bluuebunny/crossref_metadata_2025 huggingface dataset:
Heart rate variability in infants with apparent life‐threatening events
Authors: Edner A , Katz‐Salamon M , Lagercrantz H , Ericson M , Milerad J
Published: August 2010

Heart rate variability (HRV) is often used as an index of sympatho‐vagal balance. A decreased HRV has been observed in patients with central hypoventilation and in infants who have later succumbed to sudden infant death syndrome (SIDS). The aim of the present study was to investigate whether HRV is altered in infants with apparent life‐threatening events (ALTE), a group with an increased risk of SIDS. Fifty infants with ALTE were compared with 50 age‐ and sex‐matched controls. ECG was recorded overnight in all infants. Two sequences of RR intervals free of artefacts were selected from each sleep state and spectral analysis of RR variability was performed. The mean and SD of RR and the low (LFPow) and high (HFPow) frequency power were analysed. In active sleep (AS) the LF/HF ratio was lower in ALTE infants, but no differences were seen in either the LFPow or the HFPow. In quiet sleep (QS), however, ALTE infants had higher SD‐RR (p= 0.006), greater HFPow (p= 0.02) and VLFPow (very low frequency power, p= 0.02) than the control infants. The same results were seen when the two sleep states were combined for analysis, ALTE infants had higher SD‐RR (p= 0.004), HFPow (p= 0.006) and VLFPow (p= 0.04).

Conclusion: The different HRV pattern in ALTE infants compared to healthy controls suggests an altered autonomic control.
Abnormal fetal aortic velocity waveform and postnatal growth
Authors: Ley D , Laurin J , Marsal K
Published: August 2010

Postnatal growth from birth up to 7 y of age was evaluated in 151 children with varying degrees of intrauterine growth retardation who were previously examined in their intrauterine life with Doppler velocimetry of the thoracic descending aorta. The children with abnormal fetal aortic blood flow class (BFC), of which 39/46 (85%) had a birthweight 2 SD below the mean of the population, were lean at birth and had a high rate of catch‐up growth in weight and length during the first 3 and 6 mo, respectively. After the initial phases of rapid catch‐up in weight and length, mean values of SD scores for weight and height remained relatively unchanged up until 2 y of age, thereafter increasing gradually up to 7 y of age, leaving 4/46 (8%) and 4/46 (8%) below –2 SD for weight and height, respectively.

The pattern of changes in length/height and weight over time did not differ between those infants with abnormal BFC and those with normal BFC. The abnormal fetal aortic waveform was not related to rate of early catch‐up growth or to height or weight at 7 y of age after adjustment for deviation in growth at birth. The magnitude of deficit in weight and length at birth was more predictive of subsequent growth.
Efficacy and safety of rectal thiopental sedation in outpatient echocardiographic examination of children
Authors: Okutan V , Lenk MK , Sarici SÜ , Dündaröz R , Akin R , Gokçay E
Published: August 2010

The efficacy and safety of rectal thiopental administration in sedation for paediatric echocardiographic examination were prospectively investigated in infants with known or suspected congenital heart disease in an outpatient manner. A total of 1150 patients (546F, 604M) were studied; 264 were 7 d to 6 mo old (group I), 572 were 6 mo to 2‐y‐old (group II), and 314 were 2 to 6‐y‐old (group III). Thiopental sodium dissolved in 10 ml of water in a syringe to which a 6‐F feeding catheter was attached was administered prior to echocardiographic examination to patients in groups I, II and III with doses of 50, 35 and 25 mg/kg, respectively in an emergency care environment. Length of time to achieve sedation (induction time), duration of sedation, length of time to return to normal activity (recovery time), whether sedation was successful and side effects were recorded. In the overall study population, sedation was successful in 1094 (95.1%) of the patients, the induction time was 16.34 ± 3.69 min, the duration of sedation was 35.07 ± 7.04 min, the recovery time was 63.25 ± 10.17 min and the overall side‐effect prevalence was 2%. Sedation was significantly more successful, the induction time was significantly shorter, the recovery time was significantly longer and side effects significantly more prominent in groups I and II compared to group III.

Conclusion: Rectally administered thiopental is a safe and efficacious agent for sedation of infants and young children with known or suspected congenital heart disease who are undergoing echocardiography in an outpatient cardiology clinic, provided that it is used in an emergency care setting considering the risk of respiratory depression even though the prevalence of this side effect is significantly low.
Ultrasonographic detection of very thin percutaneous central venous catheter in neonates
Authors: Ohki Y , Tabata M , Kuwashima M , Takeuchi H , Nako Y , Morikawa A
Published: August 2010

To assess the ability of ultrasonography to detect the tip of a very thin (0.4 mm outer diameter) percutaneous central venous catheter (PCVC) in neonates, the PCVC tip location was assessed by ultrasonography (US) and compared to the location estimated by standard radiography for 57 PCVCs in 44 neonates. Of 57 occasions, the examiner could not find the PCVC tip in three cases (5%). In the remaining 54 instances, in 87% of cases, the PCVC tip position was consistent with the location implied by skeletal landmarks on standard radiographs. On 24 occasions we also assessed catheter tip dislodgement according to flexion and extension of the infant's arm. US could detect 78% of cases of catheter tip dislodgement. The PCVC tip was sometimes visualized as a dot and parallel lines as well as mere parallel lines. In a large population of cases, US is a reliable method for detection of a thin PCVC tip. US provides precise information about the PCVC tip position in relation to vascular structure and contributes to safer positioning of the PCVC than traditional radiography alone.
Epidemiology of Streptococcus pneumoniae in Italian children
Authors: Principi N , Marchisio P
Published: August 2010

