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Clinical ShowCase™: Developing a Personalized Treatment Plan for a Patient with Sickle Cell Disease

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There are several factors, mostly involving socioeconomic disadvantages, increase the risk of young mothers giving birth to children with 

A team, led by Brennan H. Baker, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, examined the associations of maternal age with ADHD clinical range diagnoses based on the Child Behavior Checklist and NIH Toolbox Flanker Attention Scores using mixed logistic and linear regression models, respectively.

It is currently unclear why young motherhood is commonly associated with ADHD.

In the cross-sectional ABCD study, the investigators identified 11,878 pediatric patients from 22 sites across the US between June 1, 2016 and October 15, 2018, 8514 of which were included in the final analysis. The final patient population was aged 8-11 years. There were 2260 twins or triplets, 265 adopted children, and 839 younger siblings excluded from the final analysis.

The investigators conducted confounding and causal mediation analyses using genotype array, demographic, socioeconomic, and prenatal environment data to investigate which genetic and environmental variables could explain the association between young maternal age and child ADHD.

The crude model results show for each 10-year increase in maternal age there was a 32% decrease in the odds of ADHD clinical range diagnosis (OR, 0.68; 95% CI, 0.59-0.78), as well as a 1.09-point increase in the NIH Flanker Attention Scores (

 = 1.09; 95% CI, 0.76, 1.41). This indicates a better child visual selective attention.

After adjusting for confounders, they investigators found the associations were weakened.

The strongest confounders were family income, caregiver education, and ADHD polygenic risk scores for ADHD clinical range diagnoses. For NIH Flanker Attention Scores, the strongest confounders were family income, caregiver education, and race/ethnicity. Breastfeeding duration, prenatal alcohol exposure, and prenatal tobacco exposure were the source of up to 18%, 6%, and 4% mediation, respectively.

“Socioeconomic disadvantages were likely the primary explanation for the association of young maternal age with child ADHD, although genetics and modifiable environmental factors also played a role,” the authors wrote. “Public policies aimed at reducing the burden of ADHD associated with young motherhood should target socioeconomic inequalities and support young pregnant women by advocating for reduced prenatal tobacco exposure and healthy breastfeeding practices after childbirth.”

Recently, investigators found that preterm birth and family history result in an increased risk of developing a psychiatric disorder by age 15, with many also suffering from 2 or 3 disorders, mainly anxiety, 

A team, led by Jean A. Frazier, MD, Eunice Kennedy Shriver Center at the University of Massachusetts Medical School, evaluated the prevalence, co-occurrence, sex differences, and functional correlates of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) psychiatric disorders in 15-year-old adolescents born extremely preterm.

Using the parent questionnaires, the investigators learned a positive family history of psychiatric disorders more frequently occurred in adolescents with at least 3 psychiatric disorders.

Maternal age at birth and child attention-deficit hyperactivity disorder: causal association or familial confounding?

Journal of Child Psychology and Psychiatry

This article was published by our sister publication HCP Live.

Articles

The strongest confounders were family income, caregiver education, and ADHD polygenic risk scores for ADHD clinical range diagnoses.

Young motherhood, child ADHD link explained

Mental health conditions worsened during the COVID-19 pandemic, according to a recent study.

After the onset of the COVID-19 pandemic, many families experienced drastic changes to their lifestyle. School attendance for children shifted, along with work habits for parents and family travel. 

Research has emerged on mental health impacts from the pandemic on adults and children, but there are few studies on the longitudinal psychological impact in children. There is also conflicting information between studies prior to the pandemic about eating disorders, anxiety, and depression in children.

Examining primary care settings for patterns of identification and management of mental health issues in children could indicate how the pandemic has impacted mental health. To analyze how mental health conditions changed during the pandemic, investigators conducted a study on the frequency of primary care visits.

Participants included patients from the Pediatric Physicians’ Organization at Children’s (PPOC), an independent practice associated with over 500 primary care physicians, physician assistants, and nurse practitioners. There were 310,000 thousand patients participating across 73 PPOC practices.

