Gabapentin: A novel drug as add-on therapy in cases of refractory overactive bladder in children

ObjectiveTo determine the effectiveness of gabapentin as an add-on therapy in children presenting with overactive bladder (OAB) not responding to conventional anticholinergics.Materials and methodsChildren with refractory OAB were included prospectively from March 2009 to February 2010. The inclusion criterion was persistence of symptoms while on conventional anticholinergics for 6 months. Gabapentin was prescribed as an add-on therapy. The patients were followed 4 weekly with bladder diary and urodynamic study was repeated at 3 months.ResultsThere were 31 children, 26 of neurogenic OAB and 5 of non-neurogenic origin. Mean ± SD age was 8.5 ± 5.3 years. Data were analyzed in 30 patients as treatment was terminated in 1 due to adverse effects. Continence improved in 16 (53.3%) patients. Voiding volume improved from 175 ± 90 to 320 ± 110 ml (p < 0.03). Objective assessment of OAB symptom relief showed marked improvement (p < 0.05). Mean maximum cystometric bladder capacity improved from 210 ± 94 to 360 ± 110 ml (p < 0.02). The maximal detrusor contraction decreased from 75 ± 35 to 25 ± 15 cm H₂O (p < 0.02). Fourteen patients (46.7%) failed to respond to gabapentin therapy. These patients had baseline maximum cystometric bladder capacity <60% for age and maximum detrusor contractions >50 cm of water (p < 0.03).ConclusionsGabapentin gives moderate results in children with OAB refractory to conventional anticholinergics. In general, the drug is well tolerated with fewer adverse effects.     

Severe bladder dysfunction revealed prenatally or during infancy

ObjectiveAlthough thought to be an acquired condition, non-neurogenic neurogenic bladder may sometimes be a congenital dysfunction, revealed before toilet training. We report our experience with the condition diagnosed prenatally or during early infancy.Patients and methodWe retrospectively reviewed cases of severe bladder dysfunction with upper-tract impairment, without neurological or obstructive pathology, in children diagnosed before toilet training: five with prenatal diagnosis of severe hydro-ureteronephrosis (group 1) and six with signs of bladder dysfunction during infancy (group 2).ResultsFollow up of group 1 showed decompensation toward severe bladder dysfunction, diagnosed after either toilet training or ureteral reimplantation (n = 3). After a median follow up of 14 years (0.5–20), four were on clean intermittent catheterization with bladder augmentation and one required sphincteric re-education with good result. Two of the five had chronic renal failure. In group 2, six children (two females) presented at median age of 20 months (2–30) with indirect signs of bladder dysfunction, including vesicoureteral reflux (n = 4) and/or hydro-ureteronephrosis (n = 4). After a median follow up of 11 years (5–20), three were on clean intermittent catheterization (two Mitrofanoff channels), and three underwent bladder augmentation. Three children had chronic renal failure of whom one underwent renal transplant.ConclusionThese cases of severe bladder dysfunction were initially misdiagnosed. In both groups, follow up revealed severe dilatation of the upper tract and secondary renal impairment. Antenatal diagnosis of bilateral pyeloureteral dilatation may be the first sign of early bladder dysfunction.     

Severe and fatal forms of COVID-19 in children

ObjectivesThe aim of this study was to describe severe forms of novel coronavirus disease 2019 in children, including patient characteristics, clinical, laboratory, and imaging findings, as well as the disease management and outcomes.MethodsThis was a retrospective, single-center, observational study conducted in a pediatric intensive and high-dependency care unit (PICU, HDU) in an urban hospital in Paris. All patients, aged from 1 month to 18 years, admitted for confirmed or highly suspected SARS-CoV-2 were included.ResultsWe analyzed the data of 27 children. Comorbidities (n = 19, 70%) were mainly neurological (n = 7), respiratory, (n = 4), or sickle cell disease (n = 4). SARS-CoV-2 PCR results were positive in 24 children (nasopharyngeal swabs). The three remaining children had a chest CT scan consistent with COVID-19. Respiratory involvement was observed in 24 patients (89%). Supportive treatments were invasive mechanical ventilation (n = 9), catecholamine (n = 4), erythropheresis (n = 4), renal replacement therapy (n = 1), and extracorporeal membrane oxygenation (n = 1). Five children died, of whom three were without past medical history.ConclusionThis study highlighted the large spectrum of clinical presentation and time course of disease progression as well as the non-negligible occurrence of pediatric life-threatening and fatal cases of COVID-19 mostly in patients with comorbidities. Additional laboratory investigations are needed to further analyze the mechanism underlying the variability of SARS-Cov-2 pathogenicity in children.     

