|
-
With the
likely introduction of acellular pertussis vaccine in the near future,
it is a pertinent question as to whether this vaccine can be used as a
booster in children who have earlier received the whole cell vaccine.
Case-control studies were conducted in two age groups, 18 months and 5
years. In children who received or were eligible to receive their 18
months booster, the risk of pertussis was 1.4 and 3.6 times higher for
those with 4 and 3 whole cell (wP) vaccines, respectively, compared to
those with 3 wP+1 acellular pertussis (aP) vaccine. In 5 and 6 yr old
children, the risk of pertussis among the subjects with 5 and 4 wP, was
1.4 and 2.1 times higher respectively than in those who received 4 wP+1
aP. A single dose of aP increased the protection against pertussis and
this protection was greater than that obtained with a wP booster
(Vaccine 2001; 19: 3004).
-
An interesting
study was done to test the association between childhood IQ and mortality over the normal
human lifespan.
All 2792 children in Aberdeen born in 1921 and
attending school on 1 June 1932 who sat a mental ability test as part of the Scottish mental
survey 1932
were traced for survival on 1 January 1997. 79.9% (2230) of the sample
was traced. Childhood mental
ability was positively related to survival to age 76 years in women (p <0.0001) and men (p
<0.0001). Childhood mental ability is a significant factor among the variables that
predict age at death (BMJ 2001; 322: 819). Is this an evolutionary mechanism ensuring the
survival of the fittest?
-
Do antibiotics
help in the treatment of acute sinusitis? A placebo controlled RCT was
conducted in 188 patients
(1-18 years) who had had
10 to 28 days of persistent sinus symptoms and a clinical diagnosis of acute sinusitis. Of
the 161 patients who were included in the analysis,
58 received amoxicillin, 48 received amoxi-cillin-clavulanate,
and 55 received
placebo. The rates of adverse events, relapse, and recurrence of sinus
symptoms were similar among treatment groups. The authors conclude that
neither amoxicillin nor amoxicillin-clavulanate offered any clinical
benefit compared with placebo for children with clinically diagnosed acute sinusitis
(Pediatrics 2001; 107: 619).
-
What is the
best correlator of bilirubin encephalopathy? Is it bilirubin-albumin (B:A)
molar ratio (MR), unbound bilirubin (UB) or serum total bilirubin (TB)? During a
2-year period, serial auditory brainstem reflexes (ABRs) were obtained
on 143 infants of 28 to 32 weeks’ gestational age
during the first postnatal week
to look for bilirubin encephalo-pathy. The mean peak TB concentration
(10.1 ± 1.7 mg/dL) for the 71 infants with normal
ABR maturation was not significantly different from the mean peak TB
(10.2 ± 2.1 mg/dL) in infants with abnormal ABRs
(55 infants). However, in infants with UB analyzed, the mean peak UB (0.62 ± 0.20 vs
0.40 ± 0.15 µg/dL) was significantly higher in the infants with abnormal
maturation (n = 25) than in infants with normal maturation
(n = 20). The B : A MR results were equivocal. The authors
felt that UB is a more sensitive predictor than either serum bilirubin
or B : A MR of abnormal ABR maturation, and hence transient bilirubin encephalopathy in premature
newborns with hyperbilirubinemia (Pediatrics 2001; 107: 664).
Nitric oxide is being used in the treatment of severe
hypoxemic respiratory failure in neonates. To study its long-term
consequences, echocardiographic evaluations in 40 survivors treated for
severe neonatal hypoxemic respiratory failure was undertaken. Three of
31 infants met echocardiographic criteria for pulmonary hypertension at
the 3-month examination. Two of the 3 had associated structural heart
disease (1 with an atrial septal defect and 1 with a ventricular septal
defect). At 24 months, only 1 patient had pulmonary hypertension (ASD).
The authors believe that the incidence of residual pulmonary
hypertension in infants treated as newborns for severe hypoxemic
respiratory failure is low. The group at highest risk is those with
structural heart disease (J Pediatr 2001; 138: 349).
