Τριμηνιαία
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Α. Παπαδοπούλου
Β. Παπαευαγγέλου
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Volume 76 • Number 4 • October-November-December 2013
Trimonthly publication of the Greek Paediatric Society
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A. Constantopoulos
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Director
G. S. Varlamis
Members
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E. Galanakis
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P. Panagiotopoulou-Gartagani
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Instructions to authors: http://e-child.gr/publications/ instructions-to-authors
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Greek Paediatric Society
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e-mail: grammateia@e-child.gr
Annual subscription
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EDITORIAL
G.S. Varlamis
REVIEW ARTICLES
Clinical approach of the floppy neonate
Tania Siahanidou
The role of breastfeeding in allergy prevention Evangelia Stefanaki, Vassiliki Aggelakou
Cognitive and executive profile in children with neurofibromatosis type 1 Efrosini Kalyva, Efthimia Variami, Maria Kyriazi, and Dimitrios I Zafeiriou
Childhood headache and the influence of modern socioeconomic crisis. The teacher’s perspective.
Annika Giata, Anastasia Bougea, Fotini Cristidi, Evangelia Kararizou
Asthma and obesity: A case of significant co-morbidity or overdiagnosis?
Nikolaos Karampatakis, Katerina Haidopoulou
REVIEW ARTICLES
Ten Year Obesity and Overweight Prevalence in Greek children: systematic review and meta-analysis
Eleni P.Kotanidou, Maria G.Grammatikopoulou, Bessie E. Spiliotis, Christina Kanaka-Gantenbein, Maria Tsigga, Assimina Galli-Tsinopoulou
Factors associated with complications on neonatal transport το νeonatal care units in Αttica
Stella Mouskou, Georgios Antonogeorgos, Christos Varakis, Chryssa
Τzoumaka-Bakoula, Tania Siahanidou
Bone pain or osseous radiographic findings on diagnosis as prognostic factors for children with ALL
CASE REPORTS
Congenital toxoplasmosis in dichorionic twin pregnancy. A case report and brief review
Foteini-Maria Chantzi, Vana Spoulou, Afroditi Saka, Dimitris Konstadinou, Maria Theodoridou
Τριμηνιαία
Πρόεδρος
Α. Κωνσταντόπουλος
Συντακτική
Π. Παναγιωτοπούλου-Γαρταγάνη
Α. Παπαδοπούλου
Β. Παπαευαγγέλου
Α. Παπαθανασίου
Α. Σιαμοπούλου-Μαυρίδου
Α. Συρίγου-Παπαβασιλείου
Υποβολή εργασιών e-mail: grammateia@e-child.gr
Οδηγίες προς τους συγγραφείς: http://e-child.gr/publications/ instructions-to-authors
Iδιοκτήτης
Eλληνική Παιδιατρική Eταιρεία Μπακοπούλου 15,15451, Ν. Ψυχικό
Tηλ.: 2107771140 e-mail: grammateia@e-child.gr
Eτήσια συνδρομή: €40
Eιδικευόμενοι, φοιτητές: €20
Trimonthly publication of the Greek Paediatric Society
President
A. Constantopoulos
Editorial board
Director
G. S. Varlamis
Members
S. Andronikou
E. Galanakis
A. Evangeliou
L. Thomaidou
M. Kanariou
A. Kapogiannis
S. Kitsiou-Tzeli
E. Mantadakis
P. Panagiotopoulou-Gartagani
A. Papadopoulou
V. Papaevagelou
A. Papathanassiou
A. Siamopoulou-Mavridou
A. Syrigou-Papavasiliou
Manuscript submission
e-mail: grammateia@e-child.gr
Instructions to authors: http://e-child.gr/publications/ instructions-to-authors
Owner
Greek Paediatric Society
15, Mpakopoulou st.
GR - 15451, Ν. Psychiko
Tel.: +302107771140
e-mail: grammateia@e-child.gr
Annual subscription
All foreign countries: US$50
Atypical clinical manifestation of H1N1 virus infection
www.ped-congress.gr
Tania Siahanidou. Clinical approach of the floppy neonate.
Evangelia Stefanaki, Vassiliki Aggelakou. The role of breastfeeding in allergy prevention
Efrosini Kalyva, Efthimia Variami, Maria Kyriazi, and Dimitrios I Zafeiriou. Cognitive and executive profile in children with neurofibromatosis type 1
Annika Giata, Anastasia Bougea, Fotini Christidi, Evangelia Kararizou. Childhood headache and the influence of modern socioeconomic crisis. The teacher’s perspective.
Karampatakis Nikolaos, Katerina Haidopoulou. Asthma and obesity: A case of significant co-morbidity or overdiagnosis?
