Diameter In Children Research Articles

Comparative transcatheter occlusion of patent ductus arteriosus: multicenter collaborative study across pediatric and veterinary cardiology centers

Introduction/ObjectiveTranscatheter therapeutics have revolutionized treatment of patent ductus arteriosus (PDA). Greater understanding of corrective interventions across species can advance best practices, protocols, and outcomes while minimizing adverse events. The objective of this study was to describe characteristics and outcomes in children and dogs undergoing transcatheter PDA occlusion. Animals, Materials and MethodsThis was a multicenter, retrospective cohort study from two pediatric and three veterinary centers. Demographics, procedural characteristics, and outcomes were assessed. ResultsData included 202 children and 106 dogs treated from July 2019 to June 2021. Forty-five (23%) children and 19 (18%) dogs had congestive heart failure prior to catheterization. Transvenous and transarterial approaches for deployment were most used in children and dogs, respectively. All children had percutaneous vascular access compared to 17 (16%) dogs. Intraprocedural anticoagulation was standard for children (100% of 165 reported), but not for dogs (2/103). The median (interquartile range) pulmonary ostium diameter in children was 2.2 mm (1.5–3.0 mm) and 3.0 mm (2.0–4.2 mm) in dogs when all body sizes were considered (P<0.001). Amplatzer™ Duct Occluder was most commonly used in children (64/202, 32%); the Amplatz® Canine Duct Occluder was used in dogs (96/100, 96%). Closure was manual compression in all children, whereas vessel ligation was most used in dogs (74/104, 73%). Successful device deployment was achieved in 197 (98%) children and 98 (93%) dogs (P=0.03). Major reasons for failure included device embolization in six (2.9%) children and PDA morphology concerns in four (3.8%) dogs. ConclusionsTranscatheter PDA occlusion is successful in children and dogs. Study data might be useful for optimizing transcatheter therapeutics and animal models for interventional cardiology.

Value of Transabdominal Sonographic Rectal Diameter in Children with Functional Constipation

Abstract Background Constipation is a common problem worldwide. Since rectal digital examination and abdominal radiography have both limitations, ultrasound is considered an alternative technique, thus the aim of the current study is measurement of rectal diameter among a group of children with functional constipation (FC) in comparison with a healthy control group to determine the diagnostic efficacy of dilated rectal diameter for diagnosis of constipation. Patients and Methods A case control study that was conducted on children aged between 2 and 10 years; 50 were cases with functional constipation who were recruited from gastroenterology department and an equal number of age and sex matched apparently normal and healthy children were included as a control. FC was diagnosed according to the ROME IV criteria. Pelviabdominal ultrasound was done to all cases and controls to assess the rectal transverse diameter after taking detailed history regarding personal history, symptoms and history of present illness, past history and family history. Results Rectal diameter was measured in cases initially on presentation where 80% of the cases had enlarged rectal diameter, and 20% of cases had normal rectal diameter, ranging from 1.6 cm to 4.7 cm with a median of 3.55, while only 8% of controls has enlarged rectal transverse diameter and others were normal (P value &amp;lt;0.001). Conclusion based on our results, it can be concluded that rectal diameter is. significantly enlarged in most cases with constipation.

Durable left ventricular assist device explantation following recovery in paediatric patients: Determinants and outcome after explantation.

