Etiology and Treatment Advances of Hematochezia in Infants Aged ≤3 Months

The incidence of hematochezia in infants aged three months or younger has shown an upward trend in recent years. This condition is characterized by visible bloody stools, which may appear bright red, dark red, jam-like, or mucus-purulent bloody stools, and is often accompanied by positive fecal occult blood tests, with or without additional systemic clinical symptoms. The etiology is multifactorial, potentially influenced by the maternal health status during pregnancy, neonatal diseases or treatments received in the NICU, and the methods used for establishing enteral and parenteral nutrition. Notably, allergic factors have gained prominence in recent years. This paper reviews recent studies to elucidate the incidence, primary causes, and current treatment approaches for early infant hematochezia, providing a reference for clinical practice.

Incidence of Parenteral Nutrition-Associated Liver Disease in Infants on Prolonged Parenteral Nutrition with a Soybean-Based Lipid Emulsion: A 7-Year Experience

Parenteral nutrition associated liver disease (PNALD) is a significant complication in infants receiving long-term parenteral nutrition (PN). Chronic administration of PN has been associated with its development. Our purpose is to characterize our incidence of PNALD over an extended period and identify risk factors for its development, including administration of soybean-based injectable lipid emulsions (ILEs) as we transit to novel ILEs in our practice. Infants receiving 30 days or more of PN were included. PNALD was defined as a direct bilirubin ≥ 2 mg/dL. Data collected included: patient demographics, clinical and enteral feeding characteristics. Macronutrient intake was recorded using these cut-offs: glucose infusion rate (GIR) of ≤14 mg/kg/min or above, protein doses of ≤3 g/kg/day or above and lipid doses of ≤2 g/kg/day or above. A total of 349 infants were included, with an annual incidence of PNALD ranging between 34% - 54%. Infants with PNALD were younger by gestation (27 vs. 29.5 weeks) and smaller by birthweight (900 vs. 1248 grams). Sepsis, GI disease including necrotizing enterocolitis and bowel resection were significantly associated with an increased risk for development of PNALD. PNALD infants received lower protein doses (3.0 vs 3.3 g/kg/day, p = 0.014) while receiving higher GIR (11.4 vs 10.7 mg/kg/min, p = 0.012) compared to non-PNALD infants. Low birth weight, sepsis and bowel resection remain strong indicators of risk for PNALD. No single macronutrient increased our infants’ risk for PNALD. The use of newer ILEs when available should be evaluated for their impact on PNALD development.

Clinical Effect of an Improved Post-Operative Feeding Protocol“in Transition”Infants of Congenital Heart Disease with Pulmonary Hypertension

Background:To achieve successful management of infants with congenital heart disease(CHD)together with pulmonary hypertension(PH),postoperative care,especially feeding care is vital in addition to surgery.Postoperative feeding is comprised of three stages:feeding in the intensive care unit,feeding in the general ward and family feeding,in which the general ward is considered as the“transitional stage”.At present,there is little research on the optimal mode of feeding care for the transitional stage,and there is no universally recognized and accepted protocol.Methods:We retrospectively analyzed 114 CHD infants with PH who underwent family-centered(FC)feeding care from July 2017 to December 2018,and prospectively studied 122 CHD infants with the same baseline level who adopted the improved mode,nurse-parent-driven(NPD)feeding mode from January 2019 to June 2020.The feasibility and efficacy of NPD as a“transitional”feeding nursing mode in CHD infants with PH were compared with the FC cohort by observing and analyzing the stress of family caregivers,feedingrelated complications,the proportion of breastfeeding,improvement of nutritional status,acquisition of knowledge and skills of feeding care,inpatient’s satisfaction rating and prognosis.Results:When compared with the FC feeding care,the NPD mode significantly reduced the burden of family caregivers,improved the rate of feeding care knowledge and skills and inpatient’s satisfaction rating,reduced the incidence of improper feeding-related complications,and enhanced the proportion of breastfeeding and nutritional status of infants at the“transitional stage”(all P<0.05).The self-assessment score of care ability of family caregivers and weight gain of children in the NPD group were significantly higher than those in the FC group(all P<0.05)during the follow-up.Conclusions:As a transitional mode of feeding in CHD infants with PH,NPD feeding care is superior to the conventional FC mode,which therefore can be adopted as a standard protocol in clinical practice.