Eleni P.Kotanidou, Maria G.Grammatikopoulou, Bessie E. Spiliotis, Christina KanakaGantenbein, Maria Tsigga, Assimina Galli-Tsinopoulou Ten Year Obesity and Overweight Prevalence in Greek children: systematic review and meta-analysis
Stella Mouskou, Georgios Antonogeorgos, Christos Varakis, Chryssa Τzoumaka-Bakoula, Tania Siahanidou. Factors associated with complications on neonatal transport
natal care units in attica
Baka Margarita, Doganis Dimitrios, Pourtsidis Apostolos, Mpouxoutsou Despina, Varvoutsi Mary, Zampakidis Christos, Mavromatis Emmanouil, Kosmidi Eleni. Bone pain or osseous radiographic findings on diagnosis as prognostic factors for children with ALL
Foteini-Maria Chantzi, Vana Spoulou, Afroditi Saka, Dimitris Konstadinou, Maria Theodoridou. Congenital toxoplasmosis in dichorionic twin pregnancy. A case report and brief review
Alexandra Tsialla, Zoi Mpeka, Lida Sianidou, Martha Charisi. An atypical clinical manifestation of the virus of gripe H1N1
Τάνια
Tania Siahanidou
Neonatal Department, 1st Pediatric Department of University of Athens
Tania Siahanidou
Flopiness in neonates is caused by lesions or disorders that affect any level of the nervous system from the brain to spinal cord, peripheral nerves, neuromuscular junction and muscle. The distinction of hypotonia into central and peripheral type is very useful for the determination of the level of damage and differential diagnosis. The history and physical examination of the neonate lead to the diagnosis in 40%-50% of cases. In recent years, advances in diagnostic precedures (neuroimaging, metabolic screen, molecular genetics/cytogenetics) provide the possibility to recognize the cause of hypotonia in a relatively short time period and it is expected that they will lead, in the near future, to the diagnosis of those causes of congenital hypotonia that remain obscure up to date. The present review focuses on the clinical approach of the floppy neonate by the practicing paediatrician/neonatologist. An algorithm for the diagnosis of the cause of hypotonia is suggested.
Keywords: hypotonia, neonate, causes, diagnosis
Αλληλογραφία
Τάνια
11527
Τηλ: 2132013-889, -517, 6944976085
Fax : 2107759167
e-mail: siahan@med.uoa.gr
Correspondence
Tania Siahanidou
Thivon and Levadias, 11527, Athens
Tel: +30 2132013-889, -517, 6944976085
Fax : 2107759167
e-mail: siahan@med.uoa.gr
21, 18, 13),
(Prader-Willi, Smith-LemliOpitz, Angelman, Sotos, Coffin-Lowry, Williams, 1p36 del syndrome, DiGeorge, Kabuki, Smith-Magenis, Wolf-Hirschhorn,
αισθητικοκινητικές νευροπάθειες π.χ. Charco-Marie-Tooth 1A, 1B, 2B, 4A, X (συνήθως εκδηλώνονται
αλλαντίαση
Ποικίλη έναρξη και βαρύτητα, αναπνευστικά προβλήματα συχνά και δυνητικά εξελισσόμενα
Ποικίλη έναρξη και βαρύτητα, μπορεί να βελτιωθεί με αναστολείς ακετυλοχολινεστεράσης (AchE)
Ενωρίς έναρξη με υποτονία, αναπνευστική ανεπάρκεια, άπνοια, αρθρογρύπωση. Ήπιες ή σοβαρές εκδηλώσεις
Ενωρίς αναπνευστική ανεπάρκεια, επεισόδια άπνοιας, δυσκολία στη σίτιση,
Fukuyama Σύνδρομο Walker-Warburg
MRI εγκεφάλου
Διάχυτη βλάβη λευκής ουσίας (εικόνα λευκοδυστροφίας), ± δυσπλασία φλοιού, ± υποπλασία παρεγκεφαλίδας
Φυσιολογική ή βλάβη λευκής ουσίας, δομικές διαταραχές εγκεφάλου, υποπλασία παρεγκεφαλίδας ή κύστεις παρεγκεφαλίδας
Φυσιολογική
Πολυμικρογυρία, παχυγυρία, συμμετοχή παρεγκεφαλίδας, παθολογικό σήμα στη λευκή
Λυσεγκεφαλία, υδροκέφαλος (Dandy-Walker), υποπλασία στελέχους/παρεγκεφαλίδας
Παχυγυρία και πολυμικρογυρία,
Νόσος Ullrich
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2. Leyenaar J, Camfield P, Camfield C. A schematic approach to hypotonia in infancy. Paediatr Child Health 2005;10:397-400
3. Peredo DE, Hannibal MC. The floppy infant: evaluation of hypotonia. Pediatr Rev 2009;30:e66-76
4. Prasad AN, Prasad C. The floppy infant: contribution of genetic and metabolic disorders. Brain & Development 2003;27:457-476
5. Prasad AN, Prasad C. Genetic evaluation of the floppy infant. Semin Fetal Neonatal Med 2011;16:99-108
6. Tulinius M, Oldfors A. Neonatal muscular manifestations in mitochondrial disorders. Semin Fetal Neonatal Med 2011;16:229-235
7. Staretz-Chacham O, Lang TC, LaMarca ME, Krasnewich D, Sidransky E. Lysosomal storage disorders in the newborn. Pediatrics 2009;123:1191-1207
8.
