Follow‐up of the patients after stem cell transplantation for pediatric dilated cardiomyopathy

Dilated cardiomyopathy is a serious problem in pediatric cardiology. Despite the relatively low incidence, the mortality is high. The conservative therapy does not improve the prognosis, and possibilities of heart transplantation are limited. There are multiple trials of use of stem cells for ischemic heart disease in the adult population. This allows us to believe that the method has perspectives in pediatric cardiology. We performed the cell therapy for seven patients, six of them had complete one yr follow‐up after procedure. Five to 30 milliliters of bone marrow was aspirated from the iliac crest and 17 to 122 million BMCs were isolated. The average basal EF was 33.5%. We observed increasing of EF up to 54% (=9.54, p=0.00154) in a 6‐month period and up to 54.5% (=10.82, p= 0.00315) after one yr. The changes of LVEDV also were observed. The LVEDV decreased in average per 13.05%. There were no observed side effects or heart rhythm disorders. Intramyocardial administration of bone marrow‐derived progenitor cells proved to be a technically feasible and safe method. Up until now, the results obtained have been promising and we suppose that bone marrow‐derived progenitor cell intramyocardial transplantation can be used.     

Serum vitamin D levels are lower in Australian children and adolescents with type 1 diabetes than in children without diabetes

Vitamin D is synthesised in the skin through the action of UVB radiation (sunlight), and 25‐hydroxy vitamin D (25OHD) measured in serum as a marker of vitamin D status. Several studies, mostly conducted in high latitudes, have shown an association between type 1 diabetes mellitus (T1DM) and low serum 25OHD. We conducted a case–control study to determine whether, in a sub‐tropical environment with abundant sunlight (latitude 27.5°S), children with T1DM have lower serum vitamin D than children without diabetes. Fifty‐six children with T1DM (14 newly diagnosed) and 46 unrelated control children participated in the study. Serum 25OHD, 1,25‐dihydroxy vitamin D (1,25(OH)₂D) and selected biochemical indices were measured. Vitamin D receptor (VDR) polymorphisms Taq1, Fok1, and Apa1 were genotyped. Fitzpatrick skin classification, self‐reported daily hours of outdoor exposure, and mean UV index over the 35 d prior to blood collection were recorded. Serum 25OHD was lower in children with T1DM (n = 56) than in controls (n = 46) [mean (95%CI) = 78.7 (71.8–85.6) nmol/L vs. 91.4 (83.5–98.7) nmol/L, p = 0.02]. T1DM children had lower self‐reported outdoor exposure and mean UV exposure, but no significant difference in distribution of VDR polymorphisms. 25OHD remained lower in children with T1DM after covariate adjustment. Children newly diagnosed with T1DM had lower 1,25(OH)₂D [median (IQR) = 89 (68–122) pmol/L] than controls [121 (108–159) pmol/L, p = 0.03], or children with established diabetes [137 (113–153) pmol/L, p = 0.01]. Children with T1DM have lower 25OHD than controls, even in an environment of abundant sunlight. Whether low vitamin D is a risk factor or consequence of T1DM is unknown.     

Nocturnal enuresis

Nocturnal enuresis (NE) is increasingly seen as part of a heterogeneous phenomenon that at times will include daytime lower urinary tract symptoms such as urgency, frequency and wetting – with reduced bladder storage, usually due to an overactive bladder. In turn, these may be associated with constipation and/or faecal soiling. This paper discusses these considerations in the management of NE.     

