492 e-Letters

published between 2005 and 2008

  • Assessment of growth
    David M Hall

    The paper by Lek and Hughes highlights a serious deficiency in the assessment of children admitted to their hospital and there is no reason to think that their findings are atypical. However, there are two important issues arising from their work.

    First, the authors failed to define good practice. Is it realistic to expect specialist surgeons to measure a child’s height and weight in their outpatient consul...

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  • Let the owner decide the fate of his foreskin.
    Michael Glass

    It is simple to present male circumcision as the scientific and sensible thing to do. Indeed, the foreskin is one of those parts of the body, like wisdom teeth and the appendix, that seem to be ripe for the plucking.

    However, those who argue both for and against circumcision are likely to overstate their case. Guy Cox pointed out that some people have religious and philosophical objections to circumcision. How...

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  • Risk of ritual circumcision is unproven
    Michael A Weingarten

    Prais et. al. present data showing an odds ratio of 2.8 for hopitalization for urinary infection after circumcision by a traditional mohel as compared to a medical practitioner. The 95% confidence interval includes 1 and the p value is 0.06. The authors, admitting that the results do not reach statistical significance, suggest that a larger study would strengthen the finding. They do not admit that a larger study might e...

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  • Factors related to weight gain at 3 years.
    Carol A Walshaw

    Dear Editor

    Griffiths et al have studied conditional weight gain from birth to the age of 3 years in babies from the Millennium Cohort Study and drawn conclusions concerning the effect of breastfeeding on this weight gain.1

    However there are potential confounding factors that they have not accounted for.

    Weight must be clearly related to height. The authors report weight (z score) at age 3 co...

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  • A Supplemental Nursing System for the Prevention of Neonatal Hypernatremic Dehydration
    Michael L Moritz

    Leven and Mcdonald (1) report on the common occurrence of neonatal hypernatremic dehydration in breastfed infants and how early weighting is an effective means of detecting this condition. Studies of this type are the “tip of the iceberg” of much bigger problem, that of insufficient lactation in primiparous women. It is well recognized that primiparous woman produce less milk than multiparous and that 16% of exclusivel...

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  • Consent from both parents is ethically required
    David J. Llewellyn


    This is a timely and important article. Pretermitting whether parental consent can ever be valid for non-therapeutic surgeries on minors, certainly Mr. Wheeler is correct that at the very least the permission of both parents should be necessary for the circumcision of a male child. Too often here in the U.S. the matter ends up in court. I have been involved in one way or another in seven such cases in t...

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  • Re: Non therapeutic treatment on the NHS?
    Guy C Cox

    There is a curious paradox in this debate. Male circumcision is, like immunisation, prophylactic medicine. Its benefits (protection against UTIs, HIV, balanitis, phimosis and penile and cerivcal carcinoma) are well established. The risks of circumcision are lower than those of most immunisations, and in at least some cases (where the diseases in question are now rare) its benefit is greater.

    Yet if a parent's religiou...

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  • Efforts to reduce the gap between research and practice: the Italian experience
    Maurizio de Martino

    Efforts to reduce the gap between research and practice: the Italian experience

    Elena Chiappini (1), Filippo Festini (1), Riccardo Longhi(2), Franscesca Bonsignori (1), Maurizio de Martino (1)

    (1)Department of Paediatrics, University of Florence, Italy (2)Department of Paediatrics, Sant’Anna Hospital, Como, Italy

    Key words: fever, antipyretics, guidelines

    Corresponding author: Prof. M...

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  • Is the evidence regarding fever management up to date?
    Jillian L Sussens

    We read with interest El-Radhi’s article on the management of fever and whilst we agree that fever is a very common complaint a more recent paper by Armon et al showed that the most common medical presenting complaint to a UK paediatric emergency department was breathing difficulties (31%). Febrile illness was the second most common of medical ED attendances (20%) with similar figures demonstrated in other contemporary...

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  • Response to eletter by Alessandro Amaddeo et al
    David A Spencer

    We thank Amaddeo et al for their comments regarding our follow-up study of children hospitalised with community-acquired pneumonia (CAP) 1. They are correct in stating that Castro-Rodriguez et al postulated that diminished lung function in children following CAP may be due to a pre- existing alteration in airway tone, however this is only one of the possible explanations offered by the authors 2. The second explanation is...

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