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Indian Pediatrics 1999;36: 1294-1296 |
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o Maternal malnutrition may not be the only factor in the relationship between low birth weight and hypertension in later life. A study on over 800 children in Australia concluded that the principal causal pathway must concern mechanisms within the fetoplacental unit. The stronger association in multiplets suggested that factors adversely influencing both blood pressure and birth weight are more prevalent in multiple pregnancies. The study recommended that further research should now focus on placental function and fetal exposures (BMJ 1999; 319: 1325). o Computerised analysis of gastrointestinal sounds data objectively has a potential role in Pediatric practice. The gastrointestinal sounds in 15 infants with hypertrophic pyloric stenosis were collected before and after pyloro-myotomy with a microphone placed 3 cm below the umbilicus. A computer analysis found decreased gastrointestinal sounds to be among physical findings suggestive of hyper-trophic pyloric stenosis and a useful indicator of gastric emptying and bowel motiliy after pyloromyotomy. The study concluded that Computer-assisted analysis of gastrointestinal sounds might be helpful in clinical practice for pediatric patients with some gastrointestinal disorders (Pediatrics 1999; 104: e 60). o Two studies have elucidated the usefulness of probiotics in preventing diarrhea following antibiotic therapy. In the first randomized study on 119 children from 2 weeks to 13 years of age, the incidence of diarrhea was found to be 5% in the Lacto-bacillus GG group and 16% in the placebo group within 2 weeks of antimicrobial therapy. The study concluded that the effect is probably due to production of antimicrobial substances, local competition of adhesion receptors and nutrients, and stimulation of intestinal antigen specific and nonspecific immune responses (Pediatrics 1999; 104: e64). Another randomised study on 188 children concluded that Lactobacillus GG reduces the incidence of antibiotic-associated diarrhea in children treated with oral antibiotics for common child-hood infections (J Pediatr 1999; 135: 564). o A study from Japan suggests that it may be possible to determine the timing of brain injury in neonates with periventricular leuko-malacia (PVL). Serial ECG and ultrasound examination was done on 172 preterm in- fants having a gestational age <33 weeks and weighing <2000 g. Of these, 26 were diag-nosed as having cystic PVL by ultrasono-graphy. EEG abnormalities were observed in 25 of 26 infants with PVL, while only 20 of the 146 infants without PVL had EEG abnor-malities. The presence of early EEG abnor-malities was found to correlate to anteparum injury while abnormalities detected later were found to be associated with postpartum injury (Pediatrics 1999; 104: 1077). o Studies on the advantages of breast feeding continue to be in the news. A meta-analysis on whether breast fed babies are more intelligent than formula fed found that breast feeding gives babies a three point advantage in IQ over bottle fed babies with the benefit being maximum for those born preterm. Debate continues, however, over whether factors like social class and maternal education can ever be completely accounted for in studies of breast feeding, which can never be randomized trials (Am J Clin Nutr 1999; 70: 433). In another study of over 2000 children on the relationship between breastfeeding and childhood leuke-mia, it was found that breastfeeding reduces the risk of leukemia by about 20%, with the benefit maximum on those breast fed for more than six months. The authors postulate that this could well be due to the immunological effects of breast milk (J Natl Cancer Inst 1999; 91: 1765). o Infants born to mothers for whom measles vaccination was available are more susceptible to measles infection. It has been found that women born in the United States after measles vaccine licensure in 1963, transfer less measles antibody to their infants than do older women. This has resulted in increased susceptibility to measles among infants. In this retrospective cohort study on 128 unvaccinated infants 15 months of age who had documented exposure to measles, infants whose mothers were born after 1963 had a measles attack rate of 33%, compared with 12% for infants of older mothers. This according to the study, may partly account for the measles resurgence in the US between 1989 and 1991. They believe that this should serve as a warning to ensure timely vaccination of infants in other countries (Pediatrics 1999; 104: e 59). o A large study from China has reiterated the benefits of folic acid supplementation in preventing neural tube defects (NTD). In this study conducted from 1993 to 1995, of the 130, 142 women who took folic acid at any time before or during pregnancy and 117,689 women who had not taken folic acid, the incidence of NTD was 102 and 173, respectively. The greatest reduction in risk occured in regions with high prevalence of NTD and among those women who had taken folic acid for more than 80% of the time. The