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Paperwork snarls stand between kids and at-school asthma medications
BALTIMORE – Four out of five children with asthma didn’t have access to their medication at school because the proper paperwork was missing, according to a survey of 10 inner-city Milwaukee elementary schools.
The number of students who had the required physician-signed authorization forms remained low throughout the school year, said Dr. Santiago Encalada, a pulmonary fellow at the Medical College of Wisconsin, Milwaukee.
Dr. Encalada cited administrative hurdles, lack of standardization, and challenges in school-physician-family communication as barriers to children’s access to asthma medication at school. Although school nurses in Milwaukee have standing orders for emergency albuterol administration, they otherwise need physician signatures on school-generated forms to administer both rescue and prophylactic asthma administration.
In a study whose purpose was to assess the percentage of children with asthma who had appropriate orders on file in a sample of 10 Milwaukee inner-city schools, the schools had orders on file for just 11% of students, on average, at the beginning of the 2014-2015 school year. At the second assessment in January 2015, the average number of students with orders on file at each school had risen to 22%, with schools that had performed better earlier also showing greater gains at mid-year. However, the June 2015 assessment showed that the gains did not continue, with the schools’ aggregate average of 21% of students with appropriate orders showing no improvement from mid-year.
The number of students with asthma in schools varied from about 40 to nearly 200. Numbers varied through the school year as enrollments shifted in these high-need schools, said Dr. Encalada, who presented his findings during a poster session at the annual meeting of the Pediatric Academic Societies. In general, the schools with lower enrollments tended to do better with having orders on file, although statistical analysis was not performed for this variable.
“On average, 80% of asthmatic students in the inner city schools we studied did not have school forms or orders available for life-saving asthma rescue medications, with significant variation between schools. Our findings show that access to even basic asthma care necessities are lagging for this vulnerable population, and a significant disparity exists even within this population,” said senior author Nicholas Antos*, associate director of the Cystic Fibrosis Center at Milwaukee’s Children’s Hospital of Wisconsin.
In interviews and discussion with school nurses and physicians’ offices, Dr. Antos* and Dr. Encalada found that there were often simple but fundamental misunderstandings that impeded the proper flow of paperwork. For example, schools in Milwaukee do not have standardized forms that authorize administration of prescription medications at school, so forms may be confusing to providers and their staff. Privacy concerns sometimes impeded the ability of clinic staff to authorize treatment for students. Also, the inevitable shuffle of paperwork in school-aged families meant that the forms sometimes were simply lost on the way to school.
Understanding the barriers in the process both on the school side and in physician offices has helped Dr. Antos*, Dr. Encalada, and their colleagues to start to build a better pathway. For example, a module has been built into the EHR asthma visit template that allows easy generation of a school form and asks for patient consent for release of information to the schools.
Dr. Antos* said in an interview that the work is ongoing: “To help address these problems, we have devised interventions to improve the way school nurses can contact clinicians, and helped design innovative standardized Asthma Action Plans that can double as school orders.”
In addition to working with local providers and schools, Dr. Encalada and Dr. Antos* have reached out to pediatric societies and the American Academy of Asthma, Allergy, and Immunology (AAAAI). Emphasizing the need for “education of stakeholders of all types,” Dr. Antos* said that change “may be difficult, but we hope with the support of pediatric organizations, the AAAAI, and school administrators, we can begin to break down the barriers preventing quality and timely communication with school nurses.”
The authors had no financial disclosures. The study was funded by the Centers for Disease Control and Prevention through the Wisconsin Asthma Coalition (WAC).
On Twitter @karioakes
*In a previous version, Dr. Antos' name was misspelled.
Dr. Susan Millard, FCCP: comments: The issues identified in this article are huge and not just an occurrence in the inner cities. The critical problem is that the children are even more at risk when living in the inner cities and for sudden death due to asthma. Having one form for the whole state would help tremendously because we could print out an asthma action plan and the form for the school and then fax it directly!
Dr. Susan Millard, FCCP: comments: The issues identified in this article are huge and not just an occurrence in the inner cities. The critical problem is that the children are even more at risk when living in the inner cities and for sudden death due to asthma. Having one form for the whole state would help tremendously because we could print out an asthma action plan and the form for the school and then fax it directly!
Dr. Susan Millard, FCCP: comments: The issues identified in this article are huge and not just an occurrence in the inner cities. The critical problem is that the children are even more at risk when living in the inner cities and for sudden death due to asthma. Having one form for the whole state would help tremendously because we could print out an asthma action plan and the form for the school and then fax it directly!
BALTIMORE – Four out of five children with asthma didn’t have access to their medication at school because the proper paperwork was missing, according to a survey of 10 inner-city Milwaukee elementary schools.
The number of students who had the required physician-signed authorization forms remained low throughout the school year, said Dr. Santiago Encalada, a pulmonary fellow at the Medical College of Wisconsin, Milwaukee.
Dr. Encalada cited administrative hurdles, lack of standardization, and challenges in school-physician-family communication as barriers to children’s access to asthma medication at school. Although school nurses in Milwaukee have standing orders for emergency albuterol administration, they otherwise need physician signatures on school-generated forms to administer both rescue and prophylactic asthma administration.
In a study whose purpose was to assess the percentage of children with asthma who had appropriate orders on file in a sample of 10 Milwaukee inner-city schools, the schools had orders on file for just 11% of students, on average, at the beginning of the 2014-2015 school year. At the second assessment in January 2015, the average number of students with orders on file at each school had risen to 22%, with schools that had performed better earlier also showing greater gains at mid-year. However, the June 2015 assessment showed that the gains did not continue, with the schools’ aggregate average of 21% of students with appropriate orders showing no improvement from mid-year.
The number of students with asthma in schools varied from about 40 to nearly 200. Numbers varied through the school year as enrollments shifted in these high-need schools, said Dr. Encalada, who presented his findings during a poster session at the annual meeting of the Pediatric Academic Societies. In general, the schools with lower enrollments tended to do better with having orders on file, although statistical analysis was not performed for this variable.
“On average, 80% of asthmatic students in the inner city schools we studied did not have school forms or orders available for life-saving asthma rescue medications, with significant variation between schools. Our findings show that access to even basic asthma care necessities are lagging for this vulnerable population, and a significant disparity exists even within this population,” said senior author Nicholas Antos*, associate director of the Cystic Fibrosis Center at Milwaukee’s Children’s Hospital of Wisconsin.
In interviews and discussion with school nurses and physicians’ offices, Dr. Antos* and Dr. Encalada found that there were often simple but fundamental misunderstandings that impeded the proper flow of paperwork. For example, schools in Milwaukee do not have standardized forms that authorize administration of prescription medications at school, so forms may be confusing to providers and their staff. Privacy concerns sometimes impeded the ability of clinic staff to authorize treatment for students. Also, the inevitable shuffle of paperwork in school-aged families meant that the forms sometimes were simply lost on the way to school.
Understanding the barriers in the process both on the school side and in physician offices has helped Dr. Antos*, Dr. Encalada, and their colleagues to start to build a better pathway. For example, a module has been built into the EHR asthma visit template that allows easy generation of a school form and asks for patient consent for release of information to the schools.
Dr. Antos* said in an interview that the work is ongoing: “To help address these problems, we have devised interventions to improve the way school nurses can contact clinicians, and helped design innovative standardized Asthma Action Plans that can double as school orders.”
In addition to working with local providers and schools, Dr. Encalada and Dr. Antos* have reached out to pediatric societies and the American Academy of Asthma, Allergy, and Immunology (AAAAI). Emphasizing the need for “education of stakeholders of all types,” Dr. Antos* said that change “may be difficult, but we hope with the support of pediatric organizations, the AAAAI, and school administrators, we can begin to break down the barriers preventing quality and timely communication with school nurses.”
The authors had no financial disclosures. The study was funded by the Centers for Disease Control and Prevention through the Wisconsin Asthma Coalition (WAC).
On Twitter @karioakes
*In a previous version, Dr. Antos' name was misspelled.
BALTIMORE – Four out of five children with asthma didn’t have access to their medication at school because the proper paperwork was missing, according to a survey of 10 inner-city Milwaukee elementary schools.
The number of students who had the required physician-signed authorization forms remained low throughout the school year, said Dr. Santiago Encalada, a pulmonary fellow at the Medical College of Wisconsin, Milwaukee.
Dr. Encalada cited administrative hurdles, lack of standardization, and challenges in school-physician-family communication as barriers to children’s access to asthma medication at school. Although school nurses in Milwaukee have standing orders for emergency albuterol administration, they otherwise need physician signatures on school-generated forms to administer both rescue and prophylactic asthma administration.
In a study whose purpose was to assess the percentage of children with asthma who had appropriate orders on file in a sample of 10 Milwaukee inner-city schools, the schools had orders on file for just 11% of students, on average, at the beginning of the 2014-2015 school year. At the second assessment in January 2015, the average number of students with orders on file at each school had risen to 22%, with schools that had performed better earlier also showing greater gains at mid-year. However, the June 2015 assessment showed that the gains did not continue, with the schools’ aggregate average of 21% of students with appropriate orders showing no improvement from mid-year.
The number of students with asthma in schools varied from about 40 to nearly 200. Numbers varied through the school year as enrollments shifted in these high-need schools, said Dr. Encalada, who presented his findings during a poster session at the annual meeting of the Pediatric Academic Societies. In general, the schools with lower enrollments tended to do better with having orders on file, although statistical analysis was not performed for this variable.
“On average, 80% of asthmatic students in the inner city schools we studied did not have school forms or orders available for life-saving asthma rescue medications, with significant variation between schools. Our findings show that access to even basic asthma care necessities are lagging for this vulnerable population, and a significant disparity exists even within this population,” said senior author Nicholas Antos*, associate director of the Cystic Fibrosis Center at Milwaukee’s Children’s Hospital of Wisconsin.
In interviews and discussion with school nurses and physicians’ offices, Dr. Antos* and Dr. Encalada found that there were often simple but fundamental misunderstandings that impeded the proper flow of paperwork. For example, schools in Milwaukee do not have standardized forms that authorize administration of prescription medications at school, so forms may be confusing to providers and their staff. Privacy concerns sometimes impeded the ability of clinic staff to authorize treatment for students. Also, the inevitable shuffle of paperwork in school-aged families meant that the forms sometimes were simply lost on the way to school.