The effect of recombinant human interferon α1b treatment of infants hospitalized with lower respiratory tract infection on subsequent wheezing

ObjectiveTo investigate the impact of recombinant human interferon α1b (rhIFNα1b) treatment in infants hospitalized with lower respiratory tract infections on subsequent wheezing.MethodsThe clinical data of infants (n = 540) with viral pneumonia, wheezy bronchitis, or bronchiolitis hospitalized in 19 Chinese hospitals from June 2009 to June 2015 were retrospectively analyzed. The parameters relevant to wheezing episodes within the last year were collected by telephone and questionnaires. The rhIFNα1b treatment group (n = 253) and control group (n = 287) were compared in terms of wheezing episodes within the last year. Moreover, the wheezing group (95 cases) and non-wheezing group (445 cases) were compared.ResultsOut of 540 cases, 95 (17.6%) experienced wheezing episodes, 13.8% (35/253) cases treated with rhIFNα1b, and 20.9% (60/287) cases without rhIFNα1b experienced wheezing episodes within the last year. The rhIFNα1b treatment significantly improved wheezing episodes within the last year, compared with the control peers (p = 0.031). Single-factor regression showed statistically significant differences between the wheezing and non-wheezing groups in terms of age, rhIFNα1b use, childhood and family history of allergy, housing situation, and feeding history (p < 0.05). Binary logistic regression showed a childhood history of allergy (OR = 2.14, p = 0.004), no rhIFNα1b use (OR = 1.70, p = 0.028), and living in a crowded house (OR = 1.92, p = 0.012) might be risk factors of subsequent wheezing. Accordingly, breastfeeding (OR = 0.44, p = 0.008) and hospitalization age of ≤1-year-old (OR = 0.58, p = 0.024) were protective factors.ConclusionsEarly use of rhIFNα1b in infants hospitalized with lower respiratory tract infections and breastfeeding could prevent subsequent wheezing. Living in a crowded house could promote subsequent wheezing.     

Alterations in the pulmonary histoarchitecture of neonatal mice exposed to hyperoxia

ObjectivesTo analyze the effects of exposure to hyperoxia (100% oxygen) on the lung histoarchitecture of neonatal mice.MethodsNeonatal Balb/c mice were exposed to hyperoxia (HG) (100% oxygen) (n = 10) in a chamber (15 x 20 x 30 cm) for 24 hours with a flow of 2 L/min. The control group (CG) (n = 10) was exposed to normoxia in the same type of chamber and for the same time. After exposure, the animals were euthanized by decapitation; the lungs were removed and processed for histological examination according to the laboratory routine. Three-mm thick sections were stained with hematoxylin and eosin (H&E). The morphometric analysis was performed with in order to analyze the macrophages present in the alveolar lumen, surface density (S_v) of gas exchange, volume density (V_v) of lung parenchyma, and areas of atelectasis.ResultsA decrease in the number of alveolar macrophages (MØ) was observed in the HG (HG = 0.08 ± 0.01 MØ/mm², CG = 0.18 ± 0.03 MØ/mm², p = 0.0475), S_v of gas exchange in HG (HG = 8.08 ± 0.12 mm²/mm³, CG = 8.65 ± 0.20 mm²/mm³, p = 0.0233), V_v of lung parenchyma in HG (HG = 54.7/33.5/83.5%/mm²; CG = 75/56.7/107.9%/mm², p < 0.0001) when compared with the CG. However, there was an increase in areas of atelectasis in HG (HG = 17.5/11.3/38.4 atelectasis/mm², CG = 14/6.1/24.4 atelectasis/mm², p = 0.0166) when compared with the CG.ConclusionThe present results indicate that hyperoxia caused alterations in lung histoarchitecture, increasing areas of atelectasis and diffuse alveolar hemorrhage.     

