bluuebunny/crossref_metadata_2025 huggingface dataset:
A method of assessing ventilatory responses to chemoreceptor stimulation in infants
Authors: Søvik S , Eriksen M , Lossius K , Grøgaard J , Walløe L
Published: August 2010

Various methods of assessing infant chemoreceptor responses have been reported in the literature. However, equipment dead space, trigeminal stimulation and inherent respiratory variability may have affected the results. A method is presented which attempts to reduce the effect of these factors and thereby isolate the chemoreceptor response. Inspiratory gas was delivered into a lightweight face mask with a pliable rim, minimal dead space and a connected pneumotachograph. Ventilatory data were computed breath by breath. Computer‐controlled electromagnetic valves allowed instantaneous switching between air and different gas mixtures, repeated in a randomized sequence. In 18 healthy term neonates, the mask increased ventilation by 12% (95% confidence interval 6—18%), measured by calibrated strain‐gauge bands. The effect on respiratory frequency and tidal volume differed significantly between sleep states. Neonates were challenged with short‐lasting hyperoxia, mild hypoxia, rebreathing and mild hypercapnia. Coherent averaging of several ventilatory responses from each sleep state reduced the variability while maintaining a high time‐resolution. □Chemoreceptors, infant, respiration, respiratory dead space
Does perinatal hypocarbia play a role in the pathogenesis of cerebral palsy?
Authors: Salokorpi T , Rajantie I , Viitala J , Rita H , von Wendt L
Published: August 2010

This study aimed to evaluate the role of hypocarbia as a risk factor for mortality and for cerebral palsy in extremely low birthweight infants. The records for 215 extremely low birthweight children were analysed, grouping the infants into those who died (n = 72), those who had a confirmed diagnosis of cerebral palsy (n = 27) and those without major neurological symptoms at the age of 2y (n= 116). The analysed risk factors were: birthweight, gestational age, maternal diseases and toxaemia, multiple pregnancy, male gender, respiratory distress syndrome, abnormal neonatal cerebral ultrasound, occurrence of septic infection, and/or at least one episode of systemic hypotension and/or at least two episodes of hypocarbia (<3 kPa) during the neonatal period. The mortality rate was 31% and the rate of cerebral palsy was 17% in the survivors. Hypocarbia was found in 33% of children with cerebral palsy, in 10% of infants who died and in 19% of the healthy controls; the differences were statistically insignificant. Birthweight and gestational age, episodes of systemic hypotension and abnormal ultrasound emerged as risk factors for mortality. Abnormal cerebral ultrasound was the only significant risk factor for cerebral palsy. The role of hypocarbia in the pathogenesis of CP remained indistinct but the distribution of risk factors was different in infants with a mortal outcome and in infants with cerebral palsy. □Cerebral palsy, premature children
Effect of breastfeeding and morbidity on the development of low birthweight term babies in Brazil
Authors: Morris SS , Grantham‐McGregor SM , Lira PIC , Assunçãao AMS , Ashworth A
Published: August 2010

Low birthweight (LBW) occurs in 17% of births in developing countries and many of them are full term. The subsequent development of LBW term infants is poorer than higher birthweight children and more likely to be affected by poor social circumstances. We investigated the effects of morbidity and breastfeeding on the development of these LBW term infants. Two parallel cohorts (n= 131 + 131) of LBW term (1500‐2499 g) and higher birthweight (3000–3499 g) infants were recruited from six maternity centers in northeast Brazil. The longitudinal prevalence of morbidity and the frequency of breastfeeding over the first 6 mo of life were assessed. The infants' development was assessed on the Bay ley Scales at 6 and 12 mo, and we previously reported that the low birthweight group had lower scores than the higher birthweight group. Hospitalizations in the first 6 mo were negatively associated with 6‐mo and 12‐mo Bayley scores in both groups. Among LBW infants, but not higher birthweight infants, there were significant associations between the prevalence of diarrhea and mental and motor development at 6 mo and mental development at 12 mo. Breastfeeding frequency in the first 4 wk of life was positively associated with mental development in both birthweight groups at 6 mo but not at 12 mo. Breastfeeding beyond 4 wk was not associated with the children's development. We conclude that low birthweight infants are especially vulnerable to the effects of diarrhea, and the greater frequency and differential effect of diarrhea partly explains their poorer development.
Efficacy and safety during long‐term treatment f primary monosymptomatic nocturnal enuresis with desmopressin
Authors: Tullus K , Bergström R , Fosdal I , Winnergård I , Hjälmås K ,   for the Swedish Enuresis Trial Group
Published: August 2010

The Swedish Enuresis Trial (SWEET) was conducted to evaluate the long‐term safety and efficacy of intranasal desmopressin treatment in children with primary, monosymptomatic nocturnal enuresis (PMNE). The study had an open, multicentre design and comprised a 4‐wk observation period, a 6‐wk dose titration period (with 20‐40 μg desmopressin) and a 1‐y, long‐term treatment period. A treatment‐free week was introduced every 3 mo to identify dry patients. In total, 399 children aged 6‐12 y with PMNE were recruited. Of these, 245 patients (61%) experienced ≥ 50% reduction in the number of wet nights during the last 4 wk of dose titration compared with the observation period. These responders entered the long‐term phase of the trial. The mean number of wet nights per week decreased from a median of 5.3 (range 1.3‐7.0) during the observation period to a median of 0.8 (range 0.0‐5.0) during the last 3‐mo period. Seventy‐seven children became dry, 63 (83%) within 6 mo of treatment initiation. The percentage of children who became dry was similar in all age groups. Significantly fewer children in the lowest age group were defined as responders (52%; 95% CI 45, 59) among the 6‐7‐y‐olds compared to 65% (56, 74) and 81% (72, 90) in the two older age groups. Desmopressin was well tolerated. No serious drug‐related adverse events were recorded and no clinical symptoms of hyponatraemia were reported. The SWEET trial has demonstrated that desmopressin is both safe and effective for the long‐term treatment of PMNE, with a significant therapeutic effect also in children of 6–7 y of age.
Factors associated with the duration of breastfeeding
Authors: Vogel A , Hutchison BL , Mitchell EA
Published: August 2010

