bluuebunny/crossref_metadata_2025 huggingface dataset:
Traumatic head injury in infants and toddlers
Authors: Myhre MC , Grøgaard JB , Dyb GA , Sandvik L , Nordhov M
Published: May 2008

Aim: To describe the presenting characteristics, type of injury and hospital course in young children with traumatic head injury, and to identify characteristics indicating that the trauma was inflicted.

Methods: A retrospective medical record review of 91children less than 3 years of age who were admitted to a tertiary teaching hospital in Norway from 1995 through 2005 with a traumatic head injury. Patients were identified by diagnostic codes, and categorized by type of injury as skull fractures (n = 39), epidural haemorrhage (EDH) (n = 12), subdural haemorrhage (n = 27) and parenchymal brain injury (n = 13). Further the cases were classified as inflicted injury (n = 17), accident (n = 35) or indeterminate (n = 39).

Results: The mechanism of injury was similar for EDHs and isolated skull fractures, and none were classified as inflicted. Sixty‐three percent of the cases with subdural haematoma were classified as inflicted. When compared to the accident group, children in the inflicted group more frequently had subdural haemorrhage without a skull fracture (OR = 6.9, CI = 1.7–28.2), and seizures (OR = 9.5, CI = 2.1–43.3).

Conclusions: Inflicted and accidental head injuries differed in presenting characteristics and injury type. Nearly two‐third of the subdural haemorrhages were classified as inflicted, but none of the epidural EDHs or skull fractures. Inflicted injuries tended to present with seizures.
Changes in laboratory parameters indicating cell necrosis and organ dysfunction in asphyxiated neonates on moderate systemic hypothermia
Authors: Róka Anikó , Vásárhelyi Barna , Bodrogi Eszter , Machay Tamás , Szabó Miklós
Published: May 2008

Aim: Asphyxia is a major cause of morbidity and mortality in term infants. In addition to cerebral injury other organs are also distressed due to hypoxic‐ischaemic insult. Systemic hypothermia has a beneficial effect on brain injury. We tested the impact of hypothermia on hypoxic damage of other internal organs.

Methods: Asphyxiated term neonates (n = 21) were randomised to groups treated with hypothermia (n = 12) and normothermia (n = 9). Hypothermia (33–34°C) was initiated within 6 h of life, and maintained for 72 h. We determined serum transaminase, lactate dehydrogenase, creatine kinase, uric acid, creatinine levels and diuresis during 6, 24, 48 and 72 postnatal hours.

Results: Area under curve values of aspartate aminotransferase (ASAT), lactate dehydrogenase (LDH), uric acid and creatinine during the investigated period and alanine aminotransferase (ALAT) value at 72 h were lower in neonates on hypothermia than in those on normothermia. Renal failure and liver impairment affected less hypothermic than normothermic neonates (3/12 vs. 7/9, p = 0.03, 3/12 vs. 6/9 p = 0.08, respectively). Four of the 12 hypothermic and 6 of the 9 normothermic neonates developed multiorgan failure.

Conclusions: These results suggest that systemic hypothermia may protect against cell necrosis and tissue dysfunction of internal organs after neonatal asphyxia.
Outcome of infants with inflicted traumatic brain injury (shaken baby syndrome) in Estonia
Authors: Talvik Inga , Männamaa Mairi , Jüri Piret , Leito Kaja , Põder Haide , Hämarik Malle , Kool Pille , Talvik Tiina
Published: May 2008

This is a population‐based prospective study to identify the long‐term outcome of children with inflicted traumatic brain injury (ITBI).

Twenty‐two survivors were identified and followed up. Only 2 of 22 had no developmental problems at follow‐up, 20 of 22 children were having different developmental problems, among them 3 of 22 were severely handicapped. Psychological tests passed 17 of 22, 5 did not pass due to severe handicap (3 children) or were too young (2 patients). Epilepsy was found in 7 of 22, being intractable in 3 cases. Serious motor problems were identified in 5 of 22. Ophthalmologic problems were found in 4 of 22. The most important predictor of adverse outcome was young age at the time of the insult.

Conclusion: the outcome of these potentially healthy children is poor. The key question is prevention. Health care professionals should be more concerned about these problems.
Short‐term growth in children with eczema during treatment with topical mometasone furoate and tacrolimus
Authors: Gradman Josefine , Wolthers Ole D
Published: May 2008

Background: Treatment with topical glucocorticoids in children with atopic eczema may be associated with systemic adverse effects, such as suppression of growth.

Aim: To asses if treatment with topical mometasone furoate 0.1% or topical tacrolimus 0.1% affects short‐term growth in children with atopic eczema. Primary outcome measures were lower leg growth rates measured by knemometry.

Methods: Twenty 5‐ to 12‐year‐old prepubertal children with atopic eczema were included in a randomised, investigator‐blind crossover study with five periods: two treatment periods, a run in, a wash out and a run out. All periods were of 2‐week duration. The subjects applied mometasone furoate ointment 0.1% once daily during one treatment period and tacrolimus ointment 0.1% twice daily during the other treatment period.

Results: As compared to run in mean lower leg growth rate during mometasone furoate and tacrolimus treatment was reduced by 0.09 and 0.06 mm/week, respectively, (F = 1.12, p = 0.35). Consistently, no statistically significant effects on urine levels of eosinophil protein X and crossed‐linked N‐telopeptides were detected.

