High total antioxidant activity and uric acid in tracheobronchial aspirate fluid of preterm infants during oxidative stress: an adaptive response to hyperoxia?

The effect of O2 exposure, expressed by mean daily fractional inspired oxygen concentration (FiO2), was evaluated during the first 6 d of life in the tracheobronchial aspirate fluid of 16 mechanically ventilated preterm infants in terms of both antioxidant response and oxidative damage, by measuring total antioxidant activity, uric acid concentrations and protein carbonyl content. Each day linear regression analysis was performed and a positive correlation was found between total antioxidant activity and FiO2 during the study period, especially on day 2 of life (r = 0.91, p < 0.0001), but uric acid correlated only in the first 3 d, especially on the 2nd day (r = 0.83, p < 0.0001). No correlation was found between carbonyl content and FiO2. The highest values of total antioxidant activity (416 and 790 micromol l(-1)) were found in 2 babies ventilated with highest FiO2: 1 and 0.80, respectively. Total antioxidant activity was not detectable or was very low in the babies not requiring O2 therapy. The highest value of uric acid (270 micromol l(-1)) was found in the baby ventilated with 100% oxygen. Uric acid concentrations obtained in these babies were much higher then those reported in the bronchoalveolar lavage fluid of adults. Preterm babies seem to have an antioxidant response in the tracheobronchial aspirate fluid following an oxidative stress and uric acid may be physiologically important as an antioxidant of the respiratory tract, especially during the first days of life.     

What is the intrapatient variability of mycophenolic acid trough levels?

TDM of MPA, the active compound of MMF, is rarely used despite its substantial intra‐ and interpatient variability. Little is known about the utility of long‐term MPA TDM. Data are expressed as mean (one standard deviation). All available data from 27 renal transplant recipients (mean age at transplantation: 7.7 [5.0] yr) with an average follow‐up of 9.3 (4.6) yr were analyzed. MPA levels were measured using the EMIT. GFR was measured using cystatin C and eGFR was calculated using the Filler formula. Intrapatient CV of the trough level was calculated as the ratio of the mean divided by one standard deviation. Mean cystatin C eGFR was 56.9 (24.4) mL/min/1.73 m². There was a weak but significant correlation between the MPA trough level and the AUC (Spearman r = 0.6592, p < 0.0001). A total of 1964 MPA trough levels (73 [45]/patient) were measured, as compared to 3462 Tac trough levels (144 [71]/patient). The average MPA trough level was 3.01 (1.26) mg/L and the average trough Tac level was 7.3 (1.8) ng/mL. Intrapatient CV was statistically higher (p = 0.00093) for MPA at 0.68 (0.29) when compared to Tac with a CV of 0.46 (0.12). CV did not correlate with eGFR. Intrapatient MPA trough level CV is significantly higher than for Tac, while CV for both MPA and Tac was high. MPA trough level monitoring may be a feasible monitoring option to improve patient exposure and possibly outcomes.     

Antidotes for nerve agent poisoning: should we differentiate children from adults?

PURPOSE OF REVIEW: Chemical terrorism presents a threat to the civilian population, including children. Nerve agent antidotes are available in prepackaged autoinjectors that can be delivered rapidly following an exposure. The published evidence on the use of nerve agent antidotes consists of case reports, extrapolation from pediatric organophosphate poisonings, and expert opinion. This review examines the evidence supporting the use of nerve agent antidotes in children. RECENT FINDINGS: The use of adult formulated atropine and pralidoxime autoinjectors will deliver doses above current recommendations for infants and children. Data demonstrate, however, that atropine overdose is generally well tolerated in young children. Children symptomatic of nerve agent poisoning will likely need both supraphysiologic doses and frequent re-dosing of atropine. SUMMARY: Based on limited data, the Mark 1 autoinjector kit (Meridian Medical Technologies, Columbia, Maryland, USA) appears to be the most efficacious antidote delivery system following a nerve agent attack. Symptomatic children under 1 year of age should be given a full atropine dose from the Atropen (Meridian Medical Technologies) (0.5 mg) or Mark 1 kits (2 mg), while children over 1 year of age should be given a full dose of both atropine and pralidoxime from the Mark 1 kit when more accurate weight-based dosing of antidotes is impossible.     

Can the administration of antithrombin III decrease the risk of cerebral hemorrhage in premature infants?

This study was carried out to determine whether the administration of antithrombin III decreases the risk of intraventricular hemorrhage in premature infants. In a randomized study, 60 infants born before 30 weeks of gestation were assigned to receive a loading dose of antithrombin III or placebo. There was no significant difference in the incidence of intraventricular hemorrhage between the antithrombin III and the placebo group (27.5 vs. 32%). Partial thromboplastin time, Quick's prothrombin time and platelet count were also not significantly different between the 2 groups. We conclude that the administration of antithrombin III during the first 2 days of life does not decrease incidence of intraventricular hemorrhage. Antithrombin III is a very expensive therapy and its benefits should be carefully investigated before being recommended as valuable therapy.     

