bluuebunny/crossref_metadata_2025 huggingface dataset:
Acid steatocrit: a reliable screening tool for steatorrhea
Authors: Van den Neucker AM , Kerkvliet EM , Theunissen PMVM , Forget P‐Ph
Published: August 2010

This study compared the acid steatocrit (AS) results of healthy children with those of sick children with and without gastrointestinal involvement. Stool samples of 166 children were investigated, comprising 50 healthy children, 26 asthma patients, and 90 patients with gastrointestinal problems divided into 34 treated cystic fibrosis (CF) patients with exocrine pancreatic insufficiency, 16 untreated coeliac disease (CD) patients and 40 patients with various gastrointestinal problems. The median values (5th–95th percentile) of AS results were 3.3% (0.0–21%) for healthy children, 4.5% (1.8–22.5%) for asthma patients, 24.7% (2.6–68.2%) for treated CF patients with exocrine pancreatic insufficiency, 19.8% (3–77.7%) for untreated CD patients and 5.5% (1.8–29%) for patients with various gastrointestinal diseases.

Conclusion: The AS results of treated CF patients with exocrine pancreatic insufficiency and untreated CD patients were similar and significantly higher than those of healthy children and asthma patients. AS can be considered to be a reliable tool in screening for steatorrhoea in paediatric patients.
Effect of enteral nutrition on antioxidant enzyme systems and inflammation in paediatric Crohn's disease
Authors: Phylactos AC , Fasoula IN , Arnaud‐Battandier F , Walker‐Smith JA , Fell JM
Published: August 2010

Crohn's disease is characterized by chronic inflammation of the gastrointestinal mucosa, which can be successfully treated with enteral nutrition. In this study, the activities of the antioxidant metalloenzymes copper/zinc‐superoxide dismutase (Cu/Zn‐SOD) and selenium‐glutathione peroxidase (Se‐GPx) were determined in erythrocyte lysates from children with Crohn's disease. Both enzymes exhibited significantly lower activities relative to healthy control subjects: 1.55 ±0.33 vs 2.13 ±0.75 SOD Umg‐1 protein (p < 0.025) for Cu/Zn‐SOD, and 61.9 ±17.7 vs 93.6 ±28.7 mUmg‐1 protein (p<0.01) for Se‐GPx. Treatment of patients with a specific polymeric diet, CT3211, for a period of 8 wk did not significantly alter the activities of the enzymes. In contrast, clinically, enteral nutritional therapy induced a remission in 13/14 children, and a significant fall in both median serum C‐reactive protein and mean serum tumour necrosis factor‐a levels.

Conclusion: The results imply that the anti‐inflammatory action of enteral nutrition in Crohn's disease is caused by a mechanism other than restitution of these antioxidant enzymes.
Growth hormone treatment in children with Noonan's syndrome: four year results of a partly controlled trial
Authors: Noordam C , van der Burgt I , Sengers RCA , de Waal HA Delemarre‐van , Otten BJ
Published: August 2010

The aim of the study was to evaluate the effect of continuous and discontinuous growth hormone treatment in Noonan's syndrome (NS) on linear growth and bone maturation. Thirty‐seven children with NS aged between 5.4 and 17.5 y were treated with growth hormone (GH) in a dose of 0.15 IUkg−1 per day; 23 of these children were randomly assigned to one of 2 groups in a 3 y partly controlled prospective multicentre study. Group A (n= 8) immediately started GH treatment and after 2 y discontinued GH treatment for 1 y; group B (n= 15) served as a control group during the first year and started GH treatment after 1 y. After the 3 y study period, 17 out of the 23 children continued GH treatment. An additional 14 children (group C) were treated according to the same protocol, but without discontinuation of GH treatment. The effect of GH treatment for up to 3 y was evaluated in terms of gain in height standard deviation score H‐SDS) for calendar age and for bone age. Gain in H‐SDS over the first year was significantly higher in the GH treatment group (+0.5) than in the non‐treated group (+0.0); mean bone maturation was significantly faster in the GH treatment group (1.2 vs 0.5 y/y) Discontinuation in group A in the third study year resulted in catch‐down growth (mean Δ H‐SDS ‐0.2). Over 3 y of GH treatment, mean AH‐SDS for calendar age was not significantly different between discontinuous (A: +0.8) and continuous treatment (B: +0.8; C: +1.2). Mean gain in H‐SDS for bone age in the 3 groups (+0.2, 0.0, +0.3) was minimal after 3 y of GH treatment.

Conclusion: This study confirmed the gain in H‐SDS CA in Noonan's syndrome during long‐term GH treatment. However, the accelerating effect of GH on bone maturation seemed to compromise the final height prognosis.
Effect of short‐term antenatal dexamethasone administration on type I collagen synthesis and degradation in preterm infants at birth
Authors: Saarela T , Risteli J , Kauppila A , Koivisto Maila
Published: August 2010

To assess the effects of antenatal corticoid administration on foetal collagen metabolism, cord serum concentrations of the aminoterminal propeptide and carboxyterminal telopeptide of type I procollagen (PINP and ICTP), which reflect rates of type I collagen synthesis and degradation, respectively, were measured in 67 consecutive preterm infants with gestational ages ranging from 24 to 32 wk. The samples were divided into three groups, depending on the administration and timing of antenatal corticosteroid treatment for enhancement of foetal lung maturity: cases in which the mothers had received a full 2‐dose administration of dexamethasone on consecutive days 1 to 6 d before delivery (n= 23; Complete‐Dexa), those who had received only a single dose of dexamethasone less than 24 h before delivery (n=17; Partial‐Dexa) and those who had not received any antenatal steroids (n= 27; No‐Dexa). Infants in the Complete‐Dexa group had significantly lower median PINP levels than those in the No‐Dexa group (3326 vs 4028 ug/l; p = 0.036); the median PINP level in the Partial‐Dexa group (3999 ug/l) was close to that of the No‐Dexa group. No significant differences in ICTP concentrations were seen between the groups.

