Erythropoietin (Epo) increases and maintains hematocrit using once weekly dosing in adults with anemia due to end stage renal disease. Epo is used in preterm infants to treat the anemia of prematurity, but has not been studied using once weekly dosing, a schedule which might offer neuroprotection in addition to increasing red cell mass. We compared reticulocyte responses of once weekly Epo dosing with thrice weekly dosing in preterm infants.
Infants ≤1,500 grams and ≥7 days of age were randomized to once weekly Epo, 1,200 units/kg/dose, or thrice weekly Epo, 400 units/kg/dose, subcutaneously for 4 weeks, along with iron and vitamin supplementation. Complete blood counts, absolute reticulocyte counts (ARC), transfusions, phlebotomy losses, and adverse events were recorded.
Twenty preterm infants (962±55 grams, 27.9±0.4 weeks, 17±3 days of age) were enrolled. Groups were similar at baseline. Infants in both groups increased ARC (p<0.01, thrice weekly Epo group). ARC were similar between treatment groups at the start and end of 4 weeks. Hematocrit remained stable, and similar numbers of transfusions were administered. No adverse effects of either dosing schedule were noted.
Preterm infants respond to weekly Epo by increasing ARC and maintaining hematocrit. We speculate that once weekly Epo dosing might be beneficial to preterm infants requiring increased erythropoiesis.
erythropoietin; transfusions; dosing schedule; anemia of prematurity; neuroprotection
Newborns with congenital diaphragmatic hernia frequently have catecholamine-unresponsive systemic hypotension and respiratory failure. We found that adrenal insufficiency frequently complicates the clinical course of infants with congenital diaphragmatic hernia and was associated with increased severity of illness.
To determine the relationship between serum vitamin D levels and cardiometabolic risk factors independent of adiposity in urban schoolchildren.
We assessed the relationships among serum 25-hydroxyvitamin D [25(OH)D], adiposity measured by body mass index (BMI) z-score (BMIz), and 6 cardiometabolic risk factors (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, interleukin-6, and C-reactive protein [CRP]) in a cross-sectional sample of 263 racially and ethnically diverse schoolchildren from the Boston area during late winter. Multivariate regression analyses adjusting for sociodemographic characteristics and BMIz examined associations of 25(OH)D and cardiometabolic risk factors.
Overall, 74.6% of the children were vitamin D deficient [25(OH)D <50 nmol/L; mean, 41.8 ± 13.7 nmol/L]; 45% were overweight or obese (20%and 25%, respectively; BMIz = 0.75 ± 1.1). The 25(OH)D level was not associated with BMIz, but was positively associated with the cardiometabolic risk factor CRP (β = 0.03; P < .05). BMIz was associated with elevated triglycerides (β = 0.13), CRP (β = 0.58), and interleukin-6 (β= 0.14) and low high-density lipoprotein cholesterol (β = −0.09; all P < .01).
Vitamin D deficiency is highly prevalent during the late winter months in urban schoolchildren living in the northeastern United States. This widespread deficiency may contribute to the lack of associations between 25(OH)D and both BMIz and cardiometabolic risk factors. The association between 25(OH)D and CRP warrants further study.
To examine whether mental health problems in childhood increase the likelihood of overweight or obesity during early adulthood among male subjects.
In a national prospective population-based study conducted in Finland, child mental health, including depression, emotional problems, conduct problems, and hyperactivity (determined on the basis of child, parent, and teacher information), was assessed at age 8 years. Body mass index (BMI) was obtained from military examination records (n = 2209) conducted in early adulthood (age range, 18–23 years).
Both moderate (50th–90th percentile) and high (>90th percentile) levels of conduct problems at age 8 years were prospectively associated with a young adult being obese (BMI ≥ 30; odds ratio [OR], 2.0; 95% CI, 1.2–3.2; and OR, 2.9; 95% Confidence interval [CI], 1.5–5.9; respectively). Conduct problems were also prospectively associated with a young adult being overweight (25 ≤ BMI < 30; OR, 1.5; 95% CI, 1.1–1.9 for moderate levels of conduct problems, and OR, 1.9; 95% CI, 1.2–2.8 for high levels), after controlling for hyperactive problems and sociodemographic factors.
