bluuebunny/crossref_metadata_2025 huggingface dataset:
Formation of photoproducts and cytotoxicity of bilirubin irradiated with turquoise and blue phototherapy light
Authors: Bruzell Roll Ellen , Christensen Terje
Published: August 2010

Aim:To compare a new turquoise (“green”) fluorescent phototherapy lamp (490 nm) with a conventional blue phototherapy lamp (450 nm) with respect to cytotoxicity and photochemical effects of bilirubin.Methods:Mouse lymphoma cells (L5178Y‐R) in the presence of bilirubin solutions were exposed to phototherapy light. Occurrence of necrosis and apoptosis, reduction of mitotic index and inhibited cell growth was assayed by appropriate methods. The presence of bilirubin and its photoisomers was measured by high‐pressure liquid chromatography analysis and absorption spectroscopy.Results:At constant and equal light irradiances, the cytotoxic effects in the presence of bilirubin bound to human serum albumin showed that the green lamp caused significantly less necrosis (n=4,p<0.05) and less inhibition of cell multiplication (n=3,p<0.05) than the blue lamp. A slightly lower apoptotic fraction, although not statistically significant, was observed in cells exposed to the blue lamp. Photo‐oxidation of bilirubin was more prominent with blue light irradiation. The photoequilibria between geometric isomers of bilirubin were different for the two lamps; more geometric photoisomers were formed by blue irradiation (n=6,p<0.05). The amounts of the most water‐soluble isomers (presumably mainly lumirubin) were rather similar for the two lamps.

Conclusion:The two lamps were similar in the formation of therapeutically relevant photoproducts, but the blue lamp showed potential in forming more photo‐oxidation products and in causing more severe cellular damage in the presence of bilirubin.
Sonographic detection of the optic radiation
Authors: Boxma Annemieke , Lequin Maarten , Ramenghi Luca A , Kros Max , Govaert Paul
Published: August 2010

Objective: To describe a region of hyperechoic white matter adjacent to the atrium of the lateral ventricle of preterms, and to speculate on the relevance of detecting preterm white matter injury. Patients and methods: Cranial ultrasound images of 92 preterms of gestational age (GA) 32 wk or less were reviewed. For each infant, one first week standard coronal image was used for measurement of grey values around the para‐atrial region of interest (PAROI) relative to the choroid plexus. For verification of the sonographic anatomy, MR images of an adult brain were used. For reference, neuro‐anatomical images were compared in several atlases. In a group of nine preterms of similar GA with cystic periventricular leukomalacia (PVL) or MR‐confirmed white matter disease, the disappearance of the PAROI was examined. Results: The hyperechoic para‐atrial area, subjectively detected in 84% of the patients, was situated bilaterally between the inner end of the lateral fissure and the upper third of the choroid plexus. In white matter caudal to the atrium, the hyperechoic band could be pursued towards the calcarine area. The average ratio of grey value around the PAROI to the choroid plexus was 0.787 (SD=0.072, median 0.791). There was no correlation between PAROI grey value and gestational age. At 26 wk gestational age, the average ratio was 0.781 (n=14), and 0.789 (n=17) at 31 wk. Location of the PAROI agrees with the angle of the upper loop of the optic radiation. None of the nine infants with white matter damage had PAROIs clearly distinguishable from flaring.

Conclusion: The symmetrical and unchanged acoustic character between 26 and 31 wk of gestational age argues in favour of the hypothesis that the PAROI is an anatomical structure. The localization of the hyperechoic band supports the hypothesis that it represents part of the optic radiation. Further study is needed to examine the absence of a hyperechoic para‐atrial band as a prognostic marker of the extension and severity of white matter injury.
Psychoactive drug prescribing by Dutch child and adolescent psychiatrists
Authors: Hugtenburg Jacqueline G , Heerdink Eibert R , Hwo Tso Yung
Published: August 2010

Aim: To gain more insight into the prescribing of psychoactive drugs by Dutch child psychiatrists. Methods: A questionnaire was sent to all child psychiatrists in the Netherlands. Questions were asked about the prescribing of antidepressants, antipsychotics, anxiolytics and psychostimulants for psychiatric disorders in children. Results: The preference of specific antidepressants, antipsychotics and anxiolytics depends on the disorder. For different disorders, off‐label prescribing varies from 19 to 71%.

Conclusion: Preferences differ widely. Off‐label drug prescribing is high. More studies on the efficacy and safety of psychoactive drugs in children are therefore required.
The complexity of the psychosocial situation in children and adolescents with heart disease
Authors: Birkeland Anna‐Lena , Rydberg Annika , Hägglöf Bruno
Published: August 2010

Aim: To describe the psychosocial situation of children/adolescents with heart disease and their families, an inventory method was worked out. Methods: Ninety‐seven children/adolescents with congenital heart disease (CHD) were graded into three categories with respect to complexity of CHD. Group I included 42 patients with malformations requiring standardized operations. Group II included 20 patients with more complicated malformations, and group III included 35 patients with very complex malformations. The patients were compared with controls without heart disease, matched for age and gender. The psychosocial impact of CHD was measured by the inventory. Results: The most frequent problems in the patient group were healthcare and treatment‐related needs (71/97) in the external sphere, family symptoms (68/97) in the interpersonal sphere, and somatic symptoms (19/97) in the personal sphere. Corresponding numbers in the controls were treatment‐related needs (15/97), family (9/97) and somatic symptoms (25/97). Fifty per cent of the symptoms in the patient groups were mild, 30% moderate and 20% severe. The most severe symptoms were found in the interpersonal sphere, where family symptoms constituted the most severe variable. The frequency of severe problems in the personal sphere was 11% in the patients and 1% in the controls. This inventory method differentiates the grades of medical complexity both regarding number and severity of psychosocial symptoms. It indicates severe personal problems in the most complex group and shows that they have severe personal problems independent of family problems.

