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Indian Pediatrics 2001; 38: 572-574  

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  • With the likely introduction of acellular pertussis vaccine in the near future, it is a pertinent question as to whether this vaccine can be used as a booster in children who have earlier received the whole cell vaccine. Case-control studies were conducted in two age groups, 18 months and 5 years. In children who received or were eligible to receive their 18 months booster, the risk of pertussis was 1.4 and 3.6 times higher for those with 4 and 3 whole cell (wP) vaccines, respectively, compared to those with 3 wP+1 acellular pertussis (aP) vaccine. In 5 and 6 yr old children, the risk of pertussis among the subjects with 5 and 4 wP, was 1.4 and 2.1 times higher respectively than in those who received 4 wP+1 aP. A single dose of aP increased the protection against pertussis and this protection was greater than that obtained with a wP booster (Vaccine 2001; 19: 3004).

  • An interesting study was done to test the association between childhood IQ and mortality over the normal human lifespan. All 2792 children in Aberdeen born in 1921 and attending school on 1 June 1932 who sat a mental ability test as part of the Scottish mental survey 1932 were traced for survival on 1 January 1997. 79.9% (2230) of the sample was traced. Childhood mental ability was positively related to survival to age 76 years in women (p <0.0001) and men (p <0.0001). Childhood mental ability is a significant factor among the variables that predict age at death (BMJ 2001; 322: 819). Is this an evolutionary mechanism ensuring the survival of the fittest?

  • Do antibiotics help in the treatment of acute sinusitis? A placebo controlled RCT was conducted in 188 patients (1-18 years) who had had 10 to 28 days of persistent sinus symptoms and a clinical diagnosis of acute sinusitis. Of the 161 patients who were included in the analysis, 58 received amoxicillin, 48 received amoxi-cillin-clavulanate, and 55 received placebo. The rates of adverse events, relapse, and recurrence of sinus symptoms were similar among treatment groups. The authors conclude that neither amoxicillin nor amoxicillin-clavulanate offered any clinical benefit compared with placebo for children with clinically diagnosed acute sinusitis (Pediatrics 2001; 107: 619).

  • What is the best correlator of bilirubin encephalopathy? Is it bilirubin-albumin (B:A) molar ratio (MR), unbound bilirubin (UB) or serum total bilirubin (TB)? During a 2-year period, serial auditory brainstem reflexes (ABRs) were obtained on 143 infants of 28 to 32 weeks’ gestational age during the first postnatal week to look for bilirubin encephalo-pathy. The mean peak TB concentration (10.1 ± 1.7 mg/dL) for the 71 infants with normal ABR maturation was not significantly different from the mean peak TB (10.2 ± 2.1 mg/dL) in infants with abnormal ABRs (55  infants). However, in infants with UB analyzed, the mean peak UB (0.62 ± 0.20 vs 0.40 ± 0.15 µg/dL) was significantly higher in the infants with abnormal maturation (n = 25) than in infants with normal maturation (n = 20). The B : A MR results were equivocal. The authors felt that UB is a more sensitive predictor than either serum bilirubin or B : A MR of abnormal ABR maturation, and hence transient bilirubin encephalopathy in premature newborns with hyperbilirubinemia (Pediatrics 2001; 107: 664).

    Nitric oxide is being used in the treatment of severe hypoxemic respiratory failure in neonates. To study its long-term consequences, echocardiographic evaluations in 40 survivors treated for severe neonatal hypoxemic respiratory failure was undertaken. Three of 31 infants met echocardiographic criteria for pulmonary hypertension at the 3-month examination. Two of the 3 had associated structural heart disease (1 with an atrial septal defect and 1 with a ventricular septal defect). At 24 months, only 1 patient had pulmonary hypertension (ASD). The authors believe that the incidence of residual pulmonary hypertension in infants treated as newborns for severe hypoxemic respiratory failure is low. The group at highest risk is those with structural heart disease (J Pediatr 2001; 138: 349).

