AM 37 - JAN 1

506 Pages·2002·9.03 MB·English

Pediatrics (Journal of American Academy of Pediatrics)

January 2007 | Volume 119 | Issue(pp.1-227)(1

ARTICLES
Accuracy and Interpretation of Rapid Influenza Tests in Children
Carlos G. Grijalva, Katherine A. Poehling, Kathryn M. Edwards, Geoffrey A. Weinberg, Mary A. Staat, Marika
K. Iwane, William Schaffner, and Marie R. Griffin
Pediatrics 2007; 119: e6-e11.

Cost-Effectiveness of Routine Childhood Vaccination for Hepatitis A in the United States
David B. Rein, Katherine A. Hicks, Kathleen E. Wirth, Kaafee Billah, Lyn Finelli, Anthony E. Fiore, Thomas
J. Hoerger, Beth P. Bell, and Gregory L. Armstrong
Pediatrics 2007; 119: e12-e21.

The Economics of Routine Childhood Hepatitis A Immunization in the United States: The
Impact of Herd Immunity
Gregory L. Armstrong, Kaafee Billah, David B. Rein, Katherine A. Hicks, Kathleen E. Wirth, and Beth P. Bell
Pediatrics 2007; 119: e22-e29.

Is Dieting Advice From Magazines Helpful or Harmful? Five-Year Associations With Weight-
Control Behaviors and Psychological Outcomes in Adolescents
Patricia van den Berg, Dianne Neumark-Sztainer, Peter J. Hannan, and Jess Haines
Pediatrics 2007; 119: e30-e37.

Childhood Mental Ability in Relation to Food Intake and Physical Activity in Adulthood: The
1970 British Cohort Study
G. David Batty, Ian J. Deary, Ingrid Schoon, and Catharine R. Gale
Pediatrics 2007; 119: e38-e45.

The Status of Academic General Pediatrics: No Longer Endangered?
Tina L. Cheng, Diane Markakis, and Thomas G. DeWitt
Pediatrics 2007; 119: e46-e52.

The Use of the World Wide Web by Medical Journals in 2003 and 2005: An Observational
Study
David L. Schriger, Sripha Ouk, and Douglas G. Altman
Pediatrics 2007; 119: e53-e60.

Infection in the First 2 Years of Life and Autism Spectrum Disorders
Nila J. Rosen, Cathleen K. Yoshida, and Lisa A. Croen
Pediatrics 2007; 119: e61-e69.

To What Extent Do Pediatricians Accept Computer-Based Dosing Suggestions?
Brigid K. Killelea, Rainu Kaushal, Mary Cooper, and Gilad J. Kuperman
Pediatrics 2007; 119: e69-e75.

Clinical Disease in Children Associated With Newly Described Coronavirus Subtypes
Jane Kuypers, Emily T. Martin, Judson Heugel, Nancy Wright, Rhoda Morrow, and Janet A. Englund
Pediatrics 2007; 119: e70-e76.
Prevention of Pediatric Medication Errors by Hospital Pharmacists and the Potential Benefit
of Computerized Physician Order Entry
Jerome K. Wang, Nicole S. Herzog, Rainu Kaushal, Christine Park, Carol Mochizuki, and Scott R.
Weingarten
Pediatrics 2007; 119: e77-e85.

Caregiver Health Literacy and the Use of Child Health Services
Lee M. Sanders, Valerie T. Thompson, and James D. Wilkinson
Pediatrics 2007; 119: e86-e92.

At What Age Can Children Report Dependably on Their Asthma Health Status?
Lynn M. Olson, Linda Radecki, Mary Pat Frintner, Kevin B. Weiss, Jon Korfmacher, and Robert M. Siegel
Pediatrics 2007; 119: e93-e102.

A National Assessment of Knowledge, Attitudes, and Confidence of Prehospital Providers in
the Assessment and Management of Child Maltreatment
David Markenson, Michael Tunik, Arthur Cooper, Lenora Olson, Lawrence Cook, Hedda Matza-Haughton,
Marsha Treiber, William Brown, Phil Dickinson, and George Foltin
Pediatrics 2007; 119: e103-e108.

