Risk factors for severe RSV-induced lower respiratory tract infection over four consecutive epidemics

Variability in severity among different respiratory syncytial virus (RSV) seasons may influence hospital admission rates for RSV-induced lower respiratory tract infection (LRTI) in young children. The aim of the present study was to identify through logistic regression analysis, risk factors associated with higher likelihood to acquire RSV-induced LRTI, in children with symptoms severe enough to lead to hospital admission. Over four consecutive RSV seasons (2000–2004), records from children <4 years of age admitted for RSV-induced LRTI (“cases”) were compared with those from children with LRTI not due to RSV and not requiring hospitalization (“controls”). 145 “case-patients” and 295 “control-patients” were evaluated. Independent from the severity of the four epidemic seasons, seven predictors for hospitalization for RSV infection were found in the bivariate analysis: number of children in the family, chronological age at the onset of RSV season, birth weight and gestational age, birth order, daycare attendance, previous RSV infections. In the logistic regression analysis, only three predictors were detected: chronological age at the beginning of RSV season [aOR = 8.46; 95% CI:3.09–23.18]; birth weight category [aOR = 7.70; 95% CI:1.29–45.91]; birth order (aOR = 1.92; 95% CI:1.21–3.06). Conclusions: Independent from the RSV seasonality, specific host/environmental factors can be used to identify children at greatest risk for hospitalization for RSV infection.     

Relationship between clinical sinusitis symptoms and sinus CT severity in pediatric post bone marrow transplant and immunocompetent patients

Since typical inflammatory responses may be diminished in children following bone marrow transplant (BMT), computed tomography (CT) imaging of the sinuses has been increasingly ordered to diagnose sinusitis in this group. The objective of this study was to determine the association between clinical sinusitis symptoms and sinus opacification on CT scans in post BMT versus immunocompetent children. Our sample was comprised of 64 post BMT and 86 immunocompetent children with sinus CT scans. CT sinus opacification was scored using the modified Lund–Mackay staging system. The relationship between clinical sinusitis symptoms (rhinorrhea, nasal congestion, cough, headache, and facial pain) and opacification was compared for the two groups. The severity of sinus opacification in the BMT group was significantly higher compared to the immunocompetent group. In combined patient groups the odds ratio (OR) for moderate/severe sinusitis was significantly elevated for rhinorrhea (OR = 3.00; 95% confidence interval [CI], 1.27–7.12), cough (OR = 2.80; 95% CI, 1.22–6.42), and having either rhinorrhea, nasal congestion, or cough (OR = 4.76; 95% CI, 1.71–13.24). While the immunocompetent group had a greater number of sinusitis symptoms compared to the post BMT group, both groups had a significant increase in the severity on CT with increasing number of symptoms. Conclusion: In post BMT patients, our data demonstrated higher odds of moderate/severe sinusitis on CT scans associated with rhinorrhea, cough or nasal congestion. These finding suggest that in post BMT children, detailed sinus history may still play a vital role in the diagnosis of sinusitis.     

Frequency and clinical correlates of radiographic patterns of bronchopulmonary dysplasia in very low birth weight infants by term age

