bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of feeding different amounts of arachidonic and docosahexaenoic acids in preterm infant formulas on the fatty acid content of lipoprotein lipids
Authors: Clandinin MT , Van Aerde JE , Parrott A , Field CJ , Euler AR , Lien E
Published: August 2010

This study evaluated preterm infants of less than 2.3 kg birth weight fed commercial formula (Preemie SMA®) devoid of arachidonic acid (AA) and docosahexaenoic acid (DHA) and compared this control group with similar infant groups fed one of three formulas containing a range of 0.32—1.1% AA and 0.24—0.75% DHA in the fat component of the formula. An analogous group of infants fed on their mothers' breast milk and a breast milk fortifier was also studied. Individual lipoprotein fractions were isolated from blood samples collected at 12 d of age and after a further 4 wk of feeding. The fatty acid content of individual lipid components, isolated from each lipoprotein fraction was quantitatively determined in order to identify change in marker pools of essential fatty acid. The high density lipoproteins (HDL) and low density lipoproteins (LDL) phospholipid and cholesterol ester fractions contain most of the AA and DHA found in the lipoprotein fractions (total of 0.49% and 0.35%, respectively). Infants fed a formula without AA and DHA showed a reduction in AA level in the phospholipid fraction of all lipoproteins and in the HDL and LDL cholesterol ester fraction. A reduced level of DHA was also observed primarily in the lipoprotein phospholipid fraction in comparison with infants fed breast milk or infant formula containing AA and DHA. Supplementing infant formula with increasing levels of AA and DHA produced a clear dose response in the level of AA found in the HDL and LDL phospholipid fraction. From comparison of the fatty acid levels present in the lipoproteins it appears that a formula level of 0.49% AA and 0.35% DHA provides sufficient levels of these fatty acids to achieve a similar fatty acid content to that of infants fed breast milk for the major lipoprotein fractions examined. □Diet, fatty acid, infant, lipoprotein
Atherogenic diet and blood lipid profile in children and adolescents from Galicia, NW Spain. The Galinut Study
Authors: Leis R , Pavón P , Queiro T , Recarey D , Tojo R
Published: August 2010

We studied serum levels of total cholesterol, lipoproteins and triglycerides in venous blood samples and the intake of nutrients using the subject's daily record of food eaten during a period of 7 d. The material comprised 7367 children and adolescents. The overall average lipid levels (4.55 ± 0.91 mmol/L for TC, 1.42 ± 0.47 mmol/L for HDL‐C, 2.74 ± 0.96 mmol/L for LDL‐C) are high and similar to those found in other regions of Spain in the 1990s. The proportion of children with TC ≥5.17 mmol/L (200mg/dl) was 19%; that of children with HDL‐C ≤0.91 mmol/L (35 mg/dL) 6.5%. There is a striking and statistically significant difference between the proportions of boys and girls aged 15‐20 y who have HDL‐C levels in this range (15.8% for boys and only 4.2% for girls). We also demonstrate a high total fat (44% of TCV), saturated fat (16% TCV) and cholesterol (387 mg) intake. Because of the elevated fat and saturated fat intake and the increment of a more atherogenic lipid profile in our children, preventive nutritional measures are necessary, and life habits such as physical exercise and actively reducing fat and saturated fat intake have to be applied and inculcated in children from an early age.
Vesico‐ureteric reflux and other risk factors for renal damage: identification of high‐ and low‐risk children
Authors: Jakobsson B , Jacobson SH , Hjälmås K
Published: August 2010

This article reviews the literature with respect to various risk factors for permanent renal damage in children with urinary tract infection. Vesico‐ureteric reflux is an important risk factor, but renal damage can occur in the absence of reflux. Renal damage does not always occur in the presence of gross reflux. Renal scars always develop at the same site as a previous infection in the kidney. Recurrent pyelonephritis and delay in therapy increase the likelihood of renal damage, although it is not known how long a delay is dangerous to the human kidney. Recent studies using 99mtechnetium‐dimercaptosuccinic acid (DMSA) scintigraphy have not confirmed the findings of previous studies showing that children below 1 y of age are more vulnerable to renal damage. It is more likely that all children run the risk of renal scarring in cases of acute pyelonephritis. The role of bladder pressure is still not entirely understood. Therefore more studies are needed in order to determine the relationship between high voiding pressures in some, otherwise healthy, children with urinary tract infection and renal scarring. The importance of bacterial virulence in the development of renal scarring is unclear. DMSA scintigraphy and voiding cystourethrography are the most reliable tools for identifying children at risk of renal scarring. As a single method DMSA scintigraphy appears to be better than voiding cystourethrography.
Prepulse inhibition of startle, intelligence and familial primary nocturnal enuresis
Authors: Ornitz EM , Russell AT , Gabikian P , Gehricke J‐G , Guthrie D
Published: August 2010

Previous studies have shown a significant reduction of prepulse inhibition of startle in boys with primary nocturnal enuresis. Those enuretic boys who had higher IQs showed less prepulse inhibition. This study evaluates the association of prepulse inhibition and IQ in primary nocturnal enuresis in respect to family history of primary nocturnal enuresis. Prepulse inhibition of startle was studied in 83 boys with primary nocturnal enuresis and 57 non‐enuretic boys using an interval of 120 ms between the onset of a 75 dB 1000 Hz tone and a 104 dB noise burst. Of the boys with primary nocturnal enuresis, 56 had a family history of primary nocturnal enuresis and 27 had no family history (no first‐degree relative). Of the 57 non‐enuretic boys, 42 also had no family history (no first‐degree relative) of primary nocturnal enuresis, while 15 did have a positive family history. Associations between prepulse inhibition and IQ scores were compared among these four groups. Strong and significant associations between prepulse inhibition deficit and higher IQ scores in the enuretic group with familial primary nocturnal enuresis were unique in comparison to the other groups.

