bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of estrogen in pubertal skeletal physiology: epiphyseal maturation and mineralization of the skeleton
Authors: Frank GR
Published: January 2008

The year 1994 is likely to be remembered by many endocrinologists as the year in which dramatic new light was shed on the role played by estrogen in human skeletal physiology. It was in 1994 that two new syndromes were described, each representing a human model in which estrogen action was lacking. The first case was a female with an aromatase defect and a resultant inability to synthesize estrogen, and the second case was a man with an estrogen receptor gene defect that resulted in a non‐functioning estrogen receptor and complete estrogen resistance. By examining the phenotypes of these two individuals, we were able, for the first time, to see what pubertal skeletal changes occur in the absence of estrogen action and directly extrapolate the role of estrogen in skeletal physiology. What has become abundantly clear is that it is estrogen and not androgen that is responsible for pubertal epiphyseal maturation and skeletal mineralization
Normal stimulated growth hormone secretion but low peripheral levels of insulin‐like growth factor I in prepubertal children with insulin‐dependent diabetes mellitus
Authors: Tapanainen P , Käär M‐L , Leppäluoto J , Huttunen N‐P , Knip M
Published: January 2008

The hypothalamo‐pituitary‐insulin‐like growth factor I (IGF‐I) axis was studied in 24 prepubertal children with insulin‐dependent diabetes mellitus (IDDM) and 12 non‐diabetic children. There were no significant differences between the diabetic and control subjects in basal concentrations of immunoreactive growth hormone releasing hormone (ir‐GHRH), growth hormone (GH) or stimulated GH levels, but after exercise ir‐GHRH concentrations were higher in the diabetic children. Peripheral IGF‐I levels were significantly lower in the diabetic children, and even lower in those with poor metabolic control. A positive correlation was found between IGF‐I levels and circulating free insulin concentrations in the diabetic subjects (r = 0.49,p < 0.05). These observations suggest that the GH response to physiological stimulation is normal in prepubertal diabetic children. Exercise‐induced GH response may not be mediated by GHRH. IGF‐I levels were reduced in prepubertal children with IDDM and even more so in subjects with poor metabolic control. This may be a consequence of transitory hypoinsulineamia, emphasizing the importance of adequate insulinization to facilitate optimal growth in children and adolescents with IDDM.
Congenital adrenal hyperplasia due to 11 β‐hydroxylase deficiency in Saudi Arabia: clinical and biochemical characteristics
Authors: Al‐Jurayyan NAM
Published: January 2008

Over a 10‐year‐period, 78 Saudi children with congenital adrenal hyperplasia were seen at King Khalid University Hospital, Riyadh. Of these, 20 (25.6%) patients from 11 families were 11/3‐hydroxylase deficient. Their mean age was 2.8 years (range 0‐10 years). The clinical expression was somewhat severe; pseudoprecocious puberty in males and variable degrees of virilization in females which led to wrong sex assignment in seven (58.3%). Three patients had neonatal salt‐wasting before treatment. Moderate to severe hypertension associated with hypokalaemia was present in another six. In four siblings hypertension persisted inspite of adequate hydrocortisone therapy. It is concluded that congenital adrenal hyperplasia due to 11β‐hydroxylase deficiency is relatively frequent among the Saudi Arabian population. In view of the severity of the clinical expression and complications, physicians should be aware of the disease and have a high index of suspicion in order to detect and treat such patients early enough to avoid or minimize the unwanted sequelae.
Cholelithiasis in infants with Down syndrome: report of two cases
Authors: Aynaci FM , Erduran E , Mocan H , Ökten A , Sarpkaya AÖ
Published: January 2008

Down syndrome is a chromosomal disorder most often observed in the newborn period. Various facial, limb and internal abnormalities are found in this disorder but cholelithiasis in infancy has been described in only one report. We report two infants with Down syndrome associated with cholelithiasis. Except for polycythemia and indirect hyperbilirubinemia, no hemolytic process or biochemical abnormalities were evident in both patients. We believe that the cause of gallstones in our cases may have been polycythemia in the newborn period. To our knowledge this is only the second report of gallstones in infancy in Down syndrome.
Congenital chylothorax with hydrops: postnatal care and outcome following antenatal diagnosis
Authors: Mussat P , Dommergues M , Parat S , Mandelbrot L , Gamarra E de , Dumez Y , Moriette G
Published: January 2008

We consecutively managed 25 cases of fetal chylothorax with hydrops (pleuroamniotic shunting in 20/25 cases). Three of the 16 liveborn infants died before day 5 from malformations (n = 1) or complications of antenatal origin (n= 2). Eleven of the 13 survivors were treated in our unit. Four infants whose chylothorax had resolved before birth following antenatal shunting were delivered at term, and had no respiratory disease. Seven infants, whose chylothorax persisted, were delivered prematurely and required intensive respiratory care (with mechanical ventilation for a median duration of 34 days). The 11 infants were maintained on total parenteral nutrition for a median duration of 31 days. They were discharged home after complete clinical recovery at a median age of 64 days. Antenatal pleuroamniotic shunting may improve the prognosis of congenital chylothorax with hydrops. Chylothorax persisting at birth resolves progressively with medical management. Congenital chylothorax, critical care, non‐immunologic fetal hydrops, pleuroamnotic shunting, preterm newborn
An unusual cause of congenital ascites
Authors: Puvabanditsin S , Garrow E , Vizarra R
Published: January 2008

