bluuebunny/crossref_metadata_2025 huggingface dataset:
Antipsychotic medication and marked hyperprolactinaemia: iatros or true prolactinoma?
Authors: Koves IH , Jarman FC , Cameron FJ
Published: August 2010

Aim: To demonstrate that hyperprolactinaemia and/or prolactinoma occur in association with antipsychotic medication use. Methods: Three case studies of patients with markedly elevated serum prolactin level (<132 μg/1); either antipsychotic medication induced or as a consequence of a prolactinoma.

Conclusion: The management and investigation of children with markedly elevated serum prolactin levels remains poorly defined. In our case series, two patients were found to have prolactinomas. We suggest that paediatric patients with serum prolactin level above 50 μg/1 in males and 70 μg/1 in females, regardless of any antipsychotic medication use, receive magnetic resonance imaging to exclude prolactinoma.
Poly chlorinated biphenyls in colostral milk and visual function at 12 months of life
Authors: Riva E , Grandi F , Massetto N , Radaelli G , Giovannini M , Zetterström R , Agostoni C
Published: August 2010

Background and aims: Environmental contaminants such as persistent organic chlorines and heavy metals, which are supplied to the foetus by transplacental transfer and to breastfed infants by the milk, may impair cognitive functions. Long‐chain polyunsaturated fatty acids, which are known to enhance development during foetal life and early infancy, may counteract the toxic effect of environmental contaminants. In this study, we have investigated whether polychlorinated biphenyls (PCBs) impair early development of vision, and whether such impairment can be modulated by essential long‐chain polyunsaturated fatty acids. Material: Healthy term infants born in Milan and its surroundings, and who were exclusively breastfed for at least 4 mo, were prospectively examined up to the age of 12 mo. Methods: Samples from colostrums, the first 2d after delivery, and of mature breast‐milk after 1 and 3 mo were collected. The samples were analyzed for PCB 105, 118, 138, 153, 156 and 180 and for DDT and DDE. In all infants, the plasma levels of the long‐chain polyunsaturated fatty acids (LC‐PUFAs), C18:2 n‐6, C18:3 n‐3, C20:4 n‐6, C20:5 n‐3 and C22:6 n‐3 were analysed within the first three postnatal days. The PCB levels in colostral milk, as well as of LC‐PUFAs in plasma, were considered to mirror perinatal supply. Visual function was evaluated by P100 with latency evoked potentials (VEPs) at 12 mo of age. Statistical analysis was based on simple and partial correlation coefficients (p > 0.05). Results: On bivariate analysis, wave latency VEP at 15 min was significantly related to the colostral levels of DDT, DDE and all examined PCBs except PCB 105 (with correlation coefficient r= 0.401 to 0.618), whereas P100 wave latency VEP at 60 min was related to DDT (r= 0.513) and PCB 180 (r= 0.504). Infant plasma levels of C22:6 n‐3 were inversely associated with P100 wave latency at 60 min (r=‐0.418) and at 1 Hz‐2 J (r=‐0.466). After controlling for C22:6 n‐3, the partial correlation coefficient of P100 wave latency VEP at 15 min to the colostral level of PCB 180 was 0.403 (p= 0.07).

Conclusion: Within the population of this study, a weak relation was found between impaired visual function at 12 mo of age of healthy infants and the levels of PCBs, DDT and DDE in colostral milk. The effect of impairment was no longer evident after controlling for the plasma level of LC‐PUFAs as found in the infant a few days after birth.
Effect of activators and the phosphodiesterase inhibitors Pentoxifylline and Enoximone on the deformability of neutrophils in neonates and adults
Authors: Ruef P , Poeschl JMB , Simon C , Altfelder F , Craciun E , Linderkamp O
Published: August 2010

Background: Stimulated polymorphonuclear leukocytes (PMN) are extremely rigid compared to resting PMN. They may obstruct narrow vessels and contribute to ischaemic organ injury. Deformability is a prerequisite for both active and passive movement in the microcirculation. Aim: The investigation was designed to study whether stimulators and inhibitors of stimulation show different effects on deformability of neonatal and adult PMN. Methods: Deformability of PMN was assessed by complete aspiration of a PMN into a micropipette with an internal diameter of 5 μm. Blood samples from 20 neonates and 20 adults were studied before and after stimulation with N‐formyl‐methionyl‐leucyl‐phenylalanine (fMLP), interleukin‐8 (IL‐8) or tumour necrosis factor‐α (TNF‐α). Moreover, effects of the phosphodiesterase inhibitors Pentoxifylline (PTX) and Enoximone on the deformability of stimulated PMN were investigated. Results: fMLP, IL‐8 and TNF‐α significantly delayed aspiration times of PMN in relation to the concentrations of the stimulators. The addition of PTX or Enoximone to stimulated PMN increased the deformability up to 60% depending on the concentration of the inhibitors. No significant differences in the aspiration times were found between neonatal and adult PMN at any of the experimental conditions after activation with the three stimulators and treatment with the two inhibitors.

Conclusion: Neonatal and adult PMN show similar reduction of passive deformability when stimulated with either fMLP, IL‐8 or TNF‐α compared to resting PMN and a similar improvement of deformability in response to PTX or Enoximone.
Clinicians' perspective on quality of life assessment in paediatric clinical practice
Authors: Baars RM , van der Pal SM , Koopman HM , Wit JM
Published: August 2010

Aim: This study was undertaken to investigate paediatric clinicians' views on and use of quality of life (QoL) assessment in clinical practice. Methods: A survey was conducted among members of the Dutch Paediatric Association via e‐mail. Results: Over half of the 303 respondents (57%) believed that it was possible to use QoL questionnaires in clinical practice. The majority indicated that assessing QoL was beneficial and that it was especially necessary to assess QoL in children with a chronic disease (82%). Although only a minority (17%) currently used QoL questionnaires, most respondents would want to use QoL questionnaires in the future (76%). Obstacles that prevent the use of QoL questionnaires are the extra time needed for assessment, the unavailability of standardized questionnaires and insufficient knowledge about QoL.

