bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Helicobacter pylori eradication on platelet recovery in children with chronic idiopathic thrombocytopenic purpura
Authors: Jaing T‐H , Yang C‐P , Hung I‐J , Chiu C‐H , Chang K‐W
Published: August 2010

Aim: Little is known about the influence of environmental factors on the epidemiology of idiopathic thrombocytopenic purpura (ITP). The role of Helicobacter pylori infection in relation to the development and/or persistence of ITP in infected patients remains controversial. Therapy used for eradicating H. pylori has led to a rise in platelet counts in a significant number of adult patients, but few paediatric studies have been undertaken to evaluate such treatment. The aim of this prospective study was to determine the prevalence of H. pylori and to evaluate whether H. pylori eradication can induce chronic ITP regression in children. Methods: To investigate new, non‐invasive techniques for diagnosis of H. pylori infection, an enzyme immunoassay for H. pylori antigens in faeces (HpSA) was evaluated. Patient eligibility criteria included isolated thrombocytopenia (±50 ± 109 L−1) for more than 6 months without any identifiable cause and either normal or increased marrow megakaryocytes. H. pylori status was monitored before eradication and 4, 12, and 24 mo, after the end of treatment using Premier Platinum HpSA. Results: In this study we evaluated 22 chronic ITP patients, 9 of whom were infected with H. pylori. Using repeated HpSA testing, we demonstrated for eradication of H. pylori after treatment in all infected patients. Five of the nine patients had increased platelet counts that persisted throughout the follow‐up period.

Conclusion: These results should stimulate additional research into the involvement of H. pylori infection in chronic ITP in childhood. This approach may offer an accepted algorithm at least for some of these patients.
Decreased immune response to hepatitis B eight years after routine vaccination in Israel
Authors: Gold Y , Somech R , Mandel D , Peled Y , Reif S
Published: August 2010

Background and Aim: Although immunization of infants against hepatitis B virus (HBV) is the most effective way to prevent infection, duration of the afforded protection is unknown. Titers of anti‐HBV antibodies decline with time, especially during the first few years after vaccination. Anti‐HBV antibody levels were measured in the serum of vaccinated children in order to determine the duration of the response afforded by the primary course of HBV vaccine. Methods: The immunity derived from the HBV vaccine was assessed by measuring antibody levels in 122 healthy children who were vaccinated in a routine vaccination program in Israel. Results: Ninety‐four children (77.1%) had detectable antibodies levels (HBsAb titer >10mIU/ml): 59 (48.4%) of the children had high antibodies levels (HBsAb titer MOO mIU/ml). Twenty‐eight children (22.9%) had undetectable antibodies levels (HBsAb titer <10mIU/ml). When the children were divided into three groups according to the time elapsed since vaccination, it was found that the antibody levels declined with time (p < 0.009). Most of the children with undetectable antibody levels belonged to the 5 to 8‐y post‐vaccination group (36.1% vs 20% and 14.6% for the 2.5 to 5‐y and 1 to 2.5‐y groups, respectively, p < 0.01). The mean HBsAb declined in relation to the length of time post‐vaccination (226.9 ± 248.2 mIU/ml for 1–2.5 y post‐vaccination, 199.0 ± 235.7 mIU/ml for 2.5‐5 y and 90.4 ± 138.5 for 5–8 y, p < 0.05). No correlation was found between HBsAb titers and gestational age, birthweight and parental origin, although females generated higher mean antibody levels than males (207.3 ± 217 mIU/ml vs 141.9 ± 218.9 mIU/ml, p < 0.05).

Conclusion: Our data demonstrate a steady decline in anti‐HBV titers over time after routine vaccination against HBV in Israel. The most significant decline occurred 5–8 y post‐vaccination.
Hand, foot and mouth disease in Singapore: a comparison of fatal and non‐fatal cases
Authors: Chong C‐Y , Chan K‐P , Shah VA , Ng WYM , Lau G , Teo TE‐S , Lai S‐H , Ling A‐E
Published: August 2010

Aim: An epidemic of hand, foot and mouth disease (HFMD) occurred in Singapore between September and November 2000. During the epidemic, there were four HFMD‐related deaths and after the epidemic, another three HFMD‐related deaths. This study sought to determine the risk factors predictive of death from HFMD disease. Methods: The risk factors for fatal HFMD were determined by comparing clinical and laboratory findings between fatal cases (n= 7) and non‐fatal controls (n= 131) admitted between September 2000 and April 2001. Enterovirus 71 positive fatal cases (n= 4) and non‐fatal controls (n= 63) were also compared. Results: In total, 138 HFMD cases with a mean age of 32 mo were studied. The majority of fatal cases died from interstitial pneumonitis, of whom three also had brainstem encephalitis. Of the 131 non‐fatal cases, 3 had concomitant infections (respiratory syncytial virus bronchiolitis, right‐sided pneumonia, Haemo‐philus influenzae type b meningitis), 2 had aseptic meningitis, and 1 each had transient drowsiness, intravenous immunoglobulin‐related complications and transverse myelitis. By multivariate logistic regression analysis, atypical physical findings (p= 0.0006), raised total white cell count (p= 0.0128), vomiting (p= 0.0116) and absence of mouth ulcers (p= 0.043) were predictive of a fatal course. Although previous epidemics have described neurogenic pulmonary oedema as the main cause of death, the fatal cases in this study died mainly from interstitial pneumonitis alone or with myocarditis or encephalitis.

