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Sn-Mesoporphyrin, a heme oxygenase inhibitor has been reported to
prevent severe jaundice in neonates with G6PD deficiency. In this
study from Greece 172 neonates with G6PD deficiency were given a
single IM dose of Sn-Mesoporphyrine (6 µmol/kg) within 24 hours
after birth. These neonates had significantly lower levels of
hyperbilirubinemia than normal neonates and infants with G6PD
deficiency who were not given mesoporphyrin. In fact the bilirubin
levels were lower than in the normal neonates. Moreover, none of
neonates in the mesoporphyrin group required phototherapy. The study
concluded that Sn-Mesoporphyrin is highly effective in preventing
hyperbilirubinemia in G6PD deficiency. (Pediatrics 2001; 108:
25-30).
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A study
from New York has contradicted the claim that the incidence of
intussusception has increased following the use of rotavirus
vaccine. The study examined the hospital data for intussusception
and rotavirus infections from 1989 to 1998 and compared the figures
with the 1999 data when rotavirus vaccine were given. The study
reported that the incidence of intussusception had declined from
1989 to 1998. Eighty cases of intussusception were reported in 1999
as compared to 78 in 1998. The difference was not statistically
significant. Moreover intussusception occurred throughout the year
while rotavirus infection were seen between February and April. The
link between intussusception and rotavirus vaccine is a weak one,
the researchers concluded (Pediatrics 2001; 108: 54-60).
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Varicella
infection has been found associated with an increased incidence of
stroke in children. A study from Canada has reported that 31% of 70
children aged 6 months to 10 years admitted for an ischemic stroke
had evidence of varicella infection in the past 12 months as
compared to only 9% in an equal number of healthy controls. The
varicella associated cerebrovascular accidents are more likely in
the basal ganglia, have higher chances of recurrence, and likely to
result in hemiplegia, the researchers report. The researchers
concluded that vasculitis could be the causative factor (Stroke
2001; 32: 1257-1262).
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According
to a study from the United Kingdom, cerebral edema as a complication
of diabetic ketoacidosis (DKA) is more common in freshly diagnosed
cases of diabetes. On an analysis of 2940 episodes of DKA, there
were 34 instances of cerebral edema, giving an overall incidence of
6.8/1000. Among new diabetics, it was 11.9 per 1000 episodes as
compared to a rate of 3.8 per 1000 in established cases. Cerebral
edema was associated with mortality of 24% and sequel in over a
third of the survivors. Though the etiology of cerebral edema is
still controversial, it remains an important complication in DKA
(Arch Dis Child 2001; 85: 16-22).
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A study
from the United Arab Emirates has reiterated the finding that
breastfeeding protects against lymphoma and leukemia. The study
compared the breastfeeding characteristics in 117 children with
acute leukemia and lymphomas with an equal number of healthy
controls. Children breastfed for less than 6 months were 2.79 times
more likely to develop malignacies as compared with those breastfed
for more than 6 months. The researchers concluded that their results
reinforce the beneficial effects of breastfeeding (Eur J Cancer
2001; 37: 234-238).
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Surfactant
protein levels can serve as diagnostic marker for measles associated
interstitial pneumonia. This study from Japan measured the serum
levels of surfactant protein D and KL-6 in 3 children with measles
pneumonia and 10 children with uncomplicated measles. Measles
complicated with interstitial pneumonia had higher levels of the
surfactant proteins. Levels of protein D rapidly returned to normal
after treatment with steroids, while that of KL-6 increased
transiently. These markers can be easily measured and can aid in the
early diagnosis of measles associated interstitial penumonia (Eur J
Pediatr 2001; 160: 425-429).
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Thiobarbituric acid, a marker of oxidative damage, can serve as an
indicator of hypoxic injury in neonates. This study from USA
analyzed the urinary levels of thiobarbituric acid-reacting
substances (TBARS) in the first day of life in 22 term and 52
preterm neonates. The study observed that the urinary TBARS were
elevated and correlated with APGAR and blood gas results in neonates
with asphyxia, meconium stained liquor, those requiring mechanical
ventilation and resuscitation in the labor room. The researchers,
while recommending further studies, concluded that TBARS can be used
as biomarker for perinatal hypoxic injury (Arch Pediatr Adolesc Med
2001; 155: 718-722).
