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Indian Pediatrics 1999;36: 1078-1080 |
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o Babies fed on formula milk have hard stools. However, adding long chain polyunsa-turated fatty acids to the feed, softened the stool and reduced the number of stools each day (Arch Dis Child 1999; 81: 253). These were the findings of a randomized controlled study on 88 infants in whom stool samples were examined in a three day study period following fatty acid supplementation. The authors weren't sure why the supplement softens stools, but they say it's likely to be something to do with fat absorption. Breast milk, however contains long chain polyunsaturated fatty acids, and constipation is rarely a problem in breast fed babies. o Among the many adverse effects of TV watching is a disturbance in the sleep pattern. A study on 495 children through questionnaires administered to parents and teachers found that the television-viewing habits associated most significantly with sleep disturbance were increased daily television viewing and television viewing at bedtime. The sleep disturances associated were bedtime resistance, sleep onset delay, anxiety around sleep and shortened sleep duration. The authors suggest the need for anticipatory guidance with regards to healthy sleep habits in children (Pediatrics 1999; 104: e27). o The use of computed tomography with rectal contrast (CTRC) has been found effective in diagnosis of acute appendicitis, doubtful even after clinical suspicion and ultrasound. These were the findings of a study on 139 children seen in an emergency department. The addition of CTRC after a negative ultrasonography increased the imaging sensitivity from 44% to 94%. However, they caution that its use should be only in indicated cases, as indiscriminae use could potentially result in a delay in diagnosis and unnecessary radiation exposure (JAMA 1999; 282: 1041). o Hepatitis C clears faster in kids, but the reasons are not clear! A study on 458 children who underwent heart surgery in Germany, before screening for Hepatitis C was started, found that 67 (15%) developed hepatitis C infection. Twenty years later the infection had cleared on its own in nearly half (n=30) of the patients. Among those in whom the infection was still present (n=37), only a few (n=3) had developed liver disease. In contrast, among adults, only 20% of those who acquire hepatitis C manage to fight off the infection without treatment. An accompanying editorial noted that the reasons behind the spontaneous clearance of the infection among the children remain unclear (N Engl J Med 1999; 341: 866). o Nebulizing a crying child may not be all that effective. Therapeutic aerosols are routinely used in the management of infant obstructive airways disease with the infants often becoming distressed during administ-ration. The influence of distress and disease severity on the absorption of aerosolized drug was studied on fifteen infants, who were given nebulized sodium cromoglycate. Analysis of the excreted drug in urine by radioimmuno assay found a significantly higher value in non-distressed infants, indicating increased absorption. The degree of airways disease however, did not influence the drug absorption (Arch Dis Child 1999; 81: 163). o Buccal midazolam appers to be a competitor to rectal diazepam in management of status epilepticus. In this study, buccal midazolam was used to treat 40 seizures in 14 students, and rectal diazepam 39 seizures in 14 students. Midazolam stopped 30 (75%) of 40 seizures and diazepam stopped 23 (59%) of 39 seizures. The study concluded that buccal midazolam is as effective as rectal diazepam in management of status epilepticus. Moreover, administration by mouth is more socially acceptable and convenient and this may become the preferred treatment for long seizures that occur outside a hospital (Lancet 1999; 353: 623). o A single dose of dexamethasone given early on the first day of life has been found to improve respiratory and cardiovascular adap-tation in the first week in preterm infants. In this randomized study on 70 infants less than 28 weeks of age, 37 recieved dexmethasone (0.2 mg/kg) within 2 hours of birth. A decreased incidence of intraventricular hemorrhage, rapid ventilator weaning, higher mean blood pressure and decreased use of indomethacin for patent ductus arteriosus were reported in the dexamethasone group as compared to controls (J Pediatr 1999; 135: 345). o Parents are usually excluded from watching their children undergo invasive hospital procedures, but results of this small study have questioned this convention. A prospective study evaluated the presence of either of parents during procedures like intubation, placement of central lines, or chest tubes. There were 16 patients in the study group and 7 in the control group. It was observed that allowing parental presence decreases procedure-related anxiety, with a majority of the parents finding this helpful to their children, the staff and themselves (Arch Pediatr Adolesc Med 1999; 153: 955). o From solar cookers to solar disinfection of water! In a randomized controlled study on 349 children, the incidence of diarrheal diseases was significantly lesser in households who consu-med water left in plastic bottles exposed to sunlight on the roof of the house. The study concluded that solar disinfection is effective in vivo as a free, low technology and point of consumption method of improving water quality. With effective community partici-pation, the abundance of sunshine should ensure that this method can be implemented in our country also (Arch Dis Child 1999; 81: 301). o Middle cerebral artery (MCA) is most commonly involved in ischemic cerebrovas-cular accidents. In a retrospective study on 38 children with stroke due to MCA involvement, the relation between lesion volume, lesion location, and clinical outcome was evaluated. The study found that infarction of more than 10% of intracranial volume was universally associated with a poor outcome. Pronounced residual deficits were found in some children with small subcortical lesions. Characterization of lesion volume and topography might be helpful in identification of such children for participation in future trials of treatments for acute stroke, (Arch Dis Child 1999; 81: 295). o The ratio of lactate to creatinine in urine soon after birth may identify infants at highest risk for hypoxic-ischemic encephalopathy (HIE). In a study on sixteen infants with asphyxia who subsequently developed HIE, the sensitivity and specificity of a urinary lactate: creatinine ratio of 0.64 or higher within six hours after birth in predicting the development of HIE were 94% and 100%, respectively. This compared favorably with the currently used markers involving multiple criteria (New Engl J Med 1999: 341: 328). A related editorial stressed on the need for early diagnosis of HIE so that appropriate neuroprotective measures can be initiated (New Engl J Med 1999; 341: 364). o Backache is a not a very common presenting symptom in pediatric practice. In this study, 225 children with initial complaints of back pain were evaluated. Their mean age was around 12 years with the onset mainly acute and awakening the children from sleep. Schooling was affected in more than half the cases. Musculoskeletal disorders were found to be the commonest, with direct trauma (25%) and muscle strain (24%) predominating. The other causes were sickle cell crises (13%), urinary tract infection (5%), and viral syndromes (4%). Radiographs of the back were rarely helpful. About 5% required hospital admission, with one half of these being attributed to sickle cell crises. The study concluded that though the etiology is rarely serious, back pain often affects the daily activities of symptomatic children (Clin Pediatr 1999; 38: 401). o Zinc protoporphyrin/heme ratio has been found to aid early diagnosis of iron deficiency in the preclinical stages. The ZPP/H ratio was evaluated as a single indicator of iron status by comparing it with other tests for detecting the onset of iron deficiency and for monitoring recovery after iron supplementation. Serum ferritin concentration and the ZPP/H ratio were independently more specific than was either hemoglobin or hematocrit. An increase in the ZPP/H is a sensitive, specific and cost-effective test for identifying preanemic iron deficiency in a community pediatric practice (Pediatrics 1999; 104: e37). o Babies can catch HIV through breast milk as long as they are breastfed. A study on 672 HIV negative infants born to untreated HIV positive mothers in Malawi has found that though maximum transmission was in the first six months, the transmission continued through the period of breastfeeding. High maternal parity and older maternal age were however associated with a low risk of postnatal transmission of the virus, probably due to the amount of maternal experience with breastfeeding (JAMA 1999; 282: 744). These conclusions are significant in developing countries, where breastfeeding is almost universal. An accompanying editorial has suggested that a way out could be to advise women to wean their infants early to reduce the risk of transmission. C. Vidyashankar, |
