bluuebunny/crossref_metadata_2025 huggingface dataset:
MR flow quantification with cardiovascular applications: a short overview
Authors: Ståhlberg F , Söndergaard L , Thomsen C
Published: January 2008

We present a short overview of the potential of magnetic resonance imaging (MRI) for quantification of flow in the cardiovascular system The most widespread method for creation of MRI flow information utilizes flow‐sensitizing magnetic field gradients Objects that move in the varying magnetic field introduced by such gradients change their precession frequency and therefore obtain a velocity‐dependent offset phase angle The exact phase behaviour for different types of gradients and motion patterns can be calculated and a very simple linear relationship is predicted by theory as well as confirmed in experiments between constant velocity and phase angle Phase‐sensitive flow MRI (velocity mapping) is frequently performed as a two‐dimensional gradient‐echo technique with flow sensitivity (flow encoding) in the through‐plane direction, but other encoding directions are possible Parameters that can be determined from a velocity map are linear velocity in each voxel, vessel area and flow rate In the case of a stenotic vessel, the trans‐stenotic pressure gradient can also be estimated The velocity mapping method has been extensively used for cardiac flow studies in adult patient groups, e.g. for indirect measurements of coronary artery flow and for the study of aortic valve diseases In children, the method has recently been used to determine shunt volumes in congenital heart disease We conclude that flow investigations with MRI may in the future present a good alternative for the clinical evaluation of cardiovascular disorders.
MR imaging and heart function in patients pre‐ and post‐Fontan surgery
Authors: Fellows KE , Fogel MA
Published: January 2008

MR imaging allows functional evaluation of the ventricles of the entire heart because it evaluates cardiac anatomy three‐dimensionally Such evaluation is independent of chamber size and shape, and virtually independent of mathematical assumptions Applying standard measurements of volume and function in children who have undergone multi‐staged Fontan operations, we have shown diminished ventricular volumes and mass, and decreased cardiac indices, in post‐Fontan patients We have also shown that new parameters of function, such as total heart volume and center‐of‐mass relationships, are inconstant through the multiple surgical stages of the Fontan procedure These variations may be predictive of ultimate outcome in these complex patients.
Three‐dimensional reconstruction of MR images in congenital heart disease
Authors: Fellows KE , Fogel M , Weinberg PM
Published: January 2008

Commercially available software is now available for reconstructing three‐dimensional (3D) images of hearts with congenital anomalies from standard two‐dimensional (2D) tomographic slices We have used these 3‐D images for 8 years to enhance anatomic diagnosis and functional evaluation pre‐ and postoperatively in children with congenital cardiac and great vessel diseases The advantages of 3‐D imaging are reduced examination time, improved display of complex Intracranial relationships, better understanding of relationships between great vessels and adjacent major airways, and facilitated demonstration of cardiovascular anatomy for those unfamiliar with tomography images.
A non‐linear model of growth in the first year of life
Authors: Giani U , Filosa A , Causa P
Published: January 2008

Weight gain curves in infancy and childhood show valleys and hills which cannot be simplistically ascribed to random variations, so that they are referred to as pulsatile or pulse growth. Classical mathematical models of human growth, upon which the statistical percentiles are based, do not account for these oscillations. Moreover, statistical curves can hide individual patterns of growth. In the present paper a system dynamics approach to modelling the first year weight gain is suggested which simultaneously accounts for the oscillations of weight gain, for its decreasing trend, and for a more or less marked initial spurt observed approximately in the second month of life. It is suggested that the overall weight growth in the first year is the output of complex hidden non‐linear dynamics.
Physical activity and dietary constituents as predictors of forearm cortical and trabecular bone gain in healthy children and adolescents: a prospective study
Authors: Gunnes M , Lehmann EH
Published: January 2008

We have prospectively studied forearm trabecular and cortical bone mineral density gain (ΔBMD) in relation to nutrient intake, weight‐bearing physical activity (WPA) and daylight exposure (DE) in 470 healthy boys and girls aged 8.2‐16.5 years at the baseline. BMD was assessed using single photon absorptiometry (SPA). Cortical ΔBMD peaked at the age of 14.0 ± 0.3 and 16.0 ± 0.3 (SD) years in girls and boys, respectively. Girls had achieved adult premenopausal values of trabecular BMD by the age of 15 years and cortical BMD values by the age of 16.5 years. WPA, BMD, body height, height gain, weight, weight gain, dietary polyunsaturated fat and sodium were correlated with ΔBMD. WPA, predicting cortical as well as trabecular ΔBMD, had the greatest effect on trabecular ΔBMD in the presence of a high calcium intake in children below 11 years of age. In conclusion, our results indicate that physical activity and calcium intake should be encouraged at a prepubertal age in order to increase bone density.
Reduced growth hormone secretion improves insulin sensitivity in adolescent girls with type 1 diabetes
Authors: Åman J , Kroon M , Karlsson I , Jones I , Hagenäs L
Published: January 2008

