bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiple anomalies, hypokalemic paralysis and partial symptomatic relief by terbutaline
Authors: Djurhuus MS , Klitgaard NAH , Jensen BM , Andersen PE , Schrøder HD
Published: August 2010

In this paper a follow‐up is presented of a case report initially described by Andersen in 1971. The patient presented with a syndrome including elements of familial periodic paralysis with hypokalaemia, long QT syndrome, ventricular ectopy, myopathy with fibre‐type disproportion and dysmorphic features resembling Treacher Collins' syndrome. The main symptom was hypokalaemic paralysis. The episodes were accompanied by a lowered intracellular potassium content and an increase in intracellular sodium. Treatment with terbutaline, a Na/K‐ATPase‐stimulating drug, resulted in attack‐free periods of approximately 9 months, after which the attacks reoccurred. The patient suffered severe attacks whenever treatment with terbutaline was stopped. The patient experienced two attacks of respiratory arrest, the second being fatal.
Adhesion inhibitory activity of β‐lactoglobulin isolated from infant formulae
Authors: Ouwehand AC , Salminen SJ
Published: August 2010

β‐Lactoglobulin was isolated from infant formulae that were ultra high temperature (UHT) ‐treated, sterilized or spray‐dried. The effect of the isolated β‐lactoglobulin on SfaII‐fimbriae‐mediated adhesion of Escherichia coli to human ileostomy glycoproteins was studied in vitro.β‐Lactoglobulin isolated from sterilized formulae was found to perform significantly less well than preparations from spray‐dried formulae (p= 0:05). Great heterogeneity was observed in the adhesion inhibitory capacity of β‐lactoglobulin isolated from UHT‐treated formulae. Therefore, no significant difference was observed between UHT‐treated and sterilized formulae or spray‐dried formulae (p < 0:10). It can be hypothesized that β‐lactoglobulin from spray‐dried and some UHT‐treated infant formulae may affect the colonization of mucous membranes by E. coli strains causing neonatal septicaemia and meningitis.
Are weaning foods causing impaired iron and zinc status in 1‐year‐old Swedish infants? A cohort study
Authors: Persson LÅ , Lundström M , Lönnerdal B , Hernell O
Published: August 2010

We analysed whether 12‐month‐old Swedish infants who have been fed iron‐fortified and relatively zinc‐rich foods, according to current recommendations, have adequate iron and zinc status. A cohort of 76 healthy, full term Swedish infants was followed regarding feeding habits and growth from birth to 12 months of age, when haemoglobin, iron and zinc status were evaluated. Twenty‐six percent of the infants had low (<12μg/l) s‐ferritin values, indicative of iron depletion, and 36% of the infants had low s‐zinc concentrations (<10.7/μmol/l). Only two infants had both low haemoglobin and low s‐ferritin values. s‐Zinc and s‐iron were positively correlated, and s‐zinc and s‐transferrin receptor values were negatively correlated. Lower birthweight was associated with lower s‐ferritin levels at 12 months in boys, and with increased s‐transferrin receptor values in girls. Feeding habits during infancy were relatively homogenous, dominated by breastfeeding, iron‐fortified milk‐ and cereal‐based follow‐on formula. No clear association between feeding pattern and iron and zinc status was found. The results indicate that in a group of healthy, well growing 12‐month‐old Swedish infants one‐quarter is iron‐depleted, although iron deficiency anaemiau is rare, and one‐third may be zinc‐depleted. The high cereal intake of Swedish infants from 6 months of age may have limited the bioavailability of both iron and zinc from the diet.
Cerebral excitatory amino acids and Na+, K+‐ATPase activity during resuscitation of severely hypoxic newborn piglets
Authors: Feet BA , Gilland E , Groenendaal F , Brun NC , Hellström‐Westas L , Hagberg H , Saugstad OD
Published: August 2010

We tested the hypothesis that early brain recovery in hypoxic newborn piglets is improved by resuscitating with an O2 supply close to the minimum level required by the newborn piglet brain. Severely hypoxic 2‐5‐d‐old anaesthetized piglets were randomly divided into three resuscitation groups: hypoxaemic (n= 8), 21% O2 (n= 8), and 100% O2 groups (n= 8). The hypoxaemic group was mechanically ventilated with 12‐18% O2 adjusted to achieve a cerebral venous O2 saturation of 17‐23% (baseline; 45 ± 1%, mean ± SEM). During the 2h resuscitation period, extracellular aspartate and glutamate concentrations in the cerebral striatum were higher during hypoxaemic resuscitation (p= 0:044 and p= 0:055, respectively) than during resuscitation with 21% O2 or 100% O2, suggesting an unfavourable accumulation of potent excitotoxins during hypoxaemic resuscitation. The cell membrane Na+, K+‐ATPase activity of cerebral cortical tissue after 2h resuscitation was similar in the three groups (p= 0:30). In conclusion, hypoxaemic resuscitation did not normalize early cerebral metabolic recovery as efficiently as resuscitation with 21% O2 or 100% O2. Resuscitation with 21% O2 was as efficient as resuscitation with 100% O2 in this newborn piglet hypoxia model.
Nephropathy and hypertension as manifestations in a 13‐y‐old girl with primary antiphospholipid syndrome
Authors: Ohtomo Y , Matsubara T , Nishizawa K , Unno A , Motohashi T , Yamashiro Y
Published: August 2010

