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Cuijpers MD, Baartmans MGA, Joosten KFM, Dulfer K, van Zuijlen PPM, Ket JCF, Pijpe A. The efficacy of therapeutic interventions on paediatric burn patients' height, weight, body composition, and muscle strength: A systematic review and meta-analysis. Burns 2024:S0305-4179(24)00084-6. [PMID: 38580580 DOI: 10.1016/j.burns.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE To evaluate the efficacy of therapeutic interventions on pediatric burn patients' height, weight, body composition, and muscle strength. METHODS A systematic literature search was conducted in PubMed, Embase, and Web of Science up to March 2021. Eligible interventional studies reported metrics on the height, weight, body composition, or muscle strength of pediatric burn patients in a peer-reviewed journal. Meta-analyses were performed if ≥ 2 trials of clinical homogeneity reported on an outcome measure at the same time point post-burn. RESULTS Twenty-six interventional studies were identified, including twenty-two randomised controlled trials and four non-randomised trials. Most studies were conducted by a single institution. On average, the burn covered 45.3% ( ± 9.9) of the total body surface area. Three categories of interventions could be distinguished: rehabilitative exercise programs, pharmacologic agents, and nutrition support. CONCLUSIONS Each of the interventions had a positive effect on height, weight, body composition, or muscle strength. The decision to initiate an intervention should be made on a case-by-case basis following careful consideration of the benefits and risks. In future research, it is important to evaluate the heterogeneity of intervention effects and whether participation in an intervention allowed pediatric burn patients to reach the physical and functional status of healthy peers.
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Affiliation(s)
- Maxime D Cuijpers
- Burn Center, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, the Netherlands; Plastic, Reconstructive and Hand Surgery, Amsterdam UMC -Location VU University Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Tissue Function and Regeneration, Amsterdam Movement Sciences, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Association of Dutch Burn Centers, Zeestraat 27-29, 1941 AJ Beverwijk, the Netherlands.
| | - Martin G A Baartmans
- Department of Pediatrics, Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, the Netherlands
| | - Koen F M Joosten
- Department of Pediatric and Neonatal Intensive Care, Erasmus MC-Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ Rotterdam, the Netherlands
| | - Karolijn Dulfer
- Department of Pediatric and Neonatal Intensive Care, Erasmus MC-Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ Rotterdam, the Netherlands
| | - Paul P M van Zuijlen
- Burn Center, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, the Netherlands; Plastic, Reconstructive and Hand Surgery, Amsterdam UMC -Location VU University Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Tissue Function and Regeneration, Amsterdam Movement Sciences, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Department of Plastic Surgery, Reconstructive and Hand Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, the Netherlands; Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam University Medical Center - Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Johannes C F Ket
- Medical Library, VU University, de Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Anouk Pijpe
- Burn Center, Red Cross Hospital, Vondellaan 13, 1942 LE Beverwijk, the Netherlands; Plastic, Reconstructive and Hand Surgery, Amsterdam UMC -Location VU University Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Tissue Function and Regeneration, Amsterdam Movement Sciences, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands; Association of Dutch Burn Centers, Zeestraat 27-29, 1941 AJ Beverwijk, the Netherlands.
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Cuijpers MD, van de Sande PJH, Cords CI, Scholten-Jaegers SMHJ, van Zuijlen PPM, Baartmans MGA, Pijpe A. The Effect of Burns on Children's Growth Trajectory: A Nationwide Cohort Study. J Burn Care Res 2023; 44:1083-1091. [PMID: 36728628 PMCID: PMC10483463 DOI: 10.1093/jbcr/irad013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Indexed: 02/03/2023]
Abstract
This study evaluates the short- and long-term effect of burns on children's height and weight, by comparing their pre and postburn growth trajectory. We invited children (≤17 years old), who sustained a burn requiring surgical treatment or admission at one of the Dutch burn centers in 2013 (n = 175). As well as children who sustained a severe burn, covering >10% of the total body surface area (TBSA), throughout 2009-2018 (n = 228). Data was collected from a survey on health-related topics, Youth Health Care records, and the Dutch Burn Repository R3. For all participants, height and weight were converted to Z-scores using Dutch reference values. Linear mixed modeling, nested on the individual level, was used to examine the associations between burns and children's height and weight Z-scores. Children's height and weight Z-scores remained within the normal range throughout the study period. During the first-year postburn, children's height and weight Z-scores decreased by -0.21 (95% CI -0.41, -0.01) and -0.23 (95% CI -0.46, -0.04), respectively. Beyond the first-year postburn, estimates were consistent with a positive linear association between burn size and the overall effect of burns on participants' height and weight Z-scores. This included a modest, but statistically significant, effect among participants with a burn covering ≤4.5% and >14.0% of the TBSA. Sensitivity analyses did not alter our findings. In conclusion, children were on track or even surpassed their growth potential. Our findings could therefore be considered reassuring to patients, parents, and clinicians.
