New Study Begins for Kids with High Risk Cancer, Neuroblastoma

Molecular Insight Pharmaceuticals has announced the initiation of a clinical trial of Azedra in pediatric neuroblastoma patients. Neuroblastoma is a type of neuroendocrine cancer that primarily affects children and is the most common solid tumor in children outside of the brain.

The drug Azedra is a small, targeted radiotherapeutic molecule that binds to the norepinephrine transporter, a protein highly expressed on neuroendocrine tumors such as neuroblastoma. Because of this preferential binding, Azedra can deliver a greater amount of radiation to the tumor cell, thus increase tumor killing while reducing side effects.

“Neuroblastoma is an aggressive and difficult to treat form of neuroendocrine cancer that usually affects children under five years of age,” said Katherine Matthay, M.D., Chief of Pediatric Hematology and Oncology at the University of California San Francisco Children’s Medical Center. “Unfortunately, the prognosis for many of these children is quite poor. There currently are no FDA-approved treatments available for patients who have progressive, recurrent or refractory disease, and our current treatment options are extremely limited.”

What Can Birds Teach Us About Raising Our Own Young?

Are younger siblings at a competetive disadvantage to their older brothers or sisters? What wisdom can a bird study provide to us about human sibling relationships?

Common wisdom holds that the first-laid birds in a clutch have a better chance of surviving to leave the nest. But Keith Sockman, an assistant biology professor in UNC’s College of Arts and Sciences, has discovered that first-laid eggs are, in fact, the least likely to hatch at all. His findings, based on studying a population of Lincoln’s sparrows in a remote stretch of Colorado’s San Juan Mountains, were published in the March 12,2008 issue of PLoS ONE. "I believe this is the first study to follow siblings from laying through fledging and demonstrate that the effect of laying order on hatching is very different from its effect post-hatching," said Sockman.

It is well-known that because the youngest hatchlings are too small to compete with their stronger brood-mates for the food provided by their parents, they often die. This pattern is often repeated in other animals, from beetles to marsupials to humans. But these observations have so far not allowed for whathappens to eggs before they hatch.

Female Lincoln’s sparrows usually produce three to five eggs, laying one egg a day. Monitoring the birds for three breeding seasons, Sockman and his researchers noticed that the mothers did not start incubating the eggs right away, since they had other things claiming their attention, such as foraging for food. Sockman thinks this makes it probable that first-laid eggs won’t hatch at all, besides helping ensure that a greater number of healthy, strong birds will hatch and mature into young birds.

"At these elevations, conditions can be fairly harsh even during the summer when Lincoln’s sparrows breed," said Sockman. "It’s often freezing at night, which is hard on an un-incubated egg, while daytime temperatures are warm enough to foster the growth of harmful microbes. As a result, since the mother sparrow isn’t keeping them at the most optimal incubating temperature from day one, first-laid eggs can be exposed to environmental conditions that lower the chance those embryos will ever see the world outside their shell."

"If the female did start incubating all her eggs as soon as she laid them, it would increase the probability they’d all hatch. But it would also give a huge head start to those first-laid eggs and the chicks that emerge from them, putting their younger siblings at even more of a competitive disadvantage once they begin battling for food and their mother’s attention," said Sockman.

"It may also reduce the number of eggs she is capable of laying.The mother’s careful balancing of this trade-off enables her to end up with three or four relatively equally robust offspring, instead of one or two strong hatchlings and several "runts of the litter."

Sockman plans to examine what, if any repercussions laying order has once young birds reach adulthood. "The severely competitive environment in the nest may have consequences on the individual’s ability to compete for resources and mates the following year when it is reproductively mature," said Sockman.

Keep these findings in mind as you raise your own young!

Industry Standards Needed for Children’s Flu Vaccine, Says Report

Evaluating and establishing industry standards for flu vaccines for hospitalized children could help prevent additional hospitalizations and complications from influenza, according to a study published in a recent issue of Pediatrics.