In Italy, data regarding the aetiological role, antibiotic resistance, and serotype distribution of isolates of Streptococcus pneumoniae are scarce and based on very small population samples. We found that S. pneumoniae caused about 30% of lower respiratory tract infections and 15% of acute otitis media infections in Italian children. The incidence of S. pneumoniae meningitis in subjects aged 0–4y was 1.1 ± 100000. In children <5y of age with meningitis, the most common S. pneumoniae serotypes were, in rank order, 14, 6, 23, 1 and 4; among 53 nasopharyngeal carriers the most frequent serotypes were 6 and 19. The actual percentage of resistance of S. pneumoniae to penicillin is 10.2%, while for macrolides it reaches 25.5%. More data on the distribution of serotypes in Italian children are urgently needed in order to obtain a better understanding of the impact of the new pneumococcal vaccines.
Does breastfeeding increase thymus size?
Authors: Prentice AM , Collinson AC
Published: August 2010

“No structure of the body is less understood, nor, with few exceptions, has had more functions attributed to it, than the thymus gland” (W. E. Nelson, Textbook of Pediatrics, 5th edition, 1950)
Infantile colic. Follow‐up at four years of age: still more “emotional”
Authors: Canivet C , Jakobsson I , Hagander B
Published: August 2010

This paper presents a follow‐up at 4 y of formerly colicky infants and controls, with respect to behaviour, temperament, eating and sleeping habits, psychosomatic complaints, number of hospital stays, growth and “family climate”. There were no differences between the two groups in most parameters studied. However, ex‐colicky children displayed more negative emotions according to the temperament scale. There were also more negative moods during meals, and more reported stomach‐ache. Although relationships regarding crying and mother‐infant interaction remain extremely complex, the findings point toward a possible temperamental contribution to the pathogenesis of the infantile colic syndrome.
Prediction of growth response in prepubertal children treated with growth hormone for idiopathic growth hormone deficiency
Authors: Südfeld H , Kiese K , Heinecke A , Brämswig JH
Published: August 2010

Several multiple regression models have been developed to predict the first‐year growth response to human growth hormone (hGH) in children with growth hormone deficiency (GHD). It was the aim of this study to analyse the significance of various growth parameters for a height prediction model. Data from 148 prepubertal children with idiopathic GHD were evaluated. The prediction model was developed by means of univariate and stepwise linear regression analysis and an “all possible” regression approach using Mallow's C(p) statistics. Six out of eight selected variables had a significant influence on the first‐year growth rate. The most important parameter was the difference between target height SDS and height SDS at the start of therapy (THSDS –HSDSC0), accounting for 23.95% and 25.74% of the variability. No other single variable or combination of variables was more informative than the variable THSDS –HSDSC0 alone. From these data, growth velocity for the first year of hGH treatment was estimated as 1.106 (THSDS – HSDSC0) + 6.8 cm/y ± 2.2 cm (SE), allowing a prediction for different intervals between THSDS and HSDSC0. This equation was validated in a small group of 18 GHD patients demonstrating a predicted vs. observed first‐year growth rate of 9.4 ± 1.1 vs. 9.5 ± 2.6 cm/y. We conclude that the difference between THSDS and height SDS at the start of therapy is an important predictor of the first‐year growth response in children treated with hGH for idiopathic GHD. Unlike in previous studies, additional parameters did not increase predictability.
Gait disturbance interpreted as cerebellar ataxia after MMR vaccination at 15 months of age: a follow‐up study
Authors: Plesner A‐M , Hansen F Juul , Taudorf K , Nielsen L Holme , Larsen C Brenner , Pedersen E
Published: August 2010

Measles, mumps and rubella (MMR) vaccination was included in the Danish childhood vaccination programme in 1987. During the following 10‐y period, 550 notification records of adverse events after MMR vaccination at 15 mo of age have been registered, and a total of 41 notifications have included “gait disturbance”. This corresponds to a frequency of 8 per 100 000 doses of MMR vaccine used for 15‐mo‐old children. The symptoms and signs are characteristic of cerebellar ataxia. In 28 notifications, the descriptions by the doctors included only “gait disturbance”, while in 13 an additional interpretation was included. Thirty‐two parents (78%) filled in a questionnaire and 26 (63%) agreed to participate in a clinical follow‐up study. The gait disturbance symptoms mainly occurred 7–14 d after the vaccination, and the duration was median 1–2 wk (range 1 d to more than 4 mo). One‐third of the children had symptoms lasting more than 2 wk. Significantly more children with long duration of symptoms had some kind of complaint or clinical signs at the follow‐up in 1997. Gait disturbance registered after MMR vaccination seems to be more frequent than hitherto reported. Most cases are mild and short‐lasting and a longer duration of symptoms seems to be predictive of late sequelae. A clinical diagnosis of cerebellar ataxia after MMR and the exact frequency of this adverse event remains to be tested in prospective studies.
Are data on the prevalence and duration of breastfeeding reliable? The case of Italy
Authors: Cattaneo A , Davanzo R , Ronfani L
Published: August 2010

