Article Text

PDF

Statistics from Altmetric.com

Poisoning with the oleander plant occurs throughout the tropics and subtropics and produces effects similar to those of digitalis poisoning. In Sri Lanka self-poisoning with the seeds of yellow oleander has become a problem in teenagers. A randomised trial in Colombo (Lancet2000;355:967–72) has shown that antidigoxin Fab often reverses the cardiac arrhythmia associated with this poisoning. Of 66 patients presenting with cardiac arrhythmia, 24 of 34 in the treatment group and five of 32 controls were in sinus rhythm at eight hours. Antidigoxin Fab caused an increase in heart rate and a fall towards normal in serum potassium.

Philadelphia chromosome positive acute lymphoblastic leukaemia has a poor prognosis but some children do well. In a European/American study (New England Journal of Medicine2000;342:998–1006) including 326 children and young adults, good, intermediate, and bad prognosis groups were defined on grounds of age and initial leukocyte count. Five year disease free survival in these groups was 50%, 30%, and 20%. In each group bone marrow transplantation gave better results than intensive chemotherapy alone.

Pigbel is a name that stays in the memory but how many could say just what it is? Well, it is the other name for enteritis necroticans and is derived from a Papua New Guinea dialect word. First described in northern Europe soon after the second world war, enteritis necroticans became a problem in children in Papua New Guinea in the early 1960s, often coming on after a pig feast. It is caused byClostridium perfringens. In Atlanta, Georgia (New England Journal of Medicine2000;342:1250–3) a 12 year old boy with poorly controlled diabetes developed pigbel after eating chitterlings (pig intestines). He had extensive jejunal necrosis but survived after bowel resection. PCR testing of resected bowel detected products of the genes which code for C perfringens α and β toxins.

There has been uncertainty about whether dengue virus infection affects the central nervous system. Now a report from Vietnam (Lancet2000;355:1053–9) has provided evidence of such infection in 21 patients, 11 of whom were children. The neurological diagnosis was encephalitis/encephalopathy in ten of the children and the other child had transverse myelitis. Nine of the children recovered completely within two weeks but one child with encephalitis had residual leg spasticity, and the child with transverse myelitis had mild spastic paraparesis on leaving hospital at 18 days.

Children treated with long term dialysis for end stage renal disease often develop coronary calcification in their twenties. In a Los Angeles study of 39 patients (mean age 19 years, range 7 to 30 years) (New England Journal of Medicine 2000;342:1478–83) none under the age of 20, but 14 of 16 aged 20–30, had coronary calcification on electron beam computed tomography. The mean age of those with coronary calcification was 26 years and their mean time since starting dialysis was 14 years. This finding underlines the need for early renal transplantation.

In the Netherlands almost all (27 of 29) children followed up some years after an ischaemic stroke claimed to be as happy as other children and three quarters claimed to be as healthy (Developmental Medicine and Child Neurology2000;42:313–18). Of a total of 37 children, nine developed epilepsy, eight had transient ischaemic attacks and two had a second cerebral infarct. Fifteen were left with a hemiparesis. About half (17) needed remedial teaching and behavioural changes were often reported by parents. Four had died.

The significance of a raised blood pressure in clinic but not at home (“white coat hypertension”) is debated. There are no long term follow up data on children but a study in Greece (Journal of Pediatrics2000;136:359–64) has suggested that the finding may not be entirely benign. Male, but not female, adolescents with white coat hypertension had raised 24 hour excretion of endothelin and free cortisol in urine. It is suggested that this may presage the later development of idiopathic hypertension.

In Russia, mothers may give up their babies to the care of the state by signing a document while in the maternity hospital (Archives of Pediatrics and Adolescent Medicine 2000;154:474–7). In Maternity Hospital 11 in St Petersburg before 1992, a policy of enforced separation of mother and baby for 21 hours a day was pursued and fathers were not allowed to visit. The number of babies left in hospital by their mothers was around 50 per 10 000 births at that time. In 1992, the United Nations Children's Fund Baby-Friendly Hospital Initiative was adopted, with the encouragement of early mother and baby contact, breast feeding, and rooming in. The abandonment rate rapidly fell to around 28 per 10 000 births. Lucina remembers the days, not so long ago, when babies in British hospitals spent a large part of their time away from their mothers.

The mandibular frenulum is the one which goes from the lower lip to the gum in the midline. In Italy (Journal of Pediatrics2000;136:408–10) 23 of 25 infants with hypertrophic pyloric stenosis and five of 319 control infants had hypoplasia or aplasia of the mandibular frenulum.

A study in Pennsylvania, USA (American Journal of Clinical Nutrition 2000;71:1054–61) has related the eating patterns and weight of 5 year old girls to the attitudes of their mothers. Perhaps not surprisingly, overweight mothers with unrestricted eating practices and little appreciation of the risk of excess weight in their children tended to have overweight daughters with high food energy intakes. The authors place their faith in “anticipatory guidance” as an attempt to solve the problem.

The Youth Justice and Criminal Evidence Act 1999 introduced a new way of dealing with children on first conviction: the Referral Order (National Children's Bureau 2000, highlight no 175). Children dealt with in this way will be referred to a Youth Offender Panel which will work out a “programme of behaviour” and the child will be required to sign and keep to a “youth offender contract”. The programme will be based on the principles of restoration, reintegration, and responsibility. The process is intended to be child centred and relatively informal but concerns are expressed about whether the requirements of the programme will necessarily be proportional to the offence committed, especially as legal representation will not be allowed at this stage, and about the validity of requiring a young child to sign the contract.

Some of the scientific basis behind the UK group C meningococcal conjugate vaccine programme came from a study in Oxfordshire (Journal of the American Medical Association2000;283:2795–801). The trial included 182 infants randomised to either of two lots of group C conjugate vaccine or hepatitis B vaccine (controls) along with routine immunisations at two, three, and four months. The meningococcal vaccine was well tolerated, produced satisfactory antibody responses, and induced immunological memory with increased antibody response to plain meningococcal polysaccharide vaccine at age 12 months.

Of 69 very low birthweight infants in Cambridge who developed cerebral palsy, 39 had abnormal neonatal cranial ultrasound scans (Developmental Medicine and Child Neurology2000;42:364–7). The predominant form of cerebral palsy was hemiplegia in those with abnormal neonatal ultrasound appearances and diplegia in those with normal scans. Perinatal sepsis increased the risk of cerebral palsy fourfold whether the neonatal scan was normal or abnormal.

View Abstract

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.