bluuebunny/crossref_metadata_2025 huggingface dataset:
Plasma protein Z levels in healthy and high‐risk newborn infants
Authors: Jr F Schettini , Laforgia N , Altomare M , Mautone A , Del Vecchio GC
Published: August 2010

Aim: To evaluate plasma protein Z (PZ) levels in healthy and high‐risk newborn infants. Methods: A longitudinal observational study was conducted. Inclusion criteria were: healthy term and pre‐term newborns normal for gestational age and newborns belonging to one of the following groups: newborns small for gestational age (SGA), newborns affected by respiratory distress syndrome (RDS), newborns from mothers with pre‐eclampsia. Newborns with sepsis, congenital malformation or haemorrhagic disorders were excluded. Plasma PZ levels, protein C (PC) concentration, PC activity and protein‐induced vitamin K absence levels were measured. Results: 53 newborns were enrolled into the study. PZ and PC antigen levels varied significantly among analysed subgroups on day 1 (p < 0.01): lower levels of these inhibitors were found in RDS newborns (group C), newborns from mothers affected by pre‐eclampsia (group D) and SGA newborns (group E) than in healthy term and preterm newborns (groups A and B).

Conclusion: PZ deficiency occurs in newborns affected by severe RDS, in newborns from pre‐eclamptic mothers and in SGA newborns, probably owing to activated coagulation in the first two conditions and to reduced PZ synthesis in the last condition.
The use of in‐line intravenous filters in sick newborn infants
Authors: van Lingen RA , Baerts W , Marquering ACM , Ruijs GJHM
Published: August 2010

Aim: This study assesses the improvement in outcome for newborn infants by decreasing major complications associated with intravenous fluid therapy by using an in‐line filter, and evaluates the economical impact this might have in relation to daily changing of i.v. lines. Methods: In a prospective controlled study, 88 infants were randomly assigned to receive either filtered (except for lipids, blood and blood products) or non‐filtered infusions via a central catheter. Main outcome measures such as bacteraemia, phlebitis, extravasation, thrombosis, septicaemia and necrosis were all scored. The costs attributable to patients during a standard 8‐day stay were also recorded. Results: Significant reductions were found in major complications such as thrombi and clinical sepsis (control group (21), filter group (8); p < 0.05). Bacterial cultures of the filters showed a contamination rate on the upstream surface of 15/109 filters (14%). The mean costs of disposables were less in the filter group, showing a reduction from ±31.17 to ±23.79.

Conclusions. The use of this in‐line filter leads to a significant decrease in major complications and substantial cost savings.
Feeding problems in nursery children: prevalence and psychosocial factors
Authors: Esparó G , Canals J , Jané C , Ballespí S , Viñas F , Domenèch E
Published: August 2010

Aim: In this study we analyze the prevalence of feeding problems in a sample of nursery children and examine the environmental and psychopathological factors related to such problems. Methods: We used the Early Childhood Inventory—Parents Checklist to assess 851 Spanish children aged between 3 and 6 years from both urban and rural samples. This screens emotional and behavioural problems and is based on the Diagnostic and Statistical Manual of Mental Disorders‐IV. We collected sociodemographic data and information about life events and the psychopathology of the children's parents (General Health Questionnaire‐28). Results: Our results showed that the prevalence of feeding problems was 4.8% and that there were no differences between gender. Sample subtype, socioeconomic level and family characteristics were not linked to feeding problems. Children with feeding problems had significantly more symptoms of psychological problems and somatic complaints and had experienced more life events in the previous 12 months. The psychopathology of the mother, especially in terms of anxiety problems, increased the risk of feeding problems in children.

Conclusion: When there are complaints of feeding problems in preschools, the psychological problems of children and their mothers should be taken into consideration during paediatric consultation, irrespective of gender or socioeconomic status.
Duration of breastfeeding and breastfeeding problems in relation to length of postpartum stay: a longitudinal cohort study of a national Swedish sample
Authors: Waldenström U , Aarts C
Published: August 2010

Aim: To investigate the association between length of postpartum stay and duration of breastfeeding and breastfeeding problems, with special focus on early hospital discharge. Methods: Swedish‐speaking women were recruited from all antenatal clinics in Sweden during 3 wk evenly spread over 1 y in 1999 to 2000. In total, 3293 women (71% of those who were eligible) consented to participate in the study. Data were collected by questionnaires in early pregnancy, 2 mo and 1 y postpartum, and from the Swedish Medical Birth Register. For the purpose of this study, only data from the 2709 women (82%) who filled in the question about length of stay in the 2‐mo questionnaire were analysed. Women were divided into six groups according to length of postpartum stay (day 1: < 24h to day 6: ± 120h). Results: The median duration of any breastfeeding was 7 mo in women discharged on day 1, and 8 mo in women discharged on any of the following days; a non‐significant difference (p= 0.66). Besides hospital policies regarding length of stay (residential area) and number of domiciliary visits, early discharge was associated with the following maternal characteristics, which could be divided into three categories: (1) older, multipara, many children; (2) positive experience of the first breastfeeding after birth; (3) low education, economic problems, smoking, lack of support from partner. Late discharge was associated with operative delivery, preterm birth and low infant birthweight. When these factors were controlled for by Cox regression analysis, no statistical differences were found between the six groups in the relative risk of discontinuing to breastfeed. Breastfeeding problems, such as engorgement and mastitis, did not differ, but women discharged on day 6 or later had fewer problems with sore or cracked nipples during the first week and more problems 4–8 wk postpartum.

