An unreported complication of intravenously administered ibuprofen: gastrointestinal bleeding.

Ibuprofen is used for the closure of ductus arteriosus either intravenously or enterally. Although intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, transient renal failure, oliguria, hyponatremia and thrombocytopenia are reported complications during or after ibuprofen treatment, gastrointestinal bleeding, to our knowledge, has not been reported previously. We herein report a premature newborn, in whom ibuprofen was used intravenously for the closure of ductus arteriosus and gastrointestinal bleeding developed as a complication, and aim to discuss this rare adverse effect. In conclusion, we emphasize the importance of close follow-up of premature newborns during intravenous ibuprofen treatment considering also the other rare systemic side effects reported in the literature.

Threshold value of subepicardial adipose tissue to detect insulin resistance in obese children.

AIM: Until now, the association between subepicardial adipose tissue (SAT), insulin resistance and intima-media thickness (IMT) has not been evaluated in obese children. In this study, we evaluated whether echocardiographic SAT is related to insulin resistance and IMT in obese children. SUBJECTS AND METHODS: A total of 46 obese subjects (10.2+/-2.5 years of age, 25 male patients) and 30 age- and gender-matched lean subjects (10.8+/-3.1 years of age, 13 male patients) were included in this study. The criterion for diagnosing obesity was defined as the body mass index (BMI) being over 97% percentile of the same gender and age. Serum triglyceride (TG), low- and high-density lipoprotein, cholesterol, glucose and insulin levels were measured during the fasting state. Each subject underwent a transthoracic echocardiogram and the SAT thickness was measured during end-diastole from the parasternal long-axis views. RESULTS: The obese subjects had significantly higher SAT thickness and IMT values compared with the subjects in the control group (5.7+/-1.4 vs 3.0+/-0.7 mm, 0.78+/-0.15 vs 0.51+/-0.11 mm, P=0.001, respectively). Simple linear regression analysis showed no significant correlation between SAT and insulin resistance (r=0.170, P=0.253), whereas there was significant correlation between SAT and BMI, age and IMT (r=0.625, P=0.02, r=0.589, P=0.001, r=0.343, P=0.02, respectively). As an optimal cutoff point, a SAT thickness of 4.1 mm determined insulin resistance with 90% sensitivity and 61% specificity. CONCLUSIONS: Our study showed that SAT was significantly correlated with age, BMI and IMT, but not insulin resistance. However, our findings suggest that a 4.1 mm cutoff of SAT thickness might be used as a simple, inexpensive and non-invasive screening method because of its ability to predict insulin resistance with high sensitivity in obese children.

Isolated noncompaction of ventricular myocardium.

Isolated noncompaction of the ventricular myocardium is a rare congenital cardiomyopathy resulting from an arrest in normal endomyocardial embryogenesis. The diagnosis can be made echocardiographically, and the entity may be associated with problems of cardiac rhythm. We describe two illustrative cases, with Wolf-Parkinson-White syndrome in one, and left bundle branch block in the other. We emphasize that children with problems of rhythm and findings suggestive for left ventricular cardiomyopathy, either hypertrophic or dilated; should be investigated to exclude isolated noncompaction of the ventricular myocardium.

The effect of iron supplementation on visual-evoked potentials in infants with iron-deficiency anemia.

Flash visual-evoked potentials were studied in 20 infants with iron-deficiency anemia to determine the effect of iron deficiency on visual function by using visual-evoked potentials in this type of anemia. After iron therapy for 12 weeks, visual-evoked potentials were retested in these otherwise healthy infants. All infants showed an excellent hematological response to iron therapy. Post-treatment visual-evoked potential N2 latencies (negative deflections) decreased significantly compared to the pre-treatment values (p < 0.05). These results suggest that iron-deficiency anemia causes subclinical visual impairment, and visual-evoked potentials may be a useful non-invasive means of detecting subtle effects of nutritional deficiencies and monitoring the nutritional status of infants.

Efficacy and safety of rectal thiopental sedation in outpatient echocardiographic examination of children.

