bluuebunny/crossref_metadata_2025 huggingface dataset:
Short duration of breastfeeding and early introduction of cow's milk as a result of mothers’low level of education
Authors: Ummarino M , Albano F , Marco G De , Mangani S , Aceto B , Ummarino D , Correra A , Giannetti E , De Vizia B , Guarino A
Published: August 2010

Inappropriate infant feeding including a lack of breastfeeding and the early introduction of cow's milk are the most common forms of infant feeding malpractice. To evaluate the hypothesis that infant feeding malpractices are associated with mothers’low level of education, questionnaires were administered to 400 mothers of infants below 12 mo of age divided into 3 groups according to their various educational levels. Items included the type of milk given at birth and at 1, 3 and 6 mo of age. To investigate the efficacy of paediatricians in orienting infant feeding, the same questionnaire was given to 30 paediatricians in primary paediatric healthcare, in hospitals or in private practices. Initiation of breastfeeding was similar in the three groups. An analysis of the data showed that an increasing number of infants born to mothers of low and intermediate educational level did not receive exclusive breastfeeding compared with those with a higher level of education, a difference that was significant as early as 1 mo of age. In infants aged 3 mo, the prevalence of exclusive breastfeeding was 37%, 40% and 65% in the three groups, respectively, in relation to progressively increasing levels of education. In infants of 6 mo, the respective prevalence rates were 13%, 15% and 48%. Early introduction of cow's milk showed a similar correlation with educational level. A greater number of infants born to mothers with a low level of education received cow's milk at 3 mo of age compared with those born to mothers with an intermediate education (12% vs 5%). A similar difference was observed between the latter group and infants born to mothers with a high educational level (0%). This pattern was supported by data for infants at 6 mo of age with prevalence rates for cow's milk feeding of 39%, 20% and 0% in the three groups in association with progressively increasing level of educational (p < 0.05). The analysis of the paediatricians’response to the questionnaire showed that while physicians know and correctly prescribe age‐related infant nutrition regimens, they are unaware that a substantial number of mothers do not comply with what they prescribe. Overall, these data support the relationship between a low educational level and infant feeding malpractice and suggest that a more effective role should be played by paediatricians in supporting an adequate duration of breastfeeding and the use of formula rather than cow's milk protein.
Prebiotics in infant milk formulas: new perspectives
Authors: Miniello VL , Moro GE , Armenio L
Published: August 2010

In recent years it has become accepted that healthy human intestinal microflora may play an important part in priming the infants' systemic and mucosal immunity. Dietary modulation of the gut microbiota is a topical area of nutritional sciences and the main focus of many current functional foods such as non‐digestible oligosaccharides (NDOs). Fructo‐oligosaccharides (FOS) and trans‐β‐galacto‐oligosaccharides (TOS) have been claimed to benefit the health of the colon by selectively stimulating the growth of bifidobacteria and lactobacilli (prebiotic effect). It could be of clinical interest to manipulate colonic flora because it is supposed that specific bacteria in the gut microbial microflora could promote potentially antiallergenic processes and play a key part in atopic disease prevention. Supporting this view is the finding that analysis of the composition of the intestinal bacterial populations showed different microbial patterns between healthy and allergic individuals. Assuming that non‐digestible TOS and FOS can affect the intestinal ecosystem beneficially, the opportunity for gut flora manipulation arises in bottle‐fed infants. New preterm and term infant milk formulas, supplemented with a mixture of TOS and FOS as prebiotic ingredients induced a significantly higher colonization of bifidobacteria and lactobacilli. In the future, selective manipulation of the intestinal microbiota might be an approach to novel prophylactic and therapeutic intervention strategies of atopy, by redirecting allergic Th‐2 responses in favour of Th‐1 responses.
Effects of a new mixture of prebiotics on faecal flora and stools in term infants
Authors: Moro GE , Mosca F , Miniello V , Fanaro S , Jelinek J , Stahl B , Boehm G
Published: August 2010

A double‐blind, randomized, controlled study was performed in 90 full term infants to evaluate dose‐related bifidogenic effects of a new synergistic mixture of galacto‐oligosaccharides (GOS) and fructo‐oligosacharides (FOS). The GOS/FOS mixture showed a dose‐dependent stimulatory effect on the intestinal growth of bifidobacteria. Also stool consistency and faecal pH were positively affected.
“Minor” feeding problems during the first months of life: effect of a partially hydrolysed milk formula containing fructo‐ and galacto‐oligosaccharides
Authors: Savino F , Cresi F , Maccario S , Cavallo F , Dalmasso P , Fanaro S , Oggero R , Vigi V , Silvestro L
Published: August 2010