Conclusion: This study elucidates the psychosocial complexity in children/adolescents with CHD, which has clinical implications in developing a psychosocial care programme.
Legionella waltersii–a novel cause of pneumonia?
Authors: König Corinne , Hebestreit Helge , Valenza Guiseppe , Abele‐Horn Marianne , Speer Christian P
Published: August 2010

A 5‐y‐old girl was admitted to our hospital with fever, cough, respiratory distress and rapidly increasing oxygen requirements. A chest radiograph showed bilateral central infiltrates. PCR was performed with pharyngeal washings and revealed Legionella DNA, while no genetic materials of other pathogens such as respiratory viruses, Mycoplasma and Chlamydia were detected. The clinical condition improved gradually after administration of steroids and therapy with clarithromycin. Further sequencing of Legionella DNA led to the identification of Legionella waltersii. This Legionella species has never been described as a human pathogen before.

Conclusion: For the first time, L. waltersii was identified as a cause of severe pneumonia. Since L. waltersii is not detected by routine laboratory tests, it may be speculated that these bacteria, like other Legionella species, are underestimated as a probable cause of community‐acquired pneumonia.
Maternal anxiety: An emerging prognostic factor in neonatology
Authors: Zelkowitz Phyllis , Papageorgiou Apostolos
Published: August 2010

Symptoms of anxiety in pregnant and postpartum women are of considerable concern due to their association with adverse obstetrical outcomes, postpartum depression, and emotional and behavioral problems in the children. Certain mothers are at particularly high risk for anxiety in the immediate postpartum period: those who have experienced preterm birth or other perinatal complications, as well as those lacking a satisfactory marital relationship or other forms of social support.

Conclusion: Programs to detect and intervene with anxious mothers in the early postpartum period are warranted.
Pervasive loss of function in asylum‐seeking children in Sweden
Authors: Bodegård Göran
Published: August 2010

Presently, a couple of hundred children from traumatized asylum‐seeking families in Sweden have developed severe loss of mental and physical functions without evidence of underlying disease. Of the 23 treated children treated at this clinic, 15 have recovered, three are improving and five are under initial care. Communication within the family is crucial from both pathogenic and salutogenic perspectives. A permanent residence permit, correcting the underlying situation of threat and insecurity, is a condition for good results from psychiatric treatment. In Sweden there is a lack of consensus and conflicting political and medical perspectives prevail regarding the “apathetic” children.

Conclusion: Children living under unbearable life conditions can develop life‐threatening depression‐withdrawal stress reactions well known as pervasive refusal syndrome (PRS). This is also true of children in traumatized asylum‐seeking families. Excellent results are achieved when the family's underlying fear and hopelessness can be erased and the treatment focuses on the traumatic experiences.
Proteomic evaluation of milk from different mammalian species as a substitute for breast milk
Authors: D'auria Enza , Agostoni Carlo , Giovannini Marcello , Riva Enrica , Zetterström Rolf , Fortin Riccardo , Franco Greppi Gian , Bonizzi Luigi , Roncada Paola
Published: August 2010

As milk represents the main source of nutrition for infants, the question of an effective human milk substitute becomes mandatory when a formula‐fed baby is allergic to cows' milk proteins. In this case, formulas containing extensively hydrolysed milk proteins should be preferred, but even such a formula may cause allergic reactions in highly sensitive patients. If there is evidence of cows' milk allergy with IgE‐associated symptoms, after 6 mo of age, a soy bean formula may be recommended only when tolerance to soy protein has been established by clinical challenge. In infants with allergic reactions to cows' milk proteins, even after extensive hydrolysation, proteomic techniques coupled to immunological methods may make it possible to select other milk products that do not contain the same allergens as ordinary cow's milk. In this paper, evidence will be presented that proteomic evaluation of proteins from different mammalian species may be a suitable method of testing whether proteins from the milk of different mammalian species may be used as a substitute for untreated bovine milk.

Conclusion: Proteomic evaluation of milk from different mammalian species may not only be of help when recommending suitable feeding in cases of cows' milk allergy but also gives new insight into the background to allergic reactions caused by milk proteins.
Effect of obesity on inflammatory markers and renal functions
Authors: Cindik Nimet , Baskin Esra , Isik Agras Pinar , Tulgar Kinik Sibel , Turan Munire , Saatci Umit
Published: August 2010

Aim: To examine the relationship between inflammation criteria and body mass index in otherwise‐healthy obese schoolchildren and to evaluate the effect of obesity on renal functions. Methods: Sixty‐five otherwise‐healthy obese children (median age 10.8 y, range 7.1–16.5 y; median body mass index 26.8 kg/m2, range 19.9–38.7 kg/m2) and 20 healthy controls (median age 12.4 y, range 10.1–17.1 y; median body mass index 18.8 kg/m2, range 17.3–23.1 kg/m2) were included. Blood and urine samples were taken from every child. Results: Children in the obese and control groups had similar age and sex distributions (p>0.05). Inflammatory mediators were higher in obese children (p<0.05). A significant positive correlation was found between glomerular filtration rate and body mass index in the whole study group (r=0.39, p=0.001). A positive correlation was found between body mass index standard deviation and inflammatory mediators and glomerular filtration rate. No significant difference existed regarding protein and microalbumin excretion in the urine.

