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Book Review Indian Pediatrics 2001; 38: 215-217 |
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• The Zinc Investigators’ Collaborative Group has reported that Zinc supplementation has beneficial effects in diarrhea. A pooled analyses was carried out including all available randomized controlled trials of the effects of supplementary oral zinc in children aged <5 yr with acute or persistent diarrhea. The group reported that Zinc-supplemented children had a 15% lower probability of continuing diarrhea on a given day in the acute-diarrhea trials, a 24% lower probability of continuing diarrhea and a 42% lower rate of treatment failure or death (95% CI: 10%, 63%) in the persistent-diarrhea trials. The group concluded that Zinc-supplementation reduces the duration and severity of acute and persistent diarrhea (Amer J Clin Nutr 2000; 72: 1516). • Findings of two controlled studies suggest that Recombinant Granulocyte-monocyte colony stimulating factor (rhGM-CSF) may have beneficial effects in neonatal sepsis. In the first study from Brazil, 22 neonates with a clinical diagnosis of sepsis were given rhGM-CSF for 3 days. The study reported that though there was no decrease in mortality, there was a lesser incidence of nosocomial infections in these neonates (Pediatrics 2001; 107: 30-35). In another study from Turkey, 30 neonates with neutropenia and clinical signs of sepsis were given rhGM-CSF for 7 consecutive days. This study observed that there was a significant increase in the leukocyte count and decrease in mortality in sick neonates treated with rhGM-CSF (Pediatrics 2001; 107: 36). • There is more evidence on the relationship between maternal malnutrition and heart disease in offspring. A study from Netherlands on children born during the famine in 1944-45 compared 120 subjects who were exposed to famine in late gestation, 108 subjects exposed during mid-gestation, 68 subjects who were exposed during early gestation and 440 individuals born a year after the famine. The study reported that 8.8% of those exposed to famine during early gestation developed coronary artery disease as compared with 3.2% for those not exposed. However, the investigators observed no increase in the prevalence of coronary heart disease in subjects exposed to famine during middle and late gestation. It is possible to prevent coronary artery disease by optimizing the diet in pregnancy, suggest the authors (Heart 2000; 84: 595). • A study from Vienna has reported that use of beta carotene decreases the incidence of acute pulmonary exacerbations in cases of cystic fibrosis. In this study 13 patients received beta carotene (1mg/kg/day) up to a maximum of 50 mg per day, for three months, which was lowered to 10 mg per day for the following 3 months. Patients in the supplementation group required on average 14.5 days of treatment with systemic antibiotics to treat acute pulmonary exacerbations during the three month period before starting beta carotene supplements. This decreased to 9.8 days during the high-dose period and 10.5 days in the low-dose period. None of the patients developed signs of retinol toxicity during the study period (Thorax 2001; 56: 48). • It is said that children grow out of asthma. But the findings of this study suggest that their lung function does not! This study from Los Angles followed a cohort of 2277 children aged around 12 years. These children were examined twice during the four-year study period. The study reported large and statistically significant deficits in pulmonary function in those children with a history of asthma. The deficits were more common in males and were also more severe in those with a longer duration of disease. Both the large and small airways were involved in children who were diagnosed as having asthma before they were three years of age. Lung function deficits in children with asthma persist into adulthood, concluded the researchers (Am J Respir Crit Care Med 2000; 162: 1723). • Valproate, in addition to its teratogenic effects also affects the learning of those children exposed in-utero. These were the findings of a study on 330 mothers and their school going children (n=400). One hundred and fifty children (37.5%) had been exposed to Valproate monotherapy in utero, 74 (18.5%) were exposed to polytherapy, and 176 were not exposed to any anti-epileptic drugs. Thirty per cent of those exposed to Valproate monotherapy in utero had learning difficulty and required learning aids as compared with 3.2% and 6.5% of those exposed to carbamazepine and other monotherapy groups, respectively. The authors recommend further studies on the educational outcome of children exposed to Valproate and concluded that Valproate does have an effect on learning ( J Neurol Neurosurg Psychiatry 2001; 