Acute pancreatitis in infants and children

Acute pancreatitis is being encountered more often in children due to antimetabolite therapy, accidental injury, and traumatic battering. Pancreatitis may occur in the absence of traditionally elevated serum amylase and lipase, and initial diagnosis may depend upon ultrasonography. Traditional therapy of enteric rest with nasogastric suction has been supported by the use of parenteral nutrition. Newer pharmaceutical agents have been ineffective in altering the course of the illness or in preventing complications of pseudocyst or abscess.     

Atrial natriuretic peptide in infants and children

Atrial natriuretic peptide (ANP) was measured in the plasma of 192 normal infants and children aged 1 day to 18 years. Plasma ANP was high during postnatal adaptation, particularly in premature infants. In 96 infants and children aged 4 months to 18 years, plasma ANP was similar to values obtained in 7 healthy adult volunteers (23.9 +/- 11.9 vs. 25.7 +/- 4.6 fmol/ml). There was no significant relationship between ANP and age. ANP is elevated about twofold in full-term neonates being 3-4 days of age, and returned to normal thereafter. It is concluded that ANP is raised during the postnatal adaptation. This hormone is possibly involved in the postnatal volume contraction and may antagonize vasoconstrictor hormones that are elevated during the postnatal period.     

Unusual abdominal cysts in infants and children

In a 20-year period at the Los Angeles Children's Hospital, 46 infants and children have had operation for cysts within the abdomen. The age range of patients was from newborn to 13 years. Most of them were under four years old. There were four general groups of these cysts. (1) About one-half were cysts of the ovary, some of them serous and some dermoid. These cysts are attached by a stalk that often twists, causing gangrene or rupture with acute symptoms simulating appendicitis. (2) Next in frequency were cysts arising in the mesentery of the intestine. They usually caused little trouble until by their size (up to a 2-quart capacity) they created pressure and obstruction in the intestine. (3) Enteric cysts were found in four patients. (4) Cysts of the pancreas were present in three of the children.X-ray examination was helpful in diagnosis. Usually the type of cyst was not determined until operation was done. Transection of the intestinal tract sometimes was necessary for removal of the cyst. Surgical correction was satisfactory in 44 of the 46 cases.     

Cranial computed tomography in infants and children.

Cranial computed tomography has been performed in adults for the past 2 years but relatively few children have undergone this procedure. The specific uses in children are in detecting intracranial mass lesions and identifying the character of the lesion, and evaluating congenital cranial diseases such as cerebral dysplasia, tuberous sclerosis and leukodystrophies. This safe, rapid, noninvasive technique will soon replace or supplement standard neuroradiologic techniques in infants and children.     

Aortic input impedance in infants and children.

Flow and pressure measurements were performed in the ascending aortas of six pediatric patients ranging in age from 1 to 4 yr and in weight from 7.2 to 16.4 kg. From these measurements, input impedance was calculated. It was found that total vascular resistance decreased with increasing patient weight and was approximately one to three times higher than those of adults. Conductance per unit weight was relatively constant but was approximately three times higher than for adults. Strong inertial character was observed in the impedance of four of the six patients. Among a three-element and two four-element lumped-parameter models, the model with characteristic aortic resistor (R(c)) and inertance in series followed by parallel peripheral resistor (R(p)) and compliance fitted the data best. R(p) decreased with increasing patient weight and was one to three times higher than in adults, and R(c) decreased with increasing patient weight and was 2 to 15 times higher. The R(p)-to-R(c) ratio differed significantly between infants and children vs. adults. The results suggested that R(p) developed more rapidly with patient weight than did R(c). Compliance values increased with increasing patient weight and were 3 to 16 times lower than adult values.     

Management of acute neurologic syndromes in infants and children

Neurological problems in the pediatric intensive care unit all too frequently seem to be among the most mysterious of disorders. This review provides a framework to diagnose and treat four frequently observed neurological syndromes: coma, status epilepticus, central nervous system infections, and post-infectious polyneuropathy (Guillain-Barré syndrome). An emphasis is placed on the diagnosis of coma due to metabolic disorders, the most common cause of coma, and coma as a result of supratentorial lesions. This differentiation can be effected by an easily performed assessment (Glasgow Scale) supplemented by a limited number of tests of brain stem function (pupillary responses, oculocephalic, and oculovestibular responses). Preserved pupillary responses are characteristic of the metabolic coma while an orderly rostral-caudal deterioration, termed the central syndrome, is characteristic of coma resulting from an enlarging supratentorial mass. If confusion exists, the CT scan may be helpful. The approach to emergency management emphasizes the establishment and maintenance of airway and circulation. Management of status epilepticus emphasizes the role of pharmacotherapy, particularly the use of diazepam and phenytoin in combination. The management of infections details antibiotic therapy of bacterial infections and new antiviral therapy for herpesvirus infections. The section on Guillain-Barré syndrome emphasizes good supportive care.