Type 2 diabetes mellitus in pediatrics: a new challenge

Michelle Van Name, Nicola Santoro

New Haven, USA

Author Affiliations: Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA (Van Name M, Santoro N)

Corresponding Author: Nicola Santoro, MD, PhD, Yale University School of Medicine, Department of Pediatrics, 330 Cedar Street, P.O. Box 208064, New Haven, CT 06520, USA (Tel: 203-737-6356; Fax: 203-785-6421; Email: nicola.santoro@yale.edu)

doi: 10.1007/s12519-013-0438-9

Background: The increased prevalence of childhood obesity in the last few years has been accompanied by the increase in prevalence of type 2 diabetes in pediatrics. In this paper, we will review the risk factors and the pathogenic determinants leading to type 2 diabetes in youth.

Data sources: We searched on PubMed with the key words: obesity, type 2 diabetes, children, adolescents, youth, non-alcoholic fatty liver disease, genes and selected those publications written in English that we judged to be relevant to the topic of the review.

Results: Based on the data present in the literature, we reviewed the following three topics: 1) the role of ectopic fat deposition, in particular of fatty liver, in the pathogenesis of pediatric type 2 diabetes; 2) the progression to type 2 diabetes in pediatrics and how it differs from adults, and 3) current theraputic options.

Conclusion: Type 2 diabetes in youth is a complex disease, creating new challenges in treatment and prevention.

Key words: non-alcoholic fatty liver disease; obesity; type 2 diabetes mellitus

World J Pediatr 2013;9(4):293-299

The association between hypertensive disorders in pregnancy

and bronchopulmonary dysplasia: a systematic review

Guang-Liang Bi, Fei-Li Chen,Wei-Min Huang

Guangzhou, China

Author Affiliations: Department of Neonatology (Bi GL, Huang WM)and Department of Hematology (Chen FL), Nanfang Hospital, Southern Medical University, Guangzhou 510515, China

Corresponding Author: Wei-Min Huang, MD, Department of Neonatology, Nanfang Hospital, 1838 Guangzhou Avenue North,  Guangzhou 510515, China (Tel: 86-20-61641923; Fax: 86-20-61641923; Email: drhwm2003@hotmail.com)

doi: 10.1007/s12519-013-0439-8

Background: Whether hypertensive disorders in pregnancy (HDP) are the risk factors of bronchopulmonary dysplasia (BPD) is controversial. A systematic review was made to determine the association between HDP and BPD in preterm infants.

Methods: We searched PubMed, Embase, Cochrane Library, ScienceDirect, Web of Science, with no language limitation, and reviewed the reference lists of the selected articles to identify additional relevant publications and contacted the authors of relevant studies for further information. The data were extracted independently by 2 reviewers who used a predetermined data extraction form. Studies were combined with an odds ratio (OR) using a random-effects model. Meta-regression and subgroup analysis were used to explore potential confounders. Funnel plots, Egger's test and Begg's test were used to investigate the publication bias. The Trim and Fill method was used to control the publication bias.

Results: A total of 787 studies were identified and only 15 studies (20 779 patients) were included. The pooled unadjusted OR showed that HDP was significantly associated with BPD (P=0.04; OR=1.29, 95% CI=1.01-1.65). Heterogeneity was substantial (I²=74%) and might be partially explained by different variables in maternal complications between the control groups across the studies. The pooled adjusted OR suggested the same conclusion that HDP was a risk factor for BPD (P=0.01; OR=1.59, 95% CI=1.11-2.26). Funnel plot and Egger's test showed that there were publication bias of unadjusted estimate of association between HDP and BPD.

Conclusions: Unadjusted analyses showed that the rate of BPD was slightly higher in the infants exposed to HDP, and adjusted analyses confirmed this finding. But this result should be interpreted cautiously because substantial heterogeneity and publication bias were identified in this review.

