Evidence based management guidelines for the detection and treatment of congenital CMV

CMV is the most common congenital infection in newborns worldwide. Congenital CMV causes sensorineural hearing loss in a significant proportion of infected newborns, while the majority of newborns are asymptomatic. In the last three years there have been significant advances in the diagnosis and treatment of congenital CMV. We have developed practical evidence based guidelines for the management of congenital CMV.     

Antenatal rectal perforation presenting in the neonate

Perforation of the rectum in the antenatal period is extremely rare. Three cases have been reported worldwide. Its aetiology and pathophysiology are poorly understood. Rapid recognition by its classical signs is mandatory as delay in diagnosis leads to serious morbidity. We report a fourth case, and make recommendations regarding management.     

Neonatal mortality from respiratory distress syndrome: lessons for low-resource countries

Respiratory distress syndrome (RDS) is a major contributor to neonatal mortality worldwide. However, little information is available regarding rates of RDS-specific mortality in low-income countries, and technologies for RDS treatment are used inconsistently in different health care settings. Our objective was to better understand the interventions that have decreased the rates of RDS-specific mortality in high-income countries over the past 60 years. We then estimated the effects on RDS-specific mortality in low-resource settings. Of the sequential introduction of technologies and therapies for RDS, widespread use of oxygen and continuous positive airway pressure were associated with the time periods that demonstrated the greatest decline in RDS-specific mortality. We argue that these 2 interventions applied widely in low-resource settings, with appropriate supportive infrastructure and general newborn care, will have the greatest impact on decreasing neonatal mortality. This historical perspective can inform policy-makers for the prioritization of scarce resources to improve survival rates for newborns worldwide.     

Immunosuppression in the pediatric transplant recipient

The field of pediatric solid-organ transplantation has significantly evolved since its beginnings in the early 20^th century. As advancements have led to the development of innovative surgical techniques and novel medication regimens, transplantation has now become a routine practice leading to an increase in the rates of organ recipients worldwide.The care of pediatric solid-organ transplant recipients differs from adults in several areas not only due to technically challenging surgeries, but mostly due to the complexity of their immunosuppression management. Although there is large variation of pediatric immunosuppression regimens worldwide, the use of calcineurin inhibitors, either tacrolimus or cyclosporine, still forms the backbone of immunosuppression regimens after solid-organ transplantation. Both medications are relatively well tolerated but are known to have long-term side effects, especially nephrotoxicity and neurotoxicity. The goal of care in long-term pediatric survivors of solid-organ transplant now aims to safely minimize exposure to immunosuppression and to achieve long-term graft tolerance.     

Congenital Fatal Diarrhea in Newborns

Microvillus inclusion disease is a rare autosomal recessive disorder of intestinal epithelium causing intractable secretary diarrhea in the first two months of life and about 140 cases have been reported worldwide till now. Here authors report 2 cases of Microvillus inclusion disease (MVID) diagnosed in neonates by electron microscopy study of small intestinal biopsy.     

新发现呼吸道病毒感染的流行病学及其临床特征

呼吸道感染是儿科的常见病、多发病,是引起世界范围内5岁以下儿童死亡的首位原因.其临床表现易被认识,但病因却很难明确.2001年以来许多新的人类病毒被发现,其中人类偏肺病毒、人类冠状病毒NL63和HKU1,以及人类博卡病毒,均已被证实可引起小儿呼吸道疾病,其流行病学及临床特征也得到较为深入的研究.     

First report of an Asian family with hemoglobin Evans [α2 62 (E11) Val → Met]

Hemoglobin Evans is an unstable variant caused by a single nucleotide mutation that produces a valine‐to‐methionine substitution at residue 62 of the α‐globin chain. It has not been reported in the Asian population and only three cases have been reported worldwide. We diagnosed a Japanese boy with chronic hemolytic anemia with hemoglobin Evans after genetic testing. This is the first familial case of hemoglobin Evans in an Asian population.     

