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Indian Pediatr 2015;52: 448
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Gaurav Gupta
Email:
[email protected]
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Can BCG protect children against respiratory infections and sepsis?
(Clin Infect Dis. Feb 2015 doi: 10.1093/cid/civ144)
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Bacille Calmette-Guerin (BCG) vaccination has been suggested to have
nonspecific benefits of reducing morbidity and mortality caused by
unrelated pathogens. The authors of this retrospective epidemiological
study, using data from the Official Spanish Registry of
Hospitalizations, assessed the heterologous protective effects of BCG
vaccination against respiratory infections and sepsis not attributable
to tuberculosis in children. Hospitalization rates in BCG-vaccinated
children (Basque Country, where neonatal BCG is part of the immunization
schedule and has a 100% coverage) were compared to non-BCG-vaccinated
children (from the rest of Spain, where BCG is not used). A total of
464, 611 hospitalization episodes from 1992 to 2011 were analyzed. The
hospitalization rate due to respiratory infections not attributable to
tuberculosis in BCG-vaccinated children was significant lower compared
to non-BCG-vaccinated children for all age groups, with a total
preventive fraction of 41.4% (P <0.001). The hospitalization rate
due to sepsis not attributable to tuberculosis in BCG-vaccinated
children under 1 year of age was also significantly lower, with a
preventive fraction of 52.8% ( P <0.001). The study concluded
that BCG vaccination at birth may decrease hospitalization due to
respiratory infections and sepsis not related to tuberculosis.
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Are PCV and Hib vaccines preventing bacterial
pneumonia in US? (N Engl J Med. 2015; 372:835; doi:
10.1056/NEJMoa1405870)
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Prospective data-based incidence estimates of hospitalizations for
community-acquired pneumonia among children in the United States are
limited. This active population-based surveillance for
community-acquired pneumonia requiring hospitalization among children
younger than 18 years of age was conducted in three hospitals in
Memphis, Nashville, and Salt Lake City of US. Authors excluded children
with recent hospitalization or severe immunosuppression. Blood and
respiratory specimens were systematically collected for pathogen
detection with the use of multiple methods. Chest radiographs were
reviewed independently by study radiologists. From January 2010 through
June 2012, they enrolled 2638 of 3803 eligible children (69%), 2358 of
whom (89%) had radiographic evidence of pneumonia. The median age of the
children was 2 years; 497 of 2358 children (21%) required intensive
care, and 3 (<1%) died. Among 2222 children with radiographic evidence
of pneumonia and with specimens available for bacterial and viral
testing, a viral or bacterial pathogen was detected in 1802 (81%), one
or more viruses in 1472 (66%), bacteria in 175 (8%), and both bacterial
and viral pathogens in 155 (7%). The annual incidence of pneumonia was
15.7 cases per 10,000 children, with the highest rate among children
younger than 2 years of age (62.2 cases per 10,000 children).
Respiratory syncytial virus was more common among children younger than
5 years of age than among older children (37% vs. 8%), as were
adenovirus (15% vs. 3%) and human metapneumovirus (15% vs.
8%). Mycoplasma pneumoniae was more common among children 5 years
of age or older than among younger children (19% vs. 3%). The
burden of hospitalization for children with community-acquired pneumonia
was highest among the very young, with respiratory viruses the most
commonly detected causes of pneumonia.
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MRI vs. CT scan – which is better for
traumatic pediatric brain injuries? (Hosp
Pediatr. 2015 Feb;5:79/doi:10.1542/hpeds.2014-0094)
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Computed tomography (CT) is the modality of choice to screen for brain
injuries. Magnetic resonance imaging (MRI) may provide more clinically
relevant information. The purpose of this study was to compare lesion
detection between CT and MRI after traumatic brain injury. Retrospective
cohort of 105 children and young people (0-21 years) with traumatic
brain injury (78% mild) between 2008 and 2010 at a Level 1 pediatric
trauma center with a head CT scan on day of injury and a brain MRI scan
within 2 weeks of injury was analyzed. Overall, CT and MRI demonstrated
poor agreement. MRI detected a greater number of intraparenchymal
lesions compared with CT. Among patients with abusive head trauma, MRI
detected intraparenchymal lesions in 16 (43%), compared with only 4
(11%) lesions with CT. Of 8 patients with a normal CT scan, 6 had
abnormal lesions on MRI. The prognostic value of identification of
intraparenchymal lesions by MRI is unknown but warrants additional
inquiry. Risks and benefits from early MRI (including sedation, time,
and lack of radiation exposure) compared with CT should be weighed by
clinicians.
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Very high CRP in a newborn – what does it mean? (Acta
Paediatrica. 2015. doi: 10.1111/apa.12978)
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A serious inflammatory process is suspected when C-reactive protein
(CRP) is very high. This study retrospectively reviewed 277 episodes
where CRP exceeded 100 mg/L. Of the 6025 neonates admitted during the
study period, 258 had CRP >100 mg/L at least once. The overall mortality
rate was 44/258 (17%); 36 died within 7 days of CRP >100 mg/L, and 34
were extremely preterm infants. CRP exceeded 100 mg/L in 106 infants
within the first 3 days of life – 74 term, 25 preterm and seven
extremely preterm – with no infection identified in 81%. In contrast,
infections were found in 87% of the 171 episodes from day four of life –
129 extremely preterm, 23 preterm and 19 term – predominantly coagulase-negative
staphylococcus sepsis and necrotising enterocolitis. Markedly elevated
CRP in the first 3 days of life was most likely to affect term neonates
(74/106) with no infectious cause (81%). However, CRP >100 mg/L from the
fourth day of life was most likely to affect extremely preterm neonates
(129/171) and had an infectious cause (87%).
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