Jasmin Pansy

Pacifier use: what makes mothers change their mind?

Aim: To find out the reasons for mothers to either use or not use a pacifier and to find out the mothers reasons for changing their mind.

The general movement optimality score: a detailed assessment of general movements during preterm and term age

To explore the appropriateness of applying a detailed assessment of general movements and characterize the relationship between global and detailed assessment.

Inflammatory indices in meconium aspiration syndrome.

Meconium aspiration syndrome (MAS) is linked to inflammation, but data on the patterns of hematological indices and C‐reactive protein (CRP) in MAS are lacking. The aim of the study was to evaluate CRP, white blood cell count (WBC), absolute neutrophil count (ANC), and immature‐to‐total neutrophil ratio (IT‐ratio) in MAS and to assess their association with disease severity.

Evaluating bleeding severity in children with newly diagnosed immune thrombocytopenia: a pilot study.

BACKGROUND Childhood immune thrombocytopenia (ITP) is a bleeding disorder characterized by decreased platelet counts. Assessment of the individual bleeding risk during the course of the disease would allow more accurately guiding treatment-related decisions in these patients. PATIENTS AND METHODS We conducted a pilot study and prospectively evaluated platelet counts and bleeding signs using an established bleeding (Buchanan) score in 30 patients with newly diagnosed ITP at 3 different time points (at diagnosis [TP1], on day 2-3 [TP2], and on day 5-8 [TP3]) during the first week after diagnosis. 15 patients received immune modulatory therapy. RESULTS Median platelet counts at the 3 different time points were 13, 19, 32×10 (9)/L (untreated patients) and 2, 7, 37×10 (9)/L (treated patients). Corresponding median cumulative bleeding scores were 5, 2, 0 (untreated patients) and 7, 6, 2 (treated patients). Cumulative median bleeding scores and platelet counts were inversely correlated in treated and untreated patients at all 3 time points. Cumulative median bleeding scores significantly decreased in both groups. CONCLUSIONS Bleeding signs in children with newly diagnosed ITP rapidly improve within one week after diagnosis. Serial grading of bleeding severity seems to be useful to comprehensively assess and monitor the individual bleeding risk in these patients, but has to be evaluated and validated in a larger cohort.

Add-on-therapy with bevacizumab in children and adolescents with poor prognosis non-CNS solid tumors.

Bevacizumab is increasingly being used in adult patients with cancer and children with central nervous system (CNS) tumors. Little, however, is known about the efficacy, risks, and benefits of bevacizumab administration in non-CNS tumors of childhood. The aim of the present study was to report on bevacizumab administered as add-on-therapy for poor prognosis non-CNS solid tumors of childhood and adolescence, including a prospective evaluation of side effects of bevacizumab. Seven patients (female: n=5; median age, 14.5 years) with relapsed (n=4) or primary metastatic (n=3) solid non-CNS tumors received bevacizumab at 5–10 mg/kg body weight intravenously every 2–3 weeks. Assessment of cardiac function, thyroid hormone levels, urine analysis, and radiographic responses were carried out every 3 months. The median time of bevacizumab treatment was 10 (range, 5–17) months. Patients received a median of 16 (range, 10–38) bevacizumab infusions. With a median follow-up of 25 (range, 13–38) months, five patients relapsed after 7–25 months and three of them died. Two patients are still in complete remission for 31 and 32 months, respectively. Fraction shortening decreased in two patients. Bevacizumab was associated with new-onset increase in basal thyroid-stimulating hormone (n=3), mild proteinuria/hematuria (n=5), intermittent hypertension (n=2), hypertension requiring antihypertensive medication (n=3), and epistaxis (n=2). In two patients, therapy with bevacizumab was terminated because of side effects. Selected patients with relapsed or primary metastatic solid non-CNS tumors of childhood and adolescence might benefit from add-on-therapy with bevacizumab. Although the side effects were usually mild, cardiac monitoring seems to be essential during and after the administration of bevacizumab.

Causes of hematochezia and hemorrhagic antibiotic-associated colitis in children and adolescents.

Abstract Diseases causing hematochezia range from benign to potentially life-threatening. Systematic pediatric data on the causes of hematochezia are scarce. We studied the underlying causes and long-term outcome of hematochezia in children. We further investigated the relevance of antibiotic-associated hemorrhagic colitis in children, especially if caused by Klebsiella oxytoca. Infants, children, and adolescents with hematochezia were recruited prospectively. Patients were grouped according to age (<1 year, 1–5 years, 6–13 years, >14 years). In addition to routine diagnostics, K oxytoca stool culture and toxin analysis was performed. We collected data on history, laboratory findings, microbiological diagnostic, imaging, final diagnosis, and long-term outcome. We included 221 patients (female 46%; age 0–19 years). In 98 (44%), hematochezia was caused by infectious diseases. Endoscopy was performed in 30 patients (13.6%). No patient died due to the underlying cause of hematochezia. The most common diagnoses according to age were food protein-induced proctocolitis in infants, bacterial colitis in young children, and inflammatory bowel disease in children and adolescents. Seventeen (7.7%) had a positive stool culture for K oxytoca. Antibiotic-associated colitis was diagnosed in 12 (5%) patients: 2 caused by K oxytoca and 2 by Clostridium difficile; in the remaining 8 patients, no known pathobiont was identified. Infections were the most common cause of hematochezia in this study. In most patients, invasive diagnostic procedures were not necessary. Antibiotic-associated hemorrhagic colitis caused by K oxytoca was an uncommon diagnosis in our cohort. Antibiotic-associated colitis with hematochezia might be caused by pathobionts other than C difficile or K oxytoca.

