Shoshin Beriberi and Severe Accidental Hypothermia as Causes of Heart Failure in a 6-Year-Old Child: A Case Report and Brief Review of Literature

Severe accidental hypothermia has been demonstrated to affect ventricular systolic and diastolic functions, and rewarming might be responsible of cardiovascular collapse. Until now, there have been only a few reports on severe accidental hypothermia, none of which involved children. Herein, we describe here a rare case of heart failure in a 6-year-old boy admitted to the emergency unit owing to severe hypothermia and malnutrition. After he was warmed up (core temperature of 27.2°C at admission), he developed cardiac arrest, requiring vasoactive amines administration, and veno-arterial extracorporeal membrane oxygenation. Malnutrition and refeeding syndrome might have caused the thiamine deficiency, commonly known as beriberi, which contributed to heart failure as well. He showed remarkable improvement in heart failure symptoms after thiamine supplementation. High-dose supplementation per os (500 mg/day) after reconstitution of an adequate electrolyte balance enabled the patient to recover completely within 2 weeks, even if a mild diastolic cardiac dysfunction persisted longer. In conclusion, we describe an original pediatric case of heart failure due to overlap of severe accidental hypothermia with rewarming, malnutrition, and refeeding syndrome with thiamine deficiency, which are rare independent causes of cardiac dysfunction. The possibility of beriberi as a cause of heart failure and adequate thiamine supplementation should be considered in all high-risk patients, especially those with malnutrition. Refeeding syndrome requires careful management, including gradual electrolyte imbalance correction and administration of a thiamine loading dose to prevent or correct refeeding-induced thiamine deficiency

ESPNIC clinical practice guidelines: intravenous maintenance fluid therapy in acute and critically ill children- a systematic review and meta-analysis

PURPOSE Intravenous maintenance fluid therapy (IV-MFT) prescribing in acute and critically ill children is very variable among pediatric health care professionals. In order to provide up to date IV-MFT guidelines, the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) undertook a systematic review to answer the following five main questions about IV-MFT: (i) the indications for use (ii) the role of isotonic fluid (iii) the role of balanced solutions (iv) IV fluid composition (calcium, magnesium, potassium, glucose and micronutrients) and v) and the optimal amount of fluid. METHODS A multidisciplinary expert group within ESPNIC conducted this systematic review using the Scottish Intercollegiate Guidelines Network (SIGN) grading method. Five databases were searched for studies that answered these questions, in acute and critically children (from 37 weeks gestational age to 18 years), published until November 2020. The quality of evidence and risk of bias were assessed, and meta-analyses were undertaken when appropriate. A series of recommendations was derived and voted on by the expert group to achieve consensus through two voting rounds. RESULTS 56 papers met the inclusion criteria, and 16 recommendations were produced. Outcome reporting was inconsistent among studies. Recommendations generated were based on a heterogeneous level of evidence, but consensus within the expert group was high. "Strong consensus" was reached for 11/16 (69%) and "consensus" for 5/16 (31%) of the recommendations. CONCLUSIONS Key recommendations are to use isotonic balanced solutions providing glucose to restrict IV-MFT infusion volumes in most hospitalized children and to regularly monitor plasma electrolyte levels, serum glucose and fluid balance

Factors influencing plasma transfusion practices in paediatric intensive care units around the world

Background and Objectives: Plasma transfusions are a frequent treatment worldwide, but many studies have reported a wide variation in the indications to transfuse. Recently, an international paediatric study also showed wide variation in frequency in the use of plasma transfusions: 25% of the centres transfused plasma to >5% of their patients, whereas another 25% transfused plasma to <1% of their patients. The objective of this study was to explore the factors associated with different plasma transfusion practices in these centres. Materials and Methods: Online survey sent to the local investigators of the 101 participating centres, in February 2016. Four areas were explored: beliefs regarding plasma transfusion, patients’ case-mix in each unit, unit’s characteristics, and local blood product transfusion policies and processes. Results: The response rate was 82% (83/101). 43% of the respondents believed that plasma transfusions can arrest bleeding, whereas 27% believe that plasma transfusion can prevent bleeding. Centres with the highest plasma transfusion rate were more likely to think that hypovolaemia and mildly abnormal coagulation tests are appropriate indications for plasma transfusions (P = 0·02 and P = 0·04, respectively). Case-mix, centre characteristics or local transfusion services were not identified as significant relevant factors. Conclusion: Factors influencing plasma transfusion practices reflect beliefs about indications and the efficacy of transfusion in the prevention and management of bleeding as well as effects on coagulation tests. Educational and other initiatives to target these beliefs should be the focus of research.0SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Recurrent acute event in an infant. Belgian Journal of Pediatrics

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La maladie de Kashin-Beck: évaluation des apports quotidiens en minéraux chez les jeunes enfants tibétains des régions endémiques

