Heidi Splete

Two types of insulin analogs were equally safe and effective when used in insulin pumps by children and adolescents aged 4–18 years, according to results from a study of 298 children.

The popularity of continuous subcutaneous insulin infusion (CSII) for children and adolescents with type 1 diabetes has increased, despite limited safety and effectiveness data, in part because many children and teens prefer the customized insulin delivery of a pump rather than multiple daily insulin injections.

Results from previous studies have shown that both insulin lispro and insulin aspart are safe and effective for CSII in adults with type 1 diabetes, and that CSII is as effective as multiple daily insulin injections. But this study is the first to compare the safety and effectiveness of two insulin analogs for CSII in a pediatric population (Diabetes Care 2008;31:210–5).

In this open-label study sponsored by Novo Nordisk Inc. (the manufacturer of insulin aspart), Dr. Stuart A. Weinzimer of Yale University, New Haven, Conn., and his colleagues randomized 198 children to use insulin aspart and 100 children to use insulin lispro for CSII. The intent-to-treat population included 197 children in the aspart group and 99 children in the lispro group.

The children's hemoglobin A_1c (HbA_1c) was assessed at baseline and again after 8, 12, and 16 weeks, and the primary outcome was the change from baseline to week 16.

Overall, the changes in HbA_1c were not significantly different between the two groups in the intent-to-treat population. The average HbA_1c values decreased from 8.0% at baseline to 7.9% at 16 weeks in the aspart group, and from 8.2% at baseline to 8.1% at 16 weeks in the lispro group.

In addition, 60% of the children in the aspart group and 44% of the children in the lispro group met the American Diabetes Association's age-specific recommendations for HbA_1c (less than 8% for children and adolescents aged 6–18 years, and less than 8.5% for children younger than 6 years) after 16 weeks, compared with 50% and 40%, respectively, who met those criteria at baseline.

The average fasting plasma glucose values were similar between the two groups at baseline and at the end of the study. As would be expected in a pediatric trial, children in both groups gained weight, but the average weight gain was not significantly different between the two groups (1.8 kg in the insulin aspart group vs. 1.6 kg in the insulin lispro group).

Overall, the incidence of adverse events was similar in the aspart and lispro groups (82% vs. 83%). But the majority of these events were mild, and the most common complaints included upper respiratory tract infections, hyperglycemia, and nasopharyngitis. Six children reported serious adverse events, but none of them discontinued the study as a result of these events. One child in the lispro group developed hypoglycemia, and five children in the aspart group reported hyperglycemia, hypoglycemic seizure, diabetic ketoacidosis, hypoglycemia with accidental overdose of insulin, and skin lacerations.

The average daily dose of insulin in the aspart group was significantly lower after 16 weeks, compared with the lispro group (0.86 units/kg vs. 0.94 units/kg), but the overall rates of hypoglycemia were similar in both groups, the researchers noted.

The clinical implication of the findings is that insulin aspart and insulin lispro are equally effective when used in insulin pumps to treat children and teens with type 1 diabetes, the researchers said. Regardless of the type of insulin analog used, the findings support the use of insulin pumps for young type 1 diabetes patients who want greater convenience and flexibility in managing their condition.

Two types of insulin analogs were equally safe and effective when used in insulin pumps by children and adolescents aged 4–18 years, according to results from a study of 298 children.

The popularity of continuous subcutaneous insulin infusion (CSII) for children and adolescents with type 1 diabetes has increased, despite limited safety and effectiveness data, in part because many children and teens prefer the customized insulin delivery of a pump rather than multiple daily insulin injections.

Results from previous studies have shown that both insulin lispro and insulin aspart are safe and effective for CSII in adults with type 1 diabetes, and that CSII is as effective as multiple daily insulin injections. But this study is the first to compare the safety and effectiveness of two insulin analogs for CSII in a pediatric population (Diabetes Care 2008;31:210–5).

In this open-label study sponsored by Novo Nordisk Inc. (the manufacturer of insulin aspart), Dr. Stuart A. Weinzimer of Yale University, New Haven, Conn., and his colleagues randomized 198 children to use insulin aspart and 100 children to use insulin lispro for CSII. The intent-to-treat population included 197 children in the aspart group and 99 children in the lispro group.

The children's hemoglobin A_1c (HbA_1c) was assessed at baseline and again after 8, 12, and 16 weeks, and the primary outcome was the change from baseline to week 16.

Overall, the changes in HbA_1c were not significantly different between the two groups in the intent-to-treat population. The average HbA_1c values decreased from 8.0% at baseline to 7.9% at 16 weeks in the aspart group, and from 8.2% at baseline to 8.1% at 16 weeks in the lispro group.

In addition, 60% of the children in the aspart group and 44% of the children in the lispro group met the American Diabetes Association's age-specific recommendations for HbA_1c (less than 8% for children and adolescents aged 6–18 years, and less than 8.5% for children younger than 6 years) after 16 weeks, compared with 50% and 40%, respectively, who met those criteria at baseline.

The average fasting plasma glucose values were similar between the two groups at baseline and at the end of the study. As would be expected in a pediatric trial, children in both groups gained weight, but the average weight gain was not significantly different between the two groups (1.8 kg in the insulin aspart group vs. 1.6 kg in the insulin lispro group).

Overall, the incidence of adverse events was similar in the aspart and lispro groups (82% vs. 83%). But the majority of these events were mild, and the most common complaints included upper respiratory tract infections, hyperglycemia, and nasopharyngitis. Six children reported serious adverse events, but none of them discontinued the study as a result of these events. One child in the lispro group developed hypoglycemia, and five children in the aspart group reported hyperglycemia, hypoglycemic seizure, diabetic ketoacidosis, hypoglycemia with accidental overdose of insulin, and skin lacerations.

The average daily dose of insulin in the aspart group was significantly lower after 16 weeks, compared with the lispro group (0.86 units/kg vs. 0.94 units/kg), but the overall rates of hypoglycemia were similar in both groups, the researchers noted.

The clinical implication of the findings is that insulin aspart and insulin lispro are equally effective when used in insulin pumps to treat children and teens with type 1 diabetes, the researchers said. Regardless of the type of insulin analog used, the findings support the use of insulin pumps for young type 1 diabetes patients who want greater convenience and flexibility in managing their condition.

Two types of insulin analogs were equally safe and effective when used in insulin pumps by children and adolescents aged 4–18 years, according to results from a study of 298 children.

The popularity of continuous subcutaneous insulin infusion (CSII) for children and adolescents with type 1 diabetes has increased, despite limited safety and effectiveness data, in part because many children and teens prefer the customized insulin delivery of a pump rather than multiple daily insulin injections.

Results from previous studies have shown that both insulin lispro and insulin aspart are safe and effective for CSII in adults with type 1 diabetes, and that CSII is as effective as multiple daily insulin injections. But this study is the first to compare the safety and effectiveness of two insulin analogs for CSII in a pediatric population (Diabetes Care 2008;31:210–5).

In this open-label study sponsored by Novo Nordisk Inc. (the manufacturer of insulin aspart), Dr. Stuart A. Weinzimer of Yale University, New Haven, Conn., and his colleagues randomized 198 children to use insulin aspart and 100 children to use insulin lispro for CSII. The intent-to-treat population included 197 children in the aspart group and 99 children in the lispro group.

The children's hemoglobin A_1c (HbA_1c) was assessed at baseline and again after 8, 12, and 16 weeks, and the primary outcome was the change from baseline to week 16.

Overall, the changes in HbA_1c were not significantly different between the two groups in the intent-to-treat population. The average HbA_1c values decreased from 8.0% at baseline to 7.9% at 16 weeks in the aspart group, and from 8.2% at baseline to 8.1% at 16 weeks in the lispro group.

In addition, 60% of the children in the aspart group and 44% of the children in the lispro group met the American Diabetes Association's age-specific recommendations for HbA_1c (less than 8% for children and adolescents aged 6–18 years, and less than 8.5% for children younger than 6 years) after 16 weeks, compared with 50% and 40%, respectively, who met those criteria at baseline.

The average fasting plasma glucose values were similar between the two groups at baseline and at the end of the study. As would be expected in a pediatric trial, children in both groups gained weight, but the average weight gain was not significantly different between the two groups (1.8 kg in the insulin aspart group vs. 1.6 kg in the insulin lispro group).

Overall, the incidence of adverse events was similar in the aspart and lispro groups (82% vs. 83%). But the majority of these events were mild, and the most common complaints included upper respiratory tract infections, hyperglycemia, and nasopharyngitis. Six children reported serious adverse events, but none of them discontinued the study as a result of these events. One child in the lispro group developed hypoglycemia, and five children in the aspart group reported hyperglycemia, hypoglycemic seizure, diabetic ketoacidosis, hypoglycemia with accidental overdose of insulin, and skin lacerations.

The average daily dose of insulin in the aspart group was significantly lower after 16 weeks, compared with the lispro group (0.86 units/kg vs. 0.94 units/kg), but the overall rates of hypoglycemia were similar in both groups, the researchers noted.

The clinical implication of the findings is that insulin aspart and insulin lispro are equally effective when used in insulin pumps to treat children and teens with type 1 diabetes, the researchers said. Regardless of the type of insulin analog used, the findings support the use of insulin pumps for young type 1 diabetes patients who want greater convenience and flexibility in managing their condition.

New cases of diabetes were significantly more common among pancreatic cancer patients before their cancer diagnoses, compared with controls, according to data from 736 pancreatic cancer patients and 1,875 controls.

Although previous studies have shown a link between existing diabetes and pancreatic cancer, the temporal relationship between the two diseases—and whether this relationship might be used to predict cancer—is not well understood, wrote Dr. Suresh T. Chari and colleagues at the Mayo Clinic in Rochester, Minn.

To determine the prevalence of new-onset diabetes in pancreatic cancer patients and the temporal association between these conditions, the researchers reviewed records of pancreatic cancer patients and control patients seen at the Mayo Clinic between Jan. 15, 1981, and July 9, 2004. They assigned two matched controls to each cancer case. The mean age of both patients and controls was 69 years, and approximately 50% of the subjects in each group were men.

A subject was considered to have diabetes if he or she had a fasting blood glucose level greater than 126 mg/dL or was taking diabetes medication. The proportion of cases and controls with diabetes was compared in each 12-month interval, starting with 60 months prior to a cancer diagnosis for cancer patients (Gastroenterology 2008;134:95–101).

Overall, significantly more pancreatic cancer patients met the criteria for diabetes, compared with controls, any time during the 60-month period before pancreatic cancer diagnosis (40% vs. 19%). But the proportions of individuals with diabetes were not significantly different between the cancer group and the control group during the 12-month intervals from 60 months to 48 months and from 48 months to 36 months prior to cancer diagnosis.

