Pressure In Children Research Articles

Cardiovascular Safety and Hemostatic Efficacy of Topical Epinephrine in Children Receiving Zirconia Crowns.

The primary aim of this study was to determine the cardiovascular safety of topical racemic epinephrine pellets by measuring heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure in children receiving dental care under general anesthesia. The secondary aim was to assess clinical efficacy by measuring time to reach adequate hemostasis. For this pilot study utilizing a split-mouth randomized design, 13 patients requiring prefabricated zirconia crowns on both primary maxillary first molars were recruited. Patients received continuous infusions of propofol and remifentanil with 50-70% inhaled nitrous oxide and oxygen. After randomization and tooth preparation, either saline pellets (control) or racemic epinephrine pellets (experimental) were applied directly to gingival tissue. Vital signs were recorded for 5 minutes. The procedure was repeated on the contralateral side using the alternative (control or experimental) treatment. Topical racemic epinephrine compared to saline produced a significantly larger decrease in mean diastolic blood pressure (-11.1% vs -3.9%; P < .01) and mean arterial pressure (-8.1% vs -2.1%; P < .01), although all noted decreases in cardiovascular variables were clinically insignificant. All experimental treatment teeth achieved adequate hemostasis after 2.2 minutes. Only 5 of the 13 control treatment teeth achieved adequate hemostasis during the 5-minute observation period (1.6 vs 4.2 minutes; P = .01). Overall, we conclude that use of topical racemic epinephrine pellets did not result in adverse cardiovascular effects and hemostasis was reached more quickly and predictably compared to saline pellets.

Hemoglobin and hematocrit levels are positively associated with blood pressure in children and adolescents 10 to 18\xa0years old

To investigate the associations between hemoglobin (Hb) concentration and hematocrit (Hct), and blood pressure (BP) in children and adolescents. The study population consisted of 7950 subjects total (4229 boys and 3721 girls) aged 10–18 years who participated in the Korea National Health and Nutrition Examination Surveys conducted between 2007 and 2017. The prevalence of hypertension was 19.19% (21.51% for boys and 16.5% for girls) among the study population, and the prevalence of obesity was 9.59% (10.5% for boys and 8.6% for girls). Hb count and Hct tended to increase with the degree of obesity and BP elevation. Systolic BP (SBP) and diastolic BP (DBP) positively correlated with Hb count and Hct in both sexes. Following multiple linear regression analysis, Hb count and Hct presented a positive association with SBP and DBP after adjusting for age, BMI SDS, alcohol consumption, smoking status, physical activity, rural residence, household income, diagnosis of T2DM, hypertension, and dyslipidemia. Hb count and Hct were positively associated with SBP and DBP in children and adolescents 10–18 years old.

Children’s online learning during COVID-19 pandemic: experiences and satisfaction encountered by Indian parents

Background: Online learning by children is pressure for children as well as parents. The Covid-19 lockdown was ended up putting much stress on parents in India. The current study aimed to assess the parental experience and satisfaction on online learning for their children during Covid -19 pandemic lockdown.&#x0D; Methods: A cross-sectional web-based survey was conducted among 300 parents of children who attended online learning during the COVID -19 pandemic lockdown. The data was collected using the snowball sampling technique. The survey tool consists of a sociodemographic questionnaire, self-report scales on parent's satisfaction and experiences. The collected data were analyzed using descriptive statistics, including mean, frequency, percentage, and inferential statistics such as the Chi-square test.&#x0D; Results: Out of 300 parents surveyed, 72% were mothers, 65.6% of children who attended online classes were from primary class, through zoom platform (52.2%) using an android mobile phone (71.1%) for a mean duration of 180±30 minutes. 80.4% of parents preferred the traditional learning method comparing to online classes for their children. More than half (52.2%) of parents reported that they were partially satisfied with children's online learning, whereas 26% were not satisfied. More than half of the parents (61.1%) experienced a great challenge and burden of online learning.&#x0D; Conclusion: Parents were worried that prolonged exposure to screen devices in online learning might affect child health's visual, physical, and psychological aspects.

