Poster Presentations

Acta Pædiatrica ISSN 0803-5253

POSTER PRESENTATIONS (PP001–PP166) THEME: ADOLESCENT MEDICINE PP001

PP002

OBJECTIVE MEAUSURES OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER

DEMOGRAPHICS, CLINICAL CHARACTERISTICS AND OUTCOME OF HINI PATIENTS IN AN IRISH PEDIATRIC SETTING

I Berger1, G Goldzweig2

N Barrett1, O Oluwole1, A-M Murphy2, R Pinnamaneni1, E Roche1,2, D Coughlan1, H Hoey1,2

1

The Neuro-Pediatric Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel, 2The Clinical Psychology Section, School of Behavioral Sciences, The Academic College Tel-Aviv-Yaffo, Tel-Aviv, Israel Introduction: Attention-Deficit Hyperactivity Disorder (ADHD) is among the most prevalent chronic health disorders affecting children. The disorder attracts a lot of controversies, partly due to difficulties in the diagnostic process. The impact of undiagnosed ADHD might have a significant effect. Computerized continuous performance tests designed to improve the validity of the process, but are controversial due to low odds ratios. There is a need to find more definitive measures of assessment. Purpose: We introduce a computerized continuous performance functions test (CPF) which includes multitask approach designed to achieve a higher odds ratios of assessment. Material: The CPF test includes combination of tasks, based on an algorithm designed to test several domains of attention, introducing a combination of multi-task approach. Methods: Fifty-eight children (age 6–12 years) participated. Forty five diagnosed as ADHD, thirteen non-ADHD children, served as a control group. ADHD diagnosis, established by a certified pediatric neurologist, based on DSM-IV-TR criteria after interview with the child and parents, neurological examination, filling of DSM based questionnaires by parents and teachers, and neuropsychological evaluation confirming the diagnosis. The children in the study group also completed a commercial CPT. All 58 children completed the CPF test while the child is not under an influence of a medication. All the children in the study were drug naı¨ve. Results: The CPF test was able to differentiate between non-ADHD and ADHD children. CPF test results were more accurate than other tested CPT. Results were statistically significant in all test parameters confirming the test validity and reliability. Conclusions: In this study the CPF test found to be valid and reliable tool for the diagnosis of ADHD in children. The CPF test might increase the diagnostic utility of computerized tests. The research issues the need for developing a more definitive process of ADHD diagnosis.

1 Department of Pediatrics, National Children’s Hospital Tallaght, Dublin, Ireland, 2Department of Pediatrics, Trinity College Dublin, Dublin, Ireland

Introduction: As of May 1st 2010 there were 4586 confirmed cases of H1N1 in Ireland of whom 26 died. The effect of the H1N1 on Pediatric Medicine over the past year is of particular interest with the highest rate of hospitalization being in the 0–4 year age group. Presentation was often atypical in a pediatric setting with severity correlating with underlying disease. Vulnerability was enhanced in younger children because of lack of innate immunity and inferior response to inactivated vaccines. Purpose: To determine the impact of H1N1 infection on Irish children in an effort to characterize the phenotype and explore the implications for future pandemic planning. Materials and methods: The study period was taken as the 12 month time frame between 01/04/2009 and 01/04/ 2010. All patients A in SCO2 were prevalent. At biochemical level, SCO1, SCO2 and SURF1 deficiency was found to result in highly-tissue specific pattern of COX assembly impairment. In addition, moderate to profound decrease of total cellular copper was observed in all available muscle biopsies. Conclusions: COX deficiency resulting from mutations in COX assembly factors Surf1 and Sco2 represents the most frequently recognized causes of isolated COX defects in childhood, at least in our population. The markedly reduced cellular copper levels of SCO1, SCO2 and SURF1 samples may indicate additional role of COX assembly proteins in copper homeostasis maintenance. The particular tissue-specific impact of SCO1, SCO2 and SURF1 deficiency suggests once again highly tissue-specific nature of respiratory chain biogenesis. Supported by MSM 0021620806.