The aims of the present study were to compare nocturnal growth hormone (GH) secretion, insulin requirements and insulin sensitivity on two occasions in six adolescent girls with type 1 diabetes when the GH secretion was reduced one night by an oral dose of 100 mg of pirenzepine at bedtime. The mean nocturnal intravenous insulin infusion required to maintain a normal constant blood glucose concentration between 24:00 and 07:00 was 53% higher during the night on placebo (p= 0.0212). During the night on pirenzepine, the serum GH area under the curve (AUC) was reduced in all patients to a mean concentration which was 50.1% (15‐78%) of that during the night without pirenzepine (p= 0.0036). The nocturnal urinary GH excretion was also reduced in all of the investigated patients (p= 0.0229). Insulin sensitivity in the morning, measured by the euglycaemic hyperinsulinaemic glucose clamp, increased significantly from 115±51mg m‐2 min‐1 after the night on placebo to 205±67 mg m‐2 min‐1 after the night on pirenzepine (p= 0.0161). No side‐effects were observed during the pirenzepine night. Negative correlations were found between the nocturnal serum GH AUC and the insulin‐stimulated glucose metabolism (r= 0.65, p= 0.0241) and between the nocturnal urinary GH excretion and the insulin‐stimulated glucose metabolism (r= ‐0.77, p= 0.0054). In conclusion, the present study shows a relation between GH secretion and insulin resistance in adolescent girls with type I diabetes. The administration of pirenzepine acutely reduces GH secretion and improves insulin sensitivity.
Family‐oriented support at the onset of diabetes mellitus: a comparison of two group conditions during 2 years following diagnosis
Authors: Sundelin J , Forsander G , Mattsson S‐E
Published: January 2008

As part of a prospective, randomized study, the psychological effects of two different treatment regimens on the diagnosis of children and adolescents aged 3‐15 years with insulin‐dependent diabetes insipidus were evaluated. Conventional treatment was compared to a new regimen with a crisis programme which included a milieu therapeutic setting. A total of 38 families were randomly assigned to the 2 groups and followed over a period of 2 years after initial treatment. Parents' experiences of family climate and function over this period were registered and a test battery for the children was administered on five separate occasions. No decisive difference between the two groups was found. Few significant differences were found. Further investigation of the effects of the new treatment regimen on selected groups of families with defined extra needs is suggested.
Developmental dysplasia of the hip. A population‐based comparison of ultrasound and clinical findings
Authors: Rosendahl K , Markestad T , Lie RT
Published: January 2008

Clinical and ultrasound findings were compared in 3613 newborns examined for developmental dysplasia of the hip (DDH) within 48 hours of delivery. Clinical and sonographic hip stability was described as stable, borderline unstable, dislocatable or dislocated, and the morphology on ultrasound as normal, immature or dysplastic. Persistent clinical or sonographic dislocatability or dislocation. major dysplasia or minor dysplasia combined with an unstable femoral head were indications for early treatment. A total of 123 (3.4%) infants were subjected to early treatment. of which 55 (45%) fulfilled the criteria for treatment on both clinical and ultrasound examinations, 52 (42%) were treated on the basis of ultrasound findings alone, and 16 (13%) on the basis of clinical findings alone. Thirty percent of the infants with clinically dislocated or dislocatable hips were judged to have stable or just borderline unstable hips on the first clinical examination. Of 486 (13.5%) infants with sonographically immature or minor dysplastic but stable hips, 472 (97%) normalized spontaneously, while treatment was initiated in 14 (3%) of them at 1‐3 months of age because of lack of sonographic improvement. Only one infant presented with late DDH during an observation period of 3 years. Accepting sonographic dysplasia as a criterion for early splinting may result in a treatment rate which is almost twice the rate based on clinical criteria, but late dislocation may be virtually eliminated.
Children with malignant disorders: the health and life situation of their parents examined over a 7‐year interval
Authors: Lähteenmäki PM , Salmi TT , Salo MA
Published: January 2008

The parents of 31 children with malignant disorders were clinically examined and interviewed to characterize their life situation and somatic health during treatment of their child. The follow‐up was for 7 years. Comparison groups were from the mean Finnish population matched for age, sex and occupation. The parents were generally healthy. Hypertension, headache and abdominal pain were the main symptoms. Sick leave and contact with a physician were less common than in the control population. The frequency of paramedical drug use was high but tranquilizers were used rarely. At the beginning the mothers had many symptoms indicating stress. Their attitude about their own state of health improved during the follow‐up in spite of ageing. The spare‐time physical activities of the parents increased during follow‐up. Few marital conflicts and problems with the siblings were reported. The increment in economic burden caused by the child's disease was not regarded as essentially changing the family life.
Early repair of inguinal hernia in preterm infants with oxygen‐dependent bronchopulmonary dysplasia
Authors: Emberton M , Patel L , Zideman DA , Karim F , Singh MP
Published: January 2008

Despite inguinal hernia being both common and problematic in a significant proportion of preterm infants with bronchopulmonary dysplasia (BPD), there has been a reluctance to intervene surgically for fear of exacerbating the underlying lung disease. We report our experience of early operation in 12 consecutive infants with varying degrees of oxygen‐dependent BPD and investigate the effect of general anaesthesia and herniotomy on pulmonary function by measuring oxygen requirements prior to and following operation. Two infants who required oxygen in a concentration in excess of 95% failed to improve and died from the pulmonary disease 6 and 8 weeks following their operation. The remaining infants all showed a reduction in mean oxygen requirements in the weeks following operation. We conclude that, in the short term, hernia repair performed under general anaesthesia in infants with BPD of varying severity had no adverse effects on respiratory function, as determined by oxygen requirements. We suggest that in certain infants early repair may have been beneficial‐potential mechanisms are explored.
Systemic group B streptococcal disease in neonates and young infants in Norway 1985‐94
Authors: Aavitsland P , Høiby EA , Lystad A
Published: January 2008

