Obstruction In Young Children Research Articles

Intra-breath changes in respiratory mechanics are sensitive to history of respiratory illness in preschool children: the SEPAGES cohort

BackgroundIntra-breath oscillometry has been proposed as a sensitive means of detecting airway obstruction in young children. We aimed to assess the impact of early life wheezing and lower respiratory tract illness on lung function, using both standard and intra-breath oscillometry in 3 year old children.MethodsHistory of doctor-diagnosed asthma, wheezing, bronchiolitis and bronchitis and hospitalisation for respiratory problems were assessed by questionnaires in 384 population-based children. Association of respiratory history with standard and intra-breath oscillometry parameters, including resistance at 7 Hz (R7), frequency-dependence of resistance (R7 − 19), reactance at 7 Hz (X7), area of the reactance curve (AX), end-inspiratory and end-expiratory R (ReI, ReE) and X (XeI, XeE), and volume-dependence of resistance (ΔR = ReE-ReI) was estimated by linear regression adjusted on confounders.ResultsAmong the 320 children who accepted the oscillometry test, 281 (88%) performed 3 technically acceptable and reproducible standard oscillometry measurements and 251 children also performed one intra-breath oscillometry measurement. Asthma was associated with higher ReI, ReE, ΔR and R7 and wheezing was associated with higher ΔR. Bronchiolitis was associated with higher R7 and AX and lower XeI and bronchitis with higher ReI. No statistically significant association was observed for hospitalisation.ConclusionsOur findings confirm the good success rate of oscillometry in 3-year-old children and indicate an association between a history of early-life wheezing and lower respiratory tract illness and lower lung function as assessed by both standard and intra-breath oscillometry. Our study supports the relevance of using intra-breath oscillometry parameters as sensitive outcome measures in preschool children in epidemiological cohorts.

Предикторы рецидивов бронхиальной обструкции у детей раннего возраста

Aim. To provide overview information on predictors of relapses of bronchial obstruction in young children and the likelihood of them developing bronchial asthma in the future. Key points. Over the past few years, more than 280 papers have been published confirming the important role of HLA-G in the regulation of the human immune system, indicating HLA-G antigens as a prognostic factor in the development of various pathological conditions. HLA-G proteins have been shown to be involved in the immune regulation of the pathogenesis of autoimmune and allergic diseases, such as gastrointestinal, skin, neurological and rheumatological diseases, as well as in the pathology of pregnancy. Conclusion. The level of sHLA-G is particularly significant in the development of inflammatory processes in allergic diseases, in particular bronchial asthma, which opens up new opportunities for its use as an important marker of inflammation. In addition, sHLA-G, as an accessible diagnostic indicator, can be effectively introduced into the healthcare system, thereby aiding in the prediction of allergic diseases and monitoring maintenance therapy. Keywords: bronchial asthma, predictors, allergic diseases, HLA-G, children.

Cohort analysis of pediatric intussusception score to diagnose intussusception.

Intussusception is a primary cause of intestinal obstruction in young children. Delayed diagnosis is associated with increased morbidity. Ultrasonography (USG) is the gold standard for diagnosis, but it is operator dependent and often unavailable in limited resource areas. To study the clinical characteristics of intussusception including management and evaluation of the diagnostic accuracy of abdominal radiography (AR) and the promising parameters found in the pediatric intussusception score (PIS). Children with suspected intussusception in our center from 2006 to 2018 were recruited. Clinical manifestations, investigations, and treatment outcomes were recorded. AR images were interpreted by a pediatric radiologist. Diagnosis of intussusception was composed of compatible USG and response with reduction. The diagnostic value of the proposed PIS was evaluated. Ninety-seven children were diagnosed with intussusception (2.06 ± 2.67 years, 62.9% male), of whom 74% were < 2 years old and 37.1% were referrals. The common manifestations of intussusception were irritability or abdominal pain (86.7%) and vomiting (59.2%). Children aged 6 mo to 2 years, pallor, palpable abdominal mass, and positive AR were the parameters that could discriminate intussusception from other mimics (P < 0.05). Referral case was the only significant parameter for failure to reduce intussusception (P < 0.05). AR to diagnose intussusception had a sensitivity of 59.2%. The proposed PIS, a combination of clinical irritability or abdominal pain, children aged 6 mo to 2 years, and compatible AR, had a sensitivity of 85.7%. AR alone provides poor screening for intussusception. The proposed PIS in combination with common manifestations and AR data was shown to increase the diagnostic sensitivity, leading to timely clinical management.

