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Children Older (child + older)
Selected AbstractsRisk of Serious Bacterial Infection in Isolated and Unsuspected NeutropeniaACADEMIC EMERGENCY MEDICINE, Issue 2 2010Elliot Melendez MD ACADEMIC EMERGENCY MEDICINE 2010; 17:1,5 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, The objective was to determine the risk of serious bacterial infection (SBI) among children without underlying risk factors for SBI who present to the emergency department (ED) for evaluation and have unsuspected and isolated neutropenia. Methods:, This was a retrospective consecutive chart review from October 1995 through September 2003. All patients aged 0,21 years presenting to the ED of an urban tertiary children's hospital, who were documented to have neutropenia (defined as an absolute neutrophil count [ANC] of <1,000 cells/,L) without known underlying risk factor for SBI were eligible for inclusion. SBI was defined as growth of a pathogen from culture of blood, urine, or cerebrospinal fluid (CSF). Results:, There were 3,179 children with an ANC of <1,000/,L during the study period. Of these, 1,888 had no underlying immunodeficiency or central venous catheter (CVC). Fifteen of 453 (3.3%; 95% confidence interval [CI] = 1.9% to 5.4%) infants less than 3 months of age had SBI: seven with bacteremia, four with meningitis, and eight with urinary tract infections. SBI was rare among children over 3 months of age (18 of 1,435; 1.3%; 95% CI = 0.7% to 2.0%): one had bacteremia, none had meningitis, and 13 had urinary tract infections. Conclusions:, Children older than 3 months of age without underlying immunodeficiency or CVC presenting to the ED and unexpectedly found to have isolated neutropenia are not at high risk of SBI. Infants less than 3 months of age have similar risk of SBI as febrile infants of same age. [source] Pharmacokinetics after an intravenous single dose of the opioid ketobemidone in childrenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010S. LUNDEBERG Background: Ketobemidone is often used as an alternative to morphine in children in the Scandinavian countries. The aim of this clinical trial was to explore the pharmacokinetics of ketobemidone in children because these properties have not been reported previously. Methods: Thirty children, newborn to 10 years, scheduled for elective surgery were included in the trial. Ketobemidone hydrochloride was administered as a single intravenous bolus dose and ketobemidone and norketobemidone concentrations were measured by LC-MS over 8 h. Pharmacokinetic parameters were determined using compartmental methods. Results: Six children were excluded from pharmacokinetic analysis because of incomplete blood sampling. The values of ketobemidone clearance (l/h/kg) given as median (range) were 0.84 (0.29,3.0) in Group A (0,90 days), 0.89 (0.55,1.35) in Group B (1,2.5 years) and 0.74 (0.50,0.99) in Group C (7,10 years). The corresponding values for apparent volume of distribution (l/kg) were 4.4 (3.7,6.9) (Group A), 2.6 (2.0,5.6) (Group B) and 3.9 (2.7,5.0 (Group C), and for elimination half-life (h) 3.0 (1.4,8.9) (Group A), 2.0 (1.2,4.7) (Group B) and 3.7 (2.4,6.9) (Group C), respectively. In the two neonates the elimination half-life was almost 9 h. The metabolite norketobemidone did not reach levels above the limit of quantification (0.07 ng/ml) in any of the patients. Conclusion: The pharmacokinetic parameters of ketobemidone in children older than 1 month appear to be similar to those in adults. Because of the large interindividual variability of the pharmacokinetics in neonates, further studies especially in this age group are warranted. [source] Transabdominal sonography of the normal gastroesophageal junction in childrenJOURNAL OF CLINICAL ULTRASOUND, Issue 6 2001Francesco Esposito MD Abstract Purpose Because sonography identifies abnormalities of the gastroesophageal junction, it is essential to understand the normal sonographic anatomy. The aim of this study was to determine the normal sonographic appearance of the gastroesophageal junction and its variations and to provide measurements of the abdominal esophagus in asymptomatic, healthy children. Methods In this prospective study, 124 healthy children (75 boys and 49 girls), aged 2 days,12 years, underwent abdominal sonography. With the patient in a supine position, the transducer was placed under the xiphoid and the ultrasound beam was directed cephalad through the window of the left lobe of the liver. The length of the abdominal esophagus was measured from the point at which it penetrated the diaphragm to the gastroesophageal junction. The thickness was measured on the anterior wall at the midpoint of the abdominal esophagus. Results The gastroesophageal junction was identified by sonography in all of the children. The mean length of the abdominal portion of the esophagus ranged from 18 mm in the newborns to 34 mm in children older than 6 years. The wall thickness ranged from 2.4 mm to 5.7 mm. Conclusions Our results indicate that visualization of the gastroesophageal junction and measurement of the abdominal esophagus are readily achievable with real-time sonography in healthy children. © 2001 John Wiley & Sons, Inc. J Clin Ultrasound 29:326,331, 2001. [source] More economic 25 mg 13C-urea breath test can be effective in detecting primary Helicobacter pylori infection in childrenJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 3 2007Yao-Jong Yang Abstract Background and Aim:, The high cost of the 13C-urea breath test (UBT) limits its wide application for both epidemiological and clinical studies for diagnosing Helicobacter pylori infection. This study examined if a lower-dose UBT, applying 1 mg/kg of bodyweight (maximum 25 mg, UBT25), could introduce cost savings while preserving high diagnostic yields for primary H. pylori infection. Methods:, Children aged less than 16 years were recruited after obtaining consent. Those children with administration of antibiotics or proton pump inhibitors within 1 month of the tests were excluded. Positive tests for both the UBT with 50 mg urea (UBT50) and the H. pylori stool antigen (HpSA) were qualifying criteria for H. pylori infection. Negative results for both indicated non-infection. The UBT25 was conducted 1 week after the UBT50. The cut-off points for the UBT25 ranging from 2, to 5, were examined for their sensitivity, specificity and accuracy rates. Results:, A total of 153 children were recruited (55% male; mean age 9.1 ± 3.5 years). Both the UBT50 and HpSA test were positive in 18 (13.1%) and negative in 119 children, respectively. The sensitivity and specificity of the UBT25 were optimally achieved at 88.9% (95% confidence interval [CI]: 71.4,100) and 95.0% (95% CI: 91.1,99.9), judged with a cut-off point at 3.5,. The diagnostic accuracy was significantly higher for children older than 7 years than for those younger than 7 years (98%vs 85%, P = 0.009). Conclusion:, Lower-dose UBT titration by bodyweight can cut costs while maintaining a highly reliable method to screen primary H. pylori infection in children older than 7 years, which is generally beyond school age. [source] Outcome following surgical closure of secundum atrial septal defectJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 3 2001DA Jones Objective: To assess the current outcome of surgical closure of secundum atrial septal defects (ASD) in an Australian paediatric population. Methodology: A retrospective chart review of 87 children, aged 2 months to 15 years, was performed for surgery between August 1995 and March 1999. Results: There were no deaths in the patients studied. Approximately one in four patients (24.1%) experienced complications requiring further management. Complication rates were similar to those published previously. However, one in nine patients (11.5%) required surgical drainage of a pericardial effusion. A total of five of 87 (5.7%) patients developed post-pericardiotomy syndrome (PPS), of whom four required pericardiocentesis. The risk for developing a pericardial effusion requiring drainage or PPS was more than twice in children older than 5 years of age at the time of surgery compared to those aged under 5 years, although there was an insufficient number of subjects in the study to prove this statistically (Odds ratio 2.31). Conclusions: Most patients have an uncomplicated postoperative course following surgical closure of secundum ASD. However, a significant minority (24.1%) do develop complications requiring further management and have a correspondingly longer period of hospitalization. Patients older than 5 years of age were identified as being potentially at greater risk for the development of PPS or a pericardial effusion requiring drainage. Further research needs to be performed to clarify this. [source] Hepatitis A seroprevalence and its relationship with environmental factors in children of different age groups in Kahramanmaras, Eastern Mediterranean region of TurkeyJOURNAL OF VIRAL HEPATITIS, Issue 12 2007D. Kaya Summary., Hepatitis A infections are influenced by environmental and socioeconomic factors. Epidemiologic studies regarding hepatitis A virus (HAV) infection in Turkey have not previously examined these factors. We investigated HAV seroprevalence and its association with sociodemographic factors among children of various ages in the Eastern Mediterranean region of Turkey. The study included 1142 children (603 male and 539 female) between ages of 6 months and 18 years. Seropositivity in the whole group was 57.2%. HAV prevalence rates according to age groups were as follows: 35.5% in 6,23 months group, 19.2% in 2,5 years group, 74.3% in 6,10 years group, 83.0% in 11,14 years group, 92.8% in 15,18 years group. Risk factors that influenced seropositivity were; dense population, over-crowded families, excessive number of siblings, low socioeconomic status and low education of the mother. As HAV seroprevalence in children older than 6 years of age is high, we recommend hepatitis A vaccination in this region after the first year of life. [source] Studies on cerebrospinal fluid ionized calcium and magnesium concentrations in convulsive childrenPEDIATRICS INTERNATIONAL, Issue 4 2004Yusaku Miyamoto AbstractBackground:,The concentrations of ionized calcium (iCa) and ionized magnesium (iMg) were measured in the cerebrospinal fluid (CSF) of convulsive and non-convulsive children, to investigate the relationship between seizure manifestation and CSF iCa and iMg concentrations. Standard concentrations of CSF iCa and iMg were also established. Methods:,CSF samples from 23 patients, ages 0,15 years, with various forms of seizures and 26 age-matched non-convulsive children were collected by lumbar puncture. CSF was obtained anaerobically