bluuebunny/crossref_metadata_2025 huggingface dataset:
A Prospective Incidence Study of Febrile Convulsions
Authors: FORSGREN L. , SIDENVALL R. , BLOMQUIST H. K:SON , HEIJBEL J.
Published: January 2008

ABSTRACT. A prospective epidemiological study of febrile convulsions (FC) was performed during a 20‐month period. 128 children with FCs were identified. The annual first attendance rate and annual incidence rate were 500/100 000 and 460/100 000 respectively, in the age group 0–4 years. The cumulative incidence was 4.1%. FCs were more common among boys, with a male to female ratio of 1.72 to 1. The median and mean age for first FC was for boys 16 and 19.9 months respectively, and for girls 18 and 19.7 months respectively. During an average follow‐up period of 20 months, 18% had another FC and 10% had two or more FCs. 8.6% had an initial complicated FC. Four children had FCs within two weeks after being vaccinated by combined vaccine against morbilli, rubella and parotitis. Three of these had earlier had an FC.
Prediction of Final Height in Turner's SyndromeA Comparative Study
Authors: NAERAA R. W. , EIKEN M. , LEGARTH E. G. , NIELSEN J.
Published: January 2008

ABSTRACT.Various methods are used for prediction of final height in girls with Turner's syndrome (TS), but their accuracy has not been systematically investigated or compared. We have compared predictions of final height made with the most commonly used methods in 20 Turner girls at ages 9.5–18 years. Growth standards based on growth and final height of 78 Danish Turner women were used for calculation of standard deviation scores (SDS). In order to provide the necessary basis for “index of potential height” (IPH) method, bone age development was determined from 74 X‐rays of 38 untreated Turner girls aged 5.2‐19 years. This method was further modified and improved for use in TS. Prediction methods based only on height and chronological age (CA) showed little difference from methods including bone age. The IPH method in our modification was more accurate than those of Bayley‐Pinneau and Tanner. At younger ages the IPH method showed better results when using Tanner‐Whitehouse 2 (TW2) bone age than when using Greulich‐Pyle bone age. Accuracy of predictions were considerably improved by combining methods with and without allowance for bone age. Combinations including the IPH method based on TW2 bone age appeared to be the most accurate. Predictions of final height in Turner's syndrome should therefore be made by combining the IPH method and one of the methods based on height and CA.
Neurologic Manifestations of Schönlein‐Henoch Purpura
Authors: ØSTERGAARD J. R. , STORM K.
Published: January 2008

ABSTRACT. The presence of a possible cerebral involvement in Schönlein‐Henoch Purpura was investigated in a prospective study comprising 26 children. A hampering headache accompanied by behavioural changes was present in 8 patients (31%). No cases of seizures, aphasia, ataxia, pareses or cerebral haemorrhage were found. EEG‐ahnormalities like slow wave foci, sharp waves, and paroxysms were demonstrated in 12 patients (46%) during the acute phase of the disease. The EEG‐changes were transient but persisted in 4 patients during a follow‐up period lasting one year. A significant association was found between the presence of headache and an abnormal EEG‐tracing.
Persistence of respiratory symptoms into the second year of life: predictive factors in infants born preterm
Authors: Yuksel B , Greenough A
Published: January 2008

Preterm infants frequently suffer from recurrent respiratory symptoms in the first year of life. Our aims were to assess if such respiratory morbidity persisted beyond the first year and to define the predictive factors. One hundred and seventeen infants (median gestational age 29 weeks) were followed prospectively for two years. Thirty‐eight infants had symptoms only in the first year (group A) and in a further 20 infants, symptoms were present in both years (group B). Comparison of these two groups revealed no significant difference in birth weight or gestational age, but the duration of ventilation and increased inspired oxygen concentration were significantly longer in group B. Significantly more infants in group B had had an air leak in the neonatal period, and airways resistance at six months of age was also significantly higher in group B. We conclude that infants with severe neonatal respiratory distress are likely to have persisting respiratory morbidity and that respiratory function measurements at six months of age provide the most accurate predictor of chronic respiratory symptoms.
A single pediatric center experience with 1025 children with hypertension
Authors: Wyszyńska T , Cichocka E , Wieteska‐Klimczak A , Jobs K , Januszewicz P
Published: January 2008

Between January 1982 and December 1989 1025 patients aged between one month and 18 years with increased blood pressure were referred for evaluation. Borderline hypertension was found in 389 children; 636 had sustained significant hypertension. In 351 patients, hypertension was secondary to a known disease. Renal parenchymal diseases were present in 68% of patients while renovascular and endocrine disorders were found in 10% and 11%, respectively. Of the 258 children aged less than 15 years, all but six children had known causes of hypertension, while 75% of adolescents had essential hypertension. In the 389 children with borderline hypertension, 65% developed fixed hypertension over a period of 2‐3 years.
Well‐being of children with chronic illness. A population‐based study in a Swedish primary care district
Authors: Westbom L
Published: January 2008

According to a previous study, 8% of all children in Dalby primary care district were chronically ill. The impact of the illness on the children's well‐being was investigated using parental questionnaires. No difference in socio‐demographic variables was found between responders (70%) and non‐responders. The study comprised 98 index and 168 control children. Comfort and well‐being in school and pre‐school were lower among the index than among the control children and lower among the index children in normal compared with special schools. According to the parents many teachers had insufficient knowledge of disorders/handicaps. Children with a physical disability more often had special remedial education compared with healthy children. The chronically ill children were bullied more often, had fewer contacts with peers and more emotional problems than the control group. Improved knowledge of chronic childhood disorders/disabilities and recognition of the psychosocial consequences at school/pre‐school and in the child health services is advocated.
Feeding during acute diarrhea as a risk factor for persistent diarrhea
Authors: Lanata CF , Black RE , Creed‐Kanashiro H , Lazo F , Gallardo ML , Verastegui H , Brown KH
Published: January 2008

