Background: Acute liver failure (ALF) is a rare disease, associated with high mortality, despite optimal medical therapy without emergency liver transplantation. Knowing the possible cause of ALF plays a vital role in the management, as the child could benefit from effective specific therapies in emergencies. Methods: We have analyzed the etiology and outcome of ALF in children followed-up in a tertiary care hospital between January 2012–December 2018. The patients were grouped into different age categories: neonates (0–1 month), infants (1–12 months), children (1–14 years), and teenagers (14–18 years). Results: 97 children (46 males, 47.42%, the mean age of 7.66 ± 8.18 years) were admitted with ALF. The most important causes of ALF were in neonates and infants, infections (72.72%), and metabolic disorders (43.47%), in children and adolescents were the toxic causes (60% and 79.41%). The mortality rate was 31.95% (31 patients), mainly in ALF due to infections or metabolic disorders. Conclusions: In neonates and infants, the main causes of ALF were infections and metabolic diseases, while in older children and teenagers, were toxin-induced liver injuries. The mortality among neonates and infants was significantly higher than in other ages. Early recognition and immediate therapeutic intervention could improve the outcome of these patients.

In the present research, chronic viral hepatitis in children is approached from a multidisciplinary point of view, considering social status, economic and medical aspects. We conducted a 4-year observational prospective study. A questionnaire regarding the socio-economic status of pediatric patients diagnosed with chronic viral hepatitis B or C was applied. In total, 159 patients were included, 52 % from urban areas, 2.5 % coming from centres for abandoned children. Among 119 school-aged children, 66% were attending classes. All patients are registered with a general practitioner. Regarding the monthly income per family, 49% had less than 1000 RON (5 RON = 1$), of which 17% had no income, 28% had an income ranging between 1000 and 2000 RON and in only 23% of cases the income exceeded 2000 RON (5% had more than 4000 RON). There were between 3 and 12 members per family. Concerning parents` educational level, the average years of study for mothers was 7.8, while for fathers, it was 8.2. For 17 % of children, at least one of the parents was illiterate, and for 5.6 %, both parents were illiterate. For a third of patients, both parents were unemployed. Regarding social living conditions, 38.4% did not have water facilities or sewerage, and 32 % used personal objects (scissors, nail clippers) in common. The socio-economic level can have a significant impact on disease epidemiology (infectiousness) and access to treatment, and it is tightly related to educational level and access to information, which are critical factors in disease prevention through general and specific measures and in disease management (treating infected patients and limiting the transmission).

Background and aimOver the last decades, the diagnosis of cæliac disease (CD) changed significantly both in terms of clinical picture and laboratory diagnosis. The authors present the perspective of a Pædiatric Gastroenterology Department over a 32 years period.MethodWe performed a retrospective study including patients diagnosed with CD from Jan.1985 until Dec.2016 in „Gr. Alexandrescu’ Children’s Hospital. Three groups were formed, according to the diagnostic procedures used over time: first-intestinal biopsy, second-serology and biopsy, third-serology and biopsy or high values of anti-transglutaminase antibodies, a second positive serologic marker and HLA typing. Clinical characteristics at presentation were analysed.Results231 children were included. First group contained 20 patients (mean age at diagnosis 5.9 years) diagnosed with classic forms of CD from 1985 until 1995 (1.8/year). Gastrointestinal (GI) symptoms were described in all, particularly chronic diarrhoea (90%). Four presented with cæliac crisis (20%). Second group included 152 patients diagnosed from 1996 until 2006 (once serologic screening was available the number of patients/year increased to 13.8). Mean age at diagnosis was 4.4 years. 86.8% presented with GI symptoms, but only 51.9% had chronic diarrhoea. Cæliac crisis was rarely seen (0.6%). Instead of classic forms with malabsorbtion, atypical presentations with non-GI symptoms were reported in 13.1%. Third group consisted of 59 patients diagnosed from 2007 until 2016 (at a mean age of 4). The number of patients presenting to a Gastroenterology Department decreased considerably (5.9/year). Half of the patients that reached our department presented with mild GI symptoms other than chronic diarrhoea: constipation, abdominal pain (50.9%).ConclusionThree decades ago the Pædiatric Gastroenterologist was diagnosing classic forms of CD with chronic diarrhoea in small numbers of children. Once cæliac serology was available, the diagnosis shifted to a large number of patients with a broad clinical spectrum. Now CD diagnosis is again set progressively less frequent in the Gastroenterology Department as mild GI symptoms suggesting rather functional than organic disease are often the form of presentation. As long as the CD awareness is high, the diagnosis might be successfully established in the primary care setting, in many cases without biopsy, according to the ESPGHAN guidelines.

Wilson's disease is a genetic autosomal recessive transmitted pathology, that causes disorders of copper metabolism, leading to its accumulation in target tissues. It is a multisystemic affection and has a polymorphic clinical picture. Establishing a positive diagnosis can be difficult, with no single test that confirms or definitely excludes the disease. Diagnostic criteria for the Wilson disease in adult patients were established, then reevaluated for the child. Establishing early diagnosis allows early chelation therapy, which provides a better prognosis, delaying the progression of the disease. This is the reason why the importance of family screening must be emphasised.

Objectives. Pediatricians face various challenges in different stages of celiac disease (CD) diagnosis. Whom to test is intensely debated because of CD's heterogenous clinical spectrum. The main purpose of the study was to identify symptoms or symptom associations that should initiate an active strategy of CD early diagnosis in Romanian children. Material and method. We conducted a prospective study in "Grigore Alexandrescu" Emergency Children's Hospital. From March 2013 until February 2014, 249 children with symptoms/signs at risk of CD were included. Results. CD was diagnosed in 11 (1/21 patients evaluated). One in 12.6; 16; 18; 18.5 and 18.5 children respectively with chronic diarrhea, low stature, growth failure, recurrent abdominal pain and constipation had CD. Certain symptom associations increased the risk: classical symptom associations (chronic diarrhea and weight loss), as well as other associations: recurrent abdominal pain and weight loss, constipation and weight loss, constipation and refractory iron deficiency anemia. Conclusion. Active screening among patients with symptoms and especially symptom associations at risk of CD would improve diagnosis rates in pediatric CD.