study concluded that perioconceptional intake of 400 mg of folic acid daily can reduce the risk of neural-tube defects in areas with high and low rates of these defects (N Engl J Med 1999; 341: 1485). o Unrecognized gastrointestinal disorders, especially reflux esophagitis and disaccharide malabsorption, may contribute to the beha-vioral problems of the non-verbal autistic patients. These were the findings of a study on thirty-six children with autistic disorder. The most frequent gastrointestinal complaints observed were chronic diarrhea, gaseousness, and abdominal discomfort and distension. The histologic abnormalities observed were grade I or II reflux esophagitis, chronic gastritis, chronic duodenitis and an increase in the number of Paneth's cells in the duodenal crypts. Enzymatic analysis revealed a low intestinal carbohydrate digestive enzyme activity and increased pancreatico-biliary fluid output after intravenous secretin administra-tion. The authors observed that an increase in pancreatico-biliary secretion after secretin infusion suggests an upregulation of secretin receptors in the pancreas and liver. They recommend further studies to determine the possible association between the brain and gastrointestinal dysfunctions in children with autistic disorder (J Pediatr 1999; 135: 559). o Lamotrigine has been reported to be a safe and effective adjunctive treatment for children with partial seizures. This placebo-controlled study randomized the 201 children 2 to 16 years of age to receive either lamotrigine or placebo in addition to any medications currently prescribed for epilepsy. After an initial 6-week escalation period, participants continued on a maintenance dose of the drug for 12 weeks. The study found that treatment with lamotrigine significantly reduced the frequency of partial seizures from baseline compared with placebo. The incidence of adverse effects were similar in the lamotrigine and placebo groups. However two children taking lamotrigine did develop rashes that required hospitalization (Neurology 1999; 53: 1724). o There are more results on the use of hydroxurea in sickle cell anemia. In a study on 16 children with homozygous and hetero-zygous sickle cell anemia, hydroxurea given upto a maximum dose of 30 mg/kg for 22 months was associated with a stroke recurr-ence rate of 19% compared with an average recurrence rate of 67%. The hematologic toxi-city was mild with only occasional episodes of transient, reversible myelosuppressions. The authors conclude that though the reason in not known, hydroxurea may help prevent strokes from recurring in pediatric patients with sickle cell disease (Blood 1999; 94: 3022). o Among the variables influencing warfarin therapy in children, age has been found to be the single most important. In a study on 319 patients from 1 month to 18 years of age it was found that 79% of the children reached the target international normalized ratio (INR) range within 7 days, though eventually all the children reached the target INR. However, children up to 6 years old required increased warfarin doses, longer overlap with heparin and longer times to achieve target INR ranges. (Blood 1999; 94: 3007). o A study on the TEL-AML1 translocations, the most common chromosomal aberrations in pediatric cancer has suggested that pediatric leukemia could have a prenatal origin. The translocation, TEL-AML1-t(12; 21) (p 13; q22), was detected using PCR on six of nine children studied, plus a pair of identical twins, aged 2-5 years from Italy and the UK, who had newly diagnosed acute lymphoblastic leuke-mia. The study concluded that common acute lymphoblastic leukaemia frequently originates prenatally and is frequently initiated by a chormosome translocation event in utero. (Lancet 1999; 354: 1499). However, a related commentary suggested that such an event is insufficient for clinical leukemia and that a postnatal promotional event is also required. Moreover, according to the commentary, the other issues that would have broad implica-tions for interventions and require clarifica-tions are the fraction of the population born with the t(12;21), whether the translocation persists, and how commonly there is pro-gression to common ALL (Lancet 1999; 354: 1486). o The effect of feeding frequency on the speed of recovery from diarrhea was studied on 262 hospitalized male infants aged 3-12 months with acute diarrhea. This randomized, non-blinded trial provided 0.452 MJ/kg/day as either 6 or 12 feeds of cows' milk. It was found that frequently fed infants had a signi-ficantly greater weight gain and significantly lower fecal frequency and fecal weight. The study concluded that though breastfeeding remains the preferred method of feeding infants with acute diarrhea, for adequately nourished infants with acute diarrhea who are bottle fed, cow's milk, the simple clinical manoeuvre of decreasing the volume of each feed and increasing the frequency of feeding, while maintaining the same total daily energy intake, speeds recovery, reduces fecal fre-quency and fecal weight, and increases weight gain during the recovery period (Arch Dis Child 1999; 81: 487). C. Vidyashankar, |
