bluuebunny/crossref_metadata_2025 huggingface dataset:
Considerations and approaches in determining the protein and energy composition of preterm infant formulas
Authors: Fanaro Silvia , Cristofori Gloria , Mosca Fabio , Savino Francesco , Vigi Vittorio
Published: August 2010

Optimal early nutritional support is considered a crucial issue in the care of the preterm infant, particularly of those with very low‐ or extremely low‐brithweight. Unfortunately, this goal is seldom satisfactorily attained.

Several conditions such as hypoxia, acidosis, patent ductus arteriosus, drug therapy, reduced intestinal motility may interfere with an adequate nutritional delivery in the early neonatal period. Moreover, there is still concern about metabolic and intestinal tolerance of the currently suggested intakes and a lack of uniformity in the nutritional program among different NICUs. Finally, the vast majority of the available preterm formulas are not fully adequate to the real nutritional needs of these infants. Inadequate protein content and inappropriate protein energy ratio of most preterm formulas represent a matter of major concern, since there is a strict relationship between formula composition and the quantity and quality of weight gain. As a consequence there is a need of at least two milk formulas for different preterm infants: one for LBW and VLBW infants, the other for preterm infants weighing >1500 g.
The effect of protective nutrients on mucosal defense in the immature intestine
Authors: Forchielli Maria L , Allan Walker W
Published: August 2010

Oral nutrition plays a dual role in the gut, providing nutrition to the body while affecting the function of the gastrointestinal tract. The exposure of the gut to food antigens, in the form of either beneficial or harmful nutritional substances, contributes to a vast array of physiological and pathologic gastrointestinal responses with secondary systemic implications. The immune system of the gastrointestinal tract is always involved in the first line of defense, and its actions are particularly important in the early period of life as maturation takes place. From maturation, a balance ensues in the regulatory mechanism of host defense, ultimately leading to either tolerance or immune reaction. This paper emphasizes how some nutrients may beneficially affect the gastrointestinal immune system's maturation in both term and especially premature neonates.
Novel approaches to the nutritional management of the allergic infant
Authors: Isolauri Erika , Ouwehand Arthur C , Laitinen Kirsi
Published: August 2010

The increased prevalence of atopic diseases, i.e. atopic eczema, allergic rhinitis and asthma, has been described as the epidemic of the 21st century in Western societies. New approaches in the fight against allergic diseases are clearly called for, the target being the persistence of the allergic responder pattern beyond infancy. The advantage afforded by elimination diets lies in the silencing of specific allergic inflammation induced by an offending food. Novel nutritional approaches, beyond the treatment of food allergies, have recently attracted research interest subsequent to the identification of the immunomodulatory potential of specific dietary compounds. Dietary lipids as immunomodulators may prevent allergic sensitization by down‐regulating inflammatory response whilst protecting the epithelial barrier. Probiotic bacteria have been shown to reinforce the different lines of gut defence: immune exclusion, immune elimination and immune regulation. On this basis, the strategy against allergic disease proposed here is based on the administration of tolerogenic gut‐processed peptide fragments of a specific protein, in addition to the use of specific dietary compounds such as fatty acids and antioxidants, and introducing a microbial stimulus for the immature immune system by means of cultures of beneficial live micro‐organisms characteristic of the healthy infant gut microbiota.
Z‐score of weight for age of infants with atopic dermatitis and cow's milk allergy fed with a rice‐hydrolysate formula during the first two years of life
Authors: Savino Francesco , Castagno Emanuele , Monti Giovanna , Serraino Paola , Peltran Amalia , Oggero Roberto , Fanaro Silvia , Vigi Vittorio , Silvestro Leandra
Published: August 2010

Background: Recently, rice‐based formulas have been widely used in hypoallergenic diets, but data on nutritional values are scarce. Aim: To evaluate the growth of infants fed with a rice‐based hydrolysate formula, compared to those infants fed with a soy formula or an extensively hydrolysed casein formula, in the first 2 y of life. Methods: A total of 88 infants were enrolled between March 2002 and March 2004. Fifty‐eight infants with atopic dermatitis (AD) and cow's milk allergy (CMA), confirmed by open challenge, were enrolled as study group: 15 were fed with a rice‐based hydrolysate formula (RHF), 17 with a soy‐based formula (SF) and 26 with an extensively hydrolysed casein formula (eHCF). Thirty infants with AD without cow's milk allergy were recruited as a control group (CG) and fed with a free diet. Weight was recorded on enrolment and at 3‐monthly intervals in the first year of life, and at 6‐monthly intervals in the second year. Infants were weighed naked, before feeding, by means of an electronic integrating scale. The z‐scores of weight for age were calculated. Statistics: One‐way analysis of variance and Student's t‐test were used for statistical comparison. Significance was set at p<0.05. Results: No significant differences between the RHF, SF and eHCF groups were observed for the z‐score of weight for age during the first 2 y of life, but a significantly lower difference was seen in the RHF group compared to the control group in the intervals 9 mo–1 y (p=0.025) and 1–1.5 y (p=0.020) of age. In contrast, the SF and eHCF groups were comparable to the control group, but the eHCF group was significantly lower (p=0) in the first trimester of life.