Severe renal hypertension due to both unilateral renal arterial occlusion and renal thrombotic microangiopathy developed in a 13‐y‐old girl as a manifestation of primary antiphospholipid antibody syndrome. The combination of the intravenous high‐dose urokinase therapy and oral anticoagulation therapy, comprising aspirin, warfarin and dipyridamole, was significantly effective in improving her renal function and preventing thrombotic events during an 18‐month follow‐up period.
High‐density lipoprotein subclasses and esterification rate of cholesterol in children: effect of gender and age
Authors: Dobiášová M , Urbanova Z , Rauchová H , Šamánek M , Frohlich JJ
Published: August 2010

Since the development of coronary heart disease (CAD) is affected by a specific pattern of plasma high density lipoprotein (HDL) effects it may be useful to know whether this occurs already in childhood. In this study we evaluated particle size distribution of HDL by gradient gel electrophoresis and the determination of cholesterol esterification rate (FERHDL) in plasma depleted of apo B lipoproteins in 221 children (108 boys and 113 girls) aged 4 months to 20 years. Total plasma‐ (TC), low‐density lipoprotein‐ (LDL‐C) and HDL‐(HDL‐C) cholesterol, HDL unesterified cholesterol (HDL‐UC) and plasma triglycerides (TG) were also measured. There were no significant gender and age differences with respect to the plasma TC, LDL‐TC and TG but concentration of HDL‐TC increased with age. Post‐pubertal girls had significantly higher relative concentrations of HDL2b compared to boys (30.4% vs 17.2%), while HDL3b,c was lower in post‐pubertal girls (8.7% vs. 16.5 %). FERHDL correlated inversely with HDL2b and positively with HDL3b,c particles and was significantly higher in boys of the post‐pubertal group compared to girls (16.9%/h vs 12.5%/h). While in girls there was a positive correlation between age and HDL‐C, HDL‐UC and the relative concentration of HDL2b no significant correlation were observed in boys. In girls the increase in TC showed a significant correlation with a simultaneous increase in HDL‐C, HDL‐UC and HDL2b. In boys TC correlated significantly with changes in TG only. When HDL2b and HDL3b,c cholesterol levels are calculated from HDL‐C concentration and per cent distribution the differences between males and females are further emphasized. These data indicate that HDL particle size distribution is age‐ and gender‐dependent.
Prone position may increase temperature around the head of the infant
Authors: Oriot D , Berthier M , Saulnier J‐P , Blay D , Fohr J‐P , Vuillerme V , Saulnier J‐B
Published: August 2010

Recommendations to adopt the supine position were followed by a dramatic decrease of SIDS. But no explanation has been given for the association between SIDS and the prone position nor for its decrease in the supine position. We report data on an infant and a mannequin demonstrating an increase in temperature around the head in the prone position. A 4‐month‐old boy presented an acute life‐threatening event related to temperature after febrile otitis despite treatment: 40.5°C, heart rate 280 bpm with circulatory failure and cardiorespiratory arrest requiring resuscitation. There were no seizures. Blood and CSF cultures were negative. The course under antibiotics was favourable. On d 3, we measured temperature at several sites on and around the heat. Temperatures were higher in the prone than in the supine position in pericephalic areas: + 1°C (supracephalic), +2.5°C (peritemporal), and +3.5°C (submandibular). In a thermoregulated room, we used a mechanically ventilated mannequin of an infant. The prone position was also associated with an increase in temperature around the head: +3.3°C (supracephalic), +1.8°C (peritemporal), and +1.1°C (submandibular). Changing from the supine to prone position thus increased temperature around the head (infant and mannequin). To our knowledge, this has not been reported before. SIDS is related to factors modifying temperature status and environment. Furthermore, evacuation of heat is mandatory for an infant. We think the increase in temperature around the head in the prone position is due to the absence of convective fluxes, and speculate it could impair thermolysis.
Pain in paediatric oncology: interviews with children, adolescents and their parents
Authors: Ljungman G , Gordh T , Sörensen S , Kreuger A
Published: August 2010

Ljungman G, Gordh T, Sörensen S, Kreuger A. Pain in paediatric oncology: interviews with children, adolescents and their parents. Acta Pædiatr 1999; 88: 623‐30. Stockholm. ISSN 0803‐5253

Pain diagnostics and treatment are crucial components in the care of children with cancer. This study evaluated the extent and causes of pain, the use of methods for monitoring pain intensity, principles of pain management and adverse effects of pain treatment. In addition, care, support and information given to children and parents were evaluated. Structured interviews were conducted with 55 children with malignant disease and their parents. Pain was a common symptom and a major problem during different phases of cancer treatment and pain evaluation was unsystematic. Pain due to treatment and procedures was a greater problem than pain due to the malignant disease itself, and two thirds of the pain experienced by these children seemed to have iatrogenic origin. Younger children and children with short disease duration were more concerned about procedural pain. Parents and children thought that more efficient pain treatment was often possible. Parents claimed to judge their child's pain better than professionals, and children and parents wanted more information on different aspects of pain and pain treatment. Pain identification and treatment can be substantially improved through increased use of methods for pain evaluation and through giving enhanced information to families about pain and pain treatment. □Adolescence, child, neoplasms, pain/diagnosis, pain/drug therapy, pain/epidemiology, pain/aetiology, pain/measurement, pain/ therapy
Phenylketonuria: diet for life or not?
Authors: Cerone R , Schiaffino MC , Stefano S Di , Veneselli E
Published: August 2010

Cerone R, Schiaffino MC, Di Stefano S, Veneselli E. Phenylketonuria: diet for life or not? Acta Pædiatr 1999; 88: 664‐6. Stockholm. ISSN 0803‐5253

