Showing papers in "Pediatrics International in 2007"

Complications of central venous catheterization in critically ill children.

Abstract: Background: Placement of central venous catheter is essential in the management of critically ill children. The purpose of the present paper was to evaluate the success rate, mechanical and thrombotic complications and risk factors associated with these complications from different central venous access sites in critically ill children. Methods: A prospective study was undertaken from February 2000 to March 2005 of 369 central venous catheterizations in children in a pediatric intensive care unit. Results: The veins most frequently used were femoral vein (45%), subclavian vein (32.2%), and internal jugular vein (22.8%). Mean ± SD duration of catheterization was 9.5 ± 6.5 days. The procedure was performed under emergency conditions in 18% of patients with an overall success rate of 92.4%. The success rate was significantly lower in younger patients with subclavian catheterization. Insertion-related complications were noted, including 33 arterial punctures (8.9%), 27 cases of malposition (7.3%), 19 hematomas (5.2%), 12 cases of minor bleeding (3.3%), and three cases of pneumothorax (0.8%), and they were more common in the subclavian vein than in the internal jugular and femoral vein. Multiple attempts and failed attempts significantly correlated with higher incidence of complications. Maintenance-related complications included obstruction (n = 26; 7%), accidental removal (n = 14; 3.8%), central venous thrombosis (n = 8; 2.2%), subcutaneous extravasation (n = 14; 3.8%), dislodgment (n = 1; 0.25%), and extravascular infusion (n = 1; 0.25%). The frequency of catheter maintenance-related complications was significantly higher in femoral catheterizations and increased significantly with an increase in the duration of catheterization. A total of five serious complications were seen (pneumothorax in three, dislodgment in one and extravascular infusion in one) in the present series. Conclusions: Central venous catheterization in critically ill children is a relatively safe procedure, with a 1.3% rate of serious complications and no mortality. It seems safer to choose initially the femoral or internal jugular vein instead of the subclavian vein because of high success rate without serious insertion-related complications.

Menstrual pattern and common menstrual disorders among university students in Turkey.

Abstract: Background: Menstrual disorders may affect the life of adolescents and young adult women, and may sometimes cause serious problems. The patterns of menstrual cycles were analyzed for association with age of menarche, prevalence of menstrual irregularity, dysmenorrhea, prolonged menstrual bleeding, and effect of menstrual disorders, especially dysmenorrhea, on social activities and school attendance among the female students. Methods: A total of 480 students were randomly selected and asked to complete an the anonymous questionnaire of 25 items. Results: The mean age of the subjects at menarche was 12.8 ± 1.3 years with a range of 9–17 years. The duration between two periods and the menstrual flow were 27.7 ± 2.5 days and 5.8 ± 1.4 days, respectively. The prevalence of menstrual irregularity, prolonged menstrual bleeding and dysmenorrhea were 31.2%, 5.3% and 89.5%, respectively. Approximately 10% of dysmenorrheic subjects had severe dysmenorrhea; and school absenteeism and need to consult a physician were more common in those subjects. The first source of their knowledge about menarche and menstruation was their mothers in 211 subjects (54%); only 18 subjects (4.6%) were given a lecture about menstruation and menarche at school. Conclusion: The prevalence of dysmenorrhea and menstrual irregularity was high, and most adolescents have inappropriate and insufficient information about menstrual problems. Hence, an education program is needed at the end of primary school about menarche and menstrual problems.

Lactobacillus casei rhamnosus Lcr35 in children with chronic constipation.

Abstract: Background: The purpose of the present paper was to evaluate the efficacy of probiotics (Lactobacillus casei rhamnosus, Lcr35) for treating children with chronic constipation and to compare its effect with magnesium oxide (MgO) and placebo. Methods: This double-blind placebo-controlled, randomized study enrolled 45 children under 10 years old with chronic constipation. They were randomly assigned to receive Lcr35 (8 × 108 c.f.u./day; n = 18), MgO (50 mg/kg/day; n = 18), or placebo (n = 9) orally twice daily for 4 weeks. Lactulose use (1 mL/kg per day) was allowed when no stool passage for 3 days was noted. Glycerin enema was used only when no defecation was noted for >5 days or abdominal pain was suffered due to stool impaction. Bacterial cultures of stool were performed before and after treatment to evaluate the change of intestinal flora. Comparisons of the frequency of defecation, consistency of stool and the use of lactulose or enema during the period of treatment were made among the three groups. Results: The patients who received MgO or probiotics had a higher defecation frequency (P = 0.03), higher percentage of treatment success (P = 0.01), less use of glycerin enema (P = 0.04) and less hard stool (P = 0.01) than the placebo group. There was no significant difference between MgO and probiotic groups in the aforementioned comparisons. The first effect of MgO (second week) on constipation was slightly earlier than that of probiotic (second to third week). Abdominal pain occurred less frequently in the probiotic group than in both the MgO and the placebo groups (P = 0.03). There was no statistically significant difference among the three groups in the use of lactulose, episodes of fecal soiling, and change of appetite. No adverse effect was noted in probiotic and placebo groups. Only one patient in the MgO group suffered from mild diarrhea. Conclusion: Lcr35 was effective in treating children with chronic constipation. There is no statistically significant difference in efficacy between MgO and Lcr35, but less abdominal pain occurred when using Lcr35. Study with larger case number and longer follow up is needed in the future.