Dietary intake during diarrhea in children less than three years of age was estimated from information recorded on illustrated dietary forms used by children's caretakers during the first week of illness in a prospective community‐based study of diarrheal diseases in Lima, Peru. The frequency of consumption and the amount consumed of food groups and selected commonly consumed foods were analyzed by the final duration of the diarrheal episode. Cereals were less frequently consumed during the acute phase of diarrheal episodes that ultimately became persistent (>14 days’duration), apparently shortening the duration of the episode by one day (median duration of four days in children not consuming vs three days in children consuming cereals during diarrhea, p<0.02 Kaplan‐Meier logrank test). Only roots and tubers (mainly potatoes) were consumed in greater quantity during episodes that became persistent. There was no evidence that consumption of breast milk or non‐maternal milk was associated with an alteration in diarrheal duration. This study provides further evidence of the beneficial effects of continuing feeding during diarrhea using foods available at the home level, especially cereals, which are commonly used in the diet of young children.
Role of cereal‐based oral rehydration therapy in persistent diarrhoea in children
Authors: Molla A Majid , Bari A
Published: January 2008

A total of 2000 children aged under five and 12,500 diarrhoea episodes were studied prospectively for assessing the efficacies of R‐ORS and G‐ORS and for comparing them with that of a comparison area using drugs for treatment. Efficacy was evaluated in terms of ORS use rate, consumption of ORS per episode, duration of diarrhoea and rate of recovery. The data were analysed to compare the rate of persistent diarrhoea in the three areas. Mean ORS consumption was 946 ± 576 and 1236 ± 766 ml per episode of watery diarrhoea in the R–ORS and G–ORS areas respectively. The mean durations of watery diarrhoea were 3.3 ± 2.1, 5.4 ± 3.5 and 8.8 ± 5.5 days in the R‐ORS, G‐ORS and comparison area, respectively. The median durations for dysentery were 7, 9 and 12 days in the three areas respectively. The incidences of persistent diarrhoea following watery diarrhoea were 0.4, 3 and 12% in the R‐ORS, G‐ORS and comparison area respectively, and, following dysentric episodes, 8, 18 and 40%. The results of the study suggest that R‐ORS can hasten recovery from both watery diarrhoea and dysenteries, thus reducing the incidence of persistent diarrhoea.
Is small bowel bacterial overgrowth of pathogenic significance in persistent diarrhea?
Authors: Bhatnagar Shinjini , Bhan Maharaj K , George Chechamma , Gupta Usha , Kumar Ramesh , Bright Densingh , Saini Savita
Published: January 2008

Bacterial overgrowth in the upper small intestine is postulated to cause persistent diarrhea. We compared the fecal and upper intestinal flora in 82 patients with persistent diarrhea aged 36 months and weight‐for‐length 90% of National Center for Health Statistics standards (NCHS) and 39 non‐diarrheal children with age 36 months, nutritionally matched with the patients and residing in the same environment. In the age groups 12 months and Ygt;12 months the duodenal fluid bacterial counts 105/ml were found with similar frequency in patients and controls for aerobic (p=0.33;p=0.1) and anaerobic (p=1.0;p=1.0) bacteria. However, the duodenal isolation rates of any aerobic bacteria (p<0.05) without regard to counts and Enterobacteriaceae (p= 0.06) were higher in patients than in controls. Colonization with Enterobacteriaceae was directly correlated with increased stool weight over a 7‐day observation period (p<0.05;p<0.01). One or more pathogens were isolated in the feces of 58% of the patients and 43.8% of the controls. Enteroadherent E. coli of the localized [EAEC‐L] (p<0.01) and aggregative [EAggEC] (p=0.22) phenotypes were isolated more commonly from the feces of patients. The duodenal fluid detection rates for Klebsiella were significantly greater (p<0.01) in patients, while Giardia lamblia was detected more commonly in the duodenal fluid of controls (p<0.01). The presence of specific pathogens in the feces did not seem to be related to the extent of small bowel colonization. Thus small bowel overgrowth with aerobes or anaerobes is common in malnourished children with or without diarrhea. However, specific pathogens such as EAEC‐L, EAggEC and Klebsiella may be associated with persistent diarrhea.
Determinants of dietary intake during childhood diarrhea and implications for appropriate nutritional therapy
Authors: Brown Kenneth H , Perez Fernando
Published: January 2008

Diarrheal diseases have a well recognized negative effect on children's growth, probably due in part to reduced dietary intake during illness. Previous studies have shown that the effects of diarrhea on dietary intake are greater among hospitalized children than among those observed in their homes. Breast milk intake does not change during diarrhea, however, so breast‐fed children are less likely to reduce their total energy and nutrient intakes. Recent analyses of clinical studies found that acidosis and dehydration were most closely associated with reduced dietary intake of hospitalized patients. The implications of these and other studies for the dietary management of patients during and after diarrhea are discussed.
Ambient light, ophthalmic artery blood flow velocities and retinopathy of prematurity
Authors: Baerts Willem , Blécourt‐Devilee Manon Wildervanck de , Sauer Pieter JJ
Published: January 2008