2007;19:75-78
9. Brown RH, Grant PE, Pierson CR. Case 35-2006: A newborn boy with hypotonia. N Engl J Med 2006;355:2132-2142
10. Laugel V, Cossee M, Matis J, de Saint-Marin A, Echaniz-Laguna A, Mandel JL, Astruc D, Fischbach M, Messer J. Diagnostic approach to neonatal hypotonia: retrospective study on 144 neonates. Eur J Pediatr 2008;167:517-523
11. Birdi K, Prasad AN, Prasad C, Chodirker B, Chudley AE. The floppy infant: retrospective analysis of clinical experience (1990-2000) in a tertiary care facility. J Child Neurol 2005;20:803-808
12. Goldstone AP, Holland AJ, Hauffa BP, Hokken-Koelega AC, Tauber M. Recommendations for the diagnosis and management of Prader-Willi syndrome. J Clin Endocrinol Metab 2008;93:4183-4197
13. Gunay-Aygun M, Schwartz S, Heeger S, O’Riordan MA, Cassidy SB. The changing purpose of Prader-Willi syndrome clinical diagnostic criteria and proposed revised criteria. Pediatrics 2001;108:e92
14. Harris SR. Congemital hypotonia: clinical and developmental assessment. Developmental Medicine & Child Neurology 2008;50:889-892
15. Vasta I, Kinali M, Messina S, Guzzetta A, Kapellou O, Manzur A, et al. Can clinical signs identify newborns with neuromuscular disorders? J Pediatr 2005;146:73-79
16. Milone M, Shen XM, Selcen D, Ohno K, Brengman J, Iannaccone ST, et al. Myasthenic syndrome due to defects in rapsyn. Neurology 2009;73:228-235
17. Engel AG, Shen XM, Selcen D, Sine SM. What have we learned from the congenital myasthenic syndromes. J Mol Neurosci 2010;40:143-153
18. Richer LP, Shevell MI, Miller SP. Diagnostic profile of neonatal hypotonia: an 11year study. Pediatr Neurol 2001;25:32-37
Abstract
Evangelia Stefanaki
Vassiliki Aggelakou
Paediatric Allergy Outpatients Clinic, Venizeleion General Hospital, Heraklion
Evangelia Stefanaki, Vassiliki Aggelakou
Although breastfeeding is considered the gold standard for infant feeding the impact of breastfeeding on the allergic disease risk is controversial. This article reviews the current evidence for the role of breastfeeding in the prevention of allergic disease. The most important limitation of current studies is that they are observational studies since randomized control trials in breast feeding research would be considered unethical, the most recent systemic reviews report no protective effect on eczema while there is insufficient data regarding the effects of breastfeeding on objective measures of food allergy at any age. Studies show a paradoxical effect of breastfeeding on the prevention of asthma, with an apparent protective effect against early wheezing illness in the first years of life yet an increased risk of asthma in later life; however, these findings must be interpreted with caution in relation with the protection of breastfeeding against early life respiratory illnesses. Therefore, it is possible that the effect of breastfeeding on early wheezing illness reflects protection against respiratory infection, the predominant trigger of wheezing in early childhood, rather than a true reduction in risk of asthma. In summary, there is a need for more research with improved methodology so as to clarify the role of breastfeeding in development of allergic disease.
Keywords: breastfeeding, allergy, prevention
Αλληλογραφία
Στεφανάκη Ευαγγελία
Καρυωτάκη 22, 71409 Ηράκλειο
Tηλ.: 2810210140 - 6973553754
e-mail: linastef74@gmail.com
Correspondence
Stefanaki Evangelia
Kariotaki 22, 71409 Iraklio Tel.: +30 810210140+30 6973553754
e-mail: linastef74@gmail.com
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Ευφροσύνη
College,
Sheffield,
Efrosini Kalyva
The International Faculty of the University of Sheffield, CITY College, Thessaloniki, Greece
Efthimia Variami
Maria Kyriazi
Dimitrios I Zafeiriou
Developmental Centre “Fokas”, 1st Pediatrics Clinic, Aristotle University of Thessaloniki
Efrosini Kalyva1, Efthimia Variami2, Maria Kyriazi2, and Dimitrios I Zafeiriou2
Neurofibromatosis type 1 is the most common single-gene disorder that affects the human central nervous system and causes neurological, musculoskeletal, visual and cutaneous anomalies, as well as predisposition for tumor creation. Due to the frequency of the disorder and the nature of its manifestations, studies have looked at its effects on the cognitive development of children with neurofibromatosis type 1. In this review special attention is paid to the cognitive impairments of children with neurofibromatosis type 1. Some older studies report severe mental retardation, while more recent research identifies two sub-groups with relatively low and normal intelligence quotient respectively. Special research and clinical interest is drawn upon the difficulties that children with neurofibromatosis type 1 face with their executive functioning, which is responsible for designing and executing actions – as well as adapting to the constantly changing environmental demands. Executive functioning is linked to cognitive functioning and constitutes an integral part of the
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54622 Θεσσαλονίκη
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Correspondence
Dimitrios I Zafeiriou
Εgnatia 106, 54622 Thessaloniki
Tel - Fax: +30 2310241845
Mobile: +30 6944330587
WISC-R =Wechsler Intelligence Scale for Children-Revised
educational and academic process. Impairments in cognitive functioning can lead to attention deficit hyperactivity disorder symptoms and to autism spectrum disorder symptoms in children with neurofibromatosis type 1. Based on the specific findings it is essential to provide cognitive and academic training to children with neurofibromatosis type 1 in order to deal effectively with the aforementioned difficulties.
Keywords: neurofibromatosis type 1, cognitive function, executive function, attention deficit hyperactivity disorder, autism spectrum disorders
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Αννίκα
Annika Giata¹
Faculty of Early Childhood Education, Νational and Kapodistrian University of Athens, Athens
Anastasia Bougea²
Fotini Cristidi²
Evangelia Kararizou²
1st Department of Neurology, Eginition Hospital of University of Athens, Athens
Annika Giata¹, Anastasia Bougea², Fotini Cristidi², Evangelia Kararizou²
Headache is an almost global symptom with significant personal and socioeconomic costs in adults as well in children and adolescents. Therefore, epidemiological studies are necessary to assess the extent of the problem early in childhood. The purpose of this review is to better understanding the characteristics of childhood headache, its correlation with the stressful lifestyle, the crisis of values and the position of teacher. Moreover, there are few studies on the impact of modern economic crisis on global health, but none about its association to headache in childhood.
Keywords: childhood headache, stressful lifestyle, economic crisis, teacher
Τηλ.: +302107289282
e-mail: ekarariz@med.uoa.gr
Correspondence
Evangelia Kararizou
72-74 Vas. Sofias av., 11528, Athens, Greece
Tel. +30 2107289282
Fax +30 2107216474
e-mail: ekarariz@med.uoa.gr
1. HMIΚPANIA
2. HMIΚPANIA
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Abstract
Nikolaos Karampatakis
Katerina Haidopoulou
4th Department of Paediatrics, School of Medicine, Aristotle University of Thessaloniki, Papageorgiou General Hospital
Nikolaos Karampatakis, Katerina Haidopoulou
Asthma and obesity are two of the most common chronic diseases of childhood worldwide. The parallel increase of their incidence in recent decades has led many researchers in the quest of the correlations among them, but until today the exact mechanisms linking the two diseases remain unrevealed.