Conclusion: Although HFMD is generally a benign disease, risk factors such as vomiting, absence of mouth ulcers, atypical presentation and raised total white cell count should alert the physician of a fatal course of illness.
Microbiological factors associated with neonatal necrotizing enterocolitis: protective effect of early antibiotic treatment
Authors: Krediet TG , van Lelyveld N , Vijlbrief DC , Brouwers HAA , Kramer WLM , Fleer A , Gerards LJ
Published: August 2010

Aim: The incidence of necrotizing enterocolitis (NEC) strongly increased in an neonatal intensive care unit (NICU) in 1997 and 1998 compared with previous years, which coincided with increased incidence of nosocomial sepsis. Specific risk factors related to this NICU and a possible relationship between NEC and nosocomial sepsis were studied retrospectively, including all patients with NEC since 1990 and matched controls. Methods: Clinical and bacteriological data from the period before the development of NEC and a similar period for the controls were collected retrospectively and corrected for birthweight and gestational age. Statistical analysis was performed by a stepwise regression model. Results: Data of 104 neonates with NEC and matched controls were analysed. The median day of onset of NEC was 12 d (range 1–63 d). Significant risk factors for NEC were: insertion of a peripheral artery catheter [odds ratio (OR) 2.3, 95% confidence interval (95% CI) 1.3‐3.9] and a central venous catheter (OR 5.6, 95% CI 3.1‐10.1), colonization with Klebsiella sp. (OR 3.4, 95% CI 1.5‐7.5) and Escherichia coli (OR 2.1, 95% CI 1.CM1.5), and the occurrence of sepsis, in particular due to coagulase‐negative staphylococci (OR 2.6, 95% CI 1.4‐5.1). The risk for NEC was decreased after the early use (<48h after birth) of amoxicillin‐clavulanate and gentamicin (OR 0.3, 95% CI 0.2‐0.6).

Conclusion: Insertion of central venous and peripheral arterial catheters is positively associated with NEC, as is colonization with the Gram‐negative bacilli Klebsiella and E. coli and the occurrence of sepsis, particularly due to coagulase‐negative staphylococci. Early treatment with amoxicillin‐clavulanate and gentamicin is negatively associated with NEC and may be protective against NEC.
Clinical and pathological characteristics of cystic lesions of extrahepatic bile duct in neonates
Authors: Jiexiong F , Minju L , Hongfeng T , Weizhong G , Shaoyong Y
Published: August 2010

Aim: To investigate the differences in clinical and pathological manifestations between biliary atresia with extrahepatic biliary cyst and choledochal cyst in neonates. Methods: Symptoms and clinical signs in 5 neonates with biliary atresia with extrahepatic biliary cyst (4 of type I and 1 of type III) and 17 neonates with choledochal cyst were recorded. The levels of serum alkaline phosphatase, bilirubin, direct bilirubin, transaminase, gamma‐glutamyl transpeptidase were analysed. Width and length of gallbladder and choledochal cyst were measured on B‐mode ultrasound before surgery. Intrahepatic or extrahepatic biliary ducts were visualized with intraoperative cholangiography. The pathologic features in specimens of the liver were studied with light‐ and electron transmission microscopy. Results: All malformations occurred more commonly in girls, and obstructive jaundice was the main manifestation in both groups. Laboratory tests showed similar results for all patients in this study. With regard to pathological features, no significant difference was seen in either light microscopy or transmission electron microscopy, but it was shown with ultrasound that the length and width of the cysts and the gallbladder in neonates with biliary atresia were all shorter than the measurements in patients with choledochal cyst. The intrahepatic bile ducts could not be visualized on intraoperative cholangiography in type III biliary atresia. Deformation of the biliary ducts within the liver and stricture of the portal bile duct were the predominant features in type I biliary atresia, while the bile duct within the liver was normal or dilated in neonates with choledochal cyst.

Conclusions: Cystic lesions of the extrahepatic bile duct might be a common manifestation of biliary atresia and choledochal cyst. Intraoperative cholangiography is a precise and effective technique in the differential diagnosis of those lesions and helps decide on the most rational method of treatment.
Safety in road crossing of children with cerebral palsy
Authors: te Velde AF , Savelsbergh GJP , Barela JA , van der Kamp J
Published: August 2010

Aim: Children with cerebral palsy (CP) are regularly confronted with physical constraints during locomotion. Because abnormalities in motor control are often related to perceptual deficits, the aim of this study was to find out whether children with CP were able to walk across a road as safely as their non‐handicapped peers. Method: Ten children with CP and 10 non‐handicapped children aged 4–14 y were asked to cross a simulated road if they felt the situation was safe. Results: With respect to safety and accuracy of crossings, the behaviour of children with CP was comparable with that of non‐handicapped children. However, a closer examination of children's individual crossing behaviour showed considerable differences within the CP group. In contrast to children with damage to the left hemisphere, children with damage to the right hemisphere made unsafe decisions and did not compensate for them by increasing walking speed.