Conclusion: Treatment with mometasone furoate or tacrolimus does not affect short‐term growth in children with mild to moderate atopic eczema.
Treatment‐by‐gender effect when aiming to avoid hyperoxia in preterm infants in the NICU
Authors: Deulofeut Richard , Dudell Golde , Sola Augusto
Published: May 2008

Objective: To examine gender‐specific differences in response to the O2 saturation (SpO2) targets aimed at avoiding hyperoxia in very low birth weight infants (VLBW).

Methods: Analysis of a prospectively collected database of all infants ≤1250 g in two perinatal centres. A change was instituted in January 2003 with the objective of avoiding hyperoxia with target SpO2 at 85–93% (period II). Prior to this, SpO2 high alarms were set at 100% and low alarms at 92% (period I; from January 2000 to December 2002).

Results: Of the 497 infants that met enrolment criteria, 297 (60%) were born during period I and 140 (47%) of them were male. During period II, 200 infants were born and 101 (50%) were male. Analysis by gender showed that the rate of retinopathy of prematurity, bronchopulmonary dysplasia and length of stay is significantly better for female infants than males on period II compared to period I. Neither gender experienced increased short‐term neurological morbidity in response to lower SpO2 targets.

Conclusions: There is a significant gender‐specific difference favouring females in the beneficial effects produced by avoiding high SpO2 and hyperoxia, with no difference in the distribution of any potential short‐term detrimental effects.
Universal newborn hearing screening: a 27‐month experience in the French region of Champagne‐Ardenne
Authors: Lévêque Marianne , Schmidt Pascal , Leroux Bernard , Danvin Jean‐Baptiste , Langagne Thibault , Labrousse Marc , Chays André
Published: May 2008

Objectives: This article reports the creation of a Universal Newborn Hearing Screening (UNHS) program in a French region, Champagne‐Ardenne, and the results of its first 27 months.

Materials and Methods: We introduced a UNHS program in all the Champagne‐Ardenne maternities in order to screen all newborns in the region. We used a two‐step strategy. The first test consists of automated transiently evoked otoacoustic emissions (TEOAE) and is performed before discharge by a nurse or a midwife. If TEOAE are absent in both ears (positive screening test), the baby is referred to the second test, which could be either TEOAE or automated auditory brainstem response (aABR) 15 days after discharge, by a physician in an outpatient clinic. If the retest is positive in both ears, the baby is referred to diagnostic tests in a reference centre. This procedure also applies to newborns in neonatal intensive care units but, in those cases, the first test procedure is aABR because of the higher incidence of auditory neuropathies in those units. UNHS data are recorded with the other neonatal screening tests in the Regional Neonatal Screening Center, which facilitates the follow‐up of newborns.

Results: A total of 33 873 newborns were screened, which represents a coverage rate of 92.42%. In those babies, 33 431 had a negative first test and 429 were retested. There were 34 positive retests. Among those 34 children, 27 were actually deaf (0.08%). The median age at diagnosis was shortened from 17 months to 10 weeks.

Conclusion: Those 27‐month results demonstrate the validity of our UNHS program, which relies on the cooperation with maternities, an easy protocol and a strong follow‐up procedure.
Factors influencing management and comparison of outcomes in paediatric intussusceptions
Authors: Saxena A K , Höllwarth M E
Published: May 2008

Aim: This study aims to compare management strategy and outcomes of paediatric ileocolic intussusceptions (ICI) versus small‐bowel intussusceptions (SBI).

Methods: Hospital charts of patients with intussusceptions between January 1999 and June 2006 were reviewed retrospectively.

Results: A total of 135 patients with the diagnosis of intussusceptions were found in the database. In 111 patients the diagnosis was confirmed using ultrasound. The median age of the patients was 2.25 years (range 9 weeks–10 years). ICI were documented in 83 patients (74.8%) and SBI in 28 (25.2%). Spontaneous reductions were observed in 11 of 83 (13.3%) ICI and 18 of 28 (64.3%) SBI. Pneumatic reductions were attempted and were successful in 61 of 67 (91%) ICI and 6 of 7 (85.7%) SBI. Surgery was performed in 11 of 83 (13.3%) ICI and 4 of 28 (14.3%) SBI; with 2 of 83 (2.4%) ICI and 3 of 28 (10.7%) SBI patients requiring bowel resections. The median age of patients requiring surgery was 9 months in ICI and 6 years in SBI.

Conclusion: There are differences in ICI and SBI with regard to spontaneous reductions, and bowel resection, and age with regard to surgery and bowel resection. The treatment efficacy depends on time of presentation, intussusception type, pathologic lead points, ultrasound/colour Doppler interpretation and expertise in reduction techniques.
Reduced IL‐10 production and ‐receptor expression in neonatal T lymphocytes
Authors: Schultz C , Strunk T , Temming P , Matzke N , Härtel C
Published: May 2008

Aim: To further evaluate the underlying mechanism of a formerly demonstrated immature anti‐inflammatory response in neonates (1).

Methods: Interleukin (IL)‐10 production was measured by enzyme‐linked immunosorbent‐assay (ELISA) after anti‐CD3/anti‐CD28 costimulation of neonatal and adult T cells. IL‐10 receptor expression on T lymphocytes, B lymphocytes and monocytes were analysed by flow cytometry in neonates and adult controls.

Results: After anti‐CD3/anti‐CD28 costimulation, IL‐10 production of neonatal T lymphocytes was profoundly reduced (median 247 pg/mL vs. 1062 pg/mL, p < 0.0001). IL‐10 receptor expression was diminished on neonatal T lymphocytes compared to adults (3% vs. 39.5% IL‐10 receptor positive lymphocytes; p < 0.0001). On neonatal B lymphocytes and monocytes the IL‐10 receptor expression was comparable to adult controls.