Myocardial recovery in children supported by a durable left ventricular assist device is a rare, but highly desirable outcome because it could potentially eliminate the need for a cardiac transplant and the lifelong need for immunosuppressant therapy and the risk of complications. However, experience with this specific outcome is extremely limited. All patients < 19 years old supported by a durable left ventricular assist device from the European Registry for Patients with Mechanical Circulatory Support database were included. Participating centres were approached for additional follow-up data after explantation. Associated factors for explantation due to myocardial recovery were explored using Cox proportional hazard models. The incidence of recovery in children supported by a durable left ventricular assist device was 11.7% (52/445; median duration of support, 122.0 days). Multivariable analyses showed body surface area (hazard ratio 0.229; confidence interval 0.093-0.565; P = 0.001) and a primary diagnosis of myocarditis (hazard ratio 4.597; confidence interval 2.545-8.303; P < 0.001) to be associated with recovery. Left ventricular end-diastolic diameter in children with myocarditis was not associated with recovery. Follow-up after recovery was obtained for 46 patients (88.5%). Sustained myocardial recovery was reported in 33/46 (71.7%) at the end of the follow-up period (28/33; >2 year). Transplants were performed in 6/46 (11.4%) (in 5 after a ventricular assist device was reimplanted). Death occurred in 7/46 (15.2%). Myocardial recovery occurs in a substantial portion of paediatric patients supported with durable left ventricular assist devices, and sustainable recovery is seen in around three-quarters of them. Even children with severely dilated ventricles due to myocarditis can show recovery. Clinicians should be attentive to (developing) myocardial recovery. These results can be used to develop internationally approved paediatric weaning guidelines.

Is catheterization via distal transradial access feasible in children? From vessel diameter perspective.

Distal radial artery (DRA) access is an infrequent alternative access for pediatric catheterization. The feasibility of using the DRA for arterial catheterization in children depends on the vessel's size. This study aims to provide a reference for pediatric catheterization via DRA access by evaluating the diameter of the DRA in the anatomic snuffbox (AS). We conducted a retrospective review of clinical and vascular ultrasound data of 412 children (ages 3-12) who were scheduled for arterial blood gas analysis via the DRA due to serious respiratory diseases between June 2023 and October 2023. The corrected DRA diameter in the AS was 1.97 ± 0.37 mm overall, with no significant difference between males (1.98 ± 0.38 mm) and females (1.95 ± 0.35 mm) (p = 0.457). The anteroposterior, transverse, and corrected DRA diameters increased significantly with age (p < 0.05). The DRA diameter was significantly smaller than the proximal radial artery (PRA) diameter (1.97 ± 0.37 mm vs. 2.05 ± 0.33 mm, p < 0.001) but larger than the ulnar artery (UA) diameter (1.97 ± 0.37 mm vs. 1.88 ± 0.33 mm, p < 0.001). The proportions of patients with a DRA diameter greater than 2.0 mm and 1.5 mm were 38.83% and 86.89%, respectively. The proportions of patients with DRA diameters >2.0 mm and >1.5 mm increased significantly with age (p < 0.01). The percentages of individuals with a DRA/PRA ratio ≥1.0 were 55.10% overall, 52.12% in males, and 58.60% in females. DRA diameter showed significant correlations with age (r = 0.275, p < 0.01), height (r = 0.319, p < 0.01), weight (r = 0.319, p < 0.01), BMI (r = 0.241, p < 0.01), wrist circumference (r = 0.354, p < 0.01), PRA diameter (r = 0.521, p < 0.01), and UA diameter (r = 0.272, p < 0.01). The DRA diameter in children increases with age and size, making cardiac catheterization is theoretically feasible. Preoperative evaluation of the vessel diameter and intraoperative ultrasound-guided intervention are recommended for paediatric catheterization via the DRA access.

Retinal blood vessel diameters in children and adults exposed to a simulated altitude of 3,000m.

