Repeated intravenous doses of human umbilical cord-derived mesenchymal stromal cells for bronchopulmonary dysplasia: results of a phase 1 clinical trial with 2-year follow-up.

BACKGROUND: Currently, there is a lack of effective treatments or preventive strategies for bronchopulmonary dysplasia (BPD). Pre-clinical studies with mesenchymal stromal cells (MSCs) have yielded encouraging results. The safety of administering repeated intravenous doses of umbilical cord tissue-derived mesenchymal stromal cells (UC-MSCs) has not yet been tested in extremely-low-gestational-age newborns (ELGANs). AIMS: to test the safety and feasibility of administering three sequential intravenous doses of UC-MSCs every 7 days to ELGANs at risk of developing BPD. METHODS: In this phase 1 clinical trial, we recruited ELGANs (birth weight ≤1250 g and ≤28 weeks in gestational age [GA]) who were on invasive mechanical ventilation (IMV) with FiO2 ≥ 0.3 at postnatal days 7-14. Three doses of 5 × 106/kg of UC-MSCs were intravenously administered at weekly intervals. Adverse effects and prematurity-related morbidities were recorded. RESULTS: From April 2019 to July 2020, 10 patients were recruited with a mean GA of 25.2 ± 0.8 weeks and a mean birth weight of 659.8 ± 153.8 g. All patients received three intravenous UC-MSC doses. The first dose was administered at a mean of 16.6 ± 2.9 postnatal days. All patients were diagnosed with BPD. All patients were discharged from the hospital. No deaths or any serious adverse events related to the infusion of UC-MSCs were observed during administration, hospital stays or at 2-year follow-up. CONCLUSIONS: The administration of repeated intravenous infusion of UC-MSCs in ELGANs at a high risk of developing BPD was feasible and safe in the short- and mid-term follow-up.

Asthma prevalence, lung and cardiovascular function in adolescents born preterm.

Our main objective was to study respiratory evolution and pulmonary and cardiac function in adolescents born preterm in the post-surfactant era. Observational cross-sectional study, comparing very preterm (< 32 weeks) and moderately-late preterm adolescents (≥ 32 weeks) (74 each group). We recorded respiratory symptoms, spirometry and functional echocardiogram. Very preterm adolescents required more respiratory admissions (45.9% vs. 28.4%) (p = 0.03, OR 2.1, CI95% 1.1-4.2) and had more current asthma (21.6% vs. 9.5%, p = 0.04, OR 2.3, CI95% 1.1-5.2). Preterm subjects with intrauterine growth restriction (IUGR) presented lower FEV1 (88.7 ± 13.9 vs. 95.9 ± 13.3, p = 0.027) and lower FVC (88.2 ± 13.6 vs. 95.5 ± 13.3, p = 0.025). When assessing right ventricle, very preterm showed a greater E/E' ratio (p = 0.02) and longer myocardial performance index (MPI) (p = 0.001). Adolescents with IUGR showed less shortening fraction (p = 0.016), worse E/E' ratio (p = 0.029) and longer MPI (p = 0.06). Regarding left ventricle, very preterm showed less E' wave velocity (p = 0.03), greater E/E' ratio (p = 0.005) and longer MPI (p < 0.001). Gestational age < 32 weeks is independently associated with current asthma in adolescence. Children 13-14 years old born very preterm required more respiratory admissions and had poorer diastolic and global function of both ventricles. IUGR is a risk factor for poorer lung function in preterm adolescents, regardless gestational age.

Left ventricular volumes and ejection fraction quantification using an automated three-dimensional adaptive analytic echocardiographic algorithm in pediatric population.

INTRODUCTION: The quantitative measurement of the left ventricle by echocardiography is a fundamental tool in the diagnosis and prognosis of acquired and congenital diseases in the pediatric population. The objective of this study was to validate an automated three-dimensional adaptive analytic echocardiographic algorithm, the so-called Heart Model® (HM) in the pediatric population, using as comparators the left atrial and left ventricular volumes and left ventricular ejection fraction obtained by means of conventional 2D and 3D echocardiography. METHODS: Pilot study, where a population comprised of 75 consecutive patients aged 6-17 years who attended a pediatric cardiology clinic, was evaluated. Every patient underwent a conventional 2D and 3D echocardiography and an analysis using HM. Conventional 3D echo was used as the reference method. RESULTS: Seventy-five patients were analyzed. Mean age was 11.2 (4.0) years (52.2% women). The intraclass correlation coefficient of HM vs 2D echo was poor, but it was good for the agreement between HM and 3D echo for left ventricular end-diastolic volume (ICC: 0.98; 95% CI: 0.97-0.99; P < 0.001), left ventricular end-systolic volume ICC: 0.98; 95% CI: 0.96-0.99; P = 0.001), and left ventricular ejection fraction (ICC: 0.87; 95% CI: 0.78-0.92; P < 0.001). The agreement was also good for the three parameters when the analysis was performed according to body weight. CONCLUSIONS: Heart Model® is a feasible and accurate tool for the evaluation of left atrial and left ventricular volumes and left ventricular ejection fraction in pediatric population aged above 6 years.