Many countries produce data on the prevalence and duration of breastfeeding, but are they reliable? We reviewed 16 studies on breastfeeding in Italy published after 1990. They report a prevalence of breastfeeding at and around birth ranging from 66% to 91%, decreasing to 17–52% at 4 mo and 28–36% at 6 mo. Most studies refer to a non‐representative sample of the Italian population. Two studies used standard definitions of breastfeeding, but their results are difficult to interpret or cannot be generalized. Five other studies used non‐standard definitions that undermine the interpretation of results. The remaining nine studies used no definition at all. All studies used a recall period different from 24 h, or from the whole hospital stay for breastfeeding at discharge, making the interpretation of results even more difficult. We conclude that the published information gives an inaccurate picture of the prevalence and duration of breastfeeding in Italy, leading to unjustified optimism and inaction. The actual figures may be lower, as shown by preliminary data from a small Italian region: using standard definitions and methods during a 9‐mo monitoring period, exclusive breastfeeding averaged 35% at discharge and 23% at about 4 mo of age.
Long‐chain polyunsaturated fatty acids in human milk and brain growth during early infancy
Authors: Xiang M , Alfvén G , Blennow M , Trygg M , Zetterström R
Published: August 2010

Long‐chain polyunsaturated fatty acids are essential for growth and development, and their crucial role in the development of the central nervous system and in retinal function has been the subject of many studies. As the balance between n‐6 and n‐3 fatty acids has to be optimal, their concentrations in the milk given to infants who are exclusively breastfed is of major importance. In this study, the composition of fatty acids in mothers' milk and the growth rate of the infant brain were analysed. Nineteen mother‐term infant pairs from Stockholm, Sweden, were studied from birth to 1 mo and 3 mo of age, during which time the infants were breastfed exclusively. The dietary intake of the mothers was calculated and found to concur with the recommended daily dietary allowances of Swedish lactating women as regards energy, protein, fat and carbohydrates. The amounts of linoleic acid and α‐linolenic acid in the diet were similar to those reported for European and North American women. The ratio between arachidonic acid (AA) and docosahex‐aenoic acid (DHA) in the milk from Swedish mothers is approximately the same as in the brain of infants, and was found to be positively correlated with the rate of gain of the occipito‐frontal head circumference and of the calculated brain weight at 1 mo (p< 0.01) and 3 mo (p< 0.01) of age, respectively. However, further studies are needed to establish the exact requirements of AA and DHA for optimal growth and development during early infancy in exclusively breastfed infants.
Effects of growth during infancy and childhood on bone mineralization and turnover in preterm children aged 8‐12 years
Authors: Fewtrell MS , Prentice A , Cole TJ , Lucas A
Published: August 2010

To investigate the effect of growth on later bone mass and turnover, bone mineral content (BMC) and density (BMD: dual X‐ray absorptiometry (QDR 1000W) and single photon absorptiometry (Lunar SP2)) and bone turnover (plasma osteocalcin, urine deoxypyridinoline) were measured at 8‐12 y in 244 preterm children who had weight and height measured at 18 mo and 7.5‐8 y corrected age. Weight and length at birth, 18 mo, 7.5‐8 y and current follow‐up showed increasingly strong, positive correlations with bone area, BMC and BMD. After adjusting for current size, there were significant negative associations between earlier size measurements and later whole body and lumbar spine bone mass which were stronger for length than for weight, and a negative relationship between birthweight for gestation and later radial bone mass; but no relationship with bone turnover. Current calcium intake and activity level had no independent effect on bone mass. Bone mass at 8‐12 y is related to current bone and body size, which tracks throughout childhood. However, amongst children of the same current size, those who have shown the greatest increase in size, particularly in height, have the highest bone mass. These findings raise the hypothesis that improving linear growth in vulnerable children may be important in maximizing bone mass.
Surgery is safe in very low birthweight infants with necrotizing enterocolitis
Authors: Anveden‐Hertzberg L , Gauderer MWL
Published: August 2010

The aim of this study was to determine how the operative event itself affects very low birthweight (VLBW) infants (<1500 g) with necrotizing enterocolitis (NEC) undergoing surgery, and to try to identify preventable factors leading to perioperative morbidity and mortality. Eighty‐five VLBW infants developed NEC during a 6‐year period; 34 of those required emergent celiotomies. Data were collected retrospectively from hospital charts available on 33 infants. Birthweight ranged from 566 g to 1415 g (mean ± SD: 961 ± 262 g) and gestational age from 24 to 34 wk (28 ± 3.2 wk). Thirty infants had been fed premature formula (first feed at 5 ± 3.6 d) prior to the onset of symptoms and three had not been fed at all. Age at NEC symptoms was 19 ±15 d. Infants < 1000 g developed NEC much longer after the first feed compared to infants 1000 g (p < 0.002; t‐test). In 42% of the children, intraoperative blood pressure fell at least 20% from the preoperative value. Body temperature dropped from a preoperative 36.5±0.34°C to 35.5 ± 1.20°C (p < 0.005), although in all children two or more heating devices were employed in the operating room. All infants survived the procedure. Six infants with pannecrosis died within 72 h of the operative event. In an appropriate setting, operative intervention under general anesthesia is well tolerated by VLBW infants with NEC. Since hypothermia was a major problem, the authors have modified their approach and now no longer transport these infants to the operating room. Instead, these infants are operated upon in the neonatal intensive care unit, directly on an infant radiant warmer system.
Nutrient intake among two‐year‐old children on cows' milk‐restricted diets
Authors: Henriksen C , Eggesbø M , Halvorsen R , Botten G
Published: August 2010