Prevalence of coronary artery abnormality in incomplete Kawasaki disease

Abstract: Background: The aim of the present study was to determine the prevalence of coronary artery abnormality (CAA) and other clinical features in patients with incomplete Kawasaki disease (iKD) using the data from the 17th Japanese nationwide survey of KD. Methods: iKD was defined as the presence of four or fewer of the principal symptoms of the Japanese diagnostic guidelines, regardless of whether the patient had CAA. A total of 15 857 cases were analyzed. Results: Among 15 857 cases, 83.9% of patients had five to six principal symptoms (complete KD: cKD), and 16.1% had iKD. The prevalence of CAA in cKD was 14.2%, and 18.4% in iKD. The prevalence of CAA in patients with four principal symptoms was 18.1%, which was higher than in cKD cases (14.2%). Although the reliability of the data has some limitations, the prevalence of CAA among patients with one to three symptoms was 19.3%. Among all CAA patients, 14% had four symptoms, and 6% had only one to three symptoms. Conclusion: Incomplete KD should not be equated with mild KD. Patients with four principal symptoms were comparable to cKD with respect to CAA occurrence. In patients with one to three symptoms also, especially in those under 1 year and older than 4 years of age, other significant symptoms and laboratory findings of the guidelines are very important in making a correct and early diagnosis of iKD so as to prevent CAA.

Duration of inter-facility neonatal transport and neonatal mortality: systematic review and cohort study.

Abstract: BACKGROUND: Regionalization of perinatal health services has been actively discussed, although important determinants such as effect of duration of neonatal transport on neonatal outcomes have not been investigated well as yet. Therefore the purpose of the present paper was to investigate the association between duration of inter-facility transport and perinatal mortality. METHODS: For the systematic review, six major databases were searched. Any comparative studies investigating associations between duration of inter-facility neonatal transport and their outcomes, published in the English language were selected. The studies were screened and reviewed by two independent researchers. For the cohort study, study subjects included every neonate transported to neonatal wards in Osaka, Japan between 1980 and 2000 in an existing surveillance called Neonatal Mutual Cooperative System. They are followed up until 28 days of age, or discharge if earlier. Other variables were also considered as effect modifiers or confounders, including calendar year, birthweight (BW), gestational age (GA), sex, maternal/paternal age, Apgar scores at 1 and 5 min, place of birth and personnel accompanying the neonate during transport (transport personnel), body temperature before transport and on admission, severity of illness, and intraventricular hemorrhage (IVH) grade. Cox regression analyses were performed to obtain principal results, and sensitivity analysis to support them. RESULTS: Systematic review: only one cross-sectional study conducted in an urban area in India was identified. That study showed that neonates with a long duration of transport had 79% higher odds of death than those transported for a short duration after adjusting for the confounding effects. For the cohort study, among 16 429 subjects, full data were available for 4966 neonates. There was strong evidence that those transported for >90 min had more than twice the rate of neonatal death (rate ratio [RR] 2.26, 95% confidence interval [CI]: 1.26-4.04), and some evidence that those transported for between 60 and 89 min had an 80% higher rate of neonatal death (RR 1.81, 95%CI: 1.07-3.06), both compared with those transported for between 30 and 59 min, after adjusting for the confounding effects. A sensitivity analysis on missing values also supported the results. CONCLUSION: There is evidence of an association between duration of transport and increased neonatal mortality, which can be applied to organization of perinatal health services. A prospective cohort study is needed for further investigation.

Human milk reduces the risk of retinal detachment in extremely low-birthweight infants

Abstract: Background: Retinopathy of prematurity (ROP) is a major cause of blindness in children. Because the use of oxygen is a known risk factor for development of ROP, supplemental oxygen is used carefully. However, it does not necessarily reduce the morbidity of ROP-induced blindness. The aim of the present study was to identify the possible risk factors for progression to retinal detachment, a most relevant cause of visual impairment, in extremely low-birthweight infants (ELBWI). Methods: The medical records of the 42 ELBWI who were admitted to the neonatal intensive care unit in Asahikawa Kosei Hospital from April 1999 to March 2004 were retrospectively reviewed. Seven infants (16.7% of the ELBWI) developed retinal detachment and two of them became blind. Perinatal and postnatal variables in these infants with retinal detachment were compared with those in infants without retinal detachment. Results: A striking difference in the daily intake of human milk was found between the infants with or without retinal detachment when their gestational ages at birth were matched. The infants without retinal detachment were fed more human milk (67–83% volume of total nutritional intake) as compared to those with retinal detachment (24–38% volume of total nutritional intake) at a specific postnatal period, 5–7 weeks postnatal age. Conclusions: Human milk may contain some beneficial factors to reduce the severity of ROP. Identifying these factors in human milk may contribute to development of a strategy to rescue premature infants from blindness.

Prevalence and clinical findings of migraine and tension-type headache in adolescents.

Abstract: Background: The majority of previous studies on headache in children and adolescents have focused mainly on migraine. There is a paucity of population-based studies investigating the prevalence of tension-type headache (TTH). The objectives of the present study were to estimate the prevalence of migraine and TTH in adolescents using the 2004 International Headache Society (IHS) criteria and to determine the sociodemographic and clinical differences between the migraine and TTH. Methods: Stratified group sampling was used in the present analytic, school-based, cross-sectional study. From the city of Izmir, 2384 students aged 14–18 years were invited to complete a questionnaire. Results: Migraine was found to be more common than TTH (21.3% vs 5.1%). The prevalence increased considerably to 29.9 and 15%, respectively, when the criteria defining the number and duration of headaches were excluded. All types of headaches were more frequent in female subjects but no significant difference was found in gender between the headache groups (P= 0.073). Headache in temples, number of siblings (more than one sibling), mother’s and father’s education (at least high school graduation) were more commonly seen in students with TTH. Absenteeism rate due to the headache was found to be higher in the migraine group than in the TTH group (P= 0.000). Conclusions: Migraine and TTH were found to be common types of headaches in adolescents. It was thought that, with the use of modified IHS criteria, the number of undiagnosed patients with headache will decrease.

