[ALTERATIONS IN SENSITIVE MEASURES OF CARDIAC FUNCTION IN HEALTHY NEONATES DURING PHOTOTHERAPY].

OBJECTIVES: Phototherapy has been reported to reduce coronary blood flow in neonates but without affecting gross measures of cardiac function. The aim of our current study was to evaluate earlier, more sensitive changes in cardiac function during phototherapy. METHODS: Nineteen neonates with jaundice treated with phototherapy had Doppler echocardiographic evaluation, before, during and after phototherapy and were compared to 25 matched controls. Sensitive measures for cardiac performance in this study included left ventricular dimension, ventricular Doppler parameters and regional function assessment. RESULTS: Phototherapy was associated with a significant increase in heart rate. In addition, atrioventricular valve closure to opening interval decreased significantly during phototherapy while ventricular ejection times tended to decrease. However, left and right ventricular filling parameters and outflow velocity parameters, longitudinal tissue-Doppler annular velocities and myocardial performance indices were not affected by phototherapy and were similar to those in controls. Coronary blood velocities and integrals decreased significantly during phototherapy. CONCLUSIONS: Our study found no differences in early and sensitive measures of cardiac performance including the diastolic and systolic function, despite modestly lower flow in coronary arteries among healthy neonates during phototherapy.

Effects of Phototherapy on Coronary Blood Flow in Healthy Neonates: A Pilot Study.

BACKGROUND: Phototherapy has been reported to alter blood flow to various tissues. We hypothesized that during phototherapy the coronary blood flow will decrease because of a 'steal effect' to the periphery. OBJECTIVES: To evaluate the effects of phototherapy on coronary blood flow in healthy, jaundiced, term neonates. METHODS: Flow velocity [peak diastolic velocity (Vd)] and flow measures [diastolic time velocity integral (TVId) and flow index (FI)] in the left main (LM) and left anterior descending (LAD) coronary arteries were prospectively studied with 2D/pulsed Doppler ultrasound before, during and after phototherapy in 19 healthy term, jaundiced neonates (study group) and in matched nonjaundiced controls (25 neonates). Significance was set at p < 0.05. RESULTS: The neonates' characteristics were comparable in both groups. Sequential studies in the study group showed no significant decrease in measures of velocity and flow during phototherapy; however, there was a significant increase in some of these measures (Vd and TVId in the LM coronary artery, and Vd in the LAD coronary artery) after phototherapy. Velocity (Vd) and flow measures (TVId and FI) in the LAD coronary artery, but not in the LM coronary artery, were significantly lower when comparing the study group during phototherapy with the controls. In a multivariate model, phototherapy was an independent variable affecting Vd and TVId in LAD coronary arteries. Measures of cardiac output did not change significantly throughout the study. CONCLUSIONS: While part of our findings may suggest a modestly lower flow in coronary arteries during phototherapy, we conclude that no clinically significant alteration in coronary arterial flow occurs during phototherapy in healthy term neonates.

Severe eosinophilia in children: a diagnostic dilemma.

The differential diagnosis of hypereosinophilia includes both primary (clonal and idiopathic) and secondary medical conditions. Here we raise the awareness of physicians to the unusual causes of hypereosinophilic states and describe the molecular assays used in the diagnosis of hypereosinophilia. Two unusual cases of hypereosinophilia in children that were initially misdiagnosed are reported. T-cell receptor gene rearrangement, skewed X inactivation, fluorescence in situ hybridization analysis, and chromosomal karyotyping were used to reach the final correct diagnosis. Both patients displayed significant eosinophilia and were initially misdiagnosed as having parasitic infection. Nonspecific T-cell clonal expansion was diagnosed in 1 patient based on the clonality of the T-cell receptor variable γ-chain and the skewed chromosome inactivation. The second patient was diagnosed with B-lineage acute lymphoblastic leukemia with a translocation (5;14) (q13;q32) that is well known to be associated with hypereosinophilia. The level of awareness to clonal expansion of WBC subsets which can cause hypereosinophilia should be high when evaluating a patient with extreme eosinophilia. Advanced molecular assays to detect clonal expansion should be used to exclude aberrant clonal processes in such patients.