A newborn premature male with hydrops fetalis and massive congenital ascites is presented. The ascites recurred despite repeated paracenteses. The ascites was possibly due to a portal vein obstruction caused by malposition of the portal vein and malrotation of the small intestine. This is the first case report of congenital ascites associated with malposition of the portal vein. Anterior portal vein, asplenia, malrotation of the small intestine, neonate, non‐chylous ascites, portal hypertension
Selenium in German infants fed breast milk or different formulas
Authors: Jochum F , Fuchs A , Menzel H , Lombeck I
Published: January 2008

At birth and at 4 months of age, selenium (Se) values of 129 term infants on three different diets were determined: 50 infants were breast fed (HM), 44 received formula based on cow's milk (F) and 35 were fed “hypoallergenic formula” (PHF) (partially hydrolysed whey protein). The Se status of a group of twins (n = 12) fed “hypoallergenic formula” was compared with the respective group of singletons. All infants had low plasma Se values during early infancy. The plasma Se of breast‐fed infants remained stable (plasma Se 438 ng/ml at birth and at 4 months), whereas plasma glutathione peroxidase (GSH‐Px) decreased (birth: 10729 U/l; 4 months: 6211 U/l). The formula‐fed infants showed a reduction in plasma Se levels from birth to 4 months (3810 ng/ml and 299 ng/ml, respectively). The decrease was even more pronounced in infants fed the “hypoallergenic formula”. This group presented the lowest Se values (plasma Se 399 ng/ml at birth; 206 ng/ml at 4 months). Renal excretion of Se was found to be lower in the formula‐fed infants (F and PHF) compared with the HM group. There was a significant correlation between plasma and urinary Se (r = 0.62, p = 0.0001). Urinary Se ($uMg Se/g creatinine) appeared to be a good indicator of Se intake. Measurements of urine Se might be used as a screening method for the estimation of the Se supply. Weight and length increases in all infants were within the normal range. There were no differences between the different feeding groups.Glutathione peroxidase activity, human milk, infant formula, infant nutrition, screening method, selenium, selenium excretion, trace elements, twins

F Jochum, Department of Paediatrics, Heinrich‐Heine‐University, D‐40225 Dusseldorf, Moorenstrafie 5a, Geb 23.12.02, Germany
Prognostic factors in childhood bacterial meningitis
Authors: Kaaresen PI , Flaegstad T
Published: January 2008

The purpose of this study was to identify possible risk factors associated with a poor prognosis in childhood bacterial meningitis. We also analysed the influence of duration of symptoms and prehospital antibiotic therapy on outcome. Ninety‐two children aged 1 month to 13.8 years were included, of whom 4 died (4.3%) and 14 (15.2%) experienced permanent neurological sequelae. Hearing impairment was the most frequent sequela and was strongly associated with the length of history. Multiple logistic regression revealed duration of symptoms > 48 h, pre‐hospital seizures, peripheral vasoconstriction, < 1000 ± 106/1 leucocytes in cerebrospinal fluid and temperature38.0oC on admission as risk factors independently associated with later death or sequelae. There was no association between pre‐hospital oral or parenteral antibiotic therapy and outcome. These risk factors may be of value in selecting patients for more intensive therapy and in identifying possible candidates for new treatment strategies.Bacterial meningitis, childhood, multivariate analysis, outcome

PI Kaaresen, Department of Paediatrics, University Hospital, N‐9038 RiTo, Norway
Intermittent treatment with inhaled steroids for deterioration of asthma due to upper respiratory tract infections
Authors: Scedmyr J , Nyberg E , Åsbrink‐Nilsson E , Hedlin
Published: January 2008

Upper respiratory tract infection (URTI) is a common cause of deterioration of asthma in children. We investigated if inhaled steroids (budesonide), started early after URTI, could reduce asthma. Thirty‐one children, 3‐10 years of age, with deterioration during URTI participated. The study design was double‐blind, crossover and placebo‐controlled. Peak‐expiratory flow (PEF) and symptom scores were recorded. Four treatment periods of 9 days, two with budesonide and two with placebo, were planned. Treatment was started at the first sign of URTI. Budesonide/placebo was given by Turbuhaler at 0.2 mg qid for 3 days, tid for 3 and bid for the last 3 days. Twenty‐two children completed 67 periods. Eleven visited the emergency room, only three during budesonide therapy. Five received oral steroids and two where admitted to hospital, all receiving placebo. Symptom scores were not significantly lower during budesonide treatment. PEF, both morning and evening, was significantly higher during budesonide than placebo (p= 0.015 and p = 0.022). Inhaled budesonide can attenuate exacerbation of URTI‐induced asthma.Asthma, budesonide, infection, inhaled steroids, intermittent, prophylactic

J Svedmyr, Department of Paediatrics, Falu Hospital, S‐791 82 Falun, Sweden
Early growth is not increased in untreated moderately severe 21‐hydroxylase deficiency
Authors: Thilén A , Woods KA , Perry LA , Savage MO , Wedell A , Ritzén EM
Published: January 2008

The pretreatment growth of 1 British and 14 Swedish children with late (2‐7 years) diagnosis of 21‐hydroxylase deficiency (210HD) was studied. The latter group included all patients diagnosed in Sweden after 1986. Twelve had mutations of the 21‐hydroxylase gene that are generally associated with moderately severe (“simple virilizing”) forms of 210HD, one had a severe (“salt‐losing”) and one a mild (“non‐classical”) form. The British girl was followed from 4 months of age. She had grossly elevated levels of 17a‐hydroxyprogesterone, androstenedione and testosterone in blood, but her parents refused treatment until she was 4 years of age. None of the 15 children showed any significant increase in growth or progress of virilization until after 18 months of age. These observations indicate that growth during the first 1.5 years is not very sensitive to androgens. Thus glucocorticoid replacement during the first year of life should be kept to a minimum to avoid over‐treatment.Congenital adrenal hyperplasia, CYP21, genotype, growth, infancy

