bluuebunny/crossref_metadata_2025 huggingface dataset:
Characteristics and outcome of long‐stay patients in a paediatric intensive care unit: a case‐control study
Authors: van der Heide PhA , Hassing MBF , Gemke RJBJ
Published: August 2010

Aim: To identify differences in baseline characteristics and outcome between long‐stay and other patients admitted to a paediatric intensive care unit with the same diagnosis. Methods: Over a period of 6 y, data of paediatric intensive care unit patients with a length of stay of 30 or more days (long‐stay patients) and aged 1 to 18 y were retrospectively collected. Long‐stay patients were matched with the next patient who was admitted to the paediatric intensive care unit with the same diagnosis. Evaluated characteristics on admission included: age, sex, presence of chronic morbidity, functional status, Pediatric Risk of Mortality score, presence of multiple organ system failure and complications during admission. Outcome (survival and functional status) was assessed 2.5 to 8.5 y after admission. Results: Of 19 long‐stay patients identified, 15 could be matched with a control patient admitted with the same diagnosis. No significant difference in baseline characteristics was found between long‐stay patients and the matched controls. The mean number of complications per long‐stay patient was 2.9, compared to 1.2 per control patient (p= 0.02). Infection accounted for half of the complications. Mortality rate in long‐stay patients was not higher than in the matched controls (36.8 vs 26.7%, p= 0.54). Paediatric intensive care unit stay did not change functional status in either long‐stay patients or controls.

Conclusion: Long‐stay patients in the paediatric intensive care unit had more complications, but baseline characteristics, mortality and functional outcome were not different from a control group admitted with the same diagnosis.
Short‐term outcome after active perinatal management at 23—25 weeks of gestation. A study from two Swedish tertiary care centres. Part 2: infant survival
Authors: Serenius F , Ewald U , Farooqi A , Holmgren P‐Å , Håkansson S , Sedin G
Published: August 2010

Aim: To determine neonatal survival rates based on both foetal (stillborn) and neonatal deaths among infants delivered at 23–25 wk, and to identify maternal and neonatal factors associated with survival. Methods: The medical records of 224 infants who were delivered in two tertiary care centres in 1992–1998 were reviewed retrospectively. At these centres, policies of active perinatal and neonatal management were universally applied. Data were analysed by gestational age groups and considered in three time periods. Logistic regression models were used to identify factors associated with survival. Results: The rate of foetal death was 5%. Of infants born alive, 63% survived to discharge. Survival rates including foetal deaths in the denominator at 23, 24 and 25 wk were 37%, 61% and 74%, respectively, and survival rates excluding foetal deaths were 43%, 63% and 77%, respectively. Of infants born with 1‐min Apgar scores of 0–1, 43% survived. In the total cohort, survival rates including foetal deaths in the denominator increased from 52% in time period 1 to 61% in time period 2 and 74% in time period 3 (p > 0.02). On multivariate logistic regression analysis, higher birthweight (OR: 1.91 per 100 g increment; 95% CI: 1.45–2.52), female gender (OR: 3.33; 95% CI: 1.65–6.75), administration of antenatal steroids (OR: 2.95; 95% CI: 1.46–5.98) and intrauterine referral from a peripheral hospital (OR: 2.35; 95% CI: 1.18–4.68) were associated with survival. Apgar score ± 3 at 1 min (OR: 0.46; 95% CI: 0.22–0.95) was associated with decreased survival. The use of antenatal steroids was protective at 23–24 wk (OR: 5.2; 95% CI: 2.0–13.7), but not at 25 wk.

Conclusions: Active perinatal management that included universal initiation of neonatal intensive care virtually eliminated intrapartum stillbirths and delivery room deaths, and resulted in survival rates that compare favourably with those of recent studies. However, the policies of active care postponed death in non‐survivors. Individual variations in outcome in relation to the infant's condition at birth as reflected by the Apgar scores preclude the making of treatment decisions in the delivery room.
Short‐term outcome after active perinatal management at 23–25 weeks of gestation. A study from two Swedish perinatal centres. Part 3: neonatal morbidity
Authors: Serenius F , Ewald U , Farooqi A , Holmgren P‐Å , Håkansson S , Sedin G
Published: August 2010

Aim: To determine major neonatal morbidity in surviving infants born at 23–25 weeks, and to identify maternal and infant factors associated with major morbidity. Methods: The medical records of 224 infants who were delivered at two tertiary care centres in 1992–1998 were reviewed retrospectively. At these centres, policies of active perinatal and neonatal management were universally applied. Of the 213 liveborn infants, 140 (66%) survived to discharge. Data were analysed by gestational age and considered in three time periods. Logistic regression models were used to identify factors associated with morbidity. Results: Of the survivors, 6% had intraventricular haemorrhage grade ± 3 (severe IVH) or periventricular leukomalacia (PVL), 15% retinopathy of prematurity ± stage 3 (severe ROP) and 36% bronchopulmonary dysplasia (BPD). On logistic regression analysis, severe IVH or PVL was associated with duration of mechanical ventilation (odds ratio, OR: 1.53 per 1‐wk increment in duration; 95% confidence interval, CI: 1.01–2.33). Severe ROP was associated with the presence of a patent ductus arteriosus (PDA) (OR: 3.31; 95% CI: 1.11–9.90) and birth in time period 3 versus time periods 1 and 2 combined (OR: 6.28; 95% CI: 2.10–18.74). BPD was associated with duration of mechanical ventilation (OR: 2.71 per 1‐wk increment in duration; 95% CI: 1.76–4.18) and with the presence of any obstetric complication (OR: 2.67; 95% CI: 1.07–6.65). Gestational age and birthweight were not associated with major morbidity. Of all survivors, 81% were discharged home without severe IVH, PVL or severe ROP.

