Hyponatremia secondary to severe atopic dermatitis in early infancy.

BACKGROUND: Infants with atopic dermatitis who developed hyponatremia and hyperkalemia with raised aldosterone have been repeatedly described in the Japanese-language literature, but similar reports from other countries are scarce. METHODS: We collected reports of atopic dermatitis complicated with hyponatremia (≤130 mEq/L), written either in English or in Japanese, to delineate the characteristics and to elucidate the pathophysiology of this condition. RESULTS: Of a total of 36 patients, 35 were Japanese. All patients were infants younger than 9 months. Mean height SD score (SDS) at presentation was -2.1 ± 1.4 (n = 25), with mean body mass index 14.1 ± 1.7 kg/m2 (n = 28). Mean sodium was 120.7 ± 6.1 mEq/L. While 28 patients had hyperkalemia, seven patients had normokalemia. Elevated aldosterone was documented in 15 patients. Nutrition mainly with breast-feeding (97%), parental refusal of steroid ointment (77%), and the association of hypoalbuminemia (73%) were frequent findings. Diminished urinary sodium was verified in all 12 patients tested, indicating that sodium loss from the skin exudates, with limited supply of sodium from breast milk, is the primary cause of hyponatremia. Hyperkalemia seems to result from decreased delivery of sodium to the distal nephron and from the mechanism of the so-called "aldosterone paradox", which inhibits potassium secretion. In addition, physiological aldosterone insensitivity during infancy, low muscle volume, and impaired Na+ ,K+ -ATPase function due to protein deficiency seems to exaggerate the hyperkalemia. CONCLUSIONS: Hyponatremia secondary to severe atopic dermatitis is an age-dependent manifestation, elicited by inappropriate treatment that leads to sodium loss from the damaged skin and resultant hyperkalemia via multifaceted mechanisms.

Food repertoire history in children with autism spectrum disorder in Japan.

BACKGROUND: Food selectivity is commonly reported in children with autism spectrum disorder (ASD). The aim of this study was to investigate eating habit history in children with ASD. METHODS: We analyzed 3 day food records completed by the parents and assessed how many unique foods each child consumed. The parents were also interviewed about their child's diet of complementary (i.e. transition) foods and estimated food repertoire at the ages of 3, 6, 12 and 18 years. RESULTS: A total of 28 participants were enrolled in this study. Some participants had ongoing changes in food repertoire from the age of 3 years onward. In two cases, although the number of foods consumed at age 3 years was approximately 50, this decreased markedly, becoming severely limited, by age 5 years. One of the reasons for diminished repertoire was infection, such as acute gastroenteritis and upper respiratory tract infection. In contrast, five patients had a severely limited food repertoire at age 3 years, which later increased to 15 or more. Four patients had good opportunity at school to increase their food repertoire. CONCLUSIONS: Diet history varied and changed in response to new opportunities, education and/or the environment. In some cases the number of foods consumed decreased gradually due to anxiety and stress, resulting in a severely limited food repertoire. Some patients had good opportunities to increase their repertoire at school. If an effective program in the early years achieves progress, the eating habits of children with ASD might be changed.

Effectiveness of Nutrition Support Team Intervention in Pediatric Patients with Cancer.

Malnutrition in children with cancer is associated with poor prognosis. This study aimed to determine whether nutritional support team (NST) interventions prevent adverse events and improve the nutritional status in pediatric patients admitted for cancer treatment. This was a historical cohort study of pediatric patients with acute lymphocytic leukemia, acute myeloid leukemia, neuroblastoma, or brain tumor who received chemotherapy or underwent hematopoietic stem cell transplantation. Patients admitted between June 2013 and October 2014 were classified into the intervention group. Those admitted between January 2011 and December 2012 were classified into the control group. We created a homogeneous probability model using the inverse probability of treatment weighting method, and compared outcomes. A total of 75 patients were included in the study (38 and 37 in the intervention and control groups, respectively). The intervention group had significantly fewer incidents of nothing by mouth (nil per os [NPO]) (p=0.037) and days of NPO (p=0.046) than the control group. There was no significant difference between the intervention and control groups regarding the change in body mass index z-score between admission and discharge (p=0.376). NST interventions for children with cancer were associated with a reduction in the number of NPO occurrences and NPO days. These findings suggest that NST interventions contribute to continued oral intake.

Diagnostic criteria, prevalence, and clinical outcomes of pediatric sarcopenia: A scoping review.