Conclusion: The differences in unsafe behaviour and in the ability to compensate for it within the group of children with CP might be related to damage to specific regions of the brain that are involved in the processing of spatial or temporal information.
Upper endoscopic findings in children with active juvenile chronic arthritis
Authors: Ashorn M , Verronen P , Ruuska T , Huhtala H
Published: August 2010

Aim: To investigate the association between gastroduodenal mucosal damage and symptoms of the digestive tract in children with juvenile chronic arthritis (JCA) Methods: This was a prospective, open, non‐randomized study. Gastroscopy was performed on 45 children with active JCA in 1996–2000. Gastrointestinal symptoms before and during the treatment were noted, as was the length of antirheumatic medication, for which the data were retrospectively assessed. Plasma haemoglobin (Hb) and mean corpuscular volume (MCV) levels and erythrocyte sedimentation rate (ESR) were analysed. Mucosal biopsies were obtained for histology and Helicobacter pylori culture. All patients were taking non‐steroidal anti‐inflammatory drugs (NSAIDs) and 11 (24.4%) were on peroral steroids; 16 (35.6%) were receiving hydorxychloroquine, 9 salazopyrine, 5 myocrisine and 14 methotrexate. Results: Seven children (15.6%) were found to have active inflammation in their gastric and/or duodenal mucosa, two having ulcers and two being infected with H. pylori. Abnormal endoscopic findings were more common in symptomatic children (n= 24) than in children without symptoms (n= 21) (75% vs 38%, p= 0.017). There was no clear association between the Hb or MCV level and the degree of gastroduodenal inflammation (p= 0.98 and 0.7, respectively). Significantly more children (66.6% vs 33.3%) experienced abdominal pain after beginning medical therapy than before therapy (p= 0.02).

Conclusion: Endoscopic evaluation of patients with JCA and receiving NSAIDs should be considered at least in symptomatic cases.
Acute intermittent porphyria in childhood: a population‐based study
Authors: Hultdin J , Schmauch A , Wikberg A , Dahlquist G , Andersson C
Published: August 2010

Aim: To establish age‐adjusted reference intervals of urinary δ‐aminolaevulinic acid (U‐ALA) and porphobilinogen (U‐PBG) in children, and to analyse the frequency and type of clinical manifestations of acute intermittent porphyria (AIP) in childhood. Methods: Concentrations of U‐ALA and U‐PBG in healthy children aged 3–16 y were analysed. In a population‐based study in northern Sweden of 61 children aged >18 y with DNA‐verified AIP, the clinical manifestations of AIP in childhood were analysed prospectively (up to 2.5 y). Initially the children underwent a standardized investigation (anamnesis, physical examination, laboratory tests). Instructions were issued to keep a structured diary and to provide urine samples for ALA and PBG analyses in all situations of suspected AIP attacks (prospectively). Results: Reference intervals for U‐ALA and U‐PBG showed age‐group variations in children. Baseline levels of U‐ALA and U‐PBG are increased in gene carriers, one‐quarter of them exceeding the 90th percentile of age‐ and gender‐matched controls. Baseline levels did not distinguish symptomatic from non‐symptomatic children in a short‐term perspective. Clinical evidence of AIP attacks was found in 10% of child AIP gene carriers; in all cases the first attack occurred before the age of 15 y.

Conclusion: AIP symptoms in children may be vague and of short duration and U‐ALA and U‐PBG levels are often elevated only slightly or not at all; thus, symptoms and signs may differ from those in adults. Children of AIP gene carriers should be DNA tested, followed up and carefully instructed on preventive measures to avoid developing manifest AIP.
Difference in plasma bilirubin concentration between monozygotic and dizygotic newborn twins
Authors: Ebbesen F , Mortensen BB
Published: August 2010

Aim: To investigate whether inherited factors, other than those already known, influence the bilirubin concentration in neonates of northern European descent, by comparison of monozygotic and dizygotic twins with respect to differences in the plasma bilirubin concentrations between the twins. Methods: 77 healthy pairs of twins of the same gender with a gestational age ±250 d and of northern European descent were included. Fourth postnatal day blood sampling was done. A multiple linear regression analysis was carried out with the difference in serum bilirubin concentration between the twins as the independent factor, and zygosity, gender, gestational age, postnatal age, maternal smoking, ABO blood‐type incompatibility, and the differences between the twins in blood haemoglobin concentration, formula feeding and weight loss as dependent factors. Results: 27 pairs of twins were monozygotic and 50 pairs dizygotic. The analysis showed that the difference in serum bilirubin concentration between the twins was dependent on whether the twins were monozygotic or dizygotic, i.e. the estimated difference in serum bilirubin concentration between the monozygotic twins was 17.8 μmol l−1 [SE 6.6 μmol l−l, p= 0.02, 95% confidence interval (95% CI) 3.4, 32.3 μmol l−1] less than the difference between the dizygotic twins, adjusted for the above‐mentioned potential confounders. The difference in serum bilirubin concentration between the twins was positively correlated to the difference in weight loss (%) between the twins (adjusted estimate 5.2 μmol l−1, SE 2.1 μmol l−1, p= 0.01, 95% CI 1.2, 9.3 μmol l−1).

Conclusion: In a population of northern European descent, other genetic factors than gender and ABO blood type were significant for the plasma bilirubin concentration in healthy infants.
Behaviour at 2 years of age in very preterm infants (gestational age >32 weeks)
Authors: Stoelhorst GMSJ , Martens SE , Rijken M , van Zwieten PHT , Zwinderman AH , Wit JM , Veen S ,   on behalf of The Leiden Follow‐Up Project on Prematurity
Published: August 2010

Aim: The objective of this study was to determine behavioural outcome and risk factors for abnormal behaviour at 2 y corrected age in very premature infants in a regionally defined, prospective cohort study. Methods: The Leiden Follow‐Up Project on Prematurity includes all liveborn infants of >32 wk gestational age, born in 1996/1997 (n= 266). Behaviour was assessed with the Child Behaviour Checklist 2–3. Results: An analysis of 158 questionnaires of 206 survivors (77%) was carried out. Fourteen children (9%) had a total problem score >p90 (“clinical range”). This percentage is comparable with the 10% found in a sample of 2‐ to 3‐y‐olds from the Dutch general population. Univariate analysis showed higher syndrome scale scores in one or more of the Child Behaviour Checklist scales in children of lower gestational age, small for gestational age (birthweight >p10), with neurological abnormalities at term or at 2 y and of non‐Dutch origin. Lower socioeconomic status and postnatal treatment with dexamethasone were associated with higher scores in the somatic problems scale and lower maternal age at birth with a higher total problem score. After correction for confounding variables, the associations between small for gestational age, neurological abnormalities at 2 y and the anxious/depressed and/or withdrawn scales remained significant.

