8.12.14

Pediatric exposure to laundry detergent pods.

(Las cápsulas de detergente son un producto doméstico peligroso)

Valdez ALCasavant MJSpiller HAChounthirath TXiang HSmith GA.

 2014 Dec;134(6):1127-35. doi: 10.1542/peds.2014-0057. Epub 2014 Nov 10.

OBJECTIVE:

Laundry detergent pods are a new product in the US marketplace. This study investigates the epidemiologic characteristics and outcomes of laundry detergent pod exposures among young children in the United States.

METHODS:

Using data from the National Poison Data System, exposures to laundry detergent pods among children younger than 6 years of age during 2012-2013 were investigated.

RESULTS:

There were 17 230 children younger than 6 years exposed to laundry detergent pods in 2012-2013. From March 2012 to April 2013, the monthly number of exposures increased by 645.3%, followed by a 25.1% decrease from April to December 2013. Children younger than 3 years accounted for 73.5% of cases. The major route of exposure was ingestion, accounting for 79.7% of cases. Among exposed children, 4.4% were hospitalized and 7.5% experienced a moderate or major medical outcome. A spectrum of clinical effects from minor to serious was seen with ingestion and ocular exposures. There were 102 patients (0.6%) exposed to a detergent pod via ingestion, aspiration, or a combination of routes, including ingestion, who required tracheal intubation. There was 1 confirmed death.

CONCLUSIONS:

Laundry detergent pods pose a serious poisoning risk to young children. This nationwide study underscores the need for increased efforts to prevent exposure of young children to these products, which may include improvements in product packaging and labeling, development of a voluntary product safety standard, and public education. Product constituent reformulation is another potential strategy to mitigate the severity of clinical effects of laundry detergent pod exposure.

5.12.14

 Risk and Protective Factors for Falls From Furniture in Young Children: Multicenter Case-Control Study.

Kendrick D y cols. JAMA pediatr. 2014 Dec 1. doi: 10.1001/jamapediatrics.2014.2374. [Epub ahead of print]

Importance:

Falls from furniture are common in young children but there is little evidence on protective factors for these falls.

Objective:

To estimate associations for risk and protective factors for falls from furniture in children aged 0 to 4 years.

Design, Setting, and Participants:

Multicenter case-control study at hospitals, minor injury units, and general practices in and around 4 UK study centers. Recruitment commenced June 14, 2010, and ended April 27, 2012. Participants included 672 children with falls from furniture and 2648 control participants matched on age, sex, calendar time, and study center. Thirty-five percent of cases and 33% of control individuals agreed to participate. The mean age was 1.74 years for cases and 1.91 years for control participants. Fifty-four percent of cases and 56% of control participants were male. Exposures included safety practices, safety equipment use, and home hazards.

Main Outcomes and Measures:

Falls from furniture occurring at the child's home resulting in attendance at an emergency department, minor injury unit, or hospital admission.

Results:

Compared with parents of control participants, parents of cases were significantly more likely not to use safety gates in the home (adjusted odds ratio [AOR], 1.65; 95% CI, 1.29-2.12) and not to have taught their children rules about climbing on kitchen objects (AOR, 1.58; 95% CI, 1.16-2.15). Cases aged 0 to 12 months were significantly more likely to have been left on raised surfaces (AOR, 5.62; 95% CI, 3.62-8.72), had their diapers changed on raised surfaces (AOR, 1.89; 95% CI, 1.24-2.88), and been put in car/bouncing seats on raised surfaces (AOR, 2.05; 95% CI, 1.29-3.27). Cases 3 years and older were significantly more likely to have played or climbed on furniture (AOR, 9.25; 95% CI, 1.22-70.07). Cases were significantly less likely to have played or climbed on garden furniture (AOR, 0.74; 95% CI, 0.56-0.97).

Conclusions and Relevance:

If estimated associations are causal, some falls from furniture may be prevented by incorporating advice into child health contacts, personal child health records, and home safety assessments about use of safety gates; not leaving children, changing diapers, or putting children in car/bouncing seats on raised surfaces; allowing children to play or climb on furniture; and teaching children safety rules about climbing on objects.

