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Gaurav Gupta
Email:
[email protected] |
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Sildenafil for children after Fontan Procedure – what’s
new? (Circulation 2011; 123: 1185-1193) |
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After the Fontan operation, patients often have decreased exercise
capacity. Limitation in ventricular preload, related to pulmonary artery
resistance plays an important role. A drug able to decrease pulmonary
vascular resistance might increase transpulmonary flow and ventricular
preload, therefore improving cardiac output and exercise performance. This
crossover trial conducted on 28 children (median age 14.9 years) reported
an increase in exercise capacity during submaximal exercise, after 6 weeks
of sildenafil in those patients with single left or mixed ventricular
morphology and in those with more advanced heart failure. The drug was
well tolerated. Sildenafil may play a role in improving exercise
performance and exercise-induced breathlessness in children and young
adults with single-ventricle physiology after the Fontan operation.
Editor’s Comments Who could imagine that the Blue Pill would one day
be seen as a savior of Blue Babies?
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Oral steroids linked to severe Vitamin D deficiency
(J Clin Endocrinol Metabol September 28, 2011; online first) |
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To assess the association between steroid use and vitamin D levels, the
researchers examined data from 31,000 children and adult participants of
the National Health and Nutrition Examination Survey (2001-2006) of United
States. About 1% of the participants had used oral steroids during the
previous 30 days; 11% of the self-reported steroid users had severely low
vitamin D levels compared with 5% for people not taking steroids. The risk
was particularly pronounced for steroid users younger than 18 years, who
were 14 times more likely to have severe vitamin D deficiency.
Editor’s Comments My concern is different. Why should 1% of the
general population at any given time be using steroids at all? Something
seriously wrong somewhere!!
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Comparison of umbilical venous and intraosseous access
during simulated neonatal resuscitation (Pediatrics 2011; 128, 4
online) |
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Emergent umbilical venous catheter (UVC) placement for persistent
bradycardia in the delivery room requires significant skill and involves
space constraints. Placement of an intraosseous needle (ION) in neonates
has been well described. In this study the authors compared time to
placement, errors in placement, and perceived ease of use for UVCs and
IONs in a simulated delivery room. Forty health care providers were shown
a video of both tech-niques and allowed to practice placement in 2
simulated conditions requiring intravenous epinephrine. Scenarios were
recorded for later analysis. The average time required for ION placement
was 46 seconds faster than for UVC placement (P<.001). There was no
significant difference in the number of errors between UVC and ION
placement or in perceived ease of use. Authors concluded that intraosseous
insertion should be considered when rapid intravenous access is required
in the neonate at the time of birth, especially by health care
professionals who do not routinely place UVCs.
Editor’s Comments Take with a pinch of salt as the authors’
conclusions are based on extrapolation of results obtained on a manikin.
The simulation may not always apply to a live situation!
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Are febrile respiratory illnesses in infancy a risk
factor for persistent asthma? (Eur Respir J. 2011 Sep 20.
Epub ahead of print) |
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To explore associations between severe respiratory infections and atopy in
early childhood with wheeze and asthma persisting into later childhood,
147 children at high atopic risk were followed from birth to 10 years.
Data on all respiratory infections occurring in infancy were collected
prospectively and viral etiology ascertained. Atopy was measured by skin
prick tests at 6 months, 2 and 5 years. At 10 years 60% of the cohort was
atopic, 25.9% had current eczema, 18.4% current asthma and 20.4%
persistent wheeze. 35.8% experienced
>1
lower respiratory infection (LRI) associated with fever and/or wheeze in
first year. Children who had wheezy, or in particular, febrile LRI in
infancy and were atopic by 2 years, were significantly more likely to have
persistent wheeze (RR 3.51; 95%CI 1.83-6.70; P<0.001) and current
asthma (RR 4.92; 95%CI 2.59-9.36; P<0.001) at 10 years. The
occurrence of fever during respiratory illnesses was an important marker
of risk for wheeze and asthma later in childhood.
Editors’ Comments And we were always under the
impression that the fever is good for it shows that the body is capable of
fighting aggressively against he intruder. The debate ‘‘fever-friend or
foe’’, thus continues!
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