Conclusion: Even if our findings show no significant difference between RHF and control, low weight observed in infants fed with RHF raises doubts about the nutritional adequacy of rice‐hydrolysate formulas.
Vitamin K prophylaxis: Leaving the old route for the new one?
Authors: Tandoi Francesco , Mosca Fabio , Agosti Massimo
Published: August 2010

Oral or parenteral administration of vitamin K is the accepted practice for prevention of early vitamin K deficiency bleeding (VKDB) in the newborn. However, vitamin K prophylaxis in the newborn continues to be a worldwide health concern, particularly in breastfed infants. This paper reviews the current status of the use of vitamin K for the prevention of early and late VKDB.
A prospective 10‐year study on children who had severe infantile colic
Authors: Savino Francesco , Castagno Emanuele , Bretto Roberta , Brondello Cristina , Palumeri Elisabetta , Oggero Roberto
Published: August 2010

Aim: To evaluate the association between infantile colic and gastrointestinal, allergic and psychological disorders in childhood. Methods: A prospective study was conducted on 103 infants aged 31–87 d. After 10 y, between 2001 and 2003, the children were recalled and a paediatrician evaluated the selected disorders by anamnesis, medical examination, laboratory tests and parent interviews. Results: Of the 103 infants enrolled, 96 completed the study. There was an association between infantile colic and recurrent abdominal pain (p=0.001) and allergic disorders: allergic rhinitis, conjunctivitis, asthmatic bronchitis, pollenosis, atopic eczema and food allergy (p<0.05). Sleep disorders, fussiness, aggressiveness and feelings of supremacy are more frequent in children who suffered from colic during early infancy (p<0.05). A family history of gastrointestinal diseases and atopic diseases was significantly higher in infants with colic than in controls (p<0.05).

Conclusion: Susceptibility to recurrent abdominal pain, allergic and psychological disorders in childhood may be increased by infantile colic. Our findings confirm that severe infantile colic might be the early expression of some of the most common disorders in childhood.
Early detection of podiatric anomalies in children with Down syndrome
Authors: Concolino Daniela , Pasquzzi Antonietta , Capalbo Giuseppe , Sinopoli Saverio , Strisciuglio Pietro
Published: August 2010

Aims: To verify the importance of podiatric evaluation in patients with Down syndrome for the early diagnosis and treatment of minor orthopaedic problems. Methods: Case‐control study of 50 children affected by Down syndrome (aged 4–10 y) without major orthopaedic malformations compared to 100 healthy children. A complete podiatric examination was performed on all patients and controls. Results: Children with Down syndrome showed several orthopaedic anomalies including bony deformity of the forefoot (90%), flat foot (60%), isolated calcaneal valgus (24%), knee valgus (22%) and pronated flat foot (16%). These abnormalities were responsible for postural alterations as confirmed by baropodometric examination.

Conclusion: The data demonstrated a greater incidence of minor orthopaedic alterations and suggest the necessity of regular podiatric examinations in the follow‐up of this syndrome.
Hospitalized Swedish children with hand and forearm injuries: A retrospective review
Authors: Ljungberg Elinor , Dahlin Lars B. , Granath Fredrik , Blomqvist Paul
Published: August 2010

Aim: To analyse incidences and find risk groups in children hospitalized with hand injuries in a national retrospective study. Methods: All children with a primary hand or forearm injury admitted to Swedish hospitals during 1987–2001 were retrieved from the Swedish Hospital Discharge Register and analysed as to incidence and characteristics. Results: Among 9855 children included, the median age was 7.0 y and two‐thirds were boys. The incidence increased in both younger (0–6 y) and older (7–14 y) children. Wounds and fractures almost doubled, while muscle/tendon injuries decreased. In younger children, wounds and burns were the most frequent diagnoses. In older children, fractures and muscle/tendon injuries were common. Sharp objects caused most of the injuries. University hospitals treated almost half of the children.

Conclusion: The number of children with hand injuries admitted to hospitals in Sweden increased annually. Analyses of causes behind the increase are important to counter this trend.
Thiamine‐responsive megaloblastic anaemia syndrome: Long‐term follow‐up and mutation analysis of seven families
Authors: Ricketts Christopher J. , Minton Jayne A. , Samuel Jacob , Ariyawansa Indra , Wales Jerry K. , Lo Ivan F. , Barrett Timothy G.
Published: August 2010

Aim: Thiamine‐responsive megaloblastic anaemia syndrome (TRMA) is the association of diabetes mellitus, anaemia and deafness, due to mutations in SLC19A2, encoding a thiamine transporter protein. This is a unique monogenic form of vitamin‐dependent diabetes for which there is limited long‐term data. We aimed to study genotype–phenotype relationships and long‐term follow‐up in our cohort. Methods: We have studied 13 patients from seven families and have follow‐up data for a median of 9 y (2–30 y). Results: All patients originated from Kashmir or Punjab, and presented with non‐immune, insulin‐deficient diabetes mellitus, sensorineural deafness and a variable anaemia in the first 5 y of life, the anaemia progressing to megaloblastic and sideroblastic changes in the bone marrow. The anaemia and diabetes mellitus responded to oral thiamine hydrochloride 25 mg/d, but during puberty thiamine supplements became ineffective, and almost all patients require insulin therapy and regular blood transfusions in adulthood. All patients are homozygous for mutations in the SLC19A2 gene. We have identified a novel missense mutation (T158R) that was excluded in 100 control alleles.

