bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of the lactose H2breath test to monitor mucosal healing in coeliac disease
Authors: Murphy MS , Sood M , Johnson T
Published: August 2010

Confirmation of the diagnosis of coeliac disease requires unequivocal evidence of recovery on a gluten‐free diet. The lactose H2breath test is a non‐invasive technique for detecting lactose malabsorption, and this may occur in untreated coeliac disease. The utility of this test was investigated in objectively confirming a response to gluten exclusion. The study included 44 children from 0.9 to 14.75 y of age (median 3.2) with coeliac disease. Five children were asymptomatic, being identified through coeliac antibody screening. Breath tests were performed prior to dietary treatment. If positive, they were repeated at 4‐wk intervals following gluten exclusion. Overall, 21/44 (48%) children had positive breath tests at presentation. In 18/21 children on a gluten‐free diet, this became negative after 4 wk (86%) and in all the children by 8 wk. In two children with positive tests at 4 wk, problems with dietary adherence were identified. A positive test before treatment was not associated with significant differences in individual symptoms, height, weight and body mass index standard deviation scores, serum haemoglobin or albumin. However, no positive results were found in the asymptomatic patients (p= 0.05). Lactose malabsorption was associated with earlier age of presentation (p= 0.008).

Conclusion: The lactose H2breath test objectively confirms a response to gluten exclusion. In selected cases it can help confirm a diagnosis of coeliac disease. However, the test tends to be less informative in asymptomatic patients, and in older children.
Working together: neonatal nurse practitioners in practice
Authors: Redshaw ME , Harvey ME
Published: August 2010

The aim of this study was to examine the relatively new role of neonatal nurse practitioners (NNPs) in the United Kingdom, comparing practice in different types of neonatal units and work undertaken by junior medical staff (JMS). Diary checklists sent to the total population of qualified NNPs in neonatal units (NNUs) and JMS in six regional centres with qualified NNPs were returned from 68 out of 109 qualified NNPs (62%), working in 50 different NNUs and from 25 out of 48 JMS (52%). Direct observations (totalling 263.5 h) were made by an experienced neonatal nurse researcher on 30 different NNPs. Frequencies of activities and specific procedures were compared between groups. Observational measures included type and duration of activity and interactions with other members of staff. NNPs were found to be undertaking a range of activities: in the NNU, which usually involved blood sampling, siting of intravenous cannulae, presenting at ward rounds and teaching. Outside the unit, NNPs attended the delivery suite and the postnatal ward. Significant differences were found in the nature and organization of their work in different types of NNUs. A comparison between NNPs and JMS showed similar activities, with greater direct involvement by NNPs in the NNU and in teaching. The diary data were supported by observations and together these are evidence of current NNP practice.

Conclusion: To a large extent there is an overlap in the work of JMS and NNPs in neonatal units, but although the clinical work and areas of activity are similar, there are differences in emphasis and in work organization.
How clinicians in neonatal care see the introduction of neonatal nurse practitioners
Authors: Redshaw ME , Harvey ME
Published: August 2010

The aim of this study was to investigate the views of UK clinicians in neonatal care who were working with nurses trained as neonatal nurse practitioners (NNPs). A questionnaire survey was used with a total sample of senior clinicians in the 66 neonatal units with one or more qualified NNPs. The main outcome measures were type and frequency of response, and similar data from NNPs were used to make comparisons. Data were returned from 57 of the 66 clinicians contacted (86%). NNP clinical practice as perceived by them was largely similar to that recorded by NNPs, though the clinicians expected more NNP involvement in some procedures (inserting central venous lines, umbilical arterial catheters, chest drains and peripheral arterial cannulae) than was actually found. Perceptions of the NNP role were similar, though the clinicians were significantly less likely to see taking a case‐load, conducting a ward round, accepting outside referrals and taking charge of emergency transfers as integral elements. Reflections on the utilization of NNPs in neonatal care and the impact on junior medical staff education referred to NNPs filling gaps, a reduction in the intensity of work, improvements in training and in the quality of care.

Conclusion: The introduction of NNPs is seen positively from the perspective of clinicians working alongside them in neonatal care. The development of similar models of care in countries where the introduction of NNPs is being considered is likely to be similarly supported.
A new transcutaneous bilirubinometer, BiliCheck, used in the neonatal intensive care unit and the maternity ward
Authors: Ebbesen F , Rasmussen LM , Wimberley PD
Published: August 2010