The Effects of Oxandrolone and Exercise on Muscle Mass and Function in Children With
Severe Burns
Rene Przkora, David N. Herndon, and Oscar E. Suman
Pediatrics 2007; 119: e109-e116.

Pediatrician Characteristics Associated With Attention to Spirituality and Religion in Clinical
Practice
Daniel H. Grossoehme, Judith R. Ragsdale, Christine L. McHenry, Celia Thurston, Thomas DeWitt, and
Larry VandeCreek
Pediatrics 2007; 119: e117-e123.

Lactobacillus reuteri (American Type Culture Collection Strain 55730) Versus Simethicone
in the Treatment of Infantile Colic: A Prospective Randomized Study
Francesco Savino, Emanuela Pelle, Elisabetta Palumeri, Roberto Oggero, and Roberto Miniero
Pediatrics 2007; 119: e124-e130.

Improvement in Booster Seat Use in Tennessee
Veronica L. Gunn, Rhonda M. Phillippi, and William O. Cooper
Pediatrics 2007; 119: e131-e136.

Breastfeeding and Infant Eczema in the First Year of Life in the KOALA Birth Cohort Study: A
Risk Period–Specific Analysis
Bianca E. P. Snijders, Carel Thijs, Ischa Kummeling, John Penders, and Piet A. van den Brandt
Pediatrics 2007; 119: e137-e141.

Physician Advice About Being Overweight: Association With Self-Reported Weight Loss,
Dietary, and Physical Activity Behaviors of US Adolescents in the National Health and
Nutrition Examination Survey, 1999–2002
Ashima K. Kant and Patricia Miner
Pediatrics 2007; 119: e142-e147.
Identification of Overweight Status Is Associated With Higher Rates of Screening for
Comorbidities of Overweight in Pediatric Primary Care Practice
Kimberley J. Dilley, Lisa A. Martin, Christine Sullivan, Roopa Seshadri, Helen J. Binns for the Pediatric
Practice Research Group
Pediatrics 2007; 119: e148-e155.

Revalidation of the Score for Neonatal Acute Physiology in the Vermont Oxford Network
John A. F. Zupancic, Douglas K. Richardson, Jeffrey D. Horbar, Joseph H. Carpenter, Shoo K. Lee, Gabriel J.
Escobar, and Vermont Oxford Network SNAP Pilot Project Participants
Pediatrics 2007; 119: e156-e163.

Prevention of Necrotizing Enterocolitis in Preterm Infants: A 20-Year Experience
Jeff Pietz, Babu Achanti, Lawrence Lilien, Erin Clifford Stepka, and Sudhir Ken Mehta
Pediatrics 2007; 119: e164-e170.

Cord Blood Cytokines and Acute Lower Respiratory Illnesses in the First Year of Life
Ngoc P. Ly, Sheryl L. Rifas-Shiman, Augusto A. Litonjua, Arthur O. Tzianabos, Bianca Schaub, Begoña Ruiz-
Pérez, Kelan G. Tantisira, Patricia W. Finn, Matthew W. Gillman, Scott T. Weiss, and Diane R. Gold
Pediatrics 2007; 119: e171-e178.

Antipolyribosyl Ribitol Phosphate Response of Premature Infants to Primary and Booster
Vaccination With a Combined Diphtheria-Tetanus-Acellular Pertussis-Hepatitis B-
Inactivated Polio Virus/Haemophilus influenzae Type b Vaccine
Felix Omeñaca, José Garcia-Sicilia, Pilar García-Corbeira, Reyes Boceta, and Victorio Torres
Pediatrics 2007; 119: e179-e185.

Hopeful Thinking and Level of Comfort Regarding Providing Pediatric Palliative Care: A
Survey of Hospital Nurses
Chris Feudtner, Gina Santucci, James A. Feinstein, C. Rick Snyder, Mary T. Rourke, and Tammy I. Kang
Pediatrics 2007; 119: e186-e192.

Use of Serologic Markers as a Screening Tool in Inflammatory Bowel Disease Compared With
Elevated Erythrocyte Sedimentation Rate and Anemia
Nasim Sabery and Dorsey Bass
Pediatrics 2007; 119: e193-e199.

