Clippings

Indian Pediatrics 2002; 39:515-516

Clippings

Airway narrowing in acute bronchiolitis does not respond to inhaled bronchodilators but does to adrenaline. Influences of supportive care were not considered in previous treatment studies. Thirty-eight infants were recruited, and after stabilisation, infants received a single 3 ml dose of either levo-adrenaline, or 0.9% saline placebo by nebuliser for three minutes. Supportive therapy prior to study treatment resulted in significant reductions in RR and HR. There were no further changes in any parameter in either treatment group at any assessment time after treatment. The authors feel that no improvement was shown with inhaled adre-naline in acute bronchiolitis. Improvements noted pretreatment question whether prior noted improvements were through supportive care or pharmacological interventions (Arch Dis Child 2002; 86: 276).

Are petechiae always pathological? To determine the prevalence of petechial spots in well babies a total of 116 babies under the age of 12 months were fully examined at child health surveillance clinics. A total of 27.6% of babies had one or more petechiae, 8.6% had two or more petechiae, and 2.6% had more than two. None of these babies subsequently developed sepsis. In conclusion, many well infants examined in the community are likely to have one or two petechial spots (Arch Dis Child 2002; 86: 291-292).

What works best in amblyopia? In moderate amlyopia, atropine and patching were compared as treatment modalities in 419 children in a randomized clinical trial. After six months, visual acuity improved to an equal extent using either modality. Both treatments were well tolerated. It is concluded that atropine or patching maybe used as initial therapy in moderate amblyopia in children aged 3 to 7 years (Arch Ophthalmol. 2002; 120: 268).

Does Intravenous morphine interfere with physical examination and diagnostic accuracy in children with acute abdominal pain? A randomized, double blind, placebo-controlled clinical trial was conducted in children aged 5-18 years with abdominal pain with need for surgical evaluation. Sixty patients were enrolled, and 29 received morphine and 31 received saline. There was no significant change in the diagnostic accuracy and all patients requiring laparotomy were identified. No significant complication was noted in the morphine group. Thus Intravenous morphine provides significant pain reduction to children with acute abdominal pain without adversely affecting the examination, or the ability to identify children with surgical conditions (Acad Emerg Med 2002; 9: 281).

A randomised, double blind parallel study was done to compare three-day burst of a potent corticosteroid versus a mild preparation used for seven days in children with mild or moderate atopic eczema. A total of 174 children were prescribed 0.1% betamethasone valerate for three days versus 1% hydro-cortisone applied for seven days. Both groups showed similar clinically important improve-ments in disease severity and quality of life compared with baseline, signifying that a short burst of a potent topical corticosteroid is just as effective as prolonged use of a milder preparation (BMJ 2002; 324: 768).

Treatment of infantile colic remains an open issue. The aim of this randomized, double-blind, placebo-controlled clinical trial was to investigate the effectiveness and side effects of cimetropium bromide in the treatment of infants with colic crisis. Ninety-seven infants with colic were enrolled. Response to cimetropium bromide was 74%. Response to placebo was 33% (p <0.05). Side effects did not differ significantly between the two groups, except sleepiness, which increased in the infants treated with cimetro-pium bromide. In conclusion, cimetropium bromide was more effective than placebo in reducing the duration of crying in children with infantile colic (J Ped Gastro Nutr 2002; 34: 417).

The efficacy of short course regimens for prevention of perinatal HIV transmission in predominantly breast fed population in developing countries needs further elaboration. In this regard a multi-centric, randomized, double-blind, placebo-controlled trial in Africa involving 1797 mothers was conducted, using various regimens of intra-partum and post partum zidovudine and lamivudine. Although at week 6 after birth, regimens involving intrapartum and post-partum zidovudine and lamivudine were effective in reducing HIV-1 transmission, benefits have diminished considerably after 18 months of follow-up. Thus the authors opine that introduction of short-course regimens to prevent mother-to-child transmission of HIV-1 in less-developed countries should be accompanied by interventions to minimise the risk of subsequent transmission via breast-feeding (Lancet 2002; 359: 1178).

With increasing survival of HIV infected children we need to know their long-term outcomes. This study describes the characteristics of 34 children infected vertically with HIV surviving 10 years or more. By 10 years of age, 6 (18%) children had progressed to Class A (CDC classification), 17 (52%) to class B, 7 (21%) to class C, and 3 (9%) had remained asymptomatic. Three quarters (24 patients) were on combination therapy with three or more drugs. Mothers of 13 (38%) children had died. Children infected vertically with HIV who have survived their first 10 years are mainly free of serious symptoms. As they enter adolescence, additional services are needed including support with disclosure to others, therapy, and sexual health (AIDS 2002; 29: 396).

Is rapid nasogastric hydration (RNG) an acceptable alternative to rapid IV hydration (RIV) in uncomplicated, acute moderate dehydration? Ninety-six children aged 3 to 36 months, with uncomplicated, acute moderate dehydration were randomly assigned to receive either RNG with a standard oral rehydration solution or RIV with normal saline (50 ml/kg over 3 hours). RNG and RIV administered in the emergency department are safe, efficacious, and cost-effective alter-natives to the standard treatment for uncomplicated, acute moderate dehydration in young children. RNG is as efficacious as RIV, is no more labor intensive than RIV, and is associated with fewer complications. In addition, the authors felt that most routine laboratory testing is of little value in these patients and should be avoided, except when clearly clinically indicated (Pediatrics 2002; 109: 566).