Relation between biomarkers and clinical severity in patients with Smith–Lemli–Opitz syndrome

Smith–Lemli–Opitz syndrome (SLOS), a multiple congenital anomaly with severe mental retardation, is caused by decreased activity of 7-dehydrocholesterol reductase. Fifteen Hungarian patients were diagnosed with SLOS on the basis of clinical symptoms, serum cholesterol, 7-dehydrocholesterol, and molecular genetic testing. Their age at the time of diagnosis in mild SLOS (n?=?4, clinical score <20) was 0.5–18 years, cholesterol was 2.37?±?0.8 mmol/L, and 7DHC was 0.38?±?0.14 mmol/L. In the group of typical SLOS (n?=?7, score 20–50), the diagnosis was set up earlier (age of 0.1–7 years); t-cholesterol was 1.47?±?0.7 mmol/L, and 7DHC was 0.53?±?0.20 mmol/L. Patients with severe SLOS (n?=?4, clinical score?>?50) died as newborns and had the lowest t-cholesterol (0.66?±?0.27 mmol/L), and 7DHC was 0.47?±?0.14 mmol/L. Correlation coefficient with clinical severity was 0.74 for initial t-cholesterol and 0.669 for Cho/7DHC. Statistically significant difference was between the initial t-cholesterol of mild and severe SLOS (p?=?0.01), and between the Cho/7DHC ratios of groups (p?=?0.004). In severe SLOS, the percentage of α-lipoprotein was significantly lower than in typical (p?=?0.003) and mild SLOS (p?=?0.004). Although serum albumin, total bilirubin, and hemostasis parameters remained in the reference range during cholesterol supplementation (n?=?10) combined with statin therapy (n?=?9), increase of aspartate aminotransferase and alanine aminotransferase in 50 % of the patients probably refers to a reversible alteration of liver function; therefore, statin therapy was suspended. Conclusion: life expectancy is fundamentally determined by the initial t-cholesterol, but dehydrocholesterol and α-lipoprotein have prognostic value. Accumulation of hepatotoxic DHC may inhibit the synthesis of α-lipoproteins, decreasing the reverse cholesterol transport. During statin therapy, we suggest monitoring of lipid parameters and liver function.     

Early cow’s milk introduction is associated with failed personal–social milestones after 1 year of age

Both the American Academy of Pediatrics (AAP) and the Institute of Medicine (IOM) recommend delaying the introduction of cow’s milk until after 1 year of age due to its low absorbable iron content. We used a novel computerized decision support system to gather data from multiple general pediatrics offices. We asked families whether their child received cow’s milk before 1 year of age, had a low-iron diet, or used low-iron formula. Then, at subsequent visits, we performed a modified developmental assessment using the Denver II. We assessed the effect of early cow’s milk or a low-iron diet on the later failure of achieving developmental milestones. We controlled for covariates using logistic regression. Early cow’s milk introduction (odds ratio (OR) 1.30, p?=?0.012), as well as a low-iron diet or low-iron formula (OR 1.42, p?<?0.001), was associated with increased rates of milestone failure. Only personal–social milestones (OR 1.44, p?=?0.002) showed a significantly higher rate of milestone failure. Both personal–social (OR 1.42, p?<?0.001) and language (OR 1.22, p?=?0.009) showed higher rates of failure in children with a low-iron diet. Conclusions: There is an association between the introduction of cow’s milk before 1 year of age and the rate of delayed developmental milestones after 1 year of age. This adds strength to the recommendations from the AAP and IOM to delay cow’s milk introduction until after 1 year of age.     

Soft Plastic Bag Instead of Hard Plastic Container for Long-term Storage of Breast Milk

Objective

To compare the fat content and contamination of expressed breast milk (EBM) before and after storage (30 d) in hard polypropylene containers (HC) and soft polyethylene bags (SB) containers.

