Clinical use of erythromycin in children with gastrointestinal dysmotility.

Intolerant feeding is a common symptom in gastrointestinal disorders which is commonly found in systemic diseases. Prokinetic drugs play a role in management. A low dose of erythromycin has an effect on improvement of antroduodenal motility and gastric emptying in children and adults. The objective of this study was to evaluate the efficacy of intravenous erythromycin in the treatment of GI dysmotility in children. Retrospective studies were performed in the Department of Pediatrics, Siriraj Hospital, Mahidol University between 1996 and 2000 in 22 patients with intolerance of feeding due to GI dysmotility. Their ages ranged from 11 days to 12 years (42.1 +/- 48.1 months). The patients were divided into 2 groups: 12 critically ill and 10 non-critically ill patients. Dosages of intravenous erythromycin were 1-3 mg/kg/dose every 6 hours. The result of treatment was evaluated as: good (tolerant feeding), fair (tolerant feeding but needing erythromycin for longer than 1 month) and failed (intolerant feeding). All non-critically ill patients had improved symptoms with 9 +/- 4.3 days duration of treatment. In the other group, 8 patients had good results with 10.9 +/- 6 days of treatment. Two patients needed the drug for longer than 1 month and the other 2 patients did not respond and died due to severe infection. Low dose intravenous erythromycin had good efficacy in the treatment of intolerant feeding related to GI dysmotility in children.

Clostridium difficile infection in febrile neutropenic malignancy children.

C.difficile infections were studies in 30 febrile neutropenic malignancy children with diagnoses of ALL (15), AML (9), non-Hodgkin lymphoma (3) and others (3). All children have been on chemotherapy during induction phase (15), maintenance phase (9), consolidation phase (3) and pulse therapy phase (3). They were treated with ceftazidime and amikacin intravenously for at least 7 days. Stool specimens were collected before and 2 and 4 weeks after starting antibiotics. C.difficile toxin A in stools were detected by ELISA method which showed positive results in 11 cases (36.7%). There were 5, 5, and 2 positive specimens at before and 2, and 4 weeks respectively. All 5 cases of the first group had history of the last receiving antibiotic longer than 3 months. All of positive C.difficile toxin cases had no diarrhea or abdominal pain. Chemotherapy and cephalosporin were the important factors for colonization of C.difficile in malignancy children.

A randomized clinical trial comparing the efficacy of ranitidine and famotidine on intragastric acidity in critically ill pediatric patients.

We examined the efficacy of intravenous ranitidine and famotidine on raising intragastric pH in each of 10 critically ill pediatric patients. The severity of illness was assessed by using the modified zinner index score. The study had 3 phases and each phase took 24 hours. Intragastric pH was measured by continuous pH monitoring digitrapper for 72 hours. In phase 1 and 3, the patients did not receive any H2 blockers. In phase 2, they were randomized to receive intravenous ranitidine or famotidine. The majority of cases had intragastric pH < 4 in day 1 (base line). Ranitidine and famotidine increased total time of intragastric pH > or = 4 from the base line during day 2, 38.2 +/- 16.9 per cent and 60.3 +/- 24.8 per cent respectively (P0.004), but there was no statistical difference between the 2 medications in both Zinner index score 1 and score greater than 1 group (P 0.08, 0.45). Three cases in the famotidine group had successful prophylaxis with total time pH > or = 4 more than 80 per cent. Famotidine appeared to have a trend toward increasing intragastric pH in critically ill pediatric patients.

Itraconazole for treatment of oral candidosis in pediatric cancer patients.

Oral candidosis commonly occurs in malignancy children undergoing antineoplastic chemotherapy. Inadequate response to antifungal treatment leads to a risk of disseminated infection. The aim of this study is to evaluate the efficacy and side effects of itraconazole on treatment of oral candidosis. Fourteen children with malignancy undergoing chemotherapy received itraconazole 100-200 mg/day for 10 days to treat oral candidosis. The severity of disease was defined as mild and moderate depending on the number of lesions and symptoms. Oropharyngeal lesions and symptoms were recorded initially and daily. Blood chemistries were done on day 0, day 10 and day 16. The overall response rate was 87.5 per cent. The mild group (4 cases) had a response rate of 100 per cent which had lesions and symptoms resolved on day 2 and day 1.5 +/- 0.7 respectively. The moderate group (10 cases) had 8 responders (80%) whose lesions and symptoms resolved on day 6 +/- 2.5 and day 4.1 +/- 2.3 respectively. Side effects and abnormal blood chemistry values. were not seen.

Upper gastrointestinal endoscopy in children with recurrent abdominal pain.

Over a 3 year period from 1992 to 1995, 62 patients with recurrent abdominal pain (RAP) underwent upper gastrointestinal endoscopy showing normal findings in 30 patients (48.4%), gastroduodentis 17 (27.4%), H. pylori gastritis 11 (17.7%) and esophagitis 4 (6.5%). Duodenal or gastric ulcer was not found. This study demonstrated more evidence of increased prevalence of organic causes of RAP than previous reports. Duration of illness of more than one year and vomiting were more common in H. pylori gastritis. Other symptoms including diarrhea, constipation, nocturnal awakening and pain related to meals could not differentiate between organic and functional cause. Major cases of H. pylori gastritis and gastroduodenitis responded to triple drug therapy and H2 blockers respectively.

