Clippings

Indian Pediatrics 2002; 39:901-903

Clippngs

q It is well known that most children with otitis media will not benefit symptomatically from immediate use of antibiotics. In a study to identify risk factors for acute otitis media, 315 children aged 6 months to 10 years were studied. Predictors of short term outcome were an episode of distress or night disturbance three days after child saw doctor. In children with otitis media, fever and vomiting were the only attributes that showed improvement with antibiotic treatment; in their absence a poor outcome is unlikely. (BMJ 2002; 325: 22)

q In North America, the proportion of new HIV infections involving drug-resistant strains increased from 3.4% in 1995-1998 to 12.4% in 1999-2000. In the current study the presence of drug-resistant HIV in plasma samples from 377 patients with primary HIV infection who had not yet received antiretroviral therapy was identified. The findings indicate that the proportion of new infections involving strains resistant to at least one drug class increased significantly during the study period (p=0.002). The frequency of multidrug resistance also increased significantly (p=0.01) but still was only 6.2% in the 1999 to 2000 period. In agreement with previous reports, infection with drug-resistant virus was associated with poorer patient outcomes. (N Engl J Med 2002; 347: 385)

q Steroids are used as adjuvant treatment in childhood pyogenic meningitis to attenuate host inflammatory responses to bacterial invasion, but do they really work in developing countries? In a double-blind, placebo controlled trial involving 598 children with pyogenic meningitis in Malawi, 307 (51%) were assigned to dexamethasone and 295 (49%) to placebo. At final outcome, sequelae were identified in 84 (28%) of children on steroids and in 81 (28%) on placebo. The number of children dying in hospital did not differ between groups. Steroids are not an effective adjuvant treatment in children with acute bacterial meningitis in developing countries. (Lancet 2002; 360: 211)

q In view of the increased incidence of allergy, novel therapies are being attempted to down regulate such inflammation. Recent data have outlined a relationship between the composition of the intestinal microflora and allergic inflammation. This study was done to assess the efficacy of bifidobacterial supplementation in the treatment of allergy and whether this could relate to modulation of the intestinal microflora. In 21 infants with early onset atopic eczema serum total IgE concentration correlated directly with Escherichia coli counts, indicating that the presence of these bacteria is associated with the extent of atopic sensitisation. The effect of bifidobacterium supplementation was characterised as a decrease in the numbers of Escherichia coli and bacteroides during weaning. These data indicate that bifidobacterial supplementation appears to modify the gut microflora in a manner that may alleviate allergic inflammation. Further studies are needed to confirm this conclusion. (Gut 2002; 51: 51)

q Postnatal dexamethasone used for chronic lung disease in ELBW (< 1000 gm) neonates may not be safe. One hundred seventy three ELBW neonates (1,000 gm or less) were assigned to 1 of 4 groups based on dexamethasone exposure. Abnormal cranial ultrasound findings at hospital discharge were more common in infants with postnatal dexamethasone and were also more likely to have lower scores on neurodevelopmental testing. The authors conclude that Antenatal Dexamethasone (ADX) by itself is not associated with an increase in periventricular leukomalacia or other cranial ultrasound abnormalities in ELBW infants, or with neurodevelopmental delay. On the other hand, postnatal dexamethasone, either alone or in combination with ADX, is associated with both of these adverse outcomes. (Pediatrics 2002; 110: 275)

q The most common cause of massive tropical splenomegaly is malaria, but new study findings indicate that a substantial number of cases are due to B-lymphoproliferative disorders (B-LPD), a previously unrecognized cause. In 221 Ghanian patients with spleen sizes of at least 10 cm forty-one percent of patients had hyper-reactive malarial splenomegaly (HMS) and 22% of patients had B-LPD. In 14% of patients a hematological disorder was diagnosed, while in 23% no cause was established. The authors feel that these findings have major implications for the diagnosis and management of massive splenomegaly in the tropics. (Lancet 2002; 360: 449)

q Does Bacille Calmette-Gurin (BCG) vaccine have a weak protective effect against asthma? In a study of nearly 40,000 pre-school children in Germany whose average age was six years there was no significant link between BGC vaccination and atopic dermatitis or hay fever but a weak protective effect of BCG vaccination against asthma. (Pediatr Allergy Immunol 2002; 13: 177)

q Researchers investigating a cohort of 32,200 Scottish children born in 1995 or 1996, either exclusively breastfed or formula fed, found that obesity was less common among breast fed children, and the association persisted after adjustment for socioeconomic status, birthweight, and sex. The relative reduction in risk of obesity among breast fed children was 30 percent when obesity was defined as the 98th percentile or higher for BMI. Breastfeeding is therefore potentially useful for population-based strategies aimed at obesity prevention, particularly with the other benefits that breastfeeding provides. (Lancet 2002; 359: 2003)

q Does repair of coarctation of aorta during early childhood prevent later hypertension? In 119 children the arch repair and left ventricular parameters were assessed using Doppler echocardiography. Median ages at first intervention and at blood pressure measurement were 0.2 years and 12.0 years respectively. Patients were classified as having "no" (n = 70) or "mild" (n = 49) arch obstruction. Mean 24 hour SBP was > 95th centile in 30% overall and in 19% of the no obstruction group. This unique study of a large cohort of patients treated for coarctation in early childhood showed that a disappointingly high prevalence of hypertension is already apparent in children aged 7-16 years in the absence of significant arch obstruction. (Heart 2002; 88: 163)

q How long do we really need to treat a urinary tract infection (UTI)? To compare the effectiveness of short course (2-4 days) with standard duration oral antibiotic treatment (7-14 days) for urinary tract infection (UTI), a meta-analysis of randomised controlled trials was conducted. Ten trials were eligible, involving 652 children with lower tract UTI, outcome measures were UTI at the end of treatment, UTI during follow up (recurrent UTI), and urinary pathogens resistant to the treating antibiotic. There was no significant difference in the frequency of positive urine cultures between the short (2-4 days) and standard duration therapy (7-14 days) for UTI at 0-7 days after treatment and at 15 months after treatment. There was no significant difference between short and standard duration therapy in the development of resistant organisms in UTI at the end of treatment or in recurrent UTI. It seems a pretty convincing argument for use of shorter course antibiotic therapy for lower UTI. (Arch Dis Child 2002; 87: 118)

Gaurav Gupta,