Exposure to tobacco smoke in the home in childhood may not only cause respiratory problems as a child, it may cause symptoms in middle and late adult life. In Singapore (Thorax 2005;60:1052–8) 35 000 people who had never smoked (77% women) were interviewed between 1999 and 2004 when they were aged between 51 and 80 years. Many (65%) of them reported exposure to tobacco smoke in the home as a child; 48% of their fathers and 19% of their mothers had been smokers. Such exposure was associated with a doubling of the likelihood of chronic dry cough that was still present. It was not associated with either asthma or chronic bronchitis (chronic cough with sputum) but was associated with reported sputum production without cough. The association with adult symptoms increased with increasing childhood exposure (number of smokers in the home) independently of exposure to environmental tobacco smoke as an adult.

A new system for the classification of stillbirth has been developed and tested in Birmingham (BMJ 2005;331:1113–7). The system uses nine groups (fetus, umbilical cord, placenta, amniotic fluid, uterus, mother, intrapartum, trauma, and unexplained) each with subcategories to a total of 37 causes of stillbirth based on relevant condition at death (ReCoDe). A total of 2625 stillbirths in the West Midlands region between 1997 and 2003 were classified using both ReCoDe and the classification currently used most often for national statistics (the Wigglesworth pathophysiological system). With the Wigglesworth system the most frequently used category was unexplained antepartum fetal death (66% of the stillbirths); others included congenital defect or malformation (15%) and intrapartum asphyxia, anoxia, or trauma (12%). Using ReCoDe the most frequently used categories were fetal growth restriction (43%), lethal congenital anomaly (15%), unclassified (15%), placental abruption (7%), intrapartum asphyxia (3%), fetal infection (3%), and umbilical cord constricting loop or knot (3%). The new system drastically reduces the proportion of stillbirths classified as unexplained and emphasises the importance of fetal growth restriction. It is hoped that this emphasis might stimulate research into, and improved management of, fetal growth restriction.

A cost effectiveness analysis of interventions aimed at achieving the United Nations millennium development goal 4 (reduction of mortality in children under 5 years old by two thirds between 1990 and 2015) has led to the conclusion that present interventions are not adequate to tackle the problem of malnutrition (BMJ 2005;331:1177–80). Of the interventions assessed, the most cost effective was food fortification with zinc and vitamin A. Oral rehydration therapy, case management of pneumonia, supplementation with zinc and vitamin A, and measles immunisation were of intermediate cost effectiveness and provision of supplementary food and nutritional counselling was the least cost effective intervention. All children in developing countries should receive micronutrients and measles immunisation routinely and treatment for pneumonia or oral rehydration therapy when they need them.

It is widely held, and a belief reflected in national and international guidelines, that ACE inhibitors and angiotensin-II receptor blockers (ARBs) have a kidney-protecting effect independent of their capability to lower blood pressure. Now a systematic review and meta-analysis of studies in adults (Lancet 2005;366:2026–33) has cast some doubt on the concept. Among patients with diabetes the renal protection afforded by these drugs was found to be no more than that associated with the use of other equally effective antihypertensive drugs. Among patients with non-diabetic renal disease ACE inhibitors and ARBs gave slightly greater benefit. Data for children were not included.

In the winter of 2003–2004 there were 153 reported deaths of children from laboratory-confirmed influenza in the USA (New England Journal of Medicine 2005;353:2559–67, see also perspective article, ibid: 2535–7). Almost all were due to influenza A (H3N2) virus. Sixty-three per cent of the children were aged under 5 years and 20% under 1 year. Mortality was highest among infants under 6 months old. Almost half (47%) of the children had previously been healthy; 33% had a chronic condition recognised to increase the risk from influenza, 20% had other chronic conditions, and 33% had a chronic neurological or neuromuscular condition. Only 16% of the children over 6 months old, and 26% of those with a recognised high-risk condition for which vaccination is recommended, had received influenza vaccine.

Your chances of surviving severe sepsis may depend on what type of mitochondrial DNA your mother gave you. The most common type in Europeans is haplotype H. Among 150 adult patients with severe sepsis in Newcastle upon Tyne (Lancet 2005;366:2118–21) the proportion with haplotype H (43.9%) was essentially the same as that in a group of 542 age-matched controls (44.4%). Possession of haplotype H more than doubled the likelihood of survival. The relevance of this to paediatric practice remains to be ascertained. An interesting observation is that patients with haplogroup H developed higher fever than other patients.

Data from the US Diabetes Control and Complications trial showed that intensive treatment to achieve strict control of blood glucose reduces the risk of nephropathy, retinopathy, or neuropathy in patients with type 1 diabetes. Now 17-year follow-up data (New England Journal of Medicine 2005;353:2643–53; see also editorial, ibid: 2707–9) have demonstrated that intensive treatment also reduces the risk of cardiovascular disease. The risk of any cardiovascular event (nonfatal myocardial infarction, stroke, death from cardiovascular disease, confirmed angina, or need for coronary artery revascularisation) was reduced by 42% with intensive treatment as opposed to conventional treatment; the risk of nonfatal myocardial infarction, stroke, or death from cardiovascular disease was reduced by 57%. The beneficial effect was related to decrease in glycosylated haemoglobin values. The editorialist points out that children and adolescents are the people most likely to benefit from the findings of this study but strict glucose control is difficult to achieve.