Pediatric Reports

339 KiB

Open AccessBrief Report

Cross-Transmission Rates of Enterococcal Isolates among Newborns in a Neonatal Intensive Care Unit

by Henning Böhme, Chitra Königsmark, Ingo Klare, Melanie Zischka and Guido Werner

Pediatr. Rep. 2012, 4(1), e15; https://doi.org/10.4081/pr.2012.e15 - 26 Mar 2012

Cited by 3 | Viewed by 1

Enterococci are important pathogens causing nosocomial infections and patients at risk include also premature babies requiring intensive care treatment. Our aim was to assess occurrence and cross transmission rates of enterococci among neonatal patients of a hospital ward during a two months period. [...] Read more.

Enterococci are important pathogens causing nosocomial infections and patients at risk include also premature babies requiring intensive care treatment. Our aim was to assess occurrence and cross transmission rates of enterococci among neonatal patients of a hospital ward during a two months period. Rectal and skin samples were taken between day one and 60 of infants’ age. Colonization with various potentially pathogenic bacteria was correlated with developing a subsequent infection. Enterococcal isolates were identified by colony morphology. The bacterial species was assessed and antibiotic susceptibilities were determined. A molecular analysis of 20 investigated enterococcal isolates revealed prevalence of commensal strain types; hospitalassociated strain types or multi-resistant variants were absent. Cross transmission of E. faecium and E. faecalis isolates among neonatal patients attending the intensive crare unit at the same time was demonstrable. Introduction of hospital-associated, multi-resistant variants into this special setting has to be avoided to reduce the risk of subsequent infections. Full article

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Open AccessCase Report

Urinary Sludge Caused by Ceftriaxone in a Young Boy

by Takahisa Kimata, Kauznari Kaneko, Masaya Takahashi, Sohsaku Yamanouchi, Shoji Tsuji and Minoru Kino

Pediatr. Rep. 2012, 4(1), e14; https://doi.org/10.4081/pr.2012.e14 - 26 Mar 2012

Cited by 3 | Viewed by 1

Abstract

It is known that ceftriaxone administration is associated with biliary pseudolithiasis, although the development of urolithiasis has been rarely reported. We encountered a young male with bacterial meningitis complicated by urinary precipitates composed of ceftriaxonecalcium salt which is confirmed by high-performance liquid chromatography. [...] Read more.

It is known that ceftriaxone administration is associated with biliary pseudolithiasis, although the development of urolithiasis has been rarely reported. We encountered a young male with bacterial meningitis complicated by urinary precipitates composed of ceftriaxonecalcium salt which is confirmed by high-performance liquid chromatography. This patient suggested that ceftriaxone significantly increased urinary excretion of calcium, which may be linked to ceftriaxone-related urolithiasis or sludge. It is therefore worthwhile to monitor the levels of urinary calcium to creatinine ratio in patients on ceftriaxone, as they may be at greater risk for developing large stones and renal damage. Full article

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Open AccessReview

Early Recognition and Management of Septic Shock in Children

by Paolo Biban, Marcella Gaffuri, Stefania Spaggiari, Federico Zaglia, Alessandra Serra and Pierantonio Santuz

Pediatr. Rep. 2012, 4(1), e13; https://doi.org/10.4081/pr.2012.e13 - 26 Mar 2012

Cited by 19 | Viewed by 2

Abstract

Septic shock remains a major cause of morbidity and mortality among children, mainly due to acute haemodynamic compromise and multiple organ failures. In the last decade, international guidelines for the management of septic shock, as well as clinical practice parameters for hemodynamic support [...] Read more.

