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Clippings Indian Pediatrics 2002; 39: 121-122 |
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Can prenatal ultrasound in fetuses with open spina bifida predict ambulatory potential and the need for postnatal shunt placement? Thirty-three cases of isolated open spina bifida were identified by the authors. Lower (more caudal) lesion levels and smaller ventricular size were associated with ambulatory status, and all infants except one with a sacral lesion required postnatal shunt placement. Thus they feel that sonographic determination of lesion level and type is useful in predicting the ambulatory potential of fetuses with open spina bifida (Am J Obstet Gynecol 2001; 185: 1016). Does being overweight in childhood increase risk of adult obesity and associated morbidity? A long-term study to answer this question involved 932 members of thousand families born in 1947, of which 412 attended for clinical examination till age of 50. Little tracking from childhood overweight to adulthood obesity was found when using a measure of fatness that was independent of build. Only children who were obese at 13 showed an increased risk of obesity as adults. Being thin in childhood offered no protection against adult fatness, and the thinnest children tended to have the highest adult risk at every level of adult obesity (BMJ 2001; 323: 1280). Eosinophilia can predict the risk of persistent wheezing in infants with bronchiolitis. All the 170 children aged less than 2 years who required hospitalization for bronchiolitis between 1990 and 1993 were studied. Eosinophil values during the acute phase were collected. In the population studied, eosinophil values of >1% during an episode of acute bronchiolitis in infancy was associated with a higher risk of developing persistent wheezing in the first 5 years of life. A familial history of asthma was associated with a higher risk of developing long-term persistent wheezing (An Esp Pediatr 2001; 55: 511). Can sunlight replace phototherapy units in the treatment of neonatal jaundice? In an in vitro study to investigate the efficiency of sunlight in isomerizing bilirubin, aqueous bilirubin solutions were exposed to periodic sunlight over the entire year. The reduction of bilirubin concentration was monitored spectrophotometrically. Data revealed that sunlight is almost 6.5 times more effective than a phototherapy unit when operating at the ward geometry after taking isomerization efficiency and area of exposure into considera-tion. Moreover, sunlight is still more effective during the winter season, when its intensity is lower. Thus the authors feel that sunlight may be considered an alternative phototherapy source for the treatment of neonatal jaundice, particularly in areas where conventional phototherapy units are unavailable (Photo-dermatology Photoimmunology Photo-medicine 2001; 17: 272). Prolonged use of erythromycin in infancy maybe associated with increased risk of infantile hypertrophic pyloric stenosis. This was the conclusion of a study that analyzed 469 infants who had been prescribed erythromycin over a period of 7 years. While physicians should exercise prudence in such prescriptions, the researchers also cautioned that it is important to keep the magnitude of the slight increase in risk of IHPS in perspective (J Pediatr 2001; 139: 380). Combination therapy including protease inhibitors has been shown to be effective in treating adults infected with human immunodeficiency virus type 1 (HIV-1), but there are only limited data regarding the treatment of children and adolescents. A cohort of 1028 HIV-1 infected children and adolescents, from birth through 20 years of age, showed that mortality declined from 5.3 percent in 1996 to 0.7 percent in 1999 (p<0.001). This validation of the use of combination therapy in pediatric patients is particularly relevant in view of the sharp reduction of prices of these drugs making them affordable to a wider variety of patients in our country (NEJM 2001; 345: 1522). Invasive fungal infection is associated with substantial morbidity and mortality in preterm infants. The authors evaluated the efficacy of prophylactic fluconazole in preventing fungal colonization and invasive infection in extremely-low-birth-weight infants in a double blind RCT involving 100 infants (<1000 g). Invasive fungal infections were significantly lower in the fluconazole treated group. There was no increase in resistance to fluconazole, and no adverse effects were documented (NEJM 2001; 345: 1660). What would be the single best test to predict serious infection in children less than three years old? The answer may be C-reactive protein. It was shown to be superior in predicting serious infections to total WBC counts and absolute neutrophil count in a multivariate analysis of 77 febrile children with fever >39º Celsius. This study may change the protocol of investigations in an emergency setting in this tricky sub-group of pediatric patients (Pediatr 2001; 108: 1275). Does early voiding cystourethrogram (VCUG) after an episode of UTI lead to higher incidence of detection of vesicoureteral reflux (VUR)? A retrospective case review of 162 children >5 years of age admitted with a first episode of UTI to a tertiary care pediatric hospital over a 2-year period was undertaken. Timing of the VCUG was at the discretion of the attending pediatrician. The authors conclude that the rate of detection of VUR in children with a first episode of UTI does not increase when the VCUG is done early (within the first 7 days of diagnosis) rather than later (J Pediatr 2001; 139: 568) Gaurav Gupta, |
