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Children are exposed to nitrogen dioxide (NO2) from gas cooking appliances in the home and from vehicle exhausts. In Southampton (
) 114 children aged 8-11 years with asthma were studied for up to 13 months. Individual weekly exposure to NO2 was measured using diffusion tubes worn by the child during the day and kept in the bedroom at night. High personal NO2 exposure in the week before onset of viral upper respiratory tract symptoms was associated with more severe virus-induced exacerbations of asthma and this increase in severity was particularly marked for respiratory syncytial virus infections. The higher levels of NO2 exposure mostly remained within current standards for air quality. It was thought unlikely that other, unmeasured, air pollutants could be responsible for these findings.
There is uncertainty about the best policy for the visual screening of young children. A systematic review in 1997 led to the conclusion that pre-school screening could be discontinued and that has been done in some places. It has been proposed that children should be screened by orthoptists at school entry. Data from the Avon Longitudinal Study of Parents and Children (
) has confirmed that treatment of amblyopia is more successful in children screened at 37 months than in children not offered pre-school screening. The improvement, however, was small and not seen on intention to screen analysis. The authors of this paper conclude that their results are consistent with school entry screening by orthoptists being the current “best buy”. They add, though, that improved screening methods might eventually make screening at 2-3 years worthwhile.
There is evidence that throughout the world as a whole low family income affects the health of children more than that of adults. But the effect of changes in family income in high-income welfare states is uncertain. In Sweden (
) economic recession in the early 1990s resulted in a doubling of the proportion of families with children who were living on a low income. During this period child mortality fell progressively and rates of low birth weight, abortion, accidental injury, and hospital admission for infections or asthma/allergic disorders in children did not change significantly. Furthermore, the recession had no consistent effect on the relative values of these health indicators in districts of high and low social deprivation. In high-income countries with well developed welfare systems children may be protected from the health effects of economic downturns.
A more conservative approach to surgery is often recommended for children with Hirschsprung’s disease who also have Down’s syndrome. A report from Pittsburgh, Pennsylvania (
) includes nine children with both conditions and 57 with Hirschsprung’s disease alone. Coexisting conditions were present in seven of the nine children with Down’s syndrome (four with heart disease) and nine of the 57 other children. Three children with Down’s syndrome and one other died after surgery but on postoperative follow up for an average of 22 months the groups had similar rates of enterocolitis and other complications. These authors suggest that a diagnosis of Down’s syndrome should not contraindicate a pull-through procedure unless there is associated severe cardiac disease.
Plastic surgeons in Milwaukee (
) have advised against the practice of removing pedunculated supernumary digits in infants by simple suture ligation. Instead, they excise the lesions, being careful to identify the nerve supply to the accessory digit and allowing the nerve to retract into the surrounding soft tissue after transection. They claim that this prevents the formation of painful and unsightly amputation neuromas which sometimes follows suture ligation.
Human metapneumovirus (hMPV) was first described as a respiratory pathogen in children in the Netherlands in 2001. Since then hMPV respiratory infection has been reported in Australia, Canada, and the UK. A recent study (
) has shown that it also affects children in the USA. In New Haven, Connecticut respiratory specimens from children under 5 years old that were negative for respiratory syncytial virus, influenza A and B, para influenza 1–3, and adenovirus on direct fluorescent antibody testing were tested for hMPV by reverse transcriptase-polymerase chain reaction. Over a 4-month period in the winter of 2001–2002 357 specimens were tested from 296 children and 20 specimens from 19 children were positive for hMPV. The children had presented with upper respiratory tract symptoms. No specimens from asymptomatic children were tested.
The diagnosis of McCune-Albright syndrome (characteristic clinical triad, polyostotic fibrous dysplasia of bone, café au lait spots, and endocrinopathies) may be missed in children who present with the bone disease. In Indianapolis (
) nine children who were attending a paediatric orthopaedic clinic because of monostotic or polyostotic fibrous dysplasia of bone were investigated. Five of them had café au lait spots and, of these five, one 7-year old boy had hyperthyroidism and one 14-year old girl had precocious puberty. Mutations in the McCune-Albright gene (GNAS1) were found in the blood of four patients and in thyroid tissue only in the child with hyperthyroidism. Children with fibrous dysplasia of bone should be assessed for evidence of McCune-Albright syndrome.
Adult patients posing as children could be a danger on children’s wards. At a district general hospital in London (
) two 21-year olds, one male and one female, were admitted to the children’s ward within a week of each other. Both gave their age as 15 years, asked that their families should not be informed, and had a history of mental illness. Their motives were unknown. Little is known about the frequency of this phenomenon and how big a threat it poses but the authors of this paper conclude that “professionals should be aware”.
Patients with facial port wine stains often develop glaucoma the management of which may be difficult. The prostaglandin F2a analogue, latanoprost, lowers intraocular pressure by increasing uveoscleral outflow. At Great Ormond Street Hospital (
) 14 children (17 affected eyes) with port wine stain related glaucoma (nine with isolated port wine stain, four with Sturge-Weber syndrome, and one with cutis marmorata telangiectasia congenita) were treated with latanoprost. All had had previous medical treatment for glaucoma and some had had surgery. One year after starting latanoprost ocular parameters had stabilised and there had been no need for further medical or surgical treatment in half of the patients.
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