Serum Fructosamine and Retinopathy of Prematurity

Objective

To determine whether serum fructosamine which is a good marker for detecting hyperglycemia during the previous 2 to 3 wk in infants could predict the development of retinopathy of prematurity in very low birth weight infants.

Methods

One hundred sixty seven premature infants who had a birth weight of <1500 g and a gestational age of less than 32 wk were investigated in the present study. Blood glucose was measured at the bedside and infants were recorded as hyperglycemic if their mean blood glucose levels were higher than 150 mg/dL. Serum corrected fructosamine level was obtained from the cord blood at birth and after the first month of life. The infants’ eyes were examined by ophthalmologists to detect retinopathy of prematurity at the gestational age of 32 wk or at four wk after birth, whichever came first.

Results

Corrected fructosamine was 319.6?±?59.6 and 272.8?±?50.6 mmol/l for group1 on 1^st and 30^th day respectively; 320?±?61.7 and 268.2?±?47.3 mmol/l for groups 2?+?3 on 1^st and 30^th day respectively which did not differ between groups (p?=?0.766 and p?=?0.665), whereas duration of hyperglycemia was 1.69?±?1.1 day in group 1 compared with 3.05?±?2.4 day in groups 2?+?3 which was significantly different (p?=?0.019). The multivariate regression analysis indicated that the duration of hyperglycemia in days was significantly correlated with the development of retinopathy of prematurity (OR 3.26; 95% CI 1.09–9.80; p?=?0.035).

Conclusions

Although the duration of hyperglycemia may contribute to the development of retinopathy of prematurity, serum corrected fructosamine does not have a good predictive value in developing retinopathy of prematurity in very-low-birth-weight (VLBW) infants.     

Interventioneller Verschluss eines persistierenden Ductus arteriosus

Background

A large persistent patent ductus arteriosus (PDA) in a symptomatic premature or newborn infant is to be regarded as an expression of the premature birth, which must per se be primarily treated. The PDA may persist, however, despite optimal neonatological therapy and specific pharmacological intervention, as a hemodynamically relevant connection between the aorta and the pulmonary artery stem. In this case the clinical symptoms depend on the extent of the shunt and pulmonary flooding or pulmonary pressure elevation and other concomitant phenomena may result. When preterm and newborn infants are clinically compromised by a large PDA, surgical closure is so far the only alternative to pharmacological treatment.

Aim

This study investigated whether interventional PDA closure is as effective and safe in preterm infants, full term infants and children weighing Material and methods In a retrospective analysis the experiences of two centers which performed interventional PDA closure in preterm and full-term infants and in children with body weight of Results A total of 68 children weighing ?95?%. Device-associated complications were low at 3?% and there were no mortalities.

Discussion

Interventional PDA closure in children (preterm and full term infants) with a hemodynamically relevant PDA and associated clinical symptoms represents a safe and efficient therapy option after the conservative options have been exhausted. The procedure can be applied safely and successfully in children weighing less than 6 kg and as little as 2 kg.     

