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Indian Pediatrics 2000;37: 1164-1166

Home treatment of malaria has reduced the under-five mortality in Ethiopia. The effect of teaching mothers to provide anti-malarial to their sick children at home, on the under-five mortality was studied on a cluster of 37 villages. Thirteen (19%) of 70 deaths in the intervention areas were due to malaria as compared with 68 (57%) of 120 deaths in the control areas. The researchers noted that the under-five mortality was reduced by 40% in the areas where intervention was carried out as compared to control areas. The study recommended that a major reduction in under-five mortality could be achieved in holo-endemic malaria areas through teaching mothers to give anti-malarial drugs (Lancet 2000; 356: 550).

If done at an early age, cochlear implants have a better chance of success. A study from Nottingham, UK followed up 40 deaf children who underwent cochlear implantation at an average age of 52 months. The researchers observed that the improvement in speech was more significant among children who were younger at the time of implantation and those who primarily used oral communication. The authors concluded that the age at implantation and the mode of communication were the most important factors that influence the outcome. They also recommended an universal screen-ing program in view of beneficial effects of early intervention (Lancet 2000; 356: 4660).

The Prechtl test, a clinical test for neurologic function, is the most accurate in predicting neurologic outcome in preterm neonates born before 30 weeks gestation. This study from Netherlands compared Prechtl test with other assessments on 20 infants. The researchers noted that 84% who scored normal on the Prechtl test were normal according to the results of Touwen/Hempel neurologic examination at two years of age. The researchers concluded that the Prechtl score performed at the corrected term age was the only test that independently predicted neurological and developmental outcome at two years corrected age (J Pediatr 2000; 137: 100).

A meta-analysis has concluded that inhaled steroids do have an effect on linear growth of children. Out of the 159 studies analysed, 5 studies covering a total of 633 subjects met the criteria and were chosen for the meta-analysis. Four of these five studies used beclomethasone 200-500 mg/day, while one study used fluticasone (200 mcg/day). Beclomethasone therapy was associated with a decrease in linear growth velocity of 1.51 cm/year while fluticasone treatment led to a growth velocity reduction of 0.43 cm/year. Their effect on the final adult height, however, remains unknown, state the authors (Pediatrics 2000; 106: e8).

Toys in the Neonatal Intensive Care Units do cheer up the neonates, but can also be a source of infection. A study from Australia has made this observation after studying 19 infants and their toys. During the period of study (4 weeks), it was observed that 42% of the neonates developed infections. The investi-gators found that a variety of bacteria were grown from the toys, that in most cases were the same bacteria causing infection in the neonate. The researchers observed that except for the toys everything else in the incubator gets cleaned regularly. The researchers are now studying the effects of keeping toys out, on the incidence of neonatal infections (Pediatrics 2000; 106: e18).

Untreated maternal urinary tract infection has been linked to mental retardation in the infants. A study from United States of America analysed the records of over 41,000 pregnancies from 1995 to 1998. According to this study, untreated UTI in the first or second trimester was associated with a higher risk (1.31) of mental retardation and develop-mental delay as compared to those with no infection. The researchers concluded that UTI is not just an inconvenience, but can have harmful effects on the fetus also (Obstet Gynecol 2000; 96: 113).

Maternal illnesses are known to have an influence on neonatal outcome. This study from Amsterdam goes much beyond that - the risk of obstructive airway disease in adults appears to be increased in individuals exposed to famine in the prenatal period. According to this follow up study on 912 people born at term in Amsterdam between 1943 and 1947, the prevalence of wheezing, cough and of obstructive airways disease were increased in those exposed to famine during mid-gestation. There was, however no effect on the total or specific IgE or lung function. Fetal lungs can be permanently affected by nutritional challenges during periods of rapid growth, postulated the researchers (Thorax 2000; 55: 555).

The sequel of childhood bacterial meningitis might persist well into adolescence. Neuro-psychological, auditory and behavioral assessments were carried out in 109 children at 7 and 12 years following meningitis. According to this study from New Zealand, subjects with meningitis remained at greater risk than controls for any disability, with the risk being more in those children having suffered from neurological complica-tions during the episode. The researchers concluded that families, schoolteachers, and health professionals have an important role in identifying and or helping those with learning and behavioral difficulties (Arch Dis Child 2000; 83: 111).