Our aim was to study the frequency and clinical correlates of two radiographic patterns of bronchopulmonary dysplasia (BPD), the cystic BPD (cBPD) and the leaky lung syndrome (LLS). Radiographic findings of BPD from sixth day of life until term in a cohort of 82 very low birth weight (VLBW) infants were evaluated and scored independently by a neonatologist and a paediatric radiologist. Data on prenatal factors and events during the first hospitalisation were collected prospectively. Forty-four (53.7%) infants showed radiographic evidence of BPD, 19 (23.2%) cBPD and 25 (30.5%) LLS. In multivariate analysis, the best predictors for radiographic BPD were oxygen dependency at 28 days (odds ratio (OR) 10.2 [95% confidence interval (CI) 2.49–41.4]), more than 2 days on ventilator (OR 10.4 [95% CI 1.8–61.5]) and volume expanders in the first 2 h (OR 7.36 [95% CI 1.32–41.2]). During the first week of life, infants with radiographic BPD received less energy per kilogram (p < 0.001) and more daily fluids per kilogram of body weight (p = 0.013). Sixty-two percent of the infants with radiographic BPD were not oxygen dependent at 36 weeks postmenstrual age (PMA). Seventeen (89.5%) of the 19 infants who needed oxygen supplementation at 36 weeks PMA also had abnormal chest X-rays. Conclusions: Radiographic BPD findings appeared to be common in VLBW infants. In addition to the well-known respiratory risk factors (oxygen and ventilator therapy), poor nutrition and excessive fluid administration in early life seem to be significantly associated with radiological findings of lung injury in these patients.     

Characteristics of pediatric patients with enterovirus meningitis and no cerebral fluid pleocytosis

Human non-polio enterovirus (EV) is the most important cause of aseptic meningitis in children. Only a few studies report the lack of cerobrospinal fluid (CSF) pleocytosis in children with confirmed EV meningitis; however, the characteristics of these children have not been well defined. This paper describes the clinical and laboratory features of EV meningitis in children with no CSF pleocytosis. Clinical, laboratory, and virological data of Dutch patients <16 years diagnosed with EV meningitis, between 2003 and 2008, were analyzed retrospectively. Data of children with and without CSF pleocytosis were compared. A total of 149 children were infected with EV. Patients presented mainly with fever (n = 113), malaise (n = 43), abdominal pain (n = 47), and irritability (n = 61). Of the 60 patients with EV meningitis, 23 had no pleocytosis. Those who lacked CSF pleocytosis were younger [odds ratio (OR) 1.00; 95% confidence interval (CI) 1.000–1.002; p = 0.001], had experienced drowsiness more (OR 9.60; 95% CI 2.24–41.15; p = 0.002), had lower white blood cell counts (OR 0.73; 95% CI 0.61–0.89; p = 0.001), and had higher C-reactive protein (OR 1.13; 95% CI 1.03–1.23; p = 0.006) than those with pleocytosis. Conclusion. These findings show that EV meningitis occurs in the absence of CSF pleocytosis, particularly in young infants, meaning that EV meningitis in this age group cannot be solely excluded by the absence of CSF pleocytosis. They also confirm the importance of genome detection in the diagnosis of EV meningitis in young infants.     

Respiratory hospitalizations and respiratory syncytial virus prophylaxis in special populations

Palivizumab utilization, compliance, and outcomes were examined in infants with preexisting medical diseases within the Canadian Registry Database (CARESS) to aid in developing guidelines for potential “at-risk” infants in the future. Infants who received ≥1 dose of palivizumab during the 2006–2010 respiratory syncytial virus (RSV) seasons at 29 sites were recruited and utilization, compliance, and outcomes related to respiratory infection/illness (RI) events were collected monthly. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for premature infants ≤35 completed weeks gestational age (GA) who met standard approval criteria (group 1) compared to those with medical disorders (group 2) using Cox proportional hazards regression models with adjustment for potential confounding factors. Of 7,339 registry infants, 4,880 were in group 1 and 952 in group 2, which included those with Down syndrome (20.3%), upper airway anomalies (18.7%), pulmonary diseases (13.3%), and cystic fibrosis (12.3%). Group 2 were older at enrolment (10.2 ± 9.2 vs. 3.5 ± 3.1 months, p < 0.0005), had higher GA (35.9 ± 6.0 vs. 31.0 ± 5.4 weeks, p < 0.0005), and were less compliant with treatment intervals (69.4% vs. 72.6%, p = 0.048). A greater proportion of group 2 infants were hospitalized for RI (9.0% vs. 4.2%, p < 0.0005) and RSV (2.4% vs. 1.3%, p = 0.003) (unadjusted). Being in group 2 was associated with an increased risk of RI (HR = 2.0, 95%CI 1.5–2.5, p < 0.0005), but not RSV hospitalization (HR = 1.6, 95%CI 0.9–2.8, p = 0.106). In infants receiving palivizumab, those with underlying medical disorders, though not currently approved for prophylaxis, are at higher risk for RI events compared with preterm infants. However, risk of RSV hospitalizations is similar.     

