Brain abscess in children

Objectives: Brain abscess is a serious life-threatening complication of several diseases. The objective of this study was to look at the clinical profile of patients, predisposing conditions, microbiology and outcome of children suffering from brain abscess.Methods: Thirty children aged less than 15 years were reviewed. There were 15 males and 15 females. The mean age of presentation was 5.6±4.4 years.Results: The duration of illness at the time of admission was 17.6±24.6 days. Typically patients presented with fever, vomiting, headache and seizures. The predisposing conditions found were cyanotic congenital heart disease in 11 (37%) of children, meningitis in 6 (20%), septicemia in 7 (23%), and no underlying cause was found in 5 (17%) children. The most common microbe in children with cyanotic congenital heart disease was of theStreptococcus milleri group (52%). Computerized tomography confirmed the diagnosis and the most common location of the abscess was the parietal lobe of the cerebral hemisphere. All abscesses were large, more than 2 cm in diameter and were aspirated surgically. Excision was performed in 6 children. Five children expired, one due to a intracranial bleeding and the others due to severe cerebral edema and tentorial herniation. Complications were seen in 20 children and 16 had sequelae, hemiparesis in 11 and seizure disorder in 5.Conclusion: Brain abscess is a serious infection with poor outcome if diagnosed late. Delayed surgical drainage has high morbidity and mortality. The threshold for diagnosis should be low, particularly in children with a predisposing condition like cyanotic congenital heart disease.     

Differentiated thyroid cancer

Objective: The retrospective analysis of the case files of children with differentiated thyroid carcinoma (DTC) was performed to define the disease by its presentation, clinical course and outcome of radioiodine therapy.Methods: Between 1967 to October 2002,1754 patients with thyroid cancer were treated in the Dept of Neuclear Medicine, AIIMS, out of which 122 (7%) were ≶ 20 years of age (71 girls and 51 boys). The mean age was 15.8 ± 3.6 years and the mean duration of follow-up was 90 ± 59.3 months. Mean tumor size was 4.4 cm. Histologically, 85% of the patients had papillary and rest follicular carcinoma. Cervical lymph node involvement was seen in 64%, and distant metastases, mainly pulmonary, in 23% of the patients. The presentation of the disease was very aggressive in the first decade of life with male preponderance. All but one patient in this age group had nodal and/or distant metastases; in 83.3% the disease had spread to the lymph nodes and 67% had metastases to the lungs. The post-surgery 48-hour mean radioiodine neck uptake was 10.5 ± 7.6%.Results: 94% of the residual thyroid, 88% of nodal metastases and 71% of pulmonary metastases were ablated requiring mean cumulative doses of 2.8 ± 2.7 GBq, 4.5 ± 2.7 GBq and 10.4 ± 7.9 GBq of¹³¹I, respectively. Average number of doses required for remnant, nodal and pulmonary metastases ablation were 1.3, 2.2 and 3.3, respectively. 80% of the patients with only remnant thyroid tissue and 50% with cervical lymph node metastases got ablated with a single dose of¹³¹I. Overall, 87% patients were currently free of disease. While, nine patients had nodal recurrence between surgery and radioiodine treatment, no recurrence was observed thereafter and 3 disease related deaths producing overall mortality of 2.5% (all in children ≶10 years of age) were seen in the mean follow-up of 7.5 years.Conclusion: Differentiated thyroid cancer in children and adolescents is rare but aggressive. The biological behavior differs from that in adults and is related to the age. Younger the age (≶10 years), more aggressive and widespread is the disease with male preponderance and high mortality. The Post-surgical radioiodine ablation/therapy is an important and effective adjuvant in the management of DTC in children and adolescents and even though they present with advance disease, long-term survival and overall prognosis is good.     