Transcutaneous bilirubin (TcB) was measured with a new bilirubinometer, BiliCheck, in 261 jaundiced infants in the neonatal intensive care unit (NICU) [gestational age (GA) 25–43 wk] (group 1) and in 227 healthy jaundiced term and near‐term infants (GA 35–43 wk) (group 2). Imprecision of a single determination of TcB measured on the forehead [TcB(h)], expressed as 1 standard deviation, was 15–18 μmol l−1. No statistically significant difference between intraoperator and interoperator imprecision was found. There was a good correlation between TcB(h) and total serum bilirubin (TSB) in both groups of infants, although TcB(h) was on average lower than TSB. In the NICU infants, TcB(h), other things being equal, was lower in males than in females, and decreased with increasing postnatal age, for the same TSB level. In the infants in both groups who had a GA ≥35 wk, sick infants had a higher TcB(h) than healthy infants for the same TSB level. The differences were statistically significant, but small and of minor clinical significance. Blood haemoglobin concentration, GA and ethnic origin were not found to influence TcB(h), i.e. BiliCheck corrects sufficiently for these factors. In all 488 infants, TcB was measured at four different body sites. Measurements on the forehead and sternum [TcB(s)] correlated well with TSB, while measurements on the knee and foot correlated less well. In the NICU infants TcB(h) predicted TSB statistically significantly better than TcB(s), while in the healthy term and near‐term infants TcB(h) and TcB(s) predicted TSB equally well. Therefore, the preferable body site for measurement of TcB under routine conditions is the forehead. By retrospective analysis of the data, a screening model is presented whereby TcB(h) can be used to screen infants who require phototherapy. We found that using screening limits for TcB(h), which are 70% of the currently used phototherapy limits for TSB, 80% of blood samples in healthy term and near‐term infants, and 42% of NICU infants with GA ≥32 wk, could be avoided.

Conclusion: BiliCheck is suitable for screening both NICU and healthy newborn infants with jaundice, with regard to the need for phototherapy. The authors recommend using a TcB(h) limit which is 70% of the currently recommended TSB limits for phototherapy, to decide whether TSB needs to be measured.
Early versus late treatment of posthaemorrhagic ventricular dilatation: results of a retrospective study from five neonatal intensive care units in The Netherlands
Authors: de Vries LS , Liem KD , van Dijk K , Smit BJ , Sie L , Rademaker KJ , Gavilanes AWD ,   Dutch Working Group of Neonatal Neurology
Published: August 2010

Posthaemorrhagic ventricular dilatation (PHVD) in very preterm infants carries a poor prognosis. As earlier studies have failed to show a benefit of early intervention, it is recommended that PHVD be first treated when head circumference is rapidly increasing and/or when symptoms of raised intracranial pressure develop. Infants with PHVD, admitted to 5 of the 10 Dutch neonatal intensive care units were studied retrospectively, to investigate whether there was a difference in the time of onset of treatment of PHVD and, if so, whether this was associated with a difference in the requirement of a ventriculo‐peritoneal (VP) shunt and/or neurodevelopmental outcome. The surviving infants with a gestational age ≤34 wk, born between 1992 and 1996, diagnosed as having a grade III haemorrhage according to Papile on cranial ultrasound and who developed PHVD were included in the study. PHVD was defined as a ventricular index (VI) exceeding the 97th percentile according to Levene (1981), and severe PHVD as a VI crossing the p 97 + 4 mm line. Ninety‐five infants met the entry criteria. Intervention was not deemed necessary in 22 infants, because of lack of progression. In 31 infants lumbar punctures (LP) were done before the p 97 + 4 mm line was crossed (early intervention). In 20/31 infants, stabilization occurred. In 9 a subcutaneous reservoir was placed, with subsequent stabilization in 6. In 5/31 infants a VP shunt was eventually inserted. In 42 infants treatment was started once the p 97 + 4 mm line was crossed (late intervention). In 30 infants LPs were performed and in 17 of these a VP shunt was eventually inserted. In 11 infants a subcutaneous reservoir was immediately inserted and in 8 of these infants a VP shunt was needed. In one infant a VP shunt was immediately inserted, without any other form of treatment. Infants with late intervention crossed the p 97+ 4 mm earlier (p 0.03) and needed a shunt (26/42; 62%) more often than those with early intervention (5/31; 16%). Early LP was associated with a strongly reduced risk of VP‐shunting (odds ratio = 0.22, 95% confidence interval: 0.08–0.62). The number of infants who developed a moderate or severe handicap was also higher (11/42; 26%) in the late intervention group, compared with those not requiring any intervention (3/22; 14%) or treated early (5/31; 16%).

Conclusion: In this retrospective study, infants receiving late intervention required shunt insertion significantly more often than those treated early. A randomized prospective intervention study, comparing early and late drainage, is required to further assess the role of earlier intervention.
Language impairment in Swedish bilingual children: a comparison between bilingual and monolingual children in Malmö
Authors: Salameh EK , Nettelbladt U , Håkansson G , Gullberg B
Published: August 2010

In this study two groups of children were compared, 192 bilingual and 246 monolingual, referred over a 12‐mo period to University Hospital in Malmo for suspected language impairment. Compared with monolingual children, bilingual children ran a significantly lower risk (RR = 0.76, p < 0.0001) of being referred by a child health centre, and a significantly higher risk (RR = 1.54, p < 0.0103) of being referred after 5 y of age. In the bilingual group there was also a significantly higher risk of parental refusal of assessment (RR = 2.35, p<0.0016) and of the children being diagnosed with a severe language impairment (RR=1.87, p<0.0009). The risk for bilingual children with severe language impairment being discharged owing to non‐attendance was high (RR = 6.20, p < 0.0002) compared to monolingual children. The risk increased with severity of language impairment.