Conclusions: Increased survival as a result of active perinatal and neonatal management was associated with favourable morbidity rates compared with those in recent studies. Among survivors born at 23–25 weeks, neither gestational age nor birthweight was a significant determinant of major morbidity.
PCDDs, PCDFs and Co‐PCBs in human breast milk samples collected in Tokyo, Japan
Authors: Tajimi M , Watanabe M , Oki I , Ojima T , Nakamura Y
Published: August 2010

Aim: To observe the distribution of PCDD/Fs and Co‐PCBs in samples of human breast milk collected in Japan. Methods: Using high‐resolution gas chromatography, milk samples for poly‐chlorinated dibenzo‐p‐dioxins (PCDDs; 14 congeners), poly chlorinated dibenzofurans (PCDFs; 15 congeners) and coplanar poly chlorinated biphenyls (Co‐PCBs; 12 congeners) from 240 mothers residing in Tokyo were analysed. There were 120 donors each of primiparae and secundiparae, each group including 60 donors aged 25 to 29 y (“the younger group”) and 60 aged 30 to 34 y (“the older group”). Individual milk samples (about 50 ml) were obtained 30 d after delivery in 1999 and in 2000. Results: The mean toxic equivalent (TEQ) level of PCDD/Fs (the sum of PCDDs and PCDFs) was 14.9 pg TEQ/g fat, of Co‐PCBs 10.6 pg TEQ/g fat, and the total sum of PCDD/Fs and Co‐PCBs was 25.6 pg TEQ/g fat. The mean TEQ levels of PCDD/Fs, Co‐PCBs, and total PCDD/Fs and Co‐PCBs were higher in primiparae than in secundiparae. In each of these, the levels were higher in the subgroup of older mothers. In the secundiparae, the mean levels were lower in the group of mothers who had breastfed their first babies than in those who bottle‐fed or partly bottle‐fed their first born.

Conclusions: The concentrations of PCDD/Fs and Co‐PCBs in the breast milk of Japanese women were slightly lower than those described in previous studies conducted in Japan and other countries; and the concentrations of PCDD/Fs and Co‐PCBs in the breast milk were influenced mainly by the mother's age and nursing history.
Home breastfeeding support by health professionals: findings of a randomized controlled trial in a population of Italian women
Authors: Di Napoli A , Di Lallo D , Fortes C , Franceschelli C , Armeni E , Guasticchi G
Published: August 2010

Aim: We conducted a randomized controlled trial to assess the effectiveness of a support intervention delivered by health professionals to increase the rate and duration of breastfeeding.Methods: A randomized controlled intervention study was conducted in the period 2000–2001 among 605 mothers who had given birth in a public maternity ward located in the city of Rome, Italy. The intervention consisted of a home visit by a midwife from the maternity ward of the hospital. The outcome of the study was the infant's feeding habits, assessed by a 24‐h recall. The effect of the intervention on the duration of breastfeeding was estimated by the Kaplan‐Meier method and by the Cox multivariate regression model.Results: According to intention‐to‐treat analysis, there was no significant difference between the intervention and the control group, after controlling for confounding factors (hazard ratio (HR) 1.04; 95% confidence interval (95% CI): 0.85–1.26). The duration of breastfeeding was shorter (HR 1.61; 95% CI: 1.13–2.31) for women in the intervention group who refused the obstetric visit.

Conclusion: Our study shows that an early home support programme delivered by health professionals was not effective in increasing breastfeeding initiation and duration.
Hantavirus Puumala infection as a cause of fever of unknown origin in a child
Authors: van der Werff ten Bosch J , Heyman P , Potters D , Peeters S , Cochez C , Piéerard D
Published: August 2010

Hantavirus infection due to Puumala virus causes nephropathica epidemica, a disorder characterized by fever, haematological abnormalities, mild renal dysfunction and ophthalmological abnormalities. The prevalence in most European countries is low, but the virus can be endemic. In children, hantavirus infection is rare. This paper describes a young girl diagnosed with hantavirus infection. The patient presented with high fever, proteinuria, haematuria and eye lesions, but other typical hallmarks of the disease, such as thrombocytopenia and renal dysfunction, were absent.

Conclusion: This case report demonstrates the need to consider the diagnosis of hantavirus infection in children with prolonged fever of unknown origin. The diagnosis is based on serological tests.
Low‐dose acyclovir for HSV‐2 meningitis in a child
Authors: Kohlhoff SA , Marciano TA , Rawstron SA
Published: August 2010

A 7‐y‐old girl with genital herpes following sexual abuse presented with dysuria, fever and meningeal signs. Acyclovir (15 mg/kg/d for 10 d) was administered for severe genitourinary symptoms. The CSF culture was positive for HSV type 2.

Conclusion: Complete resolution of all symptoms demonstrates that, as in adults, HSV‐2 meningitis does not require high‐dose or prolonged acyclovir therapy.
Flawed reports of immunization complications: consequences for child health
Authors: Zetterström R
Published: August 2010

Flawed studies about complications in vaccination programmes may have serious consequences for community health, as illustrated by a previous report on the adverse effect of pertussis vaccination and a more recent report about a suspected link between MMR vaccination and autistic spectrum disorders.