EM Ritzen, Pediatric Endocrinology Unit, Karolinska Hospital, S‐171 76 Stockholm, Sweden
Low levels of plasminogen in cerebrospinal fluid after intraventricular haemorrhage: a limiting factor for clot lysis?
Authors: Whitelaw A , Mowinckel M‐C , Abildgaard U
Published: January 2008

The aim of this study was to measure plasminogen in the cerebrospinal fluid (CSF) of control neonates with no infection or haemorrhage and in infants who had suffered intraventricular haemorrhage (IVH). A chromogenic substrate method was used. The 16 reference infants had a median CSF plasminogen level of 0.74% of that of normal adult plasma (range 0.17‐1.1%). The 11 infants with IVH had a median CSF plasminogen level of 0.55% of normal adult plasma (range 0‐4.4%). Six of the IVH infants went on to develop permanent hydrocephalus despite the use of intraventricular plasminogen activators. Endogenous fibrinolysis and the potential for fibrinolytic treatment in the CSF may be limited by low concentrations of plasminogen, and administration of recombinant plasminogen may assist attempts to clear intraventricular blood clots.Cerebrospinal fluid, hydrocephalus, intraventricular haemorrhage, newborn infant, plasminogen

A Whitelaw, Department of Paediatrics, Aker University Hospital, 0514 Oslo, Norway
CO2 rebreathing: a possible contributory factor to some cases of sudden infant death?
Authors: Skadberg BT , Oterhals Å , Finborud K , Markestad T
Published: January 2008

Physical and geometrical conditions influencing carbon dioxide (CO2) accumulation near the face of a sleeping infant positioned deep in a cot or pram (open cot shaft) or underneath bedding (closed cot shaft) were investigated. By means of mathematical and data‐based simulation, and an experimental rebreathing model, both hypothetical (dry, exhaled air + 20 oC, room temperature + 20 oC) and more physiological conditions (heated, humidified exhaled air, room temperature + 20 oC; with and without pooling of cold air within the shaft) were tested. With exhaled air at + 20 oC, the CO2 concentration increased to about 10% within 5 min. The increase was faster the smaller the volume, and the smaller the opening of the cot shaft. When expiratory air was heated, the CO2 concentration increased with the same speed as when the shaft was closed, but to only 0.1‐0.3% when the shaft was open. Pooling of cold air in the shaft increased CO2 accumulation 70‐200 times the concentration in air (to < 5.5%) when the shaft was open. Turbulence of the air outside the open shaft reduced the increase in CO2 concentration. The experiments imply that CO2 may accumulate around an infant's head when placed deep in a cot or pram with the bedding and walls creating a narrow, vertical, shaft‐like tunnel to the surrounding air. Although the CO2 concentration may theoretically attain dangerous levels in such circumstances, a rapid equilibrium between the air within and outside the cot usually occurs due to convection of the expiratory air and turbulence from drafts, the infant's body movements and breathing. Such factors will largely eliminate any significant rebreathing with the exception of the extreme situation when expired air is contained within a closed space.Environment, rebreathing, SIDS, suffocation
Combined treatment with enuresis alarm and desmopressin for nocturnal enuresis
Authors: Bradbury MG , Meadow SR
Published: January 2008

Seventy‐one children with nocturnal enuresis were enrolled in a controlled trial. The children were allocated to two matched groups. Children in both groups used an enuresis alarm until the end of treatment. Children in the first group were treated with 40/^g of intranasal desmopressin (Desmospray) for up to 6 weeks at the start of treatment with the alarm. During the observation period before treatment there were 2.3 dry nights per week in both groups. At the end of treatment there was a significant difference in the mean number of dry nights per week between the two groups (6.3 in the alarm and desmopressin group and 4.8 in the alarm group) and also in the number of children becoming reliably dry. The combination of desmopressin and alarm was particularly helpful for children with severe wetting and those with family and behavioural problems.Desmopressin, enuresis alarm, nocturnal enuresis

MG Bradbury, Department of Paediatrics and Child Health, St James's University Hospital, Leeds LS9 7TF, UK
Evolution of echocardiography in neonatal diagnosis
Authors: Stevenson JG
Published: January 2008

In the late 196, Edler and Lundström introduced “ultra sound cardio graphy” for the evaluation of congenital heart disease. Initial evaluations using A‐ and M‐mode echocardiography produced non‐invasive diagnosis of many defects, including specific complex malformations such as hypoplastic left heart, Ebstein's malformation, endocardial cushion defect and transposition, all with single crystal techniques. Normal values for dimensions related to patient size and indices of function developed at that time remain as components of contemporary examinations. Two‐dimensional imaging technology has evolved from 20 channels on Bom's linear array to 128‐channel systems currently providing detailed imaging of structures as small as neonatal coronary arteries. The contribution of Doppler techniques for qualitative evaluation of blood flow characteristics has been greatly augmented by both the quantitative Doppler methods for accurate assessment of pressure gradients and pulmonary pressure, and by the development of color Doppler display of intracardiac and intravascular flow. These contributions have come from centers worldwide, with many initial and ongoing contributions from Lund. The evolution of instrumentation, and of application, now provides neonatal echocardio‐graphic delineation of anatomic detail, function and hemodynamics of sufficient clarity and accuracy to replace the need for invasive study, or alternative technologies, in most cases.
Role of intraoperative transesophageal echocardiography during repair of congenital cardiac defects
Authors: Stevenson JG
Published: January 2008

