Combinación de ledipasvir/sofosbuvir como tratamiento de la infección crónica por hepatitis C

Introduction

Hepatitis C virus infection is world health problem. The aim of this study was to assess the safety and efficacy of ledipasvir/sofosbuvir combination in chronic Hepatitis C Virus (HCV) genotype 1 and 4 infection in paediatric patients.

Metotrexato en artritis idiopática juvenil: efectos adversos y factores asociados

IntroductionMethotrexate (MTX) is the drug of choice for juvenile idiopathic arthritis. Its clinical efficacy is limited due to the development of adverse effects (AEs).Patients and methodsA retrospective observational study was conducted on the AEs associated with MTX therapy in children diagnosed with juvenile idiopathic arthritis followed-up in a tertiary hospital between 2008 and 2016.ResultsThe study included a total of 107 patients, of whom 71 (66.3%) were girls (66.3%). The median age at diagnosis was 6.4 years (IQR 3.1-12.4), with a median follow-up of 45.7 months (IQR 28.8-92.4). There were 48 patients (44.9%) with oligoarthritis, and 26 children (24.3%) with rheumatoid-factor negative polyarthritis. Of these, 52/107 (48.6%) developed AEs, with the most frequent being gastrointestinal symptoms (35.6%) and behavioural problems (35.6%). An age older than 6 years at the beginning of therapy increased the risk of developing AEs, both in the univariate (OR=3.5; 95% CI: 1.5-7.3) and multivariate (12% increase per year) analyses. The doses used, administration route, or International League of Associations for Rheumatology (ILAR) classification, were not associated with the development of AEs. Twenty children required a dosage or route of administration modification, which resolved the AE in 11 (55%) cases. MTX was interrupted due to the development of AEs in 37/107 patients (34.6%), mainly due to increased plasma transaminases (n = 14, 37.8%), gastrointestinal symptoms (n = 9, 24.3%) and behavioural problems (n = 6, 16.3%).ConclusionsMTX is the therapy of choice for patients with juvenile idiopathic arthritis, but 50% of the children develop some form of AE. Although the AEs are not severe, they lead to interruption of therapy in 35% of the children.     

Decreased health-related quality of life in children and adolescents with autoimmune hepatitis

Objective

The objective of this study was to evaluate the health-related quality of life in children and adolescents with autoimmune hepatitis.

Microangiopatías trombóticas en niños críticamente enfermos. Registro español MATUCIP

IntroductionThrombotic microangiopathies (TMA) are rare diseases usually presenting with renal, haematological, neurologic and cardiovascular involvement and nonspecific but severe symptoms. A registry of TMA cases managed in Spanish paediatric intensive care units (the MATUCIP registry) was established with the aim of gaining knowledge on their clinical characteristics, diagnosis and acute-phase treatment.Patients and methodsWe conducted a prospective multicentre observational study in 20 paediatric intensive care units (PICUs) in Spain from January 2017 to December 2021 in children aged more than 1 month with TMAs, who were followed up through the discharge from the PICU.ResultsThe sample included 97 patients (51.5% female) with a median age of 2.6 years (interquartile range [IQR]: 1.6-5.7). The initial manifestations were gastrointestinal (74.2%), respiratory (14.4%), fever (5.2%), neurologic (3.1%) and other (3.1%). At admission, 75.3% of patients had microangiopathic haemolytic anaemia, 95.9% thrombocytopenia and 94.8% acute kidney injury. Of the total sample, 57.7% of patients received a diagnosis of Shiga toxin-associated haemolytic uraemic syndrome (HUS), 14.4% of Streptococcus pneumoniae-associated HUS, 15.6% of atypical HUS, 10.3% of secondary TMA and 2.1% of thrombotic thrombocytopenic purpura. Eighty-seven patients (89.7%) developed arterial hypertension, and 49.5% gastrointestinal, 22.7% respiratory, 25.8% neurologic and 12.4% cardiac manifestations. Also, 60.8% required renal replacement therapy and 2.1% plasma exchange. Twenty patients received eculizumab. The median PICU stay was 8.5 days (IQR: 5-16.5). Two children died.ConclusionsThe MATUCIP registry demonstrates the clinical variability of TMA cases requiring admission to the PICU. Knowledge of the presentation and outcomes of TMAs can facilitate early aetiological diagnosis. This registry can help improve our understanding of the clinical spectrum of these diseases, for which there is a dearth of published data.     

