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08 November, 2006 |
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Natural history of hepatitis B in perinatally infected carriers
Arch. Dis. Child. Fetal Neonatal Ed. 2004;89:456-460
E H Boxall, J Sira, R A Standish, P Davies, E Sleight, A P Dhillon, P J Scheuer and D A Kelly |
Objectives: To establish natural seroconversion rates and incidence of hepatic pathology in perinatally
infected hepatitis B carriers.
Methods: Seventy three perinatally infected hepatitis B carriers identified through maternal screening were
evaluated. Fifty three were born to parents from the Indian subcontinent, nine were Oriental, six were
Afro-Caribbean, and five were white. Median follow up was 10.24 (range 2.02–20.16) years.
Results: Only three of the children followed up had cleared hepatitis B surface antigen during this period,
and 30% of the children had seroconverted to anti-HBe. Seroconversions to anti-HBe were observed in
Asian (18/50) and white (4/5) children, but not in Oriental or Afro-Caribbean children. More girls (40%)
than boys (23%) had seroconverted, but the difference was not significant. All children were asymptomatic
with normal physical examination, growth, and development. Almost half (48%) of the hepatitis B e
antigen (HBeAg) positive children had normal hepatic transaminases and liver function. Thirty five liver
biopsies were performed in children with active virus replication (HBeAg or hepatitis B virus DNA positive)
who were being considered for antiviral treatment as part of a clinical trial and were scored using the Ishak
method. Two thirds (62%) of the children had mild hepatitis, 60% had mild fibrosis, and 18% had
moderate to severe fibrosis. There was a weak correlation between histological evidence of hepatitis and
hepatic transaminase activity, implying that biochemical monitoring of hepatic disease activity may be
ineffective.
Conclusions: These asymptomatic hepatitis B virus carrier children remain infectious in the medium to long
term with notable liver pathology. They should receive antiviral treatment to reduce infectivity and to
prevent further progression of liver disease. Hepatic transaminases alone are not a reliable marker of liver pathology, and liver histology is essential before consideration for antiviral treatment.
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08 November, 2006 |
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Frequency of Infective Endocarditis Among Infants and Children With Staphylococcus aureus Bacteremia
Pediatrics 2005;115:15-19
Anne Marie Valente, Rajiv Jain, Mark Scheurer, Vance G. Fowler, Jr, G. Ralph Corey, A. Resai Bengur, Stephen Sanders and Jennifer S. Li |
Purpose. The prevalence of infective endocarditis
(IE) among children with Staphylococcus aureus
bacteremia (SAB) is unknown. The objective of this
study was to determine prospectively the prevalence of
IE among pediatric patients with SAB in a large tertiary
care center.
Methods. Between July 1998 and June 2001, all children
who developed SAB whose parent/guardian signed
informed consent underwent echocardiography. Clinical
and follow-up results were collected prospectively. Endocarditis
was classified according to the modified Duke
criteria.
Results. Fifty-one children developed SAB during
the study interval. Definite (6 patients [11.8%]) or possible
(4 patients [7.8%]) IE was present in 10 of 51 (20%)
children with SAB. Most children (73%) developed bacteremia
as a consequence of an infected intravascular
device. Children with underlying congenital heart disease
had a significantly higher prevalence of definite or
possible IE, compared with those with structurally normal
hearts (53% vs 3%). All patients with definite IE had
multiple positive blood cultures. Mortality was high
among patients with and without IE (40% vs 12%).
Conclusions. In this study, the prevalence of definite
IE among children with SAB was 12% and was frequently
associated with congenital heart disease and
multiple positive blood cultures. The mortality for children
with SAB and definite or possible S aureus IE is high.
Pediatrics 2005;115:e15–e19. URL: www.pediatrics.org/cgi/
doi/10.1542/peds.2004-1152; infective endocarditis, Staphylococcus
aureus, congenital heart disease.
