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‘Glue
ear’ or otitits media with effusion in early childhood has been linked
to behavioral and learning problems in adolescence. This study from
Ireland assessed the behavior, learning and intelligence of 1000
children mainly in the 11-18 year group. The study found that children
with history of persistent or recurrent ‘glue ear’ were more likely
to develop learning and behavioral problems and have lower intelligence
in adolescene. The authors concluded that prompt treatment of this
condition is essential (Arch Dis Child 2001; 85: 91).
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Baby friendly
hospital initiative (BFHI) has helped in improving the breastfeeding
indices in the USA. This study compared the breast feeding rates in
1995, 1998 and 1999, that is before, during and after the
imple-mentation of the BFHI. Of the 200 records evaluated, the study
reported that the breast feeding initiation rates increased from 58%
(1995) to 77.5% (1998) to 86.5% (1999). The exclusive breastfeeding rate
also increased from 5.5% (1995) to 28.5 in 1998 to 33.5% in 1999. The
study reiterated the effectiveness of the BFHI in improving the
breast-feeding rates in a hospital setting (Pediatrics 2001; 108: 677).
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A study from
USA has reported that early postnatal dexamethasone is not effective in
prevention of chronic lung disease of prematurity. This multicentric
trial involving 42 NICU’s evaluated 542 neonates weighing between
500-1000 grams at birth who had received surfactant or required assisted
ventilation. The neonates recieved either reducing doses of
dexamethasone for 12 days starting with 0.5 mg/kg/day on day 1 or a
placebo. The study reported that there was no difference between the 2
groups in the incidence of chronic lung disease. Moreover, the
dexa-methasone group had an increased incidence of hyperglycemia,
gastrointestinal hemorr-hage and perforation and a high systolic blood
pressure. A poor weight gain and marginal increase in periventricular
leuko-malacia was also noted in the dexamethasone group (Pediatrics
2001; 108: 741).
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Neonatal
mortality rates are lower in larger hospitals, reports a study from
Norway. The records of 1.7 million births between 1967 and 1996 were
reviewed. The study reported that deliveries occurring in regions where
over 75% of the births took place in maternity units with over 3000
deliveries per year had a 20% lesser chance of neonatal death in the
first month of life. According to the researchers, the reasons are
obvious–better care during and after delivery. (Brit J Obste Gynecol
2001; 108: 904).
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A study from
Varanasi has reported that a single dose of liposomal amphotericin B is
effective in curing visceral leishmaniasis. In this study, 91 patients
with Kala Azar received either 5 mg/kg of body weight as a single
injection or 5 daily doses of 1 mg/kg given intravenously. The study
reported a cure rate of 92% in both the groups. There were no
significant side effects. A related editiorial however said that unless
liposomal amphotericin becomes affordable, it will still remain out of
reach of the poor (BMJ 2001; 323: 419).
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Birth weights
have been found linked to cognitive development in late childhood. A
retrospective cohort study from Edinburgh studied the records of 1985
births in 1921. The records of a mental survey done in 1932 were
available for 449 individuals from this cohort. After correcting for
confounding factors, the study reported that the cognitive development
as measured by the Moray’s House Test score was higher with increasing
birth weights. The study also observed that social class had a positive
correlation with cognitive function, independent of birth weights. This
study adds to the growing evidence in favor of Barker’s hypothesis.
(Arch Dis Child 2001; 85: 180).
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In what is
claimed to be the first report, the usefulness of octreotide a
somatostatin analogue, in treatment of chyloperitoneum has been
described by a team from the United Kingdom. A 5-year-girl who had
underwent laparotomy and endoscopically assisted duodenotomy later went
on to develop chyloperitoneum. The chyloperitoneum was managed
successfully with total parenteral nutrition and octreotide infusion
followed by oral medium chain triglycerides Octreotide infusion was
given as 1 µg/kg/hour to 2 µg/kg/hour for 8 days with no significant
side effects. The researchers explained that Octreotide acts by
decreasing the intestinal blood flow and lymph secretion. Octreotide and
other long acting somatostatin analogues hold promise in treatment of
chylous ascites. (Arch Dis Child 2001; 85: 234).
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Candies may
help in combating iron deficiency anemia! A study from Indonesia has
concluded that iron fortified candies had a beneficial effect on the
iron status of children. In this controlled study, 10 pieces of candy,
each containing 1 mg elemental Fe/g were given every week to 57 children
for a total duration of 12 weeks. On completion of the study, the
hemoglobin levels increased by 1 g/dl in the study group. The prevalence
of anemia also decreased and the serum ferritin levels increased. As the
total cost of supplement worked out to US $ 1 (Rs 47) equivalent,
this can serve as an affordable method for improving iron status, the
study concluded. ( J Clin Nutr 2001; 73: 1034).
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Montelukast, a
leukotrine receptor anta-gonist has been found effective in early
childhood asthma. This multicentric study evaluated the effect of
montelukast on 689 asthamatic children between 2 and 5 years of age who
were symptomatic at daytime and required beta-2 agonists. They were
random-ized to receive either montelukast ( 4 mg once a day) orally or a
placebo for 12 weeks. The study reported a significant improvement
starting from the first day of treatment in the montelukast group
irrespective of con-comitant use of other anti-asthma drugs. Side
effects were negligible. The study concluded that montelukast is safe
and effective alterna-tive in pre-school children also (Pediatrics 2001;
108:e 48).
C. Vidyashankar,
Pediatrician,
Military Hospital, Namkum,
Ranchi, Jharkhand 834 010, India.
E-mail:
[email protected]
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