Among the mechanisms possibly involved in the association of asthma and obesity have been proposed direct effects of obesity on mechanical lung function, the pro-inflammatory properties of adipose tissue, hormonal effects and the influence of sex, reduced intake of antioxidants with nutrition and changes in the immune response, leading to chronic systemic inflammation.
The general effect of obesity in children’s respiratory system is clearly seen in the case of resuscitation after elective procedures or in cases of obstructive sleep apnea syndrome. However, the exact relationship of obesity with asthma is not clear, since available up to now data on lung function and bronchial hyperresponsiveness of obese children with asthma in different studies are controversial. Also inconsistent are the data derived from studies that attempt to link obesity with asthma severity in children.
Αλληλογραφία
Νικόλαος Καραμπατάκης
Βρυούλων 1 Δ, Τ.Κ: 55132,
Καλαμαριά
Τηλ.: 6947371342
e-mail: nkarampatakis@yahoo.gr
Correspondence
Nikolaos Karampatakis
Vrioulon 1D 55132, Κalamaria, Τel.: +30 6947371342
e-mail: nkarampatakis@yahoo.gr
In conclusion, taking under consideration the up to date facts, the treatment of asthma in obese children should be scheduled following the same guidelines that apply to normal weight asthmatic children.
Keywords: Overweight, obesity, asthma, child.
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Eleni P.Kotanidou1, Maria G.Grammatikopoulou2, Bessie E. Spiliotis3, Christina Kanaka-Gantenbein4, Maria Tsigga2, Assimina Galli-Tsinopoulou1
Background: The obesity epidemic has even affected children in Western world and Greece. The aim of this study was to report the prevalence of obesity in Greek children, aged 1-12 years old and to investigate the phenomenon trend during time. Methods: A systematic review- including all studies published in English and Greek from January 2001 until December 2010 regarding the childhood obesity, using the IOTF criteria - was performed. Twenty-five out of 134 published studies were finally
Αλληλογραφία
Ασημίνα Γαλλή-Τσινοπούλου,
Περιφερειακή Οδός-Νέα
Ευκαρπία,
ΤΚ 56403, Θεσσαλονίκη
Τηλ/fax: 2310991537
e-mail: gallitsin@gmail.com galtsin@otenet.gr
Correspondence
Assimina Galli-Tsinopoulou
Περιφερειακή Οδός-Νέα
Ευκαρπία,
ΤΚ 56403, Θεσσαλονίκη
Τηλ/Φαξ: 2310991537 e-mail: gallitsin@gmail.com galtsin@otenet.gr
Eleni P.Kotanidou1
Assimina Galli-Tsinopoulou1
4th Department of Pediatrics, Faculty of Medicine, Aristotle University of Thessaloniki
Maria G.Grammatikopoulou2
Maria Tsigga2
Department of Human Nutrition and Dietetics, Alexander Technological Educational Institute of Thessaloniki
Bessie E. Spiliotis3
Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine, University of Patras
Christina Kanaka-Gantenbein4 Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics, Faculty of Medicine University of Athens
selected, including 219996 boys and 210772 girls. Random-effects meta-analytic models, sub-group meta-analysis, analysis of quality and cumulative analysis were performed. Results: Meta-analysis revealed that 10.2% (95%CI:9.8-10.7%) Greek children (1-12 years) are obese, 23.7% (95%CI:22.7-24.8%) are overweight and the combined prevalence of overweight and obesity is 34.0% (95%CI: 32.7-35.3%). Subgroup analysis by gender showed that 11% of the boys and 9.7% of the girls are obese, while 24.1% of the boys and 23.2% of the girls were overweight. The combined prevalence of excess in body weight predominated in the boys (35.0%) while in the girls the above prevalence was 32.7%. Cumulative analysis revealed an upward trend of the phenomenon (2001-2003), followed by a stabilization (20032010). Conclusions: During the decade 2000’s, 1/10 Greek children was obese and 3/10 were overweight. The adoption of policies in order to reverse the childhood obesity phenomenon is of great significance.
Keywords: obesity; overweight; children; Greece; meta-analysis
“children”, “childhood”, “obesity”, “overweight”, “weight status”, “body composition”, “Greece”, “Greek”.
Χρόνος συλλογής δείγματος
Αστικό/Επαρχιακό
≤500/501-1000/1001-2000/2001-3999/≥4000
Τοπικό/Εθνικό
Αναφέρεται (Α)/Δεν αναφέρεται(ΔΑ)
Αναφέρεται (Α)/Δεν αναφέρεται(ΔΑ)
Αναφέρεται (Α)/Δεν αναφέρεται(ΔΑ)
Αναφέρεται (Α)/Δεν αναφέρεται(ΔΑ)
≥75%/61-75%/≤60%/ΔΑ Αστικό
Αναφορά
Αναφορά
Όνομα
Έτος
Αναφορά
Όνομα
(CI 95%: 9.2%–10.3%, Q=214.9, p<0.001, I2=86.9%)
24.1% των αγοριών (CI 95%: 22.9%–25.4%, Q=846.6, p<0.001, I2=96.6%) και στο 23.2% των κοριτσιών (CI 95%: 22.1%-24.3%,Q=601.3, p<0.001, I2=95.5%).