Predicting critical closing pressure in children with obstructive sleep apnea using fluid-structure interaction.

Surgical treatment of obstructive sleep apnea (OSA) in children requires knowledge of upper airway dynamics, including the closing pressure (Pcrit), a measure of airway collapsibility. We applied a flow-structure interaction (FSI) computational model to estimate Pcrit in patient-specific upper airway models obtained from magnetic resonance imaging (MRI) scans. We sought to examine the agreement between measured and estimated Pcrit from FSI models in children with Down syndrome. We hypothesized that the estimated Pcrit would accurately reflect measured Pcrit during sleep and therefore reflect the severity of OSA as measured by the obstructive apnea-hypopnea index (AHI). All participants (n = 41) underwent polysomnography and sedated sleep MRI scans. We used Bland-Altman plots to examine the agreement between measured and estimated Pcrit. We determined associations between estimated Pcrit and OSA severity, as measured by AHI, using regression models. The agreement between passive and estimated Pcrit showed a fixed bias of -1.31 [confidence interval (CI) = -2.78, 0.15] and a nonsignificant proportional bias. A weaker agreement with active Pcrit was observed. A model including AHI, gender, an interaction term for AHI, and gender and neck circumference explained the largest variation (R2 = 0.61) in the relationship between AHI and estimated Pcrit (P < 0.0001). Overlap between the areas of the airway with the lowest stiffness, and areas of collapse on dynamic MRI, was 77.4 ± 30% for the nasopharyngeal region and 78.6 ± 33% for the retroglossal region. The agreement between measured and estimated Pcrit and the significant association with AHI supports the validity of Pcrit estimates from the FSI model.NEW & NOTEWORTHY We present a noninvasive method for estimating critical closing pressure (Pcrit) using fluid-structure interaction (FSI) simulations and magnetic resonance imaging (MRI) scans in patients with obstructive sleep apnea (OSA). We used patient-specific stiffness measures in our FSI model to account for any individual variability in the elasticity of soft tissues surrounding the upper airway. We validated this model by measuring the degree of agreement between measured and estimated Pcrit.

Features of the daily blood pressure in children with diabetes depending on the duration of the disease

Background. The presence of hypertension, which in diabetic patients occurs 2 times more often than in the general population, increases the risk of cardiovascular complications. The main tool for the diagnosis of hypertension in children is ambulatory blood pressure monitoring (ABPM) due to the fact that a number of ABPM parameters may act as predictors of the deve­lopment of cardiovascular events. The purpose was to establish the features of the daily blood pressure in children with diabetes depending on the duration of the disease. Materials and methods. The paper investigated the features of the daily arterial pressure in 53 children (mean age 14.79 ± 0.25 years) with diabetes mellitus, according to the ABPM data. Depending on the duration of the disease, there were 3 groups: group 1 — 11 children with disease duration of up to 1 year, group 2 — 19 persons with disease duration of 1–5 years, and group 3 — 23 patients with disease duration of more than 5 years. The control group consisted of 20 children, representative by the age and sex, who had no disorders of carbohydrate metabolism and intercurrent diseases. Results. In children with diabetes, with an increase in the duration of the disease, there was an elevation in the blood pressure, its variability and the index of hypertension. Hypertension occurred in 21.0 % of patients with duration of diabetes from 1 to 5 years and in 43.5 % of persons with disease duration of more than 5 years. Identified changes occurred on the background of the circadian blood pressure changes, which took place during the first year of the disease and observed in 51.0–54.5 % of patients. Among the pathological profiles of nocturnal blood pressure reduction in patients with diabetes mellitus, the non-dipper type prevailed (43.5–47.4 %). Conclusions. The majority of patients with diabetes mellitus experienced changes in blood pressure, the first signs of which were registered in the first year of the disease and progressed with an increase of its the duration. The findings suggest that children with diabetes, regardless of the duration of the disease, should be classified as high risk for developing hypertension.

