Percutaneous atrial septal defect closure in infant weighing <10 kg and having a bilateral superior vena cava: a case report

Percutaneous closure has become a preferred treatment for secundum atrial septal defect (ASD). However, this approach remains challenging in treating small infant weighing <10 kg because of procedure-related complications. The closure of ASD in other congenital anomalies, such as a bilateral superior vena cava (SVC), should be cautiously conducted. A 15-month-old boy with a body weight of 8 kg was diagnosed with secundum ASD (9–11 mm in diameter), residual pulmonary stenosis, and bilateral SVC. Transcatheter closure of ASD was successfully performed by using a 12 mm CeraFlex occluder device (Lifetech Scientific Corporation). Post-procedural examination showed good results without any impingement to the adjacent structure. Therefore,the transcatheter closure of ASD in infant weighing <10 kg and having bilateral SVC is technically feasible and safe.

P1121TOTAL PLASMA EXCHANGE (TPE) AND CITRATE CRRT IN A LOW-WEIGHT PEDIATRIC PATIENT WITH MACROPHAGE ACTIVATION SYNDROME (MAS): FEASIBILITY AND COMPLEXITIES OF BOTH TREATMENTS

Background and Aims Low-weight extracorporeal pediatric dialysis treatments remain a challenge due to their clinical and technical complexity. Apart from some metabolic congenital disorders, the usual indications for CRRT in early pediatric patients and newborns are the same as for adults with acute kidney injury (AKI). But the implementation of TPE is still in the anecdotal stage. Method Clinical case: a 7-month female infant, weighing 5.7kg, in the neonatal intensive care unit with fever, lymphadenopathy, hepatosplenomegaly, pancytopenia, hyperferritinemia, hypertriglyceridemia, was diagnosed as having macrophage activation syndrome (MAS). She developed AKI and acute respiratory distress syndrome (ARDS), due to sepsis. Because of oliguria, ruling out administration of drugs and parental nutrition, and fluid overload (more than 20% of her body-weight), CRRT was started. Results CRRT lasted 22 days in continuous venovenous hemodiafiltration (CVVHDF), with regional citrate anticoagulation (Table 1). Mean filter patency: 26±17h. 43% of treatments were interrupted after CVC failure, 21% after clinical procedures, 7% after filter coagulation. There was in this case no citrate accumulation and satisfactory metabolic and electrolyte control were obtained (Figure 1). After treatment of MAS failed with both i.v. immunoglobulins and corticosteroids, we considered TPE as a rescue therapy for the disease, even though we could not find a similar experience reported in the literature in such a small infant. We performed 3 TPE sessions, with heparin anticoagulation (Table 1), non-consecutively, with CRRT in between. Conclusion The treatments were well tolerated, resulting in a large decrease in triglycerides and ferritin (MAS index, Figure 2). Despite the death of the patient after ARDS worsened, we showed that even in a small critically ill infant, complex depurative treatments such as total plasma exchange are feasible. Highly skilled nephrologists and dialysis nurses are mandatory for treatment management.

Successful catheter ablation of premature ventricular contractions triggering torsade de pointes in a small infant with histiocytoid cardiomyopathy: a case report

Background A short-coupled variant of torsade de pointes (ScTdP) is rare and resistant to medical treatment. There has not been a reported catheter ablation (CA) of a short-coupled premature ventricular contraction (PVC) triggering ScTdP in an infant. Case summary A neonate was referred to our hospital on the day of birth for Wolff–Parkinson–White syndrome, repeated episodes of supraventricular tachycardia, and a left ventricular non-compaction. She underwent CA of an accessory pathway at 72 days of age. On the 5th day after ablation, she had recurrent TdP episodes resistant to various antiarrhythmic drugs and received extracorporeal membrane oxygenation at 86 days of age. She underwent CA of PVCs triggering TdP at 122 days of age and a weight of 3.4 kg. Two types of PVCs triggering TdP were successfully ablated, which originated from the right ventricle (RV). Pre-potentials were recorded at the earliest ventricular activation sites of the targeted PVCs. After the ablation, she had no TdP episodes and the cardiac assist device was removed. However, she died of uncontrolled heart failure at 6 months of age. The histological findings were compatible with histiocytoid cardiomyopathy and abnormal cells were distributed throughout both ventricles. At the ablation site, fibrotic transmural lesions were noted in the RV wall. Discussion The PVCs triggering TdP were successfully ablated in a 4-month-old girl with histiocytoid cardiomyopathy. The PVCs were likely caused by triggered activity and associated with abnormal Purkinje cells.

Informing the management of acute malnutrition in infants aged under 6 months (MAMI): risk factor analysis using nationally-representative demographic & health survey secondary data

Background Tackling malnutrition is a global health priority, helping children both survive and thrive. Acute malnutrition (wasting) in infants aged under 6 months (u6m) is often neglected. Worldwide, some 8.5 million infants u6m are affected yet recent World Health Organization malnutrition guidelines highlight numerous evidence gaps on how to best manage them. To inform future research, policy and programming, we aimed to identify risk factors associated with infant u6m wasting. Methods We did secondary data analysis of nationally representative, cross sectional Demographic and Health Surveys conducted in the last 10 years. We compared wasted infants u6m (weight-for-length <−2 z-scores) vs. non-wasted (weight-for-length ≥−2 z-score). We used simple and adjusted (for infant age, sex, socio-economic status) logistic regression to calculate odds of wasting associated with risk factors spanning three broad categories: household-related; maternal-related; infant-related. Results We analysed 16,123 infants u6m from 20 countries. Multiple risk factors were statistically associated with wasting. These included: poverty (Odds ratio, OR 1.22 (95% CI [1.01–1.48], p = 0.04)); low maternal body mass index (adjusted OR 1.53(1.29–1.80, p < 0.001); small infant size at birth (aOR 1.32(1.10–1.58, p < 0.01)); delayed start of breastfeeding (aOR 1.31(1.13–1.51, p < 0.001)); prelacteal feed (aOR 1.34(1.18–1.53, p < 0.001)); recent history of diarrhoea (aOR 1.37(1.12–1.67, p < 0.01)); mother disempowered (experiences violence; does not make decisions about health issues; does not engage with health services such as antenatal care, does not give birth in a health facility). ‘Protective’ factors associated with significantly decreased odds of infant u6m wasting included: educated mother (OR 0.64(0.54–0.76, p < 0.001)); mother in work (OR 0.82(0.72–0.94, p < 0.01)); currently breastfed (aOR 0.62(0.42–0.91, p = 0.02)), exclusively breastfed (aOR 0.84(0.73–0.97, p = 0.02). Discussion Infant u6m wasting is a complex, multifactorial problem associated with many risk factors; knowing them will help shape international and national management strategies. Whilst our observational study cannot prove causation, many factors identified are biologically plausible and/or socially important. They should be considered when assessing and managing infants u6m. Although supporting breastfeeding is core to future interventions, this alone is unlikely to be sufficient; strategies should involve multiple sectors, beyond just health and nutrition. By noting our results, future intervention studies could focus resources and maximise chances of achieving impact.