Непрохідність тонкої кишки продуктами харчування в дітей раннього віку: погляд на проблему, літературні дані та власні клінічні спостереження

Purpose - to improve the results of treatment of young children with small intestinal obstruction due to the introduction of informative imaging technologies and modern video treatment technologies; to present own clinical observations of food-related obstruction of the digestive tract in young children and their treatment. The article provides a review of the literature on small intestinal obstruction caused by food in young children. Only four cases have been established. There are 2 cases of food obstruction (corn kernels, pineapple, red fish) in children under 3 years of age. Based on my own experience, the use of the term «phytobezoar» in the treatment of small intestinal obstruction is substantiated. All underwent surgical treatment: 1 - laparotomy, 1 - laparoscopic. All children recovered and were discharged from the clinic. The diagnosis and verification of food-related intestinal obstruction in young children is primarily based on the results of a thorough history. It is advisable to use the following methods in order to verify the location of the obstruction and establish the factor: X-ray examination of the organs of the abdominal cavity, both during hospitalization and during the course of the disease, CT scan, as well as ultrasound of the abdominal cavity. The presence of doubts in determining the cause of small intestinal obstruction is an indication for diagnostic laparoscopy. The interpretation of the term phytobezoar should have a basis, taking into account the time of obstruction and stay of the product in the digestive system, conditions and types of food. The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent from the child’s parents was obtained for the research. No conflict of interests was declared by the authors.

Intestinal obstruction caused by acute perforated appendicitis misdiagnosed as Hirschsprung’s disease in a 31-month-old boy

Symptomatic abdominal distension in young children requires a differential diagnosis, such as overeating, constipation or surgical emergency. If the distension is associated with intestinal obstruction, clinicians should determine the cause, such as adhesion, hernia, tumor or inflammatory lesions. Herein, the author reports a case of intestinal obstruction caused by acute perforated appendicitis. A 31-month-old boy was referred with a 10-day history of abdominal distension and a presumptive diagnosis of Hirschsprung’s disease. He had undergone an unsuccessful enema. Initial plain radiography and computed tomography showed severely dilated bowel loops with the colon collapsed. During laparotomy, the perforated appendix was found attached to the retroperitoneum and mesentery, which resulted in ileal stenosis with ischemia. The author resected 10 cm of the ileum, and performed ileocecectomy. Postoperatively, the boy recovered uneventfully, except wound seroma. Due to the low incidence and vague symptoms, it is difficult to diagnose intestinal obstruction caused by appendicitis, particularly in young children. This case may serve as a reminder that acute perforated appendicitis can cause sudden onset of intestinal obstruction in young children without a history of surgery.

Usefulness of ultrasonography in diagnosis of intestinal obstruction by a water bead

Water beads are dangerous foreign bodies causing intestinal obstruction in young children because the beads absorb water and are radiolucent. Although the features lead to progressive intestinal obstruction, it is difficult to diagnose ingestion of the beads by imaging studies. For the diagnosis, ultrasonography is safe, fast, and accurate. The imaging modality can show intestinal water beads as spherical, anechoic, smoothly demarcated cysts. This characteristic finding may be more useful in rapid and accurate diagnosis than computed tomography scan. We report a case of an 8-month-old boy who obtained a timely sonographic diagnosis of water bead-induced small bowel obstruction in the emergency department.

