Vastasyntyneen keltaisuus ei ole aina harmitonta

Vasta­syn­tyneen kel­taisuus on yleistä ensim­mäi­sinä elin­vuo­ro­kau­sina, ja hyper­bi­li­ru­bi­nemiaan liit­tyvän ­aivo­sai­rauden estä­mi­seksi sen hoi­tona käy­tetään sini­valoa. Keltai­suuden pitkit­ty­minen yli kah­den vii­kon, konju­goi­tuneen bili­ru­biinin yli 20 %:n osuus koko­nais­bi­li­ru­bii­nista tai vaa­leat ulosteet voi­vat vii­tata koles­taasiin. Vasta­syn­tyneen koles­taasi edel­lyttää ri­peää diagnos­tiikkaa ja hoi­toa. Sappi­tieat­resia on yleisin ime­väisen koles­taasin aiheut­taja, ja sen hoi­to on mahdol­li­simman varhai­sessa vai­heessa suori­tettu leik­kaus. Suo­messa leikkaus­hoito on keski­tetty HYKS:n Lastenk­li­ni­kalle. Koles­taat­tisen ime­väisen ravit­se­mus­hoito aloi­tetaan viivy­tyk­settä seu­raten myös mak­san toi­mintaa ja luus­ton aineen­vaih­duntaa.Peer reviewe

Infection Prevention and Management in Pediatric Short Bowel Syndrome

Short bowel syndrome (SBS) is a rare disease with potentially life-threatening consequences. In addition to intestinal failure-associated liver disease, infections and other complications related to central venous catheters (CVCs) cause a significant burden to patients with SBS and may even necessitate an intestinal transplant eventually. The need for long-term central venous access and the intestinal dysfunction associated with SBS drive the need for intestinal failure-specific approach to prevent and treat infections in patients with SBS. In bacterial infections, the line can often be salvaged with proficient antibiotic therapy. Repeated catheter replacements are predisposed to recurrent infections and thrombotic complications, which may limit the long-term survival of patients with SBS. Protocol-based CVC access procedures and daily care including taurolidine and ethanol catheter locks have been shown to reduce infection rates substantially. Compromised intestinal function in SBS predisposes to small bowel bacterial overgrowth, mucosal injury, and increased permeability. These pathophysiological changes are concentrated in a subset of patients with excessive bowel dilatation and frequent bowel-derived infections. In such patients, reconstructive intestinal surgery may be indicated. Probiotics have not been effective in infection prevention in SBS and carry a significant risk of complications. While more studies focusing on the prevention of infections and their complications are needed, protocol-based approach and multidisciplinary teams in the care of patients with SBS have been shown to reduce complications and improve outcomes.Peer reviewe

Kun vauvan vatsa vaivaa

Vauvan vatsavaivojen taustalta on suljettava pois pikaisesti erikoissairaanhoitoa vaativat etenevät sairaudet. Rintaruokitulla koliikkilapsella tietyt probiootit vähentävät itkuisuutta. Pulauttelevan vauvan hoidossa happosalpaajilla ei ole merkittävää asemaa. Ummetusta on muutamalla prosentilla imeväisistä. Ripuli on usein toiminnallista. Tärkeä osa lääkärin ammattitaitoa on empaattinen suhtautuminen itkuisen vauvan vanhempien huoleen. Medikalisaatiota ja tutkimustietoon perustumattomia hoitoja tulee välttää.Peer reviewe

Kun vauvan vatsa vaivaa

Vauvan vatsavaivojen taustalta on suljettava pois pikaisesti erikoissairaanhoitoa vaativat etenevät sairaudet.Rintaruokitulla koliikkilapsella tietyt probiootit vähentätäät itkuisuutta.Pulauttelevan vauvan hoidossa happosalpaajilla ei ole merkitttävää asemaa.Ummetusta on muutamalla prosentilla imeväisistä. Ripuli on usein toiminnallista.Tärkeä osa lääkärin ammattitaitoa on empaattinen suhtautuminen itkuisen vauvan vanhempien huoleen.Medikalisaatiota ja tutkimustietoon perustumattomia hoitoja tulee välttää

Parentally reported early childhood upper gastrointestinal symptoms alleviate at school age

Aim This study estimated follow-up outcomes for children presenting with troublesome upper gastrointestinal (GI) symptoms in early childhood. Methods We identified from our upper endoscopy registry children with undefined GI symptoms having undergone an oesophagogastroduodenoscopy to rule out oesophagitis at a median age of 2.6 years in 2006-2016. We included only those with normal findings. In early 2020, we performed a National Patient Data Repository and Prescription Service review to note patients' current GI symptoms, medications and medical consultations. We also employed a study-specific questionnaire with a validated quality-of-life measure (the PedsQL). Results After a median of 7.9 years of follow-up, the children (n = 199) had a median age of 10.6 years. Medical consultations related to upper GI symptoms were rare. However, parents reported recurrent GI symptoms in 24% of the children, and 41% followed a specific diet. Regular anti-acid medication was in use in 3.5% of the cohort, more often when with a predisposing condition for reflux disease. The current quality of life was good. Conclusion Although some upper GI symptoms may persist after early childhood, patients without diseases predisposing to reflux disease have a good quality of life without GI-related morbidity in school age.Peer reviewe