and the concentrations of CSF iCa and iMg were measured with an electolyte analyzer (Stat Profile Ultra M1, NOVA, USA) immediately after the lumbar puncture. Results:,The concentrations of CSF iCa were significantly higher in non-convulsive children younger than 11 months old compared with children older than 12 months. The concentrations of CSF iMg in non-convulsive children did not differ significantly with aging. The concentrations of CSF iCa in convulsive children did not differ significantly from the concentrations of non-convulsive children. The concentrations of CSF iMg in convulsive children were significantly lower than in non-convulsive children. Conclusion:,These results suggest that seizure manifestation is related to age-dependent changes in iCa and decreased iMg in the developing brain. [source] Increased production of serum IgA-class antibody to lipid A in Kawasaki diseasePEDIATRICS INTERNATIONAL, Issue 1 2002Seiichiro Takeshita Abstract Background:,The etiology of Kawasaki disease (KD) remains unknown. To investigate whether a conventional bacterial antigen is involved in the pathogenesis of KD, we studied the serum response to lipopolysaccharide (LPS). Methods:,We measured the serum levels of IgG-, IgM- and IgA-class antibodies (Ab) to lipid A, a toxic site of LPS, using enzyme-linked immunosorbent assay in 20 patients with KD, 11 patients with Gram-negative bacterial infection (GNBI), 27 healthy children and 12 healthy adults. Results:,The serum levels of anti-lipid A IgG, IgM and IgA tended to increase with advancing age in healthy children older than 6 months of age. The mean level of anti-lipid A IgM in the acute phase of GNBI and the mean levels of anti-lipid A IgM and IgA in the acute phase of KD were found to increase significantly, in comparison to the age-matched controls. Furthermore, the mean level of anti-lipid A IgA also showed a significant increase from the acute to the subacute phases of KD. Regarding the IgA-subclass response, higher titers of anti-lipid A specific Ab were seen in the IgA2 subclass than in the IgA1 subclass. Conclusion:,These findings indicate that KD patients demonstrate an intense response to lipid A in the IgA, especially IgA2-subclass, thus suggesting that an unusual activation of the mucosal immune response to a ubiquitous antigen derived from Gram-negative bacteria may be involved in the pathogenesis of KD. [source] Age- and sex-related differences in antibody responses against Schistosoma mansoni soluble egg antigen in a cohort of school children in Ethiopia,APMIS, Issue 12 2001F. ABEBE Acquired immunity is believed to be the main factor in the age-related differences in prevalence and intensity of Schistosoma infections. We studied antibody responses against S. mansoni soluble egg antigen (SEA) by ELISA in children before treatment, 5 weeks and one year after treatment. After screening for S. mansoni infection, positive children were treated with praziquantel (40 mg per kg body weight). Infection rate was significantly higher in boys younger than 12 years than in girls in the same age group. Levels of all antibody isotypes, except IgG1 (before treatment) or IgA (one year after treatment), were higher in children older or equal to 12 years than in those younger. The difference between age groups was significant for IgE, IgM, IgG3 and IgG4 (before treatment) and IgE (one year after treatment). Similarly, all antibody isotypes, except IgE, before treatment were higher in boys than in girls. At 5 weeks after treatment, IgG, IgE and IgG1 showed an increasing tendency, whereas IgM and IgG3 tended to decrease. One year after treatment, significant decreases were observed in IgG, IgG1 and IgG4 and a significant increase in IgG2 levels. The study presents further evidence for the difference in acquired immunity between younger and older children, and between boys and girls. The study also suggests that praziquantel differentially affects antibody responses against S. mansoni SEA. [source] Bradycardic response during submersion in infant swimmingACTA PAEDIATRICA, Issue 3 2002E Goksör The diving response involves reflex bradycardia, apnoea and peripheral vasoconstriction and is known to exist in human infants. The response diminishes with increasing age and has been reported to disappear by the age of 6 mo. This study was performed to analyse the physiological events during natural diving of full-term healthy infants and describe how these events alter with maturation. Thirty-six infants were studied during diving exercises in infant swimming. All of the infants who participated showed an immediate decrease in heart rate when submerged. On average, the heart rate decreased by 25% (range ,5.0% to ,50.7%, p < 0.0001). The bradycardia was sustained during the dive and for some seconds afterwards. The response was often followed by a tachycardia as the bradycardia ceased. A decline of reflex bradycardia was observed with increasing age (p= 0.03), but the response was still clearly evident in infants over the age of 6 mo. Conclusion: This study demonstrates the existence of a diving response in infants, which includes an immediate bradycardic response, suggesting vagal mediation. Although the bradycardic response gradually decreases, the study shows that a clear-cut response exists in children older than has previously been reported. [source] | ||||||||||||||||||||||