bluuebunny/crossref_metadata_2025 huggingface dataset:
Sodium intake of 1 to 5‐year‐old children: the STRIP Project
Authors: Heino T , Kallio K , Jokinen E , Lagström H , Seppänen R , Välimäki I , Viikari J , Rönnemaa T , Simell O
Published: August 2010

The aim of this study is to examine sodium intake and dietary sodium sources of 1‐5‐y‐old children in a prospective, randomized long‐term coronary heart disease prevention trial, focused on dietary fat modification. Counselling included no advice about reducing salt in the children's diets. Food consumption of 100 intervention children and 100 control children was recorded for 3 consecutive days at the age of 13 mo and for 4 consecutive days at the ages of 3 and 5 y. Sodium intakes were calculated using the Micro Nutrica program. Children's mean daily sodium (NaCl) consumption (intervention and control children combined) was 1600 ± 527 mg (4.0 ± 1.3 g), 1900 ± 504 mg (4.8 ± 1.3 g) and 2200 ± 531 mg (5.5 ± 1.3 g) at the ages of 13 mo and 3 and 5 y, respectively. The intervention children consumed as much or slightly more sodium than the control children at all ages studied. Half the sodium consumption was derived from added salt in commercially prepared or homemade foods. Milk, meat products, bread and cereals were other important sodium sources.

In conclusion, nutrition counselling in the Special Turku Coronary Risk Factor Intervention Project (STRIP) trial, with its main focus on the quality of fat in child nutrition, has had minimal influence on children's sodium intake. To avoid excessive sodium intake in children, dietary counselling should include information about salt use, and food manufacturers should be encouraged to provide more low‐sodium products.
Hypo‐osmolar oral rehydration salts solution in dehydrating persistent diarrhoea in children: double‐blind, randomized, controlled clinical trial
Authors: Dutta P , Mitra U , Dutta S , Manna B , Chatterjee MK , De A , Bhattacharya SK
Published: August 2010

A double‐blind, randomized, controlled trial was conducted to compare the clinical efficacy of hypo‐osmolar oral rehydration salts (ORS) solution (224 mmol/L) and standard ORS solution (311mmol/L) in children with persistent diarrhoea who were prone to develop dehydration. Initially, 95 children aged between 3 and 24 mo were included in the study for overnight observation. Of these, 70 children who passed stool more than 2 g/kg/h were finally enrolled in the study and were randomly assigned either standard ORS or hypo‐osmolar ORS. After decoding the identity of ORS, it was observed that 37 children were in the standard ORS group and 33 in the hypo‐osmolar ORS group. Clinical parameters and microbiological findings of stool samples were comparable in the two groups at the time of enrolment. Total stool output (2.5 ± 1.1 vs 3.2 ± 1.6 kg; p= 0.04), duration of diarrhoea (114.8 ±38.3 vs 145.4 ± 40.0 h; p = 0.002), total intake of ORS (5.4 ± 1.6 vs 7.8 ± 1.8 l; p = 0.002) and total fluid intake (7.9 ± 2.6 vs 10.0 ±4.1 l, p= 0.01) were significantly less in the hypo‐osmolar ORS group compared to the standard ORS group. However, the percentage of weight gain on recovery in the hypo‐osmolar group was less compared to that of the standard ORS group, though the difference was statistically insignificant. Thirty‐five (95%) children in the standard ORS and 33 (100%) children in the hypo‐osmolar group recovered within 10 d of initiation of therapy and modified dietary management.

Conclusion: Our findings suggest that hypo‐osmolar ORS has beneficial effects on the clinical course of dehydrating persistent diarrhoea.
Vulvar symptoms in paediatric and adolescent patients
Authors: Piippo S , Lenko H , Vuento R
Published: August 2010

Vulvovaginal symptoms in children and young adolescents are not yet very well understood, nor is the actual incidence known. This study evaluates the character and possible infectious aetiology of vulvar symptoms of females aged up to 16 y. The signs, symptoms and bacteriological findings of 68 consecutive cases were studied. The study was conducted in the University Hospital of Tampere at a special gynaecological consultation clinic for children and adolescents. Sixty‐eight patients were included in the study: 48 girls (71%) were prepubertal, at Tanner stage M1P1, 26 patients were 2‐4‐y‐old and 15 were 5‐7‐y‐old. The duration of symptoms was known for 46 patients: 41% had had symptoms for >1 mo and 20% for >6 mo. Forty‐eight patients had abnormal clinical findings on examination and 16 (33%) of them had an infectious aetiology. Streptococcus pyogenes infection was identified in 11 (16%) patients, all of whom had symptoms. Candida was identified in 6 (9%) patients. No infectious aetiology was found among 26 patients who had symptoms and abnormal clinical findings. Vulvovaginal symptoms during childhood are more common among younger children (<7 y). In 67% of patients no infectious aetiology could be found. Samples for microbiological culture should be taken from symptomatic patients and symptomatic areas. Cultures of Candida and bacteria are necessary but usually sufficient. If a microbiological aetiology is established, treatment can be assigned accordingly.