In the period 1985‐94, 237 out of 575 248 (0.41 per 1000) live born infants in Norway were reported to suffer culture‐confirmed systemic group B streptococcal disease before their 90th day of life. The annual incidence increased from 0.20 per 1000 live births in 1985 to 0.64 in 1994, due solely to an increase in cases with an onset before the seventh day of life. Future studies should address the possible causes of this increase.
Etiology and pathogenesis of Attention‐deficit Hyperactivity Disorder (ADHD): significance of prematurity and perinatal hypoxic‐haemodynamic encephalopathy
Authors: Lou HC
Published: January 2008

Attention‐deficit Hyperactivity Disorder (ADHD), defined as a disorder of awareness with impul‐sivity, has lately been characterized as a dysfunction of the striatum (neostriatum = globus pallidus + putamen). This structure is in a unique position for contextual analysis and samples information from almost the entire cortex through its spiny neurons. The etiology is heterogeneous, with genetic as well as lesional factors. Among the latter, pre‐ and perinatal events are prominent. Advances in the understanding of the role of fetal circulatory insufficiency with loss of autoregulation and systemic hypotension have drawn attention to the vulnerability of watershed regions, including the striatum. Not only circulatory facts are important for this selectivity, however. The anatomical characteristics, with convergent glutaminergic afferent synaptic transmission from almost the entire cortex contribute to the vulnerability in ischemia‐induced liberation of glutamate: The striatum becomes the victim of its virtue. Repeated hypoxic‐ischemic events are particularly common in prematurity, a fact which seems to explain the high incidence of ADHD in this patient group. The magnitude of the problem is increasing with the increased survival rate among premature infants.
Fetal iron status in maternal anemia
Authors: Singla PN , Tyagi M , Shankar R , Dash D , Kumar A
Published: January 2008

Hemoglobin, serum iron, transferrin saturation and ferritin were measured on paired maternal and cord blood samples in 54 anemic (hemoglobin < 110 g/L) and 22 non‐anemic (hemoglobin ≥ 110 g/L) pregnant women at term gestation. The levels of hemoglobin, serum iron, transferrin saturation and ferritin were significantly low in the cord blood of anemic women, suggesting that iron supply to the fetus was reduced in maternal anemia. The linear relationships of these parameters with both maternal hemoglobin and maternal serum ferritin indicated that the fetus extracted iron in amounts proportional to the levels available in the mother. Infants of mothers with moderate and severe anemia had significantly lower cord serum ferritin levels and hence poor iron stores at birth. It is concluded that iron deficiency anemia during pregnancy adversely affects the iron endowment of the infant at birth.
Waist percentiles: a simple test for atherogenic disease?
Authors: Zannolli R , Morgese G
Published: January 2008

Objective: To give standards for quantification of the magnitude of waist circumference in children. Methods: We calculated the percentiles of waist circumference by age and sex from a sample of 2858 subjects (1440 males and 1418 females, aged 6‐14 years). Data were from a population survey of 15 000 school‐children in Pescara, a town in Abruzzo, a region of Central Italy. Results: We reported the values of the calculated percentiles by age and sex and gave the smoothed percentile curves. Conclusions: Some recent studies in adults have indicated that measuring waist circumference seems to be the simplest way to estimate obesity and the risk of cardiovascular disease. In children, similar evidence is emerging. To date, no example of calculating standards has been published for quantitating the magnitude of waist circumference in children; therefore, our example of standard waist measurements could be used as a practical model for selecting subjects with a value of ≤ or > 2 SD from the mean. The metabolic status should then be checked by complementary laboratory examination.
Mutations of the Epstein‐Barr virus LMP‐1 oncogene in a 10‐year‐old Japanese girl with nasopharyngeal carcinoma
Authors: Ohashi Y , Minegishi M , Fujie H , Tsuchiya S , Ichinohazama R , Konno T
Published: January 2008

A 10‐year‐old patient with nasopharyngeal carcinoma (NPC) was studied for mutations within the carboxy‐terminal portion of the Epstein‐Barr virus (EBV) latent membrane protein (LMP)‐1 gene. The EBV genome, defined as type A, was detected in biopsied tumor specimens by Southern hybridization with specific probes. Sequence analysis of the carboxy‐terminal part of the LMP‐1 gene revealed no deletions but seven single‐base substitutions, four of which were found to be identical to those previously detected in codons for amino acids 322 to 366 in the Chinese NPC CAO. Although yet unresolved, the observed mutations may be associated with the pathogenesis of NPC.
Death following elective tracheostomy decannulation in chronic neonatal lung disease
Authors: Fitzgerald D , Benjamin B , Asperen P Van
Published: January 2008

Widespread air leak as a fatal complication of elective tracheostomy decannulation in a child aged 20 months with chronic neonatal lung disease (CNLD) is reported. We discuss likely mechanisms for the development of air leak following tracheostomy tube removal in young children with obstructive airways disease and suggest that this procedure be performed in an intensive care or high dependency unit.
Oesophageal burn caused by sucking a 1.5 volt battery
Authors: Untersweg U , Mayr J , Schmidt B
Published: January 2008

