1.gif (1892 bytes)

Clipping

Indian Pediatrics 2000;37: 1038-1040

 

 

  • Do steroids given during acute bronchiolitis help prevent wheezing later? It has been postulated that during the acute RSV infection the immune response may induce long-lasting detrimental effects, thereby contributing to post-bronchiolitis wheezing (PBW). Therefore, immune-modulating drugs like corticosteroids, administered in the acute phase of RSV bronchiolitis, may prevent PBW and asthma. A randomized double-blind placebo-controlled intervention was conducted in the acute phase with oral prednisolone 1 mg/kg/day for 7 days or a placebo in fifty-four patients less than 2 years of age and hospitalized for RSV bronchiolitis between 1992 and 1995. At the mean age of 5 years, 47 patients had completed their follow-up but the incidence of wheeze in either group was not different. So if you are sure its bronchiolitis, no need for steroids (Pediatr Pulmonol 2000; 30: 92).

  • There is currently no optimal test to screen for endogenous Cushing’s syndrome (CS) in children. Traditional 24-hour urine or midnight serum cortisol values may be difficult to obtain. Sixty-seven children (5-17 years) were enrolled in a study, with a break up of 24 obese volunteers, 29 non-obese volunteers, and 14 children with CS. Saliva was obtained at 7.30 a.m., bedtime, and midnight for measurement of free cortisol by radioimmu-noassay. The diagnostic accuracies of midnight salivary cortisol and urinary free cortisol per square meter were the same (93%). Salivery cortisol measurement at bedtime or midnight rules out CS in nearly all cases. Night-time salivary cortisol sampling is thus a simple, accurate way to screen for hypercortisolism in children (J Pediatr 2000; 137:  30).

  • The effectiveness of intervention measures on the primary prevention of asthma has not been well studied. To assess the effectiveness of a multifaceted intervention program in the primary prevention of asthma in high-risk infants, a prospective, prenatally randomized, controlled study was conducted with follow-up through the age of 1 year. A total of 545 high-risk infants (at least 1 first-degree relative with asthma or 2 first-degree relative with other IgE-mediated allergic diseases) were identified before birth. They were encouraged inter-ventions in the form of avoidance of house dust mite and pet allergens and environmental tobacco smoke, encouragement of breast-feeding, and supplementation with a partially hydrolyzed formula. There was a modest but significant (p = 0.04) reduction in the risk of possible or probable asthma and rhinitis without apparent colds at the age of 12 months in high-risk infants. The authors do readily concede that a prolonged follow up is required to confirm the decrease in incidence of asthma (Arch Pediatr Adolesc Med 2000; 154: 657).

  • Studies assessing cost effectiveness of newer (and relatively expensive) techniques are few and far between in any developing country including India. A study from Hyderabad suggests that CT may be the initial investigation of choice (and cost effective too) in management of partial seizures. The etiological spectrum of 558 children (<16 years) with partial seizures seen in a university hospital in south India, was analyzed. Single CT enhancing lesion (SCTEL; solitary cysticercal granuloma), single small cerebral calcific CT lesion (SSCCCTL), and multiple small cerebral calcific CT lesions together accounted for 51% of patients categorized under symptomatic localization-related epi- lepsies. They conclude that in India a child with partial seizures with no obvious causation has a high probability of harboring one of these three lesions (J Trop Pediatr 2000; 46: 202).

  • With increasing survivors from acute leukemia it has become imperative to study the side effects of some of the drugs used in therapy. The effect of high dose dexametha-sone therapy in induction phase of ALL on adrenal function was studied in ten children with early B-cell lineage acute lymphoblastic leukemia using the corticotropin stimulation test. High-dose dexamethasone therapy can cause adrenal insufficiency lasting more than 4 weeks after cessation of treatment. This problem might be avoided by tapering doses of glucocorticoids and providing supplemental glucocorticoids during periods of increased stress (J Pediatr 2000; 137: 21).

  • What are the predictors of neonatal sepsis? In a hospital based study among 18,299 newborns ³2000 g without major congenital anomalies, 2785 (15.2%) were evaluated for sepsis with a complete blood count and/or blood culture. A total of 62 (2.2%) met criteria for proven, probable, or possible bacterial infection. It was concluded that the risk of bacterial infection in asymptomatic newborns is low. Evidence-based observation and treatment protocols could be defined based on a limited set of predictors: maternal fever, chorioamnionitis, initial neonatal examination, and absolute neutrophil count. (Pediatrics 2000; 106: 256).