Key words: bronchopulmonary dysplasia; hypertensive disorders in pregnancy; preeclampsia; pregnancy induced hypertension

World J Pediatr 2013;9(4):300-306

Effects of supervised exercise program on metabolic function in overweight adolescents

Marco Meucci, Carol Cook, Chelsea Diane Curry, Laura Guidetti, Carlo Baldari, Scott Robert Collier

Boone, NC, USA

Author Affiliations: Health Science Department, University of Rome "Foro Italico" (Meucci M, Guidetti L, Baldari C); Health Leisure and Exercise Science Department, Appalachian State University, Boone, NC, USA (Cook C, Collier SR, Curry CD)

Corresponding Author: Scott Robert Collier, 111 Rivers Street, 051 Holmes Convocation Center, Boone, NC 28608-2071, ASU Box 32071, USA (Tel: 828-262-7145; Email: colliersr@appstate.edu)

doi: 10.1007/s12519-013-0440-2

Background: Inactivity is a primary factor related to childhood obesity, yet aerobic exercise has been shown to prevent weight gain and improve fitness in adolescents. Moreover, children become less active during their summer break from school. This study compared the effects of 4 and 8 weeks of supervised summer activity versus an unsupervised summer break on metabolic function and fitness in adolescents.

Methods: Twenty-two adolescents were divided into 4-week (n=6, weight 48.1±14.9 kg, body fat 27.4±8.4%) and 8-week exercise groups (n=6, weight 43.4±10.9 kg, body fat 28.5±12.8%), that performed supervised, play-based physical activity, versus an age-matched 8 week control group that maintained their typical summer break (n=10, weight 41.7±10.0 kg, body fat 23.7±8.0%). Anthropometrics, resting energy expenditure (REE), resting heart rate (RHR) and peak aerobic capacity (VO_2peak) were evaluated before and after the intervention (4 or 8 weeks).

Results: REE showed group differences in post-training conditions (the 4-week group vs. the control group, 1220±169 vs. 1067±144 kcal/die, and the 8-week group vs. the control group, 1202±151 vs. 1067±144 kcal/die, P=0.047), but RHR decreased (pre-program vs. post program: 97±22 vs. 80±8 beat/min, P=0.001) and VO_2peak significantly increased (pre-program vs. post program: 27.8±7.8 vs. 34.8±6.5 mL/kg/min, P=0.001) in the 8-week group compared to the control group.

Conclusions: Eight weeks of supervised play-based activity increased REE and VO_2peak in adolescents with concomitant decreases in RHR. These data suggest that this novel model of exercise prescription could be considered world-wide by clinicians to improve fitness base in adolescents and help to combat the growing epidemic of childhood obesity.

Key words: cardiorespiratory fitness; functional physiology; overweight adolescents; supervised exercise

World J Pediatr 2013;9(4):307-311

Psychological, cognitive and maternal stress assessment in children with primary ciliary dyskinesia

Marco Carotenuto, Maria Esposito, Francesca Di Pasquale, Sara De Stefano, Francesca Santamaria

Naples, Italy

Author Affiliations: Unit of Child and Adolescent Neuropsychiatry Clinic, Department of Mental and Physical Health, and Preventive Medicine, Second University of Naples (Carotenuto M, Esposito M, Di Pasquale F); Department of Pediatrics, Federico II University, Naples, Italy (De Stefano S, Santamaria F)

Corresponding Author: Maria Esposito, MD, Clinic of Child and Adolescent Neuropsychiatry, Second University of Naples, Via Sergio Pansini 5 PAD, 11, 80131 Naples, Italy (Tel: 0039-81-5666988; Fax: 0039-

81-5666694; Email: maria.esposito2@unina2.it)

doi: 10.1007/s12519-013-0441-1

Background: Primary ciliary dyskinesia (PCD) is a rare disorder due to structure and functional abnormalities of respiratory cilia. There are no reports on the behavioral and psychological aspects of children and adolescents with PCD. This study was undertaken to assess the cognitive and behavioural characteristics, and the parental stress of a population of school-aged children with PCD.

Methods: Ten PCD and 34 healthy school-aged children underwent Wechsler Intelligence Scale for Children-III edition, Child Behavior Check-List questionnaire (CBCL), Parenting Stress Index-Short Form tests in order to perform a behavioural and psychological evaluation.

Results: PCD children showed significant behavioral and social competent problems in CBCL scale than control children, in particular with regard to internalizing problems score (P<0.001). Parental distress, parent-child interaction and total stress in the mothers of PCD patients were higher than those in the controls' parents (P<0.001).

Conclusion: Our findings pinpoint the importance of specific psychological support in the clinical management of children with PCD.