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08 November, 2006 |
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Prevention and Treatment of Mucositis: A Guide for Nurses
Journal of Pediatric Oncology Nursing, 2004;21:281-287
Anne Wohlschlaeger, MSN, RN |
Oral mucositis is a frequent and potentially severe
complication that can occur following chemotherapy
or irradiation. Not only is mucositis painful but it can
also result in impaired nutrition, infection, and treatment
delays. Pediatric oncology nurses have a challenge
to try to provide the most appropriate mouth care regimen
specific to each individual patient. This review of
the literature can serve as a guide for helping to prevent
and to treat mucositis. It provides information
about the chemotherapeutic agents responsible for
causing mucositis, many of the preventive approaches
used to reduce the incidence of mucositis, and the current
treatments available for active mucositis. It also
discusses dietary recommendations and the role of the
nurse caring for the patient with mucositis.
Key words: mucositis, oral hygiene, mouthwash
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08 November, 2006 |
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Comparison of Three Fluid Solutions for Resuscitation in Dengue Shock Syndrome
NEJM 2005;353:877-889
Bridget A. Wills, M.R.C.P., Nguyen M. Dung, M.D., Ha T. Loan, M.D., Dong T.H. Tam, M.D., Tran T.N. Thuy, M.D., Nicholas J. White, F.R.C.P., and Jeremy J. Farrar, F.R.C.P. |
background
Dengue shock syndrome is characterized by severe vascular leakage and disordered hemostasis
and progresses to death in 1 to 5 percent of cases. Although volume replacement
is recognized as the critical therapeutic intervention, World Health Organization
management guidelines remain empirical rather than evidence-based.
methods
We performed a double-blind, randomized comparison of three fluids for initial resuscitation
of Vietnamese children with dengue shock syndrome. We randomly assigned
383 children with moderately severe shock to receive Ringer’s lactate, 6 percent dextran
70 (a colloid), or 6 percent hydroxyethyl starch (a colloid) and 129 children with severe
shock to receive one of the colloids. The primary outcome measure was requirement
for rescue colloid at any time after administration of the study fluid.
results
Only one patient died (<0.2 percent mortality). The primary outcome measure — requirement
for rescue colloid — was similar for the different fluids in the two severity
groups. The relative risk of requirement for rescue colloid was 1.08 (95 percent confidence
interval, 0.78 to 1.47; P=0.65) among children with moderate shock who received
Ringer’s lactate as compared with either of the colloid solutions, 1.13 (95 percent
confidence interval, 0.74 to 1.74; P=0.59) among children who received dextran
as compared with starch in the group with severe shock, and 0.88 (95 percent confidence
interval, 0.66 to 1.17; P=0.38) among children who received dextran as compared
with starch in the combined analysis. Although treatment with Ringer’s lactate resulted
in less rapid improvement in the hematocrit and a marginally longer time to initial
recovery than did treatment with either of the colloid solutions, there were no differences
in all other measures of treatment response. Only minor differences in efficacy
were detected between the two colloids, but significantly more recipients of dextran
than of starch had adverse reactions. Bleeding manifestations, coagulation derangements,
and severity of fluid overload were similar for all fluid-treatment groups.
conclusions
Initial resuscitation with Ringer’s lactate is indicated for children with moderately severe
dengue shock syndrome. Dextran 70 and 6 percent hydroxyethyl starch perform similarly
in children with severe shock, but given the adverse reactions associated with the use of dextran, starch may be preferable for this group.
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08 November, 2006 |
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Newborn Tongue-tie: Prevalence and Effect on Breast-Feeding
J Am Board Fam Pract 2005;18:1-7
Lori A. Ricke, MD, Nancy J. Baker, MD, Diane J. Madlon-Kay, MD, MS, and Terese A. DeFor, MS |
Objective: The purposes of this study were: (1) to determine whether breast-fed infants with tongue-tie
have decreased rates of breast-feeding at 1 week and 1 month of age, (2) to determine the prevalence of
tongue-tie, and (3) to test the usefulness of the Assessment Tool for Lingual Frenulum Function (ATLFF)
in assessing the severity of tongue-tie in breast-feeding newborns.