Conclusion: Diabetes in this syndrome is due to an insulin insufficiency that initially responds to thiamine supplements; however, most patients become fully insulin dependent after puberty. A mutation screening strategy is feasible and likely to identify mutations in almost all cases.
Hemoglobin A1c in obese children and adolescents who participated in a weight management program
Authors: Zador Ivan , Meyer Laurie J. , Scheets Dawn R. , Wittstruck Thorne M. , Timmler Tammi , Switaj Dolores M.
Published: August 2010

Aim: The objective of this study was to compare hemoglobin A1c values in non‐diabetic obese children and adolescents before enrollment and after completion of a 12‐wk weight management program. Methods: Seventeen children and adolescents, age 10.8±2.5 y (mean±1 SD), joined a multidisciplinary weight management program. Hemoglobin A1c and body mass index were measured at the start and at the completion of the program in each participant. Results: Body mass index at the start of the program was 34.3±6.4 kg/m2. Body mass index at the end of the program was 33±6.6 kg/m2 (p<0.05). Hemoglobin A1c at the beginning of the program was 5.3±0.3%. Hemoglobin A1c at the completion of the program was 5±0.2% (p<0.05).

Conclusion: In this group of overweight children, hemoglobin A1c decreased significantly after participating in a multi‐disciplinary weight loss program. These findings further point to the beneficial effect of lifestyle changes on the metabolic status of obese children.
Gallbladder cancer in a patient with Miller‐Dieker syndrome
Authors: Ueda Shizuyo , Kubota Masaru , Kuroki Shigekazu , Wada Michihiko
Published: August 2010

We report the case of a male patient with Miller‐Dieker syndrome (MDS) and gallbladder cancer. Chromosome analysis by fluorescence in situ hybridization revealed a deletion in the 17p13.3 region, an area thought to contain tumour suppressor genes, including the hypermethylated in cancer 1 gene. Considering the rarity of gallbladder cancer in children, we propose that MDS as the genetic background of this patient may have played a role in the occurrence of gallbladder cancer.

Conclusion: Our present report indicates that the emergence of cancers should be taken into consideration during the long‐term follow‐up of patients with MDS.
Postnatal rupture of an antenatally diagnosed choledochal cyst: First case report
Authors: Siddiqui Mohammad M. F. , Grier David , Cusick Eleri
Published: August 2010

A 7‐mo‐old girl with an asymptomatic antenatally diagnosed choledochal cyst was referred to the regional paediatric surgical centre for advice on management. Following further radiological investigation and discussion with the supra‐regional centre, a date for elective surgery was arranged. However, in the interim, she was admitted as an emergency following rupture of the cyst. She made an uneventful recovery following urgent laparotomy.

Conclusion: We recommend prompt paediatric surgical referral following antenatal diagnosis of a presumed choledochal cyst. Delay in surgery may permit expansion and rupture of the cyst, even after a period of asymptomatic stability.
The true cause of pyloric stenosis is hyperacidity
Authors: Rogers Ian Munro
Published: August 2010

Pyloric stenosis (PS) has no known cause. A testable theory of cause is proposed, based on the inheritance of a parietal cell mass (PCM) at the upper end of the normal range. It is proposed that, until 3–4 wk of age, the obligatory high fasting gastrins are at maximal levels and not able to be diminished by increasing antral acidity. Hence, rising acidity is not reduced by a lowered gastrin during this time, and very high acidity occurs.

Conclusion: Persisting duodenal hyperacidity is created by an inherited high PCM and loss of gastrin control. These two factors produce pyloric stenosis through work hypertrophy from repeated pyloric contraction in response to hyperacidity.
Does inadequate maternal iron or DHA status have a negative impact on an infant's functional outcomes?
Authors: Rioux France M. , Lindmark Gunilla , Hernell Olle
Published: August 2010

Marginal intake of iron and ω‐3 long‐chain fatty acids (DHA) is prevalent among pregnant women. It is not clear to what extent poor iron or DHA status during pregnancy impacts on an infant's functional outcomes. A few studies suggest that inadequate maternal iron or DHA status may be associated with suboptimal functional outcomes in infants. In addition, there is a lack of prospective studies using randomized, double‐blind design or experimental studies with appropriate animal models. Although both nutrients are involved in early brain development and their metabolism is interrelated, no study has examined the interaction between iron and ω‐3 fatty acids during pregnancy.

Conclusion: Long‐term studies on large cohorts of pregnant women and their infants are needed to determine whether inadequate iron or DHA status during pregnancy is detrimental to infant neurodevelopment.
Body mass index references for Turkish children
Authors: Bundak Ruveyde , Furman Andrzej , Gunoz Hulya , Darendeliler Feyza , Bas Firdevs , Neyzi Olcay
Published: August 2010

Aim: To construct the body mass index reference curves for Turkish children aged 6 to 18 y, and to determine the prevalence of overweight and obesity. Subjects and methods: Height and weight measurements of healthy schoolchildren (1100 boys, 1019 girls) were obtained biannually. Body mass index was calculated from 11 648 height and weight measurements. Centile curves were constructed using the LMS method. Results: The smoothed percentile values and curves for body mass index in Turkish children show that there is a constant increase in body mass index values towards adulthood, especially during the pubertal years, in both sexes. The prevalence of overweight is 25% and obesity 4% in boys at age 18 y. The percentage of overweight and obesity in girls at age 14 was 15% and 1%, respectively. The sample size was too small to come to any conclusion regarding these rates at 18 y of age.

