October 30, 2007

2007 NCE Attendance Breaks Previous Record
Pediatricians Can Help Prevent Drug Abuse Among Adolescents
Children with Autism Benefit From Early Intervention
Plenary to Look at Use of Probiotics to Treat Bowel Diseases

2007 NCE Attendance Breaks Previous Record

The previous record of professional and overall attendance for a National Conference & Exhibition has been surpassed. Those figures were set during the 2002 NCE in Boston. As of the end of day Monday, professional attendance was at 6,434 and overall attendance was at 11,141, reflecting a 4% growth in overall attendance over the past record.

The NCE Planning Group is thrilled with this result. “This is a successful measure of the educational programming and general planning that takes place throughout the year. We’re very happy to see it culminate into such a great experience,” said Robert Perelman, MD, FAAP, Associate Executive Director/Director, Department of Education.

This year’s education and plenary sessions have been widely attended in both the San Francisco Marriott and Moscone, and most workshops were sold out. Pediatricians also enjoyed visiting with the exhibitors and dialoguing over new product information and development.

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Pediatricians Can Help Prevent Drug Abuse Among Adolescents

Alcohol and drug abuse in adolescence has long-term consequences on survival not only in the teenage years but also throughout life. Pediatricians are in a unique position to help prevent those consequences by intervening to stop substance abuse before it becomes a problem.

“We know from medical histories that the most effective intervention that we can do is prevention, and in order to prevent substance abuse successfully, we have to start in childhood,” said Nora D. Volkow, MD, director of the National Institute on Drug Abuse at the National Institutes of Health, who gave a Plenary Session address Monday titled “Adolescents — The Critical Focus in Substance Abuse Prevention.”

“Pediatricians, you have an extraordinary opportunity — and I would be bold enough to say a responsibility — to evaluate for drug abuse in your children and adolescents because an early intervention will have a lasting effect on those children and adolescents who stop taking drugs,” Dr Volkow said.

“I encourage you to become much more proactive in evaluating the pattern of drug use in your patients. And even if you are not concerned about abuse and addiction, it will improve the outcome for other medical conditions that are directly affected negatively by the use of drugs,” she added.

Studies have shown that at least 70 percent of all adolescents have experienced alcohol intoxication while in high school, and more than 50 percent of high school students have tried cigarettes at one point in their lives.

Abuse of other drugs is also prevalent among adolescents. Marijuana use ranks highest among 12th graders, according to one study, with more than 30 percent having used this drug. Next highest is the prescription drug Vicodin, followed by amphetamines, cough medications and sedatives.

However, drug abuse among adolescents is shifting away from the use of marijuana to greater abuse of prescription drugs.

“These are becoming the fasting-growing drugs of abuse in our country,” Dr Volkow said. “Experience with these drugs can have catastrophic consequences, whether the drugs are legal or illegal, as has been seen in the incidences of overdosing, incidences of accidents while intoxicated and the increasing rate of infection with sexually transmitted diseases.”

Drug addiction is a developmental disease that begins in adolescence and childhood, she noted.

“If an individual has not experimented with drugs and has not become addicted before age 21, the likelihood of becoming addicted is very low,” Dr Volkow said.

Many drugs of abuse, such as amphetamines and cocaine, increase dopamine levels in the nucleus accumbens of the brain. The dopaminergic effects of these drugs are greater in adolescent brains than in adult brains, producing more intense highs.

Maturation of the brain does not occur until early adulthood, and adolescents tend to experience life in more intense ways, engage in more risky behaviors and experience greater sexual arousal than adults, Dr Volkow said.

Adolescent brains are also more sensitive to the effects of nicotine and marijuana. Nicotinic and cannabinoid receptors in the brain are important factors in brain development, and stimulation of these receptors is likely to affect brain development in adolescents, she said.

Drug abuse and addiction are affected by both genetics and the environment, Dr Volkow noted. Adverse childhood experiences, such as sexual or physical abuse or neglect, can significantly increase the risk of drug abuse and addiction in adolescence and later in life.

Genetic factors account for an estimated 50 percent of the reasons individuals become addicted. Genetic variations partly determine an individual’s susceptibility to addiction. With the emergence of new genetic technologies, the ability to identify genes responsible for addictions could lead to new drug therapies.

Dr Volkow concluded that “Prevention strategies work.” She cited a study of marijuana abuse among 12th graders from 1975 to 2003 showing that use goes down as prevention efforts are increased.

Making adolescents aware of the dangers of taking drugs “can have a big impact in minimizing the risk of using them,” she said, adding that pediatricians have an important role to play by evaluating adolescents for drug use and counseling them about avoiding drugs.

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Children with Autism Benefit From Early Intervention

Early recognition and intervention for children with autism can significantly improve outcomes for these children. Indeed, some 30 to 40 percent who receive early interventions may be able to achieve normal function in a regular classroom, even though they still retain some symptoms of the disorder.

So said Chris P. Johnson, MD, MEd, FAAP, clinical professor of pediatrics at the University of Texas Health Sciences Center in San Antonio and co-chair of the AAP Autism Expert Panel, who spoke about “Autism Spectrum Disorders: What’s New and What to Do?” at Monday’s Plenary Session.

