Thursday, January 8, 2015

Breast Cancer Prevention Starts in Childhood

Breast-fed Newborns: How Much Weight Loss Is Normal?

Diedtra Henderson  Mescape Pediatrics December 01, 2014
Exclusively breast-fed newborns typically lost as much as 10% or more of their birth weight before beginning to gain again in the first days after birth, according to a recent study. By 48 hours, almost 5% of babies born vaginally and 10% of those born by cesarean delivery lost at least 10% of their birth weight. By 72 hours, 25% of cesarean delivered infants lost at least 10% of their birth weight. These metrics may help identify babies with steeper weight loss trajectories that could increase morbidity risk.
Valerie J. Flaherman, MD, MPH, from the Department of Pediatrics and the Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, and colleagues report the findings of their study in an article published online December 1 in Pediatrics.
According to the authors, 60% of newborns in the United States are breast-fed exclusively in the first 2 days after birth, in keeping with recommendations from a number of expert organizations, including the American Academy of Pediatrics. Most of those infants lose weight daily, but a small number of infants suffer complications from excessive weight loss, including hyperbilirubinemia and dehydration.
"These results provide the first graphical depiction of hourly weight loss for exclusively breastfed newborns from a large, diverse population," Dr Flaherman and coauthors write. "Because weight changes steadily throughout the birth hospitalization and is measured at varied intervals from the hour of birth, these new nomograms should substantially aid medical management by allowing clinicians and lactation support providers to categorize newborn weight loss and calibrate decision-making to reflect hour of age."
The authors note that hour-by-hour bilirubin levels, tracked to guard against jaundice, have been incorporated into practice guidelines. To provide a similar type of nomogram for neonate weight loss in exclusively breast-fed newborns, Dr Flaherman and coauthors studied data from 108,907 newborns born at 36 weeks' gestation at Northern California Kaiser Permanente hospitals from January 1, 2009, through December 31, 2013.

