bluuebunny/crossref_metadata_2025 huggingface dataset:
Cutaneous polyarteritis nodosa in a child and a review of the literature
Authors: Mocan H , Mocan MC , Peru H , özoran Y
Published: August 2010

The cutaneous form of polyarteritis nodosa in children is extremely rare. Findings are usually limited to the skin, muscles and joints. It has a benign but often chronic course. We describe an 8‐y‐old girl with cutaneous PAN, with extensive livedo reticularis on lower and upper extremities, tender subcutaneous nodules, arthralgia and right ankle swelling. Skin biopsy revealed vasculitis of small and medium‐sized blood vessels characterized by fibrinoid necrosis. The use of prednisolone resulted in clinical improvement initially, but recurrence occurred during tapering. She showed marked improvement with additional high dose methyl prednisolone monthly.
Low immunoglobulin G3 levels in wheezy children
Authors: öuneş Ü , Güler N , Somer A , Salman N , Yalçin I
Published: August 2010

This study aimed to investigate the prevalence of IgG subclass deficiency in wheezy children aged <3y. Serum levels of IgA, IgE and IgG subclasses were measured in 310 children with recurrent wheezing and in 100 healthy controls. IgG3 levels were below the normal lower limit in 123 (39.6%) patients. This finding may reflect delayed maturation of the immune system, predisposing young children <3 y of age to wheezing.
The coexistence of thyroid autoimmunity in children and adolescents with various allergic diseases
Authors: Lindberg B , Ericsson U‐B , Fredriksson B , Nilsson P , Olsson CM , Svenonius E , Ivarsson S‐A
Published: August 2010

The aim of our study was to investigate the coexistence of thyroid autoimmunity and allergic diseases. The prevalence of thyroid autoantibodies was studied in sera from 140 children with different kinds of allergic diseases, 370 11‐13‐y‐old schoolchildren without allergic diseases serving as controls. The prevalence of thyroid peroxidase autoantibodies was found to be higher among the patients than in the control group, 11.4% vs 5.4%(p < 0:05). Ultrasound investigation identified autoimmune thyroiditis in 4.3% (6/140) of the series, which was later confirmed with fine needle aspiration in all six cases, four of which were unknown prior to the study. Our findings may be useful to alert clinicians that thyroid diseases may be superimposed on allergic children.
Benign intracranial hypertension and recombinant growth hormone therapy in Australia and New Zealand
Authors: Crock PA , McKenzie JD , Nicoll AM , Howard NJ , Cutfield W , Shield LK , Byrne G
Published: August 2010

Benign intracranial hypertension (BIH) is reported in three children from Australia and one from New Zealand, who were being treated with recombinant human growth hormone (rhGH). Three males and one female, aged between 10.5 and 14.2 y, developed intracranial hypertension within 2 weeks to 3 months of starting treatment. A national database, OZGROW, has been prospectively collecting data on all 3332 children treated with rhGH in Australia and New Zealand from January 1986 to 1996. The incidence of BIH in children treated with growth hormone (GH) is small, 1.2 per 1000 cases overall, but appears to be greater with biochemical GHD (<10IUml ‐1), i.e. 6.5/1000 (3 in 465 cases), relative risk 18.4, 95% confidence interval 1.9‐176.1, than in all other children on the database. The incidence in patients with Turner's syndrome was 2.3/1000 (1 in 428 cases). No cases in patients with partial GHD (10–20 IUml ‐1) or chronic renal failure were identified. Possible causative mechanisms are discussed. The authors’practice is now to start GH replacement at less than the usual recommended dose of 14IUm‐2 week‐1 in those children considered to be at high risk of developing BIH. Ophthalmological evaluation is recommended for children before and during the first few months following commencement of rhGH therapy and is mandatory in the event of peripheral or facial oedema, persistent headaches, vomiting or visual symptoms. The absence of papilledema does not exclude the diagnosis.
Multicentre survey on compliance with growth hormone therapy: what can be improved?
Authors: Oyarzabal M , Aliaga M , Chueca M , Echarte G , Ulied A ,   on behalf of the Collaborative Group
Published: August 2010

A survey was undertaken to evaluate compliance in Spanish patients receiving growth hormone treatment. The 28‐item structured questionnaire was designed to collect data on compliance, treatment schedule, device used and instruction received. In total, 473 questionnaires were completed in 17 paediatric endocrine units. Compliance was divided into four categories based on percentage of doses omitted, classified as excellent if 0%, good <5%, fair 5–10% and poor >10%. The level of compliance was excellent in 74.0%, good in 20.1%, fair in 3.4% and poor in 2.5%. Compliance was better in those who injected themselves (p < 0:01), were trained by hospital staff (p < 0:01) and used automatic pens (p < 0:05). Patients using conventional syringes were less likely to comply (p < 0:05). More information on growth hormone treatment was requested by 57.6% of patients. The results indicate that the specialist nurse should spend sufficient time with the patients and relatives to ensure a higher compliance rate.
Doppler echocardiographic assessment of pulmonary blood flow in healthy newborns
Authors: Gournay V , Cambonie G , Rozé JC
Published: August 2010

The aim of this study was to determine interobserver variation in Doppler assessment of mean left pulmonary arterial flow velocity, and its normal values during the first 24 h of life. The interobserver variation was determined by a Bland and Altman analysis of the values of mean velocity measured in 21 newborns by 2 observers. Then, normal values of mean velocity were measured in 15 newborns at 5,10 and 15 min of life in the delivery room, and in 14 other newborns at 1, 2, 6, 12 and 24 h of life in the nursery unit. The interobserver variation was found to be acceptable. Mean velocity had a few variations within the first 24 h, but remained consistently above 20 cm s‐1. In conclusion, mean velocity values below 20 cm‐1 suggest low pulmonary blood flow.
Routine vaccination and vaccine‐preventable infections in children born to human immunodeficiency virus‐infected mothers
Authors: Dunn DT , Newell M‐L , Peckham CS , Vanden Eijden S
Published: August 2010