Conclusion: The prevalence of behavioural problems at 2 y corrected age in this cohort of very premature infants (gestational age >32wk) was comparable with that in a general population sample. Children born small for gestational age or with neurological abnormalities at 2 y of age had higher syndrome scale scores, mainly for anxious/depressed and/or withdrawn behaviour.
Lemierre syndrome in a previously healthy young girl
Authors: Nadal C Figueras , Creus A , Beatobe S , Moraga F , Pujol M , Vazquez E
Published: August 2010

Lemierre syndrome is a severe postanginal sepsis complicated by internal jugular thrombophlebitis. We report on a 14 y‐old girl affected by high fever, shivering chills, headache, severe lateral neck pain, left ocular proptosis and general malaise. Magnetic resonance imaging of the head and neck showed right internal jugular vein and sigmoid sinus thrombosis. Fusobacterium sp. was identified in the blood culture.

Conclusion: Our report is a reminder that Lemierre syndrome still exists and remains potentially life threatening. A high index of suspicion is necessary to prompt diagnosis and treatment.
The challenges of fostering infants and children
Authors: Gracey M
Published: August 2010

There are various reasons for and ways of fostering infants and children in different parts of the world. In a traditional society, for example among Australian Aboriginals, children who have been subjected to catastrophes such as maternal death are taken care of in their extended families, whereas children in the Western world are fostered mainly because of adverse psychosocial factors such as abuse or neglect. In transitional societies and urban slums, where there are few protective mechanisms, the sufferings of orphans may be extreme and they run a great risk of being exploited in various ways or of becoming involved in criminal street gangs.

Conclusion: The fostering of infants and children around the world creates many yet unanswered challenges. This rather neglected area is in urgent need of much more attention, especially in transitional societies.
Weekly oral vitamin K prophylaxis in Denmark
Authors: Hansen KN , Minousis M , Ebbesen F
Published: August 2010

Aim: To evaluate oral vitamin K prophylaxis at birth by giving 2 mg phytomenadione, followed by weekly oral vitamin K prophylaxis; 1 mg was administered by the parents until 3 mo of age. Methods: A total of 507 850 live babies were born in Denmark during the study period, November 1992 to June 2000. Of these infants, 78% and 22% received oral and intra‐muscular prophylaxis, respectively; i.e. about 396000 neonates received oral prophylaxis at birth. Weekly oral prophylaxis was recommended for all infants as long as they were mainly breastfed. A survey of possible cases of vitamin K deficiency bleeding (VKDB) was carried out by repeated questionnaires to all Danish paediatric departments and by checking the National Patient Register. Results: No cases of VKDB were revealed, i.e. the incidence was 0–0.9:100000 (95% CI). The questionnaires were used to evaluate compliance with the regimen. Parents of 274 infants participated. A dose of vitamin K was regarded as having been given if the infant received a drop of vitamin K or was mostly formula‐fed that week, and the prophylaxis was regarded as completed if the infant had received at least 9 doses. Compliance was good, with 94% of the infants completing the course of prophylaxis.

Conclusion: Weekly oral vitamin K supplementation during the first 3 mo of life was an efficient prophylaxis against VKBD. Parental compliance with the regimen was good.
Early use of Nasal‐BiPAP in two infants with Congenital Central Hypoventilation syndrome
Authors: Migliori C , Cavazza A , Motta M , Bottino R , Chirico G
Published: August 2010

Aim: To reduce the problems caused by prolonged artificial ventilation in babies with Congenital Central Hypoventilation syndrome (CCHS). Methods: Two term infants with CCHS, weighing 4030 g and 3100 g, respectively, at the beginning of treatment and aged 53 and 31 d, respectively, were successfully ventilated with a Nasal Bilevel Positive Airway Pressure (N‐BiPAP) device. Results: In the first patient the tcPO2 recordings (mean ± SD) during sleep were 46 ± 12 mmHg before using N‐BiPAP and 58 ± 13 mmHg after using the device, while those for tcPCO2 were 75 ± 9 mmHg and 49 ±11 mmHg, respectively. In the second patient tcPO2 during sleep was 42 ± 3 mmHg before, and 55 ± 5 after N‐BiPAP, and for tcPCO2 the recordings were 119 ± 24 mmHg and 55 ± 6 mmHg, respectively, showing a significant improvement. One infant had persistent gastro‐oesophageal reflux, and frontal skin abrasion caused by the face mask. Nevertheless, these complications did not necessitate the discontinuation of N‐BiPAP ventilation, thus precluding prolonged use of intubation and tracheotomy.

