1st Year Of Life Research Articles

Age-Dependence of Flow Homeostasis in the Left Ventricle.

Background: Intracardiac flow homeostasis requires avoiding blood stasis and platelet activation during its transit through the cardiac chambers. However, the foundations of intraventricular blood washout and its exposure to shear stresses have been poorly addressed. We aimed to characterize and quantify these features in a wide population of healthy subjects and assess the relationships of these indices with age.Methods: We used color-Doppler echocardiography and custom post-processing methods to study 149 healthy volunteers from 26 days to 80 years old. From the intraventricular flow-velocity fields we obtained personalized maps of (1) the residence time of blood in the LV, and (2) the shear index, a metric accounting for the strongest occurrence of shear stresses inside the chamber. From these maps we derived quantitative indices of the overall intraventricular blood washout and shear exposure. We addressed the age-dependence of these indices and analyzed their relationship with age-related changes in filling-flow.Results: The entire intraventricular blood pool was replaced before 8 cycles. Average residence time of blood inside the LV was <3 cycles in all subjects and followed an inverse U-shape relationship with age, increasing from median (IQR) of 1.0 (0.7 to 1.2) cycles in the 1st year of life to 1.8 (1.4–2.2) cycles in young adults (17–30 years old), becoming shorter again thereafter. Shear index showed no relation with age and was bounded around 20 dyn·s/cm2. Regions with the longest residence time and highest shear index were identified near the apex. Differences in the degree of apical penetration of the filling waves and the duration of the late-filling phase explained the age-dependence of residence time ( = 0.48, p < 0.001).Conclusions: In average, blood spends 1 to 3 beats inside the LV with very low shear stress rates. The apical region is the most prone to blood stasis, particularly in mid-aged adults. The washout of blood in the normal LV is age-dependent due to physiological changes in the degree of apical penetration of the filling waves.

New foods in the nutrition of young children and their role in eating behavior

The article deals with the formation of eating behavior in children with the use of complementary foods. It contains the data on new types of complementary foods, and the possibility of their use in children of the 1st year of life. The article presents the results of clinical studies of new types of products for younger children that are developed with innovative technologies.

Food Protein-Induced Proctocolitis

The article reflects the modern views on food protein induced proctocolitis: prevalence, pathophysiological mechanisms of intestinal damage, clinical manifestations, main food allergens that contribute to the development of this pathological condition, approaches to diagnosis and diet therapy. The article describes a clinical case of food protein induced proctocolitis in a child of the 1st year of life.

Early Life Microcirculatory Plasticity and Blood Pressure Changes in Low Birth Weight Infants Born to Normotensive Mothers: A Cohort Study.

BACKGROUNDCapillary rarefaction (CR) is an established hallmark of essential hypertension (EH). The aim of this study was to examine early changes in capillary density (CD) and blood pressure (BP) in low birth weight (LBW) infants who are at risk of developing EH in later life.METHODSWe studied 77 LBW infants and 284 normal birth weight (NBW) infants, all born to mothers with normotension, in a longitudinal multicenter study. Intravital capillaroscopy was used to measure functional basal capillary density (BCD) and maximal capillary density (MCD) at birth, 3, 6, and 12 months.RESULTSWe found that LBW infants, born preterm and at term, had a significantly higher CD at birth, then underwent significant CR in the 1st 3 months culminating in a CD similar to that seen in NBW infants. NBW infants showed a gradual reduction in CD between birth and 12 months. Non-Caucasian ethnicity and preterm birth were significant predictors of a higher CD at birth. Systolic BP in NBW infants increased significantly from birth to 3 months, and we identified a significant negative correlation between systolic BP and MCD.CONCLUSIONSThis study has identified a process of early “accelerated capillary remodeling” in LBW infants, which corrects their higher CD at birth. This remodeling is unlikely to explain the CR seen in adult individuals with, or at risk of developing EH. Further follow-up studies are required to determine the timing and mechanisms involved in CR, which is likely to occur after the 1st year of life but before early adulthood.

Case 266.

