Transient neonatal hyperthyrotropinaemia.

Of 48 consecutive newborns with elevated umbilical venous plasma thyrotropin (TSH) concentration, only two (4%) were subsequently proved to have congenital hypothyroidism, while the other 46 had transient elevation of TSH. Compared with matched controls, these 46 newborns were all delivered vaginally (P less than 0.0003) and had a longer second stage of labour (P less than 0.002), together with higher incidences of nuchal encirclement of the cord (P less than 0.05) as well as female babies (P less than 0.05). There was no difference in the incidence of antenatal complications, mean gestational age, birth weight, or birth asphyxia. There were no small-for-gestational age infants in the study group, while four were found in the controls. The results indicate that elevated umbilical cord plasma TSH concentration may represent a response to the stress of difficult or complicated delivery in the healthy appropriate- or large-for-gestational age newborn who does not have congenital hypothyroidism.     

Transient infantile hyperthyrotropinaemia. Report of a case.

A case of transient hyperthyrotropinaemia was found by mass screening for neonatal hypothyroidism using the paired TSH assay method. The patient was a baby boy born at term after a normal pregnancy who grew without any abnormal signs or symptoms. For the first 7 months after birth, his serum TSH was abnormally high while his total serum T4, T3, and free T4, T3 were within normal limits, exept for slightly low free T4 level at 7 months. The raised serum TSH decreased spontaneously to within normal limits after he was 9 months old.     

Persistent hyperthyrotropinaemia since the neonatal period in clinically euthyroid children

We describe three children, now aged between 5 and 6 years, with a persistent mild hyperthyrotropinaemia since the neonatal period and normal levels of thyroid hormones. The increased thyroid stimulating hormone concentration is not artefactual and is not caused by antibody interferences. Their growth and development is normal and none has received thyroid hormone replacement. We believe that they have compensated hypothyroidism, and that before the advent of screening for congenital hypothyroidism these children would have presented in mid-childhood with juvenile hypothyroidism.     

80例胎儿肾积水的诊断与产后转归

目的探讨胎儿肾积水的产前超声诊断及产后转归。方法对孕18～41周的胎儿进行产前超声检查，根据肾集合系统前后径情况选择分离〉0．5cm的胎儿80例（90只肾），分为3组：Ⅰ组肾集合系统前后径分离0．5～1．0cm（70例）；Ⅱ组：肾集合系统前后径分离1．0～1．5cm（16例）；Ⅲ组：肾集合系统前后径分离〉1．5cm（4例）。3组均出生后随访至2岁。结果80例（90只肾）中，14例引产，63例（73只肾）肾积水无变化或恢复正常，其中I组及Ⅱ组62例，Ⅲ组1例。Ⅲ组4例中，3例行手术治疗。结论胎儿期肾集合系统分离在1．5cm以内，且无进行性增宽者提示预后良好；〉1．5 cm伴。肾实质变薄者提示预后不良，需密切观察或手术治疗。     

The contributions of differing degrees of acute and chronic malnutrition to the intellectual development of Jamaican boys

The purpose of this paper is to determine whether differing degrees and types of malnutrition cause differing degrees of mental impairment. Subjects were 59 Jamaican boys hospitalized for malnutrition in infancy and whose intelligence was assessed at school age. The measure used for degree of chronic malnutrition was height for age and for acute malnutrition weight for height. The measure of intelligence was the I.Q. (WISC). Because the social environment in which a child lives influences his intellectual development, a measure of social background was used as an independent variable in addition to the nutrition measures. Social background showed a significant effect on I.Q. but neither measure of nutrition was significant.A further analysis using comparisons who had not been hospitalized for malnutrition suggests that malnutrition may contribute to mental impairment, through a threshold effect rather than acting as a continuous variable where increasing degrees of malnutrition cause increasing degrees of mental impairment.     

The impact of poverty on educational outcomes for children

Over the past decade, the unfortunate reality is that the income gap has widened between Canadian families. Educational outcomes are one of the key areas influenced by family incomes. Children from low-income families often start school already behind their peers who come from more affluent families, as shown in measures of school readiness. The incidence, depth, duration and timing of poverty all influence a child’s educational attainment, along with community characteristics and social networks. However, both Canadian and international interventions have shown that the effects of poverty can be reduced using sustainable interventions. Paediatricians and family doctors have many opportunities to influence readiness for school and educational success in primary care settings.     