Cognition in specific learning disability

Objective : To compare the cognition abilities of children with specific learning disability (SpLD) viz. dyslexia, dysgraphia and dyscalculia with those of non-impaired children.Methods : The study group consisted of 95 newly diagnosed SpLD children (aged 9–14 years) and the control group consisted of 125 non-impaired children (aged 9–14 years). An academic achievement of two years below the actual grade placement on educational assessment with a Curriculum-Based test was considered diagnostic of SpLD. A battery of 13 cognition function tests based on Guilford’s Structure of Intellect Model was administered individually on each child in four areas of information viz. fieural, symbolic, semantic and behavioral. Mean scores ±SD obtained in these four areas were calculated in both groups and compared using Independent Samples t-test. A P value < 0.05 was considered significant.Results : Children with SpLD had significantly lower scores (mean ±SD) in all four areas of information: maximally in the symbolic area (18.66 ±4.83 vs. 28.30 ±4.29, mean difference 9.64, P< 0.0001, df = 218,95% Cl 8.43-10.86), followed by semantic (18.72 ±5.07vs 27.36 ±4.17, mean difference 8.64, P< 0.0001, df=218, 95% Cl 7.40 9.87), figurai (17.10 ±5.24 vs 25.14 ±3.36, mean difference 8.04, P< 0.0001, df=218, 95% CI 6.89-9.19), and behavioral (5.68 ±2.10vs 7.54 ±1.46, mean difference 1.86, P< 0.0001, df = 218, 95% C11.39-2.33) areas.Conclusion : Cognition abilities are significantly impaired in children with SpLD.     

Low plasma zinc and iron in pica

Objective : To determine role of trace elements in causation of pica with specific reference to zinc and iron we studied plasma levels of iron (Fe), Zinc (Zn), calcium (Ca) and magnesium (Mg) and blood lead (Pb) levels by atomic absorption spectrophotometer in 31 children with pica (Pica Group) and 60 controls matched for age, sex and nutrition (Control Group) in an observational case and control study in the settings of outpatient clinic of a tertiary care, teaching hospital.Methods : Data from each group were further stratified by hemoglobin level &lt;9 and >9 g/dl into two subgroups pica-1 and pica-2, and control-1 and control-2 respectively, to control for confounding effect of iron deficiency anemia.Results : The plasma Fe level (mean ±SD) in children with pica (42.7 ±9.2) mg/dl) was about 20% lower than that in controls (51.5 ±10.0 mg/dl, p&lt;0.001). Plasma Zn levels in the pica group (60 ±4.4 mg/dl) was about 45% lower than those in controls (110.2±8.5 mg/dl, p&lt;0.001). Correlation of Zn and Fe levels with pica-related variables such as age at onset, duration and frequency and number of inedible objects ingested was not significant.Conclusion : These findings suggest that hypozincemia with low iron levels may be the possible cause of pica and contradict the contention that low levels of plasma Zn and Fe could be an effect of pica.     

Randomized control trial of quinine and artesunate in complicated malaria

Objective: To study the comparative efficacy of the quinine and artesunate in complicated malaria in children.Methods: All cases admitted to the Pediatrics ward of our hospital with clinical features of complicated malaria (WHO criteria) having asexual forms of P.falciparum in the peripheral smear, were included in the study. Relevant investigations were carried out for confirmation of diagnosis and to assess the prognosis. The patients were sub-grouped into 6 categories as per clinical presentations and each subgroup received alternatively either quinine or artesunate by systematic random sample method. Every odd number received quinine (Group-1) and every even number received artesunate (Group-2). 40 cases in each group were considered for the study and the data obtained were compiled and analyzed by suitable statistical tests.Results: 80 children with complicated malaria enrolled in the present study, of which 48 were boys and 32 were girls. The mean age was 7.93+3.56 years. The most common presentations were fever, splenomegaly and altered sensorium. The CRT, FCT and PCT were significantly less in the artesunate group (50.4 ±31.49hrs; 43.55 ±20.12 hrs, and 41.67 ±16.78 hrs respectively) as compared to the quinine group (70.15 ±17.56 hrs, 62.23 ±16.99 hrs, and 52.24 ±12.69 hrs respectively) (p<0.05) No side effects were observed in the artesunate treated group.Conclusion: Artesunate is a much better drug than quinine in complicated malaria in terms of rapid coma resolution,fever clearance,parasite clearance and better tolerability     