Introduction: Technological advances have made high-altitude ski slopes easily accessible to skiers of all ages. However, research on the effects of hypoxia experienced during excursions to such altitudes on physiological systems, including the ocular system, in children is scarce. Retinal vessels are embryologically of the same origin as vessels in the brain, and have similar anatomical and physiological characteristics. Thus, any hypoxia-related changes in the morphology of the former may reflect the status of the latter. Objective: To compare the effect of one-day hypoxic exposure, equivalent to the elevation of high-altitude ski resorts in North America and Europe (∼3,000m), on retinal vessel diameter between adults and children. Methods: 11 adults (age: 40.1 ± 4.1years) and 8 children (age: 9.3 ± 1.3years) took part in the study. They spent 3days at the Olympic Sports Centre Planica (Slovenia; altitude: 940m). During days 1 and 2 they were exposed to normoxia (FiO2 = 0.209), and day 3 to normobaric hypoxia (FiO2 = 0.162 ± 0.03). Digital high-resolution retinal fundus photographs were obtained in normoxia (Day 2) and hypoxia (Day 3). Central retinal arteriolar equivalent (CRAE) and venular equivalents (CRVE) were determined using an Automated Retinal Image Analyser. Results: Central retinal arteriolar and venular equivalents increased with hypoxia in children (central retinal arteriolar equivalent: 105.32 ± 7.72µm, hypoxia: 110.13 ± 7.16µm, central retinal venular equivalent: normoxia: 123.39 ± 8.34µm, hypoxia: 130.11 ± 8.54µm) and adults (central retinal arteriolar equivalent: normoxia: 105.35 ± 10.67µm, hypoxia: 110.77 ± 8.36µm; central retinal venular equivalent: normoxia: 126.89 ± 7.24µm, hypoxia: 132.03 ± 9.72µm), with no main effect of group or group*condition interaction. A main effect of condition on central retinal arteriolar and venular equivalents was observed (central retinal arteriolar equivalent:normoxia: 105.34 ± 9.30µm, hypoxia: 110.50 ± 7.67µm, p < 0.001; central retinal venular equivalent: normoxia: 125.41 ± 7.70µm, hypoxia: 131.22 ± 9.05µm, p < 0.001). Conclusion: A 20-hour hypoxic exposure significantly increased central retinal arteriolar and venular equivalents in adults and children. These hypoxia-induced increases were not significantly different between the age groups, confirming that vasomotor sensitivity of the retinal vessels to acute hypoxia is comparable between adults and prepubertal children.

The role of rectal ultrasound in children with functional constipation.

The study aimed primarily to compare the transverse rectal diameter in children with functional constipation (FC) and children without constipation in different age groups, and between cases of constipation at baseline and after treatment. Secondary aim was to determine factors that could affect the transverse rectal diameter. A controlled prospective study, including a total of 100 children between the ages of 2 and 11 years, who were divided into 50 patients suffering from constipation according to Rome IV criteria and 50 age- and sex-matched controls. Transverse rectal diameter was measured at presentation, and after 3months of laxative therapy and behavioural modification. Initial rectal diameter was significantly different between cases (3.55 cm (interquartile range, IQR), 3.2-4) and controls (2.3cm (IQR, 1.8-2.5)), P value < 0.001, and it was also significantly different between those above and below 4 years, so a separate cut-off point for diagnosis of constipation was suggested being >3cm for the former and >2.5cm for the latter. After 3months of follow-up, rectal diameter significantly reduced to become 2.6 (IQR, 2-2.8), P value < 0.001. Duration of symptoms positively correlated with rectal diameter. Ultrasound measurement of rectal diameter is an important tool to diagnose and follow-up functional constipation in children. Different values of rectal diameter are found between those above and below 4 years of age.

Ocular biometry, anterior chamber morphometry, and their relationship with serum ferritin levels in children with beta thalassemia major.

