Generalizirani edem s hipoproteinemijom kao prva prezentacija celijakije u 3-godišnjeg dječaka

Edema is defi ned as abnormal accumulation of fl uid in the interstitium. Diff erential diagnosis of generalized edema is very broad. Most often, renal and cardiac causes lead to generalized edema. The potential gastrointestinal causes of edema are liver failure and protein losing enteropathy including celiac disease and protein malnutrition. Generalized edema is rarely an initial manifestation of celiac disease. Hereby, we present a case of a 3-year-old boy with celiac disease, initially presented with generalized edema and hypoproteinemia.Edemi nastaju zbog abnormalnog nakupljanja tekućine u intersticiju. Diferencijalna dijagnoza edema je vrlo široka. Bubrežni i srčani uzroci su najčešći uzroci generaliziranih edema. Mogući gastrointestinalni uzroci edema su zatajenje jetre, enteropatija uzrokovana gubitkom proteina, uključujući celijakiju i proteinsku neishranjenost. Generalizirani edemi su rijetka prva manifestacija celijakije. Prikazujemo slučaj trogodišnjeg dječaka s celijakijom koji se inicijalno prezentirao generaliziranim edemima i hipoproteinemijom

Type 1 diabetes mellitus in children

Tip 1 šećerna bolest (ŠB) je najčešća endokrinološka bolest dječje dobi. Karakterizirana je deficitom inzulina koji nastaje zbog autoimunog uništenja β stanica gušterače. Javlja se u genetski predisponiranih osoba, a može biti potaknuta provocirajućim čimbenicima iz okoliša. Incidencija tip 1 ŠB u djece je u porastu, u prvom redu u djece mlađe od 5 godina. Znakovi i simptomi bolesti se razvijaju brzo, obično u periodu kroz nekoliko tjedana. Tipični simptomi su poliurija, polidipsija, polifagija i gubitak na tjelesnoj težini. U nekih pacijenata inicijalni simptom početka tip 1 ŠB je dijabetička ketoacidoza, po život opasno metaboličko stanje. Liječenje tip 1 ŠB tijekom djetinjstva i adolescencije je kompleksno i zahtjevno. Osnova liječenja bolesnika s tip 1 ŠB je inzulin. Postoji više različitih pripravaka inzulina i načina aplikacije inzulina. Intenzivirana terapija inzulinom u usporedbi s konvencionalnom terapijom poboljšava kontrolu glikemije i smanjuje dugoročne komplikacije ŠB. Važna komponenta u liječenju djece s tip 1 ŠB je pravilna prehrana. Glavni terapijski cilj je dobra kontrola glikemije (glikolizirani hemoglobin <7.5%) kako bi se spriječile kratkoročne i dugoročne komplikacije bolesti. Najčešće komplikacije bolesti u djece su hipoglikemija, hiperglikemija i dijabetička ketoacidoza.Type 1 diabetes mellitus is the most common chronic endocrine disease worldwide in children. It is characterised by autoimmune destruction of the β cells leading to insulin deficiency. This process occurs in genetically susceptible persons, is probably triggered by one or more environmental factors.The incidence of type 1 diabetes mellitus is rising, especially in young children (age <5 years). The signs and symptoms of disease in children usually develop quickly, over a period of a few weeks. Typical symptoms include polyuria, polydipsia and weight loss. In some patients diabetic ketoacidosis, a life-threatening metabolic state, can be an initial presentation of type 1 diabetes mellitus. Diabetes management is complex and challenging, particularly during childhood and adolescence. Insulin therapy is the mainstay in management of type 1 diabetes mellitus. There are many different insulin preparations and delivery systems available. Intensive insulin therapy compared with conventional therapy improves glycemic control and decreases long-term complications of diabetes. Other important issue in the management of children with type 1 diabetes mellitus include nutrition. The main therapeuthic goal is good glycemic control of a disease (glycated haemoglobin <7,5%) in order to prevent short and long term diabetic complications. The most common complications of type 1 diabetes mellitus in children include hypoglycemia, hyperglycemia and diabetic ketoacidosis