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Affiliation(s)
- Maxime D Cuijpers
- Red Cross Hospital, Burn Centre Beverwijk, Vondellaan 13, Beverwijk, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centre, Location VU University Medical Centre, de Boelelaan 1117, Amsterdam, The Netherlands
- Association of Dutch Burn Centres, Zeestraat 27-29, Beverwijk, The Netherlands
| | | | - Charlotte I Cords
- Association of Dutch Burn Centres, Zeestraat 27-29, Beverwijk, The Netherlands
- Maasstad Hospital, Burn Centre Rotterdam, Maasstadweg 21, Rotterdam, The Netherlands
| | | | - Paul P M van Zuijlen
- Red Cross Hospital, Burn Centre Beverwijk, Vondellaan 13, Beverwijk, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centre, Location VU University Medical Centre, de Boelelaan 1117, Amsterdam, The Netherlands
- Department of Plastic Surgery, Reconstructive and Hand Surgery, Red Cross Hospital, Vondellaan 13, Beverwijk, The Netherlands
- Department of Paediatric Surgery, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Martin G A Baartmans
- Department of Paediatrics, Maasstad Hospital, Maasstadweg 21, Rotterdam, The Netherlands
| | - Anouk Pijpe
- Red Cross Hospital, Burn Centre Beverwijk, Vondellaan 13, Beverwijk, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centre, Location VU University Medical Centre, de Boelelaan 1117, Amsterdam, The Netherlands
- Association of Dutch Burn Centres, Zeestraat 27-29, Beverwijk, The Netherlands
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Cuijpers MD, Baartmans MGA, van Zuijlen PPM, Ket JCF, Pijpe A. Children's growth and motor development following a severe burn: a systematic review. Burns Trauma 2023; 11:tkad011. [PMID: 37663674 PMCID: PMC10468649 DOI: 10.1093/burnst/tkad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 09/05/2023]
Abstract
Background The epidemiological data on post-burn growth, body composition and motor development is ambiguous and scattered. The aim of this systematic review was therefore to summarize the current body of evidence on post-burn growth, body composition and motor development in children. Methods A literature search was conducted in PubMed, EMBASE and Web of Science up to March 2021. We considered observational studies that reported (1) metrics on weight, height, body composition, bone mineral content, bone mineral density or motor development, in (2) paediatric burn patients and (3) published in a peer-reviewed journal. Results A total of 16 studies were included. Each of the included studies used quantitative methods, but with differing methodology: prospective cohort studies (n = 8), retrospective chart reviews (n = 3), case-control studies (n = 2), cross sectional studies (n = 2) and a retrospective cohort study (n = 1). When combined, the included studies represented 2022 paediatric burn patients, with a mean age of 7.7 (±3.2) years. The average burn size was 52.8% (±12.7) of the total body surface area. Identified outcome measures included weight (n = 12), height (n = 7), muscular strength (n = 4), bone mineral content (n = 5), bone mineral density (n = 5), body mass index (n = 3), fat mass (n = 5), lean body mass (n = 7) and fine and gross motor development (n = 1). Conclusions Following an initial decline, patients' growth and motor development started to recover during the first or second year post-burn. Nonetheless, burns may have a profound and prolonged effect on the paediatric burn patients' muscular strength, bone mineral content and lean body mass. It should be noted that the vast majority of studies included only patients with burns covering ≥30% total body surface area. The evidence presented in this review may thus not be representative of the whole paediatric burn population.