血N端脑钠肽前体在早产儿症状性动脉导管未闭诊治中的应用价值

目的探讨血浆N端脑钠肽前体(NT-pro BNP)在早产儿症状性动脉导管未闭(s PDA)诊治中的临床应用价值。方法选取2013年10月—2014年9月入住新生儿重症监护病房、胎龄28~32周、出生体质量??1 500 g的早产儿107例,分别于生后第4、7天检测NT-pro BNP,采血后30 min内行超声心动图检查。根据生后第4天超声心动图检查结果分PDA组(39例)与对照组(68例);PDA组根据有无超声血流动力学显著改变及临床表现分为症状性PDA(s PDA组,20例)和无症状性PDA(as PDA组,19例);s PDA组再根据是否服用布洛芬分为治疗组(13例)与非治疗组(7例)。结果生后第4天,s PDA组患儿血浆NT-pro BNP水平高于as PDA组,as PDA组高于对照组,差异均有统计学意义(P??0.05);生后第7天,s PDA组患儿血浆NT-pro BNP水平高于as PDA组和对照组,差异有统计学意义(P??0.05),as PDA组与对照组的差异则无统计学意义(P??0.05)。治疗组生后第7天血浆NT-pro BNP水平较第4天显著下降,差异有统计学意义(P??0.05);非治疗组生后第7天与第4天血浆NT-pro BNP水平的差异无统计学意义(P??0.05)。PDA患儿生后第4天血浆NT-pro BNP水平与动脉导管(DA)直径、左心房/主动脉根部内径比值(LA/AO)及DA直径与左肺动脉内径比值(TDD/LPA)呈正相关(r=0.498~0.670,P均??0.05)。生后第4天血浆NT-pro BNP水平预测s PDA的ROC曲线下面积(AUC)为0.969(95%CI:0.938~1.000),NT-pro BNP水平在13 964 pg/m L时,诊断s PDA的灵敏度为95%,特异度为95.4%。结论 s PDA早产儿血浆NT-pro BNP水平明显增高,治疗后下降。第4天血浆NT-pro BNP是预测s PDA的敏感指标,动态监测血浆NT-pro BNP水平变化对指导早产儿PDA治疗策略的选择有重要临床价值。     

Neonatal gastric perforations in very low birth weight infants: a single center experience and review of the literature

Purpose

Gastric perforation is a rare condition with high mortality rates in preterm infants. The aim of this retrospective study was to define the risk factors and prognosis in very low birth weight (VLBW) infants with gastric perforations.

Methods

VLBW infants with a diagnosis of gastric perforation between 2012 and 2016 were included. The data including birth weight, gestational age, gender, risk factors, time and location of the perforation and prognosis were recorded.

Results

A total of eight infants were identified. The median gestational age and birth weight of the infants were 26 weeks and 860 g, respectively. Five were male and 6 (75%) had a diagnosis of hemodynamically significant patent ductus arteriosus (PDA), early sepsis, persistent hypotension, and drug administration (paracetamol, ibuprofen). The main clinical finding was abdominal distension and pneumoperitoneum was detected in all infants. The median diagnosis was 6 days of life. The median perforation size was 2.5 cm and curvature major and anterior wall were the most common locations. The mortality rate was 62.5%.

Conclusion

Male gender, chorioamnionitis, early sepsis, asphyxia, hemodynamic PDA, persistent hypotension, ibuprofen and paracetamol usage, and orogastric catheter administration were the main risk factors for gastric perforations in VLBW infants.

     

Effect of Oil Massage on Growth in Preterm Neonates Less than 1800 g: A Randomized Control Trial

Objective

To study the effect of oil massage on growth in preterm babies less than 1800 g.

Methods

This randomised controlled trial was conducted in Neonatal intensive care unit of a level II hospital. Neonates with birth weight?<?1800 g, gestation?<?35 wk and?<?48 h of age at enrolment were included in the studies. Eligible neonates were randomized to one of the two groups (a) Oil massage along with standard care of low birth weight (b) Standard care of low birth weight without massage. Weight, length and head circumference was measured in the two groups at 7 d intervals. Serum triglyceride levels were measured at enrolment and at completion of study. Primary outcome variable was weight gain at 28 d after enrolment.

Results

A total of forty-eight neonates were randomisd to either oil massage group (n?=?25) or standard care of low birth weight without massage group (n?=?23). Mean (SD) weight of babies in the two groups was 1466.4?±?226.8 g in oil massage group and 1416.6?±?229.9 g in the control group. At 28 d, weight gain in the oil massage group (476.76?±?47.9 g) was higher compared to the control group (334.96?±?46.4 g) (p?<?0.05). At 7 d, less weight loss (7.80?±?9.8 g) was observed in babies in oil massage group compared to control group (21.52?±?19.4 g) (p?=?0.003). However, there was no significant difference in serum triglycerides and other anthropometric parameters.