Antimicrobial resistance: mechanisms and strategies

Antimicrobial resistance is a growing threat worldwide. S. aureus strains that combine resistance and virulence genes have become a major treatment problem in Europe and the U.S. Extended-spectrum beta-lactamases are an emerging problem in many settings. Resistance mechanisms have been found for every class of antibiotic agent. Development of new classes of antibiotics or more robust versions of old classes will be essential in the years to come. Judicious use of antimicrobial agents and improved infection control methods must become health care priorities.     

Rotavirus infection: an update on management and prevention

Rotavirus infection is the most common cause of severe diarrhea disease in infants and young children worldwide and continues to have a major global impact on childhood morbidity and mortality. Vaccination is the only control measure likely to have a significant impact on the incidence of severe dehydrating rotavirus disease. Rotavirus vaccines have reduced the burden of rotavirus disease in the United States. Long-term monitoring will need to continue to assess the effects of rotavirus immunization programs and epidemiologic strain surveillance is necessary to determine whether changes in strain ecology will affect the rotavirus vaccine effectiveness and whether rotaviruses with the ability to evade vaccine immunity emerge.     

婴儿恶性游走性部分性癫癎综合征研究进展

婴儿恶性游走性部分性癫癎综合征是在婴儿期发病的一种严重的癫癎性脑病,1995年由Coppola等首次报道,目前世界共有近80例报道,国内暂无报道.目前该综合征病因不明,早期诊断困难,传统抗癫癎药物疗效不佳.该文就婴儿恶性游走性部分性癫癎综合征可能的病因、临床特点、诊断、治疗进行综述.     

新型冠状病毒肺炎对儿童神经系统的影响

目前新型冠状病毒肺炎已经构成世界范围的大流行,可发生于儿童在内的任何年龄段。儿童新型冠状病毒肺炎可出现多个系统的临床症状,其中神经系统症状的报道不断增加,了解儿童新型冠状病毒肺炎相关的神经系统损伤显得尤为重要。该文对儿童新型冠状病毒肺炎神经系统损伤的机制及神经系统损伤的类型作一综述。     

Female genital mutilation: a hidden epidemic (statement from the European Academy of Paediatrics)

Female genital mutilation or female circumcision is frequently performed worldwide. It is estimated by the World Health Organisation that worldwide, 100–140 million girls and women currently have to live with the consequences of female genital mutilation. The article argues that the tradition is one of the causes, while another four possible reasons for undergoing such cruel mutilation of young girls exist. Today, there exists a classification of at least four different ways of such mutilation which has no health benefits, and it harms girls and women in many ways. Long-term consequences like recurrent urinary tract infections, dysmenorrhea, sexual problems, infertility and complications both for the mother and infant at delivery are mentioned. Female genital mutilation is a violation of the fundamental human rights, as well as a savage breach of the integrity and personality. Conclusion: The European Academy of Paediatrics advises its members to initiate appropriate counselling for parents and female adolescents regarding the risk of female genital mutilation and strongly condemns female genital mutilation and councils its members not to perform such procedures.     

Preventing dental caries in children: why improving children's oral health is everybody's business

Despite being largely preventable, dental caries is one of the most common diseases both in the UK and worldwide. Unmanaged dental caries may adversely impact a child and their quality of life. All healthcare professionals who have contact with children have an important role to play in improving the oral health of their patients. This can be achieved by delivering consistent, structured and supportive preventive messages and signposting to dental professionals when required. This paper outlines evidence-based guidance that should be followed to prevent dental caries, both on an individual and population basis.     

The widening scope of coronaviruses

PURPOSE OF REVIEW: In the past 2 years, at least three distinct human coronaviruses have been discovered, including the etiological agent associated with severe acquired respiratory syndrome (SARS). These recently discovered viruses, with the exception of the SARS associated coronavirus (SARS-CoV), are likely to be common respiratory viruses and may be responsible for a substantial proportion of respiratory tract disease. RECENT FINDINGS: The SARS-CoV first appeared in 2002 and spread rapidly around the globe. Although the worldwide spread of SARS-CoV may have been halted, the emergence of this new virus demonstrates the potential threat represented by species-to-species transmission of coronaviruses. NL63, initially isolated from a young child with lower respiratory tract disease, represents a group of newly described group I coronaviruses that have been identified worldwide, which are associated with both upper and lower respiratory tract disease, particularly in young children. The distribution of HKU1, a newly identified group II coronavirus, is not yet established. NL63 and HKU1 are related to the common human coronaviruses 229E and OC43, respectively. SUMMARY: The discovery of at least three new human coronaviruses represents significant advances in the investigation of human respiratory tract disease. Further studies are required to fully define the impact of these new pathogens.     