Intraoperative epicardial echocardiography has been available for several years, and has been demonstrated to be very useful in intraoperative echocardiography. With the availability of small pediatric transesophageal (TEE) probes, it has become possible to perform intraoperative TEE in infants and children of all sizes. With advantages of serial assessment of anatomy, function and flow, and lack of interference in the operative field, TEE has become routine in many surgical centers. Our experience supports its routine use in nearly all patients undergoing repair of congenital heart disease. We generally use pediatric probes in patients less than 15 kg and adult size probes for those over 15 kg. Examinations are performed before and after bypass for use in surgical planning, anesthetic and homodynamic management, and in evaluation of repairs. In 44 of 667 (6.6%) cases, TEE findings prompted a return to by pass for further surgery or revision of surgery. In 75% of these patients, the problem identified by TEE was relieved, and patients had a good outcome. The benefit obtained by avoiding later reoperation in these patients has also proved cost‐effective, supporting the use of TEE on a routine basis. Complications have been few (24/667, 3.5%), without long‐termsequelae. They include failure to insert the TEE probe (1.2%), airway obstruction (0.9%), vascular compression (0.7%), tracheal extubation (0.6%) and gastric incision (0.1 %); several of these complications are now considered avoidable. Intraoperative TEE offers major advantages in intraoperative assessment and management of patients undergoing repair of congenital heart disease.
A postoperative follow‐up study of infantile coarctation of the aorta
Authors: Abdulla S , Malmgren N , Björkhem G , Lundström N‐R
Published: January 2008

Follow‐up investigations were performed in 16 patients operated on for coarctation during infancy The follow‐up period ranged from 4.5 to 11 years (median 5.5 years) Four different surgical techniques were used: resection with end‐to‐end anastomosis (REE) (4 patients), subclavian flap aortoplasty (SFA) (10 patients), patch aortoplasty (1 patient) and resection and SFA (1 patient) One patient developed reforestation (6%) She had been operated on by REE at 7 days of age The other three patients operated on by REE had equal pulses in the arms and legs; none had hypertension and all had normal arm/leg pressure gradients at rest Seven (58%) of the 12 patients operated on by SFA or aortoplasty had weak radial pulses in the left arm but no limitation of left arm function The left arm showed a normal bone age but was smaller and shorter than the right arm in 9 (81%) of the patients None of the patients operated on by SFA had hypertension and the arm/leg gradient at rest was normal.
Mechanisms of tissue injury by oxygen radicals: implications for neonatal disease
Authors: Saugstad OD
Published: January 2008

A role of the oxygen radical generating system hypoxanthine‐xanthine oxidase in hypoxia‐reoxygenation injury was proposed 15 years ago. In recent years, however, new understanding of hypoxia‐reoxygenation injury has been achieved and the significance of other oxygen radical generating systems has been acknowledged too. The hypothesis that an oxygen radical disease exists in preterm infants has recently been strengthened; an important observation is that preterm infants have lower activities of erythrocyte Cu/Zn superoxide dismutase compared to term babies. New actions of oxygen radicals have also been emphasized, and recently it has been demonstrated that the degree of protein oxidation of the lung of newborn infants is associated with chronic lung injury. The new insight into the interaction of oxygen radicals with other systems as excitatory amino acids and the NO system also increases the possibility to understand and hence prevent oxygen radical injury in the preterm infant as well as in adults exposed to an increased load of oxygen radicals.
Growth and pubertal development in patients with meningomyelocele: a retrospective analysis
Authors: Trollmann R , Dörr HG , Strehl E , Katalinic A , Beyer R , Wenzel D
Published: January 2008

Our retrospective analysis of growth and pubertal development includes 109 children and adults with meningomyelocele (MMC) (52 M, 57 F) aged 3.2‐21.0 years (median 8.9 years). Anthropometric data, growth‐retarding factors and data on pubertal development were analysed in comparison to the normal population using standards from Prader et al. (1). The results (mean ± SD) were as follows. Fifty patients (46.8%) had short stature (height SDS for chronological age (SDS CA)< ‐2). The supine length was influenced by the level of the lesion (height SDS CA: ≥ L2 ‐3.13 ± 1.62, ≤ S2 ‐0.46 ± 1.27), ambulatory status, skeletal deformities and pubertal stage. The mean adult height (n= 15, age 16.1–21.0 years) measured 141.3cm for women (height SDS CA ‐3.83 ± 1.79) and 159.2 cm for men (height SDS CA ‐2.27 ± 1.81). In 82.6% of the subjects (n= 90), arm spans were within the normal range. Reduced arm spans (SDS < ‐2) as found in 19 patients (17.4%) with short stature (mean height SDS CA ‐3.29 ± 1.29) may be caused by factors other than neurological lesions and skeletal deformities, and require further endocrinological studies. Out of 27 pubertal patients, central precocious puberty was diagnosed in five girls. The stages of puberty in MMC girls developed earlier than expected for the age‐related group.
Efficacy of antimicrobial treatment in non‐dysenteric persistent diarrhoea in a community setting
Authors: Bahl R , Bhandari N , Bhan MK , Saxena M , Bagati A
Published: January 2008

