bluuebunny/crossref_metadata_2025 huggingface dataset:
Prediction of respiratory distress syndrome by the microbubble stability test on gastric aspirates in newborns of less than 32 weeks’gestation
Authors: Verder H , Ebbesen F , Linderholm B , Robertson B , Eschen C , Arrøe M , Lange A , Grytter C , Bohlin K , Bertelsen A ,   for the Danish‐Swedish Multicentre Study Group
Published: August 2010

Aim: There is a need for a rapid method to identify infants who will develop respiratory distress syndrome (RDS) soon after birth, to allow early treatment of affected infants with surfactant. The microbubble stability test (MST) may be one such method, but clinical experience is sparse. Methods: The MST was performed on gastric aspirates from 188 infants with a mean gestational age of 29 (range 23–31) wk. Results: 87 infants developed moderate to severe RDS, corresponding to a prevalence of 46%. The sensitivity, specificity and predictive values for identification of infants with moderate to severe RDS were determined for the average diameter of bubbles, the proportion of microbubbles with different diameters and the total number of microbubbles. The proportion of microbubbles with diameters <20 or 25 urn gave the best prediction, with a sensitivity of 78–79%, a specificity of 57–58%, a positive predictive value of 62% and a negative predictive value of 76%. Early treatment with nasal continuous positive airway pressure probably mitigated the development of RDS in some infants with a low‐degree surfactant deficiency and this may explain the relatively low specificity.

Conclusion: In infants of <32wk gestation RDS can be predicted by computerized image analysis of the size distribution of microbubbles generated in gastric aspirates.
Age at diagnosis of vesicoureteric reflux after urinary infections: historical changes
Authors: Marra G , Oppezzo C , Barberis V , Bianchetti MG
Published: August 2010

Aim: Efforts are currently made to detect vesicoureteric reflux (VUR) early after urinary infections in order to limit secondary renal damage. This study investigated the extent to which recommendations for the detection of VUR are put into practice, and their influence on the age at diagnosis. Methods: The age at diagnosis of VUR after urinary tract infections was analysed in 126 patients (48M, 78F) referred to a tertiary centre in Milan between 1976 and 1999. Results: The median age at diagnosis was 34 mo in subjects born before and 8 mo (p < 0.001) in those born after 1988. The difference was statistically significant in female but not in male subjects. The figures from Milan were compared with those for 102 patients (35M, 65F) born between 1946 and 1970, treated in Melbourne and reported in 1976. In Melbourne the median age at diagnosis was 1–2 y for boys and 5–6 y for girls; in Milan, the corresponding figures were <1y and 1–2 y. The difference between Melbourne and Milan was statistically significant for both genders.

Conclusion: In Milan VUR is now detected earlier than in the past. This trend is more marked in females than in males, but reflux is still detected earlier in boys.
Epidemiology of childhood type I diabetes in Crete, 1990–2001
Authors: Mamoulakis D , Galanakis E , Bicouvarakis S , Paraskakis E , Sbyrakis S
Published: August 2010

Aim: To study the epidemiological patterns of childhood‐onset type I diabetes in Crete, Greece. Methods: The incidence (new cases per 100000 per year) from 1990 to 2001 was determined in the population of Crete ≤14 y of age. Results: A total of 89 cases was ascertained. The standardized annual incidence rate was 6.1 per 100000 population [95% confidence interval (95% CI) 4.9‐7.5]. Incidence rates were higher in children 10–14 y of age, boys and residents of urban areas (6.8, 6.7 and 6.6 per 100000, respectively). Incidence rates were higher [relative risk (RR) 1.46, 95% CI 0.956‐2.24] during the 6 y period 1996–2001 (7.2, 95% CI 5.4‐9.4) than during the 6 y period 1990–1995 (4.9, 95% CI 3.4‐6.9). This increase was more prominent in residents of urban areas and 10–14‐y‐old children.

Conclusions: Although an increase was noted during the period 1990–2001, the childhood type I diabetes incidence rates in Crete remain among the lowest both in Europe and in the Mediterranean islands.
Postnatal dexamethasone: what is the real cost‐benefit ratio?
Authors: Halliday HL
Published: August 2010

Postnatal corticosteroids given early after birth reduce the risk of chronic lung disease in preterm infants but are associated with an approximate doubling of the risk of adverse neurosensory outcomes. Corticosteroids given after 7–10 d of age appear not to have these increased risks of neurosensory sequelae and reduce time on the ventilator.

Conclusion: Further research is needed to determine the lowest dose of corticosteroid that will improve lung function and minimize risks to the developing brain.
Early chemotherapy for non‐tuberculous mycobacterial infections in patients with cystic fibrosis
Authors: Forslöw U , Geborek A , Hjelte L , Petrini B , Heurlin N
Published: August 2010

Aim: To evaluate the response rate to antimycobacterial drug therapy in patients with cystic fibrosis (CF) suffering from infection by non‐tuberculous mycobacteria (NTM). Methods: Ten patients, aged 10–34 y, out of 180 CF patients, were diagnosed with NTM disease. They had been regularly checked and examined for pulmonary symptoms, and had had chest X‐rays and sputum cultures (including for mycobacteria) performed. One additional 36‐y‐old female received her CF diagnosis soon after the NTM diagnosis. Results: Mycobacterium avium‐intracellulare complex (MAC) was found in 10 out of 11 patients and M. kansasii in 1 patient. Treatment with antimycobacterial drugs resulted in clinical improvement (weight gain or stabilization of weight and/or improved or stabilized lung function in 8 out of 11 patients) and mycobacterial culture turned negative in 10 out of 11.