In contrast, starting with 36 months before a cancer diagnosis, the prevalence of diabetes in the pancreatic cancer patients rose steadily for each 12-month interval, while the prevalence of diabetes in the controls remained relatively stable throughout the study period. New-onset diabetes was defined as diabetes with onset at 24 months or less prior to a cancer diagnosis.

Diabetes was more likely to be new onset in patients with pancreatic cancer than in controls (52% vs. 24%, respectively) among the subjects with diabetes for whom diabetes duration was known; this difference was highly significant.

“The very high prevalence of diabetes in pancreatic cancer and its close temporal association with the diagnosis of cancer provide strong epidemiologic evidence to support the notion that pancreatic cancer causes diabetes mellitus,” the researchers wrote.

The findings support data from small clinical studies in which the removal of tumors from pancreatic cancer patients with diabetes has improved their glucose tolerance and reversed their metabolic defects. But prospective studies are needed to show the benefits of screening older adults with new-onset diabetes for pancreatic cancer, and such screening would be helpful only if a type of new-onset diabetes that is associated with pancreatic cancer could be distinguished from type 2 diabetes, perhaps with the use of a biomarker test, the researchers noted.

There is a lack of practical criteria that could be used to rule out pancreatic cancer in new-onset diabetes patients, wrote Dr. Niels Teich, of the University of Leipzig (Germany) in an accompanying editorial (Gastroenterology 2008;134:344–5). The study findings invite more research to determine whether new-onset diabetes in pancreatic cancer patients is different from new-onset type 2 diabetes mellitus in general, and whether new-onset diabetes could be an early sign of this cancer in otherwise asymptomatic persons, he noted.

New cases of diabetes were significantly more common among pancreatic cancer patients before their cancer diagnoses, compared with controls, according to data from 736 pancreatic cancer patients and 1,875 controls.

Although previous studies have shown a link between existing diabetes and pancreatic cancer, the temporal relationship between the two diseases—and whether this relationship might be used to predict cancer—is not well understood, wrote Dr. Suresh T. Chari and colleagues at the Mayo Clinic in Rochester, Minn.

To determine the prevalence of new-onset diabetes in pancreatic cancer patients and the temporal association between these conditions, the researchers reviewed records of pancreatic cancer patients and control patients seen at the Mayo Clinic between Jan. 15, 1981, and July 9, 2004. They assigned two matched controls to each cancer case. The mean age of both patients and controls was 69 years, and approximately 50% of the subjects in each group were men.

A subject was considered to have diabetes if he or she had a fasting blood glucose level greater than 126 mg/dL or was taking diabetes medication. The proportion of cases and controls with diabetes was compared in each 12-month interval, starting with 60 months prior to a cancer diagnosis for cancer patients (Gastroenterology 2008;134:95–101).

Overall, significantly more pancreatic cancer patients met the criteria for diabetes, compared with controls, any time during the 60-month period before pancreatic cancer diagnosis (40% vs. 19%). But the proportions of individuals with diabetes were not significantly different between the cancer group and the control group during the 12-month intervals from 60 months to 48 months and from 48 months to 36 months prior to cancer diagnosis.

In contrast, starting with 36 months before a cancer diagnosis, the prevalence of diabetes in the pancreatic cancer patients rose steadily for each 12-month interval, while the prevalence of diabetes in the controls remained relatively stable throughout the study period. New-onset diabetes was defined as diabetes with onset at 24 months or less prior to a cancer diagnosis.

Diabetes was more likely to be new onset in patients with pancreatic cancer than in controls (52% vs. 24%, respectively) among the subjects with diabetes for whom diabetes duration was known; this difference was highly significant.

“The very high prevalence of diabetes in pancreatic cancer and its close temporal association with the diagnosis of cancer provide strong epidemiologic evidence to support the notion that pancreatic cancer causes diabetes mellitus,” the researchers wrote.

The findings support data from small clinical studies in which the removal of tumors from pancreatic cancer patients with diabetes has improved their glucose tolerance and reversed their metabolic defects. But prospective studies are needed to show the benefits of screening older adults with new-onset diabetes for pancreatic cancer, and such screening would be helpful only if a type of new-onset diabetes that is associated with pancreatic cancer could be distinguished from type 2 diabetes, perhaps with the use of a biomarker test, the researchers noted.

There is a lack of practical criteria that could be used to rule out pancreatic cancer in new-onset diabetes patients, wrote Dr. Niels Teich, of the University of Leipzig (Germany) in an accompanying editorial (Gastroenterology 2008;134:344–5). The study findings invite more research to determine whether new-onset diabetes in pancreatic cancer patients is different from new-onset type 2 diabetes mellitus in general, and whether new-onset diabetes could be an early sign of this cancer in otherwise asymptomatic persons, he noted.

New cases of diabetes were significantly more common among pancreatic cancer patients before their cancer diagnoses, compared with controls, according to data from 736 pancreatic cancer patients and 1,875 controls.

Although previous studies have shown a link between existing diabetes and pancreatic cancer, the temporal relationship between the two diseases—and whether this relationship might be used to predict cancer—is not well understood, wrote Dr. Suresh T. Chari and colleagues at the Mayo Clinic in Rochester, Minn.

To determine the prevalence of new-onset diabetes in pancreatic cancer patients and the temporal association between these conditions, the researchers reviewed records of pancreatic cancer patients and control patients seen at the Mayo Clinic between Jan. 15, 1981, and July 9, 2004. They assigned two matched controls to each cancer case. The mean age of both patients and controls was 69 years, and approximately 50% of the subjects in each group were men.

A subject was considered to have diabetes if he or she had a fasting blood glucose level greater than 126 mg/dL or was taking diabetes medication. The proportion of cases and controls with diabetes was compared in each 12-month interval, starting with 60 months prior to a cancer diagnosis for cancer patients (Gastroenterology 2008;134:95–101).

Overall, significantly more pancreatic cancer patients met the criteria for diabetes, compared with controls, any time during the 60-month period before pancreatic cancer diagnosis (40% vs. 19%). But the proportions of individuals with diabetes were not significantly different between the cancer group and the control group during the 12-month intervals from 60 months to 48 months and from 48 months to 36 months prior to cancer diagnosis.

In contrast, starting with 36 months before a cancer diagnosis, the prevalence of diabetes in the pancreatic cancer patients rose steadily for each 12-month interval, while the prevalence of diabetes in the controls remained relatively stable throughout the study period. New-onset diabetes was defined as diabetes with onset at 24 months or less prior to a cancer diagnosis.

Diabetes was more likely to be new onset in patients with pancreatic cancer than in controls (52% vs. 24%, respectively) among the subjects with diabetes for whom diabetes duration was known; this difference was highly significant.

“The very high prevalence of diabetes in pancreatic cancer and its close temporal association with the diagnosis of cancer provide strong epidemiologic evidence to support the notion that pancreatic cancer causes diabetes mellitus,” the researchers wrote.

The findings support data from small clinical studies in which the removal of tumors from pancreatic cancer patients with diabetes has improved their glucose tolerance and reversed their metabolic defects. But prospective studies are needed to show the benefits of screening older adults with new-onset diabetes for pancreatic cancer, and such screening would be helpful only if a type of new-onset diabetes that is associated with pancreatic cancer could be distinguished from type 2 diabetes, perhaps with the use of a biomarker test, the researchers noted.

There is a lack of practical criteria that could be used to rule out pancreatic cancer in new-onset diabetes patients, wrote Dr. Niels Teich, of the University of Leipzig (Germany) in an accompanying editorial (Gastroenterology 2008;134:344–5). The study findings invite more research to determine whether new-onset diabetes in pancreatic cancer patients is different from new-onset type 2 diabetes mellitus in general, and whether new-onset diabetes could be an early sign of this cancer in otherwise asymptomatic persons, he noted.

WASHINGTON — Overweight and obese women had significantly lower embryo implantation rates than did normal-weight women, according to data from 1,870 women who underwent in vitro fertilization.

Results from recent studies suggest that weight has an impact on both fertility and pregnancy, with implications not only for prospective mothers but also for their infants.

In this study, Darlene M. Davies and her colleagues at the Fertility Centers of New England in Reading, Mass., reviewed data from 1,870 patients younger than 42 years of age who underwent IVF with intracytoplasmic sperm injection (ICSI) between January 2004 and December 2006.

Women who were classified as overweight (BMI 25–29.9 kg/m

In addition, the percentage of embryos consisting of seven to eight cells on the third day after embryo transfer—a sign of a high-quality embryo—was significantly lower in the most obese women with a BMI of 35–39.9, compared with women with a BMI of 30–34.9 (34% vs. 40%).

The findings, presented in a poster at the annual meeting of the American Society for Reproductive Medicine, support data from previous studies in which women with a BMI of 25 or higher required more gonadotropins, were less likely to become pregnant, and were more likely to miscarry, compared with women with a BMI of 25 or lower (Hum. Reprod. Update 2007;13:433–44), the investigators noted.

In addition, the percentage of spontaneous abortions, though not significantly higher, was higher in the most obese women (BMI 35–39.9), compared with all other weight groups (6% vs. 4%).

WASHINGTON — Overweight and obese women had significantly lower embryo implantation rates than did normal-weight women, according to data from 1,870 women who underwent in vitro fertilization.

Results from recent studies suggest that weight has an impact on both fertility and pregnancy, with implications not only for prospective mothers but also for their infants.

In this study, Darlene M. Davies and her colleagues at the Fertility Centers of New England in Reading, Mass., reviewed data from 1,870 patients younger than 42 years of age who underwent IVF with intracytoplasmic sperm injection (ICSI) between January 2004 and December 2006.

Women who were classified as overweight (BMI 25–29.9 kg/m

In addition, the percentage of embryos consisting of seven to eight cells on the third day after embryo transfer—a sign of a high-quality embryo—was significantly lower in the most obese women with a BMI of 35–39.9, compared with women with a BMI of 30–34.9 (34% vs. 40%).

The findings, presented in a poster at the annual meeting of the American Society for Reproductive Medicine, support data from previous studies in which women with a BMI of 25 or higher required more gonadotropins, were less likely to become pregnant, and were more likely to miscarry, compared with women with a BMI of 25 or lower (Hum. Reprod. Update 2007;13:433–44), the investigators noted.

In addition, the percentage of spontaneous abortions, though not significantly higher, was higher in the most obese women (BMI 35–39.9), compared with all other weight groups (6% vs. 4%).