Evaluation of functional capacity for exercise in children and adolescents with sickle-cell disease through the six-minute walk test

ObjectiveTo evaluate lung functional capacity (FC) for physical exercise in children and adolescents with sickle cell disease (SCD) through the six-minute walk test (6MWT).MethodA cross-sectional prospective study was performed to evaluate the FC of 46 patients with SCD through the 6MWT. The following parameters were assessed: heart rate (HR), respiratory rate (RR), peripheral pulse oxygen saturation (SpO₂), peak expiratory flow (PEF), blood pressure (systolic and diastolic), dyspnea, and leg fatigue (modified Borg scale) at rest, in the end of the test, and ten minutes after the 6MWT. The total distance walked was also recorded. For statistical analysis, the parametric variables were analyzed using the paired Student's t-test, analysis of variance (ANOVA), and Bonferroni multiple comparisons, with a significance level set at p ≤ 0.05.ResultsThe 46 patients were aged age 9.15 ± 3.06 years, presented baseline Hb of 9.49 ± 1.67 g/dL, and walked 480.89 ± 68.70 m. SCD diagnosis was as follows: group 1- HbSS (n = 20)/HbSβ⁰-thalassemia (n = 3) and group 2 - HbSC (n = 20)/HbSβ⁺-thalassemia (n = 3). Regarding total distance walked, patients in group 1 walked a shorter distance than patients in group 2 (459.39 ± 57.19 vs. 502.39 ± 73.60 m; p = 0.032). There was no statistical difference regarding PEF in the three moments of evaluation. The SpO₂ in ambient air and SpO₂ with O₂ differed between groups 1 and 2 (p < 0.001 vs. p = 0.002), as well as the RR (p = 0.001).ConclusionThese patients showed a lower FC for exercise than that predicted for the age range in the literature. Patients diagnosed with HbSS/Sβ0-thalassemia had a lower performance in the test than those with HbSC/Sβ⁺-thalassemia regarding total distance walked, RR, and SpO₂ after the 6MWT.     

Predictive factors of recurrence after pediatric acute pericarditis

ObjectiveThe predisposing factors for pericarditis recurrence in the pediatric population have not yet been established. This study aimed to define the risk factors for the unfavorable prognosis of pediatric acute pericarditis.MethodsThis was a retrospective study that included all patients with acute pericarditis treated from 2011 to 2019 at a tertiary referent pediatric center.ResultsThe study included 72 children. Recurrence was observed in 22.2% patients. Independent risk factors for recurrence were: erythrocyte sedimentation rate ≥ 50 mm/h (p = 0.003, OR 186.3), absence of myocarditis (p = 0.05, OR 15.2), C-reactive protein ≥ 125 mg/L (p = 0.04, OR 1.5), and non-idiopathic etiology pericarditis (p = 0.003, OR 1.3). Corticosteroid treatment in acute pericarditis was associated with a higher recurrence rate than treatment with non-steroid anti-inflammatory therapy (p = 0.04). Furthermore, patients treated with colchicine in the primary recurrence had lower recurrence rate and median number of repeated infections than those treated without colchicine (p = 0.04; p = 0.007, respectively).ConclusionIndependent risk factors for recurrence are absence of myocarditis, non-idiopathic etiology pericarditis, C-reactive protein ≥ 125 mg/L, and erythrocyte sedimentation rate ≥ 50 mm/h. Acute pericarditis should be treated with non-steroid anti-inflammatory therapy. A combination of colchicine and non-steroid anti-inflammatory drugs could be recommended as the treatment of choice in recurrent pericarditis.     

Long-term efficacy and safety of tolterodine in children with neurogenic detrusor overactivity

ObjectiveWe evaluated long-term (≥12 months) efficacy and safety of tolterodine in children with neurogenic detrusor overactivity.Subjects and methodsSubjects successfully completed one of three 12-week, open-label studies and had stable neurologic disease and urodynamic evidence of neurogenic detrusor overactivity requiring intermittent catheterization. Drug formulation and dosing were based on age (4 months–4 years, tolterodine oral solution 0.2–2 mg twice daily; 5–10 years, tolterodine oral solution 0.5–4 mg twice daily; 11–16 years, tolterodine extended-release capsules 2, 4, or 6 mg once daily). Daily doses were individualized for each subject. Efficacy was evaluated urodynamically and using parent-completed 3-day bladder diaries.ResultsThirty subjects were enrolled. Functional bladder capacity (volume at first leakage, first sensation of bladder fullness or 40 cm H₂O pressure) increased by month 12 in the younger age groups but not in the oldest subjects. Volume to first detrusor contraction >10 cm H₂O pressure and detrusor leak point pressure did not change in any age group. The number of incontinence episodes per 24 h decreased in all subjects, as did the number of catheterizations per 24 h. Mean volume per catheterization increased in all subjects. Seven treatment-related adverse events were reported.ConclusionsBoth tolterodine formulations were effective and well tolerated in children with neurogenic detrusor overactivity.     

