Dean Edell

Smaller volume, thickened formulas in the management of gastroesophageal reflux in thriving infants.

Background The effect of smaller volume, thickened formulas on gastroesophageal reflux is not clear. Methods The frequency of gastroesophageal reflux and duration of acid pH in the esophagus were determined in six thriving infants using extended esophageal pH monitoring. Results There was a significant reduction in frequency of emesis and gastroesophageal reflux but not the duration of acid pH in the esophagus with the use of infant formula thickened with rice cereal to provide a nutritionally appropriate intake in a smaller volume. Conclusions Thickening of formula with rice cereal in a nutritionally balanced form and smaller volume may be an appropriate strategy for reducing frequency of emesis and gastroesophageal reflux in thriving infants.

Are We Overprescribing Antireflux Medications for Infants With Regurgitation

OBJECTIVE. Our goal was to evaluate the diagnosis and treatment of infants with persistent regurgitation who were referred to a pediatric gastroenterology service. METHODS. The records of 64 infants with persistent regurgitation and without any neurodevelopmental abnormalities, underlying illness, or cigarette smoke exposure were evaluated for diagnostic workup and treatment. Forty-four infants underwent extended esophageal pH monitoring. RESULTS. Only 8 of 44 pH studies showed abnormal acid reflux. Forty-two of these 44 infants were already on antireflux medications. Other etiologies included hypertrophic pyloric stenosis (4) and renal tubular acidosis (1). Discontinuation of medication did not result in worsening of symptoms in most infants with normal pH studies. CONCLUSIONS. The majority of infants who were prescribed antireflux drugs did not meet diagnostic criteria for gastroesophageal reflux disease.

Effect of interventions during acute respiratory syncytial virus bronchiolitis on subsequent long term respiratory morbidity.

Respiratory syncytial virus (RSV) is a common cause of respiratory illness in the first 2 years of life. During the past decade the mortality from RSV bronchiolitis in infants has reduced significantly; however, the incidence of postbronchiolitis respiratory morbidity remains high. Recent data have established RSV to be an independent risk factor for the development of subsequent reactivity and impaired lung function until the age of 11 years. Earlier studies have reported that up to 70% of infants can have some respiratory sequelae for up to 10 years after initial bronchiolitis. Prevention of respiratory morbidity resulting from RSV bronchiolitis has therefore become a major focus in the management of RSV bronchiolitis. Prevention of RSV infection itself remains the best option for preventing RSV-related morbidity. The lack of an effective vaccine or immunization strategy prompts one to seek other interventions that could potentially reduce, if not prevent, the long term respiratory morbidity associated with RSV bronchiolitis. Some efforts have been made to directly or indirectly modify the initial RSV infection with a view to prevent long term sequelae. In this context the two notable interventions have been with corticosteroids and antivirals.

Lymphoproliferative disorder involving the liver following transplantation : CT appearance

Objective Our goal is to report the CT findings of liver involvement in lymphoproliferative disease in immunosuppressed patients. Materials and Methods We report CT findings in two cases of lymphoproliferative disease involving the liver. Results The findings of this disorder are nonspecific both clinically and radiographically. Conclusion Nonspecific nodular pattern in the liver on CT may represent unrestricted lymphocytic infiltration in the immunosuppressed patient.

Cocaine Poisoning: An Easily Missed Diagnosis in an Infant

We describe an infant with a positive urine drug screen for cocaine. Given the fact that he was bottle fed and 9 months of age, we presume that this drug was intentionally administered to the patient.