Conclusions

Oil application has a potential to improve weight gain and cause less weight loss in first 7 d in low birth weight neonates     

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).     

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.     

A prospective pilot study: Can the biliary tree be visualized in children younger than 3 months on Magnetic Resonance Cholangiopancreatography?

Background

Magnetic resonance cholangiopancreatography (MRCP) could aid in the diagnosis of biliary atresia, a hepatic pathology with thin, irregular or interrupted biliary ducts. There is little published evidence of MRCP appearances in normal neonates and young infants.

Objective

To assess the use of MR cholangiopancreatography in visualizing the biliary tree in neonates and infants younger than 3 months with no hepatobiliary disorder, and to assess this visibility in relationship to the child’s age, weight, and sedation and fasting states.

Materials and methods

Between December 2008 and October 2010 our department performed MRI of the brain, orbits and face on 16 full-term neonates and infants. Each child was younger than 3 months (90 days) and without any hepatobiliary disorders. The children were scanned with a respiratory-gated 0.54?×?0.51?×?0.4-mm³ 3-D MRCP sequence. We used a reading grid to assess subjectively the visibility of the extrahepatic bile ducts along with extrahepatic bile duct confluence. The visibility of the extrahepatic bile duct confluence was assessed against age, weight, and sedation and fasting states.

Results

The extrahepatic bile duct confluence was seen in 10 children out of 16 (62.5%). In the neonate sub-group (corrected age younger than 30 days), the MRCP was technically workable and the extrahepatic bile duct confluence was seen in four cases out of eight (50%). This visualization was up to 75% in the subgroup older than 30 days. However, statistically there was no significant difference in visibility of the extrahepatic bile duct confluence in relationship to age, weight or MRCP performance conditions (feeding, fasting or sedation).

Conclusion

The complete normal biliary system (extrahepatic bile duct confluence included) is not consistently visualized in infants younger than 3 months old on non-enhanced MRCP. Thus the use of MRCP to exclude a diagnosis of biliary atresia is compromised at optimal time of surgery.     

Association Between Blood Spot Transforming Growth Factor-β and Patent Ductus Arteriosus in Extremely Low-Birth Weight Infants

Permanent ductal closure involves anatomic remodeling, in which transforming growth factor (TGF)-β appears to play a role. Our objective was to evaluate the relationship, if any, between blood spot TGF-β on day 3 and day 7 of life and patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. Prospective observational study involving ELBW infants (n = 968) in the National Institute of Child Health and Human Development Neonatal Research Network who had TGF-β measured on filter paper spot blood samples using a Luminex assay. Infants with a PDA (n = 493) were significantly more immature, had lower birth weights, and had higher rates of respiratory distress syndrome than those without PDA (n = 475). TGF-β on days 3 and 7 of life, respectively, were significantly lower among neonates with PDA (median 1,177 pg/ml [range 642–1,896]; median 1,386 pg/ml [range 868–1,913]) compared with others without PDA (median 1,334 pg/ml [range 760–2,064]; median 1,712 pg/ml [range 1,014–2,518 pg/ml]). The significant difference persisted when death or PDA was considered a composite outcome. TGF-β levels were not significantly different among subgroups of infants with PDA who were not treated (n = 51) versus those who were treated medically (n = 283) or by surgical ligation (n = 159). TGF-β was not a significant predictor of death or PDA (day 3 odds ratio [OR] 0.99, 95 % confidence interval [CI] 0.83–1.17; day 7 OR 0.88, 95 % CI 0.74–1.04) on adjusted analyses. Our results suggest that blood spot TGF-β alone is unlikely to be a reliable biomarker of a clinically significant PDA or its responsiveness to treatment.     

Diffusion tensor imaging in extremely low birth weight infants managed with hypercapnic vs. normocapnic ventilation

Background

Permissive hypercapnia is a ventilatory strategy used to prevent lung injury in ventilated extremely low birth weight (ELBW, birth weight ≤1,000 g) infants. However, there is retrospective evidence showing that high CO₂ is associated with brain injury.

