THREE QUESTIONS CAN UNCOVER POSTPARTUM DEPRESSION
Routine screening for postpartum depression significantly improves detection, but it is not standard practice due to time and other constraints. The study, “Identifying Postpartum Depression: Are 3 Questions as Good as 10?” found asking a new mother three simple questions may be just as effective as a longer survey at detecting this common medical problem. Researchers asked 199 young women to complete the 10-question Edinburgh Postpartum Depression Scale (EPDS) during well-child visits to the pediatrician. Researchers found that answers to the three questions of the EPDS that focus on anxiety - a prominent feature of postpartum depression - identified 95 percent of depressed mothers. In clinical situations where a very short screening tool may be necessary (i.e, well child visits), using the three-item anxiety subscale of the EPDS is a useful and brief screening tool for postpartum depression.
Editor’s note: The lead author of this study, Catherine Stevens-Simon, MD, founded and directed the Colorado Adolescent Maternity Program (CAMP) from 1991-2006. She dedicated her career to improving the lives of teen mothers and their children. Dr. Stevens-Simon passed away in November 2007.
CHICKENPOX VACCINATION RESULTS IN DRAMATIC DROP IN DISEASE
Vaccination against varicella (chickenpox) has dramatically reduced the number of children who are infected, hospitalized and killed by the virus each year in the United States, according to the review article, “Varicella Prevention in the United States: A Review of Successes and Challenges.” After implementation of the varicella vaccination program in 1995, varicella incidence declined 90 percent by 2005. The number of varicella-related hospitalizations declined 75 percent to 88 percent. Deaths declined by more than 74 percent in people under age 50, with the greatest declines among children ages 1 to 4 years (92 percent) and 5 to 9 years (89 percent). Inpatient and outpatient medical costs associated with varicella declined 74 percent. However, even with high vaccination coverage, the effectiveness of one dose of vaccine did not generate enough herd immunity to prevent the transmission of the virus within the community. In 2006 the varicella vaccination policy was changed to recommend two doses, which in one clinical trial have shown better immune response and protection against disease.
MOM’S STRESS MAY BE IMPORTANT FACTOR IN CHILD’S WEIGHT
Millions of low-income children in the United States are overweight or at risk of overweight. A new study, “Food Security, Maternal Stressors, and Overweight Among Low-Income US Children: Results from the National Health and Nutrition Examination Survey (1999-2002),” shows that maternal stressors may increase the chances of a child being overweight, particularly in households with sufficient food. Based on data from the National Health and Nutrition Examination Survey, researchers from the University of Illinois, Iowa State University and Michigan State University looked at the impact of various factors, including stress, on obesity and overweight in low-income children. As part of this analysis, the researchers examined whether the impact of stress may differ by a child’s household’s food insecurity status (whether there is enough food to sustain healthy, active lifestyles for all household members). They found that of young children (10 and under) who experienced stress (including stress transferred from their mothers), those who were food secure were more likely to be overweight or at risk of overweight than children in food insecure households. While both food secure and food insecure children may want to eat in response to the stress they may be experiencing, due to more limited resources, food insecure children may not be able to act on this impulse. Food secure children who eat in response to stress may be more likely to consume “comfort foods” that can be of poor nutritional quality. As the majority of low-income children in the United States are food secure, the authors concluded that efforts to alleviate stress, including financial stress, can lead to reductions in childhood overweight.
A SHOT IN THE ARM HELPS PARENTS PROTECT THEIR NEWBORNS AGAINST WHOOPING COUGH
Immunizing parents while they’re in the hospital caring for a newborn is an effective way to prevent the transmission of pertussis, or whooping cough, to vulnerable infants, according to the study, “Administration of Tetanus, Diphtheria, and Acellular Pertussis Vaccine to Parents of High-Risk Infants in the Neonatal Intensive Care Unit.” Infants in the neonatal intensive care unit (NICU) who have chronic respiratory illness often have immature airways, making them particularly susceptible to respiratory diseases such as pertussis. If they contract pertussis, these infants are hospitalized at a rate of three to seven times more often than other children. A major source of disease transmission is individuals in close contact with the infants, especially the new parents. This study examined a new method to increase adult vaccination rates for pertussis to create a “cocoon” of immunity around the infant. An information sheet explaining the dangers of pertussis and the benefits of vaccination was placed at the infant’s bedside in the NICU. This program resulted in an overall vaccination rate of 86.9 percent (430) of the informed parents. The authors state that immunizing parents while they are in the hospital caring for a newborn is an effective method of increasing adult vaccination rates and preventing the spread of disease to newborns and infants.
HELMET USE UP, BICYCLING DEATHS DOWN
Bike riding is a common activity for children, especially in Ontario, Canada, where 85 percent of children own bicycles. A new study, “Trends in Pediatric and Adult Bicycling Deaths Before and After Passage of a Bicycle Helmet Law,” examined bicycle-related mortality rates in Ontario from 1991 to 2002 among children 1 to 15 years of age and among bicyclists 16 years of age through adulthood. Bicycle-related mortality rates for children 1 to 15 years of age decreased 52 percent after helmet legislation was enforced in 1995 in Ontario. The law does not apply to bicyclists 18 years of age or older, and study results do not identify a significant change in the number of deaths in that age group after the legislation was enacted. It is likely that multiple factors, including education and promotion of helmet use, and changing trends, contributed to the decrease in deaths of children. These findings support extending the law to include adults and continued enforcement of helmet use in bicyclists younger than 18.
DO PRETERM CHILDREN HAVE MORE BEHAVIOR DISORDERS?
Children who are born very prematurely are at increased risk for attention problems, hyperactivity and social relationship problems. In the study, “Pervasive Behavior Problems at 6 Years of Age in a Total-Population Sample of Children Born at < 25 Weeks of Gestation,” researchers used reports filed by parents and teachers in the United Kingdom and Ireland to test whether extremely premature children have more pervasive behavior problems than classroom peers. The results suggest extremely preterm children were four times more likely to have emotional problems or behavior disorders such as ADHD at 6 years of age, compared to children born at full term. Extremely preterm girls had a higher degree of conduct behavior problems than other girls their age, and boys experienced more difficulties relating to peers. Evidence from this study also shows that very preterm boys may suffer internalizing problems more often in middle childhood, and the impact on parents and teachers and their schooling is significant. Extremely preterm boys are especially vulnerable to develop behavior problems. Researchers feel that these patterns of behavior difficulties can have important implications on future brain imaging research on extremely preterm children and their management.
MARKETING EXCLUSIVITY OF PEDIATRIC DRUGS
The Food and Drug Administration Modernization Act of 1997 provides an additional 6-month period of marketing exclusivity to companies that perform studies of a drug in pediatric patients in response to an FDA request. The Best Pharmaceuticals for Children Act of 2002 requires the FDA to examine the pediatric adverse events reported during the 1-year period after a drug obtains marketing exclusivity. The study, “Safety Monitoring of Drugs Receiving Pediatric Marketing Exclusivity,” reviewed data from the 67 drugs granted exclusivity from June 2003 through April 2007. Researchers found that 44 of these drugs were returned for routine monitoring of adverse events; labeling changes were recommended for 12 drugs; continued close monitoring was recommended for 10; and an update on labeling changes was recommended for one drug. Several of the adverse events revealed during this process were rare and life-threatening. Study authors determined that safety monitoring during the postmarketing period is crucial to detect rare or even deadly pediatric-specific adverse events. As a result of the exclusivity program, over 130 labeling changes have been made for drugs used in children.
