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PubMed2006

Recent developments in the pharmacological management of pain in children.

PURPOSE OF REVIEW: This review explores progress in developmental pharmacokinetics, pharmacogenomics and formulations of analgesic agents, and discusses potential implications for pain therapy. RECENT FINDINGS: Characterization of the developmental pharmacokinetics of morphine, tramadol, paracetamol and nonsteroidal anti-inflammatory drugs has improved dosing in children. Oral sugar solutions have replaced the brandy/sugar pacifier and are effective for single painful events in neonates. Intravenous paracetamol offers increased dosing accuracy, and avoids absorption and bioavailability variability. New nitric-oxide-releasing versions of paracetamol and nonsteroidal anti-inflammatory drugs offer safer alternatives to their parent drugs with enhanced potency. Ketamine has come under a cloud for its possible effects on the neonatal developing brain, but it is being used increasingly in children to supplement opioids for pain after major surgery. Hopes that morphine analgesia may improve neurological outcome in premature babies have not materialized. Reports concerning chronic pain are generally case series and controlled trials are rare and nearly nonexistent in children. SUMMARY: Unlicensed drug use in the very young will increase as familiarity increases. Pharmacogenomic studies have the potential to tailor drug therapy to the individual and decrease between-patient variability. Unfortunately, the pharmacodynamic knowledge in children of analgesic agents remains neglected and is usually extrapolated from adult data.

Adolescent↗
PubMed2006

Predictors for Haemophilus influenzae colonization, antibiotic resistance and for sharing an identical isolate among children attending 16 licensed day-care centers in Michigan.

BACKGROUND: Nontypable Haemophilus influenzae is an important cause of otitis media in children. Children attending day-care centers are at an increased risk for nontypable H. influenzae colonization and otitis media. We describe the prevalence of nontypable H. influenzae colonization, antibiotic resistance and predictors for colonization and sharing an identical isolate with at least 1 other child in the same day-care centers among children attending 16 day-care centers. METHODS: Throat swabs of 198 children < 3 years old attending 16 day-care centers were cultured for H. influenzae. Day-care center directors and parents completed risk factors questionnaires. Nontypable H. influenzae isolates were screened for antibiotic resistance and genotyped. Statistics were performed using SAS software (SAS Institute, Inc., Cary, NC). RESULTS: We isolated 179 unique nontypable H. influenzae strains from 127 participants. Colonization ranged from 0% to 95% among day-care centers. As individual factors, exposure to tobacco smoke was associated with colonization (P = 0.05), and racial self-identifications as "other" (nonwhite, nonblack) was protective (P = 0.035), whereas as "black" was protective for sharing (P = 0.03). Pacifier use was associated with sharing (P = 0.04), but not with colonization. As day-care centers factors, rates of colonization and sharing were higher in day-care centers with > or = 5 classrooms (P < 0.01 and P = 0.03), with such suboptimal hygiene habits as minimal hand washing by staff after eating (P < 0.002 and P < 0.01) or by children after wiping their own nose (P = 0.01 and P = 0.003). Of colonized children, 41% presented a beta-lactamase-producing strain. Colonized children were more likely to carry resistant strains if they were taking an antibiotic (P = 0.02). CONCLUSION: Although day-care center colonization varied, the overall colonization rate was high. Colonization with nontypable H. influenzae, with beta-lactamase-producing strain and sharing were, mostly, associated with modifiable risk factors.

Carrier State↗
PubMed1997

Migration policy objectives for European East-West international migration.

"The study contains selected results of Delphi research (subjective judgements concerning the future on a collective expert basis) on international migration between Central/Eastern (C/EEc) and Western European countries. Taking part in the research were 109 scholars and officers....from all over Europe.... Results indicate growing problems and tensions in societies, the division of Europe into two parts, and the triggering rather than pacifying of further antagonisms and hostile anti-immigrant attitude on the Western side.... Concerning policy objectives, the two most important general aims were how to contribute to migration stabilization in the East, and how to maintain and further develop stable democratic order and promote economic development." (SUMMARY IN FRE AND SPA)

Attitude↗
PubMed2004

Latex allergy in infants younger than 1 year.