Conclusion: Inflammatory mediators increased significantly in obese children, and the glomerular filtration rate increased as the body mass index increased. To prevent obesity‐related complications in adulthood, it is important to take measures to prevent development of obesity during childhood.
Efficacy of an individualized written home‐management plan in the control of moderate persistent asthma: A randomized, controlled trial
Authors: Agrawal Sunil K , Singh Meenu , Mathew Joseph L , Malhi Prabhjot
Published: August 2010

Background: The management of childhood asthma necessitates a comprehensive approach including pharmacological treatment as well as education about self‐evaluation and home management of the condition. Aim: To evaluate the efficacy of adding an individualized written home‐management plan in the control of moderate persistent asthma. Methods: Children with moderate persistent asthma were randomized to receive either an individualized written home‐management plan or no plan, in addition to standard asthma therapy including education. They were followed up with serial measurement of outcome variables. Results: Children receiving an individualized written home‐management plan had fewer acute asthma events, fewer lost school days, lower symptom score and less nocturnal awakening than those who did not receive a written plan.

Conclusion: The addition of a written individualized home‐management plan improves overall control in children with moderate persistent asthma.
Topographic localization of electrocortical activation in newborn and two‐ to four‐month‐old infants in response to head‐up tilting
Authors: Grieve Philip G , Myers Michael M , Stark Raymond I , Housman Sarah , Fifer William P
Published: August 2010

Aims: (1) To confirm that head‐up tilting causes sustained increases in the heart rate (HR) of newborn infants but not during the period of maximum vulnerability to SIDS at 2–4 mo of age, and (2) to determine whether electrocortical activation (changes in high‐frequency EEG power) also shows topographic and age‐dependent effects of tilting. Methods: HR and electrocortical activity were recorded in 15 newborn and 12 2‐ to 4‐mo‐old infants during head‐up tilting. Infants were tilted, three times, to a 30° head‐up position. Electrocortical activity was acquired using a 128‐lead EEG system. Changes in HR and high‐frequency (12–50 Hz) power in the electrocortical signal were computed from the flat to the head‐up position. Results: Newborn infants had significant increases in HR and robust increases in high‐frequency power in the left frontal, right frontal‐temporal, and occipital regions following head‐up tilt. At 2 to 4 mo of age, HR did not change significantly and tilt‐related increases in high‐frequency power were smaller.

Conclusion: The patterns of HR change and electrocortical activation with tilting of newborn infants are different from infants at the age of highest risk for SIDS.
Pre‐discharge anxiety among mothers of well newborns: Prevalence and correlates
Authors: Britton John R
Published: August 2010

Objective: To explore the prevalence and correlates of maternal postpartum anxiety. Methods: 422 of 973 invited mothers (43%) were screened for anxiety before hospital discharge with the State‐Trait Anxiety Inventory (STAI). Recent medical and social life events, stress, resiliency (mastery, social support, and marital satisfaction), length of stay, discharge readiness, anticipatory medical care, and history of psychiatric illness and depression were assessed by questionnaire and medical record review. Results: 24.9% of mothers had moderate and 1% severe anxiety. Higher anxiety was observed among young, unmarried, primiparous mothers with male infants, and anxiety correlated with medical and negative social life events, stress, history of depression, and duration of postpartum stay. Inverse correlations were observed with maternal education and household income, pregnancy planning, prenatal class attendance, infant healthcare provider identification, and with all resiliency factors. In multivariate models, pre‐discharge anxiety was significantly associated with medical life events and the maternal perception of perinatal stress, and negatively associated with mastery, marital satisfaction, and choice of infant healthcare provider.

Conclusion: Moderate maternal anxiety is common prior to perinatal hospital discharge, especially among women with low mastery and marital satisfaction, stressful perinatal courses, and failure to identify an infant healthcare provider.
A framework for ethical decision making in neonatal intensive care
Authors: Baumann‐hölzle Ruth , Maffezzoni Marco , Ulrich Bucher Hans
Published: August 2010

Intensive care for neonates with high risks of severe impairment and the possibility of a prolonged dying process represents a frequent ethical issue in neonatal units. The aim of this paper is to present a framework for structured decision making that has been developed in a neonatal intensive care unit and to demonstrate its impact on the healthcare team and on survival of critically ill neonates. This framework attempts to integrate the best interests of the infants and their parents, the possibilities of high‐tech neonatal intensive care interventions, and the perspective of the nurses and doctors. An external evaluation of 84 sessions over 3 y revealed a beneficial effect on the quality of the decision‐making process itself and on the quality of the teamwork in the unit. Survival time was shorter (median 2 d, interquartile range 1–7 d) in 26 infants that died after structured decision making compared with 26 controls matched for gestational age, malformation and intracranial haemorrhage (median 7 d, interquartile range 4–15 d).