Exposure to bright light was recently proposed as a possible risk factor for the development of retinopathy of prematurity. A semi‐longitudinal Doppler ultrasound study was conducted of ophthalmic artery flow velocities at normal and increased ambient light in 22 preterm infants, at post‐menstrual ages from 28 to 37 weeks. The aim of this study was to obtain relationships between ophthalmic artery blood flow velocities at various post‐menstrual ages and lighting conditions and the occurrence of retinopathy of prematurity. A gradual increase in average blood flow velocities was seen between 28 and 37 weeks. A stepwise increase in flow velocity was seen in all cases when ambient light was increased from moderate to intense. Five of the 22 infants developed retinopathy. No association could be established between ophthalmic artery flow velocities or light‐induced changes in flow velocity and the occurrence of retinopathy.
Subcutaneous recombinant human erythropoietin in children with renal anemia on continuous ambulatory peritoneal dialysis
Authors: Aufricht C , Balzar E , Steger H , Lothaller MA , Frenzel K , Kohlhauser C , Kiss H , Khoss AE , Kernova T
Published: January 2008

Subcutaneous recombinant human erythropoietin (rHuEpo) treatment of renal anemia was performed in four boys and eight girls on CAPD, aged 0.8–12.5 (mean 7.4) years. In contrast to previous studies, our therapeutic goal was not set with a hematocrit of 30% but with full correction of anemia. Following a maximum weekly rHuEpo dosage of median 120 (range 100–240) IU/kg body weight, hcmatocrit increased in 10 children from 24 (14–29)%) within 12 (4–17) weeks to 40.1 (33.5–48.4)%. The weekly increase in hematocrit was 1.27 (0.5–3.1)%. The corrected reticulocyte count increased from I.3 (0.7–1.8)% to 2.3 (1.4–3.9)% within 4 (2–6) weeks. Eight childrcn fulfilled the protocol; six with an uncomplicated course were able to maintain a hematocrit of 37.1 (35.1–42.7)% with only one sc medication per week of approximately two‐thirds of their highest weekly rHuEpo dosage. No serious adverse effect of rHuEpo therapy was observed.
Cessation of smoking during pregnancy improves foetal growth and reduces infant morbidity in the neonatal period. A population‐based prospective study
Authors: Ahlsten G , Cnattingius S , Lindmark G
Published: January 2008

All pregnant women in Uppsala county in 1987 were questioned on three different occasions about smoking habits, socio‐demographic factors and obstetric history. After delivery, information was collected regarding their children. Twenty percent of the mothers continued to smoke during pregnancy, while 8% stopped smoking. The mean birth weight of infants of smokers was 3378 g and of non‐smokers 3589 g. The difference was significant (p < 0.001) and persisted after statistical adjustment for maternal age, parity and educational level. Perinatal morbidity (admission to the Department of Neonatology) was higher in thc smoking group (11.4% versus 8.8%, p < 0.05). The proportion of infants with a birth weight less than 2500 g and that of small‐for‐gestational‐age infants were 60% and 100% greater, respectively, in the smoking group. The mean birth weight and perinatal morbidity rate in infants of mothers who stopped smoking were almost identical to those in infants of non‐smokers. Cessation of smoking improves foetal growth and perinatal health.
Acute thrombocytopenic purpura following measles, mumps and rubella vaccination. A report on 23 patients
Authors: Nieminen U , Peltola H , Syrjälä MT , Mäkipernaa A , Kekomäki R
Published: January 2008

An acute thrombocytopenic purpura developed shortly after measles‐mumps‐rubella vaccination in 23 of approximately 700 000 children immunized over a period of seven years. The mean interval from inoculation to the onset of purpura was 19 days. Bone marrow aspirates obtained from 13 patients showed increased or normal amounts of megakaryocytes. Platelet survival time was markedly shortened in the two patients studied. Fifteen patients recovered (the platelet count exceeded 100 x 109/1) in one month, five in two months and two in six months. Increase in platelet‐associated immunoglobulin was detected in 10 of 15 patients. Circulating antiplatelet autoantibodies (AAb) against glycoprotein IIb/IIIa were detected in 5 of 15 patients. The findings are compatible with an autoimmune mechanism triggered by immune response to measles‐mumps‐rubella vaccination. As evaluated by the clinical course and the presence of AAb, post‐vaccination thrombocytopenic purpura appears to be indistinguishable from childhood acute idiopathic thrombocytopenic purpura.
Cardiac tamponade in a preterm neonate secondary to a chest tube
Authors: Quak JME , Szatmari A , Anker JN van den
Published: January 2008

In a preterm infant, chest tubes were inserted for treatment of bilateral pneumothoraces. Hemorrhagic pericardial effusion with cardiac tamponade developed, probably resulting from traumatic injury by the left chest tube. The infant survived due to timely diagnostic and therapeutic intervention. No recurrence of pericardial effusion was seen and follow‐up showed normal psychomotor development.
Myocardial infarction in a neonate with hereditary antithrombin III deficiency
Authors: Peeters Stefaan , Vandenplas Yvan , Jochmans Kristin , Bougatef Adel , Waele Marc De , Wolf Daniel De
Published: January 2008

We report the case of a newborn girl with antithrombin III deficiency type 1. The clinical features of a hypercoagulable condition that lead to this rare diagnosis differed from the reports in the literature, since the primary thromboembolic incident resulted in neonatal myocardial infarction, which is in itself a rare condition during the first days of life.
Effect of sustained inflations applied directly after cord clamping on lung function in premature newborn lambs
Authors: Klöpping‐Ketelaars WAA , Maertzdorf WJ , Blanco CE
Published: January 2008

