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Indian Pediatrics 1999;36: 961-963 |
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o There is additional evidence on the need for routine antenatal screening for hypothyroidism. According to this study, the full-scale IQ score and the scores on several developmental tests were lower in children whose mothers had hypothyroidism in the second trimester of pregnancy. The effect was present even when hypothyroidism was mild and probably asymptomatic, with the scores being lowest among the children of untreated mothers. The study recommended the need for systematic screening for hypothyroidism early in pregnancy (N Engl J Med 1999; 341: 549). A related editorial suggested dietary supple-mentation of iodine before routine screening for hypothyroidism in pregnant women is introduced (N Engl J Med 1999; 341:601). o Could the pattern of breastfeeding determine HIV transmission to infants? A prospective study on the feeding practices of 549 HIV women found that at 3 months, 18.8% of 156 children who were never breastfed were estimated to be HIV-1 infected compared with 21.3% of 393 breastfed children (p = 0.5). The infants who were exclusively breastfed had a lower estimated seroprevalence than those who received mixed feeding. These findings suggest that, exclusive breastfeeding carried a significantly lower risk of HIV-1 transmission than mixed feeding and a similar risk to no breastfeeding (Lancet 1999; 354: 471). The authors conclude that possibly the transmission could be related to the pattern of breastfeeding. A related commentary, like the investigators, urges the need for more research before further guidelines are implemented (Lancet 1999; 354:442). o Ambulatory treatment for intussusception is possible. A total of 113 children, with a median age of 12 months, were treated for intussusception. Barium enema reduction was attempted in all patients. The successful reduction rate was 81%. Fifty patients (44.2%) were completely ambulatory managed and 42 were hospital-supervised after successful enema reduction. Twenty-one children underwent laparotomy after failure of enema. The authors conclude that outpatient treatment of acute ileo-colic intussusception is secure and reduces costs but depends on the willingness of the medical team to promote this trend (Eur J Ped 1999; 158: 707). o The effect of Plasmodium vivax malaria is more pronounced in primigravida. A study on 634 cases has found an increased risk of low birth weight and anemia. This is in contrast with P. falciparum malaria where the decrease in birth weight was greater in multigravidae. P. vivax malaria was not associated with miscarriage, stillbirth, or preterm delivery. Though the effects of P. vivax infection are less striking than those of P. falciparum infection, antimalarial prophylaxis against P. vivax in pregnancy may be justified, state the investigators (Lancet 1999; 354: 546). o There appears to be little influence of diet during pregnancy on fetal growth in the western world. In a study on a large group (n = 693) of pregnant nulliparous British women, vitamin C was the only nutrient independently associated with birth or placental weights. These relations were however weak, and in later pregnancy, no nutrient was associated with either outcome. The study concluded, that among relatively well nourished women in industrialized countries, maternal nutrition seems to have only a marginal impact on infant and placental size and that other causes of variation in the size of clinically normal infants should be investigated (BMJ 1999; 319: 339). o Bullying, a major problem in schools is associated with psychosomatic problems. In a study on 3918 school students from New South Wales it was found that almost a third of students bullied others or were victims of bullying, with the boys being more affected. Students, who were both victims and perpetuators of bullying had the greatest number of psychological and psychosomatic symptoms (BMJ 1999; 319: 344). In another study from Finland of over 16,000 adolescent's aged 14-16, depression occurred equally often among bullies and those who bullied, with severe suicidal ideation occurring most commonly among bullies (BMJ 1999; 319: 348). A related editorial suggests greater liaison and communication between all those who work with children, if bullying, which is a social as well as individual problem, is to be tackled (BMJ 1999; 319: 330). o Seizures occur in 1 to 2 per cent of neonates admitted to an intensive care unit and are usually treated with either phenobarbital or phenytoin. The effectiveness of both these drugs was studied on 59 neonates. Neonates whose seizures were not controlled by the assigned drug were then treated with both drugs. The study found that phenobarbital and phenytoin, when administered alone were incompletely effective as anticonvulsants in neonates, with the seizures being controlled in only 43% of the neonates. When combined treatment was considered, seizure control achieved was better. The severity of the seizures was found to be a stronger predictor of the success of treatment than the assigned agent (N Engl J Med 1999; 341: 485). o There is further evidence to a link between in-utero exposure to cigarette smoke and childhood morbidity. In a prospective study, over 8000 women enrolled at their first antenatal session, were followed till 5 years post-delivery for assessing the incidence of middle ear disease among their offspring. The study reported that smoking at the first clinic visit was associated with an increased risk of middle ear disease and ear surgery at 5 years of age. The authors conclude this is a significant contributor to childhood morbidity and provides another reason why women should be discouraged from smoking during pregnancy (Pediatrics 1999; 104: e16). o Gastro-esophageal reflux (GER) is an important cause of persistent wheezing. In a study on 84 otherwise healthy infants under evaluation for wheezing, GER was detected in 54 (64.3%). Thirty-five (64.8%) of the 54 infants with GER were able to discontinue all daily asthma medications within 3 months of starting anti-reflux therapy, while none of the infants without GER were able to discontinue daily asthma medications during the follow-up period. The study concluded that silent GER is common in infants with daily wheezing, and controlling GER improves morbidity and decreases the need for daily asthma medications (Pediatr Pulmonol 1999; 28: 181). o The trend to early discharge of newborn infants after uncomplicated vaginal delivery may not be good for the babies. In this study from Canada, of the 7009 neonates delivered vaginally and without complication, 1083 neonates were discharged within 48 hours. The fall in the average duration of stay from 2.1 to 1.9 days was associated with a rise in the readmission rate of newborn infants from 5.2% to 10.4%, with the primary cause for readmission being neonatal jaundice. The authors attribute this to a change in attitude, with childbirth being viewed as a natural process requiring minimum medical intervention if the delivery is uncomplicated. (Canadian Med Assoc J 1999; 161: 240). C. Vidyashankar, |