Attention-deficit hyperactivity disorder in children chronically exposed to high level of vehicular pollution

The purpose of this study is to explore whether sustained exposure to vehicular air pollution affects the behavior and activities of children. The prevalence of attention-deficit hyperactivity disorder (ADHD) was assessed in two childhood populations. In a cross-sectional study 969 school-going children (9–17 years) and 850 age- and sex-matched children from rural areas were assessed, following the criteria of Diagnostic and Statistical Manual of conduct disorders (DSM-IV) of American Pediatric Association. Data of ambient particulate matter with a diameter of less than 10 μm (PM₁₀) were obtained from Central Pollution Control Board and aerosol monitor. ADHD was found in 11.0% of urban children in contrast to 2.7% of the control group (p < 0.001). Major risk factors were male gender, lower socioeconomic status, 12–14 year age group, and PM₁₀ level in breathing air. ADHD was more prevalent among boys both in urban and rural areas. It was prevalent among 18.0% of the boys enrolled in Delhi against 4.0% of the girls, giving a male/female ratio of 4.5:1. Inattentive type of ADHD was predominant followed by hyperactive–impulsive type and combined type of ADHD. Controlling potential confounder, ambient PM₁₀ level was positively correlated with ADHD (OR = 2.07; 95% CI, 1.08–3.99). Conclusion: The results of this study point to a possible association between air pollution and behavioral problems in children. Though gender, socioeconomic status, and age play a very important factor in ADHD prevalence, the association is highest and strongest between particulate pollution and prevalence of ADHD.     

Age‐specific risk factors for child anaemia in Myanmar: Analysis from the Demographic and Health Survey 2015–2016

Anaemia is prevalent among preschool‐aged children in Myanmar, but few epidemiological studies of anaemia at the national level were reported. Using data from the Myanmar Demographic and Health Survey 2015–2016, we examined risk factors for anaemia at household, maternal, and individual levels for children aged 6–23 months (n = 1,133) and 24–59 months (n = 2,393) separately. Survey design and sampling weights were adjusted for in multivariate regression analyses. The prevalence of anaemia was 77.2% in children aged 6–23 months and 50.8% in those aged 24–59 months. Living in geographic zones other than the hilly zone was associated with a higher odds of anaemia in both age groups (OR = 1.86–2.51 [95% lower limit > 1.0]). Maternal anaemia predicted child anaemia in a dose–response manner in both groups (6–23 months of age, OR = 2.01, 95% CI [1.38, 2.92; mild] and OR = 2.41, 95% CI [1.12, 5.19; moderate]; and 24–59 months of age, OR = 1.42, 95% CI [1.12, 1.81; mild] and OR = 2.92, 95% CI [1.91,4.46; moderate]). A maternal age of 14–24 years (ref: 25–34 years, OR = 1.67, 95% CI [1.06, 2.64]) and maternal tolerant attitude to domestic violence (OR = 1.61, 95% CI [1.13, 2.31]) predicted anaemia in children aged 6–23 months only. Younger child age (OR = 0.97, 95% CI [0.96, 0.98]), stunting (OR = 1.35, 95% CI [1.08, 1.69]) and using unimproved drinking water sources (OR = 1.38, 95% CI [1.10, 1.75]) were associated with anaemia in children aged 24–59 months. Consideration of age‐specific risks factors for child anaemia will help in planning anaemia control programmes in Myanmar.     

