International Journal of Clinical Pediatrics最新文献

{"title":"COVID-19 in a Down Syndrome Newborn","authors":"Gabriela Caroline Lobato Pontes, A. Lobato, Samela Miranda da Silva, Daniel Figueiredo Alves da Silva, Alexandre Ferreira da Silva, Rodrigo Santiago Barbosa Rocha, Bianca Duarte de Oliveira, Tallita Olga Calvinho Martins, A. Chermont, Katiane da Costa Cunha","doi":"10.14740/ijcp396","DOIUrl":"https://doi.org/10.14740/ijcp396","url":null,"abstract":"A 36-week premature newborn with trisomy 21, had a fever, runny nose and mild dyspnea at 27 days old. Parents had flu-like symptoms. He was admitted to intensive care unit (ICU), in isolation with support therapy. His reverse transcription-polymerase chain reaction (RT-PCR) test for coronavirus disease 2019 (COVID-19) was positive. He had leukopenia and lymphopenia and increased C-reactive protein (CRP) levels, associated with mixed and interstitial opacities on chest radiography. Antibiotic therapy was performed with ampicillin and gentamicin for 10 days. He had improvement of symptoms, with worsening of CRP levels. On the 11th day of hospitalization antibiotic therapy was replaced by clarithromycin, which was performed for 5 days, with laboratory improvement after introduction. Chest computed tomography (CT) showed bilateral ground-glass lesions. He had a good recovery and was discharged from hospital with 17 days of hospitalization. Int J Clin Pediatr. 2020;9(4):116-119 doi: https://doi.org/10.14740/ijcp396","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"5 1","pages":"116-119"},"PeriodicalIF":0.0,"publicationDate":"2020-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81185020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Severe COVID-19 Infection in Children: A Therapeutic Challenge","authors":"I. Brook","doi":"10.14740/ijcp404","DOIUrl":"https://doi.org/10.14740/ijcp404","url":null,"abstract":"Although coronavirus disease 2019 (COVID-19) occurs in children, compared to adults they have a milder disease. They are infrequently admitted to intensive care units, have better prognosis and their mortality is low [1]. However, because children are often asymptomatic or experience a mild disease the true incidence of COVID-19 in children may be higher. Infected children should be isolated and mild cases should receive supportive treatment at home [2]. The use of antiviral or immunomodulatory therapies should only be considered within a clinical trial setting or on a case-to-case basis [2]. Pediatricians should be watchful for the uncommon but serious post-infectious Kawasaki-like, pediatric multisystem inflammatory syndrome related to COVID-19 which may occur several weeks following an asymptomatic or mild infection [2]. Children with serious manifestation of COVID-19, such as septic shock, altered consciousness or multi-organ failure, severe acute respiratory distress syndrome, pediatric multisystem inflammatory syndrome, should be admitted to the hospital and receive supportive care, and organ support in case of organ failure. Administration of antiviral and immunomodulatory therapy may be required. To achieve maximal effect, antivirals should be administered as early as possible before clinical deterioration occurs [3]. Therapeutic options include lopinavir/ritonavir and ribavirin for 7 days, and remdesivir for 10 days [4]. Clinical trials of chloroquine and hydroxychloroquine in adults with COVID-19 infection have shown no efficacy [5]. Some children with acute respiratory distress syndrome manifest clinical features and serological markers seen in hyper inflammatory syndromes. The levels of these markers are often lower than those seen in other syndromes [6]. These markers include chimeric antigen receptor T cell therapy-associated cytokine release syndrome, secondary hemophagocytic lymphohistiocytosis, and sepsis-associated macrophage activationlike syndrome. Most of the inflammation in COVID-19 occurs within the lungs [7]. Children with multisystem inflammatory syndrome should be treated with immunomodulatory therapy. The decision to initiate antiviral and immunomodulatory therapy for COVID-19 should be made after carefully consideration on individual basis. This is because there is currently no proof of their effectiveness for COVID-19 in children and only limited clinical evidence in adults [8, 9]. Therapeutic choices include humanized antiinterleukin 6 (IL-6) monoclonal antibody (tocilizumab) [10], and a recombinant antagonist of the human IL-1 receptor (anakinra) [11]. Corticosteroids may be helpful in the management of rapidly worsening chest imaging and presence of acute respiratory distress syndrome, septic shock, toxic symptoms, encephalitis or encephalopathy, secondary hemophagocytic lymphohistiocytosis, and wheezing [12, 13]. Those manifesting pediatric multisystem inflammatory syndrome with clinical features similar to Kawasa","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83054835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-Cardiogenic Pulmonary Edema With Refractory Hypotension in a Child From Amlodipine