Has blood pressure increased in children in response to the obesity epidemic?

The associations between elevated blood pressure and overweight, on one hand, and the increasing prevalence over time of pediatric overweight, on the other hand, suggest that the prevalence of elevated blood pressure could have increased in children over the last few decades. In this article we review the epidemiologic evidence available on the prevalence of elevated blood pressure in children and trends over time. On the basis of the few large population-based surveys available, the prevalence of elevated blood pressure is fairly high in several populations, whereas there is little direct evidence that blood pressure has increased during the past few decades despite the concomitant epidemic of pediatric overweight. However, a definite conclusion cannot be drawn yet because of the paucity of epidemiologic studies that have assessed blood pressure trends in the same populations and the lack of standardized methods used for the measurement of blood pressure and the definition of elevated blood pressure in children. Additional studies should examine if favorable secular trends in other determinants of blood pressure (eg, dietary factors, birth weight, etc) may have attenuated the apparently limited impact of the epidemic of overweight on blood pressure in children.     

Is procalcitonin useful in early diagnosis of serious bacterial infections in children?

AIM: To compare diagnostic accuracy of procalcitonin for early diagnosis of serious bacterial infection (SBI) in children presenting with fever and no focus of infection. METHODS: Prospective, observational study involving 72 children (1-36 mo) presenting to the paediatric units of two university hospitals. All children had blood cultures, urine cultures, white blood cell counts (WBC), chest X-ray, C-reactive protein (CRP) and procalcitonin (PCT) done at presentation. RESULTS: Eight (11.1%) children had SBI (1 pneumonia, 2 meningitis, 4 septicaemia/occult bacteraemia, 2 pyelonephritis), 19 (26.4%) had possible bacterial infection (received antibiotic treatment, but no organism grown) and 45 (62.5%) had viral or possible viral infection (virus isolated and/or uneventful recovery without antibiotics). PCT (>2 ng/l), CRP (>50 mg/l) and McCarthy's score (<9) had sensitivities and specificities of 50%/85.9%, 75%/68.7% and 87.5%/67.2%, respectively. Negative and positive likelihood ratios for CRP (>50 mg/l), PCT (>2 ng/l), white blood cells (>15 x 10(5)/l) and McCarthy's score (<9) were 0.36/2.4, 0.58/3.5, 0.94/1.1 and 0.19/2.7, respectively. A combination of PCT, CRP and WBC generated a positive likelihood ratio of 10.6, changing the post-test probability to 54%. CONCLUSION: For early diagnosis of SBI in children presenting with fever and no focus of infection, the diagnostic utility of procalcitonin is similar to the traditional markers infection and clinical scoring. While a low procalcitonin level cannot be used to exclude SBI in this population, a combination of PCT, CRP and WBC may be more useful in predicting SBI.     

Home enteral nutrition in children—2010 nationwide survey of the polish society for clinical nutrition of children

Published epidemiologic data on the administration rates of enteral/parenteral home nutrition is very limited. The aim of this first nationwide study was to assess the availability of pediatric home enteral nutrition (HEN) services in Poland. The questionnaire was sent to all regional centers providing pediatric HEN services in Poland (n = 14). The analysis included the number of pediatric patients who received HEN in 2010, their demographic characteristics and geographical distribution. Furthermore, the distributions of indications and methods of enteral nutrition administration were analyzed, along with the reasons of withdrawal from the HEN program. The number and fraction of children receiving HEN increased in 2010, from 433 (11.34 per 1 million inhabitants) on January 1st to 525 (13.75) on December 31st. Marked differences were observed in geographical distribution of this parameter, from zero to up to 30 pediatric patients per 1 million inhabitants. Median age of patients was 6 years (range: 9 months–18 years). In most cases, HEN was prescribed due to neurological disorders (n = 337, 64.2%), and administered by means of gastrostomy (n = 450, 85.71%). This study revealed the dynamic development of pediatric HEN services in Poland but also documented their potential regional shortages.     

