Michel Deneyer

Gastroesophageal reflux incidence and respiratory dysfunction during sleep in infants: treatment with cisapride.

We studied the effects of positional treatment and cisapride (a new prokinetic agent) on the incidence and duration of gastroesophageal reflux in 22 infants (4–26 weeks old) in asleep, awake, fasted, and postcibal periods. In addition to gastroesophageal reflux (assessed by 24-h continuous esophageal pH monitoring), all infants presented with a disrupted irregular sleep pattern (“respiratory dysfunction”) (assessed by a simultaneously performed cardiopneumogram). Reflux was particularly prominent during the sleep and fasted periods. Investigations (cardiopneumogram and esophageal pH monitoring) in the study population were repeated under treatment conditions (cisapride) after 13–16 days. All pH monitoring data with regard to the total investigation time decreased significantly (p < 0.001). The treatment-related differences were largest in the asleep and fasted periods, but treatment data were not completely within normal ranges (established in age-matched asymptomatic infants), as they were for the awake periods. Associated symptoms of gastroesophageal reflux (belching, cough, nocturnal wheezing, irritability, and restlessness at night) were evaluated before and during treatment by history. A combination of positional treatment and cisapride seemed effective (objectivated by pH monitoring data and clinical improvement); cisapride did not cause adverse reactions. The disrupted sleep pattern improved significantly or disappeared (p < 0.001) in all infants. These data suggest that in a number of young infants, gastroesophageal reflux may be associated with a disturbed, irregular sleep of poor quality, which is characterized by a typical breathing pattern (multiple, irregularly repeated, short apneas).

Congenital Hypothyroid Goiter and Amiodarone

ABSTRACT. Amiodarone is an anti‐arrhythmic drug with a content of 39% Iodine. No adverse effects on fetal thyroid function have previously been observed with maternal ingestion of Amiodarone during pregnancy. A case of severe congenital hypothyroidism with goiter, associated with maternal ingestion of 200 mg Amiodarone daily from the 13th week of pregnancy, is described here. No other environmental causes of goiter, nor a congenital organic thyroid disorder could be demonstrated.

Esophageal pH monitoring data during chest physiotherapy.

Sixty-three infants, aged from 1 to 4 months, were examined for gastroesophageal reflux (GER) using esophageal pH monitoring. Thirty were examined because of chronic vomiting, 21 were healthy controls examined for GER as part of a screening program for sudden infant death syndrome, and 12 had an acute respiratory disease (RD). The 24-h pH monitoring data were within normal ranges in 26 infants (20 controls, 2 babies with emesis, and 4 with RD). Data were abnormal in 37 infants (1 control, 28 infants with emesis, and 8 with RD). All babies were submitted during a fasting awake period to a 30-min chest physiotherapy session. In the three groups studied, the incidence of GER episodes detected by the pH probe was significantly higher during physiotherapy if compared (a) to the calculated mean incidence during a 30-min period of the 24-h investigation or (b) to the incidence during a fasting awake period such as that during which the physiotherapy was given (p < 0.001; Wilcoxon rank-sum test). We conclude that chest physiotherapy significantly increases GER incidence. We therefore propose restricting chest physiotherapy to fasting periods. These data add to the confusion that already exists regarding the possible causal relationship between (acid) GER and respiratory disease.

Incidence of gastroesophageal reflux in sleep, awake, fasted, and postcibal periods in asymptomatic and symptomatic infants.

The incidence of gastroesophageal reflux (GER) in infants has been shown to be dependent on different factors, e.g., position, feeding, age. Using continuous esophageal pH monitoring, we examined 30 asymptomatic (15 were 1.5-2.5 months old; 15 were 2.5-4.5 months old) and 20 symptomatic infants (1.5-4.5 months old) for GER. The occurrence of GER was analyzed in different periods of interest: awake, asleep, fasted, and postcibal periods. The increasing incidence of GER we reported previously in asymptomatic infants according to their age appeared to be due to an increased occurrence in the awake (and postcibal) periods. In symptomatic infants, however, the increase was noticed mostly during the sleep (fasted) periods as far as the reflux index, the duration of the longest reflux episode, and the number of reflux episodes of greater than 5 min are concerned.

Educational paper : Detection, diagnosis, and prevention of child abuse: The role of the pediatrician

It is the pediatrician’s role to promote the child’s well-being and to help parents raise healthy, well-adjusted children. Today’s pediatricians are confronted with a patient population in which there is a high prevalence of child abuse in its different presentations (physical, sexual, and psychological abuse and/or neglect). The immediate and long-term consequences of child abuse often are lifelong and even life-threatening in its most dramatic presentation. Unfortunately, detection of child abuse remains a difficult challenge for many physicians but also for the “well-trained” pediatrician, leaving many abused children unreported. This paper addresses the important role pediatricians can play in the detection, diagnosis, and prevention of child maltreatment.