Conclusion: Maternal characteristics may be more important predictors of the duration of breastfeeding than length of stay in hospital after the birth. The effect of domiciliary support needs further research.
Oral anticoagulant treatment in children based on monitoring at home
Authors: Mähönen S , Riikonen P , Väätäinen R‐L , Tikanoja T
Published: August 2010

Aim: To evaluate the feasibility of home monitoring of oral anticoagulant treatment (OAT) in paediatric patients. Methods: A total of 19 paediatric patients received OAT and then monitored their treatment at home with CoaguChek±. Data on their International Normalized Ratio (INR) values were collected retrospectively from hospital records and from the notes kept by the families. The families of the patients were also asked to fill in a questionnaire. Results: No thrombotic or haemorrhagic complications occurred during a total amount of 44.7 follow‐up years. INR: the proportion of INR values measured at home falling within the therapeutic range for the given patient varied from 33 to 86% (median 69%). The questionnaire: all respondents were satisfied with home monitoring, and 63% felt that a major advantage of home monitoring was that there was no need to perform venipuncture. While 47% of the respondents reported no disadvantages of home monitoring, 42% reported that they occasionally lacked confidence in their ability to conduct OAT correctly at home.

Conclusion: Home monitoring of OAT is feasible and reasonably reliable in paediatric patients. However, it is crucial that healthcare professionals supervise the treatment and the families are provided with detailed and precise instructions on how to act in a variety of clinical situations.
A short‐term follow‐up of children with poor word production at the age of 18 months
Authors: Westerlund M , Eriksson M , Berglund E
Published: August 2010

Aim: (a) To study the stability of poor language development assessed by a new screening instrument based on parents' recognition of words their 18‐mo‐old children use; (b) to evaluate the predictability of the less‐than‐eight‐words cut‐off used by Child Health Centres (CHCs) in Sweden at the present 18‐mo check‐up—an assessment based on parents' recall of their children's vocabulary. Methods: All failures of the less‐than‐eight‐words criterion, corresponding to about 10% of 1000 children from a community‐based study, were followed up within half a year after the first assessment. The follow‐up instrument was an extensive, internationally well‐known and structured parent questionnaire, standardized for Swedish children. Results: Almost half of the followed‐ ups performed below the 10th percentile and more than two‐thirds were found below the 20th percentile. Thus, after a few months about one‐third of the children had caught up to a fairly normal level of performance. Two of the children who had recovered performed above median. More relaxed cut‐off criteria were applied ad hoc, reducing the proportion of children with a fast recovery.

Conclusion: Age of language assessment and/or the level of cut‐off criterion presently used at Swedish CHCs should be reconsidered.
Acute hyperammonaemic encephalopathy in a female newborn caused by a novel, de novo mutation in the ornithine transcarbamylase gene
Authors: Valik D , Sedova Z , Starha J , Zeman J , Hruba E , Dvorakova L
Published: August 2010

A full‐term female offspring of a first and uneventful pregnancy presented at 60 h of life with irritability, tachypnea and respiratory alkalosis progressing to deep coma with clinically dominant circulatory failure, tachycardia and hypotension. Diagnosis of ornithine transcarbamylase (OTC) deficiency was made on the basis of hyperammonaemia, hypocitrullinaemia and extreme hyper‐excretion of orotic acid. The baby was treated with peritoneal dialysis, arginine hydrochloride and adequate energy supply. DNA analysis revealed an as of yet unidentified missense mutation in the 6th exon of the OTC gene, resulting in a change of lysine to glutamine at position 210 (K210Q). Her parents were not found to carry this mutation, implying that this mutation may have occurred either de novo in the patient or in a parental germ cell.

Conclusion: An acute neonatal form of OTC deficiency should be considered in the differential diagnosis of coma in female newborns.
Acinar dysplasia: a rare cause of neonatal respiratory failure
Authors: Gillespie LM , Fenton AC , Wright C
Published: August 2010

Acinar dysplasia is a rare cause of death in the first few hours of life, due to an absence of alveoli. This report presents the first case associated with additional major renal malformations. The diagnosis of acinar dysplasia was unexpectedly made at autopsy.

Conclusion: Even in the presence of antenatally diagnosed severe anomalies, autopsy may reveal diagnostically important information.
An unusual case of an atypical eating disorder masquerading as a serious multi‐systemic illness
Authors: Mehta A , Viner R , Christie D , Newson T , Dattani MT
Published: August 2010

An early diagnosis and multidisciplinary team approach are mandatory in the management of eating disorders. Serious organic symptoms and nutritional effects can mimic a systemic illness, particularly in those with atypical presentations. A 15‐y‐old adolescent male presented with poor growth, low weight, abdominal pain and yellow pigmentation. Further bizarre multi‐system symptomatology resulted in a protracted admission with multiple investigations. An initial diagnosis of teratoma proved negative on abdominal laparotomy. A multidisciplinary approach followed by a feeding challenge led to the diagnosis of an eating disorder. The disorder, although more common in girls and adolescents, is increasing in incidence in both males and younger children.

Conclusion: Atypical eating disorders are potentially serious and life‐threatening illnesses, and paediatricians and psychologists should be aware of unusual presentations.
Calculation of resting energy expenditure in obese children
Authors: Flodmark C‐E
Published: August 2010

For the calculation of resting energy expenditure, which is the main part of total energy expenditure in children with low physical activity, Fusch et al. have developed an equation.

