2014's Pediatric 'Great Eight': The News You Need to Know

L. Gregory Lawton, MD

December 19, 2014

2014's Most Important Pediatric Research

Another year, another 20 or 30 (or more) pediatric journals begin to collect dust on that shelf. A couple of dozen more may "grow" next to our desks. In keeping with tradition, the Medscape Pediatrics Advisory Board has been asked to review the year in pediatric research. What were the big themes, important insights, and new guidelines?

This article summarizes the "great eight" pediatric research and guideline themes from the year. Moreover, we have provided commentary as to what each of these themes means for practicing primary care pediatricians and nurse practitioners. Perhaps most important, our New Year's present to you, we hope, is that this enables you to clear away some of those dust-gathering stacks. Although our list is not all-inclusive or exhaustive, it is a good place to spend a little time.

Bad Bugs Behaving Badly

Robert Welliver, MD, an infectious disease physician at the University of Oklahoma, chose the World Health Organization(WHO) 2014 summary of its antimicrobial resistance global report on surveillance^[1] as the most important paper of the year. He states, "This issue is a major threat to the United States—more than Ebola, more than methicillin-resistant Staphylococcus aureus, more even than obesity."

The summary notes the following key findings.

1. In many WHO regions, very high rates of antimicrobial resistance have been observed for common bacteria, such as Escherichia coli, Klebsiella pneumoniae, and S aureus; these organisms cause common infections involving the urinary tract, bloodstream, respiratory system, and wounds.

2. There is a significant gap in surveillance techniques, standards for methodology, and data sharing and coordination.

3. Multidrug-resistant tuberculosis is a growing, and largely underreported, problem.

4. Increasing levels of transmitted anti-HIV drug resistance have been observed among patients initiating antiretroviral treatment.

The bottom line as to why this is significant is as follows. According to the summary, "Patients with infections caused by bacteria resistant to a specific antibacterial drug generally have an increased risk of worse clinical outcomes and death, and consume more healthcare resources, than patients infected with the same bacteria not demonstrating the resistance pattern in question." In a phrase, more resistant bugs means more lost lives and more money.

Antimicrobial resistance is not a topic for medical journals alone. From the New York Times^[2] to The Economist,^[3] articles in lay publications have brought this issue to the fore in many countries. Yet inappropriate requests for antibiotics, accompanied by their injudicious use, indicate that there is more to do to reverse these trends.

Antimicrobial stewardship programs are one such approach. A second involves the curtailment of antibiotic use in livestock. According to the National Resources Defense Council, 80% of antibiotic in the United States is used to promote livestock growth.^[4]

The pharmaceutical research and development pipeline is losing the arms race against many common bugs. The WHO 2014 summary is likely to be a harbinger, unless some drastic policy changes come about.

Autism Prevalence Continues to Rise—but Why?

In the spring, a report^[5] from the Centers for Disease Control and Prevention (CDC) calculated the prevalence of autism spectrum disorders at 1 in 68 children aged 8 years (14.7 per 1000), compared with a 2012 estimate of 1 in 88 children (11.3 per 1000). According to Alan Greene, MD, a member of the Medscape Pediatric Advisory Board, these data were obtained "during a time when there was no change in diagnostic criteria or data collection methods" to otherwise explain the rise.

The CDC data were collected by examining school and health records in 2010 using a validated method and Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria from 11 surveillance sites around the United States. The DSM-IV has been in use since 1994, so why the increase in prevalence? In an interview with Medscape, Susan Hyman, MD, chief of neurodevelopmental and behavioral pediatrics at the University of Rochester and chair of the American Academy of Pediatrics (AAP) Autism Subcommittee, speculated that the prevalence increase is due to a combination of children who were "missed" as well as those who were "misdiagnosed."

According to Dr Hyman, "People who previously would have been considered quirky or odd may have been better described as being on the autism spectrum." Alternatively, "were these people diagnosed with other things? The answer is yes." She cited profound intellectual disability, attention-deficit/hyperactivity disorder, or other mental health disorders as other diagnoses perhaps erroneously applied to children with autism spectrum disorders. "The autism spectrum wasn't recognized."

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Cite this: L. Gregory Lawton. 2014's Pediatric 'Great Eight': The News You Need to Know - Medscape - Dec 19, 2014.

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