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Current Pediatric Reviews
ISSN: 1573-3963
Current Pediatric Reviews
Volume 3, Number 4, November 2007
Contents
Inflammation in Meconium Aspiration Syndrome: Targets
for Pharmacological Modulation Pp. 248-263
Daniela Mokra and Juraj Mokry
[Abstract]
Pulmonary Circulation and Pulmonary Function
in Neonatal Lung Hypoplasia: Treatment with Corticosteroids
Pp. 264-276
Keiji Suzuki and Richard Harding
[Abstract]
Antifungal Prophylaxis in the Neonatal Intensive Care
Unit (NICU) Pp. 277-288
David A. Kaufman, Paolo Manzoni, Matthew J. Gurka and
Leigh B. Grossman
[Abstract]
Combination Vaccines are Key to Achieving Complete
On-Time Childhood Immunization Coverage Pp. 289-292
Félix Aguilar
[Abstract]
Nutrition in Infancy Pp. 293-300
Hania Szajewska and Andrea Horvath
[Abstract]
Review of Pediatric Uveitis Pp. 301-311
Kelly L. Groppi, Janet K. Kim and Debra A. Goldstein
[Abstract]
The Role of Inflammation In Epilepsy Pp.
312-316
Alberto Verrotti, Giuseppe Latini, Alessandra Scardapane,
Rossella Manco and Antonio Del Vecchio
[Abstract]
Cortical Auditory Dysfunction in Childhood Epilepsy:
Electrophysiologic Evidence Pp. 317-327
Heather M. Wied, Peter F. Morrison, Barry Gordon, Andrew
W. Zimmerman, Eileen P. Vining and Dana F. Boatman
[Abstract]
Previously Apparently Undescribed Autosomal-Recessive
Multiple Congenital Anomalies/ Mental Retardation (MCA/MR)
Syndrome Comprising: Fronto-Nasal Dysplasia, Hypertelorism,
Short Stature and Brachydactily Pp. 328-331
Motti Haimi and Ruth Gershoni-Baruch
[Abstract]
Abstracts
[Back to top]
Inflammation in Meconium Aspiration Syndrome:
Targets for Pharmacological Modulation
Daniela Mokra and Juraj Mokry
Pathophysiology of meconium aspiration syndrome (MAS)
is complex and interactions between individual pathomechanisms
are still not completely understood. As recently shown, inflammation
plays a significant role in the pathogenesis of MAS. Activated
cells release and stimulate production of a wide variety of
mediators, including cytokines, enzymes, reactive species,
and other biologically active substances in meconium-injured
lungs. Anti-inflammatory drugs acting on different levels
of inflammatory cascade may in combination with other treatment
(exogenous surfactant, inhaled NO, liquid ventilation) improve
the clinical status of newborns with MAS. For example, corticosteroids
modulate activity of phospholipase A2
and induced NO synthase, influence migration and activation
of leukocytes, and reduce lung edema. Cyclooxygenase inhibitors
modulate production of thromboxane and prostaglandins. Phosphodiesterase
inhibitors have vasodilating, bronchodilating and anti-inflammatory
effects. Antioxidants diminish formation of reactive species.
However, there are many other drugs., e.g. anti-cytokine antibodies,
inhibitors of complement, inhibitors of angiotensin-converting
enzyme, anticoagulants, inhibitors of proteolytic enzymes,
calcium-channel blockers etc. that may be beneficial in MAS.
Nevertheless, further testing is necessary until the novel
approaches may be recommended. In this article, authors reviewed
main factors participating in meconium-induced inflammation
and pointed out some targets for its pharmacological modulation.
[Back to top]
Pulmonary Circulation and Pulmonary Function
in Neonatal Lung Hypoplasia: Treatment with Corticosteroids
Keiji Suzuki and Richard Harding
Lung hypoplasia (LH) is a common neonatal problem resulting
from small, structurally immature lungs. LH is a graded condition
which, if severe, is life threatening due to impairment of
ventilation, pulmonary blood flow and gas exchange. Although
the effects of LH on the structure of lung parenchyma have
been well defined in a number of species, little is known
about its structural or functional effects on the pulmonary
vasculature. Using an ovine model of bilateral LH we have
studied pulmonary vascular development and blood flow in relation
to ventilatory performance and lung mechanics. LH greatly
increases pulmonary vascular resistance and is associated
with evidence of impaired development of the pulmonary vasculature,
and decreased mRNA levels of vascular growth factors such
as PDGF and PECAM-1. Many studies have shown that antenatal
corticosteroid treatment has a beneficial effect on lung development
and the perinatal transition. In neonatal sheep with LH, lung
compliance is not affected by a single dose of antenatal corticosteroids
but pulmonary vascular resistance is significantly reduced,
and mRNA expressions of PDGF and PECAM-1 normalised. It is
clear that antenatal corticosteroids could be a promising
treatment option for infants experiencing difficulties with
perinatal adaptation of the pulmonary circulation associated
with LH and other pathological respiratory conditions.