Methods

Ninety specimens of EBM were collected into HC and separated into two HC and two SB. The fat content of each specimen of EBM in HC and SB was measured and cultures were performed. The specimens in the second HC and SB containers were kept frozen for 30 d before thawing and then measuring the fat content and performing cultures.

Results

The means ± SD of the fat content of fresh and thawed EBM in HC were 2.98?±?0.97 and 2.66?±?0.88 g/100 ml, respectively, with a loss of 0.32 g/100 ml (p?<?0.001). The means ± SD of the fat content of fresh and thawed EBM in SB were 3.06?±?1.00 and 2.77?±?0.91 g/100 ml, respectively, with a mean loss of 0.29 g/100 ml during storage (p?<?0.001). The loss of fat content during frozen storage did not differ significantly between the two types of containers (p?=?0.53). All bacterial cultures of fresh and thawed EBM in HC and SB showed only nonpathogenic organisms.

Conclusions

SB can replace HC for the long-term storage of frozen EBM of up to 30 d without deleterious effects on fat loss or contamination.     

Iron Stores in Low and Normal Birth Weight Infants at Birth and in Early Infancy

Serum ferritin levels of low birth weight (LBW; BW?<?2,500 g) and normal birth weight (NBW; BW?≥?2,500 g) infants were evaluated at birth and at 3 mo using electrochemiluminescence immunoassay. At birth, levels were 318.6 (31.0–829.5) ng/mL in LBW (n?=?217) and 366.2 (122.4–858.5) ng/mL in NBW infants (n?=?116; p?<?0.01), with 1.4 % of LBW and none of the NBW infants having levels <12 ng/mL (p?=?0.20). At follow up, levels were 66.9 (4.5–567.7) ng/mL in LBW (n?=?126) and 126.2 (6.8–553.7) ng/mL in NBW infants (n?=?76; p?=?0.27), with 11.9 % of LBW and 11.8 % of NBW infants having levels <12 ng/mL (p?=?0.80).     

Pentraxin 3 as a novel early biomarker for the prediction of Henoch-Schönlein purpura nephritis in children

We investigated the potential role of pentraxin 3 (PTX3) in Henoch-Schönlein purpura (HSP), a common multisystemic vasculitis affecting children, as a predictor of Henoch-Schönlein purpura nephritis (HSPN). A total of 108 cases consisting of 34 children with HSP, 37 children with HSPN, and 37 healthy control children were enrolled in this prospective study from March 2010 to February 2013. Blood and urine samples were collected to measure plasma PTX3, C-reactive protein (CRP), serum creatinine, blood urea nitrogen (BUN), urine microalbumin (MALB), and β2-microglobulin (β2-MG). Median plasma PTX3 concentrations were significantly higher in children with HSPN and HSP than in control subjects before treatment (6.99, 4.18–9.78 ng/ml; 3.19, 1.13–4.27 ng/ml; 1.24, 0.87–2.08 ng/ml, respectively; all p?<?0.05). Median plasma PTX3 concentrations were also significantly higher in children with HSPN than in children with HSP before treatment (6.99, 4.18–9.78 vs. 3.19, 1.13–4.27 ng/ml; p?<?0.05). After treatment, median plasma PTX3 concentrations significantly decreased in children with HSP (from 3.19, 1.13–4.27 to 1.08, 0.65–2.19 ng/ml; p?<?0.05) and HSPN (from 6.99, 4.18–9.78 to 1.29, 1.01–2.26 ng/ml; p?<?0.05). Plasma PTX3 concentration was positively correlated with CRP (rho?=?0.532, p?=?0.001), MALB (rho?=?0.606, p?<?0.001), β2-MG (rho?=?0.490, p?=?0.002), and 24-h urinary protein quantity (rho?=?0.650, p?<?0.001) in children with HSPN. Considering vasculitis, we found that PTX3 could be used as a more efficient potential predictor of HSPN than CRP as indicated by the area under the receiver operating characteristic (ROC) curve (AUC_ROC) of PTX3 (AUC_ROC?=?0.837; p?<?0.001) and CRP (AUC_ROC?=?0.514; p?=?0.845). The threshold PTX3 concentration with optimal sensitivity and specificity was 4.30 ng/ml (sensitivity73.0 %, specificity79.6 %). Conclusion: PTX3 seems to have an important role in multisystemic vasculitis of HSP, may be involved in the development of HSPN, and used as an early biomarker to predict HSPN.     