Approximately 2‐3% of young children develop allergy or intolerance to cows' milk. The only available treatment is elimination of milk from the diet. However, as milk is an important source of nutrients in childhood, a milk‐free diet may not adequately meet the child's nutritional needs. A dietary survey was conducted to assess the nutrient intake of children on cows' milk‐restricted diets. A population‐based sample of families with young children (31‐37 mo) with adverse reaction to cows' milk and/or eggs was contacted, of which 75% agreed to complete a dietary intake assessment. Dietary intake was assessed using a 4‐d weighed recording. The nutrient intake in a group of children on cows' milk protein‐free (n= 16) and cows' milk reduced (n = 8) diets were compared to a group of cows' milk consumers (n = 10). There were significant differences in nutrient intake of children on milk‐free diets and children consuming milk. Children on milk‐free diets had significantly lower intake of energy, fat, protein, calcium, riboflavin and niacin. Use of milk substitutes improved the nutritional content of the cows' milk‐free diets; however, the recommendations for riboflavin and calcium were still not met.

Conclusion: The results reveal a risk for malnutrition in children on cows' milk‐free diets, unless precautions are taken to replace the valuable nutrients from milk in the diet. Parents of children on milk‐free diets need advice about food choices in order to reduce the risk of low intake of energy, fat and protein. Supplements with calcium, vitamin D and riboflavin are indicated.
Abnormal fatty acid composition in umbilical cord blood of infants at high risk of atopic disease
Authors: Beck M , Zelczak G , Lentze MJ
Published: August 2010

It is well known that patients with atopic disease have anomalies of fatty acid composition in their blood. The aim of the present study was to evaluate whether infants from atopic families also have abnormal cord blood levels of long‐chain polyunsaturated fatty acids (LC‐PUFA) in plasma and red blood cells. The levels of LC‐PUFA in umbilical cord blood of 50 healthy, full‐term infants with a hereditary risk of atopic disease were analysed and compared with a control group of 50 infants from families without a history of atopic disease. The atopy group was comprised of children from families suffering from atopic dermatitis, allergic rhinitis, asthma bronchiale and food allergy. Within this group, a group (n= 11) was formed in which the risk was determined only by paternal atopy. Fatty acids of plasma and red blood cell phospholipids, triglycerides and sterol esters were separated by high‐resolution gas‐liquid chromatography. In particular, the levels of arachidonic acid (C20:4n‐6) and docosatetraenoic acid (C22:4n‐6) were significantly lower in infants at risk of atopic disease than in infants not at risk. Interestingly, there were more significant differences shown between the control group and the paternal atopy group than between the control group and the entire atopy group.

Conclusion: The results of this study could be due to a genetic influence of fatty acid metabolism or could reflect the different dietary behaviours of the mothers during pregnancy.
Consequences of infections for three‐month length increment in young children in rural Zambia
Authors: Hautvast JLA , Tolboom JJM , Willems JL , Mwela CM , Monnens LAH
Published: August 2010

It was the aim of this study to describe the relationship of infections with subsequent 3‐mo length increment in children below 2 y of age in rural Zambia. Children aged 6‐9 mo (‘infants’;n= 84) and 14‐20 mo (‘toddlers’;n= 81) attending Mother‐and‐Child Health clinics, were included and followed up after 3.0 mo (min‐max; 2.1‐3.7 mo). Anthropometric measurements were taken at each visit. At baseline, C‐reactive protein (CRP), α1‐acid glycoprotein (AGP), retinol and malaria parasitaemia were assessed. Length increment during the 3.0 ± 0.5 mo was 1.0 ± 0.5 cm/mo for infants and 0.6 ± 0.4 cm/mo for toddlers; 50‐71% of the children showed increased acute phase proteins, 79‐83% had malaria parasitaemia and 55‐64% had low serum retinol concentrations. In the total group of children, serum AGP concentrations (r= ‐0.18;p= 0.03) and serum CRP concentrations (r= ‐0.15;p= 0.05) showed a negative relation with length increment. After correcting for micronutrient status, dietary intake and maternal height, results of multiple regression analyses showed that the relation between serum AGP concentration and subsequent length increment remained significant.

We conclude that, within the multifactorial model, presence of infections in these Zambian children contributes to the short‐term retardation of linear growth.
Residual pulmonary hypertension in children after treatment with inhaled nitric oxide: a follow‐up study regarding cardiopulmonary and neurological symptoms
Authors: Göthberg S , Edberg KE , Tang SF , Michelsen S , Winberg P , Holmgren D , Miller O , Thaulow E , Lönnqvist P‐A
Published: August 2010

Inhaled nitric oxide is a potent vasodilator in acute severe pulmonary hypertension and is increasingly used as rescue treatment in intensive care algorithms aiming at reducing severe hypoxaemia in neonates and children. Although the immediate effects may seem impressive, long‐term outcome regarding residual pulmonary hypertension and other sequelae has been studied in only a very few patients. The aim of the present study was to evaluate residual pulmonary hypertension, cardiopulmonary or neurological symptoms in children after treatment with inhaled nitric oxide in severely hypoxaemic and/or pulmonary hypertensive mechanically ventilated children. The study was performed in four paediatric intensive care units in university hospitals in Sweden, Norway and Australia. Patients who had received inhaled nitric oxide as part of their intensive care treatment for severe hypoxaemia and/or pulmonary hypertension, and in whom 6 mo had elapsed since treatment, were included for evaluation. Thus 36 paediatric or neonatal patients were examined for circulatory, respiratory or neurological disorders with clinical examination, echocardiography, chest X‐ray and a capillary blood sample. Four patients with congenital heart disease had residual pulmonary hypertension. Nine patients were receiving bronchodilators. Sixteen patients had minor (n= 15) or moderate (n= 1) changes on a chest X‐ray. One patient had a possible delay in psychomotor development.