Conclusion: This survey shows that paediatric clinicians are positive towards QoL assessment, but that certain obstacles prevent the use of questionnaires. Thus, to facilitate future use, QoL questionnaires need to be developed from the perspective of the paediatrician. This means that they need to be developed for clinical use and brought to the attention of the paediatric health care community, demonstrating their validity to child health care.
Prediction of academic and behavioural limitations in school‐age survivors of bacterial meningitis
Authors: Koomen I , Grobbee DE , Roord JJ , Jennekens‐Schinkel A , van der Lei HDW , Kraak MAC , van Furth AM
Published: August 2010

Aim: To develop a prediction rule to identify postmeningitic children at high risk of academic and behavioural limitations. Methods: 182 children (mean age 10 y; range 5–14) were selected from a cohort of 674 school‐age survivors of bacterial meningitis. These children had neither meningitis with “complex onset”, nor prior cognitive or behavioural problems, nor severe disease sequelae. On average, 7 y after the meningitis, they were evaluated using an “Academic Achievement Test”, and their parents filled in the “Child Behaviour Checklist”. By reviewing the medical records, potential risk factors for academic and/or behavioural limitations were collected. Independent predictors were identified using multivariate logistic regression analysis, leading to the formulation of a prediction rule. Results: The cumulative incidence of academic and/or behavioural limitations among children who survived bacterial meningitis without severe disease sequelae was 32%. The prediction rule was based on nine independent risk factors: gender, birthweight, educational level of the father, S. pneumoniae, cerebrospinal fluid leukocyte count, delay between admission and start of antibiotics, dexamethasone use, seizures treated with anticonvulsive therapy, and prolonged fever. When 10 was taken as a cut‐off point for the risk score computed using this rule, 76% of the children with limitations could be identified, while 38% of the children in the cohort were selected as at risk for these limitations.

Conclusion: With a prediction rule based on nine risk factors, postmeningitic children at high risk of developing academic and/or behavioural limitations could be identified. Additional research is required to further validate this prediction rule. In the future, a careful follow‐up of high risk children may enhance early detection and treatment of these limitations.
Intractable congenital chylous ascites
Authors: te Pas AB , vd Ven K , Stokkel MPM , Walther FJ
Published: August 2010

A male newborn presented with congenital chylous ascites, the treatment of which is difficult and complicated due to persistent loss of chyle. The primary therapeutic goal is to reduce the lymph flow and to allow the leakage to heal naturally. Usually, conservative management—enteric rest with total parental feeding or an enteral diet with medium‐chain triglycerides—can achieve this. A new treatment option is the use of octeotride, a somatostatin analogue. Both therapies failed in our patient, and surgical ligation of the leaking lymphatic duct was successful.

Conclusion: The success of the surgical treatment depends on localizing the leaking lymphatic duct. Lymphatic imaging with lymphoscintigraphy and pre‐operative administration of lipophilic dye can assist the surgeon.
Illness and exposure to negative life experiences in adolescence: two sides of the same coin? A study of 15‐year‐olds in Oslo, Norway
Authors: Haavet OR , Straand J , Saugstad OD , Grünfeld B
Published: August 2010

Aim: To investigate associations between negative life experiences and common illnesses among adolescents. Methods: Cross‐sectional questionnaire study carried out at all lower secondary schools (10 grade) in Oslo, Norway, during 2000 and 2001 (n= 8316 pupils). Different negative life experiences and illnesses were addressed. Results: The participation rate was 88%. Among reported negative life experiences last year were a pressure felt to succeed (62%), death of a close person (26%), exposure to physical violence (22%), bullying at school (15%) and sexual violation (4%). A large number of the pupils had some chronic illness: hay fever (38%), eczema (29%) and asthma (13%). Reported illnesses the previous 12 month were: headache (56%), painful neck or shoulders (35%), sore throat at least three times (15%), lower respiratory tract infection (9%) and mental problems for which help was sought (7%). During the week prior to the survey, 26% of all girls had symptoms of a depressive disorder, while this applied to 10% of all boys. Fifty‐three percent of the boys (29% of the girls) who had depressive symptoms had been exposed to physical violence. Sexually violated boys had a high probability for seeking help for mental problems (OR = 4.9) and for frequent episodes of sore throat (OR = 2.5). Corresponding odds ratios for girls were 1.7 and 2.5, respectively.

Conclusion: Common illnesses in adolescence are significantly associated with negative life experiences. In clinical encounters with adolescents not only should the presenting complaints be addressed, but also other common illnesses and relevant background factors such as negative life events.
Immunogenicity and safety of a virosomal hepatitis A vaccine (Epaxal®) in healthy toddlers and children in Chile
Authors: Riedemann S , Reinhardt G , Ibarra H , Frösner GG
Published: August 2010

In this open study, 20 toddlers and 80 schoolchildren received an intramuscular dose of Epaxal® and a booster dose 12 mo later to assess the efficacy and safety of this aluminium‐free, virosomal hepatitis A vaccine. Four weeks after primary vaccination, 94% of toddlers and 99% of schoolchildren had seroconverted, and all toddlers and 94% of schoolchildren remained seroprotected for 12 mo.