Ketoacidosis at presentation of type 1 diabetes mellitus in children: a retrospective 20-year experience from a tertiary care hospital in Serbia

Diabetic ketoacidosis (DKA) has significant morbidity and mortality and is common at diagnosis in children. The aim of this study was to determine the frequency and clinical characteristics of DKA over a 20-year period among children diagnosed with type 1 diabetes mellitus (T1DM) at University children's hospital in Belgrade, Serbia. The study population comprised of 720 patients (366 boys) diagnosed with type 1 diabetes aged <18 years between January 1992 and December 2011. Of all patients diagnosed with T1DM, 237 (32.9 %) presented with DKA. The majority had either mild (69.6 %) or moderate (22.8 %) DKA. Sixty (55.0 %) of all children under 5 years had DKA compared to sixty-two (20.9 %) in the 5- to 10-year-old group and one hundred fifteen (36.6 %) in the 11- to 18-year-old patients (p?<?0.01), while 2.5 % of the entire DKA cohort were in real coma. During the later 10-year period, children less often had DKA at diagnosis compared with the earlier 10-year period (28.0 vs. 37.4 %) (p?<?0.01), but the frequency of severe DKA was higher in the age group <5 year and in the age group >11 year during 2002–2011, compared with the earlier 10-year period (12.9 vs. 3.4 %, p?<?0.01 and 17.1 vs. 3.8 %, p?<?0.01). Conclusion: The overall frequency of DKA in children with newly diagnosed type 1 diabetes decreased over a 20-year period at our hospital. However, children aged <5 years and adolescents are still at high risk for DKA at diagnosis.     

Chloral Hydrate,Chloral Hydrate - Promethazine and Chloral Hydrate -Hydroxyzine Efficacy in Electroencephalography Sedation

Objective

To compare efficacy and safety of chloral hydrate (CH), chloral hydrate and promethazine (CH + P) and chloral hydrate and hydroxyzine (CH + H) in electroencephalography (EEG) sedation.

Methods

In a parallel single-blinded randomized clinical trial, ninety 1–7 y-old uncooperative kids who were referred to Pediatric Neurology Clinic of Shahid Sadoughi University, Yazd, Iran from April through August 2012, were randomly assigned to receive 40 mg/kg of chloral hydrate or 40 mg/kg of chloral hydrate and 1 mg/kg of promethazine or 40 mg/kg of chloral hydrate and 2 mg/kg of hydroxyzine. The primary endpoint was efficacy in sufficient sedation (obtaining four Ramsay sedation score) and successful completion of EEG. Secondary endpoint was clinical adverse events.

Results

Thirty nine girls (43.3 %) and 51 boys (56.7 %) with mean age of 3.34?±?1.47 y were assessed. Sufficient sedation and completion of EEG were achieved in 70 % (N?=?21) of chloral hydrate group, in 83.3 % (N?=?25) of CH + H group and in 96.7 % (N?=?29) of CH + P group (p?=?0.02). Mild clinical adverse events including vomiting [16.7 % (N?=?5) in CH, 6.7 % (N?=?2) in CH + P, 6.7 % (N?=?2) in CH + H], agitation in 3.3 % of CH + P (N?=?1) group and mild transient hypotension in 3.3 % of CH + H (N?=?1) group occurred. Safety of these three sedation regimens was not statistically significant different (p?=?0.14).

Conclusions

Combination of chloral hydrate—antihistamines can be used as the most effective and safe sedation regimen in drug induced sleep electroencephalography of kids.     