Fluid intake and blood pressure in children: the Salus per Aquam project.

Sodium intake is known to contribute to the development of hypertension, thus intake reduction is a cornerstone in the prevention and management of hypertension. The increase in renal sodium excretion might represent a further potential preventive and/or therapeutic opportunity. To explore the working hypothesis that an increased fluid intake can improve renal sodium handling towards a decrease in blood pressure. The SPA Project is a multicenter, observational, cross-sectional, cohort study investigating healthy children, aged 5-8 years as to sodium and fluid intake by means of urinary sodium and creatinine from multiple samples taken in different days in order to characterize them in lower/higher sodium and lower/higher fluid intake. Both SBP and DBP (by multiple office blood pressure measurements) were used as outcome measures. Three hundred and thirty-nine healthy, nonoverweight children (51.6% boys) with a median age of 5.7 years old (IQR: 5.3-6.2) participated in the study but only 223 could be analyzed. Among children with higher sodium intake, those introducing more fluids, showed a significantly lower blood pressure (both systolic and diastolic) compared with those with lower fluid intake: systolic 86.0 ± 8.5 vs. 90.0 ± 8.1 mmHg; P = 0.014 and diastolic: 53.8 ± 4.9 vs. 58.6 ± 6.6 mmHg; P < 0.0001. An increased fluid intake is associated with a reduced blood pressure possibly by increasing renal sodium excretion. We speculate that this simple, highly acceptable, inexpensive, and harmless measure might have a role in preventing and/or minimizing the epidemics of hypertension and of its related morbidities both in children and in adults.

Short-Term Particulate Matter, Ultrafine Particles, and Blood Pressure among Children of the CorPuScula Study in Munich, Germany

BACKGROUND AND AIM: Short-term changes in particulate matter (PM) have been linked to blood pressure, but limited evidence exists on effects among children and for ultrafine particle (UFP) exposures. METHODS: We used data from 50 children (ages 6-10) in the German CorPuScula study, in which children attended up to 30 school health examinations in 2001 and 2002. Systolic and diastolic blood pressure (SBP and DBP, respectively; mmHg) were collected at each examination after children had rested for at least 5 minutes. PM10 (diameter ≤10 µm; µg/m3) and PM2.5 (diameter ≤2.5 µm; µg/m3) levels were measured at school using a low volume sampler for the entire study period, and UFPs (n/mL) were measured for six months using a particle counter. All exposures were evaluated for same-day working-hours (9:00-21:00) as well as one- and two-day lags, with UFPs also assessed for the 1-, 3-, 12-, and 24-hours prior to examination. Associations between air pollutants and blood pressure were evaluated using mixed linear regression models with a random participant intercept and adjusted for weekday as well as study day and physiological equivalent temperature index using natural cubic splines. Multipollutant models were conducted adjusting for centrally-monitored NO2. RESULTS:For the PM data (nobs=1,079; average 22 observations/child), median daily PM2.5 levels were 12.7 µg/m3. In the UFP data (nobs=420; average 8 observations/child), median daily UFP exposures were 21,544 particles/mL. We observed positive associations between PM and SBP that attenuated slightly upon adjustment for NO2, with strongest associations for 2-day lags (e.g., 1.45 mmHg [95% Confidence Interval: 0.78, 2.11] increase in SBP per 13.4 µg/m3 increase in PM2.5). PM10 was weakly inversely associated with DBP. No associations between UFP exposures and either outcome were apparent. CONCLUSIONS:While positive associations were observed between PM and SBP, we observed no evidence that UFP exposure influences blood pressure in children. KEYWORDS: Children's environmental health, Short-term exposure, Air pollution, Cardiovascular diseases, Multi-pollutant

Hypertension among South African children in disadvantaged areas and associations with physical activity, fitness, and cardiovascular risk markers: A cross-sectional study