35.0% στα αγόρια (CI 95%: 33.6%-36.6%, Q=1020.9, p<0.001, I2=97.2%)
10.7% (CI 95%: 10.2%–11.2%, Q=230.6, p<0.001, I2=94.8%)
23.8% (CI 95%: 22.4%–25.3%, Q=902.9, p<0.001, I2=98.7%) και
34.4% (CI 95%: 32.6%–36.2%, Q=953.6, p<0.001, I2=98.7%).
παχύσαρκα (CI 95%: 10.7%–11.9%, Q=147.3, p<0.001, I2=91.9%) και
23.4% υπέρβαρα (CI 95%: 21.8%–25.1%, Q=559.7, p<0.001, I2=97.9%)
(CI 95%: 9.6%–10.7%, Q=110.7, p<0.001, I2=90%)
(CI 95%: 22.3%–25.1%, Q=372.4, p<0.001, I2=97%).
33.8% (CI 95%: 32.1%–35.5%, Q=390.4, p<0.001, I2=97.2%).
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Stella Mouskou1, Georgios Antonogeorgos2, Christos Varakis3, Chryssa Τzoumaka-Bakoula4, Tania Siahanidou5
Introduction: Neonatal transport is a high risk service as it deals with a sensitive group of patients, especially premature and severely ill neonates. Purpose: Τo record and analyze complications during neonatal transport as well as
Stella Mouskou1
Pediatrician-Neonatologist, “Aghia Sophia” Children’s Hospital
Georgios Antonogeorgos2
3rd Department of Pediatrics, National and Kapodistrian University of Athens, “Attikon” Hospital
Christos Varakis3
Health Economist, PhD, National and Kapodistrian University of Athens
Chryssa Τzoumaka-Bakoula4
2nd Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, “P.& A. Kiriakou” Children’s Hospital
Tania Siahanidou5
Neonatal Unit, 1st Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, “ Aghia Sophia” Children’s Hospital
to examine whether complications during transport are associated especially with the type of transportation (air transport or ambulance) or the reference hospital (with or without Neonatal Care Unit-NCU).
Materials and methods: During 1/1/2008-31/12/ 2009 a total of 1010 neonates were transported by the Neonatal Transport Unit (NTU) of the Hellenic National Center of Emergency Care. Simple and multiple logistic regression analysis was performed to assess the aforementioned correlations.
Results: 33,9% of neonates presented with at least one complication at the time of pick-up or during their transport – hypothermia presented the most frequent (14,8%). Νeonates with birth weight <2500g and neonates from hospitals without NCU presented complications more often (p<0.001). (37,4% vs 30,3% of neonates with birth weight >2500g and 41,3% vs. 29% from hospitals without and with NCU). When air transport was used, neonates were 33% more likely to present complications, 23 times more likely to be extubated and 3,2 times more likely to require urgent intubation. Furthermore, neonates transported from hospitals with a NCU were 33% less likely to present hypoglycemia, 46% less likely to present hypothermia, 97% less likely to require an urgent intravenous line cathetirisation and 96% less likely to require urgent intubation in comparision with neonates transported from hospitals without a NCU.
Conclusion: Νeonates with birth weight <2500g, as well as neonates from hospitals which do not have a NCU or are transported via air, have a greater risk to present with complications. It is very important to identify the high risk neonates, in order to insure a safe transport without any additional burden for the infant’s health.
Keywords: neonate, transport, air transport, complications, NCU
Αλληλογραφία
Στέλλα Μούσκου
Εφέσου 15, Παπάγου
Τ.Κ. 15669, Αθήνα
Τηλ.: 6945998723
Stelli_m@yahoo.com
Correspondence
Stella Mouskou
Efessou 15, Papagou 15669, Athens
Τel.: +30 6945998723
Stelli_m@yahoo.com
Συντομογραφίες
ΦΒΓ
ΜΦΒΓ
Mann-Whitney test.
574 (56,8)
436 (43,2)
552 (54,7)
458 (45,3)
499 (49,4)
303 (30)
111(11)
97 (9,6)
218 (21,6)
792(78,4)
464(45,9)
444 (44,1)
102 (10)
250(24,8)
250(24,8)
250(24,8)
260(25,7)
558 (55,2)
218(21,5)
51(5,1)
163(16,2) 20(2)
552(54,7)
470(46,5)
205(20,3)
135(13,4)
134(13,3)
36(3,6)
33(3,3)
247(21)
2,7 95%ΔΕ:1,87-3,90)
0,37, 95%ΔΕ:0,180,75),
342(33,9)
43(8,6)
106(20,7)
43(8,6)
52(17,2)
26(23,4)
28(28,9)
26(11,9)
123(15,5)
79(13)
70(17,5)
73(13,1)
47(20,6)
6(11,8)
23(13,4)
25(10)
30(12)
32(12,8)
62(23,8)
