SERUM RETINOL-BINDING PROTEIN AND VITAMIN A LEVELS IN MALNOURISHED CHILDREN

Abstract. Reddy, V., Mohanram, M. and Raghuramulu, N. (National Institute of Nutrition, Hyderabad, India). Serum retinol-bindin protein and vitamin A levels in malnourished children. Acta Paediatr Scand 68: 65, 1979.—Serum levels of vitamin A and retinol-binding protein (RBP) were measured in children with vitamin A deficiency, in children with protein-energy malnutrition (PEM) and in normal children, before and after administration of 100000 IU of water-miscible vitamin A. Serum vitamin A and RBP levels were significantly low in children with vitamin A deficiency and in children with severe PEM, whereas the values in milder grades of PEM were similar to those of normal subjects. In severely malnourished children with corneal lesions, serum vitamin A concentration was reduced to a much greater extent than the level of serum RBP. Administration of vitamin A resulted in a significant increase in serum levels of both the components within 4 hours in all the 3 groups of children. The increase in RBP concentration observed in children with PEM was similar to that in vitamin A deficient children. These results indicate that in malnourished children, particularly in those who are at risk of developing keratomalacia, vitamin A is the main limiting factor. It is, therefore, recommended that children with PEM should be treated with vitamin A in addition to dietary protein and calories.     

LONG-TERM EFFECTS OF CHEMOTHERAPY ON DENTAL STATUS IN CHILDREN TREATED FOR NEPHROBLASTOMA

Dental abnormalities among children treated at a young age for Wilms tumor are reported. The authors retrospectively reviewed the dental records and panoramic radiographs of 27 children treated for nephroblastoma between 1994 and 1998. They evaluated the frequency of apparent microdontia, excessive caries, root stunting, hypodontia, and enamel hypoplasia and compared this group to a control group of 78 children. Seventy percent of the children developed dental abnormalities, comprising root stunting (44%), enamel hypoplasia (22%), microdontia (18%), and hypodontia (7%). Results of control subjects were significantly different regarding dental abnormalities, especially microdontia and taurodontia. These results indicate that chemotherapy in children may lead to troubles affecting teeth growing at the time of treatment. Information and prospective dental care are needed, and further investigations are required.     

AMYLASE CONTENT OF MIXED SALIVA IN CHILDREN

Abstract. Rossiter, M. A., Barrowman, J. A., Dand, A. and Wharton, B. A. (Queen Elizabeth Hospital for Children, Hackney Road, London E.2 and the London Hospital, Whitechapel, London, E.l., England). Amylase content of mixed saliva in children. Acta Paediatr Scand, 63: 389, 1974.–Salivary amylase levels were determined in normal subjects from birth until adult life and in children with conditions sometimes associated with low pancreatic amylase such as malnutrition, coeliac disease and cystic fibrosis. Mixed saliva was collected under carefully standardised conditions and amylase was measured by the method of Dahlqvist. There was a wide scatter of values in the 84 normal subjects, but concentrations rose from very low levels at birth to reach adult levels by the age of 6 months to 1 year. Salivary amylase activity rose normally over ten weeks in one premature infant fed milk by gastrostomy. Thirteen children with coeliac disease and 9 children with cystic fibrosis mostly had normal salivary amylase concentrations. Six out of 12 malnourished children with jejunal villous atrophy of uncertain aetiology had low levels which rose to normal as recovery began.     

THE UTILITY OF CROSS-SECTIONAL MEASUREMENTS OF WEIGHT AND LENGTH FOR AGE IN SCREENING FOR GROWTH FAILURE (CHRONIC MALNUTRITION) AND CLINICALLY SEVERE PROTEIN-ENERGY MALNUTRITION

ABSTRACT. The accuracy of identifying children with growth failure and/or clinically severe protein-energy malnutrition (PEM) from a single measure of length or weight for age from birth to 36 months was determined. Growth data were treated cross-sectionally and compared with National Center for Health Statistics growth standards in order to determine the sensitivity, specificity and positive predictive value of a single cross-sectional measure of weight-for-age or length-for-age in identifying children diagnosed via longitudinal records. Under 6 months of age, neither weight nor length for age was an adequate predictor of growth failure or clinical malnutrition; from 12 to 36 months, screening measures based on anthropometry were much improved. It was concluded that a single measure of weight or length for age taken close to the first birthday could identify up to 78% of the future second and third year cases of clinically severe PEM. Implications and limitations are discussed.     