Life Satisfaction and Peer Victimization Among USA Public High School Adolescents

This study explored associations between peer victimization experiences and adolescents’ perceptions of life satisfaction. Public high school students (n = 1,325) completed a self-report questionnaire measuring being bullied and life satisfaction. Multiple logistic regression analyses were conducted to examine the relationships between being bullied and perceived life satisfaction across four race and gender groups. Results indicated that significant associations (p ≤ .05) were established for reduced life satisfaction and being bullied over the past 12 months due to religion for whites and black males (OR = 3.18–4.84); victimization due to gender for black males and white females (OR = 3.07–4.52); victimization for race/ethnicity for whites and black females (OR = 2.46–3.88); victimization for sexual orientation for males (OR = 3.42–4.51) and victimization for a disability for all four race/gender groups (OR = 2.92–7.35). Results suggest that perceived life satisfaction is related to a variety of differentially motivated victimization experiences, but not uniformly across race and gender groups. Implications for the delivery of race- and gender- specific prevention interventions are discussed.     

Total serum bilirubin levels during the first 2 days of life and subsequent neonatal morbidity in very low birth weight infants: a retrospective review

To determine the relationship between total serum bilirubin (TSB) during the first 2 days of life and subsequent neonatal morbidity in very low birth weight (VLBW, less than 1500 g) infants. We performed a prospective study of 582 VLBW infants born between July 1, 2005 and December 31, 2009. TSB was measured in umbilical cord blood (UCB), at 24 and 48 h after birth. Demographic and clinical characteristics of infants in hospital were recorded. The interaction between TSB variables during the first 48 h of life and subsequent neonatal morbidity were assessed in logistic regression analyses adjusted for multiple risk factors. It was found that TSB in UCB was in a negative correlation with occurrence of respiratory distress syndrome (RDS) [OR 0.626, 95% confidence interval (95% CI): 0.446–0.879, p = 0.007], and there was also a negative correlation between TSB in UCB and occurrence of intraventricular hemorrhage (IVH) [OR 0.695, 95% CI 0.826–0.981, p = 0.020]. However, TSB in UCB positively correlated with hyperbilirubinemia [OR 2.471, 95% CI 1.326–3.551, p = 0.012], and TSB at 24 h after birth was also in a positive correlation with early onset sepsis (EOS) [OR 1.299, 95% CI 1.067–1.582, p = 0.011]. VLBW infants with low TSB levels in UCB were more likely to develop RDS and IVH, and those with low TSB levels in UCB were less likely to develop hyperbilirubinemia. Infants with high TSB levels at 24 h after birth were more likely to develop EOS. The protective effect of raised TSB in UCB with respect to RDS and IVH warrants further investigation.     

The moulded baby syndrome: incidence and risk factors regarding 1,001 neonates

Postural deformities are frequent in neonates. The moulded baby syndrome (MBS) comprises one or more of the following disorders: plagiocephaly, torticollis, congenital scoliosis, pelvic obliquity, adduction contracture of a hip and/or malpositions of the knees or feet. We analysed the incidence of MBS in healthy neonates and identified the risk factors of its composing elements. One thousand and one healthy neonates were examined on the second or third day of life by the same paediatrician. Familial, obstetrical, perinatal history and putative risk factors for postural deformities were collected. Families of newborns with a torticollis or plagiocephaly were given positioning advice and the outcome was evaluated by a phone survey 2 months later. MBS was detected in 107 neonates (10.7%): 97 plagiocephalies or torticollis, 25 congenital scoliosis or pelvic obliquities, and 13 malpositions of the knees or feet. We identified risk factors related to the mother (age: OR = 1.39, parity: OR = 0.643), to the obstetrical history (preterm labour: OR = 1.65, oligoamnios: OR = 10.179, breech presentation: OR = 2.746, pregnancy toxaemia: OR = 3.773, instrumental delivery: OR = 6.028) and to the newborn (male gender: OR = 1.982, birth length: OR = 1.196). The initial plagiocephaly or torticollis improved in 77% of infants after 2 months of stimulation and positioning measures. Paediatricians should be alert regarding the frequent but subtle MBS postural deformities and give positioning advice to the parents. A neonate of male gender or greater birth length, with an older primiparous mother, a history of preterm labour, oligoamnios or pregnancy toxaemia, a breech presentation or an assisted delivery is more likely to have MBS.     

