bluuebunny/crossref_metadata_2025 huggingface dataset:
Short‐term ceftriaxone therapy for treatment of severe non‐typhoidal Salmonella enterocolitis
Authors: Lin TY , Chiu CH , Lin PY , Wang MH , Su LH , Lin TY
Published: August 2010

Aim: To evaluate the clinical efficacy of a short‐course ceftriaxone therapy in the treatment of paediatric patients with severe non‐typhoidal Salmonella enterocolitis. Methods: During a 1 y period, all paediatric patients who were suspected having Salmonella enterocolitis by the presentation of bloody and/or mucoid diarrhoea with or without fever were eligible for the study. Patients with either negative stool cultures or bacteraemia were excluded. Severe enterocolitis was defined as a bloody and/or mucoid diarrhoea associated with high fever persisting for longer than 48 h and signs of moderate or severe dehydration. The patients with severe enterocolitis were assigned to treatment with ceftriaxone (50 mg kg−1 d−1) for 3–5 d, while the rest were given supportive treatment only. Before treatment all study patients received blood testing for white blood cell (WBC) count, C‐reactive protein (CRP) level and blood culture. The duration of the fevers was recorded. Patients were followed up after clinical recovery for the possibility of relapse. Results: Seventy‐three patients with culture‐confirmed Salmonella enterocolitis without bacteraemia were analysed. The duration of fever was longer in severe cases who were treated with ceftriaxone than those who were not. However, rapid defervescene was found after short‐course ceftriaxone therapy in those patients with severe enterocolitis. CRP was significantly higher in severe cases. There was no significant difference in the WBC count between the two groups of patients. No relapse was found in these patients.

Conclusion: High CRP, prolonged high fever and signs of moderate or severe dehydration appear appropriate to define severe cases of Salmonella enterocolitis. Short‐course ceftriaxone therapy is clinically beneficial to these patients. Neither clinical nor microbiological relapse was seen after therapy.
Dermal bilirubin kinetics during phototherapy in term neonates
Authors: Özkan H , Ören H , Duman N , Duman M
Published: August 2010

Aim: To investigate dermal bilirubin kinetics during phototherapy in the presence of neonatal indirect hyperbilirubinaemia. Methods: 33 neonates with non‐haemolytic indirect hyperbilirubinaemia, who required phototherapy, were included in the study. Phototherapy modules containing four normal and four blue fluorescent lamps were used during the study. The transcutaneous bilirubin index (TcBI) was measured in an area of the forehead covered by a 2.5 cm diameter opaque patch and a nearby exposed site. The TcBI obtained from patched and unpatched areas and simultaneous serum bilirubin (SB) concentrations were measured before the start of phototherapy and after 6, 12, 18, 30, 42 and 66 h of phototherapy. Results: SB concentration and the TcBI from the unpatched area decreased significantly during the first 6 h of exposure, while the TcBI obtained from the patched area decreased significantly after 12 h. The TcBI from the unpatched area was consistently lower than that from the patched area during phototherapy. After the onset of phototherapy, there was a weak, non‐significant correlation between SB concentrations and the TcBI from patched and unpatched areas.

Conclusion: Phototherapy was effective for both patched and unpatched areas, but the rate of decline was slower in patched areas, only becoming significant in the second 6 h of treatment. There was no significant correlation between the levels of SB and TcBI after the onset of phototherapy, and therefore the use of TcBI cannot be recommended as a surrogate measure of SB.
Reversibility of cirrhotic regenerative liver nodules upon NTBC treatment in a child with tyrosinaemia type I
Authors: Crone J , Möslinger D , Bodamer OA , Schima W , Huber WD , Holme E , Ipsiroglu S Stöckler
Published: August 2010

In a male patient with hereditary tyrosinaemia type I (HTI), NTBC [2‐(2‐nitro‐4‐trifluoro‐methylbenzoyl)‐1,3‐cyclohexandion] treatment and a diet low in phenylalanine and tyrosine were started at the age of 4 wk. At the recommended average dosage (1 mg kg−1), liver failure improved transiently. After 4 mo of treatment, with increased body weight, the dose had decreased to 0.7 mg kg−1, and diffuse cirrhotic changes in liver parenchyma and multiple nodules were visualized by ultrasonography. Multiple nodules in the liver parenchyma were differentiated from hepatocellular carcinoma by magnetic resonance imaging (MRI) using mangafodipir trisodium as a paramagnetic liver‐specific contrast agent. Augmentation of NTBC dosage resulted in a decrease in serum α‐fetoprotein levels and in significant regression of liver nodules on MRI.

Conclusion: In HTI patients with a poor response to NTBC treatment and/or development of cirrhotic changes of liver parenchyma, augmentation of the recommended NTBC dosage may result in significant improvement of symptoms.
“Maturational lag” hypothesis of attention deficit hyperactivity disorder: an update
Authors: El‐Sayed E , Larsson J‐O , Persson HE , Santosh PJ , Rydelius P‐A
Published: August 2010

This article discusses the relationship of maturation to ADHD and hyperkinetic disorder (HKD), with an emphasis on current research in ADHD and HKD, persistence and remission of ADHD symptoms over time and brain maturational trajectories.

