RESUMEN

The study objective was to determine whether Ureaplasma respiratory tract colonization of preterm infants <33 wk gestation is associated with an increased risk for necrotizing enterocolitis (NEC). One or more tracheal or nasopharyngeal aspirates for Ureaplasma culture and PCR were obtained during the first week of life from 368 infants <33 wk gestation enrolled from 1999 to 2003 or from 2007 to 2009. NEC Bell stage ≥ 2 was confirmed by radiological criteria, and pathology, if available. Cord serum samples were analyzed for IL-6 and IL-1ß concentrations, and placentas were reviewed for histological chorioamnionitis in the first cohort. NEC was confirmed in 29 of 368 (7.9%) of the combined cohorts. The incidence of NEC was 2.2-fold higher in Ureaplasma-positive (12.3%) than Ureaplasma-negative (5.5%) infants <33 wk (OR, 2.43; 95% CI, 1.13-5.2; p = 0.023) and 3.3-fold higher in Ureaplasma-positive (14.6%) than Ureaplasma-negative (4.4%) infants ≤ 28 wk (OR, 3.67; 95% CI, 1.36-9.93; p = 0.01). Age of onset, hematologic parameters at onset, and NEC severity were similar between Ureaplasma-positive and negative infants. Cord serum IL-6 and IL-1ß concentrations were significantly higher in Ureaplasma-positive than in Ureaplasma-negative NEC-affected infants. Ureaplasma may be a factor in NEC pathogenesis in preterm infants by contributing to intestinal mucosal injury and/or altering systemic or local immune responses.

Asunto(s)

Enterocolitis Necrotizante/microbiología , Recien Nacido Prematuro , Infecciones del Sistema Respiratorio/microbiología , Infecciones por Ureaplasma/microbiología , Ureaplasma/patogenicidad , Análisis de Varianza , Técnicas Bacteriológicas , Baltimore , Distribución de Chi-Cuadrado , Enterocolitis Necrotizante/epidemiología , Enterocolitis Necrotizante/inmunología , Femenino , Sangre Fetal/inmunología , Edad Gestacional , Humanos , Incidencia , Recien Nacido con Peso al Nacer Extremadamente Bajo , Recién Nacido , Recién Nacido de muy Bajo Peso , Mediadores de Inflamación/sangre , Interleucina-1beta/sangre , Interleucina-6/sangre , Masculino , Oportunidad Relativa , Reacción en Cadena de la Polimerasa , Estudios Prospectivos , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/inmunología , Medición de Riesgo , Factores de Riesgo , Ureaplasma/genética , Ureaplasma/aislamiento & purificación , Infecciones por Ureaplasma/epidemiología , Infecciones por Ureaplasma/inmunología

RESUMEN

Recent evidence strongly implicates the inflammatory response to intrauterine infection in the pathogenesis of neonatal brain and lung injury. We hypothesized that lung and brain injury in preterm infants occurs during a common developmental window of vulnerability as the result of an inflammatory response in different compartments. To determine whether inflammatory markers in these compartments are associated with bronchopulmonary dysplasia (BPD) or cranial ultrasound (CUS) abnormalities in infants <33 wk gestation age (GA) and <1501 g birth weight, we analyzed placental pathology and serum and cerebrospinal fluid (CSF) IL-6, IL-1beta, and tumor necrosis factor-alpha (TNF-alpha) concentrations in 276 infants. Logistic regressions were performed stratified by GA. Histologic chorioamnionitis was significantly associated with BPD in infants /=17 pg/mL was associated with an abnormal CUS in infants >28 wk GA (OR 3.36, p = 0.023) but not /=6.5 pg/mL and TNF-alpha >/=3 pg/mL were associated with abnormal CUS in infants /=28 wk GA. These data suggest that in infants

Asunto(s)