Publishing in pandemic times: A bibliometric analysis of early medical publications on Kawasaki-like disease (MIS-C,PIMS-TS) related to SARS-CoV-2

IntroductionAt the end of April 2020, three European pediatric societies published an alert on a new hyperinflammatory disorder linked to SARS-CoV-2. This disease has alternatively been called Kawasaki-like disease, pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS), and multisystem inflammatory syndrome in children (MIS-C). These alerts provide a clear starting point from which to study the early response of the medical and scientific community to a new disease in terms of scientific publications, and to compare the timeline of this response with levels of general public interest. To this aim, we conducted a bibliometric analysis of articles on this disease published between 1 April and 5 July 2020.MethodA literature search was performed using PubMed and in three preprint repositories. For each article, the name used for the disease in the title, the number of authors, the number of patients, the citations according to Google Scholar, the journal impact factor, and the Altmetric score were retrieved. Google search trends for the terms “Kawasaki” and “COVID,” “COVID-19,” and “coronavirus” were also retrieved, as was the number of Reuters news articles published on the topic. These data were compared longitudinally on a weekly basis. The quality of the reporting of the study was evaluated using the STROBE guidelines for observational studies with more than three patients and using the CARE guidelines for case reports of three or fewer patients.ResultsEighty-six articles were included, among which ten were preprints (three of which were subsequently published) and 49 were clinical articles (57%). A total of 857 patients were described. The median number of authors per article was five (range, 1–45), the median number of patients was four (1–186), the median number of citations was one (0–170), the median Altmetric score was 12 (0–7242), and the median journal impact factor was 3.7 (1–74.7). For the clinical articles, the median percentage of STROBE or CARE checklist items satisfied was 70% (IQR, 56.75–79.25; range, 40–90). Guideline adherence was significantly higher for observational studies than for case reports (median percentage of checklist items satisfied, 78.5% vs 61.5%; P < 0.001); however, guideline adherence did not differ significantly between peer-reviewed and preprint articles (median percentage of checklist items satisfied, 57% vs 72%; P = 0.205). The only statistically significant difference between clinical articles and other types of articles was the number of authors (median, 7 vs 2; P = 2.53E-9). Fifty-seven of the 86 articles were authored by researchers from just three countries (the USA, 31; France, 14; and the UK, 12). The names most frequently used in the title were Kawasaki-like disease (n = 37), followed by MIS-C (n = 27), PIM-TS (n = 14), and other names involving the term “inflammatory” (n = 12). Google searches for related terms peaked between weeks 18 and 21, following the initial alerts and decreased rapidly thereafter. The number of Reuters articles on the subject was correlated with Google search trends (ρ: 0.86, 95% CI [0.59; 0.96]; P = 0.00016), but the number of medical articles published was not (ρ: −0.54, 95% CI [−0.87; 0.14]; P = 0.11). The first small case series was published less than 2 weeks after the initial alert; however, if all articles had been deposited as preprints when they were submitted to journals, the cumulative number of reported cases would have been 300% higher in week 18 (3 vs 1), 400% higher in week 19 (44 vs 11), 70% higher in week 20 (124 vs 73), and 54% higher in week 21 (129 vs 84).ConclusionIn a period of 9 weeks after the initial alerts from European pediatric societies, 85 medical articles were published, involving 856 patients (one case report was published before the alerts), allowing rapid dissemination of research information. However, general public interest followed the news cycle rather than scientific releases. The quality of the reporting, as assessed by adherence to STROBE or CARE guidelines, was adequate with more than two-thirds of checklist items satisfied. Learned societies play an important role in the early dissemination of up-to-date peer-reviewed information. Preprint deposition should be encouraged to accelerate the dissemination of research information.     

