Tara Haelle

Using pimecrolimus cream as a first-line treatment for atopic dermatitis in infants spares the need for topical corticosteroids as frequently and appears safe over the long term, according to a study published online March 23 in Pediatrics.

“The efficacy results suggest that pimecrolimus has similar efficacy to topical corticosteroids in a real-world setting, which is noteworthy because pimecrolimus is not currently widely used as first-line therapy for atopic dermatitis, given the perception of lower efficacy than topical corticosteroids,” Dr. Bardur Sigurgeirsson of the University of Iceland, Reykjavik, and his associates said.

The researchers randomized 2,418 infants, between ages 3 and 12 months, to receive either pimecrolimus 1% cream, a noncorticosteroid topical calcineurin inhibitor that selectively suppresses activation of T cells and mast cells, or topical corticosteroids to treat mild to moderate atopic dermatitis affecting at least 5% of body surface area. The 1,205 infants receiving the pimecrolimus cream also received topical corticosteroids to treat short-term disease flares. Corticosteroids used were typically either 1% hydrocortisone or 0.1% hydrocortisone butyrate cream.

Success was defined as a 0 (clear) or 1 (mostly clear) on the Investigator’s Global Assessment scale, which ranges from 0 to 5.

More than half of the patients in both groups experienced cleared symptoms within the first three weeks (52.6% with pimecrolimus and 50.5% with corticosteroids). Five years later, among 1,710 patients still enrolled, 88.7% receiving pimecrolimus and 92.3% receiving corticosteroids had overall success. Facial treatment success was seen in 96.6% of infants in the pimecrolimus group and 97.2% of of those in the corticosteroids group, Dr. Sigurgeirsson and associates reported (Pediatrics 2015 March 23 [doi: 10.1542/peds.2014-1990]).

Those receiving pimecrolimus only required topical corticosteroids for a median 7 days, compared to 178 days in the corticosteroids group over the 5-year period. Just over a third (36%) of pimecrolimus patients never used topical corticosteroids.

Both groups experienced similar rates of adverse events, and neither showed negative effects on children’s humoral or cellular immunity, with similar antibody responses in both groups to routine vaccinations. Both groups also had similar growth rates, the investigators reported.

Using pimecrolimus cream as a first-line treatment for atopic dermatitis in infants spares the need for topical corticosteroids as frequently and appears safe over the long term, according to a study published online March 23 in Pediatrics.

“The efficacy results suggest that pimecrolimus has similar efficacy to topical corticosteroids in a real-world setting, which is noteworthy because pimecrolimus is not currently widely used as first-line therapy for atopic dermatitis, given the perception of lower efficacy than topical corticosteroids,” Dr. Bardur Sigurgeirsson of the University of Iceland, Reykjavik, and his associates said.

The researchers randomized 2,418 infants, between ages 3 and 12 months, to receive either pimecrolimus 1% cream, a noncorticosteroid topical calcineurin inhibitor that selectively suppresses activation of T cells and mast cells, or topical corticosteroids to treat mild to moderate atopic dermatitis affecting at least 5% of body surface area. The 1,205 infants receiving the pimecrolimus cream also received topical corticosteroids to treat short-term disease flares. Corticosteroids used were typically either 1% hydrocortisone or 0.1% hydrocortisone butyrate cream.

Success was defined as a 0 (clear) or 1 (mostly clear) on the Investigator’s Global Assessment scale, which ranges from 0 to 5.

More than half of the patients in both groups experienced cleared symptoms within the first three weeks (52.6% with pimecrolimus and 50.5% with corticosteroids). Five years later, among 1,710 patients still enrolled, 88.7% receiving pimecrolimus and 92.3% receiving corticosteroids had overall success. Facial treatment success was seen in 96.6% of infants in the pimecrolimus group and 97.2% of of those in the corticosteroids group, Dr. Sigurgeirsson and associates reported (Pediatrics 2015 March 23 [doi: 10.1542/peds.2014-1990]).

Those receiving pimecrolimus only required topical corticosteroids for a median 7 days, compared to 178 days in the corticosteroids group over the 5-year period. Just over a third (36%) of pimecrolimus patients never used topical corticosteroids.

Both groups experienced similar rates of adverse events, and neither showed negative effects on children’s humoral or cellular immunity, with similar antibody responses in both groups to routine vaccinations. Both groups also had similar growth rates, the investigators reported.

Using pimecrolimus cream as a first-line treatment for atopic dermatitis in infants spares the need for topical corticosteroids as frequently and appears safe over the long term, according to a study published online March 23 in Pediatrics.

“The efficacy results suggest that pimecrolimus has similar efficacy to topical corticosteroids in a real-world setting, which is noteworthy because pimecrolimus is not currently widely used as first-line therapy for atopic dermatitis, given the perception of lower efficacy than topical corticosteroids,” Dr. Bardur Sigurgeirsson of the University of Iceland, Reykjavik, and his associates said.

The researchers randomized 2,418 infants, between ages 3 and 12 months, to receive either pimecrolimus 1% cream, a noncorticosteroid topical calcineurin inhibitor that selectively suppresses activation of T cells and mast cells, or topical corticosteroids to treat mild to moderate atopic dermatitis affecting at least 5% of body surface area. The 1,205 infants receiving the pimecrolimus cream also received topical corticosteroids to treat short-term disease flares. Corticosteroids used were typically either 1% hydrocortisone or 0.1% hydrocortisone butyrate cream.

Success was defined as a 0 (clear) or 1 (mostly clear) on the Investigator’s Global Assessment scale, which ranges from 0 to 5.

More than half of the patients in both groups experienced cleared symptoms within the first three weeks (52.6% with pimecrolimus and 50.5% with corticosteroids). Five years later, among 1,710 patients still enrolled, 88.7% receiving pimecrolimus and 92.3% receiving corticosteroids had overall success. Facial treatment success was seen in 96.6% of infants in the pimecrolimus group and 97.2% of of those in the corticosteroids group, Dr. Sigurgeirsson and associates reported (Pediatrics 2015 March 23 [doi: 10.1542/peds.2014-1990]).

Those receiving pimecrolimus only required topical corticosteroids for a median 7 days, compared to 178 days in the corticosteroids group over the 5-year period. Just over a third (36%) of pimecrolimus patients never used topical corticosteroids.

Both groups experienced similar rates of adverse events, and neither showed negative effects on children’s humoral or cellular immunity, with similar antibody responses in both groups to routine vaccinations. Both groups also had similar growth rates, the investigators reported.

Using pimecrolimus cream as a first-line treatment for atopic dermatitis in infants spares the need for topical corticosteroids as frequently and appears safe over the long term, according to a study published online March 23 in Pediatrics.

“The efficacy results suggest that pimecrolimus has similar efficacy to topical corticosteroids in a real-world setting, which is noteworthy because pimecrolimus is not currently widely used as first-line therapy for atopic dermatitis, given the perception of lower efficacy than topical corticosteroids,” Dr. Bardur Sigurgeirsson of the University of Iceland, Reykjavik, and his associates said.

The researchers randomized 2,418 infants, between ages 3 and 12 months, to receive either pimecrolimus 1% cream, a noncorticosteroid topical calcineurin inhibitor that selectively suppresses activation of T cells and mast cells, or topical corticosteroids to treat mild to moderate atopic dermatitis affecting at least 5% of body surface area. The 1,205 infants receiving the pimecrolimus cream also received topical corticosteroids to treat short-term disease flares. Corticosteroids used were typically either 1% hydrocortisone or 0.1% hydrocortisone butyrate cream.

Success was defined as a 0 (clear) or 1 (mostly clear) on the Investigator’s Global Assessment scale, which ranges from 0 to 5.

More than half of the patients in both groups experienced cleared symptoms within the first three weeks (52.6% with pimecrolimus and 50.5% with corticosteroids). Five years later, among 1,710 patients still enrolled, 88.7% receiving pimecrolimus and 92.3% receiving corticosteroids had overall success. Facial treatment success was seen in 96.6% of infants in the pimecrolimus group and 97.2% of of those in the corticosteroids group, Dr. Sigurgeirsson and associates reported (Pediatrics 2015 March 23 [doi: 10.1542/peds.2014-1990]).

Those receiving pimecrolimus only required topical corticosteroids for a median 7 days, compared to 178 days in the corticosteroids group over the 5-year period. Just over a third (36%) of pimecrolimus patients never used topical corticosteroids.

Both groups experienced similar rates of adverse events, and neither showed negative effects on children’s humoral or cellular immunity, with similar antibody responses in both groups to routine vaccinations. Both groups also had similar growth rates, the investigators reported.

