Syndrome Infants Research Articles

The potential effects of vitamin D deficiency on respiratory distress syndrome among preterm infants.

Vitamin D deficiency is one of the most commonly deficient vitamins worldwide. Preterm infants usually suffer from different complications. However, the relationship between vitamin D levels and RDS prevalence has been emerging in the last few years. This study aimed to assess the severity of respiratory distress syndrome in preterm infants who are ≤34weeks GA, with a birth weight of ≤2kg, and its relation to their serum blood level of vitamin D. This is a multicenter study conducted at Neonatal Intensive Care Unit (NICU) at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia, and Maternity and Children Hospital (MCH), Qassim, Saudi Arabia. We observed prospectively all preterm babies who were ≤34weeksGA with 25-hydroxyvitamin D (25OHD) serum level ≤30ng/ml at 24h of life or less. Included infants were divided into 2 groups; infants with 25-hydroxyvitamin D level of ≤30ng/ml were the deficient group and those with >30ng/ml were considered in the normal group. 174 preterm infants were included in this study with an average gestational age of 30.2± 2.7 weeks. The mean vitamin D level was 30.5 (SD 19.5). Vitamin D deficiency was detected among 99 infants (56.9%). Of the deficient infants, 26.3% were severe, 42.4% moderate and 31.3% were mild. Pneumothorax was 2.9% and mortality rates were recorded among 14 cases (8%). Vitamin D deficiency was widely prevalent among preterm neonates. Pneumothorax, surfactant doses, oxygen, and mechanical ventilation requirements were statistically significant at vitamin D deficiency.

Three Immunocompetent Small Animal Models That Do Not Support Zika Virus Infection.

Zika virus (ZIKV) is a mosquito-borne flavivirus that is primarily transmitted to humans through the bite of an infected mosquito. ZIKV causes disease in infected humans with added complications of Guillain-Barré syndrome and birth defects in infants born to mothers infected during pregnancy. There are several large immunocompetent animal models for ZIKV including non-human primates (NHPs). NHP models closely reflect human infection; however, due to sample size restrictions, investigations into the effects of transmission route and the impacts on disease dynamics have been understudied. Mice have been widely used for modeling ZIKV infection, yet there are few ZIKV-susceptible immunocompetent mouse models and none of these have been used to investigate sexual transmission. In an effort to identify a small immunocompetent animal model to characterize sexual transmission of ZIKV, we attempt experimental infection of multimammate mice, New Zealand white rabbits, and Hartley guinea pigs. The multimammate mouse is the natural reservoir of Lassa fever virus and has been identified to harbor other human pathogens. Likewise, while NZW rabbits are susceptible to West Nile virus, they have not yet been examined for their susceptibility to infection with ZIKV. Guinea pigs have been successfully used as models for ZIKV infection, but only in immunocompromised life stages (young or pregnant). Here, it was found that the multimammate mouse and New Zealand White (NZW) rabbits are not susceptible ZIKV infection as determined by a lack viral RNA in tissues and fluids collected. Sexually mature male Hartley guinea pigs were inoculated subcutaneously and by mosquito bite, but found to be refractory to ZIKV infection, contrary to findings of other studies in young and pregnant guinea pigs. Interestingly, here it is shown that adult male guinea pigs are not susceptible to ZIKV infection, even when infected by natural route (e.g., mosquito bite). Although a new small animal model for the sexual transmission for ZIKV was not established through this study, these findings provide information on outbred animal species that are not permissive to infection (NZW rabbits and multimammate mice) and new information surrounding limitations of a previously established animal model (guinea pigs).

A molecular explanation of cardiovascular protection through abnormal cannabidiol: Involving the dysfunctional β-adrenergic and ATP-sensitive K+ channel activity in cardiovascular compromised preterm infants.