We studied the possibility of improving lung volume and therefore clinical outcome in premature newborn lambs by increasing the inspiratory volumes during the first minute after birth. Sixteen lambs from eight were delivered by hysterotomy after 130–131 days' gestation. In eight lambs the lungs were inflated with a bag with a sustained inspiratory inflation (SI) of 5 s and expiratory time of 5 s during the first four inflations after cord clamping and then mechanically ventilated. Their siblings did not receive SI and served as a control group. At 8 h postnatally, the SI and control groups showed the following results (mean ± SEM): mean airway pressure 14.8 ± 1.8 cmH2O versus 11.9 ± 1.1 cmH2O, PaO2 41.5 ± 7.3 kPa versus 31.3 ± 7.7kPa, alveolar‐arterial oxygen gradient 359 ± 55 mmHg versus 437 ± 58 mmHg. Clinical course, incidence of pneumothorax, oxygenation index, total static compliance, parenchymal‐alveolar air area ratio or mortality rate were not different. There was no significant difference between the two groups at this time or at any other time during the experiments.
A comparative magnetic resonance imaging study of the corpus callosum in neurologically normal children and children with spastic diplegia
Authors: Iai M , Tanabe Y , Goto M , Sugita K , Niimi H
Published: January 2008

To determine the extent of brain damage in children with spastic diplegia, we analyzed the true midsagittal magnetic resonance imaging findings for the corpus callosum in 43 children with spastic diplegia and in 69 neurologically normal children. In the normal children, the thicknesses of the genu, midbody, splenium and the entire corpus callosum were found to increase with age, while the ratios of the thickness of the splenium and of the midbody to the length were constant, regardless of age. Both ratios were significantly reduced in diplegic children and the ratio for the splenium was highly correlated with the extent of motor impairment. Assessment of the morphometric changes in the corpus callosum using magnetic resonance imaging may contribute to the determination of the extent of brain damage in diplegic children.
Bone mineral density in the cortical and trabecular distal forearm in healthy children and adolescents
Authors: Gunnes M
Published: January 2008

Gunnes M. Bone mineral density in the cortical and trabecular distal forearm in healthy children and adolescents. Acta Pædiatr 1994;83:463–7. Stockholm. ISSN 0803–5253

Bone mineral density in cortical (BMDd) and trabecular parts (BMDud) of the distal forearm was studied in 494 healthy subjects ranging from 8 to 17 years with single photon absorptiometry. Mean BMDd was 6.8% higher (p < 0.0001) in boys than in girls in the < 11 years age group (n= 163). Mean BMDud was 8.2% higher (p < 0.0001) in boys than in girls in the adolescent age group (<11 years, n= 331). While BMDd increased from 11 years of age in girls and was delayed by 2 years in boys, BMDud increased from 10 years of age in boys and was delayed by 1 year in girls. By multiple regression analysis, age, weight and height were variably related to bone density depending on measuring site, sex and age. At 14 years of age, postmenarcheal girls had obtained BMDud values similar to those of an adult premenopausal group. Cortical bone density in girls was very close to corresponding BMDd values of the adult premenopausal group at 16 years of age. In conclusion, this cross‐sectional study indicates sex and age variability in forearm bone mineralization at trabecular and cortical sites. The substantial mineralization taking place between 11 and 16 years of age, with achievement of adult premenopausal bone density values, makes this 5–year period crucial for bone development.
Insulin‐resistant diabetes during growth hormone therapy in a child with SHORT syndrome
Authors: Verge CF , Donaghue KC , Williams PF , Cowell CT , Silink M
Published: January 2008

We report the case of a 13‐year‐old boy with SHORT syndrome, including lipoatrophy and insulin resistance, who developed diabetes mellitus while receiving growth hormone therapy. The diabetes persisted after cessation of exogenous growth hormone but oral hypoglycaemic therapy was successful and could be discontinued eight months later.
Clustering of risk factors for coronary heart disease in children and adolescents. The Cardiovascular Risk in Young Finns Study
Authors: Raitakari OT , Porkka KVK , Viikari JSA , Ronnemaa T , Akerblom HK
Published: January 2008

Clustering of selected coronary heart disease (CHD) risk factors was studied in a cohort of 3457 children and adolescents, aged 3–18 years. Subjects were defined as “high‐risk1 individuals if their values for serum LDL cholesterol, systolic blood pressure and obesity index (sum of biceps, triceps and subscapular skinfolds) exceeded the age‐ and gender‐specific 75th percentile of the present study cohort. Clustering was studied by using the observed/expected ratio (O/E ratio). Statistically significant clustering was observed as 3.1% of all subjects belonged to the high‐risk group (O/E ratio = 2.0, p < 0.001). Under the assumption of no association, only 1.56% would have been expected. Clustering was stronger in boys (3.6%) than in girls (2.6%). When other lipid variables (total cholesterol, HDL cholesterol, triglycerides) or obesity indices (subscapular, biceps, triceps skinfolds, the subscapularjtriceps ratio and BMI) were used in the analyses, the degree of clustering remained essentially the same. The tendency of risk factors to cluster increased with age in boys, whereas in girls the strongest clustering was usually seen in the age group 9–12 years. When a fourth risk factor (low HDL cholesterol) was added to the analyses, the tendency of risk factors to occur simultaneously became even greater. Aggregation of multiple risk factors was strongest in boys who presented the highest levels of these risk factors. Common risk factors for CHD cluster in children and adolescents. The gender differences observed here may partly explain why males develop CHD more often than females in adulthood. Evaluation of other risk factors, in addition to adverse serum lipids, may be used as an aid to identify children at high risk of CHD.
Effects of positive and negative pressure ventilation on cerebral blood volume of newborn infants
Authors: Palmer KS , Spencer SA , Wickramasinghe YABD , Wright T , Southall DP , Rolfe P
Published: January 2008

