bluuebunny/crossref_metadata_2025 huggingface dataset:
Book Review
Authors: Elinder Göran
Published: January 2008

Lilleyman JS and Hann IM. Paediatric Haematology. London: Churchill Livingstone, 1992.
Perinatal factors associated with retinopathy of prematurity
Authors: Gallo JE , Jacobson L , Broberger U
Published: January 2008

The etiology of retinopathy of prematurity appears to be multifactorial. Introduction of new treatments in neonatal care may add new risk factors. We have analyzed thc relationship between 42 perinatal factors and the development of retinopathy of prematurity in 78 infants with a birth weight < 1501 g and/or gestational age < 33 weeks. We have also applied a chronological analysis of the maximum and minimum pO2 and pCO2 values. Retinopathy of prematurity was seen in 37 of 78 infants (47.4%). Nineteen factors were found to be related to the development of retinopathy of prematurity. However, when step‐wise logistic regression analysis was used, only birth weight, number of days of oxygen therapy and use of beta‐blocking agents by the mother before birth were found to be associated with the development of retinopathy or prematurity. The results suggest that medication with beta blockers immediately before birth should be used cautiously.
Prolonged pure granulocytopenia in children
Authors: Rajantie J , Kurki S , Juvonen E , Hovi L
Published: January 2008

In a prospective, population‐based study, 31 patients with pure granulocytopenia lasting longer than six months were followed‐up for up to 7.3 years after diagnosis. Their ages at diagnosis were 0.3–15.5 (median 0.9) years; 17 of the patients were less than 1 year of age. The lowest granulocyte count measured was 0.00–0.60 (median 0.03) × 109/l. During the granulocytopenia, 12 patients suffered from repeated infections but none was life‐threatening. In 21 patients, the granulocyte count normalized spontaneously within 0.5–5.5 (median 1.1) years: the other 10 remain granulocytopenic after follow‐up for 2.5–7.3 (median 3.7) years. We conclude that selective granulocytopcnia, if associated with unimpaired myelopoiesis, is a benign disorder in children and does not. even if prolonged, significantly incrcase thc risk of severe infections.
Recurrence of unexpected infant death
Authors: Wolkind S , Taylor EM , Waite AJ , Dalton M , Emery JL
Published: January 2008

Families which had experienced two or more unexpected infant deaths were the subject of detailed confidential enquiries, including necropsy examination. Cases were derived from two main sources: first, deaths occurring during a nationwide programme of support for families with a subsequent baby (8 families) plus 2 families from a scries of confidential enquiries in Sheffield, and second, direct referrals from paediatricians (17 families). Fifty‐seven deaths were studied. Twenty‐four families had experienced 2 and three had experienced 3 deaths: 11 deaths (19%) were found to be adequately explained by history or post‐mortem findings; 7 (12%) were probably accidental; 31 (55%) were most probably due to an action by one of the parents (filicide); only 5 (9%) were considered to be true or idiopathic sudden infant death syndrome; in 3 (5%) cases there was insufficient information to draw a conclusion. Five (18%) of the families lived in circumstances of serious social deprivation. A history of psychiatric illness was present in one or both parents in 18 (67%) of the families.
Hallucinations on withdrawal of isoflurane used as sedation
Authors: Hughes Julie , Leach Helen J , Choonara Imti
Published: January 2008

Hallucinations on withdrawal of midazolam have been noted in intensive care patients. Isoflurane is increasingly used as an alternative drug for sedation. We report a scven‐year‐old child with 15% burns who, on withdrawal of isoflurane, suffered hallucinations, a generalized seizure and disorientation. The adverse symptoms occurred within hours of stopping the isoflurane and lasted for five days.
Lipoid proteinosis: Urbach‐Wiethe disease
Authors: Cinaz P , Güvenir T , Gönlügen G
Published: January 2008

Lipoid proteinosis (Urbach‐Wicthe disease) is a rare autosomal recessive disorder in which hyalinized material is deposited in the skin, mucous membranes and brain. Laryngeal changes resulting in hoarseness may be present at birth or in early infancy, often being the first sign of the discase. A typical case is presented.
Mothers' perceptions of their preterm infants treated in an incubator or on a heated water‐filled mattress: a pilot study
Authors: Sarman Ihsan , Tunell Ragnar , Västberg Lena , Carlquist Ulla , Can Gülay , Toparlak Derya
Published: January 2008

Ten Swedish and 23 Turkish mothers delivering premature infants with a birth weight of less than 2000 g were investigated concerning their attitudes and feelings towards their newborn babies when the infants were treated either in an air‐heated incubator or on a heated water‐filled mattress (HWM). The first interview took place during the first few days after delivery and the second interview in the case of the Swedish study two wceks later and in the Turkish study one week later. In the first interview, feelings of fear, unreality and insecurity predominated, although significantly more so among the mothers of the incubator group. These feelings had changed strikingly by the time of the second interview among the mothers whose infants were treated on the HWM, but persisted to a large extent among the mothers whose infants rcmained in an incubator. The results of both investigations indicate that the mothers' perceptions of their infants improves when the prematurely born infant is treated on an HWM instead of in an incubator.
Prediction of chronic lung disease from the chest radiograph appearance at seven days of age
Authors: Yuksel B , Greenough A , Karani J
Published: January 2008

