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Myocardial velocities on first day of life in preterm neonates using tissue Doppler imaging
PAEDIATRIC RESEARCH SOCIETY ABSTRACTS
Results: The study showed that 45% of children were given nebulised salbutamol and 98% received prednisolone. Twenty-three children were admitted to the high-dependency unit, 19 of whom were admitted just for IV magnesium. Of the 23 children given magnesium, seven improved by one category an hour after infusion and 12 improved by one category after 2 hours. No cardiac or other complications occurred in any of the children who received IV magnesium. The mean length of hospital stay was 20 hours, with the minimum being 2 hours and the maximum 1 week. Conclusions: Our audit suggests that magnesium sulphate can be safely administered to children in a district general hospital. As there were no adverse events, we recommended that magnesium sulphate should be given in the general ward rather than the high-dependency unit. We plan to re-audit the effects of this change and our prescribing practice of magnesium. We await future studies into alternative routes of administration.
Myocardial velocities on first day of life in preterm neonates using tissue Doppler imaging RJS Negrine1, AK Ewer1, JGC Wright2, A Chikermane2 1Neonatal Intensive Care, Women’s Hospital 2Paediatric Cardiology, Children’s Hospital, Birmingham Introduction: Current methods of assessing cardiac function have significant limitations. Tissue Doppler imaging (TDI) measures Doppler signals from the myocardium, from which myocardial velocities can be calculated and used as an indicator of cardiac function. Only one study has specifically investigated velocities in term neonates, and none has investigated preterm infants. We set out to assess the myocardial velocities in preterm neonates in the first 24 hours using TDI. Methods: Preterm neonates were scanned by a single investigator (R.N.) at less than 24 hours of age. Myocardial velocities were acquired from an apical four-chamber view with a pulse-wave sample gate of 0.12 cm positioned at the lateral tricuspid annulus, lateral mitral annulus and basal interventricular septum. Peak velocities in systole, early diastole and late diastole were obtained. Average readings were taken from 3–5 cardiac cycles. Ethical approval was obtained. Results: Nine male and four female subjects were recruited, with a median gestational age of 32 weeks (range 25–34 weeks) and a birthweight of 1655 g (range 928–2230 g). The mean (SD) velocities (cm per second) obtained are given below:
Arterial stiffness in healthy children and children with diabetes P Maciocia1, L Bath1, D Webb2 1Royal Hospital for Sick Children 2Cardiovascular Research, Western General Hospital, Edinburgh Introduction: Arterial stiffness is recognised to be a risk factor for cardiovascular disease. Arterial stiffening is an age-dependent process in adults, involving changes in elastin and collagen, and may be affected by genetic and environmental factors. Arterial stiffening is known to be accelerated in adults with diabetes: this is hypothesised to be a result of advanced glycation end-product crosslinks between collagen and elastin, a process that is accelerated in diabetes. This study aims to investigate the relationship between arterial stiffness and age in children, and the effect of type 1 diabetes mellitus on this parameter. Methods: A total of 135 subjects aged 6–15 years (74 healthy subjects, 61 with diabetes) were recruited from outpatient clinics at a tertiary referral children’s hospital. Arterial stiffness was assessed using digital volume pulse (DVP) analysis, a simple, non-operator-dependent, non-invasive technique that analyses the contour of the peripheral arterial pulse wave using infrared photoplethysmography. Results: Age was positively correlated with arterial stiffness (r = 0.27, P = 0.002) in all children, and in both healthy children (r = 0.27, P = 0.02) and those with diabetes (r = 0.43, P = 0.0007). No effect of diabetes was seen on arterial stiffness (P = 0.62). Multivariate analysis showed no effect of gender, deprivation index, duration of diabetes or body mass index standard deviation score on arterial stiffness. Conclusions: This study confirms that arterial stiffness is age dependent in a paediatric population, and that arterial stiffening begins early in life in both healthy children and children with type 1 diabetes mellitus. No additional effect of diabetes was seen on arterial stiffness, which may reflect the short duration of diabetes in the patients studied. DVP is a useful, non-operator-dependent tool in assessing arterial stiffness. Future long-term clinical studies may utilise DVP to determine both when individuals with diabetes develop increases in arterial stiffness compared with healthy individuals, and the clinical relevance of arterial stiffness in assessing future cardiovascular risk.
PAEDIATRICS AND CHILD HEALTH 17:10
Tricuspid interventricular mitral systole 5.43 (1.09), 3.41 (0.46), 3.74 (0.50) Early diastole 5.11 (1.81), 4.50 (1.00), 5.13 (1.37) Late diastole 8.00 (1.48), 4.20 (0.74), 5.47 (1.74) These data are consistent with those from term babies, although, as might be expected, the mean velocities were lower. The smaller, sicker babies and those with a large patent ductus arteriosus demonstrated the lowest velocities. The standard deviation of intraobserver difference was 0.26 cm per second. Conclusions: Our study demonstrates similar patterns of myocardial velocities, of a slightly lower velocity, as term data, in keeping with our understanding of the preterm myocardium. TDI enables the quantification of myocardial function in preterm neonates. Acute-phase reactants and clinical disease activity in juvenile idiopathic arthritis L Arnold, K Armon University of East Anglia and Norfolk and Norwich University Hospital, Norwich Introduction: Disease activity in juvenile idiopathic arthritis (JIA) is monitored using clinical indices and acute-phase reactants. There is evidence from adult literature that C-reactive protein (CRP) level is superior to erythrocyte sedimentation rate (ESR) in reflecting disease activity. We set out to determine whether ESR or CRP performed best as a clinical marker of disease activity in JIA. Methods: Children aged 0–18 years with JIA were invited to participate in the study by returning a signed consent form. Those with a concurrent inflammatory condition were excluded. Data 413
© 2007 Published by Elsevier Ltd.