Conclusion: ADHD is a broad, heterogeneous syndrome and only a subgroup of subjects has a diagnosis of HKD, which is a subset of individuals with severe ADHD combined subtype. Children showing symptoms above the threshold for a diagnosis of ADHD are at risk of developing comorbid conditions and increasing stress in both parents and teachers. In some subjects, ADHD symptoms can improve over time during maturation and development. These children with a diagnosis of ADHD could be viewed as showing variants of normal childhood behaviour with maturational trajectories that are lagging behind but will catch up. ADHD could therefore represent a continuum from normality at one extreme to a severe disorder, HKD according to ICD‐10, at the other extreme.
A concurrent occurrence of cutis laxa, Dandy‐Walker syndrome and immunodeficiency in a girl
Authors: Litzman J , Bučková H , Ventruba J , Holčíková A , Mikyška P , Lokaj J
Published: August 2010

We report on a 17‐y‐old girl with inherited cutis laxa, immunodeficiency and Dandy‐Walker syndrome. Immunodeficiency manifested itself by decreased and fluctuating levels of IgG, IgA and IgM and intermittent leucopenia causing increased susceptibility to respiratory tract infections. Dandy‐Walker syndrome (agenesis of the cerebellar vermis with a large posterior fossa cyst communicating with an enlarged 4th ventricle) was shown on a CT scan but with the exception of macrocrania, no typical signs or symptoms were observed at the age of 17. Loose hyperextensible skin with pendulous skinfolds as a manifestation of cutis laxa was observed from birth. Anomalies of the right pulmonary artery, abnormal branching of the left arteria subclavia (arteria lusoria) from the left aortic arch and bicuspidal aortic valve were also present.

Conclusion: The combination of the rare disorders cutis laxa, Dandy‐Walker syndrome and immunodeficiency is reported here for the first time.
Do we need another NSAID instead of indomethacin for treatment of ductus arteriosus in preterm infants?
Authors: Leonhardt A , Seyberth HW
Published: August 2010

Up until now indomethacin is the most extensively evaluated non‐steroidal anti‐inflammatory drug (NSAID) in neonatal medicine. If used with due consideration to the physiologic role of prostaglandins, a 90 success rate can be reached and serious adverse drug effects prevented.

Conclusion: The results reported by Bellander et al. support the idea that we do not need to study other substances of the same therapeutic class, with the same target—cyclooxygenase—in the prostaglandin cascade and with a similar pharmacological profile. Instead, indomethacin treatment regimes should be further improved with respect to their efficacy and safety.
Influence of dietary intervention on growth in children with hypercholesterolaemia
Authors: Sánchez‐Bayle M , Soriano‐Guillén L
Published: August 2010

Aim: To determine whether a moderately reduced fat diet affects longitudinal growth in children with hypercholesterolaemia with a mean duration of 7.42 ± 1.93 y. Methods: Subjects with hypercholesterolaemia, total cholesterol above 5.18 mmol/L and LDL‐cholesterol above 3.49 mmol/L (n= 144; 69 males and 75 females) from 2 to 13 y of age were studied. Patients were seen in our outpatient department for regular health check‐ups. Weight and height were measured every year. At the same time, cholesterol, triglycerides, LDL‐C, HDL‐C, A‐apoprotein and B‐apoprotein levels were analysed. Furthermore, degrees of compliance at 1 mo, 6 mo and each year after starting the dietary treatment were determined. Results: No significant change in height or weight was found after fat restriction. In contrast, significant reductions in total cholesterol, LDL cholesterol and B‐apoprotein levels of 19%, 24% and 14%, respectively, were detected. Finally, no significant differences were seen in HDL‐cholesterol, A‐apoprotein or triglycerides.

Conclusions: These data support the hypothesis that growth is not influenced by moderate fat restriction in healthy children who otherwise have normal nutrition.
Postnatal adaptation of cerebral blood flow using near infrared spectroscopy in extremely preterm infants undergoing high‐frequency oscillatory ventilation
Authors: Noone MA , Sellwood M , Meek JH , Wyatt JS
Published: August 2010

Aim: To determine cerebral blood flow using near infrared spectroscopy in extremely preterm infants undergoing high‐frequency oscillatory ventilation during the first three days of life. Low cerebral blood flow has been associated with both intra‐ventricular haemorrhage and periventricular leucomalacia. It is well established that cerebral blood flow increases over the first three days of life in extremely preterm infants who are conventionally ventilated with intermittent positive pressure ventilation. However, there is no information about cerebral blood flow in preterm babies undergoing high‐frequency oscillatory ventilation. In addition, there are concerns that high‐frequency oscillatory ventilation may be associated with an increased incidence of intra‐ventricular haemorrhage in premature infants. Methods: Thirteen appropriately grown, preterm infants of less than 28 wk gestation who were admitted to the neonatal unit at University College Hospital, London were studied using near infrared spectroscopy. Left ventricular output and right ventricular output were assessed echocardiographically. Results: Extremely preterm infants undergoing high‐frequency oscillatory ventilation have remarkably low cerebral blood flow in the first 12 h of life, median 6.7 (range 4.4‐11) mls. 100 g−1min−1 followed by an increase over the subsequent three days. Left ventricular output also increased over the first three days of life, whereas right ventricular output showed no clear relationship with time. Despite low cerebral blood flow only one infant had evidence of major cerebral injury.