Conclusions: The strong heritabilities of primary nocturnal enuresis, intelligence and prepulse inhibition suggest genetic mediation of the association of prepulse inhibition with intelligence in familial primary nocturnal enuresis.
Dexamethasone treatment and fluid balance in preterm infants at risk for chronic lung disease
Authors: Bos AF , van Asselt WA , Okken A
Published: August 2010

The influence of dexamethasone on diuresis in preterm infants has not been well studied. We examined 15 preterm infants at risk for chronic lung disease with gestational ages ranging from 26 to 29 wk (median 27.6 wk) and birthweights ranging from 700 to 1485 g (median 965 g). Urine output, blood glucose, serum urea, serum creatinine, serum sodium and serum potassium, as well as systolic, diastolic and mean arterial pressure were measured on the day before, and on 4 consecutive days after starting treatment with dexamethasone (0.25 mg kg″1 iv., twice daily). We found an increase of diuresis of 30 ml kg″1 d″1, 48‐96 h after starting dexamethasone treatment. This coincided with a gradual but significant increase of serum urea levels and arterial pressure. During the study period, fluid and protein intake remained constant. Blood glucose and serum creatinine levels did not change. Our findings suggest that the increased urine output following dexamethasone treatment might be caused by two factors: (1) pressure diuresis induced by the increase of arterial pressure and (2) an increase of the osmolar load to the kidney due to an increase of serum urea.

Conclusions: This study demonstrates that a significant increase of diuresis occurs in preterm infants, 48‐96 h after starting dexamethasone. A careful monitoring of fluid balance during the first days of dexamethasone treatment is recommended.
Associations between cerebral blood‐flow measured by single photon emission computed tomography (SPECT), electro‐encephalogram (EEG), behaviour symptoms, cognition and neurological soft signs in children with attention‐deficit hyperactivity disorder (ADHD)
Authors: Gustafsson P , Thernlund G , Ryding E , Rosén I , Cederblad M
Published: August 2010

Twenty‐eight children with attention‐deficit hyperactivity disorder (ADHD) were examined with SPECT (single photon emission computed tomography). Seven of the children had abnormal distribution of the regional cerebral blood‐flow (rCBF) on visual evaluation and 10 had abnormal EEG findings. The only clinical finding that differentiated the group with normal from abnormal rCBF was behaviour symptom load. A factor analysis of the rCBF in different regions of interest yielded one factor with low rCBF in the temporal and cerebellar regions and high rCBF in the subcortical and thalamic regions, which was significantly associated with the degree of motor impairment and results on a cognitive test (WISC). Another factor consisting of high rCBF in frontal and parietal regions had a significant negative correlation with the degree of behaviour symptoms. There was a negative correlation between the rCBF in the right frontal regions and the degree of behaviour symptoms. The number of minor physical anomalies (MPA) was negatively correlated to the rCBF in the frontal lobes bilaterally.

These results suggest that there may be at least two functional disturbances in ADHD, one specific neurodevelopmentally determined disturbance of the frontal lobes, especially of the right hemisphere, related to behaviour deviance, and another disturbance of the integration of the temporal lobes, the cerebellum and subcortical structures, related to motor planning and aspects of cognition.
Soluble transferrin receptor levels and soluble transferrin receptor/log ferritin index in the evaluation of erythropoietic status in childhood infections and malignancy
Authors: Dimitriou H , Stiakaki E , Markaki E‐A , Bolonaki I , Giannakopoulou Ch , Kalmanti M
Published: August 2010

Soluble transferrin receptor (sTfR) is a new diagnostic tool for determining iron status and erythropoietic activity. The increased concentrations of sTfR in patients with iron deficiency reflect the hyperplasia of erythroid precursors. The objective of this study was to evaluate sTfR and sTfR/ log ferritin index (sTfR‐F) values in healthy children (n = 64), full‐term neonates (n = 18), children with iron deficiency (n= 16), hemolytic anemia (n = 7), β‐thalassemia traits (n=18), respiratory infections (n= 41) and malignancies (n= 13), and to compare these parameters for the different subgroups with those of healthy children. The sTfR levels were increased in children with iron deficiency in the same way as in adults (p < 0.0001) and in cases of increased erythropoietic activity, such as during the neonatal period (p < 0.0001), and of hemolytic anemias (p = 0.006). The index was significantly increased in iron deficiency (p < 0.0001) and decreased in neonates (p = 0.011). Children carriers of β‐thalassemia were found to have increased sTfR values (p = 0.015), but not sTfR/log ferritin index (p = 0.491), a finding suggesting that use of both parameters is necessary for distinguishing between those with and those without iron deficiency. In children with upper respiratory infection, the sTfR levels were close to normal, while the index was found to be low. In order to evaluate the iron status in infections, we further subdivided the children into two groups according to the value of ferritin, with the cut‐off point at 35 μg/L. Children with ferritin level above 35 μg/L experienced normal sTfR levels but very low index, a finding which could enable the use of these two parameters for distinguishing patients with infection without concomitant iron deficiency. In the group of malignancies under chemotherapy both indices were low (p = 0.005, p < 0.0001) mainly due to myelosuppression.