Patients with vulvar symptoms and findings but with an unclear aetiology need support and advice on proper hygiene and can intermittently use mild corticosteroids locally.
Simultaneous stimulation of growth hormone, adrenocorticotropin and cortisol with L‐dopa/L‐carbidopa and propranolol in children of short stature
Authors: Philippi H , Pohlenz J , Grimm W , Koffler T , Schönberger W
Published: August 2010

In 59 otherwise healthy children of short stature, the simultaneous response of growth hormone, cortisol and plasma adrenocorticotropin (ACTH) to L‐dopa/L‐carbidopa and propranolol at 45 and 90min after administration were investigated. A growth hormone response of 10 μg/l or higher was considered positive. The definition of a positive cortisol response included either a hormone increase of at least 193 nmol/l or a peak hormone level of at least 497 nmol/l. The ACTH increase had to be fourfold above 11 pmol/l to be considered positive. In the 59 investigated children, the median basal growth hormone levels increased from 1.35 p.g/l to 18.05 ug/l and 10.15 p.g/l at 45 and 90 min after stimulation (p <0.05). The median cortisol levels rose from 242 nmol/l to 439 nmol/l and 612 pmol/l, and the corresponding median ACTH levels from 2.94 pmol/l to 9.63 pmol/l and 11.13 pmol/l at 45 and 90 min after stimulation. Significant positive hormone response rates were 88.1% for growth hormone, 88.1% for cortisol and 69% for ACTH. These results could be attributed to the enhanced stimulating effect of the additional administration of L‐carbidopa and propranolol.

We conclude that the administration of L‐dopa/L‐carbidopa and propranolol is useful for the simultaneous evaluation of growth hormone, cortisol and ACTH secretion in children of short stature.
Bone turnover in children with vitamin D deficiency rickets before and during treatment
Authors: Baroncelli GI , Bertelloni S , Ceccarelli C , Amato V , Saggese G
Published: August 2010

Biochemical markers of bone formation [alkaline phosphatase, osteocalcin, and carboxyterminal propeptide of type I procollagen (PICP)] and bone resorption [cross‐linked carboxyterminal telopeptide of type I collagen (ICTP) and cross‐linked N‐telopeptides of type I collagen (NTX)] were measured in 14 children aged 8.5–10.5 mo with vitamin D deficiency rickets before and longitudinally during vitamin D treatment (3000–4000 IU/daily). Forty‐four healthy children aged 8–10.5 mo were enrolled as sex‐ and age‐matched controls. Before treatment, serum levels of alkaline phosphatase, PICP, and ICTP, and urinary excretion values of NTX were significantly higher, and serum osteocalcin levels significantly lower than controls (31.4 ± 3.5 mμkat/L and 9.8 ± 2.9 μkat/L, p < 0.001; 1025 ± 89 μg/L and 952 ± 97.4 μg/L, p < 0.02; 15.6 ± 2.6 μg/L and 14.2 ± 1.3 μg/L, p< 0.01 370.7 ± 109.4 nmol BCE and 201.8 ± 69.2 nmol BCE, p < 0.001; 17.6 ± 9.1 μg/L and 22.5 ± 7.6 μg/L, p <0.05, respectively). During treatment, serum alkaline phosphatase levels progressively declined in association with the radiographic healing of the skeletal lesions. Serum levels of osteocalcin, PICP, and ICTP, and urinary excretion values of NTX showed a transient but significant (p < 0.05 to p < 0.001) increase in comparison with baseline values during the first 2–4 wk of treatment, and decreased slowly thereafter. They were within the mean 2 SD of controls before the recovery of the skeletal lesions.

Conclusions: These findings suggest that children with vitamin D deficiency rickets have increased bone turnover before and during the first weeks of treatment. Alkaline phosphatase is a more reliable marker than osteocalcin, PICP, ICTP and NTX for diagnosing and monitoring these patients.
Leukocyte adhesiveness/aggregation test (LAAT) to discriminate between viral and bacterial infections in children
Authors: Urbach J , Lebenthal Y , Levy S , Berliner S , Leibovitz E , Aronson M , Branski D
Published: August 2010

Objectives: We previously noted that white blood cells (WBC) have increased adhesive properties during bacterial infections. Here, we aim to explore the possibility of using the different adhesive properties of WBC as a means of differentiating between viral and bacterial infections, a common problem in paediatrics. Methods: The adhesive properties of WBC in the peripheral blood of 25 children with documented bacterial infections, 15 with documented viral infections and 36 with probable viral infections, were studied by means of a leukocyte adhesiveness/aggregation slide test (LAAT). The results of the LAAT were compared with those of the other acute phase reactants, namely WBC, differential count and erythrocyte sedimentation rate (ESR), which were taken in the same blood sample in each patient. Results: The sensitivity, specificity and positive predictive value were 92%, 96%, and 92%, respectively for the LAAT; 83%, 87% and 80% for the ESR; 56%, 78% and 56% for the white blood cell count; and 54%, 74% and 50% for the differential count.