Conclusion: Cerebral blood flow is extremely low in this group of preterm babies. Despite this extremely low cerebral blood flow, the clinical outcome is good. There was an increase in cerebral blood flow and a corresponding increase in left ventricular output over the first few days of life.
Neonatal hypotonia: don't forget the Prader‐Willi syndrome
Authors: Trifirò G , Livieri C , Bosio L , Gargantini L , Corrias A , Pozzan G , Crinò A ,   and the Genetic Obesity Study Group of the Italian Society of Paediatric Endocrinology and Diabetology (SIEDP)
Published: August 2010

During the neonatal period the diagnosis of the Prader‐Willi syndrome (PWS) is difficult because the syndrome is expressed mainly by severe hypotonia at this age and the typical clinical features of later life are not yet present. Aim: To identify all the PWS clinical markers in severe hypotonic newborns, which could facilitate an early diagnosis of the syndrome. Methods: Twenty‐one PWS newborns (14 males and 7 females) with severe hypotonia at birth were evaluated. Paediatricians skilled in syndromology carried out a careful clinical examination. Fluorescent in situ hybridization (FISH) analysis and/or a methylation test was used to confirm the PWS clinical diagnosis. Results: The clinical diagnosis of PWS was reached at a mean age of 7.4 mo with genetic confirmation at 11 mo of life. In 12 newborns at least 3 craniofacial features were present (57%), suggesting the diagnosis of PWS. Two craniofacial dysmorphic characteristics were described in 6 newborns and only 1 in 3 cases. Cryptorchidism was monolateral in 6 and bilateral in 7 patients; in one newborn both testes were in scrotum. A micropenis was described in one patient and hypoplasia of the labia minora was reported in two females.

Conclusions: Diagnosis by means of dysmorphologic evaluation is difficult in the neonatal period. The presence of severe hypotonia should always induce neonatologists to perform specific genetic tests in order to obtain an early diagnosis of PWS.
Quality of life, anxiety and concerns among statin‐treated children with familial hypercholesterolaemia and their parents.
Authors: de Jongh S , Kerckhoffs MC , Grootenhuis MA , Bakker HD , Heymans HSA , Last BF
Published: August 2010

Aim: To assess the quality of life, anxiety and concerns among statin‐treated children with familial hypercholesterolaemia (FH) and their parents. Methods: 69 FH children on statin therapy and 87 parents (51 families) participated in this study. Quality of life of the children, and anxiety levels of both the children and their parents, were investigated using self‐report questionnaires. In addition, a questionnaire was designed to evaluate FH‐specific concerns of these children and their parents on six different topics: 1, knowledge about FH; 2, experience of the disease; 3, family communication; 4, screening; 5, diet; and 6, experience of medication therapy. Results: FH children and their parents reported no problems with regard to quality of life and anxiety. In contrast, the FH survey showed specific FH‐related concerns. One‐third of the children thought that FH can be cured, and 44% of the children suffered from the fact they have FH, but taking medication makes them feel safer (62%). The majority of the children kept a low cholesterol diet and more than 50% took care not to eat too much fat. Almost 38% of the parents experienced FH as a burden to their family and 79% suffered because their child had FH.

Conclusion: These findings show that statin‐treated children with FH and their parents did not report affected psychosocial functioning, but did show specific FH‐related concerns.
Coronary artery changes in patients with Kawasaki disease
Authors: Tulloh RMR , Wood LE
Published: August 2010

Kawasaki disease (KD) is an acute, self‐limiting, systemic vasculitis of unknown aetiology, which most commonly occurs in children aged 6 mo to 5 y, with a peak incidence at 9–11 mo. The inflammatory process preferentially involves the coronary arteries, potentially resulting in coronary arteritis, aneurysmal lesions, arterial thrombotic occlusion and sudden death. Kawasaki disease is the most common cause of acquired coronary vessel abnormalities in children. The cause of KD is not known, but evidence is presented for an inflammatory response and a genetic predisposition. The diagnostic tests are not yet defined, but treatment with immunoglobulin and aspirin is effective at reducing the risk of cardiac complications from 25% to 4.7% in the UK. Sequelae may occur, either acutely with myocardial, endocardial or pericardial inflammation, or many years after the original illness. There may be abnormalities of myocardial blood flow as assessed by MRI, radio‐nucleide studies or echo Doppler. Such abnormalities of coronary arteries may require ongoing medication, interventional catheterization or even cardiac surgery.

Conclusion: In the future, we hope to have more accurate diagnostic tests or prophylaxis against the disease, in addition to improved means of determining the susceptibility to or presence of long‐term complications.
Increasing incidence of childhood thyrotoxicosis in a population‐based area of central Sweden
Authors: Forssberg M , Arvidsson C‐G , Engvall J , Lindblad C , Snellman K , Aman J
Published: August 2010

Aim: To study the incidence, prevalence and clinical characteristics of childhood thyrotoxicosis in a population‐based area comprising five counties in central Sweden. Methods: Retrospective analysis of the medical records of all children below 16 y of age with thyrotoxicosis during a 10‐y study period. Results: Forty‐six children were identified with thyrotoxicosis. The median age at onset was 11.7 y and 85% were females. At the end of the study period on 31 December 1999, the prevalence was 0.08 per 1000. The mean annual incidence was four times higher in the second 5‐y period than in the first (2.7 and 0.7 per 100000, respectively; p < 0.001). A first‐degree relative with thyrotoxicosis was found in 21% of the children and 11/46 children (24%) showed autoimmune‐related co‐morbidity. Increased heart rate was observed in 95%, goitre in 67% and exophthalmos in 33% of the children. TSH was completely suppressed and free T4 was clearly above the upper reference limit in all children. TSH receptor‐stimulating antibodies and peroxidase antibodies were observed in 80% and 71% of the children, respectively.

