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Vol 13, No 6
Vol 13, No 6 December 2017 ISSN 1708-8569
Review articles
Original articles
Brief reports
Clinical image
Review articles:
Factors relating caesarean section to persistent pulmonary hypertension of the newborn
  Niralee Babooa, Wen-Jing Shi, Chao Chen
Background: Several studies have clearly demonstrated a significantly higher incidence of persistent pulmonary hypertension of the newborn (PPHN) in neonates delivered by caesarean section (CS) compared to those delivered vaginally. The pathophysiological factors underlying the link between CS and PPHN are still poorly understood. In this review, we describe the mechanisms that could explain the association between CS delivery and subsequent PPHN, as well as potential preventive measures.
Data sources: A literature search was conducted by electronic scanning of databases such as PubMed and Web of Science using the key words "persistent pulmonary hypertension of the newborn", "caesarean section", "iatrogenic prematurity", "oxidative stress", "late preterm", "labor" and "vasoactive agents".
Results: Iatrogenic prematurity, higher rates of late preterm delivery and lack of physiological changes of labor play an important role in the association between CS and PPHN. CS delivery also results in limited endogenous pulmonary vasodilator synthesis and lower levels of protective anti-oxidants in the neonates. In addition, CS delivery exposes infants to a higher risk of respiratory distress syndrome and its concomitant increase in endothelin-1 levels, which might indirectly lead to a higher risk of developing PPHN. We believe that neonates delivered by CS are exposed to a combination of these pathophysiological events, culminating in an endpoint of respiratory distress, hypoxia, acidosis, and delayed transition and thereby increased risks of PPHN. The use of antenatal corticosteroids prior to elective CS in late preterm deliveries, promoting accurate informed-consent process, delaying elective CS to 39 weeks of gestation or beyond and antenatal maternal anti-oxidant supplementation could potentially mitigate the effects of CS delivery and minimize CS-related PPHN.
Conclusions: The link between CS delivery and PPHN is complex. In view of the rising rates of CS worldwide, there is an urgent need to further explore the mechanisms linking CS to PPHN and experimentally test therapeutic options in order to allow effective targeted interventions.
  [Abstract] [Full Text] [PDF]  
Safety and tolerability of the ketogenic diet used for the treatment of refractory childhood epilepsy: a systematic review of published prospective studies
  Qian-Yun Cai, Zhong-Jie Zhou, Rong Luo, Jing Gan, Shi-Ping Li, De-Zhi Mu, Chao-Min Wan
Background: To review the available evidence from prospective studies on the safety and tolerability of the ketogenic diet (KD) for the treatment of refractory childhood epilepsy.
Methods: A comprehensive bibliographic search was performed with the aim of retrieving prospective studies that monitored adverse effects (AEs) in children after receiving the classic or medium-chain triglyceride KD therapy for refractory epilepsy.
Results: A total of 45 studies were retrieved, including 7 randomized controlled trials. More than 40 categories of AEs were reported. The most common AEs included gastrointestinal disturbances (40.6%), hyperlipidemia (12.8%), hyperuricemia (4.4%), lethargy (4.1%), infectious diseases (3.8%) and hypoproteinemia (3.8%). Severe AEs, such as respiratory failure and pancreatitis, occurred in no more than 0.5% of children. Specifically, patients receiving KD therapy should be monitored for osteopenia, urological stones, right ventricular diastolic dysfunction, and growth disturbance. The total retention rates of the diet for 1 year and 2 years were 45.7% and 29.2%, respectively. Nearly half of the patients discontinued the diet because of lack of efficacy. AEs were not the main reason for the KD discontinuation. None of the 24 deaths reported after initiation of the diet was attributed to the KD.
Conclusions: KD is a relatively safe dietary therapy. However, because the KD can cause various AEs, it should be implemented under careful medical supervision. Continuous follow-up is needed to address the long-term impact of the diet on the overall health of children.