Results: The study showed that 45% of children were given nebulised salbutamol and 98% received prednisolone. Twenty-three children were admitted to the high-dependency unit, 19 of whom were admitted just for IV magnesium. Of the 23 children given magnesium, seven improved by one category an hour after infusion and 12 improved by one category after 2 hours. No cardiac or other complications occurred in any of the children who received IV magnesium. The mean length of hospital stay was 20 hours, with the minimum being 2 hours and the maximum 1 week. Conclusions: Our audit suggests that magnesium sulphate can be safely administered to children in a district general hospital. As there were no adverse events, we recommended that magnesium sulphate should be given in the general ward rather than the high-dependency unit. We plan to re-audit the effects of this change and our prescribing practice of magnesium. We await future studies into alternative routes of administration.
Myocardial velocities on first day of life in preterm neonates using tissue Doppler imaging RJS Negrine1, AK Ewer1, JGC Wright2, A Chikermane2 1Neonatal Intensive Care, Women’s Hospital 2Paediatric Cardiology, Children’s Hospital, Birmingham Introduction: Current methods of assessing cardiac function have significant limitations. Tissue Doppler imaging (TDI) measures Doppler signals from the myocardium, from which myocardial velocities can be calculated and used as an indicator of cardiac function. Only one study has specifically investigated velocities in term neonates, and none has investigated preterm infants. We set out to assess the myocardial velocities in preterm neonates in the first 24 hours using TDI. Methods: Preterm neonates were scanned by a single investigator (R.N.) at less than 24 hours of age. Myocardial velocities were acquired from an apical four-chamber view with a pulse-wave sample gate of 0.12 cm positioned at the lateral tricuspid annulus, lateral mitral annulus and basal interventricular septum. Peak velocities in systole, early diastole and late diastole were obtained. Average readings were taken from 3–5 cardiac cycles. Ethical approval was obtained. Results: Nine male and four female subjects were recruited, with a median gestational age of 32 weeks (range 25–34 weeks) and a birthweight of 1655 g (range 928–2230 g). The mean (SD) velocities (cm per second) obtained are given below:
Arterial stiffness in healthy children and children with diabetes P Maciocia1, L Bath1, D Webb2 1Royal Hospital for Sick Children 2Cardiovascular Research, Western General Hospital, Edinburgh Introduction: Arterial stiffness is recognised to be a risk factor for cardiovascular disease. Arterial stiffening is an age-dependent process in adults, involving changes in elastin and collagen, and may be affected by genetic and environmental factors. Arterial stiffening is known to be accelerated in adults with diabetes: this is hypothesised to be a result of advanced glycation end-product crosslinks between collagen and elastin, a process that is accelerated in diabetes. This study aims to investigate the relationship between arterial stiffness and age in children, and the effect of type 1 diabetes mellitus on this parameter. Methods: A total of 135 subjects aged 6–15 years (74 healthy subjects, 61 with diabetes) were recruited from outpatient clinics at a tertiary referral children’s hospital. Arterial stiffness was assessed using digital volume pulse (DVP) analysis, a simple, non-operator-dependent, non-invasive technique that analyses the contour of the peripheral arterial pulse wave using infrared photoplethysmography. Results: Age was positively correlated with arterial stiffness (r = 0.27, P = 0.002) in all children, and in both healthy children (r = 0.27, P = 0.02) and those with diabetes (r = 0.43, P = 0.0007). No effect of diabetes was seen on arterial stiffness (P = 0.62). Multivariate analysis showed no effect of gender, deprivation index, duration of diabetes or body mass index standard deviation score on arterial stiffness. Conclusions: This study confirms that arterial stiffness is age dependent in a paediatric population, and that arterial stiffening begins early in life in both healthy children and children with type 1 diabetes mellitus. No additional effect of diabetes was seen on arterial stiffness, which may reflect the short duration of diabetes in the patients studied. DVP is a useful, non-operator-dependent tool in assessing arterial stiffness. Future long-term clinical studies may utilise DVP to determine both when individuals with diabetes develop increases in arterial stiffness compared with healthy individuals, and the clinical relevance of arterial stiffness in assessing future cardiovascular risk.
PAEDIATRICS AND CHILD HEALTH 17:10
Tricuspid interventricular mitral systole 5.43 (1.09), 3.41 (0.46), 3.74 (0.50) Early diastole 5.11 (1.81), 4.50 (1.00), 5.13 (1.37) Late diastole 8.00 (1.48), 4.20 (0.74), 5.47 (1.74) These data are consistent with those from term babies, although, as might be expected, the mean velocities were lower. The smaller, sicker babies and those with a large patent ductus arteriosus demonstrated the lowest velocities. The standard deviation of intraobserver difference was 0.26 cm per second. Conclusions: Our study demonstrates similar patterns of myocardial velocities, of a slightly lower velocity, as term data, in keeping with our understanding of the preterm myocardium. TDI enables the quantification of myocardial function in preterm neonates. Acute-phase reactants and clinical disease activity in juvenile idiopathic arthritis L Arnold, K Armon University of East Anglia and Norfolk and Norwich University Hospital, Norwich Introduction: Disease activity in juvenile idiopathic arthritis (JIA) is monitored using clinical indices and acute-phase reactants. There is evidence from adult literature that C-reactive protein (CRP) level is superior to erythrocyte sedimentation rate (ESR) in reflecting disease activity. We set out to determine whether ESR or CRP performed best as a clinical marker of disease activity in JIA. Methods: Children aged 0–18 years with JIA were invited to participate in the study by returning a signed consent form. Those with a concurrent inflammatory condition were excluded. Data 413
© 2007 Published by Elsevier Ltd.