Evaluation of children diagnosed with a lower respiratory tract infection due to Human metapneumovirus.

BACKGROUND: Human metapneumovirus (hMPV) is one of the leading causes of acute respiratory infections and bronchiolitis in infants. A history of prematurity and chronic diseases such as congenital heart disease or asthma/reactive airway disease (RAD) increases the risk of severe lower respiratory tract infection (LRTI) due to hMPV. In this cross-sectional study, we aimed to analyze the clinical outcome and risk factors for severe disease in children with LRTI due to hMPV. METHODS: The current cross-sectional study included children between 28 days and 18 years of age with the diagnosis of hMPV-associated LRTI hospitalizations, over two years from January 2016 to September 2018 in Health Science University Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital. hMPV virus was detected by the multiplex polymerase chain test (PCR) (Commercial Multiplex Real-Time PCR: FTD Respiratory 21 plus, Fast Track Diagnostics, Luxembourg) from a nasopharyngeal swab. Patients who had positive results in multiplex PCR tests with other viral agents simultaneously were not included in the study. Data were retrospectively collected from the computerized hospital system. RESULTS: In this cross-sectional study, 62 patients who were hospitalized with the diagnosis of LRTI due to hMPV infection were included. Thirty-five (55.7%) of the patients were male. The median age was one year (2 months-15 years). Fifty-one (82.2%) patients were younger than two years. The median hospital length of stay was found to be 10 days (2-33 days) in patients with an underlying disease and 7,5 days (ranging from 2 to 20 days) in the patients without an underlying disease, this difference was significant (p=0.031). CONCLUSIONS: Clinicians should consider hMPV as an important pathogen of LRTI even in healthy children, although we expect a poor course of disease in children with an underlying disease.

Fatty liver in childhood.

Fatty liver is a growing health problem worldwide. It might evolve to nonalcoholic steatohepatitis, cirrhosis and cause hepatocellular carcinoma. This disease, which has increased because of eating habits, changes in food content and lifestyle, affects people from childhood. The most important risk factors are obesity and insulin resistance. Besides these factors, gender, ethnicity, genetic predisposition and some medical problems are also important. Cirrhosis in children is rare but is reported. Nonalcoholic fatty liver disease (NAFLD) has no specific symptoms or signs but should be considered in obese children. NAFLD does not have a proven treatment. Weight loss with family based treatments is the most acceptable management. Exercise and an applicable diet with low glycemic index and appropriate calorie intake are preferred. Drugs are promising but not sufficient in children for today.

Clinical findings of functional and secondary constipation in children.

OBJECTIVE: We aimed to evaluate clinical features and follow-up data of children with functional and secondary constipation. METHODS: Hospital records of 335 constipated children were evaluated. Children were divided into 2 groups as functional and secondary, and were compared with regard to clinical and anthropometric data. FINDINGS: Of 335 children (M/F 167/168, mean age 4.3±3.5 years) 91% had functional constipation (group 1). Family history of constipation was significantly higher in group 1. Malnutrition was found in 18% of group 1, 56% in group 2 (p < 0.001). CONCLUSION: If a constipated child has a family history of constipation but does not have failure to thrive and constipation begins at an older age, functional constipation is more probable.

The relation of serum ghrelin, leptin and insulin levels to the growth patterns and feeding characteristics in breast-fed versus formula-fed infants.

The differences in growth patterns in breast-fed (BF) and formula-fed (FF) infants remain poorly understood. The aim of this study was to examine the relation of serum ghrelin and leptin concentrations to the different growth patterns between the formula-fed and breast-fed babies. Feeding behaviors and anthropometric data were noted at the 3rd and 6th months of age. Serum ghrelin and leptin levels in both groups and breast-milk ghrelin and leptin levels in the mothers of the BF group were determined at the 3rd month of age. Body weight, length, TSF (triceps skin fold thickness), postnatal weight gain, and serum ghrelin levels were higher in BF babies than in the FF group. In BF babies, serum ghrelin was correlated to TSF, and serum leptin was correlated to weight, TSF and weight gain at three months of age. As the serum leptin increased, energy intake from supplemental foods decreased in the BF group at the 6th month. Higher serum ghrelin in BF babies might have played a role in their faster growth rate during the first three months of age. On the other hand, lower energy intake from supplemental foods in correlation with higher serum leptin in BF babies may explain why these babies show marked decline in growth rate compared to FF babies after three months of age.

Effect of nutritional support in children with spastic quadriplegia.

Malnutrition is a common problem in patients with cerebral palsy. We evaluated the effect of nutritional support on clinical findings in children with spastic quadriplegia. Feeding history, numbers of lower respiratory tract infections, and gastrointestinal and neurologic findings were evaluated via questionnaire. Weight, height, head circumference, midarm circumference, and triceps skinfold thickness were measured. Height for age, weight for age, weight for height, body mass index, and weight and height z-scores were calculated. Clinical findings and anthropometric parameters were re-evaluated after nutritional support for 6 months. Forty-five patients were enrolled. No difference was evident between the first and the last height z-scores of 31 patients who completed the follow-up. Weight, height, weight z-scores, weight for age, weight for height, body mass index, midarm circumference, and triceps skinfold thickness exhibited improvement. Moreover, a significant decrease in number of infections was evident. Frequency of seizures and Gross Motor Function Classification System status did not change. Constipation decreased significantly. Nutritional therapy revealed improvements in some anthropometric findings and a decrease in number of infections. Although there was no difference regarding motor development or seizure frequency, further studies with a longer follow-up are required.

Growth in familial mediterranean fever: effect of attack rate, genotype and colchicine treatment.

