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It is considered by many that caesarian section is a safe mode of delivery. However, in certain difficult cases, injury may be sustained by the newborn as a result of the mechanics of delivery. In these situations, it is useful to have a high index of suspicion so as to detect the same. We report one such case sustaining fracture of the humerus in caesarian delivery.

The International Association for the Study of Pain, has defined pain as “an unpleasant sensory and emotional experience connected with actual or potential tissue damage or described in terms of such damage”. It was thought that the newborn baby does not experience pain because of incompletely developed nervous system. However, it has been shown that neurological system known to be associated with pain transmission and modulation, is intact and functional. A study was conducted in our center to study the analgesic effect of administration of oral glucose in various concentrations, in neonates undergoing heel punctures, for collection of blood for investigations. This was compared with the analgesic effects of breast milk (which contains lactose). 125 full term normal neonates with no history of birth asphyxia or underlying neurological abnormality, requiring heel punctures for collection of blood for various investigations were selected for the study. They were matched for gestational age, birth weight and sex distribution and divided into 5 groups of 25 each. One group comprised control subjects and was administered sterile water. 3 groups were administered 1 ml of varying strengths of glucose solutions i.e. 10%, 25% and 50% respectively. The last group was given 1 ml of expressed breast milk (EBM). Prior to heel pricks, state of arousal, baseline heart rate (HR) and transcutaneous oxygen saturation (SpO2) were recorded by pulse oximeter in each neonate. Autolet, a mechanical device for capillary sampling, was used for heel pricks to give equal strength of painful stimulus in each procedure. Audio tape recorder was used to record the cry. The oral solution was administered slowly over 30 seconds by means of a syringe placed in the mouth. Heel puncture was done after 2 minutes, taking all aseptic precautions. HR and SpO2 were monitored using pulse oximeter. Pain response was assessed, by recording duration of crying, change in HR, change in SpO2 and facial action score after the procedure. Mean duration of cry and total cry over 5 minutes was significantly less in groups given 25% and 50% glucose solutions as compared to the control group and babies given EBM. Difference in mean increase in HR, fall in SpO2 were statistically significant between control group, EBM group and neonates given 25% and 50% glucose solutions respectively. Compared to control group, all other administered solutions (10%, 25%, 50% glucose and EBM) were found to reduce physiological and behavioral responses in neonates undergoing heel punctures. 25% and 50% glucose solutions were found to have maximal analgesic effect and both were found to be equally effective. EBM and 10% glucose solution have an equal analgesic effect but less than 25% or 50% glucose. This simple, cheap and safe method of oral analgesia can be easily used in neonates undergoing heel prick procedures during routine neonatal care.

Bronchial asthma is an inflammatory condition. The inflammatory actions of leukotrienes (LT) B4, C4, D4, and E4 have been shown experimentally to play a role in inflammatory mechanisms, producing asthma. Antileukotrienes (ALT) or leukotrienes antagonists (LA) is a new class of anti-asthma drugs with anti-inflammatory role. LT modifiers from the groups of 5 lipoxygenase inhibitor and Cys LT1 receptor antagonists, are found useful in asthma therapy. LAs are of main use in young infants and toddler with recurrent wheezing, children with moderate to severe chronic asthma on steroid therapy and in allergic rhinitis. In chronic asthma they are required to be used for prolonged periods with other anti-asthma agents. Except for Montelukast and Zafirlukast, which can be used in children above two and six years of age respectively, the paediatric use of other agents is yet to be established. However, these agents are essentially safe. The cost of LAs is reasonably high. At present, with available evidence, these drugs are considered promising in management of asthma in children. However, there is need to do more long term clinical trials for ascertaining their effectivity in different types of asthma to compare their effects with long acting B2 agnoists and chromones, so as to optimally explore their utility.

This is a manual that supports the Integrated Management of Childhood illness (IMCI). It is meant for use by doctors, nurses and other senior health workers. The manual provides resource material for common childhood illness and strategy for treating children in both inpatient and outpatient departments in small hospitals having basic laboratory facilities and essential drugs. Many countries have adopted the IMCI strategy and once India adopts it, this manual becomes a must for all health care providers. The manual has various chapters describing the process right from the admission of a sick child, prioritization of care, assessment of the child and dealing with specific common diseases like ARI, diarrhoea, malnutrition etc. It also deals with supportive care and has appendices giving information on practical procedures, drug dosages etc. There is one drawback in the manual, that, it does not cover the early neonatal period when neonatal and infant mortality is quite high. However, many WHO publications have been incorporated to give useful information for common illnesses with appropriate illustrations. The manual is recommended for all those caring for children at the first referral level in developing countries like India.

Imaging procedures are of immense help in arriving at a diagnosis in paediatric practice. However, after initial radiographic or ultrasound examination, differential diagnosis may often elude the paediatrician. A systematic and practical approach to the findings can help arrive at a diagnosis earlier, often obviating the need for costlier procedures. In this book, eminent radiologists have pooled their years of experience. This will definitely help Paediatricians and Radiologists to co-relate the clinical features with results of imaging studies. The book is divided into seven sections on anatomy and subdivided into many chapters covering major childhood disorders. Illustrations are very lucid and biometric data very useful. Format and organisation of chapters is extremely logical and it is easy to locate a particular condition in differential diagnosis. Great emphasis has been laid on radiographic and ultrasonographic findings which are very useful guides for a clinician. Contrast studies, computed tomography and magnetic resonance imaging have been illustrated wherever required. Photographic illustrations have been given in some sections to illustrate congenital and genetic disorders. However, the book lacks in certain areas. Disorders which are more common in developing countries have not been given the attention they deserve. In fact, they have been listed as rare disorders and only texts have been provided eg. Tuberculosis. Meningitis. Cysticecrosis etc. Vitamin deficiency disorders like rickets and scurvy deserve better images than provided. All in all, a good reference book in paediatric radiology for Paediatricians and Radiologists alike and is certainly recommended for departmental libraries.

Hepatic and Biliary diseases in children are becoming increasingly common and Paediatric Hepatology is establishing itself as a distinct speciality in Paediatrics owing to the peculiarities of liver and biliary diseases in children. This book is likely to fulfill the long felt need of students and teachers to share their global experiences in this field and to focus on certain clinical problems in day to day practice. This book covers a wide range of topics - from genetic disturbances of bilirubin and bile salt transport in neonates to psychology of parents of children on transplantation waiting lists. The highlight of the book includes number of useful algorithms and provides a practical approach to paediatric liver disease. Information on hepatitis has been updated, and non-viral Hepatitis and liver abscesses have been described well. Disorders of Copper metabolism also includes Indian Childhood Cirrhosis. There are chapters on liver and intestinal transplantations, useful investigations, altered drug and protein metabolism in liver diseased which are very lucid and interesting. Neonatal liver disorders are also well covered. The academic quality is enhanced by a collection of 75 photographs. This book fills a real gap in our knowledge of liver disease and is a well needed addition of a reference material which will be very useful for postgraduate students. Paediatricians and Paediatric Hepatiologists.

Screening of 1986 consecutive live births was done for evidence of Respiratory Distress by administering Downe's scoring in a prospective study at level II nursery of a medical college. A detailed antenatal, natal and postnatal history along with detailed examination supported by relevant investigations was carried out to arrive at the etiological diagnosis of Respiratory Distress Syndrome (RDS). Results: 48 newborns developed RDS during the observation period. The incidence of RDS was 2.42%. Out of these 40.4% were