Conduct problems in childhood are prospectively associated with overweight and obese in young adulthood. Future studies should address the potential for interventions to reduce obesity risk in young adulthood for boys who manifest conduct problems early in life.
Increased cardiovascular (CV) risk has been reported in adults who are childhood cancer survivors (CCS). We sought to determine the emergence of CV risk factors in CCS while still children.
CCS in remission ≥5 years from cancer diagnosis (n=319, age=14.5yrs), and their siblings (controls, n=208, age=13.6yrs) participated in this cross-sectional study of CV risk, which included physiologic assessment of insulin sensitivity/resistance (hyperinsulinemic euglycemic clamp). Adjusted comparisons between CCS major diagnoses (leukemia [n=110], central nervous system tumors [n=82], solid tumors [n=127]) and controls were performed using linear regression for CV risk factors and insulin sensitivity.
Despite no significant differences in weight and body mass index, CCS had greater adiposity (waist [73.1 vs. 71.1cm, p=0.02]; percent fat [28.1vs.25.9%, p=0.007]), lower lean body mass (38.4vs.39.9 kg, p=0.01) than controls. After adjustment for adiposity, CCS had higher total cholesterol (154.7vs.148.3mg/dl, p=0.004), LDL-cholesterol (89.4vs.83.7mg/dl, p=0.002), triglycerides (91.8 vs. 84mg/dl, p=0.03) and were less insulin sensitive (Mlbm 12.1vs.13.4mg/kg/min, p=0.002) than controls.
CCS have greater CV risk than healthy children. Because CV risk factors track from childhood into adulthood, early development of altered body composition and decreased insulin sensitivity in CCS may contribute significantly to their risk of early CV morbidity and mortality.
cardiometabolic risk; metabolic syndrome; children; cholesterol; adiposity
To compare the reliability of blood pressure (BP) readings obtained by an oscillometric device to those obtained by auscultation and assess for differences in BP status classification based upon the two techniques.
Resting BP was measured by auscultation and with an oscillometric device at the same encounter in 235 subjects enrolled in the Chronic Kidney Disease in Children study. Resting auscultatory BP’s were averaged and compared with averaged oscillometric readings. BP agreement by the two methods was assessed using Bland-Altman plots, and BP status classification agreement was assessed by calculation of Kappa statistics.
Oscillometric BP readings were higher than auscultatory readings, with a median paired difference of 9 mmHg for systolic BP (SBP) and 6 mmHg for diastolic BP (DBP). Correlation for mean SBP was 0.624 and for mean DBP was 0.491. The bias for oscillometric BP measurement was 8.7 mmHg for SBP (P<0.01) and 5.7 mmHg for DBP (P<0.01). BP status classification agreement was 61% for SBP and 63% for DBP, with Kappas of 0.31 for SBP and 0.20 for DBP.
Compared with auscultation, the oscillometric device significantly overestimated both systolic and diastolic BP, leading to frequent misclassification of BP status.
To determine whether or not the N-terminal fragment of B-type natriuretic peptide (NTproBNP) was a biomarker of clinical, laboratory, and echocardiographic abnormalities in children with homozygous sickle cell disease (SCD).
A single-center retrospective study consisted of analysis of data from November, 2007 to December, 2010. We correlated serum NTproBNP with clinical and laboratory findings, echocardiographic data, and New York Heart Association (NYHA) functional class.
NTproBNP levels from 42 children (median age 9 years, 52% female) had significant correlations with hemoglobin (r= −0.63, p<0.05), and echocardiographic measurements including tricuspid regurgitant velocity (r=0.46, p<0.05), lateral E’ (r=−0.52, p<0.05) and lateral E/E’ ratio (r=0.60, p<0.05) suggesting diastolic dysfunction. In addition, NTproBNP levels increased from NYHA functional class I to class III and had a significant linear correlation with the NYHA functional class (r=0.69, p <0.05).
