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Retrospective study of paracetamol poisoning in children aged zero to six years found no cases of liver injury

AIM: This study focused on children aged zero to six years with suspected single-dose paracetamol poisoning, which has not been investigated in Denmark. We evaluated the incidence of liver injuries and the use of activated charcoal and N-acetylcysteine treatment.

METHODS: Our retrospective study was performed in three paediatric hospital centres from 2001 to 2012. Data on symptoms, time of ingestion, blood biochemistry, treatment and adverse reactions were collected. The results were evaluated against the Rumack-Matthew nomogram.

RESULTS: We identified 221 children (58% male), with a mean age of 2.67 ± 1.05 years. Activated charcoal treatment was given in 87% of cases, but only 15% of the children received treatment within one hour of the suspected paracetamol poisoning. Although 80% of the children received N-acetylcysteine treatment, only one case (0.5%) had a toxic plasma paracetamol level according to the treatment nomogram. Abdominal pain or vomiting was associated with higher paracetamol levels in plasma. None of the children developed liver injuries.

CONCLUSION: We found a low incidence of significant poisoning and liberal use of N-acetylcysteine and activated charcoal treatment in Danish children aged zero to six years with suspected paracetamol poisoning. Vomiting or abdominal pain was associated with elevated plasma paracetamol levels. No liver injuries were reported.

OriginalsprogEngelsk
TidsskriftActa Paediatrica
ISSN1651-2227
DOI
StatusE-pub ahead of print - 1 maj 2018
BCG Vaccination at Birth and Rate of Hospitalization for Infection Until 15 Months of Age in Danish Children: A Randomized Clinical Multicenter Trial

Background: The bacillus Calmette-Guérin (BCG) vaccine against tuberculosis might reduce the non-tuberculosis-related child mortality rate in low-income settings. We tested the hypothesis that BCG vaccination at birth would reduce early childhood hospitalization for infection in Denmark, a high-income setting. Hospitalization for infection was a secondary outcome in a randomized trial with the primary aim to estimate the potential non-specific effects of BCG vaccination at birth on all-cause hospitalization.

Methods: A total of 4262 children included in the Danish Calmette Study were assigned randomly to either receive the BCG vaccine or not and were followed through the Danish National Patient Register. The outcome was number of hospitalizations for infection until the age of 15 months. Data were analyzed by Cox regression in intention-to-treat (ITT) and per-protocol (PP) analyses.

Results: In the ITT analysis, we observed 588 hospitalizations for infection (mean, 0.28 hospitalization per child) among the 2129 children allocated to receive the BCG vaccine and 595 hospitalizations for infection (mean, 0.28 hospitalization per child) among the 2133 children allocated to the control group (hazard ratio [HR], 0.99 [95% confidence interval (CI), 0.85-1.15]). The PP analysis yielded an HR of 1.00 (95% CI, 0.86-1.16). Predefined interaction ITT analyses showed that among 740 children with a BCG-vaccinated mother, the HR for BCG-vaccinated children was 0.65 (95% CI, 0.45-0.94); the HR for children who had a non-BCG-vaccinated mother was 1.10 (95% CI, 0.93-1.29) (P = .01, test of no interaction). Cesarean delivery modified the effect of BCG vaccination (HRs, 0.73 [95% CI, 0.54-0.99] in children born by cesarean section vs 1.10 [95% CI, 0.92-1.30] in other children; P = .02). When the outcome was defined as time to first hospitalization, the HR for premature children after BCG vaccination was 1.81 (95% CI, 0.95-3.43), whereas the HR was 0.94 (95% CI, 0.82-1.08) for children born at term (P = .05).

Conclusion: BCG vaccination did not affect the rate of hospitalization for infection up to the age of 15 months in Danish children. In future studies, the role of maternal BCG-vaccination, premature birth, and cesarean delivery needs further exploration.