Conclusion: Promising results may be associated with early intervention with antimycobacterial therapy in CF patients.
Energy expenditure in infants with congenital heart disease, including a meta‐analysis
Authors: van der Kuip M , Hoos MB , Forget PP , Westerterp KR , Gemke RJBJ , Meer K de
Published: August 2010

Aim: To assess energy requirements and body composition in preoperative children with congenital heart disease (CHD). Methods: In 11 infants with CHD (2–8 mo), total daily energy expenditure (TDEE) and total body water (TBW) were measured with doubly labelled water and compared with historic data from healthy controls. Within the patient group, energy expenditure of infants with versus those without congestive heart failure was compared. Subsequently, the data were pooled with literature data in meta‐analyses. Results: CHD patients showed increased TBW (mean ± SD 66 ± 3 vs 58 ± 5% of body weight, p < 0.05) and energy expenditure (381 ± 42 vs 298 ± 36 kJ kg‐1d‐1, p < 0.001). Meta‐analyses showed that CHD infants have 35% increased TDEE (376 vs 278 kJ kg‐1 d‐1, p < 0.00001) and 7% higher TBW (p < 0.0001). Coexistent congestive heart failure (treated with diuretics) had no influence on TDEE (mean difference 14 kJ kg‐1d‐1, not significant). In patients with heart failure and growth retardation, an energy balance study showed an average 12% loss of initially ingested energy due to vomiting, increased TDEE and low faecal energy loss, resulting in low energy available for growth, compared with controls (42 ± 30 vs 96 ± 61 kJ kg‐1 d‐1, p < 0.05).

Conclusion: Many infants with CHD require substantially higher energy intake (at least 100 kJ kg‐1 d‐1 extra) owing to increased TDEE, which is not explained by a higher percentage of body water. Coexistent heart failure does not appear to have an additional influence on TDEE. In infants with CHD and growth failure factors other than elevated TDEE, including vomiting, may explain the disturbed energy balance.
Attention and memory training in children with acquired brain injuries
Authors: Hooft I van't , Andersson K , Sejersen T , Bartfai A , Wendt L von
Published: August 2010

Aim: To test the feasibility of the Amsterdam memory and attention training for children (Amat‐c) in Swedish children with acquired brain damage. Methods: Amat‐c consists of structured exercises in specific attention and memory techniques. Three Swedish children aged 9–16 y with acquired brain injuries and related memory and attention deficits trained with the Amat‐c method for half an hour a day in school or at home interactively with a teacher or parent for a period of 20 wk. Results: All children and their coaches completed the training without interruption. The results showed an improvement in several neuropsychological tests of sustained and selective attention as well as in memory performance. Questionnaires filled in by parents and teachers indicate that, using the Amat‐c method, the children learned strategies that improved their school achievement and self‐image.

Conclusions: The Amat‐c is a valuable treatment option for improving cognitive efficiency in children with acquired brain injuries. The results indicate improved performance in several psychometric measurements. On the basis of these results, the second step will be to modify the complexity and duration of the method, as well as to integrate a reward system before further evaluating the efficacy in a larger controlled study.
Correlates of breastfeeding duration in an urban cohort from Argentina
Authors: Berra S , Sabulsky J , Rajmil L , Passamonte R , Pronsato J , Butinof M
Published: August 2010

Aim: To analyse factors associated with the duration of breastfeeding in a representative cohort of mothers and children, including socio‐demographic and cultural characteristics, breastfeeding antecedents, perinatal factors and perinatal healthcare practices. Methods: The study was conducted in the city of Cordoba, between 1993 and 1998. Mother‐child binomials from all public and private hospitals were asked to participate. Follow‐up consisted of home visits at 30 d, 6, 12, 24, 36, 48 and 50 mo. Information was obtained on 650 healthy newborns. Cessation of breastfeeding during the first 24 mo of life was analysed using the Kaplan‐Meier method, and factors associated with weaning were studied using Cox's proportional risk regression. Results. The median duration of breastfeeding was 4 mo. Factors associated with weaning were: the introduction of artificial formulas within 30 d postpartum [relative risk (RR) = 2.27; 95% confidence interval (CI) = 1.82–2.82]; breastfeeding of a previous child for less than 6 mo (RR=1.64; 95% CI = 1.32–2.02); delay in the first mother‐child contact for over 90 min (RR=1.50; 95% CI = 1.17–1.93); mother's having completed primary or partially completed secondary education (RR= 1.40; 95% CI = 1.01–1.92) or completed secondary education or higher (RR= 1.59; 95% CI = 1.14–2.22); primiparous mother (RR= 1.39; 95% CI = 1.12–1.74) and; the mother recalling having been breastfed for less than 6 mo (RR = 1.27; 95% CI = 1.01–1.61).

