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This Month in Archives of Pediatrics & Adolescent Medicine
Arch Pediatr Adolesc Med. 2004;158:413.
Enteral vs Intravenous Rehydration Therapy for Children With Gastroenteritis: A Meta-analysis of Randomized Controlled Trials
Oral rehydration of children hospitalized with acute gastroenteritis is widely used in less industrialized and low-income countries but rarely for inpatient care in the United States. A barrier may be unfamiliarity with its effectiveness and the risks of intravenous rehydration. This systematic review examined 16 randomized trials comparing enteral and intravenous therapy among children with gastroenteritis. Enteral therapy had a 64% lower risk of serious complications and resulted in lengths of stay that were shorter by nearly a day. It was successful in 96% of children. The obstacles to more widespread adoption of enteral rehydration should be explored and addressed.
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How Pediatricians Counsel Parents When No "Best-Choice" Management Exists: Lessons to Be Learned From Hypoplastic Left Heart Syndrome
Hypoplastic left heart syndrome is a life-threatening condition for which the options include surgical palliation, cardiac transplantation, and comfort care without surgical intervention. This study of 14 of the largest US pediatric cardiac surgery centers sought to determine the options and recommendations presented to parents of children with this condition. Neonatologists were least likely to recommend surgery, whereas physicians who discussed surgery were nearly 3-fold more likely to recommend surgical procedures performed at their own hospital compared with those done elsewhere. One quarter of physicians did not discuss the option of no surgery with parents. Physicians' recommendations to parents are poorly associated with their predictions of postoperative outcomes, raising doubts that parents are given adequate information to make truly informed decisions.
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The Association of Caffeinated Beverages With Blood Pressure in Adolescents
Hypertension is a major cause of morbidity and mortality in adults, and the onset often begins during late adolescence. By adolescence, both African American men and women have higher systolic blood pressure than white individuals. One possible factor is dietary caffeine intake. In this study, the amount of caffeine in foods and beverages was examined in relation to blood pressure in African American and white adolescents. African American youth consuming more than 100 mg/d of caffeine had higher systolic blood pressure readings than those consuming less. This effect of caffeine on blood pressure was not observed in white adolescents. The choice of large amounts of caffeinated soft drinks by African American youth may be associated with hypertension and adverse health effects.
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Benefits of a School-Based Asthma Treatment Program in the Absence of Secondhand Smoke Exposure: Results of a Randomized Clinical Trial
Despite the attention given to asthma during the last decade and the availability of effective drugs for its control, many children with asthma continue to have poor control of their disease. Other venues to deliver care should be explored as complements to the care delivered by the regular primary care provider. Halterman and colleagues conducted a randomized controlled trial to determine if daily inhaled corticosteroids provided through the child's school could improve symptoms among children with mild to severe persistent asthma. This study in 54 urban schools found that the provision of medication through the school improved quality of life for the parents, reduced days missed from school due to asthma, and increased the number of symptom-free days. However, only children who were not exposed to secondhand smoke benefited from this school-based program.
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