Thalassemia and iron deficiency in a group of northeast Thai school children: relationship to the occurrence of anemia

The cross-sectional study assessed anemia, thalassemia, and hemoglobinopathies, as well as iron deficiency, among 190 northeastern Thai school children aged 10 to 11 years. The aim was to analyze the reasons for anemia among the group. Hemoglobin concentration and other hematological parameters were determined using an automated blood cell counter. Beta-thalassemia and other hemoglobinopathies were identified by high performance liquid chromatography (HPLC) analysis of hemoglobin. Alpha-thalassemia was identified by polymerase chain reaction (PCR) and related techniques. Iron deficiency was assessed using serum ferritin (SF) <20 ng/ml as indicator. Based on the WHO criteria, anemia was defined by hemoglobin (Hb) level <11.5 g/dl. Twenty five out of 190 children (13.2%; 95% CI = 8.7–18.8%) were anemic. Iron deficiency was found in only two out of 190 children (1.0%; 95% CI = 0.1–3.8%), but the two iron deficient children were not anemic. The proportion of thalassemia and hemoglobinopathies among the group was 61.1% (95% CI = 53.7–68.0%). As underlying reasons for anemia, thalassemia and hemoglobinopathies were found in 22 out of 25 (88.0%) anemic children. Beta-thalassemia and homozygous Hb E seem to be important, while this was less obvious for heterozygous α-thalassemia and heterozygous Hb E. Conclusion: The results suggest that thalassemia and hemoglobinopathies may be major contributing factors to the occurrence of anemia in this area among the children’s population.     

Follow-up outcomes of pediatric patients who underwent surgical resection for lipoblastomas or lipoblastomatosis: a single-institution experience with a systematic review and meta-analysis

The objective of this study was to examine the long-term outcomes of pediatric patients who underwent surgical resection for lipoblastoma and lipoblastomatosis (LB/LBM). A single-center retrospective study of pediatric patients with LB/LBMs seen between 1991 and 2015 was conducted. A systematic review, including studies published prior to late August 2018, was performed. Using a random effect meta-analysis, pooled weighted proportions and unadjusted odds ratios (OR) with 95% confidence intervals (CI) were calculated. The retrospective study included 16 patients, while the systematic review included 19 published studies consisting of 381 patients. Among 329 (82%) patients with follow-up information, the pooled recurrence rate was 16.8% (95% CI 10.9–23.5%; I2 = 59%). The reported time to recurrence ranged from < 1 to 8 years. Recurrence risk was greater for incomplete (n = 34) than complete resection (n = 150): OR 11.4 (95% CI 3.0–43.6; I2 = 43%). LBMs (n = 35) had a greater recurrence risk than LBs (n = 116): OR 5.5 (95% CI 1.9–15.9; I2 = 0%). Recurrences were higher for studies with approximately ≥ 3 years of follow-up versus studies with < 3 years of follow-up. Recurrences are more likely to occur with LBMs and/or incomplete resection. Follow-up beyond 3–5 years should be considered given that the recurrence risk appears to be greater in the long-term.     