Complicated measles in an 8-month old infant – a case report

Objective – To present a case of measles complicated by laryngotracheobronchitis and severe respiratory distress, and to emphasize the importance of vaccination. Case report – The authors report the case of an 8-month-old infant with fever, rash and wheezing. The diagnosis of measles complicated by laryngotracheobronchitis was made. The infant was admitted to the paediatric intensive care unit with severe respiratory distress, and required support with mechanical ventilation. The patient recovered fully. No nosocomial measles infections were identified. Conclusion – This case highlights the need for rapid diagnosis, appropriate treatment and determination of vaccination status of children with measles, in order to prevent complications

Urinary tract infection in children: diagnosis, treatment and imaging

Infekcija mokraćnog sustava (IMS) česta je bakterijska bolest koja se javlja poglavito u dojenačkoj dobi i među ženskom djecom. Rizik od nastanka IMS-a veći je u djece s podliježućim anomalijama mokraćnog sustava, disfunkcionalnim mokrenjem i opstipacijom. U dijela djece s recidivnim pijelonefritisom uslijed razvoja ožiljčenja bubrega moguće su kasnije u životu komplikacije, kao proteinurija, hipertenzija, kronično zatajenje bubrega i komplikacije u trudnoći. Pravodobna i ispravna dijagnoza IMS-a temelji se na bakteriološkoj kulturi nekontaminiranog uzorka urina, određivanju lokalizacije infekcije i slikovnim pretragama. Dijagnosticirani IMS zahtijeva antimikrobno liječenje bez odgađanja u trajanju od 7 do 14 dana u simptomatske, a posebno febrilne djece. Nakon prvog IMS-a, indicirane pretrage koje obuhvaćaju ultrazvuk (UZ) bubrega i mokraćnog mjehura, mikcijsku cistouretrografiju (MCUG) i scinitigrafiju bubrega s tehnecijem 99 m-dimerkaptosukcinične kiseline (DMSA), kod jednog dijela selekcionirane djece trebaju utvrditi prisutne anomalije mokraćnog sustava i rizične čimbenike koji pogoduju recidivnom IMS-u. Uz vrlo dobru prognozu IMS-a u većine djece, važno je praćenjem na vrijeme prepoznati i liječiti recidive IMS-a i tako spriječiti pojavu trajnog ožiljčenja bubrega i razvoj dugotrajnih posljedica. Primjena antibiotske profilakse s obzirom na rastuću rezistenciju bakterija predmet je još uvijek mnogobrojnih rasprava.Urinary tract infection (UTI) is a common bacterial disease occuring in infancy and particularly in females. The risk of UTI is increased with underlying urological anomalies, voiding dysfunction and constipation. A proportion of children with recurrent pyelonephritis are at risk of renal scarring and subsequent long-term complications such as proteinuria, hypertension, end-stage renal disease and pregnancy-related complications. The diagnosis of symptomatic, particularly febrile UTI necessitates 7 to 14 days of antimicrobial treatment without delay. After the first UTI, the objective of various imaging studies, including renal and bladder ultrasonography (US), voiding cystography (VCUG) and tehnetium-99m-dimercaptosuccinic acid (DMSA) scintigraphy, has to identify urinary tract malformations and patients at risk for recurrent infections. Besides excellent prognosis in majority of children with UTI, the follow-up with prompt diagnosis and the treatment of recurrent febrile infections with intention to prevent subsequent renal damage is emphasized. The treatement with antimicrobial prophylaxis due to increasing bacterial resistance is the subject of numerous discussions awaiting final results of ongoing studies

