Ceftazidime with or without vancomycin vs. cephalothin, carbenicillin and gentamicin as the initial therapy of the febrile neutropenic pediatric cancer patient

In a 28-month randomized trial we compared ceftazidime (CAZ), an extended spectrum cephalosporin, with cephalothin, carbenicillin and gentamicin (KCG) as empiric therapy for febrile neutropenic pediatric cancer patients. Because of the occurrence of ceftazidime-resistant Gram-positive primary infections, vancomycin was added to CAZ after the first year of study. Of 206 evaluable episodes 76 (37%) were documented infections including 20 bacteremias; 130 (63%) episodes were caused by fever of unknown origin. The number of complete responses to initial therapy in patients with documented infections did not differ among regimens: 26 of 43 (61%) for KCG, 9 of 16 (56%) for ceftazidime and 8 of 16 (50%) for CAZ + vancomycin (not significant). In patients with fever of unknown origin, response without modification of the initial regimen was 52 of 62 (84%) in the KCG arm, 32 of 40 (80%) on CAZ and 23 of 29 (80%) in patients treated with CAZ + vancomycin (not significant). Modifications of the regimen were similar among all three groups and were due primarily to the use of empiric antifungal or antiviral therapy and to empiric treatment of interstitial pneumonia. Hypokalemia occurred in 25 of 105 patients treated with KCG and in 4 of 101 treated with CAZ or CAZ + vancomycin (P less than 0.001). No differences between the efficacy of KCG, CAZ and CAZ + vancomycin as initial empiric therapy were demonstrated.     

Continuous infusion of ceftazidime with a portable pump is as effective as thrice-a-day bolus in cystic fibrosis children

Continuous infusion (CI) of β-lactam antibiotics provides a stable concentration which may result in a better activity against gram-negative bacteria if exceeding the minimum inhibitory concentration (MIC). Treatment outcome after 24 h CI of ceftazidime (CAZ) in cystic fibrosis (CF) children was compared with the bolus administration regimen. Fourteen CF children with chronic Pseudomonas aeruginosa pulmonary infection were treated during 14 days with the conventional CAZ thrice-a-day bolus infusion (regimen A), and few months later with 24 h CI of CAZ (regimen B) using a portable pump. Amikacin was added to both regimens. Clinical efficacy of treatment was assessed using pulmonary, inflammatory and nutritional variables. Bacteriological analyses and CAZ concentrations in serum and sputum were also measured. All patients improved clinically with both regimens. Among the parameters used to compare both regimens, only prealbumin values improved (regimen A: +0.08 g/l versus regimen B: +0.11 g/l, P=0.015). No clinically significant side-effects were noted. In regimen A, the mean predose (trough level) CAZ concentration in serum was highly variable (range 2.2–45.4 μg/ml) with some values (32% of samples) below the MIC of P. aeruginosa isolates found in the sputum of the patients. In regimen B, the serum CAZ level achieved was 28.5 ± 8.4 μg/ml without any value below the MIC. The mean sputum levels were comparable in both regimens. No CAZ resistant strains of P. aeruginosa appeared between and directly after the treatments. Conclusion The clinical outcome of children with cystic fibrosis treated with 24 h continuous infusion of ceftazidime was no different from that achieved with the conventional bolus infusion regimen. Continuous infusion provided a sustained serum ceftazidime level well above the P. aeruginosa minimum inhibitory concentration. Continuous infusion was well tolerated and appreciated by the children and this may promote home therapy for cystic fibrosis children. Received: 12 February 2000 and in revised form: 26 May and 15 July 2000 / Accepted: 17 July 2000     

Stellungnahme zur Monopolisierung in der Pharmaindustrie – Folgen für die Impfstoffbereitstellung

Ohne Zusammenfassung

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Monopolies in the pharmaceutical industry – implications for the supply of vaccinesPosition paper from the DAKJs Commission for Infectious Diseases and Questions Concerning Vaccinations