WASHINGTON — Overweight and obese women had significantly lower embryo implantation rates than did normal-weight women, according to data from 1,870 women who underwent in vitro fertilization.

Results from recent studies suggest that weight has an impact on both fertility and pregnancy, with implications not only for prospective mothers but also for their infants.

In this study, Darlene M. Davies and her colleagues at the Fertility Centers of New England in Reading, Mass., reviewed data from 1,870 patients younger than 42 years of age who underwent IVF with intracytoplasmic sperm injection (ICSI) between January 2004 and December 2006.

Women who were classified as overweight (BMI 25–29.9 kg/m

In addition, the percentage of embryos consisting of seven to eight cells on the third day after embryo transfer—a sign of a high-quality embryo—was significantly lower in the most obese women with a BMI of 35–39.9, compared with women with a BMI of 30–34.9 (34% vs. 40%).

The findings, presented in a poster at the annual meeting of the American Society for Reproductive Medicine, support data from previous studies in which women with a BMI of 25 or higher required more gonadotropins, were less likely to become pregnant, and were more likely to miscarry, compared with women with a BMI of 25 or lower (Hum. Reprod. Update 2007;13:433–44), the investigators noted.

In addition, the percentage of spontaneous abortions, though not significantly higher, was higher in the most obese women (BMI 35–39.9), compared with all other weight groups (6% vs. 4%).

Recent studies involving gastroenteritis, Kawasaki disease, and bronchiolitis represent notable advances in the field of pediatric infectious disease, according to Dr. Howard Bauchner, director of the division of general pediatrics at Boston University.

Any list of “best” clinical articles is subject to bias, but randomized, controlled trials are usually the most likely to be relevant to an office practice, said Dr. Bauchner, who also serves as the editor in chief of the journal Archives of Disease in Childhood.

“Practitioners should try to keep up with the literature, but it can be difficult,” Dr. Bauchner said in an interview.

Dr. Bauchner reviewed several notable studies at a conference on infectious diseases held in Cambridge, Mass.

He highlighted one study in which an old drug was used in a new way: An antiemetic improved the successful oral rehydration of children with gastroenteritis by reducing vomiting (N. Engl. J. Med. 2006;354:1698–1705). In this study, 215 children aged 6 months to 10 years who were treated for gastroenteritis in a pediatric emergency department were randomized to receive a single dose of ondansetron or a placebo, followed by standard oral rehydration therapy.

Overall, the children who received ondansetron were significantly less likely to vomit, compared with the placebo group (14% vs. 35%); they also had significantly fewer episodes of vomiting and significantly greater oral intake. The children who received ondansetron also were less likely to need intravenous rehydration.

There is no reason to think this strategy would not be successful in other clinical pediatric settings, Dr. Bauchner said at the meeting, sponsored by Boston University.

Another study tested the possible value of adding a single pulsed dose of intravenous methylprednisolone to the standard intravenous immunoglobulin (IVIG) treatment for children with Kawasaki disease (N. Engl. J. Med. 2007;356:663–75).

In this multicenter study, 199 children averaging 3 years of age with acute Kawasaki disease (illness less than 10 days) were randomized to receive a single 30-mg/kg dose of methylprednisolone (101 children) or a placebo (98 children).

The children in the methylprednisolone group had a significantly shorter initial hospital stay and a significantly lower erythrocyte sedimentation rate at 1 week after the treatment, compared with the placebo group. But both groups averaged similar numbers of feverish days, rates of retreatment with IVIG, and numbers of adverse events. The findings don't support the use of methylprednisolone for acute Kawasaki disease, but the authors and an accompanying editorialist noted that larger trials involving a longer follow-up period and different steroids might yield different results, Dr. Bauchner said.

A third study showed that steroids had no clinical effect on the treatment of bronchiolitis in infants (N. Engl. J. Med. 2007;357:331–9).

The value of steroids as a treatment for bronchiolitis remains controversial, said Dr. Bauchner. In this study, 600 infants aged 2–12 months diagnosed with moderate to severe bronchiolitis were randomized to receive a single oral dose (1 mg/kg) of dexamethasone or a placebo. The hospital admission rate, which was the primary outcome of the study, was essentially the same in both the steroid group and placebo group (40% vs. 41%). Children in both groups showed some respiratory improvement during an observation period following their treatments, and the hospitalization rate was similar for both groups. The caveat is that infants with a history of wheeze were excluded, Dr. Bauchner noted. But the results held up in a subgroup analysis that included a family history of asthma.

To keep up on latest research, Dr. Bauchner recommended that clinicians subscribe to any abstracting service, such as Journal Watch and Pediatric Grand Rounds.

Dr. Bauchner serves as a consultant to AstraZeneca Pharmaceuticals LP.

Recent studies involving gastroenteritis, Kawasaki disease, and bronchiolitis represent notable advances in the field of pediatric infectious disease, according to Dr. Howard Bauchner, director of the division of general pediatrics at Boston University.

Any list of “best” clinical articles is subject to bias, but randomized, controlled trials are usually the most likely to be relevant to an office practice, said Dr. Bauchner, who also serves as the editor in chief of the journal Archives of Disease in Childhood.

“Practitioners should try to keep up with the literature, but it can be difficult,” Dr. Bauchner said in an interview.

Dr. Bauchner reviewed several notable studies at a conference on infectious diseases held in Cambridge, Mass.

He highlighted one study in which an old drug was used in a new way: An antiemetic improved the successful oral rehydration of children with gastroenteritis by reducing vomiting (N. Engl. J. Med. 2006;354:1698–1705). In this study, 215 children aged 6 months to 10 years who were treated for gastroenteritis in a pediatric emergency department were randomized to receive a single dose of ondansetron or a placebo, followed by standard oral rehydration therapy.

Overall, the children who received ondansetron were significantly less likely to vomit, compared with the placebo group (14% vs. 35%); they also had significantly fewer episodes of vomiting and significantly greater oral intake. The children who received ondansetron also were less likely to need intravenous rehydration.

There is no reason to think this strategy would not be successful in other clinical pediatric settings, Dr. Bauchner said at the meeting, sponsored by Boston University.

Another study tested the possible value of adding a single pulsed dose of intravenous methylprednisolone to the standard intravenous immunoglobulin (IVIG) treatment for children with Kawasaki disease (N. Engl. J. Med. 2007;356:663–75).

In this multicenter study, 199 children averaging 3 years of age with acute Kawasaki disease (illness less than 10 days) were randomized to receive a single 30-mg/kg dose of methylprednisolone (101 children) or a placebo (98 children).

The children in the methylprednisolone group had a significantly shorter initial hospital stay and a significantly lower erythrocyte sedimentation rate at 1 week after the treatment, compared with the placebo group. But both groups averaged similar numbers of feverish days, rates of retreatment with IVIG, and numbers of adverse events. The findings don't support the use of methylprednisolone for acute Kawasaki disease, but the authors and an accompanying editorialist noted that larger trials involving a longer follow-up period and different steroids might yield different results, Dr. Bauchner said.

A third study showed that steroids had no clinical effect on the treatment of bronchiolitis in infants (N. Engl. J. Med. 2007;357:331–9).

The value of steroids as a treatment for bronchiolitis remains controversial, said Dr. Bauchner. In this study, 600 infants aged 2–12 months diagnosed with moderate to severe bronchiolitis were randomized to receive a single oral dose (1 mg/kg) of dexamethasone or a placebo. The hospital admission rate, which was the primary outcome of the study, was essentially the same in both the steroid group and placebo group (40% vs. 41%). Children in both groups showed some respiratory improvement during an observation period following their treatments, and the hospitalization rate was similar for both groups. The caveat is that infants with a history of wheeze were excluded, Dr. Bauchner noted. But the results held up in a subgroup analysis that included a family history of asthma.

To keep up on latest research, Dr. Bauchner recommended that clinicians subscribe to any abstracting service, such as Journal Watch and Pediatric Grand Rounds.

Dr. Bauchner serves as a consultant to AstraZeneca Pharmaceuticals LP.

Recent studies involving gastroenteritis, Kawasaki disease, and bronchiolitis represent notable advances in the field of pediatric infectious disease, according to Dr. Howard Bauchner, director of the division of general pediatrics at Boston University.

Any list of “best” clinical articles is subject to bias, but randomized, controlled trials are usually the most likely to be relevant to an office practice, said Dr. Bauchner, who also serves as the editor in chief of the journal Archives of Disease in Childhood.

“Practitioners should try to keep up with the literature, but it can be difficult,” Dr. Bauchner said in an interview.

Dr. Bauchner reviewed several notable studies at a conference on infectious diseases held in Cambridge, Mass.

He highlighted one study in which an old drug was used in a new way: An antiemetic improved the successful oral rehydration of children with gastroenteritis by reducing vomiting (N. Engl. J. Med. 2006;354:1698–1705). In this study, 215 children aged 6 months to 10 years who were treated for gastroenteritis in a pediatric emergency department were randomized to receive a single dose of ondansetron or a placebo, followed by standard oral rehydration therapy.

Overall, the children who received ondansetron were significantly less likely to vomit, compared with the placebo group (14% vs. 35%); they also had significantly fewer episodes of vomiting and significantly greater oral intake. The children who received ondansetron also were less likely to need intravenous rehydration.

There is no reason to think this strategy would not be successful in other clinical pediatric settings, Dr. Bauchner said at the meeting, sponsored by Boston University.

Another study tested the possible value of adding a single pulsed dose of intravenous methylprednisolone to the standard intravenous immunoglobulin (IVIG) treatment for children with Kawasaki disease (N. Engl. J. Med. 2007;356:663–75).

In this multicenter study, 199 children averaging 3 years of age with acute Kawasaki disease (illness less than 10 days) were randomized to receive a single 30-mg/kg dose of methylprednisolone (101 children) or a placebo (98 children).

The children in the methylprednisolone group had a significantly shorter initial hospital stay and a significantly lower erythrocyte sedimentation rate at 1 week after the treatment, compared with the placebo group. But both groups averaged similar numbers of feverish days, rates of retreatment with IVIG, and numbers of adverse events. The findings don't support the use of methylprednisolone for acute Kawasaki disease, but the authors and an accompanying editorialist noted that larger trials involving a longer follow-up period and different steroids might yield different results, Dr. Bauchner said.

A third study showed that steroids had no clinical effect on the treatment of bronchiolitis in infants (N. Engl. J. Med. 2007;357:331–9).

