bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal perception of excess weight in children: A survey conducted by paediatricians in the province of Milan
Authors: Genovesi Simonetta , Giussani Macro , Faini Andrea , Vigorita Federico , Pieruzzi Federico , Grazia Strepparava Maria , Stella Andrea , Grazia Valsecchi Maria
Published: August 2010

Objective: To establish whether maternal perception of a child's body weight (BW) and food intake is related to the level of maternal education. Study design: Height and BW of 569 mother/child couples were measured, and mothers received a questionnaire regarding their perception of their own weight and their child's BW and food intake. Results: Twenty‐nine percent of mothers and 35% of children were overweight or obese. Only 10% of the mothers underestimated their own weight, while 37% overestimated it. In contrast, 28% of mothers underestimated their child's BW, while 9% overestimated it. Higher maternal instruction level was significantly associated to a lower weight class in both mothers and children, and to a correct perception of the child's weight. Fifty‐seven per cent of the mothers who perceived their child to be overweight or obese were not concerned. Forty‐four per cent of the mothers with overweight or obese children believed that their child was eating correctly.

Conclusions: A better understanding of how mothers perceive the problem of excess weight in their children is relevant to the success of preventive interventions in childhood obesity.
Outcome of low birthweight in China: A 16‐year longitudinal study
Authors: Peng Yongmei , Huang Bin , Biro Frank , Feng Lingying , Guo Zhiping , Slap Gail
Published: August 2010

Aim: To compare the growth and neurodevelopment of low‐birthweight (LBW) and normal‐birthweight (control) infants born and raised in China. Design: Prospective cohort study. Subjects and setting: 203 LBW (1200–2499 g) and 71 control (2500 g) infants born at two Shanghai hospitals in 1983 did not differ for date of birth, gender, parental occupation, parental weight and age. LBW <10th centile at 37 wk gestation was defined as small for gestational age (SGA, n=102). LBW at <37 wk gestation was defined as preterm (n=101). Main outcome measures: Weight, height, head circumference, Gesell developmental quotient (DQ), Wechsler intelligence quotient (IQ), and scholastic achievement score. Results: Of the 274 enrolled subjects, 234 (85%) returned at 6 mo, 135 (49%) at 6 y, and 104 (38%) at 16 y. SGA, preterm, and control subjects did not differ in rates of follow‐up or baseline characteristics. However, SGA and preterm were lower than control subjects in weight and head circumference through 16 y, height through 4 y, DQ through 3 y, IQ at 5 and 16 y, and scholastic achievement at 16 y. Catch‐up to growth in the control group, defined as >3rd centile, and normal IQ, defined as 85, were both more common among preterm than SGA subjects.

Conclusions: Adolescents in China with birthweights of 1200–2499 g, and particularly those who were SGA, lag behind peers with birthweights >2500 g in physical growth, cognitive capacity, and school achievement. The findings suggest that LBW adolescents in China today represent a population in need of evaluation and support.
Food choices at lunch during the third year of life: high selection of animal and starchy foods but avoidance of vegetables
Authors: Nicklaus Sophie , Boggio Vincent , Issanchou Sylvie
Published: August 2010

Aim: The objective was to show patterns of food selection by 2‐ to 3‐y‐old children for a wide variety of foods in a self‐service cafeteria and to assess the effect of individual variables (gender, BMI, mode of feeding after birth and rank in sibship). Methods: In a nursery self‐service canteen, food choices at lunch made by children (n=418, 24–36 mo; 109 observations per child on average) were recorded by trained assistants who monitored portion size. An offer of eight dishes (animal products, starchy foods, combination dishes, vegetables and dairy products), excluding dessert‐type foods, was proposed. Choice level was calculated for each food. Analysis of variance was used to compare choices for the various foods and to assess the effect of the individual variables. Results: The choice of a food largely depended upon its nature: animal products, starchy foods and their combinations were widely chosen, whereas vegetables were not often selected; the choice for dairy products depended upon the type. The mode of preparation of the food influenced its choice. Segmenting products were identified; however, except for cheeses, a given child did not refuse an entire food category. Children's characteristics did not explain the choice variability.

Conclusion: At the age of 2 to 3 y, children preferentially choose animal products and starchy foods and avoid vegetables; the high individual variability of their food choices could be related to previous food experiences.
Callosal anomalies with interhemispheric cyst: Expanding the phenotype
Authors: Pavone Piero , Barone Rita , Baieli Sabrina , Parano Enrico , Incorpora Gemma , Ruggieri Martino
Published: August 2010

Aim: To determine the frequency and clinical features of corpus callosum hypoagenesis, dysgenesis or hypoplasia in conjunction with extraparenchymal interhemispheric cyst. Methods: A retrospective study of clinical files and imaging records of all 2500 children referred to the University Department of Paediatrics, Catania, Italy, who underwent neuroimaging by ultrasound, computerized tomography or magnetic resonance imaging in 1992–2003. Five children (all girls, aged 2–18 y) were found to have abnormalities of the corpus callosum associated with interhemispheric cyst. Results: Three cases were type 2b, one type 2c and one mixed type 2b and 2c according to the classification proposed by Barkovich et al. The onset of clinical symptoms was very early, with severe neurological involvement, seizures that were difficult to treat and profound psychomotor retardation.

