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Correspondence

patients with optimised RAS blockade. Timely sensory unlike other developmental domains,
We were conducting a proof-of-concept has an optimal outcome window
study; thus the choice of reduction in
stimulation and early within the first year of life. 3,5 We
proteinuria rather than the proportion childhood development believe that the Review by Wilson
of patients entering remission defined and colleagues, 1 along with the
by an arbitrary proteinuria cutoff was The Review by Wilson and colleagues robust data now emerging from the
a more logical endpoint. We examined (Dec 2, 2017)1 provides useful insights Global Burden of Disease Collaborators,
the hypothesis that IgA production on the plight of people with or at risk should assist in addressing the global
in the intestinal mucosal immune of hearing loss globally, and outlines underestimation of developmentally
system is a key pathophysiological a comprehensive blueprint for disadvantaged children, to foster more
factor in IgA nephropathy. As a proof- intervention, especially in low-income integrated ECD endeavours under the
of-concept study, the NEFIGAN study1 and middle-income countries. The SDG dispensation.
successfully reported a reduction in timing is auspicious because, in May, We declare no competing interests.
proteinuria with enteric budesonide the World Health Assembly renewed
*Bolajoko O Olusanya, Tony Sirimanna,
and an improvement in glomerular the 1995 resolution on the prevention Bradley McPherson
filtration rate, which is perhaps more of hearing impair­ment, urging member bolajoko.olusanya@uclmail.net
important than any proteinuria target, states and the director-general of WHO
Centre for Healthy Start Initiative, Lagos 221106,
as suggested by Tsuda and colleagues. to take specific steps to curtail the Nigeria (BOO); Department of Audiological
These findings provide the basis for disease burden.2 However, we wish to Medicine, Great Ormond Street Hospital, London,
larger outcome studies of targeted- draw attention to the implications of UK (TS); and Division of Speech and Hearing
Sciences, Faculty of Education, University of
release enteric budesonide in IgA this Review for the prevailing disability- Hong Kong, Pokfulam, Hong Kong (BM)
nephropathy, with the potential to inclusive Sustainable Development 1 Wilson BS, Tucci DL, Merson MH,
provide evidence of solid clinical end­ Goals (SDGs). O’Donoghue GM. Global hearing health care:
points in IgA nephropathy. Unlike the precursors of SDGs (the new findings and perspectives. Lancet 2017;
390: 2503–15.
BF reports grants and personal fees from Millennium Development Goals), one 2 World Health Assembly. Prevention of
Pharmalink AB, AstraZeneca AB, Bristol-Myers SDG (number 4) focuses specifically on deafness and hearing loss. May 31, 2017.
Squibb, Novartis, and Astellas Pharmas, and http://apps.who.int/gb/ebwha/pdf_files/
personal fees from Sandoz, outside the submitted
Early Childhood Development (ECD) WHA70/A70_R13-en.pdf?ua=1 (accessed
work. JB reports grants and personal fees from and seeks to monitor the proportion May 25, 2017).
Pharmalink AB, Anthera, Omeros, Novartis, of children under 5 years of age who 3 Grantham-McGregor S, Cheung YB, Cueto S,
Kancera, EMD Serono, and Pharmalink. JF reports et al. Developmental potential in the first
are developmentally on track in health, 5 years for children in developing countries.
personal fees from Pharmalink AB, Amgen, Chugai,
Fresenius, Vifor, and Omeros. AJ has no learning, and psychosocial wellbeing. Lancet 2007; 369: 60–70.
competing interests. This monitoring would need to entail a 4 Black MM, Walker SP, Fernald LCH, et al, for the
Lancet Early Childhood Development Series
*Bengt Fellström, Jonathan Barratt, broad range of interventions to address Steering Committee. Early childhood
Jürgen Flöge, Alan Jardine all the interdependent domains of development coming of age: science through
the life course. Lancet 2017; 389: 77–90.
bengt.fellstrom@medsci.uu.se child development, including sensory 5 Shonkoff JP. From neurons to neighborhoods:
Department of Medical Sciences, Renal Unit,
(hearing and vision), motor, cognitive, old and new challenges for developmental and
and psychosocial skills. However, behavioral pediatrics. J Dev Behav Pediatr 2003;
Uppsala University Hospital, Uppsala, S-75185
24: 70–76.
Sweden (BF); Department of Infection, Immunity the current estimate of 279 million
and Inflammation, University of Leicester, Leicester,
For The Lancet Series Advancing children who are at risk of not reaching
UK (JB); John Walls Renal Unit, Leicester General
Early Childhood Development:
Hospital, Leicester, UK (JB); Postgraduate Specialty their developmental potential in low-
form Science to Scale see http://
www.thelancet.com/series/
School of Clinical Academic Training, Health income and middle-income countries
ECD2016
Education East Midlands, Leicester, UK (JB); and the recommended interventions
Medizinische Klinik II, RWTH Aachen Univeristy,
Aachen, Germany (JF); Institute of Cardiovascular
by The Lancet Series on advancing ECD
and Medical Sciences, University of Glasgow, are restricted to children affected by
Glasgow, Scotland (AJ); and Glasgow Renal stunting and extreme poverty.3,4 This Department of Error
Transplant Unit, Queen Elizabeth Hospital, Lear SA, Hu W, Rangarajan S, et al. The effect of
practice has been attributed to the
Glasgow, Scotland (AJ) physical activity on mortality and cardiovascular
Published Online paucity of data on other risk factors for disease in 130 000 people from 17 high-income,
1 Fellström BC, Barratt J, Cook H, et al.
October 5, 2017
Targeted-release budesonide versus placebo in poor development.3 middle-income, and low-income countries:
http://dx.doi.org/10.1016/ the PURE study. Lancet 2017; 390: 2643–54—
S0140-6736(17)32596-5
patients with IgA nephropathy (NEFIGAN): a Extensive brain research, cor­
double-blind, randomised, placebo-controlled In figure 1 of this Article (published online first
phase 2b trial. Lancet 2017; 389: 2117–27. roborated by The Lancet Series on on Sept 21, 2017), the labels “lower” and
2 Kidney Disease: Improving Global Outcomes advancing ECD, shows that 80% of “higher” were incorrectly reversed below the
(KDIGO) CKD Working Group. KDIGO 2012 a child’s brain growth and synapse axis. This correction has been made to the
clinical practice guideline for the evaluation online version as of Oct 5, 2017, and the
and management of chronic kidney disease. development occurs before the age of printed Article is correct.
Kidney Int Suppl 2013; 3: 1–150. 3 years, and that sensory stimulation,

2626 www.thelancet.com Vol 390 December 16, 2017

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