2017, Vol 13, No 1
Human milk – facts and myths
Pediatr Med Rodz 2017, 13 (1), p. 11–20
DOI: 10.15557/PiMR.2017.0001
ABSTRACT

Breast milk is the most suitable nourishment for a newborn. After birth, the mammary glands produce colostrum, which is rich in proteins (including immunoglobulins). At later stages of lactation, the breast milk matures and changes its composition. Such changes are crucial to provide a young child with optimal conditions for proper development. Human milk contains lipids, proteins and carbohydrates as well as vitamins and minerals. Lipids are involved in the development of the entire nervous system, while proteins are essential for normal gastrointestinal and immunological function. Carbohydrates are responsible for the growth of intestinal microbiota and ensure resistance to microorganisms. Paediatricians recommend breastfeeding until the child is one year old, but this is not always possible. There are some conditions, concerning both mother and her child, for which breastfeeding is contraindicated. Such mothers may decide to use milk replacers based on cow’s milk. However, even the best milk replacer will never be as perfect for an infant as breast milk due to composition differences. This article summarises the current knowledge about the composition of breast milk and the role of its individual components as well as compares the properties of human and cow’s milk.

Keywords: breast milk, breastfeeding, colostrum, cow’s milk
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Retinopathy of prematurity – etiopathogenesis and treatment
Pediatr Med Rodz 2017, 13 (1), p. 22–28
DOI: 10.15557/PiMR.2017.0002
ABSTRACT

Retinopathy of prematurity belongs to the group of proliferative retinopathies. It affects preterm infants with very low birth weight, treated with high concentrations of oxygen. It is estimated that retinopathy of prematurity leads to blindness in approximately 50,000 children per year worldwide. There were two epidemics of retinopathy of prematurity in the 50s and 70s of the last century. Another increase in the incidence, referred to as the third epidemic in the literature, has been observed in recent years in developing countries. So far, high oxygen concentrations used in adjuvant oxygen therapy have been considered to be the major risk factor for retinopathy of prematurity. There are, however, reports on the development of the disease in patients who received no oxygen therapy. Low birth weight and early gestational age are well-known risk factors for retinopathy of prematurity. Other important risk factors include sex, multiple pregnancy, intraventricular haemorrhage and blood transfusions. The disease can be prevented by screening performed by an ophthalmologist within a few weeks after birth. Laser retinal photocoagulation, which is primarily aimed to inhibit fibrovascular proliferation, is the standard therapy in infants with retinopathy of prematurity. Surgical treatment is necessary in the case of disease progression despite laser photocoagulation. Attempts are also made to use vascular endothelial growth factor blockers. The aim of the paper is to present the pathomechanism and the main factors involved in the development of retinopathy of prematurity as well as the current therapeutic approaches for this disease. This information is intended to help family doctors update their knowledge on retinopathy of prematurity.

Keywords: retinopathy of prematurity, etiopathogenesis, treatment
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Basic principles of parenteral nutrition
Pediatr Med Rodz 2017, 13 (1), p. 29–39
DOI: 10.15557/PiMR.2017.0003
ABSTRACT

Parenteral nutrition provides all essential nutrients directly into the blood stream without involvement of the gastrointestinal tract if conventional oral or enteral nutrition is not possible. The awareness of how important it is to provide adequate nutrition to the ill has accompanied people for a long time, as evidenced by the first attempts to conduct nutrition by bypassing the gastrointestinal tract taken as early as in the seventeenth century. The contemporary methods of nutrition have been established in the twentieth century and are still being improved. Nutrition is carried out using specially prepared formulations containing all necessary nutrients in the most absorbable form. These mixes are adapted to individual requirements, resulting from the underlying disease. They are available in the form of ready-made preparations or separate bottles. A method of nutrition is selected on the basis of its expected duration. Disease states are associated with increased catabolism with greater demand for energy and nutrients. This often leads to the development or exacerbation of malnutrition which affects convalescence after surgery and the general condition of the patient as well as increases the risk of hospital complications. As any medical procedure, parenteral nutrition is associated with a risk of side effects. However, the principles of care of the injection site and preparation of appropriate mixes tailored to patient’s needs help minimise the risk of adverse reactions. It is necessary to detect malnutrition early, estimate risk, create nutrition plans and include nutrition to therapy, which will improve the condition of hospitalised patients, accelerate their recovery, shorten hospital stay and reduce treatment costs.

