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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]
  • Congenital cytomegalovirus infection in an extremely preterm newborn
           exposed to chemotherapy in utero

    • Authors: Clara Preto, Henrique Soares, Angelina Martins, Hercília Guimarães, Jorge Spratley, Margarida Tavares
      Abstract: Cytomegalovirus (CMV) infection is the most frequent congenital infection in developed countries and the main cause of non-hereditary sensorineural deafness.
      We report the case of a 27-week-old newborn (NB) with symptomatic congenital CMV infection. The pregnancy was monitored and CMV seroconversion was detected in the first trimester maternal serum screening. At 10 weeks of gestation the mother was diagnosed with breast carcinoma, submitted to a tumorectomy at 17 weeks and started chemotherapy by the 21st week. CMV fetal infection was confirmed by positive DNA detection in amniotic fluid at 21 weeks of gestation. The mother received valaciclovir therapy from the 22nd week of pregnancy until delivery.
      The NB was delivered by cesarean section at 27 weeks with a birth weight of 950 g. In the first day of life, the NB suffered severe thrombocytopenia and congenital CMV infection was confirmed by positive PCR for CMV DNA in both urine and blood samples. The NB completed six weeks of ganciclovir treatment with progressive clinical and analytical recovery. Auditory evoked potentials were absent in the left ear. On the 84th day of life, the infant, due to clinical and laboratory assessments deterioration, started valganciclovir, completing a total of 6 months of treatment. Currently, at 36 months, the infant presents an appropriate development for the corrected age and has no indication for cochlear implantation.
      The authors intend to point out the difficulty of treating this infection associated with a high morbimortality, as there is no definitive evidence about the potential benefit of fetal infection treatment during pregnancy, the evidences regarding the effectiveness of antiviral therapy in NB refer to a restricted group of NBs, and this therapy may be associated with important side effects. In this case, the existence of other factors that increase the NB vulnerability and potential sequelae make decisions even more difficult.

      PubDate: 2018-01-09
      Issue No: Vol. 7 (2018)
       
  • Hyponatremic hypertensive syndrome secondary to renal ischemia –
           Case report

    • Authors: Joana Cunha Oliveira, Mariana Matos Martins, Esmeralda Martins, Gustavo Rocha, Cláudia Moura, Helena Pinto, Ana Teixeira
      Abstract: Hyponatremic hypertensive syndrome (HHS) is characterized by hypertensive crisis, and hyponatremia secondary to unilateral renal damage with glomerular and tubular dysfunction. Elevated plasma levels of renin in most cases suggest that the stimulation of renin release from the ischemic kidney plays an important pathophysiologic role. Activation of the renin-angiotensin system results in hypertension and causes secondary hyperfiltration, pressure diuresis and sodium loss from contralateral non-damaged kidney. An elevated renin level is a pathognomonic finding in HHS. Potassium deficiency from hyperaldosteronism may further stimulate renin secretion and intensify this vicious circle.
      We report a female term newborn, who presented with hypertensive crisis on the seventh day after traumatic birth. The first three days of life were uneventful. Initial treatment with captopril resulted in severe hypotension and hemodynamic instability. Lab work revealed hyponatremia, hypokalemia, and elevated peripheral renin activity and aldosterone levels. Complementary sonography and magnetic resonance confirmed right adrenal gland hematoma and several ischemic areas in the upper pole of the right kidney. The diagnosis of HHS secondary to renal ischemia was evoked.
      HHS is a rare condition in the neonatal period, though still under-recognized. In the neonatal and early infancy period, renovascular disease is the most common cause of secondary hypertension. In this case, there was no sign of vascular disease, the renin-angiotensin system was activated secondary to direct renal ischemia and infarction. The intense renin stimulation and pressure through the contralateral normal kidney results in high pressure natriuresis facilitating a severe volume-depleted state. Although the use of renin-angiotensin system inhibitors is the treatment of choice, it is imperative to re-establish hydration and renal perfusion before starting this antihypertensive medication. We aimed to improve awareness of HHS diagnosis and prompt treatment, to prevent continuous renal damage and other life-threatening complications.

