bluuebunny/crossref_metadata_2025 huggingface dataset:
Knee‐heel length measurements in preterm infants: evaluation of a simple electronically equipped instrument
Authors: Engström E , Wållgren K , Hellström A , Niklasson A
Published: August 2010

Aim: To compare and evaluate a mini‐knemometer with a simple and inexpensive electronic caliper with regard to precision, handling error (technical error) and estimation of growth velocity. Methods: Thirty‐five prematurely born infants, with a median gestational age of 29 (range 24–33) wk and a median birthweight of 960 (range 480–2480) g, were measured on 409 different occasions with both instruments. On each occasion, five independent readings were made. Results: There was no significant difference in precision between the two instruments, when measuring growth velocity over a 4 wk period (median 0.41, range 0.10–0.59 mm d−1). The handling error in this study, calculated as the mean standard deviation, was 0.36 (SD 0.18, coefficient of variation 0.38%) mm for the simple electronic caliper and 0.59 mm for the mini‐knemometer. Short‐term growth was detectable within 2 d when growth velocity was normal.

Conclusion: Longitudinal measurement of lower leg length is a gentle and useful complementary method for assessing growth in preterm infants. An inexpensive electronic caliper is well suited for routine use in clinical practice, with measurements taken once or twice a week.
Rehospitalization for respiratory syncytial virus infection in infants with extremely low gestational age or birthweight in Denmark
Authors: Pedersen O , Herskind AM , Kamper J , Nielsen JP , Kristensen K
Published: August 2010

Aim: To determine the risk of rehospitalization for respiratory syncytial virus (RSV) infection during the first 2 y of life in extremely preterm infants. Methods: Records on all rehospitalizations during the first 2 living years of all infants born with gestational age < 28 wk or birthweight < 1000g during 1994 and 1995 in Denmark were retrospectively reviewed. Results: Among 240 eligible infants, 43 (18%) had been rehospitalized 48 times owing to RSV. In infants (n= 210) without CLD the risk of rehospitalization for RSV was 16%, whereas in infants with CLD (n= 30) it was 30% (p= 0.065). Eighteen infants (38%) required respiratory support (supplemental oxygen only 3, continuous positive airway pressure 14, mechanical ventilation 1). Apart from CLD the only factor that could be associated with increased risk of hospitalization for RSV was discharge during autumn (p= 0.05). No infant died from RSV infection.

Conclusion: The high rate of rehospitalization for RSV in extremely preterm infants in Denmark, especially in infants with CLD, should lead to considerations concerning more widespread use of prophylaxis against RSV in these infants.
Spontaneous intestinal perforation and Candida peritonitis presenting as extensive necrotizing enterocolitis
Authors: Robertson NJ , Kuna J , Cox PM , Lakhoo K
Published: August 2010

Spontaneous intestinal perforation (SIP) has been increasingly reported in very‐low‐birthweight (VLBW) infants, although it is still less common than necrotizing enterocolitis (NEC). In around one‐third of cases, SIP is associated with systemic candidiasis. We describe a case of SIP and Candida peritonitis in a VLBW infant, which was mistakenly diagnosed as NEC during the infant's short life. At laparotomy, the bowel surface was black and thought to be necrotic. As the infant was thought to have whole‐bowel necrosis due to NEC, her condition was deemed incompatible with survival. At postmortem, however, the bowel wall was found to be healthy apart from a very localized patch of necrosis associated with a single perforation. The bowel was covered by a thick, black, serosal exudate consisting of fungal elements from Candida albicans.

Conclusion: This case reinforces the fact that a markedly discoloured bowel is not necessarily necrotic and that the discoloration can potentially recover.
Intended plans for breastfeeding duration: a simple tool to predict breastfeeding outcome
Authors: Vogel AM
Published: August 2010

Prenatal intended duration of breastfeeding has been shown to be a powerful predictor of breastfeeding initiation and duration. This provides a tool to establish the risks for short duration of breastfeeding.

Conclusion: It is necessary to identify the factors that influence mothers' plans, and to find means to intervene effectively.
Beneficial effects of postnatal skin‐to‐skin contact
Authors: Kennell JH , McGrath SK
Published: August 2010

In a randomized trial, Bystrova et al. examined the traditional neonatal practice of swaddling. They demonstrated that extended skin‐to‐skin contact with the mother is the most effective way to maintain the infant's temperature and decrease the “stress of being born”.

Conclusion: Only through research such as that reported by Bystrova et al. can the advantages or disadvantages of routinely accepted perinatal practices be evaluated.
Ultrasonic tissue characterization of the myocardium in anorexia nervosa
Authors: Franzoni F , Galetta F , Cupisti A , Rolla M , Santoro G , Pentimone F
Published: August 2010

Aim: To determine the systodiastolic variations in the integrated backscatter (IBS) signal of the myocardium in patients with anorexia nervosa. Methods: 25 young women (aged 22.4 ± 4.3 y) with overt anorexia nervosa, compared with 25 age‐matched thin and 25 age‐matched control women with body mass index >20 kg m−2, underwent either conventional two‐dimensional echocardiography or analysis of IBS cyclic variations. Results: Compared with thin and control subjects, anorectic patients showed reduced left ventricular mass (LVM: 82.9 ± 17.1 vs 119.9 ± 13.8 and vs 126.12 ± 16.4 g, p < 0.0001; LVM indexed 21.4 ± 3.3 vs 29.4 ± 2.5 and vs 31.2 ± 3.1 g m−2.7, p < 0.0001), and IBS cyclic variations (septum: –0.49 ± 2.18 vs 6.86 ± 1.3 and vs 6.61 ± 1.74 dB, p < 0.0001; posterior wall: 2.77 ± 2.12 vs 7.15 ± 2.12 and vs 7.48 ± 2.23 dB, p < 0.01).