Information on vaccinations and vaccine‐preventable infections collected in a prospective study of children born to human immunodeficiency virus (HIV)‐infected mothers was analysed for reports of adverse reactions and to estimate the clinical efficacy of vaccines. No vaccinated, HIV‐infected child developed measles (56 child‐years’follow‐up), mumps (33), rubella (33) or pertussis (239), and only one adverse reaction ‐ to Bacillus Calmette‐Guerin (BCG) ‐ was reported. These findings provide limited evidence of the safety and efficacy of routine vaccination of HIV‐infected children.
Exploration of glucose homeostasis during fasting in growth hormone‐deficient children
Authors: Jaquet D , Touati G , Rigal O , Czernichow P
Published: August 2010

In order to define more precisely the risk of hypoglycaemia in GH‐deficient children and to clarify the role of growth hormone (GH) in glucose homeostasis, a 24‐h fast was monitored in 10 GH‐deficient children aged 1.1–6.5y. Asymptomatic hypoglycaemia (blood glucose ≤ 2.6mmol/l) occurred in 9/10 children, 2 of whom prematurely interrupted the test. Blood glucose profile was not reproducible between children and had no correlation with age (p= 0:48). Gluconeogenesis was considered as non‐altered as read from the normal plasma lactate and pyruvate concentrations throughout the test. Plasma ketone body concentrations increased during the test, but were lower than expected with respect to the decrease of blood glucose. This suggests insufficient ketogenesis which could exacerbate hypoglycaemia in GH‐deficient children if brain glucose utilization were not alleviated by ketone body oxidization, as is normally the case. The positive glucose response after glucagon stimulation in 6/10 patients indicated normal hepatic glycogen content. However, these responses were unexpected following the prolonged fast and its concomitant hypoglycaemia, and would therefore tend to suggest a defect in glycogenolysis. These results confirm the tendency to hypoglycaemia, even after infancy, in GH‐deficient children. These hypoglycaemias may occur by different types of malfunctioning, such as insufficient ketogenesis or a defect in glycogenolysis. These hypotheses require confirmation by a more systematic study of the metabolic and hormonal changes that occur during fasting in both GH‐deficient and normal children.
Once versus twice daily injections of growth hormone in children with idiopathic short stature
Authors: Phillip M , Hershkovitz E , Belotserkovsky O , Leiberman E , Limoni Y , Zadik Z
Published: August 2010

The aim of this study was to compare the growth response of 22 short pre‐pubertal children without growth hormone deficiency, treated with a single daily growth hormone injection (group A), to the growth response of 27 similar children, treated with the same daily dose divided into 2 subcutaneous injections per day (group B), for 1 y, in a randomized study. GH treatment significantly promoted growth parameters, height standard deviation score and height velocity standard deviation score in both groups. Serum insulin‐like growth factor I was also increased. There were no significant differences in growth response, serum IGF‐I levels, or the advance in bone age between the two study groups after 1 y of GH therapy. We conclude that twice daily s.c. growth hormone injections provide no advantages over once daily injection of the same dose in promoting the linear growth of short children without growth hormone deficiency.
Ketoacidosis occurring in newly diagnosed and established diabetic children
Authors: Smith CP , Firth D , Bennett S , Howard C , Chisholm P
Published: August 2010

A 6‐y retrospective case note review was performed to determine the causes of ketoacidosis. 135 patients and 463 diabetic years were involved. Fifty‐two ketoacidosis episodes occurred: 19 episodes in new patients and 33 episodes in 19 patients with established diabetes. 27% of newly diagnosed patients presented in ketoacidosis. They were similar in terms of age, sex and proportion living in single parent families to those presenting without ketoacidosis. The 33 ketoacidosis episodes occurring in established patients included 12 episodes in 3 children who were transferred to our care because of uncontrolled diabetes. Insulin omission was the cause of ketoacidosis in 9/19 (47%) patients, and was suspected in a further 5/19 (26%). Family and school problems were common and 14/19 patients came from single parent families. Established patients aged ≥11 y were predominantly female (10F, 2M), whereas patients aged ≥10y were predominantly male (6M, 1F). 7 patients with multiple ketoacidosis episodes were all ≥11 y and 6 were female. Families with ≥2 diabetic children appeared vulnerable, 4 cases coming from 3/7 such families.
Normal growth of prepubertal nephrotic children during long‐term treatment with repeated courses of prednisone
Authors: Saha M‐T , Laippala P , Lenko HL
Published: August 2010

The growth of 21 prepubertal children with steroid‐dependent frequently relapsing nephrotic syndrome was studied before and during treatment with repeated courses of oral prednisone for 4 y. The height and height velocity standard deviation scores (HSDS and HVSDS) of the nephrotic children were ‐0.11 and ‐0.06, respectively, at the onset of the disease and ‐0.12 and +0:05, +0:14 and +1:02, +0:21 and +0:78 and +0:17 and +0:66, respectively, thereafter yearly during the treatment. The mean yearly cumulative dose of prednisone was 6300, 3459, 2677 and 2081 mg/body area (m) at the first, second, third and fourth year, respectively. The nephrotic children grew normally for their age before onset of the disease and growth remained normal despite prednisone treatment.
Incidence rate of first‐time symptomatic urinary tract infection in children under 6 years of age
Authors: Mårild S , Jodal U
Published: August 2010