Cerebral hypoxia during immediate transition after birth and short term neurological outcome

In preterm neonates we investigated cerebral hypoxia assessed with near-infrared-spectroscopy during immediate transition after birth and general movement optimality score assessed before discharge. General movement optimality score decreased with increasing cerebral hypoxia. Burden of cerebral hypoxia during immediate transition might be associated with impaired short-term neurological outcome in preterm neonates.

The association between the early motor repertoire and language development in term children born after normal pregnancy

BACKGROUND The assessment of the early motor repertoire is a widely used method for assessing the infants neurological status. AIM To determine the association between the early motor repertoire and language development. STUDY DESIGN Prospective cohort study. SUBJECTS 22 term children born after normal pregnancy; video recorded for the assessment of the early motor repertoire including their motor optimality score (MOS), according to Prechtl, at 3 and 5months post term. OUTCOME MEASURES At 4years 7months and 10years 5months, we tested the childrens language performance by administering three tests for expressive language and two for receptive language. RESULTS Smooth and fluent movements at 3months of age was associated with better expressive language outcome at both 4years 7months and 10years 5months (betas 0.363 and 0.628). A higher MOS at 5months was associated with better expressive language at both ages (betas 0.486 and 0.628). The item postural patterns at 5months was the only aspect associated with poorer expressive language outcome (beta -0.677). CONCLUSION Predominantly, qualitative aspects of the early motor repertoire at the age of 3 and 5months are associated with language development.

Tricuspid Annular Plane Systolic Excursion Is Reduced in Infants with Pulmonary Hypertension Value of Tricuspid Annular Plane Systolic Excursion (TAPSE) to Determine Right Ventricular Function in Various Conditions of Pediatric Pulmonary Hypertension

have studied right ventricular (RV) systolicfunction in infants with pulmonary hypertension(PH) due to bronchopulmonary dysplasia, con-genital diaphragmatic hernia, or idiopathic PH.For assessment of RV systolic function, the tricus-pid annular peak systolic excursion (TAPSE), thetricuspid annular peak systolic velocity (S

Abnormalities in Echocardiographic Indices of Right- and Left-Ventricular Systolic Function in Pediatric Pulmonary Artery Hypertension

To the Editor, We read with great interest the article entitled ‘‘Echocardiographic Evaluation of Ventricular Function in Children with Pulmonary Hypertension’’ by Vorhies et al. [5]. This interesting article describes right(RV) and left-ventricular (LV) dysfunction in children with pulmonary artery hypertension (PAH). The authors highlight the need for a reliable noninvasive measure of biventricular function using tissue Doppler imaging (TDI), e.g. tricuspid annular peak systolic velocity (S‘), and mitral valve annular systolic velocity (Sm) in the serial assessment of pediatric PAH. The authors found that S‘ decreased significantly in PAH patients C1 year of age consistent with RV systolic dysfunction [5]. We want to emphasize their findings that RV systolic dysfunction occurs with increasing age because changes in RV function have been described to occur over time [2]. Impaired RV function in pediatric PAH patients has been reported in previous studies of pediatric PAH [1, 2, 4]. Vorhies et al. [1] showed that the Sm, a TDI marker of systolic LV function, was also decreased in their PAH cases. Measurement of RV–LV interaction is increasingly important in the follow-up of children with PAH. We support the authors’ idea of an age-stratified analysis of RV and LV function considering age-specific changes [1]. For the convenience of the readership of Pediatric Cardiology, we mention that a comparison of the authors’ S‘ data with available S‘ normal values and z scores [3] would have improved the statistical power of their analysis. A decrease of S‘ lower than -2 SD of age-related normal values determines decreased systolic RV function in children with PAH [2]. Recently reported studies on pediatric idiopathic PAH, PAH associated with lung or autoimmune disease [4], and PAH associated with congenital heart disease [1, 2] suggest that systolic RV function progressively deteriorates over time. The results of Vorhies et al. [5] nicely supported the notion that the right ventricle is highly susceptible to pulmonary vascular resistance and PAH. We thank the authors for addressing the need for careful and systematic evaluation of the right ventricle in PAH patients. We hope that with more interesting studies like this from Vorhies et al. [5], quantification of systolic biventricular function will become a routine measurement in the follow-up of pediatric PAH patients.