Methylphenidattherapie bei epilepsiekranken Kindern

Background

The efficacy and safety of methylphenidate (MPH) in children with epilepsy and attention deficit disorder (ADHS) were evaluated because MPH is thought to be associated with seizure aggravation.

Patients and methods

The patient collective included 65 children, 50 with epilepsy and 15 with pathological symptoms in the electroencephalogram (EEG) and/or occasional convulsions. The average age was 9.3 years. In a double blind standardized trial the patients received MPH (high against low dose) versus placebo over a period of 5 weeks. Before and during the study Conners’ rating scale, a questionnaire for teachers, pencil and paper test, alertness and go/no go tests from the TAP (transl. test battery for attention testing) were performed as well as a weekly EEG and evaluation of seizures.

Results

In children with epilepsy a significant improvement of attention and impulsivity was found with MPH (76?% of cases). Children with an IQ <?70 had a benefit in 63?%, the EEG and seizure frequency did not deteriorate and in two cases the EEG was improved.

Conclusions

Treatment with MPH in children with epilepsy and ADHS was found to be safe and effective and could improve attention and impulsivity in 76?% of treated patients without having deleterious effects on epilepsy and EEGs.     

Rachitis- und Kariesprophylaxe in der Praxis

Background

In Germany the recommended intake of vitamin D to prevent rickets is 10?C12.5???g (400?C500?IE)/day in the first year of life. To prevent caries 0.25?C0.5?mg of fluoride/day is recommended in the first 4 years of life. The aim of this study was to examine to what extent these recommendations are realized in German children aged 10?C36 months.

Method

The 7-day estimated dietary records of 530 children from the German Representative Study of Toddler Alimentation (GRETA) were analyzed in terms of intake of nutrient preparations. The percentage of children receiving vitamin D and/or fluoride and the dosages were evaluated.

Results

In total 42% of the children received nutrient preparations and 96% of these received vitamin D and/or fluoride. Of the infants in the age group 10?C11 months 6% received vitamin D and fluoride as recommended. After the first year of life the percentage of toddlers receiving vitamin D and fluoride declined abruptly.

Conclusion

In practice parents should be made aware of the importance of rickets and caries prophylaxis in the first year of life. After the first year of life there also should be an anamnesis of vitamin D intake and synthesis by the skin due to UV radiation as well as fluoride intake.     

Topiramate and Propranolol for Prophylaxis of Migraine

Objective

To compare efficacy and safety of topiramate (TPM) and propranolol for migraine prophylaxis in children.

Methods

In a parallel single-blinded randomized clinical trial, 5–15 y-old referred migraineurs to Pediatric Neurology Clinic of Shahid Sadoughi Medical Sciences University, Yazd, Iran from May through October 2011, were evaluated. Patients were distributed into two groups, 50 of whom were treated with 3 mg/kg/d of topiramate (TPM) and another group of 50, were treated with 1 mg/kg of propranolol for 3 mo. Primary endpoints were efficacy in reduction of monthly frequency, severity, duration and headache related disability. Secondary outcome was clinical side effects.

Results

Fifty two girls and 48 boys with mean age of 10.34?±?2.31 y were evaluated. Monthly frequency, severity and duration of headache decreased with TPM, from 13.88?±?8.4 to 4.13?±?2.26 attacks, from 6.32?±?1.93 to 2.8?±?2.12, and from 2.36?±?1.72 to 0.56?±?0.5 h, respectively. Monthly frequency, severity and duration of headache also decreased with propranolol from 16.2?±?6.74 to 8.8?±?4.55 attacks, from 6.1?±?1.54 to 4.8?±?1.6 and from 2.26?±?1.26 to 1.35?±?1.08 h, respectively. Pediatric Migraine Disability Assessment score reduced from 31.88?±?9.72 to 9.26?±?7.21 with TPM and from 33.08?±?8.98 to 23.64?±?9.88 with propranolol. Transient mild side effects were seen in 18 % of TPM and in 10 % of propranolol (P?=?0.249) groups.

Conclusions

Topiramate is more effective than propranolol for pediatric migraine prophylaxis.     

Comparative short term efficacy and tolerability of methylphenidate and atomoxetine in attention deficit hyperactivity disorder

Objective

To compare the short term efficacy and tolerability of methylphenidate and atomoxetine in children with Attention deficit hyperactivity disorder (ADHD).

Design

Open label randomized parallel group clinical trial.

Setting

Child Guidance Clinic of a tertiary care hospital of Northern India from October 2010 to June 2012.

