•  Do Low Birth Weight infants require an additional dose of Hepatitis B vaccine? Hepatitis B vaccine was given to 82 preterm (PT) and 60 term intrauterine growth-retarded (T-IUGR) infants at birth and at 6, 10 and 14wk of life. Protective anti-HB levels (>10 mIU/ml) were reached in 86.6% of PT infants and 96.7% of T-IUGR infants after three doses of HBV vaccine (p = 0.044). Birth weight was not associated with the development of a protective immune response. In PT infants after the fourth dose, there was a significant increase in the proportion of infants with protective antibody levels while the administration of the fourth dose to T-IUGR infants did not confer such a benefit. The authors conclude that preterms would benefit from an additional dose of Hepatitis B vaccine while there is no need for an additional dose for term IUGR babies. However, before implementation, larger studies are needed to confirm these findings. (Acta Paediatr 2002; 91: 995)

• Cerebral edema has a high mortality and morbidity in Diabetic Ketoacidosis. Its etiological factors are still not clear. To investigate these factors 61 cases of DKA were analysed with respect to their demographic, biochemical, and therapeutic data. Seventeen (28%) children died or survived in a vegetative state; 8 (13%) survived with mild to moderate neurologic disabilities; and 36 (59%) survived without sequelae. Factors associated with poor outcomes included greater neurologic depression at the time of diagnosis of cerebral edema, a high initial serum urea nitrogen concentration, and intubation with hyperventilation to a PCO2 <22 mm Hg. (J Pediatr 2002 ; 141: 793)

•  Duchenne muscular dystrophy is a devastating illness with no effective cure. Corticosteroids have been used anecdotally in this disease for some time. To assess their effectiveness a retrospective comparative study of 20 pediatric patients with a diagnosis of Duchenne muscular dystrophy was performed. Ten patients received deflazacort and 10 refused the treatment. Untreated patients showed progressive worsening while corticosteroids produced clinical stabilization and improved muscular strength. The positive effect of steroid treatment had a mean duration of 12 months. Loss of independent gait occurred at similar ages in both groups (10.3 vs. 10.5 years). There was no significant functional improvement in the corticosteroid treated group. The authors conclude that good coordination among multiprofessional teams is essential to achieve optimal results. (An Esp Pediatr 2002; 57: 518)

•  Infection remains one of the most important complications in cancer therapy. Continuous infusion of beta lactam antibiotics may provide superior pharmacokinetics in management of febrile neutropenia. The authors studied the pharmacokinetics of ceftazidime in children treated for malignancy and in febrile neutropenia after chemotherapy. Treatment was tolerated well. Ceftazidime's time-dependent pharmacokinetics showed the advantage of continuous infusion. This study confirmed the feasibility and safety of this administration schedule in the empiric treatment of febrile neutropenic children with cancer. (J Pediatr Hematol Oncol 2002; 24: 714)

•  Longitudinal studies of juvenile migraine are very few. This study investigated the prevalence and evolution over 5 years of migraine without aura (MWOA) and migraineous disorder (MD) in an adolescent population. Sixty-four subjects (34 girls and 30 boys, mean age 17.3+/-1.1 years) were included in the study. The data indicate that juvenile-onset MWOA and MD may change in character over time, generally with a favorable prognosis. (Headache 2002; 42: 1000)

•  To assess the impact of breast-feeding on childhood obesity a cross-sectional survey data collected in 1991 on 33,768 school-children aged 6 to 14 years in the Czech Republic were analyzed. Overall prevalence of overweight (obesity) was lower in breast-fed children. The effect of breast-feeding on overweight/obesity did not diminish with age in children 6 to 14 years old and could not be explained by parental education, parental obesity, maternal smoking, high birth weight, watching television, number of siblings, and physical activity. (J Pediatr 2002; 141: 764)

•  Do preterms differ in temperament from term babies? Although preterm infants are considered to be difficult, preterm temperament at less than 3 months is unknown empirically. To investigate the temperament characteristics of preterm infants a sample of 74 infants with gestational ages at birth between 24 and 32 weeks were enrolled. At 6 weeks the premature infants were significantly less rhythmic (regular), more distractible (soothable), less approaching (more withdrawing), and less intense than standardized norms for full-term infants. From these data the authors feel that premature infants may be initially more challenging to parent. Temperament moderated over time but remained significantly lower in persistence at 12 months. (J Dev Behav Pediatr 2002; 23: 430)

•  Use of the Internet as a source of medical information by parents is increasing. Over a six-week period parents of children attending general pediatric outpatient clinics were asked to complete a questionnaire survey regarding this issue. Of the 577 questionnaires distributed, 485 were returned, a response rate of 84%. The questionnaires revealed that a significant proportion of parents have access to the Internet and use it to find information about their child's medical condition. The parents who discuss what they find with the clinic doctor are in the minority. Doctors should be prepared to ask parents about their information needs and discuss use of the Internet. (Arch Dis Child 2002; 87: 534)

• A number of studies have shown that orally administered sweet-tasting solutions reduce signs of pain during painful procedures in neonates. The local anesthetic cream EMLA has recently been shown to be safe for use in neonates. A randomized, controlled, double-blind study to compare the efficacy of EMLA versus Glucose included 201 newborns undergoing venipuncture for clinical purposes. Ninety-nine of the newborns received EMLA and 102 received glucose 30% orally. The authors found that glucose was effective in reducing symptoms associated with pain from venipuncture in newborns and seems to be better than the local anesthetic cream EMLA. (Pediatrics 2002; 110: 1053)

Gaurav Gupta,
Ex-Senior Resident,Pediatrics,
Advanced Pediatric Centre,
PGIMER, Chandigarh.
Email: [email protected]