OriginalsprogEngelsk
TidsskriftPediatric Infectious Disease Journal
ISSN0891-3668
DOI
StatusE-pub ahead of print - 2018
Galdesten hos børn

Galdesten hos børn

Wewer, A. V., Hovendal, C. P. & Paerregaard, A. 13 jun. 2005 I : Ugeskrift for laeger. 167, 24, s. 2625-6 2 s.

Publikation: Forskning - peer reviewTidsskriftartikel

Children of all ages may develop gallstones. Ultrasonography is the diagnostic method of choice if gallstones are suspected. In children having gallstones diagnosed as a result of ultrasonography carried out due to different indication expectant treatment is recommended. Children presenting with typical clinical signs of gallstone colic need an operation. Laparoscopic cholecystectomy is the recommended choice, as data are lacking on the risk of recurrence of gallstones after cholecystolithotomy. Postoperative complications are few in otherwise healthy children.

OriginalsprogDansk
TidsskriftUgeskrift for laeger
Vol/bind167
Tidsskriftsnummer24
Sider (fra-til)2625-6
Antal sider2
ISSN0041-5782
StatusUdgivet - 13 jun. 2005
J-pouch ileoanal anastomosis in children and adolescents with ulcerative colitis: functional outcome, satisfaction and impact on social life

OBJECTIVES: The aim of this study was to evaluate, over a 10-year period, severe surgical complications, functional outcome, patient satisfaction and impact on social life after colectomy and J-pouch ileoanal anastomosis for children and adolescents <18 years with ulcerative colitis.

METHODS: Data were extracted retrospectively from medical records and obtained by mailed questionnaire.

RESULTS: Thirty patients (18 girls) with a median age of 15 years (range, 7-17 years) were identified. Two patients (7%) had the J-pouch removed because of intractable diarrhea. Twenty-seven of 28 patients with preserved J-pouch answered the questionnaire. The median follow-up was 3.7 years (range, 0.3-9.2 years). Surgical complications included eight of 30 patients (27%) with small bowel obstruction, one of 30 (4%) with intra-abdominal abscess and two of 30 (7%) with perforation of the small intestine. The median number of daytime bowel movements was six (range, 3-10) and the median number of nighttime bowel movements was one (range, 0-2). Twelve patients (44%) were completely continent for stool and mucus, 12 patients (44%) leaked now and then and three (12%) leaked often or always. Antibiotic treatment for pouchitis was given in 13 patients (48%). Seventeen patients (63%) were completely satisfied with the operation, nine patients (33%) found the result fairly good and one patient (4%) was not satisfied. Twenty-six patients (96%) reported their health as completely or fairly good.

CONCLUSIONS: The majority of patients with an intact J-pouch had an acceptable functional result with respect to defecation frequency, continence and number of pouchitis episodes. Most patients reported being satisfied with the procedure.

OriginalsprogEngelsk
TidsskriftJournal of Pediatric Gastroenterology and Nutrition
Vol/bind40
Tidsskriftsnummer2
Sider (fra-til)189-93
Antal sider5
ISSN0277-2116
StatusUdgivet - feb. 2005
Effect of probiotics on gastrointestinal symptoms and small intestinal permeability in children with atopic dermatitis

OBJECTIVE: To determine whether probiotic lactobacilli may alleviate small intestinal inflammation and strengthen the intestinal barrier function in children with atopic dermatitis.

STUDY DESIGN: In a double-blinded, placebo-controlled, cross-over study, probiotic lactobacilli (Lactobacillus rhamnosus 19070-2 and L reuteri DSM 12246) were administered for 6 weeks to 41 children with moderate and severe atopic dermatitis. Gastrointestinal symptoms were registered before and during treatment and small intestinal permeability was measured by the lactulose-mannitol test.

RESULTS: During Lactobacillus supplementation, there was a significant decrease in the frequency of gastrointestinal symptoms (39% during the placebo period versus 10% during active treatment, P=.002). There was a positive association between the lactulose to mannitol ratio and the severity of the eczema (r=0.61, P=.02 after placebo and r=0.53, P=.05 after active treatment). After probiotic treatment, the lactulose to mannitol ratio was lower (0.073) than after placebo (0.110, P=.001).