Conclusion: The introduction of this framework for structured decision making involving doctors and nurses improved the quality of the teamwork. It shortened futile intensive care, and thereby suffering for both infants and parents.
Language skills at age 6 years in Swedish children screened for language delay at 2½ years of age
Authors: Miniscalco Carmela , Westerlund Monica , Lohmander Anette
Published: August 2010

This study concerns language outcome in 6‐y‐old children who participated in a longitudinal community‐based study of 105 children screened for language delay (LD) at 2½ y of age. The purpose was to investigate (1) whether results from the 2½‐y screening were persistent at 6 y of age, and (2) what language domains at age 6 were difficult for (a) children with LD at age 2½ y and (b) children with normal language (LN) at the same age. Significant differences between LD and LN at age 2½ y were persistent at age 6. The vulnerability that was identified at 2½ y of age, such as problems with going from single‐word utterances to multiword utterances, seems to persist as delayed development at different language levels and across language domains.

Conclusion: This study has shown that children who failed the 2½‐y screening are at high risk of having persistent language problems at age 6 y.
Ultrasound diagnosis of brain atrophy is related to neurodevelopmental outcome in preterm infants
Authors: Horsch Sandra , Muentjes Carsten , Franz Annett , Roll Claudia
Published: August 2010

Background: Intraventricular haemorrhage and periventricular leukomalacia are associated with poor outcome of very preterm infants, while the role of more subtle cerebral alterations, as detected by cranial ultrasound, is less clear. Aim: In this study, we related periventricular echodensities and signs of brain atrophy to neurodevelopmental outcome at 3 y of age. Patients and methods: All preterm infants born in 1997 in our institution with a gestational age <32 wk or birthweight <1500 g were subjected to repeated standardized cranial ultrasound examinations until discharge. Survivors were examined at 3 y of age employing the Bayley Scales of Infant Development II. Results: Eighty‐seven infants were enrolled (birthweight 430–2500 g (median 1200 g), gestational age 24–34 wk (median 29 wk)). Periventricular echodensities were detected in 42 infants (48%); in 12 cases persisting <7 d, in 30 cases >7 d. At discharge, 18 infants (22%) had signs of brain atrophy. Neurodevelopmental outcome was assessed in 64 infants. Infants with signs of brain atrophy scored significantly lower on MDI (atrophy 91.8, no atrophy 101.9; p=0.02), PDI (atrophy 91.4, no atrophy 106.5; p=0.001) and Behaviour Rating Scale (atrophy 41.1, no atrophy 66.4; p=0.01) than infants without atrophy. Periventricular echodensities were not related to outcome.

Conclusion: Our data show that infants with sonographic signs of brain atrophy at discharge achieve lower scores in neurodevelopmental testing at 3 y.
Hyperglycaemia and insulinopenia in a neonate with cystic fibrosis
Authors: Siahanidou Tania , Mandyla Helen , Doudounakis Stavros , Anagnostakis Dimitris
Published: August 2010

Abnormal glucose tolerance is a frequent late complication of cystic fibrosis (CF), but the prevalence of CF‐related diabetes mellitus (CFRD) in children less than 10 y old is less than 2%. The youngest child with CFRD reported to date was 6 mo of age. Insulinopenia is the primary cause of abnormal glucose tolerance/CFRD, but it is unknown whether it may begin in the neonatal period. We describe a case of a neonate with CF who presented with hyperglycaemia in the diabetic range and marked insulinopenia. Insulinopenia and impaired glucose tolerance were permanent findings at 6 and 15 mo of age.

Conclusion: This case suggests that abnormal glucose tolerance/diabetes may occur much earlier in the course of CF, even during neonatal age. Careful follow‐up and further studies in CF infants could reveal that the real incidence of glucose intolerance and diabetes in this age group has been underestimated.
Cirrhosis in an infant heterozygous for classical citrullinaemia
Authors: Süheyl Ezgü Fatih , Tümer Leyla , Dalgiç Buket , Hasanoĝlu Alev , Kobayashi Keiko , Saheki Takeyori
Published: August 2010

Classical citrullinaemia is caused by the inherited deficiency of argininosuccinate synthetase. Although varying degrees of liver involvement have been observed in urea cycle defects, including classical citrullinaemia, the co‐existence of liver failure in a patient heterozygous for the disease has not been reported before. A female infant was investigated to find out the aetiology of early infantile liver failure. She was later found to be a heterozygote for the G390R mutation found in severe citrullinaemia patients.

Conclusion: Classical citrullinaemia is a phenotypically heterogeneous disease, and observations for signs of its presence should be made even in heterozygotes.
Blood pressure in the neonate
Authors: Michael Weindling A , Bentham Jamie
Published: August 2010

The paper by Dannevig et al. in this issue of Acta Pædiatrica carefully compares the agreement between blood pressure measurements made by three non‐invasive blood pressure monitors with those made from an indwelling intra‐arterial catheter.

