Nancy Pham

Healthy prepubescent children with mothers who smoked during pregnancy have lower levels of high density lipoprotein (HDL) cholesterol compared with children born to women who do not smoke during pregnancy, Dr. Julian G. Ayer of the University of Sydney, and his colleagues, reported.

Previous studies have shown an association between environmental tobacco smoke (ETS) exposure in adults and cardiovascular disease (CVD) and an increase of the thickening of the arterial wall and lipid alterations associated with atherosclerosis. Thus, Dr. Ayer and associates decided to examine the effects of maternal smoking in pregnancy on the lipoprotein levels and arterial wall thickness in 8-year-old children and to determine whether smoking during pregnancy could increase the risk of CVD in children later in life (Eur. Heart J. 2011 [doi:10.1093/eurheartj/ehr174]).

“Cholesterol levels tend to track from childhood to adulthood, and studies have shown that for every 0.025-mmol/L increase in HDL levels, there is an approximately 2%-3% reduction in the risk of coronary heart disease,” Dr. David Celermajer, Scandrett Professor of Cardiology at the university, who led the study, said in a written statement. “If we extrapolate this, we can suggest that the difference of 0.15 mmol/L between children of smoking mothers versus nonsmoking mothers might result in a 10%-15% higher risk for coronary disease in the children of smoking mothers. This is an approximation only, but the best one we have.”

Results showed that children born to mothers who smoked during pregnancy had lower HDL cholesterol (1.32 vs. 1.50 mmol/L), higher triglycerides (1.36 vs.1.20 mmol/L) and higher systolic blood pressure (102.1 vs. 99.9 mm Hg).

When postnatal ETS exposure and other confounders such as breastfeeding duration, physical inactivity, and maternal exposure to passive smoking during pregnancy were factored into the study, the children still had lower HDL cholesterol, (difference of 0.22 mmol/L) but had no significant difference in systolic blood pressure. When excluding postnatal ETS exposure and including all other confounders, the difference was about −0.14 mmol/L. There was no significant difference in carotid intima-media thickness (CIMT) due to smoking in pregnancy or postnatal ETS exposure.

The participants in the study included 616 newborns from Sydney who were enrolled into the Childhood Asthma Prevention Study (CAPS), a randomized controlled trial investigating for asthma and allergic disease in children from birth to 5 years of age between September 1997 and December 1999. At 8 years of age, 405 of the 616 children (66%) had parental consent to participate in a cardiovascular substudy that examined the effect of the dietary intervention on CVD risk factors. Three hundred twenty-eight children (53%) had permission to participate in the lipoprotein examination.

Using a questionnaire at an in-person interview, mothers were asked about their smoking habits during all three trimesters of their pregnancy as “1–10/day,” “11–20/day,” “20–40/day,” or “greater than or equal to 41/day.” The smoking average was then calculated during midpoint values for each range (5, 15, 30, and 50, respectively).

Dr. Ayer and associates reported that results may be important in the prevention of atherosclerosis as about 15% of women in Western countries smoke during pregnancy.

“Children born to mothers who have smoked during pregnancy will need to be watched particularly carefully for other coronary risk factors, like high blood pressure, high LDL, 'bad' cholesterol levels, and especially cigarette smoking themselves,” Dr. Celermajer said in the statement.

He suggested that HDL levels can be increased with frequent physical activity and medications such as niacin.

Researchers received funding from an Australian Government National Health and Medical Research Council Project Grant and a Pfizer CVL Grant. Funding was also provided by the National Health and Medical Research Council of Australia; Cooperative Research Centre for Asthma, New South Wales; Department of Health; and Children's Hospital at Westmead.

The researchers reported no relevant financial disclosures.

Healthy prepubescent children with mothers who smoked during pregnancy have lower levels of high density lipoprotein (HDL) cholesterol compared with children born to women who do not smoke during pregnancy, Dr. Julian G. Ayer of the University of Sydney, and his colleagues, reported.

Previous studies have shown an association between environmental tobacco smoke (ETS) exposure in adults and cardiovascular disease (CVD) and an increase of the thickening of the arterial wall and lipid alterations associated with atherosclerosis. Thus, Dr. Ayer and associates decided to examine the effects of maternal smoking in pregnancy on the lipoprotein levels and arterial wall thickness in 8-year-old children and to determine whether smoking during pregnancy could increase the risk of CVD in children later in life (Eur. Heart J. 2011 [doi:10.1093/eurheartj/ehr174]).

“Cholesterol levels tend to track from childhood to adulthood, and studies have shown that for every 0.025-mmol/L increase in HDL levels, there is an approximately 2%-3% reduction in the risk of coronary heart disease,” Dr. David Celermajer, Scandrett Professor of Cardiology at the university, who led the study, said in a written statement. “If we extrapolate this, we can suggest that the difference of 0.15 mmol/L between children of smoking mothers versus nonsmoking mothers might result in a 10%-15% higher risk for coronary disease in the children of smoking mothers. This is an approximation only, but the best one we have.”

Results showed that children born to mothers who smoked during pregnancy had lower HDL cholesterol (1.32 vs. 1.50 mmol/L), higher triglycerides (1.36 vs.1.20 mmol/L) and higher systolic blood pressure (102.1 vs. 99.9 mm Hg).

When postnatal ETS exposure and other confounders such as breastfeeding duration, physical inactivity, and maternal exposure to passive smoking during pregnancy were factored into the study, the children still had lower HDL cholesterol, (difference of 0.22 mmol/L) but had no significant difference in systolic blood pressure. When excluding postnatal ETS exposure and including all other confounders, the difference was about −0.14 mmol/L. There was no significant difference in carotid intima-media thickness (CIMT) due to smoking in pregnancy or postnatal ETS exposure.

The participants in the study included 616 newborns from Sydney who were enrolled into the Childhood Asthma Prevention Study (CAPS), a randomized controlled trial investigating for asthma and allergic disease in children from birth to 5 years of age between September 1997 and December 1999. At 8 years of age, 405 of the 616 children (66%) had parental consent to participate in a cardiovascular substudy that examined the effect of the dietary intervention on CVD risk factors. Three hundred twenty-eight children (53%) had permission to participate in the lipoprotein examination.

Using a questionnaire at an in-person interview, mothers were asked about their smoking habits during all three trimesters of their pregnancy as “1–10/day,” “11–20/day,” “20–40/day,” or “greater than or equal to 41/day.” The smoking average was then calculated during midpoint values for each range (5, 15, 30, and 50, respectively).

Dr. Ayer and associates reported that results may be important in the prevention of atherosclerosis as about 15% of women in Western countries smoke during pregnancy.

“Children born to mothers who have smoked during pregnancy will need to be watched particularly carefully for other coronary risk factors, like high blood pressure, high LDL, 'bad' cholesterol levels, and especially cigarette smoking themselves,” Dr. Celermajer said in the statement.

He suggested that HDL levels can be increased with frequent physical activity and medications such as niacin.

Researchers received funding from an Australian Government National Health and Medical Research Council Project Grant and a Pfizer CVL Grant. Funding was also provided by the National Health and Medical Research Council of Australia; Cooperative Research Centre for Asthma, New South Wales; Department of Health; and Children's Hospital at Westmead.

The researchers reported no relevant financial disclosures.

Healthy prepubescent children with mothers who smoked during pregnancy have lower levels of high density lipoprotein (HDL) cholesterol compared with children born to women who do not smoke during pregnancy, Dr. Julian G. Ayer of the University of Sydney, and his colleagues, reported.

Previous studies have shown an association between environmental tobacco smoke (ETS) exposure in adults and cardiovascular disease (CVD) and an increase of the thickening of the arterial wall and lipid alterations associated with atherosclerosis. Thus, Dr. Ayer and associates decided to examine the effects of maternal smoking in pregnancy on the lipoprotein levels and arterial wall thickness in 8-year-old children and to determine whether smoking during pregnancy could increase the risk of CVD in children later in life (Eur. Heart J. 2011 [doi:10.1093/eurheartj/ehr174]).

“Cholesterol levels tend to track from childhood to adulthood, and studies have shown that for every 0.025-mmol/L increase in HDL levels, there is an approximately 2%-3% reduction in the risk of coronary heart disease,” Dr. David Celermajer, Scandrett Professor of Cardiology at the university, who led the study, said in a written statement. “If we extrapolate this, we can suggest that the difference of 0.15 mmol/L between children of smoking mothers versus nonsmoking mothers might result in a 10%-15% higher risk for coronary disease in the children of smoking mothers. This is an approximation only, but the best one we have.”

Results showed that children born to mothers who smoked during pregnancy had lower HDL cholesterol (1.32 vs. 1.50 mmol/L), higher triglycerides (1.36 vs.1.20 mmol/L) and higher systolic blood pressure (102.1 vs. 99.9 mm Hg).

When postnatal ETS exposure and other confounders such as breastfeeding duration, physical inactivity, and maternal exposure to passive smoking during pregnancy were factored into the study, the children still had lower HDL cholesterol, (difference of 0.22 mmol/L) but had no significant difference in systolic blood pressure. When excluding postnatal ETS exposure and including all other confounders, the difference was about −0.14 mmol/L. There was no significant difference in carotid intima-media thickness (CIMT) due to smoking in pregnancy or postnatal ETS exposure.

The participants in the study included 616 newborns from Sydney who were enrolled into the Childhood Asthma Prevention Study (CAPS), a randomized controlled trial investigating for asthma and allergic disease in children from birth to 5 years of age between September 1997 and December 1999. At 8 years of age, 405 of the 616 children (66%) had parental consent to participate in a cardiovascular substudy that examined the effect of the dietary intervention on CVD risk factors. Three hundred twenty-eight children (53%) had permission to participate in the lipoprotein examination.

Using a questionnaire at an in-person interview, mothers were asked about their smoking habits during all three trimesters of their pregnancy as “1–10/day,” “11–20/day,” “20–40/day,” or “greater than or equal to 41/day.” The smoking average was then calculated during midpoint values for each range (5, 15, 30, and 50, respectively).

Dr. Ayer and associates reported that results may be important in the prevention of atherosclerosis as about 15% of women in Western countries smoke during pregnancy.

“Children born to mothers who have smoked during pregnancy will need to be watched particularly carefully for other coronary risk factors, like high blood pressure, high LDL, 'bad' cholesterol levels, and especially cigarette smoking themselves,” Dr. Celermajer said in the statement.

He suggested that HDL levels can be increased with frequent physical activity and medications such as niacin.

Researchers received funding from an Australian Government National Health and Medical Research Council Project Grant and a Pfizer CVL Grant. Funding was also provided by the National Health and Medical Research Council of Australia; Cooperative Research Centre for Asthma, New South Wales; Department of Health; and Children's Hospital at Westmead.

The researchers reported no relevant financial disclosures.

Talking to hospitalized children holds the same basic perils as dealing with children in any situation: How much do they know? How much should they know? When should they know it?

The answers may be found in the tangled web of physicians, nurses, parents, and the young patients themselves, suggests an Irish study published in the August issue of the Journal of Clinical Nursing.

