With the start of 2018, many new studies have appeared in the world of pediatrics. Here are my choices of the few most interesting and relevant picks for pediatricians at the start of this year.
Persistent Opioid Use Among Pediatric Patients After Surgery
Pediatrics (January 2018)
What we already know: The opioid epidemic in the United States is an ongoing crisis of supreme significance. It claimed 64,000 lives in the year 2016 and the toll continues to rise.
In this study, researchers at University of Michigan looked at persistent opioid usage after surgical care in the adolescent and young adult age group (13–21 years old) for the first time. They used a national cohort of 88,637 patients, in which persistent opioid usage was defined as filled prescriptions >90 days after undergoing one of 13 common surgical procedures. Their results showed 5% of the total opioid-naive patients had persistent opioid usage, as described above, compared to controls. This result is comparable to those in adults. Females, older age, and comorbid mental health and substance abuse conditions were described as risk factors. Cholecystectomy and colectomy were the two most common procedures related to persistent opioid use.
The takeaway point?
Although this study had several limitations, it raised an important point and serves as a plea to pediatric providers to use evidence-based medicine to support opioid prescription.
Effect of the School-Based Telemedicine Enhanced Asthma Management (SB-TEAM) Program on Asthma Morbidity: A Randomized Clinical Trial
JAMA Pediatrics (January 2018)
What we already know: One of the biggest barriers to care of asthmatic children for pediatric physicians is poor adherence to preventive treatment, often leading to frequent exacerbations.
This study is novel since it’s the first to incorporate telemedicine with the preventive care model for asthma. Researchers in New York enrolled children with persistent asthma, aged 3–10 years, in the Rochester City School District. Participants were randomly assigned to either the telemedicine team or enhanced usual care for asthma. Telemedicine intervention included an initial evaluation visit, followed by follow-up visits every 4–6 weeks. These follow-up visits included reassessment of symptoms and need for therapy along with directly observed treatment as well. Results showed that children in the intervention arm had more symptom-free days, fewer days with activity limitation, and fewer emergency department visits or hospitalizations for their asthma.
I personally think this is a great idea and a much better use of telemedicine.
Association of Maternal Use of Folic Acid and Multivitamin Supplements in the Periods Before and During Pregnancy With the Risk of Autism Spectrum Disorder in Offspring
JAMA Psychiatry (January 2018)
What we already know: Studies in the past have reported inconsistent associations between maternal vitamin and folic acid supplementation and ASD in offspring.
In this study, researchers in Israel followed a cohort of 45,300 cases and controls born between 2003–2007, Their study ended in 2015. In the end, 1.3 % of cases received a diagnosis of ASD. Maternal exposure to folic acid or multivitamin supplements before and during pregnancy was statistically significantly associated with a lower likelihood of ASD in the offspring compared with no exposure before pregnancy.
In another recent first of its kind study, researchers in Denmark, found an association between paternal SSRI use before conception and ASD in offspring. This was a cohort study of 669,922 children identified through the Danish registry. Results showed that, compared to unexposed children, exposed children (whose fathers had used SSRIs three months prior to conception), had a 1.62x higher risk of ASD. However, this association was more in fathers who had been exposed to SSRIs from before the exposure period delineated, indicating that underlying conditions leading to use of SSRIs may have caused the increased risk, which has been proved in the past as well.
What we learned: Something new to tell parents about autism to take the focus off vaccines!
Wheezing and infantile colic are associated with neonatal antibiotic treatment
Pediatric Allergy and Immunology (January 2018)
What we already know: Antibiotic use in the first year of life is associated with increased risk of atopy and wheezing.
Researchers in Netherlands prospectively compared 436 infants for one year. Of these infants, 151 neonates received broad spectrum antibiotics compared to healthy controls. Interestingly, they found out that wheezing and infantile colic was more prevalent in the antibiotic group. Eczema, infections, and PCP visits were the same. This study was different because it talked out about providing a rationale for cessation of antibiotics in the first week of life if not needed.
Another recent study on antibiotics done by researchers in Sweden on a national registry found an association between exposure to antibiotics in pregnancy with an incidence of early onset IBD in children.
Moral of the story: Antibiotics, when not welcome, never did anyone any good!
That’s all for this month folks! Tune in next month for some more interesting articles.