2000 Summer Issue:

Contents:

• Chair's Column.
• New Growth Charts Help Detect Early Childhood Obesity.
• Pneumococcal Conjugate Vaccine (Prevnar).

Chair’s Column:

As we head into the new academic year we look forward to the new faculty that are joining the department. We are pleased to welcome the following new members:

• Lisa Gilmer, MD,  General Pediatrics;
• Norma Villegas, MD, General Pediatrics;
• Felix Okah, MD, Neonatology;
• James Casey, MD, Pediatric Endocrinology;
• Kathleen Webster, MD, Pediatric Intensive Care.

These additions bring the total pediatric faculty to fifty-five with an additional twenty pediatric associated faculty in other departments including surgery, psychiatry and radiology. This is the  largest group of pediatric faculty in the history of the department. This growth allows us to offer more services at more locations, including our numerous outreach clinics.

Sincerely,

Carol B. Lindsley, MD,

Professor and Chair.

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New Growth Charts Help Detect Early Childhood Obesity:

Pam Shaw, MD

Pediatric growth charts have been used to track physical growth in the United States since 1977. As the charts have become universally accepted, it became clear that a revision would be necessary.

The original growth charts for infants and children up to 36 months old were derived from primarily Caucasian, formula-fed, middle-class infants from Ohio. The data for older children was from national surveys conducted from 1963 through 1974. We now have national data available from the National Heath and Nutrition Examination Survey (NHANES) and better statistical procedures to revise the outdated growth charts.

The revised growth charts consist of 16 charts (eight for boys and eight for girls). These represent revisions of the old charts as well as the introduction of two new charts relating Body Mass Index (BMI) to age for boys and girls ages 2-20 years. Body Mass Index is calculated by dividing the weight by the height squared and can be calculated using either metric or English units.

Body Mass Index:

The BMI should be used to judge whether an individual's weight is appropriate for his or her height. It should enable a clinician to detect at an early age (down to age two) children who are showing early signs of being at risk for obesity. BMI provides a guideline to determine which children are underweight or overweight.

As children grow, the amount of fat in their bodies changes. Additionally, the amount of body fat depends on the gender of the child. The BMI, therefore, is expected to change with age and gender.

BMI can be determined by using a table that relates gender, height, and weight to BMI, or by calculating it yourself. Programs designed to compute BMI are available from the Centers for Disease Control web site.

English Formula:

Formula 1: BMI = Body Mass Index, W = Weight in pounds, H = Height in inches:

Body mass index equals weight in pounds times 703, divided by height in inches squared.

Example 1: A 33 pound 4 ounce child is 37-5/8 inches tall.

33.25 pounds times 703, divided by 37.625 inches squared equals 16.5.

Metric Formula:

Formula 2: BMI = Body Mass Index, W = Weight in kilograms, H = Height in meters:

Body mass index equals weight in kilograms, divided by height in meters squared.

Example 2: A 16.9 kg child is 105.2 cm tall.

16.9 divided by 1.052 squared equals 15.3.

Intervention:

The BMI is then compared to the age-specific chart for the appropriate gender. If the BMI is out of line for the child, counseling can be undertaken with the child, parent, or both.

Health care providers should be aware that there will be a period of change as they shift from the old to the new charts. However, these revised charts are advantageous:

• They are based on a more inclusive national population.
• Future revisions will be easier as more data are collected.

We invite you to download the new growth charts at the CDC's web site.

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Pneumococcal Conjugate Vaccine (Prevnar™):

Nirav Shastri, MD

In June of 2000, the American Academy of Pediatrics (AAP) released recommendations for prevention of pneumococcal infections. This followed approval in February by the Food and Drug Administration (FDA) of the new pneumococcal vaccine Prevnar (PCV7). The antibody responses after administration of PCV7 are greater and longer as compared to 23PS vaccine, making PCV7 the preferred vaccine. However, we recommend that you read the full text of the AAP's statement before beginning administration of this vaccine.

S. pneumoniae is an important cause of acute otitis media, identified in 20 - 40% of middle ear cultures. PCV7 has seven capsular subtypes (4, 6B, 9V, 14, 18C, 19F, and 23F) compared to the 23-valent pneumococcal vaccine (23PS) in use since 1985.  The seven serotypes account for approximately 60 % of acute otitis media due to S. pneumoniae (12 to 24% of all cases of acute otitis media). Each year pneumococcal infections cause an estimated 1400 cases of meningitis, 17,000 cases of bacteremia, 71,000 cases of pneumonia and 5 - 7 million cases of otitis media in children under five years old in the US.

Efficacy:

PCV7 vaccine has reduced invasive infection (e.g., meningitis and septicemia) by 93%, consolidative pneumonia by 71%, otitis media by 7%, and tympanostomy tube placement by 20% (only in those with recurrent infections (more than three in six months or more than 4 in a year).

Administration:

Each 0.5 ml dose of PCV7 should be administered intramuscularly. Infants below 1500 grams weight should be immunized at 6 - 8 weeks of age. PCV7 may be administered with other immunizations. It does not contain thimerosal.

Cost:

PCV7 vaccine costs $58 while 23PS costs $13, excluding administration costs.

Contraindications:

This vaccine should not be administered to any individual with known hypersensitivity to any of its components.

Adverse Reactions:

Local reactions: erythema, induration, and tenderness.

Systemic reactions: fever, irritability, drowsiness, restless sleep, reduced appetite, vomiting, diarrhea, rash, and hives.

We refer you to the full text of the AAP's statement, which is available on-line.

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