A cohort study of healthy term infants was conducted to identify factors associated with breastfeeding duration. Three hundred and fifty mothers delivering in one obstetric hospital in Auckland, New Zealand were recruited. Ninety‐five percent were followed up until 1 y. Breastfeeding was initiated by 97.4%, the median duration of breastfeeding was 7.6 mo, and 30% were continuing some breastfeeding at 12 mo. Adjusted risk ratios for shorter duration of breastfeeding were: maternal age < 25 y, 2.33 (95% confidence interval = 1.33, 4.05); maternal age 25–34, 1.45 (1.01, 2.09) compared to maternal age ≥ 35; planning to cease breastfeeding ≤ 6 mo, 2.39 (1.65, 3.46); planning to breastfeed for as long as possible, 1.48 (1.00, 2.18), or not knowing plans 2.13 (1.36, 3.32) when compared to planning to cease breastfeeding after 6 mo; inverted nipples, 2.02 (1.26, 3.23), daily dummy use 1.62 (1.20, 2.18) or use of formula in the first month 2.79 (2.05, 3.80). Reporting mastitis, 0.67 (0.48, 0.94), and sharing the mother's bedroom at 3 mo, 0.69 (0.51, 0.92) were associated with a reduced risk for shorter duration of breastfeeding. We recommend that during the antenatal period attention be directed at mothers' plans for duration of breastfeeding, that mothers be encouraged to have their baby in their bedroom, and that the use of formula and dummies should be discouraged in the first months of life.
Speech and language skills in children who required neonatal intensive care. II. Linguistic skills at 6½ years of age
Authors: Jennische M , Sedin G
Published: August 2010

Linguistic skills at 6½ y of age were examined in a cohort of 284 children requiring neonatal intensive care (NIC) and in 40 controls. Ten linguistic areas were assessed. The results are presented for gestational age groups. The 10th percentile score of the controls was identified in each linguistic area. Seventy percent of the controls and <27% of the NIC children had no score lower than the 10th percentile score. Scores lower than the 10th percentile score were more common in NIC children born at term or at 23–31 wk, and within the latter group in those born at 28–31 wk, than in those born at 32–36 wk gestational age. The linguistic areas of auditory discrimination, imitation of articulatory positions and imitation of sentences were most frequently affected. NIC children born at 32–36 wk performed better in the last two areas than those born at <32 wk. To be a twin and born at 28–31 wk was associated with an increased risk of having more than five scores lower than the 10th percentile score of the controls.
Why screen for cystic fibrosis? A clinician's view
Authors: Dodge JA
Published: August 2010

Cystic fibrosis (CF) is relatively common, serious, and causes progressive lung damage. Clinical diagnosis may be delayed until lung damage has occurred, and infection may start as early as six weeks of life. A well organised screening programme should identify the great majority of affected infants within the first three weeks after birth, which leaves a small time window during which effective preventive treatment and surveillance may be instituted. Active treatment, whether for screened or unscreened infants, improves clinical status and long‐term survival of CF patients. It is anticipated that new treatments will become available within the next few years, and these will clearly give maximal benefit to young infants if instituted before lung damage is evident. In addition to any hypothetical effects on morbidity and survival, pre‐symptomatic diagnosis greatly improves the doctor‐parent relationship. Economic arguments may be distorted, but, at best, screening is cost‐beneficial, and, at worst, it is cost‐neutral. The overwhelming majority of CF professionals and parents universally support neonatal screening, so the onus is therefore on those who oppose screening to prove that their approach offers a superior strategy.
Tandem mass spectrometry screening: proving effectiveness
Authors: Pollitt RJ
Published: August 2010

Despite the considerable literature now emerging on screening by tandem mass spectrometry there are many points of uncertainty about test performance and much work to do in formalizing and validating follow‐up protocols. The relative sensitivities of tandem mass spectrometry and previously‐used diagnostic methods may differ for some diseases but not others, with the possibility of some metabolites being over‐sensitive and diagnosing mild variants or non‐disease. Cut‐offs should be set using clinical rather than analytical criteria and at this early stage it is important that presumptive positive cases diagnosed through acylcarnitine profiling are compared as thoroughly as possible with symptomatic cases diagnosed using other techniques. Caution should be used in accepting mutation analysis as the ultimate diagnostic criterion. Consideration of incidence and careful examination of family history will all contribute to evidence of the equivalence or otherwise of screen‐detected and symptomatic disease. Finally, there should be registration and long‐term surveillance of all cases detected.
State‐of‐the‐art for DNA technology in newborn screening
Authors: McCabe ERB , McCabe LL
Published: August 2010

