Is There a Potential Link between Gastroesophageal Reflux Disease and Recurrent Respiratory Tract Infections in Children?

BACKGROUND: The implications of gastroesophageal reflux disease in respiratory tract infections have been investigated over time. The aim of our study was to evaluate the relationship between these two pathologic entities and the outcome after proper antireflux treatment. METHODS: A group of 53 children with recurrent respiratory tract infections admitted in the gastroenterology clinic of a children's hospital in North-East Romania was investigated for gastroesophageal reflux disease through 24 h pH-metry. Those with a Boix-Ochoa score higher than 11.99 received proton pump inhibitor treatment and were reevaluated after 2 months. RESULTS: A total of 41 children were found with a positive Boix-Ochoa score. After 2 months of antireflux therapy, eight patients still had a positive Boix-Ochoa score. CONCLUSIONS: Recurrent respiratory tract infections with symptoms resistant to treatment should be considered a reason to investigate for gastroesophageal reflux, because the symptoms may be due to micro- or macro-aspiration of the gastric refluxate or to an esophageal-bronchial reflex mediated through the vagal nerve.

Hantavirus Infection in Children-A Pilot Study of Single Regional Center.

BACKGROUND: Hantaviruses are infectious etiological agents of a group of rodent-borne hemorrhagic fevers, with two types of clinical manifestations in humans: hantavirus pulmonary syndrome (HPS) and hemorrhagic fever with renal syndrome (HFRS). According to available statistics, the disease occurs mainly in adults, but the lower incidence in the pediatric population might also be related to a lack of diagnosis possibilities or even unsatisfactory knowledge about the disease. MATERIALS AND METHODS: The purpose of this study was to evaluate the cases of hemorrhagic fever with renal syndrome diagnosed and treated in the Department of Nephrology at St. Mary's Emergency Hospital for Children in Iasi, Romania, representative of the North-East of Romania. We also reviewed the specialized literature on the topic. RESULTS: Between January 2017 and January 2022, eight cases of HFRS, all men, and seven from rural areas, aged 11-18 years old, were referred to our clinic because of an acute kidney injury (AKI). Seven cases were identified as Dobrava serotype while one case was determined by Haantan serotype. CONCLUSIONS: HFRS should always be considered as a differential diagnosis when faced with a patient with AKI and thrombocytopenia. Dobrava serotype is the most common hantavirus subtype in the Balkans. For the specific prevention of human infections, mainly in high-risk groups, vaccines are needed. As far as we know, this is the first study on HFRS in Romanian children.

STRESS IN PEDIATRIC PATIENTS--THE EFFECT OF PROLONGED HOSPITALIZATION.

Long-term hospitalization emotionally impacts any patient, especially children, and is defined as a long period of time during which the patient is hospitalized and experiences isolation from his or her family, friends and home. Stressful situations trigger a nonspecific response that involves multiple physiological mechanisms. Currently, because of the complexity of these mechanisms, there are no laboratory markers that allow the quantification of the stress intensity felt by the patient. Laboratory determinations currently used in evaluating the response to stress are neuroendocrine, immunological and metabolic. The neuroendocrine system is the first to respond to stressful events. Stress stimulates the hypothalamus, leading to the release of CRH, which stimulates the pituitary gland to produce ACTH. Chronic stress directs the synthesis towards cortisol, which may lead to hypo secretion of the other adrenal steroid hormones. The hospital and the disease are stressors for children and caregivers, since stress can interfere with the normal development of young patients, affecting them in the long term. Admitting a child to hospital means interrupting his or her normal daily life and changing the environment that is familiar to him or her. Therefore, the involvement of the family doctor is very important, as many conditions can be solved by visiting his or her office and thus eliminating the need for hospitalization in a pediatric hospital. If, however, the nature of the condition requires that the child should be seen by a pediatrician, the period of hospitalization should not be much extended so as to prevent the appearance of other possible problems that might influence the child's state.

VACCINATION--COLLECTIVE RESPONSIBILITY OR VIOLATION OF RIGHTS?