Revisión clínica y diagnóstica de la enfermedad de Kawasaki: estudio descriptivo, retrospectivo y analítico / Review of the diagnosis and clinical features of Kawasaki disease: retrospective descriptive and analytical study

Introducción: la enfermedad de Kawasaki es una vasculitis aguda, febril y autolimitada, que puede complicarse con alteraciones cardiovasculares. Su diagnóstico se basa en criterios clínicos. A pesar de un tratamiento eficaz, es la principal causa de cardiopatía adquirida en niños de países desarrollados. Objetivos: analizar la prevalencia de alteraciones coronarias en pacientes pediátricos diagnosticados en nuestro medio; evaluar las características demográficas, clínicas y analíticas de la población de estudio y describir los factores de riesgo de alteración coronaria en niños con enfermedad de Kawasaki. Métodos: se revisaron de forma retrospectiva las historias clínicas de los niños diagnosticados de enfermedad de Kawasaki desde enero de 1997 hasta diciembre de 2016 en el Hospital Clínico San Carlos (Madrid, España). Se consideró diagnóstico de enfermedad de Kawasaki la presencia de los criterios clínicos propuestos por la Academia Americana de Pediatría en 2017. Resultados: la enfermedad de Kawasaki se presentó fundamentalmente durante el invierno (n = 13; 56,5%) en mujeres (n = 12; 52,2%) de cinco años o menos (n = 18; 78,3%), que desarrollaron fiebre (n = 23; 100%) junto con cambios en la mucosa orofaríngea (n = 21; 91,3%) y presentaron proteína C reactiva y velocidad de sedimentación globular elevadas (n = 20; 86,95% y n = 13; 86,6%). Fueron tratados con inmunoglobulina intravenosa (n = 22; 95,7%) y ácido acetilsalicílico a dosis antiinflamatoria (n = 22; 95,7%) o antiagregante (n = 20; 87%). Tres pacientes (13%) desarrollaron alteraciones coronarias, que terminaron remitiendo. Conclusiones: en nuestra cohorte, la prevalencia de alteraciones coronarias fue similar a la reportada en nuestro medio y superior a la descrita en estudios internacionales. Los factores de riesgo de alteración coronaria son predominantemente niños con retraso en el diagnóstico y tratamiento, leucocitosis >12 000/ul, proteína C reactiva >3 mg/dl y trombocitosis

Introduction: Kawasaki disease is an acute, febrile and self-limiting vasculitis that may be complicated by cardiovascular changes. Its diagnosis is based on clinical criteria. Although effective treatment is available, it is the leading cause of acquired heart disease in children in developed countries. Objectives: to assess the prevalence of coronary artery abnormalities in paediatric patients diagnosed in our area, and the demographic, clinical and laboratory characteristics of the population under study, describing the risk factors for coronary involvement in children with Kawasaki disease. Methods: we performed a retrospective review of the medical records of children given a diagnosis of Kawasaki disease between January 1997 and December 2016 at the Hospital Clínico San Carlos (Madrid, Spain). We defined Kawasaki disease as the presence of the clinical criteria proposed for its diagnosis by the American Academy of Pediatrics in 2017. Results: cases of Kawasaki disease were most frequent in the winter (n = 13; 56.5%), in girls (n = 12; 52.2%) and in children aged 5 years or less (n = 18; 78.3%). Patients presented with fever (n = 23; 100%) and changes in the oropharyngeal mucosa (n = 21; 91.3%), with elevation of C-reactive protein and the erythrocyte sedimentation rate (n = 20; 86.95% and n = 13; 86.6%). Treatment consisted of intravenous immunoglobulin (n = 22; 95.7%) and acetylsalicylic acid at anti-inflammatory doses (n = 22; 95.7%) or antithrombotic doses (n = 20; 87%). Three patients (13%) developed coronary artery abnormalities that eventually resolved. Conclusions: in our cohort, the prevalence of coronary complications was similar to the prevalence reported for Spain and higher than the prevalence reported in international studies. The main risk factors for coronary artery abnormalities were delays in diagnosis or treatment, a white blood cell count greater than 12 000 cells/µl, a serum level of C-reactive protein greater than 3 mg/dl and thrombocytosis

Parainfluenza 3 Respiratory Infection Associated with Pericardial Effusion in a Very Low Birthweight Infant.

Parainfluenza 3 virus is a frequent cause of respiratory infections in the pediatric population although it is uncommonly diagnosed in neonates, being usually reported as neonatal intensive care unit microepidemics. We report a case of parainfluenza 3 respiratory infection associated with pericardial effusion in a very low birthweight infant.

Nefritis del túbulo intersticial y uveítis con síndrome de Fanconi / Tubulo-interstitial nephritis and uveitis with Fanconi syndrome

No disponible