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Optic disc morphology in children may give information about the timing of periventricular white matter damage. In Sweden (
) 35 children aged 4–11 (median 7 years, 21 boys) with MRI or CT evidence of periventricular white matter damage on scans taken at age 4 years or older had fundus photography with digital image analysis. These children’s optic discs had a large cup area and a small neuroretinal rim area compared with 100 healthy control children born at term. An attempt was made to assess the timing of the periventricular lesions from the site of white matter loss (anterior lesions suggesting periventricular haemorrhage probably occurred earlier (24–26 weeks of gestation) than posterior lesions suggesting periventricular leucomalacia (around 31 weeks)). On this basis 10 children were thought to have suffered white matter lesions before 28 weeks gestation and 25 after. Of the ten children with earlier lesions six had normally sized optic discs (two with large cup area) and four had small optic discs. All 25 children with later lesions had normal optic disc area, nine with large cup area. Thus nine of 11 children with a large optic cup area and all four with small optic discs had white matter lesions thought to have occurred before 28 weeks gestation.
There is uncertainty about whether air pollution increases the incidence of asthma or simply aggravates the symptoms of asthma. The Swedish BAMSE birth cohort includes 4089 children born between February 1994 and November 1996. Information about nitrogen dioxide (NO2) exposure (outdoors, mostly from traffic or fossil fuel power plants; indoors, mostly from gas burning appliances or tobacco smoke) was obtained for a nested case-control study of 540 children (
). The odds of recurrent wheezing during the first 2 years of life were increased by 60% in children in the top quartile for outdoor exposure to NO2 compared with children in the bottom quartile. For indoor exposure the increase in odds was 51%. Neither increase reached statistical significance but children exposed to both indoor NO2 and environmental tobacco smoke had a significant threefold increase in risk. Exposure to air pollution including NO2 may increase the risk of recurrent wheezing in young children, especially if they are also exposed to tobacco smoke.
Everybody knows that what everybody knows is often wrong. Everybody knows that President Franklin Delano Roosevelt was paralysed by poliomyelitis. Now a strong case has been made (
) for thinking that the illness he suffered in 1921 at the age of 39 was Guillain-Barré syndrome.
The theoretical basis of osteopathic manipulative treatment to prevent recurrent otitis media depends on there having been compression of the Eustachian tube between the temporal and sphenoid bones and surrounding muscles, presumably during birth, and the possibility of relieving this compression by manipulation. Many physicians find this implausible, but does it work? In a US multicentre study (
) children aged 6 months to 6 years with recurrent acute otitis media were randomised to osteopathic manipulation or no manipulation in addition to routine paediatric care. Over 6 months of treatment the osteopathy group had significantly fewer episodes of acute otitis media and fewer of them needed surgery. Final tympanograms were better in the treated group. The editorialist discusses methodological limitations of the study but implies that, at least, manipulation may be better than rushing into surgery, though effective reassurance and close follow up might achieve the same end.
For children with pre-school viral wheeze, a 5-day course of oral prednisolone started by parents is unlikely to be helpful. In Leicester (
) 217 children aged 1–5 years were randomised to parent-initiated prednisolone or placebo for their next episode after being admitted to hospital with viral wheeze. There were no significant differences between the groups in 7-day symptom scores or need for hospital admission during the next episode. Stratification of the children according to measures of eosinophil priming (serum concentrations of eosinophil cationic protein and eosinophil protein X) made no difference to the findings.
It has been thought that rotavirus infection is confined to the gastrointestinal tract but observations on animals and humans have now shown that it can, and does, enter the blood stream (
). All the animals tested (mice, rats, rabbits, and calves) had viral antigen in serum after rotavirus was put into their stomachs and infectious rotavirus or rotavirus RNA was found in mice and calf sera. Antigenaemia was demonstrated in 22 of 33 serum samples saved from children with proved rotavirus gastroenteritis and rotavirus RNA was detected by reverse transcriptase PCR in three of six antigen-positive sera.
Increasing rates of antibiotic resistance in pneumococci and the ravages of HIV infection have added to the urgency of developing better methods of pneumococcal immunisation throughout the world. Immunisation with 7-valent conjugate vaccine is effective but does not cover the important serotypes 1 and 5. Now a 9-valent vaccine including these serotypes has been evaluated in Soweto, South Africa (
). A total of 39836 children were randomised to receive either 9-valent vaccine (pneumococcal polysaccharide conjugated to a noncatalytic cross-reacting mutant of diphtheria toxin (CRM 197)) or placebo at 6, 10, and 14 weeks of age. All children received Hib vaccine. Among HIV-negative children vaccine efficacy (against invasive disease due to vaccine serotypes) was 83% and among HIV-positive children it was 65%. First episodes of radiologically confirmed pneumonia were reduced by 20% in HIV-negative children. Invasive pneumococcal disease caused by penicillin-resistant strains was reduced by 67% and that caused by trimethoprim-sulfamethoxazole-resistant strains was reduced by 56%. Hopes are high for this vaccine but it has not yet been licensed.
Occlusion of the fetal trachea might encourage lung growth by distending the fetal lung with fluid that can no longer escape. Animal experimentation and preliminary clinical data have suggested that this procedure might be useful for fetuses with severe congenital diaphragmatic hernia. A randomised, controlled trial in San Francisco (
) however, has shown no benefit. Twenty-four fetuses at 22–27 weeks gestation with severe left-sided diaphragmatic hernia (low lung-to-head ratio and liver herniation) were randomised to endoscopic emplacement of an endotracheal balloon or no antenatal intervention. Survival to 90 days after birth was achieved in 8/11 (73%) in the intervention group and 10/13 (77%) in the control group. Mean gestational age at delivery was 30.8 vs 37.0 weeks. Neonatal morbidity was similar in the two groups.
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