Imelda Coyne, Ph.D., of the School of Nursery & Midwifery at Trinity College in Dublin, and her colleague, Pamela Gallagher, Ph.D., of Dublin City University found that children want to be included in conversations about their own health, but are often left in the dark, largely because of adults’ actions. Children spoke of being asked a few specific questions by physicians, but then the physicians would conduct the rest of the conversation with their parents. Or physicians would take their parents elsewhere to talk, leaving the children apprehensive and alone.

In a study involving focus groups and individual interviews from 10 wards and two clinics (one outpatient) in three hospitals in Ireland, results showed that only approximately 9% of children aged 7-18 years had positive experiences during their hospital stay in terms of experiences of participation in communication and decision-making in their care, Dr. Coyne said in an interview. This despite the United Nations Convention on the Rights of the Child in 1989 emphasizing that children’s voices should be heard, and the endorsement of the concept in Ireland (Ireland’s Department of Health and Children, 2000) as well as in the United States (American Academy of Pediatrics Committee on Bioethics 1995, Pediatrics 1995;95:314-7), the researchers wrote.

This lack of communication created a spur of negative feelings in the children who expressed anxiety and loneliness. Or children felt physicians "do things" to them with little or no explanation, according to the article reporting the qualitative study of 55 hospitalized children and teenagers, aged 7-18 years.

"I need to know because otherwise I’m going to be sitting there panicking going all paranoid thinking about the worst scenario," a 13-year-old girl was quoted in the published report.

The final sample of children included 28 children with acute illnesses such as appendicitis, fractures, infection, or constipation, and 27 children with chronic illnesses such as asthma, diabetes, cystic fibrosis, or sickle cell disease (J. Clin. Nurs. 2011;20: 2334-43).

Dr. Jack Gladstein, director of the pediatric hospitalist program and professor of pediatrics and neurology at the University of Maryland Medical Center, Baltimore, said the article from Ireland is "is right on target, and our inpatient pediatric unit changed our care" to reflect similar thinking.

"Six years ago, I was asked to bring our inpatient unit up to date," Dr. Gladstein said in an interview. "We were using an old model where rounding took place in the hall outside a patient’s room with the door shut, with no input from the patient, family, or nurse. Now all rounds take place in the patient’s room and include input from the child, parents, and nurse. We all see what the child looks like, how sick the child is.

"I ask children open-ended questions, such as, ‘Is there something you want to ask your team?’ I stand next to the mom, and if the resident speaks in gibberish, I’ll ask the mom, ‘Did you understand that?’ "

Since changing to this model, there has been an increase in safety and an increase in satisfaction for the physicians, patients, and nurses, as well as a decrease in length of stay, he said.

"What we’re learned is that there is nothing you can’t say in front of the family. Kids know that they’re sick. Hearing the treatment plan instills hope and takes away their worries. Even with very young children – 2- to 3-year-olds – [it helps that] they see the same people each day, people who go in, and play with them and make them smile. It is all about allaying fear," Dr. Gladstein said.

"You can empower children by letting them take part in their care. For example, when a child has an abscess, you might have the child remove the bandage and then put a new one back on. There is no downside to being at the bedside as much as possible," he noted.

At All Children’s Hospital in St. Petersburg, Fla., openness is the rule. Although the age of assent there is 7 years old, Dr. Gregory A. Hale of the hospital’s hematology and oncology division suggests that an honest relationship with the patient, at any age, is pertinent to a sick child’s development and may prevent the child from jumping to conclusions about his/her health.

"Knowledge, to a certain extent, alleviates fear. A lot of times, if you give kids a little bit of knowledge, they’re not so intimidated to ask their doctor a question," he said in an interview, emphasizing that all communication should be done in an age- and developmentally-appropriate manner.

For example, at All Children’s, child life specialists use a puppet to explain to younger patients about different types of cancers, how to take medication, and the basics of blood test results.

At Seattle Children’s Hospital, Dr. Glen S. Tamura, director of the inpatient medical service, found that, similar to findings of the study, children – particularly younger patients –are especially unlikely to start in-depth dialogue with their health care team. They prefer to stick with getting information from Mom or Dad.

"[Children] are not initiating the conversation, for the most part. You need to engage them. That said, when you engage them, they frequently have an opinion," he said in an interview.

Family-centered care is central in making sure that everybody is aware of what is happening, according to these doctors and St. Jude Children’s Research Hospital’s bone marrow transplant board life specialist, Ashley Carr. With consistent rounds with medical teams and parents, patients are able to maintain ongoing and close relationships with both physicians and nurses and have their frequent questions of – "Is it going to hurt?" or "Am I going to die?"– answered.

"[Our doctors] know what these kids like to do before they were patients at St. Jude’s," Ms. Carr said in an interview. "They go the extra mile, and they take the extra step to get to know these families as a whole and not just as a patient."

In the published study, a teenage girl articulated how the inverse in the physician-patient interaction can be equally valuable. "[The doctor] started telling me about himself which kind of got me more kind of like trusting to him that he’s going to make the right decision."

Unfortunately, too often it’s parents and guardians who are the highest hurdle in communicating with pediatric inpatients. They may be trying to protect the child or simply be offering up wrong information on their child’s behalf, the study authors observed. "Therefore, children should be allowed the opportunity to volunteer their own information," they wrote, quoting a 13-year-old boy’s sentiments this way: "I think the children should get the opportunity to tell what they think it is and not just what their parents or the doctors think it is."

And some children in the study reported learning how to negotiate the system to get the most out of talking with their doctors. As a boy, age 11, put it: "If you keep being on them and asking all these questions, they are going to get annoyed and they’ll tell you anything, so you shouldn’t really ask them that much, ask them a few times, that’s it. You just have to wait until they come to you, and if you wait, they’re much nicer to you."

Study author Dr. Coyne has considered the root of why some physicians struggle with communication issues surrounding young patients. "I believe some doctors are trying really hard to include children, but they find it difficult to get around the parent that’s blocking them," she said. "Maybe if they had good education at an undergraduate level in their medical curriculum [on] how to communicate with children and how to handle triadic encounters, then they might be better at being able to facilitate the child’s needs and the parent’s needs."

"Ultimately, these parents are their child’s biggest team leaders. They’re their biggest support, so if a parent is uncomfortable sharing information right away, I just continue to support them and educate them and continue to advocate for what I’m seeing the patient needing," Ms. Carr said.

The results of this study suggest that guidelines and policies should be established to ensure full communication among all three parties, Dr. Coyne said.

"Health care organizations need to build cultures of participation where participation is firmly embedded, not just a desirable add-on," according to the study authors. "Given that children’s participation improves the quality of care provided, it is an important investment and one that requires adults to move to a child-centered approach in how they relate to children."

"We shouldn’t discount their views just because they’re children," they said.

Funding for this study was provided by the Office of the Minister for Children, Department of Health and Children, Dublin. Researchers reported no other relevant financial disclosures.

Talking to hospitalized children holds the same basic perils as dealing with children in any situation: How much do they know? How much should they know? When should they know it?

The answers may be found in the tangled web of physicians, nurses, parents, and the young patients themselves, suggests an Irish study published in the August issue of the Journal of Clinical Nursing.

Imelda Coyne, Ph.D., of the School of Nursery & Midwifery at Trinity College in Dublin, and her colleague, Pamela Gallagher, Ph.D., of Dublin City University found that children want to be included in conversations about their own health, but are often left in the dark, largely because of adults’ actions. Children spoke of being asked a few specific questions by physicians, but then the physicians would conduct the rest of the conversation with their parents. Or physicians would take their parents elsewhere to talk, leaving the children apprehensive and alone.

In a study involving focus groups and individual interviews from 10 wards and two clinics (one outpatient) in three hospitals in Ireland, results showed that only approximately 9% of children aged 7-18 years had positive experiences during their hospital stay in terms of experiences of participation in communication and decision-making in their care, Dr. Coyne said in an interview. This despite the United Nations Convention on the Rights of the Child in 1989 emphasizing that children’s voices should be heard, and the endorsement of the concept in Ireland (Ireland’s Department of Health and Children, 2000) as well as in the United States (American Academy of Pediatrics Committee on Bioethics 1995, Pediatrics 1995;95:314-7), the researchers wrote.

This lack of communication created a spur of negative feelings in the children who expressed anxiety and loneliness. Or children felt physicians "do things" to them with little or no explanation, according to the article reporting the qualitative study of 55 hospitalized children and teenagers, aged 7-18 years.

"I need to know because otherwise I’m going to be sitting there panicking going all paranoid thinking about the worst scenario," a 13-year-old girl was quoted in the published report.

The final sample of children included 28 children with acute illnesses such as appendicitis, fractures, infection, or constipation, and 27 children with chronic illnesses such as asthma, diabetes, cystic fibrosis, or sickle cell disease (J. Clin. Nurs. 2011;20: 2334-43).

Dr. Jack Gladstein, director of the pediatric hospitalist program and professor of pediatrics and neurology at the University of Maryland Medical Center, Baltimore, said the article from Ireland is "is right on target, and our inpatient pediatric unit changed our care" to reflect similar thinking.

"Six years ago, I was asked to bring our inpatient unit up to date," Dr. Gladstein said in an interview. "We were using an old model where rounding took place in the hall outside a patient’s room with the door shut, with no input from the patient, family, or nurse. Now all rounds take place in the patient’s room and include input from the child, parents, and nurse. We all see what the child looks like, how sick the child is.

"I ask children open-ended questions, such as, ‘Is there something you want to ask your team?’ I stand next to the mom, and if the resident speaks in gibberish, I’ll ask the mom, ‘Did you understand that?’ "

Since changing to this model, there has been an increase in safety and an increase in satisfaction for the physicians, patients, and nurses, as well as a decrease in length of stay, he said.

"What we’re learned is that there is nothing you can’t say in front of the family. Kids know that they’re sick. Hearing the treatment plan instills hope and takes away their worries. Even with very young children – 2- to 3-year-olds – [it helps that] they see the same people each day, people who go in, and play with them and make them smile. It is all about allaying fear," Dr. Gladstein said.

"You can empower children by letting them take part in their care. For example, when a child has an abscess, you might have the child remove the bandage and then put a new one back on. There is no downside to being at the bedside as much as possible," he noted.

At All Children’s Hospital in St. Petersburg, Fla., openness is the rule. Although the age of assent there is 7 years old, Dr. Gregory A. Hale of the hospital’s hematology and oncology division suggests that an honest relationship with the patient, at any age, is pertinent to a sick child’s development and may prevent the child from jumping to conclusions about his/her health.

"Knowledge, to a certain extent, alleviates fear. A lot of times, if you give kids a little bit of knowledge, they’re not so intimidated to ask their doctor a question," he said in an interview, emphasizing that all communication should be done in an age- and developmentally-appropriate manner.

For example, at All Children’s, child life specialists use a puppet to explain to younger patients about different types of cancers, how to take medication, and the basics of blood test results.

At Seattle Children’s Hospital, Dr. Glen S. Tamura, director of the inpatient medical service, found that, similar to findings of the study, children – particularly younger patients –are especially unlikely to start in-depth dialogue with their health care team. They prefer to stick with getting information from Mom or Dad.