Botulinum toxin type A treatment in children with cerebral palsy: Evaluation of treatment success or failure by means of goal attainment scaling

BackgroundThere is considerable variability in the amount of response to BTX-A treatment between and within patients with cerebral palsy (CP).AimsThe purpose of this retrospective cohort study was to evaluate the clinical responsiveness of Botulinum toxin type A (BTX-A) treatment in children with CP and specifically delineate features of treatment success and failure.MethodsFour hundred and thirty-eight children (251 boys, 187 girls; mean age 8 years 2 months, SD 4 years) were included into the study. Goal Attainment Scaling (GAS) was used to classify and evaluate treatment efficacy. Two study groups were defined: one group with an excellent response (GAS ≥ 60.0) and one group with a lack of response (GAS ≤ 40.0) to BTX-A.ResultsSeventy-five patients (17.1%) had an excellent response and treatment was found to be unsuccessful for 31 patients (7.1%). Children with a lack of response to BTX-A were significantly older compared to children with a high responsiveness (p = 0.0013). In the latter group, more children received multi-level injections and fewer children had injections in proximal parts of the lower limb compared to the low responsiveness group (p = 0.0024). Moreover, there was a significant difference in the use of different types of casts between both study groups (p = 0.0263).ConclusionAge, level of treatment and casting seem to be crucial features of BTX-A treatment success or failure in children with CP.     

Congenital hydrocephalus – prevalence,prenatal diagnosis and outcome of pregnancy in four European regions

ObjectiveTo describe prevalence, prenatal diagnosis and outcome for fetuses and infants with congenital hydrocephalus.MethodsData were taken from four European registries of congenital malformations (EUROCAT). The registries included are based on multiple sources of information and include information about livebirths, fetal deaths with GA ≥ 20 weeks and terminations of pregnancy for fetal anomaly (TOPFA). All cases from the four registries diagnosed with congenital hydrocephalus and born in the period 1996–2003 were included in the study. Cases with hydrocephalus associated with neural tube defects were not included in the study.ResultsEighty-seven cases with congenital hydrocephalus were identified during the study period giving an overall prevalence of 4.65 per 10,000 births. There were 41 livebirths (47%), four fetal deaths (5%) and 42 TOPFA (48%). Nine percent of all cases were from a multiple pregnancy. Additional non-cerebral major malformations were diagnosed in 38 cases (44%) and karyotype anomalies in eight cases (9%). Median GA at TOPFA was 21 weeks. Among livebirths 61% were diagnosed prenatally at a median GA of 31 weeks (range 17–40 weeks) and median GA at birth was 37 weeks. Fourteen liveborn infants (34%) died within the first year of life with the majority of deaths during the first week after birth.ConclusionCongenital hydrocephalus is a severe congenital malformation often associated with other congenital anomalies. CH is often diagnosed prenatally, although sometimes late in pregnancy. A high proportion of affected pregnancies result in termination for severe fetal anomaly and there is a high mortality in livebirths.     

Efectos hemodinámicos del omeprazol por vía intravenosa en niños en estado crítico

IntroductionCritical patients usually have hemodynamic disturbances which may become worse by the administration of some drugs. Omeprazole is a drug used in the prophylaxis of the gastrointestinal bleeding in these patients, but its cardiovascular effects are unknown. The objective was to study the hemodynamic changes produced by intravenous omeprazole in critically ill children and to find out if there are differences between two different doses of omeprazole.Material and methodsA randomized prospective observational study was performed on 37 critically ill children aged from 1 month to 14 years of age who required prophylaxis for gastrointestinal bleeding. Of these, 19 received intravenous omeprazole 0.5 mg/kg every 12 hours, and 18 received intravenous omeprazole 1 mg/kg every 12 hours. Intravenous omeprazole was administered in 20 minutes by continuous infusion pump. Heart rate, systolic, diastolic and mean arterial blood pressure, central venous pressure and ECG were recorded at baseline, and at 15, 30, 60 and 120 minutes of the infusion.ResultsThere were no significant changes in the electrocardiogram, heart rate, blood pressure and central venous pressure. No patients required inotropic therapy modification. There were no differences between the two doses of omeprazole.ConclusionsIntravenous omeprazole administration of 0.5 mg/kg and 1 mg/kg is a hemodynamically safe drug in critically ill children.     

