bluuebunny/crossref_metadata_2025 huggingface dataset:
Ventilatory responses to rebreathing in infants exposed to maternal smoking
Authors: Campbell AJ , Galland BC , Bolton DPG , Taylor BJ , Sayers RM , Williams SM
Published: August 2010

This study assessed the effect of maternal smoking during pregnancy on ventilatory and waking responses of infants to a respiratory challenge. This challenge mimicked the time‐course and concentration of gases that an infant would experience rebreathing face‐down into soft bedding. Control (C;n= 97) and smokers' infants (SM;n= 96) were studied at ages 1 and 3 mo. Asphyxial gas (hypercapnia/hypoxia) was delivered to the supine sleeping baby via a hood by slowly altering the inspired air: CO2maximum 5% and O2minimum 13.5%. Respiratory pattern was recorded by inductive plethysmography as the sum of ribcage and abdominal movements. The change in ventilation with inspired CO2was measured over 5–6 min of the test. The slope of a linear curve fit relating inspired CO2to the logarithm of ventilation was taken as a quantitative measure of ventilatory asphyxial sensitivity (VAS). Protective responses were graded from 1: no waking and an estimated arterial carbon dioxide tension (PaCO2) ±60mmHg (least protective), to 4: fully awake (most protective). The results showed VAS was higher in SM infants than controls: +0.03 (p= 0.04). The oxygen saturation (SaO2) of SM infants fell ‐0.4% (p= 0.02) more thanSaO2of controls despite a greater tidal volume increase: +13.0% (p= 0.04). Overall protective responses were the same between groups, but grade 1, although rare, was found in 7 SM infants and only 4 control infants; this difference was not significant.

Conclusion: The study did not confirm the postulate that infants of mothers who smoked during pregnancy have a reduced ventilatory response or raised waking thresholds.
Water‐miscible tocopherol is not superior to fat‐soluble preparation for vitamin E absorption in cystic fibrosis
Authors: Soltani‐Frisk S , Gronowitz E , Andersson H , Strandvik B
Published: August 2010

Vitamin E deficiency is a major problem in cystic fibrosis. Modern pancreatic enzymes may improve the absorption of fat‐soluble vitamins to make water dispersion less important. In order to compare the absorption of fat‐soluble (F) and water‐miscible (W) tocopheryl acetate, equivalent amounts (10 mg/kg body weight) were given to five patients with cystic fibrosis (CF) and five age‐and sex‐matched healthy controls. Serum was analysed for vitamin E using HPLC before and 1, 2, 3, 4, 6, 8, 10, 24 and 28 h after the oral intake. The median peak concentrations in the sera of controls were 41.9 μmol/L after F and 39.8 μmol/L after W preparations, corresponding values in CF patients being 21.3 and 26.8 μmol/L, and corresponding means ± SD were 41.6 ± 6.7 and 38.4 ± 3.3, and 27.1 ± 14.5 and 28.8 ± 8.3, respectively. Although the area under the curve was lower for W than F preparations in both CF patients and controls, these differences were not significant.

Conclusion: The results in our study are consistent with those of an earlier study using the same preparation and suggest that it is not necessary to use water‐miscible preparation of α‐tocopheryl acetate in CF patients receiving modern pancreatic enzyme supplementation.
Pain assessment in children with juvenile chronic arthritis: a matter of scaling and rater
Authors: Berntson L , Svensson E
Published: August 2010

Twenty‐six children with juvenile chronic arthritis and their parents participated in the study. We compared the assessments of pain perceived by the children on a visual analogue scale (VAS) with assessments on a 4‐point verbal descriptor scale (VDS‐4). In children aged 10 y and older, the pain assessment results of the children and the parents were compared. The discordance in paired data from the scale comparisons and from the inter‐rater comparisons was evaluated using a statistical method developed for ordinal data. The preference of scale and motivation of the older children were summarized.

Conclusion: The parents and children used the VAS and the VDS‐4 differently. The children showed a higher inter‐scale discordance compared with the parents and they gave their pain a higher rating on the VAS but a lower rating on the VDS‐4 than their parents. The VAS was preferred by the children but did not show the most reliable results.
Behavioural correlates of early‐treated congenital hypothyroidism
Authors: Kooistra L , Stemerdink N , van der Meere J , Vulsma T , Kalverboer AF
Published: August 2010

Parents' and teachers' ratings were used to evaluate the behavioural characteristics of children with early‐treated congenital hypothyroidism (CH). Comparisons were made between 63 children with early‐treated CH and 34 healthy controls at the ages of 7.5 and 9.5 y. Additional comparisons were made between the two largest CH subgroups (thyroid agenesis, thyroid dysgenesis) and controls. The most marked differences were found on the introversion cluster and the motor clumsiness scale within it. Children with CH, particularly those with thyroid agenesis, showed introversion and motor clumsiness rather than social negativity and inattention. It is suggested that this behavioural profile may well have its origins in the often‐reported inefficient motor behaviour of these children. Results are discussed in the light of recent findings suggesting an association between thyroid hormone problems and attention deficit hyperactivity disorder.