"[Children] are not initiating the conversation, for the most part. You need to engage them. That said, when you engage them, they frequently have an opinion," he said in an interview.

Family-centered care is central in making sure that everybody is aware of what is happening, according to these doctors and St. Jude Children’s Research Hospital’s bone marrow transplant board life specialist, Ashley Carr. With consistent rounds with medical teams and parents, patients are able to maintain ongoing and close relationships with both physicians and nurses and have their frequent questions of – "Is it going to hurt?" or "Am I going to die?"– answered.

"[Our doctors] know what these kids like to do before they were patients at St. Jude’s," Ms. Carr said in an interview. "They go the extra mile, and they take the extra step to get to know these families as a whole and not just as a patient."

In the published study, a teenage girl articulated how the inverse in the physician-patient interaction can be equally valuable. "[The doctor] started telling me about himself which kind of got me more kind of like trusting to him that he’s going to make the right decision."

Unfortunately, too often it’s parents and guardians who are the highest hurdle in communicating with pediatric inpatients. They may be trying to protect the child or simply be offering up wrong information on their child’s behalf, the study authors observed. "Therefore, children should be allowed the opportunity to volunteer their own information," they wrote, quoting a 13-year-old boy’s sentiments this way: "I think the children should get the opportunity to tell what they think it is and not just what their parents or the doctors think it is."

And some children in the study reported learning how to negotiate the system to get the most out of talking with their doctors. As a boy, age 11, put it: "If you keep being on them and asking all these questions, they are going to get annoyed and they’ll tell you anything, so you shouldn’t really ask them that much, ask them a few times, that’s it. You just have to wait until they come to you, and if you wait, they’re much nicer to you."

Study author Dr. Coyne has considered the root of why some physicians struggle with communication issues surrounding young patients. "I believe some doctors are trying really hard to include children, but they find it difficult to get around the parent that’s blocking them," she said. "Maybe if they had good education at an undergraduate level in their medical curriculum [on] how to communicate with children and how to handle triadic encounters, then they might be better at being able to facilitate the child’s needs and the parent’s needs."

"Ultimately, these parents are their child’s biggest team leaders. They’re their biggest support, so if a parent is uncomfortable sharing information right away, I just continue to support them and educate them and continue to advocate for what I’m seeing the patient needing," Ms. Carr said.

The results of this study suggest that guidelines and policies should be established to ensure full communication among all three parties, Dr. Coyne said.

"Health care organizations need to build cultures of participation where participation is firmly embedded, not just a desirable add-on," according to the study authors. "Given that children’s participation improves the quality of care provided, it is an important investment and one that requires adults to move to a child-centered approach in how they relate to children."

"We shouldn’t discount their views just because they’re children," they said.

Funding for this study was provided by the Office of the Minister for Children, Department of Health and Children, Dublin. Researchers reported no other relevant financial disclosures.

Talking to hospitalized children holds the same basic perils as dealing with children in any situation: How much do they know? How much should they know? When should they know it?

The answers may be found in the tangled web of physicians, nurses, parents, and the young patients themselves, suggests an Irish study published in the August issue of the Journal of Clinical Nursing.

Imelda Coyne, Ph.D., of the School of Nursery & Midwifery at Trinity College in Dublin, and her colleague, Pamela Gallagher, Ph.D., of Dublin City University found that children want to be included in conversations about their own health, but are often left in the dark, largely because of adults’ actions. Children spoke of being asked a few specific questions by physicians, but then the physicians would conduct the rest of the conversation with their parents. Or physicians would take their parents elsewhere to talk, leaving the children apprehensive and alone.

In a study involving focus groups and individual interviews from 10 wards and two clinics (one outpatient) in three hospitals in Ireland, results showed that only approximately 9% of children aged 7-18 years had positive experiences during their hospital stay in terms of experiences of participation in communication and decision-making in their care, Dr. Coyne said in an interview. This despite the United Nations Convention on the Rights of the Child in 1989 emphasizing that children’s voices should be heard, and the endorsement of the concept in Ireland (Ireland’s Department of Health and Children, 2000) as well as in the United States (American Academy of Pediatrics Committee on Bioethics 1995, Pediatrics 1995;95:314-7), the researchers wrote.

This lack of communication created a spur of negative feelings in the children who expressed anxiety and loneliness. Or children felt physicians "do things" to them with little or no explanation, according to the article reporting the qualitative study of 55 hospitalized children and teenagers, aged 7-18 years.

"I need to know because otherwise I’m going to be sitting there panicking going all paranoid thinking about the worst scenario," a 13-year-old girl was quoted in the published report.

The final sample of children included 28 children with acute illnesses such as appendicitis, fractures, infection, or constipation, and 27 children with chronic illnesses such as asthma, diabetes, cystic fibrosis, or sickle cell disease (J. Clin. Nurs. 2011;20: 2334-43).

Dr. Jack Gladstein, director of the pediatric hospitalist program and professor of pediatrics and neurology at the University of Maryland Medical Center, Baltimore, said the article from Ireland is "is right on target, and our inpatient pediatric unit changed our care" to reflect similar thinking.

"Six years ago, I was asked to bring our inpatient unit up to date," Dr. Gladstein said in an interview. "We were using an old model where rounding took place in the hall outside a patient’s room with the door shut, with no input from the patient, family, or nurse. Now all rounds take place in the patient’s room and include input from the child, parents, and nurse. We all see what the child looks like, how sick the child is.

"I ask children open-ended questions, such as, ‘Is there something you want to ask your team?’ I stand next to the mom, and if the resident speaks in gibberish, I’ll ask the mom, ‘Did you understand that?’ "

Since changing to this model, there has been an increase in safety and an increase in satisfaction for the physicians, patients, and nurses, as well as a decrease in length of stay, he said.

"What we’re learned is that there is nothing you can’t say in front of the family. Kids know that they’re sick. Hearing the treatment plan instills hope and takes away their worries. Even with very young children – 2- to 3-year-olds – [it helps that] they see the same people each day, people who go in, and play with them and make them smile. It is all about allaying fear," Dr. Gladstein said.

"You can empower children by letting them take part in their care. For example, when a child has an abscess, you might have the child remove the bandage and then put a new one back on. There is no downside to being at the bedside as much as possible," he noted.

At All Children’s Hospital in St. Petersburg, Fla., openness is the rule. Although the age of assent there is 7 years old, Dr. Gregory A. Hale of the hospital’s hematology and oncology division suggests that an honest relationship with the patient, at any age, is pertinent to a sick child’s development and may prevent the child from jumping to conclusions about his/her health.

"Knowledge, to a certain extent, alleviates fear. A lot of times, if you give kids a little bit of knowledge, they’re not so intimidated to ask their doctor a question," he said in an interview, emphasizing that all communication should be done in an age- and developmentally-appropriate manner.

For example, at All Children’s, child life specialists use a puppet to explain to younger patients about different types of cancers, how to take medication, and the basics of blood test results.

At Seattle Children’s Hospital, Dr. Glen S. Tamura, director of the inpatient medical service, found that, similar to findings of the study, children – particularly younger patients –are especially unlikely to start in-depth dialogue with their health care team. They prefer to stick with getting information from Mom or Dad.

"[Children] are not initiating the conversation, for the most part. You need to engage them. That said, when you engage them, they frequently have an opinion," he said in an interview.

Family-centered care is central in making sure that everybody is aware of what is happening, according to these doctors and St. Jude Children’s Research Hospital’s bone marrow transplant board life specialist, Ashley Carr. With consistent rounds with medical teams and parents, patients are able to maintain ongoing and close relationships with both physicians and nurses and have their frequent questions of – "Is it going to hurt?" or "Am I going to die?"– answered.

"[Our doctors] know what these kids like to do before they were patients at St. Jude’s," Ms. Carr said in an interview. "They go the extra mile, and they take the extra step to get to know these families as a whole and not just as a patient."

In the published study, a teenage girl articulated how the inverse in the physician-patient interaction can be equally valuable. "[The doctor] started telling me about himself which kind of got me more kind of like trusting to him that he’s going to make the right decision."

Unfortunately, too often it’s parents and guardians who are the highest hurdle in communicating with pediatric inpatients. They may be trying to protect the child or simply be offering up wrong information on their child’s behalf, the study authors observed. "Therefore, children should be allowed the opportunity to volunteer their own information," they wrote, quoting a 13-year-old boy’s sentiments this way: "I think the children should get the opportunity to tell what they think it is and not just what their parents or the doctors think it is."

And some children in the study reported learning how to negotiate the system to get the most out of talking with their doctors. As a boy, age 11, put it: "If you keep being on them and asking all these questions, they are going to get annoyed and they’ll tell you anything, so you shouldn’t really ask them that much, ask them a few times, that’s it. You just have to wait until they come to you, and if you wait, they’re much nicer to you."

Study author Dr. Coyne has considered the root of why some physicians struggle with communication issues surrounding young patients. "I believe some doctors are trying really hard to include children, but they find it difficult to get around the parent that’s blocking them," she said. "Maybe if they had good education at an undergraduate level in their medical curriculum [on] how to communicate with children and how to handle triadic encounters, then they might be better at being able to facilitate the child’s needs and the parent’s needs."

"Ultimately, these parents are their child’s biggest team leaders. They’re their biggest support, so if a parent is uncomfortable sharing information right away, I just continue to support them and educate them and continue to advocate for what I’m seeing the patient needing," Ms. Carr said.

The results of this study suggest that guidelines and policies should be established to ensure full communication among all three parties, Dr. Coyne said.

"Health care organizations need to build cultures of participation where participation is firmly embedded, not just a desirable add-on," according to the study authors. "Given that children’s participation improves the quality of care provided, it is an important investment and one that requires adults to move to a child-centered approach in how they relate to children."

"We shouldn’t discount their views just because they’re children," they said.

Funding for this study was provided by the Office of the Minister for Children, Department of Health and Children, Dublin. Researchers reported no other relevant financial disclosures.

Mothers and their newborns are provided full breastfeeding support in less than 4% of U.S. hospitals, according to a report released Aug. 2 by the Centers for Disease Control and Prevention.

Breastfeeding has been shown to lower medical costs and improve children’s health by decreasing the risks of diabetes, sudden infant death syndrome, and childhood obesity. Mothers also benefit from breastfeeding with lower rates of breast cancer and ovarian cancer, according to the report.

Photo credit: ©Sami Suni/iStockphoto.com

According to CDC Director Thomas R. Frieden, breastfeeding for 9 months may reduce a baby’s chances of becoming overweight by more than 30%. A baby’s risk of becoming overweight also decreases with each month of breastfeeding. Additionally, one in three mothers who do not have enough hospital support stop breastfeeding earlier than recommended.

With many health factors that play into breastfeeding, the CDC encourages hospitals to provide more resources and training for mothers and babies on how to breastfeed early and properly (MMWR 2011;60:1-6).

The "perfect nutrition" for infants, breast milk contains the antibodies that infants cannot make until about 6 months of life, Dr. Frieden said in a press briefing.