In order to evaluate the argument whether or not a restricted phenylalanine diet should be maintained for life in patients with phenylketonuria (PKU), 16 patients with early treated PKU but off diet since their 11th birthday were investigated. The evaluation included a detailed neurological examination, IQ, neurophysiological testing and MRI of the brain. Even if IQ and electrophysiological studies were normal or unchanged if compared to results before diet discontinuation, all patients revealed abnormal neurological signs. We conclude that the diet should be continued during adult life, but somewhat higher phenylalanine levels (<10mg/dl;< 600 μmol/l) than at younger ages should be allowed. □Adolescence, dietary treatment, phenylketonuria
Fatal biphasic brainstem and spinal leptomeningitis with Cryptococcus neoformans in a non‐immunocompromised child
Authors: Ruggieri M , Polizzi A , Vitaliti MC , Magro G , Musumeci S
Published: August 2010

Ruggieri M, Polizzi A, Vitaliti MC, Magro G, Musumeci S. Fatal biphasic brainstem and spinal leptomeningitis with Cryptococcus neoformans in a non‐immunocompromised child. Acta Pædiatr 1999; 88: 671‐4. Stockholm. ISSN 0803‐5253

Cryptococcal meningitis is one of the most common life‐threatening, invasive fungal infections of the central nervous system in patients with defective T‐lymphocyte function. It is, however, unusual in children. We report on a non‐immunocompromised 10‐y‐old boy without evidence of immunological abnormality who developed headache, vomiting, disturbances of consciousness and areflexia. Magnetic resonance imaging of the brain and the spinal cord revealed enlargement of the ventricles and high signal lesions in the leptomeninges at the level of the cerebral peduncles and the cervical and thoracic cord. Cerebrospinal fluid analysis was positive for Cryptococcus neoformans. He was treated with amphotericin B and was symptom‐free within 1 wk. Despite an extended course of therapy his symptoms suddenly relapsed and he succumbed to the medical complications of cardiac and respiratory failure. Central nervous system appearances at postmortem were those of cryptococcal leptomeningitis. □Cryptococcal, children, neurological, pathology, spinal cord
Cardiac myxoma in a 6‐year‐old child‐constitutional symptoms mimicking rheumatic disease and the role of interleukin‐6
Authors: Hövels‐Gürich HH , Seghaye M‐C , Amo‐Takyi BK , Hügel W , Duchateau J , von Bernuth G
Published: August 2010

A 6‐y‐old girl with right atrial myxoma presented with remittent fever attacks, general arthralgia and laboratory investigations mimicking rheumatic or autoimmune disease. Interleukin‐6 (IL‐6) serum concentration was markedly elevated before and normal after tumour resection, whereas myxoma cells stained negatively for IL‐6. IL‐6 should be considered a myxoma marker: overproduction by myxoma cells and consecutive systemic passage are assumed to cause immunological features. □Cardiac myxoma, childhood, interleukin‐6, rheumatic disease
Nebulized budesonide versus oral steroid in severe exacerbations of childhood asthma
Authors: Matthews EE , Curtis PD , McLain BI , Morris LS , Turbitt ML
Published: August 2010

The aim of this study was to assess whether nebulized budesonide may substitute for oral prednisolone in the management of children whose asthma is severe enough to warrant hospital admission, but who have no life threatening features. In a prospective, double‐blind, randomized study nebulized budesonide (2 mg 8 hourly) was compared with oral prednisolone (2 mg/kg at entry and again at 24 h) in 46 children admitted to hospital with severe asthma exacerbations. Efficacy variables (including lung function measurements such as the primary outcome variable, Forced Expiratory Volume in 1 second (FEV1) and symptoms) were measured 24 h after treatment initiation. FEV1 improved significantly compared to baseline in patients who received nebulized budesonide compared to the prednislone group. The data show nebulized budesonide to be at least as effective as oral steroid in improving lung function and symptom severity in severe exacerbations of childhood asthma. □Asthma, budesonide, steroid
Socioeconomic and psychosocial conditions of parents and cardiovascular risk factors in their children: The Belgian Luxembourg Child Study III
Authors: Guillaume M , Lapidus L , Lambert A , Björntorp P
Published: August 2010

Socioeconomic and psychosocial handicaps are often associated with disease. There is a large body of information on adults on such relationships, but data are sparse on children. In a cohort of 1028 boys and girls, selected at random from school classes in Province de Luxembourg, a mainly rural area of Belgium, these problems were analysed in age strata of 6‐8, 8‐10, 10‐12 years. Participation rate was 71%. Information was collected from questionnaires,. Anthropometric variables, blood pressure and glucose as well as cholesterol, triglycerides and insulin were measured in the children and related to the psychosocial and socioeconomic factors, organized into rural, psychosocial, socioeconomic and alcohol/smoking clusters of observations. Rural: Duration of living in the area of the child and parents correlated with diastolic blood pressure, particularly in boys (p < 0.01). Psychosocial: Housewives (p = 0.002) and their children (p = 0.002) had higher body mass indexes (BMI) than other mothers and their children. Sons of housewives also had higher blood pressure (systolic, p = 0.0007, diastolic, p = 0.007). Socioeconomic: Socioeconomic factors of parents (profession, unemployment) played relatively minor roles. Alcohol/smoking: Alcohol consumption was related to skinfold thickness in boys (p = 0.022), but not in girls. Girls, but not boys, with smoking parents had higher BMI (p = 0.014). Multiple regression analyses suggested that psychosocial factors, such as housewives as mothers of large families, may be important for associations with cardiovascular risk factors in their children. There were apparent differences in the findings between girls and boys, suggesting that boys are more vulnerable to the impacts of the factors analysed. □Cardiovascular disease, children, diabetes, parents, psychosocial, risk factors, socioeconomic
Gender differences in children's hospitalization in Catalonia: another inequality?
Authors: Rajmil L , Fernández E , Salas T , Barba G , Raspall F , Vila C , Segura A , Plasància A
Published: August 2010