Conclusion: In infants with CCHS, early use of non‐invasive, positive‐pressure ventilation with N‐BiPAP, in association with careful monitoring, can decrease problems caused by prolonged intubation and tracheotomy.
Hypercontractile heart failure caused by catecholamine therapy in premature neonates
Authors: Germanakis I , Bender C , Hentschel R , Braun K , Dittrich S , Kececioglu D
Published: August 2010

Catecholamine treatment for hypotension is common practice in neonatal intensive care units. In the presence of left ventricular hypertrophy, the positive inotropic action of catecholamines with mainly β‐receptor specificity can lead to excessive hypercontractility and paradoxical hypotension. This reports presents two cases of hypercontractile heart failure during β‐agonist treatment in very low birthweight (VLBW) infants. Both patients (27 wk, 5 d; and 26 wk, 6 d of gestation) underwent surgical arterial duct ligation and coarctation repair. After operation they developed arterial hypotension that failed to respond to epinephrine (adrenaline) or dobutamine treatment. Echocardiography demonstrated a complete systolic obliteration of the left ventricular cavity. Epinephrine and dobutamine were stopped, and norepinephrine (noradrenaline) was successfully used to control the hypotension.

Conclusion: Treatment of hypotension with β‐agonists in VLBW infants with left ventricular hypertrophy can lead to hypercontractility and left ventricular obliteration with paradoxical hypotension. Careful echocardiographic monitoring is indicated in such cases.
Characteristics of young foster children in the urban slums of Bangladesh
Authors: Sarkar NR , Biswas KB , Khatun UHF , Datta AK
Published: August 2010

Aim: To identify the reasons for the fostering of children, and to describe their feeding practices and assess their health and nutritional status. Methods: Forty‐six pairs of mothers and their young foster children (up to 24 mo of age) were interviewed in a cross‐sectional study in the urban slums of Dhaka, Bangladesh. Another 82 pairs of mothers and their biological children of a similar age group were interviewed for comparison. Results: Sixty‐five percent of the children were fostered because of the death of their biological mothers. Eighty‐three percent of the biological mothers died because of complications during delivery or the immediate postpartum period and the remainder died after the postpartum period of diseases unrelated to their pregnancies. More than half (52%) of the foster mothers were childless and a quarter (24%) fostered children for reasons of gender preference. Almost a quarter (24%) of the children were placed in foster homes because of extreme parental poverty. Divorce or separation of the biological parents accounted for only 7% of children fostered. Approximately 90% of the foster children were given animal and/or formula milk in their first month of life while all children in the comparison group were given breast milk. Among the foster children, 58% were given semisolid or solid food before completion of 4 mo compared with 14% in the comparison group. Significantly more children in the foster group suffered from diarrhoea and acute respiratory infection than in the comparison group.

Conclusion: Maternal death, poverty and childlessness and child gender preference of foster mothers were important factors in fostering of children in the study group. Inappropriate feeding practices compounded by diseases may have contributed to the poor nutritional status of the foster children.
Increasing prevalence of overweight in young schoolchildren in Umeå, Sweden, from 1986 to 2001
Authors: Petersen S , Brulin C , Bergström E
Published: August 2010

Aim: To investigate the current prevalence and trend of overweight in young schoolchildren in Umeå, Sweden. Methods: Two cross‐sectional samples of children were studied: 1115 randomly selected children from preschool class to grade 6 (aged 6–13 y) attending school in 2001 and a matched sample of 507 schoolchildren from grades 0, 1 and 4 (aged 6–11 y) attending school in 1986. Overweight was defined according to age‐ and gender‐specific body mass index (BMI) cutoff values, corresponding to BMI values of 25 kg/m2 (level 1) and 30 kg/m2 (level 2) at late adolescence. Results: In the population from 2001, the prevalence of overweight was 23% (18% at level 1, 5% at level 2). The prevalence differed with age, with a higher prevalence at the ages of 6 and 13 y. Comparing children from grades 0, 1 and 4, attending school in 1986 and 2001, respectively, the total prevalence of overweight was twice as high in 2001 as in 1986. Regarding severe overweight (level 2), the difference was even larger (five times). In the 1986 sample, the prevalence of overweight did not differ between girls and boys, while significantly more girls than boys were overweight in 2001.

Conclusion: In this sample of young children from Sweden, the prevalence of overweight doubled over the past 15 y and severe overweight increased even more, suggesting a need for intensified preventive efforts in young schoolchildren.
Pulmonary vein stenosis mimicking chronic lung disease
Authors: Chakrabarti S , Tsao S , Vettukattil JJ , Gnanapragasam JP
Published: August 2010

The presence of recurrent respiratory symptoms and right heart enlargement in an ex‐premature infant is suggestive of chronic lung disease. Pulmonary vein stenosis is a rare, progressive disorder that produces similar symptoms and signs. A case is reported in which pulmonary vein stenosis was revealed by Doppler echocardiography, and this application is recommended in similar cases. Pulmonary vein stenosis is an extremely rare and progressive disorder, which, if left untreated, is usually fatal. The possibility of this diagnosis may not be considered during clinical examination and may be overlooked during routine echocardiography.

Conclusion: This report describes a patient with pulmonary vein stenosis in whom the diagnosis was delayed as she had symptoms and signs more commonly associated with chronic lung disease.
Epstein‐Barr virus‐associated haemophagocytic lymphohistiocytosis in Wiskott‐Aldrich syndrome
Authors: Pasic S , Micic D , Kuzmanovic M
Published: August 2010

A patient with Wiskott‐Aldrich syndrome who developed Epstein‐Barr virus‐associated haemophagocytic lymphohistiocytosis (EBV‐HLH) is described in this study. At 4 mo of age the patient developed fever associated with bicytopenia and splenomegaly. Analysis of a bone marrow specimen revealed extensive haemophagocytosis, and in situ hybridization for EBV of the bone marrow specimen using an EBV‐encoded RNA probe was positive. Diagnosis of EBV‐HLH was established and immunotherapy with HLH‐94 protocol was started. HLH has been described in patients with other well‐defined primary immunodeficiencies such as X‐linked lymphoproliferative syndrome, Chediak‐Higashi syndrome and Griscelli disease. Also, HLH was reported recently in severe combined immunodeficiency and DiGeorge syndrome.

