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Indian Pediatrics 2000;37: 119-121 |
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o Recombinant anti IgE could emerge as a new modality of treatment for moderate to severe allergic asthma. The efficacy of a re-combinant humanized monoclonal antibody (rhuMAb-E25) was studied on 307 subjects (pediatrics and adult) with 106 subjects assigned to receive a high dose of rhuMAb-E25, 106 assigned to receive a low dose, and 105 assigned to receive placebo. The drug was given intravenously on days 0 (half a dose), 4 (half a dose), and 7 (full dose) and then once every 2 weeks thereafter for 20 weeks. After the treatment, subjects in both the high and low dose rhuMAb groups were able to decrease or discontinue steroids with a significant decrease in their serum free IgE concentrations (N Engl J Med 1999; 341: 1966). A related editorial considers this approach an important step forward since severe asthma is poorly controlled by existing therapies other than oral corticosteroids, whose long-term use is asso-ciated with several adverse effects (N Engl J Med 1999; 341: 2006). o Sudden infant death syndrome (SIDS) continues to be in the news. A three year population based case-control study on 325 babies who died and 1300 control infants has found that while co-sleeping with an infant on a sofa was associated with a particularly high risk of SIDS, sharing a room with the parents was associated with a lower risk. Among parents who do not smoke or infants older than 14 weeks there was no association between infants being found in the parental bed and an increased risk of SIDS. The risk linked with bed sharing among younger infants seems to be associated with recent parental consump-tion of alcohol, overcrowded housing condi-tions, extreme parental tiredness, and the infant being under a duvet (BMJ 1999; 319: 1457). o Neonates are very sensitive to pain. In a study to assess and compare the analgesic effects of orally administered glucose and sucrose and pacifiers, 150 term newborns undergoing venepuncture were randomly assigned to one of six treatment groups: no treatment; placebo (2 ml sterile water); 2 ml 30% glucose; 2 ml 30% sucrose; a pacifier; and 2 ml 30% sucrose followed by a pacifier. The analgesic effects were clearly detected by a behavioral pain rating scale. The study found that pacifiers had a better analgesic effect than sweet solutions, with a combination of sucrose and pacifiers having a synergistic effect. The study concluded that sweet solutions and pacifiers constitute simple and safe interven-tions and should be widely used to provide analgesia in newborns during minor proce-dures (BMJ 1999; 319: 1393). o More on the fetal origns of coronary artery disease! A follow up study of 3447 women whose body size at birth was recorded found that though coronary heart disease in women is associated with low birth weight, the associa-tion is more strong with short body length at birth. Among men in the same cohort, coro-nary heart disease was also associated with low birth weight but more strongly with thinness at birth. In the whole cohort, body proportions at birth differed in the two sexes: the girls were short and the boys were thin. The authors concluded that these differences may reflect intrinsic sex differences in rates of fetal growth at similar levels of maternal nutrition. The slower fetal growth of females may underlie their lower rates of coronary heart disease (BMJ 1999; 319: 1403). o The value of post infancy breastfeeding for growth and nutritional status is debated. A prospective study of 264 children (mean age 14 months) in western Kenya for 6 months to investigate the nature of the association between breastfeeding and growth found that only 14 (5.3%) children had been weaned at baseline, and 173 (65.5%) were still breastfed at follow-up. Children in the longest-duration breastfeeding group gained 3.4 cm in length and 370 g more in weight than those in the shortest duration group, and 0.6 cm and 230 g more than children in the intermediate group. The strongest association between breast-feeding and linear growth was observed in households that had no latrine and daily water use of less than 10 litres per person. The authors conclude that their study supports WHO's recommendation to continue breast-feeding for at least 2 years, especially in settings with poor sanitation and inadequate water supply (The Lancet 1999; 354: 2041). o Testicular dysfunction is a significant complication of treatment of Hodgkin disease mainly due to the use of procarbazine. A study from Germany has found that an alternate regimen replacing procarbazine with etopside can be equally effective but without the testicular dysfunction complication. In this study on 319 boys younger than 18 years with newly diagnosed Hodgkin disease, treatment with the 4 drug regimen containing etopside in place of procarbazine resulted in an 89% probability of event-free survival and a 98% probability of overall survival after 5 years. The regimens did not differ in short-term toxicity and there were no cases of secondary leukemia (J Clin Oncol 1999; 17: 3736). o Is Zinc a magic bullet? An International study group