 |
|
Clippings Indian Pediatrics 2000;37: 922-924 |
|
Clippings |
|
The role of zinc on growth continues to be in the research news. In a study from Ethiopia, 100 stunted children between 6-12 months of age were given 10 mg/day or oral zinc supplement. An equal number of normal children were also given the supplement and served as controls. The study reported a significant increase in the length and weight of supplemented children. The authors concluded that combating zinc deficiency can increase the growth rates of stunted children most probably due to a a reduction in morbidity from infection (Lancet 2000; 355: 2021). A related commentary states that this study breaks new ground in showing that zinc is the primary growth-limiting nutrient during infancy (Lancet 2000; 355: 2008). Differentiation of Kawasaki’s disease (KD) from exanthematic illness can some-times pose a problem. A retrospective study compared the records of children with KD, atypical KD and adenovirus infection. The study found that though presenting clinical features may be similar, children with KD are more likely to have conjuctivitis, strawberry tongues, perineal peeling and distal extremity changes, and higher ESR and platelet counts. Children with acute adenoviral infection were more likely to have purulent conjuctivitis and exudative pharyngitis and a positive rapid direct fluorescent antigen test (Arch Pediatr Adolesc Med 2000; 154: 453). Another study, examined the effectiveness of immuno-globulin on 65 patients with KD. This study concluded that there were no initial patient characteristics that predicted IVIG treatment failure or the development of coronary aneurysms (Pediatrics 2000; 105: e78). For the first time, a case of horizontal transmission of HIV from one sibling to another has been reported from Africa. According to this report, the index case first presented with evidence of HIV infection at age 3.5 years. At this time, his parents and sibling tested negative for HIV. Seventeen months later, the younger sibling also presented with signs of HIV disease, and at this point tested positive for the same strain of the virus that infected the index case. The authors postulated that the mode of trans-mission could be through secretions, as the children used to share the same bed. However, the source of index case’s infection continues to remain a mystery (AIDS 2000; 14: 896). Another study on Pediatric HIV, from Malawi, has found that HIV is an important contributor to infant mortality, with 15% of the 700 infant deaths studied being due to HIV infection (Arch Dis Child 2000; 82: F200). The effectiveness of a meningococcal C conjugate vaccine was studied on 120 infants. The vaccine was given with routine immu-nization at 2, 3 and 4 months of age. Follow-ing vaccination, the serum bactericidal activity at 12 months of age was significantly higher in the meningococcal C conjugate vaccine group than in controls. The study found that meningococcal C conjugate vaccine was well tolerated, and resulted in immunologic memory when given with other routinely administered vaccines to infants (JAMA. 2000; 283: 2795). A related editorial stated that though the conjugate meningococcal vaccines offer the opportunity to make further progress in the control of bacterial meningitis, the considerable variability in serogroup distribution needs to be noted (JAMA 2000; 283). Superior vena cava (SVC) flow assess-ment using doppler has been found useful in predicting systemic blood flow in neonates. A study from Australia established the normal ranges of SVC flow in both term and preterm and found that superior vena cava flow increases over the first 48 hours in both well term and preterm infants. The authors also noted that this technique can assess blood flow form the upper body in the early post-natal period and might allow a more accurate assessment of the status of systemic blood flow (Arch Dis Child 2000; 82: F182). A related study by the same authors reported that low SVC flow is commonest in the first 12 to 24 hours, improving spontaneously after this time. Late intraventricular hemorrhage was strongly associated with these low flow states and occurs as the perfusion improves. (Arch Dis Child 2000; 82: F188). Neonatal corticosteroids are used to prevent RDS in preterm deliveries. The late side effects of antenatal corticosteroid treatment were evaluated in a 20 year random-ized double-blind, placebo-controlled study. The study found no differences between the corticosteroid-treated and placebo groups as to medical, intellectual or psychological vari-ables. The groups did not differ on gender development, sexual orientation and sex-specific