Objective

The objective of this study was to compare brain white matter development at term-equivalent age in ELBW infants randomized to hypercapnic vs. normocapnic ventilation during the first week of life and in healthy non-ventilated term newborns.

Materials and methods

Twenty-two ELBW infants from a randomized controlled trial were included in this study; 11 received hypercapnic (transcutaneous PCO₂ [tcPCO₂] 50–60 mmHg) ventilation and 11 normocapnic (tcPCO₂ 35–45 mmHg) ventilation during the first week of life while still intubated. In addition, ten term healthy newborns served as controls. Magnetic resonance imaging (MRI) with diffusion tensor imaging (DTI) was performed at term-equivalent age for the ELBW infants and at approximately 2 weeks of age for the control infants. White matter injury on conventional MRI was graded in the ELBW and control infants using a scoring system adopted from literature. Tract-based spatial statistics (TBSS) was used to evaluate for differences in DTI measured fractional anisotropy (FA, spatially normalized to a customized template) among the ELBW and term control infants.

Results

Conventional MRI white matter scores were not different (7.3?±?1.7 vs. 6.9?±?1.4, P?=?0.65) between the hypercapnic and normocapnic ELBW infants. TBSS analysis did not show significant differences (P?<?0.05, corrected) between the two ELBW infant groups, although before multiple comparisons correction, hypercapnic infants had many regions with lower FA and no regions with higher FA (P?<?0.05, uncorrected) compared to normocapnic infants. When compared to the control infants, normocapnic ELBW infants had a few small regions with significantly lower FA, while hypercapnic ELBW infants had more widespread regions with significantly lower FA (P?<?0.05, fully corrected for multiple comparisons).

Conclusions

Normocapnic ventilation vs. permissive hypercapnia may be associated with improved white matter development at term-equivalent age in ELBW infants. This effect, however, was small and was not apparent on conventional MRI. Further research is needed using larger sample sizes to assess if permissive hypercapnic ventilation in ELBW infants is associated with worse white matter development.     

Low serum 25-hydroxyvitamin D levels and bronchiolitis severity in Spanish infants

This cross-sectional study was performed to examine the prevalence of hypovitaminosis D in infants with acute bronchiolitis compared with control subjects and to evaluate the relationship between serum 25-hydroxyvitamin D (25(OH) D) and the severity of bronchiolitis. Serum 25(OH) D levels were measured by radioimmunoassay in 48 infants with acute bronchiolitis (2.5?±?2.0 months) and in 30 healthy infants (3.2?±?2.3 months). 25(OH) D levels (ng/ml) in children with acute bronchiolitis were significantly lower than in the control group (median 29.9 ng/ml (interquartile range (IQR) 21.4–37.5) versus median 38.2 ng/ml ((IQR 26.1–48.1), p?=?0.022), mainly in infants with moderate–severe bronchiolitis (median 29.8 ng/ml, IQR 19.2–35.9). The prevalence of hypovitaminosis D was remarkably greater among infants with bronchiolitis than in control subjects (52.1 versus 26.6 %). A significant inverse correlation was found between serum 25-hydroxyvitamin D levels and disease severity (rho?=??0.457, p?<?0.001). Conclusion: The prevalence of hypovitaminosis D is high in Spanish infants with bronchiolitis. The severity of acute bronchiolitis increases with a decline in serum 25 (OH) D level.     

Anterior Fontanelle Size in Healthy Indian Late Preterm and Full Term Newborns

Objective

To measure the size of the anterior fontanelle (AF) in healthy late-preterm and term newborns and correlate it with birth weight, gestational age, gender, occipito-frontal circumference, small for gestational age status and birth weight z-score.