Sunday, March 23, 2014

Breastfeeding Past Two Years Linked to Infant Tooth Decay

By Kathleen Raven
March 17, 2014
NEW YORK (Reuters Health) - Breastfeeding is credited with a long list of benefits, but one downside of extended and intensive breastfeeding may be a higher risk of cavities in baby's first teeth, according to a new study.
The more frequently a mother breastfed her child beyond the age of 24 months during the day, the greater the child's risk of severe early tooth decay, researchers found.
Benjamin Chaffee of the University of California, San Francisco led the study as a doctoral student at the University of California at Berkeley. He and his team looked at a possible link between longer-term breastfeeding and the risk of tooth decay and cavities in a survey of 458 babies in low-income families in the city of Porto Alegre, Brazil.
Because the study lasted more than one year, most babies were consuming various kinds of solid food and liquids in addition to breast milk.
The World Health Organization (WHO) recommends that babies are fed breast milk exclusively for the first six months of their lives, with solid foods added to the diet at that point. However, the WHO also recommends continued breastfeeding up to age two and beyond, the authors note.
For the study, the researchers checked in on babies when they were about six, 12 and 38 months old. At six months, the study team gathered data on the number of breast milk bottles the baby drank the day before and any other liquids, like juice.
At the 12-month mark, parents reported whether they fed their babies any of 29 specific foods, including fruits, vegetables, beans, organ meat, candy chips, chocolate milk, cookies, honey, soft drinks or sweet biscuits.
Two trained dentists examined all of the babies at each of the visits.
Nearly half of the children had consumed a prepared infant formula drink by age six months, the researchers reported February 19 online in the Annals of Epidemiology, but very few still drank formula by age one.
The researchers found that about 40% of children who were breastfed between ages six and 24 months had some tooth decay by the end of the study. For babies breastfed for longer than two years and frequently, that number rose to 48%.
"Our study does not suggest that breastfeeding causes caries," Chaffee told Reuters Health.
It is possible that breast milk in conjunction with excess refined sugar in modern foods may be contributing to the greater tooth decay seen in babies breastfed the longest and most often, the authors speculate in their report.
More research is needed to determine what's going on, but the findings are in keeping with professional dental guidelines that suggest avoiding on-demand breastfeeding after tooth eruption, they write.
"There are two aspects of breastfeeding - the actual human milk, which has some, but very little, ability to promote tooth decay," said William Bowen, professor emeritus in the Center for Oral Biology at the University of Rochester Medical Center in New York.
"The second is the physical aspect of breastfeeding, or even bottle-feeding, and that's where the problem arrives," he said.
Bowen was not involved in the new study.
When a baby sucks on a mother's breast or from a bottle, the baby's teeth are sealed off from saliva in the mouth. This physical barrier prevents the saliva from breaking down bacteria, and increases the chances of tooth decay, Bowen said.
Even though participants in the study came from poor backgrounds, "bad habits can form at any socioeconomic level," Bowen told Reuters Health.
About 16% of babies in the U.S. were still exclusively breastfed at age six months last year, according to the National Center for Chronic Disease Prevention and Health Promotion.
The good news, Bowen said, is that it's very easy to clean an infant's teeth.
A simple wipe in the mouth with a water-dampened cloth or Q-tip can effectively remove food before the baby's first teeth, he said, adding: "It's important to get the excess food out of the mouth."
One not-so-good habit is allowing infants to stay on a mother's nipple throughout the night, Bowen said. This usually means very little saliva circulates in the baby's mouth, which can increase the risk of decay.
The primary caregiver of the baby should also maintain good dental health because the bacteria that cause tooth decay in a baby usually come from the primary caregiver, Bowen explained.
The American Academy of Pediatric Dentistry recommends that parents take their child for a first dental visit when the first tooth appears, or no later than the first birthday.
Brushing teeth might help, Chaffee said, The study researchers collected data on tooth brushing habits, but did not investigate a specific link between cleaning teeth after the last feeding and caries.
"But anything that removes carbohydrates and sugars from the oral cavity should help prevent too decay," Chaffee said.
Ann Epidemiol 2014.

Limit Food Allergy Panels, AAP Says in Choosing Wisely List

Larry Hand
March 18, 2014

The American Academy of Pediatrics (AAP) has released its second list of common tests and treatments to question as part of the Choosing Wisely initiative.
The AAP also announced on March 17 the launch of an online learning module pediatricians can use to help with 2 items on its first Choosing Wisely list, released in February 2013. The module is designed to avoid use of antibiotics for viral respiratory illnesses and the use of unnecessary computed tomography scans.
"The AAP strongly supports partnerships and tools that improve the quality of care for patients," AAP President James M. Perrin, MD, said in a news release. "Pediatricians want the best possible tests and treatments for their patients, and they want them to be used appropriately. This is particularly important when treating children, because they are still growing and developing."
The new evidence-based recommendations are:
  • "Don't prescribe high-dose dexamethasone (0.5mg/kg per day) for the prevention or treatment of bronchopulmonary dysplasia in the pre-term infant.
  • Don't perform screening panels for food allergies without previous consideration of medical history.
  • Avoid using acid blockers and motility agents such as metoclopramide (generic) for physiologic gastroesophageal reflux...that is effortless, painless, and not affecting growth. Do not use medication in the so-called 'happy-spitter.'
  • Avoid the use of surveillance cultures for the screening and treatment of asymptomatic bacteruria.
  • Infant home apnea monitors should not be routinely used to prevent Sudden Infant Death Syndrome."
The AAP's complete list of Choosing Wisely recommendations is available online. The first 5 recommendations are:
  • "Antibiotics should not be used for apparent viral respiratory illnesses (sinusitis, pharyngitis, bronchitis).
  • Cough and cold medicines should not be prescribed or recommended for respiratory illnesses in children under four years of age.
  • Computed tomography (CT) scans are not necessary in the immediate evaluation of minor head injuries; clinical observation/Pediatric Emergency Care Applied Research Network (PECARN) criteria should be used to determine whether imaging is indicated.
  • Neuroimaging (CT, [magnetic resonance imaging]) is not necessary in a child with simple febrile seizure.
  • [CT] scans are not necessary in the routine evaluation of abdominal pain."
Choosing Wisely was launched in 2012 by the American Board of Internal Medicine. A national campaign, Choosing Wisely involves more than 50 medical specialty societies identifying common medical tests and treatments that may not be necessary or of benefit to patients.