Status epilepticus in Indian children in a tertiary care center

Objective: To study the clinical profile, immediate outcome and possible risk factors of SE in pediatric age group admitted to pediatric intensive care unit (PICU) in a tertiary care center.Methods: A retrospective study of case records of 451 neuroemergency patients admitted in PICU in a tertiary care center between January 1993 to April 2000, out of which 30 patients had status epilepticus. They were evaluated for their clinical presentation, laboratory parameters, treatment profile and immediate outcome.Results: The age group varied from 1 to 120 months with mean of 56.6±46.5 months. Seventeen patients were less than 60 months. Sixteen patients (53.3%) presented with SE as first presentation without prior history of seizure activity. Nine patients died (30%) during hospital course. Seizure duration >45 minutes (p-0.001) and presence of septic shock (p-0.001) were associated with significantly more mortality.Conclusion: There is a need to abort seizure activity at the earliest and this improves immediate outcome.     

Hepatic enhancement analysis in children using Smart Prep monitoring for 2 : 1 pitch helical scanning

Purpose. To analyze hepatic enhancement by using Smart Prep protocols appropriate for children of different weight groups and 2:1 pitch helical CT imaging as the investigative tools. Patients and methods. A group of 55 children ranging in weight between 20 and 180 lbs underwent 67 contrast-enhanced abdominal helical CT examinations using Smart Prep (GE Medical Systems, Milwaukee, Wisc.). Of these studies, 21 (31 %) were excluded because of failure to follow the prescribed Smart Prep protocols. Smart Prep protocols were established for nine different weight groups. Scan delay, aorta and liver time to peak, and liver enhancement over baseline were recorded. Results. Optimal abdominal CT studies with adequate contrast enhancement of hepatic and portal veins were obtained in 46 patients. There was no significant difference in the time between peak aortic and the liver enhancement among different weight groups (mean time 12.0 ± 7.1 s for all children). However, the mean hepatic enhancement over baseline in children weighing < 30 lbs was below 50 Hounsfield units (HU) compared to the rest of the children who had mean hepatic enhancement of > 50 HU. Conclusion. Two-thirds of the Smart Prep protocols were successfully implemented, and all of these resulted in good contrast enhancement of hepatic and portal veins. Optimal mean liver enhancement (> 50 HU) was seen in children ≥ 30 lbs. Children < 30 lbs had mean liver enhancement of 33 HU ± 7.2 above the baseline likely caused by contrast dose. Received: 20 October 1998 Accepted: 26 March 1999     

Oxidized LDL metabolites with high family risk for premature cardiovascular disease