Conclusions: In callosal anomalies with cysts, a prevalence in females is not confined to type 2b cysts, the spectrum of abnormalities of the corpus callosum is more varied than previously recorded, and the natural history and outcome of the condition are poor with profound developmental delay and drug‐resistant seizures. The finding that all the cases were of type 2 suggests that the overall phenotype is more widespread than previously thought and may present in association with other complex syndromes.
Postnatal peer counselling on exclusive breastfeeding of low‐birthweight infants: A randomized, controlled trial
Authors: Agrasada Grace V , Gustafsson Jan , Kylberg Elisabeth , Ewald Uwe
Published: August 2010

Aim: Exclusive breastfeeding increases survival and optimizes growth of low‐birthweight (LBW) infants. If supported, mothers can overcome the unique difficulties associated with breastfeeding from birth to 6 mo. We tested the efficacy of postnatal peer counselling among first‐time mothers that aimed to increase exclusive breastfeeding of term LBW infants. Methods: In a Manila hospital, 204 mothers were randomized into three groups. Two intervention groups receiving home‐based counselling visits, one by counsellors trained in breastfeeding counselling (n=68), the other by counsellors trained in general childcare (n=67), were compared with a control group of mothers (n=69) who did not receive counselling. Results: Eighty‐eight per cent of the participating pairs completed the trial. At 6 mo, 44% of the breastfeeding counselled mothers, 7% childcare‐counselled mothers and none of the mothers in the control group were exclusively breastfeeding. More mothers in the breastfeeding counselled group than in the other groups were still breastfeeding at 6 mo. Twenty‐four infants who were exclusively breastfed for 6 mo did not have any diarrhoea. All groups had improved mean weight‐for‐age Z‐scores at 6 mo.

Conclusion: This study has provided fundamental evidence of successful intervention to achieve 6 mo of exclusive breastfeeding among term LBW infants. By improving health outcomes, enhanced breastfeeding offers a distinct possibility of disrupting the intergenerational cycle of undernourished women giving birth to LBW infants.
Autosomal‐dominant non‐autoimmune hyperthyroidism presenting with neuromuscular symptoms
Authors: Elgadi Aziz , Arvidsson CG , Janson Annika , Marcus Claude , Costagliola Sabine , Norgren Svante
Published: August 2010

Aim: Neuromuscular presentations are common in thyroid disease, although the mechanism is unclear. In the present study, we investigated the pathogenesis in a boy with autosomal‐dominant hyperthyroidism presenting with neuromuscular symptoms. Methods: The TSHr gene was investigated by direct sequencing. Functional properties of the mutant TSHr were investigated during transient expression in COS‐7 cells. Family members were investigated by clinical and biochemical examinations. Results: Sequence analysis revealed a previously reported heterozygous missense mutation Glycine 431 for Serine in the first transmembrane segment, leading to an increased specific constitutive activity. Three additional affected family members carried the same mutation. There was no indication of autoimmune disorder. All symptoms disappeared upon treatment with thacapzol and L‐thyroxine and subsequent subtotal thyroidectomy.

Conclusion: The data imply that neuromuscular symptoms can be caused by excessive thyroid hormone levels rather than by autoimmunity.
Percutaneous transluminal angioplasty for renovascular hypertension in a neonate
Authors: Daehnert I , Hennig Bert , Scheinert D
Published: August 2010

Aim: To report on the first case of successful percutaneous transluminal renal artery angioplasty in a neonate. Methods: Case report: a 5‐d‐old neonate was admitted with cardiorespiratory failure. Monitoring of blood pressure revealed severe arterial hypertension. Doppler sonography detected stenotic flow in the right renal artery. A 99mTc‐MAG3 scan revealed highly diminished elimination by the right kidney. Selective renin levels were 23 968 ng/l in the right and 3770 ng/l in the left renal vein and the aorta. Percutaneous transluminal angioplasty using a 2×10 mm balloon catheter was performed on the 8th day of life. Results: The patient was discharged from hospital normotensive without anti‐hypertensive medication. During 8 mo follow‐up the blood pressure remained normal, Doppler sonography revealed no recurrent artery stenosis, and renal function improved.

Conclusion: Neonatal percutaneous transluminal angioplasty for renal artery stenosis may be feasible in selected patients.
Waist circumference percentiles for 7‐ to 15‐year‐old Australian children
Authors: Eisenmann Joey C.
Published: August 2010

Aim: The purpose of this study was to develop age‐ and sex‐specific reference values for waist circumference using data obtained from Australian children and adolescents. Methods: Subjects were 8439 7‐to‐15 y olds (4277 males and 4162 females) who participated in the 1985 Australian Health and Fitness Survey. Waist circumference (WC) was measured in the standing position at the level of the umbilicus to the nearest 0.1 cm using a constant tension tape. Descriptive statistics for each whole‐year age group (e.g., 10.0–10.99 y, etc.) within sex were calculated. Construction of the smoothed centile curves was performed using the LMS method. Results: Mean WC increases in both males and females, with the values being similar between males and females prior to age 11 y, after which values are slightly higher in males. The range of values varied by age and sex groups but approximated 30–60 cm. Smoothed percentile curves and percentile values for the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles are presented for boys and girls. WC increases with age in boys and girls, and boys have higher values than girls at nearly every age‐specific percentile.

