bluuebunny/crossref_metadata_2025 huggingface dataset:
Does nitric oxide prevent oxidative mediated lung injury?
Authors: Saugstad OD
Published: August 2010

The US Food and Drug Administration recently approved nitric oxide (NO) inhalation therapy for newborn infants >34 wk of gestation with hypoxic respiratory failure associated with pulmonary hypertension. In clinical trials, this therapy has reduced the need for extracorporeal membrane oxygenation. It has not reduced mortality, however. A body of accumulating data indicates that NO may act as an antioxidant as well as a prooxidant, depending on a number of known and unknown factors, e.g. the concentration of NO itself and the concentration of other oxidants. In low doses, NO is an antioxidant and in high doses its prooxidant effects are more pronounced. In this issue of Acta Paediatrica, new information regarding this question has come to light. Turanlanthi et al. have found that NO in relatively high doses induces free radical mediated injury in the lungs of 10‐wk‐old Wistar rats, while in combination with hyperoxia it attenuates the oxidative stress of hyperoxia alone. Recently, it has also become clear that NO acts as a second messenger activating a number of cytokines and inducing apoptosis. There therefore seems to be a close relation between NO, oxidative stress, regulation of growth and inflammation. For these reasons, long‐term follow‐up studies of newborn infants treated with NO inhalation are needed. So far, NO therapy has not been successful in premature infants.

Conclusions: NO inhalation has a number of both short‐term and long‐term potential adverse effects, and is still at the experimental stage in premature infants. Consequently, there is a need for further clinical studies monitoring also the long‐term consequences of this therapy.
Analysis of 20 years of prospective registration of childhood onset diabetes–time trends and birth cohort effects
Authors: Dahlquist G , Mustonen L ,   for the Swedish Childhood Diabetes Study Group
Published: August 2010

The Swedish Childhood Diabetes Registry has been recording all cases of childhood onset diabetes nationwide, with a high level of ascertainment, since 1 July 1977. The present report describes and analyses the 8358 childhood onset cases occurring between 1 January 1978 and 31 December 1997. The mean annual incidence was 26.4/100000 children per year (1978: 21.1 and 1997: 31.9). There was a significant log‐linear increase over time, with a mean annual increase of 1.7%. The steepest mean increase was seen among the young onset cases (2.5%) and the steepest yearly increase (6.3%) was seen in this age group during the last 10‐y period. A shift towards a younger age at onset was clearly indicated, as the age at onset was less during the last compared with the first 10‐y period of observation. The increase over time was similar between the sexes and during winter and summer. When analysing the six full birth cohorts covered, we found no clear‐cut shift in the trend. Birth cohorts (1978–82) up to 5y of onset showed a time variability but no clear trend over time. Ecological analyses associating cumulative incidence by birth cohort to breastfeeding frequency showed no significant association. A statistically significant log‐linear association was found to the official estimate of gross domestic product adjusted for similar price levels (p = 0.002).

Conclusion: The incidence of childhood onset diabetes is rapidly increasing in Sweden, with a shift towards the younger age groups but with no trend in birth cohorts. Precipitating rather than initiating environmental risk factors are suggested, and the correlation to gross domestic product may suggest risk factors associated with wealth–such as a high growth rate, a known risk factor for childhood diabetes.
Outcome of congenital heart defects–a population‐based study
Authors: Meberg A , Otterstad JE , Frøland G , Lindberg H , Sørland SJ
Published: August 2010

In a population‐based study including 35 218 infants born alive during the 15‐y period 1982–96, 360 (1%) were diagnosed as having a congenital heart defect (CHD). At a follow‐up 3–18 y after birth (median 9.5 y) 154 patients (42.8%) were spontaneously cured; of these, 142 (92.2%) had ventricular septal defects (VSDs). Forty‐two patients (11.7%) died, 22 of these (52.4%) during the neonatal period (0–28 d after birth). A total of 119 patients (33.1%) underwent therapeutic procedures (surgery, catheter interventions), 24 (20.2%) of whom died. Of the 95 children surviving therapeutic procedures, 54 (56.8%) had their defects completely repaired, while 41 (43.2%) had residual defects or cardiac sequelae, often of minor importance. In 69 children (19.2%) with persistent non‐operated defects, 43 (62.3%) had VSDs. A chromosomal disorder, syndrome or associated extracardiac malformation occurred in 72 children (20%).

Conclusions: The study underlines the broad variety in severity of CHDs, with a high neonatal mortality rate as well as a high rate of spontaneous cure. It is estimated that 25% of infants born with a CHD will grow into adult age with persistent non‐operated defects, residual defects or cardiac sequelae after therapeutic procedures.
Epidemiology of pneumococcal infections in Swedish children
Authors: Eriksson M , Henriques B , Ekdahl K
Published: August 2010

Objective: This paper provides an overview of pneumococcal infections in Swedish children.