Keywords: parenteral nutrition, malnutrition, nutrition of the patient, method of feeding, feeding mixes
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Interpretation of uroflowmetry in the paediatric population
Pediatr Med Rodz 2017, 13 (1), p. 40–52
DOI: 10.15557/PiMR.2017.0004
ABSTRACT

Uroflowmetry is a simple, non-invasive examination that should be the first test in the diagnostic process of lower urinary tract disorders in children. It is applicable particularly in the paediatric population where a comprehensive urodynamic examination, involving urinary bladder catheterisation, is frequently difficult due to the lack of cooperation with children. It must be remembered that the prerequisite for optimal uroflowmetry is recreating natural conditions of micturition. When interpreting results, one must assess the uroflow curve, which is a resultant of urethral resistance and pressure inside the urinary bladder. That is why the main paediatric disorders that can be suspected after uroflowmetry include a functional or anatomical subcystic barrier and hyperactivity of the detrusor muscle of the urinary bladder. In normal conditions, the uroflow curve resembles a bell. An abnormal curve can be flattened, tower-shaped or irregular, but none of them is pathognomonic for a given urinary pathology. After a preliminary interpretation of the curve, one must assess whether the calculated micturition parameters, such as maximum flow and average flow rates, are within normal ranges. For this purpose, age- and sex-specific nomograms have been created. The final part of uroflowmetry involves the evaluation of post-void residual urine volume. Currently, ultrasound scan is the recommended method. It has been shown that post-void residual urine volume decreases with age and depends upon sex and bladder capacity. It must be emphasised that one abnormal result of uroflowmetry requires re-examination. Moreover, the results should be interpreted in combination with patient’s medical history.

Keywords: uroflowmetry, urethral flow, urodynamic examination, uroflow curve
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Adverse reactions of radiotherapy for head and neck cancers. Treatment of radiation reactions in the oral cavity
Pediatr Med Rodz 2017, 13 (1), p. 53–62
DOI: 10.15557/PiMR.2017.0005
ABSTRACT

Due to painless nature and poorly specific symptoms, such as hoarseness or sore throat, head and neck cancers are usually diagnosed when the disease is locally advanced. A typical patient is older than 50 years. Low social awareness concerning the occurrence of these cancers and rare appointments with specialist physicians escalate the problem. As a result, patients usually seek medical advice when the disease is advanced and prognosis poor. The risk of these cancers increases by regular consumption of weak alcoholic beverages, cigarette smoking and infection with human papilloma virus. The head and neck location, which is a richly vascularised and innervated anatomic region, necessitates the application of highly specialised treatment, i.e. intensitymodulated radiation therapy. Radiation reactions can be divided into early (acute) and late (chronic) based on the time of occurrence. Early reactions include inflammation and fibrosis of the oral mucosa. Late reactions are more troublesome and persistent. They include: mandible necrosis or permanent impairment of salivary gland secretory function. The most common adverse effects of radiotherapy include mucositis. Patients irradiated for head and neck cancers usually suffer from persistent oral mucosa dryness that requires particular care and hygiene. Preventive measures in patients undergoing radiotherapy include: systematic plaque removal, using high-fluoride agents for oral hygiene, following a low-sugar diet and regular dental check-ups.

