Hepatotoxicity of rifampicin and isoniazid in children treated for tuberculosis

In order to determine the hepatotoxicity of rifampicin in children treated for tuberculosis, a survey was performed of 18 children receiving this medicine in combination with isoniazid. Fifteen of the 18 children (83%) showed a rise in ASAT values and 11 (61%) in ALAT values exceeding 39 U/L. Seven children with maximal ASAT values between 40 and 100 U/L were treated without any changes in the regimen and the transaminases normalized later in the treatment. Six out of the eight children with ASAT values over 100 U/L were allowed a three-week pause in their therapy, one was given the same dose of rifampicin, and in one the treatment was discontinued entirely. The therapy was discontinued in an additional three children because of a second high rise in the transaminase values. Liver injury can occur at any time during treatment, and thus makes continuous follow-up tests necessary.     

Glucose‐6‐phosphate dehydrogenase deficiency in internationally adopted children

There are conflicting guidelines about screening of internationally adopted children for glucose‐6‐phosphate dehydrogenase (G6PD) deficiency, a common genetic disorder. In a multi‐ethnic population of 2,169 internationally adopted children, we found that the prevalence of G6PD deficiency was 1.6% overall and 2.2% in males. Prevalence differed by country or region of origin, ranging from 0 to 13% overall and 0 to 22% in males. The prevalence in females was 1%. A diagnosis of G6PD deficiency informs the treatment of malaria and enables education and counseling to prevent morbidity and mortality from G6PD deficiency. Screening for G6PD deficiency should be strongly considered for internationally adopted children.     

Physical activity levels and estimated energy expenditure in overweight and normal‐weight 11‐year‐old children

Aim: To objectively evaluate physical activity and energy expenditure in overweight and normal‐weight 11‐year‐old children. Methods: The final sample consisted of 91 children (32 overweight and 59 normal‐weight children), mean age (SD) = 11.3 (0.2) years. Energy expenditure and physical activity were assessed during two weekdays and two weekend days using a multiple‐sensor body monitor (SenseWear Armband; BodyMedia Inc., Pittsburgh, PA, USA). Results: Time spent in physical activity was higher in normal‐weight compared with overweight children (p = 0.002). The highest level of physical activity was noted in normal‐weight boys [mean (SD) = 258 (114) min/day] and the lowest in overweight girls [mean (SD) = 136 (59) min/day] (p = 0.002). In contrast, energy expended during physical activity did not differ between normal‐weight and overweight children (2.6 and 2.7 MJ/day, respectively, p = 0.89). The average decrease in physical activity at weekends was 39 min in overweight children (from 166 to 127 min/day) and 27 min in their normal‐weight counterparts (from 230 to 203 min/day). Conclusion: Overweight children engaged in less physical activity of both moderate and vigorous intensity compared with their normal‐weight peers. Both overweight and normal‐weight children were less active at weekends than on weekdays. Initiatives aiming to increase physical activity of overweight children at weekends are warranted.     

Cardiac troponin T and creatine kinase MB mass concentrations in children receiving anthracycline chemotherapy

Anthracyclines (doxorubicin, daunorubicin, and derivatives) are among the most effective antineoplastic drugs for pediatric cancer with dose-limiting acute and longterm cardiotoxicity. The exact mechanism of the development of cardiomyopathy is still not clear. Anthracyclines may induce subclinical acute myocardial injury leading to lysis of a limited number of myocytes. Alternatively, myocytes may experience a transient loss of cytoplasmic membrane integrity. Both conditions may lead to a transient efflux of small amounts of cytoplasmic enzymes and other proteins specific to the heart muscle fibers. To test these hypotheses we assayed plasma creatine kinase (CK) MB mass and cardiac specific troponin T (TnT). CKMB may be released even in case of reversible cell membrane injury, while prolonged elevation of TnT is the most sensitive and specific marker of limited myocardial necrosis. Thirty-five anthracycline-containing chemotherapy courses in 22 children with cancer were analyzed. CKMB mass and TnT concentrations were within the normal range in all children before anthracycline therapy. Within 72 hours from anthracycline therapy no increment of one of these two marker proteins was detected (ANOVA for repeated measures, P = 0.94 [TnT] and 0.25 [CKMB]). We conclude that only minimal if any acute necroses of cardiac myocytes occur after anthracycline therapy. Even membrane integrity appears to be maintained within the first 3 days after anthracycline therapy, in the absence of electrocardiographic or echocardiographic signs of acute cardiotoxicity. © 1995 Wiley-Liss, Inc.     