Paracetamol poisoning in children

Paracetamol je najčešće korišteni antipiretik i analgetik u djece i dobro je znana njegova potencijalna hepatotoksičnost. Današnja široka upotreba dovela je do činjenice da je to lijek koji najčešće dovodi do namjernih i nenamjernih otrovanja, kao i jetrene toksičnosti. Iako se terapijsko i nenamjerno predoziranje događa tipično u djece, oštećenje jetre i smrt uslijed trovanja paracetamolom su ipak rijetki u odnosu na adultnu populaciju. Unatoč tome, paracetamol je trenutno najznačajniji i najčešće identificirani uzrok akutnog jetrenog zatajenja u djece. U tom svjetlu donosimo ovaj pregledni članak o dobro utvrđenim patofiziološkim mehanizmima jetrenog oštećenja i aktualnim konceptima dijagnostike i liječenja akutnog otrovanja paracetamolom, s posebnim osvrtom na acetilcistein kao temeljnu, sigurnu i efikasnu terapijsku opciju u liječenju djece i adolescenata.Paracetamol is the most commonly used antipyretic and analgesic in children and the association between paracetamol and hepatotoxicity has been well established. With it's widespread use, it became one of the most common pharmaceuticals associated with both unintentional and intentional poisoning and toxicity. Although therapeutic and unintentional overdosage typically occurs in children, hepatic damage or death due to paracetamol poisoning appears to be rare compared to adults. Despite this fact, paracetamol is currently a major and the most common identifiable cause of acute liver failure in children. Therefore, we bring this review article on well established modes of pathophysiologycal mechanisms of liver damage, current diagnostic and treatment concepts of acute paracetamol poisoning, and special overview of acetylcystein as cornerstone of therapy with proven safety and eficacy in children

Nedonešeni blizanci s akutnim oštećenjem bubrega – nije uvijek kako se čini: prikaz slučaja

Acute kidney injury (AKI) is common in critically ill premature infants. They are more susceptible to renal injury than older infants and children because of the functional and developmental immaturity of neonatal kidney. There is no unifi ed defi nition for neonatal AKI. AKI in neonates is often multifactorial and may result from prenatal, perinatal, or postnatal insults as well. Serum creatinine (SCr) concentration at birth is similar to the mother’s value. We present a case of prematurely born twins who were admitted to the paediatric intensive care unit because of AKI. Laboratory examination showed equally elevated levels of blood urea nitrogen (BUN) and SCr and metabolic alkalosis in both twins. High values of BUN and SCr were the result of the mother’s unrecognized renal disease. On the seventh postnatal day, SCr and BUN in twins were within the normal ranges. In all cases with high SCr levels in neonates in the fi rst 72 hours after birth, it is mandatory to check the mother’s renal function.Akutna bubrežna ozljeda je česta u prijevremeno rođene novorođenčadi. Zbog funkcijske i razvojne nezrelosti bubrega oni su osjetljiviji na bubrežnu ozljedu u odnosu na stariju dojenčad i djecu. Ne postoji jedinstvena defi nicija za akutnu bubrežnu ozljedu u novorođenčadi. Etiologija bubrežne ozljede je često multifaktorska i može nastati kao posljedica prenatalnih, perinatalnih i postnatalnih zbivanja. Koncentracija serumskog kreatinina novorođenčeta u trenutku porođaja podjednaka je majčinoj. Prikazujemo slučaj prijevremeno rođenih blizanki koje su primljene u Jedinicu intenzivnog liječenja zbog akutne bubrežne ozljede. Rezultati laboratorijskih analiza su pokazali podjednako povišene vrijednosti ureje i serumskog kreatinina obiju blizanki, praćene metaboličkom alkalozom. Povišene vrijednosti ureje i serumskog kreatinina bile su posljedica majčine neprepoznate bubrežne bolesti. Sedmog postnatalnog dana vrijednosti kreatinina i ureje su se normalizirale. U svim slučajevima povišenih vrijednosti serumskog kreatinina u prva 72 sata života nužno je evaluirati majčinu bubrežnu funkciju

Is There a Role of Using a Rapid Finger Prick Antibody Test in Screening for Celiac Disease in Children?