  [Abstract] [Full Text] [PDF]  
Therapeutic effects of different drugs on obstructive sleep apnea/hypopnea syndrome in children
  Jing Zhang, Jie Chen, Yong Yin, Lei Zhang, Hao Zhang
Background: This study aimed to compare the therapeutic effects of different drugs on obstructive sleep apnea/hypopnea syndrome (OSAHS) in children by using a network meta-analysis approach.
Methods: PubMed, Embase and Cochrane Library were searched from the inception of each database to November 2015. Randomized controlled trials (RCTs) concerning the comparisons in the therapeutic effects of eight placebo-controlled drugs on OSAHS in children were included in this study. Network meta-analysis combined direct evidence and indirect evidence to evaluate the weighted mean difference (WMD) and surface under the cumulative ranking curves (SUCRA) of therapeutic effects of eight drugs on OSAHS in children.
Results: A total of seven RCTs were finally incorporated into our network meta-analysis. Pairwise meta-analysis results revealed that therapeutic effect of placebo was significantly poorer than that of intranasal mometasone furoate, montelukast, budesonide and fluticasone concerning apnea hypopnea index (AHI) value [WMD=1.40, 95% confidence interval (CI)=1.17-1.63; WMD=2.80, 95% CI=1.01-4.59; WMD=3.50, 95% CI=3.34-3.66; WMD=7.20, 95% CI=5.26-9.14, respectively], and fluticasone is better than placebo concerning sleep efficiency (WMD=3.50, 95% CI=2.42-4.58); regarding visual analogue scale, the therapeutic effect of placebo was poorer compared with sucralfate and clindamycin (WMD=1.94, 95% CI=1.13-2.75; WMD=1.06, 95% CI=0.22-1.90), and sucralfate is better than clindamycin (WMD=-0.88, 95% CI=-1.65 to -0.11). However, network meta-analysis results showed no obvious difference in the therapeutic effects of different drugs on OSAHS regarding AHI and sleep efficiency. Furthermore, the best SUCRA value was very high for fluticasone concerning AHI (86.6%) and budesonide concerning sleep efficiency (94.0%) for OSAHS treatment.
Conclusion: Fluticasone and budesonide have relatively good effects in the treatment of OSAHS in children, thus providing an important guiding significance for the treatment of OSAHS in children.
  [Abstract] [Full Text] [PDF]  
Original articles:
Ventilation during cardiopulmonary resuscitation in children: a survey on clinical practice
  Rafael Gonz¨¢lez, L¨¢zaro Pascual, Alexandra Sava, Sara Tol¨®n, Javier Urbano, Jesus L¨®pez-Herce
Background: This study aimed to investigate the ventilation practice during cardiopulmonary resuscitation (CPR) and after return of spontaneous circulation (ROSC) in children.
Methods: An online survey of CPR practices was designed and sent to healthcare professionals treating children.
Results: A total of 477 healthcare professionals from 46 countries responded to this survey; 92.7% were physicians and 64.2% worked in pediatric intensive care units. Specific CPR guidelines were used by 97.7% of respondents. The respiratory rate most frequently used for children over 12 months was 13 to 20 respirations per minute (rpm) (46% in intubated and 41.8% in non-intubated). For infants under 12 months, the most frequently used respiratory rate was 21 to 30 rpm in intubated patients (37.3%): in non-intubated infants, 13 to 20 rpm (26.5%) and 21 to 30 rpm (26.5%) were used with the same frequency. In North America, the respiratory rate most widely used was 7 to 12 rpm; higher rates (13 to 20 rpm and 21 to 30 rpm) were used in Europe and Latin America (P<0.001). After ROSC, no significant differences in the respiratory rates used were found between the continents. More than 40% of healthcare professionals had a target oxygen saturation below 94%; more than 10% used a target arterial PCO2 below 35 mmHg and more than 13% above 45 mmHg.
Conclusion: There is considerable variation in the management of ventilation of children in cardiac arrest, and international recommendations are not being followed in a high percentage of cases.
