Vitamin D-Deficiency Rickets in Two Breast-Fed Infants Who Were Not Receiving Vitamin D Supplementation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66491/2/10.1177_000992287701600411.pd

Putting Families First: How the Opioid Epidemic is Affecting Children and Families, and the Child Welfare Policy Options to Address It

Abstract: Opioids and Child Welfare Across the country, placements in foster care are rising. In 2016, the U.S. Department of Health and Human Services reported that 273,539 children in the U.S. entered foster care. In 34 percent of those cases, parental drug abuse was one of the factors leading to the child’s removal from their family. Additionally, the U.S. Substance Abuse and Mental Health Services Administration estimates that 400,000 births nationally are affected by prenatal exposure to alcohol and illicit drugs, which represents 10 percent of all live births. As the opioid epidemic continues, increasing numbers of children are at high risk for developmental and behavioral disorders because of their prenatal substance and alcohol exposure. In addition, children who remain at home may endure the challenges and trauma resulting from impaired caregiving due to parental substance use disorders (SUDs). This article explores the intersection of the opioid epidemic and child welfare, examining current research and publicly available data to discuss policy opportunities for better serving families affected by parental SUDs, including: ensuring health and safety for infants prenatally exposed to substances; appropriate identification, diagnosis, and treatment of developmental and behavioral needs; ensuring parents have access to outpatient treatment and services that can allow families to stay together when safe and appropriate; and ensuring sufficient access to inpatient treatment options that can serve parents and children together

Clinical features and subdural lesions in childhood onset Haemophilus influenzae meningitis

It becomes difficult to treat the onset of childhood Haemophilus influenza type b( Hib) meningitis due tothe appearance of b-lactamase negative ampicilin resistance( BLNAR). We investigated the clinical featuresof Hib meningitis with subdural lesions. From January 2000 to December 2006, we experienced 8 patientswith Hib meningitis. All patients were not inoculated with Hib vaccine. Five of them were onset under 1year old. Rapid latex diagnoses were made in 5 patients, among whom 4 patients showed Hib positive. Thegenotypes were determined in 4 patients with BLNAR. Combined with cefotaxime sodium (CTX) and ampicillin(ABPC) were used in 3 patients for the initial antibiotics, panipenem/betamipron( PAPM/BP) in 2,meropenem hydrate( MEPM) in 1, MEPM + ceftriaxone sodium( CTRX) in 1, and concomitant use of dexamethasonein 7 paitents. MRI showed subdural hygroma in 4 patients and subdural abscess in 4 patients.Subdural lesions appeared on Day 1 to Day 18 from the onset. Three patients with subdural abscess haveperformed subdural taps, and 2of them with difficulties after subdural taps were necessary to do oral administrationof chloramphenicol( CP).In our report, all of the patients developed subdural lesions. The development of subdural lesions cannotbe avoided with only the conventional antibiotics and dexamethasone therapy. Our cases suggested earliersubdural taps with oral administration of CP might be to improve both the general condition and control thesubdural lesions with Hib meningitis. Moreover, we should pay attention to the preventive vaccination ofHib

Clinically Mild form of Joubert Syndrome-related Disorder in a 7-year-old Female:A case report

Joubert syndrome-related disorders (JSRD) is a very rare syndrome observed with agenesis of the vermis,episodic hyperpnea, abnormal eye movements, and cerebellar ataxia and mental retardation. There have been many reports on the image-based diagnosis using MRI/CT, but not many clinical reports on the intelligence of subjects with JSRD. We herein report a clinically mild form of JSRD in a 7-year-old female. The patient did not have any clinical abnormalities in the neonatal period.She initially visited the neurology outpatient department at 6 months of age because her neck was still unstable. A brain MRI was conducted to assess symptoms of abnormal eye movements and body trunk cerebella rataxia, and she was diagnosed with JSRD based on the observation of agenesis of the vermis and characteristic molar tooth signs. Regarding her motor development, she was able to hold her head up at 7months of age, and was able to sit up at 1 year and 2 months old. She underwent rehabilitation, and a wide base cerebellar gait was observed when she was 5 years old. In addition, at 5 years of age, she could intermittently speak two-word sentences, draw pictures with an understanding of color, and was able to engage in actions such as throwing a ball. At 6 years of age, her conversation became better. She entered elementary school at 7 years of age, was able to go up and down stairs, read words, do single-digit addition, and write many Chinese characters with a pencil. The intellectual dysfunction of subjects with JSRD is generally moderate to severe. Thus, this case was diagnosed to be a clinically mild form of JSRD, because the patient exhibited limited effects on her intelligence

Long survival case of trisomy 13 mosaicism in a 7-year-old male

Trisomy 13 is a complication of various congenital abnormalities of the heart, brain, etc. Regarding the vitalprognosis, many die within a year from birth. We herein report on the case of a 7-year 1-month-old boywith mosaicism trisomy 13 with the two considerations mentioned below as the cause for long-term survivalin this case. The first is that there were no serious associated abnormalities to the heart, brain, or otherorgans, and the second is that a tracheotomy was carried out on a repeated respiratory infection with respiratoryfailure. Long-term in-home care was possible for the child and he was observed playing with toys bytouching them. Trisomy 13 has a poor vital prognosis, so some argue that active treatment should be restrained.However, for cases with no severe associated abnormalities, long-term survival may be possiblewith active treatment

A prospective study of the use of antibiotics in the Emergency Department of a Chinese University Hospital

