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Journal Cover Journal of Pediatric and Neonatal Individualized Medicine
  [5 followers]  Follow
  This is an Open Access Journal Open Access journal
   ISSN (Online) 2281-0692
   Published by Hygeia Press Homepage  [1 journal]
  • Serial serum brain-type natriuretic peptide (BNP) identifies compromised
           blood flow in infants with hemodynamically significant patent ductus

    • Authors: Yasser Elsayed, Mary Seshia, Ronald J. Baier, Shyamala Dakshinamurti
      Abstract: Background: The physiological correlates of elevated serum brain-type natriuretic peptide (BNP) in hemodynamically significant patent ductus arteriosus (HSPDA) are unclear.Objective: To determine if serial BNP measured at 48-72 hours of age, before and after non-steroidal anti-inflammatory drugs (NSAID) treatment of HSPDA reflect compromised blood flow indices, in infants < 31 weeks of gestational age (GA).Design/methods: In a prospective blinded study, 70 infants < 31 weeks GA, admitted to Winnipeg NICUs from August 2010 to September 2011, had serum BNPs and echocardiograms at 48-72 hours of age, before and after medical treatment of HSPDA. All BNP and logarithm of BNP (logBNP) were correlated by linear regression with contemporaneous blood flow indices for: 1) systemic hemodynamic indices (corrected left and right ventricular outputs [LVO, RVO], RVO/LVO ratio, superior vena cava flow [SVCF], SVCF/LVO); 2) regional blood flow indices (middle cerebral artery flow [MCAF], MCAF/LVO ratio, middle cerebral artery resistive index [MCARI], middle cerebral artery pulsatility index [MCAPI]; celiac artery flow [CAF], CAF/LVO ratio, celiac artery resistive index [CARI], and celiac artery pulsatility index [CAPI]).Results: Twenty-six of 70 infants developed HSPDA at 6 ± 2 days. Both BNP and logBNP had similar correlations with all indices, but logBNP showed better goodness of fit. The best correlation was at 48-72 hours of life. Analyzing systemic hemodynamics, logBNP best correlated with SVCF (β -0.49, R2 0.24, p < 0.0001), SVCF/LVO (β -0.55, R2 0.31, p < 0.0001), RVO/LVO (β -0.59, R2 0.35, p < 0.0001), LVO (β 0.4, R2 0.16, p < 0.0001), and RVO (β -0.35, R2 0.12, p < 0.0001). For regional blood flow, logBNP best correlated with MCARI (β 0.6, R2 0.35, p < 0.0001), MCAPI (β 0.5, R2 0.29, p < 0.001), and MCAF (β -0.34, R2 0.12, p < 0.0001).Conclusions: BNP correlates with blood flow indices in preterm infants with HSPDA mainly at 48-72 hours reflecting the value of pre-symptomatic physiologic prediction by BNP.
      PubDate: 2017-08-15
      Issue No: Vol. 6 (2017)
  • Misleading presentation of staphylococcal pneumonia in an adolescent girl:
           a case report

    • Authors: Cristian Locci, Antonio Matteo Amadu, Anna Maria Oggiano, Renato Cutrera, Roberto Antonucci
      Abstract: S. aureus is a relatively uncommon causative agent of community-acquired pneumonia. The clinical presentation of staphylococcal community-acquired pneumonia is typically acute and severe. Rarely, its clinical and imaging features may mimic other lung diseases, thereby delaying and misleading the diagnosis. We report a case of a 13-year-old girl without predisposing factors who was admitted with a recent history of mild chest pain, weakness and slight fever. Although clinical presentation and imaging findings suggested tuberculosis infection, broncho-alveolar lavage results showed a positivity for methicillin-susceptible S. aureus. A complete recovery was observed after a 21-day course of antibiotics. Our case highlights that staphylococcal pneumonia may develop in adolescents without underlying risk factors, mimicking, in rare cases, clinical presentation and radiological features of pulmonary tuberculosis.