Growing cannabis efficacy, usage frequency, legal supply, and declining awareness of danger recently led to expanded United States cannabis exposure. In turn, cannabis use among elderly people over 50 has more than tripled in a decade and has contributed toward a positive association of cannabis use with pathological conditions, which include type II diabetes, metabolic syndrome, neurovascular and cardiovascular disease. Remarkably, all these outcome results are mediated by the involvement of the ATP-sensitive K+ channel. Cardiovascular compromise is a common syndrome in preterm infants that leads to incidence and death and has been distinguished by poor systemic flow or hypotension. Conditions of cardiovascular compromise include vasodysregulation and myocardial malfunction through dysfunctional β-adrenergic activity. To avoid organ hypoperfusion progressing to tissue hypoxia-ischemia, inotropic drugs are used. Many premature children, however, respond insufficiently to inotropic activity with adrenergic agonists. The clinical disturbance including myocardial dysfunction through the activation of the ATP-sensitive K+ channel is often involved and the comparative efficacy of the nonpsychotropic cannabinoid, abnormal cannabidiol(Abn-CBD) is not yet known. Therefore, our primary aim was to investigate the molecular exploration of the cannabinoid system specifically Abn-CBD in cardiovascular protection involving dysregulated KATP.

Nasal high-frequency oscillatory ventilation versus nasal continuous positive airway pressure as primary respiratory support strategies for respiratory distress syndrome in preterm infants: a systematic review and meta-analysis.

Nasal high-frequency oscillatory ventilation (NHFOV) is a new respiratory support strategy despite lacking of enough evidence in preterm infants with respiratory distress syndrome (RDS). The aim of the present systematic review was to explore whether NHFOV reduced the intubation rate as compared with nasal continuous positive airway pressure (NCPAP) as the primary respiratory support strategies in preterm infants with RDS. Medline, the Cochrane library, the Cochrane Controlled Trials Register, EMBASE, Chinese National Knowledge Infrastructure (CNKI), and Wanfang data Information Site were searched from inception to Jan 1, 2021(Prospero2019 CRD42019129316, date and name of registration: Apr 23,2019, The clinical effectiveness of NHFOV vs NCPAP for preterm babies with respiratory distress syndrome). Pooled data from clinically randomized controlled trials (RCTs) comparing NHFOV with NCPAP as the primary respiratory supporting strategies in preterm infants with RDS were performed using the fixed-effects models whenever no heterogeneity was shown. The primary outcome was intubation rate. Four randomized controlled trials involving 570 participants were included. Comparing with NCPAP, NHFOV resulted in less intubation (relative risk (RR) 0.44; 95% confidence interval (CI) 0.29-0.67, P = 0.0002), and heterogeneity was not found among the trials in the fixed-effects model (P = 0.78, I2 = 0%). Similar result also appeared in sensitivity analysis after excluding one study with significant difference (RR 0.44; 95% CI 0.25-0.78, P = 0.005) (P = 0.58, I2 = 0%).Conclusion: NHFOV decreased the intubation rate as compared with NCPAP as primary respiratory supporting strategies in preterm infants suffering from RDS. Future research should assess whether NHFOV can reduce the incidence of bronchopulmonary dysplasia (BPD) and intubation rate in preterm infants with BPD. Fund by Natural Science Foundation of Chongqing (cstc2020jcyj-msxmX0197), and "guan'ai" preterm Study Program of Renze Foundation of Beijing(K022). What is Known: • Nasal high-frequency oscillatory ventilation (NHFOV) has been described to be another advanced version of nasal continuous positive airway pressure (NCPAP). However, its beneficial effects among different studies as the primary modes in the early life of preterm infants with respiratory distress syndrome (RDS) were inconsistent. What is New: • Comparing with NCPAP, NHFOV decreases the risk of intubation as a primary respiratory supporting strategy in early life for preterm infants suffering from RDS.