Helicobacter pylori infection in Thai children with recurrent abdominal pain.

Sixty-five children with recurrent abdominal pain underwent gastrointestional endoscopy which showed Hp gastritis without duodenal ulcer in 16.9 per cent of cases. The prevalences of infection in recurrent abdominal pain and asymptomatic children were not different. Either urease test or histological method was appropriate for diagnosis of this infection. Triple therapy including bismuth subcitrate, amoxicillin and metronidazole improved abdominal pain symptom in 72.7 per cent without any side effect.

Anthropometric evaluations and vitamin A and E levels in cholestatic infants.

Antropomatric measurements and vitamin A and E levels were performed in 12 and 13 infants with idiopathic neonatal hepatitis (NH) and extrahepatic biliary atresia (EHBA) respectively. Triceps skin fold and midarm circumference demonstrated that 4 cases of NH and 1 case of EHBA had protein-calorie malnutrition. There was no clinical evidence of vitamin A and E deficiency in both groups but levels of vitamin were lower than those of normal infants. Proper feeding and vitamin supplements are necessary to prevent and treat protein-calorie malnutrition and fat soluble vitamin deficiency in cholestatic infants.

Treatment of chronic intestinal pseudo – obstruction with cisapride: Case report.

We report two cases of CIP with intractable abdominal distension. The first, an eight year old girl, suffered from severe symptoms and could not tolerate feeding. Ten mg cisapride was administered four times a day. The second child had less abdominal distension and received 10 mg cisapride three times a day. The symptoms and gastric emptying times were markedly improved in both cases. Thus cisapride is a promising medication in the treatment of CIP in children.

The upper endoscopy in upper gastrointestinal hemorrhage of children.

Between 1992-1994, 20 children aged 3 months to 16 years who were admitted to Department of Pediatrics, Faculty of Medicine, Siriraj Hospital with problems of hematemesis and melena underwent gastrointestinal endoscopy. Thirteen children developed bleeding before admission and underlying diseases in 3 of these were chronic renal failure, pulmonary TB and malignant mesenchymoma. The main causes of hemorrhage in this group were gastritis (5 cases), esophagitis (3 cases) and esophageal varices (2 cases). The underlying disease of 7 children with hemoeehage during hospitalization were blood disease, SLE with renal failure and gastroesophageal reflux. The esophagitis, candida esophagitis, and gastric esosion were the etiologies of bleeding. Nine children needed blood transfusion and one had further investigations including meckel scan, tagged red cell scan and colonoscopy. Four patients died due to sepsis. The endoscopy had the value of establishing the etiology of upper gastrointestinal hemorrhage in 19 cases.

Gastric emptying pattern in Thai infants.

Gastric emptying of milk from the stomach of Thai infants shows a biphasic pattern. At 40 minutes the amount of stomach contents is more than at 20 minutes. At 100 minutes, only 16 per cent of the initial amount was recovered. The results of our study can be used as a standard reference for further study in infants with other diseases.

Childhood malnutrition: Nutritional and social background analysis.

The analysis was done in 52 infants and Preschool children under 6 years of age who were referred to Pediatric nutrition clinic, Siriraj Hospital during September 1987 to August 1988 because of growth delay. AII of the patients, 18 boys and 34 girls were under 3rd percentile of body weight. 52% of the cases were 12.23 months old, while average age was 30 months. The onset of growth delay was noticed at the average age of 8.8 months. In 62% of the cases the onset was associated with breast milk weaning, while in 16% and 22% they were associated with additional food and illness (diarrhea, vomiting and measles) respectively. Eighty three percent of the cases was classified by modified Gomez’s criteria as having first degree malnutrition. While 17% was second degree. 29% was classified to be acute malnutrition. While another 29% was nutritional dwarfism and 40% was acute on chronic malnutrition by Waterloo’s classification. 71% and 96% of the cases were less than 10 percentiles of arm muscle area and arm fat area respectively. The three-day caloric count was completely performed in 20 patients. The caloric intake was found to be significantly lower than expected calories per both ideal body weight and recent weight. The average percentage of protein: fat: carbohydrate was 15: 30: 55.The amount of food and the way of feeding seemed to be more important to childhood malnutrition than the familial income.

Abdominal mass in children.

A retrospective study of abdominal mass was carried out among 87 patients admitted to the Department of Paediatrics, Siriraj Hospital, from October 21, 1980 to October 31, 1984. These patients were the pre-school and the school age groups with the age ranged from 1 day to 12 years with the mean of 3.3 years. Among the commonly diseases found were the lymphoma, the neuroblastoma and the Wilms’ tumour which were encountered in 19.5, 17.3 and 14.9 percent respectively. These patients presented with abdominal mass and fever in 60.9 and 35.6 percent of cases respectively. The most commonly organ involved was the liver with malignant disease in the majority of cases. The abdominal masses characterized by well-defined border with firm to hard consistency and nodular surface were found to be malignant while those did with ill-defined border and cystic consistency were benign in nature. The intravenous pyelography was carried out in 68 patients disclosing the abnormal pyelograms in 60 (88.2%). The accuracy of ultrasonography in disclosing the nature of the abdominal mass was 61.5 percent (16/26 patients).