Surgical treatment of Littre hernia in a 6-month old child

Introduction. A surgical care in complicated hernias of the anterior abdominal wall remains an acute issue in pediatric surgery. Strangulated hernia is the most common and dangerous complication. It is worth mentioning that the risk of developing this complication in children during the first six months of their life reaches 24%. The clinical course of strangulated hernia in children is characterized by a large variety of symptoms depending on patient’s age, anatomical and pathomorphological features of his/her organs and systems. A correct assessment of clinical, laboratory and instrumental findings can help in identifying uncommon types of hernia infringement.Material and methods. A case of clinical observation and surgical treatment of a 6-month old child with Littre hernia is presented.Results. By the literature data, emotional and motor restlessness prevails in the structure of complaints in infants with strangulated hernia. Patients with uncommon types of hernia infringement may be regarded as a separate group. Patients with Littre hernia, which is one of the types of parietal infringement, belong to this group. Littre hernia incidence does not exceed 0.5% of the total number of hernia strangulations. Clinical symptoms of the atypical hernia infringement may be mild or non-classical. It is known that mild clinical manifestations of strangulated hernia as well as limited diagnostic potentials of laboratory, X-ray and ultrasound examinations in young children increase the risk of developing destructive changes in the intestinal wall. Therefore, an active surgical tactics of hernia treatment prevents the development of atypical forms of hernia infringement and complications associated with it.Conclusion. Thus, early detection of hernias of the anterior abdominal wall, since the neonatal period, an adequate observation tactics and timely performed surgical intervention is the basis for preventing peritonitis and intestinal obstruction in young children.

Diagnostic Accuracy of Point-Of-Care Ultrasound for Intussusception Performed by Pediatric Emergency Medicine Physicians.

Intussusception (INT) is a common cause of bowel obstruction in young children. Delay in diagnosis can lead to significant morbidity and mortality. There have been several studies evaluating early point-of-care ultrasound (POCUS) in the diagnosis of INT by nonradiologists. Our objective was to determine the diagnostic accuracy of POCUS by novice sonographer pediatric emergency medicine physicians (PEM-Ps) who received focused US training for diagnosing INT. We performed a prospective observational study including 17 PEM-Ps (14 attendings, 3 fellows) trained to perform abdominal US for INT. Children suspected of having INT received POCUS performed and interpreted by a PEM-P, followed by a US study performed by a certified ultrasonographer and interpreted by an attending pediatric radiologist. Diagnostic concordance between PEM-P-and radiology-performed US (RPUS) results was assessed. One hundred patients were enrolled; median patient age was 24months. There was excellent diagnostic agreement for presence or absence of INT between PEM-Ps and RPUS (97% of cases; κ=0.826). POCUS-diagnosed INT was present in 8 of 9 patients with RPUS-diagnosed INT (sensitivity 89%; 95% confidence interval [CI] 51-99%; specificity 98%; 95% CI 92-100%; positive predictive value 80%; 95% CI 44-96%; negative predictive value 99%; 95% CI 93-100%). Likelihood ratio for INT with a positive POCUS was 40.44 (95% CI 10.07-162.36) and with a negative POCUS was 0.11 (95% CI 0.02-0.72). POCUS performed by novice sonographers to diagnose INT has high diagnostic concordance with RPUS. Emergency department-performed POCUS is a rapid and accurate method for diagnosing INT.

Mothers’ Knowledge and Reported Practice Regarding Inhalation Therapy for their Children Suffering from Croup

Background: Croup is one of the most common causes of upper airway obstruction in youngchildren. It is characterized by sudden onset of barky cough, hoarse voice, inspiratory stridor andrespiratory distress caused by upper airway inflammation secondary to a viral infection. Mothers’Knowledge and Reporting Practice constitute a major factor in helping to achieve successful control ofcroup in children. Aim: assess mothers' knowledge and reported practice regarding inhalation therapyfor their children suffering from croup. Design: A descriptive analytic design was used to accomplishthis study. Settings: The study was carried out in inpatient units at pediatric department and outpatientpediatric clinic affiliated to Benha University Hospital and Benha Specialized Pediatric Hospital.Subjects: A convenient sample of 100 mothers accompanying their children with croup at previouslymentioned settings. Tools of data collection: Two tools were used: Tool (1) Arabic StructuredInterviewing Questionnaire Sheet including two parts: a) Mothers and children characteristics. b)Mother’s knowledge about croup and inhalation therapy. Tool (2) Observational check lists, to assessmother's reported practice regarding inhalation therapy, physiotherapy and care of fever. Conclusion:More than half of the studied mothers had inadequate knowledge and unsatisfactory level of practiceabout croup and inhalation therapy .The low knowledge and incorrect practice of mothers mostlyaffected by residence (rural), low educational level of mother, age (less than 30 years and more than 40years), occupational status (housewives) and dis attending training courses. The study recommendedand emphasized the importance of: Improve the knowledge and practice of mothers' by provideadequate education to mothers' about croup cause, signs , symptoms, risk factors, complications andtreatment with focus on inhalation therapy by encourage the role of media, nongovernmentalorganization and health workers

Practical Imaging Strategies for Intussusception in Children.

