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Helt TW, Johansen LS, Faurholt-Jepsen D, Larsen VA, Borgwardt L, Mortensen J, Brix Christensen V. Brain imaging in children with neonatal cholestatic liver disease: A systematic review. Acta Paediatr 2024; 113:1168-1185. [PMID: 38406880 DOI: 10.1111/apa.17177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/08/2024] [Accepted: 02/19/2024] [Indexed: 02/27/2024]
Abstract
AIM To determine if children with neonatal cholestatic liver disease had concurrent and later findings on brain imaging studies that could be attributed and the cholestasis to contribute to the understanding of the impaired neuropsychological development. METHODS Ovid MEDLINE and EMBASE were searched on July 21, 2022, and updated on March 26, 2023. Studies with children under 18 years of age with neonatal cholestasis and a brain scan at the time of diagnosis or later in life were included. Excluded studies were non-English, non-human, reviews or conference abstracts. Data were extracted on demographics, brain imaging findings, treatment and outcome. The results were summarised by disease categories. Risk of bias was assessed using JBI critical appraisal tools. RESULTS The search yielded 12 011 reports, of which 1261 underwent full text review and 89 were eligible for inclusion. Haemorrhage was the most common finding, especially in children with bile duct obstruction, including biliary atresia. Some findings were resolved after liver transplantation. CONCLUSION Children with neonatal cholestasis had changes in brain imaging, which might play a role in impaired neuropsychological development, but longitudinal clinical research with structured assessment is needed to better qualify the aetiology of the impairment.
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Affiliation(s)
- Thora Wesenberg Helt
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Daniel Faurholt-Jepsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Andrée Larsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Lise Borgwardt
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jann Mortensen
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Brix Christensen
- Department of Paediatric Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Comparative Pediatrics and Nutrition, University of Copenhagen, Copenhagen, Denmark
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Alkhasov AB, Gurskaya AS, Bayazitov RR, Nakovkin ON, Sulavko MA, Karnuta IV, Ekimovskaya EV, Kyarimov IA, Akhmedova DM, Klepikova AA, Ratnikov SA, Fisenko AP. [Choledochal cysts: surgical treatment in newborns and infants]. Khirurgiia (Mosk) 2024:5-13. [PMID: 38477238 DOI: 10.17116/hirurgia20240315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To improve postoperative outcomes in newborns and infants with choledochal cysts and to determine the indications for surgery. MATERIAL AND METHODS There were 13 children aged 0-3 months with choledochal cyst who underwent reconstructive surgery between 2019 and 2023. In all children, choledochal cyst was associated with cholestasis. Acholic stool was observed in almost half of the group (n=7). All children underwent cyst resection and Roux-en-Y hepaticoenterostomy. RESULTS Symptoms of cholestasis regressed in all patients. Mean surgery time was 128±27 min. There were no complications. Enteral feeding was started after 1-2 postoperative days, abdominal drainage was removed after 6.2±1.6 days. Mean length of hospital-stay was 16±3.7 days. Adequate bile outflow is one of the main principles. For this purpose, anastomosis with intact tissues of hepatic duct should be as wide as possible. Roux-en-Y loop should be at least 40-60 cm to prevent postoperative cholangitis. CONCLUSION Drug-resistant cholestasis syndrome and complicated choledochal cysts (cyst rupture, bile peritonitis) are indications for surgical treatment in newborns and infants. When forming Roux-en-Y hepaticoenterostomy, surgeon should totally excise abnormal tissues of the biliary tract to prevent delayed malignant transformation.