Method: Data supplied by the Swedish Institute for Infectious Disease Control (SMI) provided information on invasive pneumococcal isolates and on isolates with reduced susceptibility to penicillin. Disease burden was estimated from data collected in northern Stockholm and Malmöhus County. Results: Only 3–6% of the total number of invasive pneumococcal isolates came from children 0–15 years of age. Predominant serotypes in descending frequency were 7, 6, 14, and 23. Strains from all sources with reduced sensitivity to penicillin (MIC 0.5 mg/l) were found in 3% of children and varied between 0.2% and 11%, with the highest value found in Southern Sweden (predominating strains were 9, 19, 15, 6, and 23). A 10‐year review of all cases of meningitis in Northern Stockholm reflected an incidence of 10/100000 (0–2 years) or 5.8/100000 (0–5 years), with severe sequelae occurring in 20% of children. This information can be used to predict an annual incidence of 30 cases of meningitis in Sweden.

Conclusion: The large proportion of serotype 7 among invasive isolates is distressing since this serotype is not represented in the present 7‐ and 9‐valent protein‐conjugated vaccines under development. However, the heptavalent vaccine, including serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F would (at a serotype level) provide coverage against 83% of the resistant isolates in Southern Sweden.
Treatment of infant colic with amino acid‐based infant formula: a preliminary study
Authors: Estep DC , Kulczycki A
Published: August 2010

Infant colic, a common disorder of infancy, is characterized by excessive crying and fussing. In this preliminary study we examined whether Neocate, an amino acid‐based formula, would be accepted by formula‐fed infants with colic, 3‐7 wk of age, and whether Neocate would improve their symptoms. Six infants with colic were studied using Barr‐type infant behavior diaries for 3‐6 d on their current formula and then for 5‐17 d on Neocate exclusively. All infants tolerated Neocate well and all improved, usually within 1–2 d. The total time spent crying and fussing was reduced by an average of 45%, representing a decrease of 1.0 to 5.2 h daily. After colic symptoms improved, infants were challenged with oral doses of 75 mg of bovine IgG at a 1 mg/ml concentration in order to assess its potential role in colic. Bovine IgG challenges resulted in increased crying and fussing behavior, suggesting that this protein may be etiologically important.
Comparison of the growth‐promoting effects of insulin‐like growth factor I and growth hormone in the early years of life
Authors: Laron Z , Klinger B
Published: August 2010

Aims: Four infants with isolated growth hormone deficiency (IGHD) and five with Laron syndrome (LS) were studied. Birth length ranged from –2.5 to –4.5 SDS in both groups. Results: Untreated IGHD children decreased in length from –2.5 to –5.2 SDS at 1 y and to –5.7 SDS at 2y. Human growth hormone (hGH) treatment (0.07 U/kg/d) increased height by 1.2−2.4 SDS in 3 y. Untreated children with LS decreased in length from –3.5 to –6.5 SDS. Insulin‐like growth factor (IGF)‐I treatment (150–200 M̈g/kg/d) in 3 LS patients increased height by 0.5–1.5 SDS in 3 y. All untreated infants had borderline or below normal head circumferences. Both treatments induced a rapid catch‐up in head size. In the two untreated LS patients, head circumference remained subnormal. Conclusions: Despite similar birth length, infants with IGHD responded better to hGH in terms of linear growth than did infants with LS to IGF‐I, whereas the response in brain growth was similar.
The mother‐offspring dyad and the immune system
Authors: Hanson LÅ
Published: August 2010

A. The mother and the fetus. The mother's immune system reacts against the fetus and there is therefore a risk of destruction of or damage to the fetus. We are now beginning to understand some of the mechanisms that protect the fetus, but, when these are defective, intrauterine growth retardation or abortions may ensue. However, the cytokines of this maternal immune response to the fetus also monitor different phases of pregnancy, starting with effects on the ovarium and involving preparation of the decidua for the implantation of the fertilized egg, the growth of the trophoblasts, the production of hormones important for the pregnancy and finally of the prostaglandins that induce delivery. B. The mother and the child. Human milk contains anti‐idiotypic antibodies which after transfer to the offspring are capable of enhancing antibody responses. Human milk contains numerous leucocytes especially during early lactation. There is increasing evidence that milk lymphocytes are taken up by the breastfed infant, which seems to have become tolerant to maternal HLA. Breastfeeding mothers are therefore good donors of renal transplants to their breastfed offspring in adult age, too.

Conclusion: It is suggested that the milk lymphocytes may be taken up by the offspring and that immunological information is thereby carried over from the mother. This mechanism may explain why breastfeeding seems to confer enhanced protection against infections also some years after the termination of breastfeeding.
Prevalence and characteristics of sexual abuse in a national sample of Swedish seventeen‐year‐old boys and girls
Authors: Edgardh K , Ormstad K
Published: August 2010

