Clinical Health Updates

Breastfeeding during immunization reduces infant crying

Clinical Question:
Does breastfeeding during immunization reduce infant pain?

Bottom Line:
Infants cry less when breastfed at the time of immunization. Other indicators of pain, including heart rate and oxygen saturation, were unchanged with breastfeeding compared with no breastfeeding.

Reference:
Efe E, Ozer ZC. The use of breast-feeding for pain relief during neonatal immunization injections. Applied Nursing Research 2007:20:10-16.

Study Design:
Randomized controlled trial (nonblinded)

Synopsis:
The authors examined the pain-relieving effect of breast-feeding during immunization injections in healthy neonates. Sixty-six healthy infants returning to a clinic for their second-, third-, or fourth-month immunization with intramuscular diphtheria, tetanus, and pertussis were randomized to be breast-fed before, during, and after the injection or to be given the injection according to routine clinic procedure (no breast-feeding). To assess the pain responses of the neonates during and after immunization, they noted their heart rates, oxygen saturation levels, and length of crying. The crying time was shorter in the experimental (breast-feeding) group (M +/- SD duration, 35.85 +/- 40.11 seconds) than in the control group (M +/- SD duration, 76.24 +/- 49.61 seconds; p = .001). The heart rate and oxygen saturation levels were almost the same in both groups. We concluded that breast-feeding, maternal holding, and skin-to-skin contact significantly reduced crying in infants receiving an immunization injection for diphtheria, tetanus, and pertussis.

Midodrine prevents recurrent vasovagal syncope in kids

Clinical Question:
Does midodrine reduce the frequency of syncopal episodes in children with recurrent vasovagal syncope?

Bottom Line:
In this flawed study, midodrine (ProAmatine) was more effective than usual care in reducing the frequency of syncope in children with recurrent vasovagal syncope.

Reference:
Qingyou Z, Junbao D, Chaoshu T. The efficacy of midodrine hydrochloride in the treatment of children with vasovagal syncope. J Pediatr 2006;149:777-780.

Study Design:
Randomized controlled trial (nonblinded)

Synopsis:
In this Chinese study, the authors determine whether midodrine hydrochloride therapy can prevent vasovagal syncope (VVS) in pediatric patients. They included children with recurrent syncope (n = 26) randomly assigned into 2 groups. Group I comprised children given midodrine hydrochloride as first-line therapy in addition to conventional therapy, and group II comprised patients receiving conventional therapy only. Repeat head-up tilt (HUT) testing and follow-up of least 6 months were conducted to evaluate the therapeutic effectiveness and side effects of midodrine in treating VVS in children. The HUT-based effective rate was significantly higher in group I than in group II (75% vs 20%; P < .05). During the follow-up period, the recurrence of syncope was significantly lower in group I than in group II (P < .05).

Diphenhydramine ineffective in promoting sleep in infants (TIRED)

Clinical Question:
Does diphenhydramine promote sleep in infants whose parents report frequent nocturnal awakenings?

Bottom Line:
During 1 week of therapy and at follow-up 2 and 4 weeks later, diphenhydramine was no more effective than placebo in reducing nighttime awakening or improving overall parental happiness with sleep for infants.

Reference:
Merenstein D, Diener-West M, Halbower AC, Krist A, Rubin HR. The trial of infant response to diphenhydramine: the TIRED study–A randomized, controlled, patient-oriented trial. Arch Pediatr Adolesc Med 2006;160:707-712.

Study Design:
Randomized controlled trial (double-blinded)

Synopsis:
Children aged 6 months to 15 months whose parents reported at least 2 nocturnal awakenings were randomized to receive 1 week of diphenhydramine (1 mg/kg) or placebo 30 minutes before anticipated bedtime. The main outcome was whether the child required parental attention during the night. The study design called for 38 patients in each group. However, after 44 patients completed the study, an independent data monitoring committee unanimously voted to stop the study early because of the dismal results: 1 of 22 children receiving diphenhydramine showed improvement compared with 3 of 22 infants taking placebo.

Amnioinfusion does not prevent meconium aspiration syndrome

Clinical Question:
When thick meconium is present during labor, does amnioinfusion prevent neonatal meconium aspiration syndrome?

Bottom Line:
For women in labor who have thick meconium staining of the amniotic fluid, amnioinfusion did not reduce the risk of moderate or severe meconium aspiration syndrome, perinatal death, or other major maternal or neonatal disorders.

Reference:
Amnioinfusion for the prevention of the meconium aspiration syndrome. Fraser WD, Hofmeyr J, Lede R, Faron G, Alexander S, Goffinet F, Ohlsson A, Goulet C, Turcot-Lemay L, Prendiville W, Marcoux S, Laperriere L, Roy C, Petrou S, Xu HR, Wei B; Amnioinfusion Trial Group.N Engl J Med. 2005 Sep 1;353(9):946-8.

Study Design:
Randomized controlled trial (nonblinded)

Synopsis:
It is uncertain whether amnioinfusion (infusion of saline into the amniotic cavity) in women who have thick meconium staining of the amniotic fluid reduces the risk of perinatal death, moderate or severe meconium aspiration syndrome, or both. We performed a multicenter trial in which 1998 pregnant women in labor at 36 or more weeks of gestation who had thick meconium staining of the amniotic fluid were stratified according to the presence or absence of variable decelerations in fetal heart rate and then randomly assigned to amnioinfusion or to standard care. The composite primary outcome measure was perinatal death, moderate or severe meconium aspiration syndrome, or both. Perinatal death, moderate or severe meconium aspiration syndrome, or both occurred in 44 infants (4.5 percent) of women in the amnioinfusion group and 35 infants (3.5 percent) of women in the control group (relative risk, 1.26; 95 percent confidence interval, 0.82 to 1.95). Five perinatal deaths occurred in the amnioinfusion group and five in the control group. The rate of cesarean delivery was 31.8 percent in the amnioinfusion group and 29.0 percent in the control group (relative risk, 1.10; 95 percent confidence interval, 0.96 to 1.25).