U.S. Poison Control Center Calls for Infants 0-6 Months Old

This article concerned a retrospective study on poison control center calls about infants aged 0 to 6 months.  The study used data from the National Poison Data System that combines all the electronic records of all the United States Poison Control Centers.  The study was conducted to explore the reason behind the majority of poison center calls made for infants in the first six months of their lives.  Infants at that stage of development have very little mobility, reducing the possibility of poisoning by exploration, a common cause for poisoning of infants and toddlers older than six months of age.  This rationale would indicate that poisoning caused by a mistake of a caregiver is more common in younger infants than it is in infants and toddlers older than six months of age.  Many programs for young parents that address the issue of poisoning focus on the need to keep dangerous substances out of reach of children, but the instances of caregiver mistakes in poisoning events of infants 0-6 months old would not be prevented by keeping medicines inaccessible to the infants.  Also, most of these programs do not begin poison education before children reach six months of age anyways.  The results of the study presented a couple key takeaways.  One of the results was that 97.5% of poisoning events for this age group originated in people’s homes, whereas only 85.2% of the phone calls made about these events originated in people’s homes, with others originating from health care facilities, meaning some caregivers travelled to a health care facility before contacting a Poison Control Center.  Additionally, the percentage of calls made for unintentional poisonings by the caregiver for this early infant age range was a large proportion of the total poisonings for this age range, of which there were numerous recorded over the 10-year (2004-2013) period of the study.

I believe that early education of parents about the resource of Poison Control Centers and about how to properly use medications in infants would prevent many of the poisoning events that occur in the age group of infants 0-6 months old.  The study also concluded that increased education concerning PCC’s and proper infant medical care to parents before they leave the nursery at the hospital would eradicate many of the poisoning occurrences in this age group.  What do you think the best approach to reducing poisoning of infants aged 0-6 months in the United States is?

Kang AM, Brooks DE. US Poison Control Center Calls for Infants 6 Months of Age and Younger. Pediatrics. 2016;137:1-7.

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Use of Sildenafil in term and premature infants for pulmonary hypertension

Sildenafil is more commonly being used to treat pulmonary hypertension in term and premature infants. However, the FDA has only approved this use in adults. Controlled trials that studied the efficacy of sildenafil use in term and premature infants with hypertension as well as premature infants at risk for developing bronchopulmonary dysplasia (BPD) were reviewed in a review article.

The researchers from the review article designed their study to answer two main questions: Does sildenafil use improve in-hospital mortality in term infants with pulmonary hypertension or premature infants with BPD-associated pulmonary hypertension compared with placebo or inhaled nitric oxide? Does sildenafil use in premature infants prevent or treat BPD as defined by oxygen requirement at 36 weeks’ corrected gestational age (GA)? Primary studies were found using a literature search of MEDLINE, PubMed, EMBASE, Cochrane Library, and International Pharmaceutical Abstracts databases. Studies with a focus on these questions were selected if they included term or near-term infants with pulmonary hypertension and previous exposure to sildenafil or premature infants at risk for BPD or who had BPD-associate pulmonary hypertension. Also, studies that compared efficacy of sildenafil to a placebo or inhaled nitric oxide, but not other therapies, were analyzed. The selected studies were reviewed by two people who assessed the quality of the study, research design, analysis, and results.

Of 4 articles and 1abstract reviewed, 3 articles and the abstract looked at the use of sildenafil for term or near-term infants. The other article studied sildenafil use in premature infants. Sildenafil was dosed in a range of 1mg/kg every 8 hours to 3mg/kg every 6 hours in all the trials. The results of all the trials recorded oxygen index and death. Oxygen index was seen to improve 6-8 hours after sildenafil administration whereas little to no improvement was seen after placebo administration. Combing participants from 3 of the trials, 3 of 51 infants taking sildenafil died before hospital discharge. In contrast, 16 of 37 infants receiving placebo died. In conclusion, term infants exposed to sildenafil had a relatively low mortality risk. However, although sildenafil improved oxygen index in the trials, there are still no guidelines available for dosing sildenafil in term and premature infants.

 

Clin Ther. 2015;37(11):2598-2607.

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This article made me think back to pediatric calculations with Dr. Howrie in PDA. Although this review article finds evidence to suggest that sildenafil is effective and potentially safe in infants, its use should still be utilized carefully. Dosing must dramatically be reduced for infants who have yet to develop complete organ function, especially for premature infants. While reading this article, a question about dosage form in infants came to my mind. Do you think IV is the best dosage form compared to oral or inhaled therapies to use to treat infants nfants because of their inadequate organ function?