Conclusion: The interpretation of both sTfR and sTfR/log ferritin index is useful in the evaluation of iron status and erythropoietic activity, especially in children with heterozygous β‐thalassemia, infection and malignancies.
Congenital malformations in the southeast of Sweden—a registry study with validation
Authors: Blomberg M , Selbing A , Källén B
Published: August 2010

A study was made of the occurrence of congenital malformations in the southeast region of Sweden, utilizing all available relevant health registries. Östergötland county had been pinpointed in a routine surveillance as having an increased malformation risk. Various validations of the register data were undertaken and different types of errors were detected. An increased risk was seen, in Östergötland county compared to the reference counties, for specific types of malformations: preauricular appendices, pylorostenosis, uterine/vaginal malformations, foot deformities, limb reduction defects and cardiovascular malformations. Variable classification or registration artefacts explained the excess among the first four conditions. Limb reduction defects were also mis‐coded, but the increased risk in Östergötland county may persist.

Conclusion:There is an increased risk of major cardiovascular malformations in Östergötland county compared to the reference counties that also shows an uneven distribution within the county.
Early sepsis, obstructive jaundice and right‐sided diaphragmatic hernia in the newborn
Authors: García‐Muñoz F , Santana C , Reyes D , Wiehoff A , López‐Pinto JM , García‐Alix A
Published: August 2010

A male newborn was admitted to our Unit because of early sepsis and shock. He required antimicrobial therapy and mechanical ventilation and initially did well, although he exhibited jaundice and cholestasis. During the second week he deteriorated, with radiological opacification of the right hemithorax and pleural effusion, and did poorly in spite of antibiotical therapy and drainage of the effusion. In the third week, the X‐ray suggested some bowel loops in the right hemithorax. A right‐sided diaphragmatic hernia was confirmed by a CT‐scan, and surgery was performed with good outcome. The association of delayed‐onset right‐sided CDH following early sepsis and obstructive jaundice has not been published before, and illustrates a scarcely known form of presentation of this condition.
Chronic lung disease: oxygen dogma revisited
Authors: Saugstad O D
Published: August 2010

Since the discovery of retrolental fibroplasia, and the role of oxygen in its development, oxygen has been considered a double‐edged sword in neonatal medicine, the utmost care being exercised in order not to give too much oxygen (1). However, the important observation that hypoxaemia might induce pulmonary vasoconstriction (2) and airway constriction (3) in infants at risk for bronchopulmonary dysplasia has resulted in only a minor upward adjustment of oxygen supplementation in many neonatal units.

Since oxygen toxicity has long been linked not only to retinopathy of prematurity but also to bronchopulmonary dysplasia (4), it is relevant to ask whether an increased FiO2 might have any detrimental effects on babies.
Possible new autosomal recessive syndrome of congenital lymphoedema, nail dystrophy and esotropia in a Saudi family
Authors: Fatinni Y , Asindi A , Al Falki Y , Al Harthi A , Al Fifi S , AL‐Daama S
Published: August 2010

This paper presents a family case of two brothers and two sisters with congenital lower limb lymphoedema, nail dystrophy, and with esotropia in two of them. They are offspring of healthy parents who are first cousins. This combination of congenital lymphoedema, nail dystrophy and esotropia in this sibship differs from other reported cases of congenital lymphoedema and most likely constitutes a previously unrecognized autosomal recessive syndrome.
Children's nutrient intake at preschool and at home
Authors: Sepp H , Lennernäs M , Pettersson R , Abrahamsson L
Published: August 2010

A preschool‐based dietary survey, using 7‐d records, was carried out in a suburb of Stockholm. The aim was to assess the intake of food and the quality of the diet of preschool children aged 3–5y at preschool and at home, and to compare the dietary intake with the Swedish dietary recommendations for preschool children. The respective mean intakes of protein, fat, carbohydrates and sucrose, expressed as a percentage of total energy intake were 14, 38, 50 and 9 at preschool, and at home 14, 36, 52 and 12 on weekdays, 14, 34, 55 and 16 on weekend days. The mean intakes of seven vitamins and minerals were low only for selenium as compared with the recommended level. No differences were found in nutrient density between diet at preschool and diet at home, with the exception of dietary fibre (higher at preschool). On weekdays there was a significantly higher nutrient density for calcium, zinc, selenium, vitamin A, riboflavin, vitamin C and dietary fibre compared with weekend days.

Conclusion: The average intakes of energy and nutrients per meal at preschool compared with the recommended levels for children aged 4–6 y were low for all meals (breakfast, lunch and afternoon snack). This, however, was compensated for by home meals.
Person, time and place coordinates of pedestrian injuries: a study in Athens
Authors: Moustaki M , Petridou E , Trichopoulos D
Published: August 2010

The aim of this study was to investigate whether socioeconomic status of town of residence is associated with risk for childhood pedestrian injuries. The study population consisted of all pedestrian victims, aged 0–14 y, who lived in towns of Greater Athens and who presented to the Emergency Department of a major Children's Hospital during the period 1996–98. The towns were divided into three categories by socioeconomic status according to the proportion of (a) adult household heads with a higher education degree and (b) households with less than one person per room. The rate of pedestrian injuries was estimated by socioeconomic status of the residential town and by place of accident (inside or outside the respective town). The pedestrian injury rate ranged from 5.5 to 12 injured children among a 10000 childhood population per year, with an almost twofold excess among children residing in the less wealthy towns compared with the wealthier ones. The social gradient was steeper for injuries occurring outside the residential town. The population fractions of pedestrian injury rates attributable to educational level and household crowding differentials, regardless of the place of accident, were 39% and 25%, respectively.