Conclusions: In spite of the severity of their primary illness, we found that the overwhelming majority of the surviving children were asymptomatic and doing well. The few residual circulatory and respiratory symptoms could be related to the initial condition.
HLA ‐ DQA1*05‐DQB 1*0201 positivity predisposes to coeliac disease in Czech diabetic children
Authors: Šumník Z , Koloušková S , Cinek O , Kotalová R , Vavřinec J , Snajderová M
Published: August 2010

The aims of this study were to estimate the prevalence of coeliac disease (CD) in Czech children with insulin dependent diabetes mellitus (IDDM), and to determine the contribution of HLA‐DQA1 and DQB1 to CD susceptibility among diabetic children. We screened 345 children with IDDM (186 boys and 159 girls, aged 0 to 18 y) for coeliac disease using the IgA endomysial antibodies (EMA) test. In all EMA‐positive children, small bowel biopsy was performed to confirm CD. To determine the role of the HLA‐DQA1*05‐DQB1*0201 (DQ2) and the DQA1*03‐DQB 1*0302 (DQ8) molecules in CD susceptibility among diabetic children, the HLA‐DQA1‐DQB1 was genotyped in all EMA‐positive, and in 186 of EMA‐negative diabetic patients. EMA positivity was found in 15/345 (4.3%) diabetic children. The diagnosis of CD was established in 14/345 (4.1%) children based on a bioptic finding of villous atrophy, while the remaining EMA‐positive patient had a normal bioptic finding, being diagnosed as a potential CD. The HLA DQA1*05‐DQB1*0201 (DQ2) molecule conferred a significant risk of CD among diabetic children (odds ratio = 4.1, CI 95% 1.1–15), being found more frequently in diabetic children with CD (80%) than in diabetic children without CD (49%).

Conclusion: The high prevalence of CD (4.1%) found in Czech children with IDDM emphasizes the need for their regular screening. We suggest that this CD screening protocol may be individualized according to the DQA1*05‐DQB 1*0201 positivity.
Early motor development of premature infants with birthweight less than 2000 grams
Authors: Pedersen SJ , Sommerfelt K , Markestad T
Published: August 2010

The aim was to assess motor function during infancy in order to predict later function, mainly cerebral palsy. The neuromotor development of a population‐based cohort of 209 of 236 (89%) survivors with a birthweight less than 2000 g was assessed using the Infant Neurological International Battery (INFANIB) and detailed neurological assessment. The infants were classified as being normal, dystonic, hypotonic or having suspected cerebral palsy (CP) at 4, 7, 13 and 18 mo corrected age if birthweight was less than 1500 g (n= 119) and at 7 and 13 mo if birthweight was 1500–1999 g (n= 90). Those with dystonia or suspected CP were followed until diagnosed as normal or as having CP after at least 36 mo of age. Fourteen (7%) finally developed CP. Motor function at 4 mo was inaccurate in predicting function at 7 mo and later. All who were normal at 7 mo remained normal in the follow‐up period. Eight of 65 who were dystonic at 7 mo developed suspected CP, and three judged as suspected CP were eventually normal. The 14 who developed CP were judged as suspected CP (n= 5) or dystonic (n= 8) and one as hypotonic at 7 mo of age.

Conclusions: The specificity of motor evaluation at 7 mo corrected age regarding CP is unsatisfactory, since dystonia at this age is most often transient. A normal neuromotor assessment at 7 mo is highly predictive of subsequent normal motor function.
Does maternal or paternal heredity affect carotid atherosclerosis in children with familial hypercholesterolaemia?
Authors: Tonstad S , Joakimsen O , Leren TP , Ose L
Published: August 2010

Maternal hypercholesterolaemia has recently been shown to increase the number of fatty streaks in the foetal aorta, as well as subsequent progression of fatty streaks to more advanced lesions. We compared carotid intima‐media thickness by B‐mode ultrasonography in children who inherited familial hypercholesterolaemia from their mothers or fathers, hypothesizing that children whose mothers were hypercholesterolaemic during pregnancy had increased atherogenesis compared with children whose mothers did not have familial hypercholesterolaemia.

We found that carotid intima‐media thickness and prevalence of plaque did not differ between children with familial hypercholesterolaemia who inherited FH maternally or paternally.
How do we identify hearing impairment in early childhood?
Authors: Hergils L
Published: August 2010

This review discusses the need for universal neonatal hearing screening. Historical background is given concerning conventional childhood hearing screening programmes in western countries. Direct studies on the effects of very early habilitation programmes on speech and language development are cited. Measurement of otoacoustic emissions (OAE) as a tool for neonatal hearing screening is presented. The state of neonatal hearing screening programmes in the US and in Europe, particularly in Sweden, is discussed.
The role of the Child Health Services in promoting mental health: an introduction
Authors: Wickberg B
Published: August 2010

This paper gives an introduction to the psychosocial work in the Swedish Child Health Services (CHS). There are substantial problems in defining and evaluating the preventive mental health work of the CHS. The issues raised include: why early preventive intervention is important; the promotion of parental mental health as an aim of the CHS; how the CHS can increase parenting knowledge and skills; what evidence there is about intervention among target groups; and finally, how recent research knowledge can be applied in the CHS.
The importance of the Child Health Services to the health of children
Authors: Sundelin C , Håkansson A
Published: August 2010

