 |
|
Clippings Indian Pediatrics 2002; 39:322-323 |
|
Clippings |
|
DNA has been used for diagnosing bacterial illnesses, however can DNA load predict severity of disease too? A study was done to determine bacterial loads in meningococcal disease, their relation with disease severity, and the factors that determine bacterial load. It findings suggest that patients with meningococcal disease have higher bacterial loads than previously determined with quantitative culture methods. Admission bacterial load is significantly higher in patients with severe disease and maximum load is highest in those who die. (Arch Dis Child 2002; 86: 44). The use of hyperbaric oxygen for children with cerebral palsy has spread worldwide, despite little scientific evidence of efficacy. In a randomized Multi-centric trial 111 children with cerebral palsy aged 3-12 years were randomly assigned hyperbaric oxygen (n = 57) or slightly pressurized room air (n = 54). The main outcome measure was gross motor function. Secondary outcomes included performance in activities of daily living, attention, working memory, and speech. For all outcomes, both groups improved over the course of the study, but without any difference between the two treatments. In this study, hyperbaric oxygen did not improve the condition of children with cerebral palsy compared with slightly pressurized air. (Ambulatory Child Health 2001; 7: 331). There is an absence of population-based long-term studies on the risk of neurological sequelae in children born after in-vitro fertilization (IVF). A population-based retrospective cohort study in 5680 children born after IVF, with 11360 matched controls showed that children born after IVF are more likely to need habilitation services than controls. The authors opine that children born after IVF have an increased risk of developing neurological problems, especially cerebral palsy and that these risks are largely due to the high frequency of twin pregnancies, low birthweight, and prematurity among babies born after IVF. To limit these risks, they recommend that only one embryo should be transferred during IVF. (Lancet 2002; 359: 461-65). Is childhood height a risk factor for adult obesity? A larger sample (N = 1055) of 2- to 8-year-olds who were followed for an average of 18 years showed that a child with a height-for-age above the 95th percentile was approximately 2.5 times as likely to have a BMI 30 kg/m2 and approximately 5 times as likely to have a skin fold sum >90th P in adulthood. Although these results need to be confirmed in other studies, it is possible that information on childhood height could be used to identify more accurately children who are likely to be obese in later life. ( Pediatrics 2002; 109: e23). The ideal therapy for bronchiolitis remains an enigma. To examine the efficacy of oral dexamethasone in acute bronchiolitis a double-blind randomized controlled trial involving 70 children <24 months old was undertaken. Each patient received either 1 dose of 1 mg/kg of oral dexamethasone or placebo and was assessed using a Respiratory Assessment Change Score (RACS). Of the children treated with dexamethasone, 19% were hospitalized compared with 44% in the placebo group (P = .039). This study suggests that outpatients with moderate-to-severe acute bronchiolitis derive significant clinical benefits from oral dexamethasone treatment. (J Pediatr 2002; 140: 27). Increased mortality occurs in hypoalbuminemic pediatric patients undergoing dialysis. Data from the United States Renal Data System (USRDS) were used to identify 1723 patients undergoing dialysis with 93 deaths over 2953 patient-years of observation. The multivariate analysis demonstrated that each 1 g/dL difference in serum albumin between patients was associated with a 54%higher risk of death. This was independent of glomerular causes for their ESRD and other potential confounding variables. Low serum albumin at dialysis initiation is an important marker of mortality risk in pediatric ESRD patients. (Kidney International 2002; 61: 630). Very-low-birth-weight infants (<1500 g) born during the initial years of neonatal intensive care have now reached young adulthood. This study addresses the vital issue of their educational, cognitive and academic achievements. Two hundred and forty two survivors among very-low-birth-weight infants born between 1977 and 1979 (mean weight 1179 g/ mean gestational age 29.7 weeks) were compared with 233 controls (normal birth weight) from the same population. Fewer very-low-birth-weight young adults than normal-birth-weight young adults had graduated from high school, had a lower IQ, and lower academic achievement scores. They had higher rates of neurosensory impairments and subnormal height. The article concludes that educational disadvantage associated with very low birth weight persists into early adulthood. (New Engl J Med 2002; 346:149). The natural history of stone disease in children is not well defined. An 8-year retrospective review of 129 pediatric patients with primary urinary lithiasis was performed. The results show that younger patients are less likely to pass renal stones, probably due to the relatively larger stone burden and location. Half of the children 10 years or younger who present with urinary calculi have an identifiable metabolic disorder. Thus, all children with stones should undergo metabolic evaluation. In addition, these children are nearly 5-fold more likely to have recurrent stones than those with no identifiable metabolic disorder. Thus, they should be followed aggressively. (J Urol 2002; 167: 670). Gaurav Gupta, |