The patellofemoral joint: do age and gender affect skeletal maturation of the osseous morphology in children?

Background

The osseous morphology of the patellofemoral joint is an independent factor that affects the biomechanics of patellofemoral instability.

Objective

The purpose of this study is to determine age- and gender-related differences in the osseous morphology of the patellofemoral joint in children during skeletal maturation.

Materials and methods

This study was approved by the institutional review board and was HIPAA-compliant. We included 97 children and young adults (age range 5–22 years; 51 girls and 46 boys, mean ages 14.3 years and 13.7 years, respectively). We studied 1.5-T knee MR exams, measuring the osseous morphology of the patellofemoral joint (lateral trochlear inclination, trochlear facet asymmetry, trochlear depth, patellar height ratio, tibial tubercle-trochlear groove distance, and lateral patellofemoral angle) for each MR exam. We compared measurements to published values for patellofemoral instability. Physeal patency (open or closing/closed) was determined on MR. We assessed the associations between MR osseous measurements and gender, age and physeal patency using Wilcoxon rank sum test and least square means regression models.

Results

The osseous patellofemoral joint morphology measurements were all within a normal range. There were no significant correlations between MR osseous measurements and age, gender or physeal patency.

Conclusion

During skeletal maturation, age and gender do not affect the osseous morphology or congruency of the patellofemoral joint.     

Are there early features of autism in infants and preschool children?

Autism is characterized by impairments in three areas: (i) reciprocal social interaction; (ii) communication; and (iii) repetitive and stereotyped patterns of interest and behaviour. Despite the finding that parents notice abnormalities and problems with their child's development at a very early age, research shows that diagnoses are often made at an age beyond that recommended for the commencement of early intervention. This paper reviews the range of studies that have sought to elucidate the early features of autism in young, preschool children. Impairments in the capacity for reciprocal social interaction involving preverbal, verbal and non-verbal communication, and play and symbolic behaviour are the key features indicative of autism in infants and preschool children.     

Pentraxin 3 as a novel early biomarker for the prediction of Henoch-Schönlein purpura nephritis in children

We investigated the potential role of pentraxin 3 (PTX3) in Henoch-Schönlein purpura (HSP), a common multisystemic vasculitis affecting children, as a predictor of Henoch-Schönlein purpura nephritis (HSPN). A total of 108 cases consisting of 34 children with HSP, 37 children with HSPN, and 37 healthy control children were enrolled in this prospective study from March 2010 to February 2013. Blood and urine samples were collected to measure plasma PTX3, C-reactive protein (CRP), serum creatinine, blood urea nitrogen (BUN), urine microalbumin (MALB), and β2-microglobulin (β2-MG). Median plasma PTX3 concentrations were significantly higher in children with HSPN and HSP than in control subjects before treatment (6.99, 4.18–9.78 ng/ml; 3.19, 1.13–4.27 ng/ml; 1.24, 0.87–2.08 ng/ml, respectively; all p?<?0.05). Median plasma PTX3 concentrations were also significantly higher in children with HSPN than in children with HSP before treatment (6.99, 4.18–9.78 vs. 3.19, 1.13–4.27 ng/ml; p?<?0.05). After treatment, median plasma PTX3 concentrations significantly decreased in children with HSP (from 3.19, 1.13–4.27 to 1.08, 0.65–2.19 ng/ml; p?<?0.05) and HSPN (from 6.99, 4.18–9.78 to 1.29, 1.01–2.26 ng/ml; p?<?0.05). Plasma PTX3 concentration was positively correlated with CRP (rho?=?0.532, p?=?0.001), MALB (rho?=?0.606, p?<?0.001), β2-MG (rho?=?0.490, p?=?0.002), and 24-h urinary protein quantity (rho?=?0.650, p?<?0.001) in children with HSPN. Considering vasculitis, we found that PTX3 could be used as a more efficient potential predictor of HSPN than CRP as indicated by the area under the receiver operating characteristic (ROC) curve (AUC_ROC) of PTX3 (AUC_ROC?=?0.837; p?<?0.001) and CRP (AUC_ROC?=?0.514; p?=?0.845). The threshold PTX3 concentration with optimal sensitivity and specificity was 4.30 ng/ml (sensitivity73.0 %, specificity79.6 %). Conclusion: PTX3 seems to have an important role in multisystemic vasculitis of HSP, may be involved in the development of HSPN, and used as an early biomarker to predict HSPN.     