Conclusion: Anorexia nervosa is associated with a significant reduction in the cyclic variation in IBS, which is also related to left ventricular hypotrophy. Ultrasonic tissue characterization could give an objective approach for the detection of myocardial structural properties and represent a preclinical index of myocardial dysfunction in anorexia nervosa.
How reliable is axillary temperature measurement?
Authors: Falzon A , Grech V , Caruana B , Magro A , Attard‐Montalto S
Published: August 2010

Aim: To assess whether axillary temperature measurements reliably reflect oral/rectal temperature measurements. Methods: This observational study compared paired axillary‐rectal and axillary‐oral temperatures in a general paediatric ward with the participation of 225 children aged ≤4 y and 112 children aged between 4 and 14 y. Results: Changes in oral/rectal and axillary temperatures correlated significantly (p < 0.0001). However, axillary temperature measurements were significantly lower than both oral (mean ‐0.56°C, SD 0.76°C) and rectal measurements (0.38°C; SD 0.76°C). Ninety‐five percent of axillary measurements fell within a 2.5–3°C range around respective paired oral/rectal measurements. The mean difference increased with increasing temperature, and was 0.4°C at low body temperatures, and over 1°C with a fever of 39°C. Neither seasonal fluctuations nor the amount of clothing worn influenced this difference.

Conclusion: Axillary temperatures in young children do not reliably reflect oral/rectal temperatures and should therefore be interpreted with caution.
Relationship between prenatal infant feeding intention and initiation and duration of breastfeeding: a cohort study
Authors: Donath SM , Amir LH ,   The ALSPAC Study Team
Published: August 2010

Aim: To report the relationship between maternal prenatal intention to breastfeed and the actual initiation and duration of breastfeeding. Methods: Pregnant women resident within Avon, UK, expected to give birth between 1 April 1991 and 31 December 1992 were recruited in a longitudinal cohort study. Main outcome measures included maternal infant feeding intention (breastfeed, breast and bottle feed, bottle feed, or uncertain) at 32 wk of pregnancy; intention in the first week, intention for the rest of the first month and intention in months 2 to 4; initiation and duration of breastfeeding up to six months. Results: Data were available on 10548 women. Prenatal intention to breastfeed had an influence on both initiation and duration of breastfeeding. Of the women intending to bottle feed from birth, only 3.4% initiated breastfeeding compared with 96.6% of women planning to breastfeed for at least four months. At six months postpartum, the mean duration of breastfeeding for women intending to breastfeed for at least five months was 4.4 mo (95% CI 4.3, 4.4), compared with 2.5 mo (95% CI 2.4, 2.6) for women with a prenatal intention to breastfeed for only one month. Logistic regression, using intended duration as the only explanatory variable, correctly predicted 91.4% of breastfeeding initiation and 72.2% of infant feeding at six months.

Conclusions: This large population‐based study confirms the strength of the relationship between maternal prenatal intention to breastfeed and both breastfeeding initiation and duration. Maternal intention was a stronger predictor than the standard demographic factors combined. This should be taken into account in future research, and trials should be undertaken to establish whether interventions could alter maternal intention and thereby increase rates of breastfeeding initiation and duration.
Snoring in infancy
Authors: Milerad J
Published: August 2010

Obstructive sleep apnoea (OSAS) in infants is a risk factor for sudden infant death (SIDS). Snoring in a young child should raise suspicion of OSAS, and according to recent AAP guidelines, evaluation and polysomnographic studies are recommended in selected cases as the diagnostic test of choice. However, infants under 1 y of age are excluded from the guidelines, and interventions to prevent SIDS based on respiratory monitoring remains a matter of controversy. As often happens, the evidence we need most is usually scarce.
The Centers for Disease Control and Prevention 2000 growth charts and the growth of breastfed infants
Authors: de Onis M , Onyango AW
Published: August 2010

Aim: To evaluate the performance of the 2000 Centers for Disease Control and Prevention (CDC) growth charts in comparison with the National Center for Health Statistics/World Health Organization (NCHS/WHO) reference as a tool for assessing growth in healthy breastfed infants. Methods: Weight and length measurements were obtained from a pooled longitudinal sample of 226 healthy breastfed infants. Weight‐for‐age (WA), length‐for‐age (LA) and weight‐for‐length (WL) z‐scores based on the CDC and NCHS/WHO references were computed for each child. Age‐specific mean z‐scores and proportions below and above specific cut‐off points were calculated. Results: Breastfed infants grow more rapidly in the first 2 mo of life and less rapidly from 3 to 12 mo in relation to the CDC WA curves. Similarly, breastfed infants experience greater linear growth than the CDC median until age 4 mo. Thereafter, the mean LA z‐score declines until month 9. Apart from a 1‐mo difference in the time when linear growth begins to falter, the pattern of growth is remarkably similar when compared with the two references. The growth trajectories indicate that infants in the CDC reference are heavier and shorter than the NCHS/WHO reference population. Combining the two measurements as WL reveals that higher weight overrides lower length in the CDC versus the NCHS population, thus the estimated prevalence of wasting is higher by the CDC reference.

