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This Month in Archives of Pediatrics & Adolescent Medicine
Arch Pediatr Adolesc Med. 2002;156:103.
Weekly vs Daily Iron and Folic Acid Supplementation in Adolescent Nepalese
Girls
Nutritional anemia is a common problem among adolescent girls around
the globe in both industrialized and nonindustrialized countries. Effective
treatment is often hindered by lack of compliance. In this randomized controlled
trial of anemic adolescent schoolgirls in Nepal, Shah and Gupta found that
once-weekly supplementation with iron and folate raised the hematocrit as
much as daily supplements with the same dose of iron and folate. Weekly treatment
seems to be as effective as daily nutritional supplements and may offer the
advantage of lower cost and improved compliance.
(SEE ARTICLE)
Improving Asthma Outcomes and Self-management Behaviors of Inner-city
Children: A Randomized Trial of the Health Buddy Interactive Device and an
Asthma Diary
Appropriate management of asthma, as with any chronic illness, involves
the child and family learning effective self-management skills. This randomized
controlled trial evaluated the effect of a computerized interactive asthma
self-management and education program, the Health Buddy, in 8-year-old to
16-year-old children with asthma. The program resulted in a 50% reduction
in reported limitation of activities and a 30% decrease in reported coughing
or wheezing, although there was no effect on health services utilization.
Easy-to-use Internet-based devices such as the Health Buddy may be useful
tools to empower chronically ill children to care for themselves.
(SEE ARTICLE)
Influence of Attendance at Day Care on the Common Cold From Birth Through
13 Years of Age
In another illuminating study from the Tucson Children's Respiratory
Study, Ball and colleagues found that children who were in large day care
centers during the first 3 years of life had more frequent colds at age 2
years but had 60% to 70% fewer colds during ages 6 through 11 years. Children
attending large day care centers for more than 2 years also had fewer colds
at ages 6, 8, and 11 years than children attending day care for only 12 months
or less. Regardless of whether children acquire immunity to viral respiratory
infections in preschool or primary school, they seem to have similar levels
of protection by 13 years of age. This study provides reassuring information
to parents and clinicians as pointed out by Bergman in his accompanying editorial.
(SEE ARTICLE)
Mortality Among Persons With a History of Kawasaki Disease in Japan:
The Fifth Look
Kawasaki disease is now the leading cause of acquired heart disease
in childhood, but its long-term prognosis is still unknown. In this study
from Japan, 6576 children with Kawasaki disease were followed for a mean time
of 12.6 years. Cardiac sequelae occurred in 15.3% of patients. There was an
increased mortality during the acute phase of the illness, but overall, the
standardized mortality ratio was not elevated following the acute phase. Only
among males with cardiac sequelae was there an increased risk of death during
the postacute, follow-up period. For the vast majority of patients with Kawasaki
disease who do not have cardiac sequelae, there does not seem to be a later
increased risk of death.
(SEE ARTICLE)
A Systematic Review of Nonpharmacological and Nonsurgical Therapies
for Gastroesophageal Reflux in Infants
Reflux is commonly encountered in both the office and hospital settings.
Nonpharmacological remedies such as positioning, formula changes, and thickened
formula are commonly recommended. In this systematic review, Carroll and colleagues
found no evidence to support the use of infant seats, elevating the head of
the bed, use of a pacifier, or formula changes on the symptoms of reflux in
infants. Thickened formula was the only intervention that reduced the frequency
of emesis.
(SEE ARTICLE)
Rehospitalization for Neonatal Dehydration: A Nested Case-Control
Study
Concerns about early discharge of newborns from the hospital continue.
The most common reason for rehospitalization is infant dehydration and failure
to gain weight. In this study from Kaiser Permanente, the incidence of rehospitalization
for dehydration was 2.1 per 1000 live births. Most rehospitalizations occurred
between 24 and 72 hours after initial discharge. Serious sequelae of dehydration
were rare. Risk of dehydration requiring rehospitalization was increased among
infants born to first-time mothers, infants who were exclusively breastfed,
and infants born to older mothers. Adherence to the American Academy of Pediatrics
follow-up guidelines did not seem to decrease the risk of dehydration and
rehospitalization.
(SEE ARTICLE)
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