Contemporary Pediatrics Staff

								The American Academy of Pediatrics (AAP) has 

 of the World Health Organization (WHO) Strategic Advisory Group of Experts on Immunization to retain the use of thimerosal as a preservative in vaccines.

								WHO says that the preservative should not be considered a hazardous source of environmental mercury and should not be banned in multidose vials of vaccines as proposed by the United Nations Environmental Programme. Thimerosal contains ethyl mercury but in small quantities that if disposed of responsibly as hospital waste would pose minimum danger to the environment.

								Thimerosal has been used in vaccines for more than 60 years. WHO maintains that replacing thimerosal with another preservative may affect the quality, safety, and efficacy of vaccines in multiuse vials and would affect mass immunization programs in developing countries if these vials were not available.

								With its endorsement, the AAP is reversing its earlier 

 released in 1999 that called for eliminating mercury in vaccines, a decision that was based on US Environmental Protection Agency guidelines for safe limits of elemental, inorganic, or methyl mercury. At that time, there were no specific data on the safety of ethyl mercury in the form of thimerosal, which led to public anxiety about the accumulative effects of thimerosal preservative in infant vaccines and polarity between vaccine advocates and parents who believed that their children had been harmed.

								The concern that ethyl mercury in thimerosal would accumulate in the body at a toxic rate similar to methyl mercury, a known neurotoxin, proved 

. Since 1999, pharmacology and toxicology studies have documented the differences between ethyl and methyl mercury, and efforts to produce credible evidence that thimerosal in vaccines presents any risk to human health have failed.

								The global environmental treaty that would restrict human and environmental exposure to mercury is set to be finalized in January 2013. Both the Pediatric Infectious Diseases Society and the International Pediatric Association have endorsed the WHO recommendation.

Articles

The American Academy of Pediatrics (AAP) has endorsed the recommendation of the World Health Organization (WHO) Strategic Advisory Group of Experts on Immunization to retain the use of thimerosal as a preservative in vaccines.

AAP supports use of thimerosal in vaccines

Nearly all adolescent girls with  chronic pelvic pain that doesn’t respond to conventional medical therapy were  found to have endometriosis, according to new research. 

 have found the prevalence  of endometriosis to be in the neighborhood of 60% to 70% in adolescents with  chronic pelvic pain that doesn’t improve with nonsteroidal anti-inflammatory  drugs or oral contraceptives.  

With advances in laparoscopic  techniques able to detect atypical lesions of endometriosis, researchers at  Children’s Hospital and Harvard Medical School in Boston hypothesized that an  even higher proportion of such adolescents may have lesions of endometriosis.

At the annual meeting of the North  American Society for Pediatric and Adolescent Gynecology in Miami Beach,  researchers 

 the results of laparoscopy in 117 patients younger than 22 years who were  referred for chronic pelvic pain. Ninety-eight percent (115 of 117) had  endometriosis, all of whom had Stage I or II disease. About half (50.4%) had  cyclic pain, 10.4% had acyclic pain only, and 39.1% had both cyclic and acyclic  pain.

Other presenting symptoms were  gastrointestinal (15.7%), urinary (2.6%), irregular menses (7.8%), and  menorrhagia (3.5%). Three-fourths of patients for whom data were available had  a family history of endometriosis.

Improved laparoscopic optics, improved visualization of endometrial  lesions using newer laparoscopic techniques, biopsy of visually negative  pelvises, and greater surgeon experience may account for the increase in the  rate of diagnosis of endometriosis at Children’s Hospital, the researchers  speculate. They recommend referral of adolescents with refractory chronic  pelvic pain to gynecologists experienced with subtle findings of atypical  endometriosis.

Nearly all adolescent girls with chronic pelvic pain that doesn?t respond to conventional medical therapy were found to have endometriosis. What accounts for the higher-than-expected rate of endometriosis in such adolescents?

Endometriosis likely in girls with chronic pelvic pain

Compared with passive music  classes, participatory music classes make babies more tuned to music  appropriate for their culture and more responsive to musical pitch and tone, according  to the findings of a small 

 from Canada. Active music classes also appear to lead babies toward greater  social success. 

To demonstrate the effects of  musical training on sound processing in the brain during the first year of  life, the researchers randomly assigned 38 infants aged 6 months to either  active music classes, in which parents and babies participated in movement,  singing, playing percussion instruments, and learning lullabies and action  songs, or to passive classes, in which parents and babies listened to CDs while  they played at art, book, ball, block, and stacking-cup play stations. 

After 6 months of classes, the  babies in the active course developed earlier musical “enculturation,” which  researchers define as a sensitivity to the tonal pitch and rhythmic structures  of the musical system used in the culture-in this study, Western tonality.  These infants showed larger and earlier brain responses to musical tones  compared with infants in the passive classes. 

Babies in the active classes also  demonstrated more prosocial behaviors. They showed less distress to limitations  and to confrontations with novel stimuli; they smiled and laughed more; and  they were easier to soothe than infants from the passive classes. 

 have shown that musical training enhances brain development in  older children, their study is the first to show that very early musical  training also benefits infants in the first year of life.

Playing interactive musical games makes babies more social and also alters their brain responses and sound processing, according to a new study. How do music classes benefit infants as young as 6 months?

Making music with baby makes baby more social

The combination of sumatriptan and  naproxen sodium safely and effectively relieves acute adolescent migraine pain  and its associated symptoms compared with placebo, according to the results of  a new randomized trial. 

