bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship between acute respiratory infection and malnutrition in children under 5 years of age
Authors: Cunha AL
Published: August 2010

Data from a population‐based survey, conducted in the northeast of Brazil, were used to examine the association between acute respiratory infection (ARI) and malnutrition in children under 5 y of age. Current and past malnutrition were associated with acute lower respiratory infection (ALRI), even after adjusting for potential confounders (odds ratio: 2.03; 95% confidence interval: 1.20‐2.43). Decreasing malnutrition along with timely and proper treatment of ARI may improve children's health in developing countries.
Diagnosis of Chlamydia pneumoniae in community‐acquired pneumonia in children in Chile
Authors: Tagle MA Martínez , Kogan R , Rojas P , Rubilar L , Vidal R , Paya E
Published: August 2010

The incidence of Chlamydia pneumoniae in community‐acquired pneumonia in children was studied prospectively in 112 children aged 1 mo to 14 y. Diagnosis of C. pneumoniae was performed by polymerase chain reaction (PCR) on nasopharyngeal aspirates and serology by the microimmunofluorescence test on a single serum specimen. Three (2.7%) cases of pneumonia due to this agent were diagnosed by both PCR and serology. C. pneumoniae was not found in any of 62 children below 5 y of age. In the age group 5‐8 y, only 1/30 (3%) was found positive, and in the age group 9‐14 y, C. pneumoniae was diagnosed in 2/20 (10%) children.

Conclusion: Although the number of enrolled patients is small, and the diagnostic techniques used may have some limitations, the results of this study suggest that C. pneumoniae plays a minor role in the aetiology of pneumonia in children less than 9 y of age in our country. However, it should be considered as a potential agent in pneumonia in older children.
Long‐term effects of respiratory syncytial virus (RSV) bronchiolitis in infants and young children: a quantitative review
Authors: Kneyber MCJ , Steyerberg EW , de Groot R , Moll HA
Published: August 2010

One of the major questions regarding long‐term side effects of bronchiolitis by respiratory syncytial virus (RSV) is whether or not it induces asthma in later life. In this quantitative review, the data of 10 controlled studies are analysed.Methods: Follow‐up studies of RSV bronchiolitis published between January 1978 and December 1998 were identified through a MEDLINE search. Studies were selected if (i) postnatal age at the time of the inital illness was below 12 mo, (ii) all children were hospitalized for RSV bronchiolitis, (iii) the diagnosis RSV was virologically confirmed in all cases, and (iv) a control group was used.Results: Six studies met all selection criteria. Up to 5 y of follow‐up after RSV bronchiolitis in infancy, 40% of children reported wheezing as compared to only 11% in the control group (p< 0.001). Between 5 and 10 y of follow‐up 22% of the bronchiolitis group reported wheezing against 10% of the control group (p= 0.19). The incidence of recurrent wheezing as defined by three or more wheezing episodes also decreased with increasing years of follow‐up: at 5 or more years of follow‐up the difference between the RSV group and the control group was no longer significant. Furthermore, the presence of either a personal and/or a family history of either atopy and/or asthma did not differ between the two groups.

Conclusions: Wheezing is common after RSV bronchiolitis in infancy. It may persist for 5 y of follow‐up. However, no significant difference between the RSV bronchiolitis and the control group was observed regardingrecurrentwheezing by 5 y of follow‐up. No significant difference between the RSV bronchiolitis and the control group were found regarding a personal history of atopy, a family history of atopy and/or asthma. Therefore it seems unlikely that RSV bronchiolitis is a cause of atopic asthma in later life.
Bone biopsy results and serum bone turnover parameters in uremic children
Authors: Ziółkowska H , Pańczyk‐Tomaszewska M , DęLbiński A , Polowiec Z , Sawicki A , Sieniawska M
Published: August 2010

The aim of the study was to evaluate the prevalence of renal osteodystrophy types in children undergoing haemodialysis and continuous ambulatory peritoneal dialysis and to assess the usefulness of biochemical parameters in diagnosis of renal osteodystrophy. Bone biopsy and measurements of serum parathormone (iPTH) level, alkaline phosphatase (AP), osteocalcin (OC), procollagen 1C, calcium and phosphorus levels were performed in 51 children aged 11.5 ± 2.9y with end‐stage renal failure. Renal osteodystrophy (ROD) was diagnosed as follows: adynamic bone disease (ABD) in 14 (27%); normal bone histology (NB) in 19 (37%), osteomalacia (OM) in 1 (2%), mixed lesion (Mix) in 5 (10%) and hyperparathyroidism (HP) in 12 (24%) children. There was no difference in prevalence of ROD types between children on CAPD and HD. We found significant differences in the mean value of iPTH, OC levels and AP activity in HP vs NB and HP vs ABD. The prevalence of ABD was significantly higher in patients with PTH below 50 pg/ml than in patients with PTH above 50 pg/ml (p < 0.05). In 69% of children with NB the iPTH level was between 50 and 150 pg/ml. Most HP cases (75%) were diagnosed in patients with iPTH above 200 pg/ml. A high correlation between BFR and iPTH, BFR and OC, AP levels was found.

