Is there any need to dilute salbutamol for nebulization therapy? Maybe not. Undiluted albuterol short treatments seem to be as effective as standard diluted albuterol in severe asthmatics, while offering the ease and efficiency of shorter treatment administration time. Patients were randomized to receive either the study short treatment (3.5 ml of undiluted albuterol nebulized for 20 inhalations every 20 minutes for a total of 3 treatments) or the control treatment (albuterol diluted [0.5 ml] and nebulized in normal saline [3 ml] every 20 minutes for a total of 3 treatments). The authors feel that short treatments are quick, easy, and well tolerated. However, they do concede that the sample size was too small to make generalized recommendations (Pediatrics 2000; 105: e67).

In a study to compare the efficacy of sulbutamol delivered via a metered-dose inhaler with a spacer and facial mask (MDI-S) vs. a nebulizer (NEB) for the treatment of acute exacerbations of wheezing in children less than 2 years age, it was concluded that moderate-severe exacerbations of wheezing responded faster to salbutamol delivered by MDI with a spacer and facial mask than to salbutamol delivered by nebulizer. In the first hour, the MDI-S group received 2 puffs (100 mg puff) every 10 min for 5 doses, and the NEB group received 0.25 mg/kg every 13 min for 3 doses. Success (clinical score £5) after the first hour of treatment was 90% in the MDI-S group and 71% in the NEB group while after the second hour; the success was 100% in the MDI-S and 94% in the NEB (p >0.05) (Pediatr Pulm 2000; 29: 264-269). Another study also concludes that even in the group of unselected very young children (mean age <2 years) with acute wheeze, the use of MDI with spacer is at least as effective as the use of nebulizer (Chest 2000; 117: 1309). Further proof that the role of nebulizers in emergency should be taken over by MDI with spacers in most instances, but is anyone doing it?

Can ultrasonography replace fluoroscopy in managing intussusception? Sonogra-phically guided air-enema reduction of intussusception was done in 199 children. In phase I (11 children), the success or failure of reduction was crosschecked by fluoroscopy, which confirmed the accuracy of USG in all 11 children. In phase II (188 children), complete reduction was confirmed by clinical improvement of the child and repeat sonography 1 h later showing no persistent intussusception with a success rate of initial reduction being 95% (Pediatr Radiol 2000; 30: 339).

Surgery has become an accepted treatment modality for carefully selected adults with intractable focal epilepsy. More recently, increasing numbers of pediatric patients with intractable epilepsy are also being referred for surgical consideration. Based on results from several recent pediatric surgical series, the seizure-free postoperative outcome is similar in pediatric as compared to adult population. In one series, best developmental outcomes were seen in patients with earliest surgery and highest level of preoperative development (Can J Neurol Sci 2000; 27: 106).

Does Interferon alpha really improve the long-term prognosis in chronic hepatitis B disease? A recent study to better define the long-term prognosis of infection and disease in children with chronic hepatitis B treated with interferon (IFN) alpha, it is suggested that IFN alpha simply accelerates the spontaneous course of disease (HbeAg clear-ance). A total of 107 children with chronic hepatitis B who received IFN alpha for three or six months in two clinical trials were followed for a mean period of 69 months. Estimates of cumulative HBeAg clearance rates at five years were similar between treated patients (60%) and controls (65%). However, IFN singificantly improved the rate of HBsAg loss in cases with more prominent disease activity who were early responders, and may be particularly useful in this subgroup of patients (Gut 2000; 46: 715).

A systematic review of studies comparing temperature measured at the axilla with the temperature measured at the rectum using the same type of measuring device at both sites in each patient showed wide variation across studies. Forty studies including 5528 children and young people from birth to 18 years were analyzed. The pooled (random effects) mean temperature differences (rectal minus axillary temperature) for mercury thermometers was 0.25°C and for electronic thermometers was 0.85°C. It is believed that rectal temperature can be estimated by adding 1°C to the temperature measured at the axilla. The wide range in the mean differences they have detected suggests that this is not the case. In general, limits of agreement were narrower when mercury thermometers were used. The authors believe this has implications for clinical situations where temperature needs to be measured with precision, for example in neuteropenic patients for starting antibiotics or neonates where a thermo-neutral temperature needs to be maintained (BMJ 2000; 320: 1174).

Childhood blood pressure is related to adult levels and, together with changes in body mass index, is a significant predictor of adult blood pressure. Longitudinal study of a cohort of children with baseline data and a follow-up survey after 20 years was done in a town in Lithuania. Statistically significant correlation between childhood and adult blood pressure levels was estimated. The best predictors of adult blood pressure were the initial childhood blood pressure levels and change in BMI during the 20-year period for both men and women (J Hypertens 2000, 18: 531).

In order to determine whether isolated preauricular tags are associated with urinary tract abnormalities seventy consecutive infants with isolated preauricular tags were examined by ultrasonography for urinary tract abnormalities. The study group was compared with a control group of 69 infants without preauricular tags hospitalized during the same period. Urinary tract abnormalities were detected in 6 infants with isolated preauricular tags (6/70; 8.6%), with hydronephrosis in 5 cases and horseshoe kidney in 1 case. None of the infants in the control group had such abnormalities. The authors recommend, therefore, that urinary tract ultrasonography be conducted in the routine assessment of infants with isolated preauricular tags (Pediatrics 2000; 105: e61).

In order to determine initial intravenous gammaglobulin (IVIG) treatment failures in Kawasaki Disease (KD) and to report the outcome of retreatment and use of pulse intravenous (IV) methylprednisolone and cyclophosphamide in patients with persistent KD, a retrospective analysis of the treatment and response of children with KD over 3 years was undertaken. Nearly 23% of patients with KD may require retreatment and 8% may develop coronary aneurysm. Additional anti-inflammatory therapy, such as IV methyl-prednisolone and IV cyclophospha-mide, may be helpful in treating persistent KD (Pediatrics 2000; 105: e 78).

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