Conclusions: The presence of bacterial infections in children can be tested using a simple slide test to reveal the increased state of leukocyte adhesiveness/aggregation in the peripheral blood. The LAAT is a reliable, rapid and inexpensive test, and it can be a useful laboratory tool for the paediatrician treating a child with acute febrile illness.
Association of prenatal phenobarbital and phenytoin exposure with small head size at birth and with learning problems
Authors: Dessens AB , Cohen‐Kettenis PT , Mellenbergh GJ , Koppe JG , van de Poll NE , Boer K
Published: August 2010

Small head size has been observed in prenatally anticonvulsant‐exposed neonates. In infancy, cognitive impairments were revealed. It is presently unknown whether these impairments are permanent or disappear after puberty. We studied the link between the prenatal influence of anticonvulsants on brain development and cognitive functioning in adulthood: a retrospective study on head size and a follow‐up assessing cognitive capacities among adults who had been included in the retrospective study. The retrospective study comprised 172 exposed and 168 control neonates, matched with respect to age, sex and their mothers' age. Prenatally phenobarbital + phe‐nytoin‐exposed neonates had a significantly smaller occipitofrontal circumference (OFC) than prenatally phenobarbital‐monotherapy‐exposed and control neonates (mean difference of 0.7 cm). In the follow‐up, no difference in cognitive functioning was found between the exposed and the control groups. Most of the prenatally anticonvulsant‐exposed subjects had normal intellectual capacity. However, 12% of the exposed subjects versus 1% of the controls had persistent learning problems. In addition, more of the exposed subjects were mentally retarded. There was no clear relationship between learning problems and small OFC, maternal epilepsy or unfavourable family climate.

Conclusions: We conclude that the combination of phenobarbital + phenytoin affects the fetal OFC. The smaller OFC does not seem to be related to cognitive functioning in adulthood, but learning problems and mental retardation proved to be more prevalent among exposed subjects. Phenobarbital and phenytoin may therefore affect cognitive capacity but only in infants who are susceptible to this particular influence of the drugs.
Long‐term prospective study on the natural history of Wolff‐Parkinson‐White syndrome detected during a heart screening program at school
Authors: Inoue K , Igarashi H , Fukushige J , Ohno T , Joh‐o K , Hara T
Published: August 2010

In the period 1985 to 1993, a total of 802 school‐aged children (284 first‐graders and 518 seventh‐graders) were referred to our hospital for further evaluation of electrocardiographic abnormalities. Among them, 57 (male 24 and female 33) children were confirmed as having Wolff‐Parkinson‐White (WPW) syndrome based on the findings of 12‐lead surface electrocardiograms (ECG). According to Lindsay's criteria, the locations of the accessory pathways were as follows: Left‐lateral in 10 (18%), left‐posterior in 2 (4%), right‐free‐wall in 28 (49%), anterior‐septum in 13 (23%) and posterior‐septum in 3 (5%). One 12‐y‐old girl had multiple accessory pathways. Six patients had associated diseases: Ebstein's anomaly in 4, epilepsy in 1 and mental retardation with scoliosis in 1. Follow‐up periods ranged from 2.0 to 13.0 y (mean SD: 8.0 ± 3.3 y) for 23 first‐graders with WPW syndrome, and from 2.0 to 13.0 y (mean SD: 7.3 ± 4.2 y) for 34 seventh‐graders, respectively. Initially, 5 children had at least one episode of supraventricular tachycardia (SVT) by history and 6 children developed SVT during the follow‐up. One girl with multiple accessory pathways and recurrent SVT required long‐term drug therapy.

Conclusions: The outcome of children with WPW syndrome detected by a heart screening program at school was favorable. Our 8 y follow‐up of 57 children with WPW syndrome will serve as additional information concerning the indication of radio‐frequency catheter ablation therapy for WPW syndrome in children.
Morphometry of the head of the caudate nucleus in patients with velocardiofacial syndrome (del 22qll.2)
Authors: Sugama S , Bingham PM , Wang PP , Moss EM , Kobayashi H , Eto Y
Published: August 2010

Velocardiofacial syndrome (VCFS) is a chromosomal anomaly syndrome characterized by multiple congenital malformations, including cleft palate and cardiac anomalies. Many patients have attention‐deficit (hyperactivity) disorders (AD[H]D) in childhood and schizophrenia in adulthood. We reviewed cranial magnetic resonance imaging (MRI) scans with particular attention to the head of the caudate nucleus and found that in control subjects, the head of the caudate was larger on the left than on the right, whereas VCFS patients showed a reversed right > left pattern or no significant asymmetry. A similar right > left asymmetry or a lack of this asymmetry has been reported in patients with AD(H)D.