The aims of this study, which was part of a survey on adolescent sexual behaviour, were to investigate adolescents' experience of child sexual abuse and to present possible abuse‐related problems. Representative samples of 2% of Sweden's 17‐y‐old male and female students and school non‐attenders were selected in a two‐step procedure. In all, 1943 students and 210 school non‐attenders answered a self‐administered anonymous questionnaire, distributed by school nurses. Six out of 170 questions dealt with personal experiences of child sexual abuse, i.e. age at onset, frequency of abuse and relationship to the offender. Peer abuse was excluded by the definitions used. The overall response rate was 92.2% for students and 44.2% for school dropouts. Among male and female students, 3.1% and 11.2%, respectively, acknowledged sexual abuse, 2.3% and 7.1%, respectively, when exhibitionism was excluded. Mean age at onset was 9.1 y (SD 4.3) for boys and 9.0 y (SD 3.9) for girls; 1.2% of the boys and 3.1% of the girls reported abusive oral, vaginal and/or anal intercourse. Suicide attempts or other acts of self‐harm were reported by 33.3% of the male students reporting abuse and by 5.1%(p <0.001) of those who had not been abused, and by 30.4% of the abused student girls compared to 9.1% of the non‐abused (p < 0.001). Sleep and eating disorders, use of alcohol at an early age and/or experimentation with illicit drugs and consensual coitarche before age 15 y was reported significantly more often by abused than non‐abused girls (p < 0.001, differences not found among the student boys). Of school non‐attenders, 4% of the boys and 28% of the girls reported sexual abuse. Of the abused girls, 49% reported abusive vaginal intercourse and 64% reported self‐destructive behaviour or suicide attempts. No abused boys and few abused girls had confided in a teacher, health professional or social worker.

Results from the student sample should be interpreted as markers of “minimum prevalence”, as female school non‐attenders report significantly higher prevalence of sexual abuse. Potential high‐risk groups are better included in prevalence investigations of child sexual abuse. The fact that so few adolescents confided in “professionals” about the abuse, despite having severe symptoms and signs of distress, underlines the need to address sexual abuse when recording the social, medical and psychiatric histories of adolescents.
Parents' perception of mental development and behavioural problems in 8 to 9‐year‐old children
Authors: Larsson J‐O , Lichtenstein P , Fried I , El‐Sayed E , Rydelius PA
Published: August 2010

A slow maturational rate may be an underlying antecedent of a psychiatric disorder. If this is correct, differences in behavioural problems could be related to the maturity level in children of the same chronological age. The aim of the study was to compare the parents' perceptions and assessments of their children's maturational status and behavioural problems. A population based on a nationwide sample from the Swedish twin‐register of 8 to 9‐y‐old children (n= 1079) was used. The parents completed a questionnaire including their views on their child's maturity level, the Swedish version of the Child Behaviour Checklist (CBCL) and an Attention Deficit Hyperactivity Disorder (ADHD) checklist based on the DSM‐III‐R criteria. Multivariate analyses showed a statistically significant relationship between immaturity reported by the parents and several behavioural problems reported on the CBCL: somatic complaints, anxious and depressed, social problems, thought problems, attention problems, behaviour problems and aggressive behaviour. There was also a statistically significant relationship between the maturity factor and the CBCL grouping of syndromes (internalizing, externalizing, total behaviour problems score) as well as between the maturity factor and ADHD.

Conclusion: We conclude that at least from the parents' point of view the behaviour problems in their children may be related to maturity.
Sternal tuberculosis in a 9‐month‐old infant after BCG vaccination
Authors: Kato Y , Horikawa Y , Nishimura Y , Shimoda H , Shigeto E , Ueda K
Published: August 2010

Tuberculosis osteitis is mainly observed as a late complication of the pulmonary infection. We describe a 9‐mo‐old Japanese infant who became infected with Mycobacterium tuberculosis even after receiving Bacillus Calmette‐Guérin (BCG) vaccination at 3 mo of age. This is the first report that the sternum is the localizatio n for tuberculou s osteitis in infants. He developed a localized tumor in the sternum without any respiratory symptom. Mycobacterium tuberculosis complex was detected by means of nucleic acid amplification test. Gastric aspirates also yielded Mycobacterium tuberculosis. The source of the infection was unclear. Conclusion: Tuberculous osteitis should be excluded in infants with undiagnosed bone lesions, even if they have been vaccinated with BCG. ±BCG vaccination, infant, Mycobacterium tuberculosis, sternum, tuberculous osteitis
Survey of the pre‐school child health surveillance programme in Sweden
Authors: Kornfält R
Published: August 2010

A survey of the programme for developmental surveillance in the Child Health Centres (CHCs) in Sweden was performed using a questionnaire administered to the Chief Medical Officers (CMO) of the Child Health Services. The questionnaire asked about methods used for auditory examination, developmental surveillance and identification of disturbances in mother‐child interaction. Activities for health promotion concerning breastfeeding, non‐smoking and allergy prevention were also queried. Thirty‐four CMOs representing 1731 CHCs and 645000 children answered the questionnaire. The reply rate was 81%. Various methods of auditory examination are offered all infants and children in Sweden. The national guidelines for health supervision are followed fairly closely by all. Screening for disturbances in attention, motor development and perception (DAMP) is performed by all but four districts, with various methods, resources and degrees of co‐operation with school health services. Support in mother‐child interaction is considered very important and new methods to identify and treat disturbances are gradually introduced. Breastfeeding is encouraged; breast milk is the main source of food for 67% of babies at 4 mo of age. Activities to stop or diminish use of tobacco are ongoing everywhere, as are programmes to identify children at risk of developing allergies and for allergy prevention.