Ocular biometry and anterior segment evaluations are important to determine ocular development and pathological changes, especially in thalassemia patients in Mediterranean countries such as Turkey. The objectives of this study were to compare ocular biometry and anterior segment parameters in children with thalassemia major and healthy controls and to examine the relationship between ferritin levels, anthropometric measurements, and ocular parameters. This is a prospective case-control study. The height, weight, body mass index, and occipitofrontal circumference values of the participants were recorded. Anterior and vitreous chamber depth, lens thickness, axial length, central corneal thickness, anterior chamber volume, iridocorneal angle, pupil diameter, and mean keratometry were measured. Measurements were compared between patients and healthy children, and between patients with ferritin levels above and below 1000 ng/mL. This study included 40 patients and 45 controls. Height, weight, and body mass index were significantly lower while ferritin level and occipitofrontal circumference were significantly higher in patients compared with the controls (p < 0.001 for all). There were no statistically significant differences in the other ocular parameters (p > 0.05). In comparisons between patients with ferritin levels below (n = 15) and above 1000 ng/mL (n = 25), there were no significant differences in age, height, weight, body mass index, occipitofrontal circumference, or ocular parameters (p > 0.05). Occipitofrontal circumference and mean keratometry value were positively correlated in patients with ferritin levels below 1000 ng/mL (r = 0.573, p = 0.025), while body mass index was negatively correlated with pupil diameter in patients with ferritin levels above 1000 ng/mL (r = -0.469, p = 0.018). Children with thalassemia showed significant growth retardation and large occipitofrontal circumference but did not differ from controls in terms of biometrics and anterior segment morphology. Our results demonstrated a positive correlation between the occipitofrontal circumference and mean keratometry value in children with ferritin levels below 1000 ng/mL and a negative correlation between body mass index and pupil diameter in children with ferritin levels above 1000 ng/mL.

Radial and ulnar medullary canal diameter in children: Anatomical limitations of elastic stable intramedullary nailing.

Surgery is inevitable for children who cannot achieve the ideal reduction in forearm fractures. The biggest limitation of the elastic stable intramedullary nail (ESIN) fixation method is the diameter of the medullary canal. This study aimed to measure the medullary canal diameters of the radius and ulna at different ages in children. The forearm radiographs of 540 children were retrospectively reviewed. All background characteristics, including weight, sex, maturity of the radius and ulna, and length of the radius and ulna, were measured and recorded. Children with radius and ulnar diameters shorter than 2 mm were analyzed by statistical regression analysis by SPSS software. When we set 2 mm as the minimum medullary canal diameter, our results showed that patients aged 3-12 years had radius and ulnar diameters under this limit. The regression analysis of risk factors with the 2 mm diameter limitation had significant differences based on age (P = 0.006) and sex (P = 0.033). There was no significant difference between patients based on weight (P = 0.056), ulnar length (P = 0.946), radius length (P = 0.503), radius maturity (P = 0.655), or ulnar maturity (P = 0.774). The average medullary canal diameter remained constant until 12 years of age. However, the average diameter length did not increase significantly after the age of 12 years. The incidence of medullary canal diameter shorter than 2 mm was correlated with age and sex. Our results suggest that surgeons should pay attention to the medullary diameter of the anteroposterior and lateral radiographs to determine the ESIN diameter.

Microsurgery in pediatric upper limb reconstructions: An overview.

The use of microsurgery has spread during the last decades, making resolvable many complex defects considered hitherto inapproachable. Although the small vessel diameter in children was initially considered a technical limitation, the increase in microsurgical expertise over the past three decades allowed us to manage many pediatric conditions by means of free tissue transfers. Pediatric microsurgery has been shown to be feasible, gaining a prominent place in the treatment of children affected by limb malformations, tumors, nerve injuries, and post-traumatic defects. The aim of this current concepts review is to describe the more frequent pediatric upper limb conditions in which the use of microsurgical reconstructions should be considered in the range of treatment options.

Coronary Artery Z-scores in Febrile Children with Suspected Kawasaki's Disease-The Value of Serial Echocardiography.

Progressive enlargement of the coronary artery (CA) diameters on serial echocardiography can support diagnosis of Kawasaki's disease (KD) even CA dimensions are within the normal range. A single-center, retrospective study compared mean Z-scores of the proximal CA internal diameters in children hospitalized with non-KD febrile illnesses (FCs) with those of KD patients. A total of 223 patients with suspicion of KD have been admitted over a period of 16 years and data were evaluable for 176 children. Distributions for age, sex, and body surface area were similar for both groups. FC had a significantly shorter duration of hospitalization, higher levels of hemoglobin, lower levels of liver transaminases, and segmented neutrophils, respectively. The majority of FC patients (75/82, 91.5%) had normal CA Z-scores (p < 0.001) and only 3 (3.7%) had CA Z-score ≥2.5 standard deviation (SD). In KD, subjects (46/94, 49.5%) had a CA dilation (Z-score ≥2.5 SD) and the maximum CA Z-score (Zmax) was significantly higher compared with FC patients (p < 0.001). On serial echocardiograms, FC patients showed a mild decrease, whereas KD patients developed a significant increase of CA Zmax (p < 0.001). Seven KD patients had a segmental dilation of a CA which has been confirmed by cardiac catheter. In FC, no segmental dilation of any CA was documented by echocardiography. This study found that mean CA dimensions in FCs were smaller and did not increase in serial echocardiograms compared with KD patients.

