How early should we do elective cesarean
deliveries? (N Engl J Med 2009; 360: 111-120)
Previous studies have suggested that elective cesarean section may be
performed earlier than appropriate, often for reasons of convenience, and
that many of these cesarean deliveries are repeat procedures. The new
results suggest that a high percentage of elective cesarean deliveries at
US academic medical centers are performed before 39 weeks’ gestation i.e.,
at 37-38 weeks. These deliveries are associated with an increased risk of
adverse outcomes, including adverse respiratory outcomes, mechanical
ventilation, and hospitalization for 5 days or longer. These findings
support recommendations to delay elective delivery until 39 weeks of
Comment The trend of elective cesarean section is
also increasing in India. It is important that these be delayed till the
completion of 39 weeks, as far as possible.
Role of universal PCR in diagnosing
neonatal sepsis (Arch Pediatr Adolesc Med 2009; 163: 6–11)
The goal of this study was to evaluate the ability of universal primer 16S
rRNA gene PCR to diagnose blood culture–positive neonatal sepsis before
and after starting antibiotic treatment in 242 neonates at a level 3
neonatal intensive care unit. Blood culture was positive in 52 neonates
while corresponding 0-hour PCR was positive in 57 subjects. The authors
concluded that universal primer PCR can accurately diagnose neonatal
sepsis before but not after antibiotic drugs are given.
Comment This study takes a unique perspective on
diagnosing early onset neonatal sepsis, by linking it to a PCR test that
is not specific for any single bacteria. Hopefully, further refinement of
this test would lead to the elusive holy grail of early and accurate
diagnosis of neonatal sepsis.
Saliva testing for autism (J
Proteome Res 2008; 7: 5327-5332)
The discovery of abnormal salivary peptides in a subgroup of patients with
autism spectrum disorder (ASD) may prove to be a useful biomarker for the
disorder, a small study suggests. Researchers found that more than 60% of
children with ASD had hypophosphorylation of at least 1 of 4 salivary
peptides. The molecular basis of ASD may be partly explained by a defect
in the phosphorylation process during the development of the central
nervous system in the embryo or in early infancy.
Comment A unique study that provides a completely new dimension for
testing for autism, and also suggests a possible cause for this yet
unsolved medical mystery.
Children with drowning – the relevance of
a cranial CT (Pediatr Crit Care Med 2008; 9: 567-572)
The primary aim of this study was to better define both the type and
incidence of cranial computed tomography (CT) abnormalities in 156
children following submersion injury. Eighteen percent (n=28) of
children had an abnormal initial head CT, and 15% (n=24) initially
had a normal head CT and later had an abnormal CT. Abnormal CT findings
included diffuse loss of gray-white differentiation (75%) and bilateral
basal ganglia edema/infarct (50%). All children with an abnormal initial
CT presented with a Glasgow Coma Scale of 3, and all eventually died.
Outcome was also very poor in those with a normal first CT and an abnormal
second CT; 54% died and 42% remained in a persistent vegetative state.
Comment The results of this largest study of CT scan in children
with drowning clearly indicate that abnormal CT scan at any time was
associated with a poor outcome; this can help in prognostication.