Role of Nrf2/GPX4 signaling pathway-mediated ferroptosis in midazolam-induced reduction of HIBD in neonatal rats / 中华麻醉学杂志

Objective:To evaluate the role of nuclear factor-erythroid 2-related factor 2 (Nrf2)/glutathione peroxidase-4 (GPX4) signaling pathway-mediated ferroptosis in midazolam-induced reduction of hypoxic-ischemic brain damage (HIBD) in neonatal rats.Methods:Ninety healthy 7-day-old neonatal rats, weighing 16-20 g, were divided into 6 groups ( n=15 each) using the random number table method: sham operation group (Sham group), HIBD group, low-dose midazolam (10 mg/kg) group (group L), medium-dose midazolam (20 mg/kg) group (group M), high-dose midazolam (40 mg/kg) group (group H), and Nrf2 inhibitor ML385 group (group I). The HIBD model was developed by ligating the left carotid artery and exposing to a hypoxic condition for 2 h in anesthetized animals. Starting from 2nd day after developing the model, the corresponding doses of midazolam were intraperitoneally injected in midazolam groups, the equal volume of normal saline was intraperitoneally injected in Sham and HIBD groups, midazolam 40 mg/kg and Nrf2 inhibitor ML385 30 mg/kg were intraperitoneally injected once a day for 8 consecutive days in group I. The rats were weighed and subjected to the Morris water maze test after the end of administration. Blood samples were taken from the abdominal aorta after the end of the Morris water maze test, and then the animals were sacrificed to remove the brain for determination of the concentrations of serum iron, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) (by enzyme-linked immunosorbent assay), contents of iron and GSH in hippocampal tissues (by ultraviolet spectrophotometry and micro method), the number of Nrf2/neuronal nuclear antigen (NeuN) and GPX4/NeuN positive cells (by immunofluorescent staining), and expression of Nrf2, GPX4, and 4-hydroxynonaenoic acid (4-HNE) in hippocampal tissues and for microscopic examination of the pathological changes of hippocampal neurons in brain tissues (after HE staining and Nissl staining). Results:Compared with Sham group, the first time to arrival at platform was significantly prolonged, the number of crossing the origional platform was reduced, and the time of staying at the target quadrant was shortened, the iron content in the hippocampal tissues was increased, the content of GSH and the number of Nrf2/NeuN and GPX4/NeuN positive cells were decreased, the expression of Nrf2 and GPX4 was down-regulated, the expression of 4-HNE was up-regulated, the concentrations of serum iron, IL-6 and TNF-α were increased, and the injury to hippocampal neurons was marked in HIBD group ( P<0.05). Compared with HIBD group, the first time to arrival at platform was significantly shortened, the number of crossing the origional platform was increased, and the time of staying at the target quadrant was prolonged, the iron content in the hippocampus tissues was decreased, the content of GSH and the number of Nrf2/NeuN and GPX4/NeuN positive cells were increased, the expression of Nrf2 and GPX4 was up-regulated, the expression of 4-HNE was down-regulated, the concentrations of serum iron, IL-6 and TNF-α were decreased ( P<0.05), and the injury to hippocampal neurons was significantly reduced in H, M and L groups. Compared with group H, the first time to arrival at platform was significantly prolonged, the number of crossing the origional platform was reduced, and the time of staying at the target quadrant was shortened, the iron content in the hippocampus tissue was increased, the content of GSH and the number of Nrf2/NeuN and GPX4/NeuN positive cells were decreased, the expression of Nrf2 and GPX4 was down-regulated, the expression of 4-HNE was up-regulated, the concentrations of serum iron, IL-6 and TNF-α were increased ( P<0.05), and the injury to hippocampal neurons was aggravated in group I. Conclusions:The mechanism by which midazolam reduces HIBD may be related to activation of the Nrf2/GPX4 signaling pathway and inhibition of hippocampal neuronal ferroptosis in neonatal rats.