Diagnosis of rickets and reassessment of prevalence among rural children in northern China.

Abstract: Background: Rates of rickets from 15.9 to 26.7% have been reported in China. Methods: Combining the methods of epidemiology and the behavioral sciences, this study investigated the prevalence of rickets in children in rural Shanxi Province, China. A total of 250 children age 12–24 months were examined physically for the presence of rickets, blood was drawn for laboratory analysis, and X-rays were taken of each child’s wrists. Results: Vitamin D deficiency in the spring was found among 65.3% of children. Rickets diagnosis relying on clinical signs alone determined a rickets prevalence of 41.6%, declining to 17.0% in the fall after a summer of sun exposure (χ2 = 8.356, P = 0.004). But an integrated diagnostic method exploiting clinical signs, X-ray and alkaline phosphatase levels found the prevalence of active rickets to be 3.7%. Furthermore, it was demonstrated that only five clinical signs reflect active rickets – wide wrists, frontal bossing, rachitic rosary, Harrison’s sulcus, and bowed legs. Conclusions: The prevalence of active rickets in young children in northern China is lower than previously reported. Even in poor countries, simple tests such as X-rays and alkaline phosphatase can be added to physical examination to more accurately diagnose active rickets.

Duration of fever and markers of serious bacterial infection in young febrile children.

Abstract: Background : Despite the drastic change in the evaluation of the febrile young child due to the decreased inci- dence of serious bacterial infections (SBI) effected by Haemophilus infl uenza type B and pneumococcal vac- cine, there remains a small role for blood work in the evaluation of these patients. Bacterial markers including white blood cell (WBC) count, absolute neutrophil count (ANC) and C-reactive protein (CRP) have been studied and are widely used as predictors of SBI in febrile children. It has been suggested that CRP values should be interpreted cautiously when fever has been present 12 h, and compared. Results : One hundred and twenty-eight patients were originally enrolled. Nine patients were excluded. Seven- teen patients (14%) had SBI. One patient ( 12 h. Area under the curve (AUC) for WBC, ANC and CRP was signifi cantly larger in patients with SBI presenting with fever >12 h (0.85, 0.83, 0.92 respectively) compared to patients with SBI who presented with fever for £ 12 h (0.37, 0.42, 0.68 respectively). Conclusions : Bacterial markers studied were more predictive of SBI if the duration of fever was >12 h as shown by the AUC. CRP performed better than WBC and ANC in both scenarios.

Cerebral hemiatrophy (Dyke-Davidoff-Masson syndrome) in childhood : Clinicoradiological analysis of 19 cases

Abstract: Background: The purpose of this study was to emphasize the clinical and imaging findings of 19 child cases of cerebral hemiatrophy. Methods: A total of 11 male and eight female patients underwent assessment with computed tomography and magnetic resonance imaging. The patients ranged from 1 to 17 years in age. The evaluated parameters were: location of the lesions, midline structural shift effect, ipsilateral calvarial and parenchymal changes. Results: Left cerebral hemiatrophy was seen in 14 of the cases while right cerebral hemiatrophy was observed in five cases. Unilateral calvarial thickening was seen in 11 cases, hyperpneumatization of paranasal sinuses in five, and hypoplasia of the middle frontal cranial fossa in three patients. Cerebral peduncle atrophy was noted in seven cases. In total, 11 patients had thalamic atrophy and lentiform nucleus hypoplasia. In one case, cerebral hemiatrophy was associated with ipsilateral large schizencephalic cleft and absence of the septum pellucidum, whereas in another case, there was diffuse cerebellar atrophy associated with cerebral hemiatrophy. Conclusion: Computed tomography and, in particular, magnetic resonance imaging are the procedures of choice with respect to assessment of the etiology and extent of cerebral parenchymal involvement in cerebral hemiatrophy.

Home mechanical ventilation in children: retrospective survey of a pediatric population.

Abstract: Background: Home care support is beneficial for children needing mechanical ventilation, when clinically stable. Methods: A retrospective analysis was carried out of the long-term home ventilation management of a pediatric population with chronic respiratory failure composed of 20 ventilator-dependent children categorized according to age, diagnosis and ventilation support. Age groups consisted of 10% under 1 year, 30% between 2 and 5 years, 30% between 6 and 12 years, and 30% older than 12 years. Diagnostic categories included myopathic disorder, n = 5; congenital central hypoventilation syndrome, n = 6; chest wall disorder, n = 5; cystic fibrosis, n = 1; pulmonary hypertension, n = 1; and diaphragmatic paralysis, n = 2. Results: Sixty-five percent were ventilated using non-invasive mode (NIMV): eight with nasal mask, five with full-face mask, and two children in NIMV also used negative pressure mode; 35% were ventilated using tracheostomy, one of them also used a diaphragmatic pacer. Seventy percent needed nocturnal ventilatory support, (20% 12–18 h, 10% full-day). A total of 18 children were included in the home care and follow-up program. Two children died: one because of worsening of his chronic disease and one because of septic shock. Conclusion: Although home care ventilation is not yet widely diffused, it represents a valid alternative to long hospitalization for children with stable chronic respiratory failure.