Objective: Considering the importance of primary prevention of Cardiovascular Disease (CVD) from childhood, especially in children with high family risk for premature atherosclerosis, and also the importance of oxidized LDL in the process of atherosclerosis, the main metabolites of ox-LDL i.e. Malondialdehyde (MDA) and Conjugated diene (CDE) have been measured in children of high risk families and compared with a control group.Methods: Children and adolescents (6–18 years) of parents with premature myocardial infarction (Ml ≤ 55y in men and ≤ 65y in women), were selected as the case group. The control group included neighbors of the case group matched for age and socioeconomic status. All samples have been selected by simple random sampling. Both the case and control groups were divided in two subgroups : those with a total cholesterol and/or LDL-C ≥95th centile and those with normal lipid levels. Each subgroup consisted of 32 subjects, so 128 subjects were studied (64 in the case and 64 in the control group). MDA and CDE were measured by spectrophotometry using molar absorbivity. Data were analyzed by SPSS_v10/Win software using ANOVA, Bon-ferroni, Scheffe-Duncan, Tukey-HSD, and the Student’s t-test.Result: The mean MDA value in the case and control groups was significantly different (1.84 ± 0.43 vs. 1.67 ± 0.41 Μmol/L, p=0.03), but this difference was not significant regarding the mean CDE level (0.50 ± 0.05 vs. 0.47 ± 0.04 Μmol/ L, p>0.05). The mean MDA level in the case group with hyperlipidemia was significantly higher than that in the case group without hyperlipidemia (1.985 ± 0.516 vs. 1.690 ± 0.366, Μmol/L, P=0.02) and also higher than control group with or without hyperiipidemia (1.985 ± 0.516 vs. 1.720 ± 0.389,1.615 ± 0.429 Μmol/L respectivety, P<0.05). The mean CDE level in the case group with hyperiipidemia was significantly higher than the case group without hyperlipidemia (0.542 ± 0.034 vs. 0.494 ± 0.049 Μmol/L, P=0.04) and higher than the control group with or without hyperiipidemia (0.542 ± 0.034 vs. 0.464 ± 0.051, 0.484 ±0.048 Μmol/L respectively, p<0.05). In case boys with hyperiipidemia, the mean MDA (2.03 ± 0.2 Μmol/L) and the mean of CDE (0.56 ± 0.04 Μmol/L) was significantly higher than other subgroups (P<0.05).Conclusion: Considering the increased susceptibility of LDL to oxidation in children with high family risk for premature CVD, special attention should be paid to consumption of foods and seasoning containing antioxidants from childhood especially in high risk families.     

Iron deficiency and cyanotic breath-holding spells: The effectiveness of iron therapy

Abstract

Aim: Frequent cyanotic breath holding spells cause fear and severe anxiety to parents. This study aimed to evaluate clinical, laboratory and treatment characteristics of children with cyanotic breath holding spells. Methods: Included were 180 children (mean age: 1.82?±?0.53 years) with cyanotic breath holding spells. They were divided into three groups: with iron deficiency, with iron deficiency anemia and without iron deficiency. Blood hemoglobin (HB), ferritin and iron concentrations were measured at baseline and after 3 and 6 months of iron treatment. Results: The mean spell frequency was 24.57?±?7.31/months, 83% had spells after the age of 1 year, 37% had daily spells, 16% had family history of spells, and 61% had Iron deficiency/Iron deficiency anemia (p?=?.001). No significant difference in the frequency of spells between children with iron deficiency and those with Iron deficiency anemia. Compared to patients without iron deficiency, there was significant reduction of spells frequency, increased hemoglobin, ferritin and iron levels after 3 and 6 months of iron therapy (p?=?.0001). Negative correlations were observed between spell frequency with hemoglobin (p?=?.001), ferritin (p?=?.0001) and iron (p?=?.001) levels. Conclusion: Not only Iron deficiency anemia but also iron deficiency alone without anemia is associated with a risk of high-frequency cyanotic breath holding spells. Iron therapy results in reduction in spells’ frequency which was correlated with increasing ferritin and iron levels.     

Improving quality of life in asthmatic children

Objective: To assess quality of life changes in pediatric asthmatic patients switched into a single inhaler device of BudesonideJFormoterol.Methods: Thirty pediatric patients (ages 6–15 years) with moderate to severe chronic asthma previously treated with inhaled beclometasone dipropionate at a daily dose of ≥400 μg were selected to participate in an open label study. At the baselinephase (one month), pulmonary function tests (PFTs), indicators of asthma control, and a quality of life assessment (using a special questionnaire) were evaluated. Patients were initiated on a single inhaler device containing budesonide 160 μg/formoterol 4.5 μg, one inhalation twice daily instead of their previous inhaled corticosteroid and followed for two months. PFTs, indicators of asthma control, and a quality of life assessment were evaluated at each visit.Results: After switching to the new therapy, patients showed significant changes towards better quality of life in all aspects. The overall score dropped from 1.75±0.04 to 0.80 ±0.07 (mean ±SEM), p<0.001 (Score scale varies between 0: excellent to 2: very bad Health related quality of life). There was an improvement in the PFTs, where the FEV₁% improved from 62.7±2.8 to 87.4 ±4.6 (mean ±SEM), and the FVC% improved from 83.2 ±3.5 to 101.9 ±5.3 (mean ±SEM), p <0.001, and better control of asthma.Conclusion: Switching treatment from beclomethasone dipropionate to budesonideJformoterol combination appeared to improve quality of life in the patient population evaluated and in the appropriate clinical indices.     

