Tips from the Pediatrics Academic Societies Meeting

COMMUNITY HOSPITALS MISS SOME CHILD ABUSE CASESX-rays used to detect fractures - known as skeletal surveys - are recommended procedures for doctors evaluating injured children under two years of age whenever child abuse is suspected. But research by investigators at the Johns Hopkins Children's Center and Franklin Square Hospital suggests the vast majority of community hospitals fail to conduct the X-ray studies.

The study, co-conducted by Allen R. Walker, M.D., director of the Division of Emergency Medicine at the Children's Center, examined the charts of 56 babies under the age of one who were diagnosed with a fracture in the emergency department of three community hospitals. Skeletal surveys were used in only 29 percent of the cases. Among 24 patients whose injuries were suspicious, just over half had a skeletal survey, and only one case was reported to child protective services.

"We found that skeletal surveys are underused in some community hospital emergency departments, making it likely some child abuse cases are being missed," said Walker, a member of the Maryland State Committee on Child Abuse and Neglect.

He suggests additional research to identify the educational needs of community emergency physicians with regard to child abuse.

Embargoed for release: Sunday, May 4, 11:45 A.M. PST

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ATYPICAL CHRONIC LUNG DISEASE MAY HAVE INFECTIOUS ORIGINSJohns Hopkins Children's Center specialists have found that atypical chronic lung disease (ACLD), a newly defined, less severe form of chronic lung disease, may be caused by infection or inflammation soon after birth. These findings may provide neonatologists with a better understanding of ACLD and eventually lead to the development of preventive measures that will protect babies against this disease.

"ACLD, which was only recently differentiated from chronic lung disease, seems to be a milder condition, possibly suggesting ACLD has a different pathogenesis," says the study's lead author Anusha H. Hemachandra, a neonatology fellow at the Children's Center.

An examination of the records of 185 premature babies born at The Johns Hopkins Hospital - 28 of whom were diagnosed with ACLD - showed 46 percent of the babies eventually developed sepsis, a severe bacterial infection that spreads throughout the body in the first month of life. Fourteen percent developed changes in the brain near the ventricles, which can be a sign of brain injury. These changes can be caused by an infection.

"These increased rates of infectious complications following ACLD suggest that infection and inflammation may be at the root of the disease," said Hemachandra.

Embargoed for release: Sunday, May 4, 11:45 A.M. PST

* * * *GENE MUTATION MAY CONTRIBUTE TO CHRONIC LUNG DISEASEResearchers at the Johns Hopkins Children's Center and two other institutions have identified a genetic mutation of the surfactant protein C gene (SP-C) that may contribute to chronic lung disease in newborns and infants. This is the second Hopkins study in two years to link an SP-C mutation with a lung disorder. SP-C is one of the components of surfactant, a mixture of fats and proteins that enables newborn lungs to expand and contract easily with each breath and helps prevent lung collapse on exhalation.

In the new study, Larry Nogee, M.D., a Children's Center neonatologist, and H. Scott Cameron, M.D., a neonatology fellow, identified the mutation, known as I73T, in seven unrelated children with interstitial lung disease (ILD), a term defining a group of chronic lung disorders. The mutation results in the switch of two similar, neutral amino acids located in an area of the protein that has been very conserved during evolution.

"Because the nature of the amino acid change wasn't that dramatic, it was unclear whether this was a benign mutation or if it actually contributed to the development of lung disease," said Nogee. "However, our findings lead us to believe that the I73-T mutation does cause, or predispose one, to the development of lung disease in infants."

Nogee says that while the findings provide a clue as to what may trigger chronic lung disease, further study is needed to determine exactly how I73T contributes to its development.

Researchers at Children's Hospital Medical Center, Cincinnati, and St. Louis Children's Hospital collaborated on this study.

Embargoed for release: Monday, May 5, 9:45 A.M. PST

* * * *COMMON GOUT DRUG DELAYS DEVELOPMENT OF HEART FAILURE IN MICEResearchers at the Johns Hopkins Children's Center report that allopurinol, a drug commonly used to treat gout, improved the heart function in mice with a form of heart disease that mimics cardiac stunning. In humans with the condition, heart tissue is deprived of oxygen and other nutrients. Though most cases resolve with treatment, temporary heart damage may occur. In the study, allopurinol was shown to delay the onset of such damage, including heart failure.

"These findings are significant because we already know that allopurinol is a well-established, safe, and relatively inexpensive drug," said the study's lead author, Jennifer G. Duncan, M.D., a pediatric critical care medicine fellow at the Children's Center. "If these findings hold true in the human population, this may become an effective and economical method of treating patients with heart damage and heart failure."

Investigators created a mouse genetically altered to constantly produce abnormal troponin I protein, which has been shown in animal models to occur with cardiac stunning. Researchers also noticed the stunned mice had elevated levels of xanthine oxidase, an enzyme that promotes oxidative stress. Elevated levels of xanthine oxidase also contribute to human heart failure. After one month of treatment with allopurinol, a xanthine oxidase inhibitor, the mice had normal xanthine oxidase levels and improved cardiac function.

Embargoed for release: Tuesday, May 6, 8:45 A.M. PST

* * * *STUDY FINDS FEW YOUNG MEN DISCLOSE STD DIAGNOSIS TO SEXUAL PARTNERSIt may be no surprise, but a study by researchers from the Johns Hopkins Children's Center finds that few adolescent men with a sexually transmitted disease (STD) tell their sex partners about their diagnosis. Armed with interviews with 402 Baltimore area male teens and young adults with Chlamydia and/or gonorrhea, Hopkins researchers were able to identify and interview 168 of their female sex partners. Only ten percent of the women reported that their partner disclosed their STD diagnosis.

"STD disclosure is vital in protecting uninfected partners," said the study's lead author, Lisa Lowery, M.D., an adolescent medicine fellow at the Children's Center. "Our findings underscore the importance of working with men, especially adolescent males, to stress the importance of partner notification, while also promoting screening of asymptomatic individuals."

Embargoed for release: Tuesday, May 6, 12:00 P.M. PST