Sleep Arrangements and Behavior of Bed-Sharing Families in the Home Setting
Sally A. Baddock, Barbara C. Galland, Barry J. Taylor, and David P.G. Bolton
Pediatrics 2007; 119: e200-e207.

Barriers to the Identification and Management of Psychosocial Issues in Children and
Maternal Depression
Sarah McCue Horwitz, Kelly J. Kelleher, Ruth E.K. Stein, Amy Storfer-Isser, Eric A. Youngstrom, Elyse R.
Park, Amy M. Heneghan, Peter S. Jensen, Karen G. O'Connor, and Kimberly Eaton Hoagwood
Pediatrics 2007; 119: e208-e218.

Potential for Donation After Cardiac Death in a Children's Hospital
Amy L. Durall, Peter C. Laussen, and Adrienne G. Randolph
Pediatrics 2007; 119: e219-e224.

Early Life Exposure to Antibiotics and the Subsequent Development of Eczema, Wheeze, and
Allergic Sensitization in the First 2 Years of Life: The KOALA Birth Cohort Study
Ischa Kummeling, Foekje F. Stelma, Pieter C. Dagnelie, Bianca E. P. Snijders, John Penders, Machteld
Huber, Ronald van Ree, Piet A. van den Brandt, and Carel Thijs
Pediatrics 2007; 119: e225-e231.
XXY (Klinefelter Syndrome): A Pediatric Quantitative Brain Magnetic Resonance Imaging
Case-Control Study
Jay N. Giedd, Liv S. Clasen, Gregory L. Wallace, Rhoshel K. Lenroot, Jason P. Lerch, Elizabeth Molloy Wells,
Jonathan D. Blumenthal, Jean E. Nelson, Julia W. Tossell, Catherine Stayer, Alan C. Evans, and Carole A.
Samango-Sprouse
Pediatrics 2007; 119: e232-e240.

Pulmonary Endostatin Perinatally and in Lung Injury of the Newborn Infant
Joakim Janér, Sture Andersson, Caj Haglund, and Patrik Lassus
Pediatrics 2007; 119: e241-e246.

SunSafe in the Middle School Years: A Community-wide Intervention to Change Early-
Adolescent Sun Protection
Ardis L. Olson, Cecelia Gaffney, Pamela Starr, Jennifer J. Gibson, Bernard F. Cole, and Allen J. Dietrich
Pediatrics 2007; 119: e247-e256.

The Effect of Birth in Secondary- or Tertiary-Level Hospitals in Finland on Mortality in Very
Preterm Infants: A Birth-Register Study
Liisi Rautava, Liisa Lehtonen, Mikko Peltola, Emmi Korvenranta, Heikki Korvenranta, Miika Linna, Mikko
Hallman, Sture Andersson, Mika Gissler, Jaana Leipälä, Outi Tammela, Unto Häkkinen for the PERFECT
Preterm Infant Study Group
Pediatrics 2007; 119: e257-e263.

The Role of CYP2A6 in the Emergence of Nicotine Dependence in Adolescents
Janet Audrain-McGovern, Nael Al Koudsi, Daniel Rodriguez, E. Paul Wileyto, Peter G. Shields, and Rachel F.
Tyndale
Pediatrics 2007; 119: e264-e274.

A Randomized, Controlled Trial of Heparin Versus Placebo Infusion to Prolong the Usability
of Peripherally Placed Percutaneous Central Venous Catheters (PCVCs) in Neonates: The HIP
(Heparin Infusion for PCVC) Study
Prakesh S. Shah, Angela Kalyn, Prakash Satodia, Michael S. Dunn, Boriana Parvez, Alan Daneman, Shia
Salem, Phyllis Glanc, Arne Ohlsson, and Vibhuti Shah
Pediatrics 2007; 119: e284-e291.

Will Pediatricians Adopt the New Rotavirus Vaccine?
Allison Kempe, Matthew F. Daley, Umesh D. Parashar, Lori A. Crane, Brenda L. Beaty, Shannon Stokley,
Jennifer Barrow, Christine Babbel, L. Miriam Dickinson, Marc-Alain Widdowson, James P. Alexander, and
Stephen Berman
Pediatrics 2007; 119: 1-10.