Conclusion: The Editorial Board of The Lancet has apologized for having published a paper which has misled its readers about the risk of MMR vaccination. Due to the important role of TV and newspapers in giving information about health promotion, these media should also be willing to correct false information.
Evidence‐based therapy in neonatology: distilling the evidence and applying it in practice*
Authors: Sinclair JC
Published: August 2010

Abstract: Three aspects of the role of clinical evidence in guiding therapy in the field of neonatology are presented: 1) what is embodied in the concept “evidence‐based medicine”? 2) the contribution of the Cochrane Collaboration and its Neonatal Review Group in summarizing and disseminating evidence, in the form of systematic reviews of randomized controlled trials, concerning the benefits and risks of therapies in the field of neonatology; 3) approaches to bridging the gap between the evidence per se and the uptake and application of that evidence in practice.
Midazolam and amplitude‐integrated EEG
Authors: Hellström‐Westas L
Published: August 2010

Amplitude‐integrated EEG (aEEG) is currently used in an increasing number of neonatal intensive care units. The method has been practised in newborn infants for more than 20 y. However, it was not until recently, when the method proved to be accurate for very early prediction of outcome in asphyxiated newborn infants, that it gained more widespread neonatal use. The use of aEEG in units for neonatal intensive care has increased the awareness that sick infants develop subclinical seizure activity, and that several medications affect the aEEG background.
A novel technique to measure position‐dependent resistance changes in the vertebral arteries postmortem: new insights into the aetiology of SIDS?
Authors: Wald M , Klupp N , Lawrenz K , Puig S , Heimberger K , Reiter C , Pollak A , Ipsiroglu O
Published: August 2010

Aim: A central respiratory regulation disturbance—triggered by impaired oxygen supply to the brainstem—is being discussed as an aetiological factor in sudden infant death syndrome. In this experimental study, further insight was sought into how far cervical spine movements may induce critical narrowing of the vertebral arteries. Methods: In 10 infant bodies, the vertebral arteries were cannulated close to their origin and perfused with a fluid bolus of 5 ml in 2 s. The intravascular peak pressure created was memorized. Individual resistance indices were computed for every vertebral artery by relating the average pressure maximum from 10 measurements each with maximal rotation of the neck to either side alone and then with additional hyperextension of the cervical spine to the average peak pressure in neutral head position. Results: Alterations of position‐induced pressure changes occurred in the vertebral arteries of all children. Considering exclusively the combined movements of rotation plus extension, resistance increased ipsi‐ and contralaterally—no matter which side the head was turned—in three infants. A further three reacted with resistance surges only contralateral to the direction of rotation, and one only ipsilateral. Double contralateral associated with only one‐directional ipsilateral rise was observed twice, and vice versa once.

Conclusion: The presented method enables crude quantification of postmortem dynamic resistance alterations in the vertebral arteries. How far such measurements reflect authentic circulatory conditions during life remains to be assessed.
General joint laxity in 1845 Swedish school children of different ages: age‐ and gender‐specific distributions
Authors: Jansson A , Saartok T , Werner S , Renström P
Published: August 2010

Aim: To evaluate general joint laxity in growing children with the aim of determining a cut‐off point for joint hypermobility. Methods: Using the Beighton score, 1845 children from 48 geographically randomly selected schools were evaluated for general joint laxity. The Beighton score evaluates the ability to perform a selection of manoeuvres involving five different joints. The children made up three different age groups (9, 12 and 15 y old) at the time of testing and were approximately equally distributed concerning age and gender in all groups. Results: There were significant differences in Beighton scores concerning both age and gender. Whereas boys presented significant decreases in the degree of general joint laxity with increasing age, girls presented the highest degree of general joint laxity at the age of 15. At all ages girls had a higher degree of general joint laxity

Conclusion: Based on this study of a normal population of Swedish school children, the normal distribution of general joint laxity as well as the limits for hypermobility is age and gender specific. It is necessary to take into consideration both age and gender if setting a cut‐off point for hypermobility when evaluating general joint laxity in growing individuals.
Induction of anti‐secretory factor in human milk may prevent mastitis
Authors: Svensson K , Lange S , Lönnroth I , Widström A‐M , Hanson LÅ
Published: August 2010

Aim: The aim of the study was to try to induce anti‐secretory factor (AF) in human milk and possibly prevent mastitis. Methods: Forty mothers who had normal deliveries and healthy full‐term infants were randomly divided into two groups, 3–7 days postpartum. The experimental group received a food inducing AF. The control group received the same type of food, without AF‐inducing properties. Milk was tested for AF after the mothers had eaten the cereals for 4–5 wk. AF was determined by intravenous injection of milk samples into rats measuring their capacity to prevent secretion into a gut loop of the rat injected with cholera toxin. Results: The median levels of AF differed between the experimental (n= 12) and control groups (n= 16): 1.1 (0.7–1.25) units vs 0.1 (0.0–0.25) units, Z =–4.492, p > 0.0001 (11 mothers dropped out and one milk sample is missing from one of the control mothers). The frequency of mastitis in the experimental compared with the control group was reduced (p= 0.0086, permutation test). The median AF levels in mothers with or without mastitis differed; 0.0 (0.0–0.1) vs 0.5 (0.2–1.1), Z =–2.399, p= 0.017.