Thus, the Child Health Services maintain a high standard and are ambitious about introducing new methods and ideas.
Health promotion at Swedish Child Health Centres
Authors: Bremberg S
Published: August 2010

Effective health promotion intervention is understood to modify appropriate risk and protective factors. The relevance of such interventions for the Child Health Service (CHS) was examined in three steps. In the first step, the six most important public health problems in the target group that might be affected by CHS interventions were identified. The health problems include sudden infant death syndrome (SIDS), mental health problems, injuries, infections, asthma and allergic and nutritional disorders. In the second step, three groups of modifiable determinants were identified: risk and protective factors for (i) SIDS, asthma and allergic disorders and airway tract infections (determinants: breastfeeding, environmental tobacco smoke, sleeping non‐prone and lacking indoor ventilation), (ii) injuries and (iii) mental health problems. In the third step, evidence for the preventive measure's ability to alleviate the effects of these risk factors was scrutinized. Evidence was found for effectiveness of CHS interventions aiming at decrease of environmental tobacco smoke. Evidence was also found for injury prevention provided that the intervention is a part of a wider community effort, and possibly also if it is very focused. Requirements for mental health promotion are also at hand.

Thus, effective health promotion via CHS interventions is feasible.
Pediatric journals on the Internet
Authors: Gdalevich M , Mimouni D , Mimouni M
Published: August 2010

The objective of this study was to evaluate the structure and contents of the websites of the major journals in general pediatrics. A comprehensive search of the Internet was carried out to identify all pediatric journals in English that are listed in the Scientific Citation Index. Websites of 11 journals in general pediatrics were found, and their Web pages were systematically compared. Two of the appraised websites provided free on‐line access to the full journal text, seven had online abstracts, and all provided the table of contents. The contents and abstracts covered varying periods, mostly just a few years back. Most of the journals offered easy search and other navigational options, but only a few allowed electronic submission of manuscripts.

Conclusion: We conclude that in the era of immense growth and dissemination of information. aimed either at medical professionals or their patients, general pediatrics journals are lagging behind. The pediatrician today remains dependent on hospital libraries and their limited and sometimes cumbersome capabilities. Only a few of the pediatric journal websites can serve as an efficient online source for updating the knowledge. Further developments in the future should allow for improved services.
Human milk mineral intake and serum concentrations of calcium and phosphorus in newborn term infants: influence of intrauterine growth restriction
Authors: Mataloun MMGB , Leone CR
Published: August 2010

A prospective case–control study was performed to test the hypothesis that the milk Ca and P contents of term, small‐for‐gestational‐age (SGA) newborns’mothers differs from that of term, adequate‐for‐gestational‐age (AGA) newborns’mothers. We studied 71 pairs of mothers and newborns, divided into two groups: I (control): 41 pairs of mothers and term AGA newborns and I1 (study): 30 pairs of mothers and term SGA newborns. This latter group was subdivided according to type (symmetric: birthweight, length and head circumference < 10th percentile; asymmetric: birthweight < 10th percentile) and severity (<P3: birthweight <3rd percentile and >P3 – <P10: birthweight between 3rd and 10th percentiles) of intrauterine growth restriction (IUGR). Mothers’milk and blood samples were collected for Ca and P analysis using standard techniques (milk on days 3, 15 and 30 postpartum and blood from both the umbilical cord and the newborn on days 15 and 30 of life). There were no differences in blood and human milk Ca and P contents between the two groups. In the study group, milk (p= 0.001) and serum (p= 0.002) P levels and milk Ca (p= 0.002) levels increased during the first month of life. Regarding type and seventy of IUGR, milk P levels increased in the IUGR asymmetric and P3 – <P10 group.

Conclusion: These findings suggest a tendency towards differences in human milk between AGA and SGA newborns regarding longitudinal variations.
Postnatal cystic germinolysis and neonatal chronic lung disease: evaluation of risk factors and neurodevelopmental outcome
Authors: Smets K , Schwagten B
Published: August 2010

Late neonatal onset of subependymal germinolysis in the caudothalamic groove has been associated with chronic lung disease. This clinical study had two objectives: (i) to clarify the link between chronic lung disease and germinolysis; and (ii) to evaluate the impact of germinolysis on neuromotor development of patients with chronic lung disease. Twenty‐four patients with chronic lung disease and germinolysis were compared to 24 patients, matched for gestational age, with chronic lung disease but without germinolysis. There was no difference in the occurrence of perinatal risk factors for impaired cerebral development (small for gestational age at birth, impaired postnatal growth, postnatal steroid treatment, duration of mechanical ventilation) or in the presence of clinical markers potentially related to cerebral ischaemia (need for treatment of hypotension or poor perfusion, seizures, oliguria, hypocapnia). Both groups showed a high incidence of clinically significant developmental delay (mean Bayley Development Index of 72 ± 23 [SD] in both groups), regardless of the presence or absence of germinolysis.

Conclusions: We were unable to clarify the link between chronic lung disease and germinolysis, and it seems that germinolysis has no major impact on neurodevelopmental outcome of patients with chronic lung disease.
Neonatal withdrawal syndrome after in utero exposure to selective serotonin reuptake inhibitors
Authors: Nordeng H , Lindemann R , Perminov KV , Reikvam A
Published: August 2010

Selective serotonin reuptake inhibitors (SSRIs) are a new group of antidepressants used in mild to moderate cases of depression. In studies evaluating the safety of SSRIs during pregnancy, no increase in major anomalies has been reported. This might have led to increasing off‐label prescription of SSRIs to pregnant women. Neonatal withdrawal syndrome commonly occurs in infants exposed during the third trimester to drugs known to cause addiction. We report five cases of neonatal withdrawal syndrome after third trimester in utero SSRI exposure. In three cases the mother used paroxetine in doses from 10 to 40 mg, one mother used citalopram 30 mg, and one mother fluoxetine 20 mg. Withdrawal symptoms occurred within few days after birth and lasted up to one month after birth. Four of the infants needed treatment with chlorpromazine. Symptoms were irritability, constant crying, shivering, increased tonus, eating and sleeping difficulties and convulsions.

