bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac troponin T levels and myocardial involvement in children with severe respiratory syncytial virus lung disease
Authors: Eisenhut M , Sidaras D , Johnson R , Newland P , Thorburn K
Published: August 2010

Aims: To determine the prevalence of myocardial damage in severe respiratory syncytial virus (RSV) disease as evident from elevated cardiac Troponin T (cTnT) levels. To assess the nature of the myocardial involvement as manifested in electro‐and echocardiographic abnormalities. To compare severity of disease with and without myocardial involvement as evident from duration of ventilation, inotrope requirements and death. Methods: This was a prospective observational cohort study of children with RSV infection admitted to the paediatric intensive care unit at the Royal Liverpool Children's Hospital during the winter season 2002/2003. cTnT concentrations were measured using a third generation monoclonal sandwich immunoassay (Roche Diagnostics). Results: 34 children were included in our study. 12 (35%) had elevated cTnT levels. The levels measured after admission had a median [interquartile range (IQR)] of 50 pg/ml (37.5–67.5). There was no significant difference (p > 0.05) between patients with and without elevated cTnT levels with regards to gender, gestational age at birth, history of neonatal intensive care, presence of congenital heart disease, chronic lung disease, inotrope requirements, duration of ventilation, death, fractional shortening on echocardiogram or arrhythmias. Children with elevated cTnT levels were significantly younger [median (IQR): 1.4 months (0.8–2.0)] than children without [median (IQR): 4.0 months (1.7–6.6)] (p= 0.04). The systolic blood pressure on admission was lower in children with increased cTnT compared to those with undetectable cTnT (p= 0.01).

Conclusions: Myocardial involvement is common in infants with severe RSV lung disease without congenital heart disease. cTnT level elevation was associated with hypotension.
Pain: a common symptom in human immunodeficiency virus‐infected Thai children
Authors: Lolekha R , Chanthavanich P , Limkittikul K , Luangxay K , Chotpitayasunodh T , Newman CJ
Published: August 2010

Aim: To determine the prevalence and characteristics of pain in Thai human immunodeficiency virus‐infected children. Methods: A cross‐sectional study was performed at the HIV/AIDS outpatient clinic at the Queen Sirikit National Institute of Child Health, Bangkok, Thailand from November 2002 to January 2003. Sixty‐one human immunodeficiency virus‐infected patients aged 4 to 15 y, an equal number of age‐matched children with no chronic disease and their caregivers participated. We interviewed children and their caregivers using a structured questionnaire on pain. The main outcome measure was the percentage of human immunodeficiency virus‐infected children reporting pain. Results: Forty‐four percent of the human immunodeficiency virus‐infected children reported pain compared to 13% of the children with no chronic disease (odds ratio, OR = 5.3; 95% CI: 2.0–14.3). Seven percent of the infected children experienced chronic pain. Children in human immunodeficiency virus clinical categories B and C reported more pain than children in categories N and A (OR = 4.0, 95% CI: 1.1–14.7). Pain in infected children tended to occur in the abdomen, lower limbs or head. Only 44 percent of the infected children experiencing pain received analgesic medication.

Conclusion: Despite being a common experience, pain is insufficiently taken into account and treated in Thai children with HIV/AIDS. Therefore, adequate pain identification, assessment and management should be systemically considered in their routine care.
The rate of candidaemia in preterm infants born at a gestational age of 23–28 weeks is inversely correlated to gestational age
Authors: Johnsson H , Ewald U
Published: August 2010

Aim: To assess the rate of candidaemia and the associated case fatality rate in relation to gestational age, and the variation in the rate of candidaemia over time in the neonatal period. Methods: Retrospective review of medical records of infants with a positive blood culture for fungi while in the neonatal unit, Uppsala University Children's Hospital or at autopsy following death in the unit from 1994 to 2001 (n= 30). Results: The number of cases per year was found to vary between zero and eight. The annual rate of infection did not change significantly during the study period. The preterm infants with candidaemia (n= 29) were born at a gestational age ranging from 23–28 wk. The rate of candidaemia in this group was inversely related to gestational age and varied from 2 to 24%. Five infants (17%) died from Candida infection. Of these five, four were born at a gestational age of 23 wk.

Conclusion: candidaemia in newborns occurs predominately in infants born at a gestational age ±28 wk, where the rate of infection is inversely correlated to gestational age in infants born at a gestational age of 23–28 wk. The highest case fatality rate is observed in infants born at a gestational age of 23 wk.
Behavioural and learning problems in schoolchildren related to cognitive test data
Authors: Ek U , Holmberg K , de Geer L , Swärd C , Fernell E
Published: August 2010

Aim: To assess cognitive functions in children who were reported by their teachers and parents to exhibit learning and/or behavioural problems, especially in the field of attention. Method: In connection with the scheduled school health examination in grade 4 in one municipality, 591 children were screened through questionnaires and interviews with the parents and teachers. Those with positive rating scores were subjected to further cognitive assessments, including the WISC III. A cluster analysis based on cognitive data was performed. Results: One third (175 children) of the population obtained a positive rating score, indicating significant behavioural and/or learning problems. Of these, 144 children were assessed. Cluster analysis revealed six clusters. Within these clusters, two large groups were identified: one group displayed generally low cognitive abilities and one group was dominated by attention deficit symptoms.