Conclusion: Bilingual children displayed a higher risk of a diagnosis of severe language impairment and of being discharged for non‐attendance. The problem of low compliance among bilingual parents, despite strong indications of parental distress, must be addressed.
Cerebral venous sinus thrombosis in a neonate due to factor V Leiden deficiency
Authors: Abrantes M , Lacerda AF , Abreu CR , Levy A , Azevedo A , Da Silva LJ
Published: August 2010

A case is described of cerebral venous sinus thrombosis due to factor V Leiden deficiency that occurred in the neonatal period, presenting with seizures. Diagnosis was based on ultrasonography, Doppler ultrasound (US) and magnetic resonance imaging (MRI). The aetiology was only recognized after blood‐clotting tests, antithrombin III, C and S protein levels and factor V Leiden were studied. This situation was treated with intravenous heparin controlled by activated partial thromboplastin time (APTT). MRI angiography and Doppler US were important in the follow‐up. It is important to assess periodically the neurological development of the baby and to prevent situations such as dehydration or severe infection, which can precipitate further thrombotic events. Molecular genetics allowed the identification of this trait in other family members.

Conclusion: In every newborn with a thrombotic episode, coagulation studies must be performed, including testing for activated protein C (APC) resistance. Doppler US flow measurement and the MRI studies provide the best tools for diagnosis and follow‐up. Heparin should be given to double the initial individual APTT. It is important to prevent any risk situation such as dehydration or severe infection, which could lead to a recurrence of a thrombotic episode. Regular assessment of the child's neurodevelopment is an important aspect of further care.
Progressive nature of aspartylglucosaminuria
Authors: Arvio P , Arvio M
Published: August 2010

Descriptions of the outcome of aspartylglucosaminuria (AGU) were analysed, and a comprehensive summary table of symptoms and signs by age was designed.

Conclusion: The multifarious progressive nature of AGU is obvious in the skills and abilities of patients, as well as in their personality, general health and physical appearance.
Effect of breastfeeding on cognitive development of infants born small for gestational age
Authors: Rao MR , Hediger ML , Levine RJ , Naficy AB , Vik T
Published: August 2010

Breastfeeding during infancy appears to result in enhanced cognitive development during childhood, but it is not known whether breastfeeding should be encouraged for infants born small for gestational age (SGA) whose growth might otherwise benefit from nutritional supplementation. To address this issue, duration of exclusive breastfeeding and cognitive development were evaluated prospectively for 220 term children born SGA and 299 term children born appropriate for gestational age (AGA). Cognitive development was assessed using the Bayley Scale of Infant Development at 13 mo and Wechsler Preschool and Primary Scales of Intelligence at 5 y of age. Infants born SGA were given supplemental foods significantly earlier than those born AGA. Growth of infants born SGA was not related to early nutritional supplementation. The salutary effect of exclusive breastfeeding on cognitive development was greater for children born SGA than for those born AGA. Based on a linear association between duration of exclusive breastfeeding and intelligence quotient (IQ), children born SGA and exclusively breastfed for 24 wk were predicted to have an 11‐point IQ advantage over those breastfed for 12 wk, as opposed to a 3‐point advantage for children born AGA with similar durations of breastfeeding. The IQ distribution of children born SGA and exclusively breastfed for more than 12 wk was not different from that of all children born AGA.

Conclusion: Duration of exclusive breastfeeding has a significant impact on cognitive development without compromising growth among children born SGA. These data suggest that mothers should breastfeed exclusively for 24 wk to enhance cognitive development.
Increased inspiratory effort in infants with a history of apparent life‐threatening event
Authors: Horemuzova E , Katz‐Salamon M , Milerad J
Published: August 2010

The objective of this study was to compare the results of polysomnography between infants with a history of apparent life‐threatening event (ALTE) and controls. In this case‐control study, 40 full‐term ALTE infants, aged 2–36 wk at the time of the event, were compared with 40 age‐ and sex‐matched randomly selected controls. SaO2, tcpO2, tcpCO2, heart rate (HR), vector of rib cage and abdominal respiratory movements (phase angle, as an index of inspiratory effort) were recorded during natural nocturnal active and quiet sleep (AS, QS). SaO2, tcpO2, tcpCO2 were similar in ALTE and controls in both sleep states. Phase angle was increased in ALTE infants in both AS (59 ± 46 vs 26 ± 17°) and QS (53 ± 46 vs 18 ± 14, p < 0.001). Eleven ALTE infants (27.5%) experienced SaO2 < 90%, with a mean decrease in SaO2 to 86 ± 1.6% (mean ± SD), compared with 10% for controls (p= 0.003). In eight ALTE infants, SaO2 values < 90% were linked to thoracoabdominal asynchrony. SaO2 < 90% in conjunction with HR < 100 bpm were detected in three ALTE infants and one control. Periodic breathing was observed in 45% of ALTE infants and 40% of controls.

Conclusion: The mean values of oxygen saturation, tcpO2 and carbon dioxide levels in ALTE infants are comparable with those of healthy controls but the ALTE infants exhibit more hypoxaemic episodes and increased inspiratory effort during sleep.
Septicaemia due to glucose non‐fermenting, Gram‐negative bacilli other than Pseudomonas aeruginosa in children
Authors: Ladhani S , Gransden W
Published: August 2010

Bloodstream infections due to non‐fermenting Gram‐negative bacilli other than Pseudomonas aeruginosa (NF‐GNB) are uncommon in children but their incidence is reported to be increasing. The aim of this study was to determine the characteristics of such infections in children in a London teaching hospital. All paediatric patients with positive NF‐GNB blood cultures and clinical evidence of sepsis between July 1995 and June 2000 were included in the study. A total of 10278 blood cultures was performed, of which 356 (3.5%) represented clinically significant episodes of bacteraemia. Of these, 12 (0.1%) were due to NF‐GNB. Nine of the 12 (75%) patients were receiving haemodialysis for end‐stage renal failure (ESRF). Only one patient was receiving immunosuppressive therapy and none was neutropenic or had any malignancy. An intravascular catheter was identified as the focus of infection in all 12 cases. Stenotrophomonas maltophilia was the most common organism isolated (67%). Six patients were successfully treated with antibiotics alone. Four others received antibiotics, but also required line removal, and two patients responded to line removal without the need for antibiotics.