Conclusion: This equation might be useful for research but not in daily work with obese patients.
Monitoring of IgE‐mediated food allergy in childhood
Authors: Foucard T , Lilja G
Published: August 2010

Testing for IgE‐mediated allergy is performed to reach or refute a suspected allergy. But a positive test does only indicate sensitization and not necessarily clinical allergy. A diagnostic challenge procedure is therefore necessary. Also, in the phase of tolerance development a challenge is needed as clinical tolerance is reached before allergen‐specific IgE antibodies have disappeared. During recent years, an increasing interest has been given to the possibility of using the concentration of specific IgE and the size of the skin prick test wheal to tell the optimal time to do a challenge without exposing the child to a risk of a severe reaction.

Conclusion: Algorithms on when to do and when not to do a food challenge may be useful but should be used with great caution. Reasonable consideration should be paid to the severity of previous reactions and the kind of allergen involved.
Neural maturation of breastfed and formula‐fed infants
Authors: Khedr EMH , Farghaly WMA , Amry S El‐Din , Osman AAA
Published: August 2010

Background: Human milk provides infants with a full complement of all polyunsaturated fatty acids, including docosahexaenoic acid (DHA) and arachidonic acid (AA). Formula milks only contain the precursors of DHA, AA and linoleic acid, and hence formula‐fed infants must synthesize their own DHA and AA. Aim: To evaluate the effect of feeding—whether breastfeeding or formula‐feeding—in early infancy upon subsequent neurodevelopment and achievement of optimum brain function. Subjects and methods: The study included 53 normal, healthy infants (30 exclusively breastfed infants and 23 exclusively formula‐fed infants) at the age of 1 y (±1 mo). Each infant was subjected to a full physical and neurological examination together with neurophysiological studies including flash visual evoked potential (FVEP), brainstem auditory evoked potential (BAEP) and somatosensory evoked potential (SSEP). Results: There was significant prolongation of P100 wave latency of FVEP in formula‐fed infants, together with significant prolongation of absolute latency of waves I, III and V of BAEP in formula‐fed infants compared with breastfed infants. There was significant prolongation in inter‐peak latencies between cortical and Erb's components in formula‐fed infants compared with breastfed infants.

Conclusion: We can conclude that VEP, BAEP and SSEP are more mature in breastfed infants relative to formula‐fed infants at 1 y of age, and thus breast milk helps earlier development and maturation of some aspects of the nervous system than milk formulas.
Bone mass evaluated by calcaneous ultrasound and radial peripheral computed tomography in 726 youngsters
Authors: Volta C , Bagni B , Iughetti L , Rossi M , Corazzari T , Bagni I , Bernasconi S
Published: August 2010

Aim: To compare the results of ultrasound and computed peripheral tomography in evaluating bone mass in a population of normal children. Methods: Seven hundred and twenty‐six healthy school children (260 males; age 8.3–20.9 y) underwent calcaneous ultrasound and peripheral computed tomography at the ultradistal radius. Broadband ultrasound attenuation (BUA) and areal and volumetric bone mineral density (aBMD and vBMD) were evaluated. The results were compared and correlated among them and with auxological parameters (height, BMI and pubertal stages) using the software package SPSS for Windows. Results: The three variables examined (BUA, aBMD and vBMD) all showed a progressive increase with age and a positive correlation with age, height and BMI. When the population was subdivided according to pubertal stages, all variables showed a progressive increase, the difference being significant when stages 1–2 were compared with stages 4–5. A significant correlation was present among BUA, aBMD and vBMD even if the Pearson correlation coefficient was not high.

Conclusions: The similar pattern of BUA, aBMD and vBMD with respect to age, height and pubertal stages indicates that ultrasound could be a reliable method to screen bone mass abnormalities in children. The low correlation coefficient, however, suggests that the methods employed measure different bone parameters. Moreover, the different skeletal locations could also account for these results.
Nicotine exposure in breastfed infants
Authors: Dahlström A , Ebersjö C , Lundell B
Published: August 2010

Aim: To study exposure to nicotine in breastfed infants in relation to parental smoking habits.Material and Methods: Forty mother‐infant pairs were studied. Twenty non‐smoking mothers, 18 smoking (2–20 cigarettes per day) and two snuff‐taking mothers were included. All infants were healthy, exclusively breastfed and their postnatal age was 6 wk. During a home visit, parental smoking habits were recorded, and the time of mothers' last smoke or taking of snuff and breastfeeding were recorded. Breast milk and infant urine samples were collected. Concentrations of nicotine and cotinine were analysed with gas chromatography. The amount of milk ingested during the home visit was calculated by weighing the infants.Results: Two nonsmoking and non‐snuff‐taking women had milk containing nicotine (28 and 13 μg/l, respectively). Both had smoking spouses. In the smoking and snuff‐taking group, the mean (SD) milk nicotine concentration was 44 (38) μg/l (n= 36). When milk samples taken 7h and 0.6 h after smoking were compared, the concentration of milk nicotine increased from 21 to 51 μg/l (p< 0.01). The two snuff‐taking mothers exposed their children to higher milk nicotine concentrations than all but two of the smokers. The concentrations of the metabolite cotinine in infant urine correlated with the dose of nicotine ingested during the home visit (r= 0.84,p< 0.01).

