Hyperbilirubinemia in Healthy Newborns Born to Immigrant Mothers from Southeastern Asia Compared to Italian Ones

Objective

To compare the characteristics of jaundice and hyperbilirubinemia in the newborn population of both immigrant and Italian mothers.

Methods

The authors studied a group of 1,680 infants born at “A. Gemelli” hospital during 1 y. All were with appropriate weight for gestational age, weighting more than 2,500 g, born to low-risk pregnancy. Maternal ethnicity, clinically evident jaundice (that is total serum bilirubin (TSB)?>?7 mg/dL), hyperbilirubinemia (TSB?>?12 mg/dL), the duration of hospital stay and their need of phototherapy were evaluated.

Results

In infants born to Asian mothers, hyperbilirubinemia was significantly more frequent (48.8 % vs. 26.5 %, p?=?0.003) and they reached mean TSB peak significantly later (86.5?±?38.5 vs. 74.5?±?20.6 h, P?=?0.0001) compared with Italian infants. The average length of hospitalization of infants of Asian and Latin American mothers is significantly longer compared to Italian newborns (4.5?±?1.9 vs. 3.6?±?1.1, p <0.0001 and 4.2?±?1.6 vs. 3.6?±?1.1, p?=?0.0004). With regard to the use of phototherapy, and to its duration, there are no significant differences between the populations studied.

Conclusions

Having studied all infants at low risk, the greater length of hospitalization is due to later peak and the higher frequency of jaundice in newborns of immigrant mother, especially in Asia. Therefore, as it happens to the Italian newborns, it would be desirable to build forecasting nomograms in these populations, to reduce the length of hospitalization and facilitate protected discharge.     

Clinical and Echocardiographic Outcome in Patients Receiving Carvedilol for Treatment of Dilated Cardiomyopathy

Objective

To determine outcome of children receiving carvedilol in addition to other standard drug therapy for treatment of dilated cardiomyopathy.

Methods

Children receiving carvedilol for treatment of dilated cardiomyopathy with moderate to severe ventricular dysfunction were included into the study. Data on history, clinical examination and investigations were obtained and detailed echocardiography findings were recorded for the initial and all subsequent visits.

Results

Thirty-three children, mean age 26?±?30 mo (range 7 mo to 138 mo) were enrolled. Carvedilol was initiated at a mean dose of 0.14?±?0.03 mg/kg/d and the maintenance dose was 0.46?±?0.14 mg/kg/d. At a follow up of 6–90 mo (mean of 28?±?23 mo), functional class using Ross classification for pediatric heart failure improved from 2.7 to 1.3. The left ventricular ejection fraction rose from a basal value of 22 %?±?7 % (10–40 %) to 42 %?±?15 % (15–65 %) (p?<?0.0001). Similarly, left ventricular fractional shortening increased significantly from 16?±?6 % (8–34 %) to 21?±?7 % (10–44 %) (p?<?0.0001). One patient deteriorated and died of refractory heart failure. Carvedilol was discontinued in two more patients temporarily due to bronchospasm during respiratory infection.

Conclusions

The present study suggests that improvement in ventricular function and clinical symptoms is seen on oral carvedilol added to standard drug therapy in pediatric patients with dilated cardiomyopathy and moderate to severe ventricular dysfunction. The drug is well tolerated with minimal side effects but close monitoring is required as it may worsen heart failure and bronchospasm.     

Non-enhanced ECG-gated respiratory-triggered 3-D steady-state free-precession MR angiography with slab-selective inversion: initial experience in visualisation of renal arteries in free-breathing children without renal artery abnormality

Background

ECG-gated non-enhanced balanced steady-state free precession (bSSFP) MR angiography requires neither breath-holding nor administration of contrast material.

Objective

To investigate the image quality of free-breathing ECG-gated non-enhanced bSSFP MR angiography of renal arteries in children.