Objectives: To determine the efficacy of antimicrobial treatment in non‐dysenteric persistent diarrhoea in a community setting. Methods: In this double‐blind field trial, 156 children aged 4 36 months with persistent diarrhoea not associated with Giardia lamblia infestation seeking treatment in a community outpatient clinic, were randomized to receive a combination of nalidixic acid and metronidazole, metronidazole alone, or placebo for 7 days. Results: In comparison with placebo, metronidazole treatment did not result in a significant reduction in the mean post‐enrolment diarrhoeal duration and stool frequency, increase in the proportion of patients recovered by days 3, 5 and 7 of treatment, and increase in weight gain at days 7 and 14. Comparing the combination of nalidixic acid and metronidazole with metronidazole alone, 17.5% more children treated with the combination recovered by day 3 of treatment (p= 0.08) and the mean stool frequency ascertained on day 7 for the previous 24 h was 26.8% less in them (p= 0.05). The weight gains at days 7 and 14 were similar in the two groups. Conclusions: These findings indicate that metronidazole offers no therapeutic benefit in persistent diarrhoea not associated with Giardia lamblia and nalidixic acid has only a modest clinical benefit, which is not substantial enough to warrant its routine use.
Concentrations of magnesium and ionized calcium in umbilical cord blood in distressed term newborn infants with hypoxic‐ischemic encephalopathy
Authors: Ilves P , Blennow M , Kütt E , Mägi ML , Kudrjavtseva G , Lagercrantz H , Talvik T
Published: January 2008

Magnesium and ionized calcium in mixed umbilical cord blood was assessed colorimetrically in 38 distressed and 21 healthy term newborn infants. Distressed infants with a severe or moderate degree of hypoxic‐ischemic encephalopathy (HIE) (n= 8) had significantly lower (p < 0.001 (concentrations of magnesium (0.52 ± 0.08 mmol/L) compared to the control group (0.69 ± 0.06 mmol/L). No differences in concentrations of ionized calcium between distressed and control infants were detected.
Fathers can effectively achieve heat conservation in healthy newborn infants
Authors: Christensson K
Published: January 2008

The aim of the present study was to compare axillar and skin temperatures and metabolic adaptation in healthy, fullterm elective caesarean section delivered infants who were randomized to be cared‐for either in (a) an incubator, (b) a cot, or (c) skin‐to‐skin with the father. Forty‐four infants were studied. The mean axillary temperature increase was significantly greater in the skin‐to‐skin cared‐for infants than in the cot cared‐for group. There was no significant difference in mean temperature increase between skin‐to‐skin cared‐for and incubator cared‐for infants. Blood glucose increase was significant in the skin‐to‐skin group, but not in the other two groups. The catecholamine levels at 120 min after birth were all within normal range, and there were no differences between the three groups, suggesting that none of the groups was exposed to cold stress. Interestingly, at 24 h after birth the mean axillary temperature was significantly higher in the skin‐to‐skin group than in the incubator group. It can be concluded that fathers can effectively achieve heat conservation in healthy fullterm caesarean section delivered infants.
Long‐term follow‐up of indirect hyperbilirubinemia in full‐term Turkish infants
Authors: Özmert E , Erdem G , Topçu M , Yurdakök M , Tekinalp G , Genç D , Renda Y
Published: January 2008

Objective: This retrospective follow‐up study was performed to evaluate the suitability of the recently reported exchange transfusion limits (serum indirect bilirubin level of 428‐496 μmol/1, 25‐29 mg/dl) for Turkey. Material and methods: The study groups totalled 102 children, 8‐13 years of age, who had been born at term with birthweights greater than 3000 g and had been treated for indirect hyperbilirubinemia during their newborn period; the control group consisted of 27 children of the same age‐group without indirect hyperbilirubinemia. Children were grouped according to their maximum serum indirect bilirubin levels and direct Coombs’test results. Physical and neurological examinations, visual and brainstem auditory evoked potentials and the Wechsler Intelligence Scale for Children—Revised for Turkish Children were performed. Results: There was no difference between the groups with regard to mean visual and brainstem auditory evoked potential latencies. Children whose direct Coombs’tests were positive had significantly lower IQ scores and more prominent neurological abnormalities (p < 0.05). IQ scores and prominent neurological abnormalities did not differ among the other groups. Nine children had prominent neurological abnormalities associated with abnormal brainstem auditory evoked potentials. An important risk factor was the duration that the infant's serum indirect bilirubin level remained greater than 342 μmol/1 (20 mg/dl). Conclusion: The current limit of 342 μmol/1 should continue to be used for infants whose direct Coombs’tests are positive in our country. Until better criteria for exchange transfusion other than the indirect bilirubin level are established, the current limits should also still be followed for infants whose direct Coombs’tests are negative in Turkey, where regular neonatal follow‐up examinations are not satisfactory.
Catabolic effect in premature infants with early dexamethasone treatment
Authors: Tsai F‐J , Tsai C‐H , Wu S‐F , Liu Y‐H , Yeh T‐F
Published: January 2008

To evaluate the catabolic effects of dexamethasone therapy on protein metabolism, amino acid concentrations and urinary 3‐methylhistidine (3MH) were measured in 28 premature infants who were included in a double‐blind controlled study using early dexamethasone therapy in the prevention of bronchopulmonary dysplasia. Fifteen infants received dexamethasone (0.5mg/kg/day i.v.) and 13 infants received normal saline as control. Heparinized venous blood samples for amino acid analysis were obtained before the study and again at day 5 after starting the study. Urinary 3MH was measured on days 1, 3, 5, 7, 14, 21, and 28 of treatment. A substantial increase in amino acid concentrations was observed in infants receiving dexamethasone. Alanine, glutamine, citrulline, ornithine and cystine concentrations increased twofold or more. The 3MH:creatinine ratio was increased in the treated group. These metabolic effects were most likely due to an increase in protein catabolism.
Red blood cell indices and iron status according to feeding practices in infants and young children
Authors: Kim SK , Cheong WS , Jun YH , Choi JW , Son BK
Published: January 2008