Conclusions: There is a considerable social gradient for childhood injuries irrespective of place of accident, a finding that could be partly attributable to lower socioeconomic background rather than to adverse environmental factors prevailing in less wealthy towns. Our findings indicate that there is a need for preventive programmes targeting people as well as places of low socioeconomic status.
Regional differences in stillbirth and neonatal death rate in Sweden with a cause‐of‐death specific analysis
Authors: Serenius F , Winbo I , Dahlquist G , Källén B
Published: August 2010

Regional differences in stillbirth and neonatal death rates in Sweden were studied and a cause‐of‐death analysis was done in the 4 counties (among 24) with an increased mortality. The study is based on a computerized evaluation of infant cause of death, using a slightly modified Wigglesworth classification and a hierarchical classification (NICE: Neonatal and Intrauterine death Classification according to Etiology). Differences between the identified counties with respect to specific causes of death were demonstrated.

Conclusion: There are differences between Swedish counties with respect to the risk for stillbirth or neonatal death. The NICE cause‐of‐death classification can be used for the routine surveillance of stillbirths and neonatal deaths in a population and can help in pinpointing weak elements in antenatal, delivery and neonatal care.
Cerebral palsy in southern Sweden I. Prevalence and clinical features
Authors: Nordmark E , Hagglund G , Lagergren J
Published: August 2010

The prevalence, clinical features and gross motor function of children with cerebral palsy in southern Sweden were investigated. The study covered the birth year period 1990–1993, during which 65514 livebirths were recorded in the area. On the census date (1 January 1998), 68 366 children born in 1990‐1993 lived in the area. The study comprised 167 children, 145 of them born in Sweden and 22 born abroad. The livebirth prevalence was 2.2 per 1000, and the prevalence including children born abroad was 2.4 per 1000. The distribution according to gestational age, birthweight and subdiagnoses was similar to that in earlier Swedish studies, except for a higher rate of dyskinetic syndromes in this study.

Conclusion: The point prevalence of cerebral palsy was 2.4 and the livebirth prevalence was 2.2. Children born abroad had a higher prevalence and were more often severely disabled. Severe disability was often combined with associated impairments such as mental retardation, epilepsy and visual impairment.
Paroxysmal tonic upgaze of childhood: effect of age‐of‐onset on prognosis
Authors: Verrotti A , Trotta D , Blasetti A , Lobefalo L , Gallenga P , Chiarelli F
Published: August 2010

Paroxysmal tonic upgaze (PTU) is a syndrome of childhood manifesting as sudden ocular movements with sustained upward deviation of the eyes. We describe the outcome of 6 patients, after a follow‐up of 10 years, with onset of the disease in childhood. The aims of this study were to clarify some clinical features of this syndrome and to evaluate the long‐term prognosis of these children. In all the patients, tonic upgaze episodes disappeared with time to remission, varying from 1 to 4 y, without any therapy and without any change in psychomotor development, EEG and neuroimaging. Only one child had pathologic interictal EEG with temporo‐occipital spikes, which persisted after the offset of the disease.

Conclusion: From a long‐term follow‐up, we can confirm the good prognosis of PTU and suggest it is possible to define a distinct syndrome of childhood without any neurological abnormalities and with spontaneous resolution.
Prevalence of overweight and obesity in children and adolescents in a county in Sweden
Authors: Berg I‐M , Simonsson B , Brantefors B , Ringqvist I
Published: August 2010

Overweight among young people in Sweden is increasing. The aim of the present study was to investigate the frequency of overweight and obesity based on body mass index (BMI) values among children and adolescents. Overweight was defined as a BMI value 91st percentile and obesity as a BMI value 98th percentile on an international reference BMI curve. The study population included boys and girls from four age groups: 9, 12, 15 and 18 y. The data consisted of self‐reported measures of height and weight that were obtained from questionnaires used in a cross‐sectional study in December 1997. A validation study was performed using a part of the study population. A total of 7011 (81.7%) participants completed the questionnaire. The correlation between self‐reported estimations and objective measures of height and weight was high in the oldest age groups (0.88–0.98), but lower in the 9‐y‐old age groups (0.37–0.72). These self‐reported estimations in the 9‐y‐olds were excluded from further analysis. It was found that 12.3%, 11.6% and 11.4% of the boys in the 12‐, 15‐ and 18‐y‐old age groups and 6.8%, 5.5% and 4.8% of the girls in the same age groups were overweight and 7.9%, 8.9% and 7.3% of the boys and 5.1%, 4.2% and 3.9% of the girls were obese.