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Affiliation(s)
- Maxime D Cuijpers
- Red Cross Hospital, Burn Centre Beverwijk, Vondellaan 13, Beverwijk, The Netherlands
- Amsterdam University Medical Centre, Location VU University Medical Centre, Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, The Netherlands
- Association of Dutch Burn Centres, Zeestraat 27-29, Beverwijk, The Netherlands
| | - Martin G A Baartmans
- Maasstad Hospital, Department of Paediatrics, Maasstadweg 21, Rotterdam, 3079 DZ, The Netherlands
| | - Paul P M van Zuijlen
- Red Cross Hospital, Burn Centre Beverwijk, Vondellaan 13, Beverwijk, The Netherlands
- Amsterdam University Medical Centre, Location VU University Medical Centre, Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, The Netherlands
- Red Cross Hospital, Department of Plastic Surgery, Reconstructive and Hand Surgery, Vondellaan 13, Beverwijk, 1942 LE, The Netherlands
- Paediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Johannes C F Ket
- Medical Library, Vrije Universiteit, de Boelelaan 1117, Amsterdam, The Netherlands
| | - Anouk Pijpe
- Red Cross Hospital, Burn Centre Beverwijk, Vondellaan 13, Beverwijk, The Netherlands
- Amsterdam University Medical Centre, Location VU University Medical Centre, Department of Plastic, Reconstructive, and Hand Surgery, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, The Netherlands
- Association of Dutch Burn Centres, Zeestraat 27-29, Beverwijk, The Netherlands
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Keij FM, Kornelisse RF, Hartwig NG, van der Sluijs-Bens J, van Beek RHT, van Driel A, van Rooij LGM, van Dalen-Vink I, Driessen GJA, Kenter S, von Lindern JS, Eijkemans M, Stam-Stigter GM, Qi H, van den Berg MM, Baartmans MGA, van der Meer-Kappelle LH, Meijssen CB, Norbruis OF, Heidema J, van Rossem MC, den Butter PCP, Allegaert K, Reiss IKM, Tramper-Stranders GA. Efficacy and safety of switching from intravenous to oral antibiotics (amoxicillin-clavulanic acid) versus a full course of intravenous antibiotics in neonates with probable bacterial infection (RAIN): a multicentre, randomised, open-label, non-inferiority trial. Lancet Child Adolesc Health 2022; 6:799-809. [PMID: 36088952 DOI: 10.1016/s2352-4642(22)00245-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/25/2022] [Accepted: 08/09/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Switching from intravenous antibiotic therapy to oral antibiotic therapy among neonates is not yet practised in high-income settings due to uncertainties about exposure and safety. We aimed to assess the efficacy and safety of early intravenous-to-oral antibiotic switch therapy compared with a full course of intravenous antibiotics among neonates with probable bacterial infection. METHODS In this multicentre, randomised, open-label, non-inferiority trial, patients were recruited at 17 hospitals in the Netherlands. Neonates (postmenstrual age ≥35 weeks, postnatal age 0-28 days, bodyweight ≥2 kg) in whom prolonged antibiotic treatment was indicated because of a probable bacterial infection, were randomly assigned (1:1) to switch to an oral suspension of amoxicillin 75 mg/kg plus clavulanic acid 18·75 mg/kg (in a 4:1 dosing ratio, given daily in three doses) or continue on intravenous antibiotics (according to the local protocol). Both groups were treated for 7 days. The primary outcome was cumulative bacterial reinfection rate 28 days after treatment completion. A margin of 3% was deemed to indicate non-inferiority, thus if the reinfection rate in the oral amoxicillin-clavulanic acid group was less than 3% higher than that in the intravenous antibiotic group the null hypothesis would be rejected. The primary outcome was assessed in the intention-to-treat population (ie, all patients who were randomly assigned and completed the final follow-up visit on day 35) and the per protocol population. Safety was analysed in all patients who received at least one administration of the allocated treatment and who completed at least one follow-up visit. Secondary outcomes included clinical deterioration and duration of hospitalisation. This trial was registered with ClinicalTrials.gov, NCT03247920, and EudraCT, 2016-004447-36. FINDINGS Between Feb 8, 2018 and May 12, 2021, 510 neonates were randomly assigned (n=255 oral amoxicillin-clavulanic group; n=255 intravenous antibiotic group). After excluding those who withdrew consent (n=4), did not fulfil inclusion criteria (n=1), and lost to follow-up (n=1), 252 neonates in each group were included in the intention-to-treat population. The cumulative reinfection rate at day 28 was similar between groups (one [<1%] of 252 neonates in the amoxicillin-clavulanic acid group vs one [<1%] of 252 neonates in the intravenous antibiotics group; between-group difference 0 [95% CI -1·9 to 1·9]; pnon-inferiority<0·0001). No statistically significant differences were observed in reported adverse events (127 [50%] vs 113 [45%]; p=0·247). In the intention-to-treat population, median duration of hospitalisation was significantly shorter in the amoxicillin-clavulanic acid group than the intravenous antibiotics group (3·4 days [95% CI 3·0-4·1] vs 6·8 days [6·5-7·0]; p<0·0001). INTERPRETATION An early intravenous-to-oral antibiotic switch with amoxicillin-clavulanic acid is non-inferior to a full course of intravenous antibiotics in neonates with probable bacterial infection and is not associated with an increased incidence of adverse events. FUNDING The Netherlands Organization for Health Research and Development, Innovatiefonds Zorgverzekeraars, and the Sophia Foundation for Scientific Research.