A research team led by Danielle M. Zerr, MD, MPH, medical director of infection control at Seattle Children’s Hospital and associate professor of Pediatrics at the University of Washington School of Medicine (UWSOM), monitored the number of times children with influenza had been hospitalized, and summarized their findings in an article entitled "Hospital-Based Influenza Vaccination of Children: An Opportunity to Prevent Subsequent Hospitalization."

It was found that 23% of the children admitted to hospital with influenza had a previous hospitalization during the most recent flu season. This suggests that providing in-hospital vaccinations when the children were at highest risk for influenza could reduce the rates of childrens’ influenza during the flu season.

Approximately 14,000 children were hospitalized with influenza—and 170,000 were hospitalized with influenza or a respiratory illness—during a 5-year period (2001–2006) when discharge data provided by the Pediatric Health Information System (PHIS) database was analyzed. The data was checked to see how many children had a previous hospitalization during the most recent flu season.

Researchers found approximately 16% of those hospitalized with influenza and 23% of those hospitalized with influenza and another underlying condition had previous hospital admissions during the vaccination season.

"This information will help pediatricians recognize hospitalization as an important opportunity to vaccinate the highest-risk children, and may hopefully prompt the development of hospital-based flu vaccine programs," said Zerr.

The study looked at five years of hospital discharge data from the Pediatric Health Information System (PHIS) database from 2001 through 2006 to determine how many children hospitalized with influenza or respiratory illness had a previous hospitalization during the most recent flu-vaccine season. PHIS is an administrative database developed by the Child Health Corporation of America (CHCA), used by 42 free-standing pediatric hospitals. Subjects included newborns through age 18. A previous hospitalization during flu vaccination season was considered if it occurred in the two weeks to six months prior to the influenza admission and between September 1 and March 1. Approximately 14,000 cases of children hospitalized with influenza and 170,000 hospitalized with influenza or a respiratory illness were reviewed.

Source: Pediatrics, February, 2008

Many Doctors Inadequately Trained for Prescribing Medicine to Children

Research published in Archives of Disease in Childhood suggests that inadequate training among healthcare professionals increases the risk of prescribing errors for childrens’ medicines. Children are especially vulnerable to mistaken prescribing because formulations are not designed specifically for them, and doses have to be individually figured.

Existing research revealed that junior doctors did not know what to prescribe for chest infections or anaphylaxis. The authors were able to find only two studies relevant to the teaching of prescribing skills, and these showed that the error rate fell after the introduction of specific techniques; but the conclusions did not show which had been most effective.

The survery generated a response rate of 57%, with 319 out of 559 questionnaires returned. They showed that training in the avoidance of mistakes in prescribing childrens’ medications was brief, and primarily veral with little practical training.

Eleven centers taught doctors how to complete a drug chart, with another seven reviewing common errors. Only one center offred a computer-based prescribing course showing the correct calculaton of drug doses. In thirteen centers the training amounted to a presentation by specialist pharmacists, of between 30 and 60 minutes, while another ten centers simply gave trainees an induction pack with written information. Only three centers tested prescribing competency.

This research may not present a complete picture of current prescribing training, say the authors, but meanwhile there are no national standards on the teaching of prescribing medicines for children. So that finding which teaching methods are most effective in reducing errors, if any, has geat mportance.

Source: (em>First Arch Dis Child 2007; doi: 10.1136/adc.2007.127761

Insufficient Sleep Could Lead to Overweight Kids

Research findings from the University of Michigan C.S. Mott Children’s Hospital indicate that kids who don’t get enough sleep may be at increased risk of being overweight.

A study researching the connection between length of sleep and weigh for third and sixth grade children showed that kids who got less than 9 hours sleep per day were at greater risk of being overweight—regardless of their gender, race, socioeconomic status, or home environment quality.

The study showed that sixth graders short on sleep were more likely to be overweight. Third graders who got fewer hours of sleep—regardless of their BMI—were more likely to become overweight in sixth grade. The findings of this study appear in the November issue of the journal Pediatrics.

"Many children aren’t getting enough sleep, and that lack of sleep may not only be making them moody or preventing them from being alert and ready to learn at school, it may also be leading to a higher risk of being overweight," says study lead author Julie C. Lumeng, M.D., assistant research scientist at the U-M Center for Human Growth and Development. "This study suggests that an increased risk for overweight is yet another potential consequence of short sleep duration, providing an additional reason to ensure that children are receiving adequate sleep, primarily through enforcing an age-appropriate bed time."

