California's Children

Pesticide exposure in utero correlates with lower IQ

May 3, 2012: Exposure in utero to Chlorpyrifos (CPF), a pesticide made by Dow AgroSciences, routinely used on grain, cotton, fruit, nut and vegetable crops, has a "measurable effect" on brain structure, including enlargement of specific brain regions that deal with social cognition, language comprehension, sensory and motor processing, and disruption of normal gender differences in the brain; these structural changes are also correlated with lower IQ, according to a case-control children's study by researchers from the Columbia University Center for Children's Environmental Health in New York City.

Crystal Phend, of MedPage Today reported on the study, published online April 30, 2012, in the journal Proceedings of the National Academy of Sciences.

Registered for use since 1965, CPF (common names: Dursban, Tricel, Brodan, Detmol UA, Dowco 179, Empire, Eradex, Lorsban, Paqeant, Piridane, Scout, Stipend), a broad spectrum organophosphate considered "moderately toxic" by Environmental Protection Agency (EPA), is used to control cutworms, corn rootworms, cockroaches, grubs, flea beatles, flies, termites, fire ants, mosquitos, and lice.  The  EPA banned it for residential use in 2001, but it is still used widely in commercial and agricultural locations.

From the EPA's Human Health Risk Assessment (2000):

The critical exposure commodity (CEC) analysis indicated that residues on fresh apples were the major contributor to dietary exposure estimates for children 1-6 years old at the 99.9th percentile exposure. Residues on whole tomatoes and grapes were the next major contributors to exposure.

Lead researcher Virginia A. Rauh ScD, above, compared, with her team, the MRI scans of 40 children, 20 with high exposure levels to CPF and 20 with low exposure.

"Our findings indicate that prenatal CPF exposure, at levels observed with routine (nonoccupational) use and below the threshold for any signs of acute exposure, has a measurable effect on brain structure," they wrote.

The changes are likely to be irreversible based on their persistence into childhood and findings in animal studies, the researchers noted.

The high-exposure group showed significant enlargement of brain regions -- frontal, parietal, and lateral temporal -- that "subserve higher-cognitive functions." (attention and language comprehension, sensory and motor processing, social cognition)

With regard to normal sexual differentiation of the brain, there were problems, too. Areas of the brain that are usually larger in females compared with males were not in the children with high exposure...and the normal male-larger-than-female difference of the right mesial superior frontal gyrus was also reversed.

The new results suggest that the EPA's exposure limits may not be stringent enough to protect brain development in children, Rauh's group argued.

The high-exposure group had CPF levels of 4.39 pg/g or greater in their umbilical cord blood, which is not unusually high; for e.g., the background serum concentration in one blood bank during the same time period was twice as high at an average of 9 pg/g.

Written for California's Children by Elizabeth J Carlyle.

Since 2000: 3x more infants born addicted to painkillers

UPDATE, May 2, 2012: The number of babies born addicted to prescription painkillers (Norco, Vicodin, OxyContin, Percocet) has increased three-fold from  2000 to 2009 finds a study: approximately 13,539 babies were born in 2009 with opiate dependency, equating to 1 baby born per hour, placing a massive burden on the healthcare system, and in particular state Medicaid budgets.

Karen Kaplan reported on the study, published online April 30, 2012 in the Journal of the American Medical Association (JAMA), for the LA Times Booster Shots Blog.

Stephen Patrick M.D., at left, University of Michigan Division of Neonatal-Perinatal Medicine, Ann Arbor, and colleagues analyzed hospital data compiled by the federal Agency for Healthcare Research and Quality and found 3.39 per 1000 hospital births were babies born with symptoms of opiate-dependent Neonatal Abstinence Syndrome (NAS), up from 1.2 per 1000 in 2000. Researchers also identified a 5-fold increase in opiate use in pregnant women in the same time period.

The American Academy of Pediatrics released guidelines in a February clinical report on infants with NAS (see previously reported below); this study is the first to examine the issue on a national level and  look at the associated healthcare expenditures.

The typical baby born with NAS winds up staying in the hospital for about 16 days before he or she can be discharged, according to the JAMA report.

The average cost of caring for a baby with NAS has risen from $39,400 in 2000 to $53,400 in 2009 – an increase of 35%, despite the fact that the amount of time affected infants remained in the hospital didn’t change over the decade. Adjusting for inflation, the total money spent to care for babies with neonatal abstinance syndrome jumped from $190 million to $720 million over that period. The share of the total tab picked up by Medicaid rose from 69% in 2000 to 78% in 2009, according to the JAMA study.

Antipsychotic drugs to foster kids trends up: 10% of 6-11s on meds

May 1,2012:  In preparation for an August conference on standardizing "best practices" in the field of prescribing drugs to children in foster care -- a conference called by Health & Human Services's Administration on Children, Youth & Families (ACYF) -- the PolicyLab of the Children's Hospital of Philadelphia has completed  a study comparing the use of psychoactive drugs by children in foster care in 48 states; the state-by-state data will be released on the PolicyLab website early this summer. (Earlier this year, the Governmental Accountability Office (GAO) issued a report on the same subject, but limited the survey to five states.) 

Above, David Rubin, lead author of the report and director of the PolicyLab. Dr. Rubin is a fellow of the Stoneleigh Foundation, working on a five-year project, "Children's Stability and Well-Being Study."  The Stoneleigh Foundation is dedicated to social change in the interrelated fields of child welfare and juvenile justice.

