Splenic size after division of the short gastric vessels in Nissen fundoplication in children.

PURPOSE: Nissen fundoplication is an effective treatment for gastro-esophageal reflux disease (GERD). Mobilization of the gastric fundus during fundoplication requires division of short gastric vessels of the spleen, which may cause splenic ischemia. The aim of this study was to determine if Nissen fundoplication results in hypotrophy of the spleen. METHODS: We performed pre-operative and post-operative ultrasound measurements of the spleen in children undergoing Nissen fundoplication. During operation, the surgeon estimated the compromised blood flow by assessment of the percentage of discoloration of the spleen. RESULTS: Twenty-four consecutive children were analyzed. Discoloration of the upper pole of the spleen was observed in 11 patients (48%) of a median estimated splenic surface of 20% (range 5-50%). The median ratio for pre-operative and post-operative length, width, and area of the spleen was 0.97, 1.03, and 0.96, respectively. The percentage of the estimated perfusion defect during surgery was not correlated with the ratios. In three patients, the area ratio was smaller than 0.8 (0.67-0.75), meaning that the area decreased with at least 20% after surgery. In none of these patients a discoloration was observed. CONCLUSION: Discoloration of the spleen after Nissen fundoplication is not associated with post-operative splenic atrophy.

The duration of effect of infliximab maintenance treatment in paediatric Crohn's disease is limited.

BACKGROUND: Infliximab is effective for induction and maintenance of remission in children with moderately to severely active Crohn's disease (CD). AIM: To evaluate the long-term efficacy of infliximab treatment in paediatric CD. METHODS: In this observational, multicentre study, all paediatric CD patients in The Netherlands treated with infliximab from October 1992 to November 2009 and with minimal follow-up of 3 months since start of infliximab, were studied. RESULTS: One hundred and fifty-two CD patients [81M; median age at start of infliximab 15.0 years (IQR 13.1-16.4)] received a median number of 10.5 infliximab infusions (IQR 6-21). Median follow-up after start of infliximab was 25 months (IQR 13-40). Kaplan-Meier analysis showed that the cumulative probability of losing response to infliximab in patients who initially required repeated infusions was 13%, 40% and 50% after 1, 3 and 5 years, respectively. Seventy-four patients (49%) needed dose adjustments, with a median time to any adjustment of 6 months. CONCLUSIONS: Duration of effect of infliximab is limited as 50% of patients on infliximab maintenance treatment lose their therapeutic response after 5 years. Dose adjustments after start of infliximab are frequently needed to regain therapeutic benefit. These findings emphasise the need for effective, long-term treatment strategies for paediatric CD.

Medical consumption and socioeconomic effects of infection with respiratory syncytial virus in The Netherlands.

OBJECTIVE: To calculate both medical consumption and socioeconomic effects related to hospitalization for respiratory syncytial virus (RSV) infection in the Netherlands. METHODS: During the winter seasons of 1998 to 2000, parents of all patients hospitalized for RSV in three secondary care hospitals were asked to fill out questionnaires focusing on the 2 weeks before hospitalization, the period in hospital and the 2 weeks after discharge. The questions concerned workdays lost, level of education and current profession, extra childcare needed, consultation by the family physician and drugs prescribed and costs of travelling. RESULTS: Seventy-three children were hospitalized. Median age was 79 days (range, 9 to 537 days), and median weight was 5,295 g (range, 3130 to 10,600 g). Three children were born preterm. Parents had 2 (range, 0 to 6) telephone contacts with the family doctor; the child was seen 2 (range, 0 to 4) times before hospitalization. Parents lost 0.5 workday before hospitalization. Duration of hospitalization was 5 days median (range, 1 to 12 days). Parents lost 1.5 (range, 0 to 9) workdays during hospitalization and drove 118 (range, 6 to 550) miles to visit their child. In the period after discharge expenses were negligible. Calculation of all parameters into currency resulted in a total amount of $2,200 per child hospitalized for RSV. Workdays lost, costs for travelling and consultation of family doctors resulted in $295 per child. CONCLUSIONS: RSV infections necessitating hospitalization in a secondary care hospital have remarkable effects on parental expenses, parental absence from work and medical consumption. On top of the hospital-related costs 15% should be added for parental expenses and socioeconomic costs.

[Medical care of underage refugees]. / De medische zorg voor jeugdige asielzoekers.

The growing number of people seeking asylum in the Netherlands compromises the provision of adequate medical services to all. This development may have a negative impact on refugee children especially. International literature indicates that many children, especially the ones coming from tropical areas or the ones who resided in refugee camps, are suffering from diseases such as tuberculosis, hepatitis B, anaemia, parasitic diseases, caries, malnutrition, hearing and seeing impairments. Many children have psychosocial problems due to traumatic experiences in their country of origin and/or during their flight. These problems lead to a diversity of complaints such as difficulty to sleep, enuresis, feeding problems and hyperactivity. Both the somatic and the psychosocial problems may impede the growth and development of these children. It is therefore imperative to identify the children at risk and to formulate guidelines for providing medical care to refugee children. Special care should also be given to the housing, the living conditions and the provision of specialised personnel and to limiting the duration of the asylum procedure in the case of families with children and other minors.

[Children hospitalized with acute gastro-enteritis. I. Electrolyte imbalances seen primarily in clinical dehydration]. / Kinderen opgenomen wegens acute gastro-enteritis. I. Stoornissen in de elektrolytenhuishouding vooral bij klinische dehydratie.

