Stories about: Pediatrics

How scratching may prime children with eczema for food allergy and anaphylaxis

scratching one's eczema can trigger a series of events leading to food allergy
PHOTO: ADOBE STOCK

Eczema, a chronic itchy inflammatory skin disease, affects about 15 percent of U.S. children. It’s a strong risk factor for food allergies — more than half of children with eczema are allergic to one or more foods — and most people with food allergy have eczema. But the connection between the two hasn’t been clear. New research in a mouse model demonstrates, for the first time, that scratching the skin promotes allergic reactions to foods, including anaphylaxis.

The study, led by Raif Geha, MD, and Manuel Leyva-Castillo, PhD, at Boston Children’s Hospital, also teases out the complex web of cellular signals that elicit scratching’s dangerous effects.

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Small samples, big data: A systems-biology look at a newborn’s first week of life

newborn biology, through tiny blood samples
(PHOTO: ADOBE STOCK)

The first week of a baby’s life is a time of rapid biological change. The newborn must adapt to living outside the womb, suddenly exposed to new bacteria and viruses. Yet scientists know surprisingly little about these early changes.

Reporting in today’s Nature Communications, an international research team provides the most detailed accounting to date of the molecular changes that occur during a newborn’s first seven days. The team pioneered a technique to extract volumes of data from a tiny amount of newborn blood — including what genes are turned on, what proteins the body is making and what metabolites are changing.

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Two new options for treating esophageal damage in children

Rusty Jennings, MD, and Michael Manfredi, MD (CREDIT: MICHAEL GODERRE)

A child’s esophagus can become damaged through physical trauma or ingestion of toxic chemicals or foreign objects — such as oven and drain cleaners, lye, laundry and dishwasher detergents and batteries. Depending on the substance and the amount ingested, children can develop esophageal strictures (scar tissue that narrows the esophagus) or esophageal perforations (holes in the esophagus). These problems can also be complications of surgery for esophageal atresia, in which a baby is born without part of the esophagus.

Children with esophageal perforations have traditionally been treated with long courses of antibiotics and not eating by mouth. More recently, perforations have been treated with stents, and strictures with a combination of dilation and stenting. But stenting, while it can be effective, requires up to eight weeks of therapy and can have complications such as pain, retching and local pressure necrosis, a type of ulcer that may worsen perforation. Such concerns have led researchers to investigate alternative treatments for perforation and strictures.

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Gene panel helps investigate sudden unexpected death in children

Thousands of cases of sudden unexplaied death (SUDP) occur each year.
(PHOTO: ADOBESTOCK)

Almost 10 percent of pediatric deaths occur suddenly and without explanation. In this terrible situation, the first question many parents have is “Why?” For most, answers never come.

Childhood deaths that cannot be explained by traditional autopsy and death-scene investigation are referred to as sudden unexplained deaths in pediatrics (SUDP). In children, these deaths are more common than those from either cardiac disease or cancer and typically occur in infancy or early childhood.

Robert’s Program at Boston Children’s Hospital, co-founded by Richard Goldstein, MD, and Hannah Kinney, MD, is adding a genetic approach to the search for answers.

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Children raised in institutions have impaired memory and executive functioning at age 16

long-term effects of child institutionalization

An estimated 8 million children worldwide live in institutions where they experience neglect and deprivation. Last fall, a study of children reared in Romanian orphanages reported high levels of mental health problems when they reached adolescence. In particular, they had more difficult behaviors such as rule-breaking, excessive arguing with authority figures, stealing or assaulting peers. But if they were placed early with carefully vetted foster families through the Bucharest Early Intervention Project (BEIP) , these problems were reduced.

A new BEIP study, published yesterday in the Proceedings of the National Academy of Sciences, examined cognitive functioning. It found that institutionalized children, at ages 8 and 16, also have impaired memory and executive functioning compared with peers placed early in foster homes.

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Overriding resistance to epigenetic inhibitors in neuroblastoma: Targeting PI3K

(IMAGE COURTESY NATIONAL CANCER INSTITUTE)

Children’s cancers pose unique challenges. They’re not caused by the same kinds of genetic mutations that cause adult cancers, and only a minority of their mutations can be targeted with drugs. In a recent study, Kimberly Stegmaier, MD, at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and her colleagues systematically deleted every gene in the genome in a number of childhood cancers. This led them to previously unknown — and targetable — genes that help drive tumor growth.

But Stegmaier is also interested in epigenetic regulators — proteins that help control the regulation of genes and contribute to many pediatric cancers. They’re a hot subject of research: Child cancers tend to arise in developing tissues, and epigenetic regulators are active during early development. Clinical trials are starting to test drugs that inhibit epigenetic cancer-promoting factors.

There’s a problem, though: Cancers often become resistant to targeted inhibitors, including epigenetic inhibitors. So, again using genome-wide approaches, Stegmaier set out to find ways to overcome this resistance.

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Do antibiotic-impregnated shunts reduce infection in hydrocephalus?

Antibiotic shunts compared with non-antibiotic shunts
(IMAGE: ADOBE STOCK)

Every year, nearly 400,000 children worldwide develop hydrocephalus, in which excess fluid accumulates in the brain. Many of these children have shunts placed to allow this fluid to drain. Antibiotic-impregnated shunts are widely championed as the best choice for treatment, but a new study calls their necessity into question.

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Only a third of Federally mandated ‘post-marketing’ pediatric drug trials are complete

too few mandated pediatric drug trials are getting done
Despite new requirements, pediatric drug trials largely aren’t getting done. (ADOBE STOCK)

The FDA requires clinical studies of new drugs in pediatric populations, since many drugs developed for use in adults are also used in children. These studies are often “post-marketing” trials after the drug is approved in adults. But an audit by researchers at Boston Children’s Hospital found that only about a third of these mandatory trials were completed within an average of seven years. As a result, most new drug labels continue to lack child-specific information, and most FDA-approved drugs remain untested in children.

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Could a simple injection fix spina bifida before birth?

Mesenchymal stem cells derived from amniotic fluid (FAUZA LAB / BOSTON CHILDREN’S HOSPITAL)

Ed. note: This is an update of a post that originally appeared in 2014.

The neural tube is supposed to close during the first month of prenatal development, forming the spinal cord and the brain. In children with spina bifida, it doesn’t close completely, leaving the nerves of the spinal cord exposed and subject to damage. The most common and serious form of spina bifida, myelomeningocele, sets a child up for lifelong disability, causing complications such as hydrocephalus, leg paralysis, and loss of bladder and bowel control.

A growing body of research from Boston Children’s Hospital, though still in animal models, suggests that spina bifida could be repaired at least partially early in pregnancy, through intrauterine injections of a baby’s own cells.

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Study sounds another warning about proton pump inhibitors

child crying while feeding oropharyngeal dysphagia
Toddlers with oropharyngeal dysphagia who were treated with a PPI had a nearly doubled hospitalization rate. (IMAGE: ADOBE STOCK)

A new study adds to growing concerns about a class of drugs frequently prescribed to suppress stomach acid in patients with gastroesophageal reflux disease (GERD). Previous research has linked the use of proton pump inhibitors (PPIs) to an increased risk of various pulmonary and gastrointestinal infections in both adults and children. Patients treated with PPIs are also at higher risk for upper respiratory infections, pneumonia and sepsis.

A new study, published last week in JAMA Otolaryngologysuggests that use of PPIs may also raise the risk of hospitalization of infants and children with oropharyngeal dysphagia, a common swallowing disorder. The study was led by Rachel Rosen, MD, MPH and Daniel Duncan, MD at Boston Children’s Hospital’s Aerodigestive Center.

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