The aim of this study was to assess if the chest radiograph appearance at seven days of age could be used to predict chronic lung disease (oxygen dependency at 28 days of age). Sixty preterm infants (median gestational age 28 weeks), who were ventilated and/or had supplementary oxygen at seven days of age and had a chest radiograph performed at that postnatal age, were prospectively recruited. These chest radiographs were scored according to lung volume, presence of opacification, haziness, interstitial changes and cystic elements (maximum scorc 18). Twenty‐eight infants subsequently developed chronic lung disease; their median chest radiograph score was 5.5 (range 2–14) which was significantly higher than that of the non‐chronic lung disease incants (median 3; range 0–6). A chest radiograph score of 4 had a 71%, sensitivity and 88% specificity in predicting chronic lung disease. We conclude that chest radiograph appearance at seven days of age is a sensitive and specific predictor of chronic lung disease and thus could be used to indicate the need for preventive therapy.
Unusual suppurative complications of brucellosis in children
Authors: Al‐Eissa YA
Published: January 2008

Three cases with suppurative complications of Brucella melitensis infection are presented, demonstrating localized involvement of the brain, bones and lungs, respectivcly, and the lesions were well defined on radiographic examination. The diagnosis was made on the basis of significant Brucella titres and positive blood culture. Awarness of such complications and performance of the appropriate serological and bacteriological studies will establish the diagnosis and will also differentiate this discase from other infections, especially tuberculosis.
Anti‐Rh(D) immunoglobulin for autoimmune neutropenia of infancy
Authors: Mascarin Maurizio , Ventura Alessandro
Published: January 2008

The case of a seven‐month old infant with symptomatic autoimmune corticoresistant neutropenia is reported. Neutropenia was responsive to high‐dose, iv immunoglobulin, and both to iv and im anti‐Rh(D) immunoglobulin. The latter therapy has a high benefit‐cost ratio compared to the standard approach.
Magnetic resonance and the diagnosis of short stature of hypothalamic‐hypophyseal origin
Authors: Vannelli S , Avataneo T , Benso L , Potenzoni F , Cirillo S , Mostert M , Bona G
Published: January 2008

Magnetic resonance imaging was performed in 23 patients with short stature (7 had multiple pituitary hormone defect, 11 had isolated growth hormone deficiency and 5 had normal variant short stature) to investigate if there is a relation between magnetic resonance findings and results of endocrine tests. Magnetic resonance imaging of patients with multiple pituitary hormone deficiency or with serious isolated growth hormone deficiency (growth hormone < 3 μg/l) revealed an interrupted pituitary stalk and ectopic neurohypophysis or a mass. In patients with less serious isolated growth hormone deficiency (growth hormone > 3 μg/l) or with normal variant short stature, the technique revealed a normal or hypoplastic hypophysis. Magnetic resonance appears to be a useful second‐level diagnostic tool in defining the type of alteration in growth defects of endocrine origin.
Randomized trial of umbilical arterial catheter position: clinical outcome
Authors: Kempley ST , Bennett S , Loftus BG , Cooper D , Gamsu HR
Published: January 2008

In order to determine if umbilical arterial Catheter position affects the incidence of necrotizing enterocolitis, clinical outcome was analysed in 308 infants whose umbilical arterial catheter had been randomly allocated to a high (n=162) or a low (n=146) position. Necrotizing enterocolitis was classified as suspected or confirmed; all renal, lower limb and local catheter complications were also recorded. High umbilical arterial catheters were in place for longer than low catheters, provided more samples and were removed as an emergency less often. Lower limb blanching and cyanosis were more common with low catheters. Eleven cases of confirmed necrotizing enterocolitis occurred in the “high” group and nine in the “low” group. One case of fatal aortic thrombosis was encountered in the high group. Positioning umbilical arterial catheters in a high position allowed longer functional use and did not increase the incidence of necrotizing cnterocolitis.
Hospital screening of coeliac disease in Estonian children by antigliadin antibodies of IgA class
Authors: Uibo Oivi , Maaroos Heidi‐Ingrid
Published: January 2008

Seven hundred consecutive patients from Tartu Children's Clinic were screened for coeliac disease by IgA class anti‐gliadin antibody enzyme‐linked immunosorbent test during January 1 to May 31, 1991. A positive anti‐gliadin antibody test result was revealed in 11 children and in 8 coeliac disease was diagnosed according to the criteria of the European Society. for Paediatric Gastroenterology and Nutrition. There was no suspicion of coeliac disease before anti‐gliadin antibody determinations in five children and two were asymptomatic. In five children, no suspicion of coeliac disease was raised beforehand. The present study shows that coeliac disease is underdiagnosed in Estonia.
Estimation of annual height velocity based on short‐ versus long‐term measurements
Authors: Neyzi O , Bundak R , Molzan J , Günöz H , Darendeliler F , Saka N
Published: January 2008

We assessed the relationships between annual height velocity, calculated from two measurements taken at intervals of 6, 12 and 24 months, in 69 healthy prepubertal children (34 male, 35 female) aged 6.5 years (range 6.25–6.75 yrs) who were followed for 2.5 years and measured biannually. Initial height values for age were within normal ranges except for one child with a height SDS of — 2.0. Mean annual velocities also conformed to British norms. Significant differences were observed between consecutive six‐monthly velocities and these values failed to predict annual velocities calculated from measurements taken at 12– or 24‐month intervals. Seasonal effects were thought to have some impact on the six‐monthly velocity differences. Height velocity, based on measurements taken at intervals of 12 months, was essentially similar to two‐year velocity values. The results indicate that in estimating annual height velocity, six‐month intervals between measurements may be misleading while 12‐monthly measurements are as reliable as height velocity values based on measurements taken at two‐year intervals.
Statistical study of 5473 results of nine pharmacological stimulation tests: a proposed weighting index
Authors: Rochiccioli P , Enjaume C , Tauber MT , Pienkowski C
Published: January 2008