Cardiac changes in infants of diabetic mothers

Diabetes mellitus(DM)is a systemic chronic metabolic disorder characterized by increased insulin resistance and/orβ-cell defects.It affects all ages from the foetal life,neonates,childhood to late adulthood.Gestational diabetes is a critical risk factor for congenital heart diseases(CHDs).Moreover,the risk increases with low maternal education,high body mass index at conception,undiagnosed pregestational diabetes,inadequate antenatal care,improper diabetes control,and maternal smoking during pregnancy.Maternal DM significantly affects the foetal heart and foetal-placental circulation in both structure and function.Cardiac defects,myocardial hypertrophy are three times more prevalent in infants of diabetic mothers(IDMs).Antenatal evaluation of the cardiac function and structures can be performed with foetal electrocardiography and echocardiography.Postnatal cardiac evaluation can be performed with natal and postnatal electrocardiography and echocardiography,detection of early atherosclerotic changes by measuring aortic intima-media thickness,and retinal vascular changes by retinal photography.Ameliorating the effects of diabetes during pregnancy on the offspring depends mainly on pregestational and gestational diabetes prevention.However,other measures to reduce the risk,such as using medications,nutritional supplements,or probiotics,still need more research.This review discusses the mechanism of foetal sequels and the risk factors that increase the prevalence of CHDs in gestational DM,the various cardiac outcomes of gestational DM on the foetus and offspring,cardiac evaluation of foetuses and IDMs,and how to alleviate the consequences of gestational DM on the offspring.

Gastrointestinal cytomegalovirus disease secondary to measles in an immunocompetent infant

Yang et al reported an immunocompetent infant with gastrointestinal cytomegalovirus disease secondary to measles infection.We express our opinion about the diagnosis and treatment of this rare disease.

Potential carrier priming effect in Australian infants after 7-valent pneumococcal conjugate vaccine introduction

AIM:To investigate evidence of clinical protection in infants after one dose of 7-valent pneumococcal conjugate vaccine(7vPCV) owing to carrier priming.METHODS:Using Australian National Notifiable Diseases Surveillance System data,we conducted a descriptive analysis of cases of vaccine type invasive pneumococcal disease(VT-IPD) during "catch-up" years,when 7vPCV was carrier primed by prior administration of DTPa vaccine.We compared the number of VT-IPD cases occurring 2-9 wk after a single dose of 7vPCV(carrier primed),with those < 2 wk post vaccination,when no protection from 7vPCV was expected yet.Further comparison was conducted to compare the occurrence of VT-IPD cases vs non-VT-IPD cases after a single carrier-primed dose of 7vPCV.RESULTS:We found four VT-IPD cases occurring <2 wk after one carrier primed dose of 7vPCV while only one case occurred 2-9 wk later.Upon further comparison with the non-VT-IPD cases that occurred after one carrier primed dose of 7vPCV,two cases were detected within 2 wk,whereas seven occurred within2-9 wk later;suggesting a substantial level of protection from VT-IPD occurring from 2 wk after carrier-primed dose of 7vPCV.CONCLUSION:This data suggest that infants may benefit from just one dose of 7vPCV,likely through enhanced immunity from carrier priming effect.If this is proven,an adjusted 2-dose schedule(where the first dose of PCV is not given until after DTPa) may be sufficient and more cost-effective.