      PubDate: 2017-08-12
      Issue No: Vol. 6 (2017)
  • Rare lymphatic malformation in an extreme premature infant: question

    • Authors: Veronica Mugarab Samedi, Adel Elsharkawy
      Abstract: Our patient was born to a healthy 35-year-old Asian mother.The pregnancy was uneventful until 25 weeks of gestational age (GA), when she had preterm prolonged rupture of membranes (PPROM). Ultrasound at that point showed a new finding (confirmed by MRI) of 4.7 x 4.1 cm heterogenous cystic skin-covered mass with areas of echogenicity on the posterior aspect of the fetus with blood flow to the mass and minimal vascularity overall.The male infant was delivered at 26 + 4 weeks by emergency caesarian section for fetal distress with birth weight of 720 grams. A significant finding was a massive swelling over the upper back with a firm central mass. Total size of swelling was 10.2 x 12.2 cm, central cystic mass was smaller (5.0 x 4.2 cm), firm in consistency, slightly mobile, non-pulsatile, non-compressible and non-translucent. Examination of mass did not cause changes in vital signs, thus the mass was considered as a painless malformation.
      What is your diagnosis'
      Which further investigations would you suggest'
      Which subspecialties need to be involved in the management of this case'
      PubDate: 2017-08-12
      Issue No: Vol. 6 (2017)
  • Rare lymphatic malformation in an extreme premature infant: answer

    • Authors: Veronica Mugarab Samedi, Adel Elsharkawy
      Abstract: We present a case of massive cystic lymph­angioma in an extreme preterm infant, which was initially diagnosed by prenatal ultrasound and confirmed by fetal MRI. Physical examination and postnatal ultrasound confirmed diagnosis of cystic lymphangioma. No other anomalies were detected, genetic screening for infant was normal. Despite of size of lymphatic malformation at birth, it was an isolated finding with minimal vascularity, thus the prognosis for self-resolution was very good.
      No surgical intervention was required other than skin care. The lesion started to decrease in size from day 5, and showed signs of gradual involution from the 2nd week of life.
      At 37 weeks of corrected gestational age lymphatic malformation underwent full resolution, with minimal pigmen­tation and scarring on the site of lesion.
      PubDate: 2017-08-12
      Issue No: Vol. 6 (2017)
  • Perfusion index in preterm newborns during the first week of life and
           association with neonatal morbimortality: a prospective observational

    • Authors: Sérgio Costa Monteiro, Liane Correia-Costa, Elisa Proença
      Abstract: Introduction: Perfusion index (PI) is a noninvasive method of peripheral perfusion measurement. Previous publications suggest that PI might be an useful and accurate predictor of morbidity and mortality risk in preterm newborns. This study aims: 1) to assess the PI values of preterm newborns (< 37 weeks) in the first seven days of life according to gestational age; 2) to assess differences in PI values between healthy preterm newborns and those who developed adverse outcomes during the neonatal period.Material and methods: This is a prospective observational study performed in a Neonatal Intensive Care Unit that enrolled 60 preterm newborns with less than 37 weeks admitted between 1st February 2016 and 1st February 2017. Post-ductal PI was evaluated in the newborns’ feet in the first hour and at 24 hours, 48 hours, 72 hours and 168 hours of life. The presence of an adverse outcome and/or death in the neonatal period was assessed in clinical records, along with several other clinical variables.Results: We found a non-significant trend towards decreasing PI values in the first 2 days of life, with an increase at 48 hours and stable values at 72 hours after birth. PI values had an inverse relationship with gestational age (p for linear trend: 24 hours, p = 0.029; 48 hours, p = 0.001; 72 hours, p = 0.037; 168 hours, p = 0.001). The most prevalent adverse outcomes were shock (n = 8, 13.2%), anemia (n = 10, 16.7%) and intraventricular hemorrhage grade > 2 (n = 10, 16.7%). Median PI values were found to be significantly lower in newborns with an adverse outcome (0.90 vs. 0.70 at 24 hours; 0.87 vs. 0.72 at 48 hours; 0.91 vs. 0.79 at 72 hours; and 0.90 vs. 0.80 at 168 hours) and/or death in neonatal period (0.87 vs. 0.55 at 1 hour; 0.80 vs. 0.70 at 24 hours; 0.81 vs. 0.55 at 48 hours; 0.88 vs. 0.74 at 72 hours; and 0.89 vs. 0.49 at 168 hours).Conclusions: PI values differed according to gestational age and to the presence of comorbidities, confirming that it might represent a valuable tool in the early identification of adverse outcomes in the neonatal period.
      PubDate: 2017-08-08
      Issue No: Vol. 6 (2017)
  • Ascariasis masquerading as obstructive jaundice in an infant – a
           case report