The aim of this study was to describe children's hospitalization and to analyse gender differences by selected diagnostic and procedure groups. Using the Clinical Classification for Health Policy Research Version 2 (CCHPR), 81 888 hospitalizations from the Minimum Basic Data Set of Hospital Discharge (CMBDAH) of 1995 related to children under 15 y of age in Catalonia, Spain, were studied. Hospitalization rates, number of days in hospital, average length of stay (d) in hospital and the standardized hospitalization ratio (SHR) (hospitalization rate in boys/hospitalization rate in girls) were computed. Two independent approaches were taken: (i) gender‐specific categories were excluded in order to compare hospitalizations by sex; (ii) a selected group of 17 diagnostic and procedure categories were chosen in order to carry out the specific gender comparison. In both approaches, the selected indicators were compared by age groups, and totals were standardized by age using the direct method. An excess of hospitalization in boys was observed (SHR= 1.18; 95% CI: 1.17–1.19). The number of days spent in hospital and hospitalization rates were higher in infants and were also higher for boys than for girls. The average length of stay in hospital was higher in infants and in girls at all ages. These differences were systematic when stratified by health region, admission and discharge circumstances and hospital category. Except for urinary infection, which was higher in girls (SHR: 0.65; CI 95%: 0.54—0.76), the SHR was higher in boys in all diagnostic and procedure categories analysed (all SHR > 1). Specific sex categories, injuries and poisonings cannot on their own explain a higher level of hospitalization among boys. More specific studies are needed to explain the role of the family and the healthcare system in gender inequalities in children's hospitalization. □Catalonia, children, differences, hospitalization, inequalities, sex
Non‐enzymatic nitric oxide generation in the stomachs of breastfed neonates
Authors: Iizuka T , Sasaki M , Oishi K , Uemura S , Koike M , Shinozaki M
Published: August 2010

Human breast milk contains high concentrations of nitrate and nitrite in the early postpartum period. The acidification of nitrite leads to the generation of nitric oxide (NO) in the gastric lumen. NO reportedly plays an important role in adult stomachs. The objective of the present study was to determine whether NO is generated in the stomach of breastfed neonates. We examined (i) the concentrations of nitrite and nitrate in human breast milk and formula milk, according to the method based on the Griess reaction; (ii) the concentration of NO in gases collected from the lumen of the neonatal stomach; and (iii) NO generation in acidified milks in vitro, using a NO chemiluminescence analyser. We found that breast milk contained high levels of nitrite, the NO level in the stomach gas of neonates fed only breast milk peaked on days 2 to 5, and NO was present on the milk surface in vitro. These findings suggest that a high concentration of nitrite in the stomachs of breastfed neonates enables a high production of NO. We propose that breast milk is important in regulating the mucosal blood flow and gastric motility and in achieving bacteriostasis via induction of NO generation in the neonatal stomach.
Clinical characteristics of transient glucose intolerance during acute diarrhoea
Authors: Özmert E , Yurdakök K , Aslan D , Yalçin SS , Yardim M
Published: August 2010

Transient glucose intolerance (TGI) is an important cause of WHO G‐ORS (Glucose‐Oral Rehydration Solution) treatment failure and hospitalization in dehydrated children during acute diarrhoea. This retrospective case‐control study was designed to determine some risk and predictive factors for developing TGI among moderately dehydrated patients with acute diarrhoea while under G‐ORS therapy. Among moderately dehydrated patients, files of 22 patients with TGI and 66 other dehydrated patients without intolerance were reviewed. Patients with TGI were younger (9.7 ± 10.5 mo and 11.6 ± 7.8 mo, respectively, p<0.05), the median age being 6 mo in the TGI group and 10 mo in non‐TGI group. There was no difference between groups for sex, admission season, history of fever or vomiting, frequency of vomiting, presence of blood, mucous or leukocyte in stool, presence of associated disease and duration of diarrhoea on admission. The admission haemoglobin, white blood cell, blood pH, sodium and potassium levels were similar in both groups. The mean serum chloride level (116.8 ± 6.9, 109.6 ± 7.9 mEq/l, respectively, p<0.05) was higher in the TGI group and the bicarbonate level was lower (12.9 ± 3.8, 15.3 ± 6.0, respectively, p<0.05). Stool frequency was also higher in patients with TGI (11.2 ± 5.3/24 h, 5.9 ± 4.4/24 h, respectively, p<0.05). No difference was found between the nutritional status of children in both groups. More children were breastfed in the group without TGI (34/56, 61%, 6/18, 33% respectively, p= 0.079, OR = 0.32, 95% CI [0.09‐1.11]). It was concluded that patients with TGI are younger and have high stool frequency. Although statistical significance could not be shown, breastfeeding seems to protect children from TGI, as it protects from diarrhoea.
Urinary bile alcohol profile in infants with intrahepatic cholestasis: identification of 5β‐cholestane‐3α,7α,24,25‐tetrol
Authors: Nakagawa M , Une M , Takenaka S , Kuramoto T , Abukawa D , Iinuma K
Published: August 2010