Conclusions: Breastfed infants with a smoking or snuff‐taking mother are exposed to nicotine in breast milk. The mean intake of nicotine via milk is 7 μg/kg/d. With a shorter time between the mothers' smoking and breastfeeding, the milk nicotine concentration will increase. Both passive smoking at home and snuff‐taking were associated with measurable nicotine levels in milk. Healthcare personnel promoting breastfeeding should be aware of these factors influencing exposure to nicotine in the breastfed infant.
Characteristics of respiratory syncytial virus‐related apnoea in three infants
Authors: Rayyan M , Naulaers G , Daniels H , Allegaert K , Debeer A , Devlieger H
Published: August 2010

Apnoea is a common sign in respiratory syncytial virus (RSV) infections in young infants and can be the first presentation of an acquired RSV infection. We describe polysomnographic recordings of three infants revealing prolonged RSV‐related apnoea before RSV infection was diagnosed. The apnoeas were of central origin. The caregivers had not noted any apparent life‐threatening events (ALTE) prior to the polysomnography. Cardiorespiratory monitoring after the acute infection did not reveal any further apnoeas.

Conclusion: Central, prolonged apnoea can be the first sign of an acquired RSV infection in young infants in the absence of other respiratory symptoms and without any previous observation of apnoea by the caregivers.
The role of intrauterine bacteria in brain injury
Authors: Sullivan MHF , Steel J , Kennea N , Feldman RG , Edwards AD
Published: August 2010

Organisms appear to be present in human fetal membranes without any apparent impact on pregnancy maintenance or the fetal brain. A clear link between chorioamnionitis and fetal brain damage suggests that tissue responses at the feto‐maternal interface may be the key determinant of whether preterm labour and brain damage occur.
Posthaemorrhagic ventricular dilatation: new mechanisms and new treatment
Authors: Whitelaw A , Cherian S , Thoresen M , Pople I
Published: August 2010

Post haemorrhagic ventricular dilatation is associated with a high rate of disability, multiple impairments and adverse effects of shunt surgery for hydrocephalus. Post haemorrhagic ventricular dilatation results initially from multiple small blood clots throughout the cerebrospinal fluid channels impeding circulation and re‐absorption. Transforming growth factor β is released into the cerebrospinal fluid and there is evidence that this cytokine stimulates the laying down of extracellular matrix proteins which produce permanent obstruction to the cerebrospinal fluid pathways. Prolonged raised pressure, pro‐inflammatory cytokines and free radical damage from iron may contribute to periventricular white matter damage and subsequent disability. Interventions such as early lumbar punctures, diuretic drugs to reduce cerebrospinal fluid production and intraventricular fibrinolytic therapy have been tested and, not only fail to prevent shunt dependence, death or disability, but have significant adverse effects. Surgical interventions such as subcutaneous reservoir, external drain, choroid plexus coagulation and third ventriculostomy have not been subject to controlled trial. Ventriculoperitoneal shunt is not feasible in the early phase after intraventricular haemorrhage but, despite the problems with blockages and infections, remains the only option for infants with excessive head expansion over periods of weeks. We have piloted drainage, irrigation and fibrinolytic therapy as a way of removing blood early enough to stop the progressive deposition of matrix proteins, permanent hydrocephalus and shunt dependence.
Ifosfamide/carboplatin/etoposide (ICE) as front‐line, topotecan/ cyclophosphamide as second‐line and oral temozolomide as third‐line treatment for advanced neuroblastoma over one year of age
Authors: Donfrancesco A , Jenkner A , Castellano A , Ilari I , Milano GM , De Sio L , Cozza R , Fidani P , Deb G , De Laurentis C , Inserra A , Dominici C
Published: August 2010

Children affected by advanced neuroblastoma have a discouraging prognosis, but intensive induction chemotherapy may increase the complete response rate. The combination of ifosfamide, carboplatin and etoposide (ICE) was used for the first time as front‐line regimen in patients with stage 4 neuroblastoma over the age of 1 y. Similarly, second‐line treatment for children with relapsed neuroblastoma, particularly after high‐dose chemotherapy, has been unsatisfactory. The combination of topotecan and cyclophosphamide was studied in resistant or relapsed solid tumors. Furthermore, there is a need for effective palliative treatment in patients failing therapy. Temozolomide, a new dacarbazine analog with optimal oral bioavailability, is being used in an ongoing phase II study as an alternative to oral etoposide. Seventeen patients with stage 4 neuroblastoma have entered the ICE study; 15/16 (94%) major responses after induction were observed and 6/16 (37%) evaluable patients are disease free after a median of 51 mo. Twenty‐one patients with relapsed/refractory disease (of whom 13 neuroblastomas) entered the topotecan/cyclophosphamide study: 7/21 (33%) patients responded. Forty‐one patients entered the temozolomide study (of whom 16 had neuroblastomas): stable disease and symptom relief were obtained in 15/30 (50%) evaluable patients. Intensive induction with ICE resulted in a faster response with high response rate; a larger study with longer follow‐up is needed to confirm a survival advantage. Second‐line treatment was effective in obtaining remissions, some of them long lasting. Third‐line treatment did not elicit measurable responses in neuroblastoma, but achieved prolonged freedom from disease progression and excellent palliation in several patients.
B cell‐dependent T cell development
Authors: Cascalho M , Platt JL
Published: August 2010