Conclusions: These results suggest a common pathophysiological mechanism of behavioural and cognitive problems in patients with AD(H)D and those with VCFS.
Parental perception, worries and needs in children with epilepsy
Authors: Kwong KL , Wong SN , So KT
Published: August 2010

Despite advancement in medical care, prejudice and misunderstanding of epilepsy still exist. In this study, we investigate the problems faced by epileptic children, at home and in school, and make suggestions for improvement. Questionnaires were randomly distributed to parents of epileptic children attending normal and special classes (groups A and B, respectively). Return of questionnaires was anonymous. Ninety‐one percent responded. Of the responders, 56 children were in Group A and 30 in Group B. Chronic and intractable epilepsy was more frequently observed in Group B than in Group A patients (47% vs 14%, p < 0.05). Main family concerns were seizures, school performance and side effects of medication. Half of the parents complained that their children were more restless and short‐tempered. Only 43% of parents were aware that seizures were caused by abnormal brain discharges. Twenty percent thought swimming should be prohibited even if seizures could be controlled. Schools were informed of the disease by 84% of the families. Only 29% of parents knew the name and dose of the current medication. Information was considered adequate in 27% of patients. Drug compliance was better in epileptic children with associated handicaps than in those without handicaps. Half of the parents requested more information about epilepsy and closer communication between teachers and physicians.

Conclusions: To establish comprehensive care that satisfies the needs of epileptic children and their families, further training of medical specialists in epilepsy and enhancement of networks among relevant organizations are needed.
Bodily pain, sleep problems and mental distress in schoolchildren
Authors: Bruusgaard D , Smedbråten BK , Natvig B
Published: August 2010

It has been suggested that childhood pain could be the beginning of a career with chronic disabling pain. Bodily pain is frequent in children. We examined the association between self‐reported bodily pain, mental distress and sleep problems in schoolchildren to test the following hypotheses: (i) that self‐reported bodily pain is associated with mental distress and sleep problems, (ii) that the association is dependent on the localization of pain, and (iii) that the association increases with number of painful areas. Eighty‐six percent of the pupils (569) in the 4th form (mean age 10.5 y), 7th form (mean age 13.5 y) and 9th form (mean age 15.5 y) from all the schools in a local community answered a questionnaire about self‐esteem, body‐image, physical activity and bodily pain. We found a strong association between the reporting of pain, mental distress and sleep problems. Pain in the knees was the only problem reported more frequently by boys than by girls, and knee pain did not show the same association with mental distress and sleep problems as pain from other regions.

Conclusions: A possible cause‐effect relationship between pain, mental distress and sleep problems is discussed, and the possibility that all the complaints are the simultaneous signs of a multisymptom syndrome is introduced.
A future for neonatal α1‐antitrypsin screening?*
Authors: Sveger T , Thelin T
Published: August 2010

A WHO expert group recommends neonatal screening for α1‐antitrypsin deficiency (α1ATD). Homozygous α1ATD PiZZ occurs in 1 in 5000 of the U.S. Caucasian population and up to 1 in 500 individuals of the European population, with a large regional variation. It is a risk factor that predisposes mainly to liver disease in early infancy and emphysema in early adulthood. Most importantly, smoking decreases the duration of the asymptomatic phase and life expectancy by 10‐20 y. The Swedish α1AT screening programme and subsequent information and advice prevented the majority of adolescents from starting to smoke. The involved parents and α1ATD adolescents retrospectively recommended neonatal screening. Potential advantages of neonatal α1AT screening are: early diagnosis and treatment of neonatal liver disease, optimal treatment of fever and bacterial infections theoretically preventing liver cell damage, genetic advice and information about the consequences of passive and active smoking. Potential advantages of postponing screening until age 11‐12 y are: identification of α1ATD close to the age when smoking may start, and possibility for the child to take part in the screening decision. Disadvantages of α1AT screening are: psychosocial reactions–the mother probably being most vulnerable in the neonatal period–and discrimination by insurance companies and employers.