Understanding the barriers in the process both on the school side and in physician offices has helped Dr. Antos*, Dr. Encalada, and their colleagues to start to build a better pathway. For example, a module has been built into the EHR asthma visit template that allows easy generation of a school form and asks for patient consent for release of information to the schools.
Dr. Antos* said in an interview that the work is ongoing: “To help address these problems, we have devised interventions to improve the way school nurses can contact clinicians, and helped design innovative standardized Asthma Action Plans that can double as school orders.”
In addition to working with local providers and schools, Dr. Encalada and Dr. Antos* have reached out to pediatric societies and the American Academy of Asthma, Allergy, and Immunology (AAAAI). Emphasizing the need for “education of stakeholders of all types,” Dr. Antos* said that change “may be difficult, but we hope with the support of pediatric organizations, the AAAAI, and school administrators, we can begin to break down the barriers preventing quality and timely communication with school nurses.”
The authors had no financial disclosures. The study was funded by the Centers for Disease Control and Prevention through the Wisconsin Asthma Coalition (WAC).
On Twitter @karioakes
*In a previous version, Dr. Antos' name was misspelled.
AT THE PAS ANNUAL MEETING
Key clinical point: Four out of five high-risk elementary school children lacked proper orders for at-school asthma medication administration.
Major finding: The average number of elementary school children with asthma medication orders on file was 21% at year’s end.
Data source: Yearlong study of 10 inner-city Milwaukee elementary schools; enrollees with asthma ranged from about 40 to nearly 200.
Disclosures: The study was funded by the Centers for Disease Control and Prevention through the Wisconsin Asthma Coalition (WAC).
Autism screening rises after process-based training
A 3- to 6-month learning program for pediatric and family medicine providers significantly improved their screening for autism spectrum disorders (ASD) at 18- and 24-month well child visits, based on data from 26 primary care practices that participated in the program and from 43 physicians who completed surveys before and after the program, according to findings published online May 5 in Pediatrics.
“Unlike traditional continuing medical education, the LC [learning collaborative] focused on improvement of processes of care at the practice level,” wrote Dr. Paul S. Carbone and his colleagues of the University of Utah, Salt Lake City. The first signs of ASD can be present as early as 2 years of age, but often remain undiagnosed for lack of screening at 18- and 24-month visits, they noted.
Rates of documented ASD screening among toddlers increased from 16% before starting the program to 91% during the last month of the program, and 70% of the practices sustained the 91% screening rate 4 years later.
Physician self-efficacy improved significantly from baseline to after the program on the nine autism conditions (such as sleep problems, constipation, and attention deficit/hyperactivity disorder [ADHD]) and seven autism needs (such as making referrals, addressing developmental concerns, and identifying community support services) included in the survey. On a scale of 1 to 10, the average physician’s progress rating was 6.5 after completing the program.
“A LC using the methods we describe is a successful approach to improving the early identification and ongoing care of children with ASD in primary care practices,” they researchers said.
Read the whole article at Pediatrics (2016 May. doi: 10.1542/peds.2015-1850).
A 3- to 6-month learning program for pediatric and family medicine providers significantly improved their screening for autism spectrum disorders (ASD) at 18- and 24-month well child visits, based on data from 26 primary care practices that participated in the program and from 43 physicians who completed surveys before and after the program, according to findings published online May 5 in Pediatrics.
“Unlike traditional continuing medical education, the LC [learning collaborative] focused on improvement of processes of care at the practice level,” wrote Dr. Paul S. Carbone and his colleagues of the University of Utah, Salt Lake City. The first signs of ASD can be present as early as 2 years of age, but often remain undiagnosed for lack of screening at 18- and 24-month visits, they noted.
Rates of documented ASD screening among toddlers increased from 16% before starting the program to 91% during the last month of the program, and 70% of the practices sustained the 91% screening rate 4 years later.
Physician self-efficacy improved significantly from baseline to after the program on the nine autism conditions (such as sleep problems, constipation, and attention deficit/hyperactivity disorder [ADHD]) and seven autism needs (such as making referrals, addressing developmental concerns, and identifying community support services) included in the survey. On a scale of 1 to 10, the average physician’s progress rating was 6.5 after completing the program.
“A LC using the methods we describe is a successful approach to improving the early identification and ongoing care of children with ASD in primary care practices,” they researchers said.
Read the whole article at Pediatrics (2016 May. doi: 10.1542/peds.2015-1850).
A 3- to 6-month learning program for pediatric and family medicine providers significantly improved their screening for autism spectrum disorders (ASD) at 18- and 24-month well child visits, based on data from 26 primary care practices that participated in the program and from 43 physicians who completed surveys before and after the program, according to findings published online May 5 in Pediatrics.
“Unlike traditional continuing medical education, the LC [learning collaborative] focused on improvement of processes of care at the practice level,” wrote Dr. Paul S. Carbone and his colleagues of the University of Utah, Salt Lake City. The first signs of ASD can be present as early as 2 years of age, but often remain undiagnosed for lack of screening at 18- and 24-month visits, they noted.
Rates of documented ASD screening among toddlers increased from 16% before starting the program to 91% during the last month of the program, and 70% of the practices sustained the 91% screening rate 4 years later.
Physician self-efficacy improved significantly from baseline to after the program on the nine autism conditions (such as sleep problems, constipation, and attention deficit/hyperactivity disorder [ADHD]) and seven autism needs (such as making referrals, addressing developmental concerns, and identifying community support services) included in the survey. On a scale of 1 to 10, the average physician’s progress rating was 6.5 after completing the program.
“A LC using the methods we describe is a successful approach to improving the early identification and ongoing care of children with ASD in primary care practices,” they researchers said.
Read the whole article at Pediatrics (2016 May. doi: 10.1542/peds.2015-1850).
FROM PEDIATRICS
Food Allergy Development Linked to S aureus Colonization in Children With AD
Staphylococcus aureus colonization is associated with development of food allergy in children with atopic dermatitis (AD), according to a letter to the editor from Dr. Andrea L. Jones and her associates.
In a study of 718 patients with AD, median food allergen–specific IgE levels to peanut were highest in patients with methicillin-resistant Staphylococcus aureus (MRSA) at 77.7 kilounits of allergen per liter. Patients with methicillin-sensitive S. aureus (MSSA) had median food allergen–specific IgE (sIgE) levels to peanut of 38.9 kUA/L, and patients without S. aureus had median sIgE levels to peanut of 4.3 kUA/L, below the 95% positive predictive value of oral food challenge reaction in patients of 14 kUA/L.
Total IgE levels were highest in AD patients with MRSA at 4,498 kU/L, but were also elevated in patients with MSSA at 2,709 kU/L, compared with 217 kU/L for patients without S. aureus colonization.
“Studies are needed to assess the association between S. aureus skin colonization and food allergy in patients with AD. Confirmation of our current observations opens up the possibility that therapy directed at eradicating S. aureus colonization will be important in the prevention of food allergen sensitization and possibly food allergy in patients with AD,” the investigators concluded.
Find the full letter in the Journal of Allergy and Clinical Immunology (2016 Apr. doi: 10.1016/j.jaci.2016.01.010).
Staphylococcus aureus colonization is associated with development of food allergy in children with atopic dermatitis (AD), according to a letter to the editor from Dr. Andrea L. Jones and her associates.
In a study of 718 patients with AD, median food allergen–specific IgE levels to peanut were highest in patients with methicillin-resistant Staphylococcus aureus (MRSA) at 77.7 kilounits of allergen per liter. Patients with methicillin-sensitive S. aureus (MSSA) had median food allergen–specific IgE (sIgE) levels to peanut of 38.9 kUA/L, and patients without S. aureus had median sIgE levels to peanut of 4.3 kUA/L, below the 95% positive predictive value of oral food challenge reaction in patients of 14 kUA/L.
Total IgE levels were highest in AD patients with MRSA at 4,498 kU/L, but were also elevated in patients with MSSA at 2,709 kU/L, compared with 217 kU/L for patients without S. aureus colonization.
“Studies are needed to assess the association between S. aureus skin colonization and food allergy in patients with AD. Confirmation of our current observations opens up the possibility that therapy directed at eradicating S. aureus colonization will be important in the prevention of food allergen sensitization and possibly food allergy in patients with AD,” the investigators concluded.
Find the full letter in the Journal of Allergy and Clinical Immunology (2016 Apr. doi: 10.1016/j.jaci.2016.01.010).
Staphylococcus aureus colonization is associated with development of food allergy in children with atopic dermatitis (AD), according to a letter to the editor from Dr. Andrea L. Jones and her associates.
In a study of 718 patients with AD, median food allergen–specific IgE levels to peanut were highest in patients with methicillin-resistant Staphylococcus aureus (MRSA) at 77.7 kilounits of allergen per liter. Patients with methicillin-sensitive S. aureus (MSSA) had median food allergen–specific IgE (sIgE) levels to peanut of 38.9 kUA/L, and patients without S. aureus had median sIgE levels to peanut of 4.3 kUA/L, below the 95% positive predictive value of oral food challenge reaction in patients of 14 kUA/L.
Total IgE levels were highest in AD patients with MRSA at 4,498 kU/L, but were also elevated in patients with MSSA at 2,709 kU/L, compared with 217 kU/L for patients without S. aureus colonization.
“Studies are needed to assess the association between S. aureus skin colonization and food allergy in patients with AD. Confirmation of our current observations opens up the possibility that therapy directed at eradicating S. aureus colonization will be important in the prevention of food allergen sensitization and possibly food allergy in patients with AD,” the investigators concluded.
Find the full letter in the Journal of Allergy and Clinical Immunology (2016 Apr. doi: 10.1016/j.jaci.2016.01.010).
FROM THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
Food allergy development linked to S. aureus colonization in children with AD
Staphylococcus aureus colonization is associated with development of food allergy in children with atopic dermatitis (AD), according to a letter to the editor from Dr. Andrea L. Jones and her associates.