Conclusion: Early‐treated CH is associated with introversion rather than with social negativity.
Adjustment and intelligence among children with phenylketonuria in Sweden
Authors: Lundstedt G , Johansson A , Melin L , Alm J
Published: August 2010

In this investigation we present a recent survey of treatment effects among 8 to 19‐y‐old Swedish children and youths with phenylketonuria (PKU). The results from intelligence tests and a questionnaire comprising four scales, work capacity, social competence, and internalising and externalising problems, were used. Severity of disease, early treatment, and contemporary phenylalanine levels were assessed. The results showed that development of the patients' intelligence was normal. Adjustments were rated by the patients, their parents and their teachers, and the results were compared with those of a healthy reference group. The PKU patients did not differ from the reference group except for externalising problems judged by the children themselves. None of the patients with PKU showed signs of externalising problems in contrast to the reference group, where such behaviour was observed. Patients with severe PKU, however, showed less social competence compared with patients with a milder form of the disease, according to their own and their parents’ratings. Phenylalanine level in blood tests was in accordance with treatment norms, although the teenagers had higher levels of phenylalanine than the younger patients.

Conclusion: Normal intelligence and adjustment is found among patients with PKU when plasma phenylalanine levels are within treatment norms.
Acute postnatal increase of extracellular antioxidant defence of neonates: the role of iron metabolism
Authors: Szabó M , Vásárhelyi B , Balla G , Szabó T , Machay T , Tulassay T
Published: August 2010

In this study we investigated the extracellular antioxidant capacity of neonates during the first two postnatal days and its association with iron metabolism. Cord blood and blood samples at 47 ± 6 postnatal hours were taken from 10 healthy neonates and their antioxidant capacity was determined using Randox Antioxidant kits and the heme‐specific antioxidant activity (HSAA). Randox indicates the chain‐breaking antioxidant capacity; HSAA corresponds to the ability to limit lipid peroxidation. Iron, ferritin and transferrin levels were also measured. Randox and HSAA values were 30% higher, ferritin was 100% higher and iron was 60% lower postnatally. The amount of change in HSAA values correlated with the change in ferritin level (r= 0.67, p < 0.05).

Conclusion: These results suggest that extracellular antioxidant capacity (both chain‐breaking and heme‐specific antioxidant activities) increases shortly after birth. Lower iron and higher ferritin levels could also be responsible for this phenomenon.
Brain‐specific proteins in the cerebrospinal fluid of severely asphyxiated newborn infants
Authors: Blennow M , Sävman K , Ilves P , Thoresen M , Rosengren L
Published: August 2010

Upcoming trials of neuroprotective strategies in severely asphyxiated newborn infants emphasize the need for early and objective markers of both good and bad long‐term prognosis. Traditional markers such as neurological depression and seizures are not specific. Aim: To study whether measurement in the cerebrospinal fluid of some proteins known to be specific to the central nervous system was in covariance with the clinical course and long‐term prognosis. Methods: Twenty‐two asphyxiated infants were included in the study and compared with a control group of 8 infants without signs of perinatal asphyxia. Cerebrospinal fluid (CSF) was collected during the first 4 d of life and analysed for neurofilament protein (NFp), glial fibrillary acidic protein (GFAp), protein S‐100 and neuron‐specific enolase (NSE). Results: The concentrations of all four proteins were significantly increased in the CSF of asphyxiated infants. The concentrations correlated significantly with other indicators of long‐term prognosis and to neurological impairment at 1 y of age, or death before that time. Specifically, concentrations were excessively high in the five infants who died.

Conclusions: High concentrations of brain‐specific proteins are released into the CSF of asphyxiated infants. It might therefore be useful to measure these concentrations when excluding patients with the gravest prognosis from neuroprotective trials.
Changes in body temperature and urinary cortisol after routine immunization in babies with intrauterine growth retardation
Authors: Jackson JA , Wailoo MP , Petersen SA , Thompson JR , Davies T
Published: August 2010

Aim: To investigate whether infants with intrauterine growth retardation (IUGR) experience different changes in temperature and cortisol excretion after routine immunization compared with normal healthy infants. Methods: Overnight deep body temperature and urinary cortisol to creatinine ratios were measured on the night after immunization and a control night in normal and IUGR infants. Results: In 60 normal infants, first vaccination at about 10 wk of age led to a significant increase in minumum overnight temperature compared to the control night, mean rise 0.25°C (95% CI, 0.12 to 0.38). In 35 IUGR infants the mean rise in temperature between immunization night and control night was 0.35°C (95% CI, 0.15 to 0.55). The increases in minimum temperature did not differ significantly between the normal and IUGR infants (p= 0.11). Cortisol to creatinine ratios measured from overnight urine samples showed that 23 IUGR infants had consistently higher levels than 39 normal infants; control night medians 34 and 15 (p= 0.01) and immunization night medians 56 and 26 (p= 0.02), respectively. However, the percentage increase did not differ significantly between the IUGR infants and the normal infants. A smaller number of second immunizations were studied, but no significant differences were found.

Conclusion: These results suggest that although the impact of immunization is the same for IUGR and normal infants, because IUGR infants are less mature and at greater stress before immunization, the absolute levels that they experience after immunization are higher than those for normal infants.
Gender‐specific effects of apolipoprotein E genotype on plasma lipid levels in a population‐based sample of 6–7‐year‐old children in Spain
Authors: Garcés C , Benavente M , Lasunción MA , Ortega H , Nájera G , Oya M de
Published: August 2010

Aim: The effects of gender on the association between apolipoprotein E genotype and plasma lipid levels remain unclear in children. The aim of the present work was to evaluate these gender differences in a large population‐based sample of 6–7‐y‐old children, free of the effects of sex hormones. Methods: Lipid levels and apo E genotypes were studied in a sample of 1255 (631 M, 624 F) Caucasian schoolchildren, aged 6–7 (mean age, 6.7) y in Spain. Results: A significant effect of the apo E genotype on plasma total cholesterol, LDL‐C (low‐density lipoprotein cholesterol) and apo B levels was observed. Taking the homozygous ɛ3ɛ3 genotype as reference, the presence of the ɛ2 and ɛ4 alleles is associated with substantially lower and higher plasma levels, respectively, of these variables. It was found that the effect of the apo E polymorphism on total cholesterol, LDL‐C and particularly on apo B levels was greater in girls than in boys.