Conclusion: A significant suppression of foetal collagen synthesis but not degradation was found to be associated with antenatal dexamethasone administration. This should be taken into consideration, e.g. when assessing whether to administer repeated or single courses of corticosteroids antenatally in high‐risk pregnancies.
Impact of smoking on the duration of breastfeeding in mothers with insulin‐dependent diabetes mellitus
Authors: Knudsen A , Pedersen H , Klebe JG
Published: August 2010

The effect of smoking on breastfeeding was studied in 252 mothers with insulin‐dependent diabetes mellitus (IDDM) giving birth in the period 1985–1995 and of whom 31% were classified as White group B, 16% group C, 37% group D and 16% group F or R. As part of a centralized regimen a detailed smoking history was taken during pregnancy Forty‐six percent were smokers. In 1997, a questionnaire was sent out asking for information on the duration of breastfeeding. The response rate was 87%. The duration of breastfeeding was significantly longer in the non‐smoking group (p= 0.004). Fifty‐five percent of non‐smokers versus 33% of smokers were still breastfeeding 4 mo after birth. A strong dose‐response relationship was established (p= 0.009). Cox multiple regression analysis showed a significantly negative influence of smoking (p= 0.01) and of hospitalization of the infants during the first year of life (p= 0.02) and a significantly positive influence of maternal age (p= 0.02) and birthweight (p= 0.03) on the length of breastfeeding. The breastfeeding curves for non‐smokers and smokers were mainly divergent in the first month after birth, suggesting that the effect of smoking on breastfeeding is mainly exerted during that period.

Conclusion: Smoking exerted a strong, negative, dose‐dependent influence on breastfeeding duration in mothers with IDDM. Given the hazards of smoking, the advantages of breastfeeding and the possible link between being breastfed and later development of diabetes mellitus, these results should be taken into consideration when counselling pregnant women with IDDM about smoking.
Information and socioeconomic factors associated with early breastfeeding practices in rural and urban Morogoro, Tanzania
Authors: Shirima R , Gebre‐Medhin M , Greiner T
Published: August 2010

A cross‐sectional study was undertaken in a rural and an urban area in Tanzania with the aim of identifying factors related to early infant feeding practices. The study included 320 mothers from each area with infants below 7 mo of age. A significant proportion of both rural and urban mothers had erroneous beliefs about infant feeding practices. None of the socioeconomic, demographic or biological variables studied were associated with feeding practices. Urban residence was positively associated with the duration of exclusive but not predominant breastfeeding. Better knowledge about specific breastfeeding issues was positively associated with the duration of both exclusive and predominant breastfeeding. Ownership of a radio was positively associated with both exclusive and predominant breastfeeding in the rural area. Although both rural and urban mothers had a high antenatal clinic attendance rate, 65% of the rural and 14% of the urban mothers delivered at home. Urban mothers informed about breastfeeding at the antenatal clinic had better feeding practices.

Conclusion:We hypothesize that exclusive breastfeeding is not a traditionally recognized practice and thus its duration is mainly associated with information and knowledge about breastfeeding. This suggests that information programmes to provide knowledge, beginning at antenatal visits, may reduce premature complementation, though additional support may also be required.
Arterial air embolism after venous air infusion in newborn piglets
Authors: Juvik E , Solligård E , Brubakk A‐O , Brubakk A‐M
Published: August 2010

In the newborn period, decreased right atrial pressure results in functional closure of the foramen ovale (FO). The objective of this study was to investigate whether air bubbles infused in the vena cava will pass through the FO into the arterial circulation in a newborn animal. Since air tends to rise to the highest point in a fluid, the study also investigated whether the animal's position could influence arterialization of air. Twelve 1‐3‐d‐old piglets were anaesthetized and mechanically ventilated, and had catheters placed in the vena cava for infusion of air, in the aorta for blood gas and blood pressure measurements, and in the pulmonary artery for pressure measurements. After stabilization, 0.05 ml kg1 per minute of air was infused for 25 min followed by a 3 h observation period. Six piglets were placed in the left, and six in the right lateral recumbent position. Air bubbles in the left atrium or ventricle was monitored by echocardiography. Ultrasound Doppler probes were placed on both carotid arteries for detection of air embolism. Gas bubbles were detected in the left ventricle within 45 s of air infusion in 11 of 12 piglets. Eight piglets had air bubbles in the carotid arteries. Mean pulmonary arterial pressure (PAP) increased significantly after 1 min of air infusion, whereas mean systemic arterial pressure remained unchanged. When arterial air embolism occurred, PAP had not increased significantly. The time to reach maximum PAP with the animals in the left recumbent position was significantly shorter than in the right.