Conclusions. The purpose of strategies to promote breastfeeding should be to eliminate inappropriate care practices, such as delay in the first mother‐child contact, as well as reducing the impact of other factors leading to the introduction of artificial milk. Moreover, mothers need more and better support from professionals and peers.
Prebiotic concept for infant nutrition
Authors: Boehm G , Fanaro S , Jelinek J , Stahl B , Marini A
Published: August 2010

In the neonatal period, the intestine is colonised in a stepwise process that depends on mode of delivery, environmental factors, bacterial interactions, and the host itself resulting in a colonisation with a complex heterogeneous bacterial flora. Oligosaccharides have been identified as an important prebiotic factor of human milk As long as analogues of human milk oligosaccharides are not available now and in the near future it is aimed to resemble the prebiotic effect of human milk by oligosaccharides from available sources. In the present study in preterm infants, a mixture of 90% galacto‐oligosaccharides and 10% fructo‐oligosaccharides has been tested. The mixture of GOS/FOS was composed to mimic the molecule size distribution of human milk oligosaccharides. Microbiological analysis of the faces was performed before and 7, 14, and 28 days after start of supplementation and stool characteristics have been recorded. Maltodextrin was used as placebo and infants fed human milk have been used as reference. After a 28 days feeding period, the number of bifidobacteria of the group fed the oligosaccharide supplemented formula was in the upper range of the reference group whereas the numbers of the group fed the formula supplemented with the placebo were in the lower range of the reference group (placebo: 7.9 ± 0.83 and GOS/FOS mixture: 10,0 ± 2.05 log 10 CFU/g wet stool; reference (M ± SD): 7.14‐10.7 log 10 CFU/g wet stool). Stool characteristics in the group fed the supplemented formula were close to those found in the human milk fed infants. In summary, supplementation of a preterm formula with a mixture of galacto‐ and fructo‐oligosaccharides has a stimulating effect on the growth of bifidobacteria in the intestine and results in more frequent produced and softer stools. Thus, prebiotic mixtures such like the studied oligosaccharide mixture might help in improving intestinal tolerance to enteral feeding in preterm infants.
Pro‐ and pre‐biotics administration in preterm infants: colonization and influence on faecal flora
Authors: Marini A , Negretti F , Boehm G , Destri M Li , Clerici‐Bagozzi D , Mosca F , Agosti M
Published: August 2010

Prolonged administration of probiotic in preterm babies induce a rise of specific IgA and IgM antibodies against probiotic. This fact explains why presence of living germs in stools almost disappeared in spite of continuous administration. However some positive influences were observed: decreased ratio of aerobic/anaerobic. Increased ratio of gram +/gram – germs. Prebiotic administration induces after 28 days a significant increase of faecal bifidobacteria and frequency and consistency of stools were more similar to those observed in subjects fed with human milk.
Seasonal and environmental effects on breast milk fatty acids in Burkina Faso and the need to improve the omega 3 PUFA content
Authors: Thiombiano‐Coulibaly N , Rocquelin G , Eymard‐Duvernay S , Kiffer‐Nunes J , Tapsoba S , Traoré SA
Published: August 2010

Aim: To determine the Burkinabè breast milk lipid content and fatty acid composition and to compare these values with the recommended adequate intakes. Methods: The study comprised four cross‐sectional surveys conducted in urban and rural Burkina Faso at two different times of the year: during a period of food shortage (lean season) and during a favourable food availability period (post‐harvest season). The subjects were apparently healthy mothers nursing 5‐mo‐old infants. A total of 70 urban and 52 rural mothers and 100 urban and 98 rural mothers, respectively, during the post‐harvest season and the lean season, completed the surveys. The surveys were conducted in January‐February 2001 (urban) and 2002 (rural) corresponding to the post‐harvest season, and in April‐May 1998 (urban) and 1999 (rural), which is the lean season, and were carried out during home visits. The families were informed of the objectives of the study and gave their consent to participate. Breast milk samples were collected from each mother and analysed for lipid and fatty acid concentrations. Results: Noticeable breast milk characteristics were: low lipid content (30‐35 g/L), high C6:0‐C14:0 saturated fatty acids (27%‐33% total fatty acids), high linoleic acid (15%‐20% total fatty acids) and unbalanced linoleic/α‐linolenic acid (20:1 to 53:1) and long‐chain ω6/long‐chain ω3 (3.6:1 to 4.9:1) polyunsaturated fatty acid ratios. In all life conditions and food availability, linoleic acid was in excess of and α‐linolenic was below the recommended adequate intakes. Over 80% of breast milk samples had linoleic/α‐linolenic acid and long‐chain ω6/ω3 polyunsaturated ratios well above the recommendations.

Conclusion: Improvement in breast milk ω3 PUFA seems to be recommendable in Burkina Faso, where breastfeeding is the primary infant feeding practice.
Phentolamine administration increases blood S100B protein levels in pediatric open‐heart surgery patients
Authors: Gazzolo D , Masetti P , Kornacka M , Abella R , Bruschettini P , Michetti F
Published: August 2010

Aim: Phentolamine administration during open‐heart surgery shortens the cooling and rewarming phases of cardiopulmonary bypass (CPB) and hastens weaning from mechanical ventilation and extubation. Data on the effects of phentolamine on cerebral circulation and function in this setting are lacking. This study reports the cerebral effects of phentolamine using blood S100B protein levels and the middle cerebral artery pulsatility index (MCA PI). Methods: Sixty pediatric patients undergoing congenital heart disease repair were randomly assigned to receive either phentolamine 0.2 mg kg‐1 i.v. (n= 30) or placebo (n= 30) before the cooling and rewarming phases of CPB. Samples for S100B measurement were collected at seven predetermined time‐points before, during and after surgery. MCA PI values were recorded at the same times as sampling. Results: S100B blood levels were higher in the phentolamine‐treated group than in controls after rewarming (3.53 ± 1.88 vs 1.58 ± 0.53 μg l‐1; p < 0.001), remained persistently higher at the end of surgery (2.95 ± 0.91 vs 0.79 ± 0.21 μg l‐1; p < 0.001) and returned to normal ranges 12 h later than in the placebo group (p > 0.05). MCA PI values were also significantly higher at the end of surgery in the phentolamine‐treated group (1.83 ± 0.50 vs 1.22 ± 0.34; p < 0.01). Cooling and rewarming times were shorter in the phentolamine‐treated group (p < 0.01, for all).

