Helicobacter pylori infection and peptic ulcer in eastern Turkish children: is it more common than known?

Helicobacter pylori (H. pylori) infection is mainly acquired in childhood and is frequent in developing countries. The infection is associated with chronic gastritis in all infected children, but peptic ulcer disease develops in a small number of them. In our country, H. pylori infection and associated peptic ulcer disease are common. In eastern Turkey, we found peptic ulcer disease in 13.2% of children who underwent endoscopic examination. Peptic ulcers were mostly gastric ulcers and H. pylori-positive in the studied population, and most of the children were admitted due to abdominal pain. As there are no well-established criteria leading directly to diagnosis, pediatricians should include H. pylori infection and peptic ulcer disease in the differential diagnosis list when evaluating children with abdominal pain, failure to thrive and upper gastrointestinal system bleeding.     

Weight loss in obese children with asthma – is it important?

Obesity is a significant public health problem worldwide, and it has been identified as an independent risk factor for asthma in both adults and children. Not only does obesity increase asthma risk, but it is also associated with decreased asthma-related quality of life, worsened symptoms and asthma control, increased frequency and severity of asthma exacerbations and reduced response to asthma medications. In this review we examine the epidemiology and implications of obesity in both children and adults with asthma, and how the obesogenic “western” diet contributes to asthma prevalence and progression. Finally, we summarise the current evidence on the impact of weight loss on asthma outcomes in both adults and children, highlighting the need for further research to be conducted in the paediatric population.     

Risk stratification in gastroschisis: can prenatal evaluation or early postnatal factors predict outcome?

Purpose  The prenatal or postnatal factors that predict complex gastroschisis in patients (atresia, volvulus, necrotic bowel and bowel perforation) remain controversial. We evaluated the prognostic value of prenatal ultrasonographic parameters and early postnatal factors in predicting clinical outcomes. Methods  We analyzed maternal and neonatal records of 46 gastroschisis patients treated from 1998 to 2007. Information regarding demographics, prenatal ultrasound data when available, intrapartum and postnatal course was abstracted from medical records. Outcome variables included survival, ventilator days, TPN days, time to full enteral feeds, complications and length of stay. Univariate or multivariate analysis was used, with P < 0.05 considered as significant. Result  A total of 75% of complex patients were categorized within 1 week of life. Interestingly, prenatal bowel dilation (>17 mm) and thickness (>3 mm) did not correlate with outcome or risk stratification into simple versus complex (P < 0.05). Complex patients had increased morbidity compared to simple patients (sepsis 58 versus 18%; P = 0.021, NEC 42 versus 9%; P = 0.020, short bowel syndrome 58 versus 3%; P = 0.0001, ventilator days 24 versus 10; P = 0.021; TPN days 178 versus 38; P = 0.0001 and days to full feeds 171 versus 31; P = 0.0001; and length of stay 90 versus 39 days, P = 0.0001). Conclusions  Prenatal bowel wall dilation and/or thickness did not predict complex patients or adverse outcome. Complex gastroschisis patients can be identified postnatally and have substantial morbidity.     

PET-CT in children: where is it appropriate?

The use of PET/PET-CT is a rapidly growing area of imaging and research in the care of children. Until recently, diagnostic imaging methods have provided either anatomical or functional assessment. The development of fused imaging modalities, such as PET-CT or PET-MRI, now provides the opportunity for simultaneously providing both anatomical and functional or physiological assessment. This review will discuss current established uses of PET-CT, possible uses and potential research investigations in the use of this modality in the pediatric population. The focus of this paper will be its use in children being treated for non-central nervous system and non-cardiac disorders.     

Does maternal prenatal attachment predict postnatal mother-infant interaction?

The current study examined whether maternal prenatal attachment is associated with the mother-infant relationship. One hundred pregnant women and their infants at 12 weeks participated in the study. The sample was part of the Umea Child and Family Development project and was randomly recruited by midwives or health visitors. The expectant women completed a self-administered questionnaire, the PAI (the Prenatal Attachment Inventory) measuring prenatal attachment towards their unborn baby. At about 12 weeks postpartum, mothers and their infants were observed and videotaped during an en face interaction. The results revealed that maternal prenatal attachment towards the unborn baby is a good predictor of the early mother-infant relationship. Mothers who were high on the PAI-factor fantasy, for example, in general showed more involvement while interacting with their babies. Mothers rated highly on PAI-factors such as interaction and affection stimulated their infants by using more proximal stimulation, while those rated highly on differentiation of self with the unborn baby used more distal stimulation. Maternal responsive behaviour was only predicted by infant attentive behaviour. This study demonstrated that maternal prenatal attachment during the third trimester of pregnancy is associated with the postnatal maternal involvement, and can serve as an important diagnostic aid in identifying those women for whom the mother-child interaction is likely to be sub-optimal.     