History A 1-year-old boy was referred for cochlear implant assessment after he received a diagnosis of bilateral profound sensorineural hearing loss at neonatal hearing screening shortly after birth. The child was born at term via uneventful delivery, and there was no history of familial hearing loss or maternal illness. Tympanic membranes were normal, and hearing loss was confirmed with auditory brainstem testing, which showed no response from either ear. Hearing aids were provided from 3 months of age, but no behavioral responses were noted when these were worn. He was also noted to have some mild developmental delay throughout his 1st year of life and was slow to crawl, roll over, and stand up. Physical examination showed no syndromic features or physical abnormalities. Ophthalmology confirmed normal vision and visual movements but bilateral anesthetic corneas. He had corneal abrasions due to minor repeated corneal trauma, and left-sided tarsorraphy was performed at 6 months. Facial nerve function, swallow, and voice quality were normal. To assess suitability for a cochlear implant, the patient underwent MRI of the temporal lobe and brain ( Figs 1 - 4 ) and thin-section CT of the temporal bones ( Figs 5 , 6 ). The patient subsequently underwent left cochlear implantation. Figure 1: Sagittal midline T1-weighted 1.5-T MR image (repetition time msec/echo time msec, 541/15). Figure 2: Axial T2-weighted MR image (6703/116, 4-mm section thickness) at the level of the pontomesencephalic junction. Figure 3: Axial T2-weighted MR image one level inferior to that shown in Figure 2 . Figure 4a: (a) Axial 1.5-T single-slab three-dimensional (3D) turbo spin-echo MR image (1200/271) at the level of the right internal auditory canal. (b) Corresponding axial 1.5-T single-slab 3D turbo spin-echo MR image at the level of the left internal auditory canal. Figure 4b: (a) Axial 1.5-T single-slab three-dimensional (3D) turbo spin-echo MR image (1200/271) at the level of the right internal auditory canal. (b) Corresponding axial 1.5-T single-slab 3D turbo spin-echo MR image at the level of the left internal auditory canal. Figure 5: Unenhanced axial thin-section (0.7-mm section thickness) CT image of the temporal bone at the level of the internal auditory canals and middle cochlear turns. Figure 6: Unenhanced axial thin-section (0.7-mm section thickness) CT image of the temporal bone at a level slightly inferior to that shown in Figure 5 .

Ambient ozone and fine particulate matter exposures and autism spectrum disorder in metropolitan Cincinnati, Ohio

BackgroundEpidemiological studies report fairly consistent associations between various air pollution metrics and autism spectrum disorder (ASD), with some elevated risks reported for different prenatal and postnatal periods. ObjectivesTo examine associations between ASD and ambient fine particulate matter (PM2.5) and ozone concentrations during the prenatal period through the second year of life in a case-control study. MethodsASD cases (n = 428) diagnosed at Cincinnati Children's Hospital Medical Center were frequency matched (15:1) to 6420 controls from Ohio birth records. We assigned daily PM2.5 and ozone estimates for 2005–2012 from US EPA's Fused Air Quality Surface Using Downscaling model to each participant for each day based on the mother's census tract of residence at birth. We calculated adjusted odds ratios (aORs) using logistic regression across continuous and categorical exposure window averages (trimesters, first and second postnatal years, and cumulative measure), adjusting for maternal- and birth-related confounders, both air pollutants, and multiple temporal exposure windows. ResultsWe detected elevated aORs for PM2.5 during the 2nd trimester, 1st year of life, and a cumulative period from pregnancy through the 2nd year (aOR ranges across categories: 1.41–1.44, 1.54–1.84, and 1.41–1.52 respectively), and for ozone in the 2nd year of life (aOR range across categories: 1.29–1.42). Per each change in IQR, we observed elevated aORs for ozone in the 3rd trimester, 1st and 2nd years of life, and the cumulative period (aOR range: 1.19–1.27) and for PM2.5 in the 2nd trimester, 1st year of life, and the cumulative period (aOR range: 1.11–1.17). DiscussionWe saw limited evidence of linear exposure-response relationships for ASD with increasing air pollution, but the elevated aORs detected for PM2.5 in upper exposure categories and per IQR unit increases were similar in magnitude to those reported in previous studies, especially for postnatal exposures.

