The use of vitamin E in childhood

The essential effects of Tocopherol are based on its antioxidative capacity. Tocopherol, however, is just one in a group of antioxidants, which are important for the organism. Established indication for therapeutical application of vitamin E in infancy is only vitamin-E-malabsorption in connection with chronic cholestasis, pancreatic insufficiency (cystic fibrosis) and short bowel syndrome. In emergency therapy vitamin E is suggested with high dosage in case of shock lung and haemolytic-uraemic syndrome. Positive effects of daily vitamin E application in connection with prophylaxis of retinopathy prematurity, bronchopulmonary dysplasia and intraventricular encephalorrhagia of premature infants of severe underweight are not established. Very questionable therapeutic or prophylactic efficiency is opposed to the risk of higher incidence of severe complications in caring for premature infants of severe underweight, such as enterocolitis necroticans and neonatal septicaemia.     

Supply, use, and abuse of intravenous immunoglobulin

Intravenous immunoglobulin is used as a replacement therapy in primary immunodeficiency diseases as well as an immunomodulatory agent in a variety of autoimmune and inflammatory disorders. The mechanisms of intravenous immunoglobulin action are complex and, for some disorders, not well understood. This paper reviews the recent literature and discusses approved, new, and controversial indications for intravenous immunoglobulin therapy, with special emphasis on its mechanism of action.     

The mistaken diagnosis of child abuse. A form of medical abuse?

The suspected diagnosis of child abuse may prove to be unfounded. Reports in the literature have focused on unusual diseases and folk medicine practices that may mimic abuse. We report ten cases where allegations of abuse were lodged against parents because the treating physicians in the emergency room mistook life-threatening illness or postmortem artifacts for inflicted injury. In all cases the families were from the inner city, and with two exceptions the involved institutions were small hospitals without pediatric personnel present in the emergency department. Although the histories related by the parents were in all cases truthful and consistent with the results of physical examinations of the child, the involved physicians failed to make a correct diagnosis. Not only a lack of experience with severe childhood illness and death but also an attitude of suspicion and/or hostility probably contributed to these misdiagnoses.     

A rational approach to short stature: Focus on use and abuse of growth hormone

The abundant supply of recombinant growth hormone has raised interesting possibilities of several new applications. While supplementation of the missing hormone in patients with growth hormone deficiency is still the undisputed primary indication for its use, there is now convincing evidence of its usefulness in the therapy of short stature due to Turner syndrome and pre-transplant chronic renal failure in childhood. Numerous studies on patients with other causes of short stature have failed to show any significant benefit in final adult height. Social pressures notwithstanding, it is still premature to advocate the use of this expensive therapy for indications other than the three stated above especially since our understanding of potential long-term complications from such treatment is far from complete.     

Anabolic-androgenic steroids: use and abuse in pediatric patients

The "win at all costs" mentality fuels athletes to seek performance-enhancing substances, such as anabolic-androgenic steroids, to gain an advantage over their opponents. Nonathletes espouse this same attitude to "win" the battle of attractiveness. An enhanced understanding of anabolic-androgenic steroids and the motivations behind their abuse will arm pediatricians with the ability to engage their patients in a balanced discussion of the benefits and costly risks of anabolic-androgenic steroids and successfully deter further use.     

Testosterone precursors: use and abuse in pediatric athletes

The dietary supplements androstenedione, dehydroepiandrosterone, and androstenediol are precursors in the endogenous production of testosterone. The efficacy and safety of these prohormones are not well established but are promoted to have the same androgenic effects on building muscle mass and strength as anabolic-androgenic steroids. Studies have demonstrated repeatedly that acute and long-term administration of these oral testosterone precursors does not effectively increase serum testosterone levels and fails to produce any significant changes in lean body mass, muscle strength, or performance improvement compared with placebo. The Anabolic Steroid Control Act of 2004 lists androstenedione as a schedule III controlled substance, and it is regulated by the U.S. Food and Drug Administration. Testosterone precursors are banned by most major sports organizations.     

A national survey on the use of screening tools to detect physical child abuse

Purpose

Recognition of physical child abuse is imperative for ensuring children’s safety. Screening tools (ST) may increase identification of physical abuse; however, the extent of their use is unknown. This study assessed use of STs for physical abuse in children’s hospitals and determined attitudes regarding STs.

Methods

A web-based survey was sent to child abuse program contacts at 103 children’s hospitals. The survey assessed institutional use of a ST for physical abuse and characteristics of the ST used. Respondents were asked to identify benefits and liabilities of STs used or barriers to ST use.

Results

Seventy-two respondents (70 %) completed the survey; most (64 %) were child abuse pediatricians. Nine (13 %) respondents reported using a ST for physical abuse; STs varied in length, population, administration, and outcomes of a positive screen. Most respondents (86 %) using a ST felt that it increased detection of abuse. Barriers noted included lack of time for development and provider completion of a ST.

Conclusions

While few respondents endorsed use of a ST for physical abuse, most believed that it increased detection of abuse. Future research should focus on development of a brief, uniform ST for physical abuse which may increase detection in at-risk children.