Using pimecrolimus cream as a first-line treatment for atopic dermatitis in infants spares the need for topical corticosteroids as frequently and appears safe over the long term, according to a study published online March 23 in Pediatrics.

“The efficacy results suggest that pimecrolimus has similar efficacy to topical corticosteroids in a real-world setting, which is noteworthy because pimecrolimus is not currently widely used as first-line therapy for atopic dermatitis, given the perception of lower efficacy than topical corticosteroids,” Dr. Bardur Sigurgeirsson of the University of Iceland, Reykjavik, and his associates said.

The researchers randomized 2,418 infants, between ages 3 and 12 months, to receive either pimecrolimus 1% cream, a noncorticosteroid topical calcineurin inhibitor that selectively suppresses activation of T cells and mast cells, or topical corticosteroids to treat mild to moderate atopic dermatitis affecting at least 5% of body surface area. The 1,205 infants receiving the pimecrolimus cream also received topical corticosteroids to treat short-term disease flares. Corticosteroids used were typically either 1% hydrocortisone or 0.1% hydrocortisone butyrate cream.

Success was defined as a 0 (clear) or 1 (mostly clear) on the Investigator’s Global Assessment scale, which ranges from 0 to 5.

More than half of the patients in both groups experienced cleared symptoms within the first three weeks (52.6% with pimecrolimus and 50.5% with corticosteroids). Five years later, among 1,710 patients still enrolled, 88.7% receiving pimecrolimus and 92.3% receiving corticosteroids had overall success. Facial treatment success was seen in 96.6% of infants in the pimecrolimus group and 97.2% of of those in the corticosteroids group, Dr. Sigurgeirsson and associates reported (Pediatrics 2015 March 23 [doi: 10.1542/peds.2014-1990]).

Those receiving pimecrolimus only required topical corticosteroids for a median 7 days, compared to 178 days in the corticosteroids group over the 5-year period. Just over a third (36%) of pimecrolimus patients never used topical corticosteroids.

Both groups experienced similar rates of adverse events, and neither showed negative effects on children’s humoral or cellular immunity, with similar antibody responses in both groups to routine vaccinations. Both groups also had similar growth rates, the investigators reported.

Using pimecrolimus cream as a first-line treatment for atopic dermatitis in infants spares the need for topical corticosteroids as frequently and appears safe over the long term, according to a study published online March 23 in Pediatrics.

“The efficacy results suggest that pimecrolimus has similar efficacy to topical corticosteroids in a real-world setting, which is noteworthy because pimecrolimus is not currently widely used as first-line therapy for atopic dermatitis, given the perception of lower efficacy than topical corticosteroids,” Dr. Bardur Sigurgeirsson of the University of Iceland, Reykjavik, and his associates said.

The researchers randomized 2,418 infants, between ages 3 and 12 months, to receive either pimecrolimus 1% cream, a noncorticosteroid topical calcineurin inhibitor that selectively suppresses activation of T cells and mast cells, or topical corticosteroids to treat mild to moderate atopic dermatitis affecting at least 5% of body surface area. The 1,205 infants receiving the pimecrolimus cream also received topical corticosteroids to treat short-term disease flares. Corticosteroids used were typically either 1% hydrocortisone or 0.1% hydrocortisone butyrate cream.

Success was defined as a 0 (clear) or 1 (mostly clear) on the Investigator’s Global Assessment scale, which ranges from 0 to 5.

More than half of the patients in both groups experienced cleared symptoms within the first three weeks (52.6% with pimecrolimus and 50.5% with corticosteroids). Five years later, among 1,710 patients still enrolled, 88.7% receiving pimecrolimus and 92.3% receiving corticosteroids had overall success. Facial treatment success was seen in 96.6% of infants in the pimecrolimus group and 97.2% of of those in the corticosteroids group, Dr. Sigurgeirsson and associates reported (Pediatrics 2015 March 23 [doi: 10.1542/peds.2014-1990]).

Those receiving pimecrolimus only required topical corticosteroids for a median 7 days, compared to 178 days in the corticosteroids group over the 5-year period. Just over a third (36%) of pimecrolimus patients never used topical corticosteroids.

Both groups experienced similar rates of adverse events, and neither showed negative effects on children’s humoral or cellular immunity, with similar antibody responses in both groups to routine vaccinations. Both groups also had similar growth rates, the investigators reported.

Hormone therapy in postmenopausal women does not prevent heart disease but does increase the risk of stroke and blood clots, according to a recently updated Cochrane review.

“Our review findings provide strong evidence that treatment with hormone therapy in postmenopausal women for either primary or secondary prevention of cardiovascular disease events has little if any benefit overall, and causes an increase in the risk of stroke, or venous thromboembolic events,” reported Dr. Henry Boardman of the University of Oxford John Radcliffe Hospital, and his associates.

The researchers updated a review published in 2013 with data from an additional six randomized controlled trials. The total of 19 trials, involving 40,410 postmenopausal women, all compared orally-administered estrogen, with or without progestogen, to a placebo or no treatment for a minimum of 6 months (Cochrane Database Syst. Rev. 2015 March 10 [doi:10.1002/14651858.CD002229.pub4]).

The average age of the women in the studies, mostly from the United States, was older than 60 years, and the women received hormone therapy anywhere from 7 months to 10 years across the studies. The overall quality of the studies was “good” with a low risk of bias.

The sharp rise in cardiovascular disease rates in women after menopause had been hypothesized to be related to a decline in hormone levels that causes a higher androgen-to-estradiol ratio, and observational studies starting in the 1980s showed lower mortality rates and cardiovascular events in women receiving hormone therapy – previously called hormone replacement therapy – compared to those not receiving hormone therapy.

Two subsequent randomized controlled trials contradicted these observational findings, though, leading to further study. In this review, hormone therapy showed no risk reduction for all-cause mortality, cardiovascular death, nonfatal myocardial infarction, angina, or revascularization.

However, the overall risk of stroke for those receiving hormone therapy for both primary and secondary prevention was 24% higher than that of women receiving placebo treatment (relative risk 1.24), with an absolute risk of 6 additional strokes per 1,000 women.

Venous thromboembolic events occurred 92% more and pulmonary emboli occurred 81% more in the hormone treatment groups (RR 1.92 and 1.81, respectively), with increased absolute risks of 8 per 1,000 women and 4 per 1,000 women, respectively.

The researchers calculated the number needed to treat for an additional harm (NNTH) at 165 women for stroke, 118 for venous thromboembolism, and 242 for pulmonary embolism.

Continue for further analysis >>

Further analysis revealed that the relative risks or protection hormone therapy conferred depended on how long after menopause women started treatment.

Mortality was reduced 30% and coronary heart disease was reduced 48% in women who began hormone therapy less than 10 years after menopause (RR 0.70 and RR 0.52, respectively); these women still faced a 74% increased risk of venous thromboembolism, but no increased risk of stroke.

Meanwhile, women who started hormone therapy more than 10 years after menopause had a 21% increased risk of stroke and a 96% increased risk of venous thromboembolism, but no reduced risk on overall death or coronary heart disease.

“It is worth noting that the benefit seen in survival and coronary heart disease for the group starting treatment less than 10 years after the menopause is from combining five trials all performed in primary prevention populations and all with quite long follow-up, ranging from 3.4 to 10.1 years,” the authors wrote.

These results may reflect the possibility of a time interaction, with coronary heart disease events occurring earlier in predisposed women, making it impossible to say whether short duration therapy is beneficial in this population or not, the researchers wrote .

Eighteen of the 19 trials included in the analysis reported the funding source. One study was exclusively funded by Wyeth-Ayerst. Two studies received partial funding from Novo-Nordisk Pharmaceutical, and one study was funded by the National Institutes of Health with support from Wyeth-Ayerst, Hoffman-LaRoche, Pharmacia, and Upjohn. Eight other studies used medication provided by various pharmaceutical companies.

Hormone therapy in postmenopausal women does not prevent heart disease but does increase the risk of stroke and blood clots, according to a recently updated Cochrane review.

“Our review findings provide strong evidence that treatment with hormone therapy in postmenopausal women for either primary or secondary prevention of cardiovascular disease events has little if any benefit overall, and causes an increase in the risk of stroke, or venous thromboembolic events,” reported Dr. Henry Boardman of the University of Oxford John Radcliffe Hospital, and his associates.