Can urodynamic studies be dispensed with in the initial urologic management of children with meningomyelocele? A study of 30 cases and review of the literature

ObjectiveTo identify whether a relationship exists between information gathered from voiding patterns, neurological status and radiological findings, and the actual dysfunction seen on cystometry in children with spina bifida.Patients and methodsThirty consecutive children with spina bifida underwent clinical evaluation, urinary tract imaging and cystometry. The clinical and radiological data were correlated with actual bladder dysfunction.ResultsCystometry was abnormal in 87% with overactive detrusor in 77%. Seventeen patients (57%) had significant residual urine of whom all had neurological or voiding abnormalities. Irrespective of radiological findings (abnormal in 53%), 90% of these patients had detrusor overactivity and 10% an underactive detrusor. In the group with insignificant residual urine (n = 13), upper tract was abnormal in six (46%) of which four had neurological/voiding abnormalities and detrusor overactivity. The other two patients with normal neurologic status and voiding pattern had normal cystometry, but their upper tract damage was inexplicable. Of the patients with insignificant residual urine and normal upper tracts (n = 7), four had neurologic/voiding abnormalities, three with an overactive detrusor and one underactive detrusor, and of the other three, one had an overactive detrusor.ConclusionsPatients with significant residual urine can be presumed to have detrusor overactivity and may be initially managed with clean intermittent catheterization and bladder relaxants. Cystometry is indicated if upper tract shows deterioration. In patients with insignificant residual urine and abnormal clinical evaluation or radiology, detrusor overactivity can be presumed and urodynamic studies deferred. Patients with insignificant residual urine, normal radiology but abnormal clinical findings must undergo initial cystometry.     

Risk factors for progression to end-stage renal disease in children with posterior urethral valves

ObjectiveTo identify the variables which affect long-term renal outcome in children with posterior urethral valves (PUV).Materials and methodsRetrospective analysis of 260 children with PUV who underwent ablation of valves in 1992–2008 at our tertiary care center. The following risk factors for progression to end-stage renal disease (ESRD) were analyzed: nadir serum creatinine greater than 1.0 mg/dl, bilateral grade 3 or higher VUR at diagnosis, recurrent febrile UTIs, and severe bladder dysfunction. Patients were divided into two groups: those who developed ESRD (group 1) and those who did not (group 2).ResultsForty (17.62%) patients had nadir serum creatinine >1 mg/dl. At time of initial presentation, high-grade VUR was seen in 63.1% and 33.5% of groups 1 and 2, respectively (P = 0.002). Overall, 77 (34%) of the boys developed breakthrough urinary tract infections: 37.03% and 33.5% in groups 1 and 2, respectively (P = 1). Fifty-nine (26%) patients were found to have severe bladder dysfunction: 77.8% and 19% in groups 1 and 2, respectively (P < 0.0001). Twenty-seven (11.89%) patients progressed to ESRD, at mean age of 11.21 years (5–16). On univariate analysis, the risk-predicting variables were: nadir serum creatinine value greater than 1 mg/dl (P < 0.0001), bilateral high-grade VUR (P = 0.002) and severe bladder dysfunction (P < 0.0001). On multivariate logistic regression analysis, nadir serum creatinine greater than 1 mg/dl (OR 23.79; CI 8.20–69.05) and severe bladder dysfunction (OR 5.67; CI 1.90–16.93) were found to be independent risk factors predictive of ultimate progression to ESRD.ConclusionsNadir serum creatinine and bladder dysfunction are the main factors affecting long-term renal outcome in cases of PUV. Early identification and treatment of bladder dysfunction may thus be beneficial.     