3.11.14

EVALUATION AND TREATMENT OF CRYPTORCHIDISM: AUA GUIDELINE

EVALUATION AND TREATMENT OF CRYPTORCHIDISM: AUA GUIDELINE
American Urological Association
Thomas F. Kolon , C. D. Anthony Herndon, Linda A. Baker, Laurence S. Baskin, Cheryl G. Baxter, Earl Y. Cheng, Mireya Diaz, Peter A. Lee, Carl J. Seashore, Gregory E. Tasian, Julia S. Barthold

Cryptorchidism or undescended testis (UDT) is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified at birth. The main reasons for treatment of cryptorchidism include increased risks of impairment of fertility potential, testicular malignancy, torsion and/or associated inguinal hernia. Cryptorchidism has evolved significantly over the past half century, with respect to both diagnosis and treatment. The current standard of therapy in the United States is orchidopexy (also referred to as orchiopexy in the literature), or surgical repositioning of the testis within the scrotal sac, while hormonal therapy has fewer advocates. Successful scrotal relocation of the testis, however, may reduce but does not prevent these potential long-term sequelae in susceptible individuals. The purpose of this guideline is to provide physicians and non-physician providers (primary care and specialists) with a consensus of principles and treatment plans for the management of cryptorchidism. The panel members are representative of various medical specialties (pediatric urology, pediatric endocrinology, general pediatrics).

14.10.14

Bed-Sharing in the Absence of Hazardous Circumstances: Is There a Risk of Sudden Infant Death Syndrome? An Analysis from Two Case-Control Studies Conducted in the UK


Cita:

Blair PS, Sidebotham P, Pease A, Fleming PJ (2014) Bed-Sharing in the Absence of Hazardous Circumstances: Is There a Risk of Sudden Infant Death Syndrome? An Analysis from Two Case-Control Studies Conducted in the UK. PLoS ONE 9(9): e107799. doi:10.1371/journal.pone.0107799

Abstract

Objective

The risk of sudden infant death syndrome (SIDS) among infants who co-sleep in the absence of hazardous circumstances is unclear and needs to be quantified.

Design

Combined individual-analysis of two population-based case-control studies of SIDS infants and controls comparable for age and time of last sleep.

Setting

Parents of 400 SIDS infants and 1386 controls provided information from five English health regions between 1993–6 (population: 17.7 million) and one of these regions between 2003–6 (population:4.9 million).

Results

Over a third of SIDS infants (36%) were found co-sleeping with an adult at the time of death compared to 15% of control infants after the reference sleep (multivariate OR = 3.9 [95% CI: 2.7–5.6]). The multivariable risk associated with co-sleeping on a sofa (OR = 18.3 [95% CI: 7.1–47.4]) or next to a parent who drank more than two units of alcohol (OR = 18.3 [95% CI: 7.7–43.5]) was very high and significant for infants of all ages. The risk associated with co-sleeping next to someone who smoked was significant for infants under 3 months old (OR = 8.9 [95% CI: 5.3–15.1]) but not for older infants (OR = 1.4 [95% CI: 0.7–2.8]). The multivariable risk associated with bed-sharing in the absence of these hazards was not significant overall (OR = 1.1 [95% CI: 0.6–2.0]), for infants less than 3 months old (OR = 1.6 [95% CI: 0.96–2.7]), and was in the direction of protection for older infants (OR = 0.1 [95% CI: 0.01–0.5]). Dummy use was associated with a lower risk of SIDS only among co-sleepers and prone sleeping was a higher risk only among infants sleeping alone.

Conclusion

These findings support a public health strategy that underlines specific hazardous co-sleeping environments parents should avoid. Sofa-sharing is not a safe alternative to bed-sharing and bed-sharing should be avoided if parents consume alcohol, smoke or take drugs or if the infant is pre-term.

28.9.14

A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis.

Puhan MA, Schünemann HJ, Murad MH, Li T, Brignardello-Petersen R, Singh JA, Kessels AG, Guyatt GH; GRADE Working Group.
BMJ. 2014 Sep 24;349:g5630. doi: 10.1136/bmj.g5630.

Network meta-analysis (NMA), combining direct and indirect comparisons, is increasingly being used to examine the comparative effectiveness of medical interventions. Minimal guidance exists on how to rate the quality of evidence supporting treatment effect estimates obtained from NMA.