Participants

69 patients (age 6–14 y) with a diagnosis of ADHD receiving methylphenidate or atomoxetine.

Intervention

Methylphenidate (0.2–1 mg/kg/d) or atomoxetine (0.5–1.2 mg/kg/d) for eight weeks.

Main outcome measures

Treatment response (>25% change in baseline Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS); Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS); Clinical Global Impression Severity Scale (CGI-S) at eight weeks and adverse effects.

Results

Treatment response was observed in 90.7% patients from methylphenidate group and 86.2% patients of atomoxetine group at an average dose of 0.45 mg/kg/d and 0.61 mg/kg/d, respectively. The patients showed comparable improvement on VADPRS (P=0.500), VADTRS (P=0.264) and CGI-S (P=0.997). Weight loss was significantly higher in methylphenidate group (?0.57±0.78 kg; P=0.001), and heart rate increase was observed at higher rate in atomoxetine group (7± 9 bpm; P=0.021).

Conclusion

Methylphenidate and atomoxetine are efficacious in Indian children with ADHD at lesser doses than previously used. Their efficacy and tolerability are comparable.

Trial Registration No.

CTRI/2011/08/001981     

Hypertonic (3%) saline Vs 0.9% saline nebulization for acute viral bronchiolitis: A randomized controlled trial

Objective

To compare the length of hospital stay (primary) and improvement in clinical severity scores (secondary) among children with bronchiolitis nebulized with 3 % hypertonic saline or 0.9% saline.

Design

Randomized double blind controlled trial.

Setting

Tertiary care teaching hospital.

Patients

Hospitalized children (1–24 months) with acute bronchiolitis of moderate severity.

Intervention

Nebulization of 4 ml of 3% hypertonic saline or 4 mL of 0.9% saline, along with 2.5 mg salbutamol, at 4-hourly intervals till the patient was ready for discharge.

Results

Baseline characteristics were similar in two groups. Median clinical severity score at admission was 6 (IQR-1) in both the groups. Clinical severity scores monitored afterwards 12-hourly till discharge (132 h) did not show statistically significant differences in 3% and 0.9% saline groups. Mean length of hospital stay (time to reach predefined clinical severity score<3) was 63.93 ± 22.43 h in 3% saline group and 63.51 ± 21.27 h in 0.9% saline group (P=0.878). No adverse events were reported by the parents, caregivers or treating medical attendants in both groups.

Conclusion

Nebulized 3 % saline is not superior to 0.9% saline in infants with clinically diagnosed acute bronchiolitis.     

Krefelder Bauchschmerztag

Background

Chronic abdominal pain (CAP) in childhood is very common. A successful therapy presupposes the understanding of causes, pathophysiology and psychological effects on CAP. Not many families are willing to participate in time-consuming training or therapeutic programs.

Aim

A therapeutic approach which is neither too time-consuming nor involves too many personnel should be offered for all children aged 8 years and older with CAP and the parents as an early intervention directly following diagnosis.

Material and methods

A single day training was designed for children and their parents (Krefeld abdominal pain day) as an intervention following diagnosis. Within a pilot study 79 families took part during the observation period and 71 could be interviewed by telephone 6–12 months after participation.

Results

The training day was considered helpful by 60 (85?%) participating families and 45 (63?%) had no need for further clinical diagnostics or medical consultation.

Conclusion

A clear diagnosis and classification according to the Rome III criteria, an explanation of the causes of functional abdominal pain and the influence of mental stress can lead to acceptance of the diagnosis for many families. The training day could be helpful in this aspect with an acceptable level of expenditure.     

Rehabilitation behinderter Kinder und deren Eltern mit Stepping Stones Triple P

Background

Besides acquisition of characteristics of outcome quality in ascertaining the effectiveness of treatment, the question arises how the outcome quality is perceived subjectively by affected persons. Until now, studies for parent training or therapies that focus on rehabilitation of children and adolescents with disabilities have been lacking. Within the evaluation of the parent training Stepping Stones Triple P, the study presented here addresses subjective outcome quality, its relation to objective parameters of therapeutic success, as well as predictors of subjectively experienced therapy success.

Participants

Participants were parents (n=71) of children and adolescents (20 female) with disabilities or developmental disorders and comorbid behavioral problems aged between 2 and 20.5 years.

Method

The correlation between subjective and objective parameters of outcome was conducted with stepwise regression analyses.