AAP is publishing new clinical guidelines for the identification and management of autism spectrum disorders (ASDs) in the November issue of Pediatrics, Dr Johnson said. The guidelines call for universal screening for ASDs among pediatric patients.

Autism is common in children, affecting about 1 in 150 in the United States. “We now know that there are, indeed, clinical signs that can and do occur in infancy. We know through research among cohorts of children who have the opportunity to participate in early intervention that there is an improved prognosis in many of these children,” she said.

“We suggest that you do autism surveillance screening at every well-child check and then screen all children at every 18-month and 24-month well-child check and, of course, whenever there are signs of a social skill deficit or a language deficit,” Dr Johnson explained.

“We also suggest increased vigilance in the younger siblings of children already diagnosed with autism because they have a 10 times increased risk of also developing autism,” she added.

In addition to having an older sibling or family member already diagnosed with ASD, the risk factors for autism include parental concerns about the child’s social, language and behavioral skills, or similar concerns from a caretaker or the pediatrician.

Studies have revealed some subtle signs of autism in infants in the first two years of life, “such as not responding to one’s name when called, not pointing or following a point when the parents do so, lack of to-and-fro babbling,” Dr Johnson said. “These are just a few of the signs we are beginning to learn about.”

AAP is making available an ASD toolkit that includes a poster listing developmental milestones that pediatricians can post for parents, as well as a brochure for parents about childhood development milestones and questionnaires to help determine risk factors for autism.

“The key thing in screening is to try to determine how many risk factors a child has,” Dr Johnson noted.

The number of risk factors helps determine the screening strategies a pediatrician should use. For example, if the child has one risk factor and is 18 months or older, pediatricians may give an appropriate developmental screening test, such as the M-CHAT (Modified Checklist for Autism in Toddlers).

There are currently no specific screening tests for infants under 18 months, but several are under development.

For infants and children found to be at high risk for autism, pediatricians are urged, first, to provide parents with educational materials about the disorder. Then, refer the child simultaneously to three places: an autism diagnostic clinic, an early intervention program if the child is under three years old or to a school program if the child is three or older, and an audiologist for a hearing test.

In the management of autism, “pediatricians don’t play as important a role as the therapists, the teachers, the behavioral therapists,” Dr Johnson said.

However, the clinical guidelines to be published next month contain information about the medications used for autism and alternative and complementary therapies.

“Most importantly, we want to encourage you as general pediatricians to continue to take care of these children in their medical home. We know that the diagnosis of autism can be a little scary because we don’t always feel very comfortable,” Dr Johnson said.

It can be challenging to care for children with autism that have acute illnesses or comorbidities, such as seizures or sleep disorders, especially when they are not verbal, she said. However, early recognition and intervention for autism can greatly improve the outlook for these children.

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Plenary to Look at Use of Probiotics to Treat Bowel Diseases

The promise of the safe use of probiotics in the treatment of bowel diseases in children will be addressed during the Tuesday plenary session, “Hot Topics in Infectious Diseases.”

Philip Sherman, MD, FRCPC, professor of pediatrics, microbiology and dentistry at the Hospital for Sick Children, University of Toronto, will present “Probiotics in Gastrointestinal Health: What You Need to Know in the Appraisal of the Evidence of Efficacy of Probiotics.” The presentation will be during Tuesday’s plenary presentation, from 9:20 to 9:40 am in the San Francisco Marriott’s Yerba Buena Ballroom.

Great strides have been made by researchers in the use of priobiotics, Dr Sherman said, but more trials will be needed in the next few years before treatments will make their way into common use. During the session, he will explain what probiotics are, and describe the level of evidence supporting their use in a variety of gastrointestinal disorders and how they mediate their biologic effects.

“I am going to consider meta analyses showing that probiotics are effective for use in children, but there are still a lot of unanswered questions,” Dr Sherman said. “I will address how they work, how much to give, what combination to give and how safe they are, particularly in vulnerable children.

“I will show work from my laboratory describing how probiotics work in preventing passage into disease in a cell-culture model and in animal models.”

Even with all the advances, there is still a long road to travel to the general use of probiotics, Dr Sherman said.

“My conclusion is that probiotics are not quite ready for prime time and that the therapeutic possibilities of manipulating the bowel flora are just beginning to reach clinical development,” he said. “I am optimistic that in the next decade they will come into clinical use, with a little bit of caution.”

Of interest to pediatricians is the caution Dr Sherman said must be followed before probiotics can be used in children.

“Especially with premature babies, newborns and children with primary immune deficiencies there is concern that they might be more at risk for exposure to live bacteria,” he said. “With new therapies, extra caution is always required.

“But this being said, probiotics have been used in the newborn period to prevent necrotizing entercolitis. There are some very promising studies suggesting that probiotics might not only be effective, but safe. We just need more evidence,” Dr Sherman said.

Phase one trials for probiotics have been completed in humans and phase two trials are now going on in adults, but Dr Sherman sees an eventual move to the use of genetically modified probiotics in the “not too distant future.”

“The future is going to be in genetically modified probiotics that are specially designed to provide extra therapeutic benefits,” he said. “The way of the future will probably not be with currently available probiotics, but ones that have been modified, for example, to promote anti-inflammatory effects in the gut.”

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