Vaccination is considered to be the most effective and the cheapest medical intervention through which individual and collective immunisation is achieved. Statistics show that, at present, immunisation annually saves 400 million lives and protects approximately 750,000 children against disabilities of varying degrees. Approximately 80% of worldwide children are vaccinated against diphtheria, tetanus, pertussis, polio, measles, etc.; these diseases used to be considered incurable in the past. Vaccines help the body to produce antibodies; they help the immune system to detect germs and inactivate their cells. The immunological protection is installed after a variable period of time following the inoculation and is long lasting. Immunisations can be achieved in several ways: through national immunisation campaigns with general recommendation--they may be compulsory, optional or prophylactic (for the diseases for which a vaccine is available); vaccinations not included in the compulsory immunisation programmes; they may also be targeted to the contagious infectious outbreaks or to groups of population in certain situations. There is no guarantee that a vaccine will provide 100% protection. However, it will significantly reduce the risk of getting an infection. Vaccines have side effects which can be divided into reactions triggered by the vaccine or reactions exacerbated by it, without a causal relationship to the vaccine.

Epidemiological evaluation regarding the role of cystic fibrosis as a risk factor for child malnutrition.

Cystic fibrosis (CF) is the most common monogenic autosomal recessive disorder with progressive chronic evolution which is potentially lethal. Poor growth is a characteristic of children suffering from cystic fibrosis. A poor nutritional status is an independent risk factor for inadequate survival in cystic fibrosis and is associated with disease complications. The appropriate nutritional management is an important part of the treatment so that the patient with cystic fibrosis can achieve normal growth and development and maintain the best possible health status. A balanced diet supplemented with snacks high in fat and calories is necessary to increase the caloric intake in children with cystic fibrosis. Children with cystic fibrosis have higher caloric needs than healthy children of the same age and sex. Malnutrition in CF is multifactorial. Cystic fibrosis is a complex multisystem disorder affecting mainly the gastrointestinal tract and respiratory system. In the past, malnutrition was an inevitable consequence of disease progression, leading to poor growth, impaired respiratory muscle function, decreased exercise tolerance and immunological impairment. A positive association between body weight and height and survival has been widely reported. The energy requirements of patients with CF vary widely and generally increase with age and disease severity. Cystic fibrosis remains a paediatric disorder which is often underdiagnosed but which, if therapeutically managed properly (by means of drug therapy as well as by appropriate physiotherapy techniques), can lead to improved quality of life and, thus, to a bigger life expectancy.

Methicillin-resistant Staphylococcus aureus carriage in infants with protein-energy malnutrition.

AIM: The aim of the present study was to investigate the frequency of methicillin-resistant S. aureus (MRSA) colonization in infants with protein-energy malnutrition (PEM) and to characterize the antibiotic susceptibility patterns in isolated strains. MATERIAL AND METHODS: The study included 123 infants with PEM, admitted to the Paediatric Rehabilitation Department of,,St. Mary" Emergency Clinical Children's Hospital Iasi, during October 1st 2010 and August 30th 2011. Nasal, pharyngeal and conjunctival swabs were collected for detection of colonization upon admission and at discharge. RESULTS: The study revealed a high rate of MRSA carriage among infants with PEM (62.60%), most of the isolated strains being multidrug-resistant (86.13%), with additional resistance to aminoglycosides, macrolides and inducible resistance to clindamycin. 88% of colonized infants were nasal carriers. CONCLUSIONS: Identification of MRSA carriers permits the implementation of measures that decrease the risk for subsequent infection.

[Cross-sectional study to evaluate risk factors in infant malnutrition]. / Studiu transversal de evaluare a unor factori de risc implicati în aparitia malnutritiei la sugar.