Results

The results show a high subjectively perceived outcome quality and significant correlations with objective improvements. Important predictors in the regression models are self-esteem of the disabled child (stand.?beta?=?0.472?C0.932) and reduction of depressive parental symptoms (stand.?beta?=?0.369?C0.855).

Conclusions

In particular, positive changes in parental sense of competence and already exiguous alterations in child behavior seem to be important for therapy success from the point of view of parents.     

Challenges in defining the rates of ADHD diagnosis and treatment: trends over the last decade

Background

There is a global trend of large increases in the prevalence and incidence of Attention Deficit Hyperactivity Disorder (ADHD). This study aimed to address potential causes of these major changes.

Methods

The authors used a large cohort to analyze data employing patients’ electronic medical records, with physicians’ diagnosis of ADHD, including records of medication purchases.

Results

The prevalence of ADHD diagnoses rose twofold from 6.8% to 14.4% between 2005 and 2014 (p <?0.001), while the ratio of males to females with ADHD decreased from 2.94 in 2005 to 1.86 in 2014 (p <?0.001). The incidence increased, peaking in 2011 before declining in 2014. ADHD medication usage by children and adolescents was 3.57% in 2005 and 8.51% by 2014 (p <?0.001).

Conclusions

We report a dramatic increase in the rate of ADHD diagnoses. One of the leading factors to which we attribute this increase is the physicians’ and parents’ changed attitude towards diagnosing attention/hyperactivity problems, with more parents appear to consider ADHD diagnosis and treatment as a means to improve their child’s academic achievements, commonly with the aid of medications. This change in attitude may also be associated with the dramatic increase in female ADHD diagnosis prevalence.

     

Propranolol Treatment of Complicated Hemangiomas

Objectives

To evaluate laboratory and radiological features of hemangiomas in childhood in addition to efficacy and safety of propranolol as a first-line treatment of complicated hemangiomas retrospectively.

Methods

The files of 60 patients who were diagnosed as capillary hemangioma were evaluated retrospectively. Fourteen children with complicated hemangiomas treated with propranolol were analysed, in terms of side effects, efficacy and duration of treatment.

Results

These fourteen patients (23 %) were treated with propranolol because of ulcerated, infected and/or deep seated localisations. The duration of treatment with propranolol were between 3 and 12 mo (median: 6 mo). Bronchospasm was observed in one patient during treatment. Except for two patients, all of them responded to propranolol treatment with limited side effects.

Conclusions

The present results support that propranolol is safe and effective treatment choice for complicated infantile hemangiomas, because of minimal side effects and encouraging response rates (80 %). In addition, the authors suggest that routine cranial radiological imagings might not be necessary for hemangiomas without any neurological symptoms.     

Color of Meconium and Interleukin-6

Objective

To test the hypothesis that the color of meconial fluid is associated with inflammatory biomarkers, by determining C-reactive protein (CRP) and Interleukin-6 (IL-6) in serum from the umbilical cord.

Methods

In this prospective study, the authors selected 30 newborns with meconium-stained amniotic fluid (MSAF): 14 with green/brown 656 R color and 16 with brown/cinnamon 654 R color, and 20 newborns which showed clear amniotic fluid without MSAF (non-MSAF); all newborns were from mothers without risk factors for neonatal sepsis.

Results

IL-6 concentration from umbilical cord blood, [median of 12.9?pg/mL (interquartile range {IQR} 8.7?C31.0)] of MSAF-green/brown 656 R increased significantly (p?<?0.05) when compared with IL-6 concentration, [median of 9.2?pg/mL (IQR 7.2?C12.2)] of newborns with clear amniotic fluid and without meconium. CRP from MSAF-green/brown 656 R was median of 0.5?mg/mL (IQR 0.0?C2.7), and median of 1.0?mg/mL (IQR 0.0?C5.5) from clear amniotic fluid, without meconium.

Conclusions

Significant association was found between MSAF-green/brown 656 R and increase in IL-6, with normal CRP values.     

Gesundheitszustand nach p?diatrischer Rehabilitation

Background

This article deals with the question of improvement in health status experienced by children and adolescents with chronic illnesses, such as obesity, bronchial asthma, atopic eczema and attention deficit hyperactivity disorder (ADHD)/behavior disorder, after inpatient medical rehabilitation.

Methods

Data were collected from 3,495 children and adolescents. Various endpoints were measured at the beginning of rehabilitation and after rehabilitation (e.g. quality of life, illness-related self-management and parameters of body structure and bodily function).

