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Oxpentifylline (penoxifylline) inhibits production of tumour necrosis factor and phosphatidic acid. In a randomised trial in Poland (Critical Care Medicine1999;27:807–14) 78 preterm babies with neonatal septicaemia diagnosed after the first week of life were given either oxpentifylline or placebo intravenously. One of 40 treated babies and 6 of 38 controls died. The clinical course was more severe in the placebo group.
A study of children after emergency surgery in Glasgow (British Journal of Anaesthesia1999;82:715–7) has shown that rectal diclofenac, but not paracetamol, significantly reduced the amount of morphine taken in patient controlled analgesia over the first 24 hours after surgery. Despite taking less morphine the children given diclofenac had better pain control.
A large population study of 5–11 year old children in England and Scotland (Thorax1999;54:476–81) showed that parents in an English representative sample were more likely than those in a Scottish representative sample or in an English inner city sample to report that their children had asthma attacks. In contrast the inner city children (selected for socioeconomic deprivation) were more often said by their parents to have persistent wheeze or cough. The authors interpret this as showing that severe asthma is related to deprivation.
A study at multiple centres in England and Scotland (International Journal of Epidemiology1999;28:281–6) showed that fewer 9 year olds from families of Indian subcontinent origin were able to complete a cycle ergometer test of physical fitness compared with those of other family backgrounds. The authors suggest that these children may take less exercise and be less familiar with cycling than other children. The difference was not explained by socioeconomic factors.
In a questionnaire study of Massachusetts high school students (mean age 16) 10% of the 80% responding reported at least one suicide attempt in the past year (Archives of Pediatrics and Adolescent Medicine 1999;153:487–93). Girls were more than four times as likely as boys to report such an attempt. Other risk factors were exposure to violence or victimisation, ethnicity (Hispanic), and drug use. Boys who gave their sexual orientation as gay, bisexual, or uncertain had an almost fourfold increase in risk but the same did not apply to girls independently of other risk factors.
In a multicentre US trial (New England Journal of Medicine1999;340:1962–8) intramuscular vitamin A 500 IU three times weekly for four weeks given to mechanically ventilated infants of mean birthweight 770 g and mean gestational age 27 weeks did not reduce mortality at 36 weeks’ postmenstrual age but did reduce the prevalence of chronic lung disease by 15% in survivors. Treating 15 such infants would result in one extra infant reaching 36 weeks’ postmenstrual age without chronic lung disease. The vitamin supplementation appeared to be safe.
It remains uncertain whether children with severe hypoglycaemia are at risk of permanent memory loss. In St Louis, Missouri, USA children with intensively treated diabetes had a threefold increase in risk of severe hypoglycaemia compared with children treated conventionally (Diabetes Care1999;22:1318–24). On testing some 2 years after the onset of their diabetes the intensively treated children performed less well than either conventionally treated children or non-diabetic controls on one of five tests of memory. In an editorial (Ibid: 1239–41) a psychologist questions whether impairment shown on only one test can be regarded as established impairment.
A US multicentre study involving 440 infants of HIV-1 infected mothers (New England Journal of Medicine1999;341:77–84) has shown that cytomegalovirus (CMV) infection is not just another opportunistic infection; the two infections appear to be synergistic. The rate of HIV-1 disease progression was much higher in doubly infected infants than in those with HIV-1 infection only (70%v 30% up to age 18 months) as was progressive brain disease (36% v 9%). It is important to develop ways of protecting these infants from CMV infection.
A case control study in North Carolina, USA (International Journal of Epidemiology1999;28:396–402) has added to the evidence that breast feeding protects against breast cancer. Women who had ever breast fed a baby had a 20% reduction in breast cancer incidence at ages 20–49 and a 30% reduction at ages 50–74. The number of children breast fed and the total lifetime duration of breast feeding did not affect the risk.
A retrospective survey of the practices of different surgeons at the Children’s Hospital in Houston, Texas, USA (Journal of Pediatric Surgery1999;34:959–61) showed that babies given ad lib feeds starting 4 hours after pyloromyotomy had slightly more postoperative vomiting than those given incremental feeds starting at least 8 or 12 hours after operation. They did, however, tolerate full feeds sooner and left hospital slightly earlier. Irrespective of the feeding regimen all babies did well after tolerating two consecutive full feeds and that was used as a discharge criterion.
Lucina remembers that the first suggestions that aspirin might be implicated in Reye’s syndrome were greeted with considerable scepticism by many people. Nevertheless the syndrome has almost disappeared from the United States since 1980 when the Centers for Disease Control and Prevention began to issue warnings about aspirin (New England Journal of Medicine1999;340:1377–82). That year 555 cases were reported but since 1994 there have been no more than two cases each year.
A community project in one of Chicago’s most notorious districts was made almost impossible by gang violence (Pediatrics1999;104:50–4). Eventually one brave mother was able to knock on enough doors to recruit enough controls for a study of the effect of a programme in which local adolescents gave lessons in non-violence to 7–13 year olds through games, rap songs, and sketches. The intervention apparently improved attitudes towards violence. Behaviour deteriorated in controls but not in children attending the programme.
In industrialised countries the rhesus rotavirus tetravalent vaccine is only some 50–70% effective in protecting against rotavirus disease. Now a US trial (Lancet1999;354:287–90) of a live, attenuated human rotavirus oral vaccine has shown 89% efficacy with two doses given to infants before the rotavirus season. The only significant adverse effect was low grade fever after the first dose, which occurred in about 20% of vaccinated children and 5% of controls.
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