Conclusions: These data can be added to the existing international reference values for WC of children and adolescents which should be used to create international cut‐off points similar to those for the body mass index (BMI). Future studies should consider the immediate and long‐term consequences of an elevated WC in children and also examine the interaction of BMI and WC on chronic disease risk factors.
Birth centre care over a 10‐year period: Infant morbidity during the first month after birth
Authors: Gottvall Karin , Winbladh Birger , Cnattingius Sven , Waldenström Ulla
Published: August 2010

Aim: To study morbidity during the first month of life affecting infants of mothers booked for birth centre care during pregnancy. Methods: 3238 live single‐born infants whose mothers were admitted to an in‐hospital birth centre, located at South Hospital in Stockholm, between 1989 and 2000 were compared with 179 502 infants whose mothers received standard maternity care in the Stockholm region during the same period, and who fulfilled the same medical inclusion criteria as those of the birth centre group. Information on other exposures and outcomes was collected from the Swedish Medical Birth and Hospital Discharge Registers. Logistic regression analyses were performed to calculate the odds ratio (OR), using 95% confidence intervals (95% CI). Results: Compared with infants born in standard care, infants in the birth centre group had a higher risk of respiratory problems (OR 1.39; 95% CI 1.14–1.69), a difference correlated to less serious respiratory diagnoses. However, the difference was not statistically significant if the birth centre group was compared only with infants born in standard care at South Hospital (OR 1.18; 95% CI 0.94–1.47). Birth centre care was associated with a lower risk of fractures (OR 0.40; 95% CI 0.25–0.63).

Conclusion: Birth centre care was not associated with severe infant morbidity and even appeared to reduce the risk of birth trauma, such as clavicle and other fractures.
Long‐term follow‐up of a girl with primary aldosteronism: Effect of potassium supplement
Authors: Takaya Junji , Isozaki Yuka , Hirose Yohko , Higashino Hirohiko , Noda Yukihiro , Kobayashi Yohnosuke
Published: August 2010

We followed up a girl with primary aldosteronism for 8 y, which was diagnosed at 6 y of age when she was referred to us for evaluation of heart murmur and growth failure. The diagnosis of bilateral adrenal hyperplasia was made by selective adrenal venous sampling. Following potassium supplement, her retarded growth was corrected dramatically, and she attained a normal adult height. Puberty developed normally and menarche occurred at 12 y of age. Blood pressure was also controlled adequately. Myocardial hypertrophy associated with aortic damage was noted at 13 y of age. Chronic renal failure developed with proteinuria and enlarged renal cysts.

Conclusion: Serum electrolytes should be included in the evaluation of children with impaired growth. Although primary aldosteronism is a rare occurrence in children, the condition appears to deserve special attention not only from the viewpoint of growth failure and hypokalaemia but from the occurrence of late organ damage to the kidney and heart.
Management of the obese child using psychological‐based treatments
Authors: Flodmark Carl‐Erik
Published: August 2010

Obesity is increasing in childhood and has approximately doubled during the last 10 years. Nowadays, more politicians and researchers find it necessary to start treating childhood obesity. The reasons for this are the high costs of obesity and its complications later in life—complications that also appear when obesity starts in childhood. In the following article, I will give a review of the treatments available that have been evaluated in studies. There are no relevant studies regarding surgery and medication in children. Thus, I will not comment further on those treatments. The treatment of choice is thus a change in lifestyle. To be able to help patients do this, you have to be professional when you encounter the patient. The best way to be successful is to use psychological treatments as described in this paper.
Information and communication in society
Authors: Sandberg Helena
Published: August 2010

In late modernity, the media is one of the most important social institutions in influencing people's knowledge, perceptions and actions. The media supply citizens with health‐related messages and contribute thereby to their health development. The abundant flow of health‐related messages, however, makes it difficult for the individual to separate good and reliable information from information of poor quality. The prevalence of overweight and obesity is rising each year in Sweden as well as in other countries. The future scenario is troublesome. The presented study deals with two questions: (1) How is overweight represented in the media? (2) What consequences do these representations have on public perceptions of overweight? A multi‐disciplinary approach has been chosen for the study. Theories and concepts are derived from four areas of research: consumption, bodily issues, risks and media & journalism. The aim was to describe, analyse and problematize how overweight is presented quantitatively and qualitatively in the media. The method used is content analysis. The study is limited to media content in Swedish daily newspapers, 1997–2001. In all, 1925 articles from four different papers have been analysed.

Conclusion: The ideals of journalism are easy to accept but too often difficult to realize. Reporters as well as physicians and scientists must make more of an effort to communicate comprehensible and useful information about overweight and obesity to their audiences. Still we know little about the amount, the quality and the utility of health information in the media. There is a need for further research in this field if we want to understand what chances people have in making informed health‐related decisions and how they make sense of and use the health information at their disposal.
Human milk supplementation for preterm infants
Authors: Schanler Richard J
Published: August 2010

Nutrition support of the premature infant must be designed to compensate for metabolic and gastrointestinal immaturity, immunologic compromise, and associated medical conditions. The beneficial effects of human milk extend to the feeding of premature infants. However, nutritional concerns arise because the quantity of nutrients in human milk may not meet the great nutrient needs of the premature infant born weighing less than 1500 g. Human milk fortifiers are available to provide optimum nutrition. This review summarizes the benefits and limitations of human milk for the premature infant.
Post‐discharge nutrition for the preterm infant
Authors: Schanler Richard J
Published: August 2010