Urinary bile acids and bile alcohols were examined in six infants aged between 1 and 6 mo who had intrahepatic cholestasis. Following extraction, hydrolysis and solvolysis, cholanoids were analysed by gas‐liquid chromatography and gas‐liquid chromatography‐mass spectrometry. The relative ratio of the urinary excretion of bile alcohols to bile acids was very low (0.07‐0.22) in three patients with mild to severe cholestasis, whereas the urinary excretion of bile alcohols was 2–4 times greater than that of the total bile acids in three patients with slight cholestasis. The urinary bile alcohol spectrum in infants appears to be quite different from that in adults. Although the major bile alcohol was 27‐nor‐5β‐cholestane‐3α,7α,12α,24,25‐pentol, comprising more than 50% of total urinary bile alcohols in healthy adults, it accounted for only 35% of total urinary bile alcohols in our patients. In addition, bile alcohols carrying chenodeoxycholic acid type nucleus were detected in our patients by comparison of the retention times and mass spectra with those of authentic standards. The presence of 5β‐cholestane‐3α,7α,24,25‐tetrol confirmed for the first time in this study may represent an alternative pathway for chenodeoxycholic acid biosynthesis via a “25‐hydroxylation pathway” in early life.
Social adversity, migration and hospital admissions for childhood asthma in Sweden
Authors: Hjern A , Haglund B , Bremberg S , Ringbäck‐Weitoft G
Published: August 2010

The number of children admitted to hospitals because of asthma has been reported to decrease in Sweden in recent decades despite an increasing prevalence of childhood asthma. This decrease has been explained by improved maintenance therapy of children with severe asthma. In this study we used data on hospital admissions for asthma from the Swedish National Patient Discharge Registers in Stockholm, Malmö and Gothenburg 1990‐1994 to identify social and ethnic characteristics of children 2‐18‐y‐old in need of improvement in disease management. Children in families on social welfare (adjusted odds ratios (OR): 1.3 and 1.5) and children in single‐parent households (adjusted OR: 1.3 and 1.4) were more often admitted to hospital because of asthma at least once during a calendar year in the 2‐6‐ and 7‐18‐y‐old groups. Children in families on social welfare had a particularly high risk of being admitted more than once during a calendar year (adjusted OR: 1.6 in the younger age group and 2.9 in the older group). Exposure to smoking during pregnancy was more common in socially disadvantaged families and increased the risk of hospital admission in children below 3 y of age. Children born outside Western Europe, the USA and Australia were less commonly admitted to hospital because of asthma than other children in the population (adjusted OR: 0.1‐0.5). Swedish‐born children with mothers who were born in Eastern and Southern Europe were also at lower risk for admission to hospital with a diagnosis of asthma (adjusted OR: 0.2–0.6). This probably indicates a lower prevalence of asthma in these ethnic groups. Further studies are needed to identify factors that can explain these ethnic differences in childhood asthma.
Comparison of the efficacy of conventional special blue light phototherapy and fiberoptic phototherapy in the management of neonatal hyperbilirubinaemia
Authors: Sarici SÜ , Alpay F , Ünay B , Özcan O , Gökçay E
Published: August 2010

The efficacy and usefulness of two types of phototherapy differing in the source, wavelength and irradiance of the light, conventional phototherapy consisting of special blue light and fiberoptic phototherapy, were compared in a relatively larger series of term newborns with non‐haemolytic and more significant hyperbilirubinaemia than those in previous studies. In total, 108 newborns were allocated sequentially to receive either conventional phototherapy consisting of five special blue lamps or fiberoptic phototherapy. The average spectral irradiance measured at the skin surface level of newborns during the study period was significantly greater in the conventional phototherapy group. The special blue lamp of the conventional phototherapy unit had an emission spectrum almost identical to the bilirubin absorption spectrum, whereas the tungsten‐halogen lamp of the fiberoptic phototherapy had a broad emission through the blue and green wavelengths (mainly in the green spectrum). Phototherapy was more effective in the conventional phototherapy group; the duration of exposure to phototherapy (h) was significantly shorter, and the overall bilirubin decline rate (as μmol/l/h and %/h) was significantly greater in the conventional phototherapy group. According to the nursing personnel, fiberoptic phototherapy was more comfortable than the conventional phototherapy frame because of the easier accessibility and handling of the infants during phototherapy. They complained of giddiness, nausea, glare, temporary blurring of vision and difficulty in detecting the skin colour changes of newborns with the blue light of the conventional phototherapy unit. Conventional phototherapy consisting of special blue fluorescent lamps with approximately twofold higher irradiance and an emission spectrum almost identical to the bilirubin absorption spectrum is preferable to fiberoptic phototherapy in the standard treatment of term newborns with non‐haemolytic hyperbilirubinaemia.
Very low birthweight, bronchopulmonary dysplasia and health in early childhood
Authors: Korhonen P , Koivisto AM , Ikonen S , Laippala P , Tammela O
Published: August 2010

