Clippings

Indian Pediatrics 2002; 39:1086-1087

Clippings

The raging controversy regarding use of dexamethasone in preterm neonates shows no sign of abating. In order to assess the effect of moderately early postnatal dexamethasone treatment on growth and neurodevelopmental outcome in preterm infants, 30 preterm infants were enrolled in an RCT. There was no significant difference between treated and control groups with respect to incidence of cerebral palsy, major neurosensory impairment, mean intelligence quotient scores, and behavioral abnormalities at the end of three years. The authors conclude that postnatal dexamethasone treatment with the schedule used in this study did not impair growth and neurodevelopmental outcome in preterm infants. The full extent of the risk will only be known when more trials have reported follow up data. (Arch Dis Child Fetal Neonatal Ed 2002; 87: F55)

Data from cross-sectional and short-term longitudinal studies have suggested that children infected with HIV-1 might have cardiovascular abnormalities. A long-term cohort study to test this hypothesis involved the measurement of the cardiovascular function every 4-6 months for up to 5 years in a birth cohort of 600 infants born to women infected with HIV-1. Children infected with HIV-1 had a significantly higher heart rate at all ages than internal controls. In children infected with HIV-1, fractional shortening remained significantly lower than in controls for the first 20 months of life. LV mass became significantly higher in children with HIV-1 from 4-30 months. It would appear that vertically-transmitted HIV-1 infection is associated with persistent cardiovascular abnormalities identifiable shortly after birth. (Lancet 2002; 360: 368)

To evaluate the outcomes of children with acute osteomyelitis and septic arthritis using short course of antibiotics (< 3.5 weeks) a retrospective chart review was carried out in patients at low risk for complications (illness < or = 14 days, no underlying disease, uncomplicated presentation). Thirty-two children with osteomyelitis (OM), 34 with septic arthritis (SA) and five with OM and SA (OMSA) were included. Twenty two percent of patients received antibiotics for 3.5 weeks or less. Overall, the recurrence rate was 1.4%. The conclusion was that patients treated for short courses had good outcomes. In the authors opinion increasing evidence of the efficacy and safety of short-duration treatment (3-3.5 weeks) for acute, uncomplicated OM or SA in children suggests that this could be accepted as the standard treatment, however larger trials with longer follow up are needed. (J Paediatr Child Health 2002; 38: 363)

An unusual study to determine the best position for subclavian vein cannulation has thrown up some unusual results! Previously, recommendations for subclavian vein catheter placement have been drawn from experience with adults. To determine the optimal position for children, the researchers used ultrasound imaging of the subclavian vein in nine children (average age 5.3 years) in four supine body positions. The four positions were: 1) head in a neutral position with the chin midline and no shoulder roll; 2) head turned 90 degrees away and no shoulder roll; 3) head neutral with a shoulder roll; and 4) head turned away with a shoulder roll. Measurements for the latter two positions represented a significant reduction in the cross sectional area of the subclavian vein by 22 percent and 18 percent, respectively. The researchers conclude "Maintaining the head in a normal position with the chin midline without a shoulder roll optimizes subclavian vein size. Positioning children in this manner may serve to reduce the morbidity associated with percutaneous subclavian vein cannulation." (J Trauma: Inj Inf Crit Care 2002; 53: 272)

This open-label, single-site, pilot study evaluated the therapeutic usefulness of topiramate in five children with typical absence seizures defined as loss of awareness associated with 3 Hz spike-wave activity on 24 hour ambulatory electroencephalogram (EEG). The children were previously untreated or treated unsuccessfully using other antiepileptic medication. Topiramate was initiated at a dose of 1 mg/kg/day, titrated twice weekly in 1 mg/kg/day increments to 12 mg/kg/day or individual maximally tolerated dose. Response was assessed after 6 weeks with ambulatory EEG monitoring and patient/parent record of seizure counts. The results suggest that topiramate may be effective in childhood absence epilepsy. Controlled studies are now required to identify the clinically optimal dose. (Eur J Epilepsy 2002; 11: 406).

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