Results

The effects after rehabilitation varied depending on the diagnosis and endpoint. For obesity the clearest effects were achieved uniformly across all endpoints. For asthma the effects for self-management and for atopic eczema for skin condition were especially clear. For ADHD the effects were generally only slight but in some sub-groups there were moderate effects regarding quality of life.

Conclusions

The inpatient medical rehabilitation of children and adolescents generally achieved noticeable effects for endpoints for which there is clear impairment requiring treatment.     

A case–control study of risk factors for severe hand–foot–mouth disease among children in Ningbo, China, 2010–2011

Background

A small fraction of hand–foot–mouth disease (HFMD) progression from the onset of severity to fatality may be remarkably rapid. Early recognition of children at risk of severity is critical to increase treatment effectiveness and reduce acute mortality.

Methods

A frequency-matched case–control study was conducted between January 2010 and June 2011 in Ningbo to identify risk factors associated with the occurrence of severity in children with HFMD. Data including demographic characteristics, clinical features, and laboratory test results were collected by trained interviewers through retrospective medical record review and/or face-to-face interviews with children’s parents using a standardized questionnaire.

Results

Eighty-nine cases with severe HFMD and 267 controls with mild HFMD were recruited in this study. Palm rashes (OR?=?0.004, 95%CI?=?0.000–0.039, p?p?p?=?0.030), leg trembling (OR?=?29.008, 95%CI?=?1.535–548.178, p?=?0.025), papule rash (OR?=?4.622, 95%CI?=?1.110–19.252, p?=?0.035), a raised WBC count?>?10.8?×?10⁹/L (OR?=?4.495, 95%CI?=?1.311–15.415, p?=?0.017), and human enterovirus 71 infection (OR?=?39.172, 95%CI?=?9.803–156.522, p?Conclusion Clinicians should pay increased attention to children diagnosed as HFMD with the independent risk factors above.     

Prevalence of Parent-Rated Attention Deficit Hyperactivity Disorder and Associated Parent-Related Factors in Primary School Children of Navi Mumbai—A School Based Study

Objectives

To study the prevalence of parent-rated attention deficit hyperactivity disorder and associated parent-related factors in primary school children of Navi Mumbai.

Methods

One hundred twenty two children including both boys and girls aged between 6 y and 11 y were selected from a school at Navi Mumbai and their parents were given the National Innovative for Children’s Healthcare Quality (NICHQ) Vanderbilt Assessment Scale to be filled and returned, which was subsequently analyzed using SPSS (version 16).

Results

The prevalence of attention deficit hyperactivity disorder was 12.3 % with boy to girl ratio of 3:2. It was more prevalent in nuclear type of family and in families where a single parent was working especially where the father was the sole breadwinner and doing semi-skilled or unskilled type of work. No significant relation was found between the numbers of work-related hours when parents were away from children and attention deficit hyperactivity disorder.

Conclusions

Attention deficit hyperactivity disorder is prevalent in the primary school-going population of Navi Mumbai, especially in boys. The increased prevalence in nuclear families and families with single working parent should further be explored. Further studies with larger sample size and longer period of follow up may be recommended. The study also recommends screening of school children for symptoms of attention deficit hyperactivity disorder (ADHD) for early diagnosis and treatment.     

Laparoscopy-assisted surgery for neonatal intestinal atresia and stenosis: a report of 35 cases

Purpose

Jejunal?Cileal atresias are the most common causes of intestinal occlusion in neonatal period. Treatment is classically performed by a right upper quadrant transverse laparotomy. Our study aimed to present our initial experience of intestinal atresia in newborn treated with laparoscopic assisted approach.

Methods

Overall 35 small intestinal atresias, which occurred in infants from September 2009 to July 2012 in our hospital, were treated by laparoscopy-assisted procedure. After carefully inspecting through laparoscope by a multi-port or single-site approach, these were definitely diagnosed. The anastomosis of intestinal atresia was manually performed after exteriorization of the bowel via the umbilical port site incision.

Results

There were no conversions to an open procedure and no intraoperative various complications. The incision of umbilical port was about 2?C2.5?cm. The post-operative course was uneventful.

Conclusion

Laparoscopy-assisted procedure could be safely accomplished in neonates with intestinal atresia. Comparing to open surgery, parents were extremely satisfied with the cosmetic results. The early experience suggests that the outcomes are excellent.     

Fatty liver disease and hypertransaminasemia hiding the association of clinically silent Duchenne muscular dystrophy and hereditary fructose intolerance

Background

Vaccination coverage rates against pandemic flu were far below those required by Italian Public Health Authorities. The aim of this retrospective study was to assess how the management of vaccination against pandemic flu in the Health District of Piacenza (Northern Italy) had conditioned the adherence of patients at risk to the H1N1flu immunization program.

