 |
|
This Month in Archives of Pediatrics & Adolescent Medicine
Arch Pediatr Adolesc Med. 2002;156:637.
Very Early Exposure to Erythromycin and Infantile Hypertrophic Pyloric
Stenosis
Prior studies have suggested an association between early treatment
of infants with erythromycin and the development of pyloric stenosis. This
population-based cohort study in Tennessee followed more than 300 000
infants from birth, of whom 804 developed pyloric stenosis. Infants exposed
to erythromycin between 3 and 13 days of life had a nearly 8-fold increased
risk of developing pyloric stenosis. There was no increased risk for use of
erythromycin after 2 weeks, nor was there any association between the illness
and any other antibiotics. The risks from erythromycin exposure in this age
group need to be weighed against the possible benefits.
(SEE ARTICLE)
Welfare Reform and the Health of Young Children: A Sentinel Survey
in 6 US Cities
The 1996 welfare reform law changed the United States' 2 primary social
safety-net programs, Aid to Families with Dependent Children (renamed Temporary
Assistance to Needy Families) and the Food Stamp Program. Prior research on
the effect of welfare reform on children's health is very scant. Studying
children at 6 different urban hospitals and clinics, Cook and colleagues found
that changes in welfare benefits were associated with an increased risk of
food insecurity, and with admission following a visit to an emergency department.
Receiving food stamps did not mitigate this adverse effect associated with
change in welfare benefits. Changes in welfare benefits may be associated
with important adverse effects on children.
(SEE ARTICLE)
Rebound in Serum Bilirubin Level Following Intensive Phototherapy
Although prior studies suggest that infants do not need to be kept in
the hospital to measure rebound in bilirubin levels following discontinuation
of phototherapy, many clinicians do remain watchful for rebound of hyperbilirubinemia
before patient discharge. This study found that 8% of infants treated with
phototherapy during their birth hospitalization received repeat treatment,
compared with 0.7% of infants who had been readmitted for hyperbilirubinemia
treatment. The mean rebound in level in the first group was 1.3 mg/dL (22
µmol/L), while in the second group, it was only 0.3 mg/dL (5.1 µmol/L).
(SEE ARTICLE)
Decreased Growth During Therapy With Selective Serotonin Reuptake Inhibitors
Selective serotonin reuptake inhibitors (SSRIs) have been associated
with endocrinological adverse effects in several reports in adults, but there
is no information on their effects on growth and puberty in children. This
report of 4 patients aged 11.3 to 13.7 years demonstrated substantial growth
attenuation in conjunction with SSRI treatment. Abnormalities in growth hormone
secretion were documented in 3 patients. Normal growth resumed after discontinuation
of treatment. Larger studies are warranted to investigate the effect of these
commonly used drugs on growth in children.
(SEE ARTICLE)
Mechanisms Behind the Failure of Residents' Longitudinal Primary Care
to Promote Disclosure and Discussion of Psychosocial Issues
One of the tenets of primary care is that continuity of the physician-patient
relationship leads to discussion of important psychosocial issues and improved
quality of care. Wissow and colleagues examined longitudinal relationships
in residents' continuity clinic practices. During the course of a year, parents
did not discuss or raise more psychosocial issues with their physicians, and
physicians were less likely to initiate such discussions. Enhancing training
in physician-patient communication requires more than a simple continuity
clinic experience and may require specific training in communication skills.
(SEE ARTICLE)
|