The value of steroids as a treatment for bronchiolitis remains controversial, said Dr. Bauchner. In this study, 600 infants aged 2–12 months diagnosed with moderate to severe bronchiolitis were randomized to receive a single oral dose (1 mg/kg) of dexamethasone or a placebo. The hospital admission rate, which was the primary outcome of the study, was essentially the same in both the steroid group and placebo group (40% vs. 41%). Children in both groups showed some respiratory improvement during an observation period following their treatments, and the hospitalization rate was similar for both groups. The caveat is that infants with a history of wheeze were excluded, Dr. Bauchner noted. But the results held up in a subgroup analysis that included a family history of asthma.

To keep up on latest research, Dr. Bauchner recommended that clinicians subscribe to any abstracting service, such as Journal Watch and Pediatric Grand Rounds.

Dr. Bauchner serves as a consultant to AstraZeneca Pharmaceuticals LP.

Consider a retropharyngeal abscess when faced with a drooling child who has a severe sore throat, according to Dr. Marisol Figueira of Boston University.

“Retropharyngeal abscess is a commonly seen pathology secondary to acute infection of the throat,” Dr. Figueira said in an interview. “It is a result of suppuration of the retropharyngeal lymph nodes, secondary to infection in the adenoid, nasopharynx, posterior pharyngeal wall, sinuses, and tonsils.”

A high index of suspicion is needed to diagnose retropharyngeal abscess, and the diagnosis is made based on clinical manifestations and radiologic studies.

Prompt diagnosis is important, because treatment delays could lead to life-threatening complications such as a blocked airway, jugular vein thrombosis, or mediastinitis, Dr. Figueira explained in a presentation at a conference on infectious diseases held in Cambridge, Mass.

The retropharyngeal space extends from the base of the skull to the level of the T1 or T2 vertebra, and includes the space behind the muscles of the pharynx but in front of the prevertebral fascia.

An infection in the retropharyngeal space is most common in young children. Data from one 35-year review of cases at a California hospital showed that 50% of patients with a retropharyngeal abscess were younger than 3 years and 71% were younger than 6 years, Dr. Figueira said.

The abscess may follow an upper respiratory infection, group A β-hemolytic streptococcal pharyngitis (GABHS), or even trauma.

The predominant bacterial species are Streptococcus pyogenes, Staphylococcus aureus, and respiratory anaerobes (including Fusobacteria, Prevotella, and Veillonella species). Haemophilus species also are occasionally found.

The clinical presentation can involve a spectrum of common symptoms including fever, severe sore throat, dysphagia, drooling, respiratory distress, and a muffled voice. The classic symptoms of neck stiffness and bulging of the posterior pharyngeal wall are present in fewer than 50% of patients, Dr. Figueira said.

On physical examination, the child can present with anterolateral neck swelling, hyperextension of the neck, or an enlarged cervical lymph node, she explained at the meeting, which was sponsored by the university.

Imaging is needed to confirm a diagnosis of a retropharyngeal abscess. A lateral x-ray of the neck area may show soft tissue swelling, and a CT scan of the neck can be helpful if the x-ray findings are uncertain and the clinical suspicion is high.

Immediate treatment includes airway maintenance, pain management, and hydration before admitting the child to the hospital. Consult an ear, nose, and throat specialist when the diagnosis is confirmed or if the child has an obstructed airway. The treatment plan for a retropharyngeal abscess includes incising and draining the abscess, and treating the child with parenteral antibiotics such as clindamycin or a combination of ampicillin and sulbactam.

“Prompt diagnosis and treatment of pharyngitis or upper respiratory infections will generally prevent retropharyngeal abscess,” Dr. Figueira said. “Also, it is important to know that this condition can lead to laryngeal edema with possible airway obstruction, mediastinitis, and aspiration pneumonia, but with prompt treatment a patient can make a full recovery.”

Consider a retropharyngeal abscess when faced with a drooling child who has a severe sore throat, according to Dr. Marisol Figueira of Boston University.

“Retropharyngeal abscess is a commonly seen pathology secondary to acute infection of the throat,” Dr. Figueira said in an interview. “It is a result of suppuration of the retropharyngeal lymph nodes, secondary to infection in the adenoid, nasopharynx, posterior pharyngeal wall, sinuses, and tonsils.”

A high index of suspicion is needed to diagnose retropharyngeal abscess, and the diagnosis is made based on clinical manifestations and radiologic studies.

Prompt diagnosis is important, because treatment delays could lead to life-threatening complications such as a blocked airway, jugular vein thrombosis, or mediastinitis, Dr. Figueira explained in a presentation at a conference on infectious diseases held in Cambridge, Mass.

The retropharyngeal space extends from the base of the skull to the level of the T1 or T2 vertebra, and includes the space behind the muscles of the pharynx but in front of the prevertebral fascia.

An infection in the retropharyngeal space is most common in young children. Data from one 35-year review of cases at a California hospital showed that 50% of patients with a retropharyngeal abscess were younger than 3 years and 71% were younger than 6 years, Dr. Figueira said.

The abscess may follow an upper respiratory infection, group A β-hemolytic streptococcal pharyngitis (GABHS), or even trauma.

The predominant bacterial species are Streptococcus pyogenes, Staphylococcus aureus, and respiratory anaerobes (including Fusobacteria, Prevotella, and Veillonella species). Haemophilus species also are occasionally found.

The clinical presentation can involve a spectrum of common symptoms including fever, severe sore throat, dysphagia, drooling, respiratory distress, and a muffled voice. The classic symptoms of neck stiffness and bulging of the posterior pharyngeal wall are present in fewer than 50% of patients, Dr. Figueira said.

On physical examination, the child can present with anterolateral neck swelling, hyperextension of the neck, or an enlarged cervical lymph node, she explained at the meeting, which was sponsored by the university.

Imaging is needed to confirm a diagnosis of a retropharyngeal abscess. A lateral x-ray of the neck area may show soft tissue swelling, and a CT scan of the neck can be helpful if the x-ray findings are uncertain and the clinical suspicion is high.

Immediate treatment includes airway maintenance, pain management, and hydration before admitting the child to the hospital. Consult an ear, nose, and throat specialist when the diagnosis is confirmed or if the child has an obstructed airway. The treatment plan for a retropharyngeal abscess includes incising and draining the abscess, and treating the child with parenteral antibiotics such as clindamycin or a combination of ampicillin and sulbactam.

“Prompt diagnosis and treatment of pharyngitis or upper respiratory infections will generally prevent retropharyngeal abscess,” Dr. Figueira said. “Also, it is important to know that this condition can lead to laryngeal edema with possible airway obstruction, mediastinitis, and aspiration pneumonia, but with prompt treatment a patient can make a full recovery.”

Consider a retropharyngeal abscess when faced with a drooling child who has a severe sore throat, according to Dr. Marisol Figueira of Boston University.

“Retropharyngeal abscess is a commonly seen pathology secondary to acute infection of the throat,” Dr. Figueira said in an interview. “It is a result of suppuration of the retropharyngeal lymph nodes, secondary to infection in the adenoid, nasopharynx, posterior pharyngeal wall, sinuses, and tonsils.”

A high index of suspicion is needed to diagnose retropharyngeal abscess, and the diagnosis is made based on clinical manifestations and radiologic studies.

Prompt diagnosis is important, because treatment delays could lead to life-threatening complications such as a blocked airway, jugular vein thrombosis, or mediastinitis, Dr. Figueira explained in a presentation at a conference on infectious diseases held in Cambridge, Mass.

The retropharyngeal space extends from the base of the skull to the level of the T1 or T2 vertebra, and includes the space behind the muscles of the pharynx but in front of the prevertebral fascia.

An infection in the retropharyngeal space is most common in young children. Data from one 35-year review of cases at a California hospital showed that 50% of patients with a retropharyngeal abscess were younger than 3 years and 71% were younger than 6 years, Dr. Figueira said.

The abscess may follow an upper respiratory infection, group A β-hemolytic streptococcal pharyngitis (GABHS), or even trauma.

The predominant bacterial species are Streptococcus pyogenes, Staphylococcus aureus, and respiratory anaerobes (including Fusobacteria, Prevotella, and Veillonella species). Haemophilus species also are occasionally found.

The clinical presentation can involve a spectrum of common symptoms including fever, severe sore throat, dysphagia, drooling, respiratory distress, and a muffled voice. The classic symptoms of neck stiffness and bulging of the posterior pharyngeal wall are present in fewer than 50% of patients, Dr. Figueira said.

On physical examination, the child can present with anterolateral neck swelling, hyperextension of the neck, or an enlarged cervical lymph node, she explained at the meeting, which was sponsored by the university.

Imaging is needed to confirm a diagnosis of a retropharyngeal abscess. A lateral x-ray of the neck area may show soft tissue swelling, and a CT scan of the neck can be helpful if the x-ray findings are uncertain and the clinical suspicion is high.

Immediate treatment includes airway maintenance, pain management, and hydration before admitting the child to the hospital. Consult an ear, nose, and throat specialist when the diagnosis is confirmed or if the child has an obstructed airway. The treatment plan for a retropharyngeal abscess includes incising and draining the abscess, and treating the child with parenteral antibiotics such as clindamycin or a combination of ampicillin and sulbactam.

“Prompt diagnosis and treatment of pharyngitis or upper respiratory infections will generally prevent retropharyngeal abscess,” Dr. Figueira said. “Also, it is important to know that this condition can lead to laryngeal edema with possible airway obstruction, mediastinitis, and aspiration pneumonia, but with prompt treatment a patient can make a full recovery.”

GAITHERSBURG, MD. — All three virus strains in the influenza vaccine for the 2008–2009 season will differ from this year's vaccine, based on a majority vote by an advisory committee to the Food and Drug Administration.

The Vaccines and Related Biological Products Advisory Committee members voted to accept the choices recommended by the World Health Organization for next year's trivalent vaccine: an A/Brisbane/59/2007 (H1N1)-like virus, an A/Brisbane/10/2007 (H3N2)-like virus, and a B/Florida/4/2006-like virus.

These choices represent a notable departure from the flu vaccine formulas of recent years, which have included repeat appearances by the Solomon Islands strain of influenza A.

The change was prompted in part by the rise of the A/Brisbane/10/2007-like strain, which accounted for 82% of the influenza A (H3N2) isolates characterized by the Centers for Disease Control and Prevention between October 2007 and January 2008. According to the most recent data available from the CDC, the H3N2 strain of influenza A has become the dominant strain for this year's flu season.

Although influenza A is causing most of the illness, the well-publicized mismatch between the influenza B virus chosen for this year's flu vaccine and the currently circulating B virus is drawing extra attention. But the lengthy process of developing the flu vaccine and the challenges to produce it in volume and on schedule remain the same each year.