Low-level chronic mercury exposure in children and adolescents: Meta-analysis

Abstract: Background: Mercury is a well-known neurotoxin. There are three kinds of mercury exposure: elemental mercury poisoning, inorganic mercury poisoning and organomercury poisoning. Organomercury is the most toxic. Twenty-four hour urine for mercury and blood mercury are the gold standards for diagnosis of mercury poisoning, including low-level chronic mercury exposure. Other tests for mercury level are discussed. The purpose of the present paper was to review recent data on the nature, pathophysiology, pharmacokinetics, diagnostic methods, treatment and the linkage to neurodevelopmental disabilities of mercury exposure in children. Methods: A literature search was undertaken of MEDLINE (1980–2003), and American Academy of Pediatrics, American Medical Association, American Dental Association, World Health Organization and Center for Disease Control websites. The search string ‘mercury’ was used in MEDLINE and articles were selected as appropriate by two independent reviewers. All relevant information was reviewed and data were extracted by two independent reviewers. Results: Based on the meta-analysis of the accuracy of hair mercury, hair mercury levels correlated with mercury level in blood (sample size weighted correlation coefficient, = 0.61), with 24 h urine ( = 0.46) and with cord blood ( = 0.64). However, the correlation for hair mercury level with 24 h urine level and blood level was not high enough to replace them in clinical decision-making of individual patient. Epidemiological evidence has shown that low-level mercury poisoning is not a cause of autism (relative risk = 0.49, 95%CI = 0.36–0.66). The risk of neurodevelopmental disabilities from low-level exposure to methylmercury from the regular consumption of fish is still controversial even after combining results from different epidemiological studies worldwide. There is a lack of data in the literature about the effect of chelation therapy in children with neurodevelopmental disabilities. Conclusion: Mercury poisoning should be diagnosed only with validated methods. There is no evidence to support the association between mercury poisoning and autism.

Stromal cell‐derived factor‐1α improves infarcted heart function through angiogenesis in mice

Abstract: Background: Local delivery of stromal cell-derived factor-1α (SDF-1) has been demonstrated to improve hind limb ischemia through enhanced neovascularization in animals. It was hypothesized that local administration of SDF-1 also contributes to neovascularization of ischemic heart. Method: Acute myocardial infarction was created by left coronary artery ligation in C57BL/6J mice. Immediately after infarction induction, mice were treated by injection directly into the center of ischemic myocardium either with saline (control group) or SDF-1 (SDF-1 group). Cardiac function was measured on echocardiogram 2 and 4 weeks after infarction. On week 4 mice were killed to evaluate infarction size and capillary vessel density. To determine the contribution of bone marrow cells to angiogenesis, the same procedures were performed on C57BL/6J chimeric mice reconstituted with green fluorescent protein-positive bone marrow cells. Results: Fractional shortening was greater in the SDF-1 group at 4 weeks (0.31 ± 0.06% vs 0.23 ± 0.03%, P = 0.037). The infarct area was smaller in the SDF-1 group compared to the control group (9.31 ± 2.76% vs 18.07 ± 5.69%, P = 0.028). Green fluorescent protein-positive cells accumulated predominantly at the peri-infarction site, and were located with the capillary vessels. Capillary vessel density was significantly increased in the SDF-1 group (13.08 ± 4.11 vessels/mm2 vs 34.50 ± 7.59 vessels/mm2, P = 0.014). Conclusions: SDF-1 protects against deterioration of cardiac function after acute myocardial infarction by promoting angiogenesis. The safety and long-term prognosis of this treatment remains to be determined.

Association of Helicobacter pylori infection with gastroduodenal disease, epidemiologic factors and iron-deficiency anemia in Turkish children undergoing endoscopy, and impact on growth.

Abstract: Background : The purpose of the present paper was to investigate the relationship between Helicobacter pylori infection and clinical symptomatology, breast-feeding and socioeconomic level. The relationship between H. pylori and iron-defi ciency anemia (IDA) and the effect of H. pylori infection on growth were also investigated. Methods : The subjects consisted of 70 patients aged 4 - 16 years who underwent upper gastrointestinal endos- copy for recurrent abdominal pain, nausea, vomiting, and dyspeptic complaints during a 2 year period. Patients were divided into two groups according to presence of histological evidence of H. pylori infection (group 1, H. pylori positive; group 2, H. pylori negative) and groups were compared with respect to epidemiologic charac- teristics, gastrointestinal complaints, height and weight SD scores and IDA. Results : Thirty-fi ve (50%) of the 70 patients participating in the study were H. pylori positive. The mean age of group 1 was signifi cantly higher than that of group 2. There were similar characteristics and symptomatology between groups. The majority of the patients in group 1 belonged to low socioeconomic class (class I and II; P < 0.05). The number of the patients exclusively breast-fed for ³ 4 months was signifi cantly higher in group 2 than in group 1. Gastritis was signifi cantly more frequent in group 1. Mean hemoglobin , serum Fe and ferritin levels were 11.6 ± 1.7 g/dL, 45.0 ± 23.2 g/dL and 11.9 ± 8.4 g/dL, respectively, for group 1 and 12.2 ± 0.7 g/ dL, 79.3 ± 26.4 g/dL and 42.1 ± 31.8 g/dL, respectively, for group 2. The mean serum Fe and ferritin levels of group 2 were signifi cantly higher than those of group 1. IDA was observed in 20 (57.1%) and six (17.1%) patients in groups 1 and 2, respectively. IDA was signifi cantly more frequent in group 1. Helicobacter pylori infection was found to be the only variable that had signifi cant effect on IDA. Mean SD height and weight for group 1 were lower than those of the group 2. When the patients were evaluated in four groups according to H. pylori and IDA status, mean height SD score of patients with both H. pylori infection and IDA was signifi - cantly lower than that of the patients negative for H. pylori and IDA concomitantly. Conclusion : Low socioeconomic status seems to be an important risk factor for H. pylori infection. Exclusive breast-feeding at least for 4 months can have a protective role against H. pylori infection. Increased frequency of growth retardation and IDA in H. pylori -infected patients in the present study supports similar fi ndings in the literature, although there is still need for detailed studies to clarify the causative mechanisms.