    • Authors: Ishita Majumdar, Joydeep Das, Devdeep Mukherjee
      Abstract: Ascariasis is endemic in India and is common in areas of poor sanitation. The most common complications are intestinal and biliary ascariasis, which are associated with significant morbidity. We report a 7-month-old child who presented with obstructive jaundice and was also documented to have pancreatitis. She was noted to have a round worm occluding the common bile duct following ultrasonography and magnetic resonance cholangio-pancreatography (MRCP). The baby was conservatively managed with oral anthelmintics (to which she responded) and followed up with serial ultrasound.
      PubDate: 2017-08-04
      Issue No: Vol. 6 (2017)
  • Permissive hypercapnia in ventilated preterm infants: when is it safe to

    • Authors: Sabina Terzic, Suada Heljic, Naris Pojskic, Edo Hasanbegovic
      Abstract: Introduction: In spite of measures to avoid invasive mechanical ventilation, many preterm infants are still artificially ventilated. The need for intubation and positive pressure ventilation is associated with so-called ventilator-induced lung injury (VILI) and bronchopulmonary dysplasia (BPD). A lot of strategies are made in order to minimise VILI. One of these strategies is the use of permissive hypercapnia, in which clinicians use more gentle ventilatory strategies and accept higher than “normal” alveolar partial pressure of carbon dioxide (PaCO2) values. Although there are promising studies about the use of permissive hypercapnia in preterm infants, we are still not sure if and when this mode of treatment is safe.Aim: The aim of this study is to investigate conditions in which permissive hypercapnia is safe to prematurely born infants regarding their survival.Methods: The present study was conducted in a tertiary research and educational hospital, NICU, Pediatric Clinic, Clinical Center University of Sarajevo (Sarajevo, Bosnia and Herzegovina). All infants had chest X-ray at admission, and were treated for respiratory distress syndrome (RDS) with nasal continuous positive airway pressure (nCPAP), conventional mechanical ventilation (CMV), or high frequency oscillatory ventilation (HFOV). At admission we registered data regarding birth weight (BW), gestational age in weeks (GW), Apgar score and prenatally given steroids. Inclusion criteria were fulfilled by 200 infants. According to their mean PaCO2, patients were divided into hypercapnia and normocapnia groups. We analyzed the outcome (survival) of these two groups.Results: The two groups didn’t differ regarding GW, prenatally given steroids, RDS severity, surfactant use, 1- and 5-minute Apgar score, nor according to their CRIB score. Groups had also similar survival. After performing ROC analysis we have found that infants born ≤ 27 GW and ≤ 1,000 g treated with permissive hypercapnia, and infants with normocapnia born ≤ 26 GW and ≤ 980 g, have a prediction of negative outcome regarding survival, with a high level of accuracy.Conclusions: This study shows that ventilation with permissive hypercapnia of preterm infants with RDS is not safe, considering survival in children with GW ≤ 27 and BW ≤ 1,000 g.
      PubDate: 2017-08-01
      Issue No: Vol. 6 (2017)
  • Enzyme replacement therapy in paediatric patients affected by
           Anderson-Fabry disease leads to improvement in arterial elasticity, but
           not normalization