Conclusion: After vaccination with Epaxal® and booster, all subjects were seroprotected. Epaxal® was very well tolerated by both age groups.
Lower leg growth suppression caused by inhaled glucocorticoids is not accompanied by reduced thickness of the cutis or subcutis
Authors: Schou AJ , Plomgaard AM , Thomsen K , Wolthers OD
Published: August 2010

Background: Exogenous glucocorticoids suppress short‐term lower leg growth in children as assessed by knemometry. The knemometric measurements, however, may be confounded by reductions in the thickness of the cutis and subcutis over the knee. Aim: To assess whether inhaled glucocorticoid‐induced suppression of short‐term growth is accompanied by changes in the thickness of the cutis and subcutis. Methods: The study was a randomized, controlled, crossover trial with 1 wk treatment, run‐in and washout periods. Active treatment was inhaled budesonide 200 μg twice daily. Short‐term growth was assessed by knemometry, and the thickness of the cutis and subcutis over the knee, on the volar forearm and abdomen was measured by 20 MHz B‐mode ultrasound. Material: Nineteen children with asthma aged 7 to 13 y. Results: Lower leg growth was significantly reduced during budesonide treatment (0.27 mm/wk) compared to the treatment‐free period (0.54 mm/wk) (p= 0.02, 95%: –0.50 to –0.05). Variations in the thickness of the cutis were seen during budesonide treatment (mean ± SEM): –0.01 ± 0.03 mm over the knee, –0.02 ± 0.02 mm on the forearm and 0.01 ± 0.02 mm on the abdomen. The variations in the total thickness of the cutis and subcutis were –0.05 ± 0.12 mm, 0.06 ±0.12 mm and –0.06 ± 0.10 mm during budesonide treatment. The variations in thickness of the cutis or subcutis were not statistically different during budesonide treatment and the treatment free period in any anatomical location.

Conclusions: Short‐term lower leg growth suppression induced by inhaled glucocorticoids is not confounded by variations in thickness of cutis or subcutis. The present observations further establishes knemometry as a reliable tool for assessment of the risk of growth suppression of inhaled glucocorticoids in children with asthma.
Ultrasound bone measurements in pre‐adolescent girls: interaction between ethnicity and lifestyle factors
Authors: Micklesfield LK , Zielonka EA , Charlton KE , Katzenellenbogen L , Harkins J , Lambert EV
Published: August 2010

Aim: We obtained calcaneal ultrasound measurements in 198 girls between 7.5 and 11.7 y of age, representing ethnic groups (black [n= 80], white [n= 41], mixed ancestral origin [n= 77]) in South Africa. Methods: Anthropometry was assessed. Demographics, physical activity, habitual dietary calcium intake and pubertal development were quantified by questionnaires. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) of the left calcaneus were measured. Girls in Tanner breast stage 5 and/or those menstruating were excluded from analysis. Results: Black girls were lighter than white girls (31.4 ± 7.8 vs 34.8 ± 7.5 kg; p < 0.05), and shorter than girls of mixed ancestral origin (1.29 ± 0.08 vs 1.34 ± 0.07 m; p < 0.001) and white girls (1.35 ± 0.07 m; p < 0.001), after adjusting for age. Reported calcium intake scores were higher in black than white girls (21.6 ± 11.1 vs 16.1 ± 8.4; p < 0.01). Total peak bone strain score (TPBSS) was higher in white compared to black girls (6.8 ± 4.8 vs 5.0 ± 4.7; p < 0.05), while walking energy expenditure (MET h/wk) was higher in black girls compared to the other groups (p < 0.001). BUA and SOS were higher in the black girls (59.6 ± 13.7 dB/MHz; 1575.1 ± 22.6 m/s; p < 0.001) and girls of mixed ancestral origin (59.0 ± 12.5 dB/MHz; 1567.8 ± 26.1 m/s; p < 0.01) than in the white girls (50.4 ± 8.7 dB/MHz; 1552.1 ± 19.5 m/s). Co‐varying for age and weight did not affect these results. Walking energy expenditure (r= 0.20) and calcium score (r= 0.17) were correlated (p < 0.05) with SOS for the whole group.

Conclusion: Ultrasound parameters were lower in the white compared to the black girls, who consumed more calcium on average, but who were lighter, shorter and performed less impact activity. This suggests that interactions between ethnicity and lifestyle factors determine bone quality in premenarcheal girls.
Nosocomial respiratory syncytial virus infection in neonatal units in the United Kingdom
Authors: Thwaites R , Piercy J
Published: August 2010

Nosocomial Respiratory Syncytial Virus infections are frequently reported and tend to be more severe, because of comorbidity, such reports, however, are frequently from a single centre. The incidence and outcomes of nosocomial Respiratory Syncytial Virus infection in UK neonatal units over a five year period were estimated by interrogating the Capse Health Care Knowledge Systems database, which contains anonymised details of 55% of UK hospital admissions. A total of 79,642 admissions commenced on the infants' date of birth and contained an ICD‐10 code for low birth weight or immaturity. Thirty‐seven of the 79,642 admissions also contained a Respiratory Syncytial Virus code. Two (5.4%) with Respiratory Syncytial Virus and 2,736 (3.4%) without Respiratory Syncytial Virus died. Survivors with Respiratory Syncytial Virus codes experienced significantly increased length of stay. In the extreme immaturity sub‐group the length of stay was 117.5 days with Respiratory Syncytial Virus and 51.3 days without Respiratory Syncytial Virus (p= 0.0002). In the low birth weight or other preterm sub‐group the length of stay with Respiratory Syncytial Virus was 69.2 and without Respiratory Syncytial Virus 14.7 days (p > 0.0001). The observed low rate for nosocomial Respiratory Syncytial Virus (0.46/1000 admissions) should be regarded as a minimum. The increased length of stay in infants with Respiratory Syncytial Virus infection emphasises that units should have guidelines to prevent and deal with Respiratory Syncytial Virus outbreaks.
The genetic basis of immune and autoimmune responses
Authors: Bottazzo GF , Locatelli M , Fierabracci A , Fruci D
Published: August 2010

