Influence of exclusive breast feeding on occurrence, severity and recurrence of acute lower respiratory infections in preschool children.

Objective: To determine the association between acute lower respiratory infections (ALRI) and exclusive breast feeding practices in children younger than five years of age Design: Case control study Setting: Lady Ridgeway Hospital for Children, Colombo. Method: Breast feeding practices in children younger than five years of age admitted with ALRI were compared with that of age and gender matched controls. An interviewer administered structured pretested questionnaire was used to collect the data. Results: One hundred and four cases and controls were studied; 53% of cases were exclusively breast fed for four or more months compared to 68% of controls (odds-ratio 2). Of the 14 cases with severe ALRI, 14% were exclusively breast fed for four or more months compared to 56% in non severe ALRI cases (odds-ratio 7.5). Proportion of children exclusively breast fed for four or more months was significantly lower (p < 0.001) in cases who had previous hospital admissions for ALRI (31% against 62%). Conclusions: This study provides further evidence that exclusive breast feeding has protective effect on occurrence, severity and recurrence of ALRI in young children.

Management of acute paracetamol poisoning in a tertiary care hospital.

OBJECTIVES: To compare the management of acute paracetamol poisoning with the best evidence available, and to determine the effect of plasma paracetamol level estimation on the management. DESIGN: Descriptive study with an intervention. SETTING: Medical wards of the National Hospital of Sri Lanka, Colombo. PATIENTS: Patients admitted with a history of acute paracetamol poisoning. INTERVENTION: Measurement of plasma paracetamol. METHODS: Data were obtained from the patients, medical staff and medical records. Plasma paracetamol was estimated between 4-24 hours of paracetamol ingestion. The current management practices were compared with the best evidence on acute paracetamol poisoning management. RESULTS: 157 patients were included. The mean ingested dose of paracetamol was 333 mg/kg body weight. Majority of the patients (84%) were transfers. Induced emesis and activated charcoal were given to 91% of patients. N-acetylcysteine was given to 66, methionine to 55, and both to 2. Aclinically important delay in the administration of antidotes was noted; 68% of patients received antidotes after 8 hours of the acute ingestion. Only 31 (26%) had paracetamol levels above the Rumack-Matthew normogram. 74 patients received an antidote despite having a plasma paracetamol level below the toxic level according to the normogram. INTERPRETATION: Management of acute paracetamol poisoning could be improved by following best available evidence and adapting cheaper methods for plasma paracetamol estimation.

Fulminant hepatic failure and paracetamol overuse with therapeutic intent in febrile children.

OBJECTIVE: To evaluate the risk of fulminant hepatic failure in relation to paracetamol overuse with therapeutic intent in febrile children. METHODS: It was a case control study. Paracetamol ingestion for the current febrile illness was compared between 25 cases of fulminant hepatic failure and 33 hospital age matched controls. RESULTS: Supra-therapeutic doses of paracetamol (mean 145 mg/kg/day) were consumed by all 25 cases compared to none in the control group. Mean paracetamol level in the cases and controls were, respectively, 26.84 mg /dl and 0.051 mg /dl (p< 0.001). The mean duration of paracetamol intake prior to admission in cases was 3. 45 days compared to 1.85 days in the control group. Nineteen, 5 and 3 were, respectively, graded as hepatic encephalopathy grade 1, 2 and 3. All six patients in grade 2 and 3 had hepatomegaly compared to 78% in the grade 1. Four had jaundice and all were in grade 2 or 3. Mean alanine aminotransferase was 2781 U/L None of the randomly selected cases (6) had serological evidence of Hepatitis A, Hepatitis B or Dengue. Three cases died. CONCLUSION: Exposure to multiple supratherapeutic doses of paracetamol is a risk factor to develop fulminant hepatic failure in children with an acute viral like febrile illness.