A Case Report of a Colorectal and Caudal Duplication Syndrome Associated with Caudal Regression Syndrome

We describe an uncommon clinical presentation of caudal duplication syndrome and features of caudal regression syndrome in a female infant with complex urogenital and colorectal duplication associated with lipomyleomeningocele and left lower limb hypoplasia. A staged surgical treatment plan was carried out to maintain fecal and urine continence, potential fertility, and cosmetic appearance.

Implementation of Safe Sleep Practices by Mothers with 0-1 Year-Old Infants

Aim: The sleep environment of an infant affects the likelihood of sudden infant death syndrome and other sleep-related infant deaths. This study was performed to determine the safe sleep practices of mothers with 0–1 year-old infants. Methods: This descriptive study included 204 mothers with 0–1 year-old infants who visited family health centers between October 30 and December 28, 2018. The data were collected using a questionnaire form and evaluated using the number, percentage, mean, standard deviation, and chi-squared test. Results: The mean age of the mothers was 28.48 ±5.83 years; 43.1% were primary school graduates and 84.8% were housewives; 53.9% of the infants were girls and 39.2% were 0–3 months old. It was found that 47.5% of the mothers put their infant to sleep in the supine position, 46.1% in the non-supine position, 70.1% on a soft bed, and 76.5% by using a pillow. In addition, 41.2% of the mothers stated that they used pacifiers while putting their infant to sleep, 9.8% stated that they slept in the same bed with their infant, and 92.9% stated that they slept in the same room. Conclusion: It was determined that the mothers performed certain risky practices related to the sleep environment, particularly regarding soft beds’ use, sleeping positions, pillow use, and bed-sharing. It may be recommended that healthcare professionals play an active role and take responsibility in increasing the level of knowledge and awareness of parents regarding safe sleep. Keywords: sleep, infant, mothers, family practice

Concomitant cow's milk and beef food protein–induced enterocolitis syndrome in a young infant

Acute food protein–induced enterocolitis syndrome (FPIES) is a non–immunoglobulin E (IgE) cell-mediated food hypersensitivity. Common causes include cow's milk (CM), soy, rice, and oat, although any food can be a potential culprit.1

OPPORTUNITIES AND PERSPECTIVES OF IMMUNE NUTRITION IN PRETERM INFANTS

While mortality associated withrespiratory distress syndrome in premature infants hasbeen reduced, other morbidities associated with pretermbirth, including necrotizing enterocolitis (NEC) and sepsis,are becoming more relevant. Although the pathogenesisof these diseases remains incompletely defined andunderstood, one of the leading risk factors is the immaturityof the immune system, which determines the tendencyof premature infants to develop excessive inflammatoryresponse and disruption of the formation of "healthy" gutmicrobiota. Breastfeeding provides a protective effect dueto the wide range of immunologically active components ofthis unique product. Current data suggest that donor milk isthe best alternative to native breast milk, as the use of theformula is primarily associated with an increased risk ofNEC. The use of individual immunological components ofbreast milk, such as lactoferrin or immunoglobulins, doesnot reduce the incidence of this disease. At the same time,lactoferrin may reduce the incidence of late-onset sepsis.Pro- and prebiotics have better evidence for the preventionof these diseases, however, questions remain about thechoice of the most effective strains, dosage, duration,and safety of their use, especially in extremely prematureinfants with a birth weight <1000 g. Combined data fromexperimental and clinical studies indicate that human milkoligosaccharides may protect against NEC, however, morereliable evidence of their effectiveness is needed, as wellas the solution of technological problems associated withthe synthesis of individual oligosaccharides and their useas individual supplements. For today, clinical practices toensure mothers are optimally supported to express theirown breast milk in order to optimize breastfeeding, earlyenteral feeding, and faster increase in daily feeds are keynutritional methods to prevent NEC and late infections inpreterm infants.