HLA class I and class II molecules play a major role in the presentation of short, pathogen‐derived peptides to T cells, a process that initiates the adaptive cellular and humoral immune responses. However, the factors governing a cell's ability to respond or not to particular peptides are still not completely understood. Taking the example of a viral infection, in tissues infected with a virus, viral particles are taken up by antigen‐presenting cells and uncoated. The viral DNA or RNA enters the nucleus, where it replicates. mRNA enters the cytosol and is transcribed into proteins. These proteins are degraded in proteasomes and the resulting peptides (8–10 residues) are loaded onto class I molecules for export to the surface of the cells. In the meantime, the groove of the class II molecules is also preparing to accommodate peptides (12–24 residues) generated by the endocytic protein‐processing pathway. The surface of the infected cell then becomes adorned with peptide‐loaded human leukocyte antigen (HLA) molecules. CD4+ T helper lymphocytes engage class II molecules and elicit responses from B cells, which will ultimately lead to antibody production, whereas CD8+ T lymphocytes become cytotoxic T cells. As a consequence, the virus is eliminated from the body. However, certain mysteries and challenges remain. How can, as an exception to this rule, an autoimmune response be the escape from the perfect machinery? This review offers some hypotheses on how to see the problem through to its solution.
A single‐institution Wilms' tumor and localized neuroblastoma series
Authors: Boglino C , Inserra A , Madafferi S , Jenkner A , Camassei F Diomedi , Boldrini R , Donfrancesco A
Published: August 2010

Since January 1980, 120 children affected by Wilms' tumor have been treated at Bambino Gesù, mostly with multimodality treatment according to Société Internationale d'Oncologie Pediatrique (SIOP) protocols, including chemotherapy, surgery and radiotherapy in selected cases. This treatment approach emphasizes the role of preoperative (neoadjuvant) chemotherapy as opposed to the approach favored by the National Wilms' Tumor Study, which is focused on optimizing postoperative chemotherapy after primary surgery. Thus, using SIOP guidelines, staging occurs at the time of surgery, after chemotherapy administration. These differences will constitute the baseline for a comparison between the two experiences. Bilaterality, nephroblastomatosis, partial nephrectomy in unilateral Wilms' tumor and thrombosis of the vena cava are the main topics discussed. For the present study, the analysis was restricted to 98 consecutive cases diagnosed until December 1999, for whom at least 24 mo of follow‐up is available. The more recent experience of treating resectable neuroblastoma in cooperative studies dates back to 1979, when the first Italian Cooperative Group Neuroblastoma protocol was introduced. This experience was continued within the frame of the first Localized Neuroblastoma European Study Group protocol (LNESG 94), and will be compared to North American Cooperative Group approaches and outcomes. Preoperative evaluation of surgical risk factors, intraoperative complications and their management, and long‐term outcome will be discussed.
Is there any role for protein hydrolysates to premature newborns?
Authors: Foucard T.
Published: August 2010

The use of hydrolysed cow's milk formula seems to increase beyond what is recommended based on evidence regarding allergy‐preventive effect. Infants born preterm are sometimes given such formulas without proven effect.

Conclusion: If the use of hydrolysed cow's milk formula is based on allergy‐preventive aspects, evidence‐based recommendations should be followed.
Long‐chain polyunsaturated fatty acids and neurological developmental outcome at 18 months in healthy term infants
Authors: Bouwstra H. , Dijck‐Brouwer D. A. J. , Boehm G. , Boersma E. R. , Muskiet F. A. J. , Hadders‐Algra M.
Published: August 2010

Aim: Previously, we found a beneficial effect of 2 mo supplementation of infant formula with long‐chain polyunsaturated fatty acids (LC‐PUFA) on neurological condition at 3 mo in healthy term infants. The aim of the present follow‐up study was to evaluate whether the effect on neurological condition persists until 18 mo. Methods: A prospective, double‐blind, randomized control study was conducted. Three groups were formed: a control (CF; n=169), an LC‐PUFA‐supplemented (LF; n=146) and a breastfed (BF; n=159) group. Information on potential confounders was collected at enrolment. At the age of 18 mo, neurodevelopmental condition was assessed by the age‐specific neurological examination of Hempel and the Bayley scales. The Hempel assessment resulted in a clinical neurological diagnosis, a total optimality score and a score on the fluency of motility. The Bayley scales resulted in mental and psychomotor developmental indices. Attrition at 18 mo was 5.5% and non‐selective. Multivariate regression analyses were carried out to evaluate the effect of type of feeding while adjusting for confounders. Results: None of the children had developed cerebral palsy and 23 (CF: n=8; LF: n=10; BF: n=5) showed minor neurological dysfunction. The groups did not show statistically significant differences in clinical neurological condition, neurological optimality score, fluency score, and the psychomotor and mental development indices. Multivariate analysis confirmed that there was no effect of type of feeding on neurological condition.