We report the case of a 4‐year‐old boy who sustained an oesophageal burn grade II III due to ingestion of an alkaline substance from a leaking cylindric 3.3 cm diameter battery, by putting the battery to his mouth and sucking the caustic solution. Lye ingestion by sucking a big cylindric alkaline battery has not yet been reported in the medical literature. We recommend the production of safer alkaline battery cover tubes in order to eliminate any possibility of leakage. Accidents like this might occur more often, since battery collecting and recycling is becoming more common.
Endotracheal suctioning causes right upper lobe collapse in intubated children
Authors: Boothroyd AE , Murthy BVS , Darbyshire A , Petros AJ
Published: January 2008

Objective: Right upper lobe collapse is a common radiographic finding in intubated children. We hypothesized that deep suctioning and uncontrolled negative pressures during endotracheal tube suctioning were significant contributory factors. Methods: The incidence of right upper lobe (RUL) collapse in intubated, ventilated children on a paediatric cardiac intensive care unit was determined over a 3‐month period (n= 102). Graduated suction catheters and suction vacuums of < 165 cm H2O were then introduced. Another prospective audit was carried out 3 months later (n= 60). Results: We found that 24% developed RUL collapse and 4 developed an apical pneumothorax. Following the introduction of graduated catheters and controlled vacuums pressures, a significant reduction in the incidence of RUL collapse, to 7%, was observed (p < 0.05). Conclusions: We conclude that high negative pressure and deep‐suctioning causes RUL collapse in children. Any lobar collapse not only prolongs the child's stay in intensive care, but can be associated with further morbidity which may have a serious implication. By improving suctioning technique this morbidity can be significantly reduced.
Transient dystonia in non‐handicapped low‐birthweight infants and later neurodevelopment
Authors: Sommerfelt K. , Pedersen S , Ellertsen B , Markestad T
Published: January 2008

The aim of the present study was to evaluate the long‐term prognostic significance of transient increase in muscle tone during infancy (dystonia) in very low‐birthweight (VLBW) infants without cerebral palsy. Motor (Peabody Developmental Motor Scales), cognitive (Wechsler Preschool and Primary Scale of Intelligence) and behavioural (Personality Inventory for Children, Yale Children's Inventory) development was assessed at 5 years of age. In a population‐based sample of 50 VLBW children, transient dystonia was present in 14. In explorative analyses, transient dystonia was associated with low 1 min Apgar scores, neonatal bacterial infection, and lack of breast‐milk in the neonatal period. Cognitive, neuromotor and behavioural development at 5 years of age was comparable in those with and without transient dystonia, although there was a statistically non‐significant tendency towards more neuromotor problems in the dystonic children.
Paediatric and ophthalmologic observations in offspring of alcohol abusing mothers
Authors: Strömland K , Sundelin K
Published: January 2008

The offspring of nine women who had abused alcohol and drugs during pregnancy were studied. Of the 30 children, 10 had fetal alcohol syndrome (FAS) or fetal alcohol effects (FAE). Ophthalmological impairments associated with FAS—impaired vision, optic nerve hypoplasia, cataract, increased tortuosity of retinal vessels—were common. The severity of teratogenic lesions varied among the children and was often related to the level of abuse during pregnancy. Most women were unable to take care of their children during periods of substance abuse. All children with FAS/FAE had learning difficulties. Four mothers abstained from alcohol or drugs during some of their pregnancies and gave birth to children without birth defects.
Ethnic variation of cord plasma apolipoprotein levels in relation to coronary risk level: a study in three ethnic groups of Singapore
Authors: Low PS , Saha N , Tay JSH , Hong S
Published: January 2008

In multiracial Singapore, the prevalence of coronary artery disease is highest in ethnic Indian and lowest in ethnic Chinese populations. Since susceptibility to coronary artery disease is closely associated with plasma lipid traits, we studied the cord blood lipid and apolipoprotein profiles of the three ethnic groups in Singapore to determine if ethnic differences in lipid profile are present at birth. The high‐risk lipid traits of high LDL‐cholesterol, triglycerides and apo B, low HDL‐cholesterol and apo A‐I were found to be highest in ethnic Indian and lowest in ethnic Chinese populations. This difference was concordant with the relative coronary mortality rates for their respective adult populations in Singapore.
Less severe retinopathy of prematurity induced by surfactant replacement therapy
Authors: Termote J , Schalij‐Delfos NE , Cats BP , Wittebol‐Post D , Hoogervorst BR , Brouwers HAA
Published: January 2008

To assess the effect of surfactant replacement therapy (SRT) on the prevalence and severity of retinopathy of prematurity (ROP), we compared data from 160 SRT‐treated preterm infants with data from 230 historic controls. The prevalence of ROP was 30.6% in the treatment group and 23.4% in the control group. Severe ROP (stages 3‐4) was seen in 6.1% of the infants with ROP in the treatment group and 20.3% of the ROP patients in the control group. Surfactant therapy had no influence on the prevalence of ROP (odds ratio 1.4, 95% confidence interval 0.797‐2.459, p= 0.242). However, SRT was associated with a decreased risk for severe ROP, compared to mild ROP (odds ratio 0.226, 95% confidence interval 0.056‐0.905, p= 0.036). These data suggest that SRT is associated with a decreased risk for severe ROP.
Fatal outcome of disseminated Mycobacterium avium infection in childhood. A case of primary incompetent monocyte/macrophage function?
Authors: Heurlin N , Dahlqvist G , Elinder G , Hammarstrom L , Petrini B
Published: January 2008