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The effect
of zinc supplementation in reducing infection related morbidity and
mortality was studied in 685 West African children. Oral Zinc (12.5
mg) or a placebo was given to an equal number ofchildren. The study
observed that there was no difference in the incidence of malaria,
duration of fever or parasite density between the two groups.
Mortality was lower in the zinc group, but was not statistically
significant. However, the duration of diarrhea was significantly
lower in the zinc supplemented group. Zinc does have some role to
play in decreasing infection related morbidity. (BMJ 2001; 322:
1567-1570).
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According
to a study from Italy, Risperidone, antipsychotic may have some
beneficial effects in autistic children. In this study 10 autistic
children were given risperidone in a daily oral dose of 0.25 mg for
a period of 16 weeks. A modest improvement was seen in 8 of the
children as assessed by various rating scales. No major side effects
were seen. Risperidone can be of use in autistic children with
behavioral problems like tantrum and aggressive tendencies (J Child
Neurol 2001: 16: 395-400).
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In the
long-term, prophylactic use of indomethacin in
extremely-low-birth-weight infants is not beneficial, reports a
study from Australia. In this study 1202 neonates weighing less than
1000 g were randomized to receive either indomethacin or a placebo.
On a 18 month follow up, the researcher observed that while
mortality and morbidity was 261 (46%) in placebo group, 271 (47%) in
the indomethacin group died or survived with sequel. The incidence
of PDA, periventricular and intraventricular hemorrhage were however
significantly lower in the indomethacin group. There were no long
term beneficial effects on neurosensory impairment (New Eng J Med
2001; 344: 1966-1972).
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The
decision on starting oral feeds in a preterm neonate can be taken
after measuring the flow in superior mesenteric artery (SMA) by
Doppler. In this study, the flow recordings were made on 44 neonates
before and after a test feed of 0.5 ml. The study observed that 14
neonates could be put on full enteral feed within 7 days while the
other thirty neonates took much longer. The researchers reported
that a 17% increase in the postprandial flow could indicate
tolerance to enteral feeding with a sensitivity of 100% and a
specificity of 70%. The researchers concluded that SMA flow
correlates strongly with the tolerance to feeds and can be used in
the NICU for deciding on the time to start oral feeds (Arch Dis
Child Fetal Neonatal Ed 2001; 85: F42-F45).
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When does
the ductus venosus close? Researchers from Japan noted the time of
closure of ductus venosus in 98 neonates (both term and preterm)
using ultrasonography. In preterm neonates born at 30-33 weeks, the
ductus closed by 6 days, in preterms born at 34-36 weeks by 6.1 days
and in term neonates by 4.2 days. Use of antenatal steroids hastened
the closure. In the 30-33 week neonates, the ductus closed at 5.5
days among those given antenatal steroids as compared to 7.5 days in
the non-steroid group. The study concluded that older geatational
age and antenatal steroids are associated with an early closure of
the ductus venosus (Arch Dis Child Fetal Neonatal Ed 2001; 85:
F57-F59.
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In what is
claimed to be the first report, Carbamazepine has been found useful
in controlling seizures in neonates. In this study on 10 preterm
neonates, the effectiveness of oral carbamazepine (7-23 mg/kg/day)
in seizures refractory to phenobabitone was examined. Seizure
control was achieved in nine neonates. There were no significant
side effect and no recurrence of seizures after treatment was
stopped at 5 months of age. The researchers recommend carbamazepine
as an alternative oral medication for neonatal seizures (Eur J
Pediatr 2001; 160: 440-447).
C.
Vidyashankar,
Pediatrician,
Military Hospital, Namkum,
Ranchi 834 010, Jharkhand,
India.
E-mail: [email protected]
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