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Vol 14, No 1
Vol 14, No 1 February 2018 ISSN 1708-8569
Review articles
Original articles
Letter to the Editors
Pediatrics in China: challenges and prospects
  Yang Liu, Li-Li Yang, Si-Yun Xu, Zheng-Yan Zhao
  [Abstract] [Full Text] [PDF]  
Review articles:
Significance of continuous rotavirus and norovirus surveillance in Indonesia
  Mohamad Saifudin Hakim, Hera Nirwati, Abu Tholib Aman, Yati Soenarto, Qiuwei Pan
Background: Diarrhea significantly contributes to the global burden of diseases, particularly in developing countries. Rotavirus and norovirus are the most dominant viral agents responsible for diarrheal disease globally. The aim of this review was to conduct a comprehensive assessment of rotavirus and norovirus study in Indonesia.
Data sources: Articles about rotavirus and norovirus surveillance in Indonesia were collected from databases, including PubMed and Google Scholar. Manual searching was performed to identify additional studies. Furthermore, relevant articles about norovirus diseases were included.
Results: A national surveillance of rotavirus-associated gastroenteritis has been conducted for years, resulting in substantial evidence about the high burden of the diseases in Indonesia. In contrast, norovirus infection received relatively lower attention and very limited data are available about the incidence and circulating genotypes. Norovirus causes sporadic and epidemic gastroenteritis globally. It is also emerging as a health problem in immunocompromised individuals. During post-rotavirus vaccination era, norovirus potentially emerges as the most frequent cause of diarrheal diseases.
Conclusions: Our review identifies knowledge gaps in Indonesia about the burden of norovirus diseases and the circulating genotypes. Therefore, there is a pressing need to conduct national surveillance to raise awareness of the community and national health authority about the actual burden of norovirus disease in Indonesia. Continuing rotavirus surveillance is also important to assess vaccine effectiveness and to continue tracking any substantial changes of circulating rotavirus genotypes.
  [Abstract] [Full Text] [PDF]  
Vascular dysfunction of postural tachycardia syndrome in children
  Wei Bai, Si-Yao Chen, Hong-Fang Jin, Jun-Bao Du
Background: Postural orthostatic tachycardia syndrome (POTS) is a form of orthostatic intolerance, and its incidence in children is approximately 6.8% [ 1 ]. The pathogenesis of POTS is complex with multiple, overlapping, interacting pathophysiological mechanisms. Although the specific pathogenic mechanism has remained perplexing, with the discovery of various gasotransmitters and biological peptides, the vascular dysfunction has aroused overwhelming attention.
Data sources: On the basis of searching in a wide range of recent original literatures, we reviewed the pathogenesis of vascular dysfunction in children with POTS.
Results: The flow-mediated vasodilation of POTS patients was greater than that of healthy controls, and the vasodilator factors were increased in patients with POTS under basal condition or under a standing position, while the vasoconstriction factors were reduced.
Conclusions: Vascular dysfunction, as one of pathogenesis in pediatric POTS patients, aff ects the occurrence and development of diseases through a variety of factors.
  [Abstract] [Full Text] [PDF]  
Pigeon chest: comparative analysis of surgical techniques in minimal access repair of pectus carinatum (MARPC)
  Ancuta Muntean, Ionica Stoica, Amulya K. Saxena
Background: After minimally invasive repair for pectus excavatum (MIRPE), similar procedures for pectus carinatum were developed. This study aimed to analyse the various published techniques of minimal access repair for pectus carinatum (MARPC) and compare the outcomes.
Data sources: Literature was reviewed on PubMed with the terms ¡°pectus carinatum¡±, ¡°minimal access repair¡±, ¡°thoracoscopy¡± and ¡°children¡±.
Results: Twelve MARPC techniques that included 13 articles and 140 patients with mean age 15.46 years met the inclusion criteria. Success rate of corrections was n = 125, about 89% in cumulative reports, with seven articles reporting 100%. The complication rate was 39.28%. Since the pectus bar is placed over the sternum and has a large contact area, skin irritation was the most frequent morbidity (n = 20, 14.28%). However, within the complication group (n = 55), wire breakage (n = 21, 38.18%) and bar displacement (n = 10, 18.18%) were the most frequent complications. Twenty-two (15.71%) patients required a second procedure. Recurrences have been reported in four of twelve techniques. There were no lethal outcomes.