Two types of influenza B circulate every year, and one committee member compared the choice of B virus for each year's vaccine with flipping a coin.

An influenza B virus from the Victoria group was chosen for the 2007–2008 vaccine, but the strain chosen for 2008–2009 is of the Yamagata lineage. The most recent data from the CDC for the 2007–2008 flu season (as of Feb. 9, 2008) showed that 93% of the circulating influenza B viruses in the United States were of the Yamagata lineage, while 7% of the viruses were of the Victoria lineage. “But we have both groups [of influenza B virus] circulating worldwide,” noted Nancy Cox, Ph.D., director of the influenza division at the CDC.

The committee members also discussed the possibility of tailoring future flu vaccines to different populations. Unlike previously vaccinated adults who have been exposed to both types of influenza B over time, children would likely benefit from a vaccine that has strains from both B virus lineages, noted Dr. Robert Couch, professor of molecular virology and microbiology at Baylor College of Medicine, Houston.

GAITHERSBURG, MD. — All three virus strains in the influenza vaccine for the 2008–2009 season will differ from this year's vaccine, based on a majority vote by an advisory committee to the Food and Drug Administration.

The Vaccines and Related Biological Products Advisory Committee members voted to accept the choices recommended by the World Health Organization for next year's trivalent vaccine: an A/Brisbane/59/2007 (H1N1)-like virus, an A/Brisbane/10/2007 (H3N2)-like virus, and a B/Florida/4/2006-like virus.

These choices represent a notable departure from the flu vaccine formulas of recent years, which have included repeat appearances by the Solomon Islands strain of influenza A.

The change was prompted in part by the rise of the A/Brisbane/10/2007-like strain, which accounted for 82% of the influenza A (H3N2) isolates characterized by the Centers for Disease Control and Prevention between October 2007 and January 2008. According to the most recent data available from the CDC, the H3N2 strain of influenza A has become the dominant strain for this year's flu season.

Although influenza A is causing most of the illness, the well-publicized mismatch between the influenza B virus chosen for this year's flu vaccine and the currently circulating B virus is drawing extra attention. But the lengthy process of developing the flu vaccine and the challenges to produce it in volume and on schedule remain the same each year.

Two types of influenza B circulate every year, and one committee member compared the choice of B virus for each year's vaccine with flipping a coin.

An influenza B virus from the Victoria group was chosen for the 2007–2008 vaccine, but the strain chosen for 2008–2009 is of the Yamagata lineage. The most recent data from the CDC for the 2007–2008 flu season (as of Feb. 9, 2008) showed that 93% of the circulating influenza B viruses in the United States were of the Yamagata lineage, while 7% of the viruses were of the Victoria lineage. “But we have both groups [of influenza B virus] circulating worldwide,” noted Nancy Cox, Ph.D., director of the influenza division at the CDC.

The committee members also discussed the possibility of tailoring future flu vaccines to different populations. Unlike previously vaccinated adults who have been exposed to both types of influenza B over time, children would likely benefit from a vaccine that has strains from both B virus lineages, noted Dr. Robert Couch, professor of molecular virology and microbiology at Baylor College of Medicine, Houston.

GAITHERSBURG, MD. — All three virus strains in the influenza vaccine for the 2008–2009 season will differ from this year's vaccine, based on a majority vote by an advisory committee to the Food and Drug Administration.

The Vaccines and Related Biological Products Advisory Committee members voted to accept the choices recommended by the World Health Organization for next year's trivalent vaccine: an A/Brisbane/59/2007 (H1N1)-like virus, an A/Brisbane/10/2007 (H3N2)-like virus, and a B/Florida/4/2006-like virus.

These choices represent a notable departure from the flu vaccine formulas of recent years, which have included repeat appearances by the Solomon Islands strain of influenza A.

The change was prompted in part by the rise of the A/Brisbane/10/2007-like strain, which accounted for 82% of the influenza A (H3N2) isolates characterized by the Centers for Disease Control and Prevention between October 2007 and January 2008. According to the most recent data available from the CDC, the H3N2 strain of influenza A has become the dominant strain for this year's flu season.

Although influenza A is causing most of the illness, the well-publicized mismatch between the influenza B virus chosen for this year's flu vaccine and the currently circulating B virus is drawing extra attention. But the lengthy process of developing the flu vaccine and the challenges to produce it in volume and on schedule remain the same each year.

Two types of influenza B circulate every year, and one committee member compared the choice of B virus for each year's vaccine with flipping a coin.

An influenza B virus from the Victoria group was chosen for the 2007–2008 vaccine, but the strain chosen for 2008–2009 is of the Yamagata lineage. The most recent data from the CDC for the 2007–2008 flu season (as of Feb. 9, 2008) showed that 93% of the circulating influenza B viruses in the United States were of the Yamagata lineage, while 7% of the viruses were of the Victoria lineage. “But we have both groups [of influenza B virus] circulating worldwide,” noted Nancy Cox, Ph.D., director of the influenza division at the CDC.

The committee members also discussed the possibility of tailoring future flu vaccines to different populations. Unlike previously vaccinated adults who have been exposed to both types of influenza B over time, children would likely benefit from a vaccine that has strains from both B virus lineages, noted Dr. Robert Couch, professor of molecular virology and microbiology at Baylor College of Medicine, Houston.

Every state but Florida reported widespread influenza activity by the midpoint of the flu season in February, according to data from the Centers for Disease Control and Prevention.

“We can't predict the severity and duration of an influenza season, but the data suggest that we are nearing the peak,” Nancy Cox, Ph.D., said in a teleconference. The state of Florida had reported regional activity and the District of Columbia had reported local activity.

The percentage of people with flulike symptoms who tested positive for flu spiked in mid-February, but “we are within normal parameters of what we would expect,” said Dr. Cox, director of the influenza division at the CDC.

A total of 22 deaths in children with confirmed influenza had been reported to the CDC as of Feb. 22, based on data from the National Notifiable Diseases Surveillance System. Of these, 21 occurred between Dec. 24 and Feb. 10, Dr. Cox said. The number of flu-related deaths in children so far this year remains below the totals from the past 3 years, she added. The CDC does not track flu-related deaths in adults.

The H3N2 strain of influenza A has become the dominant strain for this year's flu season, said Dr. Cox. “The influenza season started out as mostly an H1N1 year through December and into the first part of January, and then it switched to H3N2,” she said.

As of Feb. 16, 14% of the more than 100,000 specimens tested since September 2007 have been positive for influenza. Of these, the majority (more than 84%) is influenza A; less than 16% is influenza B, said Dr. Cox.

Mainstream news reports of the mismatch between the influenza virus in the 2007–2008 vaccine and the virus that is circulating this year have caused concern among many people that their flu shots might not be effective, but vaccination can still provide protection, according to the CDC.

And, whether persons have been vaccinated or not, the CDC's take-home message remains the same: Good hand hygiene and cough etiquette also are important to prevent the spread of the disease.

For the latest information on the 2007–2008 flu season, visit www.cdc.gov/flu

Every state but Florida reported widespread influenza activity by the midpoint of the flu season in February, according to data from the Centers for Disease Control and Prevention.

“We can't predict the severity and duration of an influenza season, but the data suggest that we are nearing the peak,” Nancy Cox, Ph.D., said in a teleconference. The state of Florida had reported regional activity and the District of Columbia had reported local activity.

The percentage of people with flulike symptoms who tested positive for flu spiked in mid-February, but “we are within normal parameters of what we would expect,” said Dr. Cox, director of the influenza division at the CDC.

A total of 22 deaths in children with confirmed influenza had been reported to the CDC as of Feb. 22, based on data from the National Notifiable Diseases Surveillance System. Of these, 21 occurred between Dec. 24 and Feb. 10, Dr. Cox said. The number of flu-related deaths in children so far this year remains below the totals from the past 3 years, she added. The CDC does not track flu-related deaths in adults.

The H3N2 strain of influenza A has become the dominant strain for this year's flu season, said Dr. Cox. “The influenza season started out as mostly an H1N1 year through December and into the first part of January, and then it switched to H3N2,” she said.

As of Feb. 16, 14% of the more than 100,000 specimens tested since September 2007 have been positive for influenza. Of these, the majority (more than 84%) is influenza A; less than 16% is influenza B, said Dr. Cox.

Mainstream news reports of the mismatch between the influenza virus in the 2007–2008 vaccine and the virus that is circulating this year have caused concern among many people that their flu shots might not be effective, but vaccination can still provide protection, according to the CDC.

And, whether persons have been vaccinated or not, the CDC's take-home message remains the same: Good hand hygiene and cough etiquette also are important to prevent the spread of the disease.

For the latest information on the 2007–2008 flu season, visit www.cdc.gov/flu

Every state but Florida reported widespread influenza activity by the midpoint of the flu season in February, according to data from the Centers for Disease Control and Prevention.

“We can't predict the severity and duration of an influenza season, but the data suggest that we are nearing the peak,” Nancy Cox, Ph.D., said in a teleconference. The state of Florida had reported regional activity and the District of Columbia had reported local activity.

The percentage of people with flulike symptoms who tested positive for flu spiked in mid-February, but “we are within normal parameters of what we would expect,” said Dr. Cox, director of the influenza division at the CDC.

A total of 22 deaths in children with confirmed influenza had been reported to the CDC as of Feb. 22, based on data from the National Notifiable Diseases Surveillance System. Of these, 21 occurred between Dec. 24 and Feb. 10, Dr. Cox said. The number of flu-related deaths in children so far this year remains below the totals from the past 3 years, she added. The CDC does not track flu-related deaths in adults.

The H3N2 strain of influenza A has become the dominant strain for this year's flu season, said Dr. Cox. “The influenza season started out as mostly an H1N1 year through December and into the first part of January, and then it switched to H3N2,” she said.

As of Feb. 16, 14% of the more than 100,000 specimens tested since September 2007 have been positive for influenza. Of these, the majority (more than 84%) is influenza A; less than 16% is influenza B, said Dr. Cox.

Mainstream news reports of the mismatch between the influenza virus in the 2007–2008 vaccine and the virus that is circulating this year have caused concern among many people that their flu shots might not be effective, but vaccination can still provide protection, according to the CDC.

And, whether persons have been vaccinated or not, the CDC's take-home message remains the same: Good hand hygiene and cough etiquette also are important to prevent the spread of the disease.

For the latest information on the 2007–2008 flu season, visit www.cdc.gov/flu

Infants excrete the ethyl mercury used in thimerosal-containing vaccines too quickly for the mercury to build up in their systems, according to study results.