A total of 5473 pharmacological stimulation tests were carried out in 3143 children and subjected to statistical analysis. The mean chronological age of the children was 9 years 9 months (range 3 years to 16 years 6 months) and mean bone age was 7 years 6 months (range 2 years to 14 years). Nine pharmacological tests were used: (I)arginine(n = 625); (2) clonidine (n= 339); (3) insulin (n= 198); (4) ornithine (n = 162); (5) insulin and arginine (n= 203); (6) clonidine and betaxolol (n = 2003); (7) L‐dopa (n = 685); (8) glucagon and propranolol (n=443); and (9) glucagon and betaxolol (n = 815). Measurement of plasma growth hormone was always performed using the same method. The distribution of values in each test was of the gausso‐logarithmic type. The results of the mean peak and the 95% confidence limit were as follows: (1) 10.2, 0.45; (2) 11.5,0.7; (3) 11.8,0.8; (4) 14.2,1.2; (5) 14.3, 0.9; (6) 15.7, 1.1; (7) 19.8, 2.1; (8) 20.8, 2.3; (9) 21, 2.5. These results lead to the following conclusions: the specificity of these tests is low, the mean peak may vary two‐fold from one test to another, and the percentage of peaks < 10 ng/ml ranges from 69% for test 1 to 29% for tests 8 and 9. The proportion of growth hormone deficiencies thus varies considerably according to the test used. To avoid these disparities, we propose a weighting index to adjust values according 40 the tests used: weighting index (1) 1.9; (2) 1.48; (3) 1.4; (4) 1.16; (5) 1.06; (6) 1.01; (7) 0.73; (8) 0.69; (9) 0.66.
Growth dynamics in cystic fibrosis
Authors: Greco L , Santamaria F , Salvatore D , Ritis G de
Published: January 2008

The growth profiles of 28 cystic fibrosis patients, followed for at least three years, were analysed in order to study the dynamics of growth and to verify if any correlation with clinical events exists. Heights and weights were recorded at three‐month intervals, and the patterns did not appear stable or linear, although a graphical smoothing might depict a linear pattern. Height and weight velocity profiles were plotted and all cases showed regular pulsatile patterns of height and weight velocity. By taking measurements at three‐month intervals, the pulsatile rhythm was found to be associated with a circannual rhythm. When the appearance of clinical events was related to growth velocity profiles for each individual, the majority (71–82%) occurred during the descending phase of the growth velocity. An understanding of the individual pulsatile pattern of growth may actually increase the sensitivity of surveillance, and checks might be programmed according to the individual pattern, since the risk of developing an adverse clinical event is significantly greater during the slowing phase of the growth velocity.
Fever and neutropenia in children with cancer: diagnostic parameters at presentation
Authors: Riikonen P , Jalanko H , Hovi L , Saarinen UM
Published: January 2008

We evaluated 91 episodes of fever in 46 profoundly neutropenic children with cancer, in a search for any symptom, sign or laboratory test that would serve to identify patients with septicemia and differentiate them from those in no immediate need of prompt antimicrobial therapy. Seventeen episodes (19%) were bacteremias, 59 (64%) were suspected septic infections, 9 (10%) were focal bacterial infections and 6 (7%) proved not to be bacterial infections. We were unable to detect any parameter, either on admission or after two days of antimicrobial therapy (except for blood culture findings), that would be helpful in differentiating bacteremia from an episode not of bacterial origin. We focused on serum levels of C reactive protein and found them unreliable on an individual level. Prompt institution of antimicrobial therapy at the occurrence of fever results in low mortality, but does not allow assignment of cases to different categories.
Nordic children with myelomeningocele. Parents' assessments of the handicap and physicians' classifications of the disabilities
Authors: Rasmussen F , Lie HR , Hagelsteen JH , Lagergren J , Börjeson M‐C , Lagerkvist B , Köhler L
Published: January 2008

The differences between parents' assessments of their child's handicap and professionals' assessment of disabilities were studied in 486 Nordic children with myelomeningocele aged 4–18 years. Although disability and handicap are conceptually different, agreement between the parents' assessments of the handicap and the degree of disability according to Lorber's classification was found in 51% of cases. The parents' assessments showed close agreement with overall disability according to Lagergren's method in 45% of cases. The factors most strongly associated with parental assessment of the handicap were the child's motor disability, intellectual functioning, faecal and urinary incontinence and the parents' inclination to feel inadequate with respect to the child's needs. Data from professional assessment of disabilities alone are of limited value in understanding the impact of disabilities on the daily life of a child.
Herpes simplex hepatitis with chronic cholestasis in a newborn
Authors: Marret S , Buffet‐Janvresse C , Metayer J , Fessard C
Published: January 2008