Key words: intelligent quotients; parental stress; primary ciliary dyskinesia; Wechsler Intelligence Scale for Children-III edition

World J Pediatr 2013;9(4):312-317

Influence of nose and mouth leaks on peripheral oxygen saturation during continuous positive airway pressure in neonates

Hendrik Stefan Fischer, Charles Christoph Roehr, Hans Proquitté, Gerd Schmalisch

Berlin, Germany

Author Affiliations: Department of Neonatology, Charité University Medicine Berlin, Germany (Fischer HS, Roehr CC, Proquitté H, Schmalisch G)

Corresponding Author: HS Fischer, MD, Department of Neonatology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany (Tel: +49 30 450 516104; Fax: +49 30 450 516921; Email: hendrik.fischer@charite.de)

doi: 10.1007/s12519-013-0435-z

Background: Nose and mouth leaks impair effective pressure transmission during neonatal continuous positive airway pressure (CPAP), but little is known about how these leaks affect physiological parameters. This study investigated the influence of nose leaks and spontaneous mouth opening on peripheral oxygen saturation (SpO₂) and respiratory rate (RR) using nasopharyngeal CPAP.

Methods: In 32 neonates with a gestational age of 30 (24-38) weeks and a birth weight of 1435 (710-2730) g, SpO₂ and RR measurements were taken with and without occlusion of the contralateral nostril in a randomized cross-over trial in 1-minute intervals over a 10-minute period during each condition. Mouth opening and newborn activity were documented.

Results: SpO₂ with open nostril was comparable to that with occluded nostril [93 (78.5-99.5)% vs. 94 (80-100)%, P=0.20]. RR decreased from 51 (26-82)/min to 48 (32-85)/min (P=0.027). In infants with an SpO₂ ≤93% during open nostril (n=17), SpO₂ increased after nostril occlusion [91 (80-96)% vs. 89.5 (78.5-93)%, P=0.036]. The mouth was open in 78.5% of measurements with open nostril, and in 87.4% of measurements after nostril occlusion (P=0.005). No significant influence of mouth opening or closure on SpO₂ or RR was detected.

Conclusions: In neonates on unilateral nasopharyngeal CPAP with an SpO₂ ≤93%, occlusion of the contralateral nostril significantly increased SpO₂ and reduced RR. The beneficial physiological effects further support using binasal prongs to minimize nose leaks in this population. Future studies should investigate the beneficial effects of reducing mouth leaks when applying CPAP to these infants.

Key words: continuous positive airway pressure; neonates; oxygen saturation; respiratory rate

World J Pediatr 2013;9(4):318-322

Acute kidney injury in a single neonatal intensive care unit in Turkey

Fatih Bolat, Serdar Comert, Guher Bolat, Oznur Kucuk, Emrah Can, Ali Bulbul, Hasan Sinan Uslu, Asiye Nuhoglu

Istanbul, Turkey

Author Affiliations: Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Cumhuriyet University, Sivas (Bolat F); Department of Pediatrics, Division of Neonatology, Sisli Children Hospital, Istanbul (Bolat F, Comert S, Can E, Bulbul A, Uslu HS, Nuhoglu A); Goztepe Training and Research Hospital, Istanbul (Bolat G); Department of Pediatrics, Medical Faculty, Yeditepe University, Istanbul, Turkey (Kucuk O).

Corresponding Author: Fatih Bolat, MD, Cumhuriyet Üniversitesi, Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Yenidoğan Kliniği, Sivas, Türkiye (Tel: 90-03462581171; Fax: 90-03462581305; Email: fatihbolat74@gmail.com)

doi:10.1007/s12519-012-0371-3

Background: Although advances in perinatal medicine have increased the survival rates of critically ill neonates, acute kidney injury (AKI) is still one of the major causes of mortality and morbidity in neonatal intensive care units. This study aimed to determine the prevalence of AKI and analyze demographic data and risk factors associated with the mortality or morbidity.

Methods: Of 1992 neonates hospitalized between January 2009 and January 2011, 168 with AKI were reviewed in the study. The diagnosis of AKI was based on plasma creatinine level >1.5 mg/dL, which persists for more than 24 hours or increases more than 0.3 mg/dL per day after the first 48 hours of birth while showing normal maternal renal function.