Conclusion: Neonatal withdrawal syndrome can occur after third trimester in utero SSRI exposure. Further research should focus on whether it is safe to use SSRIs during the last trimester. All neonates exposed to SSRIs during the last trimester should be followed‐up closely for withdrawal symptoms after birth.
Predicting serious bacterial infection in young children with fever without apparent source
Authors: Bleeker SE , Moons KGM , Derksen‐Lubsen G , Grobbee DE , Moll HA
Published: August 2010

The aim of this study was to design a clinical rule to predict the presence of a serious bacterial infection in children with fever without apparent source. Information was collected from the records of children aged 1‐36 mo who attended the paediatric emergency department because of fever without source (temperature ≥38°C and no apparent source found after evaluation by a general practitioner or history by a paediatrician). Serious bacterial infection included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, bacterial gastroenteritis, osteomyelitis and ethmoiditis. Using multivariate logistic regression and the area under the receiver operating characteristic curve (ROC area), the diagnostic value of predictors for serious bacterial infection was judged, resulting in a risk stratification. Twenty‐five percent of the 231 patients enrolled in the study (mean age 1.1 y) had a serious bacterial infection. Independent predictors from history and examination included duration of fever, poor micturition, vomiting, age, temperature <36.7°C or ≥40°C at examination, chest‐wall retractions and poor peripheral circulation (ROC area: 0.75). Independent predictors from laboratory tests were white blood cell count, serum C‐reactive protein and the presence of ≥70 white blood cells in urinalysis (ROC area: 0.83). The risk stratification for serious bacterial infection ranged from 6% to 92%.

Conclusion: The probability of a serious bacterial infection in the individual patient with fever without source can be estimated more precisely by using a limited number of symptoms, signs and laboratory tests.
Perianal anatomy in non‐abused preschool children
Authors: Myhre AK , Berntzen K , Bratlid D
Published: August 2010

The purpose of this study was to describe the normal variation in perianal anatomy in preschool children, selected for non‐abuse, and to compare the findings in two examination positions. A letter of invitation was sent to 3773 children, after which 305 children (103 boys and 202 girls) were recruited. Inclusion in the study was based on self‐selection, whereby parents who did not suspect any occurrence of sexual abuse of their child gave informed consent to participate. The mean age of the children was 5.63 y (range: 5.13–6.75). An anal examination was performed in the left lateral position (LLP) and the prone knee‐chest position (KCP), for approximately 30 s each. A colposcope and a camera were used. All data were systematically analysed for gender differences, and a paired sample test was used to compare findings in LLP and KCP. Venous congestion in LLP and external anal dilatation in both positions were significantly more common in girls, while midline depressions and smooth areas (both positions) were significantly more common in boys. External and total anal dilatation, midline smooth areas and depressions and the occurrence of a prominent anal verge were significantly more common in the KCP. The finding of total anal dilatation was rare.

Conclusion: We observed several gender and position differences in perianal anatomy, and most of these findings seem to be related to structure and tone in the anal muscles.
Short‐term prospective study of sleep disturbances in 5–8‐year‐old children
Authors: Smedje H , Broman J‐E , Hetta J
Published: August 2010

The course and psychological correlates of disturbed sleep during middle childhood were investigated using parents' responses to questionnaires. Five specified sleep disturbances were explored in 614 5–8‐y‐old children, at baseline and at follow‐up, 14 ± 3 mo later. Difficulties falling asleep, in 6.2% of the children at baseline, persisted in 47.4% of the cases at follow‐up; night‐waking, in 18.6% at baseline, persisted in 45.5%; snoring, in 9.4% at baseline, persisted in 60%; nightmares, in 4.4% at baseline, persisted in 29.6%, and bedwetting, in 6% at baseline, persisted in 46%. Moreover, children with difficulties falling asleep at baseline frequently displayed bedtime resistance and shorter sleep at follow‐up, while night‐waking at baseline was related to co‐sleeping at follow‐up. Snoring at baseline was associated with a trend towards restless sleep at follow‐up. Nightmares at baseline were related to several other sleep complaints as well as to behavioural difficulties during daytime at follow‐up. Bedwetting at baseline was associated with tendencies towards hyperactivity at follow‐up. Separate analyses of cases of persisting sleep disturbances showed that persisting difficulties falling asleep were associated with a need to remedy sleep problems, while persisting nightmares were strongly related to reports suggesting behavioural and emotional problems.