      PubDate: 2018-01-09
      Issue No: Vol. 7 (2018)
       
  • Cholestatic hepatitis: atypical presentation of Epstein-Barr virus
           infection

    • Authors: Carolina Guimarães, Raquel Garrido, Margarida Chaves, Sara Martins
      Abstract: Epstein-Barr virus (EBV) primary infection frequently leads to a mild and self-limited increase in liver enzymes. However, clinical manifestations of hepatitis including jaundice are very rare in children. We report a case of an 11-year-old female with fever, vomiting, abdominal pain, jaundice and choluria. The physical examination showed jaundice, cervical adenopathy and mild hepatomegaly. She later developed tonsillitis and a rash. Laboratorial evaluation revealed atypical lymphocytosis (19.3%), increased aspartate aminotransferase 371 IU/L, alanine aminotransferase 373 IU/L and γ-glutamyl transpeptidase 110 IU/L, hyperbilirubinaemia (total bilirubin 14.83 mg/dL, direct bilirubin 11.39 mg/dL), bilirubinuria and hypoalbuminaemia (minimum 2.4 g/dL). The anti-EBV viral capsid antibodies IgM and IgG were positive. Other viral serologies were negative and the abdominal ultrasound was normal. EBV first infection should be considered in the differential diagnosis of cholestatic hepatitis in children.

      PubDate: 2018-01-08
      Issue No: Vol. 7 (2018)
       
  • Atypical pleomorphic adenoma with chronic sialoadenitis of the
           submandibular gland: a case report in a child

    • Authors: Andrea Satta, Filippo Carta, Carlo Ripoli, Anna Maria Nurchi, Roberto Puxeddu, Gavino Faa, Clara Gerosa
      Abstract: A 12-year-old girl presented with an oval swelling in the left submandibular region. The tumor had gradually increased in size, during the last 9 months. Preoperative ultrasonography evidenced an hypoechoic oval mass, 14 x 12 mm in size. Submandibulectomy was performed. At macroscopy, the tumor was surrounded by a fibrous capsule, and appeared tan-white in color. At histology, an admixture of epithelial and mesenchymal cell components characterized the tumor. Epithelial cells showed large polymorphous atypical nuclei, with irregular nuclear membranes. The mesenchymal cells were embedded in a myxoid matrix, with focal areas of chondroid differentiation. The tumor showed pushing margins, focally extending into the fibrous capsule. Occasionally, some scattered foci of capsular pseudo-infiltration were detected. The proliferative index of tumor cells, detected by Ki67 immunostaining, reached levels around 10% in some tumor areas characterized by the highest frequency of atypical tumor cells. On these bases, a diagnosis of atypical pleomorphic adenoma was performed. A lymphocytic infiltrate, sometimes organized in lymphoid nodules, was observed in the surrounding submandibular gland. After 1 year of follow-up, the patient is in good health, in the absence of any recurrence. The case here reported confirms that tumors of the salivary gland occurring in children are characterized by a higher aggressive potential, here represented by the atypical tumor cells associated with the high proliferative index and with the pressure on the tumor capsule, and deserve the complete resection of the affected salivary gland, in order to prevent their potential malignant transformation. The association of the salivary gland tumor presenting in our patient with lymphocytic nodular sialoadenitis confirms previous reports of this peculiar association, and reinforces the hypothesis that the two conditions might share a common etiology.