Background: Colic, regurgitation and constipation are common feeding problems in formula‐fed infants that might benefit from dietary treatment. A formula containing fructo‐ and galacto‐oligosaccharides, partially hydrolysed proteins, low levels of lactose and palmitic acid in the β position and higher density has been tested to reduce the occurrence of these symptoms. The aim of this prospective study was to describe the effects of such a formula in infants with minor gastrointestinal disorders. Methods: An observational prospective trial involving practising Italian paediatricians was performed. Formula fed‐infants up to 90 d of age with minor gastrointestinal problems such as infantile colics and/or regurgitation and/or constipation were enrolled in the study from January 2001 to May 2001. The study was completed within 14 d of treatment. On days 1, 7 and 14 the infants were visited by the paediatricians. Parents were given a structured diary to record daily episodes of colic, regurgitation and type and number of stools. Results: Of the 932 infants enrolled, 604 completed the study. Of the 214 infants with colic, 169 (79%) demonstrated a reduction in frequency of colic from 4.1 ± 2.0 per day at the beginning of the study to 2.0 ± 1.8 at the end of the study (I.C. 95%: 1.72–2.39; p < 0.005). A reduction in the number of episodes of colic of 1.8 per day at the beginning of the study (I.C. 95%: 1.49–2.11; p < 0.05) was recorded between day 1 and day 7, and of 0.26 (I.C. 95%: 0.15–0.37; p < 0.05) between day 7 and day 14. Of the 201 infants with regurgitation problems, 141 (70%) demonstrated a reduction of frequency of the symptoms from 4.2 ± 2.0 per day at the beginningof the study to 2.1 ± 2.2 at the end of the study (I.C. 95%: 1.75–2.35; p < 0.005). A reduction of 1.87 in the number of regurgitation episodes was reported between day 1 and day 7 (I.C. 95%: 1.57–2.16; p < 0.05) and of 0.18 (I.C. 95%: 0.06–0.31; p < 0.05) between day 7 and day 14. Of the 232 infants with constipation, 147 (63%) demonstrated an increase in the daily number of stools of 0.42 (I.C. 95%: 0.5–0.3; p < 0.005). An increase in stool frequency of 0.41 (I.C. 95%: 0.51–0.23; p < 0.05) was reported between day 1 and day 7, and of 0.04 (I.C. 95%: 0.22–0.14; p= ns) between day 7 and day 14. Parents’evaluation of the formula was 7.9 ± 1.8 (score 0–10); 550 parents (91%) gave a positive judgement (score >6). The evaluation by the paediatricians of the improvement in symptoms after the treatment was 8.2 ± 1.5; 574 (95%) a positive effect (score >6).

Conclusion: This study shows that the majority of infants followed by paediatricians for minor gastrointestinal symptoms improve within 2 wk of feeding with this new formula. Further double‐blind, controlled studies are needed to confirm whether the amelioration of symptoms observed in this trial is in fact due to the new formula.
Oligosaccharides might stimulate calcium absorption in formula‐fed preterm infants
Authors: Lidestri M , Agosti M , Marini A , Boehm G
Published: August 2010

Among other components of human milk, oligosaccharides might contribute to the high efficiency of calcium absorption of breastfed infants. In adults, it can be shown that dietary oligosaccharides can improve calcium absorption. The present analysis was performed to evaluate a possible influence of dietary oligosaccharides on parameters of calcium metabolism in preterm infants. The concentrations of calcium and phosphorus in plasma and in spot urine samples as well as the plasma activity of the alkaline phosphatase were measured in preterm infants fed either a standard formula (n= 15) or a formula supplemented with dietary oligosaccharides (n= 15) at the end of a 4‐wk feeding period.

Conclusions: There was no influence of the different diets on the plasma concentration of calcium and phosphorus or on the plasma activity of alkaline phosphatase. In urine, there was a tendency towards higher calcium concentrations in the group fed the supplemented formula compared concentrations in the group fed the standard formula. The concentrations of phosphate were not significantly different and, as a consequence, there was a tendency towards a higher Ca/P molar ratio in the group fed the supplemented formula. The data indicate that the calcium absorption might be influenced by the dietary oligosaccharides. Thus, the possible effect of dietary oligosaccharides on calcium homeostasis should be included in the discussion concerning the consequences of the use of dietary oligosaccharides in preterm infant nutrition.
Outcome of wheezing in early childhood
Authors: Wennergren G
Published: August 2010

In Acta Pædiatrica 50 y ago, Boesen published a follow‐up of children with “asthmatic bronchitis”. Recent reinvestigations of children hospitalized because of wheezing in early childhood are remarkably consistent with Boesen's observations.

Conclusion: Young children admitted to hospital because of wheezing have a clearly increased risk of subsequent asthma. Recent studies confirm Boesen's observations of the prognostic importance of eosinophilia and an inverse relation between age at admission with wheezing and risk of subsequent asthma. Allergy or atopic dermatitis is predictive of subsequent asthma, whereas family history of allergy has low predictive value in infants.
The difficult balance between dietary polyunsaturated fatty acids
Authors: Agostoni C
Published: August 2010

The evidence emerging from developing countries indicates a wide variability in the fat composition of human milk. The linoleic:alpha linolenic acid ratios, suggested to be included within the range of 5:1 and 15[20]:1, tend to fluctuate, and could indicate the capability of humans to selfadapt according to different dietary and environmental conditions.

Conclusion: When referring to optimal “standard” dietary intakes for infants, the complex interactions between genetics and environment should be considered in interpreting observations from different settings.
Cataract in children
Authors: Foster A , Gilbert C
Published: August 2010

Of the estimated 1.4 million children world‐wide who are blind, cataract is responsible for an estimated 190000 (14%). The incidence varies from 1 to 3/10000 live births or 10 per million of the total population in low‐income countries. Early diagnosis, referral and surgery are important in improving results. A recent study from Sweden indicates that examination of babies in maternity wards results in earlier referral compared with well‐baby clinics or no formal screening.