Opsoclonus–myoclonus in children associated or not with neuroblastoma

ObjectiveTo compare the clinical data at diagnosis, treatment and neurological outcome in 34 children with opsoclonus–myoclonus syndrome (OMS) associated with a detected neuroblastoma or not.Study designThis is a multicentric retrospective study of 34 children presenting with OMS from four pediatric centers diagnosed between 1988 and 2008.ResultsTwenty-two patients had OMS associated with a neuroblastoma. These patients all had neuroblastomas with favourable prognostic features; all underwent surgery, six received chemotherapy. Twelve children had OMS without a detected neuroblastoma. For OMS, the main treatment in all children was corticotherapy (n = 33), but immunoglobulins (n = 13), cyclophosphamide (n = 4) and rituximab (n = 4) were also given. In the 27 OMS patients with or without neuroblastoma whose follow up was greater than two years, the neurological outcome was evaluated: 59.3% had neurological sequelae, including motor, praxic and/or language sequelae (n = 9), persistent ataxia (n = 6) and moderate motor deficit (n = 3). No significant difference in neurological outcome was noted between the two patient groups.ConclusionOur retrospective study provides further evidence that OMS with or without a detected neuroblastoma is the same disease, whose major challenges are the neurological sequelae. An international collaboration is required to improve the knowledge about OMS, the treatment and the outcome in this rare disorder.     

Rapid diagnosis of respiratory distress syndrome by oral aspirate in premature newborns

ObjectiveThe stable microbubble test on gastric aspirate and on amniotic fluid has been used for the diagnosis of respiratory distress syndrome in the newborn. However, no study has performed this test on oral aspirates from premature infants. The objective of this study was to evaluate the performance of the stable microbubble test on oral aspirates from preterm newborns to predict respiratory distress syndrome.MethodThis study included infants with gestational age <34 weeks. Oral fluids were obtained immediately after birth and gastric fluids were collected within the first 30 minutes of life. The samples were frozen and tested within 72 hours.ResultsThe sample was composed of paired aspirates from 64 newborns, who were divided into two groups: respiratory distress syndrome group (n = 21) and control group (n = 43). The median (interquartile range) of the stable microbubble count in the oral samples of infants with respiratory distress syndrome was significantly lower than that of infants who did not develop respiratory symptoms: respiratory distress syndrome group = 12 (8–22) stable microbubbles/mm²; control group = 100 (48–230) microbubbles/mm² (p < 0.001). The correlation between microbubble count in gastric and oral aspirates was 0.90 (95% confidence interval = 0.85–0.95; p < 0.001). Considering a cut-off point of 25 microbubbles/mm², the sensitivity and the specificity of the stable microbubble test were 81.4% and 85.7%, respectively.ConclusionThe study suggests that the stable microbubble test performed on oral aspirate is a reliable alternative to that performed on gastric fluid for the prediction of respiratory distress syndrome in the newborn.     

Vitamin D deficiency at pediatric intensive care admission

Objectiveto assess whether 25hydroxivitaminD or 25(OH)vitD deficiency has a high prevalence at pediatric intensive care unit (PICU) admission, and whether it is associated with increased prediction of mortality risk scores.Methodprospective observational study comparing 25(OH)vitD levels measured in 156 patients during the 12 hours after critical care admission with the 25(OH)vitD levels of 289 healthy children. 25(OH)vitD levels were also compared between PICU patients with pediatric risk of mortality III (PRISM III) or pediatric index of mortality 2 (PIM 2) > p75 [(group A; n = 33) vs. the others (group B; n = 123)]. Vitamin D deficiency was defined as < 20 ng/mL levels.Resultsmedian (p25‐p75) 25(OH)vitD level was 26.0 ng/mL (19.2‐35.8) in PICU patients vs. 30.5 ng/mL (23.2‐38.6) in healthy children (p = 0.007). The prevalence of 25(OH)vitD < 20 ng/mL was 29.5% (95% CI: 22.0‐37.0) vs. 15.6% (95% CI: 12.2‐20.0) (p = 0.01). Pediatric intensive care patients presented an odds ratio (OR) for hypovitaminosis D of 2.26 (CI 95%: 1.41‐3.61). 25(OH)vitD levels were 25.4 ng/mL (CI 95%: 15.5‐36.0) in group A vs. 26.6 ng/mL (CI 95%: 19.3‐35.5) in group B (p = 0.800).Conclusionshypovitaminosis D incidence was high in PICU patients. Hypovitaminosis D was not associated with higher prediction of risk mortality scores.     

