Why does meconium cause meconium aspiration syndrome? Current concepts of MAS pathophysiology.

One in every 7 pregnancies ends with meconium-stained amniotic fluid and approximately 5% of these infants develop the meconium aspiration syndrome (MAS). MAS is a severe disease of the (mainly) term neonate, characterized by respiratory distress, pulmonary inflammation, persistent pulmonary hypertension and chronic hypoxia. The pathophysiology of MAS is multifactorial and complex.

Delayed hemolytic transfusion reaction with hyperhemolysis after first red blood cell transfusion in child with beta-thalassemia: challenges in treatment.

Background: Delayed hemolytic transfusion reaction (DHTR) can manifest with hyperhemolysis, a serious complication of red blood cell (RBC) transfusions. This has mostly been described in sickle cell anemia but occasionally in beta-thalassemia. Treatment is challenging; immunosuppressive medication has been reported to be useful by some but not others.

Meconium-stained amniotic fluid: discharge vigorous newborns.

Background: Most infants born through meconium-stained amniotic fluid (MSAF) are observed clinically for 24 h postnatally. Only 5% of infants born through MSAF develop the meconium aspiration syndrome (MAS), a serious condition requiring medical intervention.

Objective: To evaluate the value of 24-h postnatal observation of infants born through MSAF.

Imaging of acute appendicitis in children: EU versus U.S. ... or US versus CT? A European perspective.

There is substantial evidence that imaging may reduce the negative appendectomy rate, also in children. However, controversy exists about the preferred method: US or CT, and the choice appears to be determined by the side of the Atlantic Ocean. This review brings forth several arguments in favour of US.

A visual analog scale can assess the effect of surgical treatment in children with chronic otitis media with effusion.

Background: The OM-6 survey is a validated and multinationally accepted instrument to measure the treatment effect of otitis media in children. Routine use of the OM-6 in a busy general practice is not always possible and can lead to incomplete returned surveys. A simplified method is favoured when the aim is a continuous process of complete treatment-outcome-data collection.

Axillary and rectal temperature measurements poorly agree in newborn infants.

Aim: Evaluation of the agreement between axillary temperature measurements and rectal temperature measurements in neonates.

Methods: Rectal and axillary body temperatures were simultaneously measured for 3 min in 33 neonates (gestational age 25-42 weeks, weight 840-4,005 g). Two investigators performed paired measurements, one in each neonate.

A 5-year follow-up study after knee disarticulation in two cases of Gollop-Wolfgang complex.

The Gollop-Wolfgang Complex is a very rare anomaly, which has its essential features in congenital absence of the tibia and ipsilateral bifurcation of the femur. Surgical treatment of two patients with a follow-up of 5 years is reported.

Status epilepticus in children with epilepsy: Dutch study of epilepsy in childhood.

Purpose: To study course and outcome of epilepsy in children having had a status epilepticus (SE) as the presenting sign or after the diagnosis.

Methods: A total of 494 children with newly diagnosed epilepsy, aged 1 month through 15 years, were followed prospectively for 5 years.

Results: A total of 47 Children had SE.

Urinary eosinophil protein X in children with atopic asthma.

Unlabelled: The aim of this study was to investigate the relationship between urinary eosinophil protein X (uEPX) and asthma symptoms, lung function, and other markers of eosinophilic airway inflammation in asthmatic school children.

Methods: A cross-sectional study was performed in 180 steroid dependent atopic children with stable moderately severe asthma, who were stable on 200 or 500 microg of fluticasone per day. uEPX was measured in a single sample of urine and was normalized for creatinine concentration (uEPX/c).

Long-term asthma treatment guided by airway hyperresponsiveness in children: a randomised controlled trial.

Management plans for childhood asthma show limited success in optimising asthma control. The aim of the present study was to assess whether a treatment strategy guided by airway hyperresponsiveness (AHR) increased the number of symptom-free days and improved lung function in asthmatic children, compared with a symptom-driven reference strategy. In a multicentre, double-blind, parallel-group, randomised, 2-yr intervention trial, 210 children (aged 6-16 yrs) with moderate atopic asthma, selected on the basis of symptom scores and/or the presence of AHR, were studied.

Recombinant human deoxyribonuclease in infants with respiratory syncytial virus bronchiolitis.

Background: Treatment of hospitalized infants with respiratory syncytial virus (RSV) bronchiolitis is mainly supportive. Bronchodilators and systemic steroids are often used but do not reduce the length of hospital stay. Because hypoxia and airways obstruction develop secondary to viscous mucus in infants with RSV bronchiolitis, and because free DNA is present in RSV mucus, we tested the efficacy of the mucolytic drug recombinant human deoxyribonuclease (rhDNase).

Can pyloromyotomy for infantile hypertrophic pyloric stenosis be performed in any hospital? Results from two teaching hospitals.

In order to document the incidence of perioperative complications in patients with infantile hypertrophic pyloric stenosis, a descriptive cohort study was performed in two teaching hospitals in the Netherlands. One hospital specialized in pediatric surgery and the other was a general surgery teaching hospital. All consecutive infants who underwent pyloromyotomy for the diagnosis hypertrophic pyloric stenosis in both hospitals between 1998 and 2002 were included.

Success with hydrostatic reduction of intussusception in relation to duration of symptoms.

Background: It is widely believed that hydrostatic reduction of intussusception is less successful in children with prolonged symptoms prior to presentation.

