What is the role of the prevention of allergy in the first period of life?

The widespread increase in the prevalence of allergic disease, which has occurred over the last 20 y, has created general concern in Europe and in the rest of the world. The reason for this increase is still partially unknown. In this period, despite a greater understanding of the pathogenesis and risk factors of allergies plus the greater efficacy of drugs to control the symptoms, the cost of intervention and the socio-economic impact are still very high. For these reasons, prevention in the first period of life represents a goal for both developed and developing countries in order to reduce this upward trend.     

Does the length of the history influence the outcome of pneumatic reduction of intussusception in children?

Purpose  

Intussusception is the most common cause of acute abdomen in infants and preschool children. Nonoperative reduction using air enema is an established treatment in children with intussusception. The aim of this study was to determine whether length of the history influences the outcome of pneumatic reduction of intussusception in children?     

In the footsteps of Frances Tustin: Further reflections on the construction of the body‐ego

The author cites material from infant observation and from work with children with autism which illustrates primitive processes of identification and their relation to the development of the body image. The sense of a skin which reliably contains the child's body is seen as being built up through the combination of eye contact with the mother, as a mediator of emotional containment, and tactile reinforcement of the child's sense of having a backbone. The author proposes the term ‘lateral object of primary identification’ to describe the baby's experience of his mother and himself each occupying half of his body. She describes the process by means of which the dual link with the mother — tactile and visual — is progressively inscribed in the major joints of the body, from the neck downwards, in the course of normal development. In this way, separation can be experienced as a loss of part of the body. The experience of losing part of the mouth, as described by Tustin, is discussed with reference to theories of containment (Bion) and projection (Green).     

Should dopamine be the first line inotrope in the treatment of neonatal hypotension? Review of the evidence

AIM: To determine if dopamine is effective in treating neonatal hypotension and safe to use comparing to other inotropes. METHODS: This is a review of evidence on inotropic treatment of neonatal hypotension. Databases searched were MEDLINE and the Cochrane Library, a total of 134 studies were identified. Only studies with high quality evidence (level 1a and b and 2a) were included. After review, only eight studies were included in the final analysis. Pooled risk ratios derived for each outcome [Mantel-Haenzel (M-H) fixed effect] with CI, as reported in the Cochrane reviews were plotted in forest plot form. RESULTS: Eight articles met inclusion criteria, which all included treatment in preterm infants. Dopamine increased mean arterial blood pressure (BP) (n = 163; r = 0.88, 95%CI: 0.76 to 0.94) and systolic BP (n = 142; r = 0.81, 95%CI: 0.42 to 0.94) comparing to placebo. Dopamine has been shown overall to be statistically more effective in increasing BP than dobutamine (n = 251, r = 0.26, 95%CI: 0.20-0.32). However there were no differences in short term outcomes (periventricular leucomalacia, periventricular haemorrhage) and mortality between both drugs. There is no statistical evidence of dopamine being more effective than adrenaline or corticosteroids. There was no difference in morbidity and mortality outcomes when dopamine was compared to hydrocortisone (RR 1.81, 95%CI: 0.18 to 18.39) or adrenaline. CONCLUSION: In preterms, dopamine is the most studied drug, and we suggest it could be used as first line treatment in hypotension.     

Antenatal imaging: does the postnatal impact justify the effort?

This review explores what is already understood about antenatal diagnosis of a variety of conditions, including Down syndrome, what progress has been made in this field, the role that imaging plays in the diagnostic pathway and the impact on management of pregnancies and the parental decision process. An overview of future potential developments is also made.