Conclusion: During middle childhood, difficulties falling asleep, night‐waking, snoring, nightmares or bedwetting commonly persist over the course of a year. Persistent nightmares frequently indicate significant psychological problems in affected children.
Is oxidative stress involved in the aetiology of pre‐eclampsia?
Authors: Poston L , Chappell LC
Published: August 2010

Pre‐eclampsia is one of the major indications for elective premature delivery. Several lines of evidence suggest that pre‐eclampsia is associated with a state of oxidative stress, offering hope of prevention by antioxidant supplementation. It was recently shown by the present authors that supplementation with vitamin C and E from early in pregnancy leads to a reduction in the incidence of the disease in “high‐risk” women.
Changes in body weight and body mass index (BMI) in teenage girls prior to the onset and diagnosis of an eating disorder
Authors: Swenne I
Published: August 2010

Growth charts from the school health services were used to study weight changes prior to the onset and diagnosis of eating disorders (ED) with weight loss in 122 teenage girls. In these girls menarche started at 12.6 ± 1.0 y (mean SD), which is the same for the general population. At their maximal premorbid weight, the girls were 14.6 ± 1.2 y of age and had a higher weight and body mass index (BMI) than the general population, as evidenced by standard deviation scores (SDS) above zero for weight (0.65 ± 0.95, p < 0.001) and BMI (0.61 ± 0.94, p < 0.001). Weight gain prior to the onset of weight loss followed two different patterns. Eighty‐three (68%) girls tracked upwards through the weight curves to reach their maximal weight, thus putting on weight at a higher rate than expected. Thirty‐nine (32%) girls tracked downwards through the weight curves to reach their maximal weight, but did so starting from a weight and BMI at well above average.

Conclusions: Weight gain in teenage girls prior to the onset of an ED deviates from that of the general population. Being or becoming heavier and less lean than their peers could influence body image and decisions on dieting, which, in turn, may be the start of the development of an ED in the otherwise predisposed. The deviation from normal tracking patterns prior to the onset of disease also causes problems in diagnostic procedures and in setting treatment targets for weight gain, since “normal” or expected weight becomes more difficult to establish.
Causes of childhood deaths in Bangladesh: an update
Authors: Baqui AH , Sabir AA , Begum N , Arifeen SE , Mitra SN , Black RE
Published: August 2010

Knowledge of the causes of child death is important for health‐sector planning since they relate to available interventions. Little is known about causes of child death in Bangladesh from the conventional sources since there is no vital registration system and very few deaths are attended by a qualified physician. To determine the cause structure of child deaths, verbal autopsy interviews were conducted in the Bangladesh Demographic and Health Survey (BDHS) 1993/94 national sample. Verbal autopsy is a method of finding out the causes of death based on an interview with the next of kin or other caregivers. Between BDHS 1993/94 and BDHS 1996/97, 1–4‐y‐old child mortality in Bangladesh declined by about 27.0%. This impressive decline prompted a verbal autopsy study using the BDHS 1996/97 national sample to determine whether the cause structure had changed. The same verbal autopsy instrument and methods to collect the data and the same computer algorithm to assign causes of death were used in both surveys. Comparison of BDHS 1993/94 and 1996/97 cause‐specific mortality rates revealed that deaths due to almost all causes had declined, although significantly so only for acute respiratory infections (ARI), persistent diarrhoea and drowning. Deaths due to neonatal tetanus, acute watery diarrhoea and undernutrition had not decreased at all.

Conclusion: Despite an impressive decline in deaths due to ARI, this condition remains the most important known cause of death in Bangladeshi children. Neonatal tetanus and measles together account for about 10% of deaths in children under 5 y. Further improvements in child survival are possible by improving access to and quality of available child survival interventions.
Childhood and adolescent tuberculosis in northern Taiwan: an institutional experience during 1994–1999
Authors: Wong KS , Chiu CH , Huang YC , Lin TY
Published: August 2010

This study evaluated the clinical characteristics of childhood and adolescent tuberculosis (TB) at the end of the twentieth century in a referral children's hospital in northern Taiwan. The hospital charts were reviewed retrospectively of children/adolescents aged less than 18 y who were seen in a children's hospital in northern Taiwan between 1994 and 1999 and diagnosed with TB. A total of 62 individuals was diagnosed during this period. The patients' demographic data, presenting symptoms, clinical features, bacteriological results, drug susceptibility and tuberculin skin‐test results were analysed. Most diagnosed cases lay in one of two main age ranges, younger than 5 y and adolescents. The presenting symptoms of study subjects were typically non‐specific. Bone involvement occurred for 21 patients (33.9%) and was the most common extrapulmonary manifestation. Mycobacterium tuberculosis was isolated from 47 patients (75.8%). Five isolates were resistant to pyrazinamide, three to streptomycin and one to isoniazid, but no multidrug resistant isolates of TB were detected from culture‐proven cases. Seventeen of 47 (36.2%) culture‐proven patients revealed negative acid‐fast staining initially but, subsequently, M. tuberculosis was isolated from various clinical specimens using a standard method at a later date. The tuberculin skin test was positive for 24 of 32 patients (75%) who received such an examination.