The researchers updated a review published in 2013 with data from an additional six randomized controlled trials. The total of 19 trials, involving 40,410 postmenopausal women, all compared orally-administered estrogen, with or without progestogen, to a placebo or no treatment for a minimum of 6 months (Cochrane Database Syst. Rev. 2015 March 10 [doi:10.1002/14651858.CD002229.pub4]).

The average age of the women in the studies, mostly from the United States, was older than 60 years, and the women received hormone therapy anywhere from 7 months to 10 years across the studies. The overall quality of the studies was “good” with a low risk of bias.

The sharp rise in cardiovascular disease rates in women after menopause had been hypothesized to be related to a decline in hormone levels that causes a higher androgen-to-estradiol ratio, and observational studies starting in the 1980s showed lower mortality rates and cardiovascular events in women receiving hormone therapy – previously called hormone replacement therapy – compared to those not receiving hormone therapy.

Two subsequent randomized controlled trials contradicted these observational findings, though, leading to further study. In this review, hormone therapy showed no risk reduction for all-cause mortality, cardiovascular death, nonfatal myocardial infarction, angina, or revascularization.

However, the overall risk of stroke for those receiving hormone therapy for both primary and secondary prevention was 24% higher than that of women receiving placebo treatment (relative risk 1.24), with an absolute risk of 6 additional strokes per 1,000 women.

Venous thromboembolic events occurred 92% more and pulmonary emboli occurred 81% more in the hormone treatment groups (RR 1.92 and 1.81, respectively), with increased absolute risks of 8 per 1,000 women and 4 per 1,000 women, respectively.

The researchers calculated the number needed to treat for an additional harm (NNTH) at 165 women for stroke, 118 for venous thromboembolism, and 242 for pulmonary embolism.

Continue for further analysis >>

Further analysis revealed that the relative risks or protection hormone therapy conferred depended on how long after menopause women started treatment.

Mortality was reduced 30% and coronary heart disease was reduced 48% in women who began hormone therapy less than 10 years after menopause (RR 0.70 and RR 0.52, respectively); these women still faced a 74% increased risk of venous thromboembolism, but no increased risk of stroke.

Meanwhile, women who started hormone therapy more than 10 years after menopause had a 21% increased risk of stroke and a 96% increased risk of venous thromboembolism, but no reduced risk on overall death or coronary heart disease.

“It is worth noting that the benefit seen in survival and coronary heart disease for the group starting treatment less than 10 years after the menopause is from combining five trials all performed in primary prevention populations and all with quite long follow-up, ranging from 3.4 to 10.1 years,” the authors wrote.

These results may reflect the possibility of a time interaction, with coronary heart disease events occurring earlier in predisposed women, making it impossible to say whether short duration therapy is beneficial in this population or not, the researchers wrote .

Eighteen of the 19 trials included in the analysis reported the funding source. One study was exclusively funded by Wyeth-Ayerst. Two studies received partial funding from Novo-Nordisk Pharmaceutical, and one study was funded by the National Institutes of Health with support from Wyeth-Ayerst, Hoffman-LaRoche, Pharmacia, and Upjohn. Eight other studies used medication provided by various pharmaceutical companies.

Hormone therapy in postmenopausal women does not prevent heart disease but does increase the risk of stroke and blood clots, according to a recently updated Cochrane review.

“Our review findings provide strong evidence that treatment with hormone therapy in postmenopausal women for either primary or secondary prevention of cardiovascular disease events has little if any benefit overall, and causes an increase in the risk of stroke, or venous thromboembolic events,” reported Dr. Henry Boardman of the University of Oxford John Radcliffe Hospital, and his associates.

The researchers updated a review published in 2013 with data from an additional six randomized controlled trials. The total of 19 trials, involving 40,410 postmenopausal women, all compared orally-administered estrogen, with or without progestogen, to a placebo or no treatment for a minimum of 6 months (Cochrane Database Syst. Rev. 2015 March 10 [doi:10.1002/14651858.CD002229.pub4]).

The average age of the women in the studies, mostly from the United States, was older than 60 years, and the women received hormone therapy anywhere from 7 months to 10 years across the studies. The overall quality of the studies was “good” with a low risk of bias.

The sharp rise in cardiovascular disease rates in women after menopause had been hypothesized to be related to a decline in hormone levels that causes a higher androgen-to-estradiol ratio, and observational studies starting in the 1980s showed lower mortality rates and cardiovascular events in women receiving hormone therapy – previously called hormone replacement therapy – compared to those not receiving hormone therapy.

Two subsequent randomized controlled trials contradicted these observational findings, though, leading to further study. In this review, hormone therapy showed no risk reduction for all-cause mortality, cardiovascular death, nonfatal myocardial infarction, angina, or revascularization.

However, the overall risk of stroke for those receiving hormone therapy for both primary and secondary prevention was 24% higher than that of women receiving placebo treatment (relative risk 1.24), with an absolute risk of 6 additional strokes per 1,000 women.

Venous thromboembolic events occurred 92% more and pulmonary emboli occurred 81% more in the hormone treatment groups (RR 1.92 and 1.81, respectively), with increased absolute risks of 8 per 1,000 women and 4 per 1,000 women, respectively.

The researchers calculated the number needed to treat for an additional harm (NNTH) at 165 women for stroke, 118 for venous thromboembolism, and 242 for pulmonary embolism.

Continue for further analysis >>

Further analysis revealed that the relative risks or protection hormone therapy conferred depended on how long after menopause women started treatment.

Mortality was reduced 30% and coronary heart disease was reduced 48% in women who began hormone therapy less than 10 years after menopause (RR 0.70 and RR 0.52, respectively); these women still faced a 74% increased risk of venous thromboembolism, but no increased risk of stroke.

Meanwhile, women who started hormone therapy more than 10 years after menopause had a 21% increased risk of stroke and a 96% increased risk of venous thromboembolism, but no reduced risk on overall death or coronary heart disease.

“It is worth noting that the benefit seen in survival and coronary heart disease for the group starting treatment less than 10 years after the menopause is from combining five trials all performed in primary prevention populations and all with quite long follow-up, ranging from 3.4 to 10.1 years,” the authors wrote.

These results may reflect the possibility of a time interaction, with coronary heart disease events occurring earlier in predisposed women, making it impossible to say whether short duration therapy is beneficial in this population or not, the researchers wrote .

Eighteen of the 19 trials included in the analysis reported the funding source. One study was exclusively funded by Wyeth-Ayerst. Two studies received partial funding from Novo-Nordisk Pharmaceutical, and one study was funded by the National Institutes of Health with support from Wyeth-Ayerst, Hoffman-LaRoche, Pharmacia, and Upjohn. Eight other studies used medication provided by various pharmaceutical companies.

Children’s diets in the United States are holding them back from adequate cardiovascular health, even though the vast majority have excellent blood pressure and total cholesterol and most have a body mass index in the ideal range, according to a recent study.

“The prevalence of ideal metrics declines with age, both during childhood and adolescence,” wrote Dr. Hongyan Ning of Northwestern University in Chicago and associates. “Efforts to preserve and promote cardiovascular health in childhood and adolescence are urgently needed to reduce the loss of this precious health asset, a consequence in large part to the rising prevalence of obesity” (Circ. Cardiovasc. Qual. Outcomes 2015 [doi:10.1161/circoutcomes.114.001274).

Dr. Ning’s team used four criteria of the American Heart Association to assess the cardiovascular health of 8,961 children aged 2-11 years from four National Health and Nutrition Examination Surveys (NHANES) conducted from 2003 to 2010. The criteria were blood pressure, total cholesterol, body mass index, and a healthy diet score – classified as poor, intermediate, or ideal. An ideal diet score met four of five components: at least 4.5 cups of fruits and vegetables daily, at least two 3.5-oz. fish servings per week, at least three 1-ounce servings of fiber-rich whole grains per day, less than 1,500 mg of sodium per day, and no more than 450 calories from sugar-sweetened beverages per week.

Among children aged 2-5 years, 77% had an ideal BMI, compared with 67% of children aged 6-11 years. Meanwhile, 15% of children overall were overweight, and 17% of boys and 15% of girls were obese.

Among children aged 5-11, less than 0.05% had an ideal healthy diet score while 85.6% of boys and 83.1% of girls met none or one of the components. Approximately 10% kept their sodium intake down to the required level, but even fewer got enough fruits and vegetables or fish. Only 3% of boys and 2.4% of girls met the whole grains component, and more than 50% received more than the recommended calories from sugary drinks.