Efficacy, Immunogenicity, and Safety of a Pentavalent Human-Bovine (WC3) Reassortant
Rotavirus Vaccine at the End of Shelf Life
Stan L. Block, Timo Vesikari, Michelle G. Goveia, Stephen B. Rivers, Ben A. Adeyi, Michael J. Dallas, Jeffrey
Bauder, John W. Boslego, Penny M. Heaton for the Pentavalent Rotavirus Vaccine Dose Confirmation
Efficacy Study Group
Pediatrics 2007; 119: 11-18.

Cystic Fibrosis Diagnosed After 2 Months of Age Leads to Worse Outcomes and Requires
More Therapy
Erika J. Sims, Allan Clark, Jonathan McCormick, Gita Mehta, Gary Connett, Anil Mehta on behalf of the
United Kingdom Cystic Fibrosis Database Steering Committee
Pediatrics 2007; 119: 19-28.
No Improvement in Outcome of Nationwide Extremely Low Birth Weight Infant Populations
Between 1996–1997 and 1999–2000
Viena Tommiska, Kirsti Heinonen, Liisa Lehtonen, Martin Renlund, Timo Saarela, Outi Tammela, Martti
Virtanen, and Vineta Fellman
Pediatrics 2007; 119: 29-36.

Improved Neurodevelopmental Outcomes for Extremely Low Birth Weight Infants in 2000–
2002
Deanne Wilson-Costello, Harriet Friedman, Nori Minich, Bonnie Siner, Gerry Taylor, Mark Schluchter, and
Maureen Hack
Pediatrics 2007; 119: 37-45.

Is a "Wage-Payment" Model for Research Participation Appropriate for Children?
Stephen J. Bagley, William W. Reynolds, and Robert M. Nelson
Pediatrics 2007; 119: 46-51.

Effects of Selective Serotonin Reuptake Inhibitors and Venlafaxine During Pregnancy in
Term and Preterm Neonates
Ema Ferreira, Ana Maria Carceller, Claire Agogué, Brigitte Zoé Martin, Martin St-André, Diane Francoeur,
and Anick Bérard
Pediatrics 2007; 119: 52-59.

Low-Income Uninsured Children With Special Health Care Needs: Why Aren't They Enrolled
in Public Health Insurance Programs?
Jennifer Haley and Genevieve Kenney
Pediatrics 2007; 119: 60-68.

Binge Drinking and Associated Health Risk Behaviors Among High School Students
Jacqueline W. Miller, Timothy S. Naimi, Robert D. Brewer, and Sherry Everett Jones
Pediatrics 2007; 119: 76-85.

Adverse Associations of Sleep Problems in Australian Preschoolers: National Population
Study
Harriet Hiscock, Louise Canterford, Obioha C. Ukoumunne, and Melissa Wake
Pediatrics 2007; 119: 86-93.

Pediatric Hospital and Intensive Care Unit Capacity in Regional Disasters: Expanding
Capacity by Altering Standards of Care
Robert K. Kanter and John R. Moran
Pediatrics 2007; 119: 94-100.

Adolescent Depression Screening in Primary Care: Feasibility and Acceptability
Rachel A. Zuckerbrot, Laura Maxon, Dana Pagar, Mark Davies, Prudence W. Fisher, and David Shaffer
Pediatrics 2007; 119: 101-108.
EXPERIENCE & REASON
T-Cell–Based Diagnosis of Neonatal Multidrug-Resistant Latent Tuberculosis Infection
Luca Richeldi, Katie Ewer, Monica Losi, Barbara M. Bergamini, Kerry Millington, Leonardo M. Fabbri, and
Ajit Lalvani
Pediatrics 2007; 119: e1-e5.
Mycoplasma pneumoniae, Splenic Infarct, and Transient Antiphospholipid Antibodies: A
New Association?
Char M. Witmer, Andrew P. Steenhoff, Samir S. Shah, and Leslie J. Raffini
Pediatrics 2007; 119: e292-e295.

First Report of Autologous Cord Blood Transplantation in the Treatment of a Child With
Leukemia
Ammar Hayani, Eberhard Lampeter, David Viswanatha, David Morgan, and Sharad N. Salvi
Pediatrics 2007; 119: e296-e300.