Most practices had at least 3 primary care providers and were in a suburban town. Patients were more often commercially insured, less often White or Hispanic, and equally likely to be male or female.

Data included mental health visits either in-person or through telehealth from January 1, 2019, to September 30, 2021. Patients were aged 5 to 17 years, and diagnoses were given by health providers. 

Mental health diagnosis categories included: alcohol and substance use disorders, attention-deficit hyperactivity disorders (ADHD), eating disorders, behavior disorders, anxiety disorders, stress or trauma disorders, and mood disorders.

Three time periods were established, the prepandemic period from January 2019 through February 2020, the emergency pandemic period from March 2020 through May 2020, and the pandemic period from June 2021 through September 2021. As unstable periods are often excluded from analyses, data from the emergency pandemic period was not included.

Of the 7 mental health categories, 3 saw differences between the prepandemic period and the pandemic period. Alcohol and substance use visits notably decreased during the pandemic period, with the annual visit rate decreasing from 5.8 visits per 1000 patients to 5.5.

Eating disorder visits increased during the pandemic period, from 9.3 visits per 1000 patients annually to 18.3. Mood disorder visits also increased, from 65.3 visits per 1000 patients annually to 94.

Visits from anxiety disorders and stress or trauma disorders did not see a notable increase in the pandemic period, but a previously observed trend of increasing visits continued throughout the pandemic. ADHD and behavior disorder visits were relatively unchanged from the prepandemic period to the pandemic period.

These results showed an overall trend of increasing mental health disorder visits to primary care settings during the COVID-19 pandemic. Investigators concluded that there is a need in pediatric primary care environments to identify and manage mental health disorders.

Gould JB, Walter HJ, Bromberg J, Correa ET, Hatoun J, Vernacchio L. Impact of the coronavirus disease 2019 pandemic on mental health visits in pediatric primary care. 

 2022;150(6). doi:10.1542/peds.2022-057176

Visits to primary care centers for mental health disorders saw an overall increase during the COVID-19 pandemic compared to a prepandemic period.

Mental health worsened during COVID-19 pandemic

The American Academy of Pediatrics (AAP) has released an evidence-based list of 5 conditions common in pediatric care settings which can be identified without the use of unnecessary testing.

This list was a contribution from the AAP to the Choosing Wisely campaign, an effort from the American Board of Internal Medicine Foundation, to encourage discussion between patients and providers that lets them choose care that is supported by evidence, is safe and necessary, and is not the same as treatment already received.

The conditions in the AAP’s list were chosen from the AAP Section of Emergency Medicine, which analyzed conditions common in emergency departments (EDs), urgent care centers, and primary care offices. These conditions have a high rate of unnecessary testing, leading to harmful radiation, prolonged ED stays, and unnecessary pain and expenses.

There is also a risk of further unnecessary treatment for these conditions, such as therapies and further testing because of false positives. According to Paul Mullan, MD, MPH, chair of the AAP Section of Emergency Medicine’s Choosing Wisely taskforce, the EDs ability to produce rapid results carries a risk of diagnostic over-testing.

Along with rigorous examination from experts to determine which conditions see over-testing, the taskforce received feedback from Choosing Wisely Canada and the Canadian Association of Emergency Physicians. This makes the latest Choosing Wisely list the first to be published by Choosing Wisely organizations from 2 separate countries at the same time.

“We encourage parents and providers to think again before asking for or ordering these blood tests, viral panels, X-rays, and CT scans,” said Shabnam Jain, MD, MPH, a professor of pediatrics and emergency medicine at Emory University School of Medicine and Children’s Healthcare of Atlanta. “The current crisis of emergency department overcrowding underscores more than ever the need to choose wisely and avoid tests that are not evidence-based and do not improve outcomes.”