Conclusion: As was the case when compared with the NCHS/WHO reference, there are notable differences in the growth trajectory of breastfed infants examined against the CDC reference. A reference based on healthy breastfed infants is required if the growth patterns of infants following international feeding recommendations are to be correctly assessed.
Late relapse of adrenocortical carcinoma in Beckwith‐Wiedemann syndrome. Clinical, endocrinological and genetic aspects
Authors: Hertel NT , Carlsen N , Kerndrup G , Pedersen IL , Clausen N , Hahnemann JMD , Jacobsen BB
Published: August 2010

We report on a girl with an unusual Beckwith‐Wiedemann syndrome (BWS) and hemihypertrophy, who developed an adrenocortical carcinoma with atypical clinical behaviour. At 4 y of age the girls was admitted to hospital with cushingoid features, virilization, increased excretion of steroids and low serum ACTH. A right‐sided adrenocortical carcinoma was removed. At age 12.5 y the cushingoid features reappeared together with a tumour in the left thigh. A CT scan of the thorax and abdomen revealed pulmonary metastasis only. Corticosteroid excretion was increased and serum ACTH level suppressed. The femoral and the pulmonary metastases were removed and histology showed adrenocortical carcinoma. Excretion of corticosteroids subsequently normalized. Meningeal and pulmonary metastases with similar histologies appeared one year later with normal hormone values. Twenty‐two months after the recurrence the girl died of an intracranial metastasis. Southern blot analysis of the LIT1 transcript in the KvLQT1 gene in the BWS region on chromosome 11p15 revealed hypomethylation of the maternal allele.

Conclusion: Adrenocortical carcinoma in childhood may recur years after onset and at rare sites and hormonal levels may be an insufficient indicator of small metastases.
Treatment of children with Osteogenesis imperfecta in Estonia
Authors: Maasalu K , Haviko T , Märtson A
Published: August 2010

Aim: To analyse the changes in fracture rate, bone density and histology in children with Osteogenesis imperfecta receiving treatment with alendronate (oral bisphosphonate) and calcitriol. Methods: Children treated at Tartu University Hospital from 1995 to 2001 were examined for Osteogenesis imperfecta. Radiographs and bone density measurements were obtained for all patients at the beginning of the study. Four patients also had bone biopsies prior to and one year after beginning treatment. The children were then given alendronate in weight‐dependent dosages and also calcitriol. The number of fractures during the treatment period was recorded and follow‐up bone density measurements were made. Results: Fifteen patients were treated during the 6‐y period; mean follow‐up approximately 3 y. It was found that the number of bone fractures had decreased significantly (p < 0.0001). Bone density improved in all 15 patients. Histologic studies revealed an increased number of osteoblasts and thickness of bone trabeculae as well as a more regular bone lamellar structure at the time of the second operation.

Conclusion: The complex treatment of Osteogenesis imperfecta should include alendronate and calcitriol to decrease fractures and improve bone mineral density.
Calprotectin levels in meconium
Authors: Laforgia N , Baldassarre ME , Pontrelli G , Indrio F , Altomare MA , Di Bitonto G , Mautone A
Published: August 2010

Aim: To evaluate the effect of gender, gestational age, birthweight, mode of delivery, 5′‐Apgar score and maternal conditions on calprotectin concentrations in meconium. Methods: Calprotectin was measured in 131 neonates, in the first passed meconium. Results: Calprotectin levels (mean ± SD) resulted in 145.2 ± 78.5 mg kg−1 meconium, significantly correlated with birthweight (r=–0.333; p < 0.001), gestational age (r =–0.206; p = 0.018) and 5′‐Apgar score (r= ‐0.243, p= 0.035). The estimated regression model was: calprotectin levels (mg kg−1) = 269.58–41.54 weight (kg); r = 0.383, p < 0.001. No differences were found in relation to gender, mode of delivery and maternal conditions.

Conclusion: Calprotectin is already present in the first passed meconium, with higher levels in preterm and low birthweight neonates, as well as in neonates with some degree of perinatal asphyxia, as indicated by the negative correlation with 5′‐Apgar score. These findings are probably secondary to both the immaturity of the intestinal mucosa and its hypoxic‐ischaemic damage.
Seasonality of growth and the relationship between weight and height gain in children under three years of age in rural Malawi
Authors: Maleta K , Virtanen SM , Espo M , Kulmala T , Ashorn P
Published: August 2010

Aim: To describe the seasonal pattern of growth and analyse the relationship between weight and height gain in children under 3 y of age. Methods: A population‐based cohort of 767 children was prospectively followed from birth until 36 mo of age in rural Malawi, southeast Africa. Weight and height measurements were collected at monthly intervals until 18 mo of age and quarterly thereafter. Gains in weight and height and prevalence of malnutrition in different seasons were calculated. The relationship between weight and height gain was analysed using a series of correlation analyses. Results: Both weight gain and linear growth velocity showed an age‐dependent seasonal pattern. After infancy, periods of maximal or minimal height increments systematically occurred 3 mo after those for weight gain. The prevalence of malnutrition also followed a seasonal pattern, peaking a few months after periods of reduced growth. Despite the overall pattern, weight gain and subsequent linear growth were not correlated on an individual level. At any point, however, a child's weight for height was directly, albeit weakly, correlated to height gain in the subsequent 3‐mo interval.