OBJECTIVE. Intussusception is the most common cause of intestinal obstruction in young children. Radiology has a key role in its diagnosis and treatment. This systematic review summarizes the currently available evidence for best practices in radiologic management of pediatric intussusception. CONCLUSION. High diagnostic accuracy and lack of ionizing radiation make ultrasound (US) the preferred imaging modality for diagnosing intussusception. For intussusception reduction, fluoroscopy-guided pneumatic enema and US-guided hydrostatic enema are equally dependable and safe techniques. The areas that warrant further research in this field include the efficacy and safety of the US-guided pneumatic enema, potential benefits of sedation and general anesthesia for the reduction procedure, and the optimal management of intussusceptions potentially involving pathologic lead points.

Diagnostic Accuracy of Point-of-Care Ultrasound for Intussusception in Children Presenting to the Emergency Department: A Systematic Review and Meta-analysis.

IntroductionIleocolic intussusception is a common cause of pediatric bowel obstruction in young children but can be difficult to diagnose clinically due to vague abdominal complaints. If left untreated, it may cause significant morbidity. Point-of-care ultrasound (POCUS) is a rapid, bedside method of assessment that may potentially aid in the diagnosis of intussusception. The purpose of this systematic review and meta-analysis was to determine the diagnostic accuracy of POCUS for children with suspected ileocolic intussusception by emergency physicians (EP).MethodsWe conducted a systematic search on PubMed, Embase, CINAHL, LILACS, the Cochrane databases, Google Scholar, as well as conference abstracts, and assessed bibliographies of selected articles for all studies evaluating the accuracy of POCUS for the diagnosis of intussusception in children. We dual extracted data into a predefined worksheet and performed quality analysis with the QUADAS-2 tool. Data were summarized and a meta-analysis was performed.ResultsSix studies (n = 1303 children) met our inclusion criteria. Overall, 11.9% of children had intussusception. POCUS was 94.9% (95% confidence interval [CI], 89.9% to 97.5%) sensitive and 99.1% (95% CI, 94.7% to 99.8%) specific with a likelihood ratio (LR)+ of 105 (95% CI, 18 to 625) and a LR− of 0.05 (95% CI, 0.03 to 0.10).ConclusionPOCUS by EPs is highly sensitive and specific for the identification of intussusception for children presenting to the emergency department.

Radiographic findings predictive of irreducibility and surgical resection in ileocolic intussusception.

Ileocolic intussusception is a common cause of intestinal obstruction in young children. Radiographs may be of limited value in the diagnosis of intussusception and are sometimes utilized primarily to exclude pneumoperitoneum before therapeutic enema reduction. The goal of this study was to determine if radiographic findings in ileocolic intussusception can offer prognostic information regarding the outcome of therapeutic air enema and, for those requiring surgical intervention, surgical outcomes and/or complications. A single institution retrospective study was performed including all enemas for intussusception performed during a 5-year period from September 2012 to August 2017. Radiographs obtained before therapeutic enema, including our institution radiographs, outside facility radiographs, or scout images obtained during fluoroscopy or computed tomography (CT), were independently scored by two pediatric radiologists for normal bowel gas pattern, soft-tissue mass, paucity of bowel gas, meniscus sign and bowel obstruction. The reviewers were blinded to enema and surgical outcomes at the time of review. Differences were resolved by consensus. Cases were excluded in which there was no adequate pre-procedure radiograph. In total, 182 cases were reviewed. The medical records were reviewed for enema and surgical outcomes. Radiographic findings included normal bowel gas pattern in 13%, soft-tissue mass in 26%, paucity of bowel gas in 65%, meniscus sign in 12% and obstruction in 10% of the cases, with 17.5% of patients having more than one finding. In patients with bowel obstruction on radiographs, there was a statistically significant decrease in success of therapeutic enema (83% vs. 21%, P=0.0001), increase in complicated surgical reductions (47% vs. 4%, P=0.0012), and increase in bowel resection (42% vs. 4%, P=0.003) compared to patients with normal bowel gas pattern. Radiographs can offer prognostic information regarding the potential for therapeutic enema success, as well as potential surgical outcomes in patients failing enema reduction. Particularly, bowel obstruction significantly decreases the success of therapeutic enema and increases the need for bowel resection.