Conclusion: We suggest a specially treated cereal induces AF in human milk and protects against clinically manifested mastitis.
Socio‐economic status and surgery in children: myringotomies and tonsillectomies in Ontario, Canada, 1996–2000
Authors: Croxford R , Friedberg J , Coyte PC
Published: August 2010

Aim: To examine the relation between socio‐economic status and (1) receipt of paediatric otolaryngological surgery, and (2) inclusion of adjuvant procedures. Methods: Using data on myringotomies with insertion of tympanostomy tube and tonsillectomies for all children in Ontario, Canada, from 1996 to 2000, and census data on socio‐economic status, we examined the association between socio‐economic status and (1) the probability of surgery (myringotomy or tonsillectomy), and (2) the probability that surgery was accompanied by an adjuvant procedure. Results: Lower socio‐economic status was associated with increased likelihood that a child's initial surgery was a tonsillectomy rather than a myringotomy (odds ratio per unit increase in the deprivation index = 1.09, p= 0.01, confidence interval 1.06–1.11), and with increased likelihood that those children having a myringotomy would undergo a tonsillectomy during the same hospitalization (odds ratio 1.14, p > 0.0001, confidence interval 1.11—1.16). Children from neighbourhoods with larger immigrant populations were less likely to receive either procedure (odds ratios per 1% increase in the proportion of immigrants = 0.97 (p > 0.0001, confidence interval 0.96–0.97) for myringotomies and 0.97 (p > 0.0001, confidence interval 0.97–0.98) for tonsillectomies).

Conclusions: Socio‐economic status was associated with treatment selection for the two most common paediatric surgical procedures. Further research should examine whether differences in treatment arise at the level of the primary care physician, the specialist, and/or are due to parental preference.
Phenotypic heterogeneity in AAAS gene mutation
Authors: Barat P , Goizet C , Tullio‐Pelet A , Puel O , Labessan C , Barthelemy A
Published: August 2010

We report the cases of two sibs of North African origin with AAAS gene mutation characterized by the heterogeneity of their phenotype. While an 8‐y‐old boy presented with acute adrenal insufficiency and mental retardation, the diagnosis was suggested by the clinical history of his 6‐y‐old sister who had symptomatic achalasia and chronic adrenal failure.

Conclusion: Our observations corroborate the phenotypic heterogeneity reported in triple A syndrome, and underline the possibility of a variable intra‐familial expression.
Optic nerve glioma and colonic polyposis: report of a new association
Authors: Sheta SS , El Toukhy EA , Khattab HM
Published: August 2010

Aim: The authors describe the clinical, radiological and histopathological features of an optic nerve glioma associated with colonic polyposis. The association between colonic polyposis and neuroepithelial tumours of the central nervous system has been previously described, but no association with optic nerve gliomas has ever been reported. Methods: We report a 14‐y‐old girl with colonic polyposis and unilateral proptosis for whom an excisional biopsy of the orbital lesion was performed. Results: Histopathological evidence of juvenile pilocytic astrocytoma grade 1 was detected. Correlation with criteria for Turcot's syndrome was established.

Conclusion: Optic nerve tumours should be included in the spectrum of central nervous system lesions associated with colonic polyposis.
Defective assembly of the respiratory chain
Authors: Esteitie N , Larsson N‐G
Published: August 2010

A functional respiratory chain is dependent on protein components encoded by both mtDNA and nuclear DNA. Isolated cytochrome c oxidase (COX) deficiency is often caused by mutations in nuclear genes regulating the assembly of the 13 protein subunits of this complex. The accompanying paper by Zeman and co‐workers reports that mutations in SCO2 are common in infantile COX deficiency and are associated with a very poor prognosis.

Conclusion: Molecular diagnosis is often feasible in patients with COX deficiency and particular attention should be paid to mutations in COX assembly genes.
Perinatal health in Pakistan: a review of the current situation*
Authors: Jalil F
Published: August 2010

The perinatal mortality rate of 63–92/1000 births as reported from two provinces of Pakistan is unacceptably high. A vast majority of births and neonatal deaths occur at home and remain unregistered. In spite of a number of child survival programmes of proven efficacy in place, the impact on perinatal health is poor.

Conclusion: Initiatives such as behaviour change communication, skill‐based training of birth attendants and reaching the un‐reached may be the key future strategies to reduce perinatal losses.
The effects of iron deficiency on infants' developmental test performance
Authors: Akman M , Cebeci D , Okur V , Angin H , Abali O , Akman AC
Published: August 2010

Aim: To assess the effects of iron deficiency on developmental test scores in infants. Methods: This prospective, single‐blind, controlled clinical intervention study was made on 108 children aged 6–30 mo who applied to our paediatric outpatient clinic. The cases were classified as control (n= 31, haemoglobin ± 11 g/dl, serum ferritin >12 μg/l, MCV ± 70 fl), non‐anaemic iron deficiency (NAID, n= 40, haemoglobin ± 11 g/dl, serum ferritin ± 12 μg/l, MCV ± 70 fl) and iron deficiency anaemia (IDA, n= 37, haemoglobin < 11 g/dl, ferritin ± 12 μg/l, MCV >70 fl) due to their anaemia status. In each group, MCV, haemoglobin and ferritin levels were measured, and Denver Developmental Screening Test (DDST) and Bayley Scales of Infant Development (BSID‐I) were administered before and after a 3‐mo follow‐up. IDA and about half of the NAID subjects were treated with oral iron for 3 mo. Results: Subjects with iron deficiency showed significantly lower developmental test scores both with BSID‐I and DDST‐II compared to their iron‐sufficient peers (p < 0.05). After 3 mo of iron treatment, lower mental developmental test scores were no longer observed among the IDA and NAID groups whose anaemia and iron deficiency were also corrected. No significant differences were found between control NAID and control IDA groups on DGTT‐II results after treatment. The difference in motor and mental developmental scores did not appear to depend on environmental and family factors considered in the analyses.