Conclusion: Growth of children under 3 y of age followed an age‐dependent seasonal pattern. The poor correlation between children's weight and height increments suggests that seasonality affected weight gain and linear growth through different mechanisms.
Carnitine‐acylcarnitine translocase deficiency: case report and review of the literature
Authors: Rubio‐Gozalbo ME , Vos P , Forget PPh , Van Der Meer SB , Wanders RJA , Waterham HR , Bakker JA
Published: August 2010

Aim: Carnitine‐acylcarnitine translocase (CACT) deficiency is an inborn error of metabolism involving the mitochondrial beta‐oxidation of long‐chain fatty acids. The aim of this study was to report on a new case (neonatal phenotype) and review the literature data on 24 previously reported cases. Methods: Clinical data of the new case are described and compared with the previous reports. Results: The patient with a novel mutation had clinical features and biochemical findings similar to those of the other reported patients.

Conclusion: CACT is an entity in which clinical encephalopathy, hepatomegaly and arrythmias are common. Hyperammonaemia and elevation of creatine kinase seem to be constant findings as in other disorders of mitochondrial beta‐oxidation of long‐chain fatty acids. The mortality rate is very high.
Splenic abscess caused by group A β‐haemolytic streptococcus
Authors: Chang K‐W , Chiu C‐H , Jaing T‐H , Wong H‐F
Published: August 2010

A case of a pyoderma complicated with splenic abscess and bacteraemia caused by group A streptococcus was treated successfully with antibiotics alone for 4 weeks. To our knowledge, this is the first reported case of splenic abscess associated with group A streptococcal bacteraemia. Advances in antibiotic therapy and imaging techniques have improved the management and outcomes of splenic abscesses. Clinicians should be aware of the possibility of splenic abscess after a pyoderma or a sepsis‐like episode.

Conclusion: Splenic abscesses can be diagnosed by serial ultrasound or CT scan examinations and should be treated with antibiotics for 4–6 weeks.
Can we make hospitals and the community baby friendly?
Authors: Binns CW , Scott JA
Published: August 2010

There is an increasing trend in midwifery towards shorter hospitalization, and in a world where 24–48 h will be the norm, the challenge for the baby‐friendly hospital in the new century will be to establish community support services for all mothers and to make all of our hospitals and communities “Baby and breastfeeding friendly”.
Detection of interferon‐γ‐inducible chemokines in human milk
Authors: Takahata Y , Takada H , Nomura A , Nakayama H , Ohshima K , Hara T
Published: August 2010

Aim: To assess the immunological role of human milk by analysing the concentrations of interferon‐γ‐inducible protein of 10kda (IP‐10) and monokine induced by interferon‐γ (MIG) in human milk from mothers of preterm and term infants.Methods: IP‐10 and MIG levels of colostrum, early milk, mature milk and sera were measured by enzyme‐linked immunosorbent assay (ELISA). IP‐10 and MIG mRNA expression levels in cellular components of human milk were determined by RT‐PCR. IP‐10 and MIG protein expression in mammary gland tissues was analysed by immunohistochemistry.Results: Significant amounts of IP‐10 and MIG were detected in human milk. The concentrations of IP‐10 and MIG in colostrum and early milk were significantly higher than those of sera from healthy controls or lactating mothers. These chemokine concentrations in colostrum and early milk were significantly higher than those of mature milk. Premature delivery or pregnancy complications of mothers had no significant correlation with these chemokine concentrations in breast milk. There were significant correlations between MIG and interferon‐γ (IFN‐γ) or IP‐10 levels (p< 0.001) in human milk. Expression of IP‐10 and MIG genes and proteins in the milk cells as well as in mammary gland epithelial tissues was detected by RT‐PCR and immunohistochemistry.

Conclusion: IP‐10 and MIG in human milk, probably derived from milk cells and mammary gland epithelial cells, may contribute to the migration and activation of intestinal T lymphocytes to enhance mucosal immunity during the early neonatal period.
Orlistat treatment in obese prepubertal children: a pilot study
Authors: Norgren S , Danielsson P , Jurold R , Lötborn M , Marcus C
Published: August 2010

Aim: This study investigated orlistat treatment in obese prepubertal children with regard to tolerance, safety and psychological well‐being. Methods: 11 healthy, severely obese prepubertal children (age 8.3–12.3 y, body mass index standard deviation score 5.3–9.2) were recruited for a 12wk open treatment. Before, during and after treatment, the participants were investigated by psychological evaluation, blood chemistry, and parameters reflecting obesity and fat mass. Results: The participants were able to comply with the treatment, as indicated by pill counts and self reports, and expressed a desire to continue the treatment after the study period. Gastrointestinal side effects were mild and tolerable. No negative effects on psychological or physical well‐being were detected, and the psychological evaluation demonstrated increased avoidance of fattening food, body shape preoccupation and oral control (p= 0.011). The median weight loss was 4.0 kg (range –12.7 to +2.5 kg, p= 0.016) and was highly correlated to decreased fat mass (regression coefficient 0.953, p < 0.01).