100(21,3)
49(9,1)
107(71,8)
445(51,7)
9(6,7)
140(16)
2(6,1)
147(15)
456(91,4)
405(79,3)
456(91,4)
251(82,8)
85(76,6)
69(71,1)
192(88,1)
669(84,5)
531(87)
330(82,5)
486(86,9)
181(79,4)
45(88,2)
149(86,6)
225(90)
220(88)
218(87,2)
198(76,2)
370(78,7)
491(90,9)
42(28,2)
416(48,3)
126(93,3)
735(84)
31(93,9)
830(85)
27(5,4) 7(1,4) 27(5,4) 4(1,3) 0(0) 3(3,1) 18(8,3) 16(2) 17(2,8) 17(4,3) 7(1,3) 9(3,9) 10(19,6) 8(4,7) 8(3,2) 6(2,4) 6(2,4) 14(5,4) 24(4,4) 6(1,1) 28(6,1) 11(8,1) 23(2,6) 6(18,2) 28(2,9)
472(94,6)
504(98,6)
472(94,6)
299(98,7) 111(100) 94(96,9)
200(91,7) 776(98)
593(97,2)
383(95,8)
552(98,7)
219(96,1)
41(80,4)
164(95,3)
242(96,8)
244(97,6)
244(97,6)
246(94,6)
460(97,9)
516(95,6)
546 (98,9)
430(93,9) 124(91,9)
852(97,4) 27(81,8) 948(97,1)
45(9)
58(11,4)
45(9)
30(9,9)
10(9)
18(18,6)
25(11,5)
78(9,8)
59(9,7)
44(11)
53(9,5)
24(10,5)
6(11,8)
20(11,6)
26(10,4)
35(14)
21(8,4)
21(8,1)
55(11,7)
48(8,9)
61(11,1)
42(9,2)
18(13,3)
85(9,7)
6(18,2)
454(91)
453(88,6)
454(91)
273(90,1) 101(91)
79(81,4)
193(88,5) 714(90,2)
551(90,3) 356(89)
506(90,5)
204(89,5) 45(88,2)
152(88,4)
224(89,6) 215(86)
229(91,6) 239(91,9)
415(88,3)
492(91,1)
491(88,9)
416(90,8)
117(86,7) 790(90,3) 27(81,8)
880(90,1)
20(3,3) 23(5,8)
20(3,6) 14(6,1) 0(0) 9(5,2) 4(1,6) 14(5,6) 11(4,4) 14(5,4)
30 (6,4) 13(2,4) 28(5,1) 15(3,3) 2(1,5) 41(4,7) 0(0) 43(4,4)
97(9,9) 17(3,4) 26(5,1) 17(3,4) 2(1,8) 2(1,8) 5(5,2) 9(4,1) 34(4,3)
482(96,6)
485(94,9)
482(96,6) 109(98,2) 109(98,2) 92(94,8)
209(95,9) 758(95,7)
590(96,7) 377(94,3)
539(96,4) 214(93,9) 51(100)
163(94,8)
246(98,4)
236(94,4) 239(95,6)
246(94,6)
440(93,6)
527(97,6)
524(94,9)
443(96,7)
133(98,5)
834(95,3)
33(100)
934(95,6)
214(98,2)
791(99,9)
558(99,8) 228(100) 51(100)
168(97,7)
609(99,8) 396(99)
466(99,1)
539(99,8)
548(99,3) 457(99,8) 135(100)
870(99,4)
1(6,3) 15(1,7)
211(96,8) 783(98,9)
164(95,3)
608(99,7)
386(96,5)
455(96,8)
539(99,8)
541(98)
453(98,9)
134(99,3)
860(98,3)
10(4,6) 23(2,9)
3(0,5)
208(95,4)
769(97,1)
556(99,5)
209(91,7) 51(100)
161(93,6)
607(99,5)
370(92,5)
444 (94,5)
533(98,7) 542(98)
436(95,2) 135(100)
842(96,7)
1,330 (0,976-1,814)
0,737 (0,468-1,158)
0,960 (0,453-2,033)
4,365 (2,187-8,712)
1,186 (0,735-1,912)
1,440 (0,656-3,159)
14,785 (1,644-132,97
1,607 (0,753-3,43)
3,645(0,227-58,514)
2,886 (1,062-7,841)
0,725 (0,084-6,241)
1,330 (0,976-1,814)
0,737 (0,468-1,158)
0,960 (0,453-2,033)
4,365 (2,187-8,712)
1,186 (0,735-1,912)
1,440 (0,656-3,159)
14,785 (1,644-132,97
1,607 (0,753-3,43)
3,645(0,227-58,514)
2,886 (1,062-7,841) 0,725 (0,084-6,241)
0,582 (0,447-0,759)
1,426 (1,005-2,023)
1,800 (0,975-3,322)
1,548 (0,781-3,070)
1,154 (0,764-1,744)
1,357 (0,671-2,753)
6,152 (0,685-55,238)
16,405 (4,972-54,133)
11,026 (2,492-48,780)
3,071 (0,560-16,844)
0,513 (0,373-0,707)
0,548 (0,356-0,844)
0,775 (0,389-1,054)
0,652 (0,283-1,505)
0,725 (0,445-1,181)
0,773 (0,331-1,807)
0,109 (0,007-1,655)
0,029 (0,003-0,256)
0,037 (0,005-0,296)
0,106 (0,010-1,130)
(8%) (9).
1. Bethany L, Farris, Truog WE. Immediate Care and Transport of the Sick Newborn. The Transport Guidelines Committee of the West Virginia Perinatal Partnership. http://www.wvperinatal.org/. Manual for the Washington State Regional Perinatal Care 2010;
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7. Holt J, Fagerli I. Air transport of sick newborn infant: audit from a sparsely populated country in Norway. Acta Paediatr. 1999;88:66-71.
8. Chance GW, O’Brien MJ, Swter PR. Transportation of sick neonates, 1972:an unsatisfactory aspect of medical care. Can Med Assos J. 1973;109:847.
9. Bowman E, Doyle LW, Murton LJ, Roy RN, Kitchen WH. Increased mortality of preterm infants transferred between tertiary perinatal centres BMJ. 1988;297(6656):1098-100.
10. Barry PW, Ralston C. Adverse events occurring during interhospital transfer of the critically ill. Arch Dis Child. 1994;Jul;71((1):):8–11.
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13. Gomella TL, editor. On Call problems In Neonatology p:203-321. 5th ed. Norwalk: CT : Appleton & Lange; 2004.