TONE AUDIOMERTY CONTROL OF CHILDREN TREATED FOR MENINGITIS WITH LARGR INTRAVENOUS DOSES OF AMPICILLIN

ABSTRACT. Thirty-seven children treated for bacterial meningitis with ampicillin in high doses were followed up with audiometric control. Defects were recorded in 6 cases. Two of these were ascribed to chronic otosalpingitis. In 4 patients with sensorineural hearing loss, 3 were unilateral, and in only one case was the damage bilateral. Even here there was a previous history of hearing loss. A suggested ototoxicity of ampicillin could not be confirmed.     

TONE AUDIOMETRY CONTROL OF CHILDREN TREATED FOR MENINGITIS WITH LARGE INTRAVENOUS DOSES OF AMPICILLIN

Abstract. Thirty-seven children treated for bacterial meningitis with ampicillin in high doses were followed up with audiometric control. Defects were recorded in 6 cases. Two of these were ascribed to chronic otosalpingitis. In 4 patients with sensorineural hearing loss, 3 were unilateral, and in only one case was the damage bilateral. Even here there was a previous history of hearing loss. A suggested ototoxicity of ampicillin could not be confirmed.     

EVALUATION OF PROGNOSIS AND TREATMENT IN BELL'S PALSY IN CHILDREN

Nerve-excitability measurements performed early in the course of the disease are of a good prognostic value. The results show that when excitability is maintained unimpaired after 72 hours of the onset, there is a chance of 100% spontaneous cure. When the excitability is diminished by less than 50%, 90% recovery may occur, but when it is markedly diminished or absent the prognosis is bad. The schedule of treatment to be followed should be based on the result of nerve excitability measurement early in the course of the disease. Systemic vasodilators, as nicotinic acid early in the course of the disease has excellent effect as it cuts the vicious circle of arteriolar spasm without increasing pressure within the facial canal. It is advisable that early short wave therapy should be avoided as it may increase nerve compression through local vascular congestion in the vicinity of the nerve. Incidence of physiological block is higher in children with Bell's palsy than in corresponding adult patients who, as a result have a higher incidence of nerve degeneration and worse prognosis. The severity of paralysis does not indicate the degree of nerve lesion.     

CROSS-SECTIONAL STUDIES OF PHYSICAL GROWTH IN TWINS, POSTMATURE AND SMALL-FOR-DATES CHILDREN

Abstract. From 16955 live births which occurred throughout the United Kingdom in April 1970, three groups of children who might have suffered from fetal malnutrition, i.e. the multiple, postmature and small-for-dates births were selected with a 10% random sample. Their birthweights and weights, heights and head circumference measurements were compared at the ages of 22 months and 3½ years. Differences between the random and postmature groups still present at 22 months disappeared at 37half; years. Variations in the other groups persisted and the compensation occurring at 22 months had apparently ceased at 3½ years. The three examinations were linked and the children including those in the control group showed considerable mobility in their quartile ratings. Only a minority remained unchanged. At the same time the weights of the heavier and lighter children tended to go towards the mean. As the velocity of growth slowed the redistribution tended to lessen but was still taking place at the age of 3½ years.     

CENTRAL VENOUS ACCESS PORTS IN CHILDREN TREATED FOR HEMATOPOIETIC MALIGNANCIES

During past 10 years 234 central venous access ports (CVAP) were implanted in 225 patients at the Department of Pediatric Hematology and Oncology in Zabrze. Mean exposure time was 745 days and total implantation time reached 173,768 days. Complications were encountered in 17 patients (7.6%). This mainly concerned central venous line infection, which led to removal of 10 CVAP (4.4%). The remaining complications necessitating removal of the CVAP consisted mainly of mechanical problems (catheter fracture, occlusion, and erroneous implantation to artery). In the opinion of the authors, subcutaneously implanted CVAP are a safe and effective option for high-dose chemotherapy deliverance in childhood cancer patients.     