Conclusion: The strongly reduced IL‐10 receptor expression on the main immune regulative T lymphocytes in conjunction with a significantly impaired synthesis of IL‐10 may play a crucial role in the formerly demonstrated deficient anti‐inflammatory immune response in neonates.
High‐sensitivity C‐reactive protein in children at risk for coronary artery disease
Authors: Guran Omer , Akalin Figen , Ayabakan Canan , Dereli Feyza Yagmur , Haklar Goncagul
Published: May 2008

Aim: To determine the value of high‐sensitivity C‐reactive protein (hs‐CRP) in predicting risk factors for coronary heart disease (CHD) in children.

Methods: We measured hs‐CRP levels in 51 children (11.79 ± 3.14 years) with risk factors for CHD (hypercholesterolemia, hypertension, obesity, low HDL cholesterol and familial history of CHD). The results were compared with 26 children (12.98 ± 2.59 years) without any risk factors.

Results: The children with risk factors had significantly higher serum levels of hs‐CRP compared to the control group (3.33 ± 4.58 vs. 0.92 ± 1.90 mg/L, respectively, p < 0.01). CRP concentrations significantly increased in children with three or more risk factors. Hs‐CRP levels correlated to body mass index (r = 0.411, p = 0.003), diastolic blood pressure (r = 0.323, p = 0.021), fibrinogen (r = 0.447 and p = 0.004) and HDL cholesterol levels (r =−0.461 and p = 0.001). Cutoff value for CRP was 1.04 mg/L with 58% sensitivity and 92% specificity.

Conclusion: Serum hs‐CRP level is a useful marker in screening the children who are under the risk of CHD in adulthood. Early identification of the children with risk factors and intervention for obesity, harmful habits and life style in childhood might decrease the incidence of coronary heart disease in adulthood.
Congenital heart defects—chromosomal anomalies, syndromes and extracardiac malformations
Authors: Meberg Alf , Hals Jardar , Thaulow Erik
Published: May 2008

Aim: To register chromosomal anomalies, syndromes and extracardiac malformations in patients with Congenital heart defects (CHDs).

Method: Population‐based prospective observational study.

Results: Of 57 027 live births during 1982–2005, CHDs were detected in 662 (11.6 per 1000), of whom 146 (22%) had associated anomalies. Of these 52 (36%) had chromosomal anomalies (exclusive microdeletions), 26 (18%) genetic syndromes/microdeletions, 1 (0.7%) a teratogenous syndrome and 67 (46%) extracardiac malformations. In perimembraneous ventricular septal defects (VSDs), associated anomalies occurred in 22 of 70 (31%) compared to 27 of 298 (9%) in VSDs located in the muscular part of the septum (p < 0.0001). The prevalence of CHDs with associated disorders increased significantly from the cohort born during 1982–1993 to those born during 1994–2005 (2.0 vs. 3.1 per 1000, respectively; p < 0.0001), mainly caused by an increase of chromosomal trisomies (0.5 vs. 1.1 per 1000; p = 0.026). The percentage of women giving live birth at 35 years of age or more was 7.6% for the period 1982–1993 compared to 13.4% for 1994–2005 (p = 0.001).

Conclusions: Chromosomal anomalies, syndromes and extracardiac malformations occurred in nearly one‐fourth of CHD cases. Muscular VSDs had a low prevalence of such conditions. The prevalence of CHDs with chromosomal trisomies increased, and was probably related to an increasing age of women giving birth.
Omitting control biopsy in paediatric coeliac disease: a follow‐up study
Authors: Killander Anna , Arnell Henrik , Hagenäs Lars , Finkel Yigael
Published: May 2008

Aim: To evaluate the practice of diagnosing coeliac disease with only one small‐bowel mucosal biopsy in a selected group of children with suspected coeliac disease.

Methods: A retrospective review of medical records and a follow‐up interview of 102 children (65 girls, 37 boys) at diagnosis of coeliac disease. The inclusion criteria were age >18 months, increased levels of serum antitissue transglutaminase IgA antibodies and pathologic small‐bowel mucosal biopsy. Anthropometric data were calculated for children 1.5–11 years of age.

Results: The levels of serum antitissue transglutaminase IgA antibodies were either normal (92%) or slightly elevated (8%) in all children after 1 year on a gluten‐free diet. The height‐for‐age Z score increased in 52 of 61 (85%) children, (median 0.26 SD, range −0.45 to 1.83 SD) and the weight‐for‐age Z score increased in 50 of 61 (82%) children (median 0.42 SD, range −0.77 to 2.24 SD). Sixty of 61 (98%) children showed normal or catch‐up growth. Regression of symptoms after 1 year on a gluten‐free diet was reported for 71 of 72 (98%) children.

Conclusion: We propose that a control biopsy is not necessary for the diagnosis of coeliac disease in these children.
Postnatal management of isolated mild pelvic dilatation detected in antenatal period
Authors: Merlini L , Parvex P , Anooshiravani‐Dumont M , Girardin E , Hanquinet S
Published: May 2008

Aim: Mild antenatal renal pelvic dilatation (ARPD) revealed by prenatal ultrasound (US) raises the question whether or not screening for vesicoureteral reflux (VUR) is mandatory. The aim of our study was to suggest guidelines for postnatal management of infants with mild ARPD defined as an antero‐posterior (AP) dilatation >5 and <10 mm.