Septic shock remains a major cause of morbidity and mortality among children, mainly due to acute haemodynamic compromise and multiple organ failures. In the last decade, international guidelines for the management of septic shock, as well as clinical practice parameters for hemodynamic support of pediatric patients, have been published. Early recognition and aggressive therapy of septic shock, by means of abundant fluid resuscitation, use of catecholamines and other adjuvant drugs, are widely considered of pivotal importance to improve the short and long-term outcome of these patients. The aim of this paper is to summarize the modern approach to septic shock in children, particularly in its very initial phase, when pediatric healthcare providers may be required to intervene in the pre-intensive care unit setting or just on admission in the pediatric intensive care unit. Full article

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Open AccessArticle

Comparative Analysis of Glucose-6-Phosphate Dehydrogenase Levels in Pre-Term and Term Babies Delivered at University of Ilorin Teaching Hospital, Nigeria

by Temitope Olorunsola Obasa, Omotayo Olukemi Adesiyun, Olugbenga Ayodeji Mokuolu and Ayodele Isaac Ojuawo

Pediatr. Rep. 2012, 4(1), e7; https://doi.org/10.4081/pr.2012.e7 - 20 Mar 2012

Cited by 3 | Viewed by 1

Abstract

Glucose-6-phosphate (G6P) is an enzyme in the hexose monophosphate shunt required for the production of reducing equivalents needed to mop up free radicals. thereby keeping hemoglobin in its free state. Deficiency of the enzyme can cause severe neonatal jaundice. The aim of this [...] Read more.

Glucose-6-phosphate (G6P) is an enzyme in the hexose monophosphate shunt required for the production of reducing equivalents needed to mop up free radicals. thereby keeping hemoglobin in its free state. Deficiency of the enzyme can cause severe neonatal jaundice. The aim of this study was to compare G6PD levels in pre-term and term babies, and evaluate the extent to which G6PD deficiency determines the severity of jaundice in various gestational age groups. Samples of cord blood collected from consecutively delivered babies in the University of Ilorin Teaching Hospital, Nigeria, were assayed for G6PD levels, and the babies were observed for jaundice during the first week of life. Those who developed jaundice had serial serum bilirubin measured. Nine hundred and thirty-three babies had G6PD assayed, with 348 being G6PD deficient, giving a hospital based prevalence of 37.3%. Of the 644 who were followed up, 143 (22.2%) were pre-term and 501(77.8%) were term babies. Babies with gestational age (GA) 27-29 weeks had the highest G6PD levels. However, there was no significant variation among the different gestational age groups (F=0.64, P=0.64). Jaundice occurred more in pre-term compared to term babies with a relative risk of 2.41 (χ2=60.95, P=0.00001). Occurrence of jaundice in pre-term babies was irrespective of G6PD status (χ2=0.2, P=0.66, RR=1.09, CI=0.83<RR<1.43). There is an inverse relationship between gestational age and the occurrence of jaundice (R²=-0.874). Pre-term babies are more likely to have higher G6PD levels, but occurrence of jaundice in pre-term babies is irrespective of G6PD status. More severe jaundice (especially for gestational age) occurring in pre-term babies requires critical care. Full article

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Open AccessArticle

Assessment of Post-Operative Pain in Children: Who Knows Best?

by Anjalee Brahmbhatt, Tope Adeloye, Ari Ercole, Steven M. Bishop, Helen L. Smith and Daniel W. Wheeler

Pediatr. Rep. 2012, 4(1), e10; https://doi.org/10.4081/pr.2012.e10 - 01 Mar 2012

Cited by 8 | Viewed by 2

Abstract

Pain assessment in children can be extremely challenging. Most professional bodies recommend that parents or carers should be involved with their child’s pain assessment; but the evidence that parents can accurately report pain on behalf of their children is mixed. Our objective was [...] Read more.

Pain assessment in children can be extremely challenging. Most professional bodies recommend that parents or carers should be involved with their child’s pain assessment; but the evidence that parents can accurately report pain on behalf of their children is mixed. Our objective was to examine whether there were differences in post-operative pain score ratings between the child, nurse and parent or carer after surgery. Cognitively intact children aged four upwards, undergoing all surgical procedures, whose parents were present in the post-anaesthetic recovery unit (PACU), were studied. Thirty-three children were included in the study. The numerical rating scale was used to rate the child’s pain by the child, nurse and parent on arrival to the PACU and prior to discharge. We found strong correlations between children’s, nurses’ and parent’s pain scores on admission and discharge from PACU. The intraclass correlation of pain scores reported by children, nurses and parents was 0.94 (95% confidence intervals 0.91-0.96, P<0.0001). In cognitively intact children, it is adequate to manage pain based upon the assessment of children’s and nurses’ pain scores alone. The numerical rating scale appeared to be suitable for younger children. Whilst there are benefits of parents being present in recovery, it is not essential for optimizing the assessment of pain. Full article