Conclusion: It is important that standardized protocols be developed and implemented to screen children for ocular anomalies, especially cataract, before discharge from maternity units.
Normal studies are essential for objective medical evaluations of children who may have been sexually abused
Authors: Adams JA
Published: August 2010

The findings of carefully conducted research studies of non‐abused children should be used in medical evaluations for suspected sexual abuse if they are to be legally defensible. These studies have shown that a “wide” hymenal opening and a “narrow” rim of hymen should not be used as markers of abuse.

Conclusion: The study by Myhre and associates is another addition to a growing collection of good science in a field of medicine where objectivity is essential.
Effects of passive smoking on common respiratory symptoms in young children
Authors: Shiva F , Nasiri M , Sadeghi B , Padyab M
Published: August 2010

Aim: To observe the effects of fathers' smoking on respiratory symptoms in children between the ages of 6 mo and 5 y living in Tehran during the period January to December 2001. Methods: The caregivers of 622 children attending resident‐based clinics in two university hospitals were interviewed about the respiratory illnesses incurred by the child during the previous 12 mo and the smoking habits of those living with the child. Children who lived in households in which any person, other than the father, smoked were excluded. Results: The analysis included 595 children, 40.6% of whom were living in homes where fathers smoked cigarettes. About 35% of smokers admitted to unrestricted smoking at home. In children not living with a smoker, 81.6% had experienced at least one episode of upper respiratory tract infection (URTI) during the previous year and the rate increased to 95.2% in passive smokers whose fathers were not restricted from smoking in front of the children, (p‐value <0.01). A similar pattern was found for otitis media and asthma (p‐value <0.05 and <0.01, respectively). The average number of URTI episodes during the previous year was significantly higher in children exposed to unrestricted smoking (p < 0.01).

Conclusion: The study outlines the detrimental effects of paternal smoking on the respiratory health of children from a part of world in which this problem has not been studied previously, and highlights the importance of educating fathers to alter their smoking habits so that even if they do not stop smoking altogether, they should discontinue smoking indoors.
Relationship between vasoactive intestinal peptide and intrapulmonary vascular dilatation in children with various liver diseases
Authors: Chongsrisawat V , Ampai S , Chotivitayatarakorn P , Sirisopikul T , Poovorawan Y
Published: August 2010

Aim: To evaluate the potential of vasoactive intestinal peptide (VIP) as a pathogenic factor of intrapulmonary vascular dilatation (IVD) in hepatopulmonary syndrome (HPS). Background: HPS comprises a triad comprising liver dysfunction, IVD and hypoxaemia. Although the pathogenesis of the process has not been elucidated, many vasodilating substances, such as VIP, have been implicated in the development of pulmonary vascular abnormalities. IVD can be detected by contrast‐enhanced echocardiography (CEE) before the development of abnormal gas exchange. Methods: Forty‐two children (20M, 22F; mean age 4.39 ±4.17 y) with various liver diseases who attended the paediatric liver clinic of King Chulalongkorn Memorial Hospital between March 2000 and February 2001 were recruited to the study. Each patient was tested for transcutaneous O2 saturation, CEE (applying the agitated normal saline technique), liver function test and serum VIP level. Results: Fourteen of the 42 patients (33%) were CEE positive. Only one of the 14 patients had associated hypoxia and clinical cyanosis. The serum VIP levels of children with liver disease were significantly higher than those of the controls (60.21 ± 35.04 pg/ml vs 43.71 ± 34.61 pg/ml, p= 0.03). CEE‐positive children tended to have higher serum VIP levels than CEE‐negative children (72.65 ± 40.31 vs 53.99 ±31 pg/ml, p= 0.3). The serum VIP levels of biliary atresia (BA) patients with favourable outcomes (serum bilirubin ±34μmol/L) were not significantly different from those with unfavourable outcomes (serum bilirubin >34μmol/L) (42.95 ± 14.53 pg/ml vs 66.07 ± 32.17 pg/ml, p= 0.5).

Conclusions: CEE is a non‐invasive test for early detection of IVD in children with liver disease. VIP is not solely responsible for the pathogenesis of IVD in HPS. Further studies are required to determine which substances cause the development of IVD.
Neurological assessment at five years of age in infants born preterm
Authors: Fily A , Truffert P , Ego A , Depoortere MH , Haquin C , Pierrat V
Published: August 2010

Aim: To evaluate the agreement between Touwen's neurological examination and a derived simplified one, created to be applied at the age of 5 y to infants born preterm. Methods: 185 children born at a gestational age (GA) of <33 wk and/or with a birthweight <1501 g, free of cerebral palsy, underwent Touwen's neurological examination at a mean age of 5 y and 8 mo (5‐6.5 y). One‐hundred and seventy had a full examination and were included into the study. They were born at a mean GA of 30 wk (range 24–35 wk) with a mean birthweight of 1250 g (range 600–2690 g). A simplified examination, based on the clinical experience of two of the authors, was created a priori. The data were reviewed retrospectively and the concordance between the two forms was assessed. The reviewers were blinded to the original categorization from the long form. Results: On the basis of the original Touwen's neurological examination, the 170 children were classified into 122 with a normal neurological examination, 41 with grade 1 minor neurological dysfunction (MND) and 7 with grade 2 MND, giving 28% of the cohort with MND. The concordance between the two forms was excellent, with an agreement in 169 out of 170 subjects. None of the infants with the most complex form of MND was misclassified.

