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At least 649 records · Page 36Linked to original sources
PubMed2005

Thoracoscopic repair of esophageal atresia and tracheoesophageal fistula: a multi-institutional analysis.

OBJECTIVES: For the past 60 years, successful repair of esophageal atresia (EA) and distal tracheoesophageal fistula (TEF) has been performed via a thoracotomy. However, a number of reports have described adverse musculoskeletal sequelae following thoracotomy in infants and young children. Until now, only a few scattered case reports have detailed an individual surgeon's success with thoracoscopic repair of EA/TEF. This multi-institutional review represents the largest experience describing the results with this approach. METHODS: A cohort of international pediatric surgeons from centers that perform advanced laparoscopic and thoracoscopic operations in infants and children retrospectively reviewed their data on primary thoracoscopic repair in 104 newborns with EA/TEF. Newborns with EA without a distal TEF or those with an isolated TEF without EA were excluded. RESULTS: In these 104 patients, the mean age at operation was 1.2 days (+/-1.1), the mean weight was 2.6 kg (+/-0.5), the mean operative time was 129.9 minutes (+/-55.5), the mean days of mechanical ventilation were 3.6 (+/-5.8), and the mean days of total hospitalization were 18.1 (+/-18.6). Twelve (11.5%) infants developed an early leak or stricture at the anastomosis and 33 (31.7%) required esophageal dilatation at least once. Five operations (4.8%) were converted to an open thoracotomy and one was staged due to a long gap between the 2 esophageal segments. Twenty-five newborns (24.0%) later required a laparoscopic fundoplication. A recurrent fistula between the esophagus and trachea developed in 2 infants (1.9%). A number of other operations were required in these patients, including imperforate anus repair in 10 patients (7 high, 3 low), aortopexy (7), laparoscopic duodenal atresia repair (4), and various major cardiac operations (5). Three patients died, one related to the EA/TEF on the 20th postoperative day. CONCLUSIONS: The thoracoscopic repair of EA/TEF represents a natural evolution in the operative correction of this complicated congenital anomaly and can be safely performed by experienced endoscopic surgeons. The results presented are comparable to previous reports of babies undergoing repair through a thoracotomy. Based on the associated musculoskeletal problems following thoracotomy, there will likely be long-term benefits for babies with this anomaly undergoing the thoracoscopic repair.

Cohort Studies↗
PubMed1998

Large number of CD19+/CD23+ B cells and small number of CD8+ T cells as early markers for cow's milk allergy (CMA).

Assessment of activation of immune mechanisms is valuable in the early diagnosis of cow's milk allergy (CMA). The purpose of this study was to evaluate peripheral blood lymphocyte subclasses in children suspected of having CMA and healthy infants in order to detect an early marker for food allergy. Altogether 47 breast-fed infants, aged from 0.4 to 10 months were followed-up prospectively from birth because of atopic heredity. Twenty-three of the infants were healthy and 24 infants had a strong suspicion of and later challenge-proven cow's milk allergy. Leucocyte subsets were determined from peripheral blood mononuclear cells by flow cytometry. In response to a clinical cow's milk challenge, seven infants developed urticaria, 11 infants had eczema, three patients had loose stools, diarrhoea or vomiting and three infants had eczema and diarrhoea, loose stools or vomiting. The total percentage of B cells and also the proportion of B cells bearing a low-affinity IgE receptor as a marker for activation were significantly higher, whereas the percentage of CD8+ T cells was significantly lower in infants with challenge-proven CMA than in healthy controls. These results imply that infants with active CMA have a defect in regulation of B-cell function. Further, they suggest that imbalance of the ratio of suppressor and helper T cells might be an important factor in the etiopathogenesis of CMA. Our results show that large numbers of activated CD19+ B cells and low numbers of CD8+ T cells could be considered as early markers for food allergy since they are already detectable in peripheral blood during the earliest symptoms of CMA.

Antigens, CD19↗
PubMedDate not supplied

Predictors of chronic lung disease in the 'CPAP era'.

OBJECTIVE: To assess predictors of chronic lung disease (CLD), in infants requiring nasal continuous positive airway pressure (CPAP) support in the first 4 weeks of life. METHODS: A retrospective case note audit of infants of birthweight 1250 g or less was undertaken. RESULTS: Of 290 infants identified, 50% were initially treated with ventilation, 41% with CPAP, 4% required no support, and 5% had care withdrawn. Of infants initially treated with CPAP, 23% subsequently required ventilation. Overall mortality was 19%, with a further 21% of infants developing CLD. For infants requiring CPAP support, requirement for supplementary oxygen at between 10 and 21 days predicted increased risk of CLD, and receiver operating characteristic curves suggest requirement for supplementary oxygen at 14 days to be the most reliable cut-off (area under curve = 0.72). Positive predictive values for future CLD or death for FiO2 .25, .30 and .40 while on CPAP at 14 days were 0.56, 0.61 and 0.76, respectively. CONCLUSIONS: CLD remains prevalent in very low birthweight infants in the CPAP era. Oxygen requirement at 14 days is the strongest predictor of CLD. Infants requiring 30% oxygen or more while on CPAP at 14 days have a 60% risk of subsequent CLD or death.

