Is late-preterm birth a risk factor for hypertension in childhood?

Late-preterm birth is associated with higher rates of neonatal morbidity and mortality and higher health care utilization, but its impact on later life is not well known. In this study, we aimed to evaluate whether late-preterm birth affects blood pressure, renal function, and urinary protein excretion in children later in life. Sixty-five children aged 4 to 13 years born as late-preterm and 65 age- and sex-matched children born full term were evaluated with 24-h ambulatory blood pressure monitoring (ABPM), urinary microalbumin excretion (UAE), and glomerular filtration rate (GFR). All subjects underwent ABPM prospectively. For each gender, daytime, nighttime, and 24-h systolic and diastolic and mean blood pressures (SBP, DBP, and MAP) were transformed to standard deviation scores (SDS). Blood pressure profiles (SBP DBP, and MAP) were considered abnormal when the corresponding SDS values exceeded 1.63. Urinary microalbumin excretion was expressed as milligrams per day, and the value between 30 and 300 mg/day was defined as microalbuminuria (MA). There was no significant difference in the mean GFR and MA levels between late-preterm and term children. 24-h systolic BP SDS, daytime systolic BP SDS, nighttime systolic BP SDS, 24-h diastolic BP SDS, nighttime diastolic BP SDS, 24-h MAP BP SDS, daytime MAP BP SDS, and nighttime MAP BP SDS were found to be significantly higher in late-preterm children compared to term children. Conclusion: We conclude that late-preterm children have higher BP levels, so those children should be followed up carefully by the pediatrician regarding probable hypertension in their future life.     

Is there a relationship between childhood Helicobacter pylori infection and iron deficiency anemia?

An association between Helicobacter pylori infection and iron deficiency anemia has been reported in children, and it has been proposed that H. pylori infection needs to be eradicated to treat absolutely iron deficiency anemia (IDA). We investigated whether there was any correlation between H. pylori infection and iron deficiency (ID) and IDA in children, and whether the eradication of H. pylori infection without iron treatment would lead to the resolution of ID. Hemoglobin and ferritin levels, H. pylori stool antigen test and (14)C urea breath test were measured in 140 children aged 6--16 years (median 9.5 years). Children with H. pylori infection were divided into three groups on the basis of hemoglobin, mean corpuscular volume (MCV), and serum ferritin levels: groups of IDA, ID, and control. All the children received anti-H. pylori combination therapy consisting of amoxicillin, clarithromycin, and lansoprazole. Hemoglobin and MCV values rose significantly compared with baseline values after H. pylori eradication without iron supplementation in children with IDA (p=0.002 and p=0.003, respectively). Ferritin values increased significantly after H. pylori eradication in children with ID (p<0.001). We conclude that complete recovery of ID and IDA can be achieved with H. pylori eradication without iron supplementation in children with H. pylori infection.     

Primary gastric Burkitt lymphoma in childhood: associated with Helicobacter pylori?

BACKGROUND: This retrospective study was designed to estimate the incidence of primary gastric non-Hodgkin lymphoma (NHL) in childhood and the possible association with Helicobacter pylori (H. pylori). PROCEDURE: We reviewed and analyzed the charts of 135 patients with NHL that were diagnosed and treated in a single oncology unit during the last 20 years. RESULTS: Only two patients, 5 and 12 years old, with primary gastric NHL were found. Upper gastroduodenal endoscopy detected an ulcer in the lesser curvature of the body of the stomach, in both cases. Endoscopy revealed a moderate chronic gastritis in the antrum of both patients that was H. pylori associated in one of them who also suffered from chronic gastritis. Biopsy specimens demonstrated infiltration by Burkitt lymphoma (BL). The two patients received chemotherapy for 6 months. Additionally, one of the two patients received a triple therapy regimen with bismuth, amoxicillin, and metronidazole for H. pylori. Fifteen and six years later they are in complete remission, free of symptoms. CONCLUSIONS: Primary gastric NHL in childhood is rare. It was found in fewer than 2% of our NHL patients. The temporal relationship between the H. pylori infection and BL suggest a causative link between these two events.     

