News Notes

July 2005

Health care community making safe formula access a priority

The health care community has stepped up efforts to safely use formula in the neonatal ICU, following an incident where contaminated formula led to an infant’s death, said Mark R. Corkins, MD, CNSP, SPR, at the 2005 Annual Meeting of the Pediatric Academic Societies in Washington (session 4506).

The CDC established guidelines for preparing formula after a 2002 Morbidity and Mortality Weekly Report detailed a neonatal infant death in Tennessee related to powdered formula that had been contaminated with Enterobacter sakazakii. After the infant’s death, 49 infants in a neonatal ICU were screened and 10 were found infected or colonized with E sakazakii, all related to contaminated powdered infant formula. The manufacturer later recalled the formula.

Following the infant’s death, the CDC issued formal recommendations about using formula, said Corkins, who is professor of pediatrics, Indiana University School of Medicine, Bloomington. Using an alternative to powder when possible is preferred, but when using powder, the CDC recommended preparing it using an aseptic technique, refrigerating the formula immediately and discarding it after 24 hours. The CDC also established guidelines for manufacturer recalls.

The health care community has since responded to those recommendations, Corkins said. Some facilities have created “formula rooms,” which are central facilities where formula was prepared aseptically, with sterile instruments. The rooms allow for quick refrigeration of formula.

Corkins also discussed soy-based formulas and new formula additives. According to Corkins, soy-based formulas contain isoflavones, which are phytochemicals similar to phytoestrogens. Phytoestrogens are biochemically related to estradiol, which increase uterine adenocarcinoma, early estrus and decreased thymic weight in mice. Rats experience decreased spermatogenesis and abnormal cellular maturation of the vagina, and marmosets see low testosterone levels. However, Corkins stressed, studies in humans show that nutrition and growth are equivalent to cow’s milk-based formulas. A reproductive study of more than 800 adolescents who received soy-based formulas found no differences, and IQ studies in 9- and 10-year-olds found no differences between those who were given soy-based formulas. Vaccine response was also no different in children who received soy-based formulas.

According to Corkins, long-chain polyunsaturated fatty acids (LCPUFAs) are essential to the development of the infant’s nervous system. LCPUFAs are naturally found in breast milk, and some formulas contain supplements, although Corkins said that breast milk is the best option for supplying LCPUFAs to the infant. — Lauren Riley

Behavioral therapy more beneficial to children with OCD than medication

Children who have obsessive-compulsive disorder (OCD) benefit the most from psychological treatment that teaches them to face their fears. According to a recent Mayo Clinic analysis, the cognitive behavioral therapy (CBT) produces almost twice as much benefit than medication.

The treatment is called “exposure and response prevention.” Children will learn strategies to manage their fears and rituals by facing their fears gradually. According to Jonathan Abramowitz, PhD, the lead researcher from the Mayo Clinic in Rochester, Minn., children will learn that their fears and rituals are unnecessary through gradual exposure. The treatment is short-term. The Mayo Clinic OCD program lasts from one to four months.

OCD affects about 1% of children and adolescents. The current standard treatments are CBT and medications such as fluoxetine and clomipramine. Abramowitz and colleagues analyzed 18 studies on OCD treatment published between 1983 and 2004. According to Abramowitz, the improvements that children who participate in CBT make tend to last long after therapy is completed, while obsessive-compulsive symptoms usually return after children stop taking medication. This analysis underscores the need for further study to determine whether the exposure and response CBT could be most effective paired or in sequence with medication in order to reduce symptoms more effectively, Abramowitz said. — Lauren Riley

Children can be taught to eat healthier

A new study provides insight into the eating habits of preadolescents and also showed that children who received education about healthy eating habits can alter their own habits and consume healthier foods. The seven-year Dietary Intervention Study in Children (DISC) was a multicenter, collaborative, randomized trial sponsored by the National Heart, Lung, and Blood Institute.

The children who attended a behaviorally oriented nutrition education program and were taught to follow a diet low in saturated fat and dietary cholesterol adopted better dietary habits than peers who received only general nutritional information. After three years in the study, children in the intervention group consumed more than 67% of their total calories from heart-healthy foods, compared with 57% of children in the usual group.

The DISC trial followed 663 children age 8 to 10 and had high blood cholesterol levels at the start of the study. Eating habits in both the intervention group and the control group both document a long-suspected phenomenon of today’s society; one-third of the children’s total daily calories came from snack foods, desserts and pizza. The researchers analyzed dietary recalls at the beginning of the study and again after three years. They found that the dairy group and the snacks/desserts/pizza group had the greatest effect on the children’s body mass index (BMI) and low-density lipoprotein (LDL) levels. Children who consumed more dairy products had a lower BMI, while children who consumed more snack foods, desserts and pizza had a higher BMI and higher levels of LDL.

Researchers found that neither group ate enough fruits or vegetables, but both ate a lot of pizza, although the intervention group tended to eat healthier versions.

The study was published in Pediatrics. (2005;115[6]:1723-1733). — Lauren Riley

New dosing improves height in children with growth hormone deficiency

A new dosing approach can improve height outcomes in children who have short stature because of growth hormone deficiency and idiopathic short stature. The University of California, Los Angeles study was presented at the 2005 Endocrine Society meeting.

The UCLA study described a new dosing approach based on the serum levels of insulin-like growth factor I (IGF-I). Prepubertal children with growth hormone deficiency or short stature were randomized to receive one of three treatments: a conventional dose of growth hormone based on weight, a dose adjusted to achieve an IGF-I level that was at the mean for age and gender or a dose adjusted to achieve an IGF-I level that was at the upper limit of normal.

The change in height in the children whose dosage was increased to achieve a higher IGF level grew 50% better than the children who received fixed doses of growth hormone.

The study was supported by a grant from Novo Nordisk, for whom Cohen is an investigator. — Lauren Riley