European journal of pediatrics
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Pancreatitis in children is not common and can be associated with severe morbidity and mortality. We encountered 43 children, ranging in age from 2 to 18 years, with pancreatitis over the past 10 years. The diagnosis of pancreatitis was made in those patients who showed: (1) significant intra-operative pathology or; (2) clinical findings of pancreatic inflammation and laboratory confirmation. More than one third (16 cases) of the cases were due to trauma, other causes included systemic disease (10), structural disease (8), and toxins or drugs (4). Five cases were classified as idiopathic. Most of the patients presented with abdominal pain (95%) and vomiting (56%). Jaundice was found in 7 patients and an abdominal mass in 2. Morbidity included pseudocyst (10), relapse (4), hyperglycaemia (4) and miscellaneous problems. Eight (50%) of the patients with trauma and 6 (86%) of the patients with structural diseases required surgery. Other patients were managed conservatively with bowel rest, gastric decompression, intravenous fluid and total parenteral nutrition. One case had a fatal outcome. All the survivors did well in long term follow up. Relevant literature has been reviewed and the sensitivity of various diagnostic modalities compared and discussed. A lesser known association between pancreatitis and structural anomalies such as choledochal cyst is discussed. To our knowledge, the present review is the first on pancreatitis in Chinese children. ⋯ Pancreatitis can occur from a wide variety of causes and may result in severe complications. Early diagnosis, close monitoring and aggressive intervention are mandatory to reduce morbidity and mortality.
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Randomized Controlled Trial Clinical Trial
Pentoxifylline reduces plasma tumour necrosis factor-alpha concentration in premature infants with sepsis.
Increased plasma tumour necrosis factor alpha (TNF) concentration correlates with mortality in sepsis. We suggested that pentoxifylline (PTXF), which is known to inhibit TNF production, may improve survival and attenuate clinical symptoms of sepsis in neonates. Plasma TNF levels were evaluated in 29 newborn infants with sepsis. Patients were randomly assigned into two groups, receiving PTXF in a dose of 5 mg/kg per hour for 6 h or placebo (saline), on 3 successive days. Both groups were subjected to the same conventional therapy. TNF was evaluated before and after PTXF or placebo administration on the 1st and 3rd days of therapy. There was a statistically significant decrease in plasma TNF level in the PTXF group when the values before the first and after the last PTXF infusion were compared [mean: 671.5 pg/ml; SD: 438; med: 729.6 vs mean: 41.0 pg/ml; SD: 64.1; med: 11.5; P < 0.000004]. In the placebo group, decrease was not significant [mean: 633.0 pg/ml SD: 488.6; med: 618.9 vs 246.9 pg/ml; SD: 243.9; med: 191.0]. A significantly higher plasma TNF level, evaluated after the last PTXF infusion, was found in the placebo group [246.9 pg/ml vs 41.0 pg/ml; P < 0.001]. Only one of four infants with signs of shock in the placebo group survived, whereas all of five newborns with symptoms of shock in the PTXF group survived [P < 0.04]. An increased incidence of metabolic acidosis [P < 0.05], necrotizing enterocolitis [P < 0.04] and renal insufficiency [P < 0.05] was observed in infants in the placebo group. ⋯ PTXF inhibits production of TNF and may have therapeutic value in the treatment of premature infants with sepsis complicated by shock.
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Our objective was to determine arterial oxygen saturation as measured by pulse oximetry (SpO2) in healthy term neonates during their first 4 weeks of life. Overnight recordings of SpO2 (Nellcor N200), photoplethysmographic (pulse) waveforms from the oximeter and breathing movements were performed in 60 term infants. They were studied initially during their 1st week of life (median age 4 days, range 1-7) and then again during their 2nd-4th week (median age 17 days, range 8-27). Median baseline SpO2, measured during regular breathing, was 97.6% (range 92-100) during week 1 versus 98.0% (86.6-100) during week 2-4 (P > 0.05). Episodes of desaturation, defined as a fall in SpO2 to < or = 80% for > or = 4 s, were found in 35% of recordings obtained in week 1 compared to 60% of those obtained in week 2-4 (P < 0.01). Their frequency increased from a median of (0-41) per 12 h of recording at the initial recording to 1 (0-165) at follow up (P < 0.01). Analysis of the data by week of life showed a peak in desaturation frequency in the 2nd week of life. The infants with extreme values at follow-up (e.g. a baseline SpO2 of 86.6%, 5th percentile 91.9%, or a desaturation frequency of 165 per 12 h of recording, 95th percentile 32) had had values well within the normal range during their initial recording (a baseline SpO2 of 94.4%, or a desaturation frequency of 4). Most of the desaturations in the infants with extreme values were associated with periodic apnoea. These results demonstrate only relatively minor developmental changes in oxygenation in term neonates during the first 4 weeks of life. The clinical significance of outlying values, i.e. a low baseline SpO2 or a high number of episodic desaturations, remains to be determined. ⋯ These healthy term neonates had values for baseline oxygen saturation and desaturation frequency that were not substantially different from those observed in older infants.
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Comment Letter Randomized Controlled Trial Comparative Study Clinical Trial
No evidence for use of pentoxifylline in acute Kawasaki disease.