Conclusion: Extrathoracic TB was more common in children below 5y of age than their adolescent counterparts, and chiefly involved the peripheral long bones. The potential drug resistance of M. tuberculosis in childhood and adolescent TB did not appear to have been a major problem in northern Taiwan before the year 2000.
Organization of the neuronal circuits in the central nervous system during development
Authors: Lagercrantz H , Ringstedt T
Published: August 2010

The human brain is a product of genetic instructions, cellular interactions and influences of innate activity and external stimulation. The formation of the neural tube and the patterning of the brain are determined by homeotic genes. After a prosencephalic phase with the formation of the hemispheres, the neurons prolipherate to number about 100 billion halfway through gestation. They also migrate to their final positions in an inside‐outside fashion with the newly formed neurons at the outer layer of the cortex, followed by synaptogenesis, programmed cell death and organization of the neuronal circuits. This phase is probably determined not only by genes but also by innate activity, which for example has been detected in the foetal retina: “Cells that fire together wire together while those which don't won't”.

Conclusion: Development of the neuronal circuits in the CNS can be viewed as epigenetic, i.e. many different components must come together at the right time and place.
Molybdenum in infancy: balance studies in patients with intestinal stomata
Authors: Sievers E , Schleyerbach U , Oldigs H‐D , Arpe T , Schaub J
Published: August 2010

This study investigated the supply of the essential trace element molybdenum (Mo) in infants with preternatural anus. It was divided into two separate investigations: (A) the complete fecal excretion of nine patients was collected in fractions over 24 h; and (B) 72 h balance studies and parallel plasma analysis were conducted in five infants and complemented by the longitudinal comparison of one of these patients with his (otherwise healthy) premature sister. Atomic absorption spectroscopy (balance studies) and high‐resolution inductively coupled plasma mass spectrometry (HR‐ICP‐MS, plasma) were used for analysis. The following results were obtained. (A) The fecal Mo concentration ranged from 1.98 to 42.02 nmol Mo g−1 dry fecal weight. (B) The daily intake in the balance studies was 43.2 (11.33–100.5) nmol Mo kg−1 and the median retention was –2.91 (–32.45 to 48.6) nmol Mo kg−1. In the premature twins the boy with an intestinal stoma had a negative balance and lost –3.32 μmol within 32 d, while his sister retained +0.45 μmol Mo in the same period. Plasma Mo ranged between 9.4 and 46.7 nmol 1−1.

Conclusion: The negative Mo balance results may indicate an increased risk of Mo deficiency in infants requiring a long‐term preternatural anus.
Remission of thrombotic thrombocytopenic purpura in a patient with compound heterozygous deficiency of von Willebrand factor‐cleaving protease by infusion of solvent/detergent plasma
Authors: Kentouche K , Budde U , Furlan M , Scharfe V , Schneppenheim R , Zintl F
Published: August 2010

Plasma exchange or plasma infusion is considered to be the therapy of choice in patients with thrombotic thrombocytopenic purpura (TTP) who are deficient in von Willebrand factor‐cleaving protease (VWF‐CP). Recently, mutations in the ADAMTS13 gene were identified as being responsible for VWF‐CP deficiency in patients with familial TTP (VWF‐CP deficiency in the absence of an inhibitor). Here we report on a girl who presented with recurrent thrombocytopenia and anaemia since birth, developing the full pentad of characteristic TTP at the age of 16y. Congenital TTP was confirmed on the basis of severe VWF‐CP deficiency in the absence of an acquired inhibitor. The patient was found to be compound heterozygous for two hitherto undescribed mutations in the ADAMTS13 gene: a truncating frame shift mutation, 4143insA in exon 29, and the nonsense mutation 3100A > T in exon 24 (R1034X). After infusion of solvent/detergent plasma, the patient went into remission and remained asymptomatic under regular plasma therapy at 2‐wk intervals for over two years.

Conclusion: TTP in childhood may be mild and oligosymptomatic. Determination of VWF‐CP activity is helpful in the differential diagnosis of thrombocytopenia.
Are substitutions in the first hypervariable region of the mitochondrial DNA displacement‐loop in sudden infant death syndrome due to maternal inheritance?
Authors: Arnestad M , Opdal SH , Musse MA , Vege Å , Rognum TO
Published: August 2010

Aim: To investigate whether all substitutions in the first hypervariable region (HVR1) in sudden infant death syndrome (SIDS) can be recovered along the maternal line of the family (inherited), or whether SIDS victims have new substitutions compared to maternal relatives (somatic mutations) that may be related to environmental factors. Methods: Seventy‐one SIDS/mother pairs, including 11 families with SIDS, mother and mother's relatives and/or SIDS siblings, were studied. The HVR1 sequence was recorded in the base‐pair range 16056‐16400. The recorded HVR1 sequence was compared with the Cambridge sequence, and differences were recorded as substitutions. The substitution pattern in the SIDS victims was compared with the pattern found in family members along the maternal line. Results: All the substitutions found in SIDS victims could be traced in the maternal line of the family; in 5 cases this was observed through three generations, and in 3 cases through four generations. Discussion: In patients with known mitochondrial (mt) DNA disease, a large number of sequence variants have been found in the D‐loop region. Substitutions in the D‐loop may be part of a haplotype with mutations elsewhere in the mtDNA.

