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Posted by Sylvia on Tuesday, February 03, 2004 (16:08:13)
The Miami Herald 03/02/2004
By Daniela Lamas
With news ranging from an improved arsenal to destroy acne to the need for better end-of-life care for children, hundreds of doctors converged on the Sheraton Bal Harbour Beach Resort last week to spend six days at the forefront of pediatric research.
They came from 40 states and 10 countries to the 13th annual Masters of Pediatrics Conference, which ends today. Experts conducted continuing education for programs spanning the spectrum of pediatrics -- among them, research on attention deficit disorder, nutrition, athletics and infectious disease.
Lawrence Schachner, a pediatric dermatologist at the University of Miami who directed the conference, presented work on a treatment that uses high-intensity blue light to make acne self-destruct. The light forces the acne bacteria to release peroxide -- which destroys the pimples.
This procedure, recently approved by the federal Food and Drug Administration, generally requires from five to 15 treatments, Schachner said. Also, Schachner noted, acne advances include a cheaper Acutane -- with the same host of dangerous side-effects -- and ''early work'' on whether different antibiotics, like Zithromax, clear up troublesome blemishes.
And doctors now recognize a form of baby acne, he continued, that is a fungus rather than something caused by hormones. This means it should be treated with anti-fungal cream, rather than a traditional acne treatment.
''There's lots of cool new stuff in acne,'' Schachner said.
Bioengineered skin is another exciting area, he said, particularly for a devastating genetic skin disorder called epidermolysis bullosa. With this condition, which affects one in every few thousand children, even gentle friction will cause the skin to blister, break and fail to heal.
In the past few years, Schachner said, doctors have experimented with grafting onto wounds skin created from healthy babies' foreskin. This technique is particularly useful, he said, since the foreskin contains enzymes that help the wounds heal, and a large amount of bioengineered skin -- ''football fields worth,'' he joked -- can come from one foreskin.
It's not a cure, he said, but the same treatment is also promising for wounds that won't close in babies who have received transplants or are born without sufficient skin.
The conference also included a program in behavioral and developmental pediatrics, a burgeoning field recently recognized by the American Board of Pediatrics as a specialty.
Now, immunizations have conquered most childhood diseases like measles and mumps, so behavioral issues have become the ''new morbidities'' for children, said Dr. F. Daniel Armstrong, who directs UM's Mailman Center for Childhood Development.
These include autism, cerebral palsy, childhood chronic illness, physical abuse, even the effect of living in a family where the parents divorced, Armstrong said.
His presentation tackled a painful, oft-ignored aspect of this specialty, looking at end-of-life care for children. Armstrong served as a consultant to the Washington-based health research group Institute of Medicine for its 2003 report on improving end-of-life care for children and their families.
''Essentially, what we found is that we've not really done a good job,'' Armstrong said. ``We don't like to think about children dying. It's a really hard thing.''
With major advances in cancer and HIV, Armstrong said, it's more possible than ever to ignore the possibility of children dying. But doctors can't afford to do so, and must continue to confront complex questions like how they inform children about their disease.
''How do we give children chances, opportunities to be able to respond to the information without shoving it down their throats?'' he asked. ``There's a balance there.''
On the policy side, Armstrong said, there needs to be change. For instance, he said, there's a need for hospice care designed specifically for children and bereavement programs for families, which, he said, insurance programs should cover.
''It's not easy, it's hard on everybody, but this is an essential part of how we take care of children,'' he said.
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