Metered-dose inhalers have been shown to be quicker and more cost-effective than nebulizers for older children and adults. In this study of 168 wheezing children 2 to 24 months of age who visited the emergency department, patients were randomly assigned to receive albuterol either by an inhaler or by nebulizer. While there was no difference between the 2 groups in the improvement in wheezing, patients in the inhaler group were less likely to be admitted, were less likely to receive steroids, received fewer treatments, and had a lower increase in heart rate. Inhalers seem to be a better alternative for the emergency department treatment of wheezing infants and children.
The increasing attention to children's mental health has raised concerns about the number and types of psychotropic medications being prescribed. This 10-year study of nearly 900 000 youths enrolled in 2 health care systems found that the prevalence of psychotropic medication use for youth increased 2- to 3-fold between 1987 and 1996. In 1996, 6% of youth had been treated with a psychotropic medication, most commonly stimulants, antidepressants, or anxiolytics. Prevalence of these medications is nearly as high in youth as in adults.
Antibiotics are known to alter gut motility, but they have never been examined as a risk factor for intussusception. This case-control study, of 93 children treated for intussusception and 353 control group children younger than 4 years, found that antibiotic use within 48 hours of diagnosis was associated with a 4-fold increased risk of intussusception. Cephalosporin use was associated with a more than 20-fold increased risk, emphasizing the need for judicious use of antibiotics in young infants.
Adverse drug events have been demonstrated to contribute to morbidity and mortality among hospitalized patients in the adult and pediatric populations. Holdsworth and colleagues prospectively examined 1197 consecutive admissions of hospitalized children. Adverse drug events occurred in 6% of admissions, and potential events occurred in an additional 8%. A quarter of these events were deemed serious or life-threatening. Adverse events were more common among sicker patients and patients receiving more medications, suggesting that such events were a consequence rather than a cause of increasing severity of illness.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2003;157(1):009. doi:10.1001/archpedi.157.1.009