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Open AccessCase Report

Necrotizing Fasciitis of the Lower Limbs

by Paola Muggeo, Giampaolo Arcamone, Antonino Rizzo and Nicola Santoro

Pediatr. Rep. 2012, 4(1), e4; https://doi.org/10.4081/pr.2012.e4 - 22 Feb 2012

Cited by 3 | Viewed by 1

Abstract

We report an uncommon ssevere soft-tissue infection of the thighs in a male child with acute lymphoblastic leukemia. Early and aggressive medical treatment and the conservative surgical approach were successful. Necrotizing fasciitis should be suspected in any soft-tissue infection until it can be [...] Read more.

We report an uncommon ssevere soft-tissue infection of the thighs in a male child with acute lymphoblastic leukemia. Early and aggressive medical treatment and the conservative surgical approach were successful. Necrotizing fasciitis should be suspected in any soft-tissue infection until it can be definitely ruled out, since prompt deliver of medical and surgical intervention is essential. Full article

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Open AccessArticle

Carotenoids Intake and Asthma Prevalence in Thai Children

by Sanguansak Rerksuppaphol and Lakkana Rerksuppaphol

Pediatr. Rep. 2012, 4(1), e12; https://doi.org/10.4081/pr.2012.e12 - 22 Feb 2012

Cited by 15 | Viewed by 1

Abstract

Several antioxidant nutrients have been described to inversely correlate with asthma. In order to quantify the intake of these substances, it is possible to measure skin levels by Raman spectroscopy, a novel non-invasive technique that can also be used in children. This cross-sectional [...] Read more.

Several antioxidant nutrients have been described to inversely correlate with asthma. In order to quantify the intake of these substances, it is possible to measure skin levels by Raman spectroscopy, a novel non-invasive technique that can also be used in children. This cross-sectional school-based study involved 423 children from a rural area of Thailand. Asthmatic children were diagnosed according to a Health Interview for Asthma Control questionnaire. Skin carotenoid levels were measured with Raman spectroscopy. Demographic data were obtained by directly interviewing children and their parents, whereas anthropometric parameters were measured by trained staff. Intake of carotenoids, vitamin A and C were evaluated by a food frequency questionnaire. Overall incidence of asthma in Thai schoolchildren (aged 3.5-17.8 years) was 17.3%. There was no significant difference in dietary intake of carotenoids and vitamin A and C, and skin carotenoid level between asthmatic and nonasthmatic children. Skin carotenoid level significantly correlated with all carotenoids and vitamin A intake (P<0.05). Carotenoids and vitamin A and C intakes, and skin carotenoid levels were not associated with the risk of asthma in Thai children. Skin carotenoids correlated with all carotenoids and vitamin A intake in mild to moderate degrees. Raman spectroscopy was confirmed to be a useful tool to determine antioxidant skin levels. Full article

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Open AccessReview

Epidemiology, Risk Factors, and Therapy of Candidemia in Pediatric Hematological Patients

by Chiara Cugno and Simone Cesaro

Pediatr. Rep. 2012, 4(1), e9; https://doi.org/10.4081/pr.2012.e9 - 17 Feb 2012

Cited by 25 | Viewed by 1

Abstract

Invasive fungal infections (IFI) are an important cause of morbidity, increased hospitalization and healthcare costs in critically ill or immunocompromised children. The mortality is comprised between 5 and 20%. In the last 2 decades, the epidemiology of candidemia has changed with an increase [...] Read more.