Conclusion: This study presents data and curves for body mass index values in healthy Turkish children aged 6 to 18 y. The values are in compliance with those of Western countries.
Oligonephropathy, developmental programming and nutritional management of low‐gestation newborns
Authors: Yeung Melinda Y.
Published: August 2010

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Intrauterine growth retardation is associated with oligonephropathy and the risk of hypertension and renal disease in adulthood. Animal study data show that nephron density is directly related to protein nutrition status during nephrogenesis. Among infants born at low gestation, postnatal growth retardation and major deficits in energy and protein intake have been reported.

Conclusion: Since nephrogenesis occurs mainly in late gestation, increasing protein intake during nephrogenesis could minimize the risk of long‐term morbidities associated with oligonephropathy.
Impact of repeated lifestyle counselling in an atherosclerosis prevention trial on parental smoking and children's exposure to tobacco smoke
Authors: Kallio Katariina , Jokinen Eero , Hämäläinen Mauri , Kaitosaari Tuuli , Volanen Iina , Viikari Jorma , Rönnemaa Tapani , Simell Olli
Published: August 2010

Aim: To determine whether repeated infancy‐onset lifestyle counselling alters parental smoking and children's exposure to tobacco smoke. Methods: In 1990, 1062 healthy infants were recruited to a randomized, ongoing atherosclerosis prevention trial (STRIP). Intervention families received at least twice a year individualized nutrition and lifestyle counselling. By 1999, 652 8‐y‐old children continued participation. Exposure to tobacco smoke was evaluated using serum cotinine concentration. Parents' smoking was also assessed using questionnaires and interviews. Results: Parents' smoking decreased during the study similarly in the intervention and control groups. Of the 8‐y‐old children, 46% had detectable serum cotinine concentration, suggesting exposure to tobacco smoke during the past few days. All children were non‐smokers. Serum cotinine concentrations did not differ between the intervention and control children. Children's cotinine values were highest in the families where either father or both parents were smokers.

Conclusion: Participation in the atherosclerosis prevention trial slightly decreased smoking among the intervention and control parents. However, counselling led to no differences in parental smoking between the two groups, or in exposure of the intervention and control children to tobacco smoke. This study suggests that more detailed and targeted intervention is required to achieve a significant effect on children's tobacco smoke exposure.
Vascular endothelial growth factor in children with nephrotic syndrome treated with cyclosporine A
Authors: Wasilewska Anna , Zoch‐Zwierz Walentyna , Tenderenda Edyta
Published: August 2010

Aim: To assess the effect of cyclosporine A (CyA) on the level of vascular endothelial growth factor (VEGF) in the plasma and urine of nephrotic syndrome children. Methods: The study material consisted of 15 children (F 6, M 9; group I) who were subjected to the following examinations: A) at the time of proteinuria relapse, before treatment with CyA, B) after 3 mo, C) after 6 mo, and D) after 12 mo of CyA administration with prednisone and convertase inhibitor. The control group (II) contained 20 healthy children. The immunoenzymatic ELISA method (R&D Quantikine) was used to determine plasma and urinary VEGF levels, while the immunofluorescence method was applied to assess CyA concentration in the plasma. The statistical program Statistica 6.0 was used for statistical analysis of the results. Results: In the present study, plasma VEGF level in examination A was higher than in the control group (p<0.01). After proteinuria regression (B), it did not differ from the level observed in healthy children (p>0.05). After 6 and 12 mo of CyA administration, VEGF concentration increased and was higher than in the control group (p<0.05). In all the examinations, urinary excretion of VEGF was higher than in the control group, increasing proportionally with the duration of treatment and plasma CyA level. A positive correlation was observed between plasma and urinary VEGF levels and between VEGF and CyA concentrations in the plasma.

Conclusion: Long‐term CyA treatment of nephrotic syndrome children leads to an increase in plasma and urinary VEGF.
Multiple‐step polyclonal versus one‐step monoclonal enzyme immunoassay in the detection of Helicobacter pylori antigen in the stools of children
Authors: Hauser Bruno , Wybo Inge , Tshibuabua Gerard , Pierard Dennis , Vandenplas Yvan
Published: August 2010

Objective: Evaluation of a polyclonal and a monoclonal Helicobacter pylori stool antigen test (HpSAT) for the detection of Helicobacter pylori (HP) infection in children. Methods: 43 children underwent a 13C‐urea breath test (13C UBT) and a HpSAT for the detection of HP. A child was considered HP positive if the 13C UBT was positive. Two HpSATs were tested: the “Premier Platinum HpSA” test (PP HpSAT) (polyclonal enzyme immunoassay) and the “ImmunoCard STAT! HpSA” test (ICS HpSAT) (one‐step immunochromatographic assay). Results: The mean age of the children was 8.9 y (range 3.5–17.5 y). Of the 43 children, 18 (41.9%) were HP positive and 25 (58.1%) were HP negative. The PP HpSAT showed a sensitivity of 94.4% and a specificity of 100.0%. With the ICS HpSAT, equivocal results occurred in 5/42 (11.9%) of the tests due to a problem with the visual interpretation of the change in colour of the test‐line. The ICS HpSAT had a sensitivity of 100.0% and a specificity of 76.0% when the test was considered positive in case of any change of colour of the test‐line, which is the correct practice according to the manufacturer. The ICS HpSAT had a sensitivity of 100.0% and a specificity of 96.0% when the test was considered positive only in case of a “significant change of colour” of the test‐line.

