Impact of anatomic closure on somatic growth among small, asymptomatic children with secundum atrial septal defect.

We retrospectively identified 92 children aged

Proarrhythmia associated with cisapride in children.

BACKGROUND: Cisapride is a prokinetic agent that facilitates gastrointestinal motility and is widely used for the treatment of gastroesophageal reflux disease (GERD) in adults and children. However, reports of ventricular proarrhythmia have been noted in patients taking cisapride, particularly in conjunction with other drugs that may inhibit hepatic metabolism of cisapride via the cytochrome P450 3A4 system. OBJECTIVE: We designed a prospective, blinded study to evaluate the effect of cisapride on ventricular repolarization in children with GERD. METHODS: We analyzed the electrocardiograms (ECGs) from 35 children (age 0.4 to 18 years, mean 5.2 years) including measurement of the resting QT interval (QTc), JT interval (JTc), as well as QT and JT interlead dispersion markers. Data from these patients were compared with ECGs from a control group of 1000 normal children. RESULTS: Eleven (31%) of 35 patients receiving cisapride had a prolonged QTc (> or = 450 ms). The JTc was prolonged > or = 360 ms in 16 of 35 patients (46%). The mean QTc in the cisapride group was 428 +/- 35 ms and mean JTc was 336 +/- 35 ms. An increased QT or JT dispersion (> 70 ms) was seen in only 3 of 35 children. Of the 11 children with QTc prolongation, 2 had documented torsades de pointes ventricular tachycardia. Both patients were taking cisapride concomitantly with a macrolide antibiotic. All other patients were treated with either cisapride alone or in conjunction with other GERD agents, such as ranitidine or omeprazole. CONCLUSIONS: Cisapride may cause prolongation of ventricular repolarization in children. There does not appear to be increased heterogeneity of repolarization or delayed depolarization in this small sample. The proarrhythmia may be exacerbated by medications that inhibit cytochrome P450 3A4 hepatic metabolism, overdosage, or mechanisms that result in decreased serum clearance. ECG intervals should be monitored in children maintained on cisapride, particularly when used in combination with other known QT-prolonging medications.

Effect of multiple coil closure of patent ductus arteriosus on blood flow to the left lung as determined by lung perfusion scans.

Lung perfusion scans reveal that multiple-coil closure of the ductus does not interfere with pulmonary blood flow. However, caution is necessary when placing multiple coils in small infants.

Effect of Golytely on serum electrolytes and hydration status of infants.

Golytely (GLP) is a commonly used oral preparation for infants and children undergoing intestinal surgery. Although the composition of GLP, a nonabsorbable electrolyte lavage solution, is designed to avoid electrolyte shifts and dehydration, systematic evaluation of the effects of this preparation on the hydration status and serum electrolytes of infants has not been performed. The authors evaluated 48 children (0 to 24 months of age) who received GLP. Serum electrolytes and blood urea nitrogen measurements were obtained before and after GLP administration. During GLP administration all the patients were allowed to drink clear fluids, including Rehydralyte in unrestricted quantities. Only two received intravenous fluids during the preparation. Statistical evaluation of the shifts in electrolytes were performed by the Students paired t test. Although the shift in serum electrolytes may be statistically significant, with a decrease in potassium and chloride and an increase in CO2, these changes were not clinically significant.