Conclusion: Non‐invasive blood pressure monitoring is not particularly accurate for making measurements in neonates and generally overestimates the blood pressure as observed by others. Clinicians thus should be wary about using non‐invasive blood pressure techniques as substitutes for monitoring by means of an intra‐arterial catheter and transducer.
Mastitis in early infancy
Authors: Stricker T , Navratil F , Sennhauser FH
Published: August 2010

Aim: To evaluate the clinical features and microbiological findings in young infants with mastitis. Methods: Retrospective review of medical records of 18 infants with breast inflammation during the first 3 mo of life seen in the paediatric emergency department between 1992 and 2002. Results: All were full‐term infants with female–male ratio of 3.5∶1. The age ranged from 12 to 45 d, with a peak in the 4th and 5th weeks of life. Only five patients had systemic manifestations, and five were pretreated with oral antibiotics (amoxicillin‐clavulanic acid). The latter as well as seven additional cases required incision and drainage due to abscess formation. Bacterial cultures grew Staphylococcus aureus in 10 cases including all pretreated infants. In four of these cases, Gram stain showed the pathogen. After antimicrobial treatment, no recurrence was observed in any of the patients.

Conclusions: These findings suggest that mastitis in early infancy should be treated with parenteral antibiotics guided by Gram stain when available and informative. Otherwise, β‐lactamase‐resistant antibiotics are a reasonable empirical initial treatment pending culture results. Optimizing the management of infants with mastitis is important especially since abscess formation requiring incision may be detrimental for later breast development.
Childhood idiopathic thrombocytopenic purpura in the Nordic countries: Epidemiology and predictors of chronic disease
Authors: Zeller Bernward , Rajantie Jukka , Hedlund‐Treutiger Iris , Tedgård Ulf , Wesenberg Finn , Jonsson Olafur G , Henter Jan Inge , Rosthøj Steen
Published: August 2010

Aim: To describe the epidemiology of idiopathic thrombocytopenic purpura (ITP) in the Nordic countries, to define clinical subgroups and to investigate factors predicting chronic disease. Methods: A prospective registration was done from 1998 to 2000, including all children with newly diagnosed ITP aged 0–14 y and at least one platelet count <30×109/l. Results: 506 children were registered and 423 followed for 6 mo. The incidence was 4.8/105 per year. Most children were aged 0–7 y (78%), with a predominance of boys, while patients aged 8–14 y had equal representation of the two sexes. There were seasonal variations determined by variations in postinfectious cases with sudden onset. The platelet count was <10×109/l in 58%, but bleeding manifestations were mild or moderate in 97%. The insidious form (symptoms for more than 2 wk) was more frequent in older children and girls, showed little seasonal variation, had milder manifestations and ran a chronic course in more than half the cases. Intracranial haemorrhages did not occur in the first 6 mo after diagnosis. Chronic ITP developed in 25%. The strongest predictor of chronic disease was insidious onset of symptoms (OR 5.97).

Conclusion: In the Nordic countries, ITP mainly affects children aged 0–7 y, with a winter bulk of postinfectious cases superimposed on a steady occurrence of non‐infectious cases. Clinically, it may be useful to distinguish between children with sudden versus insidious onset of symptoms rather than between different age groups.
A randomized trial comparing oxygen delivery on intermittent positive pressure with nasal cannulae versus facial mask in neonatal primary resuscitation
Authors: Capasso Letizia , Capasso Antonio , Raimondi Francesco , Vendemmia Maria , Araimo Gabriella , Paludetto Roberto
Published: August 2010

Aim: To compare, in a prospective clinical trial, oxygen delivery on intermittent positive pressure with nasal cannulae versus facial mask in primary resuscitation of the newborn with moderate asphyxia. Methods: 617 neonates with moderate asphyxia at birth were randomized: 303 were resuscitated by oxygen on intermittent positive pressure with nasal cannuale and 314 neonates by mask. Resuscitation followed the Neonatal Resuscitation Program guidelines of the American Academy of Pediatrics, 3rd edition. Results: Resuscitation through the nasal route less frequently requires chest compressions and intubations (26 neonates needed chest compression and 20 needed intubation out of 314 resuscitated by mask; five neonates needed chest compression and two needed intubation out of 303 resuscitated by nasal cannulae). Apgar scores, admission rates to neonatal intensive care units, air‐leak syndromes, birthweight, gestational age, use of prenatal steroids and deaths did not differ between groups.

Conclusion: Oxygen delivery on intermittent positive pressure with nasal cannulae in primary resuscitation of the newborn with moderate asphyxia is a less aggressive and potentially advantageous alternative to the traditional oral route.
Exposure to tobacco smoke and infant crying
Authors: Reijneveld Sijmen A , Lanting Caren I , Crone Mathilde R , van Wouwe Jacobus P
Published: August 2010

Aim: To examine the association of excessive infant crying with maternal smoking during and after pregnancy, paternal smoking, and smoking by other people in the living environment of the infant. Methods: We collected data on infant crying and smoking in a Dutch national sample of 5845 infants aged 0–3 mo (response 62.8%). We defined excessive crying as crying over 3 h a day on more than 3 d of the preceding week. Results: The prevalence rate of excessive crying was 4.0% (95% CI 3.5 to 4.5%). Excessive crying occurred more frequently among infants of fathers smoking 15+ cigarettes/d (odds ratio (OR) 1.99, 95% CI 1.38 to 2.86) and of mothers smoking 10+ cigarettes/d during pregnancy (OR 1.86, 95% CI 1.02 to 3.42). Infants whose parents were heavy current smokers or whose mothers had been so during pregnancy had a 69% higher prevalence of excessive crying than infants of non‐smoking parents (rates: 6.3% and 3.7%, respectively; odds ratio 1.80; 95% CI 1.26 to 2.57).