Conclusion: An association was found between ESRF and NF‐GNB infections, possibly related to the requirement for long‐term catheters for dialysis. Antibiotic treatment alone was only successful in half the cases of catheter‐related NF‐GNB septicaemia, while removal of the infected catheter ensured complete cure in the cases where antibiotic treatment alone did not suffice.
Bradycardic response during submersion in infant swimming
Authors: Goksör E , Rosengren L , Wennergren G
Published: August 2010

The diving response involves reflex bradycardia, apnoea and peripheral vasoconstriction and is known to exist in human infants. The response diminishes with increasing age and has been reported to disappear by the age of 6 mo. This study was performed to analyse the physiological events during natural diving of full‐term healthy infants and describe how these events alter with maturation. Thirty‐six infants were studied during diving exercises in infant swimming. All of the infants who participated showed an immediate decrease in heart rate when submerged. On average, the heart rate decreased by 25% (range –5.0% to –50.7%, p < 0.0001). The bradycardia was sustained during the dive and for some seconds afterwards. The response was often followed by a tachycardia as the bradycardia ceased. A decline of reflex bradycardia was observed with increasing age (p= 0.03), but the response was still clearly evident in infants over the age of 6 mo.

Conclusion: This study demonstrates the existence of a diving response in infants, which includes an immediate bradycardic response, suggesting vagal mediation. Although the bradycardic response gradually decreases, the study shows that a clear‐cut response exists in children older than has previously been reported.
Seizures in paediatric Chiari type I malformation: the role of single‐photon emission computed tomography
Authors: Iannetti P , Spalice A , De Felice Ciccoli C , Bruni O , Festa A , Maini CL
Published: August 2010

Chiari type I malformation is one of the posterior fossa maldevelopments with which different clinical manifestations have been associated. Seizures have only recently been associated with Chiari type I malformation. This study reports on 4 children with epilepsy (2M, 2F; age range 8–15 y) diagnosed with Chiari type I malformation by brain magnetic resonance imaging (MRI), in whom no cortical structural involvement was observed. In these patients an interictal ethylcysteinate‐dimer‐single‐photon emission computed tomographic (ECD‐SPECT) study was performed to define more precisely the relationship between Chiari type I malformation and seizures. In these patients the hypoperfusion area correlated with electroencephalographic (EEG) focal abnormalities. These hypoperfusion s may represent the functional aspect of a cerebral microdysgenesis; seizures and EEG epileptic anomalies may also be linked to the complex network connection between cortices and cerebellar hemispheres. A cerebellar hypoperfusion was also detected in two of the four examined patients, indicating a functional or structural involvement.

Conclusion: Interictal SPECT scans are helpful for the clarification of seizures in patients with Chiari type I malformation.
Smoking, nicotine and tar and risk of small for gestational age babies
Authors: Mitchell EA , Thompson JMD , Robinson E , Wild CJ , Becroft DMO , Clark PM , Glavish N , Pattison NS , Pryor JE
Published: August 2010

Aims: To assess the effect of maternal smoking and environmental tobacco smoke (ETS) on risk of small for gestational age infants (SGA). Methods: Case‐control study of 844 cases and 870 controls. Results: Maternal smoking in pregnancy was associated with an increased risk of SGA (adjusted odds ratio (OR) = 2.41; 95% confidence interval (CI) = 1.78, 3.28). We could not detect an increased risk of SGA with paternal smoking, or with other household smokers when the mother was a non‐smoker, but did find an increased risk with exposure to ETS in the workplace or while socializing. Infants of mothers who ceased smoking during pregnancy were not at increased risk of SGA, but those who decreased but did not stop remained at risk of SGA. There was no evidence that the concentration of nicotine and tar in the cigarettes influenced the risk of SGA.

Conclusions: Maternal smoking in pregnancy is a major risk factor for SGA. This study suggests that mothers should be advised to cease smoking completely during pregnancy, and that a reduction in the number of cigarettes smoked or smoking low tar or nicotine concentration cigarettes does not reduce the risk of SGA.
Socioeconomic environmental factors and hospitalization for acute bronchiolitis during infancy
Authors: Jansson L , Nilsson P , Olsson M
Published: August 2010

Bronchiolitis is a major cause of hospitalization during infancy. The aim of this study was to evaluate the influence of socioeconomic factors on the hospitalization of infants with bronchiolitis. All infants below 1 y of age living in the city of Malmö, Sweden, and hospitalized at the University Hospital, Malmö, owing to bronchiolitis during the years 1998 and 1999 were identified. The bronchiolitis hospitalization rates (BHRs) were determined for the infants living in each of the 10 different administrative residential areas of Malmö and correlated with socio‐economic factors (percentage of immigrants, per capita income, unemployment rate and households receiving social benefit) in the respective residential areas. The severity of the disease on admission and during hospital care was assessed by comparing oxygen saturation, days with supplemental oxygen and length of stay. BHR varied more than fourfold between the 10 residential areas. BHR varied significantly with per capita income and the percentage of immigrants. Infants living in the area with the highest social burden were hospitalized almost twice as often as those from the rest of the city, but the severity of disease was similar.