Less than 10% of children had poor total cholesterol levels (at least 200 mg/dL), with 30% in the intermediate range (170-199 mg/dL) and 60% with levels below 170 mg/dL. Just 2.8% of boys and 3.5% of girls had poor blood pressure (above 95th percentile), and 92.5% of boys and 91.5% of girls had ideal blood pressure.

Among the healthy diet components, only whole grain, sodium intake, and sugar-sweetened beverages intake were significantly associated with BMI, and BMI was significantly linked to total cholesterol levels and both systolic and diastolic blood pressure.

Children’s diets in the United States are holding them back from adequate cardiovascular health, even though the vast majority have excellent blood pressure and total cholesterol and most have a body mass index in the ideal range, according to a recent study.

“The prevalence of ideal metrics declines with age, both during childhood and adolescence,” wrote Dr. Hongyan Ning of Northwestern University in Chicago and associates. “Efforts to preserve and promote cardiovascular health in childhood and adolescence are urgently needed to reduce the loss of this precious health asset, a consequence in large part to the rising prevalence of obesity” (Circ. Cardiovasc. Qual. Outcomes 2015 [doi:10.1161/circoutcomes.114.001274).

Dr. Ning’s team used four criteria of the American Heart Association to assess the cardiovascular health of 8,961 children aged 2-11 years from four National Health and Nutrition Examination Surveys (NHANES) conducted from 2003 to 2010. The criteria were blood pressure, total cholesterol, body mass index, and a healthy diet score – classified as poor, intermediate, or ideal. An ideal diet score met four of five components: at least 4.5 cups of fruits and vegetables daily, at least two 3.5-oz. fish servings per week, at least three 1-ounce servings of fiber-rich whole grains per day, less than 1,500 mg of sodium per day, and no more than 450 calories from sugar-sweetened beverages per week.

Among children aged 2-5 years, 77% had an ideal BMI, compared with 67% of children aged 6-11 years. Meanwhile, 15% of children overall were overweight, and 17% of boys and 15% of girls were obese.

Among children aged 5-11, less than 0.05% had an ideal healthy diet score while 85.6% of boys and 83.1% of girls met none or one of the components. Approximately 10% kept their sodium intake down to the required level, but even fewer got enough fruits and vegetables or fish. Only 3% of boys and 2.4% of girls met the whole grains component, and more than 50% received more than the recommended calories from sugary drinks.

Less than 10% of children had poor total cholesterol levels (at least 200 mg/dL), with 30% in the intermediate range (170-199 mg/dL) and 60% with levels below 170 mg/dL. Just 2.8% of boys and 3.5% of girls had poor blood pressure (above 95th percentile), and 92.5% of boys and 91.5% of girls had ideal blood pressure.

Among the healthy diet components, only whole grain, sodium intake, and sugar-sweetened beverages intake were significantly associated with BMI, and BMI was significantly linked to total cholesterol levels and both systolic and diastolic blood pressure.

Children’s diets in the United States are holding them back from adequate cardiovascular health, even though the vast majority have excellent blood pressure and total cholesterol and most have a body mass index in the ideal range, according to a recent study.

“The prevalence of ideal metrics declines with age, both during childhood and adolescence,” wrote Dr. Hongyan Ning of Northwestern University in Chicago and associates. “Efforts to preserve and promote cardiovascular health in childhood and adolescence are urgently needed to reduce the loss of this precious health asset, a consequence in large part to the rising prevalence of obesity” (Circ. Cardiovasc. Qual. Outcomes 2015 [doi:10.1161/circoutcomes.114.001274).

Dr. Ning’s team used four criteria of the American Heart Association to assess the cardiovascular health of 8,961 children aged 2-11 years from four National Health and Nutrition Examination Surveys (NHANES) conducted from 2003 to 2010. The criteria were blood pressure, total cholesterol, body mass index, and a healthy diet score – classified as poor, intermediate, or ideal. An ideal diet score met four of five components: at least 4.5 cups of fruits and vegetables daily, at least two 3.5-oz. fish servings per week, at least three 1-ounce servings of fiber-rich whole grains per day, less than 1,500 mg of sodium per day, and no more than 450 calories from sugar-sweetened beverages per week.

Among children aged 2-5 years, 77% had an ideal BMI, compared with 67% of children aged 6-11 years. Meanwhile, 15% of children overall were overweight, and 17% of boys and 15% of girls were obese.

Among children aged 5-11, less than 0.05% had an ideal healthy diet score while 85.6% of boys and 83.1% of girls met none or one of the components. Approximately 10% kept their sodium intake down to the required level, but even fewer got enough fruits and vegetables or fish. Only 3% of boys and 2.4% of girls met the whole grains component, and more than 50% received more than the recommended calories from sugary drinks.

Less than 10% of children had poor total cholesterol levels (at least 200 mg/dL), with 30% in the intermediate range (170-199 mg/dL) and 60% with levels below 170 mg/dL. Just 2.8% of boys and 3.5% of girls had poor blood pressure (above 95th percentile), and 92.5% of boys and 91.5% of girls had ideal blood pressure.

Among the healthy diet components, only whole grain, sodium intake, and sugar-sweetened beverages intake were significantly associated with BMI, and BMI was significantly linked to total cholesterol levels and both systolic and diastolic blood pressure.

Children’s diets in the United States are holding them back from adequate cardiovascular health, even though the vast majority have excellent blood pressure and total cholesterol and most have a body mass index in the ideal range, according to a recent study.

“The prevalence of ideal metrics declines with age, both during childhood and adolescence,” wrote Dr. Hongyan Ning of Northwestern University in Chicago and associates. “Efforts to preserve and promote cardiovascular health in childhood and adolescence are urgently needed to reduce the loss of this precious health asset, a consequence in large part to the rising prevalence of obesity” (Circ. Cardiovasc. Qual. Outcomes 2015 [doi:10.1161/circoutcomes.114.001274).

© Creatas/Thinkstock

Dr. Ning’s team used four criteria of the American Heart Association to assess the cardiovascular health of 8,961 children aged 2-11 years from four National Health and Nutrition Examination Surveys (NHANES) conducted from 2003 to 2010. The criteria were blood pressure, total cholesterol, body mass index, and a healthy diet score – classified as poor, intermediate, or ideal. An ideal diet score met four of five components: at least 4.5 cups of fruits and vegetables daily, at least two 3.5-oz. fish servings per week, at least three 1-ounce servings of fiber-rich whole grains per day, less than 1,500 mg of sodium per day, and no more than 450 calories from sugar-sweetened beverages per week.

Among children aged 2-5 years, 77% had an ideal BMI, compared with 67% of children aged 6-11 years. Meanwhile, 15% of children overall were overweight, and 17% of boys and 15% of girls were obese.

Among children aged 5-11, less than 0.05% had an ideal healthy diet score while 85.6% of boys and 83.1% of girls met none or one of the components. Approximately 10% kept their sodium intake down to the required level, but even fewer got enough fruits and vegetables or fish. Only 3% of boys and 2.4% of girls met the whole grains component, and more than 50% received more than the recommended calories from sugary drinks.

Less than 10% of children had poor total cholesterol levels (at least 200 mg/dL), with 30% in the intermediate range (170-199 mg/dL) and 60% with levels below 170 mg/dL. Just 2.8% of boys and 3.5% of girls had poor blood pressure (above 95th percentile), and 92.5% of boys and 91.5% of girls had ideal blood pressure.

Among the healthy diet components, only whole grain, sodium intake, and sugar-sweetened beverages intake were significantly associated with BMI, and BMI was significantly linked to total cholesterol levels and both systolic and diastolic blood pressure.

Children’s diets in the United States are holding them back from adequate cardiovascular health, even though the vast majority have excellent blood pressure and total cholesterol and most have a body mass index in the ideal range, according to a recent study.

“The prevalence of ideal metrics declines with age, both during childhood and adolescence,” wrote Dr. Hongyan Ning of Northwestern University in Chicago and associates. “Efforts to preserve and promote cardiovascular health in childhood and adolescence are urgently needed to reduce the loss of this precious health asset, a consequence in large part to the rising prevalence of obesity” (Circ. Cardiovasc. Qual. Outcomes 2015 [doi:10.1161/circoutcomes.114.001274).

© Creatas/Thinkstock

Dr. Ning’s team used four criteria of the American Heart Association to assess the cardiovascular health of 8,961 children aged 2-11 years from four National Health and Nutrition Examination Surveys (NHANES) conducted from 2003 to 2010. The criteria were blood pressure, total cholesterol, body mass index, and a healthy diet score – classified as poor, intermediate, or ideal. An ideal diet score met four of five components: at least 4.5 cups of fruits and vegetables daily, at least two 3.5-oz. fish servings per week, at least three 1-ounce servings of fiber-rich whole grains per day, less than 1,500 mg of sodium per day, and no more than 450 calories from sugar-sweetened beverages per week.

