AimsThe definition of normal values of two-dimensional speckle-tracking echocardiography derived left ventricular (LV) deformation parameters, is of critical importance for the routine application of this modality in children. The objectives of this study were to perform a meta-analysis of normal ranges for longitudinal, circumferential and radial strain/strain rate values and to identify confounders that may contribute to differences in reported measures.Methods and ResultsA systematic search was conducted. Studies describing normal healthy subjects and observational studies that used control groups as a comparison were included. Data were combined using a random-effect model. Effects of demographic, clinical and equipment variables were assessed through meta-regression. The search identified 1,192 subjects form 28 articles. Longitudinal strain (LS) normal mean values varied from -12.9 to -26.5 (mean, -20.5; 95% CI, -20.0 to -21.0). Normal mean values of circumferential strain (CS) varied from -10.5 to -27.0 (mean, -22.06; 95% CI, -21.5 to -22.5). Radial strain (RS) normal mean values varied from 24.9 to 62.1 (mean, 45.4; 95% CI, 43.0 to 47.8). Meta-regression showed LV end diastolic diameter as a significant determinant of variation for LS. Longitudinal systolic strain rate (LSRs) was significantly determined by the age and RS by the type of vendor used.ConclusionVariations among different normal ranges were dependent on the vendor used, LV end-diastolic diameter and age. Vendor-independent software for analyzing myocardial deformation in children, using images from different vendors would be the ideal solution for strain measurements or else using the same system for patient’s follow up.
Objective -To report a rare case of hypernatremic dehydration in an exclusively breastfed infant. Case report -We present a term newborn, 14-day-old boy, exclusively breastfed, who was lethargic and severely dehydrated upon admission (35% birth weight loss). The newborn was found to have severe hypernatremic dehydration (Na + 197 mmol/l), acute renal insufficiency (Creatinine 273 µmol/l) and metabolic acidosis. Also, the blood culture result was positive. Intravenous rehydration and antibiotic therapy were started. After 22 days of hospitalization, the infant was discharged home in a good general condition. Now the child is 13 months old, he is healthy and no neurologic sequelae are noticed. Conclusion -Hypernatremic dehydration in newborns is a rare complication, which is dangerous, but also preventable. Prevention consists in educating mothers about successful breastfeeding techniques, and also early newborn reassessment after discharge from the hospital is mandatory.
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