Method: Therefore we assessed the value of postnatal US at day 30 to predict VUR, the incidence of VUR at day 30 and the rate of spontaneous resolution at 1 year. Two hundred (200) infants with ARPD were included and had renal US and voiding cystourethrography (VCUG) at day 30. If VUR was present, VCUG was repeated 1 year later.

Results: Incidence of VUR was 10% (20/200) at day 30 after birth and only 3% (6/200) 1 year later. VUR at day 30 was twice as frequent in children with postnatal dilatation (11%) than in nondilated kidneys (6%).

Conclusions: Considering the low incidence of VUR at 1 year, screening for VUR in mild ARDP seems not to be justified. However follow‐up by US to detect increase in dilatation and clinical monitoring for signs of urinary infection is required.
Effects of the home environment on unintentional domestic injuries and related health care attendance in infants
Authors: De Lourdes Drachler Maria , De Carvalho Leite José Carlos , Marshall Tom , Anselmo Hess Almaleh Carla Maria , Feldens Carlos Alberto , Vitolo Márcia Regina
Published: May 2008

Aims: To examine the effects of the home environment on unintentional domestic injuries and related health care attendance in infants from deprived families.

Methods: Ten mechanisms that caused unintentional domestic injury during the first year were investigated in a population‐based study of 1‐year‐old children in southern Brazil. Odds ratios of injury‐related health care attendance were estimated by number of injury mechanisms reported. Variation in number of mechanisms (in the whole sample) and odds ratios of care attendance (in children with reported injuries) were estimated for socioeconomic and psychosocial variables.

Results: Among all children (394) 86% had injuries; 10.9% care attendance and 0.5% hospitalisation were reported, and 14.5% presented dental trauma. Injury‐related care attendance increased with the number of injury mechanisms (linear trend OR = 1.34, 95% CI = 1.09–1.66). In multivariable linear regression, injury mechanisms increased with the number of home hazards (p = 0.047) and decreased with duration of exclusive breastfeeding (p = 0.039), maternal involvement‐responsiveness (p = 0.037) and mother's paid work (p = 0.018). Injury‐related health care attendance among children with reported injuries was positively associated with maternal involvement‐responsiveness (OR = 2.27, 95% CI = 1.11–4.67) and home organization (OR = 2.25, 95% CI = 1.09–4.65).

Conclusion: Injury control can benefit from policy and practice that improve housing, reduce home hazards and promote breastfeeding, maternal bonds, safety practices and injury care.
Perinatal and socioeconomic determinants of breastfeeding duration in very preterm infants
Authors: Flacking R , Wallin L , Ewald U
Published: May 2008

Aim: To describe the impact of prematurity, size at birth, neonatal disorders and the families' socioeconomic status (SES) on breastfeeding duration in mothers of very preterm infants.

Methods: Prospective population‐based cohort study. Data on breastfeeding, registered in databases in two Swedish counties in 1993–2001, were matched with data from two national registries: the Medical Birth Registry and Statistics Sweden. Mothers of 225 very preterm singleton infants were identified and included.

Results: Seventy‐nine percent of the mothers breastfed at 2 months, 62% at 4 months, 45% at 6 months, 22% at 9 months and 12% at 12 months. Prematurity, size at birth and neonatal disorders did not show an effect on breastfeeding duration. Being adversely exposed to any of the SES factors (maternal education, unemployment benefit, social welfare and equivalent disposable income in the household) was significantly associated with earlier weaning up to 6 months of infants' postnatal age.

Conclusions: This study shows new and noteworthy results concerning breastfeeding duration in mothers of very preterm infants, which was not influenced by degree of prematurity, size at birth or neonatal disorders but was affected by SES. This highlights the need for improved support of socioeconomically disadvantaged mothers, during and after the hospital stay.
Coping strategies among Swedish children and adolescents with mobility impairment in relation to demographic data, disability characteristics and well‐being
Authors: Jemtå L , Dahl M , Nordahl G , Fugl‐Meyer KS
Published: May 2008

Aim: The first aim of the present study was to evaluate the applicability of a four‐dimensional model of coping strategies, which includes ‘active coping’, ‘distraction’, ‘avoidance’ and ‘support seeking’ strategies, on children and adolescents with mobility impairment. The second aim was to identify coping strategies in this group. Finally, we analysed the relation between coping strategies and demographic data, disability characteristics and well‐being.

Methods: Children and adolescents aged 7–18 years with mobility impairment (n = 133) were interviewed, and demographic and disability characteristics were recorded. The Children's Coping Strategies Checklist, a 52‐item self‐report inventory, was used to characterise dispositional style in coping.

Results: The four‐factor model of coping strategies provides an adequate fit to the data of the sample studied. Three of the four coping strategies, all except ‘avoidance’, were significantly related to several demographic and disability features. Well‐being was not significantly related to any of the four coping strategies, although the higher the trust in the strategies, the higher the estimation of one's own well‐being.

Conclusion: Identification of coping strategies among children and adolescents with mobility impairment should form the basis of our understanding of how they face the complexity of challenges while growing up.
Survey of neonatal respiratory support strategies
Authors: Sharma Atul , Greenough Anne
Published: May 2008

Aim: To survey current practice regarding neonatal respiratory support strategies to determine whether it reflected evidence from randomised trials.