Methods: A case-control design was used. All infants in the Regions Hospital newborn nursery were
examined for tongue-tie. Tongue-tied babies were examined using the ATLFF. Two breast-feeding babies
with normal tongues were identified and matched for each case. Mothers were interviewed when the
babies were 1 week and 1 month old.
Results: The prevalence of tongue-tie was 4.2%. Forty-nine tongue-tied and 98 control infants were
enrolled. Tongue-tied babies were 3 times as likely as control babies to be bottle fed only at 1 week
[risk ratio (RR), 3.11; 95% confidence interval (CI), 1.21, 8.03) By 1 month, tongue-tied babies were as
likely as controls to be bottle fed only. (RR, 1.00; 95% CI, 0.55, 1.82) Twelve of the tongue-tied infants
had ATLFF scores of “Perfect,” none had scores of “Acceptable,” and 6 had scores of “Function Impaired.”
The remaining 31 infants had scores that fell into none of these categories.
Conclusions: Tongue-tie is a relatively common condition in newborns. Affected infants are significantly
more likely to be exclusively bottle-fed by 1 week of age. The ATLFF was not a useful tool to identify
which tongue-tied infants are at risk for breast-feeding problems.
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08 November, 2006 |
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Is Bloodstream Infection Preventable Among Premature Infants? A Tale of Two Cities
Pediatrics 2005;115:1513-1518
Hany Aly, Victor Herson, Anne Duncan, Jill Herr, Jean Bender, Kantilal Patel and Ayman A. E. El-Mohandes |
Background. Bloodstream infection (BSI)
is a significant cause of morbidity and death encountered
in the NICU. The rates of BSIs vary significantly in
NICUs across the nation. However, no attempt has been
made to correlate this variation with specific infectioncontrol
practices and policies. We experienced a significant
increase in BSIs in the NICU at the George Washington
University Hospital and were seeking additional
precautionary measures to reduce BSI rates. Our objective
was to review policies and practices associated with
lower infection rates nationally and to test their reproducibility
in our unit.
Design and Methods. Data on BSI rates in 16 NICUs
were reviewed. The BSI rate at Connecticut Children’s
Medical Center (CCMC) was the lowest among those
reviewed. A team from George Washington University
Hospital conducted a site visit to CCMC to examine their
practices. Differences in the aseptic precautions used for
intravenous line management were noted at CCMC,
where a closed medication system is used. This system
was applied at George Washington University Hospital
starting January 1, 2001. Infection rates among low birth
weight infants (<2500 g) at George Washington University
Hospital in the period from January 1998 to December
2000 (group 1) were compared with those in the
period from January 2001 to December 2003 (group 2).
Comparisons between the 2 cohorts were made with
Fisher’s exact test, the Kruskal-Wallis test, and Student’s
t test. Multivariate analysis was used to control for differences
in birth weight, gestational age, central line
days, and ventilator days. Analyses were repeated for the
subgroup of very low birth weight infants (<1500 g).
Results. A total of 536 inborn low birth weight infants
were included in this retrospective study (group 1,
N 169 infants; group 2, N 367). The incidence of
sepsis decreased significantly from group 1 to group 2
(25.4% and 2.2%, respectively). The reduction of sepsis
observed in association with the new practice was statistically
significant after controlling for birth weight, central
line days, and ventilator days in a multiple regression
model (regression coefficient: 0.95 0.29). The odds
ratio of reduction in sepsis after implementation of the
new practice was 2.6 (95% confidence interval: 1.5– 4.5).
The central line-related BSI rate decreased from 15.17
infections per 1000 line days to 2.1 infections per 1000
line days. The study included 233 very low birth weight
infants, ie, 90 in group 1 and 143 in group 2. The rate of
BSIs decreased significantly from group 1 to group 2
(46.7% and 5.6%, respectively). The decrease in sepsis
rate remained significant in a multiple regression model
(regression coefficient: 1.42 0.35). The odds ratio of
decreased sepsis in relation to the new policy application
among the very low birth weight infants was 4.15 (95%
confidence interval: 2.1– 8.3).
