Denis Leduc

«Sucrose analgesia» and diphtheria-tetanus-pertussis immunizations at 2 and 4 months

In human newborns, small amounts of sucrose reduce crying with procedural pain by about 50%. To determine whether “sucrose analgesia” could be extended to painful procedures beyond the newborn period, 57 infants were randomly assigned to receive three 250-

Determinants of weight and adiposity in the first year of life

mUl doses of 50% sucrose solution (g/100 mL) or water before their diphtheria-tetanus-pertussis immunizations at 2 and 4 months of age. Crying during and after injection was measured separately to determine whether sucrose modified crying during the noxious stimulus, recovery from the stimulus, or both. Sucrose was effective in reducing crying only from 83 to 69%, and the reduction was limited to the postinjection period. We conclude that, although sucrose continues to have some effect beyond the newborn period, the effect is limited to recovery from the noxious stimulus, is clinically modest, and is probably smaller than in the newborn period.

Adverse drug reactions in general pediatric outpatients

To overcome methodologic defects (failure to control for confounding factors, univariate statistical analyses) in previous studies of etiologic determinants of childhood adiposity, we carried out a prospective cohort study of 462 healthy, full-term infants observed from birth to 12 months. Postpartum, we obtained sociodemographic data and administered two recently validated scales of maternal attitudes toward feeding and infant body habitus. Parental heights and weights and infant feeding variables were determined by interview, and at 6 and 12 months we measured height and weight and triceps, subscapular, and suprailiac skinfolds. Multiple regression analysis was used to determine independently predictive factors for weight, body mass index (BMI = weight/height), and the sum of the three skinfold measurements. Birth weight, sex, age at introduction of solid, and duration of breast-feeding were all significant predictors of weight at 12 months (r2 = 0.296, P less than 0.0001). Significant determinants for BMI included birth weight, duration of breast-feeding, sex, and IBH (r2 = 0.125, P less than 0.0001); those for total skinfold were age at introduction of solid foods and birth weight (r2 = 0.038, P = 0.002). Similar results were obtained at 6 months, although slightly less of the variance was explained. We conclude that the ability to predict which babies will be heavy or obese during the first year is limited. Breast-feeding and delayed introduction of solid foods do offer some protective effect, however, and thus efforts to encourage these practices may be reaping some benefit.

DETERMINANTS OF WEIGHT AND ADIPOSITY IN THE FIRST 12 MONTHS OF LIFE

We used a recently developed diagnostic adverse drug reaction (ADR) algorithm and an intensive telephone surveillance program to monitor all courses of prescription and nonprescription drug therapy in a general pediatric group practice for 1 year. A total of 3181 different children visited the practice during the year and received 4244 separate courses of drug therapy. Adverse symptoms were noted in 473 (11.1%) of these courses of therapy. Of 534 total adverse symptoms, however, only 24 scored as definite and 176 as probable ADRs. The main ADRs noted were antibiotic-associated gastrointestinal complaints and rashes, and various manifestations of CNS stimulation with bronchodilators. Sociodemographic variables significantly associated with the risk of a definite or probable ADR were socioeconomic status (P less than 0.0001), ethnic origin (P = 0.0015), and age (P less than 0.05). Treatment-related risk factors included treatment by a practitioner outside the study practice (usually during nonoffice hours) (P less than 0.001) and administration of a dosage above the range recommended by the manufacturer (P less than 0.001). Half the ADRs were judged as inconsequential by the childrens parents, and most of the remainder resulted in only minor morbidity. Half were judged to be highly or probably preventable. Our results suggest that ADRs do not occur commonly in general pediatric outpatients and that most are mild and self-limited.

The Crying of Infants With Colic: A Controlled Empirical Description

To overcome methodologic defects (failure to control for confounding factors, univariate statistical analyses) in previous studies of etiologic determinants of childhood adiposity, we carried out a prospective cohort study of 462 healthy, full-term infants followed from birth to 12 mo. Post-partum, we obtained sociodemographic data and administered 2 recently validated scales of maternal attitudes toward feeding and infant body habitus. Parental height and weight and infant feeding variables were determined by interview during the 12 mo. At 6 and 12 mo, we measured height, weight, and triceps, subscapular, and suprailiac skinfolds. Multiple regression analysis was used to determine independently predictive factors for weight (W), body mass index (BMI=wt/ht2), and the sum of the 3 skinfolds (SF).Birthweight, age at introduction of solids, sex, breast feeding, and fathers relative weight were all significant predictors of W at 12 mo (R2=.291; P<.0001). For BMI, age at introduction of solids, birthweight, and sex (R2=.119; P .0001), and for SF, birthweight and breast feeding (R2=.041; P<.004), were significant determinants. Similar results were obtained at 6 mo, though slightly less of the variance was explained. We conclude that the ability to predict which babies will be fat during the first 12 mo is limited. Breast feeding and delayed introduction of solids do offer some protective effect, however, and thus our efforts to encourage these practices may be reaping some benefit.