Conclusion: The prevalence of overweight and obesity was found to be high in the study population and is a serious public health problem. The prevalence of obesity was significantly higher (p <0.05) in 15‐y‐old boys living in rural areas than in city and town dwellers of the same age.
Cornelia de Lange syndrome associated with cecal volvulus: report of a case
Authors: Masumoto K , Izaki T , Arima T
Published: August 2010

Cornelia de Lange syndrome is known to be occasionally associated with gastrointestinal malformation. However, the occurrence of cecal volvulus in such anomalies is very rare. We report a 15‐y‐old Japanese boy with Cornelia de Lange syndrome associated with a cecal volvulus secondary to non‐fixation of the cecum and ascending colon. The patient was admitted to our hospital because of abdominal pain and bilious vomiting. At emergent laparotomy, cecal volvulus with non‐fixation of the ascending colon and cecum was diagnosed. Release of the cecal volvulus and the fixation of the cecum and ascending colon to the right retroperitonium were performed. The postoperative course was uneventful, except for sepsis caused by aspiration pneumonia soon after the operation.

Conclusion: Clinicians treating patients with this syndrome should be aware that such patients may be at risk for developing severe gastrointestinal anomalies, including cecal volvulus.
Levels of certain metals, organochlorine pesticides and dioxins in cord blood, maternal blood, human milk and some commonly used nutrients in the surroundings of the Aral Sea (Karakalpakstan, Republic of Uzbekistan)
Authors: Ataniyazova OA , Baumann RA , Liem AKD , Mukhopadhyay UA , Vogelaar EF , Boersma ER
Published: August 2010

Since the 1960s a massive decline in the volume of the Aral Sea has occurred as a result of the diversion of the supplying rivers to cotton irrigation schemes. The contaminated sediment of the former seabed has been disseminated over the surrounding area by strong winds. This deterioration of the ecosystem has created a hazardous situation for the health of approximately 3.5 million people. This pilot study was undertaken to assist Karakalpak health workers in investigating the degree of exposure to metals, persistent organochlorine pesticides (OCPs) and dioxins during the most vulnerable prenatal and postnatal period and to provide guidelines for future research. All subjects came from areas located within 200 km of the southern border of the Aral Sea. Blood was obtained from 18 pregnant women and 28 newborns (cord blood) to determine the levels of metals, lead, cadmium, zinc and selenium and the OCPs a‐, b‐ and g‐hexachlorocyclohexane (HCH; lindane is the product name of g‐hexachlorocyclohexane), hexachlorobenzene (HCB), and isomers and metabolites of dichlorodiphenyltrichloroethan e (DDT), i.e. op‐DDT, pp‐DDT, pp‐DDE and pp‐TDE. Levels of metals were also determined in blood from 28 non‐pregnant women. In addition, levels of 17 dioxins were determined in 41 human milk samples and 1 batch of formula. Information about possible dietary sources of the fat‐soluble OCPs and dioxins was obtained from a pooled sample of butter and from seven cottonseed oil samples. A mass‐selective detector coupled to a gas chromatograph equipped with a large volume injector was used to analyse the selected OCPs, whereas the dioxins were determined by gas chromatography with high‐resolution mass spectrometry. The levels of metals in cord and maternal blood were consistent with concentrations observed in European countries. Only three women (7%) had lead levels greater than 100 ppb. The most notable pollutants in maternal and cord blood were the OCPs, notably HCB, β‐HCH, pp‐DDE and the most toxic dioxin, 2,3,7,8‐TCDD, when calculated as TEQs. A similar pattern was observed in human milk: β‐HCH and pp‐DDE levels of more than 1000 ng g−1 fat were found in 68 and 43% of the subjects, respectively. Levels of 2,3,7,8‐TCDD were six times higher than those observed in Western Europe. Traces of pp‐DDE were detected in the batch of formula milk. Contaminated animal fat, but not cottonseed oil, is the most likely dietary source of OCPs and dioxins.

Conclusion: Further epidemiological research is needed to elucidate the health implications of these pollutants on perinatal and maternal health, including lactation. More importantly, an investigation should be initiated to identify the emission sources of persistent organic pollutants in Karakalpakstan and adjacent regions.
Low‐dose oral etidronate therapy for immobilization hypercalcaemia associated with Guillain‐Barré syndrome
Authors: Go T
Published: August 2010

A low dose of oral etidronate (3.7 mg kg−1 d−1) was administered for immobilization hypercalcaemia associated with Guillain‐Barré syndrome in a 12‐y‐old boy. There was a slight increase in osteoblastic bone formation reflected by alkaline phosphatase and in particular bone‐specific alkaline phosphatase during the treatment and serum calcium decreased to the normal range within 2 wk. No adverse side effects were observed and the patient's linear growth subsequently progressed.

Conclusion: A low dose of oral etidronate is safe and effective for treatment of immobilization hypercalcaemia in children, without inhibiting bone formation.
Predictional need for supplementing breastfeeding in preterm infants under Kangaroo Mother Care
Authors: Ruiz JG , Charpak N , Figueroa Z
Published: August 2010