Conclusion. Applying the closed medication system
was associated with reduced BSI rates in our unit. This
protocol was easily reproducible in our environment
and showed immediate results. Serious attempts to share
data can potentially optimize outcomes and standardize
policies and practices among NICUs. Pediatrics 2005;115:
1513–1518; infection, sepsis, closed medication system,
premature infants.
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08 November, 2006 |
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Oral Sildenafil in Infants With Persistent Pulmonary Hypertension of the Newborn: A Pilot Randomized Blinded Study
Pediatrics 2006;117:1077-1083
Hernando Baquero, Amed Soliz, Freddy Neira, Maria E. Venegas and Augusto Sola |
BACKGROUND. Persistent pulmonary hypertension (PPHN) occurs in as many as 6.8 of
1000 live births. Mortality is 10% to 20% with high-frequency ventilation,
surfactant, inhaled nitric oxide, and extracorporeal membrane oxygenation but is
much higher when these therapies are not available. Sildenafil is a phosphodiesterase
inhibitor type 5 that selectively reduces pulmonary vascular resistance.
OBJECTIVE. Our goal was to evaluate the feasibility of using oral sildenafil and its effect
on oxygenation in PPHN.
DESIGN. This study was a proof-of-concept, randomized, masked study in infants
35.5 weeks’ gestation and 3 days old with severe PPHN and oxygenation index
(OI) 25 admitted to the NICU (Hospital Nin˜ o Jesu´ s, Barranquilla, Colombia). The
sildenafil solution was prepared from a 50-mg tablet. The first dose (1 mg/kg) or
placebo was given by orogastric tube 30 minutes after randomization and every
6 hours. Preductal saturation and blood pressure were monitored continuously. OI
was calculated every 6 hours. The main outcome variable was the effect of oral
sildenafil on oxygenation. Sildenafil or placebo was discontinued when OI was
20 or if there was no significant change in OI after 36 hours.
RESULTS. Six infants with an OI of 25 received placebo, and 7 received oral
sildenafil at a median age of 25 hours. All infants were severely ill, on fraction of
inspired oxygen 1.0, and with similar ventilatory parameters. Intragastric sildenafil
and placebo were well tolerated. In the treatment group, OI improved in all infants
within 6 to 30 hours, all showed a steady improvement in pulse oxygen saturation
over time, and none had noticeable effect on blood pressure; 6 of 7 survived. In the
placebo group, 1 of 6 infants survived.
CONCLUSIONS. Oral sildenafil was administered easily and tolerated as well as placebo
and improved OI in infants with severe PPHN, which suggests that oral sildenafil
may be effective in the treatment of PPHN and underscores the need for a large, controlled trial.
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08 November, 2006 |
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Neonatal Hyperbilirubinemia and Risk of Autism Spectrum Disorders
Pediatrics 2005;115:135-138
Lisa A. Croen, Cathleen K. Yoshida, Roxana Odouli and Thomas B. Newman |
Objective. To investigate the association
between neonatal hyperbilirubinemia and autism spectrum
disorders (ASD).
Methods. We conducted a large case-control study
nested within the cohort of singleton term infants born
between 1995 and 1998 at a northern California Kaiser
Permanente hospital. Case subjects (n 338) were children
with an ASD diagnosis recorded in Kaiser Permanente
outpatient databases; control subjects (n 1817)
were children without an ASD diagnosis, who were randomly
sampled and frequency-matched to case subjects
according to gender, birth year, and birth hospital.
Results. Approximately 28% of case and control subjects
received >1 bilirubin test in the first 30 days of life.