In a study of 718 patients with AD, median food allergen–specific IgE levels to peanut were highest in patients with methicillin-resistant Staphylococcus aureus (MRSA) at 77.7 kilounits of allergen per liter. Patients with methicillin-sensitive S. aureus (MSSA) had median food allergen–specific IgE (sIgE) levels to peanut of 38.9 kUA/L, and patients without S. aureus had median sIgE levels to peanut of 4.3 kUA/L, below the 95% positive predictive value of oral food challenge reaction in patients of 14 kUA/L.
Total IgE levels were highest in AD patients with MRSA at 4,498 kU/L, but were also elevated in patients with MSSA at 2,709 kU/L, compared with 217 kU/L for patients without S. aureus colonization.
“Studies are needed to assess the association between S. aureus skin colonization and food allergy in patients with AD. Confirmation of our current observations opens up the possibility that therapy directed at eradicating S. aureus colonization will be important in the prevention of food allergen sensitization and possibly food allergy in patients with AD,” the investigators concluded.
Find the full letter in the Journal of Allergy and Clinical Immunology (2016 Apr. doi: 10.1016/j.jaci.2016.01.010).
Staphylococcus aureus colonization is associated with development of food allergy in children with atopic dermatitis (AD), according to a letter to the editor from Dr. Andrea L. Jones and her associates.
In a study of 718 patients with AD, median food allergen–specific IgE levels to peanut were highest in patients with methicillin-resistant Staphylococcus aureus (MRSA) at 77.7 kilounits of allergen per liter. Patients with methicillin-sensitive S. aureus (MSSA) had median food allergen–specific IgE (sIgE) levels to peanut of 38.9 kUA/L, and patients without S. aureus had median sIgE levels to peanut of 4.3 kUA/L, below the 95% positive predictive value of oral food challenge reaction in patients of 14 kUA/L.
Total IgE levels were highest in AD patients with MRSA at 4,498 kU/L, but were also elevated in patients with MSSA at 2,709 kU/L, compared with 217 kU/L for patients without S. aureus colonization.
“Studies are needed to assess the association between S. aureus skin colonization and food allergy in patients with AD. Confirmation of our current observations opens up the possibility that therapy directed at eradicating S. aureus colonization will be important in the prevention of food allergen sensitization and possibly food allergy in patients with AD,” the investigators concluded.
Find the full letter in the Journal of Allergy and Clinical Immunology (2016 Apr. doi: 10.1016/j.jaci.2016.01.010).
Staphylococcus aureus colonization is associated with development of food allergy in children with atopic dermatitis (AD), according to a letter to the editor from Dr. Andrea L. Jones and her associates.
In a study of 718 patients with AD, median food allergen–specific IgE levels to peanut were highest in patients with methicillin-resistant Staphylococcus aureus (MRSA) at 77.7 kilounits of allergen per liter. Patients with methicillin-sensitive S. aureus (MSSA) had median food allergen–specific IgE (sIgE) levels to peanut of 38.9 kUA/L, and patients without S. aureus had median sIgE levels to peanut of 4.3 kUA/L, below the 95% positive predictive value of oral food challenge reaction in patients of 14 kUA/L.
Total IgE levels were highest in AD patients with MRSA at 4,498 kU/L, but were also elevated in patients with MSSA at 2,709 kU/L, compared with 217 kU/L for patients without S. aureus colonization.
“Studies are needed to assess the association between S. aureus skin colonization and food allergy in patients with AD. Confirmation of our current observations opens up the possibility that therapy directed at eradicating S. aureus colonization will be important in the prevention of food allergen sensitization and possibly food allergy in patients with AD,” the investigators concluded.
Find the full letter in the Journal of Allergy and Clinical Immunology (2016 Apr. doi: 10.1016/j.jaci.2016.01.010).
FROM THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
Consider behavior therapy first for young children with ADHD
The Centers for Disease Control and Prevention is urging pediatricians treating children with attention-deficit/hyperactivity disorder (ADHD) to recommend behavior therapy before prescribing any ADHD-specific medications.
In its latest Vital Signs report, the CDC highlights the importance of having parents of children with ADHD – specifically, children between the ages of 2 and 5 years – develop critical communication, reinforcement, and disciplinary skills to improve the children’s behavior without the use of any additional medication.
“Behavior therapy has been shown to improve symptoms of children with ADHD and can be as effective as medicine, but without the side effects,” CDC Principal Deputy Director Anne Schuchat explained during a teleconference on May 3.
Behavior therapy involves parents of children with ADHD attending a series of therapist-led sessions designed to teach strategies that will “encourage positive behavior, discourage negative behaviors, improve communication, and strengthen their relationship with their child,” according to the CDC. The number of sessions is typically eight, although that number often can run higher.
“This kind of therapy … strengthens the relationship between the parent and child, and it gives parents more effective tools to help their child learn positive behaviors,” said Dr. Georgina Peacock, director of the division of human development and disability at the CDC’s National Center on Birth Defects and Developmental Disabilities.
There are three key takeaways from behavior therapy: positive communication, or giving children your full attention and using the same words with them that they use with you to show that you’re listening; positive reinforcement, or praising your child when he or she does something well to incentivize similar behavior in the future; and structure, or setting up daily routines so that children know what to expect and everyday life becomes predictable for them. Parents who have undergone behavior therapy have reported that their children perform better in school, behave better at home, and improve interpersonal relationships, according to Dr. Peacock.
“Sometimes a therapist works directly with a parent and child; other times, the therapist meets with just the parents,” she clarified. “Parents will go home and practice techniques, and then go back to the therapist to talk about what worked and what didn’t, and what new skills to practice again.”
According to the CDC, only 15% of young children with ADHD are receiving only psychological services, compared with an overwhelming 49% who are receiving only medication and 27% who are receiving medication and psychological services. Nine percent of children aged 2-5 years with ADHD are not receiving either form of care.
Data from 2011 and 2012 show that 6.4 million U.S. children aged 4-17 years have ADHD, with about 2 million of them diagnosed before the age of 6 years. Childhood ADHD has been linked to higher rates of emergency department visits, unintentional injuries, high school dropouts, and grade level retention.
““The bottom line is that we know parents want to do what’s best for their children, and we want to help,” said Dr. Schuchat, adding that “we know that medicine can be appropriate for some young children, but we encourage pediatricians, therapists, and other health care providers to work with families to make sure that children with ADHD are receiving the most appropriate treatment.”
The Centers for Disease Control and Prevention is urging pediatricians treating children with attention-deficit/hyperactivity disorder (ADHD) to recommend behavior therapy before prescribing any ADHD-specific medications.
In its latest Vital Signs report, the CDC highlights the importance of having parents of children with ADHD – specifically, children between the ages of 2 and 5 years – develop critical communication, reinforcement, and disciplinary skills to improve the children’s behavior without the use of any additional medication.
“Behavior therapy has been shown to improve symptoms of children with ADHD and can be as effective as medicine, but without the side effects,” CDC Principal Deputy Director Anne Schuchat explained during a teleconference on May 3.
Behavior therapy involves parents of children with ADHD attending a series of therapist-led sessions designed to teach strategies that will “encourage positive behavior, discourage negative behaviors, improve communication, and strengthen their relationship with their child,” according to the CDC. The number of sessions is typically eight, although that number often can run higher.
“This kind of therapy … strengthens the relationship between the parent and child, and it gives parents more effective tools to help their child learn positive behaviors,” said Dr. Georgina Peacock, director of the division of human development and disability at the CDC’s National Center on Birth Defects and Developmental Disabilities.
There are three key takeaways from behavior therapy: positive communication, or giving children your full attention and using the same words with them that they use with you to show that you’re listening; positive reinforcement, or praising your child when he or she does something well to incentivize similar behavior in the future; and structure, or setting up daily routines so that children know what to expect and everyday life becomes predictable for them. Parents who have undergone behavior therapy have reported that their children perform better in school, behave better at home, and improve interpersonal relationships, according to Dr. Peacock.
“Sometimes a therapist works directly with a parent and child; other times, the therapist meets with just the parents,” she clarified. “Parents will go home and practice techniques, and then go back to the therapist to talk about what worked and what didn’t, and what new skills to practice again.”
According to the CDC, only 15% of young children with ADHD are receiving only psychological services, compared with an overwhelming 49% who are receiving only medication and 27% who are receiving medication and psychological services. Nine percent of children aged 2-5 years with ADHD are not receiving either form of care.
Data from 2011 and 2012 show that 6.4 million U.S. children aged 4-17 years have ADHD, with about 2 million of them diagnosed before the age of 6 years. Childhood ADHD has been linked to higher rates of emergency department visits, unintentional injuries, high school dropouts, and grade level retention.
““The bottom line is that we know parents want to do what’s best for their children, and we want to help,” said Dr. Schuchat, adding that “we know that medicine can be appropriate for some young children, but we encourage pediatricians, therapists, and other health care providers to work with families to make sure that children with ADHD are receiving the most appropriate treatment.”
The Centers for Disease Control and Prevention is urging pediatricians treating children with attention-deficit/hyperactivity disorder (ADHD) to recommend behavior therapy before prescribing any ADHD-specific medications.
In its latest Vital Signs report, the CDC highlights the importance of having parents of children with ADHD – specifically, children between the ages of 2 and 5 years – develop critical communication, reinforcement, and disciplinary skills to improve the children’s behavior without the use of any additional medication.
“Behavior therapy has been shown to improve symptoms of children with ADHD and can be as effective as medicine, but without the side effects,” CDC Principal Deputy Director Anne Schuchat explained during a teleconference on May 3.
Behavior therapy involves parents of children with ADHD attending a series of therapist-led sessions designed to teach strategies that will “encourage positive behavior, discourage negative behaviors, improve communication, and strengthen their relationship with their child,” according to the CDC. The number of sessions is typically eight, although that number often can run higher.
“This kind of therapy … strengthens the relationship between the parent and child, and it gives parents more effective tools to help their child learn positive behaviors,” said Dr. Georgina Peacock, director of the division of human development and disability at the CDC’s National Center on Birth Defects and Developmental Disabilities.
There are three key takeaways from behavior therapy: positive communication, or giving children your full attention and using the same words with them that they use with you to show that you’re listening; positive reinforcement, or praising your child when he or she does something well to incentivize similar behavior in the future; and structure, or setting up daily routines so that children know what to expect and everyday life becomes predictable for them. Parents who have undergone behavior therapy have reported that their children perform better in school, behave better at home, and improve interpersonal relationships, according to Dr. Peacock.