In the list, it is recommended that providers avoid radiographs in pediatric patients present with asthma, croup, bronchitis, or first-time wheezing. Screening laboratory tests for patients needing inpatient psychiatric admission should also be avoided unless clinically indicated.

Additionally, abdominal radiographs for suspected constipation, comprehensive viral panel testing for suspected respiratory viral illnesses, and laboratory testing for unprovoked or simple febrile seizure in patients who have returned to baseline status should be avoided.

Evidence-based guidance on when these tests may be necessary is included in the list. The list was based on recommendations from a diverse selection of ED providers, then scored for frequency of inappropriate use, lack of evidence for use, and risk of harm from overuse. 

Choosing wisely: five thingsphysicians and patients should question in the practice of pediatric emergency medicine. American Academy of Pediatrics. December 1, 2022. Accessed December 1, 2022. 

https://www.aap.org/en/news-room/news-releases/aap/2022/choosing-wisely-five-things-physicians-and-patients-should-question-in-the-practice-of-pediatric-emergency-medicine/

The AAP recently released a list of 5 frequent conditions in pediatric patients which often see unnecessary testing.

AAP: 5 conditions where testing may be unnecessary

Maternal vaccination against influenza during pregnancy prevents young infants from being hospitalized with influenza, according to a recent study.

Influenza vaccination has been proven effective in preventing influenza in pregnant women. As maternal antibodies could cross the placenta and protect infants at the start of life, it is possible for maternal vaccination to protect infants as well. As there is no influenza vaccine approved for infants aged under 6 months, maternal vaccination could be a valuable form of protection.

While the incidence of influenza associated hospitalizations is low, making observation difficult, data from observational studies has shown a reduction of influenza-based hospitalizations in infants after maternal vaccination during pregnancy.

To understand how influenza vaccination during pregnancy affects severe influenza in infants, investigators conducted a prospective test-negative study. The primary outcome of the study was a reduction of influenza confirmed through polymerase chain reaction (PCR) in the first 6 months of life.

Vaccinations were provided to 2 cities in South Africa to increase maternal vaccinations among women attending selected antenatal clinics. Trivalent IIV formulations were the only vaccines available against influenza during the testing period.

Infants aged under 6 months underwent prospective active surveillance if they had been hospitalized for acute respiratory or febrile illness. Pregnant women and women withing 42 days postdelivery also underwent surveillance if they had been hospitalized for cardiorespiratory illness during any of the 4 influenza seasons where studying took place.

Respiratory swabs were collected from participants and analyzed by real-time influenza PCR. Information from antenatal cards was used to determine maternal immunization status. Written documentation of IIV vaccination during pregnancy and more than 14 weeks before birth was necessary for women to be considered vaccinated.

Of the infants included in the analysis, 71 tested positive for influenza and 371 tested negative. For the infants who tested positive, 26.8% had mothers who were vaccinated against influenza during pregnancy, while 35.6% of infants who tested negative had mothers who were vaccinated.

Among women who tested positive for influenza, 28.6% were vaccinated, while 38.3% of women who tested negative for influenza were vaccinated. These results showed effectiveness in preventing influenza in mothers, which transferred to infants when vaccination occurred during pregnancy.

Nunes MC, Walaza S, Meiring S, Zar HJ, Reubenson G, McMorrow M, et al. Effectiveness of influenza vaccination of pregnant women for prevention of maternal and early infant influenza-associated hospitalizations in south africa: aprospective test-negative study. 

In a recent study, infants born from mothers vaccinated against influenza were less likely to be hospitalized from the disease than those born to unvaccinated mothers.

Maternal influenza vaccination during pregnancy protects infants

New research examined brain structure and connectivity in patients to observe the effects of psoriasis in relation to depression. Depression coexists with 

According to Georgia Lada, MD, Dermatology Centre, Salford Royal NHS Foundation Trust, National Institute for Health Research Manchester Biomedical Research Centre, The University of Manchester, and her team, an immune-mediated relationship between the brain and skin has been hypothesized in psoriasis before.