In the case of the central nervous system or hepatic involvement, the prognosis of neonatal herpes simplex infection remains poor, despite antiviral drugs, presumably effective if given early. We report the case of a neonate with herpes simplex hepatitis, where the course of the illness was unusual with chronic, ultimately fatal, cholestasis. The treatment was not effective, because its administration was delayed, because of high infant C reactive protein level and the absence of clinical maternal genital infection, and because it was interrupted due to misleading information: clinical improvement, negative viral tests and raised herpes IgG antibody titer.
Acute lymphoblastic leukemia following optic glioma treated by radiotherapy and surgery
Authors: Sayli Tülin , Cemeroḡlu Ayse Pinar , Tuncer A Murat , Gürgey Aytemiz
Published: January 2008

A 14‐year‐old girl was diagnosed as having acute lymphoblastic leukemia following 5000 cGy cranial radiotherapy for treatment of optic glioma. In the absence of underlying predisposing factors, development of acute leukemia was attributed to the oncogenic effect of radiation.
Fever and neutropenia: bacterial etiology revealed by serological methods
Authors: Riikonen P , Leinonen M , Jalanko H , Hovi L , Saarinen UM
Published: January 2008

In a prospective study, 91 episodes of fever in neutropenic children with cancer were evaluated. Fifteen episodes were septicemias, verified by a positive blood culture, 62 were fevers of unknown origin, 6 were focal infections and 8 were of other etiologies (i.e. drug fevers and viral infections). Serum antibody responses to bacteria were measured in paired sera by an enzyme immunoassay method. Bacterial infection was demonstrated serologically in 20% of documented septicemias, in 35% of fevers of unknown origin and occasionally in the other groups. Tests were available and found positive in the fever of unknown origin group for Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella (Branhamella) catarrhalis and enterobacteria. Some had multiple etiology. In conclusion, bacterial serology is a promising method of identifying bacterial etiology in fever of otherwise unknown origin in neutropenic children with cancer.
The changing panorama of cerebral palsy in Sweden. VI. Prevalence and origin during the birth year period 1983–1986
Authors: Hagberg B , Hagberg G , Olow I
Published: January 2008

The prevalence and origin of cerebral palsy in children born between 1983 and 1986 are reported. The crude live‐birth prevalence was 2.49 per 1000; 1.56 for term births, 0.93 for preterm births. The increasing trend from 1970 persisted and was statistically significant for both groups. The most pronounced increase during 1983–1986 occurred in term cerebral palsy. The increasing use of neuroimaging techniques made the timing of damaging events more reliable. In term cerebral palsy, the origin was convincingly prenatal in 28% of cases and perinatal in 25%. The particular critical period for the brain damage underlying cerebral palsy was considered to be weeks 26–34 of gestation, i.e. when periventricular structures are extraordinarily vulnerable. In term infants, this occurs during late intrauterine life, while in the majority of preterms it occurs in early neonatal life. In total, two‐thirds of cerebral palsy lesions might have been acquired during these decisive months of brain development.
Preliminary findings on increased muscle tension and tenderness, and recurrent abdominal pain in children. A clinical study
Authors: Alfvén Gosta
Published: January 2008

Recurrent abdominal pain of “non‐organic origin” is a common pediatric problem. In most instances it is related to psychological factors. The origin of the pain itself, however, is still unknown. In this study, we question whether or not the complaint could have a muscular origin. In this clinical study of recurrent abdominal pain of probable “psychosomatic origin”, all 27 children had tense and tender abdominal muscles, which was not the case in a control group. The children with recurrent abdominal pain also had a typical pattern of muscular tension and tenderness in other muscles. These children often have tension headache, “tension” chest pains and also more general symptoms such as loss of appetite and disturbed bowel function.
Non‐immune hydrops fetalis and bilateral pulmonary hypoplasia in a newborn infant with extralobar pulmonary sequestration
Authors: Brus F , Nikkels PGJ , Loon AJ van , Okken A
Published: January 2008

Extralobar pulmonary sequestration was found in a newborn premature infait that presented with non‐immune hydrops fetalis, massive bilateral hydrothorax and polyhydramnios in utero. The baby died of severe respiratory insufficiency 15 h after birth. Postmortem examination revealed distended lymphatic vessels in the sequestered lung tissue probably due to impeded lymph drainage. We suggest that not extralobar pulmonary sequestration itself but a subsequent massive unilateral hydrothorax due to severe obstruction of lymph drainage was the cause of the non‐immune hydrops fetalis, pulmonary hypoplasia and polyhydramnios. If these symptoms are diagnosed before delivery, a search for extralobar pulmonary sequestration is indicated.
Renal effects of cyclosporin A in children treated for idiopathic nephrotic syndrome
Authors: Tirelli AS , Paterlini G , Ghio L , Edefonti A , Assael BM , Bettinelli A , Cavanna G , Sereni F
Published: January 2008

Little data have been published on tubular renal function during cyclosporin A treatment in children without transplants. We studied 12 young subjects (mean age 10 years) with steroid‐responsive idiopathic nephrotic syndrome and with signs of steroid toxicity. After achieving remission with prednisone 60 mg/m2, 8 children started cyclosporin A therapy (6 mg/kg/day) (group A) and 4 children were given cyclophosphamide 2.5 mg/kg/day (group B). The latter were considered as controls together with 10 other children with idiopathic nephrotic syndrome in complete remission and off therapy (group C). We monitored creatinine clearance and tubular handling of β2‐microglobulin, sodium, phosphorus and uric acid for one year. Cyclosporin A induced a decrease in creatinine clearance with a decrease in fractional excretion of β2‐microglobulin; sodium excretion was similar in the two treated groups and a transient decrease in fractional excretion of uric acid was seen only in patients receiving cyclosporin A. Both groups showed an increased renal threshold phosphate concentration. Our results suggest that in children, cyclosporin A therapy induces a decrease in glomerular filtration rate associated with increased reabsorption activity of proximal tubular cells.
Dietary changes in Swedish adolescents
Authors: Bergström E , Hernell O , Persson LÅ
Published: January 2008

