Anthracycline-induced clinical heart failure in a cohort of 607 children: long-term follow-up study.

Purpose: To determine the early and late cumulative incidence of anthracycline-induced clinical heart failure (A-CHF) after anthracycline therapy in childhood and to identify associated risk factors.

Patients And Methods: The cumulative incidence of A-CHF and the risk factors of A-CHF were assessed in a cohort of 607 children who had been treated with anthracyclines between 1976 and 1996. For 96% of the cohort, we obtained the clinical status up to at least January 1997.

Prophylactic vitamin K for vitamin K deficiency bleeding in neonates.

Background: Vitamin K deficiency can cause bleeding in an infant in the first weeks of life. This is known as Hemorrhagic Disease of the Newborn (HDN). HDN is divided into three categories: early, classic and late HDN.

Neuromuscular paralysis for newborn infants receiving mechanical ventilation.

Background: Ventilated newborn infants breathing in asynchrony with the ventilator are at risk for complications during mechanical ventilation, such as pneumothorax or intraventricular hemorrhage, and are exposed to more severe barotrauma, which consequently could impair their clinical outcome. Neuromuscular paralysis, which eliminates spontaneous breathing efforts of the infant, has potential advantages in this respect. However, a number of complications have been reported with muscle relaxation in infants, so that concerns exist regarding the safety of prolonged neuromuscular paralysis in newborn infants.

[Sensitive and specific screening for detection of spina bifida by echography in the second trimester; systematic review and meta-analysis].

Objective: Evaluation of the diagnostic accuracy of ultrasound in the second trimester for the detection of spina bifida.

Design: Systematic review and meta-analysis.

Method: Medline and Embase were searched to identify prospective studies in a general pregnant population.

Elective high frequency oscillatory ventilation versus conventional ventilation for acute pulmonary dysfunction in preterm infants.

Background: Respiratory failure due to lung immaturity is a major cause of mortality in preterm infants. Although intermittent positive pressure ventilation (IPPV) saves lives, lung distortion during its use is associated with lung injury and chronic lung disease (CLD). Conventional IPPV is provided at 30-80 breaths per minute while a newer form of ventilation called high frequency oscillatory ventilation (HFOV) provides 'breaths' at 10-15 seconds.

Twin-to-twin transfusion syndrome: a case report. Antepartum prediction of underlying placental vascular pattern in monochorionic twin pregnancies may be possible.

A case of twin-to-twin transfusion syndrome is described. Comparing data of serial antepartum ultrasonography with a haemodynamic model suggests the possibility of predicting the underlying placental vascular anatomy. It is suggested that serial ultrasonography, including full biometry, pulsatility indices of the umbilical arteries, foetal echocardiography, assessment of amniotic fluid indices and foetal bladder filling could serve as ultrasound parameters for pattern recognition of the underlying placental vascular anomaly.

Indium-111-antimyosin scintigraphy in the early detection of heart damage after anthracycline therapy in children.

Purpose: To determine the value of indium-111-antimyosin ((111)In-AM) scintigraphy in the early detection of myocardial damage in children treated with doxorubicin.

Patients And Methods: Twelve planar scintigrams were made of eight patients (seven children and one young adult; mean age, 12 years). Three scans were obtained before doxorubicin therapy in three patients, and nine scans were obtained during doxorubicin therapy in seven patients.

Meta-analysis of elective high frequency ventilation in preterm infants with respiratory distress syndrome.

Aim: To summarise the evidence on the efficacy of elective high frequency ventilation compared with conventional ventilation in preterm infants with respiratory distress syndrome.

Methods: A search from 1987 onwards was made on Embase, Medline, and the Cochrane Library. A questionnaire was also circulated during an international meeting on high frequency ventilation.

[The practice of systematic reviews. I. Introduction].

A systematic review of the results of randomized, controlled trials employs explicit, systematic methods to produce unbiased and precise estimates of the effect of a treatment on outcomes of clinical importance. The results of such systematic reviews are of importance in that they inform providers and consumers about the effect of treatments and identify priorities for new research. The Cochrane Collaboration is a systematic programme to try to harness this valuable information.

[Excess mortality in critically ill patients after treatment with human albumin].

According to the results of a systematic review of randomized clinical studies administration of human albumin to critically ill patients is associated with excess mortality, compared with withholding albumin or administration of crystalloid fluids. The study appears to be well done. Also, there are various explanatory pathophysiological mechanisms supporting the association.

Variability in management of symptomless microhaematuria in schoolchildren.

The evaluation of incidentally detected symptomless microhaematuria in schoolchildren is controversial. Some authors advocate varying numbers of immediate tests, while others recommend investigations only in cases who develop systemic symptoms or signs, or a decline in renal function. The objective of this study was to estimate the extent to which this uncertainty affects the declared habits of practising physicians.

