Increased incidence of renal and urinary tract anomalies among individuals with fetal alcohol spectrum disorders (FASD).

BACKGROUND: Fetal alcohol spectrum disorders (FASD) in a spectrum of neurodevelopmental conditions resulting from prenatal alcohol exposure (PAE). Animal models have confirmed the toxic effects of PAE on the kidneys and urinary tract, yet the evidence from human studies is contradictory. The purpose of this study was to establish the incidence of renal and urinary tract anomalies (RUTA), impaired kidney function, and hypertension among patients with FASD. METHODS: Children from the FASD Diagnostic Center with FASD diagnosis (FAS, pFAS, or ARND) were offered participation in the study. The control group consisted of patients from the Gastroenterology Department of the same hospital. The patients underwent renal and urinary tract ultrasound examination. The serum creatinine level was also evaluated and the blood pressure was taken twice. Polish OLAF charts were used to determine the percentiles of blood pressure. RESULTS: The incidence of kidney and urinary tract defects in the study group was significantly higher than in the control group (OR: 2.64 [1.60-4.34]). The kidney size among FASD patients was significantly lower (73 mm [60-83] vs. 83 mm [70-96]; p < .001) when compared to the control group. No differences were observed in the estimated glomerular filtration rate. In the study group, significantly lower systolic blood, diastolic blood pressure, percentile of systolic pressure, and diastolic pressure were observed. CONCLUSIONS: RUTA occurred more frequently among patients with FASD compared to the control group, and decreased kidney size was also demonstrated among patients with FASD. However, impaired kidney function and the risk of hypertension were not observed.

Sleep problems among children with Fetal Alcohol Spectrum Disorders (FASD)- an explorative study.

BACKGROUND: Fetal alcohol spectrum disorders (FASD) is a group of conditions resulting from prenatal alcohol exposure (PAE). Patients with FASD experience a variety of neuropsychological symptoms resulting from central nervous system impairment. Little is known about sleep disorders associated with PAE. The objective of this study was to investigate sleep problems related to FASD. METHODS: Forty patients (median age 8 years (6; 11)) diagnosed with FASD and forty typically developing children (median age 10 years (8; 13)) were recruited for the 1st phase of the study. In the 1st phase, the screening of sleep problems was performed with Child Sleep Habit Questionnaire (CSHQ) filled in by a caregiver. Those of the FASD group who scored above 41 points were qualified to the 2nd phase of the study and had an in-lab attended polysomnography (PSG) performed. The measurements consisted of electroencephalogram, electrooculograms, chin and tibial electromyogram, electrocardiogram, ventilatory monitoring, breathing effort, pulse oximetry, snoring and body position. Their results were compared to PSG laboratory reference data. RESULTS: The number of participants with sleep disturbances was markedly higher in the FASD group as compared to typically developing children (55% vs. 20%). The age-adjusted odds ratio for a positive result in CSHQ was 4.31 (95% CI: 1.54-12.11; p = 0.005) for FASD patients as compared to the control group. Significant differences between the FASD as compared to the typically developing children were observed in the following subscales: sleep onset delay, night wakings, parasomnias, sleep disordered breathing, and daytime sleepiness. Children from the FASD group who underwent PSG experienced more arousals during the sleep as compared with the PSG laboratory reference data. The respiratory indices in FASD group appear higher than previously published data from typically developing children. CONCLUSION: The results support the clinical observation that sleep disorders appear to be an important health problem in individuals with FASD. In particular distorted sleep architecture and apneic/hypopneic events need further attention.

Incontinence in persons with fetal alcohol spectrum disorders: a polish cohort.