Elevated levels of secretory immunoglobulin A (sIgA) in urinary tract infections

Objective : Urinary secretory IgA (slgA), an immunoglobulin synthesized locally in mucosal surface is an important immunological defense in preventing bacterial adherence to periurethral epithelia and uroepithelia. Therefore attempts were made to measure secretory IgA in the urine of children with urinary tract infections (UTI), by using slgA specific ELISA.Methods : Fresh or unprocessed urine samples from healthy donors (children and adults N=10 each), 68 children and 17 Adults with UTI were tested for the presence of slgA.Results : The level of slgA in 10 healthy normal children was 2.7 ± 0.94 ug/ml and that in 10 healthy adults was 5.2 ± 0.73 ug/ml. Children with UTI showed highly elevated levels of slgA amounting to 279 ± 80 ug/ml (p<0.001). It was interesting to note that 96% of children and 76% of adults with UTI had slgA level significantly above that of + 2SD of respective controls (287 ± 99 and 80 ± 48 ug/ml respectively). On culturing the urine obtained from these children the colonies identified wereE. coli about 46%, Klebsiella about 24% and Pseudomonas about 24%. The slgA antibody from urine samples assessed by indirect immunoflourescense. specifically reacted with the respective organism.Conclusion : Taken together the results show that the presence of slgA not only correlated with the UTI in children as well in adults but slgA seems to be directed to the infective agent and can also be used to identify the type of infection.Thus measurement of urine antibody levels may provide an alternative marker of host responses to infection, which can be used either as a simple screening test or could be useful to assist alongwith other tests in establishing a diagnosis.     

Respiratory motion in children and young adults undergoing liver magnetic resonance imaging with intravenous gadoxetate disodium contrast material

Background

Gadoxetate disodium, utilized in hepatobiliary magnetic resonance (MR) imaging, has been associated with transient respiratory motion during the arterial phase in adults.

Objective

The purpose of this study was to determine the presence and severity of this phenomenon in children imaged awake versus under general anesthesia.

Materials and methods

This retrospective cohort study was approved by the institutional review board; informed consent was waived. One hundred thirty exams of children ≤18 years old who underwent dynamic liver MR imaging with gadoxetate disodium between October 2010 and January 2018 were reviewed. Three pediatric radiologists scored respiratory motion artifacts on all imaging phases using a 5-point Likert scale. Differences in mean motion scores were assessed with analysis of variance and Tukey’s multiple comparisons test, and multivariable regression was used to identify predictors of arterial phase motion in awake patients.

Results

One hundred thirty patients (50% [n=65] female; mean age: 9.8±3.7 years, 48.5% [n=63] awake) were included. There were significant differences in mean motion scores between phases in the awake cohort (P<0.0001) but not in the general anesthesia cohort (P=0.051). In the awake cohort, arterial phase motion score (mean: 3.52±0.83) was significantly higher than mean motion score in all other phases (P≤0.0003). There were no significant patient-specific predictors of arterial phase motion score in the awake cohort.

Conclusion

Significantly increased arterial phase respiratory motion artifact in awake children undergoing dynamic liver MR imaging with gadoxetate disodium suggests that transient respiratory motion occurs in children. General anesthesia may suppress this phenomenon.