Important uncertainties are: lack of knowledge concerning participation in a voluntary α1AT screening, psychosocial reactions and the efficacy of anti‐smoking advice if the information is given to school‐age children and families. Thus the question whether and when to screen for α1ATD is still the topic of lively debate.
New reference for the age at childhood onset of growth and secular trend in the timing of puberty in Swedish
Authors: Liu YX , Wikland K Albertsson , Karlberg J
Published: August 2010

The objectives of the present work were to present a new reference for the age at childhood onset of growth and to investigate the secular trend in the timing of puberty in a community‐based normal population in Sweden. A total of 2432 children with longitudinal length/height data from birth to adulthood were used to determine the two measures by visual inspection of the measured attained length/height and the change in growth velocity displayed on a computer‐generated infancy‐childhood‐puberty (ICP) based growth chart. The series represents a sample of normal full‐term children born around 1974 in Göteborg, Sweden. We found about 10% of children were delayed (>12 mo of age) in the childhood onset of growth based on the previous reported normal range, i.e. 14% in boys and 8% in girls. Distribution of the age at childhood onset of growth was skewed. The medians were 10 and 9 mo for boys and girls, respectively. After natural logarithmic transformation, the mean and standard deviation (SD) were 2.29 (anti‐log 9.9 mo) and 0.226 for boys, 2.23 (anti‐log 9.3 mo) and 0.220 for girls, respectively. The 95% normal ranges were 6.3‐15.4 and 6.0‐14.3 for boys and girls, respectively. The distribution of the timing of PHV was close to the normal distribution. The mean values were 13.5 y for boys and 11.6 y for girls with 1 y SD for both sexes.

Conclusion: A downward secular trend in the onset of puberty was clearly shown in the population. The age at childhood onset of growth did not correlate with the timing of puberty (r=−0.01 and 0.05, p > 0.7 and 0.1 in boys and girls, respectively). Normal ranges of the age at childhood onset of growth are in need of revise, as this study indicates. The new reference presented here could be a reliable indicator in further studies.
Effect of growth hormone therapy on feeding problems and food intake in children with growth disorders
Authors: Blissett J , Harris G , Kirk J
Published: August 2010

To assess the effect of therapeutic doses of growth hormone (GH) on the feeding problems, food intake, body fat and mealtime interactions of children with growth disorders, an age‐matched group of 46 children with Turner syndrome (TS) or Silver Russell syndrome (SRS) was examined using questionnaire measures and direct observation. The children's body fat was measured using bio‐electrical impedance analysis and skinfold thickness measurements. Children receiving GH consumed significantly more energy, protein, fat and carbohydrate than did the children who were not receiving GH, independent of the extent of the child's feeding problems. Children receiving GH had less body fat than did children who were not receiving GH. Children who were not receiving GH distracted their parents from the mealtime significantly more often and received more negative prompting and coaxing from their parents to eat than did children who were receiving GH. This study provides evidence to support the theory that appetite and intake is determined in part by growth and growth potential. Feeding problems seen in children with growth disorders are partly due to parental attempts to impose control over their child's intake, when their child consumes less than the parent believes to be adequate.

Conclusion: GH has a significant impact on both the food intake and parent‐child interaction at mealtimes of children with SRS and TS.
Serum total magnesium and ionized calcium concentrations in asphyxiated term newborn infants with hypoxic‐ischaemic encephalopathy
Authors: Ilves P , Kiisk M , Soopõld T , Talvik T
Published: August 2010

Total magnesium, ionized calcium, potassium and sodium concentrations in mixed umbilical cord blood and venous blood serum at a median (min.‐max.) age of 33 h (24‐48 h) were assessed colorimetrically in 46 asphyxiated and 35 healthy term infants. Asphyxiated infants without any signs or with signs of mild hypoxic‐ischaemic encephalopathy (HIE) had significantly higher, and infants with severe HIE lower umbilical cord blood serum total magnesium (mean (95%CI) 0.81 (0.75‐0.87) mmol/l and 0.64 (0.47‐0.87) mmol/l, respectively, p < 0.05) compared with the control group (0.72 (0.69‐0.76) mmol/l). An increase in serum total magnesium in spite of normalized acid‐base status in asphyxiated infants suffering from severe HIE compared with the control group infants was found by the second day of life (0.97 (0.87‐1.07) mmol/l and 0.86 (0.81‐0.9) mmol/l, respectively, p < 0.05). At the age of 24‐48 h hypermagnesaemia (>2 SD) was discovered in 36%, hyponatremia (<2 SD) in 38%, and hypocalcaemia (<2 SD) in 23% of asphyxiated infants. Derangements (>2 SD) in at least two electrolytes by the second day of life were significantly associated with poor outcome.

Conclusions: Magnesium, calcium and sodium derangements are a frequent finding in asphyxiated infants, and these abnormalities are significantly associated with poor outcome. For a better outcome prediction, the routine determination of magnesium in addition to other electrolytes in asphyxiated infants is recommended.
Birthweight and social deprivation: influences on serum lipids and fibrinogen
Authors: Morley R , Harland PSEG , Law CM , Lucas A
Published: August 2010

Epidemiological studies have shown that adults with low birthweight have a higher risk of cardiovascular disease and some others have shown that they have a less favourable serum lipid and lipoprotein profile. If cholesterol metabolism were programmed in utero, we would expect to see an influence of birthweight on blood lipids in children. In 422 children aged 11‐15 y in Middlesborough, Cleveland, UK, we investigated the association between birthweight and serum lipids and plasma fibrinogen. We also investigated the influence of childhood social deprivation, measured using the Townsend deprivation index, on these measures.