UNLABELLED: Malnutrition is a major health problem in our country by maintaining a high number of infants with poor nutritional status. Various studies have highlighted the role of infant's malnutrition in the development of adult diseases. METHODS: We made a cross-sectional study during six months (October 2010 - March 2011) on a group of 63 infants admitted in Pediatric Recovery Department-Children's Hospital, Iasi; we evaluated the presence of risk factors for malnutrition. The data were processed using SPSS 16 and Epilnfo 3.5.2. (December 2010). RESULTS: The infants were predominantly female (52,4%); the most affected age group was 5-24 weeks (84,11%). Most of them came from rural areas (79,4%), from families with low socioeconomic income (95,2%), mothers with a low educational status (63,4%), housewives (88,9%). We noted the presence of previous diseases in 71,4% infants. Only 12 infants received breast milk for a short time (three weeks), the other 51 infants have been bottle-fed since birth. Complementary food was incorrect in 68,42% cases. With a proper diet the mean weight gain was 895,68 g and the Z score values (weight for age, height for age, weight for height) have improved during an average of 34,15 days; positive correlation between these factors is strong. CONCLUSIONS: Low socio-economic income, rural areas, low maternal educational level, diet errors, small infants with multiple previous diseases are the main risk factors in malnutrition's occurrence. We consider particularly important to solve social problems too, not only the medical, because when the infant returns in the same disadvantaged family there is an increased risk for malnutrition to recur.

[Cross-sectional study to evaluate the development and risk factors in premature children]. / Studiu transversal de evaluare a evolutiei si a unor factori de risc la copilul nascut prematur.

UNLABELLED: Prematurity represents an important medical problem due to the increased incidence and complex treatment measures. MATERIAL AND METHOD: We have made a cross-sectional study to evaluate the causes and risk factors of prematurity and after-birth evolution in 652 premature children. RESULTS: Most children had mothers of low socio-economic status (70.1%), from the countryside (70.5%), housewives (82.8%), elementary educational level (67.7%). The age of pregnancy at the beginning of the observation was significantly different in the urban environment in comparison with the rural (p < 0.05). Emergency life support at birth was needed for 63.2% of the premature newborns and hospitalization in Intensive Care for respiratory distress for 77.6%. Intense icterus required phototherapy in 92% of preterm newborns. Epidemiologic survey proved bacterial colonization in 72.6% of the infants, mostly nasal (24.5%). There was an increased number of bottle-fed infants (63.6%), but regardless of the feeding method, the weight increase was proper. CONCLUSION: The improvement of perinatal care allowed the increase of survival rate of premature infants, but a more serious medical surveillance is needed in order to reduce the number of preterm births.

Zinc--essential micronutrient for child health and nutrition.

Ubicuity of zinc in nature has generally lead to the idea that human zinc deficiency is hardly to appear; however, the last 40 years of research studies showed clear correlation between zinc deficiency and several clinic manifestations: growth retardation, predisposal to infections, delay of wound healing, hypogonadism in boys. Zinc plays multiple roles, especially in pregnant women and children. Although the issue of micronutrient malnutrition has been pointed out in developing countries, it has been remarked also in developed ones, due to unbalanced nutrition and diets. The article aims pointing out important aspects related to zinc micronutrient: metabolic pathway, daily dosage, health benefits as prophylaxis and therapy of respiratory and digestive infections in children.

[Nutrition of low birth weight infants]. / Nutritia copilului cu greutate mica la nastere.

The low birth weight infant's (LBW) nutrition needs special attention. Energy requirements are increased due to a high metabolic rate and a low thermogenesis. Increased protein requirements are, easy to be absorbed (from lacto-serum). Lipids, as important energetic source requires an appropriate content in essential fatty acids and medium chain triglycerides (TGM) which are easy absorbed in absence of lipase and deficit of bile salt secretion. The carbohydrates should be represented by lactose or equivalents like di-, oligo or polysaccharides. The addition of maltodextrin avoid an exaggerate supply and incomplete digestion of lactose. Sodium requirement are increased due to exaggerated loss consequence of renal immaturity. The rapid rate of growth impose the addition of Calcium, Phosphorus, Iron, Copper, and vitamins, especially Vitamin D, E and Folic acid. The appropriate nutrition of LBW must cover his special needs to maintain the homeostasis and rapid growth. Precise nutrient requirements are, however, difficult to establish.