ABSTRACT Childhood hypertension drives hypertension in later life; hence, assessing blood pressure in children is an important measure to determine current and future cardiovascular health. There is, however, a paucity of childhood blood pressure data, particularly for sub-Saharan Africa. This study explores blood pressure and associations with age, sex, socioeconomic status, physical activity, fitness, and cardiovascular risk markers. In the ‘Disease, Activity and Schoolchildren’s Health’ (DASH) study, a cross-sectional analysis was conducted in disadvantaged neighbourhoods in the Eastern Cape province of South Africa. Assessments included blood pressure, accelerometer-measured physical activity, physical fitness, and cardiovascular risk markers. The study consisted of 785 children (383 boys, 402 girls, M = 12.4±0.9 years). Overall, 18% of the children were classified as hypertensive, while 20% were either overweight/obese, and almost four out of ten children did not meet global daily physical activity recommendations. Hypertensive children were more likely to be overweight/obese, χ2 (2,785) = 14.42, p < 0.01, but only if they did not meet physical activity recommendations, χ2 (2,295) = 11.93, p < 0.01. Considering the moderating effect which sufficient activity has on the relationship between hypertension and body weight, more emphasis should be placed on early primary health intervention and education strategies.

High blood pressure in children and adolescents from urban peripheral areas of La Plata, Argentina

Objective: The aim of the present study was to estimate the prevalence of high blood pressure in schoolchildren aged 4-14 years from urban peripheral areas of the city of La Plata, and analyze variations in high blood pressure prevalence by sex, age, excess weight and family socioeconomic status. Materials and methods: Systolic and diastolic blood pressure, body weight and height were measured in 3,312 schoolchildren of both sexes. The prevalence of high blood pressure (HBP), overweight and obesity was calculated. Socioeconomic information was obtained through a semi-structured survey and processed by categorical principal-component analysis. The prevalence of HBP was compared with sex, age and nutritional status (chi square test) and family socioeconomic status (generalized linear model) (p&lt; 0.05.). Results: The results showed that the prevalence of HBP, was 20.5% and that it varied by age, nutritional status and family socioeconomic status. Sexual differences were observed only in HBP obese schoolchildren. Conclusions: Children and adolescents living in urban peripheral areas of the city of La Plata, Argentina, presented higher HBP prevalence. While HBP prevalence was higher among overweight/obese children, those aged &gt;8 years and those of more favorable family socioeconomic status, sex did not affect HBP development. However, when HBP was analyzed associated with nutritional status, obese boys were more likely to have HBP than girls.

Parental history of arterial hypertension and arterial pressure in children of persons with early ischemic heart disease

Background and Aims: To investigate the associations between parental status of arterial hypertension (AH) and levels of systolic (SBP) and diastolic (DBP) blood pressure in children of individuals with early (onset ≤55, men; ≤60, women, years) ischemic heart disease.

Prevalence and correlation of vitamin D deficiency and high blood pressure in primary and middle school students in Chongqing