      PubDate: 2017-12-29
      Issue No: Vol. 7 (2017)
       
  • Survey on the use of Homeopathy among Pediatricians of the Italian
           Federation of Pediatric Physicians (FIMP) [Article in English and Italian]
           • [Indagine sull’utilizzo dell’Omeopatia tra i Pediatri della
           Federazione Italiana Medici Pediatri (FIMP)]

    • Authors: Gianfranco Trapani, Tiziana Di Giampietro, Luisella Zanino, Domenico Careddu
      Abstract: ENGLISH TEXT: The use of Complementary Alternative Medicine (CAM), and more specifically of Homeopathy, is common among the pediatric population in Italy. In order to verify the attitude of family pediatricians (pediatri di famiglia) towards the use of Homeopathy, a survey has been carried out among 5,399 (number of doctors who received the questionnaire) family pediatricians enrolled in the Italian Federation of Pediatric Physicians (Federazione Italiana Medici Pediatri, FIMP) by means of an online questionnaire. The response has been significant (1,252 questionnaires have been filled in, corresponding to 23.19% of the total submitted) and has highlighted that 29.4% of the pediatricians who took part in the survey use homeopathic medicine to cure their patients. The study has also analyzed several other parameters related to the use of Homeopathy, including age and pediatric education, most commonly treated diseases, pharmaceutical forms and possible adverse effects.ITALIAN TEXT: L’impiego delle Medicine Complementari e Al­ter­native (Complementary Alternative Medicine, CAM), e più spe­cifica­men­te dell’Omeopatia, è comune tra la popolazione pediatrica in Italia. Allo scopo di verificare l’attitudine dei pediatri di famiglia nei confronti dell’utilizzo dell’Omeopatia, è stata condotta un’indagine, tramite un questionario online, tra i 5.399 (numero di medici che ha ricevuto il questionario) pediatri di famiglia appartenenti alla Federazione Italiana Medici Pediatri (FIMP). Il riscontro è stato significativo (1.252 questionari, corrispondenti al 23,19% di quelli inviati, sono stati compilati ) ed ha evidenziato che il 29,4% dei pediatri che hanno risposto all’indagine utilizza la medicina omeopatica per curare i propri pazienti. Lo studio ha anche analizzato alcuni altri para­metri correlati all’impiego dell’Omeopatia, inclusi l’età e la formazione dei pediatri, le patologie più frequentemente trattate, le forme farmaceutiche utilizzate e i possibili effetti avversi.
      PubDate: 2017-12-28
      Issue No: Vol. 7 (2017)
       
  • Neonates exposed to excipients: concern about safety

    • Authors: Laura Cuzzolin
      Abstract: Excipients are generally perceived as inert and pharmacologically inactive. Instead, serious adverse reactions have been reported in vulnerable patient populations and little is known about exposure of newborns to excipients. The aim of this review is to deepen the presence of potentially harmful excipients in drugs commonly used in neonates. From an analysis of articles and case reports present in the international literature emerges that several medicines administered to newborns contain potentially harmful excipients such as ethanol, propylene glycol and benzyl alcohol. Neonatologists should be aware of this problem and possibly prescribe substitutive treatments.
      PubDate: 2017-12-24
      Issue No: Vol. 7 (2017)
       
  • Low-grade fibromyxoid sarcoma in a child presenting as a popliteal fossa
           swelling

    • Authors: Suraj Gandhi, Charu Sharma, Pankaj Dwivedi, Neha Sisodiya Shenoy, Hemanshi Shah
      Abstract: Popliteal fossa masses are rare in paediatric age group. Even rarer are the malignancies of this area. Low-grade fibromyxoid sarcoma (LGFMS) is a distinctive variant of fibrosarcoma. It is a rare tumor with benign histologic appearance but high metastasizing potential. We describe an 11-year-old child with a popliteal fossa mass, which was excised, and histopathological report revealed LGFMS.
      PubDate: 2017-12-19
      Issue No: Vol. 7 (2017)
       
  • Prader-Willi Syndrome: an under-recognized cause of hypotonia'

