Arterial flow patterns in healthy transitioning near-term neonates.

OBJECTIVE: Significant haemodynamic changes occur at delivery impacting organ blood flow distribution. We aimed to characterise Doppler indices patterns over time in three different organs (brain, gut and kidney) and test them as measures of vascular resistance. DESIGN: Observational cohort study. Serial Doppler interrogations of the anterior cerebral, superior mesenteric and renal arteries within 2 hours, 2-6, and 24 hours of life, in combination with central haemodynamic data. PATIENTS: Healthy, near-term (>36 weeks of gestation) neonates. OUTCOME MEASURES: Pulsatility (PI) and Resistance Indices (RI) patterns and organ-specific conductances, detailed echocardiographic haemodynamic measures. RESULTS: Twenty-one babies were studied. Doppler morphology and adaptation patterns were distinctly different between the organs (brain, gut and kidney) supporting autonomous vascular regulatory effects. The PI differentiated especially between kidney and other organ flow consistently over time. PI and RI for all three organs decreased. The variance in organ conductance did not explain the variance in 1/PI, indicating that PI is not a measure of resistance. Superior mesenteric artery had the highest velocity with 72 cm/s. Non-invasively acquired pilot serial values in a normal population are given. Patent ductus arteriosus flow remained open at discharge for 36%. CONCLUSIONS: Haemodynamic transitioning patterns assessed by serial Dopplers in healthy near-term neonates differ in brain, gut and kidney: Doppler waveform morphology differs, and PI differentiates renal Doppler morphology, compared with the other organs. While PI and RI decline for all organs, they do not measure resistance. Brain artery velocity increases, mesenteric perfusion is variable and renal Vmax decreases.

Does Postmenstrual Age Affect Medical Patent Ductus Arteriosus Treatment Success in Preterm Infants?

OBJECTIVE: Patent ductus arteriosus (PDA) is the most common cardiovascular problem of prematurity. Our objective was to examine the effect of postmenstrual age (PMA) on response to medical PDA treatment. STUDY DESIGN: This retrospective cohort study included infants ≤ 32 weeks' gestational age (GA) who received nonsteroidal anti-inflammatory drugs (NSAIDs) for PDA treatment. Response was positive if echocardiogram showed closed or small PDA or no further treatment was required. Baseline characteristics between responders and nonresponders were compared. Multivariable logistic regression analysis with generalized estimating equations was used to analyze the association between PMA and response. RESULTS: A total of 183 infants with a mean GA of 26.4 ± 2.2 weeks and birth weight of 870 ± 313 g received 257 courses of NSAIDs. Positive response rate to the first course was 65.6%. Two and three courses were given in 62 and 12 infants, with response rates of 48.4 and 50%, respectively. Surgical ligation of PDA occurred in 30 (16.4%) infants. Multivariable logistic regression analysis with generalized estimating equations revealed that PMA was not associated with a positive response (adjusted odds ratio [aOR]: 0.88; 95% confidence interval [CI]: 0.71-1.10). GA at birth remained the most influential factor (aOR: 1.33; 95% CI: 1.02-1.73). CONCLUSION: GA rather than PMA is the strongest predictor for a positive response in medical PDA treatment.

Neonatal Pneumopericardium in a Nonventilated Term Infant: A Case Report and Review of the Literature.

Neonatal pneumopericardium (PPC) is a rare form of neonatal air leak syndrome with high morbidity and mortality. Air leak syndrome in the newborn is usually associated with active resuscitation, respiratory distress syndrome, meconium aspiration syndrome, mechanical ventilation, or trauma associated with labour. Neonatal PPC can be associated with other air leak syndromes such as pneumomediastinum, pneumothorax, pneumoperitoneum, and subcutaneous and interstitial emphysema. Spontaneous PPC is a rare event in the neonatal period. We report a case of PPC in association with pneumothorax in a nonventilated term infant. The infant responded to thoracocentesis without the need for pericardiocentesis.

Neurological paraneoplastic syndrome as presentation of leukemia.

Acute disseminated encephalomyelitis (ADEM) has been reported in acute leukemia and after stem cell transplantation, but ADEM as a presenting feature in pediatric acute lymphoblastic leukemia is rare. We report an 8-year-old child with acute lymphoblastic leukemia who presented with features of ADEM. The diagnosis was confirmed by neuroimaging and the lesions disappeared with chemotherapy.

Etiology and prognostic factors of acute liver failure in children.

Acute liver failure (ALF) is a life-threatening condition characterized by jaundice, encephalopathy and coagulopathy leading to multiorgan failure in a patient with no prior history of liver disease. Forty three consecutive patients of ALF admitted in Pediatric ICU were studied for etiology and prognostic factors. Etiology was established in 91% cases. Viral infections were the most common cause. Mortality rate was 44%. Increasing grade of encephalopathy, >7 days interval between the onset of prodromal symptoms and encephalopathy, blood glucose <45mg/dL, serum bilirubin > 10mg/dL and pH <7.35 or >7.45 on admission were found to be associated with increased risk of mortality.

Acute transverse myelitis: an unusual complication of typhoid fever.

Typhoid fever is associated with a wide spectrum of neurological complications. Acute transverse myelitis is a rare complication with only a few reports in adults and none in children. A 15-year-old boy with typhoid fever is reported who developed acute transverse myelitis in the 3rd week of illness. He was treated with antibiotics and corticosteroids and made a complete recovery.

Assessment of sexual maturity in a cohort of adolescents with celiac disease on gluten-free diet.

Delayed sexual maturation is a known complication of celiac disease (CD). There is paucity of data regarding the effect of gluten-free diet (GFD) on sexual maturity in patients with CD in India. We did a cross-sectional observational study to assess the sexual maturity in 30 adolescents with CD on GFD for at least 1 year, and evaluated factors which affect their sexual maturity. Sexual maturation was assessed using Tanner's stages of sexual development. All adolescents had completed 2 years of GFD and 53 % had completed 4 years of GFD. Sexual maturation was delayed in 30 %. Age at initiation of GFD was associated with attaining appropriate sexual maturity (p = 0.048). We conclude that delayed sexual maturation is not uncommon in adolescents with CD and may be corrected by early diagnosis and initiation of GFD.

Henoch-Schönlein purpura with uveitis: an unusual case and review of literature.

Henoch-Schönlein purpura (HSP) is a small vessel vasculitis with IgA dominant immune complex deposition. It is characterized by a triad of palpable purpura (without thrombocytopenia), abdominal pain and arthritis. Uveitis is rarely associated with HSP with only 3 cases reported in literature. All these cases were in adult population and were associated with nephritis. However, this association is not reported in paediatric age group. We are reporting a case of an 11-year-old child of recurrent HSP with uveitis.