Conclusions: We found a significant inverse association between birthweight and serum triglyceride level, but not with other serum lipid levels. From a regression model we estimate that triglyceride rose by 1.1 mmoll−1 kg−1 fall in birthweight after adjustment for sex, current age and weight. Findings were similar in boys and girls separately. This could contribute to the observed inverse association between birthweight and cardiovascular mortality. Social deprivation was associated with higher fibrinogen, but not lipid levels. Our data highlight the importance of considering influences throughout the life course on adult disease.
Visual analogue scale for the perceived influence of exertion and movements/positions on low back problems in surveys of adolescents
Authors: Staes F , Stappaerts K , Vertommen H , Nuyens G
Published: August 2010

The test‐retest reproducibility of visual analogue scales for the perceived influence of exertion and movements/positions on low back problems in adolescents was investigated. The study was performed on 61 adolescents with low back problems. Item completion, median score, interquartile range and weighted kappa were calculated. Results showed that visual analogue scales produce repeatable information for all items tested (weighted kappa: 0.59‐0.83), except for the influence of pulling materials on back problems (0.45).

Conclusion: The results of this study suggest that adolescents, aged 16‐18‐y, can reproduce their visual analogue scores.
Longitudinal changes in 11‐13‐year‐olds' physical activity
Authors: Armstrong N , Welsman JR , Kirby BJ
Published: August 2010

The influence of age, sex, maturity, body mass and body fatness on the physical activity (PA) of 11‐13‐y‐olds was examined longitudinally. Body mass, triceps and subscapular skinfold thickness and pubic hair were recorded and 3‐d continuous heart rate (HR) monitoring was used to estimate PA on each annual measurement occasion. At the onset, subjects were 11.0 (0.4)‐y‐old and data were available on 202, 143 and 160 subjects in years 1 to 3, respectively with an almost equal sex distribution. Multilevel regression modelling examined age‐, sex‐ and maturity‐related changes in time spent with HR above 139 (moderate activity) and 159 (vigorous activity) bpm. Sustained (10 or 20 min) periods of moderate or vigorous activity were not characteristic of PA patterns. Both PA measures declined with age, with a consistent sex difference reflecting the lower PA levels of girls. Body mass and fatness were not significant explanatory variables, but an additional decrement in activity was evident in late maturity.

Conclusion: Few children experience extended bouts of PA, and from 11‐13 y, PA decreases, with more girls than boys becoming inactive. The data emphasize the importance of promoting active lifestyles during youth.
Evaluation of oral hypo‐osmolar glucose‐based and rice‐based oral rehydration solutions in the treatment of cholera in children
Authors: Dutta D , Bhattacharya MK , Deb AK , Sarkar D , Chatterjee A , Biswas AB , Chatterjee K , Nair GB , Bhattacharya SK
Published: August 2010

In a randomized controlled clinical trial, the efficacy of a low‐sodium low‐glucose oral rehydration solution (ORS) and a low‐sodium rice‐based ORS was compared with standard WHO glucose ORS in the treatment of severe cholera in children aged 2‐10 y. In total, 120 children were evaluated for the study, of whom 58 patients were positive for Vibrio cholerae and were included in the study. Of these 58 cases, 19 received rice‐based hypo‐osmolar ORS, 20 received WHO‐ORS and 19 received glucose‐based hypo‐osmolar ORS. The clinical characteristics (age, preadmission duration of diarrhoea, frequency of stool before admission, incidence of vomiting, body weight and volume of initial fluid requirement) were comparable in the three treatment groups. All patients received tetracycline in a dose of 50 mg/kg/d of body weight in 4 divided doses for 3 d.

Conclusions: Patients who received rice‐based hypo‐osmolar ORS had subsequently reduced (p < 0.05) stool output, ORS consumption and diarrhoea duration than the patients who received either WHO‐ORS or glucose‐based hypo‐osmolar ORS.
Cerebrospinal fluid concentrations of α‐melanocyte‐stimulating hormone in bacterial and aseptic meningitis
Authors: Ichiyama T , Nishikawa M , Hayashi T , Hayashi S , Ryozawa M , Furukawa S
Published: August 2010

α‐Melanocyte‐stimulating hormone (α‐MSH) has potent anti‐inflammatory effects in several experimental models of inflammation. It inhibits both the actions and production of proinflammatory cytokines and neutrophil migration. We investigated whether α‐MSH in cerebrospinal fluid (CSF) increases during the acute stage in patients with bacterial and aseptic meningitis by measuring α‐MSH in CSF via radioimmunoassay. The α‐MSH concentrations in CSF from the children with bacterial meningitis who survived (n= 8), those with aseptic meningitis (n= 16), and the control subjects (n= 23) were all below the detection limit. However, CSF α‐MSH was elevated in four of the five children with bacterial meningitis who had neurological sequelae. We speculate that elevated a‐MSH levels in CSF during acute bacterial meningitis reflect negative feedback in response to severe inflammation associated with neurological sequelae induced by proinflammatory cytokines.