Conclusion: This study indicates that the beneficial neurodevelopmental effect of 2 mo LC‐PUFA supplementation in healthy term infants can not be detected at the age of 18 mo.
Cytomegalovirus transmission to extremely low‐birthweight infants through breast milk
Authors: Doctor S. , Friedman S. , Dunn M. S. , Asztalos E. V. , Wylie L. , Mazzulli T. , Vearncombe M. , O'brien K.
Published: August 2010

Aim: To determine the incidence, timing and clinical significance of acquired postnatal cytomegalovirus (CMV) in extremely low‐birthweight (ELBW) infants. Methods: Prospective, longitudinal surveillance study. ELBW infants were recruited in the first week of life. Maternal blood was tested for CMV‐specific IgG antibodies. Weekly urine samples were obtained from infants for CMV culture and rapid antigen testing. Data were collected regarding clinical course and breast milk intake. Results: Of 181 eligible infants, 119 infants, born to 101 mothers, were enrolled. Eighty of the 101 mothers had their serum checked for CMV status. Seventy percent of those tested were seropositive for CMV. Of the 65 infants born to seropositive mothers, 94% received breast milk during their hospital stay. Complete urine collection was obtained in 92 infants. CMV was cultured from the urine of only four infants, all of whom were born to seropositive mothers. Only one of these four infants was symptomatic. The range at which CMV was first detected was between 48 and 72 postnatal days of age.

Conclusions: Despite a very high CMV seropositivity rate in mothers of ELBW infants, and the previously reported high rate of CMV excretion into breast milk, the incidence of postnatal CMV transmission was extremely low in our study.
Socio‐economic characteristics in children with coeliac disease
Authors: Ludvigsson J. F. ,   for the ABIS study group
Published: August 2010

Aim: To study the relationship between socio‐economic factors and coeliac disease. Methods: This study was part of a prospective cohort study of 16 286 children born from 1 October 1997–1 October 1999 (the ABIS study; All Babies in Southeast Sweden). Eight paediatric departments recorded all children with coeliac disease in southeast Sweden. Coeliac disease was confirmed through biopsy. Socio‐economic characteristics (maternal employment, civil status, whether parents were born in Sweden, parental education, place of living before pregnancy and during pregnancy, crowded living), infant sex, previous siblings, parental age and maternal alcohol consumption during pregnancy were analysed using logistic regression. All data, except for those related to diagnosis of coeliac disease, were obtained through a questionnaire distributed at birth. Results: Coeliac disease in the offspring was less common among mothers who had worked <3 mo during pregnancy (odds ratio, OR=0.29; 95% CI: 0.09–0.94; p=0.039). This risk decrease remained after adjustment for confounders (adjusted OR=0.28; 95% CI: 0.09–0.92; p=0.035). No other socio‐economic factor was related to coeliac disease.

Conclusion: This study indicates that most socio‐economic factors are probably of little importance to the development of coeliac disease.
The impact of newborn bathing on the prevalence of neonatal hypothermia in Uganda: A randomized, controlled trial
Authors: Bergström Anna , Byaruhanga Romano , Okong Pius
Published: August 2010

Aim: To elucidate the impact of bathing on the prevalence of hypothermia among newborn babies exposed to the skin‐to‐skin (STS) care technique before and after bathing. Methods: Non‐asphyxiated newborns after vaginal delivery (n=249) in a Ugandan referral hospital were consecutively enrolled and randomized either to bathing at 60 min postpartum (n=126) or no bathing (n=123). All mothers practised skin‐to‐skin care of their newborns. Four rectal and tympanic registrations of newborn temperatures were carried out in both groups directly after drying at birth, and at 60, 70 and 90 min postpartum. Results: Bathing of newborns in the first hour after delivery resulted in a significantly increased prevalence of hypothermia, defined as temperature <36.5°C, at 70 and at 90 min postpartum despite the use of warmed water and the application of the STS method. There was no neonatal mortality. Aside from the bathing procedure, no background factor potentially predisposing the newborns to hypothermia was identified.

Conclusion: Bathing newborn babies shortly after birth increased the risk of hypothermia despite the use of warm water and STS care for thermal protection of the newborn.
Thrombolytic therapy with tissue plasminogen activator for superior vena cava thrombosis in an infant with sepsis
Authors: Tan H , Kizilkaya M , Alper F , Becit N , Kürşat H
Published: August 2010

Superior vena cava syndrome is rare in infants, and rarely responds to conservative treatment. We report a 22‐mo‐old girl with superior vena cava syndrome due to the use of a central venous line and/or sepsis. Doppler study and computed tomography angiography of the neck showed thrombosis within the superior vena cava and jugular veins. She was admitted to a monitored setting and received recombinant tissue plasminogen activator for 2 d. The clinical features of superior vena cava syndrome disappeared completely 3 d after treatment. No complications were observed and radiological investigations showed blood flow through the thrombus after treatment.

Conclusion: Systemic recombinant tissue plasminogen activator may be useful in the treatment of superior vena cava syndrome in children.
Cefuroxime axetil versus placebo for children with acute respiratory infection and imaging evidence of sinusitis: A randomized, controlled trial
Authors: Kristo Aila , Uhari Matti , Luotonen Jukka , Ilkko Eero , Koivunen Petri , Alho Olli‐Pekka
Published: August 2010

Aim: To evaluate the efficacy of antibiotic treatment in children who presented in medical care with respiratory infection and had imaging evidence of sinusitis. Methods: Eighty‐two children (4–10 y) with acute respiratory symptoms and ultrasonography findings suggestive of acute rhinosinusitis were enrolled in a randomized, double‐blind trial. The sinus findings were confirmed with plain radiographs. The children received either cefuroxime axetil in 125‐mg capsules twice a day for 10 d or placebo. Main outcome measures were complete cure in 2 wk and absence of prolonged symptoms or complications. Results: A total of 72 children (88%) completed follow‐up. The sinusitis findings in the ultrasound could be confirmed with plain radiographs in 65 of the 72 patients (90%). The proportion of children completely cured by day 14 was similar in both groups (difference 6%, 95% confidence interval −16% to 29%). Similarly, there was no significant difference in the proportions of children who escaped prolonged disease and complications between the groups (difference 7%, −9% to 24%).