Oxidative stress and free radicals related diseases of the newborn

Free radicals (FRs) generation is an unavoidable consequence of the life in an oxygen-rich atmosphere. FRs can be considered a double-edged sword. Beneficial effects of FRs occur at moderate concentrations and involve physiological roles in cellular responses to noxia, as in defense against infectious agents, in the function of a number of cellular signaling pathways and the induction of a mitogenic response. The over-production of FRs and the insufficiency of an antioxidant mechanism result in oxidative stress (OS), a deleterious process and important mediator of damage to cell structures and tissues. It occurs at birth in all newborns as a consequence of the hyperoxic challenge after the transition from the hypoxic intrauterine environment to extrauterine life. During the perinatal period, OS can be magnified by others predisposing conditions such as hyperoxia, hypoxia, ischemia, hypoxia-reperfusion, inflammation and high levels of non-protein bound iron. Epidemiological studies linked OS occurring during fetal stages and early infancy with adverse health outcomes later in life, indicating that OS is an early event in the etiology of these chronic diseases. Newborns, especially if preterm, are particularly susceptible to OS and damage due to the increased generation of FRs, the lack of adequate antioxidant protection, and the inability to induce antioxidant defenses during the hyperoxic challenge at birth. This impairment of the oxidative balance has been thought to be the common factor of pathologies grouped together as “free radical disease in the neonate” that include retinopathy of prematurity (which may lead to blindness in severe cases), bronchopulmonary dysplasia (a particularly debilitating pulmonary lesion of the preterm infant), periventricular leukomalacia (an important cause of severe neurodisability) and necrotizing enterocolitis. In this review we discuss in detail these perinatal diseases. Particularly, we analyze the current knowledge about the role of OS in their pathogenesis.

Short-Term Outcomes of Two Surgical Techniques for the Treatment of Coarctation of the Aorta in Infants: Subclavian Flap Repair and Resection with Extended End-to-End Anastomosis Technique

Background: The aims of the study were to analyze the importance of two different surgical procedures, and to determine outcomes for neonates with coarctation of the aorta in two newly established centers. Methods: Outcomes of two different surgical repairs for coarctation of the aorta in 43 infants were evaluated retrospectively. The study was designed as a nonrandomized, cross-sectional study. The subclavian flap repair was applied to 22 patients (51%) and resection with extended end-to-end anastomosis technique to 21 patients (49%). After all operative survivors were followed up with a mean follow-up of 1.8 ± 0.8 years, data analyzed with t-test and the p value < 0.05 were considered statistically significant. Results: The overall mortality rate was 4.6%. Forty mmHg gradients were determined in a patient from Resection Group postoperatively in the fifteenth month. After the balloon angioplasty, the gradient decreased to 25 mmHg. The presence of ventricular septal defect (p = 0.094) was the only significant predictor of adverse short-term outcome among the associated cardiac defects analyzed. The first-year survival rate was 100% in both groups in isolated coarctation (p = 0.965), however;such rate was found as 100% and 93.25% in Waldhausen Group and Resection Group, respectively in complex coarctation (p = 0.294). Conclusions: Both the subclavian flap repair and resection with extended end-to-end anastomosis for coarctation of the aorta in infants provide excellent short-term outcomes with lower recurrence rates requiring surgery or angioplasty.

Wilson disease with hepatic presentation in an eight-month-old boy

Wilson disease is an autosomal recessive disorder of copper metabolism that can cause fatal neurological and hepatic disease if not diagnosed and treated. The youngest child with normal liver function reported so far is an 8-mo-old Japanese boy with low ceruloplasmin levels, and the youngest child with elevated aminotransferase ever reported so far is a 9-mo-old Korean boy with confirmed by genetic testing. Here we report an 8-mo-old Chinese boy presented with elevated liver enzymes, and low serum ceruloplasmin level. Genetic analysis of ATP7 B gene detected two heterozygous disease causing mutations(c.2621C>T/p.A874 V and c.3809A>G/p.N1270S), and parental origins were determined. Persistent elevation of serum aminotransferase in this infant was normalized after zinc therapy. To our best knowledge, this is the youngest patient with elevated liver enzymes ever reported worldwide. We hope that this will raise awareness among pediatricians, leading to earlier diagnosis, timely treatment, and better clinical outcome.