A school‐based dietary survey, using seven‐day records, was performed in two cohorts of Swedish adolescents; 14– and 17‐year‐olds. The study comprised 366 boys and 365 girls. When compared to previous studies in Sweden, a striking finding was a decrease in dietary fat intake and an increase in carbohydrate intake. However, the relative intake of saturated fat had not changed (15% of total energy). The dietary change was mainly due to an increased consumption of cereal products. There were no major differences in dietary habits or nutrient density of the food between the two age groups, or between boys and girls. The mean intakes of protein, fat and carbohydrate, expressed as a percentage of the total energy intake, were 15, 33 and 52%, respectively. The mean intakes of vitamins and minerals were low only for selenium. The boys had a high iron intake (1.5 and 1.7 times the recommended intake for 14‐ and 17‐year‐olds, respectively) while the mean iron intake for girls was 0.9 times the recommended dietary allowances in both age groups. The intake of dietary salt was higher in boys than in girls (7.7 g and 9.0 g per day in 14‐ and 17‐year‐old boys, respectively, and 5.8 g per day in both 14‐ and 17‐year‐old girls). In a long‐term health perspective, this positive change in nutrient intake in adolescents may contribute to a reduction in the incidence of diet‐related diseases in Sweden. However, our results strongly suggest that if intakes are further reduced in the adolescent age groups, this may reduce the energy intake to a hazardously low level in a significant number of adolescents, particularly in girls.
Respiratory insufficiency as a cause of neonatal death (with aspects on the potential need for ECMO treatment)
Authors: Ehrén H , Frenckner B , Palmér K , Herin P
Published: January 2008

In order to identify children with fatal outcome in a neonatal intensive care unit in which only outborns are admitted, a retrospective study over a 10‐year period was undertaken. The study was limited to respiratory disorders. The aim of the study was to identify lethal risk factors and thereby the need for improving therapeutic tools. Diagnoses, perinatal history, ventilator settings, blood gases, medical treatment, X‐ray findings, head ultrasounds, echocardiograms, laboratory tests, surgical procedures and autopsy findings were evaluated. Severe respiratory insufficiency requiring mechanical ventilation was found in 777 patients and of these babies, 207 (27%) died while still on the ventilator. Fifty‐eight patients were excluded for various reasons and thus 149 patients were included in the study. It is concluded that the mortality rate from respiratory insufficiency in the material studied was consistently high over the 10‐year period. New therapeutic modalities, one of which is ECMO, are offered nowadays in clinical practice and may improve mortality and morbidity rates.
Immunodeficiency with increased immunoglobulin M associated with growth hormone insufficiency
Authors: Ohzeki T , Hanaki K , Motozumi H , Ohtahara H , Hayashibara H , Harada Y , Okamoto M , Shiraki K , Tsuji Y , Emura H
Published: January 2008

Growth hormone deficiency associated with hypogammaglobulinemia has been reported only in a few publications. Our patient was a male with recurrent episodes of infections. Serum immunoglobulin (Ig) G was extremely low although IgM concentration was much greater than the normal limit. Growth hormone responses to insulin, 1‐Dopa and growth hormone‐releasing hormone were low. The mean growth hormone concentration during sleep was less than the normal limit. These results are consistent with hyper‐IgM immunodeficiency associated with growth hormone deficiency. The mode of transmission appears to be autosomal dominant. This combination has not been reported previously.
Prognostic factors in meningococcal disease and a new scoring system
Authors: Tüysüz Beyhan , Öziü Ihsan , Aji Dolly Yafet , Erginel Ayten
Published: January 2008

One‐hundred‐and‐forty patients diagnosed as having meningococcal disease have been investigated retrospectively with respect to prognostic factors. The overall mortality was 8.6%, the mortality rate of the infants under 6 months of age being higher than that of the other groups. In cases where there was no meningitis or leucocytosis, the presence of hypotension, disturbed consciousness and diffuse petechiae increased the mortality rate significantly. High fever did not have any effect on mortality. We propose a new practical and reliable scoring system for meningococcal disease for determining the influence of prognostic factors on mortality.
Early child health in Lahore, Pakistan: III. Maternal and family situation
Authors: Hagelcull B , Nazir R , Jalil F , Karlberg J
Published: January 2008

The family situation for mothers, in three areas differing in degree of urbanization and an upper middle class control group, in Lahore, Pakistan was described. Area differences in socio‐economic, family composition, and housing and sanitary conditions were investigated. Data from a longitudinal sample (n=1476 newborns) were compared with data from a cross‐sectional population survey (n= 2998 families). Risk factors for child mortality and morbidity were common in the village and periurban slum area; conditions were somewhat better in the urban slum community. The sample was concluded to be representative of the population in the three areas and also for Pakistan in general. Two indices for cross‐study comparisons were proposed, one for socio‐economic background and the other for housing standard. The two indices were shown to be related to maternal weight for height at 9 months of pregnancy in the urban slum area; the socio‐economic level was also functionally related to the weight for height measure in the village. The lower socio‐economic and housing standard level, the lower was the mothers' relative weight just before childbirth. The findings were discussed in terms of risk factors for infant mortality, morbidity and psychological development.
Early child health in Lahore, Pakistan: IV. Child care practices
Authors: Zaman S , Jalil F , Karlberg J
Published: January 2008