Celiac disease (CD) is an autoimmune disease triggered by gluten in genetically predisposed individuals. Despite the increasing prevalence of CD, many patients remain undiagnosed. Standard serology tests are expensive and invasive, so several point-of-care tests (POC) for CD have been developed. We aimed to determine the prevalence of CD in first-grade pupils in Primorje-Gorski Kotar County, Croatia, using a POC test. A Biocard celiac test that detects IgA antibodies to tissue transglutaminase in whole blood was used to screen for celiac disease in healthy first-grade children born in 2011 and 2012 who consumed gluten without restrictions. 1478 children were tested, and none of them were tested positive with a rapid test. In 10 children (0,6%), IgA deficiency has been suspected; only 4 of them agreed to be tested further for total IgA, anti-tTG, and anti-DGP antibodies. IgA deficiency was confirmed in 3 patients, and in all 4 children, CD has been excluded. Our results have not confirmed the usefulness of the POC test in screening the general population of first-grade schoolchildren. Further research is needed to establish the true epidemiology of CD in Primorje-Gorski Kotar County and to confirm the value of the rapid test in comparison with standard antibody CD testing

Recurrent Urine Retention Caused by a Posterior Urethral Polyp in a 8-Year-Old Boy

Cilj: Polipi stražnje uretre u muške djece rijetke su i obično benigne kongenitalne lezije. U ovom radu prikazat ćemo slučaj osmogodišnjeg dječaka koji je po drugi put primljen u bolnicu zbog akutne retencije urina (ARU) uzrokovane polipom stražnje uretre. Prikaz slučaja: Kod prvog primitka dječaka u bolnicu, zbog ARU-a, učinjene su uretrocistoskopija i cistouretrografija. No, navedenim pretragama nije se uspio pronaći uzrok dječakovim tegobama. Njegovo mokrenje postupno se normaliziralo i dječak je otpušten kući. Dvije godine kasnije, kada je ponovno primljen zbog ARU-a, ultrazvukom (UZ) je uočena polipoidna tvorba na bazi mjehura i defekt punjenja na mikcijskoj cistouretrografiji (MCUG). Magnetskom rezonancijom (MR) točno se definiralo mjesto na kojem se nalazi polip; s ishodištem u verumontanumu i protruzijom u mokraćni mjehur, gdje slobodno prominira. Nakon transuretralne resekcije učinjena je patohistološka analiza kojom je potvrđen fibroepitelni polip koji je vrlo vjerojatno kongenitalan. Rasprava: Uretralni polipi izuzetno su rijetki, a njihova etiologija je stalna tema rasprave. Prezentirajući simptomi su intermitentna retencija urina, nepotpuno pražnjenje mjehura, hematurija i urinarna infekcija. Mogu biti i asimptomatski, ali rijetko. Dijagnoza se obično postavlja s UZ-om i MCUG-om. MR definira kirurški pristup polipoznoj tvorbi, dok se uretrocistoskopijom postavlja definitivna dijagnoza. Zaključci: Dijagnoza uretralnog polipa može se postaviti sa UZ, MCUG i MR, ali uretrocistoskopija ima važnu ulogu, kako dijagnostičku, tako i terapijsku.Aim: Polyps of the male posterior urethra are rare and usually benign congenital lesions. We report a case of an 8-year-old boy who presented with recurrent urine retention caused by urethral polyp. Case report: At his first admittance to the hospital, the 8-year-old boy presented with urine retention. The performed urethrocystoscopy and cystourethrography were not diagnostic. His condition spontaneously improved, micturition was normal and the boy was discharged. Two years later he presented with recurrent urine retention, and ultrasonography (US) revealed a polypoid mass at the bladder base while cystourethrogram showed a filling defect. Magnetic resonance imaging (MRI) revealed the localization of urethral polyp projecting from verumontanum into the bladder cavity. After successful transurethral resection, histological analysis showed fibroepithelial polyp indicating congenital origin. Discussion: Urethral polyps are very rare and their etiology is controversial. The presenting symptoms are intermittent urine retention, incomplete bladder emptying, hematuria and urinary infection. Rarely, they are asymptomatic. The diagnosis is usually made by US and voiding cystourethrogram (VCUG). Urethrocystoscopy is always diagnostic. The role of MRI is to define the surgical approach to the polypoid lesion. Conclusions: The diagnosis of urethral polyp can be made by US, VCUG or MRI but urethrocystoscopy still has a major diagnostic and therapeutic value, especially in boys presenting with urine retention