No case-control differences were observed for maximal
bilirubin levels of >15 mg/dL (10.1% vs 12.1%), >20
mg/dL (2.1% vs 2.5%), or >25 mg/dL (0.3% vs 0.2%).
Compared with children whose maximal neonatal bilirubin
levels were <15 mg/dL or not measured, children
with any degree of bilirubin level elevation were not at
increased risk of ASD, after adjustment for gender, birth
facility, maternal age, maternal race/ethnicity, maternal
education, and gestational age (for bilirubin levels of
15-19.9 mg/dL: odds ratio: 0.7; 95% confidence interval:
0.5-1.2; for bilirubin levels of 20-24.9 mg/dL: odds ratio:
0.7; 95% confidence interval: 0.3-1.6; for bilirubin levels
of >25 mg/dL: odds ratio: 1.1; 95% confidence interval:
0.1-11.2).
Conclusion. These data suggest that neonatal hyperbilirubinemia
is not a risk factor for ASD. Pediatrics
2005;115:e135–e138. URL: www.pediatrics.org/cgi/doi/
10.1542/peds.2004-1870; autism spectrum disorders, hyperbilirubinemia,
jaundice, pervasive developmental disorder,
neonatal risk.
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03 November, 2006 |
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Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial
BMJ 2004;328:1237
Janet James, Peter Thomas, David Cavan and David Kerr |
Objective To determine if a school based educational
programme aimed at reducing consumption of carbonated
drinks can prevent excessive weight gain in children.
Design Cluster randomised controlled trial.
Setting Six primary schools in southwest England.
Participants 644 children aged 7-11 years.
Intervention Focused educational programme on nutrition
over one school year.
Main outcome measures Drink consumption and number of
overweight and obese children.
Results Consumption of carbonated drinks over three days
decreased by 0.6 glasses (average glass size 250 ml) in the
intervention group but increased by 0.2 glasses in the control
group (mean difference 0.7, 95% confidence interval 0.1 to 1.3).
At 12 months the percentage of overweight and obese children
increased in the control group by 7.5%, compared with a
decrease in the intervention group of 0.2% (mean difference
7.7%, 2.2% to 13.1%).
Conclusion A targeted, school based education programme
produced a modest reduction in the number of carbonated
drinks consumed, which was associated with a reduction in the number of overweight and obese children.
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03 November, 2006 |
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Treatment Regimens for Helicobacter pylori Infection in
Children: Is In Vitro Susceptibility Testing Helpful?
Journal of Pediatric Gastroenterology and Nutrition 2005;40:571-574
Joseph Faber, *Maskit Bar-Meir, †Bernard Rudensky, ‡Yechiel Schlesinger, *Elena Rachman, |
Background: Treatment regimens for Helicobacter pylori have
variable success rates, and data comparing effectiveness with
respect to strain sensitivity are relatively scarce.
Objective: To evaluate the efficacy of two treatment regimens
for eradication of H. pylori and the impact of bacterial susceptibility
testing.
Study Design: 265 children endoscopically diagnosed with
H. pylori infectionwere randomly assigned to receive omeprazole +
amoxicillin with clarithromycin oromeprazole + amoxicillin with
metronidazole. Bacterial culture and susceptibilitywas performed
in a subgroup. Eradication was assessed by 13C-urea breath test.
Results: Eradication was achieved in 73.4% by omeprazole +
amoxicillin with metronidazole and in 62.6% by omeprazole +
amoxicillin with clarithromycin (P = 0.078). H. pylori was
cultured successfully in 105 patients. Resistance to metronidazole
was detected in 31.4% of the isolates and resistance to
clarithromycin in 15%. Eradication rate by omeprazole +
amoxicillin with metronidazole for metronidazole-susceptible
bacteria (N = 38) was 90%, and for resistant bacteria (N = 19) it
was 42%. Only 75% of clarithromycin-sensitive strains were
successfully treated by omeprazole + amoxicillin with clarithromycin,
and none of the cases with clarithromycin-resistant
strains responded to omeprazole + amoxicillin with clarithromycin
treatment.