Ocular outcomes and comorbidities in preterm infants enrolled for retinopathy of prematurity screening: A cohort study from western India

BACKGROUND:Retinopathy of prematurity (ROP) is emerging as an important cause of childhood blindness in middle-income countries such as India. Although blindness can be prevented in most cases with timely screening and treatment, certain ocular comorbidities can lead to visual impairment. We evaluated and compared 1-year visual, refractive, and structural outcomes and comorbidities in three subsets of preterm infants enrolled for screening of ROP.SUBJECTS AND METHODS:Preterm children enrolled in the hospital's ROP screening program and with diagnosis of no ROP, mild ROP, or severe ROP were followed at 1 year of age to evaluate and compare visual, refractive, and structural outcomes as well as the presence of ocular comorbidities. Risk of poor outcome was calculated in children with mild and severe ROP reference population being children without ROP.RESULTS:Eyes with severe ROP were at highest risk of poor visual (risk ratio [RR]: 3.5, P < 0.001), refractive (RR: 45, P < 0.001), and structural (RR: 11, P = 0.006) outcome as well as ocular comorbidities (RR 11, P < 0.001). Eyes with mild ROP were at higher risk of myopia (RR: 11, P = 0.06) and ocular comorbidities (RR: 4, P = 0.04). Sixteen (16%) of the eyes without ROP developed poor visual outcome.CONCLUSION:Eyes with severe ROP are at highest risk of poor ocular outcomes and comorbidities and need a long-term follow-up. Eyes which do not develop ROP can have poor visual outcome and need to be assessed within the 1st year of life.

Anomalous origin of the left coronary artery from the pulmonary artery-adult type with heart failure and ventricular arrhythmia presentation

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome is a rare congenital anomaly occurring in 1 of 300,000 births. As it has high mortality rate during the 1st year of life, adult type is very rare. Arrhythmias, heart failure, myocardial infarction, and sudden cardiac death are common presentations of ALCAPA syndrome in adults. Here, we report a 28-year-old male with malignant ventricular arrhythmia and sudden cardiac death. ALCAPA syndrome was diagnosed by coronary angiography and echocardiography; finally, cardiac surgery was performed with a good result.

Influence of maternal periodontal health as a risk factor for low-birth-weight infants in Terai population of Nepal

BACKGROUND:Preterm low birth weight (PLBW) is a leading perinatal problem in developing countries. PLBW is considered as a leading cause of neonatal death in the 1st year of life, with problems in childhood and adulthood. Several studies have suggested a possible relationship between PLBW and periodontal status of the expectant mothers. The present study was conducted to determine the association between the maternal periodontitis and the low birth weight (BW) of the babies.MATERIALS AND METHODS:This study consisted of 200 primipara mothers ranging between 18 and 35 years old, with a mean age of 23.96 years. The mothers were categorized based on the weight of the infants as cases (BW <2500 g) and as controls (BW ≥2500 g). Age, mean weight, height, body mass index, and periodontal status of the mothers as well as weight of the babies were recorded. Periodontal parameters were assessed using the community periodontal index (CPI). The data were recorded, analyzed, and statistically compared using the Chi-square test (χ2).RESULTS:BW of the babies was regressed against CPI. Periodontitis was significantly associated with decrease in BW of the babies (P < 0.0001).CONCLUSION:Our findings showed an association of maternal periodontal disease with PLBW that emphasizes to promote good oral hygiene of the expectant mothers during routine prenatal visits.

