Percutaneous Balloon Angioplasty for Severe Native Aortic Coarctation in Young Infants Less Than 6 Months： Medium- to Long-term Follow-up

Background： Although balloon angioplasty （BA） has been performed for more than 20 years, its use as a treatment for native coarctation of the aorta （CoA） during childhood, especially in young infants, remains controversial. This study aimed to assess the effects and potential role ofpercutaneous transcatheter BA for native CoA as an alternative therapy to surgical repair in young infants. Methods： The 37 patients aged from 6 days to 6 months with severe CoA in congestive heart failure or circulatory shock were admitted for BA. Patient＇s weight ranged from 2.4 to 6.1 kg. All 37 patients were experiencing cardiac dysfunction, and eight patients were in cardiac shock with severe metabolic acidosis. Eleven patients had an isolated CoA, whereas the others had a CoA associated with other cardiac malformations. Cardiac catheterization and aortic angiography were performed under general anesthesia with intubation. Transfemoral arterial approaches were used for the BA. The size of the balloon ranged from 3 mm × 20 mm to 8 mm × 20 mm, and a coronary artery balloon catheter was preferred over a regular peripheral vascular balloon catheter. Results： The femoral artery was successfully punctured in all but one patient, with that patient undergoing a carotid artery puncture. The systolic peak pressure gradient （PG） across the coarctation was 41.0 ± 16.0 mmHg （range 13-76 mmHg）. The mean diameter of the narrowest coarctation site was 1.7 ± 0.6 mm （range 0.5-2.8 mm）. All patients had successful dilation; the PG significantly decreased to 13.0 ± 11.0 mmHg （range 0-40 mmHg）, and the diameter ofcoarctation significantly improved to 3.8 ± 0.9 mm （range 2.5-5.3 mm）. No intraoperative complications occurred for any patients. However, in one case that underwent a carotid artery puncture, a giant aneurysm formed at the puncture site and required surgical repair. The following observations were made during the follow-up period from 6-month to 7-year： （1） The PG across the coarctation measured by echocardiography further decreased or remained stable in 31 cases. The remaining six patients, whose PGs gradually increased, required a second dilation. No patient required further surgery because of a CoA; （2） in two cases, an aortic aneurysm was found with an angiogram performed immediately postdilatation and disappeared at 18 and 12 months of age, respectively; （3） tricuspid regurgitation and pulmonary hypertension improved in all patients; （4） all patients were doing well and were asymptomatic. Conclusions： Percutaneous BA is a relatively safe and effective treatment for severe native CoA in young infants, and should be considered a valid alternative to surgery because of its good outcome and less trauma and fewer complications than surgery.

Effects of Nutrient Fortified Complementary Food Supplements on Anemia of Infants and Young Children in Poor Rural of Gansu

Objective To assess the effectiveness of complementary food supplements with protein and multi-micronutrients on hemoglobin and anemia in infants and young children. Methods In 5 poor counties of Gansu, 984 children aged 6-12 months were enrolled and divided into two groups. In addition to the usual home-made complementary food, all the children were fed one sachet of either Formula Ⅰ or Formula Ⅱ supplements each day. Protein and micronutrients were provided in Formula Ⅰ, while the same energy intake was secured in Formula Ⅱ as in Formula Ⅰ. A massive dose of vitamin A was supplemented to all the children every 6 months. Hemoglobin test was done at the same time. Results Prevalence of anemia was about 35% in both Formula Ⅰ and Formula Ⅱ group at baseline, and there were no differences in hemoglobin concentration between the two groups, During the 6-month and 12-month supplementation, hemoglobin of children in Formula Ⅰ group was higher than that in Formula Ⅱ group （P〈0.05）, and hemoglobin increase in Formula Ⅰ group was significantly higher than that in Formula Ⅱ group （P〈0.001）. After 6- and 12-mouth supplementation, the prevalence of anemia in Formula Ⅰ group dropped to 19.1% and 8.2% respectively, and it was 28.0% and 12.4% in Formula 2 group. The prevalence of anemia in Formula Ⅰ group was significantly lower than that in Formula Ⅱ group （P〈0.05）. After adjusting age and hemoglobin level at baseline, the hemoglobin increase at age of 24 months in formula 1 group was higher （10.7 g/L vs 7.9 g/L, P〈0.0001）. Conclusion Micronutrient fortified complementary food supplements, with large-dose vitamin A, is effective for children aged 6-12 months in terms of iron deficiency prevention.

