ABSTRACT
Neutropenia refers to a decrease in the absolute neutrophil count according to age and race norms and poses a common concern in pediatric practice. Neutrophils serve as host defenders and act crucially in acute inflammation procedures. In this narrative review, we systematically present causes of neutropenia in childhood, mainly adopting the pathophysiological classification of Frater, thereby studying (1) neutropenia with reduced bone marrow reserve, (2) secondary neutropenia with reduced bone marrow reserve, and (3) neutropenia with normal bone marrow reserve. Different conditions in each category are thoroughly discussed and practically approached from the clinician's point of view. Secondary mild to moderate neutropenia is usually benign due to childhood viral infections and is expected to resolve in 2-4 weeks. Bacterial and fungal agents are also associated with transient neutropenia, although fever with severe neutropenia constitutes a medical emergency. Drug-induced and immune neutropenias should be suspected following a careful history and a detailed clinical examination. Cytotoxic chemotherapies treating malignancies are responsible for severe neutropenia and neutropenic shock. Rare genetic neutropenias usually manifest with major infections early in life. Our review of taxonomies clinical findings and associates them to specific neutropenia disorders. We consequently propose a practical diagnostic algorithm for managing neutropenic children.
ABSTRACT
Developmental hemostasis refers to age-related alterations related to the progressive maturation of the hemostatic system. Although the conventional coagulation tests, such as prothrombin time (PT) and activated partial thromboplastin time (aPTT), are indeed helpful in coagulation workup, they do not accurately delineate the hemostasis in vivo. The viscoelastic tests, namely thromboelastography (TEG) and rotational thromboelastometry (ROTEM), seem to reflect hemostasis more accurately since they measure various clot parameters without excluding the cellular coagulation components. TEG and ROTEM have shown redaction in blood product administration when used in therapeutic algorithms in older children and adults, but their use in neonates is limited. This review summarizes the current literature regarding using these tests in the neonatal population. Several studies tried to resolve the lack of neonatal reference values of the TEG/ROTEM parameters by publishing neonatal reference ranges for various gestational age groups. Moreover, few studies concerning therapeutic hypothermia, neonates undergoing surgery, and critically ill neonates have shown some predictive value of these tests regarding bleeding events. Even though their results seem promising, larger studies of higher quality are needed to clarify any discrepancies and point out whether these tests have significant predictive value. In conclusion, viscoelastic tests need to be increasingly part of the NICUs' clinical routine and should be used along with conventional coagulation tests in transfusion therapy.
ABSTRACT
Current literature regarding the association of vitamin D insufficiency and food allergy is contradicting. The purpose of our study was to investigate this association. This is a systematic review and meta-analysis according to the PRISMA statement. PubMeD and Scopus databases were systematically searched for case-control studies investigating the association between pediatric food allergy and vitamin D insufficiency. Our search yielded 806 studies. Ten final studies were considered eligible for qualitative and quantitative analysis. Children with vitamin D insufficiency were found to have 68% more probability to present a food allergy episode (adjusted pooled OR: 1.68, 95% CI [1.25-2.27], p-value: 0.001). In their second year of life they were 4 times more likely to present a food allergy episode (adjusted pooled OR: 4.06, 95% CI [1.93-8.56], p-value: < 0.001), and 56% more probable to develop food sensitization (OR: 1.56, 95% CI [1.15-2.11], p-value: < 0.004). Children in Australia with vitamin D insufficiency were almost 4 times more likely to develop egg sensitization (adjusted OR: 3.79, 95% CI [1.19-12.08], p-value: 0.024). Children with vitamin D insufficiency were almost twice as likely to have peanut sensitization (OR: 1.96, 95% CI [1.08-3.57], p-value: 0.028). Conclusion: Decreased maternal vitamin D levels and infant vitamin D insufficiency appear to increase the incidence of food allergies, particularly in the second year of life. To confirm this association, multicenter longitudinal studies are required. What is Known: ⢠In newborns and young children, vitamin D deficiency and insufficiency are prevalent. ⢠The exact role of vitamin D in atopic diseases remains controversial. What is New: ⢠Decreased maternal vitamin D levels and infant vitamin D insufficiency appear to increase the incidence of food allergies. This association is more evident in the second year of life.
