Transpyloric Feed in Reflux-Associated Apnea in Preterm Newborns: A Prospective Study.

Background: The etiological correlation between gastroesophageal reflux (GER) and apnea is controversial. We conducted a prospective interventional study designed to address the controversy. Methods: Preterm neonates with apnea at a tertiary care center, who had clinical features of GER without any other comorbidities likely to cause apnea, were included in the study. The enrolled neonates underwent continuous transpyloric tube feeding for 72 hours. The primary outcome measure was the difference in the number of apneic episodes pre- and post-initiation of nasoduodenal (ND) feeding. Secondary outcome measures included the incidence of necrotizing enterocolitis, other gastrointestinal disturbances, and mortality. Results: Sixteen preterm neonates were included in the study. A substantial proportion (n =11, 68.8%) of the included neonates had a reduction in the number of apneic episodes. There was a significant decrease in the mean number of apneic episodes from 1.75 (±0.837) to 0.969 (±0.957) (P=.007). The median number of apneas was 1.5 (IQR 0.875) before and 0.5 (IQR 0.875) after ND feeds. There were no serious adverse events observed that were attributable to transpyloric feeding. Conclusion: This prospective study suggests that in a selected group of preterm neonates with reflux- associated apnea, transpyloric feeding can be an effective therapeutic modality.

Development and initial validation of a composite disease activity score for systemic juvenile idiopathic arthritis.

OBJECTIVE: To develop a composite disease activity score for systemic JIA (sJIA) and to provide preliminary evidence of its validity. METHODS: The systemic Juvenile Arthritis Disease Activity Score (sJADAS) was constructed by adding to the four items of the original JADAS a fifth item that aimed to quantify the activity of systemic features. Validation analyses were conducted on patients with definite or probable/possible sJIA enrolled at first visit or at the time of a flare, who had active systemic manifestations, which should include fever. Patients were reassessed 2 weeks to 3 months after baseline. Three versions were examined, including ESR, CRP or no acute-phase reactant. RESULTS: A total of 163 patients were included at 30 centres in 10 countries. The sJADAS was found to be feasible and to possess face and content validity, good construct validity, satisfactory internal consistency (Cronbach's alpha 0.64-0.65), fair ability to discriminate between patients with different disease activity states and between those whose parents were satisfied or not satisfied with illness outcome (P < 0.0001 for both), and strong responsiveness to change over time (standardized response mean 2.04-2.58). Overall, these properties were found to be better than those of the original JADAS and of DAS for RA and of Puchot score for adult-onset Still's disease. CONCLUSION: The sJADAS showed good measurement properties and is therefore a valid instrument for the assessment of disease activity in children with sJIA. The performance of the new tool should be further examined in other patient cohorts that are evaluated prospectively.

Evaluation of joint cartilage thickness in healthy children by ultrasound: An experience from a developing nation.

OBJECTIVES: Musculoskeletal ultrasound (MSUS) has a crucial role in clinical assessment and monitoring of patients with rheumatologic diseases. Early detection of joint cartilage destruction is difficult. MSUS is a cheap, noninvasive, nonhazardous bedside tool that can be used for detection of cartilage damage. We aimed to generate normative data of joint cartilage thickness of children in our population using this tool. METHODS: Healthy children, aged between 2 and 12 years, not suffering from any joint disorders and not on any chronic medication were recruited. The thickness of joint cartilage at wrist, knee and ankle were measured by ultrasound as per European League Against Rheumatism standard scan criteria. The scans were done by a single observer. RESULTS: Data of 409 children revealed median cartilage thickness at right wrist, knee and ankle joints as 2.20 (interquartile range [IQR] 1.60-3.00) mm, 2.40 (1.80-3.10) mm and 2.20 (1.80-3.00) mm, respectively. The right-left differences were not statistically significant except at the knee joint. Comparison between genders showed that boys had marginally thicker cartilage than girls at all three joints; this difference was statistically significant for the knee and ankle joints, but not at the wrist. Joint cartilage thickness showed a steady decline with age. CONCLUSIONS: Measurement of joint cartilage thickness in children with MSUS and comparison with these normative values can help in better screening for joint-related disease in children.

A randomized controlled trial to evaluate the efficacy of lactobacillus GG in infantile diarrhea.

In a randomized, double-blind, placebo-controlled trial, 229 infants hospitalized for acute diarrhea in rural India were given a 10-day course of Lactobacillus rhammosus GG (minimum dose, 10 degrees bacteria) or placebo. There was no difference in groups in the duration of diarrhea or numbers of stool on days 3, 6, or 10 of treatment.

A prospective study of rotavirus diarrhea in children under 1 year of age.

The aim of this study was to document the changing clinical profile and prognosis of acute diarrhea in infants. This was a prospective observational study with follow-up. Demographic, anthropometric, and clinical data were collected in children younger than 1 year with acute diarrhea. Stool was examined under the microscope, cultured, tested for presence of reducing substance and occult blood, and subjected to electrophoresis to detect rotavirus infection. Thirty-one (91.2%) of the 34 infants were breastfed, 18 exclusively and 13 partially. Twenty-three had rotavirus infection and had slower nutritional recovery than others. There was no difference in the incidence of rotavirus infection between exclusively and partially breastfed infants. Continuation of feeds containing lactose did not affect prognosis, though 23 (67.6%) infants had reducing substance in stool. We documented a high incidence of rotavirus infection, which negatively affected growth of infants by some ill-defined mechanism. Failure of exclusive breastfeeding to protect against rotavirus infection highlights the need for universal rotavirus vaccination. Lactose malabsorption detected in many infants did not affect prognosis after acute diarrhea.