Methods: A questionnaire (in Supplementary Material online) survey of all U.K. neonatal units was undertaken to determine what modes of ventilation, types of endotracheal tube, lung function monitoring and oxygen saturation levels were used.

Results: There was an 80% response rate. Most (73%) units used in prematurely born infants (in the first 24 h) the intermittent positive pressure ventilation, and other respiratory modes included: CPAP (2%), triggered ventilation with or without volume guarantee (22%) and high frequency oscillation (2%). Only 15% of units used assist control mode for weaning; the preferred weaning mode was synchronous intermittent mandatory ventilation (73%). Few units used shouldered endotracheal tubes (3%) or lung function measurements (25%) to aid choice of ventilator settings. Oxygen saturation levels from 80% to 98% were used, levels greater or equal to 95% were used by 11% of units for infants with acute respiratory disease but by 34% of units for BPD infants (p < 0.001).

Conclusion: Many practitioners do not base their choice of neonatal respiratory support strategies on the results of large randomised trials; more effective methods are required to ensure evidence‐based practice.
Delayed diagnosis of critical congenital cardiovascular malformations (CCVM) and pulse oximetry screening of newborns
Authors: Aamir Tajwar , Kruse Lakota , Ezeakudo Osita
Published: May 2008

Objective: Congenital cardiovascular malformations (CCVMs) are relatively common with a prevalence of 5–10 per 1000 live births. Pulse oximetry screening is proposed to identify newborns with critical CCVMs which are missed by routine prenatal ultrasound and by pre‐discharge physical examinations. The purpose of this study was to identify the number of infants with a delayed diagnosis of critical CCVMs potentially detectable by pre‐discharge pulse oximetry screening.

Patients and Methods: Hospital Discharge records in New Jersey from 199–2004 for infants with critical CCVMs were identified using ICD‐9 codes. These records were matched to the Electronic Birth Certificate records to identify newborns who were discharged as normal newborns and were later admitted with a diagnosis of critical CCVMs. Chart review was completed on these cases to confirm a delay in diagnosis.

Results: Chart reviews confirmed delayed diagnosis of critical CCVM in 47 infants out of 670,245 births. Coarctation of the Aorta was the most common delayed diagnosis. The age at final diagnosis varied from 3 days to 6.5 months.

Conclusions: Further examination of pulse oximetry as a routine newborn screening service is warranted. Implementation of pre‐discharge pulse oximetry screening for newborns may improve the timely detection of asymptomatic critical CCVMs.
Effect of intravenous pamidronate therapy on everyday activities in children with osteogenesis imperfecta
Authors: Löwing Kristina , Åström Eva , Oscarsson Katarina Allbrink , Söderhäll Stefan , Eliasson Ann‐Christin
Published: May 2008

Aim: To evaluate the effect of intravenous pamidronate therapy on everyday activities, well‐being, skeletal pain and bone density in children with osteogenesis imperfecta (OI).

Methods: In a prospective observational study, monthly intravenous pamidronate infusions were given to 43 children (aged 4 months–16 years) with different severity and form of OI. Outcome measures included the Pediatric Evaluation of Disability Inventory (PEDI), a score of well‐being, registration of days with pain and bone density measured by using dual energy X‐ray absorptiometry (DXA). Data were collected before and after the first year of treatment.

Results: Self‐care and mobility measured by PEDI increased significantly in both the Functional Skill scale and in the Caregiver Assistance scale. The youngest children improved more than the older ones according to the PEDI. The days with skeletal pain were reduced and both well‐being and bone density increased.

Conclusions: Intravenous treatment with bisphosphonates influenced health status, according to the International Classification of Functioning, Disability and Health (ICF). This group of 43 children experienced beneficial effects on everyday activities, skeletal pain, well‐being and bone density.
Evaluation of the educational impact of the WHO Essential Newborn Care course in Zambia
Authors: McClure E M , Carlo W A , Wright L L , Chomba E , Uxa F , Lincetto O , Bann C
Published: May 2008

Objectives: To evaluate the effectiveness of the World Health Organization (WHO) Essential Newborn Care (ENC) course in improving knowledge and skills of nurse midwives in low‐risk delivery clinics in a developing country.

Methods: The investigators identified the content specifications of the training material, developed both written and performance evaluations and administered the evaluations both before and after training clinical nurse midwives in Zambia.

Findings: Based on these evaluations, both the knowledge and skills of the nurse midwives improved significantly following the course (from a mean of 65% correct pretraining to 84% correct post‐training and from 65% to 77% correct on the performance and written evaluations, respectively). The ENC course written evaluation was validated and both tools allowed evaluation of the ENC course training.

Conclusions: We found significant improvements in trainees' knowledge and skills in essential newborn care following the WHO ENC course; however, lack of basic resources may have limited the application of the ENC guidelines. Implementation of the ENC course should be undertaken in consideration with the local conditions available for newborn care.
The postnatal changes in red blood cell NO levels
Authors: Bard Harry , Bellemin Karine , Gagnon Carmen
Published: May 2008

Aim: To determine the levels of RBC HbSNO and HbFe(II)NO using chemiluminescence in very low birth weight infants breathing room air, during the first 2 days of life.

Method: RBC NO values were compared to the levels obtained in cord blood at birth from infants of similar gestational age. Five infants ranging from 25 to 27 weeks of gestation were sampled between 12 and 24 h after birth. These infants were considered as the postnatal group and had normal blood gases at room air.

