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An American trial of a non-Fc-receptor-binding antiCD3 monoclonal antibody given within 6 weeks of the onset of type 1 diabetes (
; see also commentary, ibid: 1740–2) included children as young as 7 years and the median age was 13 in the treated group and 16 in the control group. The antibody treatment reduced or reversed the fall in insulin production in the first year in nine of 12 patients and treated patients had lower glycosylated haemoglobin concentrations and needed less insulin.
The nucleoside analogue lamivudine may provide some benefit for children with chronic hepatitis B. In a multinational trial (
) virological response at 52 weeks was achieved in 44 (23%) of 191 children treated with oral lamivudine and 12 (13%) of 95 given placebo. This response rate is similar to that reported in a previous trial of interferon in children.
Death is rare in children and young people with epilepsy but no other neurological abnormality. In Nova Scotia (
) 26 of 692 children who developed epilepsy between 1977 and 1985 died up to 1999. Twenty-two of these deaths occurred in the 101 patients with severe neurological deficit. Their median age at death was 10 years (1–29 years) and causes of death included pneumonia, sepsis, pulmonary embolism, heart failure, and gastrooesophageal reflux. Only one of these patients died in status epilepticus. The four patients who died from the group of 591 without severe neurological deficit were older (18–30 years) and three died a violent death (two suicide, one homicide). The fourth was a young woman with tuberous sclerosis who died of probable “sudden unexpected death in epilepsy”.
Young children with personal or parental atopy have impaired lung function. In Manchester (
) whole-body plethysmography was used to measure specific airway resistance (sRaw) in 503 asymptomatic 3-year-olds. Mean sRaw was significantly higher in children who had ever wheezed, children with two atopic parents, and children who were themselves atopic.
Most cases of congenital neurosyphilis can be diagnosed with a combination of physical examination, radiological studies, and conventional tests on cerebrospinal fluid (CSF)). In Dallas (
) such tests proved 94% sensitive, 61% specific, and had a positive predictive value of 41% when measured against rabbit-infectivity testing of CSF. Sixteen of 17 infants with no prior exposure to antibiotics and a positive rabbit-infectivity test for Treponema pallidum in CSF had some abnormality on conventional assessment. Only one of 51 clinical normal children of mothers with syphilis during pregnancy not previously exposed to antibiotics had a positive CSF rabbit-infectivity test. In a few cases other tests such as IgM immunoblotting and PCR assay for T pallidum DNA in blood and CSF may be necessary to make the diagnosis.
Preoperative ultrasound examination is a guide to what would be found at operation in children with inguinal hernias. In Israel (
) the ultrasound findings were compared with the findings at operation in 642 children (1284 groins). Operative findings and width of the inguinal canal at ultrasound correlated as follows: normal inguinal canal—ultrasound width 3.6 ± 0.8 mm, patent processus vaginalis—4.9 ± 1.1 mm, hernia—7.2 ± 2.0 mm, large hernia—12.8 ± 3.6 mm, hydrocoel—4.8 ± 2.2 mm. The findings might be useful in deciding whether to explore the contralateral groin.
The infants of mothers who smoke during pregnancy are smaller at birth than the infants of nonsmoking mothers. Data from the 1958 British birth cohort, however, (
) have shown that such infants, although smaller at birth, are more likely to be obese in adult life. This increased risk started at adolescence and the risk of being obese at the age of 33 was increased by 56% in the sons and by 41% in the daughters of women who smoked in pregnancy.
When a neonate vomits bile the likely diagnosis is intestinal obstruction. This dictum has been passed down for almost 50 years and it is a good one. But not all neonates with bilious vomiting have intestinal obstruction. In Leeds (
) 63 neonates (gestational ages 31–42 weeks, median 40 weeks) presented with bilious vomiting to a paediatric surgical unit over a period of 2 years. A surgical cause was found in 24 (Hirschsprung’s disease 9, small bowel atresia 5, intestinal malrotation 4, meconium cleus 3, meconium plug 1, colonic atresia 1, milk inspissation 1). Nineteen of these infants had abnormal findings both on clinical abdominal examination and on abdominal x ray, four had an abnormal x ray without clinical abnormality, and one (with intestinal malrotation) was normal both clinically and on plain x ray. The 39 infants with no surgical cause for their bilious vomiting were all term infants and their symptoms resolved spontaneously. Thirty-one had no symptoms on follow up, four had gastro-oesophageal reflux, three had mild constipation but not Hirschsprung’s disease, and one was lost to follow up.
Preliminary evidence has suggested that combination antiretroviral treatment in pregnancy might increase the risk of preterm delivery. A combined analysis of seven US studies including 3266 HIV-positive women (
) has shown no association between combination antiretroviral treatment, either with or without a protease inhibitor, during pregnancy and preterm delivery, low birthweight, low Apgar scores, or stillbirth. More data are needed to confirm or refute a possible association between combination treatment including a protease inhibitor and very low birthweight.
Zinc deficiency is common in young children in developing countries and zinc supplementation reduces the incidence of pneumonia and of diarrhoea. A meta-analysis of 33 randomised controlled trials (
, see also editorial, ibid: 957–8) has shown that zinc supplementation is very effective in increasing serum zinc concentrations and in promoting growth in height and weight. Zinc supplementation for young children in developing countries is beset with practical difficulties. Fortification of complementary foods, either by mothers in the home or industrially, is thought to hold most promise and needs detailed evaluation.