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Kawasaki disease (KD) represents systematic vasculitis of unknown etiology that typically occurs in childhood. Its most important complications are coronary artery changes described in 15 to 25% of untreated children. The diagnosis is based on fever criteria longer than five days and at least four additional criteria: polymorphic exanthema, changes in the extremities, mucosal changes in the oral cavity or on the lips, bilateral conjunctival injection and unilateral cervical lymphadenopathy. Affection of lungs is rare manifestation in KD and can present as pneumonia, pulmonary nodules, bronchopneumonia, hydropneumothorax and pleural effusion. During a ten year period, we treated 11 children diagnosed with KD in our clinic, of which KB presented with clinical and image-proven lung involvement during the acute phase.

INTRODUCTION: In an attempt to improve the identification of young athletes at potential risk of sudden cardiac death (SCD), screening protocols are established. There are two main approaches to pre-participation cardiovascular screening of the athletes: those of American Heart Association (AHA), and the other one of European Society of Cardiology (ESC) and the International Olympic Committee (IOC). The AHA recommendations consist of 12-key elements of personal and family medical history, and physical examination. The ESC/IOC recommends using a standard 12-lead ECG in addition to a focused medical history and physical examination. In this study, implementation and results of a standardized pre-participation cardiovascular screening in young athletes, according to relevant guidelines, are described. METHODS: In 2011, 1240 children and young adolescent athletes aged 5-17 years underwent cardiac evaluation as part of a pre-participation screening program. The majority were male and participated in football, team handball and martial arts. Level of training was different. They were investigated in outpatient sports clinic in Samobor, Zagreb County, Croatia, by physician, licensed specialist in sport medicine. Cardiac evaluation consisted of a health questionnaire (relevant personal and family medical history), physical examination, and 12-lead ECG - interpreted in accordance with the 2010 ESC recommendations. RESULTS: Of examined athletes, 49 (4%) were reffered for further cardiovascular evaluation due to symptoms (6 athletes ; 12.2%), detection of a cardiac murmur or other abnormalities in physical examination (16 athletes ; 32.7%), an abnormal ECG (25 athletes ; 51%), and a presence of a family history of inherited cardiac disorder or premature (≤50 years old) SCD (2 athletes ; 4.1%). The most frequent ECG changes included first degree AV block, complete RBBB and left-axis deviation. After attending specialist cardiac clinic, 27 (55%) athletes showed normal findings, 15 (31%) need further follow-up, and for 7 (14%) there were no feedback data. CONCLUSIONS: In a study population of young athletes undergoing pre-participation screening, the prevalence of abnormal ECG findings, suggestive for underlying cardiac disease and mandating additional testing, is low (2% of the overall population). Therefore, under existing financial circumstances, a correct interpretation of an ECG should not represent additional burden in prevention and saving lives.

Introduction: Hypertensive crisis is a life- threatening condition, defined as severe hypertension complicated with acute target- organ dysfunction (mainly neurological, renal or cardiac). It rarely occurs in childhood and most children and adolescents who presents with hypertensive crises symptoms have secondary hypertension, mainly of renal etiology. Case reports: We present the cases of three children with severe hypertension of different renal etiology who presented with the characteristic features of hypertensive emergency. Case 1 is a 11-year-old girl with reflux nephropathy who at admission had blood pressure (BP) as high as 250/200 mmHg. She was lethargic, with headache, vomiting and a 3-month history of weight loss. Case 2 is a 13-year-old boy with renal artery stenosis who had clinical presentation of generalized tonic-clonic seizures and BP 220/150 mmHg. Case 3 is a 9-year-old boy with chronic renal insufficiency of unexplained etiology and BP as high as 220/135 mmHg. This patient, like two others, presented dominantly with symptoms of hypertensive encephalopathy, as well as signs of renal damage. All three patients have documented hypertrophic cardiomyopathy. In the patient who had renal artery stenosis, removal of his dysplastic atrophic right kidney failed to normalize his blood pressure. Conclusion: We discuss the cases of unrecognized long-standing hypertension, with progression to malignant hypertension, as the first manifestation of renal disease - two with renal parenchymal disorders and one with renovascular disease. Hypertension is underdiagnosed in children and thev purpose of these case reports is to raise awarness about it and point to the importance of routine careful measurement of blood pressure in pediatric patients.

Child with coronary artery disease evolve as a new specialty. Assessment of traditional cardiovascular risk factors is mainstay of evaluation. Subclinical markers, cardiac and especially vascular, are helpful because they are sensitive to early and less atherosclerotic load. CIMT is an independent predictor of future cardiovascular events. OBJECTIVE: In children with esential hypertension determine CIMT and investigate whether there exists an association between CIMT and left ventricle mass index (LVMI). METHODS: A cross-sectional study of 32 subjects (mean age 15.3 yr, SD 1.7 yr) was conducted. The inclusion criteria were: (1) children ages 10-18 years with hypertension, defined as average systolic and/or diastolic blood pressure that is ≥95th percentile for gender, age, and height on 3 or more separate occasions ; (2) secondary hypertension exclusion ; and (3) no drugs with effect on blood pressure. CIMT measurements made of far wall from proximal and distal common carotid on both the right and left sides (mean of 4 measuraments). The correlation among CIMT and LVMI was determined using the Pearson correlation coefficient. RESULTS: Average CIMT was 0.66 ± 0.10 mm. The prevalence of left ventricle hypertrophy (LVMI > 38.6 g/m2.7) was 31.3%. CIMT was positively correlated with LVMI (r = 0.30 ; p = 0.09). CONCLUSIONS: Positive correlation between CIMT and LVMI is probably due to the same adaptational mechanisms and, as assessment of CIMT in adults is widely accepted as a valid and reliable measure of atherosclerotic burden, based on this and many other studies in children, these markers represent the end result of risk exposures in children as well.