Conclusion: The simplicity of this examination could allow its diffusion and its use in follow‐up programmes. It could improve the quality of routinely collected follow‐up data of preterm neonates.
Effect of methotrexate and folinic acid on skeletal growth in mice
Authors: Iqbal MP , Ahmed M , Umer M , Mehboobali N , Qureshi AA
Published: August 2010

Aim:To investigate whether chronic administration of medium doses of methotrexate (MTX) causes suppression of skeletal growth in young mice and to determine whether folinic acid supplementation could reverse this effect.Methods: Four equal groups of Balb/c young male mice (6 animals in each group; mean body weight 11.9 ± 0.25g, in their rapid growth phase) were subjected to the following drug treatment for a period of 3 wk. Group 1 was given intraperitoneal MTX (3.5 mg kg‐1body weight) every second day. Group 2 received folinic acid (7.0 mg kg‐1body weight) intraperitoneally every second day. Group 3 was given both drugs (MTX every second day and folinic acid 8 h post‐MTX injection). Group 4 was injected with physiological saline every other day to serve as a control group. Total body weight of the animals in each group was monitored every second day for the entire study period. The animals were sacrificed, the bilateral femurs and tibias of each animal were harvested and X‐rays of the bones were taken. The length of each femur and tibia was measured using a micrometer. Measurements from the radiographs were also recorded using image analysis software. The MTX concentrations in the plasma and the folate levels in erythrocytes were determined. The heights of the distal femoral and the proximal tibial growth plate for each animal were measured on histological tissue sections.Results: Mean lengths of both the tibia and femur of animals were compared in the four treatment groups. A significant decrease in the mean lengths (one‐way ANOVA,p< 0.005) was observed in the group receiving MTX alone. Similarly, there was a significant decrease (p< 0.001) in the height of the femoral and tibial growth plate in this group when compared with the other groups. The main effect of MTX seemed to be on the hypertrophic proliferative zone of chondrocytes in the growth plate. Furthermore, animals in this MTX‐treated group also showed increased levels of MTX in plasma and low levels of erythrocyte folate.

Conclusion: These data show that chronic administration of MTX induces suppression of skeletal growth in mice, possibly through the inhibition of the pathway ofde novoDNA synthesis. Folinic acid treatment following MTX administration appears to reverse this growth inhibition. Based on these observations, children suffering from juvenile rheumatoid arthritis, osteosarcoma or acute lymphoblastic leukaemia and receiving MTX over long periods of time could be at risk of short‐term suppression of skeletal growth. If this is the case, it is possible that they could benefit from dietary supplementation with folinic acid.
Do adult patients with phenylketonuria improve their quality of life after introduction/resumption of a phenylalanine‐restricted diet?
Authors: Gassió R , Campistol J , Vilaseca MA , Lambruschini N , Cambra FJ , Fusté E
Published: August 2010

Aim: To evaluate the possible influence of dietary treatment on the quality of life of adult patients with PKU (phenylketonuria) following late introduction or resumption of a Phe‐restricted diet. Methods: Fifteen adult patients with classical PKU (10F, 5M; mean age: 27.5 y, range: 16.4–37.5 y) were selected for the study. These patients had either resumed a restricted diet after a period of discontinuation, or were placed on a restricted diet after late diagnosis. All of them were interviewed about their quality of life using a 24‐item questionnaire. Results: The index of dietary control was poor (median Phe: 954 μmol/L) in 8/15 patients, regular (Phe: 514 μmol/L) in 4/15 and good (Phe: 354 μmol/L) in 3/15 patients. Fifty‐three percent of patients reported that their state of health was very good, 47% described it as good, and 40% felt that their present health on‐diet was better than it had been off‐diet; 53% believed that they were calmer, quieter and less easily upset and 40% were more alert and were more able to maintain attention while on‐diet. Thirty‐three percent of the patients felt happier, and 27% felt more vital; 20% thought that they were less impulsive and aggressive, and that they were now less argumentative than before. Sixty percent of the patients felt that their quality of life had improved on‐diet compared with the situation off‐diet.

Conclusion: More than half of our patients believed that their quality of life improved with a Phe‐restricted diet; they reported feeling calmer, quieter, and less easily upset. Only 47% attained regular to good dietary control.
Down syndrome and breastfeeding
Authors: Pisacane A , Toscano E , Pirri I , Continisio P , Andria G , Zoli B , Strisciuglio P , Concolino D , Piccione M , Giudice C Lo , Vicari S
Published: August 2010

Aim: The aim of the study was to investigate the frequency of breastfeeding among children with Down syndrome. Methods: The mothers of 560 children with Down syndrome attending four university hospitals in Italy were interviewed and the neonatal clinical records retrieved. Information was collected on the type of infant feeding and on why some mothers had not breastfed their children. Two groups of healthy children whose feeding habits had been previously investigated were recruited as control subjects (1601 and 714, respectively). A paediatrician in each hospital was interviewed about the neonatal admission policy of children with Down syndrome. Results: Among the 560 Down children, 246 (44%) were admitted to the neonatal unit. Compared with the two control groups, children with Down syndrome were significantly more frequently bottle‐fed (57% vs 15% and 24%, respectively, odds ratio 7.5, 95% CI 6.0–9.4 and 4.2, 95% CI 3.3–5.4. respectively). Only 30% of infants admitted to the neonatal unit were breastfed. The main reasons reported by the mothers for not having breastfed were infants’illness in infants who had been admitted to the neonatal unit and frustration or depression, perceived milk insufficiency and difficulty with suckling for those babies who had not been admitted to the unit. The paediatricians reported that the admission of a baby with Down syndrome to the neonatal unit could sometimes take place not for medical reasons, but for diagnostic work‐up or for a more appropriate diagnosis and to maintain communication with the family.