Implications of non-accidental trauma on resource utilization and outcomes

Purpose

The purpose was to compare the resource utilization and outcomes between patients with suspected (SUSP) and confirmed (CONF) non-accidental trauma (NAT).

Methods

The institutional trauma registry was reviewed for patients aged 0–18 years presenting from 2007 to 2012 with a diagnosis of suspicion for NAT. Patients with suspected and confirmed NAT were compared.

Results

There were 281 patients included. CONF presented with a higher heart rate (142?±?27 vs 128?±?23 bpm, p?<?0.01), lower systolic blood pressure (100?±?18 vs 105?±?16 mm Hg, p?=?0.03), and higher Injury Severity Score (15?±?11 vs 9?±?5, p?<?0.01). SUSP received fewer consultations (1.6?±?0.7 vs 2.4?±?1.1, 95% CI ? 0.58 to ? 0.09, p?<?0.01) and had a shorter length of stay (1.6?±?1.3 vs 7.8?±?9.8 days, 95% CI ? 4.58 to ? 0.72, p?<?0.01). SUSP were more often discharged home (OR 94.22, 95% CI: 21.26–417.476, p?<?0.01). CONF had a higher mortality rate (8.2 vs 0%, p?<?0.01).

Conclusions

Patients with confirmed NAT present with more severe injuries and require more hospital resources compared to patients in whom NAT is suspected and ruled out.

     

Hyperbilirubinemia in Healthy Newborns Born to Immigrant Mothers from Southeastern Asia Compared to Italian Ones

Objective

To compare the characteristics of jaundice and hyperbilirubinemia in the newborn population of both immigrant and Italian mothers.

Methods

The authors studied a group of 1,680 infants born at “A. Gemelli” hospital during 1 y. All were with appropriate weight for gestational age, weighting more than 2,500 g, born to low-risk pregnancy. Maternal ethnicity, clinically evident jaundice (that is total serum bilirubin (TSB)?>?7 mg/dL), hyperbilirubinemia (TSB?>?12 mg/dL), the duration of hospital stay and their need of phototherapy were evaluated.

Results

In infants born to Asian mothers, hyperbilirubinemia was significantly more frequent (48.8 % vs. 26.5 %, p?=?0.003) and they reached mean TSB peak significantly later (86.5?±?38.5 vs. 74.5?±?20.6 h, P?=?0.0001) compared with Italian infants. The average length of hospitalization of infants of Asian and Latin American mothers is significantly longer compared to Italian newborns (4.5?±?1.9 vs. 3.6?±?1.1, p <0.0001 and 4.2?±?1.6 vs. 3.6?±?1.1, p?=?0.0004). With regard to the use of phototherapy, and to its duration, there are no significant differences between the populations studied.

Conclusions

Having studied all infants at low risk, the greater length of hospitalization is due to later peak and the higher frequency of jaundice in newborns of immigrant mother, especially in Asia. Therefore, as it happens to the Italian newborns, it would be desirable to build forecasting nomograms in these populations, to reduce the length of hospitalization and facilitate protected discharge.     

Incomplete clinical manifestation as a risk factor for coronary artery abnormalities in Kawasaki disease: a meta-analysis

Incomplete Kawasaki disease (KD) comprises a large proportion of the total number of cases. Although it has the potential of delaying diagnosis, it is not conclusive whether an incomplete presentation is a risk factor for coronary artery abnormalities (CAAs). We performed a meta-analysis to establish the risk of CAA in 20 studies including 4,504 cases and 32,519 controls, and the risk of giant aneurysm in two studies including 5,390 cases and 37,648 controls. The pooled results indicated that incomplete KD was associated with an increased risk of CAA [odds ratio (OR)?=?1.447, 95 % confidence interval (CI)?=?1.158–1.808, p?=?0.001]. Subgroup analyses demonstrated higher associations in patients younger than 12 months (OR?=?2.023, 95 % CI?=?1.252–3.271, p?=?0.004), Asians and Indians (OR?=?1.57, 95 % CI?=?1.234–1.999, p?<?0.001 and OR?=?7.088, 95 % CI?=?1.640–30.631, p?=?0.009, respectively). Subgroup analysis according to the period of patient enrollment before and after 2004 showed increased association of incomplete KD with CAA only among studies with patients enrolled after 2004 (OR?=?1.969, 95 % CI?=?1.240–3.127, p?=?0.004). In conclusion, incomplete KD seems to be associated with an increased risk of CAA, and this is more prominent in patients younger than 12 months, Asians and Indians.     