"Although there has been some improvement in hospital practices to support mothers who want to breastfeed, we’re still a very long way from where we need to be," Dr. Frieden said. "Hospitals need to greatly improve practices to support mothers who want to breastfeed."

Using data from Maternity Practices in Infant Nutrition and Care (mPINC), the CDC’s national survey conducted every 2 years, only 14% of U.S. hospitals have a written breastfeeding policy. Only 33% of hospitals practice rooming in, which helps mothers establish intimacy and learn how to breastfeed.

Furthermore, about 80% of hospitals provided formula to healthy breastfeeding babies when it was not medically necessary, which can make learning how to breastfeed and continue to breastfeed at home even harder for mothers and babies, according to a written statement issued by the CDC.

There needs to be a "cultural change" in hospitals, said Dr. Frieden. In exchange for hospitals promoting special baby formula, it is common for hospitals to provide gift bags that include formula to give to women on discharge, which saves the hospital money for the specialty formulas.

However, "breastfeeding infants that are supplemented in the hospital unnecessarily are much less likely to continue breastfeeding exclusively or continue for longer durations once they go home," Dr. Cria Perrine, an epidemiologist from the CDC’s division of Nutrition, Physical Activity and Obesity, said during the press briefing.

One of the recommendations to support breastfeeding is for U.S. hospitals to become Baby-Friendly, indicating that breastfeeding support policies are consistent with the WHO/UNICEF’s Ten Steps to Successful Breastfeeding. Steps include giving no artificial nipples or pacifiers to breastfeeding infants, helping mothers to initiate breastfeeding within 1 hour of birth, and encouraging mothers to join breastfeeding support groups after discharge from hospitals.

"The steps are additive, and more is better: ideally all 10 steps, and they’re really not hard to get to if there’s a commitment from the top level of the hospital or hospital system to do so," Dr. Frieden said.

Earlier CDC studies found that the more Baby-Friendly practices a hospital implements, the more likely mothers will continue to breastfeed after leaving the hospital. Women were more than 10 times as likely to breastfeed at 2 months when they delivered at a hospital that practiced the 10 steps, according to Dr. Frieden.

"Baby-Friendly hospital practices work," he said. "They greatly increase the likelihood that women who want to breastfeed will breastfeed [and] that they will be breastfeeding in the hospital at discharge and months later."

In 2011, only two states, Alaska and Nebraska, had 20% or more of births in Baby-Friendly facilities, according to Baby-Friendly USA. Nineteen states, including the District of Columbia, had 0% of births in Baby-Friendly facilities in 2011. As of July 28, there are 114 Baby-Friendly hospitals and birth centers in the United States.

"At current trends, it will take more than 100 years before every baby in this country is born in a hospital where the hospital fully supports a mother’s desire to breastfeed," Dr. Frieden commented.

Community support is also an important recommendation that can lead to more successful breastfeeding. Currently only about one-fourth of hospitals practice and encourage community support, Dr. Frieden said.

"Supporting breastfeeding is something that needs to be done, not just by hospitals, but also by doctors and nurses who encourage women; by the federal government, which is promoting policies; by state and local governments that can have quality standards for hospitals and encourage hospitals to become Baby-Friendly; and by mothers and their families," he asserted.

Click the Play button below to listen in on a telebriefing with Dr. Thomas Frieden, director of the CDC, and Dr. Cria Perrine, an epidemiologist from the CDC's division of Nutrition, Physical Activity, and Obesity, about the CDC's push for more breastfeeding support in hospitals.

Mothers and their newborns are provided full breastfeeding support in less than 4% of U.S. hospitals, according to a report released Aug. 2 by the Centers for Disease Control and Prevention.

Breastfeeding has been shown to lower medical costs and improve children’s health by decreasing the risks of diabetes, sudden infant death syndrome, and childhood obesity. Mothers also benefit from breastfeeding with lower rates of breast cancer and ovarian cancer, according to the report.

Photo credit: ©Sami Suni/iStockphoto.com

According to CDC Director Thomas R. Frieden, breastfeeding for 9 months may reduce a baby’s chances of becoming overweight by more than 30%. A baby’s risk of becoming overweight also decreases with each month of breastfeeding. Additionally, one in three mothers who do not have enough hospital support stop breastfeeding earlier than recommended.

With many health factors that play into breastfeeding, the CDC encourages hospitals to provide more resources and training for mothers and babies on how to breastfeed early and properly (MMWR 2011;60:1-6).

The "perfect nutrition" for infants, breast milk contains the antibodies that infants cannot make until about 6 months of life, Dr. Frieden said in a press briefing.

"Although there has been some improvement in hospital practices to support mothers who want to breastfeed, we’re still a very long way from where we need to be," Dr. Frieden said. "Hospitals need to greatly improve practices to support mothers who want to breastfeed."

Using data from Maternity Practices in Infant Nutrition and Care (mPINC), the CDC’s national survey conducted every 2 years, only 14% of U.S. hospitals have a written breastfeeding policy. Only 33% of hospitals practice rooming in, which helps mothers establish intimacy and learn how to breastfeed.

Furthermore, about 80% of hospitals provided formula to healthy breastfeeding babies when it was not medically necessary, which can make learning how to breastfeed and continue to breastfeed at home even harder for mothers and babies, according to a written statement issued by the CDC.

There needs to be a "cultural change" in hospitals, said Dr. Frieden. In exchange for hospitals promoting special baby formula, it is common for hospitals to provide gift bags that include formula to give to women on discharge, which saves the hospital money for the specialty formulas.

However, "breastfeeding infants that are supplemented in the hospital unnecessarily are much less likely to continue breastfeeding exclusively or continue for longer durations once they go home," Dr. Cria Perrine, an epidemiologist from the CDC’s division of Nutrition, Physical Activity and Obesity, said during the press briefing.

One of the recommendations to support breastfeeding is for U.S. hospitals to become Baby-Friendly, indicating that breastfeeding support policies are consistent with the WHO/UNICEF’s Ten Steps to Successful Breastfeeding. Steps include giving no artificial nipples or pacifiers to breastfeeding infants, helping mothers to initiate breastfeeding within 1 hour of birth, and encouraging mothers to join breastfeeding support groups after discharge from hospitals.

"The steps are additive, and more is better: ideally all 10 steps, and they’re really not hard to get to if there’s a commitment from the top level of the hospital or hospital system to do so," Dr. Frieden said.

Earlier CDC studies found that the more Baby-Friendly practices a hospital implements, the more likely mothers will continue to breastfeed after leaving the hospital. Women were more than 10 times as likely to breastfeed at 2 months when they delivered at a hospital that practiced the 10 steps, according to Dr. Frieden.

"Baby-Friendly hospital practices work," he said. "They greatly increase the likelihood that women who want to breastfeed will breastfeed [and] that they will be breastfeeding in the hospital at discharge and months later."

In 2011, only two states, Alaska and Nebraska, had 20% or more of births in Baby-Friendly facilities, according to Baby-Friendly USA. Nineteen states, including the District of Columbia, had 0% of births in Baby-Friendly facilities in 2011. As of July 28, there are 114 Baby-Friendly hospitals and birth centers in the United States.

"At current trends, it will take more than 100 years before every baby in this country is born in a hospital where the hospital fully supports a mother’s desire to breastfeed," Dr. Frieden commented.

Community support is also an important recommendation that can lead to more successful breastfeeding. Currently only about one-fourth of hospitals practice and encourage community support, Dr. Frieden said.

"Supporting breastfeeding is something that needs to be done, not just by hospitals, but also by doctors and nurses who encourage women; by the federal government, which is promoting policies; by state and local governments that can have quality standards for hospitals and encourage hospitals to become Baby-Friendly; and by mothers and their families," he asserted.

Click the Play button below to listen in on a telebriefing with Dr. Thomas Frieden, director of the CDC, and Dr. Cria Perrine, an epidemiologist from the CDC's division of Nutrition, Physical Activity, and Obesity, about the CDC's push for more breastfeeding support in hospitals.

Mothers and their newborns are provided full breastfeeding support in less than 4% of U.S. hospitals, according to a report released Aug. 2 by the Centers for Disease Control and Prevention.

Breastfeeding has been shown to lower medical costs and improve children’s health by decreasing the risks of diabetes, sudden infant death syndrome, and childhood obesity. Mothers also benefit from breastfeeding with lower rates of breast cancer and ovarian cancer, according to the report.

Photo credit: ©Sami Suni/iStockphoto.com

According to CDC Director Thomas R. Frieden, breastfeeding for 9 months may reduce a baby’s chances of becoming overweight by more than 30%. A baby’s risk of becoming overweight also decreases with each month of breastfeeding. Additionally, one in three mothers who do not have enough hospital support stop breastfeeding earlier than recommended.

With many health factors that play into breastfeeding, the CDC encourages hospitals to provide more resources and training for mothers and babies on how to breastfeed early and properly (MMWR 2011;60:1-6).

The "perfect nutrition" for infants, breast milk contains the antibodies that infants cannot make until about 6 months of life, Dr. Frieden said in a press briefing.

"Although there has been some improvement in hospital practices to support mothers who want to breastfeed, we’re still a very long way from where we need to be," Dr. Frieden said. "Hospitals need to greatly improve practices to support mothers who want to breastfeed."

Using data from Maternity Practices in Infant Nutrition and Care (mPINC), the CDC’s national survey conducted every 2 years, only 14% of U.S. hospitals have a written breastfeeding policy. Only 33% of hospitals practice rooming in, which helps mothers establish intimacy and learn how to breastfeed.

Furthermore, about 80% of hospitals provided formula to healthy breastfeeding babies when it was not medically necessary, which can make learning how to breastfeed and continue to breastfeed at home even harder for mothers and babies, according to a written statement issued by the CDC.

There needs to be a "cultural change" in hospitals, said Dr. Frieden. In exchange for hospitals promoting special baby formula, it is common for hospitals to provide gift bags that include formula to give to women on discharge, which saves the hospital money for the specialty formulas.

However, "breastfeeding infants that are supplemented in the hospital unnecessarily are much less likely to continue breastfeeding exclusively or continue for longer durations once they go home," Dr. Cria Perrine, an epidemiologist from the CDC’s division of Nutrition, Physical Activity and Obesity, said during the press briefing.

One of the recommendations to support breastfeeding is for U.S. hospitals to become Baby-Friendly, indicating that breastfeeding support policies are consistent with the WHO/UNICEF’s Ten Steps to Successful Breastfeeding. Steps include giving no artificial nipples or pacifiers to breastfeeding infants, helping mothers to initiate breastfeeding within 1 hour of birth, and encouraging mothers to join breastfeeding support groups after discharge from hospitals.

"The steps are additive, and more is better: ideally all 10 steps, and they’re really not hard to get to if there’s a commitment from the top level of the hospital or hospital system to do so," Dr. Frieden said.

Earlier CDC studies found that the more Baby-Friendly practices a hospital implements, the more likely mothers will continue to breastfeed after leaving the hospital. Women were more than 10 times as likely to breastfeed at 2 months when they delivered at a hospital that practiced the 10 steps, according to Dr. Frieden.