Conclusion: The biochemical markers of bone turnover have only limited value in the differentiation of renal osteodystrophy types.
A unique point mutation in the fibroblast growth factor receptor 3 gene (FGFR3) causes non‐syndromic craniosynostosis
Authors: Tsai F‐J , Wu J‐Y , Lee C‐C , Tsai C‐H
Published: August 2010

A unique Pro250Arg mutation in fibroblast growth factor receptor 3 (FGFR3) was recently found in patients with non‐syndromic craniosynostosis. We studied 18 Taiwan Chinese patients with various types of craniosynostosis to evaluate if this mutation is also prevalent in the Chinese population. Genomic DNA was analysed by polymerase chain reaction based restriction analysis and direct sequencing to identify the Pro250Arg mutation in FGFR3. Five (28%) of 18 probands were heterozygous for the Pro250Arg mutation. Only those patients with coronal synostosis carried this mutation.

Conclusion: Our findings suggest that all patients with coronal synostosis should be examined for this unique mutation.
Erythropoietic activity and soluble transferrin receptor level in neonates and maternal blood
Authors: Choi JW , Kim CS , Pai SH
Published: August 2010

Serum transferrin receptor (sTfR) concentration reflects functional iron status and erythropoietic activity. The aims of this study were to examine gender differences of erythropoiesis in newborns and to evaluate the influences of maternal anaemia or iron deficiency on foetal cord blood parameters for iron status and sTfR. In total, 527 newborns and their mothers were examined. Reticulocytes were analysed by flow cytometry and sTfR was measured by an immunoenzymo‐metric method. There were no sex differences in haematological or iron parameters. However, the reticulocyte maturity index (RMI) of male neonates was 37.45%, significantly higher than the 26.81% in female neonates (p < 0.01). The high fluorescence reticulocytes (HFR) and middle fluorescence reticulocytes (MFR) of male neonates were 4.91% and 22.36%, respectively, while those of female neonates were 3.31% and 17.83%, respectively (p < 0.01 for each gender). The sTfR concentrations of male and female neonates were 6.27 mg/l and 5.09 mg/l, respectively (p < 0.01). Values for serum iron, ferritin and reticulocyte subpopulations were significantly lower in the newborns of anaemic mothers. However, newborns of iron‐deficient mothers showed no differences in iron parameters from those of non‐iron‐deficient mothers.

Conclusions: The higher values of RMI and sTfR observed in male neonates indicate that erythropoietic activity is higher in this group. Iron transport to the foetus appears to be independent of maternal iron deficiency. However, iron transport and erythropoiesis in newborns seems to decline from the time that the mothers acquire frank iron deficiency anaemia.
Clinical and laboratory impact of coagulase‐negative staphylococci bacteremia in preterm infants
Authors: Maayan‐Metzger A , Linder N , Marom D , Vishne T , Ashkenazi S , Sirota L
Published: August 2010

A retrospective evaluation of the clinical and laboratory impact of coagulase‐negative staphylococci (CONS) bacteremia in preterm infants was carried out. The study population included all preterm infants (n= 31) in whom two or more blood cultures were positive for CONS within a period of 4 d, with negative blood cultures 1 wk before and 1 wk after the CONS bacteremia. Clinical manifestations and the results of laboratory tests 7 d before and after the positive blood cultures, and on the first day of sepsis, were recorded and compared. During CONS bacteremia, the infants demonstrated apnoea and bradycardia (88%) and a need for oxygen (59%) and ventilatory support (69%). Significant laboratory findings were leukopenia below 5000 cells/mm3 (12%), leukocytosis above 30000 cells/mm3 (39%), and thrombocytopenia below 150000/mm3 (25%). These clinical and laboratory manifestations differed significantly during the bacteremia infection compared with the week before and after.

Conclusion: CONS bacteremia is a clinically significant infection in preterm infants, causing episodes of apnoea and bradycardia, and a need for ventilatory support.
Investigation of prolonged neonatal jaundice
Authors: Hannam S , McDonnell M , Rennie JM
Published: August 2010

Jaundice persisting beyond 14 d of age (prolonged jaundice) can be a sign of serious underlying liver disease. Protocols for investigating prolonged jaundice vary in complexity and the yield from screening has not been assessed. In order to address these issues, we carried out a prospective study of term infants referred to our neonatal unit with prolonged jaundice over an 18 mo period. Infants were examined by a paediatrician and had the following investigations: a total and conjugated serum bilirubin, liver function tests, full blood count, packed cell volume, group and Coombs' test, thyroid function tests, glucose‐6‐phosphate dehydrogenase levels and urine for culture. One‐hundred‐and‐fifty‐four infants were referred with prolonged jaundice out of 7139 live births during the study period. Nine infants were referred to other paediatric specialties. One infant had a conjugated hyperbilirubinaemia, giving an incidence of conjugated hyperbilirubinaemia of 0.14 per 1000 live births. Diagnoses included: giant cell hepatitis (n= 1), hepatoblastoma (n= 1), trisomy 9p (n= 1), urinary tract infections (n= 2), glucose‐6‐phosphate dehydrogenase deficiency (n= 3) and failure to regain birthweight (n= 1).

Conclusions: In conclusion, a large number of infants referred to hospital for prolonged jaundice screening had detectable problems. The number of investigations may safely be reduced to: a total and conjugated bilirubin, packed cell volume, glucose‐6‐phosphate dehydrogenase level (where appropriate), a urine for culture and inspection of a recent stool sample for bile pigmentation. Clinical examination by a paediatrician has a vital role in the screening process.
Organized violence and mental health of refugee children in exile: a six‐year follow‐up
Authors: Hjern A , Angel B
Published: August 2010

In an earlier study we described a high rate of poor mental health in 63 refugee children from Chile and the Middle East during the first 18 mo of exile. In this follow‐up study the mental health of 49 of these children is described in parent, teacher and child interviews 6‐7 y after settlement in Sweden. The level of poor mental health in parent interviews has improved from 47% 18 mo after settlement to 22%(p <0.01 in paired t‐test) at follow‐up.

