The diagnostic value of a single measurement of superior vena cava flow in the first 24?h of life in very preterm infants

Low superior vena cava (SVC) flow has been associated with intraventricular haemorrhage (IVH) in very preterm infants. We studied the diagnostic value of a single measurement of SVC flow within the first 24?h of life in very preterm infants and its association with occurrence or extension of IVH in a setting of limited availability of neonatal echocardiography. Preterm infants who were born at less than 30?weeks gestation and who had an echocardiogram within 24?h after birth were eligible. Baseline, clinical and ultrasound data were collected. A total of 165 preterm infants were included. Low SVC flow (<41?ml/kg/min) occurred in six infants and was associated with severe IVH and extension of IVH, although this was not significant after adjusting for confounders. The only independently associated variable with low SVC flow was admission temperature (odds ratio 0.27, p?=?0.001). A review of SVC flow values shows that these are higher now than initially reported. This study does not show an association of low SVC flow and severe IVH or extension of IVH after adjusting for confounders as a single measurement of SVC flow did not add any diagnostic value in this cohort. Thus, the exact role of SVC flow measurements in the circulatory assessment of preterm infants remains to be elucidated. However, admission temperature may have an effect on systemic blood flow in very preterm infants.     

Concordance between school outcomes and developmental follow-up results of very preterm and/or low birth weight children at the age of 5 years

Introduction Long-term follow-up studies have revealed a high frequency of developmental disturbances in preterm survivors of neonatal intensive care who were formerly considered to be non-disabled. These developmental disturbances interfere with the acquisition of everyday skills and, in particular, with normal school functioning. Methods Developmental and school outcomes of 355 children, age 5 years at the time of the study, who had a mean gestational age of 30.2 weeks (SD: 1.95) and a mean birth weight of 1272 g (SD: 326) were investigated. Children with severe handicaps were excluded from the study. Perinatal data, information from a parental and school questionnaire and data from standardized developmental tests were used to explain the differences. Results An agreement of 72% was found between developmental follow-up and school outcomes. Normal developmental results but problematic school outcomes were found for 15% of the children tested. There were more boys than girls in this latter group as well as small-for-gestational-age children with relatively poor motor or language development. The schools had not identified problems in 13% of the children, whereas their developmental outcomes were problematic. These children had less neonatal morbidity and relatively higher IQ’s than children who also had problematic developmental outcomes but who had been signalled as problematic by their schools. Conclusions Schools have a good insight in the school functioning of children who are developing well and of children with the lowest developmental scores and the most complicated neonatal histories. How school and developmental outcomes interrelate in the in-between groups remains a challenging question that could be answered by following these children throughout their school career. The study was supported by a grant of the Praeventiefonds, project no. 28-2756 and Zorg Onderzoek Nederland (ZON), project no. 10010004-20.     

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.     

Quantitative and qualitative study of gastric lipolysis in premature infants: do MCT-enriched infant formulas improve fat digestion?

Intragastric fat digestion was investigated by analyzing the products of lipolysis and the gastric lipase (HGL) levels of premature infants fed with a formula enriched with medium chain triglycerides (MCT) and those of infants fed with human milk. Infants were fed using a gastric tube and the gastric contents were aspirated twice a day for 5 d, before and at various times after gavage feeding. HGL levels were measured using the pHstat technique. After extraction, lipids were separated and quantified using thin-layer chromatography coupled to a flame ionization detector. Fatty acid methyl esters were analyzed by gas chromatography. HGL concentration increased during digestion, reaching 77.4 +/- 43.1 microg/mL (around 75% of those recorded in adults). Mean HGL output was 115 +/- 43 microg for 3 h and the overall intragastric lipolysis was 6.1 +/- 2.6%. Although the formula was enriched with octanoic and decanoic acid, the main fatty acids released in the stomach were palmitic (C16:0, 17.03 +/- 0.23% wt/wt) and oleic (C18:1 n-9, 28.23 +/- 1.26% wt/wt) acid. Similar results were obtained with infants fed with human milk. MCT supplementation has no quantitative or qualitative effects on the intragastric lipolysis, which is not higher in premature infant than in adults.     

Does neonatal screening of cystic fibrosis affect outcome? Comparative study of two cohorts in Britanny and Loire-Atlantique with follow-up after ten years]

Neonatal screening for cystic fibrosis was started in Brittany in 1989 but not in the adjacent department of Loire-Atlantique. This study compares the outcome from the children of both populations nine years after the beginning of the screening. Those children were seen in different centers but with the same following guidelines. POPULATION AND METHODS: All children with cystic fibrosis born between 01/01/89 and 31/12/97 in Brittany and the Loire-Atlantique, excluding the meconium ileus, were compared for their initial characteristics and their outcome after nine years of follow-up. RESULTS: There was no significant difference between both populations for sex ratio, gestational age, birth biometry, percentage of homozygotes delta F508, and mean age of children. Age at diagnosis was lower in Brittany (37 vs 372 days, P < 10(-7)), as was the delay for starting pancreatic supplementation (1.5 vs 14.3 months, P < 10(-7)). Percentage of children hospitalized at least once was higher in Loire-Atlantique (84.4 vs 40.3%, P < 10(-4)). There was no significant difference for colonization with Pseudomonas aeruginosa. Z-scores for weight and height were better in Brittany, as were Shwachman's and Brasfield's scores. CONCLUSION: The homogeneity of both populations and their follow-up points out that even if the numbers of children are small and the study is retrospective, some benefits of neonatal screening appear, which are already found in other countries where it is partly practiced. This leads us recommend its general use in our populations, which should be associated with the follow-up of the screened children in cystic fibrosis centers to achieve the most of its benefits.     