Estimated intake levels of methylmercury in children, childbearing age and pregnant women in a Mediterranean region, Murcia, Spain

Methylmercury (MeHg) is a bioaccumulable toxin in the trophic chain and a powerful neurotoxin during fetal and child development. Consumption of contaminated fish and shellfish is a principal environmental source of MeHg exposure. This study was designed to assess the Hg and estimated MeHg intake in vulnerable groups of the Murcia region, a Mediterranean part of Spain, compared with international regulations. A validated food frequency questionnaire was used to assess seafood consumptions in 320 children younger than 10 years, 301 women of childbearing age, and 537 pregnant women. Hg concentrations were measured in the most consumed fish products by cold vapor generation–atomic fluorescence spectrometry. The weekly intake of MeHg (μg/kg bw/week) was 2.60 (95% CI = 2.10–3.10) in children 1–5 years, 2.65 (95% CI = 2.26–3.03) in children 6–10 years, 0.98 (95% CI = 0.89–1.07) in women of childbearing age, and 0.88 (95% CI = 0.81–0.95) in pregnant women. The main exposure to MeHg, especially in young children, is related to intake of bluefin tuna and swordfish. Fifty-four percent of children aged 1–10 years, 10% of pregnant women, and 15% of women of childbearing age exceed the Joint Expert Committee on Food Additives provisional tolerable weekly intake of MeHg. In the Murcia region, where fish is a central component of the diet, the focus should be on educating vulnerable populations to reorient fish consumption in order to lower the amount of Hg incorporated with the diet as well as to reduce Hg emissions into the environment.     

Relationship between symptoms of attention-deficit/hyperactivity disorder and family functioning: a community-based study

This study examined the relationship between family functioning and attention-deficit/hyperactivity disorder (ADHD) symptoms in an Australian community-based sample. Children were screened for ADHD in their second year of formal schooling. Two hundred and two (202) primary caregivers completed validated measures of family quality of life (QoL), parent mental health, parenting styles and parental relationship quality. Compared with controls, parents of children screening positive for ADHD reported poorer family QoL in the domains of emotional impact (mean difference [MD] −20.1; 95% CI −38.2 to −1.9, p = 0.03) and impact on family activities (MD −17.2; 95% CI −27.9 to −6.5, p = 0.002), less parental warmth (MD −3.4; 95% CI −6.0 to −0.9, p = 0.01) and higher parental depression (MD 6.8; 95% CI 1.8 to 11.7, p = 0.009) and anxiety (MD 6.2; 95% CI 1.7 to 10.6, p = 0.008) after adjusting for socio-demographic characteristics and child conduct symptoms. Parents of children screening positive for ADHD reported higher stress (MD 4.5; 95% CI 1.2 to 7.1, p = 0.007) and more inconsistent (MD 3.0; 95% CI 1.2 to 4.8, p = 0.002) and hostile (MD = 2.2; 95% CI 1.0 to 3.4, p = 0.001) parenting after adjusting for socio-demographic factors only. No difference in parental relationship quality and parental inductive reasoning was identified. Conclusion: These findings suggest a strong association between poor family functioning and ADHD symptoms and carry implications for comprehensive ADHD management and the importance of seeing the child within the family context.     

QT interval prolongation and risk for cardiac events in genotyped LQTS-index children

Congenital long-QT syndrome (LQTS) is an inherited cardiac disorder with a disturbance in repolarization characterized by a prolonged QT interval on the surface electrocardiogram and life-threatening ventricular tachycardia. Publications from the International LQTS Registry have provided information that the cardiac risk may be influenced by gender, genotype, exposure to arrhythmia triggers, and previous cardiac events. In children, early-onset of disease, changes in life style, and medical treatment is a sensitive issue and significant, gender-related differences of a first life-threatening event were reported. Thus, we investigated the clinical features of a large genotyped population of LQTS-index children (age ≤16 years) upon a single-center experience and determined risk factors for symptoms. Of 83 children [mean corrected QT interval (QTc) 510 ± 74 ms], 89% had LQT1, -2, or -3. Nine patients (11%) were identified as having Jervell and Lange-Nielsen syndrome. Among symptomatic children (n = 51, 61%), syncope was the most prevalent symptom at initial presentation (49%); however, aborted cardiac arrest (ACA) occurred in 33% and sudden cardiac death (SCD) in 18%, respectively, as the initial manifestation. During a mean follow-up period of 5.9 ± 4.7 years, 31% of the children developed symptoms while on therapy (86% syncope, 9% ACA, 5% SCD). Statistical analyses of risk factors for cardiac events showed that the QTc >500 ms was a strong and significant predictor for cardiac events during follow-up (p = 0.02). Furthermore, a prior syncope [hazard ratio (HR), 4.05; 95% confidence interval (CI), 1.1 to 15.0; p = 0.03] or an ACA (HR, 11.7; 95% CI, 3.1 to 43.4; p = <0.001) identified children with an increased risk for recurrent cardiac events compared to asymptomatic LQT children. LQTS-index children manifest with a high percentage of severe symptoms. Among presently validated risk factors for LQTS, a QTc interval >500 ms and a history of prior syncope or ACA were strong predictors for recurrent cardiac events.     

