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Children’s viral upper respiratory tract infections cause anxiety among parents and it is useful to know how long they usually last. In a multiple general practice study in south Wales involving children not given antibiotics (
) children had had symptoms for an average of 3 days before seeing their general practitioner. The rates of recovery (from the time of first consultation) were 25% at 2–3 days, 50% at 4–5 days, 75% at 7 days and 95% at 14 days.
After catheterisation of the femoral artery in neonates around 30–45% of arteries become occluded. A 4 French catheter has an external diameter of 2 mm but the diameter of neonatal femoral vessels is usually not more than 1.5 mm so the vessel is completely occluded by the catheter. Paediatric cardiologists in Paris (
) have used 3 French sheaths and catheters for diagnostic or interventional procedures in 15 infants (age 7 (1–180) days, weight 2.8 (2.0–4.0) kg). Diagnostic catheterisation provided the required information in all of 11 cases and interventional procedures were carried out successfully. There were no complications and follow up ultrasound scans showed no damage to the vessels. Using 3 French sheaths and catheters added about £16 to the cost of a procedure. There are still concerns about the quality of angiography and pressure measurements using 3 French catheters.
High heritability has been demonstrated for attention deficit hyperactivity disorder (ADHD). In Australia (
) a boy with ADHD and intellectual disability had a pericentric inversion of chromosome 3, 46N inv (3) (p14: q21). Ten of 21 family members tested also had the inversion, impulsive behaviour, and intellectual deficit. Further investigation showed that the inversion breakpoint on the short arm of chromosome 3 affected the dedicator of cytokinesis 3 (DOCK3) gene and the breakpoint on the long arm affected a new member of the solute carrier family 9 (sodium/hydrogen exchanger) isoform 9 (SLC9A9) gene. Both of these genes are expressed in the brain. It remains to be seen whether, or to what extent, these genes are involved in behavioural disorders.
Ophthalmologists in London (
) have used a contact digital fundus camera with a semiautomated analysis programme to study the principal temporal retinal blood vessels close to the optic disc in infants with and without retinopathy of prematurity (ROP). They analysed 52 images from 42 babies and found that the degree of arteriolar tortuosity near to the disc was significantly associated with the severity of ROP at the periphery of the retina. Increases in arteriolar or venular diameter with increasingly severe ROP were not significant. The associations were similar irrespective of gestational age. Digital imaging could increase the cost effectiveness of ROP screening and allow screening by non-ophthalmologists.
Parvovirus B19 causes erythema infectiosum, transient aplastic crises in bone marrow, arthritis, non-immune hydrops fetalis, and chronic pure red cell aplasia in immunocompromised subjects. In Manchester (
) parvovirus B19 DNA was detected soon after diagnosis in the cerebrospinal fluid of three out of 14 children with acute lymphoblastic leukaemia and one of two children with acute myelogenous leukaemia. None had evidence of infection or leukaemia in the CSF. All four parvovirus B19 DNA positive children carried at least one HLA-DRB-1 allele associated with symptomatic parvovirus B19 infection. CSF from 23 control children (10 with benign intracranial hypertension and 13 with hydrocephalus) did not contain parvovirus B19 DNA.
In Pittsburgh, Pennsylvania 833 liver transplant operations were performed on children between March 1981 and December 1998 (
). Sixteen of these operations were performed on 12 children with cystic fibrosis (mean age at transplant 10 years, 10 boys). Five of the 12 patients died at a mean of 6.8 years post-transplant (one within a month, two between 2 and 5 years, and two more at 10 years and 15 years post transplant). All five deaths were related to lung disease. Survival after liver transplantation was better for children with cystic fibrosis than for children without cystic fibrosis.
Tamoxifen may benefit girls with precocious puberty and McCune-Albright syndrome. In a multicentre US trial (
) 28 girls aged 2.9–10.9 years were enrolled and 25 completed 12 months treatment with tamoxifen. On treatment vaginal bleeding episodes were reduced from a mean of 3.4 to a mean of 1.2 per year and there were significant reductions in growth velocity and rate of advancement of bone age. Long-term data will be needed to establish the effectiveness and safety of tamoxifen for these girls.
There have been few studies of statin treatment for hypercholesterolaemia in children. A multinational study (
) has demonstrated the effectiveness and safety of atorvastatin. The randomised, placebo-controlled study included 187 subjects aged 10–17 years with familial or severe hypercholesterolaemia. Atorvastatin 10 mg daily (increased to 20 mg after 4 weeks if necessary) or placebo were given for 26 weeks after which all subjects received atorvastatin for the next 26 weeks. Plasma low density lipoprotein cholesterol concentrations were reduced by 40% in the atorvastatin group and by 0.4% in the placebo group. Treatment also produced significant reductions in concentrations of total cholesterol, triglycerides, and apolipoprotein B, and an increase in high density lipoprotein cholesterol concentration. The drug was well tolerated.
Most cases of diarrhoea-associated haemolytic uraemic syndrome follow infection with Shiga toxin producing strains of Escherichia coli. An agent that binds this toxin might, therefore, be a useful treatment. Shiga toxin is bound to endothelial cells by globotriaosylceramide. In a North American placebo-controlled, randomised trial (
) a binding agent (silicon dioxide particles linked to the trisaccharide moiety of the globotriaosylceramide molecule) was given orally to patients aged 6 months to 18 years with diarrhoea–associated haemolytic uraemic syndrome. It did not reduce the severity of disease.
The worldwide increase in childhood obesity has been accompanied by the emergence of type 2 diabetes as a paediatric problem. Researchers in New Haven, Connecticut (
) studied 28 obese children and adolescents, 14 with impaired and 14 with normal glucose tolerance. Impaired glucose tolerance was associated with reduced peripheral glucose disposal, increased fat within muscle cells, increased visceral fat, and less fat under the abdominal skin.