Indian Pediatrics 2000;37: 230-232
Tachypnea is a sensitive clinical indicator for diagnosis of pneumonia. The effect of age, nutritional status and duration of disease on the sensitivity and specificity of tachypnea as an indicator was studied in 110 children with acute respiratory infection. The study found that tachypnea used as the only clinical sign is useful for identifying pneumonia in children with no significant variations for age. In children with low weight for age, tachypnea had higher sensitivity, but lower specificity. However, during the first three days of disease, the sensitivity and specificity were signi-ficantly lower (Arch Dis Child 2000; 82: 41). Another study evaluated respiratory rate as an indicator of hypoxia in 200 infants less than 2 months of age. This study found that a respiratory rate greater than 60/min was a good predictor of hypoxia with symptoms of any acute illness (Arch Dis Child 2000; 82: 46).
o The pathogenesis of nephrotic syndrome remains an enigma. In a study to test the hypothesis that oxygen free radicals are mediators of excessive protein permeability in steroid responsive nephrotic syndrome, 20 children were evaluated. Biochemical assays were carried out on their blood samples to quantify the indirect markers of free radical injury in the body, namely, vitamin E, reduced glutathione (GSH), glucose 6-phosphate dehydrogenase (G6PD), malonyldialdehyde (MDA), and membrane cholesterol in erythro-cytes. Changes in the concentrations of MDA, G6PD, and vitamin E were found to be consistent with increased amounts of oxidation in steroid responsive nephrotic syndrome. However, the authors conclude that further research is needed to explain the exact nature of these changes (Arch Dis Child 2000; 82: 76).
o Skin-to-skin contact between mothers and their newborns has an analgesic effect. In a prospective, randomized controlled trial, 30 newborn infants were studied. The infants were assigned randomly to either being held by their mothers in whole body, skin-to-skin contact or to no intervention (swaddled in crib) during a standard heel lance procedure. The study found that crying, grimacing and heart rate were substantially reduced as compared to controls and concluded that skin-to-skin contact is a potent analgesic in newborns (Pediatrics 2000; 105: e14).
o A study which aimed to identify children with sickle cell anemia who are likely to have severe complications later in life followed 392 children from infancy to about the age of 10 years. Of the 392 infants in the cohort, 18% subsequently had an adverse outcome (death, stroke, painful crisis). On analysis, the statistically significant predictors of an adverse outcome later in life were an episode of dactylitis before the age of one year, a hemoglobin level of less than 7 g per deciliter, and leukocytosis in the absence of infection. These markers may permit accurate prog-nostication, tailoring of therapy and facilitate planning of clinical trials (N Engl J Med 2000; 342: 83).
o Much of fever during term labor may not be infectious, but can have adverse effects on the neonate. In a study to investigate the association of elevated maternal intrapartum temperature with neonatal outcome, 1218 nulliparous women in normal labor were studied. The study found that infants whose mothers' maximum temperature was greater than 101°F were more likely to require bag and mask resuscitation, oxygen therapy in the nursery and have a higher rate of neonatal seizures. The authors conclude that intra-partum maternal fever is associated with a number of apparently transient adverse effects in the newborn. However, its role in any lasting injury to the fetus remains unknown. (Pediatrics 2000; 105: 8).
o The search for the perfect analgesic in children is still continuing! In this study on 43 children with cancer, the analgesic effect of nasal administration of midazolam spray (0.2 mg/kg body weight) was compared with placebo prior to the insertion of a needle in a subcutaneously implanted central venous port. Children, parents, and nurses completed a visual analog scale questionnaire to evaluate the efficacy. Parents and nurses reported reduced pain, anxiety, discomfort, and procedure problems for children in the midazolam group and would prefer the same medication at next procedure. Children reported reduced anxiety and procedure problems but reduction of pain and discomfort was not significant. Nasal discomfort was the most common side effect. Nasal midazolam spray offers relief to children anxious about procedures with rectal and oral routes as alternatives in patients with nasal discomfort (Pediatrics 2000; 105: 73).
o The association of bronchiolitis in infancy with childhood wheeze and asthma is still to be explained. In an attempt to explain this association, the peripheral blood eosinophil counts at the time of bronchiolitis were estimated and the children were then followed up till 7 years of age. Eosinophilia at the time of bronchiolitis was found to be positively correlated to wheezing at 7 years of age. The authors explain this association to an immunologic anomaly that precedes the development of, or is induced by, bronchiolitis rather than to structural damage to the airway as a result of bronchiolitis, as is commonly thought (Pediatrics 2000; 105: 79).
o The effectiveness of postexposure prophylaxis in varicella, using varicella vaccine was studied in 67 homeless shelter residents including 42 children less than 13 years of age. The study found that vaccine effectiveness was 95.2% for prevention of any disease and 100% for prevention of moderate or severe disease among the children less than 13 years of age. It was concluded that when used within 36 hours after exposure to varicella in a setting where clsoe contact occurred, varicella vaccine was highly effective in preventing further disease. This study provides support for the recent recommendation by the Advisory Committee on Immunization Practices to administer varicella vaccine after exposure (Pediatrics 2000; 105: 84).
o The anti-infective effects of human milk is well known, with many mechanisms involved in this. Granulocyte colony-stimulating factor (G-CSF) could be one of the mechanisms. The role of granulocyte colony-stimulating factor (G-CSF) in the anti-infective effect of human milk was studied on 126 milk samples obtained from breastfeeding women. G-CSF levels were measured by enzyme-linked immunoassay. All milk samples contained G-CSF with significantly higher levels of G-CSF being found in milk collected during the first 2 postpartum days than in later days. Milk from women who delivered prematurely had lesser G-CSF during the first 2 postpartum days than milk from women who delivered at term. When intra-amniotic infection was present, the concentration of G-CSF in milk was elevated significantly. G-CSF-Receptors were also found to be expressed on fetal villus enterocytes (Pediatrics 2000; 105: e7).
o Though constipation is a common and distressing problem in children there are very few controlled treatment trials of constipation in children. Two studies attempted to address this issue. The first study, a randomized one on forty children with chronic constipation found cisapride, a prokinetic to be effective as compared to placebo (J Pediatr 2000; 136: 35). The second study on 20 children with brain damage and chronic constipation found glucomannan, a soluble fiber, effective in improving stool frequency but with no effect on colonic motility (J Pediatr 2000; 136: 41). A related editorial stressed on the need for development of safe prokinetics with a more selective action on colonic motility (J Pediatr 2000; 136: 4).