BACKGROUND & AIMS: Sarcopenia, characterized by loss of muscle mass and decreased muscle strength, significantly affects adults but also influences pediatric health. However, definitions for low muscle mass, decreased strength, and sarcopenia in children are less established, impacting interventions for improving health outcomes. The objective of this scoping review is synthesize the existing literature on the diagnostic criteria, prevalence and clinical outcomes of sarcopenia. METHODS: A scoping review, following the PRISMA extension for scoping reviews, examined pediatric sarcopenia literature until June 2023. The literature search was performed using MEDLINE and the Cochrane Central Register of Controlled Trials with the last search conducted on June 30, 2023. Criteria included studies on aged 0-20 years, covering healthy subjects, acutely ill patients, and chronic disease cases excluding specific conditions like neuromuscular diseases or prematurity. RESULTS: Initial search found 503 studies, finally, we included 56 studies. Most studies diagnosed sarcopenia using skeletal muscle mass indicators like total psoas muscle area from Computed Tomography or Magnetic Resonance Imaging. Around half of the longitudinal studies highlighted sarcopenia as a risk factor for various clinical outcomes, predominantly in hospitalized patients. However, cutoff values for sarcopenia indicators lacked consistency, with studies employing diverse percentile-based measurements or z-scores. CONCLUSION: Pediatric sarcopenia diagnosis primarily relies on skeletal muscle mass, with identified links to future clinical outcomes in specific conditions. The lack of standardized cutoffs for sarcopenia indicators underscores the necessity for age, gender, and race-specific cutoff values derived from studies establishing reference values for muscle mass and strength across diverse pediatric populations.

Adoption of an Enhanced Recovery after Surgery Protocol for Neuromuscular Scoliosis Shortens Length of Hospital Stay.

Introduction: We aimed to implement the enhanced recovery after surgery (ERAS) protocol for pediatric neuromuscular scoliosis (NMS) surgery and to examine the effectiveness of this program in this study. Methods: Subjects were children with NMS who underwent scoliosis surgery at our department by a surgeon using a single posterior approach. A series of 27 cases before the introduction of ERAS and 27 cases during program stabilization were included in the study. Patient backgrounds did not show significant differences before and after introducing ERAS. Perioperative data, complications, length of hospital stay (LOS), and readmission within 90 days were investigated and statistically analyzed. Results: When the pre- and post-ERAS induction groups were compared, no significant differences in anesthesia induction time (p=0.979), pelvic fixation (p=0.586), fusion levels (p=0.479), intraoperative hypothermia duration (p=0.154), end-of-surgery body temperature (p=0.197), operative time (p=0.18), postoperative main Cobb angle (p=0.959), main Cobb angle correction rate (p=0.91), postoperative spino-pelvic obliquity (SPO) (p=0.849), and SPO correction rate (p=0.267) were observed. However, significant differences in using V-flap technique (p=0.041), intraoperative blood loss (p=0.001), and LOS (p=0.001) were observed. Intraoperative blood loss was weakly correlated with LOS (p=0.432 and 0.001). No statistically significant difference existed between the V-flap method and LOS (p=0.265). Multiple regression analysis using LOS as the objective variable and ERAS protocols and intraoperative blood loss as explanatory variables revealed that the effect of ERAS on LOS was greater than that of intraoperative blood loss. No statistically significant differences in the readmission rates within 90 days were found. Conclusions: After the introduction of ERAS, LOS decreased without an increase in complications or readmissions within 90 days.

Tissue remodeling induced by hypersecreted epidermal growth factor and amphiregulin in the airway after an acute asthma attack.

BACKGROUND: Epidermal growth factor receptor ligands, such as epidermal growth factor (EGF) and amphiregulin, may play key roles in tissue remodeling in asthma. However, the kinetics of EGF and amphiregulin secretion in the airway after an acute asthma attack and the effect of prolonged airway exposure to these ligands on airway remodeling are unknown. OBJECTIVE: To measure the EGF and amphiregulin concentrations in sputa obtained from patients with asthma under various conditions, and to examine the effects of EGF and amphiregulin on the proliferation or differentiation of airway structural cells. METHODS: Epidermal growth factor and amphiregulin levels were measured by ELISA in sputum specimens collected from 14 hospitalized children with asthma during an acute asthma attack, 13 stable outpatients with asthma, 8 healthy control children, and 7 children with respiratory tract infections. The effects of EGF and amphiregulin on the proliferation and/or differentiation of normal human bronchial epithelial cells (NHBE), bronchial smooth muscle cells (BSMC), and normal human lung fibroblasts (NHLF) were examined. RESULTS: The sputum levels of EGF were significantly higher for about a week after an acute asthma attack compared with the levels in stable subjects with asthma and control subjects. In contrast, upregulation of amphiregulin in the sputa of patients with asthma was observed only during the acute attack. EGF caused proliferation of NHBE, BSMC, and NHLF, whereas amphiregulin induced proliferation of only NHBE. Prolonged exposure of NHBE to EGF and amphiregulin induced mucous cell metaplasia in an IL-13-independent manner. CONCLUSION: Acute asthma attacks are associated with hypersecretion of EGF and amphiregulin in the airway. Recurrent acute attacks may aggravate airway remodeling.