Detection of Mycobacterium tuberculosis in gastric aspirate and sputum collected from Ethiopian HIV-positive and HIV-negative children in a mixed in- and outpatient setting

AIM: To investigate, through a prospective study, the detection rate of Mycobacterium tuberculosis in sputa and gastric aspirate from tuberculous children in a low-income country with high prevalence of tuberculosis and an increasing HIV epidemic. METHODS: Gastric aspirates and/or sputum samples were collected from 355 children with pulmonary tuberculosis as follows: from 136 children under 5 y only gastric aspirate was taken, for 159 children aged 5 to 9 y both methods were used, and for 60 children over 10 y only sputum was analysed. The diagnosis of tuberculosis was based on clinical data, tuberculin test and chest radiography. All children were tested for HIV infection. RESULTS: Direct microscopy for acid-fast bacilli was positive for 55 (15%) and mycobacterial culture for 183 (52%) children. The proportion of positive cultures was similar in all age groups. Among the 5 to 9 year-old children who could produce a sputum sample, sputum gave just as good culture yield of M. tuberculosis as gastric aspirate. Of the clinical or radiological findings only weight loss was associated with a higher yield. Repeat gastric aspirate increased the culture yield by 6%. Mycobacterial culture from HIV-positive children gave lower yield compared with HIV-negative children. CONCLUSION: Our data suggest that one gastric aspirate for children less than 6 y and three sputum samples for the older children collected at an outpatient TB clinic, is enough to provide a close to 50% yield of M. tuberculosis available for culture and further analyses. However, with an increasing prevalence of HIV, this detection rate may be reduced.     

Suboptimal maternal and cord plasma pyridoxal 5′ phosphate concentrations are uncommon in a cohort of Canadian pregnant women and newborn infants

Vitamin B₆ is important in fetal development, but little is known of the vitamin B₆ status of pregnant women and newborns in North America and potential modifying factors. This prospective study determined maternal and cord plasma concentrations of pyridoxal 5′ phosphate (PLP; an indicator of vitamin B₆ status) in a convenience sample of 368 Canadian pregnant women and their newborns. The association of maternal intake of vitamin B₆ and fetal genetic variants with cord plasma PLP and homocysteine concentrations was also examined. Dietary and supplemental intakes of vitamin B₆ were assessed in early and mid to late pregnancy. PLP concentrations were measured in maternal plasma in early pregnancy and at delivery, and in cord plasma. Six fetal variants of the MTHFR and CβS genes were assessed for their association with cord plasma PLP and homocysteine concentrations. Geometric mean (95% CI) PLP concentrations were 107 (98, 116) nmol/L in early pregnancy and 58 (53, 62) nmol/L at delivery, respectively, and 296 (275, 319) nmol/L in cord blood (p < .0001). During early pregnancy and at delivery, 3.6% and 5.5% of women had plasma PLP concentrations <20 nmol/L, respectively. Ninety eight percent of the women with supplemental B₆ intake of at least the recommended dietary allowance had PLP concentrations >20 nmol/L. Fetal genetic variants were not associated with cord PLP and homocysteine concentrations. Vitamin B₆ deficiency is uncommon in a cohort of Canadian pregnant women due largely to prevalent vitamin B₆ supplement use.     

