American Academy of Pediatrics (AAP)
0031-4005
1098-4275
Cơ quản chủ quản: American Academy of Pediatrics , AMER ACAD PEDIATRICS
Lĩnh vực:
Pediatrics, Perinatology and Child Health
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Các bài báo tiêu biểu
Maternal Supplementation With Very-Long-Chain n-3 Fatty Acids During Pregnancy and Lactation Augments Children’s IQ at 4 Years of Age Objectives. Docosahexaenoic acid (DHA; 22:6 n-3) and arachidonic acid (AA; 20:4 n-6) are important for development of the central nervous system in mammals. There is a growth spurt in the human brain during the last trimester of pregnancy and the first postnatal months, with a large increase in the cerebral content of AA and DHA. The fetus and the newborn infant depend on maternal supply of DHA and AA. Our hypothesis was that maternal intake of DHA during pregnancy and lactation is marginal and that high intake of this fatty acid would benefit the child. We examined the effect of supplementing pregnant and lactating women with very-long-chain n-3 polyunsaturated fatty acids (PUFAs; cod liver oil) on mental development of the children, compared with maternal supplementation with long-chain n-6 PUFAs (corn oil).
Methods. The study was randomized and double-blinded. Pregnant women were recruited in week 18 of pregnancy to take 10 mL of cod liver oil or corn oil until 3 months after delivery. The cod liver oil contained 1183 mg/10 mL DHA, 803 mg/10 mL eicosapentaenoic acid (20:5 n-3), and a total of 2494 mg/10 mL ∑ n-3 PUFAs. The corn oil contained 4747 mg/10 mL linoleic acid (18:2 n-6) and 92 mg/10 mL α-linolenic acid (18:3 n-3). The amount of fat-soluble vitamins was identical in the 2 oils (117 μg/mL vitamin A, 1 μg/mL vitamin D, and 1.4 mg/mL dl-α-tocopherol). A total of 590 pregnant women were recruited to the study, and 341 mothers took part in the study until giving birth. All infants of these women were scheduled for assessment of cognitive function at 6 and 9 months of age, and 262 complied with the request. As part of the protocol, 135 subjects from this population were invited for intelligence testing with the Kaufman Assessment Battery for Children (K-ABC) at 4 years of age. Of the 135 invited children, 90 came for assessment. Six children did not complete the examination. The K-ABC is a measure of intelligence and achievement designed for children aged 2.5 years through 12.5 years. This multisubtest battery comprises 4 scales: Sequential Processing, Simultaneous Processing, Achievement (not used in the present study), and Nonverbal Abilities. The Sequential Processing and Simultaneous Processing scales are hypothesized to reflect the child’s style of problem solving and information processing. Scores from these 2 scales are combined to form a Mental Processing Composite, which serves as the measure of intelligence in the K-ABC.
Results. We received dietary information from 76 infants (41 in the cod liver oil group and 35 in the corn oil group), documenting that all of them were breastfed at 3 months of age. Children who were born to mothers who had taken cod liver oil (n = 48) during pregnancy and lactation scored higher on the Mental Processing Composite of the K-ABC at 4 years of age as compared with children whose mothers had taken corn oil (n = 36; 106.4 [7.4] vs 102.3 [11.3]). The Mental Processing Composite score correlated significantly with head circumference at birth (r = 0.23), but no relation was found with birth weight or gestational length. The children’s mental processing scores at 4 years of age correlated significantly with maternal intake of DHA and eicosapentaenoic acid during pregnancy. In a multiple regression model, maternal intake of DHA during pregnancy was the only variable of statistical significance for the children’s mental processing scores at 4 years of age.
Conclusion. Maternal intake of very-long-chain n-3 PUFAs during pregnancy and lactation may be favorable for later mental development of children.
Tập 111 Số 1 - Trang e39-e44 - 2003
Recognition of a Kawasaki Disease Shock Syndrome OBJECTIVE. We sought to define the characteristics that distinguish Kawasaki disease shock syndrome from hemodynamically normal Kawasaki disease. METHODS. We collected data prospectively for all patients with Kawasaki disease who were treated at a single institution during a 4-year period. We defined Kawasaki disease shock syndrome on the basis of systolic hypotension for age, a sustained decrease in systolic blood pressure from baseline of ≥20%, or clinical signs of poor perfusion. We compared clinical and laboratory features, coronary artery measurements, and responses to therapy and analyzed indices of ventricular systolic and diastolic function during acute and convalescent Kawasaki disease. RESULTS. Of 187 consecutive patients with Kawasaki disease, 13 (7%) met the definition for Kawasaki disease shock syndrome. All received fluid resuscitation, and 7 (54%) required vasoactive infusions. Compared with patients without shock, patients with Kawasaki disease shock syndrome were more often female and had larger proportions of bands, higher C-reactive protein concentrations, and lower hemoglobin concentrations and platelet counts. Evidence of consumptive coagulopathy was common in the Kawasaki disease shock syndrome group. Patients with Kawasaki disease shock syndrome more often had impaired left ventricular systolic function (ejection fraction of <54%: 4 of 13 patients [31%] vs 2 of 86 patients [4%]), mitral regurgitation (5 of 13 patients [39%] vs 2 of 83 patients [2%]), coronary artery abnormalities (8 of 13 patients [62%] vs 20 of 86 patients [23%]), and intravenous immunoglobulin resistance (6 of 13 patients [46%] vs 32 of 174 patients [18%]). Impairment of ventricular relaxation and compliance persisted among patients with Kawasaki disease shock syndrome after the resolution of other hemodynamic disturbances. CONCLUSIONS. Kawasaki disease shock syndrome is associated with more-severe laboratory markers of inflammation and greater risk of coronary artery abnormalities, mitral regurgitation, and prolonged myocardial dysfunction. These patients may be resistant to immunoglobulin therapy and require additional antiinflammatory treatment.