  [Abstract] [Full Text] [PDF]  
Oxcarbazepine oral suspension in pediatric patients with partial seizures and/or generalized tonic-clonic seizures: a multi-center, single arm, observational study in China
  Yi Wang, Yin-Bo Chen, Yu-Qin Zhang, Rong Luo, Hua Wang, Jun-Lan Lv, Dong Wang, Sui-Qiang Zhu, Zhong-Dong Lin, Jiong Qin
Background: To assess efficacy and safety of oxcarbazepine (OXC) oral suspension in pediatric patients aged 2-16 years with partial seizures (PS) and/or generalized tonic-clonic seizures (GTCS) in real-world clinical practice in China.
Methods: This 26-week, single arm, multicenter and observational study recruited patients aged 2-16 years with PS or GTCS suitable for OXC oral suspension treatment. Enrolled patients received OXC oral suspension treatment for 26 weeks. Primary endpoints included mean seizure frequency at the end of the treatment and mean seizure frequency reduction at the end of the treatment vs. baseline. Secondary efficacy-related endpoints and safety parameters were also assessed.
Results: Nine hundred and eighty-seven pediatric patients were enrolled and 912 (92.4%) completed the study. The mean seizure frequencies at baseline and the end of week 26 were 13.40¡À64.92 and 1.62¡À19.47 times/month, respectively. The mean seizure frequency reduction was 10.03¡À63.67 times/month and the mean seizure frequency reduction percentage was 90.02%¡À5127.0% (P<0.0001). After 26 weeks of treatment, 82.36%, 7.24% and 3.86% of the patients became controlled, significantly improved and improved, respectively. Adverse events (AEs) were reported in 74 (7.65%) patients. Rash was the most common AE. The efficacy of OXC was not affected by seizure types, age or gender.
Conclusion: This study confirms the efficacy and good safety profile of OXC oral suspension in Chinese pediatric patients aged 2-16 years with PS and/or GTCS.
  [Abstract] [Full Text] [PDF]  
A 2-year step-down withdrawal from inhaled corticosteroids in asthmatic children receiving immunotherapy
  Chun-Hui He, Xing Li, Jun-Hong Lin, Qiang Xiao, Jia-Lu Yu, Ying-Fen Liu, Wen-Hui Jiang, Chen Chen, Li Deng, Jie Zhou
Background: Inhaled corticosteroids (ICSs) for treating asthma are controversial because of their negative effects on the growth of asthmatic children and without clearly defined withdrawal strategy. A 2-year ICS step-down and withdrawal strategy has been developed for asthmatic children receiving 3-year subcutaneous immunotherapy (SCIT).
Methods: Eleven children were included into the SCIT group and 13 children into the ICS group. ICSs were discontinued when children met the following criteria: requiring only 1 puff per day, with good control, for at least 6 months; having a forced expiratory volume in 1 second (FEV1)/forced vital capacity ¡Ý80%; and SCIT discontinued for ¡Ý24 months. The main endpoints were the results of both the childhood asthma control test (C-CAT) and the methacholine bronchial provocation test.
Results: In the SCIT group, all the 11 children had ICS discontinued, with one child developed asthma attack after pneumonia and received ICS again after completion of SCIT. In the ICS group, five children discontinued ICS and developed asthma attacks later and received ICS again; the other eight children developed severe symptoms during ICS step-down. Thus, the discontinuation of ICS was only achieved in the SCIT group. The dose of methacholine that caused a decrease of 20% in FEV1 continued to improve after discontinuation of ICS for the SCIT group and presented better results than the ICS group (P=0.050). After completion of SCIT, the C-CAT had improved significantly after 30 months of treatment compared with the ICS group (P<0.05).
Conclusion: In the present study, we developed a 2-year step-down and withdrawal strategy from ICSs strategy for allergic asthma children receiving SCIT; the strategy was efficacious and safe.
  [Abstract] [Full Text] [PDF]  
Trends of childhood diabetes in Southern Thailand: 20-year experience in a tertiary medical center
  Somchit Jaruratanasirikul, Sudarat Thammaratchuchai, Hutcha Sriplung
Background: The incidence and/or prevalence of both childhood diabetes and the percent of type 2 diabetes mellitus (T2DM) cases in children and young adolescents have been increasing worldwide. This study aimed to examine the 20-year trends of childhood diabetes in a single tertiary medical center in Southern Thailand.