INTRODUCTION: Fetal alcohol spectrum disorders (FASD) is an important preventable public health concern, associated to a number of common pediatric problems such as incontinence. Little is known about the prevalence and presentation of incontinence in FASD, which hinders effective management. OBJECTIVE: The aim of the present study was to investigate incontinence among people with FASD. STUDY DESIGN: Parental questionnaires were sent to all eligible FASD participants. To enable comparing the observed prevalence with typically developing, non-prenatally alcohol-exposed individuals, two clinical control groups of patients undergoing immunotherapy for pollen allergy (GKA) and patients diagnosed with celiac disease (GKG) were selected. RESULTS: A total of 119 participants were included in the study (FAS: n = 24, partial fetal alcohol syndrome [pFAS]: n = 19, alcohol-related neurodevelopmental disorder [ARND]: n = 28, GKA: n = 34, and GKG: n = 14). Overall incontinence for FASD was estimated to be 24% (confidence interval [CI] ranges from 15 to 36); nocturnal enuresis (NE) was present in 10% (CI ranges from 4 to 19), daytime urinary incontinence (DUI) in 11% (CI ranges from 5 to 21), and fecal incontinence (FI) in 13% (CI ranges from 6 to 23). Symptoms of urgency were present for 52%, voiding postponement for 10%, and straining for 2%. These data are both consistent with higher prevalence in individuals with FASD and with similar prevalence (the CIs overlap). CONCLUSION: Children and adolescents with FAS, pFAS, ARND, GKA, and GKG are affected by incontinence. Highest rates were observed in pFAS and ARND. Persons with FAS were mostly affected by DUI, those with pFAS by NE, and those with ARND by FI.

Air pollution is associated with incidence of viral croup among children living in Kraków area, Poland.

BACKGROUND: Air pollution is a severe problem in Poland, with Kraków area being among the regions with the worse air quality. Viral croup or pseudocroup is a common childhood disease that may manifest with severe upper respiratory tract obstruction. Our aim was to evaluate the associations between incidence and severity of viral croup symptoms among children living in Kraków area, Poland, and air pollution. METHODS: The retrospective cross-sectional study included Kraków area residents <18 years of age admitted to the Emergency Department of St. Louis Children Hospital in Kraków, Poland over 2-year period. Daily mean concentrations of air pollutants: particulate matter (PM10 and PM2.5), nitric oxides (NOx), carbon oxide (CO), sulfur dioxide, ozone, and benzene were retrieved from public database of measurements performed at three local stations. Numbers of cases of viral croup per week were correlated with weekly mean concentrations of air pollutants. Mean air temperature was treated as a cofactor. RESULTS: During the studied period, mean concentrations of PM10, PM2.5, and NOx exceeded the allowable levels (yearly means) specified by Polish law regulations. Significant positive correlations of moderate strength were observed between weekly mean concentrations of most air pollutants, especially PM10, PM2.5, CO and benzene, and numbers of cases of viral croup recorded per week, confirmed in the analysis restricted to non-holiday period and to winter months only. The correlations between NOx, CO, benzene and croup prevalence were independent of temperature in non-holiday period. CONCLUSIONS: Our results support adverse impact of air pollution on children's respiratory health.

Magnetic resonance imaging (MRI) findings among children with fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (pFAS) and alcohol related neurodevelopmental disorders (ARND).

Background: The aim of the study was to analyze the findings in MRI (magnetic resonance imaging) of the brain amongst children diagnosed with fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (pFAS) or alcohol related neurodevelopmental disorders (ARND). The issue has been studied in several researches previously but the experts agree that there is still few data on the MRI results in the group of younger children. Material and Methods: MRI results of 121 patients with either FAS or pFAS or ARND diagnosed with Canadian criteria were analyzed regarding the presence of abnormalities. The group consisted of 71 patients diagnosed with FAS, 33 diagnosed with pFAS and 17 diagnosed with ARND. The mean age of the patients was 8.03 years (standard deviation 4.07). Results: In the total group of FASD patients 61.98% of the patients' MRI results were abnormal. The most common abnormality in MRI of the patients were demyelination plaques (incidence 23.1%) and corpus callosum narrowing (20.7%) as well as ventricular asymmetry (18.8%).The demyelination plaques and corpus callosum narrowing were more frequent among children ≤4 years old (41.7% vs 18.6%; p=0.016 and 50.0% vs.13.4%; p<0.001, respectively). Age ≤4 years predicted the presence of demyelination plaques and corpus callosum narrowing independently of FAS diagnosis. Among younger children, multiple central nervous system abnormalities were observed more often than in the older age group (54.2% vs. 14.4%; p<0.001). Odds ratio for multiple changes was 0.84 per one-year increase in age (95% CI 0.73-0.97), p=0.016. Furthermore, in the analysis according to the specific diagnosis, among the patients diagnosed with FAS, multiple anomalies were more common than in pFAS and ARND. Both age ≤4 years and FAS diagnosis were independent predictors for multiple anomalies in multiple logistic regression. Conclusion: In structural brain MRI of younger children, multiple anomalies were found more frequently than among older children. Demyelination plaques and corpus callosum narrowing were more common in younger FASD patients than in older ones.