A retrospective population‐based study was performed to describe the incidence rate of first time symptomatic urinary tract infection in children under 6 y of age. A total number of 299 children was identified during the 20‐month study period in a population of 20 000 girls and 21 000 boys. The cumulative incidence rate during the first 6y of life was 6.6% for girls and 1.8% for boys. The annual incidence rate in girls of urinary tract infection/1000 at risk was between 9 and 14 for each of the six 1‐y age intervals. In girls, the proportion of febrile urinary tract infection was high during the infant year, while girls older than 2 y most often had non‐febrile infection. For infant boys, the incidence rate and the proportion of febrile urinary tract infection were comparable to that of girls, while after the first year of life urinary infection of any kind was rare, with an incidence rate of 1–2/1000 at risk.
Factitious illness by proxy presenting as anorexia and polydipsia by proxy
Authors: Moszkowicz M , Bjørnholm KI
Published: August 2010

Factitious illness by proxy is a highly pathological form of parent‐child relationship. To our knowledge no former case of polydipsia by proxy has been published. The case of a 2‐y‐old boy suffering from malnutrition due to displacement of maternal anorexia and polydipsia is presented. Child psychiatric evaluation found cognitive delay and psycho‐social impairment in the child, as well as a severe mother‐child relationship disturbance. Psychological assessment showed a personality disorder with depressive and paranoid features in the mother. The father was described as a schizoid personality. The possible mechanisms of displacement are hypothesized.
Potassium homeostasis: ontogenic aspects
Authors: Aizman R , Grahnquist L , Celsi G
Published: August 2010

Potassium is the most abundant intracellular cation and plays an important role in a variety of cell functions. Potassium regulation and homeostasis during infancy are, owing to growth and development, different from in later life: infants need to retain more K+than adults, to avoid growth retardation. Since the K+requirements are different in infants and in adults, the mechanisms regulating K+homeostasis also need to be different. This paper includes a review of the literature concerning the regulation of internal and external K+balances during ontogeny. We examined the role of gastrointestinal tract, kidney and some tissue stores in K+excretion and distribution during development. We conclude that positive K+balance in infancy is characterized by higher K+absorption in gut, lower K+secretion/excretion in kidney and immaturity of the mechanisms regulating intra/extracellular K+distribution. Several factors contribute to maintain the positive K+balance. They include higher expression of absorptive transporters in colon and probably in kidney, lower expression of secretive transporters in colon and kidney, lower renal K+excretion following K+loading, immaturity of hepato‐renal K+reflex mechanism, immaturity of tissue K+binding/ releasing capacity and immaturity of the neuro‐hormonal control of K+transport in several organs.
Incidence of febrile convulsions in children with congenital hypothyroidism
Authors: Asami T , Sasagawa F , Kyo S , Asami K , Uchiyama M
Published: August 2010

Brain excitability has been inconsistently reported to be increased both in hypo‐ and hyperthyroidism, but there have been few studies on the effects of thyroid hormones on brain excitability in children. With this in mind, we investigated the incidence of febrile convulsions (FCs) among patients with congenital hypothyroidism, who have been taking L‐ thyroxine since the age of 1 month. The incidence of FCs among congenital hypothyroid patients was 1.6% (1/63) which was significantly low (p < 0:05) compared with that of normal control children who visited our hospitals as outpatients (28/341, 8.2%) and that of others (322/3301, 9.8%) investigated 33 years ago in the same area. The incidence of FC among siblings of the 63 patients (7/74, 9.5%) was not statistically different from the controls. At least 8 of the 126 parents (6.4%) had experienced FC, however, only one child was affected in the 8 families. In conclusion, it seems likely that patients with congenital hypothyroidism on regular L‐T4 replacement are less prone to experience FC. More studies on the incidence of convulsive disorders in children with thyroid diseases are needed to clarify the effects of thyroid hormones on brain excitability.
Cerebrospinal fluid shunt infections in infants and children in Mobile, Alabama
Authors: Mancao M , Miller C , Cochrane B , Hoff C , Sauter K , Weber E
Published: August 2010

Cerebrospinal fluid shunt systems are used to treat hydrocephalus in infants and children; unfortunately, some shunt systems become infected. We sought to define the epidemiology of shunt infections and shunt survival prior to infection at our institution. We identified 268 shunt procedures performed from January 1990 to June 1996 in 145 patients. There were 29 episodes of shunt infection for an incidence of 10.8% per procedure and 13.1% per patient. Staphylococcus epidermidis was the most common isolate recovered. The probability of shunt infection was highest during the first 8 weeks after a shunt procedure and subsequent infection was less likely after 28 weeks.
Erythrocyte indicators of oxidative stress in gestational diabetes
Authors: Kamath U , Rao G , Raghothama C , Rai L , Rao P
Published: August 2010

