Indian Medicine

BOSTON (Reuters) - Some of the intense care given to the smallest premature infants may be a little too intense, suggest two studies published on Wednesday.

One showed that light treatment for jaundice may overwhelm the smallest infants while another questions the practice of giving insulin to premature newborns.

Dr. Brenda Morris of the University of Texas Medical School in Houston and colleagues found that babies weighing less than 2 pounds (1 kg) were slightly more likely to die if they were given early light therapy for rising levels of bilirubin, the compound that can turn the skin yellow but, more dangerously, can cause permanent brain damage.

When the liver is slow to clear bilirubin, which can be toxic if too much accumulates, high-intensity light is used to break down the compound from outside the body.

The study of 1,974 infants, published in the New England Journal of Medicine, found aggressively treating rising bilirubin levels reduces the rate of brain injury in the form of cerebral palsy, blindness, severe hearing loss and poor cognitive development.

Only 26 percent of light-treated babies had brain damage, compared 30 percent for babies whose treatment was delayed until the levels got a bit higher.

But in the smallest babies, weighing 1.1 to 1.65 pounds (501 to 750 grams), those treated aggressively were 13 percent more likely to die than those who got conservative care.

The increase was not statistically significant, meaning not enough babies died to know whether the pattern is more than a fluke. Nonetheless, Morris said doctors may want to pause before rushing into light therapy.

"Aggressive phototherapy may be preferred for infants with birth weights of 751 to 1000 grams (1.6 to 2.2 pounds), because we found significant neurodevelopmental benefits in this subgroup and no evidence that the therapy increased the rate of death or other outcomes at 18 to 22 months," they wrote.

Dr. Rosemary Higgins, a researcher with the Pregnancy and Perinatology Branch at the National Institutes of Health and co-author of the study, said because jaundice "is one of the many medical problems they're facing, you need to look at these babies on an individual basis" to decide what treatment would be best.

The last study of light therapy was done in the 1970s, before advances allowed much smaller babies to survive.

A second team found that early insulin therapy offers little clinical benefit in very-low-birth-weight infants, putting them at risk of dangerous hypoglycemia or low blood sugar.

Their trial of more than 300 babies showed that putting them on continuous insulin from birth raised the risk of death, with nearly 12 percent dying after four weeks, compared to 5.7 percent of infants not given insulin.

"Mortality at 28 days was higher in the early-insulin group than in the control group," Dr. Kathryn Beardsall of Britain's University of Cambridge and colleagues wrote.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - Young people with attention-deficit hyperactivity disorder (ADHD) may be particularly vulnerable to serious nicotine addiction if they start smoking, a new study suggests.

Past research has shown that kids with ADHD are more likely than their peers without the disorder to start smoking. These latest findings suggest that once they do take up the habit, they also tend to become more severely nicotine-dependent, researchers report in the Journal of Pediatrics.

"The nicotine dependence appears to be about twice as bad," said lead researcher Dr. Timothy E. Wilens of Massachusetts General Hospital in Boston.

The study, which included 166 15- to 25-year-olds with and without ADHD, found that those with the disorder scored significantly higher on a questionnaire that gauges physical dependence on nicotine.

Their average score was double that of smokers without ADHD.

ADHD was not the only factor that influenced nicotine dependence, however. Young people who had a parent who smoked, friends who smoked or who lived with a smoker all tended to have more-severe nicotine addiction.

Importantly, Wilens told Reuters Health, these environmental factors all had a greater impact on study participants with ADHD. This suggests that a mix of biology and environment is at work, according to Wilens.

It's not clear why ADHD and smoking are linked, he explained, but there is evidence that nicotine affects brain systems believed to be involved in ADHD. One study, for example, found that nicotine and the ADHD drug Ritalin each had similar effects on a protein that regulates levels of the brain chemical dopamine.

Some recent studies have also suggested that nicotine can help alleviate ADHD symptoms.

It's possible, Wilens said, that some young people with ADHD are using cigarettes as a way to self-medicate.

The bottom line for parents of children with ADHD, he noted, is that they should discuss the importance of not smoking with their children, and make sure that their ADHD symptoms are minimized to the extent possible.

Parents should also be aware of the environmental factors that push some kids to smoke, Wilens pointed out. "If parents smoke, themselves," he said, "they should certainly stop."

SOURCE: Journal of Pediatrics, September 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - Breastfeeding may have a positive influence on behavior in early childhood, according to results of a study presented Wednesday at the American Public Health Association's annual meeting in San Diego.

