Current Pediatric Reviews (v.6, #4)
Parvovirus B19 (B19V) Infection and Pregnancy by Susan A. Feeney, Dorothy E. Wyatt, Alison P. Watt, Peter V. Coyle (210-218).
Human parvovirus B19 (B19V; genus Erythrovirus) is a small, non-enveloped, single-stranded DNA virus which causes the common childhood exanthem fifth disease, or and#x2018;slapped-cheek syndromeand#x2019;. Infection during pregnancy can cause severe fetal anaemia and nonimmune hydrops fetalis (NIHF), often leading to miscarriage or fetal death. B19V has a pronounced tropism for rapidly proliferating erythroid progenitor cells (EPC) leading to the cessation of erythropoiesis. The fetus is particularly vulnerable to adverse outcome following B19V infection due to rapid fetal blood volume expansion and a reduced reticulocyte half-life. B19V is not a significant teratogen. The risk to the fetus is increased if maternal infection occurs during the first two trimesters. Approximately 35-45and#x25; of women of child bearing age are not immune to B19V. Maternal seroconversion during a seasonal epidemic may reach 10and#x25;. Vertical transmission following infection is estimated at 33and#x25;, therefore a significant proportion of pregnancies are vulnerable to fetal infection. However, approximately 50and#x25; of primary infections are asymptomatic and may go undetected until adverse fetal outcome becomes apparent. This could be reduced if B19V awareness amongst pregnant women was heightened. Prenatal screening of antenatal booking-bloods would identify at-risk pregnancies and appropriate advice could be given to mothers at this stage. Recommended case management following maternal primary B19V infection is regular Doppler ultrasound monitoring of the middle cerebral artery peak systolic flow velocity for a 12 week follow-up period. Treatment of severe fetal anaemia is cordocentesis transfusion with a success rate of approximately 80and#x25;.
Syndromes Caused by the Mutations in GLI3 Gene by Ichiro Naruse, Etsuko Ueta, Yoshiki Sumino, Masaya Ogawa (219-225).
Responsible gene for Greig cephalopolysyndactyly syndrome (GCPS), Pallister-Hall syndrome (PHS), Postaxial polydactyly type-A (PAP-A), and Preaxial polydactyly type-IV (PPD-IV) has been known to be GLI3. In the present review, relationship between mutation points of GLI3 and resulting phenotypes is discussed. It has been proposed that mutations in the upstream or within zinc finger domain of GLI3 gene induce GCPS, those in the post zinc finger region including protease cleavage site induce PHS, and those in far 3' terminal of GLI3 gene induce PAP-A and PPD-IV. Meanwhile, it has been known that mutations in the near 3' terminal end also induce GCPS. There is an argument whether clear genotype-phenotype correlations were apparent or not. A lot of mutant and knockout mice in Gli3 gene, which exhibit similar phenotypes to human syndromes caused by GLI3 mutations, have been maintained and produced. Investigations using mouse homolog of GCPS, PHS and PPD-IV may be the way to elucidate this argument. Mysterious issue is that GCPS and PHS appear in spite of having half amount of normal GLI3 protein, however, complete loss of normal Gli3 protein induces the similar phenotypes in mice. It has been speculated that truncated mutant GLI3/Gli3 protein might induce the phenotypes of GLI3/Gli3-related birth defects both in humans and mice.
Current Applications of Therapeutic Gases in Neonatal Intensive Care by Claudio Migliori, Elena Garzoli, Gaetano Chirico (226-233).
Various gases are utilized in respiratory care. Though oxygen is the most frequently administered, the use of other gases has become common practice in recent years. This report reviews the literature concerning some of the therapeutic gases utilized in Neonatal Intensive Care Unit (NICU). Inhaled Nitric Oxide is a selective pulmonary vasodilator largely employed in the Intensive Care Units. Its effects are well known as well as cost/effectiveness and consequently limitations, mainly in the developed countries. An alternative gas with comparable characteristics is Onitrosoethanol. In experimental studies, this gas seems to improve oxygenation and systemic haemodynamics, reducing the rebound hypoxaemia and the production of toxic by-products. Helium-oxygen mixture is less common, although it is widely known to both the decrease the pressure required to ventilate the lung and the resistive work of breathing, improving gas exchange in particular clinical conditions. Recent studies showed its efficacy and feasibility both in infants and in preterms. Carbon dioxide is usually employed for the management of some specific congenital heart defects characterised by various grades of pulmonary vascular resistance. Its major effect is the reduction of pulmonary blood flow to decrease cardiac work. The Xenon, already known for its anaesthetic proprieties although rarely used, has recently been considered for neuroprotection, opening a new field of interest in neonatal hypoxia/ischemia syndrome.
Tapering Enteroplasty for Complicated Meconium Ileus by Charles W. Hartin, Stanley T. Lau, Sani Z. Yamout, Mauricio A. Escobar, Michael G. Caty (234-236).
Meconium ileus (MI) presenting with complications such as volvulus, atresia, necrosis, perforation, peritonitis, or giant cystic meconium peritonitis demands operative intervention and often requires a small bowel resection. These patients are at increased risk of short bowel syndrome if a significant portion of bowel must be resected. We report on a 1- day-old boy who was found to have a complicated MI with volvulus causing a long ischemic strip of small bowel. An enteroplasty was successfully employed to maintain bowel continuity after removing a 2 by 50 cm segmental area of ischemic bowel.
Adolescents' Attitudes Toward Vaccinations: A Systematic Review by Julia E. Painter, Lisa M. Gargano, Jessica M. Sales, Allena J. Perez, Gina M. Wingood, Michael Windle, Ralph J. DiClemente (237-249).
Adolescent immunization coverage remains sub-optimal. Although parental consent is required for most vaccinations, adolescents' own attitudes may impact vaccine uptake. The current study sought to review the literature regarding adolescents' attitudes toward vaccination to inform efforts toward increasing vaccination rates. Two researchers searched five databases for literature published in English from 1999-2009, and coded included articles for demographics, methodological information, type of attitudes assessed, and significant associations. Of 1,348 titles and abstracts screened, 28 studies met inclusion criteria. Most studies assessed attitudes toward HPV or other STI vaccines. No studies assessed attitudes towards influenza vaccination. Most studies were cross-sectional, and many analyzed adolescent data combined with young adult data. Existing research suggests that perceived risk of disease, benefits and barriers to vaccination, and normative beliefs may be salient factors in adolescents' vaccine acceptance. Future research should expand the evidencebase regarding adolescents' attitudes toward all recommended vaccines, particularly non-STI vaccines.