Diagnostic ionizing radiation exposure in premature patients.

OBJECTIVE: Concern regarding the magnitude and consequences of diagnostic radiation exposure in premature infants in neonatal intensive care units (NICUs) has increased as survival of premature infants has improved. Radiation exposure is not often rigorously monitored in NICU patients. The purpose of this observational study was to quantify the amount of ionizing radiation exposure in infants <33 weeks gestational age and to identify the indications for diagnostic imaging. STUDY DESIGN: We conducted a retrospective review of 215 premature infants who were <33 weeks gestation and who received central venous line (CVL) placement during their NICU stay during the period from 2006 to 2011. Absorbed ionizing radiation was estimated using the method of Puch-Kapst and colleagues (2009) and compared with recommended radiation exposure limits. All infants were 29.2±2.3 weeks (mean±s.d.) and 1262±433 g birth weight. RESULT: Subjects received 15±15 radiographs (4.4±2.9 for CVL placement, 5.7±9.8 for gastrointestinal (GI) evaluations and 5.2±9.3 for respiratory indications). Eleven infants (5.1%) received more than the maximum recommended radiation from radiographs (>1000 µSv). Inclusion of fluoroscopic procedures increased to 26 the number of infants (12.1%) who received more than the maximum recommended 1000 µSv. CONCLUSION: Ionizing radiation exposure that exceeded the recommended maximum in premature infants at high risk for long-term sequelae occurred in 12.1% of infants who were <33 weeks gestation and who were cared for in our NICU over the past 5 years. CVL placement accounted for 22% of this radiation exposure. GI evaluations accounted for the greatest amount of ionizing radiation exposure. We suggest that the increased use of other imaging strategies may reduce total ionizing radiation exposure in this vulnerable population.

3D multidetector CT angiographic evaluation of extralobar pulmonary sequestration with anomalous venous drainage into the left internal mammary vein in a paediatric patient.

Pulmonary sequestration is a congenital lung malformation, defined by dysplastic and non-functioning lung tissue lacking normal tracheobronchial connections and accompanied by an anomalous systemic blood supply. Recognition of anomalous arteries and veins in pulmonary sequestration is paramount to making the correct diagnosis. In contrast to intralobar pulmonary sequestration, where anomalous venous drainage is usually into the pulmonary venous system, the pattern of anomalous venous drainage is more varied in extralobar pulmonary sequestration. To the best of our knowledge, anomalous venous drainage to the internal mammary vein in extralobar sequestrations has not been reported. We report an anomalous venous drainage into the internal mammary vein in an extralobar sequestration which was evaluated with 3D multidetector CT angiography.

Symptoms of sleep disorders, inattention, and hyperactivity in children.

Children with sleep disorders are often inattentive or hyperactive, and some carry a diagnosis of attention deficit/hyperactivity disorder (ADHD) until their sleep disorder is detected. However, the potential behavioral impact of undiagnosed sleep disorders is not known. We sought to determine whether children with higher levels of inattention and hyperactivity more frequently have symptoms of sleep-related breathing disorders (SRBDs) or periodic limb movement disorder (PLMD). We surveyed parents of 2-18-year-old patients at a child psychiatry clinic (n = 70) and a general pediatrics clinic (n = 73) to assess the children's behavior, snoring, complaints of restless legs at night, and daytime sleepiness. A validated pediatric sleep questionnaire provided the explanatory variables, and a scale for inattention and hyperactivity, derived from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), provided the dependent variable. Habitual snoring was more frequent (33%) among children who carried a diagnosis of ADHD than among the other children at the psychiatry or general pediatric clinics (11 and 9%, respectively, chi-square test, p = 0.01). Snoring scores, derived from six snoring- and SRBD-related question items, were associated with higher levels of inattention and hyperactivity. The complaint of restless legs and a composite score for daytime sleepiness showed some evidence, though less consistent, of an association with inattention and hyperactivity. The association of snoring with inattention and hyperactivity suggests that SRBDs and perhaps other sleep disorders could be a cause of inattention and hyperactivity in some children. If a causal effect is present, our data suggest that 81% of habitually snoring children who have ADHD--25% of all children with ADHD--could have their ADHD eliminated if their habitual snoring and any associated SRBD were effectively treated.

Plasma catecholamines and social behavior in male vervet monkeys (Cercopithecus aethiops sabaeus).

Many investigations in humans indicate that epinephrine, norepinephrine and their ratio may correlate with such traits as social competence, academic achievement, and aggression. However, the socioeconomic, dietary, and environmental confounds accompanying most human studies complicate their interpretation. Social status, aggression, and other social behaviors can be reliably assessed in nonhuman primates under conditions controlling for crucial environmental factors. If interpretation of human studies is correct, dominant and subordinate male vervet monkeys should exhibit distinctive patterns of catecholamine secretion. To test this possibility, seventeen adult male monkeys living in six stable social groups were observed for 6 months. Based on their success in agonistic events, subjects were categorized as dominant or subordinate. Alpha scores were calculated from empirically derived factors to provide a noncategorical measure of dominant behavioral style. Plasma epinephrine and norepinephrine samples obtained from anesthetized subjects did not differ between dominant and subordinate males. Alpha scores, however, distinguished high from low norepinephrine/epinephrine ratio groups. These findings are consistent with studies in humans linking high epinephrine, low norepinephrine, and social competence.

Self-injurious behavior associated with clonidine withdrawal in a child with Tourette's disorder.

A 7-year-old boy with Tourette's disorder, atypical pervasive developmental disorder, borderline mental retardation, and a history of self-injurious behavior was treated for 21 months with clonidine transdermal patches at doses ranging from 0.1 to 0.5 mg weekly. When withdrawn from clonidine over 4 weeks to assess the need for continued therapy, the patient developed multiple self-destructive behaviors involving the theme of suffocation. The importance of careful clinical monitoring of the behavior of patients undergoing withdrawal from prolonged treatment with high doses of clonidine is emphasized.