33 例非免疫性胎儿水肿临床特征及转归

目的探讨非免疫性胎儿水肿(NIHF)临床特征及转归。方法回顾分析2014年1月—2016年12月收治的33例NIHF新生儿的临床资料,将其分为死亡组和治愈组,进行两组间各因素的比较分析。结果 33例患儿中,男16例、女17例,中位胎龄33.4周(31.2～35.1周),出生体质量(2 714±712)g,死亡20例。死亡组出生体质量、1分钟及5分钟Apgar评分低于治愈组,差异均有统计学意义(P0.05)。新生儿产时复苏插管组和未插管组的母亲孕期合并症发生率及宫内干预率的差异有统计学意义(P0.05)。宫内干预是导致新生儿需产时复苏的独立危险因素(OR=15.30,95%CI:2.46～95.19);1分钟Apgar评分是NIHF疾病转归的独立危险因素(OR=1.75,95%CI:1.20～2.53),评分越低、死亡率越高。结论宫内干预与产时需要复苏有关,而1分钟Apgar评分是影响NIHF结局的重要因素。     

The covariation of common psychosomatic symptoms among children from socio-economically differing residential areas. An epidemiological study

Psychosomatic symptoms among children are believed to be commonplace. In this investigation by questionnaire, 47% of 1333 schoolchildren reported one or several symptoms, such as recurrent abdominal pain, headache, chest pains, loss of appetite and disturbances in bowel function. Coexistence of such symptoms was considerable and if a child had one of these, the probability that it would have one or more other symptoms was significantly increased. This correlation may strengthen both the suspicion that these symptoms are often psychosomatic and the idea that they have common CNS origin. There were appreciable differences in the frequency of the symptoms, between children at the more socially stable schools and schools with social problems. In the latter, the frequencies of symptoms differed between Swedish and immigrant children, which was not the case in the more socially stable schools.     

Focal nodular hyperplasia of the liver imaging by differing modalities

The logistic approach in diagnosis of focal nodular hyperplasia (FNH) of the liver is discussed, based on the experience with three children. In only one child could the diagnosis be made without angiography. In that child the combination of hypervascularity on the radionuclide angiogram and uptake of the radiocolloid by Kupffer cells was sufficient for the diagnosis of FNH. If the radionuclide scintigraphy is inconclusive, angiography has to be done to show the typical features of FNH, seen in all three patients. Only if scintigraphy and angiography are not able to differentiate FNH from hepatic adenoma, biopsy or exploratory laparotomy is indicated as a final diagnostic procedure. Ultrasonography or computerized tomography is of value only in screening for hepatic mass lesions.     

The impact of cognitive delay on pediatric heart transplant outcomes

The presence of CD may be viewed as a relative contraindication to transplantation; however, its impact on pediatric HTx outcomes is poorly characterized. The aim of this study was to assess the impact of CD on pediatric HTx outcomes using academic progress as a surrogate measure of cognitive performance. The OPTN database was queried for all pediatric HTx recipients (2004‐2014) with reported academic progress. Multivariable analysis assessed the impact of DGL and the need for SE on post‐HTx graft survival. A total of 2245 children were included: 1707 (76%) within grade level, 269 (12%) with DGL, and 269 (12%) who required SE. The need for SE was not a risk factor for post‐HTx mortality; however, DGL was an independent risk factor for worse post‐HTx outcomes (AHR 1.4, 95% CI 1.02, 1.79, P=.03). Patients who require SE have similar outcomes compared to those without CD, likely secondary to significant parental involvement. Children with DGL demonstrate inferior post‐HTx survival, which could result from less parental oversight in children perceived to maintain compliance. Ensuring adequate social support for patients with evidence of CD may help to improve outcomes.     

The impact of surgical strategies on outcomes for pediatric chronic pancreatitis

Purpose

To review our institutional experience in the surgical treatment of pediatric chronic pancreatitis (CP) and evaluate predictors of long-term pain relief.

Methods

Outcomes of patients ≤21 years surgically treated for CP in a single institution from 1995 to 2014 were evaluated.

Results

Twenty patients underwent surgery for CP at a median of 16.6 years (IQR 10.7–20.6 years). The most common etiology was pancreas divisum (n = 7; 35%). Therapeutic endoscopy was the first-line treatment in 17 cases (85%). Surgical procedures included: longitudinal pancreaticojejunostomy (n = 4, 20%), pancreatectomy (n = 9, 45%), total pancreatectomy with islet autotransplantation (n = 2; 10%), sphincteroplasty (n = 2, 10%) and pseudocyst drainage (n = 3, 15%). At a median follow-up of 5.3 years (IQR 4.2–5.3), twelve patients (63.2%) were pain free and five (26.3%) were insulin dependent. In univariate analysis, previous surgical procedure or >5 endoscopic treatments were associated with a lower likelihood of pain relief (OR 0.06; 95% CI 0.006–0.57; OR 0.07; 95%, CI 0.01–0.89). However, these associations were not present in multivariate analysis.

Conclusion

In children with CP, the step-up practice including a limited trial of endoscopic interventions followed by surgery tailored to anatomical abnormalities and gene mutation status is effective in ensuring long-term pain relief and preserving pancreatic function.