This brain imaging study was the first to look at the position of depression and systemic inflammation in brain measures while including the largest sample of patients with psoriasis to date.

Data of 1048 brain magnetic resonance imaging (MRI) cases from the UK Biobank were assessed. Study populations included 131 comorbid patients with psoriasis and depression, who were matched by age and sex to 131 non-depressed patients with psoriasis. Then, 393 patients with depression served as a control group, along with 393 non-depressed controls.

"Interaction effects of psoriasis and depression on volume, thickness and surface of a-priori defined regions of interest (ROIs), white matter tracts and 55x55 partial correlation resting-state connectivity matrices were investigated using general linear models," investigators wrote. "Linear regression was employed to test associations of brain measures with C-reactive protein (CRP) and neutrophil counts."

With the presence of depression, increased thickness in the right precuneus was evident in patients with psoriasis compared with controls. This thickening demonstrated a marginal correlation with recurrent lifetime suicidality in patients with depression and psoriasis.

Findings revealed no differences in regional, global brain volumes, or white matter integrity compared with controls without psoriasis or psoriatic arthritis (PsA). Unrelated to depression comorbidity, patients with coexisting psoriasis and PsA showed fronto-occipital decoupling in resting-state connectivity compared to patients without joint involvement and controls.

Investigators reported that CRP and neurophil counts did not predict precuneus thickness and fronto-occipital connectivity.

"Our findings provide evidence for a combined effect of psoriasis and depression on the precuneus, which is not directly linked to systemic inflammation, and may relate to suicidality or altered somatosensory processing," the team concluded. "The use of the UK Biobank may limit generalizability of results in populations with severe disease."

Brain structure and connectivity in psoriasis and associations with depression and inflammation; findings from the UK biobank

How can psoriasis, depression impact the brain?

The threat of measles has grown, putting children at a greater risk, according to the Centers for Disease Control and Prevention (CDC).

The CDC noted that measles vaccination rates have been on a consistent decline since the start of the COVID-19 pandemic, with a record 40 million children missing a vaccine dose in 2021. Data from the CDC and World Health Organization (WHO) showed that 25 million children missed their first dose, and another 14.7 million missed their second dose.

This decline in vaccination rates has left millions of children susceptible to measles infection, creating a major setback in eliminating measles worldwide. There were 9 million cases of measles in 2021, leading to 128,000 deaths. Large and disruptive outbreaks were seen in 22 countries.

Along with a decline in vaccination rates, weakened measle surveillance and immunization delays caused by COVID-19 have contributed to the growing threat of measles. According to WHO Director-General Dr. Tedros Adhanom Ghebreyesus, COVID-19 caused severe disruptions to routine immunization programs, causing millions of kids to miss vaccinations against dangerous diseases such as measles.

“Getting immunization programs back on track is absolutely critical,” Tedros said. “Behind every statistic in this report is a child at risk of a preventable disease.”

Measles is one of the most contagious human viruses, but can almost be entirely prevented through vaccination, according to the CDC. Herd immunity can be achieved if coverage of 2 or more vaccine doses reaches 95%. Currently, only 81% of children receive their first dose, and only 71% reach their second dose.

Measles is a worldwide threat, with no WHO region successfully achieving and sustaining measles elimination. Transmission was reestablished in 10 countries that had previously eliminated measles since 2016.

COVID-19 led to almost 61 million delayed or missed measle vaccines across 18 countries in 2021. Because of this, the CDC and WHO have urged public health officials to increase vaccination efforts and improve surveillance through collaborative efforts on global, regional, national, and local scales.

Nearly 40 million children are dangerously susceptible to growing measles threat. Centers for Disease Control and Prevention. November 23, 2022. Accessed November 30, 2022. 

https://www.cdc.gov/media/releases/2022/p1123-measles-threat.html

COVID-19 has caused millions of children worldwide to miss their measles vaccinations, putting them at increased risk of measles infection. 

