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clippings

Indian Pediatr 2012;49: 596

Clippings


Amit P Shah

Email: [email protected] 
 

Hypertonic saline more effective in acute wheezing in preschool children (Pediatrics 2012;129:6)


This study established that length of stay was significantly shorter in wheezy children nebulized with 5% hypertonic saline as compared to the Normal saline group. The admission rate was also significantly lower in the hypertonic saline than the Normal saline group. This suggests that using hypertonic saline inhalations significantly shortens length of stay and lowers admission rate in preschool children presenting with an acute wheezing episode to the emergency department.


Weak head and neck control early indicator of autism (11th Annual Meeting for Autism Research – IMFAR, Abstract 9882)


Poor postural control, defined as poor head control while being pulled up from a supine position during pull-to-sit maneuver, has been documented to be an early predictor of developmental problems in children with cerebral palsy and preterm infants. This study examined the association between poor postural control (head lag) at 6 months of age in high-risk infants and diagnosis of autism at 36 months. The infants were scored according to whether their head maintained alignment with the spine or were in front of the spine during the task. Lack of this head control indicated head lag. At 3 years of age, 90% of infants diagnosed with ASD and 54% of those meeting criteria for social/communication delay had exhibited head lag at 6 months of age. In comparison, 35% of children not meeting the criteria for social or communication delay or ASD exhibited head lag at 6 months. This study suggests that adding a simple motor skill evaluation like "pull-to-sit" to existing developmental screenings at pediatric well-child visits might improve early detection of autism spectrum disorder.


Zinc reduces treatment failure in infants with probable serious bacterial infection (The Lancet. 2012; 379:2072-8)


This prospective study, undertaken in India, measured the effect of zinc as an adjunct to antibiotics in infants with probable serious bacterial infection. Zinc supplementation reduced the incidence of treatment failure and had a greater effect in infants with diarrhea than in those without diarrhea. Further studies are needed to confirm this but it is interesting that zinc probably has much more application than its proved usefulness in diarrhea and pneumonia in under five children. This study suggests that zinc could be given as adjunct treatment to reduce the risk of treatment failure in infants aged 7-120 days with probable serious bacterial infection.

Prediction of treatment failure in diabetic kids on basis of HbA1c level (Ahead of Print, ADA 2012)


In April 2012, The Lancet published TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth) study where almost half of study group between ages 10 to 17, with type 2 diabetes eventually failed treatment. It was concluded that combination oral drug therapy is better. To assess factors that may predict treatment failure, subanalyses were done in patients who maintained glycemic control for 48 months and compared them with patients who failed to maintain control during that time. It was found that the rate of rise in HbA1c was the only longitudinal factor associated with treatment failure, which may suggest the need to intensify treatment early. It was concluded that even if the HbA1c is in the non-diabetic range, the higher it was, the more likely they were to fail the treatment.

Allergic rhinitis responds well when probiotics added to antihistamine (Int J Ped Otorhinolaryng. 2012;76:994-1001)


Perennial allergic rhinitis is traditionally treated by antihistamines. In this study, a probiotic Lactobacillus johnsonii EM1 (Lj EM1) was added to antihistamine levocetrizine and results were encouraging. This difference persisted for at least 3 months after discontinuation of Lj EM1.

Patient photos help cut medical errors in using electronic medical records (Pediatrics, doi: 10.1542/peds.2011-2984)


The use of computers in hospitals and by doctors is increasing in India also and it is believed that using electronic records improve the quality of medical care– which includes preventing errors. This American study tried to add patient photograph on the record part. The hospital changed its computer system so that each order triggered an "order verification screen", which included a photo of the child in question. The result of this exercise paid off and there was no error in treatment part after this mandatory inclusion of patient photograph.

 

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