     

Mapping versus source methods for quantifying myocardial T1 in controls and in repaired tetralogy of Fallot: interchangeability and reproducibility in children

Background

Myocardial T1 relaxometry can be performed by contouring on individual T1-weighted source images (source method) or on a single T1 map (mapping method).

Objective

This study compares (a) agreement between native T1 and extracellular volume results of the two methods and (b) interobserver reproducibility of the two methods in children without heart disease and those with tetralogy of Fallot (TOF).

Materials and methods

We retrospectively analyzed pediatric patients (controls and those with repaired TOF) with cardiac magnetic resonance examinations including extracellular volume quantification using the modified Look-Locker inversion recovery (MOLLI) sequence. We compared native T1 and extracellular volume of the entire left ventricle and interventricular septum derived using the source and the mapping approaches.

Results

In the control group (n=25, median age 14.0 years, interquartile range [IQR] 11.5–16.5 years), the mapping method produced lower native T1 values than the source method in the interventricular septum (mean difference ± standard deviation [SD] = 12±15 ms, P<0.001). In the TOF group (n=50, median age 13.3 years, IQR 9.9–15.0 years), the mapping method produced lower values for native T1 and extracellular volume in the interventricular septum (mean difference 9±14 ms and 0.6±1.1%, P<0.001). In 6–12% of the children, differences were >3 standard deviations from the mean difference. Interobserver reproducibility between the two methods by intraclass correlation coefficients were clinically equivalent.

Conclusion

T1 and extracellular volume values generated by the source and mapping methods show systematic differences and can vary significantly in an individual child, and thus cannot be used interchangeably in clinical practice. The source method might allow for easier detection and, in some cases, mitigation of artifacts that are not infrequent in children and can be difficult to appreciate on the T1 map.

     

Clinical manifestations of HIV infected children

Objective : Heterosexual contact is the predominant mode of transmission among adults in India with an increasing number of women of childbearing age becoming infected with HIV. Consequently, children in India increasingly getting infected, primarily from vertical transmission. A retrospective review of the profile of HIV infected children attending an HIV clinic in South India is reported.Methods : All HIV-infected children under 15 years of age at the time of first presentation and managed at this center between June 1996 and June 2000 are included in this report. Socio-demographic characteristics and clinical manifestation were collected in a precoded proforme. A complete physical examination and baseline laboratory investigations were performed at entry into the clinic and at subsequent follow-up.Results : Fifty-eight HIV-infected children were included: thirty-nine (67.2%) were male with mean age 4 years. Perinatal transmission was the predominant mode of HIV acquisition (67%). Common clinical manifestations in these children at presentation included oral candidiasis (43%), pulmonary tuberculosis (35%), recurrent respiratory infections (26%), bacterial skin infection (21%), papulo-pruritic dermatitis (19%), hepatosplenomegaly and lymphadenopathy (14%) each and chronic diarrhea (7%).Conclusion : An understanding of the epidemiology of pediatric HIV infection may reveal opportunities to reduce and perhaps eliminate perinatal transmission. Knowledge of clinical manifestations in this setting will help physicians meet the management challenges presented by HIV infected children.     