An unusual clinical course of congenital subglottic stenosis – case report

Cilj: Prikazati slučaj neuobičajenog kliničkog tijeka prirođenog laringealnog stridora i razmotriti indikacije za endoskopskim pregledom u takvim slučajevima. Prikaz slučaja: Terminsko eutrofično muško novorođenče je po porodu radi akutnog skrotuma te respiratornih teškoća u vidu tahipneje i hipoksemije primljeno u Kliniku za pedijatriju. Neposredno nakon kirurškog zahvata dijete je rutinski ekstubirano. Međutim, vrlo brzo nakon odvajanja od tubusa ponovno je naglo razvilo respiratorne teškoće obilježene stridorom i hipoksemijom. Dijete je ponovno intubirano i vraćeno na strojnu ventilaciju. U daljnjem tijeku se u više navrata pokušavao provesti postupak ekstubacije. Isti nije bilo moguće učiniti jer bi se nakon odvajanja od tubusa vrlo brzo vratili znakovi respiratornih teškoća pod kliničkom slikom akutnog laringotraheobronhitisa. S obzirom na probleme otežane ekstubacije i ovisnosti o tubusu te na perzistentne atipične simptome krupa i neučinkovitost farmakoterapije, dijete je u dobi od mjesec dana podvrgnuto endoskopskom pregledu dišnih putova. Vizualizirana je koncentrična subglotična stenoza membranskog tipa. U pripremama za liječenje endoskopskom laserskom ablacijom stridor je bivao sve manje izražen. Dva tjedna nakon prvog endoskopskog pregleda učinjen je kontrolni na kojem je vizualni nalaz sugerirao značajnu regresiju subglotičnog membranskog suženja. Odustalo se stoga od planirane intervencije laserom, a stridor se u dojenčeta spontano povukao. Zaključak: Iako je laringomalacija daleko najčešća etiološka podloga prirođenog stridora, i ne predstavlja apsolutnu indikaciju za endoskopijom dišnog puta, isti može biti izazvan nizom drugih rijetkih stanja uključujući prirođenu subglotičnu stenozu. U prikazanom slučaju zabilježena je neuobičajena spontana regresija subglotične stenoze membranskog tipa.Aim: To report an unusual clinical course of an infant with congenital laryngeal stridor. Indications for endoscopic examination of airways in such cases have also been discussed. Case report: A full-term male newborn was admitted to the Department of Paediatrics because of the symptoms of acute scrotum as well as because of breathing difficulties and severe hypoxemia. Soon after surgery the child was extubated but breathing difficulties persisted. A loud inspiratory stridor together with rapid respiratory deterioration occurred. The infant was intubated and underwent mechanical ventilation again. In the following period several trials of extubation were repeatedly unsuccessful despite favourable weaning parameters. Just few hours after each trial of extubation symptoms of acute laryngotracheobronchitis were apparent. Because of extubation failure, tube dependency and persistent atypical symptoms of croup unresponsive to standard pharmacotherapy, endoscopic assessment was performed at the age of one month. Concentric central membranous subglottic stenosis was visualized. While preparing for the endoscopic laser ablation treatment, stridor was getting less pronounced. Two weeks later patient underwent endoscopy again and significant regression of subglottic membrane narrowing was documented. Planned laser intervention was canceled. At the age of four months stridor disappeared. Conclusion: Laryngomalacia is the most common cause of congenital laryngeal stridor and endoscopic evaluation is usually not indicated in such cases. However, there are other causes of congenital stridor which are not so common, including congenital subglotttic stenosis. In this case an unusual spontaneous regression of congenital membranous subglottic stenosis was reported

THE INFLUENCE OF GLUCOSE DISTURBANCES IN EARLY NEONATAL PERIOD ON THE NEURODEVELOPMENTAL OUTCOME OF PRETERM INFANTS AT THE AGE OF TWO