Methods

This was an observational study carried out from October 2013 through April 2015 at a tertiary care hospital. Newborns?≥?34 wk gestation were enrolled. Fontanelle edge was palpated with index finger and size calculated by adding anterior-posterior and transverse diameters and dividing by two.

Results

A total of 1010 neonates were enrolled. The mean AF size was 2.23?±?0.52 cm (mean?±?SD). There was a significant decrease in the size of the AF with advancing gestational maturity on one-way ANOVA (F?=?31.30) (P?<?0.001) and also by increasing birth weight (F?=?20.34) (P?<?0.001). There was no significant difference in the mean AF size between males; 2.21?±?0.54 cm and females; 2.25?±?0.55 cm (mean?±?SD) (P?=?0.575). There was a strong correlation between AF size with increasing birth weight; correlation (r)?=?0.985. In small for gestational age neonates the AF was larger, 2.27?±?0.55 (mean?±?SD) and a strong correlation between birth weight z-score and AF size was noted (r?=?1.012).

Conclusions

The mean AF size in late-preterm and term Indian newborns in a mixed community hospital was 2.23?±?0.52. A strong correlation was found between AF size with increasing birth weight and with birth weight z-score in small for gestational age babies.

     

Diaphragmatic paralysis among very low birth weight infants following ligation for patent ductus arteriosus

Management of diaphragmatic paralysis (DP) among newborn infants remains controversial, especially for very low birth weight (VLBW) infants following ligation for patent ductus arteriosus (PDA). This study aimed to characterize the impact of DP after PDA ligation among VLBW infants. Clinical characteristics of DP cases treated with either diaphragmatic plication or conservative methods were described as well. The medical records of VLBW infants who underwent PDA ligation in Chang Gung Memorial Hospital between January 2000 and December 2011 were retrospectively reviewed, and DP was suspected if postligation chest X-rays showed an elevation of the left diaphragm as confirmed by a chest ultrasonograph. For each DP case, three other infants that received PDA ligation with proximate birth dates and who were closely matched in terms of gestational age (±1?week) and birth weight (±10?%) were selected as the control group. A total of eight preterm infants were diagnosed as having DP and 24 infants were selected as the control group. The affected infants usually presented with respiratory distress and extubation failure. The study demonstrated that, among our patient population, DP was associated with a significantly longer duration of ventilator dependency (56.1?±?16.0 vs. 29.8?±?17.7?days, p?=?0.001) and a higher incidence of severe bronchopulmonary dysplasia (87.5 vs. 23?%, p?=?0.002). For selective infants with DP-related ventilatory failure after PDA ligation, surgical plication may facilitate extubation. Diaphragmatic paralysis should be evaluated carefully among VLBW infants receiving PDA ligation because of its adverse impact on ventilator dependency and correlation to a higher incidence of severe bronchopulmonary dysplasia.     

The Association Between Vitamin D Status and Recurrent Wheezing

Objective

To investigate association between vitamin D status and recurrent wheezing in infants.

Methods

Thirty infants with recurrent wheezing and 45 healthy, similar aged infants without any history of acute or chronic illness were included in the study. The clinical features of infants were recorded and serum 25-hydroxyvitamin D [25(OH)D] levels were measured. Data analysis was performed using SPSS 13 package program.

Results

The mean value of 25 (OH) D vitamin levels were 22.1?±?8.9 IU/L and 18.8?±?11 IU/L for the control and recurrent attack group respectively. Seventy-three percent of subjects with recurrent wheezing had vitamin D levels in the deficient range (<20 ng/ml) and 48.9 % had vitamin D levels under?<?20 ng/ml in the control group. The percentage of insufficient vitamin D levels (<30 ng/ml) were 90 and 77.8 for the patient and control group respectively. Eight patients had extremely deficient vitamin D (<10 ng/ml) levels. There was no statistical significance between the groups in terms of the distribution of 25 (OH)D level.

Conclusions

The present study did not demonstrate significant association between vitamin D status and recurrent wheezing in the infants.     