Conclusion: A 10‐d course of cefuroxime axetil offered no clinical benefit to children with an acute respiratory illness and imaging evidence of acute sinusitis.
Safety of intravenous terbutaline in acute severe asthma: A retrospective study
Authors: Kambalapalli Mamatha , Nichani S. , Upadhyayula S.
Published: August 2010

Objective: (1) To determine the effect of intravenous terbutaline in children with acute severe asthma on parameters like heart rate, blood pressure, electrocardiogram and serum electrolytes; (2) to assess the safety profile and to evaluate the outcome of children treated with intravenous terbutaline for acute severe asthma. Design: Retrospective study of admission records of children admitted with acute severe asthma who needed intravenous terbutaline. Setting: Children's Hospital at the Leicester Royal Infirmary, UK. Patients: 77 children with acute severe asthma admitted between April 1999 and October 2002. Results: There was a significant increase in heart rate and significant fall in diastolic blood pressure in this cohort. Four patients required inotropic support. None of the patients had cardiac arrhythmias. Potassium supplements were required in 10 patients due to hypokalaemia. All patients improved and none required initiation of ventilation after commencing terbutaline. There was no mortality in this cohort.

Conclusions: Terbutaline was found to be safe for use in this patient group in doses ranging between 1 and 5 μg/kg/min. Intravenous terbutaline was found to be a useful adjunct in those who failed to respond to standard initial therapy.
Low‐birthweight adolescents: Quality of life and parent–child relations
Authors: Indredavik Marit S. , Vik Torstein , Heyerdahl Sonja , Romundstad Pål , Brubakk Ann‐Mari
Published: August 2010

Aim: To explore the effect of low birthweight on quality of life, the parent–child relationship and the parents' mental health. Design/study groups: A population‐based follow‐up of 56 very‐low‐birthweight (1500 g), 60 term small‐for‐gestational‐age (birthweight <10th centile) and 83 term control adolescents (birthweight10th centile) at 14 y of age. Outcome measures: Child Health Questionnaire (Child Form, Parent Form), Parental Bonding Instrument rated by adolescents and parents; Symptom Checklist‐90‐Revised rated by mothers and fathers. Results: There were no group differences in self‐reported health or self‐esteem. Parents reported more behavioural problems and lower psychosocial health for very‐low‐birthweight adolescents (p<0.001) compared with controls. Results did not differ significantly between small‐for‐gestational‐age and control adolescents. The youngsters, their mothers and fathers perceived the same amount of relational warmth in all three groups. Very‐low‐birthweight parents reported more emotional impact than control parents, especially in the presence of psychiatric problems and cerebral palsy. There were no group differences in mothers' or fathers' mental health.

Conclusion: The low‐birthweight adolescents perceived quality of life as others did, but the parents reported functional disadvantages for the very‐low‐birthweight group. Birthweight did not influence the warmth in the parent–child relationship. Parents of very‐low‐birthweight adolescents experienced increased emotional burden, but they did not have more mental health problems than others.
Pharmacokinetic profile of recombinant human N‐acetylgalactosamine 4‐sulphatase enzyme replacement therapy in patients with mucopolysaccharidosis VI (Maroteaux–Lamy syndrome): a phase I/II study
Authors: Harmatz P , Kramer W G , Hopwood J J , Simon J , Butensky E , Swiedler S J ,   on behalf of the Mucopolysaccharidosis VI Study Group
Published: August 2010

Aim: Mucopolysaccharidosis VI (Maroteaux–Lamy syndrome) is a lysosomal storage disease caused by a deficiency of the enzyme N‐acetylgalactosamine 4‐sulphatase (ASB). Enzyme replacement therapy with recombinant human ASB (rhASB) has been studied in a randomized, double‐blind, two‐dose (0.2 and 1.0 mg/kg/week) phase I/II study (n=7) followed by an open‐label single dose (1.0 mg/kg/week) extension study. We report the pharmacokinetic profile of rhASB and the impact of antibody development. Methods: Pharmacokinetic analysis was performed at weeks 1, 2, 12, 24, 83, 84 and 96. Infusions were administered over 4 hours using a ramp‐up protocol. Plasma ASB and rhASB antibody concentrations and urine glycosaminoglycan (GAG) concentrations were determined. Results: The area under the plasma concentration–time curve (AUC0−t) for the high‐dose group increased from week 1 to week 2, but remained unchanged at weeks 12 and 24. A large difference in mean AUC0−t was observed between the low‐ and high‐dose groups. Pharmacokinetic results at weeks 83, 84 and 96 were similar to those at week 24. Six patients developed antibodies to rhASB. One patient developed high antibody levels in combination with a high ASB concentration, while a second patient also developed high antibody levels with undetectable ASB concentrations. Antibodies from the second patient blocked detection of ASB. By week 72, antibody levels had decreased in all patients. The high‐dose rhASB produced a more rapid and greater percentage reduction in urinary GAG concentrations than the lower dose (70% versus 55% at 24 weeks). Antibody levels did not appear to influence urinary GAG concentrations.