  • Nosocomial diarrhea is a major problem in pediatric hospitals worldwide. The efficacy of orally administered Lactobacillus GG (LGG) in the prevention of this disease in young children was demonstrated in a recent randomized double blind trial. Eighty-one children aged 1 to 36 months who were hospitalized for reasons other than diarrhea were enrolled to receive LGG (n = 45) at a dose of 6 × 109 colony-forming units or a comparable placebo (n = 36) twice daily orally for the duration of their hospital stay. LGG reduced the risk of nosocomial diarrhea in comparison to placebo (6.7% vs 33.3%). The prevalence of rotavirus infection was similar in LGG and placebo groups (20% vs 27.8%); however, the use of LGG compared to the placebo significantly reduced the risk of rotavirus gastroenteritis (1/45 [2.2%] vs 6/36 [16.7%]). (J Pediatr 2001;138: 361).

  • To determine the frequency and characteristics of seizure induced cerebrospinal fluid (CSF) abnormalities in children and to identify potential alternative causes of these findings, 80 consecutive patients who underwent lumbar puncture within 24 hours after a seizure were studied retrospectively. Coexisting conditions that could affect CSF findings, such as traumatic lumbar puncture, concurrent neurologic disease, and undiagnosed meningitis, were identified. Eighteen of the 80 patients were excluded from the final study group because of the presence of another condition that could alter the CSF. In the remaining 62 patients, postictal pleocytosis was detected in only 3 (5%), and increased protein was detected in only 6 (10%). Seizure-induced CSF abnormalities are rare in children, and alternative, often unidentified, disease processes may account for many observed postictal abnormalities. All patients with abnormal CSF after a seizure should be thoroughly evaluated for other causes of the abnormality (J Pediatr 2001; 138: 373).

  • Osteoporosis or bone fracture can be induced in nephrotic children treated long- term with high doses of glucocorticoids. The purpose of this study was to determine whether short-term prednisolone therapy affects the skeleton in children with steroid-responsive nephrotic syndrome (NS). Bone mineral density (BMD) and biochemical parameters of mineral and skeletal homeostasis in nine children (four girls, five boys) aged between 2 and 7 years at the first episode of NS were measured. Prednisolone was started at 60 mg/m2 for 4 weeks, then decreased every 2 weeks for 12 weeks. All patients were steroid-responsive and had no relapse. BMD and biochemical parameters of mineral and skeletal homeostasis returned to normal values at 16 weeks after the cessation of prednisolone therapy, thus leading the authors to conclude that the skeletal effects of short-term prednisolone therapy were transient in children with steroid-responsive NS without relapse. (Clin Experimental Nephro-logy 2001; 5: 40).

  • A longitudinal cohort of children (n = 41) with symptomatic congenital CMV infection was evaluated at birth and followed up with serial age-appropriate neurodevelopmental testing. Microcephaly was the most specific predictor of mental retardation and major motor disability. An abnormality detected by CT was the most sensitive predictor for mental retardation and motor disability. A highly significant (p <0.001) positive correlation was found between head size at birth and the intelligence/developmental quotient (IQ/DQ). There was no association between sensorineural hearing loss at birth and cognitive outcome, though they had lower IQ/DQ (p = 0.006) than those with normal hearing. Children with normal findings on head CT and head circumference proportional to weight exhibited a good cognitive outcome (J Pediatr 2001; 138: 325).

  • A comparison of the World Health Organization (WHO) oral rehydration solution (ORS) and 2 different formulations of reduced osmolarity ORSs in infants with persistent diarrhea has revealed the latter to be more effective. Infants with persistent diarrhea (n = 95) were randomized to 1 of the 3 ORSs: WHO-ORS (control, n = 32), a glucose-based reduced osmolarity ORS (RORS-G, n = 30), or a rice-based reduced osmolarity ORS (RORS-R, n = 31) for replacement of ongoing stool losses for up to 7 days. The stool volume was approximately 40% less in the reduced osmolarity ORS groups; consequently, these children required less ORS. A higher proportion of children in the RORS-R groups also had resolution of diarrhea during the study period. Reduced osmolarity ORS may thus be advantageous for use in the treatment of children with persistent diarrhea (J Pediatr 2001; 138: 532).

Gaurav Gupta,
Senior Resident,
Department of Pediatrics,
Postgraduate Institute of Medical
Education and Research,
Chandigarh 160 012, India.
Email: drgauravpeds@yahoo.com

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