Prediction of febrile seizures in siblings: a practical approach.

Unlabelled: To quantify the risk of febrile seizures (FS) in relatives of children with FS and to predict the risk of FS in siblings, we calculated cumulative risks of FS in first degree relatives of 129 children with FS. The study was conducted as a prospective follow up study of FS recurrences at the outpatient clinic of the Sophia Children's Hospital in Rotterdam. Thirteen parents and 12 siblings had experienced FS, accounting for a 6-year cumulative risk of 7%.

Symptomless microhaematuria in schoolchildren: causes for variable management strategies.

We reviewed published data on the frequency of underlying disorders in schoolchildren with microscopic or gross isolated haematuria (IH), and evaluated management strategies. We found five reports of microscopic IH in screened asymptomatic schoolchildren, three reports of microscopic IH detected by case-finding, and five surveys of kidney biopsies in referred children with microscopic and gross IH. We listed the reported underlying disorders, and estimated the benefit from their early detection and treatment.

Antipyretic efficacy of ibuprofen and acetaminophen in children with febrile seizures.

Objective: To compare the antipyretic efficacy of ibuprofen syrup (5 mg/kg per dose) and acetaminophen syrup (10 mg/kg per dose) in children with a history of febrile seizures.

Design: Randomized, multiple-dose, double-blind, cross-over trial.

Setting: The outpatient department of a university-affiliated teaching hospital.

Seizures associated with fever: current management controversies.

Controversies about seizures with fever continue. The definition and differential diagnosis of seizures with fever are developed. A practical scheme for selective lumbar punctures is presented with emphasis on the empirical data that allows use of clinical risk factors to select those with meningitis while confidently avoiding a lumbar puncture in others.

Family history and recurrence of febrile seizures.

To determine the value of a detailed family history for the assessment of the risk of recurrence of febrile seizures, 115 children who visited the emergency room of an academic children's hospital were studied prospectively. The recurrence risk of febrile seizures was analysed in relation to the child's family history and the proportion of relatives affected by febrile seizures using Kaplan-Meier estimates and Cox proportional hazard models. A first degree family history positive for febrile seizures (parents or siblings affected by febrile seizures) increased a child's two year recurrence risk from 27 to 52%.

Risk factors for seizure recurrence in children with febrile seizures: a pooled analysis of individual patient data from five studies.

To reassess the relations between postulated risk factors and seizure recurrence after a first febrile seizure (FS), the individual data from five follow-up studies that used similar definitions of FSs and risk factors were pooled and reanalyzed. The risk of frequent recurrent seizures and of the occurrence of complex seizures in previously healthy, untreated children was studied. Seizure recurrence hazard was described as a function of the child's attained age.

Severity of respiratory syncytial virus infections and immunoglobulin concentrations.

In a prospective study in 86 children with respiratory syncytial virus infections, no relation was detected between the severity of infection (based on diagnosis, chest radiography findings, need for mechanical ventilation, and duration of hospitalisation) and serum concentrations of IgG, IgA, IgM, and IgG1-4 on admission.

Postoperative care after craniofacial surgery: evaluation of routine laboratory testing.

In this study, two protocols for monitoring children after major craniofacial surgery were compared. The first protocol consisted of repetitive laboratory testing in 37 children to detect surgical and medical complications during a 2-year period. None of the complications were predicted by abnormal test results, and abnormal results of routinely performed tests never led to a change in management.

Risk factors for mechanical ventilation in respiratory syncytial virus infection.

In a prospective study, risk factors for mechanical ventilation were identified in 102 patients with respiratory syncytial virus (RSV) infection admitted to the Sophia Children's Hospital, Rotterdam. Age, weight on admission and prematurity were associated with the need for mechanical ventilation. Using multivariate analysis, only low weight was an independent risk factor for mechanical ventilation.

Seizures and fever: can we rule out meningitis on clinical grounds alone?

A study was done of 309 children seen in two ERs with a first seizure and fever to assess whether meningitis could be recognized using readily available clinical information. Among these children, 23 (7%) cases of meningitis were diagnosed. A group of 69 children with seizures and fever but no meningitis served as controls.

The value of urinary red cell shape in the diagnosis of glomerular and post-glomerular haematuria. A meta-analysis.

The proportion of dysmorphic red cells (DRC) in the urinary sediment and their mean corpuscular volume (MCV) have been claimed to discriminate between glomerular and postglomerular sources of haematuria. To determine the diagnostic value of urinary DRC and MCV, we searched the literature and critically reviewed 21 published studies using a predetermined set of criteria for evaluation. All studies originated from referral centres.