The findings may help to quell chronic concerns that thimerosal-containing vaccines can increase a child's risk for developmental problems, such as autism. These concerns led to the removal of thimerosal from most vaccines given to children in the United States and Europe as of March 2001, although it remains a component of vaccines used in other countries.

Previous studies have described how the body processes methyl mercury—the type associated with the consumption of fish—but few studies have examined how the body processes ethyl mercury after exposure via intramuscular injection.

In this study, Dr. Michael Pichichero of the University of Rochester (N.Y.), and his colleagues evaluated the ethyl mercury in blood, urine, and stool samples from 216 healthy children prior to vaccination with thimerosal-containing vaccines and again at several points between 12 hours and 30 days after vaccination, depending on the age group.

The study population included 72 newborns, 72 2-month-old infants, and 72 6-month-old infants who were vaccinated at a children's hospital in Argentina between February 2003 and February 2004 (Pediatrics 2008;121:e208–14).

The main hypothesis of the study was that ethyl mercury does not stay long in the bloodstreams of vaccinated infants. Complete pre- and postvaccination blood samples were available from 128 children (59%): 40 newborns, 50 2-month-olds, and 38 6-month-olds.

Overall, the blood mercury levels in all three age groups were highest at the first postvaccination measurements—12 hours after vaccination for newborns and 24 hours after vaccination for the 2-month-olds and 6-month-olds. In all age groups, the blood mercury levels quickly dropped and the levels in most of the children had returned to normal by 11 days after vaccination.

The average maximal blood mercury levels after vaccinations for the newborns, 2-month-olds, and 6-month-olds were 5.0 ng/mL, 3.6 ng/mL, and 2.8 ng/mL, respectively.

Even the highest level of mercury was relatively low. The overall highest level detected in the study was 8.0 ng/mL, and it was noted in a newborn 12 hours after a birth dose of a hepatitis B virus (HBV) vaccine that included 32.5 mcg of mercury.

Another important finding was that the prevaccination levels among the 6-month-olds were not higher than the prevaccination levels among the 2-month-olds, which suggests that ethyl mercury does not accumulate in the blood as a result of exposure to thimerosal-containing vaccines, the researchers noted.

“Using a model that accounted for baseline mercury levels, ethyl mercury dosage, and timing of vaccination, we estimated the blood half-life of mercury after administration of thimerosal to be 3.7 days, which did not vary significantly by age group,” the researchers wrote.

“This study is very timely for something that pediatricians are going to be facing,” Dr. Pichichero said in an interview. The ABC-TV network recently aired the debut of a fictional series about a lawyer, “Eli Stone,” that suggested a conspiracy between vaccine companies and physicians to keep an association between vaccines and autism under wraps. “So every pediatrician in America is going to face parents who see this fictional program,” he said. “We are going to have parents wondering whether their doctors are in cahoots with the vaccine companies.”

Dr. Pichichero said that this study virtually eliminates the argument that mercury can accumulate to unsafe levels in children as a result of standard infant vaccinations. “Our study shows beyond a shadow of a doubt that that is not true given how quickly ethyl mercury disappeared from the blood,” he said.

In fact, inorganic mercury was found in almost all the stool samples in all age groups. Mercury levels in the stool increased shortly after vaccinations in all age groups, but then they began to decline, which suggests that the mercury is leaving the body in the stool, Dr. Pichichero said. By contrast, the urine samples in all age groups showed barely detectable levels of mercury, which suggests that the kidneys are likely not affected, he added.

The results were limited by the combination of methyl and ethyl mercury in the blood samples from some children and by the researchers' inability to identify the exact proportion of mercury excreted through the stool and urine.

However, the short half-life of ethyl mercury in the blood suggests a need to reassess the risk of thimerosal as a preservative, they wrote.

Dr. Pichichero is an unpaid consultant for the World Health Organization on vaccine-related issues, and he has served as a consultant to several vaccine manufacturers including GlaxoSmithKline Biologicals, Sanofi Pasteur, Wyeth Pharmaceuticals, MedImmune, and Merck & Co.

The findings support results from recent studies, including a study conducted by the Centers for Disease Control and Prevention that showed no association between exposure to ethyl mercury from thimerosal-containing vaccines during infancy and neuropsychological outcomes at age 7–10 years (N. Engl. J. Med. 2007;357:1281–92).

In addition, a population-based study that was conducted in California last year showed an increase in the prevalence of autism in the years since thimerosal-containing vaccines were discontinued (Arch. Gen. Psychiatry 2008;65:19–24).

This study virtually eliminates the argument that mercury can accumulate to unsafe levels. DR. PICHICHERO

Infants excrete the ethyl mercury used in thimerosal-containing vaccines too quickly for the mercury to build up in their systems, according to study results.

The findings may help to quell chronic concerns that thimerosal-containing vaccines can increase a child's risk for developmental problems, such as autism. These concerns led to the removal of thimerosal from most vaccines given to children in the United States and Europe as of March 2001, although it remains a component of vaccines used in other countries.

Previous studies have described how the body processes methyl mercury—the type associated with the consumption of fish—but few studies have examined how the body processes ethyl mercury after exposure via intramuscular injection.

In this study, Dr. Michael Pichichero of the University of Rochester (N.Y.), and his colleagues evaluated the ethyl mercury in blood, urine, and stool samples from 216 healthy children prior to vaccination with thimerosal-containing vaccines and again at several points between 12 hours and 30 days after vaccination, depending on the age group.

The study population included 72 newborns, 72 2-month-old infants, and 72 6-month-old infants who were vaccinated at a children's hospital in Argentina between February 2003 and February 2004 (Pediatrics 2008;121:e208–14).

The main hypothesis of the study was that ethyl mercury does not stay long in the bloodstreams of vaccinated infants. Complete pre- and postvaccination blood samples were available from 128 children (59%): 40 newborns, 50 2-month-olds, and 38 6-month-olds.

Overall, the blood mercury levels in all three age groups were highest at the first postvaccination measurements—12 hours after vaccination for newborns and 24 hours after vaccination for the 2-month-olds and 6-month-olds. In all age groups, the blood mercury levels quickly dropped and the levels in most of the children had returned to normal by 11 days after vaccination.

The average maximal blood mercury levels after vaccinations for the newborns, 2-month-olds, and 6-month-olds were 5.0 ng/mL, 3.6 ng/mL, and 2.8 ng/mL, respectively.

Even the highest level of mercury was relatively low. The overall highest level detected in the study was 8.0 ng/mL, and it was noted in a newborn 12 hours after a birth dose of a hepatitis B virus (HBV) vaccine that included 32.5 mcg of mercury.

Another important finding was that the prevaccination levels among the 6-month-olds were not higher than the prevaccination levels among the 2-month-olds, which suggests that ethyl mercury does not accumulate in the blood as a result of exposure to thimerosal-containing vaccines, the researchers noted.

“Using a model that accounted for baseline mercury levels, ethyl mercury dosage, and timing of vaccination, we estimated the blood half-life of mercury after administration of thimerosal to be 3.7 days, which did not vary significantly by age group,” the researchers wrote.

“This study is very timely for something that pediatricians are going to be facing,” Dr. Pichichero said in an interview. The ABC-TV network recently aired the debut of a fictional series about a lawyer, “Eli Stone,” that suggested a conspiracy between vaccine companies and physicians to keep an association between vaccines and autism under wraps. “So every pediatrician in America is going to face parents who see this fictional program,” he said. “We are going to have parents wondering whether their doctors are in cahoots with the vaccine companies.”

Dr. Pichichero said that this study virtually eliminates the argument that mercury can accumulate to unsafe levels in children as a result of standard infant vaccinations. “Our study shows beyond a shadow of a doubt that that is not true given how quickly ethyl mercury disappeared from the blood,” he said.

In fact, inorganic mercury was found in almost all the stool samples in all age groups. Mercury levels in the stool increased shortly after vaccinations in all age groups, but then they began to decline, which suggests that the mercury is leaving the body in the stool, Dr. Pichichero said. By contrast, the urine samples in all age groups showed barely detectable levels of mercury, which suggests that the kidneys are likely not affected, he added.

The results were limited by the combination of methyl and ethyl mercury in the blood samples from some children and by the researchers' inability to identify the exact proportion of mercury excreted through the stool and urine.

However, the short half-life of ethyl mercury in the blood suggests a need to reassess the risk of thimerosal as a preservative, they wrote.

Dr. Pichichero is an unpaid consultant for the World Health Organization on vaccine-related issues, and he has served as a consultant to several vaccine manufacturers including GlaxoSmithKline Biologicals, Sanofi Pasteur, Wyeth Pharmaceuticals, MedImmune, and Merck & Co.

The findings support results from recent studies, including a study conducted by the Centers for Disease Control and Prevention that showed no association between exposure to ethyl mercury from thimerosal-containing vaccines during infancy and neuropsychological outcomes at age 7–10 years (N. Engl. J. Med. 2007;357:1281–92).

In addition, a population-based study that was conducted in California last year showed an increase in the prevalence of autism in the years since thimerosal-containing vaccines were discontinued (Arch. Gen. Psychiatry 2008;65:19–24).

This study virtually eliminates the argument that mercury can accumulate to unsafe levels. DR. PICHICHERO

Infants excrete the ethyl mercury used in thimerosal-containing vaccines too quickly for the mercury to build up in their systems, according to study results.

The findings may help to quell chronic concerns that thimerosal-containing vaccines can increase a child's risk for developmental problems, such as autism. These concerns led to the removal of thimerosal from most vaccines given to children in the United States and Europe as of March 2001, although it remains a component of vaccines used in other countries.

Previous studies have described how the body processes methyl mercury—the type associated with the consumption of fish—but few studies have examined how the body processes ethyl mercury after exposure via intramuscular injection.

In this study, Dr. Michael Pichichero of the University of Rochester (N.Y.), and his colleagues evaluated the ethyl mercury in blood, urine, and stool samples from 216 healthy children prior to vaccination with thimerosal-containing vaccines and again at several points between 12 hours and 30 days after vaccination, depending on the age group.

The study population included 72 newborns, 72 2-month-old infants, and 72 6-month-old infants who were vaccinated at a children's hospital in Argentina between February 2003 and February 2004 (Pediatrics 2008;121:e208–14).

The main hypothesis of the study was that ethyl mercury does not stay long in the bloodstreams of vaccinated infants. Complete pre- and postvaccination blood samples were available from 128 children (59%): 40 newborns, 50 2-month-olds, and 38 6-month-olds.

Overall, the blood mercury levels in all three age groups were highest at the first postvaccination measurements—12 hours after vaccination for newborns and 24 hours after vaccination for the 2-month-olds and 6-month-olds. In all age groups, the blood mercury levels quickly dropped and the levels in most of the children had returned to normal by 11 days after vaccination.