Materials and methods

Fourteen boys and seven girls (mean age, 9.7?years; range, 7?weeks–17?years) with no history of renovascular disease were included. MRI was performed at 1.5?T. Subjective image quality of axial and coronal maximum-intensity-projection reconstructions of four segments (I, aorta and renal artery ostium; II, main renal artery; III, segmental branches; IV, intrarenal vessels) was evaluated using a 4-point scale (4?=?excellent, 3?=?good, 2?=?acceptable, 1?=?non-diagnostic).

Results

Image quality was excellent for segments I (mean ± SD, 3.9?±?0.3) and II (4.0?±?0.1), good for segment III (3.4?±?0.9) and acceptable for segment IV (2.3?±?1.1 ). Mean image quality did not differ between sedated and non-sedated children.

Conclusion

bSSFP MR angiography enables visualisation of renal arteries in children.     

Serum Fructosamine and Retinopathy of Prematurity

Objective

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

Methods

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

Results

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

Conclusions

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

Lung Function and Respiratory Health at School Age in Ventilated Very Low Birth Weight Infants

Objective

To investigate respiratory health and lung function in school-aged children without broncho-pulmonary dysplasia (BPD), who were very low birth weight (VLBWi) and randomized at birth to high frequency oscillatory ventilation (HFOV) or volume guarantee (VG) ventilation for severe respiratory distress syndrome (RDS).

Methods

In this observational study, 7-y-old ex-preterm infants with severe RDS, randomly assigned at birth to receive assisted/control ventilation?+?VG (Vt?=?5 mL/kg, PEEP?=?5 cmH₂O)(VG group; mean GA 27?±?2 wk; mean BW 1086?±?158 g) or HFOV (HFOV group; mean GA: 27?±?2; mean BW: 1090?±?139 g) (both groups were ventilated with Drager Babylog 8000 plus) were recalled. Neonatal clinical data and outcome were known. Actual outcomes were investigated with an interview; lung function was measured by whole-body plethysmography.

Results

Twenty five children were studied (VG group, n?=?13 vs. HFOV group, n?=?12). There were no differences in anthropometric data, drugs (steroids/bronchodilators and antibiotics) or hospital readmission for respiratory disorders. Compliance to the test was adequate. The authors found a similar obstructive deficit (elevated values: airway resistance (RAW), residual volume (RV), total lung capacity (TLC) with near-normal spirometry) in both groups suggesting a persistent airflow limitation even in absence of BPD.

Conclusions

VLBW infants even in absence of BPD, need long term respiratory follow-up, because they frequently show an impairment of lung function, independent from initial respiratory support, even if at birth the choice is a lung protective approach (e.g., HFOV or VG ventilation).     

Does Mesenchymal Stem Cell Population in Umbilical Cord Blood Vary at Different Gestational Periods?

Objective

To identify and quantitatively determine Mesenchymal stem cells (MSCs) in the umbilical cord blood (UCB) of neonates born at different gestational periods.

Methods

UCB was collected at birth in neonates of three different gestational groups. The mononuclear cells (MNCs) were phenotypically analyzed by flow cytometer.

Results

The yield of total MNCs did not differ much with gestation; the average values were 22.6?±?6.48?×?106 cells/ml. The MSCs were significantly higher in the lower gestation group. These were 0.0219?±?0.012 %, 0.0044?±?0.003 % and 0.0022?±?0.003 % in 28 to 31 wk, 32 to 35 wk and >36 wk, respectively (P?=?0.00). There was a significant inverse correlation between the gestational age and the presence of MSCs with a correlation co-efficient of ?0.54 (P?=?0.0001).

Conclusions

The MSCs population was significantly higher in infants born at lesser gestation than those born at term gestation.     

Intrapulmonary Shear Stress Enhancement: A New Therapeutic Approach in Pulmonary Arterial Hypertension

Objective

Pulmonary arterial hypertension (PAH) is a dysfunctional endothelium disease with increased pulmonary vascular resistance (PVR) and poor prognosis. Current therapies are still insufficient. Here we propose a new pulsatile device as a more effective tool for PAH management compared with traditional treatments.

