Accidental detection of lupus anticoagulants in children

During routine pre-operative evaluation, a 6-month-old infant and an 11-year-old girl were found to have prolonged activated partial thromboplastin time with positive lupus anticoagulants. Both children underwent successful cardiac surgery and had no thrombotic or bleeding complications. A literature search revealed that positive lupus anticoagulants can follow minor infections in otherwise asymptomatic children and are benign and self-limiting. A minority, however, can develop bleeding, thrombosis or an auto-immune disorder.     

An overview of the GHMonitor, a registry of children treated with Saizen somatropin [recombinant hGH for injection

The GHMonitor, introduced in 1998, monitors demographics and outcomes in children treated with Saizen (somatropin [recombinant hGH for injection]). Follow-up data are available on 697 patients. The proportion of male to female patients receiving growth hormone (GH) treatment was 67:33. Severity of the height deficit present at enrollment varied by diagnosis with patients with Turner syndrome being shortest [height standard deviation score (SDS)=-3.7+/-1.7] and those with organic GH deficiency the least severely stunted (height SDS=-1.9+/-1.5). Forty-eight patients (6.9%) discontinued participation in the registry. The most common reason for discontinuing GH was completion of growth; the second was family relocation. There were 53 adverse events reported in 33 patients in 1977 patient-years of followup. Most were self-limited but 13 were serious, and 5 resulted in discontinuation of treatment. Data from The GHMonitor provide a real world glimpse of current North American GH treatment practices.     

Evaluation of paediatric intensive care in a regional centre.

All 162 consecutive admissions to a multidisciplinary paediatric intensive care unit in the UK have been prospectively evaluated in terms of therapeutic intention, sickness levels, age, utilisation of resources, and outcome. For 101 (62.3%) of the children admitted the aim of treatment was to cure the condition but for 30 (18.5%) ultimately only a palliative option was available. Five children were admitted to avail of specialised monitoring facilities. One half of the children admitted were physiologically unstable. The majority (102, 62.9%) were age 12 months or less. Resource utilisation, which was not affected by therapeutic intention, was greatest for the sickest patients, those age 1 month or less and non-survivors. Mortality rate overall was 17.9%. Mortality was unaffected by age and therapeutic intention and was inversely related to level of sickness. The information provided by this study forms a basis for medical audit within the unit and is essential for meaningful comparisons of standards of care and outcome with other units.     

The effects of parental divorce and parental conflict on children: an overview

Pediatricians and other primary care professionals are frequently called upon to offer their advice concerning the psychosocial problems that families confront. Currently, one area that appears to be of great concern to parents is the effect that parental divorce has on children. However, giving advice in this area is difficult as parental divorce does not have the same effect on all children. Researchers are now beginning to identify and study numerous factors that appear to play a critical role in mediating child adjustment following parental divorce. Understanding these mediating factors will likely prove crucial when addressing questions pertaining to parental divorce. Several investigators believe that one of the most important of these mediating factors is parental conflict. This article reviews the research addressing the relationship between parental divorce, parental conflict, and child adjustment.     

结核病高危儿童预防服药效果及不良反应观察

目的观察结核痛高危儿童应用不同方案预防服药疗效及发生的不良反应,探讨儿童预防用药的最佳方案。方法 对1605例结核菌素强阳性儿童分3组给予不同服药方案进行预防性治疗 结果 3组儿童规则治疗率分别为84.9％、42.4 ％、60.6％;不良反应发生率分别为11.4 ％、16.1 ％、9.3 ％;1年发病率分别为0.49％、1.58 ％、2.13％;2年发病率分别为0.99％、2.63％、3.19％ 结论 结核病高危儿童预防服药时,联合用药3个月的短程方案效果最佳     

Acquired anticoagulants in children. Apropos of a series of 35 cases

The authors report the clinical and biological data in 35 children presenting with circulating anticoagulant. The discovery of this abnormality was fortuitous in 28 cases, on the occasion of preoperative tests. In all cases they consisted of anticoagulants of the antiprothrombinase type, directed against the phospholipidic part of the complex. In 34 cases, no thrombosis or hemorrhage complication occurred. Among the 18 children who were followed, anticoagulant disappeared spontaneously in 17 cases. Some aspects of the circulating antibodies are quite particular in children: the frequent lack of clinical expression, the frequent postviral or drug-related etiology, the most often spontaneously favourable outcome.     

