Antiepileptic drugs during pregnancy have been found linked to congenital malformations. In this study from Finland, the records of 970 pregnant women with epilepsy - 740 of whom had taken anti-epileptic drugs, were analyzed. Congenital malformations were present in offspring of 3.8% of mothers on anti-epileptic drugs and only 0.8% of those in the non-exposed group. Significant risk factors noted were - low folate levels in first trimester and antenatal use of valproate, carbamazepine and derivatives. The researchers recommend the use of a single anti-epileptic drug, substitution with newer anti-convulsants, and folate supplements for pregnant women with epilepsy. (Neurology. 2003; 60:575-579)

Iron supplements are of benefit in upper respiratory tract infections. In this randomized controlled study from Sri Lanka, over 350 children received either iron supplements for eight weeks or a placebo. Over half of the children in both the groups had anemia prior to the study. The researchers noted a significant reduction in the severity and episodes of respiratory infections and also a rise in the hemoglobin and ferritin levels in the iron supplemented group. But for mild diarrhea in some of the children, iron supplements were safe and probably act by improving the immune status, they observed. The study recommends universal iron supplementation in areas with high prevalence of iron deficiency. (Am J Clin Nutr 2003; 77: 234-241)

Iron supplements may, however influence the vitamin A status! In a randomized controlled trial from Indonesia, 387 infants aged 4 months were given supplements of iron, zinc, carotene or a placebo. The researchers noted that though their iron status was better, the iron-supplemented infants had the lowest serum retinol levels and highest risk of vitamin A deficiency. This was accompanied by an increase in the liver stores of vitamin A in these children, suggesting a redistribution of vitamin A from circulation to stores following iron supplements. Iron supplements should thus be accompanied by "measures to improve vitamin A status," the study concludes. (Am J Clin Nutr 2003; 77: 651-657)

CSF Lysozyme can help in the rapid diagnosis of tubercular meningitis. In this study from Benares, India, the diagnostic role of CSF Lysozyme was studied in 95 children admitted with CNS infections, including tubercular meningitis. The lysozyme levels in CSF were more than two times higher in tubercular meningitis as compared to bacterial meningitis, encephalitis and controls. Using a CSF lysozyme level of 26 IU/L or more as 'cut-off' for diagnosis of tubercular meningitis resulted in a sensitivity and specificity of over 90% and 80% respectively. CSF lysozyme can be used as a rapid screening test for tubercular meningitis and for differentiating it from other CNS infections, the study concludes. (J Trop Pediatr 2003; 49: 13-16)

Educating children with asthma using the Internet has been found beneficial! In this randomized study from USA, over two hundred children with asthma used either an interactive multimedia based education program or continued with the conventional program. The internet based program resulted in a significant improvement in the patient knowledge of disease, reduced the need for steroids and also the severity of attacks as noted by the lower symptom days and emergency room visits. The Internet based patient education program can be used as an "effective supplement" to the conventional care, the researchers conclude. (Pediatrics 2003; 111: 503-510)

Chemoprophylaxis to both mother and neonate reduces Group B streptococcal infections. This study from Texas, USA, used a risk-factor based approach of giving chemoprophylaxis to both mother and neonate. In a regimen that was followed from 1995 onwards, mothers received parenteral ampicillin intrapartum, while their neonates received a single dose of penicillin soon after delivery. The investigators noted a 76% decrease in episodes of GBS infections in the period from 1995 to 1999 when the intervention was in place as compared to the period prior to the intervention. The combined approach was a success in reducing GBS infections, the report concludes. (Pediatrics 2003; 111: 541-547)

Inhaled nitric oxide alleviates symptoms of vaso-occlusive sickle cell crises. Twenty patients aged between ten and twenty-one years with vaso-occlusive crises received in addition to the conventional regimen, either inhaled nitric oxide for four hours or a placebo. The researchers observed that the pain scores, use of opiod analgesics and duration of hospitalization was significantly lesser in the nitric oxide group. Low nitric oxide levels may precipitate vaso-occlusive crises and hence the noticeable benefit with nitric oxide, the researchers conclude. (JAMA 2003; 289: 1136-1142)

Fecal lactoferrin can be used to rule out invasive diarrhea in children. This study form Vellore evaluated the diagnostic efficacy of fecal lactoferrin in 262 children with acute gastroenteritis. When compared the stool cultures, fecal lactoferrin in a 1:50 dilution could identify invasive microorganisms with a sensitivity of 83.3% and negative predictive value of 90%. Fecal lactoferrin was better than other clinical criteria like tenesmus and blood and mucus in stool for diagnosis of invasive diarrhea, the researchers observe As fecal cultures are costly, time consuming and may result in a poor yield, the researchers conclude that fecal lactoferrin can be used as a rapid screening test for diarrhea due to invasive pathogens. (Annals of Tropical Paediatrics 2003; 23: 9-13)

A new screening protocol has been found effective for antenatal diagnosis of Down's syndrome. Researchers from UK tested four criteria taken together - maternal serum alphafetoprotein, unconjugated estriol, inhibin A and hCG as a screening test for selecting patients for amniocentesis. The quadruple criteria had a sensitivity of 81% as compared to 51% sensitivity for maternal age alone in detecting Down’s syndrome. Maternal serum testing should be primary screening test for Down's syndrome, comments a related editorial. Use of maternal age alone as screening criteria results in "overuse of invasive tests" like amnio-centesis, they conclude. (Lancet. 2003; 361:794-795, 835-836)

Canadian researchers have defined the risk factors for poor outcome in extremely low birth weight infants. Over 900 ELBW infants who survived were studied. Three criteria - bronchopulmonary dysplasia, brain injury and retinopathy of prematurity were associated with a poor outcome according to the Canadian researchers. The risk of long-term poor outcome was 42%, 62% and 88% with the presence of one, two or all three criteria, the Canadian group reports. Use of these criteria will help early identification of infants who are likely to better or have long term complications, the report concludes. (JAMA 2003; 289: 1124-1129)

Researchers from Sweden have noted that perinatal mortality was higher among babies born at nighttime. They analyzed over 600,000 deliveries and observed that mortality within the first week of birth was 1 in 573 births among those born at nighttime as compared to a mortality of 1 in 649 among those born at daytime. Day-night differences in the quality of skilled care available may be responsible for these differences, they conclude.(Epidemiology 2003; 14: 218-222)

A recombinant antioxidant compound has been found to improve the outcome in premature infants who received surfactant therapy. In this randomized study, over 300 preterm neonates treated with surfactant received either recombinant human Copper-Zinc superoxide dismutase or a placebo. The study reported that the incidence of wheeze, respiratory infections and need for bronchodilators in the first year of life was significantly lesser in the antioxidant group. Recombinant surfactant is safe and acts by preventing oxidant-related damage to the neonatal lungs, the New York researchers conclude.(Pediatrics 2003; 111: 469-476)

C. Vidyashankar,
Pediatrician,
Military Hospital, Kamptee,
Nagpur 441001, Maharashtra,
India.
E-mail: [email protected]