The impact of very low birthweight (<1500g) and bronchopulmonary dysplasia (BPD) on respiratory morbidity, on need of medical resources and rehabilitation at 2–8 y of age, and on the everyday life of the child's family was evaluated by means of a questionnaire addressed to parents of 143 very low birthweight children, 36 of whom had had BPD at 28 d postnatal age, and 131 term controls. In the preceding year, respiratory symptoms provoked by exercise, use of inhaled medications, regular follow‐up visits and hospitalizations, need for physiotherapy, occupational therapy, technical aids and financial support from society had been more common in the very low birthweight groups compared to children born at term. Children with BPD suffered respiratory infections and needed antibiotic courses more frequently than term controls. Repeated antibiotic courses, physiotherapy and occupational therapy were more common among very low birthweight children with BPD than among those without. Concern for the child and the impact of the child's health on his or her everyday life and the parents' work and education were more often reported in target families than in term controls. Compared to term families, more parents in the BPD group felt that the child's health affected the pastimes of other family members. To the families concerned, very low birthweight and BPD constitute a significant burden far beyond the neonatal period. Validated scales for the assessment of their quality of life are needed to develop supportive measures and to evaluate the effects of such interventions.
Comparison of the incidences of neuroblastoma for screened and unscreened cohorts
Authors: Bessho F
Published: August 2010

The incidences of neuroblastoma in screened cohorts and unscreened cohorts were compared to evaluate the usefulness of neuroblastoma mass screening. Data for screened and unscreened populations were collected from annual reports from the Neuroblastoma Committee and the number of cases of neuroblastoma with information on the screening history was provided by the Japan Children's Cancer Registry, whose registration rate has been estimated to be 0.71. In the age category of 6–11 months, the ratios of incidences per 106 person‐years for unscreened to screened cohorts were 6.58 [95% confidence intervals (CI) 4.51‐9.60] during the early period, 1985–1989, and 11.15 (95% CI 7.65‐16.25) during the later period, 1990–1994. However, they were 0.67 (95% CI 0.31‐1.44) and 0.81 (95% CI 0.33‐2.03) for the age categories of 1–4 y and 2–4 y during the early period and 1.32 (95% CI 0.63‐2.76) and 1.17 (95% CI 0.48‐2.89) for the age categories of 1–4 y and 2–4 y, respectively. The incidences of neuroblastoma per 10 person‐years were not different among screened and unscreened cohorts. Neuroblastoma mass screening has not contributed to any decrease in the incidence of neuroblastoma in children over 1 y of age.
Hypnotherapy: an effective treatment modality for trichotillomania
Authors: Cohen HA , Barzilai A , Lahat E
Published: August 2010

This study describes a non‐pharmacological treatment modality for children with trichotillomania. Three children with trichotillomania were treated using a hypnotherapy technique. All patients were observed in the outpatient clinic for 8 consecutive weeks and subsequently followed for 12–18 months. All children were cooperative in performing the hypnotherapy technique (relaxation/ mental imagery). Two patients reported complete resolution of their complaints after 7–8 weeks and 1 patient after 16 weeks. The latter, reporting recurrence of the complaint after 4 weeks due to stressful school problems, was resolved after successful retreatment over 3 weeks. During a mean follow‐up period of 16 months, there were no recurrences. In conclusion, hypnotherapy may be considered as a primary treatment modality for trichotillomania in children without associated emotional disorders.
Quality assurance and standardization: summary of the satellite meeting, Turku, Finland, 11‐12 June 1999
Authors: Webster D , Dhondt J‐L , Hannon WH , Loeber G , Torresani T
Published: August 2010

The Quality Assurance (QA) and Standardization satellite meeting addressed five major issues in newborn screening: (i) Pre‐ and post‐analytical phases are important in the overall quality of screening, and quality assurance programs should include these aspects. (ii) It is possible to run a single screening program using laboratories on more than one site, as is done in Europe, California and Cuba. Special quality assurance procedures are necessary for success. (iii) It is possible to achieve improved analytical quality and international comparison of results by use of common reference materials such as the amino acid materials developed in Europe and the US. It will be important to use tested paper with defined performance characteristics. (iv) It is appropriate for newborn screening programs to be accredited, but it will also be important to develop criteria for pre‐ and post‐analytic phases of screening. (v) A new QA program is being developed for Latin America. The Australasian QA program now includes amino acids and acylcarnitines in a form suitable for tandem mass spectrometry blind QA. The European Society for Paediatric Endocrinology has developed guidelines for CAH screening.
Relation of basic and clinical research on foetal and neonatal thyroid pathology to neonatal thyroid screening
Authors: Dussault JH
Published: August 2010

In this short review the importance is emphasized of basic and clinical research in regard to the interpretation of screening results. This review covers foetal thyroid physiology during the first 48 h of life, the importance of thyroid hormones for normal brain development, the definition of a critical period which might explain intellectual abnormalities in 10‐15% of detected hypothyroid children and the importance of autoimmunity in the aetiology and diagnosis of transient congenital hypothyroidism.
The need for universal neonatal hearing screening–some aspects of epidemiology and identification
Authors: Parving A
Published: August 2010

The devastating consequences of a congenital/early‐acquired hearing disability on the speech language and social development of a child and the estimated prevalence rates of at least 1−1.5/ 1000 live births of congenital permanent hearing impairment are important health problems. Universal neonatal hearing screening programs have provided the opportunity to detect neonates with permanent congenital hearing loss, and thus initiate auditory rehabilitation before the age of 3 mo. Universal neonatal hearing screening represents secondary prevention of hearing impairment/ deafness, and the world‐wide documented delayed identification of children with congenital/early‐acquired hearing impairment will no doubt be improved with the implementation of universal neonatal hearing screening programs.
Epidemiology of breastfeeding in Italy
Authors: Giovannini M , Banderali G , Agostoni C , Silano M , Radaelli G , Riva E
Published: August 2010