Methods

From a population of 27.018 children aged between 6?months and 16?years, 2361 pediatric patients considered at risk according to the guidelines of the Ministry of Health were enrolled to receive pandemic flu vaccination. Children enrolled in the immunization program were vaccinated with one of the following three options:

1. by their pediatrician in his office after contacting him directly or by phone
2. by their pediatrician in his office or in a public Health District office with the assistance of a nurse after an appointment had been booked by patient??s parents using a dedicated free of charge phone number
3. by a doctor of the public Health District after an appointment had been booked as for option B

Results

The best outcomes of population vaccination coverage for pandemic flu were achieved when patients were vaccinated with option B (44.2%). For options A and C rates coverage results were 22.8% (OR 2,69) and 24.9% (OR 2, 39) respectively.

Conclusion

The results of this study may be taken into account by the public health Authorities when planning the management of future immunization campaigns out of the usual vaccination schedule or in an emergency event.     

Nebenwirkungen einer Methylphenidat-Therapie bei Schulkindern

Objective. Methylphenidate is an effective drug to treat developmental attention deficits.The frequency of side effects of methylphenidate is evaluated.We search factors, which are combined with a higher risk for side effects. Patients and methods. In a retrospective cohorten-study 73 parents were asked to completed the Barkley Side Effect Rating Scale.Additionally the emotional comorbidity was documented with Child Behavior Checklist.The children about age of 9 years were interviewed by means of standardized questionnaires about their body complaints (Giessener Beschwerdefragebogen) and personality traits like neuroticism und extraversion (Hamburger Neurotizismus- und Extraversionsskala).Data about neuropsychological impairements and motor behavior were documented retrospective.Data of 57 children (78%) could be enrolled for the study. Results. Appetite suppression (62%), proneness to crying (44%) and headache (42%) are so most reported side effects of a therapy with methylphenidate.Adverse effects are not correlated with daydoses,age, the severity of body complaints and the high of neuroticism and extraversion.The children with more side effects showed more emotional comorbidity. Conclusion. The application of methylphenidate in therapy of attention deficit disorder and the interpretation of side effects of methylphenidate is a multimodale task.     

Radiologische Befundqualit?t bei Verdacht auf Kindesmisshandlung

Background

The quality of radiological primary diagnostics in suspected child abuse was assessed

Patients and methods

All radiological documents in cases of suspected child abuse from July 2007 to October 2009 were subjected to an independent second analysis by 2 pediatric radiologists concerning image quality, completeness according to present guidelines and diagnosis.

Results

A total of 28 cases, aged between 6 weeks and 2 years (mean 5.8 months, median 3.5 months, 11 females and 17 males) from clinics in Rhineland-Palatinate (n=25) and Hesse (n=3) were included.

Image quality was generally sufficient to good.

In 17 cases (>?60%) irritating superimposed artefacts could be seen.

In 6 boys no gonadal shielding was used for pelvic X-rays.

In 17 cases (>?60%) the documentation of the skeleton was incomplete and 1 whole body film was presented.

In 15 cases (>?50%) the number of fractures had to be corrected: in 3 patients the number of fractures had to be reduced by 1?C5, in 13 cases 1?C4 fractures were initially missed, in one case the number had to be reduced as well as increased. The interpretation of both pediatric radiologists was concordant in 100%.

In 17 cases (>?60%) the second opinion had an effect on the legal proceedings.

Conclusion

There is an obvious deficit in the radiologic diagnostics of fractures in children. Urgent attention has to be paid to this matter.     

Telefontriage in der Pädiatrie

Background

Would a nationwide telephone triage and advice program (TTA) help save costs in Germany without endangering the current quality in health care? TTA programs have become quite common especially in the US. Specially trained nurses guide parents to the right level of health care after assessing the severity of their child’s sickness with computer-controlled clinical algorithms.

Methods and results

We calculated potential savings based on data provided by emergency department consultations in one German city and its surroundings and compared them to the costs for introducing and operating a TTA program. If up to 25% of all emergency department consultations could be avoided annually, it would not result in cost reductions.

Conclusions

Since data are lacking on TTA, we suggest a regional pilot to evaluate before and after parent satisfaction, gather data on when and for what reasons parents presently tend to bring in their children, and assess the clinic personnel’s contentment with their work load.