Child care practices and hygiene measures were studied at 6 months of age in a longitudinally followed cohort of 1476 infants born between September 1984 to March 1987 in four socio‐economically different areas in and around Lahore, Pakistan. Although, 76–98% of the mothers looked after their infants during health and 96–98% during a diarrhoeal illness, child care practices and hygiene measures differed significantly between the four areas. During a diarrhoeal episode, the mothers from the upper middle class took timely medical help, fed ample food and Oral Rehydration Salts (ORS) to the sick infants and provided uncontaminated food to them in clean surroundings. The mothers from the village and the periurban slum took their sick child, mostly after the second day of illness, to a doctor, but preferred home remedies. Fourteen percent of the mothers in the village and 6% in the periurban slum did not seek any medical help at all. One‐third of the families, from these two areas, fed food to children 12 hours after cooking; the surroundings of the child were dirty with large numbers of flies present throughout the year, though the food was commonly kept covered with a lid. We constructed a simple measure of the surroundings of the child, rated as dirty, medium or clean; it was found to be associated to both parental illiteracy and child growth, but not with housing standard. The main conclusion is that any attempt to improve child‐care practices and the hygienic environment for the child, should focus on maternal literacy and simple health messages.
Early child health in Lahore, Pakistan: VIII. Microbiology
Authors: Khalil K , Lindblom G‐B , Mazhar K , Khan SR , Kajiser B
Published: January 2008

The causative agents of acute diarrhoea were investigated in children under the age of five years from 1985–1991 in three socio‐economically different areas in Lahore, Pakistan. The aim was to determine the frequencies of the most common enteropathogens in faeces. The total isolation rate was 73.4%; two thirds (53.5%) were of bacterial and one third (19.9%) of viral origin. ETEC‐LT (23.4%), Rota virus (19.9%), EPEC (15%) and Campylobacter (12%) were the single most frequent pathogens in all age groups and areas of living. The positivity of Campylobacter increased from 1.6% to 12% after the change of isolation technique. Shigella was isolated significantly (p>0.001) more in children over than under one year of age. The incidence of bacterial infections was high during all seasons, while in certain years Rota virus was relatively low in the summer compared to the cooler months. The prevalence of ETEC‐LT diarrhoea was higher in the periurban slum as compared to the village and the urban slum. The study is the first of its kind in Pakistan, and the results are similar to other comparable studies. It is thus possible to establish a well functioning and reliable microbiological laboratory in developing countries in a setting with restricted trained personnel and material resources.
Early child health in Lahore, Pakistan: XIII. Primary teeth emergence
Authors: Saleemi M , Jalil F , Karlberg J , Hägg U
Published: January 2008

The aim of this study was to investigate the number of emerged primary teeth at various ages from 6 to 24 months in 1347 longitudinally followed Pakistan infants sampled from four socio‐economically different areas in Lahore, Pakistan; from a very poor periurban slum to a privileged upper middle class group. The emergence of the primary teeth was found to be little, or not all related to sex or to the area of living. However, in comparison with studies conducted in other continents, the Indo‐Pak subcontinent population lags behind in primary teeth emergence, especially in early life. This genetic difference makes it necessary to create specific standards of primary teeth emergence for this population.
Developmental screening at four years of age. Relation to home situation, perinatal stress, development and behaviour
Authors: Larsson J‐O , Aurelius G , Nordberg L , Rydelius P‐A , Zetterström R
Published: January 2008

Larsson J‐O, Aurelius G, Nordberg L, Rydelius P‐A, Zetterström R. Developmental screening at four years of age. Relation to home situation, perinatal stress, development and behaviour. Acta Pædiatr 1994;83:46–53. Stockholm. ISSN 0803–5253

A developmental screening programme constructed for the use of Swedish child welfare centres on four‐year‐old children has been tested on a cohort of 471 children who have been followed up from the stage of early pregnancy. The results of the screening test were compared with data in the project using a multidisciplinary, longitudinal and prospective design. The test, which can be performed by a child welfare centre nurse and which is not time‐consuming, includes four items summed up in a four‐years‐of‐age score: the child is asked to name three easily recognizable objects, to draw a cross (according to a model), and to draw a man; in addition, an evaluation is made of speech development. On average, boys were found to have a lower score than girls. The results of the screening test were related to data available in the ongoing project; to the psychosocial conditions of the families, to foetal and perinatal factors (reduced optimality score according to Prechtl), to the presence of psychopathology, and to the results of Griffiths' developmental scales. The developmental screening score, which in most instances was associated with the Griffiths' scales, was found to be related to psychosocial problems in the family and to abnormal behaviour and psychiatric symptoms in the child, but not to reduced optimality scores. The results indicate that a relatively simple screening method is of value for the identification of children who are at risk of abnormal mental and behavioural development, and who may thus be in need of special care and attention.
Nicotine and cotinine levels in pericardial fluid in victims of SIDS
Authors: Milerad J , Rajs J , Gidlund E
Published: January 2008

Milerad J, Rajs J, Gidlund E. Nicotine and cotinine levels in pericardial fluid in victims of SIDS. Acta Paediatr 1994;83:59–62. Stockholm. ISSN 0803–5253

