Bone mineral content for preterm neonates treated with caffeine using dual energy X-ray absorptiometry: An observational study.

BACKGROUND: Prematurity is associated with lots of comorbidities. Premature neonates also have lower bone mineral content (BMC) compared to term neonates. Apnea of prematurity is a common complication and caffeine citrate is widely used for its prevention and treatment. Caffeine also affects creatinine clearance, urine flow rate and releases calcium from its storage sites. OBJECTIVES: The primary objective was to assess BMC in preterm neonates treated with caffeine using dual energy X-ray absorptiometry (DEXA). Secondary objectives were to determine whether caffeine therapy is associated with increased incidence of nephrocalcinosis or bone fracture. METHODS: Prospective observational study on 42 preterm neonates, 34 weeks' gestation or less; 22 of them received intravenous caffeine (caffeine group) and 20 did not (control group). Serum levels of calcium, phosphorus, alkaline phosphatase, magnesium, sodium, potassium, and creatinine, abdominal ultrasonography, and DEXA scan were done for all included neonates. RESULTS: BMC showed significant lower levels in the caffeine compared to control group (p = 0.017). Additionally, BMC was significantly lower in neonates who received caffeine for more than 14 days compared to those who received it for 14 days or less(p = 0.04). BMC showed significant positive correlation to birth weight, gestational age, serum P and significant negative correlation to serum ALP. Caffeine therapy duration was negatively correlated to BMC (r = -0.370, p = 0.000) and positively correlated to serum ALP levels (r = 0.667, p = 0.001). None of the neonates had nephrocalcinosis. CONCLUSIONS: Caffeine administration for more than 14 days in preterm neonates may be associated with lower BMC but not nephrocalcinosis or bone fracture.

Methylene blue versus vasopressin analog for refractory septic shock in the preterm neonate: A randomized controlled trial.

BACKGROUND: Refractory septic shock in neonates is still associated with high mortality, necessitating an alternative therapy, despite all currently available treatments. This study aims to assess the vasopressor effect of methylene blue (MB) in comparison to terlipressin (TP) as adjuvant therapy for refractory septic shock in the preterm neonate. METHODS: A double-blinded randomized controlled trial was conducted in the Neonatal Intensive Care Units at Ain Shams University, Egypt. Thirty preterm neonates with refractory septic shock were randomized to receive either MB or TP as an adjuvant to conventional therapy. Both MB and TP were administered as an intravenous loading dose followed by continuous intravenous infusion. The hemodynamic variables, functional echocardiographic variables, and oxidant stress marker were assessed over a 24 h period together with the side effects of MB. RESULTS: MB causes significant improvement in mean arterial blood pressure with a significant decrease of the norepinephrine requirements (1.15±0.21µm/kg/min at baseline vs. 0.55±0.15µm/kg/min at 24 h). MB infusion causes an increase of the pulmonary pressure (44.73±8.53 mmHg at baseline vs. 47.27±7.91 mmHg after 24 h) without affecting the cardiac output. Serum malonaldehyde decreased from 5.45±1.30 nmol/mL at baseline to 4.40±0.90 nmol/mL at 24 h in the MB group. CONCLUSION: Administration of MB to preterm infants with refractory septic shock showed rapid increases in systemic vascular resistance and arterial blood pressure with minimal side effects.

Hepatic Hilar Lymph Node Reactivity at Kasai Portoenterostomy for Biliary Atresia: Correlations With Age, Outcome, and Histology of Proximal Biliary Remnant.

We hypothesized that if infection is the proximate cause of congenital biliary atresia, an appropriate response to antigen would occur in lymph nodes contiguous with the biliary remnant. We compared the number of follicular germinal centers (GC) in 79 surgically excised hilar lymph nodes (LN) and 27 incidentally discovered cystic duct LNs in 84 subjects at the time of hepatic portoenterostomy (HPE) for biliary atresia (BA) to autopsy controls from the pancreaticobiliary region of non-septic infants >3 months old at death. All 27 control LN lacked GC, a sign in infants of a primary response to antigenic stimulation. GC were found in 53% of 106 LN in 56 of 84 subjects. Visible surgically excised LN contiguous with the most proximal biliary remnants had 1 or more well-formed reactive GC in only 26/51 subjects. Presence of GC and number of GC/LN was unrelated to age at onset of jaundice or to active fibroplasia in the biliary remnant but was related to older age at HPE. Absent GC in visible and incidentally removed cystic duct LNs predicted survival with the native liver at 2 and 3 years after HPE, P = .03, but significance was lost at longer intervals. The uncommon inflammatory lesions occasionally found in remnants could be secondary either to bile-induced injury or secondary infection established as obstruction evolves. The absence of consistent evidence of antigenic stimulation in LN contiguous with the biliary remnant supports existence of at least 1 major alternative to infection in the etiology of biliary atresia.

Bartonella henselae-mediated disease in solid organ transplant recipients: two pediatric cases and a literature review.

Bartonella henselae, the etiologic agent of cat-scratch disease, causes a well-defined, self-limited syndrome of fever and regional lymphadenopathy in immunocompetent hosts. In immunocompromised hosts, however, B. henselae can cause severe disseminated disease and pathologic vasoproliferation known as bacillary angiomatosis (BA) or bacillary peliosis. BA was first recognized in patients infected with human immunodeficiency virus. It has become more frequently recognized in solid organ transplant (SOT) recipients, but reports of pediatric cases remain rare. Our review of the literature revealed only one previously reported case of BA in a pediatric SOT recipient. We herein present 2 pediatric cases, one of which is the first reported case of BA in a pediatric cardiac transplant recipient, to our knowledge. In addition, we review and summarize the literature pertaining to all cases of B. henselae-mediated disease in SOT recipients.

