Prediction of cerebral palsy in very low birth weight preterm infants: a comparative study between cranial ultrasound and brain MRI

This prospective study was carried out in the neonatal intensive care unit, El-Minia university hospital. Two diagnostic modalities, serial cranial ultrasound [US] scans and brain magnetic resonance imaging [MRI] were performed once at near term on 38 very premature infants, "less than 32 weeks gestation" [20 males and 18 females] with very low birth weight [< 1500 g]. The aim was to compare both diagnostic modalities in identification of different brain injuries such as periventricular leucomalacia and intraventricular hemorrhage and to assess their value in early prediction of cerebral palsy [CP]. Infants were followed up by neurorehabilitation service up to 20 months corrected age, when all cases of CP can be diagnosed clinically. In the first group [8 patients with CP], MRI findings predicted CP cases with 87.3% sensitivity and positive predictive value of 70%. The corresponding figures for cranial US were 50% and 44.4% respectively. In the other group [30 infants without CP or with minor neurological abnormalities], MRI findings predicted neurologically normal infants [i.e. without CP] with 90% specificity and negative predictive value of 96.4%. The corresponding figures for cranial US being 83.3% and 86.2% respectively. It can be concluded that, though MRI is superior to cranial US for early prediction of CP; cranial US is still being used as a repeatable easy bed side diagnostic modality to demonstrate severe parenchymal lesions. MRI can be reserved for subtle lesions or cases with normal or controversial result by cranial US

Performance of cardiac imaging and a new cardiomarker assay for early detection of myocardial injury in asphyxiated term neonates

Myocardial ischemia of newborns is a well known syndrome and is usually related to perinatal asphyxia. Recognition of myocardial ischaemia is more difficult in neonates than adults; it can be clinically occult, especially when hypoxia is mild. Cardiac troponin T [cTnT] is a cardiac specific marker that can be used for early detection of myocardial injury. This prospective observational study aimed to investigate the diagnostic values of cardiac troponin T [cTnT], electrocardiography [ECG] and echocardiography in early detection of myocardial injury in term asphyxiated neonates. This study included 44 term infants [24 neonates with asphyxia and 20 controls]. Term neonates with asphyxia had significantly higher cardiac troponin t concentration than control healthy neonates of 0.20 +/- 0.09 versus 0.04 +/- 0.02 ng/ml [p<0.05] respectively. Finally, five out of 24 asphyxiated term group [20.8%] died during the first week of life. Significant negative correlations were found between cardiac troponin t and umbilical blood pH, base excess and Apgar score [r = -0.67, -0.83, -0.79, respectively; p < 0.01]. ECG changes of grades 3 and 4 suggestive of myocardial ischemia are present only in asphyxiated group with incidence of 50%. Four out of five patients died had grade 4 and one had grade 3 ECG changes. However, in control group, normal ECG was found in 90% and only grade 1 ECG alterations in 10%. Regarding, echocardiographic findings, fractional shortening [FS] was significantly lower in asphyxiated neonates than the control group. There was no significant difference between both groups as regards to cardiac index and cardiac output. Tricuspid regurgitation was observed in 12 neonates [50%]. Seven [29%] asphyxiated neonates developed clinical signs of heart failure. A significantly higher serum cTnT was found in asphyxiated neonates with heart failure than those without heart failure [P < 0.05]. The sensitivity and specificity of serum cTnT in detecting myocardial injury presenting with heart failure was 71.4% and of 33.3%, respectively. It is concluded that Serum cTnT is a useful new cardiac biomarker that can be used for early detection and estimation of the incidence of myocardial injury in asphyxiated term neonates. Reduced fractional shortening and tricuspid insufficiency in Echocardiography and grades 3 and 4 ECG changes are important indicators of severe myocardial damage

Heart rate variability in normal children and patients with congenital left to right shunt: time domain analysis based study

Three groups of subjects were included in this study. Group I: 50 subjects with no evidence of structural heart disease to study normal heart rate variability indices using time domain analysis in normal children. Group II included 30 patients with congenital left to right shunt with no evidence of heart failure. Group III included 20 patients with congenital left to right shunt and heart failure. All groups are both age and weight matched. Based on analysis of 24 hours ambulatory electrocardiographic monitoring data we noticed no significant difference between group I and group II in all time domain indices while there was significant reduction of all indices in group three compared to other 2 groups [P <0.001 for both SDNN and SDANN and <0.01 for pNN50 and rMSSD] using one way ANOVA]. We concluded that, the presence of heart failure in patients with CHD augments sympathetic nervous system activity in those patients and is responsible for the genesis of arrhythmias in them

