Current Pediatric Reviews - Volume 4, Issue 2, 2008

Maternal depression during pregnancy and the postpartum period has been associated with a variety of consequences in the fetus and newborn. In particular, depression has been shown to compromise maternal bonding to her fetus antenatally, and mother-infant interaction and attachment patterns during the postpartum period. In turn, these alterations in the relationship between a mother and her infant can impact the child's social, psychological, behavioral, and cognitive development. The present paper discusses attachment theory, and then reviews literature on the impact of both antenatal and postnatal depression on the relationship between a mother and her child. Developmental consequences for the child are discussed, as are possible treatment options.

Perinatal brain injury is an important cause of both early and long term morbidity and mortality. The pathophysiology of perinatal brain injury is complex, and often gestation dependent. Ultrasound has traditionally been the imaging modality of choice used to diagnose these lesions; however, the advent of Magnetic Resonance Imaging (MRI) has improved diagnosis and has enabled the correlation of lesions in the neonatal period with longer term neurodevelopmental sequelae. This review aims to address injury in both the term and pre-term brain, its relationship with long term outcome as well as discussing potential treatment strategies which may be deployed in the future.

Neonatal diabetes mellitus (NDM) is a rare cause of hyperglycemia in the neonatal period. We encountered a patient with neonatal diabetes mellitus and exocrine pancreatic insufficiency secondary to a homozygous insulin promoter factor-1 (IPF1) mutation. We sought to review the available literature regarding current etiologies and therapeutic options available to patients with NDM. Identification of genetic mutations and further investigation of neonatal diabetes mellitus has allowed for improvement in patient care and a better understanding of the etiology of neonatal diabetes mellitus. Given the rarity of the condition, the neonatologist, pediatrician and family practitioner must be aware of these changes in order to organize and facilitate appropriate care.

The presence of fever in the neonatal period demands urgent evaluation from healthcare providers since signs and symptoms of a serious bacterial infection in this age group can be nonspecific. Current practice guidelines recommend that febrile neonates should be presumed to have a serious bacterial infection and undergo a sepsis evaluation and hospitalization until the results of diagnostic testing are known. However, less than 50% of outpatient practitioners in a recent study followed these recommendations without apparent adverse outcomes even though the rate of serious bacterial infections in the neonatal period is higher than febrile infants 1-3 months of age. In this article we examine various clinical scenarios that healthcare providers confront when caring for febrile neonates, including whether febrile neonates with respiratory syncytial virus are at increased risk for developing a serious bacterial infection and whether diagnostic testing and empiric antiviral therapy for herpes simplex virus should be part of the standard evaluation of febrile neonates. Although the discovery of inflammatory mediators that are elevated during the early stages of infection has the potential to improve diagnostic capabilities in this age group, there is enough evidence to support international guidelines recommending hospitalization and sepsis evaluations in febrile neonates.

The origin of probiotics and the use of fermented foods and cultured milk products are quite ancient. However, it was not until the turn of the 20th century that Metchnikoff made intelligent observations that human longevity and health are associated with the consumption of lactic acid bacteria. Since those observations have been made a plethora of probiotic studies in adults and children have been performed. The purpose of this review is to describe the history of probiotics, discuss the current evidence supporting the use of probiotics in a variety of gastrointestinal and non-intestinal conditions, as well as, to focus our attention on where probiotics will be heading in the future with potential new innovations and concepts.