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15. Stoll BJ. Hypoglycemia. The fetus and the neonatal infant. In Nelson.Textbook of Pediatrics. 18th ed. 2007:785-6.
16. Gomella TL, editor. Temperature Regulation in Neonatology p 39-43. 5th ed. Norwalk: CT: Appleton & Lange 2004.
17. Dodgin C. Web 0800 Use of neonatal stabilization score on neonatal transport [Abstract]. Journal of Air Medical Transport. 1989;8:53.
18. Meberg A, Hansen T. Neonatal transports—risks and opportunities. . Open Journal of Pediatrics, [Internet]. 2011;1(4):45-50 Webpage:http://www.scrip.org/journal/ojped.
19. Kempley ST, Baki, Y, Hayter, G, Ratnavel, N, Cavazzoni, E, Reyes, T. Effect of a centrilised transfer service on characteristics of inter-hospital neonatal transfers. Arch Dis Child Fetal Neonatal. 2007;92:185-8.
20. Cusack J, Field D, Manktelow B. Impact of service changes on neonatal transfer patterns over 10 years. Arch Dis Child Fetal Neonatal. 2007;2007(92):181-4.
21. Παιδιατρική, Εταιρεία, Βορείου, Ελλάδος. 4ο
Νεογνού-Βρέφους-Παιδιού (Πρακτικά) Νοεμβριος 2002, Θεσσαλονίκη.
22. Θεοδωράκη Μ,
2008 [Abstract].
2009;4:44.
24. Gill AB, Bottomley L, Chatfield S, Wood C. Perinatal transport : problems in neonatal intensive care capacity. Arch Dis Child Fetal Neonatal. 2004;89:220-3.
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28. Hellstrom-Westas L, Hanséus, K.,Jogi, P ,Lundstrom, N.R., Svenningsen N. Longdistance transports of newborn infants with congenital heart disease. Pediatric Cardiology. 2001;22:380-4.
29. Hatherill M, Waggie Z, Reynolds L, Argent A. Transport of critically ill children in
a resource-limited setting. Intensive Care Med. 2003;29:1547-54.
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Bone pain or osseous radiographic findings on diagnosis as prognostic factors for children with ALL
Abstract
The charts of 253 patients with Acute Lymphoblastic Leukemia (ALL) diagnosed from 11/92 to 12/05 and treated as per the BFM90/95, were reviewed. Clinical, laboratory findings and outcome were compared between children with bone pain and/οr radiographic bone findings and those without these findings. From the 253 children, 79 had bone pain at the time of diagnosis and 15 of them had bone radiographic findings as well. Children with bone pain at diagnosis were from 7 months to 14 years old (boys:36, girls:43) and the duration of symptoms was from 2 to 180 days (median 20 days). Of these 79 children 4 had T cell ALL, in 13 bone marrow on day 15 was M2 or M3 and 67/79 are alive. Children with bone pain at diagnosis and bone radiographic findings were from 2 to 136/12 years old, 10 were boys and 5 were girls and the duration of symptoms was from 17 to 180 days (median 50 days). Of these 15 children, one had T cell ALL, in 3 bone marrow was M2 or M3 on day 15 and 14 are alive. Statistical evaluation showed a) children with ALL and bone pain on diagnosis are predominantly girls b) in children with ALL and bone pain at diagnosis compared to those without bone pain duration of symptoms is longer (p=0.001), they have lower number of blasts on diagnosis (p=0.028), smaller blast percentage (p=0.033), lower LDH values (p=0.016) c) in children with ALL and imaging findings compared to those with bone pain but without imaging findings, duration of symptoms is longer (p=0.000), they have lower WBC count on diagnosis (p=0.016), smaller blast percentage (p=0.001) and absolute number of blasts (p=0.002) and higher platelet count on diagnosis (p=0.000), lower LDH values (p=0.007) d) the presence of osseous radiographic findings and / or bone pain does not influence the prognosis (p=ns). Conclusions: Children with bone pain at diagnosis are predominantly girls. In children with bone pain at diagnosis compared to those without pain, duration of symptoms is longer, LDH and percentage of blasts are lower and platelet count is higher. In children with bone pain and bone imaging findings compared to those without imaging findings duration of symptoms is longer, WBC count, LDH and percentage of blasts are lower and platelet count is higher. However, overall prognosis is not influenced by the above described imaging findings or the presence of bone pain.
Keywords: BONE PAIN, OSSEOUS RADIOGRAPHIC FINDINGS, CHILDREN, ALL
Αλληλογραφία
Δογάνης Δημήτριος Καπετάν Πετρούτσου 12, ΤΚ 11523
Τηλ.: 6972427616
e-mail: doganisd@gmail.com
Correspondence
Δογάνης Δημήτριος Καπετάν Πετρούτσου 12, ΤΚ 11523
Τηλ.: 6972427616
e-mail: doganisd@gmail.com
4 ETH 2/12 (7/12 - 14) AΓΟΡΙΑ 36 (46%)
43 (54%) 20 (2-180)
ΛΕΥΚΑ (x 109/L)
ΒΛΑΣΤΕΣ (x 109/L)
Ηb (gr/dl)
PLT (x 109/L)
LDH (U/L)
(174-12620)
4 ETH 3/12 (11/12 - 14 4/12) AΓΟΡΙΑ 108 (62%)
66 (38%) 10 (1-168) 19.2 (1.1-580) 8.365 (0-552.9) 52% (0-98%) 8.3 (3.3-14.8) 68000 (1000-491000)
(296-10000)
(15)
4 ETH 5/12 (2 – 13 6/12)
AΓΟΡΙΑ 10 (67%) ΚΟΡΙΤΣΙΑ 5 (33%)
50 (17-180) 4.9 (2.8-43.5) 0.196 (0-34.8) 4%
3 ETH 8/12 (7/12 - 14)
AΓΟΡΙΑ 26 (41%)
ΚΟΡΙΤΣΙΑ 38 (59%)
(0-144)
(0-100%)
(2.8-14)
(5-409)
<100
100-500
500-1000
>1000
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Abstract
Foteini-Maria Chantzi1
Vana Spoulou1
Afroditi Saka1
Maria Theodoridou1
First Department of Pediatrics, Aghia Sofia Children’s Hospital, University of Athens, Greece
Dimitris Konstadinou2
Neonatal Intensive Care Unit, IASO Maternity Hospital, Athens, Greece
Congenital toxoplasmosis in dichorionic twin pregnancy. A case report and brief review.