In September 1999, a state‐of‐the‐art conference was held in Sigtuna outside Stockholm, Sweden. The subject of the conference was the future of the Child Health Services. The approximately 40 participants included researchers from all professions with a link to child healthcare. The conference was prepared by a working committee consisting of Claes Sundelin (chairman), Uppsala, Sven Bremberg, Huddinge, Gisela Dahlqvist, Umeå, Kerstin Hedberg Nyqvist, Uppsala, Anders Håkansson, Malmö, Gunilla Lindmark, Uppsala, Birgitta Wickberg, Göteborg and Maria Nyström Peck (secretary), Stockholm. The state‐of‐the‐art report has recently been published by the National Council for Medical Research and is briefly summarized below.
Heart weight in infants—a comparison between Sudden Infant Death Syndrome and other causes of death
Authors: Råsten‐Almqvist P , Eksborg S , Rajs J
Published: August 2010

Heart and body weights were compared with regard to heart pathology and cause of death in well‐defined groups of infants under I y of age. In the period 1980 to 1998, out of 468 infants autopsied at the Department of Forensic Medicine in Stockholm, Sweden, 331 died of sudden infant death syndrome (SIDS), while 137 died of other causes. Physical violence was the known cause of death in 30 infants and cardiovascular malformations in another 19. Inflammatory alterations of the myocardium were found in 74 cases (16%): in 17 cases (3.6%) myocarditis was interpreted as the main cause of death; in 45 (10%) it was interpreted as contributing to SIDS and in 12 cases (2.5%) it was observed but judged not to be a contributory cause of death in non‐SIDS victims. Two of these infants died as a result of physical violence. Body weight was the best predictor for heart weight as analysed by multiple regression, including age, sex, body weight, length, BMI and birth weight. An equation for estimating heart weight from body weight gave an accuracy within the range 0.75–1.25 in 89.2% and 85.0% of the SIDS and non‐SIDS groups, respectively.

Conclusion: Body weight is the best predictor for estimating heart weight. No evidence supported the notion that heart weight, body weight or birth weight of SIDS victims differs from non‐SIDS, although heart weight in infants with cardiovascular malformations deviated from observations in the other groups.
Asn540Lys mutation in fibroblast growth factor receptor 3 and phenotype in hypochondroplasia
Authors: Grigelioniené G , Eklöf O , Laurencikas E , Ollars B , Hertel NT , Dumanski JP , Hagenäs L
Published: August 2010

Hypochondroplasia is characterized by a disproportionate short stature with rhizomelic shortening of the limbs. Amino acid substitutions Asn540Lys, Asn540Thr and Ile538Val in the fibroblast growth factor receptor 3 (FGFR3) are considered to cause hypochondroplasia. In this study we examined the FGFR3 gene for the previously described hypochondroplasia mutations and the phenotype of 23 probands with clinically and radiologically diagnosed hypochondroplasia. For the phenotype comparison, the patients were divided into two groups: Group 1: hypochondroplasia with Asn540Lys substitution; Group 2: hypochondroplasia with no mutations identified so far. A three‐generation family negative for the known hypochondroplasia mutations was examined with polymorphic markers flanking the FGFRI, FGFR2 and FGFR3 genes. Nine (39%) of 23 probands were found to be heterozygous for the Asn540Lys substitution. The individuals positive for the Asn540Lys substitution were significantly more disproportionate than the individuals without this mutation. In this respect, a genotype–phenotype correlation was found in our patients. However, some individuals belonging to the group without mutations identified so far showed similarly abnormal proportions. Genotyping/haplotyping in the three‐generation family with hypochondroplasia showed that FGFR1, FGFR2 and FGFR3 genes were not linked to the hypochondroplasia phenotype in this family, thus further confirming the genetic heterogeneity of hypochondroplasia.

Conclusion: Individuals with hypochondroplasia heterozygous for the Asn540Lys substitution are significantly more disproportionate than individuals without this mutation. Our study further confirms the clinical and genetic heterogeneity of hypochondroplasia.
Topographic mapping of brain potentials in the newborn infant: the establishment of normal values and utility in assessing infants with neurological injury
Authors: Mandelbaum DE , Krawciw N , Assing E , Ostfeld B , Washburn D , Rosenfeld D , Hiatt M , Hegyi T
Published: August 2010

Aim: To demonstrate that quantitative EEG (qEEG) can be used as a non‐invasive measure of brain injury by establishing normative data in term infants and contrasting it with other modalities of brain imaging. Design: qEEG during quiet sleep was performed on 13 healthy full‐term infants comprising a normal group and on 10 infants with neurological abnormalities identified on brain imaging studies (abnormal group) at 36–47 wk postconceptional age. Quantitative analysis was performed and topographic maps were produced for each patient. The EEG data from the normal group, after spectral analysis, yielded power data in the delta, theta, alpha, and beta frequency bands and coherence information, which then formed the normative database. qEEG from the infants in the abnormal group was then compared to this normative data. Results: The normal group's mean absolute power in the delta, theta, alpha, and beta bands for all EEG leads combined were 278.48 ± 83.83, 31.71 ± 10.12, 29.20 ± 2.04, and 35.76 ± 11.35 uv2, respectively. The median frequency was 1.49 ± 0.07, 5.45 ± 3.46, 9.74 ± 5.11, and 18.01 ± 3.38 Hz, respectively. The qEEG was abnormal in all 10 study infants, while abnormalities were noted in the clinical EEG in 4 of 10, in the neuroultrasound in 5 of 10, in the CT in one of 6, and in the MRI in 2 of 2 tested.

