Effect of biologicals and JAK inhibitors during pregnancy on health-related outcomes in children of women with inflammatory bowel disease.

Current guidelines advise to maintain immunomodulators and biologicals in pregnant patients because relapse of inflammatory bowel is associated with unfavourable pregnancy outcome. With the exception of Methotrexate, IBD therapy seems not to be related to an increase of congenital malformations or infections requiring hospitalisation of the babies, although the effect the on the developing immune system of the exposed infants remains unknown. In this review we will focus on the effect of IBD drugs on health-related outcomes in children taking into account possible long-term effects of biologicals and immunomodulators, which are transferred across the placenta.

Continuous infusion versus intermittent flushing: maintaining peripheral intravenous access in newborn infants.

OBJECTIVE: To compare the patency duration of a peripheral intravenous cannula (PIVC) using either continuous infusion with 5% dextrose or intermittent flushing with 0.9% saline. STUDY DESIGN: Prospective comparative cohort study, including full-term newborn infants in whom PIVC were placed for the administration of antibiotics. In cohort 1 (n=48), 5% dextrose was infused at 3 ml h(-1); in cohort 2 (n=50), the cannula was flushed six times daily with 2 ml 0.9% saline. Primary outcome was the duration of PIVC patency. Secondary outcomes included the occurrence of complications, time required by the nursing staff and the cost of materials. RESULT: Duration of PIVC patency was similar. However, significantly, more complications occurred in cohort 1 (P=0.02), and both cost and time were significantly lower in cohort 2 (P=0.001). CONCLUSION: Intermittent flushing and continuous infusion provide a similar duration of PIVC patency; however, intermittent flushing is associated with fewer complications, lower cost and reduced time.

[Limping in toddlers due to disorders of the spine and spinal cord]. / Mank lopen bij peuters door afwijkingen aan de wervelkolom en het ruggenmerg.

Limping is a frequent symptom during childhood and can be caused by a variety ofdiseases, the most common causes being trauma and infections of the bones or joints. The authors describe three cases of limping in toddlers caused by infrequent spinal diseases. The toddlers presented with limping without a preceding trauma. In the first patient, an 18-month-old girl, the limping was caused by spondylodiscitis. She recovered completely after antibiotics. The second patient, a 13-month-old boy, presented with limping caused by neuroblastoma with extensive bone metastasis. Despite chemotherapy and partial resection of the neuroblastoma, the boy did not survive. In the last patient, a 19-month-old girl, the limping was caused by an intraspinal intramedullary astrocytoma. She recovered after partial resection of the tumour. In young children presenting with limping, diagnoses involving the spine should also be considered because early intervention can influence the prognosis favourably.

[Coma in a child after treatment with the 'magic salve' lidocaine-prilocaine cream]. / Coma bij een peuter na behandeling met de 'toverzalf' lidocaine-prilocaïnecrème.

A 2-year-old girl lost consciousness after the topical application of lidocaine-prilocaine cream (EMLA) in preparation for the removal of multiple mollusca contagiosa. Both the area on which cream was applied (80% of body surface) and the total amount of cream (90 g) exceeded the maximum dosage. Lidocaine-prilocaine cream is a widely used local anaesthetic with few side effects when used properly. Intoxication with a lidocaine-prilocaine preparation may have serious consequences, such as changes in intracardiac conduction, excitation or depression of the central nervous system and methaemoglobinaemia. In our patient both methaemoglobinaemia and depression of the central nervous system occurred, resulting in loss of consciousness. She was treated with 100% oxygen and fully recovered.

[Acute rheumatic fever in children, a diagnostic problem]. / Acuut reuma bij kinderen; een diagnostisch probleem.

Three girls of Moroccan descent, aged 9, 10 and 7 years, presented with fever, joint pain and other symptoms. After Streptococcus infection and carditis were confirmed and the Jones criteria for acute rheumatic fever were met, the patients were treated with penicillin and acetylsalicylic acid. All 3 patients recovered. However, the second girl presented 2 months later with cardiac decompensation caused by valve disorders, after which aortic and mitral valvuloplasty was performed. The third girl developed joint pain again after 3 weeks and was diagnosed with juvenile idiopathic arthritis; treatment was adjusted accordingly. The prevalence of rheumatic heart diseases is 10-20 times higher in developing countries than in industrialised nations. The diagnosis 'acute rheumatic fever' should be considered in children of school age with unexplained fever, also when the Jones criteria have not yet been met. This may apply to migrant children in particular.