Conclusion: These findings support the conclusions that iron deficiency may cause lower mental and motor test scores in infants and these adverse effects can be improved by iron therapy.
Cushing's syndrome in pregnancy and neonatal hypertrophic obstructive cardiomyopathy
Authors: Fayol L , Masson P , Millet V , Simeoni U
Published: August 2010

Cushing's syndrome is rare in pregnancy but can cause spontaneous abortion, stillbirth or premature birth. We report a case of transient hypertrophic obstructive cardiomyopathy in a newborn whose mother had hypercortisolism due to a primary adrenal lesion. There was no family history of hypertrophic obstructive cardiomyopathy. Follow‐up revealed complete resolution of the cardiac abnormalities in the infant. Cushing's syndrome in the mother resolved after delivery. Although maternal hypercortisolism seldom results in symptomatic hypercortisolism in the newborn, hypertrophic obstructive cardiomyopathy can occur.
A classification of end‐of‐life decisions in neonates and infants
Authors: Provoost V , Deliens L , Cools F , Deconinck PG , Ramet J , Mortier F , Vandenplas Y
Published: August 2010

Aim: Valid and reliable data are needed to gain insight into the decisions of paediatricians concerning the end of life of newborns and infants. Such data could throw light on the poorly documented aspects of medical practice regarding these end‐of‐life decisions (ELDs). In this article a classification of ELDs is developed.Methods: The classification is developed from knowledge generated from large‐scale epidemiological studies on ELDs.Results: This classification sets out from considerations of the various possible medical end‐of‐life procedures for newborns and infants and from important ethical aspects of the decision‐making process. From both ethical and legal viewpoints the life‐shortening intention of the physician is a significant factor for the qualification of ELDs. Furthermore, the consultation of the parents is an important factor in absence of the possibility of the patient's self‐determination.

Conclusion: This classification has been devised with the aim of making reliable and valid descriptions of both the incidence and nature of ELDs in this specific population of newborns and infants.
Prevention of neonatal cold injury in preterm infants
Authors: Tunell R
Published: August 2010

In many parts of the world neonatal cold injury still contributes to neonatal death in preterm or growth‐retarded neonates. Kangaroo Mother Care might improve the situation and is the only effective, affordable and available method to prevent neonatal hypothermia in most developing countries. In developed countries, highly sophisticated incubators and radiant warmers are available but there is increasing concern about the long‐term effects of high levels of sound, disturbing light and unplanned procedures which can have a bearing on the use of these tools. A controlled clinical trial of cot‐nursing with a heated, water‐filled mattress is presented in this issue of Acta Pædiatrica.

Conclusion: The results from the new trial and the recently published systematic reviews by the Cochrane Library of technologies to provide warmth to preterm infants in modern neonatal intensive care units, makes it possible to suggest the place of available tools: incubators, radiant warmers, heated water‐filled mattresses and care in skin‐to‐skin contact.
Detection of Mycobacterium tuberculosis in gastric aspirate and sputum collected from Ethiopian HIV‐positive and HIV‐negative children in a mixed in‐ and outpatient setting
Authors: Palme I Berggren , Gudetta B , Bruchfeld J , Eriksson M , Giesecke J
Published: August 2010

Aim: To investigate, through a prospective study, the detection rate of Mycobacterium tuberculosis in sputa and gastric aspirate from tuberculous children in a low‐income country with high prevalence of tuberculosis and an increasing HIV epidemic. Methods: Gastric aspirates and/or sputum samples were collected from 355 children with pulmonary tuberculosis as follows: from 136 children under 5y only gastric aspirate was taken, for 159 children aged 5 to 9 y both methods were used, and for 60 children over 10 y only sputum was analysed. The diagnosis of tuberculosis was based on clinical data, tuberculin test and chest radiography. All children were tested for HIV infection. Results: Direct microscopy for acid‐fast bacilli was positive for 55 (15%) and mycobacterial culture for 183 (52%) children. The proportion of positive cultures was similar in all age groups. Among the 5 to 9 year‐old children who could produce a sputum sample, sputum gave just as good culture yield of M. tuberculosis as gastric aspirate. Of the clinical or radiological findings only weight loss was associated with a higher yield. Repeat gastric aspirate increased the culture yield by 6%. Mycobacterial culture from HIV‐positive children gave lower yield compared with HIV‐negative children.