Conclusion: CSF α‐MSH is elevated in children with severe bacterial meningitis who had neurological sequelae.
Characterization of the developmental stages of sucking in preterm infants during bottle feeding
Authors: Lau C , Alagugurusamy R , Schanler RJ , Smith EO , Shulman RJ
Published: August 2010

It is acknowledged that the difficulty many preterm infants have in feeding orally results from their immature sucking skills. However, little is known regarding the development of sucking in these infants. The aim of this study was to demonstrate that the bottle‐feeding performance of preterm infants is positively correlated with the developmental stage of their sucking. Infants' oral‐motor skills were followed longitudinally using a special nipple/bottle system which monitored the suction and expression/compression component of sucking. The maturational process was rated into five primary stages based on the presence/absence of suction and the rhythmicity of the two components of sucking, suction and expression/compression. This five‐point scale was used to characterize the developmental stage of sucking of each infant. Outcomes of feeding performance consisted of overall transfer (percent total volume transfered/volume to be taken) and rate of transfer (ml/min). Assessments were conducted when infants were taking 1‐2, 3‐5 and 6‐8 oral feedings per day. Significant positive correlations were observed between the five stages of sucking and postmenstrual age, the defined feeding outcomes, and the number of daily oral feedings. Overall transfer and rate of transfer were enhanced when infants reached the more mature stages of sucking.

We have demonstrated that oral feeding performance improves as infants' sucking skills mature. In addition, we propose that the present five‐point sucking scale may be used to assess the developmental stages of sucking of preterm infants. Such knowledge would facilitate the management of oral feeding in these infants.
Pyelectasis and hydronephrosis in the newborn and infant
Authors: Fanos V , Agostiniani R , Cataldi L
Published: August 2010

The aim of this review is to describe the present status of prenatally diagnosed pyelectasis and hydronephrosis. Ultrasonographic definitions are presented, along with guidelines for the management of urinary tract dilatations. Isolated pyelectasis without caliceal involvement rarely constitutes a pathological situation and does not require any particular diagnostic or therapeutic measures. Obstructive dilatation is characterized by an obstacle to normal urinary flow situated at any level in the urinary tract, with consequent stagnation of urine and dilatation upstream of the obstruction. If the obstruction is not correctly treated it can cause a progressive deterioration of renal function. The presence of ureterectasia plays a crucial role in the diagnostic algorithm and a micturitional cystourethrography is necessary to look for a vesicoureteric reflux (VUR). The significance of urinary tract dilatation is discussed in detail.

Conclusion: In newborns with pyelectasis or hydronephrosis the paediatrician's goal should be to strike the right balance between excessive medical intervention and sufficient intervention for the diagnosis of potentially dangerous conditions.
Lipid profiles in Polish adolescents from high‐ and low‐risk families: tracking unfavourable lipid levels over a one‐year period
Authors: Malecka‐Tendera E , Lewin‐Kowalik J , Wazowski R , Piskorska D , Klimek K
Published: August 2010

In a country with a high cardiovascular mortality rate, lipid profiles were studied in 929 adolescents (440 from affected and 489 from non‐affected families for cardiovascular disease and hypercholesterolaemia). In 334 children with elevated or borderline total cholesterol level, lipid profiles were re‐measured after a 1‐y period. In boys from affected families, in contrast to boys from non‐affected families, significantly higher total cholesterol levels (4.36 ± 0.81 vs 4.19 ± 0.78mmol/L, p < 0.05) and LDL‐C level (2.1 ± 0.72 vs 1.89 ± 0.79 mmol/L, p < 0.05) and significantly lower HDL‐cholesterol levels (1.81 ± 0.34 vs 1.93 ± 0.38 mmol/L, p < 0.05) were found. The odds ratio for being in the most unfavourable decile for LDL‐cholesterol was significantly higher for girls from affected families (2.17, p = 0.02). A relatively high HDL‐C level as well as a favourable TC/HDL‐C ratio was demonstrated in all groups, being lowest in boys from affected families. A significant correlation was found between baseline lipids and their values re‐measured after 1 y.