Materials and Methods

Twelve piglets (10.3?±?3.8?kg) were given either intrapulmonary pulsatile [P (n?=?6)] or nonpulsatile [NP (n?=?6)] tadalafil treatment. After median sternotomy and heparin injection (250?IU/kg), both groups underwent aorto-pulmonary surgical shunt for 1?h. During a second 1?h period in group P, a catheter prototype, driven by a small ventilator, was introduced into the pulmonary trunk and pulsated intermittently at 110?bpm irrespective of heart rate (90.6?±?10.74 bpm). In group NP, tadalafil was given orally (1?mg/kg).

Results

Hemodynamics and cardiac output (CO) were significantly (p?<?0.05) improved in group P compared with group NP: CO was 0.56?±?0.0.26 versus 0.54?±?0.11 (L/min), respectively. Mean pulmonary artery pressure (PAP) was decreased in group P compared with group NP: PAP was 9.6?±?2.97 versus 32.2?±?5.07, respectively. Vascular resistances (dynes.s.cm^?5/kg) were significantly lower in group P versus group NP: pulmonary resistance was 85?±?42.12 versus 478?±?192.91 and systemic resistance was 298.8?±?172.85 versus 1301?±?615.79, respectively. Using Western blot analysis, endogenous NO synthase expression in PA segments was nonsignificantly (p?>?0.05) greater in group P (0.81?±?0.78) versus (0.62?±?0.35) group NP.

Conclusion

Induced with an appropriate device, intrapulmonary shear stress?Cmediated endothelial function enhancement provides a more effective nearly physiological therapy for PAH.     

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.     

Evaluation of image quality and radiation dose at prospective ECG-triggered axial 256-slice multi-detector CT in infants with congenital heart disease

Background

There are a limited number of reports on the technical and clinical feasibility of prospective electrocardiogram (ECG)-gated multi-detector computed tomography (MDCT) in infants with congenital heart disease (CHD).

Objective

To evaluate image quality and radiation dose at weight-based low-dose prospectively gated 256-slice MDCT angiography in infants with CHD.

Materials and methods

From November 2009 to February 2010, 64 consecutive infants with CHD referred for pre-operative or post-operative CT were included. All were scanned on a 256-slice MDCT system utilizing a low-dose protocol (80?kVp and 60?C120?mAs depending on weight: 60?mAs for ??3?kg, 80?mAs for 3.1?C6?kg, 100?mAs for 6.1?C10?kg, 120?mAs for 10.1?C15?kg).

Results

No serious adverse events were recorded. A total of 174 cardiac deformities, confirmed by surgery or heart catheterization, were studied. The sensitivity of MDCT for cardiac deformities was 97.1%; specificity, 99.4%; accuracy, 95.9%. The mean heart rate during scan was 136.7?±?14.9/min (range, 91?C160) with a corresponding heart rate variability of 2.8?±?2.2/min (range, 0?C8). Mean scan length was 115.3?±?11.7?mm (range, 93.6?C143.3). Mean volume CT dose index, mean dose-length product and effective dose were 2.1?±?0.4?mGy (range, 1.5?C2.8), 24.7?±?5.9?mGy·cm (range, 14.7?C35.8) and 1.6?±?0.3?mSv (range, 1.1?C2.5), respectively. Diagnostic-quality images were achieved in all cases. Satisfactory diagnostic quality for visualization of all/proximal/distal coronary artery segments was achieved in 88.4/98.8/80.0% of the scans.

Conclusion

Low-dose prospectively gated axial 256-slice CT angiography is a valuable tool in the routine clinical evaluation of infants with CHD, providing a comprehensive three-dimensional evaluation of the cardiac anatomy, including the coronary arteries.     

Age-related probability of contralateral processus vaginalis patency in children with unilateral inguinal hernia

Purpose

Contralateral groin exploration with closure of a patent processus vaginalis (PPV) in children with a unilateral inguinal hernia remains controversial. We aimed to generate precise, age-related probabilities of patency of the contralateral processus vaginalis (PV) in infants with a unilateral inguinal hernia to guide practice.

