Background: Surveys of pediatric endotracheal tube (ETT) management previously reported that specialists in pediatric anesthesia and intensive care medicine preferred to use uncuffed ETTs for children younger than 8 t...Background: Surveys of pediatric endotracheal tube (ETT) management previously reported that specialists in pediatric anesthesia and intensive care medicine preferred to use uncuffed ETTs for children younger than 8 to 10 years of age. The aim of this study was to reveal the most recent attitudes and clinical practices of pediatric ETT management in Japan. Methods: The attitudes and clinical practices of pediatric ETT management were investigated using the data sheets of each institution and each patient. The data sheets contained information on patient characteristics and type of hospital, surgical procedures, devices used for intubation, and ETT information including types, size, depth, intracuff pressure (ICP), interval of ICP measurement, laryngeal packing, ETT exchange, airway complications, and reintubations. Results: The response rate of this survey was 66.7%. More than half of children older than 2 years of age were intubated with cuffed ETTs;83.5% of cuffed ETTs were used with the cuffs inflated, and ICP was measured in 80.7% of cuffed ETTs. More than half of ICP measurements were only taken at the time of intubation. Post-extubation stridor was rarely observed in cuffed (0.4%) or uncuffed ETTs (1.2%). The pediatric ETT management questionnaire revealed age-based size selection, differences in pressure of air leakage between cuffed (15 - 20 cmH2O) and uncuffed ETTs (20 - 30 cmH2O) of different sizes, the depthmarking method of insertion length. Continuous measurement of ICP was not common. Conclusion: This study revealed widespread use of cuffed ETTs in children older than 2 years of age, rarely occurrence of post-extubation stridor, inflation of cuffs, and practice of ICP measurement.展开更多
AIM:To analyze small intestinal bacterial overgrowth in school-aged children and the relationship between hydrogen and methane production in breath tests.METHODS:This transversal study included 85 children residing in...AIM:To analyze small intestinal bacterial overgrowth in school-aged children and the relationship between hydrogen and methane production in breath tests.METHODS:This transversal study included 85 children residing in a slum and 43 children from a private school,all aged between 6 and 10 years,in Osasco,Brazil.For characterization of the groups,data regarding the socioeconomic status and basic housing sanitary conditions were collected.Anthropometric data was obtained in children from both groups.All children completed the hydrogen(H 2) and methane(CH 4) breath test in order to assess small intestinal bacterial overgrowth(SIBO).SIBO was diagnosed when there was an increase in H 2 ≥ 20 ppm or CH 4 ≥ 10 ppm with regard to the fasting value until 60 min after lactulose ingestion.RESULTS:Children from the slum group had worse living conditions and lower nutritional indices than children from the private school.SIBO was found in 30.9%(26/84) of the children from the slum group and in 2.4%(1/41) from the private school group(P = 0.0007).Greater hydrogen production in the small intestine was observed in children from the slum group when compared to children from the private school(P = 0.007).A higher concentration of hydrogen in the small intestine(P < 0.001) and in the colon(P < 0.001) was observed among the children from the slum group with SIBO when compared to children from the slum group without SIBO.Methane production was observed in 63.1%(53/84) of the children from the slum group and in 19.5%(8/41) of the children from the private school group(P < 0.0001).Methane production was observed in 38/58(65.5%) of the children without SIBO and in 15/26(57.7%) of the children with SIBO from the slum.Colonic production of hydrogen was lower in methaneproducing children(P = 0.017).CONCLUSION:Children who live in inadequate environmental conditions are at risk of bacterial overgrowth and methane production.Hydrogen is a substrate for methane production in the colon.展开更多