Is Helicobacter pylori infection associated with Henoch-Schonlein purpura in Chinese children? a meta-analysis

Background

The prevalence of Helicobacter pylori (H. pylori) infection is high in China. It not only causes the damage of gastric epithelium, but also plays a potential pathogenic role in several extraintestinal diseases. Henoch-Schonlein purpura (HSP) is one of the most common vasculitis syndromes affecting children. Although its cause is unclear, HSP is often considered to be associated with infectious agents. This metaanalysis of previously published studies was conducted using a predefined protocol to evaluate the underlying association between H. pylori infection and HSP in Chinese children.

Methods

Predefined search strategy and inclusion criteria were set up to select studies reporting the prevalence of H. pylori infection among HSP children and control groups. Included studies were subjected to quality assessment and data extraction by two independent reviewers. The pooled odds ratio (OR) was calculated as the effect size via both traditional and cumulative meta-analysis. Heterogeneity was investigated by subgroup analysis, and the nonparametric ??trim and fill?? method was performed to adjust the overall estimate for the existence of publication bias.

Results

Ten eligible studies covering 749 HSP children and 560 controls were included for metaanalysis. Observational epidemiology studies clearly aimed at detecting the potential association between H. pylori infection and HSP with retrospective data collection from the children enrolled consecutively. Overall, 49.27% (369/749) of HSP children had evidence of H. pylori infection compared with 23.39% (131/560) of children in the control group. The pooled OR of H. pylori infection in HSP children (10 studies with 749 HSP children) was 3.80 [95% confidence interval (CI): 2.54?C5.68, P<0.001], and the overall estimate from the cumulative meta-analysis confirmed the association with more narrow confidence interval (OR=3.35, 95% CI: 2.95?C3.81). In HSP children mainly with abdominal manifestations (8 studies with 337 HSP children), the pooled OR was 4.62 (95% CI: 2.66?C8.01, P<0.001). The adjusted pooled OR was 2.04 (95% CI: 1.48?C2.82, P<0.001), determined by the nonparametric ??trim-andfill?? method for eliminating the effect of publication bias. H. pylori eradication therapy (4 studies with 266 HSP children) was capable of reducing the recurrence of HSP (RR=0.38, 95% CI: 0.25?C0.58, P<0.001). Although the subgroup analysis for heterogeneity suggested that diagnostic methods and geographical diversity might be account for the heterogeneity, statistical analysis of differences revealed no differences between subgroups, indicating their limited impact on the overall estimates.

Conclusions

These results suggest the necessity of screening H. pylori infection in HSP children, particularly in those with gastrointestinal manifestations in China. Eradication therapy may reduce the recurrence of HSP in children with H. pylori infection. However, further mechanistic and more clinical studies in different populations and regions are needed to confirm this association and the effect of eradication of H. pylori in HSP children.     

Is there a relationship between Helicobacter pylori infection and erosive reflux disease in children?

Aim:  The aim of this study was to investigate the relationship between Helicobacter pylori infection and erosive reflux disease in children.
Methods:  A total of 206 children [mean age 8.4 ± 4.9 (0.16–18) years] who underwent diagnostic upper endoscopy were tested for H. pylori infection between 2002 and 2005 and the relationship between H. pylori infection and gastro-oesophageal reflux disease was investigated retrospectively. Endoscopic and histopathological findings were examined retrospectively. When reflux-related oesophageal damage was identified as a result of the histological examination of endoscopic biopsy samples collected from distal oesophagus, the patients were diagnosed with gastro-oesophageal reflux disease and divided into two groups: those with macroscopic erosions or ulceration constituted the erosive oesophagitis group; those without constituted the non-erosive reflux disease group.
Results:  Prevalence of H. pylori infection was 31.3% in the patients with gastro-oesophageal reflux disease and 36.7% in the control group (p > 0.05). Prevalence of erosive oesophagitis was found to be 23.8% in the patients with H. pylori infection and 41.3% in those without (p > 0.05).
Conclusion:  No negative significant association was found between the prevalence of H. pylori infection and erosive oesophagitis. Presence of H. pylori infection did not influence the severity of oesophagitis either.     

Is surgery a risk factor for separation anxiety in children?

Objective

Postoperative anxiety symptoms are distressing for both family and child. The aim of this study was to examine the prevalence of postoperative anxiety symptoms in children.

Methods

60 children aged 6–12 undergoing surgery were included in the study group. The study group was assessed three times in terms of separation anxiety disorder (SAD), at the time of presentation, 1 and 3 months postoperatively. A personal information form and the SAD section of the K-SADS-PL on the basis of DSM-IV diagnostic criteria for screening SAD symptoms were used.