Results: The prevalence of AKI was 8.4%. The common cause of AKI was respiratory distress syndrome, followed by sepsis, asphyxia, dehydration, congenital anomalies of the urinary tract, congenital heart disease, and medication. The prevalence of AKI in neonates with birth weight lower than 1500 g was about three-fold higher than in those with birth weight higher than 1500 g (P<0.05). Pregnancy-induced hypertension, preterm prolonged rupture of membranes, and administration of antenatal corticosteroid were associated with increased risk of AKI (P<0.05). Umbilical vein catheterization, mechanical ventilation and ibuprofen therapy for patent ductus arteriosus closure were found to be associated with AKI (P<0.05). The overall mortality rate was 23.8%. Multivariate analysis revealed that birth weight less than 1500 g, mechanical ventilation, bronchopulmonary dysplasia, anuria, and dialysis were the risk factors for the mortality of infants with AKI.

Conclusions: Prenatal factors and medical devices were significantly associated with AKI. Early detection of risk factors can reduce the mortality of AKI patients.

Key words: acute kidney injury; mortality; neonatal intensive care unit; prevalence; risk factors

World J Pediatr 2013;9(4):323-329

Morphometric assessment of liver fibrosis may enhance early diagnosis of biliary atresia

Ahmed F Abdalla, Abeer Fathy, Khaled R Zalata, Ahmed Megahed, Ahmed Abo-Alyazeed, Mohammed Ezz El regal

Mansoura, Egypt

Author Affiliations: Pediatric Gastroenterology and Hepatology Unit, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Egypt (Abdalla AF, Fathy A, Megahed A, Ezz El regal M); Pathology Department, Faculty of Medicine, Mansoura University, Egypt (Zalata KR); Community and Public Health Medicine; Department of Public Health, Faculty of Medicine, Mansoura University, Mansoura, Egypt (Abo-Alyazeed A)

Corresponding Author: Abeer Fathy, Pediatric Gastroenterology and Hepatology Unit, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Egypt (Tel: 00201009832561; Fax: 0020502220679; Email: abeerfathy2000@yahoo.com)

doi: 10.1007/s12519-013-0423-3

Background: Neonatal cholestasis syndrome is considered as a major challenge in pediatric practice. This study was undertaken to investigate the value of morphometric assessment of hepatic fibrosis in early diagnosis of biliary atresia.

Methods: We studied liver biopsy specimens from 53 patients with neonatal cholestasis. The patients were assigned to two groups: group 1 (25 patients with biliary atresia) and group 2 (28 patients with non-obstructive cholestasis). Morphometric assessment of fibrosis was performed for all biopsies; in addition, another twelve histological parameters were estimated and scored on a scale of 0 to 4. Biopsies of infants aged 60 days or younger were characterized and analyzed separately.

Results: Morphometric value of fibrosis was significantly higher in group 1 than in group 2 (16.8±8.4% vs. 5.9±2.3%, respectively; P<0.001). By multiple regression analysis, bile ductular plugs, morphometric assessment of fibrosis, rosetting, portal tract inflammation and pattern of cholestasis were found to be significant in discriminating the two groups. In infants aged 60 days or younger, a cutoff value for morphometric assessment of fibrosis of 7.5% was the discriminating point between the two groups with a sensitivity of 80% and a specificity of 84%.

Conclusion: Morphometric assessment of hepatic fibrosis could enhance the value of liver biopsy in early diagnosis of biliary atresia.

Key words: biliary atresia; morphometry; neonatal cholestasis; neonatal hepatitis

World J Pediatr 2013;9(4):330-335

Comparison of underlying factors behind parental refusal or consent for lumbar puncture

Hassib Narchi, Ghassan Ghatasheh, Noura Al Hassani, Layla Al Reyami, Qudsiya Khan

Al Ain, United Arab Emirates

Author Affiliations: Faculty of Medicine & Health Sciences (Narchi H); Tawam Hospital (Ghatasheh G, Hassani NA, Reyami LA); Al Ain Hospital, Al Ain, United Arab Emirates (Khan Q)

Corresponding Author: Hassib Narchi, Department of Pediatrics, Faculty of Medicine & Health Sciences, United Arab Emirates University, P.O Box 17666, Al Ain, United Arab Emirates (Tel: +971 3 7137414; Fax: +971 3 7672022; Email: hassib.narchi@uaeu.ac.ae)

doi: 10.1007/s12519-013-0419-z

Background: Although lumbar puncture (LP) is a safe procedure in experienced hands, some parents fear having it performed on their children and refuse consent. The factors associated with this refusal are unclear, and any differences with consenting parents might provide clues as to how to address them. Therefore, we compared the underlying factors between the parents who refuse and those who consent to this procedure, as well as their children's outcomes.