2010 The Author(s)/Journal Compilation 2010 Foundation Acta Pædiatrica/Acta Pædiatrica 2010, 99 (Suppl. 462), pp. 47–120

Poster Presentations

THEME: HAEMATOLOGY & ONCOLOGY PP079 LANGERHANS CELL HISTIOCYTOSIS (LCH) IN CHILDREN: A SINGLE INSTITUTION EXPERIENCE T Papageorgiou, Z D Pana, V Tsotoulidou, A Tragiannidis, E Hatzipantelis, P F Athanasiadou Pediatric Hematology Oncology Unit, 2nd Pediatric Department, AHEPA University Hospital, Thessaloniki, Greece Introduction: LCH is a rare disorder in childhood with unclear etiology and pathogenesis, which is characterized by abnormal clonal proliferation and accumulation of Langerhans cells at various tissue and organs. The clinical presentation of LCH is very heterogeneous, ranging from a single-system involvement, generally benign, to a multisystem life-threatening disease. Purpose: To present epidemiological data, management and outcome of LCH. Material and methods: Fifteen children with the diagnosis of LCH treated at a single Greek Pediatric Unit of Northern Greece from 1995 to 2010 were evaluated retrospectively for clinicopathological features, laboratory findings, treatment and long-term outcome. Results: Median age at the time of diagnosis was 7 years (IR 2.5–10 years) and male/female ratio was 10/5. The most common complaint at presentation was bone lesionrelated symptoms followed by recurrent otitis media. Ten patients had initially single-system and five had multisystem disease. Initial organ involvement included bone (60%), ear (20%), skin (13.3%), lung (13.3%) and diabetes insipidus (13.3%). Treatment consisted of surgery in seven pts, chemotherapy in three and combination of them in five pts. Chemotherapy regimen was based on LCHII or LCH III-protocol in nine pts, three of them received as relapse treatment 2-Chlorodeoxyadenosine (2CDA) and Cytarabine (Aracytin). In total, five children (33.3%) relapsed at a median time of 5 years after diagnosis. One patient with multisystem disease died in 2 months from diagnosis. Fourteen children are alive (OS 93.3%). Median duration of follow up was 11 years (range 5 months–15 years). Conclusion: Due to the lack of understanding of the pathogenesis of LCH and to the limited number of epidemiological studies, optimal therapy remains a challenge. PP080 THE MEASUREMENT OF SYMPTOMS IN CHILDREN WITH CANCER D Yildiz1, B E Fydanci1, K Fydanci2, D Konukbay1 1

Gulhane Military Medical Academy School of Nursing, Turkey, 2Gulhane Military Medical Academy Depatment of Pediatric, Turkey

Introduction: Usage of high dosage chemotherapeutic medicine causes many symptoms and problems in children with cancer. Understanding symptom prevalence and characteristics in children with cancer is important to observe measurement of outcomes that reflect the impact of treatment and nursing care on patients and families. Purpose: The purpose of this methodological study was to determine symptom prevalence, characteristics, and distress in children with cancer. Material and method: The study is being carried out at Gulhane Military Medical Academy, Department of Pediatric Oncology between October 2008 and April 2009. The research sample is constituted of 56 children, 10–18 aged, who had received chemotherapy for cancer. Data is being collected by a descriptive questionnaire and Memorial Symptom Assessment Scale (MSAS 10–18) that has 30 items used to assess patients’ symptom. Results: The most prevalent symptom were lack of apetiate, nausea and alopecia. In the first month, the children with cancer experienced more symptoms than the later months. Conclusion: The MSAS 10–18 and the other measures clearly demonstrate that children with cancer have a high prevalence of physical and psychological symptoms, and a high level of symptom distress. Pediatric nurses should know these symptoms and arrange the patients’ care for them.

PP081 THE ART OF TIMING FOR DMSA STUDY FOR THE EVALUATION OF PATIENT OUTCOME AFTER URINARY TRACT INFECTION (UTI) X Geronikola-Trapali1, I Armeniakos1, P Karampina1, A Stafanoyiannis1, V Lyra1, S Bakalis1, P Zotou1, A Prentakis1, S Fessatou2 1 University General Hospital ‘Attikon’, Nuclear Medicine Department, Chaidari, Greece, 2University General Hospital ‘Attikon’, 3rd Pediatric Department, Chaidari, Greece

