Current Pediatric Reviews - Volume 14, Issue 4, 2018

Background: Fetal Growth Restriction (FGR) is one of the most common noxious antenatal conditions in humans, inducing a substantial proportion of preterm delivery and leading to a significant increase in perinatal mortality, neurological handicaps and chronic diseases in adulthood. This review summarizes the current knowledge about the postnatal consequences of FGR, with a particular emphasis on the long-term consequences on respiratory, cardiovascular and neurological structures and functions. Result and Conclusion: FGR represents a global health challenge, and efforts are urgently needed to improve our understanding of the critical factors leading to FGR and subsequent insults to the developing organs.

Background: Cardiovascular and chronic kidney diseases are a part of noncommunicable chronic diseases, the leading causes of premature death worldwide. They are recognized as having early origins through altered developmental programming, due to adverse environmental conditions during development. Preterm birth is such an adverse factor. Rates of preterm birth increased in the last decades, however, with the improvement in perinatal and neonatal care, a growing number of preterm born subjects has now entered adulthood. Clinical and experimental evidence suggests that preterm birth is associated with impaired or arrested structural or functional development of key organs/systems making preterm infants vulnerable to cardiovascular and chronic renal diseases at adulthood. This review analyzes the evidence of such cardiovascular and renal changes, the role of perinatal and neonatal factors such as antenatal steroids and potential pathogenic mechanisms, including developmental programming and epigenetic alterations. Conclusion: Preterm born subjects are exposed to a significantly increased risk for altered cardiovascular and renal functions at young adulthood. Adequate, specific follow-up measures remain to be determined. While antenatal steroids have considerably improved preterm birth outcomes, repeated therapy should be considered with caution, as antenatal steroids induce long-term cardiovascular and metabolic alterations in animals' models and their involvement in the accelerated cellular senescence observed in human studies cannot be excluded.

Objective: While the survival of extremely premature infants has improved over the past decades, the rate of complications – especially for bronchopulmonary dysplasia (BPD) – remains unacceptably high. Over the past 50 years, no safe therapy has had a substantial impact on the incidence and severity of BPD. Methods: This may stem from the multifactorial disease pathogenesis and the increasing lung immaturity. Mesenchymal Stromal Cells (MSCs) display pleiotropic effects and show promising results in neonatal rodents in preventing or rescuing lung injury without adverse effects. Early phase clinical trials are now underway to determine the safety and efficacy of this therapy in extremely premature infants. Results and Conclusion: This review summarizes our current knowledge about MSCs, their mechanism of action and the results of preclinical studies that provide the rationale for early phase clinical trials and discuss remaining gaps in our knowledge.

Definition: Hydrops Fetalis (HF) or fetal hydrops is identified as an abnormal interstitial collection of fluid in at least 2 or more compartments of the fetal torso (peritoneal cavity, pleura, and pericardium). An alternative definition discusses about liquor accumulation in two fetal anatomical areas or an effusion in one site and anasarca. Background: Parvovirus B-19 is a common childhood illness; the virus can cause fetal anemia, non-immune fetal hydrops, and spontaneous abortion and might lead to fetal demise. HF is the pathological distribution of body fluids between the interstitial and the intravascular areas of the fetus. Normally, in the fetal organism there is a continuous circular movement of the lymph from the interstitial space into the vascular system and vice versa. The detection of a solely effusion represents the initial stage of a systemic disorder that will lead to a fully developed hydrops or remain just a local disorder. Objective: The connection between parvovirus B-19 and fetal hydrops. Conclusion: The view is unbeatable, severely swollen babies; immune hydrops is surfaced because of the maternal antibodies targeted against red blood cells with Rh positive antibody of the fetus, while the non-immune is due to a variety of pathological conditions in pregnancy.

Introduction: Subtle neurocognitive deficits have been recently observed in Acute Lymphoblastic Leukemia (ALL) survivors. Aim: We aim to assess the neurocognitive functions of ALL survivors who had been treated with chemotherapy only using two different protocols, and to identify treatment-related risk factors. Patients and Methods: We carried a multicenter study involving 3 pediatric oncology centers on 100 children who were treated for ALL. Fifty patients were treated by the modified Children's Cancer Group (CCG) 1991 protocol with low dose methotrexate and 50 children were treated by Total XV protocol with high dose methotrexate. Fifty healthy children were included as a control group. Psychometric assessment using Arabic version of Wechsler intelligence scale for children (WISC III) was performed for all patients and controls. Results: Patients had significantly lower mean full scale IQ, performance IQ and verbal IQ than controls. Patients ≤ 5 years at diagnosis had significantly lower mean full scale IQ and performance IQ than patients>5 years at diagnosis, while the verbal IQ showed no significant difference between both age groups. Female patients had significantly lower mean full scale IQ, performance IQ and verbal IQthan males. Patients who received Total XV protocol with high dose methotrexate had significantly lower mean full scale IQ, performance IQ and verbal IQ than patients who received modified CCG 1991 protocol with low dose methotrexate. Conclusions: CNS directed chemotherapy might appear to affect neurocognitive functions in children with ALL, which is more significant in young children at diagnosis, in girls and in those receiving high dose methotrexate.

Background: Iron Deficiency Anemia (IDA) is a major public health problem worldwide. Iron Bisglycinate Chelate (FeBC) and polymaltose iron (FeP) are used for the treatment of IDA and exhibit good tolerability with a low incidence of adverse effects. However, these compounds have important differences in their structures and bioavailability. Objective: To compare the efficacy of oral supplementation with FeBC and FeP in anemic children. Methods: In this double-blind study, children aged 1 to 13 years who were diagnosed with IDA were randomly divided into two groups: i) FeBC, supplemented with iron bisglycinate chelate, and ii) FeP, supplemented with polymaltose iron (3.0 mg iron/kg body weight/day for 45 days for both groups). Results: Both treatments resulted in significant increases in hemoglobin levels, Mean Corpuscular Volume (MCV) and Cell Distribution Width (RDW) and in a reduction of transferrin levels, relative to initial values. However, only FeBC treatment significantly increased ferritin and Mean Corpuscular Hemoglobin (MCH) levels. A significant negative correlation was observed between the increase in ferritin and initial hemoglobin levels in the FeBC group, indicating that the absorption of FeBC is regulated by the body iron demand. Conclusion: These results provide preliminary evidence to suggest a greater efficacy of FeBC than FeP in increasing iron stores.