Conclusion: This study indicates an increase in the incidence of childhood thyrotoxicosis in a population‐based area of central Sweden. A prospective study aimed at identifying specific aetiological risk factors for development of thyrotoxicosis has been initiated.
Efficacy of three treatment schedules in severe meconium aspiration syndrome
Authors: Salvia‐Roigés MD , Carbonell‐Estrany X , Figueras‐Aloy J , Rodríguez‐Miguélez JM
Published: August 2010

Aim: To compare three different schedules in severe meconium aspiration syndrome (MAS) treatment: standard, bronchoalveolar lavage (BAL) with diluted surfactant, and diluted surfactant BAL plus a single early dexamethasone dose. Methods: Twenty‐four full‐term newborns with severe MAS (needing mechanical ventilation and with oxygenation index ± 15) were divided into three groups: group I (historical control group; n= 6) treated with standard therapy; group II (n= 7) treated in the first hours of life with one BAL using diluted surfactant (beractant 5 mg/mL) in a volume of 15 mL/kg in four aliquots; and group III (n = 11) treated with one diluted surfactant BAL and a previous single dose of intravenous dexamethasone (0.5 mg/kg) Results: At 12h, groups II and III showed a significant improvement in oxygenation index (OI) compared with group I (14.7% and 27.0% vs – 19.6% respectively; p= 0.012). Group III also showed a significantly lower OI than group I at 24 h (63.6% vs – 27.9%) and at 48 h (87.1% vs 49.6%). Group III, in comparison to group I, showed a lower FiO2 requirement at 12 h (0.66 vs 1), at 24 h (0.4 vs 0.87) and at 48 h (0.35 vs 0.67), and a decrease in the number of days of inhaled nitric oxide administration, mechanical ventilation, oxygen therapy and hospitalisation period. All patients from groups II and III survived and none developed pneumothorax or respiratory infections.

Conclusion: Diluted surfactant BAL in the first hours of life combined with an intravenous single dose of dexamethasone may be an effective treatment for severe MAS.
Diagnosis and management of gastro‐oesophageal reflux in preterm infants in neonatal intensive care units
Authors: Dhillon AS , Ewer AK
Published: August 2010

Aim: There is relatively little published information regarding gastro‐oesophageal reflux (GOR) in preterm infants, therefore the aim of this study was to elucidate the incidence of GOR and management regimes employed for this condition in major neonatal intensive care units (NICUs). Methods: A standard questionnaire was sent to consultants in 77 level II (or secondary) and III (or tertiary) NICUs. Results: Seventy‐eight percent of consultants responded. Of babies born in these units, 40% were less than 34 wk gestational age and the estimated incidence of GOR in this group was 22%. GOR was diagnosed on a clinical basis alone in 42% of units, 8% used clinical features and/or investigations, and 50% used clinical features plus investigations and/or therapeutic trials. Intra‐oesophageal pH monitoring was available in 93% of units but used regularly in only 32% of suspected cases. Common treatment strategies for diagnosed GOR included non‐drug options—body positioning (98%) and placement on a slope (96%); and drugs—H2‐receptor antagonists (100%), feed thickeners (98%), antacids (96%), prokinetic agents (79%), proton‐pump inhibitors (65%) and dopamine‐receptor antagonists (53%). However, the frequency with which all of these treatments were used varied widely between units. Surgery was required in only 1% of cases.

Conclusions: GOR is perceived to be a common condition in preterm infants but the lack of published evidence relating to the management of GOR in preterm infants is reflected in the wide variation in diagnostic and treatment strategies used in major NICUs. It is clear that randomized, controlled trials to evaluate appropriate and effective treatments are needed.
Protective effect of breastfeeding against urinary tract infection
Authors: Mårild S , Hansson S , Jodal U , Odén A , Svedberg K
Published: August 2010

Aim: To assess the possible protective effect of exclusive breastfeeding against first‐time febrile urinary tract infection (UTI) in children. Methods: Two children's hospitals and local child health centres in the Göteborg area, Sweden, participated in a prospective case‐control study. In total, 200 consecutive cases (89M, 11 1F), aged 0–6 y, presenting with first‐time febrile UTI were enrolled. The mean ± SD age was 0.98 ± 1.15y. As control subjects, 336 children (147M, 189F) were recruited from the child health centre of the case, matched for age and gender and included consecutively for each case during the first days after diagnosis. The duration of exclusive breastfeeding was obtained from the case and controls by a standardized procedure. Results: Ongoing exclusive breastfeeding gave a significantly lower risk of infection. A longer duration of breastfeeding gave a lower risk of infection after weaning, indicating a long‐term mechanism. The protective role of breastfeeding was strongest directly after birth, then decreased until 7 mo of age, after which age no effect was demonstrated.

Conclusion: A protective role of breastfeeding against UTI was demonstrated. The study provides statistical support to the view that breast milk is a part of the natural defence against UTI.
Serum procalcitonin and C‐reactive protein in children with diarrhoea of various aetiologies
Authors: Korczowski B , Szybist W
Published: August 2010

