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Current Pediatric Reviews
ISSN: 1573-3963
Current Pediatric Reviews
Volume 6, Number 4, November 2010
Contents
Parvovirus B19 (B19V) Infection and Pregnancy
Pp. 210-218
Susan A. Feeney, Dorothy E. Wyatt, Alison P. Watt and
Peter V. Coyle
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Syndromes Caused by the Mutations in GLI3 Gene
Pp. 219-225
Ichiro Naruse, Etsuko Ueta, Yoshiki Sumino and
Masaya Ogawa
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Current Applications of Therapeutic Gases in Neonatal
Intensive Care Pp. 226-233
Claudio Migliori, Elena Garzoli and Gaetano Chirico
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Tapering Enteroplasty for Complicated Meconium
Ileus Pp. 234-236
Charles W. Hartin, Jr, Stanley T. Lau, Sani Z. Yamout,
Mauricio A. Escobar, Michael G. Caty
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Adolescents’ Attitudes Toward Vaccinations:
A Systematic Review Pp. 237-249
Julia E. Painter, Lisa M. Gargano, Jessica M. Sales, Allena
J. Perez, Gina M. Wingood, Michael Windle and Ralph
J. DiClemente
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Abstracts
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Parvovirus B19 (B19V) Infection and Pregnancy
Susan A. Feeney, Dorothy E. Wyatt, Alison P. Watt and
Peter V. Coyle
Human parvovirus B19 (B19V; genus Erythrovirus) is a small,
non-enveloped, single-stranded DNA virus which causes the
common childhood exanthem fifth disease, or ‘slapped-cheek
syndrome’. Infection during pregnancy can cause severe
fetal anaemia and nonimmune hydrops fetalis (NIHF), often
leading to miscarriage or fetal death. B19V has a pronounced
tropism for rapidly proliferating erythroid progenitor cells
(EPC) leading to the cessation of erythropoiesis. The fetus
is particularly vulnerable to adverse outcome following B19V
infection due to rapid fetal blood volume expansion and a
reduced reticulocyte half-life. B19V is not a significant
teratogen. The risk to the fetus is increased if maternal
infection occurs during the first two trimesters. Approximately
35-45% of women of child bearing age are not immune to B19V.
Maternal seroconversion during a seasonal epidemic may reach
10%. Vertical transmission following infection is estimated
at 33%, therefore a significant proportion of pregnancies
are vulnerable to fetal infection. However, approximately
50% of primary infections are asymptomatic and may go undetected
until adverse fetal outcome becomes apparent. This could be
reduced if B19V awareness amongst pregnant women was heightened.
Prenatal screening of antenatal booking-bloods would identify
at-risk pregnancies and appropriate advice could be given
to mothers at this stage. Recommended case management following
maternal primary B19V infection is regular Doppler ultrasound
monitoring of the middle cerebral artery peak systolic flow
velocity for a 12 week follow-up period. Treatment of severe
fetal anaemia is cordocentesis transfusion with a success
rate of approximately 80%.
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Syndromes Caused by the Mutations in GLI3 Gene
Ichiro Naruse, Etsuko Ueta, Yoshiki Sumino and
Masaya Ogawa
Responsible gene for Greig cephalopolysyndactyly syndrome
(GCPS), Pallister-Hall syndrome (PHS), Postaxial polydactyly
type-A (PAP-A), and Preaxial polydactyly type-IV (PPD-IV)
has been known to be GLI3. In the present review, relationship
between mutation points of GLI3 and resulting phenotypes is
discussed. It has been proposed that mutations in the upstream
or within zinc finger domain of GLI3 gene induce GCPS, those
in the post zinc finger region including protease cleavage
site induce PHS, and those in far 3’ terminal of GLI3
gene induce PAP-A and PPD-IV. Meanwhile, it has been known
that mutations in the near 3’ terminal end also induce
GCPS. There is an argument whether clear genotype-phenotype
correlations were apparent or not. A lot of mutant and knockout
mice in Gli3 gene, which exhibit similar phenotypes to human
syndromes caused by GLI3 mutations, have been maintained and
produced. Investigations using mouse homolog of GCPS, PHS
and PPD-IV may be the way to elucidate this argument. Mysterious
issue is that GCPS and PHS appear in spite of having half
amount of normal GLI3 protein, however, complete loss of normal
Gli3 protein induces the similar phenotypes in mice. It has
been speculated that truncated mutant GLI3/Gli3 protein might
induce the phenotypes of GLI3/Gli3-related birth defects both
in humans and mice.