Conclusion: Pharmacokinetic parameters appear to be independent of the duration of treatment and are not linear between the 0.2 and 1.0 mg/kg/week doses. Antibodies to rhASB develop in most patients, but their concentration decreases over time. Antibody formation may influence pharmacokinetic parameters during the early phases of treatment, although it appears to have limited impact on biochemical efficacy.
Genetic factors and clinical significance of acanthosis nigricans in obese Japanese children and adolescents
Authors: Miura Naoko , Ikezaki Ayako , Iwama Saika , Matsuoka Hisafumi , Ito Keiko , Sugihara Shigetaka
Published: August 2010

Aim: To clarify the clinical significance of acanthosis nigricans (AN) and the association of gene polymorphisms in the β2‐ and β3‐adrenergic receptors (B2ADR and B3ADR) in Japanese obese children and adolescents. Methods: Seventy obese subjects (56 boys, 14 girls) from 5 to 19 y of age were examined as to clinical features. Genetic analyses were performed in 83 obese subjects (61 boys, 22 girls), 2 to 17 y of age. Typing of gene polymorphisms in B2ADR and B3ADR was achieved by polymerase chain reaction (PCR) of genomic DNA and restriction fragment‐length polymorphism analysis (PCR‐RFLP). Results: The group with AN (n=30) had higher values for percent overweight, BMI, waist circumference, fasting insulin, HOMA‐R, leptin and PAI‐1 than the AN‐negative group (n=40), but there were no significant differences in age, sex or percent body fat between the two groups. The prevalences of B2ADR Gly16 and B3ADR Arg64 were significantly higher in AN‐positive (n=26) than in AN‐negative (n=57) subjects. In addition, the AN frequency was significantly higher in the group with both Gly16 and Arg64 than in the group with neither of these alleles (55.6% vs 12.5%, p < 0.05).

Conclusion: We demonstrate that AN is a useful clinical marker for the severity of obesity associated with a high BMI, and that B2ADR Gly16 and B3ADR Arg64 are associated synergistically with AN in obese children and adolescents.
Fetal growth and postnatal growth failure in very‐low‐birthweight infants
Authors: Marks Kyla‐Anna , Reichman Brian , Lusky Ayala , Zmora Ehud ,   IN COLLABORATION WITH THE ISRAEL NEONATAL NETWORK
Published: August 2010

Aim: To determine in a cohort of very‐low‐birthweight (VLBW) infants the incidence of postnatal growth failure and the influence of intrauterine growth and neonatal morbidities on the risk for severe postnatal growth failure (PNGF). Methods: The study was based on analysis of data from the Israel Neonatal Network database on VLBW infants born between 1995 and 2001. Z‐score was determined for weight at birth and discharge, and severe PNGF was defined as a decline in z‐score of greater than 2. Univariate analysis and multi‐linear regression determined the effect of fetal growth and neonatal morbidities on the risk for severe PNGF. Results: Severe PNGF occurred in 10.6% of the cohort. The mean±SD birthweight (BW) z‐score was −0.59±0.74, decreasing to −1.67±0.77 at discharge. The incidence of severe PNGF increased significantly with decreasing BW and gestational age. Each 1‐unit increase in z‐score BW was associated with a 2.37‐fold increased risk for severe PNGF. Severe respiratory distress syndrome, patent ductus arteriosus, sepsis, necrotizing enterocolitis, and bronchopulmonary dysplasia were associated with severe PNGF.

Conclusion: Severe PNGF among VLBW infants was markedly influenced by intrauterine growth as well as major morbidities. In the assessment of postnatal growth among VLBW infants, growth status at birth should be considered.
Unintentional injuries among primary and middle school students in Maanshan City, eastern China
Authors: Sun Ye‐Huan , Ts Yu Ignatius , Zhang Yan , Fan Ya‐Ping , Guo Shu‐Qin , Wai Wong Tze
Published: August 2010

Aim: To describe the rates and patterns of unintentional injuries among primary and middle school students in China. Methods: A cross‐sectional survey was conducted in Maanshan City of the Anhui Province in eastern China. All students attending six primary and four middle schools, selected randomly, were asked to report unintentional injuries occurring in the 12‐mo period before the survey. The occurrence of unintentional injuries that resulted in medical attendance was summarized by study grade, sex, month and external causes. Results: The annual event‐based injury rate per 100 students was higher among boys (21.7) than girls (17.6). Only 1.9% of the episodes resulted in hospitalization, and 17.8% resulted in missing school. The most frequent injuries were falls (38.2%) and transportation‐related injuries (19.6%). The risk of injury was lower in middle schools than primary schools. Distribution by month of occurrence showed two peaks in boys during spring and autumn, but no clear peak was observed in girls.

Conclusion: The descriptive epidemiology of unintentional injuries among students in China provides useful information on the distributions in person, place and time, which in turn provide hints for the further exploration of possible risk factors that are important in planning strategies for future prevention.
Tibial cortical bone properties of preadolescents and their mothers in an urban area associated with lifestyle: A longitudinal study
Authors: Inose Tomoko , Takano Takehito , Nakamura Keiko , Kizuki Masashi , Seino Kaoruko
Published: August 2010

Aim: A 12‐mo follow‐up observation was performed to evaluate the tibial cortical bone properties of preadolescent children and their mothers in a densely populated area of Tokyo in association with their lifestyle in the context of healthy bone development of urban children. Methods: Fifty‐four volunteer mother–child pairs were examined twice: once in the 1st grade of elementary school and once in the following year. Tibial cortical speed of sound (TCSOS) was measured by non‐invasive quantitative ultrasonometry. Nutritional intake and recreational activity were examined using a structured interview. Results: TCSOS of the children showed a positive association with intake of vegetables, including potatoes and fruits (1st grade, r=0.31, p < 0.05; 2nd grade, r=0.33, p < 0.05), and inversely correlated with indoor recreational activities (1st grade, r= − 0.28, p < 0.05). The z‐score of TCSOS of the mothers was correlated with intake of milk, dairy products and eggs (r=0.35, p < 0.001). However, there were no statistically significant correlations in TCSOS between children and their mothers.