Objective To understand the status of vitamin D deficiency and high blood pressure in primary and middle school students aged 7 to 17 years old in Chongqing, and to explore the correlation between vitamin D deficiency and high blood pressure in children and adolescents. Methods From 2016 to 2017, a total of 1 360 primary and middle school students, aged 7 to 17 years old, were selected from three rural and three urban sites in Chongqing using multi-stage stratified random sampling. This study carried out a questionnaire survey, and participants underwent a physical examination which included blood pressure and serum vitamin D assessments. Results The deficiency and insufficiency rates of vitamin D were 9.71%, and 62.57%, respectively. The high blood pressure rate was 25.88%. Multivariate Logistic regression analysis showed that after adjusting for age, economic status, waist circumference, BMI classification, and family history of hypertension, the risk of hypertension was 1.42 times that of the normal group ( P<0.05), and the risk of high systolic blood pressure was 1.59 times that of the normal group ( P<0.05). Conclusion The deficiency and insufficiency rate of vitamin D among children and adolescents aged 7 to 17 years old in Chongqing was high, and the phenomenon of high blood pressure was prominent. Students with vitamin D deficiency and insufficiency were more likely to have high blood pressure. 【摘要】 目的 了解重庆市中小学生维生素 D 缺乏和血压偏高现况及其相关性, 为有针对性防治儿童高血压的发生发展 提供参考依据。 方法 2016 年 10 月至 2017 年 1 月, 通过多阶段分层随机抽样在重庆市选择 3 个农村点和 3 个城市点共 1 360 名 7~17 岁中小学生, 开展问卷调查、体格测量、血压测量和血清维生素 D 检测。 结果 中小学生维生素D缺乏率为 9.71%, 不足率为 62.57%; 血压偏高率为 25.88%。多因素 Logistic 回归分析结果显示, 调整了年龄、经济状况、腰围和体质 量指数 (BMI) 分类、高血压家族史等因素后, 维生素 D 缺乏和不足组发生高血压的风险是正常组的 1.42倍, 收缩压偏高的 风险是正常组的 1.59倍 ( P 值均<0.05)。 结论 重庆市中小学生维生素 D 缺乏和不足、血压偏高现象较突出, 需引起关 注。维生素 D 不足和缺乏者较容易出现血压偏高。

Hemodynamic and prognostic impact of the diastolic pulmonary arterial pressure in children with pulmonary arterial hypertension-a registry-based analysis.

Diastolic pulmonary arterial pressure (dPAP) is regarded to be less sensitive to flow metrics as compared to mean PAP (mPAP), and was therefore proposed for the assessment of a precapillary component in patients with postcapillary pulmonary hypertension (PH). To analyze the diagnostic and prognostic impact of dPAP in patients with pure precapillary PH, we purposed to compare the correlation between dPAP and mPAP, as well as hemodynamically-derived calculations [ratio of PAP to systemic arterial pressure (PAP/SAP), pulmonary vascular resistance index (PVRI), transpulmonary gradient (TPG)], using both dPAP and mPAP, at rest and during acute vasoreactivity testing (AVT) in children with idiopathic or heritable pulmonary arterial hypertension (IPAH/HPAH). Furthermore, we aimed to assess the association of these metrics (at baseline and changes after AVT) with transplant-free survival. We conducted a retrospective analysis of the TOPP (Tracking Outcomes and Practice in Pediatric Pulmonary Hypertension) registry including 246 IPAH/HPAH patients. Of these, 45 children (18.3%) died, and 13 (5.3%) received lung transplantation during the observation period. dPAP and mPAP-derived variables showed almost linear relationship. Higher mPAP/mSAP, and dPAP-/mPAP-derived PVRI at rest was associated with time to death/transplantation. At maximum AVT-response, the decrease of dPAP and mPAP, diastolic pulmonary gradient (DPG) and TPG, as well as dPAP/dSAP and mPAP/mSAP was associated with time to death/transplantation, showing higher significance than corresponding baseline values. Remarkably, no predictive value was found for PVRI-reduction during AVT, neither dPAP- nor mPAP-derived. There is a strong relationship between dPAP and mPAP-derived variables. According to our results, hemodynamics during AVT (irrespectively of dPAP- or mPAP-derived) may have more prognostic implications than resting hemodynamics in children with IPAH/HPAH, except for PVRI.

Prenatal methylmercury exposure is associated with decrease heart rate variability in children