NTproBNP correlated with low hemoglobin and tissue Doppler data as indicators of diastolic dysfunction. Elevated NTproBNP may be a prognostic biomarker for the presence of diastolic dysfunction related to anemia in children with SCD.
To evaluate the hypothesis that elevated levels of inflammation-related proteins in early postnatal blood predict impaired mental and motor development among extremely preterm infants.
We measured concentrations of 25 inflammation-related proteins in blood collected on postnatal days 1, 7, and 14 from 939 infants born before 28 weeks gestation. An elevated level was defined as a concentration in the highest quartile for gestational age and day of blood collection. We identified impaired development at 24 months of age using the Bayley Scales of Infant Development. The primary outcomes were scores on the Mental or Motor Scale below 55 (more than 3 standard deviations below the mean).
For 17 of the 25 inflammation-related proteins, one or more statistically significant association (p < 0.01) was found between an elevated blood level of the protein and a developmental impairment. Elevations on multiple days were more often associated with developmental impairment than elevations present for only one day. The highest number of elevations was found in day-14 blood.
In extremely preterm infants, elevated levels of inflammation-related proteins in blood collected on postnatal days 7 and 14, especially when sustained, are associated with impaired mental and motor development at age two years.
cytokines; developmental disability; prematurity; Bayley Scales of Infant Development; neurodevelopmental outcome
cilia; basal body; centrosome; primary ciliary dyskinesia; polycystic kidney disease
We report the successful use of abatacept and sodium thiosulfate in a patient with severe recalcitrant juvenile dermatomyositis complicated by ulcerative skin disease and progressive calcinosis. This combination therapy resulted in significant reduction in muscle and skin inflammation, decreased corticosteroid dependence, and halted the progression of calcinosis.
To assess whether reporting “possible cystic fibrosis (CF)” newborn screening (NBS) results via fax plus simultaneous telephone contact with primary care providers (PCPs), versus fax alone, influenced three outcomes: getting a sweat chloride test, age at sweat chloride test, and sweat-testing before 8 weeks old.
Retrospective cohort comparison of infants born in Wisconsin whose PCPs received telephone intervention (n=301), versus recent historical controls whose PCP did not (n=355). Intervention data were collected during a longitudinal research and quality improvement effort; de-identified comparison data were constructed from auxiliary NBS tracking information. Parametric and nonparametric statistical analyses tested for group differences.
Most infants (92%) with “possible CF” NBS results whose PCPs lacked telephone intervention ultimately underwent sweat-testing, underlining efficacy for fax-only reporting. Telephone intervention was significantly associated with improvements in infants undergoing sweat-testing at both ≤6 and <8 weeks and a slight, but non-significant, 3.5-day reduction in infants’ age at sweat-testing. The effect of telephone intervention was greater for PCPs whose patients underwent sweat-testing at community-affiliated medical centers versus academic medical centers (p=0.008).
Reporting “possible CF” NBS results via fax plus simultaneous telephone follow-up with PCPs increases the number of infants who have sweat chloride tests before 8 weeks of age, when affected infants are more likely to receive full benefits of early diagnosis and treatment.
Neonatal screening; sweat chloride testing; heterozygote; genetic carrier detection; genetic testing; public health genetics; parent-provider communication
To explore associated clinical factors in children with pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS).
Children with tics and/or OCD (n = 109) were examined by personal and family history, diagnostic interview, physical examination, medical record review, and measurement of baseline levels of streptococcal antibodies.
Significant group differences were found on several variables, such that those diagnosed with PANDAS (versus without PANDAS) were more likely to have had dramatic onset; definite remissions; remission of neuropsychiatric symptoms during antibiotic therapy; a history of tonsillectomies/adenoidectomies; evidence of GAS infection, and clumsiness.
The identification of clinical features associated with PANDAS should assist in delineating risks for this subtype of OCD/tics.
Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections; PANDAS; Obsessive-Compulsive Disorder; Tic disorder; Children
To examine prevalence of DSM-IV psychiatric disorders in youth with chest pain compared with a control sample with innocent heart murmur.