Overdoses","authors":"I. Gjeta, D. Sala, I. Bakalli, E. Celaj, E. Kola","doi":"10.14740/IJCP398","DOIUrl":"https://doi.org/10.14740/IJCP398","url":null,"abstract":"Intoxications from calcium blockers are not common in daily pediatric practice, but often they can be life-threatening and result fatal for children. Non-cardiogenic edema in children as a result of overdose from amlodipine is rare. In this article, we want to present a case of an intentional intoxication from overdose of amlodipine in a teen girl who suffered complications with refractory hypotension and non-cardiogenic pulmonary edema after 2 days from ingestion. This article wants to highlight the reporting of this rare life-threatening complication because of overdose. It will also focus on the successful supportive treatment with liquids, salt of calcium, vasopressors, glucagon, intra-lipids, mechanical ventilation and the superiority of using high-dose insulin-euglycemia in the concomitant refractory hypotension. Int J Clin Pediatr. 2020;9(4):120-124 doi: https://doi.org/10.14740/ijcp398","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"7 1","pages":"120-124"},"PeriodicalIF":0.0,"publicationDate":"2020-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90201789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Work Engagement as a Measure of Wellness in Pediatric Hospital Medicine","authors":"E. Lu, Kathryn Leyens, Tony R Tarchichi, Sylvia Choi, S. McIntire, A. McCormick","doi":"10.14740/IJCP399","DOIUrl":"https://doi.org/10.14740/IJCP399","url":null,"abstract":"Background: Literature on wellness in pediatrics is limited and there are no published data specific to pediatric hospital medicine (PHM). Existing literature on wellness focuses largely on physician burnout, but wellness also includes positive traits like work engagement. We sought to assess work engagement and burnout in pediatric hospitalists nationwide. Methods: The study utilized a survey including demographic data, the Utrecht Work Engagement Scale (UWES-17), and the Mini-Z burnout measure. The survey recruited participants via the American Academy of Pediatrics Section on Hospital Medicine Listserv. Results: Totally, 432 of 3,085 (14%) respondents completed the survey with mean total UWES score of 4.36 and 36% reported burnout. As expected, higher work engagement scores correlated with decreased rates of burnout (P < 0.0005). Interestingly, work engagement varied by gender and career stage, with lowest scores found in women in early to mid-career (P < 0.05). Conclusions: In this study we evaluated the wellness of pediatric hospitalists, a group that has not been previously studied, using a combination of burnout and work engagement measures which, while validated, had not been previously used to evaluate physician wellness. This study suggests that wellness interventions could be most effective if targeting women in early to mid-career. Further study is needed to determine causes of decreased work engagement and consider appropriate interventions. Int J Clin Pediatr. 2020;9(4):105-109 doi: https://doi.org/10.14740/ijcp399","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"21 1","pages":"105-109"},"PeriodicalIF":0.0,"publicationDate":"2020-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89388909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Oxygen Delivery Patterns on Arterial Oxygen Saturation Among Children","authors":"Deepali Gunjal, Radha Vaidyanathan, Vaibhav Bhosale","doi":"10.14740/ijcp388","DOIUrl":"https://doi.org/10.14740/ijcp388","url":null,"abstract":"Background: Adequate oxygenation to treat hypoxia by suitable oxygen delivery pattern is the essence of pediatric critical care medicine. Monitoring oxygen saturation (SpO 2 ) is thus essential in order to decide course of treatment. It is commonly carried out using painless sequential non-invasive pulse oximetry as well by severely painful random arterial blood gas (ABG) analysis. Methods: This study compared both methods to determine the impact of various oxygen delivery patterns upon SpO 2 at bedside for meaningful and continuous evaluation. In a prospective cohort adopted for study, 60 children from acute pediatric wards of an academic tertiary referral hospital were observed. Children were eligible for enrollment using cross sectional approach, if the treating pediatricians ordered an ABG, on pulse oximetry monitoring with oxygen support by any oxygen delivery device using a validated checklist. Results: Among all the samples, 60 % were infants and 55 % were male. Complaints on admission were vomiting (35%), shortness of breath (33%), diarrhea (28%), lethargy (31%) and Kussmaul breathing (30%). SpO 2 was > 90% for 88% of children. Oxy hood box was used to deliver oxygen to 73% of children. SpO 2 had positive correlation with oxygen delivery methods (r = 0.8) and partial pressure of oxygen (PaO 2 ) by ABG analysis had positive correlation with SpO 2 by pulse oximetry (r = 0.9). Conclusions: Pulse oximetry can be used as a reliable bed side tool to evaluate oxygen delivery patterns and diagnose early respiratory failure in emergency settings where ABG analysis facility is not available. Int J Clin Pediatr. 