Conclusion: Parents stopping smoking may prevent excessive infant crying.
Home‐based therapy with ready‐to‐use therapeutic food is of benefit to malnourished, HIV‐infected Malawian children
Authors: Ndekha MJ , Manary MJ , Ashorn P , Briend A
Published: August 2010

Aim: To determine if home‐based nutritional therapy will benefit a significant fraction of malnourished, HIV‐infected Malawian children, and to determine if ready‐to‐use therapeutic food (RUTF) is more effective in home‐based nutritional therapy than traditional foods. Methods: 93 HIV‐positive children >1 y old discharged from the nutrition unit in Blantyre, Malawi were systematically allocated to one of three dietary regimens: RUTF, RUTF supplement or blended maize/soy flour. RUTF and maize/soy flour provided 730 kJ·kg−1·d−1, while the RUTF supplement provided a fixed amount of energy, 2100 kJ/d. These children did not receive antiretroviral chemotherapy. Children were followed fortnightly. Children completed the study when they reached 100% weight‐for‐height, relapsed or died. Outcomes were compared using regression modeling to account for differences in the severity of malnutrition between the dietary groups. Results: 52/93 (56%) of all children reached 100% weight‐for‐height. Regression modeling found that the children receiving RUTF gained weight more rapidly and were more likely to reach 100% weight‐for‐height than the other two dietary groups (p<0.05).

Conclusion: More than half of malnourished, HIV‐infected children not receiving antiretroviral chemotherapy benefit from home‐based nutritional rehabilitation. Home‐based therapy RUTF is associated with more rapid weight gain and a higher likelihood of reaching 100% weight‐for‐height.
Recurrent abdominal pain: A five‐year follow‐up study
Authors: Størdal Ketil , Nygaard Egil André , Bentsen Beint S
Published: August 2010

To explore the long‐term prognosis for children referred for recurrent abdominal pain (RAP), 44 children investigated for RAP 5 y ago were compared to a group of controls (n=88). The former RAP patients reported RAP, headache and school absence more frequently than controls.

Conclusion: A high proportion of children referred with RAP have persistent symptoms, with more headache and school absence than controls. The diagnostic subgroup did not predict persistence of abdominal pain.
What is the yield from asking, at the end of the consultation, if there are any further questions? An obserational study
Authors: Lloyd BW
Published: August 2010

Aim: I set out to determine how often families, when invited, have further questions at the end of a general paediatric consultation and to determine the nature of such questions. Results: Over a 2½‐y period, there were 64 further questions arising from a total of 477 consultations (13%).

Conclusions: Inviting questions is worthwhile; two‐thirds of the responses provided evidence that there had been suboptimal communication during the consultation.
Extensive cervical spinal cord lesion with late foetal presentation
Authors: Hedderly T , Chalmers S , Fox G , Hughes E
Published: August 2010

Neonatal cervical spinal cord injury occurring in the perinatal period is rare but has been described after both traumatic and atraumatic birth. Recently, a case of atraumatic, late third trimester, pre‐labour presentation has been described. We report a second such case, but with important diagnostic differences and outcome.

Conclusion: This case showed loss of foetal movements late in the third trimester. This was secondary to an extensive cervical lesion with no history of trauma. This emphasizes the need to consider cervical cord lesions when foetal or postnatal movements are reduced, even in the absence of trauma.
Clinical implications of mother‐to‐child transmission of HCV
Authors: Kesson Alison M
Published: August 2010

Testing for vertical transmission of hepatitis C virus (HCV) infection in infants and children will enable early identification of the majority of uninfected HCV‐exposed infants and children, and will provide significant emotional relief for the parents.
Immunoglobulin heavy G2 chain (IGHG2) gene restriction in the development of severe respiratory syncytial virus infection
Authors: Aurivillius Magnus , Øymar Knut , Oxelius Vivi‐Anne
Published: August 2010

Aim: Respiratory syncytial virus (RSV) is a prominent cause of airway morbidity in children under 1 y of age. It is assumed that host factors influence the severity of disease presentation, and thus the need for hospitalization. The variation of IGHG genes from chromosome 14q32 are linked to serum IgG subclass levels but also to the variations in IgG responses to pneumococcal, meningococcal and Haemophilus influenzae antigens. The aim of this investigation was to clarify whether IGHG genes are involved in the development of severe RSV lower respiratory tract infection (LRTI). Methods: The alternative expressions of IGHG3(b) and (g), IGHG1(f) and (a), and IGHG2(n) and (‐n) genes were studied in a cohort of 49 previously healthy children hospitalized for RSV LRTI. The gene frequencies were compared to a population of healthy individuals. Results: The homozygous IGHG2(‐n/‐n) genotypes dominated in hospitalized children with severe RSV infection: 55.1%, compared with 34.2% in the healthy population (OR 2.3; p=0.004). The IGHG2 genotypes containing (n/n) and (n/‐n) were significantly decreased. The IGHG(bf‐n) alleles were significantly increased (OR 1.7; p=0.025) and the IGHG(bfn) alleles significantly decreased (OR 0.5; p=0.005).