T and B cells are thought to develop independently. While it is widely recognized that T cells help B cells in the production of antibodies to protein antigens, less well understood is whether or how B cells contribute to T cell development and function. Defects in cell‐mediated immunity in individuals with B cell deficiency and in B cell‐deficient mice suggest that B cells contribute to T cell function. The question of whether T cell development is B cell dependent was revisited using two novel mouse strains: mice with monoclonal T cells (MT) and mice with monoclonal compartments of both B and T cells (MBT). It was found that T cell development and thymocyte selection is modified by the presence of B cells. These results suggest that B cells, or B cell products, contribute to thymocyte selection and T cell development.
How common is attention‐deficit/hyperactivity disorder? Towards resolution of the controversy: results from a population‐based study
Authors: Barbaresi W , Katusic S , Colligan R , Weaver A , Pankratz V , Mrazek D , Jacobsen S
Published: August 2010

Attention‐deficit/hyperactivity disorder (AD/HD) is a common behavioral disorder among children, yet there is uncertainty about many aspects of AD/HD, including its precise frequency of occurrence, presence of comorbid conditions, long‐term outcomes and the impact of treatment on long‐term outcome. The objectives of the studies described in this paper were to address these important questions about AD/HD. The study subjects were from a population‐based birth cohort, and included all children born in Rochester, Minnesota, from 1976 to 1982, who remained in the community after the age of 5 y (n= 5718). Complete medical and school records were available for all members of the birth cohort, including detailed information about AD/HD symptoms, psychometric test and questionnaire results, medical and non‐medical treatments, and long‐term academic and psychosocial outcomes. This information was used to identify 375 subjects from the birth cohort with AD/HD, based on well‐defined research criteria. The estimated cumulative incidence of AD/HD at the age of 19 y was 7.5% (95% confidence interval 6.5–8.4). Data from these 375 subjects with AD/HD will be used in ongoing studies of this disorder.
Incidence of autism spectrum disorders: Changes over time and their meaning*
Authors: Rutter M.
Published: August 2010

Aim:Several reviews have noted a huge increase in the rate of diagnosed autism spectrum disorders. The main aims of this paper are: 1) to use published empirical findings to consider whether the rise reflects a true increase in incidence, as distinct from the consequences of better ascertainment and a broadening of the diagnostic concept; and 2) to consider how epidemiological data may be used to test hypotheses about possible causal influences, using MMR and thimerosal as examples.Methods:Search of the literature for studies with a large epidemiological base population, systematic standardized screening, a focus on an age group for which diagnostic assessments are reliable and valid, and diagnosis by trained professionals using high‐quality research assessments. Also, search of a broader literature to consider the evidence from all epidemiological studies with respect to the hypothesized causal effect of MMR and thimerosal on autism spectrum disorders.Results:The true incidence of autism spectrum disorders is likely to be within the range of 30–60 cases per 10 000, a huge increase over the original estimate 40 years ago of 4 per 10 000. The increase is largely a consequence of improved ascertainment and a considerable broadening of the diagnostic concept. However, a true risk due to some, as yet to be identified, environmental risk factor cannot be ruled out. There is no support for the hypothesis for a role of either MMR or thimerosal in causation, but the evidence on the latter is more limited.

Conclusion:Progress in testing environmental risk hypotheses will require the integration of epidemiological and biological studies.
Is screening ultrasound of the urinary tract indicated in infants with hypertrophic pyloric stenosis?
Authors: Cascio S. , Siddiqui M. M. F. , Barrett A. M.
Published: August 2010

Aim: Few retrospective studies have evaluated infants with hypertrophic pyloric stenosis (HPS) for associated urological anomalies. They have led to contradictory conclusions. The aim of this study was to evaluate the incidence of urinary tract anomalies in infants with HPS and to establish the clinical significance of this association. Methods: One hundred and twenty‐two infants (100 boys) who underwent pyloromyotomy between 1992 and 2002 were prospectively evaluated. Screening ultrasound (Us) of the urinary tract was performed in 107 infants, while 15 did not attend their ultrasound appointment. Results: Renal ultrasound was abnormal in 4 (4%) of 107 screened patients with HPS. Three patients were found to have mild hydronephrosis and, in one patient, a small, normal kidney was detected. Two patients with hydronephrosis had Us follow‐up and the third patient underwent Tc‐99 mercaptoacetyl triglycine (MAG 3) scan. In all three patients, the hydronephrosis resolved completely on follow‐up scan.

Conclusion: The incidence of abnormal renal ultrasound in children with HPS is similar to the reported incidence of 3–6% determined with routine ultrasound screening of healthy newborns. The abnormalities detected were not clinically relevant and did not require surgical intervention. We do not recommend screening of the urinary tract in infants with HPS.
Determination of the six major human herpesviruses in cerebrospinal fluid and blood specimens of children
Authors: Dong G. , Shang S. , Liang L. , Yu X.
Published: August 2010

Aim: To detect and differentiate six major human herpesviruses in the cerebrospinal fluid (CSF) and blood of children by polymerase chain reaction restriction fragment length polymorphism (PCR‐RFLP). Methods: We synthesized two pairs of primers in the well‐conserved regions of the DNA polymerase gene in human herpesviruses. One pair was designed to amplify cytomegalovirus (CMV), Epstein‐Barr virus (EBV), herpes simplex virus type 1 (HSV‐1) and type 2 (HSV‐2), and the other pair to amplify varicella‐zoster virus (VZV) and human herpesvirus 6 (HHV‐6) by PCR. Virus species identification was achieved by restriction enzyme digestion with BamHI and BstUI. Ninety‐eight CSF and 75 blood specimens were analysed by this technique. At the same time, all blood specimens were also examined by enzyme‐linked immunosorbent assay (ELISA). Results: Thirteen (13.3%) of 98 CSF specimens and 26 (34.7%) of 75 blood specimens were positive for herpesvirus DNA in this PCR assay. Only 10 (13.3%) of the blood specimens were positive in ELISA for virus‐IgM antibody. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PCR in detecting herpesvirus infections compared with ELISA were 100% (10/10), 75.4% (49/65), 38.5% (10/26) and 100% (49/49), respectively. These results indicate that the positive rate of PCR was significantly higher than that of ELISA (p<0.05). The herpesvirus type of these positive specimens was rapidly detected using restriction enzyme digestion with BamHI and BstUI.