Conclusion: Our data suggest that one gastric aspirate for children less than 6 y and three sputum samples for the older children collected at an outpatient TB clinic, is enough to provide a close to 50% yield of M. tuberculosis available for culture and further analyses. However, with an increasing prevalence of HIV, this detection rate may be reduced.
Elemental versus polymeric enteral nutrition in paediatric Crohn's disease: a multicentre randomized controlled trial
Authors: Ludvigsson JF , Krantz M , Bodin L , Stenhammar L , Lindquist B
Published: August 2010

Aim: To compare the efficacy and safety of an elemental and a polymeric diet as the primary therapy for active Crohn's disease in children. Methods: In a randomized, non‐blind, multicentre, controlled trial in Sweden, 16 children with Crohn's disease received Elemental 028 Extra (E028E) and 17 Nutrison Standard (NuS). Remission rates (Paediatric Crohn's Disease Activity Index (PCDAI) < 10 or a PCDAI decrease of 40% or 15 points of initial level) were compared at 6 wk. Results: There was no significant difference between the two groups in remission rate at 6 wk (intent‐to‐treat analysis): E028E 11/16 (69%) and NuS 14/17 (82%) (p= 0.438). There was no difference in the decrease in PCDAI and CDAI between patients treated with E028E and those treated with NuS from 0 to 6 wk. Patients treated with NuS gained significantly more weight than patients treated with E028E (+2.5 kg; 95% CI 0.9, 4.1; p= 0.004), this difference remained when adjusting for maximum caloric intake per kilogram bodyweight (+2.9 kg; 95% CI 1.4, 4.5; p= 0.001). Concomitant disease, complications and side effects were seen in 5/33 patients (pyelonephritis, pneumonia, intraabdominal abscess, perianal abscess and borborygmi).

Conclusion: E028E and NuS did not differ in terms of remission rate. Patients treated with NuS gained more weight than patients with E028E. Polymeric diet may be superior to elemental diet in the treatment of paediatric Crohn's disease where the primary aim is to increase the patient's weight.
Cot‐nursing using a heated, water‐filled mattress and incubator care: a randomized clinical trial
Authors: Gray PH , Paterson S , Finch G , Hayes M
Published: August 2010

Aims: To evaluate the thermal responses and weight gain in preterm infants nursed in a cot on a heated, water‐filled mattress (HWM) compared with infants receiving care in an air‐heated incubator and to compare mothers' stress, anxiety levels and perceptions of their infants in the two groups. Methods: Stable preterm infants weighing 1300 to 1500 g were enrolled, being randomly allocated to either the study group (n= 41) receiving care in a cot on an HWM, or the control group (n= 33) receiving incubator care. The mean daily body temperature and episodes of cold stress and hyperthermia were recorded. Weight gain (g kg−1 body weight d−1) was also calculated. The mothers completed questionnaires on their perceptions of their infants, and their anxiety and stress levels before randomization, and 2–3 wk later during the trial. Results: The mean body temperature was similar for the first week of the trial (study group 36.9°C vs controls 36.9°C). There were no significant differences in the incidence of cold stress, while more hyperthermic episodes were seen in the study group (p= 0.03). There were no significant differences in weight gain during the first (study group 21.4 g vs controls 19.6 g) or second weeks of the trial (study group 20.5 g vs controls 19.2 g). Neonatal morbidity did not differ between the groups. There were no differences in mothers' perceptions of their babies, or feelings of stress or anxiety.

Conclusion: There were no differences between infants cot‐nursed on an HWM and those receiving incubator care, with the exception of episodes of high temperature. The results suggest that the HWM may be used safely for low‐weight preterm infants.
Evaluation of an amikacin loading dose for nosocomial infections in very low birthweight infants
Authors: Berger A , Kretzer V , Gludovatz P , Heinze G , Haiden N , Pollak A
Published: August 2010

Aim: To develop a simplified amikacin dosage regimen for nosocomial infections in preterm infants including a loading dose in order to achieve therapeutic Maximum Serum Concentrations early in the course of therapy. Methods: Open, non‐comparative study during November 2000 to April 2001. The modified amikacin dosing and monitoring protocol included a loading dose of 10mg/kg in the first week of life, followed by a maintenance regimen of 7.5 mg/kg every 24 h. After the first week of life the corresponding doses were 17 mg/kg (loading) and 15 mg/kg (maintenance). A peak level was measured 30 min after the second dose, a trough level immediately before the third dose. Results: Twenty‐five very low birthweight infants (median birthweight 739 g, median gestational age 25 wk) who had 34 episodes of amikacin treatment were included in the analysis. Median amikacin peak and trough values were 37.1 μmol/1 and 6.3 μmol/1, respectively. Twenty‐nine of all peak levels (85%) and 30 of all trough levels (88%) were within the targeted range of >35 μmol/1 and <8.5 μmol/1, respectively. All patients with elevated trough levels were of extremely low birthweight and were born in the 24th week of gestation. Hearing evaluations were performed in 17 of 19 surviving infants at discharge home, all of which gave normal results.

Conclusion: The new amikacin dosing protocol yielded targeted peak and trough concentrations in a high percentage of very low birthweight infants with nosocomial infection after the first week of life. Our simplified dosage regimen achieved acceptable serum concentrations in all birthweight and gestational age groups, with the exception of extremely low birthweight infants weighing less than 700 g and/or with a gestational age of 24 wk or less. Only limited information can be gained from our data regarding the use of amikacin during the first week of life.
Long‐term follow‐up of otherwise healthy term infants with marked hyperbilirubinaemia: should the limits of exchange transfusion be changed in Turkey?
Authors: Duman N , Özkan H , Serbetçioglu B , Ögün B , Kumral A , Avci M
Published: August 2010

Aim: To evaluate prospectively non‐haemolytic term infants with marked hyperbilirubinaemia treated by phototherapy only for evidence of bilirubin toxicity at 2–6 y of age, and to determine the suitability for Turkish children of the exchange transfusion limits recently reported by the American Academy of Pediatrics. Methods: The study group included a total of 30 children, aged 2–6 y, who had developed marked hyperbilirubinaemia (20–24 mg dl−1, 342–410 μmol l−1) during the newborn period (gestational age >37wk, birthweight >2500 g) and were treated without exchange transfusion because intensive phototherapy, instituted during the preparations for exchange transfusion, was successful in decreasing their serum bilirubin levels. The control group consisted of 30 children of the same age group without clinical jaundice in the newborn period. Physical and neurological examinations, brainstem auditory‐evoked potentials (BAEPs) and developmental tests for Turkish children were performed in both the study and control children. Results: There was no difference between the groups with regard to mean BAEP latencies and developmental scores. None of the infants had hearing loss, developmental delay or abnormal neurological findings.