Foetuses born to mothers with gestational diabetes are at increased risk of developing respiratory distress, foetal macrosomia, foetal anomalies and platelet hyperaggregability. High blood glucose level induces oxidative stress and decreases antioxidant defences. The present study discusses the possibility of lipid peroxidation and protein oxidation in both maternal and foetal erythrocytes as an indicator of oxygen radical activity. The level of lipid peroxidation and protein oxidation in erythrocytes was estimated in 20 mothers with gestational diabetes and their newborns. The maternal age varied between 19 and 42 y and foetal age ranged between 34 and 39 weeks. The proteolytic activities in the erythrocyte lysates obtained from mothers with gestational diabetes and their newborns were significantly greater [(mean ± SD) 24.41 ± 9.05 and 16.70 ± 3.36μM of amino groups/g haemoglobin, n= 20, respectively] than those from control group (10.18 ± 4.84 and 14.64 ± 6.21 μM amino groups/g haemoglobin, n= 15, respectively; p < 0:05 in both cases). Similarly erythrocyte malondialdehyde levels were significantly elevated in babies born to mothers with gestational diabetes (10.11 ±2.21 nM/g haemoglobin) when compared to controls (6.8 ± 3.75 nM/g haemoglobin) (p < 0:05). In the erythrocytes of mothers with gestational diabetes, malondialdehyde levels correlated significantly with glycated haemoglobin levels (p < 0:01). The results of this study indicate that the oxidative stress induced by gestational diabetes manifests as increased lipid peroxidation and protein oxidative damage in the erythrocytes of both mothers with gestational diabetes and their newborn infants.
Successful use of tissue plasminogen activator (t‐PA) in catheter‐related intracardiac thrombi of two premature infants
Authors: Giuffrè B , Compagnoni G , Farina C , Mosca F
Published: August 2010

We describe the cases of two premature infants carrying a central venous line who developed on the fourth day of life a catheter related intracardiac thrombus. Although they were clinically asymptomatic we opted for thrombolytic treatment considering the potential risks of this situation. Treatment with recombinant tissue plasminogen activator (rt‐PA) was performed for one day in the first case and for three days in the second one, in association with fresh frozen plasma. Thrombus dissolution occurred in both patients and no adverse effects were noted. In our experience tissue plasminogen activator was a therapy acceptably safe and effective inducing clot lysis in very low birthweight neonates into critical situations.
Toxic Shock Syndrome in a neonate?
Authors: Carvalho L , Neves JF
Published: August 2010

Toxic Shock Syndrome is an acute multisystemic disease, characterized by high fever, hypotension and involvment of the skin and mucous membrane, associated with multisystem dysfunction. It is a rare condition in the paediatric population. We describe a newborn child with asphyxia and meconium aspiration, who developed a temperature of ≥ 38.9oC, severe hypotension and rash with desquamation, associated with evidence of coagulopathy and renal and muscular dysfunction. Strict CDC criteria of toxic shock syndrome were fulfilled in our patient, with all major criteria verified. These criteria have never been validated in neonates, but in this case some symptoms favour a diagnosis of toxic shock syndrome since they are not associated with birth asphyxia, viral intrauterine infection or other disease. We believe a probable intrapartum transmission occurred through ingestion or aspiration of contaminated amniotic fluid. The patient described in this report is, to our knowledge, one of the youngest described to fulfil all of the strict CDC criteria for Toxic Shock Syndrome.
Are elevated cerebrospinal fluid levels of IL‐6 in sudden unexplained deaths, infectious deaths and deaths due to heart/lung disease in infants and children due to hypoxia?
Authors: Vege Å , Rognum TO , Aasen AO , Saugstad OD
Published: August 2010

Many SIDS cases probably die after periods of hypoxia and it has been shown that hypoxia may stimulate IL‐6 production. The purpose of this paper was to examine if there were any correlations between hypoxanthine in vitreous humour and II‐6 in CSF. The concentration of IL‐6, IL‐1β and TNFα in cerebrospinal fluid of 50 Sudden Infant Death syndrome (SIDS) cases, 9 borderline SIDS cases, 18 infectious deaths, 8 violent deaths and 22 cases with heart/lung disease were measured by ELISA. The hypoxanthine (Hx) vitreous humour concentrations in the same groups were determined by high performance liquid chromatography. The IL‐6 levels in cases of infectious death, heart/lung disease and borderline cases were significantly higher than in the SIDS cases (p < 0:01). The Hx levels were in the same range in cases of SIDS, borderline SIDS and infectious death, and they were significantly higher than the levels in cases of violent death and heart/lung disease (p < 0:01). There was no correlation between hypoxanthine and IL‐6 in any of the groups. In the cases studied IL‐6 elevation is probably not induced by hypoxia, but is rather a result of immunological stimulation.
Importance of training for correct Turbuhaler use in preschool children
Authors: Agertoft L , Pedersen S
Published: August 2010

Aim: To study the impact of both audiovisual information and nurse‐training on the use of budesonide Turbuhaler in preschool children who had never used a dry powder inhaler. Design: A single‐blind, randomized, parallel‐group trial studied 72 children aged 3–5 y. All children and their parents were shown an instructional video and given written instruction. After this, peak inspiratory flow (PIF1) through Turbuhaler was measured. Children in group A (n= 36) then received individual training by a nurse while those in Group B (n= 36) did not and PIF2 was measured. Afterwards, Group B received similar individual training while Group A received no additional training, and PIF3 was measured. Group A was given a placebo Turbuhaler and encouraged to practice at home. Two weeks later, both groups returned to the clinic where PIF4 was measured. Results: The number of children who were able to correctly perform PIF1, PIF2 and PIF4 in Group A was 27, 34 and 36, respectively. The corresponding numbers for Group B were 30,29, and 29. No effect of training was seen in 3‐y‐old children. Individual training by a nurse was associated with a statistically significant increase inPIF2 (10l/min;p= 0:014). Moreover, 2 weeks of home training was associated with an additional increase in PIF of 8l/min compared with Group B (p < 0:015). After individual instruction and home training, mean PIF in children aged 4 and 5 was 56 (42‐72) and 55 (41‐66) l/min, respectively. Conclusion: After individual instruction and training at home, the vast majority of children aged 4 and 5 y can use Turbuhaler correctly. Audiovisual information and individual instruction is not sufficient in the majority of these children. Few 3‐y‐old children can learn the correct use of Turbuhaler.
Nursery Neurobiologic Risk Score and outcome at 18 months
Authors: Lefebvre F , Grégoire M‐C , Dubois J , Glorieux J
Published: August 2010

