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Amit P Shah
Email:
[email protected]
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Use of filtered sunlight in neonatal jaundice (Pediatrics.
2014;May 26:pii: peds.2013-3500)
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Queries related to efficacy, safety and method of sunlight therapy for
physiological jaundice are common from parents of such neonates. Till
now, we offer variable answers, but without any such evidence. This
study from Nigeria examined the safety and efficacy of filtered-sunlight
phototherapy (FS-PT) in 227 term/late preterm neonates (³4 day old).
Sunlight was filtered with commercial window-tinting films that remove
most ultraviolet and significant levels of infrared light, and transmit
effective levels of therapeutic blue light. FS-PT was efficacious in 92%
of evaluable treatment days. There were only minor temperature-related
adverse events.
In India, we have abundant sunlight, and in absence of
availability of phototherapy in remote areas, this treatment mode may be
worth exploring.
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Levofloxacin – No evidence of cartilage
toxicity (Pediatrics. 2014; doi:
10.1542/peds.2013-3636)
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There is a lot of controversy about use of fluoroquinolones in pediatric
practice. This 5-year follow-up study – from efficacy trials of
levofloxacin, in comparison to comparators, in acute otitis media and
community acquired pneumonia – examined the musculoskeletal adverse
events in children treated with levofloxacin. Out of all children
initially reporting any musculoskeletal adverse event, 124 children
treated with levofloxacin, and 83 children treated with comparator
agents were followed-up for five years after treatment. The number that
were ‘possibly related’ to drug therapy was equal for both arms – 1 of
1340 for levofloxacin and 1 of 893 for comparator, and no case was
assessed as "likely related" to study drug. The authors concluded that
risks of cartilage injury with levofloxacin appear to be uncommon, and
are clinically undetectable during 5 years.
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Vitamin D supplementation of breastfed infants
(Pediatr Res. 2014; doi:
10.1038/pr.2014.76)
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Most agencies recommend vitamin D supplementation in breastfed infants
but we know little about the optimum dose. This study compared daily 200
IU, 400 IU, 600 IU or 800 IU of vitamin D given from one month of age
till 9 months in exclusively breastfed infants. The four doses of
vitamin D produced different plasma levels of 25(OH)D, with higher doses
leading to less chances of insufficiency. There was no effect on illness
or growth. Authors recommended the dose of 400 IU/d and stressed on the
need to start supplementation at birth as a significant proportion of
children were deficient at one month of age, when the supplements were
started.
The most appropriate dose in Indian settings – where a significant
proportion of neonates are likely to be born with low birth weight –
needs to be determined.
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Paracetamol in treatment of patent ductus arteriosus in
preterm infants (J Perinatol. 2014; May
22:doi: 10.1038/jp.2014.96)
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The role of ibuprofen in the treatment of patent ductus arteriosus (PDA)
is well known. There are some cases where ibuprofen does not work and
surgical ligation is required. In this recent study, paracetamol 15
mg/Kg 6 hourly for up to 7 days was found to be effective. Ductus closed
in five out of seven infants where ibuprofen failed or could not be
given. Although there is a possibility that PDA might have closed
spontaneously, paracetamol seems to contribute to its closure in preterm
infants.
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Waist-to-height ratio plus BMI identifies
obese at highest cardiovascular disease risk (Medscape.
Jun 02, 2014.)
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Usually we measure body mass index (BMI) of the child and classify the
obesity. We also consider all obese people to be at high risk of
developing cardiovascular diseases and metabolic disorders like diabetes
in future. A study from Ireland suggests that combining 2 ways of
assessing a person’s size – BMI and waist-to-height ratio – may be a
better way of identifying which overweight and obese individuals are at
highest risk for cardiovascular disease and diabetes than either
measurement alone. This could help focus resources on the early
identification of those who should be prioritized for pharmacological
and lifestyle interventions.
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Safety of Sildenafil in infants (Pediatr Crit
Care Med. 2014;15:362-368)
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Recently USFDA warned against the use of sildenafil in pediatric
patients for the treatment of pulmonary hypertension. In response to
this, this review examined the current guidelines, dosage and safety
information for use of sildenafil in pediatric population. After going
through about 50 published studies, authors found that there is
currently no evidence of serious adverse event in infants exposed to
sildenafil, and it remains a valuable option for the treatment of
pulmonary hypertension in young infants.
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