Aim: Procalcitonin (PCT) and C‐reactive protein (CRP) are two acute‐phase reactants with different clinical features. The study aimed to compare the diagnostic value of admission serum PCT and CRP concentrations as indicators of aetiology and intensity of inflammation in children hospitalized with diarrhoea. Methods: Serum PCT and CRP concentrations were determined on admission in 129 children hospitalized with diarrhoea. They were divided into four groups: group A: 37 children with diarrhoea as one of symptoms of ongoing systemic bacterial infection (sepsis/meningitis); group B: 36 children with bacterial enterocolitis; group C: 43 children with rotaviral enterocolitis; and group D: 13 children with active inflammatory bowel disease (IBD). For comparison serum PCT and CRP concentrations were determined in 30 healthy controls. Results: PCT concentration was >0.5 ng ml−1 in all 37 (100%) children with diarrhoea and systemic bacterial infection (mean 18.5 ± 3.2 ng ml−1) and CRP was above 2 mg dl−1 in 33 (89%) of these children (11.7 ± 1.5 mg dl−1). PCT concentration was ± 0.5 ng ml−1 in 22 of 36 (61%) children with bacterial enterocolitis (2.2 ± 0.6 ng ml−1), in 3 of 43 (7%) children with rotaviral infection (0.2 ± 0 ng ml−1) and in 3 of 13 (23%) patients with IBD (0.3 ± 0.1 ng ml−1). CRP value was ± 2 mg dl−1 in 22 (61%) children from group B (5.4 ± 1.0 mg dl−1), in 8 (19%) children from group C (1.3 ± 0.3.mg dl−1) and in 6 (46%) patients from group D (3.3 ± 0.9 mg dl−1). In the control group the PCT (0.1 ± 0.1 ng ml−1) and CRP (0.03 ± 0.1 mg dl−1) levels were low or undetectable.

Conclusion: In this study PCT was a more reliable marker than CRP of systemic bacterial infection in children with diarrhoea. PCT was more specific but less sensitive in the differentiation of bacterial and non‐bacterial aetiology of inflammation.
High efficacy and minor renal effects of indomethacin treatment during individualized fluid intake in premature infants with patent ductus arteriosus
Authors: Leonhardt A , Strehl R , Barth H , Seyberth HW
Published: August 2010

Aim: To determine the efficacy and the renal side effects of indomethacin treatment for closure of a patent ductus arteriosus (PDA) in premature infants during an individualized fluid regime that avoids hypovolaemia and subsequent prostaglandin‐dependent renal perfusion. Methods: Observational retrospective analysis of the efficacy of indomethacin in premature infants with PDA treated in a single institution from June 1992 to May 2000. The clinical course and renal effects were analysed in the subgroup of infants born from June 1995 to May 2000. The management of infants at risk and the treatment of infants with PDA followed a standardized protocol that included echocardiographic screening for PDA, indomethacin treatment before congestive failure develops (early symptomatic treatment) and an individualized fluid intake. Results: In total, 412 infants with a gestational age ±32 wk were identified. Fifty‐six infants with a PDA (14%) were treated with indomethacin [mean birthweight 936 (95% confidence interval 866–1006) g; gestational age 27.3 (26.8–27.9) wk]. Indomethacin treatment was successful in 52 infants (93%). The clinical course and renal effects were analysed in 41 infants. Most infants received three indomethacin doses of 0.2 mg kg−1 every 12h. Urine output transiently decreased from 5.6 (4.6–6.4) to 4.6 (3.9–5.3) ml kg−1 h−1. Serum creatinine temporarily increased from 0.90 (0.83–0.98) to 1.06 (0.87–1.24) mg dl−1. Fluid intake was 158 (148–168) ml kg−1 d−1 before indomethacin and decreased to 142 (131–154) ml kg−1 d−1Conclusion: Indomethacin is very effective for closure of a PDA, even in very premature infants, and is not associated with clinically significant renal side effects.
Reports of pain among German children and adolescents: an epidemiological study
Authors: Roth‐Isigkeit A , Thyen U , Raspe HH , Stöven H , Schmucker P
Published: August 2010

Aim: The aim of this study was to investigate the prevalence of pain and characteristics of pain (frequency, duration, intensity) among children and adolescents and to compare them across different age and gender groups. Methods: 735 children and adolescents aged 10–18 y from schools in the Luebeck region of Germany were surveyed using a modified German version of the self‐completion pain questionnaire of Perquin and co‐workers. Results: 715 out of 735 questionnaires (97.3%) were returned completed. Pain during the preceding 3 mo was reported by 85.3% (n= 610) of the respondent children and adolescents. The prevalence of pain increased with age. The most common complaints were headache (65.6%), abdominal pain (47.7%), limb pain (46.4%) and back pain (38.6%). A pain duration of longer than 3 mo was reported by 45.5% (35.4% for longer than 6mo). Pain once a week or more frequently was reported by 33.7% of children and adolescents.

Conclusion: Almost half of the surveyed children and adolescents had suffered complaints for longer than 3 mo. The experience of pain in general and especially pain with a duration of longer than 3 mo is very common in children and adolescents, and requires further attention. Further studies are necessary to investigate the natural course, functional implications and prognosis due to pain complaints in children and adolescents.
Do inhaled steroids differ from cromones in terms of hospital admission rates for asthma in children?
Authors: Korhonen K , Dunder T , Klaukka T , Reijonen TM , Issakoff K , Kiviharju M , Linna O , Remes K , Korppi M
Published: August 2010

Aim: The aim of the present study was to investigate the characteristics of hospital admissions in two child populations receiving different types of drugs as their regular medication for steady‐state asthma. Methods: Annual data on children aged under 16 y treated for asthma, including consumption of regular medication for asthma, numbers of hospital periods, lengths of hospitalizations and annual proportions of readmissions, were collected using patient‐specific medical records from 1995 to 1999. In the Kuopio province, on average, 35.6–36.7/1000 children were on maintenance for asthma, of which 23% were receiving cromones, 51% were taking inhaled steroids and 26% were treated with cromones plus intermittent steroids. In the Oulu province, the respective prevalence was 32.7–34.9/1000, and the respective proportions were 5%, 93% and 2%. Results: Total and first admissions, as well as hospital days were clearly less in the Oulu province. In the children aged ≥6 y, the average annual total admissions were 0.3/1000 (Oulu) vs 1.2/1000 (Kuopio) (p < 0.001). Similarly, the first admissions were 0.2/1000 vs 1.0/1000 (p < 0.001), proportions of readmissions 6.3% vs 19.3% (p < 0.05), and numbers of hospital days 0.7/1000 vs 3.8/1000 (p < 0.001). The differences were in the same direction, though less prominent, also among children 2–5 y of age.