Cerebral palsy among children of immigrants in Denmark and the role of socioeconomic status

BackgroundChildren of immigrants in Denmark have excess risk for some of the most well-established risk factors for cerebral palsy (CP).ObjectivesTo study differences in risk of CP between children of immigrants and children of Danish-born mothers, and explore whether socioeconomic status drives any potential association.MethodsA register-based cohort study including 1,274,616 children born in Denmark between 1981 and 2007. Of these, 2807 had a validated CP diagnosis in the Danish CP Register. We estimated the risk of CP as odds ratios (OR) using logistic regression and assessed mediation through socioeconomic status using natural effect models.ResultsIn children of Danish-born mothers, 2.2/1000 had CP overall and the prevalence was similar for children of immigrants. However, children of immigrants had lower risk of unilateral spastic CP than children of Danish native-born mothers; OR = 0.59 (95% CI:0.38–0.91) for Western and OR = 0.79 (95% CI:0.61–1.03) for Non-Western immigrants. By contrast, the risk of bilateral spastic CP was higher in children of Non-Western immigrants (OR = 1.27 (95% CI:1.05–1.53)), especially from Turkey and Pakistan compared with children of Danish native-born mothers. The mediation analysis revealed an indirect effect (through maternal educational level and household income) with an OR of 1.06 (95% CI:0.99–1.14) for children of Non-Western immigrants.ConclusionsWhile children of immigrants had lower risk of unilateral spastic CP than children of Danish-born mothers, the risk of bilateral spastic CP was increased in children of Non-Western immigrants. Socioeconomic status did not appear to be a significant contributor to the increased risk of bilateral spastic CP.     

Molecular and clinical characteristics of adenoviral infections in Taiwanese children in 2004–2005

This study clinically and molecularly characterizes an adenovirus epidemic that broke out in Taiwan in April 2004. Clinical data on 325 children diagnosed with acute illness were collected between April 2004 and April 2005, and a diagnosis of adenovirus was confirmed by viral isolation. Polymerase chain reaction and restriction fragment length polymorphism were used to identify the adenovirus genotypes in 267 patients. There was a seasonal variation, with a peak incidence between November 2004 and January 2005 (p < 0.001). The median age was 52 months, range 1–210 months. Most cases (90.8%) were younger than 7 years old. Male-to-female ratio was 1.56:1. The most common clinical diagnosis was exudative tonsillitis (50.8%), followed by bronchitis/bronchiolitis (29.9%), conjunctivitis or pharyngoconjunctival fever (22.5%), and acute otitis media (16.3%). Adenovirus type 3 was found in 215 patients (80.5%). The other 52 patients had other genotypes: type 2 (10.1%), type 1 (6.0%), type 5 (1.9%), type 7 (0.7%), type 4 (0.4%), and type 6 (0.4%). Patients with type 3 were significantly older [age >52 months, adjusted odds ratio (OR) 8.55, 95% confidence interval (CI) 1.84–40, p = 0.006), their family members had a higher incidence of illness (adjusted OR 8.77, 95% CI 1.55–50, p = 0.01), they coughed (adjusted OR 6.37, 95% CI 1.54–26.3, p = 0.01), and they had a higher C-reactive protein (CRP) level (>2.87 mg/dL, adjusted OR 3.64, 95% CI 1.06–12.3, p = 0.04) than the 52 cases with other genotypes. In conclusion, this adenovirus outbreak, from late autumn to winter, was predominately caused by adenovirus type 3. Patients with this genotype were significantly older, had a higher incidence of cough and family transmission, and had higher CRP levels than those with other genotypes.     