Conclusion: The results suggest that successful intensive phototherapy without exchange transfusion in otherwise healthy term newborn infants with marked hyperbilirubinaemia (20–24 mg dl−1, 342–410 μmol l−1) might not increase the risk of bilirubin brain injury and that the conventional limit of 20 mg dl−1 (342 μmol l−1) could be changed to 22–24 mg dl−1 (376–410 μmol l−1) for healthy term infants in Turkey. These limits, however, address only infants who do not have haemolytic disease, and the data are not sufficient to draw conclusions on the safety of even higher bilirubin levels (i.e. >24 mg dl−1, 410 μmol l−1) in this population.
Cross‐sectional study of allergic disorders in relation to familial factors in Japanese adolescents
Authors: Miyake Y , Yura A , Iki M
Published: August 2010

Aim: The roles of heredity and the household environment in the development of allergic disorders are not clearly established. This study examined the relationship between selected familial factors and the prevalence of symptoms of wheeze, atopic eczema and rhinoconjunctivitis in Japanese adolescents. Methods: Study subjects were 5539 students aged 12–15 y in Suita City. A questionnaire ascertained gender, grade, number of older siblings, maternal age at childbirth, smoking in the household, domestic pets and parental history of allergy, as well as signs and symptoms of allergy in the previous 12 mo. The latter were based on diagnostic criteria from the International Study of Asthma and Allergies in Childhood. Results: Male gender was independently associated with an increased prevalence of wheeze and a decreased prevalence of atopic eczema. The prevalence of rhinoconjunctivitis, but not wheeze or atopic dermatitis, significantly increased with advancing grade. A significant inverse dose‐response relationship between the number of older siblings and the prevalence of rhinoconjunctivitis, but not wheeze or atopic dermatitis, was observed. Maternal age at childbirth, smoking in the household and domestic pets were not apparently related to any of the allergic disorders. A positive maternal allergic history was more evidently associated with an increased prevalence of wheeze and rhinoconjunctivitis, but not atopic eczema, than a positive paternal allergic history.

Conclusion: The findings suggest that the factors associated with allergic disorders in Japan are largely the same as those already identified in Western populations.
Urinary and faecal incontinence: a population‐based study
Authors: Söderstrom U , Hoelcke M , Alenius L , Söderling A‐C , Hjern A
Published: August 2010

Aim: To investigate the coexistence of urine and faecal incontinence in Swedish schoolchildren. Methods: Cohort study of all schoolchildren in the first and fourth grades in the city of Eskilstuna. A questionnaire was used, in which parents reported the prevalence of urine and faecal incontinence for their children, with a response rate of 67%. Data were analysed with multiple logistic regression. Results: Daytime urinary incontinence (at least once a month) was reported in 6.3% of the first graders and 4.3% of the fourth graders, while bedwetting (at least once a month) was reported in 7.1% and 2.7% and faecal incontinence in 9.8% and 5.6%, respectively. Daytime urinary incontinence was strongly associated with faecal incontinence; adjusted odds ratio (OR) 7.2 (p < 0.001) as well as with bedwetting; OR 4.1 (p < 0.001), whereas faecal incontinence and bedwetting lacked a significant association (OR 1.2).

Conclusion: This study demonstrates that soiling and daytime urinary incontinence often coexist in Swedish schoolchildren. Collaborative treatment strategies with gastroenterological and urological content need to be developed for these children.
Serosurveillance for Japanese encephalitis in children in several districts of West Bengal, India
Authors: Chatterjee S , Chattopadhyay D , Bhattacharya MK , Mukherjee B
Published: August 2010

Aim: To evaluate the prevalence of antibodies to flaviviruses, particularly Japanese encephalitis (JE) in children. Methods: Virological and serological investigations were conducted into JE, along with dengue 2 (Den2) and West Nile viruses, in the Flavivirus group. The paediatric age group (up to 10 y), in the districts of Burdwan, Bankura, Midnapore and Purulia of West Bengal, India, was assessed for recent activity of these viruses, for 4 consecutive years from 1996 to 1999. In total, 2260 sera samples were collected, of which 204 were from acute fever cases; only 72 paired sera were available. There was a significantly higher incidence of fever cases in children belonging to the schedule caste and schedule tribes. These communities occupy the lowest level in the society and are closely associated with pigs. Results: No virus could be isolated from the sera collected from fever cases. The results of the serological survey showed the presence of antibodies to JE virus in only 13.3% of the contact sera, 33.3% of acute sera and 22.1% of convalescent sera investigated. Only 3.1% of the contact sera had antibodies to Den2 and no antibodies were found against West Nile virus. This indicates that the JE virus is in recent circulation in the population of these four districts, and as the majority of children lack substantial immunity to JE virus, they may be affected by an epidemic.

