THE JOURNAL OF PEDIATRICS
www.jpeds.com
41. Ockene JK, Kuller LH, Svendsen KH, Meilahn E. The relationship of smoking cessation to coronary heart disease and lung cancer in the Multiple Risk Factor Intervention Trial (MRFIT). Am J Public Health 1990;80:954-8. 42. Bell RA, Mayer-Davis EJ, Beyer JW, D’Agostino RB Jr, Lawrence JM, Linder B, et al. Diabetes in non-Hispanic white youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care 2009;32(Suppl 2):S102-11. 43. Vital signs: current cigarette smoking among adults aged $18 years—United States, 2005-2010. MMWR Morb Mortal Wkly Rep 2011;60:1207-12. 44. From the American Academy of Pediatrics: Policy statement—Tobacco use: a pediatric disease. Pediatrics 2009;124:1474-87. 45. Haire-Joshu D, Glasgow RE, Tibbs TL. Smoking and diabetes. Diabetes Care 2004;27(Suppl 1):S74-5. 46. Mays D, Streisand R, Walker LR, Prokhorov AV, Tercyak KP. Cigarette smoking among adolescents with type 1 diabetes: strategies for behavioral prevention and intervention. J Diabetes Complications 2012;26:148-53.
Vol. 165, No. 1 47. Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation 2002;106:2085-90. 48. Mitchell GF, Hwang SJ, Vasan RS, Larson MG, Pencina MJ, Hamburg NM, et al. Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation 2010;121: 505-11. 49. Vlachopoulos C, Aznaouridis K, O’Rourke MF, Safar ME, Baou K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis. Eur Heart J 2010;31:1865-71. 50. Urbina EM, Kieltkya L, Tsai J, Srinivasan SR, Berenson GS. Impact of multiple cardiovascular risk factors on brachial artery distensibility in young adults: the Bogalusa Heart Study. Am J Hypertens 2005;18: 767-71.
50 Years Ago in THE JOURNAL OF PEDIATRICS The Incidence of Asymptomatic Bacteriuria and Pyuria in Infancy Randolph MF, Greenfield M. J Pediatr 1964;65:57-66
B
y the early 1960s, Edward Kass had reported asymptomatic urinary tract infections in adults, and Calvin Kunin reported in 1962 that with a single screening of >10 000 healthy school-aged children, 1% of female and 0.026% of male children had bacteriuria. These 2 giants in infectious diseases contributed immeasurably to the scientific approach to collecting urine specimens and quantification of bacterial isolates. The study by Randolph (Danbury, Connecticut private practitioner and member of the Department of Pediatrics at Yale University School of Medicine) and Greenfield (Department of Urology at the Albert Einstein College of Medicine) was as big an undertaking as Kunin’s. Urine samples were collected on more than one occasion from 200 girls and 200 boys younger than 24 months of age who had no signs or symptoms of urinary tract infection. Investigators carefully described the technique of this early use of a “Pediatric Urine Collector” to obtain a voided specimen (what we currently would call a “bagged urine specimen”) and use of a platinum-rhodium wire loop to inoculate precisely 0.01 mL of urine onto agar (thus quantifying growth as 10x colony-forming units/mL by counting the number of colonies visible on agar and multiplying by 103). On initial screening, 2% of female infants and no male infants had asymptomatic bacteriuria, defined as $100 000 colony-forming units/mL. With repeated collections, 4.5% of female and 0.5% of male infants had asymptomatic bacteriuria. Pyuria ($20 white blood cells per high-power field viewed of a centrifuged specimen) was found to have low sensitivity for bacteriuria. The findings as reported above probably were valid. The following reported findings/conclusions are less clear or are unfortunate. Although all infants were screened for symptoms before entry in the study, once informed of positive cultures, 80% of “infected” infants’ parents recalled “symptoms” (frequent or infrequent urination, type of voiding stream, evidence of abdominal distress) that were concluded to be cryptogenic symptoms caused by infection. Six infant girls and one boy had one or all of the following performed: cystoscopy, urethral bougienage (dilation) or voiding cystourethrography, with descriptions of bladder “trabeculations,” bladder neck or urethral “strictures,” and lower urinary tract obstruction or ureteral reflux. The concluding sentence advocated routine screening of healthy toddlers to find bacteriuria, which should be “diagnosed early before it may become a malignant process.” In fact “bagged urine” screening at 12 months of age to seek bacteriuria became standard of care for at least 3 decades, and countless infants underwent needless repeated urethral dilating procedures. The unfortunate conclusion that asymptomatic bacteriuria is a pathologic condition deserving of diagnostic and therapeutic intervention was assumed, without evidence, and still requires undoing 50 years later. Sarah S. Long, MD Department of Pediatrics St. Christopher’s Hospital for Children Philadelphia, Pennsylvania http://dx.doi.org/10.1016/j.jpeds.2014.01.032
116
Shah et al
www.jpeds.com
41. Ockene JK, Kuller LH, Svendsen KH, Meilahn E. The relationship of smoking cessation to coronary heart disease and lung cancer in the Multiple Risk Factor Intervention Trial (MRFIT). Am J Public Health 1990;80:954-8. 42. Bell RA, Mayer-Davis EJ, Beyer JW, D’Agostino RB Jr, Lawrence JM, Linder B, et al. Diabetes in non-Hispanic white youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care 2009;32(Suppl 2):S102-11. 43. Vital signs: current cigarette smoking among adults aged $18 years—United States, 2005-2010. MMWR Morb Mortal Wkly Rep 2011;60:1207-12. 44. From the American Academy of Pediatrics: Policy statement—Tobacco use: a pediatric disease. Pediatrics 2009;124:1474-87. 45. Haire-Joshu D, Glasgow RE, Tibbs TL. Smoking and diabetes. Diabetes Care 2004;27(Suppl 1):S74-5. 46. Mays D, Streisand R, Walker LR, Prokhorov AV, Tercyak KP. Cigarette smoking among adolescents with type 1 diabetes: strategies for behavioral prevention and intervention. J Diabetes Complications 2012;26:148-53.