CONCLUSIONS: Impairment of the intestinal mucosal barrier appears to be involved in the pathogenesis of atopic dermatitis. The study suggests that probiotic supplementation may stabilize the intestinal barrier function and decrease gastrointestinal symptoms in children with atopic dermatitis.

OriginalsprogEngelsk
TidsskriftThe Journal of pediatrics
Vol/bind145
Tidsskriftsnummer5
Sider (fra-til)612-6
Antal sider5
ISSN0022-3476
DOI
StatusUdgivet - nov. 2004
Maelkesyrebakterier og andre probiotika ved infektiøse og inflammatoriske sygdomme hos børn. Hvad tror vi?--hvad ved vi?

Maelkesyrebakterier og andre probiotika ved infektiøse og inflammatoriske sygdomme hos børn. Hvad tror vi?--hvad ved vi?

Nielsen, V. R., Michaelsen, K. F. & Paerregaard, A. 2 dec. 2002 I : Ugeskrift for laeger. 164, 49, s. 5769-72 4 s.

Publikation: Forskning - peer reviewTidsskriftartikel

Probiotics are microorganisms which, when ingested, may have a positive effect in the prevention or treatment of a specific pathologic condition. Probiotics are used for a number of gastrointestinal and certain systemic infectious and inflammatory diseases. The efficacy of selected probiotics to promote recovery from acute viral gastroenteritis in young children is well-documented. However, the role of probiotics in systemic diseases, e.g. atopic dermatitis, need to be confirmed in larger randomised controlled trials. This paper describes the theoretical background for the use of probiotics and reviews results from randomised controlled trials describing the effect of probiotics, particularly in paediatric diseases.

OriginalsprogDansk
TidsskriftUgeskrift for laeger
Vol/bind164
Tidsskriftsnummer49
Sider (fra-til)5769-72
Antal sider4
ISSN0041-5782
StatusUdgivet - 2 dec. 2002
Kronisk inflammatorisk tarmsygdom hos børn. En epidemiologisk opgørelse fra østdanmark 1998-2000

Kronisk inflammatorisk tarmsygdom hos børn. En epidemiologisk opgørelse fra østdanmark 1998-2000

Urne, F. U. & Paerregaard, A. 2 dec. 2002 I : Ugeskrift for laeger. 164, 49, s. 5810-4 5 s.

Publikation: Forskning - peer reviewTidsskriftartikel

INTRODUCTION: The purpose of this retrospective study was to investigate the epidemiology and anthropometrical status in children and adolescents with chronic inflammatory bowel disease in Denmark during the period 1998-2000.

MATERIAL AND METHODS: Patients from the eastern part of Denmark below 15 years of age were included. The study covered 43% of the total pediatric population (< 15 years) in Denmark. Data from the patient records were used to register diagnosis, area of living, age when presenting symptoms, age at diagnosis, height, weight, and disease location for Crohn's disease at the time of the diagnosis.

RESULTS: A total of 98 patients < 15 years with inflammatory bowel disease were identified in the period 1998-2000. Fifty patients had ulcerative colitis, 44 had Crohn's disease, and four had indeterminate colitis. The mean annual incidence of inflammatory bowel disease was 4.3 (1.8 for ulcerative colitis, 2.3 for Crohn's disease, and 0.2 for indeterminate colitis) per 100,000 children < 15 years. The mean annual prevalence of inflammatory bowel disease was 15.8 per 100,000 children < 15 years (ulcerative colitis: 8.3; Crohn's disease: 6.7; indeterminate colitis: 0.8). A subpopulation of Crohn's disease patients with growth retardation was found. Undernutrition was also common among children with Crohn's disease. Eighty-three percent had an age-related BMI below the 50-percentile.

DISCUSSION: Compared to an earlier Danish investigation, the incidence of Crohn's disease had risen 11-fold whereas the incidence of ulcerative colitis remained at the same level. The subpopulation with growth failure and low age-related BMI among children with Crohn's disease is in line with data described in the literature.