Conclusions: Down syndrome babies are less frequently breastfed compared with healthy children. Support in breastfeeding should become a relevant point of health supervision for children with Down syndrome.
Lack of appropriate formulations of medicines for children in the community
Authors: Schirm E , Tobi H , de Vries TW , Choonara I , De Jong‐van den Berg LTW
Published: August 2010

Aim: Appropriate formulations are essential in pharmacotherapy. This study surveyed the use of different formulations by children in the community, and examined the reported lack of appropriate formulations (oral solutions) in relation to the licensing status of drugs. Methods: A crosssectional study based on 68 019 pharmacy dispensing records was performed in The Netherlands. For each prescription the formulation was assessed, and all prescriptions were categorized: unlicensed (no product licence), off‐label (licensed drugs used outside the licence terms) and authorized (licensed drugs used according to the licence). The types of formulation used were assessed in relation to age and licensing status. Results: In all age groups, approximately half of all prescriptions were for oral drugs. The only major age‐related trend was within oral drugs: younger children were more likely to be prescribed oral solutions. For authorized drugs the proportion of tablet/capsules exceeded oral solutions at the age of 7 y, whereas for off‐label drugs this occurred at 3 y of age. For those medicines prepared by the pharmacy, tablets and capsules were more likely to be prescribed from the age of 9 y.

Conclusion: Many children in the community receive inappropriate oral formulations. Regulatory authorities and the pharmaceutical industry need to ensure that children have access to medicines with appropriate formulations.
The role of sleep and arousal in nocturnal enuresis
Authors: Nevéus T
Published: August 2010

Aim: To review what is known about the role of sleep and arousal mechanisms in the pathogenesis of nocturnal enuresis. Methods: A review of the literature was carried out. Results: The sleep of enuretic children, although polysomnographically quite normal, is exceedingly “deep”; that is enuretic children have high arousal thresholds. Apart from some overlap between enuresis and the (other) classic parasomnias, the sleep of enuretic children is no more problematic than that of the general population. Recently, the exciting possibility has arisen that the low arousability of enuretic children may be linked to the autonomous nervous system and to disturbances in the upper pons.

Conclusions: Enuresis is not just a nocturnal problem but a disorder of sleep. The high arousal threshold is one of three major pathogenetic factors in enuresis—nocturnal polyuria and detrusor hyperactivity being the other two.
Birth characteristics and different dimensions of intellectual performance in young males: a nationwide population‐based study
Authors: Lundgren EM , Cnattingius S , Jonsson B , Tuvemo T
Published: August 2010

Aim: To study the effect of size at birth on different dimensions of intellectual capacity. Methods: The study comprised a population‐based cohort including all male single births without congenital malformations in Sweden from 1973 to 1976, and conscripted before 1994 (n= 168 068). Information from the Swedish Birth Register was individually linked to the Swedish Conscript Register. The test of intellectual performance included four different dimensions: logical, spatial, theoretical and verbal capacity. These data were available for 80–86% of the males at conscription. Results: Compared with boys born appropriate for gestational age, males born small for gestational age (SGA) had an increased risk for subnormal performance in all four dimensions. Among males born SGA who were also of short adult stature at conscription, and in individuals born SGA with a head circumference < – 2 SDS at birth, the risk of subnormal performance was most marked in the logical dimension (OR 1.52; CI 1.25–1.84 and 1.33; 1.15–1.55, respectively).

Conclusions: Being born small for gestational age is associated with increased risk of subnormal capacity in all four dimensions of intellectual performance. In SGA males, short adult stature, or a small head circumference at birth is especially associated with the risk of subnormal logical performance.
Postnatal and postprandial changes in plasma concentrations of glicentin in term and preterm infants
Authors: Tadokoro R , Shimizu T , Hosaka A , Kaneko N , Satoh Y , Yamashiro Y
Published: August 2010

Aim: To examined the changes in basal plasma concentrations of glicentin in developing children and the postnatal and postprandial changes in plasma glicentin levels in infants. Methods: Glicentin, an active component of enteroglucagon, is considered to have a significant trophic action on the intestinal mucosa. Fasting plasma concentrations of glicentin in healthy children and in term and preterm infants were measured before and 30 min after feeding during the first 14 d of life. Results: Plasma basal concentrations of glicentin in children under 1 y of age were significantly higher than those in children aged 1 to 15 y. Plasma basal concentrations of glicentin at 5 or 6 d (2496 and 2190 pg/ml) and at 14 d (2987 and 2817 pg/ml) after birth were significantly higher than those at 1 or 2 d (1098 and 1240 pg/ml) after birth in normal birthweight (NBW) and low‐birthweight (LBW) infants. There was no significant difference in the glicentin level between infants at 1 or 2 d (1864 pg/ml) and at 5 or 6 d (1910 pg/ml) after birth in very‐low birthweight (VLBW) infants, but the levels at 14 d (3310 pg/ml) after birth were significantly higher than either of those levels. Plasma glicentin concentrations after feeding were significantly higher than those before feeding at 1 or 2 d and at 5 or 6 d after birth in NBW and LBW infants, but a significant increase in the plasma glicentin level after feeding was first observed at 14 d after birth in VLBW infants. There were no significant differences in the basal plasma (2401 and 2718 pg/ml) and postprandial (3007 and 3912 pg/ml) glicentin levels between breastfed and formula‐fed infants.