Risk factors for protein-energy malnutrition in children under 5 years: study from Luangprabang province, Laos.

Abstract: Laos is one of the poorest countries in which chronic malnutrition is highest. The aim of the present study was to determine the prevalence of and to identify risk factors associated with protein-energy malnutrition (PEM) in children under 5 years of age in Luangprabang province Laos. This cross-sectional study was undertaken from March to May 2004. Anthropometric measurements of 798 children were done and data were transformed into height-for-age weight-for-age and weight-for-height ratios. Mothers were also interviewed with a semi-structured questionnaire. Anthropometric data were entered into Nutstat in Epi-Info 2000 and transferred to SPSS for analysis. There was a high prevalence of stunting underweight and wasting that is 54.6% 35% and 6% respectively. It was also noted that children aged 12-23 months and Khmu ethnic children had a higher prevalence of stunting (65% and 66%) and underweight (45% and 40%) respectively. However it was also found that boys were more prone to be stuntedand underweight. Furthermore restricted intake of meats vegetables during illness and low maternal education were main risk factors for child malnutrition in the study area. Socioeconomic-demographic factors low maternal education poor nutrition knowledge for mother and feeding practices for sick children are affecting childrens health regarding stunting and underweight. It is recommended that an improvement in societal infrastructure better maternal education and nutrition are needed to address the child malnutrition issue. (authors)

Human heme oxygenase-1 deficiency: a lesson on serendipity in the discovery of the novel disease.

Abstract: The first case of human heme oxygenase (HO)-1 deficiency was reported by Yachie et al. at our laboratory in the Department of Pediatrics, Angiogenesis and Vascular Development, Kanazawa University Graduate School of Medical Science, in 1999. In the present paper I would like to review this novel disease. Our studies into HO-1 deficiency were called by us 'Kanazawa version Project X'. From the story of our successful discovery we have learned that serendipity is a very important spiritual factor. Serendipity is the making of fortunate and unexpected discoveries by chance (from its possession by the heroes in the Persian fairy tale The Three Princes of Serendip).

Risk factors for small for gestational age.

Abstract: Background: The purpose of the paper was to determine the risk factors for small-for-gestational-age (SGA) infants at full term, in Japan. Methods: The study was conducted at four hospitals and clinics in the Tokyo metropolitan area. A retrospective review of 2972 mothers and their infants born from singleton pregnancies at any time during the years 2002 and 2003 was conducted. Results: Of these women, 8.4% gave birth to SGA infants. The proportion of SGA infants was significantly higher among heavy smokers (>10 cigarettes/day; 13.7%, P 12 kg. Conclusion: The present study clearly confirms the detrimental effect of a low prepregnancy body mass index, low maternal weight gain and maternal smoking during pregnancy on the incidence of SGA infants.

Clinical characteristics and survival of trisomy 13 in a medical center in Taiwan, 1985-2004.

Abstract: This study investigated the survival and natural history of trisomy 13 in a series of patients comparing the management and outcome before and after the implementation of Taiwans National Health Insurance program (NHI). A total of 28 cases of trisomy 13 seen at Mackay Memorial Hospital Taipei Taiwan from 1985 to 2004 were retrospectively reviewed. Survival and management before (12 cases) and after (16 cases) the implementation of National Health Insurance were compared and structural defects imaging findings and cytogenetic results were analyzed. The cases that were diagnosed prenatally and finally terminated were excluded from this study. The diagnosis of trisomy 13 was based on the postnatal chromosome analysis. All patients except one with trisomy 13 translocation died in their first year because of severe malformations of the cardiovascular or central nervous system. The median survival was 9 days. After implementation of National Health Insurance survival with trisomy 13 was significantly longer than before (P < 0.05). The three most common structural defects were abnormal auricular helices or low-set ears (89%) cryptorchidism and abnormal scrotum of male (73%) and cleft lip and/or palate (71%). Using echocardiography the most commonly detected heart defects were patent ductus arteriosus (68%) ventricular septal defect (50%) and atrial septal defect (50%) and eight cases (36%) had complex congenital heart defects. The most common brain lesion was lenticulostriate vasculopathy (22%) followed by holoprosencephaly (17%) brain edema (13%) and subependymal cyst (13%). Early diagnosis and the survival patterns from the data collected should be used to inform parents and health-care professionals to assist in decision making. Although most patients with trisomy 13 die within the first weeks after birth it is important to recognize that a few may survive the first year. When counseling families the long-term survival prospects of trisomy 13 patients should be included. (authors)

Study of Japanese encephalitis and other viral encephalitis in Nepali children.