Methods

Retrospective review of all unilateral laparoscopic inguinal hernia repairs in 5?years to determine patency of contralateral PV. Using logistic binomial regression, age-adjusted odds ratio (OR), probability of contralateral PPV and number needed to explore (NNE) in order to close all PPVs were estimated.

Results

Data from 331 children [262 male, median 3.8?months corrected gestational age (CGA)] were analysed; 160 (48?%) had a contralateral PPV. In the regression model, CGA is linearly related to log[OR] such that for each month increase in CGA, the log[OR] of having a contralateral PPV decreased by 0.017?±?0.006 (mean?±?SEM; p?=?0.005). Gender and side of hernia had no significant effect. The probability of contralateral PPV is 50?% (NNE?=?2) at 8?m CGA, 33?% (NNE?=?3) at 49?m and 25?% (NNE?=?4) at 72?m.

Conclusions

These data contribute to our knowledge of the natural history of the PV and may help guide the need for contralateral groin exploration in infants with inguinal hernia.     

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

Objective

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

Methods

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

Results

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

Conclusions

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

Body Temperature Changes of Newborns Under Fluorescent Versus LED Phototherapy

Objective

To determine changes in body temperature (BT) of hyperbilirubinemic newborns under conventional phototherapy with fluorescent lamps and light emitting diodes (LED) at different irradiances.

Methods

Otherwise healthy newborn infants >34 wk gestational age (GA) hospitalized for indirect hyperbilirubinemia, requiring phototherapy in the first 10 d of life were enroled. Infants who received conventional phototherapy with fluorescent lamps (10–15 μW/cm²/nm irradiance) were defined as group 1, LED phototherapy of 26–60 μW/cm²/nm irradiance as group 2, and LED phototherapy of 60–120 μW/cm²/nm irradiance as group 3. Primary outcome measure was mean BT which was defined as arithmetical mean of axillary BT measured at 2 h intervals during the first day of phototherapy.

Results

Thirty patients were enroled in each group. Mean birth weight and GA of the total cohort was 2800?±?530 g and 36.6?±?2 wk, respectively. Baseline demographic variables and serum total bilirubin levels were similar among groups. Mean BT was 36.7?±?0.1 °C in group 1, 36.6?±?0.2 °C in group 2, 37.7?±?0.2 °C in group 3. Mean BT was higher in group 3 compared to group 1 (p?<?0.001) and group 2 (p?<?0.001). Group 1 and group 2 had similar mean BT measurements (p?=?0.09). During phototherapy all the patients in group 3 had at least one BT measurement ≥37.5 °C and 77 % had BT ≥38 °C. Only one patient in group 2 had BT?≥?37.5 °C which was also ≥38 °C. During phototherapy all BT measurements were <37.5 °C in group 1.

Conclusions

LED phototherapy of ≥60 μW/cm²/nm intensity significantly increases BT in hyperbilirubinemic newborns.     

Behavioral counseling to prevent childhood obesity – study protocol of a pragmatic trial in maternity and child health care

Background

Literacy is important for success in school and in adulthood. Book-gift programs at birth exist to help develop these foundations early on. The effectiveness of the Read to Me! Nova Scotia Family Literacy Program (a program where books and literacy materials are given to families in hospital when their baby is born) on the duration and frequency with which mothers engage in reading and other literacy based activities with their newborns was assessed.

Methods

An observational cohort study design was used. Mothers of babies who received the Read to Me! package in Nova Scotia born between January-August 2006 made up the intervention group (N?=?1051). Mothers of babies born in Prince Edward Island between December 2006 and March 2008 made up the control group (N?=?279) and did not receive any literacy package when their baby was born. A phone questionnaire was conducted consisting of questions regarding frequency and duration of maternal engagement in language and literacy-based activities with their infants. These activities included reading, singing, talking, listening to CDs and the radio and watching TV. Babies were aged 0?C10?months at the time of the interview.