Conclusion: The results of the study suggest that glicentin may play an important role in intestinal mucosal growth in the early period of life, although its role in VLBW infants should be further investigated.
Methemoglobinemia induced by refrigerated vegetable puree in conjunction with supraventricular tachycardia
Authors: Bryk T , Zalzstein E , Lifshitz M
Published: August 2010

We report on a case of methemoglobinemia in conjunction with supraventricular tachycardia. A 6‐mo‐old infant was admitted to hospital with perioral cyanosis three hours after eating a refrigerated mixed‐vegetable puree. The patient developed supraventricular tachycardia (SVT) and had a heart rate of 230 beats/min. The arrhythmia resolved spontaneously. A chemical analysis showed oxygen saturation of 85% and a methemoglobin level of 25%. The infant was treated with oxygen and referred to the Pediatric Intensive Care Unit. The patient had two additional short episodes of SVT, which were resolved spontaneously without treatment. She received oxygen for 8 h until the methemoglobin level dropped to 1%.

Conclusion: Long‐term storage of refrigerated vegetables can cause methemoglobinemia in infants. Methemoglobinemia can appear in conjunction with SVT, but it is also possible that in a child with a tendency to develop SVT, methemoglobinemia involved hypoxemia, which then triggers SVT.
Life‐threatening haemorrhage as a complication of a congenital haemangioma
Authors: Agesta N , Boralevi F , Sarlangue J , Vergnes P , Grenier N , Léauté‐Labrèze C
Published: August 2010

Life‐threatening complications of congenital haemangiomas are rare. A case of haemorrhage in a neonate is reported here. A neonate presented a congenital haemangioma of the limb complicated by a massive life‐threatening haemorrhage. Colour ultrasonography showed a hypervascularized, highly haemodynamically active mass with a large, superficial drainage vein just under the ulceration. Surgical resection was performed with satisfactory postoperative outcome and no evidence of recurrence.

Conclusion: Early surgical removal can be a good therapeutic option for complicated congenital haemangiomas.
Epilepsy evaluation by electroencephalography and magnetoencephalography in Lafora‐body disease: a case report
Authors: Verrotti A , Salusti B , Trotta D , Madonna L , Chiarelli F , Pizzella V
Published: August 2010

Lafora‐body disease (LBD) is a rare neurometabolic disorder of autosomal recessive inheritance associated with progressive myoclonic epilepsy. We report here the first description of ictal and interictal recording by electroencephalography (EEG) and magnetoencephalography (MEG) of a 15‐y‐old girl suffering from LBD.

Conclusions: Complementary use of MEG and EEG might be of future help to the clinician in better defining the pathophysiology of complex seizures, and also in patients with progressive neurological disorders, despite the poor prognosis of syndromes such as LBD.
Instrumental dead space in neonatology, and its elimination by continuous tracheal gas insufflation during conventional ventilation
Authors: Kalous P , Kokstein Z
Published: August 2010

Instrumental dead space (iDS) is a major part of total dead space in newborns, and thus significantly determines effective alveolar ventilation. Continuous tracheal gas insufflation (CTGI) is a method for reducing the role of iDS, allowing a reduction in respiratory support and secondary lung injury. The literature and authors' experience with the method are reviewed. Major attention is paid to the risks in providing CTGI, optimal equipment and optimal management of CTGI.
Impact of zinc supplementation on diarrhoeal morbidity in rural children of West Bengal, India
Authors: Gupta DN , Mondal SK , Ghosh S , Rajendran K , Sur D , Manna B
Published: August 2010

Aim: To determine the role of zinc supplementation in reducing diarrhoeal morbidity in children. Methods: A randomized, double‐blind, community‐based intervention study was conducted in 280 rural children aged between 6 and 41 mo. Children were randomly allocated into three groups. One group received a daily dose of 10 mg zinc for 5 d wk−1, another group received 50 mg zinc once weekly and the remaining group received placebo. Zinc was supplemented for 16 wk from November 1999. Diarrhoeal episodes were detected by weekly surveillance during the supplementation period. Results: Eighty diarrhoeal episodes were detected among 59 children in all 3 groups. The groups were compared with each other at baseline and as regard to the outcome variable (incidence of diarrhoea). The proportion of children suffering from diarrhoea during the period was significantly lower in the zinc‐supplemented groups (15.8% in daily and 16.5% in weekly group) than in the placebo group (30.8%). The incidence of diarrhoea in the daily and weekly zinc‐supplemented groups was 0.68 and 0.69 episodes child−1 y−1, and that in the placebo group was 1.67 episodes child−1 y−1 (relative risk 0.41, 95% confidence interval 0.24–0.71). Diarrhoeal incidence of >4d duration was found to occur significantly less often in the supplemented groups. There was no difference in diarrhoeal incidence between the daily and weekly zinc‐supplemented children. There were no detected adverse reactions in any of the supplemented groups.