Conclusion: We found a surprisingly high number of positive rating scores in the cohort (30%). This could be explained, on the one hand, by known developmental disorders, such as mental retardation and learning disabilities, ADHD (Attention Deficit Hyperactivity Disorder) and pervasive developmental disorders, and, on the other hand, by prevalent milder cognitive dysfunctions that, in combination with inappropriate demands, seemed to lead to overt behavioural problems.
Low‐cost intervention to decrease mastitis among lactating women
Authors: Filteau S
Published: August 2010

Mastitis is a common maternal health problem which can lead to serious infant health problems such as poor growth and HIV infection. Anti‐secretory factor (AF), which can be induced in milk by maternal consumption of a low‐cost cereal product, has been associated with decreased mastitis.

Conclusion: Consumption of cereals which induce AF should be investigated as a potential intervention in less‐developed countries where the consequences of mastitis for infants are most severe.
Contributions of bone maturation measurements to the differential diagnosis of neonatal transient hypothyroidism versus dyshormonogenetic congenital hypothyroidism
Authors: Niu DM , Hwang B , Tiu CM , Tsai LP , Yen JL , Lee NC , Lin CY
Published: August 2010

Aim: To a) evaluate the contribution of bone maturation in the diagnosis of neonatal transient hypothyroidism versus dyshormonogenetic congenital hypothyroidism in full‐term newborns, and b) use bone maturation to test the hypothesis that neonatal transient hypothyroidism is perinatal in onset. Materials and methods: The study included 20 patients with dyshormonogenetic and 43 with transient hypothyroidism. Thyroid function and measurements of the distal femoral epiphysis area, obtained at the time of first confirmatory diagnosis, were compared between the two groups. The epiphysis area in two control groups with normal thyroid function was also measured and compared with that in patients with transient hypothyroidism, at age 1–3 d (control A), or at the age when normal thyroid function was confirmed (control B). Results: Mean epiphysis area was 0.04 cm2 in patients with dyshormonogenetic versus 0.22 cm2 in patients with transient hypothyroidism (p < 0.0001). An area >0.05 cm2 was limited to patients with dyshormonogenetic hypothyroidism. Conversely, a normal area (>0.2 cm2) was only observed in patients with transient hypothyroidism. Mean epiphysis areas in control A (0.20 cm2) and in patients with transient hypothyroidism were similar (p= 0.37), consistent with perinatal onset of transient hypothyroidism. Mean epiphysis area in control B (0.31 cm2) was significantly greater than in patients with transient hypothyroidism (p < 0.01).

Conclusions: A short duration of hypothyroidism can significantly delay bone maturation. Examination of bone maturation at initial confirmatory evaluation yields important information pertaining to congenital hypothyroidism, not only to predict intellectual development, but also to evaluate the risk of dyshormonogenetic hypothyroidism.
Breastfeeding and perceived changes in the appearance of the breasts: a retrospective study
Authors: Pisacane A ,   P Continisio, on behalf of the Italian Work Group on Breastfeeding
Published: August 2010

Aim: To investigate the association between breastfeeding and the perception that women have of changes in the appearance of their breasts. Methods: Four hundred and ninety‐six Italian women were interviewed in three health centres 18 mo (SD 3.4 mo, range 12.6–23.1 mo) after the birth of their first baby in May 2002. Information was collected on pregnancy, infant feeding and bra cup size before pregnancy. The main outcome measures were self‐reported changes in the appearance of the breasts (enlargement or reduction in breast size and loss of firmness) and bra cup size at the time of the interview. Results: Seventy‐three percent of the mothers reported that their breasts were different compared with before pregnancy; enlargement and loss of firmness representing the most common changes. The prevalence of changes among the mothers who had and had not breastfed was 75% and 69%, respectively (relative risk: 1.09, 95% CI: 0.96–1.23). Bra cup size before pregnancy was neither associated with the frequency of breastfeeding nor with the occurrence of changes in the appearance of the breasts.

Conclusions: In Italy, mothers frequently report that the size and the shape of their breasts have changed after childbirth, but these changes do not seem to be associated with breastfeeding.
Positive pressure ventilation at neonatal resuscitation: review of equipment and international survey of practice
Authors: O'Donnell CPF , Davis PG , Morley CJ
Published: August 2010

Background: The equipment used to provide positive pressure ventilation to newborns needing resuscitation at delivery varies between institutions. Devices were reviewed and their use surveyed in a sample of neonatal centres worldwide. Aim: To determine which equipment is used to resuscitate newborns at delivery in a sample of teaching hospitals around the world. Methods: A questionnaire was sent via e‐mail to a neonatologist at each of 46 NICUs in 23 countries on five continents, asking which resuscitation equipment they used. If it was not returned, follow‐up was by e‐mail. Results: Data were obtained from 40 (87%) centres representing 19 countries. Round face masks are used at 34 (85%) centres, anatomically shaped masks are used exclusively at six (15%) and a mixture of types are used at 11 (28%). Straight endotracheal tubes are used exclusively at 36 (90%) centres; shouldered tubes are used infrequently at three of the four centres that have them. The self‐inflating bag is the most commonly used manual ventilation device (used at 33 (83%) centres), the Laerdal Infant Resuscitator± the most popular model. Flow‐inflating bags are used at 10 (25%) centres. The Neopuff Infant Resuscitator± is used at 12 (30%) centres. Varying oxygen concentrations are provided during neonatal resuscitation at half of the centres, while 100% oxygen is routinely used at the other half.

