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Indian Pediatrics 2000;37: 1412-1414

 

 

  • Clear urine on visual inspection can be a reasonable screening test for urinary tract infection, according to a study from Ohio, USA. Visual examination was compared with standard urinalysis in 159 children between 4 weeks to 19 years of age. One hundred ten of the samples (69%) were clear to visual inspection. The authors observed that the finding of clear urine on visual inspection had a negative predictive value of 97.3% when compared with the results obtained with standard urinalysis. The authors summarized that though a clear urine on visual inspection cannot completely eliminate the possibility that a child has a urinary tract infection, it is a reproducible test that offers the advantages of being simple, fast, and inexpensive (Pediatrics 2000; 106: e60).

  • The use of cisapride in children has generated a lot of controversy. This study from Mexico however, allays the fears. The ECG changes in 63 children who had received cisapride and 57 normal children who had not received the drug were compared. Five children from cisapride group and 6 from control group had a prolonged QT interval. In 3 children, the QTc interval returned to normal values when cisapride was discontinued. Prolonged QT interval was not associated with any life-threatening event, observed the researchers. A 24-hour Holter recording performed among children detected to have a prolonged QT interval was normal in all the cases. Prolonged QT interval can be found in normal children with or without cisapride, concludes the study. (Pediatrics 2000; 106: 1028)

  • Epinephrine through inhalations may not achieve the desired blood levels for treatment of anaphylaxis. In this study, the plasma epinephrine concentrations were measured following supervised epinephrine inhalations in 19 asymptomatic children with a history of anaphylaxis. When compared with those receiving placebo, the mean plasma epinephrine concentrations, heart rates and blood pressure were not significantly higher among the children receiving epinephrine. Moreover, because of the bad taste most children were unable to inhale sufficient epinephrine to increase their plasma epinephrine concentrations promptly and significantly. The study urged caution in recommending epinephrine inhalation as a substitute for epinephrine injection for out-of-hospital treatment of ana-phylaxis symptoms in children (Pediatrics 2000; 106: 1040).

  • Sudden infant death syndrome (SIDS) has now been linked to Helicobacter pylori infection. Stomach, trachea, and lung tissues from 32 cases of SIDS and eight control cases were examined retrospectively for evidence of H. pylori infection, in this study from UK. Ages of SIDS cases ranged from 2 to 28 weeks. Extracted DNA from these tissues was tested for H. pylori ureC and cagA sequences using Polymerase chain reaction. The authors observed that for the ureC and cagA sequences, 25 SIDS cases were positive in one or more tissues compared to only 1 in the controls. The study concluded that there is a highly significant association between H. pylori ureC and cagA genes in the tissues of cases of SIDS when compared with controls (Arch Dis Child 2000; 83: 429). Another study, from Israel has reported that babies who die of SIDS could have a small pineal gland. The study observed a low urine excretion of a melatonin metabolite in cases with acute life threatening event. The authors explain that delayed maturation of pineal gland may be responsible for this (Dev Med Child Neurol 2000; 42: 487).

  • Early postnatal dexamethasone treatment for prevention of chronic lung disease has been associated with an increased incidence of cerebral palsy. Dexamethasone treated pre-term neonates when followed up to a mean age of 53 months had a significantly higher incidence of cerebral palsy than those receiving placebo [39/80 (49%) vs 12/79 (15%)]. Developmental delay was also significantly more common in the dexamethasone treated group [44/80 (55%)] than in the placebo treated group. Dexamethasone treated infants also had more periventricular leucomalacia and less of intraventricular hemorrhage in the neonatal period than those in the placebo group, although these differences were not statistically significant. The study concluded that both periventricular leucomalacia and use of dexamethasone were highly significant predictors of abnormal neurological outcome (Arch Dis Child Fetal Neonatal Ed 2000; 83: F177).