Motor nerve conduction velocity in normal children under 5 years of age

Background: Development of peripheral nerves is age dependent. It begins during fetal life and gets completed at around 5 years of age. Conduction velocity of any nerve is determined by myelination, diameter of the fiber, and internodal differences. Since all these three factors are remodeled during normal development of a nerve, motor nerve conduction velocity (MNCV) varies in different age groups in under-five children. Aims and Objectives: The aim of this study was to evaluate the MNCV of ulnar, median, and common peroneal nerve during the 1st years of life and to examine correlation between age factor and MNCV in these participants. Materials and Methods: Nerve conduction study was performed prospectively on median, ulnar, and common peroneal nerves with Neuroperfect electromyography/nerve conduction velocity/evoked potential system, and MNCV was measured in 106 normal children under 5 years of age. Results were analyzed using the Statistical Package for the Social Science (17.0) software. Results: There was a steady increase in MNCV of all three nerves from birth to 5 years of age. A significant positive correlation was found between age and MNCV of ulnar, median, and common peroneal nerve. Conclusion: MNCV of nerves of both upper and lower limbs varies significantly with age in children under 5 years of age. Thus, it is essential to have standard values of MNCV for the different age groups of under-five children while conducting nerve conduction studies.

234: NAFTNET retrospective report on dexamethasone and fetal heart block

Complete atrioventricular block (CAVB) occurs in 1-2% of SSA positive pregnancies and the consequences are significant: approximately 20% die and 50% require permanent cardiac pacing by 1 year of age. We hypothesize that dexamethasone (DEX) treatment for fetal anti-SSA/SSB antibody-mediated cardiac disease leads to better pregnancy outcome. Therefore, we assessed recent era experience of treatment with DEX of pregnancies with SSA/SSB-mediated fetal cardiac disease including all degrees of heart block on pregnancy, neonatal outcome and complication rates. We performed a retrospective multi-center cohort study of all SSA/SSB antibody positive pregnancies with fetal conduction system disease reported to the participating NAFTNet centers between January 2010 through December 2017. The primary outcomes included preterm delivery, maternal comorbidities, neonatal complications and secondary outcomes were, need for a pacemaker < 28 days, heart transplantation in the 1st year of life, and intrauterine or neonatal death in maternal/fetal days treated with DEX versus managed expectantly. There was a total of 101 SSA/SSB positive pregnancies of which 75 were treated with DEX and 26 were not. Of those treated, 49/75 (65%) met the primary outcome including 37 premature deliveries; 12 mothers developed comorbidities during treatment (4 with fetal growth restriction, 4 with oligohydramnios, 2 with new or worsening gestational diabetes, and 6 with mood disturbances). In comparison, in the untreated group 11/26 (42%) met the primary outcome of premature delivery. Regarding secondary outcomes, 32/75 (43%) dexamethasone-treated fetuses either required a pacemaker or had a fetal demise/died by 28 days of life, while 13/26 (50%) untreated met the secondary outcome of requiring pacemaker placement or fetal demise/dying prior to 28 days of life, while 1 infant required listing for cardiac transplantation. While the use of dexamethasone in SSA and SSB positive pregnancies is associated with a high rate of poor pregnancy outcomes, there was a similarly high rate in untreated SSA/SSB positive pregnancies suggesting that the maternal disease itself is influencing pregnancy complications. A trend suggesting that treatment decreases neonatal morbidity and progression of conduction disease deserves further study.

Tracheal Diameter and Respiratory Outcome in Infants with Congenital Diaphragmatic Hernia Treated by Fetal Endoscopic Tracheal Occlusion

Aim: To evaluate tracheal diameters and their clinical impact in patients with congenital diaphragmatic hernia (CDH) after fetal endoscopic tracheal occlusion (FETO). Methods: Patients born with CDH between January 2012 and August 2016 were divided into two groups: noFETO and FETO. Tracheal diameters at three levels (T1, carina, and maximum tracheal dilation) on chest X-ray at 1, 3, 6, 12, 24, and 36 months of follow-up, requirements of invasive and noninvasive respiratory support, the incidence of respiratory infections, and results of pulmonary function tests (PFT) were compared. Results: A total of 71 patients with CDH were born in the study period, and there were 34/41 survivors in the no­FETO group (82.9%) and 13/30 in the FETO group (43.3%). The maximum tracheal diameter was significantly greater in the FETO group at all ages. No differences were observed in the diameters at T1 and the carina, in the requirements of invasive and noninvasive respiratory support, and in the incidence respiratory infections. At the PFT (6–12 months), the FETO group presented higher respiratory rates (46.1 ± 6.2 vs. 36.5 ± 10.6, p = 0.02). No differences in PFT results were found between the groups after the 1st year of life. Conclusions: The FETO procedure leads to persistent tracheomegaly. However, the tracheomegaly does not seem to have a significant clinical impact.