Conclusions: MARPC techniques are not standardized, as MIRPE are, so comparative analysis is difficult as the only common denominator is minimal access. Surgical morbidity is high in MARPC and affects > 2/3rd patients with about 15% requiring surgery for complication management.
  [Abstract] [Full Text] [PDF]  
The cost-effectiveness of hypertonic saline inhalations for infant bronchiolitis: a decision analysis
  Paula Heikkilä, Minna Mecklin, Matti Korppi
Background: This study evaluated the cost-effectiveness of hypertonic saline (HS) inhalations for infant bronchiolitis, compared to normal saline inhalations or standard treatment without inhalations as controls.
Methods: The decision tree in the decision analysis was used to calculate the expected costs. Actual cost data were obtained from our retrospective case-control study on bronchiolitis treatment. The effectiveness of treatment, based on the hospitalization rate of those admitted to the emergency department and the length of stay (LOS) of those who were hospitalized, was collected from previous studies. For the effectiveness estimations, we made a meta-analysis summarizing the results of the meta-analysis of the Cochrane review in 2013 and the results of 10 studies published after it.
Results: The mean hospitalization rate was 24.7% in the HS inhalation group and 32.6% in the control group [risk ratio: 0.80, 95% confidence interval (CI) 0.67¨C0.96] and the mean LOS was 3.736 (HS group) and 4.292 (controls) days (mean difference: − 0.55 days, 95% CI − 0.96 to − 0.15), respectively. The expected costs per patient, when both inpatients and outpatients were included, were €816 ($1111) in the HS inhalation group and €962 ($1310) in the control group. The expected costs per hospitalization, when only inpatients were included, were €2600 ($3540) in the HS inhalation group and €2890 ($3935) in the control group.
Conclusions: HS inhalations slightly reduced the expected hospitalization costs of infant bronchiolitis. However, the low effectiveness, rather than the cost, is the factor that will limit the use of HS inhalations in infant bronchiolitis.
  [Abstract] [Full Text] [PDF]  
Original articles:
Survey of Staphylococcus aureus in a general pediatric population and focus on isolates with three clinically relevant toxin-encoding genes
  Anne Filleron, Sarah Beauregard-Birba, Thibault Mura, Fabien Aujoulat, Anne Laure Michon, Michel Rodi¨¨re, Tu Anh Tran, Eric Jeziorski, H¨¦l¨¨ne Marchandin
Background: In children, surveys on Staphylococcus aureus have focused on specific infections, situations or strains but no study has so far given an overview on S. aureus isolation without any selection. Here, we describe the overall bacteriological and clinical characteristics of S. aureus isolation in children, with a special focus on isolates harbouring tst, sea, and/or luk-PV genes, respectively, encoding the three clinically relevant toxins: toxic shock syndrome toxin-1, enterotoxin A and Panton¨CValentine leukocidin.
Methods: Data associated with S. aureus isolation were reviewed: isolation site, infection status, tst, sea and luk-PV genes, antimicrobial susceptibility pattern, agr typing.
Results: Three hundred and seventy-seven isolates retrieved from 328 children during S. aureus infection (55.2%) or colonization (44.8%) were included. tst, sea and luk-PV genes were amplified in 14.3, 9.5 and 5.8% of the isolates, respectively. These isolates were significantly more frequently retrieved during infection (69.1%) than colonisation but differences were observed according to isolation site. Methicillin-resistance was found in 7.2% of the isolates, 78% of which harboured ¡Ý 1 of the targeted toxin-encoding genes.
Conclusions: This first comprehensive study of S. aureus in children showed S. aureus to be mainly retrieved during infection and a high rate of colonisation, not limited to the nasopharynx. Predominant infections were skin and soft tissue infections where tst was most frequently detected. luk-PV was most commonly detected during bone and joint infections. Isolates harbouring targeted toxin-encoding genes were significantly associated with infections but a quarter of children were asymptomatic carriers representing a reservoir for dissemination of isolates with virulence potency.
  [Abstract] [Full Text] [PDF]  
Trend and causes of neonatal mortality in a level III children¡¯s hospital in Shanghai: a 15-year retrospective study
  Xue-Lian Wang, Jin Wang, Lin Yuan, Wen-Jing Shi, Yun Cao, Chao Chen
Background: To determine the trend and causes of neonatal mortality in a large level III neonatal intensive care unit in Shanghai during a 15-year period.