Conclusions: Eighteen percent of 34 children still in primary school were judged by their teachers to show deviant behaviour in the classroom. Three children were found to suffer from either re‐experience or avoidance of painful memories, whereas only one neurologically impaired child fulfilled the criteria of PTSD according to DSM‐IV. Recent stress in the family sphere and exposure to acts of organized violence in the country of origin are identified as the major determinants of poor mental health.
Kangaroo care improves post‐extubation cardiorespiratory parameters in infants after open heart surgery
Authors: Gazzolo D , Masetti P , Meli M
Published: August 2010

The aim of this investigation was to study whether kangaroo care could be helpful in full‐term infants subjected to cardiac postoperative intensive care during the early post‐extubation hours. Kangaroo care was performed at 2‐h intervals in the first 12 h after extubation in 5 male infants and assessed by cardiorespiratory parameters. Results showed that, during kangaroo care, heart rate (123 ± 4 vs 128 ± 5 bpm), respiratory frequency (43 ± 3 vs 51 ± 5 breath pm), transcutaneous carbon dioxide (46 ± 2 vs 50 ± 4 mmHg) and central venous pressure (11 ±0.8 vs 12±1.2mmHg) significantly decreased (p<0.05 for all), while oxygen saturation (78 ± 6 vs 74 ± 5 mmHg) and transcutaneous oxygen pressure increased (42 ±2 vs 38 ± 3 mmHg) (p < 0.05 for all).

Conclusion: We conclude that kangaroo care might be a useful technique contributing to stabilization of the cardiorespiratory status in postoperative paediatric cardiac intensive care.
Comparison of hand‐to‐leg and leg‐to‐leg bioelectric impedance devices in the assessment of body adiposity in prepubertal children. The STRIP study
Authors: Jartti L , Hakanen M , Paakkunainen U , Raittinen P , Rönnemaa T
Published: August 2010

The body composition of 40 seven‐year‐old children and of 50 of their parents was measured using two bioelectric impedance devices, the Model 101, RJL Systems, USA (conventional hand‐to‐leg device) and TANITA body fat analyser, TBF 105, Tanita Co, Tokio, Japan (newer leg‐to‐leg device). There were strong correlations between impedances obtained by these two devices [r= 0.95, r= 0.93, r= 0.82, r= 0.81 for girls (n= 22), boys (n= 18), mothers (n= 27) and fathers (n= 23), respectively (p < 0.0001 for all)]. However, there was a clear difference in the absolute impedance values due to the fact that the devices measure different segments of the body. Fat percentages based on inbuilt equations of the two devices correlated in girls, mothers and fathers (r= 0.71, r= 0.94, r= 0.80, respectively; p < 0.001) but not in boys (r= 0.21, p= 0.41). Using the Bland‐Altman comparison method, a large intraindividual difference was observed in the fat percentages by the two devices, independent of adiposity level. Both devices detected significant gender differences in fat percentages in 7‐y‐old girls and boys with similar BMIs.

Conclusion: When using the Tanita 105 leg‐to‐leg bioelectric impedance device to assess adiposity in children there is an obvious need for revised equations. For this, comparative studies using more validated methods, i.e. densitometry or DEXA, as part of a multi‐compartment model are needed.
Bangladeshi rural mothers prepare safer rice oral rehydration solution
Authors: Molla AM , Bari A , Greenough WB , Molla AM , Budhiraja P , Sharma PN
Published: August 2010

Mothers in rural Bangladesh were trained to prepare and use either Rice‐ORS (R‐ORS) or Glucose‐ORS (G‐ORS) solutions to treat children with diarrhoea. Families were provided with either G‐ORS or R‐ORS of the same electrolyte composition through a depot holder. Subsequently, random samples of solutions actually used for treatment by the mothers were collected from homes by field workers. A total of 227 R‐ORS and 239 G‐ORS samples were analysed. The sodium concentration in about 90% of the samples had a safe range (50‐120 mmol/l). Only 4% of R‐ORS solutions were above 120 mmol/l in sodium concentration, while 12% of G‐ORS solutions exceeded these limits (p < 0.0025). R‐ORS (after acid hydrolysis) provided significantly higher glucose (257 ± 42 mmol/l) for active but safe absorption compared to G‐ORS (115 ± 39 mmol/l). To make R‐ORS liquid enough to drink requires addition of sufficient water, preventing the risk of higher sodium concentration.

Unlike rice starch, glucose is a highly soluble substance. It is thus possible to prepare a drinkable solution containing dangerously high concentrations of both sodium and glucose, but this can be minimized by more intensive training of the mothers.
Recognition of facial expressions of emotions in school‐age children: the intersection of perceptual and semantic categories
Authors: Vicari S , Reilly J Snitzer , Pasqualetti P , Vizzotto A , Caltagirone C
Published: August 2010

Recognition of the facial expressions of emotions is a critical communicative system early in development and continues to play an important role throughout adulthood. In the past, the results of developmental studies of emotional facial recognition have often conflicted. The present study was designed to examine the development of emotional facial recognition in a large sample of school‐aged children (n=120, ages 5‐10 y). In particular, we investigate whether emotion categories, i.e., those based on the visual spatial parameters of facial expression, develop in a similar fashion to those that also recruit lexical knowledge of emotion terms. We have found two distinct patterns of development and we suggest that these different profiles are a consequence of the very different cognitive abilities that they recruit.