Characteristics of video electroencephalogram and cranial magnetic resonance imaging in newborns with inherited metabolic disorders and predictive value for prognosis / 中国新生儿科杂志

Objective:To study the characteristics of video electroencephalogram (VEEG) and cranial magnetic resonance imaging (MRI) in neonates with inborn errors of metabolism (IEM) and to determine the predictive value for prognostic.Method:From June 2016 to December 2018, a retrospective study was performed on newborns diagnosed with IEM receiving VEEG examinations at the Neonatology Department of our hospital. VEEG and cranial MRI were used as prognostic indicators and the follow-up results were used as criteria predicting the accuracy of prognosis. The accuracy of the prediction was calculated using a 4 × 4 table.Result:A total of 21 eligible cases with 14 types of IEM were included. The most common type of IEM was organic acidemia (47.6%, 10/21). 16 cases (76.2%) had abnormal VEEG background patterns, including 8 cases of organic acidemia, 3 cases of urea cycle disorders, 1 case of energy metabolism disorder and 4 cases of other IEMs. No significant differences existed in the abnormality rate of VEEG background patterns among these groups ( P=0.882). VEEG showed 3 cases of seizures including 2 cases of electrographic-only seizures. Interburst interval durations were shortened on VEEG background with the decrease of blood ammonia level. The positive predictive values of the moderate-to-severe abnormal VEEG background and the presence of major cerebral lesions on MRI in predicting poor prognosis were 90.0% (95% CI 55.5%~99.7%) and 100% (95% CI 66.4%~100%), respectively, and the negative predictive values were 50.0% (95% CI 18.7%~81.3%) and 85.7% (95% CI 42.1%~99.6%), respectively. Conclusion:Neonates with IEM have higher incidences of abnormal VEEG. Continuous VEEG may accurately diagnose neonatal seizures and effectively monitor brain function. VEEG is a useful tool monitoring infants with IEM and predicting adverse outcomes, especially when used in combination with brain MRI.

Cannot extubate a newborn patient after an arterial switch operation? check major aortopulmonary collaterals!

Abstract The standard treatment of transposition of the great arteries is the arterial switch operation (ASO). Despite successful surgical correction, patients cannot tolerate extubation after the operation. Major aortopulmonary collaterals (MAPCAs) are one of the rare causes of prolonged mechanical ventilation due to significant hemodynamic effects. We report a 28-day-old newborn with transposition of the great arteries and a ventricular septal defect (VSD) who underwent ASO and VSD closure. After postoperative extubation failed twice, four large MAPCAs were revealed during heart catheterization. After transcatheter closure of these four MAPCAs, the patient was extubated and discharged 27 days after the procedure.

The exploration of Guardian real-time continuous monitoring system in high-risk infants with hypoglycemia / 中华实用儿科临床杂志

