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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ahj.2007.11.001 Byline: Christopher Ratnasamy, Daniel D. Kinnamon, Steven E. Lipshultz, Paolo Rusconi Abstract: Adult heart failure (HF) has been shown to be associated with neuroendocrine and inflammatory activation. We hypothesize that neuroendocrine and inflammatory activation also associate with symptom severity and echocardiographic measurements in pediatric HF. Author Affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, The Children's Heart Center, Holtz Children's Hospital, University of Miami/Jackson Memorial Medical Center, Miami, FL Division of Pediatric Clinical Research, Department of Pediatrics, Leonard M. Miller School of Medicine, University of Miami, The Children's Heart Center, Holtz Children's Hospital, University of Miami/Jackson Memorial Medical Center, Miami, FL Article History: Received 9 March 2007; Accepted 2 November 2007

OBJECTIVE. Antenatal hydronephrosis is diagnosed in 1% to 5% of all pregnancies; however, the antenatal and postnatal management of hydronephrosis varies widely. No previous studies define the risk of postnatal pathology in infants with antenatal hydronephrosis. Our objective was to review the current literature to determine whether the degree of antenatal hydronephrosis and related antenatal ultrasound findings are associated with postnatal outcome. METHODS. We searched Medline (1966-2005), Embase (1991-2004), and the Cochrane Library databases for articles on antenatal hydronephrosis. We required studies to have subjects selected on the basis of documented measurements of antenatal hydronephrosis and followed to a postnatal diagnosis. We excluded case reports, review articles, and editorials. Two independent investigators extracted data. RESULTS. We screened 1645 citations, of which 17 studies met inclusion criteria. We created a data set of 1308 subjects. The risk of any postnatal pathology per degree of antenatal hydronephrosis was 11.9% for mild, 45.1% for moderate, and 88.3% for severe. There was a significant increase in risk per increasing degree of hydronephrosis. The risk of vesicoureteral reflux was similar for all degrees of antenatal hydronephrosis. CONCLUSIONS. The findings of this meta-analysis can potentially be used for prenatal counseling and may alter current postnatal management of children with antenatal hydronephrosis. Overall, children with any degree of antenatal hydronephrosis are at greater risk of postnatal pathology as compared with the normal population. Moderate and severe antenatal hydronephrosis have a significant risk of postnatal pathology, indicating that comprehensive postnatal diagnostic management should be performed. Mild antenatal hydronephrosis may carry a risk for postnatal pathology, but additional prospective studies are needed to determine the optimal management of these children. A well-defined prospective analysis is needed to further define the risk of pathology and the appropriate management protocols. Key Words hydronephrosis, renal, kidney disease, prenatal, outcome Abbreviations ANH--antenatal hydronephrosis VCUG--voiding cystourethrogram APD--anterior posterior diameter UPJ--ureteropelvic junction obstruction VUR--vesicoureteral reflux CI--confidence interval, ANTENATAL HYDRONEPHROSIS (ANH) affects ~1% to 5% of all pregnancies and is one of the most common birth defects. (1-4) However, the reported clinical relevance of varying degrees of ANH [...]

BACKGROUND. Newborn screening programs now identify children with >30 biochemical genetic disorders. False-positive identifications may increase as disorders are added to screening panels. Concerns arise regarding the potential impact on parental stress, family relationships, and perceptions of the child's health. METHODS. Parents of 173 infants with false-positive screening results for a biochemical genetic disorder in the expanded newborn screening panel were compared with parents of 67 children with normal screening results. Parents completed an interview that elicited information about demographic features, child and parental health, and understanding of newborn screening. Parents also completed the parenting stress index. RESULTS. Parents in the false-positive group attained higher total scores on the PSI than did parents in the normal-screened group, scoring higher on the parent-child dysfunction subscale and the difficult child subscale. Only approximately one third of parents in the false-positive group reported knowing the correct reason for repeat screening. Mothers who reported knowing the correct reason for their child's repeat screening test experienced less total stress than did mothers who were misinformed, were not informed, or did not remember. CONCLUSIONS. False-positive screening results may affect parental stress and the parent-child relationship. Improved communication with parents regarding the need for repeat screening tests may reduce the negative impact of false-positive results. Key Words newborn screening, false-positive, parental stress, vulnerable child, nocebo phenomenon, parent-child relationship Abbreviations PKU--phenylketonuria PSI--parenting stress index, RECENT EXPANSION OF newborn screening for biochemical genetic disorders has led not only to an increase in positive identifications but also to a dramatic increase in false-positive test results. A [...]

Cerebellar hemorrhage (CBH) in premature infants is increasingly diagnosed secondary to improved neuroimaging techniques and survival of very small preterm infants. Information is limited, however, on the incidence, topography, and risk factors for CBH in the preterm infant. Objectives. To define the incidence of CBH in preterm infants diagnosed by neonatal cranial ultrasound (US), describe the sonographic features of CBH, and identify maternal and perinatal risk factors associated with this lesion. Methods. A systematic electronic database search identified preterm infants born 1998-2002 with US diagnosis of CBH. For 35 cases of CBH we double-matched (according to gestational age, gender, and year of birth) 70 preterm controls with normal cranial USs and performed detailed medical-record reviews for both patients and controls. Results. Unilateral CBH was seen in 25 patients (71%), vermian hemorrhage was seen in 7 (20%), and combined bihemispheric and vermian hemorrhage was seen in 3 (9%). Isolated CBH occurred in 8 patients (23%); the remaining infants had associated supratentorial lesions. The incidence of CBH in preterm infants weighing Conclusions. CBH is an important complication of extreme preterm birth and has been underrecognized in surviving preterm infants. Predictors of CBH seem to be multifactorial and include combined maternal, intrapartum, and early postnatal factors. Pediatrics 2005;116:717-724; cerebellar hemorrhage, premature infants, cranial ultrasound, incidence, risk factors., ABBREVIATIONS. CBH, cerebellar hemorrhage; US, ultrasound/ ultrasonographic; GM-IVH, germinal matrix-intraventricular hemorrhage; PVHI, periventricular hemorrhagic infarction; PDA, patent ductus arteriosus; BPD, bronchopulmonary dysplasia; OR, odds ratio; CI, confidence interval. Hemorrhage into [...]