Conclusions: This survey shows considerable variation in practice, reflecting this lack of evidence and consequent uncertainty among clinicians. Comparison of the two most popular manual ventilation devices, the Laerdal Infant Resuscitator and the Neopuff Infant Resuscitator, is urgently required.
Up for grabs — Authors are a dime a dozen: The problem of multiple authors
Authors: Lazar R
Published: August 2010

Aim: To outline some of the major ethical problems related to multiple authorship. Methods: A survey of the literature, data collected over the years, regarding multiple authors, e.g., definition, contribution, ethical behavior and guidelines, and personal experience were the primary inputs. Results: Despite the efforts of a number of editors' organizations, there still is a major problem in the attribution of authors' credits to those who had nothing to do with the writing.

Conclusions: The solution to this problem may be found in one of two ways: strict enforcement of standards of authorship by journal editors, i.e., rejection of articles, no matter how good they may appear to be, because they violate these standards, and/or adoption of authorship standards as understood by commercial publishers.
Retrospective evaluation of long‐term efficacy and safety of splenectomy in chronic idiopathic thrombocytopenic purpura in children
Authors: Aronis S , Platokouki H , Avgeri M , Pergantou H , Keramidas D
Published: August 2010

Aim: To review the long‐term efficacy and safety of splenectomy in children with chronic idiopathic thrombocytopenic purpura (cITP). Patients and methods: Data from 33 splenectomized children were retrospectively analysed (median follow up period: 18.8 y from the removal of the spleen). The median age of children at splenectomy was 12 y and the median ITP duration 3.3 y. Indications for splenectomy were: persistent severe thrombocytopenia with extensive purpura, epistaxis and/or gum bleeds, menorrhagia (n= 5) and severe or recurrent haemorrhage from various sites (n= 11). Results: Eighty‐five per cent of the patients showed an excellent (n= 26) or partial response to splenectomy. Five children (15%), all females, failed to respond. Of the responders, 25% experienced a transient recurrence of thrombocytopenia within 6 mo to 4 y from splenectomy. The mortality rate due to severe sepsis was 3%. However, the majority of the splenectomized patients have not so far suffered any severe or mild bacterial infection, despite incomplete vaccination and/or antibiotic prophylaxis.

Conclusion: Splenectomy remains the only effective therapeutic modality for children with cITP, although it is associated with transient recurrence and rarely with post‐splenectomy sepsis, which could be fatal. Nonetheless, splenectomy should be the last treatment option for the cITP patient, after all available therapeutic modalities have been exhausted and the child still remains profoundly thrombocytopenic and symptomatic.
A comparison of Likert scale and visual analogue scales as response options in children's questionnaires
Authors: van Laerhoven H , van der Zaag‐Loonen HJ , Derkx BHF
Published: August 2010

Aim: To examine which response options children prefer and which they find easiest to use, and to study the relative reliability of the different response options. Methods: A consecutive group of unselected children (n= 120) filled out three questionnaires in a paediatric outpatient clinic. Each questionnaire included seven similar questions, but had different response options: the Likert scale, the Visual Analogue Scale (VAS) and the numeric VAS. In general, the questions were not related to the children's particular diseases, but dealt with the frequency of simple activities, their feelings and opinions. The pages with the three different response options were offered in random order. Afterwards, the children rated their preference and ease of use of the different response options on a scale from one to 10. Results: Children preferred the Likert scale (median mark 9.0) over the numeric VAS (median mark 8.0) and the simple VAS (median 6.0). They considered the Likert scale easiest to fill out (median mark 10 vs 9 and 7.5 for the numeric and simple VAS, respectively). Results of the different response options correlated strongly with each other (rho = 0.67–0.90, p < 0.05).

Conclusion: Children prefer the Likert scale over the numeric and simple VAS and find it easiest to complete. The Likert scale, the simple VAS and the numeric VAS are of comparable reliability. The Likert scale is recommended for use in questionnaires for children, although research into larger and more diverse samples is needed.
Indications for surgical treatment of epilepsy in childhood: a clinical and neurophysiological approach
Authors: Fusco L , Vigevano F
Published: August 2010

Resistant epilepsy is defined as the persistence of unacceptable seizures, despite correct drug treatment, or control of seizures at the cost of excessive side effects. About 30% of partial seizures are resistant to treatment; many of them is potentially a candidate for surgical treatment. Selection of patients is based fundamentally on precise identification of the epileptogenic area and on the evaluation that possible removal of that area will not be followed by serious neurological or neuropsychological deficits, or by onset of seizures in another part of the brain. To this end, careful clinical, neuro‐physiological and functional studies are conducted. Compared with adults, video‐electroencephalographic (EEG) study of seizures in childhood is more difficult because of the lack of patient cooperation and, therefore, the lack of every subjective element in the seizures. Furthermore, the criteria for defining drug resistance in childhood are still under discussion, as many epilepsies are age dependent and seizures stop with growth. Despite this, the age at time of surgery has been steadily decreasing, in the conviction that the persistence of intractable partial epilepsy is detrimental to cognitive development and can damage brain areas that are apparently healthy. The clinical and EEG criteria for epilepsies that are secondary to some specific disorders have been defined, e.g. hemimegalencephalia and focal cortical dysplasias often produce epilepsy with onset in the first days of life characterized by partial seizures and subintrant spasms, EEG record of focal or hemispheric burst suppression and drug resistance that can be defined within the first months of life. Prolonged video‐EEG monitoring is always necessary to establish congruence between the area in which the seizure originates and the brain lesion evidenced at neuroimaging. Correct monitoring of seizures means close cooperation between neurologist, neurophysiology technician and the patient, if the child is at least 5–6 y old. Absence of cooperation also limits the use of in‐depth recording. Neuropsychological assessment of the child can be of great help in defining the area damaged by the epileptogenic site as well as the state of the other brain areas. Close cooperation between neurologist, radiologist, neuropsychologist and brain surgeon is necessary for a case‐by‐case assessment of indication for surgical treatment.
Insight into B cell development and differentiation
Authors: Moschese V , Orlandi P , Di Matteo G , Chini L , Carsetti R , Di Cesare S , Rossi P
Published: August 2010