Results

Mothers who received the Read to Me! literacy package spent significantly more time reading to their babies, 17.9?±?17.6?min/day compared to controls 12.6?±?10.7?min/day, (p?<?0.0001).

Conclusions

Read to Me! may be an inexpensive, easy to administer and effective intervention which results in increased shared reading of mothers and their newborns.     

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

Background

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

Objective

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

Materials and methods

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

Results

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

Conclusions

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

Non Benign Neonatal Arrhythmias Observed in a Tertiary Neonatal Intensive Care Unit

Objective

To analyze non benign neonatal arrhythmias (NA) observed in a tertiary neonatal intensive care unit (NICU).

Methods

From June 2006 through July 2011, newborns admitted to the NICU for NA or diagnosed as NA after hospitalization were evaluated retrospectively. The newborns with non benign NA were included in the study.

Results

During the study period, the incidence of non-benign NA was 0.7 % (n?=?55/7880). The mean age at diagnosis was 16.7?±?1.8 d ranging from 1 d to 90 d. The most common type was supraventricular arrhythmia (SVT) with an incidence of 0.3 %. Univariate analyses showed that there were significant differences between the survived and died infants according types of congenital heart disease (CHD), electrolyte imbalance, and arrhythmias. The mortality rates were higher among infants with obstructive type left-to right shunt and common mixing type CHD. The most dangerous type of electrolyte imbalance was hyperkalemia.

Conclusions

Many arrhythmias could not be noticed at neonatal period even in NICU, implying that it is increasingly important for the physician to be aware of the etiology, development, and natural history of these arrhythmias.     

Doppler US measurement of the superior mesenteric artery blood flow in children and adolescents

Background

Blood flow volume in the superior mesenteric artery (SMA) measured by pulsed Doppler has been used in adults to evaluate Crohn disease but has not been utilized in children and adolescents.

Objective

To establish a cutoff point for normal SMA blood flow using pulsed Doppler US measurement in healthy children and adolescents.

Materials and methods

The study included healthy volunteers from an urban community, divided into two age groups, children (5–9?years) and adolescents (10–17?years). Anthropometric measurements included waist circumference and body surface area classified according to the z-score of body mass index. Heart rate, blood pressure, oxygen saturation and temperature were measured immediately before US evaluation.

Results

The average age of the 60 participants was 12.2?years. Of these, 21 (35%) were ages 5–9?years and 39 (65%) were ages 10–17?years; 21 (35%) were boys. Findings of the two examiners coincided for 58 of the 60 (96.7%) participants. SMA blood flow was significantly lower in the children (mean ± SD?=?556?±?122?ml/min) than in adolescents (mean ± SD 775?±?311?ml/min) (P?<?0.001). SMA blood flow showed statistically significant positive associations with body surface area.

Conclusion

We found that superior mesenteric artery blood flow is significantly lower in children than in adolescents and is associated with body surface area.     

Usefulness of Pulsed Wave Tissue Doppler Imaging in Assessment of Left Ventricular Functions in Children with Beta-Thalassemia Major

Objective

To evaluate the changes in the LV systolic and diastolic function in children with beta-thalassemia major (β-TM) using pulsed wave tissue doppler (TD) echocardiography.

Methods

Clinical, conventional echo doppler and pulsed wave tissue doppler imaging parameters were compared in 40 beta-thalassemia major patients (mean age, 6.52?±?3.5 y) and 25 age and sex matched normal subjects (mean age, 6.5?±?2.7 y).

