Stability of systolic blood pressure reactivity to exercise in young children

Blood pressure reactivity to stress in childhood has predicted development of hypertension 45 years later, so it is important to understand the characteristics of blood pressure reactivity in childhood. The present study assessed the 1-week and 6-month stability of systolic blood pressure reactivity to a 40-meter run stressor in preschool children. Sixty-three low-income children (mean age, 3.9 years) were assessed on four different days over a 6-month period. One-week stability (r = 0.39 to 0.50) and 6-month stability (r = 0.56) of reactive systolic blood pressure levels were highly significant. Reactive systolic blood pressure level was more stable than resting systolic or diastolic blood pressure in this sample. Sex, body mass index, family cardiovascular disease history, and child Type A behavior all were unrelated to systolic blood pressure reactivity. Systolic blood pressure reactivity to exercise appears to be an enduring characteristic that emerges in early childhood.     

Serial echocardiographic and Doppler evaluation of left ventricular systolic performance and diastolic filling in premature infants

To examine the effects of somatic growth on left ventricular systolic and diastolic functions in premature infants, we performed serial two-dimensional, M-mode and Doppler echocardiograms of 18 premature infants in the early neonatal period (mean of 14 days) and on the day when they were discharged from the hospital (mean of 94 days). The relation between rate-corrected mean velocity of fiber shortening and end-systolic wall stress relation was used as a load-independent estimate of contractility. Diastolic function was assessed by transmitral Doppler filling velocity patterns. The end-systolic wall stress was significantly lower in the first examination than in the second examination (38+/-8 vs. 46+/-10 g/cm2, P < 0.005). However, there was no significant difference in the rate-corrected velocity of fiber shortening between the two examinations. An inverse linear relation between the end-systolic wall stress and the rate-corrected mean velocity of fiber shortening was found in each examination. The slopes of these two regression lines showed no significant difference, suggesting that the left ventricular contractility is on the same level during this study period. The transmitral Doppler flow velocity patterns markedly altered between the two observations. The peak E wave, peak A wave, peak E/A ratio, flow velocity time integral of E/A wave, the first third filling fraction, and the normalized peak filling rate to stroke volume increased significantly during the study period (78+/-14 vs. 31+/-9 cm/s, 61+/-12 vs. 33+/-7 cm/s, 1.29+/-0.18 vs. 0.93+/-0.19, 1.75+/-0.58 vs. 1.17+/-0.24, 0.42+/-0.07 vs. 0.37+/-0.05, and 9.48+/-1.71 vs. 7.30+/-0.96/s, respectively, P < 0.001), suggesting a relative shift of Doppler filling into the early diastole. We demonstrated that the age- and growth-related alterations in the transmitral Doppler filling patterns occurred dramatically without changes in contractility during the first 3 months after birth. This diastolic filling change may be related to the age-related maturation in the left ventricular diastolic properties.     

Measurement of systolic blood pressure in fingers of newborn infants.

The systolic blood pressure in the index finger was measured using a minicuff and a strain gauge both placed around the finger. 122 measurements in four newborn infants were performed during monitoring in an incubator and the systolic blood pressure values obtained were compared with the simultaneously recorded intra-arterial blood pressure in the aorta. Good correlation between direct and indirect pressure values was found. An important advantage is that the measurements do not arouse the infants nor disturb their sleep. The procedure seems suited for further technical development and automatic measurements.     

Assessment of anxiety in young children.

Anxiety disorders are highly prevalent and disabling conditions that can be identified in young children. Observations of infant temperament and attachment relationships have shown that certain early infant behaviors can be linked to later anxiety disorders. Research involving play narrative stories, pictures, cartoons, and puppets has demonstrated preliminary validity for new assessment methods of young children. Preliminary studies also have been conducted with new questionnaires and diagnostic interviews. Additional research is needed to refine these methods and to develop new comprehensive measures that focus specifically on different aspects of anxiety in young children.     

Quantitative noninvasive method to measure cerebral blood flow in newborn infants.

We measured cerebral blood flow (CBF) in 32 healthy neonates by venous occlusion plethysmography. Mean CBF was 63 ml/min/100 gm which compared favorably with invasive methods used in older children and adult subjects. We suggest that this is a useful method to quantify CBF in neonates. It may be valuable in assessing sequential changes occurring during asphyxia, intracranial hemorrhage, or during administration of various gas mixtures and drugs such as theophylline.     

Renal ultrasound and excretory urography in infants and young children with urinary tract infection

The main purpose of the study was to see whether excretory urography (EU) can be safely replaced by ultrasound (US) in children with urinary tract infection (UTI) younger than 6 years. 101 hospitalised children were admitted to the prospective study. They were all diagnosed as having UTI and were treated accordingly. All children had voiding cystography (VCU), EU and US done. US and EU correlated well in 94% of the cases. In all 6 cases with discrepancy between EU and US, the VCU was abnormal. Our results confirm the data from other authors, that VCU and US should be sufficient as an initial work-up on children with UTI, while EU should be done only in the cases with abnormal findings on either one or both of the former investigations. However, it should be kept in mind that some cases of parenchymal involvement or mild subpelvic stenosis can be missed using this protocol. If EU is obtained only in the cases with abnormal US and/or VCU, only 55 children (54%) in our group would have had an EU done.     

Red blood cell indices and iron status according to feeding practices in infants and young children

With the electronic counters routinely used, it has become practical to determine the concentration of hemoglobin, red cell indices, and RDW concurrently in association with transferrin saturation and ferritin in accordance with feeding practices. The 1028 infants and children aged 6 to 24 months, who had been mainly admitted with acute infectious or inflammatory diseases, were divided into three groups, i.e., children who were exclusively breast-fed more than 6 months (group A), those who had been given iron-fortified formula milk since birth (group B), and those who had been given breast milk for 5–6 months and then switched to the iron-fortified formula (group C). Children with anemia comprised 34.8% (104/299) of group A, significantly more than 5.6% (34/608) of group B and 6.6% (8,/121) of group C ( p < 0.001, respectively). Children with MCV < 70 fl comprised 39.5% (118/299) of group A, significantly more than 7.1% (43/608) of group B and 13.2% (16/121) of group C. Out of the total 146 patients with anemia, 82.2% ( n = 120) had laboratory evidence of iron deficiency, which was mostly suggested by a dietery history. The sensitivity of MCV values < 70 fl in IDA patients was 90.0%; specificity was 53.8%. The sensitivity of RDW values ≥ 15% was 83.3%; specificity was 57.7%. The positive predictive value could be increased to 97.8% by combining MCV < 70 fl and RDW ≥ 15%. The sensitivity of serum ferritin concentrations < 10ng/ml was 62.4% and specificity was 100%. The sensitivity of transferrin saturation < 12% was 72.3% and specificity was 81.3%. By combining the hemoglobin with MCV and RDW in screening for iron deficiency, the diagnostic accuracy of IDA can be increased. We support the use of appropriately iron-fortified weaning foods or the routine iron supplement starting at 6 months of age in exclusively breast-fed infants.