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Transcervical intraamniotic infusion of saline (amnioinfusion) may not prevent meconium aspiration syndrome. In a multinational trial including 1998 women with thick meconium staining of amniotic fluid in labour (
) there were no significant differences between amnioinfusion and control groups in the rate of the composite primary outcome (perinatal death, moderate or severe meconium aspiration syndrome, or both). The rates of each separate outcome and of caesarean section were also similar in the two groups. These researchers conclude that amnioinfusion should not be used to prevent meconium aspiration syndrome in centres with standard peripartum surveillance.
Daily supplementation with zinc prevents pneumonia and diarrhoea among young children in developing countries. Now researchers in Bangladesh (
) have assessed the use of weekly supplements. The trial included 1665 children aged between 60 days and 12 months who were randomised to zinc (70 mg of zinc acetate) or placebo, once weekly for 12 months. Zinc supplementation significantly reduced the number of incidents of pneumonia (by 17%) and the incidence of diarrhoea (by 6%). Two children in the zinc group and 14 in the placebo group died. The authors of this paper suggest that compliance with a weekly regimen might be poor outside a clinical trial.
The Lancet has had it with homeopathy. In a recent paper (
) it was concluded that the effects of homeopathy, but not of allopathy (conventional medicine), may be placebo effects. The paper reported meta-analyses of 110 placebo controlled trials of homeopathy and 110 trials of allopathy matched with the homeopathy trials for type of disorder treated and of outcome measured. Smaller and lower-quality trials were more likely to give positive results and more of the homeopathy trials were of higher quality. Analysis restricted to higher-quality trials, however, showed a non-significant 12% beneficial effect for homeopathy and a significant 42% beneficial effect for allopathy. Hardly the final coup de grace, but the Lancet ran an editorial under the heading “The end of homeopathy”, including a statement reprinted in large on the front cover, that “now doctors need to be bold and honest with their patients about homeopathy’s lack of benefit”. It will not be the end of homeopathy, of course. People have been shouting for more than a century and a half that the principles of homeopathy beggar belief [and they do] but it survives. William Osler in 1889 enjoined new medical graduates in Philadelphia to show equanimity and to “restrain your indignation when you find your pet parson has triturates of the 1000th potentiality in his waistcoat pocket”. Don’t shout at the parson then; but the theory is fair game.
Around 5% of 2 or 3 year old children begin to stutter but three quarters of them recover spontaneously. For children who continue to stutter treatment before starting school is considered important to prevent the stuttering becoming ingrained. The Lidcombe programme is a behavioural treatment provided by parents (under the supervision of a speech therapist) for preschool children. In New Zealand (
) 54 children with stuttering for more than 6 months were randomised to the Lidcombe programme or no treatment. After 9 months children in the treatment group stuttered significantly less than children in the control group ((1.5% vs 3.9%) of syllables stuttered). Treatment for stuttering should not be delayed unduly and should begin in the preschool years.
Dengue haemorrhagic fever is a viral disease that first appeared in Thailand 50 years ago and has since spread throughout Asia and South America. It mainly affects children and between 250 000 and 500 000 cases are reported to the WHO each year. Its chief features are vascular leakage and coagulopathy and the most severe form is dengue shock syndrome, which has a mortality rate of 1–5%. For this form of the disease WHO guidelines recommend fluid replacement with crystalloid solutions with later boluses of colloid as necessary. Research in Vietnam (
) has supported these guidelines. A total of 512 children were included in a trial of fluid therapies. Three hundred and eighty-three had moderately severe dengue shock (pulse pressure 10–20 mm Hg) and were randomised to Ringer’s lactate, 6% dextran 70 (a colloid), or 6% hydroxyethyl starch for initial fluid replenishment. One hundred and twenty-nine children had severe shock (pulse pressure 10 mm Hg or less) and were randomised to one or other of the colloid solutions. There were few differences in outcome between the different treatment groups. These researchers recommend Ringer’s lactate for initial resuscitation in moderately severe dengue shock syndrome. For patients with severe shock they use colloid solutions (they did not assess crystalloid) and prefer the starch because it was associated with fewer adverse reactions than the dextran.
Prescribing errors occur in about 1.5% of prescriptions for adults and may be more frequent with prescriptions for children. For research, an agreed definition of prescribing error is needed. Workers in London (
) have used the Delphi technique with a panel of doctors, pharmacists, nurses, risk managers, and others working in paediatrics. They accepted a definition of prescribing error that included the two factors, reduction in the probability of treatment being timely or effective, and increase in risk of harm. Failure to communicate essential information, transcription errors, and use of drugs, formulations, or doses inappropriate for the patient were considered prescribing errors: deviations from policies or guidelines, use of unlicensed and off-label drugs, and omission of non-essential information were not.
Benign acute childhood myositis has most commonly been associated with influenza B virus infection but often the cause has been unknown. In Edinburgh (
) four children presented in one week in February 2003. They were a girl aged 5 years and three boys aged 8, 8, and 9 years. All four presented to the emergency department with a history of fever, headache, and upper respiratory tract symptoms prior to the development of painful calves. Two recovered within 24 hours of presentation and two were well when seen after 1 and 2 weeks. All had raised serum creatinine phosphokinase concentrations at presentation (801, 325, 5647, and 457 units/litre) with rapid return to normal values. There was mild leucopenia at presentation and three children had borderline or slightly low platelet counts. All these abnormalities were transient. Serological testing showed evidence of recent respiratory syncytial virus infection in one child and of recent influenza B virus infection in another. There was influenza B virus infection in the community at the time but the four children lived in different areas of the city and went to different schools.