We assessed youth ages 8–17 years who were evaluated in cardiology settings for medically unexplained chest pain (N=100) or innocent heart murmur (N=80). We conducted semi-structured interviews and assessed medical history, quality of life, and disability.
Youth with chest pain had a higher prevalence of psychiatric disorders compared with those with murmur (74% vs. 47%, X2 = 13.3; p<.001). Anxiety disorders predominated, although major depression was also more common in the chest pain group (9% vs. 0%; FET; p<.01). Onset of psychiatric disorders generally preceded chest pain. Patterns were similar for boys and girls and for children and adolescents. Chest pain was associated with poorer quality of life and with pain-related disability for youth with comorbid psychiatric disorder.
In childhood and adolescence, medically unexplained chest pain is associated with a high prevalence of psychiatric disorders. Systematic mental health screening may improve detection and enhance management of these patients.
Children; adolescents; cardiology; anxiety
To measure the circulating concentrations of nitric oxide (NO) adducts with NO bioactivity following inhaled NO therapy in infants with pulmonary hypertension.
In this single center study five sequential blood samples were collected from infants with pulmonary hypertension before, during and after therapy with iNO (n=17). Samples were collected from a control group of hospitalized infants without pulmonary hypertension (n=16) and from healthy adults for comparison (n=12).
After beginning iNO (20 ppm) whole blood nitrite increased about two-fold within two hours (P<0.01). Whole blood nitrate increased to four-fold higher than baseline during treatment with 20ppm iNO (P<0.01). S-nitrosohemoglobin (SNO-Hb) increased measurably after beginning iNO (P<0.01) whereas iron nitrosyl hemoglobin and total Hb-bound NO-species compounds did not change.
Treatment of pulmonary hypertensive infants with iNO results in increases in nitrite, nitrate, and SNO-Hb in circulating blood. We speculate that these compounds may be carriers of NO bioactivity throughout the body and account for peripheral effects of iNO in the brain, heart and other organs.
newborn; nitric oxide
To assess the effects of chronic erythrocyte transfusions on prevalence of sonographic incidence of organ damage in children with sickle cell anemia (SCA).
Children (n=148; mean age, 13.0 years) with SCA, receiving chronic transfusions (average, 7 years) underwent abdominal sonography at 25 institutions. After central imaging review, spleen, liver and kidney measurements were compared with published normal values. Potential relations between ultrasound, clinical and laboratory data were explored via Analysis of Variance, Student t-test and Cochran Mantel Haenzel tests of non-zero correlation.
Average spleen length was similar to normal children, but over one-third had spleen volumes > 300mL, 15 had previous splenectomy for splenomegaly and 24 had abnormal splenic echotexture. Two-thirds had hepatobiliary disease; 37 had prior cholecystectomy, 46 had gallstones, 16 had gallbladder sludge. Gallbladder disease correlated with older age (p = 0.002), longer liver length (p < 0.001), longer duration of transfusions (p = 0.034) and higher total bilirubin (p < 0.001). Liver (p < 0.001) and renal lengths (p ≤ 0.005) were larger than published norms.
In children with SCA, long-term transfusion therapy may not prevent development or progression of abdominal organ dysfunction.
sickle cell anemia; iron overload; splenomegaly; gallstones; hepatomegaly; nephromegaly
To determine what children know about preventing dog bites and parental desires for dog bite prevention education.
This cross-sectional study sampled 5-15 year olds and their parents/guardians presenting to a pediatric emergency department with non-urgent complaints or dog bites. Pairs completed surveys and knowledge-based simulated scenario tests developed from American Academy of Pediatrics (AAP) and Center for Disease Control and Prevention (CDC) dog bite prevention recommendations. Regression analyses modeled knowledge test scores and probability of passing; a passing score was ≥11/14 questions.
Of 300 parent/child pairs, 43% of children failed the knowledge test. Older children had higher odds of passing the knowledge test than younger children, as did children with white parents versus non-white parents. No associations were found between knowledge scores and other sociodemographic or experiential factors. Over 70% of children had never received dog bite prevention education, although 88% of parents desired it.