Conclusion A 1‐y longitudinal study in urban children indicated the effects of specific types of food intake and recreational activities of children on tibial bone properties.
Behavioural changes after anaesthesia: Validity and liability of the Post Hospitalization Behavior Questionnaire in a Swedish paediatric population
Authors: Karling Mats , Stenlund Hans , Hägglöf Bruno
Published: August 2010

Aim: To study the validity and liability of a Swedish translation of the Post Hospitalization Behavior Questionnaire (PHBQ) in children in Sweden. Methods: The PHBQ was translated using a back‐translation method. The subjects were 340 children, ages 2–13 y, admitted for elective surgery or diagnostic procedure with anaesthesia. The results were analysed using exploratory factor analysis with principal component analysis with Oblimin rotation. The fit to data was examined using confirmative factor analysis with a good measure of fit for the model (p>0.09 for all factors). Results: Five factors emerged as being most consistent: general anxiety‐withdrawal, eating disturbances, separation anxiety, regression‐aggression and sleep anxiety. A panel of child psychologists confirmed the face validity of factors. Internal consistency (Chronbach's alpha) was adequate (0.75–0.87) for subscales and excellent for total score (0.93). Children less than 5 y old had higher scores than older children (mean 0.046±0.018 vs −0.0089±0.014, p<0.001). There were no gender differences. Conclusion: The results support a conclusion that a five‐factor model better fits data from Swedish children than the original six‐factor model.
Hypocalcaemia following therapy of thyrotoxicosis in an infant
Authors: Kansra Sonal , Dayal Devi , Suri Deepti , Singh Meenu
Published: August 2010

A 2‐mo‐old infant born to a mother with Graves’ disease and having symptoms of thyrotoxicosis was started on antithyroid drugs. Life‐threatening hypocalcaemia requiring high‐dose calcium infusions developed 1 mo after starting therapy. Serum alkaline phosphatase and paratharmone levels were elevated. This communication may serve to alert treating physicians about this rare complication in infants with thyrotoxicosis after initiation of antithyroid therapy.

Conclusion: Severe hypocalcaemia may follow initiation of antithyroid therapy in infants with thyrotoxicosis.
Nosocomial transmission of Mycobacterium tuberculosis in kangaroo mother care units: A risk in tuberculosis‐endemic areas
Authors: Heyns Louis , Gie Robert P. , Goussard Pierre , Beyers Nulda , Warren Rob M. , Marais Ben J.
Published: August 2010

Background and aim: Kangaroo mother care (KMC) has become the standard of care for low‐risk preterm babies born in developing countries. However, the potential risk of nosocomial transmission of Mycobacterium tuberculosis within KMC units, particularly in tuberculosis‐endemic areas, has not been explored. We report an infant (sentinel case) who was admitted to our paediatric intensive care unit (PICU) with extensive pulmonary tuberculosis.

Methods and results: When interviewed, the mother reported no household contact with a tuberculosis source case, but mentioned that she shared a KMC room with someone who had symptoms suspicious of tuberculosis. We found molecular evidence that nosocomial transmission of M. tuberculosis occurred within the KMC unit and conducted a contact investigation of all infants exposed to this infectious source case during her stay in the KMC unit.

Conclusion: We present the findings of the contact investigation and discuss the implications of these findings for KMC units, particularly in tuberculosis‐endemic areas.
Epidemiological study of constipation and other gastrointestinal symptoms in 8000 children
Authors: Ludvigsson J. F. ,   FOR THE ABIS STUDY GROUP
Published: August 2010

Aim: Adult studies indicate that gastrointestinal symptoms vary with sex and socioeconomic status. We examined socioeconomic factors, infant sex, smoking and gastrointestinal symptoms, especially constipation, in 2.5 year‐old children. Methods: This study was part of a prospective cohort study of children born 01.10.97–01.10.99 (the ABIS study; All Babies in Southeast Sweden). Socioeconomic factors, infant sex, smoking were analyzed vs. constipation, diarrhoea, anorexia, abdominal pain, meteorism and vomiting using logistic regression. All data were obtained through questionnaires distributed at infant birth, at 1 and 2.5 years of age. Results: Out of 8341 children, 539 (6.5%) suffered from constipation. In a backward stepwise regression analysis (AOR; and 95% CI AOR = are given within brackets), constipation correlated with low maternal education (1.60; 1.08–2.35), female sex (1.52; 1.23–1.85), living in a large community with >3000 inhabitants (1.35; 1.09–1.64) and having no older siblings (1.28; 1.04–1.59). Smoking during pregnancy was linked to diarrhoea (multivariate analysis: 1.76; 1.02–3.02), anorexia (univariate analysis: 1.43; 1.09–1.87) and meteorism (univariate analysis: 1.58; 1.11–2.27). Adjusting for confounders, paracetamol use was linked to a five‐fold increased risk of anorexia (5.12; 1.26–20.70).

Conclusions: This study indicates that socioeconomic status, infant sex and parental smoking, are associated with gastrointestinal symptoms in children.