It has been estimated that 95% of low‐birthweight infants are born in developing countries. Nevertheless, most of the globally available resources are invested in developed countries, both for sophisticated, expensive technological care and for research focused on solving problems in scenarios in which access to expensive resources is available. Very little research on scientifically sound, economically accessible interventions reaches internationally recognized scientific journals. For instance, one accepted scientific dogma is that all premature infants must receive breast‐milk fortifiers. Thus, healthcare workers consider that not offering fortification or supplementation to all preterm infants under 2000 g is unethical, as it denies them the proven benefits of this intervention. This approach oversimplifies the problem by assuming that infants under 2000 g are a homogeneous population, with similar needs and risks. The largest proportion of preterm survivors in developing countries comprises infants weighing <1200g, and their nutritional needs differ from those weighing >1200g, who represent a significantly smaller proportion. In developing countries, fortification of breast milk is seldom a feasible option. Even supplementing breast milk with formula implies an expense that cannot always be covered. In addition, many preterm infants (particularly those weighing >1200g) can grow properly on exclusive breastfeeding. In our experience, about 45% of infants under ambulatory Kangaroo Mother Care (KMC) thrive properly. The choice between giving and withholding supplementation for all preterm infants is not an ethical issue, because there is no choice. This was the justification for conducting the study reported here, which attempts to answer the question of how to identify, as early as possible, those premature infants who survive the early neonatal period and have no obvious risk factors for inadequate growth other than prematurity, but who are less likely to thrive with exclusive breastfeeding.

Conclusion: The answer to this question will allow us to use our meagre resources in the most reasonable way, as supplementing breast milk involves not only the direct cost of the formula but also that of training the mothers in techniques for feeding their infants without compromising breastfeeding or increasing the risk of infectious diseases.
Positive experiences and the relationship between stress and asthma in children
Authors: Sandberg S , McCann DC , Ahola S , Oja H , Paton JY , McGuinness D
Published: August 2010

Ninety children aged 6 to 13 y and suffering from chronic asthma were included in a prospective follow‐up study lasting 18 mo in order to assess whether life events involving substantial positive effects on the child can protect against the increased risk associated with stressful life events. The main outcome measures included positive life events, positive long‐term experiences, severely negative life events, chronic psychosocial stress and new asthma exacerbation. The results showed that, provided they occurred in close proximity to severely negative life events, positive life events, generally related to the child's own achievements, afforded protection against the increased risk of a new asthma exacerbation precipitated by severe events in children whose lives were marked by low to medium levels of chronic stress. No such effect was found in children exposed to high chronic stress nor did long‐term positive experiences, such as when the child has a rewarding hobby, affect the asthma risk.

Conclusion: Life events with a definite positive effect can counteract the increased risk of an asthma exacerbation precipitated by a severely negative life event, provided the chronic stress is only of low to medium level. Because this protective influence does not apply where there is high chronic stress, reducing this condition must be seen as a priority in children suffering from asthma, as these children are also more vulnerable to negative life events precipitating asthma exacerbation.
Hypothalamo‐pituitary hypothyroidism detected by neonatal screening for congenital hypothyroidism using measurement of thyroid‐stimulating hormone and thyroxine
Authors: Asakura Y , Tachibana K , Adachi M , Suwa S , Yamagami Y
Published: August 2010

The optimal strategy in neonatal screening for congenital hypothyroidism is still a subject of controversy. In Kanagawa Prefecture in Japan, simultaneous thyroid‐stimulating hormone (TSH) and T4/fT4 determination has been used, while the results of our program may provide valuable information. Cumulative findings were analysed to determine the type and frequency of thyroid disorders in infants detected by simultaneous TSH and f4/fT4 determination, and the TSH and T4/fT4 screening strategy was validated. A total of 1284130 neonates were screened between October 1979 and September 1997 and infants followed because of low T4/fT4 without elevated TSH (T4 < 51.5 nmol/L or fT4<9 pmol/L and TSH<15 mU/L) were retrospectively analysed. The first survey was carried out within 6 mo of birth and the second in 1998; 258 infants were diagnosed with congenital hypothyroidism at the first medical evaluation, 15 of them with hypothalamo‐pituitary hypothyroidism. However, in the second survey, only 8 children were confirmed as having hypothalamo‐pituitary hypothyroidism, therefore the incidence detected by the present strategy was 1/160516. Of 8 children with hypothalamo‐pituitary hypothyroidism, mental retardation was prevented in 3 owing to early treatment.

Conclusions: Simultaneous measurement of TSH and T4/fT4 is a useful strategy for detecting hypothalamo‐pituitary hypothyroidism, but more studies are needed to show the cost‐benefits of using this strategy.
Coeliac disease in children and adolescents with type 1 diabetes: a study of growth, glycaemic control, and experiences of families
Authors: Saukkonen T , Väisänen S , Åkerblom HK ,   E Savilahti and the Childhood Diabetes in Finland Study Group
Published: August 2010

The aim of this study was to evaluate whether coeliac disease affects growth, glycaemic control, and general well‐being of children and adolescents with type 1 diabetes. Eighteen subjects were found to have coeliac disease by a screening program. Gastrointestinal symptoms, changes in growth and the levels of glycated haemoglobin (GHbA1) were analysed, as well as subjective well‐being before and after diagnosis of coeliac disease. Overt gastrointestinal symptoms and deterioration of growth prior to disclosure of coeliac disease were seen only in one patient who had both of these conditions. Retrospectively, most subjects reported mild gastrointestinal complaints, which resolved on a gluten‐free diet. Introduction of a gluten‐free diet did not have any positive effect on glycaemic control, but was associated with an increase in weight‐for‐height (from 4.3 ± 18.1 to 8.2 ± 15.4% deviation from population median, p= 0.02). This increase in weight‐for‐height was inversely correlated with changes in GHbA1 (r=– 0.574, p= 0.02).