DIURNAL VARIATION OF SERUM IRON IN INFANTS AND CHILDREN

The diurnal variation of serum iron found in healthy adults was evaluated in two groups of children of different ages. No variation was found in 12 children aged 2 weeks to 20 months. In contrast, there was a significant variation of the per cent relative change of serum iron from a. m. to p. m. for a group of 12 children from 3 to 14 years of age. These results support the evidence for the late appearance of a biological “clock” in children.     

PHARMACOKINETICS OF AMIKACIN IN INFANTS AND PRE-SCHOOL CHILDREN

Abstract. The pharmacokinetic properties of amikacin sulfate in infants and children aged from three weeks to 6 years were studied during treatment with doses of 7.5 mg/kg every 12 hours using standard assay methods and technique of two compartment open model kinetic analysis. Peak serum concentrations of amikacin were measured 30 or 60 min after the first intramuscular injection. These ranged from 11.8 μg/ml to 23 /μg/ml in infants and from 9.0 /μg/ml to 29 8 μg/ml in children. Five minutes after the first intravenous bolous injection they varied from 16 μg/ml to 29.8 μg/ml in infants and from 34 μg/ml to 42 μg/ml in children. Twelve hours after injection serum concentrations were less than 0.8 μg/ml in all patients. Mean serum half-lives of amikacin in infants and children were 2.1 hours and 2.0 hours after intramuscular, and 2.2 and 2.0 hours after intravenous administration respectively. No evidence of accumulation was observed after four days treatment. The amount of antibiotic recovered within 12 hours from the urine in all patients ranged from 34.5 to 65 % of an intramuscular dose, and from 45.8 to 63.3% of an intravenous dose. The dosage regime of 7.5 mg/kg body weight given every 12 hours should be safe and effective for the treatment of infections in the age groups studied.     

PAPAVERINE IN THE PROPHYLAXIS OF MIGRAINE AND OTHER VASCULAR HEADACHE IN CHILDREN

ABSTRACT. A Daily dose of papaverine (5–10 mg per kg body weight) was administered on a double-blind basis for two months to 42 successive child patients suffering from migraine or other vascular headache attacks not less than twice a month. Thirty-seven patients received the drug for the whole period of two months and 31 of these could be followed for a period of one to 10 months (mean 4.5 months) after the cessation of the treatment. Nineteen received papaverine and 18 placebo. Six out of 19 papaverine patients and none of 18 placebo patients were completely free from attacks during the treatment. Altogether 11 patients in the papaverine group and 5 in the placebo group experienced a 75–100% reduction in attack frequency which was accompanied by lower intensity and shorter duration of attacks. The results were best in cases with classical migraine. An "excellent" or "good" drug effect was experienced by 58% of papaverine patients and 17% of placebo patients.     

INSULIN ANTIBODIES IN THE SERUM OF DIABETIC CHILDREN TREATED FROM THE DIAGNOSIS OF THE DISEASE WITH HIGHLY PURIFIED INSULINS

Abstract. Fitly-one diabetic children, treated with highly purified, porcine insulins from the diagnosis of the disease were studied for the development of insulin antibodies during the first years of treatment. Sera were obtained before the start of treatment and at repeated intervals thereafter. Serum insulin antibodies were measured by three methods in three laboratories. Twenty-nine children were treated with R.I. (rare immunogenic) insulins at one department and 22 with MC (monocomponent) insulins at the other department. Before the start of treatment, serum insulin antibodies were almost invariably zero or below the limit of detection. During the first year a considerable number of cases, more than that reported for adults, formed detectable amounts of antibodies, and more so in the R.I. than in the MC series. The levels were however definitely lower than those observed with the Same methods in diabetic children on conventional insulins. Analysis of variance showed no differences between the various age groups. No significant correlation was found between the highest titre of serum insulin antibodies on the one hand and insulin dose or glucosuria on the other hand. The results confirm the concept that children form antibodies to insulin more actively than adults.     

RUBIDOMYCIN IN BLASTIC PHASES OF ACUTE PROMYELOCYTIC AND MYELOBLASTIC LEUKEMIA IN CHILDREN

Rubidomycin was administered in doses of 1 mg/kg body weight, usually in combination with prednisone. The best results were obtained in promyelocytic leukemia. Promyelocy-tic leukemia in children seems to be characterized by sensitivity to rubidomycin even in late exacerbations.