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Each of five brands of soy formula tested in Cincinnati, Ohio (Lancet 1997;350:23–7) contained appreciable amounts of isoflavone phyto-oestrogens. Plasma concentrations of these substances in seven soy formula fed 4 month olds were more than 200 times those found in babies fed on cows’ milk formula or breast milk. These concentrations are immensely higher than plasma oestradiol concentrations in infants. Whether this is harmful, beneficial, or neither is not known.
A US case-control study (Journal of the American Medical Association 1997;278:207–11) has for the first time shown an association between maternal infection and cerebral palsy in babies weighing over 2500 g at birth. One or more indicator of maternal infection was present in 3% of 378 controls and 22% of children who developed cerebral palsy after being born between 1983 and 1985. For those with spastic quadriplegia the maternal infection rate was 37%. Maternal infection was associated with low Apgar scores, neonatal hypotension, neonatal seizures, endotracheal intubation, and a diagnosis of hypoxic-ischaemic encephalopathy.
Glasgow acuity cards differ from Sheridan-Gardiner test letters in that they are used at 3 metres rather than 6, there is a linear progression of letter size, each card contains a line of four letters, and they incorporate a surrounding thick black line (the crowding bar). Glasgow workers (British Journal of Ophthalmology1997;81:465–9) reckon that the Sheridan-Gardiner letters will only detect just over a half of children with unilateral amblyopia whereas the Glasgow acuity cards will pick up all of them.
Since the start of neonatal hepatitis B vaccination in Taiwan in 1984 mortality from hepatocellular carcinoma in under 10s has fallen by 70% whereas that at older ages has increased (Pediatrics 1997;99:351–3).
A review of 28 published articles devoted to the treatment of pica in people with developmental disabilities, including autism (Autism 1997;1:77–95) revealed many different methods, all insufficiently tested. Many articles were single case reports and none included more than four patients. Treatments ranged from physical restraint and environmental adjustments, through aversive and behavioural methods, to dietary supplements and thioridazine. Many are now thought to be unacceptable for use in mainstream schools.
An American meta-analysis of the results of 20 studies of treatment for idiopathic scoliosis (Journal of Bone and Joint Surgery 1997;79A:664–74) included 1910 patients treated with bracing (1459), lateral electrical surface stimulation (322), or observation (129). Bracing for 23 hours a day with a Milwaukee brace was said to be 99% successful. Bracing for 16 or eight hours a day gave only 60% success rates, and other managements less than 50%.
Guidelines for the management of acute idiopathic thrombocytopenic purpura in children were published in Archives in 1992. A 1995–96 survey (Lancet1997;350:620–3) has shown that UK practice deviates from the guidelines in that children are more readily admitted to hospital, bone marrow examinations may be done unnecessarily or not done before starting steroid treatment, intravenous immunoglobulin is as popular as steroids when treatment is given, treatment is given more often than recommended, and platelet transfusions are sometimes given when not indicated. The underlying principle should be, treat the child not the platelet count.
The WHO plan for worldwide tuberculosis control has five main points: government commitment, case detection from symptoms and sputum microscopy, directly observed treatment (short course) (DOTS), regular supply of drugs, and standard reporting and recording. The strategy has been adopted by 75/180 countries including about 23% of the world’s population (Lancet 1997;350:624–9) and treatment success rates are around 76% in countries using the strategy and 42% in other countries.
Two American trials (Journal of the American Medical Association 1997;278:637–43 and 644–52) have shown several benefits from nurse visiting of mothers during pregnancy and for two years after delivery, including less pregnancy induced hypertension, fewer repeat pregnancies, fewer injuries to the children, less child abuse, less use of welfare, less drug use, and less police involvement.
The use of paracetamol for children with falciparum malaria has been questioned by workers in Gabon (Lancet 1997;350:704–9). They found that paracetamol increased parasite clearance times and had only a small effect on fever duration. They suggest that the effect on parasite clearance might be due to reduced tumour necrosis factor and oxygen radical production.
Of 616 babies born in Sweden with cleft lip and/or palate (Pediatrics 1997;100:180–6) 127 (21%) had other malformations (28% of those with cleft lip and palate, 22% of those with cleft palate only, and 8% of those with cleft lip only). A third of associated malformations affected the limbs or spine and a quarter the cardiovascular system. Seventeen infants had chromosomal and 16 recognised non-chromosomal syndromes.