Assessment of myocardial performance in preterm infants less than 29 weeks gestation during the transitional period

BackgroundThe transitional circulation and its effect on myocardial performance are poorly understood in preterm infants.AimsWe assessed myocardial performance in infants less than 29 weeks gestation in the first 48 h of life using a comprehensive echocardiographic assessment.DesignInfants < 29 weeks gestation were prospectively enrolled. Small for gestation, infants on inotropes and/or inhaled nitric oxide and septic infants were excluded. Conventional echocardiography, left ventricular (LV), septal and right ventricular (RV) tissue Doppler imaging (TDI) and tissue Doppler-derived strain and strain rate (SR), tricuspid annular plane systolic excursion (TAPSE) and global RV fractional area change (FAC) were assessed at a median of 10 and 45 h post-delivery.ResultsFifty-four infants with a median [IQR] gestation and birth weight of 26.5 weeks [25.8–28.0 weeks] and 915 g [758–1142 g] were included. There was no change in shortening or ejection fraction across the two time points. Systolic and diastolic TDI of the LV, septum and RV increased across the two time points (all p values ≤ 0.01). There was an increase in septal peak systolic and early diastolic SR (p = 0.002). Septal systolic strain and late diastolic SR did not change. With the exception of RV strain and early diastolic SR, all RV functional parameters including SR, late diastolic SR, TAPSE, and FAC increased across the two time points (all p values < 0.01).ConclusionDescribing the normal hemodynamic adaptations in stable preterm infants during the transitional period provides the necessary information for the assessment of those parameters in various disease states.     

Laparoscopic heminephrectomy in infants and children: first 54 cases

ObjectiveHeminephrectomy in the pediatric population remains a popular open surgical procedure. We describe our experience with laparoscopic heminephrectomy using a retroperitoneoscopic approach.Materials and methodsData were collected retrospectively and prospectively on all patients undergoing laparoscopic heminephrectomy by a single surgeon using a prone retroperitoneoscopic approach. Information relating to the age, sex, laterality, duration of surgery, analgesic requirements, duration of hospital stay, postoperative complications and outcome was recorded.ResultsBetween March 2001 and August 2005 54 laparoscopic heminephrectomies were performed in 48 children (34 girls and 14 boys). The median age at surgery was 14 months (range 2–112 months). Forty-four upper and 10 lower moieties were removed. The median operative time was 105 min (range 50–150 min). There were no intraoperative complications and no conversions. There were four minor complications, comprising haematuria (n = 1) and postoperative pyrexia (n = 3). The median length of follow up was 22 months (range 3–57 months). All patients remained asymptomatic at last follow up. Ultrasound findings included presence of a visible ureteric stump (n = 7) and cysts at the resection margin of the remaining remnant (n = 17); none of these patients manifested clinical symptoms (e.g. infection, pain).ConclusionsWith advanced laparoscopic skills, laparoscopic heminephrectomy is a feasible operation for the treatment of non-functioning duplex renal units in children and infants.     

Optimización del tratamiento con azatioprina: determinación de la actividad de tiopurina metiltransferasa y las concentraciones de metabolitos tiopurínicos

IntroductionIndividualised doses of azathioprine (AZA) may be prescribed by monitoring the levels of the enzyme thiopurine methyltransferase (TPMT). The measurements of thiopurine metabolites of AZA, 6-thioguanine (6-TGN) and 6-methylmercaptopurine (6-MMP), have also been reported as new markers of AZA activity.ObjectivesTo describe TPMT phenotype in our population and to establish a relationship between thiopurine metabolites,and therapeutic activity and adverse effects.Material and methodsData on TPMT were retrospectively collected from 107 patients, and 6-TGN and 6-MMP levels in 18 patients currently on treatment with AZA (Crohn's disease 5, ulcerative colitis 5, autoimmune hepatitis 5).ResultsMean value of TPMT was 20.19 U/ml. None of the patients had a TPMT activity<5 U/ml. Of the 18 patients on treatment, 13 showed sub-therapeutic levels of 6-TGN (<235 pmol/8×10⁸ red blood cells). Clinical remission was maintained in 45% of patients. Mean levels of 6-TGN in patients with clinical remission were 259 pmol/8×10⁸ red blood cells versus 209 pmol/8×10⁸ red blood cells in non-responders (p=0.37). There was an inverse relationship (r=?0.28) between TPMT and 6-TGN levels. Toxic effects occurred in 6 of 18 patients, with leukopenia in 5 and hyperamylasemia in 1.ConclusionsDetermination of TPMT and monitoring of thiopurine metabolites allows AZA treatment to be optimised, although further studies are necessary to establish therapeutic effectiveness and toxicity ranges.     