To evaluate the rates of initiation and duration of breastfeeding in the major geographical areas of Italy, 1601 mothers randomly selected as representative of the November 1995 deliveries in all 20 regional districts underwent interviews within 1 mo after delivery. A cross‐sectional telephone scanner‐ready questionnaire was administered by trained personnel. Mothers who started breastfeeding were interviewed again at 3, 6, 9 and 12 mo after delivery. The results indicate that 85.3% mothers initiated breastfeeding, with significant geographical differences (rate ranging from 75.8% in the islands to 90.8% in the north‐east; p < 0.0001). The overall breastfeeding prevalence considering all 1601 mothers decreased steadily to 41.8% at 3 mo and 19.4% at 6 mo, and was even lower when considering only exclusive/predominant breastfeeding (37.3% and 8.1%, respectively). The duration of breastfeeding was shorter in the islands than in other areas, particularly the north‐east (p = 0.001). Although the rate of breastfeeding initiation is fairly high in Italy, the rapid decrease in breastfeeding practice throughout the first 6 mo requires strategies for improvement. The differences between the continental areas and the islands should be considered in programming intervention plans.
Long‐chain polyunsaturated fatty acids in human milk
Authors: Agostoni C , Marangoni F , Bernardo L , Lammardo AM , Galli C , Riva E
Published: August 2010

Arachidonic acid and docosahexaenoic acid are the most representative long‐chain polyunsaturated fatty acids (LCPUFA) since they may affect infants' growth and development. LCPUFA are present in the milk of all lactating women throughout lactation. The mothers' dietary habits may affect the levels of these fatty acids in maternal blood lipids and then in milk. LCPUFA show marked differences in levels as wt%, particularly from colostrum to mature human milk, but only mild differences in absolute content. Both the major presence of LCPUFA in human milk phospholipids and some regulatory mechanisms in the mammary gland cells could contribute to the LCPUFA levels in milk beyond those in maternal plasma.
Long‐chain polyunsaturated fatty acids and development of human infants
Authors: Carlson SE
Published: August 2010

Human infants require n‐6 and n‐3 long‐chain polyunsaturated fatty acids (LCPUFA), derivatives of the essential fatty acids, linoleate (n‐6) and linolenate (n‐3), for growth and neural development. Animals fed diets deficient in the essential fatty acids have low neural LCPUFA and behavioral changes that imply adverse effects on brain function. Studies of animals deficient in essential fatty acids have provided the rationale and outcomes for studies to determine whether human infants need dietary LCPUFA. After including n‐3 LCPUFA in formula, preterm infants showed higher sensory function (retinal responses to light, visual acuity), visual attention characteristic of higher maturity during infancy, and higher scores on test of global development (6‐ and 12‐mo Bayley Mental Developmental Index). In term infants, some but not all studies found higher visual acuity, 4‐mo Brunet‐Lezine psychomotor development, and 10‐mo means‐end problem solving with LCPUFA‐containing formulae compared to formulae in general use. Because preterm infants have lower LCPUFA accumulation at birth than term infants, it may be easier to show benefits of dietary LCPUFA for neural development in the former group. In addition to low gestational age, other variables may influence LCPUFA accumulation at birth and determine whether a particular group of infants will respond to dietary LCPUFA. One current challenge is to identify and characterize the effects of those variables. Another is to learn the mechanisms by which LCPUFA status may influence behavior.
Randomized trial comparing natural and synthetic surfactant: increased infection rate after natural surfactant?
Authors: Kukkonen AK , Virtanen M , Järvenpää A‐L , Pokela M‐L , Ikonen S , Fellman V
Published: August 2010

The efficacy of a natural porcine surfactant and a synthetic surfactant were compared in a randomized trial. In three neonatal intensive care units, 228 neonates with respiratory distress and a ratio of arterial to alveolar partial pressure of oxygen <0.22 were randomly assigned to receive either Curosurf 100mgkg−1 or Exosurf Neonatal 5 ml kg−1. After Curosurf, the fraction of inspired oxygen was lower from 15min (0.45 ± 0.22 vs 0.70 ± 0.22, p = 0.0001) to 6 h (0.48 ± 0.26 vs 0.64 ± 0.23,p= 0.0001) and the mean airway pressure was lower at 1 h (8.3 3.2 mmH2O vs 9.4 ± 3.1 mmH2O β= 0.01). Thereafter the respiratory parameters were similar. The duration of mechanical ventilation (median 6 vs 5 d) and the duration of oxygen supplementation (median 5 vs 4 d) were similar for Curosurf and Exosurf After Curosurf, C‐reactive protein value over 40 mg r1 occurred in 45% (vs 12%; RR 3.62, 95%CI 2.12‐6.17, p = 0.001), leukopenia in 52% (vs 28%; RR 1.85, 95%CI 1.31‐2.61, β= 0.001) and bacteraemia in 11% (vs 4%; RR3.17, 95%CI 1.05‐9.52, p < 0.05).