States of serum leptin and insulin in children with epilepsy: Risk predictors of weight gain

Background and objectivesWeight gain is an adverse metabolic effect in some children with epilepsy. The studies done to detect the effect of antiepileptic drugs and weight homeostatic hormones, insulin and leptin, were limited and controversial.Materials and methodsWe evaluated the serum leptin and insulin as predictors of weight gain in children receiving long-term treatment with valproate (VPA), carbamazepine (CBZ), lamotrigine (LTG). This study included 90 patients (treated: 70; untreated: 20). Serum lipid profile, insulin and leptin were measured.ResultsBMI, serum leptin and insulin were significantly elevated in VPA compared with controls, untreated patients and those treated with CBZ, LTG and combined therapy with LTG. Girls on VPA had higher BMI and leptin levels than boys. With VPA, serum insulin was correlated with BMI (r = 0.625, p < 0.01), leptin (r = 0.823, p < 0.001), treatment duration (r = 0.775, p < 0.01) and VPA dose (r = 0.975, p < 0.0001). Serum leptin was correlated with age (r = 0.980, p < 0.0001), BMI (r = 0.704, p < 0.01), serum insulin (r = 0.823, p < 0.001), LDL-c (r = 0.630, p < 0.01), HDL-c (r = ?0.880, p < 0.001), treatment duration (r = 0.770, p < 0.01) and VPA dose (r = 0.970, p < 0.001). BMI is correlated with serum insulin, leptin, LDL-c (r = 0.835, p < 0.001) and HDL-c (r = ?0.955, p < 0.0001).ConclusionHyperinsulinemia and hyperleptinemia are common with VPA and marked among epileptic children who gained weight suggesting states of insulin and leptin resistances. These alterations were not demonstrated with CBZ or LTG. The relationship between VPA, leptin and weight seems to be gender specific. Serum leptin may serve as a sensitive parameter for weight gain and reduction with intervention programs during follow-up of girls with epilepsy.     

Maternal breastfeeding: indicators and factors associated with exclusive breastfeeding in a subnormal urban cluster assisted by the Family Health Strategy

ObjectiveTo describe and analyze indicators of feeding practices related to breastfeeding and factors associated with exclusive breastfeeding (EBF) in a subnormal urban cluster (slums) in Pernambuco, Brazil.MethodsFour breastfeeding indicators were used to interview mothers of children under 3 years of age. An inventory of the families’ socioeconomic and environmental factors, maternal obstetric history, and basic health care access was undertaken. The sample consisted of all 310 children under the age of 3 years from Coelhos, PE, Brazil. Spearman's correlation was carried out, as well as crude and adjusted prevalence ratios for a final statistical model that showed associated factors with the main outcome at a level of 0.05.ResultsThe prevalence of breastfeeding in the first hour of life, exclusive breastfeeding up to 6 months, continued breastfeeding at 1 year, and continued breastfeeding at 2 years were 60.2%, 32.9%, 45.9, and 35.9%, respectively. A correlation was observed between start of pacifier use and duration of either exclusive (r_s = 0.358 [p < 0.001]) or non-exclusive breastfeeding (r_s = 0.248 [p = 0.006]). Maternal age over 35 years (p < 0.001), home visit in the first week after birth (p = 0.003), having had a male baby (p = 0.029), and not using a pacifier (p < 0.001) remained protective factors in the final model.ConclusionThe prevalence rates of exclusive breastfeeding at 6 months were well above the results obtained by other Brazilian authors. Home visit and maternal age prevailed as protective factors, while pacifier use was shown to be a discouraging practice.     

The efficacy of vagal nerve stimulation in children with pharmacoresistant epilepsy: Practical experience at a Turkish tertiary referral center