With the electronic counters routinely used, it has become practical to determine the concentration of hemoglobin, red cell indices, and RDW concurrently in association with transferrin saturation and ferritin in accordance with feeding practices. The 1028 infants and children aged 6 to 24 months, who had been mainly admitted with acute infectious or inflammatory diseases, were divided into three groups, i.e., children who were exclusively breast‐fed more than 6 months (group A), those who had been given iron‐fortified formula milk since birth (group B), and those who had been given breast milk for 5–6 months and then switched to the iron‐fortified formula (group C). Children with anemia comprised 34.8% (104/299) of group A, significantly more than 5.6% (34/608) of group B and 6.6% (8,/121) of group C (p < 0.001, respectively). Children with MCV < 70 fl comprised 39.5% (118/299) of group A, significantly more than 7.1% (43/608) of group B and 13.2% (16/121) of group C. Out of the total 146 patients with anemia, 82.2% (n= 120) had laboratory evidence of iron deficiency, which was mostly suggested by a dietery history. The sensitivity of MCV values < 70 fl in IDA patients was 90.0%; specificity was 53.8%. The sensitivity of RDW values ≥ 15% was 83.3%; specificity was 57.7%. The positive predictive value could be increased to 97.8% by combining MCV < 70 fl and RDW ≥ 15%. The sensitivity of serum ferritin concentrations < 10ng/ml was 62.4% and specificity was 100%. The sensitivity of transferrin saturation < 12% was 72.3% and specificity was 81.3%. By combining the hemoglobin with MCV and RDW in screening for iron deficiency, the diagnostic accuracy of IDA can be increased. We support the use of appropriately iron‐fortified weaning foods or the routine iron supplement starting at 6 months of age in exclusively breast‐fed infants.
A field trial of wheat‐based oral rehydration solution among Afghan refugee children
Authors: Murphy HH , Bari A , Molla AM , Zaidi A , Hirschhorn N
Published: January 2008

A total of 326 Afghan children aged between 6 months and 5 years with uncomplicated nondysenteric diarrhea for the previous 24 h to 5 days were treated at home by their mothers with either wheat‐salt solution (WSS) or World Health Organization recommended glucose‐oral rehydration salts (G‐ORS). For 7 consecutive days the children were examined in the household and the mothers interviewed to assess the progress, feeding practices, and perception of treatment efficacy. Children treated with WSS recovered significantly earlier; the mean duration on treatment was 4.0 days (SD 1.7 days) on WSS compared to 6.4 days (SD 1.7 days) on G‐ORS. By the second day of treatment, significantly more mothers using WSS (56%) reported that their children had formed stools versus 11 % of their G‐ORS counterparts; the mean stool frequency after 2 days was also significantly reduced; 3 stools day−1 (SD 2.1) on WSS versus 5 (SD 2.9) on G‐ORS. The cereal‐based solution was not confused with normal food and led to better feeding patterns. By day 2, 74% of the mothers using WSS had resumed their normal feeding frequencies as opposed to 33% of G‐ORS mothers. On recovery the WSS group had gained significantly more weight; the WSS group gained 169 g (SD 142 g) while the G‐ORS group lost 150g (SD 174 g). This study suggests by subjective and objective measures that WSS could be considered as an effective home fluid for the first‐line treatment of diarrhea.
Decreasing admissions for childhood asthma to a Swedish county hospital
Authors: Strömberg L
Published: January 2008

Hospital admission rates for childhood asthma have increased in many countries. To study if this is also true for Norrköping Hospital, paediatric admission rates for asthma every fifth year were examined for the period 1973 to 1993. Admission rates were found to have fallen over the last 10 years, especially in children of school age. Among the younger age groups (below 5 years of age) a fall in admission rates was also observed over the last 5 years. This fall occurred in spite of reported increases in the prevalence of childhood asthma. The relative risk for admission due to asthma thus decreased from 1 in 1973 to 0.09 in 1993. The readmission rate has been stable. The mean length of stay in hospital for asthma decreased significantly. The observed decreasing trend in hospital admissions for childhood asthma is contrary to that found in many other countries. Possible explanations are discussed.
Amphetamine addiction during pregnancy: 14‐year follow‐up of growth and school performance
Authors: Cernerud L , Eriksson M , Jonsson B , Steneroth G , Zetterstrom R
Published: January 2008

Sixty‐five children born to women who all abused amphetamine during pregnancy have been followed prospectively since their birth in 1976‐77. At the age of 14‐15 years, information about growth and school achievement was collected from school records. For comparison of school achievements the means of schoolmates were used, and for growth a group of Stockholm children born in the same year. By the age of 14 years only 14 children (22%) had stayed with their biological mothers for the whole period since birth. In the eighth grade, 10 (15%) were one grade lower than indicated by their biological age. The norm for Sweden is less than 5%. The means of the points in mathematics, Swedish language and sports were statistically below those of their classmates. At the age of 10 years the girls were significantly shorter and lighter than their peers born in 1976. At the age of 14 years the boys were statistically taller and heavier than their peers. It can be concluded that maternal amphetamine abuse during pregnancy will influence children at least up to the age of 14–15 years even though many of them have been living in foster homes since a young age.
Phototherapy for neonatal jaundice*
Authors: Tan KL
Published: January 2008