analyzed ten randomized con-trolled trials from nine developing countries on the effects of oral zinc in apparently healthy children younger than 5 years. There were seven continuous trials (in which 1-2 times the US recommended daily allowance [RDA] of zinc was given 5-7 time per week) and the three short-course trials (2-4 times the RDA daily for 2 weeks). In both continuous supple-mentation and short course trials, the pooled result was a significant decrease in the inci-dence of respiratory illness and diarrhea with Zinc supplementation. (J Pediatr 1999; 135: 689). Though it may seem to be another magic bullet like vitamin A some experts have cautioned that mass national supplementation programs are premature and can lead to commercial exploitation which south Asian economies cannot afford (Lancet December 10, 1999). o Neonatal care is not available to most neonates in developing countries because hospitals are inaccessible and costly. A home-based neonatal care program, including management of sepsis (septicemia, meningitis, pneumonia), developed and tested in the field in India has been found to an effective intervetnion. In this program 39 intervention and 47 control villages in Gadchiroli district in India were chosen with village health workers trained in neonatal care being involved in the intervention. Neonatal, infant and perinatal mortality rates in the intervention area reduced by nearly 50% compared with the control area. Home-based neonatal care cost US$5.3 per neonate, and in 1997-98 such care averted one death (fetal or neonatal) per 18 neonates cared for. The authors conclude that home-based neonatal care, is acceptable, feasible and can reduce neonatal mortality substantially in developing countries (Lancet 1999; 354: 1955). o A study from Germany has found that urinary levels of eosinophil protein X (EPX) are useful in monitoring response to asthma treatment in children. Compared with after-noon values, urinary EPX levels were signifi-cantly elevated in morning samples from asthmatics. In addition, there was a significant decrease in EPX value in children after 6 weeks of corticosteroid therapy. The investiga-tors concluded that measuring EPX excretion is a valid tool for monitoring the effects of anti-inflammatory therapy in children with different grades of bronchial asthma. How-ever, because of circadian variation, the team recommended that the procedure should be always performed on a given patient at the same time of day (Clin Exp Allergy 1999; 29: 1454). o Indian researchers report that male sex and a family history of atopic disorders are among the leading risk factors for asthma develop-ment in children. An analysis of over 18000 completed questionnaires found the cumula-tive prevalence of asthma to be 15.3%, with 11.9% of children reporting current asthma (male 12.8%, female 10.7%) and 3.4% report-ing having had asthma in the past. Asthma induced by exercise alone was reported by 2.1%. In addition, there was a strong associa-tion with smoking in the family, family history of atopic disorders and the prevalence of current asthma. However, no link was seen between asthma and pollution exposure or of use of single type of domestic fuel (Ann Allergy Asthma Immunol 1999; 83: 385). o Magnesium deficiency contributes to the pathogenesis of migraine in children and adolescents as has been shown in adults. In this study from Italy on 128 pateints with headache, EMG ischemic tests were done and intracellular levels of magnesium estimated. The EMG ischemic tests were positive in more than 70% of migraine cases who also had intraerythrocyte and mononuclear cell magne-sium concentrations below the norm. These data, the team concludes, support the validity of performing EMG ischemic tests and determining magnesium concentrations, as a means of diagnosing juvenile migraine. Oral magnesium supplementation, they add, may correct magnesium deficiency and have a positive impact on headache (Cephalalgia 1999; 19: 802). o RSV infection is associated with signifi-cant morbidity and mortality. A study to deter-mine the frequency of future respiratory tract morbidity after respiratory syncytial virus (RSV) disease in infancy was conducted in Gambia. The subjects included 105 admitted to the hospital with severe RSV disease with an equal number of controls. The study found that though pneumonia and wheezing were significantly more common in children after RSV-associated lower respiratory tract disease than in control subjects, the incidence declines rapidly with increasing age (J Pediatr 1999; 135: 683). o Folate deficiency may have a role in the origin of cleft lip and cleft palate, and it can be neutralized by folic acid supplementation during critical period of gestation. Thse were the findings of a prospective cohort study on newborn infants born to mothers with or without perioconceptional folic acid-contain-ing multivitamin supplementation. However, the study concluded that the protective effect was dose dependent and was seen only after the use of folic acid during the critical period of primary and secondary palate development, i.e., during the first and second months of gestation (Pediatrics 1999; 104: e66). C. Vidyashankar, |
