No abstract

Iron deficiency anemia may lead to impairment of many vital functions, including those in the cardiovascular system. However, the effects of iron depletion on cardiac function in the absence of anemia are not well known. In this study the authors examined the effects of iron deficiency without overt anemia on cardiac function in 59 children. Complete blood count, serum iron, serum iron-binding capacity, and serum ferritin levels were measured in all children. The children were divided into two groups according to serum ferritin levels: an iron-depleted group (n = 28) and a non-iron-depleted control group (n = 31). Echocardiographic examinations were performed using M mode and Doppler echocardiographic methods in all children to assess cardiac function. No statistically significant difference was found between the two groups in terms of echocardiographic indices. Although the number of subjects in this study was small, the authors conclude that iron deficiency in the absence of overt anemia does not lead to important changes in cardiac function.

Although the clinical features and natural course of discrete subaortic stenosis (DSS) are well defined, the etiology remains speculative. The purpose of this study was to identify the echocardiographic, morphologic, and geometric variations of the left ventricular outflow tract associated with DSS in children and to determine whether these variations have a role in the pathogenesis of DSS. The aortoseptal angle (ASA), mitral-aortic valve separation (MAS), and the size of the aortic annulus were determined in two groups of children. Group 1 comprised 11 patients with isolated DSS, who were compared with an age- and body surface area- (BSA) matched healthy children (Group 1A, n: 20). Group 2 comprised 10 patients with DSS and ventricular septal defect (VSD). Group 2 was compared with an age- and BSA-matched patients with isolated perimembranous VSD (Group 2A, n: 22). Measurements were carried out from previously recorded echocardiographic studies. The ASA was steeper (119.3 +/- 6.1 degrees vs 137.5 +/- 5.6 degrees , p < 0.001), and the MAS was wider (6.1 +/- 1.6 vs 3.2 +/- 0.7 mm, p < 0.001) in patients with isolated DSS than in healthy control subjects. Similar differences were found between patients in Group 2 and Group 2A; the ASA was steeper (122.2 +/- 6.5 degrees vs 141.3 +/- 5.0 degrees, p < 0.001), and the MAS was wider (5.8 +/- 1.5 vs 3.8 +/- 1.1 mm, p < 0.001). The size of the aortic annulus was not different among the four study groups. Although the MAS was significantly wider in patients with DSS, there was significant overlap in MAS between patients and controls. However, if an ASA < or = 130 degrees was chosen as a predictive variable, it was found to be a highly sensitive, specific, and positive predictive marker for the development of DSS. This study demonstrates that DSS is associated with a steeper ASA, and a wider MAS, in patients with or without associated VSD. These morphologic abnormalities, especially a steeper ASA, may be risk factors for the development of DSS.

A 4-day-old male infant presented with complaints of jaundice on the third day of life. He was full-term and appropriate for gestational age and born to unrelated parents. All laboratory investigation tests were normal except total serum bilirubin of 27.4 mg/dl with a direct bilirubin 0.29 mg/dl. Abdominal and cranial ultrasonography (US) was performed on sixth day of life because of severe hyperbilirubinemia. Abdominal US revealed adrenal hematoma. Enclosed hematomas may cause significant unconjugated hyperbilirubinemia in absence of other high-risk conditions.

The purpose of this study was to determine the role of intravenous immunoglobulin (IVIG) administration in preterm neonates with S. typhimurium infection. A randomized trial of 47 preterm neonates with intestinal or extraintestinal S. typhimurium infection was performed. Neonates were randomly divided into two groups: 22 neonates were only given cefoperazone (group 1); 25 neonates were given cefoperazone plus IVIG (group 2). IVIG was given at a dose of 500 mg/kg on days 1, 2, 3, and 8 after entry into the study. Following treatment, bacteremia, complications, mortality rate, recovery time, and duration of antimicrobial therapy were evaluated in two groups. Bacteremia was found in 31.4% in group 1 and 8% in group 2 (P < .05); complications developed in 81.8% in group 1 and 16% in group 2 (P < 0.01); mortality was 40.9% in group 1 and 12% in group 2 (P < .05). Recovery took 15 days in group 1 and 8 days in group 2 (P < .01). The duration of antimicrobial therapy was 20 days in group 1 and 14 days in group 2 (P < .01). We conclude that IVIG treatment in combination with antibiotics in preterm neonates with S. typhimurium infection reduces the complications, mortality rate, and duration of therapy.

