Current Pediatric Reviews - Volume 3, Issue 4, 2007

Pathophysiology of meconium aspiration syndrome (MAS) is complex and interactions between individual pathomechanisms are still not completely understood. As recently shown, inflammation plays a significant role in the pathogenesis of MAS. Activated cells release and stimulate production of a wide variety of mediators, including cytokines, enzymes, reactive species, and other biologically active substances in meconium-injured lungs. Anti-inflammatory drugs acting on different levels of inflammatory cascade may in combination with other treatment (exogenous surfactant, inhaled NO, liquid ventilation) improve the clinical status of newborns with MAS. For example, corticosteroids modulate activity of phospholipase A2 and induced NO synthase, influence migration and activation of leukocytes, and reduce lung edema. Cyclooxygenase inhibitors modulate production of thromboxane and prostaglandins. Phosphodiesterase inhibitors have vasodilating, bronchodilating and anti-inflammatory effects. Antioxidants diminish formation of reactive species. However, there are many other drugs., e.g. anti-cytokine antibodies, inhibitors of complement, inhibitors of angiotensinconverting enzyme, anticoagulants, inhibitors of proteolytic enzymes, calcium-channel blockers etc. that may be beneficial in MAS. Nevertheless, further testing is necessary until the novel approaches may be recommended. In this article, authors reviewed main factors participating in meconium-induced inflammation and pointed out some targets for its pharmacological modulation.

Lung hypoplasia (LH) is a common neonatal problem resulting from small, structurally immature lungs. LH is a graded condition which, if severe, is life threatening due to impairment of ventilation, pulmonary blood flow and gas exchange. Although the effects of LH on the structure of lung parenchyma have been well defined in a number of species, little is known about its structural or functional effects on the pulmonary vasculature. Using an ovine model of bilateral LH we have studied pulmonary vascular development and blood flow in relation to ventilatory performance and lung mechanics. LH greatly increases pulmonary vascular resistance and is associated with evidence of impaired development of the pulmonary vasculature, and decreased mRNA levels of vascular growth factors such as PDGF and PECAM-1. Many studies have shown that antenatal corticosteroid treatment has a beneficial effect on lung development and the perinatal transition. In neonatal sheep with LH, lung compliance is not affected by a single dose of antenatal corticosteroids but pulmonary vascular resistance is significantly reduced, and mRNA expressions of PDGF and PECAM-1 normalised. It is clear that antenatal corticosteroids could be a promising treatment option for infants experiencing difficulties with perinatal adaptation of the pulmonary circulation associated with LH and other pathological respiratory conditions.

In the NICU neonates at highest risk for invasive Candida infections are extremely preterm infants and neonates with complicated gastrointestinal diseases. Due to the high mortality, neurodevelopmental impairment, end-organ involvement and need for central venous catheter removal in the management of fungal bloodstream infections, prevention of invasive Candida infections should be paramount in each NICU. Even with prompt treatment, the mortality rate is as high as 40% and neurodevelopmental impairment 57% in infants <1000 grams. Multiple studies have been performed with fluconazole prophylaxis, including a recent multicenter randomized controlled trial. All of the studies have demonstrated efficacy, safety and no increase or emergence of fungal resistance. Analysis of these studies demonstrates that fluconazole prophylaxis reduces the risk of developing invasive fungal infection in high risk infants <1000g at birth by 90% (P<0.0001) and all infants <1500g at birth by 85% (P<0.0001). The mortality rate from all causes was also decreased by 24% (P = 0.02). Additionally, studies have demonstrated that Candida-related mortality can be eliminated in an entire NICU by targeting fluconazole prophylaxis in infants <1000 grams birth weight. In preventing invasive Candida infections, fluconazole prophylaxis can eliminate these infections as a cause of neurodevelopmental impairment and mortality and should be combined with infection control practices in every NICU.

Pediatric vaccination programs have dramatically reduced the morbidity and mortality of infectious diseases [1], but timeliness remains an important barrier to full realization of the potential health benefits. Recent data suggest that 1 in 3 children in the United States are undervaccinated for more than 6 months [2], a delay that can raise the risk of infection both for the child and for community members with whom the child comes in contact. Of the factors contributing to undervaccination, the complexity inherent to multiple schedules for multiple vaccines may be one of the most challenging. A number of combination vaccines have already been introduced to simplify immunization schedules, but further progress in this direction is warranted. With several promising new vaccines nearing clinical application, combination vaccines will play an even more critical role in maintaining children on schedule to achieve the full benefits of this approach to disease prevention.

The purpose of this paper is to review current knowledge and provide advice on breastfeeding, formula feeding of term infants (including which type of formula may be appropriate for a given patient), and the timing and composition of complementary feeding. The review is primarily aimed at children living in Europe, generally in an industrialised country. In brief, all infants should be exclusively breastfed from birth to about 6 months (26 weeks) of age or at least for the first 4 months (18 weeks) of life. Breastfeeding should preferably continue beyond the first year of life. Infants who cannot be breastfed, or should not receive breast milk, or for whom breast milk is not available, require breast milk substitutes of high quality. Based on the available evidence, it is reasonable to advise that for all infants, complementary foods should not be given before 17 weeks and should be introduced by 26 weeks; however, no data are available to form evidencebased recommendations. New foods should not be introduced too often - generally not more frequently than every 3 days - nor should more than one new food be introduced at a time.

Uveitis is a significant cause of blindness and vision loss in children and encompasses a diverse group of disease processes. It is important that physicians become familiar with presenting symptoms and signs of uveitis. Early recognition and referral to a uveitis specialist is key in preventing irreversible vision loss. Aggressive management with antiinflammatory medications and immunosuppressive agents may be necessary. This chapter will provide an introduction to common causes of pediatric uveitis, as well as a discussion of classification, etiologies, work-up, and management.

Experimental and clinical data suggest that activation of inflammation may occur after epileptic seizures without any evidence of systemic or central nervous system infection. Various animal and human studies have recently shown that cytokines are involved in the pathogenesis of epilepsy. Although little is known about the role of inflammation in epilepsy, it has been hypothesized that activated immune system and subsequent inflammatory reaction in the brain can intervene to facilitate certain molecular and structural changes occurring during and after seizure activity. This review focuses on the relationship between inflammation and epilepsy.

Children with epilepsy are at increased risk for language impairments. Recent studies have suggested that abnormal cortical processing of complex sounds, including speech, may be a contributing factor. Cortical auditory evoked potentials provide an objective, non-invasive method for assessing auditory function in children. We begin with an overview of the cortical auditory system, cortical auditory evoked potentials, and childhood epilepsies. This overview provides a framework for reviewing recent studies using auditory evoked potentials to evaluate sound processing in children with epilepsy. Clinical implications, methodological considerations, and directions for future research are discussed.

We describe two sisters born to a consanguineous Arab Muslim couple in northern Israel. Among other clinical findings, both have moderate mental retardation, short stature, “leonine” facies, hypertelorism, broad nasal root, long philtrum, fronto-nasal dysplasia, pigmented lesions of the irises, brachy-clinodactily, apparantly low-set posteriorly angulated ears and a webbed neck. This association of anomalies defines a new syndrome. Parental consanguinity and familial occurrence in two sisters suggest autosomal recessive inheritance.