Staphylococcal Scalded Skin Syndrome in Healthy Infant

Staphylococcal scalded skin syndrome (SSSS) describes a spectrum of superficial blistering skin disorders caused by the exfoliative toxins of Staphylococcus aureus that originates from a focus of infection that may be a purulent conjunctivitis, otitis media, or occult nasopharyngeal infection. It usually begins with fever, irritability, and a generalized, paint, orange-red, macular erythema with cutaneous tenderness, and the rash progress from scarlatiniform to a blistering eruption in 24 to 48 hours. A diagnosis must distinguish SSSS from other skin diseases, such as toxic epidermal necrolysis, epidermolysis bullosa, bullous erythema multiforme, Streptococcal impetigo or listeriosis and thermal or chemical burns, all of which can manifest with similar symptoms. The prognosis of SSSS in children who are appropriately treated is good, with a mortality of less than 5%. A case was a three moths old boy hospitalized in Pediatric ward M. Djamil hospital with chief complain redness and peeling of the skin since 2 days before hospitalized. Culture of the skin, eyes and nose was Staphylococcus aureus , and patients was given ampicillin and gentamycin for seven days.

Clinical and Instrumental Exploration of Sensitive Skin in a Pediatric Population

Studies on sensitive skin pathophysiology in infants are challenging because most assessment methods require self-reporting of signs. In this study, we aimed to identify and characterize sensitive skin in children for the first time. A newly developed parent-reported questionnaire was used to recruit children with sensitive skin. This questionnaire was also tested on an adult group. Hydration, transepidermal water loss (TEWL), and inflammatory markers (cytokines, and polyunsaturated fatty acids (PUFAs)) were quantified. A total of 77 children and 20 adults (33 and 10 with sensitive skin, respectively) were recruited. The groups with sensitive skin had more clinical signs of skin dryness. Skin hydration was lower in children in the sensitive compared with the nonsensitive skin group. TEWL levels were similar between sensitive and nonsensitive subjects in both infant and adult groups. Sensitive skin exhibited higher levels of cytokines and proinflammatory PUFAs as well as lower levels of anti-inflammatory PUFAs. Sensitive skin syndrome was associated with normal skin barrier function but lower hydration in infants and children. The higher levels of proinflammatory markers suggest that sensitive skin is associated with low-level inflammation. It is hypothesized, for the first time, that PUFAs are involved in sensitive skin syndrome in infants.

Effect of Kangaroo care on Vulnerable Infant Syndrome in mother

ABSTRACT This study aims to examine the effect of kangaroo care on Vulnerable Infant Syndrome (VIS) in the mother. The sample group consisted of 58 preterm infants, 27 of whom were control and 31 were experimental groups. Data were collected using the question form, the Vulnerable Baby Scale (VBS), the Edinburgh Post PartumDepression Scale (EPDS), the Maternal Attachment Scale (MAS). The mean scores of VBS were found in the kangaroo group (17.22 ± 0.96) and in the control group (43.66 ± 0.89). It was found that there was a significant difference between the two groups in terms of VBS scores (p < 0.01). In addition, the mothers in the experimental group compared to the mothers in the control group; the mean EPDS score was low and the MAS mean score was high (p < 0.01).It was determined kangaroo care reduces maternal vulnerability, postpartum depression and increases maternal attachment.

Association of Adherence to Surfactant Best Practice Uses With Clinical Outcomes Among Neonates in Sweden