Results: The HbSNO levels were increased in the postnatal group from 49.0 ± 17.4 nm to 152.3 ± 54.3 nm (p = 0.0006). There was no difference in HbFe(II)NO levels between the two groups (mean of 267.6 ± 186.5 nm in cord blood and 180.3 ± 89.2 nm in the postnatal sample.

Conclusion: The increase in HbSNO postnatally could be an important mechanism for the neonatal pulmonary adaptation to extra‐uterine life.
Wheeze detection as a measure of bronchial challenge in young children with cough‐variant asthma and with classic asthma
Authors: Koh Young Yull , Kang Hee , Yoo Young , Kim Do Kyun , Yu Jinho , Kim Chang Keun
Published: May 2008

Aim: Tracheal and chest auscultation for wheeze and transcutaneous oximetry have both been suggested as outcome measures of bronchial provocation tests in young children. The aims of this study were to compare the sensitivity of these two techniques as endpoints for methacholine challenge in young children with cough‐variant asthma (CVA) and with classic asthma (CA), and to investigate whether oxygen saturation levels at the presence of wheezing differ in these two groups.

Methods: We performed a retrospective analysis of methacholine challenge test data from 4‐ to 6‐year‐old children with CVA (n = 41) and from those with CA (n = 53). The challenges used a modified auscultation method that set wheeze detection and/or oxygen desaturation for determining the endpoint.

Results: The frequency of wheeze detection at the endpoint was significantly lower than that of oxygen desaturation (46.3% vs. 78.0%) in the CVA group, which contrasted with findings (75.5% vs. 50.9%) in the CA group. Oxygen saturation levels at the presence of wheezing were significantly lower in the CVA group than in the CA group (94.5 ± 1.5% vs. 95.9 ± 1.8%, p = 0.006).

Conclusion: Wheeze detection is a less sensitive outcome measure than oxygen desaturation and is associated with a lower oxygen saturation level in young children with CVA, compared to those with CA.
Benefits of breastfeeding in cystic fibrosis: A single‐centre follow‐up survey
Authors: Colombo Carla , Costantini Diana , Zazzeron Laura , Faelli Nadia , Russo Maria Chiara , Ghisleni Diana , Gatelli Italo , Giovannini Marcello , Riva Enrica , Zetterström Rolf , Agostoni Carlo
Published: May 2008

Aim: To study the effect of breastfeeding (BF) on growth, lung function and number of infections during the first 3 years of life in children with cystic fibrosis (CF).

Material and methods: One hundred forty‐six CF patients, 5–18 years old, were recruited at their annual care visit. Information about infant feeding, psychosocial and socioeconomic conditions and smoking exposure was obtained by interviews. Anthropometric parameters at 1 year of age and the number of infections and hospitalisations during the first 3 years of life were obtained from clinical charts. Anthropometrics and pulmonary function parameters were obtained at enrolment.

Results: In CF patients, particularly those with pancreatic insufficiency, the prevalence of BF was lower than the general Italian population. After multivariate analysis patients with prolonged BF showed higher values of CED expiratory volume in 1 sec (FEV‐1) (p = 0.001) and a lower number of infections during the first 3 years of life (p = 0.098).

Conclusion: Prolonged BF is beneficial in children with CF and may protect them against decline of pulmonary function. Particular attention should be paid to promote BF in infants with CF.
Prevalence and independent risk factors for hearing loss in NICU infants
Authors: Hille Elysée TM , Van Straaten HLM (Irma) , Verkerk Paul H ,   the Dutch NICU neonatal hearing screening working group
Published: May 2008

Aim: To determine the prevalence and independent relationship between hearing loss and risk factors in a representative neonatal intensive care unit (NICU) population.

Methods: Automated auditory brainstem response (AABR) hearing screening has been introduced since 1998 in the Dutch NICUs. After a second AABR failure, diagnostic ABR was used to establish diagnosis of hearing loss. Newborns who died before the age of 3 months were excluded. In the present study only the NICU infants who were born with a gestational age <30 weeks and/or a birth weight <1000 g between October 1, 1998 and January 1, 2002 were included. Risk factors included in the study were familial hearing loss, in utero infections, craniofacial anomalies, birth weight <1500g, hyperbilirubinemia, ototoxic medications, cerebral complications, severe birth asphyxia, assisted ventilation ≥5 days and syndromes.

Results: A nationwide cohort of 2186 newborns were included. Mean gestational age was 28.5 weeks (SD 1.6) and mean birth weight was 1039 g (SD 256). Prevalence of uni‐ or bilateral hearing loss was 3.2% (71/2186; 95% CI 2.6–4.1). Multivariate analysis revealed that the only independent risk factors for hearing loss were severe birth asphyxia (OR 1.7; 95% CI 1.0–2.7) and assisted ventilation ≥5 days (OR 3.6; 95% CI 2.1–6.0).

Conclusion: The prevalence of hearing loss in a representative NICU population was 3.2%. Independent risk factors for hearing loss were severe birth asphyxia and assisted ventilation ≥5 days.
Insulin‐like growth factor‐1 as an indicator of nutrition during treatment of adolescent girls with eating disorders
Authors: Swenne Ingemar , Stridsberg Mats , Thurfjell Barbro , Rosling Agneta
Published: May 2008

Aim: The use of serum insulin‐like growth factor‐1 (IGF‐1) concentrations as an index of nutrition has been analysed in teenage girls with eating disorders and weight loss.