The effects of intermittent positive airway and continuous negative extrathoracic pressure ventilation on cerebral blood volume in preterm infants were studied using near infrared spectroscopy. In 12 infants continuous negative extrathoracic pressure caused a median decrease in cerebral blood volume of 0.14ml/100ml brain (95% confidence intervals (CI) 0.035–0.280) compared with no respiratory support. Oxygenated and deoxygenated haemoglobin also decreased, implying increased venous drainage as the main effect. In 17 infants intermittent positive pressure ventilation also caused a median reduction in cerebral blood volume of 0.06 ml/100 ml brain (95% CI 0.010–0.115) compared with endotracheal positive airway pressure. Deoxygenated haemoglobin increased by 0.07 ml/100 ml brain (95% CI 0.010–0.100) while oxygenated haemoglobin decreased by O.lOml/lOOml brain (95% CI 0.005–0.175). The increase in deoxygenated haemoglobin implies decreased venous drainage and the decrease in oxygenated haemoglobin implies that other factors may also be significant. Heart rate, blood pressure and oxygen saturation were monitored continuously and remained stable.
Prospective evaluation of Candida antigen and antibody assays for detection of Candida infections in children with malignant disease
Authors: Örmälä T , Korppi M , Katila M‐L , Ojanen T , Perkkiö M
Published: January 2008

The clinical efficacy of assays for Candida albicans antigens by latex agglutination and for antibodies by indirect haemagglutination were prospectively evaluated in the diagnosis of invasive Candida infections in 38 children suffering from acute leukaemia or other malignant disease. The controls were 74 other patients without any malignancy; 72 of these had no signs or symptoms of fungal infections, but 2 had an invasive C. albicans infection. During a period of 21 months, 302 serum samples were tested by both assays, and the results were compared with clinical and other microbiological data. Invasive fungal infection was diagnosed on clinical grounds in 2 of the immunocompromised children, and periodic gut colonization was demonstrated in 11 of 36 (31 %) children in this group. Positive Candida antigen was detected in 14 patients (37%) and a positive antibody titre in 7 patients (18%). Colonization was not correlated with antigen or antibody titre. Compared with the presence of invasive fungal infection, the antibody assay detected all four infections, whereas the antigen assay detected one of the two C. albicans septicaemias. Although the Candida antibody assay performed well, a detectable change in antibody titres appeared only slowly. Thus it was of no clinical help when antifungal treatment was to be considered. Follow‐up of antibody titres, however, gave confirmation of the presence of fungal infection as well as the response to antifungal treatment.
Contact allergy in relation to hand eczema and atopic diseases in north Norwegian schoolchildren
Authors: Dotterud LK , Falk ES
Published: January 2008

Dotterud LK, Falk ES. Contact allergy in relation to hand eczema and atopic diseases in north Norwegian schoolchildren. Acta Psediatr 1995;84:402–6. Stockholm. ISSN 0803–5253

Patch testing was carried out in 424 schoolchildren (223M, 201F), aged 7–12 years, in northern Norway. In 99 (23.3%) of these children, one or more allergic patch test reactions were demonstrated; 30 children reacted to two and 6 to three or more substances; 53 irritant reactions were recorded in 33 (7.8%) of those tested. From a total of 144 positive tests, the most common allergen was nickel (14.9%), followed by cobalt (5.7%), kathon CG (5.2%), lanolin (1.7%) and neomycin (1.4%). Both allergic and irritant reactions were found twice as frequently in girls as in boys. Positive patch tests were significantly more frequent in atopic (28.8%) than in non–atopic (17.9%) children, being most pronounced in atopic girls (37.4%). Hand eczema was reported to have occurred or to be present in 6.5% of cases. Twenty–nine of 36 children reporting hand eczema participated in the clinical examination. Altogether 15 (3.5%) children had hand eczema at the time of the clinical examination but 12 of these children had no previous history of hand eczema. In 14 of these 15 subjects, the eczema was localized to the back of the hands, with 13 having atopic dermatitis. In 4 of these 15 children, an allergic patch test reaction was found; however, in only 2 of these 4 was the test considered to be clinically relevant for the diagnosis allergic hand eczema. In conclusion, irritant hand eczema may occur in early childhood and is most prevalent in children with atopic dermatitis
von Willebrand factor‐collagen binding activity is increased in newborns and infants
Authors: Thomas KB , Sutor AH , Altinkaya N , Grohmann A , Zehenter A , Leititis JU
Published: January 2008