Conclusion: Despite improved peripheral vasodilatation and perfusion, phentolamine administration in pediatric open‐heart surgery is correlated with increased cerebrovascular resistance and brain damage.
Unilateral submandibular suppurative sialadenitis in a premature infant
Authors: de Haan TR , Grooters E , Frijns JHM , Walther FJ
Published: August 2010

Isolated submandibular suppurative sialadenitis is extremely rare in newborn infants and is associated with prematurity and prolonged gavage feeding. This report describes a premature infant who developed a life‐threatening airway obstruction due to suppurative submandibular sialadenitis. The diagnosis was made on clinical grounds and confirmed by ultrasonography. Staphylococcus aureus was grown from the pus expressed from the Wharton's duct orifice. Upper airway obstruction and respiratory failure were managed with intubation and mechanical ventilation, and the sialadenitis resolved quickly and completely with flucloxacillin treatment. Possible causes of sialadenitis include dehydration, decreased saliva flow and stasis during gavage feeding, duct obstruction by stones and direct bacterial inoculation. Ultrasonography is the diagnostic imaging of choice to exclude congenital tumours, lymphadenitis, congenital malformations of the Wharton's duct or the gland itself, and subcutaneous fat necrosis.

Conclusion: Early diagnosis and antibiotic treatment of suppurative submandibular sialadenitis may prevent complications such as abscess formation, septicaemia and respiratory failure.
Goldenhar syndrome and neuroblastoma: a chance association?
Authors: Michel‐Adde C , Laquerrière A , Eurin D , Drouin‐Garraud V , Marret S
Published: August 2010

Oculoauriculovertebral dysplasia, also called Goldenhar syndrome, includes several anomalies: epibulbar dermoids or lipodermoids, microtia, mandibular hypoplasia, vertebral, skeletal, cardiac and kidney anomalies, among others. Tumours have also been observed in patients with oculoauriculovertebral dysplasia. We report the first case of oculoauriculovertebral dysplasia associated with a neuroblastoma. This tumour consists of cells identical to early migratory neural crest cells in the embryo. Several theories have been proposed regarding the pathogenetic explanation of oculoauriculovertebral dysplasia. Currently, some researchers have suggested a deficiency in mesodermal formation or defective interaction between neural crest and mesoderm as a possible aetiology.

Conclusion: It is suggested that the case reported here is an additional argument for an anomaly in neural crest cell migration or interaction with the mesoderm in the pathogenesis of oculoauriculovertebral dysplasia.
Cholesterol metabolism in 8 to 12‐year‐old children born preterm or at term
Authors: Mortaz M , Fewtrell MS , Cole TJ , Lucas A
Published: August 2010

Studies in animals have indicated that cholesterol metabolism is susceptible to manipulation by diet and growth in early life. In humans, low birthweight has been associated with increased risk of coronary heart disease. Aim: To establish whether plasma lipids and indicators of cholesterol absorption, synthesis and breakdown differ in children born preterm and at term. Methods: Plasma total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, triacylglycerols, apolipoprotein A1, apolipoprotein B, lathosterol (indicator of cholesterol synthesis), campesterol (indicator of cholesterol absorption), 7‐α hydroxycholesterol (indicator of cholesterol breakdown) were measured in up to 407 children born preterm and 36 children born at term. Results: Children born preterm had lower cholesterol synthesis (p= 0.002) and lower cholesterol breakdown (p < 0.001) than those born at term, but their plasma cholesterol concentration was not significantly different. After adjusting for current size, birthweight and gestational age were significantly related to plasma lathosterol and 7‐α hydroxycholesterol. However, when both birthweight and gestational age were adjusted, only gestational age remained significant. There were no significant differences in plasma campesterol between the two groups.

Conclusion: Being born preterm may have a long‐term effect on cholesterol metabolism in children 8–12 y later. Those born prematurely had lower cholesterol synthesis and breakdown, but their plasma cholesterol concentration was similar at this age. These parameters need to be studied in older cohorts.
Vincristine in childhood leukaemia: no pharmacokinetic rationale for dose reduction in adolescents
Authors: Frost B‐M , Lönnerholm G , Koopmans P , Abrahamsson J , Behrendtz M , Castor A , Forestier E , Uges DRA , de Graaf SSN
Published: August 2010

Aim: To investigate whether there is any pharmacokinetic rationale for the common practice of administering vincristine to adolescents at relatively lower doses than those to younger children. Methods: A total of 98 children, aged 1.3–17.3 y, with acute lymphoblastic leukaemia (ALL) were studied on day 1 of induction therapy. Plasma samples were drawn before and 10, 30, 360 and 1380 min after injection of vincristine 2.0 mg/m2 (maximum dose 2.0 mg) and analysed by high‐performance liquid chromatography. Results: The median value (and range) for distribution half‐life was 6.4 min (0.8–11.8), elimination half‐life 1014 min (258–2570), volume of distribution 445 L/m2 (137–1241) and total body clearance 362 ml/min/m2 (134–2553). No correlation was found between age and any of these pharmacokinetic parameters. The area under the concentration time curve (AUC) was significantly correlated to age (p= 0.002; ρ– 0.31), as expected from the dosage of vincristine. The lower AUC in children with a body surface area > 1 m2, which is reached at 8–9 y of age, indicates that they received a less intense treatment because of the capping of the vincristine dose at 2.0 mg.