While surfactant therapy for respiratory distress syndrome (RDS) in preterm infants has been evaluated in clinical trials, less is known about how surfactant is used outside such a framework. To evaluate registered use, off-label use, and omissions of surfactant treatment by gestational age (GA) and associations with outcomes, mainly among very preterm infants (GA <32 weeks). This population-based cohort study used registry data for 97 377 infants born in Sweden between 2009 and 2018. Infants did not have malformations and were admitted for neonatal care. Data analysis was conducted from June 2019 to June 2020. Timing and number of surfactant administrations, off-label use, and omission of use. Registered use was defined by drug label (1-3 administrations for RDS). Omissions were defined as surfactant not administered despite mechanical ventilation for RDS. In-hospital survival, pneumothorax, intraventricular hemorrhage grade 3 to 4, duration of mechanical ventilation, use of postnatal systemic corticosteroids for lung disease, treatment with supplemental oxygen at 28 days' postnatal age and at 36 weeks' postmenstrual age. Odds ratios (ORs) were calculated and adjusted for any prenatal corticosteroid treatment, cesarean delivery, GA, infant sex, Apgar score at 10 minutes, and birth weight z score of less than -2. In total, 7980 surfactant administrations were given to 5209 infants (2233 [42.9%] girls; 2976 [57.1%] boys): 629 (12.1%) born at full term, 691 (13.3%) at 32 to 36 weeks' GA, 1544 (29.6%) at 28 to 31 weeks' GA, and 2345 (45.0%) at less than 28 weeks' GA. Overall, 977 infants (18.8%) received off-label use. In 1364 of 3508 infants (38.9%) with GA of 22 to 31 weeks, the first administration of surfactant was given more than 2 hours after birth, and this was associated with higher odds of pneumothorax (adjusted OR [aOR], 2.59; 95% CI, 1.76-3.83), intraventricular hemorrhage grades 3 to 4 (aOR, 1.71; 95% CI, 1.23-2.39), receipt of postnatal corticosteroids (aOR, 1.57; 95% CI, 1.22-2.03), and longer duration of assisted ventilation (aOR, 1.34; 95% CI, 1.04-1.72) but also higher survival (aOR, 1.45; 95% CI, 1.10-1.91) than among infants treated within 2 hours of birth. In 146 infants (2.8%), the recommended maximum of 3 surfactant administrations was exceeded but without associated improvements in outcome. Omission of surfactant treatment occurred in 203 of 3551 infants (5.7%) who were receiving mechanical ventilation and was associated with lower survival (aOR, 0.49; 95% CI, 0.30-0.82). In full-term infants, 336 (53.4%) of those receiving surfactant had a diagnosis of meconium aspiration syndrome. Surfactant for meconium aspiration was not associated with improved neonatal outcomes. In this study, adherence to best practices and labels for surfactant use in newborn infants varied, with important clinical implications for neonatal outcomes.

Multisystem Inflammatory Syndrome in Infant with Negative SARS-CoV-2 RT-PCR and Antibodies

Since the declaration of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in March 2020 by the World Health Organization (WHO), there has been an emergence of a new syndrome termed multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. MIS-C is defined by the presence of fever, systemic inflammation and multiorgan dysfunction in association with SARS-CoV-2 infection or COVID-19 exposure. Knowledge of this syndrome’s presentation and pathophysiology is constantly evolving as more cases are reported in the literature. This case identifies a 3-month-old patient who tested negative for SARS-CoV-2 antigen, reverse transcriptase polymerase chain reaction (RT-PCR) and antibodies but qualified for MIS-C diagnosis. To the best of our knowledge and through extensive research at the time of diagnosing and reporting this condition to the healthcare authorities, we report the youngest pediatric patient with MIS-C diagnosis. We document this case to contribute to further understanding the variable manifestations of MIS-C and the importance of early diagnosis and treatment with intravenous immunoglobulin (IVIG).

Effects of early intervention strategies using telehealth on an infant with Down syndrome: A case study

Purpose: To present the strategies used and the effects of early physiotherapy intervention using telehealth on a Down syndrome infant. Materials and methods: An infant diagnosed with Down syndrome performed the early intervention. Telehealth was performed synchronously according to the biopsychosocial model The assessments were carried out using the International Classification of Functioning, Disability and Health checklist. The Alberta Infant Motor Scale and the Brazilian version of the Affordances in the Home Environment for Motor Development - Infant scale were used to assess the activity component and environmental factors, respectively. Evaluations were performed at 5, 50, 79, and 105 days of corrected age. Results: The infant obtained progressive and constant gains during 100 days of early intervention. It is known that environmental and personal factors interfere with the performance of the infant's skills. Conclusion: Early intervention initiated in the first month of life using telehealth in an infant with Down syndrome proved an effective intervention method.