Conclusion: This study shows that venous gas bubbles enter the arterial circulation through the FO in newborn piglets and that body position may influence the haemodynamic effect of these bubbles.
Defecation problems in children with Hirschsprung's disease: a prospective controlled study of a multidisciplinary behavioural treatment
Authors: van Kuyk EM , Brugman‐Boezeman ATM , Wissink‐Essink M , Oerlemans HM , Severijnen RSVM , Bleijenberg G
Published: August 2010

Constipation, faecal incontinence, soiling and difficult toilet training remain significant problems in children with Hirschsprung's disease after corrective surgery. Chronic defecation problems can have various negative implications. At the University Medical Centre Nijmegen, a multidisciplinary behavioural treatment was developed to treat defecation problems. In this paper, a prospective controlled study is presented concerning the effect of this treatment upon children suffering from chronic defecation problems following corrective surgery for Hirschsprung's disease. The effect of treatment was studied in 27 children (21M, 6F, mean age 5.2 y, range 2–11 y). Fourteen children were allocated to the experimental treatment group. The 13 children allocated to the waiting‐list control group were also treated following a waiting period of 6 mo. On all outcome variables, children in the experimental treatment group had significantly better results after treatment than children in the waiting‐list control group after the waiting period. No effect of age upon treatment was found. The effect of treatment remained significant on all outcome variables at a mean follow‐up of 7 mo after the end of treatment.

Conclusion: Multidisciplinary behavioural treatment is successful in decreasing chronic defecation problems in children with Hirschsprung's disease.
Diagnostic accuracy of the atopy patch test and the skin‐prick test for the diagnosis of food allergy in young children with atopic eczema/dermatitis syndrome
Authors: Strömberg L
Published: August 2010

Aim: To evaluate the diagnostic value of the skin‐prick test and the atopy patch test in diagnosing basic food allergy in young children suffering from atopic eczema/dermatitis syndrome. Methods: 141 children, the majority under 2y of age (mean 16 mo) with atopic eczema/dermatitis syndrome were investigated using skin‐prick and atopy patch tests for milk, egg, wheat and rye. Open diagnostic elimination challenge was done since this has been reported to be a reliable method in young children. Results: A positive challenge response was found to milk in 63 (45%), egg in 78 (55%), wheat in 61 (43%) and rye in 61 (43%). Sensitivity/specificity of the atopy patch test was 60%/97% for milk, 71%/97% for egg, 90%/94% for wheat and 93%/90% for rye. For the skin‐prick test the corresponding figures were 41%/99%, 60%/97%, 13%/98% and 15%/99%.

Conclusion: Patch testing was found to be a more sensitive method than the skin‐prick test in diagnosing food allergy in children with atopic eczema/dermatitis syndrome, especially in those under 2 y of age. Many children with a negative skin‐prick test result have a positive patch test result, especially in the case of cereals. A diagnosis of food allergy should be confirmed by elimination and in the research setting also by challenge.
Septicaemia and meningitis in neonates and during early infancy in the Göteborg area of Sweden
Authors: Persson E , Trollfors B , Brandberg L Lind , Tessin I
Published: August 2010

In a retrospective study of neonatal septicaemia and meningitis carried out in 1987–1996 in the Göteborg area of Sweden, 305 cases during the first 28 d of life were found. The incidence was 3.7/1000 live births, which was higher than that found in a study from 1975 to 1986 in the same area, 2.8/1000 live births. The most common pathogens were group B streptococci, aerobic Gram‐negative rods, Staphylococcus aureus and enterococci. The cases were approximately equally divided between very early, early and late onset infections. The case‐fatality rate was lower in the present study (9%) than that in the previous study (15%). The case‐fatality rate varied between 23% in neonates with a gestational age of ≤29 wk and 3% in full‐term neonates. Eighty‐three very late onset infections occurred between days 28 and 120 after birth, corresponding to an incidence of 1.0/1000 live births. Of those, 47 occurred in preterm neonates. The most common organisms were aerobic Gram‐negative rods. Coagulase‐negative staphylococci (CoNS) were studied separately. This organism was isolated in 60 and 32 cases during the first 28 d of life and between days 28 and 120, respectively, in neonates fulfilling the criteria of the Yale‐New Haven Hospital for infections caused by commensal species. The incidence rates of CoNS infections were 0.7 and 0.4/1000 live births, respectively.

Conclusion: The incidence of neonatal infections increased and the case‐fatality rate decreased in the Göteborg area compared to the findings of a previous study. Very late onset infections should be added to the total burden of neonatal infections. CoNS are important pathogens but their role is difficult to determine since they are both pathogens and contaminants of cultures from blood and cerebrospinal fluid.
Decreased interleukin‐10 in tracheal aspirates from preterm infants developing chronic lung disease
Authors: Oei J , Lui K , Wang H , Henry R
Published: August 2010

