Jim Kling

October 02, 2014

SAN DIEGO — The headline-grabbing enterovirus D68 is expected to be a hot topic at this year's American Academy of Pediatrics (AAP) 2014 National Conference and Exhibition. Organizers anticipate that 14,000 participants will attend, including 8500 pediatricians.

The conference received close to 2000 research abstracts and accepted 819, many of them about personalized medicine and neonatal infectious diseases.

Of note will be research on the parental use of car seats when newborns leave the hospital, the reasons mothers choose to breast-feed longer than one year, and parental misconceptions about concussions.

In recent weeks, the pediatric community has been shaken by news of enterovirus outbreaks in the United States. The virus has been linked to at least 4 deaths, and severe respiratory symptoms have been triggered in some children. More worrying, there are reports in Denver of children with muscle weakness and other paralysis-like symptoms, some of whom tested positive for enterovirus D68. That finding raises the specter that the virus could lead to a syndrome similar to that caused by its relative, the polio virus.

The virus isn't yet part of the official program, but it's sure to be the subject of much discussion. "This is an area where people are going to have to spend a lot of time in the lab to figure out what's going on," said Judy Aschner, MD, from the Albert Einstein College of Medicine and physician in chief at The Children's Hospital at Montefiore in Bronx, New York.

"The pediatric community is pretty shaken up," she told Medscape Medical News.

Dr. Aschner will present the Gerald Merenstein lecture about her efforts to develop therapies for neonatal lung disease.

In the neonatal area, research will be presented on new forms of mechanical ventilation and other respiratory support. Infectious diseases, like respiratory syncytial virus, hepatitis C, and herpes simplex virus, continue to be a challenge, as is the treatment of gastroesophageal reflux and retinopathy in premature infants. "Finding effective ways to design and initiate quality improvement in kids is a really huge issue," Robert Cicco, MD, chair of the planning group for the AAP meeting and associate director of the neonatal intensive care unit at Western Pennsylvania Hospital in Pittsburgh, said during an interview.

Cytomegalovirus (CMV) is another concern in neonates. "I'm looking forward to hearing about some of the newer therapies available for congenital CMV," Dr. Aschner noted. "It's a terrible disease, and there's some evidence that it can be transmitted in breast milk. There's a lot of controversy about what to do, and there are no good therapies. We treat with ganciclovir, but it's not curative."

Changing Guidelines

Other talks will focus on recently updated guidelines. In July, the AAP changed its recommendation for immunoprophylaxis with palivizumab in infants and young children at high risk for respiratory syncytial virus (Pediatrics. 2014;134:415-420). THe guideline authors suggest that prophylaxis has little effect on hospitalizations and no effect on mortality. "The feeling of the infectious disease committee was that the data do not support treating as many kids as we treated before," said Dr. Cicco.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) changed the diagnostic criteria for autism. "The feeling now is that the interventions that you have can be much more attuned to specific children, based on where they fall in that autism spectrum," Dr. Cicco explained. "It will help determine how much they will need communication and interactive therapy. This improved understanding will better guide pediatricians in terms of which services they should be providing."

In the field of neurologic development, there is increasing interest in the way stressful environments affect the developing brain. "There will be sessions on the effects of what we now call toxic stress on brain development in children," said Dr. Cicco.

Personalized medicine and genetics will be another hot topic, with several plenary lectures addressing gene therapy and pharmacogenomics, which looks at the genetic underpinnings of responses to medications. "There's a big move afoot to bring genetics into primary care, rather than just referring everything to geneticists," Dr. Cicco explained.

Other concerns include the testing of drugs in pediatric populations — something that hasn't been done traditionally but is gaining support. "Kids are not small adults. They have different metabolism, different immune systems. In pediatric oncology, pulmonary medicine, and other fields, you will find innovative research being presented," said Dr. Aschner.

Some $750 billion a year is spent on healthcare that has nothing to do with improving health outcomes. There is a role here for pediatricians to improve this.

There will also be a session on the Randomized Intervention for Children With Vesicoureteral Reflux (RIVUR) trial, which evaluated interventions in children with vesicoureteral reflux. The study suggests that antibiotic prophylaxis reduces urinary tract infections by about half, but there is no evidence of reduction in renal scarring. The results have left some doubting the value of voiding cystourethrography to diagnose because it is expensive, painful, and exposes patients to radiation.

Other topics will include a debate on whether marijuana can play a role in the treatment of seizure disorders. "The literature is conflicting, so we'll have people presenting pros and cons as to whether or not there's any use," said Dr. Cicco.

Healthcare expenditure will be another important topic. There is increasing evidence of the overuse of medical services, from unnecessary antibiotic prescriptions to the overuse of diagnostic procedures. "The National Institutes of Health estimate that some $750 billion a year is spent on healthcare that has nothing to do with improving health outcomes. There is a role here for pediatricians to improve this," said Dr. Cicco.

Global healthcare issues will also be well represented, said Dr. Aschner. "There are usually two or three entire sessions dedicated to improving delivery and outcomes for children in developing countries."

Dr. Aschner and Dr. Cicco have disclosed no relevant financial relationships.


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