[Erythema toxicum neonatorum]. / Eritemul toxic al nou nascutului.

(ETN) is a benign, self limited, asymptomatic skin condition, that only occurs during the neonatal period. This clinical entity is caractherized by small, sterile, erythematous papules, vesicles, and occasionally pustules, appearing on the trunk, extremities, and the face. The lesions are transitory, appear after 1-2 day of life, and regres after 5-14 days. ETN occurs in 30-50% of full-term infants, and just in 5% of preterm infants, with no significant differences based on race or sex. The ethiology or pathophysiology of ETN are uncertain, but the presence of the eosinophilic infiltrate in the lesions of erythema suggests an allergic ethiology, even no allergens have been identified. The treatment is not required, and the prognosis is excellent with spontaneous resolution.

[Clinical and epidemiologic considerations in the role of newborn diseases causing asthma in children]. / Consideratii clinico-epidemiologice privind implicarea patologiei neonatale în inducerea astmului bronsic la copil.

The authors present results of a multidisciplinary study in 712 children with asthma concerning the role of certain newborns events and the role of feeding in the onset of disease: resuscitation during the delivery--82.68%, respiratory distress--75.5%, Apgar score = 7 - 58.56%, bottle-feeding 50.50%, multi-pregnancy--44.23%, abnormal pregnancy--20.11%, premature infant and small for gestational age infant 10.60%, mother age less then 20 years 8.6%.

[Prematurity--risk factor for morbidity in infants]. / Prematuritatea--factor de risc al morbiditatii la sugar.

UNLABELLED: The premature child from the anatomo-physiological deficiencies represents one of the most important medical problems. In this context we present the results of an retrospective study on 2 lots of infants followed for one year in the Infant Care Clinic of Iasi. The first lot was formed by infants with a normal weight at birth and the second one by premature infants. At this two lots we study the age of admission in Clinic, the care period, the nutritional status, the total number of diseases, the type of affections. We study the most frequent affections of infants such as: respiratory, digestive, otic, cutaneo-mucous. The total number of diseases was 61 for the first lot and 153 for the second lot. From the affections the most frequently were respiratory diseases 60% for the first lot and 104% for the second lot (p < 0.01). The digestive affections were presented at 47.5% of first lot of children and 92% for the second one (p < 0.001); the otic affections 25% for the first lot and 50% for the second one (p < 0.05); cutaneo-mucous affection were represented by 20% from the first lot and 60% for the second one (p < 0.001). CONCLUSIONS: The prematurity continued to represent one of the most important risk factors of morbidity to infant, for that to those children we must to grant a special medical care.

An educational intervention improves developmental progress of young children in a Romanian orphanage.

From 1991 to 1994, a group of Romanian and American colleagues undertook an experimental and humanitarian effort to try to improve the quality of life, mental health, and developmental progress of young children in a Romanian orphanage. In the context of institutional care, we experimentally introduced stable adult-child relationships, small group size, and a protocol of enriched caregiving and educational activities. These procedures were adapted from an intervention in childcare centers in the United States that had been proven effective in reducing intellectual decline in at-risk children. Developmental scores for orphanage children were derived from the Denver II (a revision of the Denver Developmental Screening Test; Frankenburg & Dodds, 1990), which was translated into Romanian and administered as a pre- and posttest to the experimental subjects and comparison groups in the same institution. Mixed models combining both within- and between-subject heterogeneous variance-covariance structures were utilized to analyze the impacts of time, intervention/control group assignment, child sex, child age, and interaction of Group × Time on the developmental scores. For the developmental outcome variables, the effects of group assignment (experimental vs. comparison) were highly significant. There also was a Group × Time interaction effect. We conclude that an educational intervention which includes the addition of resources and training can be initiated and sustained in an orphanage for young children as a way of improving institutional care. ©2005 Michigan Association for Infant Mental Health.