Conclusion: Compared to the 13C UBT, the PP HpSAT shows a comparably good sensitivity and specificity, the ICS HpSAT has a comparably good sensitivity but lower specificity due to a high percentage of equivocal results when the test is used according to the manufacturer's instructions, and the ICS HpSAT has a comparably good sensitivity and specificity when a weakly positive test is considered negative for the diagnosis of HP infection in children. The ICS HpSAT is easy to perform with results available within 10 min, and is therefore of particular interest in ambulatory medicine.
Clinical predictors of self‐limited urinalysis abnormality in childhood Henoch‐Schönlein purpura nephritis
Authors: Hung Shuo‐Hsun , Yang Yao‐Hsu , Lee Chien‐Chang , Wang Li‐Chieh , Lin Yu‐Tsan , Chiang Bor‐Luen
Published: August 2010

Background and aim: The majority of patients (85–95%) with Henoch‐Schönlein purpura nephritis (HSPN) suffer from a prolonged course of urinalysis abnormality. We sought to identify favourable prognostic factors predicting a self‐limited urinalysis abnormality within 1 y. Methods: Fifty‐eight HSPN patients admitted to the University Hospital between 1990 and 2003 were retrospectively analysed. Detailed information on clinical and laboratory manifestations on admission and sequential follow‐up clinics were recorded. The χ2 or Fisher's exact test were used for univariate analysis, and multiple logistic regression was used for multivariate analysis. Results: The study cohort included 31 boys and 27 girls, with a mean age of onset of 8.0±4.3 y and a median follow‐up duration of 5.9 y (range 1 to 25). Of 58 patients, 39 (67.3%) had a self‐limited urinalysis abnormality within 1 y. On multivariate analysis, onset age less than 9 (p=0.038), low‐grade proteinuria (p=0.044) and interval between purpura onset and renal manifestations less than 2 wk (p=0.005) predicted self‐resolved urinalysis abnormality within 1 y. With two or more predictive factors, the sensitivity for short‐term course was 84.6%, the specificity was 73.7%, and the positive predictive value was 84.8%.

Conclusion: A small number of variables were important for detecting a favourable short‐term course of urinalysis abnormality.
Ten years’ experience of enzyme infusion therapy of Norrbottnian (type 3) Gaucher disease
Authors: Erikson Anders , Forsberg Håkan , Nilsson Magnus , Åström Marianne , Månsson Jan‐Eric
Published: August 2010

Aim: To study the long‐term effects of enzyme replacement therapy on the neurological signs of chronic neuronopathic Gaucher disease and to evaluate some biochemical parameters for monitoring the treatment. Methods: Eight patients from the Norrbottnian cohort were followed during 10 y of treatment. They were followed with regular clinical observations, biochemical tests and psychometric testing. Results: After the start of treatment, their general well‐being improved and was stable during the follow‐up. In three of the patients there were some indications of slow neurological deterioration. The mean results of psychometric testing did not decrease. Glucosylceramide and chitotriosidase levels were useful in monitoring the treatment. The chemokine CCL18 also seems to be a useful parameter for future monitoring.

Conclusions: Enzyme replacement therapy seems to slow down further neurological and mental deterioration in mild chronic neuronopathic (type 3) Gaucher disease.
Polymorphisms in four candidate genes in young patients with essential hypertension
Authors: Marčun Varda Nataša , Zagradišnik Boris , Stangler Herodež Špela , Kokalj Vokač Nadja , Gregorič Alojz
Published: August 2010

Aim: To determine whether four potential genetic factors (polymorphisms in genes for alpha‐adducin, beta‐adducin, the G‐protein beta‐3 subunit and nitric oxide synthase) are important for the development of essential hypertension (EH) in Slovenian children and young adults with EH. Methods: Both a nuclear families approach and case‐control study have been performed. Genotyping of common polymorphisms in these genes using polymerase chain reaction was carried out in 104 nuclear families (an affected child, both parents) and in 200 control patients. Results: Using the transmission disequilibrium test, no statistically significant differences were found between the frequencies of transmitted and non‐transmitted alleles in nuclear families for all four investigated polymorphisms. In addition, the distributions of genotypes and alleles for the four polymorphisms did not differ significantly between our children and 200 healthy control patients. The allele frequencies of all polymorphisms were concordant with those observed in some other Caucasian populations.

Conclusion: We found no association between the investigated gene variants and EH, so we conclude that they do not confer a significantly increased risk of the development of EH in the Slovenian population of hypertensive children.
Tap‐water enema for children with myelomeningocele and neurogenic bowel dysfunction
Authors: Mattsson Sven , Gladh Gunilla
Published: August 2010

Aim: To evaluate the outcome of transrectal irrigation (TRI) using clean tap water without salt in children with myelomeningocele and neurogenic bowel problems. Methods: 40 children (21 boys and 19 girls; aged 10 mo to 11 y) with myelomeningocele and neurogenic bowel dysfunction were treated with TRI given by a stoma cone irrigation set daily or every second day. A questionnaire on the effects on faecal incontinence, constipation and self‐management was completed by the parents, 4 mo–8 y (median 1.5 y) after start. Effects on rectal volume, anal sphincter pressure and plasma sodium were evaluated before and after the start of irrigation. Results: At follow‐up, 35 children remained on TRI, four had received appendicostomy, while one defecated normally. For all children but five (35/40; 85%) the procedure worked satisfactorily, but a majority found the procedure very time consuming and only one child was able to perform it independently. All children were free of constipation; most (35/40) were also anal continent. Rectal volume and anal sphincter pressure improved, while plasma sodium values remained within the normal range.