Conclusion: Children up to 10 y of age in the four districts of West Bengal are mostly non‐immune to JE virus. If an outbreak occurs, the majority of these populations may be affected.
Follow‐up of acute pulmonary complications in cystic fibrosis by magnetic resonance imaging: a pilot study*
Authors: Hebestreit A , Schultz G , Trusen A , Hebestreit H
Published: August 2010

The aim of this pilot study was to obtain information on the value of MRI in the follow‐up of atelectasis and pneumonic infiltrates in cystic fibrosis (CF). Six patients aged 5–15 y were initially examined using chest X‐ray and magnetic resonance imaging (MRI). Both methods provided identical information. During follow‐up, MRI proved suitable to monitor pulmonary complications.

Conclusion: MRI of the lung is feasible and valuable in the follow‐up of atelectasis and pulmonary infiltrates in CF.
The number of authors of scientific publications
Authors: Zetterström Rolf
Published: August 2010

As in most other scientific journals, the number of authors per paper published in Acta Paediatrica is gradually increasing. In the 2003 volume, the number of authors was six or more in about one‐third of the Regular papers and Clinical observations. The editorial board has handled several conflicts of interest due to disputes about authorship.

Conclusion: Editors of scientific journals should promote a policy with the aim of creating a true balance between authorship and originality of papers.
N‐terminal pro‐B‐type natriuretic peptide: reference plasma levels from birth to adolescence. Elevated levels at birth and in infants and children with heart diseases
Authors: Nir A , Bar‐Oz B , Perles Z , Brooks R , Korach A , Rein AJJT
Published: August 2010

Aim: Determination of plasma levels of N‐terminal pro‐B‐type natriuretic peptide (N‐BNP) in infants and children with and without heart diseases. Methods: Plasma N‐BNP was measured in 78 infants and children without heart disease and in 55 infants and children with heart disease causing volume and pressure overload. Heart diseases included chronic dilated cardiomyopathy, acute left ventricular dysfunction, and congenital cardiac anomalies resulting in left and right ventricular volume or pressure overload. The Mann‐Whitney rank‐sum test and the ANOVA for ranks test were used to compare two or more groups, respectively. Results: N‐BNP levels were elevated in the first days of life but were not significantly different in children from 4 mo to 15 y old. The upper limit in children older than 4 mo with no heart disease was 349 pg/ml. In patients with heart disease, N‐BNP levels were significantly higher than in control children (p < 0.0001).

Conclusion: N‐BNP levels are elevated in the first days of life and are stable from age 4 mo to adolescence. Elevated N‐BNP levels reflect cardiac dysfunction in infants and children.
Lung volume and the response to high volume strategy, high frequency oscillation
Authors: Dimitriou G , Cheeseman P , Greenough A
Published: August 2010

Background: Infants with severe respiratory failure are frequently transferred to high volume strategy, high frequency oscillation (HFO). Mean airway pressure (MAP) is then elevated, the aim being to open up atelectatic lungs and hence improve gas exchange. Aim: To test the hypothesis that lung volume prior to transfer would predict the response to high volume strategy HFO and identify which factors related to poor outcome (death). Methods: Lung volume was assessed by measurement of functional residual capacity (FRC) and the response to HFO determined by the change in the alveolar arterial gradient (AaDO2) on transfer from conventional mechanical ventilation (CMV) to the optimal MAP on high volume strategy HFO. Patients: Forty‐two infants with a median gestational age of 28 (range 23 to 40) wk were studied. Results: FRC prior to transfer correlated significantly with the change in MAP necessary to optimize oxygenation (p= 0.012), but not the change in AaDO2 in response to HFO. There were no significant differences in the lung volumes of survivors and non‐survivors, but those who died were more immature (p= 0.0009) and had a smaller response to HFO (p= 0.035).

Conclusion: Lung volume prior to transfer to high volume strategy HFO might be helpful to guide oscillatory settings, but is a poor predictor of the response to high volume strategy HFO.
Whole blood interleukin 8 and plasma interleukin 8 levels in newborn infants with suspected bacterial infection
Authors: Franz AR , Sieber S , Pohlandt F , Kron M , Steinbach G
Published: August 2010

Aim: To evaluate a new micro‐method technique for measurement of interleukin 8 in detergent‐lysed whole blood (whole blood IL‐8) applicable to capillary blood sampling as a test for bacterial infections in neonates. Methods: Whole blood IL‐8 was measured at the first suspicion of infection along with IL‐8 determined in plasma (plasma IL‐8), C‐reactive protein and blood cultures in 154 consecutive newborn infants with clinical signs of bacterial infection. Only 20 μl of whole blood were required for the new assay. Results: Blood culture‐proven infections were diagnosed in six infants and clinical infection (defined as a combination of clinical and laboratory signs) in 20 infants. 1000 pg/ml was determined as the suitable threshold for whole blood IL‐8 by ROC‐curve analysis. At that threshold, whole blood IL‐8 detected blood culture‐proven infections with a sensitivity of 83% and a specificity of 67%. The areas under the ROC curves were similar for whole blood IL‐8 and plasma IL‐8.

Conclusions: Compared with plasma IL‐8, whole blood IL‐8 offers the advantages that measurements of whole blood IL‐8 require a smaller blood sample volume and are not altered by haemolysis. The diagnostic accuracy of whole blood IL‐8 remains to be studied in more detail in the future.