HT is a frequent finding in pediatric CD patients and, in a substantial proportion, may be the only manifestation of CD. Thus, serological markers of CD should be introduced in the first step of the diagnostic workup of liver diseases in pediatric patients.

Objective: To analyze our institution’s work-up for patients with a diagnosis of subdural haematoma (SDH) in order to determine how many of them are secondary to child abuse, as well as to examine their final functional outcome. Methods: Retrospective review of children under 2 years of age diagnosed as having SDH between 1995 and 2005. Results: A total of 35 cases were identified. Fifteen patients that had underlying conditions that predispose them to bleed were excluded. Among the remaining 20 patients, seizures and head trauma were the main causes for consultation. All patients had a coagulation study and a head computed tomography carried out, 11 of these had a magnetic resonance imaging and 1 had a post-mortem examination. Bilateral SDHs in different stages of evolution was the most common pattern of intracranial haemorrhage. Fourteen infants had a skeletal survey, 4 had a bone scintigraphy and 19 had an ophthalmoscopic examination. Fractures were diagnosed in 7 patients and retinal haemorrhages in 11. The final diagnoses were: 10 shaken baby syndromes, 4 idiopathic SDH, 3 strokes, 2 coagulopathies and 1 accidental head injury. Upon follow-up, 1 patient had died and 9 had sustained permanent disabilities. Conclusions: Cases of infantile SDH are usually thoroughly investigated. In spite of this, sometimes it is not possible to determine the SDH aetiology. Nonetheless, shaken baby syndrome remains the most frequent cause of SDH in infants, and it carries a poor prognosis.

No abstract

TFUS is a valid and reliable alternative to CT for minor head trauma in infants with skull fractures. Its innocuousness and cost-effectiveness in comparison with CT makes it a good choice in this situation.

Any cranial injury from a vertical fall that produces severe epidural bleeding can also cause retinal haemorrhages, mainly unilateral. The finding of diffuse and bilateral retinal haemorrhages or their presence in the absence of this type of intracranial haemorrhage must continue to point out another cause different from the fall as origin of the traumatism, being necessary to exclude non-accidental trauma.

Transfusion of cryopreserved HPCs carries a risk of serious adverse effects due to the use of DMSO. Some studies have shown that the incidence and severity of adverse reactions are dose related. 1 It is desirable therefore to reduce the amount of DMSO in cryopreserved components to minimize toxicity, particularly in children.The concentration of DMSO and the concentration of cells to be cryopreserved determine the volume and the amount of DMSO infused. Previous studies 2,3 describe satisfactory results using 5-percent DMSO or 3.5percent DMSO with HES. Also, high cell concentrations (up to 800 ‫ן‬ 10 6 /mL) in 10-percent DMSO have not shown a deleterious impact on function or engraftment of HPCs, either in vitro or in vivo. 4 Our approach used a high cell concentration (>200 ‫ן‬ 10 6 /mL) and a low DMSO concentration (5 percent) for cryopreservation. We report hematologic recovery in patients who received such transplants.HPCs were collected from 13 consecutive patients for autologous transplant. The cells were cryopreserved with 5-percent DMSO in autologous plasma as the only cryoprotectant at a final cell concentration equal to or greater than 200 ‫ן‬ 10 6 per mL. The cells were frozen at -80ЊC by immersion in a methanol bath in a mechanical freezer, 5 and stored at that same temperature. All patients were conditioned with myeloablative regimens and medicated with corticosteroids, antihistamines, and diuretics prior to transfusion of their thawed, unmanipulated HPCs.There were 6 boys and 7 girls with a median age of 11.8 years (range 4.5-19.2). Diagnoses were brain tumor in 5, Ewing sarcoma in 3, Hodgkin disease in 2, neuroblastoma in 1, T-cell acute lymphoblastic leukemia in 1, and Burkitt lymphoma in 1.The median volume of the cryopreserved HPCs and their cell concentrations were 300 mL (range, 134-700) and 263 ‫ן‬ 10 6 per mL (range, 192-390), respectively, with a median CD34+ cell content of 3.66 ‫ן‬ 10 6 per kg (range, 2.00-6.44). Median time from cryopreservation to transplantation was 10 days (range, 9-108).The median dose of DMSO infused was 0.41 mL per kg (range, 0.13-0.58) in an HPC component with a median volume of 8.2 mL per kg (range, 2.7-11.7). Adverse effects during transfusion were minimal. One patient experienced abdominal pain and vomiting and another required treatment for hypertension with nifidipine. If the HPCs had been cryopreserved by standard protocols (cell concentration 100 ‫ן‬ 10 6/ mL in 10 percent DMSO), the median volume of DMSO and HPC component transfused would have been 1.8 mL per kg (range 0.70-4.55) and 18 mL per kg (range 7-45), respectively.A granulocyte count > 0.5 ‫ן‬ 10 9 per L and a platelet count > 20 ‫ן‬ 10 9 per L were achieved after a median of 11 (range 10-14) and 12 (range 10-23) days, respectively. Hematologic recovery was adequate (Hb > 100 g/L, platelets > 100 ‫ן‬ 10 9/ L, and granulocytes > 1 ‫ן‬ 10 9/ L) in 9 of 12 evaluable patients at 3 months and in 9 of 10 evaluable patients at 6 months post-transplant. The only patient not achieving the target values was ...

Convulsions alone are unlikely to cause retinal haemorrhages in children under 2 years of age.

Objectives The aim of this study is to determine the prevalence and characteristics of fractures in young infants attended at the pediatric emergency department (PED). Methods This is a retrospective study for 2 years (2011–2012) of children younger than 12 months attended with a fracture at the PED. Age, sex, site and type of fracture, mechanism of injury, time interval before seeking medical attention, and management were analyzed. Results One hundred one patients were included. They represented 0.3% (95% confidence interval, 0.2%–0.4%) of all children younger than 12 months attended at the PED. The median age was 7.7 months (interquartile range, 5.2–10.1 months); 58 (57.4%) were boys. The most common fracture was skull fracture (58, 57.4%), mostly parietal, followed by long bone fractures (27, 26.7%); transverse and torus fractures were the most common types, located at the diaphysis and distal metaphysis, respectively. The principal mechanism reported was falling (83, 82.2%) mainly from furniture. Fifty-one patients (50.1%) were attended in the first 6 hours after injury. Sixty-five patients (64.4%) were admitted at the hospital and the other 9 (8.9%) were controlled in outpatient visits. One of them was injured because of negligence and another was diagnosed with osteoporosis. Conclusions Fractures in young infants are uncommon at the PED, the skull fracture being the most common. Pediatricians should alert caretakers of the risks in normal development to prevent these injuries. Fractures caused by child abuse should always be discarded.