Vol. 165, No. 1 47. Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation 2002;106:2085-90. 48. Mitchell GF, Hwang SJ, Vasan RS, Larson MG, Pencina MJ, Hamburg NM, et al. Arterial stiffness and cardiovascular events: the Framingham Heart Study. Circulation 2010;121: 505-11. 49. Vlachopoulos C, Aznaouridis K, O’Rourke MF, Safar ME, Baou K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with central haemodynamics: a systematic review and meta-analysis. Eur Heart J 2010;31:1865-71. 50. Urbina EM, Kieltkya L, Tsai J, Srinivasan SR, Berenson GS. Impact of multiple cardiovascular risk factors on brachial artery distensibility in young adults: the Bogalusa Heart Study. Am J Hypertens 2005;18: 767-71.
50 Years Ago in THE JOURNAL OF PEDIATRICS The Incidence of Asymptomatic Bacteriuria and Pyuria in Infancy Randolph MF, Greenfield M. J Pediatr 1964;65:57-66
B
y the early 1960s, Edward Kass had reported asymptomatic urinary tract infections in adults, and Calvin Kunin reported in 1962 that with a single screening of >10 000 healthy school-aged children, 1% of female and 0.026% of male children had bacteriuria. These 2 giants in infectious diseases contributed immeasurably to the scientific approach to collecting urine specimens and quantification of bacterial isolates. The study by Randolph (Danbury, Connecticut private practitioner and member of the Department of Pediatrics at Yale University School of Medicine) and Greenfield (Department of Urology at the Albert Einstein College of Medicine) was as big an undertaking as Kunin’s. Urine samples were collected on more than one occasion from 200 girls and 200 boys younger than 24 months of age who had no signs or symptoms of urinary tract infection. Investigators carefully described the technique of this early use of a “Pediatric Urine Collector” to obtain a voided specimen (what we currently would call a “bagged urine specimen”) and use of a platinum-rhodium wire loop to inoculate precisely 0.01 mL of urine onto agar (thus quantifying growth as 10x colony-forming units/mL by counting the number of colonies visible on agar and multiplying by 103). On initial screening, 2% of female infants and no male infants had asymptomatic bacteriuria, defined as $100 000 colony-forming units/mL. With repeated collections, 4.5% of female and 0.5% of male infants had asymptomatic bacteriuria. Pyuria ($20 white blood cells per high-power field viewed of a centrifuged specimen) was found to have low sensitivity for bacteriuria. The findings as reported above probably were valid. The following reported findings/conclusions are less clear or are unfortunate. Although all infants were screened for symptoms before entry in the study, once informed of positive cultures, 80% of “infected” infants’ parents recalled “symptoms” (frequent or infrequent urination, type of voiding stream, evidence of abdominal distress) that were concluded to be cryptogenic symptoms caused by infection. Six infant girls and one boy had one or all of the following performed: cystoscopy, urethral bougienage (dilation) or voiding cystourethrography, with descriptions of bladder “trabeculations,” bladder neck or urethral “strictures,” and lower urinary tract obstruction or ureteral reflux. The concluding sentence advocated routine screening of healthy toddlers to find bacteriuria, which should be “diagnosed early before it may become a malignant process.” In fact “bagged urine” screening at 12 months of age to seek bacteriuria became standard of care for at least 3 decades, and countless infants underwent needless repeated urethral dilating procedures. The unfortunate conclusion that asymptomatic bacteriuria is a pathologic condition deserving of diagnostic and therapeutic intervention was assumed, without evidence, and still requires undoing 50 years later. Sarah S. Long, MD Department of Pediatrics St. Christopher’s Hospital for Children Philadelphia, Pennsylvania http://dx.doi.org/10.1016/j.jpeds.2014.01.032
116
Shah et al