Thrombolytic therapy using a low dose of tissue plasminogen activator in children

ObjectiveTo analyse the efficacy and side effects of low doses of tissue plasminogen activator for the treatment of acute arterial and/or venous thrombosis in children.Patients and methodsProspective observational clinical study. 18 children between 1 months and 11 years treated with low doses (0.01-0.06 mg/kg/h) of continuous intravenous thrombolytic therapy with t-PA were studied.ResultsA total of 94% of patients improved with low doses t-PA (72% complete resolution of the thrombosis and 22% partial resolution). One patient suffered a severe haemorrhage secondary to t-Pa and had to stop the treatment. The incidence of severe side effects was low (5%)ConclusionsThrombolytic therapy with low doses of t-PA (0.01-0.05 mg/kg/h) is effective in a high percentage of children with acute arterial and/or venous thrombosis and produces a relatively low frequency of side effects.     

Valor pronóstico de la espectroscopia cercana al infrarrojo en la encefalopatía hipóxico-isquémica

IntroductionDespite treatment with hypothermia, 40% of newborns with hypoxic-ischaemic encephalopathy die or suffer moderate to severe disability. Near-infrared spectroscopy (NIRS) could be a useful, non-invasive tool to establish the prognosis.ObjectivesTo evaluate the prognostic value of NIRS in predicting neurodevelopmental outcomes at 18 to 36 months in newborns with hypoxic-ischaemic encephalopathy, and to establish the time points and cut-off values of regional cerebral oxygen saturation that exhibit the strongest correlation to these outcomes.Patients and methodsThe study included all term newborns with hypoxic-ischaemic encephalopathy managed with hypothermia and NIRS between 2013 and 2016. We established 3 outcome categories: normal neurodevelopment, moderate disability and severe disability.ResultsThe sample comprised 28 newborns (median gestational age, 39 weeks; median birth weight, 3195 g). The median regional cerebral oxygen saturation increased from 65% to 85% at 48 hours post birth. Neurodevelopmental outcomes were normal in 28.6%, while 35.7% developed moderate disability and 35.7% severe disability; 3 patients died. We found a statistically significant difference between groups at 48 hours (P = .005) and after hypothermia (P = .03), with higher values in patients with disability. When we compared patients in the severe disability group with the other groups, we found a statistically significant area under the ROC curve at 48 hours of 0.872 (P = .001) applying a regional cerebral oxygen saturation cutoff of 83.5%. After hypothermia, regional cerebral oxygen saturation values below 66.0% (AUC, 0.794; P = .017) predicted normal development, while values above 82% (AUC, 0.881; P = .001) predicted severe disability.ConclusionsNIRS seems to be a valuable tool to predict neurodevelopmental outcomes in patients with hypoxic-ischaemic encephalopathy, even after hypothermia, with higher cerebral oxygen saturation values in patients with disability.     

A lower fistula rate in hypospadias surgery

ObjectiveTo determine whether specific steps taken after a critical quality control of our results in hypospadias surgery lead to a decrease in fistula rate.Patients and methodsRetrospective review of prospectively collected data. Between 1994 and 2001, our series of 85 tubularized plate urethroplasties (modified Duplay or Duplay-Snodgrass procedure) had a fistula rate of 25.9%. In 2001, we modified our approach by systematically padding the urethral suture with a layer of vascularized subcutaneous preputial tissue, as described by Snodgrass. Scrotal hypospadias were excluded. Surgical outcome was assessed at 1 and 12 months. In both groups, all repairs were performed by or under direct supervision of the senior author (BJM).ResultsAfter 2001, 57 hypospadias repairs were performed in 57 patients aged 8 months to 14 years (median 1.4 years). Fistula occurred in two cases, one of which closed spontaneously within 6 months. Our fistula rate had dropped to 3.5%, with a minimum follow up of 12 months.ConclusionCovering the urethral suture with a padding flap of vascularized preputial tissue helps avoid fistula formation. Technique modification after critical appraisal of our own series led to a much better outcome in this demanding surgery.     