Method: Blood samples for analysis of IGF‐1 were obtained at 349 assessments of 302 patients and biweekly during 56 treatment periods in 46 patients. IGF‐1 was related to body size, weight loss, degree of leanness (BMI standard deviation score) and rate of weight loss.

Results: At assessment, when most of the girls were on a weight‐losing course, serum IGF‐1 concentrations were low. Weight loss immediately prior to assessment was the most important predictor of IGF‐1. Together with measurements of weight, height, weight loss and BMI standard deviation score the rate of weight loss predicted IGF‐1 to 32–55%. During treatment when there was net weight gain, IGF‐1 increased in parallel with the BMI standard deviation score, a measure of leanness, and was also influenced by the short‐term weight trend.

Conclusion: The serum IGF‐1 concentration is an indicator of nutritional status in adolescents with eating disorders. It is sensitive to short‐term weight changes measured in a clinical setting and could be used at assessment and to monitor nutritional rehabilitation.
Bone mineral density in children with neurofibromatosis 1
Authors: Yilmaz Kutluhan , Ozmen Meral , Bora Goksan Suleyman , Eskiyurt Nurten
Published: May 2008

Aim: Our aim was to detect the status of bone mineral density (BMD) in children with NF1, and thus to help the management of the skeletal complications of NF1.

Methods: Dual‐energy X‐ray absorptiometry (DEXA) was performed in lumbar spine, total body, proximal femur and forearm in 31 children (3.1–18 years) with NF1. Correlations among the BMD values of four regions were calculated statistically. Z‐scores of lumbar‐ and total body‐BMD were also evaluated in 24 patients at and older than 5 years.

Results: Eleven children had skeletal findings, including mild scoliosis in 5 patients. No case with total body‐Z score <–2 was detected. Lumbar‐Z score was lower than −2 in 3 out of 24 cases. Patients with any skeletal involvement of NF1 were likely to have a lumbar‐BMD lower than −2 in comparison with patients with no skeletal finding (odds ratio 4; 95% CI 0.01–4.62). Proximal femur‐BMD values (g/cm2), yet forearm‐BMDs, were correlated with both lumbar‐ and total body‐BMD, regardless of skeletal involvements of NF1.

Conclusions: Our findings suggest that lumbar‐ or proximal femur‐DEXA, rather than forearm‐ or total body‐DEXA, could reveal significantly decreased BMD in children with NF1, especially in those with skeletal involvement of NF1.
Presidential Policy Initiatives: How the Public Learns about State of the Union Proposals from the Mass Media
Authors: BARABAS JASON
Published: May 2008

Media coverage of State of the Union proposals increases public knowledge on presidential policy initiatives, especially among individuals who follow news coverage. These estimates are based on within‐survey/within‐subjects comparisons of answers to factual questions for respondents who are simultaneously unexposed and exposed to media coverage on the same issue. In this powerful but underused design, individuals serve as counterfactuals for themselves, holding constant all relevant observed and unobserved characteristics. The findings are based on statistical analyses of data from four national surveys conducted since the late 1990s covering a range of topics from health care to Social Security reform. Watching or listening to the address directly does not appreciably affect knowledge once control variables are added for whether individuals follow news coverage of the speech, the amount of news coverage, and the interaction of these two factors.
“An Informal and Limited Alliance”: The President and the Supreme Court
Authors: CURRY BRETT W. , PACELLE RICHARD L. , MARSHALL BRYAN W.
Published: May 2008

Presidential influence transcends some of the barriers imposed by the separation of powers to influence decision making by the Supreme Court. Specifically, we test Robert Scigliano's proposition that an informal and limited alliance exists between the president and the Court. The analysis utilizes Supreme Court decisions on civil rights and civil liberties cases from 1953 to 2000 to assess the effects of the presidency, Congress, judicial policy preferences, and legal factors on the Court. The findings demonstrate that presidential ideology influences Court decisions, while the effects of Congress are more conditional and limited. The results provide support for Scigliano's notion of an informal alliance.
The Last Word: Presidential Power and the Role of Signing Statements
Authors: KELLEY CHRISTOPHER S. , MARSHALL BRYAN W.
Published: May 2008

Signing statements have become an important device that both protects and enhances presidential power by signaling how legislation is to be implemented, offering a mechanism of electoral reward, and protecting presidential prerogatives. We offer a first cut at explaining signing statements by applying William Howell's theory of unilateral action. The evidence shows that presidents use signing statements under conditions of gridlock, such as divided government, which erode their influence in Congress. The findings also suggest a strategic element to signing statement behavior. Presidents issue significantly more signing statements on major legislation when the policy and political stakes are greatest. The results provide insight into the theory of unilateral action and demonstrate how signing statements complement rather than contradict the Richard Neustadt view of power.
Presidential Decision Making and Minority Nominations to the U.S. Courts of Appeals
Authors: KILLIAN MITCHELL
Published: May 2008

Substantive and descriptive representation of racial minorities bolsters the legitimacy of governmental institutions. Prior research on the judicial branch has examined what factors influence the proportion of minorities on U.S. district courts. However, there are no quantitative analyses on what factors affect presidential decisions to nominate minorities for seats on the U.S. courts of appeals. The U.S. courts of appeals are effectively the courts of last resort for nearly all federal cases. Drawing on data from a variety of sources, I show that these decisions are strategic, primarily reflecting presidents’ own ideology and minority representation in the U.S. House of Representatives.
Substance versus Style: Distinguishing Presidential Job Performance from Favorability
Authors: MCAVOY GREGORY E.
Published: May 2008

