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Gurgaon, India

Vitamin A deficiency is a significant public health problem in low and middle income countries. Vitamin A supplementation (VAS) provided to lactating postpartum mothers or to infants less than six months of age are two possible strategies to improve the nutrition of infants at high risk of vitamin A deficiency and thus potentially reduce their mortality and morbidity. To evaluate the effect of:1. VAS in postpartum breast feeding mothers in low and middle income countries, irrespective of antenatal VAS status, on mortality, morbidity and adverse effects in their infants up until the age of one year.2. VAS initiated in the first half of infancy (< 6 months of age) in low and middle income countries, irrespective of maternal antenatal or postnatal VAS status, on mortality, morbidity and adverse effects up until the age of one year. The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), EMBASE, MEDLINE, clinical trials websites, conference proceedings, donor agencies, 'experts' and researchers (up to October 15, 2010). Randomized or quasi-randomised, individually or cluster randomised, placebo controlled trials involving synthetic VAS provided to the postpartum mothers or their infants up to the age of six months were eligible. Two review authors assessed the studies for their risk of bias and collected data on outcomes. Of the 18 included studies, eight provided information on maternal VAS and 15 on infant VAS.For maternal VAS, there was no evidence of a reduced risk of mortality of their babies during infancy (96,203 participants, seven studies, high quality evidence; random-effects model RR 1.00, 95% CI 0.94 to 1.06, P = 0.9; test of heterogeneity I(2) = 0%, P = 0.9) or in the neonatal period (moderate quality evidence); nor of morbidities (very low quality evidence).  For infant VAS, there was no evidence of a reduced risk of mortality during infancy (59,402 participants, nine studies, moderate quality evidence; random-effects model RR 0.97, 0.83 to 1.12, P = 0.65; test of heterogeneity I(2) = 49%, P = 0.05) or in the neonatal period, nor morbidities (low quality evidence), but an increased risk of bulging fontanelle (32,978 participants, 10 studies, low quality evidence; random-effects model RR 1.55, 1.05 to 2.28, P = 0.03; test of heterogeneity I(2) = 68%, P = 0.0009). There is no convincing evidence that either maternal postpartum or infant vitamin A supplementation results in a reduction in infant mortality or morbidity in low and middle income countries. Source

Sorensen L.G.,Child and Adolescent Psychiatry | Neighbors K.,Pediatrics | Martz K.,EMMES Corporation | Zelko F.,Child and Adolescent Psychiatry | And 2 more authors.
American Journal of Transplantation

This multicenter study examined prevalence of cognitive and academic delays in children following liver transplant (LT). One hundred and forty-four patients ages 5-7 and 2 years post-LT were recruited through the SPLIT consortium and administered the Wechsler Preschool and Primary Scale of Intelligence, 3rd Edition (WPPSI-III), the Bracken Basic Concept Scale, Revised (BBCS-R), and the Wide Range Achievement Test, 4th edition (WRAT-4). Parents and teachers completed the Behavior Rating Inventory of Executive Function (BRIEF). Participants performed significantly below test norms on intelligence quotient (IQ) and achievement measures (Mean WPPSI-III Full Scale IQ = 94.7 ± 13.5; WRAT-4 Reading = 92.7 ± 17.2; WRAT-4 Math = 93.1 ± 15.4; p < 0001). Twenty-six percent of patients (14% expected) had 'mild to moderate' IQ delays (Full Scale IQ = 71-85) and 4% (2% expected) had 'serious' delays (Full Scale IQ = 70; p < 0.0001). Reading and/or math scores were weaker than IQ in 25%, suggesting learning disability, compared to 7% expected by CDC statistics (p < 0.0001). Executive deficits were noted on the BRIEF, especially by teacher report (Global Executive Composite = 58; p < 0.001). Results suggest a higher prevalence of cognitive and academic delays and learning problems in pediatric LT recipients compared to the normal population. © 2011 The American Society of Transplantation and the American Society of Transplant Surgeons. Source