ABSTRACT. von Willebrand factor (vWF) antigen (vWF:Ag) and vWF‐collagen binding activity (vWF:CBA) were measured in plasma by parallel quantitative ELISAs in normal newborns and infants (n=71). The medians for vWF:Ag (IUjml) and vWF:CBA (Ujml), respectively, were 1.46 and 1.91 for 2‐7 day‐old (n= 43), 1.22 and 1.40 for 2‐4 week‐old (n= 14), 1.22 and 1.15 for 2‐6‐month‐old (n= 14) infants and 0.98 and 1.08 (n= 36) in normal adults. Elevated levels of vWF:Ag, but particularly vWF:CBA were seen for up to 4 weeks of life reaching adult levels between 2 and 6 months of life. The elevated levels of the vWF parameters indicate that caution should be exercised when interpreting laboratory data and diagnosing von Willebrand disease in newborns and young infants and warrant the use of age‐specific reference ranges. The efficient haemostasis observed during early neonatal life may in part be due to the increased ability of vWF to interact with collagen.
Postoperative pulmonary vascular supply in congenital heart disease evaluated with MR imaging at 0.3 T
Authors: Malmgren N , Brockstedt S , Johansson J , Björkhem G
Published: January 2008

The aim of this study was to investigate the usefulness of static spin‐echo MR imaging at low field strength in evaluating postoperative pulmonary arterial supply Twenty‐seven patients operated on for complex congenital heart disease underwent cardiac MR imaging: 27 stenoses in 20 patients and 4 aneurysms were present in the material Five patients had normal pulmonary arteries Twenty stenoses were detected on MR images Five of the overlooked stenoses were located in the ventricular outflow tract or in the valvular region All four aneurysms were well depicted The final diagnoses were based on two‐dimensional echocardiography, Doppler and invasive studies MR correctly evaluated the pulmonary arterial supply in 21 patients In two cases the evaluation was incomplete and in the remaining four patients MR failed to show the senses MR imaging at 0.3 T is an effective non‐invasive tool for postoperative evaluation of pulmonary arteries.
Acute haemorrhagic oedema of infancy, a benign variant of leucocytoclastic vasculitis
Authors: Krause I , Lazarov A , Rachmel A , Grunwald MM , Metzker A , Garty BZ , Halevy S , Nitzan M
Published: January 2008

Acute haemorrhagic oedema of infancy (AHEI) is an acute leucocytoclastic vasculitis affecting infants and young children. It has a striking appearance of large purpuric skin lesions in a target‐like pattern and marked oedema mainly on the face, auricles and extremities. In some patients there is mucosal involvement as well. We present five patients with skin lesions characteristic of AHEI with no visceral involvement and complete resolution within 7‐14 days. In three of our five cases, histopathological examination was performed, and demonstrated typical leucocytoclastic vasculitis. Although sometimes confused with Schönlein‐ Henoch purpura, we suggest that AHEI should be regarded as a separate entity. Clinical criteria for diagnosis are proposed.
Arginine vasopressin and renin in acutely ill children: implication for fluid therapy
Authors: Gerigk M , Gnehm HpE , Rascher W
Published: January 2008

The hypothesis was tested that in young children when admitted to the hospital for acute illness, vasoactive hormone levels are raised. The plasma concentration of arginine vasopressin (AVP) and plasma renin activity (PRA) were measured in 103 acutely ill infants and children admitted to the hospital. Compared to 31 control children with elective surgery, plasma AVP and PRA levels were significantly elevated and plasma osmolality reduced in acute illness, indicating non‐osmotic, cardiovascular AVP release. AVP and PRA elevations were found to be independent of the underlying diseases (e.g. respiratory infections, gastroenteritis, bacterial infections and the viral syndrome). Since cardiovascular AVP activation bears the risk of hyponatraemia in the case of hypotonic fluid therapy, initial fluid management should be performed with solutions containing half‐normal or normal saline in acutely ill children.
Urea production in normal breast‐fed infants measured with primed/intermittent oral doses of [15N,15N]urea
Authors: Steinbrecher HA , Griffiths DM , Jackson AA
Published: January 2008

Urea kinetics were measured on 11 occasions in six normal, breast‐fed infants aged 29‐88 days. Prime and intermittent oral doses of [15N,15N]urea with measurement of enrichment of urea in urine were used. The rate at which urea appeared in the urea pool was 265 mg N/kg per hour, 85% of which derived from endogenous production and 15% from the diet. Urinary excretion of urea was 87 mg N/kg per hour. Therefore, 60% of the urea entering the pool each day was hydrolysed by the metabolic activity of the colonic microflora and the nitrogen was made available for further metabolic interaction. The rate of urea appearance and the extent to which urea nitrogen was salvaged were greater in infants under 6 weeks than in those over 6 weeks, indicating that urea kinetics is a more active process at an early age, and slows with time. With respect to factors influencing urea kinetics, the apparently conflicting results which have appeared in the literature may be explained. The results may help explain the growth of breast‐fed infants on low protein intakes.
Dental enamel defects and screening for coeliac disease
Authors: Martelossi S , Zanatta E , Del Santo E , Clarich P , Radovich P , Ventura A
Published: January 2008

Specific dental enamel defects (DEDs) in permanent teeth are frequently observed in coeliac patients. We examined the permanent teeth in 6949 secondary school children living in Trieste (78% of 8724 children born between 1978 and 1982). Children with DEDs were tested for serum antigliadin antibodies (AGAs) and antiendomysium antibodies (AEAs), and those positive for serum AGAs and/or AEAs underwent intestinal biopsy. Specific DEDs were observed in 52 children (0.59% of the total population examined). Serum AGAs and/or AEAs were positive in 10 cases. Nine patients underwent intestinal biopsy (one refused) and in four cases a flat mucosa was documented (one with short stature, three completely asymptomatic). The known incidence of CD in the study area was 1:1000 before the study programme and 1:670 (an increase of 44%) after it. Dental enamel inspection may be utilized for detecting undiagnosed coeliac disease in symptom–free schoolchildren. This clinical test is probably less sensitive than serum AGA screening test, but deserves some consideration because it is cheap, easy to perform and well accepted by the population.
Serological screening (antigliadin and antiendomysium antibodies) for non‐overt coeliac disease in children of short stature
Authors: de Lecea A , Ribes‐Koninckx C , Polanco I , Calvete J Ferrer
Published: January 2008

