Randomized placebo-controlled trial of a 42-Day tapering course of dexamethasone to reduce the duration of ventilator dependency in very low birth weight infants.

OBJECTIVE: To assess the effect on duration of ventilator dependency of a 42-day tapering course of dexamethasone in very low birth weight neonates. METHODS: Infants (N = 118) were assigned randomly, within birth weight/gender strata, to treatment with either a 42-day tapering course of dexamethasone or an equal volume of saline as placebo. Entry criteria were 1) birth weight <1501 g; 2) age between 15 and 25 days; 3) <10% decrease in ventilator settings for 24 hours and FIO2 >/=0.3; 4) absence of patent ductus arteriosus, sepsis, major congenital malformation, congenital heart disease; and 5) no evidence of maternal HIV or hepatitis B infection. The dosage schedule was 0.25 mg/kg bid for 3 days, then 0.15 mg/kg bid for 3 days, then a 10% reduction in the dose every 3 days until a dose of 0.1 mg/kg had been given for 3 days, from which time a dose of 0.1 mg/kg qod was continued until 42 days after entry. The primary endpoint was the number of days on assisted ventilation after study entry. Secondary outcomes of interest included days on supplemental oxygen, days of hospitalization, and potential adverse effects, such as infection, gastrointestinal bleeding, left ventricular hypertrophy, and severe retinopathy of prematurity. RESULTS: Infants in the dexamethasone- and placebo-treated groups were similar in terms of baseline attributes, including birth weight, gestational age, gender, race, and ventilator settings at entry. Infants treated with dexamethasone were on assisted ventilation and supplemental oxygen for fewer days after study entry (median days on ventilator, 5th and 95th percentiles, 13 [1-64] vs 25 [6-104]; days on oxygen, 59 [6-247] vs 100 [11-346]). No differences were found in risk of death, infection, or severe retinopathy. In subgroup analyses, the association of dexamethasone with more rapid weaning from the ventilator was weaker among infants enrolled before the 16th day of life, infants with chest radiographs showing cystic changes and/or hyperinflation, and infants requiring an FIO2 >/=0.7 or a peak inspiratory pressure >/=19 at study entry. CONCLUSIONS: A 42-day tapering course of dexamethasone decreases the duration of ventilator and oxygen dependency in very low birth weight infants and is not associated with an increased risk of short-term adverse effects.

Diffuse neonatal hemangiomatosis with extensive involvement of the brain and cervical spinal cord.

BACKGROUND: Diffuse neonatal hemangiomatosis (DNH) is a rare disorder first recognized at birth or during the neonatal period. DNH is characterized by numerous cutaneous and visceral hemangiomas involving three or more organ systems. MATERIALS AND METHODS: Although the skin and liver are most frequently affected, we present a case of DNH demonstrating an unusual predilection for the central nervous system (CNS). RESULTS AND CONCLUSION: We report the imaging findings in a patient with this disorder, paying particular attention to the features seen on cranial sonography and spinal MR imaging.

A complex communicating bronchopulmonary foregut malformation: diagnostic imaging and pathogenesis.

We report a newborn with an esophageal lung, a rare type of communicating bronchopulmonary foregut malformation (CBPFM). Associated findings included esophageal atresia, tracheoesophageal fistula (TEF) to the distal esophagus, duodenal stenosis with annular pancreas, imperforate anus, vertebral anomalies and ambiguous genitalia. Radiologic evaluation included chest radiographs, esophagrams, chest ultrasound and chest CT. After colostomy and surgical repair of duodenal stenosis and TEF, a right thoracotomy was performed to treat an esophageal lung. Radiologic features of this unusual variant of CBPFM are presented. Accurate preoperative imaging diagnosis is essential for planning surgical treatment of an esophageal lung.

Pediatric uroradiology update.

The present focus in pediatric uroradiology is a healthy reappraisal of the indications for and clinical use of the numerous modalities available for evaluating the child who has a urinary tract infection. The purpose of this article is to update the urologist with respect to the problems that are involved in discussing the diagnosis and imaging of the pediatric urinary tract infection.

Response to dexamethasone in ventilated preterm infants: effect of radiographic subtype of chronic lung disease.

We compared the response to prolonged treatment with dexamethasone in two groups of ventilated preterm infants: one whose chest radiographs showed homogenous opacity, and one whose radiographs showed cystic changes and hyperinflation. Forty-nine infants were treated with dexamethasone for 42 days, beginning when they were 15 to 27 days old, had no evidence of sepsis or patent ductus arteriosus, and had experienced no decrease in ventilator support for 24 hours. Forty-nine controls were selected who met these criteria for dexamethasone treatment. All had birthweights of 500 to 1250 g. Two radiographs made between 14 and 28 days of age were reviewed. Among infants with homogeneous opacity (19 dexamethasone, 26 controls), dexamethasone was associated with fewer days on assisted ventilation (median [interquartile range]: 7 [3-11] versus 23 [9-40]; p = 0.001). Among those with cystic changes and hyperexpansion (30 dexamethasone, 23 controls), no difference was found between dexamethasone treated infants and controls (17 [7-34] versus 32 [16-47]; p = 0.9). Thus, the effect of dexamethasone on days of ventilation was attenuated in infants with cystic changes and hyperinflation.