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Mitglieder der Kommission für Infektionskrankheiten und Impffragen, Deutsche Akademie für Kinder- und Jugendmedizin e.V.: Prof. Dr. Dr. med. P. Bartmann (Bonn), Prof. Dr. med. U. Heininger (Basel, Vorsitzender), Prof. Dr. med. H.-I. Huppertz (Bremen), Dr. med. M. Kinet (Rendsburg), PD Dr. med. G. Ch. Korenke (Oldenburg) und Dr. med. R. Klein (Saarbrücken)     

Cefepime versus ceftazidime as empiric monotherapy for fever and neutropenia in children with cancer

BACKGROUND: Monotherapy with cefepime or ceftazidime is an effective alternative to combination therapy for the treatment of febrile neutropenic adult cancer patients. We compared the efficacy and safety of cefepime and ceftazidime as empiric monotherapy of febrile neutropenia in children with cancer. MATERIALS AND METHODS: A prospective, open label, randomized, comparative study in pediatric cancer patients was conducted at Chang Gung Children's Hospital from January 1, 2000, to April 15, 2001. Patients with fever and neutropenia (absolute neutrophil count of < or = 500/mm3) were randomized to receive either intravenous cefepime or ceftazidime (50 mg/kg/dose as two or three doses daily). Febrile episodes were classified as microbiologically documented infection, clinically documented infection or unexplained fever. Clinical response to therapy was classified as success and failure. RESULTS: Ninety-five pediatric cancer patients with 120 febrile neutropenic episodes were randomized to receive empiric treatment with cefepime or ceftazidime. After 72 h of treatment, 82.8% (48 of 58) of the eligible patients in the cefepime group continued with unmodified therapy, compared with 87.9% (51 of 58) in the ceftazidime group. The neutrophil count was <100/mm3 at randomization for 76% of the patients in the cefepime group and 83% of those in the ceftazidime group; the median durations of neutropenia (<500/mm3) were 8.5 and 6.5 days, respectively. Of the 96 evaluable episodes the overall success rate with unmodified empiric therapy until the end of the treatment course in the cefepime group was comparable with that in the ceftazidime group (69% vs. 71%, P = 0.95). The response rate after glycopeptides were added to the regimens was 79.2% for the cefepime group and 77.1% for the ceftazidime group. The bacterial eradication rate was 33% for the cefepime group and 20% for the ceftazidime group (P = 0.85), and the rates of new infections were 10.4% vs. 4.2% (P = 0.67), respectively. Both study drugs were well-tolerated. Three (6.4%) patients in the cefepime group and 2 (4.3%) patients in the ceftazidime group died. CONCLUSION: Cefepime appeared to be as effective and safe as ceftazidime for empiric treatment of febrile episodes in neutropenic pediatric cancer patients.     