Results

Study group consisted of 19 girls (31.7%) and 41 boys (68.3%) (mean age 8.9?±?2.3). Four (6.6%) of the cases at the time of presentation and 13 (21.6%) in the study group met SAD diagnostic criteria in 1 month and 21 (35.0%) in 3 months. Anxiety disorder symptoms were significantly higher in the study group at 3 months postoperatively (p?<?0.05). There is significant correlation between both SAD symptoms and duration of hospitalization. There was also a positive correlation between duration of hospitalization and parental education and SAD symptoms.

Conclusion

Greater SAD was observed in children undergoing surgical procedures. It will be useful to physicians to consider SAD after surgery in pediatric patients especially when the level of parental education and duration of hospitalization increase. Since SAD may persist long after surgery, it may cause constant fear in personality disorders and lead to psychological problems by significantly lowering quality of life.

     

Can pre-neoplastic lesions be detected in gastric biopsies of children with Helicobacter pylori infection?

BACKGROUND: Active gastritis, gastric mucosal atrophy and intestinal metaplasia are lesions associated with Helicobacter pylori infection. Atrophy and intestinal metaplasia are only seen in adults. OBJECTIVES: We describe pediatric patients with atrophy and metaplasia, and compare the inflammatory response in these patients to controls. METHODS: As part of a multicenter study of pediatric H. pylori infection, gastric biopsy specimens obtained during diagnostic upper endoscopy of 19 H. pylori-infected children and 45 uninfected controls were reviewed and graded by using the updated Sydney system. The inflammatory response was characterized using immunohistochemistry for T lymphocytes, B lymphocytes, and macrophages, and TUNEL assay for apoptosis. RESULTS: Histology of H. pylori-infected and control biopsy specimens showed active gastritis in 32% and 2% respectively (P = 0.002). Mild intestinal metaplasia was found in 4 H. pylori-infected children, in two of whom it appeared to be accompanied by atrophy. Specimens from patients with H. pylori infection contained increased numbers of B lymphocytes in lymphoid nodules, and apoptosis in the superficial epithelium and inflammatory cells. T lymphocytes and macrophages appeared in similar numbers in specimens from controls and infected patients. CONCLUSIONS: We describe intestinal metaplasia associated with H. pylori infection in children. Since atrophy usually precedes intestinal metaplasia in adults, we suggest that atrophy exists in children. High numbers of B lymphocytes and apoptosis in the surface epithelium are seen in patients with H. pylori infection and may be related to the development of atrophy and intestinal metaplasia.     

Is preschool language impairment a risk factor for dyslexia in adolescence?

The literacy skills of 56 school leavers from the Bishop and Edmundson (1987) cohort of preschoolers with specific language impairment (SLI) were assessed at 15 years. The SLI group performed worse on tests of reading, spelling, and reading comprehension than age-matched controls and the literacy outcomes were particularly poor for those with Performance IQ less than 100. The rate of specific reading retardation in the SLI group had increased between the ages of 8 1/2 and 15 years and there had been a substantial drop in reading accuracy, relative to age. However, over 35% had reading skills within the normal range and those who had had isolated impairments of expressive phonology had a particularly good outcome. Our findings highlight the limitations of discrepancy definitions of dyslexia that do not take account of the changing demands of reading over time. We argue that children's phonological difficulties place them at risk of literacy failure at the outset of reading and that later, impairments of other language skills compromise development to adult levels of fluency.     

Bronchiolitis in young infants: is it a risk factor for recurrent wheezing in childhood?

Background

Acute bronchiolitis in infancy is considered a risk factor for recurrent wheezing episodes in childhood. The present study assessed prevalence, clinical manifestations and risk factors for recurrent wheezing events during the first 3 years of life and persistent wheezing events beyond this age in children hospitalized as young infants with acute bronchiolitis.

Methods

Two groups of children aged 6 years were included. The study group comprised 150 children with a history of hospitalization for bronchiolitis, with the first event at <6 months of age. The control group comprised 66 age- and sex-matched children with no history of bronchiolitis before 6 months of age. Children in both groups had been followed until 6 years of age by their pediatricians; data were obtained retrospectively by reviewing ambulatory records during children’s visits in pediatricians’ clinics. The data included epidemiological parameters, prevalence, age at onset, number of and treatments given for episodes of wheezing events prior to 6 years of age, pathogens detected, and severity of acute bronchiolitis in the study group.