AIM:To assess the safety and utility of capsule endoscopy(CE)for children who are unable to swallow the capsule endoscope.METHODS:The medical records of all of the children who underwent CE between 2010 and 2012 were ...AIM:To assess the safety and utility of capsule endoscopy(CE)for children who are unable to swallow the capsule endoscope.METHODS:The medical records of all of the children who underwent CE between 2010 and 2012 were retrospectively reviewed.The patients were divided into 2groups:group A included patients who were unable to swallow the capsule endoscope,and group B included patients who were able to swallow it.For the patients who were unable to swallow the capsule endoscope,it was placed in the duodenum endoscopically.The small bowel transit time,endoscopic diagnosis and complications of the 2 groups were compared.RESULTS:During the study period,28 CE procedures were performed in 26 patients.Group A included 11patients with a median age of 2 years(range 10 mo-9years),and group B included 15 patients with a median age of 12 years(range 8 years-16 years).The lightest child in the study weighed 7.9 kg.The detection rates did not differ between the 2 groups.The median small bowel transit time was 401 min(range 264-734 min)in group A and 227 min(range 56-512 min)in group B(P=0.0078).No serious complications,including capsule retention,occurred.No significant mucosal trauma occurred in the pharynx,esophagus,stomach or duodenum when the capsule was introduced using an endoscope.CONCLUSION:CE is a safe and useful procedure for infants and young children who are unable to swallow the capsule endoscope.展开更多
AIM: To evaluate the presentation patterns of a cohort of children diagnosed with coeliac disease(CD) at Christchurch Hospital, New Zealand.METHODS: Children aged 16 years or less diagnosed with CD at Christchurch Hos...AIM: To evaluate the presentation patterns of a cohort of children diagnosed with coeliac disease(CD) at Christchurch Hospital, New Zealand.METHODS: Children aged 16 years or less diagnosed with CD at Christchurch Hospital, Christchurch, New Zealand, over the 11 year period between 2000 and 2010 were identified retrospectively. Diagnosis of CD was based upon standard histological criteria of endoscopically-obtained duodenal biopsies. Overlapping search methods were used to identify all relevant diagnoses within the time period. Endoscopy reports and histology findings were reviewed to confirm diagnosis. The numbers of diagnoses per year were calculated and changes in annual rates over the study period were delineated. Available records were reviewed to ascertain presenting symptoms, baseline anthropometry and the indication for referral for each child. In addition, the results of relevant investigations prior to diagnosis were accessed and reviewed. These key investigations included the results of coeliac serology testing(including tissue transglutaminase and endomysial antibodies) as well as the results of tests measuring levels of micronutrients, such as iron. In addition, the histological findings of concurrent biopsies in the oesophagus and stomach were reviewed. RESULTS: Over the 11 year study period, 263 children were diagnosed with CD at this New Zealand paediatric facility. Children were diagnosed from late infancy to 16.9 years: the largest subgroup of children(n = 111) were diagnosed between 5 and 12 years of age. The numbers of children diagnosed each year increased from 13 per year to 31 per year over the 11 years(P = 0.0095).Preschool children(aged less than 5 years) were more likely to have low weight, and to have diarrhoea and abdominal pain prior to diagnosis. Older children(over 5 years of age) most commonly presented with abdominal pain. Fifty-six(21.6%) of the 263 children were diagnosed following screening in high risk groups, with 38 of these children having no symptoms at diagnosis. Mean weight Z scores were lower in children aged less than five years than children aged 5-12 years or older children(-0.4096 ± 1.24, vs 0.1196 ± 0.966 vs 0.0901 ± 1.14 respectively: P = 0.0033). CONCLUSION: Increasing numbers of children were diagnosed with CD in this New Zealand centre over this time, with varied presentations and symptoms.展开更多
BACKGROUND Magnetic resonance enterography (MRE) and wireless capsule endoscopy (WCE) are equally accepted modalities for noninvasive screening of small bowel involvement (SBI) in children with Crohn’s disease (CD) a...BACKGROUND Magnetic resonance enterography (MRE) and wireless capsule endoscopy (WCE) are equally accepted modalities for noninvasive screening of small bowel involvement (SBI) in children with Crohn’s disease (CD) and indeterminate colitis (IC) albeit there is a paucity of data comparing the two and thereby guiding the clinician in selecting the ideal diagnostic approach. Therefore, the goal of this study is to provide additional evidence for capsule endoscopy role in the evaluation of established Crohn’s disease exacerbation compared to MRE in relation to Pediatric Crohn's Disease Activity Index (PCDAI), and