We evaluated the effect of attack frequency, homozygosity for the M694V mutation and colchicine treatment on growth in children with familial Mediterranean fever (FMF). Prepubertal patients with FMF (19 M, 14 F) were evaluated retrospectively for height SDS, weight SDS and body mass index (BMI) before and after 46.2 +/- 39.8 months of colchicine therapy. Pretreatment attack frequency and acute phase markers at diagnosis were also recorded. While acute phase markers were not correlated to anthropometric variables, attack rate was negatively, albeit insignificantly, correlated to height and weight SDS. Height SDS did not change, while BMI showed a slight but significant increase during colchicine therapy (16.2 +/- 2.6 to 17.3 +/- 3.1 kg/m2, p = 0.035). Homozygosity for M694V did not affect time from the onset of symptoms to diagnosis, anthropometric variables and acute phase markers. In conclusion, pre-treatment attack rate and anthropometric development correlated negatively. Colchicine therapy improved BMI slightly, but significantly. Homozygosity for M694V had no effect on anthropometric development.

Alpha-defensin expression in the gastric tissue of children with Helicobacter pylori-associated chronic gastritis: an immunohistochemical study.

In this study, we evaluated the expression of alpha-defensin and its correlation with histological criteria in children with and without Helicobacter pylori-associated gastritis. Forty-five children were included. Immunohistochemical staining was performed and the relationship between alpha-defensin immunoscoring and H. pylori status and histological criteria was evaluated. Expression of alpha-defensin was significantly higher in the H. pylori-positive group (P < 0.001) and it was significantly associated with higher grades of chronic inflammation and neutrophil density (P < 0.001 for both). Our data show that alpha-defensin expression is increased in H. pylori infection in childhood and is associated with inflammatory tissue damage.

Nephrocalcinosis in glucose-galactose malabsorption: nephrocalcinosis and proximal tubular dysfunction in a young infant with a novel mutation of SGLT1.

We report an association of proximal renal tubular dysfunction in a 50-day-old girl with glucose-galactose malabsorption who was found to have nephrocalcinosis, but no sign of nephrolithiasis. A novel homozygous nonsense mutation at 267Arg-->stop (CGA-->TGA) in the Na(+)-dependent glucose transporter (SGLT1) was found in loop 5 connecting transmembrane segments 6 and 7, indicating the complete loss of glucose transport activity. This case indicates that hypercalcaemia, nephrocalcinosis and proximal tubular dysfunction may be seen in association with glucose-galactose malabsorption and that most of these abnormalities improve with a glucose-galactose-free diet.

Helicobacter pylori infection: effect on malnutrition and growth failure in dyspeptic children.

There are conflicting reports regarding the association of Helicobacter pylori (H. pylori) infection with growth failure. We evaluated the role of H. pylori infection on malnutrition and growth failure in dyspeptic children. The study cases included 108 dyspeptic children and were evaluated by endoscopic gastric biopsy, while 50 healthy children constituted the control group. The study cases were grouped as H. pylori [+] (n = 57) and H. pylori [-] (n = 51) by the presence or absence of microorganism in gastric tissue, respectively. Age, gender, height for age (H/A), weight for height (W/H), body mass index (BMI), weight and height z scores and the daily calorie intake of the children were recorded. Malnutrition and growth failure were evaluated by the Waterlow criteria and height z score, respectively. Then, the H. pylori [+], H. pylori [-] and control groups were compared in relation to the variables defined above. All groups were similar with respect to gender and age. The daily calorie intake was lower in dyspeptic children. Although anthropometric variables were similar in the H. pylori [+] and [-] groups, the control cases had higher W/H compared to both H. pylori [+] (p = 0.030) and H. pylori [-] (p = 0.000) cases, and higher BMI (p = 0.001) and weight z scores (p = 0.014) than those in the H. pylori [-] group. The malnutrition rate was similar in the H. pylori [+] and [-] groups. However, mild acute (p = 0.033) and general malnutrition rates (p = 0.000) were lower in the control cases compared to the study cases. The short stature rate was not different significantly in all three groups. In conclusion, the results of this study do not support the data that H. pylori infection plays an extra role in malnutrition and growth failure in children presenting with dyspeptic complaints. However, as a major cause of dyspepsia, H. pylori infection might be considered to cause malnutrition secondary to decreased calorie intake associated with dyspepsia.

Does feeding in infancy effect the development of IgA nephropathy?

Gut permeability to antigens is immature at birth, and while early administration of antigenic foods delays its maturation, breast-feeding accelerates it. We aimed to evaluate whether exposure to antigenic foods in early life is associated with a predisposition for immunoglobulin A nephropathy (IgAN). Three groups of children with IgAN (group 1), non-IgA glomerulopathies (group 2), and healthy controls (group 3) were formed. Parents filled out a questionnaire regarding gestational and postnatal ages, birth weight, and feeding by breast milk, formula, cow's milk, and complementary foods. All groups were similar for age, gender, birth weight, rate and duration of breast-feeding, and rate of formula feeding. Cow's milk consumption rate was higher in groups 1 and 2 than in group 3. Whereas introduction of formula was earlier in groups 1 and 2 than in group 3, feeding by cow's milk and weaning were earlier in group 1 than in the other groups. The respective best cutoff ages were 3.5 [odds ratio (OR) 28)], 3.75 (OR 5.7), and 5.5 (OR 10.5) months for formula, cow's milk, and complementary foods, respectively, for predicting the presence of IgAN. The results of this preliminary study indicate that early introduction of antigenic foods might increase the risk of future primary IgAN.