BackgroundAlthough several epidemiological studies have suggested mercury (Hg) might be associated with cardiotoxicity, the impact of Hg exposure on cardiac autonomic activity and blood pressure in children has not been investigated at Hg exposure levels equivalent to the Environmental Protection Agency (EPA) reference dose. ObjectiveTo investigate the association between low dose prenatal and recent methylmercury (MeHg) exposures and cardiac autonomic function and blood pressure with adjustment for factors such as fish consumption among children from a high fish consumption coastal city. MethodsChildren aged 7–8 years were recruited from the birth cohort of our previous study. Heart rate variability (HRV), resting heart rate (RHR) and blood pressure were measured as surrogate markers of cardiac autonomic function. Cord blood and current whole blood Hg concentration were used as biomarkers of prenatal and recent MeHg exposure, respectively. Recent fish consumption information was estimated with a food frequency questionnaire. ResultsAmong 604 children, median cord blood and whole blood Hg concentrations were 45.9 nmol/L (IQR: 32.8–65.03 nmol/L) and 13.57 nmol/L (IQR: 9.29–19.72 nmol/L), respectively. Our results demonstrated that prenatal MeHg exposure was associated with decreased HRV (i.e. low CVRR, SDRR, and RMSSD), reflecting reduced parasympathetic activity (i.e. low CCVHF and HF), and a sympathovagal balance shift toward sympathetic predominance (i.e. high %LF and LF/HF ratio). Adjustment of recent fish consumption further increased the significance and magnitude of the adverse associations of MeHg. ConclusionThe results of this study suggest that prenatal MeHg exposure is associated with decreased parasympathetic modulation of cardiac autonomic function in children.

Association between pubertal development and elevated blood pressure in children.

Blood pressure (BP) increased with age and height development, but little was known about the effect of pubertal development on blood pressure in children. A cross‐sectional study was performed among 4146 children aged 7–12 years old in China. Pubertal development was assessed based on breast stages and testicular volume. The associations of pubertal development with BP levels and the rate of elevated blood pressure (EBP) were quantified using multiple linear and logistic regressions. We found that pubertal developmental level was positively correlated with BP, and children who experienced puberty onset and early pubertal timing had higher BP levels and prevalence of EBP. After adjusting for covariates, children experienced puberty onset had 3.84 and 2.24 mmHg increase in systolic blood pressure and diastolic blood pressure, and 70%, 53%, and 62% increased odds of EBP, ESBP, and EDBP, respectively, compared with those without puberty onset. Similar results were observed for children who had early pubertal timing. The change of BP in puberty is greater and the association between pubertal development and BP is stronger in girls than boys. These findings suggested that pubertal development could be an important independent factor and one critical period for the EBP progress. Monitoring and management of pubertal development are necessary particularly among girls.

Ventricular Function and Pulmonary Artery Pressure in Children with Mild and Moderate Bronchial Asthma

Background: Bronchial asthma is a chronic airway disease. Cardiac affection in children with bronchial asthma was reported mainly in cases with severe asthma and during acute exacerbations. Aim of the Work: To study cardiac affection in children with mild and moderate bronchial asthma using conventional and tissue Doppler imaging [TDI] echocardiography. Patients and Methods: This was a prospective case control study. Study involved 160 children aged 6-14 years old who were following in outpatient pediatric clinic, Al-Hussein hospital, Al-Azhar University, Cairo, Egypt, during the period from January 4, 2016, till February 15, 2017. All children underwent peak expiratory flow rate [PEFR] assessment. Echocardiography was done for all to assess systolic and diastolic functions of right ventricle [RV] and left ventricle [LV] using conventional and tissue Doppler imaging [TDI] echocardiography. Results: TDI parameters showed evidence of RV diastolic dysfunction in patients with moderate asthma in the form of significantly lower tricuspid valve [TV] e’ [12.1 ± 2.7 cm/s], lower TV e’/a’ ratio [1.28 ± 0.18], prolonged RV isovolumetric relaxation time [IVRT] [71.8 ± 2.4 ms], and higher RV myocardial performance index [0.49 ± 0.04] compared to control group. Also, patients with mild asthma had impaired RV diastolic function in the form of significantly lower TV e’/a’ [1.51 ± 0.13] and longer RV IVRT [65 ± 2.9 ms] compared to control group. Pulmonary artery pressure was significantly elevated in moderate asthma group [18.4 ± 9.2 mmHg]. RV IVRT was the only parameter showing a significant negative correlation to PEFR Conclusion: Pediatric patients with mild and moderate bronchial asthma may have RV diastolic dysfunction. TDI is a good screening tool to detect early changes in cardiac function in such patients. RV IVRT measured by TDI is a sensitive tool to detect early diastolic impairment.

