Copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2003
Diagnosis of serious bacterial infection during the neonatal period has always proved challenging. Various combinations of hematologic and acute-phase reactants have been proposed as tests to assist with diagnosis and decision making. In this systematic review, the diagnostic yield of 12 different tests was examined in 17 different studies. Measurement of procalcitonin and interleukins appears to be promising, but the small sample sizes and limited studies to date do not provide enough information to allow their routine use as clinical tools.
Chlamydia trachomatis exposure at birth may cause subsequent conjunctivitis or pneumonia. Although prophylaxis with oral erythromycin has been advocated, recent studies suggest that the early use of erythromycin may lead to an increased risk of pyloric stenosis. In a decision analysis comparing watchful waiting with erythromycin prophylaxis, Rosenman and colleagues found that for every 30 infants given oral erythromycin, 1 additional case of pyloric stenosis would be expected to occur, and fewer than 2 cases of C trachomatis pneumonia would be prevented. Prophylaxis would not be warranted unless more than 3.4% of exposed infants were hospitalized for pneumonia.
Early malnutrition is linked to poor cognitive function, but the long-term effects have not been extensively studied. In this study of 1559 children from Mauritius, cognitive function was measured at ages 3 and 11 years and compared with nutritional status at age 3 years. Malnutrition was associated with poorer cognitive function at both ages and appeared to be stable across time. Children with worse malnutrition had a 15-point IQ deficit at age 11 years.
Most adult smokers begin smoking during adolescence. Quitting appears to be harder with each passing year of addiction, so efforts to increase smoking cessation among adolescents are critical. In this community-based sample of 4078 high school students, Klesges and colleagues report that 5% of adolescents overall and 40% of former smokers have used nicotine replacement therapy, either as gum or patches. Of concern, however, is that 18% of nicotine replacement users have never smoked, indicating inappropriate use of these products. The fact that half of adolescents report easy access to nicotine replacement therapies indicates the need for appropriate restrictions on their use and dissemination.
Children with bilateral severe to profound hearing impairment that is sensorineural may be candidates for cochlear implantation. This study examines the outcomes of 40 patients who had received cochlear implants at a mean age of 51 months. There were significant improvements in speech perception, the developmental quotient, socialization, and communication after the implant. Notably, children who had received implants before age 48 months appeared to have greater improvement than those who had undergone cochlear implantation at a later age.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2003;157(6):507. doi:10.1001/archpedi.157.6.507