James G. Parker

Food allergies in children affect nutrient intake and growth.

OBJECTIVES To identify if specific food allergies, elimination diets, or other variables associated with food allergies have an impact on the growth and nutrient intake of children with food allergies. DESIGN Measurements of height, weight, and body mass index were used to determine potential growth problems. Estimates of energy and nutrient intakes were based on 3-day diet records. A questionnaire was used to determine number of food allergies and other variables. SUBJECTS Ninety-eight children with food allergies (subjects, mean age 3.7 +/- 2.3 years) and 99 children without food allergies (controls, mean age 4.1 +/- 2.4 years) participated in this age-matched, consecutive sampling, cross-sectional study. STATISTICAL ANALYSIS PERFORMED Cochran-Mantel-Haenszel statistics using general association and Fisher Exact Test, with 2-sided probability, were conducted. RESULTS Children with two or more food allergies were shorter, based on height-for-age percentiles, than those with one food allergy (P<.05). More than 25% of children in both groups consumed less than 67% of the DRI (RDA or AI) for calcium, vitamin D, and vitamin E. More children with cows milk allergy or multiple food allergies consumed dietary calcium less than age- and gender-specific recommendations compared with children without cows milk allergy and/or one food allergy. The possibility of consuming a less than recommended intake of calcium and vitamin D in children with food allergy was less if the child received nutrition counseling (P<.05) or consumed a safe infant/toddler formula or fortified soy beverage. APPLICATIONS/CONCLUSIONS Children diagnosed with food allergies need an annual nutrition assessment to prevent growth problems or inadequate nutrient intake. Children with milk allergies or multiple food allergies are at greater risk. Nutrition education needs to address how to avoid all forms of the allergen and incorporate alternative nutrient-dense foods. This population would benefit from the development and validation of a medical nutrition therapy protocol.

Hospitalizations for critically ill children with traumatic brain injuries: A longitudinal analysis*

Objective:This study examines the incidence, utilization of procedures, and outcomes for critically ill children hospitalized with traumatic brain injury over the period 1988–1999 to describe the benefits of improved treatment. Design:Retrospective analysis of hospital discharges was conducted using data from the Health Care Cost and Utilization Project Nationwide Inpatient Sample that approximates a 20% sample of U.S. acute care hospitals. Setting:Hospital inpatient stays from all types of U.S. community hospitals. Participants:The study sample included all children aged 0–21 with a primary or secondary ICD-9-CM diagnosis code for traumatic brain injury and a procedure code for either endotracheal intubation or mechanical ventilation. Interventions:None. Measurements and Main Results:Deaths occurring during hospitalization were used to calculate mortality rates. Use of intracranial pressure monitoring and surgical openings of the skull were investigated as markers for the aggressiveness of treatment. Patients were further classified by insurance status, household income, and hospital characteristics. Over the 12-yr study period, mortality rates decreased 8 percentage points whereas utilization of intracranial pressure monitoring increased by 11 percentage points. The trend toward more aggressive management of traumatic brain injury corresponded with improved hospital outcomes over time. Lack of insurance was associated with vastly worse outcomes. An estimated 6,437 children survived their traumatic brain injury hospitalization because of improved treatment, and 1,418 children died because of increased mortality risk associated with being uninsured. Improved treatment was valued at approximately

Noninvasive Cerebral Oximeter as a Surrogate for Mixed Venous Saturation in Children

17 billion, whereas acute care hospitalization costs increased by

Invasive pneumococcal infections in pediatric cardiac transplant patients.

1.5 billion (in constant 2000 dollars). Increased mortality in uninsured children was associated with a

Feeding of soy protein isolate to rats during pregnancy and lactation suppresses formation of aberrant crypt foci in their progeny's colons: interaction of diet with fetal alcohol exposure.

3.76 billion loss in economic benefits. Conclusions:More aggressive management of pediatric traumatic brain injury appears to have contributed to reduced mortality rates over time and saved thousands of lives. Additional lives could be saved if mortality rates could be equalized between insured and uninsured children.