Results

Overall, 58% and 27% of children in the study and control groups, respectively (P=0.001) had recurrent wheezing episodes prior to the age of 3 years. Children in the study group had earlier onset of recurrent wheezing, had more episodes of wheezing, and required more bronchodilator and systemic steroids treatments compared to the control group.

Conclusion

Hospitalization within the first six months of life for acute bronchiolitis is an independent risk factor for recurrent wheezing episodes during the first 3 years of life.

     

Treatment regimens for Helicobacter pylori infection in children: is in vitro susceptibility testing helpful?

BACKGROUND: Treatment regimens for Helicobacter pylori have variable success rates, and data comparing effectiveness with respect to strain sensitivity are relatively scarce. OBJECTIVE: To evaluate the efficacy of two treatment regimens for eradication of H. pylori and the impact of bacterial susceptibility testing. STUDY DESIGN: 265 children endoscopically diagnosed with H. pylori infection were randomly assigned to receive omeprazole + amoxicillin with clarithromycin or omeprazole + amoxicillin with metronidazole. Bacterial culture and susceptibility was performed in a subgroup. Eradication was assessed by C-urea breath test. RESULTS: Eradication was achieved in 73.4% by omeprazole + amoxicillin with metronidazole and in 62.6% by omeprazole + amoxicillin with clarithromycin (P = 0.078). H. pylori was cultured successfully in 105 patients. Resistance to metronidazole was detected in 31.4% of the isolates and resistance to clarithromycin in 15%. Eradication rate by omeprazole + amoxicillin with metronidazole for metronidazole-susceptible bacteria (N = 38) was 90%, and for resistant bacteria (N = 19) it was 42%. Only 75% of clarithromycin-sensitive strains were successfully treated by omeprazole + amoxicillin with clarithromycin, and none of the cases with clarithromycin-resistant strains responded to omeprazole + amoxicillin with clarithromycin treatment. CONCLUSION: There is a trend of greater efficacy of eradication with omeprazole + amoxicillin with metronidazole versus omeprazole + amoxicillin with clarithromycin therapy. Although resistance negatively influences eradication, first-line sensitivity-based treatment would be expected to improve this rate only slightly. Susceptibility testing should probably be reserved only for treatment failures.     

Is adolescent pregnancy a risk factor for low birth weight?

OBJECTIVE: This paper was designed to study the pregnancy in adolescence as a risk factor for low birth weight.METHODOLOGY: A case-control study was designed, including 354 mothers whose babies' weight was less than 2.5 kg and another group of the same size, with babies of 3.0 kg or more. All deliveries took place at Maternidade de Campinas, and all mothers were interviewed and compared. Besides mother's age, other variables that could offer risk of low birth weight were also evaluated. A multiple logistic regression analysis was applied, to control possible influences of these variables.RESULTS: Adolescents accounted for 22.9% of the mothers whose babies had low birth weight. The risk of low birth weight among this group (OR=0.72; 95%IC=0.45-1.14; p=0.16) was not considered greater when compared with that of mothers between 20 and 34 years old (before and after correction for income, marital status, educational level, race, previous pregnancies, prenatal assistance, exposure to smoking and caffeine, arterial hypertension, weight prior to pregnancy and employment). Complementary analysis showed that pregnancy in adolescence is a protection factor against intrauterine growth retardation (OR=0.24; 95%IC =0.10-0.56; p= 0.001).CONCLUSION: In this population, pregnancy in adolescence did not represent a greater risk for occurrence of low birth weight, when others factors like psychosocial, pre-gestational risks, smoking and poor prenatal care were controlled for.     

Childhood Helicobacter pylori infection and growth impairment in developing countries: a vicious cycle?

We hypothesize that infection with the gastric pathogen Helicobacter pylori in children in developing countries is the initiator of a vicious cycle of events that result ultimately in malnutrition and growth impairment. Acute infection with H. pylori is accompanied by hypochlorhydria, which facilitates the acquisition of other enteropathogens because of removal of the gastric acid barrier, which then results in diarrheal disease and iron-deficiency anemia. This is likely to occur most frequently in developing regions where the prevalence of H. pylori infection is disproportionately high and multiple enteric coinfections are common. The consequent synergistic impact of diarrheal disease and micronutrient deficiency on growth and cognitive function in children has significant public health implications for socioeconomic development in these countries.