Conclusion: At this prepubertal age, the influence of the apo E genotype on total cholesterol, LDL‐C and apo B levels is more evident in girls than in boys. This difference in effect is not due to sex hormones. In our opinion, the earlier increase in adrenal androgens in girls than in boys at this age related to pubertal maturation could be responsible for these differences.
Oral mannose therapy persistently corrects the severe clinical symptoms and biochemical abnormalities of phosphomannose isomerase deficiency
Authors: Harms HK , Zimmer K‐P , Kurnik K , Bertele‐Harms RM , Weidinger S , Reiter K
Published: August 2010

Phosphomannose isomerase (PMI) deficiency (CDG‐Ib) is a newly recognized disorder of mannose and glycoprotein metabolism. PMI deficiency manifests itself mainly as a gastrointestinal disorder with protein‐losing enteropathy and life‐threatening intestinal bleeding. Hypoglycaemia is an additional prominent symptom. In contrast to phosphomannomutase deficiency (CDG‐Ia), there are no neurological symptoms. PMI deficiency blocks the endogenous mannose formation from glucose. Exogenous oral mannose supply bypasses the enzymatic block and leads to the disappearance of all symptoms in the patient. The striking ultrastructural abnormalities of the rough endoplasmatic reticulum of the duodenal epithelial cells completely normalize and the hypoglycosylation disappears, as evidenced by the normal isoelectric focusing pattern of serum transferrin, the standard diagnostic procedure for recognition of CDG. This paper includes a detailed description of the clinical symptomatology of the first‐ever diagnosed and treated patient with PMI deficiency and a 5–y follow‐up study of mannose therapy.
Effects of magnesium sulphate on amplitude‐integrated continuous EEG in asphyxiated term neonates
Authors: Groenendaal F , Rademaker CMA , Toet MC , de Vries LS
Published: August 2010

In this study it is hypothesized that magnesium sulphate in asphyxiated full‐term neonates could lead to a gradual improvement in background pattern of the amplitude integrated EEG (aEEG), an early marker of hypoxic‐ischaemic brain injury. In a double‐blind, randomized, controlled pilot study of 22 asphyxiated full‐term neonates 8 received magnesium sulphate, reaching serum Mg2+levels of 2.5 mmol/L. Magnesium sulphate had no immediate effect on aEEG‐patterns. At 12 h of age, aEEG was more depressed compared with aEEG at 3 h in 6 of the 8 magnesium‐treated neonates, and in 3 of the 14 placebo‐treated neonates (Mg2+vs placebo:p< 0.05, Mann‐Whitney). No further significant changes in aEEG were seen between 12 and 24 h. Outcome was unfavourable in 4 of the 8 magnesium‐treated neonates, and in 8 of the 14 placebo‐treated neonates.

Conclusion: Magnesium sulphate did not have a positive effect on aEEG patterns in this small group of asphyxiated term neonates.
Can severity‐of‐illness indices for neonatal intensive care predict outcome at 4 years of age?
Authors: Eriksson M , Bodin L , Finnström O , Schollin J
Published: August 2010

Aim: To test four neonatal severity‐of‐illness indices (CRIB, NTISS, SNAP, SNAP‐PE) for their ability to predict short‐ and long‐term outcome in very low‐birthweight infants receiving neonatal intensive care. Methods: Data on 240 newborns with birthweights below 1500 g from two Swedish neonatal units were collected. The predictive values of the indices for an adverse outcome in the neonatal period and at 4 y of age were compared with those of gestational age and birthweight. Results: An early adverse outcome (in‐hospital death, severe haemorrhagic‐ischaemic brain lesion, retinopathy, chronic lung disease) was better predicted with CRIB (area under ROC curve (Az) = 0.87) and SNAP‐PE (Az = 0.86), while SNAP‐PE was best for predicting late problems (deviations in growth and psychomotor development, neurosensory impairment, difficulties in concentration, and impairment in vision, and hearing,) (Az = 0.63). All indices predicted the early outcome better than the outcome at the 4‐y follow‐up. Severity‐of‐illness indices can be used as instruments to follow and improve the level of neonatal intensive care, but unfortunately seem to be of little value in long‐term follow‐up.

Conclusion: CRIB and SNAP‐PE indices are better in predicting hospital mortality than birth‐weight. None of the systems can predict adverse outcome at 4 y of age.
Developmental profiles and auditory perception in 25 children attending special preschools for language‐impaired children
Authors: Fernell E , Norrelgen F , Bozkurt I , Hellberg G , Löwing K
Published: August 2010

Aim: To study different developmental profiles and auditory perception in a representative group of children with language impairment (LI). Methods: A multidisciplinary investigation was carried out in a group of 25 children attending units specifically for language‐impaired children. An assessment of the cognitive level, motor performance, behaviour and auditory perception was performed and the results were compared with those for age‐matched groups of children. Results: Among those with moderate or severe language impairment (LI), around 90% had additional developmental disorders. In three tests of auditory perception, children with LI had problems with working memory and speech discrimination. No problems were found with the children's temporal resolution in auditory perception. Another conclusion from the auditory perceptual tests was that the children's cognitive abilities were important for their success in these tests.