BACKGROUND: The prevalence of latex allergy in children is increasing worldwide. Previous multiple operations or atopic predisposition are known risk factors. In contrast, only sporadic cases of latex allergy have been reported in infants younger than 1 year, and the causative latex-containing products or symptoms in young infants have not been studied in detail. OBJECTIVE: The purpose of this study is to analyse the symptoms and risk factors of latex allergy in young infants. METHODS: Cases of latex allergy in infants younger than 1 year were studied in detail. Clinical course, causative latex-containing products were spotted and detailed analysis for latex allergy in patients and patients' parents was performed. CONCLUSION: We report nine cases of latex allergy in infants younger than 1 year. None of them have any abnormality or previous operations. Six patients had atopic eczema/dermatitis syndrome, one patient had bronchial asthma, whereas two patients had no overt allergic diseases. Symptoms of latex allergy were wheezing, swelling of face or lips, facial rash, or anaphylaxis, and causative latex-containing products were teat, pacifier, nose cleaner, teether, balloon, or enema tube. All of the nine patients had positive skin prick test to latex and extract from causative latex-containing products, whereas eight patients had positive serum latex-specific IgE. Study for family history revealed that latex allergy was noted in either father or mother in six patients, in both father and mother in one patient, whereas no latex allergy was noted in parents in two patients. It should be noted that all of these patients had latex-induced symptoms at home. Latex allergy in young infants may not be unusual. Physicians should be aware of latex allergy, and care should be taken to avoid contact with latex in young infants, especially when there is family history for latex allergy.

Asthma↗
PubMed2004

Increased prevalence of latex-sensitization among children with chronic renal failure.

BACKGROUND: Type-I-allergy to natural rubber latex (NRL) has been shown to be more prevalent among certain groups of patients. Children suffering from chronic renal failure (CRF) could be a suspected risk group because of their intense exposure to latex through catheters, gloves and anesthetic equipment during frequent hospitalizations from early life on. We investigated the prevalence of latex-sensitization among this group of patients and sought to identify risk factors. METHODS: Ninety-three patients (mean age 10.5 years) suffering from CRF were assessed by questionnaire-based history (details on renal disease, number and kind of surgical procedures, family and personal history of atopic diseases, allergic reactions to NRL, and the use of pacifiers) and by measurement of total and latex-specific serum immunoglobulin (Ig)E. RESULTS: Ten of 93 (10.8%) patients showed elevated latex-specific IgE-levels. One of 10 patients reported clinical symptoms to latex-allergen, but no allergic reactions to NRL during medical care were reported. Sensitized patients were significantly more likely to be atopic, reflected by a positive history of other allergies as well as elevated total serum IgE-levels, and had a significantly higher number of urogenital surgeries (P = 0.02 in all cases, Fisher's exact and Wilcoxon test, respectively). CONCLUSION: This study demonstrates that children with CRF are at increased risk of latex-hypersensitivity. Significant associations with atopy and repeated surgeries were observed. Larger studies are required to elucidate whether these children are also at increased risk of anaphylaxis and therefore deserve preventive measures.

Adolescent↗
PubMed1998

Development of latex allergy in children up to 5 years of age--a retrospective analysis of risk factors.

The aim of the study was to investigate possible associations between the time course of early sensitization to latex and various life style factors. Of the 398 children from a prospective birth cohort study, 20 (5%) showed specific serum IgE to latex at the age of 5 years. Sensitization started beyond the first year of life and 19 out of 20 sensitized children showed increasing specific IgE-values over time. All 20 sensitized children were atopic (p < 0.00000). Total IgE was significantly higher in the sensitized group (median 394.5 kU/I) than in the non-sensitized group (median 39.2 kU/l) (p < 0.00001). Comparing the latex-sensitized group with the non-sensitized children, there were significantly more operations in the latex group (p < 0.05) during the first 5 years of life. Medical history, certain foods, the use of pacifiers, mattress composition and socio-economic data proved not to be significant risk factors. From our study we conclude that besides the number of operations and an atopic predisposition--no other definite risk factor for developing sensitization or allergy to latex (such as everyday household objects) can be identified in children up to 5 years of age.