UNLABELLED: The efficacy and safety of rectal thiopental administration in sedation for paediatric echocardiographic examination were prospectively investigated in infants with known or suspected congenital heart disease in an outpatient manner. A total of 1150 patients (546F, 604M) were studied; 264 were 7 d to 6 mo old (group I), 572 were 6 mo to 2-y-old (group II), and 314 were 2 to 6-y-old (group III). Thiopental sodium dissolved in 10 ml of water in a syringe to which a 6-F feeding catheter was attached was administered prior to echocardiographic examination to patients in groups I, II and III with doses of 50, 35 and 25 mg/kg, respectively in an emergency care environment. Length of time to achieve sedation (induction time), duration of sedation, length of time to return to normal activity (recovery time), whether sedation was successful and side effects were recorded. In the overall study population, sedation was successful in 1094 (95.1%) of the patients, the induction time was 16.34 +/- 3.69 min, the duration of sedation was 35.07 +/- 7.04 min, the recovery time was 63.25 +/- 10.17 min and the overall side-effect prevalence was 2%. Sedation was significantly more successful, the induction time was significantly shorter, the recovery time was significantly longer and side effects significantly more prominent in groups I and II compared to group III. CONCLUSION: Rectally administered thiopental is a safe and efficacious agent for sedation of infants and young children with known or suspected congenital heart disease who are undergoing echocardiography in an outpatient cardiology clinic, provided that it is used in an emergency care setting considering the risk of respiratory depression even though the prevalence of this side effect is significantly low.

Is a standard protocol necessary for oscillometric blood pressure measurement in term newborns?

OBJECTIVE: The necessity of taking only one randomized blood pressure measurement or averaging three repeated measurements and, the effects of various stages of the restful state and body position on blood pressure measurements obtained with the oscillometric technique were investigated in 138 healthy term newborns. METHODS: The Athena oscillometer was used to measure blood pressure. Three successive measurements with a 5-min interval were made in each of two positions, prone and supine, in random order 30 min after the last feeding if newborns were in very quiet or quiet sleep. During routine recording of vital signs, another (single) measurement was obtained before feeding the infant regardless of the body position of the newborn, provided that they were not struggling, crying or moving. RESULTS: For all systolic, diastolic and mean blood pressures measured, there were no significant differences among either prone, supine and single measurements or among three successive measurements in each position. CONCLUSIONS: We conclude that, in the routine care of term newborns, blood pressure measurements with the oscillometric technique may be made without the need of a special position or sleep state, provided that the measurements are made with an appropriate sized cuff in the absence of struggling, crying and movement of the newborn. Taking only one randomized measurement under these conditions would be enough and practical in daily newborn care practice instead of repeating and averaging many measurements.

The role of erythrocyte protoporphyrin in the diagnosis of iron deficiency anemia of children.

The values of erythrocyte protoporphyrin, ferritin and mean corpuscular volume (MCV) measurements in diagnosing iron deficiency anemia were investigated in 72 iron deficient and in 25 healthy control infants. Receiver operator curve, sensitivity and specificity of erythrocyte protoporphyrin, ferritin and mean corpuscular volume were compared between the study and control groups. In the study group mean corpuscular volume, hemoglobin and ferritin concentrations were significantly lower, and erythrocyte protoporphyrin was significantly higher when compared to the control group. In the iron deficient study group, erythrocyte protoporphyrin was the most sensitive test and ferritin was the most specific test, whereas ferritin was the most diagnostic test and mean corpuscular volume was the least diagnostic test. A significant correlation between erythrocyte protoporphyrin and hemoglobin values was determined. We conclude that erythrocyte protoporphyrin is a more sensitive but less specific test than ferritin, and it can be used as a first-line diagnostic test in the evaluation of iron deficiency and in diagnosing iron deficiency anemia in infants.

High-dose intravenous immunoglobulin therapy in neonatal immune haemolytic jaundice.

A controlled study was conducted to assess the role of high-dose i.v. immunoglobulin (HDIVIG) therapy in neonatal immune haemolytic jaundice. Patients with ABO and/or Rh incompatibilities proved by significant hyperbilirubinaemia (>204 mmol l(-1)), positive direct antiglobulin test and high reticulocyte count (> or =10%) were randomly assigned to receive either conventional phototherapy alone or phototherapy with high-dose i.v. immunoglobulin (1 g kg(-1), over 4 h) as soon as the diagnosis was established. Exchange transfusions were performed if serum bilirubin concentrations exceeded 290 mmol l(-1) and increased by more than 17 mmol l(-1) per h despite both treatment manoeuvres. Eight of 58 patients in the HDIVIG group required exchange transfusions, whereas it became necessary in 22 of 58 patients in the control group (p<0.001). The durations of phototherapy and hospitalization in terms of hours were significantly shorter in the HDIVIG group (p<0.05). No side effects of HDIVIG therapy were observed. In conclusion, HDIVIG therapy in newborns with ABO or Rh haemolytic diseases reduces haemolysis, serum bilirubin levels and the need for blood exchange transfusion, a procedure which has potential complications and carries a risk of mortality.

