Francis B. Mimouni

Bone Ultrasound Velocity Curves of Newly Born Term and Preterm Infants

BACKGROUNDnUltrasound velocity (speed-of-sound [SOS]) has been proposed as a non-invasive method of evaluation of bone status in infants. We hypothesized that SOS correlates with both gestational age and birth weight.nnnMETHODSnWe measured SOS within the first 96 hours of life at the right tibial midshaft location in 73 neonates ranging in gestational age from 25 to 41 weeks, and in birth weight from 825 to 3880 grams. We used the Sunlight Omnisense 7000p device (Tel Aviv, Israel). Results are expressed as meanS +/- 1 SD; statistical analyses included linear regression and computation of 95% CI regression lines; p<0.05 was considered significant.nnnRESULTSnThere was, as hypothesized, a significant correlation between gestational age (or birth weight) and SOS. There were no significant differences between males and females. Ninety-five percent confidence intervals were established.nnnCONCLUSIONSnThese data may be used as reference ranges for further studies.

Retarded skeletal maturation in children with primary enuresis

Primary nocturnal enuresis (PNE) is a common paediatric problem of multifactorial aetiology. Growth and skeletal maturation were studied in 35 otherwise healthy children with PNE, 26 boys and 9 girls aged 6–14 years, and comparison was made with a control (CTR) group of 19 boys and 3 girls aged 6–13 years of similar ethnic origin. There was no significant difference between the mean height and weight centiles of the two groups. Bone age (BA) determined by the TW-2 method showed a significant lag behind chronological age (CA); the CA-BA difference being 1.46±1.56 years in the PNE group and -0.08±0.8 years in the CTR group (P<0.001). In 11 of the PNE group (31%) the BA retardation was greater than 24 months: in 4 it was between 24 to 36 months and in 7 the difference was greather than 36 months. In all these children T4 and TSH were found to be normal.It is hypothesised that the retarded bone age in children with PNE may reflect delayed maturation of regulatory CNS functions.

Predictive factors of morbidity in childhood parapneumonic effusion-associated pneumonia: a retrospective study.

Study Objective: To find the clinical and laboratory criteria that best predict a prolonged fever in children with parapneumonic effusion-associated pneumonia treated conservatively. Design: Retrospective, cohort study. Patients: Children admitted to the Shaare Zedek Medical Center between January 1, 1997, and December 31, 2006, and who had been discharged with a diagnosis of empyema and pleurisy. Measurements and Results: One hundred-twenty children were included, all of whom were treated with antibiotics; in 80 patients, a thoracic drain was introduced; in 23, pleural tap was performed; and in 17 patients, no special procedure was performed. In no case was video-assisted thoracic surgery performed. The mean total days of fever was 12.8 ± 5.9 (2–29 days), and the mean length of stay at the hospital was 11.5 ± 4.9 (3–25) days. In 44 patients (37%), a bacterial culture was positive either in blood or in pleural fluid or both. A positive blood or a positive pleural fluid culture was significantly associated with a prolonged fever as was a history of an underlying disease. Platelet counts, serum Na, serum protein, pleural lactate dehydrogenase (LDH), pleural glucose, pleural/serum LDH ratio, pleural/serum glucose ratio, and pleural fluid pH were the only factors significantly but weakly correlated with the total duration of fever or duration of fever after admission. A “fever duration” score using platelet count, pleural fluid pH, pleural/serum LDH ratio, and pleural/serum glucose ratio predicted a prolonged course of fever (>7 days) with a sensitivity of 91% (95% confidence interval: 60%–100%) and a specificity of 47% (95% confidence interval: 25%–71%). Conclusions: In children with parapneumonic effusion-associated pneumonia, a positive bacterial culture and an underlying disease are associated with prolonged fever. A low score based on platelet count, pH pleural fluid and glucose, and LDH pleural/serum ratio is associated with a prolonged fever. We speculate that children with the risk factors mentioned earlier may be the best candidates for an early aggressive approach.

Vitamin D requirements in the first year of life.