Lapsen vajaaravitsemus

VertaisarvioituPuolet sairaalassa olevista lapsipotilaista on vajaaravitsemuksen vaarassa. Lapsen ravitsemustilaa seurataan ensisijaisesti kasvukäyrän avulla, mutta se ei välttämättä tunnista normaalipainoisen huonoa ravitsemusta. Vajaaravitsemus voi heikentää lapsen kasvua, motorista ja kognitiivista kehitystä sekä oppimista. Sairaala¬hoitojaksot ovat pidempiä ja komplikaatioita esiintyy enemmän. Vajaaravitsemusriskin seulonta suositellaan tehtäväksi sairaalassa kaikille lapsipotilaille viimeistään toisena hoitopäivänä.Peer reviewe

Upper endoscopy for non-acute non-specific symptoms is seldom beneficial for children under the age of seven

Abstract Aim This study estimated the diagnostic yield of oesophagogastroduodenoscopy (OGD) in young children with non-acute, non-specific gastrointestinal or respiratory symptoms who were treated by a Finnish tertiary level referral centre. Methods A retrospective chart analysis was performed on 1850 Finnish children under seven years of age who underwent their first diagnostic OGDs at Helsinki University Hospital during 2006-2016. We noted the endoscopy indications, macroscopic findings, the histology of the mucosal biopsies and the follow-up data. Results After the exclusion criteria were applied, we enrolled 666 patients (57.7% boys) at a median age of 3.5 years. The number of children with non-specific symptoms referred for OGD increased 2.3-fold in 11 years. A routine set of biopsies was obtained in 644/666 (96.7%) of the endoscopies. The OGD was both macroscopically and histologically normal in 519/644 (80.6%) of cases. The most common indication was to rule out gastro-oesophageal reflux disease in 268/666 (40.2%) cases and the most frequent histological diagnosis was mild to moderate oesophagitis in 57/644 (8.9%) cases. There was no erosive oesophagitis. Conclusion The diagnostic yield of macroscopic and histological OGD findings was low in our cohort. Unless there are alarming symptoms, younger children do not need OGD.Peer reviewe

Small Bowel Dilatation Predicts Prolonged Parenteral Nutrition and Decreased Survival in Pediatric Short Bowel Syndrome

Objective: To analyze risk factors and prognostic significance of small bowel (SB) dilatation in children with short bowel syndrome (SBS). Background: In SBS, the remaining SB may dilate as part of intestinal adaptation. The impact of dilatation on parenteral nutrition (PN) dependence and survival has not been studied systematically. Methods: SB diameter of SBS children (n = 61) was measured in contrast SB series (n = 169, median age 0.94, range 0.32-2.7 years) during 2002 to 2015, and expressed as millimeters (SB width) and as ratio to L5 vertebra height (SB diameter ratio). Linear regression was used to examine risk factors for dilatation. PN weaning and survival were analyzed with Cox proportional hazards regression. Results: Maximal SB diameter ratio during follow-up was predicted by PN dependence and SB atresia, while maximal absolute SB width by birth weight, age, PN duration, and remaining bowel length. Weaning off PN was 14-fold more likely in patients with maximal SB diameter ratio 3.00 (P = 0.005), and 5.4-fold more likely when maximal SB width was 30mm (P = 0.023). After adjustment for age, remaining SB length, and the presence of ileocecal valve, both estimates of maximal SB dilatation remained significant independent predictors for weaning off PN. When all measurements were included, the cumulative survival was worse if SB diameter ratio exceeded 2.00 (P = 0.002-0.042). Conclusions: SB dilatation predicts prolonged PN duration and decreased survival in SBS children. Measurement of maximal SB diameter standardized to L5 vertebra height may be a valuable objective tool for patient follow-up and assessment of prognosis.Peer reviewe

Health-related quality of life and neurodevelopmental outcomes among children with intestinal failure

Treatment results of pediatric intestinal failure have improved markedly during the last decades. With improved survival the attention is turning to other essential outcomes including quality of life and neurodevelopment. So far, relatively few studies with limited number of patients and variable methodology have addressed these issues. Based on these studies using generic health related quality of life tools, children with intestinal failure demonstrate decreased physical health, while PN-dependence is also associated with compromised emotional functioning. Impairments of social functioning are frequently observed among older children and parents. Few recent studies on neurodevelopment imply significant impairments in motor and mental skills among children with intestinal failure despite small sample sizes and limited follow-up times. Development of a disease-specific survey designed for the pediatric intestinal failure population could better reveal the health issues with greatest impact on quality of life. Robust studies with appropriate methodology on neurodevelopment in pediatric intestinal failure with extended follow-up times are urgently needed. Quality of life and neurodevelopment requires greater attention from medical professionals managing children with intestinal failure. (C) 2018 Elsevier Inc. All rights reserved.Peer reviewe