Methods: The medical records of pediatric diabetic patients, aged 0-15 years, diagnosed at Songklanagarind Hospital from 1995 to 2014 were retrospectively reviewed.
Results: During the 20-year period, 156 children were diagnosed with DM: 99 (63.4%) with T1DM, 43 (27.6%) with T2DM, 2 (1.3%) with neonatal diabetes, and 12 (7.7%) with secondary diabetes. The estimated incidence of new patients with diabetes per 100 000 per year doubled from 0.12 in 1995-2000, to 0.24-0.28 in 2001-2004, and further increased to 0.39-0.48 in 2005-2012 and 0.59-0.64 in 2013-2014; and also the proportion of T2DM cases increased from 10%-15% during 1995-2003 to 25%-30% during 2004-2008, and 35%-40% during 2009-2014. At the time of diagnosis, the fasting plasma glucose and glycated hemoglobin levels were significantly greater in T1DM than T2DM patients while the lipid profiles were more abnormal in T2DM than T1DM patients.
Conclusion: The estimated incidences of both T1DM and T2DM in pediatric patients have increased markedly over the 20-year period, and also the percentage of T2DM cases, from 10%-15% in 1995 to 35%-40% in 2014.
  [Abstract] [Full Text] [PDF]  
Cutaneous lesions and disorders in healthy neonates and their relationships with maternal-neonatal factors: a cross-sectional study
  Rita Ábrah¨¢m, Ang¨¦la Meszes, Zita Gyurkovits, Judit Bakki, Hajnalka Orvos, Zsanett Ren¨¢ta Csoma
Background: Cutaneous lesions are very common in neonates. Although a number of studies have reported on their incidence, very little is known about the factors that influence them. We set out to investigate a large population of neonates with the aims of achieving an overall picture of neonatal skin manifestations, and examining their relationships with various maternal, neonatal and perinatal factors.
Methods: This study was conducted on neonates born at the Department of Obstetrics and Gynaecology at the University of Szeged between June 2013 and July 2015. A total of 4658 consecutive infants underwent a whole-body skin examination within the first 72 hours of extrauterine life. The official neonatal medical charts were used to collect data on the history of the participating neonates and on maternal factors.
Results: 74.35% of the neonates exhibited at least one skin manifestation. The major diagnosis groups were transient, benign cutaneous lesions; vascular lesions; traumatic, iatrogenic, congenital or acquired disorders with skin injuries; pigmented lesions; and developmental abnormalities or benign skin tumours. The relationships between the skin findings and six neonatal or maternal factors were examined: gender, gestational age and birth weight of the neonates; maternal age and the number of previous pregnancies of the mothers, and mode and circumstances of the delivery.
Conclusions: We found several significant correlations between the examined maternal/neonatal factors and the occurrence of birthmarks and neonatal skin disorders. Of course, further studies are required to confirm and better understand these associations.
  [Abstract] [Full Text] [PDF]  
Ambulatory clinical parameters and sleep respiratory events in a group of obese children unselected for respiratory problems
  Marco Zaffanello, Giorgio Piacentini, Angelo Pietrobelli, Cristiano Fava, Giuseppe Lippi, Claudio Maffeis, Emma Gasperi, Luana Nosetti, Sara Bonafini, Angela Tagetti, Franco Antoniazzi
Background: Obstructive sleep apnea in children is frequently due to tonsil and adenoid hypertrophy. This study aimed to investigate the relationship between ambulatory clinical parameters and sleep respiratory events in obese children.
Methods: We carried out a prospective respiratory sleep study between 2013 and 2015. Nails obstruction, tonsils enlargement and palate position were subjectively measured. Italian attention deficit hyperactivity disorder (ADHD) rating scale for parents was also performed. The polygraph study was performed using a portable ambulatory device.
Results: Forty-four obese children were consecutively recruited into this study. Mild sleep respiratory disturbance was showed in 31.8% of patients; 18.2% previously had an adeno (tonsillectomy). In 50% of these obese children, both apnea-hypopnea index and oxygen desaturation index showed polygraph abnormal results. ADHD rating scale for parents scores were positive in 9.1% of patients.