Oral versus intravenous antibiotics in treatment of paediatric febrile neutropenia

The purpose of this study is to determine whether, in low‐risk febrile neutropenic paediatric populations, oral antibiotics are as effective as intravenous antibiotics in obtaining resolution of the febrile neutropenic episode. A comprehensive literature search of MEDLINE, EMBASE and CENTRAL identified prospective, randomised controlled trials comparing oral antibiotics with intravenous antibiotics in the treatment of febrile neutropenic episodes in low‐risk paediatric oncology patients. Outcomes assessed were mortality, rate of treatment failure, length of the febrile neutropenic episode and adverse events. The random effects model was used to calculate risk ratios (RRs) for dichotomous data and mean difference with standard deviation for continuous data. Seven trials were included in the overall analysis, which included 934 episodes of febrile neutropenia in 676 patients aged between 9 months and 20 years. The overall treatment failure rates were not significantly different between oral and intravenous antibiotics (RR: 1.02, 95% confidence interval 0.78–1.32, P= 0.91). In carefully selected low‐risk febrile neutropenic children, empiric treatment with oral antibiotics is a safe and effective alternative to intravenous antibiotics as they lower the cost of treatment as well as psychosocial burden on these children and their families.     

ESRT and MCL correlations in experienced paediatric cochlear implant users

Abstract

The use of electrically evoked stapedius reflex thresholds (eSRT) has been suggested as a useful means for creating a cochlear implant speech processor programme. Studies in adults have shown that there is a high correlation between eSRT programmes and Irrogrammes created through behavioural testing. This study assessed the viability of using eSRT to create speech processor programmes in children, an often difficult-to-test population. Seven children with an average cochlear implant experience of 1.1 years participated in the study. Their most comfortable levels (MCL), established either through behavioural testing or through eSRT, were compared to each other; and parents were asked about their observations on which prrogramme was superior. There was a high correlation between MCLs (r² = 0.789), and there was no significant difference between the programmes, with the eSRT programme being slightly softer than the behavioural programme. Parents reported that the eSRT programme was as good as or better than the behavioural programme. Further studies need to be conducted on using the eSRT programme in the first fitting period in inexperienced cochlear implant users. However, current data suggest the viability of using eSRT programmes safely in the paediatric and difficult-to-assess population.     

From small beginnings: the euthanasia of children with disabilities in Nazi Germany

Although they are the lesser known Nazi atrocities, it is estimated that some 5000-8000 children with physical and intellectual disabilities were killed in Nazi Germany under a programme of euthanasia. Chronologically, they were a precedent, being the Nazis' first organised and systematic killing programme that would later enlarge to include adults with disabilities and ultimately, to the broader programme of racially motivated 'euthanasia' of the holocaust. The programme intimately involved medical staff, including a number of paediatricians, many of whom would go unpunished and continue to practice for many years after the war. This paper outlines the origins and development of the programme, examines how families were involved and affected and looks at what motivated the medical staff involved with the killing. The history of the Nazi child euthanasia programme has a number of important lessons for practicing doctors and health policy-makers in the 21st century.     

Parental attitudes to digital recording: A paediatric hospital survey

Aim: Digital recording is ubiquitous in the community. Its objectivity, permanence and utility in medical education have led to increasing use in health‐care settings. As participants in this process, the perspectives of families are important to inform practice. We surveyed family members of hospitalized children to evaluate their opinions. Methods: A survey was administered to adults in emergency, operating room or ICU waiting areas at a university‐affiliated paediatric hospital in Toronto. Respondents rated the frequency of digital recording in the community and hospital environments, the acceptability of five clinical indications and of consent discussions. Results: Participants completed 154 surveys (response rate 83%) with median (interquartile range) of 2 (1–2) children. Community use of recording >4 times in the week prior was reported by 47 (31%); 42 (28%) reported no recording. The respondents rated the following indications for digital recording acceptable in the health care research 142 (94%), medical education 140 (93%), quality improvement 140 (92%), patient safety 147 (97%), and clinical care (96%). Within healthcare, consent discussions at different times were rated as acceptable before recording by 99%; after recording by 41%; and with no consent by 17%. Conclusion: We performed the first post‐privacy legislation survey of digital recording in Canadian health care. There is widespread acceptance of digital recording in public spaces and health care; however, respondents preferred to provide consent before recording. Balancing these preferences with the demonstrated advantages of video recording in health care presents challenges for optimal health policy creation. This study provides contemporary data to inform discussions.