We have analyzed the levels of nicotine and cotinine in pericardial fluid in 24 consecutively autopsied cases of sudden unexpected death in infants aged one to six months. Our aim was to determine to what extent victims of sudden infant death may have been exposed to passive smoking near the time of death. Sixteen of the decreased infants were classified as SIDS at autopsy. Other contributing causes of death, predominantly infections, were found in eight cases. Eight infants (30%) had cotinine levels less than 2 ng, indicating that no significant exposure to nicotine had occurred near the time of death. Of the remaining 70%, five had been moderately exposed, seven markedly exposed and four heavily exposed (cotinine levels 2–10 ng, 10–50 ng and more than 50 ng, respectively). Since only 18% of Swedish women smoke after childbearing we conclude that nicotine exposure in infants who died suddenly was much higher than one would otherwise expect. It is hypothesized that high concentrations of nicotine and nicotine metabolites around the heart may affect cardiac function and thus play a role in the mechanisms causing SIDS or other categories of sudden unexpected death.
Outcome of cadaver kidney transplantation in small children
Authors: Cochat Pierre , Castelo Fernanda , Glastre Catherine , Martin Xavier , Stamm Didier , Long Denise , Lavocat Marie‐Pierre , Hadj‐Aïssa Aoumeur , Lyonnet Denis , Floret Daniel
Published: January 2008

Cochat P, Castelo F, Glastre C, Martin X, Stamm D, Long D, Lavocat M‐P, Hadj‐Aïssa A, Lyonnet D, Floret D. Outcome of cadaver kidney transplantation in small children. Acta Pædiatr 1994;83:78–83. Stockholm. ISSN 0803–5253

Small children have often been reported to have poor outcome after kidney transplantation (KT). Recent reports from North America have shown that the use of living‐related donors improves patient and graft survival. We report the experience in one centre of primary cadaveric KT using sequential immunosuppression in nine children aged 8–30 months and weighing 5.4–9.8 kg; donors were 0.7–12.3 years old. Four patients had pre‐emptive KT and the other five were on peritoneal dialysis; the mean ± SD waiting time was 2.0 ± 2.4 months. Perioperative care has been published previously. The surgical approach was intraperitoneal if the aorta and vena cava were used (n= 7) and extraperitoneal for common iliac vessels anastomosis (n = 2); the duration of surgery was 3.5 ± 0.9 h and the time for vascular anastomosis was 32 ± 6 min. The recipients received ATG, azathioprine, prednisone and delayed administration of cyclosporin A. The patients were followed for 12–98 (median 41) months and showed good graft function (inulin clearance 63–100 ml/min/1.73 m2); only one child with recurrent haemolytic uraemic syndrome lost his graft three months post‐transplantation and died after he had received a second graft. None of the recipients required post‐transplant dialysis; arterial hypertension involved four children and was related to graft artery stenosis in two. Growth improved by 0.24 ± 0.48 SD score of height per year. Compared to earlier reports on cadaver transplantation in small children (about 40% graft survival after five years) and to the outcome of chronic peritoneal dialysis, the present results are better and appear to be similar to those obtained with living‐related donor transplantation.
Viral infections acquired during neonatal intensive care and lung function of preterm infants at follow‐up
Authors: Yuksel B , Greenough A
Published: January 2008

Yuksel B, Greenough A. Viral infections acquired during neonatal intensive care and lung function of preterm infants at follow‐up. Acta Pzdiatr 1994;83:117–18. Stockholm. ISSN 0803–5253

Respiratory function was assessed at a median postnatal age of seven months in seven infants born prematurely who suffered from chronic lung disease and had a proven viral infection while on the neonatal unit (study group). The results were compared with those of seven infants with chronic lung disease who were gestational age‐ and gender‐matched but who did not have a viral infection (controls). Six of the study group and two controls were symptomatic at follow‐up. Airways resistance was significantly higher (p < 0.04) and specific conductance significantly lower (p < 0.05) in the study group compared with the controls. We conclude in premature infants with chronic lung disease that viral infections acquired in the neonatal nursery are associated with impaired lung function at follow‐up.
Inspiratory and expiratory times for infants ventilator‐dependent beyond the first week
Authors: Chan V , Greenough A
Published: January 2008

The aim of this study was to determine optimum inspiratory and expiratory times to be used for ventilation of infants older than one week of age. Each infant was studied at a rate of 30 breaths/min (inspiratory times (TI) of 1.0, 0.67 and 0.5 s with expiratory times (TE) of 1.0, 1.33 and 1.5 s, respectively) and at a rate of 60 breaths/min (TI 0.5, 0.33 and 0.25 s and TE 0.5, 0.67 and 0.75 s, respectively). Arterial blood‐gases were examined after 20 min on each setting. Fifteen infants with a median gestational age of 27 weeks were studied at a median postnatal age of 9 days and 10 infants with a median gestational age of 27 weeks at a median postnatal age of 24 days. All infants had type I chronic lung disease. Oxygenation did not consistently improve as TI was prolonged, elevating mean airway pressure but, particularly in older infants, was better at TI± 0.5 s compared with TI < 0.5 s. In both groups, carbon dioxide elimination was better at 60 than at 30 breaths/min. Thus we suggest that in infants fully ventilator‐dependent beyond the first week of life, an inspiratory and expiratory time of 0.5 s should be used as the first choice.
Improved arterial oxygenation in children with the adult respiratory distress syndrome: the prone position
Authors: Murdoch IA , Storman MO
Published: January 2008