Conclusions: PCR‐RFLP is a specific, sensitive and accurate technique for the identification of herpesvirus infections in the CSF and blood of children.
Effects of Saccharomyces boulardii in children with acute diarrhoea
Authors: Kurugöl Z. , Koturoğlu G.
Published: August 2010

Aim: Certain probiotic agents, e.g. Lactobacillus GG, have shown efficacy in clinical trials for the treatment of acute childhood diarrhoea, but few studies have examined the effect of Saccharomyces boulardii. We evaluated the effect of S. boulardii in children with acute diarrhoea. Methods: Two hundred children were randomized to receive S. boulardii in a granulated form in a daily dose of 250 mg (S. boulardii group) or placebo (placebo group) for 5 d. Clinical and demographic characteristics on admission were similar between the study groups. Results: The medians of the average stool frequency after the second day of the treatment were significantly lower in the S. boulardii group than in the placebo group (p=0.003). The duration of diarrhoea significantly reduced in the S. boulardii group compared with the placebo group (4.7 vs 5.5 d, p=0.03). The effect of S. boulardii on watery diarrhoea became apparent after the second day of the treatment. The duration of hospital stay was shorter in the S. boulardii group than in the placebo group (2.9 vs 3.9 d, p<0.001). Four children from the placebo group versus only one child from the S. boulardii group had persisting diarrhoea.

Conclusion: The placebo‐controlled study suggested that S. boulardii significantly reduced the duration of acute diarrhoea and the duration of hospital stay. S. boulardii seems to be a promising agent for the amelioration of the course of acute diarrhoea in children when used therapeutically.
Extreme hyperbilirubinaemia in term and near‐term infants in Denmark
Authors: Ebbesen F. , Andersson C. , Verder H. , Grytter C. , Pedersen‐bjergaard L. , Petersen J. R. , Schaarup J.
Published: August 2010

Aim: To determine the incidence amongst infants born at term or near‐term of extreme hyperbilirubinaemia, i.e., with a serum concentration of unconjugated bilirubin exceeding the limit above which an exchange transfusion was indicated according to the authorized guidelines. Method: The investigation period covered 2 y, 1 January 2000 to 31 December 2001, and included all infants born alive at term or near‐term in Denmark. All infants with extreme hyperbilirubinaemia admitted to paediatric departments were recorded. Results: Thirty‐two infants developed extreme hyperbilirubinaemia, i.e., an incidence of 25 per 100 000. The maximum total serum bilirubin concentration (TSB) was 492 (385–689) μmol/l (median (range)). The median value of the exchange transfusion limits was 450 μmol/l. Twelve infants had signs and symptoms of central nervous system involvement; 11 had acute bilirubin encephalopathy phase‐1 symptoms; and one had phase‐2 symptoms. Nineteen infants developed extreme hyperbilirubinaemia during primary admission to the maternity ward or neonatal department; the others after having been discharged. There was no difference in maximum TSB between those infants not discharged from hospital and those infants admitted to hospital from home. Maximum TSB appeared latest amongst those infants admitted from home (p<0.01), and these more often had signs and symptoms of central nervous system involvement (p<0.05). Ten infants were of non‐Caucasian extraction. Less than half of all Danish mothers receive both verbal and written information after birth on jaundice in the infant.

Conclusion: Twenty‐five per 100 000 infants born at term or near‐term developed extreme hyperbilirubinaemia, the majority of them whilst in hospital. Infants admitted from home more often had signs and symptoms of central system involvement.
Seasonality of invasive Candida infection in neonates
Authors: Edi‐Osagie N. E. , Emmerson A. J. B.
Published: August 2010

Aim: To evaluate season of birth as a risk factor for the development of invasive Candida in our population of preterm low‐birthweight infants. Methods: Retrospective identification of Candida‐positive blood or cerebrospinal fluid (CSF) cultures in infants <32 wk over an 8‐y period. Results: There were 1400 admissions of infants <32 wk gestation, of whom 52 (3.7%) developed invasive Candida infection. Thirty‐eight of 52 (73%) occurred during the months September to February.

Conclusions: It may be appropriate to consider seasonal associations when targeting selective antifungal chemoprophylaxis.
Higher urinary excretion of essential amino acids in preterm infants fed protein hydrolysates
Authors: Maggio L. , Zuppa A. A. , Sawatzki G. , Valsasina R. , Schubert W. , Tortorolo G.
Published: August 2010

Aim:Protein hydrolysates have been introduced in preterm formulae, but it is not clear whether they are needed for the feeding of preterm infants. We designed a randomized, controlled trial to test the effects of a preterm formula with hydrolysed cow's milk proteins on short‐term growth and urinary and plasma amino acids levels.Methods:Infants with a birthweight 1750 g and gestational age 34 wk fed a conventional preterm infant formula (formula B) or a hydrolysed formula (formula A). Weight was measured daily; length, head circumference, mid‐arm circumference and total skinfold thickness were measured weekly. Blood and urine were analysed for amino acid concentrations at start, 14 and 28 d.Results:Twenty‐one infants met the criteria for randomization. The daily feeding volumes were: formula A 172.8±5.6 vs formula B 170.1±2.8 ml/kg/d. Infants fed with formula A showed slower weight gain (17.4±3.4 vs 20.5±3.3 g/kg/d;p=0.045) and lower mean change in Z‐scores for weight (−0.18±0.16 vs 0.00±0.09;p=0.009) and for head circumference (−0.06±0.13 vs 0.06±0.13;p=0.049). After 14 d, infants receiving formula A had statistically significant higher urinary levels of essential amino acids compared to infants receiving formula B.