    • Authors: Pier Paolo Bassareo, Claudio Barbanti, Andrea Raffaele Marras, Giuseppe Mercuro
      Abstract: Introduction: Increase in blood pressure, probably due to an impairment in arterial elasticity, is frequent in patients affected by Anderson-Fabry disease (FD). The purpose of this study was to evaluate arterial distensibility in a group of children or adolescent with FD before and after enzyme replacement therapy and compare after enzyme replacement therapy findings with those of healthy controls (C).Material and methods: Sixteen FD patients were recruited (87.5% male; mean age at diagnosis: 13.5 ± 1.5 years; mean age at study: 15.7 ± 2.1 years; mean treatment length: 2.2 ± 0.6 years). Arterial distensibility was evaluated by means of the previously validated non-invasive QKd100-60 method, coupled with a 24-h ambulatory blood pressure monitoring (ABPM).Results: FD subjects before therapy vs after therapy – systolic ABPM: p < 0.05; diastolic ABPM: p < 0.05; mean ABPM: p < 0.05; QKd100-60: p < 0.009. FD subjects after therapy vs C – systolic ABPM: p < 0.01; diastolic ABPM: p < 0.03; mean ABPM: p < 0.02; QKd100-60: p < 0.04.Conclusions: Impaired arterial distensibility in paediatric FD patients implies an early vascular involvement even in these still so young subjects. Enzyme replacement therapy resulted in a significant improvement in arterial elasticity when compared with before treatment findings, but was not able to normalize it. It may explain the differences in ABPM levels.
      PubDate: 2017-07-31
      Issue No: Vol. 6 (2017)
  • Premature vascular deterioration in young patients affected by
           Wilson’s disease: a pilot study

    • Authors: Georgios Kouvelas, Pier Paolo Bassareo, Valentina Pisano, Luigi Demelia, Anna Maria Nurchi, Giuseppe Mercuro
      Abstract: Introduction: Wilson’s disease (WD) is a genetically inherited pathology which leads to an excessive deposition of copper in the human tissues, most of all in those of liver and brain. Even the cardiovascular system may be involved, although heart and vessels in those suffering from WD were fleetingly studied. This research aimed at evaluating the autonomic control of blood pressure (BP) and the endothelial function in a sample of young WD subjects.Methods: Eleven WD individuals were recruited in the study (54% females; mean age and age at diagnosis: 16.3 ± 5.0 and 8.3 ± 4.0 years, respectively). BP was measured at the right arm (supine and upright after 3 minutes of standing) and ankle-brachial index (ABI) was evaluated as well. WD findings were compared with those of healthy peers (controls).Results: In those with WD, systolic BP in the upright position raised when compared to the value in the supine position (128 ± 2 vs 112 ± 3 mmHg, p < 0.002), while declined in the controls. ABI was significantly lower in WD group (0.9 ± 0.2 vs 1.1 ± 0.1 in the control group, p < 0.05) and an inverse correlation was found between the disease duration and ABI as well (r = -0.66, p < 0.03).Conclusions: These preliminary results suggest an early vascular de­terioration in WD patients, notwithstanding their very young age and concomitant copper-chelating treatment. Although the heart and vessels are not the main target of WD, the detection of this unique population, potentially predisposed to cardiovascular accidents, suggests to enhance strategies of primary prevention.
      PubDate: 2017-07-31
      Issue No: Vol. 6 (2017)
  • Impact of changes in perinatal care on bronchopulmonary dysplasia: an
           overview of the last two decades

