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Clippings Indian Pediatrics 2001; 38: 442-444 |
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• More on "fetal origins...". Low birth weights and thin children have been reported to have an increased risk of developing schizophrenia. This study from Finland evaluated the medical records of over 700 individuals born between 1924 and 1933 and found that 114 of these had developed schizophrenia. The researchers observed that those who were less than 49 cm long at birth and had a low body mass index (BMI) at 7 years of age were four times more likely to develop schizophrenia. The other related risk factors noticed were a maternal BMI of less than 30 in late pregnancy and small placental size. Both herediatry and environmental factors are involved in the causation of schizophrenia, the researchers concluded (Arch Gen Psych 2001; 58: 48). • There is more evidence on the association between MMR vaccine and Idiopathic Thrombocytopenic Purpura (ITP), a finding first reported in 1980’s. This study from UK analyzed 36 children with ITP who were admitted for a total of 45 times. They study found that 28 episodes of ITP in 21 children occurred within 42 days of MMR vaccination. The researchers reported a relative risk of 3.27 and an absolute risk of 1 in 22,300 doses for ITP occurring within six weeks of MMR vaccine. ITP associated with MMR was of shorter duration and had higher platelet count. However, giving the vaccine to patients with prior ITP was not associated with recurrence (Arch Dis Child 2001; 84: 227). • Children born through Caesarian section have been found to be at a higher risk, among others, of persistent pulmonary hypertension. This study analyzed over 25,000 deliveries between 1992-1999 of which 4301 were Caesarian sections. Caesarian born neonates had a 4 in 1000 incidence of persistent pulmonary hypertension as compared to 0.8 per thousand among vaginal deliveries. The authors suggest that the benefit of physical compression during vaginal delivery has a beneficial effect on the pulmonary vascula-ture and decreases the chances of persistent pulmonary hypertension. (Obstet Gynecol 2001; 97: 439). • A study from Delhi has reported that hypo-osmolar oral rehydration solution (ORS) is more beneficial as compared with the standard ORS in malnourished children with acute diarrhea. In this study 64 children (<60% weight for age) between 6 months and 4 years received either the standard ORS or hypo-osmolar ORS (224 mmol/1). • The duration and volume of diarrhea and consequently their fluid and ORS intake were significantly lower in the hypo-osmolar group. These children also did not develop hypo-natremia. It was concluded that hypo-osmolar ORS has beneficial effects on the clinical course of dehydrating acute watery diarrhea in severely malnourished children (Arch Dis Child 2001; 84: 237). • Non-Steroidal Anti-inflammatory Drugs (NSAID) used by pregnant women can lead to Persistent Pulmonary Hypertension of Newborn (PPHN), according to a study from USA. This study analyzed the NSAID levels in meconium of 101 infants of whom 40 were detected in meconium of 49.5% of the neonates of which 22.8% were due to ibuprofen and 43.6% for aspirin. PPHN was significantly associated with the presence of at least one NSAID in meconium. Though patients do not give the history regarding the use of NSAIDs during pregnancy, their use is significantly associated with PPHN, the researchers concluded (Pediatrics 2001; 107: 480). • Hyberbaric oxygen is not beneficial to children with cerebral palsy reports a study from Canada. In this study 57 children with cerebral palsy aged between 3 to 12 years old received 40 sitting of hyperbaric oxygen while 54 received slightly pressurized room air for an equal number of times. There were no differences in gross motor function, memory and speech between the groups as regards the response with both groups showing some improvement. The researchers attributed this to the motivation of the parents towards treatment. On the contrary the hyberbaric oxygen group showed an increased incidence of ear problems (Lancet 2001; 357: 582). • Children with acute respiratory failure can achieve better oxygenation when placed in the prone position. These were the findings of a study which examined 10 children with acute respiratory failure. The children were randomly placed in prone followed by supine position or the reverse order with 12 hours in each position. The study found that the oxygenation and urine output improved significantly in the prone position. Though they could not explain the exact reason for the positional variation in oxygenation, the researchers recommended that prone position should be maintained for atleast 12 hours in a day, unless contraindicated due to cardiovascular compromise (Chest 2001; 119: 211). • A corticosteroid, deflazacort has been found to preserve muscle function when given to patients with Duchenne Muscular Dystrophy. Researchers from Canada studied 30 boys with an average age of 8 years who were treated with deflazacort 0.9 mg/kg per day. The boys were followed up for over 3 years. Controls were 24 boys who were not given this drug. At 10 years of age, significantly larger number of children in the corticosteroid group were able to walk, climb stairs and to get up from the floor as compared to the controls. The forced vital capacity was also significantly better than the controls at 10 years as well as 13 years of age. None of the steroid group required surgery for scoliosis at 13 years as compared to 13 children in the control group. Growth suppression was the main side effect in the study group, but the researchers suggest that this is beneficial as it helps in preserving muscle function (J Pediatr 2001; 138; 45). • Dexamethasone has been found bene-ficial in neonates with respiratory failure and persistent pulmonary hypertension secondary to meconium aspiration. Fourteen infants with this condition were studied over a 3-year period. These infants had received mechani-cal ventilation and had an oxygenation index greater than 25. Dexamethasone was commenced on day 5 in a dose of 0.5 mg/kg per day and given for up to a maximum of 9 days in a reducing schedule. There was a rapid, significant improvement in the respiratory status in 13 of these infants after commencing dexamethasone, allowing wean-ing from the ventilator and eventual extubation at a mean age of 8 days. Only one infant died. Dexamethasone may be effective in improving gas exchange and help in avoiding extra-corporeal membrane oxygena-tion if started early (Pediatr 2001; 160: 150). C. Vidyashankar, |