An Unusual Case of Severe Therapy-Resistant Hypertension in a Newborn
Stefan G. Kiessling, Nitin Wadhwa, Vesna M. Kriss, Joseph Iocono, and Nirmala S. Desai
Pediatrics 2007; 119: e301-e304.
STATE-OF-THE-ART REVIEW ARTICLES
New Developments in the Treatment of Hypoplastic Left Heart Syndrome
Bahaaldin Alsoufi, Jayme Bennetts, Subodh Verma, and Christopher A. Caldarone
Pediatrics 2007; 119: 109-117.
REVIEW ARTICLES
Adverse Events Associated With Pediatric Spinal Manipulation: A Systematic Review
Sunita Vohra, Bradley C. Johnston, Kristie Cramer, and Kim Humphreys
Pediatrics 2007; 119: e275-e283.

Will Esophageal Impedance Replace pH Monitoring?
Yvan Vandenplas, Silvia Salvatore, Mario C. Vieira, and Bruno Hauser
Pediatrics 2007; 119: 118-122.
SPECIAL ARTICLES
Legal and Ethical Considerations: Risks and Benefits of Postpartum Depression Screening at
Well-Child Visits
Linda H. Chaudron, Peter G. Szilagyi, Amy T. Campbell, Kyle O. Mounts, and Thomas K. McInerny
Pediatrics 2007; 119: 123-128.
COMMENTARIES
Identifying Children With Autism Early?
Vidya Bhushan Gupta, Susan L. Hyman, Chris Plauché Johnson, James Bryant, Barbara Byers, Ronald
Kallen, Susan E. Levy, Scott M. Myers, Alan I. Rosenblatt, and Marshalyn Yeargin-Allsopp
Pediatrics 2007; 119: 152-153.

Stimulant-Drug Therapy for Attention-Deficit Disorder (With or Without Hyperactivity) and
Sudden Cardiac Death
Matthew Knight
Pediatrics 2007; 119: 154-155.

The Meaning of "Early" Diagnosis in a New Era of Cystic Fibrosis Care
Philip M. Farrell
Pediatrics 2007; 119: 156-157.
The Limits of Viability and the Uncertainty of Neuroprotection: Challenges in Optimizing
Outcomes in Extreme Prematurity
Michael E. Msall
Pediatrics 2007; 119: 158-160.
FROM THE AMERICAN ACADEMY OF PEDIATRICS
Access to Optimal Emergency Care for Children
Committee on Pediatric Emergency Medicine
Pediatrics 2007; 119: 161-164.

Cord Blood Banking for Potential Future Transplantation
Section on Hematology/Oncology and Section on Allergy/Immunology
Pediatrics 2007; 119: 165-170.

Prevention of Rotavirus Disease: Guidelines for Use of Rotavirus Vaccine
Committee on Infectious Diseases
Pediatrics 2007; 119: 171-182.

The Importance of Play in Promoting Healthy Child Development and Maintaining Strong
Parent-Child Bonds
Kenneth R. Ginsburg, and the Committee on Communications and the Committee on Psychosocial Aspects
of Child and Family Health
Pediatrics 2007; 119: 182-191.

Preventing and Treating Homesickness
Christopher A. Thurber, Edward Walton and the Council on School Health
Pediatrics 2007; 119: 192-201.

Office-Based Counseling for Unintentional Injury Prevention
H. Garry Gardner and the Committee on Injury, Violence, and Poison Prevention
Pediatrics 2007; 119: 202-206.

Recommended Immunization Schedules for Children and Adolescents—United States, 2007
Committee on Infectious Diseases
Pediatrics 2007; 119: 207-208.
LETTERS TO THE EDITOR
Intratracheal Sildenafil in the Newborn With Pulmonary Hypertension
Miguel Martell, Fernanda Blasina, Fernando Silvera, Salvador Tellechea, Carolina Godoy, Lucía Vaamonde,
Luana Benenatti, and Walter Olivera
Pediatrics 2007; 119: 215-216.

Intratracheal Sildenafil in the Newborn With Pulmonary Hypertension: In Reply
Hernando Baquero and Augusto Sola
Pediatrics 2007; 119: 216.