congitive functioning. The authors concluded that one course of antenatally administered corticosteroid to prevent respira-tory distress syndrome does not have adverse effects up to adulthood (Pediatrics 2000; 105: e77). A plastic bottle modified as spacer has better aerosol deposition in the lungs as compared to conventional spacers. These were the findings of a study on 40 children with asthma aged between 3 years-7 years. The lung deposition of aerosolised techne-tium-99m DTPA inhaled via two conven-tional spacers and a home made spacer (modified 500 ml plastic cold drink bottle) was evaluated. The study reported that the two conventional spacers (Babyhaler or Aero-chamber) produce equivalent lung deposition of aerosol. There was no difference in lung deposition when a mask or mouthpiece is used. The authors, however concluded that a modified 500 ml plastic bottle produces greater pulmonary aerosol deposition than a conventional small volume spacer (Arch Dis Child 2000; 82: 495). Infantile colic subsides spontaneously, irrespective of the treatment used. These were the findings of a study comparing a crib vibrator (n = 30) and infant massage (n = 28) in treatment of infantile colic in infants less than 7 weeks of age. Three daily intervention periods were recommended in both the groups for a duration of three weeks. It was observed that the colicky crying decreased significantly by the same magnitude in both the interven-tion groups. The authors suggest that the decrease in the total as well as colicky crying in the present study reflects more on the natural course of early infant crying and colic than a specific effect of the intervention (Pediatrics 2000; 105: e84). Antibiotic treatment in children with E. coli O157: H7 infection increases the risk of hemolytic uremic syndrome. These were the observations from a prospective study on 71 children less than 10 years of age with E. coli O157: H7 diarrhea. Hemolytic-uremic syndrome developed in 10 (14%) children with 5 of these 10 children having received antibiotics. The authors postulate that anti-biotics might increase the risk of the hemolytic-uremic syndrome by causing the release of cytotoxins from injured bacteria in the intestine, making the toxin more available for absorption. They conclude by recommen-ding against giving antibiotics to children who may be infected with E. coli O157:H7 until the results of a stool culture indicate that the pathogen responsible is one that is appro-priately treated by an antibiotic (N Engl J Med 2000; 342). A novel oral treatment has been found to produce improvement in non-neuronopathic forms of Gaucher’s disease. Researchers in a multicentric trial, studied the safety and efficacy of OGT-918 in decreasing the biosynthesis of glucocerebroside on 28 adults with Gaucher’s disease. The existing modality of treatment involves degrading the accumu-lated glucocerebroside using IV glucocerebro-sidase. After one year of treatment they observed a significant reduction in the spleen and liver volumes and an improvement in hematological parameters. The chitotriosidase activity, a sensitive marker of Gaucher’s activity also showed a decrease. The results of this trial justify further research on this modality of treatment (Lancet 2000; 255: 1481). Neonatal nitric oxide (NO) therapy has not been linked to any sequelae. These were the findings of a two year prospective study on 235 hypoxic neonates born at a gestational age of over 34 weeks. They received either NO or 100% oxygen. The surviving infants were evaluated at 18 to 24 months of age. There were no significant differences between groups in physical handicap, mental or psychomotor developmental index score. The authors conclude that NO is a beneficial therapy for the hypoxic term and near-term neonate that will reduce the need for extra-corporeal membrane oxygenation without an increase in neurodevelopmental abnormality (J Pediatr 2000; 136: 611). A new oral cholera vaccine tested in Peru has shown positive results. The vaccine consisted of inactivated whole cell Vibrio cholerae plus a recombinant formulation of the B subunit of cholera toxin and was administered to over 17,000 children and adults. The study found an overall reduction in the number of cholera episodes by 61% after three doses. The authors reported an efficacy of 72% in those aged over 15 years (72%), and an efficacy of 50% in children aged between 2 to 5 years. In addition, the vaccina-tion reduced the need for hospitalization by 82%. The authors concluded that their find-ings were an improvement over a field trial of a similar vaccine in Bangladesh (J Infect Dis 2000; 181: 1667). C. Vidyashankar,
|
|
|