Methods: A prospective study of the two groups of parents was conducted by a face-to-face structured interview. Parents' demographic factors, knowledge, perceptions, beliefs and attitudes, as well as their children's outcomes, were compared. The odds ratio (OR) with 95% confidence intervals was calculated for significant associations.

Results: Consent was declined by 24 out of 55 families (44%). Alternative options were offered more often to those refusing consent (OR=5.7). Significantly more parents who refused consent also refused bladder catheterization (OR=18), knowing someone with complications following LP (OR=8.7), felt that it was not needed (OR=7.9) or that it induced complications (OR=12.5). A significantly higher proportion of the consenting parents were aware that meningitis might cause convulsions (OR=4.6), deafness or blindness (OR=2.9).

Conclusion: The differences in the understanding, perceptions, beliefs and fears between the parents who refused consent and those who agreed, can provide clues to the developing of appropriate strategies when requesting consent for LP.

Key words: consent; lumbar puncture; procedure; spinal tap

World J Pediatr 2013;9(4):336-341

Efficacy and safety of serial injections of botulinum toxin A in children with spastic cerebral palsy

Ya-Jie Wang, Bao-Qin Gao

Beijing, China

Author Affiliations: Department of Pediatrics, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China (Wang YJ, Gao BQ)

Corresponding Author: Ya-Jie Wang, Department of Pediatrics, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China (Tel: +86-10-67096620; Email: yajienet@yahoo.com.cn)

doi: 10.1007/s12519-013-0442-0

Background: Botulinum toxin A (BTX-A) has been successfully used as a treatment for children with spastic cerebral palsy; however, the effect of BTX-A on reducing spasticity only lasts a few months, thus serial injections are required. The present study was to evaluate the efficacy and safety of serial injections of BTX-A in children with spastic cerebral palsy.

Methods: Fifty-two pediatric patients with spastic cerebral palsy, 2-12 years of age (mean age, 4.79±2.70), were retrospectively analyzed. Muscle tone was assessed with the Modified Ashworth Scale, and gait was assessed with the Physician Rating Scale. Assessments were undertaken at baseline, 3 months, and 6 months after serial injections of BTX-A.

Results: The beneficial effects of BTX-A occurred 1 week after the injection, whereas the adverse side-effects appeared within 1 week and lasted <2 weeks. BTX-A significantly improved muscle tone and gait 3 and 6 months after its serial injections compared to baseline (P <0.05).

Conclusions: Serial injections of BTX-A are effective and safe for children with spastic cerebral palsy. The side-effects of serial injections of BTX-A are mild and self-limited.

Key words: botulinum toxin A; cerebral palsy; children; spasticity

World J Pediatr 2013;9(4):342-345

Clinical characteristics of adenovirus associated lower respiratory tract infection in children

Mei-Ping Lu, Li-Ya Ma, Qi Zheng, Li-Li Dong, Zhi-Min Chen

Hangzhou, China

Author Affiliations: Department of Respiratory (Ma LY, Dong LL, Chen ZM, Lu MP); Department of Rheumatology and Immunology and Allergy (Zheng Q), Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China

Corresponding Author: Mei-Ping Lu, Department of Pulmonology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China (Tel: 86-571-87061007; Fax: 86-571-87033296; Email: meipinglu@126.com)

doi: 10.1007/s12519-013-0431-3

Background: Acute lower respiratory tract infection (ALRI) due to adenovirus infection is a low frequency event but often causes severe outcome. This study was undertaken to uncover the clinical and epidemiological features of adenovirus infection in children.

Methods: Hospitalized children with ALRI were analyzed through continuous monitoring from 2006 to 2012. Nasopharyngeal aspirates were examined by direct immunofluorescence to detect respiratory agents including respiratory syncytial virus, adenovirus, influenza virus types A/B, parainfluenza virus types 1/2/3. Chlamydia pneumonia, Mycoplasma pneumonia and Chlamydia trachomatis were determined by real-time PCR. A retrospective analysis was made of 479 patients with positive infection of adenovirus.