Conclusion: Neurodevelopmental deviations are very common in LI children. The optimal route for the assessment and treatment of these children would be a multidisciplinary approach.
Neonatal jaundice and scientific fraud in 1804
Authors: Hansen TWR
Published: August 2010

In 1785 the University of Paris issued a prize challenge: “Describe neonatal jaundice and distinguish between those circumstances in which jaundice needs professional help and those in which one only needs to await the course of nature.” The prize was awarded to Jean Baptiste Timothée Baumes for a paper, published as a pamphlet in 1788, in which he described 10 jaundiced neonates and discussed his theories on the causes and mechanisms. In a revised edition published in 1806 Baumes accused François Bidault of plagiarism in his 1804 thesis submitted for the MD degree at the University of Paris. Herein, Baumes’1788 original is compared with Bidault's thesis as well as Baumes’1806 revision. It is clear beyond doubt that the 10 cases discussed by Bidault were the same as those Baumes had published 16 y earlier. Parts of Bidault's descriptions and discussions were verbatim transcripts of Baumes’original. However, Bidault had economized with paper, ink and effort by significantly reducing the overall length of Baumes’original. In his second edition Baumes denounced Bidault in strong terms and suggested that the University of Paris take strong action to punish him for his dishonesty. Unfortunately, university records from that period are incomplete, and it is not clear what, if anything, was done about the matter. Baumes had a very distinguished career and achieved a great reputation as both a teacher and clinician.
Spontaneous haemothorax: an uncommon presentation of Glanzmann thrombasthenia
Authors: Kara A , Yaral N , Fsgn T , Duru F
Published: August 2010

Glanzmann thrombasthenia is a rare hereditary qualitative platelet disorder characterized by a lifelong bleeding tendency due to quantitative and qualitative abnormalities of the platelet integrin αIIbβ3. Common clinical manifestations include purpuric type skin bleeding, prolonged bleeding from minor cuts, epistaxis, gingival bleeding and menorrhagia. Less frequently, gastrointestinal system bleeding may occur. Haemarthrosis, haematuria, intracranial and visceral haemorrhage are very rare symptoms. This study reports a 3‐y‐old girl with Glanzmann thrombasthenia who presented with life‐threatening haemothorax. There was no history of recent trauma or drug usage and no vascular or parenchymal abnormalities to explain the development of haemothorax.

Conclusion: To the authors’knowledge this is the first case of Glanzmann thrombasthenia complicated by spontaneous haemothorax.
Regression of autoimmunity and abnormal glucose homeostasis in an adolescent boy with silent coeliac disease
Authors: Banin P , Perretta R , Ravaioli E , De Sanctis V
Published: August 2010

We report on a 15‐y‐old adolescent boy affected by silent coeliac disease, abnormalities in glycoregulation and with autoantibodies specific to diabetes mellitus type I (ICA: islet cell antibodies) and GAD 65 (autoantibodies against glutamic acid decarboxylase), in whom normalization of glycoregulation and disappearance of the immunological markers of pre‐diabetes were observed after 6 mo on a gluten‐free diet. The patient was followed‐up for 36 mo and showed a normal insulin response to an intravenous glucose tolerance test and no markers of autoimmunity. It is possible that undiagnosed coeliac disease over a long period could lead to a direct autoimmune mechanism against pancreatic β cells.

Conclusion: Our findings seem to confirm the theory that undiagnosed coeliac disease can induce an autoimmune process against the pancreatic β cells and that, following a gluten‐free diet, the immunological markers for diabetes mellitus type 1 will disappear.
Does heredity modify the association between farming and allergy in children?
Authors: Remes ST , Pekkanen J , Soininen L , Kajosaari M , Husman T , Koivikko A
Published: August 2010

Aim: It has been suggested that living on a farm decreases the risk of childhood allergy, especially if farming involves livestock. The aim of this study was to examine the association between farming and allergy in children, and the influence of atopic heredity in this association. Methods: The cross‐sectional data of the 7981 children aged 13‐14 y who participated in the Finnish ISAAC study between the years 1994 and 1995 were used to evaluate the association between farming and allergy. Results: Living on a farm was associated with a decreased risk of current symptoms of allergic rhinoconjunctivitis among all children (aOR 0.79; 95% CI 0.63,0.99), and with a decreased risk of hay fever, especially among those children with a parental history of hay fever (aOR 0.60; 95% CI 0.40‐0.89, p= 0.072 for interaction). The children of farmers with a history of hay fever also had a decreased risk of current wheeze (aOR 0.38; 95% CI 0.12‐1.24, p= 0.040 for interaction). No significant association was found between farming and either asthma or eczema. Children living on a farm with livestock had the lowest risk of allergic rhinoconjunctiviti s (aOR 0.69), followed by those living on a farm without livestock (aOR 0.89) compared with the non‐farming children (p‐value for trend 0.024).