Objective To explore the feasibility of Guardian real-time continuous monitoring system (GRT) in high-risk infants with hypoglycemia.Methods The glucose of 72 infants admitted to Neonatal Intensive Care Unit (NICU) of Children's Hospital of Fudan University between May 2015 and December 2016 were detected by GRT (provided by Medtronic),there were 43 males and 29 females with gestational age [(35.25 ± 4.45) weeks],and birth weight [(2 385.69 ± 1 062.63) g].At the same time,the capillary glucose was monitored intermittently detected by using ACCU-CHEK(R).Results A total of 1 134 paired glucose levels were collected.A good correlation between the paired capillary[(5.23 ± 1.96) mmol/L] and GRT continuous monitor measurements [(5.19 ± 1.99) mmol/L] was found(r =0.88,P ＜ O.05),and the value of mean absolute difference (MAD) was 11.88％.Through the Clarke error grid analysis,there were 98.24 ％ points located in region A and region B,only 20 paired(1.76％) glucose located in region D.Hypoglycemia was defined as glucose concentration ＜ 2.6 mmol/L,while hyperglycemia was defined as glucose concentration ＞ 7.0 mmol/L.A high/low blood glucose detected by peripheral blood glucose monitoring is a high/low blood glucose event,and a high/low blood glucose detected by GRT in a continuous period is a high/low blood glucose event.Twelve cases of hypoglycemia,26 episodes of hypoglycemia,29 cases of hyperglycemia,and 151 episodes of hyperglycemia were detected by using fast blood glucose meter.Twenty-six cases of hypoglycemia,88 episodes of hypoglycemia,38 cases of hyperglycemia,and 229 episodes of hyperglycemia were detected by using GRT.Sixty-two episodes of hypoglycemia were not detected by the fast blood glucose meter,with 14 episodes lasting longer than 30 min,4longer than 60 min,and 5 longer than 90 min.There were 78 hyperglycemic episodes that were not detected by the fast blood glucose meter,with 44 episodes lasting longer than 30 min,15 longer than 60 min,and 70 longer than 90 min.There were significant differences in the testing of hypoglycemia and pathoglycemia(x2 =7.00,18.60;all P ＜ 0.05),but,there was no significant difference in the testing of hyperglycemia between the 2 kinds of detection(x2 =2.26,P ＞0.05).GRT was acceptable to parents,medical staffs and children as only 3 infants bled when the continuous glucose sensor was imbedded,but there was no progressive increase in blood loss.There was no redness,edema,infections,or effusions at the insertion sites.Conclusions The use of GRT continuous monitoring system in high-risk infants of hypoglycemia was feasible.Compared with the conventional intermittent peripheral blood glucose monitoring,more abnormal blood glucose events and their duration could be detected.

Early predictive value of lactate/albumin ratio in neonatal infants with septic shock / 中华实用儿科临床杂志

Objective@#To analyze the predictive value of lactate/albumin(L/A) ratio in neonatal infants with septic shock.@*Methods@#The data of 185 neonatal infants with sepsis from January to December 2017 were retrospective analyzed in Guangdong Women and Children Hospital.The data were divided into low level of L/A group(L/A<0.1), medium level of L/A group(0.1≤L/A<0.2) and high level of L/A group(L/A≥0.2)according to L/A ratio level within 24 hours of sepsis.The clinical features, related laboratory indications and prognosis among the 3 groups were compared.Multivariate Logistic regression was used to analyze the effects of various factors on the occurrence of neonatal septic shock.Receiver operating characteristic (ROC) curve analysis was performed to evaluate the early predictive va-lue of related indicators for neonatal septic shock.@*Results@#A total of 185 neonatal infants with sepsis were collected.There were 88 cases in low level of L/A group, 64 cases in medium level of L/A group and 33 cases in high level of L/A group.There were no significant difference in gender, gestational age, birth weight, 1 and 5-minute Apgar scores, small for gestational age, use of pulmonary surfactant, maternal preeclampsia, gestational diabetes mellitus, maternal fever and severe meconium stained (all P>0.05). There were no statistical differences among three groups in C-reactive protein, white blood cell count, neutrophil count and proportion, leucine count and proportion and platelet count(all P>0.05). Compared with low and medium level of L/A groups, the high level of L/A group had higher proportion of cesarean section, higher procalcitonin and lactate, severe intracranial hemorrhage, periventricular leucomalacia, multiple organ dysfunction syndrome, disseminated intravascular coagulation, septic shock and the dead; low level of L/A group had higher proportion of maternal premature rupture of membranes>24 hours, albumin, pH or base excess(BE), and there were statistically significant differences in all of those(all P<0.05). Multivariate Logistic regression analysis showed that hypoalbuminemia, hyperlacticemia, decreased pH and L/A≥0.1 were independent predictors for neonatal septic shock.L/A more than 0.114 within 24 hours was associated with neonatal septic shock, with a sensitivity of 76.90% and specificity of 81.30%.@*Conclusions@#The increased of L/A within 24 hours of sepsis can be used as an independent risk factor for predicting septic shock in neonatal infants.