Children at greater risk of measles infection

Health care leaders are on notice that physicians, support staff, and patients deserve and expect care settings free from violence.

The U.S. Centers for Medicare & Medicaid Services’ (CMS) 

Center for Clinical Standards and Quality

“Exposure to workplace violence hazards come at a high cost; however, with appropriate controls in place, it can be addressed,” the notice said. “CMS will continue to enforce the regulatory expectations that patient and staff have an environment that prioritizes their safety to ensure effective delivery of healthcare.”

Because of the risk, health care leadership must ensure adequate training, sufficient staffing levels, ongoing assessment of patients and residents for aggressive behaviors, and appropriate care interventions and environment. CMS acknowledged Medicare-certified hospitals already have a regulatory obligation to care for patients in safe settings under current Medicare Hospital Conditions of Participation.

“The intention of this requirement is to specify that each patient receives care in an environment that a reasonable person would consider safe,” with standards ranging from infection control to security that affect emotional and physical health and safety, the memo said.

The Nov. 28 memo sent to state survey agency directors included statistics and examples of workplace violence involving clinicians who face risk factors such as working with people who have a history of aggressive behavior, behavioral issues, or are under the influence of drugs.

An April 2020 facts sheet by the U.S. Bureau of Labor Statistics reported health care workers accounted for 73% of all nonfatal workplace injuries and illnesses due to violence in 2018. That number has grown steadily since tracking began in 2011.

In the latest memo, CMS said hospitals must:

Identify patients at risk for intentional harm to themselves or others.

Identify environmental safety risks, such as ligatures, sharps, access to medications, breakable windows, light fixtures, plastic bags, oxygen tubing, and more.

Take steps to minimize risks, while noting not all strategies are appropriate for all units. For example, strategies for a post-partum unit most likely would not be the same as those in an emergency department.

Implement training for new staff, with ongoing training recommended at least every two years.

Maintain an emergency preparedness plan that accounts for facility risks, community risks, and all hazards.

Workplace violence in hospitals can lead to dire consequences. CMS used examples from facilities that were cited for failing to meet safety obligations:

A nurse in a unit without adequate staffing was sexually assaulted by a behavioral health patient who was stopped by other patients.

A patient died when staff and law enforcement officers performed a takedown that resulted in a custodian holding down the patient on the floor with his knee on the patient’s back.

A patient who was acting out, was shot in a hospital room by police officers when hospital staff failed to assess the patient and de-escalate the situation.

“These cases highlight systemic failures in facilities that place both patients and staff at risk,” the CMS memo said.

The CMS memo is the latest to shine light on the problem and 

 this year began including workplace safety measures among its criteria for evaluating and credentialing hospitals.

 all have condemned aggression toward medical staff. At least two bills have been introduced in Congress to bolster 

 for physicians, nurses and support staff.

This article was published by our sister publication Medical Economics.

CMS publishes memo to reinforce safety standards for physicians, support staff, and patients.

Hospitals on notice about adding measures to curb growing problems of workplace violence

Congenital hypopigmented macules on a healthy child

You are asked to evaluate an African American boy aged 4 years with a birthmark on his back and right arm. He is healthy with normal growth and development. What's the diagnosis?

Roflumilast cream safe, effective for atopic dermatitis in children 6 years and up

Recently announced data from the INTEGUMENT-1 phase 3 clinical trial demonstrated positive safety and efficacy results for atopic dermatitis patients 6 years and older treated with roflumilast cream (Arcutis Biotherapeutics).

Pfizer announces positive phase 3 data for RSV vaccine

Pfizer announced positive data from a phase 3 trial on a bivalent RSV vaccine.

You are asked to evaluate a healthy 1.5-day-old girl who has a congenital red patch with coarse telangiectasias and a surrounding ring of pallor on the right shoulder. What's your diagnosis?

