Clippings

Indian Pediatrics 2002; 39:711-712

Clippings

Can adrenaline infusion be used safely in VLBW neonates? Thirty-one infants with a median gestational age of 26 (23-30) wk and birthweight 690 (390-1310) g were included in this retrospective chart review. The authors conclude that infusion of epinephrine increased the MABP (mean arterial BP) and the heart rate without decreasing urine output in VLBW neonates with hypotension not responding to a dopamine infusion up to 15mg kg per minute. A potential adverse effect was an increase in metabolic acidosis. (Acta Pediatrica 2002; 91: 566)

Topical therapy to enhance skin barrier function may be a simple, low-cost, effective strategy to improve outcome of preterm infants with a developmentally compromised epidermal barrier. Natural oils are applied topically as part of a traditional oil massage to neonates in many developing countries. In a study to identify inexpensive, safe, vegetable oils available in developing countries that improved epidermal barrier function the authors studied the impact of oils on mouse epidermal barrier function and ultrastructure. The data suggest that topical application of linoleate-enriched oil such as sunflower seed oil might enhance skin barrier function and improve outcome in neonates with compromised barrier function, while mustard oil may have toxic effects on the epidermal barrier that warrant further investigation. (Acta Pediatrica 2002; 91: 546)

In children with minimal change nephrotic syndrome (MCNS), the steroid dependent group constitutes an especially difficult case for management. Therapy with the immunostimulant drug levamisole may therefore be an option in the attempt to maintain remission with minimal side effects. In a prospective study of 20 steroid dependent primary pediatric MCNS patients; levamisole was added in a dose of 2.5 mg/kg body weight on alternate days for 6 months. At the end of the 6-month treatment period ten patients (50%) were maintaining remission on levamisole alone. At the end of the 12-month study period (i.e. after 6 months of levamisole discontinuation), five patients (25%) were still in remission without any treatment for the previous 6 months. No significant side effects were reported during levamisole therapy. Thus levamisole may be worth a trial before other types of more hazardous adjunctive therapies are considered. (Ped Nephrol 2002; 17: 355)

What are the long term sequelae of bacterial meningitis? In a survey, questionnaires were sent to the parents of the 463 children with meningitis. The nearest-age siblings were used as a comparison group. The majority of post-meningitic children were healthy and attended normal school but they had more hearing impairment, headaches, inattention, hyperactivity and impulsiveness than their siblings. Except for hearing impairment, severe sequelae after bacterial meningitis which are not discovered at discharge do not appear later. (Eur J Pediatr 2002; 161: 330)

Is lamivudine effective for chronic hepatitis B infection in children? 191 children were randomly assigned to receive lamivudine and 97 to receive placebo. The rate of virologic response at week 52 was higher among children who received lamivudine than among those who received placebo (p=0.04). Lamivudine therapy was well tolerated and was also associated with higher rates of seroconversion from hepatitis B e antigen to hepatitis B e antibody, normalization of alanine aminotransferase levels, and suppression of HBV DNA. (NEJM 2002; 346:1706)

As the life expectancy of children with human immunodeficiency virus (HIV) increases, quality-of-life outcomes are of increasing concern. There is limited research concerning pain in HIV-infected children and youth. A total of 985 HIV-positive participants had a baseline pain evaluation in 1995. The prevalence of pain averaged 20%. Lower CD4+ T-lymphocyte percentage, female gender, and an HIV/AIDS-related diagnosis were highly associated with an increased risk of reported pain. Individuals reporting pain were over 5 times more likely to die than those not reporting. These findings emphasize the importance of pain management in this population. (Pediatrics 2002; 109: 1144)

The objective of this study was to evaluate whether breastfeeding is analgesic for healthy newborns undergoing blood collection. The investigators evaluated response to pain during blood collection by heel stick among a random sample of 15 breastfed infants and 15 infants who were not breastfed during the procedure. There was a significant difference in the response to pain between the 2 groups. Four percent of those infants who were breastfed cried during the procedure compared with 43% of those who were not breastfed (P = .0002). Grimacing was also significantly less frequent among breastfed infants. Additionally, the investigators observed that tachycardia during blood collection was prevented by breastfeeding. This would seem to be an attractive modality to naturally alleviate pain in newborns that undergo blood collections and other procedures. (Pediatrics 2002; 109: 590)

Gaurav Gupta,