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Current Pediatric Reviews
ISSN: 1573-3963
Current Pediatric Reviews
Volume 3, Number 2, May 2007
Contents
Renal Tubular Acidosis Pp. 103-107
Iradj Amirlak, Hassib Narchi and Lihadh Al-Gazali
[Abstract]
Novel Concepts in the Pathogenesis and Management
of Pediatric Hypertension Pp. 109-114
Douglas M. Silverstein
[Abstract]
Respiratory Viruses, Eosinophil Activation, and Early
Allergen Sensitization – Early Life Predictors of Persistent
Wheezing and Asthma Pp. 115-127
Anne Kotaniemi-Syrjänen and Matti Korppi
[Abstract]
Mastering the Treatment of Diabetes Mellitus Type
1 in Childhood and Adolescence Pp. 129-139
Jana Varvarovská, Konrad Siala, Renata Pomahacová,
Josef Sýkora, František Stožický and
Zdenek Rušavý
[Abstract]
Dopamine Administration in Very Low Birth Weight Preterm
Infants: Emerging Issues on Endocrine Effects Pp.
141-166
Luca Filippi, Chiara Poggi and Marco Pezzati
[Abstract]
Intrahepatic Cholestasis of Pregnancy and Bile Acids
Induced Lung Injury in Newborn Infants Pp. 167-176
Enrico Zecca, Daniele De Luca, Marco Marras, Giada Barbato
and Costantino Romagnoli
[Abstract]
Abstracts
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Renal Tubular Acidosis
Iradj Amirlak, Hassib Narchi and Lihadh Al-Gazali
Renal tubular acidosis (RTA), a clinical syndrome with
hyperchloremic metabolic acidosis with normal anion gap, is
an uncommon and sometimes overlooked condition. It may have
multiple causes, some sporadic, some genetically transmitted;
some are isolated or may be associated with other renal or
systemic pathologies or diseases. All these factors add to
the complexity of recognition and management of this extended
range of conditions.
We hereby describe several children with different types of
RTA, illustrating the different mode of presentations and
some of the etiologies. Pathophysiology is reviewed, as well
as the practical approach to the diagnosis and management.
In addition, recent genetically identified conditions are
reviewed, with emphasis on increasingly recognized association
with other systems involvement.
[Back to top]
Novel Concepts in the Pathogenesis and Management
of Pediatric Hypertension
Douglas M. Silverstein
Hypertension is a major cause of morbidity and mortality throughout
the world and an independent risk factor for cardiovascular
disease. Although the incidence of hypertension is significantly
greater in adults than children, recent trends reveal a rising
percentage of children with high blood pressure. Coincident
with the dramatic increase of the number of children with
hypertension has been a growing field of knowledge regarding
novel causes and therapeutic options for children with high
blood pressure. Most reviews in pediatric hypertension focus
on the many traditional causes of hypertension in children
including renovascular disease, renal parenchymal disease,
medication usage, endocrine causes (e.g. hyperthyroidism),
and cardiovascular causes (e.g. coarctation of the aorta).
However, recent research suggests that non-traditional causes
of hypertension including chronic inflammation, low nephron
number, prematurity/low birth weight, malnutrition, obesity
(as part of the metabolic syndrome), hyperinsulinemia/insulin
resistance, elevated uric acid, and dietary factors may be
more common than previously thought. There are also innovative
concepts in the treatment of childhood hypertension, including
behavioral and combination drug therapy. In a rapidly evolving
field and epidemic of children developing high blood pressure,
it is therefore imperative for the generalist and specialist
to be cognizant of the many changes occurring in the pathogenesis
and management of childhood hypertension.
[Back to top]
Respiratory Viruses, Eosinophil Activation, and Early
Allergen Sensitization – Early Life Predictors of Persistent
Wheezing and Asthma
Anne Kotaniemi-Syrjänen and Matti Korppi
Approximately 20% of all children will suffer from wheezing
illnesses, and in 1-3% of all infants, respiratory distress
is severe enough to require hospitalization. As wheezing infants
form a heterogeneous group with different phenotypes and outcomes,
it is still a challenge to identify those who will go on wheezing
to develop asthma. In order to facilitate the prediction of
later asthma, algorithms have been developed for clinical
use. The algorithms validated this far are based on personal
atopic findings and the parental history of asthma, and blood
eosinophilia has been the only laboratory marker included.
In this review, we will focus on the role of respiratory viruses,
eosinophil activation markers, specific immunoglobulin E antibodies,
and skin prick tests, as early life predictors of persistent
wheezing and asthma.