[Back to top]
Antifungal Prophylaxis in the Neonatal Intensive Care
Unit (NICU)
David A. Kaufman, Paolo Manzoni, Matthew J. Gurka and
Leigh B. Grossman
In the NICU neonates at highest risk for invasive Candida
infections are extremely preterm infants and neonates with
complicated gastrointestinal diseases. Due to the high mortality,
neurodevelopmental impairment, end-organ involvement and need
for central venous catheter removal in the management of fungal
bloodstream infections, prevention of invasive Candida
infections should be paramount in each NICU. Even with prompt
treatment, the mortality rate is as high as 40% and neurodevelopmental
impairment 57% in infants <1000 grams. Multiple studies
have been performed with fluconazole prophylaxis, including
a recent multicenter randomized controlled trial. All of the
studies have demonstrated efficacy, safety and no increase
or emergence of fungal resistance. Analysis of these studies
demonstrates that fluconazole prophylaxis reduces the risk
of developing invasive fungal infection in high risk infants
<1000g at birth by 90% (P<0.0001) and all infants <1500g
at birth by 85% (P<0.0001). The mortality rate from all
causes was also decreased by 24% (P = 0.02). Additionally,
studies have demonstrated that Candida-related mortality
can be eliminated in an entire NICU by targeting fluconazole
prophylaxis in infants <1000 grams birth weight. In preventing
invasive Candida infections, fluconazole prophylaxis
can eliminate these infections as a cause of neurodevelopmental
impairment and mortality and should be combined with infection
control practices in every NICU.
[Back to top]
Combination Vaccines are Key to Achieving Complete
On-Time Childhood Immunization Coverage
Félix Aguilar
Pediatric vaccination programs have dramatically reduced the
morbidity and mortality of infectious diseases [1], but timeliness
remains an important barrier to full realization of the potential
health benefits. Recent data suggest that 1 in 3 children
in the United States are undervaccinated for more than 6 months
[2], a delay that can raise the risk of infection both for
the child and for community members with whom the child comes
in contact. Of the factors contributing to undervaccination,
the complexity inherent to multiple schedules for multiple
vaccines may be one of the most challenging. A number of combination
vaccines have already been introduced to simplify immunization
schedules, but further progress in this direction is warranted.
With several promising new vaccines nearing clinical application,
combination vaccines will play an even more critical role
in maintaining children on schedule to achieve the full benefits
of this approach to disease prevention.
[Back to top]
Nutrition in Infancy
Hania Szajewska and Andrea Horvath
The purpose of this paper is to review current knowledge and
provide advice on breastfeeding, formula feeding of term infants
(including which type of formula may be appropriate for a
given patient), and the timing and composition of complementary
feeding. The review is primarily aimed at children living
in Europe, generally in an industrialised country. In brief,
all infants should be exclusively breastfed from birth to
about 6 months (26 weeks) of age or at least for the first
4 months (18 weeks) of life. Breastfeeding should preferably
continue beyond the first year of life. Infants who cannot
be breastfed, or should not receive breast milk, or for whom
breast milk is not available, require breast milk substitutes
of high quality. Based on the available evidence, it is reasonable
to advise that for all infants, complementary foods should
not be given before 17 weeks and should be introduced by 26
weeks; however, no data are available to form evidence-based
recommendations. New foods should not be introduced too often
– generally not more frequently than every 3 days –
nor should more than one new food be introduced at a time.
[Back to top]
Review of Pediatric Uveitis
Kelly L. Groppi, Janet K. Kim and Debra A. Goldstein
Uveitis is a significant cause of blindness and vision loss
in children and encompasses a diverse group of disease processes.
It is important that physicians become familiar with presenting
symptoms and signs of uveitis. Early recognition and referral
to a uveitis specialist is key in preventing irreversible
vision loss. Aggressive management with anti-inflammatory
medications and immunosuppressive agents may be necessary.
This chapter will provide an introduction to common causes
of pediatric uveitis, as well as a discussion of classification,
etiologies, work-up, and management.
[Back to top]
The Role of Inflammation In Epilepsy
Alberto Verrotti, Giuseppe Latini, Alessandra Scardapane,
Rossella Manco and Antonio Del Vecchio
Experimental and clinical data suggest that activation of
inflammation may occur after epileptic seizures without any
evidence of systemic or central nervous system infection.
Various animal and human studies have recently shown that
cytokines are involved in the pathogenesis of epilepsy. Although
little is known about the role of inflammation in epilepsy,
it has been hypothesized that activated immune system and
subsequent inflammatory reaction in the brain can intervene
to facilitate certain molecular and structural changes occurring
during and after seizure activity. This review focuses on
the relationship between inflammation and epilepsy.
[Back to top]
Cortical Auditory Dysfunction in Childhood Epilepsy:
Electrophysiologic Evidence
Heather M. Wied, Peter F. Morrison, Barry Gordon, Andrew
W. Zimmerman, Eileen P. Vining and Dana F. Boatman
Children with epilepsy are at increased risk for language
impairments. Recent studies have suggested that abnormal cortical
processing of complex sounds, including speech, may be a contributing
factor. Cortical auditory evoked potentials provide an objective,
non-invasive method for assessing auditory function in children.
We begin with an overview of the cortical auditory system,
cortical auditory evoked potentials, and childhood epilepsies.
This overview provides a framework for reviewing recent studies
using auditory evoked potentials to evaluate sound processing
in children with epilepsy. Clinical implications, methodological
considerations, and directions for future research are discussed.
[Back to top]
Previously Apparently Undescribed Autosomal-Recessive
Multiple Congenital Anomalies/ Mental Retardation (MCA/MR)
Syndrome Comprising: Fronto-Nasal Dysplasia, Hypertelorism,
Short Stature and Brachydactily
Motti Haimi and Ruth Gershoni-Baruch
We describe two sisters born to a consanguineous
Arab Muslim couple in northern Israel. Among other clinical
findings, both have moderate mental retardation, short stature,
“leonine” facies, hypertelorism, broad nasal root,
long philtrum, fronto-nasal dysplasia, pigmented lesions of
the irises, brachy-clinodactily, apparantly low-set posteriorly
angulated ears and a webbed neck. This association of anomalies
defines a new syndrome. Parental consanguinity and familial
occurrence in two sisters suggest autosomal recessive inheritance.
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