BackgroundVagus nerve stimulation (VNS) is an effective therapy for pharmacoresistant epilepsy. Nevertheless, information regarding the long-term outcome of VNS in children is limited.AimTo describe the long-term outcome of VNS in patients with pharmacoresistant epilepsy treated at the Gazi University Medical Faculty Epilepsy Center, Turkey.Patients and methodsThe study included 24 patients – all younger than 18 years of age (mean age: 14.31 years). Median age at the time of VNS device implantation was 11 years. Median age at onset of epilepsy was 21 months and median duration of epilepsy was 126 months. All the patients’ seizures were intractable with antiepileptic drug treatment and all had been treated with an average of 6 ± 2 antiepileptic medications. In all, 12 patients had secondary generalized seizures and 12 had partial seizures. Because this was a retrospective open study, the number of seizures could not be enumerated in most of these cases.ResultsThe only factor that was associated with seizure reduction was duration of follow-up. Age at seizure onset and age at VNS device implantation were not associated with seizure reduction. The difference in seizure reduction between patients >12 years of age and patients <12 years of age was not significant. Mean percentage of seizure reduction after 6 months–7 years of treatment was, respectively, 22.5% (n = 24) (6th month), 32% (n = 20) (1st year), 42% (n = 16) (2nd year), 50.45% (n = 11) (3rd year), 52% (n = 10) (4th year), 60% (n = 8) (5th year), 61.25% (n = 8) (6th year), and 61.6% (n = 6) (7th year). The positive effect of VNS persisted throughout the follow-up period.ConclusionsAlthough it is an expensive method, VNS is an effective treatment method. This series shows the necessity of long-term follow-up series for understanding the efficacy and advantages of VNS. Prospective, long-term double-blind studies with large samples are needed to confirm the present study's findings.     

Safety and one-year efficacy of intrathecal baclofen therapy in children with intractable spastic cerebral palsy

BackgroundProspective studies that address both efficacy and safety of continuous infusion of intrathecal baclofen (CITB) in children with spastic cerebral palsy (CP), and that use outcome measures beyond muscle tone are lacking.AimsTo study the efficacy at 12 months and safety up to 24 months after start of CITB in children with intractable spastic CP.MethodsNine girls and eight boys, aged 13.7 years (SD 2.9), received a SynchroMed pump for CITB. We prospectively recorded effects and adverse events at regular follow-up visits up to 24 months. Outcome measures included the 0–10 visual analogue scale (VAS) for individual problems, Gross Motor Function Measure (GMFM) and health related quality of life as measured with the Child Health Questionnaire-PF50.ResultsCITB for 12 months significantly improved the VAS for individual problems with 4.7 (SD 2.0; p = 0.000), VAS for ease of care with 5.2 (SD 2.1; p = 0.000), VAS for pain with 5.4 (SD 2.7; p = 0.002); GMFM sitting dimension with 3.3 (range ?4.0 to 22.0; p = 0.022), GMFM goal dimension with 4.0 (range 0.0–26.0; p = 0.007); and Child Health Questionnaire-PF50 domains of bodily pain/discomfort with 25.6 (SD 35.9; p = 0.016) and mental health with 9.8 (SD 11.3; p = 0.007). During a mean follow-up of 18.4 months (range 12–24), we recorded 80 adverse events. Eight adverse events were serious, but not life-threatening.ConclusionsCITB was effective at 12 months and safe up to 24 months for carefully selected children with intractable spastic CP. CITB relieved pain, facilitated ease of care and improved mental health. The majority of children could extend their activities and participation.     

Iron deficiency and anemia are associated with low retinol levels in children aged 1 to 5 years

ObjectiveTo analyze the occurrence of anemia and iron deficiency in children aged 1 to 5 years and the association of these events and retinol deficiency.MethodsThis was an observational analytic cross-sectional study conducted in Vitoria, ES, Brazil, between April and August of 2008, with healthy children aged 1 to 5 years (n = 692) that lived in areas covered by primary healthcare services. Sociodemographic and economic conditions, dietary intake (energy, protein, iron, and vitamin A ingestion), anthropometric data (body mass index-for-age and height-for-age), and biochemical parameters (ferritin, hemoglobin, and retinol serum) were collected.ResultsThe prevalence of anemia, iron deficiency, and retinol deficiency was 15.7%, 28.1%, and 24.7%, respectively. Univariate analysis showed a higher prevalence of anemia (PR: 4.62, 95% CI: 3.36, 6.34, p < 0.001) and iron deficiency (PR: 4.51, 95% CI: 3.30, 6.17, p < 0.001) among children with retinol deficiency. The same results were obtained after adjusting for socioeconomic and demographic conditions, dietary intake, and anthropometric variables. There was a positive association between ferritin vs. retinol serum (r = 0.597; p < 0.001) and hemoglobin vs. retinol serum (r = 0.770; p < 0.001).ConclusionsAnemia and iron deficiency were associated with low levels of serum retinol in children aged 1 to 5 years, and a positive correlation was verified between serum retinol and serum ferritin and hemoglobin levels. These results indicate the importance of initiatives encouraging the development of new treatments and further research regarding retinol deficiency.     