“Sometimes a therapist works directly with a parent and child; other times, the therapist meets with just the parents,” she clarified. “Parents will go home and practice techniques, and then go back to the therapist to talk about what worked and what didn’t, and what new skills to practice again.”
According to the CDC, only 15% of young children with ADHD are receiving only psychological services, compared with an overwhelming 49% who are receiving only medication and 27% who are receiving medication and psychological services. Nine percent of children aged 2-5 years with ADHD are not receiving either form of care.
Data from 2011 and 2012 show that 6.4 million U.S. children aged 4-17 years have ADHD, with about 2 million of them diagnosed before the age of 6 years. Childhood ADHD has been linked to higher rates of emergency department visits, unintentional injuries, high school dropouts, and grade level retention.
““The bottom line is that we know parents want to do what’s best for their children, and we want to help,” said Dr. Schuchat, adding that “we know that medicine can be appropriate for some young children, but we encourage pediatricians, therapists, and other health care providers to work with families to make sure that children with ADHD are receiving the most appropriate treatment.”
FROM A CDC TELECONFERENCE
Children with internalizing symptoms may not get enough attention
BALTIMORE – Children who exhibit only internalizing symptoms, which are often indicative of anxiety and depression, are less likely to be referred to mental health services than children who exhibit not only the same internalizing behavior, but also external and attentional behavior.
“Pediatricians now are doing much more about mental health; we’ve been energized about how this is an important determinant not only of the child’s present health, but the child’s long-term health, and how they function in the world,” explained Dr. Diane Bloomfield of The Children’s Hospital at Montefiore, Bronx, N.Y., at the annual meeting of the Pediatric Academic Societies.
In a video interview, Dr. Bloomfield discussed the importance of making sure children with internalizing symptoms are referred to the proper specialists, how electronic health records can play a part in children slipping through the cracks, and why educating parents is a critical step in addressing the needs of internalizing children.
Dr. Bloomfield did not report any relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BALTIMORE – Children who exhibit only internalizing symptoms, which are often indicative of anxiety and depression, are less likely to be referred to mental health services than children who exhibit not only the same internalizing behavior, but also external and attentional behavior.
“Pediatricians now are doing much more about mental health; we’ve been energized about how this is an important determinant not only of the child’s present health, but the child’s long-term health, and how they function in the world,” explained Dr. Diane Bloomfield of The Children’s Hospital at Montefiore, Bronx, N.Y., at the annual meeting of the Pediatric Academic Societies.
In a video interview, Dr. Bloomfield discussed the importance of making sure children with internalizing symptoms are referred to the proper specialists, how electronic health records can play a part in children slipping through the cracks, and why educating parents is a critical step in addressing the needs of internalizing children.
Dr. Bloomfield did not report any relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BALTIMORE – Children who exhibit only internalizing symptoms, which are often indicative of anxiety and depression, are less likely to be referred to mental health services than children who exhibit not only the same internalizing behavior, but also external and attentional behavior.
“Pediatricians now are doing much more about mental health; we’ve been energized about how this is an important determinant not only of the child’s present health, but the child’s long-term health, and how they function in the world,” explained Dr. Diane Bloomfield of The Children’s Hospital at Montefiore, Bronx, N.Y., at the annual meeting of the Pediatric Academic Societies.
In a video interview, Dr. Bloomfield discussed the importance of making sure children with internalizing symptoms are referred to the proper specialists, how electronic health records can play a part in children slipping through the cracks, and why educating parents is a critical step in addressing the needs of internalizing children.
Dr. Bloomfield did not report any relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT THE PAS ANNUAL MEETING
Acid blockers boost infections in outpatient preemies
BALTIMORE – Treatment of premature infants with a drug that blocks gastroesophageal reflux once they are discharged home during the first year of life was associated with a significantly increased risk for development of pneumonia and gastroenteritis in a case-control study with 695 matched-pairs of infants.
Administering either a histamine2-receptor antagonist or proton pump inhibitor to these children was associated with an adjusted 75% increased risk for pneumonia and a 2.4-fold increased risk for gastroenteritis during the periods when the infants were on these acid-blocking drugs, Dr. Scott A. Lorch said at the annual meeting of the Pediatric Academic Societies. However, these medications did not appear to produce any lingering effects, with the rates of these infections falling to match control rates after acid-blocking treatment ceased.
The findings highlight that acid-blocking drugs “are not without consequences” and so should be “carefully considered before initiating therapy in this medically fragile population [premature infants], and if they are prescribed their continued need should be frequently assessed,” said Dr. Lorch, a neonatologist at the Children’s Hospital of Philadelphia.
In his experience, acid blockers “are being used like water, both in the hospital as well as after the infants go home. That is where there is concern. We see a fair number of kids on these medications for a much longer period of time than you’d expect. The average time on these medications is 6 months, and that is a long time to be on them,” Dr. Lorch said.
He noted that study results reported in 2015 by himself and his associates showed that in the 30-site primary care network affiliated with the Children’s Hospital of Philadelphia, three-quarters of the acid-blocking drug prescriptions written for infants who had been born prematurely came from primary care physicians once the infants had been discharged from the hospital.
The current study used data that had been collected on more than 2,000 infants who had been born at less than 36 weeks’ gestation during 2007-2009 and then discharged within 4 months of delivery into care by the primary care network and then followed until they were 3 years old. From this cohort, the researchers identified 695 infants who began treatment with either a histamine2-receptor antagonist or a proton pump inhibitor at some time during their first year and matched them by gestational age at birth and race with an equal number of infants from the cohort who never received an acid-blocking drug.
Dr. Lorch and his associates then analyzed the incidence rates of four different types of infections in the children during three time periods: while they were on the acid-blocking medication, and at 7 months and 13 months after the acid-blocking treatment stopped. Infection rates in the controls were tallied at ages that matched the periods studied in those who received the acid blockers.
The four infections they studied were pneumonia, gastroenteritis, bronchiolitis, and conjunctivitis. The last was included as a control as the researchers presumed that acid-blocker use should have no impact on the rates of conjunctivitis.
The results showed that during acid-blocker treatment, the incidence rate of pneumonia was 5% in those on an acid blocker and 3% in the controls, and the incidence of gastroenteritis was 19% in those on an acid blocker and 12% in the controls, Dr. Lorch reported. However, the rates of both infections were similar at 7 and 13 months after acid-blocker treatment stopped, and there was also no difference in the rates of both bronchiolitis and conjunctivitis during any period examined.
A multivariate analysis that controlled for a variety of clinical and demographic variables determined the 75% increased odds ratio for pneumonia and the 2.4-fold increased rate of gastroenteritis, compared with the controls, during periods of acid-blocker treatment. The analysis also showed that the presence of chronic lung disease appeared to have no impact on these infection rates.
Dr. Lorch had no relevant financial disclosures.
On Twitter @mitchelzoler
BALTIMORE – Treatment of premature infants with a drug that blocks gastroesophageal reflux once they are discharged home during the first year of life was associated with a significantly increased risk for development of pneumonia and gastroenteritis in a case-control study with 695 matched-pairs of infants.
Administering either a histamine2-receptor antagonist or proton pump inhibitor to these children was associated with an adjusted 75% increased risk for pneumonia and a 2.4-fold increased risk for gastroenteritis during the periods when the infants were on these acid-blocking drugs, Dr. Scott A. Lorch said at the annual meeting of the Pediatric Academic Societies. However, these medications did not appear to produce any lingering effects, with the rates of these infections falling to match control rates after acid-blocking treatment ceased.
The findings highlight that acid-blocking drugs “are not without consequences” and so should be “carefully considered before initiating therapy in this medically fragile population [premature infants], and if they are prescribed their continued need should be frequently assessed,” said Dr. Lorch, a neonatologist at the Children’s Hospital of Philadelphia.
In his experience, acid blockers “are being used like water, both in the hospital as well as after the infants go home. That is where there is concern. We see a fair number of kids on these medications for a much longer period of time than you’d expect. The average time on these medications is 6 months, and that is a long time to be on them,” Dr. Lorch said.
He noted that study results reported in 2015 by himself and his associates showed that in the 30-site primary care network affiliated with the Children’s Hospital of Philadelphia, three-quarters of the acid-blocking drug prescriptions written for infants who had been born prematurely came from primary care physicians once the infants had been discharged from the hospital.
The current study used data that had been collected on more than 2,000 infants who had been born at less than 36 weeks’ gestation during 2007-2009 and then discharged within 4 months of delivery into care by the primary care network and then followed until they were 3 years old. From this cohort, the researchers identified 695 infants who began treatment with either a histamine2-receptor antagonist or a proton pump inhibitor at some time during their first year and matched them by gestational age at birth and race with an equal number of infants from the cohort who never received an acid-blocking drug.
Dr. Lorch and his associates then analyzed the incidence rates of four different types of infections in the children during three time periods: while they were on the acid-blocking medication, and at 7 months and 13 months after the acid-blocking treatment stopped. Infection rates in the controls were tallied at ages that matched the periods studied in those who received the acid blockers.
The four infections they studied were pneumonia, gastroenteritis, bronchiolitis, and conjunctivitis. The last was included as a control as the researchers presumed that acid-blocker use should have no impact on the rates of conjunctivitis.
The results showed that during acid-blocker treatment, the incidence rate of pneumonia was 5% in those on an acid blocker and 3% in the controls, and the incidence of gastroenteritis was 19% in those on an acid blocker and 12% in the controls, Dr. Lorch reported. However, the rates of both infections were similar at 7 and 13 months after acid-blocker treatment stopped, and there was also no difference in the rates of both bronchiolitis and conjunctivitis during any period examined.
A multivariate analysis that controlled for a variety of clinical and demographic variables determined the 75% increased odds ratio for pneumonia and the 2.4-fold increased rate of gastroenteritis, compared with the controls, during periods of acid-blocker treatment. The analysis also showed that the presence of chronic lung disease appeared to have no impact on these infection rates.
Dr. Lorch had no relevant financial disclosures.
On Twitter @mitchelzoler
BALTIMORE – Treatment of premature infants with a drug that blocks gastroesophageal reflux once they are discharged home during the first year of life was associated with a significantly increased risk for development of pneumonia and gastroenteritis in a case-control study with 695 matched-pairs of infants.