Unabhängige klinische Forschung im Kindesalter und die 12. AMG-Novelle

Zusammenfassung Klinische Prüfungen an Patienten, die aufgrund ihrer Minderjährigkeit nicht einwilligungsfähig sind, sollen gemäß einer geplanten europaweiten Gesetzesnovellierung in Zukunft auch dann zulässig sein, wenn von ihnen ein Nutzen für die betroffene Patientengruppe zu erwarten ist. Diese Änderung würde erstmals in Deutschland echte kontrollierte klinische Studien in der Pädiatrie ermöglichen und wird daher von allen, die an einer evidenzbasierten Therapie im Kindesalter interessiert sind, begrüßt. Allerdings könnte die zur Gesetzesnovellierung gehörende Rechtsverordnung mit ausnahmslos an den internationalen Standards der guten klinischen Praxis orientierten Durchführungsbestimmungen nach dem derzeitigen Entwurf so hohe technische und administrative Anforderungen an klinische Studien an sich bedeuten, dass eine wissenschaftsinitiierte, unabhängige Forschung kaum mehr möglich wäre. Im Interesse einer wissenschaftlich begründeten Medizin im Kindesalter muss daher mit Nachdruck darauf hingewirkt werden, dass in die erwähnte Verordnung Regelungen einfließen, die die klinische Forschung in industrieunabhängigen pädiatrischen Fragestellungen und an nicht kommerziell orientierten Einrichtungen auch zukünftig möglich machen.An der im Jahr 1999 gegründeten unabhängigen Initiative Kinder in Klinischen Prüfungen beteiligen sich Ärztinnen und Ärzte, die an Universitäten, bei Auftragsforschungsinstitutionen oder in der pharmazeutischen Industrie tätig sind. Mit ihren gemeinsamen Aktivitäten wollen sie zur Verbesserung der Arzneimitteltherapie im Kindesalter beitragen. Die Initiative befürwortet, dass innovative Medikamente, die sich in der Entwicklung befinden, frühzeitig und kontrolliert auch bei Kindern geprüft werden, wenn erkennbar ist, dass ihr Einsatz auch in dieser Altersgruppe mit einem therapeutischen Nutzen verbunden sein wird. Bedarf für klinische Prüfungen wird aber auch dann gesehen, wenn Medikamente bereits in der Kinderheilkunde eingesetzt werden und deren Nutzen und Unbedenklichkeit nicht durch langjährige ärztliche Erfahrung gesichert sind. Mitglieder der Initiative sind Prof. Dr. Joachim Boos, Universitäts-Kinderklinik Münster; Dr. Insa Bruns, Verband Forschender Arzneimittelhersteller, Berlin; Dr. Ulrike Ebert, KKS Heidelberg; Dr. Heinz Endres, Abteilung für Med. Informatik, Biometrie und Epidemiologie der Ruhr-Universität Bochum; Dr. Reinhard Feneberg, KKS Heidelberg, Dr. Reiner Frey, Institut für Klinische Pharmakologie, Bayer AG Wuppertal; Dr. Christian Hinze, Medcom Drug Development Service GmbH, Kehl; Dr. Günter Hopf, Ärztekammer Nordrhein; Dr. Martin Hulpke-Wette, Kinderklinik des Universitätsklinikums Göttingen; Dr. Michael Kölch, Universitätsklinik und Poliklinik für Kinder- und Jugendpsychiatrie/ Psychotherapie, Ulm; Priv. Doz. Dr. Stephanie Läer, Institut für Experimentelle und Klinische Pharmakologie am Universitätsklinikum Hamburg-Eppendorf, Hamburg; Prof. Dr. Bernd Mühlbauer, Institut für Klinische Pharmakologie Bremen (Sprecher); Dr. Jenny Müller, Bundesverband der Pharmazeutischen Industrie e.V., Berlin; Prof. Dr. Wolfgang Rascher, Klinik für Kinder und Jugendliche der Universität Erlangen, Dr. Karin Rossol-Haseroth, PAED-Net KKS Mainz; Dr. Matthias Schwab, Dr. Margarete Fischer-Bosch-Institut für Klinische Pharmakologie, Stuttgart; Dr. Joachim A. Schwarz, Quintiles GmbH, Neu-Isenburg; Prof. Dr. Hannsjörg Seyberth, Zentrum für Kinder-und Jugendmedizin, Universität Marburg, Prof. Dr. Barbara Sickmüller, Bundesverband der Pharmazeutischen Industrie e.V. Berlin, Prof. Dr. Burkhard Tönshoff, Universitätskinderklinik, Heidelberg.     

Urinary oligosaccharide screening in patients with β-galactosidase deficiency

Following ion-exchange chromatography and subsequent thin-layer chromatography, 3 peculiar oligosaccharide excretion patterns were distinguished in 3 patients with -galactosidase deficiency. Each patient differed clinically and it is proposed that this method may be of use in characterising various forms of -galactosidase deficiency.Dedicated to Prof. Dr. H.-R. Wiedemann on the occasion of his 65th birthdaySupported by a grant from the Stiftung Volkswagenwerk     

