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This Month in Archives of Pediatrics & Adolescent Medicine
Arch Pediatr Adolesc Med. 2001;155:437.
Piracetam and Cognitive Functioning in Children With Down Syndrome
Interest in using piracetam to improve
the cognitive function of children with Down syndrome dramatically increased
following a nationally broadcast television program in 1995 and follow-up
national television news programs in 1996 and 1997. Despite its the widespread
use, there are no well-designed studies in the peer-review literature. This
double-blind, randomized controlled trial tested piracetam in 18 children
with Down syndrome. It had no effect on cognitive performance compared with
placebo but was associated with adverse central nervous system stimulatory
effects in 7 of the 18. The results are strikingly different from the testimonials
presented in the popular press.
(SEE ARTICLE)
Partial Uptake of Varicella Vaccine and the Epidemiologic Effect on
Varicella Disease in 11 Day-Care Centers in North Carolina
What happens when only a portion of children in day care centers is
immunized against varicella? In 11 day care centers (N = 4064), of vaccine
coverage increased from 4.4% in 1995 to 63% in 1999. Rates of varicella decreased
by 81% in the vaccinated group and 91% in the unvaccinated. Despite substantial
herd immunity, some children will be susceptible and at risk for complications
if varicella is contracted at a later age.
(SEE ARTICLE)
Consultations for Holistic Pediatrics for Inpatients and Outpatient
Oncology Patients at Children's Hospital
The use of complementary and alternative medical (CAM) therapies is
common and increasing in pediatric populations. However, little is known about
pediatric inpatients' need for and interest in receiving consultation regarding
CAM services. Kemper and Wornham describe their experience in providing CAM
consultation at a tertiary center, (Boston Children's Hospital). Of the 70
patients seen, 61% were from the oncology unit. The most common goal for the
consultation was to help manage symptoms, such as nausea, pain, and anxiety,
followed by assistance in building up the child's strength and resilience.
Most families were interested in information about herbs or dietary supplements.
This study indicates the desire of many patients and families for CAM and
the need to integrate CAM into regular care.
(SEE ARTICLE)
Intravenous Ketorolac in the Emergency Department Management of Sickle
Cell Pain and Predictors of Its Effectiveness
Pain control in children and adolescents coming to the emergency department
with vaso-occlusive pain continues to be challenging. Ketoralac is a potent
nonnarcotic analgesic with few adverse effects and known narcotic-sparing
properties. Beiter and colleagues evaluated intravenous (IV) ketoralac as
first-line therapy in the treatment of patients with sickle cell disease with
moderate to severe pain. Of 70 episodes, 53% responded to IV ketoralac and
IV fluids without requiring opoids. Patients who required narcotics were more
likely to have more sites of pain and higher initial pain scores. First-line
therapy with IV ketoralac seems to be successful in at least half of patients
with acute vaso-occlusive pain.
(SEE ARTICLE)
Child Care and Common Communicable Illnesses
Results From the
NICHD Study of Early Child Care
It is well known that children in child care have higher rates of common
communicable infections than children cared for at home. The effect of this
higher rate of illness on children's development is unknown. This study prospectively
followed more than 1200 children from birth to age 3 years. While the rates
of illness were higher in children attending child care than in children reared
exclusively at home during the first 2 years of life, these differences disappeared
by age 3. There was no evidence that increased rates of illness had a negative
effect on school readiness or language competence.
(SEE ARTICLE)
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