Quadriceps Tendon Autograft in Pediatric Anterior Cruciate Ligament Reconstruction: Graft Dimensions and Prediction of Size on Preoperative Mri

Background:There has been a growth of interest in quadriceps autograft anterior cruciate ligament (ACL) reconstruction in the pediatric population.Hypothesis/Purpose:The goal of this study was to evaluate children and adolescents who underwent ACL reconstruction using a quadriceps autograft to determine the properties of the harvested graft and to assess the value of demographic, anthropometric, and MRI measurements in predicting the graft size preoperatively.Methods:A retrospective IRB-approved database search was performed from January 2018 through October 2020 for patients undergoing ACL reconstruction. Patients <18 years old at the time of surgery in whom a quadriceps tendon autograft was used were selected. Demographic data and anthropometric measurements were recorded and graft measurements were abstracted from the operative note. Knee magnetic resonance images (MRI) were reviewed to measure the quadriceps tendon thickness on sagittal cuts (Figure 1). Graft length and diameter were then correlated with anthropometric and radiographic data.Results:A total of 169 patients (98 male) were included in the final analysis, with a median age of 15 years (range, 9-17). A tendon length of 65mm or more was harvested in 159 (94%) patients. The mean final graft diameter was 8.4 ± 0.7mm (range, 7 – 11mm) (Table 1). All patients had a graft diameter of 7mm or more, and 139 (82%) had a diameter of 8mm or larger. Preconditioning decreased the graft diameter by a mean of 0.68 ± 0.23mm. Age (P=0.04) and quadriceps thickness on MRI (P<0.001) were significant predictors of the final graft diameter. An MRI sagittal thickness of >6.7mm was 97.4% sensitive for obtaining a graft of ≥8mm in diameter.Conclusion:Our findings suggest that tendon-only quadriceps autograft is a reliable graft source in the pediatric ACL reconstruction, yielding a graft of ≥8mm in diameter in 82% of pediatric patients. Furthermore, preoperative MRI measurements can be reliably used to predict a graft of adequate diameter in children and adolescents undergoing ACL reconstruction, with a sagittal thickness of >6.7mm being highly predictive of a final graft size ≥8mm.Table 1.Univariable and multivariable logistic regression models predicting a final graft diameter of 8mm or more. Significant predictors are indicated in bold. 95%CI: 95% Confidence interval, BMI: body mass index.Figure 1.Preoperative knee sagittal proton density-weighted MRI of a 13-year-old boy with ACL tear. Quadriceps tendon sagittal thickness was measure 1cm above the patella. The three layers of the quadriceps tendon (vastus medialis/lateralis, rectus, intermedius) are also visible in this image.

Normative values for ureteral diameter in children.