Lesiones Encefálicas/sangre , Lesiones Encefálicas/líquido cefalorraquídeo , Displasia Broncopulmonar/sangre , Displasia Broncopulmonar/líquido cefalorraquídeo , Sangre Fetal/metabolismo , Mediadores de Inflamación/metabolismo , Lesiones Encefálicas/etiología , Displasia Broncopulmonar/etiología , Corioamnionitis/sangre , Corioamnionitis/líquido cefalorraquídeo , Corioamnionitis/complicaciones , Estudios de Cohortes , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Mediadores de Inflamación/líquido cefalorraquídeo , Interleucina-1/sangre , Interleucina-1/líquido cefalorraquídeo , Interleucina-6/sangre , Interleucina-6/líquido cefalorraquídeo , Masculino , Embarazo , Resultado del Embarazo , Factores de Riesgo , Factor de Necrosis Tumoral alfa/líquido cefalorraquídeo , Factor de Necrosis Tumoral alfa/metabolismo , Útero/irrigación sanguínea , Útero/metabolismo

RESUMEN

A fibrous, cartilaginous, or bony (or a combination thereof) connection between two tarsal bones, or tarsal coalition usually involves the calcaneonavicular or talocalcaneal articulations. Foot pain, beginning when an initially fibrous coalition becomes partially or totally osseous and coinciding with trauma or increased stress such as athletic activity, is the usual presenting symptom. Although often identified on radiographs of the foot (including specialized projections), tarsal coalitions are increasingly imaged with computed tomography of the feet. Plain tomography, single contrast arthrography, and bone scintigraphy are no longer used in the evaluation of tarsal coalition. Magnetic resonance imaging has some advantages over computed tomography but its exact role remains undetermined. Surgical resection of symptomatic tarsal coalitions is used when conservative methods fail to alleviate symptoms.

RESUMEN

A component of the evaluation of scoliosis in children is radiography of the spine, initially in anteroposterior and lateral projections. In selected circumstances, additional imaging of the neural axis with magnetic resonance imaging is indicated to identify or exclude an associated spinal cord or neural canal abnormality. The initial management of scoliosis is almost always conservative, employing bracing or casting. When conservative methods fail to control curvature progression, spinal surgery is indicated. A variety of instrumentation devices have been developed in order to reduce and stabilize spinal curvatures. This article will dicuss and illustrate the more frequently used instrumentation devices as well as other selected aspects of spinal surgery.

RESUMEN

Cerebral palsy is a term applied to a variety of clinical syndromes that have as a common feature the abnormal control of motor function by the brain, resulting in disorders of movement and posturing. Sensory function is often affected as well. Cerebral palsy afflicts the immature brain (under 2 years of age) and usually produces neuropathologic changes that do not progress with increasing age. Because myelination of the brain is a progressive process that begins late in the third trimester and continues into adolescence in a well defined pattern, only after the neuronal pathways from brain lesions have become myelinated and the pattern of abnormality determined, can the brain lesions forming the basis of cerebral palsy be detected.

RESUMEN

Both underrecognized and underreported, child abuse has a spectrum of findings on imaging of the musculoskeletal structures that may permit the radiologist to first suggest the occurrence of child abuse or to help support clinical concern for a diagnosis of child abuse. This article will discuss the approach to imaging of the musculoskeletal system in suspected child abuse, illustrate many of the more common imaging findings, and present imaging pitfalls and alternative diagnostic considerations. Injuries to the brain, spinal cord, gastrointestinal and genitourinary systems, and cardiopulmonary structures are outside the scope of this article.

RESUMEN

Legg-Calve-Perthes disease reflects avascular necrosis of the proximal femoral epiphysis and growth plate in children age 4 to 8 years typically. The most likely etiology is vascular deficiency to the epiphysis and growth plate. The pathologic stages consist of necrosis, resorption, reossification, and remodeling. Radiologic findings reflect the pathologic stages. Containment of the femoral head with the acetabulum is the most important component of treatment, with preservation of range of motion also indicated in most patients. Surgical options for treatment include varus or valgus femoral osteotomy, innominate osteotomy, and shelf arthroplasty.