Administering either a histamine2-receptor antagonist or proton pump inhibitor to these children was associated with an adjusted 75% increased risk for pneumonia and a 2.4-fold increased risk for gastroenteritis during the periods when the infants were on these acid-blocking drugs, Dr. Scott A. Lorch said at the annual meeting of the Pediatric Academic Societies. However, these medications did not appear to produce any lingering effects, with the rates of these infections falling to match control rates after acid-blocking treatment ceased.
The findings highlight that acid-blocking drugs “are not without consequences” and so should be “carefully considered before initiating therapy in this medically fragile population [premature infants], and if they are prescribed their continued need should be frequently assessed,” said Dr. Lorch, a neonatologist at the Children’s Hospital of Philadelphia.
In his experience, acid blockers “are being used like water, both in the hospital as well as after the infants go home. That is where there is concern. We see a fair number of kids on these medications for a much longer period of time than you’d expect. The average time on these medications is 6 months, and that is a long time to be on them,” Dr. Lorch said.
He noted that study results reported in 2015 by himself and his associates showed that in the 30-site primary care network affiliated with the Children’s Hospital of Philadelphia, three-quarters of the acid-blocking drug prescriptions written for infants who had been born prematurely came from primary care physicians once the infants had been discharged from the hospital.
The current study used data that had been collected on more than 2,000 infants who had been born at less than 36 weeks’ gestation during 2007-2009 and then discharged within 4 months of delivery into care by the primary care network and then followed until they were 3 years old. From this cohort, the researchers identified 695 infants who began treatment with either a histamine2-receptor antagonist or a proton pump inhibitor at some time during their first year and matched them by gestational age at birth and race with an equal number of infants from the cohort who never received an acid-blocking drug.
Dr. Lorch and his associates then analyzed the incidence rates of four different types of infections in the children during three time periods: while they were on the acid-blocking medication, and at 7 months and 13 months after the acid-blocking treatment stopped. Infection rates in the controls were tallied at ages that matched the periods studied in those who received the acid blockers.
The four infections they studied were pneumonia, gastroenteritis, bronchiolitis, and conjunctivitis. The last was included as a control as the researchers presumed that acid-blocker use should have no impact on the rates of conjunctivitis.
The results showed that during acid-blocker treatment, the incidence rate of pneumonia was 5% in those on an acid blocker and 3% in the controls, and the incidence of gastroenteritis was 19% in those on an acid blocker and 12% in the controls, Dr. Lorch reported. However, the rates of both infections were similar at 7 and 13 months after acid-blocker treatment stopped, and there was also no difference in the rates of both bronchiolitis and conjunctivitis during any period examined.
A multivariate analysis that controlled for a variety of clinical and demographic variables determined the 75% increased odds ratio for pneumonia and the 2.4-fold increased rate of gastroenteritis, compared with the controls, during periods of acid-blocker treatment. The analysis also showed that the presence of chronic lung disease appeared to have no impact on these infection rates.
Dr. Lorch had no relevant financial disclosures.
On Twitter @mitchelzoler
AT THE PAS ANNUAL MEETING
Key clinical point: Premature infants who were discharged home and then received a drug to prevent gastroesophageal reflux during their first year had significantly increased rates of pneumonia and gastroenteritis during the periods when they were on the acid-blocking drugs.
Major finding: Treatment with an acid-blocking drug was associated with a 75% increased rate of pneumonia and a 2.4-fold higher rate of gastroenteritis.
Data source: Case-control study involving 695 matched pairs of infants from a single U.S. primary care network.
Disclosures: Dr. Lorch had no relevant financial disclosures.
Study Reaffirms That Maternal Flu Immunization Reduces Infants’ Risk for Flu
Infants born to mothers who received flu immunization during pregnancy were 70% less likely to contract lab-confirmed influenza and 81% less likely to be hospitalized for flu before age 6 months, compared with infants of unimmunized mothers, a study reaffirmed.
Yet just one in ten pregnant women received the vaccine, a proportion that has steadily risen since the 2009-2010 H1N1 flu season.
“The results of this large retrospective study support the conclusions of prospective studies regarding the protective benefit of maternal influenza immunization during pregnancy,” reported Dr. Julie H. Shakib of the University of Utah, Salt Lake City, and her associates (Pediatrics. 2016 May 3. doi: 10.1542/peds.2015-2360). “Interventions that target both healthy pregnant women and those with chronic conditions are needed to increase vaccine uptake,” they wrote.
The researchers analyzed self-reported seasonal influenza immunization uptake in the 245,386 women who gave birth between December 2005 and March 2014 in the Intermountain Healthcare facilities in Utah and Idaho. Although 10% of the women overall received flu vaccinations, just 2.2% of the women who delivered before the 2009-2010 H1N1 pandemic had received them. That number rose after the pandemic to 21% (P < .001). More than half (52%) of the women giving birth during the 2013-2014 flu season reported getting the seasonal flu vaccine.
Among the women’s 249,387 infants, 866 had at least one influenza-like illness (ILI), including 32 born to vaccinated women and 834 born to unvaccinated women. The infants born to women receiving the flu vaccine during pregnancy were 64% less likely to develop an ILI, with illnesses in 1.34 per 1,000 born to vaccinated women and 3.7 per 1,000 born to unvaccinated women (relative risk, 0.36).
The rates of laboratory-confirmed influenza in the 658 children who contracted it were 0.84 per 1,000 children born to vaccinated mothers and 2.83 per 1,000 children born to unvaccinated mothers, translating to a 70% lower risk of flu in those born to vaccinated mothers (RR, 0.30). Similarly, infants born to vaccinated mothers were 81% less likely to be hospitalized for lab-confirmed influenza (RR, 0.19, P = .005). Just 3 of 151 hospitalized infants had been born to mothers who received the flu vaccine, for a rate of 0.13 per 1,000 for children of vaccinated mothers and 0.66 per 1,000 for children of unvaccinated mothers.
Pregnant women with public insurance or no insurance were less likely to report getting the seasonal vaccine than were privately insured women, but those with chronic conditions were more likely to be vaccinated. Uptake also was lower among women with incomes below the federal poverty level and among women living in either rural or frontier areas or in the Urban South or Southwest Intermountain regions.
“The Intermountain Urban South region includes Utah County, 1 of 30 U.S. counties with the largest estimated numbers of unvaccinated children from 1995-2001 CDC National Immunization Surveys (NIS) data,” the authors wrote. “It is possible that factors leading to parental vaccine hesitancy in children may similarly affect pregnant women considering maternal immunization during pregnancy.”
Because of widespread testing for respiratory viruses at Intermountain facilities, the researchers also could determine that flu vaccine receipt among the mothers did not affect incidence of RSV.
“Our study strengthens the evidence that maternal immunization provides passive protection against influenza to infants during the vulnerable period before they are old enough to receive active immunization,” Dr. Shakib and her associates wrote.
The research was funded by the National Institutes of Health, the University of Utah Children’s Health Research Center and the Pediatric Clinical and Translational Scholar Program, the H.A. and Edna Benning Presidential Endowment, and the University of Utah Center for Clinical and Translational Science through the National Center for Research Resources and the National Center for Advancing Translational Sciences. The authors reported no disclosures.
Infants born to mothers who received flu immunization during pregnancy were 70% less likely to contract lab-confirmed influenza and 81% less likely to be hospitalized for flu before age 6 months, compared with infants of unimmunized mothers, a study reaffirmed.
Yet just one in ten pregnant women received the vaccine, a proportion that has steadily risen since the 2009-2010 H1N1 flu season.
“The results of this large retrospective study support the conclusions of prospective studies regarding the protective benefit of maternal influenza immunization during pregnancy,” reported Dr. Julie H. Shakib of the University of Utah, Salt Lake City, and her associates (Pediatrics. 2016 May 3. doi: 10.1542/peds.2015-2360). “Interventions that target both healthy pregnant women and those with chronic conditions are needed to increase vaccine uptake,” they wrote.
The researchers analyzed self-reported seasonal influenza immunization uptake in the 245,386 women who gave birth between December 2005 and March 2014 in the Intermountain Healthcare facilities in Utah and Idaho. Although 10% of the women overall received flu vaccinations, just 2.2% of the women who delivered before the 2009-2010 H1N1 pandemic had received them. That number rose after the pandemic to 21% (P < .001). More than half (52%) of the women giving birth during the 2013-2014 flu season reported getting the seasonal flu vaccine.
Among the women’s 249,387 infants, 866 had at least one influenza-like illness (ILI), including 32 born to vaccinated women and 834 born to unvaccinated women. The infants born to women receiving the flu vaccine during pregnancy were 64% less likely to develop an ILI, with illnesses in 1.34 per 1,000 born to vaccinated women and 3.7 per 1,000 born to unvaccinated women (relative risk, 0.36).
The rates of laboratory-confirmed influenza in the 658 children who contracted it were 0.84 per 1,000 children born to vaccinated mothers and 2.83 per 1,000 children born to unvaccinated mothers, translating to a 70% lower risk of flu in those born to vaccinated mothers (RR, 0.30). Similarly, infants born to vaccinated mothers were 81% less likely to be hospitalized for lab-confirmed influenza (RR, 0.19, P = .005). Just 3 of 151 hospitalized infants had been born to mothers who received the flu vaccine, for a rate of 0.13 per 1,000 for children of vaccinated mothers and 0.66 per 1,000 for children of unvaccinated mothers.
Pregnant women with public insurance or no insurance were less likely to report getting the seasonal vaccine than were privately insured women, but those with chronic conditions were more likely to be vaccinated. Uptake also was lower among women with incomes below the federal poverty level and among women living in either rural or frontier areas or in the Urban South or Southwest Intermountain regions.
“The Intermountain Urban South region includes Utah County, 1 of 30 U.S. counties with the largest estimated numbers of unvaccinated children from 1995-2001 CDC National Immunization Surveys (NIS) data,” the authors wrote. “It is possible that factors leading to parental vaccine hesitancy in children may similarly affect pregnant women considering maternal immunization during pregnancy.”
Because of widespread testing for respiratory viruses at Intermountain facilities, the researchers also could determine that flu vaccine receipt among the mothers did not affect incidence of RSV.