histological indices. AIM To prospectively compare the findings of MRE and WCE and their agreement with PCDAI or histology in children with CD or IC. METHODS Consecutive patients diagnosed with CD and IC were screened for inclusion. After informed consent, patient’s demographic and clinical data was abstracted. The current pediatric disease activity index (PCDAI) and endoscopic findings were included. Patients underwent MRE and WCE including preprocedural patency capsule within a maximum of 7 d of each other. Pathological presence of active small bowel disease in ileal and duodenal biopsies were collected if the endoscopy was performed within 2 mo of the WCE study. Patients who failed to pass the PC were excluded from the study. WCE was read by two different experienced gastroenterologists (Attard TM and Colombo JM) blinded to each other's findings and to the findings on MRE (Mardis NJ). Agreement between WCE reviewers, WCE and MRE findings and concordance between positive PCDAI and SBI based on MRE compared with WCE was computed. RESULTS Forty-five patients were included in the study, 18 withdrew and 27 (20 males and 20 CD), mean age (standard deviation) 13.46 (2.4) years, completed the study protocol. There were no instances of capsule retention. Concordance between gastroenterologist reviewers was excellent for the diagnosis of small intestinal CD with good correlation between the two Lewis scores (r=0.875, P<0.001). Concordance between WCE and MRE was poor (69%). In CD patients, when both MRE and WCE were compared using PCDAI>10 as the standard reference reflecting active small intestinal CD, the sensitivity of MRE and WCE were 100% and 83% respectively and the specificity of MRE and WCE were 57.14% and 78.6%, respectively. If the histology in ileum or/and duodenum was used as the reference for active small bowel involvement, WCE had a higher specificity as compared to MRE (83.3% vs 50%). In patients with Crohn’s disease, those with a positive PCDAI (>10) were more likely to have a positive WCE as compared to those with a negative PCDAI (83% vs 21%;P=0.018). CONCLUSION We suggest that MRE and WCE have a complementary role in the assessment of SBI in CD. WCE detected SBI with a much higher specificity while MRE had a higher sensitivity.展开更多
目的分析早产小于胎龄儿(small for gestational age infant,SGA)发生的危险因素,为加强围生期教育及进行临床干预提供依据。方法选取2017年1月至2022年1月河北大学附属医院新生儿科收治的1483例早产儿为研究对象,根据出生体质量和胎龄...目的分析早产小于胎龄儿(small for gestational age infant,SGA)发生的危险因素,为加强围生期教育及进行临床干预提供依据。方法选取2017年1月至2022年1月河北大学附属医院新生儿科收治的1483例早产儿为研究对象,根据出生体质量和胎龄的关系将研究对象分为2组,即早产SGA组和早产适于胎龄儿(appropriate for gestational age infant,AGA)组,分析每组患儿的围生期高危因素,并运用单因素及多因素Logistic回归分析早产SGA发生的危险因素。结果早产SGA组母亲孕期合并妊娠期高血压、羊水过少、胎盘异常、妊娠期贫血、双胎/多胎妊娠、高龄产妇、接受辅助生殖技术比例高于早产AGA组,差异有统计学意义(P<0.05);Logistic回归分析显示,母亲患有妊娠期高血压、胎盘异常、妊娠期贫血是早产SGA发生的独立危险因素(P<0.05)。结论母亲患有妊娠期高血压、胎盘异常、妊娠期贫血与早产SGA的发生关系密切,在临床工作中应针对性开展围生期教育并及时干预,降低SGA的发生率。展开更多
文摘Background: Surveys of pediatric endotracheal tube (ETT) management previously reported that specialists in pediatric anesthesia and intensive care medicine preferred to use uncuffed ETTs for children younger than 8 to 10 years of age. The aim of this study was to reveal the most recent attitudes and clinical practices of pediatric ETT management in Japan. Methods: The attitudes and clinical practices of pediatric ETT management were investigated using the data sheets of each institution and each patient. The data sheets contained information on patient characteristics and type of hospital, surgical procedures, devices used for intubation, and ETT information including types, size, depth, intracuff pressure (ICP), interval of ICP measurement, laryngeal packing, ETT exchange, airway complications, and reintubations. Results: The response rate of this survey was 66.7%. More than half of children older than 2 years of age were intubated with cuffed ETTs;83.5% of cuffed ETTs were used with the cuffs inflated, and ICP was measured in 80.7% of cuffed ETTs. More than half of ICP measurements were only taken at the time of intubation. Post-extubation stridor was rarely observed in cuffed (0.4%) or uncuffed ETTs (1.2%). The pediatric ETT management questionnaire revealed age-based size selection, differences in pressure of air leakage between cuffed (15 - 20 cmH2O) and uncuffed ETTs (20 - 30 cmH2O) of different sizes, the depthmarking method of insertion length. Continuous measurement of ICP was not common. Conclusion: This study revealed widespread use of cuffed ETTs in children older than 2 years of age, rarely occurrence of post-extubation stridor, inflation of cuffs, and practice of ICP measurement.