Disseminated BCG infection rarely heals, and disseminated disease caused by the Mycobacterium avium complex usually has a poor prognosis with a short time to death. The case of a boy who died after 9 years of diagnosed disseminated M. avium complex infection is described. He showed no signs of previously known immunodeficiency except an incompetent primary monocyte/macrophage function. This case has been commented on in Acta Paediatrica Scandinavia (1982) as “the first infant to survive a generalized BCG infection”
The relationship between the intrauterine environment and blood pressure in 3‐year‐old Japanese children
Authors: Hashimoto N , Kawasaki T , Kikuchi T , Takahashi H , Uchiyama M
Published: January 2008

In 195 Japanese children the systolic pressure at 3 years of age was inversely correlated to the body weight at birth and positively correlated to the mothers' systolic pressure during pregnancy: the average systolic pressure in children whose body weight at birth exceeded 3510 g was 3.0 mmHg, which was lower than that of children whose body weight at birth was 2990 g or less. There was an increase of 0.12 mmHg in the children's systolic pressure with each increment of 1 mmHg in the systolic pressure of their mothers. The systolic pressure at 3 years in children of mothers who had had pretibial oedema during pregnancy (101.0 ± 8.8 mmHg) was significantly higher compared with children whose mothers did not have oedema (96.6 ± 9.6 mmHg).
Interleukin‐1α and interleukin‐1 receptor antagonist in the urine of children with acute pyelonephritis and relation to renal scarring
Authors: Tullus K , Escobar‐Billing R , Fituri O , Burman LG , Karlsson A , Wikstad I , Wretlind B , Brauner A
Published: January 2008

Urinary concentrations of interleukin‐lα (IL‐lα) and interleukin‐l receptor antagonist (IL‐Ira) standardized to urinary creatinine concentrations were studied. The median standardized IL‐1α creatinine quotient in children with first‐time acute pyelonephritis was 3.6 pg/μmol, but was non‐detectable in children with recurrent pyelonephritis, children with non‐renal febrile conditions and children convalescent after acute pyelonephritis (p < 0.05–0.01). IL‐lra levels were also significantly higher in children with acute first‐time pyelonephritis (median of 239 pglpmol) compared to these three groups of children (p < 0.01–0.001). The highest urinary 1L‐lra levels, however, were found in the healthy controls (median value 1.019; p < 0.001). Both cytokines were higher among children younger than one year compared to older children. The acute IL‐lα creatinine quotients were lowest in children with uptake defects on 99mTC‐dimercaptosuccinic acid (DMSA) scintigraphy both during the acute infection (reflecting the acute inflammation) (p < 0.001) and 1 year after the acute infection (reflecting permanent kidney scarring) (p < 0.01). In conclusion, persisting high urinary levels of 1L‐lα were associated with less renal inflammation and scarring.
Influence of breathing pattern on transcutaneous oxygen and carbon dioxide tension during histamine provocation in children with bronchial asthma
Authors: Holmgren D , Bjure J , Engström I , Sixt R , Sten G
Published: January 2008

The influence of the breathing pattern on transcutaneous blood gases was evaluated in 18 boys and 8 girls 7–18 years of age, with bronchial asthma, during bronchial provocation with histamine‐HCI. Transcutaneous oxygen tension (tcPo2), carbon dioxide tension (tcPco2) and the breathing pattern assessed by the transthoracic impedance technique were continuously monitored during the provocation. At reaction, when the fall in the forced expiratory volume in 1 s (FEV1) was 20% or more. the tcPo2 fell by 15% or more below the baseline in 22/26 and by 20% or more in 14/26 children. In some children, a marked fall in the tcPo2 was already noted after the saline inhalation and the first histamine dose steps without simultaneous changes in the FEV1. This early fall in the tcPo2 correlated to changes in the breathing pattern and was interpreted as a sign of compensatory hypoventilation secondary to the hyperventilation observed during the inhalations. We conclude that transcutaneous oxygen tension can be used as an indicator of a bronchial reaction during bronchial provocation tests in children only if one takes account of the fact that the breathing pattern during the inhalation of the challenge compound per se has an effect on the oxygen tension.
Going Dutch in nocturnal enuresis
Authors: Schulpen TWJ , Hirasing RA , de Jong TPVM , van der Heyden AJ , Dijkstra RH , Sukhai RN , Janknegt RA , Scholtmeijer RJ
Published: January 2008

Based on several intervention programmes, a strategy for the treatment of nocturnal enuresis has recently been developed by an expert committee in the Netherlands. It consists of three parts. First, two structured interviews are given: one to differentiate between enuresis and incontinence and one to detect associated problems such as diurnal enuresis, constipation or behavioural problems. Secondly, a medical examination is made, confined to the inspection of the external genitalia and lower back, palpation of the abdomen and urine examination. Thirdly, the following guidelines for treatment at different age levels are applied: up to the age of 6 years no intervention is needed; between the ages of 6 and 8 years, lifting out of bed and/or the calendar method; between the ages of 8 and 12 years, enuresis alarm (if not successful, medication with desmopressin is prescribed for a restricted period of time), and ambulatory dry‐bed training in a group setting may follow; over 13 years of age, clinical dry‐bed training according to the Messer/Azrin method is advised. According to the expert committee, these guidelines offer sufficient possibilities to deal with the problem of nocturnal enuresis.
Clinical implications of unstable DNA repeat sequences
Authors: Lindblad K , Schalling M
Published: January 2008