Conclusion: Emotion cognition is a variegated domain which is differentially related to such areas of cognition as visuo‐spatial and lexical semantic abilities.
Bone isoenzyme of serum alkaline phosphatase and serum inorganic phosphate in metabolic bone disease of prematurity
Authors: Backström MC , Kouri T , Kuusela A‐L , Sievänen H , Koivisto A‐M , Ikonen RS , Mäki M
Published: August 2010

We wanted to improve detection of low bone mineral density in preterm infants by combining serum measurements of total alkaline phosphatase, its bone‐type isoenzyme and serum inorganic phosphate in a prospective design. The subjects were 43 preterm infants. Total and bone isoenzyme activity of alkaline phosphatase was determined at 3 wk chronological age and at 3 and 6 mo corrected age. The main outcome measure, apparent bone mineral density (BMAD) at the distal forearm and forearm shaft, was assessed by dual energy X‐ray absorptiometry at 3 and 6 mo corrected age. An apparent density below 95 mg/cm3 at 3 mo corrected age was considered to indicate bone disease, based on the distribution of BMAD values of children with non‐complicated courses of prematurity. At 3 mo corrected age, total alkaline phosphatase activities exceeding 900 IU/l revealed low bone mineral density with 88% sensitivity and 71% specificity. Measurements of bone isoenzyme activity did not improve diagnostic performance. Serum inorganic phosphate levels below 1.8 mmol/l reflected low bone density with high specificity (96%), but the sensitivity was only 50%.

Conclusion: A combination of the criteria “serum total alkaline phosphatase activity above 900 IU/l” and “serum inorganic phosphate concentrations below 1.8 mmol/l” yielded a sensitivity of 100% at a specificity of 70%. This was the best available screening method for low bone mineral density in preterms.
Do phototherapy hoods really protect the neonate?
Authors: Ostrowski G , Pye SD , Laing IA
Published: August 2010

The objective of the current study was to evaluate the protection given to the eyes of neonates by an Amber 300 phototherapy hood during blue‐light phototherapy from Drager Phototherapie 800 units, and to make recommendations for clinical practice. Hazard‐weighted blue‐light radiance of phototherapy lamps was measured inside neonatal incubators, with and without the use of a protective phototherapy hood. The study was carried out in a tertiary referral neonatal unit. No patients were involved. A mannequin was used as model of a jaundiced neonate being treated with blue‐light phototherapy. The study shows that hazard‐weighted blue‐light radiance levels detectable from within the space enclosed by the hood may be several times greater than accepted industrial threshold limits for adults.

Conclusions: Nursing and medical staff must ensure meticulous care in the positioning of infants, so that the caudal edge of the shadow cast by the hood is always at least 30 mm inferior to the infants' lower eyelids. The vulnerability of the neonatal retina and the relatively high levels of blue‐light radiance visible from within the shadow of the hood may make it advisable to use more effective eye protection. Triple phototherapy using lamps at the foot‐end of the incubator is clearly hazardous and should not be carried out unless the infant's eyes are protected by eye‐patches.
Influence of feeding regimens on non‐invasive inferior vena cava and hepatic vein velocity measurements in infants
Authors: Kurugöl Z , Özyürek R , Dorak C , Levent E , Egemen A , Parlar A
Published: August 2010

The aim of this study was to investigate the effects of feeding type and osmotic load on intravascular volume status. Ninety term, healthy infants 2 mo of age were included in the study. The breastfed and formula‐fed groups each consisted of 45 infants. Echocardiographic examination was performed before and after feeding. The collapse index of the inferior vena cava (IVCIC) and right atrial pressure (RAP) were calculated. No statistically significant differences were found between before‐ and after‐feeding values of IVCIC, RAP and hepatic vein velocities in breastfed infants. In the formula‐fed group, after‐feeding values of IVCIC were significantly lower and RAP, hepatic vein systolic and diastolic velocities were significantly higher compared to the before‐feeding values. Most of the mothers (78%) were unsuccessful at preparing the formula at appropriate concentrations. No statistically significant differences were found between the before‐and after‐feeding values of IVCIC, RAP and hepatic vein velocities in infants being fed appropriately prepared formula. The after‐feeding values of hepatic vein velocities were higher than those of before‐feeding values; after‐feeding values of IVCIC were lower than before‐feeding values in infants being fed highly concentrated formula.

Conclusion: The values of inferior vena cava indices and hepatic vein velocities were not effected by feeding in infants receiving appropriately concentrated formula, like those of infants receiving breast milk. However, feeding with highly concentrated formula may cause intravascular volume expansion.
Reliability of sweat‐testing by the Macroduct® collection method combined with conductivity analysis in comparison with the classic Gibson and Cooke technique
Authors: Mastella G , Di Cesare G , Borruso A , Menin L , Zanolla L
Published: August 2010

This study was to ascertain the reliability of sweat‐testing by the Macroduct collection method combined with conductivity analysis (MCS) compared with the Gibson and Cooke technique (GCT). Sweat stimulation by pilocarpine iontophoresis was identical for both procedures, sweat being collected for 30 min on a filter paper on one forearm and in the coil of the Macroduct® collector on the other. Chloride, sodium and potassium concentrations were chemically analysed both on paper‐eluted and tube‐collected sweat; the latter was also analysed using a conductivity analyser. Chemical analyses were compared with conductivity analyses. This prospective study was carried out on 318 subjects with MCS (118 CFs, 200 controls) and on 305 of them with the GCT (113 CFs, 192 controls). The pilocarpine iontophoresis produced adequate sweat in 96.4% of collections with GCT and in 90.9% with the MCS. Sensitivity and specificity of the Macroduct®/ conductivity system were comparable to the GCT. No patient detected by the GCT technique was considered negative by conductivity, but one GCT positive was “borderline” with the MCS. Six non‐CF subjects identified as negative by the GCT (3.3%) were in the borderline range with the MCS.