Design of a multiple longitudinal study of growth and health in teenagers

This paper describes the design of a study to follow the development of boys and girls in secondary schools from the age of 12 through 17 on an annual basis, in order to acquire more information concerning the growth and development of teenagers.In this study, both physical and psychological characteristics are measured. Normal daily diets, usual physical activity, and attitudes towards physical education are measured to assess their influence on physical and psychological characteristics.In view of the inadequacies of pure-longitudinal and of cross-sectional designs, a multiple longitudinal design has been chosen in which four repeated measurements are made in two overlapping cohorts by which age-, time of measurement-, and cohort-effects can be distinguished.Test effects are isolated by comparing the data from the test cohorts with data from an independent sample of identical cohorts from a second control school.This research was performed in the Lab. of Health Sciences (Prof. Dr. R. L. Zielhuis) and the Lab. of Psychophysiology (Prof. Dr. P. Visser) of the University of Amsterdam, and was supported by a grant from the Praeventiefonds and the Stichting voor Onderzoek van het Onderwijs (S.V.O.) in The Hague, The Netherlands (projectnumber 0255)     

Long versus standard prednisone therapy for initial treatment of idiopathic nephrotic syndrome in children

Two regimens of steroid treatment for the initial attack of idiopathic nephrotic syndrome (NS) in children were compared in a controlled prospective multicentre study. Long prednisone therapy consisted of 60 mg/m² per 24 h for 6 weeks, followed by alternate day 40 mg/m² per 48 h for 6 weeks. The standard prednisone therapy was 60 mg/m² per 24 h for 4 weeks, followed by 40 mg/m² per 48 h for 4 weeks. A total of 71 children with an initial attack of idiopathic NS were allocated at random to the two groups. The cumulative rate of patients with sustained remissions after 2 years was significantly higher after the long course than after the standard treatment (49% vs 19%,P=0.0079). The mean relapse rate per patient at intervals of 3, 6 and 12 months was lower in the long-course prednisone group than in the standard prednisone group, and the proportion of children with frequent relapses during any subsequent 6 months period was lower in the long-course group than in the standard group (29% vs 57%,P=0.03). Mild side-effects of corticosteroid therapy were observed more frequently after long-course prednisone treatment. It is concluded that long-course prednisone therapy of the initial attack of steroid responsive NS is preferable to the standard regimen because it reduces the rate of subsequent relapses without increasing the risk for severe steroidal side-effects. Contributing investigators and centres were: Prof. F. R. Egli (Basel, Switzerland); Prof. G. Mau, Dr. J. Zimmermann (Braunschweig, Germany); Dr. W. Marg (Bremen, Germany); Dr. R. Mallmann (Bonn, Germany); Dr. K. Witzel (Düsseldorf, Germany); Prof. D. Michalk (Erlangen, Germany); Prof. H. Olbing (Essen, Germany); Dr. E. Bopp (Flensburg, Germany); Prof. J. Dippel (Frankfurt, Germany); Dr. H. Zappel (Göttingen, Germany); Dr. D. Schwarke (Hamburg, Germany) Prof. J. Brodehl (Hannover, Germany); Prof. K. Schärer (Heidelberg, Germany); Prof. F. Schindera (Karlsruhe, Germany); Dr. M. Kirschstein (Lübeck, Germany); Prof. H. P. Weber (Lüdenscheid, Germany); Prof. M. Brandis (Marburg, Germany); Prof. R. Eife (München, Germany); Dr. F. K. Hübner (München, Germany); Dr. K. Gellissen (Neuwied, Germany); Prof. W. Rauh (Trier, Germany).     

Male infant with cat cry syndrome and apparent absence of the Y chromosome

We report a boy with cri-du-chat syndrome and apparent absence of the Y chromosome.The karyotype is interpreted as 45,X,del(5)(qterp13:). The boy has normal male external genitalia and bilateral testes although no Y chromosome was found in lymphocytes or fibroblasts.Dedicated to Prof. Dr. H.-R.Wiedemann on the occasion of his 65th birthday     

Autosomal dominant inheritance of hypercalciuria

We examined 37 first and second degree relatives of 10 children with hypercalciuria. In 2 families only the index patient was affected, while in 8 others one of the parents was hypercalciuric; in the total of 47 persons examined 23 cases of idiopathic hypercalciuria could be identified. None of the subjects was hypercalcemic. The pedigrees suggest autosomal dominant inheritance of the trait.Dedicated to Prof. Dr. H.-R. Wiedemann on the occasion of his 65th birthday     

