Hyperglycemia and insulin therapyin preterms
Very low birth weight infants are born with numerous prob-lems that can interfere with insulin/glucose homeostasis. They haveessentially no fat stores and minimal glycogen stores, and the ma-ternal source of glucose is acutely cut off at delivery. They inevitablyare stressed and rapidly become catabolic, often with glucose intol-erance. Consistent administration of adequate calories soon afterbirth is complicated by the glucose intolerance, variable fluid needs,and other disease specific therapies (e.g. caffeine for apnea of pre-maturity, hydrocortisone for low blood pressure). Previous studieshave demonstrated that the amount of glucose administered to theseinfants can be increased by concurrent insulin treatment. However,insulin therapy is not easy because frequent measurements of bloodglucose are necessary to avoid hypoglycemia. But, hyperglycemiamay have a number of adverse effects on short-term and long-termoutcomes. Beardsall et al report that an early intervention to deliverglucose and insulin resulted in better glucose control and increasedIGF-1. The normalization of counter-regulating and growth relatedhormones such as IGF-1 may be important benefits of such therapy.However, a compelling case needs to be made that the intensivemanagement of blood glucose will be of significant long-term benefitbefore clinicians should routinely attempt such management.
Alan H. Jobe, MD, PhDpage 611
Maternal smoking disrupts fetal andneonatal calcium metabolism
Maternal smoking is associated with a modest fetal growthrestriction and altered lung development. Daz-Gomez et al showthat maternal smoking is associated with decreased parathyroidhormone (PTH) and increased phosphorus, a result consistent withother reports for smokers in general. The maternal smoking resultedin newborns with lower PTH levels, higher phosphorus, and lowerserum 25 hydroxyvitamine D levels. These results demonstrate arelative hypoparathyroidism in both mother and fetus/newborn. Thefetus is utilizing large amounts of transplacental calcium to grow andossify bones during late gestation. Any disruption in bone ossifica-tion will be reflected in decreased bone density, and it may bedifficult for the newborn to catch up. The effects of post deliveryexposure to smoking on calcium metabolism are unknown.
Alan H. Jobe, MD, PhDpage 618
The role of parents in medicaldecision making
Parents of children being admitted to the inpatient service atthe University of Michigan were surveyed with regards to theirparticipation in medical decision making during hospitalization andtheir assessment of self-efficacy with physician interactions. Theparents with higher self-efficacy scores had significantly greaterprobability of participating in medical decision making compared tothe parents in the lowest group. Younger parents of previouslyhospitalized children were somewhat more likely to participate inmedical decision making whereas parents with a high school educa-tion or less were less likely. Tarini et al suggest that interventionscould be developed to increase self-efficacy that might also improveparental participation in medical decision making.
Robert W. Wilmott, MDpage 690
Consumption of dairy, fat, and calciumin childhood and adolescence
Obesity and bone health are important issues that are partiallyrelated to diet in children and adolescents. Intake of diary productsand the choice of specific dairy products are important aspects of thediet for young people. Kranz et al evaluated the intake of dairyproducts in children in the United States. They found that dairyintake was inadequate compared with normal standards in 4-18 yearold individuals. In addition, most children who consume dairy prod-ucts consume the high fat forms of these products. These dietarypatterns for children may be adverse for both bone health andobesity. Pediatricians should be encouraging the consumption of lowfat dairy products in their patients.
Stephen R. Daniels, MD, PhDpage 642
Molecular clues in the Staphylococcusaureus puzzle
In this issue of The Journal, Faden et al describe clinical andmolecular characteristics of staphylococcal skin abscesses in childrenin Buffalo, New York. In an accompanying Editorial, Frank high-lights the importance of the careful molecular characterization ofmethicillin-susceptible and methicillin-resistant isolates, and putsinto context what such studies show about the quick-change artistryof staphylococci that makes them such formidable foes.
Sarah S. Long, MDpage 700 (article)
page 561 (editorial)
2A December 2007 The Journal of Pediatrics
Molecular clues in the Staphylococcus aureus puzzle