disease (PID) were treated according to the CDC treatment guidelines. “This finding has substantial implications because inadequate treatment of PID may lead to serious long-term sequelae such as chronic pelvic pain or tubal infertility,” Goyal and colleagues said.

The researchers reported an uptake in compliance after the guidelines were implemented in 2006, but many clinicians continued to inappropriately treat patients with ceftriaxone sodium and azithromycin, which may indicate that the clinicians believe treatment of PID is identical to treatment of cervicitis or that they are worried patients will not adhere to doxycycline regimens.

“We were surprised that almost two-thirds of adolescent patients diagnosed with PID in EDs were being treated inappropriately,” Goyal told Infectious Diseases in Children. “This supports the need for the creation of quality improvement interventions to improve the care of this vulnerable population.”

The researchers said their findings highlight the potential high impact of using the ED as a strategic setting to further understand these issues and change clinical practice.

Goyal M. JAMA Pediatrics. 2013;doi:10.1001/jamapediatrics.2013.1042.

Global Rotavirus Network Increased Surveillance Capacity

To help reduce mortality and morbidity associated with rotavirus, WHO recommends that all countries include the rotavirus vaccine into their national immunization programs.

“Timely, quality surveillance data can provide baseline estimates of rotavirus disease burden to inform decisions regarding rotavirus vaccine introduction in national immunization programs and can help monitor the impact of vaccine introduction on disease trends,” researchers wrote.

The Global Rotavirus Surveillance Network (GRSN) was created in 2008 to produce data for decision making regarding rotavirus vaccine introduction and use; assess and monitor disease trends; create a platform for vaccine effectiveness studies; and highlight the importance of surveillance data.

The GRSN includes the Global Rotavirus Laboratory Network (GRLN), designed to conduct diagnostic testing for rotavirus diarrhea and distinguish dominant genotypes among strains isolated in different locations. As of April, the network includes 107 sentinel hospital laboratories, 36 national laboratories, nine regional reference laboratories and one global reference laboratory.

WHO established a rotavirus laboratory technical working group in 2012 to create ways to improve laboratory network capacities and increase standardization of key methods and procedures.

Data reported through GRSN includes percentage of children hospitalized for rotavirus and strain prevalence in each WHO region and country.

“The number of reporting countries has grown from 44 in 2008, to 64 in 2011,” researchers wrote. “During the same period, the number of participating sentinel hospitals expanded from 132 to 185, and the annual number of enrolled children increased from 41,414 to 48,947.”

WHO and partners have begun an in-depth review of data from the past 5 years.

“This review will identify strengths and weaknesses of the GRSN, including the GRLN, and will guide decisions on strategies and actions to ensure the network is responsive to information needs of all immunizations stakeholders,” researchers wrote. “The review also will provide recommendations related to the potential use of the network for surveillance needs around vaccines in development and other important gastroenteric pathogens.”

CDC. MMWR. 2013;62:409–412.

Disclosure: The researchers report no relevant financial disclosures.

Authors

Trend Watch written by Amber Cox and Colleen Zacharyczuk.

10.3928/00904481-20130619-02

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