Cardiometabolic risk in children and adolescents: mediation analysis of crosssectional study.

The aims of this study were a) to assess whether obesity acts as a mediator between i) cardiorespiratory fitness (CRF) and mean blood pressure; and ii) between between physical activity (PA) and mean blodd pressure in children and adolescents. A cross-sectional study was conducted with a 632 children and adolescents. It was measured mean blood pressure, body mass index, fat mass and waist circumference. CRF and PA was assessing with Course Navette test and ActiGraph. The analysis of the mediation was performed using Process macro for SPSS. The results indicate that obesity acts as a partial mediation in the association between CRF and mean blood pressure in 10-12 years old children (z=from -5.81 to -5.40; all p˂0.000). These results indicate that obesity acts as a complete mediator in the association between PA and mean blood pressure in 10-12 years old children (z=from -4.49 to -1.94; all p˂0.000). Our result reinforces the relevance of prevent weight increse and improve cardiorespiratory fitness level since erly age in children and adolescents to prevent high mean blood pressure. Increasing the level of physical activity can influence on obesity and cardiorespiratory fitness.

Nutritional status as a risk factor of elevated blood pressure in preschool children

Background: High blood pressure is a risk factor for cardiovascular disease and neurological disease among children and adults. The American Heart Association recommended blood pressure evaluation among children aged more than 3 years for early detection of complications. Nutritional status was considered to have association with elevated blood pressure in children. Objective: To assess the association between nutritional status and the blood pressure of preschool children in Denpasar, Bali. Methods: This was a descriptive analytic cross-sectional study. Four hundred and fifty-six children aged 3-6 years who attended Kindergarten 2019 in Denpasar were enrolled by the cluster random sampling design. Results: From 456 samples obtained ratio between boys and girls was 1,1: 1. Median age of the sample was 5 years (3-5 years old). The majority of nutritional status was well nourished (52.2%) and obesity was found 11.8%. majority children had normotension (64%), and followed by pre-hypertension (25.4%), hypertension stage 1 (8.6%) and hypertension stage 2 (2%). Bivariate analysis showed that obesity and sex were risk factor for toddler having higher level of blood pressure with. Multivariate analysis showed children with obesity and boys are 2.8- and 1.8-times more likely to have hypertension (CI 95% 1.72-4.81; CI 95% 1.24-2.76, respectively). Low birth weight and prematurity were not found to be significantly related to level of blood pressure. Conclusion: Children with obesity were found to be significantly related to elevated blood pressure (hypertension).

Acute Effects of Vasopressin Arginine Infusion in Children with Congenital Heart Disease: Higher Blood Pressure Does Not Equal Improved Systemic Oxygen Delivery.

The use of vasopressin has been increased in recent years in children after congenital heart surgery. However, there is limited information regarding its effects on cardiac output, systemic oxygen delivery, and myocardial energetics. The purpose of this study is to characterize the effects of vasopressin infusions on hemodynamics and systemic oxygen delivery in children with congenital heart disease. A retrospective, single-center study of patients with congenital heart disease who received vasopressin infusions in a pediatric cardiac intensive care unit between January 2019 and May 2020. The measured values collected for study were systolic and diastolic blood pressure, heart rate, arterial oxygen saturation as determined by pulse oximetry, arterial pH, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide, serum lactate, serum sodium, and renal and cerebral oximetry based on near-infrared spectroscopy. The calculated values for this study were the difference between arterial and NIRS oximetry, the reno-cerebral near-infrared spectroscopy gradient and the vasoinotrope score. A Wilcoxon signed-rank test was utilized to compare values of paired continuous variables before and after initiation of the vasopressin infusion. Correlations were assessed using Spearman correlation analyses and stepwise regressions were completed. A total of 26 vasopressin infusions among 20 unique patients were included in the final analyses. Of these 26 vasopressin infusions, 18 were in patients with biventricular circulation and 8 were in patients with functionally univentricular circulation. The median vasopressin infusion dose at initiation was 0.4 (0.1-1) milliunits/kg/min. For the entire cohort 2 h after the initiation of vasopressin, systolic blood pressure increased to 8.4mmHg, p < 0.01, but no significant correlation was found to markers of systemic oxygen delivery. Similar results were obtained when only those with biventricular circulation were considered. Those with functionally univentricular circulation were not found to have any statistically significant rise in blood pressure. Vasopressin infusions appear to statistically significantly increase systolic blood pressure in children with congenital heart disease who have a biventricular but not functionally univentricular circulation. Even when an increase in systolic blood pressure is present, systemic oxygen delivery did not improve.