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Affiliation(s)
- A B Alkhasov
- National Medical Research Center for Children's Health, Moscow, Russia
| | - A S Gurskaya
- National Medical Research Center for Children's Health, Moscow, Russia
| | - R R Bayazitov
- National Medical Research Center for Children's Health, Moscow, Russia
| | - O N Nakovkin
- National Medical Research Center for Children's Health, Moscow, Russia
| | - M A Sulavko
- National Medical Research Center for Children's Health, Moscow, Russia
| | - I V Karnuta
- National Medical Research Center for Children's Health, Moscow, Russia
| | - E V Ekimovskaya
- National Medical Research Center for Children's Health, Moscow, Russia
| | - I A Kyarimov
- National Medical Research Center for Children's Health, Moscow, Russia
| | - D M Akhmedova
- National Medical Research Center for Children's Health, Moscow, Russia
| | - A A Klepikova
- National Medical Research Center for Children's Health, Moscow, Russia
| | - S A Ratnikov
- National Medical Research Center for Children's Health, Moscow, Russia
| | - A P Fisenko
- National Medical Research Center for Children's Health, Moscow, Russia
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Kowalski A, Kowalewski G, Kaliciński P, Pankowska-Woźniak K, Szymczak M, Ismail H, Stefanowicz M. Choledochal Cyst Excision in Infants-A Retrospective Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020373. [PMID: 36832502 PMCID: PMC9954880 DOI: 10.3390/children10020373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/02/2023] [Accepted: 02/11/2023] [Indexed: 02/16/2023]
Abstract
A choledochal cyst is a rare malformation primarily diagnosed in children. The only effective therapy remains surgical cyst resection followed by Roux-en-Y hepaticojejunostomy. Treating asymptomatic neonates remains a point of discussion. Between 1984 and 2021, we performed choledochal cyst (CC) excision in 256 children at our center. Out of this group, we retrospectively reviewed the medical records of 59 patients who were operated on under one year of age. Follow-up ranged from 0.3 to 18 years (median 3.9 years). The preoperative course was asymptomatic in 22 (38%), while 37 patients (62%) had symptoms before surgery. The late postoperative course was uneventful in 45 patients (76%). In symptomatic patients, 16% had late complications, while in asymptomatic patients, only 4%. Late complications were observed in the laparotomy group in seven patients (17%). We did not observe late complications in the laparoscopy group. Early surgical intervention is not followed by a high risk of complications and may prevent the onset of preoperative complications, giving excellent early and long-term results, especially after minimally invasive laparoscopic surgery.
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Al Khawaja FFK, Al-Amri MHAN, Toaimah FHS. Intracranial Bleeding as an Atypical Clinical Presentation of Choledochal Cyst in a Young Infant. JPGN REPORTS 2020; 1:e021. [PMID: 37206612 PMCID: PMC10191569 DOI: 10.1097/pg9.0000000000000021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/27/2020] [Indexed: 05/21/2023]
Affiliation(s)
- Farah F. Kadhim Al Khawaja
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed H. A. Nasser Al-Amri
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Pediatrics and Clinical Emergency Medicine, Weill Cornell Medical College in Qatar, Cornell University, Doha, Qatar
| | - Fatihi Hassan Soliman Toaimah
- From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Pediatrics and Clinical Emergency Medicine, Weill Cornell Medical College in Qatar, Cornell University, Doha, Qatar
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Intra-cerebral hemorrhage associated with choledochal cyst in an infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2019.101373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Liem NT, Huyen TL, Huong LT, Doan NV, Anh BV, Anh NTP, Tung DT. Outcomes of Bone Marrow Mononuclear Cell Transplantation for Neurological Sequelae Due to Intracranial Hemorrhage Incidence in the Neonatal Period: Report of Four Cases. Front Pediatr 2019; 7:543. [PMID: 32039110 PMCID: PMC6993568 DOI: 10.3389/fped.2019.00543] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 12/12/2019] [Indexed: 12/24/2022] Open
Abstract
Aim: The aim of this study was to present primary outcomes of autologous bone marrow mononuclear cell (BMMNC) transplantation to improve neurological sequelae in four children with intracranial hemorrhage (ICH) incidence during the neonatal period. Methods: GMFM88 and modified Ashworth score were used to assess motor function and muscle spasticity before BMMNC transplantation and after transplantation. Brain MRI was performed to evaluate brain morphology before and after BMMNC transplantation. Bone marrow were harvested from anterior iliac crest puncture and BMMNCs were isolated using Ficoll gradient centrifugation. The microbiological testing, cell counting, and hematopoietic stem cell (hHSC CD34+ cell) analysis were performed, following which BMMNCs were infused intrathecally. Results: Improvement in motor function was observed in all patients after transplantation. In addition, muscle spasticity was reduced in all four patients. Conclusion: Autologous BMMNC transplantation may improve motor function and reduce muscle spasticity in children with ICH incidence during the neonatal period.