Although much of the systematic, over‐time research on the presidency has focused on presidential approval and how it varies in response to economic conditions and world events, there is growing interest in the impact that the public's character evaluations of the president can have on presidential approval. In an age when “image is everything,” it is important to understand how these character evaluations of the president vary over time and to assess their impact on presidential approval. Here, I develop a measure of the favorability of the president and show its utility for studying the personal dimension of the public's assessment of the president and its impact on the president's job performance rating.
The Evolution of the Modern Rhetorical Presidency: A Critical Response
Authors: MURPHY CHAD
Published: May 2008

In his 2003 article on the evolution of presidential rhetoric, Teten finds three distinct time periods in the rhetorical presidency. Teten asserts that the modern rhetorical presidency is characterized by greater use of group words and shorter addresses and began with Woodrow Wilson. By expanding his analysis to all State of the Union addresses rather than a sample, I repeat the analysis of group word usage and show that the enduring change in rhetorical styles occurred during Franklin D. Roosevelt's administration rather than Wilson's. This shift may be attributed to the advent of radio and other forms of mass media rather than the personal style of one particular president.
The Evolution of the Rhetorical Presidency and Getting Past the Traditional/Modern Divide
Authors: TETEN RYAN LEE
Published: May 2008

Scholars of the presidency often begin research or examination of the institution with the “modern” presidential era that is said to begin with Woodrow Wilson or Franklin Delano Roosevelt. This kind of approach, as well as the “traditional/ modern” paradigm in general, is problematic because it tends to summarily dismiss a large percentage of the executive officeholders due to their seeming lack of contribution to our understanding of the contemporary presidency. Instead, when the presidents of the eighteenth and nineteenth centuries are closely examined alongside all of their peers, they are remarkable not for the ways in which they fail to resemble today's executive, but for the ways in which they are similar. As such, we, as scholars who are looking for the most complete examination of the presidency, its evolution, and its changes, must move past the adoption of easy handles and evaluate the entirety of presidential history to ensure each era be recognized for its important contributions to the twenty‐first century presidency.
The Contemporary PresidencyExecutive Privilege and the U.S. Attorneys Firings
Authors: ROZELL MARK J. , SOLLENBERGER MITCHEL A.
Published: May 2008

Political observers have debated whether George W. Bush's exercises of secrecy have shielded him from accountability for many of his administration's actions. In particular, the president's use of executive privilege to conceal information about the U.S. attorneys firings set off a firestorm of protest, especially among members of Congress who sought documents and testimony from White House aides. This essay describes and analyzes the president's use of executive privilege in this latest dispute between the political branches. It examines President Bush's actions in the context of his various uses of executive privilege during two terms in office. The essay assesses means by which controversies over executive privilege can be managed by the political branches without resorting to intervention by the courts.
The Law Saving the Presidency from Lawyers
Authors: SPITZER ROBERT J.
Published: May 2008

Legal training is well suited to prepare lawyers for the study and practice of law in the advocacy‐based legal system. But when lawyers as academics enter the realm of constitutional law, legal training offers poor preparation for academic analysis. Worse, the vast realm of legal publishing—law reviews—is run by students who do not rely on peer review, unlike every other academic discipline. The result of these two factors is great potential for wayward constitutional theorizing, which has adverse consequences not only for academic constitutional debates but also for political debate and policy outcomes. This article examines two cases in which lawyer‐made theorizing has deformed constitutional meaning pertaining to the presidency: the inherent item veto and the unitary executive view of the commander‐in‐chief power.
Polls and Elections The Ground War 2000‐2004: Strategic Targeting in Grassroots Campaigns
Authors: PANAGOPOULOS COSTAS , WIELHOUWER PETER W.
Published: May 2008

This article uses survey data from the National Election Studies to examine personal contacting and grassroots mobilization strategies in presidential election campaigns, focusing on the 2000 and 2004 elections. Consistent with widespread journalistic accounts, we find that respondents overall report higher levels of mobilization in 2004. We also find evidence of strategic targeting and mobilization and report on shifts in targeting strategies between the two election cycles.
The Stories of Nico and Brooke Revisited: Toward a Cross‐Disciplinary Dialogue About Teaching and Learning
Authors: Immordino‐Yang Mary Helen
Published: May 2008

ABSTRACT— In “A tale of two cases: Lessons for education from the study of two boys living with half their brains” (M. H. Immordino‐Yang, 2007), I showed that Nico (missing his right cerebral hemisphere) and Brooke (missing his left) had compensated for basic neuropsychological skills to previously unexpected degrees and argued that the ways they had compensated revealed general principles about the active role of the learner and the organizing role of emotion and social interaction in development. Here, I briefly review my findings and interpretations of that work as background for readers to engage in the cross‐disciplinary conversation that follows in this journal issue.
Learning as Problem Design Versus Problem Solving: Making the Connection Between Cognitive Neuroscience Research and Educational Practice
Authors: Ablin Jason L.
Published: May 2008

ABSTRACT— How can current findings in neuroscience help educators identify particular cognitive strengths in students? In this commentary on Immordino‐Yang’s research regarding Nico and Brooke, I make 3 primary assertions: (a) the cognitive science community needs to develop an accessible language and mode of communicating applicable research to educators, (b) educators need proper professional development in order to understand and relate current research findings to practice in the classroom, and (c) the specific research on Nico and Brooke clearly suggests that educators need to rethink the classroom as a place not of problem solving but rather problem design in order to further understand and use the cognitive strengths of each individual student.