Clippings

Indian Pediatrics 2001; 38: 1442-1444  

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Another report from Sweden compared the incidence of infantile hypertrophic pyloric stenosis (IHPS) and SIDS in Sweden between 1970 and 1997. In this study the researchers observed an initial increase in incidence of IHPS from 0.5 per 1000 live births in 1970 to 2.8 in the 1980’s followed by a decline in the 1990’s. A similar pattern was observed in the incidence of SIDS. The decline in incidence of SIDS followed the implementation of recommendations for infants to sleep on their backs, the researchers noted. Sleeping in prone position could be the common link in the causation of SIDS and hypertrophic pyloric stenosis. (Pediatrics 2001; 108: e70).

Serious side effects of Henna application have been described in this case report from the United Arab Emirates. The researchers have reported four children with glucose-6-phosphate dehydrogenase (G6PD) deficiency who developed life threatening hemolysis following Henna application. One was a neonate who survived following exchange transfusion done following a serum bilirubin over 40 mg/dl, while another died despite transfusion. Two toddlers survived after blood transfusion. Henna causes hemolysis because it contains lawsone (2-hydroxy-1,4 naphtho-quinone) a structural analogue of naphthalene which can precipitate severe hemolysis in G6PD deficiency. The report highlights the dangers of Henna, more so in G6PD deficiency (Arch Dis Child 2001; 85: 411).

The findings of a study from France suggest that obese children have decreased elasticity of their arteries. The study compared the arterial wall parameters of 48 obese children and 27 controls using ultrasound. The researchers observed that obese children have a decrease in compliance, elasticity and a decline in endothelial function. The researchers cautioned that this can predispose to stroke, hypertension and coronary artery disease and concluded that measures need to be taken to control obesity among children (Lancet 2001; 358: 1400).

"Respiratory flutter syndrome", is a new addition to the list of causes of respiratory distress syndrome in neonates. Neonatologists from the Johns Hopkins described three neonates who developed respiratory failure and flutter of the inspiratory muscles. All the neonates responded to a combination conti-nuous positive airway pressure followed by chlorpromazine till seven months of age. According to the study, the neonates also had dysphagia, laryngomalacia and gastroeso-phageal reflux. This combination describes the respiratory flutter syndrome (Am J Respir Crit Care Med 2001; 164: 1161).

Hookworm infection has been found associated with decreased predisposition to asthma. This study from Ethiopia compared 205 adults with wheeze and 400 controls. They found that overall, the incidence of hookworm infestation was 24%. The incidence of wheeze was also nearly 50% lesser in the hookworm infested group as compared to those free of infestation. The researchers postulated that this could possibly be due to the immunosuppressive effect of ankylostoma, which can suppress the inflammatory response following initial challenge with the allergen. This adds to evidence in favor of hygiene hypothesis, which links increase risk of allergy to decrease incidence of infections (Lancet 2001; 358: 1493).

Vitamin D supplements during childhood have been associated with a decreased inci-dence of insulin dependent diabetes mellitus (IDDM) in later life. The intake of vitamin D by children born to 10,000 mothers in 1966 were noted and the children followed up. The study noted that while 88% had given vitamin D supplements in the first year, 81 children were diagnosed as having diabetes during the course of a 31 year follow up. The researchers also noted that the infants receiving 2000 units or more of vitamin D were 80% less likely to develop diabetes. Vitamin D probably produces this beneficial effect by inhibiting autoimmune reactions which are the cause IDDM (Lancet 2001; 358: 1476).

The benefits of botulinum toxin in decreasing spasticity in children with cerebral palsy have been reiterated in this study. One hundred and fifty five children with spasticity and equinus deformity completed this multicentric study in which 41U/kg of botulinum toxin-A was given 3 monthly for at least one year. The study noted that the gait pattern and the ankle position improved significantly and was maintained in over half the patients on two year follow up. While serious side effects were not noted in any of the patients, stumbling and leg cramps were seen in around 10% of children. Botulinum toxin, which acts by producing a neuro-muscular blockade is an effective alternative in spasticity (Pediatrics 2001; 108: 1062).

Kangaroo care, consisting of contact of the baby with the mother’s chest throughout the day, breast-feeding and short stay in hospital improves growth and decreases mortality in low birth weight neonates. In a study from France, 746 newborns weighing less than 2000 g were either given Kangaroo care or the conventional management in NICU. The researchers observed that while the head circumference growth index was significantly more, the severity of infections and the duration of hospitalization were significantly lesser in the neonates who were placed in Kangaroo care. Mortality was lesser in the Kangaroo care group, though not statistically significant. Kangaroo care is thus beneficial in managing low birth weight neonates (Pediatrics 2000; 108: 1072).

Is pre-eclampsia linked to neonatal encephalopathy? This prospective study, which followed the outcome of pregnancy on over 6000 women, postulates so. The study noted that pre-eclampsia was associated with increased risk of maternal fever (Odds Ratio 3.39), neonatal encephalopathy (OR 25.5) and low cord blood pH. The risks of both maternal fever and neonatal encephalopathy were independent of each other and were not linked to the type of delivery. An inflammatory reaction in the mother could possibly be responsible for the maternal fever, the study suggests. The researchers concluded that a similar reaction in the fetus may lead to neonatal encephalopathy, probably mediated through oxidative stress and cerebral vasoconstriction (Arch Dis Child Fetal Neonatal Ed 2001; 85: F170).

Triamcinolone acetate has been found to decrease the severity of childhood asthma. In this tudy 48 children with mild–to–moderate asthma received either 400 µg of inhaled triamcinolone for 4 weeks or a placebo. The researchers observed that at the end of treatment, the FEV1 was higher while the levels of inflammatory mediators like eosinophil count, eosinophil cationic protein and Interleukin 2 receptor were lower in the triamcinolone group. Triamcinolone might thus have a role in childhood asthma (Ann Allergy Asthma Immunol 2001; 87: 319).

The long term outcome of extremely low birth weight (ELBW) neonates (0.5-1.0 kg) is not all that good. A study from Australia followed up 351 such neonates and 60 controls with normal weight for 14 years. In the low birth weight group, 88 (24.9%) survived but only 79 children were available for follow up. Forty six per cent of these children had a low IQ, with cerebral palsy, deafness and blindness being the other common disabilities. The researchers noted that only 46% of the ELBW children were diability free on follow up. In comparison, 83% of the controls were free from diability. The researchers concluded that extremely low birth weight children have a high risk for neurologic impairment and called for screening of these children for early detection of disability (Arch Dis Child Fetal Neonatal Ed 2001; 85: F159).

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