Conclusion: The association between socioeconomic factors and hospitalization indicates that these factors may have a significant influence on the hospitalization rate in bronchiolitis during infancy.
Quality of life in paediatric inflammatory bowel disease measured by a generic and a disease‐specific questionnaire
Authors: Loonen HJ , Grootenhuis MA , Last BF , Koopman HM , Derkx HHF
Published: August 2010

This study assessed the impact of inflammatory bowel disease (IBD) on the health‐related quality of life (HRQoL) of children and adolescents, using both a generic and a disease‐specific instrument. Three questionnaires were sent to all patients (8–18 y old) from the database of two large secondary/tertiary hospitals in the western part of The Netherlands. In total, 83 (66%) children responded, 18 were between 8 and 12 y old and the remaining 65 were older. HRQoL was measured using a generic instrument, the TNO‐AZL Children's Quality of Life questionnaire (TACQOL), assessing seven domains, and the Impact‐II (NL), a disease‐specific instrument assessing six domains. Disease activity was measured by a five‐item symptom card. Compared with scores from a large reference population (n= 1810), younger children with IBD had a comparable HRQoL (measured by the TACQOL) on six domains, and better cognitive functioning, although they did not have severely active disease. Adolescent patients with IBD had a significantly impaired HRQoL on four domains (body complaints, motor functioning, autonomy and negative emotions). The Impact‐II discriminated well between patients with varying disease activity states on all domains.

Conclusion: Adolescents with IBD have a severely affected HRQoL. Impairment on motor functioning and autonomy is a threat to gaining independence from caregivers, and a high occurrence of negative emotions places patients at risk for depressive and behavioural disorders. The Impact‐II is recommended for clinical use because of its high discriminative validity.
Effect of early skin‐to‐skin contact after delivery on duration of breastfeeding: a prospective cohort study
Authors: Mikiel‐Kostyra K , Mazur J , Boltruszko I
Published: August 2010

Aim: To study the influence on breastfeeding of skin‐to‐skin contact after birth. Methods: Using a prospective cohort study design, a group of 1250 Polish children was investigated with 3 y follow‐up. Results: The implementation of the practice significantly increased mean duration of exclusive breastfeeding by 0.39 mo and overall breastfeeding duration by 1.43 mo. The infants kept with the mothers for at least 20 min were exclusively breastfed for 1.35 mo longer and weaned 2.10 mo later than those who had no skin‐to‐skin contact after delivery. The skin‐to‐skin contact after birth significantly coexisted with the other hospital practices supportive to breastfeeding, especially rooming‐in without separation longer than 1 h per 24 h [relative risk (RR) = 3.18, 95% confidence interval (95% CI): 2.34–4.31] and first breastfeeding within 2 h after birth (RR = 2.94, 95% CI: 2.36–3.67. Multivariate analysis performed by a general linear model with duration of exclusive breastfeeding as the dependent variable indicated skin‐to‐skin contact and mother education as two independent variables influencing the duration of exclusive breastfeeding.

Conclusion: The results indicate that extensive mother‐infant skin‐to‐skin contact lasting for longer than 20 min after birth increases the duration of exclusive breastfeeding.
Waist circumference for the screening of the metabolic syndrome in children
Authors: Moreno LA , Pineda I , Rodriguez G , Fleta J , Sarria A , Bueno M
Published: August 2010

Aim: To identify the best anthropometric predictor of the metabolic syndrome in children. Methods: Screening performance was evaluated in a clinical setting. The study included 140 children: 72 non‐obese and 68 with non‐syndromal obesity. Body mass index (BMI), waist circumference and triceps/subscapular skinfolds ratio were used as predictor variables, and systolic blood pressure, diastolic blood pressure, glucose, uric acid, fasting insulin, triglycerides and HDL‐C as metabolic syndrome variables. Results: The areas under the receiver operating characteristic (ROC) curves were 0.849 (95% CI: 0.780,0.919) for BMI, 0.868 (95% CI: 0.801,0.934) for waist circumference and 0.834 (95% CI: 0.757,0.910) for the triceps/subscapular skinfolds ratio. No statistically significant differences were found for the three areas under the ROC curves. The point on the ROC curve closest to 1 corresponded to the 65th percentile for BMI, to the 70th percentile for waist, and to the 40th percentile for the triceps/subscapular skinfolds ratio.

Conclusion: Waist circumference seems to be the best predictor of children with the metabolic syndrome in paediatric clinical settings.
Abnormal heart rate response to hypercapnia in boys with an apparent life‐threatening event
Authors: Edner A , Ericson M , Milerad J , Katz‐Salamon M
Published: August 2010

Aim: To determine instantaneous cardiac variability responses to increased carbon dioxide (CO2) during quiet sleep in infants who may be at risk for the Sudden Infant Death syndrome (SIDS). Methods: The cardiac rate variability before, during and after a CO2 challenge was examined in 41 infants who had experienced an apparent life‐threatening event (ALTE) and 41 gender‐ and age‐matched control infants. Results: The ALTE infants responded to CO2 breathing with a significant increase in R‐R intervals, i.e. decreases in heart rate, compared to the controls (45.1% increase in R‐R intervals vs. 41.4%; p= 0.005). The differences between ALTE infants and controls depended primarily on the boys' responses.

