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Clippings Indian Pediatrics 2001; 38: 1343-1344 |
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While weekly courses of corticosteroids are often given to women at risk of preterm delivery, they may not reduce neonatal morbidity any more than a single course. Five hundred and two pregnent women between 24 and 32 weeks’ gestation who were at high risk of preterm delivery were randomized to receive either multiple weekly steroids or single dose only. The composite neonatal morbidity rates in the single and weekly groups were 28.0% and 22.5%, respectively. In showing a lack of benefit in composite (short-term) morbidity, the study contributes to concerns that multiple courses of antenatal corticosteroids may have negative effects on long-term neurodevelopmental outcomes. (JAMA 2001; 286: 1581). Chronic asthma depends heavily on compliance of the patient, and this may be difficult to achieve with inhaled drugs, especially in children. In a randomized study, children and their parents showed a significantly higher overall satisfaction for oral montelukast at 6 months than for inhaled beclomethasone. According to parents, montelukast was more convenient, less difficult to use, and was used as instructed more of the time compared with beclo-methasone. Almost twice as many children on montelukast compared with inhaled beclo-methasone were highly compliant (82% versus 45%). The two study groups were similar with respect to overall safety, change in FEV1, asthma-related medical resource utilization, school absenteeism, and parental work loss. Montelukast may represent a safe and effective asthma treatment regimen to which children with asthma are more likely to adhere. (Current Med Res Opin 2001; 17: 96). Ketamine is being increasingly used for short painful procedures. The authors describe its use in critically ill children. Out of a total of 442 procedures, inadequate sedation was noted in only nine (2%) procedures. Adverse effects were rare and no adverse outcomes were attributable to ketamine. Thus they feel that ketamine can be safely administered in pediatric critical care setting. (Pediatric Emerg Care 2001; 17: 244). Sometimes things are effective even without a known mechanism! Ketogenic diet is one such entity that has a role in refractory seizures. In a prospective study involving 150 children on ketogenic diet, 20 (13%) were seizure-free and an additional 21 (14%) had a 90% to 99% decrease in their seizures. Twenty-nine were free of medications, and 28 were on only 1 medication; 15 remained on the diet. There was no known cardiac complica-tions. The authors observe that ketogenic diet is more effective than many of the newer anticonvulsants and is well tolerated when it is effective. (Pediatrics 2001; 108: 898). Computers have penetrated every sphere of medicine, and rightly so. An anti-infective decision computerized support tool in a pediatric intensive care unit (PICU) was evaluated. The rate of erroneous drug doses declined by 59%, while the estimated anti-infective costs per patient decreased by 9%. The surveyed clinicians reported that use of the program improved their anti-infective agent choices as well as their awareness of impairments in renal function and reduced the likelihood of adverse drug events. (Pediatrics 2001; 108: e75). How much acetaminophen does a child need? To compare the antipyretic efficacy of an initial 30 mg/kg acetaminophen loading dose versus a 15 mg/kg maintenance dose, a double-blind, randomized clinical trial was conducted enrolling 121 febrile but otherwise healthy outpatients (4 month to 9 years). The time to obtain a temperature lower than 38.5ºC was significantly shorter in the 30 mg/kg than in the 15 mg/kg group. The maximum temperature decrease, as well as the duration of decrease was significantly higher in the 30 mg/kg than in the 15 mg/kg group. Adverse events were not statistically significantly different. These data suggest that acetamino-phen treatment of fever may be more efficient in an intial loading dose. (Pediatrics 2001; 108; e73). Elevated uric acid concentrations reflect adenosine triphosphate degradation and suggest poor prognosis since they indicate a cellular bioenergetic crisis. The clinical validity of this assumption was studied in 78 patients admitted in a Pediatric ICU. The authors concluded serum uric acid concentra-tions can be considered as a marker of severity in critically ill patients without craniocerebral trauma and especially in patients with meningococcal infection. (Ann Esp Pediatr 2001; 55: 305). Gaurav Gupta, |