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Current Applications of Therapeutic Gases in Neonatal
Intensive Care
Claudio Migliori, Elena Garzoli and Gaetano Chirico
Various gases are utilized in respiratory care. Though oxygen
is the most frequently administered, the use of other gases
has become common practice in recent years. This report reviews
the literature concerning some of the therapeutic gases utilized
in Neonatal Intensive Care Unit (NICU). Inhaled Nitric Oxide
is a selective pulmonary vasodilator largely employed in the
Intensive Care Units. Its effects are well known as well as
cost/effectiveness and consequently limitations, mainly in
the developed countries. An alternative gas with comparable
characteristics is O-nitrosoethanol. In experimental studies,
this gas seems to improve oxygenation and systemic haemodynamics,
reducing the rebound hypoxaemia and the production of toxic
by-products. Helium-oxygen mixture is less common, although
it is widely known to both the decrease the pressure required
to ventilate the lung and the resistive work of breathing,
improving gas exchange in particular clinical conditions.
Recent studies showed its efficacy and feasibility both in
infants and in preterms. Carbon dioxide is usually employed
for the management of some specific congenital heart defects
characterised by various grades of pulmonary vascular resistance.
Its major effect is the reduction of pulmonary blood flow
to decrease cardiac work. The Xenon, already known for its
anaesthetic proprieties although rarely used, has recently
been considered for neuroprotection, opening a new field of
interest in neonatal hypoxia/ischemia syndrome.
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Tapering Enteroplasty for Complicated Meconium
Ileus
Charles W. Hartin, Jr, Stanley T. Lau, Sani Z. Yamout,
Mauricio A. Escobar, Michael G. Caty
Meconium ileus (MI) presenting with complications such as
volvulus, atresia, necrosis, perforation, peritonitis, or
giant cystic meconium peritonitis demands operative intervention
and often requires a small bowel resection. These patients
are at increased risk of short bowel syndrome if a significant
portion of bowel must be resected. We report on a 1-day-old
boy who was found to have a complicated MI with volvulus causing
a long ischemic strip of small bowel. An enteroplasty was
successfully employed to maintain bowel continuity after removing
a 2 by 50 cm segmental area of ischemic bowel.
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Adolescents’ Attitudes Toward Vaccinations:
A Systematic Review
Julia E. Painter, Lisa M. Gargano, Jessica M. Sales, Allena
J. Perez, Gina M. Wingood, Michael Windle and Ralph
J. DiClemente
Adolescent immunization coverage remains sub-optimal. Although
parental consent is required for most vaccinations, adolescents’
own attitudes may impact vaccine uptake. The current study
sought to review the literature regarding adolescents’
attitudes toward vaccination to inform efforts toward increasing
vaccination rates. Two researchers searched five databases
for literature published in English from 1999-2009, and coded
included articles for demographics, methodological information,
type of attitudes assessed, and significant associations.
Of 1,348 titles and abstracts screened, 28 studies met inclusion
criteria. Most studies assessed attitudes toward HPV or other
STI vaccines. No studies assessed attitudes towards influenza
vaccination. Most studies were cross-sectional, and many analyzed
adolescent data combined with young adult data. Existing research
suggests that perceived risk of disease, benefits and barriers
to vaccination, and normative beliefs may be salient factors
in adolescents’ vaccine acceptance. Future research
should expand the evidence-base regarding adolescents’
attitudes toward all recommended vaccines, particularly non-STI
vaccines.
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