According to recently published results, rhinoviral infection
seems to carry a high risk for persistence of wheezing. Sensitization
to inhalant allergens in infancy strongly increases the risk
for later respiratory allergy. Eosinophil activation markers
seem not to offer significant additional value over blood
eosinophils.
Determination of viral etiology of wheeze, and/or screening
for early sensitization to inhalant allergens in individuals
with no clinically evident atopy might be of use in identifying
future asthmatics.
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Mastering the Treatment of Diabetes Mellitus Type
1 in Childhood and Adolescence
Jana Varvarovská, Konrad Siala, Renata Pomahacová,
Josef Sýkora, František Stožický and
Zdenek Rušavý
Diabetes mellitus type 1 (T1DM), the most common variant of
the disease in childhood, requires a well-informed patient
and/or parents, as well as an enthusiastic diabetologist.
This paper notes that disease compensation is influenced by
several diverse factors of which basic therapeutic components
include intensified insulin therapy, diet and regular physical
activity. The authors engage in the issues of T1DM complications
as well as the adverse effects of common organic diseases
in childhood on glycemic profiles and patient’s psyche.
A supporting family background and a fusion of medical carers
involving nutritional therapists, nurses, physiotherapists,
education supervisors and the diabetologist, lead to the successful
management of this increasingly common childhood illness.
[Back to top]
Dopamine Administration in Very Low Birth Weight Preterm
Infants: Emerging Issues on Endocrine Effects
Luca Filippi, Chiara Poggi and Marco Pezzati
Preterm newborns weighing less than 1500 g (very low birth
weight infants, VLBW) represent a critical population with
high prevalence of morbidities, often requiring hemodynamic
stabilization. Dopamine is a natural cathecolamine widely
used for this purpose because it exerts pleiotropic anti-shock
effects on cardiovascular, renal and endocrine systems, acting
on adrenergic and dopaminergic receptors. Dopamine is a first
choice drug in VLBW infants for inotropic support and optimisation
of renal and splanchnic perfusion, mostly indicated for the
treatment of hypotension, symptomatic patent ductus arteriosus
and renal failure.
Dopamine reversibly suppresses pituitary functions in adults
but its effects on endocrine balance have been poorly studied
in VLBW infants. Recent studies showed a dose-dependant reduction
of TSH and T4 plasmatic levels in dopamine-treated VLBW infants
and a positive correlation between dopamine infusion and incidence
of transient hypothyroxinemia of prematurity.
Further studies demonstrated that dopamine infusion also reduces
PRL secretion in VLBW infants. TSH, T4 and PRL suppression
rapidly reverses after dopamine withdrawal, when a significant
hormonal rebound is observed. Therefore, such iatrogenic suppression
probably cannot involve long-term injuries and T4 substitutive
administration appears unecessary during short course dopamine
treatment.
Recent observations suggest that dopamine infusion can prevent
early diagnosis of congenital hypothyroidism (CH) when screening
programs are merely based on TSH plasmatic levels. Considering
the severe neurodevelopmental outcome of undiagnosed CH, other
screening strategies should be considered in treated neonates,
such as simultaneous T4 and TSH testing and hormonal re-evaluation
after dopamine discontinuation.
A final issue of this review regards a possibile role of dobutamine
as an alternative safer inotropic drug.
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Intrahepatic Cholestasis of Pregnancy and Bile Acids
Induced Lung Injury in Newborn Infants
Enrico Zecca, Daniele De Luca, Marco Marras, Giada Barbato
and Costantino Romagnoli
Intrahepatic cholestasis of pregnancy (ICP) is a
clinical syndrome of unknown pathophysiology, occurring during
the second half of pregnancy and persisting until delivery.
The incidence of ICP varies from 0.1% to 1.5% of pregnancies
in Europe, North America and Australia and from 9.2% to 15.6%
in South American countries such as Bolivia and Chile. This
syndrome has been associated with increased foetal distress,
intrauterine death, premature delivery, perinatal mortality
and, more recently, with the occurrence of respiratory distress
syndrome in the newborn infant. Bile acids (BA) are supposed
to be the main mediators for these complications because ICP
seriously impairs the placental clearance of foetal BA leading
to a dangerous accumulation of these compounds within the
foetus and the newborn. Cholestatic pregnancies have to be
considered high risk ones, recent reports showing that BA
can interfere with surfactant metabolism and are particularly
harmful for the developing lung.
This review summarizes existing literature data on this topic
with particular emphasis on bile acids-induced lung injury.
The authors discuss possible mechanisms of lung damage and
highlight future research perspectives in this field.
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