Effect of sleeping position on cardiac output, pulmonary pressure, and superior vena cava flow in healthy term infants.

BACKGROUND: Although the mechanism of action in newborns is unknown, sleep positioning is associated with many pathophysiological events. This study aimed to compare the effects of supine and prone sleeping positions on cardiac output (CO), systolic pulmonary arterial pressure (SPAP), and superior vena cava (SVC) flow in healthy newborns. METHODS: In the first 24-72 h of life, 40 healthy term newborns born in the same hospital were included in this prospective, cross-sectional, observational study. CO, SVC flow, and SPAP values of newborns in the supine and prone sleeping positions were calculated using echocardiographic examination. The measurements were statistically compared. RESULTS: In the supine sleeping position, CO, SVC flow, and SPAP were 235.00 (193.07-283.30) ml/kg/min, 92.80 (77.82-121.87) ml/kg/min, and 27.85 (24.70-30.48) mmHg. In the prone sleeping position, CO, SVC flow, and SPAP were measured as 195.35 (166.00-229.40) ml/kg/min, 67.25 (51.82-96.66) ml/kg/min, 31.60 (28.45-37.20) mmHg, respectively. Depending on sleeping position, these variables were significantly different between the groups. CONCLUSION: SVC flow and CO decreased in the prone sleeping position compared to the supine sleeping position in healthy newborns, whereas SPAP increased. The different hemodynamic effects of sleeping position on the cardiac, pulmonary, and nervous systems should be considered as flow and pressure changes are important in newborns.

Superior Vena Cava Flow in Children With Attention Deficit Hyperactivity Disorder.

OBJECTIVE: Attention deficit/hyperactivity disorder (ADHD), whose definition, diagnosis and treatment has been the subject of debate in the scientific community for a long time, is the most common neurobehavioral disorder in childhood. There are many studies on the pathophysiology of attention deficit. However, there is no study in the literature based on direct or indirect measurement of cerebral venous circulation in ADHD, and the effect of methylphenidate (MPH) treatment on cerebral venous circulation. Therefore, it was aimed to noninvasively measure superior vena cava (SVC) flow, which is an indirect indicator of cerebral venous flow, by transthoracic echocardiography in patients with ADHD. METHODS: In the study, 44 healthy children, and 40 ADHD patients who were planned to start on osmotic-release oral system (OROS)- MPH were included. SVC flows were measured in healthy children and before and after drug therapy of ADHD patients. RESULTS: SVC flow was found to be higher in ADHD patients compared to healthy children. A significant decrease was found in SVC flow of ADHD patients after OROS-MPH treatment. There was no decrease in SVC flow of patients who did not respond adequately to MPH treatment. CONCLUSION: This first study of SVC flow in children with ADHD showed that ADHD was associated with increased SVC flow and MPH treatment had a reducing effect on this increased SVC flow. We believe that noninvasive, easily measurable, and reproducible SVC flow may be a new focus of interest for future comprehensive studies as a biomarker to support clinical evaluation in the diagnosis and treatment follow-up of ADHD patients.

Etiological Evaluation in Children Referred to the Pediatric Cardiology Outpatient Clinic with Chest Pain.

Objectives: One of the most common reasons for pediatric cardiology referrals is chest pain in childhood. Although it is mostly innocent in character, it is rarely associated with life-threatening pathologies. In this study, it was aimed to evaluate the etiological causes in children with chest pain. Methods: Our study included 1000 children who were referred to the pediatric cardiology clinic with the complaint of chest pain between January 2019 and June 2022. Demographic characteristics, accompanying complaints, echocardiographies, electrocardiographies, 24-h rhythm holters, treadmill exercise test, computed tomography angiography, and non-cardiac findings related to etiology were analyzed retrospectively from the file archives of the patients. Results: Five hundred and nine (50.9%) of the patients were female and 491 (49.1%) were male. The mean age of the patients was 11.3 y (range: 3-18 years). Cardiological pathology associated with chest pain was detected in only 6.8% of the patients. Among the etiologies of chest pain, mitral valve prolapse (MVP) was the most common cardiological pathology with a rate of 2.1%. In the non-cardiac etiological evaluation of chest pain, idiopathic causes with a frequency of 48%, musculoskeletal pathologies with a frequency of 22.6%, respiratory pathologies with a frequency of 7.9%, psychiatric pathologies with a frequency of 7.3%, gastrointestinal pathologies with a frequency of 4.1%, and familial Mediterranean fever with a frequency of 2.4%, miscellaneous with a frequency of 1.1% were found, respectively. Conclusion: In the study, it was determined that non-cardiac causes were more common among the etiological causes of chest pain in the pediatric age group. In addition, MVP was the most common cause of cardiac chest pain.

Increased incidence of mitral valve prolapse in children with pectus chest wall deformity.

BACKGROUND: Pectus anomalies constitute 95% of chest anomalies. Pectus carinatum (PC) and excavatum (PE) are often asymptomatic in childhood. However, symptoms and signs such as chest pain, dyspnea, and mitral valve prolapse (MVP) can be seen in pectus anomalies. Demographic characteristics and accompanying cardiac signs in children with pectus deformity were investigated. METHODS: In this study, the clinical findings for children with pectus deformity, and the incidence of MVP and other concomitant heart diseases detected in echocardiographic examinations were evaluated. RESULTS: Eighty-two children with PE, 27 with PC, and 107 healthy children were included in this study. In the echocardiographic examination of PE, PC patients, and healthy children, MVP was detected with frequencies of 25%, 33%, and 2% respectively. CONCLUSIONS: The study showed that pectus anomalies were associated with an increased incidence of MVP. All patients with pectus deformity should therefore undergo a screening echocardiogram in adolescence to assess for the presence of MVP.

Cardiac Evaluation in Children with Multisystem Inflammatory Syndrome Associated with SARS-CoV-2.

Objectives: The heart is one of the organs frequently affected by the multisystem inflammatory syndrome in children (MIS-C), associated with severe acute respiratory syndrome coronavirus 2 infection. Cardiac involvement in patients with MIS-C was evaluated with physical examination findings, biochemical test, and cardiological imaging tests. We reported the degree of cardiac involvement in patients with MIS-C. Methods: In this retrospective study, the complaints, physical examination, and cardiac findings of patients with MIS-C were evaluated. Results: Sixteen patients (four males and 12 females) with MIS-C were included in the study. The median age was 6 (5-17) years. In patients, palpitations (6%), chest pain (12%), ECG changes (50%), valve insufficiency (50%), low ejection fraction (6%), coronary dilatation (6%), troponin (38%), and d-dimer (88%) elevation were detected. One patient died. Valve insufficiency persisted in 5 (31%) patients. Conclusion: Severe cardiac involvement can be seen in MIS-C patients. Due to its serious effects on mortality and morbidity, cardiac involvement should be evaluated with cardiac imaging tools such as echocardiography and ECG in all MIS-C patients.