Age Factors↗
PubMed1994

Carbon dioxide concentrations in the environment of sleeping infants.

In 22 infants continuous measurements were made of the concentration of carbon dioxide (CO2) in inspired air during sleep. Evidence was found of CO2 enrichment of inspired air in certain environmental conditions. The levels achieved were not sufficiently high to acutely endanger an infant. Carbon dioxide concentrations as high as 2-3% were observed in the prone position when the infant's head was under a blanket and when the lower face was obscured by bedding. Sleeping prone on a sheepskin also resulted in an increased concentration of CO2 but to a lesser extent than being under a blanket. In awake infants the presence of a pacifier also promoted an excess of CO2 in the inspired air, both in the prone and supine positions. The physiological and clinical implications of these findings, in relation to the Sudden Infant Death Syndrome (SIDS), are unknown and warrant investigation.

Air↗
PubMed1992

Sucking technique and its effect on success of breastfeeding.

We investigated the prognostic value of sucking technique (faulty vs correct) during the first week after birth in relation to the long-term success of breastfeeding. At discharge from the maternity ward, 82 healthy mother-infant pairs were observed for assessment of breastfeeding technique and followed for four months by regular telephone checkups. Correct sucking technique was defined as the infant having a wide-open mouth, with the tongue under the areola, and expressing milk from the breast by slow, deep sucks; faulty technique was defined as superficial nipple sucking. The study population was divided into three groups: one in which faulty sucking technique was corrected when observed (n = 29), one with faulty but uncorrected technique (n = 25), and a control group with a correct technique (n = 28). At the four-month follow-up assessment, the faulty but uncorrected group was characterized by a greater proportion of mothers with breastfeeding problems and early cessation of breastfeeding than the other two groups. Regular use of a pacifier (> 2 hrs/day) was more common among those with breastfeeding problems.

Breast Feeding↗
PubMed1991

Drug-exposed infants at home: strategies and supports.

This longitudinal, descriptive study gathered information on drug-exposed infants at home and identified effective public health nurse interventions for them and their caregivers. These infants exhibit symptoms that may well interfere with their ability to give clear cues as part of the infant-caregiver interactive system. This may amplify or perpetuate the effects of the drugs and low birth weight. Fifteen infants with a positive toxicology screen were compared to controls at birth and followed for up to 12 months of age through home visits by a public health nurse practitioner. The drug-exposed infants were significantly smaller at birth, and their most common initial problems were the need for nonnutritive sucking, excessive extensor tone, infections, and irritability. The mean weight, length, and head circumference went from the 10th to the 25th percentile at birth to the 25th to 50th percentile at 12 months. The support system and organization of the home predicted the family's ability to sustain caregiving for these infants. Effective strategies to care for these infants included recognizing states and cues, swaddling, use of pacifier, waking to eat, and smaller feedings. The role of the public health nurse was crucial for conducting early assessment, implementing strategies, and facilitating a therapeutic relationship.

Birth Weight↗
PubMedDate not supplied

Pooled human albumin primes neutrophils.

Human pooled albumin has traditionally been used both to pacify the artificial surfaces in a cardiopulmonary bypass circuit and also for volume repletion following surgery. In evaluating the routine use of albumin in multiple phases of cardiac surgery, conscientious surgical teams must assess both the physiological and financial price of albumin. Albumin indiscriminately binds many plasma proteins and lipids. In this series of experiments, we explored the influence of highly purified albumin devoid of bound lipids and globulins on both receptor-dependent (FMLP) and receptor-independent (PMA) priming/activation of human neutrophils. We believe that it is important to distinguish the direct influence of albumin from the albumin-bound proteins and lipids. We, therefore, also examined the effect of clinically accessible human pooled albumin on human neutrophils. We observed a dose-dependent priming/activation (elastase release) of human neutrophils by both pooled and purified albumin. We conclude that it is increasingly difficult to justify the routine use of albumin in cardiac surgical patients.

Biomarkers↗
PubMedDate not supplied

Nonnutritive sucking during tube feedings: effect on clinical course in premature infants.

