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Are antibiotics for childhood pneumonia overprescribed?
Interpretation of Antibiotic Trials in Pediatric Pneumonia; JAMA Network Open, Feb. 2, 2024.
Clinicians have been baffled by studies suggesting that neither the intensity nor duration of antibiotic treatment in kids with pneumonia affected outcomes.
A Harvard and Boston Children’s Hospital research letter suggests the problem with those studies was that many of those children did not have pneumonia.
To demonstrate this, investigators enrolled 1,252 children, ages 3 months to 6 years, of whom 507 met inclusion criteria for the CAP-IT Trial, meaning they would normally receive antibiotics.
This study, on amoxicillin treatment for pediatric pneumonia, included subjects who had all of the following: cough within the previous four days, fever within the previous two days, and either labored breathing, focal chest signs or lobar pneumonia.
These criteria are typically assessed through clinical judgment, not X-rays.
When those 507 CAP-IT-eligible patients were X-rayed, just 154 (30%) had pneumonia and 49 (10%) had possible pneumonia. The remaining 304 (60%), who did not have X-ray-confirmed pneumonia, did fine without treatment.
This led investigators to conclude that nearly half of children prescribed antibiotics for pneumonia recover without the medication, and that future antibiotic prescriptions should be based on X-ray confirmation.
Could feeding fish to young kids lower risk of inflammatory bowel disease?
Early-life diet and risk of inflammatory bowel disease: a pooled study in two Scandinavian birth cohorts; GUT, Jan. 30, 2024.
Children who ate a diet high in fish experienced a 30% lower risk for inflammatory bowel disease (IBD) at age 1 and a 54% reduction in the incidence of ulcerative colitis compared with children who ate less fish.
Findings were based on a Swedish study of 81,280 children followed from birth through childhood and adolescence, 307 of whom were diagnosed with IBD.
Higher vegetable consumption at 1 year was also associated with lower IBD risk, while sugar-sweetened drinks raised the risk of IBD. The only associations that persisted at age 3 were the connection between fish intake and either IBD or colitis.
The time factor for dietary changes or interventions is critical because the gut microbiome undergoes “significant changes” before stabilizing around age 2-3 years.
“Regrettably, the lack of microbiome data prevented the study of whether changes in microbial composition mediated the IBD risk related to early-life diet,” the authors wrote.
Air pollution raises risk of respiratory distress in newborns
Prenatal Exposure to Air Pollution and Respiratory Distress in Term Newborns: Results from the MIREC Prospective Pregnancy Cohort; Environmental Health Perspectives, Jan. 25, 2024.
Canadian and U.S. researchers have uncovered a link between fine particulate matter (PM) and nitrogen dioxide (NO2) in polluted air and serious respiratory issues in newborns.
Drawing on data from the Maternal-Infant Research on Environmental Chemicals study, the team recruited 2,001 women in their first trimester from 10 Canadian cities.
Prenatal exposures to PM and NO2 were estimated from land use, satellite images and ground-level monitoring and linked to subjects based on their geographic place of birth.
Approximately 7% of babies born to the mothers in the study experienced respiratory distress and 4% were admitted to neonatal intensive care units. While NO2 exposure only slightly increased the risk for one bad outcome — administration of systemic antibiotics — PM exposure was strongly linked to the need for assisted ventilation, multiple treatments and systemic antibiotics.
The study authors explained this phenomenon based on possible increases in inflammation, oxidative stress, placental disruption, or the effects of air pollution on genetic and epigenetic factors affecting lung and immune system development.
mRNA COVID vaccination during pregnancy: 3 red flags
Timing of Maternal COVID-19 Vaccine and Antibody Concentrations in Infants Born Preterm; JAMA Network Open, Jan. 19, 2024.
U.S. and Israeli researchers were curious about COVID-19 spike protein antibody levels in preterm children of women vaccinated during pregnancy, so they recruited 220 vaccinated expectant mothers. Of those, 121 had received two mRNA COVID-19 shots and 99 got three doses.
First red flag: Within this group of 220 mothers, 36 (16.4%) delivered their baby prematurely, compared with a general-population preterm birth rate of 10.4% — meaning COVID-19-vaccinated mothers delivered prematurely 50% more than one would expect.
Average antibody levels for mothers were 674 after two doses but jumped to 8,159 after three or more shots. Umbilical cord levels reflecting fetal exposure were 1,000 (two maternal doses) and 9,992 (three or more doses).
Regardless of when during their pregnancies mothers were vaccinated, cord levels were consistently higher than maternal levels.
Second red flag: A search on PubMed, the National Library of Medicine, yielded just 11 studies on spike antibody levels in children of mothers vaccinated during pregnancy — but none of the studies specifically addressed safety.
Third red flag: The authors assumed that cord anti-spike antibodies originated through passive transfer from the mother and did not consider the possibility that fetuses raised those antibodies as a result of mRNA-induced spike protein exposure.
Despite official recommendations for COVID-19 vaccinations for pregnant women, safety data is almost nonexistent. Pfizer, for example, halted its study of its mRNA vaccines in pregnant women as soon as U.S. officials recommended them.