In the study, parents of 1- to 5-year-old children who were breastfed as infants were 15 percent less likely to report concern for the child's behavior than parents of kids who were not breastfed.

In addition, breastfed children were 37 percent less likely to have doctor-diagnosed behavior or conduct problems or to have received mental health care.

The findings -- based on more than 100,000 interviews with parents or guardians on the health of their children conducted as part of the 2003 National Survey of Children's Health -- also support studies that have showed that breastfeeding enhances intellectual ability in children.

Specifically, parents of breastfed children were 23 percent less apt to report concern about their child's ability to learn, according to study presenter and lead researcher Dr. Katherine Hobbs Knutson from Massachusetts General Hospital, Boston.

"Although correlations between breastfeeding and childhood cognition are well supported by research, our findings provide new evidence for a lesser understood issue of whether breastfeeding may also influence childhood emotional development," Knutson told Reuters Health.

"Our research is promising, indicating that human milk may be protective against childhood behavioral disorders," she concluded.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - African Americans with heart disease are as likely to suffer from depression as their white counterparts, but they are less likely to be on medication for it, a new study suggests.

The study of 864 adults with coronary heart disease found that 35 percent of African Americans and 27 percent of whites had symptoms of depression. Yet black patients were less than half as likely to be on an antidepressant medication.

The findings are important, the researchers say, because depression in people with heart disease has been linked to a two- to four-fold higher risk of complications.

Studies have found that depressed heart disease patients have higher risks of a heart attack or stroke, and may die earlier than those without depression.

"Undertreatment of depression is a serious clinical issue," Dr. James Blumenthal, one of researchers on the current study, said in a statement.

These latest findings suggest that black heart patients, in particular, need better diagnosis and treatment of depression, according to Blumenthal and his colleagues at Duke University Medical Center in Durham, North Carolina.

The study included 727 white patients and 137 black patients seen at Duke for coronary heart disease. All completed a standard questionnaire used to screen for depression.

Blumenthal's team found that depression was similarly common among black and white patients, and the severity of their symptoms was comparable as well.

However, while 21 of depressed white patients were on an antidepressant, only 12 percent of black patients were.

The difference was greatest among men; 43 percent of moderately to severely depressed white men were taking an antidepressant, versus 22 percent of their black counterparts.

The researchers are not sure why the racial disparity exists. They lacked information on the study patients' health insurance, so it's not possible to tell whether differences in coverage are a factor. Nor do they know whether doctors were less likely to prescribe to black patients, or whether African Americans were less likely to want an antidepressant.

Blumenthal pointed out that therapies other than antidepressants may be helpful for heart disease patients' depression. He is currently conducting a study comparing aerobic exercise with drugs in treating depression.

"We clearly need to do a better job of recognizing and treating depression, especially in heart patients," Blumenthal said. "We need treatments that work, treatments that are acceptable to patients, and treatments that are actually incorporated into medical practice."

SOURCE: American Heart Journal, October 2008.

Copyright © 2008 Reuters Limited.

NEW YORK (Reuters Health) - A diagnosis of multiple sclerosis (MS) may be delayed in people who are obese or in those with conditions such as diabetes, high blood pressure or high cholesterol, research indicates. As a result, these patients are prone to greater disability once the neurologic condition is recognized, the researchers say.

"Our study suggests that doctors who treat people with chronic diseases should not attribute new neurological symptoms, such a numbness and tingling, to existing conditions without careful consideration," study chief Dr. Ruth Ann Marrie noted in a written statement.

Marrie, from the University of Manitoba in Winnipeg, Canada, and colleagues examined the records of 8,983 people who had been diagnosed with MS.

They found that it took 1 to 10 years longer for people who were obese, smoked, or had physical or mental health conditions to be diagnosed with MS compared to people without these conditions.

They also found that the more medical problems a person with MS had, the more severe the disease had become by the time they were diagnosed.

People with blood vessel problems or who were obese were "about one-and-a-half times more likely to be moderately disabled at the time of diagnosis compared with those who had MS but did not have any heart or weight problems," Marrie noted. "People who had a mental disorder or any muscle or joint problem along with MS were nearly two times more likely to be severely disabled at the time of diagnosis."

Pre-existing conditions like high blood pressure and diabetes are common in the United States and can mask symptoms of a new disease or affect access to care. "People with multiple medical problems on top of MS may need more healthcare resources or might respond differently to medication," Marrie said. "This needs more study."

SOURCE: Neurology, online October 29, 2008.

Copyright © 2008 Reuters Limited.