• Do overweight infants become overweight adolescents? A cross-sectional study in Brazil tried to answer this question using a total of 1076 adolescents aged 14-16 y (51% males). Anthropometric status in early life was measured through birthweight and through weight and length/height at average ages of 20 and 43 months. The study concluded that birth size and particularly growth velocity in early life were associated with increased prevalence of obesity and overweight in Brazilian adolescents. On the other hand, the vast majority of overweight or obese adolescents were not overweight children. (Int J Obesity 2003; 27: 1274).
   

• What is the time period of risk of bleeding for a newly diagnosed Idiopathic Thrombocytopenic Purpura (ITP)? In a study from a Nordic registry of ITP patients, at presentation (n = 501), more than half of the children had a platelet count <10 × 10(9)/L, but only 3% had a hemorrhage requiring blood transfusion. Events occurred with an average frequency of 0.39 per month at risk. The authors opine that most children with ITP are at risk for serious bleeding for less than one month. Continuing severe thrombo-cytopenia is associated with little morbidity, bleeding episodes being infrequent and very rarely serious.( J Pediatr 2003; 143: 302).
   

• Kawasaki disease leads to significant fever & irritability. Can the addition of oral corticosteroids to IVIG treatment produce quicker relief of symptoms and reduce serum cytokine levels faster? In a randomized study involving 32 subjects, the levels of Interleukin (IL)-2, IL-6, IL-8, and IL-10 within 24 hours after initiating IVIG therapy were signi-ficantly lower when steroids were added to the regimen. Also, the duration of fever was shorter, and the C-reactive protein concentration decreased more quickly in these children as compared to the controls. (J Pediatr 2003; 143: 363).
   

• A significant proportion of patients diagnosed with cough-variant asthma eventually manifest classic asthma signs, such as wheezing and dyspnea. The aim of this study was to investigate predictors for the development of classical asthma in this sub-group of patients. Sixty-two children with cough-variant asthma were prospectively studied for 4 years. Twenty-four (47.1%) of the 51 subjects available for follow-up developed signs of classic asthma, while 27 did not. The only significant difference in the sputum parameters between these two groups was a higher percentage of sputum eosinophils in subjects who developed classic asthma. Thus the study concludes that sputum eosinophilia in cough-variant asthma may be a correlate of the later development of classic asthma and may be useful in the clinical management of patients with cough-variant asthma. (Clin Exp Allergy 2003; 33: 1409).
   

• The incidence of diabetes is rising. Various theories have been attributed for this increase, and this study tries to determine whether the age of introduction of gluten-containing foods in infancy has any influence on the development of islet autoimmunity that may precede type I diabetes. In 1610 children the development of islet autoantibodies (insulin, glutamic acid decarboxylase, or IA-2 antibodies) in 2 consecutive blood samples was studied from birth to 8 years. Food supplementation with gluten-containing foods before age 3 months was associated with significantly increased islet autoantibody risk. Early exposure to gluten did not significantly increase the risk of developing celiac disease-associated autoantibodies. The study recommends ensuring compliance to infant feeding guidelines as a possible way to reduce the risk of development of type 1 DM autoantibodies. (JAMA 2003; 290: 1721).
   

• Long acting beta-agonists (LABAs) are fast being accepted as a standard add-on therapy for asthmatics to reduce inhaled corticosteroid use. The purpose of this meta-analysis was to examine the effect of LABAs on the asthma exacerbation rate in pediatric patients. Eight studies were identified that fulfilled these criteria. Analysis of data from the eight studies revealed no apparent protection from an asthma exacerbation among children on a LABA compared to patients on comparator treatment. The authors opine that the lack of evidence for the control of asthma exacerbations in children regularly using a LABA should bring into question its general use as add-on therapy. (Pediatr Pulmonol 2003; 36: 391).
   

• Status epilepticus (SE) is a life-threatening medical condition associated with significant morbidity and mortality that requires urgent medical intervention. Although several agents are available to treat SE, they occasionally fail to abort seizure activity. In this study, the authors evaluated the efficacy of Topiramate (TPM) administered to 3 children with this condition who failed to respond to conventional treatment. Additional treatment with TPM was administered by nasogastric tube. The ages of the three children were 4.5 months, 34 months, and 11 years. The status was terminated in all three children Within 24 h of maintenance therapy with TPM at 5-6 mg/kg/ day. These results support the potential efficacy of TPM for children with refractory SE. Larger prospective series are needed to confirm those results. (Epilepsia 2003; 44: 1353).
   
• Human fetuses and neonates ingest erythropoietin (Epo) when they swallow amniotic fluid, colostrum, and human milk. this study was designed to determine whether enterally dosed recombinant Epo (rEpo) stimulates erythropoiesis in preterm neonates. Enteral rEpo was well tolerated. However there were no differences in erythropoeietic indexes or transfusion requirements in the treatment group versus placebo. Thus the authors conclude that oral administration of rEpo is not an effective substitute for parenteral administration. (J Pediatr 2003; 143: 321).
   
• In the ongoing fight against resistant gram positive bacteria, Linezolid, a new oxazolidinone antibiotic, has shown promise and has recently been approved for treating Gram-positive infections in pediatric patients. To compare the clinical efficacy and safety of linezolid with vancomycin in neonates (age 0 to 90 days), 63 hospitalized infants (0-90 days) with known or suspected hospital-acquired pneumonia, complicated skin or skin structure infections, bacteremia or other infections (e.g., pyelonephritis, abdominal abscess) were enrolled. The study found that linezolid is well-tolerated and as effective as vancomycin in the treatment of resistant Gram-positive infections in neonates. (Pediatr Infect Dis J 2003; 22: S158).

Gaurav Gupta,
Senior Resident Pediatrics,
P.G.I.M.E.R.,
Chandigarh - 160 012,
India.
Email: [email protected]