Conclusion: The IGHG(bf‐n) allele and homozygous IGHG2(‐n/‐n) genotypes are associated with the development of severe RSV LRTI.
Accuracy of acute otitis media diagnosis in community and hospital settings
Authors: Asher Elad , Leibovitz Eugene , Press Joseph , Greenberg David , Bilenko Natalya , Reuveni Haim
Published: August 2010

Aim: To evaluate the accuracy rates of acute otitis media (AOM) diagnosis in the community by analyzing the initial AOM diagnosis (according to information from the referral letters to the Pediatric Emergency Department [PED]) among children with AOM diagnosis confirmed by tympanocentesis at PED. Methods: A descriptive, retrospective study conducted during the year 2000, including 590 children aged 0–48 mo diagnosed with AOM at PED. AOM was confirmed by tympanocentesis. We defined: (1) simple AOM as <3 or <4 episodes during the last 6 or 12 mo, respectively; (2) complicated AOM as 3 or 4 episodes during the last 6 or 12 mo, respectively, and/or not improving with antibiotics. Results: 571 (96.8%) were <24 mo of age; 355 (60%) were Arab Bedouins and 235 (40%) Jews. Seventy‐three pediatricians, 57 general practitioners and 27 family practitioners provided referral letters. Information on disease severity was available in 471/590 (79.8%) patients, of whom 320 (68%) had simple and 151 (32%) complicated AOM. Three hundred and sixty‐five (62%) of 590 patients were accurately diagnosed by referring physicians, more frequently in patients with complicated than simple AOM ( p<0.001). Diagnostic accuracy was similar among physician specialties ( p=0.33) and ethnic groups ( p=0.11). Multivariable logistic regression analysis showed that complicated AOM, adjusted for age, sex, ethnic origin, and physician specialty, was the only predictive factor for accurate AOM diagnosis (odds ratio 4.0, p<0.001).

Conclusions: Inaccurate diagnosis of AOM in community settings is common, occurring more frequently in simple than in complicated AOM, and is unrelated to physician specialty and children's ethnicity.
Trends in the epidemiology of neonatal sepsis of vertical transmission in the era of group B streptococcal prevention
Authors: López Sastre José B , Fernández Colomer Belen , Coto Cotallo GD , Ramos Aparicio Antonio
Published: August 2010

Aim: To assess trends in the epidemiology of culture‐proven and clinical neonatal sepsis of vertical transmission in the era of intrapartum antibiotic prophylaxis. Methods: Since 1995, the neonatal services of 28 acute‐care teaching hospitals in Spain (“Grupo de Hospitales Castrillo”) have been involved in the prospective surveillance of neonatal infection of vertical transmission. We here report the comparison of the incidence for the periods 1996–1997 and 2000–2001, and look separately at two groups of hospitals according to the time at which the official hospital policy to provide intrapartum antibiotic prophylaxis for group B Streptococcus (GBS) prevention was adopted. In 16 hospitals the policy was adopted in 1999 and in 10 before 1998 (nine hospitals in 1996, one in 1997). Results: The incidence of proven sepsis decreased significantly by 22% and 54% in the hospitals that started prophylaxis in 1999 and before 1998, respectively. The incidence of GBS sepsis also declined significantly by 36.4% and 65.4% in both groups of hospitals, respectively. Significant variations in the incidence of clinical vertical sepsis as well as in the incidence of sepsis caused by Haemophilus influenzae and Klebsiella were not found. Sepsis caused by Escherichia coli increased in the hospitals with prophylaxis from 1999 and decreased in those that began prophylaxis before 1998, in which the mortality rate of proven and clinical sepsis also decreased significantly by 58.6%.

Conclusions: There was a substantial decline in the incidence of proven vertical sepsis, with a significant reduction of GBS sepsis, although decreases were more marked when antibiotic prophylaxis was started before 1998. In this group of hospitals, there was also a decrease in the mortality rate. Fluctuations in the incidence of E. coli infection suggest the need for continuing epidemiological surveillance.
Role of physical activity and eating behaviour in weight control after treatment in severely obese children and adolescents
Authors: Deforche Benedicte , de Bourdeaudhuij Ilse , Tanghe Ann , Debode Patrick , Peter Hills Andrew , Bouckaert Jacques
Published: August 2010

Aim: To investigate the role of physical activity and eating behaviour in weight control 1.5 y after a weight‐reduction programme in severely obese children. Methods: Forty‐seven children (13.4±2.1 y) were measured 1.5 y after the completion of a 10‐mo residential treatment programme. Stature and body mass were measured; physical activity, fat and fibre intake, and self‐efficacy in relation to physical activity and healthy eating behaviour were assessed using validated structured interviews. The total sample was divided into four subgroups according to unhealthy versus healthy physical activity and eating behaviour at follow‐up. Results: One‐and‐a‐half years after treatment, subjects had regained 34±19% overweight, but were on average still 20±19% less overweight than before treatment (p<0.001). The four subgroups did not differ in level of overweight at the beginning or end of treatment. At follow‐up, there was a significant difference in overweight between the four subgroups (p<0.05). The least healthy group (unhealthy physical activity and unhealthy eating behaviour) had a significantly higher level of overweight 1.5 y after treatment (183±36%) in comparison with the other groups (unhealthy physical activity and healthy eating: 150±21%; healthy physical activity and unhealthy eating: 156±14%; healthy physical activity and healthy eating: 138±16%) (p<0.05), whilst the healthiest group showed the lowest level of overweight after treatment when compared to the other groups (p<0.05).