"Baby-Friendly hospital practices work," he said. "They greatly increase the likelihood that women who want to breastfeed will breastfeed [and] that they will be breastfeeding in the hospital at discharge and months later."

In 2011, only two states, Alaska and Nebraska, had 20% or more of births in Baby-Friendly facilities, according to Baby-Friendly USA. Nineteen states, including the District of Columbia, had 0% of births in Baby-Friendly facilities in 2011. As of July 28, there are 114 Baby-Friendly hospitals and birth centers in the United States.

"At current trends, it will take more than 100 years before every baby in this country is born in a hospital where the hospital fully supports a mother’s desire to breastfeed," Dr. Frieden commented.

Community support is also an important recommendation that can lead to more successful breastfeeding. Currently only about one-fourth of hospitals practice and encourage community support, Dr. Frieden said.

"Supporting breastfeeding is something that needs to be done, not just by hospitals, but also by doctors and nurses who encourage women; by the federal government, which is promoting policies; by state and local governments that can have quality standards for hospitals and encourage hospitals to become Baby-Friendly; and by mothers and their families," he asserted.

Click the Play button below to listen in on a telebriefing with Dr. Thomas Frieden, director of the CDC, and Dr. Cria Perrine, an epidemiologist from the CDC's division of Nutrition, Physical Activity, and Obesity, about the CDC's push for more breastfeeding support in hospitals.

Many ECGs are misinterpreted, which could be detrimental to young athletes if ECGs became a part of routine sports preparticipation screening, Dr. Allison C. Hill and her colleagues suggested, in light of their findings in an online questionnaire–based study published July 14 in the Journal of Pediatrics.

Because of the rise of sudden cardiac deaths (SCDs), some European countries now require preparticipation screening ECGs. Currently, in the United States, the American Heart Association recommends a thorough checkup every 2 years. However, there has been an urge to include ECGs in preparticipation examinations even though the accuracy of interpreting them has been questioned (J. Pediatr. 2011 [doi: 10.1016/j.jpeds.2011.05.014]).

(c) David Peeters/iStock.com

"Although other countries have enacted laws mandating ECG screening for their athletes," Dr. Hill of Stanford (Calif.) University, wrote, "the difficulty of interpreting ECG results, combined with the very large population of young athletes in the United States (more than 10.7 million), may make such laws impractical."

A total of 53 of 212 pediatric cardiologists from the Western Society of Pediatric Cardiology voluntarily responded to an online survey, interpreting 18 ECGs from the Lucile Packard Children’s Hospital at Stanford. Eight of those ECGs were from patients with normal hearts, and 10 were from patients with conditions that might cause SCD. Those conditions included long QT syndrome (one), hypertrophic cardiomyopathy (four), Wolff-Parkinson-White syndrome (two), pulmonary arterial hypertension (one) and myocarditis (two).

The pediatric cardiologists, most of whom had been practicing for 5-15 years and almost half of whom read more than 100 ECGs/month, were asked to determine whether the ECG was normal or abnormal and to interpret it. Respondents also were asked what heart conditions they thought each patient might have, what additional tests the patient should receive, and whether or not the patient should participate in athletic events. The ages and sexes of the patients were given to the respondents; no other clinical information was provided.

To compare with the respondents’ answers, two pediatric electrophysiologists also took the online survey and had 100% concordance for all diagnoses.

The respondents were given one point for each correct diagnosis and one point for each correct permission for sports participation, for a total of 36 points. Only 69% of the ECG interpretations were correct, with a mean score of 12.4 of a possible 18. The range of correct interpretations was 34% for pulmonary arterial hypertension to 98% for long QT syndrome. In all, 71% of respondents correctly identified normal ECGs. The mean percentage for correct sports participation was 78% (14 of 18).

According to the study, the respondents had a sensitivity of 68% and a specificity of 70% for recognizing any abnormality in the ECGs. The false-positive and false-negative rates were 30% and 32%, respectively.

As for the follow-up tests, both the respondents and experts ordered 508 additional tests for the 18 patients. However, the respondents ordered 380 more unnecessary tests and missed 340 tests that the experts would recommend.

According to the study, the most common cause of SCD in the United States is hypertrophic cardiomyopathy. Only 59% of all respondents were able to correctly identify this entity. Researchers note that although some respondents were not able to identify the underlying disease, they were still able to identify that there was some sort of abnormality.

"One problem with interpreting athletes’ ECGs is that, as athletes’ hearts grow stronger, they may get somewhat larger and beat more slowly," Dr. Hill said in the statement. "Although these changes are normal for a well-trained athlete, they can look similar on ECG scans to defects that predispose people to sudden cardiac death."

The findings suggest that the difficulty in interpreting ECGs can be costly, both monetary and physically for athletes. A misinterpreted ECG may lead to an undiagnosed issue, which can be dangerous for athletes who were given permission to continue participating in athletic activity. The study also identifies a need for more training in pediatric cardiology, according to the researchers.

Researcher Dr. Anne M. Dubin of the university received fellowship support from Medtronic. The other researchers had no relevant financial disclosures.

Many ECGs are misinterpreted, which could be detrimental to young athletes if ECGs became a part of routine sports preparticipation screening, Dr. Allison C. Hill and her colleagues suggested, in light of their findings in an online questionnaire–based study published July 14 in the Journal of Pediatrics.

Because of the rise of sudden cardiac deaths (SCDs), some European countries now require preparticipation screening ECGs. Currently, in the United States, the American Heart Association recommends a thorough checkup every 2 years. However, there has been an urge to include ECGs in preparticipation examinations even though the accuracy of interpreting them has been questioned (J. Pediatr. 2011 [doi: 10.1016/j.jpeds.2011.05.014]).

(c) David Peeters/iStock.com

"Although other countries have enacted laws mandating ECG screening for their athletes," Dr. Hill of Stanford (Calif.) University, wrote, "the difficulty of interpreting ECG results, combined with the very large population of young athletes in the United States (more than 10.7 million), may make such laws impractical."

A total of 53 of 212 pediatric cardiologists from the Western Society of Pediatric Cardiology voluntarily responded to an online survey, interpreting 18 ECGs from the Lucile Packard Children’s Hospital at Stanford. Eight of those ECGs were from patients with normal hearts, and 10 were from patients with conditions that might cause SCD. Those conditions included long QT syndrome (one), hypertrophic cardiomyopathy (four), Wolff-Parkinson-White syndrome (two), pulmonary arterial hypertension (one) and myocarditis (two).

The pediatric cardiologists, most of whom had been practicing for 5-15 years and almost half of whom read more than 100 ECGs/month, were asked to determine whether the ECG was normal or abnormal and to interpret it. Respondents also were asked what heart conditions they thought each patient might have, what additional tests the patient should receive, and whether or not the patient should participate in athletic events. The ages and sexes of the patients were given to the respondents; no other clinical information was provided.

To compare with the respondents’ answers, two pediatric electrophysiologists also took the online survey and had 100% concordance for all diagnoses.

The respondents were given one point for each correct diagnosis and one point for each correct permission for sports participation, for a total of 36 points. Only 69% of the ECG interpretations were correct, with a mean score of 12.4 of a possible 18. The range of correct interpretations was 34% for pulmonary arterial hypertension to 98% for long QT syndrome. In all, 71% of respondents correctly identified normal ECGs. The mean percentage for correct sports participation was 78% (14 of 18).

According to the study, the respondents had a sensitivity of 68% and a specificity of 70% for recognizing any abnormality in the ECGs. The false-positive and false-negative rates were 30% and 32%, respectively.

As for the follow-up tests, both the respondents and experts ordered 508 additional tests for the 18 patients. However, the respondents ordered 380 more unnecessary tests and missed 340 tests that the experts would recommend.

According to the study, the most common cause of SCD in the United States is hypertrophic cardiomyopathy. Only 59% of all respondents were able to correctly identify this entity. Researchers note that although some respondents were not able to identify the underlying disease, they were still able to identify that there was some sort of abnormality.

"One problem with interpreting athletes’ ECGs is that, as athletes’ hearts grow stronger, they may get somewhat larger and beat more slowly," Dr. Hill said in the statement. "Although these changes are normal for a well-trained athlete, they can look similar on ECG scans to defects that predispose people to sudden cardiac death."

The findings suggest that the difficulty in interpreting ECGs can be costly, both monetary and physically for athletes. A misinterpreted ECG may lead to an undiagnosed issue, which can be dangerous for athletes who were given permission to continue participating in athletic activity. The study also identifies a need for more training in pediatric cardiology, according to the researchers.

Researcher Dr. Anne M. Dubin of the university received fellowship support from Medtronic. The other researchers had no relevant financial disclosures.

Many ECGs are misinterpreted, which could be detrimental to young athletes if ECGs became a part of routine sports preparticipation screening, Dr. Allison C. Hill and her colleagues suggested, in light of their findings in an online questionnaire–based study published July 14 in the Journal of Pediatrics.

Because of the rise of sudden cardiac deaths (SCDs), some European countries now require preparticipation screening ECGs. Currently, in the United States, the American Heart Association recommends a thorough checkup every 2 years. However, there has been an urge to include ECGs in preparticipation examinations even though the accuracy of interpreting them has been questioned (J. Pediatr. 2011 [doi: 10.1016/j.jpeds.2011.05.014]).

(c) David Peeters/iStock.com

"Although other countries have enacted laws mandating ECG screening for their athletes," Dr. Hill of Stanford (Calif.) University, wrote, "the difficulty of interpreting ECG results, combined with the very large population of young athletes in the United States (more than 10.7 million), may make such laws impractical."

A total of 53 of 212 pediatric cardiologists from the Western Society of Pediatric Cardiology voluntarily responded to an online survey, interpreting 18 ECGs from the Lucile Packard Children’s Hospital at Stanford. Eight of those ECGs were from patients with normal hearts, and 10 were from patients with conditions that might cause SCD. Those conditions included long QT syndrome (one), hypertrophic cardiomyopathy (four), Wolff-Parkinson-White syndrome (two), pulmonary arterial hypertension (one) and myocarditis (two).

The pediatric cardiologists, most of whom had been practicing for 5-15 years and almost half of whom read more than 100 ECGs/month, were asked to determine whether the ECG was normal or abnormal and to interpret it. Respondents also were asked what heart conditions they thought each patient might have, what additional tests the patient should receive, and whether or not the patient should participate in athletic events. The ages and sexes of the patients were given to the respondents; no other clinical information was provided.

To compare with the respondents’ answers, two pediatric electrophysiologists also took the online survey and had 100% concordance for all diagnoses.

The respondents were given one point for each correct diagnosis and one point for each correct permission for sports participation, for a total of 36 points. Only 69% of the ECG interpretations were correct, with a mean score of 12.4 of a possible 18. The range of correct interpretations was 34% for pulmonary arterial hypertension to 98% for long QT syndrome. In all, 71% of respondents correctly identified normal ECGs. The mean percentage for correct sports participation was 78% (14 of 18).

According to the study, the respondents had a sensitivity of 68% and a specificity of 70% for recognizing any abnormality in the ECGs. The false-positive and false-negative rates were 30% and 32%, respectively.