Hereditary thyroglossal duct cysts

Thyroglossal duct cysts are one of the most commonly encountered benign neck lumps found in the paediatric population. Despite their relative frequency, reports of familial inheritance are rare. A total of 21 patients with hereditary thyroglossal duct cysts from seven families worldwide have been reported. The most common inheritance pattern is dominant, with a minority possibly representing a recessive aetiology. We describe a further instance of dominantly inherited thyroglossal duct cysts in two generations.     

Whose side are you on? The diagnostic conundrum of solitary crossed renal ectopia

A 56-year-old man presents with haematuria and through extensive investigation is found to have solitary crossed renal ectopia. This congenital abnormality occurs as a result of a combination of unilateral renal agenesis and renal ectopia. With only 34 cases reported in the worldwide literature, the rarity of solitary crossed renal ectopia makes its diagnosis a challenge.We review the embryological theories behind this congenital anomaly and highlight some of the typical features demonstrated in our case that would lead one to consider a diagnosis of solitary crossed renal ectopia. We also describe features which have not previously been noted in case reports.     

Epidemiology and seasonality of respiratory tract virus infections in the tropics

Acute viral respiratory tract infections are a significant cause of morbidity worldwide. Information on the epidemiology and seasonality of these infections is important in planning vaccination and treatment strategies. In temperate climes, there are distinct seasonal peaks in the winter months. This paper reviews the seasonal trends of respiratory viral infections in the tropics. Despite the absence of a winter season, consistent seasons of infection, albeit less distinct, have been observed. With few exceptions, respiratory syncytial virus and influenza infections have been observed mainly during the rainy seasons in Asian, African and South American countries.     

Live attenuated human rotavirus vaccine, Rotarix

Rotavirus infections are the leading cause of severe gastroenteritis in young children worldwide. Recently two new rotavirus vaccines have entered the world market. This review provides a summary of the rationale, development, and evaluation of one of these vaccines, Rotarix. Rotarix is a live oral rotavirus vaccine developed from a single protective human strain following multiple passages in tissue culture to attenuate the strain. The vaccine is administered as two oral doses at approximately 2 and 4 months of age. Large safety and efficacy trials have shown the vaccine is safe, not associated with intussusception, and effective against the most common circulating human serotypes. Efficacy against severe rotavirus gastroenteritis and hospitalization have ranged from 85 to 100 percent.     

Successful unrelated cord blood transplantation following reduced-intensity conditioning for refractory acute myeloid leukemia

Patients with relapsed acute myeloid leukemia following autograft have a poor prognosis. The possibility of allograft is frequently time-limited, as the disease reappears before a stem cell donor can be found in the worldwide registries. Cord blood transplantation is a new therapeutic approach, since cord blood units are rapidly available. The authors show how a relapsed chemotherapy-refractory patient was successful transplanted with a mismatched cord blood unit after reduced-intensity conditioning. Twenty-three months after transplantation, the child is in continuous complete remission and has full donor chimerism and no signs of chronic graft-versus-host disease.     

儿童艰难梭菌感染

随着广谱抗生素的大量使用,艰难梭菌相关性腹泻(CDAD)的发生率明显上升,特别是高毒力株(027/NAP1/BI)在欧美的出现及流行,已经引起全世界的关注.CDAD的临床症状轻重不一,可从轻度腹泻到致死性假膜性肠炎和中毒性巨结肠.CDAD的确诊依赖于实验室检查,包括厌氧菌培养及细胞毒性试验、细菌毒素抗原检测、毒素基因扩增检测.处理包括停用相关抗生素,尽早应用甲硝唑或万古霉素,以及益生菌药物.