Non-fluoroscopic percutaneous transcatheter closure of atrial septal defects in children under transesophageal echocardiographic guidance

Background

This study sought to investigate the feasibility, safety and effectiveness of transcatheter closure of atrial septal defects (ASDs) under the guidance of transesophageal echocardiography (TEE) in children.

Methods

We reviewed the medical records of patients who underwent percutaneous ASD closure at our center from August 2016 to December 2017. For a total of 88 patients who were identified as having a single-hole defect and were undergoing percutaneous transcatheter ASD closure, a procedure completely guided by TEE was performed. There were 31 male patients and 57 female patients. The patients’ mean age was 60.09?±?36.42 months (13–182 months), and their mean body weight was 20.16?±?10.04 kg (9–77 kg). Patients were followed up by performing transthoracic echocardiography and obtaining chest X-rays and electrocardiograms.

Results

The transcatheter closure of ASDs was successful in all patients. The mean ASD size was 11.58?±?5.31 mm (3–28 mm), and the mean size of the occlusion device was 16.07?±?5.29 mm (6–36 mm). The mean procedural times were 13.33?±?2.82 minutes (6–16 minutes). The mean hospitalization costs were 27,259.66?±?2507.04 RMB (25,200.00–33,911.45 RMB). The mean postoperative hospital stay was 3.22?±?0.53 days (3–5 days). Residual shunt, occlusion device shedding or displacement, and pericardial effusion were not observed during or after the operation.

Conclusion

Percutaneous transcatheter ASD closure completely guided by TEE is a feasible, safe, non-invasive and easy procedure.

     

Oxygen Saturation Immediately after Birth in Infants Delivered in Tertiary Care Hospital in India

Objective

To study the sequential changes in SpO₂ values in newborns delivered in a teaching hospital in India.

Methods

Full-term infants born by normal vaginal delivery to registered mothers at KLE University Hospital, Belgaum with birth weight more than 2,500 g, no congenital anomalies and who had received only routine care at birth were included in the study. After delivery, newborn infants were placed on a resuscitation trolley under a radiant warmer; the oxygen saturation sensor was attached (Nellcor DURA-Y multisite oxygen sensor) and then connected to the monitor (Planet 55 multiparameter recorder).

Results

The mean (SD) gestational age of infants included in the study was 38.8 (1.1) wk and birth weight was 2,800 (300) g. The median (IQR) oxygen saturation level (SpO₂) at 2 min of age was 69 % (68 %–79 %). The median level of SpO₂ at 90 % and 95 % saturation was attained at 6.5 min and at 11 min of life, respectively.

Conclusions

Infants delivered in resource poor facilities of developing countries take 11 min to reach 95 % saturations after birth but they are within the reference range values of Neonatal Resuscitation Program 2010 guidelines.     

Evaluation of the impact of organ-specific dose reduction on image quality in pediatric chest computed tomography

Background

Organ-specific dose reduction significantly reduces the radiation exposure of radiosensitive organs.

Objective

The purpose of this study was to assess the impact of a novel organ-specific dose reduction algorithm on image quality of pediatric chest CT.

Materials and methods

We included 28 children (mean age 10.9?±?4.8 years, range 3–18 years) who had contrast-enhanced chest CT on a 128-row scanner. CT was performed at 100 kV using automated tube current modulation and a novel organ-specific dose-reduction algorithm (XCare?; Siemens, Forchheim, Germany). Seven children had a previous chest CT performed on a 64-row scanner at 100 kV without organ-specific dose reduction. Subjective image quality was assessed using a five-point scale (1-not diagnostic; 5-excellent). Contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were assessed in the descending aorta.