Conclusion: ALTE infants, particularly ALTE boys, have an autonomic dysfunction—lower sympathetic stimulation and/or inhibited vagal withdrawal when stressed with CO2. The outcome might provide clues to the mechanisms underlying the cardiovascular processes contributing to the terminal event in SIDS.
Supplementary oxygen and risk of childhood lymphatic leukaemia
Authors: Naumburg E , Bellocco R , Cnattingius S , Jonzon A , Ekbom A
Published: August 2010

Aim: Childhood leukaemia has been linked to several factors, such as asphyxia and birthweight, which in turn are related to newborn resuscitation. Based on the findings from a previous study a population‐based case‐control study was performed to investigate the association between childhood leukaemia and exposure to supplementary oxygen and other birth‐related factors. Methods: Children born in Sweden and diagnosed with lymphatic leukaemia between 1973 and 1989 (578 cases) were individually matched by gender and date of birth to a randomly selected control. Children with Down's syndrome were excluded. Exposure data were blindly gathered from antenatal, obstetric and other standardized medical records. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated by conditional logistic regression. Results: Resuscitation with 100% oxygen with a facemask and bag immediately postpartum was significantly associated with an increased risk of childhood lymphatic leukaemia (OR = 2.57, 95% CI 1.21–6.82). The oxygen‐related risk further increased if the manual ventilation lasted for 3 min or more (OR = 3.54, 95% CI 1.16–10.80). Low Apgar scores at 1 and 5 min were associated with a non‐significantly increased risk of lymphatic leukaemia. There were no associations between lymphatic leukaemia and supplementary oxygen later in the neonatal period or other birth‐related factors.

Conclusion: Resuscitation with 100% oxygen immediately postpartum is associated with childhood lymphatic leukaemia, but further studies are warranted to confirm the findings.
Rhinitis in 10‐year‐old children and early life risk factors for its development
Authors: Arshad SH , Kurukulaaratchy RJ , Fenn M , Waterhouse L , Matthews S
Published: August 2010

Aim: To study the prevalence, characteristics of and risk factors for childhood rhinitis. Methods: In a whole population birth cohort study (n= 1456) the prevalence and characteristics of rhinitis among 10‐y‐old children were examined. At this age 1373 children (94%) completed standardized questionnaires, 1043 (72%) skin‐prick testing, 953 (65%) serum inhalant immunoglobulin E antibody screening and 784 (54%) methacholine bronchial challenges. Results: At the age of 10 y the prevalence of hayfever ever was 18.6% and current nasal symptoms (rhinitis) 22.6%. Rhinitis at 10 y was largely seasonal and associated with low morbidity, although 62.7% of cases required pharmacological treatment. Atopy (positive skin test) and other allergic states were associated with rhinitis (p > 0.001). Wheeze or diagnosed asthma was higher with coexistent rhinitis. Among wheezing children physician‐diagnosed asthma (p > 0.024) and inhaled corticosteroid use (p > 0.001) were greater with the presence of rhinitis. Significant bronchial hyperresponsiveness (methacholine concentration giving a 20% fall in forced expiratory volume in 1 s >4.0 mg ml‐1) was greater if rhinitis was present even when the child did not wheeze (p > 0.001). Risk factor analysis for rhinitis identified the independent significance for atopy (p > 0.001) and eczema (p= 0.009) at the age of 4 y plus paternal rhinitis (p > 0.001), maternal rhinitis (p= 0.033) and maternal food allergy (p= 0.016).

Conclusion: Rhinitis is common at the age of 10 y, with strong associations with atopy, wheezing, asthma and bronchial hyperresponsiveness. An inherited predisposition towards atopy appears to predominate over environment in the aetiology of this state.
Measurement error associated with spinal mobility measures in children with and without low‐back pain
Authors: Jones MA , Stratton G , Reilly T , Unnithan VB
Published: August 2010

Aim: Evidence of the reliability of measurements in children is scarce, particularly in children with low‐back pain. The aim of this investigation was to evaluate the measurement error associated with repeated measures of spinal mobility measures in children with and without low‐back pain by establishing 95% limits of agreement. Methods: A repeated measures study was performed involving 119 children aged 11–16 y. Of this sample 30 subjects reported recurrent low‐back pain and were classified as symptomatic, the remaining 89 subjects were asymptomatic. Standardized measures were taken, including the sit‐and‐reach test, hip range of motion (Leighton flexometer), lumbar flexibility (modified Schöber test) and lateral flexion of the spine. The same experimenter performed all testing, with 1 wk between the repeated measures. Results: Correlation coefficients suggested that all measures exhibited good reliability in both the symptomatic (r= 0.80–0.95) and asymptomatic groups (r= 0.88–0.99). In contrast, the limits of agreement showed that all measures exhibited random error. The magnitude of random error was typically greater in the symptomatic subjects, suggesting that low‐back pain may influence the reliability of typical measures used in this population.