This study aimed to assess the value of IgA‐antigliadin and antiendomysium antibodies for coeliac disease screening in children with short stature. In 118 children with height less than the 3rd percentile for age preliminary work‐up included absorption, hormonal and genetic studies, sweat test. X‐ray for bone age, serum immunoglobulin levels and antigliadin antibodies. In 65 patients antiendomysium antibody and a small‐intestinal biopsy were performed. Forty‐three children had a normal mucosa and 22 a subtotal villous atrophy. Three coeliac children were negative for both antigliadin and antiendomysium antibodies; one further 11‐year‐old boy was negative only for antiendomysium antibodies. Sensitivity and specificity for antigliadin antibodies were 94.75% and 93%, respectively, and for antiendomysium antibodies 88.3% and 90.5%. Our results show that the use of antiendomysium antibodies as a confirmatory test to select patients for biopsy could result in coeliac disease going undiagnosed in adolescents.
Body composition in appropriate and in small for gestational age infants
Authors: Lapillonne A , Braillon P , Claris O , Chatelain PG , Delmas PD , Salle BL
Published: January 2008

The body composition of 70 appropriate for gestational age newborn infants whose gestational age ranged from 32 to 41 weeks was determined by dual‐energy X‐ray absorptiometry during the first 48 h of life. The evolution of the bone mineral content, fat and lean mass was well correlated with gestational age (r= 0.66, r= 0.66 and r= 0.82. respectively) but even more closely with birthweight (r= 0.85, r= 0.91 and r= 0.97. respectively). The body composition of 20 symmetric small for gestational age infants (mean gestational age ± SD = 38.1 ± 1.2 weeks: mean birthweight ± SD = 2117 ± 183 g) was also studied. The total body fat, the lean mass and the bone mineral content of small for gestational age infants were decreased significantly in comparison with those of appropriate for gestational age infants with the same gestational age (p≤ 0.05, p≤ 0.0001 and p≤ 0.05) but was not significantly different from those observed in appropriate for gestational age infants of the same birthweight.
Diagnosis of hypoglycaemia: effects of blood sample handling and evaluation of a glucose photometer in the low glucose range
Authors: Elimam A , Horal M , Bergström M , Marcus C
Published: January 2008

Hypoglycaemia is a dangerous condition. Rapid and reliable blood glucose measurements are necessary for the initiation of treatment to reduce the risk of neurological sequelae. The aim of this study was to compare a bedside glucose photometer (HemoCue) with three methods of handling blood glucose measurements in a routine chemistry laboratory and to estimate the reliability of glucose measurements in the low glucose range during controlled hypoglycaemia. Nine children underwent an arginine‐insulin tolerance test as part of a growth hormone deficiency investigation. Only blood samples below 4.0mmoll‐1 were included (n= 35). Significant (0.3‐1.0mmoll‐1) differences in blood glucose measurements were found, depending on the handling of the blood sample. The differences seem primarily to be due to glycolysis which occurred in spite of the addition of the glycolysis inhibitor NaF to the blood samples. Immediate centrifugation and analysis of the supernatant or immediate analysis with the HemoCue results in higher, and presumably more correct, values than routine procedures and permits a more accurate diagnosis of hypoglycaemia.
High dose vitamin A supplementation in the course of pneumonia in Vietnamese children
Authors: Si NV , Grytter C. , Vy NNT , Hue NB , Pedersen FK
Published: January 2008

We carried out a randomized, placebo‐controlled, double‐blinded trial to evaluate the effect on morbidity of high dose oral vitamin A, given on hospital admission to 592 children aged 1–59 months with moderate and severe pneumonia. Severely underweight children were not included, but 45% were moderately underweight. The vitamin A and placebo groups were comparable in baseline characteristics. Four patients died. Among all of the surviving children, no differences were found regarding mean time for normalization of fever, respiratory rate and time of hospitalization. Stratification for moderate malnutrition, degree of pneumonia, age and sex revealed moderately malnourished vitamin A‐supplemented children to have a shorter time of hospitalization (p= 0. 04), due to an effect in females aged > 12 months (p= 0. 02) and females with very severe pneumonia (p= 0. 048). This study indicates that, in developing countries like Vietnam, supplementation with vitamin A in children with pneumonia could shorten the recovery rate in the ones that are undernourished, especially females > 1 y old.
Respiratory distress syndrome in infants with impaired intrauterine growth
Authors: Ley D. , Wide‐Swensson D. , Lindroth M. , Svenningsen N. , Marsal K.
Published: January 2008