Синдром Жильбера в новонародженої дитини (клінічний випадок)

Purpose — to demonstrate the features of the course and treatment of Gilbert's syndrome in a newborn. Materials and methods. We present A clinical case of follow-up of a newborn with Gilbert's syndrome. The paper examines the features of the course and treatment of this disease. Results. Important is the fact that the difficulties in diagnosing Gilbert's syndrome in newborns are primarily due to current problems in neonatology, namely the diagnostics of pigmentary disorders that occur during bilirubin metabolism. The polymorphism of Gilbert's syndrome symptoms and the lack of a clear association with plasma bilirubin levels make it difficult to diagnose the disease, especially in newborns. The peculiarity of the course of Gilbert's syndrome in the given case is as follows: early onset of the disease (from the day of birth), the presence of high hyperbilirubinemia (total bilirubin — 189.2 μmol/l, direct bilirubin — 24.3 μmol/l, indirect bilirubin — 164.9 μmol/l), intermittent attacks of jaundice. The severity of the disease is also due to the transient condition of the newborn: hypoxic and ischemic lesions of the CNS, transient dysfunction of the adrenal cortex, open oval window, and the mother's failure to follow clear principles of treatment of Gilbert's syndrome in breastfed infants. Conclusions. The peculiarity of this disease is the fact that the mother is at risk of giving birth to a sick child due to a burdened hereditary history of the paternal line (Gilbert's syndrome). Therefore, it is necessary to provide medical and genetic counseling when planning the birth of a child to determine the degree of risk of birth with this disease. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: Gilbert's syndrome, hyperbilirubinemia, a newborn.

Floppy infant syndrome as a first manifestation of LMNA-related congenital muscular dystrophy

LMNA-related congenital muscular dystrophy (L-CMD) is the most severe phenotypic form of skeletal muscle laminopathies. This paper reports clinical presentation of the disease in 15 Polish patients from 13 families with genetically confirmed skeletal muscle laminopathy. In all these patients floppy infant syndrome was the first manifestation of the disease. The genetic diagnosis was established by next generation sequencing (targeted panel or exome; 11 patients) or classic Sanger sequencing (4 patients). In addition to known pathogenic LMNA variants: c.116A > G (p.Asn39Ser), c.745C > T (p.Arg249Trp), c.746G>A (p.Arg249Gln), c.1072G>A (p.Glu358Lys), c.1147G>A (p.Glu383Lys), c.1163G>C (p.Arg388Pro), c.1357C > T (p.Arg453Trp), c.1583C > G (p.Thr528Arg), we have identified three novel ones: c.121C > G (p.Arg41Gly), c.1127A > G (p.Tyr376Cys) and c.1160T > C (p.Leu387Pro). Eleven patients had de novo mutations, 4 - familial. In one family we observed intrafamilial variability of clinical course: severe L-CMD in the male proband, intermediate form in his sister and asymptomatic in their mother. One asymptomatic father had somatic mosaicism. L-CMD should be suspected in children with hypotonia in infancy and delayed motor development, who have poor head control, severe hyperlordosis and unstable and awkward gait. Serum creatine kinase may be high (~1000IU/l). Progression of muscle weakness is fast, leading to early immobilization. In some patients with L-CMD joint contractures can develop with time. MRI shows that the most frequently affected muscles are the serratus anterior, lumbar paraspinal, gluteus, vastus, adductor magnus, hamstrings, medial head of gastrocnemius and soleus. Ultra-rare laminopathies can be a relatively common cause of generalized hypotonia in children. Introduction of wide genome sequencing methods was a breakthrough in diagnostics of diseases with great clinical and genetic variability and allowed approach "from genotype do phenotype". However target sequencing of LMNA gene could be considered in selected patients with clinical picture suggestive for laminopathy.