Conclusion: The magnitude of error must be interpreted in relation to analytical goals and the expected magnitude of change. In the authors' opinion the error presented appears acceptable for the serial monitoring of patients, although this will depend on the differences in mobility typically found.
First information and support provided to parents of children with Down syndrome in Sweden: clinical goals and parental experiences
Authors: Hedov G , Wikblad K , Annerén G
Published: August 2010

When parents are informed that their newborn child has Down syndrome (DS), they often respond with a traumatic crisis reaction. The aims of this study were to assess the clinical goals regarding the first information and support provided to parents of newborn children with DS at the Swedish paediatric departments, and to analyse the parents' experiences of how they were first informed and treated. Data were collected during 1992–1993 from all of the 51 departments of paediatrics in Sweden. Information on the parents' experiences, collected retrospectively in 1996, was based on recollection by 165 parents of 86 children with DS born between 1989 and 1993 at 10 of the paediatric departments considered representative for Sweden. Seventy‐five percent of the families were informed about the diagnosis within 24 h post partum. Some parents felt they were informed too late, and a few parents that they were told too soon. Half of the parents were satisfied with the timing. About 70% of the parents considered the information insufficient and 60% felt that they had been unsupported. Seventy percent would have liked more frequent information. Parental criticisms concerning the way in which the information was provided were that they received too much negative information about DS and that both the communication skills and the basic knowledge of DS on the part of the professionals could have been better.

Conclusion: The Swedish paediatric departments fall short of their reported strong clinical goals regarding the initial information in Sweden, and improvements in this area are desirable.
Cytokine response in cerebrospinal fluid from preterm infants with posthaemorrhagic ventricular dilatation
Authors: Sävman K , Blennow M , Hagberg H , Tarkowski E , Thoresen M , Whitelaw A
Published: August 2010

Aim: Posthaemorrhagic ventricular dilatation (PHVD) is closely associated with white matter damage and neurological disability in the preterm infant. Proinflammatory cytokines have been implicated in the pathogenesis of white matter injury and subsequent cerebral palsy. The aim of this study was to determine the levels of proinflammatory cytokines in cerebrospinal fluid (CSF) from preterm infants with PHVD and to correlate the levels to white matter damage and neurodevelopmental outcome. Methods: CSF samples were obtained from 24 preterm infants with expanding PHVD and 19 preterm infants with normal ultrasound. Tumour necrosis factor‐α (TNF‐α), interleukin‐β (IL‐1β), interleukin‐8 (IL‐8) and interferon‐γ (IFN‐γ) in CSF were measured by enzyme‐linked immunosorbent assay, and IL‐6 was measured by bioassay. Results: The concentrations of TNF‐α, IL‐1β, IL‐6 and IL‐8 were significantly elevated in CSF from infants with PHVD. TNF‐α was detected in 43% of PHVD infants and 11% of controls (p= 0.04). IL‐1β was detected in 67% of PHVD infants and 0% of controls (p > 0.0001). The concentrations of IL‐6 were 368 (145–460) pg ml‐1 in the PHVD group and 30 (25–41) pg ml‐1 in the control group (p > 0.0001), and those of IL‐8 were 3000 (1620–3400) pg ml‐1 in the PHVD group and 35 (0–230) pg ml‐1 in the control group (p > 0.0001). Cytokine concentrations did not correlate with white matter lesions on ultrasound, shunt dependence or neurological outcome within the PHVD group.

Conclusion: There was an intense and prolonged inflammatory reaction in CSF from preterm infants with PHVD and a high risk for subsequent white matter injury and permanent neurological impairment.
Large variability in Performance IQ associated with postnatal morbidity, and reduced Verbal IQ among school‐aged children born preterm
Authors: Gabrielson J , Hård A‐L , Ek U , Svensson E , Carlsson G , Hellström A
Published: August 2010

Aim: To assess cognitive ability in a population‐based group of prematurely born school‐aged children and to relate these findings to postnatal morbidity. Method: The study group consisted of a cohort of 51 children born preterm, 43 (26 boys, 17 girls) of whom were available for psychological evaluation At evaluation, their median age was 10 y (range 8–11 y). They were all born between 1988 and 1991, with gestational age less than 29 wk (median 27, range 24–28). Their median birthweight was 1060 g (range 450–1450). The Wechsler Intelligence Scale for Children (WISC‐III) was used, and the test results were compared with those of a standardized, age‐matched, normative group of children. Results: Thirteen children (30%) performed below average [intelligence quotient (IQ) >80] for Full Scale IQ (FSIQ). Thirty‐six children had a Verbal IQ (VIQ) below the mean value of 100 [84%, 95% confidence interval 73–95%], p > 0.0001. The Performance IQ (PIQ) was within the expected range of a normal population, although a large variability was observed. Discrepancies between VIQ and PIQ of more than 15 IQ units were found in 42% of the children. High postnatal morbidity (days with assisted ventilation, number of blood transfusions) and low birthweight standard deviation scores (SDS) were associated with lower PIQ than VIQ, while low postnatal morbidity and high birthweight were associated with higher PIQ than VIQ.