Racecadotril (acetorphan), an anti-secretory and anti-diarrheal has been found effective in treatment of acute diarrhea. In this study from Peru, racecadotril (1.5 mg/kg orally 8 hourly) was administered to 135 boys between 3 to 35 months of age with watery diarrhea. This was in addition to the standard oral rehydration solution (ORS). The researchers observed that racecadotril, an enkephalinase inhibitor, was well tolerated and was associated with decreased mean duration of diarrhea, decreased stool output and decreased intake of ORS. The study concluded that in young children with acute watery diarrhea, racecadotril is an effective and safe treatment (N Engl J Med 2000; 343: 463).

In nephrotic syndrome, the longer the duration of initial treatment the better. A meta-analysis on the duration of steroid treatment in nephrotic syndrome has reached this conclu-sion after analysing five trials. A total of 868 children aged between 3 months to 18 years were involved in these studies. The researchers reported a relapse of 60% with two months initial treatment and found that a longer duration of initial treatment reduced the risk of relapse at 12-24 months. The authors recommend that first episodes of steroid responsive nephrotic syndrome should be treated with prednisolone for at least three months, with increased benefits being observed up to seven months treatment (Arch Dis Child 2000; 83: 43).

Inhaled nitric oxide has been found effective in refractory severe asthma. According to this study from Virginia, USA, five children with refractory acute severe asthma were given nitric oxide as a continuous inhalation for a median of 16 hours. Signifi-cant improvement was seen in four patients, with a fall in PCO2 by more than 20% and an increase in the PaO2. One patient died. Nitric oxide probably acts through a bronchodilating effect, suggest the authors. They concluded that nitric oxide can be a life-saving therapy in refractory asthma (J Pediatr 2000; 137: 119).

Ibuprofen has been found as effective as the conventional indomethacin in the management of patent ductus arteriosus in the neonate. In a multicentric study from Belgium, 148 children were assigned to receive either indomethacin or ibuprofen. Three doses of indomethacin (0.2 mg/kg/q 12 h) or ibuprofen (a first dose of 10 mg/kg, followed at 24 hour intervals by two doses of 5 mg per kilogram each), starting on the third day of life were administered. It was observed that the rate of ductal closure was similar in both groups: 66% with indomethacin and 70% with ibuprofen. Oliguria developed in 14 infants in the indomethacin group and in 5 infants in the ibuprofen group. Ibuprofen therapy is as efficacious and has lesser side effects than indomethacin for the treatment of patent ductus arteriosus in preterm infants, concluded the study (New Engl J Med 2000; 343: 674).

The factors associated with an adverse outcome neonatal bacterial meningitis were identified in a study from Canada. This retrospective study analyzed the records of 101 infants admitted with bacterial meningitis between 1979 and 1988. Thirteen died and 17 had moderate or severe disability at 1 year of age. The study reported that adverse outcome can be predicted within 12 hours of admission, with the presence of seizures, coma, use of inotropes, and leukopenia being the predictive factors. The authors used a prognostic tree model and recommended its use by the clinician because of its ease of use and accuracy (Pediatrics 2000; 106: 477).

Researchers from Canada have developed a new infrared method of analyzing amniotic fluid for fetal lung maturity. The researchers explored the accuracy and precision of the infrared-based method by comparing it with an automated fluorescence depolarization tech-nique (TDx FLM II) as a reference method. The study observed that the surfactant and albumin ratios obtained with the infrared method correlated closely with those produced by the TDx FLM II calibrator. Authors concluded that infrared spectroscopy is simple to perform, requires small volumes and can be used as a rapid screening test for respiratory distress syndrome (Am J Obstet Gynecol 2000; 183: 181).

C. Vidyashankar,
Pediatrician,
Military Hospital, Namkum,
Ranchi 834010, Bihar.,
India.
E-mail: [email protected]