As for the follow-up tests, both the respondents and experts ordered 508 additional tests for the 18 patients. However, the respondents ordered 380 more unnecessary tests and missed 340 tests that the experts would recommend.

According to the study, the most common cause of SCD in the United States is hypertrophic cardiomyopathy. Only 59% of all respondents were able to correctly identify this entity. Researchers note that although some respondents were not able to identify the underlying disease, they were still able to identify that there was some sort of abnormality.

"One problem with interpreting athletes’ ECGs is that, as athletes’ hearts grow stronger, they may get somewhat larger and beat more slowly," Dr. Hill said in the statement. "Although these changes are normal for a well-trained athlete, they can look similar on ECG scans to defects that predispose people to sudden cardiac death."

The findings suggest that the difficulty in interpreting ECGs can be costly, both monetary and physically for athletes. A misinterpreted ECG may lead to an undiagnosed issue, which can be dangerous for athletes who were given permission to continue participating in athletic activity. The study also identifies a need for more training in pediatric cardiology, according to the researchers.

Researcher Dr. Anne M. Dubin of the university received fellowship support from Medtronic. The other researchers had no relevant financial disclosures.

Healthy prepubescent children with mothers who smoked during pregnancy have higher systolic blood pressures and lower HDL cholesterol levels than do children born to women who do not smoke while pregnant, Dr. Julian G. Ayer of the University of Sydney, and his colleagues, reported in a longitudinal study.

“Cholesterol levels tend to track from childhood to adulthood, and studies have shown that for every 0.025-mmol/L increase in HDL levels, there is an approximately 2%-3% reduction in the risk of coronary heart disease,” Dr. David Celermajer, Scandrett Professor of Cardiology at the university, who led the study, said in a statement. “If we extrapolate this, we can suggest that the difference of 0.15 mmol/L between children of smoking mothers versus nonsmoking mothers might result in a 10%-15% higher risk for coronary disease in the children of smoking mothers.”

Results showed that children born to mothers who smoked during pregnancy had lower HDL cholesterol (1.32 vs. 1.50 mmol/L), higher triglycerides (1.36 vs.1.20 mmol/L) and higher systolic blood pressure (102.1 vs. 99.9 mm Hg). When postnatal ETS exposure and other confounders such as breastfeeding duration, physical inactivity, and maternal exposure to passive smoking during pregnancy were factored into the study, the children still had lower HDL cholesterol (a difference of −0.22 mmol/L) but had no significant difference in systolic blood pressure. When excluding postnatal ETS exposure and including all other confounders, the difference was about −0.14 mmol/L (Eur. Heart J. 2011 June 21 [doi:10.1093/eurheartj/ehr174]).

Included in the study were 328 children from Sydney who were enrolled into the Childhood Asthma Prevention Study (CAPS) at birth and who underwent a lipoprotein study at age 8 years.

Researchers received funding from an Australian Government National Health and Medical Research Council Project Grant and a Pfizer CVL Grant. The researchers reported no relevant financial disclosures.

Healthy prepubescent children with mothers who smoked during pregnancy have higher systolic blood pressures and lower HDL cholesterol levels than do children born to women who do not smoke while pregnant, Dr. Julian G. Ayer of the University of Sydney, and his colleagues, reported in a longitudinal study.

“Cholesterol levels tend to track from childhood to adulthood, and studies have shown that for every 0.025-mmol/L increase in HDL levels, there is an approximately 2%-3% reduction in the risk of coronary heart disease,” Dr. David Celermajer, Scandrett Professor of Cardiology at the university, who led the study, said in a statement. “If we extrapolate this, we can suggest that the difference of 0.15 mmol/L between children of smoking mothers versus nonsmoking mothers might result in a 10%-15% higher risk for coronary disease in the children of smoking mothers.”

Results showed that children born to mothers who smoked during pregnancy had lower HDL cholesterol (1.32 vs. 1.50 mmol/L), higher triglycerides (1.36 vs.1.20 mmol/L) and higher systolic blood pressure (102.1 vs. 99.9 mm Hg). When postnatal ETS exposure and other confounders such as breastfeeding duration, physical inactivity, and maternal exposure to passive smoking during pregnancy were factored into the study, the children still had lower HDL cholesterol (a difference of −0.22 mmol/L) but had no significant difference in systolic blood pressure. When excluding postnatal ETS exposure and including all other confounders, the difference was about −0.14 mmol/L (Eur. Heart J. 2011 June 21 [doi:10.1093/eurheartj/ehr174]).

Included in the study were 328 children from Sydney who were enrolled into the Childhood Asthma Prevention Study (CAPS) at birth and who underwent a lipoprotein study at age 8 years.

Researchers received funding from an Australian Government National Health and Medical Research Council Project Grant and a Pfizer CVL Grant. The researchers reported no relevant financial disclosures.

Healthy prepubescent children with mothers who smoked during pregnancy have higher systolic blood pressures and lower HDL cholesterol levels than do children born to women who do not smoke while pregnant, Dr. Julian G. Ayer of the University of Sydney, and his colleagues, reported in a longitudinal study.

“Cholesterol levels tend to track from childhood to adulthood, and studies have shown that for every 0.025-mmol/L increase in HDL levels, there is an approximately 2%-3% reduction in the risk of coronary heart disease,” Dr. David Celermajer, Scandrett Professor of Cardiology at the university, who led the study, said in a statement. “If we extrapolate this, we can suggest that the difference of 0.15 mmol/L between children of smoking mothers versus nonsmoking mothers might result in a 10%-15% higher risk for coronary disease in the children of smoking mothers.”

Results showed that children born to mothers who smoked during pregnancy had lower HDL cholesterol (1.32 vs. 1.50 mmol/L), higher triglycerides (1.36 vs.1.20 mmol/L) and higher systolic blood pressure (102.1 vs. 99.9 mm Hg). When postnatal ETS exposure and other confounders such as breastfeeding duration, physical inactivity, and maternal exposure to passive smoking during pregnancy were factored into the study, the children still had lower HDL cholesterol (a difference of −0.22 mmol/L) but had no significant difference in systolic blood pressure. When excluding postnatal ETS exposure and including all other confounders, the difference was about −0.14 mmol/L (Eur. Heart J. 2011 June 21 [doi:10.1093/eurheartj/ehr174]).

Included in the study were 328 children from Sydney who were enrolled into the Childhood Asthma Prevention Study (CAPS) at birth and who underwent a lipoprotein study at age 8 years.

Researchers received funding from an Australian Government National Health and Medical Research Council Project Grant and a Pfizer CVL Grant. The researchers reported no relevant financial disclosures.

The second day of the Avastin hearing at the Food and Drug Administration has started. Following the FDA's presentation yesterday, representatives for Genentech will argue why the drug should be approved for breast cancer treatment. Following a question-and-answer session, the FDA's independent advisory board will announce its vote this afternoon.

Naseem S. Miller and Elizabeth Mechcatie contributed to this report.

The second day of the Avastin hearing at the Food and Drug Administration has started. Following the FDA's presentation yesterday, representatives for Genentech will argue why the drug should be approved for breast cancer treatment. Following a question-and-answer session, the FDA's independent advisory board will announce its vote this afternoon.

Naseem S. Miller and Elizabeth Mechcatie contributed to this report.

The second day of the Avastin hearing at the Food and Drug Administration has started. Following the FDA's presentation yesterday, representatives for Genentech will argue why the drug should be approved for breast cancer treatment. Following a question-and-answer session, the FDA's independent advisory board will announce its vote this afternoon.

Naseem S. Miller and Elizabeth Mechcatie contributed to this report.

The second day of the Avastin hearing at the Food and Drug Administration has started. Following the FDA's presentation yesterday, representatives for Genentech will argue why the drug should be approved for breast cancer treatment. Following a question-and-answer session, the FDA's independent advisory board will announce its vote this afternoon.

Naseem S. Miller and Elizabeth Mechcatie contributed to this report.

The second day of the Avastin hearing at the Food and Drug Administration has started. Following the FDA's presentation yesterday, representatives for Genentech will argue why the drug should be approved for breast cancer treatment. Following a question-and-answer session, the FDA's independent advisory board will announce its vote this afternoon.

Naseem S. Miller and Elizabeth Mechcatie contributed to this report.

The second day of the Avastin hearing at the Food and Drug Administration has started. Following the FDA's presentation yesterday, representatives for Genentech will argue why the drug should be approved for breast cancer treatment. Following a question-and-answer session, the FDA's independent advisory board will announce its vote this afternoon.

Naseem S. Miller and Elizabeth Mechcatie contributed to this report.

The second day of the Avastin hearing at the Food and Drug Administration has started. Following the FDA's presentation yesterday, representatives for Genentech will argue why the drug should be approved for breast cancer treatment. Following a question-and-answer session, the FDA's independent advisory board will announce its vote this afternoon.

Naseem S. Miller and Elizabeth Mechcatie contributed to this report.

The second day of the Avastin hearing at the Food and Drug Administration has started. Following the FDA's presentation yesterday, representatives for Genentech will argue why the drug should be approved for breast cancer treatment. Following a question-and-answer session, the FDA's independent advisory board will announce its vote this afternoon.

Naseem S. Miller and Elizabeth Mechcatie contributed to this report.

The second day of the Avastin hearing at the Food and Drug Administration has started. Following the FDA's presentation yesterday, representatives for Genentech will argue why the drug should be approved for breast cancer treatment. Following a question-and-answer session, the FDA's independent advisory board will announce its vote this afternoon.

Naseem S. Miller and Elizabeth Mechcatie contributed to this report.

Healthy prepubescent children with mothers who smoked during pregnancy have lower levels of high density lipoprotein (HDL) cholesterol compared with children born to women who do not smoke during pregnancy, Dr. Julian G. Ayer of the University of Sydney, and his colleagues, reported in a longitudinal study published June 21 in the European Heart Journal.

Previous studies have shown an association between environmental tobacco smoke (ETS) exposure in adults and cardiovascular disease (CVD) and an increase of the thickening of the arterial wall and lipid alternations associated with atherosclerosis. Thus, Dr. Ayer and associates decided to examine the effects of maternal smoking in pregnancy on the lipoprotein levels and arterial wall thickness in 8-year-old children and to determine whether smoking during pregnancy could increase the risk of CVD in children later in life (Eur. Heart J. 2011 June 21 [doi:10.1093/eurheartj/ehr174]).

Photo credit: Catherine Harrell

"Cholesterol levels tend to track from childhood to adulthood, and studies have shown that for every 0.025-mmol/L increase in HDL levels, there is an approximately 2%-3% reduction in the risk of coronary heart disease," Dr. David Celermajer, Scandrett Professor of Cardiology at the university, who led the study, said in a written statement. "If we extrapolate this, we can suggest that the difference of 0.15 mmol/L between children of smoking mothers versus nonsmoking mothers might result in a 10%-15% higher risk for coronary disease in the children of smoking mothers. This is an approximation only, but the best one we have."