Conclusion:Our results support the hypothesis of less nutritional value of hydrolysed versus conventional preterm formulae. Higher renal excretion of essential amino acids may be one of the mechanisms involved. These findings must be confirmed by further studies with larger sample sizes and protein hydrolysates with different degrees of hydrolysis.
Lung function in immature baboons with respiratory distress syndrome receiving early caffeine therapy: A pilot study
Authors: Yoder B. , Thomson M. , Coalson J.
Published: August 2010

Aim: The cardiopulmonary effects of early caffeine therapy in surfactant‐treated immature baboons were measured. Methods: Nine 125‐d (term=185 d) baboons receiving caffeine citrate at 1 and 12 h age as part of a pilot study on the use of nasal CPAP at 24 h were compared to six untreated animals destined for prolonged ventilator support. All received surfactant prior to their first breath and again at 6 h age. Serial physiologic and ventilatory parameters were recorded. Lung mechanics were measured by body plethysmography. Data were compared from 1 through 24 h age. Results: There were no between‐group differences in any study variables prior to caffeine therapy at 1 h age. Airway resistance (RA) was significantly lower in caffeine‐treated compared to non‐caffeine‐treated animals at 12 and 24 h age [median (range)12 h: 47 (35–107) cm H2O/l/s to 135 (120–259) cm H2O/l/s; and 24 h: 93(60–137) cm H2O/l/s to 211 (86–235) cm H2O/l/s; p<0.05]. Respiratory system compliance (CRS) was higher in caffeine‐treated compared to non‐caffeine‐treated animals at 18 and 24 h age [median (range) 18 h: 0.60 (0.29–1.58) ml/cm H2O/kg to 0.39 (0.33–0.46) ml/cm H2O/kg; and 24 h: 0.68 (0.36–1.20) ml/cm H2O/kg to 0.36 (0.33–0.55) ml/cm H2O/kg; p<0.05]. Ventilatory efficiency index and arterial/alveolar ratio significantly improved in caffeine‐treated animals over the 24‐h study period (p<0.05, repeated measures ANOVA).

Conclusions: In this pilot study, early caffeine treatment, combined with prophylactic surfactant therapy, was associated with better lung function during the initial 24 h of life. This combined approach may facilitate earlier extubation or prophylactic efforts to support infants on nasal CPAP. Randomized, controlled investigation is warranted.
Normal physical working capacity in prepubertal children with type 1 diabetes compared with healthy controls
Authors: Heyman Elsa , Briard David , Gratas‐Delamarche Arlette , Delamarche Paul , de Kerdanet Marc
Published: August 2010

Background: Exercise testing has become a valuable help for the physician to examine the influence of recommended exercise training on physical fitness. However, the question as to how diabetic prepubertal children differ from their non‐diabetic peers in their performance capacity has only partial and sometimes conflicting answers in the literature. Aim and methods: The aim of the current study was thus to evaluate aerobic fitness during an incremental submaximal test (measure of the Physical Working Capacity 170 (PWC170)) in 17 well‐controlled prepubertal insulin‐dependent diabetic boys aged 8.5–13 y. Eighteen healthy prepubertal boys matched for age, body size and physical activity served as controls. Part of the method was to check capillary blood glucose level in the diabetic patients and in nine of the healthy subjects throughout the exercise. Results: From this experiment it appeared that the level of physical fitness was similar in diabetic and healthy boys (PWC170 2.28±0.09 vs 2.37±0.13 W·kg−1). While glucose homeostasis was well maintained in the healthy group, diabetic children showed a marked fall in blood glucose during the exercise. In addition, the PWC170 level correlated significantly with the estimate of energy expenditure attributed to vigorous activities in the diabetic boys.

Conclusion: By studying the responses to incremental exercise there is growing evidence that normal physical fitness is preserved in diabetic prepubertal boys given appropriate involvement in physical activity.
Persistent effects of a pedagogical device targeted at prevention of severe hypoglycaemia: A randomized, controlled study
Authors: Nordfeldt Sam , Johansson Calle , Carlsson Eric , Hammersjö Jan‐Åke
Published: August 2010

Aim: To study the long‐term use of self‐study material in type 1 diabetes patient education targeted at the prevention of severe hypoglycaemia. Methods: Randomized 1∶1∶1 control study in three local hospitals. We studied 332 type 1 diabetes patients from the geographic population, aged 2.6–18.9 y at entry. The intervention group received a videotape and brochure in which interviewed patients, parents and medical experts reviewed in detail practical skills for self‐control and treatment, with the aim of preventing severe hypoglycaemia. There were two control groups: one received a videotape and brochure with general diabetes information and the other only traditional treatment. Primary endpoints were severe hypoglycaemia needing assistance by another person and HbA1c. Dissemination, reading/viewing level, patients' attitudes and extra contact with caregivers were also investigated. At 24 mo, 249 subjects provided data. Results: The yearly incidence of severe hypoglycaemia decreased at 24 mo from 42% to 25% (difference 17%, 95% CI 3–31, p=0.0241) in the intervention group, but not in controls. HbA1c remained unchanged. Video use during months 13–24 was higher in the intervention group than in controls (p=0.0477), ranging from 1–15 (median 2) times, among 37% of patients (months 1–12, 100%). Higher future use was anticipated for intervention material (p=0.0003). Extra caregiver contact was related to severe hypoglycaemia (p=0.0009). The cost of the material was <EUR 10 per patient.