Chronic Disease↗
PubMed1989

Complications of diazoxide treatment in persistent neonatal hyperinsulinism.

Seven infants with persistent neonatal hyperinsulinism were treated in Dhahran Health Centre from 1983 to 1986. The insulin:glucose ratio (serum insulin concentration pmol/l) divided by the blood glucose concentration (mmol/l) ranged from 12 to 636, mean (SD) 177 (201). To control hypoglycaemia, diazoxide (12-24 mg/kg/day) was given in a continuous intravenous glucose infusion (12-22 mg/kg/min) on 11 separate occasions, four infants twice each and three infants once each. An increase of more than one standard deviation in the heart and respiratory rates, together with other symptoms of heart failure, was considered to be evidence of diazoxide toxicity. Cardiorespiratory failure (toxicity) occurred on eight of the 11 occasions (73%) in seven infants. The average daily fluid intake, weight change, respiratory rate and heart rate before treatment were similar whether or not the infant developed toxicity. A diazoxide toxicity index was obtained by multiplying the dose of diazoxide by the insulin:glucose ratio to relate the diazoxide dose to the severity of the disease. In all instances when the toxicity index was more than 1533 (mean (SD) 3732 (2741) cardiac toxicity developed. In contrast, infants with a toxicity index of less than 675 (mean (SD) 364 (270), had no symptoms of toxicity. Symptoms were significantly related to the severity of the disease and the diazoxide dose. It is possible to use the toxicity index to predict the risk of toxicity and to calculate a safe dose of diazoxide in infants with persistent neonatal hyperinsulinism.

Blood Glucose↗
PubMed1986

[Botulism in the infant. Presentation of a case].

First case reported in our country with infant botulism is described in a 5 month old infant. Clinical and electrodiagnostic abnormalities are the only relatively specific findings in infant botulism, which were seen in this infant, but it requires isolation of "C. botulinum" for diagnosis confirmation. "C. botulinum" type B spores were identified in stool samples from this infant. It has been described frequently isolation of "C. botulinum" from honey specimens that had been fed to infants who subsequently developed infant botulism. They are now studying honey samples with appropriate methods (MDL-10), obtained from alimentation of this infant.

Botulism↗
PubMed1994

Cognitive, psychosocial, and physical development in infants and children with end-stage renal disease.

The purpose of this article is to synthesize research related to the cognitive, physical, and psychosocial development of children with end-stage renal disease who are receiving conservative management, hemodialysis or peritoneal dialysis, or who have received transplants. An impressive array of research in these three areas of development was found, but more work is needed. Suggestions are made for more multicenter research with larger sample sizes and greater generalizability. In addition, more developmental research that includes measures of renal disease, such as age at onset, severity of disease, and length of time in renal failure, is needed.

Adaptation, Psychological↗
PubMed1986

Selective screening device for the early detection of normal or delayed cognitive development in infants at risk for later mental retardation.

The present study tested the predictive validity at 3 years of age of a screening device for the early identification of later cognitive delay. The screening device, administered between 3 and 7 months of age, is based on the infant's differential fixation "to novel" over previously shown pictures. The sample was composed of 62 infants suspected to be at risk for later mental retardation. The prevalence of delayed cognitive development (IQ less than or equal to 70) at 3 years of age was 13%. Novelty preference scores correctly identified six of eight (75%) of the delayed children. The test identified 49 of 54 (91%) of the normal children. Validity for predicting cognitive delay was 55%. Validity for the prediction of normality was 96%. The screening device proved to be equally sensitive, specific, and valid when the sample was divided into infants born at term or born preterm. The results of the present study and of a previous study indicate that detection of cognitive delay based on early novelty preferences is as easily accomplished for infants who will later be mildly delayed (IQ scores 60 to 70) as it is for those who will later be severely delayed (IQ scores less than or equal to 50). Moreover, such results are in contrast to those obtained with conventional tests tapping sensorimotor development.

Child Development↗
PubMed1989

[The physical development of infants and young children. 4. Body mass--a longitudinal study].

As a result of a longitudinal study (performed 1979-1982) on the somatic development of 84 male and 91 female children from birth up to the third year of life, values of body mass expressed as distance values, increments, and growth velocity are presented. As compared to earlier investigations made in the G. D. R. and to studies from other countries differences of the dynamics of body mass development have been found: with the exception of the birth weight the body mass tends to be higher during the first six month of life in contrast to previous studies, whereas between the 9th to the 18th month of life lower values of body mass have been measured. Additional differences in the dynamics of body mass development between boys and girls are presented.

Body Height↗