Diagnosis of pulmonary hemorrhage of the newborn infants using lung ultrasonography / 中华儿科杂志

Objective@#To investigate the accuracy and reliability of lung ultrasound in diagnosis of pulmonary hemorrhage of the newborn infants.@*Method@#From January 2014 to May 2016, 142 neonates from the Army General Hospital of the Chinese PLA were enrolled in the study. They were divided into two groups: a study group of 42 neonates, who were diagnosed with pulmonary hemorrhage according to their medical history, clinical manifestations and chest X-ray findings, and a control group of 100 neonates with no lung disease. All subjects underwent bedside lung ultrasound in a quiet state in a supine, lateral or prone posture, performed by a single experienced physician. The ultrasound findings were compared between the two groups.Fisher′s exact test was uesd for comparison between two groups.@*Result@#The lung ultrasound main findings associated with pulmonary hemorrhage included: (1) Shred sign: which was seen in 40 patients(95%). (2) Lung consolidation with air bronchograms: which were seen in 35 patients(83%). (3) Pleural effusion: which was seen in 34 infants(81%), pleurocentesis confirmed that the fluid was really bleeding.(4)Atelectasis: which was seen in 14 cases(33%). (5) Pleural line abnormalities and disappearing A-lines with an incidence of 100%. (6) Alveolar-interstitial syndrome: 5 patients(12%)had the main manifestations of alveolar-interstitial syndrome. The above signs were not seen in normal controls (all P<0.01) and the normal lung mainly manifested with clear pleural line and A-lines under ultrasound.@*Conclusion@#Lung ultrasonography is accurate and reliable for diagnosing pulmonary hemorrhage, which is suitable for routine application for the diagnosis of pulmonary hemorrhage in the neonatal intensive care unit.

Analysis of monitoring information about infant congenital heart disease in Changzhou / 中华全科医师杂志

Screening of CHD of infants (11 178) born from May 1st 2012 to April 30th 2013.92 infants were screening positive,68 were diagnosed.The detectable rate of CHD was 6.08‰,while boys were 3.31‰,girls were 2.77‰.68 CHD patients,the top three were VSD(2.14‰),PDA(1.34‰) and ASD (0.89‰).In these infants,detectable cardiac souffle were 61,abnormal pulse oximetry were 40.The detectable rate of CHD among infants was identical compare the average level of whole country,but the distributional characteristics was disparity.The screening of CHD was feasible,and cardiac souffle and pulse oximetry were recommended.

Feasibility of constructing a screening-evaluating-intervention system of congenital heart disease in Changzhou city / 中华实用儿科临床杂志

Objective To investigate the prevalence and the distribution of congenital heart disease(CHD) in Changzhou city.The clinical data of 106 CHD infants were reviewed,so as to provide some evidence for making CHD screening-evaluating-intervention system.Methods All infants(16 070 cases) born in Changzhou Maternal and Child Health Hospital from May 1st 2011 to Apr.30th 2013 were screened for CHD.The infants with CHD were followed up for one year periodically after discharge.Results One hundred and seventeen infants were screened positive,and 106 cases of them were diagnosed as CHD,and the detectable rate was 6.60‰.The top three incidence was VSD (2.18‰,35/16 070 cases),PDA(1.74‰,28/16 070 cases) and ASD(1.06‰,17/16 070 cases).Among them,81 cases were detected as cardiac souffle,and 48 cases as abnormal pulse oximetry.In 106 cases,97 cases were followed up and 9 cases did not receive follow-up.The close ratio were higher in ASD,PDA,VSD,which was 76.47％,64.29％,62.86％.The size of gap had an effect on close ratio,small gap of VSD,ASD and premature PDA were higher and medium and large gap and full-term infants were lower.Some serious type of CHD infants received operations,and others were still followed up.Conclusion The detectable rate of CHD among infants was identical to the average level of whole country.The follow-up study may improve the quality of the survival of CHD infants,and it is feasible to construct a system of screening-evaluating-intervention systcm of CHD.