Reduced exercise capacity in non-cystic fibrosis bronchiectasis

Objective : Bronchiectasis not due to cystic fibrosis is usually a consequence of severe bacterial or tuberculous infection of the lungs, which is commonly seen in children in developing countries. Our aim was to study its functional sequelae and affect on work capacity in children.Methods : Seventeen children (7-17 years of age) with clinical and radiological evidence of bronchiectasis of one or both lungs were studied at the Cardiopulmonary Unit of the Tuberculosis Research Centre. Pulmonary function tests including spirometry and lung volume measurements were performed. Incremental exercise stress test was done on a treadmill, and ventilatory and cardiac parameters were monitored. Control values were taken from a previous study.Results : Children with bronchiectasis had lower forced vital capacity (FVC) (1.1 + 0.4 L versus 1.5 + 0.4 L, p=0.003) and FEV, (0.95 ±0.2 L versus 1.4 ±0.3 L, p<0.002) compared to age- and sex-matched healthy controls. The patient group had significantly higher residual lung volumes (0.7 ±0.3 L versus 0.4 + 0.1 L, p<0.02). At maximal exercise, they had lower aerobic capacity (28 +- 6 ml/min/kg versus 38 ±5 ml/min/kg, p<0.0001) and maximal ventilation (24 ±8 L/min versus 39 ±10 L/min, p<0.001). At maximal exercise, while none of the controls desaturated, oxygen saturation fell below 88% in eight of 17 patients.Conclusion : The findings show that children and adolescents with non-cystic fibrosis bronchiectasis have abnormal pulmonary function and reduced exercise capacity. This is likely to interfere with their life as well as future work capacity. Efforts should be made to minimize lung damage in childhood by ensuring early diagnosis and instituting appropriate treatment of respiratory infections.     

Patterns of development in young children with autism

Objective: To determine the extent to which the developmental profile of children less than 4 years can help in distinguishing children with autism from children with developmental delay.Methods: Subjects were 32 children with autism as per the DSM IV criteria and 32 children with developmental delay matched on chronological and academic age. The Developmental Profile II was used to assess the developmental functioning in five domains including physical, social, self help, academic, and communication.Results: The two groups showed significantly different developmental profiles and these differences were accounted for mainly by significantly lower social skills and superior motor skills in the autistic group as compared to the developmentally delayed group.Conclusion: Developmental Profile II may help in distinguishing young children with autistic disorder from non-autistic children with comparable developmental delays     

Relationship between body mass index and pediatric urologic diagnoses

ObjectiveWe had the clinical impression that children with certain urological diagnoses were thinner and others were heavier. We therefore reviewed body mass index (BMI) in children with a variety of urological diagnoses.Materials and methodsThe data from all pediatric patients treated as outpatients in our office between 1 Jan and 30 Sept 2004 were analyzed retrospectively. The patients were counted only once, even if they came back to the office several times. They were grouped by the principal billing diagnosis, but groups of less than nine patients were excluded. BMI percentiles were determined based on data from the Centers for Disease Control and compared to diagnosis codes.ResultsThe data from 1054 patients were analyzed: 53% were female, mean age was 8.0 ± 3.7, mean BMI was 18.7 ± 5.1 and mean BMI percentile was 64 ± 31%. BMI varied significantly by diagnosis. Children with hernias and penile problems had the lowest BMI percentile and those with urinary infection and incontinence the highest, e.g. the mean BMI percentile was 46 ± 31% for children with a hernia but 71 ± 27% for those patients with nocturnal enuresis.ConclusionsThe rate of obesity varied considerably based on pediatric urological diagnosis. Diet and personality may be part of the etiology for some urological disorders. It is possible that lifestyle changes may benefit urological patients who are obese.     

High incidence of urinary stones in Uyghur children may be related to local environmental factors

ObjectiveTo analyze the causes of urolithiasis in Uyghur children from Xinjiang.Patients and methodsWe retrospectively evaluated the clinical features and characteristics of urinary stone composition of 220 Uyghur pediatric patients with urolithiasis between March 2009 and June 2011. The data were compared with that of 100 Uyghur children without urolithiasis who visited the Child Care Clinic for regular health check-ups. The stones were collected by endoscopy or open surgery, and analyzed using infrared spectroscopy.ResultsThe mean age of the 220 Uyghur children was 7.48 ± 4.73 years (range, 0.8–17.0 years). The overall sex ratio (male:female) was 2.23:1. The predominant pure stone was ammonium urate (58.9%), whereas the predominant mixed stone was calcium oxalate mixture (91.1%). Uric acid stones comprised 54% of all stones. Urinary tract infections were observed in 42.3% and 4.0% of the patient and control groups, respectively. The mean urinary pH values were 5.77 ± 0.67 and 6.42 ± 0.67, respectively (p < 0.001). pH values were <5.5 in 52.7% and 6% of the patient and control groups, respectively. On 24-h urine analysis, we found metabolic disturbances in these patients: hypercalciuria in 6.8% cases, hyperphosphaturia in 16.8% cases, hyperuricosuria in 21.4% cases, and hypomagnesiuria in 34.1% cases.ConclusionsUrolithiasis in Uyghur children may be primarily related to local environmental factors.     