Cardiac side effects of long-acting beta-2 agonist salmeterol in asthmatic children

BACKGROUND: Salmeterol is a new long-acting beta 2 selective adrenoreceptor agonist. There are some reports about the cardiac side-effects of salmeterol in asthmatic adults. The aim of this study was to determine the cardiac side effects of salmeterol in children. METHODS: Seventeen children with moderate asthma (aged between 6 and 13 years, mean 8.76 years) received salmeterol with a spacer device (Volumatic 200 micrograms daily, b.i.d.) for 3 weeks. All the children were evaluated by 24 h ambulatory electrocardiography monitoring and echocardiography before, on the second and on the 21st day of treatment. RESULTS: In minimum heart rate measurements, there were significant differences between the baseline (mean +/- SD 54.29 +/- 7.13), second (59.24 +/- 6.86) and 21st day (60.65 +/- 8.23) results. Also, the mean heart rate before the treatment (89.59 +/- 6.78) was significantly different from that on the second (94.76 +/- 6.51) and 21st day (92.65 +/- 8.90) of treatment. Although all the values were within normal limits and there were no significant differences between the control group's values, a trend of increase in mean and the minimum heart rates was seen. There were no significant differences in blood pressure, serum K+, maximum heart rate, supraventricular and ventricular ectopic beats, ejection fraction, stroke volume, cardiac output and corrected QT interval at any time. No complaints of tremors or palpitations were reported. CONCLUSIONS: As no cardiac side effects were detected, it could be concluded that salmeterol is quite a safe drug for use in childhood asthma treatment.     

Impact of the new european paediatric regulatory framework on ethics committees: overview and perspectives

Aim: To evaluate the impact of the new European paediatric regulatory framework on the activities of Ethics Committees operating in Europe and to assess their involvement and interest in paediatric research. Methods: Task‐force in Europe for Drug Development for the Young Network of Excellence and Relating Expectations and Needs to the Participation and Empowerment of Children in Clinical Trials project set up an inventory of Ethics Committees existing in Europe and conducted a survey on their approach to paediatric trials. Results: Ethics Committees operating in 22 European Countries participated in this survey. Results showed a high lack of knowledge, understanding and awareness of the current European paediatric regulatory framework and a lack of involvement of Ethics Committees in paediatric research, especially in terms of training and education, demonstrated also by the decreasing number of Ethics Committees answering exhaustively to the whole questionnaire. The majority of participating Ethics Committees expressed interest in future initiatives related to paediatric research. Conclusions: Despite a limited knowledge and understanding of the current paediatric regulatory framework, a significant number of Ethics Committees operating in Europe show interest in initiatives related to paediatric research. Networking may be an essential tool to be used to enhance Ethics Committees role in supporting paediatric research. Any initiative should be undertaken at European level in collaboration with European Union Institutions.     

Echocardiography studies for detection of cardiotoxic side effects of anthracycline therapy in childhood

An anthracycline-induced cardiomyopathy can already appear at a total cumulative dose of less then 550 mg/m2. Noninvasive cardiological methods have been used in order to detect these fatal side effects early. For cardiological control we applied echo-cardiography with measurements of ventricular size and left ventricular function. 5 out of 39 children who were off anthracycline therapy for 3 months to 8 years showed a decline in left ventricular function, but no clinical symptoms. At present 16 children with anthracycline therapy are controlled by echocardiography. In 2 patients a transient myocardial dysfunction was diagnosed. After stopping anthracycline therapy the left ventricular function improved within 2 to 3 months without specific cardiac treatment.     

Dermatological side effects and complications of continuous subcutaneous insulin infusion in preschool-age and school-age children

Objective:  The objective of this study was to evaluate whether very young children develop more dermatological complications during insulin pump treatment compared with school children.
Study design:  Cross-sectional study in 78 consecutive children using insulin pump treatment >4 months.
Results:  Children in group A [n = 40, 28 males (M) and 12 females (F)] were 2.3 ± 1.3 yr (±SD) and those in group B (n = 38, 13 M and 25 F) were 11.0 ± 2.9 yr old at the start of continuous subcutaneous insulin infusion (CSII). The mean duration of CSII was similar in both groups (23.6 ± 16.5 months in group A and 21.8 ± 16.1 in group B). The most common dermatological complications were scars <3 mm (50% in group A vs. 71% in group B, p < 0.05) and lipohypertrophic areas at the insertion sites (45% in group vs. 47% in group B). Local abscesses and blisters were rare findings in both groups (7.5–12%), none leading to interruption or stop of CSII.
Conclusions:  Dermatological side effects during CSII are not more frequent or severe in very young diabetic children compared with diabetic children in school age.