Exchange transfusion for severe neonatal jaundice is a tedious and expensive procedure with high morbidity and mortality rates, and is followed by a prompt and marked bilirubin rebound. It has largely been replaced by phototherapy, which though more gradual in its effect results in a prolonged reduction of the bilirubin concentration. Its efficacy is influenced by the gestational age, birthweight and postnatal age of the infant, the aetiology of the jaundice, and the spectral emission and intensity (dose) of the light; its dose‐response relationship enables it, at the optimal dose, to control very severe jaundice or a rapidly rising bilirubin concentration, including severe haemolysis. Its relative freedom from complications together with its non‐invasive nature, ease of usage and convenience has resulted in widespread acceptance in virtually all neonatal units.
Relationship of interleukin‐8 and colony‐stimulating factors to neutrophil migration in aseptic meningitis
Authors: Yokoyama T , Oda M , Ogura S , Horiuchi T , Seino Y
Published: January 2008

Polymorphonuclear neutrophilic leucocyte (PMNL) migration into the subarachnoid space in aseptic meningitis of probable enteroviral aetiology was evaluated in relation to cerebrospinal fluid and serum levels of interleukin‐8 (IL‐8), macrophage colony‐stimulating factor (M‐CSF) and granulocyte colony‐stimulating factor (G‐CSF). IL‐8 levels reached a plateau within 12 h of onset, while M‐CSF and G‐CSF levels reached a peak between 12 and 24 h after onset, corresponding to the peak increase in PMNL count. G‐CSF levels had the closest correlation with PMNL count. M‐CSF levels were weakly correlated with PMNL count. IL‐8 levels were not correlated with PMNL count except within 12 h of onset. IL‐8 and G‐CSF were detected predominantly in cerebrospinal fluid, while the M‐CSF levels in the two compartments were not different except between 12 and 24 h after onset. It is considered that IL‐8 triggers rapid and transient migration of PMNL, and that G‐CSF then promotes gradual and consistent infiltration of PMNL.
Generation of hydroxytrimethyllysine from trimethyllysine limits the carnitine biosynthesis in premature infants
Authors: Melegh B , Hermann R , Bock I
Published: January 2008

ε‐N‐Trimethyl‐L‐lysine (TML) was given orally for 1 day to two groups of premature infants. There was no change in the output or plasma levels of carnitine at a dose of 100μmol/day; however, the urinary TML increased 17‐fold. In the second group, administration of 1 mmol TML increased the plasma levels and urinary output of carnitine; the output of TML increased 62‐fold. During a search of the metabolites of carnitine biosynthesis by 1H NMR analysis of urine, only one new resonance (corresponding to the TML) could be identified in both groups. Fast atom bombardment mass spectrometry (FAB‐MS) analysis of urine samples indicated an increase in TM L in the treated patients; no changes were found in the relative abundance of any other precursors. These data show that a significant limitation of the conversion of hydroxy‐TML to carnitine is not likely; rather, the conversion of TML to hydroxy‐TML is regulatory in neonatal carnitine biosynthesis.
The effect of carnitine supplementation in valproate‐induced hyperammonaemia
Authors: Böhles H , Sewell AC , Wenzel D
Published: January 2008

The aim of the study was to investigate the effect of carnitine supplementation in valproic acid (VPA) treated patients presenting with increased plasma ammonia concentrations. Plasma ammonia concentrations were recorded in 69 children and young adults on VPA monotherapy (25.6 ± 9.2 mg VPA/kg per day; mean plasma VPA concentration 68.8 ± 27.6 μg/1). Their mean plasma ammonia concentration was 80.2 ± 32.1 μg/dl (median 73.1/i,g/dl), A total of 24 patients (35.3%) presenting with ammonia concentrations >80 μg/dl were considered hyperammonaemic. Of these, 15/24 (22.1 %) showed ammonia concentrations > 100 μg/dl, even up to 194 μg/dl. In 48/69 patients, plasma carnitine concentrations could be determined. The plasma total carnitine (TC) concentrations were rather low (26.9 ± 8.8 μmol/l) compared to normal values obtained in our laboratory (40.9 ± 7.2 μmol/l). The percentage of free carnitine was considered decreased (<75% TC) in 13/48 samples (27%). Fourteen hyperammonaemic patients and one with a plasma ammonia level of 60 μg/dl agreed to be supplemented with L‐carnitine (1 g/m2 per day divided into two equal doses). Their plasma ammonia and carnitine concentrations were re‐evaluated after a mean of 9.1 ± 4.0 days (median 9.0 days) and in 9 patients again after a mean of 79.6 ± 30.1 days (median 75 days) of L‐carnitine supplementation. Plasma ammonia concentrations decreased in all 15 patients. The decrease was 25.4 ± 11.2% (median 28.3%) after a mean of 9.1 ± 4.0 days and amounted to 46.0 ± 17.2% (median 48%) after 79.6 ± 30.1 days. L‐Carnitine supplementation led to an increase in plasma free carnitine of 11.6 ± 13.0% (median 15.6%) and to a further increase of 11.1 ± 8.4% (median 11.5%) when re‐evaluated a second time. The plasma ammonia concentrations were significantly correlated with the percentage of free plasma carnitine (r=—0.67; p < 0.0001). The results show that carnitine supplementation is a means of normalizing elevated plasma ammonia concentrations. However, we cannot conclude from our results whether this lowers the risk of developing a VPA‐induced Reye's‐like syndrome.
Crying in separated and non‐separated newborns: sound spectrographic analysis
Authors: Michelsson K , Christensson K , Rothgänger H , Winberg J
Published: January 2008

