Rm Vlad

Clinical characteristics of rotavirus diarrhea in hospitalized Romanian infants.

Clinical characteristics of rotavirus enteritis were evaluated by comparison with acute diarrhea of other etiologies. We reviewed the medical records of children (aged 0–12 months) admitted with acute diarrhea in our hospital between January and December 2011. Of the 839 patients, 49.3% had rotavirus diarrhea. The incidence of severe disease was significantly higher for rotavirus diarrhea (65.2%, P < 0.01) than for other types of diarrheal disease.

Antibiotic treatment of Clostridium difficile infection in children – a challenge in pediatric practice

Results Between January 1 2005 and July 31 2014, 52 patients were diagnosed with CDI. A large number of cases (61%) were diagnosed in the age group 1 to 4 years. The sex ratio was M/F = 0.9/1. 36% of patients had communityacquired CDI. In mild/moderate forms metronidazole was administered as a first-line treatment in 32 (61%) cases and proved efficient in 25/32 (78.1%) cases; vancomycin was used and was efficient in 18 cases. In severe forms (7.7%), the association of intravenous metronidazole and oral vancomycin was the option of choice and this approach cured all these cases. We report 11 patients with recurrent CDI (21%); in these cases oral vancomycin was efficient for the treatment of the recurrence. In 3 cases with a second recurrence rifaximin was the chosen therapy. Six out of 11 children with recurrent CDI had comorbidities (Hirschsprung disease, ulcerative colitis).

P30 Why is cow’s milk protein allergy diagnosis so difficult in infants with gastrointestinal symptoms?

Background and aims Current research reveals an increasing prevalence of cow’s milk protein allergy (CMPA). We aimed to evaluate infants with gastrointestinal symptoms and the consequent diagnosis of CMPA in a Romanian paediatric population. Methods Authors report partial results (July 2014-November 2016) of an on-going prospective study conducted in the Gastroenterology Department of ‘Grigore Alexandrescu’ Emergency Children’s Hospital, Bucharest. Children aged≤12 month with gastrointestinal symptoms suggestive for CMPA were included (persistent diarrhoea, bloody stools, loose mucous stools, recurrent vomiting, food refusal, constipation, abdominal pain). All underwent clinical evaluation, blood work-up, exclusion diet and for those without immediate reaction a oral food challenge (OFC) was done. Results Our study included 139 infants with symptoms suggesting CMPA. We excluded 87 patients: 7 infants didn’t respond to exclusion diet, 11 of them had negative OFC and the rest of 69 didn’t have an OFC (parents refused, had growth impairment or were lost from follow-up). 52 children were consequently diagnosed with CMPA following ESPGHAN guidelines. Median age at onset of symptoms was 3 months. 92% of infants came from urban areas. Sex ratio M/F=0.9. One third of the patients had a first-degree sibling with allergy. Only 37.5% were exclusively breastfeed until 4 month. Growth impairment was noted in 42.3% of cases. The most frequent presenting symptoms were loose mucous stool (46%), recurrent vomiting (28.8%), regurgitation (28.8%), food refusal (25%), bloody stools (23%). Cutaneous manifestations (urticaria, atopic eczema) were associated in 88.4% of patients. Specific IgEs were positive in 44.2% of patients. 15.3% of infants associated another food allergy (mostly eggs allergy). Conclusions CMPA remains a challenge for the paediatrician. Gastrointestinal symptoms are non-specific. However, associated cutaneous manifestations may be an usefull clinical indicator of CMPA. The gold standard in diagnosing CMPA remains OFC, which in daily practice is underused.

P246 Diagnosing caeliac disease in a romanian paediatric gastroenterology department over three decades

Background and aim Over the last decades, the diagnosis of cæliac disease (CD) changed significantly both in terms of clinical picture and laboratory diagnosis. The authors present the perspective of a Pædiatric Gastroenterology Department over a 32 years period. Method We performed a retrospective study including patients diagnosed with CD from Jan.1985 until Dec.2016 in „Gr. Alexandrescu’ Children’s Hospital. Three groups were formed, according to the diagnostic procedures used over time: first-intestinal biopsy, second-serology and biopsy, third-serology and biopsy or high values of anti-transglutaminase antibodies, a second positive serologic marker and HLA typing. Clinical characteristics at presentation were analysed. Results 231 children were included. First group contained 20 patients (mean age at diagnosis 5.9 years) diagnosed with classic forms of CD from 1985 until 1995 (1.8/year). Gastrointestinal (GI) symptoms were described in all, particularly chronic diarrhoea (90%). Four presented with cæliac crisis (20%). Second group included 152 patients diagnosed from 1996 until 2006 (once serologic screening was available the number of patients/year increased to 13.8). Mean age at diagnosis was 4.4 years. 86.8% presented with GI symptoms, but only 51.9% had chronic diarrhoea. Cæliac crisis was rarely seen (0.6%). Instead of classic forms with malabsorbtion, atypical presentations with non-GI symptoms were reported in 13.1%. Third group consisted of 59 patients diagnosed from 2007 until 2016 (at a mean age of 4). The number of patients presenting to a Gastroenterology Department decreased considerably (5.9/year). Half of the patients that reached our department presented with mild GI symptoms other than chronic diarrhoea: constipation, abdominal pain (50.9%). Conclusion Three decades ago the Pædiatric Gastroenterologist was diagnosing classic forms of CD with chronic diarrhoea in small numbers of children. Once cæliac serology was available, the diagnosis shifted to a large number of patients with a broad clinical spectrum. Now CD diagnosis is again set progressively less frequent in the Gastroenterology Department as mild GI symptoms suggesting rather functional than organic disease are often the form of presentation. As long as the CD awareness is high, the diagnosis might be successfully established in the primary care setting, in many cases without biopsy, according to the ESPGHAN guidelines.