Conclusions: Vincristine pharmacokinetics were not age dependent in this paediatric population. Thus, we found no pharmacokinetic rationale for dose reduction in adolescents. The common practice of limiting the vincristine dose to 2.0 mg should be carefully reconsidered.
In the eye of the beholder: how accurate is clinical estimation of jaundice in newborns?
Authors: Riskin A , Kuglman A , Abend‐Weinger M , Green M , Hemo M , Bader D
Published: August 2010

Aim: Hour‐specific serum total bilirubin (STB) percentiles have proved useful in predicting which babies will develop significant neonatal hyperbilirubinemia (NHB) requiring intervention. This study investigated whether this assessment could be performed visually instead of by blood test. The aim was to evaluate the ability of experienced clinicians to determine accurately the level of clinical jaundice in neonates by visual means. Methods: Four neonatologists were asked to estimate the level of bilirubin in a group of 283 term clinically jaundiced infants before discharge from the nursery on day 3 of life. Their clinical estimation was compared with actual measurement of STB from samples drawn simultaneously. Results: Clinical estimation of STB had a high correlation to actual serum bilirubin levels (Pearson's correlation coefficient = 0.682, p < 0.001).

Conclusion: Clinical impression of jaundice by the eye of an experienced clinician is a reliable method to assess newborns for significant NHB and may diminish the need for universal serum sampling.
Thymic size in preterm neonates: a sonographic study
Authors: Jeppesen DL , Hasselbalch H , Nielsen SD , Sørensen TU , Ersbøll AK , Valerius NH , Heilmann C
Published: August 2010

Aim: To assess the variation in size of the thymus in vivo in preterm neonates and to identify relations between thymic size and gestational age (GA), birthweight, occurrence of postnatal infections and maternal alcohol and tobacco intake during pregnancy. Methods: Eighty preterm neonates with a GA between 24 and 36 wk, and a birthweight between 490 and 4110 g were examined between days 0 and 19 after birth. The thymic size was assessed by sonography as a volume estimate, the so‐called thymic index (Ti). The median Ti was 5.2 (1.2–17.9). Ti was positively correlated with birthweight and GA and negatively correlated with occurrence of postnatal infection (p < 0.01, p= 0.03, p= 0.05, R2= 0.68). A correlation between thymic size and maternal alcohol and tobacco intake was not demonstrated.

Conclusion: It is possible to assess the size of the thymus by sonography in very low‐birthweight and preterm neonates. A normal range for Ti in preterm neonates has been established. The sonographic method is a safe and effective technique for measuring the size of the thymus in preterm infants.
Short‐ and long‐term effects of neonatal glucocorticoid therapy: is hydrocortisone an alternative to dexamethasone?
Authors: van der Heide‐Jalving M , Kamphuis PJGH , van der Laan MJ , Bakker JM , Wiegant VM , Heijnen CJ , Veen S , van Bel F
Published: August 2010

Aim: To compare short‐term effects and neurodevelopmental outcome of neonatal glucocorticoid therapy between two centres. Methods: A retrospective study was performed in two centres using a tapering course of either 5 to 1 mgkg−1 hydrocortisone (HC; 22 d) or 0.5 to 0.1 mg kg−1 dexamethasone (DEX; 21 d). In both centres glucocorticoid‐treated infants and control patients were matched for gestational age, birthweight, severity of infant respiratory distress syndrome and periventricular‐intraventricular haemorrhage. The following short‐term glucocorticoid‐induced effects were investigated in 25 HC‐treated and 25 control patients in centre A, and in 23 DEX‐treated and 23 control patients in centre B: oxygen dependency (inspiratory oxygen fraction), arterial pressure, blood glucose and urea concentrations, weight gain and head circumference before, during and after therapy (in treated infants), or at an interval comparable to treated infants (in control infants). Neurological outcome, psychomotor development and school performance at 5–7 y of age was evaluated in all groups. Results: HC and DEX were equally potent in reducing oxygen dependency. Mean arterial pressure as well as blood glucose and urea concentrations were significantly increased during DEX, but not during HC treatment. Weight gain stopped during DEX therapy, but not during HC. Head circumference in both treatment groups was decreased after therapy compared with controls. Neonatally DEX ‐treated children needed special school education significantly more often (p < 0.01) than controls at 5–7 y of age. No differences between neonatally HC‐treated children and controls on neurodevelopmental outcome were found at 5–7 y of age.

Conclusion: Neonatal HC therapy has fewer short‐ and long‐term adverse effects than neonatal DEX therapy.
Vertical transmission of HIV‐1 infection and dilemma of infant feeding
Authors: Ehrnst A , Zetterström R
Published: August 2010

The problem of giving proper recommendations on early feeding of infants of HIV‐1‐positive mothers in countries with deficient hygienic conditions is discussed. Even in exclusive breastfeeding, which is associated with a lower risk of HIV transmission than when supplements are given, the risk that the infant will acquire HIV‐1 has to be balanced against the risk of formula feeding. Furthermore, it also has to be stressed that exclusive breastfeeding is a rarity in many poor countries.