Conclusion: Results suggest that both physical activity and nutritional habits play an important role in weight maintenance after initial weight loss in obese children and that one healthy behaviour can not compensate for another unhealthy behaviour.
Alarming prevalences of overweight and obesity for children of Turkish, Moroccan and Dutch origin in The Netherlands according to international standards
Authors: Miranda Fredriks A , van Buuren Stef , Hira Sing Remy A , Maarten Wit Jan , Pauline Verloove‐vanhorick S
Published: August 2010

Aim: Prevalences of overweight in The Netherlands, defined by international cut‐off points, are presented in 14 500 children of Dutch origin, 2904 of Turkish and 2855 of Moroccan origin, aged 0–21 y. Results: The mean prevalence for Turkish boys and girls was 23.4% and 30.2%, for Moroccans 15.8% and 24.5%, for Dutch youths in large cities 12.6% and 16.5%, and for other Dutch participants 8.7% and 11.3%, respectively.

Conclusion: The development of adequate prevention strategies is urgently needed.
Ghrelin, leptin and the neurometabolic axis of breastfed and formula‐fed infants
Authors: Agostoni Carlo
Published: August 2010

The possible long‐term effects of prolonged breastfeeding in preventing obesity have led to the reconsideration of different growth curves of breastfed and formula‐fed infants in the light of haematochemical markers. Leptin, ghrelin, insulin‐like growth factors and other compounds may not only represent mediators involved in the metabolism of fat tissues, but may also potentially be able to explain the complex relationships between the gastrointestinal tract and the hypothalamic regulation of the sense of hunger and satiety.

Conclusion: Diet‐related differences in the circulating levels of mediators implicated in energy metabolism during infancy might explain anthropometric and behavioural differences between breastfed and formula‐fed infants with potential long‐term consequences.
Ghrelin, leptin and IGF‐I levels in breast‐fed and formula‐fed infants in the first years of life
Authors: Savino Francesco , Fissore Maria F , Grassino Erica C , Nanni Giuliana E , Oggero Roberto , Silvestro Leandra
Published: August 2010

Aim: To establish ghrelin, leptin and IGF‐I serum levels in breastfed (BF) and formula‐fed (FF) infants during the first period of life. Methods: A cross‐sectional study was conducted on fasting blood venous samples obtained from exclusively BF (n=106) and FF (n=100) infants to measure total ghrelin (RIA test), leptin (RIA test) and IGF‐I (chemiluminescence). Anthropometrical measurements of weight, length and cranial circumference were performed. Results: During the first 4 mo of life, FF infants compared to BF ones showed higher ghrelin levels (2654.86 vs 2132.96 pg/ml; p<0.032), higher IGF‐I levels (3.73 vs 3.15 ng/ml; p=0.00) and lower leptin levels (0.68 vs 1.16 ng/ml; p<0.04). Leptin values were higher in females than in males (0.80 vs 0.47 ng/ml; p<0.03), while no gender‐related difference was found for ghrelin and IGF‐I. No differences were found in anthropometrical measurements comparing the two groups of infants. A multiple regression analysis showed an inverse correlation between ghrelin and leptin values (p<0.04) and between IGF‐I and leptin levels (p=0.00).

Conclusion: Our finding suggests that breastfeeding influences hormones such as ghrelin, leptin and IGF‐I in infancy, mainly during the first 4 mo of life. Further evidence is needed to confirm and clarify the role of a protective link from mother to infants as seen in our observations.
A doctor's ability to assess the severity of childhood asthma by simple clinical features
Authors: Linna Olavi
Published: August 2010

Aims: To ascertain whether the severity of childhood asthma can be reliably assessed by simple clinical features, 94 newly diagnosed, school‐aged asthmatic children were investigated. Methods: The study included parental interviews, physical examination, skin prick tests, lung function studies, including a brief visual interpretation of the flow–volume curve, and a 6‐min exercise challenge test on a treadmill, which was used as a reference. Results: Baseline lung function studies showed a concave‐shaped flow–volume curve in 40 (43%) patients, reduced maximal mid‐expiratory flow (MMEF) in 25 (27%) and a reduced ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC) in 14 (15%). The drop in peak expiratory flow (PEF) after exercise ranged from 0 to 79% of the baseline (mean 21.3%) and exceeded 12.5% in 52 (55%) patients. There was a small but significant correlation between the baseline FEV1/FVC and MMEF values and the response to exercise (r=−0.39 and −0.35; p=0.000, respectively), but when studied by linear regression analysis, the response to exercise was best predicted by the past symptom rate and a concave pattern in the pre‐test maximal expiratory flow–volume curve. The values of traditional lung function tests or age, atopy, duration of symptoms or history of exercise‐induced wheezing did not remain in the model.

Conclusions: These results show that the severity of asthma in school‐aged children can be predicted at the first visit based on the past rate of symptoms and a visual interpretation of the maximal expiratory flow–volume curve.