The inability to balance pulmonary injury with healing may predispose preterm infants to chronic lung disease (CLD). It is postulated that the production of interleukin (IL)‐10, an anti‐inflammatory cytokine, is gestationally influenced and that CLD‐prone infants may have a reduced ability to produce IL‐10. Methods: Tracheal fluid (TF) was collected at least twice weekly from 48 mechanically ventilated infants within the first 7 d of life while intubated. Results: A total of 87 TF specimens were obtained. None of the 11 CLD infants (24‐31 wk of gestation) had TF IL‐10 levels above 4 pg/ml (0/20 TF specimens), while 14 (70%) of the 20 non‐CLD preterm infants (27–36 wk of gestation) had IL‐10 levels above 5 pg/ml in one or more of their TF specimens (18/48 TF specimens, p < 0.001). Only the 5 term infants who were ventilated for severe lung disease had raised IL‐10 levels (17 infants, 5/19 TF specimens). IL‐10 levels, if detected, (range 6‐938 pg/ml) tended to be higher with increasing gestation (Spearman's rho coefficient = 0.43; p= 0.003). TF IL‐10 detection was not associated with hyaline membrane disease, antenatal steroids or influenced by TF sample volume. Overall IL‐8 levels were wide ranging but towards the end of week 1 the levels were significantly higher in CLD infants (CLD: median 34 184 ng/ml, preterm non‐CLD: median 699 ng/ml, p < 0.001, term: 2961 ng/ml, p= 0.028).

Conclusion: A gestationally influenced low IL‐10 may predispose preterm infants to persistent pulmonary inflammation of CLD.
Comparative outcome study between triplet and singleton preterm newborns
Authors: Maayan‐Metzger A , Naor N , Sirota L
Published: August 2010

Aim: To evaluate the outcome of triplet versus singleton preterm newborns. Methods: The study population included 64 sets of preterm triplet (gestational age 25‐34 wk) and 64 singleton controls. Data on prenatal and perinatal findings, neonatal complications, duration of hospitalization, and neonatal mortality were collected by chart review. Results: Mothers of triplets were more likely to receive prenatal tocolytic treatment and more antenatal steroids for foetal lung maturation, and to be delivered by caesarean section. No differences were found between the groups in perinatal parameters (cord pH, Apgar score, respiratory support after birth), respiratory parameters (severity of acute and chronic lung disease, use and duration of oxygen treatment and assisted ventilation), or neonatal complications (patent ductus arteriosus, intraventricular haemorrhage, periventricular leukomalacia, necrotizing enterocolitis, retinopathy of prematurity, meningitis, sepsis and jaundice). This was also true for duration of hospitalization and neonatal mortality. No differences were recorded by birth order among the triplets for any of these parameters.

Conclusion: The study indicates that good prenatal care can lead to a good outcome for preterm triplets, close to that of preterm singleton infants. Families and physicians should consider this information when foetal reduction is offered.
Epidemiology of invasive Streptococcus pneumoniae infections in children in an area of Barcelona, Spain
Authors: Pineda V , Fontanals D , Larramona H , Domingo M , Anton J , Segura F
Published: August 2010

Aim: Streptococcus pneumoniae is the most common cause of bacteraemia, pneumonia, sinusitis and acute otitis media. With the advent of conjugate vaccines, there is now the possibility of preventing disease caused by this organism. However, little is known about the epidemiology of invasive pneumococcal disease in children in Spain. The aim of this study was to determine the incidence and the clinical and microbiologic characteristics of invasive pneumococcal disease in Sabadell, an industrial area in the province of Barcelona, Spain. Methods: From January 1990 to December 2000, the case records of children with pneumococcal invasive disease at Sabadell Hospital were retrospectively (1990–1996) reviewed and prospectively (1997–2000) collected. The hospital serves a population of 61 143 children under 15 y of age, 18 073 children under 4y of age and 7300 children under 2 y of age. Results: A total of 112 children (54% under 24 mo of age and 93% under 6 y of age) with invasive pneumococcal disease were diagnosed during a period of 11 y. The incidence of invasive pneumococcal disease was 76 per 100000 for children aged 0 to 24 mo, 45 for children aged 0–48 mo and 16.6 for children aged 0‐14 y. Occult bacteraemia was the most common manifestation of invasive pneumococcal disease (66 cases), pneumonia was the second form (34 cases) and meningitis (10 cases) and arthritis (2 cases) were the other clinical manifestations. Of the 105 strains tested, 8.6% were highly penicillin resistant, 37.1% were intermediately penicillin resistant, 16.2% were intermediately cefotaxime resistant and 32.4% were erythromycin resistant. Pneumococci of serogroups 6, 14, 18, 19, 1, 5, 4, 9, 23 and 33 were the most frequently isolated groups (92%) but only 6, 9, 14, 19 and 23 were resistant to penicillin, cefotaxime, or erythromycin.

Conclusions. In this study the incidence of invasive pneumococcal disease was found to be greater than that reported elsewhere in Spain and Europe. Penicillin resistance levels are high but the trend towards increasing penicillin resistance may have ended over the past few years. The currently licensed seven‐valent (7‐V) pneumococcal conjugate vaccine would cover 78% of cases of invasive pneumococcal in children aged 0–14 y, 80% in children aged 0–24 mo and 100% of cases of penicillin‐ or cefotaxime‐resistant invasive pneumococcal disease.
Origins of reactive airways disease in early life: do viral infections play a role?
Authors: Piedimonte G
Published: August 2010

There is mounting evidence suggesting that infection with respiratory syncytial virus (RSV) in early life increases the risk of developing reactive airway disease (RAD) later in childhood. A recent prospective study demonstrated that children hospitalized with RSV bronchiolitis in infancy face a significantly increased risk of recurrent wheezing and allergy at least until the age of 7 y that is independent of hereditary factors. Proposed mechanisms for this link include immune dysregulation, in which RSV‐specific IgE or an imbalance between T‐lymphocyte‐dependent immune pathways may be involved, and abnormal neural control, in which the non‐adrenergic, non‐cholinergic pathways are altered by RSV infection. More recent studies suggest that immune and neural mechanisms may be linked and that post‐RSV airway inflammation may be explained, at least in part, on the basis of these neuroimmune interactions.