Conclusion: Sweat‐testing by the MCS has acceptable sensitivity and specificity when performed by trained CF sweat‐testing technicians. Additional studies will be required to find out if these results can be confirmed in small clinics and hospitals where testing is done infrequently. Wherever the MCS is used all positive or borderline results should be confirmed by the GCT at a reference Cystic Fibrosis Center.
Etiologic spectrum and pattern of antimicrobial drug susceptibility in bacterial meningitis in Sokoto, Nigeria
Authors: Emele FE
Published: August 2010

Etiologic agents of meningitis were prospectively investigated among patients admitted to Usman Danfodio University Teaching Hospital, Sokoto. Of 1097 cerebrospinal fluid (CSF) samples submitted to the microbiology laboratory from various wards of the hospital, 289 (26%) were microscopically, culturally and/or serologically proven to be bacterial meningitis. The etiologic spectrum was as follows: Neisseria meningitidis (61%), Streptococcus pneumoniae (18%), Haemophilus influenzae (10%), Staphylococcus aureus (6%), Coliform bacilli (3%), Escherichia coli (0.7%), Mycobacterium tuberculosis (0.7%), Listeria monocytogenes (0.4%), Flavobacterium meningosepticum (0.4%) and Pseudomonas putrifasciens (0.4%).

Bacterial meningitis was most prevalent (195 or 68%) among children aged 1‐9 y, while adults and neonates were least affected. Coliform bacilli caused five of eight neonatal cases. Males were more frequently affected than females (x2=12.50;p < 0.05). Culture and microscopy were comparatively less efficient than the search for bacterial antigens, especially in the diagnosis of Haemophilus meningitis. Antimicrobial susceptibility of N. meningitidis to ampicillin and benzyl penicillin reduced progressively over the years (F = 406.98;p < 0.001). Nineteen (11%) of the isolates (5 Meningococci, 7 Staph. aureus, 1 Haem. influenza and 6 others) showed simultaneous resistance to chloramphenicol, ampicillin and benzyl penicillin.
Outcome of infants 23‐26 weeks' gestation pre and post surfactant
Authors: Jacobs SE , O'Brien K , Inwood S , Kelly EN , Whyte HE
Published: August 2010

To describe mortality and neurodevelopmental outcome before and after the introduction of rescue therapy with natural surfactant in two neonatal units in Toronto, Canada, a retrospective cohort study of 891 liveborn 23–26 wk gestational age infants, 421 presurfactant (1982–1987) and 470 postsurfactant (1990–1994) was performed. Overall mortality was stable over time (41% vs 35%, p = 0.077), but declined for inborn 24 (71% vs 43%, p = 0.03) and 26 wk (26% vs 13%, p = 0.01) gestational age infants and was higher in surfactant‐treated infants (p > 0.0001). Chronic lung disease (61% vs 34%, p > 0.0001) and bilateral blindness (8% vs 4%, p = 0.004) declined over time, with stable rates of cerebral palsy (12% vs 15%), cognitive deficit (27% vs 26%) and aided sensorineural hearing loss (5% vs 4%). Sixty‐five percent of surviving infants in both eras were free from neurodevelopmental impairment, and severe impairment declined over time (p = 0.035).

This study shows no secular change in overall mortality in a large cohort of 23–26 wk gestational age infants since the introduction of rescue therapy with natural surfactant. However, it does suggest that maternal transfer to and delivery of all extremely preterm infants in high risk perinatal centres is justified.
Family function in families with children of normal height and in families with short children
Authors: Starke M , Erling A , Möller A , Wikland K Albertsson
Published: August 2010

The purpose of this study was to examine any differences regarding cohesion and adaptability between Swedish families with children of normal stature (group A) and those with children of short stature (group B). Cohesion and adaptability were measured using a Swedish translation of the third version of the self‐report questionnaire FACES (Family Adaptability and Cohesion, Evaluation Scales). Most of the 55 families in group A and most of the 49 families in group B appeared to be well balanced with regard to cohesion and adaptability. There was no statistically significant difference between the two groups concerning the variable cohesion. Significant differences were found in adaptability: fathers in group A had higher values than mothers in group A and than mothers and fathers in group B.

Conclusion: There are no major differences between families with children of normal stature and those with short children. However, it was found that fathers with children of normal stature perceived a greater adaptation within their families compared with mothers with children of normal stature and mothers and fathers with children of short stature.
Sexual abuse at a Swedish daycare centre: allegations, confessions and evaluations
Authors: Lindblad F , Kaldal A
Published: August 2010

In September 1997, sexual abuse at a Swedish daycare centre was disclosed. The suspect, a male member of the staff, admitted having abused six children. A total of 30 children were included in the police investigation. In this study, these cases were evaluated individually using a child psychiatric method. Information was collected from the police investigation and from interviews with parents. The conclusions–categorized as “abuse likely”, “abuse conceivable” or “abuse uncertain”–were compared with the children's own reports, the legal evaluations and the confessions of the suspects.