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Affiliation(s)
- Fleur M Keij
- Department of Paediatrics, Division of Neonatology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands; Department of Paediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands.
| | - René F Kornelisse
- Department of Paediatrics, Division of Neonatology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Nico G Hartwig
- Department of Paediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
| | | | | | - Arianne van Driel
- Department of Paediatrics, IJsselland Hospital, Capelle aan den IJssel, Netherlands
| | | | - Ilka van Dalen-Vink
- Department of Paediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
| | - Gertjan J A Driessen
- Department of Paediatrics, Juliana Children's Hospital, Haga Teaching Hospital, the Hague, Netherlands
| | - Sandra Kenter
- Department of Paediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
| | | | | | | | - Hongchao Qi
- Department of Biostatistics, Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | | | | | - Clemens B Meijssen
- Department of Paediatrics, Meander Medical Centre, Amersfoort, Netherlands
| | - Obbe F Norbruis
- Department of Paediatrics, Isala Hospital, Zwolle, Netherlands
| | - Jojanneke Heidema
- Department of Paediatrics, St Antonius Hospital, Nieuwegein, Netherlands
| | | | | | - Karel Allegaert
- Department of Hospital Pharmacy, Erasmus University Medical Centre, Rotterdam, Netherlands; Department of Development and Regeneration and Department of Pharmaceutical and Pharmacological Sciences, Catholic University of Leuven, Leuven, Belgium
| | - Irwin K M Reiss
- Department of Paediatrics, Division of Neonatology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Gerdien A Tramper-Stranders
- Department of Paediatrics, Division of Neonatology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands; Department of Paediatrics, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands.
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Abstract
We present a case study of a 10-year-old child with severe burns that were misinterpreted as inflicted burns. Because of multiple injuries since early life, the family was under suspicion of child abuse and therefore under supervision of the Child Care Board for 2 years before the boy was burned. Because the boy incurred the burns without feeling pain, we conducted a thorough medical examination and laboratory testing, evaluated detection and pain thresholds, and used MRI to study brain morphology and brain activation patterns during pain between this patient and 3 healthy age- and gender-matched controls. We found elevated detection and pain thresholds and lower brain activation during pain in the patient compared with the healthy controls and reference values. The patient received the diagnosis of hereditary sensory and autonomic neuropathy type IV on the basis of clinical findings and the laboratory testing, complemented with the altered pain and detection thresholds and MRI findings. Hereditary sensory and autonomic neuropathy IV is a very rare congenital pain insensitivity syndrome characterized by the absence of pain and temperature sensation combined with oral mutilation due to unawareness, fractures, and anhidrosis caused by abnormalities in the peripheral nerves. Health care workers should be aware of the potential presence of this disease to prevent false accusations of child abuse.
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Affiliation(s)
| | | | - Paul Vos
- Department of Pediatrics, Medical Center Haaglanden, Den Haag, Netherlands
| | - Jan Dokter
- Burn Center, Maasstad Hospital, Rotterdam, Netherlands; and
| | - Tonya White
- Child and Adolescent Psychiatry/Psychology, and Radiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Dick Tibboel
- Intensive Care and Departments of Pediatric Surgery
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Baartmans MGA, van Baar ME, Boxma H, Dokter J, Tibboel D, Nieuwenhuis MK. Accuracy of burn size assessment prior to arrival in Dutch burn centres and its consequences in children: a nationwide evaluation. Injury 2012; 43:1451-6. [PMID: 21741042 DOI: 10.1016/j.injury.2011.06.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 06/06/2011] [Accepted: 06/13/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total body surface area (TBSA) burned, expressed as percentage is one of the most important aspects of the initial care of a burn victim. It determines whether transfer to a burn centre is necessary as well as the need for, and amount of, intravenous fluid resuscitation. Numerous studies, however, have highlighted inaccuracies in TBSA assessment. Therefore, the differences in burn size estimates between referrers and burn centre's in children and its consequences in terms of transfer and intravenous fluid resuscitation were investigated. METHODS This study involved two time periods from January 2002 until March 2004 and January 2007 until August 2008. All referred children admitted to a Dutch Burn centre within 24h post burn were eligible. Data were obtained from patient records retrospectively and in part prospectively. RESULTS A total of 323 and 299 children were included in periods 1 and 2, respectively. Referring physicians overestimated burn size with a factor two (mean difference: 6% TBSA ± 5.5). About one in five children was referred to a burn centre without fulfilling the criteria for referral with regard to burn size (assessed by burn specialists) special localisation or inhalation trauma. Proportions of children receiving intravenous fluid resuscitation regardless of indication increased from 33% to 49% (p<0.01). The received volumes tended to be higher than necessary. CONCLUSIONS Referring physicians overestimate burn size in children admitted to Dutch burn centres. This has little negative consequences, however, in terms of unindicated transfers to a burn centre or unnecessary fluid resuscitation.