Assessment of the ureter is a fundamental part of the radiologic evaluation of the urinary tract. Abnormal ureteral dilation warrants further investigation to assess the etiology, which includes obstruction and/or reflux. Despite this fundamental need, there are no established normative values in children based on imaging. To provide normative values for ureteral diameter in pediatric patients with age-related ranges. We retrospectively reviewed all magnetic resonance (MR) urography studies and chose only normal ureters for assessment. The images were analyzed on commercially available software to assess maximum internal diameter. Manual measurements were done in cases where the images were below the resolution for automated assessment. Maximum intraluminal ureteral diameters were measured in upper, mid and lower thirds and the average of the three maximum ureteral diameters was used to obtain the average widest internal ureteral diameter. Multivariable linear regression was performed to test the association between the calculated diameter and gender. Differences in sizes between the left and right ureter were assessed using paired Wilcoxon signed rank test. One hundred twenty-one MR urography studies were selected, which included 160 ureter units. The diameter increases progressively with age, ranging from 3.2mm during infancy to 5.0mm in patients older than 16years of age. After 9years of age, the average widest internal ureteral diameter is slightly larger in males compared to females (odds ratio [OR]=1.91, 95% confidence interval [CI] [1.63, 2.25], P<0.0001). The right ureter was slightly larger than the left (3.9mm vs. 3.7mm, P=0.004) among 39 patients in whom both right and left ureter units were included. The average mid ureteral diameter is widest, followed by the distal third then proximal third. We present the normative values for the average widest internal ureteral diameter based on laterality and different segments. In the pediatric population, 3.8mm should be considered the average widest internal ureteral diameter.

Z-score regression model for coronary artery diameter in healthy Chinese Han children.

Coronary artery distension and aneurysm are complications of Kawasaki disease in children. To develop a Z-score regression model for coronary artery diameter in children that could be used as reference. This retrospective analysis included children with normal heart structure between March 2013 and April 2017. Body surface area (BSA) was calculated. The diameters of the right coronary, left main coronary, left anterior descending, and circumflex arteries were measured by echocardiography. Pearson correlation analysis was used to establish linear, exponential, logarithmic, power, and square root regression models. The analysis included 509 children (280 boys) aged 1 day to 15.2 years. Coronary artery diameters were significantly correlated with age, height, body mass, BSA, and (r = 0.663-0.826; P < 0.05), with a stronger correlation for than BSA (P < 0.05). The adjusted determination coefficients () were higher for the exponential and square root models than for the other models (P < 0.05). The random error term variance was constant for the exponential model (P > 0.05), and processing with the weighted least-square methods eliminated heteroscedasticity in the other models. The Z-scores were normally distributed for the exponential and square root models (P > 0.05). Overall, the square root model was the optimal equation for the calculation of coronary artery Z-score in Chinese Han children. This model could be used to facilitate the diagnosis of coronary artery distension in children with suspected Kawasaki disease.

Esophageal Diameter as a Function of Weight in Neonates, Children and Adolescents: Reference Values for Dilatation of Esophageal Stenoses.

IntroductionEsophageal stenoses are frequent complications after esophageal atresia surgery as well as after acid, alkali and battery ingestion. Worldwide, repeated balloon dilatations are the most frequently performed procedures for these stenoses. In most cases the stenoses can be dilated sufficiently to allow adequate enteral nutrition. Until recently, age dependent esophageal lumen size has not been established; which was aim of the current study.MethodsAll children in whom an esophageal contrast imaging was performed between 1/2011 and 5/2021 were included. The width was measured by two investigators at two measuring points in two planes, the diameter was calculated and plotted against the respective weight of the child. Bland-Altmann plots have confirmed the validity of the measurements of both investigators.ResultsEsophagus diameter was measured in more than 100 children. The resulting curves show a very good correlation with weight (upper measuring point: r = 0.86743, p < 0.0001; lower measuring point: r = 0.80593, p < 0.0001).ConclusionThese results are the first to define the esophageal diameter in children. The results of this study may guide physicians performing esophageal interventions including dilatations in future.