Conclusion: Our results suggest that inhaled steroids are better than cromones in preventing admissions for asthma when two provinces with different practices for maintenance medication of steady‐state asthma were compared.
Pheochromocytoma in childhood: implication for further diagnostic procedures
Authors: Beck O , Fassbender WJ , Beyer P , Kriener S , Neumann HPH , Klingebiel T , Lehrnbecher T
Published: August 2010

We report on our experience with two patients with pheochromocytoma. One patient underwent surgery of pheochromocytoma at the age of 30 y; 18 y later, medullary thyroid carcinoma (MTC) was detected in his son. Subsequently, multiple endocrine neoplasia (MEN) type 2A was diagnosed by genetic examination in both father and son. Further diagnostic procedures also revealed an MTC in the father. The other patient suffered from bifocal pheochromocytoma of the left suprarenal gland. Diagnostic work‐up revealed papillary thyroid carcinoma, which was also detected in the mother 8 mo later. Whereas a point mutation in SDHB gene was found in the son, no genetic abnormality was detected in the mother.

Conclusion: Every pheochromocytoma in childhood warrants further diagnostic work‐up, including genetic examination. In addition, clinical data of patients suffering from pheochromocytoma and papillary thyroid carcinoma should be collected by an international registry, and a joint effort should be undertaken in order to define possible underlying mutated genes in these patients.
Congenital staphylococcal scalded skin syndrome in a premature infant
Authors: Haveman LM , Fleer A , de Vries LS , Gerards LJ
Published: August 2010

A case of congenital staphylococcal scalded skin syndrome (SSSS) with fatal outcome in a premature infant is reported. An intrauterine infection with Staphylococcus aureus was probably the cause for the fulminant course of the disease. Despite adequate antibiotic treatment, the infant died within 24 h after birth because of respiratory failure.

Conclusion: Although rare, infection may occur in the perinatal period and SSSS may present within the first 24 h of life. In this situation, early administering of appropriate antibiotics is essential.
Behavioural outcome of regulatory problems in infancy
Authors: Larsson J‐O
Published: August 2010

Infant regulatory problems at 3 mo of age and later hyperkinetic problems in childhood were evaluated in a prospective longitudinal study.

Conclusion: There was a less favourable long‐term behavioural outcome in children with multiple regulatory problems. However, family adversity clearly outweighed infant regulatory problems as a predictor of hyperkinetic symptoms.
Gastrointestinal manifestations in Henoch‐Schönlein purpura: a review of 261 patients
Authors: Chang W‐L , Yang Y‐H , Lin Y‐T , Chiang B‐L
Published: August 2010

Aim: Henoch‐Schönlein purpura is an IgA‐mediated autoimmune vasculitis of children. It often presents with symptoms including purpuric rash, abdominal pain, renal involvement or arthritis. Abdominal pain is a frequent symptom in children with HSP and raises the suspicion of intussusception or perforation. We sought to evaluate abdominal pain via stool occult blood and image studies.Methods: A retrospective study of 261 patients diagnosed with Henoch‐Schönlein purpura from December 1991 to December 2001 was conducted. Image studies, including abdominal echo, abdominal CT and panendoscopy, were performed for patients who suffered from abdominal pain.Results: Of the 261 patients, 151 (58%) had abdominal pain, and 46 (17.6%) suffered either overt gastrointestinal bleeding or had positive stool occult blood. Seven patients had gross bloody stools. One acute intussusception and one bowel perforation were noted. One patient suffered from hypovolemic shock due to massive gastrointestinal bleeding. When stool occult blood was 3+ or 4+, the incidence of a positive image finding was high.

Conclusion: We found that stool occult blood and image studies may be necessary regarding severe gastrointestinal involvement. Ultrasonography is an important tool when intussusception or bowel perforation is suspected. Monitoring the vital signs is important, especially in patients with massive gastrointestinal bleeding.
Randomized controlled trial of intrapleural streptokinase in empyema thoracis in children
Authors: Singh M , Mathew JL , Chandra S , Katariya S , Kumar L
Published: August 2010

Aim: To compare intrapleural streptokinase and placebo in paediatric empyema. Methods: Children with empyema greater than stage 5 received intrapleural streptokinase (n= 19) or normal saline (n= 21) along with intercostal drainage. Clinical and serial sonographic outcomes were compared. Results: Although there was no difference in clinical and sonographic outcome, none of the children with stage 7 empyema (multi‐loculated empyema) who received streptokinase developed pleural thickening 30 d later.