2020;9(3):72-76 doi: https://doi.org/10.14740/ijcp388","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"34 1","pages":"72-76"},"PeriodicalIF":0.0,"publicationDate":"2020-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81438425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Focal Bacterial Nephritis Associated With Reversible Splenial Corpus Callosum Lesion","authors":"H. Terada, T. Fuchigami, Ryuta Yonezawa, Chihiro Sugiyama, Satoko Takahashi, Yuko Moriuchi, T. Kamioka, Yu Takahashi, Miho Yamanishi, Mina Otsubo, Y. Ohashi, Jun Negishi, I. Morioka","doi":"10.14740/ijcp395","DOIUrl":"https://doi.org/10.14740/ijcp395","url":null,"abstract":"Acute focal bacterial nephritis (AFBN) is a localized bacterial infection of the kidney, which presents as an inflammatory mass without formation of a frank abscess. Rare cases of AFBN are accompanied by neurological symptoms such as meningeal irritation, unconsciousness, and seizures. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is characterized by transient high signal intensity splenial lesions on diffusion-weighted magnetic resonance imaging. MERS can be divided into two types: type 1 with an isolated splenium of the corpus callosum and type 2 with extensive white matter and/or entire callosal lesions. We experienced three rare cases of pediatric AFBN associated with neurological symptoms, including unconsciousness and reversible splenial corpus callosum lesion. The first case was an 8-year-old girl who had neurological symptoms, including unconsciousness, and AFBN was associated with MERS type 2. The second (5-year-old boy) and third (5-year-old girl) cases had neurological symptoms, including unconsciousness and AFBN with MERS type 1. Two of the three cases had AFBN caused by Escherichia coli . All three cases showed high levels of urinary β2-microglobulin (B2MG). AFBN should be suspected in children with fever, rapid clinical deterioration, neurological symptoms including unconsciousness, and high urinary B2MG level. We recommend that abdominal enhanced computed tomography should be performed for the diagnosis of AFBN. Int J Clin Pediatr. 2020;9(3):82-86 doi: https://doi.org/10.14740/ijcp395","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"43 1","pages":"82-86"},"PeriodicalIF":0.0,"publicationDate":"2020-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80795040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mycoplasma pneumoniae Infection in a 13-Year-Old Girl With Down’s Syndrome During the COVID-19 Pandemic","authors":"T. Corbisier, O. Chatzis, D. Linden, P. Petit, D. Tuerlinckx, Dana Dumitriu, A. Haenecour","doi":"10.14740/ijcp384","DOIUrl":"https://doi.org/10.14740/ijcp384","url":null,"abstract":"We report the case of a 13-year-old girl with Down’s syndrome who presented with cough, fever, and a rapidly evolving respiratory failure leading to intensive care unit transfer during coronavirus disease 2019 (COVID-19) outbreak in Belgium. COVID-19-related acute respiratory distress syndrome (ARDS) is rare in teenagers and its diagnosis remains challenging as reverse transcription-polymerase chain reaction (RT-PCR)-testing sensitivity and radiological criteria still have to be defined in that population. We finally concluded to severe Mycoplasma pneumoniae infection. This case report gives the opportunity to discuss the rare occurrence of that disease, and to review the radiological findings of M. pneumoniae - and COVID-19-related pneumonia in teenagers. Int J Clin Pediatr. 2020;9(3):77-81 doi: https://doi.org/10.14740/ijcp384","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"23 1","pages":"77-81"},"PeriodicalIF":0.0,"publicationDate":"2020-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89094083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe Cardiac and Abdominal Manifestations Without Lung Involvement in a Child With COVID-19","authors":"Miriam Gutiérrez-Jimeno, Adriana Ibanez Sada, J. Gavira, Carolina Cebrian-Nebot, Laura López, M. Mojon, Marcos Garcia Howard, Valentín Alzina de Aguilar","doi":"10.14740/ijcp387","DOIUrl":"https://doi.org/10.14740/ijcp387","url":null,"abstract":"Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic, affecting humans of all ages. Clinical features of the pediatric population have been published, but there is not yet enough information to make a definitive description. Fever is typical, as it is respiratory symptom. Rarely are the infection and complications severe, and, when they are, it is almost always in a patient with another underlying disease. However, some otherwise healthy children with COVID-19 do suffer critical organ injury, such as acute myocarditis, heart failure and gastrointestinal inflammation. The mechanism of these organ damages remains unclear. An otherwise normally healthy 13-year-old male was admitted to the pediatric intensive care unit with acute abdomen pain, possible myocarditis and a suspected diagnosis of COVID-19. Noteworthy basal findings were