August 2014  Volume 165  Number 2 Copyright ª 2014 Elsevier Inc.

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Man’s best friend,

except .
J ust about everyone who owns and loves a pet, likely cannot imagine life
without “man’s best friend.” There is no question of a pet’s value to the happi-
ness and well-being of children. Pet-associated infectious risks for patients with
— Sarah S. Long, MD cancer (and other immunocompromised children) also are clear. Guidance for pa-
tients with cancer targets personal hygiene, as well as types and ages of animals
suited/not suited as pets: dogs and cats under 6 months of age more likely carry
Campylobacter and Bartonella species; reptiles, amphibians, and exotic animal spe-
cies are nearly obligate Salmonella carriers; poultry and rodents have Salmonella
and other communicable bacteria; and rodents can harbor lymphocytic choriome-
ningitis virus.
Veterinary, medical, public health, and population health departments teamed up
to develop and administer a questionnaire to children cared for at the Children’s Hos-
pital of Eastern Ontario to assess knowledge and attitudes toward pet ownership,
perceived infectious risks, and ownership practices. They solicited enrollment of

217
 children diagnosed with cancer as the group of interest and children with diabetes (as
also having a chronic condition, with less risk of infection) as “controls” to assess ef-
fects of knowledge and education on action. Sixty-five percent of parents/guardians
completed the questionnaire (64 whose child had cancer and 150 whose child had dia-
betes). At diagnosis, 45% of respondents had a household pet; few found them a new
home. Twenty percent of patients with cancer acquired a pet after diagnosis, 77% of
which were high-risk pets.
These findings and more, which can be found in the authors’ report, provide
convincing evidence of the need for improved education of households with immuno-
compromised children, as well as that of pediatric and veterinary healthcare profes-
sionals.
Article page 348

Bones, breaks,
and BMI
I t seems that just about any childhood travail is somehow linked to obesity. Some of
these associations are consistently reproducible, and others are less so. One of the
more interesting of these is the association between obesity and fracture risk. Studies
— Thomas R. Welch, MD of this association have been mixed in their results, and are confounded by things like
activity levels, sports participation, etc.
This issue of The Journal contains an article by Sabhaney et al that brings some
clarity to the matter and has a surprising finding. These investigators studied over
2000 children who came to one of two emergency departments with a non penetrating
extremity injury. The children were classified according to body mass index, and the
authors examined the risk of having a fracture as a function of obesity status. Over-
weight children had a small but significant decreased risk of fracture compared with
those of normal weight. Underweight children, however, had a significantly increased
risk of fracture.
It is not immediately clear what we should do with this information. As the authors
point out, weight status may have been a surrogate for bone mineral density, which
could have been the major (unmeasured) risk factor. It also should be considered
that these are generally low-severity upper extremity fractures, which may be the
often-unavoidable consequence of an active childhood!
Article page 313

An evaluation
of pediatric clinical
S inha et al from the University of Sydney, Australia, asked whether recently pub-
lished randomized controlled trials of pharmacologic agents in children demon-
strated any more risk of bias than similar trials performed in adults. This was
trial design investigated by evaluating 100 trials involving only children and matching them
by drug class and therapeutic area with similar trials completed in adults. The Co-
— Robert W. Wilmott, MD chrane risk of bias tool was used to compare the pediatric and adult trials. The re-
sults were reassuring in that the published randomized control trials involving
children had a largely similar risk of bias compared with the randomized controlled
trials in adults, suggesting that pediatric clinical investigators have a similar capa-
bility to conduct and report randomized controlled trials to their adult colleagues.
The study demonstrated several areas where bias potentially exists in pediatric trials,
although, in most areas, the pediatric trials were slightly better than the adult ones.
However, these areas will need close attention in the future. An important message
from this study is that we have the capability in pediatrics to perform robust, ran-
domized, controlled trials in children, so there is no reason to neglect assessing
drugs in the pediatric population.
Article page 367

218 Vol. 165, No. 2

 A healthy mind in a
healthy body
T he concept that overall physical fitness is positively associated with academic per-
formance has been in circulation for a long time. In this issue of The Journal, Es-
teban-Cornejo et al advance this area of study considerably, with a study that is
— Thomas R. Welch, MD impressive for the number of children involved and the detail with which the associ-
ation was tested. In a group of over 2000 children, these authors performed standard-
ized measures of three components of fitness: muscle strength, cardiorespiratory
capacity, and motor fitness. These were examined in relation to four measures of ac-
ademic achievement.
Cardiorespiratory capacity and motor fitness were positively associated with all
academic measures, but muscular strength had no independent association. Obvi-
ously, this work does not demonstrate cause and effect, but the results are striking.
Their findings should stimulate carefully-designed interventional studies.
Article page 306

MgSO4 for
neuroprotection
S urvivors of very preterm birth often have neurodevelopmental abnormalities that
are certainly multifactoral in origin. Both antenatal and postnatal exposures can
contribute to these adverse outcomes. One of the few interventions that has been
— Alan H. Jobe, MD, PhD tested in randomized controlled trials is maternal treatment with MgSO4 prior to
very preterm delivery. This intervention, developed based on the frequent use of
MgSO4 as a tocolytic for preterm labor, decreased cerebral palsy diagnosed at 2 years
of age. In this issue of The Journal, Chollat et al report the school-age outcomes for one
of the MgSO4 trials. Although not statistically significant, infants exposed to MgSO4
had less motor dysfunction, fewer behavioral disorders, fewer cognitive difficulties,
less frequent repeating of school grade, and less use of special education services
than the control infants. An unsatisfying aspect of this therapy is that the mechanism
of action of MgSO4 on the very preterm fetus/newborn is unknown. Nevertheless, all
assessments were in the direction of benefit, at least demonstrating no harm, from the
MgSO4 exposure at school age.
Article page 398

August 2014 219