The main topic of this article is B cell development and differentiation, with a special focus on the mechanisms and molecules that regulate the expression of humoral immunity. Molecular epidemiological analysis was performed on the genes responsible for the X‐linked agammaglobu‐linemia (XLA) phenotype of the majority of Italian patients and their distinct mutations were characterized. Mutations in Bruton's tyrosine kinase (BTK), a member of Tec Family of protein tyrosine kinases, have been found to be mainly responsible for XLA disease. The exact function of BTK in signal transduction is not yet known; thus, the specific role of BTK in receptor‐dependent calcium signaling and the pro‐antiapoptotic regulatory activity was addressed by transfecting RAMOS‐1, a BTK‐deficient human Burkitt's/B cell leukemia line with wild‐type and mutant constructs. This work may provide clues about critical sites in the molecule and give support for gene therapy as a potential successful approach to XLA. Another aspect of this research is the identification and dissection of the molecular events that are likely to be directly related to the ability to express various isotypes of immunoglobulin with differing function and certain B cell immunodeficiency, mainly common variable disease and non‐X‐linked hyperIgM. B cell development and maturation steps in different compartments of the immune system are tracked by the analysis of cell‐surface molecules and components of the signal transduction pathways, i.e. CD40, CD30, CD27, CD38, CD22 and CD24. A few components involved in B cell development, maturation and differentiation and their specific functional role are at least partially known, but these are far from fitting into an understandable pathway at present.
Views on neonatal care of newborns weighing less than 500 grams
Authors: Schollin Jens
Published: August 2010

The limit of viability is intensely debated. Newborns below 500 g birthweight are often small for gestational age with an increased risk of short‐ and long‐term mortality and morbidity. The level of given neonatal care must be individualized.

Conclusion: A long‐term follow‐up for newborns with extremely low birthweight is urgently needed.
Tight junctions, leaky intestines, and pediatric diseases
Authors: Liu Z , Li N , Neu J
Published: August 2010

Background: Tight junctions (TJs) represent the major barrier within the paracellular pathway between intestinal epithelial cells. Disruption of TJs leads to intestinal hyperpermeability (the so‐called “leaky gut”) and is implicated in the pathogenesis of several acute and chronic pediatric disease entities that are likely to have their origin during infancy. Aim: This review provides an overview of evidence for the role of TJ breakdown in diseases such as systemic inflammatory response syndrome (SIRS), inflammatory bowel disease, type 1 diabetes, allergies, asthma, and autism.

Conclusion: A better basic understanding of this structure might lead to prevention or treatment of these diseases using nutritional or other means.
Serum amyloid A (SAA) protein and high‐sensitivity C‐reactive protein (hsCRP) in healthy newborn infants and healthy young through elderly adults
Authors: Lannergård Anders , Friman Göran , Ewald Uwe , Lind Lars , Larsson Anders
Published: August 2010

Aim: To determine the levels of serum amyloid A (SAA) protein and high‐sensitivity C‐reactive protein (hsCRP) in different age groups. Methods: Serum samples from 70 healthy newborn infants, 80 blood donors and 81 healthy elderly individuals were analysed using a nephelometric method. The 231 samples were grouped as follows: 35 umbilical cords, 35 newborns, 48 young adults, 28 middle‐aged adults, and 85 elderly adults. Results: Serum levels of both SAA and hsCRP were lower in umbilical cords than in the newborns and young, middle‐aged and elderly adults (p<0.0001). The SAA and hsCRP levels were comparable in newborns, and young and middle‐age adults, but higher in elderly adults (p<0.0001–0.03). SAA (r2=0.159, p<0.0001) and hsCRP (r2=0.059, p<0.0001) were positively correlated with age and to each other (r2=0.385, p<0.0001).

Conclusion: Serum levels of SAA and hsCRP in umbilical cord blood are close to the detection limit and lower than in the other age groups investigated. The elderly have generally higher levels than the younger age groups, which require higher decision levels in inflammatory diseases, including infections. In newborns and young and middle‐aged adults, the lower decision levels of 10 mg/l for SAA and 5 mg/l for CRP are suggested.
Is globotriaosylceramide a useful biomarker in Fabry disease?
Authors: Young E , Mills K , Morris P , Vellodi A , Lee P , Waldek S , Winchester B
Published: August 2010

Aim: The aim of this study was to determine whether globotriaosylceramide (Gb3) is a useful biomarker in Fabry disease. Methods: The levels of Gb3 were measured in plasma and urine by tandem mass spectrometry in untreated hemizygotes and heterozygotes with Fabry disease and in healthy controls, and the levels were monitored in patients on treatment with enzyme replacement therapy (ERT). Results: Hemizygotes with classic Fabry disease showed elevated levels of Gb3 in both plasma and urine and could readily be distinguished from normal controls. Male patients with the N215S mutation had normal levels in their plasma but 50% had marginally elevated levels in their urine. Thirty‐three percent of proven heterozygotes had elevated Gb3 concentrations in plasma but 97% of those without the N215S mutation (36/37) had an elevated level in urine. The four heterozygotes with the N215S mutation had normal Gb3 levels in urine. The level of Gb3 in plasma initially fell following the start of ERT in all patients who had an elevated level before treatment. However, in a few patients the level subsequently rose. Similar results were found for the levels of Gb3 in urine.