Dog bites are preventable injures disproportionately affecting children. Dog bite prevention knowledge in our sample was poor, particularly among younger children and children with non-white parents. Formal dog bite prevention education is warranted and welcomed by a majority of parents.
dog bite; injury prevention; education; knowledge; emergency department
Objectives To evaluate whether the use of adult heart rate (HR) criteria is appropriate for diagnosing Postural Tachycardia Syndrome (POTS) and orthostatic intolerance (OI) in children and adolescents and to establish normative data and diagnostic criteria for pediatric POTS and OI.
Study design 106 normal controls between the ages 8 and 19 years (14.5±3.3 years) underwent standardized autonomic testing, including 5 minutes of 70 degree head-up tilt. The orthostatic HR increment and absolute orthostatic HR were assessed and retrospectively compared with 654 pediatric patients of similar age (15.5±2.3 years), who were referred to our Clinical Autonomic Laboratory with symptoms of OI.
Results The HR increment was mildly higher in patients referred for POTS/OI but there was considerable overlap between patient and control group. 42% of normal controls had a HR increment of 30bpm or more. The 95th percentile for the orthostatic HR increment in normal controls was 42.9bpm. Absolute orthostatic HR showed a greater and more consistent difference between groups, although there was still considerable overlap.
Conclusions The diagnostic criteria for OI/POTS in adults are inadequate for children and adolescents. Based on our normative data, new criteria are proposed for the diagnosis of OI and POTS in children and adolescents.
nervous system; autonomic; orthostatic intolerance; postural tachycardia; adolescent autonomic dysfunction
To evaluate relationships between vitamin D, proteinuria, and disease activity in pediatric systemic lupus erythematosus (SLE) and juvenile dermatomyositis (JDM).
Multiple linear regression was used to associate subject-reported race, sunscreen use, and vitamin D intake with physician-assessed disease activity and serum 25-hydroxyvitamin D [25(OH)D] in subjects with pediatric SLE (n = 37) or JDM (n = 21). Serum 25(OH)D was correlated with urinary vitamin D binding protein/creatinine ratio (DBP/C) and other indicators of proteinuria.
Serum 25(OH)D levels in subjects with SLE were inversely associated with the natural log of urinary DBP/C (r = −0.63, p < 0.001) and urine protein to creatinine ratio (r = −0.60, p<0.001), with an adjusted mean 10.9 (95% CI 5.1, 16.8) ng/mL decrease in 25(OH)D for those with proteinuria. Excluding subjects with proteinuria, serum 25(OH)D levels were inversely associated with disease activity in JDM, but not in SLE. Overall, 66% of all subjects were taking concurrent corticosteroids, but this was not associated with 25(OH)D levels.
Low serum 25(OH)D in patients with SLE is associated with proteinuria and urinary DBP. Vitamin D deficiency is associated with disease activity in patients with JDM and SLE; this relationship in SLE may be confounded by proteinuria.
25-hydroxyvitamin D; vitamin D binding protein
To identify factors associated with frequent severe vaso-occlusive pain crises in a contemporary pediatric cohort of sickle cell anemia (SCA)enrolled in a prospective study of pulmonary hypertension and the hypoxic response in sickle cell disease (SCD).
Clinical and laboratory characteristics of children with SCA who had ≥3 severe pain crises requiring health care in the preceding year were compared with subjects with <3 such episodes.
Seventy-five children (20%) reported ≥3 severe pain episodes in the preceding year, and 232 (61%) had none. Frequent pain episodes were associated with older age (OR 1.2; 95% CI 1.1–1.3; P<0.0001), α-thalassemia trait (OR 3.5; 1.6–6.7; P=0.002), higher median hemoglobin (OR 1.7; 95% CI: 1.2–2.4; P<0.003) and lower lactate dehydrogenase (LDH) concentration (OR 1.82; 95% CI: 1.07–3.11; P = 0.027). Children with high pain frequency also had an increased iron burden (serum ferritin 480 vs. 198 μg/L; P=0.006) and higher median tricuspid regurgitation jet velocity (2.41 vs. 2.31 m/s; P=0.001). Neither hydroxy urea use nor fetal hemoglobin levels were significantly different according to severe pain history.