The average maximal blood mercury levels after vaccinations for the newborns, 2-month-olds, and 6-month-olds were 5.0 ng/mL, 3.6 ng/mL, and 2.8 ng/mL, respectively.

Even the highest level of mercury was relatively low. The overall highest level detected in the study was 8.0 ng/mL, and it was noted in a newborn 12 hours after a birth dose of a hepatitis B virus (HBV) vaccine that included 32.5 mcg of mercury.

Another important finding was that the prevaccination levels among the 6-month-olds were not higher than the prevaccination levels among the 2-month-olds, which suggests that ethyl mercury does not accumulate in the blood as a result of exposure to thimerosal-containing vaccines, the researchers noted.

“Using a model that accounted for baseline mercury levels, ethyl mercury dosage, and timing of vaccination, we estimated the blood half-life of mercury after administration of thimerosal to be 3.7 days, which did not vary significantly by age group,” the researchers wrote.

“This study is very timely for something that pediatricians are going to be facing,” Dr. Pichichero said in an interview. The ABC-TV network recently aired the debut of a fictional series about a lawyer, “Eli Stone,” that suggested a conspiracy between vaccine companies and physicians to keep an association between vaccines and autism under wraps. “So every pediatrician in America is going to face parents who see this fictional program,” he said. “We are going to have parents wondering whether their doctors are in cahoots with the vaccine companies.”

Dr. Pichichero said that this study virtually eliminates the argument that mercury can accumulate to unsafe levels in children as a result of standard infant vaccinations. “Our study shows beyond a shadow of a doubt that that is not true given how quickly ethyl mercury disappeared from the blood,” he said.

In fact, inorganic mercury was found in almost all the stool samples in all age groups. Mercury levels in the stool increased shortly after vaccinations in all age groups, but then they began to decline, which suggests that the mercury is leaving the body in the stool, Dr. Pichichero said. By contrast, the urine samples in all age groups showed barely detectable levels of mercury, which suggests that the kidneys are likely not affected, he added.

The results were limited by the combination of methyl and ethyl mercury in the blood samples from some children and by the researchers' inability to identify the exact proportion of mercury excreted through the stool and urine.

However, the short half-life of ethyl mercury in the blood suggests a need to reassess the risk of thimerosal as a preservative, they wrote.

Dr. Pichichero is an unpaid consultant for the World Health Organization on vaccine-related issues, and he has served as a consultant to several vaccine manufacturers including GlaxoSmithKline Biologicals, Sanofi Pasteur, Wyeth Pharmaceuticals, MedImmune, and Merck & Co.

The findings support results from recent studies, including a study conducted by the Centers for Disease Control and Prevention that showed no association between exposure to ethyl mercury from thimerosal-containing vaccines during infancy and neuropsychological outcomes at age 7–10 years (N. Engl. J. Med. 2007;357:1281–92).

In addition, a population-based study that was conducted in California last year showed an increase in the prevalence of autism in the years since thimerosal-containing vaccines were discontinued (Arch. Gen. Psychiatry 2008;65:19–24).

This study virtually eliminates the argument that mercury can accumulate to unsafe levels. DR. PICHICHERO

Consider a retropharyngeal abscess when faced with a drooling child who has a severe sore throat, according to Dr. Marisol Figueira of Boston University.

Retropharyngeal abscess is a common pathology secondary to acute throat infection, Dr. Figueira said in an interview. “It is a result of suppuration of the retropharyngeal lymph nodes, secondary to infection in the adenoid, nasopharynx, posterior pharyngeal wall, sinuses, and tonsils.”

A high index of suspicion is needed to diagnose retropharyngeal abscess, and the diagnosis is made based on clinical manifestations and radiologic studies. Prompt diagnosis is important, because delays could lead to life-threatening complications such as a blocked airway, jugular vein thrombosis, or mediastinitis, Dr. Figueira said in a presentation at a conference on infectious diseases held in Cambridge, Mass.

The retropharyngeal space extends from the base of the skull to the level of the T1 or T2 vertebra and includes the space behind the muscles of the pharynx but in front of the prevertebral fascia.

An infection in the retropharyngeal space is most common in young children. Data from a 35-year review of cases at a California hospital showed that 50% of patients with such abscesses were younger than 3 years and 71% were younger than 6 years.

The abscess may follow an upper respiratory infection, group A β-hemolytic streptococcal pharyngitis (GABHS), or even trauma. The predominant bacterial species are Streptococcus pyogenes, Staphylococcus aureus, and respiratory anaerobes (including Fusobacteria, Prevotella, and Veillonella species). Haemophilus species also are occasionally found.

The clinical presentation can involve a spectrum of common symptoms including fever, severe sore throat, dysphagia, drooling, respiratory distress, and a muffled voice. The classic symptoms of neck stiffness and bulging of the posterior pharyngeal wall are present in fewer than 50% of patients.

On physical examination, the child can present with anterolateral neck swelling, hyperextension of the neck, or an enlarged cervical lymph node, she explained at the meeting, which was sponsored by the university.

Imaging is needed to confirm a diagnosis of a retropharyngeal abscess. A lateral x-ray of the neck area may show soft tissue swelling, and a CT scan of the neck can be helpful if the x-ray findings are uncertain and the clinical suspicion is high.

Immediate treatment includes airway maintenance, pain management, and hydration before admitting the child to the hospital. Consult an ear, nose, and throat specialist when the diagnosis is confirmed or if the child has an obstructed airway. The abscess treatment plan includes incising and draining the abscess, and treating the child with parenteral antibiotics, such as clindamycin or a combination of sulbactam and ampicillan.

“Prompt diagnosis and treatment of pharyngitis or upper respiratory infections will generally prevent retropharyngeal abscess,” said Dr. Figueira. This condition can [also] lead to laryngeal edema with possible airway obstruction, mediastinitis, and aspiration pneumonia, but with prompt treatment a patient can make a full recovery.”

Consider a retropharyngeal abscess when faced with a drooling child who has a severe sore throat, according to Dr. Marisol Figueira of Boston University.

Retropharyngeal abscess is a common pathology secondary to acute throat infection, Dr. Figueira said in an interview. “It is a result of suppuration of the retropharyngeal lymph nodes, secondary to infection in the adenoid, nasopharynx, posterior pharyngeal wall, sinuses, and tonsils.”

A high index of suspicion is needed to diagnose retropharyngeal abscess, and the diagnosis is made based on clinical manifestations and radiologic studies. Prompt diagnosis is important, because delays could lead to life-threatening complications such as a blocked airway, jugular vein thrombosis, or mediastinitis, Dr. Figueira said in a presentation at a conference on infectious diseases held in Cambridge, Mass.

The retropharyngeal space extends from the base of the skull to the level of the T1 or T2 vertebra and includes the space behind the muscles of the pharynx but in front of the prevertebral fascia.

An infection in the retropharyngeal space is most common in young children. Data from a 35-year review of cases at a California hospital showed that 50% of patients with such abscesses were younger than 3 years and 71% were younger than 6 years.

The abscess may follow an upper respiratory infection, group A β-hemolytic streptococcal pharyngitis (GABHS), or even trauma. The predominant bacterial species are Streptococcus pyogenes, Staphylococcus aureus, and respiratory anaerobes (including Fusobacteria, Prevotella, and Veillonella species). Haemophilus species also are occasionally found.

The clinical presentation can involve a spectrum of common symptoms including fever, severe sore throat, dysphagia, drooling, respiratory distress, and a muffled voice. The classic symptoms of neck stiffness and bulging of the posterior pharyngeal wall are present in fewer than 50% of patients.

On physical examination, the child can present with anterolateral neck swelling, hyperextension of the neck, or an enlarged cervical lymph node, she explained at the meeting, which was sponsored by the university.

Imaging is needed to confirm a diagnosis of a retropharyngeal abscess. A lateral x-ray of the neck area may show soft tissue swelling, and a CT scan of the neck can be helpful if the x-ray findings are uncertain and the clinical suspicion is high.

Immediate treatment includes airway maintenance, pain management, and hydration before admitting the child to the hospital. Consult an ear, nose, and throat specialist when the diagnosis is confirmed or if the child has an obstructed airway. The abscess treatment plan includes incising and draining the abscess, and treating the child with parenteral antibiotics, such as clindamycin or a combination of sulbactam and ampicillan.

“Prompt diagnosis and treatment of pharyngitis or upper respiratory infections will generally prevent retropharyngeal abscess,” said Dr. Figueira. This condition can [also] lead to laryngeal edema with possible airway obstruction, mediastinitis, and aspiration pneumonia, but with prompt treatment a patient can make a full recovery.”

Consider a retropharyngeal abscess when faced with a drooling child who has a severe sore throat, according to Dr. Marisol Figueira of Boston University.

Retropharyngeal abscess is a common pathology secondary to acute throat infection, Dr. Figueira said in an interview. “It is a result of suppuration of the retropharyngeal lymph nodes, secondary to infection in the adenoid, nasopharynx, posterior pharyngeal wall, sinuses, and tonsils.”

A high index of suspicion is needed to diagnose retropharyngeal abscess, and the diagnosis is made based on clinical manifestations and radiologic studies. Prompt diagnosis is important, because delays could lead to life-threatening complications such as a blocked airway, jugular vein thrombosis, or mediastinitis, Dr. Figueira said in a presentation at a conference on infectious diseases held in Cambridge, Mass.

The retropharyngeal space extends from the base of the skull to the level of the T1 or T2 vertebra and includes the space behind the muscles of the pharynx but in front of the prevertebral fascia.

An infection in the retropharyngeal space is most common in young children. Data from a 35-year review of cases at a California hospital showed that 50% of patients with such abscesses were younger than 3 years and 71% were younger than 6 years.

The abscess may follow an upper respiratory infection, group A β-hemolytic streptococcal pharyngitis (GABHS), or even trauma. The predominant bacterial species are Streptococcus pyogenes, Staphylococcus aureus, and respiratory anaerobes (including Fusobacteria, Prevotella, and Veillonella species). Haemophilus species also are occasionally found.

The clinical presentation can involve a spectrum of common symptoms including fever, severe sore throat, dysphagia, drooling, respiratory distress, and a muffled voice. The classic symptoms of neck stiffness and bulging of the posterior pharyngeal wall are present in fewer than 50% of patients.

On physical examination, the child can present with anterolateral neck swelling, hyperextension of the neck, or an enlarged cervical lymph node, she explained at the meeting, which was sponsored by the university.