Data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development on reported sleep problems, sleep duration and BMI for 785 elementary school children, aged 9 to 12, was reviewed . 50% were male, 81% were white, 18% were overeight in the sixth grade. The overweight sixth grade lids slept fewer hours than those were not overweight, with boys in the majority of overweight sixth grade children.

"Even more important," Lumeng says, "is emerging research that shows a connection between sleep disruption and the hormones that regulate fat storage, appetite and glucose metabolism. Short sleep duration alters carbohydrate metabolism, and leads to impaired glucose tolerance, which can affect a person’s weight. Circadian rhythms, too, affect the body’s leptin, glucose and insulin levels."

So weight gain may not be a result of sleep’s effect on behavior, notes Dr. Lumeng, but rather sleep’s effect on hormone secretion in the body, specifically leptin and grehlin.

The National Sleep Foundation recommends these basic daily sleep requirements for children, adolescents, pre-teens and teens:

  • Preschoolers: 11-13 hours
  • Elementary school students: 10-12 hours
  • Pre-teens: 9 – 11 hours
  • Teens: 8 ½ – 9 hours

In addition to Lumeng, co-authors from the U-M Center for Human Growth and Development are Deepak Somashekar, B.S., and Niko Kaciroti, Ph.D.; Danielle Appugliese, MPH, with the Data Coordinating Center, Boston University; and Robert F. Corwyn, Ph.D., and Robert H. Bradley, Ph.D., with the Center for Applied Studies in Education, University of Arkansas.

The study was supported by the American Heart Association Fellow-to-Faculty Transition Award, and the American Heart Association Midwest Affiliate Grant-in-Aid.

Reference: Pediatrics, November 2007, Vol. 120, Issue 5.

Childcare by Mothers with Low Education Levels More Likely to Lead to Aggresive Child Behavior

In a recent study of mothers with low education levels and their children, those kids receiving regular care from adults other than their mothers during their preschool years were found to exhibit less physical aggression, such as hitting, kicking or biting.

"The origin of physical aggression problems can be traced back to early childhood, and studies have specifically shown that maternal characteristics, especially low levels of education, are among the best predictors of high physical aggression from early childhood to adolescence," the study’s authors write.

Sylvana M. Cote, Ph.D. of the University of Montreal and colleagues studies 1,795 infants, a cross-section of all children born in Montreal in 1997 and 1998. Mothers were asked to provide information on family, parent and child characteristics from when the child was 5 months to 60 months, including details of adult non-maternal care provided, including daycare centers, family arrangements or other non-maternal care provided regularly during preschool years.

Overall, 1,691 children were followed for the whole study, of which 111 (6.6 percent) received no non-maternal care before preschool, 234 (13.8 percent) received some type of non-maternal care beginning before age 9 months and 1,346 (79.6 percent) received non-maternal care beginning at age 9 months or after.

Children whose mothers had a low education level (i.e., did not have a high school diploma) were less likely to receive daycare. However, those children who did receive non-maternal care had lower levels of physical aggression, and the association was statistically significant among children who started day care before age 9 months.

Children of mothers who graduated from high school were at lower risk of developing physical aggression problems, and non-maternal care had no additional effect on their behavior.

The study’s authors conclude that "provision of non-maternal care services to children of mothers with low levels of education could substantially reduce their risk of chronic physical aggression, and that the protective impact is more important if children begin to receive these services before age 9 months… Because the children most likely to benefit from non-maternal care services are those less likely to receive them, universal programs involving the provision of non-maternal care should include special measures encouraging the use of non-maternal care services among high-risk families."

The study was supported by the Quebec Government Ministry of Health and Fond, Quebecois de la Recherche sur la Societe et la Culture, Canada’s Social Science and Humanities Research Council, Canadian Institutes for Health Research, St-Justine Hospital’s Research Center and the University of Montreal.