Risk of acute otitis media in relation to acute bronchiolitis in children

A prospective study was carried out to evaluate the prevalence and the etiology of acute otitis media [AOM] In children with acute bronchiolitis. Also to determine whether AOM occurring with acute bronchiolitis "Which mainly due to respiratory syncytial virus [RSV]" is accompanied with another pathogens "which usually found in the middle ear aspirate [MEA]" or not. Thirty-six children with acute bronchiolitis aged 3 to 18 months that were admitted to pediatrics department, El-Minia University Hospital during the period from September 2005 to December 2005 were included In this study. In patients with AOM at entry or developed AOM within 14 days, Gram-stained smears, bacterial cultures, and enzyme-linked immunosorbent assay [ELISA] were performed on middle-ear aspirates to detect the presence of bacterial pathogens and RSV respectively. Twenty children [55.6%] with acute bronchiolitis had AOM at entry or developed AOM within 14 days, 9 patients [25%] had developed otitis media with effusion, and only 7 patients [19.4%] remained free of both AOM and otitis media with effusion, throughout the 2-weeks observation period. Of 27 middle-ear aspirates [13 unilateral and 7 bilateral], bacterial pathogens were isolated in 23 [85%] [10 bacteria alone "37%" and 13 mixed bacteria and RSV "48%"], RSV was identified in 15 [55.5%] of middle ear aspirates [mixed with bacteria in 13 and RSV alone in 2 cases [7.5%]], so RSV was identified in 15 of 20 patients [75%] with AOM. Streptococcus pneumoniae was isolated in 11 middle ear aspirates, Haemophilus influenza in 6, Moraxella catarrhalis in 4, Staphylococcus aureus in 2, Streptococcus pyogenes in one aspirate and Pseudomonas aeruginosa in one aspirate only. Of 20 cases of AOM, 15 [75%] responded clinically to usual dose of antibiotic [Amoxicillin and clavulanic acid and/or Cefotaxime]. Finally we concluded that bacterial AOM is a complication In most children with acute bronchiolitis. Streptococcus pneumoniae and Haemophilus influenza were the commonest organisms isolated from middle ear aspirate. RSV is identified in most cases of acute otitis media [75%] and mixed with bacterial pathogens. Accordingly, in patients with acute bronchiolitis and associated AOM, antimicrobial treatment is indicated

Serum carnitine levels in children with iron deficiency anemia

This study was designed to evaluate the carnitine serum levels as co-morbidity in apparently healthy children with iron deficiency anemia. Fifty four apparently healthy well nourished children [29 boys and 25 girls], their ages ranged from 9 months to 12 months with iron deficiency anemia were enrolled in the study. Twenty five healthy non anemic children with matched age and sex included as a control group. Malnourished children with iron deficiency anemia were excluded from the study. For all anemic children with suspected iron deficiency anemia as well as control group, we performed complete blood count [CBC] including measuring of hemoglobin [Hb] level, hematocrit% [Hct], mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCH], mean corpuscular hemoglobin concentration [MCHC]; serum ferritin, serum iron [SI], and total iron binding capacity[TIBC]. Serum total carnitine levels were measured by spectrophotometric method. Hb, MCV, MCH, serum ferritin and serum iron were significantly lower in patients with iron deficiency anemia than in control non anemic group [p < 0.001]. Serum carnitine levels were significantly lower in children with iron deficiency anemia than in healthy control group [p<0.001]. There was a significant positive correlation between hemoglobin and serum carnitine [r=0.84; p<0.001]. Also, we found a significant positive correlation between serum iron, serum ferritin and serum carnitine [r=0.91; p<0.001 and r = 0.9; P<0.001, respectively]. In conclusion, iron is required for biosynthesis of carnitine. Low serum carnitine levels in these children may be due to iron deficiency. Therefore, iron fortification of the diets of children seems to be essential not only to prevent iron deficiency anemia but also to avoid other possible effects of iron deficiency in the growing children, such as secondary carnitine deficiency. However, additional studies are still needed to ascertain the frequency of carnitine deficiency and the need for carnitine supplementation in children with iron deficiency anemia

Diagnosis and genetic susceptibility of pulmonary tuberculosis in children

This study consisted of 3 closely related parts; the first part included 70 children with pulmonary tuberculosis [TB], aged 2 - 10 years and 20 healthy children as controls. All were subjected to thorough history taking, clinical examination, chest x-ray and tuberculin test. Blood samples were taken to perform glutaraldehyde test and for detection of IgG antibodies against mycobacterium TB by ELISA technique using antigen A60. The sensitivity of glutaraldehyde test was 87.1% and its specificity was 90% with high significance, while the sensitivity of ELISA test was 48.6% and its specificity was 90%. In the second part of the study, sputum samples from 57 children recently diagnosed as having pulmonary tuberculosis, were processed for microscopic examination of smears after staining for acid fast bacilli, culture on Lowenstein-Jensen medium and nested polymerase chain reaction [PCR]. Patients included in this part were divided into 3 groups. In a group of 20 children not-receiving antituberculous therapy yet, the results of smear examination and PCR were identical in 75% of cases. In 10% of cases culture was most sensitive, but in 25% of patients nested PCR was positive even when smear and culture were negative. In a group of 20 children receiving antituberculous therapy for less than six months, PCR positive results were obtained even when both smear and culture were negative. In a group of 17 children receiving antituberculous therapy for more than six months, positive PCR results were detected up to the 7[th] month of therapy. The third part of the study included the HLA [A, B, C loci] phenotyping in 25 cases out of 70 studied in the first-part, and 92 controls. The results showed higher frequency of the following HLA antigens among cases of pulmonary TB than the controls: A25[10], A26[10], AW66, B35, BW55, CW3, CW4 and CW5, and associated with increased relative risk [RR] above one and the etiologic factor for CW4 antigen was 0.408. On the other hand HLA- B5+ B18+ B35, B12, B27 were significantly higher among the controls than the cases. We concluded that glutaraldehyde test can be used as simple, rapid, inexpensive, not tedious test and was positive in cases of TB with malnutrition. Concerning ELISA test, it can be used as rapid serodiagnostic test which is reliable and relatively inexpensive technique for diagnosis of active pulmonary TB in children. Application of nested PCR assay could be used as a follow-up tool in monitoring of pulmonary tuberculosis in children. Regarding HLA antigens the results showed high frequency of the previously mentioned HLA antigens with pulmonary TB, which may indicate, increased susceptibility to pulmonary TB infection. On the other hand, high frequency of other mentioned HLA antigens among controls may indicate a protective effect of these antigens. Anyhow further studies are still needed to be done and on a wide scale to prove the association of HLA antigens and tuberculosis