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

Aetiology and risk factors for cerebral palsy in children born at term

Cerebralna paraliza najčešći je uzrok trajnih i teških motoričkih oštećenja u djece. Smatra se posljedicom oštećenja nezrelog mozga ili mozga u razvoju. U terminske novorođenčadi etiologija je još i danas nedovoljno poznata i razlikuje se od etiologije CP-a u prijevremeno rođene djece. Prikazana je etiologija i rizični čimbenici za razvoj CP-a u terminske novorođenčadi rođene i/ili liječene u KBC-u Rijeka od 2002. do 2013. godine. Udio terminske novorođenčadi u skupini djece sa CP-om iznosio je 40%, uz najvišu zastupljenost postnatalne etiologije od 47%, za razliku od drugih autora koji navode prenatalnu etiologiju vodećom. Razlog tome može biti i primjena suvremene klasifikacije i podjele CP-a. Intrapartalna etiologija nađena je u 18%, a prenatalna u 35% slučajeva. U djece s nepoznatom etiologijom nađeni su rizični čimbenici tijekom porođaja koji mogu upućivati na intrapartalnu etiologiju, čime bi se povećao njen udio u ukupnoj etiologiji CP-a. Radi eventualne prevencije potrebna su daljnja ciljana istraživanja o etiologiji CP-a u terminske novorođenčadi, služeći se jasnom klasifikacijom i definicijom CP-a. Ključne riječi: cerebralna paraliza; postnatalno; prenatalno; rizični čimbeniciCerebral palsy is the most common cause of permanent and severe motor impairment in children. It is considered as a consequence of damage to immature or developing brain. The aetiology in infants born at term is still mostly unknown and differs from the aetiology in premature infants. We present aetiology and risk factors for CP in infants born at term and/or treated at Rijeka University Hospital Centre from 2002 to 2013. Infants born at term comprised about 40% of the children with CP, with the highest contribution of postnatal aetiology (47%), unlike other authors who cite prenatal aetiology as the leading one. The modern definition and classification of CP may be the reason for this observation. Intrapartum aetiology was found in 18% and prenatal in 35% of cases. In children with undetermined aetiology, most risk factors were found during birth, which may indicate intrapartum aetiology, and thus the increase in the percentage of intrapartum aetiology in the overall aetiology of CP. Aiming at possible prevention, additional research into CP aetiology in infants born at term is required using clear definition and classification of CP

Rizični i etiološki čimbenici u terminske novorođenčadi za nastanak cerebralne paralize

Cerebral palsy is the most common cause of permanent and severe motor impairment in children. It is considered as a consequence of damage to immature or developing brain. The aetiology in infants born at term is still mostly unknown and differs from the aetiology in premature infants. We present aetiology and risk factors for CP in infants born at term and/or treated at Rijeka University Hospital Centre from 2002 to 2013. Infants born at term comprised about 40% of the children with CP, with the highest contribution of postnatal aetiology (47%), unlike other authors who cite prenatal aetiology as the leading one. The modern definition and classification of CP may be the reason for this observation. Intrapartum aetiology was found in 18% and prenatal in 35% of cases. In children with undetermined aetiology, most risk factors were found during birth, which may indicate intrapartum aetiology, and thus the increase in the percentage of intrapartum aetiology in the overall aetiology of CP. Aiming at possible prevention, additional research into CP aetiology in infants born at term is required using clear definition and classification of CP.Cerebralna paraliza najčešći je uzrok trajnih i teških motoričkih oštećenja u djece. Smatra se posljedicom oštećenja nezrelog mozga ili mozga u razvoju. U terminske novorođenčadi etiologija je još i danas nedovoljno poznata i razlikuje se od etiologije CP-a u prijevremeno rođene djece. Prikazana je etiologija i rizični čimbenici za razvoj CP-a u terminske novorođenčadi rođene i/ili liječene u KBC-u Rijeka od 2002. do 2013. godine. Udio terminske novorođenčadi u skupini djece sa CP-om iznosio je 40%, uz najvišu zastupljenost postnatalne etiologije od 47%, za razliku od drugih autora koji navode prenatalnu etiologiju vodećom. Razlog tome može biti i primjena suvremene klasifikacije i podjele CP-a. Intrapartalna etiologija nađena je u 18%, a prenatalna u 35% slučajeva. U djece s nepoznatom etiologijom nađeni su rizični čimbenici tijekom porođaja koji mogu upućivati na intrapartalnu etiologiju, čime bi se povećao njen udio u ukupnoj etiologiji CP-a. Radi eventualne prevencije potrebna su daljnja ciljana istraživanja o etiologiji CP-a u terminske novorođenčadi, služeći se jasnom klasifikacijom i definicijom CP-a