The aim of this study was to confirm the predictive value of the nursery Neurobiologic Risk Score. Prospectively, 121 infants (mean birthweight 961 ± 179 g, gestation 27.0 ± 1.2 weeks) were followed at 18 months. The nursery Neurobiologic Risk Score was correlated to the developmental quotient (r=– 0.54). From low (scores 0‐4), to moderate (scores 5–7) to high (scores ≥8) risk groups, respectively, significant differences were found in mean developmental quotient (101 ± 9 vs 92 ± 19 vs 76 ± 24) and in prevalence of developmental quotients < 90 (12 vs 24 vs 71%), of cerebral palsy (4 vs 19 vs 41%), of severe disabilities (0 vs 24 vs 50%) and of any disability (16 vs 30 vs 71%). Sensitivity, specificity, positive and negative predictive values for any disability were 81, 54,49 and 84% for a score ≥ 5 and 56, 87, 71 and 78% for a score ≥ 8. The nursery Neurobiologic Risk Score was useful in predicting 18 months outcome of very premature infants.
Childhood hypersensitivity pneumonitis probably caused by cat hair
Authors: Olesen HV , Thelle T , Møller JCF
Published: August 2010

A case is reported of a 10‐y‐old boy with hypersensitivity pneumonitis probably caused by his cat. Hypersensitivity pneumonitis caused by animal hairs is reported in furriers, but hypersensitivity pneumonitis in children has only been described as caused by birds, moulds or other fungi. Steroid treatment may interfere with the possibility of finding the causative antigen.
Influence of breastfeeding and complementary food on growth between 5 and 10 months
Authors: Nielsen GA , Thomsen BL , Michaelsen KF
Published: August 2010

The aim of this study was to examine the nature of the association between breastfeeding, complementary feeding and growth in a random sample of infants from Denmark, where the prevalence of breastfeeding is high. A semiquantitative food frequency questionnaire and a questionnaire on breastfeeding duration and on weight and length measurements taken at the infant welfare visit at 5 and 10 months were sent to 590 families with 10‐month‐old infants. A total of 339 infants with complete growth data were included in the analyses. When controlling for mid‐parental height and birth weight infants breastfed for ≥ 7 months gained 198 g less in weight (p < 0:01) and 7 mm less in length (p < 0:01) during the period from 5 to 10 months than infants breastfed for < 7 months. Controlling for these effects, the 10% of the sample with the highest protein intake (i.e. ≥16 energy percentage) gained 262g more than those with a lower protein intake (p= 0:03). Infants breastfed for ≥ 7 months received significantly less cow's milk (p < 0:01), and fewer meat‐containing dishes (p < 0:05) and sweets or cakes (p < 0:01), which may partly explain the effect of breastfeeding. The long‐term consequences of this moderate difference in growth velocity are unknown and the findings should not be used to advocate against breastfeeding during late infancy.
Lymphocyte subsets and cytokines in adenoviral infection in children
Authors: Mistchenko AS , Koch ERR , Kajon AE , Tibaldi F , Maffey AF , Diez RA
Published: August 2010

To determine the distribution of major blood lymphocyte subsets we evaluated blood lymphocytes by flow cytometry in adenovirus‐infected infants aged 30–730 d. In addition, interleukin‐1‐receptor antagonist, interleukin‐10 and transforming growth factor‐β1 were measured in serum by enzyme‐linked immunosorbent assay. According to clinical parameters, mechanical ventilation and outcome, infections were classified as moderate (n= 15), severe (n= 11) and fatal (n= 12). Controls were 13 healthy children. In severe and fatal infection, T cells (CD5+/CD19‐), NK effectors (CD16+), CD4+ T subset and B1 subset of B lymphocytes (CD5+/CD19+) were all significantly decreased. CD8+ cells were decreased in severe but not fatal cases. There was no difference in serum values of interleukin‐10; however, fatal cases had high interleukin 1‐receptor antagonist values. Interestingly, patients with moderate infection showed significantly increased values of transforming growth factor‐β1. These results demonstrate that life‐threatening adenoviral infection is associated with marked abnormalities in blood lymphocyte and cytokine profile.
Streptococcus pneumoniae isolated from a paediatric population: changes in 10 years
Authors: Latorre C
Published: August 2010

Susceptibility to penicillin, cefotaxime, erythromycin and chloramphenicol, as well as serotypes of 100 Streptococcus pneumoniae strains isolated between 1984 and 1985, were compared to those of the same number of strains isolated between 1994 and 1995. The strains were obtained in Hospital Sant Joan de Déu, Barcelona, and were thought to be the cause of a variety of infectious diseases in paediatric patients attending this centre. Minimal inhibitory concentrations (MICs) of penicillin were higher in strains of the second period (51% of resistant strains during the first period vs 61% during the second one), as were those of cefotaxime (12% vs 18%) and erythromycin (6% vs 36%), while chloramphenicol MICs showed a light decrease (65% vs 46%). Serotypes 6, 19 and 23 were the most prevalent. Five new serotypes (4, 10, 18, 22 and 31) were detected in 10 penicillin‐susceptible strains during the second period. Because of the increase in resistance to antibiotics commonly used in the treatment of systemic and localized infections, therapeutic alternatives must be studied and suggested in order to offer oral and percutaneous treatment for our children's infections caused by pneumococci.
Vitamin K in preterm breastmilk with maternal supplementation
Authors: Bolisetty S , Gupta JM , Graham GG , Salonikas C , Naidoo D
Published: August 2010