The Need to Assess Benefits and Not Just Risks of 100% Oxygen for Newborn Resuscitation
Henry J. Rozycki
Pediatrics 2007; 119: 217.
The Need to Assess Benefits and Not Just Risks of 100% Oxygen for Newborn Resuscitation:
In Reply
Ola Didrik Saugstad, Siddarth Ramji, and Maximo Vento
Pediatrics 2007; 119: 217a-219.

Give Synagis via Home Health
John Goldenring
Pediatrics 2007; 119: 219.

Predictive Model for Lyme Meningitis: A Reply
Robert A. Avery, Gary Frank, and Stephen C. Eppes
Pediatrics 2007; 119: 219a-220.

Treated Hypotension in Extremely Low Birth Weight Infants
Joseph A. Kitterman and Roderic H. Phibbs
Pediatrics 2007; 119: 220-221.

The Research Failed, but the Patients Are Doing Well
Kathi J. Kemper and Teresa Shaw
Pediatrics 2007; 119: 221-222.

Trends in Asthma Prevalence and Recommended Number of Childhood Immunizations Are
Not Parallel
Rachel Enriquez, Victoria Persky, and Tina Hartert
Pediatrics 2007; 119: 222-223.

The Economic Burden of All-Terrain Vehicle–Related Pediatric Deaths in the United States
Jim Helmkamp and Bruce A. Lawrence
Pediatrics 2007; 119: 223-225.

Further Efforts to Reduce the Incidence of Neural Tube Defects
Robert L. Brent and Godfrey P. Oakley, Jr
Pediatrics 2007; 119: 225-226.