Novel methionyl-tRNA synthetase gene variants/phenotypes in interstitial lung and liver disease: A case report and review of literature

Interstitial lung and liver disease(ILLD) is caused by biallelic mutations in the methionyl-tRNA synthetase(MARS) gene. To date, no genetic changes other than missense variants were reported in the literature. Here, we report a five-month old female infant with typical ILLD(failure to thrive, developmental delay, jaundice, diffuse interstitial lung disease, hepatomegaly with severe steatosis, anemia, and thrombocytosis) showing novel phenotypes such as kidney stones, acetabular dysplasia, prolonged fever, and extreme leukocytosis. Whole exome sequencing revealed a novel truncating variant(c.2158 C>T/p.Gln720 Stop) together with a novel tri-nucleotide insertion(c.893_894 insTCG that caused the insertion of an arginine at amino acid position 299) in the MARS gene.

Disagreement between symptom-reflux association analysis parameters in pediatric gastroesophageal reflux disease investigation

AIM: To assess the agreement within 3 commonly used symptom-reflux association analysis (SAA) parameters investigating gastroesophageal reflux disease (GERD) in infants. METHODS: Twenty three infants with suspected GERD were included in this study. Symptom index (SI), Symptom sensitivity index (SSI) and symptom association probability (SAP) related to cough and irritability were calculated after 24 h combined pH/multiple intraluminal impedance (MII) monitoring. Through defined cutoff values, SI, SSI and SAP values are differentiated in normal and abnormal, whereas abnormal values point towards gastroesophageal reflux (GER) as the origin of symptoms. We analyzed the correlation and the concordance of the diagnostic classification of these 3 SAA parameters.RESULTS: Evaluating the GER-irritability association, SI, SSI and SAP showed non-identical classification of normal and abnormal cases in 39.2% of the infants. When irritability was taken as a symptom, there was only a poor inter-parameter association between SI and SSI, and between SI and SAP (Kendall’s tau b = 0.37, P < 0.05; Kendall’s tau b = 0.36, P < 0.05, respectively). Evaluating the GER-cough association, SI, SSI and SAP showed non-identical classification of normal and abnormal cases in 52.2% of the patients. When cough was taken as a symptom, only SI and SSI showed a poor inter-parameter association (Kendall’s tau b = 0.33, P < 0.05). CONCLUSION: In infants investigated for suspected GERD with pH/MII-monitoring, SI, SSI and SAP showed a poor inter-parameter association and important dis-agreements in diagnostic classification. These limitations must be taken into consideration when interpreting the results of SAA in infants.

Gastroesophageal reflux disease in children: What’s new right now?

Gastroesophageal reflux(GER)in children is very common and refers to the involuntary passage of gastric contents into the esophagus.This is often physiological and managed conservatively.In contrast,GER disease(GERD)is a less common pathologic process causing troublesome symptoms,which may need medical management.Apart from abnormal transient relaxations of the lower esophageal sphincter,other factors that play a role in the pathogenesis of GERD include defects in esophageal mucosal defense,impaired esophageal and gastric motility and clearance,as well as anatomical defects of the lower esophageal reflux barrier such as hiatal hernia.The clinical manifestations of GERD in young children are varied and nonspecific prompting the necessity for careful diagnostic evaluation.Management should be targeted to the underlying aetiopathogenesis and to limit complications of GERD.The following review focuses on up-to-date information regarding of the pathogenesis,diagnostic evaluation and management of GERD in children.

Study on the Effects of Infant Fostering Interventions in Xuhui District,Shanghai

Objective To assess the effects of fostering interventions on the infants and their families through the community. Methods A total of 309 infants born on 1st August, 2003 to 30th August, 2004 and their families were recruited as participants by cluster sampling in Longhua and Kantian sub-districts of Xuhui district, Shanghai. The newborns were randomly assigned to intervention group （156 cases） and control group （153 cases）. The infants and their families will be followed up during 3-year interventions. Results After 6 months＇ intervention, the proportion of infants who could turn over the body in the intervention group （88.46%） was higher than that in control group （75.16%）. The morbidity of upper-respiratory tract infection in intervention group （20.51%） was significantly lower than that in control group （32.68%）. The incidence rates of pneumonia, diarrhea and anemia in intervention group were all lower than that in control group, except for pneumonia, the differences were not significant. Both of the knowledge about how to foster infants and service utility in intervention group were higher than that in control group. Conclusion The fostering interventions through the community promote the prevention and control of infants disease, increase the knowledge level and service util ity of families.