Conclusion: The possibility of an underlying primary immunodeficiency should be considered in paediatric patients who present with HLH during infancy.
Circadian variations in sudden infant death syndrome: associations with maternal smoking, sleeping position and infections. The Nordic Epidemiological SIDS Study
Authors: Daltveit AK , Irgens LM , Øyen N , Skjærven R , Markestad T , Wennergren G
Published: August 2010

Aim: To study circadian variation in the sudden infant death syndrome (SIDS) and possible associations with risk factors for SIDS. Methods: A questionnaire‐based case‐control study matched for place of birth, age and gender was conducted in Denmark, Norway and Sweden: The Nordic Epidemiological SIDS Study. The study comprised 244 SIDS victims and 869 control infants between September 1992 and August 1995. The main outcome was hour found dead. Results: A significant circadian pattern was observed among the 242 SIDS victims with a known hour found dead, with a peak at 08.00‐08.59 in the morning (n= 33). Of the SIDS victims, 12% were found dead at 00.00‐05.59, 58% at 06.00‐11.59, 21% at 12.00‐17.59 and 9.0% at 18.00‐23.59. When comparing night/morning SIDS and day/evening SIDS (found dead 00.00‐11.59 and 12.00‐23.59, respectively), the proportion of night/morning SIDS was high among infants of smoking mothers (81% vs 53%, p < 0.001), infants with a reported cold (82% vs 64%, p= 0.007) and infants sleeping side/supine (81% vs 60%, p < 0.001). No associations were observed between hour found dead and other sociodemographic risk factors for SIDS. Risk (odds ratio and 95% confidence interval) of night/morning SIDS and day/evening SIDS was 7.0 (4.5‐10.9) and 1.5 (0.8‐2.5), respectively, for maternal smoking, 2.2 (1.5‐3.1) and 0.6 (0.3‐1.3), respectively, if the infant had a reported cold, 3.7 (2.1‐6.6) and 3.1 (1.1‐8.4), respectively, if the infant was put to sleep in the side position (supine reference), and 11.0 (5.9‐20.2) and 21.6 (7.6‐60.8), respectively, if the infant was put to sleep in the prone position.

Conclusion: The observed higher proportion of night/morning cases in SIDS if the mother smoked, if the infant was reported to have a cold and if the infant was sleeping side/supine may contribute to the understanding of some epidemiological characteristics of SIDS.
Longitudinal growth and height velocity of Japanese children with Down's syndrome
Authors: Kimura J , Tachibana K , Imaizumi K , Kurosawa K , Kuroki Y
Published: August 2010

Aim: To determine the natural growth pattern of Japanese children with Down's syndrome. Methods: Longitudinal height data of 85 patients (43 males, 42 females) from birth to final height were analyzed. Based on these data, semi‐longitudinal standard growth curves and height velocity curves for Down's syndrome were drawn. Results: The means ± SD of final height of males and females with Down's syndrome were 153.2 ± 5.6 and 141.9 ± 4.2 cm, respectively. They were –3.0 SD and –2.8 SD for Japanese standards. Mean peak height velocities were 8.9 and 7.5 cm y−1, and the ages at peak height velocity were 11.6 and 10.2 y for males and females, respectively.

Conclusion: The mean height of patients with Down's syndrome was around –2 SD for normal children before puberty. Their pubertal growth spurt starts about 1 y earlier and their peak height velocity was about 1.3–1.4 cm shorter than for normal children.
Glomerular filtration rate: measure creatinine and height rather than cystatin C!
Authors: Martini S , Prévot A , Mosig D , Werner D , van Melle G , Guignard J‐P
Published: August 2010

Aim. Inulin clearance (Cin) is the gold standard for assessing glomerular filtration rate (GFR). Other methods are based on the plasma creatinine concentration (Pcreat), creatinine clearance (Ccreat), the Haycock‐Schwartz formula and the plasma concentration of cystatin C (PcysC), a 13kDa basic protein produced at a constant rate by all nucleated cells. The present prospective study was thus designed to evaluate the reliability of PcysC as a marker of GFR in comparison with that of Pcreat, Ccreat and the Haycock‐Schwartz formula, using Cin as the gold standard. Methods: Ninety‐nine children (51 m/48 f), with a median age of 8.3 y (1.0–17.9) were studied. Using a cut‐off for Cin of 100ml/min per 1.73 m2, 54 children (54.5%) had impaired GFR. Those with normal GFR were comparable for age, height, weight and body mass index. Results: Logistic regression, ROC analysis and linear regression all showed that Ccreat was the best parameter to discriminate between impaired and normal GFR, followed by the Haycock‐Schwartz formula, PcysC, and finally Pcreat, each one being significantly more predictive than the next.