A prevalência do uso de sonda nasogástrica em bebês portadores de fissura de lábio e/ou palato / Prevalence of the use of nasogastric tube in babies with cleft lip and/or palate

OBJETIVO: Investigar a prevalência do uso de sonda nasogástrica em bebês com fissura labiopalatina, sua correlação com tipo de fissura, maternidade e cidade de origem, e a idade na primeira consulta. MÉTODOS: A amostra constituiu-se de 137 bebês de ambos os gêneros, com fissura de lábio e/ou palato, sem outros comprometimentos, nascidos a termo, e que chegaram para primeira consulta em um centro especializado em fissura entre zero e 12 meses (mediana=33 dias). Realizou-se análise estatística pelo teste de coeficiente de contingência (p<0,05). RESULTADOS: Da amostra total, 61 por cento eram do gênero masculino e 39 por cento do feminino, 51 por cento apresentavam fissura de lábio e palato, 35 por cento de palato e 14 por cento de lábio. Quanto ao nascimento, 36 por cento nasceram em maternidades particulares e 64 por cento em públicas, 60 por cento em Belo Horizonte, 15 por cento em outras cidades da região metropolitana e 25 por cento no interior do estado. O uso de sonda ocorreu em 23 por cento dos casos. Não houve associação entre tipo de fissura ou de maternidade e o uso de sonda, mas este foi mais frequente na região metropolitana (p=0,007). CONCLUSÃO: A prevalência do uso de sonda em bebês com fissura foi considerada alta, visto que nasceram a termo e não apresentavam comprometimentos associados que indicassem o uso da mesma. O uso de sonda é mais frequente em bebês nascidos em maternidades da região metropolitana de Belo Horizonte, quando comparados a outras cidades do estado de Minas Gerais.

PURPOSE: To investigate the prevalence of the use of nasogastric tube in babies with cleft lip and/or palate, and to correlate its use with type of cleft, maternity hospital (private or public) and city of origin, and age at the first visit to a cleft center. METHODS: The sample consisted of data collected from 137 babies of both genders with cleft lip and/or palate, without any other associated anomalies, born full-term, who attended their first consultation at a specialized cleft center with ages between zero and 12 months (median=33 days). Statistical analyses used the coefficient of contingency test (p<0,05). RESULTS: From the subjects, 61 percent were male and 39 percent were female; 51 percent presented cleft lip and palate, 35 percent cleft palate, and 14 percent cleft lip. Regarding place of birth, 36 percent were born in private and 64 percent in public maternity hospitals; 60 percent were born in the city of Belo Horizonte (Minas Gerais, Brazil), 15 percent in other cities of the metropolitan area, and 25 percent in other cities at the state of Minas Gerais (Brazil). The use of nasogastric tube was reported in 23 percent of the cases. There was no association between the type of cleft or maternity and the use of the tube, but the later was more frequent within the metropolitan area (p=0,007). CONCLUSION: The prevalence of the use of nasogastric tube in babies with cleft lip and/or palate was considered high since they were born full-term and without any other associated anomalies that would indicate the need of the tube. The use of nasogastric tube was more frequent in babies born at the metropolitan area of Belo Horizonte, when compared to other cities in the state of Minas Gerais (Brazil).

Effect of postural drainage assisting trachea suction on meconium aspiration syndrome / 中国小儿急救医学

