Pediatrics

Postcardiac surgery neurodevelopmental evaluation in children with congenital heart disease Moustafa M Abdel Raheem, Naji Y Safieldeen Alexandria Journal of Pediatrics 2018 31(3):91-96 Background Congenital heart disease (CHD) is one of the most common congenital anomalies. It may carry risk of neurodevelopment (ND) delay. Open heart surgery has been widely introduced to those patients. The outcome of this surgery on patient’s development is unclear. Objective The aim was to evaluate ND outcomes in children with CHD who underwent open heart surgery. Patients and methods Fifty children with CHD were enrolled in this study: 23 were surgically repaired (group 1) and 27 had no surgical intervention (group 2). Twenty normal children of matched age and sex were enrolled in the study as controls (group 3). Bayley-III test was used to compare the ND parameters in all groups. Results ND aspects showed lower significant differences in groups 1 and 2 when matched with the control group (P<0.05). However, there were no significant differences in ND parameters between groups 1 and 2 in gross motor and receptive communication parameters (P>0.05). Conclusion CHD carries the risk of ND delay, and exposure to open heart surgery increases this risk.

Quantitative electroencephalographic changes in children with autism spectrum disorders Hanan G Azouz, Mona Khalil, Samia H Abdeldayem Alexandria Journal of Pediatrics 2018 31(3):97-105 Background Autism spectrum disorders (ASD) are a group of neurodevelopmental disorders characterized by impairment of social interaction, communication, and behavior. It has been recently suggested that ASD are characterized by abnormal brain networks and connectivity, which was studied using neuroimaging modalities. Objective The aim of this study is to assess the quantitative electroencephalographic (QEEG) findings in children with ASD compared with age-matched children and to assess if QEEG analysis is a sensitive and simple method to aid in the diagnosis of ASD in children. Patients and methods QEEG recordings of 50 children with ASD between the ages of 2 and 6 years were compared with those of 50 age-matched controls under eyes-closed condition. Brain functioning and its connectivity were examined using measurements of spectral analysis of both absolute and relative power and interhemispheric coherence. Results There were statistically significant differences in electroencephalogram spectral power and coherence between the study and control groups. It revealed an increased absolute delta power in the frontal, anterior temporal, midtemporal, central, and parietal regions and an increase of absolute alpha power mainly in the prefrontal and frontal regions. There was a greater beta power in midtemporal and posterior temporal regions. In addition, interhemispheric coherence showed a pattern of frontal overconnectivity and temporal underconnectivity with the other brain areas in children with ASD in comparison with the control group. Moreover, statistical differences in electroencephalogram spectral power and coherence between the different grades of children with ASD were noticed. Conclusion These results suggested that children with ASD have QEEG dysfunctions that underlie their symptomatology. Hence, QEEG provides a useful method that aids in the diagnosis of children with ASD.

Bedside ultrasonographic evaluation of the degree of dehydration in infants and children with acute gastroenteritis Marwa S Barakat, Hanan A El-Halaby, Hoda F Al-Domiatty Alexandria Journal of Pediatrics 2018 31(3):106-111 Background Dehydration is one of the most common problems facing pediatricians; efforts were made to detect its degree accurately. Aims Evaluate the accuracy of inferior vena cava collapsibility index (IVCCI) and IVC/aortic (IVC/Ao) ratio for the detection of dehydration degree in infants and children with acute gastroenteritis. Settings and design A cross-sectional descriptive study performed in Mansoura University Children’s Hospital from April 2014 till December 2016. Patients and methods The degree of dehydration was assessed clinically via clinical dehydration scale and by portable ultrasonography. Measurements of IVC diameters and IVC/Ao ratio were performed. IRB approved the study. Statistical analysis used Mann–Whitney test were used to compare nonparametric data. Sensitivity and specificity were tested by receiver operating characteristic curves. Results Eighty-one children, aged from 1 month to 3 years, were enrolled in this study; 41 presented with some dehydration and 40 with moderate/severe dehydration, classified according to the clinical dehydration scale. There was a statistically significant positive correlation between dehydration degree and IVCCI and IVC/Ao ratio (r=0.67 and 0.54, respectively, P=0.001 each). When plotting the receiver operating characteristic curve for IVCCI, area under the curve was 0.81, using a cutoff value of 73%, the sensitivity and specificity, for the detection of dehydration degree, were 90 and 71%, respectively, while for IVC/Ao ratio, the area under the curve was 0.78, with a cutoff value of 0.8, the sensitivity and specificity were 90 and 64%, respectively. Conclusions Measurements of IVCCI and IVC/Ao ratio aid in the detection of the degree of dehydration in infants and children with high sensitivity and moderate specificity.