Conclusion: GFR is better assessed by the Haycock‐Schwartz formula than by PcysC or Pcreat alone. It is therefore concluded that when urine collection is not possible, simply measuring the child's Pcreat and height is the best, easiest and cheapest way to assess GFR.
Supraventricular tachycardia: an incidental diagnosis in infants and difficult to prove in children
Authors: Vos P , Pulles‐Heintzberger CFM , Delhaas T
Published: August 2010

Aims: To determine (a) the age distribution at first clinical supraventricular tachycardia (SVT) presentation; (b) the time interval between first clinical suspicion and electrocardiographic proof of SVT; c) the most indicative symptoms and signs of SVT; and (d) the SVT mechanism and its age distribution according to surface ECG.Methods: The records of 55 children (32 males and 23 females) with electrocardiographically proven SVT but without congenital heart disease were reviewed.Results: At diagnosis, 27 patients (49%) were younger than 1 y (infants), and 28 (51%) were older than 1 y (children). Only a quarter of infants presented with symptoms. The majority (20/27), however, were detected during routine investigation without having any complaints. Children presented with symptoms (mostly palpitations) in almost 90% of cases. Despite these symptoms, the median time interval between first clinical presentation suggestive of SVT and electrocardiographic proof of SVT was 138 d. Using surface ECG, we were unable to show any age‐dependency of the SVT mechanism in our study group.

Conclusion: In infants SVT is a chance finding; SVT can only be proven electrocardiographically with a median delay of 138 d, despite the presence of symptoms; SVT using a (concealed) accessory pathway is the most common mechanism
Diaphragm dimensions of the healthy term infant
Authors: Rehan VK , McCool FD
Published: August 2010

Aim: Human neonatal diaphragm development has not been extensively studied. Previous work in children and adults suggests that diaphragm thickness (tdi) is in scale with body size such that maximal transdiaphragmatic pressure (Pdimax) remains relatively constant. Such assessments have not been made in healthy term infants. This study was designed to evaluate the relationships among tdi, body dimensions and Pdimax healthy term infants. Methods: It was hypothesized that in healthy term infants 1) tdi is positively correlated with body size and 2) calculated Pdimax is independent of body weight and length. Fifteen clinically stable term infants (8 males and 7 females) were recruited [birthweight (BW), 3.3 ± 0.7 kg, (mean ± SD); head circumference (HC), 33.7 ± 2 cm; body length (BL) 50 ± 3 cm; gestational age (GA) 39 ± 1 wk; and postnatal age 1.7 ± 0.8 day]. Ultrasound was used to visualize the diaphragm at the level of the zone of apposition and measure tdi. Standard techniques were used to measure the anthropometric dimensions of the rib cage. Pdimax was calculated using the piston‐in‐cylinder model of diaphragm function. Results: Significant correlations were found among tdi and BW (R = 0.58), BL (R = 0.58) and HC (R = 0.65) but not between GA (R = 0.20). Larger infants tended to have thicker diaphragms and larger cross‐sectional areas of the lower rib cage (AZAP). For the group, calculated Pdimax was independent of either body weight or length and was greater than that calculated for adults.

Conclusion: It is concluded that diaphragm mass in healthy term infants is proportional to body size, whereas calcuated Pdimax is independent of body size. Since calculated Pdimax is greater than that predicted for adults, there may be perinatal diaphragm strengthening. This may assist the infant in generating sufficient pressure to overcome the enormous elastic and resistive loads imposed during perinatal pulmonary transition.
Haemodynamic features during high‐frequency oscillatory ventilation in preterms
Authors: Cambonie G , Guillaumont S , Luc F , Vergnes C , Milesi C , Voisin M
Published: August 2010

Aim: To compare the haemodynamic status during high‐frequency oscillatory ventilation and conventional mechanical ventilation in very preterm infants with respiratory distress syndrome. Methods: Thirty‐two neonates of less than 30 wk gestation randomly assigned to high‐frequency oscillatory ventilation (n= 15) or conventional mechanical ventilation (n= 17) had three echocardiographies and one cerebral Doppler‐echography under the same ventilation during the first 48 h of life. Results: Mean airway pressure was 2 cm H2O higher in infants ventilated with high‐frequency oscillatory ventilation at the different echocardiographies. Comparable right ventricular indexes were observed in the two groups. Reduction of the ductus arteriosus diameter and ductal closure were significant only in neonates ventilated conventionally. Left ventricular performance and left ventricular contractility did not differ between the groups. The high‐frequency group had lower end diastolic velocity and a higher resistance index in the anterior cerebral artery.

Conclusion: Compared with conventional mechanical ventilation, high‐frequency oscillatory ventilation was achieved without altering cardiac function. However, the inability of the left ventricle to improve its performance in the presence of a significant ductal shunt suggests a narrow range of optimal pressures under this ventilatory mode.
Tolerance to early human milk feeding is not compromised by indomethacin in preterm infants with persistent ductus arteriosus
Authors: Bellander M , Ley D , Polberger S , Hellström‐Westas L
Published: August 2010

Aim: Early human milk feeding is beneficial for gut and brain development. Persistent ductus arteriosus (PDA) and indomethacin may compromise enteral function in preterm infants. For many years enteral milk feedings have continued in preterm infants receiving indomethacin for PDA. The aim of this study was to investigate whether this strategy is efficient in terms of risks and tolerance to early enteral feeding. Methods: This retrospective study included 64 inborn infants of <29 wk gestational age (GA), 32 infants who received indomethacin for symptomatic PDA (case infants) and 32 matched controls. Case infants had a mean (SD) GA of 26.3 wk (1.3) and body weight 839 g (203) versus controls GA 26.4 wk (1.2) and body weight 896 g (213) (p= 0.82 and 0.27, respectively). Case infants had higher respiratory morbidity; 90.6% versus 50% of controls needed mechanical ventilation (p= 0.000). Results: Case infants received human milk from a median (range) age of 4.0 h (1.5‐27.5), and controls from 5.3 h (2.0‐38.0) (p= 0.092). The first dose of indomethacin was given at a mean age of 1.7 d (1.0). There were no differences between the two groups in feeding volumes or gastric residuals on days 1 to 7. Mean (SD) feeding volume on day 7 was 64 ml/kg (31) in case infants and 76 ml/kg (30) in controls (p= 0.23). Four infants developed necrotizing enterocolitis: two case infants and two controls (p= 1.00).