“Our study strengthens the evidence that maternal immunization provides passive protection against influenza to infants during the vulnerable period before they are old enough to receive active immunization,” Dr. Shakib and her associates wrote.
The research was funded by the National Institutes of Health, the University of Utah Children’s Health Research Center and the Pediatric Clinical and Translational Scholar Program, the H.A. and Edna Benning Presidential Endowment, and the University of Utah Center for Clinical and Translational Science through the National Center for Research Resources and the National Center for Advancing Translational Sciences. The authors reported no disclosures.
Infants born to mothers who received flu immunization during pregnancy were 70% less likely to contract lab-confirmed influenza and 81% less likely to be hospitalized for flu before age 6 months, compared with infants of unimmunized mothers, a study reaffirmed.
Yet just one in ten pregnant women received the vaccine, a proportion that has steadily risen since the 2009-2010 H1N1 flu season.
“The results of this large retrospective study support the conclusions of prospective studies regarding the protective benefit of maternal influenza immunization during pregnancy,” reported Dr. Julie H. Shakib of the University of Utah, Salt Lake City, and her associates (Pediatrics. 2016 May 3. doi: 10.1542/peds.2015-2360). “Interventions that target both healthy pregnant women and those with chronic conditions are needed to increase vaccine uptake,” they wrote.
The researchers analyzed self-reported seasonal influenza immunization uptake in the 245,386 women who gave birth between December 2005 and March 2014 in the Intermountain Healthcare facilities in Utah and Idaho. Although 10% of the women overall received flu vaccinations, just 2.2% of the women who delivered before the 2009-2010 H1N1 pandemic had received them. That number rose after the pandemic to 21% (P < .001). More than half (52%) of the women giving birth during the 2013-2014 flu season reported getting the seasonal flu vaccine.
Among the women’s 249,387 infants, 866 had at least one influenza-like illness (ILI), including 32 born to vaccinated women and 834 born to unvaccinated women. The infants born to women receiving the flu vaccine during pregnancy were 64% less likely to develop an ILI, with illnesses in 1.34 per 1,000 born to vaccinated women and 3.7 per 1,000 born to unvaccinated women (relative risk, 0.36).
The rates of laboratory-confirmed influenza in the 658 children who contracted it were 0.84 per 1,000 children born to vaccinated mothers and 2.83 per 1,000 children born to unvaccinated mothers, translating to a 70% lower risk of flu in those born to vaccinated mothers (RR, 0.30). Similarly, infants born to vaccinated mothers were 81% less likely to be hospitalized for lab-confirmed influenza (RR, 0.19, P = .005). Just 3 of 151 hospitalized infants had been born to mothers who received the flu vaccine, for a rate of 0.13 per 1,000 for children of vaccinated mothers and 0.66 per 1,000 for children of unvaccinated mothers.
Pregnant women with public insurance or no insurance were less likely to report getting the seasonal vaccine than were privately insured women, but those with chronic conditions were more likely to be vaccinated. Uptake also was lower among women with incomes below the federal poverty level and among women living in either rural or frontier areas or in the Urban South or Southwest Intermountain regions.
“The Intermountain Urban South region includes Utah County, 1 of 30 U.S. counties with the largest estimated numbers of unvaccinated children from 1995-2001 CDC National Immunization Surveys (NIS) data,” the authors wrote. “It is possible that factors leading to parental vaccine hesitancy in children may similarly affect pregnant women considering maternal immunization during pregnancy.”
Because of widespread testing for respiratory viruses at Intermountain facilities, the researchers also could determine that flu vaccine receipt among the mothers did not affect incidence of RSV.
“Our study strengthens the evidence that maternal immunization provides passive protection against influenza to infants during the vulnerable period before they are old enough to receive active immunization,” Dr. Shakib and her associates wrote.
The research was funded by the National Institutes of Health, the University of Utah Children’s Health Research Center and the Pediatric Clinical and Translational Scholar Program, the H.A. and Edna Benning Presidential Endowment, and the University of Utah Center for Clinical and Translational Science through the National Center for Research Resources and the National Center for Advancing Translational Sciences. The authors reported no disclosures.
FROM PEDIATRICS
Study reaffirms that maternal flu immunization reduces infants’ risk of flu
Infants born to mothers who received flu immunization during pregnancy were 70% less likely to contract lab-confirmed influenza and 81% less likely to be hospitalized for flu before age 6 months, compared with infants of unimmunized mothers, a study reaffirmed.
Yet just one in ten pregnant women received the vaccine, a proportion that has steadily risen since the 2009-2010 H1N1 flu season.
“The results of this large retrospective study support the conclusions of prospective studies regarding the protective benefit of maternal influenza immunization during pregnancy,” reported Dr. Julie H. Shakib of the University of Utah, Salt Lake City, and her associates (Pediatrics. 2016 May 3. doi: 10.1542/peds.2015-2360). “Interventions that target both healthy pregnant women and those with chronic conditions are needed to increase vaccine uptake,” they wrote.
The researchers analyzed self-reported seasonal influenza immunization uptake in the 245,386 women who gave birth between December 2005 and March 2014 in the Intermountain Healthcare facilities in Utah and Idaho. Although 10% of the women overall received flu vaccinations, just 2.2% of the women who delivered before the 2009-2010 H1N1 pandemic had received them. That number rose after the pandemic to 21% (P < .001). More than half (52%) of the women giving birth during the 2013-2014 flu season reported getting the seasonal flu vaccine.
Among the women’s 249,387 infants, 866 had at least one influenza-like illness (ILI), including 32 born to vaccinated women and 834 born to unvaccinated women. The infants born to women receiving the flu vaccine during pregnancy were 64% less likely to develop an ILI, with illnesses in 1.34 per 1,000 born to vaccinated women and 3.7 per 1,000 born to unvaccinated women (relative risk, 0.36).
The rates of laboratory-confirmed influenza in the 658 children who contracted it were 0.84 per 1,000 children born to vaccinated mothers and 2.83 per 1,000 children born to unvaccinated mothers, translating to a 70% lower risk of flu in those born to vaccinated mothers (RR, 0.30). Similarly, infants born to vaccinated mothers were 81% less likely to be hospitalized for lab-confirmed influenza (RR, 0.19, P = .005). Just 3 of 151 hospitalized infants had been born to mothers who received the flu vaccine, for a rate of 0.13 per 1,000 for children of vaccinated mothers and 0.66 per 1,000 for children of unvaccinated mothers.
Pregnant women with public insurance or no insurance were less likely to report getting the seasonal vaccine than were privately insured women, but those with chronic conditions were more likely to be vaccinated. Uptake also was lower among women with incomes below the federal poverty level and among women living in either rural or frontier areas or in the Urban South or Southwest Intermountain regions.
“The Intermountain Urban South region includes Utah County, 1 of 30 U.S. counties with the largest estimated numbers of unvaccinated children from 1995-2001 CDC National Immunization Surveys (NIS) data,” the authors wrote. “It is possible that factors leading to parental vaccine hesitancy in children may similarly affect pregnant women considering maternal immunization during pregnancy.”
Because of widespread testing for respiratory viruses at Intermountain facilities, the researchers also could determine that flu vaccine receipt among the mothers did not affect incidence of RSV.
“Our study strengthens the evidence that maternal immunization provides passive protection against influenza to infants during the vulnerable period before they are old enough to receive active immunization,” Dr. Shakib and her associates wrote.
The research was funded by the National Institutes of Health, the University of Utah Children’s Health Research Center and the Pediatric Clinical and Translational Scholar Program, the H.A. and Edna Benning Presidential Endowment, and the University of Utah Center for Clinical and Translational Science through the National Center for Research Resources and the National Center for Advancing Translational Sciences. The authors reported no disclosures.
Infants born to mothers who received flu immunization during pregnancy were 70% less likely to contract lab-confirmed influenza and 81% less likely to be hospitalized for flu before age 6 months, compared with infants of unimmunized mothers, a study reaffirmed.
Yet just one in ten pregnant women received the vaccine, a proportion that has steadily risen since the 2009-2010 H1N1 flu season.
“The results of this large retrospective study support the conclusions of prospective studies regarding the protective benefit of maternal influenza immunization during pregnancy,” reported Dr. Julie H. Shakib of the University of Utah, Salt Lake City, and her associates (Pediatrics. 2016 May 3. doi: 10.1542/peds.2015-2360). “Interventions that target both healthy pregnant women and those with chronic conditions are needed to increase vaccine uptake,” they wrote.
The researchers analyzed self-reported seasonal influenza immunization uptake in the 245,386 women who gave birth between December 2005 and March 2014 in the Intermountain Healthcare facilities in Utah and Idaho. Although 10% of the women overall received flu vaccinations, just 2.2% of the women who delivered before the 2009-2010 H1N1 pandemic had received them. That number rose after the pandemic to 21% (P < .001). More than half (52%) of the women giving birth during the 2013-2014 flu season reported getting the seasonal flu vaccine.
Among the women’s 249,387 infants, 866 had at least one influenza-like illness (ILI), including 32 born to vaccinated women and 834 born to unvaccinated women. The infants born to women receiving the flu vaccine during pregnancy were 64% less likely to develop an ILI, with illnesses in 1.34 per 1,000 born to vaccinated women and 3.7 per 1,000 born to unvaccinated women (relative risk, 0.36).
The rates of laboratory-confirmed influenza in the 658 children who contracted it were 0.84 per 1,000 children born to vaccinated mothers and 2.83 per 1,000 children born to unvaccinated mothers, translating to a 70% lower risk of flu in those born to vaccinated mothers (RR, 0.30). Similarly, infants born to vaccinated mothers were 81% less likely to be hospitalized for lab-confirmed influenza (RR, 0.19, P = .005). Just 3 of 151 hospitalized infants had been born to mothers who received the flu vaccine, for a rate of 0.13 per 1,000 for children of vaccinated mothers and 0.66 per 1,000 for children of unvaccinated mothers.
Pregnant women with public insurance or no insurance were less likely to report getting the seasonal vaccine than were privately insured women, but those with chronic conditions were more likely to be vaccinated. Uptake also was lower among women with incomes below the federal poverty level and among women living in either rural or frontier areas or in the Urban South or Southwest Intermountain regions.