Results

There were no significant statistical differences between mean fractional shortening (FS) and ejection fraction (EF) of left ventricle (LV) of the patients and control group. Children with beta-thalassemia had significantly lower E′ wave velocities measured at the left ventricular septal annulus (8.1?±?3.3 vs. 13?±?2.5, P?<?0.001), lateral margin of the mitral annulus (9.1?±?5.4 vs. 13.3?±?2.5, P?<?0.001) and lateral margin of the tricuspid annulus (9.3?±?3.9 vs. 13.3?±?2.5, P?<?0.001) when compared to the control group. Furthermore children with beta-thalassemia had significantly lower E′/A′ wave ratio at the left ventricular septal annulus (0.76?±?0.34 vs. 1.36?±?0.23), lateral margin of the mitral annulus (0.83?±?0.17 vs. 1.28?±?0.22), and lateral margin of the tricuspid annulus ((0.90?±?0.27 vs. 1.26?±?0.23, (P?<?0.05) when compared to the control group.

Conclusions

This study showed that patients with beta-thalassemia major and normal conventional echo doppler parameters had statistically significant changes detected by pulsed wave tissue doppler imaging.     

Soft Plastic Bag Instead of Hard Plastic Container for Long-term Storage of Breast Milk

Objective

To compare the fat content and contamination of expressed breast milk (EBM) before and after storage (30 d) in hard polypropylene containers (HC) and soft polyethylene bags (SB) containers.

Methods

Ninety specimens of EBM were collected into HC and separated into two HC and two SB. The fat content of each specimen of EBM in HC and SB was measured and cultures were performed. The specimens in the second HC and SB containers were kept frozen for 30 d before thawing and then measuring the fat content and performing cultures.

Results

The means ± SD of the fat content of fresh and thawed EBM in HC were 2.98?±?0.97 and 2.66?±?0.88 g/100 ml, respectively, with a loss of 0.32 g/100 ml (p?<?0.001). The means ± SD of the fat content of fresh and thawed EBM in SB were 3.06?±?1.00 and 2.77?±?0.91 g/100 ml, respectively, with a mean loss of 0.29 g/100 ml during storage (p?<?0.001). The loss of fat content during frozen storage did not differ significantly between the two types of containers (p?=?0.53). All bacterial cultures of fresh and thawed EBM in HC and SB showed only nonpathogenic organisms.

Conclusions

SB can replace HC for the long-term storage of frozen EBM of up to 30 d without deleterious effects on fat loss or contamination.     

The Association Between Vitamin D Status and Recurrent Wheezing

Objective

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

Methods

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

Results

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

Conclusions

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

Growth and neurodevelopmental outcome of VLBW infants at 1 year corrected age

Objectives

To evaluate growth and neurodevelopmental outcome of very low birth weight infants (VLBW) and compare with term normal birth weight infants (NBW) till 12 months corrected age.

Design

A prospective cohort study

Setting

Tertiary care neonatal unit in northern India

Subjects

37 VLBW infants and 35 NBW infants born between January 2007 and December 2007.

Interventions

Anthropometric measurements were recorded and Z-scores were computed serially at birth, discharge, 40 weeks post menstrual age (PMA), and at 1, 3, 6 and 12 months of corrected age. Developmental quotient (DQ) at 12 months corrected age was assessed.

Results

Z-scores for weight, length and head circumference (HC) at birth were ?1.21(±0.92), ?0.98(±1.32) and ?0.70(±1.14), respectively for VLBW infants and ?0.37(±0.72), ?0.11(±0.96) and 0.05(±0.73) respectively for NBW infants. VLBW infants had a significant drop in all Z-scores by discharge (P<0.001). There was a catch up to birth scores by 12 month age. VLBW infants had significantly lower Z-scores for weight, length and HC at one year corrected age as compared to NBW infants (P =0.01, 0.04 and 0.001, respectively). DQ at 12 months was significantly lower in VLBW infants (91.5+7.8) than NBW infants (97.5±5.3) (P <0.001). DQ of small for gestational age (SGA) and appropriate for gestational age (AGA) VLBW infants was comparable.

Conclusion

VLBW infants falter in their growth during NICU stay with a catch-up later during infancy. In comparison to NBW infants, they continue to lag in their physical growth and neurodevelopment at 1 year of corrected age.