Conclusions: The correspondence of child reports with child psychiatric evaluations was fairly high, indicating that child reports may serve as a good screening indicator of abuse. There was little agreement between child psychiatric evaluations and legal decisions, which were based on the reports of suspects. Some differences may be explained by varied methodology, definitions and criteria. Others reflect real differences in opinion. Our study illustrates the need to establish legal criteria for statements from pre‐schoolers if such evidence is to constitute the basis of a ruling without a confession. Studies comparing professional psychological assessments of children's statements about sexual abuse with independent data stand out as an important line of research for the future.
Kernicterus in term and near‐term infants–the specter walks again
Authors: Hansen TWR
Published: August 2010

Diagnostic and therapeutic intervention is common in newborns with neonatal jaundice, motivated by the fear of bilirubin‐associated brain damage, kernicterus. In recent years, a resurgence of kernicterus has been noted in countries in which this complication had essentially disappeared. Both early postnatal discharge and relaxation of attitudes to neonatal jaundice have been implicated. Guidelines for the management of neonatal jaundice show significant disparity, attesting to our inadequate understanding of the underlying biology. Aggressive guidelines expose infants to unnecessary risks, risks that are significant when it comes to exchange transfusion, and may also involve improper use of limited resources. Relaxed guidelines, on the other hand, may expose infants to increased risk of brain toxicity.

Conclusion: At present we have no tools for ensuring certain identification of individuals with increased vulnerability to bilirubin toxicity. Relaxation of guidelines which have been proven safe through prolonged use should therefore be undertaken only in an atmosphere of increased vigilance. Guidelines that allow for a range of therapeutic and diagnostic options underline the need for careful assessment of each case on its individual merits.
A follow‐up study of serum ferritin and transferrin receptor concentrations in Swedish adolescents at age 17 years compared to age 15
Authors: Samuelson G , Lonnerdal B , Kempe B , Elverby J‐E , Bratteby L‐E
Published: August 2010

Serum ferritin and serum transferrin receptor concentrations, growth and food habits were studied in healthy Swedish boys (n= 103) and girls (n= 124) at the age of 17 y and compared with those in the same adolescents at age 15. Between these ages, serum transferrin receptor increased significantly in both boys and girls. Serum ferritin increased significantly in boys but not in girls. The transferrin receptor/ferritin ratio increased significantly in girls but not in boys, indicating insufficient iron stores in the 17‐y‐old girls in relation to erythropoiesis and iron needs. Between 15 and 17 y the boys' frequency of consumption of milk and bread decreased, while they more often consumed pasta, cheese and coffee. The girls decreased their frequency intake of fat products, milk and meat. The frequency of meat consumption emerged as the single significant predictor for serum ferritin < 12μg/L in girls, but not in boys. The median daily iron intake, determined in a subsample, decreased in boys from 18.7 to 13.6mg and in girls from 14.1 to 8.8 mg, and the decrease was to a large extent due to cessation of iron fortification of flour.

Conclusions: The results indicate insufficient iron stores in the 17‐y‐old girls in relation to erythropoiesis and iron needs, but more favourable iron stores in the boys. The absence of a significant decrease in mean serum ferritin despite rapid growth suggests that the earlier iron fortification of flour only marginally contributed to the iron status of Swedish adolescents of this age group.
Status of children with cow's milk allergy in infancy by 10 years of age
Authors: Tikkanen S , Kokkonen J , Juntti H , Niinimãki A
Published: August 2010

To assess the development of milk protein tolerance and atopic diseases in children diagnosed for cow's milk allergy (CMA) in infancy, we conducted re‐examinations of 56 CMA subjects at the age of 10 y using 204 age‐matched controls. The children underwent clinical examinations and skin prick tests (SPT), and their IgE‐specific antibodies to milk and five other food allergens were determined. By the age of 10 y, all but four subjects had become tolerant to at least small amounts of milk protein. However, gastrointestinal symptoms relating to more abundant milk consumption were reported by 45% of the study subjects and 15% of the controls (p < 0.001). The incidence figures for asthma, allergic rhinitis and dermatitis, as well as the occurrence of recurrent otitis, were three to four times higher than in the controls. Positive SPTs were seen in two‐thirds of the subjects, the figure being highest (83%) in those with dermatitis onset CMA. Seven subjects showed positive titres of IgE‐class milk‐specific antibodies, and five showed a clinical response.

Conclusion: This re‐examination study showed that CMA in infancy, even when properly treated, has significant clinical consequences by posing special risks for respiratory atopy and persistence of atopic dermatitis as well as positive SPT and recurrent ear infections. However, each of these clinical manifestations seems to have an independent curriculum unrelated to the persistence of CMA itself.
Gastroduodenal ulcers in the Helicobacter pyloriera
Authors: Stringer MD , Veysi VT , Puntis JWL , Batcup G , Dixon MF
Published: August 2010

The aim of the study was to evaluate the current spectrum of gastroduodenal ulcers in children referred to a regional paediatric unit in the United Kingdom. During a 5‐y period (1994–98), all children with a visibly discrete gastric and/or duodenal ulcer diagnosed at endoscopy were prospectively identified. Patients with ulcers associated with Helicobacter pylori gastritis underwent repeat endoscopy 2–3 mo after medical treatment. Thirty‐seven children, 21 boys and 16 girls of median age 11 y (range 7 mo to 16 y), had gastric and/or duodenal ulceration. Specific aetiological factors were identified in 21 of 22 with H. pylori negative ulcers, including Crohn's disease (n = 6), coeliac disease (n = 4) and treatment with ulcerogenic drugs (n = 4). Fifteen children (41%) had ulcers associated with H. pylori gastritis, including all 10 children with a chronic ulcer. Endoscopically confirmed ulcer healing was achieved in 14 of these using a 1 wk triple therapy regimen (omeprazole and a combination of two antibiotics).

