Failure-to-thrive: lessons from animal models and developing countries

To better understand the complex associations between undernutrition and poverty in determining behavioral outcome for infants with failure-to-thrive (FTT), we have reviewed findings from research in undernutrition among animal models and among children in developing countries, where rates of infant undernutrition are extremely high. The associations among undernutrition, poverty, and family functioning persist in both animal and human research, whether manipulated in laboratory settings or observed in natural settings. Although environmental support and stimulation appear to ameliorate many of the negative consequences associated with undernutrition, infants with a history of nutritional deprivation are at increased risk for behavioral and emotional problems. Recommendations for prevention and intervention follow an ecological framework and include adequate access to food, knowledge of nutritional requirements and feeding approaches, support for parents and families, and a nurturant environment for infants.     

Persistent transitional circulation

Six infants presented within 24 hours of birth with cyanosis. The clinical findings, combined with catheter studies in 4 cases, led to the conclusion that there was a persistent fetal direction of ductus arteriosus flow with pulmonary hypertension, i.e. a `persistent transitional circulation''. The occurrence was 1/1454 live births, and it is thus an important condition to recognize and differentiate from cyanotic congenital heart disease. 4 of the children went through the transition to a normal infant circulation with medical treatment alone, one died before this occurred, and one recovered after an exchange transfusion. The cause of the persistent transitional circulation is not clear, but it is probably the end result of several different pathological processes.     

Breastfeeding: 1999 perspective.

Although the vast majority of pediatricians agree that breastfeeding is the preferred form of infant feeding, a large number of infants are still exclusively formula-fed or rarely breastfed for an extended period of time. This review explores focuses on data that speak to mothers' decisions to initiate and continue breastfeeding. Current research focuses on the immunomodulatory effects of breast milk, especially its protective benefits as relates to infection and allergy. The evidence clearly indicates that pediatricians must continue to play a critical role in the promotion of breastfeeding.     

Rickettsial infections: Indian perspective

Context  

Underdiagnosed and misdiagnosed rickettsial infections are important public health problems. They also lead to extensive investigations in children with fever of undetermined origin contributing to financial burden on families. The present review addresses the epidemiology, clinical features, diagnosis and management issues of these infections, primarily for a practicing clinician.     

Twins: a neonatal perspective

Multiple gestational pregnancies have become more common with the development of assisted reproductive technologies and increasing maternal age. It is important to be aware of the factors that need to be considered when expecting their impending arrival to the neonatal unit. Their antenatal course has unique considerations and monochorionicity can complicate their antenatal and postnatal course so closer monitoring is required. Perinatal interventions for optimal outcomes are undertaken according to local policies, NICE and RCOG recommendations. Short and long term outcomes depend on various factors and their neonatal course of stay should they need admission to the unit. Families need support when they are expecting twins as there are considerable socio-economic implications of a twin pregnancy. This short article provides advice to healthcare professionals looking after twins and their families.     

Shwachman-Diamond syndrome: UK perspective

So much has been added to our knowledge of Shwachman-Diamond syndrome (SDS) since it was last reviewed in this journal some 25 years ago, that there is now an urgent need to bring the condition to the attention of a new generation of paediatricians. SDS, although a rare autosomal recessive disorder, demands wide attention because it features in the differential diagnosis of a number of important childhood diseases. It can be diagnosed in children of all ages, or in adults. SDS most commonly presents in infancy with features of exocrine pancreatic insufficiency, bone marrow dysfunction, and short stature.     

静滴安定在小儿癫痫撤换药中的应用研究

目的缩短平均住院日,降低医疗费用,防止抗癫痫药撤换时所致的癫痫持续状态。方法对１５例癫痫患儿以持续静滴安定作为抗癫痫药撤换时的替换药,并与２０例经典方法撤换药进行对比。结果应用安定组其平均住院日、医疗费用均较经典组显著降低。两组均无癫痫持续状态发生。结论静滴安定用于抗癫痫药撤换中的替代药,是一种安全、经济、简便的方法     

Emergency physician intershift handovers: an analysis of our transitional care

The emergency department intershift transfer of patient care is a universal event. Despite the frequency of its occurrence and complexity of issues surrounding the exchange, emergency department patient handover is insufficiently explored in our literature. This article reviews the effectiveness and efficiencies of the handover practice. The authors provide personal opinion regarding favorable parameters for the prehandover, intershift meeting, and posthandover activities.     

Cerebral palsy: a 1987 perspective

Changing views on reaching a diagnosis, methods of assessment, and management are apparent for neurological disorders in general, and cerebral palsy in particular. A personal approach to the problems associated with the evaluation and care of children and young people with cerebral palsy is outlined, with particular emphasis on the contributions form, and optimal use of, the multidisciplinary assessment team.