  • Very low birth weight male neonates have a poor outcome as compared to their female counterparts. A multicentric study comparing 3356 male and 3382 female neonates weighing between 501-1500 grams observed that the mortality for boys was 22% and that for girls was 15%. The males were less stable after birth, had lower APGAR scores, and required intubation and medication during resuscitation more often. The males also had a higher risk of pulmonary morbidity, intraventricluar hemorr-hage and urinary tract infection. The authors admit that biological mechanisms contributing to the male disadvantage or female advantage are yet to be elucidated (Arch Dis Child Fetal Neonatal Ed 2000; 83: F182).

  • The list of uses of botulinum toxin (botox) is increasing. Cerebral palsy is one of the newer beneficiaries. According to a study on 30 children with hemiplegic cerebral palsy, botox injections produced a significant improvement in muscle function in the children’s arms within one month of use. The botox group had 13% improvement in muscle function as compared with <2% improvement among those getting physical therapy alone. A related editorial comments that though there are unanswered questions about the dosage of botox for the various muscle groups, its use reduces the deformity and improves function for many children (J Pediatr 2000; 137: 300, 331).

  • Children with severe asthma are at a high risk of osteoporosis, reports a study from Colorado, USA. This study on 163 children with severe asthma aged 9 to 17 years has found that 40% of the girls and 20% of the boys had suffered bone mineral loss. The contributing factors could be lack of exercise and inadequate calcium intake, suggest the authors. Surprisingly, no association was found, between the use of inhaled steroids and osteoporosis. The authors concluded by advising calcium supplements and careful monitoring in children with severe asthma (J Allergy Clin Immunol 2000; 106: 651).

  • Bronchiolitis may take weeks to resolve, more so in ambulatory children. This study from South Africa assessed the duration of illness and its potential predictors in 181 children with bronchiolitis. The study found that the median duration of illness was 12 days while 18% and 9% of children were still symptomatic after 21 days and 28 days, respectively. There was however, no association between duration of illness and age, weight, sex, or respiratory rate. The researchers conclude that this information is important in counseling parents and could help reduce the high rate of unscheduled return visits (Arch Pediatr Adolesc Med 2000; 154: 997).

  • Intravenous magnesium sulfate at a dose higher than previously recommended has been found to be very effective in acute severe asthma, according to a study from USA. This double-blind placebo-controlled trial evaluated the effectiveness of IV magnesium sulfate (40mg/kg) on 30 patients aged between 6 and 18 years of age with acute asthma. After twenty minutes the magnesium group had a significant improvement in PEFR, FVC and FEV1. These results are better than that observed with lower dose of magnesium sulfate (25mg/kg) in previous studies, noted the researchers. The researchers concluded that this is safe, fast-acting, and effective and can be considered in status asthmaticus not responding to nebulization therapy (Arch Pediatr Adolesc Med 2000; 154: 979).

  • Longer needles significantly reduce the incidence of local reactions following immunization. A study from UK analyzed the effects of immunization with a 25 gauge, 16 mm and a 23 gauge, 25 mm, needle on 110 infants aged 4 months. The rates of erythema and swelling were significantly lower with the use of a longer needle (25 mm). The tenderness was also lower with the longer needle throughout the follow up period, though the difference was not significant. The authors suggested that vaccine manufacturers should review their policy of supplying the shorter needle in vaccine packs (BMJ 2000; 321: 931).

  • Carbamazepine therapy may be associated with an increased risk of atherosclerosis, These were the observations from a study comparing the effects of carbamazepine and valproic acid on serum lipid and liver function test results in 38 epileptic children. Thirty-one children received carbamazepine and 7 children received valproic acid. After six months of treatment, the total cholesterol, low-density lipoprotein, total cholesterol/high-density lipo-protein, and gamma glutamyl transferase levels were significantly increased in the carbamazepine group but not so in the valproic acid group. The changes could be even more significant in a longer term, observed the researchers. They recommended larger trials to assess the relative risk of atherosclerosis during carbamazepine treatment (Pediatr Neurol 2000; 23: 142).

C. Vidyashankar,
Pediatrician,
Military Hospital, Namkum,
Ranchi 834 010,
India.
E-mail:
[email protected]

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