Impacts des facteurs maternels sur l’allaitement maternel en réanimation néonatale

ObjectiveAdmission at birth to a Neonatal Intensive Care Unit (NICU) complicates breastfeeding especially for preterm babies despite hospital staff trained to encourage breastfeeding. The aim of this study was to find factors related to the mother, the pregnancy or the neonate influencing breastfeeding rate on a NICU.Patients and methodsThis was a retrospective study including neonatal admissions to the NICU at Antoine-Béclère University Hospital from 1st May 2009 to 30th April 2010. Data was collected from medical notes. The breastfeeding rate (at initiation and at discharge) was analysed with regards to maternal age, method of procreation, type of pregnancy (single or multiple), parity, mode of delivery (vaginal delivery or C-section), birthweight, gestational age and intra-uterine growth restriction (IUGR).ResultsThe study was based on 460 neonates having complete documentation. The average maternal age was 32 years. Premature infants represented 74.8% of the population (median gestational age = 34 weeks) of which 57% were less than 33 weeks (42.6% of all infants, n = 196). The median birthweight was 1900 g with 17.6% of IUGR infants. Breastfeeding rate at initiation was 58.7 and 43.9% at discharge (mean admission days: 17.1 [0–180], median = 8 days). For infants born of multiple pregnancies (24.3% of the population) 51.6% were born of medically assisted pregnancies (MAP) and 17.6% of spontaneous pregnancies. Breastfeeding rate among these infants was 57.1% at initiation and 45.5% at discharge. It was higher in infants born of MAP at initiation (70.3% versus 55.8% for spontaneous pregnancies, P < 0.05) and at discharge (49.5% versus 42.5% for spontaneous pregnancies). For these infants, average maternal age was higher for breastfed infants (33.9 versus 32.1 years for the formula-fed, P < 0.05). Breastfeeding rate in infants born to primipares was higher at initiation (64.9% versus 53.6% for multipares, P < 0.05) and at discharge (48.5% versus 40.8% for multipares, P < 0.05). The rate of infants breastfed was influenced neither by maternal age alone (31.8 ± 5.6 versus 31.4 ± 5.7 years for formula-fed), nor by type of delivery (56.7% for infants born by C-section versus 62.5% for infants born by vaginal delivery), nor gestational age (33.2 ± 4.3 weeks for breastfed, versus 33.4 ± 4.2 weeks for formula-fed infants), nor birthweight (2060 ± 978 g for breastfed versus 2055 ± 909 g for formula-fed infants), nor IUGR (58% versus 58.8% for eutrophes).DiscussionOur maternal population was different as 16.7% of deliveries were accounted for by MAP, superior to the French average (< 10%). We describe for the first time MAP as a positive influencing factor on breastfeeding rates in newborns admitted to a NICU. A better breastfeeding information policy during pregnancy, higher maternal age and increased multiple pregnancies would explain a higher breastfeeding rate among the women who had MAP. An impact of increasing maternal age was found on the rate of breastfed infants born of MAP. Primiparity was also a contributing factor for breastfeeding. Professional formation for all hospital staff concerned would be essential to give out clear and consistent information to families and to encourage support and intimacy throughout hospitalisation as well as at discharge.     

Respiratory distress management in moderate and late preterm infants: The NEOBS Study

ObjectiveTo investigate the characteristics and management of respiratory failure (RF) in moderate-to-late preterm infants.MethodsNEOBS was a prospective, multicenter, observational study conducted in 46 neonatal intensive care units caring for preterm infants (30 + ^0/7 to 36 + ^6/7 weeks of gestation [WG]) in France in 2018. The cohort was stratified into two groups: 30–33 WG (group 1) and 34–36 WG (group 2). Infants with early neonatal RF were included and the outcomes assessed were maternal, pregnancy, and delivery characteristics and how RF was managed.ResultsOf the 560 infants analyzed, 279 were in group 1 and 281 were in group 2. Most pregnancies were singleton (64.1%), and 67.4% of women received prenatal corticosteroids (mostly two doses). Infants were delivered by cesarean section in 59.6% of cases; 91.7% of the infants had an Apgar score ≥ 7 at 5 min. More than 90% of infants were hospitalized post-birth (median duration, 36 and 15 days for groups 1 and 2, respectively). Medical intervention was required for 95.7% and 90.4% of the infants in group 1 and group 2, respectively, and included noninvasive ventilation (continuous positive airway pressure [CPAP]: 88.5% and 82.9%; high-flow nasal cannula: 55.0% and 44.7%, or other) and invasive ventilation (19.7% and 13.2%). The two main diagnoses of RF were respiratory distress syndrome (39.8%) and transient tachypnea of the newborn (57.3%). Surfactant was administered to 22.5% of the infants, using the less invasive surfactant administration (LISA) method for 34.4% of the patients. In the overall population, 8.6% of the infants had respiratory and/or hemodynamic complications.ConclusionsThe NEOBS study demonstrated that CPAP was widely used in the delivery room and the LISA method was chosen for 34.4% of the surfactant administrations for the management of RF in moderate-to-late preterm infants. The incidence of RF-related complications was low.     