[Retrospective analysis of coexistence of acidic gastroesophageal reflux in children with atopic bronchial asthma]. / Retrospektywna analiza wspólistnienia kwasnego refluksu zoladkowo-przelykowego u dzieci z atopowa astma oskrzelowa.

INTRODUCTION: Epidemiologic studies consistently demonstrate strong associations between gastro-esophageal reflux disease (GERD) and bronchial asthma also in children. A significant percentage of patients with GERD may experience extra-esophageal manifestations like cough or bronchspasm, which are typical symptoms of uncontrolled asthma. OBJECTIVE: retrospective analysis of prevalence and severity of GERD in children with atopic bronchial asthma and influence of proton pomp inhibitor (PPI) therapy in management of asthma. METHODS: The retrospective analysis of children with uncontrolled bronchial asthma between 6 and 18 years of age was performed. Thirty (21 boys) children were evaluated for acidic gastroesophageal reflux using 24-h esophageal pH-monitoring. Age, area of residence, presence and clinical severity of GERD, nocturnal episodes of GERD, pulmonary function parameters were analyzed. The effect of PPI therapy on modification of asthma treatment and lung function was assessed. RESULTS: Acidic gastroesophageal reflux was diagnosed in 17 (56%) children (fraction time of pH < 4 above 4.2%). Most of those patients (88%) came from urban area. Mean age at diagnosis of GERD was 10.5 years of age. Mild GERD was diagnosed in 13 children, moderate--in 4 children. Nocturnal episodes of reflux were present in 9 children (53%). Differences between lung function parameters (FEV1, FVC, PEF) before and after PPI treatment were not statistically significant, although their mean values were about 10% higher after treatment. PPI therapy allowed reduction of inhaled steroids dose in 24% of children; LABA were withdrawn in 3 children. CONCLUSION: The association of GERD with atopic asthma in children is common. It seems to be reasonable to perform work up of pathologic GER in children with uncontrolled asthma.

[Compliance with gluten free diet, physical development and bone mineral status in patients with celiac disease]. / Przestrzeganie diety bezglutenowej a rozwój fizyczny i stopien uwapnienia koscca u chorych z celiakia.

OBJECTIVES: The aim of the study was the assessment of the influence of a gluten free diet on physical development and bone mineral density (BMD) in patients with celiac disease. MATERIALS & METHODS: 59 patients (40 girls, 19 boys) aged 10-20 years with celiac disease, diagnosed according to ESPGAN criteria were included in the study. Patients were divided in 3 groups: 1--strict gluten free diet, II--not entirely compliant i.e. faults in gluten free diet 1-2 times per week, III--gluten free diet not followed or frequent faults. Daily calcium (Ca) intake and physical activity was assessed. BMD of the lumbar spine L2-L4 was measured by dual-energy-X-ray absorptiometry with LUNAR DPX-IQ. Physical development was assessed by anthropometric measurements: growth and weight. RESULTS: Gluten free diet was strictly followed by 16 (27%) patients (group I), group II consisted of 23 (39%) patients. Diet was not followed by 20 (34%) patients. Thirty five (59%) patients had low Ca intake and they made up the majority of the patients in every group. High physical activity declared 35 (59%) patients. No statistically significant differences in BMD were found between group I and II. BMD was lower in group III in comparison to group I (p = 0.01) and group II (p = 0.003). BMD was higher in patients with high Ca intake (p = 0.002). Physical activity had no significant influence on BMD. There was no statistically significant difference in physical development between groups. CONCLUSIONS: Majority of the patients with celiac disease did not strictly follow gluten free diet. Poor compliance to the diet had no significant influence on physical development. BMD was lower in patients who were not compliant to the gluten free diet, occasional faults in the diet had no influence on the BMD.