Clippings

Indian Pediatrics 2001; 38: 117-118

• An interesting surgical modality for management of refractory seizures was tried recently. The effects of vagal nerve stimulation (VNS) on seizure frequency and quality of life were analyzed retrospectively in thirty-eight children aged 11 months to 16 years. The median follow-up period was 12 months (range, 10-18 mo). For all children, seizure reduction by seizure type was as follows: atonic (80%), absence (65%), complex partial (48%), and generalized tonic-clonic (45%). Seizure reduction was greater in children with onset of epilepsy after 1 year of age (p <0.05). The authors feel that VNS should be considered for children with medically refractory epilepsy who have no surgically resectable focus (Neurosurgery 2000; 47: 1353).

• Is elective repair of acyanotic Tetralogy of Fallot’s (ToF) justified? Early primary repair of TOF normalizes intracardiac flow patterns, which may allow subsequent normal right ventricular outflow tract (RVOT) growth. Traditionally repair is deferred until symptoms occur or children are deemed of adequate size for operative risk to be acceptable because of a perceived increased requirement for TAP (transannular patch) in small infants. In this study on 42 acyanotic infants aged 4 to 87 days who underwent complete repair of TOF, only 10 (24%) required TAP. It seems that complete repair of acyanotic TOF can be performed in early infancy with low morbidity and mortality and low requirement for TAP. Early repair may allow normal RVOT growth thereafter (J Amer College Cardiol 2000; 36: 2279).

• How exclusive is exclusive breastfeeding? A longitudinal study in which 506 mother-infant pairs were included suggests a wide discrepancy between the results obtained from longitudinal questionnaire (fortnightly survey over 6 months) versus a single 24 hour survey. The difference in the exclusive breastfeeding rate was over 40 percentage points at both 2 and 4 months of age (92% versus 51% at 2 months and 73% versus 30% at 4 months) and 9 percentage points at 6 months (11% versus 1.8%). Thus, it is proposed that current status indicators based on a 24-hour period may be inadequate and even misleading for many purposes and a new indicator called ‘exclusive breastfeeding since birth’ could be added. (Int J Epidemiol 2000; 29: 1041)

• What are the effects of inhaled steroids on growth? A million dollar question that has now been answered in two high quality RCTs with long term follow-ups (N Engl J Med 2000; 343:1054 and 1063). Both studies have clearly demonstrated that there is only a transient decline in growth velocity for around a year after which the child grows normally and attains a normal expected adult height.

• Laparoscopy is useful in diagnosis and treatment of acute abdominal diseases in children. Two thousand seven hundred and sixty five children with abdominal pains were observed. During the observation period, abdominal pains persisted in 85 children. These children underwent diagnostic laparoscopy. Destructive changes in the appendix were revealed in 12 patients; 73 patients thus avoided unnecessary laparotomy and appendectomy. It is concluded that diagnostic potential of laparo-scopy is not inferior to diagnostic laparotomy (Surgery 2000; 12).

• To examine the association between routine childhood vaccinations and survival among infants in Guinea-Bissau a follow up study of 15,351 women and their children was done. Mortality was lower in the group vaccinated with any vaccine compared with those not vaccinated. After cluster, age, and other vaccines were adjusted for, BCG was associated with significantly lower mortality (0.55). Measles and BCG vaccines may have beneficial effects in addition to protection against measles and tuberculosis (BMJ 2000; 321: 1435)

• Radiofrequency catheter ablations provide an effective control of a variety of supra-ventricular and ventricular tachycardias in adults, but pediatric data is limited. Ninety-three ablations were performed in 84 children ranging from 5 months to 18 years of age. All but 1 patient were successfully treated (98.8%). Tachyarrhythmic episodes recurred in 4 patients within 1-5 months after ablation, which were successfully treated by repeating the intervention. Significant complications occurred in 3 of the ablations (3.2%). Although radiofrequency ablations are very effective and safe in pediatric patients, indications should be restricted in patients younger than 4 years because of a higher risk of possibly life-threatening complications (Cardiology 2000; 94: 44).

• Lice infestation is a problem in local communities, probably because reservoirs remain undetected. Wet combing (combing systematically through wet, well conditioned hair with a fine toothed comb) has been presented as a cheap, ecological, self sufficient, and feasible technique for diagnosis and treatment of head lice. However, its efficacy as a diagnostic tool and as a therapeutic inter-vention has not been proved; hence it is not evidence based. An observational study comparing detection of head lice using traditional scalp inspection and wet combing in 260 pupils, aged 2-12 years, of a primary school revealed that traditional scalp inspection is a poor technique for detecting head lice, as 30% of its "positive" results and 10% of its "negative" results were false. High values for false positives and false negatives call into question this test’s screening efficiency (BMJ 2000; 321: 1187).

Gaurav Gupta,
Senior Resident,
Department of Pediatrics,
Post Graduate Institute of Medical 
Education and Research,
Chandigarh 160 012, India.
E-mail: [email protected]