-
Nosocomial
diarrhea is a major problem in pediatric hospitals worldwide. The
efficacy of orally administered Lactobacillus GG (LGG) in the prevention
of this disease in young children was demonstrated in a recent
randomized double blind trial. Eighty-one children aged 1 to 36 months
who were hospitalized for reasons other than diarrhea were enrolled to
receive LGG (n = 45) at a dose of 6 × 109
colony-forming units or a comparable placebo (n = 36) twice daily orally
for the duration of their hospital stay. LGG reduced the risk of
nosocomial diarrhea in comparison to placebo (6.7% vs 33.3%). The
prevalence of rotavirus infection was similar in LGG and placebo groups
(20% vs 27.8%); however, the use of LGG compared to the placebo
significantly reduced the risk of rotavirus gastroenteritis (1/45 [2.2%]
vs 6/36 [16.7%]). (J Pediatr 2001;138: 361).
-
To determine
the frequency and characteristics of seizure induced cerebrospinal fluid
(CSF) abnormalities in children and to identify potential alternative
causes of these findings, 80 consecutive patients who underwent lumbar
puncture within 24 hours after a seizure were studied retrospectively.
Coexisting conditions that could affect CSF findings, such as traumatic
lumbar puncture, concurrent neurologic disease, and undiagnosed
meningitis, were identified. Eighteen of the 80 patients were excluded
from the final study group because of the presence of another condition
that could alter the CSF. In the remaining 62 patients, postictal
pleocytosis was detected in only 3 (5%), and increased protein was
detected in only 6 (10%). Seizure-induced CSF abnormalities are rare in
children, and alternative, often unidentified, disease processes may
account for many observed postictal abnormalities. All patients with
abnormal CSF after a seizure should be thoroughly evaluated for other
causes of the abnormality (J Pediatr 2001; 138: 373).
-
Osteoporosis
or bone fracture can be induced in nephrotic children treated long- term
with high doses of glucocorticoids. The purpose of this study was to
determine whether short-term prednisolone therapy affects the skeleton
in children with steroid-responsive nephrotic syndrome (NS). Bone
mineral density (BMD) and biochemical parameters of mineral and skeletal
homeostasis in nine children (four girls, five boys) aged between 2 and
7 years at the first episode of NS were measured. Prednisolone was
started at 60 mg/m2
for 4 weeks, then decreased every 2 weeks for 12 weeks. All patients
were steroid-responsive and had no relapse. BMD and biochemical
parameters of mineral and skeletal homeostasis returned to normal values
at 16 weeks after the cessation of prednisolone therapy, thus leading
the authors to conclude that the skeletal effects of short-term
prednisolone therapy were transient in children with steroid-responsive
NS without relapse. (Clin Experimental Nephro-logy 2001; 5: 40).
-
A longitudinal
cohort of children (n = 41) with symptomatic congenital CMV infection
was evaluated at birth and followed up with serial age-appropriate
neurodevelopmental testing. Microcephaly was the most specific predictor
of mental retardation and major motor disability. An abnormality
detected by CT was the most sensitive predictor for mental retardation
and motor disability. A highly significant (p <0.001) positive
correlation was found between head size at birth and the
intelligence/developmental quotient (IQ/DQ). There was no association
between sensorineural hearing loss at birth and cognitive outcome,
though they had lower IQ/DQ (p = 0.006) than those with normal hearing.
Children with normal findings on head CT and head circumference
proportional to weight exhibited a good cognitive outcome (J Pediatr
2001; 138: 325).
-
A comparison
of the World Health Organization (WHO) oral rehydration solution (ORS)
and 2 different formulations of reduced osmolarity ORSs in infants with
persistent diarrhea has revealed the latter to be more effective.
Infants with persistent diarrhea (n = 95) were randomized to 1 of the 3
ORSs: WHO-ORS (control, n = 32), a glucose-based reduced osmolarity ORS
(RORS-G, n = 30), or a rice-based reduced osmolarity ORS (RORS-R, n =
31) for replacement of ongoing stool losses for up to 7 days. The stool
volume was approximately 40% less in the reduced osmolarity ORS groups;
consequently, these children required less ORS. A higher proportion of
children in the RORS-R groups also had resolution of diarrhea during the
study period. Reduced osmolarity ORS may thus be advantageous for use in
the treatment of children with persistent diarrhea (J Pediatr 2001; 138:
532).
Gaurav Gupta,
Senior Resident,
Department of Pediatrics,
Postgraduate Institute of Medical
Education and Research,
Chandigarh 160 012, India.
Email:
[email protected]
|