Newly designed, ‘enriched,’ formulas are now available for the formula feeding premature infant after hospital discharge. These new formulations add to the array of milks from which to choose when the discharge of the premature infant is approaching. However, the data to support optimal or reference nutrient intakes to use for the premature infant in the post‐discharge are lacking. Breastfeeding should be encouraged as its beneficial effects may be related to the duration in which it is fed. Infants at risk for growth failure in the post‐discharge period, such as infants unable to consume ad libitum intakes of milk, and who already have growth faltering or abnormal nutritional indices, may benefit for the addition of enriched formula. This review summarizes the recent data and comments on recommendations on post‐discharge nutrition for premature infants.
The relation between inferior vena cava oxygen saturation, superior vena cava flow, fractional oxygen extraction and haemoglobin affinity in sick newborns: A pilot study
Authors: Hart James , Vemgal Prakash , Cocks‐Drew Sandra , Harrison Catherine , Andersen Chad
Published: August 2010

Aim: To determine whether inferior vena cava oxygen saturation (UvO2) or lower‐body fractional oxygen extraction (FOE) could detect poor cardiac output in newborns. Methods: UvO2 and arterial oxygen saturation (SaO2) were measured simultaneously with echocardiographic determination of superior vena cava blood flow (SVC flow) at <12, 12–24 and >24 h. Haemoglobin concentration ([Hb]), haemoglobin oxygen affinity (HOA) and lactate were measured and FOE calculated. Results: 56 studies in 17 infants, gestational age (median (range)) 26 wk 4 d (23 wk 2 d–42 wk 3 d): UvO2 (mean (SD)) was 84.9% (5.0), 77.6% (9.2) and 81.7% (12.9) at <12, 12–24 and >24 h, respectively; SVC flow (mean (SD)) increased from 71.7 (33) to 85 (66) and 123 (88) ml/kg/min at <12, 12–24 and >24 h, respectively. Despite a fall in mean [Hb], mean upper‐body oxygen delivery increased due to increases in both SVC flow and arteriovenous content difference. There was a negative correlation between [Hb] and FOE. Infants with high HOA had significantly lower FOE.

Conclusion: Measurement of UvO2 is feasible in newborns. Changes to SVC flow and arteriovenous content difference lead to improvements in oxygen delivery. The interaction of HOA warrants further study.
Central/diffuse abdominal perception of urological pain in children
Authors: Polito Cesare , Cioce Fabrizio , Signoriello Giuseppe , La Manna Angela
Published: August 2010

Aim: In children with recurrent abdominal pain (RAP), the location of pain to the flank may suggest the involvement of the urinary apparatus. We aimed to evaluate the location of pain in different age groups of children with idiopathic hypercalciuria (HC) and/or hyperuricosuria (HU) and RAP. Methods: Location of pain was assessed in 180 consecutive HC/HU children with RAP, aged 3–17.6 y, presenting to a single centre. Results: Considering four age groups, central/diffuse was more prevalent than lateral location of pain in youngsters, with a progressive and significant (p<0.0001, χ2 test for trend) decrease of the prevalence of central/diffuse location with rising age, and with the most relevant drop after age 8 y. Location of pain was central/diffuse in 81% of patients under and lateral in 79% of those over 8 y of age (p<0.0001). The location of pain changed from central/diffuse to lateral in 16/18 children followed at least 1 y, within 1 to 2 y by age 8.

Conclusion: Only after 8 y of age did the lateral location of abdominal pain become the rule in children with HC/HU and RAP. This has to be kept in mind in order to avoid overlooking the urologic origin of pain.
A Quisling on neonatal jaundice
Authors: Hansen Thor Willy Ruud
Published: August 2010

Background/methods: Nils Andreas Quisling was born in Telemark, Norway, in 1854 and became an obstetrician. In 1893 he published a monograph on neonatal jaundice. This monograph was studied and compared with other published sources from the same time period. Results: Quisling discussed four theories on the cause of neonatal jaundice. “Suppression jaundice” held that jaundice was the result of suppressed liver function. “Haematogenous jaundice” claimed that bilirubin was formed from haemoglobin outside the liver, and had nothing to do with the liver. “Polycholia” held that neonatal jaundice was due to an increased secretion of all the constituents of bile. Quisling rejected these and supported the “hepatogenous” theory–jaundice was always a liver‐related phenomenon. He described 50 cases of neonatal jaundice. The incidence of neonatal jaundice at the Kristiania Maternity Foundation was 26%. In Quisling's cases, gastrointestinal disturbances were common, and he felt this to be an under‐reported complication of neonatal jaundice. He found that neonatal jaundice was often accompanied by fever.

Conclusion: Gastrointestinal disturbances were causally involved in neonatal jaundice, resulting in impeded bile drainage. At the time of Quisling's study (1887), this ‘hepatogenous” theory of neonatal jaundice probably still had majority support in the European literature.
Stop SIDS – sleeping solitary supine, sucking soother, stopping smoking substitutes
Authors: Alm Bernt , Lagercrantz Hugo , Wennergren Göran
Published: August 2010

The recognition of prone sleeping and maternal smoking as modifiable risk factors for sudden infant death syndrome (SIDS), has drastically decreased SIDS incidence. However, during the last years other factors have become necessary to consider to further reduce the risk of SIDS. Side sleeping implies a greater risk than supine sleeping but is still common. Bed sharing may increase the risk of SIDS, while use of a pacifier seems to be protective. Replacement of maternal smoking with nicotine substitutes is not harmless.