In this article we review the clinical and genetic features characteristic of a number of diseases recently explained by a novel genetic mechanism: unstable segments of the genome containing trinucleotide repeat sequences. Disorders identified to date are mostly progressive, and display unusual inheritance patterns such as anticipation. Anticipation is manifested as an earlier age at onset or a more severe phenotype in later generations of a family, and can be correlated to an increased repeat expansion size. Thus in later generations the disease onset can take place in childhood whereas affected individuals in earlier generations had only adult symptoms. Paediatric cases of typically adult disorders have been shown to be caused by exceptionally long repeat sequences. Anticipation has been observed in a number of disorders not yet identified at the molecular level. Such disorders could be caused by repeat expansions, and are presently subject to intense research efforts. If repeat sequence expansions are related to these disorders, the longest expansions should be seen in the childhood cases, making these the optimal cases to study. Various DNA‐based methods have been developed for the detection of these mutations, making possible preclinical and prenatal diagnostics as well as detection of novel expansions.
Serum lipids and apolipoproteins in Spanish children and adolescents: a 5 year follow‐up
Authors: Sanchez‐Bayle M , Gonzalez‐Requejo A , Ruiz‐Jarabo C , Asensio J , Baeza J , Vila S , Arnaiz P
Published: January 2008

This study was designed to assess “tracking” of serum lipids and apolipoproteins in three age groups of Spanish children over a 5 year period. A total of 84 6‐year‐old, 89 10‐year‐old and 64 14‐year‐old children were evaluated in 1989 (with measurement of serum total cholesterol, triglycerides, lipoproteins and apolipoproteins A1 and B), and re‐evaluated in 1994. Correlation coefficients between initial and final lipid and apolipoprotein values were as follows: total cholesterol, 0.66; low‐density lipoprotein (LDL) cholesterol, 0.65; high‐density lipoprotein (HDL) cholesterol, 0.61; triglycerides, 0.61; apolipoprotein A1, 0.60; apolipoprotein B, 0.66. When age groups were analysed separately, children who were 14 years old at the beginning of the study showed higher correlation coefficients, particularly for total cholesterol and LDL cholesterol (> 0.7 in both cases). More than 70%, of children who were in the top quintile of total, LDL or HDL cholesterol as well as apolipoprotein A1 or B in 1989 remained in the top quintile 5 years later.
No fine motor deficits in patients with untreated non‐phenylketonuria hyperphenylalaninaemia*
Authors: Weglage J , Ullrich K , Pietsch M , Fünders B , Zass R , Koch HG
Published: January 2008

Twenty‐four untreated adolescent and adult patients with non‐phenylketonuria (PKU) hyperphenylalaninaemia (HPA) (serum phenylalanine levels < 600 μmoll−1) and 24 healthy controls matched for age, sex and IQ were investigated for their neurological outcome, especially for fine motor abilities by the Motor Performance Task. No pathological findings could be revealed by clinical neurological examination. Patients with HPA and healthy controls did not significantly differ in their fine motor performances. These performances were not significantly influenced by serum phenylalanine concentrations. Our results indicate that untreated patients with non‐PKU HPA are not at clinically significant risk for developing fine motor deficits and severe neurological impairment. From this point of view a dietary treatment is not necessary in patients with HPA, as recommended most recently.
Long‐term pulmonary function in children with Hodgkin's disease
Authors: Ilhan I , Sarialioǧlu F , Bilgiç H , Göçmen A , Büyükpamukcu M , Akyüz C , Kutluk T
Published: January 2008

We studied the long‐term pulmonary function of 25 patients who were at least 5 years post‐treatment for Hodgkin's disease. The mean age of the patients was 17 years (range 9.5–25 years) at the time of study. Twenty‐one of the patients were male. All patients received six courses of COPP chemotherapy and, in addition, 8 of the 25 patients received radiotherapy to the mediastinum in low or moderate doses (20–30 Gy). One patient had symptoms of bronchiectasia. The chest radiographs of nine patients (36%) showed minimal abnormalities. We divided patients into two groups while evaluating their pulmonary function tests according to whether they received mantle irradiation or not. In patients who received mantle irradiation, pulmonary function tests showed a minimal decrease in FEV1. The decrease in FEV1 indicated an obstructive ventilatory defect. We concluded that our treatment protocols for paediatric Hodgkin's disease were curative, well tolerable and might minimize pulmonary functional changes.
Grief following the loss of a newborn twin compared to a singleton
Authors: Cuisinier M , de Kleine M , Kollée L , Bethlehem G , de Graauw C
Published: January 2008

This study, involving five level III neonatal intensive care units, investigated whether there are any differences between parental grief following the death of a newborn twin and parental grief following the death of a newborn singleton. A total of 142 parents were examined using the Perinatal Grief Scale (PGS): 72 who had lost a newborn twin and 70 matched controls who had lost a newborn singleton 0.5–3.5 years previously. We found that bereaved twin parents did not differ in grief reactions from bereaved singleton parents (PGS: F= 0.00, p= 0.962). This held true both for the short and the long term (F= 0.13, p= 0.721). Mothers showed more grief than fathers (F= 8.16, p= 0.005). In conclusion, grief in bereaved twin parents should be taken as seriously as grief in bereaved singleton parents. The present guidelines regarding care for the latter ought to be adapted to meet the needs of the former.
Measurement of transepidermal water loss in Tanzanian cot‐nursed neonates and its relation to postnatal weight loss
Authors: Thijs HFH , Massawe AW , Okken A , Coenraads PJ , Muskiet FAJ , Huisman M , Boersma ER
Published: January 2008