Quadriceps Tendon Autograft in Pediatric ACL Reconstruction: Graft Dimensions and Prediction of Size on Preoperative MRI

Background:There is increased interest in quadriceps autograft anterior cruciate ligament (ACL) reconstruction in the pediatric population.Purpose:To evaluate children and adolescents who underwent ACL reconstruction using a quadriceps autograft to determine the properties of the harvested graft and to assess the value of demographic, anthropometric, and magnetic resonance imaging (MRI) measurements in predicting the graft size preoperatively.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A retrospective database search was performed from January 2018 through October 2020 for patients undergoing ACL reconstruction. Patients <18 years old at the time of surgery in whom a quadriceps tendon autograft was used were selected. Demographic data and anthropometric measurements were recorded, and graft measurements were abstracted from the operative notes. Knee MRI scans were reviewed to measure the quadriceps tendon thickness on sagittal cuts. Graft length and diameter were then correlated with anthropometric and radiographic data.Results:A total of 169 patients (98 male) were included in the final analysis, with a median age of 15 years (range, 9-17 years). A tendon length ≥65 mm was harvested in 159 (94%) patients. The final graft diameter was 8.4 ± 0.7 mm (mean ± SD; range, 7-11 mm). All patients had a graft diameter ≥7 mm, and 139 (82%) had a diameter ≥8 mm. Preconditioning decreased the graft diameter by a mean 0.67 ± 0.23 mm. Age (P = .04) and quadriceps thickness on MRI (P = .003) were significant predictors of the final graft diameter. An MRI sagittal thickness >6.7 mm was 97.4% sensitive for obtaining a graft ≥8 mm in diameter.Conclusion:Our findings suggest that tendon-only quadriceps autograft is a reliable graft source in pediatric ACL reconstruction, yielding a graft diameter ≥8 mm in 82% of pediatric patients. Furthermore, preoperative MRI measurements can be reliably used to predict a graft of adequate diameter in children and adolescents undergoing ACL reconstruction, with a sagittal thickness >6.7 mm being highly predictive of a final graft size ≥8 mm.

New approaches to sonomorphometry of the inferior vena cava in children

Objective: to develop a criterion for normality/abnormality of the inferior vena cava diameter in children that is convenient to use in wide clinical practice.Material. In order to achieve the above objective, we performed measurements of the antero-posterior cross-section of the inferior vena cava in children (n = 100) in different age periods.Results. We have determined a criterion allowing of assessing the normality/abnormality of the inferior vena cava diameter in different age periods with sufficiently high accuracy.Conclusion. The work has concluded on the potential of the use of the coefficient reflecting the ratio of height and diameter (range — 0.04–0.1) as a reliable reference point for the assessment of the normality / abnormality of the inferior vena cava diameter in different age periods.

Normative data for inferior vena cava diameters and collapsibility index in healthy Indian children from a tertiary care hospital of Chennai

Background: An ultrasound evaluation of the inferior vena cava (IVC) collapsibility index (CI) has proven to be an excellent noninvasive method of evaluating hydration in adult patients. There is a lack of normative data on the IVC diameters and CI in Indian children. This study was planned to formulate the normative values for IVC diameter in children and adolescents and to assess its correlation with various somatic parameters in Indian children aged 6 months–16 years. Subjects and Methods: Children aged 6 months–16 years in good general health, normal hydrations, and without any significant underlying medical condition who were coming to hospital for their treatment in the outpatient department were consecutively enrolled in the study. The maximum and minimum diameters of IVC were measured during the expiratory and inspiratory phase of the respiratory cycle, respectively, using M mode ultrasonography. CI was also calculated for each subject. These values were correlated with age, gender, and body surface area (BSA). Results: One hundred patients were enrolled in the study, 48 were boys and 52 were girls. The mean (standard deviation) CI was 23.3% (11.9) among males and 20.1% (11.7) among females. The mean maximum and minimum IVC diameter increased significantly with age (r = 0.738, P = 0.00; r = 0.789 P = 0.000) and with BSA (r = 0.73, P = 0.0001; r = 0.77, P = 0.0001). CI did not show significant correlation with age or BSA. Conclusion: IVC dimensions during inspiration or expiration increases with age and BSA, but same relation does not hold for CI. These values were similar among males and females.

Bedside sonographic measurements of optic nerve sheath diameter in children with diabetic ketoacidosis.