Blood pressure in children with renal cysts and diabetes syndrome.

Cystic kidney diseases such as autosomal recessive or dominant polycystic kidney disease (ARPKD and ADPKD) are associated with high prevalence of arterial hypertension. On the contrary, studies on hypertension in children with renal cysts and diabetes (RCAD) syndrome caused by abnormalities in the HNF1B gene are rare. Therefore, the primary aim of our study was to investigate the prevalence of high blood pressure in children with RCAD syndrome due to HNF1B gene abnormalities and secondary to search for possible risk factors for development of high blood pressure. Data on all children with genetically proven RCAD syndrome from three pediatric nephrology tertiary centers were retrospectively reviewed (office blood pressure (BP), ambulatory blood pressure monitoring (ABPM), creatinine clearance, renal ultrasound, echocardiography, albuminuria/proteinuria). High blood pressure was defined as BP ≥ 95th percentile of the current ESH 2016 guidelines and/or by the use of antihypertensive drugs. Thirty-two children with RCAD syndrome were investigated. Three children received ACE inhibitors for hypertension and/or proteinuria. High blood pressure was diagnosed using office BP in 22% of the children (n = 7). In the 7 performed ABPM, 1 child (14%) was diagnosed with hypertension and one child with white-coat hypertension. Creatinine clearance, proteinuria, albuminuria, body mass index, enlargement, or hypodysplasia of the kidneys and prevalence of HNF1B-gene deletion or mutation were not significantly different between hypertensive and normotensive children.Conclusion:High blood pressure is present in 22% of children with RCAD syndrome. What is Known: • Arterial hypertension is a common complication in children with polycystic kidney diseases. What is New: • High office blood pressure is present in 22% and ambulatory hypertension in 14% of children with renal cyst and diabetes (RCAD) syndrome.

A Comparative Study of Hypertonic Saline V/S Mannitol in Raised Intracranial Pressure in Children Aged Between 02 to 12 Years

Raised intracranial pressure, the most common problem encountered in critical care unit, is often end result of various neurological disorders1. It is an important independent prognostic factor1 Most of the available therapies in the management of raised intracranial pressure in children are like double edged sword. Hence this study was undertaken, to know the efficacy, safety, complications and outcome of Osmotherapies (hypertonic saline v/s Mannitol). This study was carried out in children aged between 02-12 years, admitted to paediatric critical care Unit in the Department of paediatric, at Vijayanagar institute of medical sciences Ballari, from January-16 to December-16 with features of raised ICP. 50 children were randomly given. Hypertonic saline (HTS) and 50 were given mannitol. Following parameters compared n results drawn: symptomatology, GCS, papilledema, pupillary reactions after 72 hrs of administration and effects on serum electrolytes, urea n creatinine, and osmolarity. We found that out of 50 children who were onmannitol therapy, 12 children needed HTS for sustained reduction of ICP beyond 72 hours (p=0.056). Improvement in GCS was better with use of mannitol (p=0.024) during first 72 hours compared to HTS. Increase in serum sodium levels were seen with use of HTS which was statistically significant (p=0.064). But mortality in both groups was similar. Hence, we concluded that mannitol was a better drug to be used in first 72 hrs but for sustained reduction of ICP beyond 72 hrs hts was better option.