Among children aged 2-5 years, 77% had an ideal BMI, compared with 67% of children aged 6-11 years. Meanwhile, 15% of children overall were overweight, and 17% of boys and 15% of girls were obese.

Among children aged 5-11, less than 0.05% had an ideal healthy diet score while 85.6% of boys and 83.1% of girls met none or one of the components. Approximately 10% kept their sodium intake down to the required level, but even fewer got enough fruits and vegetables or fish. Only 3% of boys and 2.4% of girls met the whole grains component, and more than 50% received more than the recommended calories from sugary drinks.

Less than 10% of children had poor total cholesterol levels (at least 200 mg/dL), with 30% in the intermediate range (170-199 mg/dL) and 60% with levels below 170 mg/dL. Just 2.8% of boys and 3.5% of girls had poor blood pressure (above 95th percentile), and 92.5% of boys and 91.5% of girls had ideal blood pressure.

Among the healthy diet components, only whole grain, sodium intake, and sugar-sweetened beverages intake were significantly associated with BMI, and BMI was significantly linked to total cholesterol levels and both systolic and diastolic blood pressure.

Children’s diets in the United States are holding them back from adequate cardiovascular health, even though the vast majority have excellent blood pressure and total cholesterol and most have a body mass index in the ideal range, according to a recent study.

“The prevalence of ideal metrics declines with age, both during childhood and adolescence,” wrote Dr. Hongyan Ning of Northwestern University in Chicago and associates. “Efforts to preserve and promote cardiovascular health in childhood and adolescence are urgently needed to reduce the loss of this precious health asset, a consequence in large part to the rising prevalence of obesity” (Circ. Cardiovasc. Qual. Outcomes 2015 [doi:10.1161/circoutcomes.114.001274).

© Creatas/Thinkstock

Dr. Ning’s team used four criteria of the American Heart Association to assess the cardiovascular health of 8,961 children aged 2-11 years from four National Health and Nutrition Examination Surveys (NHANES) conducted from 2003 to 2010. The criteria were blood pressure, total cholesterol, body mass index, and a healthy diet score – classified as poor, intermediate, or ideal. An ideal diet score met four of five components: at least 4.5 cups of fruits and vegetables daily, at least two 3.5-oz. fish servings per week, at least three 1-ounce servings of fiber-rich whole grains per day, less than 1,500 mg of sodium per day, and no more than 450 calories from sugar-sweetened beverages per week.

Among children aged 2-5 years, 77% had an ideal BMI, compared with 67% of children aged 6-11 years. Meanwhile, 15% of children overall were overweight, and 17% of boys and 15% of girls were obese.

Among children aged 5-11, less than 0.05% had an ideal healthy diet score while 85.6% of boys and 83.1% of girls met none or one of the components. Approximately 10% kept their sodium intake down to the required level, but even fewer got enough fruits and vegetables or fish. Only 3% of boys and 2.4% of girls met the whole grains component, and more than 50% received more than the recommended calories from sugary drinks.

Less than 10% of children had poor total cholesterol levels (at least 200 mg/dL), with 30% in the intermediate range (170-199 mg/dL) and 60% with levels below 170 mg/dL. Just 2.8% of boys and 3.5% of girls had poor blood pressure (above 95th percentile), and 92.5% of boys and 91.5% of girls had ideal blood pressure.

Among the healthy diet components, only whole grain, sodium intake, and sugar-sweetened beverages intake were significantly associated with BMI, and BMI was significantly linked to total cholesterol levels and both systolic and diastolic blood pressure.

Preterm infants responded less robustly to the 13-valent pneumococcal conjugate vaccine following the three-shot infant series compared with term infants, but they caught up following the 12-month booster dose, a recent study found.

“Although the immune response to PCV13 1 month after the infant series was lower in preterm infants versus term infants, it is likely to provide adequate protection against disease,” reported Dr. Federico Martinón-Torres of Hospital Clinico Universitario de Santiago de Compostela and the Healthcare Research Institute of Santiago in Spain. Preterm infants, especially those born before 32 weeks, are at higher risk for invasive pneumococcal disease. “These results reinforce the importance of timely pneumococcal vaccination for all infants, including those born prematurely,” wrote Dr. Martinón-Torres and his associates (Pediatrics 2015 March 16 [doi: 10.1542/peds.2014-2941]).

The researchers enrolled 100 healthy term and 100 healthy preterm infants, aged 42-98 days, in a parallel-group study in which the children received the standard PCV13 series at ages 2, 3, and 4 months, followed by the booster dose at 12 months. The children also received all other childhood recommended vaccines (DTaP, hepatitis B vaccine, inactivated poliovirus vaccine, Haemophilus influenzae type b vaccine, and meningococcal group C conjugate vaccine).

The World Health Organization’s established protection threshold for PCV13 response is an IgG concentration of 0.35 mcg/mL or greater. One month after the third dose, at least 85% of the infants achieved this IgG threshold, but a smaller proportion of preterm infants than term infants reached this threshold for serotypes 5, 6A, and 6B. Response for serotypes 6A and 6B generally decreased along with gestational age. Overall titers were generally higher for infants born between 32 and 37 weeks’ gestation compared with those born before 32 weeks’ gestation.

One month after the toddler dose, however, more than 97% of term and preterm infants achieved at least 0.35 mcg/mL of IgG antibodies for all serotypes except serotype 3, for which response was lower with younger gestational age. “Differences in IgG response between preterm and term infants almost disappeared after toddler vaccination, emphasizing the importance of timely administration of the booster dose,” the authors wrote.

Continue for reactions >>

Local reactions were similar across both infant groups and decreased with each subsequent dose. Decreased appetite, irritability, or decreased sleep occurred slightly more often among preterm infants than among term infants. Most reactions were mild or moderate, with fewer than 10% overall experiencing a severe reaction and only one (term) infant experiencing a fever above 40ºC following the toddler dose. One preterm infant also experienced a vaccine-related rash. Overall, 14% preterm infant and 5% of term infants experienced serious adverse events, primarily infections, not necessarily vaccine-related.

The study was funded by Pfizer. Dr. Martinón-Torres and several other investigators reported ties to GlaxoSmithKline, Sanofi Pasteur MSD, Sanofi Pasteur, Pfizer/Wyeth, Novartis, MedImmune, and/or Baxter. The remaining investigators, except for Dr. Concheiro-Guisán who reported no disclosures, are Pfizer employees and stockholders.

Preterm infants responded less robustly to the 13-valent pneumococcal conjugate vaccine following the three-shot infant series compared with term infants, but they caught up following the 12-month booster dose, a recent study found.

“Although the immune response to PCV13 1 month after the infant series was lower in preterm infants versus term infants, it is likely to provide adequate protection against disease,” reported Dr. Federico Martinón-Torres of Hospital Clinico Universitario de Santiago de Compostela and the Healthcare Research Institute of Santiago in Spain. Preterm infants, especially those born before 32 weeks, are at higher risk for invasive pneumococcal disease. “These results reinforce the importance of timely pneumococcal vaccination for all infants, including those born prematurely,” wrote Dr. Martinón-Torres and his associates (Pediatrics 2015 March 16 [doi: 10.1542/peds.2014-2941]).

The researchers enrolled 100 healthy term and 100 healthy preterm infants, aged 42-98 days, in a parallel-group study in which the children received the standard PCV13 series at ages 2, 3, and 4 months, followed by the booster dose at 12 months. The children also received all other childhood recommended vaccines (DTaP, hepatitis B vaccine, inactivated poliovirus vaccine, Haemophilus influenzae type b vaccine, and meningococcal group C conjugate vaccine).

The World Health Organization’s established protection threshold for PCV13 response is an IgG concentration of 0.35 mcg/mL or greater. One month after the third dose, at least 85% of the infants achieved this IgG threshold, but a smaller proportion of preterm infants than term infants reached this threshold for serotypes 5, 6A, and 6B. Response for serotypes 6A and 6B generally decreased along with gestational age. Overall titers were generally higher for infants born between 32 and 37 weeks’ gestation compared with those born before 32 weeks’ gestation.

One month after the toddler dose, however, more than 97% of term and preterm infants achieved at least 0.35 mcg/mL of IgG antibodies for all serotypes except serotype 3, for which response was lower with younger gestational age. “Differences in IgG response between preterm and term infants almost disappeared after toddler vaccination, emphasizing the importance of timely administration of the booster dose,” the authors wrote.