In our cohort of children with SCA increasing age was associated with higher frequency of severe pain episodes as were α-thalassemia, iron overload, higher hemoglobin and lower LDH concentration and higher tricuspid regurgitation velocity.
Sickle cell anemia; vaso-occlusive crisis; pain
To determine whether delivery room cardiopulmonary resuscitation (DR-CPR) independently predicts morbidities and neurodevelopmental impairment (NI) in extremely low birth weight (ELBW) infants.
Cohort study of infants born with birth weight (BW) 401-1000g and gestational age (GA) 23-30wks. DR-CPR was defined as chest compressions and/or drugs. Logistic regression was used to determine associations between DR-CPR and morbidities, mortality and NI at 18-24 months (Bayley II mental or psychomotor index < 70, cerebral palsy, blindness or deafness). Data are adjusted Odds Ratio (OR) with 95% confidence interval.
Of 8685 infants, 1333(15%) received DR-CPR. DR-CPR infants had lower BW (708±141vs 764±146g, p<0.0001) and GA (25±2 vs 26±2 wks, p<0.0001). DR-CPR infants had more pneumothoraces (OR 1.28, 1.48-2.99), Grade 3-4 intraventricular hemorrhage (OR 1.47, 1.23-1.74), bronchopulmonary dysplasia (OR 1.34, 1.13-1.59), death by 12 hours (OR 3.69, 2.98-4.57) and by 120 days after birth (OR 2.22, 1.93-2.57). NI among survivors (OR 1.23, 1.02-1.49), and death or NI (OR 1.70, 1.46-1.99) were higher for DR-CPR infants. Only 14% of DR-CPR recipients with 5-minute Apgar score<2 survived without NI.
DR-CPR is a prognostic marker for higher mortality and NI for ELBW survivors. New DR-CPR strategies are needed for this population.
cardiac compressions; epinephrine; neurodevelopmental outcomes
To test the hypothesis that resistin is associated with insulin resistance and inflammation in pediatric patients with chronic kidney disease (CKD).
This study is a cross-sectional analysis of 319 children in the Chronic Kidney Disease in Children cohort, a large cohort of children with stage II–IV CKD. Univariate and multivariate regression modeling was used to evaluate the association of serum resistin level with glomerular filtration rate (GFR), demographic data, and cardiovascular risk factors, including inflammatory cytokines, insulin resistance, and serum lipids.
In univariate analyses, serum resistin level was negatively correlated with GFR (P < .01). Increased serum resistin was associated with elevated inflammatory cytokines, including interleukin (IL)-6 (P < .01), IL-10 (P < .01), and tumor necrosis factor-α (P < .01). Resistin level was not associated with insulin resistance, although it was positively correlated with serum triglycerides (P < .01) and negatively correlated with high-density lipoprotein cholesterol (P < .01). In multivariate analysis, GFR (β = −0.01; P < .001), IL-6 (β = 0.18; P < .001), IL-10 (β = 0.09; P = .01), and pubertal status (β = 0.18; P < .01) were significantly associated with serum resistin level.
These results indicate that serum resistin level increases with GFR decline and is involved in the inflammatory milieu present in CKD.
To investigate the variation and trends in neuroimaging among children evaluated for minor head injury at major U.S. pediatric emergency departments (ED).
We conducted a retrospective study of children < 19 years of age with mild head injury who were evaluated and discharged home from the ED at 40 pediatric hospitals from 2005–2009 using the Pediatric Health Information Systems™ database. Variation in CT rates between hospitals was assessed for correlation with hospital specific rates of intracranial hemorrhage, admission and return visits. Age adjusted trends in CT utilization were calculated over the 5 years.
Over the 5 years, the median rate of imaging for minor head injured patients was 36% [IQR 29–42%, range 19–58%]. There was no correlation between institution-specific rates of CT imaging and intracranial hemorrhage, admission or return visit rates. Age-adjusted rates of CT utilization decreased over the 5-year period on CT rates (OR 0.94 [95% CI 0.92, 0.97], p<0.001).