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Affiliation(s)
- Nguyen Thanh Liem
- Cellular Manufacturing Department, Vinmec Research Institute of Stem Cell and Gene Technology, Hanoi, Vietnam
| | - Truong Linh Huyen
- Cellular Manufacturing Department, Vinmec Research Institute of Stem Cell and Gene Technology, Hanoi, Vietnam
| | - Le Thu Huong
- Vinmec Times City General Hospital, Hanoi, Vietnam
| | - Ngo Van Doan
- Vinmec Times City General Hospital, Hanoi, Vietnam
| | - Bui Viet Anh
- Cellular Manufacturing Department, Vinmec Research Institute of Stem Cell and Gene Technology, Hanoi, Vietnam
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Badebarin D, Aslanabadi S, Teimouri-Dereshki A, Jamshidi M, Tarverdizadeh T, Shad K, Ghabili K, Khajir G. Different clinical presentations of choledochal cyst among infants and older children: A 10-year retrospective study. Medicine (Baltimore) 2017; 96:e6679. [PMID: 28445267 PMCID: PMC5413232 DOI: 10.1097/md.0000000000006679] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Choledochal cyst is a rare and often benign congenital cystic dilation throughout the biliary tree. Due to the benign nature of choledochal cyst among early-diagnosed patients, the clinical assumption and diagnosis seem to be of utmost significance. Therefore, we sought to assess different clinical manifestations of choledochal cyst and relevant laboratory findings in infants and older children.Retrospectively, medical records of all patients with the diagnosis of choledochal cyst between 2005 and 2015 were reviewed. Demographic data, initial clinical presentation, positive findings on physical examination, history of any remarkable behavior such as persistent and unexplained crying and poor feeding, and diagnostic imaging modalities were listed. In addition, laboratory values for total and direct bilirubin, alkaline phosphatase, alanine transaminase, aspartate transaminase, prothrombin time, and partial thromboplastin time (PTT) were recorded for each patient. Patients were divided into 2 groups; younger than 1-year-old (infants), and 1 year to 18 years old (older children). Demographic data, clinical data, and laboratory values were compared between the infants and older children.Thirty-two patients with a diagnosis of choledochal cyst were included in the study: 9 patients (28.12%) were infants and 23 patients (71.87%) were older children. Abdominal pain was the most common presenting symptom (62.5%), followed by nausea/vomiting (59.4%) and jaundice (28.1%). None of the patients presented with the classic triad of abdominal pain, jaundice, and right upper quadrant mass. Seventeen older children (73.91%) presented with nausea and vomiting, while 2 subjects (22.22%) in the infantile group presented with this feature (P = .01). Similarly, abdominal pain was found in 20 older children (86.95%); however, none of the infants presented with abdominal pain at diagnosis (P < .001). By contrast, the abdominal mass was more detected in infants than the older children (33.33% vs. 0%, P = .01). In terms of laboratory values, the median PTT was 44 and 36 s in infants and older children, respectively (P = .04).Infants were more likely to present with abdominal mass and older children were more likely to have nausea, vomiting, and abdominal pain. Furthermore, infants had more prolonged PTT than older children, implying a potential bleeding tendency.
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Affiliation(s)
- Davoud Badebarin
- Pediatric Health Research Center, Tabriz University of Medical Sciences
| | - Saeid Aslanabadi
- Pediatric Health Research Center, Tabriz University of Medical Sciences
| | | | - Masoud Jamshidi
- Pediatric Health Research Center, Tabriz University of Medical Sciences
| | - Tuba Tarverdizadeh
- Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kaveh Shad
- Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamyar Ghabili
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Ghazal Khajir
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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