Conclusion: There is a trend of greater efficacy of eradication
with omeprazole + amoxicillin with metronidazole versus
omeprazole + amoxicillin with clarithromycin therapy. Although
resistance negatively influences eradication, first-line sensitivitybased
treatment would be expected to improve this rate only
slightly. Susceptibility testing should probably be reserved only
for treatment failures.
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03 November, 2006 |
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Anemia Is a Poor Predictor of Iron Deficiency Among Toddlers in the United States: For Heme the Bell Tolls
Pediatrics 2005;115:315-320
Keith C. White |
Context. Many toddlers in the United
States have their hemoglobin (Hb) measured periodically.
Is this worthwhile?
Objective. To determine if the presence of anemia
correctly diagnoses iron deficiency (ID) and if the absence
of anemia correctly rules out ID in young children.
Methodology. An analysis of data from the US National
Health and Nutrition Examination Survey III
(1988 –1994) was performed. Subjects were children 12 to
35 months old for whom complete blood counts and
cardinal measures of iron nutrition (ferritin, transferrin
saturation, and free erythrocyte protoporphyrin) were
reported.
Results. In the US National Health and Nutrition Examination
Survey III, the prevalence of ID ranged from
6% to 18% in various subpopulations of toddlers. In the
general population, the positive predictive value of Hb
concentration ([Hb]) <110 g/L for ID was 29% (95% confidence
interval [CI]: 20–38%), and the sensitivity was
30% (95% CI: 20–40%). Changing the diagnostic cutoff
point to [Hb] <107 g/L resulted in a positive predictive
value of 38% (95% CI: 24–52%) but lowered the sensitivity
to 15% (95% CI: 7–22%).
Conclusions. ID remains common in the United
States. In agreement with other reports, anemia in toddlers
in developed countries is more likely to be due to
causes other than ID. Conversely, most children with ID
are not anemic. Many false-positive and false-negative
results render the measurement of Hb a screening test of
relatively little value. The current detection strategy
needlessly treats and retests many children without ID
and leaves many iron-deficient toddlers unattended. Pediatrics
2005;115:315–320; African Americans, anemia,
child, preschool, evidence-based medicine, hemoglobin,
Mexican Americans, iron deficiency, iron-deficiency anemia,
NHANES III, positive predictive value, poverty, sensitivity,toddlers, United States.
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03 November, 2006 |
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Controlled, double-blind, randomized clinical trial to evaluate the
impact of fruit juice consumption on the evolution of infants with acute diarrhea
Nutrition Journal 2005;4:1-8
Sandra Valois1, Hugo Costa-Ribeiro Jr1, Ângela Mattos1, Tereza Cristina Ribeiro1, Carlos Maurício Mendes1 and Fima Lifshitz |
In order to assess the effects of juice feedings during acute diarrhea a double-blind, randomized study was
performed in 90 children, mean age of 10 ± 4.28 months. Thirty patients with acute diarrhea were fed twice-daily
15 ml/kg of Apple Juice (AJ), 30 received White Grape Juice (WGJ), and 30 were given colored and flavored water
(WA) as part of their age appropriate dietary intake. The duration and severity of diarrhea were the main
endpoint variables of the study performed in a metabolic unit. The patients were similar among the 3 groups, had
diarrhea for 50–64 hours prior to admission, and were dehydrated when admitted to the unit for study. Half of
the patients in each group were well nourished and the others had mild to moderate degrees of malnutrition.