In healthy cot‐nursed Tanzanian neonates (n= 92, gestation 26–42 weeks) measurements of transepidermal water loss (TEWL) and weight change were performed during the first 24 h after birth at an average ambient humidity of 70% and an environmental temperature of 32°C. Urine production on day 1 (ml/kg per 24h) was documented for a subgroup of 13 preterm and 8 term infants. In a limited group of preterm infants (n= 5) TEWL measurements, weight and 24 h urine volume measurements were repeated daily for 7 days. Maximum weight loss was determined in 7 preterm (gestational age 30–36 weeks) and 6 term infants. TEWL was estimated by measuring the evaporation rate at three sites of the body using the water vapour pressure gradient method. On day 1, TEWL was highest in the most preterm infants, whereas TEWL and urine production were higher in large for gestational age infants as compared to appropriate for gestational age (AGA) infants of the same gestational age (31–36 weeks). For the whole group, weight loss on day 1 was correlated with TEWL (r= 0.49, p<0.05). At follow‐up TEWL in preterm infants remained almost constant during the first 4 days and decreased after the fourth day, at which time weight gain commenced. Preterm AGA infants (gestational age 24–37 weeks) showed a mean postnatal weight loss of 4.4% of the birth weight, while in term infants this loss was only 2.6%. A reduced postnatal weight loss as compared to Caucasian infants may be explained by a lower water loss during the first days after birth, through both skin evaporation and urine excretion.
Effects of fentanyl administration on general and cerebral haemodynamics in sick newborn infants
Authors: Hamon I , Hascoët JM , Debbiche A , Vert P
Published: January 2008

Despite the wide use of fentanyl for analgesia in newborns, concerns have been raised about potential haemodynamic side‐effects. Since sick newborns may lose their cerebral blood flow autoregulation, a drug‐induced haemodynamic instability could lead to brain injury. We assessed the effects of a 15‐min infusion of fentanyl (3μg/kg) on the general and cerebral haemodynamics in I5 newborns (median gestational age 29 weeks, 25th–75th percentile, range 28–31 weeks; birthweight 1170 g. range 955–1790 g). The heart rate and mean arterial blood pressure were continuously recorded. Mean cerebral blood flow velocity and pulsatility index were measured using pulsed Doppler ultrasound before, during and up to 60 min after the onset of fentanyl administration. No significant modification of general or cerebral haemodynamics was observed. In conclusion, the infusion or 3μg/kg of fentanyl did not lead to any deleterious effect on the general or cerebral haemodynamics in sick normovolaemic newborns.
Serum interleukin‐1β in neonatal sepsis
Authors: Atici A , Satar M , Alparslan N
Published: January 2008

Serum levels of interleukin‐1β (IL‐1β) in newborn infants with septicaemia were measured and possible relationships between the clinical course of the infants, causative micro‐organisms and IL‐1β levels were investigated in a prospective study. The study groups comprised 49 newborn infants (25 mature, 24 premature) with proven sepsis and 40 healthy newborn infants (20 mature, 20 premature). Serum IL‐1β levels were measured using the IL‐1β immunoradiometric assay. The levels were found to be lower in neonates with sepsis (median 0.1 pg/ml) than in healthy controls (median 27.9 pg/ml) (p<0.001). Non‐significant trends towards lower levels were observed in children with shock and in non‐survivors. No correlation was found between IL‐1β and postnatal age, gestational age or the study weight of the patients. There was no significant difference in the serum IL‐1β level in septic patients infected with Gram‐positive bacteria and those infected with Gram‐negative bacteria. The results show that the concentration of IL‐1β is significantly decreased in preterm and term neonates with sepsis.
Evidence for possible Mendelian inheritance of septo‐optic dysplasia
Authors: Wales JKH , Quarrell OWJ
Published: January 2008

We describe two siblings from a highly consanguineous pedigree with absent mid‐line brain structures and hypopituitarism. This raises the possibility of a heritable basis for at least some forms of the septo‐optic dysplasia sequence.
Prediction and non‐invasive assessment of neonatal jaundice in the term healthy newborn infant
Authors: Knudsen A
Published: January 2008

The maternal and umbilical cord bilirubin concentration at delivery, a yellow skin colour on the first postnatal day, an increase in the yellow skin colour during the first 24 h of postnatal life, and carbon monoxide excretion are all associated with the later development of neonatal jaundice in the healthy, mature newborn infant. Based on the results from these methods, and especially when the results from two or more of the methods are combined, it is possible to define low‐ and high‐risk groups as far as subsequent jaundice is concerned. If jaundice develops, yellow skin colour measurements can often replace plasma bilirubin determinations. Dependent upon the local current consensus for bilirubin determinations, around 50% of plasma bilirubin determinations can be avoided. Recent research suggests that yellow skin colour measurements may provide information concerning the risk of bilirubin encephalopathy, in addition to their relation to the plasma bilirubin concentration.
Infantile colic—less common than previously estimated?
Authors: Canivet C , Hagander B , Jakobsson I , Lanke J
Published: January 2008