Metabolic bone disease in children and adolescent patients with ulcerative colitis

ObjectiveMetabolic bone disease concerns a broad spectrum of conditions related to reduced bone density. Metabolic bone disease has been linked to chronic inflammatory diseases, such as ulcerative colitis. This study examines the prevalence of metabolic bone disease in ulcerative colitis patients and explores possible clinical predictors.MethodThe authors performed a retrospective study involving children and adolescents with confirmed ulcerative colitis between January 2013 and December 2018. Bone density was evaluated through a dual-energy X-ray absorptiometry scan of the spine and total body. Osteoporosis was defined as a bone mineral density Z-score of <?2 and osteopenia as a Z-score of between ?1.0 and ?2.ResultsA total of 37 patients were included in this analysis, with a mean age of 13.4 ± 3.9 years and a mean duration of illness of 2.1 ± 2.4 years. Using lumbar spine Z-scores and total body Z-scores, osteoporosis and osteopenia were identified by dual-energy X-ray absorptiometry scan measurements in 11 patients (29.7%) and 15 patients (40.5%), and in ten patients (27%) and 13 patients (35%), respectively. Lumbar spine Z-scores were significantly positively associated with male gender (B = 2.02; p = 0.0001), and negatively associated with the presence of extraintestinal manifestations (B = ?1.51, p = 0.009) and the use of biologics (B = ?1.33, p = 0.004). However, total body Z-scores were positively associated with body mass index Z-scores (B = 0.26, p = 0.004) and duration of illness in years (B = 0.35, p = 0.003).ConclusionsMetabolic bone disease is very common in this cohort of Saudi Arabian children and adolescents with ulcerative colitis and its occurrence appears to increase in female patients who suffer from extraintestinal manifestations.     

Challenges in choosing the appropriate guidelines for use in children and adolescents with hypertension

BackgroundThis study was designed to observe the effect of antihypertensive treatment on blood pressure (BP) and target organ damage in patients followed up according to the American Academy of Pediatrics Hypertension Guidelines (AAPG). The results were also assessed in comparison with the definitions and target organ damage according to the European Society of Hypertension Guidelines 2016 (ESHG).Materials and methodsA total of 44 (34 male) out of 140 patients were enrolled in the study and the mean age was 14 ± 3.19 years. The follow-up period was at least 12 months. All patients underwent the following assessments: anthropometrical measurements of body mass index (BMI), left ventricular mass index (LVMI), and biochemical parameters according to the relevant guidelines. The pre-treatment and post-treatment datasets collected were compared.ResultsThe frequency of symptomatic patients decreased from 88% to 30%. After treatment, 29.4% (n = 13) of patients still had elevated and stage 1 hypertension (HT) according to the AAPG. These patients were older and had higher BMI z-scores, LVMI z-scores, mean BP indices, and also had longer symptom duration than normotensive patients (P < 0.001). When patients were assessed according to the ESHG, 34.1% (n = 15) of patients had high–normal stage 1 and stage 2 HT. While 53.3% (n = 8) of the patients aged 13–15 years were classified as having high–normal stage 1 and stage 2 HT according to the ESHG, 33.3% (n = 5) were classified as having elevated BP and stage 1 HT according to the AAPG. Additionally, 36.4% (n = 4) of the patients aged ≥ 16 years were classified as having high–normal and stage 1 HT according to the ESHG, whereas 45.5% (n = 5) were classified as having elevated BP and stage 1 HT according to the AAPG.ConclusionTo control HT in children with higher BMI z-scores, higher LVMI z-scores, and higher BP indices, an earlier and more intensive approach is needed. Considering that the duration of exposure to HT may also affect the LVMI, adjusting age and gender or decreasing the current thresholds for LVMI may lead to an earlier diagnosis for more patients. According to the present classifications, the ESHG covers more children aged between 13 and 15 years in contrast to the AAPG, which covers more patients aged ≥ 16 years. However, further studies are needed to confirm these results.