Rotavirus infection was the agent causing the illness in 63% of the patients. The infants fed juice ingested 14–17%
more calories than those given WA, (those receiving AJ and WGJ ingested 95 and 98 Calories/Kg/d respectively)
whereas those receiving WA consumed 81 cal/kg/d). The increased energy intake was not at the expense of other
foods or milk formula. The mean body weight gain was greater among patients receiving WGJ (+ 50.7 gm) as
compared with the patients in the AJ group (+ 18.3 gm) or the patients fed WA (- 0.7 gm) (p = 0.08). The duration
of the illness was longer in the infants fed juice as compared with those given WA (p = 0.006), the mean +/- SD
duration in hours was 49.4 ± 32.6, 47.5 ± 38.9 and 26.5 ± 27.4 in patients fed AJ, WGJ and WA respectively. All
patients improved while ingesting juice and none of them developed persistent diarrhea; most recovered within
50 hours of the beginning of treatment and less than one fourth had diarrhea longer than 96 hours in the unit.
The fecal losses were also increased among the juice fed patients (p = 0.001); the mean ± SD fecal excretion in
g/kg/h was 3.94 ± 2.35, 3.59 ± 2.35, and 2.19 ± 1.63 in AJ, WGJ and WA respectively. The stool output was highest
during the first day of treatment among all the patients, though those fed AJ had the highest volume of fecal losses
and those who received WA had the lowest stool excretion. After the first day of treatment the differences in
fecal excretion were not significant. The ability to tolerate carbohydrates during the illness and immediately after
recovery was similar among the 3 groups of patients. Intake of juices with different fructose/glucose ratios and
osmolarities resulted in more fecal losses and more prolonged diarrhea as compared with water feedings, but the
patients given juice ingested more calories and gained more weight, particularly among those being fed the juice with equimolar concentrations of fructose and glucose.
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03 November, 2006 |
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Tuberculous meningitis in BCG vaccinated and unvaccinated children
J. Neurol. Neurosurg. Psychiatry 2005;76:1550-1554
R Kumar, A Dwivedi, P Kumar and N Kohli |
Background: A modified clinical presentation of tuberculous meningitis (TBM) in children vaccinated with
BCG has been described in the literature. However, most reports are old and not based on actual
comparisons and tests of significance. Also, neuroimaging features were not compared. With large scale
BCG coverage, it becomes pertinent to describe the ‘‘modified’’ presentation and identify any significant
differences between vaccinated and unvaccinated children with TBM.
Methods: A total of 150 consecutive hospitalised children (96 unvaccinated, 54 vaccinated) were enrolled.
They all satisfied predefined criteria for diagnosis of TBM. Clinical and radiological features of children
with/without a BCG scar were compared.
Results: Univariate analysis revealed that the vaccinated children with TBM had significantly lower rates of
altered sensorium (68.5% v 85.4% unvaccinated; OR 2.2 (1.1 to 6.2); p = 0.019) and focal neurological
deficits (20.3% v 39.5% unvaccinated; OR 2.6 (1.1 to 6.0); p = 0.016), and higher mean (SD) Glasgow
Coma Scale score (10.2 (3.4) v 8.76 (2.7) unvaccinated; p = 0.010) and cerebrospinal fluid cell count
(210.9 v 140.9 unvaccinated; p = 0.019). No significant radiological differences were seen. Short term
outcome was significantly better in the vaccinated group with 70% of the total severe sequelae and 75% of
the total deaths occurring in the unvaccinated group (p = 0.018).
Conclusion: Children with TBM who have been vaccinated with BCG appear to maintain better mentation
and have a superior outcome. This may in part be explained by the better immune response to infection, as reflected in the higher CSF cell counts in this group in the present study.
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03 November, 2006 |
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Preterm Infants With Congenital Heart Disease and Bronchopulmonary Dysplasia: Postoperative Course and Outcome After Cardiac Surgery
Pediatrics 2005;116:423-430
Colin J. McMahon, Daniel J. Penny, David P. Nelson, Anne M. Ades, Salim Al Maskary, Michael Speer, Julie Katkin, E. Dean McKenzie, Charles D. Fraser, Jr, MD |
Objective. Success in treatment of premature
infants has resulted in increased numbers of neonates
who have bronchopulmonary dysplasia (BPD)
and require surgical palliation or repair of congenital
heart disease (CHD). We sought to investigate the impact
of BPD on children with CHD after heart surgery.