Fifty-nine infants, 28--34 weeks' gestation, were assigned to treatment and control groups. Treatment infants were offered a pacifier during and following every tube feeding; control infants received routine care. The treatment began when an infant could tolerate room air and 10 cc of full-strength formula by tube; it ended when the infant was totally bottle fed. Treated infants showed readiness for bottle feeding 3.4 days earlier, i.e., with 27 fewer tube feedings each. Performance during the first bottle feeding was assessed with a feeding scale and was statistically similar for both groups. From study entry to first bottle feeding the treated infants gained 2.6 gm/day more and were discharged 4 days sooner. Complications differed between the two groups.

Body Weight↗
PubMedDate not supplied

An evidence-based multidisciplinary protocol for neonatal circumcision pain management.

Pain experienced in infancy may have effects later in life. Neonatal circumcision is a common painful procedure. In addition to dorsal penile nerve block, interventions that may have a role in minimizing pain and distress in neonatal circumcision include use of a sucrose pacifier, buffered lidocaine, small needles, acetaminophen, swaddling, and environmental modification. The evidence for each intervention is presented and evaluated. Implementation of a comprehensive evidence-based circumcision pain control standard of practice is discussed.

Circumcision, Male↗
PubMed2004

Cross-sectional study of oral mucosal conditions among a central Amazonian Indian community, Brazil.

BACKGROUND: A cross-sectional study on the oral mucosal conditions among the Waimiri Atroari Indians from central Amazonia, Brazil, has been conducted. These Indians keep their traditional way of life and are free from habits such as smoking, alcohol drinking, and use of pacifiers. METHODS: Clinical examinations of a representative, randomly selected sample of patients during routine dental treatment, following ethical procedures recommended by Brazilian laws were made. RESULTS: Out of 922 individuals, 587 were examined, among which 52.57% of the children up to 12 years old and 73.44% of patients aged 13 years or older presented at least one oral mucosal condition. The conditions more frequently observed were, in decreasing order of prevalence: fissured tongue, focal epithelial hyperplasia (FEH), lesions of traumatic origin, geographic tongue, Fordyce's spots, and candidiasis. Only one case of leukoplakia was identified. CONCLUSIONS: Conditions observed among theses Indians were essentially the same that have been described in other populations around the world, except for FEH, which, as a characteristic lesion of Indians, had high prevalence (20.95%). The lesions observed were related to the way of life of this specific population.

Adolescent↗
PubMed1987

The effect of non-nutritive sucking on plasma insulin, gastrin, and somatostatin levels in infants.

The aim of the present investigation was to study the effect of non-nutritive sucking on plasma levels of insulin, gastrin, and somatostatin in infants. These hormones were measured with radioimmunoassay in plasma collected from fullterm and preterm infants sucking a pacifier. In fullterm infants, sucking caused a significant increase of insulin levels from 13 +/- 10 microU/ml to 40 +/- 36 microU/ml and 21 +/- 17 microU/ml after 45 sec and 5 min respectively, from when the infants started sucking. A similar pattern was seen in preterm infants. In contrast, gastrin and somatostatin levels were not significantly affected. We suggest that sucking causes an activation of the vagal nerve, which results in the release of insulin. We also suggest that in infants, oral feeding is superior to bolus feeding, since in the latter case no vagal activation and consequently no release of hormones with anabolic properties occurs.

Gastrins↗
PubMed1997

Recording non-nutritive sucking in the neonate. Description of an automatized system for analysis.

A new method for automatic analysis of non-nutritive sucking in newborn infants is described, which uses a specially designed computer program that analyses an analogue signal obtained from a pressure transducer inside a pacifier. Validation is done with four independent methods: electromyogram, visual identification, control of the automatic treatment and comparison of inter-observer results. A high degree of correspondence is shown. The system was applied to 58 healthy full-term neonates. Infants less than 24 h old demonstrated a significantly different sucking pattern compared with the 3-day-old infant. The duration of their bursts was longer (3.7 vs 2.8 s), the frequency of their sucking was lower (1.7 vs 2.0 Hz) and the variability of their sucking pattern was greater. These results also testify to the validity of the method inasmuch as the values for the different sucking parameters are similar to corresponding values presented earlier.

Age Factors↗
PubMed2005

Modifiable risk factors for SIDS in Germany: results of GeSID.

