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Infantile acne is uncommon; only 29 children received this diagnosis at a Leeds dermatology clinic over a period of 25 years (
). The acne was mostly on the cheeks and the median age of onset was 9 months (range 6–16 months). It was assessed as mild in seven infants, moderate in 18, and severe in four. The type of acne was inflammatory (17), comedonal (5), mixed (5), and nodular (2). Mild acne responded well to topical treatment (retinoids, benzoyl peroxide, or erythromycin). Moderate acne was treated with oral erythromycin in addition to topical treatment. Two patients had erythromycin-resistant Propionibacterium acnes and responded to trimethoprim. Treatment lasted between 6 and 40 months. One child with severe acne was treated successfully with oral isotretinoin. Scarring occurred in five children.
What do human beings have in common with rabbits, and Californian sea lions? Well, they are all prone to preterm birth after exposure to DDT. Data from the US Collaborative Perinatal Project (
) show that the risk of preterm birth increases steadily with maternal serum concentration of the DDT metabolite, DDE. There is also a direct relationship between maternal serum DDE concentration and risk of being born small-for-gestational-age. DDT was banned in industrialised countries several decades ago (the US data are from births between 1959 and 1966) but is still used extensively for malaria control in developing countries.
Apart from known genetic cancer syndromes genetic factors seem relatively unimportant in childhood cancers. A study in the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) including data on 42277 siblings of 25605 children with cancer (
) showed no increase in standardised incidence ratio for cancer in the siblings after the exclusion of 56 families with genetic syndromes linked to cancer. About 40% of cancers in siblings before the age of 20 years could be explained by known genetic factors but there was no evidence that autosomal recessive genes made a significant contribution to other cancers in siblings.
Women who were abused as children are more likely to suffer from depression as adults. A Boston, Massachusetts case-control study (
) included 236 women with current or past depression and 496 controls. The risk of depression was doubled in women who reported abuse in childhood or adolescence (relative risks: any abuse 2.5, physical abuse only 2.4, sexual abuse only 1.8, sexual and physical abuse 3.3). The risk of depression increased with the severity of the reported abuse.
Opioids, both endogenous and administered, are important in the production of postoperative ileus. A new opiate receptor inhibitor under investigation, ADL 8-2698, is poorly absorbed when given orally and does not readily cross the blood-brain barrier: it should, therefore, reduce the gastrointestinal effects of opioids without antagonising the analgesic effect. A study in adults undergoing major abdominal surgery (
) has shown that the drug reduces the duration of postoperative ileus without increasing the need for morphine.
People with autism have difficulty with facial interactions. Now research in California (
) has shown abnormal brain processing on face perception tasks. On functional MRI imaging all of eight normal adult control subjects showed maximal activation in the fusiform gyrus on face processing whereas in seven adults with autism maximal activation was at other sites including the frontal cortex and primary visual cortex but different for each individual. Activation in the fusiform face area was weak or absent in autistic subjects.
Preterm infants may benefit from receiving nutrient-enriched formula after going home. In Cambridge, Leicester and Nottingham (
) 229 preterm infants were randomised at hospital discharge to standard term formula or a postdischarge formula (PDF) with extra protein, energy, mineral, and micronutrient content. Children in the PDF group were heavier at 9 months and heavier and longer at 9 and 18 months. The effect on growth was greater in boys. There was a trend towards better motor development in the PDF group. A breastfed group of 65 infants grew less well than the PDF group.
Slipped upper femoral epiphysis is classified as unstable if there is sudden onset of severe pain which precludes walking. The risk of avascular necrosis is high with unstable slips. In a study in the south of England (
) 14 of 100 slips were unstable and they were reduced and stabilised within 24 hours of the onset of severe symptoms. Four of the 86 stable hips developed avascular necrosis but none of the 14 unstable hips did so. Early reduction and stabilisation of unstable slipped upper femoral epiphyses may prevent avascular necrosis.
In Madrid (
) eight children (mean age 9 years, 6 boys) presented with acute food bolus impaction in the lower oesophagus. All had evidence of longstanding gastrooesophageal reflux with oesophagitis but no stenosis and six had increase peristaltic activity in the distal oesophagus after nocturnal reflux. Endoscopic removal of the food bolus, was performed on several occasions in six patients. On follow up all improved on cisapride and an H2-receptor blocker but four needed fundoplication.
Infants who live on farms are less likely to develop atopic diseases in childhood. A study in rural Austria, Germany, and Switzerland (
) has related this protective effect to exposure to stables and to farm (often unpasteurised) milk in the first year of life. Asthma developed in 1% of children exposed to both stables and farm milk in infancy, 11% of children exposed to either or both after infancy, and 12% of children never exposed. Atopic sensitisation occurred in 12%, 29%, and 33% respectively. The mechanism of protection is unknown but it is suggested that the important factor might be exposure to bacteria or bacterial products with promotion of Th1 rather than Th2 immunity.
Maternal mental health in pregnancy is important for the wellbeing of the fetus and newborn baby. Stress or anxiety in pregnancy has been associated with poor fetal growth, preterm delivery, and increased use of epidural analgesia. Now a study of 959 pregnant women in Hong Kong (
) has shown that depression in late pregnancy significantly increases the risk of epidural analgesia (33% v 19%), caesarean section or instrumental vaginal delivery (39% v 27%), and admission to the neonatal care unit (24% v 19%).
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