Abstract: A hospital-based prospective cross-sectional study was conducted in children aged 1 month - 14 years to identify the proportion of viral encephalitis due to Japanese encephalitis (JE) and compare the clinico-laboratory profile and outcome of JE with that of other viral encephalitis (non-JE). All probable cases of viral encephalitis on clinical and laboratory evaluation were confirmed as JE on anti-JE IgM in cerebrospinal fluid (CSF) and/or serum. Patients not having anti-JE IgM in CSF and/or serum were diagnosed as having non-JE. Of 94 cases 58 were JE and 36 non-JE. Although practice of rearing pigs at home was associated with JE (P = 0.0001) significantly higher serum creatinine protein aspartate aminotransferase and CSF protein levels were observed in non-JE. Longer duration of fever was associated with complete recovery in JE whereas shorter duration of fever was associated with recovery in non-JE. Risk of neurological sequelae (P = 0.01) especially hemiparesis (P = 0.03) was significantly more in JE. Sequelae were observed at 6 weeks follow up in 18.8% of JE and 13.9% of non-JE. JE was the most common cause of viral encephalitis in eastern Nepal and should be suspected in encephalitic patients having pig rearing at home and neurological sequelae. Although duration of hospitalization and complication were higher in JE final outcome was similar to non-JE. Longer duration of fever in JE and shorter duration of fever in non-JE correlated with recovery while altered sensorium and focal neurological deficit were independent predictors of sequelae at 6 weeks only in JE and not in non-JE. (authors)

Factors determining prenatal HIV testing for prevention of mother to child transmission in Dar Es Salaam, Tanzania.

Abstract: The objectives of the study were (i) to evaluate the Prevention of Mother to Child Transmission (PMTCT) services in Temeke district Tanzania and (ii) to identify factors for non-acceptance of HIV testing among pregnant mothers in the area. A structured questionnaire was used in face-to-face interviews at five health centers in the district. Univariate and multiple logistic regression analyses were used to assess the association of the refusal of human immunodeficiency virus (HIV) testing with risk factors. Two hundred and seventy-three (68.1%) of the participants had already had HIV testing while 128 (31.9%) had not. Participants general knowledge of HIV was high but specific knowledge of mother to child transmission (MTCT) was relatively low. In the multiple logistic regression analysis frequencies of antenatal clinic visits awareness of MTCT and intensive family support were significantly and inversely associated with the refusal of HIV testing. Frequency of antenatal care visits spreading information on HIV/acquired immune deficiency syndrome especially MTCT and husbands intensive support are significant factors for increase of HIV test acceptance among pregnant women in the study area. (authors)

Pain management and the effect of guidelines in neonatal units in Austria, Germany and Switzerland.

Abstract: BACKGROUND: Painful invasive procedures are frequently performed on preterm infants admitted to a neonatal intensive care unit (NICU). The aim of the present study was to investigate current pain management in Austrian, German and Swiss NICU and to identify factors associated with improved pain management in preterm infants. METHODS: A questionnaire was sent to all Austrian, German and Swiss pediatric hospitals with an NICU (n = 370). Pain assessment and documentation, use of analgesics for 13 painful procedures, presence of written guidelines for pain management and the use of 12 analgesics and sedatives were examined. RESULTS: A total of 225 units responded (61%). Pain assessment and documentation and frequent analgesic therapy for painful procedures were performed more often in units using written guidelines for pain management and in those treating >50 preterm infants at <32 weeks of gestation per year. This was also the case for the use of opioid analgesics and sucrose solution. Non-opioid analgesics were used more often in smaller units and in units with written guidelines. There was a broad variation in dosage of analgesics and sedatives within all groups. CONCLUSION: Pain assessment, documentation of pain and analgesic therapy are more frequently performed in NICU with written guidelines for pain management and in larger units with more than 50 preterm infants at <32 weeks of gestation per year.

Neonatal subgaleal hemorrhage: Clinical presentation, treatment, and predictors of poor prognosis

Abstract: Background: Neonatal subgaleal hemorrhage (SGH) is a rare but potentially lethal medical emergency. The objective of the present retrospective study was to clarify the clinical presentation, management, and factors associated with morbidity and mortality. Methods: The records of all newborns from January 1995 to December 2004 were reviewed for evidence of SGH, based on the presence of a fluctuating hemorrhagic mass that crossed suture lines and extended toward the neck. Characteristics were compared between those with a poor or a good outcome. Results: Forty-two newborns with SGH were identified, 77% having had an instrumental delivery. The incidence was 0.6/1000 deliveries and 4.6/1000 vacuum-assisted deliveries. Thirteen patients (31%) had a poor outcome (five died, four had epilepsy, three with severe auditory dysfunction, two with cerebral palsy, and one with renal vein thrombosis). The group with the poor outcome had significantly more patients who had been transferred from other hospitals (P < 0.001). Those with a poor outcome had significantly more hypotension (P < 0.001) and seizures (P < 0.05). Laboratory findings associated with a poor outcome included anemia, coagulopathy, metabolic acidosis, and renal impairment. Other predictors of a poor prognosis included skull bone fracture, the need for pressors, blood transfusion, ventilator support, intensive care unit admission, and a longer hospital stay. Conclusions: SGH may be associated with serious complications and death. The condition must be recognized promptly and monitored closely. Those with poor prognostic factors should be referred for intensive care, treated aggressively, and followed in the long term.

Child abuse study among Swedish physicians and medical students.