Conclusions: We found a high rate of mild sleep respiratory disturbance and ADHD-like symptoms referred by parents. The respiratory disturbance was not totally cured by surgery. Finally, otorhinolaryngology variables were not able to explain mild sleep respiratory disturbance.
  [Abstract] [Full Text] [PDF]  
Is routine use of transanastomotic tube justified in the repair of esophageal atresia?
  Sarath Kumar Narayanan, Arun Preeth Vazhiyodan, Prathap Somnath, Arun Mohanan
Background: Transanastomotic feeding tube (TAFT) is commonly used for post-operative enteral nutrition after esophageal atresia (EA)/tracheoesophageal fistula (TEF) repairs. The purpose of this study is to analyze the therapeutic implications of avoiding a TAFT and its impact on the outcomes post-operatively.
Methods: The medical data of 33 inpatients with EA/TEF type C repair from 2009 to 2014 were retrospectively reviewed. Patients were divided into two groups for comparison based on the usage of TAFT during the repair: TAFT- (without) and TAFT+ (with) groups, without randomization. Both groups were compared statistically for post-operative complications and outcomes.
Results: Eighteen neonates were males and 15 females, with an average birth weight of 2.43¡À0.43 kg and a mean gestational age of 36.15 weeks. Nineteen (57.5%) in the TAFT- group and 14 (42.4%) were in the TAFT+ group. The post-operative complications, need for dilatations, duration of total parenteral nutrition (TPN) and length of hospital stay were similar in both groups. The incidence of pneumonitis was significantly higher in the TAFT+ group.
Conclusions: By avoiding a TAFT, there is no increase in complication rates nor does it entail a prolonged period of TPN. Besides, not using a TAFT may have the advantage of reducing incidence of aspiration and consequent pneumonitis.
  [Abstract] [Full Text] [PDF]  
Pharmacokinetics of sildenafil in children with pulmonary arterial hypertension
  Hugo Ju¨¢rez Olgu¨ªn, Hector Osnaya Mart¨ªnez, Carmen Flores P¨¦rez, Blanca Ram¨ªrez Mendiola, Liliana Rivera Espinosa, Juan Luis Ch¨¢vez Pacheco, Janett Flores P¨¦rez, Ignacio Mora Magaña
Background: Recently, sildenafil was introduced to treat pulmonary arterial hypertension (PAH); however, there are currently few studies on the pharmacokinetics of sildenafil in children. Therefore, we aimed to carry out a pharmacokinetic study of sildenafil in children with PAH using a single dose.
Methods: Twelve children diagnosed with PAH, consisting of with ten males and two females, were recruited for the study after obtaining written consent from their parents or guardians. Blood samples were obtained pre-dose and at 0.25, 0.5, 1, 2, 4, 8 and 12 hours after the oral administration of 1 mg/kg of sildenafil using an extemporal pediatric formulation developed in our laboratory. The samples were analyzed using a previously validated high performance liquid chromatography method.
Results: A pharmacokinetic analysis using the WinNonlin 3.1 program that considered the Akaike information criterion (AIC) for selecting a more adjustable model was performed. The following pharmacokinetic parameters were obtained: maximal concentration (Cmax): 366¡À179 ng/mL, time to maximal concentration: 0.92¡À0.30 hours, elimination half-life (t1/2): 2.41¡À1.18 hours, total clearance (CLtot/F): 5.85¡À2.81 L/hour, volume of distribution (Vd/F): 20.13¡À14.5 L, absorption rate constants (Ka): 0.343 hour¨C1, elimination rate (Ke): 0.35 hour¨C1, area under curve from zero to infinity: 2061¡À618 ng/mL/hour. The data of all patients adjusted to the model of one compartment were corroborated using AIC.
Conclusions: The parameters Ka, Ke and t1/2 were found to be similar to those reported in adults; however, the values of Cmax and Vd/F were significantly higher. Based on these findings, we propose that treatment regimen of sildenafil be adjusted in children with PAH.