Evaluation of awareness of job responsibilities and incentives of accredited social health activist in the delivery of health care services

Background: Accredited social health activist (ASHA) workers are the female health volunteers of the community who takes steps to generate awareness and provide information to the community on determinants of health such as nutrition, hygiene practices and basic sanitation, healthy living condition. Our aim was to evaluate the level of awareness of job responsibilities of ASHA workers, to assess about their awareness about the different incentives in the delivery of health care services and to recommend for improvement on the functioning of the ASHA workers.Methods: A cross sectional study was conducted in Khordha district of Odisha from March 2018 to July 2018. 3 blocks were selected purposively i.e. Bhubaneswar under urban block, Bolagarh under rural block and Banapur a tribal block. Working in the 3 selected blocks, 331 ASHA’s participated in the study.Results: 37% were between 34-39 years and 30% were in the age group of 34-39 years in the rural block and about 40% ASHA workers belonged to 25-29 years of age. For full immunization in the 1st year of life per beneficiary an amount of Rs. 100 is given to an ASHA worker. However, 67 (68.4%) in urban block, 79 (63.2%) in rural block and 83 (76.8%) ASHAs in tribal block were aware about this incentive.Conclusions: The role of ASHAs should be well defined and accordingly with supportive supervision, the ASHAs should be monitored to efficiently &amp; effectively play their roles and discharge duties.

LAPAROSCOPIC NEPHRECTOMY IN FATAL CHILDREN WITH WILMS TUMOR

Over the past decades, minimally invasive surgical procedures have been widely applied in the field of pediatric urology. However, very few cases of possible laparoscopic removal of a nephroblastoma (Wilms’ tumor) in children have been reported, especially during the 1st year of life. In this study, we estimated our experience of laparoscopic nephrectomy for Wilms’ tumor in young children. 5 children with unilateral Wilms’ tumor who were less than 1 year of age and underwent radical nephrectomy via laparoscopic approach were observed from 2010 to 2017. During the intervention, the average age of the patients was 7.4 months. All children who underwent the laparoscopic surgery had a favourable early perioperative period. No continuous tumor growth, tumor implantation in the perioperative wound and trocar-related injury were noted. No delayed complications were found during the 12 to 60 month control period. The observed patients had no phenomena of renal insufficiency. The survival rate was 92.9%. Laparoscopic tumor nephrectomy is feasible in infants. It can be performed when the Wilms’ tumor reaches a volume of no more than 70 cm3 at specialized pediatric hospitals that provide oncological and urological services.

ALLERGIC MANIFESTATIONS OF PRIMARY IMMUNODEFICIENCY DISEASES AND ITS TREATMENT APPROACHES

Allergic manifestations are one of the clinical signs of primary immunodeficiency diseases (PID). In this review, the common allergic manifestations of PID are summarized, and their main differential characteristics and treatment approaches are outlined. Allergic manifestations occur more often in patients with combined immunodeficiencies with or without associated or syndromic features. In patients with PID they usually are present in the 1st year of life, may be among the first symptoms of PID, and are commonly manifested by eczema and increased immunoglobulin (Ig)-G levels. Often the skin barrier function is not impaired in patients with eczema and PID, although some diseases (such as Comel-Netherton syndrome) do affect skin barrier function. There is usually no correlation between IgE levels and the severity of allergic skin manifestations. Allergic-like manifestations in PID patients include urticaria-like rash and angioedema. Urticaria-like rash is associated with autoinflammatory disorders, which are commonly accompanied by fever, and caused by a neutrophilic infiltrate in the dermis. Angioedema in hereditary angioedema patients is caused by high bradykinin production. Early differentiation of allergic manifestations in PID from atopic dermatitis and other atopic conditions is very difficult; however, it is very important because it influences on treatment methods. A multidisciplinary approach to the management of PID patients, with the involvement of immunologists, allergists, and formulation of appropriate treatment improve the prognosis and quality of life of the PID patients.