What is the role of tonsillectomy in children?]

Tonsillectomy is mandatory in the case of chronic airway obstruction associated with tonsillar hypertrophy and in the case of a unilateral enlarged tonsil which may be malignant. Tonsillectomy may be indicated in recurrent tonsillitis. More rarely, tonsillectomy is performed in children for tonsil bleeding or chronic tonsillitis. Allergy and bleeding disorders are not a contraindication for tonsillectomy.     

Deficits in selective and sustained attention processes in early treated children with phenylketonuria — result of impaired frontal lobe functions?

Twenty normally intelligent children with early treated phenylketonuria (PKU) (IQ: mean=101.4, SD=10.0; age: mean=10 years 11 months, SD=1.3 years) and 20 healthy controls, matched for age, sex and IQ, were assessed for their selective (Stroop Task) and sustained attention (Test-d-2). Using positron emission tomography an activation of the frontal lobe during the Stroop task had previously been demonstrated. In addition to the Stroop Task and the Test-d-2, a short-term memory test as a non-frontal-lobe-function-task was administered to all subjects. Group comparisons demonstrated that PKU children had specific deficits in selective and sustained attention, which were significantly correlated with the concurrent serum phenylalanine concentration.Conclusion The results give evidence that even dietary treated children with PKU were suffering from impaired attentional control mechanisms in spite of a normal IQ. The deficits might be the result of impaired frontal lobe functions.     

Does the length of the history influence the outcome of pneumatic reduction of intussusception in children?

Purpose  

Intussusception is the most common cause of acute abdomen in infants and preschool children. Nonoperative reduction using air enema is an established treatment in children with intussusception. The aim of this study was to determine whether length of the history influences the outcome of pneumatic reduction of intussusception in children?     

The use of laparoscopy in the management of Littre’s hernia in children

Littre's hernia is a rare complication of Meckel's diverticulum. It was originally defined as 'the presence of a Meckel's diverticulum in any hernia sac' by Rieke in 1841. It is difficult to diagnose before surgery. With the advances in the development of laparoscopic surgery in children, diagnosis of this rare condition, together with subsequent repair of Littre's hernia and Meckel's diverticulectomy can be performed by laparoscopy. We herein report the use of laparoscopy in the management of two boys with Littre's hernia, including one with incarcerated hernia.     

Food allergy in children—the current status and the way forward

Food allergy in children is a major health concern, and its prevalence is rising. It is often over-diagnosed by parents, resulting occasionally in unnecessary exclusion of some important food. It also causes stress, anxiety, and even depression in parents and affects the family’s quality of life. Current diagnostic tests are useful when interpreted in the context of the clinical history, although cross-sensitivity and inability to predict the severity of the allergic reactions remain major limitations. Although the oral food challenge is the current gold standard for making the diagnosis, it is only available to a small number of patients because of its requirement in time and medical personnel. New diagnostic methods have recently emerged, such as the Component Resolved Diagnostics and the Basophil Activation Test, but their use is still limited, and the latter lacks standardisation. Currently, there is no definite treatment available to induce life-long natural tolerance and cure for food allergy. Presently available treatments only aim to decrease the occurrence of anaphylaxis by enabling the child to tolerate small amounts of the offending food, usually taken by accident. New evidence supports the early introduction of the allergenic food to infants to decrease the incidence of food allergy. If standardised and widely implemented, this may result in decreasing the prevalence of food allergy.