Comparison Between Small and Large Bowel Intussusception in Children: The Experience of a Large Tertiary Care Pediatric Hospital.

Intussusception is the most common cause of intestinal obstruction in young children, and delayed diagnosis may lead to serious sequelae. The objective of this study was to determine the prevalence of ileoileal intussusception and to document and compare clinical outcomes with ileocolic intussusception. A retrospective cohort study of children with an abdominal ultrasound that diagnosed intussusception. Clinical data and diagnostic studies were retrieved, to compare ileoileal with ileocolic intussusception. A total of 488 patients were evaluated with an abdominal ultrasound on suspicion of intussusception; 54 (11%) had ileoileal intussusception and 30 (6%) ileocolic intussusception. The significant features distinguishing the 2 conditions were fever, more common in patients with ileoileal intussusception, and an abdominal mass, which was papable more commonly in ileocolic intussusception. None of the ileoileal intussusception patients required surgical intervention, and all were discharged without complication. With recent advances in abdominal ultrasound, the diagnosis of ileoileal intussusception has become easier than before. Patients presenting with small bowel intussusception may not need any immediate intervention. The presence of fever supports the diagnosis of ileoileal intussusception.

The epidemiology of childhood intussusception in South Korea: An observational study.

Intussusception is one of the most common causes of intestinal obstruction in young children. We report a retrospective, observational study of the epidemiology of intussusception in South Korea using the National Health Insurance Service-National Sample Cohort (NHIS-NSC). A cohort of newborns born between 2002 and 2008 was selected. The primary objective was to assess the incidence of intussusception in the pediatric population of Korea. The secondary objectives were to describe the basic epidemiological characteristics of intussusception and to identify risk factors. A total of 362 children were identified. The highest incidence of intussusception (2.6 per 1,000) was observed in children aged 1–2 years. A total of 58.8% of the children were male, and there was no significant difference in incidence according to the birth year (P = 0.804). Most of the children diagnosed with intussusception underwent air reduction, while only 0.6% had surgery. In all, 82.3% of the children were admitted to the hospital, 0.8% of them had to be admitted to the ICU, and the 6-month mortality was only 0.3%. In this retrospective, observational study, the incidence of intussusception was highest among children between 1 and 2 years of age. Most of the children underwent air reduction.

Fever as a Presenting Symptom in Children Evaluated for Ileocolic Intussusception: The Experience of a Large Tertiary Care Pediatric Hospital.

Intussusception is the most common cause of intestinal obstruction in young children, and delayed diagnosis may lead to bowel perforation. The objective of this study was to determine the prevalence of fever in patients with ileocolic intussusception and to determine its utility as a predictive symptom. This was a 3-year retrospective study, at a tertiary care center, of children aged 1 month to 6 years, presenting with possible intussusception. Charts were reviewed for clinical signs and symptoms at presentation, and all diagnostic studies were retrieved. A pediatric radiologist reviewed all ultrasounds. A total of 488 ultrasounds were performed on suspicion of intussusception. In 30 patients with confirmed ileocolic intussusception, mean age was 27 months and all were successfully reduced by air enema. Of 118 patients with fever, 2 had confirmed intussusception, 1 with pneumonia and 1 with acute otitis media, compared with 116 febrile patients with negative ultrasounds (P < 0.05). Traditional teaching is that intussusception presents as intermittent colicky abdominal pain, red currant jelly stool, vomiting, and a palpable abdominal mass, but it is important to remember that this classic triad is a very late finding and this condition should be recognized before the development of these findings. The concurrence of fever can help to rule out the possibility of intussusception and prompt the health care professional to search diligently for alternative infectious etiologies but cannot eliminate the possibility, especially when other findings suggestive of intussusception are present.