Gastrointestinal symptoms as the first sign of chronic granulomatous disease in a neonate: A case report

BACKGROUND Chronic granulomatous disease(CGD)characterized by recurrent and severe bacterial and fungal infections is most common in childhood.CASE SUMMARY We reported a 24-d-old male infant who developed gastrointestinal symptoms as the first sign of CGD.CONCLUSION Gastrointestinal symptoms representing the first sign of CGD are very rare,and prompt diagnosis and treatment with broad-spectrum antibiotics were of crucial importance.

Current Status of Acute Rheumatic Fever and Relationship with Acute Rheumatic Heart Disease at the University Teaching Hospital of Brazzaville (Congo)

Aim: To determine the epidemiological findings of acute rheumatic fever (ARF) and relationship with acute rheumatic heart disease (RHD). Patients and method: This cross sectional study was conducted from January 2012 to December 2016 (5 years) in the Department of Pediatrics. We had included patients aged from 5 to15 years old, admitted for ARF. Results: Twenty-nine black African children, 15 boys (51.7%) were included. The incidence was 5.8 cases/year. The mean age was 10.4 ± 2.7 years. The mean age of parents was 34.5 ± 6.9 years (range: 24-48) for mother and 41.2 ± 6.9 years (range: 28 - 56) for father. Parents were low-income 10 (34.5%), the delay of consultation was 17.7 ± 19.5 days. The medical history was: frequent pharyngitis 22 (76%), previous ARF 17 (58.6%), previous hospitalization 11 (38%). Signs were: polyarthralgia (n = 28, 96.6%), fever (n = 24, 82.8%), asthenia (n = 18, 62%), migratory polyarthritis (n = 12, 41.4%). Organic heart murmur has been reported in 13 cases (44.8%), and heart failure in 7 cases. The anomalies of blood analysis were inflammatory syndrome (100%), elevation of streptococcal enzymes (n = 27, 93%), and anemia (n = 16, 55.2%). In cardiac ultrasound, anomalies were: thickened valve (n = 13, 44.8%), mitral regurgitation (n = 13, 44.8%), dilatation of left ventricle (n = 9, 31%), aortic regurgitation (n = 5, 17.2%). The nosology of pathology was acute RHD (n = 15, 51.7%), ARF only (n = 14, 48.3%). Associated factors of acute RHD were: female sex (OR 1.52, 95%CI 0.35 - 6.6), low-income (OR 1.33, 95%CI 0.24 - 7.4), previous hospitalization (OR 2.7, 95%CI 0.58 - 13) and migratory polyarthritis (OR 1.12, 95%CI 0.25 - 4.9). Conclusion: The ARF remains prevalent in our countries. Its complications lead to sequelae that are difficult to treat, because of the lack of cardiac surgery centers in many sub-Saharan African countries including Congo. Prevention and effective treatment of angina should be applied by practitioners.

Effects of Palivizumab Guideline Changes on RSV Admissions in Patients with Congenital Heart Disease and Prematurity

Background: Respiratory syncytial virus (RSV) causes significant morbidity and mortality in patients with a history of prematurity and congenital heart disease (CHD). In 2014, the guidelines for Palivizumab became more restrictive for this population. We hypothesized the percentage of RSV+ admissions would increase overall and in this target group (TG) specifically. Methods: We conducted a retrospective review of patients under age 2 years admitted with bronchiolitis two seasons prior to the change (Pre) and two seasons after (Post). Our TG included patients who were eligible prior to the 2014 changes but currently no longer eligible. We used chi-square analysis to answer the two main hypotheses: 1) Percent RSV+/total bronchiolitis Pre vs Post and 2) Percent of TG/RSV+ Pre vs Post. Results: 1283 patients (546 pre, 737 post) were admitted with the diagnosis of RSV between 2012-2016, 866 actually tested positive for RSV (367 Pre, 499 Post). There was no significant difference in the number of total patients admitted with RSV (Pre = 67.2%, Post = 67.7%) or in our TG (Pre 7.1% vs Post 8.2%). TG overall had a more complicated course: longer length of stay, median 5 days, IQR 2 - 12 vs 3 days, IQR 1 - 5, (p < 0.001), intensive care unit admissions (36% vs 22.8%, p = 0.02), positive pressure ventilation (25.4% vs 15.4%, p = 0.03) and intubation (16.4% vs 6.8%, p = 0.004), but there was no difference Pre vs Post. Conclusion: The TG had an overall higher acuity, but there was no increase in the number of patients hospitalized with RSV or severity as a result of the Palivizumab guideline changes.