Results: The positive detection rate of adenovirus was 0.63% in patients with ALRI. The incidence rate of adenovirus-associated acute lower respiratory tract infection peaked at the second six months of life. The morbidity was much higher in winter, spring and summer than in autumn. Patients with pneumonia accounted for 73.90% of the patients. More than one-third of the patients developed severe pneumonia, whereas no death was found. Features of severe adenovirus-associated lower respiratory tract infection included persistent high fever with serious infective symptoms, and hepatic dysfunction was one of the most common complications. Mixed infection of atypical pathogens was common (18.58%) in this study.

Conclusions: Adenovirus is a critical pathogen that can cause severe respiratory infections even in immunocompetent children. Coinfection of adenovirus with atypical pathogens is common. Antibiotic treatment with azithromycin or erythromycin is necessary in patients with mixed infection of atypical pathogens.

Key words: adenovirus; children; respiratory tract infection

World J Pediatr 2013;9(4):346-349

Relations of maternal psychopathologies, social-obstetrical factors and mother-infant bonding at 2-month postpartum: a sample of Turkish mothers

Emel Örün, Sıddıka Songül Yalçın, Banu Mutlu

Ankara, Turkey

Author Affiliations: Department of Pediatrics, Fatih University Hospital, Ankara, Turkey (Örün E); Social Pediatrics Unit, Hacettepe University İhsan Doğramacı Children's Hospital, Ankara, Turkey (Yalçın SS, Mutlu B)

Corresponding Author: Sıddıka Songül Yalçın, Department of Pediatrics, Hacettepe University Faculty of Medicine, Social Pediatrics Unit, Samanpazari 06100 Ankara, Turkey (Tel: 90 312 305 11 34; Fax: 90 312 324 32 84; Email: siyalcin@hacettepe.edu.tr)

doi: 10.1007/s12519-013-0432-2

Background: The mental health of the mother influences early mother-infant relationship. This study aimed to explore the relations between maternal psychopathologies, particularly postpartum depression, social-obstetrical factors and mother-infant bonding.

Methods: One hundred and eighty-nine mother-infant pairs who participated in the longitudinal study entitled "Mother-Infant Care Study" were evaluated at the second month postpartum. The Brief Symptom Inventory (BSI) had been applied to all mothers in the first 3 days postpartum. At the second month postpartum, mothers were assessed with the Edinburgh Postpartum Depression Scale (EPDS), Postpartum Bonding Questionnaire (PBQ), and Mother-Infant Bonding Scale (MIBS).

Results: The mean maternal age was 25.1 (±5.2) years. The EPDS scores were higher in the mothers who had been supported lifelong by a psychologist due to psychological problems, had a birth interval of ≤2 years, and had smoking habits at the second month postpartum. Mothers with a female infant had higher PBQ score than those with a male infant. The EPDS score was correlated positively with the PBQ and MIBS scores. There were positive correlations between the EDS scores and all subscales of PBQ and MIBS scores. Some subscales and indexes of the BSI were correlated with the PBQ, MIBS and EPDS scores.

Conclusion: Identifying postpartum depression and other psychopathologies in mothers is critical for prevention of mother-infant bonding impairment in the early postpartum period.

Key words: maternal psychopathologies; mother-infant bonding; postpartum depression; risk factors

World J Pediatr 2013;9(4):350-355

Effect of thimerosal on the neurodevelopment of premature rats

Yan-Ni Chen, Jue Wang, Jie Zhang, Su-Jiao Li, Li He, Dong-Dong Shao, Hui-Ying Du

Xi'an, China

Author Affiliations: The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Institute of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, China (Chen YN, Wang J, Li SJ); Affiliated Xi'an Children's Hospital of Medical College of Xi'an Jiaotong University, Xi'an 710002, China (Chen YN, Zhang J, He L, Shao DD, Du HY)

Corresponding Author: Jue Wang, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, and Institute of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an 710049, China (Tel: 86-29-82663497; Fax: 86-29-82663497; Email: Juewang1@126.com).

doi: 10.1007/s12519-013-0443-z

Background: This study was undertaken to determine the effect of thimerosal on the neurodevelopment of premature rats.

