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Indian Pediatr 2009;46: 86

 

Amit P Shah

E-mail: [email protected]  

 

Severe iron-deficiency anemia in adolescents: Consider Helicobacter pylori infection (J Paediatr Child Health 2008; 44:647-650)

Clinicians at Royal Melbourne Hospital at University of Melbourne, Australia reported three cases of refractory iron deficiency anemia in otherwise healthy adolescents All three were found to have H. pylori gastritis on diagnostic endoscopic gastric biopsy. Iron deficiency was successfully corrected following antibiotic eradication of H. pylori infection.

Comment We come across a large number of adolescents suffering from iron deficiency anemia. This study highlights the importance of considering H. pylori infection as a cause of refractory iron-deficiency anemia in adolescents, even in the absence of gastrointestinal symptoms.

Clinicians fail to recognize obesity clinically (Arch Dis Child 2008; 93: 1065-1066)

Eighty health care professionals were asked to view photographs of 33 children and assign each into one of six categories, ranging from "very underweight" to "obese". The health care professionals’ categorization was compared with the children’s degree of adiposity based on conventional clinical criteria for BMI. The health care professionals were found to be generally poor at assessing the weight status of the children, and in particular tended to underestimate overweight and obesity in children.

Comment Pediatricians in India are also now facing the increasing prevalence of obese children in our society. This study suggests that it is not appropriate to rely on informal assessment to identify obesity and it is imperative to have anthropometric measurements every time we see a child in our clinic.

Pseudoephedrine use is common among young children (Pediatrics 2008 Dec;122(6):1299-304)

Pseudoephedrine, a decongestant found in many cough-and-cold medications, is known to be associated with deaths and adverse events in young children. This study was done at Boston University, USA to describe the prevalence and patterns of pseudoephedrine use among 4267 US children, aged 0 to 17 years and enrolled from 1999 to 2006 in a USA national random-digit-dial telephone survey of medication use. Overall, use was highest for children who were younger than 2 years. Of the pseudoephedrine products used, most were multiple-ingredient liquids (58.9%) and multiple-ingredient tablets (24.7%).

Comment India, like USA, has a number of over the counter and prescription cough remedies containing pseudoephedrine and its exposure mostly in the form of multiple-ingredient products, is common among children, especially who are younger than 2 years. These are at the highest risk for toxicity and safe dosing recommendations are lacking. We should discourage its use for extended period of time.
 

Parents of new babies should be considered for a whooping cough booster vaccination (BMJ 2008; 337: a343)

Evidence is growing that the incidence of pertussis is rising in adolescents and adults all over the world and many developed countries have recommended to give booster dose of Tdap to adults and adolescents. Infectious adults within a family are the main source of infection for unimmunized infants. Doctors at the Royal Hospital for Sick Children in Edinburgh reported two fatal cases of invasive pertussis in unvaccinated young infants where investigation revealed the pertussis infection in one of the parents.

Comment Pre-vaccination infants now account for the majority of pertussis-related complications, hospitalizations and deaths. Most of these infants catch the disease from affected household members, with parents accounting for more than half of the cases. Introduction of an adult booster or targeted vaccination of household contacts of young infants should be considered. This is reflected in the latest IAPCOI Recommendation also.

 

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