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Speciality Spotlight
Children’s
Health
- Premature Infants
Khalak R, Pichichero ME, D’ Angio CT (Strong Children’s Research Ctr, Rochester, NY; Univ of Rochester, NY)
Three-Year Follow-up of Vaccine Response in Extremely Preterm Infants
Pediatrics 101: 597-603, 1998
Infants born before 29 weeks of pregnancy and with a birth weight of less than 1000 gms were vaccinated according to the chronologic age. Diphtheria, pertusis, tetanus, polio, Haemophilus influenzae and hepatitis B were immunized against.
Geometric mean titers (GMT) in the serum were compared with normal children at 3-4 years of age. They were lower in the former for polio serotype 3 and Haemophilus.
- Immunization
Kesler K, Nasenbeny J, Wainwright R, et al (Providence Alaska Med Ctr, Anchorage)
Immune Responses of Prematurely Born Infants to Hepatitis B Vaccination: Results Through Three Years of Age
Pediatr Infect Dis J 17: 116-119, 1998
Because of a high incidence of hepatitis B infection in the local population of Alaska, children born before 37 weeks were vaccinated before leaving the center one month later and again after 6 months.
Compared to normal hepatitis B surface antigen titer in serum of premature was lower at 1 to 3 months and after 2.5 to 3 years. Not one of these suffered from hepatitis B infection.
- Infectious diseases
Lee GM, Harper MB (Children’s Hosp, Boston)
Risk of Bacteremia for Febrile Young Children in the Post-Haemophilus influenzae Type b Era
Arch Pediatr Adolesc Med 152: 624-628, 1998
Children between the ages of 3 months and 3 years who had fever of 390 C or above were studied. Initial examination also included a history of recent immunization and drug therapy. They were febrile but not toxic. In the absence of an obvious cause, blood count, and blood culture were carried out. Bacteremia was discovered in 1.6% of the approximately 200000 children.
Asscociated with neutrophilia this seems to be logical in distinguishing between a viral and bacterial infection.
- Andrade MA, Hoberman A, Glustein J, et al (Univ of Pittsburgh, Pa; Children’s Hosp of Pittsburgh, Pa)
Acute Otitis Media in Children With Bronchiolitis
Pediatrics 101: 617-619, 1998
Children between the ages of 2 and 24 months with bronchiolitis and acute otitis media (AOM) for respiratory syncytial viral and bacterial infections. Fluid aspirates from the middle ear were studied for both parameters.
The authors conclude that bacterial infections predominate hence appropriate antibiotic therapy is mandatory.
- Helicobacter pylori infection
Bode G, Rothenbacher D, Brenner H, et al (Univ of Ulm, Germany)
Helicobacter pylori and Abdominal Symptoms: A Population-based Study Among Preschool Children in Southern Germany
Pediatrics 101: 634-637, 1998
Despite an up to 40 percent prevalence of Helicobacter pylori in children established by Urea breath test abdominal pain was rarely correlated thus; indeed infected children had less abdominal symptomatology.
This is reverse of the situation in adults. Does latent childhood infection blossom into a syndrome infection in adult life?
Comment: Childhood Helicobacter pylori infection if detected should be treated.
- Bronchiolitis
Dobson JV, Stephens-Groff SM, McMahon SR, et al (Maricopa Med Ctr, Phoenix, Ariz)
The Use of Albuterol in Hospitalized Infants With Bronchiolitis
Pediatrics 101: 361-368, 1998
Albuterol a b-adrenergic agent was compared with normal saline both in a nebulized form in the treatment of viral bronchiolitis children below 2 years of age.
No difference in recovery rate or other parameters was observed by the authors.
- Sports Medicine
Corrado D, Basso C, Schiavon M, et al (Univ of Padua, Italy; Natl Health Service, Padua, Italy)
Screening for Hypertrophic Cardiomyopathy in Young Athletes
N Engl J Med 339: 364-369, 1998
Sudden deaths in the mean age group of 23 years were due to arrhythmia associated with right ventricular cardiomyopathy, abnormal origin of a coronary artery and hypertrophic cardiomyopathy. Though coronary atherosclerosis was observed it was more common in those above 35 years of age.
Preparticipation testing is thus necessary, and in Italy mandatory since 1971 for all athletes.
- Smith J, Laskowski ER (Mayo Clinic Rochester, Minn)
The Preparticipation Physical Examination: Mayo Clinic Experience With 2,739 Examinations
Mayo Clin Proc 73: 419-429, 1998
Preparticipation physical examination (PPE) along the Mayo Clinic pattern divides athletes into 3 groups. Group 1 comprises those cleared for participation, group 2 is cleared but has to be followed up (CFU) and the third group is not cleared. Cardiac abnormalities, hypertension, visual difficulties, musculoskeletal disorders, epilepsy, syncope hernia, testicular problems and others fall into the elastic group 2 and 3.
