Episodes of overtreatment during the first six months in children with congenital hypothyroidism and their relationships with sustained attention and inhibitory control at school age.

BACKGROUND/AIMS: Contradictory results regarding the optimal initial dose of levothyroxine in children with congenital hypothyroidism (CH) hamper the clinical management of these children during their early infancy. We explore the relationships between the initial dose of levothyroxine and endocrine control during the first 6 months and cognition at school age. SUBJECTS AND METHODS: Fifty children with CH, 14 boys (10+/-3.1 years) and 36 girls (9.7+/-2.6 years), at the Pediatric Endocrine Unit of the Hospital Gregorio Marañón in Madrid were studied. Neurocognitive evaluation was carried out exploring alertness and inhibitory control. The number of episodes of overtreatment during the first 6 months, the initial dose of levothyroxine, etiology and sex were the predictor variables. RESULTS: Inhibitory control was significantly lower in children with CH than in controls. An interaction with gender and etiology was obtained. Alertness had an inverse relationship with the number of episodes of overtreatment with no interaction with gender or etiology. CONCLUSION: Episodes of overtreatment and not the initial dose of levothyroxine are a risk factor for deficit in alertness whereas subtle inhibitory control deficit seems to be a permanent problem with the current therapeutic approach.

[Autoimmune thyroid disease: autoimmune gastritis association's possibility]. / Enfermedad tiroidea autoinmunitaria: posibilidad de asociación a gastritis autoinmunitaria.

INTRODUCTION: A high prevalence of parietal cell antibodies (PCA) has been reported in children with autoimmune thyroid disease (AITD). The aim of this study was to determine the prevalence of autoimmune gastritis markers among children diagnosed as AITD. PATIENTS AND METHODS: We studied 26 patients with AITD. Basal samples were taken to determine: hemogram, vitamin B12 and folic acid plasmatic levels, gastrin plasmatic levels, and PCA's determination. Other autoimmune disease comorbidity were also studied. RESULTS: Free T4 and TSH values were normal, with hormonal substitutive treatment. Hb, MCV, HCM, vitamin B12, folic acid and gastrin were in normal range for all 26 patients. We reported 6 cases diabetes mellitus type 1 and 2 of celiac disease. A single patient was PCA positive. It was a 14-year-old hyperthyroid girl without any other autoimmune disease. CONCLUSIONS: AITD in childhood and adolescence is associated with other autoimmune diseases, specially DM1 and CD. PCA becomes an early and sensitive marker to detect autoimmune gastritis.

[Heliox-driven bronchodilator nebulization in the treatment of infants with bronchiolitis]. / Heliox como fuente de nebulización del tratamiento broncodilatador en lactantes con bronquiolitis.

INTRODUCTION: Heliox is a helium-oxygen mixture which improves laminar flow and decreases airway resistance and the work of breathing. The aim of this study was to assess the effects of salbutamol or epinephrine nebulization driven by heliox in infants with moderate-to-severe bronchiolitis. MATERIALS AND METHODS: This prospective, observational, interventional, controlled and randomized study included ninety-six children who came to our pediatric emergency department with first episode of moderate-to-severe bronchiolitis. The patients were randomized to receive salbutamol or epinephrine nebulized with either oxygen (control group) or heliox (70% helium and 30% oxygen) as the driving gas. Heart rate, respiratory rate, pulse oximetry oxygen saturation and clinical score were measured before and after the treatment period. We also reported hospitalization rates and the number of patients who returned to the emergency department in the following seventy two hours. RESULTS: There were no significant differences between both groups. The only statistically significant difference was that, in the heliox group, patients with severe bronchiolitis needed a lower number of nebulizations than infants in the control group. CONCLUSIONS: According to our study, heliox-driven salbutamol or epinephrine is not an effective therapy in patients with acute bronchiolitis.

[Efficacy of heliox therapy in respiratory insufficiency in infants and children]. / Eficacia del tratamiento con heliox en niños con insuficiencia respiratoria.

OBJECTIVE: To analyze response to heliox therapy in critically ill infants and children with upper and/or lower airway respiratory insufficiency. PATIENTS AND METHODS: Sixty-five patients, aged between 12 days and 8 years old, treated with heliox through facial mask, nasal prongs or non-invasive ventilation were studied. Diagnoses were bronchiolitis (25), upper postextubation respiratory insufficiency (19), respiratory insufficiency after airway surgery (14), and croup-laryngotracheomalacia (7). Response to heliox treatment was measured by the change in clinical scores, respiratory rate, heart rate, pulse oximetry, blood gas analysis, and the need for non-invasive and invasive mechanical ventilation. RESULTS: Fifty-four patients (83.1 %) improved after heliox therapy, with statistically significant differences in clinical score (from 8.7 to 5.5), respiratory rate (from 51.4 to 38.8 rpm), and heart rate (from 161.6 to 145.6 bpm). No changes were observed in saturation or blood gas analysis. After heliox therapy, 29.8 % of patients required non-invasive ventilation and 26.5 % required intubation. Patients with bronchiolitis and those aged less than 1 year had a lesser response to heliox therapy and more frequently required non-invasive ventilation. No significant differences were found in intubation requirements. No adverse effects were observed. CONCLUSIONS: Heliox therapy improved clinical scores in infants and children with upper and lower airway respiratory insufficiency, but a significant percentage of patients needed non-invasive or invasive mechanical ventilation.

[Aortic and cerebral trombosis caused by hypernatremic dehydration in an exclusively breast-fed infant]. / Trombosis aórtica y cerebral secundarias a deshidratación hipernatrémica en un recién nacido con lactancia materna exclusiva.

Complete aortic thrombosis is rare in neonates. Because it carries high morbidity and mortality, this entity requires aggressive and early treatment. This report describes an 8-day-old healthy and exclusively breast-fed infant, without specific coagulopathy, who developed complete aortic and cerebral venous thrombosis, which was attributed to inadequate breast-feeding and severe hypernatremic dehydration. Early systemic anticoagulation and thrombolytic therapy allowed complete resolution of the problem.