A preliminary report on the efficacy of the Multicare AR-Bed in 3-week-3-month-old infants on regurgitation, associated symptoms and acid reflux.

OBJECTIVES: The aim of this preliminary study was to evaluate the efficacy of a 40 degrees supine body position on infant regurgitation, reflux-associated symptoms and acid reflux. INTERVENTION: Thirty of 52 consecutive infants presenting with frequent regurgitation and reflux-associated symptoms occurring mainly during feeding were evaluated in the Multicare AR-Bed (Peos, Ninove, Belgium). The Infant-Gastroesophageal Reflux Questionnaire-Revised (I-GERQ-R) and an oesophageal pH monitoring were performed at inclusion and after 1 week. RESULTS: Eight out of 30 (27%) infants did not tolerate the 40 degrees positioning, and had to be taken out of the study within the first 2 days. However, in 22/30 (73%) infants the I-GERQ-R and acid reflux decreased significantly with the Multicare AR-Bed. The mean duration of use of the Multicare AR-Bed was 3.2 months. CONCLUSION: The results of this pilot study suggest that a specially made bed that nurses the infant at 40 degrees supine body position reduces regurgitation, acid reflux and reflux-associated symptoms. However, the intervention was open, the sample size small and the withdrawal rate was substantial. Larger trials are needed.

Childhood celiac disease: a long-term analysis of relapses in 91 patients.

The diagnosis of celiac disease (CD) was uniformly established between 1960 and 1983 in 314 infants and children according to the following criteria: a flat proximal small bowel mucosa in untreated patients and an unequivocal response and remission on a gluten-free diet (GFD). In 91 patients, one or more interruptions of the GFD (challenges) were documented by repeated intestinal biopsies. Sixty-eight percent of the challenges were initiated by the patients themselves. Seventy-one patients (Group A, 81.4%) had a flat mucosa after 0.25-14.67 years off diet. In 11 (Group B, 12%), a successive deterioration of the mucosa occurred during 0.5-6.67 years after interruption of GFD without becoming flat. Six patients (Group C, 6.6%) had a normal intestinal mucosa after 2.24-6.92 years off diet. Three patients are still under study, being off diet for less than 2 years. Median age at diagnosis was similar in all three groups (1.16, 1.16, and 1.12 years). Median duration of GFD prior to challenge was 4.54 years in Group A, 12.16 years in Group B (p less than 0.001), and 6.38 years in Group C. A mucosal relapse within 2 years after the beginning of challenge was observed in 21 of 24 patients (87.5%) studied longitudinally during planned challenges. It is concluded that only a minority (6.6%) of CD patients, when diagnosed as above, will not relapse after an interruption of GFD and that another small group (12%) will deteriorate very slowly. Routine gluten challenges in all CD patients, interrupting established life and dietary habits and including repeated biopsies in the majority of patients who deteriorate and relapse, seem therefore not justifiable.

Neonatal hepatitis with obstructive jaundice in an SZ heterozygous alpha 1-antitrypsin-deficient boy and destructive lung disease in his SZ mother. A review of the literature.

SZ-Alpha 1-antitrypsin deficiency, leading to severe transient neonatal cholestasis with mild hepatitis is rare. In our patient, intrahepatic bile duct hypoplasia was suspected. Since cholecystography and hepatic scintigraphy failed to reveal intrahepatic bile ducts, a diagnostic surgical liver biopsy was performed. Typical intrahepatocytic PAS-positive granules and a low serum alpha 1-antitrypsin concentration allowed a correct diagnosis of the SZ phenotype. The administration of an elementary diet quickly improved the clinical condition of our patient. Follow-up studies of this case and others will allow a better establishment of prognostic criteria and help in genetic counselling.

The use of sweat osmolality in the diagnosis of cystic fibrosis.

Sweat osmolality determination with 7-10 microliter of sweat for the establishment of the diagnosis of cystic fibrosis (CF) was evaluated in 297 probands. In 12 out of 26 infants below 2 months of age and in 3 out of 271 older probands not enough sweat could be collected at the first attempt. A final diagnosis was established before the age of 2 months in 21 out of 26 infants. In 27 CF patients sweat osmolality was 285.86 +/- 41.25 mmol/kg (mean +/- SD), the mean value - 2 SD being 203.36 mmol/kg. In 266 control subjects sweat osmolality was 107.38 +/- 29.49 mmol/kg (mean +/- SD), the mean value + 2 SD being 166.36 mmol/kg. There was no overlap between CF patients and controls in each age group. The method is simple, rapid and reliable, and improves diagnostic possibilities especially in young infants. Sweat osmolality values above 180 mmol/kg should be repeated and checked for final confirmation or exclusion of the diagnosis of cystic fibrosis.

Acute extrapyramidal dysfunction after domperidone administration. Report of a case.

The authors relate the observation of a 3-month-old boy who showed acute neurological dysfunction of the extrapyramidal system secondary to the administration of domperidone, a new anti-emetic drug. This drug was first believed not to provoke neurological dysfunction. Yet, this and three other published cases document the possibility of adverse neurological reactions due to domperidone administration.

Severe neonatal anemia possibly caused by spontaneous cephalic version, with excellent outcome--a case report.

A 29-year-old primipara with breech presentation had a spontaneous cephalic version a few days before her admission. She was hospitalised because of a sudden decrease in fetal movements perceived. During labour a sinusoidal fetal heart rate pattern was observed. The mother gave birth to a strikingly pale 3250 g weighing boy. His APGAR score was 1/5/6. Cord hemoglobin was 2.9 g/dl and an acid elution test showed the presence of 9.1% fetal red cells in the maternal circulation. Following a transfusion of packed cells and total blood, the babies hemoglobin rose to above 10 g/dl. On the second day of life he developed an acute functional renal failure which responded well to fluid restriction and furosemide administration. Upon discharge, 10 days after birth, the physical and neurological examination were normal. At present time the child is two years old and thriving well. Anemia in the newborn due to occult blood loss may be the result of bleeding of the fetus into the maternal circulation. The incidence of a massive transplacental blood loss is increased by traumatic amniocentesis, by external cephalic version and during cesarian section. As illustrated by the present case, spontaneous cephalic version may possibly account for another cause of feto-maternal transfusion resulting in severe neonatal anemia. Severe anemia at birth secondary to an acute and massive feto-maternal hemorrhage is commonly associated with a poor prognosis. Under such conditions immediate re-expansion of the blood volume proved to be life saving.

Volume limited ventilation for treatment of severe respiratory distress in neonates.

Ventilatory treatment of the very small infant with severe respiratory distress remains controversial. At several occasions pressure limited ventilators have shown not to provide adequate alveolar ventilation in these newborn babies. On the other hand, until now few data are found concerning the ventilation of newborns with volume limited ventilators. The authors report two cases with successful ventilation using a servo controlled volume limited machine and they stress the possibilities and advantages of such a type of ventilator in a neonatal intensive care unit.