Conclusion: The study indicates that zinc supplementation is effective in reducing diarrhoeal morbidity when administered either daily or in a weekly schedule.
Effect of vitamin E treatment on the oxidative damage occurring in Henoch‐Schönlein purpura
Authors: Erdoǧan Ö , Öner A , Aydin A , Işimer A , Demircin G , Bülbül M
Published: August 2010

Aim: To evaluate the role of reactive oxygen molecules (ROMs) in the pathogenesis of Henoch‐Schonlein purpura and the effect of vitamin E on oxidative damage. ROMs have been suggested to contribute in many pathological conditions including renal diseases and vasculitis. Methods: The activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH‐Px) as antioxidant enzymes were measured, and the level of malondialdehyde (MDA) as an indicator of lipid peroxidation in 27 children with Henoch‐Schönlein purpura at the onset of the disease and during the remission period. The results of this study were compared with those of 11 healthy children studied as a control group. Results: With regard to all the oxidative damage parameters such as SOD, GSH‐Px and MDA, significant differences were detected between the patients and the control group in both the acute and remission periods. But no such differences were detected between patients with and those without renal involvement. In 15 patients receiving vitamin E treatment, oxidative damage parameters and clinical course showed no improvement despite significant increases in plasma vitamin E levels. Conclusion: Oxidative damage and lipid peroxidation may play an important part in the pathogenesis of Henoch‐Schonlein purpura but vitamin E given after initiation of lipid peroxidation, which is the last phase of cellular damage, is of no use in breaking down the oxidative chain reactions that have already been triggered.
Plasma nitrite/nitrate and endothelin‐1 concentrations in neonatal sepsis
Authors: Figueras‐Aloy J , Gómez L , Rodríguez‐Miguélez JM , Jordán Y , Salvia MD , Jiménez W , Carbonell‐Estrany X
Published: August 2010

Aim: To determine the changes in plasma nitrite/nitrate (NOx) and endothelin‐1 (ET‐1) concentrations during neonatal sepsis. Methods: In a prospective study, 60 consecutive newborns meeting the criteria for sepsis and without receiving exogenous nitric oxide (25 haemoculture‐positive [HC+] and 35 haemoculture‐negative [HC–]) were compared with 68 healthy newborns (46 full‐term and 22 preterm). NOx and ET‐1 concentrations were measured in each newborn within 48 h of diagnosis of sepsis and then every third day up to three determinations. SNAP‐II and SNAPPE‐II severity scores were performed at the moment of highest clinical severity. Results: At the beginning of the sepsis period, controls and septicaemic newborns had similar NOx and ET‐1 levels, with the exception of infants with severe HC+ sepsis. Throughout the sepsis period, NOx increased in moderate HC+ sepsis and decreased in HC– sepsis, reaching a significant difference at the end of the study period (59.9 ± 72.7 vs 33.9 ± 15.3 μmol/L; p= 0.036). Meanwhile, ET‐1 in newborns with severe HC+ sepsis remained higher than that in the moderate HC+ sepsis group and HC– group, reaching significant differences in all the periods. The highest ET‐1 value was positively correlated with SNAP‐II and SNAPPE‐II scores.

Conclusion: NOx concentrations increased throughout the neonatal HC+ sepsis period, reaching significant differences after 7–9 d. The highest ET‐1 levels in neonatal HC+ sepsis emerged before the NOx peak, at 3–5 d, and later decreased. Only newborns with severe HC+ sepsis presented a significant increase in ET‐1 concentrations from the beginning of the septicaemic process.
Effects of short‐term dexamethasone treatment on collagen synthesis and degradation markers in preterm infants with developing lung disease
Authors: Saarela T , Risteli J , Koivisto M
Published: August 2010

Aim: To assess the effects of dexamethasone treatment on collagen turnover in preterm infants. Methods: The serum concentrations of the amino‐terminal propeptide of type I and III procollagens (PINP and PIIINP), which reflect rates of type I and III collagen synthesis, respectively, and the carboxyterminal telopeptide of type I procollagen (ICTP), which reflects the rate of type I collagen degradation, were monitored in 13 preterm infants receiving dexamethasone and 13 matched control infants without glucocorticoid treatment for a total period of 12 mo. Dexamethasone was started at a median age of 12 d and continued at tapering doses for a median total duration of 10 d. Blood samples were taken immediately after birth, at 7, 14 and 28 d of age and at 2, 3, 6, 9 and 12 mo. The same markers were also measured just before the initiation of dexamethasone and on days 1, 3, and 7 of treatment. Results: A striking decrease in all of the markers was already observed in every case on day 1 of dexamethasone, the suppression being greatest on day 3 and still considerable on day 7. The percentages from the pretreatment levels recorded on days 1, 3 and 7 were: for PINP 51, 26 and 45%; for PIIINP 63, 44% and 52%; and for ICTP 64, 41 and 51%. A rebound rise in PINP levels was seen in dexamethasone‐treated infants, the levels exceeding those of the controls at 3 and 6 mo of age. A similar phenomenon was noted concerning PIIINP at 3 mo. The levels settled down at 9 and 12 mo.

Conclusion: Dexamethasone causes an immediate, inevitable, deep suppression of type I and III collagen synthesis and also type I collagen degradation. This should be taken into consideration, e.g. when assessing for the indications for steroid treatment in sick preterm infants and its dosing and duration.
Secular trends in sports: participation and attitudes among adolescents in Sweden from 1974 to 1995
Authors: Westerståhl M , Barnekow‐Bergkvist M , Hedberg G , Jansson E
Published: August 2010

Aim: To study the secular trend (time changes) in participation in leisure‐time sports activities and in attitudes towards sports activities and physical education in a representative sample of Swedish adolescents between 1974 and 1995. Methods: A questionnaire was distributed to 16‐y‐old girls and boys (n= 395 in 1974, n= 542 in 1995) to assess participation in leisure‐time sports activity, attitudes towards sports activities and attitudes towards physical education at school. Height and weight were measured and body mass index (BMI) was calculated. Results: Compared with 1974, more subjects in 1995 answered that they were engaged in leisure‐time sports activities, and that they were members of sports clubs. BMI increased from 1974 to 1995. By 1995, adolescents participated in and had become more interested in individual sports activities, including keep‐fit activities (e.g. strength training and aerobics) compared with 1974. A gender difference in the feeling of anxiety towards physical education, with more girls experiencing it, appeared in 1995, but not in 1974.