Supplement May Reduce Diarrhea Burden in Preschoolers

Larry Hand
March 17, 2014
Daily doses of live bacterial supplementation may reduce the occurrence and duration of diarrhea and respiratory tract infection (RTI) in preschool children, as well as lower the costs of treatment, according to a study published online March 17 inPediatrics.
Pedro Gutierrez-Castrellon, MD, DSc, from the National Perinatology Institute, Mexico City, Mexico, and colleagues conducted a randomized, double-blind, placebo-controlled trial at 4 day care centers near the institute between April 2011 and June 2012.
A computer-generated randomization placed 336 healthy children aged 6 to 36 months who were born at term (≥36 weeks' gestation) and who had similar socioeconomic characteristics in 2 equal-number groups. Half the children (168) received Lactobacillus reuteri DSM 17938 (1 × 108 colony-forming unit) and half (168) received placebo once a day for 12 weeks. All of the children completed the study with no breached protocols, the researchers report.
Parents gave the dropper doses on first feedings in the morning, and researchers assessed compliance on the basis of empty bottles returned and parent-kept diaries. Researchers instructed parents on how to monitor daily the stool consistency of their children and to report any respiratory symptoms. Confirmed RTI cases led to hospitalized or outpatient care.
L reuteri supplementation helped reduce the number of days with diarrhea per child from 0.96 (0.2) to 0.32 (0.1; P = .03) during the trial and from 1.1 to 0.5 (P = .01) during a 12-week follow-up period.
In addition, the researchers report that 99 episodes of diarrhea occurred among the L reuteri group compared with 152 episodes among the placebo group (P = .01). Diarrhea lasted an average of 1.6 ± 0.9 days in the L reuteri group and 2.7 ± 1.1 days in the placebo group (P = .02).
L reuteri supplementation helped reduce the number of days with RTI per child from 4.6 (1.8) to 1.5 (0.6; P = .01) during the trial and from 4.4 (1.1) to 2.1 (0.8; P = .01) during follow-up.
L reuteri supplementation also helped significantly reduce the number of days of school absences (P = .03), the number of healthcare visits (P = .04), and the number of days of antibiotic use (P = .04) during the trial and in follow-up. In a cost–benefit analysis, the first such analysis they are aware of, the researchers found that L reuteri supplementation also helped reduce healthcare costs.
"The prophylactic use of L reuteri was associated with a reduction of $36 US dollars (USD) for each case of diarrhea and $37 USD for each case of RTI," the researchers write. They calculated the incremental cost effectiveness ratio at −35.7 for diarrhea and −37.4 for RTI.
"This study adds independent support to previously published evidence that can now be used in systematic reviews to establish evidence-based recommendations for the use of L reuteri DSM 17938 in the prevention of infectious diseases in day care Centers," the researchers conclude.
This research was supported by GioGaia AB, Stockholm, Sweden, who supplied the L reuteri and placebo products used in the trial. The authors have disclosed no relevant financial relationships.
Pediatrics. Published online March 17, 2014. Abstract