Conclusion: Early enteral feeding with human milk, starting within the first hours of life, seems to be as well tolerated in preterm infants treated with indomethacin for PDA as in their matched controls.
Risk factors for coronary heart disease in children and young adults
Authors: Viikari JSA , Niinikoski H , Juonala M , Raitakari OT , Lagström H , Kaitosaari T , Rönnemaa T , Simell O
Published: August 2010

This review covers two ongoing studies in Finland: the Cardiovascular Risk in Young Finns study, which started in 1978, and the Special Turku Coronary Risk Factor Intervention Project for Children (STRIP), which started in 1989. In the cross‐sectional Cardiovascular Risk in Young Finns study, cardiovascular risk factors were first assessed in 1980 in 3596 children and adolescents covering ages between 3 and 18 y at 3‐y intervals. The latest follow‐up examination was performed in 2001, when risk factors and early markers of atherosclerosis in carotid and brachial arteries were examined in 2264 subjects from the original cohorts, now covering ages from 24 to 39 y. The results clearly show that an individual's coronary heart disease (CHD) risk factor profile is regulated by early lifestyle‐related factors and that exposure to risk factors in childhood induces changes in arteries that contribute to the development of atherosclerosis in adulthood. In the STRIP study, 1062 infants were randomized into an intervention group (n= 540; low‐saturated‐fat, low‐cholesterol diet) or a control group (n= 522) at 7 mo of age. Fat, saturated fat and cholesterol intakes have been lower, while the polyunsaturated to saturated fat ratio has been higher in the intervention children than in the control children throughout the ongoing trial. During the first 7 y of life, serum cholesterol concentration was 0.2–0.3 mmol/l lower in the intervention boys than in the control boys, but the difference was negligible in girls. Neurological development of the intervention children at age 5 y was at least as good as that of the control children. Counselling had no effect on children's growth.
Arterial endothelial injury due to infection in childhood: ticking bomb or innocent bystander?
Authors: Liuba P
Published: August 2010

Atherosclerosis is regarded as a chronic disease that begins in early life. While the main underlying mechanism of atherosclerosis is nowadays unequivocally attributed to a low‐grade inflammatory reaction, the spectrum of aetiological conditions is far from being fully elucidated. Both viruses and bacteria have been suggested to intervene at various stages of atherosclerosis development, although a clear pathogenic link between infection and atherosclerosis remains debatable. As one key event in atherogenesis involves a perturbation of the protective mechanisms normally posed by the arterial endothelium, a number of studies have enquired into the possible detrimental effects of microbes and their components on the endothelial cells. This review aims to scrutinize the current literature in this regard, and to suggest several possible directions for future studies.
Corticosteroid treatment in meconium aspiration syndrome: a solution for better outcome?
Authors: Kääpä P
Published: August 2010

Corticosteroid treatment in severe meconium aspiration syndrome may afford, especially if started early, some improvement in oxygenation, lung function and pulmonary haemodynamics during the acute phase of the disorder. Still, the effects of corticosteroids on lung tissue perturbations and outcome of diseased infants remain unclear.

Conclusion: Further research is needed to determine the clinical significance and optimal timing and dosing of corticosteroid treatment in severe meconium aspiration syndrome.
Alpha/beta intraepithelial lymphocytes, serum gliadin antibodies and allergy test positivity in children
Authors: Linkosalo L , Kaila M , Ashorn M , Turjanmaa K , Haapala A‐M , Karikoski R , Holm Kati
Published: August 2010

Aim: To determine whether the amount of αβ‐positive intraepithelial lymphocytes (IELs) is connected to allergy test positivity in children with gastrointestinal symptoms and whether elevated serum gliadin antibodies have any role in the diagnosis. Methods: Twenty‐seven children suffering from gastrointestinal‐symptoms in whom intestinal biopsies had previously been obtained via endoscopy or with capsule biopsy to exclude coeliac disease were included into the study. The other inclusion criteria were increased amounts of CD3 and αβ‐positive IELs with normal amounts of γδ‐positive IELs in duodenal or jejunal biopsy specimens. At the control visit, the children underwent a physical examination and parents filled in a questionnaire concerning gastrointestinal‐and atopic symptoms. Skin prick‐ and patch tests were done and serum gliadin, endomysium, transglutaminase antibodies and specific IgEs were measured. Results: Only nine children (33%) had at least one positive result in the allergy tests, the rest remaining test negative. In children with digestive symptoms, IgG‐class gliadin antibody titres were higher than those of the non‐symptomatic children. A significant correlation was found between IgG‐class gliadin antibodies and total amount of αβ‐positive IELs (p= 0.017).

Conclusion: No positive skin test or specific IgE positivity for cereals in children with high intestinal T‐cell densities was observed. The correlation between IgG‐class gliadin antibodies and the total amount of αβ‐TCR positive‐cells is likely to be a reflection of local immune response of the gut.