Continue for reactions >>

Local reactions were similar across both infant groups and decreased with each subsequent dose. Decreased appetite, irritability, or decreased sleep occurred slightly more often among preterm infants than among term infants. Most reactions were mild or moderate, with fewer than 10% overall experiencing a severe reaction and only one (term) infant experiencing a fever above 40ºC following the toddler dose. One preterm infant also experienced a vaccine-related rash. Overall, 14% preterm infant and 5% of term infants experienced serious adverse events, primarily infections, not necessarily vaccine-related.

The study was funded by Pfizer. Dr. Martinón-Torres and several other investigators reported ties to GlaxoSmithKline, Sanofi Pasteur MSD, Sanofi Pasteur, Pfizer/Wyeth, Novartis, MedImmune, and/or Baxter. The remaining investigators, except for Dr. Concheiro-Guisán who reported no disclosures, are Pfizer employees and stockholders.

Preterm infants responded less robustly to the 13-valent pneumococcal conjugate vaccine following the three-shot infant series compared with term infants, but they caught up following the 12-month booster dose, a recent study found.

“Although the immune response to PCV13 1 month after the infant series was lower in preterm infants versus term infants, it is likely to provide adequate protection against disease,” reported Dr. Federico Martinón-Torres of Hospital Clinico Universitario de Santiago de Compostela and the Healthcare Research Institute of Santiago in Spain. Preterm infants, especially those born before 32 weeks, are at higher risk for invasive pneumococcal disease. “These results reinforce the importance of timely pneumococcal vaccination for all infants, including those born prematurely,” wrote Dr. Martinón-Torres and his associates (Pediatrics 2015 March 16 [doi: 10.1542/peds.2014-2941]).

The researchers enrolled 100 healthy term and 100 healthy preterm infants, aged 42-98 days, in a parallel-group study in which the children received the standard PCV13 series at ages 2, 3, and 4 months, followed by the booster dose at 12 months. The children also received all other childhood recommended vaccines (DTaP, hepatitis B vaccine, inactivated poliovirus vaccine, Haemophilus influenzae type b vaccine, and meningococcal group C conjugate vaccine).

The World Health Organization’s established protection threshold for PCV13 response is an IgG concentration of 0.35 mcg/mL or greater. One month after the third dose, at least 85% of the infants achieved this IgG threshold, but a smaller proportion of preterm infants than term infants reached this threshold for serotypes 5, 6A, and 6B. Response for serotypes 6A and 6B generally decreased along with gestational age. Overall titers were generally higher for infants born between 32 and 37 weeks’ gestation compared with those born before 32 weeks’ gestation.

One month after the toddler dose, however, more than 97% of term and preterm infants achieved at least 0.35 mcg/mL of IgG antibodies for all serotypes except serotype 3, for which response was lower with younger gestational age. “Differences in IgG response between preterm and term infants almost disappeared after toddler vaccination, emphasizing the importance of timely administration of the booster dose,” the authors wrote.

Continue for reactions >>

Local reactions were similar across both infant groups and decreased with each subsequent dose. Decreased appetite, irritability, or decreased sleep occurred slightly more often among preterm infants than among term infants. Most reactions were mild or moderate, with fewer than 10% overall experiencing a severe reaction and only one (term) infant experiencing a fever above 40ºC following the toddler dose. One preterm infant also experienced a vaccine-related rash. Overall, 14% preterm infant and 5% of term infants experienced serious adverse events, primarily infections, not necessarily vaccine-related.

The study was funded by Pfizer. Dr. Martinón-Torres and several other investigators reported ties to GlaxoSmithKline, Sanofi Pasteur MSD, Sanofi Pasteur, Pfizer/Wyeth, Novartis, MedImmune, and/or Baxter. The remaining investigators, except for Dr. Concheiro-Guisán who reported no disclosures, are Pfizer employees and stockholders.

Administering continuous positive airway pressure to children for acute respiratory failure with a helmet leads to lower treatment failure rates and fewer air leaks and skin sores than does using a face mask, a recent study found.

“These results suggest that helmet CPAP was better tolerated than facial mask CPAP, with less need for sedation,” reported Dr. Giovanna Chidini of Ospedale Maggiore Policlinico, Milan, and her associates. “Its application in mild pediatric acute respiratory failure is feasible and free from adverse events, thus allowing longer treatment than with the mask” (Pediatrics 2015 March 16 [doi: 10.1542/peds.2014-1142]).

The authors randomly assigned 30 infants, all experiencing mild acute respiratory failure resulting from respiratory syncytial virus (RSV), to receive CPAP from a helmet or from a face mask. Treatment failure occurred in 17% (3 of 17 infants) of those using the helmet CPAP but in 54% (7 of 13) of those receiving CPAP with a face mask, primarily because of intolerance (P = .009). Infants who did not tolerate the face mask did successfully tolerate the helmet after being switched.

All the infants receiving face mask CPAP required sedation, compared with 35% of those receiving helmet CPAP (P = .02), and more air leaks and skin sores occurred in the face mask group, despite use of protective pads. Gas exchange and breathing patterns improved equally with both CPAP methods, but all infants required intubation within the first 24 hours because of worsening gas exchange.

No major adverse events, including cardiac arrest, pneumothorax, or safety system failures, occurred in either group. Number of days on CPAP and the CPAP application time in the first 24 hours were similar across both groups. Length of stay in the pediatric intensive care unit did not significantly differ between the two groups, and no gastric distension, eye irritation, or mortality occurred in either group.

“The pediatric helmet was introduced in clinical practice to increase the infant’s comfort while on CPAP,” Dr. Chidini and her associates wrote. “The helmet is supposed to have several advantages over nasal or whole-face masks: it allows free movement of the infant’s head as well as a good interaction with the environment while maintaining a good seal without compression.” No standardized measure of comfort has yet been established, however.

The study did not receive external funding, and the authors reported no disclosures.

Administering continuous positive airway pressure to children for acute respiratory failure with a helmet leads to lower treatment failure rates and fewer air leaks and skin sores than does using a face mask, a recent study found.

“These results suggest that helmet CPAP was better tolerated than facial mask CPAP, with less need for sedation,” reported Dr. Giovanna Chidini of Ospedale Maggiore Policlinico, Milan, and her associates. “Its application in mild pediatric acute respiratory failure is feasible and free from adverse events, thus allowing longer treatment than with the mask” (Pediatrics 2015 March 16 [doi: 10.1542/peds.2014-1142]).

The authors randomly assigned 30 infants, all experiencing mild acute respiratory failure resulting from respiratory syncytial virus (RSV), to receive CPAP from a helmet or from a face mask. Treatment failure occurred in 17% (3 of 17 infants) of those using the helmet CPAP but in 54% (7 of 13) of those receiving CPAP with a face mask, primarily because of intolerance (P = .009). Infants who did not tolerate the face mask did successfully tolerate the helmet after being switched.

All the infants receiving face mask CPAP required sedation, compared with 35% of those receiving helmet CPAP (P = .02), and more air leaks and skin sores occurred in the face mask group, despite use of protective pads. Gas exchange and breathing patterns improved equally with both CPAP methods, but all infants required intubation within the first 24 hours because of worsening gas exchange.

No major adverse events, including cardiac arrest, pneumothorax, or safety system failures, occurred in either group. Number of days on CPAP and the CPAP application time in the first 24 hours were similar across both groups. Length of stay in the pediatric intensive care unit did not significantly differ between the two groups, and no gastric distension, eye irritation, or mortality occurred in either group.

“The pediatric helmet was introduced in clinical practice to increase the infant’s comfort while on CPAP,” Dr. Chidini and her associates wrote. “The helmet is supposed to have several advantages over nasal or whole-face masks: it allows free movement of the infant’s head as well as a good interaction with the environment while maintaining a good seal without compression.” No standardized measure of comfort has yet been established, however.

The study did not receive external funding, and the authors reported no disclosures.

Administering continuous positive airway pressure to children for acute respiratory failure with a helmet leads to lower treatment failure rates and fewer air leaks and skin sores than does using a face mask, a recent study found.

“These results suggest that helmet CPAP was better tolerated than facial mask CPAP, with less need for sedation,” reported Dr. Giovanna Chidini of Ospedale Maggiore Policlinico, Milan, and her associates. “Its application in mild pediatric acute respiratory failure is feasible and free from adverse events, thus allowing longer treatment than with the mask” (Pediatrics 2015 March 16 [doi: 10.1542/peds.2014-1142]).

