Peritoneal Dialysis in Infants and Children After Open Heart Surgery

BackgroundInfants and children who undergo surgical repair of complex congenital heart diseases are prone to developing renal dysfunction. The purpose of this study was to investigate the risk factors associated with prolonged peritoneal dialysis (PD) and the mortality of pediatric patients with acute renal failure (ARF) after open heart surgery.MethodsFrom June 1999 to May 2007, a total of 542 children underwent open heart surgery for congenital heart disease. Fifteen (2.8%) experienced ARF and seven (1.3%) required PD. The clinical and laboratory variables were compared between the survivor and non-survivor groups of ARF patients that needed PD.ResultsThe non-survivors (n = 3, 43%) had a longer cardiopulmonary bypass time (154 ± 21 vs. 111 ± 8 minutes, p = 0.012) and longer aorta clamping time (92 ± 40 vs. 66 ± 15 minutes, p = 0.010) than the survivors (n = 4, 57%). Before the PD, the pH and base excess of the arterial blood gas analysis in the survivors was much higher than that non-survivors (7.30 ± 0.04 vs. 7.16 ± 0.10, p = 0.039; −5.15 ± 3.13 vs. −12.07 ± 2.9 mmol/L, p = 0.031). Furthermore, the survivors had a shorter interval between the onset of ARF and the day the PD was begun (1.2 ± 0.4 vs. 4.3 ± 1.2 days, p = 0.001), and shorter duration of PD (6.6 ± 2.7 vs. 13.0 ± 3.5 days, p= 0.036) than non-survivors.ConclusionEarly intervention with PD is a safe and effective method for managing patients with ARF after open heart surgery. The cardiopulmonary bypass and aortic clamping duration, time of initiating PD, duration of the PD, sepsis, and relative complications may predict the prognosis of these patients

Comparison of Clinical Features of Childhood Norovirus and Rotavirus Gastroenteritis in Taiwan

Viral gastroenteritis is a common acute infectious disease in infants and young children. This study compared the incidence and clinical features of childhood norovirus (NV) and rotavirus (RV) gastroenteritis in Taiwan. Methods: Stool specimens were collected from children with acute gastroenteritis aged 6 months to 14 years who were treated at the Children's Medical Center of Taipei Veterans General Hospital between January 2004 and March 2005. The incidence, clinical manifestations, and laboratory findings of childhood NV gastroenteritis were analyzed and compared with those of patients with RV gastroenteritis. Patients with underlying diseases associated with diarrhea or those diagnosed with bacterial gastroenteritis were excluded. Stool specimens were tested for NV and RV using enzyme immunoassay (EIA). NV genogroups were determined by reverse-transcriptase polymerase chain reaction. Results: Among the 201 patients included in this study, NV was detected in 44 (21.9%) by 1 or more tests (22 by EIA). Five of these isolates were genogroup I (11.3%), and 39 were genogroup II (88.7%). Fifty-two (25.9%) specimens had a positive EIA result for RV. Compared with NV, patients with RV gastroenteritis had a significantly higher percentage of diarrhea (94 vs. 69%, p < 0.001), fever (82 vs. 26.2%, p < 0.001), and longer hospital stay (3.81 vs. 2.93 days, p = 0.048). Laboratory studies showed significantly higher liver enzymes and C-reactive protein levels in patients with RV infection. In contrast, white blood cell counts were significantly higher in patients with NV infection. Conclusion: Norovirus is one of the leading agents of acute gastroenteritis in children in Taiwan, and genogroup II is the predominant type

Reaction at the Bacillus Calmette–Guérin Inoculation Site in Patients with Kawasaki Disease

The bacillus Calmette–Guérin (BCG) reaction is not included in the classical clinical criteria for Kawasaki disease (KD). However, a reaction at the BCG inoculation site has been mentioned among the “other clinical findings” that are present in about 30–50% of KD patients. The objective of this study was to investigate the clinical characteristics of KD patients with reactions at the BCG inoculation site. Methods: A retrospective study of all patients diagnosed with KD between September 2000 and August 2010 was performed. The clinical presentations, laboratory results, treatment outcomes, and coronary artery abnormalities in the BCG-reactive [BCG(+)] and BCG-nonreactive [BCG(–)] groups were analyzed and compared. Results: In total, 145 patients with KD diagnosed at our institution were included; 46 (31.7%) had a reaction at the BCG inoculation site. The BCG(+) group was younger than the BCG(–) group. Laboratory results showed higher white blood cell counts, platelet counts, and serum potassium levels, and lower low-density lipoprotein levels in the BCG(+) group. The BCG(+) group had a shorter fever duration before intravenous immunoglobulin treatment and a shorter total fever duration than the BCG(–) group. Multivariable logistic regression analysis showed that the age at diagnosis was the only factor significantly associated with a reaction at the BCG inoculation site in KD patients. Conclusions: In countries with a national BCG vaccination program, a reaction at the BCG inoculation site could be a useful and early diagnostic sign of KD among younger patients, especially those younger than 6 months

The Role of Eosinophil Cationic Protein in Patients with Mycoplasma pneumoniae Infection

To study the role played by eosinophil cationic protein (ECP) in patients with Mycoplasma pneumonia infection. Methods: Pediatric patients aged 4 to 14 years old were divided into 3 groups, each consisting of 30 patients. Group 1 comprised patients with known M. pneumoniae infection. Group 2 comprised patients with asthma who were in a stable condition with no infection, acute asthma exacerbation or steroid use in the last 2 months. Group 3 consisted of healthy children and was designated the control group. The level of ECP in patients' serum was measured by an ECP radioimmunoassay kit. Results: There were 90 children enrolled in this study; 59 (65.56%) were boys and 31 (34.44%) were girls. Mean serum ECP levels between males and females was not significantly different (p = 0.544). The variance of serum ECP levels decreased as patient age increased, but there was no relationship between serum ECP level and patient age (g= 0.118, p = 0.267). Serum ECP levels were similar in both the M. pneumoniae-infected and asthma groups; serum ECP levels in the control group were less than the levels seen in the other 2 groups. The difference in serum ECP levels among the 3 groups was statistically significant (p < 0.001). Conclusion: Both the children who had M. pneumoniae infection and the children with asthma had significantly increased serum ECP levels compared to normal healthy children. The elevated ECP levels found in the serum of patients with M. pneumoniae infection may be associated with damage to the respiratory epithelium and accelerated hypersensitivity in the respiratory system. Decreasing the serum level of ECP may potentially be a method of relieving symptoms in patients with M. pneumoniae infection. Additional studies are warranted to further validate this conclusion