We present a four-step approach to rate the quality of evidence in each of the direct, indirect, and NMA estimates based on methods developed by the GRADE working group. Using an example of a published NMA, we show that the quality of evidence supporting NMA estimates varies from high to very low across comparisons, and that quality ratings given to a whole network are uninformative and likely to mislead.


Effect of Home Visiting by Nurses on Maternal and Child Mortality: Results of a 2-Decade Follow-up of a Randomized Clinical Trial.


Olds DL, Kitzman H, Knudtson MD, et al. Effect of Home Visiting by Nurses on Maternal and Child Mortality: Results of a 2-Decade Follow-up of a Randomized Clinical Trial. JAMA Pediatr. 2014 Sep 1;168(9):800-6. doi: 10.1001/jamapediatrics.2014.472. (Original) PMID: 25003802

IMPORTANCE: Mothers and children living in adverse contexts are at risk of premature death.
OBJECTIVE: To determine the effect of prenatal and infant/toddler nurse home visiting on maternal and child mortality during a 2-decade period (1990-2011).
DESIGN, SETTING AND
PARTICIPANTS: A randomized clinical trial was designed originally to assess the home visiting program`s effect on pregnancy outcomes and maternal and child health through child age 2 years. The study was conducted in a public system of obstetric and pediatric care in Memphis, Tennessee. Participants included primarily African American women and their first live-born children living in highly disadvantaged urban neighborhoods, who were assigned to 1 of 4 treatment groups: treatment 1 (transportation for prenatal care [n = 166]), treatment 2 (transportation plus developmental screening for infants and toddlers [n = 514]), treatment 3 (transportation plus prenatal/postpartum home visiting [n = 230]), and treatment 4 (transportation, screening, and prenatal, postpartum, and infant/toddler home visiting [n = 228]). Treatments 1 and 3 were included originally to increase statistical power for testing pregnancy outcomes. For determining mortality, background information was available for all 1138 mothers assigned to all 4 treatments and all but 2 live-born children in treatments 2 and 4 (n = 704). Inclusion of children in treatments 1 and 3 was not possible because background information was missing on too many children.
INTERVENTIONS: Nurses sought to improve the outcomes of pregnancy, children`s health and development, and mothers` health and life-course with home visits beginning during pregnancy and continuing through child age 2 years. MAIN OUTCOMES AND MEASURES: All-cause mortality in mothers and preventable-cause mortality in children (sudden infant death syndrome, unintentional injury, and homicide) derived from the National Death Index.
RESULTS: The mean (SE) 21-year maternal all-cause mortality rate was 3.7% (0.74%) in the combined control group (treatments 1 and 2), 0.4% (0.43%) in treatment 3, and 2.2% (0.97%) in treatment 4. The survival contrast of treatments 1 and 2 combined with treatment 3 was significant (P = .007); the contrast of treatments 1 and 2 combined with treatment 4 was not significant (P = .19), and the contrast of treatments 1 and 2 combined with treatments 3 and 4 combined was significant (post hoc P = .008). At child age 20 years, the preventable-cause child mortality rate was 1.6% (0.57%) in treatment 2 and 0.0% (SE not calculable) in treatment 4; the survival contrast was significant (P = .04). CONCLUSIONS AND RELEVANCE: Prenatal and infant/toddler home visitation by nurses is a promising means of reducing all-cause mortality among mothers and preventable-cause mortality in their first-born children living in highly disadvantaged settings.

31.8.14

Fluoride Use in Caries Prevention in the Primary Care Setting

http://pediatrics.aappublications.org/content/early/2014/08/19/peds.2014-1699.full.pdf

Fluoride Use in Caries Prevention in the Primary Care Setting. Melinda B. Clark, Rebecca L. Slayton and SECTION ON ORAL HEALTH. Pediatrics; originally published online August 25, 2014; DOI: 10.1542/peds.2014-1699

