European journal of pediatrics
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Inhaled nitric oxide (iNO) has been shown to improve oxygenation in severe persistent pulmonary hypertension of the newborn (PPHN). However, PPHN is often associated with various lung diseases. Thus, response to iNO may depend upon the aetiology of neonatal acute respiratory failure. ⋯ Conclusion, iNO improves the oxygenation in most newborns with severe hypoxaemic respiratory failure including preterm neonates. However, response to iNO is disease-specific. Furthermore, iNO when combined with adequate alveolar recruitment and limited barotrauma using exogenous surfactant and HFOV may obviate the need for extracorporeal membrane oxygenation in many term infants.
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Aim of our study was to evaluate Doppler renal blood flow velocity in asphyxiated neonates and to correlate renal function to Doppler findings. Doppler renal blood flow velocity was evaluated in 23 severely asphyxiated neonates born at a gestational age > 32 weeks and compared to our standard Doppler data obtained in 25 healthy neonates comparable for gestational age and birth weight. Renal Doppler ultrasound was performed on the 1st and 3rd days of life. Renal function was investigated in the first 2 weeks of life. Asphyxiated neonates showed mean values of systolic velocity and mean velocity significantly reduced (P < 0.001) compared with our standard Doppler values on the 1st day of life. Seven out of the 23 asphyxiated neonates were affected by acute renal failure and 14 showed no renal involvement. Two neonates were oliguric but did not develop acute renal failure. On the 1st day of life, neonates with acute renal failure had significantly lower mean values of systolic velocity and mean velocity than the asphyxiated neonates without renal involvement (P < 0.01). All 7 neonates affected by acute renal failure showed a systolic velocity more than 2SD below the mean standard value, while only 4 of the 16 asphyxiated neonates (25%) without acute renal failure had low systolic velocity values on the 1st day of life. Doppler velocities in asphyxiated neonates were similar to standard values on the 3rd day of life. Renal failure recovered before the 11th day of life in all cases. ⋯ Our findings indicate that decreased Doppler renal flow systolic velocity observed in asphyxiated neonates on the st day of life is a useful predictive index for subsequent development of acute renal failure, with 100% sensitivity and 63.6% specificity.
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We developed a predictive model to assess the probability of normal biochemical blood test results in children presenting with a seizure associated with fever. The models were based on various combinations of patient characteristics of the history and physical examination of 203 children. The characteristics included gender, age in years, previous history of febrile seizures, family history of febrile seizures, fever previous to the seizure, vomiting and diarrhoea previous to the seizure. Further, clinical characteristics of the seizure were considered: focal seizure signs, multiple seizure, seizure duration and rectal temperature at seizure. The outcome was defined as normal test results of serum levels of sodium (n=115, 68%), calcium (n=149, 89%) and glucose (n=173, 100%), according to the hospital reference values. The prevalence of abnormal test results was rather low and the abnormalities were outside the morbidity range. We used logistic regression to relate the outcome to the several clinical characteristics. The discriminative ability of the models was 0.63 (area under the receiver operating characteristic curve of the model predicting normal sodium), 0.66 (normal calcium) and 0.66 (both normal). The score chart we constructed is an additional tool to a carefully performed patient history and physical examination and it may help to decide if a biochemical test is indicated for the individual patient. ⋯ In children with seizures associated with fever, abnormal biochemical blood test results are rare and outside the morbidity range. The biochemical tests are generally not required. In children with a low probability of a normal result as calculated by the score chart, the test may be indicated.
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Case Reports
Rapidly progressive glomerulonephritis in a boy with hypocomplementaemic urticarial vasculitis.
The present paper reports the fourth case of hypocomplementaemic urticarial vasculitis in a child. We describe a boy who, after many years of arthritis, urticaria, eye inflammation and hypocomplementaemia, developed rapidly progressive glomerulonephritis which was completely reversed by immunosuppressive therapy. ⋯ Only three paediatric patients with hypocomplementaemic urticarial vasculitis have been described. Severe renal involvement was reversible with early appropriate treatment.
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Re-entrant supraventricular tachycardia is the most common cardiac arrhythmia in infancy. Pharmacological prevention of recurrencies is a standard recommendation for infants less than 1 year of age. In view of the often benign spontaneous clinical course of the disease, the risk-benefit analysis of any antiarrhythmic agent given is important. It was the aim of this retrospective study, to assess the value of oral long-term digoxin given to paediatric patients with supraventricular tachycardia with onset in the first 4 months of life. Twenty-six newborns and infants fulfilled the inclusion criteria. Median age at first presentation of the patients was 7 days. Eight patients (31%) had structural heart disease, 9 patients had a pre-excitation syndrome, and the other 17 children had a concealed accessory atrioventricular pathway. Long-term prophylaxis with oral digoxin was considered successful in 17 children (65%). In 2 patients therapy with digoxin was considered partially effective and in 7 patients (27%) failure of digoxin to improve symptoms led to the introduction of other anti-arrhythmic agents. Serum digoxin levels were no different in the patients with successful therapy as compared to those with treatment failure. No side-effects due to digoxin were noted in all the patients treated. After a mean followup of 54 months (12-130 months), 19 children (73%) were free of recurrencies and on no medication, 5 children were free of recurrencies but had anti-arrhythmic therapy. Only 2 patients, both on anti-arrhythmic therapy, were still suffering from tachycardia. ⋯ Digoxin remains an effective treatment option in infants with supraventricular tachycardia and it helped to avoid the long-term use of other anti-arrhythmic drugs with potentially more serious side-effects (pro-arrhythmia) in a considerable proportion of infants treated.