    • Authors: Marlene Rodrigues, Miguel Costa, Joana Teixeira, Carla Sá, Liliana Pinheiro, Eduarda Abreu, Albina Silva, Nicole Silva, Matos Marques, Miguel Rocha, Almerinda Pereira
      Abstract: The “floppy infant” is a well-recognized entity characterized by general­ized hypotonia presenting at birth or in early life. Hypotonia represents a diagnostic challenge because it may be the presentation sign of numerous diseases, as central or peripheral nervous system abnormalities, myopathies, genetic disorders, endocrinopathies, metabolic diseases and acute/chronic illness. Prader-Willi syndrome (PWS) is a complex neurodevelopmental disorder that results from an abnormality in chromosome 15. Diagnosis is often delayed because clinical findings are relatively nonspecific and the dysmorphism is often subtle.
      We describe three term male newborns admitted in the first day of life for hypotonia and feeding difficulties. Pregnancy and familiar history were unremarkable. Clinical examination revealed marked global hypotonia, few active movements, weak cry, poor suck reflex, micrognathia, cryptorchidism, facial dysmorphic features: almond-shaped eyes with short palpebral fissures, narrow bifrontal diameter and short neck. Laboratory evaluations were normal. Brain ultrasound and magnetic resonance had no alterations. Cardiac and metabolic evaluations were irrelevant. PWS was suspected and genetic evaluation was performed. The methylation analysis specific for PWS confirmed the diagnosis. In the three cases it was observed development milestones delay, with progressive improvement after multidisciplinary approach. At last follow-up visit, all of them walk alone, explore the surrounding environment, understand simple language and say some words.
      These reports reinforce the idea that PWS should be considered in the presence of newborn hypotonia, and feeding difficulties, even in absence of typical facial features. Detecting PWS at neonatal age is important because it allows early intervention and better management of such infants.

      PubDate: 2017-12-06
      Issue No: Vol. 7 (2017)
       
  • Congenital intestinal lymphangiectasia. A case report

    • Authors: Georgios Mitsiakos, Eftychia Drogouti, Maria Drogouti, Charalampos Doitsidis, Elisabeth Pazarli, Ioannis Spyridakis
      Abstract: Congenital intestinal lymphangiectasia, first described by Waldmann et al. in 1961, is a rare congenital malformation of the lymphatics, presented with generalized edema, hypoproteinemia and lymphopenia. Diagnosis is based on endoscopy findings and pathology.
      We present here a case of a male neonate, second child of an indigenous woman, delivered by caesarean section. Prenatally, multiple cystic abdominal masses were identified by ultrasound. The patient was treated successfully with enterectomy and anastomosis. Histopathology revealed primary intestinal lymphangiectasia with no features of malignancy.
      Intestinal lymphangiectasia is a rare pathology, which should be differentiated while exploring abdominal masses, hypoproteinemia and edema especially in neonates.
      PubDate: 2017-12-05
      Issue No: Vol. 7 (2017)
       
  • Metabolic alkalosis with multiple salt unbalance: an atypical onset of
           cystic fibrosis in a child

    • Authors: Dimitri Poddighe, Lucia Castelli, Elena Virginia Comi, Ilaria Brambilla, Paola Bruni
      Abstract: Dehydration with multiple salt abnormalities is frequently encountered in the paediatric emergency department, during acute illnesses complicated by loss of body fluids. Metabolic alkalosis is not a common finding in dehydrated children. The presence of unusual electrolyte unbalance, such as metabolic alkalosis, hyponatremia, hypochloremia and hypokalemia, without evidence of renal tubular defects, is named as pseudo-Bartter syndrome. It can occur in several clinical settings and, in infancy, it is described as a potential complication of cystic fibrosis. We report a case of pseudo-Bartter syndrome representing the onset of cystic fibrosis in childhood.