Foteini-Maria Chantzi1, Vana Spoulou1, Afroditi Saka1, Dimitris Konstadinou2, Maria Theodoridou1
We report a case of primary infection by Toxoplasma gondii during dizygotic twin pregnancy. While the first neonate presented with severe CNS and ophthalmologic involvement, the second twin was free of disease. This case points out the possibility of different clinical presentation among twins after infection with the parasite during pregnancy, illustrates the clinical progression after the suggested management and gives the opportunity to express relative concerns regarding the prenatal and perinatal diagnosis and management.
Keywords: Toxoplasma gondii, neonate, twin pregnancy, hydrocephalous
fchantzi@yahoo.co.uk
Correspondence
Foteini-Maria Chantzi
Santorinis 24, Vari, Attiki Tel: +30 6974839090 e-mail: fchantzi@yahoo.co.uk
Συντομογραφίες
ΚΝΣ = Κεντρικό νευρικό
MRI = Μαγνητική τομογραφία
PCR
(θετικό >0,6 IU/ml)
IgG (θετικό>10 IU/ml)
Γενική Αίματος Ηb (g/dl)
Hct (%)
Γενική
Hb (g/dl)
Hct (%)
WBC (ανά μL)
Poly (%)
Lym (%)
PLT (ανά μL)
Βιοχημικός
Ur (mg/dl)
Cr (mg/dl)
Κ (mmol/L)
Na (mmol/L)
Cl (mmol/L)
γGT (U/L) ALP (U/L)
Ca (mg/dl)
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Αλεξάνδρα
Abstract
Alexandra Tsialla1
Zoi Mpeka1
Lida Sianidou1
PICU Penteli’s Children Hospital, Athens
Martha Charisi2
First Paediatric Department Penteli’s Children Hospital, Athens
Alexandra
Tsialla1
, Martha Charisi2 , Zoi Mpeka1 , Lida Sianidou1
H1N1 influenza virus ιinfection is the main cause of hospitalization mainly because it causes breathing difficulty. Rare clinical signs of H1N1 virus are leukopenia, thrombocytopenia, and shock. We describe the case of a boy of 5,5 years old with neurological problem with H1N1 infection and clinical picture of SIRS without breathing impairment. Discuss the clinical picture, laboratory findings, treatment with a review of a relevant literature.
Keywords: H1N1 influenza virus infection, leukopenia, thrombocytopenia, SIRS.
15236,
e-mail: alexandra_tsialla@yahoo. gr
Correspondence
Alexandra Tsialla 15236, Palaia Pentelie-mail: alexandra_tsialla@yahoo.gr
2.080Κ/μL
748,
Ραβδοπύρηνα/10% ΜΜ/6%), Hb: 11,3 gr/dl, Hct: 33,1%, Αιμοπετάλια: 25.200 Κ/μL PT: 14,9’’ (ΧΜ 12’’) PTTK: 58,5’’ (φτ 40’’) SGOT: 1.659 IU/L, SGPT: 539 IU/L, λευκωματίνες: 2,4 g/dL, NH3: 99 U/L, σάκχαρο ορού: 44 mg/dL, ουρία: 21 mg/dL, κρεατ: 0,2 mg/dL, Κ: 3,5 mEq/L , Να: 132 mEq/L, Ca: 8,4 mg/ dL, Cl: 103 mEq/L, P: 2,5 mg/dL, Mg: 1,3 mg/dL, CPK: 97 IU/L, γGT: 32 IU/L, ALP: 129 IU/L , LDH: 637 IU/L, χολερυθρίνη ολική: 0,2 mg/dL.
γεν. ούρων: ΕΒ: 1031, pH: 6, κετόνες: (++), Na: 125 mEq/lL, K: 48 mEq/L, Cl: 160 mEq/L.
Ag: γρίπης (-), ΕΝΥ: αιμορραγικό δείγμα, κ/α ΕΝΥ: (-), IgG:1570 mg/dL (340-1200), IgM: 184 mg/dL (45-200), IgA: <7,13 mg/dL (18-160), IgE: 71,1 IU/ml (<60), C3: 68,1 gr/dL (70-200), C4: 12,5 gr/dL (11-40).
κ/α ανωτ. αναπνευστικού: staph. aureus
(-).
SIRS = Systemic Inflammatory Response Syndrome
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Μαύρου
Παναγιωτοπούλου
Παντελιάδης Χρήστος
Παπαβασιλείου -Συρίγου Αντιγόνη
Παπαδοπούλου Αλεξάνδρα
Παπαευαγγέλου Βασιλική
Παπαθανασίου - Καϊμαρά
Παυλοπούλου Ιωάννα
Παύλου Ευάγγελος
Πλατοκούκη Ελένη
Σαλάκος Χρήστος
Σιαμοπούλου - Μαυρίδου Αντιγόνη
Σούμπαση Βασιλική
Τσίτσικα Άρτεμις
Χατζησεβαστού - Λουκίδου Χαρίκλεια