  • Markers for airway inflammation that can be measured noninvasively in expired air may be helpful in treating patients with asthma. For example, levels of nitric oxide are high in the breath of children with asthma exacerbations and decrease with anti-inflammatory therapy. Expired nitric oxide testing has now been standardized and may be useful for children with recurring wheezing that is diagnostically or therapeutically challenging. However, the results may be influenced by several bio-chemical and anatomic variables and must therefore be interpreted with caution (J Pediatr 2000; 137: 14).

  • The recognition, follow-up, and early treatment of neonatal jaundice has become more difficult, since the earlier discharge of newborns from hospitals has become common practice. This prospective study was under-taken to identify the newborns at risk for developing significant hyperbilirubinemia by trying to determine the cutoff critical predictive serum bilirubin value on the first day of life. A total of 498 healthy term newborns were followed with daily serum total bilirubin measurements for the first 5 days of life, and cases with serum bilirubin levels of 17 mg/dL after 24 hours of life were defined to have significant hyperbilirubinemia. They conclude that a serum bilirubin measurement of 6 mg/dL in the first 24 hours of life will predict nearly all of the term newborns who will have significant hyperbilirubinemia and will deter-mine all those who will require a phototherapy treatment later during the first days of life. (Pediatrics 2000; 106: e16).

  • Can neonatal MRI predict later neurodevelopmental outcome? Fifty-two term infants who presented at birth with a neonatal encephalopathy consistent with HIE and who had neonatal brain MRI were entered into the study. Head circumference charts were evaluated retrospectively and the head growth over the first year of life compared with the pattern of brain lesions on MRI and with the neurodevelopmental outcome at 1 year of age. Suboptimal head growth was documented in 53% of the infants with HIE as compared to 3% of the controls. Suboptimal head growth was significantly associated with the pattern of brain lesions, in particular involvement of white matter, basal ganglia and thalamic lesions and was a better predictor of neurodevelopmental outcome than microcephaly (Pediatrics 2000; 106: 235).

  • How soon do blood cultures become positive? Conventional wisdom suggests that routine techniques would take a minimum of 48-72 hours. However, a recent study suggests otherwise. During the 47-month study period, 10,200 single bottle blood cultures were obtained, 711 (6.97%) of which became positive. Of the 258 cultures containing only pathogens, 14% were positive by 12 hours, 87% by 24 hours, 92% by 36 hours, 95% by 48 hours, 98% by 60 hours, and 99.7% by 72 hours. Ninety-five per cent of critical pediatric pathogens including Streptococcus pneumo-niae, Salmonella and other Enterobacteria-ceae, Neisseria meningitidis, and groups A and B streptococci were detected in <24 hours. This study can assist emergency department, clinic, and primary care clinicians when making critical decisions concerning patients on whom blood cultures were obtained. Use of short stay (<24 hours) or extended care units requiring less patient supervision may be easier to justify when a continuously monitoring blood culture instrument is used in the microbiology laboratory (Pediatrics 2000; 106: 251).

  • SIDS has long been a topic of a raging debate. Now there’s another interesting and complex theory as to its causation that implicates the cerebellum! Dysfunction in affected brain areas appears to arise prenatally from a compromised fetal environment, with a nicotinic component contributing to the deficient mechanism. Physiologic character-istics of infants who later succumb to SIDS, and cardiovascular events associated with the fatal scenario suggest a failure of interaction between somatomotor and autonomic control mechanisms in infants at risk for the syndrome. A failure of compensatory motor actions to overcome a profound hypotension, perhaps mediated by cerebellar mechanisms that regulate blood pressure, may underlie the fatal event (Pediatr Res 2000; 48: 140).

  • Use of IV terbutaline has increased in PICU management of severe asthma. To examine the cardiac toxicity as measured by elevations in serum cardiac troponin T (cTnT), a prospective cohort study was conducted. Only 3 (10%) of the 29 patients had elevations in cTnT. Each underwent mechanical ventilation for >72 hours, which was the earliest point at which cTnT elevations were identified. Both mechanical ventilation (p = 0.02) and prolonged administration (>72 hours) of intravenous terbutaline (p = 0.02) were significantly associated with elevations in cTnT. The authors found no clinically significant cardiac toxicity from the use of intravenous terbutaline for severe asthma as measured by serum cTnT elevations (J Pediatr 2000; 137: 73).

Gaurav Gupta,
Senior Resident,
Advanced Pediatric Center,
Postgraduate Institute of Medical
Education and Research,
Chandigarh 160 012, India.

E-mail:
[email protected]

Home

Past Issue

About IP

About IAP

Feedback

Links

 Author Info.

  Subscription