Clippings

Indian Pediatrics 2002; 39:1177-1179

Clippings

Omalizumab, a recombinant humanized anti-IgE monoclonal antibody has been found effective in the management of allergic asthma. In this randomized controlled study, omalizumab (0.016 mg/kg/IgE [IU/mL] was administered to children receiving inhaled steroids for a duration of 28 weeks. The researchers noted that the requirement of steroids was significantly lesser and the quality of life better in children receiving omalizumab. Omalizumab is safe, effective and has a steroid-sparing role in allergic asthma, the report concludes.(Pediatrics 2002; 110: e55)

MMR vaccine is safe! A study from Denmark has negated the link between MMR vaccine and autism. On a retrospective analysis of records of over 500,000 infants who had received the vaccine, autistic spectrum disorders were noted in over 700 infants. The researchers observed that the relative risk of autism among those vaccinated with MMR was 0.92 as compared the un-vaccinated and confirmed the absence of link between MMR vaccine and autism. A related editorial confirmed the benefits of vaccination and described the link between MMR vaccine and autism as unsubstantiated and only a predictable coincidence. (NEJM 2002; 19: 1474-1475 and 1477-1482) Another study from Helsinki, Finland concluded that there is no link between MMR vaccine and autism, encephalitis and aseptic meningitis, based on a analysis of records of 500,000 children who were administered the vaccine. (Pediatrics 2002; 110: 957-963)

Childhood wheezing has been found linked to maternal drug use during pregnancy.

This study from UK examined 900 mothers for a link between acetaminophen intake during pregnancy and childhood wheezing. The researchers noted acetaminophen use in 1% of mothers. They also observed a two times higher risk of asthma among offspring of mothers who took acetaminophen regularly between 20 and 32 weeks of pregnancy. No link however, was detected between acetaminophen intake and eczema. These results strengthen the evidence in favor of an in-utero origin of childhood asthma, the study concludes. (Thorax 2002; 57:958-963.)

A rapid test has been found effective in early diagnosis of Pneumococcal bacteremia. This test was evaluated on 24 children with Pneumococcal bacteremia and 72 controls. The test involved detection of Pneumococcal antigen from a urine sample and produced results within fifteen minutes. The researchers reported a sensitivity and specificity of 95.8% and 93% respectively in detecting the bacteremia and concluded that it is a useful non-invasive test for Pneumococcal infection. (Ann Emerg Med 2002;40: 399-404.)

For reasons not known, electrolyte abnormalities in diarrhea vary with the season. This study from South Africa noted that while hyperkalemia was significantly more prevalent in February, hypernatremia was more common during August. The researchers made these observations based on a study of over 3500 children admitted with diarrhea. The researchers postulate that this could be due to the seasonal variation in the microorganisms causing diarrhea in South Africa, with ETEC common being in summers and rotavirus in winters. (Arch Disease Child 2002; 87:426-427)

A newly discovered virus has been implicated in the causation of acute wheeze in children. The virus, named metapneumovirus, is a member of the Paramyxoviridae family, and has been isolated from the nasopharyngeal secretions of over 100 children admitted with acute wheezing. The researchers also noted that infection with this virus occurs mainly from January to April and was associated with a median hospital stay of less than 3 days.. Unlike in RSV infection, this infection was associated with low levels of an eosinophilic chemotactic factor, RANTES. Metapneu-movirus can thus be added to the list of viruses causing wheezing in children, the researchers conclude. (Lancet 2002; 360:1393-1394)

Ceftriaxone for seven days has been found adequate in uncomplicated acute bacterial meningitis. This study from India compared the effectiveness of a seven-day and a ten-day course of ceftriaxone in 73 children admitted with acute bacterial meningitis. The researchers noted that while the clinical outcome was similar in both the groups, the incidence of nosocomial infections and duration of hospitalization was lesser in the shorter regimen. The researchers concluded by recommending a 7-day ceftriaxone regimen for uncomplicated bacterial meningitis in developing countries. ( J Trop Pediatr 2002; 48: 273-279)

Most breast fed children do not require iron supplements! A multi-center study from Sweden and Honduras compared the efficacy of iron supplements starting at 4 months with a regimen starting at 6 months in over 200 infants. The supplements were continued till 9 months of age and benefits compared with a placebo group. The researchers noted that in infants with normal initial hemoglobin levels, iron supplements did not influence the morbidity, and surprisingly the gain in length and head circumference was lower. However, in infants with low initial hemoglobin, iron supplements decreased the incidence of diarrhea. Thus iron supplements are beneficial only in breast-fed infants with low hemoglobin, the researchers conclude. (J Nutr 2002; 132:3249-3255)

Another indication for using magnesium sulfate! A multi-center study from Japan has found Magnesium sulfate infusion, in a dose of 250mg/kg/day beneficial in management of neonatal asphyxia. Neonates with APGAR of 7 or less and absence of spontaneous breathing by 10 minutes comprised the study population. The researchers noted that while the clinical profile and incidence of seizures were similar; oral feeds were started earlier and abnormalities in EEG, CT scan lesser in the magnesium sulfate group. Magnesium sulfate improves the short-term outcome in neonatal asphyxia, the report concluded. (Pediatrics International 2002; 44: 505-509)

Zinc supplements are beneficial in children with acute diarrhea. A randomized trial from Bangladesh compared the efficacy of a 14-day course of oral zinc in over 8000 children with diarrhea. The researchers observed the benefits of zinc persist even after completion of treatment and that the mortality, hospital admissions, duration and incidence of diarrhea and lower respiratory infections during the next 3 months were significantly lesser. Zinc supplementation is an inexpensive intervention that can be integrated into the existing diarrhea control programs, they conclude. (BMJ 2002; 325: 1059)

A genetic polymorphism resulting in increased nitric oxide production has been found protective against severe malaria. A polymorphism in the nitric oxide synthase gene (- 1173 c® T) was identified in children from Kenya and Tanzania, which was protective against severe forms of malaria including cerebral malaria and malarial anemia. Metabolites of nitric oxide in plasma and urine, a known anti-plasmodial toxin in-vitro, were also increased in children with the gene polymorphism, indicating the protective role of nitric oxide in these children. These results suggest a role for nitric oxide based interventions in control of malaria, the report concludes. (Lancet 2002; 360: 1468-1475)

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