The authors call this the station examination system and is useful in sports preparticipation evaluation.
- Adenoids
Paradise JL, Bernard BS, Colborn DK, et al (Univ. of Pittsburgh, Pa; Children’s Hosp of Pittsburgh, Pa)
Assessment of Adenoidal Obstruction in Children: Clinical Signs Versus Roentgenographic Findings
Pediatrics 101: 979-986, 1998
A combination of reduction in the nasal component of speech with added stuffiness and the degree of mouth breathing are adequate to assess enlargement of adenoids.
Soft tissue radiology is considered as a pre-operative but rare requirement.
- Adenoids
Sclafani AP, Ginsburg J, Shah MK, et al (New York Eye & Ear Infirmary; New York Med College, Valhalla)
Treatment of Symptomatic Chronic Adenotonsillar Hypertrophy With Amoxicillin/Clavulanate Potassium: Short- and Long-term Results
Pediatrics 101: 675-681, 1998
Chronic adenotonsillar hypertrophy (CATH) without recurrent infection is common enough to lead to surgery. There are enough children that make up a poor surgical risk.
A combination of amoxicillin with clavulanate potassium (AMOX/CLAV) in a dose of 40 mg/kg per day in 3 equal doses for 30 days was used. The authors followed up these patients for 2 years and found a marked reduction of necessity of surgical intervention.
Comment: Prevention of Adenoid surgery by antibiotics is reminiscent of prevention of Acne with tetracyclines or erythromycin or other chemotherapy given for several months.
- Gynecomastia
Sher ES, Migeon CJ, Berkovitz GD (Johns Hopkins Univ, Baltimore, Md)
Evaluation of Boys With Marked Breast Development at Puberty
Clin Pediatr (Phila) 37: 367-372, 1998
Gynecomastia when idiopathic is called macromastia and is common in boys around puberty. It often disappears spontaneously. Endocrinal abnormalities observed in a minority of cases were partial androgen insensitivity, primary testicular failure, Klinefelter’s syndrome and others.
Serum levels of luteinizing hormone, testosterone, estradiol and follicle-stimulating are suggested by the authors.
Comment: Examination for lepromatous leprosy should not be overlooked in the tropics.
- Sudden Infant Death Syndrome
Skadberg BT, Morild I, Markestad T [Univ Hosp of Bergen, Norway]
Abandoning Prone Sleeping : Effect on the Risk of Sudden Infant Death Syndrome
J Pediatr 132: 340-343, 1998
Sudden infant death syndrome [SIDS] has sleeping prone as one of its associations. This was avoided in this Norwegian study in the age group of 1 week to 1 year from 1993 through 1995.
Comment: In moderately educated Indian families infants are kept in a supine position, helped by a U shaped pillow hollowed in the middle and followed down the neck. The child’s body is wrapped in soft cotton cloth preventing it in turning over into a prone position.
- Carroll JL, Siska ES [Johns Hopkins Children’s Ctr., Baltimore, Md; SIDS Network – Pennsylvania Connection, York]
SIDS: Counseling Parents to Reduce the Risk
Am Fam Physician 57: 1566-1572, 1998
In the absence of physiologic abnormalities in infants other factors need to be attended to. These include prevention of sleeping in a prone position, avoidance of smoking by women during and after pregnancy: this applies to the father also, avoiding soft and dangerous clothing, soft toys and above all educating parents.
- Ford
RPK, and the New Zealand Cot Death Study Group [ Community Child and Family Service, Christchurch, New Zealand; Univ of Auckland, New Zealand; Univ of Otago, New Zealand]
Heavy Caffeine Intake in Pregnancy and Sudden Infant Death Syndrome
Arch Dis Child 78: 9-13, 1998
Heavy coffee drinking is defined as drinking 400 mgm or more of caffeine per day. With this amount during the first and third trimesters of pregnancy low infant birth weight and spontaneous abortions have been implicated as caffeine undergoes transplacental passage.
New Zealand has a high incidence of sudden infant death syndrome [SIDS]. This paper adds heavy coffee drinking as a factor of minor importance in SIDS causation.
- Schluter PJ, Ford RPK, Brown J, et al [Healthlink South, Christchurch, New Zealand; New Zealand Meteorological Service]
Weather Temperatures and Sudden Infant Death Syndrome: A Regional Study over 22 Years in New Zealand
J Epidemiol Community Health 52: 27-33, 1998
Sudden infant death syndrome [SIDS] is more commonly observed towards the end of winter. When warming begins, a phase of steady temperature is reached. This is more fatal for infants older than 12 weeks.