Introduction: DMSA study is an established method for the assessment of renal sequeale after acute pyelonephritis related to febrile UTI. However, its prognostic value during the acute phase for the evaluation of the patient’s outcome has not yet been well established. Purpose: To evaluate the contribution of DMSA study during the febrile UTI for the prediction of the patient’s outcome. Material: Our study involved 67 children (three boys, 64 girls: 2 months–5 years). All children had positive suprabubic urine culture (94.5% E. Coli, 4% Proteas mirabilis, 1.5% Klebsiela) and received antiobiotic therapy. Direct


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voiding cystography was performed after the acute phase for the detection of vesicoureteric reflux. Nineteen children (28.3%) with abnormal DMSA study, VUR or recurrent UTI had control DMSA scan (6– 8 months after UTI). Methods: DMSA study was carried out during the acute phase of the UTI (first 4 days). Planar and pinhole scintigraphy was performed. Results: DMSA study was normal during the acute phase in 48 children (71.7%). We did not effectuate DMSA follow up study in 30 of them because of a good clinical outcome (no VUR, no UTI recurrence). The rest (18) had normal DMSA follow up study. Nineteen children (28.3%) who presented cortical lesions (focal or indinstinct margins) during febrile UTI underwent DMSA control study. Fifteen presented normal study. The rest four (6% of all) presented cortical lesions, one associated with high grade VUR. Nineteen children were followed up by control DMSA and no significant correlation between initial and follow up study was observed. Conclusions: We conclude that DMSA study performed during the acute (febrile) phase may not be a useful tool for the prediction of the children outcome. Control DMSA and cystography appears to be more useful for the detection and selection of patients at risk for future chronic cortical lesions development.

PP082 ALLOIMMUNE THROMBOCYTOPENIA AND TWO PARADIGMATIC CASES S Nobrega1, C Marecos1, O Voutsen1, R Barroso1, G T Sousa2, A Barradas2, A Dias1

Purpose: To present two paradigmatic cases of NAT observed in the first semester of 2010 in a metropolitan area secondary hospital. Clinical cases: Third child of a 37-year-old healthy woman, uneventful 39-week pregnancy, normal delivery and birth weight, no malformations. With 18 h of life the newborn presented generalised petechiae and bruises. Isolate Platelet count of 10 000/mm3. No ICH, but deep bilateral retinal haemorrhages were found. The patient started compatible donor platelet transfusion and immunoglobulin. Strongly positive crossmatch between maternal serum and paternal platelets but negative antiplatelet antibodies on maternal serum – genotyping study revealed incompatibility anti HPA 1b. The newborn recovered from purpura in the sixth day of life and was discharged on the 27th with 163 000/mm3 platelets. The second case refers to the fourth son of a healthy 41year-old ORh- woman, 39-week uneventful pregnancy, normal delivery and birth weight, no malformations. Newborn blood group ARh-, no isoimmunization. Platelet count was 32 000/mm3 on the third day – no anaemia, leucopenia or infection parameters. Next day platelets felt to 23 000/mm3. Positive crossmatch between mother and father and newborn antiplatelet antibodies were present. The newborn made one dose of immunoglobulin and platelet transfusion with platelet raising to 67 000/mm3, stable until discharge on the 10th day. Comments: NAT is the most important cause of severe thrombocytopenia in healthy newborns. Neither patients had ICH, but one had retinal haemorrhage: treatment must not be delayed, even in the absence of confirmatory tests.

PP083 WITHDRAWN

1

Department of Pediatrics, Hospital Professor Doutor Fernando Fonseca, Amadora, Lisbon, Portugal, 2 Department of Immunohemotherapy, Hospital Professor Doutor Fernando Fonseca, Amadora, Lisbon, Portugal

PP084 WITHDRAWN

Introduction: In fetal/ neonatal alloimmune thrombocytopenia (NAT) maternal sensitization occurs against a paternal antigen present in fetal platelets, usually HPA 1a. Its estimated incidence is one case in 800–1000 births. Most cases manifest as early isolated and severe thrombocytopenia. Intracranial haemorrhage (ICH), the most dangerous complication, dictates prognosis.

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PP085 WITHDRAWN



THEME: INFECTIOUS DISEASES PP086

PP087

SAFETY OF PROCALCITONIN LEVEL OF