q  Not all children with seizures need to be subjected to CT or MRI. Researchers from Boston came to these conclusions after an analysis of records of 491 children with seizures who underwent neuroimaging investigations. The Boston team noted abnormalities in only 8% of the children, of whom 1% were diagnosed as having a brain tumor or infarct. Based on statistical analysis, the Boston team concluded that only children with focal seizures and those aged less than 33 months need neuroimaging for diagnosis of seizures. (Pediatrics 2003; 111: 1-5)

q  Montelukast, in addition to its role in asthma has been found useful in treating childhood migraine as well. These were the conclusions of a study from Brazil which noted that montelukast not only decreases the frequency of acute episodes of asthma, but also produces a 7 fold decrease in the episodes of migraine. (Headache 2002; 42: 1044-1047) In another study, this time from Pennsylvania, 175 children with persistent asthma were given montelukast either alone or in combination. The researchers noted a three- fold improvement in the asthma symptom score after one month of treatment in both the groups, with the improvement more apparent in the monotherapy group.(J Asthma 2002;39: 757-765)Both the reports have reiterated the benefits of montelukast in childhood asthma, while in migraine it needs further evaluation.!

q  Zinc-ORS is a better option for childhood diarrhea. A randomized study from Delhi compared the effect of zinc premixed with ORS, ORS alone or zinc given separately in over 1200 children with acute diarrhea. The researchers reported a nearly 20% lesser stool frequency and 40% lesser frequency of watery stools in the zinc-ORS group as compared to controls. The duration of diarrhea was also lesser in the zinc syrup group. Zinc ORS was well tolerated and there were no associated side effects. The report concluded that Zinc- ORS might have a role in decreasing the severity of diarrhea and preventing prolonged diarrhea. (J Pediatrics 2002; 141: 677-682)

q  Vitamin A supplementation is necessary for children with measles. A systematic review evaluated five randomized trials conducted on over 900 children with measles. The review noted a 39% reduction in mortality with 200,000 IU of vitamin A given on two consecutive days. A similar reduction in mortality due to pneumonia was also recorded. A single dose of vitamin A however, did not result in a reduction in mortality. The review recommended a two-dose schedule vitamin A (200,000 IU per dose) for measles patients in areas with high measles related mortality. (J Tropical Pediatrics 2002; 48: 323-327)

q  Paternal type 2 diabetes has been found linked to low birth weight in offspring. These were the findings of an analysis conduced on around 4000 mothers and fathers. The researchers noted that the birth weight of infants of fathers with type 2 diabetes was 186 grams lesser than those without diabetes. Similarly, the birth weight was also lower among infants of mothers who later developed diabetes, the weights being lower with increasing birth order. A common genetic link may explain the predisposition to both low birth weights and type 2 diabetes mellitus, the researchers conclude. (BMJ 2003;326:19-20)

q  A report from Quebec, Canada has questioned the role of nebulized broncho-dilators in bronchiolitis of infancy. In this randomized study, 149 infants with bronchio-litis received nebulized albuterol, epinephrine or saline. The researchers noted no difference in any of the groups as regards duration of hospitalization, oxygenation and respiratory distress. Nebulized bronchodilators are not recommended in bronchiolitis, the researchers conclude. (J Pediatr 2002; 141: 818-824)

q  Oral rehydration is better! A randomized trial from USA compared the efficacy of ORS with intravenous fluids in 34 children with gastroenteritis and moderate dehydration. The duration of hospital stay was 33% lesser in the ORS group. The researchers also noted that the parent satisfaction, hospital admission rate and time spent by the staff with the patient were significantly lesser in the ORS group. Only three patients did not respond to ORS and needed IV fluids. It is a misconception that patients would prefer their children to be administered IV fluid for dehydration, hence there is a need to encourage the use of ORS is diarrhea, the researchers conclude. (Arch Pediatr Adolesc Med. 2002; 156: 1240-1243)

q  Breast-feeding is an effective analgesic in neonates! This randomized study from France evaluated the effect of breast-feeding as an analgesic during venepuncture. One hundred and eighty neonates were divided into four equal groups - breast-feeding, placebo, held in mother’s arms and 30% glucose in combination with pacifier given orally. The pain as assessed by Douleur Aiguë Nouveau-né scale was 1, 10, 10 and 3 respectively. Both breast-feeding and oral glucose produced a significant reduction in pain. Breast-feeding is an effective analgesic and is comparable with sugar solution, the researchers concluded.(BMJ 2003; 326: 13-15)

q  Mom’s diet during pregnancy can influence child's IQ! Researchers from Norway examined the effect of very long chain n-3 fatty acids during pregnancy and lactation on the child's development. In this randomized double blind trial, over 300 mothers received either cod liver oil (rich in VLCFA) or corn oil(rich in linoleic acid) from 18 week of pregnancy till 3 months after delivery. The researchers evaluated the intelligence scores of the offspring using the Kaufman Assessment Battery for Children and noted that the offspring of mothers in the cod- liver oil group had higher intelligence scores at four years of age. These findings reiterate the importance of very long chain poly-unsaturated acids for the development of central nervous system of the fetus, they conclude. (Pediatrics 2003; 111: 39-44)

q  Post-natal depression in mothers can influence the infant’s mental development. These were the findings of a study conducted on 37 infants of mothers with postnatal depression and 134 controls. Mental assess-ment of mothers was carried out six weeks after delivery, while physical assessment and mental assessment of infants was done at 6 weeks and 6 months respectively. The researchers noted that infants of depressed mothers were shorter, underweight and had lower developmental assessment scores (Developmental assessment score for Indian infants) as compared to controls. Lesser emotional bonding and breast-feeding by the depressed mothers could be the contributing factor, the report concludes. (Archives of Disease in Childhood 2003; 88: 34-37)

C. Vidyashankar,
Pediatrician,
Military Hospital, Namkum,
Ranchi - 834010, Jharkhand,
Email: [email protected]