197 e-Letters

published between 2009 and 2012

  • Malaria is an important cause of encephalopathy in children.
    Kelsey DJ Jones

    The review on assessment and management of encephalopathy in children by Davies et al is welcome(1). However, it might have included specific consideration of risk of cerebral malaria. We recognise that providing an exhaustive list of potential causes of encephalopathy risks diverting attention from those that are most common. However, cerebral malaria, whilst rare in the UK, is one of the most important causes of childho...

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  • Wrong "small for gestational age" definition in indications for growth hormone therapy in children
    Gianluca Tornese

    Dear Editor,

    in his review on the indications for growth hormone therapy in children, Kirk states that "small for gestational age (SGA) is usually defined as a birth weight and/or length more than -2.5 standard deviation scores (SDS) below the mean", which correspond to the 0.4th centile (1).

    Battaglia and Lubchenco were the first to classify newborns as SGA (2), and until recentely, several definition...

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  • PICU Retrieval and sustainable staffing
    Iain D Macintosh

    Dr Ramnarayan is to be commended for his review of the state of paediatric intensive care retrieval(1) in the UK. I would share his view that the 'future of the specialty lies in developing a successful model for a sustainable workforce'. Each time a separate regional retrieval service is set up, 5 whole time equivalent consultant posts have to be funded and staffed. This is in addition to the consultant staff required...

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  • Improving diagnostics for rational antibiotic use in childhood pneumonia
    Adam D. Irwin

    The study of Grant et al exploring primary care antibiotic prescribing in children subsequently admitted with pneumonia is well considered and their findings thoughtfully discussed. They find little evidence of improved outcome in children who had received antibiotics prior to admission. A greater likelihood of focal changes on chest X-ray, or of peripheral leucocytosis -a poor indicator of severity of infection - in tho...

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  • Neonatologists as echo-technicians: a supervised model for echocardiography training in the NICU?
    Bharati Sinha

    Even though it has been more than a decade, since Dr Skinner and his team introduced echocardiography to the neonatologists, a formal training for the neonatologist to acquire this important skill is still shrouded in controversy. In the United States, echocardiography in the NICU is often performed by an echocardiography technician and the images remotely read by the cardiologist. A model for a more supervised echocardi...

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  • Re:Please correct me if I am wrong ...
    Edward Purssell

    Thank you for taking the time to respond to the paper. What we need to be quite clear about is the purpose and safety of this therapy. Antipyresis is not a necessary outcome, we know that many parents worry a lot about fever and this is a fear that is shared by quite a lot of parents. We also know that we have two very good drugs, which are generally very safe.

    By combining drugs we are saying to parents f...

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  • Breastfeeding linked to language development and to head circumference at birth
    Sergio Verd

    Dear Editor, it is with great interest that we read the paper by Whitehouse et colleagues (1) on positive associations between small head circumference at birth and specific language impairment (SLI). They point out that their findings are consistent with the notion that atypical brain development in SLI may commence prenatally. This is a case-control study. Matching criteria for SLI cases were maternal race, sex, gestati...

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  • anecdotal evidence should provisionally inform clinical practice
    oscar,m jolobe

    Notwithstanding the statement made in the recommendation made by the Italian Pediatric Society Guidelines that "paracetamol and ibuprofen are generally well tolerated[as antipyretics]...when used at the recommended dosage"(1), and also notwithstanding the fact that "there are few data regarding toxicity[of either ibuprofen or paracetamol]..." and that "no conclusions can be reached regarding safety of any treatments"(2),...

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  • Omission of relevant systematic review
    Morag K Heirs

    Dear Editors,

    I would like to draw the authors' attention to an eligible systematic review which was not included in their critical overview. Our systematic review of homeopathy for ADHD has been published in the Cochrane Library for some years and is indexed on Medline: Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005648. Homeopathy for attention deficit/hyperactivity disorder or hyperkinetic disorder.


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  • Statistical vs. Clinical Significance
    Anton R Miller

    The interesting and well-conducted study of Potijk et al reminds us once again (though we probably don't need reminders) of the important difference between statistically versus clinically significant differences in research studies. The authors report that moderately preterm-born children had significantly worse scores on all subscales of the CBCL than did term born children; inspection of the P values in Table 2 shows t...

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