Conclusion: Although more adolescents participated in leisure‐time sports activity in 1995 than in 1974, the lifestyle of adolescents between sports training sessions may have become more sedentary. This is negative in a health perspective, since the benefits of physical activity on health are largely correlated to the total energy expenditure. However, the increased interest in keep‐fit activities is important, since these activities have the potential to be continued into adulthood.
Hospital admissions for childhood asthma in Rogaland, Norway, from 1984 to 2000
Authors: Engelsvold DH , Øymar K
Published: August 2010

Aim: The prevalence of childhood asthma is increasing, and it is important to monitor factors related to hospital admissions in order to understand the different aspects of the disease. The aim of this study was to investigate admissions for childhood asthma to Rogaland Central Hospital, Norway, in order to elucidate time trends related to rates of admissions and treatment modalities. Methods: A population‐based study was conducted in which data extracted from the medical records, including number of admissions, length of hospitalization, medication and symptom scores, were recorded for children aged 1 to 14 y admitted to hospital for asthma during four periods, of two years each, from 1984/1985 to 1999/2000. Results: For all the children there was an increase in annual admission rates for asthma from 1984/1985 to 1989/1990 and stabilization thereafter, but there were substantial differences between age groups. For children of 1 or 2 y of age the annual admission rate increased from 43/10000 in the first period to 104/10000 in the last period (p < 0.001), with an increase in both primary admissions and re‐admissions. For children aged 3 and 4 y, the admission rates increased from the first to the second period, and then declined to an annual admission rate of 40/10000 in 1999/2000. For older children, the admission rate was low and stable. There was a gradual increase in the use of inhaled corticosteroids both prior to admission and at discharge, and the percentage of children receiving systemic corticosteroids at admission increased from 19% to 45% (p < 0.001). The average hospital in‐days decreased from 3.4 to 1.9 (p < 0.001).

Conclusion: A disturbingly high and increasing rate of both primary admissions and readmissions for asthma has been observed in children aged 1 and 2 y, which seemed to be unaffected by changes in treatment modalities during the period. The decrease in admissions for children aged 3 and 4 y may have been influenced by the increased use of inhaled corticosteroids.
Foetal development and breastfeeding in early texts of the Islamic tradition
Authors: Koçtürk T
Published: August 2010

Background: Knowledge of some early Islamic teachings regarding foetal development and breastfeeding may be of interest to health workers in paediatric practice. The Koran describes the creation of human beings in verses 22:5, 23:12 and 39:6. Some descriptions are reminiscent of phrases in Genesis and Ecclesiastes of the Old Testament. Symbiosis between mother and child is implicit in Koranic verse 46:15, which defines this period as lasting for 30 mo. Accumulated knowledge from earlier periods on the beneficial effects of breastfeeding is reflected in verse 2:233, as a recommendation that infants be breastfed for 2 y. In early Islam it was a father's obligation to ensure that his child received human milk, if the biological mother was indisposed to provide it. Securing human milk was of vital importance for the survival of the child. The historical solution was to employ a wet nurse. Paying a good salary to wet nurses and giving them a status similar to that of a biological mother was a precaution for securing that babies received sufficient milk. During the period of Islamic expansion, the medieval physician Ibn Sina of Buckara (AD 980–1037) contributed to the significance of breastfeeding by describing breast milk as “white blood”.

Conclusion: The significance of breastfeeding was recognized in early texts of the Islamic tradition. These have inspired positive attitudes to breastfeeding in Muslim communities. Adherence may differ among contemporary groups, but it may be important to keep original teachings in mind when planning breastfeeding programmes in Muslim communities.
New mutations in the lipoprotein lipase gene in a young boy with chylomicronaemia syndrome and in his family
Authors: Brites F , Henriksen F , Fernández K , Brusgaard K , Castro G , Wikinski R
Published: August 2010

The case is reported of a 4‐y‐old boy with chylomicronaemia syndrome, under treatment with a low‐fat diet and medium‐chain triglycerides. The clinical and biochemical characteristics of the patient and 11 members of his family were studied. Lipoprotein profile, lipoprotein lipase (LPL) mass and activity were evaluated. Nucleotide substitutions in LPL promoter and exons were screened. The proband presented with severe hypertriglyceridaemia (triglycerides = 13.25 mmol l−1) and non‐detectable LPL activity and mass. The boy was a compound heterozygote for four molecular defects in the LPL gene, two of which have not been reported before (C±T764± C±T/Arg170± Leu; GG±1482± GG±Gly409± Gly). Among the family members, the proband was the only one who carried two genetic variants that modify LPL amino acid composition.

Conclusion: The association of different alterations in the LPL gene could be a key factor in causing the severe phenotype observed. Moreover, treatment with a low‐fat diet and medium‐chain triglycerides failed to normalize the patient's hypertriglyceridaemia.