In this study, we found significant practice variation in CT utilization at pediatric hospitals evaluating children with minor head injury. These data may help guide national benchmarks for the appropriate use of CT imaging in pediatric minor head injury patients.
Trauma; Radiology; Computed Tomography
To investigate whether abnormal regional white matter architecture in the perisylvian region could be used as an easy and sensitive quantitative method to demonstrate language pathway abnormalities in children with developmental delay (DD).
We performed diffusion tensor imaging (DTI) in 15 DD subjects (age: 61.1± 20.9 months) and 15 age-matched typically developing (TD) children (age: 68.4± 19.2). Using DTI color-coded orientation maps, we quantified the fraction of fibers in the perisylvian region that are oriented in anteroposterior (AP) and mediolateral (ML) directions and their ratio(AP/ML) was calculated.
The AP/ML ratio was more sensitive than tractography in characterizing perisylvian regional abnormalities in DD children. The AP/ML ratio of the left perisylvian region was significantly lower in DD children compared with TD children (p = 0.03). The ML component of bilateral perisylvian regions was significantly higher in DD children compared with TD children (p=0.01 (left) and p=0.004(right)). No significant difference was found in the AP component between the two groups. A significant negative correlation of the left ML component with Vineland communication skills was observed (r = −0.657, p=0.011).
The AP/ML ratio appears to be a sensitive indicator of regional white matter architectural abnormalities in the perisylvian region of DD children.
Developmental delay; Arcuate Fasciculus; Diffusion tensor imaging; Mental retardation; perisylvian language pathways
To quantify lean mass (LM) and fat mass (FM) in survivors of childhood allogeneic hematopoietic stem-cell transplantation (alloHSCT) compared with healthy reference participants, and identify risk factors for body composition abnormalities.
Whole body LM and FM were measured bydual energy x-ray absorptiometry in 54 survivors (ages 5–25 yr) and 894 healthy reference participants in a cross-sectional study. Multivariate regression models were used to compare sex-and race- specific Z-scores for LM (LM-Ht-Z) and FM (FM-Ht-Z) relative to height in survivors and reference participants, and to identify correlates of LM-Ht-Z and FM-Ht-Z in alloHSCT.
Height-Z was significantly lower in alloHSCT (P<0.001) vs. reference participants; BMI-Z did not differ (P=0.13). Survivors had significantly lower mean LM-Ht-Z [−0.72 (95% CI:−1.02, −0.42);P<0.001] and greater FM-Ht-Z[1.10 (95% CI:0.84, 1.39;P<0.001], compared with reference participants. LM-Ht-Z deficits in alloHSCTwere larger [−1.26(95% CI:−1.53, −0.99;P<0.001] after adjustment for FM-Ht-Z. Endocrinopathies and alloHSCT characteristics were not associated with LM-Ht-Z or FM-Ht-Z.
Survivors of childhood alloHSCT have significant LM deficits and FM excess. Future studies should identify the mechanism and consequences of these abnormalities.
Allogeneic hematopoietic stem cell transplantation; growth failure; body composition; LM; fat mass
To determine the effect of mild fluid restriction on the hospital course of neonates with transient tachypnea of the newborn (TTN).
This is a pilot prospective randomized controlled trial of 64 late preterm and term neonates diagnosed with TTN at a single tertiary-care hospital in the United States. Patients were randomized to receive standard fluid management or mild fluid restriction. Primary outcome was duration of respiratory support. Secondary outcomes were duration of admission to the ICU, time to first enteral feed, and total and composite hospital charges. Results were analyzed by t-test, chi-square, Kaplan-Meier estimation and proportional hazards regression.
Fluid restriction did not cause adverse events or unsafe dehydration. Fluid management strategy did not affect primary or secondary outcomes in the broad study population. Fluid restriction significantly reduced duration of respiratory support (p=0.008) and hospitalization costs (p=0.017) for neonates with severe TTN.
Mild fluid restriction appears safe in late preterm and term neonates with uncomplicated TTN. Fluid restriction may be of benefit in decreasing duration of respiratory support and hospitalization charges in term and late preterm neonates with uncomplicated severe TTN.