      PubDate: 2017-12-01
      Issue No: Vol. 7 (2017)
       
  • One-time needle aspiration: a safe and effective treatment for neonatal
           spontaneous pneumoperitoneum

    • Authors: Kamal Nain Rattan, Alka Yadav, Poonam Dalal, Jasbir Singh, Ananta Rattan
      Abstract: Introduction: Pneumoperitoneum is a rare surgical emergency to be seen in the neonates, occurring most commonly secondary to necrotizing enterocolitis (NEC). The term spontaneous or non-surgical pneumoperitoneum is used for cases not associated with a perforated viscus. Recommended treatment options for the former is primary peritoneal drainage (PPD) and exploratory laparotomy. Our study evaluates one-time needle aspiration alone through the right hypochondrium for effective management of the pneumoperitoneum in neonates.
      Material and methods: Twenty neonates presenting to the emergency department with massive pneumoperitoneum and respiratory distress were subjected to one-time needle aspiration of the peritoneal cavity. Effectiveness of the intervention was defined by decompression of abdominal distension, permanent disappearance of free intra-peritoneal air, cessation of non-bilious aspirates and complete haemodynamic stability during the 48-hour period following the procedure.
      Results: All 20 neonates improved initially with abdominal decompression by virtue of improvement in respiratory function. Of the 20 neonates, 6 neonates with spontaneous pneumoperitoneum (SIP) made a rapid recovery and needed no further surgical intervention; thereby the procedure was labeled as “effective”. In the remaining 14 patients (with NEC and perforated bowel), free peritoneal air re-appeared in the next 24-48 hour period and PPD/exploratory laparotomy had to be performed. Feeds were established earlier (approximately 2 days) and mean hospital stay was significantly shorter in the group with “effective” procedure (by 3 days). Four neonates expired in postoperative period in the group requiring surgery.
      Conclusion: One-time needle aspiration can serve as an effective treatment for neonates with spontaneous pneumoperitoneum and can obviate the need for exploratory laparotomy in small sick neonates with SIP who carry poor risk for extensive surgical intervention.
      PubDate: 2017-11-28
      Issue No: Vol. 7 (2017)
       
  • Cystic lesion of posterior cranial fossa: is it Dandy-Walker'

    • Authors: Stella De Nardi, Carmela Porcu, Pier Luigi di Paolo, Daniela Longo, Melania Puddu, Francesca Santoro, Luca Saba
      Abstract: Accidental discovery of a fluid collection within the posterior cranial fossa in a fetus or a newborn can be a tricky incidental finding during a routine scan, alarming for a Dandy-Walker Malformation (DWM).
      The main cystic lesions of the posterior cranial fossa are DWM, Blake’s Pouch Cyst (BPC), Arachnoid Cyst (AC) and Mega Cisterna Magna (MCM), although the latter is not a proper cyst. The key event for the development of a DWM is a cerebellar vermis hypoplasia that causes the persistence of the superior membranous area, which expands into the posterior fossa forming a large cystic 4th ventricle. BPC is caused by the persistence and herniation of a different membrane, the inferior membranous area, that is supposed to disappear leaving a median opening that would become the foramen of Magendie.
      MCM originates if this membrane eventually disappears, leaving an enlarged posterior fossa cavity filled with cerebrospinal fluid physiologically connected with the subarachnoid fluid. Finally, ACs are caused by a defined duplication of the arachnoid membrane filled with CSF-like fluid. Consequently, the radiological finding of a regular cerebellar vermis excludes the hypothesis of DWM and the position of the choroid plexus helps differentiating between DWM and BPC in controversial cases. Moreover, radiological findings in DWM include cystic dilatation of the 4th ventricle and enlargement of the posterior fossa. Absence of hydrocephalus comes out in favor of MCM. Absence of communication with surrounding cerebrospinal fluid defines an AC.
      This review assesses the cystic lesions of posterior cranial fossa on the basis of embryological development, radiological findings and associated clinical aspects, in order to clarify the radiological differential diagnosis through embryology.
      PubDate: 2017-11-22
      Issue No: Vol. 7 (2017)
       