Conclusion: To further reduce the risk of SIDS, exclusive supine sleeping should be encouraged and side sleeping discouraged. When the breast‐feeding is established, a pacifier can very well be used at bedtime. Bed sharing can increase the risk of SIDS if the infant is below 2–3 months of age, especially if the mother is a smoker. Any nicotine use should be avoided during pregnancy and breast‐feeding.
Failure to diagnose critical heart malformations in newborns before discharge—an increasing problem?
Authors: Mellander Mats , Sunnegårdh Jan
Published: August 2010

Aim: To determine what proportion of newborns with critical heart defects are discharged undiagnosed from the maternity ward. Methods: Data were retrieved retrospectively for infants born in our referral area from 1993 to 2001 and undergoing surgical or catheter‐based intervention before 2 mo of age because of critical heart defects. Results: 259 full‐term infants had critical heart defects. Duct‐dependent systemic circulation was present in 129, duct‐dependent pulmonary circulation in 106, and 24 infants were not duct dependent but critically ill. In 51 infants (20%) the heart defect was not suspected before discharge from the maternity ward. Such late detection occurred more often in infants with duct‐dependent systemic circulation (30%) and in children with defects that were not duct dependent (38%) than in children with duct‐dependent pulmonary circulation (4%) (p<0.001). The proportion detected after discharge from the maternity ward increased from 13% in 1993–1995 and 21% in 1996–1998 to 26% in 1999–2001 (p<0.05). Conclusion: Many infants with critical congenital heart defects are not diagnosed before discharge from the neonatal maternity ward. The proportion discharged undiagnosed has increased. Neonatal screening fails mainly in children with duct‐dependent systemic circulation.
Ten‐year trends in obesity among Israeli schoolchildren: 1990–2000
Authors: Huerta Michael , Gdalevich Michael , Haviv Jacob , Bibi Haim , Scharf Shimon
Published: August 2010

Aim: To analyze trends in childhood body mass index (BMI) in Israel between 1990 and 2000, and to determine the proportion of obese children using US and population‐specific reference values. Methods: Cross‐sectional data from 13 284 second‐ and fifth‐grade schoolchildren were collected, including age, sex, height, weight, country of birth, and time since immigration. Age‐ and sex‐specific BMI means and centiles were calculated, and the prevalence of obesity was determined using Israeli and US reference values. Results: BMI values at the 95th centile increased monotonously over time in all age and sex categories. Between 1990 and 2000, 95th centile values increased by 12.7% and 11.8% among second‐grade boys and girls, respectively. Among fifth‐grade children, 95th centile values increased by 10.2% and 8.4%, respectively. Among second graders in 2000, 11.4% of both boys and girls exceeded the BMI value recorded at the 95th centile in 1990. Among fifth‐graders in 2000, 10.7% of boys and 11.1% of girls exceeded the 1990 BMI reference value (p for all comparisons < 0.001). The proportion of obese children increased over time using both Israeli and US reference values.  Conclusion: This substantial increase in childhood obesity poses a serious health threat, and requires implementation of suitable public health interventions.
Hyperglycaemia as a possible marker of invasive fungal infection in preterm neonates
Authors: Manzoni Paolo , Castagnola Elio , Mostert Michael , Sala Ugo , Galletto Paolo , Gomirato Giovanna
Published: August 2010

Aim: The incidence of invasive fungal infection in preterm newborns is rising steadily. Early recognition and treatment are imperative, but diagnosis is difficult as data from microbiological investigations are often poor, and clinical and laboratory signs do not help in differentiating bacterial from fungal infections. We evaluated whether glucose intolerance could represent a possible surrogate marker predictor of invasive fungal infection in preterm neonates. Methods: We performed a case‐control study on neonates with birthweight less than 1250 g admitted to our tertiary‐level unit during the years 1998–2004 (n=383), comparing those with invasive fungal infection (n = 45, group A) to matched controls with late‐onset sepsis caused by bacterial agents (n=46, group B). We investigated in both groups the occurrence of hyperglycaemia (serum glycaemia > 215 mg/dl, i.e. 12 mmol/l) in the first month of life, and its temporal relationship with the episodes of sepsis. Results: Hyperglycaemia occurred significantly more often in group A (21/45, 46.6%) than in group B neonates (11/46, 23.9%) (OR 1.95, 95% CI 1.235–4.432, p=0.008). Moreover, in 19 of 21 (90.4%) neonates with hyperglycaemia in group A, the carbohydrate intolerance episode typically occurred 72 h prior to the onset of invasive fungal infection; in contrast, no temporal relationship was found in neonates with bacterial sepsis (p=0.002). Correction of hyperglycaemia was successfully achieved in all neonates of both groups, with no significant differences in the number of days of insulin treatment needed to normalize glycaemia (p = 0.15).