Serum ferritin, iron, and haemoglobin (Hb) values of 27 pregnant women who did not receive oral iron therapy during pregnancy, and Hb of their normal full-term babies were determined. Maternal blood samples were obtained at 16 and 24 weeks of pregnancy and infants' blood samples were obtained at the first day and 3 months of life. Mothers were divided into two groups according to their serum ferritin values. By analysing the results we were not able to detect any correlation between maternal ferritin, Hb, and newborn gestational age, and Hb and birth weight. The same was found when the groups were compared by a maternal serum ferritin above and below 12 ng/ml.

Carvajal syndrome (OMIM 605676) is a familial syndrome consisting of woolly hair, palmoplantar keratoderma and heart disease. It leads to dilated cardiomyopathy that affects predominantly the left ventricle. It is caused by a recessive mutation in desmoplakin, an intracellular protein that links desmosomal adhesion molecules to intermediate filaments of the cytoskeleton. Very few patients with this syndrome have been reported, and all have been from Equador or India. We report a 7-year-old Turkish girl with Carvajal syndrome.

RESUMENLos andadores se utilizan frecuentemente a pesar de que su uso puede ocasionar lesiones. Se realizó una encuesta para obtener información sobre las actitudes y el abordaje de los pediatras respecto del uso de andadores. Se invitó a 247 pediatras que asistieron al 44° Congreso Turco de Pediatría y Europediatría (2008) a responder un cuestionario preparado por los autores. Se incluyeron en el análisis 226 cuestionarios respondidos en forma completa. La mediana de edad de los participantes (119 mujeres) fue de 39 años (29 a 58). De ellos, 4% recomendaban el uso de andadores, 32,3% dejaban la decisión a criterio de los padres y 63,7% no lo recomendaban. Ciento cinco habían tratado con anterioridad a un bebé que sufrió una lesión relacionada con el uso del andador; de ellos, 73,3% no recomendaron su uso y 57,1% opinaron que la producción y el uso de andadores deberían prohibirse. Conclusiones. El 4% de los pediatras encuestados recomiendan el uso de andadores para bebés y más del 30% dejan la decisión a los padres. Los pediatras que atendieron a un bebé que sufrió una lesión por el uso del andador fueron menos proclives a recomendarlo. Palabras clave: andador, pediatra, prevención de las lesiones infantiles.http://dx.doi.org/10.5546/aap.2013.528 INTRODUCCIÓNLos andadores son todavía de uso común en todo el mundo, aunque pueden ocasionar a c c i d e n t e s d o m é s t i c o s , q u e m a d u r a s y e n v e n e n a m i e n t o s .1,2 L o s p a d r e s p u e d e n considerarlos seguros porque mantienen al bebé tranquilo y satisfecho, le permiten ejercitarse y caminar antes, favorecen su movilidad y le proporcionan un lugar de alimentación, al tiempo que le brindan a la madre la oportunidad de hacer las tareas domésticas. 11 Esas muertes suelen relacionarse con un traumatismo craneal sufrido al caerse por una escalera.11 El uso de andadores aumenta el riesgo de lesión por caída de escalera cuatro veces y el riesgo de fractura por esta caída, dos veces.12 Debido a estos riesgos, la Academia Estadounidense de Pediatría propone prohibir la producción y venta de andadores para bebés, 13 como sucede en Canadá desde 2004.14 El 25% a 50% de los padres cuyos hijos sufrieron una lesión relacionada con el andador lo han seguido utilizando; es necesario que los pediatras orienten a los padres de un modo más firme y contundente. [15][16][17] En nuestro conocimiento, hay pocos estudios sobre la actitud de los pediatras al respecto. El objetivo del presente estudio fue obtener información acerca de las actitudes de los pediatras sobre el uso de andadores y el abordaje de este tema con los padres. MATERIAL Y MÉTODOSEl estudio incluyó a pediatras que asistieron al 44 o Congreso Turco de Pediatría celebrado en Estambul en junio de 2008. Después de informar a todos los asistentes sobre el estudio, se les pidió que respondieran a un cuestionario de 23 preguntas preparado por los autores. Se registró la edad, el sexo, el grado, la afiliación, las actitudes respecto del uso del andador, la lectura de artículos científicos sobre el t...