Results

Overall mean subjective image quality was 4.1?±?0.6. In the subgroup of the seven children examined both with and without organ-specific dose reduction, subjective image quality was comparable (score 4.4?±?0.5 with organ-specific dose reduction vs. 4.4?±?0.7 without it; P?>?0.05). There was no significant difference in mean signal-to-noise ratio and contrast-to-noise ratio with organ-specific dose reduction (38.3?±?10.1 and 28.5?±?8.7, respectively) and without the reduction (35.5?±?8.5 and 26.5?±?7.8, respectively) (P?>?0.05). Volume computed tomography dose index (CTDI_vol) and size-specific dose estimates did not differ significantly between acquisitions with the organ-specific dose reduction (1.7?±?0.8 mGy) and without the reduction (1.7?±?0.8 mGy) (P?>?0.05).

Conclusion

Organ-specific dose reduction does not have an impact on image quality of pediatric chest CT and can therefore be used in clinical practice to reduce radiation dose of radiosensitive organs such as breast and thyroid gland.     

Outcomes of laparoscopic nissen fundoplications in children younger than 2-years: single institution experience

Background

Variation exists in the diagnostic testing for gastroesophageal reflux (GER) in infants and in the application of surgical therapy. There has been an increase in antireflux surgery (ARS) since the development of laparoscopy but the outcomes in high-risk infants is unclear. This study examines the results of laparoscopic fundoplication in infants less than 2 years.

Methods

The results of infants less than 2 years undergoing laparoscopic Nissen fundoplication (Lap-F) from 2012 to 2015 were retrospectively reviewed and outcomes were followed until 2017.

Results

There were 106 patients, median gestational age 32.50 weeks?±?6.35 SD and non-corrected age at operation 23.0 weeks?±?19.0 SD, mean weight of 4.81 kg?±?2.10 SD. One of the most common reasons for surgical consultation was improvement in respiratory status after insertion of nasoduodenal feeding tube. Of the Lap-F, 100 were with gastrostomy tube (GT). There were no conversions to open or intraoperative complications. The complication rate was 4.71%, and the reoperation rate was 5.66%, one fundoplication revision and the others gastrostomy revisions. The median time for feeds and to reach goal were 1 (1–14) and 4 (2–279) days, respectively. The 30-day mortality was 0.9% and long-term it was 4.71%. The long-term mortality was related to the underlying medical problems. The median follow-up was 113 (3–286) weeks. One patient required revision of the fundoplication and none required esophageal dilatation during the follow-up period.

Conclusion

Fundoplication is effective for relief of symptoms of GER in children younger than 2 years. The procedure has a low morbidity and mortality in this population.

     

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.

     

Cardiac Function After the Immediate Transitional Period in Very Preterm Infants Using Speckle Tracking Analysis

Background

The postnatal period in preterm infants involves multiple physiologic changes starting directly after birth and continuing for days or weeks. To recognize and treat compromise, it is important to measure cardiovascular function. We used a novel technique (speckle tracking echocardiography, STE) to measure cardiac function in this period.

Methods

We obtained cardiac ultrasound images at day 3, 7, 14, 21 and 28 in preterm infants <30-week gestation. Conventional measures included cardiac size, left ventricular stroke volume, atrial volume and the patent ductus arteriosus (PDA). Four chamber images were analyzed with STE, which provided parameters of left ventricular volume, longitudinal deformation and myocardial velocities.

Results

Images of 54 infants (gestational age 23–29 weeks) were analyzed. STE-derived stroke volume correlated well with conventional echocardiography-derived stroke volume, but agreement was suboptimal. Most STE parameters showed good reliability. All volume parameters and systolic and atrial velocities increased over time. Cardiac deformation and early diastolic velocity did not change. A PDA was associated with 33 % increased stroke volume at day 3 up to 98 % at day 28 with a spherically enlarged heart and increased filling pressure.

Conclusion

Speckle tracking echocardiography analysis is a feasible and reliable technique that can simultaneously obtain systolic and diastolic volumes, longitudinal deformation and myocardial velocities from one ultrasound window. Preterm hearts maintain cardiac function well during the first weeks of life, even with increased preload as a consequence of a PDA.