Multisystem Inflammatory Syndrome in Infants

Multisystem inflammatory syndrome in children (MIS-C), temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been identified in infants <12 months old. Clinical characteristics and follow-up data of MIS-C in infants have not been well described. We sought to describe the clinical course, laboratory findings, therapeutics and outcomes among infants diagnosed with MIS-C. Infants of age <12 months with MIS-C were identified by reports to the CDC's MIS-C national surveillance system. Data were obtained on clinical signs and symptoms, complications, treatment, laboratory and imaging findings, and diagnostic SARS-CoV-2 testing. Jurisdictions that reported 2 or more infants were approached to participate in evaluation of outcomes of MIS-C. Eighty-five infants with MIS-C were identified and 83 (97.6%) tested positive for SARS-CoV-2 infection; median age was 7.7 months. Rash (62.4%), diarrhea (55.3%) and vomiting (55.3%) were the most common signs and symptoms reported. Other clinical findings included hypotension (21.2%), pneumonia (21.2%) and coronary artery dilatation or aneurysm (13.9%). Laboratory abnormalities included elevated C-reactive protein, ferritin, d-dimer and fibrinogen. Twenty-three infants had follow-up data; 3 of the 14 patients who received a follow-up echocardiogram had cardiac abnormalities during or after hospitalization. Nine infants had elevated inflammatory markers up to 98 days postdischarge. One infant (1.2%) died after experiencing multisystem organ failure secondary to MIS-C. Infants appear to have a milder course of MIS-C than older children with resolution of their illness after hospital discharge. The full clinical picture of MIS-C across the pediatric age spectrum is evolving.

May-Thurner syndrome in infant

May-Thurner syndrome in infant

Surveillance guidelines for children with trisomy 13.

Trisomy 13 is one of the three most common aneuploidy syndromes in live-born infants. It is associated with mortality rates as high as 90% within the first year of life, in large part, due to the high prevalence of severe congenital abnormalities that increase mortality and morbidity. However, life-saving and life-prolonging medical interventions are being performed at a higher rate for these infants, resulting in increased rates of survival. Although cardiac complications have been well described in infants with trisomy 13, these patients also experience other complications such as respiratory, neurological, genitourinary, abdominal, otolaryngologic, and orthopedic complications that can impact their quality of life. The goal of this review is to present a comprehensive description of complications in children with trisomy 13 to aid in the development of monitoring and treatment guidelines for the increasing number of providers who will be caring for these patients throughout their lives. Where the evidence is available, this review presents screening recommendations to allow for more rapid detection and documentation of these complications.

Pharmacologic Differences in Children

Children are physiologically different from adults. Their anesthetic care requires ample consideration of the pharmacologic effects of medications on their minds and bodies to provide an overall pleasant and safe experience. There are many available pharmacologic agents that can be used in the course of a child’s anesthetic. It is essential to be aware of the potential uses and risks of each. Pediatric anesthesia providers must consider physiologic differences in children versus adults that affect pharmacodynamics. They should also consider various medication routes that are available to initiate sedation or anesthesia, dosing changes that need to be made due to metabolism immaturity and increased risk of medication toxicity, concern for possible neurotoxic effects of medications on the developing brain, and adverse effects of medication due to congenital issues or undiagnosed pathology. Medications we use in pediatric anesthesia have always been off label due to limited studies in this population of patients and ongoing studies will help enhance our practice. This review contains 4 figures, 7 tables, and 64 references. Key Words: anesthetic neurotoxicity, anesthesia uptake, apnea risk, benzodiazepine effects, neonates, midazolam bioavailability, opioids, opioid-sparing medications, premedication routes, propofol infusion syndrome, succinylcholine complications, sugammadex, uptake and distribution in infants.