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

Aetiology and risk factors for cerebral palsy in children born at term

Cerebralna paraliza najčešći je uzrok trajnih i teških motoričkih oštećenja u djece. Smatra se posljedicom oštećenja nezrelog mozga ili mozga u razvoju. U terminske novorođenčadi etiologija je još i danas nedovoljno poznata i razlikuje se od etiologije CP-a u prijevremeno rođene djece. Prikazana je etiologija i rizični čimbenici za razvoj CP-a u terminske novorođenčadi rođene i/ili liječene u KBC-u Rijeka od 2002. do 2013. godine. Udio terminske novorođenčadi u skupini djece sa CP-om iznosio je 40%, uz najvišu zastupljenost postnatalne etiologije od 47%, za razliku od drugih autora koji navode prenatalnu etiologiju vodećom. Razlog tome može biti i primjena suvremene klasifikacije i podjele CP-a. Intrapartalna etiologija nađena je u 18%, a prenatalna u 35% slučajeva. U djece s nepoznatom etiologijom nađeni su rizični čimbenici tijekom porođaja koji mogu upućivati na intrapartalnu etiologiju, čime bi se povećao njen udio u ukupnoj etiologiji CP-a. Radi eventualne prevencije potrebna su daljnja ciljana istraživanja o etiologiji CP-a u terminske novorođenčadi, služeći se jasnom klasifikacijom i definicijom CP-a. Ključne riječi: cerebralna paraliza; postnatalno; prenatalno; rizični čimbeniciCerebral palsy is the most common cause of permanent and severe motor impairment in children. It is considered as a consequence of damage to immature or developing brain. The aetiology in infants born at term is still mostly unknown and differs from the aetiology in premature infants. We present aetiology and risk factors for CP in infants born at term and/or treated at Rijeka University Hospital Centre from 2002 to 2013. Infants born at term comprised about 40% of the children with CP, with the highest contribution of postnatal aetiology (47%), unlike other authors who cite prenatal aetiology as the leading one. The modern definition and classification of CP may be the reason for this observation. Intrapartum aetiology was found in 18% and prenatal in 35% of cases. In children with undetermined aetiology, most risk factors were found during birth, which may indicate intrapartum aetiology, and thus the increase in the percentage of intrapartum aetiology in the overall aetiology of CP. Aiming at possible prevention, additional research into CP aetiology in infants born at term is required using clear definition and classification of CP

Advances in diagnosis of chronic liver diseases in pediatric patients

Background Chronic liver diseases (CLD) present important clinical problem in children with various age-dependent causes. Nonalcoholic fatty liver disease (NAFLD) with its increasing prevalence is a major problem with regard to its timely recognition and the need for long-term disease monitoring. At present, a perfect non-invasive method for the evaluation of liver fibrosis is not available. Methods A non-systematic literature search was performed to summarize the current knowledge about transient elastography (TE) with controlled attenuation parameter (CAP) in children with CLD. Ovid MEDLINE, Ovid EMBASE, Google scholar, and The Cochrane Library databases were searched for relevant articles evaluating TE in the pediatric population. Results Normal values of liver stiffness measurements (LSM) according to the age are given, as well as the advantages and disadvantages of the method. The utility of TE in specific liver disease in pediatric population is summarized. Conclusions TE with CAP is a valuable non-invasive method for the liver-damage assessment. Clinical interpretation of TE results should be made in parallel with the assessment of the patient’s demographics, disease etiology, and essential laboratory parameter

Management of Childhood Iron Deficiency Anemia in a Developed Country—A Multi-Center Experience from Croatia

Iron deficiency anemia (IDA) continues to be a global public health concern, mostly in the developing countries. However, precise epidemiological data on childhood IDA in Croatia are lacking. In order to establish its frequency, underlying etiologies, the rationale for tertiary care visits, diagnostic practices, and current treatment regimens of IDA, medical records of children referred to pediatric hematologists for iron deficiency in a five-year period at tertiary institutions (Zagreb, Rijeka, Split, Osijek) throughout Croatia were retrospectively analyzed. Eight hundred and sixty-four children, predominately of preschool age, were referred mainly by the primary care pediatricians, who, in general, performed basic diagnostics but failed to initiate oral iron therapy in half of the patients. Approximately one-third of patients were symptomatic, with inadequate nutrition prevailing as underlying etiology. Dextriferron was the preferred iron formulation among hematologists, with a median dose of 5 mg/kg, with acceptable compliance rates (63.5–93.2%). Hospital admission rates varied among the centers (9.4–35%), and so did transfusion policies (6.4–22.9%). The greatest difference was observed in the frequency of parenteral iron administration (0.3–21.5%). In conclusion, the burden of childhood IDA, even in a high-income country, remains substantial, necessitating consistent implementation of national guidelines and additional education of primary health care providers