Traffic-Related Air Pollution, Noise and Infant Mortality in London

BackgroundThere is evidence that ambient air pollution is associated with increased risk of infant mortality. Road traffic is a major contributor to ambient air pollution, but it also generates noise. This study investigates long-term exposure to both traffic-related air and noise pollution and risk of infant mortality. MethodsWe conducted a matched case-control study of infant deaths (deaths occurring in 1st year of life) from singleton births across Greater London from 2003-2010. Controls were singleton births in the study area between 2003-2010 surviving to age 1. Cases were matched to controls (n&amp;#61;29) on birthdate and sex. Monthly concentrations of NO2, NOX, source-specific traffic-related PM2.5, PM2.5, PM10 and ozone were estimated at 20x20m resolution using a dispersion model, and time-weighted averages calculated for pregnancy/trimesters and birth to case death at address-level. Road traffic noise was modelled at address-level. We analysed the relationship between air pollutants/noise and infant mortality using conditional logistic regression, with adjustment for confounding. ResultsThe study population comprises 3390 infant deaths (69% neonatal, 31% postneonatal). Average air pollutant exposures for cases from birth to death were 42&amp;#956;g/m3 NO2, 77&amp;#956;g/m3 NOx, 15&amp;#956;g/m3 PM2.5, 24&amp;#956;g/m3 PM10 and 31&amp;#956;g/m3 O3. Average day- and night-time noise levels were 58 and 53 dB respectively. Higher road traffic air pollution and noise exposures were particularly associated with non-White ethnicity and lower socio-economic status. Preliminary results from adjusted single-pollutant models suggest increased risk of infant mortality associated with higher ozone exposure, but not with other air pollutants or noise. Analyses of joint air pollution&amp;#8211;noise exposures are currently underway. ConclusionsTo our knowledge, this is the first epidemiological study to investigate risk of infant mortality in relation to both road traffic air pollution and noise co-exposures.

Abstract 134: The Effect of Low Birth Weight on the Microcirculation in the 1 St Year of Life

Introduction: Capillary rarefaction, defined as a reduction in capillary density, is an established hallmark of essential hypertension. Low birth weight (LBW) infants, known to have an increased risk of developing hypertension as adults, were unexpectedly found to have a significantly higher capillary density at birth when compared to normal birth weight (NBW) infants. We therefore hypothesised that there is a microcirculatory window in the 1 st year of life of LBW infants, during which a process of extensive capillary loss, known as “hyperpruning”, occurs. Methods: The George’s Capillary Rarefaction Offspring Study (G-CROS) is a longitudinal, multi-centre study of which 284 infants were NBW, born at term, and 77 were LBW. Intravital microscopy was used to measure the functional (also known as basal) capillary density (BCD), and the structural (also known as maximal) capillary density (MCD) at birth, 3 months, 6 months and 12 months. Results: LBW infants had a significantly higher capillary density at birth when compared to NBW infants ( p &lt; 0.0001). NBW infants showed a gradual reduction in capillary density between birth and 12 months, with their greatest reduction occurring between birth and 3 months (BCD mean difference = -27.62 cap/field, p &lt;0.0001 and MCD mean difference = -31.49 cap/field, p &lt;0.0001). Similarly, the most significant reduction in BCD and MCD, in the LBW cohort, was between birth and 3 months (BCD mean difference = -47.01 cap/field, p &lt; 0.0001 and MCD mean difference = -48.01 cap/field, p &lt; 0.0001). However, within this same 3-month interval, LBW infants demonstrated a significantly higher percentage reduction in BCD (mean difference = 7.81%, p = 0.0194) and MCD (mean difference = 8.29%, p = 0.0361) when compared to NBW infants. Conclusions: Once again, LBW infants were shown to have a higher capillary density than NBW infants at birth. However, this study has shown for the first time that there appears to be a microcirculatory window in the first 3 months of life during which LBW infants undergo capillary “hyperpruning”. Further follow-up studies are required to investigate the role of early capillary rarefaction in the pathogenesis of hypertension, as well as the mechanisms orchestrating these early microcirculatory changes.

