Adding long chain poly-unsaturated fatty acids (LCPUFA) to infant foods has been associated with lower blood pressure in adult life, British researchers report. In this randomized study infants received formula feeds with or without LCPUFA supplements in the first four months of life. The blood pressure of these children was then followed up till 6 years of life. The researchers noted that blood pressure of the LCPUFA group were significantly lower than those of the non-supplemented group and were also comparable to those of the breastfed group. LCPUFA supplementation is a simple dietary measure that could have a lasting beneficial effect on blood pressure, the British team concluded. (BMJ 2003;326:953-955)

A free web based decision support tool for pediatric care, the ISABEL (www.isabel. org.uk), has been found useful in patient care settings. In a study from UK, the ISABEL diagnostic tool was tested in 99 hypothetical and 100 children admitted with various illnesses. The patient data were entered into the system by residents and the diagnosis was correlated with the final diagnosis. The diagnostic accuracy of ISABEL was 90% in hypothetical situations and 95% in real-life clinical scenarios. ISABEL has the "potential to remind doctors of diagnoses they might otherwise discount," the study concluded. (Arch Dis Child. 2003; 88: 408-413)

Two recent reports suggest that cardio-myopathy in children is not that uncommon! Australian researchers note that dilated cardiomyopathy was the commonest cause of cardiomyopathy in Australian children. Their study, conducted over a ten-year period from 1986 to 1996, identified 314 children with cardiomyopathy and noted that cardio-myopathy was more common among males. Dilated cardiomyopathy (DCM) accounted for 58.6% of cases followed by hypertrophic cardiomyopathy (HOCM) with 25.5% of cases. Lymphocytic cardiomyopathy was the commonest cause of DCM according to the Australian study. A study from USA identified over 450 cases in three years. DCM remained predominant with 51% followed by HOCM with 42%, with the incidence peaking in the first year of life followed by a second smaller peak during adolescence. Both studies have noted an annual incidence of around 1: 100,000, a strong familial preponderance and among ethnic groups like blacks, Hispanics and aborigines. A related editorial called for early diagnosis and research into newer treatment methods like stem cell injections in management of pediatric cardiomyopathy. (NEJM 2003; 348:1639-1646, 1647-1655, 1703-1705)

Excess physical activity during pregnancy has been found linked to small birth size. A study from Pune followed over 700 rural women through their pregnancy using an activity questionnaire administered at 18 weeks and 28 weeks gestation. The researchers noted that offspring of women performing strenuous physical activity, including carrying water and working in farms were lower in birth weight, and had lower head circumference and mid arm circumference than those involved in mild levels of activity. Activity induced reduction in placental blood flow could be responsible, the researchers explain and conclude that reduction of physical activity could help in improving birth weights in rural communities of developing countries. (Eur J Clin Nutr 2003; 57: 531-542)

Zinc supplementation has been found to have a positive effect on the growth of premature neonates. In a randomized trial from Spain, thirty-six neonates with an average gestation of thirty-two weeks and birth weight 1.7 kg received either a zinc fortified formula or the same formula without zinc till the age of six months. The researchers observed that biochemical parameters including serum zinc and zinc alkaline phosphatase levels and growth parameters including linear growth were significantly higher in the zinc group and concluded that zinc supplements have a role in premature neonates also. (Pediatrics 2003; 111:1002-1009)

Hypomagnesemia is common in children admitted to the PICU and has been found linked with higher mortality. This report from Chandigarh studied the serum magnesium levels in 100 children admitted to a PICU. The researchers recorded both hypomagnesemia and hypermagnesemia, in 60% and 4% in their patients, respectively. They also observed that the mortality was 30% in children with hypomagnesemia and only 3.3% in those with normal magneseium levels. Co-existence of hypomagnesemia with hypocalcemia increased the risk of mortality further, they concluded. (J Trop Pediatr 2003; 49: 99-103)

Aminophylline infusion has been found to be better than intravenous salbutamol in acute severe asthma. In this randomized study from UK, intravenous aminophylline or salbutamol in recommended doses, were used in 44 patients who had not responded to nebulized salbutamol and intravenous steroids. The researchers observed that while the response to treatment in the first two hours was similar, the duration of hospitalization and use of supplemental oxygen was significantly lesser in the aminophylline group. While recommending larger trials, the researchers concluded aminophylline continues to have an important role in acute asthma and that the use of aminophylline reduces the cost of hospitalization by cutting the duration of hospitalization. (Thorax 2003; 58: 306-310)

An unexpected benefit has been observed following the use of measles vaccine by researchers from India and Bangladesh. The study from Bangladesh analyzed the benefits of measles vaccine in over 8000 children and observed that measles vaccine results in a non-specific reduction in child mortality by as much as 43% as compared to children who had not received the vaccine. The Indian study compared 318 matched pairs and found that the mortality from all causes was three times more among children who had not received measles vaccine. The risk of mortality was highest among children of lower classes. Measles vaccine induced stimulation of T helper cells could be responsible for the immuno-stimulation and non-specific protec-tion against infections, the researchers explained. These findings reiterate the importance of improving measles vaccine coverage! (Int J Epidemiol 2003; 32: 106-115 and Bull WHO 203; 81-244-150).

C. Vidyashankar,
Pediatrician,
Military Hospital, Kamptee,
Nagpur 441001, Maharashtra,
India.
E-mail: [email protected]