Conclusion: Transrectal irrigation with tap water is a safe method to resolve constipation and faecal incontinence in children with myelomeningocele and neurogenic bowel dysfunction, but it does not help children to independence at the toilet.
Prophylaxis with palivizumab against respiratory syncytial virus infection in infants with congenital heart disease—who should receive it?
Authors: Sunnegårdh Jan
Published: August 2010

Respiratory syncytial virus (RSV) infection is the leading cause of infection of the lower respiratory tract in infants, and is also the leading cause of hospitalization during the first year of life. In this issue of Acta Paediatrica, Meberg and Bru report on the incidence and estimated costs of hospitalizations for RSV infections in children with congenital heart disease from a specified region in Norway.

Conclusion: Incidence figures of hospitalization due to RSV infection in this high‐risk group of infants were similar to the results from several other reports. The cost‐benefit analysis of prophylaxis against RSV infection in infants with congenital heart disease, using the monoclonal antibody palivizumab, should also take into account potential savings attributable to such prophylaxis.
Detecting heart defects in newborn infants – innocent murmurs mixed with silent dangers
Authors: Norman Mikael
Published: August 2010

Detection of severe heart defects without unnecessary delay is a primary task for providers of infant care. Screening is challenged by the fact that a normal physical examination after birth does not exclude severe defects. Shorter hospital stay for newborn infants and a reduced number of examinations may further hamper a successful mission. Reassuringly, most critical heart defects are reported to be identified early.

Conclusion: Increased awareness of the limitations of screening and continued monitoring of detection rates, as well as studies on how they can be improved, are warranted.
Respiratory syncytial virus infections in congenital heart defects – hospitalizations and costs
Authors: Meberg Alf , Bruu Anne‐Lise
Published: August 2010

Aims: To register hospitalizations for respiratory syncytial virus (RSV) infections and estimate costs of prophylaxis with humanized monoclonal antibodies (palivizumab) against RSV, compared to hospital care, in cases with congenital heart defects (CHDs). Methods: Population based study with prospective registration of CHDs. Costs for hospital treatment of RSV‐infections in CHD‐patients calculated by means of the Norwegian Diagnosis Related Groups system. Results: In 43 470 infants live born in the population through the 18‐year period 1987–2004 a structural CHD was diagnosed in 527 (1.2%). A total of 898 (2.1%) hospitalizations for RSV‐infections occurred in the study population 1987–2005. The hospital admittance rate was significantly higher for CHD‐cases (4.8%) than for children without CHD (2%) (P=0.002). Severe CHDs (need for surgery or catheter intervention) had a higher admittance rate (9.2%) compared to the group of remaining CHDs (3.3%) (P=0.01). Number needed to treat with palivizumab to avoid one hospitalization for RSV‐infection in cases of severe CHDs was calculated to 24, at costs of US$ 195 000. The expenses for palivizuamab prophylaxis in severe CHDs were 31 times that of hospital treatment.

Conclusion: Prophylaxis with palivizumab in severe CHDs is not cost‐effective.
Feeding disorders related to nutrition
Authors: Lindberg Lene , Östberg Monica , Isacson Inger‐Marie , Dannaeus Margareta
Published: August 2010

Aim: To study the relationship between early feeding disorders and nutritional intake during the second and third year of life. Methods: 15 children, nine girls and six boys, with a feeding problem identified at the Specialist Child Health Care Unit at a mean age of 14.5 mo were matched with respect to age and sex with healthy control children. Four‐day dietary records were collected at inclusion (time 1) and follow‐up of the study (time 2). Measures of growth at birth, at times 1 and 2 of the study, and at 3 y of age were obtained from Child Health Centre records. Results: A lower intake of energy, carbohydrate and protein was evident at times 1 and 2 for the group of children with feeding disorders compared to the controls. Zinc and vitamin B6 were the only micronutrients that differed for the feeding disorder group compared to the control group at times 1 and 2. Children with feeding disorders decelerated in weight during the second year of life and in height during the third year of life as compared to controls.

Conclusion: The criterion of a persistent failure to eat adequately with a subsequent failure to gain weight, required for the diagnosis of feeding disorders in DSM‐IV, was supported by the findings in this study. The relation between nutrition and growth in feeding disorders has not, to our knowledge, been reported in previous research.
Health‐related quality of life in children diagnosed with asthma, diabetes, juvenile chronic arthritis or short stature
Authors: Norrby Ulla , Nordholm Lena , Andersson‐Gäre Boel , Fasth Anders
Published: August 2010

Aim: 1) To assess the reliability and validity of the Swedish version of the Child Health Questionnaire (CHQ), 2) to determine the correlation between children's and parents’ responses to the CHQ, and 3) to describe and compare responses to the CHQ of four diagnostic groups. Methods: A total of 199 Swedish children aged 9–16 with diagnoses of asthma (n=53), diabetes (n=48), short stature (n=51) and juvenile chronic arthritis (JCA, n=47) and their parents answered the CHQ and relevant validation instruments at a clinic check‐up. Coefficient alphas were determined for all dimensions of the instrument, and all but four had acceptable to very good reliability (0.75–0.94). Results: Concerning construct validity, the CHQ correlated significantly with appropriate dimensions of the validation instruments. In general, there were significant correlations between the children's and parents’ responses. Comparisons between the diagnostic groups showed several significant differences. The short stature group had the highest quality of life and the JCA group the lowest. There were no sex differences, but children who had not reached puberty scored better on the dimensions of mental health and self‐esteem.