Splenic cysts in the pediatric population: a report of 21 cases with review of the literature.

Splenic cysts are rare lesions that can occur in parasitic and non-parasitic forms. Because they are uncommon, the classification, pathogenesis, and management techniques are still debated. The continual review of splenic cyst cases in the pediatric population is essential for establishing a clear diagnosis and course of treatment. This report presents 21 cases of pediatric splenic cysts observed at Children's Healthcare of Atlanta over an 18 year period (1993-2011). The cases include both parasitic and and nonparasitic cysts. The current splenic cyst classification and treatment methods are analyzed through a review of the current theories and based on our experiences.

Histiocytoid cardiomyopathy: three new cases and a review of the literature.

Histiocytoid cardiomyopathy (HC), a rare arrhythmogenic disorder, presents as difficult-to-control arrhythmias or sudden death in infants and children, particularly girls. Three cases are described with autopsy findings. In two cases, yellow-tan nodules were grossly visible in the myocardium; in the third case, no gross lesions were identified. Microscopic examination in all three cases revealed multiple, scattered clusters of histiocytoid myocytes which on ultrastructural examination were filled with abnormal mitochondria, scattered lipid droplets, and scanty myofibrils. These pathologic findings are similar to those previously described. The pathogenesis of this entity remains controversial. It was recently proposed that this disorder is X-linked dominant with the associated gene located in the region of Xp22.

Sudden death in neonate with staphylococcal endocarditis.

A 27-week-old girl, 936 gm, with initial diagnosis of birth asphyxia resulting from prolapse of the umbilical cord, respiratory distress syndrome, and suspected neonatal sepsis received antibiotics for the first 7 days of life. On day 24, evidence developed of acute Staphylococcus aureus endocarditis of the anterior leaflet of the mitral valve, and she died 4 days later. We believe that a rapid enlargement of the endocardial vegetation caused acute occlusion of the small mitral valve and was the cause of sudden death in this infant.

Fixed drug eruption to Tylenol: report of two cases and review of the literature.

Fixed drug eruptions due to Tylenol (paracetamol, acetaminophen) are very rare. The authors report two additional cases and review the literature.

The effects of ileocystoplasty on the development of renal failure in a rat model 5/6 nephrectomy.

We examined the effects of ileocystoplasty on renal function and bone mineral content in 160 juvenile male Wistar-Furth rats with and without renal insufficiency induced by 5/6 nephrectomy. At intervals up to 20 weeks blood, bone and kidney samples were obtained with the animals under anesthesia and then they were sacrificed. Serum parameters of renal function and calcium metabolism were measured. Samples of bone were analyzed for calcium, magnesium and phosphorus content. At 20 weeks after 5/6 nephrectomy renal function was decreased by approximately half. The decrease in renal function and the changes in renal histology were identical in animals with and without ileocystoplasty. Bone mineral content in the animals with renal insufficiency with or without ileocystoplasty was not different from sham operated animals or from animals with an ileocystoplasty and normal renal function. These studies demonstrate that ileocystoplasty per se does not hasten the progression to renal failure or produce bone demineralization in rats having moderate renal insufficiency.

Histologic analysis of placental tissue in first trimester abortions.

The value of histologic evaluation in the analysis of material from first trimester abortions is not completely defined. We prospectively analyzed placenta and decidua from 75 first trimester, spontaneous abortions to ascertain if morphologic features were predictive of karyotype. The histologic features analyzed included hydropic villus change, villus fibrosis, villus scalloping with trophoblastic invaginations, atypical stromal cells, aggregates of lymphocytes in placenta or decidua, and acute inflammation of placenta or decidua. Normal karyotypes were observed in 44 cases and abnormal karyotypes were demonstrated in 31. The presence of villus scalloping with trophoblastic invagination was significantly associated with abnormal karyotypes, particularly triploidy, and the demonstration of acute inflammation was seen significantly more often in cases with normal karyotypes. We conclude that histology can provide only a suggestion as to the likelihood of an abnormal karyotype; the findings are not specific enough to obviate the need for karyotyping in the individual case.

PIP: Placenta and decidua from 75 1st-trimester spontaneous abortions were prospectively analyzed to determine whether morphologic features were predictive of karyotype. The histologic features analyzed included hydropic villus change, villus fibrosis, villus scalloping with trophoblastic invaginations, atypical stromal cells, aggregates of lymphocytes in placenta or decidua, and acute inflammation of placenta or decidua. Of the 103 cases submitted during the 12-month study period, 75 had successful karyotypes and sufficient histologic material for analysis. Normal karyotypes were found in 44 cases (26 females and 18 males). The 31 cases with abnormal karyotypes included 10 cases of triploidy, 9 cases of trisomy, 6 cases of monosomy, 3 cases of tetraploidy, and 3 cases of unbalanced translocation. The presence of villus scalloping with trophoblastic invaginations was seen significantly more frequently in cases with abnormal karyotypes (p0.05). The positive predictive value of this finding was 59% and the negative predictive value was 75%. Analysis of specific karyotype abnormalities demonstrated that triploid cases contributed the majority of cases with these villus changes. Acute inflammation of the placenta and decidua was significantly associated with a normal karyotype (p0.01). A low frequency of acute inflammation was observed in all the specific karyotype abnormalities. The other histologic features analyzed were found with approximately equal frequency in placentas with normal and abnormal karyotypes. These findings indicate that histology can provide only a suggestion as to the likelihood of an abnormal karyotype; the results are not specific enough to obviate the need for karyotyping in the individual case.