Clinical outcome of parapneumonic empyema in children treated according to a standardized medical treatment

Treatment of parapneumonic empyema (PE) consists of intravenous antibiotics and, in case of large effusions and persisting fever, pleural chest drain (±intrapleural fibrinolytics) or video-assisted surgical intervention. We standardized the treatment for PE in our tertiary care center choosing a first-step nonsurgical approach. The aim was to evaluate the need for surgery and to collect data on disease course, outcome, and microbiology. For all children treated for PE between 2006 and 2013, data were prospectively collected concerning treatment, length of stay, duration of fever, complications, and causative agent. Of 132 children treated for PE, 20 % needed surgical intervention. Analyzed per year, the need for surgery decreased from almost 40 % in 2007 to 0 % in 2010 again increasing to 40 % although this did not reach statistical significance (p?=?0.115). Median duration of “in-hospital fever” was 5 days (IQR, 3–8). The duration of fever correlated with pleural LDH (r?=?0.324; p?=?0.002) and pleural glucose (r?=??0.248; p?=?0.021) and was inversely correlated with pleural pH (r?=??0.249; p?=?0.046). Based on pleural PCR data, 85 % of PE were caused by Streptococcus pneumoniae (40 % serotype 1). Conclusion: After introduction of a standardized primary medical approach (chest drain?±?fibrinolysis) for PE in our institution, the need for surgical rescue interventions overall remained at 20 %, which is higher than in some other reports. Difference in microbiology or disease severity could not be proven.     

A prospective randomly controlled clinical trial on azithromycin therapy for induction treatment of children with nephrotic syndrome

A prospective study was designed to evaluate the efficacy of azithromycin (AZM) when combined with prednisone therapy compared with prednisone therapy alone in children with primary nephrotic syndrome (PNS) undergoing induction treatment. A prospective randomly controlled clinical trial was conducted. Randomization was performed to select the research subjects who were composed of children with PNS and treated with AZM combined with prednisone (the intervention group) and with prednisone alone (the control group). A total of 211 randomly selected patients with PNS received either AZM combined with prednisone (n?=?106) or prednisone alone (n?=?105) for 6 months. At three months in the follow‐up period, 12 patients were lost to follow up (intervention group, 7; control group, 5), and 6 patients had a transient hypocomplementemia (intervention group, 4 ; control group, 2). AZM was administered at a dose of 10 mg/kg q.d (1 dose per day) for three consecutive days. The median duration before remission was 6 days in the intervention group and 9 days in the control group (p?<?0.0001). Relapse rate differed among the groups at 3 months (11.6 vs. 21.4 %, p?=?0.049). No difference in relapse rate was observed between the two groups within 4 to 6 months and at 6 months (p?=?0.168, 0.052). After 4 weeks of treatment, steroid resistance occurred in 1 out of 95 (1.05 %) patients in the intervention group and in 10 out of 98 (10.2 %) patients in the control group (p?=?0.006). After 8 weeks of treatment, no difference was found in steroid resistance between two groups (1/95 vs. 3/98, p?=?0.327). During follow-up at 6 months, no difference was exhibited by the two groups on frequent relapse rates (p?=?0.134). Conclusion: If a course of AZM is added to the glucocorticoid-induced treatment among children with PNS, then the sensitivity of prednisone increases. This increase consequently reduces duration to remission and decreases relapse. However, further studies are necessary to confirm these results.     