Bedside sonographic assessment of the optic nerve sheath has gained popularity for evaluating intracranial pressure in recent years. To investigate the bedside sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball diameter ratios, which are related with cerebral edema (CE), in children with diabetic ketoacidosis (DKA) before and after treatment. Children aged 12 months to 18 years, who were diagnosed with DKA were included. The ONSD was measured at 3 mm posterior to the globe in the anterior axial transbulbar view. The eyeball transverse diameter (ETD) and eyeball vertical diameter (EVD) were measured and ratios of ONSD/ETD and ONSD/EVD were calculated. Bedside ultrasound (US) examinations were performed at the beginning and at the end of fluid therapy. About 43 patients were enrolled. About 12 (27.9%) patients had mild, 14 (32.6%) moderate, and 17 (39.5%) severe DKA. At baseline, the ONSD measurements and ratios were significantly higher in severe DKA group than in those with mild or moderate DKA group. All ONSD measurements, ONSD/ETD, and ONSD/EVD ratios at the end of therapy were significantly lower compared with baseline measurements. At the end of therapy, ONSD measurements and ratios were similar among DKA severity groups. The ONSD measurements and ratios decreased from the beginning of DKA treatment, which could be considered as an indicator of an increase in intracranial pressure at the time of admission. Ocular US may serve as a promising tool to perform further risk stratification of children with DKA and to identify DKA-related CE.

Vitamin D Status in Children with Idiopathic Dilated Cardiomyopathy

AbstractDilated cardiomyopathy (DCM) is the third leading cause of heart failure in pediatrics. The exact etiology of DCM is unknown in more than half of the cases. Vitamin D receptors are represented in cardiac muscles, endothelium, and smooth muscles of blood vessels suggesting that vitamin D could have a vital cardioprotective function. This study aimed to assess serum level of vitamin D in children with idiopathic DCM and to correlate the serum level of vitamin D with the left ventricular dimensions and function. This study is a descriptive cross-sectional single-center study, includes 44 children of both sexes, diagnosed as idiopathic DCM. Serum level of vitamin D was assessed and correlated with the left ventricular dimensions and function. Mean age of studied children was 6.08 ± 4.4 years. Vitamin D deficiency was found in 90.9% of children with idiopathic DCM with a mean level 13.48 ng/mL. There was a negative correlation between vitamin D level and fraction shortening and left ventricular end-diastolic diameter in children with DCM. Vitamin D level is not only significantly low in children with idiopathic DCM but it is also significantly correlated with the degree of left ventricular dysfunction.

Evaluation of the Relationship between Corneal Diameter and Lens Diameter in Children

Primary intraocular lens (IOL) implantation has gained acceptance for management of infantile cataracts because of the advantage of reduced amblyopia risk. The aim of the study was to investigate the association between corneal diameter as measured from the white-to-white distance and natural lens diameter in children. This association may aid intraocular lens selection following cataract removal in infants and young children. A cross-sectional study was performed on forty eyes from 40 children less than 4 years, who needed to be examined, were planned for a procedure or operation under general anaesthesia. Subjects were recruited from Eye Clinic,Kuala Lumpur General Hospital from January 2010 to September 2011. Corneal diameter was measured with Holladay-Godwin corneal gauge while lens diameter was measured with ultrasound biomicroscope (UBM) during surgery. For the results, mean age of subjects was 24.7 + 12.1 months. Mean corneal diameter was 11.62 + 0.50 mm horizontally and 11.20 + 0.58 mm vertically. Mean horizontal lens diameter was 7.94 + 0.47 mm. A medium positive correlation was found between mean horizontal corneal diameter and lens diameter (r=0.479, p=0.002). Lens diameter had a strong correlation with patient’s age (r=0.718, p&lt;0.001). Lens diameter can be calculated by using this model of equation: [Lens diameter (mm) = 7.010 + 0.021 Corneal Diameter (mm) + 0.028 Age (months)] (r2=0.52). In conclusion, there was a moderate positive correlation between corneal and lens diameter. UBM can be used to measure lens capsular bag size directly preoperatively.