Abstract: Background: The purpose of the present paper was to examine the attitudes and experiences of reporting child abuse and neglect among primary care and hospital-based physicians and to study the responses of physicians and medical students to case vignettes suggestive of possible physical abuse or neglect. Methods: Physicians at the child health centers in Goteborg primary care (n= 44) and the general pediatricians at the pediatric hospital (n= 21) in Goteborg answered a questionnaire regarding their attitude and experiences reporting child abuse and neglect. The physicians and medical students (n= 34) responded to three case vignettes in which child abuse and neglect could be suspected. Results: A majority of the physicians had reported child abuse and neglect to the social services (80%). No differences were found between primary care and hospital-based physicians in terms of reporting or attitudes. Two-thirds of the physicians had suspected child abuse and neglect and decided not to report, and the major reason for not reporting was a lack of confidence in social services organization. Twenty-one percent had never reported a child for abuse or neglect during their working career. Medical students were more likely to report hypothetical cases than physicians. Conclusion: Many physicians have reported child abuse to social services but also have neglected to do so even when suspecting abuse. It is important that medical students' willingness to report is continued when starting to work clinically and that all physicians should be continuously educated. Language: en

Thyroid function and volume in epileptic children using carbamazepine, oxcarbazepine and valproate

Abstract: Background The aim of the present study was to investigate the effects of carbamazepine (CBZ), oxcarbazepine (OXC), and valproic acid (VPA) on thyroid function and volume in epileptic children. Methods Fifty-three epileptic children (age, 3-17 years) treated with OXC (n = 10), CBZ (n = 12), or VPA (n = 31) at least for 1 year were evaluated in terms of thyroid hormones, thyroid-stimulating hormone (TSH) levels, response to thyrotropin-releasing hormone (TRH) stimulation test, and thyroid volumes. Results The patients in the OXC and CBZ groups had similar total thyroxin (TT4) and free T4 (fT4) median levels that were significantly lower than those of the VPA group (P 0.016). One child from the OXC group (10%), one from the CBZ group (%8.3), and six from the VPA group (19.3%) had hypothyroidic status according to the TRH stimulation test. No statistically significant correlations were found between thyroid gland volume and thyroid function variables and between anti-epileptic drug receiving time and thyroid function or thyroid volume, respectively, in any of the groups (P > 0.05). Conclusions Thyroid function should be evaluated periodically in children using CBZ, OXC or VPA. The children taking VPA seems to be at greater risk compared to children onr CBZ or OXC therapy. Except for the basal TSH values in the VPA group, the parameters predictive for the subclinical hypothyroid status remain to be evaluated in further studies.

Adult asthma after non-respiratory syncytial virus bronchiolitis in infancy: subgroup analysis of the 20-year prospective follow-up study.

Abstract: Background: Recent studies have stressed the influence of other viruses than respiratory syncytial virus (RSV) in the development of asthma in later childhood after bronchiolitis in infancy. However, the virus-specific prognosis until adulthood has remained obscure, due to lack of sufficiently long follow-up studies. The aim of the present study was to evaluate adult respiratory morbidity after bronchiolitis in infancy, focused on cases not caused by RSV. Methods: A total of 54 children hospitalized for bronchiolitis at age <2 years were re-studied at median age 19 years; 22 with RSV bronchiolitis and 22 with non-RSV bronchiolitis outside RSV epidemic were included. RSV etiology was studied by antigen and antibody assays on admission. Adult asthma was defined by two ways, based on written questionnaire, clinical examination and home peak expiratory flow monitoring. Lung function was evaluated by flow-volume spirometry (FVS), bronchial reactivity by methacholine inhalation challenge (MIC), and atopy by skin prick tests (SPT). Results: In the non-RSV group, asthma by two definitions was present in 41–50% (vs 18–27% in RSV group). In logistic regression, adjusted for gender, age on admission, current atopy and smoking, non-RSV etiology of bronchiolitis, compared with RSV etiology, increased asthma risk by both strict (odds ratio [OR], 8.34; 95% confidence interval [CI], 1.18–58.69) and less strict (OR, 7.93; 95% CI, 1.14–55.41) criteria. An abnormal result in FVS was present in 32–41% and in MIC in 48–52% of cases in non-RSV and RSV groups, respectively. Conclusions: Infants with non-RSV bronchiolitis requiring treatment in hospital are at an increased risk for subsequent asthma in adulthood.

Etiology of neonatal gastric perforations: Review of 10 years’ experience

Abstract: Background: Neonatal gastric perforation (NGP) is a rare event and its etiology is still controversial. Although it has previously been described as spontaneous, recently some risk factors have been reported to be associated with the development of NGP including prematurity and nasal ventilation. The purpose of the present paper was to report and discuss etiology, clinical features, and outcome of the authors’ NGP cases over a 10 year period. Methods: Charts of five infants with NGP was reviewed in terms of gender, birthweight, gestational age, time of diagnosis, associated disease, site of perforation, type of surgery performed, and clinical outcome. Results: There were three boys and two girls with a mean birthweight and gestational age of 1650 g and 32 weeks, respectively. Three of them were premature. Mean perforation time was day 10 postnatally. Three infants had associated problems including prematurity, respiratory distress syndrome type 1, necrotizing enterocolitis, mechanical ventilator support, and one of them had tracheaesophageal fistula. Mothers of two out of these three infants had chorioamnionitis. One full-term infant received dexamethasone because of brain edema. Only one patient had no associated problem. Perforation occurred in the lesser curvature in three infants and in the greater curvature in two infants. Mortality rate was 60%. Conclusions: Contrary to previous literature, and similar to recent publications, it was found that essentially low-birthweight infants with tracheaesophageal fistula or chorioamnionitis and full-term babies on steroid therapy may have a risk for NGP, suggesting that an infant with contributing factors should be monitored more carefully for the development of NGP.

Hypernatremic dehydration in the newborn period and long-term follow up.