Conclusions: Hyperglycaemia is significantly more frequent in neonates who subsequently develop fungal rather than bacterial late‐onset sepsis, with a typical 3‐d interval. We suggest that a preterm neonate whose birthweight is less than 1250 g in its first month of life should be carefully evaluated for systemic fungal infection whenever signs of carbohydrate intolerance occur.
Attention‐deficit/hyperactivity disorder in schoolchildren in Crete
Authors: Skounti Maria , Philalithis Anastas , Mpitzaraki Katerina , Vamvoukas Michail , Galanakis Emmanouil
Published: August 2010

Aim: To explore the prevalence of attention‐deficit/hyperactivity disorder (ADHD) in 7‐y‐old child residents of Crete, Greece. Methods: The study combined information from both parents and teachers for 1708 elementary school children attending the first grade in 101 classes of 55 primary schools. A two‐stage screening process was employed, including the ADHD test and a rating scale of student behaviour. Parents completed the ADHD test and teachers the rating scale of student behaviour. Results: Both questionnaires were completed for 1285 (75.2%) children. Among them, 84 children (6.5%; 95% CI 5.2–7.9%) met the study criteria for ADHD. The estimated prevalence was 8.8% for boys (95% CI 6.6–11.0%) and 4.2% for girls (95% CI 2.6–5.7%). No significant differences were observed regarding urban, semi‐urban or rural residence.

Conclusion: By using a combination screening procedure, both the ADHD prevalence among first‐grade schoolchildren in Crete and the gender differences in prevalence were found to be comparable to those reported from other countries. The methods used and the problems faced illustrate the challenges involved in conducting population‐based studies of ADHD.
Ghrelin and motilin concentration in colicky infants
Authors: Savino Francesco , Clara Grassino Erica , Guidi Carla , Oggero Roberto , Silvestro Leandra , Miniero Roberto
Published: August 2010

Aim: To evaluate serum ghrelin and motilin concentration in infants with infantile colic. Methods: A case‐control study was conducted on fasting blood venous samples obtained from 18 infants with infantile colic and 20 healthy infants to measure ghrelin (RIA test) and motilin (RIA test). Results: Colicky infants showed higher ghrelin serum levels (2534.2±600.0 pg/ml; ln 7.8±0.2) than controls (2126.1±281.3 pg/ml; ln 7.6±0.1) (p = 0.011). Serum motilin concentration was significantly higher in colicky infants (94.6±23.2 pmol/l) than in controls (64.1±30.1 pmol/l) (p=0.001). Motilin concentrations were higher in formula‐fed colicky infants (104.5±20.4 pmol/l) than in breastfed ones (82.2±21.3 pmol/l) (p = 0.038).

Conclusion: Our finding shows that ghrelin and motilin concentrations are higher in infants with colic than in controls, supporting an organicistic aetiopathogenesis of this disorder. Furthermore, the role of ghrelin on gastrointestinal motility may open new doors to better understand the aetiology of infantile colic.
Inflicted traumatic brain injury (ITBI) or shaken baby syndrome (SBS) in Estonia
Authors: Talvik Inga , Metsvaht Tuuli , Leito Kaja , Põder Haide , Kool Pille , Väli Marika , Lintrop Mare , Kolk Anneli , Talvik Tiina
Published: August 2010

Background: Inflicted traumatic brain injury (ITBI) or shaken baby syndrome (SBS) is recognized as a major cause of disability and death in the paediatric population. Aim: To find out the incidence of ITBI in Estonia. Methods: 26 cases of ITBI were recognized: four children died, 22 survived. Results: Of 26 children, 20 (77%) were boys and six (23%) were girls. Median age at admission to hospital was 3.9 mo, and the boys were younger than the girls. Conclusion: The overall incidence of ITBI was 28.7 per 100 000 infants. In the prospective group the incidence was 40.5 per 100 000, and in retrospective group 13.5 per 100 000. ITBI is not rare but not always a recognized form of child abuse. Healthcare professionals should be more aware of this condition.
The timing of complementary feeding of infants in Switzerland: Compliance with the Swiss and the WHO guidelines
Authors: Dratva Julia , Merten Sonja , Ackermann‐Liebrich Ursula
Published: August 2010

Background: The importance of adequate complementary feeding of infants is increasingly acknowledged. Little is known of the actual complementary feeding practices in Switzerland.

Aim: To report the prevalence of adequate timing of complementary feeding, comparing the compliance to Swiss and World Health Organization (WHO) guidelines, and to investigate factors influencing infant complementary feeding.

Methods: In 2003 a cross‐sectional study was conducted of mother‐and‐infant pairs in Switzerland. The mothers, randomly chosen by local community mother‐and‐child health services, completed a 24‐h dietary recall questionnaire and reported the infant's age at the first introduction of various foods. Descriptive analysis, group testing and regression analysis of data collected were conducted.

Results: Introduction of solids mainly occurred between the 5th and 6th months. Five per cent of the mothers introduced complementary food before the age of 4 mo. The main influencing factors for infant feeding were maternal age, language regions, mother's BMI and smoking status, the presence of siblings, and an allergic predisposition of the infant.

Conclusion: The timing of the introduction of complementary foods meets with Swiss guidelines. WHO recommendations, however, are not met. This may be due to a misunderstanding of the Swiss Paediatric Association's age‐range recommendations or insufficient promotion of the WHO recommendations.
Fetal stroke and congenital parvovirus B19 infection complicated by activated protein C resistance
Authors: De Haan Timo R. , Van Wezel‐Meijler Gerda , Beersma Matthias F. C. , von Lindern Jeanette S. , Van Duinen Sjoerd G. , Walther Frans J.
Published: August 2010

Parvovirus B19 infection in gestation has been associated with severe fetal complications such as anaemia, hydrops and fetal demise. Fetal infection in the first trimester poses the greatest risk for these complications, but infection during the third trimester is more common than previously appreciated and can be associated with severe complications, i.e. fetal death, in the absence of hydrops or classical clinical symptoms. Parvovirus B19 infection has been associated with vasculitis and pathological changes in the central nervous system, which may cause stroke. We report a newborn infant with a rare combination of a recent central nervous system infection with parvovirus B19 and a factor V Leiden mutation, who developed fetal stroke.