  [Abstract] [Full Text] [PDF]  
A comparative analysis of child passenger restraint use in China and the United States
  Jing-Zhen Yang, Li-Ping Li, Hong-Qian Wu, Daniel McGehee, Corinne Peek-Asa
Background: Few published studies have examined child passenger safety practices across countries. This study compared the prevalence and associated factors of child passenger restraint use among children, aged 0 to 17 in the state of Iowa in the United States, and the city of Shantou in China.
Methods: Child restraint use observations were conducted in Iowa and in Shantou in 2012, respectively, among child passengers. Observations in Iowa were conducted at randomly selected gas stations, while in Shantou observations were completed at randomly selected schools or medical clinics. Research observers approached the driver, observed restraint use, and collected brief survey data.
Results: A total of 3049 children from Iowa and 3333 children aged 0 to 17 years from Shantou were observed. For children aged 0 to 3 years, only 0.1% were compliantly restrained in Shantou as compared to 95.9% in Iowa. The proportion of children who were compliantly restrained in Shantou increased with age, but generally decreased with age in Iowa. In Shantou, 36.0% of children aged 0 to 3 were sitting in the front seat as compared to only 1.7% of children of the same age in Iowa. Driver seat belt use was significantly associated with child restraint in both Iowa and Shantou; the association was stronger in Iowa than Shantou for all age groups.
Conclusions: A significantly higher prevalence of children who were not appropriately restrained was observed in Shantou than in Iowa. Our findings support the need of mandatory child safety restraint use legislation in China.
  [Abstract] [Full Text] [PDF]  
Characteristics and clinical role of bronchoscopy in diagnosis of childhood endobronchial tuberculosis
  An-Xia Jiao, Lin Sun, Fang Liu, Xiao-Chun Rao, Yu-Yan Ma, Xi-Cheng Liu, Chen Shen, Bao-Ping Xu, A-Dong Shen, Kun-Ling Shen
Background: Endobronchial tuberculosis (EBTB) is the most frequent complication of primary pulmonary tuberculosis (PTB) in children. The aim of the study was to analyze characteristics and clinical role of bronchoscopy in diagnosis of childhood EBTB.
Methods: A retrospective, descriptive study was undertaken in 157 children with EBTB undergone flexible bronchoscopy (FB) between January 2006 and June 2014.
Results: The median age of the enrolled patients was 3.4 years, with 73.2% of patients under five years old. The most common subtype was tumorous type (145/157, 92.4%). If only involved bronchus were considered, the common affected sites were right middle lobe bronchus (49/228, 21.5%), left upper lobe bronchus (41/228, 18.0%), right upper lobe bronchus (41/228, 18.0%), right main bronchus (35/228, 15.4%), respectively. Children younger than five years old were at higher risk to have multiple endobronchial lesions (P=0.044), with an odds ratio of 2.313 (95% confidence interval: 1.009-5.299). Before the bronchoscopy, only 16 (10.2%) patients were highly suspected of EBTB, while the others were diagnosed as PTB without EBTB (69.4%), or misdiagnosed as pneumonia or foreign body aspiration (20.4%) on admission.
Conclusions: The patients under five years old are at high risk to progress to EBTB and have multiple endobronchial lesions. The most frequent subtype of EBTB in children is tumorous type. The lesions are seen in the right bronchial system more frequently. FB should be performed to detect the endobronchial lesions in suspected patients as soon as possible.
  [Abstract] [Full Text] [PDF]  
Expression of programmed death-1 and its ligands in the liver of biliary atresia
  Pan-Liang Wang, Jun Wang, Ying Zhou, Xiao-Song Chen, Ke-Jun Zhou, Jie Wen, Jian-Jun Zhang, Wei Cai
Background: An aberrant immune response is the predominant pathogenetic factor in biliary atresia (BA). Programmed death-1 (PD-1) and its two ligands, programmed death ligand-1 and programmed death ligand-2 (PD-L1 and PD-L2, respectively) play an important inhibitory role in immune reactions. We aimed to illustrate the expression of these molecules in BA.