The authors randomly assigned 30 infants, all experiencing mild acute respiratory failure resulting from respiratory syncytial virus (RSV), to receive CPAP from a helmet or from a face mask. Treatment failure occurred in 17% (3 of 17 infants) of those using the helmet CPAP but in 54% (7 of 13) of those receiving CPAP with a face mask, primarily because of intolerance (P = .009). Infants who did not tolerate the face mask did successfully tolerate the helmet after being switched.

All the infants receiving face mask CPAP required sedation, compared with 35% of those receiving helmet CPAP (P = .02), and more air leaks and skin sores occurred in the face mask group, despite use of protective pads. Gas exchange and breathing patterns improved equally with both CPAP methods, but all infants required intubation within the first 24 hours because of worsening gas exchange.

No major adverse events, including cardiac arrest, pneumothorax, or safety system failures, occurred in either group. Number of days on CPAP and the CPAP application time in the first 24 hours were similar across both groups. Length of stay in the pediatric intensive care unit did not significantly differ between the two groups, and no gastric distension, eye irritation, or mortality occurred in either group.

“The pediatric helmet was introduced in clinical practice to increase the infant’s comfort while on CPAP,” Dr. Chidini and her associates wrote. “The helmet is supposed to have several advantages over nasal or whole-face masks: it allows free movement of the infant’s head as well as a good interaction with the environment while maintaining a good seal without compression.” No standardized measure of comfort has yet been established, however.

The study did not receive external funding, and the authors reported no disclosures.

Preterm infants responded less robustly to the 13-valent pneumococcal conjugate vaccine following the three-shot infant series compared with term infants, but they caught up following the 12-month booster dose, a recent study found.

“Although the immune response to PCV13 1 month after the infant series was lower in preterm infants versus term infants, it is likely to provide adequate protection against disease,” reported Dr. Federico Martinón-Torres of Hospital Clinico Universitario de Santiago de Compostela and the Healthcare Research Institute of Santiago in Spain. Preterm infants, especially those born before 32 weeks, are at higher risk for invasive pneumococcal disease. “These results reinforce the importance of timely pneumococcal vaccination for all infants, including those born prematurely,” wrote Dr.  Martinón-Torres and his associates (Pediatrics 2015 March 16 [doi: 10.1542/peds.2014-2941]).

Steve Mann_ThinkStock

The researchers enrolled 100 healthy term and 100 healthy preterm infants, aged 42-98 days, in a parallel-group study in which the children received the standard PCV13 series at ages 2, 3, and 4 months, followed by the booster dose at 12 months. The children also received all other childhood recommended vaccines (DTaP, hepatitis B vaccine, inactivated poliovirus vaccine, Haemophilus influenzae type b vaccine, and meningococcal group C conjugate vaccine).

The World Health Organization’s established protection threshold for PCV13 response is an IgG concentration of 0.35 mcg/mL or greater. One month after the third dose, at least 85% of the infants achieved this IgG threshold, but a smaller proportion of preterm infants than term infants reached this threshold for serotypes 5, 6A, and 6B. Response for serotypes 6A and 6B generally decreased along with gestational age. Overall titers were generally higher for infants born between 32 and 37 weeks’ gestation compared with those born before 32 weeks’ gestation.

One month after the toddler dose, however, more than 97% of term and preterm infants achieved at least 0.35 mcg/mL of IgG antibodies for all serotypes except serotype 3, for which response was lower with younger gestational age. “Differences in IgG response between preterm and term infants almost disappeared after toddler vaccination, emphasizing the importance of timely administration of the booster dose,” the authors wrote.

Local reactions were similar across both infant groups and decreased with each subsequent dose. Decreased appetite, irritability, or decreased sleep occurred slightly more often among preterm infants than among term infants. Most reactions were mild or moderate, with fewer than 10% overall experiencing a severe reaction and only one (term) infant experiencing a fever above 40ºC following the toddler dose. One preterm infant also experienced a vaccine-related rash. Overall, 14% preterm infant and 5% of term infants experienced serious adverse events, primarily infections, not necessarily vaccine-related.

The study was funded by Pfizer. Dr. Martinón-Torres and several other investigators reported ties to GlaxoSmithKline, Sanofi Pasteur MSD, Sanofi Pasteur, Pfizer/Wyeth, Novartis, MedImmune, and/or Baxter. The remaining investigators, except for Dr. Concheiro-Guisán who reported no disclosures, are Pfizer employees and stockholders.

Preterm infants responded less robustly to the 13-valent pneumococcal conjugate vaccine following the three-shot infant series compared with term infants, but they caught up following the 12-month booster dose, a recent study found.

“Although the immune response to PCV13 1 month after the infant series was lower in preterm infants versus term infants, it is likely to provide adequate protection against disease,” reported Dr. Federico Martinón-Torres of Hospital Clinico Universitario de Santiago de Compostela and the Healthcare Research Institute of Santiago in Spain. Preterm infants, especially those born before 32 weeks, are at higher risk for invasive pneumococcal disease. “These results reinforce the importance of timely pneumococcal vaccination for all infants, including those born prematurely,” wrote Dr.  Martinón-Torres and his associates (Pediatrics 2015 March 16 [doi: 10.1542/peds.2014-2941]).

Steve Mann_ThinkStock

The researchers enrolled 100 healthy term and 100 healthy preterm infants, aged 42-98 days, in a parallel-group study in which the children received the standard PCV13 series at ages 2, 3, and 4 months, followed by the booster dose at 12 months. The children also received all other childhood recommended vaccines (DTaP, hepatitis B vaccine, inactivated poliovirus vaccine, Haemophilus influenzae type b vaccine, and meningococcal group C conjugate vaccine).

The World Health Organization’s established protection threshold for PCV13 response is an IgG concentration of 0.35 mcg/mL or greater. One month after the third dose, at least 85% of the infants achieved this IgG threshold, but a smaller proportion of preterm infants than term infants reached this threshold for serotypes 5, 6A, and 6B. Response for serotypes 6A and 6B generally decreased along with gestational age. Overall titers were generally higher for infants born between 32 and 37 weeks’ gestation compared with those born before 32 weeks’ gestation.

One month after the toddler dose, however, more than 97% of term and preterm infants achieved at least 0.35 mcg/mL of IgG antibodies for all serotypes except serotype 3, for which response was lower with younger gestational age. “Differences in IgG response between preterm and term infants almost disappeared after toddler vaccination, emphasizing the importance of timely administration of the booster dose,” the authors wrote.

Local reactions were similar across both infant groups and decreased with each subsequent dose. Decreased appetite, irritability, or decreased sleep occurred slightly more often among preterm infants than among term infants. Most reactions were mild or moderate, with fewer than 10% overall experiencing a severe reaction and only one (term) infant experiencing a fever above 40ºC following the toddler dose. One preterm infant also experienced a vaccine-related rash. Overall, 14% preterm infant and 5% of term infants experienced serious adverse events, primarily infections, not necessarily vaccine-related.

The study was funded by Pfizer. Dr. Martinón-Torres and several other investigators reported ties to GlaxoSmithKline, Sanofi Pasteur MSD, Sanofi Pasteur, Pfizer/Wyeth, Novartis, MedImmune, and/or Baxter. The remaining investigators, except for Dr. Concheiro-Guisán who reported no disclosures, are Pfizer employees and stockholders.

Preterm infants responded less robustly to the 13-valent pneumococcal conjugate vaccine following the three-shot infant series compared with term infants, but they caught up following the 12-month booster dose, a recent study found.

“Although the immune response to PCV13 1 month after the infant series was lower in preterm infants versus term infants, it is likely to provide adequate protection against disease,” reported Dr. Federico Martinón-Torres of Hospital Clinico Universitario de Santiago de Compostela and the Healthcare Research Institute of Santiago in Spain. Preterm infants, especially those born before 32 weeks, are at higher risk for invasive pneumococcal disease. “These results reinforce the importance of timely pneumococcal vaccination for all infants, including those born prematurely,” wrote Dr.  Martinón-Torres and his associates (Pediatrics 2015 March 16 [doi: 10.1542/peds.2014-2941]).

Steve Mann_ThinkStock

The researchers enrolled 100 healthy term and 100 healthy preterm infants, aged 42-98 days, in a parallel-group study in which the children received the standard PCV13 series at ages 2, 3, and 4 months, followed by the booster dose at 12 months. The children also received all other childhood recommended vaccines (DTaP, hepatitis B vaccine, inactivated poliovirus vaccine, Haemophilus influenzae type b vaccine, and meningococcal group C conjugate vaccine).

