Clippings

Indian Pediatrics 2002; 39:992-993

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Vitamin supplements in the ante-natal period have been found to reduce the risk of neuroblastoma in offspring. This study compared the records of children with neuroblastoma from USA and Canada and an equal number of controls. The researchers noted that ante-natal vitamin supplements reduced the risk of neuroblastoma by around 30%-40%. Though the researchers have not identified the exact mechanism and the specific vitamin responsible, they conclude that vitamins are important in the ante-natal period. (Epidemiology 2002; 13: 575-580)

A study from the UK recommends routine pulse oximetry in newborns prior to discharge. In this study, pulse oximetry was carried out prior to discharge on over 6000 neonates. A fractional SaO2 of less than 95% was detected in 1% of the neonates. Of these, 50 neonates had congenital heart disease, while 13 babies had other illnesses. Pulse oximetry can detect congenital heart disease before other signs appear, the researchers concluded.(Arch Dis Child: Fetal and Neonatal 2002; 87: F83-F88)

King’s College Hospital, London has reported good results with split liver transplants in children. Sixteen children with acute liver disease and 64 with chronic liver disease underwent ex-situ split liver transplants between 1994 and 2000. The overall survival and graft survival were 93.5% and 89.7% at one year and 88.1% and 86.1% at three years post-transplant respectively. The survival in transplants performed for acute liver failure was 93.7% and 76.4% at one and three years post-transplant respectively. Ex-situ transplants are as successful as the in-situ method, this study concludes.(Ann Surg 2002; 2: 248- 253)

Language disorders are common in children with focal epilepsy. This study from the UK conducted a neurological and language assessment in over 100 children with epilepsy aged between 5 and 17 years. Language disability was noted in 46(42.2%) of the children. It was also noted that language disabilities were 30% more common in children with focal epilepsy as compared to other epilepsies. This association needs to be kept in mind while managing childhood epilepsy, the report concluded. (Dev Med Child Neurol 2002; 44: 533-537)

A higher dose of botulinum toxin A(BTX-A) may be needed to produce a optimal muscle relaxation in cerebral palsy. In this randomized study, 48 children were administered either 24 U/kg or 8 U/kg of the toxin. The researchers noted that a 24 U/kg dose was more effective and long lasting as compared to the 8 U/kg dose. The researchers noted that the dose-effect relationship was not linear and concluded that the optimal dose of BTX-A to produce sufficient relaxation was between 200 and 500 IU. (Dev Med Child Neurol 2002; 44: 551-555)

Early diagnosis of Gullian-Barre syndrome(GBS) may be possible before the albumino-cytological dissociation appears. This study from Israel compared the CSF LDH levels in 5 patients with Gullian-Barre syndrome and an equal number of controls. LDH-3 fraction accounted for over 50% of LDH activity in patients with GBS as compared to a predominance of LDH 1 & 2 in controls. The total LDH levels, however, remained in the normal range. Abnormalities in LDH isoenzyme distribution may be useful in diagnosis of GBS, especially when CSF protein levels are normal in the early stages of illness, this report concludes. (Arch Dis Child 2002; 87: 255-256)

The Barker’s hypothesis has been challenged! A meta-analysis has questioned the link between low birth weights and hypertension in later life. Over 100 studies on this association were analyzed. The researchers note that link between hypertension and low birth weight was weakest in the larger studies. After adjusting for current weight, the blood pressure was only 0.4 mm Hg lesser for every one kg increase in birth weight. The researchers conclude that there is no link between birth weight and blood pressure later in life and that such associations could be because of inappropriate adjustment for the current weight and for confounding factors.(Lancet 2002; 360: 659-665)

A visual motor coordination test can predict response to DDAVP treatment in nocturnal enuresis. Researchers from UK made this observation after administering the Rey-Osterrieth test to 34 children with nocturnal enuresis. The Rey-Osterrieth test is a neuro-psychologial test that assesses the visual, motor, memory and cognitive functions and involves drawing the Rey-Osterrieth figure. The assessment is made based on the accuracy of reproduction. None of the children with more than 3 errors in the test responded to DDAVP, the researchers note. Delayed maturation of neurological pathways could be the reason behind both the non-response to DDAVP and errors in the Rey-Osterrieth test, the researchers concluded. (Arch Dis Child 2002; 87: 188-191)

Imaging-guided catheter drainage of parapneumonic effusions is more effective than imaging-guided thoracocentesis. Researchers from USA made these observations based on a retrospective analysis of records of 67 children with parapneumonic effusions. The researchers noted that while the length of stay and complication rates were similar, re-intervention was more in the thoracocentesis group. Low pH (<7.2) and glucose of the pleural fluid were the other risk factors associated with re-interventions. Catheter drainage is preferred option, especially in effusions with a low pH and glucose, the report concluded. (Pediatrics 2002; 110: e37)

According to a study conducted in Sweden and Honduras, boys have a higher risk of iron deficiency anemia during infancy. Over 250 breast fed infants were randomized to receive either iron supplements or a placebo from 4 - 9 months of age. The study noted lower hemoglobin, MCV and ferritin levels in boys and also reported a ten times higher risk of iron deficiency at nine months of age as compared to girls. While the reasons for the sex differences were not conclusively proved, the researchers suggested that both genetic and acquired factors could be responsible.(Pediatrics 2002; 110: 545-552)

C. Vidyashankar,

Email:[email protected]