We conclude that when given as rescue therapy Curosurf had no advantage compared with Exosurf in addition to the more effective initial response. Curosurf may increase the risk of infection.
Infants of women with severe early pre‐eclampsia: the effect of absent end‐diastolic umbilical artery Doppler flow velocities on neurodevelopmental outcome
Authors: Kirsten GF , van Zyl JI , van Zijl F , Maritz JS , Odendaal HJ
Published: August 2010

Umbilical artery Doppler flow velocity waveform studies were performed over a period of 4 y on 242 women with severe pre‐eclampsia before 34 wk gestation. Sixty‐eight (28%) had absent end‐diastolic umbilical artery Doppler flow velocities. One hundred and ninety‐three infants survived to hospital discharge and were followed at 6‐monthly intervals until 48 mo of age. Fhe mean corrected developmental quotient was 94 ± 8 at 24 mo of age and 87 ± 9 at 48 mo. Ninety‐two percent of the infants had a developmental quotient of >80 at 24 mo and 72% at 48 mo of age. Fhis decline is thought to be due to the impact of social circumstances. Fhere were no differences between the developmental quotients of the infants with normal and those with absent end‐diastolic umbilical artery Doppler flow velocities at either 24 or 48 mo of age. At 24 mo of age, infants with absent end‐diastolic umbilical artery Doppler flow velocities scored lower in the Performance subscale test (p= 0.03).

developmental quotients of infants from poorer socioeconomic backgrounds were significantly lower than those living in more privileged circumstances. At 48 mo, 153 (97%) of the children presented with normal gross motor development. Four infants had cerebral palsy. No differences were noted in the motor outcomes between the infants of women with normal umbilical artery waveforms and those with absent end‐diastolic umbilical artery Doppler flow velocities.
Structural hair shaft abnormalities in hypomelanosis of Ito and other ectodermal dysplasias
Authors: Selvaag E , Aas AL Maseng , Heide S
Published: August 2010

Hair samples from patients with different ectodermal dysplasias; hypohidrotic ectodermal dysplasia, pachyonychia congenita, tricho‐dento‐osseous syndrome, tricho‐rhino‐phalangeal syndrome, and hypomelanosis of Ito were investigated using a scanning electron microscope. The hairs of the patients showed different structural abnormalities; twisted hairs, longitudinal grooves, trichorrhexis nodosa as well as variations in the hair caliber. Hair shaft abnormalities, as in our patients with tricho‐dento‐osseous syndrome, and hypomelanosis of Ito have so far not been described.
Neisseria meningitidis: evolution of penicillin resistance and phenotype in a children's hospital in Barcelona, Spain
Authors: Latorre C , Gene A , Juncosa T , Muñoz C , González‐Cuevas A
Published: August 2010

Neisseria meningitidis is the most prevalent micro‐organism involved in paediatric bacterial meningitis in the Barcelona area in children over 3 mo of age and it is an important cause of morbidity and mortality in Spain. A total of 498 strains of N. meningitidis, obtained between the years 1986 and 1997 from children with sepsis and/or meningitis, were characterized according to their serogroup and penicillin resistance; their distribution in serotypes and subtypes was studied from 1990. A decreasing tendency in the number of annual isolates was observed in this period. Most isolates belonged to serogroups B (403 strains) and C (77 strains). Serogroup C accounted for 1.8% of the strains in 1986 and 57.1% in 1997. The most prevalent phenotype between 1990 and 1996 was B:4:P1.15, but C:2b:P1.2,5 was the most prevalent in 1997. Overall penicillin‐resistance rates ranged from 9.1% in 1986 (when a non‐susceptible strain was isolated for the first time in the Hospital Sant Joan de Deu, Barcelona, Spain) to 71.4% in 1997, and it was more common among strains belonging to serogroup C (52% of resistant strains) than to serogroup B (22.1% of resistant strains). The penicillin‐resistance level was low, MIC always <0.5 μg/ml. The present increase in N. meningitidis group C isolates, mainly C:2b:P1.2,5, and the availability of preventive measures for this highly pathological and resistant phenotype, argues strongly for the establishment of an epidemiological monitoring system. Detection of penicillin resistance should be standardized worldwide in order to unify data from all laboratories.

Conclusion: A shift between serogroups B and C is observed in Barcelona from 1986 to 1997, as well as a rapid distribution of decreased penicillin susceptibility.
Prediction of vesico‐ureteric reflux in childhood urinary tract infection: a multivariate approach
Authors: Oostenbrink R , van der Heijden AJ , Moons KGM , Moll HA
Published: August 2010

In this study, independent predictors obtained from patient history, physical examination and laboratory results for vesico‐ureteric reflux (VUR) in children of 0‐5 y with a first urinary tract infection (UTI) were assessed and the added value of renal ultrasound (US) investigated. Information was collected from children visiting the paediatric outpatient department with a first proven UTI, defined as a urine monoculture with ≥105 organism/ml, with clinical symptoms and possible white cell count ≥ 20 per high‐power field of spun fresh urine. Children with neurologic bladder dysfunction were excluded. VUR was determined by voiding cystourethrography (VCUG) and graded from I to V. The diagnostic value of predictors was judged using multivariate logistic modelling with the area under the receiver operating characteristic (ROC area). A risk score was derived based on the regression coefficients of the independent predictors in the logistic model. In 140 children (51 boys and 89 girls) VUR was diagnosed in 37. Independent predictors for VUR were male gender, age, family history for uropathology, serum C‐reactive protein level (CRP) and dilatation of the urinary tract on US. The ROC area of this model was 0.78 (95% CI: 0.69‐0.87). This prediction model identified 12% (95% CI: 7‐18) of the patients without VUR without missing one case of VUR. If we used VUR ≥ grade 3 as a threshold, the model assessed VUR to be absent in 34% (95% CI: 26‐42).

Conclusion: A prediction rule based on age, gender, family history, CRP and US results is useful in assessing the probability of VUR in the individual child with a first UTI and may help the physician to make decisions about performing additional imaging techniques. Prospective validation of the model in future patients, however, will be necessary before applying the rule in practice.