Is postoperative transanastomotic feeding beneficial in neonates with congenital duodenal obstruction?

Purpose We aimed to evaluate possible positive and negative effects of postoperative use of transanastomotic feeding tube (TAFT) in neonates operated for congenital duodenal obstruction (CDO). Methods This is a retrospective study reviewing medical records of neonates operated for CDO during 2003–2020 and comparing postoperative feeding outcomes and complications in patients with and without TAFT. Approval from the hospital’s data protection officer was obtained. Results One hundred patients, 59% girls, were included, and 37% received TAFT. Mean birth weight and gestational age were 2628 (675.1) grams and 36.6 (2.4) weeks, respectively. Furthermore, 45% had no other malformations, and 36% had Down syndrome. Patient demographics were similar for TAFT and not-TAFT patients, except that not-TAFT neonates weighed median 335 g less (p = 0.013). The TAFT group got parenteral nutrition 2 days shorter (p < 0.001) and started enteral feeds 1.5 days earlier (p < 0.001) than the not-TAFT group. Fewer neonates with TAFT got a central venous catheter [65 vs 89%, (p = 0.008)]. In the TAFT group, 67% were breast fed at discharge compared to 49% in the not-TAFT group (p = 0.096). Conclusion Neonates with TAFT had earlier first enteral feed, fewer days with parenteral nutrition and fewer placements of central venous catheters.

COVID-19 pneumonia: a tailor-made dress for a Down syndrome patient

We report here a case of coronavirus disease 2019 pneumonia in a 40-year-old Caucasian woman with Down syndrome admitted to the Internal Medicine Unit. She was initially treated with hydroxychloroquine and azithromycin. When respiratory conditions dramatically worsened, she was not admitted to the intensive care unit because of impaired cognitive function. Thus helmet-based continuous positive airway pressure was started. The respiratory conditions progressively improved, reaching spontaneous breathing.

Taurodontismo – Série de casos em pacientes jovens não sindrômicos e sindrômicos associado à hipodontia

Several human dentition developmental anomalies are reported in the literature. The etiology of these occurrences is related to genetic, environmental or sometimes idiopathic factors. Taurodontism is defined as apical displacement of the pulp floor and consequent enlargement of the pulp chamber in multiradicular teeth. It is a result of the failure to invaginate Hertwigs epithelial sheath horizontally and commonly expresses bilaterally. This morphological pattern of molars is observed in ruminant animals and was also found in ancient Neanderthals. Association of this condition to syndromes is not exclusive, it may be associated with genetic disorders such as Down Syndrome, Klinefelter Syndrome, among others. The diagnosis is exclusively radiographic, with no alterations in the dental element crown. Among the consequences is the complexity of endodontic treatment, greater fragility of taurodontic teeth submitted to endodontics and lower orthodontic anchorage of these elements. In this paper, three case reports of patients with taurodontism are described, two of them associated with hypodontia and one in a Down Syndrome patient. This paper also includes a literature review and discussion with the main clinical implications of this occurrence.

SARS-CoV-2 Triggering Severe Acute Respiratory Distress Syndrome and Secondary Hemophagocytic Lymphohistiocytosis in a 3-Year-Old Child With Down Syndrome

Down syndrome (DS) predisposes to severe immunologic reaction secondary to infectious triggers. Here, we report a pediatric DS patient with coronavirus disease 2019 (COVID-19) who developed a hyperinflammatory syndrome, severe acute respiratory distress syndrome, and secondary hemophagocytic lymphohistiocytosis requiring pediatric intensive care unit admission and treatment with steroids, intravenous immunoglobulin, and remdesivir. Investigations into genetic susceptibilities for COVID-19 and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated complications warrant systematic clinical and scientific studies. We report a pediatric Down syndrome patient with coronavirus disease 2019 (COVID-19) who developed secondary hemophagocytic lymphohistiocytosis requiring treatment with steroids, intravenous immunoglobulin, and remdesivir. Investigations into genetic susceptibilities for COVID-19-associated complications warrant systematic clinical and scientific studies.