Airway inflammation in probiotic‐treated children at 5 years

To cite this article: Kukkonen AK, Kuitunen M, Savilahti E, Pelkonen A, Malmberg P, Mäkelä M. Airway inflammation in probiotic‐treated children at 5 years. Pediatr Allergy and Immunol 2011; 22 : 249–251. Early treatment of new‐born high‐risk children with certain probiotic strains has reduced the risk of atopic eczema. Whether probiotics reduce risk for airway inflammation in long term is not known. We aimed at studying the effect of probiotic treatment during the six first months of life on airway inflammation at age 5 yr. In a randomized double‐blind allergy prevention trial between 2000 and 2007 in Helsinki, Finland, we gave a probiotic combination, plus pre‐biotics, or placebo, to 1018 children during 6 months from birth. At age 5, we measured exhaled nitric oxide (FE_NO) in a randomized sub‐population of 160 children. Allergic diseases and IgE‐sensitization were assessed in all infants. FE_NO did not differ between probiotic and placebo groups, median (interquartile range, IQR) 5.45 (4.3–7.3) vs. 5.70 (3.9–6.8) ppb, p = 0.22. FE_NO was elevated among those suffering from asthma during the first 5 yr than in healthy non‐sensitized children (p = 0.009). FE_NO correlated positively with serum total and allergen‐specific IgE concentrations. Early intervention with probiotics and pre‐biotics does not affect airway inflammation later in childhood.     

Multimodal treatment including tandem high‐dose chemotherapy and autologous stem cell transplantation in children with anaplastic ependymomas

In this study, we evaluated the results of multimodal treatment that included tandem HDCT/auto‐SCT in children with anaplastic ependymomas. Fourteen patients with anaplastic ependymomas were enrolled from 2006 to 2014. Six cycles of induction chemotherapy were administered to all patients before they underwent tandem HDCT/auto‐SCT. Patients who were older than 3 years of age were administered RT after two cycles of induction chemotherapy. In patients under 3 years of age, RT was either omitted or delayed until they reached 3 years of age, if the patients experienced CR after tandem HDCT/auto‐SCT. All patients, including two who experienced disease progression during induction treatment, underwent the first HDCT/auto‐SCT, and 13 subsequently underwent the second HDCT/auto‐SCT. One patient died from hepatic VOD during the second HDCT/auto‐SCT; other toxicities occurring during tandem HDCT/auto‐SCT were manageable. Relapses or progression occurred in seven patients, and five of seven of them remain alive till date after salvage treatment, including surgery and RT. The 5‐year overall and event‐free survival rates were 85.1% ± 9.7% and 50.0% ± 13.4%, respectively. These findings suggest that multimodal treatment including tandem HDCT/auto‐SCT could be a feasible option for improving survival in children with anaplastic ependymomas.     

Nasopharyngeal carcinoma in children and young adults—Beyond 5‐year survival

Nasopharyngeal carcinoma (NPC) is a rare and locally aggressive form of childhood cancer. Treatment of NPC includes chemotherapy and radiotherapy. With current treatment protocols, survival rates for patients with nonmetastatic disease is over 80%. Data regarding very late events including long‐term treatment‐related morbidities and second malignancies are scarce. We present our data on 42 patients with NPC treated in Israel between 1989 and 2014, and followed until 2019. During follow up, five patients had disease recurrence, and four children developed secondary malignancy. Median time to diagnosis of secondary malignancy was 105 months. Eighty‐eight percent of patients have long‐term treatment‐related morbidities.     

Stroke in Swedish children II: long‐term outcome

Aim: To evaluate the long‐term outcome of childhood stroke in a population‐based cohort of Swedish children. Methods: We followed up children with stroke over 7 years from 2000 to 2006 in a health care region covering one‐fifth of the Swedish population. Children aged between 28 days and 18 years, who had arterial ischaemic stroke, cerebral sinus venous stroke or nontraumatic haemorrhagic stroke, were included. The long‐term outcome study 1.6–8.6 years later included a clinical investigation, evaluation of school performance, everyday activities and participation and health‐related quality of life questionnaires (International Classification of Functioning, Disability and Health, Child Health Questionnaire and Short‐Form General Health Survey). Results: Of 51 children, 4 (8%) had died and 85% of the long‐term survivors had some acquired impairment: 65% of the children had neurological impairment, and 59% had deficits affecting school activity and participation. The parents experienced the negative effect of the stroke on their child’s general health, daily life activities and participation and also on their own family life. Conclusion: Childhood stroke results in serious long‐term functional deficits in 85% of survivors affecting their everyday life, the child’s performances and the life of the family as a whole.