Methods: Thimerosal was injected into premature SD rats at a dose of 32.8, 65.6, 98.4 or 131.2 μg/kg on postnatal day 1. Expression of dopamine D4 receptor (DRD4) and serotonin 2A receptor (5-HT2AR), apoptosis in the prefrontal cortex on post-injection day 49, and learning and memory function were studied and compared with those in a control group injected with saline.

Results: Expression of DRD4 and 5-HT2AR and learning function decreased, and apoptosis increased significantly in the 131.2 μg/kg group (P<0.001). Memory function was significantly impaired by 65.6 (P<0.05), 98.4 and 131.2 μg/kg (P<0.001).

Conclusions: The negative adverse consequences on neurodevelopment observed in the present study are consistent with previous studies; this study raised serious concerns about adverse neurodevelopmental disorder such as autism in humans following the ongoing worldwide routine administration of thimerosal-containing vaccines to infants.

Key words: dopamine D4 receptor; neurodevelopment; serotonin 2A receptor; thimerosal

World J Pediatr 2013;9(4):356-360

Isolated persistent elevation of alanine transaminase for early diagnosis of pre-symptomatic Wilson's disease in Chinese children

Joannie Hui, Yuet-Ping Yuen, Chung-Mo Chow, Josephine Chong, Grace Chiang, Chi Keung  Cheung, Eric LK Law, Chloe Miu Mak, Ching-Wan Lam, Patrick MP Yuen, Nelson LS Tang

Hong Kong, China

Author Affiliations: Department of Pediatrics (Hui J, Chow CM, Chong J, Chiang G, Yuen PMP), Joint Metabolic Clinic (Hui J, Chong J, Chiang G, Law ELK, Tang NLS), Department of Chemical Pathology (Yuen YP, Cheung CK, Law ELK, Tang NLS), Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Kowloon West Cluster Laboratory Genetic Service, Department of Pathology, Princess Margaret Hospital, Hong Kong (Mak CM); Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong (Lam CW)

Corresponding Author: Joannie Hui, MD, 6/F, Clinical Sciences Building, Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China (Tel: 852-2632-2982; Fax: 852-2636-0020; Email: joanniehui@cuhk.edu.hk)

doi: 10.1007/s12519-013-0436-y

Background: Recent studies presented a contradictory approach for the investigation of pediatric patients with an isolated increase in alanine transaminase. While classical teaching advised for a thorough investigation, recent studies suggested the yield on further investigation was low and thus not necessary. Yet the approach to the same clinical problem may need to be different due to variable disease prevalence rates among different ethnic populations. For the population with a higher prevalence rate of genetic liver diseases like Wilson's disease, an abnormal liver function may be the first presenting feature for some patients.

Methods: We reviewed 10 Chinese children with Wilson's disease who were diagnosed at a presymptomatic stage because of an isolated persistent elevation of alanine transaminase.

Results: All 10 patients did not have overt symptoms of liver impairment or neurological deficit. They were picked up incidentally with an abnormal liver function test. All patients were started on treatment shortly after diagnosis, and they remained well and symptom-free on the latest follow-up.

Conclusions: This case series illustrated that an isolated persistent elevation of alanine transaminase is an important clue to the early diagnosis of pre-symptomatic Wilson's disease. It is particularly relevant in the Asian population where the disease is more prevalent.

Key words: alanine transaminase; isolated persistent elevation; Wilson's disease

World J Pediatr 2013;9(4):361-364

Ventilator-associated pneumonia in an Italian pediatric intensive care unit: a prospective study

Maria Francesca Patria, Giovanna Chidini, Ludovica Ughi, Cinzia Montani, Edi Prandi, Carlotta Galeone, Edoardo Calderini, Susanna Esposito

Milan, Italy

Author Affiliations: Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (Patria MF, Esposito S); Pediatric Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy (Chidini G, Ughi L, Montani C, Prandi E, Calderini E); Department of Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (Galeone C); Department of Occupational Health, Clinica del Lavoro Luigi Devoto, Università degli Studi di Milano, Milan, Italy (Galeone C)

Corresponding Author: Susanna Esposito, MD, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, via Commenda 9, 20122 Milan, Italy (Tel: +39-02-55032498; Fax: +39-02-50320206; Email: susanna.esposito@unimi.it)

doi: 10.1007/s12519-013-0444-y

Background: This study was undertaken to determine the prevalence, risk factors and outcomes associated with ventilator-associated pneumonia (VAP) in a European pediatric intensive care unit (PICU).