Just as metabolites, hormones and proteins are measured in newborn screening tests, DNA has become an analyte that is important in the screens for certain disorders. DNA confirmatory testing on the original dried blood specimen reduces the age at diagnostic confirmation and antibiotic prophylaxis initiation for neonates with sickle cell disease. Molecular genetic analysis of the initial specimens from newborns with elevated immunoreactive trypsinogen (IRT) for cystic fibrosis (CF) screening permits reduction of the IRT threshold value, improving specificity without compromising sensitivity. Because of this cost reduction, CF neonatal screening programs routinely incorporate DNA confirmatory testing into their initial CF screening algorithm. DNA analysis is also a valuable adjunct in screening programs for congenital adrenal hyperplasia (CAH), improving sensitivity and specificity. Incorporation of DNA into newborn screening programs will continue to be stimulated by development of robust, high throughput technologies for evaluation of this analyte. New paradigms for neonatal screening are evolving, including hearing screening in the newborn nursery. DNA testing, such as for mutations in the connexin 26 gene, may have a role in the evaluation of those screened positive. Newborn screening dried blood specimens are DNA databases. Therefore, there are significant ethical, legal and social issues that must be considered in the storage and utilization of neonatal screening specimens.
Biological specimen banks in neonatal screening
Authors: Nørgaard‐Pedersen B , Simonsen H
Published: August 2010

The Danish neonatal screening program analyses dried blood spot samples (DBSS) from close to 70 000 newborns annually from Denmark, Greenland and the Faroe Islands. Since 1982, all DBSS have been stored in a biological specimen bank at −20°C as a routine procedure after analysis. Before sampling, parents are given written information about the screening tests, the biobank and its use, and can choose to opt out. Since 1993 the biobank has been regulated by specific legislation, and thus assumes a unique position among biological specimen banks. Its purposes are: (i) diagnosis and treatment of diseases screened for, including repeat testing, quality assurance and group statistics; (ii) other diagnostic uses during infancy; and (iii) research projects. The stored samples have been used successfully to diagnose a range of genetic diseases using biochemical and molecular genetic assays, and to diagnose congenital CMV and toxoplasmosis infections using assays for specific IgM antibodies and pathogen nucleic acids. The unbiased nature and comprehensive coverage of the samples in the biobank make them attractive for research purposes. Our studies have focused on the epidemiology of genetic disease alleles and other molecular disease markers and on retrospective screening projects, which have allowed rapid appraisal of the performance of novel screening modalities, saving years of prospective screening trials. Storage of neonatal screening samples is thus beneficial not only to the individual testees, but also to future generations of newborns.
Rehydration of moderately dehydrated children with transient glucose intolerance using rice oral rehydration solution
Authors: Yurdakök K , Ozmert E , Yalçin SS , Coşkun T
Published: August 2010

Following the successful rehydration of two moderately dehydrated patients with transient glucose intolerance (TGI) using rice‐oral rehydration solution (R‐ORS), R‐ORS has been used in Hacettepe University Ihsan Dogramaci Children's Hospital Diarrhea Training and Treatment Unit (DTTU) to rehydrate moderately dehydrated children with TGI. The files of children with moderate dehydration and glucose intolerance admitted to the unit were reviewed retrospectively within two periods according to the availability of R‐ORS. The clinical and laboratory findings were analysed where available. Before R‐ORS became available (September 1993) 6 patients were admitted, all of whom deteriorated with glucose (G)‐ORS treatment in 7.0 ± 3.8 h and were hospitalized for i.v. fluid treatment. During the second period 22 moderately dehydrated children with TGI were admitted. The clinical and laboratory characteristics on admission of the children in the two periods were not statistically different (p >0.05). Among the 22 patients admitted during the second period 10 were administered G‐ORS in the unit and 12 had already received G‐ORS at home. Clinical and laboratory deterioration was observed in these 10 patients while receiving G‐ORS in the unit within 6.3 ± 3.7 h and rehydration was continued with R‐ORS. Clinical and laboratory improvement were demonstrated in 8 patients within 18.2 ± 6.5 h. Overall, 17 patients were rehydrated successfully with R‐ORS, with a mean time of 18.0 ± 7.2 h. Five patients were hospitalized. The overall success rate of R‐ORS was 77.3%. R‐ORS may be considered as an alternative mode of therapy to i.v. treatment in the rehydration of moderately dehydrated children with TGI.
Frequency of fever episodes related to febrile seizure recurrence
Authors: van Stuijvenberg M , Jansen NE , Steyerberg EW , Derksen‐Lubsen G , Moll HA
Published: August 2010

The aim of this study was to assess the number of fever episodes as a risk factor for febrile seizure recurrence during the first 6 months after the last previous febrile seizure. In a 6‐month follow‐up study of 155 children, aged 3 months to 5 y, with a first or a recurrent febrile seizure, the occurrence of fever episodes and febrile seizure recurrences was prospectively documented. Using logistic regression analysis the association between the baseline characteristics and the number of fever episodes and the outcome, a febrile seizure recurrence, was studied. In total, 260 fever episodes were registered; 29 children experienced 1 or more febrile seizure recurrence during follow‐up. Two factors were associated with febrile seizure recurrence: the number of fever episodes [odds ratio (OR) =1.8; 95% confidence interval (CI): 1.4‐2.4)] and age at study entry (OR = 0.6; 95% CI: 0.3‐1.1). In a multivariable model, only the number of fever episodes remained significant. In conclusion, the number of fever episodes increases the risk of a febrile seizure recurrence with a factor of 1.8 per fever episode in the first 6 months after a febrile seizure.
Air transport of the sick newborn infant: audit from a sparsely populated county in Norway
Authors: Holt J , Fagerli I
Published: August 2010