Great challange of every community is insuring the most optimal growth and development of the children. All social resources must participate in it. How realize? A model of holistic and interdisciplinary approach to children` health in a community is designed in Croatia by programme "Towns and districts-friends of children". Programme has taken place since 1999. ; its duration is not limited. Programme organizers are Croatian Union of Societies "Our Children" and Croatian Society for Social and Preventive Pediatrics. At the beginning, programme was sponsored by UNICEF-Croatian Office and supported by the Nacional Institute for the Protection of Family, Motherhood and Youth. The goal of the programme is to motivate and stimulate adults in Croatian towns and districts to fully satisfy the rights and needs of children, as recognized in the UN Covention on Children`s Right. Special value of this comprehensive, professional and soccial action is that it is based on implementation of the UN Covention on Children`s Right on local level. Programme covers all important aspects of child`s life:education of children ; child in secure and healthy town/district ; children`s health ; social welfare for children ; sports and culture for children ; childrens leisure time and and recreation ; support and help to the associations that have children`s programmes and the inclusion of children in meaningful decision that regard them. At present 54 Croatian towns and district participate in it. The final evaluation of towns/districts` attained results, based on qualitative and quantitative parameters is carried by the Central Coordinating Committee through its accredited professional prize-awarding committee. Every town and district who achieves at least 80% of the programme`s requirements will be given the honorary title Town/District-Friend of Children. Realization of this programme guarantees holistic approach to child`s health in a community.

The effects of implementation WHO/UNICEF Breastfeeding Hospital Initiative (BFHI) and community postnatal support on breastfeeding rates were examined during and after the breastfeeding promotion campaign in one county of Croatia. Comparison with a control group indicated increase of breastfeeding prevalence in a period of BFHI implementation (1994-1998) - 68% vs. 87% at infant age 1 mo, 30% vs. 54% at 3 mo, 11, 5% vs. 28% at 6 mo, and 2% vs. 3, 5% at infant age 11-12 mo (chi-squore test, p < 0, 05). More considerable increase has been noticed in a period 1999-2000 which is characterized by breastfeeding support groups activity: 68% vs. 87% at infant age 1 mo, 30% vs. 66% at 3 mo, 11, 5% vs. 49% at 6 mo, and 2% vs. 23% at infant age 11-12 mo (chi-squore test, p < 0, 05). Our conclusion is that activities aiming to promote breastfeeding in maternity hospitals have had limited success. They have resulted in satisfactory increase of breastfeeding prevalence in early infant's period, but for far-reaching effect postnatal support is also required.

At the beginning of the third millennium we find ourselves involved in new children’ s health issues. Child surrounding environment has strong influence on child's health: ecology issues, inadequate life styles, lack of social adaptation, and new infective and non-infective diseases. We are talking about health issues, which paediatricians primarily oriented to curative medicine cannot successfully solve. It is necessary to develop new strategy of community health promotion based on holistic approach to a child. Paediatrician, who is by vocation child's advocate, should be oriented on promotion of these programs. In this paper we present programme with holistic and cross-sector approach to child’ s health in a community. Project Towns and districts – friends of children has taken place in Croatia since 1999. At the beginning under the sponsorship of UNICEF, goal of this comprehensive professional and social action was to motivate and stimulate adults in towns and districts of Croatia to satisfy fully the rights and needs of children as recognized by the UN Convention on Children's Rights. Programme covers all important aspects of child's life: protection and education of children ; child in a secure and healthy town/district ; children's health ; education of children ; social welfare for children ; sports and culture of children and for children ; children's leisure time and recreation ; support and help for parents in their care and education of children. At present 54 Croatian towns and districts participate in it. This is unique project in the world and its realization guarantees holistic approach to child’ s health in a community.

Serum sodium, chloride and potassium concentrations in children with febrile seizures were examined. The study included 135 children ; of these, 75 (54%) were boys and 62 (46%) girls. The mean serum sodium, chloride and potassium values were 136, 3 &plusmn ; 4, 9 mmol/l and 4, 29 &plusmn ; 0, 49 mmol/l, respectively. Decreased sodium, chloride and potassium values below the lower normal limits were found in 84 (62, 2%) and 3 (2, 2%) subjects, respectively. The frequency of decreased as compared to that of increased values was higher for sodium (X2 = 115, 54 ; p < 0, 001), whereas increased chloride values were more frequent as compared to decreased ones (X2 = 59, 49 ; p < 0, 001). There were no significant differences in serum sodium, chloride and potassium concentrations in children with typical, recurrent and atypical febrile seizures (p > 0, 05).

Retrospektivno su obrađene jednoplodne trudnoće, porodi i novorođenčad mnogorotkinja (5 i više poroda) s 40 i više godina. Kontrolnu skupinu čine mnogorotkinje od 20. do 34. godine života. Iz medicinske povijesti bolesti dobiveni su podaci o spontanim i hotimičnim pobačajima, o zdravstvenom reprodukcijskom stanju, zatim o tijeku trudnoće, porodu i novorođenčadi. Statistička obrada učinjena je pomoću X2-testa, 2x2 tablica kontingencije. Razlika je značajna ako je p ili = 5) (5, 0%), što je više u odnosu na kontrolnu skupinu (p

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