Cilj istraživanja: Ispitati povezanost poremećene razine glukoze u krvi nedonoščadi u novorođenačkom razdoblju i neurorazvojnog ishoda u dobi od dvije godine. Ispitanici i metode: Prospektivnim istraživanjem obuhvaćeno je 445 nedonoščadi rođene prije 37. tjedna gestacije i liječene u Zavodu za intenzivno liječenje i neonatologiju Klinike za pedijatriju, Kliničkog bolničkog centra Rijeka u razdoblju od 1. siječnja 2018. godine do 31. prosinca 2020. godine. Temeljem izmjerenih vrijednosti glukoze u krvi ispitanici su podijeljeni u četiri skupine: normoglikemijsku, hipoglikemijsku, hiperglikemijsku i nestabilnu skupinu. Razina glukoze određivana je iz uzorka kapilarne krvi u 1., 3., 6. i 12. satu života, a od drugog do sedmog dana života barem jednom dnevno prije obroka. U dobi od dvije godine učinjena je neurorazvojna procjena u 196 ispitanika neurološkim pregledom i primjenom razvojne skale Bayley Scales of Infant and Toddler Development III (BSID-III). Neurorazvojni ishod je kategoriziran kao normalan, blago oštećen, umjereno oštećen ili teško oštećen. Rezultati: Novorođenačka hipoglikemija i hiperglikemija u nedonoščadi su česte i uglavnom asimptomatske. U usporedbi s normoglikemijskom skupinom, hiperglikemijska i nestabilna skupina imaju značajno nižu gestacijsku dob, rodnu masu i Apgar bod u prvoj i petoj minuti. Većina nedonoščadi u dobi od dvije godine ima normalan neurorazvojni ishod (67,4% ispitanika). Ispitanici s hipoglikemijom imaju sličan neurorazvojni ishod kao ispitanici s normoglikemijom. Ispitanici s hiperglikemijom i nestabilnom glikemijom imaju veću vjerojatnost za nepovoljan neurorazvojni ishod u dobi od dvije godine. Periventrikularna leukomalacija i muški spol su rizični čimbenici za nepovoljan neurorazvojni ishod u dobi od dvije godine. Nije utvrđena povezanost između novorođenačke glikemije i neurorazvojnog ishoda u dobi od dvije godine nakon uključivanja u analizu perinatalnih čimbenika koji mogu biti prediktori nepovoljnog neurorazvojnog ishoda. Zaključci: Vrijednosti razine glukoze u ranom novorođenačkom razdoblju u nedonoščadi nisu prediktori neurorazvojnog ishoda u dobi od dvije godine.Objectives: To investigate relationship between early neonatal glycemia and neurodevelopmental outcomes at two years of age in preterm infants. Patients and methods: This prospective study included 445 preterm infants <37 weeks of gestation admitted to the Neonatal Intensive Care Unit between January 2018 and December 2020. Based on blood glucose levels in the first week of life, infants were divided into four groups: normoglycemic, hypoglycemic, hyperglycemic, and unstable. Blood glucose levels were measured from capillary blood at the 1st, 3rd, 6th, and 12th hour of life during the first 24 hours, and at least once a day from days two to seven prefeed. Neurodevelopmental assessment was performed in 196 children at two years of age and included neurological examination and Bayley Scales of Infant Development III (BSID-III). Neurodevelopment was categorized as normal, mild, moderate or severe impairment. Results: Neonatal hypoglycemia and hyperglycemia in preterm infants are common and mostly asymptomatic. Compared with normoglycemic infants, hypoglycemic and unstable infants were of lower gestational age, birth weight and had lower Apgar score. The majority of preterm infants at the age of two had normal neurodevelopmental outcome (67.4% infants). Hypoglycemic infants had similar outcomes as normoglycemic infants. Hyperglycemic and unstable infants were less likely to survive without neurodevelopmental impairment at two years of age. Periventricular leukomalacia and male gender are risk factors for adverse neurodevelopmental outcome at two years of age. No associations between measures of neonatal glycemia and 2-year outcomes remained after including other possible perinatal risk factors for adverse neurodevelopmental outcome. Conscusions: In preterm infants, measures of neonatal glycemia are not independent predictors of neurodevelopmental outcomes at two years of ag