Prognostic factors for the outcome of Kasai portoenterostomy for infants with biliary atresia in Egypt Sammeh M Shehata, Saber M Waheeb, Maher O Osman, Aml A.A Mahfouz, Ahmed E Elrouby Alexandria Journal of Pediatrics 2018 31(3):112-119 Background Biliary atresia (BA) is the most common surgically correctable liver disorder in the pediatric age group. If untreated, progressive liver cirrhosis leads to death by the age of 2 years. Aim The aim was to study the outcome of Kasai portoenterostomy for infants with BA in Egypt and identify some prognostic factors of this outcome. Patients and methods A prospective clinical and laboratory study including 20 patients with BA who underwent Kasai operation was conducted. A detailed history taking, clinical examination, liver function tests, ultrasound of the abdomen, preoperative liver biopsy, and intraoperative cholangiography were done for all patients. Patients were followed up for a period of 6 months postoperatively. The schedule and indications for liver transplantation were also evaluated. Results Overall, 55% of operated infants showed gradual reduction of serum bilirubin, which reached a level less than 2 mg/dl, as well as reduction of liver enzymes. On the contrary, the remaining 45% of infants failed to show satisfactory reduction of serum bilirubin, which continued to be greater than 2 mg/dl as well as liver enzymes. Both groups showed statistically significant differences regarding age at operation, presence of preoperative ascites, liver size, and patients’ Child–Pugh score. Moreover, preoperative total serum bilirubin and its direct fraction, liver enzymes, and cholestatic enzymes were significantly higher among infants with a bad outcome. There were no mortalities within the 6-month follow-up period. Conclusion Kasai portoenterostomy showed better results with short-term follow-up if done at an early age. Certain preoperative clinical, laboratory, radiological, and pathological factors might predict the outcome of Kasai operation.

Study of functional constipation among children attending the Gastroenterology Clinic at Alexandria University Children's Hospital Ahmed F Khalil, Mohamed Alkot Alexandria Journal of Pediatrics 2018 31(3):120-127 Background Functional constipation is a common health problem in the pediatric age group. Delayed management leads to a significant childhood morbidity. Aim The purpose of this study is to evaluate the prevalence, precipitating factors, and clinical characteristics and management of children with functional constipation in our community. Patients and methods This work was performed as a prospective study that included all children aged 1–15 years with functional constipation who presented to the Pediatric Gastroenterology Clinic at Alexandria University Children’s Hospital between August 2015 and January 2016. Demographic data, precipitating factors, clinical characteristics, and prereferral management were recorded. All patients were treated and followed up for at least 4 months. Results During the study period, 86 patients were enrolled. They constituted the most important cause for referral to the Gastroenterology Clinic during the study period. Most of the patients were living in low to middle socioeconomic status and were belonging to mothers of low to intermediate level of education. Low-fiber diet, diminished fluid intake, and urge postponing when present at public places were the commonest risk factors for developing constipation. Family history of constipation was positive in 32.6% of patients. The mean duration of complaints before presentation to our clinic was 19.22±22 months. Chronic abdominal pain was the most common presenting symptom (77.9%). Only 28% of the parents were aware that their children are constipated. The passage of hard painful stools was the most common character of stool in the studied group (98.8 and 95.3%) followed by infrequent evacuations (<4/week) in 85% of patients. Of the patients, 24.4% had fecal soiling. Urinary symptoms were present in 39.5%. Abdominal distention and palpable fecal mass were found in 83.7 and 67.5%, respectively. Only one-third of the patients were correctly diagnosed as having chronic constipation. None of the studied children were previously treated properly according to the accepted guidelines for functional constipation. Our cases were referred very late when they develop debilitating abdominal pain due to massive stool impaction or present with stool incontinence. Oral disimpaction was successful even in severely constipated children. All clinical symptoms and stooling characteristics were significantly improved after treatment. Conclusion Functional constipation is a very common, yet underestimated, underdiagnosed, and maltreated health problem our community.