[Case of pollinosis to grass pollens who presented with dyspnea successfully treated by rush immunotherapy].

We present a 15 years old boy who experienced unusual symptoms for pollen allergy, and successfully treated by rush immunotherapy. The patient started to complain erythema and edema on his face and serous rhinorrhea at 10 years old when going out. He entered baseball team at junior high school, and subsequently experienced choking sensation, dyspnea, face edema, and it was sometimes impossible to continue play. He was diagnosed as bronchial asthma at some hospital, and prescribed many anti-asthma medications including inhaled corticosteroid, which did not take effect. His symptoms deteriorated in summer and ameliorated in winter. When he was 15 years old, he was referred to us by a pediatrician for reassessment of his symptoms. Flow-volume curve was normal, and bronchial provocation test (acetylcholine and histamine), and exercise challenge were negative. IgE antibodies specific to grass pollens were highly positive. We made a diagnosis of pollinosis to grass pollens instead of bronchial asthma. Oral antihistamines and intranasal corticosteroid partially improved his symptoms. We started rush-immunotherapy of grass-pollens (oats and bromegrass), Japanese cedar, and ragweed. His symptoms improved dramatically on the next season of grass pollens.

Standard values of rapid turnover proteins and zinc in Japanese children.

Measurement of rapid-turnover proteins has an established place in nutrition assessment and is partly dependent on the zinc metallo-enzymes involved. We investigated the reference values of rapid turnover proteins and zinc in Japanese children. This cross-sectional study was conducted at a single center. We collected data from children aged 0 to 12 years with inguinal hernia, umbilical hernia, or hydrocele of the spermatic cord, who had body mass index z scores of -2 to 2. The standard references (mean±2 SD) of transthyretin were 11.5-21.5 mg/dL in infants (<=1.5 years), 13.6-21.5 mg/dL in preschool children (1.6-6 years), and 12.3-23.4 mg/dL in preadolescent children (6.1-12 years). The standard references of retinol binding protein were 1.27-2.55 mg/dL, 1.28-2.54 mg/dL, and 1.27-2.44 mg/dL in each age group, respectively. Rapid turnover proteins did not differ significantly in each group. The transthyretin level was weakly correlated with aging (r=0.284, p=0.003) and estimated lean body mass (r=0.274, p=0.004). Retinol-binding protein was not correlated with aging and anthropometric parameters. We established reference values for rapid turnover proteins with known zinc status in Japanese children. These values were not, or only weakly, correlated with anthropometric parameters for assessing protein energy malnutrition.

[Measles vaccination for children with allergic diseases].

To predict the side effects of vaccination, some skin tests are performed for patients with allergic diseases, though at present time there is no standard method. We have performed skin tests of measles vaccine by prick test with undiluted vaccine, 1 : 10 dilution, and/or intradermal test with 1 : 100 dilution. 75 cases of children with allergic diseases were assessed with more than two types of these skin tests. The cases with negative response for the skin tests were subcutaneously administered with 0.5ml of vaccine at once (normal method). On the other hand, the cases with positive or+/-response at least one skin test were subcutaneously administered with the vaccine in increments of 0.05ml (divided method). Including+/-response, intradermal test with 1 : 100 dilution showed highest sensitivity (88%) and relatively high specificity (75%) for the prediction of side effects in the 3 types of skin tests. Forty nine cases were vaccinated with the normal method, and 26 cases were vaccinated with the divided method. Compared with the cases with normal method, the cases with divided method showed higher frequency for patients with the elimination therapy of foods besides egg, and significantly higher value of total IgE, and specific IgE for egg white, cow's milk, wheat, and cat dander. Twenty five of 26 cases with the divided method showed specific IgE for egg white>3.5UA/ml, and 8 of 11 cases showed specific IgE for cat dander>0.35 UA/ml. In 8 cases who appeared side effects (one was administered by t he normal method, and 7 were administered by the divided method), 7 cases were local skin reaction only, and there were no cases of anaphylaxis. We recommend that the intradermal test of dilution 1: 100 should be performed to determine the vaccination method. The cases with the elimination therapy of foods besides egg, cases with specific IgE for egg white>3.5UA/ml, or cases with specific IgE for cat dander>0.35UA/ml, should be considered as high risk patients.

Fried-potato diet causes vitamin A deficiency in an autistic child.

A 5-year-old boy with autism developed dry eye and xerophthalmia. Serum vitamin A was undetectable. Dietary history revealed a markedly altered intake consisting of only fried potatoes and rice balls for 2 years. Fried potatoes contain no vitamin A. Autism is a multifaceted developmental disorder infrequently accompanied by abnormal eating practices. To the authors' knowledge, most children with autism who develop dietary vitamin A deficiency have consumed an excess of fried potatoes. Attention to possible vitamin A deficiency is essential when fried potatoes are consumed exclusively.