Clinical case of tuberculosis in infant with bronchial obstructive syndrome

The objective of this article is to improve the etiology verification of the obstruction in young children by informing the physicians about the rare causes of obstructive syndrome which are difficult to diagnose, in particular about tuberculosis. Analyzed the clinical and medical history girls 6 months, presented data on the treatment and examination of the patient. The survey revealed that the main pathogenetic mechanism of bronchial obstruction of airway compression was increased bronchopulmonary lymph nodes on the background of specific tubercular process in lungs.

Acute management of croup in the emergency department.

Croup is one of the most common causes of upper airway obstruction in young children. It is characterized by sudden onset of barky cough, hoarse voice, inspiratory stridor and respiratory distress caused by upper airway inflammation secondary to a viral infection. Published guidelines for the diagnosis and treatment of croup advise using steroids as the mainstay treatment for all children who present to emergency department (ED) with croup symptoms. Dexamethasone, given orally as a single dose at 0.6 mg/kg, is highly efficacious in treating croup symptoms. Despite the evidence supporting the use of steroids as the cornerstone of croup treatment, there is significant practice variation among physicians treating croup in the ED. This practice point discusses evidence-based management of typical croup in the ED.

The Case Files

The Case Files

Assessment of Airway Bronchodilation by Spirometry Compared to Airway Obstruction in Young Children with Asthma.

A reversibility test by an increase of greater than 12% in FEV1 can support a diagnosis of asthma and alter a patient's treatment plan but may not be applicable to the young ages. We retrospectively gathered spirometric data from 85/271 asthmatic children having mild obstruction (FEV1 > 80% predicted), age 2.6–6.9 years. Spirometry was performed before and 20 min after inhalation of 200 mcg Albuterol. We defined a deviation below −1.64 z scores from control as obstruction and an increased above 1.64 scores from control as a positive response to bronchodilators. Sensitivity of the index was considered significant if it captured >68% of the participants. The sensitivity of detecting airway obstruction in these children by FEV1 was 15.3% and 62.4% by FEF25–75. A positive response to Albuterol was an increase of 9.2% for FEV1 (12% for adults) and 18.5% for FEF25–75. The sensitivity for detecting a response to Albuterol in mild asthma was 64.7% by FEV1 and 91.8% by FEF25–75. Young children having normal spirometry can demonstrate airway reversibility. The response of spirometry parameters to bronchodilators may be more sensitive than obstruction detection and may help to support the diagnosis of asthma and adjust treatment plan.

Hydrostatic Reduction With Barium Enema Is A Preferred Treatment Option for Uncomplicated Intussusception : Five Years Experience in Cmch

Intussusception is a common cause of intestinal obstruction in young children and is a common emergency in infants and children. Hydrostatic reduction of intussusception is a less invasive procedure for both diagnosis and treatment of it. We describe our experience with hydrostatic reduction of intussusception. A retrospective review of the patients of Intussusception admitted in the department of Pediatric Surgery Chittagong Medical College Hospital (CMCH) Chittagong, Bangladesh from January 2009 to December 2013 was done. Patients underwent hydrostatic reduction were evaluated separately. Data were analyzed with regard to success and failure of hydrostatic reduction, necessitating laparotomy, complication and mortality. There were 231 patients of Intussusception. Age range was lmonth to 15 years with median age of 8 months. Male to Female ratio was 2.9:1. Mean duration of presentation was 40 hours after onset of symptoms. Hydrostatic reduction was attempted in 142 patients and was successful in 107 patients, 35 patients needed surgery in whom per-operative manual reduction was done in 28 patients and intestinal resection anastomosis was done in in 7 patients. There were 2 cases of recurrence following hydrostatic reduction and no case of perforation due to hydrostatic reduction. 2 patients died following&#x0D; JCMCTA 2015 ; 26 (1) : 9-13