Conclusion: The Swedish version of the CHQ is a reliable and valid instrument. Furthermore, it is recommended to ask children themselves about their health‐related quality of life.
Complications of video‐assisted gastrostomy in children with malignancies or neurological diseases
Authors: Arnbjörnsson Einar , Backman Torbjörn , Mörse Helena , Berglund Yvonne , Kullendorff Carl Magnus , Lövkvist Håkan
Published: August 2010

Aim: To test the hypothesis whether the administration of cytostatic drugs close to surgery in children with malignancies influences the rate of postoperative complications. Method: Included in the study were 27 children with malignancies and a control group of 27 neurologically impaired children. All the children had nutritional problems and underwent a video‐assisted gastrostomy (VAG) operation during the period 1997–2002. The children were postoperatively followed up. All complications were documented according to a protocol by a specially trained nurse and correlated to the time elapsed from completion of the last preoperative or the first postoperative cytostatic drug treatment. The complications in the two groups were compared. Results: The children with malignant diseases did not have more postoperative complications of the VAG than those having neurological defects. There was no correlation to complications regarding timing of the operation and administration of cytostatic drugs.

Conclusion: This study revealed no aggravated influence of cytostatic drug treatment on early postoperative problems of VAG. The timing of cytostatic drug administration in relation to the surgical intervention did not influence the frequency of postoperative complications.
Asthma symptoms in early childhood – what happens then?
Authors: Goksör Emma , Åmark Mainor , Alm Bernt , Gustafsson Per M , Wennergren Göran
Published: August 2010

Aim: To study the outcome in early adulthood for children with early asthma symptoms and to analyse the factors associated with current asthma. Methods: In a prospective study, we have re‐investigated 89/101 children who were hospitalized before the age of two years due to wheezing. The children were investigated using a questionnaire and allergy and bronchial hyper‐responsiveness tests at the age of 17–20 years and compared with age‐matched controls. Results: In the cohort, 43% had had asthma symptoms in the preceding 12 months compared with 15% in the control group. The strongest risk factors for asthma were current allergy, bronchial hyper‐responsiveness and female gender. Female gender and passive smoking in infancy were independent infantile risk factors. In addition to female gender, two pathways led to current asthma: an allergic pathway from family atopy via the development of allergy and another pathway from early passive smoking via hyper‐responsiveness and active smoking.

Conclusion: In children with early wheezing disorder, current allergy, bronchial hyper‐responsiveness and female gender were the strongest risk factors for asthma in early adulthood, while female gender and passive smoking in infancy were independent infantile risk factors. The effects of early passive smoking persist longer than previously reported.
Endogenous ethanol fermentation in a child with short bowel syndrome
Authors: Jansson‐Nettelbladt Evelyn , Meurling Staffan , Petrini Björn , Sjölin Jan
Published: August 2010

The term “auto‐brewery syndrome” has been frequently used to describe patients who show features of alcohol intoxication because of abnormal yeast proliferation after ingesting carbohydrate‐rich meals. We present a case of a 3‐y‐old girl with short bowel syndrome (SBS) who demonstrated signs of alcohol intoxication on repeated occasions. A blood test indicated an ethanol concentration of 15 mmol/l, and cultures from gastric fluid and faeces showed the presence of Candida kefyr. An association was found between the introduction of a carbohydrate‐rich fruit drink and the occurrence of symptoms.

Conclusion: The possibility of endogenous ethanol fermentation should be considered in patients with SBS and the diagnosis of auto‐brewery syndrome added to the differential diagnosis list for D‐lactic acidosis. Management includes both antifungal treatment and special diet modification.
Infantile polyarteritis nodosa presenting as hyponatraemic hypertensive syndrome
Authors: Peco‐Antić Amira , Perišić Vojislav , Bonaći‐Nikolić Branka , Djukić Milan , Krušcić Divna , Kostić Mirjana
Published: August 2010

The association of arterial hypertension with hyponatraemic dehydration, known as hyponatraemic hypertensive syndrome (HHS), is a rare and serious hypertensive complication. Here, we describe a 17‐mo‐old girl who presented with severe hyponatraemic dehydration, hypokalaemia, polyuria, and nephrotic‐range proteinuria associated with malignant arterial hypertension and systemic inflammatory disease. Diagnosis of classic polyarteritis nodosa (c‐PAN) was made on the basis of renal arteriography demonstrating small arterial aneurysms in association with non‐aneurismal changes such as arterial cut‐off, arterial tapering stenosis and nephrogram perfusion defect. A decrease of blood pressure by antihypertensive treatment resulted in the normalization of HHS abnormalities. However, c‐PAN became well controlled only after 4 mo of immunosuppressive therapy.