Six healthy lactating mothers who gave birth to preterm infants at a median post conceptional age of 29.5 (range 26‐30) weeks were given 2.5 mg phylloquinone (vitamin K1) orally daily for 2 weeks beginning at a median postconceptional age of 31.5 (range 28–32) weeks. Phylloquinone was measured in the breastmilk daily for 14 d. Trough plasma phylloquinone concentrations were also determined on four occasions. Phylloquinone levels in the breastmilk increased from a baseline of 3 ± 2.3ngml‐1 to 22.6 ± 16.3 ng ml‐1 (mean ± SD) after the first dose (p < 0:05); a gradual increase was noted until phylloquinone levels reached a plateau of 64.2 ± 31.4ng ml‐1 after the sixth daily dose.
A case of vertical transmission of hepatitis A virus infection
Authors: Erkan T , Kutlu T , Çullu F , Tümay GT
Published: August 2010

We present a case of hepatitis A infection in a 2.5‐month‐old male who became icteric after 18 d of birth. The diagnosis of hepatitis A was made by compatible clinical symptoms, laboratory results and liver biopsy showing evidence of hepatitis, and confirmed by detection of anti‐HAV IgM antibodies. Because the mother had an acute icteric hepatitis A 1 week before delivery, and the viraemic phase of hepatitis A infection is very short, approximately 7 d, we suggest that the infant was infected by his mother, before birth.
Congenital chylothorax in siblings
Authors: Fox GF , Challis D , O'Brien KK , Kelly EN , Ryan G
Published: August 2010

We describe two cases of congenital chylothorax in siblings with important differences from previously described familial cases. Our findings support the likelihood of an autosomal recessive inheritance in some cases of this condition, rather than X‐linked recessive inheritance, which has also been suggested. Autopsy findings from one of these cases and others previously described suggest that the pathophysiological mechanisms involved may be variable.
Oral bedtime cornstarch supplementation reduces the risk for nocturnal hypoglycaemia in young children with type 1 diabetes
Authors: Detlofson I , Kroon M , Åman J
Published: August 2010

Detlofson I, Kroon M, Åman J. Oral bedtime cornstarch supplementation reduces the risk for nocturnal hypoglycaemia in young children with type 1 diabetes. Acta Pædiatr 1999; 88: 595‐7. Stockholm. ISSN 0803‐5253

The effect of oral cornstarch supplementation was evaluated in 14 pre‐school children with type 1 diabetes in a randomized, double‐blind, placebo‐controlled trial. The children received cornstarch (0.3 g/kg) or placebo at bedtime on five occasions each, and their blood glucose concentrations were measured at bedtime, at 02.00 h and in the morning. The mean nocturnal blood glucose concentration (at 02.00 h) was 2.2 mmol/L higher and the number of blood glucose concentrations below 5 mmol/L were reduced by 64% when cornstarch had been ingested at bedtime. We conclude that cornstarch may be used in pre‐school children with type 1 diabetes to reduce the risk for nocturnal hypoglycaemia. □Cornstarch supplementation, diabetes mellitus, hypoglycaemia, pre‐school children
Clinical symptoms and social factors in a cohort of children spontaneously clearing Helicobacter pylori infection
Authors: Tindberg Y , Blennow M , Granström M
Published: August 2010

Tindberg Y, Blennow M, Granström M. Clinical symptoms and social factors in a cohort of children spontaneously clearing Helicobacter pylori infection. Acta Pædiatr 1999; 88: 631‐5. Stockholm. ISSN 0803‐5253

In a cohort study of 305 Swedish children, repeated blood samples and structured questionnaires were obtained from 6 mo to 11 y of age. Of the 40 children seropositive for Helicobacter pylori in one or more samples, 32 (80%) had cleared the infection by 11 y of age. No association was found between H. pylori seropositivity at any time and reported antibiotic consumption, size of home and family, type of day‐care, history of atopic disease, length of breastfeeding or peptic ulcer disease in the family. Girls reported more (p = 0.002) unspecified abdominal pain during childhood than boys, but the difference in H. pylori infection rate (15/150, 10% for boys and 25/144, 17% for girls) was not significantly different (p = 0.09). Unspecified abdominal pain during childhood was reported more often (OR adjusted for gender = 2.2, 95% CI = 1.0‐4.4, p = 0.04) for the children seropositive at some point (17/39, 44%) than for the seronegative children (54/217, 25%). RAP at 11 y of age was more often reported by the 9/36 (25%) children seropositive at some time in life than by the 23/172 (13%) seronegatives, but the difference was not statistically significant (OR adjusted for gender = 2.0, 95% CI = 0.8‐4.6, p = 0.1). The study shows that H. pylori seropositivity was associated with a parental report of unspecified abdominal pain during childhood. Also, a history of unspecified abdominal pain was more common (OR = 51.6, 95% CI = 15.6‐220, p< 0.001) in children reporting RAP at 11 y of age. □Childhood infection, H. pylori, socioeconomic conditions
Assisted mechanical ventilation using combined elastic and resistive unloading in cats with severe respiratory failure: effects on gas exchange and phrenic nerve activity
Authors: Schulze A , Jonzon A , Sindelar R , Schaller P , Dammann V , Sedin G
Published: August 2010