Kashin-Beck disease is an endemic and chronic osteochondropathy. This disease principally occurs in the Tibet Autonomous Region and in several provinces of the People’s Republic of China. Although many studies have already been conducted and many others are still underway, its ethiology remains unknown. A multifactorial hypothesis has been proposed: selenium deficiency, high concentration of organic matters in drinking water (fulvic acids) and mycotoxin poisoning by fungi infecting cereals. This original study aimed to measure the mineral contents of the food most often consumed in severe endemic regions and then to evaluate the daily intake of minerals in young Tibetan children from endemic areas. The mineral elements were selected in relation to their implications in bone metabolism. A sampling campaign split up into two time periods (winter and spring) was carried out. Ten families from two distinct regions were selected based on three criteria: they live in endemic areas; they include a 3 to 5 year-old child; this child has a KBD brother or sister. At the same time, a nutritional survey was made by the means of a prospective questionnaire in order to list the 24h food intake of the 3 to 5 year-old child. This survey highlighted the extremely monotonous cereal-based Tibetan diet. An analytical method for the minerals was developed as follows: mineralization of samples performed by microwave-assisted wet process; mineralized solutions measured by several atomic absorption or emission spectrometric methods and molecular absorption spectrometric methods. The analytical method was validated by mean of certified reference materials. Mean food contents were calculated and compared to food composition reference tables. High iron contents and selenium deficiencies were highlighted in several foods. Daily intakes were estimated combining mineral measurements and nutritional survey results. These were compared to dietary reference intakes from reference tables. This estimation reveals some crucial points: we confirm a marked deficiency in calcium; Ca/P ratios are always low; iron and copper intakes are excessive; zinc is the most probably deficient; while selenium could be deficient; manganese intakes often exceed toxicity thresholds. Nevertheless, this study encounters some limits. The bioavailability of minerals is a critical point that deserves further investigations. Moreover, a larger study over a longer term covering both endemic and non-endemic regions is required for definite conclusions to be reached

Evolution of care in hypoplastic left heart syndrome and related single ventricle lesions: a 16-year single center experience in Belgium.

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Growth, nutritional status, and signs of rickets in 0-5-year-old children in a Kashin-Beck disease endemic area of Central Tibet

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Effect of calcium and vitamin D on growth, rickets and Kashin-Beck disease in 0- to 5-year-old children in a rural area of central Tibet

Objective: To evaluate the effect of calcium (15 mmol/day) and vitamin D (625 μg/month), as single supplement or in combination, vs. no supplement on growth, clinical signs of rickets and Kashin-Beck disease (KBD) and dental health. Methods: Prospective controlled trial involving children aged 0-5 years living in four groups of villages in a KBD-endemic rural area of central Tibet who received either calcium and/or vitamin D or no supplement. The cohort was followed over 3 years. Primary outcome was the impact of the different supplementation regimes on KBD, rickets and growth; secondary outcomes were impact on urinary levels of calcium and phosphorus, biomarkers of bone and cartilage turnover, and dental health. Results: No difference was observed between the four groups with regard to anthropometric data, rickets, KBD, urinary levels of CrossLaps® and CartiLaps®. Weight for height or age, mid-upper arm circumference and skinfold thickness decreased in the four groups. Height for age increased and the prevalence of KBD fell in the four groups. Dental health was better in the group receiving calcium and vitamin D. Urinary calcium levels increased after 3 years of follow-up in all groups; the group receiving vitamin D had a higher increase (P-value: 0.044). The same global increase was observed for urinary phosphorus levels; the group receiving calcium had a higher increase (P-value: 0.01). Conclusions: Calcium and vitamin D failed to improve growth and bone metabolism of children living in a KBD-endemic rural area. Calcium and vitamin D supplementation improved dental health.SCOPUS: ar.jFLWINinfo:eu-repo/semantics/publishe

Food intake of Tibetan children living in Kashin Beck disease endemic areas in Central Tibet

Introduction: Kashin-Beck disease (KBD) is a bone and joint pathology. KBD begins during childhood, causes deformities, pain, lack of mobility, and short stature. The pathophysiology of the disease is unknown. Nutrition possibly plays a role. Children living in KBD endemic areas in Central Tibet present severe growth retardation, signs of chronic malnutrition and a high prevalence of rickets. A food consumption study was conducted. We have focused our attention on total energy intake, calcium, phosphorus and vitamin D. Material and methods: Prospective food intake measurements have been performed. The investigation concerned children from 9 to 16 years old living in KBD endemic areas. All food and drinks have been measured during several days at the 4 seasons of the year. Anthropometric data were obtained. Results: 30,5% of the children presented with stunting (height for age ratio below -2 z score); 13,8% of the cohort suffered from acute malnutrition (body mass index below -2 z score). Mean total energy intake was 87% of the recommended value. Calcium and vitamin D intakes never covered the needs (44 % and 14 %, respectively). Phosphorus intake was high. Mean Ca / P ratio was 0.54. Conclusion: Calcium and vitamin D deficiency may play a role in the etiology of bone and joint diseases in this population. To improve the nutritional status of the children, a large program of calcium and vitamin D supplementation among 0 - 5 years old children living in KDB endemic areas was started. Besides, chemical analyses of locally grown foods are performed, in order to have a more precise evaluation of nutrient intake. In the future, the effect of increased energy intakes will be evaluated