Conclusion: Gb3 is not an ideal marker of Fabry disease or the response to treatment in all patients. Plasma and urine levels of Gb3 cannot be used as a marker of Fabry disease in patients with the N215S mutation and many heterozygotes do not have elevated Gb3 levels in plasma. The urine concentration is more informative in heterozygotes and can be used as a measure of the response to therapy. The fall in Gb3 levels in patients receiving ERT was not sustained in some patients, despite a clinical improvement. Additionally, Gb3 cannot be used to monitor the response to treatment in patients who initially have normal plasma and urine concentrations of this glycolipid.
Enzyme replacement therapy in mucopolysaccharidosis type I
Authors: Miebach E
Published: August 2010

Mucopolysaccharidosis (MPS) type I is a lysosomal storage disorder caused by deficiency of the enzyme α‐l‐iduronidase (IDUA), which presents with a wide spectrum of phenotypes. Recently, enzyme replacement therapy (ERT) became available for patients with MPS I and has been demonstrated to be safe and effective in patients with the milder Hurler–Scheie and Scheie phenotypes. Treatment for 26 weeks with recombinant human IDUA (laronidase) has been shown to significantly increase the percentage of predicted normal forced vital capacity and the distance walked in the 6‐minute walk test. There was also a clear reduction in the volume of the liver and the levels of urinary glycosaminoglycan excretion. The drug was generally well tolerated. There were no drug‐related severe adverse events, and although the majority of patients developed IgG antibodies, these declined by the end of the study.

Conclusion: ERT seems to be a very promising new therapeutic regimen for patients with MPS I, especially for those with the less severe variants. However, as laronidase does not cross the blood–brain barrier it will probably not influence the central nervous manifestations in the most severely affected patients with the Hurler phenotype, although it may improve general lung and heart function, making bone marrow transplantation easier to tolerate.
Young children non‐immunized against measles: Characteristics and programmatic implications
Authors: Chowdhury F , Khan Ashraful I , Hossain Mohammad I. , Malek M. A , Faruque A. S. G , Ahmed Tahmeed , Salam Mohammad A.
Published: August 2010

Aim: To examine the presenting characteristics, including nutritional status, of young children without measles immunization and to suggest appropriate public health measures to improve immunization status. Methods: In this retrospective case‐control analysis, we studied 4075 children aged 12–23 mo of either sex, who attended ICDDR, B's Dhaka hospital during 1994–2003. Cases included children who reported to this facility without receiving measles vaccine, and the control children were those who received the vaccine. Results: 3181 of 4075 (78%) children, including 1227 (39%) girls and 1954 (61%) boys, received measles immunization. The proportion of vaccinated children increased from 74% in 1997 to 82% in 2001. Some non‐specific effects of measles immunization were observed. Fifty‐one per cent of the children without measles immunization were stunted, 76% were underweight, and 48% were wasted. The non‐immunized children were twice as likely to be stunted, underweight, and wasted than the immunized children; they were more often dehydrated (some or severe dehydration) (28% vs 22%, p<0.001), required longer duration (>72 h) of hospitalization (15% vs 10%, p<0.001), did not receive vitamin A capsule in the previous 6 mo (56% vs 36%, p<0.001), and had more frequent abnormal lung auscultation indicative of acute lower respiratory tract infections (8% vs 5%, p<0.001). Female children, illiterate mother, lack of vitamin A supplementation, and history of measles were significantly associated with non‐immunization against measles after controlling for co‐variables. Results were similar when different nutritional indicators (underweight, stunting, or wasting) were added separately to logistic regression models.

Conclusion: Intervention strategies to enhance immunization coverage in infants should target illiterate mothers and their children, particularly the females and malnourished ones, provide them with measles immunization and vitamin A capsule, and encourage their periodic follow‐up visits as part of a preventive nutritional programme.
Dexamethasone reduces reintubation rate due to postextubation stridor in a high‐risk paediatric population
Authors: Lukkassen Ingrid M. A. , Hassing Marre B. F , Markhorst Dick G.
Published: August 2010

Objective: To study the effect of dexamethasone on postextubation stridor (PS) incidence and reintubation rate due to PS in a high‐risk paediatric intensive care population. Patients and methods: All children aged between 4 wk and 6 y, who were intubated for at least 24 h and extubated between August 1999 and May 2002, were retrospectively included (n=60). Medical records of the included patients were studied; records of patients treated with dexamethasone prior to and following extubation (n=23) were compared with control patients who had not received prophylactic medication (n=37). Results: Nine patients in the control group developed significant postextubation stridor, necessitating nebulized epinephrine or glucocorticosteroids. In six of these children, reintubation as a result of postextubation stridor was indicated. None of the patients treated with dexamethasone developed severe postextubation stridor or required reintubation.