70: 15). • Drug resistant Pneumococci are on the increase. According to a report from the CDC, of the 4013 cases of invasive Streptococcus pneumoniae reported in 1998, 24% of the isolates were resistant to penicillin. Between 1995 and 1998, the proportion of isolates that were resistant to three or more classes of drugs had increased from 9 per cent to 14 per cent. The researchers observed that resistance to individual drug groups including penicillins, cefotaxime and meropenem also increased significantly, with the vaccine serotypes accounting for a majority of the drug resistant strains. The authors concluded that though drug resistance is on the rise, the new conjugate vaccines can prevent them to a large extent (NEJM 2000; 343: 1917). • According to a report from Australia, daytime urinary incontinence is more common than reported among primary school children. A study on over 1400 primary school children reported incontinence in 19.2% of the children. Of these, 16.5% of children had experienced one or more episodes of wetting in the last 6 months, 2% had wet twice or more per week (moderate), and 0.7% were wet every day (severe) (overall prevalence of 19.2%). According to the study, emotional stress and a family history of daytime wetting were the independent risk factors for moderate to severe daytime wetting. However, only 16% of families with affected children had sought medical help, thus indicating a need for greater awareness of the disease (J Pediatr 2000; 137: 814). • Abnormal heart rate characteristics can be early indicator of neonatal sepsis. In this study from the University of Virginia over 350 neonates were divided into 3 groups: infants showing signs of illness whose blood tested positive for infection; infants who had similar signs but had blood testing negative for infection; and a control group without signs of illness. The researchers monitored the heart rate using non-invasive, continuous online monitor-ing procedure and observed that the abnormal heart rate characteristics preceded visible symptoms by as much as 24 hours. The authors believe that their early detection method will cut mortality and illness rates among NICU babies, shorten hospital stay and save healthcare costs (Pediatrics 2001; 107: 97). • A short course of ceftriaxone has been found effective in non-responsive otitis media. These were the conclusions of a prospective study from Israel of 109 patients, aged between 3 to 36 months with non-responsive acute suppurative otitis media. The children were randomized to receive either one or three doses of ceftriaxone (50 mg/kg/day) given intramuscularly. The researchers observed a bacteriological clearance rate of 73% in the 1-day and 98% in the 3-day group. The 3-day regimen is the treatment of choice, particularly in those cases caused by penicillin-resistant Streprococcus pneumoniae, concluded the researchers (Pediatr Infect Dis J 2000; 19: 1040). • Oral ciprofloxacin may be as safe and effective as ceftriaxone in acute infectious diarrhea. Over two hundred children with acute bacterial diarrhea were randomized to receive either oral ciprofloxacin or intramuscular ceftriaxone for 3 days. Two hundred of the 201 patients improved with no significant difference between the two groups. The researchers suggest that ciprofloxacin, because of its low cost and oral formulation, may play a potential role in the treatment of childhood gastrointestinal infections (Pediatr Infect Dis J 2000; 19: 1060). • Maternal illness during pregnancy has now been linked to higher risk of asthma in childhood. These were the findings of a population-based study on 2531 children born in Oslo, who were followed up for 4 years. The odds of bronchial obstruction, asthma and allergic rhinitis were significantly increased with maternal complications like antepartum hemorrhage. The study also observed that in contrast to findings of some other studies, increasing maternal age decreased the risk of asthma and particularly allergic rhinitis. The researchers suggest that uterine factors play a role in the increased risk of childhood asthma (J Allergy Clin Immunol 2000; 106: 867). • Vitamin A given orally does not prevent chronic lung disease in low birth weight neonates. A study from United Kingdom evaluated the role of oral Vitamin A given in a dose of 5000 IU/day for 28 days. According to the researchers there were no significant differences between the Vitamin A group (n = 77) and placebo (n = 77) in the survival, requirement for oxygen, incidence of retinopathy, intraventricular hemorrhage and chronic lung disease. The researchers concluded that oral supplementation of vitamin A in extremely low birth weight infants does not significantly alter the incidence of chronic lung disease (Arch Dis Child Fetal Neonatal Ed 2001; 84: F9). C. Vidyashankar, |