Esophagitis of likely traumatic origin in newborns.

We describe 17 full-term newborns presenting with vague symptoms related to the upper gastrointestinal tract (anorexia, poor feeding, retching, regurgitation, and incessant crying) during their stay in the maternity unit. After an esophagogastroduodenoscopy performed between days 2 and 5 of life, the babies could clearly be divided into two groups. Twelve babies (group 1) had an extremely severe esophagitis (circular ulcerations), without gastroduodenitis. In the remaining five babies (group 2), the upper gastrointestinal tract was unaffected. Allergic, infectious, metabolic, and toxic etiologies were excluded. Esophageal pH monitoring data were within normal ranges in all. All babies of group 1 were treated as follows: prone anti-Trendelenburg position, cisapride, and cimetidine syrup. Symptoms and lesions disappeared within 48–72 h. Reendoscopy after 72 h showed an almost normal esophagus with greatly improved histology. These observations highlight four points of interest: (a) the existence of an extremely severe ulcerative esophagitis in apparently healthy newborns, (b) the very rapid clinical and histological recovery, (c) the difficulties in predicting esophagitis on clinical grounds, and (d) the mysterious origin despite thorough assessment. The distribution of the lesions (more severe in the upper esophagus), the early onset (almost at birth), the very rapid healing, and the absence of gastric and duodenal lesions are in favor of a possible “traumatic” origin (pharyngeal, esophageal, and gastric suction at birth). Finally, because the condition described is transient, questions arise regarding the necessity of treatment, and we currently do not recommend overtreating newborns presenting with similar symptoms and/or endoscopie findings.

Influence of respiratory physiotherapy on gastro-oesophageal reflux in infants: A systematic review

To provide a survey on the literature concerning the influence of respiratory physiotherapy on gastro‐oesophageal reflux (GOR) in infants and young children.

Effectiveness of airway clearance techniques in children hospitalized with acute bronchiolitis

To evaluate the effectiveness of two airway clearance techniques (ACTs) in children <24 months hospitalized with mild to moderate bronchiolitis.

Influence of intrapulmonary percussive ventilation in upright position on gastro‐oesophageal reflux in infants

To determine the influence of physiotherapy using intrapulmonary percussive ventilation on gastro‐oesophageal reflux (GOR) in infants <1 year.

The influence of the law on patient's rights on the practice of the Flemish paediatricians anno 2010.

Abstract Background : The law on patients’ rights in Belgium was issued in 2002. The new legal framework recommends the establishment of a true dialogue between physician and patient, and it assigns decisive priority to the adolescent rather than to the physician or his parents. Purpose and methods : The purpose of this study is to map the current interpretation of the paediatrician and the realisation of the law in practice. The answers of 117 Flemish paediatricians to an anonymous questionnaire were analyzed. Results : Only 7.8% of the paediatricians state that they know the law well. 15.5% experience the law as a burden. 20.9% have adopted a different attitude when rendering care to adolescents under impulse of this law. 6.2% say they do not strictly follow the law. 27.8% think that the emancipating thought is too far-reaching. Most paediatricians apply protocols to interpret the traditional values that are stamped as being good medical practice: high quality care (81%), free patient’s choice (70.7%), adequate pain control (77.4%). On the other hand paediatricans seldom dispose of procedures regarding the more emancipated amenities in the law such as obtaining informed consent (16.4%), access to the medical file (24.8%) and safe-guarding the privacy (13%). In practice most of the physicians offer the possibility of a free choice in 80% of the cases. All questioned physicians strive for a high quality care, for adequate pain control and for a careful maintained medical file. 79.1% of the physicians transfer to the parents all medical information regarding the adolescent. Proper experience and expertise (80.7%), case by case completed, are most often used as the basis for the judgment about the competence of the adolescent. From the patient’s side, little advance is taken to exercise his own rights. Barely 1% of the adolescents consulting a paediatrician use their legal right to autonomously consent to a medical intervention. In barely 0.16% access is requested to the medical file. Practically no complaints are received regarding the law on patients’ rights (0.1% in intramural setting, versus 0.001% extramural). Conclusion : The law on patients’ rights is, after 8 years of issuance, badly penetrated in the paediatric practice. On the one hand this is due to a poor knowledge of the law as well from the side of the physician as from the side of the adolescent and/or his parents. On the other hand 42.2% of the paediatricians experience difficulties with the practical interpretation of the law because of the lack of applicable guidelines. An important obstacle is the fact that more than a quarter of the paediatricians do not agree with the in the law foreseen autonomy of the adolescents. For that reason, paediatricians urgently need to be instructed in these matters. It is the moral duty of the Society of Paediatrics to organize workshops on these matters and develop clear guidelines concerning this law. Proper application of the legal context, the handling of the watertight procedures and the necessary communication in this respect is indispensable for the confidence and will lower the barrier for adolescents to use the healthcare system.