Conclusions: The risk of postextubation stridor is relatively high in the group of children aged between 4 wk and 6 y with intubation exceeding 24 h. We found dexamethasone to be effective in preventing reintubation due to postextubation stridor in this paediatric high‐risk group.
Developmental changes in infant heart rate responses to head‐up tilting
Authors: Myers Michael M. , Gomez‐Gribben Esperanza , Smith Kiersten S. , Tseng Angela , Fifer William P.
Published: August 2010

Aim: Newborn infants produce significant heart rate responses to both head‐up and head‐down tilting: heart rate increases with head‐up tilting and decreases with head‐down tilting. However, previously we found that, at 2–4 mo of age, heart rate increases were no longer significant following slow head‐up tilting. This study was designed to determine if 2–4‐mo‐old infants have significant increases in heart rate when tilted rapidly. Methods: Fifty‐four infants were tested as newborns or at 2–4 mo of age. Heart rate was measured while infants were tilted to a 30° head‐up angle either slowly over a period of 30 s or rapidly in 5 s. Results: Newborns exhibited increases in heart rate using both tilt speeds; however, at 2–4 mo of age, heart rate did not change significantly using either speed of tilting.

Conclusion: There are significant early developmental changes in cardiac responses to hypotensive challenge. Newborns react like adults, mounting sustained increases in heart rate in response to head‐up tilting, but at 2–4 mo of age sustained heart rate responses are no longer significant. Tilt tests may provide a standardized method for assessing autonomic competence during the period of maximum vulnerability to sudden infant death syndrome.
Rheumatic heart disease and coronary vasculitis in children
Authors: Gunal Nazlihan , Baysal Kemal , Haciomeroglu Pelin , Belet Nursen , Kolbakir Fersat
Published: August 2010

Rheumatic fever is a systemic inflammatory disease which may also cause vasculitis in multiple organ systems.

Conclusion: Two children with rheumatic mitral valve disease and mitral valve replacement developed myocardial ischaemia due to coronary vasculitis. One of them had neurological findings that may be attributed to cerebral vasculitis.
Ototoxic drugs and sensorineural hearing loss following severe neonatal respiratory failure
Authors: Robertson Charlene M. T. , Juzer M. Tyebkhan , Peliowski Abraham , Philip C. Etches , Cheung Po‐Yin
Published: August 2010

Aim: To determine relationships between ototoxic drugs and 4‐y sensorineural hearing loss (SNHL) in near‐term and term survivors of severe neonatal respiratory failure. Methods: All 81 survivors of the Canadian arm of the Neonatal Inhaled Nitric Oxide Study (mortality 32, loss to follow‐up 9) received loop diuretics, aminoglycosides, and neuromuscular blockers (NMB), and 50 received vancomycin as neonates. Prospective, longitudinal secondary outcome using audiological tests diagnosed late‐onset, progressive SNHL in 43 (53%); not flat (sloping) in 29, flat (severe to profound) in 14. Risk for SNHL was determined. Results: A combination of duration of diuretic use of >14 d and average NMB dose of >0.96 mg/kg/d contributed to SNHL among survivors (odds ratio 5.2; 95% CI 1.6, 16.7). Markers of illness severity did not contribute. Dosage or duration of aminoglycosides use did not relate to SNHL. Cumulative dosages and duration of use of diuretics; NMB; use of vancomycin; and overlap of diuretics with NMB, aminoglycosides, and vancomycin individually linked to SNHL (p<0.001).

Conclusion: Overuse of loop diuretics and/or NMB contributes to SNHL after neonatal respiratory failure; markers of illness severity or the appropriate administration of aminoglycosides do not.
Maternal signs of chorioamnionitis: Persistent cognitive impairment in low‐birthweight children
Authors: Versland Lene B. , Sommerfelt Kristian , Elgen Irene
Published: August 2010

Aim: To examine whether chorioamnionitis (CA) is associated with long‐term cognitive impairment in low‐birthweight (LBW) children without major handicaps such as cerebral palsy. Methods: Population‐based long‐term follow‐up study at 11 y of age of 130 LBW children with birthweight less than 2000 g, without major handicaps. Thirteen children with maternal signs of clinical CA were compared with the 117 LBW children without. Main outcome measure was psychometric intelligence, assessed using four subscales from the Norwegian version of the Wechsler Intelligence Scale for Children – Revised. Results: Mean performance IQ for the LBW children with maternal signs of CA (89, SD 13) was significantly lower compared to the other LBW children (98, SD 16) at 11 y of age (difference of mean 10, 95% CI of difference 0.4 to 19, p=0.04).