Conclusion: Mass‐distributed pedagogical devices such as high‐quality video programmes and brochures may reach high dissemination levels and, when targeted, contribute to the prevention of severe hypoglycaemia over a longer period of time, being a cost‐effective complement to traditional care.
Bone age and probable aetiological causes in primary nocturnal enuresis
Authors: Ergüven Müferet , Çelik Yalçin , Devecí Murat
Published: August 2010

Aim: To investigate probable aetiological risk factors and to identify whether there are any differences in bone age between normal children and children with primary nocturnal enuresis (PNE). Methods: Ninety children with primary nocturnal enuresis and 40 healthy children were included in the study. Enrolment began in January 2001, and continued through July 2002. Data were obtained via consultation with children and their families, physical examination and laboratory findings. Left hand and wrist graphs of each patient were acquired, and, using Tanner Whitehouse charts (TW‐2), bone ages were determined via comparison of 20 hand and wrist bones. Results: Of the total of 90 children with primary nocturnal enuresis participating in the study, 52 (57.8%) were male and 38 (42.2%) were female. Of the control group, 24 (60%) were male and 16 (40%) were female. Differences between chronological ages and bone ages of the PNE and control groups were 0.57±0.59 and 0.54±0.67 y, respectively, and no significant difference was seen (p=0.484). In 90% of the children in the PNE group there was found to be a primary nocturnal enuresis history in the family, whereas in the control group this rate was only 7.5%. Of the children with PNE, 62.2% had very deep sleeping habits, while 7.5% of the control group had this problem.

Conclusion: Our study provides no evidence that bone ages of children suffering from PNE are lower than normal children. We found that a family history of enuresis, male sex and difficulty in waking were risk factors in primary nocturnal enuresis.
Blood glucose testing at alternate sites in newborn infants
Authors: Norman Mikael , Schiött Jessica , Åkerström Susanne , Lattunen Nina , Berggren‐broström Eva
Published: August 2010

Aim: To compare a method of testing at alternate skin sites (AST) with that of the usual heel‐stick approach (SM) for determining blood glucose levels in newborn infants. Our other aims were to compare these methods as regards their accuracy, the pain caused by the procedures, the times taken to obtain a result and the possible delay in accurate test results using AST during rapid changes in blood glucose. Methods: One hundred and eighty‐six preterm and term infants were enrolled. The blood glucose levels were determined by a standard bedside method (SM, HemoCue®) and AST (Freestyle™), which permitted blood samples to be taken from the arm or leg. Results: The levels of blood glucose ranged between 0.6 and 8.6 mmol/l. We found a significant correlation between SM and AST (r=0.90, p<0.001). The coefficient of variation was similar, pain was significantly less (median pain score 3.5 vs 7.5, p<0.01) and the time taken to obtain a result significantly shorter (mean 35 vs 111 s, p<0.01) with AST than with SM. No significant differences were found between these methods during rapid changes in the blood glucose levels.

Conclusion: AST, a relatively simple and painless method of determining blood glucose levels in newborn infants, is acceptably accurate and causes minimal blood loss.
Effects of bilirubin and phototherapy on osmotic fragility and haematoporphyrin‐induced photohaemolysis of normal erythrocytes and spherocytes
Authors: Bruzell Roll Ellen , Christensen Terje , Gederaas Odrun A
Published: August 2010

Aim: To study the effects of phototherapy on erythrocyte haemolysis in vitro and to determine possible differences in sensitivity to phototherapy between normal erythrocytes and spherocytes. Methods: Erythrocytes from four normal healthy donors and two donors with hereditary spherocytosis were treated with bilirubin (160 μM) in the presence of human serum albumin in the molecular ratio bilirubin/albumin 0.8. Treated cells were maintained either in the dark or in blue light (450 nm, 8 mW/cm2, 30 min). The experimental light dose was comparable to 2 h of clinical phototherapy. The osmotic fragility of the treated cells was measured by scoring haemolysis in hypo‐osmolar solutions (0.10–0.90% NaCl). The sensitivity to photohaemolysis of cells pre‐treated with bilirubin (BR) and/or phototherapy was tested by exposing the cell suspensions to haematoporphyrin and UVA radiation. The delayed (18 h) photohaemolysis was measured by spectrophotometry. Results: Osmotic fragility, expressed as percentage haemolysis, of normal erythrocytes was more than doubled in the presence of BR combined with phototherapy (n=6, p<0.05). In contrast, osmotic fragility of spherocytes was unaffected by either treatment (n=8, p<0.05). Increased photohaemolysis was seen in spherocytes treated with BR (n=13, p<0.05), phototherapy (n=13, p<0.05) and a combination of the two agents (n=13, p<0.05) compared with spherocytes without BR in the dark (n=6).

Conclusion: Bilirubin may make the plasma membrane of normal erythrocytes more fragile. Newborns with hereditary spherocytosis may be sensitive to phototherapy.