Conclusion: The dilemma of recommending appropriate early feeding to HIV‐1‐positive mothers will persist until further studies of the type performed by the Coutsoudis group in South Africa have been performed.
Overnight central and peripheral temperature changes in normal infants
Authors: Tappin DM , Ford RPK , Price B , Macey PM , Larkin J
Published: August 2010

Aim: To explore the relationship between central and peripheral temperature in normal infants after being put down to sleep. Methods: Overnight shin and rectal temperatures of 21 normal infants were continuously recorded at home for three nights at 2 wk, 6 wk, 3 mo and 5 mo of age. Parents documented the start and end of feed/nappy changes during the night. Results: An initial fall in rectal temperature was recorded on 149 out of 161 nights. This was linearly correlated with a rise in shin temperature for 106/149 (71%) nights (median R2= 0.95, lower quartile 0.92, upper quartile 0.97). It was not possible to rule out a change in thermal insulation over the shins as a confounding variable in this strong association. However, a similar inverse relationship was seen between shin and rectal temperature during 111 of 121 (92%) feed/nappy changes.

Conclusion: The fall in rectal temperature after being put down to sleep may be due to redistribution of heat rather than decreased production or heat loss. If causal, the development in early infancy of an inverse relationship between shin and rectal temperature may be important for cardiovascular homeostasis. Further sleep laboratory work is required to distinguish peripheral temperature changes on falling asleep from those associated with changes in thermal insulation.
Urinary 8‐hydroxydeoxyguanosine excretion in children before and after therapy for eradication of Helicobacter pylori infection
Authors: Shimizu T , Lee T , Shoji H , Kudo T , Satoh Y , Yamashiro Y
Published: August 2010

Aim: A number of reports have implicated oxygen free radicals in the pathogenesis of Helicobacter pylori (H. pylori)‐associated disease. 8‐hydroxydeoxyguanosine (8‐OHdG) has recently been accepted as a sensitive marker for reflecting the oxidative DNA damage. However, there have been no previous studies comparing the changes in urinary 8‐OHdG excretions before and after therapy for eradication of H. pylori infection, or to examine 8‐OHdG excretions in children with H. pylori infection. The aim of this study was therefore to examine the DNA damage in gastric mucosal cells in children with H. pylori infection. Methods: Urinary 8‐OHdG excretions were measured before and after therapy for eradication of H. pylori infection in 15 children diagnosed with the H. pylori infection and 13 parents who were also suffering from the same infection. Results: In both the children and their parents, no significant differences were found in urinary 8‐OHdG excretions either before or after the eradication therapy. Furthermore, there was no significant difference in urinary 8‐OHdG excretions between 8 children with peptic ulcers and 7 children without ulcers, either before or after the therapy.

Conclusion: These results suggest that measurement of urinary 8‐OHdG levels is not useful for evaluation of the DNA damage in H. pylori‐infected gastric mucosa in children.
Chediak‐Higashi syndrome: four cases from Northern Finland
Authors: Möttönen M , Lanning M , Baumann P , Saarinen‐Pihkala UM
Published: August 2010

Chediak‐Higashi syndrome (CHS) is a rare multiorgan disease entity with autosomal recessive inheritance characterized by oculocutaneous albinism, bleeding tendency, recurrent bacterial infections and various neurological symptoms. Intracellular vesicle formation is deficient, resulting in giant granules in many cells, e.g. giant melanosomes in the melanocytes. Diagnosis has been based on morphological examination of peripheral blood and bone marrow, with giant granules seen in cells of the myeloid lineage and in lymphocytes. The ultimate diagnostic test is to look for a mutated LYST gene. Most patients develop an accelerated phase of the disease with deposition of lymphohistiocytes in the liver, spleen, lymph nodes and bone marrow, resulting in hepatosplenomegaly, bone marrow infiltration and haemophagocytosis. Peripheral blood neutropenia becomes more profound as anaemia and thrombocytopenia develop. Most patients succumb before the age of 10 years. Four patients with CHS are described, one of whom is a long‐term survivor after successful allogeneic bone marrow transplantation, two succumbed during the accelerated phase and one is living with a chronic form of the disease.

Conclusion: Allogeneic bone marrow transplantation from an HLA‐matched sibling is the therapy of choice and should be performed early. If there is no matched family donor, an unrelated donor or a placental blood graft is a good alternative. The clinical picture of CHS is heterogeneous and therapeutic decisions need to be made on an individual basis.
Development of the coronary vasculature and its implications for coronary abnormalities in general and specifically in pulmonary atresia without ventricular septal defect
Authors: Groot AC Gittenberger‐de , Eralp I , Lie‐Venema H , Bartelings MM , Poelmann RE
Published: August 2010

Aim: Coronary vascular anomalies are an important factor in congenital heart disease in the neonate. However, our knowledge of the pathomorphogenesis is still defective. Material and methods: 1) Study of coronary anomaly variations in congenital heart disease using specimens and 2) study of the role of epicardium‐derived cells (EPDC) and neural crest cells in coronary vascular formation using quail‐chicken chimeras. Results: The clinical and pathological data revealed the existence of ventriculo‐coronary arterial communications during fetal life before pulmonary atresia was established. This supported a primary coronary developmental anomaly as the origin of some cases of pulmonary atresia as opposed to other cases in which the pulmonary orifice atresia was the primary anomaly. Our experimental work showed the high relevance of the development of the epicardium and epicardium‐derived cells for the formation of the coronary vasculature, and showed the coronary vascular ingrowth into the myocardium and subsequently into the aorta and the right atrium. The absence of epicardium‐derived cells leads to embryonic death, while delayed outgrowth could result in the absence of the main coronary arteries to pinpoint orifice formation. In these cases, the circulation was maintained through ventriculocoronary arterial communications. Neural crest cells were important for the patterning of the coronary vasculature. We have extended this knowledge to a number of other heart malformations.