Conclusion: This pilot study indicates that obese prepubertal children were able to reduce their fat intake to avoid gastrointestinal side effects. Thus, orlistat may be suitable as a component in behaviour‐modification programmes for obese children, and the results prompt a placebo‐controlled investigation of its effectiveness in promoting weight loss.
Azithromycin in the treatment of cholera in children
Authors: Bhattacharya MK , Dutta D , Ramamurthy T , Sarkar D , Singharoy A , Bhattacharya SK
Published: August 2010

Aim: To evaluate the efficacy of azithromycin in the treatment of cholera in children. Methods: A double‐blind, randomized, controlled clinical trial on 80 children with acute watery diarrhoea and moderate to severe dehydration compared the efficacy of azithromycin and erythromycin in treating cholera. Data were analysed for 56 patients who were stool culture positive for Vibrio cholerae. In conjunction with rehydration therapy, 29 patients received azithromycin and 27 patients received erythromycin. Patients in the two treatment groups had comparable clinical and blood biochemical characteristics on admission. Results: Patients who received azithromycin had significantly less stool output, shorter duration of diarrhoea and lower fluid intake compared with patients who received erythromycin.

Conclusion: Azithromycin appears to be superior to erythromycin for treating cholera in children.
Decreased bone mineral density in normal‐growing patients with cystic fibrosis
Authors: Gronowitz E , Garemo M , Lindblad A , Mellström D , Strandvik B
Published: August 2010

Aim: To study bone mineral density (BMD) in normal‐growing patients with cystic fibrosis (CF) and its relation to clinical and biochemical markers of nutrition and lung function. Methods: Seventy consecutive patients aged 6–49 y with CF were investigated using dual X‐ray absorptiometry and the findings related to anthropometric data. Energy intake was calculated and basal metabolic rate and serum values for calcium, phosphorus, calcitonin and 25(OH) calcidiol measured. Working capacity, lung function and pseudomonas colonization were determined as parameters of physical fitness and severity of pulmonary disease. Results: The average z‐score of BMD was decreased in the lumbar spine in both children and adults, being –0.7 ± 1.0 and –0.5 ± 1.0, respectively, as was the femoral neck BMD z‐score, being –0.3 ± 0.9 and –1.1 ± 1.0 for children and adults, respectively. BMD was correlated to lung function and working capacity, but not to anthropometric data at multiple regression analysis compensating for age and calcitonin. No correlation was found with energy intake, basal metabolic rate or biochemical markers, with the exception of calcitonin.

Conclusion: BMD z‐scores were significantly lower than those in the normal population despite normal anthropometry. Osteoporosis was rare. The strongest correlation was found with lung function. Our data indicate that BMD at all ages might be a sensitive indicator of the general status of patients with CF.
Aspects of activities and participation in daily life related to body structure and function in adolescents with obstetrical brachial plexus palsy: a descriptive follow‐up study
Authors: Strömbeck C , Fernell E
Published: August 2010

Aim: To analyse whether activities and participation in daily life differed between adolescents with obstetrical brachial plexus palsy (OBPP) and their able‐bodied peers. Method: Fifty‐one teenagers born in 1985–1987 with OBPP and a comparison group consisting of 116 age‐matched adolescents in a socioeconomically and socioculturally representative area answered a self‐report questionnaire concerning their daily life, school performance and friendships. The OBPP group was divided into three functional groups according to the degree of severity of the OBPP. Results: Subjects with OBPP had interests, activities and a social life very similar to those of the teenagers in the comparison group. Differences were, however, found in self‐esteem for sport/motor activities, with self‐esteem being significantly lower in teenagers with the most severe type of OBPP. The OBPP groups were concerned about the risks for their affected and unaffected limb.

Conclusion: In our society, adolescents with OBPP report a typical teenage life today. However, the indications for distress and worry related to the disability have to be considered
Nutritional status of mentally retarded children in north‐west Spain. I. Anthropometric indicators
Authors: Sánchez‐Lastres J , Eirís‐Puñal J , Otero‐Cepeda JL , Pavón‐Belinchón P , Castro‐Gago M
Published: August 2010

Aim: To evaluate the nutritional status of mentally retarded children in the region of Galicia in north‐west Spain, on the basis of anthropometric variables. Methods: The following variables were determined in a sample of 128 mentally retarded children (81 M, 47 F): birth weight, body weight, height/length, head circumference, mid‐arm circumference, mid‐arm muscle circumference, triceps skinfold thickness, subscapular skinfold thickness, arm area, arm muscle area, arm fat area, arm lean‐to‐fat ratio, Shukla's nutrition index and Quetelet's body mass index (BMI). A preliminary statistical analysis indicated that most information content could be maintained considering only eight of these variables. A factor analysis of the resulting 8 × 128 (variables by subjects) data matrix was performed, identifying two factors (FA1 and FA2) that together explained 82% of total variance. Taking these factors as indicators of nutritional status, the data were analysed for possible effects of age, gender, socioeconomic and family environment, intelligence quotient (IQ), presence/absence of cerebral palsy, quality of diet, appetite and antiepileptic use. Results: The analysis suggested that most subjects were in the normal nutrition range, but about 33% showed either borderline or definite malnutrition. Mean score on FA2 showed a significant negative correlation with age. Children with cerebral palsy had lower mean scores on both factors, and scores on both factors varied with IQ. Children with definite malnutrition had a significantly lower IQ than those in the normal nutrition range. Mean score on both factors varied with appetite and quality of diet. The mean FA1 score of children from inland‐rural areas was significantly lower than that of children from coastal or urban areas. Mean FA1 score increased with increasing age of the parents. The prevalence of obesity was 13% when obesity was defined on the basis of Shukla's nutrition index, and 19% when defined on the basis of FA1 score.