Invasive fungal infections (IFI) are an important cause of morbidity, increased hospitalization and healthcare costs in critically ill or immunocompromised children. The mortality is comprised between 5 and 20%. In the last 2 decades, the epidemiology of candidemia has changed with an increase of episodes caused by non-Candida albicans species. Central venous catheter, diagnosis of malignancy, and receipt of either vancomycin or antimicrobials with activity against anaerobic organisms for >3 days have been associated with the development of candidemia in the pediatric intensive care unit (PICU). Additional risk factors found in hematological patients were the diagnosis of aplastic anemia, performing an unrelated bone marrow or cord blood transplant, the occurrence of a graft versus host disease and the use of steroids. Early antifungal treatment is recommended to reduce mortality. In neutropenic patients, liposomal amphotericin B, an echinocandin (caspofungin, micafungin), and voriconazole are considered the best option especially for C. glabrata and C. krusei. Fluconazole remains a valid option for infection by Candida albicans in patients not exposed to fluconazole prophylaxis. Amphotericn B deoxycholate is generally not recommended because of its nephrotoxicity. Full article

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Open AccessArticle

Antistreptolysin O Titer in Health and Disease: Levels and Significance

by Alyaa Amal Kotby, Nevin Mamdouh Habeeb and Sahar Ezz El Arab

Pediatr. Rep. 2012, 4(1), e8; https://doi.org/10.4081/pr.2012.e8 - 09 Feb 2012

Cited by 22 | Viewed by 1

Abstract

Over diagnosis of acute rheumatic fever (ARF) based on a raised antistreptolysin O titer (ASOT) is not uncommon in endemic areas. In this study, 660 children (aged 9.2 ±1.7 years) were recruited consecutively and classified as: G1 (control group, n=200 healthy children), G2 [...] Read more.

Over diagnosis of acute rheumatic fever (ARF) based on a raised antistreptolysin O titer (ASOT) is not uncommon in endemic areas. In this study, 660 children (aged 9.2 ±1.7 years) were recruited consecutively and classified as: G1 (control group, n=200 healthy children), G2 (n=20 with ARF 1st attack), G3 (n=40 with recurrent ARF), G4 (n=100 with rheumatic heart disease (RHD) on long acting penicillin (LAP)), G5 (n=100 with acute follicular tonsillitis), and G6 (n=200 healthy children with history of repeated follicular tonsillitis more than three times a year). Serum ASOT was measured by latex agglutination. Upper limit of normal (ULN) ASOT (80th percentile) was 400 IU in G1, 200 IU in G4, and 1600 IU in G6. Significantly high levels were seen in ARF 1st attack when compared to groups 1 and 5 (P<0.001 and P<0.05, respectively). ASOT was significantly high in children over ten years of age, during winter and in those with acute rheumatic carditis. ASOT showed significant direct correlation with the number of attacks of tonsillitis (P<0.05). Egyptian children have high ULN ASOT reaching 400 IU. This has to be taken into consideration when interpreting its values in suspected ARF. A rise in ASOT is less prominent in recurrent ARF compared to 1st attack, and acute and recurrent tonsillitis. Basal levels of ASOT increase with age but the pattern of increase during infection is not age dependent. Full article

322 KiB

Open AccessCase Report

Long Term Outcome of Acquired Food Allergy in Pediatric Liver Recipients: A Single Center Experience

by Antigoni Mavroudi, Ioannis Xinias, Aristidis Deligiannidis, Efthimia Parapanissiou and George Imvrios

Pediatr. Rep. 2012, 4(1), e6; https://doi.org/10.4081/pr.2012.e6 - 30 Jan 2012

Cited by 14 | Viewed by 1

Abstract

Food induced sensitization has been reported in pediatric liver recipients. However long term follow up has not been established so far. We report here our experience regarding 3 pediatric patients who developed acquired food allergy after liver transplantation. The first patient suffered from [...] Read more.

Food induced sensitization has been reported in pediatric liver recipients. However long term follow up has not been established so far. We report here our experience regarding 3 pediatric patients who developed acquired food allergy after liver transplantation. The first patient suffered from persistent diarrhea and eczema. The second one presented with abdominal pain with no signs of rejection, abdominal discomfort, vomiting when ingesting milk proteins and responded well to the elimination diet. The third patient presented with facial angioedema and hoarseness of voice. She had multiple food allergies and reacted to milk, egg and sesame. All the patients had elevated total Immunoglobulin E (IgE) and elevated specific IgE antibodies to the implicated food allergens. The first patient presented clinical manifestations of allergy when she was 19 months old. The second patient became allergic at the age of 16 and the third patient at the age of 3. The symptoms of food allergy persisted for 8 years in the first case and for 2 years in the other two cases. Low levels of specific IgE antibodies to the implicated food allergens and an enhanced T-helper 1 cell immune response toward interferon-gamma production were markers of tolerance acquisition. The long term prognosis in our cases was excellent. Food allergy resolved in all the patients. The long term prognosis of acquired food allergy after liver transplantation is currently obscure. More studies would be needed including greater number of patients to determine whether acquired food allergy is transient in pediatric liver recipients. Full article