Conclusions: Coronary vascular anomalies are highly linked to the development of extracardiac contributors like the epicardium and the neural crest. A proper interaction between these cell types and the myocardium and aortic arterial wall are important for normal vascular development.
The developmental origins of chronic adult disease
Authors: Barker DJP
Published: August 2010

Low birthweight is now known to be associated with increased rates of coronary heart disease and the related disorders stroke, hypertension and non‐insulin‐dependent diabetes. These associations have been extensively replicated in studies in different countries and are not the result of confounding variables. They extend across the normal range of birthweight and depend on lower birthweights in relation to the duration of gestation rather than the effects of premature birth. The associations are thought to be consequences of developmental plasticity, the phenomenon by which one genotype can give rise to a range of different physiological or morphological states in response to different environmental conditions during development. Recent observations have shown that impaired growth in infancy and rapid childhood weight gain exacerbate the effects of impaired prenatal growth. Coronary heart disease and the disorders related to it arise through a series of interactions between environmental influences and the pathways of development that preceded them. These diseases are the product of branching pathways of development in which the branchings are triggered by the environment before and after birth.
Epicardial and microvascular graft vessel disease in children
Authors: Hiemann NE , Wellnhofer E , Abdul‐Khaliq H , Hetzer R , Meyer R
Published: August 2010

Aim: Graft vessel disease (GVD) is one of the main limiting factors to long‐term survival after adult heart transplantation (HTx). The incidence of epicardial and microvascular GVD in paediatric patients was studied.Methods: A total of 137 coronary angiographies from 130 paediatric HTx and heart and lung transplant (HLTx) patients (70 male, 60 female, aged 0–18 y) were evaluated according to the Stanford classification and its supplements (minor vessel alterations). In H&E stainings from right ventricular endomyocardial biopsies (EMB = 397), light microscopic diagnosis of acute cellular rejection (ISHLT classification) and vascular reaction (morphology of endothelial cells and vessel walls) was performed.Results: Moderate rejection was present in 32.8% and severe rejection in 13.3% of EMB. Microvascular EC swelling was found in 33.5% and vessel wall thickening in 53.8% of EMB. The results of the coronary angio‐graphic investigations were: Stanford lesions = 61.2%, peripheral obliterations = 52.5%, diameter fluctuations = 86.3%, pathologic tapering = 64.0%, calcifications = 10.8%. Long‐term survivors (≥5 y) showed macrovascular alterations in 78% of cases and microvascular alterations in 67% of cases.

Conclusion: The development of micro‐ and macrovascular GVD is one of the predominant complications in long‐term survivors after paediatric HTx and HLTx.
Effect of tilting on cerebral haemodynamics in preterm infants with periventricular leucencephalomalacia
Authors: Pichler G , Urlesberger B , Schmölzer G , Müller W
Published: August 2010

Aim: Measurement of cerebral haemodynamics to detect impaired cerebral blood flow and impaired cerebral autoregulation might make prevention of brain lesions and especially periventricular leucencephalomalacia (PVL) achievable. Methods: Changes in cerebral blood volume (CBV) and the cerebral haemoglobin oxygenation index (cHbD) following tilting up and down in 10 preterm infants with PVL and 25 preterm infants without PVL, measured by near infrared spectroscopy (NIRS), were analysed. Tilting manoeuvres were recorded with a polysomnographic system in combination with NIRS. CBV and cHbD of the baseline phase (1 min before tilting) were compared with data from the post‐tilting phase (1 min after tilting). Results: Changes in CBV and cHbD after tilting were significantly pronounced in infants with PVL compared with infants without PVL. CBV decreased in infants with PVL, by ‐0.099 ± 0.081 ml 100 g−1 brain (mean ± SD) after tilting up, and increased by 0.106 ± 0.104 ml 100 g−1 brain after tilting down. CBV decreased in infants without PVL, by –0.041 ± 0.068 ml 100 g−1 brain after tilting up, and increased by 0.020 ± 0.096 ml 100 g−1 brain after tilting down. cHbD showed similar changes after tilting.

Conclusion: Changes in CBV and cHbD after tilting were pronounced in preterm infants with PVL and this may indicate reduced cerebral autoregulatory capacity.
Invited commentary to supplement hot topics in neonatology
Authors: Ives NK
Published: August 2010

The very interesting and varied collection of papers from the UK Hot Topics meeting held at Egham, Surrey, UK on 27 September 2002 (chaired by Professor Anne Greenough of King's College Hospital, London and sponsored by Abbott Laboratories Limited) has been reviewed.