Severe Gastro-oesophageal reflux disease (GORD) is a disabling condition, causing significant morbidity and mortality. Fundoplication has long been seen as the gold standard operative solution, but in 5-43% of patients it will fail. Oesophagogastric disconnection or dissociation (OGD) is a relatively new procedure used for severe GORD. With this review we look at the current literature on the indications and outcomes after oesophagogastric disconnection; focusing on which patients are undergoing OGD and whether it is being performed as a primary or secondary operation. Articles were found using Scirus and Pubmed as search engines, with (o)esophagogastric disconnection/ dissociation/ separation (OGD) as keywords. Ten relevant papers were found; from Bianchi's original paper in 1997, to the most recent and largest two-centre study published in 2006. In total the papers include 158 patients undergoing OGD. Two of the papers set out to compare fundoplication vs OGD; two set out to compare the procedure as a primary vs secondary operation; the remaining 6 give information on their outcomes after OGD. All ten papers show how OGD is beneficial to patients severely affected by GORD. The results suggest that the morbidity and mortality, length of stay and post operative recovery of the operation is not significantly worse than for fundoplication. In those with severe neurological impairment and significant co-morbidities the outcome after OGD can be better than after fundoplication. The majority of the authors would consider OGD as a primary operation in severely neurologically impaired children, but realise that it has its risks and limitations.

Obesity has become a major public health concern in this century. Yet, the widespread popularisation in managing overweight and obesity indicates that the problem of body weight maintenance has developed from an only medical into an interdisciplinary and already political problem. Current ideas about lifestyle and strategies to maintain health and weight have become dominated by increasingly popular beliefs that contrast scientific evidence. Particularly the relationship between physical activity, energy intake and body mass index (BMI) explains markedly less of the within-population variance of the BMI than commonly assumed. Instead, it has been noted that protein consumption significantly correlates with BMI explaining up to 13% of the BMI variance in young adolescents. Increasing evidence suggests that nutritional protein can stimulate food intake. Serum levels of most amino acids increase following a protein rich meal. Regions of the brain that are involved in the regulation of appetite accumulate glutamate and other small molecules. Free glutamate can be toxic for some of the essential neuronal structures of hypothalamic appetite regulation, may impair satiety and result in voracity. Protein toxicity in humans occurs at amounts beyond an intake of 200 g/d. Protein intake needs supplementation either by carbohydrate or fat in order to reduce its contribution to total energy intake to less than 40%, and the protein content of many popular high-protein weight loss diets must for the same reasons be regarded with great caution, and should particularly be avoided during pregnancy and childhood.

Nocturnal enuresis (NE) is a very common clinical disorder. According to DSM-IV, NE is defined as repeated voiding, accidental or on purpose, into clothing or into the bed, at least twice a week, for 3 consecutive months, in children older than 5 years, age in which the sfincterial control is acquired. The pathophysiology of NE is not fully understood. It has been suggested that NE is the result of a combination of osmoregulatory or urodynamic disturbances, disorders of arousal and genetic factors. The evaluation of a child with minctional disorders begins with a good history and a physical examination. Then laboratory analysis and instrumental investigations can be used. There are pharmacological and non-pharmacological treatments for NE. The role of drugs is a short-term possibility that allows the child to recover confidence, or a temporary measure to tide him/her over nights spent away from home. For too long, NE has not been recognised as a severe condition, because there was no specific education at medical school and a poor involvement by the practitioners.

Reduced sleep duration has been implicated in a range of negative and consequential physiological and psychological daytime problems. Detection strategies such as polysomnography, actigraphy, and subjective reports have been utilised to assess paediatric sleep patterns such as sleep duration, and problems in both clinical and non-clinical samples. Although objective assessments have more validity in assessing and diagnosing sleep disorders, subjective sleep reports are commonly used for screening sleep patterns and disturbance in large scale community studies. In the past few years several studies have studies explored the accuracy of subjective measures in estimation of sleep duration by comparing them with objective measures. This review examined and evaluated the paediatric literature dating from 1992 comparing subjective sleep measures (sleep diaries and/or questionnaires) to objective measures (PSG and/or actigraphy) of sleep duration. These studies suggest subjective sleep reports are valid for screening, but are less consistent in estimating sleep pattern variables such as sleep duration, night wakings, and sleep onset latency. Understanding the congruence between subjective and objective measures in large studies may advance understanding of the validity of subjective sleep measures, an important factor given the integral role of self-report in large scale community research and the negative daytime sequelae associated with reduced sleep.