Purpose of reviewTo understand the basis for current recommendations for vitamin D supplementation in childhood and the differences between the recommendations published by major expert committees, using the Medline engine of the US National Library of Medicine and the National Institutes of Health. Recent findingsRecent recommendations published by major national expert committees are essentially based on expert opinion (a relatively low level of evidence). Randomized controlled trials are very few, and there are no systematic reviews or meta-analyses on the topic. Most trials have examined the question of whether a specific daily vitamin D dose is capable or not to prevent rickets (by studying surrogate markers of rickets). There are no trials that have systematically attempted to determine the upper limit of daily vitamin D dose beyond which its toxic effects may appear. Whether or not outcomes such as osteoporosis (or low bone mass) and specific types of cancer may be prevented by ‘generous’ vitamin D supplementation is unclear and mostly based on indirect epidemiologic data not clearly substantiated by randomized controlled trials SummaryThe dose of daily vitamin D supplements needed to prevent rickets is probably much lower than that recommended by most expert committees. Whether higher doses of daily vitamin D supplements may or may not prevent other poor outcomes such as adult osteoporosis or specific types of cancer is not yet known.

Orotracheal Tube Insertion in Extremely Low Birth Weight Infants

Thirty-one consecutive infants <1000 g at birth were intubated according to Tochens rule; placement was verified/modified after auscultation and by radiology. Depth measurements were by caliper and radiology. Tochens rule alone would lead to inadequate tube placement in 47% of infants. Auscultation allows adequate placement in only three-fourths of patients.

The epidemiologic trends of scabies among Israeli soldiers: a 28-year follow-up

Background Scabies is not a notifiable disease in most countries. Thus, the reported rates of the disease in large populations are usually inaccurate and based on estimations. Scabies is usually reported only when large outbreaks occur.

Neonatal polycythaemia: critical review and a consensus statement of the Israeli Neonatology Association

The aim of this paper is to critically review neonatal polycythaemia (NP) literature, in terms of definition, diagnosis and management. We reviewed all Medline articles on NP up to December 2009. (i) The textbook definition of NP [venous haematocrit (HCT)u2003>u200365%] is empirical and not based on statistical definition, symptoms or complications. (ii) Measurement of viscosity is not better than HCT in predicting complications. (iii) Normovolaemic NP because of increased erythropoiesis may be different from hypervolaemic polycythaemia because of excessive foetal transfusion. (iv) Coexisting hypoglycaemia may worsen long‐term outcome. (v) Four clinical trials (CTs) studied partial exchange transfusion (PET) on outcomes. In all trials, PET was performed after 6u2003h of life. There is no evidence that PET improves neurodevelopmental outcome of asymptomatic NP, and it might increase the risk of necrotizing enterocolitis. These CTs have inherent design flaws: (a) CNS ‘damage’ may occur before PET. (b) Confounding variables that may affect outcome have not been studied. (vi) If PET is performed, normal saline is the best alternative. (vii) The long‐term effect of PET on symptomatic infants has not been studied.

Bhutani-based nomograms for the prediction of significant hyperbilirubinaemia using transcutaneous measurements of bilirubin

Aim:u2002 Prospectively establish the relationship between transcutaneous bilirubin (TcB) and total serum bilirubin (TSB), and develop nomograms similar to Bhutani’s nomograms, based on our TcB data.

Decreased bone ultrasound velocity in large-for-gestational-age infants

BACKGROUND: Bone speed of sound is a measure of bone breakability. There are few reports on bone mineral content in large for gestational age infants; most of them in infants of diabetic mothers. There are no data on bone speed of sound in large for gestational age infants of nondiabetic mothers.OBJECTIVE: To test the hypothesis that large for gestational age infants of nondiabetic mothers have lower bone speed of sound than appropriate for gestational age infants.DESIGN/METHODS: Bone speed of sound was measured within the first 96 hours of life at the right tibial midshaft in 25 singleton large for gestational age infants of non diabetic mothers and compared to appropriate for gestational age controls.RESULTS: Bone speed of sound measured in large for gestational age infants of nondiabetic mothers was lower than in controls.CONCLUSIONS: Large for gestational age infants of nondiabetic mothers have lower bone speed of sound than controls.

Neonatal blood glucose concentrations in caesarean and vaginally delivered term infants

Background:u2002 Little is known about the glucose concentrations at and after birth of infants delivered by caesarean section (CS), when compared with infants born vaginally (VD).