Source: Arch Gen Psychiatry. 2007;64(11):1305-1312.

Teaching Kids Hand Washing Habits to Avoid Flu

A new study, presented at the American Public Health Association’s Annual Meeting & Exposition in Washington, D.C. shows that with a little effort, kids can be taught to make hand-washing a lifetime habit.
A sample of 492 children in grades 1 through 6 was coached by a teacher, with role-playing and education on hand hygiene and a visual demonstration of its effectiveness. The coaching resulted in a lasting increase in the frequency of hand hygiene among elementary school-aged children.
The researchers suggest that with parent volunteers and the limited funds available, the school nurse could train the volunteers to teach a hand hygiene method, using germ-simulating lotion. The teachers could then prompt students to wash their hands before lunch, setting the example by washing their own hands.
"With flu season right around the corner, now is a great time to be having a conversation about what schools can do to encourage kids to develop the habit of washing their hands," said Michelle Snow, RN, MSPH, SHR, lead researcher on the study. "Our research shows that for a very low cost and just a little bit of effort, we can have an impact on a behavior that is important for our children’s health, not just now, but throughoutmtheir lives."
Source: American Public Health Association (APHA)

It’s Official! Feds Nix Cold and Cough Meds for Kids Under Six

After weeks of speculation, the Food and Drug Administration (FDA) took the additional step of recommending that cold and cough medicines used by parents for generations no longer be administered to children under six.

While the resolution of the FDA is "not binding," it will surely impact how such medications are marketed, displayed and used.

The recommendation applies to medications containing any of the following ingredients: decongestants, antitussives (against cough) and antiistamines.

Not only to the over-the-counter medicines for cough and colds apparently not work for kids, but there are documented incidents of the meds leading to death in the recipient kids (generally due to parental misuse).

In a separate action, the American Academy of Pediatrics recently backed a petition by pediatricians urging banning such medications from kids under six.

Source: FDA


List of Withdrawn Pediatric Cold Medicines

The following medicines are among those that have been withdrawn from the market by their manufacturers for treatment of coughs and colds in infants. If you have any of these medicines at home, it would be wise to discard them to avoid accidental administration.

If you wish to use any of these medications for children between the ages of 2 -6, please contact your pediatrician for additional information. Be advised that their use in the 2-6 age group, while not covered by the current voluntary withdrawal, remains controversial.

Manufactured by Johnson & Johnson:

  • Concentrated Infants’ Tylenol Drops Plus Cold
  • Concentrated Infants’ Tylenol Drops Plus Cold & Cough
  • Pediacare Infant Drops Decongestant (PSE)
  • Pediacare Infant Drops Decongestant & Cough (PSE)
  • Pediacare Infant Dropper Decongestant (PE)
  • Pediacare Infant Dropper Long-Acting Cough
  • Pediacare Infant Dropper Decongestant & Cough (PE)

Manufactured by Novartis:

  • Triaminic Infant & Toddler Thin Strips Decongestant
  • Triaminic Infant & Toddler Thin Strips Decongestant Plus Cough

Manufactured by Prestige Brands Holding

  • Little Colds Decongestant Plus Cough
  • Little Colds Multi-Symptom Cold Formula

Manufactured by Wyeth Labs

  • Dimetapp Decongestant Infant Drops
  • Dimetapp Decongestant Plus Cough Infant Drops
  • Robitussin Infant Cough DM Drops

Source: FDA

Baby Cold Medicines Withdrawn

In a voluntary drug withdrawal initiated by the FDA, major manufacturers of over-the-counter cold and cough medicine targeted to infants have withdrawn their products.

The stated reason was to avoid misuse by misinformed parents. The withdrawal only affects products for infants, leaving products for use in children 2 and older on the market.

Further research, and further negotiations between pharmaceutical companies and the FDA will decide the fate of cold medicines marketed to the 2 – 6 year old population.

In the New York Times, Dr. Daniel Fratarelli, a pediatrician on the American Academy of Pediatric’s committee on drugs stated in regard to pediatric cough and cold medicines, "I don’t recommend their use in any child… These medicines don’t help, they may hurt, so don’t use them."