Methods: Liver specimens were obtained from infants with BA during the Kasai procedure (early BA) and liver transplantation (late BA). Intrahepatic expression of PD-1, PD-L1, and PD-L2 were examined by immunostaining and compared with that in patients with neonatal hepatitis syndrome and normal controls. The correlation between the expression levels of these molecules in the liver and clinicopathological parameters was analyzed for each group.
Results: Enhanced expression of PD-1 and its ligands occurred in the livers with early BA. In the BA-affected livers, PD-1 was correlated with the degree of peri-biliary inflammation, while PD-L2 was linked more directly with portal fibrosis. None of the three molecules was correlated with the prognosis of the Kasai procedure in patients with early BA.
Conclusion: Only PD-1 and PD-L1 are involved in the immune reactions of early BA. Elucidation of the detailed role of PD-L2 in BA requires further research.
  [Abstract] [Full Text] [PDF]  
Brief reports:
Seroepidemiology of echovirus 30 in Korean children
  Joo Young Lee, Yumi Seo, Ui Yoon Choi, Jong-Hyun Kim, Jin Han Kang
Background: Although aseptic meningitis associated with echovirus type 30 has emerged as a global public health concern, no data have been reported on children's immune status against echovirus type 30. The current study aimed to investigate the seropositivity among Korean children for antibodies against echovirus 30.
Methods: Two hundred and fifty residual serum samples were collected at St. Paul's Hospital. Individuals were categorized by age into four groups: group 1 (3 months-2 years), group 2 (3-6 years), group 3 (7-10 years) and group 4 (11-15 years). Neutralizing antibodies against echovirus 30 were measured.
Results: Seroprotective neutralizing antibodies against echovirus 30 were detected in 129 (49%) individuals. Seropositivity rates were 23%, 48%, 55% and 73% in groups 1-4, respectively. For antibody titers, 1:256-1:512 was the highest neutralizing antibody titer range in group 2, while 1:1024-1:2048 in group 3 and 4. Among the seropositive individuals in group 3 and 4, 6% and 12% had neutralizing antibody titers of 1:2048, respectively.
Conclusions: The seropositivity rate increased significantly with age. The distribution of neutralizing antibody titers varied by age group, and higher ranges of neutralizing antibody titers were observed in higher age groups. These findings suggest high susceptibility to echovirus 30 infection in children younger than 2 years old. Echovirus 30 infection in childhood may have contributed to increased neutralizing antibody titers with age.
  [Abstract] [Full Text] [PDF]  
A transversal pilot study of oropharyngeal carriage of Kingella kingae in healthy children younger than 6 months
  Vasiliki Spyropoulou, Gabriel Brändle, Albane Bertha Rosa Maggio, Rebecca Anderson della Llana, Abdessalam Cherkaoui, Gesuele Renzi, Jacques Schrenzel, Sergio Manzano, Dimitri Ceroni
Background: The aim of this pilot study was to investigate the extent of oropharyngeal Kingella kingae carriage during the first 6 months of life.
Methods: We conducted a monocentric transversal pilot study on healthy children younger than 6 months in order to define the oropharyngeal carriage rate. Participants were recruited between December 2013 and September 2015 among children without symptoms or signs of invasive infections.
Results: We demonstrated an oropharyngeal carriage rate of 0.67% in children younger than 6 months. Due to the really low carriage rate, it was not possible to draw statistically significant conclusion about any other characteristic of our population.
Conclusions: The present study suggests that the oropharyngeal carriage of Kingella kingae among a Swiss population of healthy infants younger than 6 months is exceptional. The scarcity of colonization and disease in the early months of life suggests thus that defense against mucosal carriage and invasive infection is above all provided by vertically acquired immunity. Limited exposure of the neonates due to limited social contacts may also represent another factor avoiding neonates' mucosal Kingella kingae carriage.
  [Abstract] [Full Text] [PDF]  
Clinical image:
A protracted infectious swelling on the neck
  Soner Sertan Kara
  [Abstract] [Full Text] [PDF]  
World Journal of Pediatric Surgery
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