568 KiB

Open AccessArticle

Current Role of Community-Acquired Methicillin-Resistant Staphylococcus Aureus among Children with Skin and Soft Tissue Infections

by Carlos G. Teran, Sunitha Sura, Tarek Mohamed, Thant Lin, Marsha Medows, Donkor Cynthia and Sze H. Wong

Pediatr. Rep. 2012, 4(1), e5; https://doi.org/10.4081/pr.2012.e5 - 17 Jan 2012

Cited by 6 | Viewed by 1

Abstract

Community-acquired methicillin-resistant Staphylococcus aureus has become a wellestablished pathogen with alarming rates during the last decade. The current situation of this bacteria in pediatric infections is very limited and motivated us to conduct this study. This is a retrospective and analytical study including [...] Read more.

Community-acquired methicillin-resistant Staphylococcus aureus has become a wellestablished pathogen with alarming rates during the last decade. The current situation of this bacteria in pediatric infections is very limited and motivated us to conduct this study. This is a retrospective and analytical study including patients less than 18 years of age with the diagnosis of skin or soft tissue infections in 2008 and 2009 meeting the criteria of Community-acquired infection. A prevalence of 41.9% among skin and soft tissue infections was found. Inducible resistance to clindamycin was detected in 1.3% of the strains and the infection shows a seasonal predilection for summer (P=0.003); 57.8% of the cases required hospitalization with a mean stay of 3.3±2.5 days. The susceptibility to clindamycin and co-trimoxazole is 88 and 97% respectively. The resistance to erythromycin has reached 92%. The main diagnoses at presentation was gluteal abscess plus cellulitis (34.2%). The prevalence of CA-MRSA is trending up and seems to become a large burden for the health system in our community. Clindamycin is still an excellent option in the community setting since inducible clindamycin resistance is extremely low in this community. Co-trimoxazole should be kept as a reserved drug to avoid the rapid resurgence resistance in the community. Full article

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Open AccessCase Report

Two Cases of Paralitic Ileus in Onco-Hematologic Patients

by Francesca Carraro, Elisa Rivetti, Erica Romano and Franca Fagioli

Pediatr. Rep. 2012, 4(1), e3; https://doi.org/10.4081/pr.2012.e3 - 17 Jan 2012

Cited by 2 | Viewed by 1

Abstract

ileus is a severe complication resulting from a variety of disorders. It occurs most commonly in patients with serious underlying medical or surgical conditions. Prompt diagnosis and appropriate management may improve the outcome. We describe 2 cases of onco-hematologic patients who presented this [...] Read more.

ileus is a severe complication resulting from a variety of disorders. It occurs most commonly in patients with serious underlying medical or surgical conditions. Prompt diagnosis and appropriate management may improve the outcome. We describe 2 cases of onco-hematologic patients who presented this complication after intensive chemotherapy. Full article

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Open AccessArticle

Muscle Fat Content and Abdominal Adipose Tissue Distribution Investigated by Magnetic Resonance Spectroscopy and Imaging in Obese Children and Youths

by Cilius E. Fonvig, Dorthe S. Bille, Elizaveta Chabanova, Tenna R. H. Nielsen, Henrik S. Thomsen and Jens-Christian Holm

Pediatr. Rep. 2012, 4(1), e11; https://doi.org/10.4081/pr.2012.e11 - 09 Jan 2012

Cited by 21 | Viewed by 1

Abstract

The degree of fat deposition in muscle and its implications for obesity-related complications in youth are not well understood. One hundred and fifty-nine patients (mean age: 13.3 years; range: 6-20) with a body mass index (BMI) >90th percentile for age and sex were [...] Read more.