Comparison of growth hormone releasing hormone therapy and growth hormone therapy in growth hormone deficiency

Seven children with growth hormone deficiency of hypothalamic origin responded to an i.v. bolus of growth hormone releasing hormone (GHRH) (1–29)-NH2 with a mean serum increase of 10.7 ng/ml growth hormone (GH) (range 2.5–29.3 ng/ml). Continuous s.c. administration of GHRH of 4–6 g/kg twice daily for at least 6 months did not improve the growth rate in five of the patients. One patient increased his growth rate from 1.9 to 3.8 cm/year and another from 3.5 to 8.2 cm/year; however, the growth rate of the latter patient then decreased to 5.4 cm/year. When treatment was changed to recombinant human growth hormone (rhGH) in a dose of 2 U/m² daily, given s.c. at bedtime, the growth rate improved in all patients to a mean of 8.5 cm/year (range: 6.2 to 14.6). Presently GHRH cannot be recommended for the routine therapy of children with growth hormone deficiency since a single daily dose of rhGH produced catch-up growth which GHRH therapy did not.Abbreviations GH growth hormone - GHD growth hormone deficiency - GHRH growth hormone releasing hormone - hGH human growth hormone - rhGH recombinant human growth hormone - SM C/IGF I somatomedin C/insulin-like growth factor I On the occasion of the 85th birthday of Prof. Dr.Dr.h.c. mult. Adolf Butenandt     

Renal magnesium wasting,incomplete tubular acidosis,hypercalciuria and nephrocalcinosis in siblings

Polyuria, hyposthenuria, hypomagnesemia, hypercalciuria, advanced nephrocalcinosis, low citrate excretion and low glomerular filtration rates were observed in two female siblings who were followed over 10 years. Acid loading revealed incomplete distal tubular acidosis. Hypomagnesemia was due to renal magnesium wasting. It is suggested that the defect in tubular transport of magnesium is an important factor in the pathogenesis of this syndrome.Supported by the German Research Foundation within the SFB 90 Cardiovaskuläres System and grant Lo/260/1Dedicated to Prof. Dr. H. Bickel on the occasion of his 60th birthday     

Parathyroid function in different stages of vitamin D deficiency rickets

Direct measurements of parathyroid activity are available in only small numbers of children with vitamin D deficiency rickets (VDR). Therefore serum immunoreactive parathyroid hormone (iPTH) and the urinary cyclic adenosine-3,5-monophosphate excretion (UcAMP) were measured together with other important indices of calcium metabolism in 24 patients (aged 2–42 months) with VDR before vitamin D treatment. iPTH and UcAMP were significantly elevated in comparison to age-matched controls. In patients there was a highly significant positive correlation between iPTH and UcAMP and a negative relationship between both indices of parathyroid activity to serum phosphate and urine calcium, respectively, indicating that the simple measurement of serum phosphate and/or urine cAMP and Ca provides a reliable tool for the assessment of secondary hyperparathyroidism in VDR. In two patients classified as being in the early stage of VDR the parathyroid activity was not elevated despite hypocalcemia indicating relative hypoparathyroidism.Twelve patients with VDR were followed during vitamin D therapy: Within the first 2 weeks of treatment UcAMP slightly increased and thereafter decreased in most patients, but was still elevated in three patients even after 7 weeks, whereas iPTH became normal within 3 weeks of treatment. This favors the concept that vitamin D deficiency diminishes the activation of renal adenylate cyclase by PTH which is overcome by the highly increased PTH secretion in the advanced stages of rickets.The basal and calcium-stimulated serum calcitonin (CT) levels, determined in some of the patients, were normal, ruling out a significant disturbance of CT secretion in VDR.Dedicated to Prof. Dr. H. Bickel on the occasion of his 65th birthday     

Partial replacement of the left ventricular wall for a large intramural fibroma

Summary A case of successful operative treatment of an intramural fibroma of the left ventricular posterior wall is presented. Symptomatology, diagnosis, and a surgical procedure based on ventricular replacement using a doubled Dacron patch, fixed in sandwich technique, are discussed. It is possible to resect and replace large parts of the ventricular wall because of the well-developed compensatory capacity of the remaining unaffected myocardium in children.Dedicated to Prof. Dr. J. Chr. Reidemeister on the occasion of his 50th birthday.     