Can Experience from Adults Regarding Acute Liver Failure Fit Children?

Till date, comparison of clinical characteristics in acute liver failure (ALF) between adults and children has not been performed. In this study, authors retrospectively collected data on adult acute liver failure (AALF) and pediatric acute liver failure (PALF) in seven hospitals in different areas of China from January 2007 through December 2012. A total of 177 AALF cases and 32 PALF cases were eventually included. Several vital clinical variables were significantly different between AALF and PALF, including serum alkaline phosphatase, serum creatinine, serum urea nitrogen, serum lactate dehydrogenase, platelet count, prothrombin activity, international normalized ratio and blood ammonia. It is concluded that experience from AALF could not be proper for PALF.     

Can the Children's Communication Checklist differentiate between children with autism,children with ADHD,and normal controls?

BACKGROUND: The Children's Communication Checklist (CCC; Bishop, 1998) is a questionnaire that was developed to measure pragmatic language use and may be completed by parents and teachers. Two studies are reported, which were designed to investigate: (1) whether children with Attention Deficit Hyperactivity Disorder (ADHD) encounter pragmatic language problems in comparison with normal controls (NC), (2) whether children with ADHD and children with High Functioning Autism (HFA) can be differentiated using the CCC, (3) the usefulness of the CCC for parents and teachers in a clinical and in a research setting, and (4) the role of age in pragmatic language use in ADHD and HFA. METHOD: In the first study (clinical sample) 50 children with ADHD, 50 children with HFA, and 50 NC were compared to each other using the CCC. In the second study (research sample) CCC data was gathered on 23 children with ADHD (without co-morbid disorders), 42 children with HFA, and 35 NC. RESULTS: Compared to NC, children with HFA showed pragmatic deficits on all CCC scales. Children with ADHD demonstrated deficits compared to NC as well. Moreover, the ADHD and HFA groups differed from each other on most of the scales. Discriminant analyses showed that CCC scales were relevant for case identification in these samples. Furthermore, profiles of impairment seen in children with HFA and ADHD did not vary with age. CONCLUSION: Pragmatic difficulties do occur in both HFA and ADHD. The present studies indicate that the CCC is a useful instrument to obtain information concerning pragmatic language use in both a clinical and a research setting. Although the information of parents is more tightly linked to the diagnosis, combining the information of both parent and teacher slightly improves case identification.     

Can donor liver left lateral sector weight be predicted from anthropometric variables?

Most of the pediatric LT grafts consist in a LLS. Liver graft size matching is one of the major factors determining a successful outcome. The aim of our study was to assess whether anthropometric parameters can be used to estimate the LLS weight. A total of 122 donors (48F/74M) from two transplantation centers were retrospectively reviewed. Eighteen were living related donors (LRLT) and 104 DDs. The donor age was 28.2 yr (range 15-63). The BW and height were, respectively, 70.1 kg (range 45-111) and 172.7 cm (range 152-197). The WLW (n = 66) was 1462 g (range 921-2340), and the liver-to-BW ratio was 2% (range 1.45-2.8%). The LLS graft weight was 313 g (range: 183-537 g). The ratio between LLS and BW was 0.452% (range 0.27-0.74). The LLS represented 22.3% of the WLW with a large variability (range 15.4-31.3%). None of the developed models (linear, nonlinear, or multiple) was clinically usable. The LLS weight is highly variable and is not predictable using simple anthropometric variables. When available, we propose that ultrasonographic estimation of the liver volume should be performed when a liver splitting is considered.     

Do parent and child behaviours differentiate families whose children have obsessive-compulsive disorder from other clinic and non-clinic families?

BACKGROUND: Limited research has been conducted investigating parent and child behaviour during family interactions in families who have a child with obsessive-compulsive disorder (OCD). While a number of authors in the field of childhood OCD have suggested possible parent and child behaviours that are characteristic of these families, few studies have attempted to explore these in a methodologically sound approach. METHOD: This study compared the observed behaviours of parents and children in families whose children were diagnosed with OCD, to families whose children were diagnosed with other anxiety disorders, externalising disorders and no clinical problems. During family discussions, parent and child behaviours and affect were coded using a Likert-scale system. Family members were rated on behavioural dimensions of control, warmth, doubt, avoidance, confidence, positive problem solving, and rewarding independence. RESULTS: Results indicated that parents and children in the OCD group could be clearly differentiated from families in the other groups based on parent and child behaviour. Mothers and fathers of OCD children were less confident in their child's ability, less rewarding of independence, and less likely to use positive problem solving. Children in the OCD group showed less positive problem solving, less confidence in their ability to solve the problem, and they displayed less warmth during their interactions with their parents. CONCLUSIONS: Parents and children in families where there is a child with OCD behave in a different manner during family interactions to other families. These findings offer interesting and important exploratory information relating to observed parent and child behaviour across different clinical and non-clinical groups. Limitations of this study are addressed and directions for further research are discussed.