  • How to manage fetomaternal hemorrhage' Description of five cases and
           literature review

    • Authors: Alessandra Marciano, Luisa Di Luca, Eugenia Maranella, Emanuela Conte, Cecilia Di Natale, Veronica Pannone, Sandra Di Fabio
      Abstract: Fetomaternal hemorrhage (FMH) is a poorly understood condition in which there is a transfer of fetal blood to the maternal circulation. It occurs in approximately 1-3 per 1,000 births. We described five cases with characteristics suggestive of both acute and chronic anemia. When FMH is suspected, maternal blood can be checked for the presence of fetal red blood cells and usually there are three diagnostic modalities: Kleihauer-Betke test, flow cytometry and Rosette test. The clinical manifestations and the prognosis of FMH depend on the gestational age, the volume of the hemorrhage and the rapidity with which it has occurred. Red blood transfusion is recommended, while in case with severe anemia and cardiac failure an exchange transfusion can be considered. The physician’s awareness of the condition, the ability to suspect and diagnose it with appropriate testing have a significant impact on the epidemiology, accurate management and prognosis for the anemic neonates.

      PubDate: 2017-11-21
      Issue No: Vol. 7 (2017)
       
  • Impact of mydriatic eye drops on neonatal cerebral blood flow

    • Authors: Atef Alshafei, Mahmoud Ahmed, Shymaa Farouk, Ahmed Gouda, Anwar Khan, Rashid Mustafa
      Abstract: Retinopathy of prematurity (ROP) screening is a common routine procedure carried out on preterm infants in neonatal intensive care units (NICUs). Mydriatic eye drops containing phenylephrine hydrochloride 2.5% (a sympathomimetic agent) and tropicamide 0.5% (a cycloplegic medication) are readily absorbed from the conjunctiva and produce systemic responses in various organs. To our knowledge, no studies have investigated the direct effects of these medications on cerebral blood flow velocities (CBFVs) in preterm infants.
      To evaluate the systemic effects of locally instilled mydriatic eye drops (phenylephrine hydrochloride 2.5% and tropicamide 0.5%) used for ROP screening, on cerebral blood flow velocity in preterm infants, a prospective observational study was conducted among preterm infants with gestational age (GA) < 31 weeks admitted to the NICU at Dubai Hospital between February 20, 2017 and June 20, 2017.
      The infants (at a post-menstrual age of 31-34 weeks) underwent duplex ultrasound evaluation of CBFV before and after mydriatic eye drops administration.
      Pulsed-wave Doppler ultrasound studies were performed 1 h before and 1 h after eye mydriasis. We measured peak systolic velocity (PSV) and end diastolic velocity (EDV) for both the anterior cerebral artery (ACA) and middle cerebral artery (MCA) and calculated the resistive index (RI), defined as PSV – EDV/PSV. Mean arterial blood pressure (MAP), heart rate, oxygen saturation and pain score were assessed before and 1 h after ROP examination.
      A paired t-test and McNemar’s test were used to assess the statistical significance of the difference between pairs of means and the qualitative variables measured twice for the same study group.
      Among the 42 eligible preterm infants, the mean (SD) GA was 27 (2.68) weeks (range, 24-31 weeks). The mean (SD) RI of ACA before and 1 h after eye drops administration was 0.84 (0.06) and 0.83 (0.07) respectively (p = 0.453). The mean (SD) RIs of MCA before and then 1 h after mydriasis were 0.83 (0.05) and 0.83 (0.09), respectively (p = 0.559).
      Phenylephrine hydrochloride 2.5% and tro­picamide 0.5% eye drops for neonatal ROP screening were not associated with significant changes in CBFVs. There was no effect on pain score or hemodynamic stability in the preterm infants.

      PubDate: 2017-11-20
      Issue No: Vol. 7 (2017)
       
 
 
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