Conclusion: Our results support the recent findings on a decreased risk of allergy among the children living on farms. A possible differential effect of parental history of hay fever on the relation of farming environment and the risk of allergic symptoms warrant further investigation.
Differential diagnosis and clinical course of autoimmune neutropenia in infancy: comparison with congenital neutropenia
Authors: Taniuchi S , Masuda M , Hasui M , Tsuji S , Takahashi H , Kobayashi Y
Published: August 2010

Aim: Autoimmune neutropenia in infancy (AIN) is caused by granulocyte‐specific autoantibodies. Clinical presentation and diagnosis have not been well studied, resulting in cumbersome diagnostic investigations and unnecessary treatment such as granulocyte colony‐stimulating factor (G‐CSF) therapy. Methods: Clinical, laboratory and immunological data of 18 infants with AIN were evaluated. Granulocyte‐specific autoantibodies were detected by the direct granulocyte immuno‐fluorescence test (D‐GIFT), indirect granulocyte immunofluorescence test (I‐GIFT) and immuno‐blotting. Results: The average age of onset and resolution of neutropenia in AIN was 7.4 ± 3.4 mo (mean ± SD) and 20.4 ± 4.9 mo, respectively. Sixteen of the 18 patients presented with mild infectious symptoms; the other 2 patients were detected by chance and presented with no infectious symptoms. D‐GIFT was positive in all patients, and I‐GIFT was positive in 17 of these 18 patients. Most patients showed preferential binding to neutrophils from NA(1 + 2−)‐phenotyped donors by I‐GIFT and immunoblotting. An antibiotic (sulfamethoxazole‐trimethoprim) was given to 15 patients for prophylaxis. G‐CSF was given to only one infectious patient.

Conclusion: A combination of diagnostic tests for the detection of granulocyte‐specific autoantibodies was useful in diagnosing AIN, thus avoiding unnecessary investigations. Continuous treatment with G‐CSF was not necessary for prophylaxis, even if neutrophil counts were extremely low.
Soluble forms of the selectin family in children with Kawasaki disease: prediction for coronary artery lesions
Authors: Furui J , Ishii M , Ikeda H , Muta H , Egami K , Sugahara Y , Himeno W , Akagi T , Kato H , Matsuishi T
Published: August 2010

Aim: To investigate the relationship between the plasma levels of soluble forms of the selectin family and the incidence of coronary artery lesions (CALs) in patients with Kawasaki disease (KD). Methods: Thirty‐three patients with KD, including group A patients (n= 22) who had no CALs and group B patients (n= 11) who had CALs, as well as age‐matched febrile (n= 10) and afebrile controls (n= 11), were studied. Results: Peak plasma E‐selectin levels (172.0 ± 58.6 ng ml‐1) occurred during the acute phase of KD, while peak plasma P‐selectin levels (260.3 ± 43.2 ng ml‐1) occurred during the subacute phase of the illness (p± 0.05). Plasma L‐selectin levels (1757.3 ± 244.3 ng ml‐1) during the convalescent phase tended to be higher than in either the acute or the subacute phase (not significant). Before intravenous immunoglobulin treatment, the plasma levels of E‐ (225.1 ± 46.8 ng ml‐1) and P‐selectin (259.4 ± 76.2 ng ml‐1) of patients with CALs (n= 11) were significantly higher than those of patients (n= 22) with no CALs (E‐selectin, 131.6 ± 36.9 ng ml‐1; P‐selectin, 184.9 ± 84.6 ng ml‐1; p± 0.05). When a plasma E‐selectin value before immunoglobulin treatment of ± 184.7 ng ml‐1 was used as the cut‐off point, the sensitivity and specificity for the incidence of CALs were 81.8% and 90.9%, respectively. These findings demonstrate the relationship between plasma levels of selectins and disease severity of Kawasaki vasculitis.

Conclusion: Higher plasma levels of E‐selectin may have potential as a predictor of the incidence of coronary artery lesions in Kawasaki disease patients.
Feeding behaviour of infants with cleft lip and palate
Authors: Mizuno K , Ueda A , Kani K , Kawamura H
Published: August 2010

Aim: To determine whether the feeding behaviour of infants with cleft lip and palate is improved with a type‐P teat, which is widely used in Japan by such infants, compared with a standard teat. The difference in intra‐oral movements between the type‐P teat, modified for the evaluation of feeding behaviour, and an unmodified type‐P teat was also compared using ultrasonography. Methods: In part 1 of the study, 15 infants aged 2 to 3 mo and 7 infants aged 2 wk were evaluated for sucking pressure, expression pressure, frequency and duration of sucking. All the infants had a complete unilateral cleft lip and palate without any other abnormalities. In part 2, an ultrasonographic analysis of intra‐oral movement was done for 5 infants enrolled in part 1 of the study. Results: Sucking pressure did not occur in all infants. It was found that feeding efficiency improved with the type‐P teat compared with the standard teat. The expression pressure with the type‐P teat was significantly higher than that with the standard teat, and the feeding frequency with the type‐P teat was lower than that with the standard teat.

