[Patency of foramen ovale in fullterm and preterm neonates. A follow-up study]. / Pervietà del foramen ovale nei neonati a termine e nei prematuri. Uno studio di follow-up.

The aim of our study was evaluate the clinical outcome of PFO without associated congenital heart disease, in the 1st year of life, in a consecutive series of preterm vs term infants. Out of 178 infants, 83 F/94 M, 49% born preterm, with echo diagnosis of PFO (< 5 mm) by 1 month of age, 122 were controlled at 3 mo, 67 at 6 mo and 30 at 12 mo distance. 23 (12%) had an associated PDA, 11 preterm (6 G.A. <32 w). Closure at f-u GA > 38 > 32 < 38 < 32 3mo 38/122 31% 24/66 35% 11/42 26% 3/14 22% 6mo 38/67 57% 20/35 57% 13/25 52% 5/7 71% 12 m 11/30 37% 5/13 38% 5/15 33% 1/2 50% PFO diameter slightly increased in 2 out of 122 (ga. > 38 w), remained so in 6, and decreased in 108. Only 3/33 children whose PFO was closed at 3rd month control were. <32 wGA. No one was hemodynamically significant. In all right ventricular prevalence both at ECG and Echo normalized by 3 mo of age: 21/23 PDA spontaneously closed by the following control before PFO closure. Our data show that: (1) PFO has no clinical relevance even in the WLGA newborn; (2) Inverse correlation between GA and early closure; (3) PDA was'nt predictive for early closure; (4) Spontaneous closure of ductus was always earlier the the FOP's one. Our data support that even in preterm infants PFO is benign and there is no need for an emotionally expensive and time losing follow-up.

[Diagnostic and therapeutic criteria of arterial hypertension in childhood]. / Criteri diagnostici e terapeutici dell'ipertensione arteriosa in età pediatrica.

Arterial hypertension (AH), either primary or secondary, is an important issue in childhood for its short- and long-term cardiovascular morbidity. Renal diseases are the most frequent causes of AH in children, but essential hypertension can also be detected early in life. It is important for blood pressure (BP) to be checked regularly (at least once every 5 years) in healthy children and adolescents and every year in those belonging to at-risk categories (family history of AH, low birth weight, obesity, etc). In children, AH is defined as BP recorded in three non-consecutive measurements with an appropriate device and cuff size > or = 95th centile for age, gender and height. Ambulatory BP monitoring is a valuable diagnostic tool and once AH is confirmed, a specific primary cause should always be ruled out (renovascular, cardiac, vascular, endocrine, pharmacologic, other). In case of border-line or significant AH (between 90th and 99th centile) a non-pharmacological treatment should be considered, whereas severe hypertension (>99th centile for height and age) will require pharmacological treatment (Diuretics, Angiotensin Converting Enzyme Inhibitors, Angiotensin Receptor Blockers, beta - and Calcium blockers).

[Cardiovascular abnormalities in Kawasaki disease. An Italian prospective study]. / Complicanze cardiovascolari in una popolazione pediatrica con malattia di Kawasaki. Uno studio prospettico.

We report a prospective study performed over a 9 year period in 96 children with Kawasaki disease (mean age 35 +/- 29 months), 84 of whom < 5 years of age. The male/female ratio was 1.5 (57/39). A total of 38 patients had cardiac involvement, including flattened T waves in the ECG (10 patients), pericardial effusion (6 patients), myocarditis (1 patient), and coronary artery aneurysms (25 patients; frequency of aneurysms: 26%). All patients were evaluated during the acute phase (first month) of the illness. The first echocardiographic examination was performed 15 days (range 4.30 days) from the appearance of fever, and coronary aneurysms were observed in 23 patients; in 2 patients, however, aneurysms appeared later (2 and 6 months). Aneurysms were small (< or = 4.5 mm) in 12, medium (4.5-7 mm) in 11, and large (> 7 mm) in 12 patients. Male sex (p = 0.02), age < 12 months (p = 0.005), ESR (p = 0.001), platelet count (p = 0.009), and pericardial effusion (p = 0.02) were significantly related to the presence of aneurysm. Among females, incidence of aneurysms was significantly higher in infants < 12 months than in older patients (60 vs 6%, p < 0.001). Intravenous immunoglobulin treatment was started early (within 10 days) in 61 patients and late (> 10 days) in 22. Compared to late treatment, early i.v. immunoglobulin treatment was associated with smaller aneurysms and higher regression rate (67 vs 28%, p < 0.05). No difference was observed concerning frequency and number of dilated vessels as related to therapeutical regimens. Total i.v. immunoglobulin dose (2 g/kg) was administered over 1-2 days in 26 patients (scheme I) or over 4-5 days in 58 (scheme II). Frequency of aneurysms was significantly lower in patients treated early (p = 0.02). No myocardial infarctions or deaths occurred at short- or long-term follow-up.