Conclusion: Coeliac disease is rarely associated with signs of malabsorption in children and adolescents with type 1 diabetes. Introduction of a gluten‐free diet may be associated with excess weight gain. We recommend intensified follow‐up for these subjects.
Anaphylaxis after first exposure to ceftriaxone
Authors: Ernst MR , van Dijken PJ , Kabel PJ , Draaisma JMTh
Published: August 2010

Life‐threatening anaphylaxis developed in a 5‐y‐old boy with septic shock within minutes of receiving his first intravenous injection of ceftriaxone. Hypersensivity could not be demonstrated by skin testing and ceftriaxone‐specific IgE. However, an in vivo, controlled, intravenous challenge was clearly positive.

Conclusion: Clinicians should be aware of the possibility of anaphylaxis occurring with the first dose of ceftriaxone, especially since such a reaction could go unnoticed in patients with life‐threatening infections and unstable vital signs.
Cerebral palsy in preterm infants: a population‐based case‐control study of antenatal and intrapartal risk factors
Authors: Jacobsson B , Hagberg G , Hagberg B , Ladfors L , Niklasson A , Hagberg H
Published: August 2010

Previous studies have indicated that foetomaternal infection increases the risk of spastic cerebral palsy (CP) in term infants, whereas this association appears to be less evident in preterm infants. The aim of this study was to analyse infection‐related risk factors for spastic CP in preterm infants. A population‐based series of preterm infants with spastic CP, 91 very preterm (>32wk) and 57 moderately preterm (32–36 wk), born in 1983–90, were included and matched with a control group (n= 296). In total, 154 maternal, antenatal and intrapartal variables were retrieved from obstetric records. In the entire group, histological chorioamnionitis/pyelonephritis, long interval between rupture of membranes and birth, admission‐delivery interval >4 h and Apgar scores of >7 at 1 min just significantly increased the risk of CP, and Apgar scores of >7 at 5 and 10 min were strongly associated with an increased risk. Abruptio placentae, Apgar scores >7 at 1 min and pathological non‐stress test (reason for delivery) were significant risk factors of CP only in the moderately preterm and hemiplegic groups, whereas fever before delivery was a significant risk factor in the very preterm and spastic diplegic groups. Antibiotics during pregnancy was associated with CP only in the spastic diplegic CP group.

Conclusion: Antenatal infections marginally increased the risk of CP. Low Apgar score and abruptio placentae were associated with CP, especially in moderately preterm infants with hemiplegic CP.
Enzyme replacement therapy in mucopolysaccharidosis type II (Hunter syndrome): a preliminary report
Authors: Muenzer J , Lamsa JC , Garcia A , Dacosta J , Garcia J , Treco DA
Published: August 2010

Mucopolysaccharidosis type II (MPS II; Hunter syndrome) is an X‐linked disease caused by a deficiency of the enzyme iduronate‐2‐sulphatase (IDS), which results in the lysosomal accumulation of glycosaminoglycans (GAG). This paper describes a knockout mouse model of MPS II which has been used to assess the effect of enzyme replacement therapy. Therapy with IDS results in a marked decrease in urinary GAGs, as well as reduced GAG accumulation in several tissues. These studies have been used to support the first clinical trial of recombinant IDS in patients with Hunter syndrome.
First‐time mothers' satisfaction with early encounters with the nurse in child healthcare: home visit or visit to the clinic?
Authors: Jansson A , Sivberg B , Larsson B Wilde , Udén G
Published: August 2010

The aim of this study was to describe first‐time mothers' views of satisfaction with their first encounter with the nurse, in order to investigate differences between home visits and clinic visits and between high/middle and low socioeconomic classification (SEC). A nation‐wide postal questionnaire sent to 800 first‐time mothers yielded the data for statistical analysis. Data were collected using a modified version of the questionnaire “Quality of Care from the Patient's Perspective”, the part concerning child healthcare. The results showed that mothers who had received home visits were more content with the encounter than were mothers who had to visit the clinic. This particularly concerned advice on breastfeeding, being able to talk to the nurse in peace and quiet, and the fact that the nurse took time and was personal. In contrast, the mothers who had received a home visit were less content with the competence of the nurse when she examined the child. Mothers of low SEC were less satisfied with the first encounter than were mothers of high/middle SEC with regard to several points.

Conclusion: Home visits were shown to have advantages over visits to the clinic. Mothers of low SEC were less satisfied with the first encounter with the nurse than were mothers in the high/ middle SEC.
Indoor maternal smoking doubles adolescents' exhaled carbon monoxide
Authors: Gourgoulianis KI , Gogou E , Hamos V , Molyvdas PA
Published: August 2010

The aim of this study was to evaluate the effects of indoor smoking. Exhaled carbon monoxide (CO) concentrations were measured on a CO monitor by a vital capacity manoeuvre in three groups of adolescents: non‐smokers with non‐smoking families, non‐smokers with smoking mothers, and smokers. Each group included eight families. Smokers had higher exhaled CO (mean ± SD, 35.67 ± 14.62 ppm) than non‐smokers with smoking mothers (6 ± 2.5 ppm) and non‐smokers (2.37 ± 0.56 ppm), late in the evening (21.00h). The levels of exhaled CO in nonsmoking adolescents doubled if their mothers smoked.