Clinical experience with continuous intravenous sedation using midazolam and fentanyl in the paediatric intensive care unit

Twenty-four patients in a paediatric intensive care unit mostly undergoing cardiac surgery, received a midazolam dosage between 50–400 g/kg per hour as a continuous intravenous infusion partly in combination with fentanyl [0,5–2,5 g/kg per hour] for analgesia and sedation. The mean duration of midazolam infusion was 11.6 days (range 38h–40 days). Blood samples for the HPLC assay of serum midazolam concentration were taken and the clearance estimated. The efficiency of sedation in correlation to the midazolam concentration was evaluated by a clinical sedation score. Serum midazolam concentrations between 100–400 g/l were sufficient for sedation. Dosage had to be increased during therapy according to an increased midazolam clearance. The evaluation of the sedation score showed that sedation of artifically ventilated infants and young children can be established by continuous intravenous infusion of midazolam.Dedicated to the 65th birthday of Prof.Dr. Erich Gladtke     

The Clinical and Bacteriogical Spectrum of Neonatal Sepsis in a Tertiary Hospital in Yaounde,Cameroon

Objective

Sepsis is an important cause of morbidity and mortality in neonates especially in developing countries where identification of the germs and treatment is often unsatisfactory. The aim of the study was to assess the clinical presentation, and bacteriological profile of neonatal infections, and the sensitivity of the causative germs to antibiotics.

Methods

We carried out a prospective analytic study in the Yaounde Gynaeco-Obstetric and Pediatric Hospital in Cameroon over a 6 months period from 18^th November 2008 to 18^th May 2009. On the basis of history and/or clinical findings and paraclinical investigations, 218 neonates out of a total of 628 admissions were investigated and managed for neonatal infection.

Findings

The most frequent symptoms were fever (44.95%), refusal to feed/irritability (32.11%), and respiratory distress/cough (28.90%). Premature birth and prolonged rupture of membranes were the most frequent risk factors. Klebsiella spp, Escherichia coli and Enterobacter spp were the most frequent germs identified in respectively 28.6%, 21.4% and 14.3% of the positive samples. Overall sensitivity of the cultures to ampicillin, netilmicin and gentamycin was poor at 29.4%, 31.4% and 18.9% respectively, whereas imipenem, ofloxacin, ciprofloxacin and ceftazidime had the best sensitivities in 91.7%, 90%, 85.3% and 69.4% of the cultures respectively. The mortality rate was 22%, and low birth weight, premature birth and septicemia were significant risk factors for death.

Conclusion

Mortality from neonatal sepsis in this context is still high and there is an upsurge of multi-resistant germs to currently used antibiotics, calling for the need for rational use of antibiotics in the management of these infections.     

Quantitative determination of single serum proteins during acute hepatitis in childhood

Fifteen serum proteins were estimated by linear immunodiffusion in blood samples from children with acute hepatitis.Blood was drawn at the beginning of the disease and three weeks later. The results were compared with results obtained from a group of age-matched normal children.At the beginning of the disease prealbumin and beta-2-glycoprotein I were depressed, whereas alpha-1-acid-glycoprotein, alpha-1-antitrypsin, ceruloplasmin and alpha-2-HS-glycoprotein were found to be elevated.Alpha-2-macroglobulin, transferrin and beta-lipoprotein showed a significant elevation after three weeks. Beta-1-A/C, IgM and IgG remained elevated during the time of observation.Albumin, haptoglobin and IgA were similar in patients and controls and did not change during the period of observation.Dedicated to Prof. Dr. H. Bickel on the occasion of his 60th birthdaySupported by Deutsche ForschungsgemeinschaftThis work is part of the M.D. thesis of C.M. and was presented in part at the 26th congress of the Süddeutschen Kinderärzte, Stuttgart, June 1977     