The aim of this study was to describe principal problems and to analyse transport times, stabilizing procedures, adverse events during transfer, outcome, effectiveness and the care of infants transferred by air from district general hospitals and maternity homes to a central hospital. Transfer times, equipment adverse events and clinical deterioration were recorded as they occurred. Data regarding clinical problems, diagnoses and outcome were collected retrospectively from hospital records. During the study period (1984‐95) 275 infants (267 transports) were transferred by fixed‐wing aircraft (233) or helicopter (34). Median time from request of transfer to arrival of the transport team (usually a neonatal nurse and a paediatrician) was 120 min, median stabilizing time 60min. Ninety‐six infants (35%) were intubated, 62 (22.5%) by the transport team. During 34 transports (12.7%), equipment‐related adverse events occurred making six infants worse. Ten more infants deteriorated during transit. A significant correlation between birthweight and after‐transfer temperature was recorded. After‐transfer temperature for very low birthweight (<1500g, VLBW) infants was significantly higher when the transport team attended the delivery than when they did not (35.9 °C vs 34.7 °C). All nine infants (3.2%) with after‐transfer temperature <34.0°C died, 15 infants (5.5%) died within 24 h after transfer and 20 (7.3%) died later. Adjusted OR for death among transported versus in utero transferred VLBW infants was 3.8 (1.4‐10.4). Every effort should be taken to transfer VLBW infants in utero. If preterm deliveries at 26‐28 weeks of gestation at district general hospitals is unavoidable, an early request for the neonatal transport team to be there at delivery is advisable. Transport of very immature infants <26 weeks gestational age is not recommended. An outreach educational program (“Team Pink Newborn”) has been created. Staff training to combat hypothermia and regular inspection and control of the transport equipment by three neonatal intensive care nurses has now been implemented.
Hospital policies and their influence on newborn body weight
Authors: Mikiel‐Kostyra K , Mazur J
Published: August 2010

On the basis of data collected in a survey of the practices in maternity wards in Poland, we analysed newborn body weight differences between two groups of hospitals: one with the highest percentage of exclusive breastfeeding and other supportive practices, the other with the lowest. The aim of the study was to investigate whether hospital procedures can influence the newborn weight profile in the first days after birth. Healthy infants–normal birth, birthweight ≥2500 g, discharged within 2‐7 days, no missing data–were chosen for the analyses. The difference between discharge and birthweight, percentage of birthweight loss or gain on the day of discharge and percentage of the infants who at least regain birthweight on the day of discharge were compared between the two groups of hospitals. All analyses indicated the positive influence of exclusive breastfeeding and practices supporting it on infant body weight profile while in hospital.
Education of staff–a key factor for a safe environment in day care
Authors: Sellström E , Bremberg S
Published: August 2010

In order to create a safe environment in day‐care settings, an understanding of factors within the organization of day care, factors which influence safety, is essential. Day‐care directors in 83 daycare centres completed a mail‐in survey that contained questions about professional experience, the day‐care centre's organization of child safety measures and a battery of questions designed to evaluate the directors' perceptions and beliefs about child safety. The day‐care directors also carried out a safety inspection at their centre. The results were analysed using the multivariate logistic regression technique. The existence of a continuing plan for continued staff education in child safety was shown to be the strongest predictor of few safety hazards in day‐care centres. The day‐care directors' perceptions and beliefs about injury prevention were of less importance.

Conclusions: This study indicates that in order to promote safety in day‐care settings, an on‐going plan for continued staff education in child safety should be a matter of routine. The introduction of such a plan should be the concern of the individual day‐care directors, policy‐makers and managers at the local and national level, and health professionals working in this field.
Foetal size to final height
Authors: Karlberg J , Luo ZC
Published: August 2010

It is well known that some adult diseases, such as cardiovascular diseases, may be programmed during foetal life. It is not clear, however, whether final height may be predicted from foetal growth. A longitudinal cohort of full‐term healthy Swedish babies (n = 3650) was followed up from birth to maturity in a population‐based growth study. Length or height and its changes were analysed from birth to 18 y of age; 2807 children, with data available on birth length, final height and parental height, were included in this analysis. The result clearly shows that length at birth relates to final height. In terms of standard deviation scores (SDS), the mean difference in length at birth from the mean was greatly decreased in final height, but retained the same order as was seen at birth. In terms of centimeter difference from the reference mean values, the difference in length at birth remained roughly stable into final height. For instance, babies 5 cm above or below the mean birth length will end up approximately 5 cm above or below the mean in final height. Parental height–a surrogate value of the genetic final height potential of an individual–is shown to influence postnatal growth in height strongly. However, the difference from the mean in length at birth remained into adulthood within the same midparental height group.

Conclusion: This study reveals that trends in foetal linear growth continue into maturity. Foetal growth is a significant predictor of postnatal growth. Final height is dependent on both the magnitude of foetal growth and the genetic potential in stature, and appears to some extent to be programmed from foetal growth.
Colic in breast‐milk‐fed infants: treatment by temporary substitution of Neocate infant formula
Authors: Estep DC , Kulczycki A
Published: August 2010

Infant colic is a common problem characterized by excessive crying and fussing. We examined whether colic symptoms of exclusively breast‐milk‐fed infants would be improved by temporary substitution of Neocate, an amino acid‐based infant formula, for breast milk. Six infants with colic were studied using Barr‐type infant behavior diaries for a 3‐5 d baseline period while they continued exclusive breast‐milk‐feeding, followed by a 4‐8 d intervention period of exclusive Neocate feeding. All infants showed improvement in distressed behavior during intervention; five of the six improved within 1‐2 d. For the period after 1 d of Neocate feeding, the total recorded crying and fussing time was reduced by an average of 42%, representing a decrease of 1.0 to 3.1 h daily. A significant difference was found between cry and fuss time at baseline versus during exclusive Neocate use. Concurrent with Neocate intervention, mothers strictly avoided all milk and dairy products. After colic symptoms improved, infants were reintroduced to breast milk, which was reasonably well tolerated in four of the six infants. Two infants had rapid recurrences of crying and fussing upon return to breastfeeding and required an additional period of Neocate feedings before subsequent reintroduction to breastfeeding. All infants exhibited colic symptoms when directly or indirectly challenged with bovine IgG (BGG), suggesting that BGG may play an etiologic role in colic.