Clinical Value of Echocardiographic Screening and Dynamic Observations for Ductus Arteriosus Closure in Newborns

Objective:To explore and analyze the clinical value of echocardiography screening and dynamic observation for ductus arteriosus closure in newborns.Methods:The study was conducted from August 2022 to December 2023.500 newborns who were admitted to our hospital were selected as research subjects for this study(Kunming Tongren Hospital).All subjects underwent echocardiography to determine the severity of patent ductus arteriosus(PDA).The inner diameter of the pulmonary artery was measured,and the pulmonary artery pressure was estimated through tricuspid regurgitation.If the patient had high pulmonary artery pressure,elective closure surgery was performed.Results:Among the 500 subjects,448 cases of ductus arteriosus closure and 52 cases of PDA were detected by echocardiography,including 23 cases of simple PDA,15 cases with patent foramen ovale,11 cases with atrial septal defect,1 case with muscular ventricular septal defect,1 case with tricuspid valve prolapse,and 1 case with tricuspid valve chordae tendineae rupture.After symptomatic treatment and intervention,their echocardiogram results were reviewed and no abnormalities were found.All measurement results of children with PDA combined with pulmonary hypertension were better than before treatment(P<0.05).Conclusion:Echocardiography is a fast,accurate,and reliable non-invasive imaging examination technology.It can significantly improve congenital heart disease detection rate in infants and young children.Early intervention based on the examination results can dramatically improve the quality of life of infants and young children with PDA.

Socioeconomic Characteristics of Child-Bearing Mothers and Feeding Practices of Under-Five Children in Kori Chiefdom, Sierra Leone

Introduction: The use of proper feeding practices is key for the overall development of children. Generally, breastfeeding and complementary feeding make up the diet and therefore the nutritional status of children. However, the degree to which mothers adhere to the recommendations of the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) regarding breastfeeding and complementary feeding is key to the nutritional status of children. Again, the adherence to this dietary recommendation is contingent on the socio-economic conditions of the child-bearing parents, especially the mothers. Here in this study, the socio-economic characteristics were analyzed along with the feeding practices of children not more than five years old in rural Sierra Leone. Method: Data were collected in 2017 on representative mothers with children within 0 - 5 years old. A total of 10 communities and 200 respondents were randomly covered in the Kori Chiefdom of Moyamba District, Sierra Leone. The data collection instruments included structured questionnaire, inter-personal interaction, personal observation and experience. The collected data were analyzed in Microsoft Excel and SPSS and the results presented in simple graphs. Results: A large number of the respondents were married teenage mothers with 1 - 2 children and living under extreme hardship by the United Nations (UN) standard. Also, most of the mothers were illiterate and started breastfeeding their children within the very hour of birth. Because complementary feeding was started all too early, exclusive breastfeeding last for not more than two months for most of the respondent mothers. Also, because rice is by far the most widely eaten the staple food in Sierra Leone, complementary food was mostly powdered rice mixed with salt and oil. Hardly was protein food supplement used as complementary food, probably due to the economic conditions of the poor rural women. Conclusion: The study has thrown sufficient light on the socio-economic characteristics and adopted feeding practices of children in poor rural Sierra Leone. In this sense, the study has laid the basis for sufficient for in-depth correlativity studies on the factors driving feeding practices of children and how it in turn impacts nutritional status of children in poor rural Africa. From here, practically adoptable recommendations can be advanced for the attention of the governments, public institutions, the private sector and the individuals of the society.

Parainfluenza Virus Types 1, 2, and 3 in Pediatric Patients with Acute Respiratory Infections in Beijing During 2004 to 2012

Background： Although human parainfluenza virus （HPIV） has been determined as an important viral cause of acute respiratory infections （ARIs） in infants and young children, data on long-term investigation are still lacking to disclose the infection pattern of HPIV in China. Methods： Nasopharyngeal aspirates were collected from 25,773 hospitalized pediatric patients with ARIs from January 2004 through December 2012 for respiratory virus screen by direct immuno-fluorescence assay. Results： Out of these specimens, 1675 （6.50%, 1675/25,773） showed HPIV positive, including 261 （1.01%, 261/25,773） for HPIVI, 28 （0.11%, 28/25,773） for HPIV2, and 1388 （5.39%, 1388/25373） for HPIV3, 2 of the samples were positive for both HPIV1 and HPIV3, and 36 were co-detected with other viruses. The positive rates of HPIVs were higher in those younger than 3 years old. HPIV3 was detected from all age groups, predominantly from patients under 3 years of age, and the highest frequency was found in those 6 months to 1-year old （352/4077, 8.63%）. HPlV3 was the dominant type in each of the years detected between May and July. HPIV1 showed a peak in every odd year, mainly in August or September. HPIV was detected most frequently from patients with upper respiratory infection （12.49%, 157/1257）, followed by bronchitis （ 11.13%, 176/2479）, asthma （9.31%, 43/462）, bronchiolitis （5.91%, 150/2536）, pneumonia （6.06%, 1034/17,068）, and those with underlying diseases （1.0%, 15/1506）. HPIV3 is the dominant type in these six disease groups referred above, especially in the asthma group. Conclusions： HPIV is one of the important viral causes of ARIs in infants and young children in Beijing based on the data from the hospitalized children covering a 9-year term. HPIV3 is the predominant type in all these years and in most of the disease groups. HPIVs with different types show different seasonality.

Knowledge

Natural disasters, war, civil unrest and other catastrophes continue to disrupt, and often seriously endanger, the lives of millions of people around the world. Whatever their cause, emergencies pose a particularly grave threat to health, nutritional status and very survival of infants and young children. Fortunately, much of the disability and death typical among this age group in such circumstances can be averted-provided proper feeding and care can be ensured.