Objective To evaluate the effect of postural drainage assisting trachea suction on meconium aspiration syndrome. Methods Total 61 cases of asphyxia neonates with MAS who were born in our hospital from Jan,2007 to Dec,2008, were divided into control group (24 cases) and observing group( 37 cases). The neonates in control group had endotracheal suction directly after intubation. But the infant in observing group was treated with endotracheal suction after postural drainage. The amount of suction from endotracheal tube,the complication of MAS and the outcome of these newborns were evaluated. Results The total amount of meconium drainage from endotrachea in observing group was statistics significantly more than that in control group [( 2. 16 ± 1.82) ml vs ( 1.23 ± 0. 97 ) ml, P ＜ 0. 05 )]; The intubating times in observing group were statistical significantly less than that in control group[( 1.19 ± 0. 46) vs ( 1.79 ± 0. 83 ) times, P ＜0. 01 ). The incidence of complication in observing group was 8. 11% ,which was significantly lower than that in control group(29. 17% ,P ＜0. 05). There were shorter needing oxygen time [(21.30 ± 22. 38) h vs (52. 91 ±39. 20) h,P ＜0. 01]and shorter hospitalization days [(9. 24 ±3.94) d vs ( 14. 39 ±6. 49) d,P ＜0.01 )]in observing group than those in control group respectively. The mortality in control group was 4. 17%, and no death occurred in observing group. Apgar scores of the first minute was similar in both groups ( P ＞ 0. 05 ). But there was significant difference(70. 16% vs 58. 34% ,respectively;P ＜0. 05) in the fifth minute Apgar scoring of 8 ～ 10 scores between the observing group and the control group. Conclusion Postural drainage assisting endotracheal suction may remove meconium in trachea effectively, decrease the complications of MAS and shorten the oxygen days and hospitalization time.

Radiologic Findings of Neonatal Cerebral Infarction related with Portal Vein Thrombosis: Case Report

A cerebral infarction in a newborn infant is not uncommon and is major cause of neonatal seizure. The author encountered one case of cerebral infarction that was assumed to be related to a portal vein thrombosis, and reports the radiology findings of a neonatal cerebral infarction and portal vein thrombosis.

Transverse Testicular Ectopia Diagnosed by US and MR Imaging: A Case Report

Transverse testicular ectopia (TTE) is a rare congenital anomaly in which both testes migrate toward the same hemiscrotum. In most cases, the correct diagnosis is not made preoperatively, but it's made during an inguinal herniotomy or during surgical exploration for an undescended testis because TTE is clinically misdiagnosed as an symptomatic inguinal hernia or as a tumor of the testis on the side to which the ectopic testis has migrated or as an undescended testis on the contralateral side. US and MR imaging can detect the transverse testicular ectopia by its characteristic appearance and so provide useful information about any associated anomalies. We report here on a case of transverse testicular ectopia that was diagnosed by US and MR imaging in a 10-month-old boy, and we review the relevant literature.

Transverse Testicular Ectopia Diagnosed by US and MR Imaging: A Case Report

Transverse testicular ectopia (TTE) is a rare congenital anomaly in which both testes migrate toward the same hemiscrotum. In most cases, the correct diagnosis is not made preoperatively, but it's made during an inguinal herniotomy or during surgical exploration for an undescended testis because TTE is clinically misdiagnosed as an symptomatic inguinal hernia or as a tumor of the testis on the side to which the ectopic testis has migrated or as an undescended testis on the contralateral side. US and MR imaging can detect the transverse testicular ectopia by its characteristic appearance and so provide useful information about any associated anomalies. We report here on a case of transverse testicular ectopia that was diagnosed by US and MR imaging in a 10-month-old boy, and we review the relevant literature.

Mediastinitis and Pneumomediastinum in a Preterm Infant with Iatrogenic Esophageal Perforation: A Case Report

Iatrogenic esophageal perforation is very rare in pediatric patients. Preterm infants or low birth weight babies are more susceptible to esophageal perforation due to performing frequent tracheal intubation and/or gastric tube installation. When perforation occurs, it may present as pneumothorax and pulmonary interstitial emphysema. However, isolated pneumomediastinum without pneumothorax is a rare finding. Furthermore, the mediastinitis after esophageal perforation is rare complication, but it can be a critical complication. Therefore, making an immediate and precise diagnosis as well as instituting proper treatment of esophageal perforation and mediastinitis are important. To the best of our knowledge, few reports have described mediastinitis after pneumomediastinum that was secondary to esophageal perforation. We describe here the radiologic findings of a rare case of mediastinitis after pneumomediastinum in a preterm infant with esophageal perforation.

