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Gaurav Gupta
Email:
[email protected]
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Can we discharge children with acute osteomyelitis on
oral antibiotics? (JAMA Pediatr.
2014;doi:10.1001/jamapediatrics.2014.2822.)
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This retrospective cohort study compared the efficacy and adverse
outcomes of post-discharge antibiotic therapy administered via the
peripherally inserted central catheter (PICC) or the oral route, among
2060 children and adolescents with osteomyelitis from 36 participating
children’s hospitals. Children treated with antibiotics via the oral
route (n=1005) did not experience more treatment failures than
those treated with antibiotics via the PICC route (n=1055). Rates
of adverse drug reaction were low (<4% in both groups) but slightly
greater in the PICC group. Among the children in the PICC group, 158
(15%) had a PICC complication that required an emergency department
visit (n=96), a rehospitalization (n=38), or both (n=24).
The authors conclude that given the magnitude and seriousness of PICC
complications, clinicians should reconsider the practice of treating
otherwise healthy children with acute osteomyelitis with prolonged
intravenous antibiotics after hospital discharge when an equally
effective oral alternative exists.
Peripheral intravenous cannulation is the predominant
method for administration of post-discharge intravenous antibiotics for
children in India and similar settings where PICC is not routinely
available. Securing repeated intravenous access is challenging for the
pediatrician, and traumatic for the child. Use of oral antibiotics in
post-discharge situations should help reduce these challenges.
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Should we monitor children with Down syndrome
for congenital hearing loss? (J Pediatr. 2015;166:
168-171.e1.)
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A cross-sectional, retrospective chart review of 109 infants with Down
syndrome born or referred to the study hospital after birth were
followed-up in this study. Twenty-eight infants failed their newborn
hearing screen; 27 of them were referred for audiologic evaluation, and
19 completed the evaluation. Fifteen of these 19 infants (79%) had
confirmed hearing loss. The prevalence of congenital hearing loss in
this sample of neonates with Down syndrome was 15%, and the loss to
follow-up rate for infants with positive hearing screens was 32%.
Authors suggest that continued monitoring of hearing is needed in
children with Down syndrome.
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Children with chronic cough: When is watchful
waiting appropriate? (Chest.
2014;doi:10.1378/chest.14-2155.)
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Chronic cough is associated with poor quality of life and may signify a
serious underlying disease. Differentiating non-specific cough (when
watchful waiting can be safely undertaken) from specific cough
(treatment and/or further investigations are beneficial) would be
clinically useful. In 326 children, the authors of this study used a
dataset from a multi-center study involving children newly referred for
chronic cough (median duration 3-4 months) to determine the sensitivity,
specificity, predictive values and likelihood ratios (LR) of cough
pointers (symptoms, signs and simple investigations) recommended in
guidelines. The pre-test probability of specific cough was 88%. The
absence of false positive results meant that most pointers had strongly
positive LRs. The most sensitive pointer (wet cough) had a positive
LR=26.2. While absence of other individual pointers did not change the
pre-test probability much (negative LRH"1), the absence of all pointers
had a strongly negative likelihood (LR=0, 95%CI 0-0.03). Children in the
spontaneous-resolution group were significantly more likely to be older,
non-indigenous, have dry cough, and with normal chest X-ray.
Results of this study suggest that children with chronic dry cough
without any cough pointers can be safely managed using the ‘watchful
waiting approach’.
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Predicting subsequent risk of renal
involvement in children with Henoch-Schonlein purpura? (Pediatr
Nephrol. 2014; Dec 28. [Epub ahead of print])
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The aim of this analytical cohort study was to evaluate the potential of
serum pentraxin 3 (PTX3) values as an early predictor of subsequent
renal involvement in patients with Henoch-Schönlein purpura (HSP) with
no abnormalities on urinary examination and in renal function tests at
disease onset. Sixty children (age range 3-15 years) with HSP and sixty
age- and sex-matched healthy controls were followed up for at least
18 months. Clinical findings were recorded for all patients at first
examination, and blood samples for routine laboratory parameters and
PTX3 value as well as skin biopsy specimens were obtained from each
subject. Of the 60 patients with HSP, 29 (48.3%) developed subsequent
renal involvement, of whom four underwent kidney biopsy. The mean serum
PTX3 level of patients with subsequent renal involvement was
significantly higher than those of patients without renal involvement
and of the controls (P=0.004). Immunofluorescence evaluation of
skin biopsy revealed that in addition to immunoglobulin A (IgA)
deposition, the IgM deposition was significantly associated with
subsequent renal involvement (P=0.008). A high PTX3 level and IgM
staining in skin biopsies from HSP patients may be harbingers of
subsequent renal involvement.
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To cut or not to cut early – the Umbilical Cord! (Pediatrics.
2014;134:257-64.)
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The study included 64 healthy pregnant women who went
into spontaneous labour, and delivered vaginally at a hospital in
Granada, Spain. Half of the newborns had their umbilical cord cut 10
seconds after delivery, whereas the other half had it cut after 2
minutes. The study showed that delaying the cutting of the umbilical
cord in newborns by just 2 minutes lead to a better development of the
baby during the first days of life. The findings suggest that the time
in cutting the umbilical cord influences the resistance to oxidative
stress in newborns. The researchers observed an increase in the
antioxidant capacity of mature newborns, as well as moderation of
inflammatory effects in the case of induced delivery.
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