Conclusion: Passive immunoprophylaxis may protect against persistent viral‐induced inflammation of the respiratory tract, long‐term changes in pulmonary function and increased frequency of RAD episodes.
Nature and extent of gastric lesions in symptomatic Chilean children with Helicobacter prylori‐associated gastritis
Authors: Guiraldes E , Peña A , Duarte I , Triviño X , Schultz M , Larraín F , Espinosa MN , Harris P
Published: August 2010

Chile has one of the highest rates of gastric cancer in the world and most children and adolescents in the country are colonized by Helicobacter pylori. This study assessed the nature and extent of the gastric lesions in 73 consecutive patients aged 5‐17 y, referred for upper gastrointestinal endoscopy. Their H. pylori‐associated gastric pathology was characterized and these data were compared with their sociodemographic status. Endoscopic assessment was normal in 43 patients while in 30 there was a variety of mucosal lesions. Sixty patients (83%) had histological chronic gastritis of the antrum and in 45 (63%) the lesions also involved the gastric corpus; 90% of patients with chronic gastritis were colonized by H. pylori. Although most of these patients had epithelial erosions and dedifferentiation of the pit epithelium, atrophy and metaplasia were not found. Patients' socioeconomic status was inversely correlated with their rate of colonization by H. pylori (p < 0.005), the frequency of gastric lesions on endoscopy (p < 0.01) and the frequency of involvement of antral and corpus mucosa by chronic gastritis (p < 0.002). This latter feature was positively correlated with age (p < 0.001).

Conclusion: This study shows a high frequency of extensive lesions of H. pylori‐associated chronic gastritis in young Chilean patients. This histological picture is consistent with the hypothesis of a H. pylori‐associated progressive gastric pathology which may represent a major factor in the high local rate of gastric cancer.
Faecal calprotectin levels in infants with infantile colic, healthy infants, children with inflammatory bowel disease, children with recurrent abdominal pain and healthy children
Authors: Olafsdottir E , Aksnes L , Fluge G , Berstad A
Published: August 2010

This study investigated faecal calprotectin concentration, a measure of intestinal inflammation, in infants and children with abdominal pain. Faecal calprotectin was measured by an enzyme‐linked immunosorbent assay kit in spot stool samples in 76 infants with typical infantile colic, 7 infants with transient lactose intolerance and 27 healthy infants. All infants were 2‐10 wk of age. In addition, 19 children with recurrent abdominal pain (RAP; mean age 11.5 y), 17 with inflammatory bowel disease (IBD; mean age 11.1 y; 10 had Crohn's disease and 7 ulcerative colitis) and 24 healthy children (mean age 5.3 y) were studied. In infants with infantile colic the mean faecal calprotectin concentration was not different from that in healthy infants (278 ± 105 vs 277 ± 109 mg kg−1, p= 0.97) or in infants with transient lactose intolerance (300.3 ± 124 mg kg−1, p= 0.60). The calprotectin level was similar in boys and girls and fell significantly with age (p = 0.04). Children with IBD had faecal calprotectin levels (293 ± 218 mgkg−1) much higher than healthy children (40 ± 28 mg kg−1, p < 0.0001) and children with RAP without identified organic disease (18 ± 24 mg kg−1, p < 0.0001).

Conclusion: Faecal calprotectin may differentiate between functional abdominal pain and IBD in school‐aged children. In young infants high faecal calprotectin levels are normal.
Cardiovascular responses to submaximal treadmill running in 11 to 13 year olds
Authors: Armstrong N , Welsman JR
Published: August 2010

The influence of age, sex, maturity, body size and body fatness on cardiac output (Q) and stroke volume (SV) during treadmill running at 2.22 m·s−1 was examined longitudinally. Mass, stature, triceps and subscapular skinfold thickness, and oxygen uptake (VO2) were recorded and Q was estimated using the CO2 rebreathing technique on each of three annual measurement occasions. Maturity was assessed using the indices for pubic hair described by Tanner. At the onset, subjects were 11.3 (0.4) y of age and data were available from a total of 274 Q determinations with equal numbers from boys and girls. Age‐, sex‐ and maturity‐associated changes in Q and SV adjusted for differences in body size and fatness were examined using multilevel regression modelling within an allometric framework. Changes in Q in both sexes were essentially in direct proportion to body surface area but, even with anthropometric variables controlled for, girls demonstrated a lower SV than boys, which was compensated for by a higher heart rate (HR) at each observation.