In conclusion, the recognized spectrum and the management of gastroduodenal ulceration have changed during the last decade. Although H. pylori gastritis is an important aetiological factor, a wide range of other conditions needs to be considered. Surgical intervention is only rarely necessary.
Selected trace elements and minerals in cord blood: association with lipids and lipoproteins at birth
Authors: Bastida S , Vaquero MP , Veldhuizen M , Sánchez‐Muniz FJ
Published: August 2010

Recent studies have found that some minerals are associated with lipoprotein metabolism, peroxidation and coronary heart disease. The present study was designed to obtain information on the relationship between the concentrations of minerals and trace elements and those of lipids, lipoproteins and apolipoproteins (Apo) in cord blood. Seventy‐nine healthy singleton normoweight full‐term newborns without foetal distress according to Apgar scores were studied. The quartile distribution of neonates, according to serum concentrations of the different minerals studied, displayed significant differences in lipid values between infants in the lowest and highest quartiles of: magnesium, for HDL‐cholesterol, Apo A‐I, Apo B and the HDL‐cholesterol/Apo A‐I ratio; iron, for HDL‐cholesterol and the HDL‐cholesterol/Apo A‐I ratio; copper, for triglycerides and the LDL‐cholesterol/Apo B ratio. With the exception of calcium, several significant correlations were found between the minerals and trace elements and the lipids, Apo and lipoproteins tested.

The present data suggest for the first time that minerals and trace elements appear to be involved in the lipoprotein metabolism, particularly in HDL levels, at birth. Moreover, the zinc/copper ratio was positively correlated with total cholesterol and the LDL‐cholesterol/Apo B ratio, while negatively with triglycerides, suggesting a role for the balance between these trace elements and the LDL metabolism and particle size.
Recurrence of kernicterus in term and near‐term infants in Denmark
Authors: Ebbesen F
Published: August 2010

Classical acute bilirubin encephalopathy (kernicterus) in term and near‐term infants had not been seen in Denmark for at least 20 y until 1994. From 1994 to 1998, however, six cases were diagnosed. Aetiology of the hyperbilirubinaemia was known in two infants; spherocytosis and galactosaemia, most likely known in two infants; possible A‐O blood type immunization, and unknown in two infants. However, one of these last‐mentioned infants had a gestational age of only 36 wk. The maximum plasma total bilirubin concentrations were 531–745 μmol/L. The increase in the number of cases of kernicterus was considered to have been caused by: (i) a decreased awareness of the pathological signs, (ii) a change in the assessment of the risk of bilirubin encephalopathy, (iii) early discharge of the infants from the maternity ward, (iv) so‐called breastfeeding‐associated jaundice, (v) demonstration of bilirubin being an antioxidant, and (vi) difficulty in estimating the degree of jaundice in certain groups of immigrants. Accordingly, for prevention: (a) Attempt to change the healthcare workers' understanding of the risk of bilirubin encephalopathy, (b) give further instructions, both orally and in writing, to mothers before discharge from the maternity ward, (c) be more liberal in giving infant formula supplements, (d) conduct home visits by the community nurse at an earlier stage, (e) follow authorized guidelines for phototherapy and exchange transfusion, (f) lower plasma bilirubin concentration limits as an indication for phototherapy and exchange transfusion, (g) screen all term and near‐term infants, and (h) measure the skin's yellow colour with a device that corrects for the skin's melanin content.

Conclusions: Audit of the six cases presented indicates that measures are necessary in both the primary and secondary healthcare sectors if the risk of kernicterus is to be avoided. Screening may be considered, but in order to identify the problems it would first be reasonable to perform a larger prospective study in which audit is performed on all newborn infants, born at term and near‐term, who develop a plasma bilirubin concentration above the exchange transfusion limit.
Surfactant phospholipids and surface activity among preterm infants with respiratory distress syndrome who develop bronchopulmonary dysplasia
Authors: Kazzi SNJ , Schürch S , McLaughlin KL , Romero R , Janisse J
Published: August 2010

Our objective was to determine if preterm infants with respiratory distress syndrome who develop bronchopulmonary dysplasia have abnormalities in surfactant phospholipids and/or function. Tracheal aspirate samples obtained from preterm infants with respiratory distress syndrome on days 1, 3–5, 7–10, 14–17, 21–24 and 27–30 were analyzed for total phospholipids and phospholipids fractions by determination of total phospholipid phosphorus and thin layer chromatography, respectively. Surfactant properties were assessed with captive bubble surfactometer. Sixteen out of 56 (29%) infants died during the first 30 d of life. Infants who died were more immature, required more ventilatory support and had a surfactant with lower surface‐tension‐reducing properties than infants who survived (p < 0.05). Surviving infants were divided into group I (no bronchopulmonary dysplasia at 27–30 d, n= 25) and group II (with bronchopulmonary dysplasia at 27–30 d, n= 15). No significant differences in concentrations of surfactant phospholipids nor measurements of surface tension were noted among groups of infants.