Neuronal Intestinal Dysplasia in an Infant: Case Report

Neuronal intestinal dysplasia in pediatric patients has similar clinical symptoms and often similar radiologic findings to those of Hirschsprung's disease. Yet neuronal intestinal dysplasia shows hyperplasia of the myenteric plexus for the pathology, and it requires different treatment compared with Hirschsprung disease. This disease has been reported many times in Europe but, to date, only one case has been reported in the radiologic literatures in Korea. We report here on a case of neuronal intestinal dysplasia that involved the entire colon in a two-month-old boy, and we include the radiographic findings.

Neuronal Intestinal Dysplasia in an Infant: Case Report

Neuronal intestinal dysplasia in pediatric patients has similar clinical symptoms and often similar radiologic findings to those of Hirschsprung's disease. Yet neuronal intestinal dysplasia shows hyperplasia of the myenteric plexus for the pathology, and it requires different treatment compared with Hirschsprung disease. This disease has been reported many times in Europe but, to date, only one case has been reported in the radiologic literatures in Korea. We report here on a case of neuronal intestinal dysplasia that involved the entire colon in a two-month-old boy, and we include the radiographic findings.

Sonography-guided Gastrografin Enema for Meconium Plug Syndrome in Premature Newborns: Preliminary Results

PURPOSE: To evaluate the usefulness of sonography-guided Gastrografin enema for the diagnosis and treatment of meconium plug syndrome in premature newborns in a neonatal intensive care unit (NICU). MATERIALS AND METHODS: Fifteen premature newborns underwent 23 sonography-guided Gastrografin enemas on the 8th day of life on average (range: 3 days-21 days). The gestational age and birth weight (mean+/-standard deviation) of the patients were 29+/-2 weeks and 999+/-148 g, respectively. The diagnosis of meconium plug syndrome was based on relevant clinical and radiological findings. Diluted Gastrografin (1:3, 17-45 ml) was administered through a rectal tube under the guidance of sonography until it reached to the cecum. Thereafter, immediate post-procedure and delayed portable abdominal radiographs were taken. All the procedures were done within the NICU. We reviewed the dates of meconium evacuation and the first feeding after the last enema from the clinical data. Radiologically, the timing of the radiographic improvement after the last enema was checked. In cases of distended distal ileum with meconium on pre-enema sonography, follow-up sonography was performed to determine the interval change after gastrografin enema. RESULTS: None of the sonography-guided Gastrografin enemas performed within the NICU caused procedure-related complications. Meconium was evacuated within one day in all patients. In 14 patients, on average, feeding was started on the 7th day and radiographic improvement was observed on the 3rd day. Four of the five patients showing a distended distal ileum with meconium revealed a decrease in ileal distension on follow-up sonography. On the other hand, the other patient, who did not show such a decrease on follow-up sonography, was found to have ileal stenosis during subsequent surgery. CONCLUSION: Sonography-guided Gastrografin enema is a safe and effective bedside procedure, when performed in the NICU for the diagnosis and treatment of meconium plug syndrome.

Usefulness of MR Cholangiography in the Evaluation of Neonatal Cholestasis: Comparison with 99mTc DISIDA Scan