Conclusions: qEEG appears to be a usefd non‐invasive method for measuring brain injury as it correlates well with other modalities of brain imaging and, if corroborated by further study, may, in fact, be more sensitive in determining abnormalities in brain function.
Risk factors for perinatal mortality in West Africa: a population‐based study of 20 326 pregnancies
Authors: Chalumeau M , Salanave B , Bouvier‐Colle M‐H , de Bernis L , Prua A , Bréart G
Published: August 2010

The aim of the study was to identify simple clinical risk factors for perinatal mortality (PNM) in different areas of West Africa, to quantify their prevalence among pregnant women and to estimate their relative contribution in the definition of high‐risk status of PNM. The MOMA study was a prospective population‐based study in which data were collected on 20 326 pregnant women in various, primarily urban, areas of Burkina Faso, Ivory Coast, Mali, Mauritania, Niger and Senegal. The present report analyses 19 870 singleton births and 31 simple clinical variables with univariate and multivariate methods. The mean PNM ratio was 42 per 1000 total births, and 62% of these deaths were stillbirths. In the crude analysis, after adjustment or taking prevalence into account, the principal risk factors were: vaginal bleeding (immediately antenatal and intrapartum), hypertension (especially during labour), dynamic (prolonged labour and use of oxytocin) and mechanic (non‐cephalic presentation) dystocia, and infection (prolonged rupture of the membranes and intrapartum fever).

Conclusions: Most of the principal risk factors for PNM cannot be detected during antenatal care visits but only in early labour. High‐risk status should not be based solely on antenatal care visits, but should also take into account monitoring during labour.
Establishment of intestinal microbial functions at birth: bilirubin and bacteria
Authors: Midtvedt T
Published: August 2010

At birth, several “cross‐talks” are rapidly established between the child and its developing microflora. Bile pigments and bile acids represent host‐derived compounds that are acted upon by this microflora, thereby creating possibilities for several cross‐talks of both physiological and pathophysiological importance. The major aim of this article was to characterize and quantitate individually the bilirubin pigments by newly developed methods. The results clearly demonstrate that quantitative and qualitative alterations in bilirubin metabolism occur shortly after birth.

Conclusion: It is hoped that the methodological improvements will create new interest in bilirubin and its metabolism in early infancy.
Effect of gender in response to an aerobic training programme in prepubertal children
Authors: Mandigout S , Lecoq AM , Courteix D , Guenon P , Obert P
Published: August 2010

The aim of the present study was to investigate the gender effect of an endurance training programme on the maximal oxygen uptake (VO2max) of prepubertal children. The subjects comprised eighty‐five 10–11‐y‐old prepubertal children: 35 (17 girls, 18 boys; EG) were involved in a 13‐wk running training programme and 50 (22 girls, 28 boys; CG) served as a control group. Each subject carried out a continuous and progressive cycle ergometer test before and after the 13‐wk study period under the same conditions and procedures. Oxygen consumption, carbon dioxide, ventilation and heart rate (HR) were continuously monitored during the test The training programme consisted of interval and continuous long‐distance running (frequency: 3 times a week duration: 1 h per session, intensity: higher than 80% of maximal HR). VO2max significantly increased after the training programme for EG (before = 42.3 ± 7.7, after = 45.3 ± 7.5 ml.min‐1. kg‐1, p < 0.01), while no alterations were noticed for CG (before = 43.1 ± 6.7, after = 42.6 ±7.6ml.min‐1.kg‐1, p < 0.01). Such an increase was higher in the girls (+9.1%) than the boys (+4.6%). The lower initial fitness of the girls could explain this, however, because a significant relationship was found between the percentage of VO2max increase after training and the initial VO2max.

The present longitudinal study shows that maximal oxygen uptake can increase in prepubertal children after an aerobic training programme and that such an increase is of the same order in boys and girls when the initial aerobic fitness is taken into account.
Incidence rate of recurrent Kawasaki disease and related risk factors: from the results of nationwide surveys of Kawasaki disease in Japan
Authors: Hirata S , Nakamura Y , Yanagawa H
Published: August 2010

To investigate the incidence of recurrent Kawasaki disease, and to discuss some of the potential risk factors, data of the 13th and 14th nationwide surveys of Kawasaki disease in Japan were analyzed. To calculate the rate of recurrence, 10 679 patients with 31 501.9 person‐years were observed. The mean observation period was 2.95 y. The rate of recurrence was 6.89 per 1000 person‐years, with a high incidence within the 12 mo following the first episode.

Conclusion: The incidence was high among those under 3 y of age and those with cardiac sequelae during the first episode. None of the other factors affected the incidence.
The Paediatric Asthma Caregiver's Quality of Life Questionnaire in Swedish parents
Authors: Reichenberg K , Broberg AG
Published: August 2010

With the Paediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ), parents grade impaired activities (5 items) and emotional concern (8 items) from 1 to 7 regarding how much their own quality of life (QoL) has been affected by the disease of their child during the last week. The questionnaire was translated into Swedish. To test the feasibility and validity of the Swedish version, 71 asthmatic children and their families were approached. Sixty‐one families (86%) participated. The mean age of the children was 8.7 y. Parental grading of symptoms (Spearman's rho = 0 637, p < 0.001), the asthma‐specific QoL of the child (rho = 0.359, p = 0 002) and gradings of asthma from medical records (mild asthma median score 6.69, moderate 6.27 and severe 5.12, p= 0.001) were all related to overall PACQLQ scores.