PO-0146 Phenotypical Features In Childhood Wilson Disease: The Experience Of A Hepatology Centre From Bucharest

Background and aims Wilson’s disease (WD) may have a polimorphic clinical picture and positive diagnosis can sometimes be difficult. The study aimed to analyse the clinical and laboratory characteristics of children with WD, diagnosed in the “Grigore Alexandrescu” Children’s Hospital, Bucharest. Methods The study included 23 patients diagnosed with WD between 1995 and 2013. From the medical records we extracted: age, sex, family history, clinical manifestations and laboratory parameters at diagnosis. Results The mean age at diagnosis was 12.1 years. Sex ratio was male/female = 2.1/1. Eight patients had family history of WD. The frequency of clinical signs was: hepatomegaly (47.8%), ascites (22%), jaundice (22%), splenomegaly (22%), esophageal varices (15%). Neurological manifestations were encountered in 4 cases. Children aged 10–14 years presented the largest number of clinical and laboratory abnormal findings. Urinary excretion of cooper was increased in 22 patients. Elevated transaminases was a common finding. Serum ceruloplasmin was low in 74%. Haematological abnormalities were: thrombocytopenia (26%), leucopenia (4%). Hepatic steatosis was found in 56%, fibrosis in 18% and signs of portal hypertension in 11%. Liver biopsy was performed in 8 cases, 6 presenting vacuolar lesions. Genetic testing was performed in 6 patients, 4 had heterozygote exon 8 mutation. Conclusions WD is sometimes difficult to diagnose. Symptoms are more frequent in elder children and are dominated by liver disease with moderate cytolysis syndrome without liver failure; rarely neurological signs are associated. Family screening is extremely useful and allows precocious diagnosis in asymptomatic patients with early therapy initiation.

PO-0210 Features Of Hcv Infection In Children From A Hepatology Department In South-eastern Europe

Background and aims Hepatitis C virus (HCV) infection is cause of significant morbidity and mortality, especially in children. The study aimed to describe the epidemiological characteristics of children infected with HCV diagnosed in „Grigore Alexandrescu” Children’s Hospital, Bucharest. Methods We reviewed the medical records of HCV infected children diagnosed between January 1991 and December 2012 and analysed demographic data, viral serology and route of infection. Results We identified 58 cases, all diagnosed by detection of anti-HCV antibodies. 47.3% of the patients came from Bucharest, the rest residing in neighbouring districts. They were equally distributed by means of sex (52.6% boys) and age groups. Regarding alleged route of transmission: 43.7% had infected mothers (perinatal infection), 22.8% had a history of parenteral procedures (surgical intervention, blood transfusions, iv drug abuse, tattoos). 69.5% underwent evaluation for fibrosis, by either hepatic biopsy or fibroscan: 85% had a low fibrosis score (< 3). 58% of the patients had minimal cytolysis, with ALT less than 1.5 fold the normal value. Regarding viremia, 40% of the patients had less than 100 000 copies and only 1.75% over 10 millions. No correlation was found between the level of transaminases and the viraemia or fibrosis scores on hepatic biopsy. Conclusions HCV infection in children is a public health issue. Materno-fetal transmission is the main route of infection followed by transfusions and other parenteral routes. We predict that a thorough pregnancy monitorization and an accurate blood donor screening will significantly reduce the number of infected children in our country.

PO-0145 Celiac Disease – The Experience Of A Single Centre In 29 Years

Aims The study aimed to evaluate the epidemiological and clinical profile of the patients diagnosed with celiac disease in ‘Grigore Alexandrescu’ Children’s Hospital over a 29 years period. Methods We performed a retrospective study including 224 patients diagnosed with celiac disease, from January 1985 until December 2013. Three groups resulted. The first group included patients diagnosed from 1985 until 1995, before celiac serology was available, the second group patients diagnosed from 1996 until 2006 using qualitative antitissue-transglutaminase antibodies and the third group patients diagnosed from 2007 until 2013 using quantitative antitissue-transglutaminase antibodies and HLA DQ2/DQ8 typing. From the medical records we extracted age and clinical characteristics of patients at presentation. Results The groups included 1.8, 13.8 and 7.7 patients/year. The mean age at diagnosis was 5.9 ± 4.7, 4.4 ± 3.6 and 4.4 ± 3.5 years respectively. Gastrointestinal symptoms were described in 100%, 86.8% and 59.2%, particularly chronic diarrhoea in 90%, 51.9% and 48.1%. Twenty percent of patients in the first group presented with celiac crisis, only 0.6% in the second group and none in the third. Non-gastrointestinal symptoms were not observed in the first group and were reported in the second and third groups in 13.1% and 61.1%. Conclusion Since 2007 a decreasing tendency in the number of patients diagnosed/year was observed. Gastrointestinal symptoms were initially the sole clinical finding, particularly chronic diarrhoea, but in time patients presented with non-gastrointestinal symptoms or oligosymptomatic/asymptomatic celiac disease with an increasing frequency.

