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Historically, the factors associated with declines in infant and early childhood mortality in the nineteenth and early twentieth centuries seem to have varied from country to country. Around the beginning of the twentieth century, for instance, child mortality was high in the USA and, in contrast to the situation in the UK, the rich and advantaged did not fare much better than the poor. In England and Wales, infant mortality was greater in urban areas, a fact attributed in the main to diarrhoea and lack of adequate sanitation. A study in the Netherlands, however, (International Journal of Epidemiology2000;29:1031–40) has shown no “urban-sanitary-diarrhoeal-effect” on infant mortality in the last quarter of the nineteenth century. Urbanisation there had the greatest impact on post-infantile, early childhood mortality from acute respiratory diseases. These authors stress the association between religion and infant mortality rates in the Netherlands at that time. The rates were higher in Roman Catholic areas and this they attribute to lower rates of breast feeding, adherence to folk medicine, and reluctance to accept newer ideas about medicine and public health.

Data from a 1997 study in Pakistan (American Journal of Clinical Nutrition 2000;72:1164–9) and from the third US National Health and Nutrition Examination Survey (NHANES III) of 1988–94 (Ibid: 1170–8) confirm that infection lowers serum concentrations of retinol and knowledge of serum concentrations of acute phase proteins may help to correct for this.

In Finland (Diabetes Care2000;23:1755–60) the risk of developing diabetes before the age of 15 years was increased by 50–60% in children who had a 10% unit increment in relative weight (weight relative to mean weight for height) before the age of 3 years and by 20–40% with such an increment at 3–10 years of age. Obesity, defined as relative weight > 120%, more than doubled the risk of childhood diabetes.

Increased antibiotic use in a community means increased antibiotic resistance. A study in the 20 municipalities of a Swedish county (Pediatric Infectious Disease Journal2000;19:1172–7) has shown a significant correlation between community rates of antibiotic prescribing for children aged 0–6 years and the proportion of pneumococci isolated from nasopharyngeal swabs from children of that age which were penicillin non-susceptible. This applied to total antibiotic prescriptions and to prescriptions for co-trimoxazole, amoxicillin, macrolides, and cephalosporins but, strangely, not to prescriptions for penicillin V.

In the outpatient treatment of croup, oral dexamethasone appears to be as effective as intramuscular dexamethasone. In Denver, Colorado (Pediatrics2000;106:1344–8) 277 children with moderate croup were randomly assigned in the emergency department to oral or intramuscular dexamethasone, each at a dose of 0.6 mg/kg (maximum 8.0 mg) and sent home. There was no significant difference in response between the two groups. Only half of the children were symptom-free after 48–72 hours and almost a third came back to the emergency department. Nevertheless, only two children in each group were eventually admitted to hospital.

Whey hydrolysate is said to taste and smell better than casein hydrolysate and is cheaper. In Amsterdam (Pediatrics2000;106:1349–54) 43 babies with infantile colic were randomised to whey hydrolysate or standard formula. The reduction in daily duration of crying was significantly greater in the whey hydrolysate group but most babies still had infantile colic (they cried for three hours or more on at least three days a week).

In 1997 there were 142 child deaths in the USA from accidental shooting. Seventeen states have introduced laws making the gun owner criminally liable when a child is injured by a gun that was not stored safely. Data from 15 of these states (Pediatrics2000;106:1466–9) show that the enactment of these laws was followed by a significant reduction in accidental gun deaths in children in only one state (Florida). Such deaths are nine times more common in the USA than in 25 other industrialised countries combined.

The prevalence of coeliac disease in children with Down's syndrome has been estimated at between 4% and 17% in different studies. In Amsterdam (Journal of Pediatrics2000;137:756–61) 137 children with Down's syndrome were screened by testing for serum immunoglobulin A antiendomysium antibodies at a mean age of 5 years and again two years later. Biopsy-proved coeliac disease was diagnosed in eight children on the first screening and in three more on the second. A third screening three years after the second identified no new cases. All of the children with coeliac disease carried the HLA-DQ alleles known to be associated with coeliac disease (DQA1*0501-DQB1*02). These workers suggest initial screening with HLA-DQ typing followed by repeated antibody screening.

The auditory evoked, even-related, potentials (ERPs) of newborn babies differ according to whether they are elicited by the mother's voice or that of a stranger (the ‘P2’ peak is of greater amplitude and latency with the mother's voice). American researchers (Journal of Pediatrics2000;137:777–84) tested 25 infants of diabetic mothers and 32 infants of mothers who did not have diabetes. ERP evidence of recognition of novelty (negative slow wave) in response to a stranger's voice was found in the infants of non-diabetic mothers but this response was diminished in the infants of diabetic mothers. The negative slow wave correlated with higher developmental scores at 1 year. Auditory processing may be impaired in the infants of diabetic mothers.

In a multinational study of omeprazole in the treatment of chronic erosive reflux oesophagitis (Journal of Pediatrics2000;137:800–7) healing occurred in 54 of 57 children. Most (72%) responded to doses of either 0.7 or 1.4 mg/kg/day but some needed up to 3.5 mg/kg/day. All 57 patients had marked symptomatic improvement. No adverse events were attributed to omeprazole.

Orthopaedic surgeons in Glasgow, Sheffield, and Bristol have performed leg lengthening procedures on 10 young women with Turner's syndrome (Journal of Bone and Joint Surgery [Br] 2000;82-B:1174–6) and have been disappointed with the results. Nine of 10 lengthened femurs fractured and six of those needed intramedullary nailing. Of 18 lengthened tibias corrective osteotomy was needed in four and five patients needed lengthening of the Achilles tendon. These surgeons no longer recommend leg lengthening in Turner's syndrome.

Giving dexamethasone to small preterm babies in an attempt to prevent chronic lung disease may do more harm than good. In a multicentre American trial (New England Journal of Medicine2001;344:95–101), ventilated babies weighing between 501 and 1000 g were randomised to a moderate dose of dexamethasone (0.15 mg/kg/day for three days, gradually tapering off over the next seven days) or placebo. Mortality and the incidence of chronic lung disease were not significantly different between the two groups. Babies in the dexamethasone group were significantly less likely to be receiving supplemental oxygen or to be taking open-label dexamethasone at 28 days but gastrointestinal perforation in the first 14 days occurred in 13% (dexamethasone) v4% (placebo) and at 36 weeks postmenstrual age the dexamethasone group had lower weights and head circumferences than the control group.

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