The relationship between the continuous opening of arterial catheters and platelet parameters in preterm infants北大核心CSCD

Objective To analyze the correlation between the continuous opening of patent ductus arteriosus (PDA) in preterm infants and platelet parameters in the first 24 hours of life. Methods The preterm infants (gestational age <34 weeks) admitted to Neonatal Intensive Care Unit(NICU)of the Affiliated Xuzhou Hospital of Southeast University from November 2012 to July 2018 were enrolled. The following data were collected retrospectively: the platelet parameters in the first 24 hours of life, clinical factors possibly related to continuous opening of PDA, and echocardiography examination fin-dings on the 4 -7 day after birth. According to the diagnostic criteria of PDA, all preterm infants were divided into symptomatic PDA (sPDA) group, non - sPDA (nsPDA) group, and non - PDA (nPDA) group. SPSS 20.0 software was used for data analysis. Data were analyzed by Chi -square test,LSD or Tambane's T2 of One - Way analysis of variance, and binary Logistic regression analysis of the receiver operating characteristic (ROC) curve. Results Totally 760 preterm infants were chosen, and among them there were 67 cases (8. 8%) in sPDA group, 106 cases (14. 0%) in nsPDA group,and 587 cases (77. 2%) in nPDA group. There were significant differences in the terms of gestation age,birth weight,platelet counts (PLT),and plateletcrit (PCT) in the first 24 hours of life among 3 groups (all P < 0. 05). The smaller gestation age, the lower birth weight, the lower PLT and PCT in the first 24 hours of life,and the higher incidence of PDA in preterm infants. There were no significant differences in the platelet distribution width,mean platelet volume,and platelet large cell ratio in the first 24 hours of life among 3 groups (all P >0. 05). The low lower birth weight and PCT in the first 24 hours of life were independent risk factors for the occurrence of sPDA in preterm infants (P =0. 013,0. 000). The risk of occurrence of sPDA in preterm infants will be increased by 3.279 -fold (95% CI;2. 369 -4.479) if PCT in the first 24 hours of life is decreased by 0. 10%. The area under the ROC curves of PCT and PLT in the first 24 hours of life for prediction of sPDA in preterm infants was 0. 757 (95%C/:0.712 -0.814) and 0.718 (95%C/:0.671 -0.768),respectively. The best cutoff values of PCT and PLT were 0. 178% (sensitivity was 75. 7%, specificity was 71. 9%) and 207. 5 x 10 /L (sensitivity was 71. 4% specificity was 63. 2%). Conclusions The continuous opening of PDA in preterm infants may have correlation with the platelet. The low PCT, rather than PLT, in the first 24 hours of life was an independent risk factor and has medium predictive value for the occurrence of sPDA in preterm infants on the 4 - 7 day after birth. © 2019 Authors. All rights reserved.     

Borderline low conus medullaris on infant lumbar sonography: what is the clinical outcome and the role of neuroimaging follow-up?

Background  

Isolated borderline low conus medullaris is a frequent finding on screening lumbar sonography of unknown significance that often prompts further imaging and clinical follow-up.     

Therapy of monosymptomatic nocturnal enuresis in childhood and adolescence: what is the evidence?

Nocturnal enuresis (bedwetting) is one of the most frequent urological symptoms in children, affecting about 20% of five year olds. It is a heterogeneous disorder with a whole variety of etiologic factors (genetic, endocrinological, neurobiological), particularly a dysfunction of the lower urinary tract. Despite the prevalence of enuresis many questions regarding the complex pathophysiological mechanisms remain unanswered. While nocturnal enuresis per se is clearly not a disease, psychosocial problems have been reported in up to 40% of affected children. Management strategies comprise behavioural and pharmacological approaches, either in isolation or combined. Although expectations were high, especially with pharmacological interventions, the results are usually disappointing with high recurrence rates. Extensive analyses of the available literature on the efficacy of enuresis treatment modalities reveal a poor quality of many trials with a whole range of methodological flaws. Therefore, further comparative studies of adequate methodological quality are needed.     

The Use of Codeine and Tramadol in the Pediatric Population—What is the Verdict Now?

Codeine and tramadol are opioid analgesics approved for the management of pain in the United States. Both agents are metabolized in the liver to active compounds via the cytochrome P450 2D6 enzyme. Case reports of pediatric patients with overactive CYP2D6 enzymes have been reported. These ultra-rapid metabolizers experience an increase in the production of active metabolites of codeine and tramadol, which can lead to oversedation, respiratory depression, and death. In 2017, the U.S. Food and Drug Administration updated their warnings regarding codeine and tramadol use in the pediatric population, making their use contraindicated in patients under the age of 12 years.