Methods: A total of 451 children who had been mechanically ventilated in the PICU for ≥48 hours during a 3-year period were enrolled in this prospective study.

Results: In comparison with children without VAP, 30 children (6.6%) who developed VAP had a longer PICU stay (P=0.0001) and hospital stay (P=0.0001), and a higher mortality rate (P=0.04). Logistic regression analysis showed that the need for re-intubation (P=0.0001), the presence of tracheostomy (P=0.04), and enteral feeding (P=0.02) were independent risk factors for VAP.

Conclusions: A relevant proportion of intubated children develop VAP, which is closely related to invasive procedures. As VAP is associated with increased medical costs and death, multicenter studies are urgently needed to improve the therapeutic approach to VAP and VAP prevention.

Key words: nosocomial infections; pneumonia; ventilator-associated pneumonia

World J Pediatr 2013;9(4):365-368

Aseptic intussuscepted incidental appendectomy: three successful cases

Evangelia Rachmani, Zacharias Zachariou, Ulf Kessler

Berne, Switzerland

Author Affiliations: Department of Pediatric Surgery, Inselspital, University of Berne, Berne, Switzerland (Rachmani E, Kessler U); University of Berne, Berne, Switzerland (Zachariou Z)

Corresponding Author: Ulf Kessler, MD, Department of Pediatric Surgery, University of Berne, Inselspital, CH-3010 Berne, Switzerland (Tel: 0041 31 632 21 11; Fax: 0041 31 632 92 92; Email: ulf.kessler@insel.ch)

doi: 10.1007/s12519-013-0422-4

Background: Incidental appendectomy remains a controversial issue. We aimed to collect experience using a modified surgical technique that could be applied securely in infants.

Methods: We performed aseptic intussuscepted incidental appendectomy (AIIA) in three patients using a technique that is thought to assure appendix necrosis along with intact cecal wall.

Results: There was no perioperative morbidity due to AIIA in the three patients. In two infants the necrotic appendix was found in the diaper. One infant died secondary to diaphragmatic hernia. Autopsy with histological examination revealed that the cecum was intact along with appendix necrosis.

Conclusions: Modified AIIA could securely be performed in the 3 reported cases. We advocate prospective evaluation of the method.

Key words: appendectomy; appendicitis; inversion appendectomy

World J Pediatr 2013;9(4):369-372

Active rehabilitation with venovenous extracorporeal membrane oxygenation as a bridge to lung transplantation in a pediatric patient

Don Hayes Jr, Patrick I McConnell, Thomas J Preston, Andrew R Yates, Stephen Kirkby, Mark Galantowicz

Columbus, Ohio, USA

Author Affiliations: Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA (Hayes D Jr, Yates AR, Kirkby S); Department of Cardiothoracic Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA (McConnell PI, Galantowicz M); Department of Cardiovascular Perfusion, The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA (Preston TJ)

Corresponding Author: Don Hayes Jr, MD, MS, The Ohio State University Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA (Tel: 614-722-3425; Fax: 614-722-3426; Email: hayes.705@osu.edu)

doi: 10.1007/s12519-013-0437-x

Background: Active physical rehabilitation while bridged to lung transplantation with venovenous (VV) extracorporeal membrane oxygenation (ECMO) is an evolving treatment option in adults with limited published experience in pediatric patients.

Methods: The administration of VV ECMO through the placement of a single-site bicaval dual-lumen (BCDL) catheter (Avalon Laboratories, Rancho Dominguez, CA, USA) permits respiratory support in a critically ill patient with avoidance of sedation and paralytics while allowing rehabilitation and oral nutrition.

Results: A 13-year-old girl with advanced interstitial lung disease underwent active rehabilitation while being bridged to lung transplantation with single-site VV ECMO.

Conclusions: The innovative use of single-site VV ECMO with a BCDL catheter is transforming the care of adult patients with advanced lung disease and acute respiratory failure as a method to extend the life of a lung transplantation candidate to maximize all opportunities for organ availability. Based on our experiences, clinicians caring for children should be aware of this potential option in pediatric patients requiring lung transplantation.

Key words: active rehabilitation; bridge; extracorporeal membrane oxygenation; lung transplantation; venovenous

World J Pediatr 2013;9(4):373-374