Surfactant therapy after birth was associated with a significant increase in concentrations of total phospholipids, lecithin, phosphatidylinositol and lower surface‐tension measurements at 3–5 d of age among surviving infants (p < 0.01). Abnormalities in concentrations of surfactant phospholipids or surfactant function could not be demonstrated during the first month of life among preterm infants with respiratory distress syndrome who develop bronchopulmonary dysplasia.
Effect of training on peak oxygen uptake and blood lipids in 13 to 14‐year‐old girls
Authors: Stoedefalke K , Armstrong N , Kirby BJ , Welsman JR
Published: August 2010

The aim of this study was to investigate the effects of exercise training on the peak oxygen uptake (peak VO2) and blood lipid profile of 13 to 14‐y‐old postmenarcheal girls. Treadmill determined peak VO2, total cholesterol, high density lipoprotein cholesterol, low density cholesterol, and triglycerides were the outcome measures assessed at baseline and following exercise training. Twenty girls completed a 20‐wk programme of exercise training which involved maintaining the heart rate at 75–85% maximum for 20 min, three times per week. Heart rate was rigorously monitored using telemetry throughout each training session. Eighteen girls acted as the control group. There were no significant (p≫ 0.05) changes in the outcome measures following the training programme.

Conclusions: These findings suggest that exercise training of this frequency, intensity and duration for a period of 20 wk has no significant effect on either the peak VO2 or blood lipid and lipoprotein profile of normolipidaemic, postmenarcheal girls.
Cag A seropositivity and the severity of Helicobacter pylori infection in dyspeptic children
Authors: Lerro P , Perrucci V , Morra I , Lombardo L , Gaido F , Ansaldi N
Published: August 2010

Aim: To assess the incidence of cag A (cytotoxin‐associated protein) and to evaluate its correlation with endoscopic‐histologic findings and with eradication rate in a series of children affected by Helicobacter pylori (H. pylori) gastritis. Methods: Fifty consecutive H. pylori gastritis children (27M; median age 10 y and 11 mo) were tested for IgG cag A protein (Western Blot technique). Pretreatment H. pylori infection was assessed on the grounds of endoscopic antral biopsy specimens by means of rapid urease test and histologic examination (Giemsa staining). All the children were treated with omeprazole (1 mg/kg/d), clarithromycin (15mg/kg/d) and amoxycillin (50 mg/kg/d) for 2 wk. According to universally accepted clinical practice, outcome of treatment was assessed by 13C urea breath test at least 6 wk after the end of therapy. Results: Thirty‐five children (70%) were seropositive to cag A+ protein (median age 11 y and 1 mo). Endoscopic findings of cag A+ patients were similar to those of cag A‐ patients. In cag A seropositive patients the severity of histologic gastritis was higher (p < 0.05) and the granulocytic infiltration more marked (p < 0.01) than in seronegative ones. In cag A+ children, H. pylori eradication rate was significantly lower (p < 0.02).

Conclusions: cag A testing may be of useful clinical interest because its positivity can imply a more severe gastritis and a lower susceptibility to eradication treatment.
Does early hospital discharge with home support of families with preterm infants affect breastfeeding success? A randomized trial
Authors: Gunn TR , Thompson JMD , Jackson H , McKnight S , Buckthought G , Gunn AJ
Published: August 2010

The aim of the present study was to determine if earlier discharge of preterm infants (<37 wk) from hospital is safe and if it affects breastfeeding rates. In a pilot observational study, premature infants received full oral (sucking) feeds for a mean (SD) 7.7 ± 7.9 d before discharge. In the main study, 308 preterm infants were randomly assigned to either Early Discharge (148 infants) when fully orally fed but not yet gaining weight or Routine Discharge (160 infants) when fully orally fed and also gaining weight before discharge. A further 122 mothers declined randomization. The Early Discharge group was followed by Visiting Nurse Specialists who were available 24 h a day, while the Routine group was followed by the Home Care Nurses available on week days. There were no significant differences between the groups in birthweight or gestational age. The Early Discharge group were discharged 2.5 ± 2 d after full oral feeding compared to 4.4 ± 2.7 d for the Routine group (p < 0.001) and 6.1 ± 5 d for those who declined. However, there was no significant difference between the Early and Routine groups for breastfeeding either at discharge (80 vs 83%), or 6 wk (55 vs 60%) or 6 mo after discharge (36 vs 36%), or for weight gain, or rates of re‐hospitalization (8.8% vs 11.9% at 6 wk, p = 0.37).

Conclusion: Early discharge from hospital once a preterm infant can take full oral feeds does not alter later breastfeeding rates when adequate visiting nursing support is available.
Smoking preceded pulmonary involvement in adults with Langerhans cell histiocytosis diagnosed in childhood
Authors: Bernstrand C , Cederlund K , Å%hström L , Henter J‐I
Published: August 2010

ABSTRACT. Two patients with childhood Langerhans cell histiocytosis (LCH) (aged 2 and 6 y at diagnosis) in whom pulmonary involvement was diagnosed in adulthood, 23 and 12 y later, respectively, are presented. In each patient, smoking preceded the diagnosis of pulmonary involvement by 3 y, providing further evidence that smoking is a risk factor in the development of pulmonary LCH. □Langerhans cell histiocytosis, lungs, smoking