Stimulants: How big is the problem and what are the effects of prenatal exposure?

Globally, cocaine use increased by 7%–18.2 million people in 2016 or 0.4% of the world population aged 15–64. In 2016, over 34 million (0.7%) people aged 15–64 used amphetamines and a further 0.4% used MDMA (Ecstasy). Women of child bearing age worldwide are increasingly using and becoming dependent on stimulants; and are, in turn, more vulnerable to sexually transmitted diseases, sexual violence, unplanned pregnancies and mental health problems. Stimulant use during pregnancy increases obstetric complications for the mother, increases the rate of preterm birth and decreases birth weight, length and head circumference for the exposed infant. No consistent signs of neonatal abstinence syndrome requiring pharmacological treatment have been identified for cocaine or methamphetamine, however, infants exposed to one or both drugs exhibit disorganized neurobehaviour at birth. Increased efforts worldwide are needed to determine the extent of maternal stimulant use and to prevent or identify and treat substance use early during pregnancy.     

Factors affecting breastfeeding duration in Greece: What is important?

AIM: To investigate factors associated with breastfeeding duration (BD) in a sample of mothers living in Greece. METHODS: Four hundred and twenty-eight mothers (438 infants) were initially recruited in a tertiary University Hospital. Monthly telephone interviews (1665 in total) using a structured questionnaire (one for each infant) were conducted until the sixth postpartum month. Cox regression analysis was used to assess factors influencing any BD. RESULTS: Any breastfeeding rates in the first, third, and sixth month of the infant’s life reached 87.5%, 57.0% and 38.75%, respectively. In the multivariate analysis, maternal smoking in the lactation period [hazard-ratio (HR) = 4.20] and psychological status (HR = 1.72), and the introduction of a pacifier (HR = 2.08), were inversely associated, while higher maternal education (HR_{university/collegevsprimary/high school} = 0.53, HR_{master’svsprimary/high school} = 0.20), and being an immigrant (HR = 0.35) were positively associated with BD. CONCLUSION: Public health interventions should focus on campaigns against smoking during lactation, target women of lower educational status, and endorse the delayed introduction of pacifiers.     

How important is permanency planning for children? Considerations for pediatricians involved in child protection

"Permanency planning" refers to maximizing stability in living situations for children in the care of child protection agencies. This issue concerns pediatricians who may be involved in assessing and providing care for these children. In North America, permanency planning is widely advocated if not always effectively implemented. The concept, however, is still controversial from the perspective of protecting parents' interests. This paper examines the principles and evidence underlying the concept of permanency planning in order to ascertain whether emphasizing it remains justified in terms of children's emotional health and development. Three related bodies of literature are reviewed: requirements for healthy child development, conditions that create risk for children, and outcomes for children in care. The findings suggest that permanency planning is vitally important for children and is not only justified, but should be given major emphasis. The implications for pediatricians are discussed.     

Mesenteric lymph nodes in children: what is normal?

Background: Enlarged mesenteric lymph nodes (MLN) are frequently seen in children with abdominal pain and, in the absence of other disorders, have been attributed to primary mesenteric lymphadenitis. Objective: To evaluate the prevalence of enlarged MLN (short axis 5 mm) as detected by abdominal CT in children with a low likelihood for mesenteric lymphadenopathy. Materials and methods: During a 14-month period, we identified all non-contrast abdominal CT examinations performed at a tertiary care pediatric hospital for evaluation of suspected or known renal stones. Two radiologists reviewed the examinations and recognized all enlarged MLN, measured the short-axis diameter, and noted the quadrant location. Results: Sixty-one children were identified who met entry criteria; mean age was 10.7 years (range 1.1–17.3 years). Enlarged MLN were found in 33 (54%) of the 61 children; the largest enlarged MLN was most frequently in the right lower quadrant (RLQ) (29 of 33, 88%). Seventeen of the 61 children (28%) had three or more enlarged MLN; all were in the RLQ. The largest short-axis diameter measured was 10 mm. Summary: MLN with a short-axis diameter of >5–10 mm are commonly found on abdominal CT examination of children with a low likelihood for mesenteric lymphadenopathy and should be considered a non-specific finding. A short-axis diameter of 8 mm might better define the upper limit of normal mesenteric lymph node size in children.