Platelet indices as a diagnostic tool in pediatric immune thrombocytopenic purpura Maha Y Kamal, Wessam El Gendy, Ahmed Salama Alexandria Journal of Pediatrics 2018 31(3):128-131 Background Bone marrow examination is the gold-standard test in discriminating between hyperdestructive thrombocytopenia and hypoproductive thrombocytopenia. However, this procedure is invasive. Mean platelet volume (MPV) and platelet distribution width (PDW) are simple, inexpensive, and noninvasive methods that may be used in discriminating between these two types of thrombocytopenia. Aim This study investigated the significance of the platelet indices, MPV and PDW, in the diagnosis of immune thrombocytopenic purpura (ITP). Patients and methods The study population were divided into three groups: 15 patients with hyperdestructive thrombocytopenia and 15 with hypoproductive thrombocytopenia were compared with control group (15 healthy controls). The sensitivity and specificity of these platelet indices to diagnose immune thrombocytopenic purpura were also measured. Results The MPV showed a sensitivity of 93.3% and a specificity of 66.7% at a cutoff value of 7.7 fl, and the PDW showed a sensitivity of 86.7% and specificity of 73.3% at a cutoff value of 40.6%. Conclusion The study concluded that although MPV and PDW can be used as an initial hint for predicting the type of thrombocytopenia, they have limited sensitivity and specificity.

Ionized calcium, 25-hydroxyvitamin D, and parathyroid hormone in children with steroid-sensitive nephrotic syndrome Mahmoud M.E El Kersh, Ola A Sharaki, Omneya M Omar, Yasmine A.S Galal Alexandria Journal of Pediatrics 2018 31(3):132-140 Background The chief complications of nephrotic syndrome (NS) are infections and thromboembolic events. Others include hypovolemic crisis, acute renal failure, and hormonal and mineral alterations. Objective The aim was to study the level of serum ionized calcium during the active stage and after remission in steroid-sensitive nephrotic syndrome (SSNS) patients and 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH) during the active stage of the disease. Patients and methods The study was conducted on two groups. Twenty children with the first episode of SSNS were investigated and compared with 20 healthy children as a control group. Serum ionized calcium, serum 25(OH)D, PTH, phosphorus, and alkaline phosphatase were measured during the active stage of the disease and serum ionized calcium was repeated after remission. Results Children with active SSNS had low ionized calcium, low-serum 25 (OH)D levels, with high PTH and high phosphorus and low alkaline phosphatase levels compared with the control. All patients had 25(OH)D deficiency, of which, 80% were severely deficient. Both serum ionized calcium and 25(OH)D had a significant negative correlation with PTH (r=−0.655, P=0.002 and r=−0.575, P=0.008, respectively). Serum ionized calcium was negatively correlated to spot protein/creatinine ratio in urine (r=− 0.565, P=0.009). Levels of serum ionized calcium during the active stage of the disease were markedly lower than that after remission. However, both were significantly lower than the control group. Conclusion Children with SSNS are at risk of vitamin D deficiency and hypocalcemia, therefore, further research will be needed to prove the need for vitamin D supplementation to prevent the occurrence of possible complications.

Diagnostic and prognostic values of soluble CD14 (presepsin) in sepsis in pediatric intensive-care patients Mai M Ghazy, Hanan A El-Halaby, Amr M El-Sabbagh, Ali A Shaltout Alexandria Journal of Pediatrics 2018 31(3):141-147 Background Early recognition and management of sepsis is a challenge facing intensivists. Many biomarkers were investigated but none is optimal. Aim Appraise the value of presepsin as a biomarker for the diagnosis, differentiation of severity, and prognosis of sepsis. Settings and design A prospective diagnostic test accuracy study performed in Mansoura University Children’s Hospital from April 2016 to April 2017. Patients and methods Plasma presepsin was estimated in 30 patients with sepsis on the first and third days from sepsis diagnosis (group A). Pediatric sequential organ failure assessment score, white blood cells count, and C-reactive protein were assessed on the same timing. Group B patients, 30 healthy patients, were assessed for presepsin level. IRB approved the study. Statistical analysis Independent sample t-test was performed to compare parametric data. Receiver operating characteristic curves were used to detect threshold values. Results A significantly higher presepsin level in the sepsis group (983 ng/l) compared with the healthy group (300 ng/l, P=0.001) was detected. A statistically significant higher serum presepsin level on day 3 was noticed in patients with severe sepsis opposed to sepsis and in nonsurvivors versus survivors (P=0.041 and 0.012, respectively). Receiver operating characteristic curve for plasma presepsin level on day 3 for the prediction of 30-days mortality was designed. Sensitivity and specificity were 86 and 73%, respectively, for a threshold point of 1300 ng/l [area under the curve (AUC)=0.820, P=0.001]. Conclusion Presepsin is a diagnostic marker for sepsis, a good discriminator of sepsis severity, and a sensitive predictor of 30-day mortality, but it should not be alone but in combination with other biomarkers.