CT of the pediatric gastrointestinal tract.

Despite the fact that children are not small adults, some children will invariably be evaluated with adult imaging protocols. As CT gains popularity in the evaluation of the adult gastrointestinal (GI) tract, there will undoubtedly be some spillover into the pediatric age group. This pictorial essay reviews the CT appearance of some common pediatric GI disorders as common diseases may present uncommonly, both clinically and radiographically.

Pediatric upper gastrointestinal tract.

In conclusion, plain-film radiography and the UGI series are useful, easily obtained tests for screening the pediatric UGI tract and differentiating between medical and surgical disease. Ultrasound continues to develop as an initial test for evaluation of the vomiting infant because of its reliability in diagnosing HPS. Endoscopy remains the superior method for diagnosis of mucosal diseases given the limitations of single-contrast barium studies and the newcomer status of ultrasound. Although scintigraphy is the most sensitive and physiologic imaging method for evaluation of gastroesophageal reflux, the UGI series and endoscopy currently play dominant roles in the evaluation of the child with "significant" GERD. CT, MR imaging, and endoscopy are secondary procedures because of their preparation, sedation, monitoring requirements, and cost. Each modality provides the radiologist a different perspective on pediatric UGI disease and therefore improves our ability to understand and diagnose abnormalities in the pediatric UGI tract.

Congenital cyst of the pancreas.

The case of a 4-month-old girl with a rare multilocular congenital pancreatic cyst is presented, along with radiological/pathological correlation and a review of the literature. Congenital cyst of the pancreas is a rare lesion most often seen in infant girls, although it may be demonstrated in utero. Conventional radiographic signs and clinical symptoms primarily reflect mass effects, whereas imaging modalities show the cystic nature of the mass. Although rare, this cyst should be considered in the differential diagnosis of fetal and pediatric cystic abdominal masses.

Magnetic resonance imaging in the evaluation of lymphangioma circumscriptum.

BACKGROUND: Lymphangioma circumscriptum is characterized clinically by grouped vesicles, some of which may be filled with serosanguineous fluid. The depth and extent of involvement of lymphangioma circumscriptum cannot be adequately estimated from the cutaneous examination. OBSERVATION: We describe two patients with lymphangioma circumscriptum evaluated by magnetic resonance imaging. Magnetic resonance imaging accurately demonstrated the true extent of involvement. CONCLUSIONS: With magnetic resonance imaging to delineate the entire lesion of lymphangioma circumscriptum, one can (1) provide education to the family regarding the extent of involvement and (2) prevent incomplete invasive surgical procedures from being performed.

Multifocal primary neuroblastoma.

UNLABELLED: The purpose of this study is to present three patients with multifocal primary neuroblastoma, to review the literature, and describe the radiographic findings. SUBJECTS AND METHODS: Three children with multifocal neuroblastoma have been identified. The case histories and imaging findings in these patients are reviewed. RESULTS: Two children had synchronous and one child had metachronous multifocal primary neuroblastoma. The primary tumors were both in the abdomen in one patient, both in the chest in another patient, and in the chest and abdomen in the third patient. Evidence for multifocal origin of these tumors, rather than metastatic spread, is presented. CONCLUSION: Multifocal primary neuroblastomas can occur. The tumors maybe synchronous or metachronous. Awareness of this disorder may prevent errors in diagnosis and staging. Although not identified in our patients there is a strong familial incidence of neuroblastomas in those patients with multifocal tumors.

Thymic calcifications in histiocytosis X.

We report a case of an infant with pulmonary histiocytosis X with punctate thymic calcifications on conventional CT without an anterior mediastinal mass.

Radiology on the air. A continuing medical education experiment.

RATIONALE AND OBJECTIVES: The purpose of Radiology on the Air was to assess the technical and educational feasibility of providing radiologic continuing medical education via a fully interactive live telecommunications network. METHODS: Thirty-nine radiologic conferences were broadcast over the communications network of the Microelectronics Center of North Carolina (MCNC). Category 1 credit for the Physicians Recognition Award of the American Medical Association was available to participants who returned a completed program evaluation sheet by mail. RESULTS: Three participating academic institutions regularly offered the programming to a total of 684 participants, of whom 129 viewed programs at distant sites. Despite adequate-to-excellent technical quality and positive feedback concerning educational content, no continuing medical education (CME) credits were issued by the parent institution. CONCLUSIONS: The Radiology on the Air experiment suggests that a live telecommunications network is a capable vehicle for providing CME in radiology.

Inflammatory pseudotumor: a gallium-avid mobile mesenteric mass.

An 8-yr-old boy with a 1-mo history of culture-negative fever and anemia underwent gallium, ultrasound, and computed tomography studies as part of the evaluation of a fever of unknown origin. These studies revealed a mobile gallium-avid solid abdominal mass subsequently proven to be an inflammatory pseudotumor of the mesentery, a rare benign mass. This report documents the gallium-avid nature of this rare lesion and discusses associated characteristic clinical, pathologic, and radiographic features.