Conclusion: Malnutrition as revealed by anthropometric variables occurs with a high prevalence among mentally retarded children. The prevalence increases with age, increasing IQ deficit and cerebral palsy.
Automotive child restraint systems in Northeastern Italy
Authors: Valent F , Barbone F
Published: August 2010

Aim: To evaluate the use of automotive restraint systems among children in Northeast of Italy and to describe parental knowledge and reasons for either use or non‐use. Methods: This population survey included subjects recruited at three Vaccination Services serving approximately 24000 children aged 0–12 y. From March 8, 2002 to June 7, 2002 parents of children being vaccinated were asked to complete a self‐administered structured questionnaire. A total of 1093 questionnaires were collected. Data were analysed using contingency tables, χ2 tests, and multivariable logistic regression. Results: Although 98% of children were restrained when riding in a car, less than 90% were using the restraint system appropriate to their body size, and 38% of parents were making some errors in the way they transported their children. Parents of children ≥3 y of age were significantly more likely to make errors. Less than half of the respondents had ever received any information on child restraint systems and it was found that being given information significantly reduced the likelihood of parents making errors when transporting children.

Conclusion: Many children ride unrestrained or inappropriately restrained in cars. Parents should be provided with information on child restraint systems in order to decrease the frequency of incorrect child transportation. Special attention should be devoted to the parents of children ≥3 y of age.
Paediatric utilization of a general emergency department in a developing country
Authors: Goh AY , Chan TL , Abdel‐Latiff ME
Published: August 2010

Aim: Knowledge of the spectrum and frequencies of paediatric emergencies presenting to an emergency department (ED) of individual developing countries is vital in optimizing the quality of care delivered locally. Methods: A prospective 6 wk review of all paediatric (< 18y) attendees to an urban ED was done, with patient age, presenting complaints, diagnoses, time of arrival and disposition recorded. Results: Complete data were available on 1172 patients, with an age range of 4 d to 18 y (mean ± SD 6.9 ± 5.6 y); 43% were aged ≤4 y. The main presenting complaints were injuries (26.9%), fever (24%) and breathing difficulties (16.6%). The most common diagnosis was minor trauma (24.2%), with soft‐tissue injuries predominating (80.6%). The other diagnoses were asthma (12.6%), upper respiratory infections (12.1%), other infections (12.1%) and gastroenteritis (11.8%). Equal proportions of patients were seen throughout the day. 25% of patients were admitted. Young age (<1 y); presence of past medical history, general practitioner referrals, diagnosis of bronchiolitis and pneumonia were significantly associated with risk of admission.

Conclusion: A wide spectrum of paediatric illnesses was seen in the ED, with an overrepresentation of young children. This supports the decision to have either a separate paediatric ED or paediatric residents on the staff. The training curricula should emphasize the management of paediatric trauma, infections and asthma. Alternatively, developing guidelines for the five most common presenting complaints would account for 82% of all attendees and could be directed towards all staff on the ED.
Successful thrombolysis by prolonged low‐dose alteplase in catheter‐directed infusion
Authors: Ruud E , Holmstrøm H , Aagenæs I , Hafsahl G , Handeland M , Kyte A , Brosstad F
Published: August 2010

Catheter‐directed thrombolysis is a sophisticated method in the treatment of thromboembolism with maximum effect on the thrombus and minimal systemic effect. The consequences are enhanced local thrombolysis and a reduction in general bleeding tendency, compared with systemic thrombolysis. At our institution, two children had successful thrombolysis by prolonged continuous catheter‐directed low‐dose alteplase. The first patient, a boy with Fontan physiology, was successfully treated for a massive pulmonary thromboembolism by catheter‐directed very low‐dose alteplase for five days. The second patient, who suffered from relapsing nephrotic syndrome, achieved satisfactory thrombolysis of an arterial leg thrombosis after four days of continuous catheter‐directed low‐dose alteplase.

Conclusion: Although catheter‐directed thrombolysis seems to be a valuable method in thrombolytic therapy, there is a lack of evidence‐based recommendations concerning dosage, effect of bolus, simultaneous anticoagulation and duration of treatment for children.
Post‐discharge nutrition of the very low‐birthweight infant: interim results of the multicentric GAMMA study
Authors: Agosti M , Vegni C , Calciolari G , Marini A ,   the Investigators of the “GAMMA” Study Group
Published: August 2010

This report presents the interim results up to 12 mo corrected age (c.a.) of a multicentric, prospective, controlled study on very low‐birthweight infants, randomized at 40 wk post‐conception in two different groups of formula feeding: 80 Kcal/dL (group A) vs 70 Kcal/dL (group B) up to 55 wk of postconceptional age. Subsequently, all the babies were fed with a follow‐on formula, with the introduction of solid foods at 6 mo c.a. Weight, length, head circumference and neurological conditions with psychomotor development (evaluated by the Griffiths’Developmental Scale) were measured at regular intervals and all of these parameters were satisfactory in both groups. For growth, in group A there was a greater increase in weight in boys at 55 wk and at 6 mo c.a., and small for gestational age (SGA) babies had a greater increase in length at 1 y of age, while head circumference caught up on growth from week 40 to week 55. Measured by the Griffiths’Developmental Scale, the SGA group fed 80 Kcal/dL had a better score at 6 mo; similarly boys fed 80 Kcal/dL had a better score at 6 and at 9 mo.

