Clippings

Indian Pediatrics 2003; 40:807-808

Clippings

• A stool test has been found useful in diagnosis of helicobacter pylori infection in children. A monoclonal enzyme immuno-assay test to detect the helicobacter antigen was evaluated by German researchers in over 300 healthy children. When compared with the urea breath test and urease test, the stool test gave a sensitivity of 98% and a specificity of 99%, the study noted. This will be an accurate and non-invasive tool to study helicobacter infection in children, the German team concludes.(Gut 2003; 52: 804-806)
   

• Growth of low birth weight neonates has drawn considerable attention lately. A study from Cleveland, Ohio, compared the growth of around 200 low birth weight infants and an equal number of controls with normal birth weight, till twenty years of age. The researchers observed that low birth weight females caught-up with their normal weight counterparts by 20 years, while males lagged behind. Metabolic and cardiovascular disease in adult-life among low-birth weight survivors may differ with sexes, they conclude. (Pediatrics 2003; 112; e30-e38).
   

• Early physical activity has been found to prevent osteopenia among very low birth weight neonates. In this randomized study from Israel, twelve infants received regular exercise in the form of stretching limbs five minutes daily, five days a week for 4 weeks while an equal number of controls were managed without exercise. The researchers noted that the bone strength, as measured by an ultrasonic measurement of the speed-of sound in the tibial shaft was significantly greater in the exercise group as compare to controls. Exercise may have a role in reducing the risk of osteopenia in very low birth weight neonates, the report concludes. (Pediatrics 2003; 112; 15-19)
   

• Nitric oxide concentration in exhaled air can help detect asthma in pre-school children, Researchers from Finland report. Around 100 children with history suggestive of asthma and 62 controls were evaluated with lung functions tests and the exhaled concentration of nitric oxide (FENO) test. The researchers observed that FENO had a sensitivity, specificity and negative predictive value of 86%, 92% and 95% in diagnosis of asthma. The FENO was better than oscillometric evaluation of lung function in detecting asthma in pre-schoolers, the report concluded.(Thorax 2003; 58:494-499).
   

• Steroids may be beneficial when added to Intravenous Immunoglobulin in treatment of Kawasaki’s disease. Thirty-nine children with Kawasaki’s disease were randomized to receive either a combination of intravenous methylprednisolone and aspirin/IV Immuno-globulin or aspirin/IV Immunoglobulin alone. The researchers noted that addition of steroids resulted in lower ESR, CRP, earlier resolution of fever and shorter duration of hospital stay. A related editorial, however, was skeptical and recommended larger studies before recommending steroids in combination with IV Immunoglobulin and suggested repeat courses of Immunoglobulin in treatment failures instead.(J Pediatr 2003;142: 611-616, 601-603).
   

• Nebulized epinephrine has not been found useful in infants with bronchiolitis. In a double-blind randomized study from Australia, 194 infants with bronchiolitis received either nebulized 1% epinephrine or normal saline. The duration of hospitalization and the need for supplemental oxygen were similar in both the groups, the researchers report. Management of bronchiolitis in infants is mainly "supportive" the researchers conclude. A related editorial stressed that though epinephrine is slightly better in reducing the airway resistance as compared to salbutamol, bronchodilators are not necessary in treatment of bronchiolitis (N Engl J Med. 2003; 349: 27-35, 82-83).
   

• A report from USA has reiterated the adverse effects of sweetened drinks on children. In this study conducted on thirty children, the dietary intake over a 4-8 week period was recorded. The researchers noted that consumption of sweetened drinks in excess of 12 oz per day (300 ml approx) resulted in a reduction in milk consumption by around 130 g/day, increased weight gain of over 1kg in the study period and an increased caloric intake. The reduced milk consumption could lead to deficiencies in protein, calcium, magnesium, phosphorus, and vitamin A intakes, the researchers report. Sweetened drinks displace healthy food from the diet and can contribute to excess weight gain, the report concludes. (J Pediatr 2003; 142: 604-610).
   

• Fever in healthy neonates is mostly harmless. An analysis of 122 healthy neonates with fever by an Israeli team of researchers noted that dehydration, cesarean deliveries and high birth weight were the common causes of fever, while only one case was due to a bacterial infection. They also noted that breast fed babies were more likely to develop fever. Fever among healthy neonates should not be cause for worry as infection is unlikely in the absence of risk factors, the study concluded.(Arch Dis Child 2003; 88: F312)
   

• Clinical Evidence