The degree of fat deposition in muscle and its implications for obesity-related complications in youth are not well understood. One hundred and fifty-nine patients (mean age: 13.3 years; range: 6-20) with a body mass index (BMI) >90th percentile for age and sex were included. Muscle fat content (MFC) was measured in the psoas muscle by proton magnetic resonance spectroscopy. The patients were assigned to two groups: MFC <5% or ³5%. Visceral adipose tissue volume (VAT) and subcutaneous adipose tissue volume (SAT) were measured by magnetic resonance imaging. Blood samples were obtained from 119 patients, and liver enzyme concentrations and other variables were measured. The data were analysed to detect any associations between MFC and BMI standard deviation scores, VAT and SAT, blood values, and physical activity levels. The mean BMI standard deviation score (SDS) was 3.04 (range 1.32-5.02). The mean MFC was 8.9% (range 0.8-46.7), and 118 (74.2%) of 159 patients had an MFC ³5%. Children with a high MFC had a higher BMI SDS (P=0.03) and had a higher VAT, but not SAT or SAT/VAT ratio. Both intramyocellular lipid (IMCL) and extramyocellular lipid (EMCL) content were elevated in patients with an MFC ³5%. Blood values and physical activity levels did not differ between the two groups. Severely obese children and adolescents tend to have a high MFC, which is associated with elevated VAT and IMCL and EMCL content. An increased MFC may be associated with impaired metabolic processes, which may predispose young people to obesity-related complications. Full article

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Open AccessReview

Empiric Antibiotic Therapy in a Child with Cancer and Suspected Septicemia

by Desiree Caselli and Olivia Paolicchi

Pediatr. Rep. 2012, 4(1), e2; https://doi.org/10.4081/pr.2012.e2 - 03 Jan 2012

Cited by 5 | Viewed by 1

Abstract

Improved outcome in the treatment of in childhood cancer results not only from more aggressive and tailored cancer-directed therapy, but also from improved supportive therapy and treatment of life-threatening infectious complications. Prompt and aggressive intervention with empiric antibiotics has reduced the mortality in [...] Read more.

Improved outcome in the treatment of in childhood cancer results not only from more aggressive and tailored cancer-directed therapy, but also from improved supportive therapy and treatment of life-threatening infectious complications. Prompt and aggressive intervention with empiric antibiotics has reduced the mortality in this group of patients. Physical examination, blood tests, and blood cultures must be performed, and antibiotic therapy must be administered as soon as possible. Beta-lactam monotherapy, such as piperacillin-tazobactam or cefepime, may be an appropriate empiric therapy of choice for all clinically stable patients with neutropenic fever. An anti-pseudomonal beta-lactam antibiotic plus gentamicin is recommended for patients with systemic compromise. Full article

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Open AccessBrief Report

Hyperbaric Oxygen Treatment of Superficial Soft Tissue Lesions in Children with Oncologic Disease

by Eleonora Cesca, Giacomo Garetto, Emanuela Frascella, Simone Cesaro, Patrizia Dall'Igna and Giovanni Cecchetto

Pediatr. Rep. 2012, 4(1), e1; https://doi.org/10.4081/pr.2012.e1 - 27 Dec 2011

Cited by 1

Abstract

This study aimed to assess the feasibility and results of hyperbaric oxygen therapy (HOT) as supportive treatment of lesions of superficial soft tissues in children with oncological diseases. This was a retrospective analysis and review of all records of children observed at the [...] Read more.

This study aimed to assess the feasibility and results of hyperbaric oxygen therapy (HOT) as supportive treatment of lesions of superficial soft tissues in children with oncological diseases. This was a retrospective analysis and review of all records of children observed at the Pediatric Hematology-Oncology Department of the University of Padova and treated adjuvantly with HOT. Between 1996 and 2010, 12 patients (5 males and 7 females, median age 7 years, range 0.5-16) underwent HOT. The effectiveness of HOT varied according to the lesion treated. Ten out of 12 patients were cured. Efficacy was most questionable in 2 patients with skin graft and flaps at risk. Compliance to therapy was close to 100%. In just one case, HOT was interrupted for the appearance of local skin metastases close to the site of primary tumor. HOT showed itself to be safe and effective in most patients even those immunocompromised or critically ill. Full article

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Pediatr. Rep., Volume 4, Issue 1 (January 2012) – 15 articles

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