    • Authors: Alexandra Azevedo, Filipa Flor-de-Lima, Gustavo Rocha, Carina Rodrigues, Hercília Guimarães
      Abstract: Objective: To compare the clinical approach and outcomes of bron­chopulmonary dysplasia (BPD) patients in the last two decades (1996-2005 vs 2006-2015) in a neonatal intensive care unit.Methods: Out of 1,196 admissions of very low birth weight and/or less than 32 weeks of gestational age infants, 96 had BPD and were dichotomized into two groups according to the year of birth (1996-2005 and 2006-2015). Their clinical data were studied and conclusions were drawn about their morbidity and mortality.Results: There was a decrease in mortality (23.3% vs. 14.4%, p < 0.001) and in BPD prevalence (9.7% vs 6.1%, p = 0.023); in the delivery room, early nasal continuous positive airways pressure (nCPAP) was used in 41.2% vs 1.6%, p < 0.001 and tracheal intubation in 70.6% vs 96.8%, p < 0.001. We observed an increase on the duration of non-invasive ventilation (nCPAP, 22.5 vs 45.5 days, p < 0.001) and a decrease of invasive ventilation (39.5 vs 20 days, p = 0.013) from the first to the second period.Conclusions: Improvement in perinatal and neonatal intensive care practices, namely the use of non-invasive methods of mechanical ventilation implemented in the last years, probably contributed to the better evolution of preterm infants with BPD.
      PubDate: 2017-07-20
      Issue No: Vol. 6 (2017)
  • Congenital remnants as a cause of neonatal respiratory impairment

    • Authors: Filippo Carta, Riccardo Antonio Caria, Clara Gerosa, Sara Sionis, Melania Puddu, Giovanni Ottonello, Roberto Puxeddu
      Abstract: Neonatal respiratory distress is a potentially life-threatening condition, representing a diagnostic and therapeutic challenge for physicians, especially when it is caused by rare pathologies. Head and neck remnants are benign congenital neoplasms rarely observed in newborns. Teratoma is the most common congenital tumor in childhood, while head and neck epithelial and mesenchymal hamartomas are uncommon. We report three cases of pharyngeal congenital remnants presenting with neonatal airway obstruction.
      We observed a 9-month-old, 35-day-old, and 15-hour-old patients, who have been referred to our Department of Otorhinolaryngology with acute airway distress. All the patients showed a pharyngeal benign lesion, since teratomas originated from the left lateral wall of the pharynx in two cases and one “fibrovascular” hamartoma originated from the base of the tongue. Timely surgical excision through transoral CO2 laser microsurgery was curative in all the cases.
      Dyspnoea in newborns is a challenging condition and must be managed, when possible, by a well-trained paediatric team. When clinicians face obstructive airway congenital remnants, a timely and radical surgical excision is necessary to avoid potentially lethal asphyxia.
      PubDate: 2017-06-25
      Issue No: Vol. 6 (2017)
  • Phenylketonuria: central nervous system and microbiome interaction

    • Authors: Demian Arturo Herrera Morban
      Abstract: Phenylketonuria (PKU) is an autosomal recessive inborn error of metabolism characterized by increased phenylalanine (Phe) levels causing an inadequate neurodevelopment; the treatment of PKU is a Phe-restricting diet, and as such it can modulate the intestinal microbiome of the individual, generating central nervous system secondary disturbances that, added to the baseline disturbance, can influence the outcome of the disease.
      PubDate: 2017-06-23
      Issue No: Vol. 6 (2017)
  • Microbiota and probiotics

    • Authors: Mara Corpino
      Abstract: Microbiota, the collection of microorganisms peacefully coexisting with their human host, colonize virtually every surface of the human body exposed to the external environment. The complex community of microorganisms living in the digestive tract, the gut microbiota, is determined by the delivery mode, prematurity, sex, genetics and subsequent environmental exposures (diet, drugs).
      It has also been claimed that the constant interaction between the host and the gut microbiota influences the health of the host. Probiotics are defined as live non-pathogenic microorganisms that, when administered in adequate amounts can replicate and colonize in sufficient numbers the gastrointestinal tract. This is the main reason for the use of probiotics in different clinical settings where they may act as biomodulators of the intestinal microbiota. The therapeutic efficacy of probiotics has been evaluated in randomized controlled trials for various diseases. In this paper, the usage and the efficacy of probiotics in different conditions like necrotizing enterocolitis, sepsis, diarrhea, functional gastrointestinal disorders, inflammatory bowel disease, allergies are analyzed.
      The usefulness of a probiotic treatment is affected by many factors including: bacterial strain, duration of administration, disease and age and not all products marketed as probiotics provide the same safety and efficacy. Therefore, comparative studies to assess the most effective formulations, timing and the optimal length of therapy are mandatory.
      PubDate: 2017-06-09
      Issue No: Vol. 6 (2017)
  • Critical questions on nutrition of preterm infants