How Much Sucrose Is Too Much Sucrose?
C. Celeste Johnston, Francoise Filion, Laurie Snider, Catherine Limperopoulos, Annette Majnemer,
Ermelinda Pelausa, Heather Cake, Sharon Stone, Adam Sherrard, and Kristina Boyer
Pediatrics 2007; 119: 226.
ERRATA
ERRATA
Pediatrics 2007; 119: 227.
EXPERIENCE&REASON
T-Cell–Based Diagnosis of Neonatal Multidrug-
Resistant Latent Tuberculosis Infection
LucaRicheldi,MD,PhDa,KatieEwer,PhDb,MonicaLosi,PhDa,BarbaraM.Bergamini,MDa,KerryMillington,BScb,c,LeonardoM.Fabbri,MDa,
AjitLalvani,FRCP,DMb,c
aDepartmentsofRespiratoryDiseaseandPediatrics,UniversityofModenaandReggioEmilia,Modena,Italy;bTuberculosisImmunologyGroup,NuffieldDepartmentof
ClinicalMedicine,UniversityofOxford,JohnRadcliffeHospital,Oxford,UnitedKingdom;cTuberculosisImmunologyGroup,DepartmentofRespiratoryMedicine,National
HeartandLungInstitute,WrightFlemingInstituteofInfectionandImmunity,ImperialCollegeLondon,London,UnitedKingdom
FinancialDisclosure:DrLalvaniisanamedinventoronpatentsrelatingtoT-cell–baseddiagnosisfiledbytheUniversityofOxford.RegulatoryapprovalandcommercializationofELISpot(T-SPOT.TB)hasbeen
undertakenbyaspin-offcompanyoftheUniversityofOxford(OxfordImmunotecLtd,Oxford,England),inwhichDrLalvanihasashareofequityandtowhichheactsasscientificadvisorinanonexecutive
capacity.DrEwerisanamedinventoronapatentapplicationrelatingtotheapplicationofELISpotfiledbytheUniversityofOxford.TheUniversityofOxfordhasashareofequityinOxfordImmunotecLtd.
ABSTRACT
Youngchildrenexposedtotuberculosishaveahighriskofprogressiontoseveretuberculosisdisease,butdiagnosis
ofrecentinfectionishinderedbythepoorsensitivityofthetuberculinskintest.Whethernewbloodtestscandetect
latentinfectioninthisvulnerablegroupisunknownbecausethereisnogoldstandard.Wemonitoredatuberculin
skintest–negativeinfantwhosemotherhadinfectiousmultidrug-resistanttuberculosiswithenzyme-linkedimmu-
nospot,abloodtestthatenumeratesMycobacteriumtuberculosis–specificTcells.Theenzyme-linkedimmunospottest
became persistently positive by 6 months, and 18 months later the child developed active tuberculosis despite
appropriatechemoprophylaxis.Atthispoint,themagnitudeoftheenzyme-linkedimmunospotresponseincreased
(cid:1)10-fold.Ourfindingsdemonstratethatthisbloodtestdetectedlatentinfectionwithdormant,yetviable,bacilliand
illustrate how enzyme-linked immunospot could improve diagnosis of childhood tuberculosis infection.
T
HECURRENTSTRATEGYoftargetedtuberculintesting individual interferon-(cid:1)–producing T cells (T-SPOT.TB,
andtreatmentoflatenttuberculosisinfection(LTBI) Oxford Immunotec Ltd, Abingdon, United Kingdom) is
isaimedathigh-riskgroups,includingHIV-infectedpeo- approved for use in Europe and Canada and is being
ple, people on immunosuppressive medication, and evaluatedbytheUSFoodandDrugAdministration;this
young children.1 Unfortunately, it is precisely these assay has higher diagnostic sensitivity than the TST in
groups in whom the tuberculin skin test (TST) is least children with active tuberculosis, particularly children
reliable, because the results are frequently false-nega-
younger than 3 years.8 Moreover, in a large school tu-
tive.2Themostvulnerablegroupcomprisesinfantsaged berculosis outbreak, ELISpot results correlated more
under 1 year, whose risk of progression after Mycobacte-
closelywithMtuberculosisexposurethantheHeafintra-
rium tuberculosis infection is (cid:1)50%.3,4 The TST can be
dermal test, suggesting that it is also more sensitive for
falsely negative in active tuberculosis and LTBI, but the
detecting LTBI.9 However, in the absence of a gold-
false-negativerateinLTBIcannotbecalculatedbecause
standardtestforlatentinfection,itisdifficulttoconfirm
of the absence of a gold-standard test.5 A recent review
ofneonatalexposuretotuberculosisinNorthAmerican KeyWords:tuberculosis,neonate,diagnosis,ELISpot
neonatal units found that none of the 2635 newborns Abbreviations:LTBI,latenttuberculosisinfection;TST,tuberculinskintest;ELISpot,
developed a positive skin test.6 We believe that it is enzyme-linkedimmunospot;MDR,multidrug-resistant;PPD,purifiedprotein
derivative;ESAT-6,earlysecretoryantigenictarget6;CFP10,culturefiltrateprotein10;
unlikely that none of the newborns would have ac-
SKSD,streptokinase-streptodornase;SFC,spot-formingcell
quiredinfectionandassumethatthelackofanypositive
www.pediatrics.org/cgi/doi/10.1542/peds.2006-1057
skin-testresultssuggeststhattheTSThaslowsensitivity
in this age group. doi:10.1542/peds.2006-1057
Newrapidbloodtests,basedondetectionofinterfer- AcceptedforpublicationAug2,2006
AddresscorrespondencetoAjitLalvani,FRCP,DM,TuberculosisImmunologyGroup,WrightFleming