     

The immediate and long-term outcomes of newborns with congenital diaphragmatic hernia

In spite of the innovations in the management of newborns with congenital diaphragmatic hernia (CDH) presenting with respiratory distress at birth, mortality and ongoing morbidity still remain high. This is a retrospective analysis of newborns with CDH to determine the immediate and long-term outcomes among survivors. Medical records of newborns with CDH and respiratory distress at birth between January 1993 and March 2002 were reviewed retrospectively. There were 45 newborns, 29 males and 16 females. Eleven newborns (24%) died during the period of preoperative stabilization, 9 from pulmonary hypoplasia and 2 with complex anomalies who were not resuscitated. Surgery was performed in 34 newborns (76%). Three died postoperatively from severe pulmonary hypoplasia and pulmonary hypertension. Eleven newborns (24%) had sepsis from coagulative-negative staphylococci. Thirty-one of 43 newborns (72%) with isolated CDH were discharged home. Twenty-seven of 31 survivors (87%) had adverse long-term outcome and 2 late deaths were from pulmonary complications. Twenty-nine of 43 newborns (67%) with isolated CDH survived. The principal determinant of survival was pulmonary hypoplasia. Eighty-seven percent of survivors have associated morbidity including ongoing pulmonary, nutritional and neuro-developmental problems. Nevertheless preoperative stabilization and delayed surgery have been a satisfactory mode of management.     

The crucial role of tumour specimen handling in childhood cancer outcomes

The significant advances achieved in the care of children with cancer have been the result of carefully conducted clinical trials in international cooperative group settings. Specialized biological testing of tumour specimens is now an essential component of risk and treatment assignment for many childhood cancers. Thus, the appropriate collection and handling of tumour specimens is crucial to maintaining and further advancing the excellent outcomes that we have achieved. We recommend that all children with a strongly suspected malignancy, or cases in which the situation is unclear, be discussed with a paediatric oncologist before obtaining a tumour specimen. When a tumour is discovered incidentally at surgery, we recommend that the tumour be placed in a saline-soaked gauze and a paediatric pathologist or oncologist contacted immediately. Further progress in understanding and treating childhood cancer is intimately linked to basic studies of biology, translational research and determining the role of biological markers in risk stratification. Early and careful collaboration between front-line physicians and tertiary care oncology specialists is essential to the continuing success of treatment of children with cancer.     

The influence of nutrition on clinical outcomes in children with cancer

Adequate and appropriate nutrition is essential for growth and development in children; all put at risk in those with cancer. Overnutrition and undernutrition at diagnosis raise the risk of increased morbidity and mortality during therapy and beyond. All treatment modalities can jeopardize nutritional status with potentially adverse effects on clinical outcomes. Accurate assessment of nutritional status and nutrient balance is essential, with remedial interventions delivered promptly when required. Children with cancer in low‐ and middle‐income countries (LMICs) are especially disadvantaged with concomitant challenges in the provision of nutritional support. Cost‐effective advances in the form of ready‐to‐use therapeutic foods (RUTF) may offer solutions. Studies in LMICs have defined a critical role for the gut microbiome in the causation of undernutrition in children and have demonstrated a beneficial effect of selected RUTF in redressing the imbalanced microbiota and improving nutritional status. Challenges in high‐income countries relate both to concerns about the potential disadvantage of preexisting obesity in those newly diagnosed and to undernutrition identified at diagnosis and during treatment. Much remains to be understood but the prospects are bright for offsetting malnutrition in children with cancer, resulting in enhanced opportunity for healthy survival.     

The effectiveness of health promotion materials and activities on breastfeeding outcomes

Aim: To determine the effect of mothers receiving health promotion material and education antenatally and/or postnatally on breastfeeding outcomes in Perth, Western Australia. Methods: A 12‐month longitudinal study was conducted in two public maternity hospitals in Perth, Western Australia, between 2002 and 2003. Data were collected on a consecutive sample 587 mothers. Results: The results showed that mothers who received an individual consultation or were involved in a discussion on breastfeeding antenatally with hospital staff were approximately 55% less likely to cease fully breastfeeding (HR 0.44; 95% CI 0.24–0.88) before 6 months, and 50% less likely to cease any breastfeeding before 12 months postnatally (HR 0.51; 95% CI 0.28–0.92). In the postnatal period, mothers who received instruction on positioning and attachment of the infant to the breast while in hospital were approximately 30% less likely to cease fully breastfeeding before 6 months (HR 0.66; 95% CI 0.45–0.99). Conclusion: The results of this study suggest a positive association between receiving individualized breastfeeding information in both the antenatal and postnatal period, and breastfeeding outcomes.