Segment Ratio, Bilious Vomiting,Intestinal Obstruction and Vaccines

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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	Specialist Answers
Question
1.Can u please tell me the reference where its given how to calculate the upper segment, lower segment ratio? Not how to measure. We need the reference to calculate. 2.What is the chance for the recurrence of cleft lip/palate if the parent is normal and if the parents are also affected? 3.Can bilious vomiting be taken lightly? 4.When to call there is an intestinal obstruction radiologically? Other words what are the normal fluid levels seen in the plain x-ray abdomen erect view? 5. For a child who has taken iv Immunoglobulin say for kawasaki disease, how long u advice live virus vaccines to be avoided? So for a 4month old child who was given iv Ig, should not we give measles vaccine at 9th month or due to its ineffectiveness, should we repeat the MMR at 15th month also? Why is that only parenteral live virus vaccines are contra-indicated? PLEASE HELP.
Answer
You can get reference for upper segment lower segment ratio at the ref: Acta Pediatric. 2005:407-13 Isolated cleft carries 4% recurrence risk if no affected family members. 10-15% recurrence risk with another affected first degree relative. Bilious vomiting should not be taken lightly and intestinal obstruction should be ruled out. Radiological signs of bowel obstruction include bowel distension and the presence of multiple (more than six) gas-fluid levels on supine and erect abdominal radiographs. Vaccines should be avoided for at least 3 months after IVIG (minimum period is 6 weeks) A child who has received measles vaccine should still receive MMR at 15 months to ensure immunity against rubella and mumps also. Back to All Questions

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