on-(cid:1) released by T cells in response to M tuberculosis InstituteofInfectionandImmunity,NationalHeartandLungInstitute,ImperialCollegeLondon,
antigens,offeranovelapproachtodiagnosingLTBI.7An NorfolkPlace,LondonW21NY,UnitedKingdom.E-mail:[email protected]
PEDIATRICS(ISSNNumbers:Print,0031-4005;Online,1098-4275).Copyright©2007bythe
enzyme-linkedimmunospot(ELISpot)assaythatdetects AmericanAcademyofPediatrics
PEDIATRICSVolume119,Number1,January2007 e1
whetherinfants,andotherhigh-riskgroups,withapos- formed consent. Accordingly, the child had an ELISpot
itiveELISpotresultsandanegativeTSTresulttrulyhave test,TST,andclinicalreviewattheageof11weeksand
LTBI.Onlyprogressiontoactivetuberculosiscanprovide again at 6, 12, 18, and 24 months of age.
definitive evidence that ELISpot detects LTBI when the
TSTfailstodoso,buttherearenoreportedexamplesof METHODS
this.HerewereporttheapplicationofELISpotfordiag- The TST was administered by the Mantoux method us-
nosis of LTBI in a neonate born to a mother with un- ing 5 IU of purified protein derivative-Siebert (Biocine
treated multidrug-resistant (MDR) tuberculosis. TestPPD,ChironCorporation/Sclavo,Siena,Italy).PPD-
Siebert(ortuberculinPPD,lotnumber49608)istheUS
CASEREPORT standard for all PPD preparations, which are standard-
A24-year-oldwomanfromMoldovadeliveredahealthy ized against this product. The transverse diameter of
infant at the University Hospital of Modena, Italy. One cutaneous induration was measured with a ruler and
week after delivery, chest radiography strongly sug- recorded 72 hours after inoculation, using 5 mm as the
gested active tuberculosis (Fig 1A). Three sputum sam- cutoff for a positive test.2 TSTs were placed and read by
pleswerestronglypositiveforacid-fastbacilli.Standard an experienced pulmonologist who routinely looks
4-drugantituberculoustherapywasstarted,andshewas after patients with tuberculosis and who was blinded
separated from her infant. Three weeks later, her spu- to the ELISpot results. The cutaneous appearance of
tum specimens grew M tuberculosis that was resistant to peau d’orange was noted, confirming intradermal inoc-
isoniazidandrifampinbutsensitivetopyrazinamideand ulation of PPD. No specific measures were used to pre-
ethambutol.Afterswitchingtoa5-drugregimen(pyra- vent terminal rounding of the induration measure-
zinamide, moxifloxacin, ethambutol, streptomycin, and ments. The ELISpots were performed as described
clofazimine), the woman progressively improved. previously by using recombinant early secretory anti-
Herasymptomatic4-week-oldinfanthadbeeninten- genic target 6 (ESAT-6), recombinant culture filtrate
sively exposed during the 11 days from birth until the protein10(CFP10),and6poolsofoverlappingpeptides
mother’shospitaladmission.Chestradiographyandme- derivedfromtheseantigens(3poolsofpeptidesforeach
diastinalultrasoundwerenormal,andtheTSTwasneg- antigen).11 Mitogen-stimulated positive control wells
ative. The infant did not receive BCG vaccination and containedphytohemagglutinin(ICNBiomedicals,Solon,
was given 9 months of chemoprophylaxis with etham- OH), and antigen-stimulated positive control wells con-
butol (15 mg/kg daily) and pyrazinamide (20 mg/kg tained streptokinase-streptodornase (SKSD; Wyeth
daily) with directly observed therapy, consistent with FarmaSA,Madrid,Spain)asanindexofMtuberculosis–
CentersforDiseaseControlandPreventionguidelines.10 unrelatedantigen-specificT-cellresponsiveness.ELISpot
RecognizingthattheTSTresultmightbefalse-negative, plates were scored by an automated counter (AID-
weofferedsupplementaryELISpottestingwithinapro- GmbH, Strasburg, Germany).11 All test conditions were
tocolapprovedbytheModenaUniversityHospitalInsti- in duplicate wells, each of which contained 250000
tutional Review Board, and the parents provided in- peripheral blood mononuclear cells. Pairs of wells con-
FIGURE1
A,Chestradiographoftheindexcase.Extensivepatchyconsol-
idationwithareasofcavitationisseeninthemiddleandupper
zones,consistentwithactivetuberculosis.B,Chestradiograph
ofthechildat24monthsofage,thetimeatwhichhepre-
sentedwithfeverandrespiratorysymptoms,showingright-
sided hilar lymphadenopathy and ipsilateral parenchymal
compression.C,Molecularstraintyping(DNAfingerprinting)
using insertion sequence 6110 restriction fragment length
polymorphism(RFLP)analysis(IS6110-basedRFLP)oftheMDR
Mtuberculosisisolatesobtainedfromthemother’ssputumin
November2001(upper)andfromherchild’sgastricaspiratein
December2003(lowerlane).TheIS6110RFLPpatternsare
identical,indicatingthatthemotherandchildwereinfected
withthesamestrain.
e2 RICHELDIetal