Factors Influencing the Television Viewing Practices of Indian Children

Objectives

To study the effect of socio-demographic factors, parental regulations and maternal television usage on the television viewing practices of Indian schoolchildren.

Methods

Mothers of 6–12 y old children were interviewed using a pre-tested questionnaire at the pediatric outpatient. The television viewing practices of 405 schoolchildren with maternal television viewing and parental television rules were analyzed. Specific television viewing practices considered harmful in the present study were- viewing television >2 h, viewing television just prior to sleep (at bedtime), predominantly viewing general adult channels and using television as an aid to sleep.

Results

35.8 % (n?=?145) of the children viewed television for >2 h on schooldays. 20 % (n?=?81) used television as sleep-aid. 28.1 % (n?=?114) children had televisions in the room they slept. The frequency of parental television rules were with respect to: duration of viewing- 77.5 % (n?=?314), timing of viewing- 63.7 % (n?=?258), content- 35.6 % (n?=?144). The children of families with the rule needing of parental permission to switch on the television [present in 34.8 % (n?=?141) children] had lower harmful television viewing practices: duration of television viewing on schooldays >2 h (23.4 %, n?=?33, P?<?0.001); television viewed just before sleep (39 %, n?=?55, P?<?0.001); use of television as sleep-aid (12.1 %, n?=?17, P?=?0.003). 26.7 % (n?=?108) of the mothers viewed television for >2 h. Linear regression analysis showed association between average television duration of children and average maternal television duration on schooldays (Beta?=?0.246, t?=?5.09, P?<?0.001). Binary logistic regression analysis showed that harmful television viewing practices were significantly more in children with television in bedroom [OR?=?7.49(4.19–13.38), P?<?0.001]. It was reduced significantly by the parental rules on content viewed [OR?=?0.41(0.23–0.72), P?=?0.002]; need of permission to switch on television [OR?=?0.31(0.18–0.53), P?<?0.001] and a higher maternal education [OR?=?0.29 (0.14–0.59), P?=?0.001].

Conclusions

Lower maternal education, increased maternal television usage, presence of television in bedroom resulted in harmful television viewing practices among Indian children. The parental rules that were effective in countering these were the rule on content viewed and needing parental permission to switch on television.     

Reference values of perfusion indices in hemodynamically stable newborns during the early neonatal period

We aimed to determine reference values of perfusion index (PI) in healthy newborns during the early neonatal period. Preductal (right hand) and postductal (foot) PI values were assessed during the first 5 days of life by using a new generation pulse oximetry. A total of 241 newborn infants (196 [81.3 %] term and 45 [18.7 %] preterm) were enrolled to the study. On the first day, in term infants, the median (interquartile range [IQR]) preductal and postductal PI were 1.35 (1.02–1.91) and 0.88 (0.62–1.22), respectively (p?=?0.001). These values were 0.88 (0.60–1.26) and 0.61 (0.35–0.92) in preterm infants, with the same respect (p?=?0.001). From the first to third days, preductal PI remained significantly higher than the postductal PI (p?<?0.001, for all comparisons). Both preductal and postductal PI of term newborns were significantly higher than those of preterm infants (p?<?0.001, for both comparisons). These differences in PI disappeared on the fifth day of life. Conclusion PI values which reflect peripheral perfusion seem to reach to a steady state on the fifth day of life following physiological maturation.     

Clinical manifestations associated with Kawasaki disease shock syndrome in Mexican children