Keywords: radiotherapy, radiation reactions, oral cavity, care
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Electronic cigarettes: health impact, nicotine replacement therapy, regulations
Pediatr Med Rodz 2017, 13 (1), p. 63–71
DOI: 10.15557/PiMR.2017.0006
ABSTRACT

While the adverse effects of conventional cigarettes on human health have been thoroughly examined, in the last 15 years we have witnessed the birth of electronic cigarettes. There are many types of these devices available on the market. Studies are still underway to determine their negative impact on the human body. Electronic cigarettes comprise of power supply and a vaporising system. The user inhales the aerosol produced by heating up the liquid containing nicotine. In contrast with conventional cigarettes, the tobacco is not combusted, thus the compositions of the aerosol and cigarette smoke are considerably different. Out of 93 chemical substances present in the e-cigarette smoke, the aerosol contains only acetaldehyde, acetone, acrolein, formaldehyde and nicotine. More toxic substances, such as polycyclic aromatic hydrocarbons and heavy metals, are not present. The amount of evidence suggesting electronic cigarettes’ harmful effects on the human body is constantly increasing. Some reports imply that the electronic cigarettes negatively influence pregnancy, human psyche, respiratory and cardiovascular systems. They might also be involved in oncogenesis. With electronic cigarettes constantly gaining popularity, the question about the adverse effects of passive smoking becomes increasingly more relevant. Although various methods of helping people cease smoking or delivering nicotine to their bodies without burning toxic substances are being explored, electronic cigarettes are not recommended in nicotine substitution therapy. Legal regulations regarding electronic cigarettes are still being worked on. The purpose of this paper is to evaluate the effects electronic cigarettes have on the human’s health.

Keywords: electronic cigarettes, liquid, nicotine, second hand smoking, smoking cessation
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Postural defects in children and teenagers as one of the major issues in psychosomatic development
Pediatr Med Rodz 2017, 13 (1), p. 72–78
DOI: 10.15557/PiMR.2017.0007
ABSTRACT

Postural defect is a set of postural abnormalities defined as minor single deviations from correct posture, which may be repaired with the use of appropriate exercises, passive or active. Studies concerning the evaluation of children and teenagers’ health condition have shown that the incidence of postural defects in the population ranges from 30 to 60%. The greatest threat for the development of incorrect body posture is present in the period of fast growth, namely between the age of 5 and 7 and in the period of adolescence. The most common postural defects in the population of children in Poland include: scoliosis, juvenile kyphosis of the spine (Scheuermann’s disease) and static deformations of lower extremities. Owing to the common nature of the issue and the possibility to apply effective preventive measures, it is necessary to early detect postural defects through appropriate examinations. Preventive healthcare for children is aimed at early diagnosis of irregularities in a child’s development. Screening tests among children detect three types of the motor system disorders: scoliosis, excessive thoracic kyphosis and static deformations of lower extremities and asymmetry in the length of lower extremities. Early detection of the defect prevents against its further development or the development of further abnormalities. The results of a report Health Behaviour in School-aged Children concerning the health of children clearly show that recently, there has been a substantive increase in the number of factors causing the creation of postural defects. School period is the most optimum one to carry out preventive actions in this respect. Postural defects develop in some children, despite preventive measures carried out. In accordance with the recommendations of experts, it is then necessary to perform secondary prophylaxis, which prevents further development of the defect, the creation of muscular contracture and is aimed at the so-called postural re-education. The selection of physical activity should be adequate to the type of postural defect.

Keywords: postural defect, scoliosis, platypodia, prophylaxis, obesity
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Monacolin and atorvastatin in cardiovascular prevention – an attempt at positioning
Pediatr Med Rodz 2017, 13 (1), p. 79–92
DOI: 10.15557/PiMR.2017.0008
ABSTRACT

Cardiovascular diseases are the leading cause of premature death worldwide. Dyslipidemia, in turn, is the most common modifiable cardiovascular risk factor. According to NATPOL 2011, hypercholesterolaemia defined as total cholesterol of at least 190 mg/dL is diagnosed in 61% of adult Poles. Non-pharmacological management, i.e. lifestyle modification, including, in the first place, physical activity and a proper diet, is the basis of intervention aimed to normalise cholesterol levels. Statins are the most important and the most common class of agents in the treatment of lipid disorders and there is strong and clear evidence supporting their effects on lipid reduction and prognosis improvement. These agents are well tolerated and safe, and their efficacy in primary and secondary cardiovascular prevention was well-documented in clinical trials. The use of a dietary supplement in the form of monacolin K contained in the red yeast rice, whose efficacy in reducing cholesterol levels has been demonstrated in a number of randomised clinical trials, may be an intermediate stage between non-pharmacological treatment and statin therapy. In everyday practice, patients who do not qualify for aggressive lipidlowering therapy, but show no desired effects when on behavioural therapy, are often encountered. It seems that monacolin K therapy may be used in such cases. However, it should be strongly emphasised that monacolin K may be only an adjuvant, and not a substitute for behavioural therapy. This paper presents the potential place of monacolin K and atorvastatin in modern cardiovascular pharmacotherapy, attempting to define target patient populations for both these substances.