Imaging is needed to confirm a diagnosis of a retropharyngeal abscess. A lateral x-ray of the neck area may show soft tissue swelling, and a CT scan of the neck can be helpful if the x-ray findings are uncertain and the clinical suspicion is high.

Immediate treatment includes airway maintenance, pain management, and hydration before admitting the child to the hospital. Consult an ear, nose, and throat specialist when the diagnosis is confirmed or if the child has an obstructed airway. The abscess treatment plan includes incising and draining the abscess, and treating the child with parenteral antibiotics, such as clindamycin or a combination of sulbactam and ampicillan.

“Prompt diagnosis and treatment of pharyngitis or upper respiratory infections will generally prevent retropharyngeal abscess,” said Dr. Figueira. This condition can [also] lead to laryngeal edema with possible airway obstruction, mediastinitis, and aspiration pneumonia, but with prompt treatment a patient can make a full recovery.”

More than half of adolescents with type 2 diabetes underestimate their weight, and so do their parents, according to results from interviews with 104 child-parent pairs.

“Clinicians should recognize that even extremely overweight children and their parents may not accurately perceive the presence of weight problems, let alone the negative consequences of failing to make difficult lifestyle changes that result in weight loss,” wrote Asheley Cockrell Skinner, Ph.D., of the University of North Carolina, Chapel Hill, and her colleagues.

Recognition of overweight is essential for adolescents with diabetes so they can make diet and exercise choices to lose weight and reduce their risk of complications associated with the disease and with overweight, the researchers said.

To determine the accuracy of weight perception in adolescents with type 2 diabetes and the impact of their perceived weight on healthy behaviors, the researchers interviewed 104 adolescents aged 12–20 years, and their parents, by telephone. The average weight of the study population was 221 pounds; 69% were girls and 47% were black. The average hemoglobin A_1c level was 7.7%, and most were taking insulin, other medications, or both.

Overall, 87% of the adolescents met the Centers for Disease Control and Prevention's criteria for overweight, and the group's average body mass index was 36 kg/m

In parents who said the child's weight was “about right,” 40% had children whose BMI was in the 95th percentile or higher; 55% of adolescents who said their weight was “about right” had a BMI in the 95th percentile or higher.

Adolescents were significantly more likely to underestimate their weight if their parents also underestimated it, compared with adolescents whose parents accurately estimated their weight (66% vs. 34%).

“Previous studies have shown that parents and adolescents often underestimate weight status, [but] we were surprised that in this population, where the adolescents were generally very overweight and already had type 2 diabetes, underestimation of weight status was still very common,” Dr. Russell Rothman, study coauthor and deputy director of the Diabetes Research and Training Center at Vanderbilt University, Nashville, Tenn., said in an interview.

“Underestimation of weight was also associated with poorer dietary behaviors and more perceived barriers to following a healthy diet and exercising,” he said.

The interview results showed that, overall, adolescents who underestimated their weight were significantly less likely than were those who estimated their weight correctly or overestimated to report healthy eating behaviors (31% vs. 52%) and exercise (27% vs. 44%). And parents who underestimated the adolescent's weight were significantly less likely to report that the adolescent exercised than were those who estimated the adolescent's weight correctly or overestimated it (26% vs. 46%).

No significant differences in weight perceptions according to race or insulin use were noted by parents or teens. Girls were significantly more likely than were boys to underestimate their weight, but the accuracy of the parents' estimates was not significantly different for boys versus girls.

Weight estimates by parents and adolescents were least accurate for adolescents aged 13–16 years compared with those older than 16 and younger than 13, but these differences were not significant (Diabetes Care 2008;31:227–9).

Dr. Rothman said although the findings seem obvious, they are worth noting so that doctors will raise the subject of weight with teen patients and ask about healthy eating and exercise.

He advised clinicians to practice shared goal-setting to help the adolescent set specific goals and then identify specific barriers. The next step is to guide the adolescent in problem solving, which will improve his or her self-management. “Try to avoid a lot of jargon and keep communication simple, clear, personal to the patient, and culturally sensitive,” he said, adding the entire family should be in the process of diabetes management.

The researchers were funded by awards from Vanderbilt University, the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Department of Veterans Affairs.

More than half of adolescents with type 2 diabetes underestimate their weight, and so do their parents, according to results from interviews with 104 child-parent pairs.

“Clinicians should recognize that even extremely overweight children and their parents may not accurately perceive the presence of weight problems, let alone the negative consequences of failing to make difficult lifestyle changes that result in weight loss,” wrote Asheley Cockrell Skinner, Ph.D., of the University of North Carolina, Chapel Hill, and her colleagues.

Recognition of overweight is essential for adolescents with diabetes so they can make diet and exercise choices to lose weight and reduce their risk of complications associated with the disease and with overweight, the researchers said.

To determine the accuracy of weight perception in adolescents with type 2 diabetes and the impact of their perceived weight on healthy behaviors, the researchers interviewed 104 adolescents aged 12–20 years, and their parents, by telephone. The average weight of the study population was 221 pounds; 69% were girls and 47% were black. The average hemoglobin A_1c level was 7.7%, and most were taking insulin, other medications, or both.

Overall, 87% of the adolescents met the Centers for Disease Control and Prevention's criteria for overweight, and the group's average body mass index was 36 kg/m

In parents who said the child's weight was “about right,” 40% had children whose BMI was in the 95th percentile or higher; 55% of adolescents who said their weight was “about right” had a BMI in the 95th percentile or higher.

Adolescents were significantly more likely to underestimate their weight if their parents also underestimated it, compared with adolescents whose parents accurately estimated their weight (66% vs. 34%).

“Previous studies have shown that parents and adolescents often underestimate weight status, [but] we were surprised that in this population, where the adolescents were generally very overweight and already had type 2 diabetes, underestimation of weight status was still very common,” Dr. Russell Rothman, study coauthor and deputy director of the Diabetes Research and Training Center at Vanderbilt University, Nashville, Tenn., said in an interview.

“Underestimation of weight was also associated with poorer dietary behaviors and more perceived barriers to following a healthy diet and exercising,” he said.

The interview results showed that, overall, adolescents who underestimated their weight were significantly less likely than were those who estimated their weight correctly or overestimated to report healthy eating behaviors (31% vs. 52%) and exercise (27% vs. 44%). And parents who underestimated the adolescent's weight were significantly less likely to report that the adolescent exercised than were those who estimated the adolescent's weight correctly or overestimated it (26% vs. 46%).

No significant differences in weight perceptions according to race or insulin use were noted by parents or teens. Girls were significantly more likely than were boys to underestimate their weight, but the accuracy of the parents' estimates was not significantly different for boys versus girls.

Weight estimates by parents and adolescents were least accurate for adolescents aged 13–16 years compared with those older than 16 and younger than 13, but these differences were not significant (Diabetes Care 2008;31:227–9).

Dr. Rothman said although the findings seem obvious, they are worth noting so that doctors will raise the subject of weight with teen patients and ask about healthy eating and exercise.

He advised clinicians to practice shared goal-setting to help the adolescent set specific goals and then identify specific barriers. The next step is to guide the adolescent in problem solving, which will improve his or her self-management. “Try to avoid a lot of jargon and keep communication simple, clear, personal to the patient, and culturally sensitive,” he said, adding the entire family should be in the process of diabetes management.

The researchers were funded by awards from Vanderbilt University, the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Department of Veterans Affairs.

More than half of adolescents with type 2 diabetes underestimate their weight, and so do their parents, according to results from interviews with 104 child-parent pairs.

“Clinicians should recognize that even extremely overweight children and their parents may not accurately perceive the presence of weight problems, let alone the negative consequences of failing to make difficult lifestyle changes that result in weight loss,” wrote Asheley Cockrell Skinner, Ph.D., of the University of North Carolina, Chapel Hill, and her colleagues.

Recognition of overweight is essential for adolescents with diabetes so they can make diet and exercise choices to lose weight and reduce their risk of complications associated with the disease and with overweight, the researchers said.

To determine the accuracy of weight perception in adolescents with type 2 diabetes and the impact of their perceived weight on healthy behaviors, the researchers interviewed 104 adolescents aged 12–20 years, and their parents, by telephone. The average weight of the study population was 221 pounds; 69% were girls and 47% were black. The average hemoglobin A_1c level was 7.7%, and most were taking insulin, other medications, or both.

Overall, 87% of the adolescents met the Centers for Disease Control and Prevention's criteria for overweight, and the group's average body mass index was 36 kg/m

In parents who said the child's weight was “about right,” 40% had children whose BMI was in the 95th percentile or higher; 55% of adolescents who said their weight was “about right” had a BMI in the 95th percentile or higher.

Adolescents were significantly more likely to underestimate their weight if their parents also underestimated it, compared with adolescents whose parents accurately estimated their weight (66% vs. 34%).

“Previous studies have shown that parents and adolescents often underestimate weight status, [but] we were surprised that in this population, where the adolescents were generally very overweight and already had type 2 diabetes, underestimation of weight status was still very common,” Dr. Russell Rothman, study coauthor and deputy director of the Diabetes Research and Training Center at Vanderbilt University, Nashville, Tenn., said in an interview.

“Underestimation of weight was also associated with poorer dietary behaviors and more perceived barriers to following a healthy diet and exercising,” he said.

The interview results showed that, overall, adolescents who underestimated their weight were significantly less likely than were those who estimated their weight correctly or overestimated to report healthy eating behaviors (31% vs. 52%) and exercise (27% vs. 44%). And parents who underestimated the adolescent's weight were significantly less likely to report that the adolescent exercised than were those who estimated the adolescent's weight correctly or overestimated it (26% vs. 46%).

No significant differences in weight perceptions according to race or insulin use were noted by parents or teens. Girls were significantly more likely than were boys to underestimate their weight, but the accuracy of the parents' estimates was not significantly different for boys versus girls.

Weight estimates by parents and adolescents were least accurate for adolescents aged 13–16 years compared with those older than 16 and younger than 13, but these differences were not significant (Diabetes Care 2008;31:227–9).

Dr. Rothman said although the findings seem obvious, they are worth noting so that doctors will raise the subject of weight with teen patients and ask about healthy eating and exercise.

He advised clinicians to practice shared goal-setting to help the adolescent set specific goals and then identify specific barriers. The next step is to guide the adolescent in problem solving, which will improve his or her self-management. “Try to avoid a lot of jargon and keep communication simple, clear, personal to the patient, and culturally sensitive,” he said, adding the entire family should be in the process of diabetes management.

The researchers were funded by awards from Vanderbilt University, the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Department of Veterans Affairs.