Pediatric care has come so very far - Albuquerque Journal

Pediatric care has come so very far

Q: What has research in pediatrics done for me lately?

A: A rhetorical question perhaps, from the people of the world. Recently, the American Academy of Pediatrics and the pediatric research societies combined their efforts to select seven of the greatest successes in pediatric research over the past 40 years. They did so to strengthen the case for continued robust funding for research into children’s medical problems. I have been in pediatric practice in Albuquerque for just a little over 40 years.

Like the U.S. Public Health Service in 2000, the AAP in 2015 placed immunization at the top of the list. There are many new vaccines that we give children now that were only dreams in 1975. My favorite among them is the vaccine that prevents disease due to a germ called Haemophilus influenzae, confusing because it really has nothing to do with influenza.

When I first practiced medicine in New Mexico, we saw almost weekly cases of the terrible nervous system disease meningitis, usually caused by what we nickname H. flu. Now it has been years, not weeks, since I have seen a case, thanks to a vaccine given to almost all infants.

I see far less pneumonia and severe, dehydrating diarrhea too, thanks to vaccines introduced in the last 20 years; we will soon begin to see a reduction in cancer caused by a virus called HPV, thanks to a vaccine that we started giving to preteens and teenagers about 10 years ago.

Second on the list is a decrease in sudden and unexpected “crib death,” or SIDS. Epidemiologic studies in the last two decades of the 20th century showed clearly that children dying of SIDS were much more likely to have been sleeping face down than babies who lived.

“Back to sleep” became a mantra, overcoming the concern, proven now to be unfounded, that babies might vomit and breathe the vomit into their lungs if left on their backs. The rate of SIDS has been cut by 56 percent as the rate of infants sleeping on their stomachs has fallen from 83 percent to 26 percent. I now rarely find myself in the emergency room late at night consoling families riven by grief over a very small child dead from SIDS.

Third, stepwise improvements in treatment of the most common pediatric cancer, leukemia, have increased the survival rate five years after diagnosis from 60 to 90 percent. It wasn’t a single “Eureka,” but a careful assessment of what worked best and application of learned principles.

When I was in medical school, most premature infants born 10 or more weeks before they should have been died, usually of a lung disease called respiratory distress syndrome (RDS), which we were powerless to prevent. Pioneering research on examining the lungs of those babies showed that they lacked a chemical substance called surfactant that kept the lungs from closing up after each breath.

Now premature babies who begin to show disease are given surfactant through a tube placed into their breathing passages, and this once common cause of death has lost its grip.

Fifth on the AAP’s list of remarkable pediatric research successes is the discovery of antiviral drugs that keep HIV-infected mothers from passing the disease on to their newborns. Before these drugs began to be given to pregnant women with HIV infection, 40 percent of them passed the fatal disease on to their infants, whereas now very few of us have seen a newborn with the disease – just 200 are seen in the whole country each year, 200 too many but still far fewer than before zidovudine and other anti-HIV drugs were used.

Almost all pregnant women in the U.S. are now screened for HIV so that those infected can be treated. Although done increasingly in the Third World with the same remarkable success when used, there’s still a long way to go to apply this life-saving therapy universally.

Next on the list is the often incredible improvement in both the quality and quantity of life for children with chronic medical diseases over the past 40 years. Let’s take just two of many examples: Children with cystic fibrosis, a condition where glands and lungs fill up with fluid and infections overwhelm the patient, can’t be cured, but gradual improvements in the care of these children have doubled their life expectancy from less than 18 years in 1975 to 37.5 in 2010 and improved the quality of their existence immeasurably.

Children born with sickle cell disease, a defect of the red blood cells, are much less prone to very painful “crises,” as they are called, to severe infections, and to early death than they were 40 years ago.

The seventh achievement on this list, like most of the others, is not complete – all too many children still die in motor vehicle accidents (MVAs), though the rate of death in the first year from an MVA is decreased 71 percent by car seats, and in older children by more than half.

While I happily bounced and jumped around our old Plymouth in my unprotected youth, I was lucky. I’ll write more about child passenger safety in my next column since this story could have an increasingly happy outcome.

It’s interesting to me that so many of these wonderful successes have to do with prevention of disease – through vaccines, car seats, surfactant, sleep position and transmission of HIV. Truly an ounce of prevention, as well as a pound of cure, are worthy of enthusiastic support.

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