Der Einfluß einer protrahierten ACTH-Gabe auf die Steroidausscheidung des Säuglings,untersucht am Behandlungsmodell der Blitz-, Nick-und Salaam-Krämpfe

Zusammenfassung Es wird über die Harnausscheidung des Pregnan-3-, 17-, 20-triol bei einer protrahierten ACTH-Behandlung BNS-krampfkranker Kinder berichtet. Die Ausscheidungsgröße dieser Substanz kann das 20fache des Ausgangswertes erreichen. Die bisher untersuchten Patienten zeigten eine unterschiedliche Erhöhung der Pregnantriolausscheidung, so daß unter Berücksichtingung des jeweiligen klinischen Bildes die Möglichkeit einer prognostischen Klassifizierung diskutiert werden kann. Diesbezüglich findet die Ausscheidungsgröße durch Bestimmung des Quotienten F (frei+Glukuronid): Pregnantriol auf der Spitze der Ausscheidung ihren Ausdruck.Die Arbeit wurde mit Unterstützung durch die Deutsche Forschungsgemeinschaft, Bad Godesberg, durchgeführt.Der Schering AG., Berlin, danke ich für die großzügige Überlassung von ß-Glukuronidase.Herrn Prof. W. Klyne, London, bin ich für die Überlassung authentischer Eichsubstanzen besonders zu Dank verpflichtet.     

DIALYSIS ENCEPHALOPATHY IN A NON-DIALYSED URAEMIC BOY TREATED WITH ALUMINIUM HYDROXIDE ORALLY

Abstract. Nathan, E. and Pedersen, S. E. (Department of Paediatrics, Kolding Hospital, Kolding, Denmark). Dialysis encephalopathy in a non-dialysed uraemic boy treated with aluminium hydroxide orally. Acta Paediatr Scand, 69: 793, 1980.—Brain aluminium concentration has been found significantly higher in patients dying with dialysis encephalopathy than in uraemic patients without this syndrome, and it has previously been reported only in haemodialysed patients. We report a case of high brain aluminium concentration in a uraemic boy showing symptoms of severe encephalopathy. He was never dialysed but only treated with aluminium hydroxide orally. Baluarte reported corresponding symptoms in non-dialysed uraemic children, but brain aluminium concentrations were not reported. His patients as well as ours had very high levels of parathormone which may play a role in the resorption and distribution of aluminium. Aluminium preparations should be avoided in children with renal failure.     

Relationship between asymptomatic rotavirus infection and jaundice in neonates: a retrospective study

Background

Rotavirus (RV) infection in neonates can be mild or even asymptomatic. In RV infection, jaundice is often reported, but the relationship between jaundice and RV infection has not been studied. This study aimed to determine the importance of asymptomatic RV screening in neonates with jaundice.

Methods

Neonates from the neonatal intensive care unit (NICU) of Chonbuk National University Hospital, those transferred from local obstetrics and gynecology hospitals and outpatient clinics were selected from 2014 to 2017. The study included only infants aged between 3 and 28?days. Jaundice was defined according to gestational age and birth age, in accordance with the American Academy of Pediatrics guidelines criteria. RV infection was confirmed by a stool test, and RV screening and laboratory tests were performed at admission.

Results

Among 596 patients, 166 patients had jaundice. RV infection was observed in 70 (42%) jaundice patients. There were 36 (22%) jaundice patients with asymptomatic RV infection. Patients with onset of jaundice 3–7?days after birth had a high incidence of RV infection. When the RV test was positive, the risk of jaundice was significantly high [odds ratio (OR) 1.89; 95% confidence interval (CI), 1.20–2.98; p?=?0.006].

Conclusions

Infants with the onset of jaundice >?3?days after birth were likely to have RV infection. Therefore, we suggest that screening tests for RV infection be included as part of the evaluation of jaundiced infants presenting to NICU.