The recently introduced intrauterine growth curve, based on ultrasonically estimated foetal weights, was retrospectively applied to an inborn population of 883 infants bom before 33 gestational weeks at the University Hospital of Lund, during 1985–94. The estimation of birthweight deviation resulted in 630 (71.3%) infants with a birthweight appropriate for gestational age (AGA), 244 (27.6%) infants with a birthweight small for gestational age (SGA) and 9(1.1%) infants with a birthweight large for gestational age. Birthweight deviation was associated with an increased mortality [odds ratio (OR) adjusted for gestational age 1.29 per SD (12%) change in birthweight for gestational age, 95% CI: 1.10–1.50; p= 0.002]. At gestational age 25–28 weeks, SGA‐infants had an increased incidence of respiratory distress syndrome (RDS) as compared to AGA‐infants (OR adjusted for gestational age: 1.98,95% CI: 1.12–3.52; p= 0.019). At gestational age 29–32 weeks, SGA‐infants had a lower incidence of RDS as compared to AGA‐infants (OR adjusted for gestational age: OR 0.52,95% CI: 0.34–0.80; p= 0.003). After adjustment for confounding variables, infants born at gestational age 25–28 weeks from mothers with pre‐eclampsia, appeared to be a high‐risk group for RDS, whereas at the age of 29–32 gestational weeks, negative birthweight deviation had a protective effect against RDS. Antenatal corticosteroid administration appeared to have a less beneficial effect on mortality, RDS and cerebral haemorrhage in infants born SGA vs in those born AGA.
Reproducibility of QuantiFERON-TB Gold In-Tube Assay
Authors: Perry Sharon , Sanchez Luz , Yang Shufang , Agarwal Zubin , Hurst Philip , Parsonnet Julie
Published: January 2008

Studies are needed to characterize the reproducibility of QuantiFERON-TB Gold (QFT-G) for targeted U.S. screening populations. Members of northern California households were tested with the QFT-G in-tube assay (QFT-G-IT) at two home visits 3 months apart. Reproducibility and agreement with the tuberculin skin test (TST) were assessed. Monte Carlo simulation was used to evaluate the role of test-related error. Of 63 individuals (49 adults and 14 children) completing QFT-G-IT at both time points, 79% were foreign-born (98% from Latin America) and 68% reported
Mycobacterium bovis
BCG vaccination. At the baseline visit, 23 (37%) were TST positive and 15 (24%) were QFT-G-IT positive (κ = 0.48 [± 0.11]). At 3 months, 3/48 (6.3%; 95% confidence interval [95CI], 2 to 17) of those initially QFT-G-IT negative converted, and 5/15 (33%; 95CI, 15 to 58) of those initially QFT-G-IT positive reverted. Among the 8 individuals with inconsistent QFT-G-IT results, the maximum gamma interferon response at either visit was 0.68 IU/ml versus means of 4.99 (± 3.74) and 6.95 (± 5.6) for 10 persistent positives at the first and second visits, respectively. Expected false-reversion and -conversion rates were 32% (90CI, 25 to 39%) and 6.95% (90CI, 4.6 to 9.8%) when the sensitivity and specificity were assumed to average 70% and 98%, respectively. Transient responses to QFT-G-IT are common, and low positive results need to be interpreted with caution. Further studies are needed to characterize the predictive value of the test for U.S. foreign-born and other targeted screening populations.
Rational Combination of Peptides Derived from Different
Mycobacterium leprae
Proteins Improves Sensitivity for Immunodiagnosis of
M. leprae
Infection
Authors: Geluk Annemieke , van der Ploeg Jolien , Teles Rose O. B. , Franken Kees L. M. C. , Prins Corine , Drijfhout Jan Wouter , Sarno Euzenir N. , Sampaio Elizabeth P. , Ottenhoff Tom H. M.
Published: January 2008

The stable incidence of new leprosy cases suggests that transmission of infection is continuing despite the worldwide implementation of multidrug therapy programs. Highly specific tools are required to accurately diagnose asymptomatic and early stage
Mycobacterium leprae
infections which are the likely sources of transmission and cannot be identified by using the detection of antibodies against phenolic glycolipid I. One of the hurdles hampering T-cell-based diagnostic tests is that
M. leprae
antigens cross-react at the T-cell level with antigens present in other mycobacteria, like
M. tuberculosis
or
M. bovis
bacillus Calmette-Guerin (BCG). Using comparative genomics, we previously identified five candidate proteins highly restricted to
M. leprae
which showed promising features with respect to application in leprosy diagnostics. However, despite the lack of overall sequence homology, the use of recombinant proteins includes the risk of detecting T-cell responses that are cross-reactive with other antigens. To improve the diagnostic potential of these
M. leprae
sequences, we used 50 synthetic peptides spanning the sequences of all five proteins for the induction of T-cell responses (gamma interferon) in leprosy patients, healthy household contacts (HHC) of leprosy patients, and healthy controls in Brazil, as well as in tuberculosis patients, BCG vaccinees, and healthy subjects from an area of nonendemicity. Using the combined T-cell responses toward four of these peptides, all paucibacillary patients and 13 out of 14 HHC were detected without compromising specificity. The peptides contain HLA binding motifs for various HLA class I and II alleles, thereby meeting an important requirement for the applicability of diagnostic tools in genetically diverse populations. Thus, this study provides the first evidence for the possibility of immunodiagnostics for leprosy based on mixtures of peptides recognized in the context of different HLA alleles.
Increasing Prevalence of Toxin A-Negative, Toxin B-Positive Isolates of
Clostridium difficile
in Korea: Impact on Laboratory Diagnosis
Authors: Kim Heejung , Riley Thomas V. , Kim Myungsook , Kim Chang Ki , Yong Dongeun , Lee Kyungwon , Chong Yunsop , Park Jong-Woo
Published: January 2008

Of 462 Korean
Clostridium difficile
isolates, 77.5% were toxin B positive but 21.4% were toxin A negative (A
−
B
+
). The binary toxin gene was detected in nine isolates. A higher fluoroquinolone resistance of A
−
B
+
strains may contribute to the increase of these strains. Toxin A detection alone may underdiagnose
C. difficile
-associated disease.