Post-pyelonephritic renal scars are not associated with high voiding pressures

ObjectiveThe aim of this study was to evaluate whether renal scars and vesicoureteral reflux (VUR) are associated with bladder dysfunction in children after first clinical pyelonephritis.Patients and methodsSixty-four children were evaluated with urodynamics and voiding cystourethrography at a median of 8 weeks after their first episode of clinical pyelonephritis. All patients had ultrasonography and dimercaptosuccinic acid (DMSA) scintigraphy during the infection. After 2 years, DMSA scintigraphy was repeated in 58 patients. Re-infections were recorded.ResultsOveractive detrusor was found in 27 (42%) patients. There was no significant difference in the incidence of overactive detrusor between boys and girls. The maximal voiding pressure was higher in boys (median 92.5, range 48–191 cmH₂O) than in girls (median 82, range 37–150 cmH₂O) (P = 0.0117). Thirty-one (48%) patients had renal defects in scintigraphy during the infection. Ultimately, 12 patients (21%) developed renal scars; 11 patients (17%) had VUR. Renal defects in DMSA scintigraphy and the presence of VUR were not associated with overactive detrusor or high voiding pressures.ConclusionOveractive detrusor is a common finding after first episode of pyelonephritis. The dysfunction may explain the development of urinary tract infections in some children. There were no differences in the incidence of overactive detrusor or voiding pressures in patients with and without VUR, or in those with and without renal defects on DMSA scintigraphy. Urodynamic study is not a primary investigation in pyelonephritic children.     

Management of calculus anuria in children: Experience of 54 cases

ObjectiveTo evaluate the outcome of different treatment plans for calculus anuria in children.Patients and methodsPatients were subdivided into three groups, A, B and C. Group A included patients who were critically ill, had serum creatinine ≥ 3.5 mg/dl, blood urea ≥ 100 mg/dl, serum potassium ≥ 7 meq/l and/or blood pH ≤ 7.1; and they were treated initially by peritoneal dialysis. Patients in groups B and C were stable with serum creatinine < 3.5 mg/dl, blood urea < 100 mg/dl, serum potassium level < 7 meq/l and blood pH > 7.1. In group B, the obstructing stone could not be localized, and they were treated either by percutaneous nephrostomy or JJ stent. In group C, stone level was confidently determined and patients were treated by open surgery.ResultsFifty-four patients were included. All patients regained normal serum creatinine levels within 72–120 h. Overall complication rate in groups A and C was 26% and 13%, respectively. In group B, overall complication rate was 66% for percutaneous nephrostomy and 50% for internal stent.ConclusionsUrinary diversion in children is associated with a high complication rate while dialysis is highly effective in children. Formal surgery in compensated children is associated with a low complication rate with good outcome and early recovery.     

Testicular torsion: Orchiectomy or orchiopexy?

ObjectiveTo evaluate the impact on testicular function of the surgical approach used to treat testicular torsion.Patients and methodsSeventeen males operated on for testicular torsion at a median age of 14 years were investigated. Serum follicle-stimulating hormone (FSH), testosterone and inhibin B as well as testicular volume were measured early (median 36 days) and/or late (median 1.1 years) after operation.ResultsOrchiectomy was performed in six, and testicular detorsion and orchiopexy in 11 patients. The duration of the preoperative symptoms in the detorsion group was 15 h (range 6–168) and in the orchiectomy group 42 h (range 24–96) (P = 0.03). Preoperative colour Doppler ultrasonography showed some circulation in 40% of the patients. At 1 month the median serum inhibin B level was significantly higher after preserving surgery (P = 0.01). At 1 year postoperatively, the median serum FSH level tended to be lower after testicular preservation (P = 0.09). Abnormal inhibin B or FSH values were observed in 35% of the patients.ConclusionsTesticular function is often compromised in patients with testicular torsion. Testis-preserving surgery yields better testicular function than orchiectomy in the short term if the testis is not obviously necrotic. Testicular torsion does not necessarily cause the circulation to cease completely, and preserving surgery can also sometimes be attempted after delayed diagnosis.