Facial birthmark and new-onset seizures in infant

The parents of a 3-month-old girl seek medical advice regarding recent seizures and a facial birthmark. What’s the diagnosis?

Does stimulant medication for pediatric ADHD affect adult height?

A recent review found that multiple clinical trials indicated a reduction in adult height potential for children with long-term use of stimulant medication for treatment of ADHD, but other studies conflict with this data.

COVID-19 vaccine effective in adolescents

A real-world study determined the efficacy of mRNA vaccines for protection against COVID-19 in adolescents.

Increased neurologic involvement from COVID-19 in 2021

In a recent study, investigators found that life-threatening neurologic conditions from severe acute COVID-19 were more frequent in 2021 than 2020.

AAP: How to manage the surge of respiratory infections

In a recent statement, the American Academy of Pediatrics discussed how patients with respiratory infections can be managed, along with guidance on RSV treatment.

RSV, influenza, and COVID-19: Gearing up for the threat of a 'triple epidemic'

Tina Q. Tan, MD, FAAP, FIDSA, FPIDS, sits down to discuss the rising threat of a "triple epidemic" consisting of influenza, COVID-19, and RSV in children.

November’s news roundup

Childhood cancer survivors with public health insurance will face more barriers for transferring to adult-oriented care, according to a recent study.

Adolescents and young adults (AYAs) face an increased risk for late effects of childhood cancer after surviving the disease, such as cerebrovascular accidents, congestive heart failure, and cognitive deficits. This has led to recommended follow-up care annually to treat effects and risk of effects.

Care for childhood cancer survivors is provided by subspecialists such as pediatric oncologists, eventually shifting to adult cancer centers or primary care. However, this transition is only seen in 1/3 of survivors, and less than 20% of survivors receive adult-oriented care, which includes education on managing the risk of follow-up effects.

The follow-up effects in childhood cancer survivors are also impacted by health disparities caused by socioeconomic factors, race, and age. This affects the quality of long-term treatment. Investigators sought to analyze how these factors impact goals, expectations, and beliefs for transition.

To evaluate the association between sociodemographic factors and expectations for transition into adult-oriented care, investigators conducted a longitudinal randomized controlled trial. Pediatric patients were recruited into the study, completed baseline measures, and received care at a pediatric center.

Patients were included if they were aged 15 to 29 years, had received cancer treatment at a pediatric cancer center, were in remission at the time, had the cognitive ability to complete the study procedures, and were receiving follow-up care at a pediatric care center.

Liquid cancer diagnoses had been given to 54% of patients, solid tissue diagnoses to 37.4%, and brain tumor diagnoses to 8.7%. Patients were aged an average of about 10 years when diagnosed, and time off treatment for AYAs was an average of 8.17 years. 

About 7.7% of patients’ primary insurance was public insurance, and 9 users of private insurance had received it through school or work. For work status, 33% of participants worked part time, 10.3% full time, 7.2% were part-time students, and 75.2% were full-time students.

AYAs lived with caregivers 86% of the time, while 1.5% lived alone, and the rest lived with a roommate or friend. Of the primary caregivers, 15% were the sole caregiver.

Data was gathered on patients’ race and ethnicity, primary caregiver education, primary caregiver partnered status, insurance type, and home address. Home address was used to measure neighborhood income, with the median neighborhood income used for the study.

A Transition Readiness Inventory (TRI) was used to determine AYAs goals, expectations, and beliefs on transition. A Health Competence Beliefs Inventory was used to determine participants’ health perceptions, satisfaction with healthcare, autonomy, and cognitive competence.

TRI responses were not affected by sociodemographic factors. Health competence beliefs and transition readiness were instead impacted by insurance type. Participants with public insurance had lower transition goals and overall healthcare satisfaction than those with private insurance. Health competence beliefs and transition expectations were significantly associated.

As participants with public insurance had lower health competence beliefs and therefore lower transition goals, expectations, and beliefs, investigators concluded that public insurance is a barrier to positive expectations for transition.