Conclusion: Maternal chorioamnionitis, known to be associated with an increased frequency of cerebral palsy, may have lasting negative consequences for fetal brain development, resulting in long‐term cognitive impairments, even when major handicaps such as cerebral palsy are absent.
Enhanced intensive care for the neonatal ductus arteriosus
Authors: Teixeira Lilian S. , McNamara Patrick J.
Published: August 2010

Failure of ductal closure is common in extremely low birth weight infants with significant postnatal morbidities from both pulmonary overcirculation (i.e. chronic lung disease) and/or systemic hypoperfusion (i.e. necrotizing enterocolitis). Early clinical signs of a hemodymanically significant ductus may be non‐specific (i.e. hypotension, increasing ventilator requirements, metabolic acidosis) necessitating early screening by echocardiography. Cyclooxygenase inhibitors remain the first‐line treatment option. Indomethacin remains the most commonly used agent, despite comparable efficacy and reduced risk of adverse events with ibuprofen. Surgical intervention is recommended after failure of medical therapy, contraindications to medical treatment or fulminating duct‐related cardiorespiratory deterioration. Wherever possible, surgical intervention in ELBW infants should be avoided in the first week of life due to the potential risks of ischemia‐reperfusion cerebral hemorrhage. The postoperative course is often complicated by left ventricular failure, pulmonary edema, and/or hemodynamic instability requiring close monitoring and physiologically relevant therapeutic interventions.
Maternal BMI and serum leptin concentration of infants in the first year of life
Authors: Savino Francesco , Alfonsina Liguori Stefania , Oggero Roberto , Silvestro Leandra , Miniero Roberto
Published: August 2010

Aim: To evaluate the relationship between serum leptin concentration in infants and infant and maternal BMI. Methods: 75 healthy term infants aged 0–12 mo, 51 exclusively breastfed (BF) for at least 4 mo and 24 formula fed (FF), were included in a cross‐sectional study. Weight, length and cranial circumference of infants and their mothers were measured, body mass index (BMI) was calculated using the formula weight (kg)/height (m)2 and infant serum leptin concentration was determined. Results: A significant positive correlation between infant serum leptin concentration and maternal BMI was observed in BF infants (r = 0.389, p = 0.005), confirmed in a multiple regression model adjusted for infant age and infant BMI (β = 0.065, p = 0.006), but not in FF infants. As regards the first 4 mo of life, we have already observed a positive correlation between infant serum leptin concentration and maternal BMI in BF infants (β = 0.113, p = 0.005), but not in FF infants.

Conclusion: In BF infants, serum leptin concentration correlates positively with maternal BMI. Higher maternal BMI values might increase leptin levels in breast milk, and maternal adiposity could be involved in infant energy balance.
Diarrheal illness in a cohort of children 0–2 years of age in rural Bangladesh: I. Incidence and risk factors
Authors: Pathela Preeti , Zahid Hasan K. , Roy Eliza , Huq Fazlul , Kasem Siddique A. , Bradley Sack R.
Published: August 2010

Aim: To describe clinical characteristics and age‐ and season‐specific incidences of diarrheal episodes, and to evaluate risk factors associated with the occurrence of diarrheal disease. Methods: A total of 252 infants from rural Bangladesh were followed through household surveillance for 2 y from birth during the years 1993–1996. Demographic and household determinants were linked to the probability of illness using logistic regression models. Results: The overall incidence of diarrhea was 4.25 episodes per child per year. Peak rates of overall, acute, and persistent diarrhea occurred in the 6–11‐mo and 12–17‐mo age groups. Diarrheal rates peaked during the spring and summer. Among host‐related characteristics, having a sibling in the household and having had prior diarrhea were significant risk factors for diarrhea. Among environmental characteristics, spring season remained a highly statistically significant risk factor for diarrhea.

Conclusion: Diarrheal disease continues to be a substantial burden in young children in rural Bangladesh. Most diarrheal episodes are of short duration, and should primarily be treated with oral rehydration therapy to prevent diarrhea‐related mortality. Improved knowledge of oral rehydration therapy, feeding during episodes to prevent further malnutrition, prolonged breastfeeding, and the keeping of livestock in corralled areas of the home are advocated.
Familial dysautonomia's impact on quality of life in childhood, adolescence, and adulthood
Authors: Sands Stephen A. , Giarraffa Philip , Jacobson Colleen M. , Axelrod Felicia B.
Published: August 2010

Aim: To evaluate the quality of life (QoL) of children, adolescents, and adults treated for familial dysautonomia (FD), a pervasive neurological disorder. Methods: The Child Health Questionnaire was completed by parents of 71 patients, while an additional 74 patients completed the Short Form – 36. Results: FD imposed a greater physical than psychosocial burden on the child, while the young adults reported both mental and physical quality of life within the average range. Self‐esteem was problematic and improved with age, while both groups reported lowering physical quality of life as they grew older, with worsening general health that limited their role at school or work.

Conclusion: Younger FD patients should be closely monitored for lowered self‐esteem and referred for counseling when appropriate, while physical and occupational therapy should be provided in advance of expected lowered physical QoL and role fulfillment with increasing age. This becomes important as the need for additional surgical interventions, such as fundoplication with gastrostomy or spinal fusion, contribute to lower physical functioning. Given the high degree of parental involvement required for the varied manifestations of this multisystem disorder, the need for continued parental assessment and psycho‐education about this chronic medical illness is warranted.
Fever of unknown origin in 185 paediatric patients: A single‐centre experience
Authors: Pasic Srdjan , Minic Aleksandra , Djuric Predrag , Micic Dragan , Kuzmanovic Milos , Sarjanovic Ljudmila , Markovic Milanka
Published: August 2010

Aim: We conducted a prospective study to evaluate the causes and outcome in children with fever of unknown origin (FUO). Methods: From 1990 to 1999, 185 children with FUO were evaluated. Initial evaluation included routine haematological analysis, Epstein‐Barr virus (EBV) serology, urine, stool or blood cultures, chest X‐ray and tuberculin probe. Results: In 131 (70%) patients diagnosis was established, and 70 (37.8%) had infectious disease. EBV infection was the most common infection followed by visceral leishmaniasis (VL), urinary tract infection (UTI) and tuberculosis. Autoimmune disorders were diagnosed in 24 (12.9%), Kawasaki disease in 12 (6.4%), malignant diseases in 12 (6.4%) and miscellaneous conditions in 15 (8.1%) patients. In the remaining 54 (30%) patients, diagnosis was not established and most of them had self‐limited disease. During the investigation, 26 (14%) patients developed serious organ dysfunction and five patients (two with virus‐associated haemophagocytic syndrome, one with VL and two unknown) died.