Maternal estimates of mental age in developmental assessment

Objective: To examine the accuracy and clinical utility of maternal estimates of mental age in young children referred for developmental assessment.Methods : Mothers of 100 children aged 16 to 60 months referred for developmental evaluation to psychology services of Department of Pediatrics of a tertiary care teaching hospital were asked to estimate the mental age of their child. Maternal estimates were converted to intelligence quotient (IQ) and were compared to results from developmental tests of cognitive and adaptive behavior functioning which were administered to all children.Results : Maternal estimate IQ was highly correlated with IQ calculated from Developmental Profile II (r=.83, p&lt;.001) and social quotient (SQ) calculated from Vineland Social Maturity Scale (r=.81, p&lt;.001). Maternal estimate IQ was 82% sensitive to cognitive delay and 81% specific in identifying children likely to have normal development. Twenty seven percent of the maternal estimates were within ±5 IQ points of actual IQ. Mothers were more likely to overestimate their child’s functioning. Maternal IQ (Mean=62.1, S.D. =25.8) was significantly higher (t=2.93, p&lt;.004) than the actual IQ (Mean=57.9, S.D.=21.9). Step-wise multiple regression analysis revealed that the child’s IQ and SQ explained 10% of the variance (F=6.40, p&lt;.001) in maternal accuracy. The lower the SQ and IQ of the child, more accurate the estimates.Conclusion : Maternal estimates of mental age provide an accurate measure of developmental functioning in young children and may be used as a screening technique to identify a subset of children who need more detailed evaluation.     

Clinical presentation and metabolic consequences in 40 breastfed infants with nutritional vitamin B12 deficiency – What have we learned?

BackgroundMaternal vitamin B₁₂ (Cbl) deficiency causes nutritional Cbl deficiency in breastfed infants.AimsTo analyse clinical presentation and metabolic consequences in 40 breastfed infants with Cbl deficiency.MethodsCbl levels in serum and breast milk were determined by an electrochemiluminescence immunoassay, methylmalonic acid level by GC/MS, plasma homocysteine by HPLC and propionylcarnitine by MS/MS. Profound Cbl deficiency was found in 17 children (69 ± 17 ng/l, controls 200–900), and milder Cbl deficiency in 23 children (167 ± 40 ng/l). Maternal Cbl deficiency was mostly caused by insufficient Cbl absorption. Only six mothers were vegetarian.ResultsThe average age at diagnosis was 4.4 ± 2.5 months. Clinical symptoms included failure to thrive (48% of children), hypotonia (40%), developmental delay (38%) and microcephaly (23%). 63% of children had anaemia (megaloblastic in 28% of all children). All but one patient had methylmalonic aciduria, 80% of patients had hyperhomocysteinemia and 87% had increased aminotransferases. Propionylcarnitine was elevated in two out of 25 infants. Comparing groups with severe and mild Cbl deficiency, a marked difference was found in severity of clinical and laboratory changes.ConclusionMaternal Cbl status and diagnostic delay are the major factors influencing severity and progression of Cbl deficiency in breastfed infants. In our cohort, propionylcarnitine was not sufficiently sensitive marker of Cbl deficiency. Although symptoms are reversible on Cbl substitution, permanent neurological damage can result. Selective screening for Cbl deficiency is indicated in all breastfed infants with failure to thrive, hypotonia, developmental delay, microcephaly or megaloblastic anaemia. The best prevention in future could be the screening of all pregnant women.