Conclusion: At a given level of submaximal exercise over the age range 11–13 y Q is directly related to body size in both sexes. With body size and fatness controlled for, boys have greater SVs than girls when exercising at the same absolute VO2, Q and treadmill running speed. Age and maturation do not exert independent effects on either Q or SV.
Geographic variations in possible risk factors for severe cardiac malformations
Authors: Cedergren M , Selbing A , Kaällén B
Published: August 2010

The aim of this study was to investigate various putative risk factors in a county in Sweden, described as having a 28% increased prevalence of cardiovascular malformations, and to compare them with the risk factors in two reference counties. Women giving birth in the studied counties differed in age and parity distribution, smoking, and educational level but these differences could not explain the increased risk of cardiovascular malformations in the county, since after stratification for these variables, the risk estimate did not change substantially. A number of potential risk factors were studied in a case/control design: spontaneous abortions, involuntary childlessness, maternal disease, body mass index, medical drug use, alcohol use, parental employment, paternal age, and urban/rural residency. No single factor could be attributed to the increased rate, with the exception of living in a rural district. Nearly all risk factors, however, were stronger in the county studied than those in the reference counties (0.02 > p > 0.01).

Conclusion: The only single putative risk factor that could have contributed to the increased risk for cardiac defects described in the county studied was maternal residency in a rural district. Notably, nearly all potential risk factors studied were stronger in the county studied compared with those in the reference area. A conceivable explanation is that one or more unidentified factors related to rural residency could potentiate prevalent and weak teratogenic risk factors for cardiac defects.
Sidestream end‐tidal capnometry as related to infant's position and maturation
Authors: Kugelman A , Bilker A , Bader D , Cohen A , Tirosh E
Published: August 2010

The objective of this study was to investigate the effect of body position on sidestream, end‐tidal carbon dioxide (EtCO2) wave measurements in maturing infants. Sidestream EtCO2 wave patterns were analysed longitudinally in 20 preterm infants (born at ≪ 32 wk) at 32–37 wk gestation, and in 39 full‐term controls. Capnography measurements included maximal EtCO2, inspired CO2 and frequency of apnoea events (<3 s) in the supine, supine with inclination, side and prone positions. Apnoea frequency decreased during maturation, and was less prevalent in the prone than in the supine and side positions in preterm as well as in term infants (p > 0.05). No clinically significant apnoea episodes were found in our cohort. EtCO2 in term infants was lower than that in preterm infants (p > 0.05) and was not affected by sleep position in the most premature (>33 wk) and in term infants (<36 wk). EtCO2 was higher in the prone position than in supine or side positions in infants between 33 and 35 wk gestation (p > 0.01).

Conclusion: Short apnoeic episodes decrease during maturation, and are less prevalent in the prone position in maturing infants (32–37 wk). Only modest changes in EtCO2 were recorded in the different positions during maturation.
Oral versus rectal midazolam as a pre‐anaesthetic sedative in children receiving dental treatment under general anaesthesia
Authors: Jensen B , Matsson L
Published: August 2010

Dental treatment in children who are too young or too apprehensive to cooperate is often performed under sedation. In Sweden, the tradition has been to administer sedatives rectally in small children, but oral liquid sedation is now increasingly used.

Aim: To compare the sedative effects of oral and rectal administration of midazolam in children undergoing dental treatment under general anaesthesia and to assess acceptance of sedative administration, acceptance of application of the facemask, and amnesia. Methods: Fifty children aged 2–7 y were randomly allocated to receive either liquid oral or rectal sedation, with 25 children in each group. Results: The sedative effect of rectal administration was higher, but not statistically significantly, than that of oral administration (p= 0.07). No significant differences in acceptance of sedative administration, acceptance of mask application or amnesia were found between the groups.

Conclusion: Both the oral and the rectal routes can in most cases be appropriate. However, the better sedative effect of rectal administration of midazolam makes it a more favourable route in pre‐cooperative and non‐compliant children.
Treatment of sleep problems in families with small children: is written information enough?
Authors: Eckerberg B
Published: August 2010

The aim of this study was to evaluate a standardized sleep programme, i.e. a two‐step variation of graduated extinction, where the child is first taught to fall asleep by him/herself at bedtime (first intervention) and 2 wk later also after night wakings (second intervention). The outcome after consultations with a therapist followed by telephone support during both interventions was compared with the outcome after giving written information only during the first intervention and therapist support during the second. A total of 67 families with infants exhibiting spontaneous awakening and crying episodes during the night were randomly assigned to either programme. There were no significant differences in terms of outcome between the two groups. In both groups the number of registered night wakings decreased immediately following the first intervention. At registration, at 1 mo and 3 mo later, all parents, with the exception of one couple at the 3‐mo follow‐up, reported that the sleep problem had improved.

Conclusion: If parents experience their infant's night awakenings as a problem, teaching their infant to fall asleep by him/herself usually solves this problem quickly. Written information is in most cases sufficient to help parents introduce the new evening routines.
Association of cytokine responses with disease severity in infants with respiratory syncytial virus infection
Authors: Chen ZM , Mao JH , Du LZ , Tang YM
Published: August 2010

Aim: To explore the relationship between cytokine responses and severity of respiratory syncytial virus (RSV) infection in infants. Methods: Intracellular interleukin‐4 (IL‐4) and interferon‐γ (IFN‐γ) expression in peripheral blood CD3+ and CD8+ lymphocytes was measured by four‐colour flow cytometry. Serum IL‐12, IL‐4 and IFN‐γ levels were also determined by enzyme‐linked immunosorbent assay. Results: The frequency of IL‐4 and IFN‐γ expression in CD3+CD8‐ cells was the same in RSV‐infected, non‐RSV‐infected and control infants and in those with RSV bronchiolitis or RSV pneumonia, indicating that no Th2 predominance exists in the acute phase of RSV infection and RSV bronchiolitis. Furthermore, RSV‐infected infants had a more frequent IFN‐γ expression in CD3+CD8+ cells than controls, and they also showed a much lower serum IL‐4/IFN‐γ ratio because of decreased IL‐4 and elevated IFN‐γ, the latter being most prominent in RSV bronchiolitis. The serum IL‐12 level in RSV‐infected infants was the same as in control infants, while those with non‐RSV infections had a much higher level. Serum IL‐12, IFN‐γ and frequency of IFN‐γ expression in CD3+CD8+ cells in mild RSV infection were much higher than in controls, while no difference existed between severe cases and controls.