Conclusion: A type‐P teat is suitable for infants with cleft lip and palate who have sucking difficulties. However, a type‐P nipple with a squeezable bottle does not fully solve the feeding problems of infants with cleft lip and palate. New artificial teats that allow a higher expression pressure are desirable, and the measurement of the expression pressure may be helpful in the evaluation of artificial nipples.
The burden of asthma as reflected by the prevalence defined by doctor's diagnosis and the use of healthcare services by preschool children in a Swedish region
Authors: Hederos C‐A , Janson S , Bornehag C‐G , Hedlin Gunilla
Published: August 2010

Aim: Epidemiological data and reports on the prevalence and burden of preschool asthma are mainly based on questionnaires and generally give a prevalence of above 6% in Sweden. In this study we used other ways of studying the prevalence, risk factors and the use of healthcare services in a defined region. Methods: The catchment area included 9410 children aged 0‐6 y. All outpatient clinics had computerized records of patients and visits to the outpatient clinic could be studied as well as admissions to hospital for asthma between 1988 and 1998. Results: According to patients’record data, the prevalence of doctor‐diagnosed asthma was 4.5% in 1998. Seventy‐nine percent of recorded patients are seen outside the hospital, thus the burden of asthma for the health system is mainly on the outpatient clinics. Admissions and especially readmissions to the hospital have decreased during the past decade. One‐third of the children with newly diagnosed asthma had recurring exacerbations and risk for persistent asthma.

Conclusions: The prevalence of doctor‐diagnosed asthma as measured by total mapping in a region is lower than that reported from questionnaire‐based studies. Hospital admissions for preschool asthma have decreased possibly as a result of improved medical care in the paediatric outpatient clinics where asthma is a dominating diagnose. In one‐third of identified new asthmatics, there is a high risk of developing persistent asthma.
Severe liver haemorrhage during laparotomy in very low birthweight infants
Authors: Pumberger W , Kohlhauser C , Mayr M , Pomberger G
Published: August 2010

A review is presented of severe liver haemorrhage as a serious complication in surgery on very low birthweight (VLBW) infants. Clinical data and pathological findings, as well as the outcome of the treatment, of five VLBW infants (< 1000 g) who experienced liver haemorrhage during surgical exploration for necrotizing enterocolitis or spontaneous intestinal perforation were reviewed retrospectively. At the time of surgery, all infants had signs and symptoms of impending sepsis. The bleeding was predominantly “spontaneous” without obvious iatrogenic liver damage. In three infants, severe liver haemorrhage could be stabilized by early liver tamponade using absorbable thrombostatic sponges and polyglactin mesh.

Conclusion: Intraoperative liver haemorrhage potentially life‐threatening complication of surgery in preterm infants, which is not frequently investigated. Immediate perihepatic liver packing may be used to achieve adequate bleeding control.
Role of oxidant injury in the pathogenesis of neonatal lung disease
Authors: Davis Jonathan M
Published: August 2010

Bronchopulmonary dysplasia (BPD) is a chronic lung disease that develops in newborn infants treated with oxygen and mechanical ventilation for a primary lung disorder. With significant improvements in survival of many critically ill infants, BPD has become an extremely important complication of newborn intensive care. The pathogenesis of BPD is complex and involves a variety of causative factors. However, increasing evidence has suggested that an oxidative insult could be an extremely important component of the injury process. Premature infants are especially sensitive to oxidant injury since they are exposed to supraphysiological concentrations of oxygen at birth while endogenous antioxidant enzyme activity may be relatively deficient.

Conclusion: Superoxide dismutase is an antioxidant enzyme that has been shown in numerous basic and clinical studies to protect cells against oxidant injury.
Book review
Authors: Samuelson Gösta
Published: August 2010

Book Reviewed in this article:

Preedy V, Grimble G, Watson R. Nutrition in the Infant. Problems and Practical Procedures. London: Greenwich Medical Media Ltd, 2001. 447 pp. Price GBP 85. ISBN 1 900151626.
Child health in an urbanizing world
Authors: Gracey M
Published: August 2010

The aim of this study is to document and comment on the effects of urbanization on child health, internationally, using published reports and the author's personal experience. Urbanization is having profound effects on the health and well‐being of infants and children in industrialized and developing countries. This will affect generations into the future. The changes are not confined to cities and large towns; they rapidly influence transitional societies in remote and rural areas, because globalization is changing infant feeding practices and children's diets and lifestyles. In developing countries, overcrowding and environmental pollution are massive problems made worse by undernutrition and infections, particularly respiratory and diarrhoeal diseases. In developed societies there are many other problems, e.g. injuries, poisonings, violence, drug abuse, exposure to industrial and atmospheric pollutants, including pesticides, sexually transmissible diseases, and “lifestyle”, diseases including obesity and cardiovascular disease risk. There is an urgent need for paediatricians, health planners, policy‐makers, governments and the community to understand these issues and work towards minimizing their harmful effects on children.

Conclusion: Urbanization has profound effects on child health, globally; these must be recognised so that harmful influences of urbanization can be reduced for the benefit of all children.
Coeliac disease is associated with intrauterine growth and neonatal infections
Authors: Sandberg‐Bennich S , Dahlquist G , Källén B
Published: August 2010

To investigate whether factors in the fetal or neonatal period influence the risk of later development of coeliac disease we conducted a population‐based register study. The Swedish Medical Birth Register was linked with the Hospital Discharge Register and identified 3392 singleton infants born in the period 1987‐97 who developed coeliac disease. Perinatal data for these children were compared with all children born in these years. Exposure variables: Maternal age, parity and smoking habits in early pregnancy, preeclampsia, pregnancy duration and birthweight, birthweight by gestational week, Apgar score, neonatal icterus, neonatal infections, maternal‐fetal blood group incompatibility, exchange transfusion, phototherapy. Odds ratios and test‐based confidence intervals were calculated. Analyses were made with stratification for year of birth and other risk factors. The risk of developing coeliac disease decreased with maternal age and was lower in first‐born than in second‐born children. Maternal smoking in early pregnancy was a weak risk factor, as was low birthweight. The most evident risk factors were being exposed to neonatal infections (OR = 1.52, confidence limits 1.19; 1.95) and being small for gestational age (OR = 1.45, confidence limits 1.20; 1.75). These risk factors were independent of each other.

