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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).
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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)
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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).
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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).
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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).
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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).
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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).
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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).
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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).
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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).
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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).
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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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