Keywords: monacolin, atorvastatin, dyslipidemia, cardiovascular diseases
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Behaviour health pregnant women with secondary and higher education – preliminary studies
Pediatr Med Rodz 2017, 13 (1), p. 94–102
DOI: 10.15557/PiMR.2017.0009
ABSTRACT

Pregnancy is a special physiological condition in a woman’s life. It usually involves a substantial change in health behaviour and lifestyle. The aim of rational nutrition among pregnant women is to prevent complications during pregnancy and ensure normal development of the foetus. Practical realisation of the principles of rational nutrition involves the application of a balanced diet. It limits both shortages and excessive amount of nutrients in the body. The aim of the paper was to evaluate health behaviour of pregnant women with secondary and higher education and the level of knowledge about healthy lifestyle and its impact on child development. The study included 43 pregnant women aged 20–40 years from Gdańsk birth schools of higher and secondary education. The study based on questionnaire provided information about the current state of knowledge about nutrition while pregnant and assessed the health behaviour of women: nutrition, substance abuse and physical activity. A pilot study reported that 84% of pregnant women were interested in proper nutrition while pregnant. An increased amount of food consumed per day (69%) and portions of fruit and vegetables (98%) was noticed. Also, it was noted that 58.1% of the respondents did not increase the consumption of sweets. Good appetite was observed only in the case of 53% of studied women, 47% presented loss of appetite; 19% of the respondents occasionally consumed alcohol, 30% drank coffee once per day and 9% several times a day. There was no woman smoking tobacco. Among the respondents, physically active ones included 51.2% and 39.5% did physical activity occasionally. The studied group of pregnant women with secondary and higher education changed their eating habits during pregnancy. Preliminary analysis of the results indicates the validity of conducting nutrition education in antenatal classes, which raises the nutritional knowledge and has a positive effect on health behaviour modification in a specific group of pregnant women.

Keywords: pregnant women, health behaviour, changes in diet, nutrition
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Clinical picture and epidemiology of atypical and pertussis-related pneumonia in unsuccessfully treated paediatric outpatients, hospitalised during the infectious season of 2015–2016
Pediatr Med Rodz 2017, 13 (1), p. 103–107
DOI: 10.15557/PiMR.2017.0010
ABSTRACT

The incidence of respiratory tract infections caused by Mycoplasma, Chlamydophila pneumoniae and Bordetella pertussis in children increases in the infectious season of autumn-winter-spring. Infection with atypical bacteria manifests with slightly increased body temperature, dry cough and headaches. However, these clinical signs are insufficient to determine the aetiology of individual atypical forms of pneumonia. The aim of the study was to outline the clinical picture of children with atypical and pertussis-related pneumonia unsuccessfully treated as outpatients and hospitalised at the Department of Paediatric and Allergy during the infectious season of 2015–2016. In this period of time, 507 patients at the age from 5 weeks to 17.5 years were hospitalised. Pneumonia caused by Mycoplasma pneumoniae and Chlamydophila pneumoniae was confirmed by the presence of IgA and/or IgM antibodies (positive result >1.1 RU/mL), and infection caused by Bordetella pertussis – by IgA antibodies in the serum (positive result >2 IU/mL). Most of the patients had chest X-ray performed. Mycoplasma pneumoniae and/or Chlamydophila pneumoniae were detected in 51 children, and pertussis – in 131 children. Patients admitted to hospital usually presented lung signs on auscultation such as wheezing, crepitation and rales; some of them also presented rash and fever. The radiological image indicated densities depending on interstitial, parenchymal or mixed changes. Fever and rash usually occurred in younger children (2.5% and 5%, respectively), whilst 38% of patients did not present with auscultatory signs or fever at admission (mainly older children). This study reveals that clinical symptoms of atypical and pertussis-related infections can be very uncharacteristic, and delay in making a proper diagnosis results in improper treatment.

