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Indian Pediatrics 2002; 39:802-804

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While the link between weight gain in pregnancy and birth weight is established, a study from USA has reported that first trimester weight gain has a greater influence on birth weight. Researchers analyzed the weight gain of 379 mothers and birth weight of their term babies. They noted that a one kg gain in weight in first trimester translated into a 31 grams gain in birth weight, while a similar gain in third trimester was not associated with any increase in birth weight. The Ponderal index was also similarly affected with a 1 kg increase leading to a 0.21 units increase in the index, while a similar decrease was associated with 1.2 units fall in the index and a decrease in birth weight by 211 grams. Thus, nutritional intervention programs need to be initiated early in pregnancy, the researchers conclude. (Amer J Clin Nutr, 2002; 76: 205-209)

According to a study from Germany, placental blood can be used for autologous transfusion in neonates. The researchers obtained about 20 ml of blood each from placenta of 131 preterm and term neonates and noted that 19 of these neonates required transfusion within first 12 weeks of life. The blood collected using a placental blood collecting system was more than adequate in 5 of these neonates, while it reduced the need for blood in the rest, they observed. The researchers concluded that autologous placental blood will be of benefit mainly to preterm neonates and those requiring surgical intervention. (Biol Neonate 2002; 81: 236-243)

An evidence based summary has reported that iron supplements are beneficial in treating breath holding spells. Based on an analysis of 6 scientific articles, they observed that most children with breath holding spells had iron deficiency anemia. They also noted that an eight week course of oral iron (5-6 mg/kg/day) would be appropriate and that iron supplements are more effective in breath holding spells associated with iron deficiency anemia. (Arch Dis Child 2002; 87: 77-78)

Oral sucrose is an effective analgesic for neonatal procedures, reports another evidence based summary. According to the report, all 17 studies analyzed have observed the analgesic effect as manifest by a reduction in the duration of cry. Studies have also noted a synergistic effect with the additional use of a pacifier and by holding the baby during the procedure. Significant side effects were not noted in any of the studies. The report recommends that for effective analgesia, 2 ml of 12% -50%sucrose should be given orally 2 minutes before the procedure. (Arch Dis Child 2002;87:80-81)

Nebulised budesonide has been found effective in persistent childhood asthma. In this placebo-control study, 301 children received either a placebo or nebulised budesonide twice daily. The researchers noted that budesonide in doses of 0.25mg as well as 0.50mg twice daily were free from side effects, produced significant symptomatic improvement and reduced the need for bronchodilators. Nebulised budesonide is a safe and effective option in persistent childhood asthma, the study concluded. ( J Asthma 2002;39:227-237)

According to a report from Sweden, enterovirus infection may have a role in causation of childhood type 1 diabetes mellitus. Tests for enterovirus RNA in mononuclear cells were conducted on twenty four freshly diagnosed type 1 diabetes cases, their siblings(n=20) and controls(n=24). The researchers observed that enterovirus RNA was present in 75% of cases, 63% of their siblings and 29% of controls. Using a phylogenetic analysis of the polymerase chain reaction, the researchers also detected the presence of diabetogenic enterovirus strains and conclude that enteroviruses have a definite role in etiology of type 1 diabetes mellitus in children. (Diabetes 2002;51:1964-1971)

Low birth weight infants are at a higher risk of developing strabismus, reports as study from the UK. The researchers examined 572 children aged between 10 and 12 years who weighed less than 1.7 kg at birth and 169 children with a normal birth weight for the presence of strabismus. The incidence of strabismus was 20.1% and 3% in low birth weight and controls respectively. While recommending screening of all low birth weight infants for strabismus, the researchers concluded that low birth weight is an independent risk factor for strabismus.(Arch Ophthalmol 2002;120:767-773)

Smoking during pregnancy may increase the risk of autism in offspring. This study from Sweden analyzed records of 408 children with autism and 2040 healthy controls. The researchers noted that daily smoking during pregnancy increased the risk of autism by 40%. Cesarean deliveries and low birth weight were also associated with a increased risk of autism, they note. Previously reported smoking induced behavioral problems in offspring and the present association with autism may have a common link, they conclude.(Epidemiol 2002;13:417-423)

Intravenous atropine sulfate can decrease the need for surgery in infantile hypertrophic pyloric stenosis. In a study from Japan, 19 infants with a confirmed diagnosis received 0.01 mg/kg six times a day of intravenous atropine sulfate given before feeds. With an improvement in the symptoms, oral atropine was used and the dose tapered off and stopped. The researchers observed that 17 infants improved with this regimen which was continued for a median of 44 days while only 2 required surgery. Clinically all the seventeen infants were asymptomatic on follow up at six months of age, they note. Atropine induced decrease in pyloric muscle thickness was the mechanism of action, they concluded.(Arch Dis Child 2002;87:71-74)

A study from Chandigarh, India, analyzed the clinical profile of 67 children with fulminant hepatic failure. Viral markers for Hepatitis A were detected in 54% and for hepatitis E in 27%. Twenty five percent of the children died. All the 31 children with grade 1 and 2 encephalopathy and 19 of 36 children with grade III and IV encephalopathy survived. Asictes associated with spontaneous peritonitis, severe jaundice, low serum albumin levels and prolonged prothrombin time were the other predictors of mortality noted in this study. (Arch Dis Child 2002;87:54-56)

Recombinant Hepatitis B vaccine at birth does not increase auto-antibody production in childhood. Two hundred children who had received hepatitis B at birth and 109 controls were screened for various autoantibodies, including anti nuclear, anti thyroid and tyrosine phosphatase (IA-2A) and glutamic acid decarboxylase, the auto-antibodies found in type 1 diabetes mellitus. Autoantibodies were detected in only 16(8%) of vaccinated children and in a similar number of controls, the researchers observed. The autoantibodies were predominantly antinuclear, with anti smooth muscle antibodies detected in a few. Recombinant hepatitis vaccine given at birth is not linked to auto-antibody production in childhood, the study concluded.(Pediatr 2002; 110: e4)

The earliest age of administration of varicella vaccine may need to be revised. An investigation conducted by the CDC, Atlanta, USA on a outbreak of varicella in a day-care center observed an overall vaccine effectiveness of 79%. Importantly, they noted that 11 out of 44 children vaccinated before 14 months of age developed varicella as compared with only 3 of 36 vaccine vaccinated after the age of 14 months. While noting that there were no other factors responsible for the differences in vaccine response, the researchers conclude that the optimal age of vaccination may need to be revised.(J Infect Dis 2002;186:102-105)

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