Prussien KV, Barakat LP, Darabos K, Psihogios AM, King-Dowling S, O’Hagan B. Sociodemographics, health competence, and transition readiness among adolescent/young adult cancer survivors. 

. 2022;47(10):1096–1106. doi:10.1093/jpepsy/jsac039

In a recent study, it was found that individuals with public health insurance had worse health competence beliefs, reducing transition goals, expectations, and beliefs.

How public insurance creates barriers for childhood cancer survivors

A recent study found no significant relationship between atopic dermatitis (AD) severity, as measured by patient-oriented scoring of 

 (PO-SCORAD) and Patient Oriented Eczema Measure (POEM) surveys, and peanut sensitivity.

 through Immunoglobulin E (IgE) or skin prick test levels. The study was led by Sara Bilimoria, MD, of the Northwestern University Feinberg School of Medicine.

The investigators noted that AD was a primary risk factor for the developing food sensitisation and IgE-mediated food allergies, which prompted further examination in the study itself. The study population was acknowledged to be smaller and consequently the subject may warrant further research.

“Despite no significant relationship found between PO-SCORAD or POEM score and peanut sensitivity, the hypothesis that AD severity can predict risk of peanut sensitivity may still be valid based on a growing body of evidence,” Bilimoria and colleagues wrote. “The negative results of this study are likely due to the small study population used due to limitations of the COVID-19 pandemic. Moreover, evaluating AD severity through PO-SCORAD and POEM surveys may not be ideal for pediatric patients.”

The investigators recruited study participants between the ages of 3 months and 18-years-old without a previous diagnosis of peanut allergy who were receiving IgE or skin prick testing for peanut allergies. They were pulled from 2 allergy clinics around the Chicago area, with participants or their guardians filling out both a PO-SCORAD survey and a POEM survey.

The PO-SCORAD score is determined 60% through clinical signs and 20% through participants’ subjective symptoms, and possible PO-SCORAD scores can be anywhere from 0 to 83, with 83 being the highest 

The POEM is made up of 7 questions asking about the frequency of AD-related itch, sleep disturbance, cracked skin, weeping, bleeding, oozing, flaking, and dryness within the past week, with a score range of 0 to 28. A 0 points to being clear or almost clear of AD, whereas a score ranging from 25 to 28 points to significant AD severity.

The study reported that 20 total patients were able to meet inclusion criteria in their required time frame, with the mean age of patients recruited being 19.9 months.

The researchers found no significant difference between sexes or age categories in severity of AD as assessed by POEM or PO-SCORAD scores (≥12 months compared to <12 months). They also did not identify a significant relationship between PO-SCORAD or POEM scores and the rate of peanut sensitivity.

The investigators stress that the study’s negative results may be due to the smaller population tested, which they connected to COVID-19 pandemic limitations.

“If providers continue to use the (National Institute of Allergy and Infectious Disease)’s guidelines to direct their clinical decisions, it is crucial to identify those at highest risk of epicutaneous exposure and subsequent peanut allergy by using a tool to objectively evaluate AD severity,” they wrote. “At the same time, recent consensus guidelines…recommend introducing peanuts into children's diets at 6 months of age, irrespective of their baseline risk, as the potential benefit of introducing peanuts early outweighs delayed peanut introduction.”

Evaluating the predictive utility of patient-oriented scoring of atopic dermatitis (PO-SCORAD) versus Patient-Oriented Eczema Measure (POEM) for peanut sensitivity in patients with atopic dermatitis

Journal of the European Academy of Dermatology and Venereology

Research suggested no significant relationship between peanut sensitivity and AD severity as measured by two scores, although the study was acknowledged to have a smaller population due to pandemic restrictions.

Children at greater risk of measles infection

Hospitals on notice about adding measures to curb growing problems of workplace violence

November’s news roundup

How public insurance creates barriers for childhood cancer survivors

Study finds no significant link between atopic dermatitis severity scores, peanut sensitivity