Schulze A, Jonzon A, Sindelar R, Schaller P, Dammann V, Sedin G. Assisted mechanical ventilation using combined elastic and resistive unloading in cats with severe respiratory failure: effects on gas exchange and phrenic nerve activity. Acta Pædiatr 1999; 88: 636‐41. Stockholm. ISSN 0803‐5253

This study tests the efficacy of respiratory mechanical unloading as a mode of assisted mechanical ventilation in cats with an intact breathing‐control system but severe pulmonary parenchymal injury. Twelve anaesthetized, intubated cats received multiple saline lung lavages so that their total respiratory system compliance decreased from 56.1 ± 10.4 to 26.8 ± 6.8 ml/kPa (p < 0.001) and their PaO2 fell to 12.38 ± 4.71 kPa when 100% O2 was used as inspired gas. They were then exposed to three consecutive 15‐min periods of CPAP of 0.5 kPa, respiratory unloading and again CPAP of 0.5 kPa. Unloading was applied with end‐expiratory pressure of 0.5 kPa, elastic assistance of 0.03 kPa/ml and resistance compensation of 2.0 kPa/l/s. Arterial blood gases for the CPAP baselines did not differ significantly before and after unloading: pH 7.14 ± 0.04 vs. 7.16 ± 0.06; PaCO2 8.99 ± 2.07 vs. 8.33 ± 2.01 kPa; PaO2 12.4 ± 4.7 vs. 13.3 ± 7.6 kPa. Nor did the baselines differ in terms of tidal volume, respiratory rate and phrenic nerve activity. Unloading increased tidal volume substantially by about 50% and increased respiratory rate slightly, while inspiratory time remained unchanged. PaCO2 fell to 6.63 ± 1.57 kPa and pH rose to 7.25 ± 0.06. Phrenic nerve activity was significantly down‐regulated in terms of total number of impulses and mean impulse frequency in the phrenic nerve burst. These results suggest that combined elastic and resistive unloading may be an effective means of assisted mechanical ventilation in severe respiratory failure of pulmonary parenchymal origin. □Control of breathing, phrenic nerve activity, proportional assist ventilation, respiratory failure, respiratory mechanical unloading
Clinical and molecular biological analysis of a nosocomial outbreak of vancomycin‐resistant enterococci in a neonatal intensive care unit
Authors: Lee HK , Lee WG , Cho SR
Published: August 2010

Lee HK, Lee WG, Cho SR. Clinical and molecular biological analysis of a nosocomial outbreak of vancomycin‐resistant enterococci in a neonatal intensive care unit. Acta Pædiatr 1999; 88: 651‐4. Stockholm. ISSN 0803‐5253

Vancomycin‐resistant enterococci (VRE) have emerged as important nosocomial pathogens since 1988. We report here an outbreak of VRE between April 1997 and May 1997 in our neonatal intensive care unit (NICU). All isolates from four patients were identified as Enterococcus faecium positive and were resistant to vancomycin and teicoplanin. All of the patients with VRE were isolated for at least 5 d after admission to the unit and the positive cultures lasted between 13 and 31 d. There were no cases of sepsis or mortality in the patients with VRE. Two cases had previously received vancomycin therapy. All isolates were shown to have the vanA gene and had the same band pattern on repetitive PCR. After the four episodes, all equipment used to care for the patients were decontaminated and the staff engaged in therapy used disposable gloves and gowns. There were no more episodes. However, the NICU is no longer a safety area with regards to vancomycin‐resistant enterococcal infection. □Neonatal intensive care unit, outbreak, vancomycin‐resistant enterococci
Late neurological sequelae of non‐hemolytic hyperbilirubinemia of healthy term neonates
Authors: Grimmer I , Berger‐Jones K , Bührer C , Brandl U , Obladen M
Published: August 2010

Grimmer I, Berger‐Jones K, Bührer C, Brandl U, Obladen M. Late neurological sequelae of non hemolytic hyperbilirubinemia of healthy term neonates. Acta Pædiatr 1999; 88: 661‐3. Stockholm. ISSN 0803‐5253

Records of the only children's hospital equipped to perform exchange transfusions in West Berlin were used to identify all 29 non‐hemolytic healthy term newborns with total serum bilirubin between 20 and 30 mg/dL, 16 of whom were available for follow‐up neurological examination according to Touwen. Compared to 18 case controls with bilirubin <12 mg/dL, jaundiced children scored significantly worse only on the choreiform dyskinesia scale. □Bilirubin, infant, neurological impairment, newborn
Growth of prepubertal children with juvenile chronic arthritis
Authors: Saha M‐T , Verronen P , Laippala P , Lenko HL
Published: August 2010

The height and height velocity standard deviation scores (HSDS and HVSDS) of 64 prepubertal children with mild to moderate chronic arthritis were calculated at the time of diagnosis and then annually during treatment and follow‐up of 4 y. Preceding the diagnosis, children with chronic arthritis were as a group slightly taller than their healthy peers. During the year before the diagnosis they had grown faster than their peers. During the first year of treatment their growth velocity decreased (change in the mean HVSDS from +0.63 to ‐0.52), but during further follow‐up it returned to the pretreatment level (the mean HVSDS being +0.53 four years after the diagnosis). The growth was influenced more by polyarticular than by pauciarticular disease. The cumulative total dose of glucocorticosteroids did not have statistically significant influence on growth. In conclusion, growth retardation in prepubertal children with chronic arthritis was seen following the diagnosis and initiation of treatment, more so in polyarticular disease. During further follow‐up, growth velocity increased. This reflected the growth promoting effect of inflammatory process control. □Arthritis, glucocorticosteroids, growth, juvenile, prepubertal
Promoting breastfeeding through health education at the time of immunizations: a randomized trial from Guinea Bissau
Authors: Jakobsen MS , Sodemann M , Mølbak K , Alvarenga I , Aaby P
Published: August 2010