Keywords: pneumonia, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Bordetella pertussis, children
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Diagnostic usefulness of some test kits used in detection of Borrelia burgdorferi
Pediatr Med Rodz 2017, 13 (1), p. 108–118
DOI: 10.15557/PiMR.2017.0011
ABSTRACT

Diagnosis of Lyme disease is often problematic. Atypical clinical symptoms and diversified immunological response to the various Borrelia burgdorferi species present in the environment cause difficulties in a correct diagnosis. Hence the importance of using diagnostic methods least significantly affected by false positive and false negative results. The comparison of results achieved with ELISA test kit and two different Western blot test kits shows a considerable number of false positive and false negative results. The total conformity of ELISA test and Western blot tests results in our study was 65.6% (IgM ELISA: Mikrogen), 69.8% (IgM ELISA: Viramed), 83.9% (IgG ELISA: Mikrogen), 81.9% (IgG ELISA: Viramed). Higher conformity was observed in results for IgG antibodies. However, for IgM antibodies 11.45% (Mikrogen) and 13.5% (Viramed) of negative results achieved with ELISA test kit were indicated as positive using Western blot test kits. Despite the use of a very sensitive screening test, a considerable amount of false negative results was obtained. Such a situation is concerning in a two-step diagnostic procedure where only positive and equivocal results are further confirmed by Western blot method. The obtained results have demonstrated that ELISA test kit used in this study is not sensitive enough to be used as a screening test. The divergences obtained in Western blot tests results may be caused by the differences in the composition of each test and the differences in the methods of deriving antigens.

Keywords: Borrelia burgdorferi, borreliosis, ELISA, Western blot
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Non-specific signs of neuroinfection after a tick bite in a 10-year-old boy – a case report
Pediatr Med Rodz 2017, 13 (1), p. 121–125
DOI: 10.15557/PiMR.2017.0012
ABSTRACT

Borrelia burgdorferi (the aetiological factor in Lyme disease) and the tick-borne encephalitis virus are two of the pathogens transmitted by ticks in Poland, which are an important cause of central nervous system infections. According to the data of the National Institute of Hygiene, a total of 13,866 cases of Lyme disease and 196 cases of tick-borne encephalitis were reported in 2014. The highest incidence of Lyme disease is observed in summer in the north-eastern part of the country. The disease may manifest with skin, motor, cardiovascular and neural symptoms. A history of exposure to ticks is important information for determining the aetiology of meningitis. An early diagnosis and effective treatment of neuroinfection reduces the risk of permanent complications. The presented case illustrates the need to include Lyme disease in the differential diagnosis of central nervous system infections.

Keywords: neuroinfection, tick-borne diseases, vector-borne diseases, children
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Late diagnosed congenital agenesis of the left lung in 15-year-old boy
Pediatr Med Rodz 2017, 13 (1), p. 126–132
DOI: 10.15557/PiMR.2017.0013
ABSTRACT

Pulmonary agenesis is a rare congenital lung defect involving the complete absence of the primary bronchus as well as pulmonary parenchyma and vessels. Unilateral agenesis occurs at the rate of 1/10,000–20,000 pregnancies. The cause of this defect is still unknown. This abnormality does not cause any specific symptoms; it may lead to respiratory failure, but an asymptomatic course lasting many years is also possible. This defect can often be suspected based on a chest radiograph performed for other reasons. We present the case of a 15-year-old boy with an accidental diagnosis of left pulmonary agenesis. Upon diagnosis the patient did not report any complaints. During a routine visit at an allergy clinic decreased vesicular sounds were present on the left side. A subsequent chest radiograph was reported as showing left lung inferior lobe atelectasis, which was an indication for a more comprehensive diagnostic investigation. A computed tomography scan revealed the complete absence of the left lung.

Keywords: pulmonary agenesis, congenital defect, lungs
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