Conclusion: Nutrition of very low birthweight infants post‐discharge could have an influence on physical growth and on neurodevelopmental outcome. This interim report needs to be confirmed at the end of the study.
Soy‐based formulas and phyto‐oestrogens: a safety profile
Authors: Miniello VL , Moro GE , Tarantino M , Natile M , Granieri L , Armenio L
Published: August 2010

Phyto‐oestrogens are non‐steroidal plant‐derived compounds that possess oestrogenic activity and act as selective oestrogen receptor modulators (SERMs). Among the dietary oestrogens, the isoflavone class enjoy a wide‐spread distribution in most of the members of theLeguminosaefamily, including such prominent high‐content representatives as soybean. Phyto‐oestrogen research has grown rapidly in recent years owing to epidemiological studies suggesting that diets rich in soy may be associated with potential health benefits. There is a paucity of data on endocrine effects of soy phytochemicals during infancy, the most sensitive period of life for the induction of toxicity. The safety of isoflavones in infant formulas has been questioned recently owing to reports of possible hormonal effects. Infants fed soy formula receive high levels of phyto‐oestrogens in the form of isoflavones (genistein, daidzein and their glycosides). To date, no adverse effects of short‐ or long‐term use of soy proteins have been observed in humans and exposure to soy‐based infant formulas does not appear to lead to different reproductive outcomes than exposure to cow milk formulas. Soy formula seems to be a safe feeding option for most infants. Nevertheless, much closer studies in experimental animals and human populations exposed to phyto‐oestrogen‐containing products, and particularly soy‐based infant formulas, are necessary.
Troponins in children and neonates
Authors: Adamcová M
Published: August 2010

Cardiac troponin T and cardiac troponin I—the biochemical markers of myocardial injury—are characterized by high specificity and sensitivity in comparison with other markers used in the past.

Conclusion: Troponins have been studied in a wide range of clinical settings. Some of them are unique to paediatric care, but many questions, mainly concerning laboratory limitations and data interpretation in paediatrics, are still open to debate.
Trans fatty acids in human milk in Poland and their association with breastfeeding mothers’diets
Authors: Mojska H , Socha P , Socha J , Soplińska E , Jaroszewska‐Balicka W , Szponar L
Published: August 2010

Aim: To determine the content of trans fatty acids in human milk in relation to breastfeeding mothers’diet. Methods: Samples of milk were collected from 100 breastfeeding mothers and 7‐d dietary records and anthropometry from 69 mothers were obtained. Results: The following total trans fatty acids contents (median (lower‐upper quartile); % wt/wt) in milk samples were determined: 1) data for Spring: colostrum—1.37 (1.00–2.00), mature milk at 5–6 wk of lactation—2.59 (1.49–3.34) and at 9–10 wk of lactation—2.36 (1.55–3.92); 2) data for Autumn: colostrum—1.80 (1.42–2.48), mature milk at 5–6 wk of lactation—2.41 (1.79–4.31) and at 9–10wk of lactation—2.77 (1.53–4.18). The major sources of trans fatty acids in mothers’diets were bakery products, confectionery and snacks. Mothers who had high level of trans isomers in their milk consumed significantly higher amounts of these products.

Conclusions: Bakery products, confectionery and snacks are a major source of trans fatty acids in maternal diet in Poland. The levels of trans fatty acids in human milk may reflect the current diet of the mother as well as the diet consumed early in pregnancy.
Anogenital human papillomavirus in non‐abused preschool children
Authors: Myhre AK , Dalen A , Berntzen K , Bratlid D
Published: August 2010

Aim: To estimate the prevalence of human papillomavirus (HPV) in anogenital samples from children selected for non‐abuse. Methods: A letter of invitation was sent to 2731 girls and 1042 boys, all of them aged 5 or 6 y. Inclusion was based on self‐selection, whereby parents who did not suspect any occurrence of sexual abuse of their child gave informed consent to participate. Several mechanisms were undertaken to exclude abused children. A complete examination was done of each child, including anogenital examination with a colposcope and microbiological sampling from the genitals and anus. Polymerase chain reaction (PCR) using primers MY09 and MY11 was used to identify HPV, and sequencing was done on each positive amplicon. Results: PCR was performed on 325 adequate specimens from 211 children enrolled. Seven samples from 5 girls were HPV‐positive, making 2/161 (1.2%) of the anal and 5/164 (3.0%) of the genital specimens positive. HPV was not detected in any of the boys. In four girls strong associations with HPV 6 genotypes were found, while one girl probably had a mixed infection with HPV 6 and 16. Three girls (1.8%) had clinically detectable anogenital warts.

Conclusion: Since our results are comparable with a prevalence reported from allegedly abused children, and higher rates have been reported from the oral cavity in healthy children, we find detection of HPV unreliable as an indicator of sexual abuse in 5–6‐y‐old children. The rate of anogenital warts found in our study is comparable with a rate reported in abused children.
Genital anatomy in non‐abused preschool girls
Authors: Myhre AK , Berntzen K , Bratlid D
Published: August 2010

Aim: To describe the normal variations in genital anatomy in preschool girls selected for non‐abuse. Methods: A total of 2731 girls aged 5 or 6 y were invited to take part in the study; 195 girls were recruited. Inclusion was based on self‐selection, whereby parents who did not suspect any occurrence of sexual abuse of their children gave informed consent to participate. Several steps were taken to exclude abused girls and girls with previous accidental genital injuries. The genital examination, using a colposcope and a camera, was performed in supine position using a separation and traction technique, and in the prone knee‐chest position. Results: A number of genital anatomical features and hymenal measurements were described and found consistent with previous studies. An important finding was outward folding of the posterior hymenal rim in many girls, a feature that could be difficult to distinguish from attenuation of the posterior hymen. A gaping hymenal orifice, previously suggested to be a supportive sign of sexual abuse, was fairly frequently found and significantly associated with a large horizontal hymenal diameter.