Imaging Evaluation of Pediatric Parotid Gland Abnormalities.

Parotid gland lesions in children can be divided into benign or malignant. The age of the patient helps narrow the differential diagnosis, with vascular and congenital lesions being more frequent in the 1st year of life, while solid tumors are more frequent in older children. Inflammatory disease usually has rapid onset in comparison with that of neoplastic or congenital processes, which have more gradual clinical evolution. Currently, multiple imaging techniques are available to study the parotid region, such as US, CT, and MRI. However, it is still a challenge to distinguish nonmalignant lesions from malignant ones. US is the first-line diagnostic approach in children to characterize the morphology and vascularity of these lesions. CT in children may be indicated for evaluation of abscesses or sialolithiasis. MRI is the imaging modality of choice for investigating the nature of the lesion and its extent. In addition to complete and detailed clinical information, knowledge of parotid gland anatomy and characteristic radiologic features of parotid disorders is essential for optimal radiologic evaluation and avoiding unnecessary interventional diagnostic procedures or treatment. This article illustrates a variety of entities (congenital, inflammatory, vascular, neoplastic) that can occur in the parotid gland, highlighting the most frequent radiologic patterns of manifestation and correlating them with clinical, surgical, and pathologic findings. ©RSNA, 2018.

Twenty years' experience with myelomeningocele management at a single institution: lessons learned.

The authors reviewed 20 years' experience with the surgical management of open myelomeningocele in a well-defined retrospective cohort from a single large academic medical center. Their goal was to define the characteristics of a modern cohort of children with myelomeningocele to allow for evidence-based decision-making for the treatment of these patients. After IRB approval was obtained, the authors queried an operative database maintained by the Department of Neurological Surgery at Children's Hospital of Pittsburgh for patients who underwent closure of a myelomeningocele between 1995 and 2015. They identified 153 infants, and a retrospective chart review was performed. Eighty-eight percent of the patients required placement of a ventriculoperitoneal shunt, and 15% of these patients acquired shunt-related infections. Eighteen percent of patients underwent Chiari malformation type II (CM-II) decompression. Sixteen percent of patients underwent a tethered cord release. Three percent of patients died within the 1st year of life. Predictors of an early demise included poor Apgar scores, large head circumference, and need for early CM-II decompression. Functional motor outcome was slightly better than predicted by anatomical level of defect. Myelomeningoceles represent a severe birth defect with life-threatening complications. The authors provide long-term follow-up data and insight into factors that contribute to early death.

Surgical interventions and anesthesia in the 1st year of life for lower urinary tract obstruction

BackgroundPatients with a prenatal diagnosis of lower urinary tract obstruction (LUTO) may undergo prenatal interventions, such as vesicoamniotic shunt (VAS) placement, as a temporary solution for relieving urinary tract obstruction. A recent FDA communication has raised awareness of the potential neurocognitive adverse effects of anesthesia in children. We hypothesized as to whether a prenatal LUTO staging system was predictive of the number of anesthesia events for prenatally diagnosed LUTO patients. MethodsWe retrospectively reviewed the prenatal and postnatal clinical records for patients with prenatally diagnosed LUTO from 2012 to 2015. Patients were stratified by prenatal VAS status and by LUTO disease severity according to Ruano et al. (Ultrasound Obstet Gynecol. 2016). Results31 patients were identified with a prenatal LUTO diagnosis, and postnatal records were available for 21 patients (seven patients in each stage). When combining prenatal and postnatal anesthesia, there was a significant difference in the number of anesthesia encounters by stage (1.6, 3.7, and 6.7 for Stage I, II, and III respectively, p = .034).Upon univariate analysis, higher gestational age (GA) at birth was associated with a decreased number of anesthesia events in the first year (p = .031). ConclusionsThe majority of infants with prenatally diagnosed LUTO will undergo postnatal procedures with general anesthesia exposure in the first year of life. Patients with higher prenatal LUTO severity experienced a higher number of both prenatal and postnatal anesthesia encounters. In addition, higher GA at birth was associated with fewer anesthesia encounters in the first year. Level of evidenceThis is a prognostic study with Level IV evidence.