Methods: This is a retrospective, single-centered study. All neonates who died during the period from January 1, 1999 to December 31, 2013 at Children¡¯s Hospital of Fudan University were included. We extracted relevant clinical information from their medical records, analyzed neonatal mortality rate and the characteristics of these patients, and compared neonatal deaths between different periods and populations.
Results: Among a total of 50,957 admissions during the study period, there were 929 neonatal deaths. The neonatal mortality rate was 1.82%. Trends in neonatal mortality rate showed an increase in the period from 1.0% in 2003 to 2.2% in 2013. The main causes of neonatal mortality were complications of preterm birth (33.6%), congenital anomalies (21.3%), infections (12.6%), and birth asphyxia (9.1%). The proportions of complications of preterm birth (P < 0.001) and congenital anomalies (P = 0.018) increased yearly, while the proportions of birth asphyxia (P < 0.001) and infections (P < 0.001) decreased. Proportions of deaths caused by birth asphyxia (P = 0.005) and infections (P < 0.001) were both higher in the migrating population than in the permanent residents.
Conclusions: Neonatal mortality rate increased from 2003 to 2013 in our study. The proportion of preterm infants in neonatal deaths also increased within the same period. Complications of preterm birth were the main cause of neonatal mortality and the percentage increased year by year. Neonates in the migrating population appeared to be at a higher risk of death during the neonatal period compared to those in the permanent residents, and efforts should be made towards improving perinatal care to prevent infections and birth asphyxia in this vulnerable population.
  [Abstract] [Full Text] [PDF]  
Gene variants of the phosphatidylcholine synthesis pathway do not contribute to RDS in the Chinese population
  Yu-Jun Chen, Julia Meyer, Jennifer A. Wambach, Kelcey DePass, Daniel J. Wegner, Xin Fan, Qun-Yuan Zhang, Heins Hillary, F. Sessions Cole, Aaron Hamvas
Background: To determine population-based prevalence and disease contribution of phosphatidylcholine synthetic pathway-associated gene variants in a native southern Chinese cohort.
Methods: We used bloodspots from 2010 that were obtained from the Guangxi Neonatal Screening Center in Nannning China and included the Han (n = 443) and Zhuang (n = 313) ethnic groups. We sequenced the exons of cholinephosphate cytidylyltransferase (PCYT1B) lysophospholipid acyltransferase 1 (LPCAT1), and cholinephosphotransferase (CHPT1) genes, and analyzed both rare and common exonic variants.
Results: We obtained fi ve mutations (G199D, A299V, G434C, Y490C, L312S) with eight alleles in the three candidate genes. The collapsed minor allele frequency for candidate genes was not significantly different between the Han and Zhuang populations (0.0045 vs. 0.0064, respectively, P = 0.725). The combined Han and Zhuang pool collapsed carrier frequency of rare mutation allele was found to be 1.06%, which is much higher than previously reported for the Missouri population (0.1%). Further, we detected six exonic common variants (three in LPCAT1 and three in CHPT1), with three non-synonymous variants (F162S, F341L, M427K) among them. Two of the non-synonymous exonic variants (F341L, M427K) were not found in CHB; F341L was also not previously reported in exome sequencing project.
Conclusions: The population-based frequency of mutations in the phosphatidylcholine synthesis pathway-associated genes PCYT1B, LPCAT1, CHPT1 is low in southern Chinese newborns and there is no evidence of contribution to population-based disease burden of respiratory distress syndrome. As a population-based study of rare mutations and common variants, this work is valuable in directing future research.
  [Abstract] [Full Text] [PDF]  
Behavioral consequences of children with sleep-disordered breathing after adenotonsillectomy
  Ji Yoon Kim, Chang Ho Lee, Hyoung-Mi Kim
Background: Adenotonsillectomy (AT) has been an effective treatment for sleep-disordered breathing (SDB) in children, and several studies described the risk of postoperative weight gain and obesity in children treated with AT. The present study aimed to evaluate behavioral improvements in children with SDB one year after adenotonsillectomy and to investigate an influence of postoperative weight gain on behaviors.
Methods: The study included 170 children aged 5¨C11 years who underwent adenotonsillectomy for SDB and 150 controls. Body mass index percentile was obtained for age and gender, and parental sleep-related breathing disorder (SRBD) questionnaire was used to assess the severity of SDB. Psychological assessment was performed pre- and post-adenotonsillectomy using standardized questionnaires including strength and difficulties questionnaire, children¡¯s depression inventory and screen for child anxiety-related emotional disorder.