Conclusion: This cohort of preterm children had reduced overall verbal capacity independent of morbidity, and a large variability in performance capacity that was associated with postnatal morbidity. The findings suggest that there are different mechanisms influencing the outcome of verbal and performance capacity in preterm children.
Expert consensus in the development of a European health‐related quality of life measure for children and adolescents: a Delphi study
Authors: Herdman M , Rajmil L , Ravens‐Sieberer U , Bullinger M , Power M , Alonso J ,   The European Kidscreen and Disabkids groups
Published: August 2010

Aim: To determine the level of consensus among experts regarding content, structure and sources of content for a new European measure of health‐related quality of life in children and adolescents. Methods: A three‐round Delphi questionnaire was sent by e‐mail to 24 experts in quality of life measurement in 9 European countries. Consensus was considered reached when ≫90% of experts either agreed or disagreed with a given statement, or where median scores were over 6 on a scale of 1–10, and score dispersion was within predefined limits. Results: Completed questionnaires were received from 20 panellists in each round. It was agreed that the new instrument should be a multidimensional, profile measure with 30–49 items covering 5–8 dimensions, which should take no more than 10–15 min to complete. Agreement was also reached on 8 specific dimensions to include in the questionnaire (psychological well‐being, self‐esteem, body image, cognitive functioning, mobility, energy/vitality, social relations, family/home function). Consensus was against the use of individualized questionnaires. Focus groups with children, parents and workers in the field, literature and instrument reviews were considered appropriate sources for content.

Conclusion: Using a Delphi method in this way for the first time showed it to be a feasible and useful method for establishing a conceptual and operational framework for the Kidscreen questionnaire.
Homocysteine and other vascular risk factors in patients with phenylketonuria on a diet
Authors: Schulpis KH , Karikas GA , Papakonstantinou E
Published: August 2010

The aim of this study was to investigate the known risk factors, such as lipids, homocysteine and endothelin, for the development of coronary artery disease (CAD) in phenylketonuria (PKU) patients, depending on their diet. The PKU patients (n= 74) were divided into two groups. Group A (n= 34; mean age 6.78 ± 1.5 y) adhered strictly to a diet and group B (n= 40; mean age 8.0 ± 3.2 y) did not comply with the diet. The control group comprised 50 healthy non‐PKU children. All groups were evaluated for blood levels of homocysteine and vitamin B6 by high‐performance liquid chromatography, vitamin B12 and folate in serum by a radioassay, lipids by a routine method, and lipoprotein(a) and endothelin‐1 with an immunoassay. Homocysteine levels (28.65 ± 3.3 μmol 1‐1) were increased in group A compared with group B (6.86 ± 1.6 μmol 1‐1) and the controls (6.9 ± 2.0 μmol 1‐1) (p > 0.001). Vitamin B6 (10.7 ± 10.9 nmol 1‐1), vitamin B12 (98.5 ± 22.3 pmol 1‐1), folate (2.35 ± 1.3 nmol 1‐1) and lipids were decreased in group A. The other vascular risk factors, which were not dependent on diet [lipoprotein(a) and endothelin‐1], did not differ among the three groups.

Conclusion: PKU patients on a strict diet had low vitamin B6, vitamin B12 and folate levels resulting in moderate hyperhomocysteinaemia. The evaluation of these vitamins at short intervals and their supplementation could be an early measure in the prevention of CAD.
Neonatal hip instability: results and experiences from ten years of screening with the anterior‐dynamic ultrasound method
Authors: Andersson JE
Published: August 2010

Aim: To record the results and experiences from a 10‐y screening period with the anterior‐dynamic ultrasound method for detecting neonatal hip instability. Methods: An ultrasonographic improvement of the Palmen/Barlow test was used. The screening programme included 22 047 newborns. Decisions about treatment were made solely on the ultrasound result. Results: It was found that 175 infants (7.9/1000) had at least one unstable hip—dislocated or dislocatable. Dislocated hips were found in 1.1/1000. Dislocatable hips were found in 6.8/1000 but only 1.1/1000 needed treatment. The total frequency of treatment was 2.2/1000. All cases but one were diagnosed before discharge from the maternity ward. The rate of surgery was 0.1/1000 newborns. Girls were more affected than boys, by a ratio of 3:1. Among the affected hips 64.4% were a left hip.

Conclusion: Neonatal hip instability is always present at birth and can be diagnosed immediately after birth. We have no indications that instability can appear at a later stage. The anterior‐dynamic ultrasound screening programme is an efficient tool to diagnose neonatal hip instability and to decide when to begin treatment.
Low birth weight children: coping in school?
Authors: Elgen I , Sommerfelt K
Published: August 2010

Aim. To describe and compare school performance and IQ at 11 y of age in a population of 130 children weighing less than 2000 g at birth without any major handicaps (low birthweight) and a random control sample of 131 children born at term weighing over 3000 g (normal birthweight); and to evaluate the relative strength of parental factors versus child birthweight in predicting IQ. Methods. The mothers and teachers completed validated questionnaires addressing school performance and the child's IQ was evaluated by WISC‐R, prorated. In addition, socioeconomic status was investigated using different questionnaires. Results. According to maternal reports, twice as many low birthweight children had school problems and three times as many of these children were referred to the School Psychological Service. Mean prorated IQ was 5 points lower in the low birthweight group. No statistically significant difference was found for mean IQ between the groups with birthweights of less than 1500 g vs 1500–2000 g. In a multivariate linear regression analysis, parental factors accounted for 13% of the variance in child IQ compared with only 3% accounted for by child birthweight.

Conclusion. Low birthweight significantly increases the risk of school problems.