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A charity founded mainly by German dermatologists has provided funding for 30 community health workers who examine about 30 000 children a year in rural Kenya, looking for skin diseases and providing cheap or free treatment (British Journal of Dermatology2001;144:118–24). They provide 1% hydrocortisone cream for dermatitis, 1% gentian violet for bacterial infections, Whitfield's ointment for fungal infections, and 25% benzylbenzoate emulsion for scabies. Disappointingly, surveys carried out 1 year and 5 years after the start of the project showed little change in prevalence of dermatoses, in fact the prevalence of all dermatoses increased from 32% to 40%. Only tropical ulcers became significantly less common (1.2% in 1993, 0.1% in 1999). Flooding, cholera, and a teachers' strike all interrupted the project in 1998. As the authors point out, treatment schemes in rural Africa are very vulnerable to socioeconomic change.
General practice researchers in Australia (British Journal of General Practice 2001;51:112–6) and England (Ibid: 117–20) used a computer questionnaire (Australia) and a postal questionnaire (England) to identify children with asthma. The computerised system was found to give reliable results and the postal questionnaire identified asthma in 23% of children and more severe asthma in 16%, of whom 35% and 25% had no indication of asthma in their general practice records. Nevertheless, an editorialist (Ibid: 92–3) commenting on active case-finding in childhood asthma writes, “On the currently available evidence, it is difficult to justify the resources that such a change in practice would involve”.
Recombinant granulocyte colony-stimulating factor given intravenously to 22 preterm infants with suspected sepsis in Brazil (Pediatrics2001;107:30–5) did not affect mortality but was associated with fewer nosocomial infections in the next two weeks. In Turkey (Ibid: 36–41) recombinant human granulocyte-macrophage colony-stimulating factor given to 30 neonates with neutropenia and clinical sepsis was associated with increased neutrophil, eosinophil, monocyte, lymphocyte, and platelet counts and reduced mortality (10%v 30% in controls).
Idiopathic hyperuricosuria (high urinary uric acid concentration (corrected for creatinine clearance) with normal serum uric acid concentration) was diagnosed in 102 children in Naples (Pediatrics2001;107:86–90). Forty-one also had hypercalciuria. The most common presenting symptoms or findings were microscopic haematuria on routine testing (26) and abdominal or flank pain (25). Microscopic haematuria was a more common presentation in those with hyperuricosuria alone; otherwise there was no significant difference in presenting symptoms between the two groups. On ultrasonography 53% had renal microlithiasis and 12% renal stones. Seventy-five per cent had a first- or second-degree family history of renal stones. Of children without haematuria at presentation 77% had calculi or microcalculi. Hyperuricosuria, with or without hypercalciuria, should be suspected in children with dysuria and those with recurrent abdominal or flank pain, with or without haematuria, especially with a family history of urolithiasis.
Urinary fluorescence on examination with a Wood's lamp has been suggested as a quick test for ethylene glycol ingestion. In Columbus, Ohio (Pediatrics2001; 107:113–4) all of 46 urine specimens from non-poisoned children were considered fluorescent by at least one observer. Twenty-one of 30 hospital specimens were considered fluorescent by all of three observers and 11 of 16 community specimens were considered positive by both of two observers. Fluorescence of children's urine under a Wood's lamp is normal.
In Finland, between 1982 and 1996 (Pediatric Infectious Disease Journal2000;19:1127–34), 1.8 million children received almost 3 million doses of MMR vaccine. A nationwide surveillance system revealed 173 serious postvaccination events of which 78 were considered to have causes other than the MMR vaccination. Of the 95 serious events possibly related to MMR, 46 were classified as allergic, 43 as neurological (including 28 reports of febrile convulsions), and six as “miscellaneous” (five with pneumonia). No case of MMR-associated autism was detected. The rate of serious events possibly related to MMR was 3.2 per 100 000 doses or 5.3 per 100 000 children vaccinated.
After almost half a century the Apgar score is still being proved useful. In Dallas, Texas between 1988 and 1998 (New England Journal of Medicine 2001;344:467–71) an Apgar score of between 0 and 3 at 5 minutes was associated with much the same neonatal mortality as an umbilical artery blood pH of 6.8 or less and, in term infants, with eight times the neonatal mortality associated with a pH of 7.0 or less. The neonatal death rates associated with 5 minute Apgar scores of 0–3, 4–6, and 7–10 were 244, 9, and 0.2 per 1000 in term babies and 315, 72, and 5 per 1000 in preterm babies.
Not only is it good to be breastfed but it is good to have been breastfed. Two hundred and sixteen of a total of 926 children who, as preterm babies, had taken part in two parallel UK trials of infant feeding (bank breast milk v preterm formula, and term v preterm formula) had their blood pressures measured at age 13 to 16 years (Lancet2001;357:413–9; see also commentary, Ibid: 406–7). There were no significant differences in blood pressure between the two groups of the second trial, but in the groups from the first trial those who received breast milk had lower blood pressure in adolescence than those who received preterm formula (mean mean arterial pressure 81.9 v 86.1 mm Hg, mean systolic pressure 113.6 v 116.3 mm Hg, mean diastolic pressure 61.9 v 65.0 mm Hg). What it is about formula milk that leads to higher blood pressure in later life is not known.
In American infants given an oral rotavirus vaccine at 2, 4, and 6 months (New England Journal of Medicine2001;344:564–72) the risk of intussusception in the period 3 to 14 days after the first dose increased 22-fold. The vaccine was withdrawn in the USA but in countries with a high mortality from rotavirus infection the benefit might still outweigh the risk.
Whether eating a lot of carbohydrate makes people overweight is debated but there is some evidence that you are more likely to compensate by eating less at the next meal if you take in your food energy in solid form rather than as liquid. This may, in part, explain why the body mass index and weight gain of 11 to 12 year olds in Boston, Massachusetts (Lancet2001;357:505–8; see also commentary, Ibid: 490–1) was related to their intake of sugar-sweetened cold drinks. However, as 27% of them were obese at the start of the 19 month study they may have been predisposed to react in this way.
Research in Quebec (Lancet2001;357:582–6) has shown that hyperbaric oxygen treatment is no better than slightly pressurised air in treating children with cerebral palsy. A total of 111 children aged 3–12 years were randomised to 40 one hour sessions of hyperbaric oxygen over eight weeks or a similar course in which they were exposed to air at just enough pressure to feel it. Both groups improved but there were no intergroup differences as regards gross motor function, activities of daily living, attention, memory, or speech. The researchers consider it unlikely that both treatments were effective.