701 Burden of Rotavirus Gastroenteritis Among Hospitalized Infants in Romania

Background and Aims The rotavirus infection is a major cause of acute diarrhea in young children. The study aimed to evaluate the impact on healthcare and the economic burden associated with rotavirus gastroenteritis in infants, looking at incidence, disease severity and hospitalization costs. Methods We conducted an observational, retrospective study which included children younger than one year, hospitalized with rotavirus gastroenteritis in the Department of Pediatrics in “Grigore Alexandrescu” Emergency Children’s Hospital from January until June 2011. From the medical records we extracted: month of admission, age and sex, history of the disease, clinical characteristics, data on hospital course and costs of hospital stay. Vesikari severity score was calculated for each patient (score ≥11 = severe infection). Results We selected 429 infants hospitalized with acute diarrhea from a total of 11383 patients admitted in our department. The study included 247 infants with rotavirus gastroenteritis (2.17% of all children hospitalized). The percentage of rotavirus diarrhea was 57.6%. The highest incidence of rotavirus infection was recorded in January (78%). Mean age was 7 months and 62.3% of infants had severe diarrhea. Mean severity score was 11.3. Nosocomial infection represented 25.5% of cases. The mean duration of hospitalization was 6.4 days; the average cost for hospitalization was 581.3 euros/patient. Conclusions The rotavirus infection represented the etiology of acute diarrhea in more than half the cases. We report a high percentage of severe gastroenteritis and a significant percentage of nosocomial rotavirus diarrhea. The considerable medical costs should justify prevention through vaccination.

724 Hla Dq2/Dq8 Typing in Children Diagnosed with Celiac Disease

Background and Aims Genes encoding HLA DQ2/DQ8 are associated with celiac disease (CD) and testing for their presence has high negative predictive value for the diagnosis. The aim of this study was to assess the role of HLA typing in symptomatic individuals in whom the diagnosis of CD is uncertain. Methods We proceded a retrospectiv study leaded on a group of children investigated for CD in “Grigore Alexandrescu” Emergency Children’s Hospital from 2007 to 2012 that underwent HLA typing. Inclusion criteria were all patient with mild enteropathy (Marsh 1, 2, 3a), moderate elevated values of tisular tranglutaminase (tTG) antibodies (between cut off point and 5 times nomal value) and poor response to gluten free diet. The medical records of all patients investigated for CD were reviewed. Results 164 patients were performed HLA typing; 26 patients satisfied the inclusion criteria; 20 (76.9%) of these had HLA DQ2/DQ8 present and 6 (23.07%) had a negative test for HLA DQ2/DQ8. The mean age of our investigated group was 23.46 months and the mean age for HLA DQ2/DQ8 negative group was 21.08 months. Sex distribution indicated 9 boys and 17 girls. Gastrointestinal symptoms dominated: 17 children had diarrhea, 9 had failure to thrive and 13 patients had both chronic diarrhea and poor weight gain. Conclusion Patients with clinical suspicion of CD that have moderate levels of tTG antibodies, mild biopsy changes and poor response to gluten free diet need to have HLA typing specially at younger ages (under 3 years old).

423 Acute Respiratory Failure in Children - A 3 Years Epidemiological Study

Background and Aims Acute respiratory failure is the most frequent reason for admission in a pediatric emergency department. This study aimed to investigate the epidemiological characteristics of patients admitted with acute respiratory failure. Methods We performed a retrospective study regarding the period September 2009–January 2012 that included all patients admitted with the diagnosis of acute respiratory failure in “Grigore Alexandrescu” Children Emergency Hospital in Bucharest; we evaluated: personal data (sex, age), time of admission (year, month, day, hour, hospitalization period), admission diagnosis and co morbidities. Statistical analyze was performed with Microsoft Excel and SPSS. Results We had 836 patients admitted for acute respiratory failure being 3.14% of all hospitalised patients and 5.4% of all patients suffering of respiratory diseases; the mean age of our study group was 2years9months. Sex distribution indicates 537 boys and 299 girl, p=0.00. The maximum incidence was in 2010 (mean 33cases/month), in October (15.2%), between 18.00–21.00 p.m.(17.6%). In the majority of cases we claim that acute pneumonia (48.7%) was the main cause of respiratory impairment followed by bronchiolitis (25.4%) and asthma (9.1%). Rare causes of respiratory failure were: intoxications, neurological conditions, cardiac malformations and diabetes. Conclusions Acute respiratory failure still remains an important issue of pediatric emergency departments. The diseases complicated with acute respiratory failure are various and sometimes surprising.