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Indian Pediatr 2013;50: 254
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Clippings |
Gaurav Gupta
Email:
[email protected]
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Mother’s vitamin D level linked to birth weight (JCEM 2013 98: 398-404)
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Mothers’ vitamin D levels at a gestation of 26 weeks or less were
positively related to birth weight and head circumference, and, in the
first trimester were negatively associated with risk of a baby being
born small for gestational age, according to this study. The major
source of vitamin D for children and adults is exposure to natural
sunlight. Very few foods naturally contain or are fortified with vitamin
D. Previous studies have shown inconsistent associations between
maternal vitamin D status and fetal size. In this study, researchers
examined 2146 women delivering term, live births with vitamin D levels
measured at a gestation of 26 weeks or less. Birth weight was measured
just after birth and infant head circumference and placental weight were
measured within 24 hours of birth. The study found that a mother’s
vitamin D level, in the first or second trimester of pregnancy, was
related to the normal growth of babies who delivered at term. If a
mother was vitamin D deficient, the birth weight of her baby was 46 g
lower after accounting for other characteristics of the mom. Also if
moms were vitamin D deficient in the first trimester, they had twice the
risk of delivering a baby that suffered from growth restriction during
the pregnancy. The authors further suggest that randomized trials that
supplement pregnant women with vitamin D are needed to test this
finding.
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A large study on propranol therapy in
infantile hemangioma (Pediatric Dermatology
DOI: 10.1111/pde.12046)
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The study reports the observations after propranolol therapy in 109
Chinese patients with infantile hemangioma. Response to treatment was
favorable; 19 (17.4%) showed total regression, 89 (81.7%) partial
regression, and 1 (0.9%) had no response. Twenty-three patients (21.1%)
had some reactions, possibly due to the medication, but no
life-threatening adverse effects were observed. Propranolol therapy for
infants with hemangioma is a serendipitous discovery that is changing
the way infantile hemangioma are being managed. This large study shows
that even though it is useful in almost all infants, a majority undergo
only partial regression. The effect is seen to be most pronounced after
the first dose. Monitoring for side-effects including hypoglycaemia
should be considered when starting infants with the suggested dose of
propranolol of 1 mg/kg/day in three divided doses.
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Metformin improves blood glucose levels and BMI in very obese
children (JCEM 2013 98: 322-329)
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Metformin therapy has a beneficial treatment effect over placebo in
improving body mass index (BMI) and fasting glucose levels in obese
children, according to this study. Childhood obesity has increased
globally over the last two decades and it is linked to an increase in
the diagnosis of type 2 diabetes in childhood, previously a condition
that was only diagnosed in adults. Metformin is a first line drug for
type 2 diabetes, and has been used for many decades. In adults metformin
delays the onset of type 2 diabetes, but there is no evidence that the
drug has a similar effect on children. This prospective, randomized,
double-blind, placebo-controlled trial was conducted at six pediatric
endocrine centers in the United Kingdom and involved 151 obese children
and young people with hyperinsulinemia and/or impaired fasting glucose
or impaired glucose tolerance. Study participants received either
metformin or placebo daily for six months. There was a significant
reduction in BMI, fasting glucose and adiponectin to leptin ratio (ALR)
in the treated group as compared to the children taking placebo. The
study showed reduction in BMI was sustained for six months. This trial
is the largest of its kind to focus on metformin in obese non-diabetic
children and young people. The authors conclude that metformin can
improve BMI and blood glucose levels in obese children, but longer term
effects such as reduction in the incidence of type 2 diabetes need
further study.
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Predicting postconcussion syndrome after mild
traumatic brain injury in children and adolescents who present
to the emergency department (Arch Pediatr Adolesc Med.
2012 Dec 17:1-6)
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To determine the acute predictors associated with the development of
postconcussion syndrome (PCS) in children and adolescents after mild
traumatic brain injury. Retrospective analysis of a prospective
observational study was carried out in the Pediatric emergency
department (ED) in a children's hospital. Four hundred six children and
adolescents aged 5 to 18 years with closed head trauma were included.
The Rivermead Post Concussion Symptoms Questionnaire administered 3
months after the injury. Of the patients presenting to the ED with mild
traumatic brain injury, 29.3% developed PCS. The most frequent PCS
symptom was headache. Predictors of PCS, while controlling for other
factors, were being of adolescent age, headache on presentation to the
ED, and admission to the hospital. Patients who developed PCS missed a
mean (SD) of 7.4 (13.9) days of school. Adolescents who have headache on
ED presentation and require hospital admission at the ED encounter are
at elevated risk for PCS after mild traumatic brain injury.
Interventions to identify this population and begin early treatment may
improve outcomes and reduce the burden of disease.
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