Conclusion: There is no short‐term clinical benefit of intrapleural streptokinase in paediatric empyema; this therapy may be reserved for those with stage 7 empyema to prevent pleural thickening in the long term.
How do paediatricians communicate with children and parents?
Authors: Wassmer E , Minnaar G , Aal N Abdel , Atkinson M , Gupta E , Yuen S , Rylance G
Published: August 2010

Aim: The outpatient clinic visit is the major focus of the hospital medical process for most paediatricians, children and parents. The importance of children as active participants in this interaction has been recognized. Our study aims are to describe and assess the components of doctor‐parent‐child communication in the outpatient setting. Methods: Fifty‐one medical paediatric clinic consultations were recorded on audio cassette, and communication was analysed according to quantitative methods. Questionnaires assessed parents' and children's perceptions. Results: Doctors contributed most to the conversation (61%), children only 4%. Behaviour: Doctors' communication was 84% instrumental (e.g. asking questions, giving information or instructions), 13% affective behaviour (expressing concerns and worries) and 3% social (small talk). Parents' communication included giving information (83%), seeking information (13%) and social (4%). The child asked less information (3%) and had more social conversation (19%). Control: Doctors dominated in turn taking (52%). Children took 9% of all turns. Perception: There was no correlation between parents' and children's perception and the informative or affective behaviour of the doctor.

Conclusion: Communication is mainly instrumental. Doctors tend to direct the interview. Children's contribution is small. The participation of children needs to be encouraged as part of a patient‐centred approach.
A case of Kawasaki Disease associated with syndrome of inappropriate secretion of antidiuretic hormone
Authors: Mine K , Takaya J , Hasui M , Ikemoto Y , Teraguchi M , Kobayashi Y
Published: August 2010

Kawasaki disease (KD) is an acute vasculitis of unknown aetiology with varied clinical manifestations. Although coronary arteritis is common in the course of KD, central nervous system involvement is rare. We report a case of KD in an infant who developed convulsions and apnoea during his illness associated with syndrome of inappropriate secretion of antidiuretic hormone (SIADH).

Conclusion: The possibility of severe hyponatraemia should be anticipated in children with KD. Infants with KD are at risk of SIADH and should be monitored closely for its development.
Transcutaneous bilirubinometry in very low birthweight infants
Authors: Karolyi L , Pohlandt F , Muche R , Franz AR , Mihatsch WA
Published: August 2010

Aim: To evaluate whether transcutaneous bilirubinometry (TcB) would be a reliable and efficient screening technique for hyperbilirubinaemia in very low birthweight (VLBW, ±1500 g) infants in an intensive care unit setting. Methods: TcB measurements (Minolta Airshield Jaundice Meter JM‐102, Osaka, Japan) were obtained immediately before or within 10min following routine blood sampling for plasma bilirubin concentration measurements in 124 VLBW infants not receiving phototherapy. The relationship between the two techniques was analysed by linear regression analysis. A plasma bilirubin ±150 μmol/1 was defined as hyperbilirubinaemia. The sensitivity and specificity of possible TcB cut‐off readings to detect hyperbilirubinaemia was evaluated. Results: There was a significant correlation between the measurements of both techniques (p < 0.0001, r= 0.68). In the present study, a TcB cut‐off reading of 14 would have reduced the need for plasma bilirubin measurements by 26% without missing true hyperbilirubinaemia.

Conclusion: The data suggest that TcB will improve VLBW infant care in an intensive care unit setting by reducing the need for invasive bilirubin concentration measurements.
Extensively and partially hydrolysed preterm formulas in the prevention of allergic diseases in preterm infants: a randomized, double‐blind trial
Authors: Szajewska H , Mrukowicz JZ , Stoiska B , Prochowska A
Published: August 2010

Aim: A randomized, double‐blind study was conducted to evaluate whether use of protein hydrolysate‐based preterm formulas in infants with an atopic predisposition helps prevent the development of allergic diseases. Methods: Preterm infants (n= 122) with at least one first‐degree relative (parent or sibling) with allergic disease were randomly assigned to receive an extensively or partially hydrolysed preterm formula (intervention groups) or a standard preterm formula until 4 to 5 mo of age. Infants whose parents preferred that they be breastfed received their mothers' fortified breast milk. Results: Intention‐to‐treat analysis showed that the overall incidence of allergic diseases did not significantly differ between groups at both 4–5 and 12 mo of age. However, by 12 mo, use of the extensively hydrolysed versus the standard preterm formula had significantly reduced the risk of atopic dermatitis. At 4–5 and 12 mo, there was a significantly increased risk of non‐acceptance of the extensively hydrolysed formula compared with the other formulas.

Conclusions: This study failed to show that extensively or partially hydrolysed preterm formulas in comparison with a standard preterm formula reduced the overall incidence of allergic diseases in infants at high risk for atopic disease. However, use of the extensively hydrolysed compared with a standard preterm formula significantly reduced the incidence of atopic dermatitis observed at 12 mo. Infants who received extensively hydrolysed formulas were at increased risk for intervention discontinuation for any reason, particularly non‐acceptance of the formula. Because of the small number of patients eligible for this analysis, these results should be interpreted with caution.
Expression of neurotrophic factors in cerebrospinal fluid and plasma of children with viral and bacterial meningoencephalitis
Authors: Chiaretti A , Antonelli A , Piastra M , Genovese O , Polidori G , Aloe L
Published: August 2010

Aim: To evaluate the expression of neurotrophic factors (nerve growth factor (NGF), brain‐derived neurotrophic factor (BDNF), glial‐derived neurotrophic factor (GDNF)) and their association with the clinical‐radiological characteristics and outcome of children with viral and bacterial meningoencephalitis (ME). Methods: Prospective observational clinical study performed on 13 children with ME and 12 controls with non‐inflammatory obstructive hydrocephalus. Neurotrophic factor levels in the cerebro‐spinal fluid (CSF) and plasma were measured using an immunoenzymatic assay. Results: High levels of NGF and BDNF were demonstrated in all patients, while GDNF levels did not undergo significant variations. NGF expression in the CSF was higher in viral ME than in bacterial ME and was correlated with CSF cellularity (particularly mononuclear cells). BDNF expression in the CSF was higher in bacterial ME than in viral ME and was correlated with CSF cellularity and blood platelet count. No relationships were noted between CSF protein or serum C‐reactive protein levels and the expression of neurotrophic factors. Regarding clinical and radiological features, elevated NGF/BDNF levels in the CSF correlated with higher incidence of seizures and prolonged comatose state and with specific radiological lesions. No correlation was found between NGF/BDNF levels and final outcome.