“The Intermountain Urban South region includes Utah County, 1 of 30 U.S. counties with the largest estimated numbers of unvaccinated children from 1995-2001 CDC National Immunization Surveys (NIS) data,” the authors wrote. “It is possible that factors leading to parental vaccine hesitancy in children may similarly affect pregnant women considering maternal immunization during pregnancy.”
Because of widespread testing for respiratory viruses at Intermountain facilities, the researchers also could determine that flu vaccine receipt among the mothers did not affect incidence of RSV.
“Our study strengthens the evidence that maternal immunization provides passive protection against influenza to infants during the vulnerable period before they are old enough to receive active immunization,” Dr. Shakib and her associates wrote.
The research was funded by the National Institutes of Health, the University of Utah Children’s Health Research Center and the Pediatric Clinical and Translational Scholar Program, the H.A. and Edna Benning Presidential Endowment, and the University of Utah Center for Clinical and Translational Science through the National Center for Research Resources and the National Center for Advancing Translational Sciences. The authors reported no disclosures.
Infants born to mothers who received flu immunization during pregnancy were 70% less likely to contract lab-confirmed influenza and 81% less likely to be hospitalized for flu before age 6 months, compared with infants of unimmunized mothers, a study reaffirmed.
Yet just one in ten pregnant women received the vaccine, a proportion that has steadily risen since the 2009-2010 H1N1 flu season.
“The results of this large retrospective study support the conclusions of prospective studies regarding the protective benefit of maternal influenza immunization during pregnancy,” reported Dr. Julie H. Shakib of the University of Utah, Salt Lake City, and her associates (Pediatrics. 2016 May 3. doi: 10.1542/peds.2015-2360). “Interventions that target both healthy pregnant women and those with chronic conditions are needed to increase vaccine uptake,” they wrote.
The researchers analyzed self-reported seasonal influenza immunization uptake in the 245,386 women who gave birth between December 2005 and March 2014 in the Intermountain Healthcare facilities in Utah and Idaho. Although 10% of the women overall received flu vaccinations, just 2.2% of the women who delivered before the 2009-2010 H1N1 pandemic had received them. That number rose after the pandemic to 21% (P < .001). More than half (52%) of the women giving birth during the 2013-2014 flu season reported getting the seasonal flu vaccine.
Among the women’s 249,387 infants, 866 had at least one influenza-like illness (ILI), including 32 born to vaccinated women and 834 born to unvaccinated women. The infants born to women receiving the flu vaccine during pregnancy were 64% less likely to develop an ILI, with illnesses in 1.34 per 1,000 born to vaccinated women and 3.7 per 1,000 born to unvaccinated women (relative risk, 0.36).
The rates of laboratory-confirmed influenza in the 658 children who contracted it were 0.84 per 1,000 children born to vaccinated mothers and 2.83 per 1,000 children born to unvaccinated mothers, translating to a 70% lower risk of flu in those born to vaccinated mothers (RR, 0.30). Similarly, infants born to vaccinated mothers were 81% less likely to be hospitalized for lab-confirmed influenza (RR, 0.19, P = .005). Just 3 of 151 hospitalized infants had been born to mothers who received the flu vaccine, for a rate of 0.13 per 1,000 for children of vaccinated mothers and 0.66 per 1,000 for children of unvaccinated mothers.
Pregnant women with public insurance or no insurance were less likely to report getting the seasonal vaccine than were privately insured women, but those with chronic conditions were more likely to be vaccinated. Uptake also was lower among women with incomes below the federal poverty level and among women living in either rural or frontier areas or in the Urban South or Southwest Intermountain regions.
“The Intermountain Urban South region includes Utah County, 1 of 30 U.S. counties with the largest estimated numbers of unvaccinated children from 1995-2001 CDC National Immunization Surveys (NIS) data,” the authors wrote. “It is possible that factors leading to parental vaccine hesitancy in children may similarly affect pregnant women considering maternal immunization during pregnancy.”
Because of widespread testing for respiratory viruses at Intermountain facilities, the researchers also could determine that flu vaccine receipt among the mothers did not affect incidence of RSV.
“Our study strengthens the evidence that maternal immunization provides passive protection against influenza to infants during the vulnerable period before they are old enough to receive active immunization,” Dr. Shakib and her associates wrote.
The research was funded by the National Institutes of Health, the University of Utah Children’s Health Research Center and the Pediatric Clinical and Translational Scholar Program, the H.A. and Edna Benning Presidential Endowment, and the University of Utah Center for Clinical and Translational Science through the National Center for Research Resources and the National Center for Advancing Translational Sciences. The authors reported no disclosures.
FROM PEDIATRICS
Key clinical point: Young infants born to mothers receiving the flu vaccine were less likely to develop the flu and serious complications.
Major finding: Infants under 6 months old were 64% less likely to develop influenza-like illness, 70% less likely to develop lab-confirmed flu, and 81% less likely to be hospitalized for flu if born to vaccinated mothers.
Data source: The findings are based on a retrospective cohort study of 245,386 women who gave birth to 249,387 infants between December 2005 and March 2014 in the Intermountain Healthcare facilities in Utah and Idaho.
Disclosures: The research was funded by the National Institutes of Health, the University of Utah Children’s Health Research Center and the Pediatric Clinical and Translational Scholar Program, the H.A. and Edna Benning Presidential Endowment, and the University of Utah Center for Clinical and Translational Science through the National Center for Research Resources and the National Center for Advancing Translational Sciences. The authors reported no disclosures.
Vitamin D supplementation cuts dust mite atopy
BALTIMORE – Three months of daily, oral treatment with a relatively high but safe dosage of a vitamin D supplement to pregnant mothers during late gestation followed by continued oral supplementation to their neonates during the first 6 months of life led to a significant reduction in the prevalence of dust-mite skin reactivity in those children once they reached 18 months old in a randomized, controlled trial with 259 mothers and infants.
And in a preliminary assessment that tallied the number of children who required primary care office visits for asthma through age 18 months, children who had received the highest vitamin D supplementation also showed a statistically significant reduction of these visits, compared with the placebo control children, Dr. Cameron C. Grant reported at the annual meeting of the Pediatric Academic Societies.
This suggestion that the vitamin D intervention could cut asthma development is not completely certain because in 18-month-old children, diagnosis of asthma is “very insecure,” noted Dr. Grant, a pediatrician at the University of Auckland, New Zealand and at Starship Children’s Hospital, also in Auckland. In addition, a limitation of the observed effect on dust mite atopy on skin-test challenge was that this follow-up occurred in only 186 (72%) of the 259 infants who participated in the study.
The study’s premise was that vitamin D is an immune system modulator, and that New Zealand provides an excellent setting to test the hypothesis that normalized vitamin D levels can help prevent development of atopy and asthma because many of the country’s residents are vitamin D deficient due to their diet and sun avoidance to prevent skin cancers. Results from prior studies had shown that 57% of New Zealand neonates have inadequate levels of vitamin D at birth, defined as a serum level of 25-hydroxyvitamin D of less than 20 ng/ml (less than 50 nmol/L), Dr. Grant noted.
“I think this intervention will only work in populations that are vitamin D deficient,” Dr. Grant said in an interview. In his study, the average serum level of 25-hydroxyvitamin D among control neonates was 38 nmol/L (about 15 ng/mL). In contrast, neonates born to mothers who had received a daily, higher-dose vitamin D supplement during the third trimester had serum measures that were roughly twice that level.
The study enrolled 260 pregnant women from the Auckland area with a single pregnancy at 26-30 weeks’ gestation; average gestational age at baseline was 27 weeks. Dr. Grant and his associates randomized the mothers to receive 1,000 IU oral vitamin D daily, 2,000 oral vitamin D daily, or placebo. The women delivered 259 infants. Infants born to women on the lower dosage supplement then received 400 IU vitamin daily for 6 months, those born to mothers on the higher level supplement received 800 IU vitamin D daily for 6 months, and those born to mothers in the placebo group received placebo supplements daily for 6 months.
Both supplement regimens led to statistically significant increases in serum levels of 25-hydroxyvitamin D in maternal serum at 36 weeks’ gestation, in cord blood at delivery, in the neonates’ serum at ages 2 months and 4 months, and in infant serum in the higher dosage group at 6 months of age, compared with similar measures taken at all these time points in the placebo group.
In addition, the neonates in the higher dosage group had significantly higher serum levels at 2, 4, and 6 months, compared with the lower dosage group. When measured a final time at 18-month follow-up, a year after the end of vitamin D supplementation, average serum levels of 25-hydroxyvitamin D in an three subgroups of children were virtually identical and similar to maternal serum levels at baseline. Dr. Grant and his associates had previously reported these findings and also had documented the safety of both the low and high levels of vitamin D supplements for both mothers and their children (Pediatrics. 2014 Jan;133[1]:e143-53).
The new findings reported by Dr. Grant focused on clinical outcomes at 18 months. He and his colleagues ran skin-prick testing on 186 of the 259 (72%) children in the study (the remaining children weren’t available for this follow-up assessment). They tested three aeroallergens: cat, pollen, and house dust mite. They saw no significant differences in the prevalence of positive skin-prick reactions among the three study groups to cat and pollen, but prevalence levels of positive reactions to dust mite were 9% in the controls, 3% of children in the low-dosage group, and none in the high dosage group. The difference between the controls and high dosage groups was statistically significant; the difference between the controls and the low dosage group was not significant, Dr. Grant said. Additional testing of specific IgE responses to four different dust mite antigens showed statistically significant reductions in responses to each of the four antigens among the high dosage children, compared with the controls and with the low dosage children.
The researchers also tallied the number of acute, primary care office visits during the first 18 months of life among the children in each of the three subgroups for a variety of respiratory diagnoses. The three groups showed no significant differences in total number of office visits for most of these diagnoses, including colds, otitis media, croup, and bronchitis. However, about 12% of children in the control group had been seen in a primary care office for a diagnosis of asthma, compared with none of the children in the low dosage group and about 4% in the high-dosage group. The differences between the two intervention groups and the control group were statistically significant. Dr. Grant cautioned that this finding is very preliminary and that any conclusions about the impact of vitamin D supplements on asthma incidence must await studies with larger numbers of children who are followed to an older age.