Conclusion: Exhaled CO can be used as an indicator of indoor smoking. Maternal smoking plays a major role in the health of adolescents.
Overweight among international adoptees in Sweden: a population‐based study
Authors: Johansson‐Kark M , Rasmussen F , Hjern A
Published: August 2010

This study investigated the prevalence of overweight [body mass index (BMI) ± 25 kg m‐2] in young adulthood among international adoptees. The prevalence of overweight among adoptees from various countries of origin was compared with that in a large group of non‐adopted individuals. All 275026 young men born in 1973–1977 and living in Sweden at 17y of age were included. A record linkage was made between the Military Service Conscription Register and several population registers. Data on BMI at 18 y of age were obtained from military conscription examinations conducted in 1991–1995. BMI was missing for 12.7% of 2400 adoptees and 10.8% of 263173 non‐adoptees. Among 623 adoptees from Latin America 21.5% (95% confidence interval 18.3–24.7) were overweight, with a particularly high prevalence of overweight among the 266 adoptees from Chile (28.6%, 23.1–34.0). Among 502 adoptees from the Indian subcontinent 8.4% (5.9–10.8) were overweight and the prevalence of overweight was 8.8% (5.7–12.0) among 317 adoptees from India. Among 817 adoptees from the Far East 12.0% (9.8–14.2) were overweight and the prevalence of overweight was 10.9% (7.9–13.9) among 404 from South Korea. The corresponding figure was 14.1% (14.0–14.2) among the non‐adopted individuals.

Conclusion: These differences in prevalence of overweight between various groups of adoptees and between adopted and non‐adopted subjects are remarkable and are probably due to diversity in genetic susceptibility to overweight.
Differential trafficking of the Niemann‐Pick C1 and 2 proteins highlights distinct roles in late endocytic lipid trafficking
Authors: Zhang M , Sun M , Dwyer NK , Comly ME , Patel SC , Sundaram R , Hanover JA , Blanchette‐Mackie EJ
Published: August 2010

The cellular location of Niemann‐Pick C2 protein (NPC2) in cultured human fibroblasts and Chinese hamster ovary cells was examined immunocytochemically and in living cells by expression of a functional red fluorescent protein chimeric analogue. Results: NPC2 is present in the lysosomes of both cholesterol‐depleted and ‐replenished cells, unlike Niemann‐Pick C1 protein (NPC1) which is recruited to late endosomes only upon uptake of low‐density lipoprotein. With mobilization of cholesterol from lysosomes, immunocytochemical detection of NPC2 in lysosomes is greatly diminished, whereas NPC1 remains in the late endosomal compartment. We found a partial overlap in the trafficking and organellar sites of accumulation of NPC2 and NPC1. In living cells, NPC2 traffics with NPC1 in late endosomal tubules. However, in contrast to NPC1, which remains either in late endosomal vesicles and tubules or at the peripheries of cholesterol‐laden lysosomes, NPC2 moves into the central core of lysosomes. Glycolipid analysis reveals that, in contrast to null mutant NPC1 cells, which accumulate GM2 ganglioside only at the plasma membrane, with no endocytic storage, absence of NPC2 protein in null mutant NPC2 cells does not block internalization of GM2 into endocytic vesicles. This difference in the cellular distribution of GM2 in NPC1 and NPC2 null mutants is the first report of a variation in the phenotypic expression of these genotypically distinct lesions.

Conclusion: We speculate that while NPC1 may play a major role in the sorting of glycolipids as well as cholesterol within the late endosomes, NPC2 primarily plays a role in the egress of cholesterol and, potentially, glycolipids from lysosomes. These proteins appear not to be integrated into a tightly bound biological complex, but rather represent separate functional entities that complement each other.
Procalcitonin and interleukin‐6 in the diagnosis of early‐onset sepsis of the neonate
Authors: Resch B , Gusenleitner W , Müller WD
Published: August 2010

The reliability of procalcitonin (PCT) and interleukin‐6 (IL‐6) was determined and compared with that of C‐reactive protein (CRP) in the diagnosis of early‐onset sepsis of the neonate within the first 12 h of life. ROC analysis of values of 41 neonates with blood‐cultures‐positive and clinical sepsis compared with those of 27 uninfected neonates revealed sensitivities for PCT (≥6ng/mL), IL‐6 (≥60pg/mL), and CRP (≥2.5 mg/L) of 77%, 54%, and 69% and specificities of 91%, 100% and 96%, respectively. Sensitivity of CRP at ≥8 mg/L was 49% (p= 0.012 compared to PCT).

Conclusion: PCT was the most sensitive diagnostic parameter in the diagnosis of early‐onset sepsis within 12 h of life.
Influence of different types of post‐discharge feeding on somatic growth, cognitive development and their correlation in very low birthweight preterm infants
Authors: Marini A , Vegni C , Gangi S , Benedetti V , Agosti M
Published: August 2010

The influence of appropriate post‐discharge nutrition on somatic growth and cognitive development of very low‐birthweight infants in the first year of life is currently a major topic in infant nutrition. Appropriate intakes of proteins, iodine and the addition of LC‐PUFAs (arachidonic acid (AA), docosahexaenoic acid (DHA)) in the “right” quantities improve cognitive development and are conducive to a good correlation between somatic growth and neurodevelopment.

Conclusion: When mother’milk is not available post‐discharge, in addition to more proteins and minerals, formula for low‐birthweight infants should contain AA and DHA, since the endogenous production of these important compounds from the precursors can be reduced in the first months of life, chiefly in the very low‐birthweight infants.