Conclusion: The scientific value and clinical implications for neonatal intensive care of the papers presented reflect the status of a meeting that has grown to be head and shoulders above comparable UK neonatology gatherings.
Coagulase‐negative staphylococcal sepsis as a predictor of bronchopulmonary dysplasia
Authors: Liljedahl M , Bodin L , Schollin J
Published: August 2010

Aim: To determine whether sepsis caused by coagulase‐negative staphylococci (CoNS) is a risk factor for developing bronchopulmonary dysplasia (BPD) in premature newborns. Methods: All newborns born at ±30 wk of gestation at Örebro University Hospital during 1994–2001 with clinical sepsis caused by CoNS (group A, n= 22) or by other bacteria (group B, n= 17) were included and compared with premature newborns without sepsis (group C, n= 53). Clinical sepsis was defined as a positive blood culture (monoculture) plus clinical symptoms and laboratory findings. BPD was defined as treatment with oxygen >21% for at least 28 d. Results: The incidence of BPD differed between the three groups, as follows: CoNS sepsis (A) 64%, other sepsis (B) 41% and control (C) 24%. The difference between the control group and the sepsis groups was highly significant (p= 0.006). In a univariate model the crude estimates of relative risk (RR) for occurrence of BPD increased with presence of sepsis and particularly with presence of sepsis with CoNS (A: RR 2.6, 95% CI 1.5–4.6, p= 0.001; B: RR 1.7, CI 0.8–3.5, p= 0.17). When regression was performed with two additional predictive variables in multivariate models including sepsis, gestational age and mechanical ventilation (group A: RR 1.5, CI 1.1–2.0, p= 0.004; group B: RR 0.9, CI 0.6–1.4, p= 0.67), the estimates were lower.

Conclusion: The relative risk for BPD is significantly increased in premature newborns with sepsis caused by CoNS compared with those with sepsis caused by other bacteria and compared with premature newborns with no sepsis.
Congenital chylothorax: lymphopenia and high risk of neonatal infections
Authors: Wasmuth‐Pietzuch A , Hansmann M , Bartmann P , Heep A
Published: August 2010

Aim: To describe the clinical course of patients with congenital chylothorax focusing on infectious complications. Congenital chylothorax is a common manifestation of non‐immune hydrops fetalis (NIHF). The drainage of chyle leads to loss of cellular and plasmatic factors that influence the patient's immune response and increase the risk of infections. Methods: In a retrospective analysis of 24 preterm infants with NIHF treated between 1998 and 2002, congenital chylothorax was diagnosed in 7 patients. Results: All 7 patients were treated conservatively with pleural drainage over a median period of 22 d (range 10–36 d). Lymphopenia was found in all patients (median of minimal lymphocyte counts 285/μl, range 80–770). The nadir was on day 5 (2‐6 d). Lymphopenia lasted for 12 d median (range 4–39 d) and was significantly correlated with the duration of lymph drainage (p= 0.001). Cell‐surface analysis of peripheral blood lymphocytes was performed in two patients. Both patients had a decreased number of total T cells. Four out of seven (57%) patients developed nosocomial infections. This incidence of nosocomial infections in patients with congenital chylothorax is about three times higher than that in other neonatal patients. None of the children suffered from fungal or viral infection. Although there was a very high incidence of infections, no correlation between lymphopenia and the occurrence of infections could be shown.

Conclusion: Drainage of congenital chylothorax results in the loss of lymphocytes and bears a high risk of infections.
The Greek family system when a child has diabetes mellitus type 1
Authors: Tsamparli A , Kounenou K
Published: August 2010

Aim: To depict the characteristic ways that families who have a child suffering from diabetes and face difficulties with metabolic control function. In addition, to reveal the ways that this functioning is related to metabolic control problems. Methods: Qualitative methods were used, including an in‐depth interview and observation of 30 Greek families having one child suffering from diabetes mellitus type 1 and facing difficulties with metabolic control. An average of 10 meetings were conducted with each family, including separate meetings with each individual family member, the parental couple and the family as a whole. Methods were based on thematic categories provided by the model of the “psychosomatic family”. Results: The presence of the disease and the requirements of the treatment regimen seemed to be associated with certain family characteristics: enmeshed relationships, ambiguous roles and rules, break down of hierarchy, coalition between mother and patient, absence of father's involvement and “infantilization” of the suffering child. Also in such families, healthy siblings are assigned parental roles and, finally, the families present signs of social exclusion.

Conclusion: The study provides important findings concerning the psychological characteristics of the families under study. The present ways of functioning are associated with the difficulties families face when coping with the treatment regimen.
High prevalence of cagA and vacA seropositivity in asymptomatic Bangladeshi children with Helicobacter pylori infection
Authors: Sarker SA , Nahar S , Rahman M , Bardhan PK , Nair GB , Beglinger C , Gyr N
Published: August 2010

Aim: To evaluate the prevalence of antibodies against two major markers of virulence of Helicobacter pylori—cytotoxin‐associated gene A (cagA) and the vacuolating cytotoxin gene (vacA)—among children in a peri‐urban community of Bangladesh, and to evaluate Western blot (WB) assay for detection of H. pylori infection diagnosed by 13C urea breath test (UBT) in such children. Methods: One hundred and eighty‐two children aged 18–60 mo, of the peri‐urban community of Dhaka, were screened for H. pylori infection using UBT, and the serum samples were analysed for antibody against cagA and vacA by Western blot. Results: The overall prevalence of H. pylori infection by 13C‐urea breath test was 80%. The seroprevalence of cagA with or without vacA, vacA with and without cagA, and both cagA and vacA were 82%, 82% and 81%, respectively. Among children with a positive UBT, 95% were seropositive for both cagA and vacA, indicating that the products of these genes are frequently co‐expressed in H. pylori infection in this community. The sensitivity, specificity, positive and negative predictive value of the Western blot test for H. pylori infections, compared to UBT, were 94%, 68%, 92% and 76%, respectively.

Conclusion: Compared to UBT, Western blot test is reliable for the detection of H. pylori infection. The high seroprevalence of cagA‐ and vacA‐positive virulent H. pylori strains in an asymptomatic paediatric population indicate that such strains are common in this population and may cause characteristic H. pylori infection in Bangladesh.