- Allogenic blood transfusions are
asso-ciated with a risk of infection, immunological reactions,
immunosuppression, and the induction of antibodies in blood cells.
Autologous blood transfusions have become an accepted mode of
therapy in adults. A recent study demonstrates the effectiveness of
giving predeposited autologous blood trans-fusion (PABT) to children
for an operation. Wherever these facilities exist in our country,
this could become an attractive option, given the chronic shortage
of blood, and its lack of adverse effects (Surgery Today 2000; 30:
773).
-
Is a 10 day course of
antibiotics justified in URTI? A review of available literature
demonstrates particularly strong justification for shortening the
therapy from the standard 10 days to 5 days in acute otitis media,
and suggest that tonsillopharyngitis, too, can be effectively
treated with nonpencillin anti-biotics given for fewer than 10 days.
Although sinusitis data are less plentiful than those for acute
otitis media and tonsillopharyngitis, the results do suggest a
shorter course of therapy (Pediatr Infectious Dis J 2000; 19: 929).
-
To breastfeed or not
to breastfeed? This controversial question in HIV infected mothers
in developing countries has been reviewed. Several factors influence
the trans-mission of HIV by breastfeeding (overall risk 12-14%
increase), including whether a woman acquires her infection during
breastfeeding (29% risk of transmission) or before preg-nancy (7-10%
risk of breastfeeding trans-mission), the degree of maternal plasma
and breastmilk viral load, and the presence of mastitis. In areas of
the world where adequate sanitary replacement feeding is not
available, the decision to withhold breastfeeding so as to decrease
HIV transmission may lead to increased rates of child morbidity and
mortality from diarrheal and respiratory diseases, and malnutrition.
Clearly, women must be fully informed about the risk of
breastfeeding transmission of HIV, the risk of morbidity and
mortality among nonbreastfed infants, and the expense and
availability of procuring adequate replacement formula. If an
uninterrupted access to a nutritionally ade-quate breastmilk
substitute that can be safely prepared is ensured, the author
recommends that HIV infected women should be counseled not to
breastfeed their infants (Birth 2000; 27: 199).
-
The old giveth way to
new. A retrospective study to access the relative efficacy of plain
abdominal radiographs and detailed renal tract ultrasound (US)
examination in the diagnosis and follow-up of children with renal
tract calculi, has clearly recommended that US should be the
investigation of choice in suspected renal tract calculi. The
records and imaging studies of 28 pediatric patients who had
presented with proven renal tract calculi over a period of 5 years
were examined. All renal calculi (100%) visible on plain films were
demonstrated on US. Furthermore, detailed US often provided other
clinically significant findings that were not apparent on plain
films (Clin Radiol 2000; 55: 708).
-
Colic is a poorly
understood condition of infancy. The association of maternal smoking
and type of feeding with colic was assessed in 3345 children aged
1-6 months. The prevalence of colic was twofold higher among infants
of smoking mothers, but less among breastfed infants. Maternal
potential risk factor for infantile crying needs further study (Arch
Dis Child 2000; 83: 302).
-
Intranasal Midazolam
seems to be an effective alternative to PR Diazepam in rescue
therapy of seizures. A dose of intranasal Midazolam was prescribed
for those who had previously responded to other rescue medication.
Midazolam was prescribed buccally if excessive head movement
accompanied seizures. Twenty-two patients received 84 treatment
episodes and 79 of these were considered clinically effective. Five
treatment failures were recorded, three due to poor technique in
delivering the Midazolam. There are clear advantages in the use of
Midazolam over Diazepam in the treatment of acute seizures,
including favorable pharmacokinetic and pharmacodynamic, as well as
the potential of a more acceptable and dignified administra-tion
route (Seizure 2000; 9: 417).
-
There is extensive
experimental evidence to support the investigation with mild hypo-thermia
after birth asphyxia. However, clinical studies have been delayed by
the difficulty in predicting long-term outcome very soon after birth
and by concern about adverse effects of hypothermia. This study
indicates that after birth asphyxia, infants can be objectively
selected by aEEG (augmented EEG) and hypothermia started within 6
hours of birth in infants at high risk of developing severe neonatal
encephalopathy. Prolonged mild hypotehermia to 33°C to 34°C is
associated with minor physiologic abnormalities. Further studies of
both the safety and efficacy of mild hypothermia, including further
neuroimaging studies, are warranted (Pediatrics 2000; 106: 684).