Abstract: Background Hypernatremic dehydration due to inadequate fluid intake can be a significant problem during the neonatal period and thereafter. The objective of the present study was to evaluate the term newborn infants admitted to Gazi University Hospital neonatal intensive care unit (NICU) for hypernatremic dehydration between June 2001 and June 2003 and compare the results with those of the literature search performed via MEDLINE for infants with the same diagnosis. Methods Infants with weight loss > or =10% were evaluated for hypernatremia and the ones with serum Na level > or =150 mEq/L were admitted to NICU. Long-term follow-up evaluations were performed using Bayley Scales of Infant Development I (BSID I) and Bayley Infant Neurodevelopmental Screener (BINS) tests. Results Between June 2001 and June 2003, 28 newborns were admitted to NICU with hypernatremic dehydration. Literature review found 178 newborns with the same diagnosis since 1979 and detailed information was available for 150 patients. In the study and MEDLINE groups, respectively mean days of admission were 3.39 and 11.7; mean serum sodium, 156.5 and 178.6 mEq/L; and mean % weight loss, 11.5 and 25.7. Long-term follow up was performed in 15 patients from the study group, and two patients were found to be severely neurologically delayed. Five patients were found to have moderate risk scores by BINS tests. Conclusions Early follow-up visits of newborns soon after discharge are important to determine risk for hypernatremic dehydration. Long-term follow up of this group of babies is also required to gather knowledge about the repercussions of early hypernatremic dehydration later in life.

Mycoplasma pneumonia: clinical and radiographic features in 39 children

Abstract: The purpose of the present paper was to evaluate the clinical and chest radiographic features of pediatric patients with serologically proven Mycoplasma pneumoniae pneumonia (mycoplasma pneumonia). The clinical records and chest radiographs of 39 consecutive patients (19 male 20 female; age 3-13 years) with serologically positive IgG and IgM mycoplasma pneumonia were reviewed. More than 90% of patients presented with fever and cough and 48% of patients had leukocyte count >10 000/mm/3. A C-reactive protein (CRP) level >0.375 mg/dL was noted in 28 patients (72%). Chest radiographs displayed four different patterns: (i) peribronchial and perivascular interstitial infiltrates (n = 19 49%); (ii) airspace consolidations (n = 15 38%); (iii) reticulonodular opacification (n = 3 8%); and (iv) nodular or mass-like opacification (n = 2 5%). Bilateral peribronchial perivascular interstitial infiltrations in central and middle lung zones were frequently seen (n = 19 49%). Other radiological features were bilateral lesions in 51% of patients pleural effusion in 23% and hilar lymphadenopathy in 13%. Means of duration for treatment response and hospitalization were 2.5 and 5 days respectively. There are various radiological features of mycoplasma pneumonia in children. Bilateral peribronchial and perivascular interstitial infiltrates were most frequently seen in the present patients. (authors)

Reduced shear stress and disturbed flow may lead to coronary aneurysm and thrombus formations.

Abstract: Background: With Kawasaki disease it is important to clarify the mechanisms of coronary artery aneurysm and thrombus to avoid acute myocardial infarction. The authors tested the hypothesis that shear stress is reduced at coronary branching sites and in coronary artery aneurysms, and that this reduction of shear stress can promote formation of coronary artery aneurysms and thrombus. Methods: The subjects were 111 children with Kawasaki disease with left coronary artery aneurysms, classified into three groups: giant coronary artery aneurysm (n= 28, diameter of coronary artery >8 mm), aneurysm (n= 44, diameter of coronary artery =8 mm), and normal-appearing coronary (n= 39). Averaged peak flow velocity (APV), flow patterns and shear stress were measured and calculated at normal-appearing coronary vessels, left coronary artery branching sites and intra-coronary aneurysm using flow wire, and coronary angiography. Also, presence and appearance of thrombus were detected by intravascular ultrasonography. Results: The authors found that 90.3% of the coronary artery aneurysms occurred at major left coronary branching sites. APV and shear stress were significantly decreased in giant coronary artery aneurysms (APV, 7.1 ± 2.1 cm/s; shear stress, 3.8 ± 2.1 dyne/cm2) and at the left coronary artery branching site (APV, 9.1 ± 1.2; shear stress, 1±±.2 3.0). In total, 20 of 24 thrombi were detected only in giant aneurysm, and all patients exhibited disturbed flow pattern in their giant coronary artery aneurysms. Conclusions: Reduced shear stress and disturbed flow pattern may lead to coronary artery aneurysm and thrombus formation.

Are foot posture and functional health different in children with growing pains

Abstract: Background: The aim of the present paper was to investigate and compare findings of foot posture and functional health between groups of children aged 4–6 years with and without leg pain (described as “growing pains”). The null hypothesis: that there is no difference in measures of either foot posture or functional health between groups of children with and without leg pain. Methods: A stratified random sample of children was obtained. The children were identified with and without leg pain using a validated questionnaire for parents. The examiner was blind to the children’s pain status. The schools and child care centers were from each geographical quadrant of metropolitan Adelaide and a northern rural region of South Australia. One hundred and eighty children (94 boys, 86 girls) entered and completed the study. Children whose parents returned a completed questionnaire and consent form were entered into the study. All participants were assessed by the one examiner. The foot posture measures used were those found to be most reliable in previous studies and for which the intra-rater reliability of the examiner was ascertained. Results: Initial analysis of foot posture measures between the leg pain and no leg pains groups indicated a statistically significant result for the measure of navicular height, but only on the left side (P = 0.033). Logistic regression modeling showed that navicular height (left foot only) was positively yet weakly related to growing pains (odds ratio, 1.072; 95% confidence interval: 0.991–1.160) and the effect was not significant (P = 0.08). Measures of functional health returned many statistically significant yet weakly correlated relationships. Conclusions: The null hypothesis of the present study was supported in terms of clinical significance. While the foot posture measure of navicular height on the left foot was statistically significant it was not predictive for growing pains nor clinically significant as a measure between groups. The present study does not support the anatomical theory for growing pains and does not find a meaningful relationship between foot posture or functional health measures and leg pain in young children.