Seven ventilated children with the adult respiratory distress syndrome (ARDS) were studied. While supine and haemodynamically stable, baseline arterial blood‐gas analyses and haemodynamic measurements, including cardiac output, were performed. Each child was then turned prone and 30 min later a repeat set of measurements were made. Following this, the children were returned to the supine position and 30 min later a final set of measurements were performed. Ventilation and inotropic support remained unchanged during these positional changes. No significant effect on heart rate, mean systemic arterial blood pressure and cardiac output occurred following these positional changes (p < 0.05; Friedman's ANOVA). Arterial oxygen saturation significantly improved, however, when nursed in the prone position (p < 0.02). Similarly, oxygen delivery significantly increased (p < 0.02). The prone position improves arterial oxygenation and oxygen delivery in children with ARDS. By adopting the prone position, in ventilated children with ARDS, we surmise that realistic gas exchange targets may be reachable with lower levels of inspired oxygen and/or peak airway pressures.
Dysgenesis of thyroid is the common type of childhood hypothyroidism in environmentally iodine deficient areas of north India
Authors: Shankar SM , Menon PSN , Karmarkar MG , Gopinath PG
Published: January 2008

Forty‐five children (28 girls and 17 boys; mean age 4.5 years) with hypothyroidism referred to us from January 1989 to November 1990 were evaluated prospectively for the pattern of hypothyroidism by hormone assays, scintiscan and urinary iodine estimation. Among the 6 children from non‐endemic areas, athyreosis and/or hypoplasia were seen in 3, ectopia in 2 and dyshormonogenesis in 1. Of 39 children from moderate to severe environmentally iodine deficient regions, 18 (46%) had athyreosis and/or hypoplasia and 10 (26%) ectopic thyroid. Iodine deficiency was seen in 4, dyshormonogenesis in 4, secondary/tertiary hypothyroidism in 2 and thyroiditis in 1. The mean age of these children at the onset of symptoms was 1.4 years and at clinical presentation 4.5 years. There was significant growth retardation with 54% of children being below the 5th centile of Indian standards. There was no significant difference in the age at onset of symptoms and presentation, clinical features and bone age for the different types. The levels of serum total T4 were significantly low in dysgenesis (athyreosis, hypoplasia and ectopia, p < 0,001). Dysgenesis of the thyroid is the most common type of childhood hypothyroidism in iodine deficiency endemias. We postulate that severe iodine deficiency in the intrauterine and early neonatal period may lead to dysgenesis of the thyroid.
Increasing incidence of childhood celiac disease in Sicily: results of a multicenter study
Authors: Magazzú G , Bottaro G , Cataldo F , Iacono G , Donate F Di , Patane R , Cavataio F , Maltese I , Romano C , Arco A , Rotolo N , Bragion E , Traverso G , Greco L
Published: January 2008

By screening the patient list of four Sicilian centers of gastroenterology and those with gluten‐free product consumption, 1074 patients (607 females and 467 males) with celiac disease, diagnosed between 1975 and 1989, were identified. A maximum cumulative incidence rate by birth cohort was reached in 1986 (1.65/1000). When the incidence rate was adjusted for the years of follow‐up, the actual standardized rate was 3 cases per 1000 live births. Growth failure and chronic diarrhea were the most common symptoms, but a diminishing trend for chronic diarrhea was observed when symptoms were distributed by year of diagnosis. Even though 61.1% of all cases were diagnosed within six months from the onset of symptoms, mean age at diagnosis showed an increasing trend, from less than two years to approximately four years of age. The results of our study showed an increasing incidence of celiac disease due to diagnosis of less typical cases at an older age and also to a steady increase in the rate of diagnosis of cases with a classic clinical picture.
Bronchogenic cyst presenting in the neonatal period
Authors: Dale PJ , Shaw NJ
Published: January 2008

A term infant presented at birth with worsening respiratory distress which resulted in him requiring mechanical ventilation. A CT scan of the chest revealed a bronchogenic cyst, removal of which resulted in full recovery and, to date, no respiratory sequelae.
An unusual case of an aldosterone‐producing adenoma in a prepubertal girl with severe post‐surgical adrenal suppression
Authors: Legault L , Lean A De , Brunette MG
Published: January 2008

An 11‐year‐old girl was referred with hypertension, hypokalemia, low renin activity, metabolic alkalosis and hyperaldosteronism. Adrenal computed tomography revealed the presence of a large left adrenal adenoma of 4 ± 4.5 cm in size. Following adrenalectomy, the child presented an unusual acute salt‐loosing syndrome which necessitated administration of a large quantity of sodium chloride and corticoids. The cells from the tumor were plated. They rapidly proliferated to a monolayer. After incubation for 24 h, basal production of aldosterone (55.4 ± 9.07 pmol/ml) was observed. This production was stimulated by the presence of ACTH 10‐8 M and KCI 55 mM; angiotensin II 10‐8 M failed to enhance aldosterone secretion. In the four experimental conditions, however (control, ACTH, angiotensin II and KCI), ANF 10‐8 M decreased aldosterone secretion. We conclude that hyperaldosterone secretion by an adrenal adenoma is not due to resistance to the inhibitory effect of ANF but rather to cell multiplication itself. In this patient, the post‐surgical salt‐loosing syndrome was attributed to the combined effect of the chronic state of high ANF, low potassium and low ACTH in the contralateral gland on the one hand and a certain degree of transitory renal unresponsiveness of the renal distal tubule to aldosterone on the other.