We propose that a brief intervention with Neocate, coupled with strict maternal avoidance of milk and dairy products under direct supervision of a lactation consultant, may be an effective treatment for colic in some breast‐milk‐fed infants.
Non‐infectious causes of uveitis in 70 Swiss children
Authors: Stoffel PB , Sauvain MJ , von Vigier RO , Beretta‐Piccoli BC , Ramelli GP , Bianchetti MG
Published: August 2010

Many diseases are linked with uveitis, but few studies have specifically looked at the noninfectious triggers of childhood uveitis in Central Europe. The charts of 70 paediatric patients with non‐infectious uveitis admitted to the Department of Pediatrics, University of Bern, Switzerland, between 1983 and 1998 were therefore reviewed. In the patients the age at presentation with uveitis ranged between 0.3 and 16 y, median 8.5 y. Based on the localization, uveitis anterior was diagnosed in most cases (n= 40; 57%), followed by panuveitis (n= 20; 29%) and uveitis posterior (n= 10; 14%). Uveitis was chronic in 54 (77%) and acute in 16 (23%), bilateral in 38 (54%) and unilateral in 32 (46%) cases. An associated condition was noted in 32 (46%) cases: juvenile idiopathic arthritis in 24 cases, sarcoidosis and juvenile spondyloarthropathy in 3 cases, and Sjögren's syndrome and Behçet's disease in 1 case each. In the remaining 38 (54%) patients, no associated condition was diagnosed.

It is concluded that in Swiss children, uveitis can be due to a wide spectrum of non‐infectious diseases, juvenile idiopathic arthritis being the leading cause. In the majority of the children, no associated condition was recognized.
Nitric oxide and hyperoxia in oxidative lung injury
Authors: Turanlahti M , Pesonen E , Lassus P , Andersson S
Published: August 2010

Therapy with inhaled nitric oxide is usually given with high concentrations of oxygen. As nitric oxide (NO) is a free radical and hyperoxia increases oxygen radical production, we examined the effect of short exposure to NO or oxygen (O2) or both, on free radical‐mediated changes in macromolecules, i.e. lipids and proteins, in vivo. Wistar rats were exposed to >95% O2 or 40 ppm NO, or both, for 6 h. Rats in 21% O2 served as controls. Lipid peroxidation was quantified as expired pentane, oxidative protein modification as carbonyl concentration, and pulmonary neutrophil accumulation as myeloperoxidase activity in the lungs. Hyperoxia for 6 h caused higher expired pentane (4.83 ± 1.39 pmol/min/100 g) and protein carbonylation (15.91 ± 2.49 nmol/mg) compared to controls (2.26 ± 1.00 pmol/min/100 g, and 7.40 ± 1.12 nmol/mg, respectively; both p < 0.05). After exposure to NO in air, protein carbonylation (14.50 ± 5.44 nmol/mg) and myeloperoxidase activity (4.85 ± 1.52 mU/mg) were higher than in controls (myeloperoxidase 2.49 ± 0.56 mU/mg; both p < 0.05). NO with hyperoxia decreased pentane (2.56 ± 1.51 pmol/min/ 100 g) and protein carbonylation (11.38 ± 3.58 nmol/mg) compared to hyperoxia (both p < 0.05).

Conclusion: In vivo, 6 h exposure to hyperoxia or to 40 ppm NO induces free radical‐mediated lung injury. The combination of hyperoxia and 40 ppm NO significantly attenuates free radical‐mediated effects in the lungs compared to hyperoxia or 40 ppm NO in air.
Phagocyte activation in preterm infants following premature rupture of the membranes or chorioamnionitis
Authors: Nupponen I , Venge P , Pohjavuori M , Lassus P , Andersson S
Published: August 2010

Phagocyte activation was studied in 48 preterm infants, gestational age 27.3 ± 0.3 wk, birthweight 968 ± 40 g, during the first postnatal week. Human neutrophil lipocalin as a marker of neutrophil activation was measured in plasma and tracheal aspirate fractions; and lysozyme, as a marker of monocyte and macrophage activation, in plasma. The concentration of plasma human neutrophil lipocalin was 69 (46–126) μg/l (median and quartiles), tracheal aspirate fraction fluid 213 (71–433) (μg/l and plasma lysozyme 1337 (923–1764) μg/l. Infants born to mothers with premature rupture of the membranes or clinical chorioamnionitis (group A, n 20) had significantly higher plasma [73 (58–151) vs 53 (38–108) μg/l; p 0.027], and tracheal aspirate fraction human neutrophil lipocalin [319 (129–540) vs 190 (57–324) μg/l; p= 0.019], and plasma lysozyme [1739 (1356–2021) vs 1140 (739–1557) μg/l; p 0.0001] than did infants whose mothers had intact membranes and who had no suspicion of infection (Group B, n 28). In infants born to mothers receiving corticosteroids ante partum, correlations existed between time from treatment to delivery and plasma (r 0.322, p 0.0256) and tracheal aspirate fraction human neutrophil lipocalin (r= 0.314, p 0.0096).