Results showed that children born to mothers who smoked during pregnancy had lower HDL cholesterol (1.32 vs. 1.50 mmol/L), higher triglycerides (1.36 vs.1.20 mmol/L) and higher systolic blood pressure (102.1 vs. 99.9 mm Hg). When postnatal ETS exposure and other confounders such as breastfeeding duration, physical inactivity, and maternal exposure to passive smoking during pregnancy were factored into the study, the children still had lower HDL cholesterol, (difference of -0.22 mmol/L) but had no significant difference in systolic blood pressure. When excluding postnatal ETS exposure and including all other confounders, the difference was about -0.14 mmol/L. There was no significant difference in carotid intima-media thickness (CIMT) due to smoking in pregnancy or postnatal ETS exposure.

The participants in the study included 616 newborns from Sydney who were enrolled into the Childhood Asthma Prevention Study (CAPS), a randomized controlled trial investigating for asthma and allergic disease in children from birth to 5 years of age between September 1997 and December 1999. At 8 years of age, 405 of the 616 children (66%) had parental consent to participate in a cardiovascular substudy that examined the effect of the dietary intervention on CVD risk factors. Three hundred twenty-eight children (53%) had permission to participate in the lipoprotein examination.

Using a questionnaire at an in-person interview, mothers were asked about their smoking habits during all three trimesters of their pregnancy as "1-10/day," "11-20/day," "20-40/day,’ or "greater than or equal to 41/day." The smoking average was then calculated during midpoint values for each range (5, 15, 30, and 50, respectively). Mothers also were asked whether anybody else in the home smoked during pregnancy.

Information on postnatal ETS exposure was collected during visits to the home or by telephone at the age of 4 weeks, at 3 monthly intervals from the age of 3 months to 5 years, and at six monthly intervals to the age of 7.5 years.

Dr. Ayer and associates reported that results may be important in the prevention of atherosclerosis as about 15% of women in Western countries smoke during pregnancy.

"Children born to mothers who have smoked during pregnancy will need to be watched particularly carefully for other coronary risk factors, like high blood pressure, high LDL, ‘bad’ cholesterol levels, and especially cigarette smoking themselves," Dr. Celermajer said in the statement.

He suggested that HDL levels can be increased with frequent physical activity and medications such as niacin.

Researchers received funding from an Australian Government National Health and Medical Research Council Project Grant and a Pfizer CVL Grant. Funding was also provided by the National Health and Medical Research Council of Australia; Cooperative Research Centre for Asthma, New South Wales; Department of Health; and Children’s Hospital at Westmead. The researchers reported no relevant financial disclosures.

Healthy prepubescent children with mothers who smoked during pregnancy have lower levels of high density lipoprotein (HDL) cholesterol compared with children born to women who do not smoke during pregnancy, Dr. Julian G. Ayer of the University of Sydney, and his colleagues, reported in a longitudinal study published June 21 in the European Heart Journal.

Previous studies have shown an association between environmental tobacco smoke (ETS) exposure in adults and cardiovascular disease (CVD) and an increase of the thickening of the arterial wall and lipid alternations associated with atherosclerosis. Thus, Dr. Ayer and associates decided to examine the effects of maternal smoking in pregnancy on the lipoprotein levels and arterial wall thickness in 8-year-old children and to determine whether smoking during pregnancy could increase the risk of CVD in children later in life (Eur. Heart J. 2011 June 21 [doi:10.1093/eurheartj/ehr174]).

Photo credit: Catherine Harrell

"Cholesterol levels tend to track from childhood to adulthood, and studies have shown that for every 0.025-mmol/L increase in HDL levels, there is an approximately 2%-3% reduction in the risk of coronary heart disease," Dr. David Celermajer, Scandrett Professor of Cardiology at the university, who led the study, said in a written statement. "If we extrapolate this, we can suggest that the difference of 0.15 mmol/L between children of smoking mothers versus nonsmoking mothers might result in a 10%-15% higher risk for coronary disease in the children of smoking mothers. This is an approximation only, but the best one we have."

Results showed that children born to mothers who smoked during pregnancy had lower HDL cholesterol (1.32 vs. 1.50 mmol/L), higher triglycerides (1.36 vs.1.20 mmol/L) and higher systolic blood pressure (102.1 vs. 99.9 mm Hg). When postnatal ETS exposure and other confounders such as breastfeeding duration, physical inactivity, and maternal exposure to passive smoking during pregnancy were factored into the study, the children still had lower HDL cholesterol, (difference of -0.22 mmol/L) but had no significant difference in systolic blood pressure. When excluding postnatal ETS exposure and including all other confounders, the difference was about -0.14 mmol/L. There was no significant difference in carotid intima-media thickness (CIMT) due to smoking in pregnancy or postnatal ETS exposure.

The participants in the study included 616 newborns from Sydney who were enrolled into the Childhood Asthma Prevention Study (CAPS), a randomized controlled trial investigating for asthma and allergic disease in children from birth to 5 years of age between September 1997 and December 1999. At 8 years of age, 405 of the 616 children (66%) had parental consent to participate in a cardiovascular substudy that examined the effect of the dietary intervention on CVD risk factors. Three hundred twenty-eight children (53%) had permission to participate in the lipoprotein examination.

Using a questionnaire at an in-person interview, mothers were asked about their smoking habits during all three trimesters of their pregnancy as "1-10/day," "11-20/day," "20-40/day,’ or "greater than or equal to 41/day." The smoking average was then calculated during midpoint values for each range (5, 15, 30, and 50, respectively). Mothers also were asked whether anybody else in the home smoked during pregnancy.

Information on postnatal ETS exposure was collected during visits to the home or by telephone at the age of 4 weeks, at 3 monthly intervals from the age of 3 months to 5 years, and at six monthly intervals to the age of 7.5 years.

Dr. Ayer and associates reported that results may be important in the prevention of atherosclerosis as about 15% of women in Western countries smoke during pregnancy.

"Children born to mothers who have smoked during pregnancy will need to be watched particularly carefully for other coronary risk factors, like high blood pressure, high LDL, ‘bad’ cholesterol levels, and especially cigarette smoking themselves," Dr. Celermajer said in the statement.

He suggested that HDL levels can be increased with frequent physical activity and medications such as niacin.

Researchers received funding from an Australian Government National Health and Medical Research Council Project Grant and a Pfizer CVL Grant. Funding was also provided by the National Health and Medical Research Council of Australia; Cooperative Research Centre for Asthma, New South Wales; Department of Health; and Children’s Hospital at Westmead. The researchers reported no relevant financial disclosures.

Healthy prepubescent children with mothers who smoked during pregnancy have lower levels of high density lipoprotein (HDL) cholesterol compared with children born to women who do not smoke during pregnancy, Dr. Julian G. Ayer of the University of Sydney, and his colleagues, reported in a longitudinal study published June 21 in the European Heart Journal.

Previous studies have shown an association between environmental tobacco smoke (ETS) exposure in adults and cardiovascular disease (CVD) and an increase of the thickening of the arterial wall and lipid alternations associated with atherosclerosis. Thus, Dr. Ayer and associates decided to examine the effects of maternal smoking in pregnancy on the lipoprotein levels and arterial wall thickness in 8-year-old children and to determine whether smoking during pregnancy could increase the risk of CVD in children later in life (Eur. Heart J. 2011 June 21 [doi:10.1093/eurheartj/ehr174]).

Photo credit: Catherine Harrell

"Cholesterol levels tend to track from childhood to adulthood, and studies have shown that for every 0.025-mmol/L increase in HDL levels, there is an approximately 2%-3% reduction in the risk of coronary heart disease," Dr. David Celermajer, Scandrett Professor of Cardiology at the university, who led the study, said in a written statement. "If we extrapolate this, we can suggest that the difference of 0.15 mmol/L between children of smoking mothers versus nonsmoking mothers might result in a 10%-15% higher risk for coronary disease in the children of smoking mothers. This is an approximation only, but the best one we have."

Results showed that children born to mothers who smoked during pregnancy had lower HDL cholesterol (1.32 vs. 1.50 mmol/L), higher triglycerides (1.36 vs.1.20 mmol/L) and higher systolic blood pressure (102.1 vs. 99.9 mm Hg). When postnatal ETS exposure and other confounders such as breastfeeding duration, physical inactivity, and maternal exposure to passive smoking during pregnancy were factored into the study, the children still had lower HDL cholesterol, (difference of -0.22 mmol/L) but had no significant difference in systolic blood pressure. When excluding postnatal ETS exposure and including all other confounders, the difference was about -0.14 mmol/L. There was no significant difference in carotid intima-media thickness (CIMT) due to smoking in pregnancy or postnatal ETS exposure.

The participants in the study included 616 newborns from Sydney who were enrolled into the Childhood Asthma Prevention Study (CAPS), a randomized controlled trial investigating for asthma and allergic disease in children from birth to 5 years of age between September 1997 and December 1999. At 8 years of age, 405 of the 616 children (66%) had parental consent to participate in a cardiovascular substudy that examined the effect of the dietary intervention on CVD risk factors. Three hundred twenty-eight children (53%) had permission to participate in the lipoprotein examination.

Using a questionnaire at an in-person interview, mothers were asked about their smoking habits during all three trimesters of their pregnancy as "1-10/day," "11-20/day," "20-40/day,’ or "greater than or equal to 41/day." The smoking average was then calculated during midpoint values for each range (5, 15, 30, and 50, respectively). Mothers also were asked whether anybody else in the home smoked during pregnancy.

Information on postnatal ETS exposure was collected during visits to the home or by telephone at the age of 4 weeks, at 3 monthly intervals from the age of 3 months to 5 years, and at six monthly intervals to the age of 7.5 years.

Dr. Ayer and associates reported that results may be important in the prevention of atherosclerosis as about 15% of women in Western countries smoke during pregnancy.

"Children born to mothers who have smoked during pregnancy will need to be watched particularly carefully for other coronary risk factors, like high blood pressure, high LDL, ‘bad’ cholesterol levels, and especially cigarette smoking themselves," Dr. Celermajer said in the statement.

He suggested that HDL levels can be increased with frequent physical activity and medications such as niacin.

Researchers received funding from an Australian Government National Health and Medical Research Council Project Grant and a Pfizer CVL Grant. Funding was also provided by the National Health and Medical Research Council of Australia; Cooperative Research Centre for Asthma, New South Wales; Department of Health; and Children’s Hospital at Westmead. The researchers reported no relevant financial disclosures.

Healthy prepubescent children with mothers who smoked during pregnancy have lower levels of high density lipoprotein (HDL) cholesterol compared with children born to women who do not smoke during pregnancy, Dr. Julian G. Ayer of the University of Sydney, and his colleagues, reported in a longitudinal study published June 21 in the European Heart Journal.

Previous studies have shown an association between environmental tobacco smoke (ETS) exposure in adults and cardiovascular disease (CVD) and an increase of the thickening of the arterial wall and lipid alternations associated with atherosclerosis. Thus, Dr. Ayer and associates decided to examine the effects of maternal smoking in pregnancy on the lipoprotein levels and arterial wall thickness in 8-year-old children and to determine whether smoking during pregnancy could increase the risk of CVD in children later in life (Eur. Heart J. 2011 June 21 [doi:10.1093/eurheartj/ehr174]).