Friday, February 14, 2014

Varicella Vaccine Works Well Over Time

April 03, 2013
By David Douglas
NEW YORK (Reuters Health) Apr 03 - Since its introduction in the mid-1990s, varicella vaccine has reduced the average incidence of chickenpox by as much as tenfold, according to researchers.
The vaccine was licensed in the US in 1995 for children at least 12 months old. In 2006, a second dose was recommended.
For a study reported Monday in Pediatrics, Dr. Roger Baxter of the Kaiser Permanente Vaccine Study Center, Oakland, California and colleagues tracked 7,585 children vaccinated in 1995 when they were in their second year of life. This group included 2826 youngsters who received a second dose between 2006 and 2009. All were members of the Kaiser Permanente Northern California health delivery system.
The study showed "the long-lasting effectiveness of varicella vaccine, and the benefit of the second dose," Dr. Baxter told Reuters Health by email.
More than 97% of the children enrolled completed the study. Overall, over 14 years, the average incidence of varicella was 15.9 per 1000 person-years, nine- to tenfold lower than in the prevaccine era.
Annual vaccine effectiveness ranged from 73% to 80% in the first two years of the study to 80% to 90% in the last 10 years. Effectiveness did not seem to wane.
Most cases of varicella were mild and occurred early after vaccination, at which time varicella virus zoster was still widely circulating. No child developed varicella after a second dose. In addition, herpes zoster cases were mild and rates were lower in the vaccine era than earlier (relative risk, 0.61).
The investigators concluded, "Varicella vaccine was effective at preventing chicken pox, and no evidence of waning protection was noted over a 14-year period. One dose provided excellent protection against moderate to severe disease, and most cases occurred shortly after the cohort was vaccinated."
SOURCE:  Pediatrics 2013.

    Daily Sunscreen May Prevent Skin Aging

    June 04, 2013

    By Genevra Pittman
    NEW YORK (Reuters Health) Jun 04 - Using sunscreen every day may help protect against aging skin, according to a new study from Australia.
    Although the benefits of sunscreen are well know when it comes to preventing sunburns and lowering skin cancer risks, researchers said rigorous studies were lacking on how sunscreen use affects photoaging.
    Still, one dermatologist who wasn't involved in the new study said the findings just reinforce what skin doctors already know and tell their patients.
    "If you ask most dermatologists... they'll tell you the two things they recommend for people who really want to avoid photoaging are, don't smoke and use sunscreen," said Dr. Alan Boyd, from Vanderbilt University Medical Center in Nashville.
    "There are definitely a diminished number of people who have pre-cancerous (skin) changes if they are regular users of sunscreen," he told Reuters Health. "It's not too much of a leap to assume the signs and features of photoaging would follow hand in hand."
    For the new study, Dr. Adele Green from the Queensland Institute of Medical Research and her colleagues analyzed data from 903 adults younger than 55 who were followed between 1992 and 1996.
    Half of them were told to put sunscreen of SPF 15 or greater on their head, neck, arms and hands every morning, and to reapply when necessary. The others used sunscreen according to their own discretion.
    At the start and end of the study, the researchers measured photoaging using the skin on the back of each person's left hand. They found that over four years, there were no detectable changes in the skin condition of people who were told to use sunscreen daily, once other sun-related factors were taken into account.
    Australians in that group were 24% less likely to show any increased aging - clinical changes that might not be visible to the naked eye - than those who decided on their own when to wear sunscreen, Dr. Green and her colleagues reported June 3 online in the Annals of Internal Medicine.
    Beta carotene, which was also given to some of the participants, did not seem to have any protective effect on skin aging, however.
    Photoaging happens after long-term exposure to ultraviolet radiation, which penetrates the skin and can cause collagen to break down and DNA to mutate, said Dr. Brundha Balaraman, a dermatology researcher from the Washington University School of Medicine in St. Louis.
    "This study effectively shows that daily sunscreen can reduce the signs of photoaging and photodamage," Dr. Balaraman, who also wasn't part of the research team, told Reuters Health in an email.
    "I believe that daily use of broad-spectrum sunscreens with frequent reapplications may have more profound measurable effects on photoaging," she added. "But the key to prevention is to develop these healthy sun-protective habits at a young age."