Infants born to mothers with at risk of infection are exposed to the potentially harmful effects of activated neutrophils. Premature rupture of the membranes, even without signs of clinical infection of the mother or the fetus, is associated with phagocyte activation that may begin already in utero. Corticosteroid treatment of the mother may cause transient inhibition of neutrophil activation in the newborn.
Socio‐economic differences in daycare arrangements and use of medical care and antibiotics in Swedish preschool children
Authors: Hjern A , Haglund B , Rasmussen F , Rosen M
Published: August 2010

In this study we describe socio‐economic patterns of daycare enrolment, medical care and antibiotics in children, 0–5 y, whose parents participated in the Swedish Survey of Living Conditions 1996–97. Children in families with low socio‐economic status and unemployed parents were less often enrolled in out‐of‐home care. Multivariate analyses (adjusted for various socio‐demographic indicators, type of daycare and chronic morbidity) demonstrated that children 1–5 y in families with low social status (low parental education and/or low SES) were less likely to have paid a visit to a physician because of an acute infection during the previous 3 mo [odds ratio (OR) 0.6 (0.4–0.8)] or to have consumed antibiotics during the previous 12 mo [OR 0.8 (0.6–1.0)] compared to children with a higher social status. Children in out‐of‐home care more often had paid a visit to a physician because of an acute infection during the previous 3 mo [OR 1.5 (1.2–1.9)] and more often had consumed antibiotics during the previous 12 mo [OR 1.7 (1.3–2.1)] than children in home care. The effect of out‐of‐home care on use of medical care and antibiotics decreased with increasing age of the child, and deviated from the null hypothesis in children 1–3 y only.

Conclusion: Preschool children in families with a low social status consume less medical care and are less likely to attend out‐of‐home care compared to children with a higher social status in Swedish society. This inequity needs to be addressed in social and health policy.
Development of schoolchildren's smoking habits: questionnaire studies in intervention and control groups
Authors: Edvardsson I , Håkansson A
Published: August 2010

The objective of the present study was to describe the development of smoking from the sixth grade (age 12) to the eighth (age 14), for girls and for boys, and to study the effect of a simple anti‐smoking intervention carried out in the sixth grade. All the roughly 2000 schoolchildren in Kronoberg County, born in 1982, completed an annual anonymous classroom questionnaire on smoking habits in the years 1994–96. In 1994, there were two visits, each lasting 80 min, by a campaigner from A Non‐Smoking Generation to the 59 schools which opted for intervention, and no visits to the 21 schools which declined intervention. Before the intervention there were no differences in the frequency of smokers between the intervention group and the control group. In 2y the proportion of smokers then rose among the girls from 1% to 12% and among the boys from 2% to 7%. Two years after the intervention, the proportion of smokers in the intervention group was approximately two‐thirds of that in the control group. When the statistical analysis was based on the individual pupils, the difference between the two groups was statistically significant, but if the schools were used as the unit of analysis, the result was non‐significant.

Even a small‐scale intervention may have an effect on the development of smoking among schoolchildren, but other preventive measures in the schools probably also contributed to the positive development of smoking in the intervention group.
A single intramuscular dose of ceftriaxone changes nasopharyngeal bacterial flora in children with acute otitis media
Authors: Heikkinen T , Saeed KA , McCormick DP , Baldwin C , Reisner BS , Chonmaitree T
Published: August 2010

The increasing prevalence of drug‐resistant bacteria is attributed to the extensive use of antibiotics, which causes selective pressure on the nasopharyngeal bacterial flora. Shortened courses of antibiotics have been proposed to decrease the development of resistant strains. We determined the effect of a single intramuscular dose of ceftriaxone (50 mg/kg) on the nasopharyngeal bacterial flora in 167 children (median age 13 mo) with acute otitis media. Nasopharyngeal samples for bacterial culture were obtained before and 5 d after treatment with ceftriaxone. Before treatment, Moraxella catarrhalis was isolated in 99 (59%) children, Streptococcus pneumoniae in 87 (52%), and Haemophilus influenzae in 53 (32%). After treatment, M. catarrhalis was found in 62 (37%) children, which constitutes a 37% decrease in the colonization rate by this pathogen (p < 0.001). S. pneumoniae was isolated in 50 (30%; 43% decrease) and H. influenzae in 17 (10%; 68% decrease) children after treatment (p < 0.001 for both). Before treatment, 60% of pneumococcal isolates were sensitive to penicillin, 26% were of intermediate susceptibility, and 14% were penicillin‐resistant. Eradication of S. pneumoniae occurred mainly in children with penicillin‐sensitive isolates. As a consequence, only 24% of pneumococcal isolates that remained after treatment were sensitive to penicillin, 59% were penicillin‐intermediate, and 16% were penicillin‐resistant.