Dr. Grant had no disclosures.
On Twitter @mitchelzoler
BALTIMORE – Three months of daily, oral treatment with a relatively high but safe dosage of a vitamin D supplement to pregnant mothers during late gestation followed by continued oral supplementation to their neonates during the first 6 months of life led to a significant reduction in the prevalence of dust-mite skin reactivity in those children once they reached 18 months old in a randomized, controlled trial with 259 mothers and infants.
And in a preliminary assessment that tallied the number of children who required primary care office visits for asthma through age 18 months, children who had received the highest vitamin D supplementation also showed a statistically significant reduction of these visits, compared with the placebo control children, Dr. Cameron C. Grant reported at the annual meeting of the Pediatric Academic Societies.
This suggestion that the vitamin D intervention could cut asthma development is not completely certain because in 18-month-old children, diagnosis of asthma is “very insecure,” noted Dr. Grant, a pediatrician at the University of Auckland, New Zealand and at Starship Children’s Hospital, also in Auckland. In addition, a limitation of the observed effect on dust mite atopy on skin-test challenge was that this follow-up occurred in only 186 (72%) of the 259 infants who participated in the study.
The study’s premise was that vitamin D is an immune system modulator, and that New Zealand provides an excellent setting to test the hypothesis that normalized vitamin D levels can help prevent development of atopy and asthma because many of the country’s residents are vitamin D deficient due to their diet and sun avoidance to prevent skin cancers. Results from prior studies had shown that 57% of New Zealand neonates have inadequate levels of vitamin D at birth, defined as a serum level of 25-hydroxyvitamin D of less than 20 ng/ml (less than 50 nmol/L), Dr. Grant noted.
“I think this intervention will only work in populations that are vitamin D deficient,” Dr. Grant said in an interview. In his study, the average serum level of 25-hydroxyvitamin D among control neonates was 38 nmol/L (about 15 ng/mL). In contrast, neonates born to mothers who had received a daily, higher-dose vitamin D supplement during the third trimester had serum measures that were roughly twice that level.
The study enrolled 260 pregnant women from the Auckland area with a single pregnancy at 26-30 weeks’ gestation; average gestational age at baseline was 27 weeks. Dr. Grant and his associates randomized the mothers to receive 1,000 IU oral vitamin D daily, 2,000 oral vitamin D daily, or placebo. The women delivered 259 infants. Infants born to women on the lower dosage supplement then received 400 IU vitamin daily for 6 months, those born to mothers on the higher level supplement received 800 IU vitamin D daily for 6 months, and those born to mothers in the placebo group received placebo supplements daily for 6 months.
Both supplement regimens led to statistically significant increases in serum levels of 25-hydroxyvitamin D in maternal serum at 36 weeks’ gestation, in cord blood at delivery, in the neonates’ serum at ages 2 months and 4 months, and in infant serum in the higher dosage group at 6 months of age, compared with similar measures taken at all these time points in the placebo group.
In addition, the neonates in the higher dosage group had significantly higher serum levels at 2, 4, and 6 months, compared with the lower dosage group. When measured a final time at 18-month follow-up, a year after the end of vitamin D supplementation, average serum levels of 25-hydroxyvitamin D in an three subgroups of children were virtually identical and similar to maternal serum levels at baseline. Dr. Grant and his associates had previously reported these findings and also had documented the safety of both the low and high levels of vitamin D supplements for both mothers and their children (Pediatrics. 2014 Jan;133[1]:e143-53).
The new findings reported by Dr. Grant focused on clinical outcomes at 18 months. He and his colleagues ran skin-prick testing on 186 of the 259 (72%) children in the study (the remaining children weren’t available for this follow-up assessment). They tested three aeroallergens: cat, pollen, and house dust mite. They saw no significant differences in the prevalence of positive skin-prick reactions among the three study groups to cat and pollen, but prevalence levels of positive reactions to dust mite were 9% in the controls, 3% of children in the low-dosage group, and none in the high dosage group. The difference between the controls and high dosage groups was statistically significant; the difference between the controls and the low dosage group was not significant, Dr. Grant said. Additional testing of specific IgE responses to four different dust mite antigens showed statistically significant reductions in responses to each of the four antigens among the high dosage children, compared with the controls and with the low dosage children.
The researchers also tallied the number of acute, primary care office visits during the first 18 months of life among the children in each of the three subgroups for a variety of respiratory diagnoses. The three groups showed no significant differences in total number of office visits for most of these diagnoses, including colds, otitis media, croup, and bronchitis. However, about 12% of children in the control group had been seen in a primary care office for a diagnosis of asthma, compared with none of the children in the low dosage group and about 4% in the high-dosage group. The differences between the two intervention groups and the control group were statistically significant. Dr. Grant cautioned that this finding is very preliminary and that any conclusions about the impact of vitamin D supplements on asthma incidence must await studies with larger numbers of children who are followed to an older age.
Dr. Grant had no disclosures.
On Twitter @mitchelzoler
BALTIMORE – Three months of daily, oral treatment with a relatively high but safe dosage of a vitamin D supplement to pregnant mothers during late gestation followed by continued oral supplementation to their neonates during the first 6 months of life led to a significant reduction in the prevalence of dust-mite skin reactivity in those children once they reached 18 months old in a randomized, controlled trial with 259 mothers and infants.
And in a preliminary assessment that tallied the number of children who required primary care office visits for asthma through age 18 months, children who had received the highest vitamin D supplementation also showed a statistically significant reduction of these visits, compared with the placebo control children, Dr. Cameron C. Grant reported at the annual meeting of the Pediatric Academic Societies.
This suggestion that the vitamin D intervention could cut asthma development is not completely certain because in 18-month-old children, diagnosis of asthma is “very insecure,” noted Dr. Grant, a pediatrician at the University of Auckland, New Zealand and at Starship Children’s Hospital, also in Auckland. In addition, a limitation of the observed effect on dust mite atopy on skin-test challenge was that this follow-up occurred in only 186 (72%) of the 259 infants who participated in the study.
The study’s premise was that vitamin D is an immune system modulator, and that New Zealand provides an excellent setting to test the hypothesis that normalized vitamin D levels can help prevent development of atopy and asthma because many of the country’s residents are vitamin D deficient due to their diet and sun avoidance to prevent skin cancers. Results from prior studies had shown that 57% of New Zealand neonates have inadequate levels of vitamin D at birth, defined as a serum level of 25-hydroxyvitamin D of less than 20 ng/ml (less than 50 nmol/L), Dr. Grant noted.
“I think this intervention will only work in populations that are vitamin D deficient,” Dr. Grant said in an interview. In his study, the average serum level of 25-hydroxyvitamin D among control neonates was 38 nmol/L (about 15 ng/mL). In contrast, neonates born to mothers who had received a daily, higher-dose vitamin D supplement during the third trimester had serum measures that were roughly twice that level.
The study enrolled 260 pregnant women from the Auckland area with a single pregnancy at 26-30 weeks’ gestation; average gestational age at baseline was 27 weeks. Dr. Grant and his associates randomized the mothers to receive 1,000 IU oral vitamin D daily, 2,000 oral vitamin D daily, or placebo. The women delivered 259 infants. Infants born to women on the lower dosage supplement then received 400 IU vitamin daily for 6 months, those born to mothers on the higher level supplement received 800 IU vitamin D daily for 6 months, and those born to mothers in the placebo group received placebo supplements daily for 6 months.
Both supplement regimens led to statistically significant increases in serum levels of 25-hydroxyvitamin D in maternal serum at 36 weeks’ gestation, in cord blood at delivery, in the neonates’ serum at ages 2 months and 4 months, and in infant serum in the higher dosage group at 6 months of age, compared with similar measures taken at all these time points in the placebo group.
In addition, the neonates in the higher dosage group had significantly higher serum levels at 2, 4, and 6 months, compared with the lower dosage group. When measured a final time at 18-month follow-up, a year after the end of vitamin D supplementation, average serum levels of 25-hydroxyvitamin D in an three subgroups of children were virtually identical and similar to maternal serum levels at baseline. Dr. Grant and his associates had previously reported these findings and also had documented the safety of both the low and high levels of vitamin D supplements for both mothers and their children (Pediatrics. 2014 Jan;133[1]:e143-53).
The new findings reported by Dr. Grant focused on clinical outcomes at 18 months. He and his colleagues ran skin-prick testing on 186 of the 259 (72%) children in the study (the remaining children weren’t available for this follow-up assessment). They tested three aeroallergens: cat, pollen, and house dust mite. They saw no significant differences in the prevalence of positive skin-prick reactions among the three study groups to cat and pollen, but prevalence levels of positive reactions to dust mite were 9% in the controls, 3% of children in the low-dosage group, and none in the high dosage group. The difference between the controls and high dosage groups was statistically significant; the difference between the controls and the low dosage group was not significant, Dr. Grant said. Additional testing of specific IgE responses to four different dust mite antigens showed statistically significant reductions in responses to each of the four antigens among the high dosage children, compared with the controls and with the low dosage children.
The researchers also tallied the number of acute, primary care office visits during the first 18 months of life among the children in each of the three subgroups for a variety of respiratory diagnoses. The three groups showed no significant differences in total number of office visits for most of these diagnoses, including colds, otitis media, croup, and bronchitis. However, about 12% of children in the control group had been seen in a primary care office for a diagnosis of asthma, compared with none of the children in the low dosage group and about 4% in the high-dosage group. The differences between the two intervention groups and the control group were statistically significant. Dr. Grant cautioned that this finding is very preliminary and that any conclusions about the impact of vitamin D supplements on asthma incidence must await studies with larger numbers of children who are followed to an older age.
Dr. Grant had no disclosures.
On Twitter @mitchelzoler
AT THE PAS ANNUAL MEETING
Key clinical point: Maternal treatment to achieve adequate vitamin D levels during late gestation followed by neonatal vitamin D supplementation significantly cut dust mite atopy at 18 months of age, along with a suggestion of reduced asthma incidence.
Major finding: Dust mite reactivity at 18 months occurred in no children treated with higher vitamin D supplementation and in 9% of controls.
Data source: A randomized, controlled, single-center study with 260 pregnant women who delivered 259 infants.
Disclosures: Dr. Grant had no disclosures.