During the first 1‐2 h after birth crying occurs during separation from the mother and stops on reunion. In rats, such “separation distress calls” have distinct phonetic properties. We examined this early crying by sound spectrography in 29 healthy, full‐term, vaginally delivered babies, randomly assigned either to be kept in a cot or to be placed in body contact with the mother during the 90 min following birth. The former babies cried almost 10 times more than the latter ones. The duration of the cry signal (the smallest element of a cry analysed by spectrography) in both groups was 0.8‐0.9s; the melody contour was flat or slightly rising‐falling with a fundamental frequency of around 500 hertz. The cry is provisionally characterized as a discomfort cry, elicited mainly by separation from the mother.
Infection with Ureaplasma urealyticum and Mycoplasma hominis and the development of chronic lung disease in preterm infants
Authors: Iles R , Lyon A , Ross P , McIntosh N
Published: January 2008

In a prospective cohort study in a tertiary referral neonatal intensive care unit, the endotracheal secretions of 40 consecutively intubated newborn infants, less than 31 weeks' gestation. were examined weekly for the genital mycoplasmas and all other common bacterial pathogens. Fifteen (37%) infants were positive for Ureaplasma urealyticum and/or Mycoplasma hominis. There were no differences in gestation, birthweight, use of surfactant, or time on ventilator between the culture‐positive and negative babies. Thirteen (87%) of the culture‐positive group developed chronic lung disease (CLD) compared with 11 (41%) of the negative group (p= 0.0196). Of those culture‐positive, 37% were not identified on the first specimen taken at the time of admission. These data suggest a significant association between infection with the urogenital mycoplasmas and CLD and also stress the need for repeated cultures to identify these organisms.
Current concepts and issues in the management of regurgitation of infants: a reappraisal
Authors: Vandenplas Y , Belli D , P‐H Benhamou , Cadranel S , Cezared JP , Cucchiara S , Dupont Chr , Faure Chr , Gottrand F , Hassall E , Heymans HSA , Kneepkens CMF , Sandhu BK.
Published: January 2008

Regurgitation in infants is a common problem. Recent issues, such as the increased risk of sudden infant death in the prone sleeping position, the finding of persisting occult gastro‐oesophageal reflux with feed thickeners, and the increasing awareness of the cost‐benefit ratio of medications may challenge the currently recommended management approach. A round table was organized to elaborate on the impact of (i) the pro supine sleeping campaigns in relation to sudden infant death and (ii) advancement in medical treatment on therapeutic strategies in regurgitating infants. The participants were opinion leaders from Europe and North America (Belgium, Canada, France, UK, Italy, Switzerland and The Netherlands). The importance of parental reassurance is stressed. As a consequence of the supine sleeping campaigns aiming to decrease the incidence of sudden infant death syndrome, the “prone elevated sleeping position” is no longer advised as a first‐line therapeutic approach, although it is still recommended in “complicated reflux”. It is emphasized that milk thickeners are an adequate therapeutic tool for regurgitation, but not in reflux disease. According to the literature, the efficacy of (alginate‐) antacids, although very popular in some countries, is questionable. These recommendations will be of interest to first‐line paediatricians, since about 40% of their patients, according to the literature, present because of regurgitation.
Mild mental retardation in schoolchildren in a Swedish suburban municipality: prevalence and diagnostic aspects
Authors: Fernell E
Published: January 2008

The prevalence of mild mental retardation (MMR) (IQ 50–72) was investigated in a Swedish suburban municipality with special demographic characteristics. The study population consisted of the 6397 children aged 9–15 years residing in the municipality on December 31, 1994. A total of 82 children fulfilled psychometric and adaptive criteria of MMR, corresponding to a prevalence of 12.8/1000. The prevalence was higher than that reported in previous Swedish and Finnish studies using similar case‐finding methods. This can probably be explained by the lower socioeconomic status in the municipality studied and by the fact that testing is now more acceptable. Nearly 90% of the MMR children had symptoms in their preschool years, mainly motor, speech/language deviations and a relative inability to perform certain tasks. These symptoms also occur in children with minimal brain dysfunction/deficits in attention, motor control and perception which should be taken into consideration when selecting screening tests.
Aldosterone cord levels in preterm newborn infants
Authors: Procianoy RS , Oliveira‐Filho EA de
Published: January 2008

We measured umbilical cord aldosterone concentrations in 64 premature newborn infants. The median serum aldosterone level was 74.5 ngdl‐1 (range 22‐280 ng dl‐1). Of the studied perinatal factors, only gestational age and birthweight presented a significant influence on the umbilical cord aldosterone levels. Newborn infants with a gestational age of over 34 weeks and a birthweight of over 2000 g had a significantly higher aldosterone cord level than those aged 34 weeks or younger and 2000 g or less in weight.
Growth velocity among preschool Ethiopian children
Authors: Alemu T , Lindtjørn B
Published: January 2008

We describe the height and weight velocities of 1529 preschool Ethiopian children from two rural and semi‐urban communities. Compared to international references, our results show a marked deficit in both height and weight velocities. Most importantly, these deficits occurred among the youngest children. As most of the children had normal body proportions, the weight velocity deficits are probably a consequence of increasing prevalence of stunting alone.