基金Supported by Coordination for the Improvement of Higher Education Personnel (CAPES) and Food and Nutrition Fund Municipal Health Fund of Osasco,Sao Paulo,Brazil
文摘AIM:To analyze small intestinal bacterial overgrowth in school-aged children and the relationship between hydrogen and methane production in breath tests.METHODS:This transversal study included 85 children residing in a slum and 43 children from a private school,all aged between 6 and 10 years,in Osasco,Brazil.For characterization of the groups,data regarding the socioeconomic status and basic housing sanitary conditions were collected.Anthropometric data was obtained in children from both groups.All children completed the hydrogen(H 2) and methane(CH 4) breath test in order to assess small intestinal bacterial overgrowth(SIBO).SIBO was diagnosed when there was an increase in H 2 ≥ 20 ppm or CH 4 ≥ 10 ppm with regard to the fasting value until 60 min after lactulose ingestion.RESULTS:Children from the slum group had worse living conditions and lower nutritional indices than children from the private school.SIBO was found in 30.9%(26/84) of the children from the slum group and in 2.4%(1/41) from the private school group(P = 0.0007).Greater hydrogen production in the small intestine was observed in children from the slum group when compared to children from the private school(P = 0.007).A higher concentration of hydrogen in the small intestine(P < 0.001) and in the colon(P < 0.001) was observed among the children from the slum group with SIBO when compared to children from the slum group without SIBO.Methane production was observed in 63.1%(53/84) of the children from the slum group and in 19.5%(8/41) of the children from the private school group(P < 0.0001).Methane production was observed in 38/58(65.5%) of the children without SIBO and in 15/26(57.7%) of the children with SIBO from the slum.Colonic production of hydrogen was lower in methaneproducing children(P = 0.017).CONCLUSION:Children who live in inadequate environmental conditions are at risk of bacterial overgrowth and methane production.Hydrogen is a substrate for methane production in the colon.
文摘AIM:To assess the safety and utility of capsule endoscopy(CE)for children who are unable to swallow the capsule endoscope.METHODS:The medical records of all of the children who underwent CE between 2010 and 2012 were retrospectively reviewed.The patients were divided into 2groups:group A included patients who were unable to swallow the capsule endoscope,and group B included patients who were able to swallow it.For the patients who were unable to swallow the capsule endoscope,it was placed in the duodenum endoscopically.The small bowel transit time,endoscopic diagnosis and complications of the 2 groups were compared.RESULTS:During the study period,28 CE procedures were performed in 26 patients.Group A included 11patients with a median age of 2 years(range 10 mo-9years),and group B included 15 patients with a median age of 12 years(range 8 years-16 years).The lightest child in the study weighed 7.9 kg.The detection rates did not differ between the 2 groups.The median small bowel transit time was 401 min(range 264-734 min)in group A and 227 min(range 56-512 min)in group B(P=0.0078).No serious complications,including capsule retention,occurred.No significant mucosal trauma occurred in the pharynx,esophagus,stomach or duodenum when the capsule was introduced using an endoscope.CONCLUSION:CE is a safe and useful procedure for infants and young children who are unable to swallow the capsule endoscope.
文摘AIM: To evaluate the presentation patterns of a cohort of children diagnosed with coeliac disease(CD) at Christchurch Hospital, New Zealand.METHODS: Children aged 16 years or less diagnosed with CD at Christchurch Hospital, Christchurch, New Zealand, over the 11 year period between 2000 and 2010 were identified retrospectively. Diagnosis of CD was based upon standard histological criteria of endoscopically-obtained duodenal biopsies. Overlapping search methods were used to identify all relevant diagnoses within the time period. Endoscopy reports and histology findings were reviewed to confirm diagnosis. The numbers of diagnoses per year were calculated and changes in annual rates over the study period were delineated. Available records were reviewed to ascertain presenting symptoms, baseline anthropometry and the indication for referral for each child. In addition, the results of relevant investigations prior to diagnosis were accessed and reviewed. These key investigations included the results of coeliac serology testing(including tissue transglutaminase and endomysial antibodies) as well as the results of tests measuring levels of micronutrients, such as iron. In addition, the histological findings of concurrent biopsies in the oesophagus and stomach were reviewed. RESULTS: Over the 11 year study period, 263 children were diagnosed with CD at this New Zealand paediatric facility. Children were diagnosed from late infancy to 16.9 years: the largest subgroup of children(n = 111) were diagnosed between 5 and 12 years of age. The numbers of children diagnosed each year increased from 13 per year to 31 per year over the 11 years(P = 0.0095).Preschool children(aged less than 5 years) were more likely to have low weight, and to have diarrhoea and abdominal pain prior to diagnosis. Older children(over 5 years of age) most commonly presented with abdominal pain. Fifty-six(21.6%) of the 263 children were diagnosed following screening in high risk groups, with 38 of these children having no symptoms at diagnosis. Mean weight Z scores were lower in children aged less than five years than children aged 5-12 years or older children(-0.4096 ± 1.24, vs 0.1196 ± 0.966 vs 0.0901 ± 1.14 respectively: P = 0.0033). CONCLUSION: Increasing numbers of children were diagnosed with CD in this New Zealand centre over this time, with varied presentations and symptoms.