Aim: To prospectively evaluate success in relation to duration of symptoms.

Methods: Prospective study in which children, regardless of symptom duration, underwent an attempt at hydrostatic reduction.

US features of the normal appendix and surrounding area in children.

Purpose: To evaluate prospectively the frequency of depiction with ultrasonography (US) of the appendix in children without clinical suspicion of acute appendicitis and to evaluate the US appearance of the normal appendix.

Materials And Methods: Between March 2003 and July 2003, 146 consecutive patients (62 boys and 84 girls; mean age, 7 years; age range, 2-15 years) without clinical suspicion of acute appendicitis were examined with US. Patients with cystic fibrosis and those with acute abdominal pain were excluded from the study.

Appendix in children with cystic fibrosis: US features.

Purpose: To evaluate the ultrasonographic (US) appearance of the appendix in children with cystic fibrosis but who were asymptomatic for appendicitis.

Materials And Methods: Between March 2001 and March 2002, 31 children (14 boys, 17 girls; mean age, 9.5 years; range, 2-16 years) with cystic fibrosis underwent graded-compression US of the appendix.

The triplane variant of the tibial apophyseal fracture: a case report and a review of the literature.

A rare case of tibial apophyseal fracture with extension in the antero-lateral physis and epiphysis in a 17-year-old boy is described. This type of fracture, which can be associated with intra-articular lesions and lesions of the extensor mechanism, resembles the better known distal tibial triplane fracture. Arthroscopic controlled anatomic reduction with restoration of the articular surface was achieved.

Meconium is a source of pro-inflammatory substances and can induce cytokine production in cultured A549 epithelial cells.

Inflammation plays an important role in the pathogenesis of meconium aspiration syndrome, and pneumonitis is one of the major characteristics. We have previously shown that meconium has chemotactic properties because of the presence of IL-8. We hypothesize that IL-8 and other proinflammatory substances in meconium may amplify inflammation in meconium aspiration syndrome, inducing endogenous cytokine production by lung epithelial cells.

Parent-reported subjective complaints in children using antiepileptic drugs: what do they mean?

We used a parent-completed 20-item "side effect scale" quantifying complaints that parents perceive to be caused by antiepileptic drugs (AEDs) in 108 children with active epilepsy. We studied the associations between parent-reported complaints, severity of seizures, and restrictions due to epilepsy, and clinical data including number and AED load. In 85% of the children at least one complaint was reported, in less than 20% complaints were perceived as a substantial problem.

Transepidermal water loss during halogen spotlight phototherapy in preterm infants.

Among preterm infants there is a relationship between skin blood flow and transepidermal water loss (TEWL). The aim of this study was to assess whether halogen spotlight phototherapy without significant heat stress increases TEWL and affects maintenance fluid requirements in preterm infants. TEWL was measured noninvasively before the start and after 1 h of halogen spotlight phototherapy in a group of preterm infants, nursed in double-walled incubators with moderately high relative humidity.

Efficacy of desmopressin combined with alarm therapy for monosymptomatic nocturnal enuresis.

Purpose: We evaluated the combination of alarm and desmopressin versus alarm monotherapy for the treatment of nocturnal enuresis.

Materials And Methods: A double-blind, placebo controlled study of alarm therapy combined with desmopressin for children with nocturnal enuresis is described. Of 93 patients 47 were randomized to receive alarm therapy and 40 microg.

Hospital admissions and readmissions for asthma in the age group 0-4 years.

SUMMARY. Childhood rates for admission and readmission for asthma are highest under the age of 5 years. From a registration study in 0-4-year-olds, 100 patients (68 male) were admitted to hospital for asthma and followed for 1 year, yielding a total of 136 admissions.

Nasal peak inspiratory flow through Turbuhaler in children with symptomatic rhinitis and in healthy children.

Topical treatment of allergic or vasomotor rhinitis is possible by means of pressurized metered dose inhalers, aqueous spray, or dry powder inhalers. In children, little is known about nasal drug delivery by dry powder inhalation. The airflow through the device is critical for the drug release and a sufficient nasal inspiratory flow is needed for intranasal drug delivery from a dry powder inhaler.

Risk factors for exacerbations and hospital admissions in asthma of early childhood.

Hospital admissions and readmissions for asthma in early childhood remain causes for concern. The purpose of this study was to identify predisposing risk factors related to asthma exacerbations and precursors of hospital admissions in young children. Subjects were patients with doctor-diagnosed asthma from a clinical registration study, aged 0-4 years, and followed up for 2 years.

Prognostic characteristics of asthma diagnosis in early childhood in clinical practice.

A registration study from clinical practice was set up to assess the prognostic value of symptoms and laboratory data at first visit for doctor-diagnosed 'asthma' in early childhood. A total of 419 children aged 0-4 y, who were newly referred to the outpatient department of the Juliana Children's Hospital with possible asthma were enrolled over a 2-y period. Data from history taking, physical examination, laboratory tests for atopic status at first visit and data from follow-up visits were recorded.

Sample size estimation in studies monitoring exercise-induced bronchoconstriction in asthmatic children.

Background: The repeatability of the response to standardised treadmill exercise testing using dry air and monitoring of heart rate in asthmatic children suffering from exercise-induced bronchoconstriction (EIB) has not been well established.

Methods: Twenty seven asthmatic children with known EIB performed standardised exercise testing twice within a period of three weeks. The tests were performed on a treadmill while breathing dry air.