As an intervention against diarrhoea, promotion of breastfeeding has been suggested by the World Health Organization (WHO). In the present study from Guinea Bissau we tested the possibilities of promoting breastfeeding at a local health centre. A total of 1250 children were allocated randomly into two groups. Mothers in the intervention group were given health education according to WHO's recommendations; about exclusive breastfeeding for at least the first 4 mo, prolonged breastfeeding and family planning methods. At 4 mo of age introduction of weaning food was delayed in the intervention group (risk rate 1.18 (95% CI 1.03‐1.38) and more mothers had an IUD inserted (risk rate 2.45 (1.27‐4.70). The median length of breastfeeding was 23 mo in both groups. There was no difference in the number of children weaned early. Although exclusive breastfeeding was promoted by the intervention, early weaning of children in special risk groups was not avoided. An evaluation of the impact of the WHO recommendations in different settings is warranted. □Breastfeeding promotion, intervention study, Guinea Bissau, epidemiology, WHO recommendations
Smoking and alcohol use during pregnancy affects preterm infants' docosahexaenoic acid (DHA) status
Authors: Smuts CM , Tichelaar HY , Dhansay MA , Faber M , Smith J , Kirsten GF
Published: August 2010

This study investigated the effect of alcohol consumption and smoking during pregnancy on the fatty acid composition of the infants. A total of 40 very‐low‐birth‐weight (VLBW) infants, weighing between 750 and 1500g, were enrolled in the study after being hospitalized and ventilated for respiratory distress syndrome (RDS). Maternal and infant demographic information was recorded. Questions regarding maternal smoking (none, <10 and ≥10 cigarettes/d) and alcohol consumption (none, occasionally, moderate and severe) were recorded. Erythrocyte membrane (EMB;n= 40) total fatty acid analyses were performed at birth (baseline) and on days 14 and 28 postnatally. During pregnancy, 42% of mothers consumed alcohol and 50% smoked. At birth, infants of mothers who smoked and consumed alcohol during pregnancy, had significantly higher blood docosahexaenoic acid (DHA;p< 0.05) than infants of mothers who abstained from both alcohol and smoking. The consequences of this finding remain unknown.?Alcohol, essential fatty acids, pregnancy, smoking, very‐low‐birthweight infants
Staphylococcal scalded skin syndrome: exfoliative toxin A (ETA) induces serine protease activity when combined with A431 cells
Authors: Ladhani S , Poston SM , Joannou CL , Evans RW
Published: August 2010

Staphylococcal scalded skin syndrome is the term used for a spectrum of primarily neonatal blistering skin diseases caused by the exfoliative toxins, ETA and ETB, of Staphylococcus aureus. Despite 25 y of research, the toxins' mechanism of action is still poorly understood, although evidence suggests that they may act as serine proteases. In this study, 0.1 mg purified ETA isolated from a baby with pemphigus neonatorum was incubated with A431 cells (a human squamous cell line) at 37 ˚C for 8, 24 and 48 h and the supernatant tested for protease activity using azocasein as a non‐specific substrate. Phosphate‐buffered saline was also incubated as negative control. Incubation of ETA with A431 cells for 48 h resulted in a four‐fold increase in supernatant azocaseinolytic activity compared with buffer and cells, ETA alone and buffer alone (p < 0.001). Furthermore, this proteolytic activity was inhibited by PMSF (p <l 0.001), a specific serine protease inhibitor. These results provide further evidence for the role of the exfoliative toxins as serine proteases. Furthermore, the A431 cell assay provides a simpler, quicker, cheaper and more acceptable alternative to neonatal mouse epidermis to study the mechanism of action of the exfoliative toxins. □A431 cells, ETA, exfoliative toxin, serine protease, Staphylococcus aureus
Bone mineral acquisition and somatic development in highly trained girl gymnasts
Authors: Courteix D , Lespessailles E , Jaffre C , Obert P , Benhamou CL
Published: August 2010

The present study was conducted to investigate both skeletal and somatic developments in a group of highly trained prepubertal girl gymnasts at the beginning of their peak bone mass acquisition. The experimental group included 14 gymnasts who had trained 12—15 h per wk for 3 y before starting the study. The control group consisted of 15 non‐exerciser children and 6 swimmers training for 5—6 h/wk. Body composition and bone mineral density (BMD) of the total body, lumbar spine, non‐dominant hip and radius were measured using dual‐energy X‐ray absorptiometry. Calculation of bone age and measurement of body height and weight were done. All measurements and analyses were carried out twice with a 1‐y interval by the same technician. There were no differences between groups in age, bone age, body height and weight and lean tissue mass at the start of the study and 1 y later. The somatic changes observed between the first and second years tended to be greater in gymnasts compared to controls, except for body height. At the first and second investigations, BMD values in the gymnasts were statistically higher than in the controls at all skeletal sites, but not for the whole body (from p < 0.05 to p < 0.001, depending on the site). Percentage changes in BMD pre‐investigation compared with post‐investigation tended to be greater in gymnasts. Variations in lean mass, bone age and fat mass were found to be the best independent predictors of annual changes in BMD for total body, lumbar spine, trochanter and femoral neck sites. These results suggested that high‐volume impact loading training could promote a higher annual gain in bone mineral acquisition at the strained body sites in prepubertal girls without affecting somatic growth dimensions. □Bone mass, growth, gymnasts, prepubertal training, somatic development