Methods. This was a retrospective, multicenter study
of patients who had BPD, defined as being oxygen dependent
at 28 days of age with radiographic changes, and
CHD and had cardiac surgery (excluding arterial duct
ligation) between January 1991 and January 2002. Fortythree
infants underwent a total of 52 cardiac operations.
The median gestational age at birth was 28 weeks (range:
23–35 weeks), birth weight was 1460 g (range: 431–2500 g),
and age at surgery was 2.7 months (range: 1.0 –11.6
months). Diagnoses included left-to-right shunts (n
15), conotruncal abnormalities (n 13), arch obstruction
(n 6), univentricular hearts (n 4), semilunar valve
obstruction (n 3), Shone syndrome (n 1), and cor
triatriatum (n 1).
Results. Thirty-day survival was 84% with 6 early and
6 late postoperative deaths. Survival to hospital discharge
was 68%. There was 50% mortality for patients
with univentricular hearts and severe BPD. The median
duration of preoperative ventilation was 76 days (range:
2–244 days) and of postoperative ventilation was 15 days
(range: 1–141 days). The median duration of cardiac ICU
stay was 7.5 days (range: 1–30 days) and of hospital stay
was 115 days (range: 35–475 days). Current pulmonary
status includes on room air (n 14), O2 at home (n 4),
and ventilated at home (n 4) or in hospital (n 4), and
5 patients were lost to follow-up.
Conclusions. BPD has significant implications for
children who have CHD and undergo cardiac surgery,
leading to prolonged ICU and hospital stays, although
most survivors are not O2 dependent. Postoperative mortality
was highest among patients with univentricular
hearts and severe BPD. Optimal timing of surgery and
strategies to improve outcome remains to be delineated.
Pediatrics 2005;116:423–430; bronchopulmonary dysplasia,
congenital heart disease/defects, cardiac surgery, low
birth weight.
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03 November, 2006 |
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Oral Probiotics Reduce the Incidence and Severity of Necrotizing Enterocolitis in Very Low Birth Weight Infants
Pediatrics 2005;115:1-4
Hung-Chih Lin, Bai-Horng Su, An-Chyi Chen, Tsung-Wen Lin, Chang-Hai Tsai, Tsu-Fuh Yeh and William Oh |
Objective. We evaluated the efficacy of
probiotics in reducing the incidence and severity of necrotizing
enterocolitis (NEC) in very low birth weight
(VLBW) infants.
Patients and Methods. A prospective, masked, randomized
control trial was conducted to evaluate the beneficial
effects of probiotics in reducing the incidence and
severity of NEC among VLBW (<1500 g) infants. VLBW
infants who started to fed enterally and survived beyond
the seventh day after birth were eligible for the trial.
They were randomized into 2 groups after parental informed
consents were obtained. The infants in the study
group were fed with Infloran (Lactobacillus acidophilus
and Bifidobacterium infantis) with breast milk twice
daily until discharged. Infants in the control group were
fed with breast milk alone. The clinicians caring for the
infants were blinded to the group assignment. The primary
outcome was death or NEC (> stage 2).
Results. Three hundred sixty-seven infants were enrolled:
180 in the study group and 187 in the control
group. The demographic and clinical variables were
similar in both groups. The incidence of death or NEC
(> stage 2) was significantly lower in the study group (9
of 180 vs 24 of 187). The incidence of NEC (> stage 2) was
also significantly lower in the study when compared
with the control group (2 of 180 vs 10 of 187). There were
6 cases of severe NEC (Bell stage 3) in the control group
and none in the study group. None of the positive blood
culture grew Lactobacillus or Bifidobacterium species.
Conclusion. Infloran as probiotics fed enterally with
breast milk reduces the incidence and severity of NEC in
VLBW infants. Pediatrics 2005;115:1–4; probiotics, necrotizing
enterocolitis, sepsis, mortality, very low birth
weight infants.
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Kategori Berita : Jurnal Pediatrik