[Comentario en una revista de noticias médicas online]
Pediatricians should prescribe fluoride as soon as their patients' teeth emerge, the American Academy of Pediatrics (AAP) says in new guidelines.
Pediatricians should prescribe fluoride as soon as their patients' teeth emerge, the American Academy of Pediatrics (AAP) says in new guidelines.
Published online August 25 in Pediatrics, the clinical report lays out specific recommendations for children at each stage of development.
Although the AAP endorsed the guidelines on fluoride use from the Centers for Disease Control and Prevention in 2001, it is only now incorporating them into its own publications.
Fluoride has both risks and benefits for children, and pediatricians must be aware of these to promote their patients' oral health, write report authors Melinda B. Clark, MD, and Rebecca L. Slayton, DDS, PhD.
Although largely preventable, dental caries remains the most common chronic childhood disease in the United States. Research long ago established the effectiveness of fluoride in stopping the progression of the disease.
Fluoride use does carry some risks. The best established risks are fluorosis, subsurface hypomineralization, and porosity between developing enamel rods. Fluorosis has been increasing the last 2 decades, as sources of fluoride have become more prevalent, and it now affects about 41% of US adolescents, the authors report.
In mild cases, fluorosis takes the form of clinically insignificant striations and opaque areas. Moderate to severe cases, which are rare in the United States, can cause pitting, brittle incisor edges, and weakened grove anatomy in permanent 6-year molars. However, the risk for fluorosis development largely passes by age 8 years.
Fluoride also can also be toxic when consumed in very large quantities. The authors estimate the toxic dose of elemental fluoride at 5 to 10 mg/kg body weight. For this reason, they recommend limiting the quantity prescribed at 1 time to no more than a 4-month supply and providing supervision for fluoride use by small children.

4.8.14

Dental interventions to prevent caries in children. A national clinical guideline

http://www.sign.ac.uk/pdf/SIGN138.pdf

Scottish Intercollegiate Guidelines Network (SIGN). Dental interventions to prevent caries in children. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2014 Mar. 45 p.

Acceso a texto completo

Major Recommendations
Note from the Scottish Intercollegiate Guidelines Network (SIGN) and National Guideline Clearinghouse (NGC): In addition to these evidence-based recommendations, the guideline development group also identifies points of best clinical practice in the full-text guideline document.
The grades of recommendations (A-D) and levels of evidence (1++, 1+, 1-, 2++, 2+, 2-, 3, 4) are defined at the end of the "Major Recommendations" field.
Predicting Caries Risk
Carries Risk Assessment
C - The following factors should be considered when assessing caries risk:
  • Clinical evidence of previous disease
  • Dietary habits, especially frequency of sugary food and drink consumption
  • Social history, especially socioeconomic status
  • Use of fluoride
  • Plaque control
  • Saliva
  • Medical history
D - Specialist child healthcare professionals should consider carrying out a caries risk assessment of children in their first year as part of the child's overall health assessment.
D - Children whose families live in a deprived area should be considered as at increased risk of early childhood caries when developing preventive programmes.
Delivery of Dental Brief Interventions in the Practice Setting
Effectiveness of Dental Brief Interventions
B - Oral health promotion interventions should facilitate daily toothbrushing with fluoride toothpaste.
Format of Dental Brief Interventions
B - Oral health promotion interventions should be based on recognised health behaviour theory and models such as motivational interviewing.
Social Determinants of Oral Health
C - As part of the patient assessment, a social history should be taken which will contribute to dental brief interventions being specific to individuals and tailored to their particular needs and circumstances.
Toothbrushing with Fluoride Toothpaste
Concentration of Fluoride Toothpaste
A - Following risk assessment, children and young people up to the age of 18 years who are at standard risk of developing dental caries should be advised to use toothpastes in the range 1,000 to 1,500 parts per million fluoride (ppmF).
- Following risk assessment, children aged from 10 to 16 years who are at increased risk of developing dental caries should be advised to use toothpastes at a concentration of 2,800 ppmF.
Frequency and Duration of Brushing
Frequency of Toothbrushing
A - Toothbrushing with fluoride toothpaste should take place at least twice daily.
Supervised Toothbrushing
A - Supervision of toothbrushing with fluoride toothpaste is recommended as an effective caries prevention measure.
Toothbrushing Practice
A - Children should be encouraged to spit out excess toothpaste and not rinse with water after brushing.
Topical Anticaries Interventions
Topical Fluoride Varnish
A - Fluoride varnish should be applied at least twice yearly in all children.
Sealants
Use of Sealants
A - Resin-based fissure sealants should be applied to the permanent molars of all children as early after eruption as possible.