A two‐part population‐based study investigating the occurrence of infantile colic was undertaken. in which 92% of mothers with newborn healthy infants were reached. In the prospective part 152 mothers (“diary group”) registered crying and fussing in their infants during 12 weeks. In the retrospective part 224 mothers (“interview group”) were contacted by telephone at an infant age of 5‐7 months. The colic occurrence was determined according to four different definitions; the rates varied from 3.3 to 17.1%. The classical “Wessel‐type” colic was present in 9.3%. Colic defined as “crying seen as a problem by parent” was present in 12.1% of the “interview group”, but in only 3.3% of the “diary group”. Some earlier studies may have overestimated colic occurrence. Another possibility is an actual decline. The contributive part of preventive measures is discussed.
Early childhood appendicitis is still a difficult diagnosis
Authors: Paajanen H , Somppi E
Published: January 2008

We report on 90 pre‐school children operated on for suspected acute appendicitis. The data analysis was retrospective. The outcome of exploration was negative in 54% (49/90) of cases; inflamed non‐perforated appendix was removed in 28% (25/90) and a perforated appendix in 18% (16/90) of cases. In infants aged >3 years (n= 26) the perforation rate was 60%, and in children aged 4‐5 years (n= 64) it was 27%. Tenderness in the iliac fossa, blood leukocytosis and urinanalysis had little diagnostic value. Preoperative signs of diffuse peritonitis and elevated values of serum C‐reactive protein were found more frequently only in the children with a perforated appendix. There was no mortality and the postoperative morbidity varied between 10 and 20%. Thus, although appendectomy is currently a safe procedure in children, more specific non‐invasive diagnostic aids are still needed to reduce the number of negative explorations and the rate of perforation.
Effects of recombinant human growth hormone treatment in intrauterine growth‐retarded preterm newborn infants on growth, body composition and energy expenditure
Authors: Toledo‐Eppinga L van , Houdijk ECAM , Cranendonk A , De Waal HA Delemarre‐Van , Lafeber HN
Published: January 2008

The effects of recombinant human growth hormone treatment during the early postnatal period on growth, body composition and energy expenditure were studied in seven intrauterine growth‐retarded newborns. Seven infants were studied as controls. No differences were seen in bodyweight or height gain (15.9 ± 1.5g/kg per day and 1.02 ± 0.24cm/week in the treated and 16.3 ± 1.4g/kg per day and 1.11 ± 0.30 cm/week in the control group). Skinfold growth rate was 0.52 ± 0.20 mm/week in the treated vs. 0.56 ± 0.28 mm/week in the control group. Total body water (as a percentage of body‐weight, 80 ± 3.0% vs. 80 ± 4.0%) and energy expenditure (67.5 ± 7.4 vs. 66.7 ± 6.4kcal/kg per day) using 2H218O showed identical results in both groups. We conclude that recombinant human growth hormone treatment directly after birth in intrauterine growth‐retarded newborn infants results neither in an increase in growth rate nor a change in body composition or energy expenditure during the early postnatal period.
Intralesional steroids in Langerhans cell histiocytosis of bone
Authors: Bernstrand C , Björk O , $Arhström L , Henter J‐I
Published: January 2008

Langerhans cell histiocytosis may involve single or multiple organ systems. Bone involvement is the most common feature. We have examined retrospectively the effects of 20 intralesional injections of steroids into bone in seven patients seen at our department from 1988 to 1993. Most of these injections (75%) relieved the symptoms, and no side‐effects were observed. However, injections into the jaw were seldom effective. Our results suggest that the dose of the steroids administered is of importance.
Transient gastric outlet obstruction and tetralogy of Fallot: a true association or a coincidental finding?
Authors: Regev RH , Dolfin T , Katz S
Published: January 2008

Infants suffering from congenital heart anomalies who are receiving intravenous prostaglandins may present with gastric outlet obstruction. We describe a newborn with tetralogy of Fallot who was not being treated with prostaglandins and presented with gastric outlet obstruction. The typical clinical and radiological signs of infantile hypertrophic pyloric stenosis resolved spontaneously within several days. We suggest that there may be an association between cyanotic heart disease and gastric outlet obstruction unrelated to the use of prostaglandins.
Microdialysis for metabolic monitoring in neonates after surgery
Authors: Hildingsson U , Selldén H , Ungerstedt U , Marcus C
Published: January 2008

Microdialysis is a new method for continuous metabolic monitoring. We studied the possibility of using microdialysis in neonates treated in a paediatric intensive care unit after surgery. A microdialysis catheter was inserted in the abdominal subcutaneous adipose tissue in 14 neonates for a median of 93 h (range 24–106h). In four neonates, two microdialysis catheters were used simultaneously. Samples were taken hourly for analysis of glucose, lactate and glycerol. Dialysate and blood concentrations were compared. Serum/whole blood glucose values (n= 68) were in the range 2.1–15.4 mM. The serum glucose levels showed good agreement with the dialysate concentrations of glucose, although these infants were subjected to various forms of stress, drugs and glucose infusions. The whole blood glucose levels were significantly lower than the dialysate levels. The microdialysis concentrations of glucose varied considerably. As almost identical dialysate glucose levels were found when two microdialysis catheters were used simultaneously, the variability probably reflects true changes in blood glucose levels. Our results indicate that microdialysis can be used in neonates.