The World Health Organization’s established protection threshold for PCV13 response is an IgG concentration of 0.35 mcg/mL or greater. One month after the third dose, at least 85% of the infants achieved this IgG threshold, but a smaller proportion of preterm infants than term infants reached this threshold for serotypes 5, 6A, and 6B. Response for serotypes 6A and 6B generally decreased along with gestational age. Overall titers were generally higher for infants born between 32 and 37 weeks’ gestation compared with those born before 32 weeks’ gestation.

One month after the toddler dose, however, more than 97% of term and preterm infants achieved at least 0.35 mcg/mL of IgG antibodies for all serotypes except serotype 3, for which response was lower with younger gestational age. “Differences in IgG response between preterm and term infants almost disappeared after toddler vaccination, emphasizing the importance of timely administration of the booster dose,” the authors wrote.

Local reactions were similar across both infant groups and decreased with each subsequent dose. Decreased appetite, irritability, or decreased sleep occurred slightly more often among preterm infants than among term infants. Most reactions were mild or moderate, with fewer than 10% overall experiencing a severe reaction and only one (term) infant experiencing a fever above 40ºC following the toddler dose. One preterm infant also experienced a vaccine-related rash. Overall, 14% preterm infant and 5% of term infants experienced serious adverse events, primarily infections, not necessarily vaccine-related.

The study was funded by Pfizer. Dr. Martinón-Torres and several other investigators reported ties to GlaxoSmithKline, Sanofi Pasteur MSD, Sanofi Pasteur, Pfizer/Wyeth, Novartis, MedImmune, and/or Baxter. The remaining investigators, except for Dr. Concheiro-Guisán who reported no disclosures, are Pfizer employees and stockholders.

Reminders for childhood immunizations are slightly more successful and cost-effective when sent from county health departments with a child’s primary care provider’s endorsement than when sent only from the practices themselves, according to a recent study.

“The effect sizes seen in the present trial, although modest, are important from a public health perspective,” Dr. Allison Kempe of Children’s Hospital Colorado, Aurora, and her associates reported online.

“Our findings and those of previous studies support consideration of a centralized collaborative, compared with a practice-based reminder/recall approach to increase immunization rates during the preschool years,” they said. “The present trial demonstrates the poor reach of a practice-based approach from the population perspective,” (JAMA Pediatr. 2015 Feb. 23 [doi:10.1001/jamapediatrics.2014.3670]).

The researchers randomized 15 Colorado counties to implement one of two immunization reminder approaches for the 18,235 children, aged 19-35 months as of Sept. 7, 2012, through March 17, 2013. In the centralized collaborative approach, county health departments mailed and/or autodialed immunization reminders up to four times per child, with the option for primary care providers to add their names to the message. In the practice-based approach, individual practices were invited up to eight times to a Web-based reminder training and received financial support for sending notifications. Only two practices sent reminder/recall notifications in the practice-based counties, but 56.3% of practices added their name to reminders in centralized-collaborative counties.

In the collaborative counties, 87% of eligible children received at least one reminder, compared with just 0.8% in the practice-only counties. In the collaborative counties, 26.9% of children received at least one new immunization, and 12.8% of children became up to date in immunizations, compared with 21.7% and 9.3%, respectively, in practice-based counties. In collaborative counties, 32.1% of children came in for an immunization and 19.2% reached up-to-date status when the health department message included the child’s primary care provider’s name, compared with 24.2% and 9.5% of children, respectively, when the practice name was left off.

The cost of a centralized collaborative reminder system was $11.75 per child for any new immunization and $24.72 for reaching up-to-date status, compared with $74 and $124.45 per child, respectively, in practice-based counties. Each mail contact cost an average $0.73, and each autodial cost an average $0.53. No difference was seen between mailed vs. called reminders. “However, costs would have been much lower if the accuracy of all contact data could be increased,” the researchers noted.

The research was funded by the Agency for Healthcare Research and Quality. The authors reported no relevant financial disclosures.

Reminders for childhood immunizations are slightly more successful and cost-effective when sent from county health departments with a child’s primary care provider’s endorsement than when sent only from the practices themselves, according to a recent study.

“The effect sizes seen in the present trial, although modest, are important from a public health perspective,” Dr. Allison Kempe of Children’s Hospital Colorado, Aurora, and her associates reported online.

“Our findings and those of previous studies support consideration of a centralized collaborative, compared with a practice-based reminder/recall approach to increase immunization rates during the preschool years,” they said. “The present trial demonstrates the poor reach of a practice-based approach from the population perspective,” (JAMA Pediatr. 2015 Feb. 23 [doi:10.1001/jamapediatrics.2014.3670]).

The researchers randomized 15 Colorado counties to implement one of two immunization reminder approaches for the 18,235 children, aged 19-35 months as of Sept. 7, 2012, through March 17, 2013. In the centralized collaborative approach, county health departments mailed and/or autodialed immunization reminders up to four times per child, with the option for primary care providers to add their names to the message. In the practice-based approach, individual practices were invited up to eight times to a Web-based reminder training and received financial support for sending notifications. Only two practices sent reminder/recall notifications in the practice-based counties, but 56.3% of practices added their name to reminders in centralized-collaborative counties.

In the collaborative counties, 87% of eligible children received at least one reminder, compared with just 0.8% in the practice-only counties. In the collaborative counties, 26.9% of children received at least one new immunization, and 12.8% of children became up to date in immunizations, compared with 21.7% and 9.3%, respectively, in practice-based counties. In collaborative counties, 32.1% of children came in for an immunization and 19.2% reached up-to-date status when the health department message included the child’s primary care provider’s name, compared with 24.2% and 9.5% of children, respectively, when the practice name was left off.

The cost of a centralized collaborative reminder system was $11.75 per child for any new immunization and $24.72 for reaching up-to-date status, compared with $74 and $124.45 per child, respectively, in practice-based counties. Each mail contact cost an average $0.73, and each autodial cost an average $0.53. No difference was seen between mailed vs. called reminders. “However, costs would have been much lower if the accuracy of all contact data could be increased,” the researchers noted.

The research was funded by the Agency for Healthcare Research and Quality. The authors reported no relevant financial disclosures.

Reminders for childhood immunizations are slightly more successful and cost-effective when sent from county health departments with a child’s primary care provider’s endorsement than when sent only from the practices themselves, according to a recent study.

“The effect sizes seen in the present trial, although modest, are important from a public health perspective,” Dr. Allison Kempe of Children’s Hospital Colorado, Aurora, and her associates reported online.

“Our findings and those of previous studies support consideration of a centralized collaborative, compared with a practice-based reminder/recall approach to increase immunization rates during the preschool years,” they said. “The present trial demonstrates the poor reach of a practice-based approach from the population perspective,” (JAMA Pediatr. 2015 Feb. 23 [doi:10.1001/jamapediatrics.2014.3670]).

The researchers randomized 15 Colorado counties to implement one of two immunization reminder approaches for the 18,235 children, aged 19-35 months as of Sept. 7, 2012, through March 17, 2013. In the centralized collaborative approach, county health departments mailed and/or autodialed immunization reminders up to four times per child, with the option for primary care providers to add their names to the message. In the practice-based approach, individual practices were invited up to eight times to a Web-based reminder training and received financial support for sending notifications. Only two practices sent reminder/recall notifications in the practice-based counties, but 56.3% of practices added their name to reminders in centralized-collaborative counties.

In the collaborative counties, 87% of eligible children received at least one reminder, compared with just 0.8% in the practice-only counties. In the collaborative counties, 26.9% of children received at least one new immunization, and 12.8% of children became up to date in immunizations, compared with 21.7% and 9.3%, respectively, in practice-based counties. In collaborative counties, 32.1% of children came in for an immunization and 19.2% reached up-to-date status when the health department message included the child’s primary care provider’s name, compared with 24.2% and 9.5% of children, respectively, when the practice name was left off.

The cost of a centralized collaborative reminder system was $11.75 per child for any new immunization and $24.72 for reaching up-to-date status, compared with $74 and $124.45 per child, respectively, in practice-based counties. Each mail contact cost an average $0.73, and each autodial cost an average $0.53. No difference was seen between mailed vs. called reminders. “However, costs would have been much lower if the accuracy of all contact data could be increased,” the researchers noted.

The research was funded by the Agency for Healthcare Research and Quality. The authors reported no relevant financial disclosures.