The sex of the child, the presence of other diseases related to allergy, peak flow rate (PEFR) and socio‐economic level did not affect the scores. Lower scores in the emotional domain were seen in parents of children on steroids (p = 0.049). The distribution of scores was heavily skewed towards the positive end of the scale, leading to limited power to discriminate among parents of children with mild asthma. The instrument had good internal consistency and was well accepted by the parents.
Breastfeeding duration and previous breastfeeding experience
Authors: Nagy E , Orvos H , Pál A , Kovács L , Loveland K
Published: August 2010

The aim of this study was to examine the effect of duration of earlier breastfeeding on the duration of breastfeeding with subsequent births. Medical records of 327 women who had had at least two deliveries were analysed; 89 of these women had had three deliveries. The average duration of breastfeeding increased from 6.01 mo to 6.85 mo with the second baby, but did not increase significantly with the third. A significant negative correlation was found between duration of first breastfeeding and change of breastfeeding duration at the second breastfeeding. Mothers who breastfed their first child for 0–7 mo significantly increased the duration of breastfeeding with the second child, whereas mothers who breastfed their firstborn for 8 mo or longer significantly reduced breastfeeding with the second baby.

Conclusion: Results support earlier studies showing that duration of breastfeeding of the second child is significantly related to previous breastfeeding experience. Results also suggest that previous breastfeeding experience may lead mothers to regulate duration of subsequent breastfeeding toward a level that is optimal for them. The results are interpreted with respect to societal changes in breastfeeding patterns, as well as the role of maternal learning in breastfeeding behaviour.
Socio‐demographic risk factors for home‐type injuries in Swedish infants and toddlers
Authors: Hjern A , Ringbäck‐Weitoft G , Andersson R
Published: August 2010

In this paper we use data from Swedish national registers to study socio‐demographic patterns of hospital admissions as a result of injuries sustained at home (poisoning, falls, scalding and ingestion/intrusion of foreign objects) in children 0–3 y. The study population comprised 546 336 children born in Sweden during the period 1987–91. The different injury mechanisms peaked at different ages: ingestion of foreign objects at 10–12 mo, scald injuries at 13–15 mo, non‐drug poisoning at 16–18 mo and drug poisoning at 24–30 mo. In a multivariate analysis it was demonstrated that children of young mothers (<24 y) were more likely to have been admitted to hospital because of fall injuries and poisonings, while children with more than two siblings had a slightly increased risk for all injuries. Children of mothers born in a non‐western country were more likely to have been admitted to hospital because of scald injuries; odds ratio (OR) 1.7 (95% CI: 1.4–2.1), while they were less likely to have been admitted because of fall injuries; OR 0.8 (0.7–0.8) and non‐drug poisoning; OR 0.5 (0.4–0.6). Children in families who received social welfare benefits were more likely to have been admitted to hospital because of fall injuries; OR 1.3 (1.2–1.4), drug poisoning; OR 1.8 (1.7–2.0), non‐drug poisoning; OR 1.4 (1.3–15) and scald injuries; OR 1.1 (1.1–1.5), while injuries with ingestion/intrusion of foreign objects tended to vary little with socio‐economic indicators.

Conclusion: Infants and toddlers in families with young mothers and in families on social welfare are at particular risk for home injuries in Sweden. The knowledge that the risk of poisoning, scalding and ingestion of foreign objects is related to specific ages can be used in timing of parent counselling.
Bilirubin‐IX α and ‐IX β pigments, coproporphyrins and bile acids in meconium and stools from full‐term and preterm neonates during the first month of life
Authors: Aziz S , Kotal P , Leroy P , Servaes R , Eggermont E , Fevery J
Published: August 2010

Individual bilirubin pigments in the excreta were quantitated by newly developed methods. In meconium, bilirubin‐IX β predominated, whereas bilirubin‐IXγ and ‐IXδ remained undetectable. The daily excretion of bilirubin‐IXα plus ‐IXβ was 0.03–1.00 and 0.04–2.00 μmoles kg1 of birthweight in preterm and full‐term infants, respectively. The ratio of bilirubin‐IXα to ‐ IXβ in meconium was 0.25 ± 0.34, 0.32 ± 0.30 and 0.46 ± 0.55 in newborns of gestational ages below 30, from 31 to 36 and above 36 wk, respectively. The predominance of bilirubin‐IXβ disappeared within the first week in those with gestational age ± 31 wk but more slowly in the very preterm group. The ratio of monoconjugated to diconjugated bilirubin‐IXα was 4 to 5 in full‐term infants, whereas this ratio was only reached after 1 mo in preterm infants. The ratio of glucuronide or glucoside to xyloside varied widely, independent of gestational age. No correlation between faecal UCB‐IXα and β‐glucuronidase was observed. The daily coproporphyrin excretion fell from a median of 500 μg on day 1 to below 20 μg from day 7 onwards; this decrease correlated with that of bilirubin‐IXβ. The daily 3α‐hydroxylated bile acid loss in the excreta was two‐ to fivefold higher than in the adult; this, together with the higher neonatal serum levels (12–90 nmoles ml‐1), indicates an immature intestinal reabsorption and an enhanced bile acid synthesis.

Conclusion: Both zinc coproporphyrin and bilirubin‐IXβ are characteristic compounds of human meconium, diconjugated bilirubin‐IXα is low or absent in meconium of very preterm infants, and faecal and serum bile acids are high.