Conclusion: Type 2 cytokine predominance was not found in the acute phase of RSV infection and RSV bronchiolitis, but both were accompanied by enhanced production of IFN‐γ and a much higher serum IFN‐γ level than in healthy controls, especially in those with RSV bronchiolitis, suggesting a role in causing airway obstruction. IFN‐γ and IL‐12 may also play a protective role in RSV infections by diminishing viral replication, and high levels of IL‐12 and IFN‐γ may be associated with lessening of the severity of infection.
Psychological functioning in boys of short stature: effects of different levels of growth hormone secretion
Authors: Erling A , Wiklund I , Wikland K Albertsson
Published: August 2010

Aim: To examine the relationship between growth hormone (GH) and psychological functioning, especially self‐perception and well‐being, in 60 prepubertal boys of short stature with a wide range of GH levels. Methods: A comparison was made of the well‐being and self‐perception of children with GH insufficiency, children with idiopathic short stature (ISS), a normative sample and healthy boys with normal stature. Results: Children with GH insufficiency had a more negative perception of their own physical appearance than the normative sample. They perceived themselves as more alert but also more inhibited than both the children with ISS and the healthy boys with normal stature. In comparison with the healthy boys with normal stature they perceived themselves as having more stability. The parents of the boys with GH insufficiency also perceived their children as being more stable compared with how the parents of boys with ISS perceived their children. To elucidate the effects of GH on psychological functioning a multiple regression analysis was performed.

Conclusion: The lower the levels of GH the more inhibited were the boys of short stature, as perceived both by themselves and by their parents. The boys with GH insufficiency had a more negative perception of their physical appearance than the normative sample.
Cushing's syndrome due to pharmacological interaction in a cystic fibrosis patient
Authors: Main KM , Skov M , Sillesen IB , Dige‐Petersen H , Müller J , Koch C , Lanng S
Published: August 2010

Treatment of allergic bronchopulmonary aspergillosis with itraconazole is becoming more widespread in chronic lung diseases. A considerable number of patients is concomitantly treated with topical or systemic glucocorticoids for anti‐inflammatory effect. As azole compounds inhibit cytochrome P450 enzymes such as CYP3A isoforms, they may compromise the metabolic clearance of glucocorticoids, thereby causing serious adverse effects. A patient with cystic fibrosis is reported who developed iatrogenic Cushing's syndrome after long‐term treatment with daily doses of 800 mg itraconazole and 1600 μg budesonide. The patient experienced symptoms of striae, moon‐face, increased facial hair growth, mood swings, headaches, weight gain, irregular menstruation despite oral contraceptives and increasing insulin requirement for diabetes mellitus. Endocrine investigations revealed total suppression of spontaneous and stimulated plasma cortisol and adrenocorticotropin. Discontinuation of both drugs led to an improvement in clinical symptoms and recovery of the pituitary‐adrenal axis after 3 mo.

Conclusion: This observation suggests that the metabolic clearance of budesonide was compromised by itraconazole's inhibition of cytochrome P450 enzymes, especially the CYP3A isoforms, causing an elevation in systemic budesonide concentration. This provoked a complete suppression of the endogenous adrenal function, as well as iatrogenic Cushing's syndrome. Patients on combination therapy of itraconazole and budesonide inhalation should be monitored regularly for adrenal insufficiency. This may be the first indicator of increased systemic exogenous steroid concentration, before clinical signs of Cushing's syndrome emerge.
Erythropoietin in the central nervous system, and its use to prevent hypoxic‐ischemic brain damage
Authors: Juul S
Published: August 2010

A new field of clinical and scientific interest has recently developed based on the discovery that the hematopoietic cytokine erythropoietin (Epo) has important non‐hematopoietic functions in the brain and other organs, particularly during development. The biological effects of Epo in the central nervous system (CNS) involve activation of its specific receptor and corresponding signal transduction pathways. Epo receptor expression is abundant in the developing mammalian brain, and decreases as term approaches. Epo has been identified as a neurotrophic and neuroprotective agent in a wide variety of experimental paradigms, from neuronal cell culture to in vivo models of brain injury. Several mechanisms by which Epo produces neuroprotection are recognized. Epo (i) decreases glutamate toxicity, (ii) induces the generation of neuronal anti‐apoptotic factors, (iii) reduces inflammation, (iv) decreases nitric oxide‐mediated injury, and (v) has direct antioxidant effects.

