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In Vienna (
) simple vaginal smear screening for abnormal vaginal flora early in the second trimester of pregnancy, and subsequent treatment, reduced the preterm birth rate from 5.3% to 3.0%. The proportion of babies born both preterm and of low birthweight was reduced from 3.5% to 1.7%. An unexpected finding was that the improvements were associated with treatment of vaginal candidiasis rather than of bacterial vaginosis. Vaginal colonisation with candida has not been thought to increase the risk of preterm birth.
Mothers in a village in Gabon, Central Africa (
) considered “fever” and “malaria” to be synonyms. They believed that fever was of two types, natural and supernatural. Natural fever responded to conventional treatment but supernatural fever was a result of witchcraft and needed to be treated by a traditional healer (Nganga), who is both a herbalist and a witch doctor. Worryingly, it is believed that one way of distinguishing supernatural fever is that the child is sicker. Another distinguishing feature is failure to respond to medical treatment. Mothers might stop the treatment and consult a Nganga. The two types of fever could occur in the same child simultaneously.
Methods for promoting good teamwork and error avoidance have been developed in several industries and some may be useful in medicine. Researchers in the University of Texas (
) have modified a method used in the aviation industry (Line Operations Safety Audit, LOSA) to record team behavioural markers during neonatal resuscitation. They relied on neonatal professional focus groups, surveys of professional attitudes, and video recordings of neonatal resuscitations to develop a form (the University of Texas Behavioural Markers for Neonatal Resuscitation (UTBMNR) form) on which they recorded the observability and frequency of 10 behavioural markers on the video recordings. The ten behavioural markers were: information sharing, inquiry, assertion, verbalisation of intentions, teaching, evaluation of plans, workload management, vigilance/environmental awareness, teamwork overall, and leadership. Each behavioural marker is defined in the paper. Future research will aim to determine the relationships between these behavioural markers and the occurrence and management of errors in neonatal resuscitation.
A new genetic test could be used to diagnose, or to screen for, adult-type hypolactasia in children. Researchers in Finland (
) investigated 329 children and adolescents with abdominal complaints. Intestinal biopsies obtained at upper gastrointestinal endoscopy were assayed for lactase, sucrase, and maltase activities and genotyped by PCR minisequencing for a polymorphism in the lactase gene at chromosome 2q 21-22. (Genotypes C/T-13910 and T/T-13910 are associated with lactase persistence and C/C-13910 with adult-type hypolactasia). The prevalence of the C/C genotype was 37/252 (15%) among Finnish children, 9/12 (75%) among other white European children, and 62/65 (95%) among black African children. Almost all children with the CC genotype aged 8 years or older had very little lactase activity. Among children aged 12 years or older the C/C genotype was 93% sensitive and 100% specific for hypolactasia.
Data from New Zealand (
) have confirmed an association between antibiotic treatment in infancy and later asthma. It remains uncertain, however, whether the antibiotics interfere with the postulated effect of early infections in suppressing the development of atopy (the hygiene hypothesis) or whether children who are going to develop asthma are given antibiotics because their early atopic symptoms are misdiagnosed as infections. In the New Zealand study children who had notifiable infectious diseases before the age of 4 years and children in a general population control group had similar prevalences of current wheezing at age 6–7 years (23.5% vs 24.3%). There was also an association between paracetamol use and later wheezing.
The relationship between early allergen exposure and later atopy has been investigated in a birth cohort study in Ashford, Kent (
). Six hundred and twenty-five children were followed to the age of 5.5 years. Concentrations of house dust mite and cat fur allergens were measured in living room floor dust when the children were 8 weeks old and skin tests to the two allergens performed at the end of the study. There was no statistically significant relationship between 8-week allergen levels and 5-year skin test results or prevalence of atopic wheeze. On further analysis, however, there was an “arch-shaped-curve” relationship between the levels of housedust mite allergen and the later prevalence of skin test positivity to the same allergen or of atopic wheeze. End-point prevalence increased with increasing low-level allergen exposure, reaching a maximum at the second or third quintile of exposure, and then decreased at higher levels of exposure. This response profile was less clearly seen with cat fur allergen. First-born status and paternal atopy increased end-point prevalences at all levels of allergen exposure. These results suggest that reducing allergen exposure in infancy to moderately low levels may not result in a fall in the incidence of asthma and could increase it.
Exhaled nitric oxide concentration (FeNO) is thought to be a measure of airway eosinophilic inflammation. Forty four children aged 6–16 years attending a London hospital because of seasonal allergic asthma were studied before and during the grass pollen season (
). FeNO increased during the pollen season (median FeNO 9.2 parts per billion during the season vs 6.2 parts per billion before) and was associated with mean pollen count in the previous week and with severity of asthma symptoms. It is suggested that sequential FeNO testing might be better than lung function monitoring for asthma control and anticipation of exacerbations.
Routine suction applied to the mouth, nose, and throat of infants born through meconium stained amniotic fluid does not prevent meconium aspiration syndrome. In a trial in 11 hospitals in Argentina and one in the USA (
) a total of 2514 term infants with cephalic presentation and meconium stained amniotic fluid were randomised to suction or no suction before delivery of the shoulder. Meconium aspiration syndrome occurred in 4% of each group. There were no significant differences between the groups in need for mechanical ventilation, mortality, or duration of ventilation, oxygen treatment, or hospital stay.
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