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Affiliation(s)
- M G A Baartmans
- Department of Pediatrics, Maasstad Hospital, PO Box 9100, 3007 AC, Rotterdam, The Netherlands.
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Baartmans MGA, Dokter J, den Hollander JC, Kroon AA, Oranje AP. Use of skin substitute dressings in the treatment of staphylococcal scalded skin syndrome in neonates and young infants. Neonatology 2011; 100:9-13. [PMID: 21150225 DOI: 10.1159/000317997] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 06/24/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Staphylococcal scalded skin syndrome (SSSS) is a rare toxin-mediated skin disease caused by Staphylococcus aureus and seen in infants and children younger than 5 years. OBJECTIVES The supportive role of skin substitutes in SSSS is stressed as a new and relatively unknown method. METHODS Retrospective observational case-series study, in neonates and young infants diagnosed with SSSS. RESULTS Seven infants with SSSS, treatment with antibiotics, skin substitutes, strict pain relief strategy and prognosis were described. One of them was severely affected and deceased. CONCLUSION This study describes 7 infants with SSSS and stresses the important role of skin substitutes as Omiderm® and Suprathel® as valuable adjuvant treatment modality.
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Affiliation(s)
- M G A Baartmans
- Department of Paediatrics, Maasstadziekenhuis, Rotterdam, The Netherlands.
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Riedijk MA, Voortman G, van Beek RHT, Baartmans MGA, Wafelman LS, van Goudoever JB. Cyst(e)ine requirements in enterally fed very low birth weight preterm infants. Pediatrics 2008; 121:e561-7. [PMID: 18283068 DOI: 10.1542/peds.2007-0494] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Optimal nutrition is of utmost importance for the preterm infant's later health and developmental outcome. Amino acid requirements for preterm infants differ from those for term and older infants, because growth rates differ. Some nonessential amino acids, however, cannot be sufficiently synthesized endogenously. Cyst(e)ine is supposed to be such a conditionally essential amino acid in preterm infants. The objective of this study was to determine, at 32 and 35 weeks' postmenstrual age, cyst(e)ine requirements in fully enterally fed very low birth weight preterm infants with gestational ages of <29 weeks. METHODS Infants were randomly assigned to 1 of the 5 graded cystine test diets that contained generous amounts of methionine. Cyst(e)ine requirement was determined with the indicator amino acid oxidation technique ([1-(13)C]phenylalanine) after 24-hour adaptation. RESULTS Fractional [1-(13)C]phenylalanine oxidation was established in 47 very low birth weight preterm infants (mean gestational age: 28 weeks +/- 1 week SD; birth weight: 1.07 kg +/- 0.21 kg SD). Increase in dietary cyst(e)ine intake did not result in a decrease in fractional [1-(13)C]phenylalanine oxidation. CONCLUSIONS These data do not support the hypothesis that endogenous cyst(e)ine synthesis is limited in very low birth weight preterm infants with gestational ages of <29 weeks, both at 32 and 35 weeks postmenstrual age. It is safe to conclude that cyst(e)ine requirement is <18 mg/kg per day in enterally fed very low birth weight preterm infants who are older than 32 weeks' postmenstrual age and whose methionine intake is adequate. Therefore, cyst(e)ine is probably not a conditionally essential amino acid in these infants.
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Affiliation(s)
- Maaike A Riedijk
- Erasmus MC-Sophia Children's Hospital, Department of Pediatrics, Division of Neonatology, Dr Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
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Dansen MJ, Baartmans MGA. [Diagnostic image (343). A neonate with a red, swollen umbilicus]. Ned Tijdschr Geneeskd 2007; 151:2147. [PMID: 17957991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
A male neonate had fecal loss from a patent omphalomesenteric duct.
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Affiliation(s)
- M J Dansen
- Medisch Centrum Rijnmond-Zuid, locatie Zuider, afd. Kindergeneeskunde, Postbus 9100, 3007 AC Rotterdam
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