Tập 123 Số 5 - Trang e783-e789 - 2009
Severe Pediatric COVID-19 Presenting With Respiratory Failure and Severe Thrombocytopenia The novel severe acute respiratory syndrome coronavirus 2 is a worldwide pandemic. The severe morbidity and mortality associated with coronavirus disease 2019 has mostly affected the elderly or those with underlying medical conditions. We present a case of a 12-year-old girl with no past medical history who presented with fever, cough, and vomiting. Laboratory evaluation revealed severe thrombocytopenia and elevated markers of inflammation. The patient progressed to respiratory failure, and testing results for the severe acute respiratory syndrome coronavirus 2 returned positive. Because of the severity of her thrombocytopenia, she was treated with intravenous immunoglobulin and steroids with prompt improvement in platelets. The patient’s severe acute respiratory distress syndrome was managed with mechanical ventilation, inhaled nitric oxide, and then airway pressure release ventilation. After azithromycin and hydroxychloroquine were given without improvement, our patient received tocilizumab, an anti–interleukin-6 receptor antibody, and remdesivir, a broad antiviral agent, with significant clinical benefit soon afterward. Given that severe pediatric coronavirus disease 2019 is rare, we hope to inform pediatric providers on the clinical course and management considerations as this pandemic continues to spread.
Tập 146 Số 1 - 2020
Immune Thrombocytopenia (ITP) in a Pediatric Patient Positive for SARS-CoV-2 Immune thrombocytopenia (ITP) is a potential presentation of COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral testing should be considered in these patients to allow for appropriate hospital triaging and isolation to limit community spread and health care worker infection during epidemics or pandemics. ITP is characterized by isolated thrombocytopenia. Approximately two-thirds of children with primary ITP have a history of a viral infection during the previous month.1,2 Viruses commonly identified as triggers include cytomegalovirus, hepatitis C, herpes, varicella zoster, Epstein-Barr, influenza, and HIV.3–7 In this case report, we describe the first documented case of a pediatric patient with ITP who tested positive for SARS-CoV-2. This case raises awareness of ITP as a possible pediatric presentation of coronavirus disease.
Tập 146 Số 2 - 2020
Epidemiology of COVID-19 Among Children in China
OBJECTIVE:
To identify the epidemiological characteristics and transmission patterns of pediatric patients with the 2019 novel coronavirus disease (COVID-19) in China.
METHODS:
Nationwide case series of 2135 pediatric patients with COVID-19 reported to the Chinese Center for Disease Control and Prevention from January 16, 2020, to February 8, 2020, were included. The epidemic curves were constructed by key dates of disease onset and case diagnosis. Onset-to-diagnosis curves were constructed by fitting a log-normal distribution to data on both onset and diagnosis dates.
RESULTS:
There were 728 (34.1%) laboratory-confirmed cases and 1407 (65.9%) suspected cases. The median age of all patients was 7 years (interquartile range: 2–13 years), and 1208 case patients (56.6%) were boys. More than 90% of all patients had asymptomatic, mild, or moderate cases. The median time from illness onset to diagnoses was 2 days (range: 0–42 days). There was a rapid increase of disease at the early stage of the epidemic, and then there was a gradual and steady decrease. The disease rapidly spread from Hubei province to surrounding provinces over time. More children were infected in Hubei province than any other province.
CONCLUSIONS:
Children of all ages appeared susceptible to COVID-19, and there was no significant sex difference. Although clinical manifestations of children’s COVID-19 cases were generally less severe than those of adult patients, young children, particularly infants, were vulnerable to infection. The distribution of children’s COVID-19 cases varied with time and space, and most of the cases were concentrated in Hubei province and surrounding areas. Furthermore, this study provides strong evidence of human-to-human transmission.