Conclusion: Factor V Leiden mutation leads to activated protein C resistance and increases the risk of thromboembolism. Thromboembolism occurs rarely in newborns with activated protein C resistance, but can be precipitated by dehydration, asphyxia and infection. Although parvovirus B19 infection of the central nervous system may be a precipitant in neonatal and/or fetal stroke, it can also cause stroke independent of a thrombophilic mutation. In this case, both causative factors may have coincided.
Enrolment and baseline characteristics in the WHO Multicentre Growth Reference Study
Authors:   WHO MULTICENTRE GROWTH REFERENCE STUDY GROUP, de Onis Mercedes
Published: August 2010

Aim: To describe the WHO Multicentre Growth Reference Study (MGRS) sample with regard to screening, recruitment, compliance, sample retention and baseline characteristics.

Methods: A multi‐country community‐based study combining a longitudinal follow‐up from birth to 24 mo with a cross‐sectional survey of children aged 18 to 71 mo. Study subpopulations had to have socio‐economic conditions favourable to growth, low mobility and ≥ 20% of mothers practising breastfeeding. Individual inclusion criteria were no known environmental constraints on growth, adherence to MGRS feeding recommendations, no maternal smoking, single term birth and no significant morbidity. For the longitudinal sample, mothers and newborns were screened and enrolled at birth and visited 21 times at home until age 24 mo.

Results: About 83% of 13 741 subjects screened for the longitudinal component were ineligible and 5% refused to participate. Low socio‐economic status was the predominant reason for ineligibility in Brazil, Ghana, India and Oman, while parental refusal was the main reason for non‐participation in Norway and USA. Overall, 88.5% of enrolled subjects completed the 24‐mo follow‐up, and 51% (888) complied with the MGRS feeding and no‐smoking criteria. For the cross‐sectional component, 69% of 21 510 subjects screened were excluded for similar reasons as for the longitudinal component. Although low birthweight was not an exclusion criterion, its prevalence was low (2.1% and 3.2% in the longitudinal and cross‐sectional samples, respectively). Parental education was high, between 14 and 15 y of education on average.

Conclusion: The MGRS criteria were effective in selecting healthy children with comparable affluent backgrounds across sites and similar characteristics between longitudinal and cross‐sectional samples within sites.
Relationship between physical growth and motor development in the WHO Child Growth Standards
Authors:   WHO MULTICENTRE GROWTH REFERENCE STUDY GROUP, de Onis Mercedes
Published: August 2010

Aim: To examine relationships among physical growth indicators and ages of achievement of six gross motor milestones in the WHO Child Growth Standards population. Methods: Gross motor development assessments were performed longitudinally on the 816 children included in the WHO Child Growth Standards. Six milestones (sitting without support, hands‐and‐knees crawling, standing with assistance, walking with assistance, standing alone, walking alone) were assessed monthly from 4 until 12 mo of age and bimonthly thereafter until children could walk alone or reached 24 mo. Failure time models were used 1) to examine associations between specified ages of motor milestone achievement and attained growth z scores and 2) to quantify these relationships as delays or accelerations in ages of milestone achievement. Results: Statistically significant associations were noted between ages of achievement of sitting without support and attained weight‐for‐age, weight‐for‐length and BMI‐for‐age z scores. An increase of one unit z score in these indicators was associated with 3 to 6 d acceleration in the respective achievement age. Statistically significant associations also were noted between various milestone achievement ages and growth when 3‐ or 6‐mo and birth length‐for‐age z scores were entered jointly in the failure time models. In these analyses, one unit z‐score increase in length‐for‐age was associated with 1 to 3 d delay in the respective achievement age.

Conclusion: Sporadic, significant associations were observed between gross motor development and some physical growth indicators, but these were quantitatively of limited practical significance. These results suggest that, in healthy populations, the attainment of these six gross motor milestones is largely independent of variations in physical growth.
Unifocalization and repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries
Authors: Carotti Adriano , Albanese Sonia B. , Di Donato Roberto M.
Published: August 2010

Aim: To correlate anatomic and genetic features of paediatric patients with pulmonary atresia, ventricular septal defect (VSD) and multiple aortopulmonary collateral arteries with surgical outcome.

Methods: 44 consecutive patients aged 33±40 mo underwent either primary one‐stage unifocalization (n=32) or palliative right ventricular outflow tract reconstruction (n=12) followed by secondary unifocalization and repair (n=10) based on preoperative morphometric and functional evaluation of pulmonary blood sources. Chromosome 22q11.2 microdeletion occurred in 41% of cases. Combined VSD closure during one‐stage procedures was guided by an intraoperative pulmonary flow study. Complete repair was accomplished in 35 cases (83%, 95% CI 72–95%). Variables examined included occurrence of confluent intrapericardial pulmonary arteries, central pulmonary arteries, confluent intraparenchymal pulmonary arteries, dominant collateral or pulmonary arteries, and chromosome 22q11.2 microdeletion. The sensitivity and specificity of the pulmonary flow study in predicting postoperative pulmonary haemodynamics were also tested.