Background: Antibiotics are one of the most widely misused group of medicines. The aim of this study was to investigate the use of antibiotics in one of the paediatric emergency departments in China. Methods: We performed a prospective, cross-sectional study of antibiotic use in the paediatric emergency room of West China Second University Hospital. A total of 500 consecutive patients from March 25 to April 3 2013 were included. Clinical details of the patients were also collected in order to analyse antibiotic use. Key findings: The median age of patients was 2 years 2 months. The five most common conditions seen in the emergency department were wheezy bronchitis, upper respiratory tract infections, tonsillitis, pneumonia and diarrhoea. A total of 311 children (62%) received antibiotics. The antibiotics prescribed were predominantly cephalosporins and penicillins. More than one antibiotic was used in 51 patients. In total, 75% of the antibiotics prescribed were cephalosporins. More than three-quarters of the young children with wheezy bronchitis received antibiotics. Antibiotic use for children with an upper respiratory tract infections or tonsillitis was greater than the 20% maximum recommended by the European Surveillance of Antimicrobial Consumption. Conclusions: The majority of children attending the emergency department received antibiotics. For many of the conditions, the use of antibiotics was inappropriate

Validity and Reliability of the Perceived Readiness for Discharge After Birth Scale

Objective: To assess the psychometric properties of a scale measuring mothers’ perceptions of readiness for discharge after birth. Design: Psychometric analyses including construct validity using factor analysis and known groups comparisons, predictive validity, and reliability. Data were collected at discharge and 6 weeks postdischarge. Setting: Tertiary-level perinatal center in the Midwestern United States. Participants: 1,462 postpartum mothers. Intervention: None. Main Outcome Measures: Perceived Readiness for Discharge After Birth Scale scores; subscale scores for personal status and knowledge factors.\u27 Results: Exploratory and confirmatory factor analyses indicated that the scale contained two factors. Perceived Readiness for Discharge After Birth Scale scores were lower for mothers who were breast-feeding, married, primiparous, and had a short hospital stay (less than 30 hours) than for their comparison groups. The Perceived Readiness for Discharge After Birth Scale personal status factor was predictive of self-reported physical and psychosocial problems and unscheduled utilization of health services in the first 6 weeks postpartum. The knowledge factor was predictive of postdischarge telephone calls to the pediatric provider. Reliability estimates ranged from 0.83 to 0.89 for the total scale and subscales. Conclusions: The Perceived Readiness for Discharge After Birth Scale performed well in psychometric testing. Assessing mothers’perceptions of readiness for discharge is important for measuring outcomes of hospitalization and for identifying mothers at risk for postdischarge problems

A Fatal Case of Acute Encephalopathy in a 8-year-old girl from a Pandemic of Influenza A( H1N1) in 2009

We report on a case in which a child died from acute encephalopathy associated with Influenza A( H1N1)pdm. The case pertains to an 8-year-old girl, who was diagnosed with influenza A on the previous day andwas prescribed zanamivir hydrate. She experienced abdominal pain and delirium the next morning, so shewas referred to our hospital. Her level of consciousness at the time of consultation was JCS 200. In the brainCT scan, a swollen brain stem and bilateral middle cerebral artery were depicted. She was in a state of respiratoryfailure, and was admitted to the intensive care unit. She was diagnosed with acute encephalopathycaused by Influenza A, and therapeutic brain hypothermia as well as steroid pulse therapy were performed;however, she died on the third day after hospitalization from multiple organ failure

Stress in Children with Pervasive Developmental Disorders

The purpose of this study is to examine urinary 17-hydroxycorticosteroid (OHCS) excretion as a measureof stress response in controls and in children with pervasive developmental disorders (PDDs) accompaniedby mental retardation( MR, intelligence quotient[ IQ]<70)( low-functioning PDD:LFPDD) or notaccompanied by MR( IQ≧70)( high-functioning PDD:HFPDD). Prospective, non-randomized study of 24children with LFPDD ─ 17 with autism and seven with PDDs not otherwise specified( PDDs-NOS) ─ and14 children with HFPDD ─ 11 with PDDs-NOS and three with Asperger\u27s disorders. Urinary 17-OHCSwas measured between June 2002 and June 2004. In 21 of 24 LFPDD subjects and 8 of 14 HFPDD subjectsa second measurement was taken 6 to 12-months after the first, after the subjects had received interventionfor developmental disorders. Baseline urinary 17-OHCS levels in both LFPDD( p<0.0005) and HFPDD(p<0.005) were significantly higher than in controls. LFPDD subjects had significantly greater (p<0.05)levels of this stress hormone than did HFPDD subjects. Levels of 17-OHCS in both LFPDD (p<0.05) andHFPDD (p<0.05) decreased significantly after 6 to 12 months of intervention. PDD subjects showed higherlevels of 17-OHCS than controls and showed a significant reduction in the level of stress indicator after theyhad received intervention for developmental disorders

Literature overview highlights lack of paediatric donation protocols but identifies common themes that could guide their development

Aim: Paediatric donation is a unique and extremely sensitive process that requires specific knowledge and competencies. Most countries use protocols for organ and tissue donation to ensure optimal care for the donor and family, but these mainly focus on adults. However, the donation process for children differs from adults in many ways. An overview of the literature was performed to identify protocols for the paediatric population. Methods: PubMed, Web of Science, EMBASE and the Internet were searched up to March 2016 for papers or other sources in English related to specific organ and tissue donation protocols for children and neonates. This comprised title, abstract and then full-text screening of relevant data. Results: We included 12 papers and two electronic sources that were mainly from North America and Europe. Most discussed donations after cardiac death. The recurring themes included identifying potential donors, approaching parents, palliative care and collaboration with organ procurement organisations. Most papers called for paediatric donation policies to be standardised. Conclusion: Scientific publications in English on paediatric donation protocols are very scarce. No comprehensive paediatric donation protocol was found. We identified several recurring themes in the literature that could be used to develop such protocols