HEADS UP

Authors

  • Craig Mellis


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Breastfeeding may reduce the risk of epilepsy

About 1% of children have epilepsy. A Danish record linkage study tested the hypothesis that breastfeeding might reduce the risk of epilepsy.1 They postulated that a dose–response between duration of breastfeeding and incidence of epilepsy would strengthen the likelihood of a causal relationship. Information on breastfeeding was obtained by telephone interview regarding 69 750 singleton babies from the Danish National Birth Cohort, while information on epilepsy in inpatients and outpatients was obtained from a national hospital database.

An impressive 98.2% of babies were breastfed at any time and 77.8% were exclusively breastfed. Breastfeeding was associated with a significantly reduced risk of epilepsy with onset either in the first year or older. Furthermore, there was a dose–response effect, with the risk of epilepsy falling progressively with increasing duration of breastfeeding. The authors attempted to adjust for potential confounding factors, including gestational age and socio-economic status, but concede that residual confounding is possible. They claim biological plausibility because human milk contains many nutritional factors important for neuro-development, including docosohexaenoic acid, which are not present in cows milk. This study puts another arrow in the quiver of breastfeeding advocates.

Reference

Link: http://www.jpeds.com/article/S0022-3476(10)01006-1/fulltext

Reviewers: Nick Wood, nicholw2@chw.edu.au; David Isaacs, david.isaacs@health.nsw.gov.au

A scoring system for bronchiolitis

A number of studies have explored factors determining whether to admit a child with bronchiolitis to the hospital, but few are clinically useful. A retrospective UK study used logistic regression to analyse presenting clinical parameters as predictors of hospital admission.1 Of 449 infants <12 months old presenting to one hospital with a clinical diagnosis of bronchiolitis, 163 (36%) were admitted to the hospital. The authors found a number of clinical factors that predicted hospitalisation but selected the five ‘best’ predictors (age, duration of symptoms, respiratory rate, heart rate and oxygen saturation) to generate a scoring system (see Table). A score of 3 or greater demonstrated acceptable diagnostic accuracy. The authors do not propose use of the scoring system in an absolute way to rule in or rule out admission, but suggest that it might be useful to guide inexperienced clinicians in when to seek senior review.

Table Table.  Bronchiolitis risk of admission score
Clinical parameterMeasureScore
Age<18 weeks1 point
Duration of symptoms<5 days1 point
Respiratory rate50 breaths/min or greater1 point
Heart rate155 beats/min or greater1 point
Oxygen saturation<97%1 point
Maximum total 5 points

Reference

Reviewer: David Isaacs, david.isaacs@health.nsw.gov.au

Australian HPV vaccination programme prevents pre-cancerous lesions in girls

Australia was the first country to introduce an extensive national vaccination programme with human papillomavirus (HPV) vaccine starting in April 2007. Australia instituted sustained school-based immunisation of all 12–13-year-old girls and, in addition, a catch-up programme for 13–17-year-olds through schools and 18–26-year-olds through general practice. Three-dose vaccine coverage in Victoria is estimated at 79% of first year high school students and 71% of final year students. The Victorian Cytology Service has documented a 38% decrease (95% confidence intervals 16–61%) in ‘high-grade’ cervical abnormalities in girls younger than 18 years in the 3 years since HPV vaccine introduction.1 These lesions are purported to be precursors of cervical cancer, although the definition used included some early changes not so convincingly associated with cancer. A similar decrease has not yet occurred in older women, suggesting that the decline in younger girls is truly a result of the immunisation programme. These promising data should help us persuade vacillating girls and their parents of the considerable benefits of HPV vaccination.

Reference

Reviewer: David Isaacs, david.isaacs@health.nsw.gov.au

Adjunctive corticosteroids for acute pyelonephritis

Adjunctive corticosteroids have been studied for the treatment of a number of infectious diseases including bacterial meningitis, septic arthritis and sepsis. For acute pyelonephritis, the use of corticosteroids has not previously been investigated. This randomised placebo-controlled study in Taiwan included children below the age of 16 with their first episode of pyelonephritis.1 Patients with abnormal results on ultrasonography or dimercaptosuccinic acid (DMSA) scan within 72 h of admission were randomised to receive either oral methylprednisolone (1.6 mg/kg per day) every 6 h for 3 days or placebo in addition to standard antibiotic treatment. A DMSA scan performed 8 (range 6 to 38) months later showed a greater median volume of cortical defects in the placebo group suggesting a higher proportion of renal scarring, 60% in the placebo group versus 33% in the methylprednisolone group. Interestingly, the study used a 1:3 randomisation (according to the authors ‘justified on ethical grounds’) resulting in only 19 patients receiving methylprednisolone. In addition, the grade of vesicoureteric reflux, a risk factor for renal scarring, is not specified for both groups. This study is certainly hypothesis generating. However, small numbers and additional factors in the study design precluded any further conclusions. Larger studies investigating the effect of corticosteroids in this setting are underway.

Reference

Link: http://pediatrics.aappublications.org/content/128/3/e496.long

Reviewers: Irina Bopp, Irina.Bopp@ukbb.ch; Nicole Ritz, Nicole.Ritz@rch.org.au

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