Conclusion: To distinguish between girls with outward folding of the posterior hymen and those with attenuated hymens, we recommend the use of the saline irrigation method. Even though normative hymenal measurement data now exist from a reasonable number of girls, these measurements should be used with caution in sexual abuse evaluations.
Evaluation of screening procedures for congenital cataracts*
Authors: Magnusson G , Jakobsson P , Kugelberg U , Lundvall A , Maly E , Tornqvist K , Abrahamsson M , Andreasson B , Borres MP , Broberger U , Hellström‐Westas L , Kornfält R , Nelson N , Sjöstrand J , Thiringer K
Published: August 2010

Aim: To evaluate the efficacy of two different Swedish screening procedures for early detection of congenital cataracts in comparison with no screening. Methods: Children born between January 1992 and December 1998 in Swedish regions with an established eye‐screening routine procedure, diagnosed with congenital cataract, and operated on before 1 y of age, were included in a retrospective study. Age at referral and age at time of the operation were compared between regions using different screening procedures: screening in the maternity wards (Region 1), at the well‐baby clinics (Region 2) and one region without any screening (Region 3). Results: Seventy‐two children were included in the study. Concerning early diagnosis and surgery, Region 1 differed significantly from Regions 2 and 3, which were more similar and were combined for further analysis. The difference in detected cases was greatest at 21 d of age (55% vs 18%; p < 0.001), but persisted even at 100 d of age (78% vs 64%; p < 0.02). Region 1 screening resulted in more and earlier cases detected than the other two regions (22 vs 15 per 100000 births). In 72% of all cases, surgery was performed in response to referrals from either the maternity wards (36%), or the well‐baby clinics (36%). However, half of the cases from the well‐baby clinics were detected too late, i.e. at >100d.

Conclusion: Eye screening in the maternity ward is preferable to well‐baby clinic screening and to no screening at all, since it leads to early detection. Screening should also be performed routinely at well‐baby clinics within the period when successful treatment is possible.
Body mass index for Saudi children with Down's syndrome
Authors: Husain M Al
Published: August 2010

Aim: Children with Down's syndrome (DS) have a higher prevalence of obesity than children without DS. This study aimed to assess the prevalence of overweight/obesity and to establish reference body mass index (BMI) percentile curves for Saudi children with uncomplicated DS below the age of 5 y. Methods: BMI was measured prospectively in 785 children with DS and compared with 989 Saudi children without DS. Both groups were compared with the international cut‐off point figures for age and gender. Results: Obesity was not a prominent features in Saudi children with DS and their mean BMI curves were linear to the international cut‐off points for BMI, indicating a clear tendency for overweight. BMI reference percentile curves were constructed.

Conclusion: Reference curves for BMI worked out in this study, taken in conjunction with those for height and weight, will be useful in monitoring the size and shape of Saudi children with DS up to the age of 5 y.
Early nasal continuous positive airway pressure for preterm neonates: the need for randomized trials
Authors: Lundstrøm KE
Published: August 2010

The use of early nasal continuous positive airway pressure (nCPAP) as prophylaxis and treatment for respiratory distress syndrome in preterm neonates, with or without prophylactic surfactant, is becoming increasingly popular. However, the justification for this is limited to comparisons between centres and comparisons of historical controls.

Conclusion: Randomized trials and appropriate evaluation of the nCPAP technique are needed.
Body size and early growth in appropriate‐ and large‐for‐gestational‐age infants
Authors: Sun M , Schutz Y , Grezzani A , Clementi M , Gaudino R , Maffeis C
Published: August 2010

Aims: To study weight, length, body composition, sleeping energy expenditure (SEE), and respiratory quotient (RQ) at birth and at 5 mo of age in both adequate‐for‐gestational‐age (AGA) and large‐for‐gestational‐age (LGA) subjects; to compare the changes in body weight and body composition adjusting for gender, age, SEE, RQ and several maternal factors; to investigate the contribution of initial SEE and RQ to changes in body weight and body composition. Methods: Sixty‐nine neonates were recruited among term infants in the University Hospital of Verona, Italy. Forty‐nine subjects participated until follow‐up. At birth and follow‐up, weight and length were measured and arm‐fat area and arm‐muscle area were calculated from triceps and subscapular skinfolds. SEE and RQ were measured by indirect calorimetry. Results: At birth, weight, length, arm‐muscle and arm‐fat areas were significantly higher in LGA subjects than in AGA subjects. Weight status, SEE and RQ at birth did not explain the relative weight change after adjusting for gestational weight, placental weight, age at follow‐up and gender. Arm‐fat area and weight/length ratio at birth were negatively associated with relative changes in body weight after adjusting for the above variables (p < 0.05).

Conclusion: Early growth from birth to 5 mo of life is significantly affected by body size and adiposity at birth. Fatter newborns had a slower growth rate than thinner newborns.