Results: The mean age of 170 patients was 7.7 ¡À 1.5 years with 73 (42.9%) girls and 97 (57.1%) boys. The mean follow-up period were 15.4 ¡À 2.7 months. The patients had shown significant improvements in SDB scores as well as in questionnaire-based behavioral problems after adenotonsillectomy. The odds of a child being overweight were significantly increased after adenotonsillectomy. Less improvements in hyperactivity and conduct problems were observed in the patients with older ages, higher SRBD scores, and overweight/obesity at 1-year follow-up after adenotonsillectomy.
Conclusion: These data suggest that abnormal behavioral outcomes should be evaluated postoperatively, which potentially could be reduced with the early adenotonsillectomy and adequate postoperative weight control.
  [Abstract] [Full Text] [PDF]  
Socioeconomic inequality in screen time frequency in children and adolescents: the weight disorders survey of the CASPIAN IV study
  Ramin Heshmat, Mostafa Qorbani, Nafi seh Mozaffarian, Shirin Djalalinia, Ali Sheidaei, Mohammad Esmaeil Motlagh, Saeid Safi ri, Kimia Gohari, Asal Ataie-Jafari, Gelayol Ardalan, Hamid Asayesh, Morteza Mansourian, Roya Kelishadi
Background: This study aimed to assess the socioeconomic inequality and determinants of screen time (ST) frequency in Iranian children and adolescents.
Methods: This nationwide study was conducted as part of a national school-based surveillance program among 36,486 students consisting of 50.79% boys and 74.23% urban inhabitants, aged 6¨C18 years, living in urban and rural areas of 30 provinces of Iran. Socioeconomic inequality in ST, including the time spent for ST, watching TV and leisure-time working with computer, was assessed across quintiles of SES using concentration index (C) and slope index of inequality (SII).
Results: Overall, 36,486 students completed the study (response rate 91.25%). Their mean (SD) age was 12.14 (3.36) years. The national estimation of frequency of ST was 31.66% (95% CI 31.16¨C32.17) with ascending change from 20.80% (95% CI 19.81¨C21.82) to 36.66% (95% CI 35.47¨C37.87) from the first to the last quintal of SES. Estimated C value at national level was positive (0.08), which indicate inequality was in favor of low SES groups. Considering the SII values, at national level [− 0.16 (− 0.39, 0.06)], the absolute difference in ST frequency between the bottom and top of the socioeconomic groups had descending trends. In multivariate logistic regression model, family history of obesity, generalized obesity and age were the main significant determinants of prolonged ST, watching TV, and computer working (P < 0.001).
Conclusions: Socioeconomic inequality in ST frequency was in favor of low SES groups. These findings are useful for health policies, better programming and future complementary analyses.
  [Abstract] [Full Text] [PDF]  
Prevalence of pre-school children for overweight/obesity in Turkey
  Fatih Santas, Gulcan Santas
Background: Most of the studies and interventions are targeted to address undernutrition, but childhood obesity has become a silent killer among children. Developing countries, including Turkey, could recognize the importance of the issue now and have begun to discuss the necessity of studies on this subject. Therefore, this study aims to examine the prevalence of obesity among pre-school children in Turkey.
Methods: The data source of this study is the Turkey Demographic and Health Survey (TDHS)-2013. The TDHS-2013 was a sample study to gather information about the fertility levels and changes in them, infant and child mortality, family planning, and maternal and infant health at the national level.
Results: Overweight/obesity for height was 8.6% and 6.6% for age. Overweight/obesity problems are mostly observed in the West and are higher in urban areas. Overweight/obesity decreases with increasing age. There is a positive correlation between overweight/obesity and maternal educational level. As the household welfare level increases, overweight/obesity increases in pre-school children. Female children are at higher risk of overweight/obesity than males. As birth order increases, overweight/obesity decreases. Children living in other regions have overweight/obesity problems more than the pre-school children living in the East.
Conclusions: This study speculates that obesity appears to be a major problem among pre-school children in Turkey. Based on the findings, the current situation of overweight/obesity among pre-school children is so close to many developing and developed countries, whose obesity levels are a greater concern. This finding demonstrates that effective interventions of obesity should begin as early as infancy in Turkey, as it is a developing country.
