Comparison of methemoglobin levels in food protein-induced enterocolitis syndrome and other gastrointestinal diseases in neonates

INTRODUCTION AND OBJECTIVES: Methemoglobinemia has been reported to be associated with severe food protein-induced enterocolitis syndrome (FPIES). However, no reports have evaluated methemoglobin (MHb) levels in FPIES without symptomatic methemoglobinemia or the usefulness of MHb measurement for the diagnostic prediction of FPIES. To evaluate the MHb levels of patients with neonatal-onset FPIES and determine whether MHb levels are higher in FPIES than in other gastrointestinal diseases. PATIENTS AND METHODS: Eleven neonates with severe acute FPIES (FPIES group) and 139 neonates with other gastrointestinal diseases (non-FPIES group) were included in this study. Patient characteristics, symptoms, and venous blood test values (MHb, pH, HCO3-, and C-reactive protein) were evaluated. RESULTS: The median age at onset was 16 days vs. 1 day; males comprised 64% vs. 46%, the median gestational age was 38 weeks vs. 38 weeks, the median birth weight was 2710g vs. 2880g, and the median hospitalization duration was 31 days vs. 6 days for the FPIES vs. non-FPIES groups, respectively. MHb (%) was higher in the FPIES group than in the non-FPIES group [median (range), 1.1 (0.6-10.9) and 0.6 (0.3-1.2), respectively, p < 0.001]. There were no differences in terms of pH, HCO3-, and C-reactive protein (p > 0.05). In the receiver operating characteristic analysis for FPIES diagnosis based on MHb (%), the area under the curve was 0.885, specificity was 97.1%, and sensitivity was 72.7% at a MHb cutoff of 1.0. CONCLUSION: High MHb levels may help diagnose severe acute FPIES in neonates, but careful evaluation is needed

No disponible

A new index of ultrasonography for estimating cerebral circulation in newborn infants.

PURPOSE: To quantitatively estimate the influence of ductal shunt on cerebral blood flow and establish a new index of ultrasonography for estimating cerebral circulation without the influence of ductal shunt in newborn infants. METHODS: We retrospectively examined the records of anterior cerebral artery (ACA) and left pulmonary artery (LPA) blood flow velocity curves recorded by pulsed Doppler ultrasonography within 6 h after birth in 123 newborn infants without asphyxia (normal group) and in 31 newborn infants with asphyxia (asphyxia group). RESULTS: In the normal group, the resistance index (RI) of the ACA showed a positive correlation with the ratio of LPA diastolic-to-systolic flow velocities (LPAD/LPAS) (P < 0.001, r = 0.58), and the estimated RI (eRI) of the ACA was calculated using the following formula: Y = 0.47X + 0.67 (Y estimated RI; X LPAD/LPAS). In the asphyxia group, the RI of the ACA showed a weak correlation to base excess (BE) (P < 0.05, r = 0.46). The eRI of the ACA was calculated by the LPAD/PLAS in the asphyxia group, and the difference between the RI and eRI showed a better correlation to BE than RI (P < 0.001, r = 0.64). CONCLUSION: We determined the relation between cerebral blood flow RI and ductal shunt, and (RI - eRI) may be a new useful ultrasonographic index indicating cerebral circulation without the influence of ductal shunt in newborn infants.

Comparison of methemoglobin levels in food protein-induced enterocolitis syndrome and other gastrointestinal diseases in neonates.

INTRODUCTION AND OBJECTIVES: Methemoglobinemia has been reported to be associated with severe food protein-induced enterocolitis syndrome (FPIES). However, no reports have evaluated methemoglobin (MHb) levels in FPIES without symptomatic methemoglobinemia or the usefulness of MHb measurement for the diagnostic prediction of FPIES. To evaluate the MHb levels of patients with neonatal-onset FPIES and determine whether MHb levels are higher in FPIES than in other gastrointestinal diseases. PATIENTS AND METHODS: Eleven neonates with severe acute FPIES (FPIES group) and 139 neonates with other gastrointestinal diseases (non-FPIES group) were included in this study. Patient characteristics, symptoms, and venous blood test values (MHb, pH, HCO3-, and C-reactive protein) were evaluated. RESULTS: The median age at onset was 16 days vs. 1 day; males comprised 64% vs. 46%, the median gestational age was 38 weeks vs. 38 weeks, the median birth weight was 2710g vs. 2880g, and the median hospitalization duration was 31 days vs. 6 days for the FPIES vs. non-FPIES groups, respectively. MHb (%) was higher in the FPIES group than in the non-FPIES group [median (range), 1.1 (0.6-10.9) and 0.6 (0.3-1.2), respectively, p<0.001]. There were no differences in terms of pH, HCO3-, and C-reactive protein (p>0.05). In the receiver operating characteristic analysis for FPIES diagnosis based on MHb (%), the area under the curve was 0.885, specificity was 97.1%, and sensitivity was 72.7% at a MHb cutoff of 1.0. CONCLUSION: High MHb levels may help diagnose severe acute FPIES in neonates, but careful evaluation is needed.