Clinical and diagnostic relevance of Meckel’s diverticulum in children

Meckel’s diverticulum (MD) has varied clinical manifestations and is a diagnostic challenge for pediatricians. This study investigates the clinical and diagnostic characteristics of MD in children with different presentations. We retrospectively reviewed the medical records of pediatric patients diagnosed with MD from 1988 to 2008. The data including the age, sex, clinical features, laboratory data, sensitivity of diagnostic methods, and pathological finding were recorded. These patients were classified into three groups: diverticulitis, intestinal obstruction, and intestinal bleeding. A total of 47 children (35 boys and 12 girls) with a median age of 5.6 years were enrolled and categorized as follows: diverticulitis (n = 12), obstruction (n = 12), bleeding (n = 21), and two diagnosed incidentally. Patients with intestinal obstruction were significantly younger than those with bleeding (3.7, 95% CI, 1.6–5.7 vs. 6.6, 95% CI, 4.5-8.7, P = 0.04). In the obstruction group, intussusception was found in eight of 12 patients, of whom 62.5% were aged older than 3 years. Heterotopic tissues were found in 46.3% of surgical specimens and more frequently existed in patients with bleeding than those with diverticulitis (P = 0.02) and obstruction (P = 0.047). Tc-99m scans yielded a diagnostic sensitivity of about 65% in bleeding patients. Repeated Tc-99m scans and red blood cell (RBC) scans can be good supplementary tools in Tc-99m scan-negative bleeding patients. In conclusion, manifestations of childhood MD are variable and may depend on the presence of heterotopic tissues and the patients’ age. Tc-99m scans supplemented with RBC scans are appropriate to diagnose childhood MD with bleeding.     

Maternal migraine and risk of pediatric cancers

Background

Maternal migraine has been linked to adverse birth outcomes including low birth weight and preterm birth, as well as congenital anomalies in offspring. It has been speculated that this may be due to the use of medications in pregnancy, but lifestyle, genetic, hormonal, and neurochemical factors could also play a role. There is evidence for varying cancer incidences among adults with migraine. Here, we utilized data from national registries in Denmark to examine associations between maternal diagnoses of migraine and risk for cancer in offspring.

Methods

We linked several national registries in Denmark to identify cases from the Cancer Registry among children less than 20 years (diagnoses 1996–2016) and controls from the Central Population Register, matched to cases by birth year and sex (25:1 matching rate). Migraine diagnoses were identified from the National Patient Register using International Classification of Diseases, versions 8 and 10 codes and migraine-specific acute or prophylactic treatment recorded in the National Pharmaceutical Register. We used logistic regression to estimate the risk of childhood cancers associated with maternal migraine.

Results

Maternal migraine was positively associated with risk for non-Hodgkin lymphoma (odds ratio [OR] = 1.70, 95% confidence interval [CI]: 1.01–2.86), central nervous system tumors ([OR = 1.31, 95% CI: 1.02–1.68], particularly glioma [OR = 1.64, 95% CI: 1.12–2.40]), neuroblastoma (OR = 1.75, 95% CI: 1.00–3.08), and osteosarcoma (OR = 2.60, 95% CI: 1.18–5.76).

Conclusions

Associations with maternal migraine were observed for several childhood cancers, including neuronal tumors. Our findings raise questions about the role of lifestyle factors, sex hormones, genetic, and neurochemical factors in the relationship between migraine and childhood cancers.