OBJECTIVE: To determine how often electrolyte disturbances occurred in children with acute diarrhoea and whether these findings had therapeutic consequences. DESIGN: Retrospective. METHOD: The hospital records of 265 children (152 boys and 113 girls; mean age: 1 year and 9 months (range: 1 month-12 years)) admitted with acute diarrhoea during the period 1992-1996 to the department of Paediatrics of Sint Joseph Ziekenhuis, Veldhoven, the Netherlands, were examined for abnormal laboratory values of Na, K, urea, creatinine and base excess. It was also determined if dehydration was present and if the findings affected the treatment. The therapeutic protocol included administration of a rehydration fluid if the child did not drink well; the own nutrition was resumed after 4-6 hr. RESULTS: 74 of the children admitted (28%) were clinically dehydrated. Abnormal laboratory values were found mainly (38/47) among these children. The majority (68; 92%) had isonatraemic dehydration. Most of the abnormal laboratory values normalised after rehydration. Only in the one case of hypokalaemia did this lead to a change in the composition of the rehydration fluid. CONCLUSION: Routine determination of electrolytes, urea, creatinine and blood gas is not necessary in all children with acute diarrhoea. These laboratory measures should be restricted to dehydrated children. Even then abnormal laboratory values are few and seldom have therapeutic consequences.

[Children hospitalized with acute gastroenteritis. II. No relation between clinical symptoms and causative agents isolated from feces]. / Kinderen opgenomen wegens acute gastro-enteritis. II. Geen verband tussen klinische kenmerken en geïsoleerde verwekkers uit feces.

OBJECTIVE: To determine if it is possible to predict a bacterial cause in children with gastroenteritis on the basis of clinical features and if the number of stool cultures can be reduced. DESIGN: Retrospective. METHOD: The results of the stool cultures of 227 children admitted with acute gastroenteritis to the department of Paediatrics of Sint Joseph Hospital, Veldhoven, the Netherlands, in the period 1992-1996 were related by review of medical records to clinical symptoms and blood tests. The diagnostic values of the various parameters were calculated. RESULTS: Rotavirus was identified in 40% of the faeces of the children, other viruses in 10% and bacteria in 8%. In 95% the bacterial pathogen was identified in the first stool sample. The diagnostic value of the investigated parameters was low. CONCLUSION: It is not possible on the basis of clinical parameters to predict a bacterial gastroenteritis. The number of stool samples may, however, be reduced if the stools of each child with acute diarrhoea are first investigated for rotavirus. Only if this test is negative are further investigations required. The number of bacterial cultures can be limited to one stool sample.

[Lidocaine poisoning in a newborn infant following perineal infiltration for episiotomy]. / Lidocaïne-intoxicatie bij een pasgeborene na perineale infiltratie voor episiotomie.

Intoxication of the newborn by a local anesthetic is a relatively unknown disease. A newborn born alive after being accidentally injected with lidocaine during perineal infiltration for episiotomy is described and the pharmacokinetics and possible therapies are discussed.

The effects on weight and attendance of a supplementary feeding programme operating in two under-5 clinics in Lesotho.

The routinely collected weight data of 2202 pre-school children who visited two under-5 clinics in Lesotho between 1978 and 1983 were used to calculate growth curves and to assess the effects of supplementary feeding. Up to the age of 5 months growth curves were above the NCHS reference. Growth started to decrease at the age of 3 months and stabilized at 11-13 months at the 10th percentile of the reference. The decrease of growth might have been due to environmental factors such as under-nutrition and disease. If this was the case, supplementary feeding might have had a positive impact on weight, but such an effect was not observed in this study. Supplementary feeding had, however, a positive effect on attendance rates and hence contributed to higher coverage of other under-5 clinic activities, such as immunization, health and nutrition education, and growth monitoring. Whether this positive effect warrants its extra cost remains open to question.

[The yield of autopsies in a pediatric practice]. / Het rendement van obducties in een pediatrische praktijk.

The yield of autopsies in a paediatric population. A retrospective analysis is presented of 91 autopsies on children, who died during the period January 1975 and December 1984 in St. Joseph Ziekenhuis, Eindhoven. In 21% of the cases (newborns 23% and older children 13%) the autopsy provided the definitive explanation for the cause of death. In 43% of the cases unexpected findings were obtained during autopsy. In 12% of the cases autopsy could not substantiate a suspected diagnosis and in 12% of the cases the findings at the autopsy influenced genetic counseling. This high rate of return stresses the importance of autopsy as a mean to improve the quality of medical care in a paediatric population.

Early postnatal growth of Basotho infants in the Mantsonyane area, Lesotho.

The records of 814 infants born in a rural hospital in Lesotho were analysed. It was calculated that on average Basotho infants regained their birthweight between 3 and 4 days of age and the average weight loss amounted to 3%. Compared with Caucasian infants, Basotho infants regained their birthweight sooner. Of 289 infants in whom the gestational age was assessed, small-for-dates infants showed an increased mean growth rate compared with pre-term and appropriate-for-dates full-term infants.

Birthweight distribution in the Mantsonyane area: Lesotho.

A total of 832 maternal and newborn records in a rural hospital in Lesotho were analysed. The mean birthweight was 3.07 kg and the incidence of low birthweight rate 7.5%. This was compared with other countries in Africa. Increasing birth order was associated with higher birthweight irrespective of maternal age, except for the very young mothers. No seasonal variation in birthweight was observed. Of 313 newborns the gestational age was assessed. The overall anthropometric measurements of newborns in the Mantsonyane area were comparable to better off industrialized countries.