ventricular extrasystoles in the electrocardiogram (EKG) and moderate left ventricular systolic dysfunction. Chest X-ray was normal. Blood tests revealed altered levels of inflammation factors (C-reactive protein (CRP), D-dimer, fibrinogen, interleukin 6 (IL-6)), lymphopenia and elevated cardiac enzymes. The first test for polymerase chain reaction (PCR) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was negative. The patient’s condition worsened, and he entered cardiogenic shock (hypotension, tachycardia and oliguria). He was vomiting continuously, which made pain control difficult; imaging of his abdomen was undertaken. There was no response to fluid resuscitation, and so milrinone and epinephrine were administered. Empiric treatment began with azithromycin, foscarnet, carnitine and immunoglobulins. Hydroxychloroquine was given before the results of repeated SARS-CoV-2 and serology tests were available. Tocilizumab was administered once COVID-19 had been confirmed and massive inflammation had been observed. Progressively the clinical situation and the levels of the parameters studied improved. The patient was discharged 8 days after admission. Most children with SARS-CoV-2 infection are asymptomatic or present only mild symptoms. However, physicians should be aware of atypical and severe manifestations that may occur in the hyperinflammatory phase of the illness. Int J Clin Pediatr. 2020;9(3):92-97 doi: https://doi.org/10.14740/ijcp387","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"1 1","pages":"92-97"},"PeriodicalIF":0.0,"publicationDate":"2020-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82786536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lane-Hamilton Syndrome With Respiratory Failure: A Case Report","authors":"A. Chakravarty, R. Harish, Rizwan Naqishbandi","doi":"10.14740/ijcp379","DOIUrl":"https://doi.org/10.14740/ijcp379","url":null,"abstract":"Lane-Hamilton syndrome is a rare coexistence of idiopathic pulmonary hemosiderosis with celiac disease. Idiopathic pulmonary hemorrhage presents clinically as a classic triad of hemoptysis, iron deficiency anemia and infiltrates on chest radiograph with a variable clinical course. Celiac disease is an autoimmune enteropathy in genetically susceptible individuals triggered by gluten-containing food. We describe a 12-year-old girl with Lane-Hamilton syndrome presenting with severe anemia, pulmonary hemorrhage and respiratory failure. The child had remained previously asymptomatic. A high index of suspicion is required for diagnosis of Lane-Hamilton syndrome in a critically ill child. Int J Clin Pediatr. 2020;9(3):87-91 doi: https://doi.org/10.14740/ijcp379","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"14 1","pages":"87-91"},"PeriodicalIF":0.0,"publicationDate":"2020-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75474746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Significance of P16, EZH2, FOXJ1, and Tenascin Expression in Pediatric Ependymoma","authors":"Sadeq Al-Dandan, S. N. Hussain, Musa Alharbi","doi":"10.14740/ijcp385","DOIUrl":"https://doi.org/10.14740/ijcp385","url":null,"abstract":"Background: The prognosis of pediatric ependymomas remains poor, with treatment being predominantly based on surgery with or without radiotherapy. The lack of robust therapeutic molecular markers for clinical use has hampered attempts to improve survival from ependymomas. This study aimed to assess the prognostic significance of p16, enhancer of zeste homolog 2 (EZH2), forkhead box protein J 1 (FOXJ1), and tenascin in pediatric ependymomas by evaluating their immunohistochemical expression and comparing them with clinical outcomes. Methods: A total of 22 children (< 14 years) with ependymoma were retrospectively analyzed for the expression of p16, EZH2, FOXJ1, and tenascin by immunohistochemical staining. Kaplan-Meier analysis was used to evaluate the association between immunohistochemical marker expression and patient survival. Results: Higher expression of p16, EZH2, FOXJ1, and tenascin was observed in 59.0%, 36.3%, 40.9%, and 68.1% of the ependymoma samples, respectively. Patients with p16-positive and p16-negative tumors had an overall median survival time of 5.38 and 3.38 years and an overall cumulative survival rate of 44.5% and 36.5%, respectively. P16 negativity was significantly associated with poorer outcome (P = 0.009). No relationship was observed between EZH2, FOXJ1, and tenascin expression and overall survival (P = 0.904, 0.844, and 0.646, respectively). Conclusions: Loss of p16 expression was associated with poor prognosis and may be used for risk stratification. Limitations of the present study include its small sample size and variable sensitivity of different antibody clones and detection methods. Int J Clin Pediatr. 2020;9(3):67-71 doi: https://doi.org/10.14740/ijcp385","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"9 1","pages":"67-71"},"PeriodicalIF":0.0,"publicationDate":"2020-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88194814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}