Health Status of Children After Admission for Injury

We evaluated the relationship between regional cerebral oxygen saturation (rSO2) measured by near-infrared spectroscopy (NIRS) cerebral oximeter with superior vena cava (SVC), inferior vena cava (IVC), right atrium (RA), and pulmonary artery (PA) saturation measured on room air and 100% inspired oxygen administered via a non-rebreather mask (NRB) in children. Twenty nine pediatric post-orthotopic heart transplant patients undergoing an annual myocardial biopsy were studied. We found a statistically significant correlation between rSO2 and SVC saturations at room air and 100% inspired oxygen concentration via NRB (r = 0.67, p = 0.0002 on room air; r = 0.44, p = 0.02 on NRB), RA saturation (r = 0.56, p = 0.002; r = 0.56, p = 0.002), and PA saturation (r = 0.67, p < 0.001; r = 0.4, p = 0.03). A significant correlation also existed between rSO2 and measured cardiac index (r = 0.45, p = 0.01) and hemoglobin levels (r = 0.41, p = 0.02). The concordance correlations were fair to moderate. Bias and precision of rSO2 compared to PA saturations on room air were −0.8 and 13.9%, and they were 2.1 and 15.6% on NRB. A stepwise linear regression analysis showed that rSO2 saturations were the best predictor of PA saturations on both room air (p = 0.0001) and NRB (p = 0.012). In children with biventricular anatomy, rSO2 readings do correlate with mixed venous saturation.

National Hospitalization Impact of Pediatric All-Terrain Vehicle Injuries

BACKGROUND Bacterial infections cause significant morbidity and mortality in cardiac transplant patients. Because Streptococcus pneumoniae is the most prominent bacterial pathogen of childhood, the objective of this study was to define the role of S. pneumoniae as a pathogen in the cardiac transplant population. METHODS Medical records of cardiac transplant patients from March, 1990, through November, 2000, were reviewed to identify invasive pneumococcal infections after transplantation. Demographic, clinical and microbiologic data were reviewed. RESULTS Nine (11%) of 80 patients had 12 episodes of pneumococcal bacteremia for an incidence rate of 39 cases/1,000 patient years. Patients who were African-American, transplanted before 2 years of age and transplanted because of idiopathic dilated cardiomyopathy were at increased risk of invasive pneumococcal disease (P < 0.05). Six patients were eligible for the 23-valent pneumococcal polysaccharide vaccine before their first invasive infection, but only 1 had received it at the recommended age. Most isolates (82%) were penicillin-susceptible, and no single serotype predominated. There were 2 deaths in the study group, but each was unrelated to infection. Three patients (33%) had recurrent invasive disease with a second serotype an average of 12 months after the first infection. CONCLUSIONS The incidence of pneumococcal bacteremia in cardiac transplant patients is higher than in the general pediatric population. Risks for infection were being African-American, being younger than 2 years at the time of transplant and being transplanted because of idiopathic cardiomyopathy. It is plausible that pneumococcal vaccine would decrease this risk.

Determinants of Renal Function in Pediatric Heart Transplant Recipients: Long-term Follow-up Study

Soy protein isolate (SPI) in the diet may inhibit colon tumorigenesis. We examined azoxymethane (AOM)-induced aberrant crypt foci (ACF) in male rats in relation to lifetime, pre-weaning, or post-weaning dietary exposure to SPI and also within the context of fetal alcohol exposure. Pregnant Sprague Dawley rats were fed AIN-93G diets containing casein (20%, the control diet) or SPI (20%) as the sole protein source starting on gestation day 4 (GD 4). Progeny were weaned on postnatal day (PND) 21 to the same diet as their dams and were fed this diet until termination of the experiment at PND 138. Rats received AOM on PND 89 and 96. Lifetime (GD 4 to PND 138) feeding of SPI led to reduced frequency of ACF with 4 or more crypts in the distal colon. Progeny of dams fed SPI only during pregnancy and lactation or progeny fed SPI only after weaning exhibited similarly reduced frequency of large ACF in distal colon. Number of epithelial cells, in the distal colon, undergoing apoptosis was unaffected by diet. SPI reduced weight gain and adiposity, but these were not correlated with fewer numbers of large ACF. Lifetime SPI exposure similarly inhibited development of large ACF in Sprague Dawley rats whose dams were exposed to ethanol during pregnancy. In summary, feeding of SPI to rat dams during pregnancy and lactation suppresses numbers of large ACF in their progeny, implying a long-term or permanent change elicited by the maternal diet. Moreover, results support the use of ACF as an intermediate endpoint for elucidating effects of SPI and its biochemical constituents in colon cancer prevention in rats.