Hypertension, Cancer Survivors' Parents, Breastfeeding, Antibiotics, Allergies

Welcome back to our regular roundup of research news from Children’s Hospital of Philadelphia! Now that we are bringing you these updates biweekly, we have an even richer collection of stories to share. This week’s highlights include an important update for clinicians to recognize that hypertension risk may be underdiagnosed in children; research on the ongoing needs of childhood cancer survivors; findings about what it takes for working mothers to continue breastfeeding their babies successfully; a new study getting underway in an effort to reduce children’s exposure to antibiotic side effects while also reducing resistant bacteria; and a national update on the state of knowledge about food allergy prevalence. Read on for the details.

Hypertension Underdiagnosed and Undertreated in Children

Hypertension (high blood pressure) and prehypertension in children often go undiagnosed, according to a new study published in Pediatrics. The study is the first to show a widespread underdiagnosis of these conditions by pediatricians in children ages 3 to 18. Children with hypertension are predisposed to adult hypertension and can also show early signs of cardiovascular disease, which if left untreated can increase long-term morbidity and mortality.

Researchers analyzed the electronic health records of 400,000 children from nearly 200 pediatric primary care sites across the country, between 1999 and 2014. They found that only 23 percent of those who had blood pressures consistent with hypertension at multiple primary care visits were diagnosed with the disease, and only 10 percent of patients with symptoms of prehypertension were diagnosed. Of those children and adolescents with diagnoses of hypertension for at least a year, only 6 percent of those who needed anti-hypertension medication received a prescription.

“The new reality for pediatricians is that we’re taking care of more and more children who are winding up with chronic conditions, such as hypertension, that were previously seen primarily in adults,” said senior author Alexander G. Fiks, MD, MSCE, a pediatrician at CHOP, faculty member at CHOP’s PolicyLab and director of the Pediatric Research in Office Settings network at the American Academy of Pediatrics that coordinated this research. “This study shows that many pediatricians are not responding to this new reality — not only are we underdiagnosing hypertension, but we’re often not providing recommended treatment to children with the condition in order to minimize health risks.”

Read more in the CHOP press release and Philadelphia Inquirer article.

Childhood Cancer Survivors Fare Better with Parental Transition Help

Survivors of childhood cancer can still use a helping hand from their parents as they grow up, according to a new study led by Dava Szalda, MD, MSHP, an oncologist who treats pediatric patients at CHOP and young adult patients through their transition to adult care at the Hospital of the University of Pennsylvania.

“Parents who both act as a support for their children as they age and encourage their young adults to take responsibility for their health, for example talking to providers and understanding their health and healthcare, can provide a valuable balance of support and promotion of self-advocacy that is so important for young adults to stay engaged in their care,” Dr. Szalda told Reuters.

Dr. Szalda and colleagues surveyed 80 adult survivors of childhood cancer about their engagement in follow-up care as well as various psychosocial and transition readiness measures. The findings were published in the Journal of Adolescent Health.

Dr. Szalda and study co-author Lisa Schwartz, PhD, are collaborating on another study of young adult cancer survivors, with Christine Hill-Kayser, MD. This team is testing whether the combination of an online survivorship care plan and a mobile health intervention can help survivors integrate follow-up care and healthy self-management behaviors into their daily lives.

Read more about the new study in Reuters.

Study Finds Workplace Social Challenges for Breastfeeding

Women who have returned to work after having a baby will not find it surprising to hear that pumping breast milk during the work day can be challenging. A CHOP and Penn research team has helped fill in more of the details of how and why that is so by asking mothers about their workplace experiences here.

“Even if you put into place really excellent support and access to hospital pump rooms and have a strong policy, even with all that, some women can still find it challenging,” said Diane Spatz, PhD, RN-BC, a perinatal nursing and nutrition professor in the University of Pennsylvania’s School of Nursing and CHOP’s lactation program director, in a Penn press release. “It only takes one person to say, ‘Why are you taking a pump break?’”

Dr. Spatz and Elizabeth Froh, PhD, MS, RN, clinical supervisor of CHOP’s lactation team and Human Milk Management Center, interviewed women working at CHOP who had taken and returned from maternity leave about their experiences with breastfeeding and pumping while working. Some women acknowledged and felt supported by the hospital’s resources, but many still reported challenges with time. The findings were reported in the Journal of Human Lactation.

Read more in the Penn press release.

Seeking A Shorter Course of Antibiotics

Could half as much medicine do just as much good — and less harm — than the standard course? Researchers at CHOP and four other medical centers are part of a study that will enroll up to 400 children to determine if a five-day course of antibiotics works as well as the usual 10-day course for children with community-acquired pneumonia, if they show improvement in the first few days of treatment. The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, is sponsoring the clinical trial, which will use an innovative evaluation method developed by a group of scientists who specialize in antibiotic resistance research.

At CHOP, the study will be conducted by researchers in Clinical Futures, a CHOP Research Institute Center of Emphasis, and will build on past and ongoing work aimed at reducing children’s exposure to side effectt from antimicrobial medicines while also reducing the risk of resistant microbes.

Read more in the NIAID press release.

Rise in Childhood Food Allergies Hard to Quantify

“There are a lot of misconceptions about what a food allergy is,” Virginia Stallings, MD, a pediatrician and director of the Nutrition Center at CHOP, told NPR.

Dr. Stallings chaired a committee for the National Academy of Sciences, Engineering, and Medicine that issued a report this week stating that there have not been any studies in the U.S. with a large and diverse enough population to determine the true prevalence of food allergies. There are widespread perceptions that children’s food allergies are increasing, but the data aren’t strong enough to validate that perception.

“To prioritize food allergy as a public health concern and ensure that adequate resources are directed at the issue, the extent of the problem must first be defined,” Dr. Stallings said in the National Academies press release.

In addition to clinical recommendations, the committee recommended research priorities in areas that include diagnosis and prognosis, mechanisms, risk determinants, and management of food allergies.

Read more in the National Academies press release, and read a Q&A on Cornerstone with other CHOP allergy researchers who studied food allergy prevalence (though their study was not national in scope).

ICYMI

In case you missed it, recently on Cornerstone we profiled Adeline L. Vanderver, MD, the new program director of the Leukodystrophy Center of Excellence at CHOP, and shared PolicyLab experts’ view toward the future of children’s health after the election.

Our previous In the News post featured research on the impact of mental health conditions on the length of hospital stays, research on bystander CPR, findings of adherence to new ADHD diagnosis and prescribing guidelines for young children, and a focus on innovation at CHOP.

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