We measured blood levels of fatty acids, vitamin A, and trace metals in children undergoing ambulatory surgery for placement of tympanostomy tubes and a comparison group having other ambulatory surgical procedures. We then performed a small, outpatient, secondary prevention study using nutritional supplements chosen on the basis of those blood levels. The study subjects had lower levels of red blood cell eicosapentaenoic acid (EPA) than did adult controls. Consistent with previous reports, the levels of vitamin A were < or = 40 microg/dL for 69% of our subjects, and the plasma selenium levels for children were lower than published values for adults. We then studied one otitis media (OM) season; 8 children (0.8 to 4.4 years of age) received 1 teaspoon of lemon-flavored cod liver oil (containing both EPA and vitamin A) and 1 half-tablet of a selenium-containing children's chewable multivitamin-mineral tablet per day. During this OM season, study subjects received antibiotics for OM for 12.3% +/- 13.4% (SD; p < .05) fewer days during supplementation than before supplementation. Larger, controlled trials are warranted to assess the utility of cod liver oil (of acceptable purity and taste) and a children's multivitamin-mineral preparation containing selenium, both for the prevention of OM and for the acceptance of delayed prescription of antibiotics for this disorder.
We studied the effect of daily supplementation with lemon-flavored cod liver oil and a children's multivitamin-mineral supplement containing selenium on the number of pediatric visits by young, inner-city, Latino children from late autumn of 2002 through early spring of 2003. Two private pediatric offices with similar demographics, located 1.1 miles apart in upper Manhattan, New York City, were randomized to a supplementation site and a medical records control site. Ninety-four children (47 at each site), 6 months to 5 years of age, were enrolled. The mean age of the supplementation group was 2.03 years (SD, +/- 1.04 years); that of the control group was 2.08 years (SD, +/- 1.10 years). Children > or = 1 year of age in the supplementation group received 1 teaspoon of lemon-flavored cod liver oil per day and one half-tablet of a children's multivitamin-mineral; the starting dose was halved for children < 1 year of age. The supplements were given from enrollment through May 1, 2003. The primary outcome measure was the number of upper respiratory tract pediatric visits during the follow-up/supplementation period. The supplementation group had a statistically significant decrease in the mean number of upper respiratory tract visits over time (p = .042; r = 0.893; y = 0.602 - 0.002x); the medical records control group had no change in this parameter (p = .999; r = 0.0006; y = 0.259 + 1.43 x 10(-6)x). The supplements were well tolerated; per parental report, 70% of children completed the 5- to 6-month course of cod liver oil. Use of these nutritional supplements was acceptable to the inner-city Latino families and their young children, and was associated with a decrease in upper respiratory tract pediatric visits over time; this approach therefore deserves further research and attention.
A 30-day course of AMOX/CLAV significantly reduces the need for surgery in children with obstructive adenotonsillar hypertrophy at 1-month follow-up. This relative reduction persists at 3 and 24 months posttreatment, although the absolute percentages of patients requiring surgery increased in both groups as time after treatment increased. The reduction in symptoms in AMOX/CLAV-treated patients is modest but significant even in long-term follow-up. The precise role of this treatment for CATH is yet to be determined; however, our results suggest that a 30-day course of AMOX/CLAV can be used in situations when a temporary relief in symptoms is desirable or surgery would incur unacceptable risk.
Vitamin D is essential for the production of endogenous antimicrobial peptides, and has been linked to seasonal, epidemic influenza A. However, the level of 25(OH)D needed to prevent infection with various human pathogens has not been defined. In view of increasing bacterial resistance and emerging new pathogens, further research on the relationship of infection to 25(OH)D and other nutritional factors is warranted.
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