基金Supported by the donation of wireless Small bowel capsule and patency capsules from Giving imaging,Ltd Medtronic company with the funding agreement from Given investigator-initiated study No.13-12
文摘BACKGROUND Magnetic resonance enterography (MRE) and wireless capsule endoscopy (WCE) are equally accepted modalities for noninvasive screening of small bowel involvement (SBI) in children with Crohn’s disease (CD) and indeterminate colitis (IC) albeit there is a paucity of data comparing the two and thereby guiding the clinician in selecting the ideal diagnostic approach. Therefore, the goal of this study is to provide additional evidence for capsule endoscopy role in the evaluation of established Crohn’s disease exacerbation compared to MRE in relation to Pediatric Crohn's Disease Activity Index (PCDAI), and histological indices. AIM To prospectively compare the findings of MRE and WCE and their agreement with PCDAI or histology in children with CD or IC. METHODS Consecutive patients diagnosed with CD and IC were screened for inclusion. After informed consent, patient’s demographic and clinical data was abstracted. The current pediatric disease activity index (PCDAI) and endoscopic findings were included. Patients underwent MRE and WCE including preprocedural patency capsule within a maximum of 7 d of each other. Pathological presence of active small bowel disease in ileal and duodenal biopsies were collected if the endoscopy was performed within 2 mo of the WCE study. Patients who failed to pass the PC were excluded from the study. WCE was read by two different experienced gastroenterologists (Attard TM and Colombo JM) blinded to each other's findings and to the findings on MRE (Mardis NJ). Agreement between WCE reviewers, WCE and MRE findings and concordance between positive PCDAI and SBI based on MRE compared with WCE was computed. RESULTS Forty-five patients were included in the study, 18 withdrew and 27 (20 males and 20 CD), mean age (standard deviation) 13.46 (2.4) years, completed the study protocol. There were no instances of capsule retention. Concordance between gastroenterologist reviewers was excellent for the diagnosis of small intestinal CD with good correlation between the two Lewis scores (r=0.875, P<0.001). Concordance between WCE and MRE was poor (69%). In CD patients, when both MRE and WCE were compared using PCDAI>10 as the standard reference reflecting active small intestinal CD, the sensitivity of MRE and WCE were 100% and 83% respectively and the specificity of MRE and WCE were 57.14% and 78.6%, respectively. If the histology in ileum or/and duodenum was used as the reference for active small bowel involvement, WCE had a higher specificity as compared to MRE (83.3% vs 50%). In patients with Crohn’s disease, those with a positive PCDAI (>10) were more likely to have a positive WCE as compared to those with a negative PCDAI (83% vs 21%;P=0.018). CONCLUSION We suggest that MRE and WCE have a complementary role in the assessment of SBI in CD. WCE detected SBI with a much higher specificity while MRE had a higher sensitivity.
文摘目的分析早产小于胎龄儿(small for gestational age infant,SGA)发生的危险因素,为加强围生期教育及进行临床干预提供依据。方法选取2017年1月至2022年1月河北大学附属医院新生儿科收治的1483例早产儿为研究对象,根据出生体质量和胎龄的关系将研究对象分为2组,即早产SGA组和早产适于胎龄儿(appropriate for gestational age infant,AGA)组,分析每组患儿的围生期高危因素,并运用单因素及多因素Logistic回归分析早产SGA发生的危险因素。结果早产SGA组母亲孕期合并妊娠期高血压、羊水过少、胎盘异常、妊娠期贫血、双胎/多胎妊娠、高龄产妇、接受辅助生殖技术比例高于早产AGA组,差异有统计学意义(P<0.05);Logistic回归分析显示,母亲患有妊娠期高血压、胎盘异常、妊娠期贫血是早产SGA发生的独立危险因素(P<0.05)。结论母亲患有妊娠期高血压、胎盘异常、妊娠期贫血与早产SGA的发生关系密切,在临床工作中应针对性开展围生期教育并及时干预,降低SGA的发生率。