OriginalsprogDansk
TidsskriftUgeskrift for laeger
Vol/bind164
Tidsskriftsnummer49
Sider (fra-til)5810-4
Antal sider5
ISSN0041-5782
StatusUdgivet - 2 dec. 2002
Effect of probiotic Lactobacillus strains in young children hospitalized with acute diarrhea

BACKGROUND: Oral bacteriotherapy promotes recovery from acute childhood diarrhea, but few strains have been shown to have therapeutic potentials. We examined the effect of two newly identified probiotic Lactobacillus strains in acute childhood diarrhea.

METHODS: Sixty-nine children were randomized during hospitalization for acute diarrhea to receive a mixture of Lactobacillus rhamnosus 19070-2 and Lactobacillus reuteri DSM 12246, 10(10) colony-forming units of each strain or placebo twice daily for 5 days. Before selection of these stains their potential probiotic characteristics were demonstrated in vitro and in healthy volunteers.

RESULTS: In patients receiving probiotics, the diarrheal phase was reduced by 20%. The duration of diarrhea was 82 h in the treatment group vs. 101 h in the control group (not significant, P = 0.07). However, 3 of 30 patients from the treatment group vs. 13 of 39 from the control group still had loose stools at the end of the study period (P = 0.03). In patients with diarrhea for <60 h before start of treatment (early intervention), a clear effect of the probiotics was demonstrated (80 h in the treatment group vs. 130 h in the control group, P = 0.003). After early intervention, the length of hospitalization was reduced by 48% (3.5 vs. 1.7 days, P = 0.03). At the end of the intervention, rotavirus antigen was found in 12% of patients from the treatment group vs. 46% from the control group (P = 0.02).

CONCLUSIONS: The two probiotics, L. rhamnosus 19070-2 and L. reuteri DSM 12246, ameliorated acute diarrhea in hospitalized children and reduced the period of rotavirus excretion. Oral bacteriotherapy was associated with a reduced length of hospital stay. The beneficial effects were most prominent in children treated early in the diarrheal phase.

OriginalsprogEngelsk
TidsskriftThe Pediatric infectious disease journal
Vol/bind21
Tidsskriftsnummer5
Sider (fra-til)411-6
Antal sider6
ISSN0891-3668
StatusUdgivet - maj 2002
Effect of probiotic Lactobacillus strains on acute diarrhea in a cohort of nonhospitalized children attending day-care centers

BACKGROUND: Certain strains of lactobacilli have been shown to promote recovery from rotavirus enteritis in hospitalized children. Few studies have examined the effect of probiotics in nonhospitalized children with mild diarrhea.

METHODS: We studied in a randomized placebo-controlled trial the effect of lyophilized Lactobacillus rhamnosus 19070-2 and Lactobacillus reuteri DSM 12246, 10(10) colony-forming units of each strain twice daily for 5 days, on acute diarrhea in children in a cohort of children recruited from local day-care centers. The duration of diarrhea and assessment of stool consistency were recorded by the parents.

RESULTS: In patients treated with the selected Lactobacillus strains, the mean duration of diarrhea after intervention was reduced (76 h in patients treated with probiotics vs. 116 h in the placebo group; P = 0.05). In patients with diarrhea for <60 h before start of treatment (early intervention), a more pronounced effect of probiotics was found. The time to recovery after early treatment was 79 h vs. 139 h in the placebo group (P = 0.02); 1 of 17 patients treated early vs. 6 of 13 in the control group still had loose stools 120 h after start of treatment (P = 0.03).

CONCLUSIONS: In children from day-care centers with mild gastroenteritis, the combination of L. rhamnosus 19070-2 and L. reuteri DSM 12246 was effective in reducing the duration of diarrhea.

OriginalsprogEngelsk
TidsskriftThe Pediatric infectious disease journal
Vol/bind21
Tidsskriftsnummer5
Sider (fra-til)417-9
Antal sider3
ISSN0891-3668
StatusUdgivet - maj 2002

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