Photo credit: Catherine Harrell

"Cholesterol levels tend to track from childhood to adulthood, and studies have shown that for every 0.025-mmol/L increase in HDL levels, there is an approximately 2%-3% reduction in the risk of coronary heart disease," Dr. David Celermajer, Scandrett Professor of Cardiology at the university, who led the study, said in a written statement. "If we extrapolate this, we can suggest that the difference of 0.15 mmol/L between children of smoking mothers versus nonsmoking mothers might result in a 10%-15% higher risk for coronary disease in the children of smoking mothers. This is an approximation only, but the best one we have."

Results showed that children born to mothers who smoked during pregnancy had lower HDL cholesterol (1.32 vs. 1.50 mmol/L), higher triglycerides (1.36 vs.1.20 mmol/L) and higher systolic blood pressure (102.1 vs. 99.9 mm Hg). When postnatal ETS exposure and other confounders such as breastfeeding duration, physical inactivity, and maternal exposure to passive smoking during pregnancy were factored into the study, the children still had lower HDL cholesterol, (difference of -0.22 mmol/L) but had no significant difference in systolic blood pressure. When excluding postnatal ETS exposure and including all other confounders, the difference was about -0.14 mmol/L. There was no significant difference in carotid intima-media thickness (CIMT) due to smoking in pregnancy or postnatal ETS exposure.

The participants in the study included 616 newborns from Sydney who were enrolled into the Childhood Asthma Prevention Study (CAPS), a randomized controlled trial investigating for asthma and allergic disease in children from birth to 5 years of age between September 1997 and December 1999. At 8 years of age, 405 of the 616 children (66%) had parental consent to participate in a cardiovascular substudy that examined the effect of the dietary intervention on CVD risk factors. Three hundred twenty-eight children (53%) had permission to participate in the lipoprotein examination.

Using a questionnaire at an in-person interview, mothers were asked about their smoking habits during all three trimesters of their pregnancy as "1-10/day," "11-20/day," "20-40/day,’ or "greater than or equal to 41/day." The smoking average was then calculated during midpoint values for each range (5, 15, 30, and 50, respectively). Mothers also were asked whether anybody else in the home smoked during pregnancy.

Information on postnatal ETS exposure was collected during visits to the home or by telephone at the age of 4 weeks, at 3 monthly intervals from the age of 3 months to 5 years, and at six monthly intervals to the age of 7.5 years.

Dr. Ayer and associates reported that results may be important in the prevention of atherosclerosis as about 15% of women in Western countries smoke during pregnancy.

"Children born to mothers who have smoked during pregnancy will need to be watched particularly carefully for other coronary risk factors, like high blood pressure, high LDL, ‘bad’ cholesterol levels, and especially cigarette smoking themselves," Dr. Celermajer said in the statement.

He suggested that HDL levels can be increased with frequent physical activity and medications such as niacin.

Researchers received funding from an Australian Government National Health and Medical Research Council Project Grant and a Pfizer CVL Grant. Funding was also provided by the National Health and Medical Research Council of Australia; Cooperative Research Centre for Asthma, New South Wales; Department of Health; and Children’s Hospital at Westmead. The researchers reported no relevant financial disclosures.

Healthy prepubescent children with mothers who smoked during pregnancy have lower levels of high density lipoprotein (HDL) cholesterol compared with children born to women who do not smoke during pregnancy, Dr. Julian G. Ayer of the University of Sydney, and his colleagues, reported in a longitudinal study published June 21 in the European Heart Journal.

Previous studies have shown an association between environmental tobacco smoke (ETS) exposure in adults and cardiovascular disease (CVD) and an increase of the thickening of the arterial wall and lipid alternations associated with atherosclerosis. Thus, Dr. Ayer and associates decided to examine the effects of maternal smoking in pregnancy on the lipoprotein levels and arterial wall thickness in 8-year-old children and to determine whether smoking during pregnancy could increase the risk of CVD in children later in life (Eur. Heart J. 2011 June 21 [doi:10.1093/eurheartj/ehr174]).

Photo credit: Catherine Harrell

"Cholesterol levels tend to track from childhood to adulthood, and studies have shown that for every 0.025-mmol/L increase in HDL levels, there is an approximately 2%-3% reduction in the risk of coronary heart disease," Dr. David Celermajer, Scandrett Professor of Cardiology at the university, who led the study, said in a written statement. "If we extrapolate this, we can suggest that the difference of 0.15 mmol/L between children of smoking mothers versus nonsmoking mothers might result in a 10%-15% higher risk for coronary disease in the children of smoking mothers. This is an approximation only, but the best one we have."

Results showed that children born to mothers who smoked during pregnancy had lower HDL cholesterol (1.32 vs. 1.50 mmol/L), higher triglycerides (1.36 vs.1.20 mmol/L) and higher systolic blood pressure (102.1 vs. 99.9 mm Hg). When postnatal ETS exposure and other confounders such as breastfeeding duration, physical inactivity, and maternal exposure to passive smoking during pregnancy were factored into the study, the children still had lower HDL cholesterol, (difference of -0.22 mmol/L) but had no significant difference in systolic blood pressure. When excluding postnatal ETS exposure and including all other confounders, the difference was about -0.14 mmol/L. There was no significant difference in carotid intima-media thickness (CIMT) due to smoking in pregnancy or postnatal ETS exposure.

The participants in the study included 616 newborns from Sydney who were enrolled into the Childhood Asthma Prevention Study (CAPS), a randomized controlled trial investigating for asthma and allergic disease in children from birth to 5 years of age between September 1997 and December 1999. At 8 years of age, 405 of the 616 children (66%) had parental consent to participate in a cardiovascular substudy that examined the effect of the dietary intervention on CVD risk factors. Three hundred twenty-eight children (53%) had permission to participate in the lipoprotein examination.

Using a questionnaire at an in-person interview, mothers were asked about their smoking habits during all three trimesters of their pregnancy as "1-10/day," "11-20/day," "20-40/day,’ or "greater than or equal to 41/day." The smoking average was then calculated during midpoint values for each range (5, 15, 30, and 50, respectively). Mothers also were asked whether anybody else in the home smoked during pregnancy.

Information on postnatal ETS exposure was collected during visits to the home or by telephone at the age of 4 weeks, at 3 monthly intervals from the age of 3 months to 5 years, and at six monthly intervals to the age of 7.5 years.

Dr. Ayer and associates reported that results may be important in the prevention of atherosclerosis as about 15% of women in Western countries smoke during pregnancy.

"Children born to mothers who have smoked during pregnancy will need to be watched particularly carefully for other coronary risk factors, like high blood pressure, high LDL, ‘bad’ cholesterol levels, and especially cigarette smoking themselves," Dr. Celermajer said in the statement.

He suggested that HDL levels can be increased with frequent physical activity and medications such as niacin.

Researchers received funding from an Australian Government National Health and Medical Research Council Project Grant and a Pfizer CVL Grant. Funding was also provided by the National Health and Medical Research Council of Australia; Cooperative Research Centre for Asthma, New South Wales; Department of Health; and Children’s Hospital at Westmead. The researchers reported no relevant financial disclosures.

Healthy prepubescent children with mothers who smoked during pregnancy have lower levels of high density lipoprotein (HDL) cholesterol compared with children born to women who do not smoke during pregnancy, Dr. Julian G. Ayer of the University of Sydney, and his colleagues, reported in a longitudinal study published June 21 in the European Heart Journal.

Previous studies have shown an association between environmental tobacco smoke (ETS) exposure in adults and cardiovascular disease (CVD) and an increase of the thickening of the arterial wall and lipid alternations associated with atherosclerosis. Thus, Dr. Ayer and associates decided to examine the effects of maternal smoking in pregnancy on the lipoprotein levels and arterial wall thickness in 8-year-old children and to determine whether smoking during pregnancy could increase the risk of CVD in children later in life (Eur. Heart J. 2011 June 21 [doi:10.1093/eurheartj/ehr174]).

Photo credit: Catherine Harrell

"Cholesterol levels tend to track from childhood to adulthood, and studies have shown that for every 0.025-mmol/L increase in HDL levels, there is an approximately 2%-3% reduction in the risk of coronary heart disease," Dr. David Celermajer, Scandrett Professor of Cardiology at the university, who led the study, said in a written statement. "If we extrapolate this, we can suggest that the difference of 0.15 mmol/L between children of smoking mothers versus nonsmoking mothers might result in a 10%-15% higher risk for coronary disease in the children of smoking mothers. This is an approximation only, but the best one we have."

Results showed that children born to mothers who smoked during pregnancy had lower HDL cholesterol (1.32 vs. 1.50 mmol/L), higher triglycerides (1.36 vs.1.20 mmol/L) and higher systolic blood pressure (102.1 vs. 99.9 mm Hg). When postnatal ETS exposure and other confounders such as breastfeeding duration, physical inactivity, and maternal exposure to passive smoking during pregnancy were factored into the study, the children still had lower HDL cholesterol, (difference of -0.22 mmol/L) but had no significant difference in systolic blood pressure. When excluding postnatal ETS exposure and including all other confounders, the difference was about -0.14 mmol/L. There was no significant difference in carotid intima-media thickness (CIMT) due to smoking in pregnancy or postnatal ETS exposure.

The participants in the study included 616 newborns from Sydney who were enrolled into the Childhood Asthma Prevention Study (CAPS), a randomized controlled trial investigating for asthma and allergic disease in children from birth to 5 years of age between September 1997 and December 1999. At 8 years of age, 405 of the 616 children (66%) had parental consent to participate in a cardiovascular substudy that examined the effect of the dietary intervention on CVD risk factors. Three hundred twenty-eight children (53%) had permission to participate in the lipoprotein examination.

Using a questionnaire at an in-person interview, mothers were asked about their smoking habits during all three trimesters of their pregnancy as "1-10/day," "11-20/day," "20-40/day,’ or "greater than or equal to 41/day." The smoking average was then calculated during midpoint values for each range (5, 15, 30, and 50, respectively). Mothers also were asked whether anybody else in the home smoked during pregnancy.

Information on postnatal ETS exposure was collected during visits to the home or by telephone at the age of 4 weeks, at 3 monthly intervals from the age of 3 months to 5 years, and at six monthly intervals to the age of 7.5 years.

Dr. Ayer and associates reported that results may be important in the prevention of atherosclerosis as about 15% of women in Western countries smoke during pregnancy.

"Children born to mothers who have smoked during pregnancy will need to be watched particularly carefully for other coronary risk factors, like high blood pressure, high LDL, ‘bad’ cholesterol levels, and especially cigarette smoking themselves," Dr. Celermajer said in the statement.

He suggested that HDL levels can be increased with frequent physical activity and medications such as niacin.

Researchers received funding from an Australian Government National Health and Medical Research Council Project Grant and a Pfizer CVL Grant. Funding was also provided by the National Health and Medical Research Council of Australia; Cooperative Research Centre for Asthma, New South Wales; Department of Health; and Children’s Hospital at Westmead. The researchers reported no relevant financial disclosures.