Billed as the first large-scale,  placebo-controlled evidence for acute relief of adolescent migraine pain, the 

 involved approximately 600 teenagers aged 12 to 17 years who suffered an  average of 2 to 8 migraines per month. The trial consisted of a 12-week,  single-blind, run-in phase followed by a 12-week, double-blind, treatment phase  in which patients received either placebo or 1 of 3 combinations of the active agents  sumatriptan 10 mg/naproxen sodium 60 mg; sumatriptan 30 mg/naproxen 180 mg; or  sumatriptan 85 mg/naproxen 500 mg.

All doses were significantly more  effective compared with placebo for leaving takers pain free at 2 hours  posttreatment, and no significant differences existed among doses (29%, 27%,  and 24%, respectively). Patients reported fewer adverse effects with the lowest  dose versus the highest; nausea-free rates at 2 hours posttreatment were no  better with the highest dose than they were with placebo. Overall, little  difference existed in incidence of adverse effects among the 3 regimens. 

In terms of efficacy, the 85/500-mg  combination provided significant sustained pain relief from 2 to 24 hours  posttreatment compared with placebo (23% vs 9%). In addition, a greater  percentage of teenagers who received the 85/500-mg dose compared with placebo  were photophobia-free (59% vs 41%) and phonophobia-free (60% vs 42%) at 2 hours  posttreatment.

The researchers concluded that all 3 doses were effective and well  tolerated, but the efficacy and better tolerability at earlier time points  shown by the 10/60-mg dose may make it superior for shorter-duration headaches  and younger teenagers, whereas good tolerability and better efficacy at later  time points may make the 85/500-mg dose superior for longer-duration and  recurring migraines and older teenagers.

Adolescent migraine sufferers soon may be able to get the same relief as adults. Does the combination of sumatriptan and naproxen sodium stack up against teenage migraine pain and its associated symptoms?

Finally, effective migraine relief for teenagers?

High levels of maternal antibodies  directed at a dietary antigen during pregnancy increase the risk for 

 and other nonaffective psychoses in offspring.

 using data from the Swedish Medical Birth Register, an elevated risk of  nonaffective psychoses was found in offspring when mothers had high levels of  antibodies directed at gliadin, a component of wheat gluten. Antibodies to  gliadin are often observed in persons with celiac disease.

Researchers analyzed dried blood  spots obtained from 211 newborns in Sweden who were later diagnosed with  nonaffective psychoses, investigating the levels of immunoglobulin G (IgG)  directed at gliadin and casein, a milk protein. A group of 553 participants  without a psychiatric admission served as comparison.

Levels of maternal antigliadin  antibodies above the 90th percentile increased the risk for nonaffective  psychoses by 70%. Antigliadin antibody levels above the 95th percentile more  than doubled the risk of the development of a nonaffective psychosis. The level  of anticasein antibodies had no effect on the risk of later development of  nonaffective psychosis.

The excess risk associated with  high levels of IgG antigliadin antibodies was independent of maternal age,  immigration, and mode of delivery, and fetal growth or gestational age at birth  did not modify the association between elevated IgG levels and nonaffective  psychoses.

The researchers speculate that high levels of antigliadin antibodies may  predispose to inflammation and that maternal inflammation can affect the  developing fetus. They add that antibodies to gliadin can be reduced in  pregnant women by limiting consumption of gluten-containing foods.

High levels of maternal antibodies directed at a dietary antigen during pregnancy increase the risk for schizophrenia and other nonaffective psychoses in offspring. Which food-derived antigen was the culprit in this study?

Psychoses linked to mom's antibodies to food antigen

Completion rates among young women  for the 3-dose series of 

) declined sharply  between 2006 and 2009, a study has found. 

 examined insurance data from 2006 through 2009 and identified 271,976 patients  who had received the first HPV vaccination. Participants were assigned to 1 of  4 groups based on age at the time of first vaccination: 9 to 12 years, 13 to 18  years, 19 to 26 years, and 27 years and older. The latter group was comprised  of adults who received the vaccine as off-label.

Those persons who had at least 3  claims for quadrivalent HPV vaccine on 3 different dates within 1 year were  considered as completers of the vaccine series.

Findings showed that across the  time period, the proportion of participants who completed the HPV vaccine  series declined for all age groups. For those aged 9 to 12 years, the  percentage of completers declined from 57% in 2006 to 21% in 2009; for ages 13  to 18 years, from 55% in 2006 to 21% in 2009; and for ages 19 to 26 years, the  rate dropped from 44% in 2006 to 23% in 2009. For women aged 27 years and  older, the percentage of completers increased from 2006 to 2008, but declined  slightly in 2009.

Researchers say that the results  are disturbing because the average age of first sexual encounter for girls is  17 years, and it could be lower than 14 years in 5% of them. Women need to  complete the vaccine series by 18 years to achieve maximum protection against  HPV infection and 

Health care providers may not be  following up with patients to encourage subsequent doses of the vaccine, and  higher insurance copays and deductibles might discourage those patients who are  experiencing economic difficulties from completing the series of vaccinations.

The study also found that although pediatricians were more likely to  begin vaccinating for HPV, obstetricians and gynecologists were more likely to  administer first doses to completers of the HPV series.

Completion rates among young women for the 3-dose series of quadrivalent vaccine for human papillomavirus (HPV) declined sharply between 2006 and 2009, a study has found. Why aren?t young women returning for subsequent vaccinations?