"While it is encouraging to see fewer kids being prescribed multiple classes of drugs, and--to some degree--a slowing rate of growth in the use of antipsychotics by 2007, these medications are still being prescribed much too frequently to children in the foster care system," said David Rubin, M.D., director of PolicyLab.

The research team looked at the 686,000 foster-care children enrolled in Medicaid annually in 48 states from 2002-2007, and saw that both overall psychoactive use and polypharmacy-- the practice of prescribing multiple classes of psychoactive drugs at once-- increased from 2002 to 2004, and then began to decline from 2005 to 2007. Prescriptions for antipsychotics, on the other hand, increased each year from 2002 to 2007.

The updated findings show the percentage of children in foster care taking antipsychotics--a class of psychoactive drugs associated with serious side effects for children-- continued to climb in the last decade. At the same time, a slight decline was seen in the use of other psychoactive medications, including the percentage of children receiving 3 or more classes of these medications at once (polypharmacy).

As public scrutiny has increased about the use of psychoactive medication by children over the past decade, children in foster care continue to be prescribed these drugs at exceptionally high rates compared with the general population of U.S. children. According to the PolicyLab study, 1 in 10 school-aged children (aged 6-11) and 1 in 6 adolescents (aged 12-18) in foster care were taking antipsychotics by 2007.

 

Kids not included in drug trials -- for meds they are prescribed

May 1, 2012: Children are being overlooked for clinical drug trials for health conditions that typically impact them in high numbers (such as asthma): a preliminary study examining drug trials for the top 10 highest burden pediatric health problems found only 12% involved children, and in high-income countries, it drops to 10%. 

Lead researcher Florence Bourgeois, MD, at left, pediatrics professor, Children's Hospital Boston, presented the preliminary findings at the Pediatrics Academic Societies annual meeting in Boston last weekend, reported on by Crystal Phend for Medpage Today, an online medical news source co-developed by The University of Pennsylvania School of Medicine.

The concern is that children's bodies absorb and distribute drugs at different rates and durations than adults, yet are prescribed them based on clinical trials that do not include pediatric participants; furthermore, pediatric trials were less likely to examine safety outcomes than adult trials (10% v. 17%).

"There is a deficiency in the amount of research activity not just for rare diseases, but also for diseases that are quite common among children, such as asthma," Bourgeois told MedPage Today.

Bourgeois' team identified all the drug trials registered from 2006-2011 with the National Institutes of Health's ClinicalTrials.gov, a database of federally and privately supported clinical trials conducted both in the United States and world-wide, for health conditions that impact children: asthma, migraine headache, schizophrenia, depression, diarrhea, lower respiratory infection, malaria, bipolar disorder, and HIV/AIDS.

Researchers found that funding for pediatric trials primarily comes from government or non-profit organization (60%), with little private funding from private industry (compared to 35% of adult trials).

When the researchers analyzed the trials by the type of country they were done in, they found even greater discrepancy for children in lower income nations.

In higher-income countries, children bore 21.4% of the disease burden for the conditions studied, but 9.8% of the clinical trials done for those conditions (P<0.001).

In middle- and low-income countries, children accounted for 61.9% of the disease burden, but just 11.9% of the trials (P<0.001).

"Given the current distribution of funding sources, we need more support from both nonprofit organizations as well as commercial entities or industry," Bourgeois said in an interview.

The Pediatrics Academic Societies meeting is jointly sponsored by the American Pediatric Society, the Society for Pediatric Research, the Academic Pediatric Association, and the American Academy of Pediatrics.

Written for California's Children by Elizabeth J Carlyle.

Kids w/special needs: depression risk high, research shows

April 30, 2012: Results of a study investigating the emotional well-being of 109 youth with special health needs (attention-deficit hyperactivity disorder, cystic fibrosis, diabetes, sickle cell disease, obesity, learning disability, autism spectrum disorder) show that these children may be at an elevated risk for depression and anxiety due to bullying or being ostracized by peers.

The findings were published online April 29, 2012, in the American Academy of Pediatrics newsletter AAP News, and presented this weekend in the Pediatric Academic Societies (PAS) annual meeting in Boston.

Researcher Margaret McKenna M.D., senior fellow in developmental-behavioral pediatrics at Medical University of South Carolina, screened for symptoms of depression and anxiety by using questionnaires completed by both the child and the guardian (the Children's Depression Inventory, the Achenbach's Youth Self Report and the Achenbach's Child Behavior Checklist), and found bullying and/or being ostracized by peers to be the stongest predictors to increased symptoms of depression.

“What is notable about these findings is that despite all the many challenges these children face in relation to their chronic medical or developmental diagnosis, being bullied or excluded by their peers were the factors most likely to predict whether or not they reported symptoms of depression,” Dr. McKenna said.

“Professionals need to be particularly alert in screening for the presence of being bullied or ostracized in this already vulnerable group of students,” she added.

Previous research has found that children with autism spectrum disorder are particularly vulnerable to being bullied: 63% of children diagnosed with autism reported being bullied at some point in their life; 39% of the children reported being bullied in the past month, at a rate 3 times higher than their siblings.

Written for California's Children by Elizabeth J Carlyle.