A single dose of ceftriaxone resulted in significant changes in the nasopharyngeal bacterial flora, increasing the relative prevalence of pneumococcal strains with decreased susceptibility to penicillin.
Prophylaxis of patent ductus arteriosus with ibuprofen in preterm infants
Authors: Dani C , Bertini G , Reali MF , Murru P , Fabris C , Vangi V , Rubaltelli FF
Published: August 2010

The aim of our study was to evaluate whether the prophylactic use of ibuprofen would reduce the incidence of significant patent ductus arteriosus (PDA) and to confirm the effectiveness of ibuprofen as rescue treatment in closing PDA. Eighty preterm infants with gestational age less than 34 wk with infant respiratory distress syndrome (iRDS) were randomized to receive intravenous ibuprofen lysine (10 mg/kg, followed by 5 mg/kg after 24 and 48 h) either within 24 h of life (group A) or after echocardiographic diagnosis of PDA (group B). To evaluate the severity of RDS in each patient, we calculated the initial and highest values of Oxygenation Index (O.I. =mean airway pressure × FiO2 × 100 / PaO2) and Ventilatory Index (V.I. = O.I. × mechanical respiratory rate). Other studied variables were ventilatory support, renal function, biochemical and haematological profiles, frequency of bronchopulmonary dysplasia (BPD), intraventricular haemorrhage (IVH), necrotizing enterocolitis (NEC) and retinopathy of prematurity (ROP). On the 3rd day of life, 8% (3/40) of patients of group A and 53% of patients (21/40) of group B (p < 0.0001) developed a significant PDA. Between patients of group B who presented PDA at 3 d of life 90% (19/21) had a closure of ductus arteriosus after ibuprofen treatment. Initial and highest values of O.I. and V.I. were similar in both groups A and B. No significant differences between the groups were observed in regard to respiratory support, renal function and frequency of BPD, IVH, NEC and ROP. Ibuprofen was not associated with adverse effects.

Conclusion: Prophylactic treatment with ibuprofen reduces PDA occurrence in preterm infants with iRDS at 3 d of life in comparison with rescue treatment, but both modes are effective in closing the ductus without significant adverse effects.
Effectiveness of casein hydrolysate feedings in infants with colic
Authors: Jakobsson I , Lothe L , Ley D , Borschel MW
Published: August 2010

This study found that two casein hydrolysate formulas varying in composition were equally effective in managing colicky symptoms associated with protein sensitivity. Both hydrolysate formulas were associated with a significant, comparable reduction in crying duration and intensity from baseline in 15 of 22 infants with complete data. Subsequent challenge data suggest that the population studied were infants experiencing colicky symptoms due to protein sensitivity. A greater proportion of infants showed a positive reaction (≥1.5h of crying/d) to the protein challenges than the placebo challenge, and crying was rated as more intense during whey and milk protein challenges.
Fat intake and metabolism in Swedish and Italian infants
Authors: Åkeson P Karlsland , Axelsson IEM , Räihä NCR , Warm A , Minoli I , Moro G
Published: August 2010

The purpose of the study was to compare fat intake and metabolism between two infant populations from Sweden and Italy given breast milk or similar infant formulas, but different weaning foods. Nutrient intake and fat metabolism were studied prospectively from 3–12 mo in 68 Swedish and 46 Italian healthy infants, breastfed or given similar infant formulas in combination with Swedish or Mediterranean weaning foods. Although nutrient intake and fat metabolism were similar at 6 mo, fat intake was lower at 12 mo in the Italian than in the Swedish formula group (p < 0.001). At 6 and 12 mo, higher dietary ratios of monounsaturated to saturated fatty acids (p < 0.01 and p < 0.001, respectively), and monounsaturated to polyunsaturated fatty acids (p < 0.05, p < 0.001) were found in the Italian than in the Swedish formula group. Total cholesterol and apolipoprotein B were lower at 6 mo (p < 0.01) in Italian breastfed infants than in Swedish ones. Lower concentrations at 6 and 12 mo of total cholesterol (p < 0.05, p < 0.05, respectively), apolipoprotein B (p < 0.05, p<0.01) and triglycerides (p< 0.001, p<0.01), and of apolipoprotein A1 (p < 0.01) at 12 mo, were found in the Italian formula group than in the Swedish one. In conclusion, plasma total cholesterol, apolipoprotein B and triglycerides were found to be lower in Italian infants than in Swedish infants during the second half of infancy. These findings may partly result from differences in fat compositions between Swedish and Mediterranean weaning diets and in total fat intake in late infancy. Differences in duration of breastfeeding and possibly in breast milk composition may also have influenced our results.
Incidence of Type I diabetes among children and young adults (0– 29 years) in the province of Badajoz, Spain during 1992 to 1996
Authors: Morales‐Peréz FM , Barquero‐Romero J , Peréz‐Miranda M
Published: August 2010

In this study, we determine the incidence of Type I (insulin‐dependent) diabetes mellitus in the 0–29‐y‐old group in Badajoz (the largest and least developed province of Spain). We test for differences in incidence by age at diagnosis, time cluster and sex. Diabetes clinics and periodic review of hospital administration data provided the primary source of ascertainment. The secondary independent data source was based on registries of local Diabetic Associations and guarantee cards of blood glucose meters. Data were collected retrospectively in the period 1992–95 and prospectively for 1996. During the 5‐y period (1992–96), 186 new cases of Type I diabetes were identified. Completeness of ascertainment was 95%. Average annual incidence (95% CI) for the 0–14, 15–29 and 0–29‐y‐old groups was 17.6/100,000 (14.5−21.2), 8.8/100,000 (6.9–11.1) and 12.8/100,000 (11–14.7). The highest age‐specific annual incidence rate was found in the 10–14 age group: 23.4/100,000 (17.6–30.4). The incidence in males (14.7/100,000/y) was higher than in females (10.7/100,000/y). There was a seasonal onset pattern, with the highest incidence in autumn and winter. October was the month with the highest number of new cases (29/186). The province of Badajoz has a moderately high incidence of Type I diabetes in 0–14‐y‐old children, similar to that found in other more developed and densely populated regions of Spain. These data contradict the hypothesis of a decrease in the incidence of the disease from north to south over Europe.
Protein intake and metabolism in formula‐fed infants given Swedish or Italian weaning foods
Authors: åkeson P Karlsland , Axelsson IEM , Räihä NCR , Warm A , Minoli I , Moro G
Published: August 2010

