The youngest victims of child maltreatment: what happens to infants in a court sample?

Current data show that infants represent an increasing proportion of cases of child maltreatment. To learn more about how infants fare in the current system and to provide baseline data against which to compare outcomes following recent legislative reforms, this study examined a subsample of infants in a sample of 200 care and protection cases brought before the Boston Juvenile Court in 1994. Child, parent, and case characteristics of infants 0 to 3 months of age (n = 46) were compared with characteristics of older children in the sample. All cases were followed prospectively for 4 years, and data were abstracted from court records. Results revealed that the infants were primarily children of substance abusers who had extensive prior histories of child protective service system involvement. Although the majority of the infants were eventually permanently removed from parental custody and adopted, many experienced time delays and multiple placements before achieving permanent homes.     

Is vernix caseosa a protective material to the newborn? A biochemical approach

Twenty random samples of vernix caseosa were collected from immediately born neonates, in Jamahiriya Hospital, Benghazi. Biochemical studies of these samples revealed presence of lipids (62.5%) proteins (36%) and carbohydrate (1.5%). Also we could observe inhibition of staph. aureus and klebsiella growth on nutrient agar by this vemix. This observation could be explained either by its higher asparagine content or by its elevated lipid component. In addition tripalmitin was found to be the major lipid constituent, responsible for its hydrophobic property. So we recommend leaving this vernix layer on newborn skin until spontaneous drying.     

5 years after an ACE: what happens then?

Purpose

Antegrade continence enema (ACE) revolutionised the lives of children with chronic constipation and soiling. Parents often ask how long the ACE will be required. We looked at our patients 5 years after ACE formation to answer the question.

Methods

We reviewed clinical notes of all patients undergoing ACE procedure during January 1990 to December 2010. Only patients with >5 years follow-up were included. Data are given as median (range).

Results

133 patients were included with >5 years of follow-up. Primary pathology was anorectal anomaly (ARA) 64 (48 %); spinal dysraphism (SD) 40 (30 %); functional constipation (FC) 14 (10 %); Hirschsprung’s Disease (HD) 10 (8 %) and others 5 (4 %). Median follow-up was 7 years (5–17 years). Overall 74 % still use their ACE; whilst 26 % no longer access their stoma, of whom 47 % recovered normal colonic function. 50 % of HD patient recover colonic function. FC has the highest failure rate at 21 %.

Conclusions

Overall 86 % achieved excellent clinical outcome with 74 % of patient still using their ACE at 5 years. HD has the highest recovery rate of 50 %. FC has a more unreliable clinical outcome with 21 % recovered colonic function and 21 % failed. Outcome varied dependent on the background diagnosis.

     

High-flow ventilation in newborn infants – what is the evidence?

Heated Humidified High Flow Nasal Cannula (HHHFNC) devices deliver an adjustable mixture of heated and humidified oxygen and air at a variable flow rate. Over recent years HHHFNC devices have become a popular method of non-invasive respiratory support in infants and preterm neonates due to ease of use and being well tolerated by infants. Recent evidence suggests that HHHFNC therapy may reduce work of breathing and improve the efficiency of ventilation in newborn infants, possibly with clinically significant outcomes such as avoidance of the need for nasal continuous positive airways pressure (nCPAP) and a reduced requirement for invasive ventilation. Despite its rapid adoption, there is relatively limited data about the exact mechanisms of action of HHHFNC. There is growing evidence of the feasibility of HHHFNC as an alternative to other forms of non-invasive ventilation in preterm infants. We review the mechanisms of action, and the supporting evidence in favour of using heated humidified high-flow nasal cannula therapy in newborn infants.     

What happens to the thymus in children who have undergone a median sternotomy?

Background

The thymus grows rapidly during fetal life and continues to grow during childhood. When a child undergoes a median sternotomy during cardiac surgery, most of the thymus is removed to gain access to the mediastinum. What happens to the residual thymic tissue in the long term?

Objective

To test the hypothesis that residual thymic tissue left after sternotomy regenerates into an identifiable thymus and is visible on MRI.

Materials and methods

We retrospectively reviewed the cardiac MR images obtained over a 14-month period in all children under the age of 17 years who had undergone a median sternotomy (n=62) to establish the presence/absence of a thymus. We also reviewed the cardiac MR images obtained over the same time period in children who had never undergone open cardiac surgery (n=37).

Results

In the sternotomy group, 18 patients (29%) had an identifiable thymus on MR images, compared to 92% (n=34) in the nonsternotomy group. This difference was statistically significant.

Conclusions

The majority of children in the study group did not have a visible thymus on MR images, which suggests that in these children any residual thymic tissue left postoperatively does not regenerate.

     

How to Proceed with Examination of a Child?

The assessment of a child is quite different from that of adults and requires knowledge of normal variations in anatomy and physiology with growth and development. An important part of initial assessment includes triage and recognizing children with emergency signs so that they can be managed at the earliest to prevent death and referred timely to the specialist. After ruling out emergency signs, the children with priority signs require prompt assessment, management and referral to the specialist. In addition to normal history as in adults, prenatal and birth history, developmental history, immunization history, feeding history and social history are important for complete assessment of the child. The approach to physical examination should consider age and developmental level. It is important to make the child comfortable with pleasant surroundings and playful behavior to yield maximum information from the examination. In addition to diagnosing disease, pediatric assessment should involve identification of malnutrition, immunization status, level of development, screening for 4 Ds (Defects at birth, Deficiencies, Diseases and Developmental Delay including Disability), hearing and visual assessment and detection of child abuse. Tanner staging and psychosocial assessment should be done in adolescents.     

Asthma symptoms in early childhood – what happens then?

Aim: To study the outcome in early adulthood for children with early asthma symptoms and to analyse the factors associated with current asthma. Methods: In a prospective study, we have re-investigated 89/101 children who were hospitalized before the age of two years due to wheezing. The children were investigated using a questionnaire and allergy and bronchial hyper-responsiveness tests at the age of 17-20 years and compared with age-matched controls. Results: In the cohort, 43% had had asthma symptoms in the preceding 12 months compared with 15% in the control group. The strongest risk factors for asthma were current allergy, bronchial hyper-responsiveness and female gender. Female gender and passive smoking in infancy were independent infantile risk factors. In addition to female gender, two pathways led to current asthma: an allergic pathway from family atopy via the development of allergy and another pathway from early passive smoking via hyper-responsiveness and active smoking.

Conclusion: In children with early wheezing disorder, current allergy, bronchial hyper-responsiveness and female gender were the strongest risk factors for asthma in early adulthood, while female gender and passive smoking in infancy were independent infantile risk factors. The effects of early passive smoking persist longer than previously reported.     

Inherited peripheral neuropathies: what does a paediatrician need to know?

Collectively, inherited peripheral neuropathies (IPN) are relatively common in children. They have a combined estimated incidence of 1 in 2500 live births. Therefore, it is likely that most paediatricians and many healthcare professionals working in primary care settings will encounter children with IPN during their careers. This article outlines when to suspect an IPN, the common manner of presentation and how to diagnose and classify these conditions in children. It offers advice on the differential diagnosis, the genetic aspects of childhood IPN and the importance of genetic counselling. The modern aspects of diagnosis, which often use next generation sequencing to rapidly diagnose both common and rare IPNs, are considered. The common surveillance measures and treatment modalities together with the basic science developments that underpin future treatments for IPNs are discussed.