Conclusions: We have demonstrated that the intrauterine environment, mainly as mirrored by a low birthweight for gestational age and, independently, neonatal infection diagnosis, is associated with the risk of developing coeliac disease, supporting the idea of a multifactorial aetiology of the disease.
Folic acid supplementation on red kidney bean‐induced diarrhoea and enteric bacterial translocation into mesenteric lymph nodes in rats: a pilot study
Authors: Shoda R , Mahalanabis D , Islam KN , Wahed MA , Albert MJ
Published: August 2010

Deaths following childhood diarrhoea, a major health problem in developing countries, are often associated with malnutrition and septicaemic complications. Folic acid has been used in the treatment of acute and chronic diarrhoea in the tropics. Using a rat model, we evaluated the protective effect of large doses of folic acid on diarrhoea, small intestinal bacterial overgrowth and translocation of enteric bacteria into mesenteric lymph nodes induced by a raw red kidney bean‐based diet containing lectin (phytohemagglutinin). Long‐Evans rats in 2 groups of 5 each (60 g to 70 g in weight, 28 d old) were used. All 10 rats, individually kept in metabolic cages, received a raw red kidney bean‐based diet for 10 d, and 5 of them also received a daily folic acid supplement (160 μg/g feed) both during and for 10 d before the experiment. The faecal weight was measured and a quantitative aerobic bacterial culture of the small intestinal mucosal scrapings and of the mesenteric lymph nodes was made. Folic acid supplementation did not reduce faecal output nor did it prevent loss of body weight associated with lectin‐induced diarrhoea. However, the mean total count of enteric bacteria translocated to the mesenteric lymph nodes was significantly reduced in the supplemented rats (1.27 ± 0.61 vs 2.66 ± 0.84, p= 0.028) and a trend towards reduced bacterial count in the small intestinal mucosal scrapings (0.40 ± 0.89 vs 1.42 ± 1.31, p= 0.16) was documented. A significant positive correlation was also seen between the bacterial count in the jejunal mucosal scrapings and in the mesenteric lymph nodes.

Conclusion: Although large‐dose folic acid supplementation did not prevent diarrhoea and malnutrition induced by a lectin‐based diet, it substantially reduced the count of enteric bacteria translocated into the mesenteric lymph nodes and showed a trend towards a reduction in indigenous bacteria adhering to jejunal mucosa. These findings could be of relevance in the prevention of septicaemic complications following many clinical conditions, including diarrhoea with malnutrition in children known to have bacteraemic and septicaemic complications.
Antibiotic treatment for five days is effective in children with acute cystitis
Authors: Abrahamsson K , Hansson S , Larsson P , Jodal U
Published: August 2010

Short courses of antibiotics are often recommended to treat children with acute cystitis despite lack of firm evidence to support such management. The aim of this study therefore was to analyse the short‐term outcome of such treatment. The retrospective analysis included 300 children (252F, 48M) fulfilling the criteria of first‐time acute cystitis and managed according to a protocol recommending 5 d treatment. In 214 (71%) the treatment was given according to the protocol and in the others for 7 or 10 d. Nitrofurantoin was used in 150 (50%) and trimethoprim without or with sulfonamide in 129 (43%). The short‐term results were excellent with 96% of the children being free from symptoms at the first follow‐up visit after a median of 6 d. Only 2 girls had persisting bacteriuria and thus the frequency of bacteriological treatment failure was 1%. Recurrence within 30 d occurred in 4 girls (2%).

Conclusion: A 5 d treatment with antibiotics is adequate in children with acute cystitis. Routine follow‐up visits after a first acute cystitis may not be necessary, providing that the bacteria causing the infection are sensitive to the prescribed antibiotic and that there is no history of defective bladder or bowel emptying.
Rickettsia typhi infection in childhood
Authors: Bitsori M , Galanakis E , Gikas A , Scoulica E , Sbyrakis S
Published: August 2010

Rickettsia typhi infection (murine typhus) is generally underdiagnosed in childhood, as clinical presentations are often non‐specific. We present the manifestations in nine children hospitalized in the Department of Paediatrics of the University Hospital, Heraklion, Crete, over a 3‐y period from 1998 to 2000. Titres >1:400 for IgM and >1:960 for IgG and/or a fourfold increase in a second sample were considered strongly suggestive of acute infection. Children presented with prolonged fever, hepatosplenomegaly and lymphadenopathy. Five children presented with a rash. Unusual manifestations included aseptic meningitis and Kawasaki‐like presentation. Laboratory findings included anaemia, leucopenia, and thrombocytopenia. Three children were treated with appropriate antibiotic regimens and all nine had a complete recovery.