Conclusions: The variations in neurotrophic factor levels may reflect an endogenous attempt at neuroprotection against biochemical and molecular changes during both viral and bacterial ME. The expression of these factors is likely to play a neuro‐immunomodulatory or neurosurvival role in ME infections.
Wolcott‐Rallison syndrome: a clinical and genetic study of three children, novel mutation in EIF2AK3 and a review of the literature
Authors: Iyer S , Korada M , Rainbow L , Kirk J , Brown RM , Shaw N , Barrett TG
Published: August 2010

Background: Wolcott‐Rallison syndrome is a rare autosomal recessive condition characterized by early infancy onset diabetes mellitus and multiple epiphyseal dysplasia. So far, 17 children have been described in the world literature. Recently, mutations in the gene encoding EIF2AK3 have been shown to segregate with the syndrome in three affected families. Aims: We aimed to describe the clinical characterization and mutation analysis of a further child, and full clinical and follow‐up details on our first family including the longest surviving child. Methods: Retrospective case notes review of three children presenting to the diabetic unit at our institution; mutation analysis of the EIF2AK3 gene in our most recent patient; and review of the literature on Wolcott‐Rallison syndrome. Results: Previously unreported phenotypic features in our patients included developmental regression after episodes of hepatic failure, and pachygyria on brain imaging. We have identified a novel 4‐base pair deletion (nt 3021–3024 del GAGA) in exon 13, which results in a frameshift and premature stop codon (R908 F/S +22X), causing premature truncation of the protein and abolition of the carboxy‐ segment of the catalytic domain.

Conclusions: Wolcott‐Rallison syndrome causes early‐onset diabetes and acute hepatic failure, before epiphyseal dysplasia is manifest. We have identified a novel mutation in EIF2AK3, and prenatal diagnosis may now be offered to affected families.
Selective neonatal BCG vaccination
Authors: Bakshi D , Sharief N
Published: August 2010

Aims: To assess the implementation of the “Selective Neonatal BCG Immunisation Policy”, and to study the causes of non‐compliance, or failure of uptake of BCG immunization. Methods: The Birth Register data were used to generate a list of babies born in the catchment area of Basildon and Thurrock NHS Trust between 1 January 2001 and 31 December 2001 who were eligible for BCG immunization. The Community Child Health computer was used to generate information about their BCG immunization status. Results: 201 children were included in the study. One hundred and seventy‐one children had received BCG immunization in the neonatal period, out of which 169 had received it before discharge from the hospital. Two children were immunized in the community in the neonatal period. Thus, 85% of the newborns eligible for BCG immunization received their vaccination in the neonatal period.

Conclusions: The current “Neonatal BCG Immunisation Policy” is effective, and there is a high uptake of the vaccine in the neonatal period within the hospital itself. Newborn infants who do not receive BCG immunization in hospital rarely get immunized in the community.
Breathing patterns in term infants delivered by caesarean section
Authors: Bader D , Riskin A , Paz E , Kugelman A , Tirosh E
Published: August 2010

Aim: To compare the breathing patterns of infants born by elective caesarean section to those infants delivered by caesarean section after a failed trial of labour. Methods: Healthy term infants born by caesarean section were studied. The study group (n= 13) had no trial of labour, whereas infants in the control group (n= 13) failed a trial of labour. Polysomnographic study was performed at 36 h of age. Heart and respiratory rate, type and duration of apnoeas, arterial oxygen saturation and lower limb movements were analysed. Results: Term infants born by elective caesarean section had a shorter duration of pregnancy and weighed less. Their heart rate was faster, they had more mixed apnoeas, and during quiet sleep they had more central apnoeas of longer duration.

Conclusion: Cardiorespiratory patterns in infants delivered by elective caesarean section are different from those delivered by caesarean section after a failed trial of labour.
Subacute sclerosing panencephalitis after intrauterine infection
Authors: Dasopoulou M , Covanis A
Published: August 2010

Subacute sclerosing panencephalitis (SSPE), in the majority of cases, is caused by the wild measles virus, although there are some reports relating SSPE to vaccination. This paper presents an inborn that was infected during pregnancy by the measles virus and developed SSPE within the first year of life after a short incubation period. He progressed rapidly after a mild arrest with treatment. Subacute sclerosing panencephalitis is a fatal degenerative disease and, although it had largely disappeared because of nearly universal measles vaccination, it still remains a serious infection among children affected by human immunodeficiency virus (HIV). The lack of newer cases of SSPE occurring among normal children nowadays should not wane alertness by obstetricians and paediatricians, to recognize the risk with measles during pregnancy and the need for prevention and recognition of SSPE at an early stage. Although some references exist which report on SSPE cases related to vaccination, new work weakens the possible links between measles vaccine and SSPE. Conclusion: This report would like to stress the importance and success of reducing the SSPE problem with the aid of general measles vaccination with high coverage.