Recently, there have been increasing reports of severe forms of Kawasaki disease (KD) associated with shock that have been managed in pediatric intensive care units. It has been suggested that KD is more severe in the Hispanic population. We conducted a study to determine the frequency of Kawasaki disease shock syndrome (KDSS) in our population and compared characteristics between patients with KD without shock and patients with KDSS. Data from 214 patients with KD treated in a tertiary pediatric hospital were collected during a 12-year period. We compared clinical and laboratory features of KD patients without shock and KDSS patients. Of 214 consecutive patients with KD, 11 (5 %) met the definition for KDSS. All of these patients received fluid resuscitation, seven (64 %) required inotropic treatment, and six (54 %), ventilatory support. On admission, seven of these patients (64 %) had an incomplete presentation of the disease, whereas in the group of patients without shock, the relative frequency of an incomplete presentation was 29 %. Twenty percent (3/11) of patients with KDSS presented giant coronary aneurysms versus none of 203 KD patients without shock (p?=?0.001); myocardial infarction, 27 % (3/11), versus 1 % (2/203) (p?=?0.001); and intravenous immunoglobulin (IVIG) resistance, 60 % (6/11), versus 12 % (24/203). Gastrointestinal manifestations in the acute phase occurred in 91 % of KDSS patients versus 30 % patients without shock (p?=?0.001). Conclusion. Patients with KD presenting in shock seem to have an increase in gastrointestinal manifestations, incomplete presentation, IVIG resistance, and worse cardiac outcomes. Larger, prospective, multicentre studies should be carried out to corroborate these findings.     

Caloric beverage drinking patterns are differentially associated with diet quality and adiposity among Spanish girls and boys

The present study assesses the impact of beverage consumption pattern on diet quality and anthropometric proxy measures for abdominal adiposity in Spanish adolescents. Data were obtained from a representative national sample of 1,149 Spanish adolescents aged 10–18 years. Height, weight, and waist circumferences were measured. Dietary assessment was performed with a 24-h recall. Beverage patterns were identified by cluster analysis. Adherence to the Mediterranean diet was measured by the KIDMED index. Three beverage clusters were identified for boys—“whole milk” (62.5 %), “low-fat milk” (17.5 %) and “soft drinks” (20.1 %)—and for girls—^“whole milk” (57.8 %), “low-fat milk” (20.8 %) and juice (21.4 %), accounting for 8.3, 9.6, 13.9, 8.6, 11.5 and 12.9 % of total energy intake, respectively. Each unit of increase in the KIDMED index was associated with a 14.0 % higher (p?=?0.004) and 11.0 % lower (p?=?0.048) probability of membership in the “low-fat milk” and “soft drinks” cluster in girls and boys, respectively, compared with the “whole milk” cluster. Boys in the “soft drinks” cluster had a higher risk of 1-unit increase in BMI z score (29.0 %, p?=?0.040), 1-cm increase in waist circumference regressed on height and age (3.0 %, p?=?0.027) and 0.1-unit increase in waist/height ratio (21.4 %, p?=?0.031) compared with the “whole milk” cluster. Conclusion: A caloric beverage pattern dominated by intake of “soft drinks” is related to general and abdominal adiposity and diet quality in Spanish male adolescents.     

Bronchopulmonary dysplasia and neurodevelopmental outcome in extremely preterm neonates

We tested the hypothesis that the use of supplemental oxygen (sO₂) at discharge from the NICU in extremely preterm neonates is associated with a greater risk of neurodevelopmental impairment (NDI) at 18 months corrected gestational age (CGA) than the risk of NDI of those neonates discharged in room air. Four hundred twenty-four charts were retrospectively reviewed from infants born at <27 weeks and transferred to Nationwide Children’s Hospital from December 1, 2004 to June 14, 2010. Use of sO₂ was evaluated on day of life (dol) 28, at 36 weeks post-menstrual age (PMA), and at discharge. Logistic regression was used to identify postnatal risk factors associated with sO₂ at discharge and NDI. At dol 28, 96 % of surviving patients received sO₂, and therefore had bronchopulmonary dysplasia (BPD) by definition from a National Institutes of Child Health and Human Development workshop. At 36 weeks PMA, 89 % continued on sO₂ (moderate/severe BPD), and at discharge, 74 % continued on sO₂. When factors associated with NDI were examined, the need for mechanical ventilation ≥28 days (adjOR?=?3.21, p?=?0.01), grade III–IV intraventricular hemorrhage (IVH) (adjOR?=?4.61, p?<?0.01), and discharge at >43 weeks PMA (adjOR?=?2.12, p?=?0.04) were the strongest predictors of NDI at 18 months CGA. There was no difference in Bayley Scales of Infant Development, third edition composite scores between patients with no/mild BPD and patients with moderate/severe BPD (cognitive p?=?0.60, communication p?=?0.53, motor p?=?0.19) or those scores between patients on and off oxygen at discharge (cognitive p?=?0.58, communication p?=?0.70, motor p?=?0.62). Conclusions: The need for sO₂ at discharge is not associated with an increased risk of NDI in these patients. The strongest predictors of poor neurodevelopmental outcome in this population were prolonged positive pressure support, grade III–IV IVH, and discharge at >43 weeks PMA.     