Conclusion: HVR1 substitutions in SIDS victims are hereditary and not due to somatic mutations.
Software and scan acquisition technique‐related discrepancies in bone mineral assessment using dual‐energy X‐ray absorptiometry in neonates
Authors: Picaud JC , Lapillonne A , Pieltain C , Reygrobellet B , Claris O , Salle BL , Rigo J
Published: August 2010

Aim: In adults, whole‐body mineralization assessment by dual‐energy X‐ray absorptiometry can be affected by the densitometer and/or the software used. As there are no published data on neonates, the aim of this study was to evaluate the magnitude of such effects in growing preterm infants. Methods: We analysed the absorptiometry results obtained from 44 preterm infants scanned at discharge and again 6 wk later using densitometers from the same manufacturer equipped with “Pediatric” (Group A, n= 24) or with “Infant” (Group B, n= 20) packages. Results of bone mineral content assessment were compared using an unpaired f‐test and a linear regression analysis. Results: At the time of the first absorptiometry (body weight = 2119 ± 144 g, n= 44), the bone mineral content was three times lower in Group A (10 ± 3 g) than in Group B (29 ± 4 g) (p < 0.001). Subsequently, on the second absorptiometry (body weight = 4037 ± 236 g, n= 44) such significant differences in bone mineral content (A: 65 ± 19 g, B: 66 ± 9 g, p= 0.85) were no longer in evidence. The differences in bone mineral content were related to differences in analysis algorithms between the two programs, which can lead to an overestimation of bone mineral content accretion when two successive measurements are made using the “Pediatric” package.

Conclusion: Considering that significant differences in bone mineral assessment may depend upon which program is used, data previously collected in low birthweight infants using the “Pediatric” package should be analysed with caution. Data obtained using the “Pediatric” and “Infant” packages are not directly comparable. Careful validation studies of future densitometers and programs are required before their use in clinical paediatric studies.
Prophylactic high‐frequency oscillatory ventilation in preterm infants
Authors: Calvert S
Published: August 2010

The role of high‐frequency oscillatory ventilation (HFOV) for the treatment of respiratory disease in preterm infants remains uncertain. Several randomized trials, comparing HFOV and conventional ventilation (CV) have been performed and their results suggest that HFOV may reduce the incidence of chronic lung disease (CLD) in preterm infants. However, the trials have several limitations and it remains unclear whether HFOV might increase intracranial pathology in very prematurely born infants. UKOS, a large, UK‐based, multicentre trial was conducted to establish conclusively the role of prophylactic HFOV for the prevention of CLD in infants born prior to 29 wk of gestational age.

Conclusion: There is still a need to fully evaluate prophylactic HFOV with particular emphasis on both short and long term respiratory and neurological outcomes.
Antimicrobial susceptibility of Haemophilus influenzae among children in Beijing, China, 1999–2000
Authors: Hu YY , Yu SJ , Liu G , Gao W , Yang YH
Published: August 2010

A study on the nasopharyngeal carriage and antimicrobial susceptibility of Haemophilus influenza among children was conducted in Beijing Children's Hospital from April to May 2000. The study included 292 children between 1 and 60 mo of age with acute upper respiratory tract infection. Nasopharyngeal swabs from these patients were cultured, and 105 Haemophilus influenzae strains were isolated, 3 of which were type b. Antibiotic susceptibility of the strains was determined using disk diffusion and E‐tests and the results compared with those of isolates from children with pneumonia in 1999. The carriage rate of Haemophilus influenzae was 36.0% (105/292). It was found that 4.8% and 1.0% of isolates were resistant to ampicillin and cefaclor, respectively, and 5.7%, 16.2% and 77.1% were resistant to chloramphenicol, tetracycline, and sulphamethoxazole/trimethoprim, respectively. Amoxicillin/clavulanic acid, cefuroxime, ceftriaxone, azithromycin, and clarithromycin were uniformly active to all strains. Compared with the data from 1999, there was a significant increase in resistance to tetracycline (from 12.7% in 1999 to 16.2%) and sulphamethoxazole/trimethoprim (from 40.5% in 1999 to 77.1%).

Conclusion: H. influenzae isolates from outpatients in Beijing Children's Hospital had low ampicillin resistance and were sensitive to amoxicillin/clavulanic acid. Sulphamethoxazole/trimethoprim resistance rates increased rapidly compared with those in the 1999 data. Further surveillance investigations are important for the choice of empiric therapy of acute respiratory tract infection.
Risk factors for invasive fungal infection in neonates
Authors: EI‐Masry FAY , Neal TJ , Subhedar NV
Published: August 2010

Invasive fungal infection is an uncommon, but increasing cause of morbidity and mortality in neonates. There are few controlled studies defining risk factors for the development of fungal infection in a contemporary neonatal population. This retrospective case‐control study was undertaken to investigate antenatal, demographic and postnatal variables that may be potentially important in the development of fungal infection. Two gestation‐matched controls were identified for each index case. Information about perinatal and demographic variables, as well as important neonatal outcomes, was obtained from case notes. Microbiological data collected included the presence of fungal colonization, and organisms responsible for invasive fungal infection. Over a 5‐y period, 24 infants with invasive fungal infection and 48 controls were identified. Candida albicans was the organism identified in 75% of cases of fungal septicaemia, and in all cases complicated by fungal meningitis. Preceding fungal colonization, pulmonary haemorrhage and intrauterine growth restriction were factors significantly and independently associated with invasive fungal infection. Fifty‐four percent of infants with invasive fungal infection died, and 82% of survivors developed chronic lung disease.

Conclusion: Some new and potentially important risk factors for the development of invasive fungal infection in a contemporary population of infants admitted to a neonatal intensive care were identified.