Conclusion: The most important infectious causes of FUO in our study were EBV infection and VL. Kawasaki disease represented a significant cause of FUO at the beginning of our study because it was not recognized by primary‐care physicians. We report myelodysplastic syndrome as another emerging cause of paediatric FUO. Repeated clinical examination and careful use of specific laboratory examinations, invasive diagnostic procedures or imaging are crucial in approaching paediatric FUO.
Better care of immature infants; has it influenced long‐term pulmonary outcome?
Authors: Halvorsen Thomas , Torunn Skadberg Britt , Egil Eide Geir , Drange Røksund Ola , Markestad Trond
Published: August 2010

Aims: To assess whether lung function in late childhood had improved in subjects born extremely prematurely in the early 1990s compared to the early 1980s, and whether neonatal factors in the respective periods had different impact on long‐term pulmonary outcome. Design: Population‐based, controlled cohort study. Lung function was determined in 81 of 86 (94%) eligible subjects born with gestational age ≤28 weeks or birthweight ≤1000 g in Western Norway in 1982–85 (n=46) and 1991–92 (n=35), and in 81 matched control subjects born at term. Results: The incidence of bronchopulmonary dysplasia was similar in the two periods. At follow‐up, airway obstruction, hyper‐responsiveness and pulmonary hyperinflation were similarly increased in both preterm cohorts compared to matched controls. Furthermore, current lung function was similarly related to neonatal respiratory disease in both birth‐cohorts: FEV1 was reduced with respectively 18.6% and 18.7% of predicted in preterms dependent on supplemental oxygen at 36 weeks postmenstrual age. Lack of antenatal treatment with corticosteroids and prolonged neonatal oxygen treatment predicted similar significant airway obstruction in the two birth‐cohorts. Conclusion: Preterms born in different eras of neonatology had similar long‐term decreases in lung function. Long periods of oxygen supplementation are still required to salvage immature infants, and airway obstruction may still be a common long‐term outcome.
Bone, lean and fat mass of newborn twins versus singletons
Authors: Demarini Sergio , Koo Winston W. K. , Hockman Elaine M.
Published: August 2010

Aim: Twin gestations are associated with disturbed fetal growth. The aim of this study was to compare body composition measurements of twins to those of singletons. Methods: Anthropometric and dual energy X‐ray absorptiometry (DXA) measurements were performed in twins and in matched singleton neonates. There were 48 pairs of twins in which 76 infants were appropriate for gestational age (AGA) with birth weights between the 10th and 90th percentile and 20 were small for gestational age (SGA) with birth weights <10th percentiles. Each AGA twin was matched as closely as possible for birth weight to an AGA singleton. Each SGA twin was matched with two cohorts of AGA singletons: one with similar birth weight and one with similar gestation. Results: For AGA twins and their singleton cohort matched for birth weights, profile analysis using repeated measure analysis of variance showed that there were no significant differences in bone, fat and lean mass either as absolute values or as percentage of total weight. This was also the case for body composition of SGA twins compared to singletons matched for birth weight. In contrast, SGA twins have significantly lower absolute amounts of lean with tendency to lower fat and bone mass. Conclusion: For clinically normally grown neonates, with comparable weight, the body composition with respect to bone, fat and lean mass components are similar regardless whether they are products of singleton or twin pregnancies.
Serum neopterin levels in children with primary nephrotic syndrome
Authors: Bakr Ashraf , Rageh Ibrahim , El‐Azouny Mohamed , Deyab Safaa , Lotfy Hend
Published: August 2010

Aim: To assess the changes that occurs in serum neopterin levels in children with primary nephrotic syndrome. Methods: Serum neopterin levels were measured by ELISA in 38 children with active primary nephrotic syndrome (group I) and 17 children with primary nephrotic syndrome in remission (group II) and 20 healthy controls. All patients had normal creatinine clearance. Among group I, 28 patients were steroid‐sensitive while 10 patients were steroid‐resistant. Results: Serum neopterin levels were significantly elevated in group I patients (median = 30, 7.2–43.2 nmol/l) compared with group II (median = 6, 2–10 nmol/l, P<0.001) and controls (median = 3.2, range: 0.4–1.8 nmol/l, P<0.001). Group II patients had similar neopterin levels compared with controls (P=0.71). There was a significant positive correlation between serum neopterin levels and the degree of proteinuria in group I patients (r = 0.4, P=0.01). No significant differences in serum neopterin levels were noted between steroid‐sensitive and steroid‐resistant patients (P=0.4).

Conclusion: Serum neopterin could be used as a marker of the activity of primary nephrotic syndrome but it could not be used to differentiate between steroid‐sensitive and steroid‐resistant patients.