BACKGROUND: The incidence of sudden infant death syndrome (SIDS) has been falling in Germany over the last decade. However, little is known about the prevalence and the importance of well-known risk factors in Germany since a local prevention campaign in 1992. DESIGN: A 3-y, population-based, case-control study was conducted in half of Germany, consisting of 333 cases. All sudden and unexpected deaths in infancy, if they fitted the inclusion criteria, were included in the study. Parental interview was carried out soon after the death, and three living control infants, matched for age, gender, region and sleep time, were recruited. RESULTS: The prevalence of placing infants prone to sleep was only 4% in the control group, but this was associated with a markedly increased risk of SIDS (adjusted odds ration, aOR=6.08). Other modifiable risk factors for SIDS were: maternal smoking during pregnancy, breastfeeding for less than 2 wk (aOR=1.71) and co-sleeping (aOR=2.71), while using a pacifier during the last sleep reduced the risk (aOR=0.39). CONCLUSIONS: Previously recognized risk factors for SIDS also occur in Germany. Despite knowledge about the major modifiable risk factors for SIDS, these factors are still present in Germany. To reduce the incidence of SIDS in Germany, a continued effort is needed to inform all parents about preventable risk factors for SIDS.

Adult↗
PubMed2006

Breastfeeding in the WHO Multicentre Growth Reference Study.

AIM: To document how children in the WHO Multicentre Growth Reference Study (MGRS) complied with feeding criteria and describe the breastfeeding practices of the compliant group. METHODS: The MGRS longitudinal component followed 1743 mother-infant pairs from birth to 24 mo in six countries (Brazil, Ghana, India, Norway, Oman and the USA). The study included three criteria for compliance with recommended feeding practices that were monitored at each follow-up visit through food frequency reports and 24-h dietary recalls. Trained lactation counsellors visited participating mothers frequently in the first months after delivery to help with breastfeeding initiation and prevent and resolve lactation problems. RESULTS: Of the 1743 enrolled newborns, 903 (51.8%) completed the follow-up and complied with the three feeding criteria. Three quarters (74.7%) of the infants were exclusively/predominantly breastfed for at least 4 mo, 99.5% were started on complementary foods by 6 mo of age, and 68.3% were partially breastfed until at least age 12 mo. Compliance varied across sites (lowest in Brazil and highest in Ghana) based on their initial baseline breastfeeding levels and sociocultural characteristics. Median breastfeeding frequency among compliant infants was 10, 9, 7 and 5 feeds per day at 3, 6, 9 and 12 mo, respectively. Compliant mothers were less likely to be employed, more likely to have had a vaginal delivery, and fewer of them were primiparous. Pacifier use was more prevalent in the non-compliant group. CONCLUSION: The MGRS lactation support teams were successful in enhancing breastfeeding practices and achieving high rates of compliance with the feeding criteria required for the construction of the new growth standards.

Breast Feeding↗
PubMed2003

Altered arousal response in infants exposed to cigarette smoke.

AIMS: A failure of the arousal mechanism is a key feature in the apnoea theory for sudden infant death syndrome (SIDS). In infants studied at an age when the incidence of SIDS is highest, we evaluated whether in utero smoke exposed infants have altered arousal response to standardised auditory stimuli, and/or sleep pattern, as recorded on overnight complex sleep polysomnography. METHODS: A standardised sequence of audiology stimuli was applied binaurally to 20 in utero smoke and non-smoke exposed infants aged 8-12 weeks during a rapid eye movement (REM) and NREM epoch, in a controlled (temperature, position, pacifier use, noise) sleep environment. Infants were monitored for 10-12 hours using complex sleep polysomnography. RESULTS: Five infants exposed to in utero tobacco smoke did not have behavioural arousal response, whereas all non-smoke exposed infants aroused during NREM (p = 0.016). There was, however, no difference in REM sleep, and the groups did not differ in routine overnight complex sleep polysomnography parameters. CONCLUSION: At the age when the incidence of SIDS is at its peak, infants of smoking mothers are less rousable than those of non-smoking mothers in NREM sleep; this may partly explain why such infants are more at risk of SIDS.

Adult↗