Visual Abstract

Neonatal acute myocardial infarction (MI) is a rare event, with a high mortality rate. Early recognition and intensive care management can be successful, and it requires a high index of suspicion in cases of unknown cardiogenic shock. The lack of access to cardiac catheterization should not delay management. Furthermore, there is great potential for myocardial regeneration to occur in surviving neonates with MI, emphasizing the importance of early recognition and management. The present report describes a neonate with an anatomically normal heart and coronary arteries who developed clinical, laboratory and electrocardiographic features of MI, and was managed successfully with fluid resuscitation, inotropic drugs and vasodilators.

There are increasing trends in childhood obesity and pre-pregnancy maternal BMI. Higher pre-pregnancy BMI increases the risk for increased BMI z-score and blood pressure z-score in children. Since elevated BMI and blood pressure clearly are known risk factors of future CKD, targeting healthier weights prior to conception is likely to reduce the CKD burden in children.

Following 10 years of clinical use of mycophenolate mofetil (MMF), a prodrug of mycophenolic acid, the FDA has approved enteric-coated mycophenolate sodium (EC-MPS). EC-MPS was developed to reduce the upper-gastrointestinal (GI) effects of MMF. Unlike oral MMF, where absorption starts in the stomach, EC-MPS releases MPA in the small intestine. Along with the pharmacology and pharmacokinetics, three randomized, controlled clinical trials in solid-organ transplantation, comparing MMF and EC-MPS, are reviewed. Disappointingly, EC-MPS was similar to MMF in efficacy and safety and did not significantly improve the GI side effects. Moreover, bioequivalence dosing has only been established with concomitant ciclosporin. The pharmacokinetic characteristics must be studied in greater detail. EC-MPS is a safe and effective immunosuppressive agent approved for use in the prevention of acute rejection after renal transplantation. However, the anticipated improvement of GI side effects has not been forthcoming.

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