Conclusion: The main interest of this case was the uncommon presentation of systemic polyarteritis nodosa in a very young child. Renal ischaemia from intrarenal vessel disease may have been the trigger event for HHS in our case. Management of PAN‐associated severe arterial hypertension is based on immunosuppressive and antihypertensive treatment.
Children's growth: A health indicator and a diagnostic tool
Authors: Gelander Lars
Published: August 2010

The publication of Werner and Bodin in Acta Paediatrica should inspire countries to use the growth of children as an indicator of health. The development of databases that cover all measurements of all children that have contact with healthcare and medical care will provide new knowledge in this area. Such databases will give us the opportunity to explore health in different areas of the country and to evaluate community projects in order to prevent obesity. Conclusion: Growth charts that are used to identify sick children or children that have other causes for growth disturbances must reflect how a healthy child should grow. If such prescriptive growth charts are computerized together with regional databases, they will provide necessary growth data for descriptive health surveys.
Infant feeding and cost of health care: A cohort study
Authors: Cattaneo Adriano , Ronfani Luca , Burmaz Tea , Quintero‐Romero Sofia , MacAluso Anna , Di Mario Simona
Published: August 2010

Aim: To compare the use and cost of health care in infants with different feeding patterns. Methods: Observational study on a cohort of 842 infants born in ten hospitals in northern Italy and followed up to age 12 months. Data on feeding gathered through telephone interviews with 24‐hour recall. Data on use of health services reported by mothers and checked against records. Data on hospital cost derived from Disease Related Groups codes. Data on cost of other services obtained from maternal reports and available price lists. Results: At three months, 56% of infants were fully breastfed, 17% complementary fed and 27% not breastfed. Infants fully breastfed at three months had 4.90 episodes of illness requiring ambulatory care and 0.10 hospital admissions per infant/year compared with 6.02 and 0.17, respectively, in infants not or not fully breastfed. They had also a lower cost of health care: €34.69 versus 54.59 per infant/year for ambulatory care, and €133.53 versus 254.03 per infant/year for hospital care. Higher cost of health care was significantly associated with having a hospital admission and being a twin; cost of health care decreased with each additional gram of birth weight, each month of delayed return of the mother to work after the third month, and each extra month of breastfeeding. Conclusion: Lack of breastfeeding and higher use and cost of health care are significantly associated.
Effects of hydroxyethyl starch on cardiac output in hypotensive neonates: A comparison with isotonic saline and 5% albumin
Authors: Michel Liet Jean , Kuster Alice , Denizot Sophie , Caillaux‐Varin Gaelle , Gras‐Leguen Christele , Rozé Jean‐Christophe
Published: August 2010

Aim: To evaluate the effects of hydroxyethyl starch (6% HES 200/0.5) on cardiac output in hypotensive neonates with low cardiac output and absence of myocardial dysfunction. Methods: In a prospective randomized blinded trial, 21 hypotensive neonates (mean gestational age of 29±3 wk) were randomly allocated to receive infusions of either 5% albumin (albumin group), isotonic saline (saline group) or hydroxyethyl starch (HES group). Infants had to show low cardiac output and an absence of myocardial dysfunction for inclusion in the study. Cardiac output was assessed by Doppler‐derived mean aortic flow velocity. Results: Ten minutes after infusion, 67% of all infants had more than a 10% increase in cardiac output. Increases in mean aortic flow velocity (m/s; median and range) were 0.05 (−0.02, +0.07), 0.03 (−0.03, +0.12) and 0.03 (−0.04, +0.11) for the albumin, saline and HES groups, respectively (p = 0.79). The percentage of blood pressure normalization (95% confidence interval) was 86% (60–100) in the albumin group, 57% (20–94) in the saline group and 71% (37–100) in the HES group (p = 0.50). Conclusion: This study did not provide evidence that hydroxyethyl starch is more efficient than isotonic saline or albumin.
Screening of obstructive and central apnoea/hypopnoea in children using variability: A preliminary study
Authors: Foo Jong Yong A. , Bradley Andrew P. , Wilson Stephen J. , Williams Gordon R. , Dakin Carolyn , Cooper David M.
Published: August 2010

Aim: Polysomnography (PSG) is the current standard protocol for sleep disordered breathing (SDB) investigation in children. Presently, there are limited reliable screening tests for both central (CE) and obstructive (OE) respiratory events. This study compared three indices, derived from pulse oximetry and electrocardiogram (ECG), with the PSG gold standard. These indices were heart rate (HR) variability, arterial blood oxygen de‐saturation (SaO2) and pulse transit time (PTT). Methods: 15 children (12 male) from routine PSG studies were recruited (aged 3–14 years). The characteristics of the three indices were based on known criteria for respiratory events (RPE). Their estimation singly and in combination was evaluated with simultaneous scored PSG recordings. Results: 215 RPE and 215 tidal breathing events were analysed. For OE, the obtained sensitivity was HR (0.703), SaO2 (0.047), PTT (0.750), considering all three indices (0) and either of the indices (0.828) while specificity was (0.891), (0.938), (0.922), (0.953) and (0.859) respectively. For CE, the sensitivity was HR (0.715), SaO2 (0.278), PTT (0.662), considering all indices (0.040) and either of the indices (0.868) while specificity was (0.815), (0.954), (0.901), (0.960) and (0.762) accordingly.

Conclusions: Preliminary findings herein suggest that the later combination of these non‐invasive indices to be a promising screening method of SDB in children.