Complications in Infants of Diabetic Mothers Related to Glycated Albumin and Hemoglobin Levels During Pregnancy.

BACKGROUND: This study was conducted to investigate whether glycated albumin is a useful glycemic marker from the point of view of infant complications for monitoring glycemic control in pregnant women with diabetes or gestational diabetes mellitus. METHODS: We retrospectively studied 42 Japanese infants of diabetic mothers and their mothers at our facility between May 2010 and July 2013. The mean glycated albumin and glycated hemoglobin levels were compared between mothers of infants with complications and those without complications. We used 15.8% as the cutoff value of glycated albumin and calculated the sensitivity and specificity of items that were significantly different between the two groups. RESULTS: Glycated albumin was significantly higher in mothers of infants with hypoglycemia (15.5±1.8 vs. 13.8±1.2%, p = 0.001), respiratory disorders (15.6±1.8 vs. 13.9±1.2%, p < 0.001), hypocalcemia (15.7±2.1 vs. 14±1.2%, p = 0.004), myocardial hypertrophy (15.2±1.9 vs. 13.7±1%, p = 0.007), and large-for-date status (15.8±1.9 vs. 14±1.3%, p = 0.002). By contrast, considering hypoglycemia, glycated hemoglobin was not significantly different between the two groups. The sensitivity and specificity with 15.8% as the cutoff value of glycated albumin were as follows: hypoglycemia (70% and 81.2%), respiratory disorders (61.5% and 82.8%), hypocalcemia (62.5% and 84.4%), myocardial hypertrophy (87.5% and 79.4%), and large-for-date status (75% and 85.3%). CONCLUSION: Glycated albumin is a useful marker of glycemic control considering infant complications during pregnancy. This study also suggests that evaluating both glycated hemoglobin and glycated albumin levels can lead to better glycemic control in pregnant women.

Myocardial strain of the left ventricle in normal children.

BACKGROUND: There have been few reports regarding cardiac strain in children. The present study was performed to determine the reference values for circumferential and radial strains of the left ventricle in normal children and discern the relative influence of aging and cardiac growth on these left ventricular functional indices. METHODS: The study population consisted of 180 children (aged 2 months to 21 years) who had normal cardiac function and normal cardiac load. None of the patients had symptoms, and none was receiving medical therapy. 2D cine-loop recordings of short-axis views at the papillary muscle level were stored for off-line analysis. Custom acoustic-tracking software was used to measure left ventricular strain. Continuous variables are reported as mean values ± standard deviation. The correlation coefficients were calculated to identify the relative influences of aging on the strains. Tukey's test was used to assess differences in strain among the six-myocardial segments. In all analyses, p<0.01 was taken to indicate statistical significance. RESULTS AND CONCLUSIONS: The strains of all segments could be analyzed in 136 of 180 children. There were no significant age-related changes in circumferential or radial strain in children, but regional heterogeneity in left ventricular strain. The circumferential and radial strains showed inverse distributions; the circumferential strain in the region with low radial strain was high, and that in the region with high radial strain was low. These observations indicated there are differences among the three-dimensional movements of the regions.

Congenital hemophagocytic lymphohistiocytosis in a preterm infant: cytokine profile and a review of the disease.

A preterm infant with very low birth weight was born with fetal onset familial hemophagocytic lymphohistiocytosis. Known gene abnormalities responsible for the disease were not identified in the patient. The infant died at 13 months of age owing to complications from cord blood stem cell transplantation. We found selectively elevated expression of interleukin-6 and chemokines in the cord blood of the patient. We also reviewed 7 other preterm cases of congenital hemophagocytic lymphohistiocytosis to highlight the significance of this condition, as it can cause ascites and hepatosplenomegaly in utero and be mistaken for congenital infection in the fetus.

Aging change of left ventricular function in children evaluated by acoustic quantification method.

BACKGROUND: There are few reports about acoustic quantification (AQ) in the area of pediatrics. We aim to determine normal values of AQ analysis and investigate the aging change of left ventricular function in children. METHODS: The subjects in this study included 137 patients (aged 29 days to 18 years) who had normal cardiac function and no cardiac load. None of the patients were receiving medical therapy. The instrument used was a PH-6500 (Philips, Andevor). Change of left ventricular area in short-axis view was detected by AQ analysis. From the mitral inflow, peak early (E) and peak late (A) diastolic velocities were measured, and E/A was calculated. RESULTS: End-diastolic area (EDA) and end-systolic area (ESA) increased with age. Fractional area change (FAC) decreased with age. Peak ejection rate (PER) and peak rapid filling rate (PRFR) decreased with age up to 10 years. Atrial filling fraction (AFF) decreased and E/A increased with age up to 5 years. CONCLUSIONS: Maturational or developmental alterations in LV diastolic properties were found up to 5 years old. AQ analysis is one of the useful indexes for investigating left ventricular diastolic function.