Results: Eight‐year actuarial survival and freedom from reoperation were 85% and 63%, respectively. Sensitivity and specificity of the pulmonary flow study were 94% and 100%, respectively. None of the anatomical variables examined was significantly related to the outcome of treatment. The only statistically relevant association was detected between survival and occurrence of 22q11.2 microdeletion (p<0.003). Logistic analysis showed an increased likelihood of positive outcome in relation to first‐ (p<0.02) or second‐stage (p<0.04) complete correction.

Conclusion: Morphology of pulmonary blood supply has no major impact on surgical outcome. Pulmonary flow study is a highly specific and sensitive intraoperative test. Chromosome 22q11.2 microdeletion remains the only variable significantly affecting survival.
Hypogonadal Men Nonresponders to the PDE5 Inhibitor Tadalafil Benefit from Normalization of Testosterone Levels with a 1% Hydroalcoholic Testosterone Gel in the Treatment of Erectile Dysfunction (TADTEST Study)
Authors: Buvat Jacques , Montorsi Francesco , Maggi Mario , Porst Hartmut , Kaipia Antti , Colson Marie Helène , Cuzin Beatrice , Moncada Ignacio , Martin-Morales Antonio , Yassin Aksam , Meuleman Eric , Eardley Ian , Dean John Daniel , Shabsigh Ridwan
Published: August 2010

Introduction

Addition of testosterone (T) may improve the action of phosphodiesterase type 5 inhibitors (PDE5-Is) in patients with erectile dysfunction not responding to PDE5-Is with low or low-normal T levels.

Aims

To confirm this add-on effect of T in men optimally treated with PDE5-Is and to specify the baseline T levels at which such an effect becomes significant.

Methods

A multicenter, multinational, double-blind, placebo-controlled study of 173 men, 45–80 years, nonresponders to treatment with different PDE5-Is, with baseline total T levels ≤4 ng/mL or bioavailable T ≤ 1 ng/mL. Men were first treated with tadalafil 10 mg once a day (OAD) for 4 weeks; if not successful, they were randomized in a double-blind, placebo-controlled design to receive placebo or a 1% hydroalcoholic T gel (50 mg/5 g gel), to be increased to 10 mg T if results were clinically unsatisfactory.

Main Outcomes Measures

Mean change from baseline in the Erectile Function Domain Score of the International Index of Erectile Function and rate of successful intercourses (Sexual Encounter Profile 3 question).

Results

Erectile function progressively improved over a period of at least 12 weeks in both the placebo and T treatment groups. In the overall population with a mean baseline T level of 3.37 ± 1.48 ng/mL, no additional effect of T administration to men optimally treated with PDE5-Is was encountered. The differences between the T and placebo groups were significant for both criteria only in the men with baseline T ≤3 ng/mL.

Conclusions

The maximal beneficial effects of OAD dosing with 10 mg tadalafil may occur only after as many as 12 weeks. Furthermore, addition of T to this PDE5-I regimen is beneficial, but only in hypogonadal men with baseline T levels ≤3 ng/mL.
The Serotonin Transporter Plays an Important Role in Male Sexual Behavior: A Study in Serotonin Transporter Knockout Rats
Authors: Chan Johnny S.W. , Snoeren Eelke M.S. , Cuppen Edwin , Waldinger Marcel D. , Olivier Berend , Oosting Ronald S.
Published: August 2010

Introduction

Serotonin (5-HT) is an important neurotransmitter for sexual behaviors. Heterozygous (+/−) serotonin transporter (SERT) rats and SERT knockout rats (−/−) have serotonergic disturbances with significant elevations of basal extracellular 5-HT levels.

Aim

To investigate the putative role of the SERT in male sexual behavior.

Methods

After extensive sexual training, the effects of the 5-HT1A/7 receptor agonist ±8-OH-DPAT, the 5-HT1A receptor antagonist WAY100 635 and a combination of both on sexual behaviors of SERT−/− and SERT+/− knockout and wildtype (SERT+/+) male Wistar rats were examined.

Main Outcome Measures

Male rat sexual behaviors of mounts, intromissions, and ejaculations.

Results

SERT−/− had lower basal ejaculation frequencies than SERT+/− and SERT+/+ animals. ±8-OH-DPAT enhanced sexual performance in all three genotypes to the same extent. WAY100635 dose-dependently inhibited sexual behavior in all three genotypes with significant dose to genotype interactions. WAY100635 exerted the strongest effects in SERT−/− animals. The combination of a dose range of ±8-OH-DPAT and a selected dose of WAY100635 revealed only partial antagonism by ±8-OH-DPAT of the sexual inhibitory effects of WAY100635.

Conclusions

Absence of the serotonin transporter reduces basal ejaculatory performance in male rats. Pharmacological experiments suggest that separate pools of 5-HT1A receptors regulate different aspects of sexual performance in male rats. 5-HT7 receptors may play a minor role in the partial recovery of sexual behavior after combination of ±8-OH-DPAT and WAY100635. The SERT−/− rat may be a model for chronic SSRI treatment, delayed ejaculation, anorgasmia, and/or low libido.