Conclusion: Rickettsia typhi infection should be considered in the differential diagnosis of children residing in or returning from Southern Europe countries who present with prolonged fever, rash and lymphadenopathy.
Agreement between capillary and arterial lactate in the newborn
Authors: Fauchère J‐C , Bauschatz AS , Arlettaz R , Zimmermann‐Bär U , Bucher HU
Published: August 2010

Arterial blood lactate is a reliable indicator of tissue oxygen debt and is of value in expressing the degree and prognosis of circulatory failure as a result of various diseases. Therefore, the practical issue of whether capillary lactate measurements might be of equal value was investigated in newborns. In total, 193 simultaneous measurements of capillary and arterial blood lactate concentrations were performed in 25 newborn babies with an indwelling umbilical arterial catheter. A strong linear correlation was found between capillary and arterial lactate concentration (Lcap= 1.02 Lart+ 0.04; r= 0.98; p < 0.001). The mean difference was −0.08 mmol/1 and the limits of agreement (± 2 SD) were ± 0.69 mmol/1 (−0.77 to 0.61 mmol/1).

Conclusion: Our data show that capillary blood lactate measurements in newborn babies yield lactate concentrations equivalent to arterial measurements over a large concentration range.
Adverse drug events in children during hospitalization and after discharge in a Norwegian University Hospital
Authors: Buajordet I , Wesenberg F , Brørs O , Langslet A
Published: August 2010

The frequency and characteristics of adverse drug events (ADEs) in children hospitalized in the paediatric department of Ullevaal University Hospital, Norway, were determined using intensive monitoring. Of 579 children treated with drugs, 28% experienced ADEs; 7% at the time of admission, 18% during hospitalization and 9% after discharge. All children treated for cancer, 19% treated with anti‐infective drugs, 15% treated with antiasthmatics and 10% treated with drugs affecting the nervous system experienced ADEs. The most frequent events were gastrointestinal, CNS‐ and skin reactions and 19% were considered as serious. ADEs caused 6% of the admissions and 44% required interventions. Most ADEs were found by screening patient records, where physicians mostly described adverse drug events requiring interventions and nurses described less serious events. Parents reported 14% of the events, of which a majority were CNS reactions. CNS reactions may be more common than expected and observations by parents are important when investigating such reactions in children.

Conclusions: ADEs, mainly gastrointestinal, CNS and skin reactions related to drugs affecting the nervous system, anti‐infectives and antiasthmatics, were seen in 28% of the patients. The reporting of events by parents was a useful supplement to the screening of patient records.
Orbital lymphangioma with non‐contiguous cerebral arteriovenous malformation, manifesting with thrombocytopenia (Kasabach‐Merritt syndrome) and intracerebral hemorrhage
Authors: Vachharajani A , Paes B
Published: August 2010

This study describes the first reported case in a preterm infant of an orbital lymphangioma with non‐contiguous cerebral arteriovenous malformation, manifesting with thrombocytopenia (Kasabach‐Merritt syndrome) and intracerebral hemorrhage.

Conclusion: Neonates presenting with orbital lymphangiomas should undergo radiological investigations of the lesion and a detailed cerebral evaluation for associated arteriovenous developmental anomalies.
Randomized double‐blind controlled trial on the effects on iron status in the first year between a no added iron and standard infant formula received for three months*
Authors: Tuthill DP , Cosgrove M , Dunstan F , Stuart ML , Wells JCK , Davies DP
Published: August 2010

Recent research has not only questioned the necessity of iron supplementation in human milk substitutes prior to weaning, but also suggested some potential adverse effects. This study investigated the hypothesis that infant formula need not contain added iron in the first 3 mo. Healthy term infants were recruited into a double‐blind controlled trial and randomized to receive either a new no added iron formula (New; <0.1 mg Fe 100 ml−1) or a standard formula (Standard; 0.5 mg Fe 100 ml−1) for the first 3 mo of life. A breastfed reference group was also studied. Iron status was assessed at 3 and 12 mo from heel‐prick capillary blood samples evaluated by full blood‐count analysis, including reticulocytes and serum ferritin. In total, 149 infants were entered (51 New, 49 Standard, 49 breastfed) with no differences between the groups in gender distribution, birthweight, gestation or numbers completing the study. There were no significant differences between the principal outcome measures: mean values for haemoglobin, mean cell volume and ferritin, between the two formula‐fed groups, and the proportion with a haemoglobin level <11 g dl−1 or ferritin <10 μg l−1 did not differ.

Conclusion: The use of a “no added iron” infant formula in place of an iron‐fortified formula during the first 3 mo of life did not clinically affect iron status at 3 and 12 mo of age. The universal supplementation of formulae with iron during this initial period needs further consideration.
Inadequate leptin level negatively affects body fat loss during a weight reduction programme for childhood obesity
Authors: del Giudice E Miraglia , Santoro N , Marotta A , Nobili B , Di Toro R , Perrone L
Published: August 2010

Obesity is a typical example of a complex multifactorial disease arising from behavioural, environmental and genetic factors that may affect individual responses to dietary intake and physical activity. Observational, longitudinal dietary interventional studies in obese patients present contrasting reports on the predictive value of baseline leptin levels. We report on the effect of a weight reduction programme in three different groups of obese children (82 patients in all) assembled on the basis of their baseline leptin levels adjusted for body mass index (BMI), gender and pubertal development. The effectiveness of this programme was decreased in patients with relative hyperleptinaemia or hypoleptinaemia compared to children with baseline leptin levels appropriate to BMI gender and pubertal development.

Conclusion: Information gained from leptin assays could provide predictive insight into an individual's ability to lose body fat and may therefore have important implications for our approach to the treatment and prevention of childhood obesity.