PURPOSE: To evaluate the diagnostic validity of MR cholangiography as a second-line imaging tool following sonography in the evaluation of neonatal cholestasis, we compared MR cholangiography with 99mTc DISIDA scan. MATERIALS AND METHODS: We retrospectively evaluated sonography, 99mTc DISIDA scan and MR cholangiography in twenty-two neonates and infants (age range, 23-103 days; mean age, 57 days) presenting with conjugated hyperbilirubinemia. Of the 22 patients, 15 were diagnosed as biliary atresia by operative cholangiography and liver biopsy and six as neonatal hepatitis by imaging finding and clinical data. Remaining one patient was diagnosed as neonatal hepatitis by operative cholangiography and liver biopsy. Two independent observers for each study were assigned to review the images of 99mTc DISIDA scan and MR cholangiography without giving the final diagnosis or other clinical data. Diagnostic accuracy and interobserver variability for each study were evaluated. RESULTS: On 99mTc DISIDA scan, biliary atresia was mistaken for neonatal hepatitis in eight patients and vice versa in four patients. On MR cholangiography, it was mistaken biliary atresia as neonatal hepatitis and vice versa in each two patients. Sensitivity, specificity, accuracy, positive and negative predictive values of 99mTc DISIDA scan were 48%, 47%, 48%, 66% and 30%, respectively, and those of MR cholangiography were 90%, 71%, 84%, 87% and 81%, respectively. Interobserver variabilities for 99mTc DISIDA scan and MR cholangiography were 0.62 and 0.85, respectively. CONCLUSION: In the evaluation of patients with neonatal cholestasis, it would be advisable to use MR cholangiography, having superior diagnostic accuracy to 99mTc DISIDA scan, as a second-line imaging tool following sonography.

Nodular Regenerative Hyperplasia of the Liver in an Infant: Case Report

Nodular regenerative hyperplasia (NRH) of the liver is an uncommon disease entity, especially in the pediatricage group. A few cases have been reported in the radiologic literature, but follow-up imaging studies are rare. We describe a case of NRH, diagnosed by ultrasound-guided needle biopsy, in a seven-month-old infant with cri-du-chat syndrome. Initial ultrasound revealed several small hypoechogenic nodules in the liver, but CT and MR failed to demonstrate their presence. Two follow-up sonographic examinations were performed 7 and 20 months later, revealing increases in the size and number of the nodules.

Sonographic Evaluation of Acute Osteomyelitis in Infants

PURPOSE: To analyze the related sonographic findings and to determine the value of sonography in establishing the diagnosis of acute osteomyelitis in infants. MATERIALS AND METHODS: The sonographic findings of eleven infants aged 10 days-4 months (mean, 45 days) with acute osteomyelitis were retrospectively evaluated. The involved bones were the femur (n=5), humerus (n=2), tibia (n=2), rib(n=1), sternum(n=1), and calcaneus(n=1). Discontinuity or destruction of cortical margins, echotexture of the metaphysis and epiphysis, the presence of subperiosteal hypoechoic lesion, adjacent soft tissue swelling, distension of the joint capsule, the echotexture of joint effusion, and dislocation or subluxation of the involved joint were evaluated. The sonographic findings were compared with the plain radiographic (n=12) and MR (n=5) findings, with special attention to the identification of the metaphyseal or epiphyseal bony lesions and the involvement of adjacent joints. RESULTS: The sonographic findings of osteomyelitis were cortical discontinuity or destruction (n=12), hypoechoic lesions with an echogenic rim in the metaphysis (n=12), subperiosteal hypoechoic lesions (n=8), soft tissue swelling (n=9), a distended hip joint, with echogenic fluid (n=5), ill-demarcated echogenic lesions in the capital femoral epiphysis (n=5), and a subluxated hip joint (n=3). Plain radiographs revealed well or ill-defined osteolytic lesions in the metaphysis, accompanied by cortical destruction (n=8), new periosteal bone formation (n=3) and reactive sclerosis (n=2). Abnormality of the femoral epiphyses and joint involvement were not detected on plain radiographs, and in four cases no abnormality was noted. MR imaging showed that at T1WI, affected bony lesions were of low signal intensity and enhanced, with high signal intensity at T2WI. In all cases, both metaphyseal and epiphyseal lesions were demonstrated at MRI, but in one of the three cases in which an epiphyseal lesion was seen at MRI, this was not detected at US. CONCLUSION: Sonography is not only more sensitive than radiography in evaluating metaphyseal bony lesions but also useful in assessing concomitant joint and epiphyseal involvement of acute osteomyelitis in infants. Sonography is, therefore, a useful additional diagnostic tool for the early detection and management of acute osteomyelitis in infants.