-
How soon can we start
in to VLBW infants? Well if this study is anything to go by, the
earlier, the better. Infants were randomly assigned to receive
enteral iron supplementa-tion of 2 to 6 mg/kg/day as soon as enteral
feeding of >100 ml/kg/day were tolerated (EI) or at 61 days of
life (late enteral iron supplementation [LI]). Ferritin at 61 days
was not different between the groups. Infants in the LI group were
more often iron-deficient (26/65 vs 10/68) and received more
blood transfusion after day 14 of life. No adverse effects of EI
were noted. EI is feasible and probably safe in infants with birth
weight <1301 g. EI may reduce the incidence of ID and the number
of late blood transfusions (Pediatrics 2000; 106: 700).
-
Is Penicillin still
the best? Penicillin administered for 10 days had been the treat-ment
of choice for group A beta-hemolytic streptococcal
tonsillopharyngitis since the 1950s. Initial failure rates of just
2-10% have increased to 30% now. The primary cause of penicillin
treatment failure in streptococcal tonsillopharyngitis may be lack
of compliance with the 10-day therapeutic regimen. Other causes
include re-exposure to Streptococcus infected family members
or peers; copatho-genicity, in which bacteria susceptible to a class
of drugs are protected by other, colocalized bacterial strains that
lack the same susceptibility; antibiotic-associated eradica-tion of
normal protective pharyngeal flora; and penicillin tolerance. Thus
they conclude that ten days of penicillin therapy may not be the
best therapeutic choice for all pediatric patients. The authors
further claim that other antibiotics, shortened courses of the
cephalo-sporins in particular, may be preferable in some cases (Pediatr
Infectious Dis J 2000; 19: 917).
-
Palliation of TOF
with systemic-to-pulmonary artery shunts had been accepted standard
for symptomatic neonates and in-fants. Complete repair has
traditionally been reserved for infants older than 6 months of age
because of the perception that younger and smaller infants face an
unacceptably high surgical risk. This view is challenged by a recent
study where complete repair for TOF was attempted in neonates. A
retrospective review from August 1998 to November 1999 consisted of
61 consecutive symptomatic neonates with TOF who underwent complete
repair. The mean age at repair was 16 ± 13 days, and the mean
weight was 3.2 ± 0.7 kg. Right ventricular outflow tract
obstruction was managed with a transannular patch in 49 patients and
a right ventricle-to-pulmonary artery conduit in 12. Cardiopulmonary
bypass time averaged 71 ± 26 minutes. Actuarial survival was 93% at
5 years. Twenty two patients required a total of 24 reoperations at
an average interval of 26 months after repair. Complete repair of
TOF in the neonate is associated with excellent intermediate-term
survival, although the reoperation rate is significant (Ann Surg
2000; 232: 508).
-
The conventional
therapeutic approach in polycythemic infants is to apply partial
exchange transfusion (PET) when hematocrit value exceeds 70% or when
the infant has symptoms with the exception of plethora. In order to
investigate the possibility of using platelet count as a simple
criterion implying the PET requirement the authors retro-spectively
reviewed 18 polycythemic infants with thrombocytopenia (group 1,
35%) and 34 without it (group 2, 65%). Perinatal asphyxia,
gestational toxemia and intrauterine growth retardation, which are
the three common causative factors leading to polycythemia, were not
significantly different in the two groups. No correlation existed
between platelet counts and hematocrit values within each group, but
there was a very significant difference between the two groups in
terms of severity of clinical findings (p <0001). Partial
exchange transfusion was performed in all patients in group 1, while
only 12 infants in group 2 (32%) received transfusion and the
difference was statistically significant (p <0.05). This study
emphasizes the relationship between thrombocytopenia and the
severity of clinical findings and PET performance rate in
polycythemic newborn infants, implying that thrombocytopenia is a
possible marker of hyperviscosity, the results of which warrant
further investigation (Pediatr Int 2000; 42: 343).
-
Can parents predict
the zygosity of their twins? A parental report questionnaire posted
to a population sample of 18-month-old twins correctly assigned
zygosity in 95% of cases when validated against zygosity determined
by identity of polymorphic DNA markers. The questionnaire was as
accurate when readministered at 3 years of age, with 96% of children
being assigned the same zygosity on both occasions. The results
validate the use of parental report questionnaire data to determine
zygosity in infancy (Twin Research 2000; 3: 129).
Gaurav Gupta
Senior Resident,
Advanced Pediatric Center,
Post Graduate Institute of Medical
Education and Research,
Chandigarh 160 012, India.
E-mail: [email protected]
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