婴幼儿川崎病急性期肠道菌群的特征分析

目的分析婴幼儿川崎病(Kawasaki disease,KD)急性期肠道菌群的构成、丰度及功能差异,探索肠道菌群在KD发病机制中的作用。方法前瞻性选择2021年7—10月在首都儿科研究所附属儿童医院心血管内科住院的6例0~3岁KD急性期婴幼儿为KD组,选取同期体检的年龄、性别匹配的6例健康婴幼儿为健康对照组。采用宏基因组测序检测并比较两组婴幼儿粪便样本的菌群结构及功能差异。结果两组样本肠道菌群在结构组成、多样性分析方面差异有统计学意义(P<0.05)。KD组婴幼儿肠道菌群中单核细胞增生李斯特菌(李斯特菌科、李斯特氏菌属)、鲁塞蒂双歧杆菌、海氏肠球菌、鸟肠球菌丰度高于健康对照组(|LDA|>2,P<0.05)。KD组中类固醇降解和细胞凋亡通路较健康对照组显著升高,而细菌分泌系统、硫代谢、丁酸甲酯代谢、苯甲酸降解、β丙氨酸代谢、α亚麻酸代谢等通路显著减低(|LDA|>2,P<0.05)。结论0~3岁KD急性期婴幼儿肠道菌群在结构及多样性方面与健康婴幼儿相比均有显著差异,提示KD急性期存在肠道菌群紊乱,尤其是单核细胞增生李斯特菌、海氏肠球菌、鸟肠球菌可能通过类固醇降解及细胞凋亡参与KD的发病机制。

≤10 kg婴幼儿先天性心脏病的围手术期治疗

目的评估低体重(≤10 kg)婴幼儿先心病的外科手术效果,总结临床经验。方法回顾性分析心外科低体重(≤10 kg)婴幼儿先心病1382例的临床资料。男性665例,女性717例;年龄6 d~3岁,平均(9.58±1.84)个月;体重1.6~10.0 kg,平均(8.82±1.13)kg。其中1305例在全身麻醉下行心脏畸形根治术,77例行姑息手术。结果全组手术顺利,术后死亡13例,占0.94%。死亡原因:低心排综合征7例,恶性心律失常1例,低氧血症5例(其中严重肺部感染2例)。结论低体重婴幼儿先心病的外科手术治疗是安全可行且有价值的,临床效果肯定,但必须正确掌握手术时机,缩短手术时间,严格进行围手术期管理,提高手术疗效。

安康市早产儿视网膜病变筛查结果及影响因素分析

【目的】分析安康市早产儿视网膜病变筛查结果及其影响因素。【方法】选取2018年6月至2021年12月在安康市妇幼保健院进行眼底筛查的836例早产儿,依据诊断标准根据出生胎龄与出生体重进行分组,研究各组早产儿视网膜病变的检出率及其影响因素。【结果】836例早产儿视网膜病变检出率为13.88%(116/836),其中重度早产儿视网膜病变患儿8例,占早产儿视网膜病变患儿的6.90%(8/116)。不同出生胎龄、出生体重、吸氧时间、输红细胞史的早产儿视网膜病变检出率比较,差异有统计学意义(P<0.05)。【结论】安康市早产儿视网膜病变检出率较高,需重点关注胎龄小、出生体重低、吸氧时间大于7 d和输注红细胞史的早产儿。