    • Authors: Fabio Mosca, Maria Lorella Giannì, Paola Roggero, Camilla Menis, Laura Morlacchi, Nadia Liotto, Beatrice Bracco
      Abstract: Infants born preterm represent a nutritional emergency that must be addressed immediately in order to avoid/limit the development of nutritional deficits that lead to postnatal growth retardation. When taking care of preterm infants from a nutritional point of view, it must be taken into consideration that promotion of growth is achieved by the accomplishment of their high nutritional needs, that become even more demanding with the occurrence of comorbidities. Identification of the factors that determine and/or affect nutrient requirements is therefore mandatory. A full understanding of the most appropriate biological setting that should be used for establishing preterm infants nutritional requirements is desirable. A deeper knowledge with regard to these points would allow for the provision of appropriate amount of specific essential nutrients, avoiding the under- or overexposure to certain nutrients, and for the individualization of nutritional care of preterm infants.
      The avoidance of early malnutrition is of major importance since adequate postnatal growth has been associated with improvement of later neurodevelopment outcome. Limitation of extrauterine growth restriction prevents the need for rapid catch-up growth after discharge which, in turns, has been linked to later adverse metabolic consequences. Increasing evidence has indicated that postnatal growth retardation is accompanied by a fat-free mass deficit, probably related to immature metabolic mechanisms, delayed amino acid administration and protein intakes lower than recommendations. The potential long-lasting effects of these body composition modifications on future health, both in terms of neurodevelopment outcome and metabolic risk, are still under investigation.

      PubDate: 2017-06-05
      Issue No: Vol. 6 (2017)
  • Miracles and mysteries of breast milk: from Egyptians to the 3 M’s
           (Metabolomics, Microbiomics, Multipotent stem cells)

    • Authors: Vassilios Fanos, Roberta Pintus, Alessandra Reali, Angelica Dessì
      Abstract: The ancient Egyptians considered breast milk the nectar of Gods that could give life, strength and ensure a very long existence. Nowadays, it is well known that breast milk is a dynamic bioactive mixture that is tailored upon the needs of the neonates. In fact breast milk contains nutritional substances (such as lipids, carbohydrates, proteins, vitamins and minerals), bioactive substances (such as hormones, cytokines, chemokines, immunoglobulins, leucocytes) and, according to the newest works, bacteria (microbiome of maternal milk) and multipotent stem cells.
      Metabolomics is one of the newest “omics” sciences that make it possible to have a snapshot of the metabolic state of an individual or a biufluid. Now about 10 papers have been published in the last 3 years on metabolomics in human milk.
      Human breast milk was mistakenly thought to be sterile for almost a century, but nowadays using the modern technologies it is well known that it is “contaminated”: in fact investigators we know that bacteria can be found in breast milk speaks about maternal milk microbiota. A breastfed baby is thought to ingest up to 10 milions of live bacteria per day.  There are as much as 600 species of bacteria in maternal milk.
      The possible future applications of stem cells found in are potentially endless: a tailored regenerative medicine with less ethical problems and better outcomes for the patients could be developed.
      PubDate: 2017-06-03
      Issue No: Vol. 6 (2017)
  • Promotion and support of breastfeeding: which role for a hospital

    • Authors: Giuseppe Giordano
      Abstract: The encouragement and the support of breastfeeding are public health priorities. Since 2013 “Ospedali Riuniti” of Palermo has been running a portal to promote initiation and duration of breastfeeding. The “Allattamenti Riuniti” portal provides women with information and individualized answers in case of breastfeeding problems. The activity of the service between April 2013 and January 2017 has been assessed. We illustrate the characteristics of mothers and the kind of questions asked.

      PubDate: 2017-06-02
      Issue No: Vol. 6 (2017)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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Fax: +00 44 (0)131 4513327
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