On-time immunization of very low birthweight infants

Pfister and colleagues have performed a meticulous study ofadverse events associated with immunization with a DTaP-containing vaccine of a most vulnerable group of very-low-birth-weight premature infants. Although immunizing experienceswith premature infants have been reported previously by others,the attention to detail and categorization of infants’ underlyingcharacteristics, the careful monitoring over the 24 hours beforeand 48 hours after immunization, and delineation of severity ofevents make this study definitive.

One can expect that: (1) approximately 50% of such infantsoverall will have resurgence or increase in cardiorespiratory eventspostimmunization, which peaks at 24 hours; (2) relative risk ispredictable by severity of underlying conditions up to the time ofimmunization; and (3) postimmunization events may requiretransient increased monitoring or simple intervention, but willnot have detrimental impact on infants’ clinical course. The glassis more than half full. The authors describe policy for immuniza-tion in their neonatal intensive care units that evolved fromevidence of this study. Importantly, it applies to both infantsbeing discharged and those staying in the hospital. With pertussisprevalent in all of our communities, their policies should becomebroad recommendations.

—Sarah S. Long, MDPage 58

Evidence of early lung involvement in CFBrody and colleagues studied chest high-resolution com-

puterized tomography (HRCT) in cystic fibrosis (CF) patientswith mild to moderate chest disease and relatively normal pulmo-nary function tests. The investigators identified a high incidenceof regional bronchiectasis, air trapping, and mucous plugging inotherwise normal appearing lungs (Figure). These findingsdemonstrate that HRCT is a sensitive tool that will be valuablein understanding the natural history of this disease. In theaccompanying editorial, McColley points out how these findingscan be used in clinical trials that seek to alter the course of lungdisease in its earliest stages.

—Thomas Green, MDPage 6 (editorial)Page 32 (article)

2A July 2004

Behavior, food, and obesityClearly, dietary intake of calories is a major factor in the

development of obesity in children. It seems likely that theinteraction of a child and their parents around food is important,but the literature on this is not extensive. In this issue of TheJournal, Agras et al examine factors that are related to the devel-opment of overweight. They followed children from birth to age 9years and found that childhood overweight is strongly related toparental overweight. They also found evidence that persistenttantrums over food in preschool children is predictive of child-hood overweight. This type of research may provide informationon the children at highest risk to gain excess weight and also mayhelp inform behavioral interventions that can prevent weight gain.

—Stephen R. Daniels, MD, PhDPage 20

Nutrition in children with sickle cell diseaseIt is well known that vitamin A deficiency in children living

in developing countries is associated with greater mortality andmorbidity as well as poor growth and development. Unfor-tunately, growth failure and abnormalities in nutrient metabolismare also not uncommon in children with sickle cell disease in theUnited States. Schall et al have documented suboptimal vitaminA status (lower serum retinol levels) in a significant percentage ofpatients with sickle cell disease cared for in a tertiary care settingin Philadelphia. They further document that suboptimal vitaminA status in these children was associated with worse clinical statusand outcomes—such as an increased number of hospitalizations,increased severity of anemia, and more frequent fever and painevents than children with sickle cell disease who had normalserum retinol levels. This data presents a compelling argument forus all to intensify our efforts to optimize the nutritional status ofchildren with chronic disease to improve outcomes.

—William F. Balistreri, MDPage 99

The Journal of Pediatrics