The aim of the study was to compare protein intake and metabolism between infants from two countries given similar infant formulae but different weaning foods. Healthy Swedish and Italian infants were studied between 3 and 12 mo. Infants in both populations were assigned to 1 of 3 infant formulae, containing 13, 15 or 18/20 g l‐1 of protein, given in addition to Swedish or Italian weaning foods. Protein intake from weaning foods was higher in Italian than in Swedish infants at 6 and 12 mo, whereas protein intake from formula at 6 mo and from formula/milk at 12 mo was similar in both populations. Plasma isoleucine, leucine, lysine, histidine and valine at 6 mo were lower in Italian than in Swedish infants fed formula with 13 g l‐1 of protein. All essential plasma amino acids were similar in Italian and Swedish groups at 12 mo. Serum urea was similar at 6 mo in corresponding formula groups, but was higher at 12 mo in the Italian than in the Swedish formula group. Serum albumin and growth were normal in both populations throughout infancy. In conclusion, formula with protein content of 13 g l_1 seems to provide sufficient protein intake when combined with Swedish or Italian weaning foods during the second half of infancy, as indicated by normal serum albumin and normal growth. However, the bioavailability of protein and amino acids from weaning foods, in addition to their protein content, should be considered, as indicated by some indices of protein metabolism in the Italian infants.
Randomized trial of two levels of fluid input in the perinatal period– effect on fluid balance, electrolyte and metabolic disturbances in ventilated VLBW infants
Authors: Kavvadia V , Greenough A , Dimitriou G , Forsling ML
Published: August 2010

The aim of this study was to determine whether fluid restriction does indeed significantly increase acute adverse effects. One‐hundred‐and‐sixty‐eight ventilated infants, median gestational age 27 wk (range 23–33) and birthweight 953 g (range 486–1500), entered into a randomized controlled trial of two fluid regimes. Infants on regime A were to be prescribed 60 ml/kg of fluids on day 1 which was gradually increased over the first week to 150 ml/kg, infants on fluid regime B were to be prescribed approximately 20% less fluid over the first week. Daily fluid input and output were recorded. Serum electrolytes, bilirubin, creatinine and urine osmolalities were measured daily. Arginine vasopressin levels were assessed on days 1, 3 and 5. Episodes of jaundice, hypoglycae‐mia and hypotension requiring treatment were noted. Infants on regime B actually received overall 11% and, in the first 4 days, 19% less fluid than those on regime A (p < 0.001). There were no statistically significant differences in the occurrence of episodes of jaundice, hypotension, hypoglycaemia, hypernatraemia or hyponatraemia between infants on the two regimes. Although the infants on regime B had significantly higher urine osmolalities and lower urine output for most of the perinatal period, their median creatinine and arginine vasopressin levels did not differ significantly from those on regime A. We conclude that fluid restriction to less than 90% of usual maintenance fluids is not associated with an excess of acute adverse effects.
A local cluster of achalasia in a province of Crete
Authors: Galanakis E , Gardikis S , Vlachakis J , Kokori H , Charissis G , Sbyrakis S
Published: August 2010

Achalasia has a largely obscure aetiology and is uncommon in childhood. We report three cases of otherwise well children, residents of a small province of Crete, two of them female cousins. This cluster probably indicates an autosomal recessive trait of inheritance. All three children were surgically treated (Heller cardiomyotomy combined with Nissen fundoplication), with excellent results.
Dextran reduces surfactant inhibition by meconium
Authors: Tashiro K , Kobayashi T , Robertson B
Published: August 2010

We have previously shown that an addition of dextran to surfactant increases resistance to inactivation by albumin. The present study was designed to investigate whether dextran has a protective effect against inactivation of surfactant by meconium. The dynamic surface properties of various mixtures of modified natural surfactant (Curosurf, meconium and dextran were evaluated with the pulsating bubble technique. In the absence of meconium, an addition of dextran at 10 mg ml1 significantly shortened the surface adsorption time of Curosurf suspended in normal saline at a concentration of 5 mg m‐1 from 1.6 ± 1.3 (mean ± SD) sec to 0.4 ± 0.4 sec (p < 0.05). Meconium at 5mgm‐1 increased the mean minimum surface tension (γmin) after 3 min of pulsation from 2.1 mN m‐1 to 24 mN m‐1 (p < 0.05). An addition of dextran at 5 and 10 mg m‐1 to the meconium‐surfactant mixture significantly reduced the γmin to 6.4 ± 4.5 mN m‐1 and 2.6 ± 5.6 mN m‐1, respectively (p < 0.05 vs dextran 0mgml‐1). Meconium also increased the maximum surface tension (γmax) of Curosurf from about 33 mN m‐1 to 53 mN m‐1. An addition of dextran at 5 and 10 mg ml‐1 to the meconium‐surfactant mixture reduced the γmax to 41 and 39 mN m‐1, respectively (p < 0.05 vs dextran 0mgml‐1). There were significant negative correlations between dextran concentration and both γmin and γmax.

We conclude that dextran reduces surfactant inhibition by meconium in a dose‐dependent manner.