  [Abstract] [Full Text] [PDF]  
Plasma adrenomedullin level in children with obesity: relationship to left ventricular function
  Kotb Abbass Metwalley, Hekma Saad Farghaly, Tahra Sherief
Background: Obese children are at increased risk for abnormal cardiac structure and function. Little is known about adrenomedullin (AM), a cytokine produced in various organs and tissues, as a biomarker of cardiac hypertrophy in obese children. This study aimed to assess the plasma AM levels in a cohort of obese children and its relationship to left ventricular (LV) functions.
Methods: The study included 60 obese children and 60 non-obese children matched for age and gender as control group. Blood pressure, serum lipid profile, fasting glucose, insulin and plasma AM and the homeostatic model assessment of insulin resistance (HOMA-IR) were measured. Cardiac dimensions and LV functions were assessed using conventional echocardiography.
Results: Compared to control subjects, obese children had higher blood pressure (P = 0.01), insulin (P = 0.001), HOMA-IR (P = 0.001), and AM (P = 0.001). Moreover, obese children had higher LV mass index (LVMI) (P = 0.001), indicating LV hypertrophy; prolonged isovolumic relaxation times (P = 0.01), prolonged mitral deceleration time (DcT) (P = 0.01) and reduced ratio of mitral E-to-mitral A-wave peak velocity (P = 0.01), indicating LV diastolic dysfunction. Laboratory abnormalities were only present in children with LV hypertrophy. In multivariate analysis in obese children with LV hypertrophy, AM levels were positively correlated with LVMI [odds ratio (OR) 1.14, 95% confidence interval (Cl) 1.08¨C1.13, P = 0.0001] and mitral DcT (OR 2.25, 95% CI 1.15¨C2.05, P = 0.01) in the presence of higher blood pressure and HOMA-IR. A cut-off value of AM at 52 pg/mL could differentiate obese children with and without left ventricular hypertrophy at a sensitivity of 94.32% and specificity of 92.45%.
Conclusions: Plasma AM levels may be elevated in obese children particularly those with LV hypertrophy and is correlated with higher blood pressure and insulin resistance. Measurement of plasma AM levels in obese children may help to identify those at high risk of developing LV hypertrophy and dysfunction.
  [Abstract] [Full Text] [PDF]  
Hematopoietic stem cell transplantation for children
  Xin-Yu Li, Xin Sun, Jing Chen, Mao-Quan Qin, Zuo Luan, Yi-Ping Zhu, Jian-Pei Fang
Background: ¦Â-Thalassemia major (¦Â-TM) has become a public health problem in mainland China. Hematopoietic stem cell transplantation (HSCT) has remained the only cure for ¦Â-TM in mainland China since 1998.
Methods: This multicenter retrospective study provides a comprehensive review of the outcomes of 50 pediatric patients with ¦Â-TM who received HSCT between 1998 and 2009 at five centers in mainland China. Both related (n = 35) and unrelated donors (n = 15) with complete human leukocyte antigen matches were included. The stem cell sources included bone marrow (BM), peripheral blood stem cells, umbilical cord blood (UCB) and a combination of BM and UCB or a combination of BM and peripheral blood stem cells from a single sibling donor.
Results: The probabilities of 5-year overall survival (OS) and thalassemia-free survival (TFS) after the first HSCT were 83.1 and 67.3%, respectively. Graft failure (GF) occurred in 17 patients. Univariate analyses showed that umbilical cord blood transplantation (UCBT) was one of the potential risk factors for decreased OS (P = 0.051), and that UCBT (P = 0.002) was potentially related to TFS. GF incidence was distinct between the UCBT and non-UCBT groups (P = 0.004). Four cases of UCB-BM combined transplantation led to decreased risks of mortality and recurrence. In the UCBT group, related donor transplantation produced more favorable results than unrelated donor transplantation in OS (P = 0.009) but not in TFS (P = 0.217).
Conclusions: GF was the primary cause of UCBT failure. Though UCBT from related donors was not favorable, the combined transplantation of UCB and BM could improve the prognosis of UCBT.
  [Abstract] [Full Text] [PDF]  
Letter to the Editors:
CD117 is not always positive in infantile gastrointestinal
  Jin-Peng He, Jie-Xiong Feng
  [Abstract] [Full Text] [PDF]  
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