Auditory brainstem responses in children with congenital heart disease.

BACKGROUND: Cyanotic congenital heart diseases usually lead to growth and developmental delay in children due to chronic hypoxemia and undernourishment that may affect the central nervous system. The auditory brainstem responses are determined to assess the maturation and function of the brainstem. Therefore, we used the auditory brainstem responses to investigate the effect of cyanotic congenital heart diseases on brainstem maturation. METHODS: The auditory brainstem responses were investigated in 45 children (23 cyanotic, 22 acyanotic) with congenital heart diseases and compared with the results of 30 healthy counterparts (all children were aged between 2 months and 15 years). RESULTS: The results of auditory brainstem responses were similar in acyanotic patients and in normal children. The cyanotic patients under 1 year of age had more prolonged I-V interpeak latencies than those of control and acyanotic patients (P < 0.05). There was no difference between all groups older than 1 year of age. In cyanotic children, I-V interpeak latencies showed significant negative correlation with arterial oxygen saturation and partial oxygen pressure (P < 0.05). CONCLUSIONS: Cyanotic congenital heart diseases may cause significant retardation on brainstem maturation due to chronic hypoxemia, especially in infants under 1 year of age, whereas acyanotic congenital heart diseases have no effect on auditory brainstem responses.

Detection of early anthracycline-induced cardiotoxicity in childhood cancer with dobutamine stress echocardiography.

Asymptomatic long-term survivors of childhood cancer treated with anthracyclines may have latent cardiac dysfunction which is undetected by commonly used echocardiographic methods. A more sensitive echocardiographic screening test, dobutamine stress echocardiography, was performed on 22 patients (mean age 9.10 +/- 3.79 years) treated with 75 to 450 mg/m2 of anthracyclines (mean 210.45 +/- 127.34) and results were compared with 22 healthy age-matched control subjects. Echocardiographic Doppler studies were performed after each dobutamine infusion of 0.5, 2.5, 5 and 10 micrograms/kg/min. Although left ventricular mass was decreased and end-systolic walls stress increased in the patient group when compared with the control subjects (p < 0.01 and p < 0.05, respectively), no differences were found between shortening fraction and ejection force in control subjects and patients, at rest and during each dobutamine infusion. A decreased mitral E/A ratio (ratio of early-to-late peak filling velocity) was demonstrated in anthracycline-treated patients only during dobutamine infusion (p < 0.01). Our data showed left ventricular diastolic dysfunction during intropic stimulation with dobutamine, and suggest that dobutamine stress echocardiography is a useful technique for evaluating the cardiac status of anthracycline-treated patients on a long-term basis.

Evaluation of bone mineral density in children receiving antiepileptic drugs.

The effects of the valproic acid and carbamazepine monotherapies on bone mineral density were evaluated. Bone mineral density was measured in 53 children with primary epilepsy taking either valproic acid (n = 25) or carbamazepine (n = 28) for longer than 1 year and in a healthy control group (n = 26) by the dual-energy x-ray absorptiometry method at L2-L4 levels of lumbar vertebrae. The mean serum levels of valproic acid and carbamazepine were 66 +/- 2.2 microg/mL and 7.0 +/- 9.3 microg/mL, respectively, and the mean duration of treatment for each drug was 2.4 +/- 0.2 years and 2.6 +/- 0.5 years, respectively. Calcium intakes in diet were similar in both the control and study groups. The serum levels of calcium and phosphorus in all groups were normal. Bone mineral density values of both valproic acid and carbamazepine groups were not statistically different from that of the control group (P > 0.05).

[Acquired cytomegalovirus infection in infants. A case successfully treated with ganciclovir]. / Infection acquise par cytomégalovirus chez le nourrisson. Un cas traité avec succès par le ganciclovir.

BACKGROUND: Congenital cytomegalovirus infection is a severe condition. When acquired after birth prognosis is less severe although sensorial sequelae and risks justify treatment. CASE REPORT: A 2.5 year old infant with hepatitis due to cytomegalovirus infection acquired after birth was treated with intravenous ganciclovir (7.5 mg/kg b.i.d for 2 weeks then 10 mg/kg three times a week for 2 months. No side effect or toxicity was observed and the patient recovered without sequellae. DISCUSSION: In our experience, in addition to severe and symptomatic congenital cytomegalovirus infections, ganciclovir can be used in the treatment of less severe symptomatic acquired cytomegalovirus in infants.