Conclusion: Collectively, the evidence suggests that Epo may provide a new approach to the treatment of a variety of CNS disorders in adults and children, especially as a possible therapy for perinatal asphyxia. This review summarizes the current knowledge on the neurotrophic and neuroprotective functions of Epo in the developing and injured brain.
Enteral administration of hematopoietic growth factors in the neonatal intensive care unit
Authors: Calhoun DA
Published: August 2010

By 20 wk of gestation, the human fetal gastrointestinal (GI) tract morphologically resembles that of the term infant, but functional development is limited before 26 wk. By 30 wk of gestation, the fetus has the capacity for limited digestion and enteral absorption. GI growth and development continue postnatally. Trophic factors, including nutrients, peptides, hormones and growth factors, are recognized as having important influences on the morphology and histology of the developing GI tract. Other trophic factors are important in adaptation and repair following injury. Many such factors are provided in utero via amniotic fluid swallowing and later by human colostrum and milk.

Conclusion: This review discusses cytokines with known GI trophic effects, either in vitro or in vivo, and focuses on those cytokines that have been used in the neonatal intensive care unit.

GI trophic factors have been identified that influence the prenatal and postnatal growth and development of the GI tract. Systemically as well as enterally administered growth factors can stimulate GI growth and maturation, suggesting that trophic factors in the serum of neonates can modulate GI growth via receptors on the serosal membranes of enterocytes. GI trophic factors can be synthesized endogenously or provided prenatally in amniotic fluid and postnatally in human milk.

GI trophic factors in human milk play an important role in regulating the adaptive functional changes that accompany the transition to postnatal enteral feedings. Although human milk growth factors are not essential for infant survival, the elevated risk of GI‐related illnesses in formula‐fed compared with human milk‐fed infants suggests that bioactive compounds in human milk contribute to the protective effects of human milk feedings (13).

GI trophic factors have the potential to be used therapeutically to enhance GI maturation and repair following injury. These applications may be particularly useful in the premature or postsurgical infant. Several issues require further research, including: (i) the efficacy of oral versus systemic administration; (ii) characterization of the complex interactions among the various growth factors; (iii) the effect of exogenously administered growth factors on endogenous production of that factor, its receptor or other growth factors; (iv) the effect of growth factors upon tissues not directly associated with the GI tract; and (v) the determination of safe and effective limits. Significant advances in feeding strategies to reduce feeding intolerance in the neonate are likely to occur with the application of these principles in clinical neonatology.
Using fluorescence‐activated cell sorting followed by fluorescence in situ hybridization to study lineage relationships: the 8;21 translocation is present in neutrophils but not monocytes in a patient with severe congenital neutropenia and a granulocyte colony‐stimulating factor‐responsive clonal abnormality
Authors: White C , Chen Z , Raetz E , Pulsipher M , Spangrade GJ , Slayton WB
Published: August 2010

Severe congenital neutropenia (Kostmann syndrome) is a disorder that presents in the neonatal period, but predisposes to leukemia later in life. This report describes a 4‐y‐old female with a history of severe congenital neutropenia, who developed a clonal abnormality associated with the translocation (7;21;8) (q32;q22;q22) (AML‐1/ETO). She had circulating peripheral blasts and bone marrow blast counts as high as 64% when she received recombinant granulocyte colony‐stimulating factor (rG‐CSF). Her marrow blasts decreased to 4‐20% when rG‐CSF was discontinued. Fluorescence in situ hybridization analysis was performed on bone marrow cell populations sorted by flow cytometry to determine which cell populations had the AML‐1/ETO translocation. The translocation was found in mature neutrophils and blasts, but not in monocytes, lymphocytes or stem cells.

Conclusion: These findings suggest that the translocation occurred in a neutrophil progenitor, past the point in ontogeny where monocytes and neutrophils separate. The techniques described may be useful in understanding lineage relationships and leukemogenesis in other clonal abnormalities associated with myelodysplasia and leukemia.
Endothelial markers and homocysteine in patients with classic Fabry disease
Authors: Demuth K , Germain DP
Published: August 2010

Aim: Fabry disease is an X‐linked inborn error of glycosphingolipid metabolism due to the deficient activity of α‐galactosidase A, a lysosomal enzyme. It is a multisystem disorder characterized by progressive renal insufficiency, with added morbidity from cardio‐ and cerebrovascular involvement. The recent availability of genetically engineered enzyme offers an effective targeted treatment approach, but also emphasizes the need for surrogate markers to delineate organ damage and monitor the efficacy of enzyme replacement therapy (ERT). Methods: Multiple endothelial factors and plasma homocysteine concentrations were investigated in 12 consecutive hemizygous males with classic Fabry disease and 15 controls as part of an exhaustive baseline evaluation prior to ERT. Results: Compared with the controls, plasma concentrations of homocysteine were significantly (p > 0.01) higher in patients with Fabry disease in the absence of chronic renal failure or vitamin deficiency. Plasma concentrations of vascular cell adhesion molecule‐1 were also significantly (p > 0.05) higher in the patients, and there was a trend for decreased endothelin‐1 levels. No difference was found in serum intercellular adhesion molecule‐1, plasma P‐selectin, serum E‐selectin and plasma thrombomodulin between the patients and controls.

Conclusions: The results do not reveal measurable evidence for endothelial and leukocyte activation that could reliably serve as surrogate markers for routine monitoring of the efficacy of ERT in patients with Fabry disease. While the exact origin and clinical significance of hyperhomocysteinaemia in Fabry disease remains to be studied in a larger cohort of patients carefully monitored for their concurrent medications, especially carbamazepine, we suggest that patients may benefit from folic acid or multivitamin therapy to treat this additional vascular risk factor, when present.