Tập 145 Số 6 - 2020
SARS-CoV-2–Induced Kawasaki-Like Hyperinflammatory Syndrome: A Novel COVID Phenotype in Children We describe 2 children with persistent fever and profuse diarrhea who developed signs of mucocutaneous involvement (conjunctivitis, fissured lips, skin rash, erythema, and edema of the hands and feet). Blood tests revealed elevated markers of inflammation, lymphopenia, thrombocytopenia, and complement consumption. Afterward, diffuse edema with hypoalbuminemia appeared in the context of a capillary leak syndrome. In both patients, repeated nasal swabs were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but each patient had high titers of immunoglobulin G and immunoglobulin M against the SARS-CoV-2 virus. The negative PCR results in the presence of immunoglobulin M and immunoglobulin G suggested that the inflammatory response developed in the late phase of viral infection, when SARS-CoV-2 was not detectable in the upper airway. In this report, we describe patients with what we propose to name as SARS-CoV-2–induced Kawasaki-like hyperinflammatory syndrome. SARS-CoV-2–induced Kawasaki-like hyperinflammatory syndrome seems to be caused by a delayed response to SARS-CoV-2. It resembles Kawasaki disease complicated by macrophage activation syndrome, although it has peculiar features, such as prodromal diarrhea, capillary leak syndrome, and myocardial dysfunction. Intravenous corticosteroid treatment appears to be helpful.
Tập 146 Số 2 - 2020
Challenges Associated With Prolonged Survival of Patients With Thalassemia: Transitioning From Childhood to Adulthood Thalassemia is a chronic condition that presents a range of clinical and psychosocial challenges. Although recent advances in the treatment of thalassemia can prolong patient life spans, problems may arise when patients are transferred from pediatric health care settings to adult health care settings. These issues and our recommendations for handling them are discussed.
Tập 121 Số 5 - Trang e1426-e1429 - 2008
CHRONIC EOSINOPHILIA DUE TO VISCERAL LARVA MIGRANS Three cases of chronic extreme eosinophilia with granulomatous lesions in the liver have been studied. A larval nematode observed in sections from the liver of one patient has been identified either as Toxocara canis or Toxocara cati, common cosmopolitan ascarids of dogs and cats; available evidence favors the former.
The term visceral larva migrans is proposed for this type of parasitism, known in animals but not previously described in humans. It is related to better known cutaneous larva migrans, in that both are usually caused by infective stage larvae of nematode parasites of other animals. Man being an abnormal host, either has unfavorable tissue reactions or otherwise fails to provide stimuli for usual tissue migration and development of the parasite. As a result, larvae remain active for variable periods in various tissues. Similar but less severe and less prolonged reactions occur when the larvae of normal nematode parasites of man invade the tissues of a hyperimmune individual.
Visceral larva migrans is usually a relatively benign disease, characterized chiefly by sustained eosinophilia, pneumonitis and hepatomegaly, and probably is due both to direct tissue damage by migrating larvae and to allergic responses to their products. Its severity varies with the number of larvae in the tissues and the immune or allergic state of the infected individual.
Tập 9 Số 1 - Trang 7-19 - 1952
EOSINOPHILIA-HEPATOMEGALY SYNDROME OF INFANTS AND YOUNG CHILDREN Attention is directed to the existence of a recently recognized syndrome in infants and young children with the prominent features of chronic eosinophilia, hepatomegaly, liver biopsy findings of eosinophilic infiltrative and granulomatous lesions, a benign course, and occasionally symptoms and signs of transient pneumonitis.
An analysis of 15 reported cases with the syndrome is presented, including the report of a case due to an unidentified nematode larva, but probably Toxocara canis, invading the liver.
Signs and symptoms, pathology, pathogenesis, etiology, course and prognosis, and treatment are discussed.
Evidence is preponderantly in favor of the etiology in all cases being nematode larvae invasions of the liver and other viscera.
These cases cause conjecture as to whether other diseases of chronic eosinophilia, such as Löffler's syndrome, tropical eosinophilia, familial eosinophilia and pseudoleukemic cosinophilia, may not also be due to visceral nematode larvae migrations. Further investigation is warranted in these diseases.
Tập 11 Số 4 - Trang 358-367 - 1953
VISCERAL LARVA MIGRANS SYNDROME: CLINICAL CHARACTERISTICS AND IMMUNOLOGIC STUDIES IN 51 PATIENTS Fifty-one preschool children with hypereosinophilia and signs of visceral involvement were studied. The most common symptoms were pica (90%), pulmonary symptoms (86%), and fever (80%). Fourteen patients (28%) had convulsions. Hepatomegaly (encountered in 65%) was the most prominent physical finding. Anemia was present in almost half of the patients. Albumin concentrations were decreased and globulin concentrations increased in the patient group. Total gamma-globulins and gamma1 M globulins were significantly elevated. Precipitating antibody to A and B blood group substances and/or helminth antigens was found in one-half of the patients. Isohemagglutinin titers were elevated (above 1:256) in two-thirds of the patients. Sheep cell agglutination titers were slightly elevated in the patient group, and heat stable antiglobulins were found in 14 of 29 patients tested. The significance of the hypergammaglobulinemia, anemia, and central nervous system symptoms was discussed.
Tập 36 Số 4 - Trang 523-536 - 1965