Corkum P.,Dalhousie University | Davidson F.,Dalhousie University | MacPherson M.,Pediatrics
Pediatric Clinics of North America

Children with attention-deficit/hyperactivity disorder (ADHD) have high rates of sleep problems and sleep disorders. It is critical that pediatricians assess for sleep problems during the course of ADHD assessment and when treating children with stimulant medication. Sleep must be considered in the differential diagnosis and in terms of comorbidity with ADHD. The most common sleep problem in children with ADHD is insomnia, and the first line of treatment should be the implementation of behavioral interventions rather than medication. More research is needed to determine if children with ADHD respond to behavioral interventions in a similar manner as typically developing children. © 2011 Elsevier Inc. Source

BACKGROUND AND OBJECTIVES: To evaluate the burden of Rotavirus gastroenteritis (GE) among pediatric hospital admissions. DESIGN AND SETTINGS: This is a retrospective observational study, in which all pediatric cases admitted to one of the biggest tertiary hospitals in Jeddah, with the diagnosis of GE, in the year 2010, were enrolled. PATIENTS AND METHODS: This is a retrospective observational study in which all pediatric cases admitted with the diagnosis of GE in the year 2010 were enrolled. Clinical data and laboratory findings were compared between Rota positive and Rota negative cases. The data was statistically analyzed. RESULTS: GE cases represented 8.8% of all pediatric hospital admissions in 2010. Almost 43% (42.9%) of these cases proved to have Rotavirus GE. Rotavirus infection alone, adenovirus infection alone, combined Rotavirus and adenovirus infection, and other causes of GE were present in 101 (33.6%), 21 (7%), 28 (9.3%), and 151 (50.2%) patients respectively. Coinfection with adenovirus was higher in Rota-positive GE (RPG; P=.039). Vaccination against Rotavirus was protective against Rotavirus GE (P=.042). CONCLUSIONS: Rotavirus infection is the most important causative organism of GE in our community that accounted for 42.9% of children hospitalized for GE in our study, either alone or with other infections. Among our patients, vaccination against Rotavirus appeared to be protective against Rotavirus GE. In view of the high disease prevalence among children, locally and worldwide, we recommend routine Rotavirus vaccination as the most effective available means of control despite improvement in sanitation and hygiene. Source

Theodorsson E.,Pediatrics | Ludvigsson J.,Linkoping University

OBJECTIVE: To investigate cortisol concentrations in hair as biomarker of prolonged stress in young children and their mothers and the relation to perinatal and sociodemographic factors. METHODS: Prospective cohort study of 100 All Babies In Southeast Sweden study participants with repeated measures at 1, 3, 5, and 8 years and their mothers during pregnancy. Prolonged stress levels were assessed through cortisol in hair. A questionnaire covered perinatal and sociodemographic factors during the child's first year of life. RESULTS: Maternal hair cortisol during the second and third trimester and child hair cortisol at year 1 and 3 correlated. Child cortisol in hair levels decreased over time and correlated to each succeeding age, between years 1 and 3 (r = 0.30, P = .002), 3 and 5 (r = 0.39, P , .001), and 5 and 8 (r = 0.44, P , .001). Repeated measures gave a significant linear association over time (P , .001). There was an association between high levels of hair cortisol and birth weight (b = .224, P = .020), nonappropriate size for gestational age (b = .231, P = .017), and living in an apartment compared with a house (b = .200, P = .049). In addition, we found high levels of cortisol in hair related to other factors associated with psychosocial stress exposure. CONCLUSIONS: Correlation between hair cortisol levels in mothers and their children suggests a heritable trait or maternal calibration of the child's hypothalamic-pituitary-adrenocortical axis. Cortisol output gradually stabilizes and seems to have a stable trait. Cortisol concentration in hair has the potential to become a biomarker of prolonged stress, especially applicable as a noninvasive method when studying how stress influences children's health. Pediatrics 2013;132:e1333- e1340. Copyright © 2013 by the American Academy of Pediatrics. Source

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