Body fat percentage is better than indicators of weight status to identify children and adolescents with unfavorable lipid profile

Objective

To assess whether the indicators of weight status body mass index and waist-to-height ratio are similar to body fat percentage to identify obese children and adolescents with unfavorable lipid profile.

Long-term quality of life of patients treated in paediatric intensive care unit

The changes in long-term quality of life (QOL) of children treated in paediatric intensive care unit (PICU) were investigated in relation to their QOL before critical illness together with the influence of underlying chronic health condition and severity of illness estimated by Paediatric Index of Mortality 2 on the long-term outcome. This study included 189 children treated in PICU and 179 children from outpatient clinics as controls. QOL was evaluated according to the Royal Alexandra Hospital for Children Measure of Function (RAHC MOF). The long-term QOL in 70 % of children treated in PICU was good, although there was a significant diminution of QOL in children treated in PICU in comparison with their preadmission scores and with the children from outpatient clinics who served as controls (p?<?0.001). Severity of illness had a significant impact on children’s QOL (p?=?0.016) 6 months after treatment in PICU. Twenty-four months after discharge, the RAHC MOF score was still decreased in 19 % of children treated in PICU, and in significantly more patients with a chronic health condition (CHC) treated in PICU, than in their peers from outpatient clinics (p?=?0.029). Reduced QOL was significantly more frequent in children with neurodevelopmental disability than in children without CHC 24 months after discharge from PICU (p?=?0.013). Conclusion: Acute illness has a significant impact both on children with and without CHC after treatment in PICU 6 months after discharge. Twenty-four months after discharge, comorbidity was identified as the decisive factor for diminished QOL in children after PICU treatment.     

Predictors of Stress Among Parents in Pediatric Intensive Care Unit: A Prospective Observational Study

Objective

To determine the sociodemographic and clinical factors leading to stress among parents whose children are admitted in pediatric intensive care unit (PICU).

Methods

A prospective observational study was conducted in PICU of a tertiary care hospital of north India. Parents of children admitted to PICU for at least 48 h duration were eligible for participation. At the end of 48 h, parental stress was assessed using parental stress scale (PSS:PICU) questionnaire which was administered to the parents. Baseline demographic and clinical parameters of children admitted to PICU were recorded. The parental stress was compared with demographic and clinical characteristics of children using appropriate statistical methods.

Results

A total of 49 parents were finally eligible for participation. Mean (SD) parental stress scores was highest in domains of procedures [1.52 (0.66)] and behavior and emotional [1.32 (0.42)] subscales. Mean (SD) total parental stress score among intubated children [1.31 (0.25)] was significantly more than among non intubated children [0.97 (0.26)] (p?p?=?0.15) and socioeconomic status (p?=?0.32). On subscale analysis, it was found that professional communication is a significant stressor in age groups 0–12 mo [0.61(0.41)] (p?=?0.02). It was observed that parents of intubated children were significantly stressed by the physical appearance of their children (p?p?=?0.008) and impairment in parental role (p?=?0.002). Total parental stress score had a positive correlation with PRISM score (r?=?0.308).

Conclusions

Indian parents are stressed maximally with environment of PICU. Factor leading to parental stress was intubation status of the child and was not affected by gender or socio demographic profile of the parents.