It is concluded that (1) adolescents with a positive family history are at increased risk for unfavourable lipid profile, (2) adolescents with elevated total cholesterol and LDL‐cholesterol levels remain hypercholesterolaemic after a 1‐y period and are therefore candidates for further biochemical and clinical monitoring, and (3) children with elevated total cholesterol may not be at high risk for cardiovascular disease owing to the favourable TC/HDL‐C ratio. The study results do not indicate that general cholesterol screening in Polish adolescents is necessary, as the proportion of children with elevated LDL‐cholesterol is relatively low.
Time course of severe respiratory syncytial virus infection in mechanically ventilated infants
Authors: Tasker RC , Gordon I , Kiff K
Published: August 2010

The time course of intensive care for severe respiratory syncytial virus (RSV) lower respiratory tract illness may be predicted by the severity of gas exchange during the first 48 h of mechanical ventilation. To test this hypothesis, two studies were undertaken in RSV‐positive mechanically ventilated patients who did not have chronic lung disease, congenital heart disease or immunodeficiency. First, a retrospective criteria‐generating review of 45 infants was carried out. In these infants, more severe lower airway disease, as demonstrated by four‐quadrant consolidation on chest X‐ray, was associated with‘best’alveolar arterial oxygen gradients (AaDO2, torr) and mean airway pressure (MAP, cm H2O) values as follows: first 24 h, AaDO2 > 400 and MAP > 10 (positive and negative predictive values 100% and 97%, respectively); second 24 h, AaDO2 300 and MAP > 10 (positive and negative predictive values 91% and 100%, respectively). The second study, a prospective, hypothesis‐testing, analysis of length‐of‐stay in 44 infants stratified according to the above AaDO2 and MAP criteria demonstrated that the duration of intensive care was longer in the severe group: median (interquartile range in days) 17 (15‐39) vs 7 (4‐8) (p < 0.01).

We suggest that, in mechanically ventilated infants with RSV, the time course of intensive care is predictable based on early clinical features and respiratory parameters. Therefore reports on the effectiveness of special therapies using intensive care stay as a measure of outcome should be interpreted with respect to these observations before drawing conclusions about efficacy.
Nutritional factors affecting serum phenylalanine concentration during pregnancy for identical twin mothers with phenylketonuria
Authors: Fox C , Marquis J , Kipp DE
Published: August 2010

The effect of energy, protein, fat, and phenylalanine on serum phenylalanine concentrations during pregnancy for a set of identical twins with phenylketonuria (PKU) was examined. Blood samples were collected one to two times per week. The subjects completed a 3‐d food record prior to each blood collection. The effect of the factors on serum phenylalanine levels was evaluated statistically using time‐series analysis. Dietary intakes of the nutrients evaluated were similar for the subjects. For one subject, there were highly significant effects of energy, protein, and fat on serum phenylalanine levels. In contrast, these nutrients had no significant effect on serum phenylalanine for the other subject. Dietary phenylalanine had no significant effect on serum phenylalanine for either twin.

Conclusions: There was no effect of phenylalanine intake and no consistent effect of energy, protein, or fat on serum phenylalanine. Other dietary or environmental factors or a combination of factors may impact serum phenylalanine levels of pregnant women with PKU.
Aminophylline influences cerebral hyperperfusion after severe birth hypoxia
Authors: Robel‐Tillig E , Vogtmann C
Published: August 2010

Doppler sonographic investigations have presented cerebral hyperperfusion in neonates after severe asphyxia. Neonates with disturbed cerebral blood flow velocity (CBFV) tend to have poor outcomes. The purpose of this clinical study was to examine the influence of aminophylline on cerebral hyperperfusion. An intravenous bolus of 4 mg/kg aminophylline was given to nine neonates with Doppler sonographic signs of cerebral hyperperfusion. CBFV was determined before, 5 min, 60min and 120 min after aminophylline administration and on the following day. After aminophylline the mean systolic (56.5 vs. 41.6 cm/s) and end diastolic (21.0 vs. 12.3 cm/s) blood flow velocity decreased and the mean pulsatility index (0.83 vs. 1.1) increased significantly. Repeated measurements showed a decrease in blood flow velocities and an increase in pulsatility index on the following days. Heart rate, mean arterial blood pressure and pCO2 were not significantly changed.

We conclude that aminophylline influences cerebral hyperperfusion in neonates with disturbed autoregulation.
Balloon dilatation of critical left heart stenoses in low birthweight infants
Authors: Koch A , Buheitel G , Gerling S , Klinge J , Singer H , Hofbeck M
Published: August 2010

We describe the results of balloon angioplasty in 5 infants with body weights of 850‐2400 g. Three patients with severe aortic valve stenosis and two patients with isthmic coarctation of the aorta experienced relief of stenosis. Two patients with aortic valve stenosis developed thrombosis of the femoral artery; however, complete resolution of the compromised pulse occurred following thrombolytic therapy. In both patients with isthmic coarctation, pulses on the right leg remained diminished. All patients are doing well 0.28 to 3.32 y after the procedure; none has required additional therapy. Our results in a limited number of consecutive low birthweight infants show that balloon dilatation is feasible and can be performed successfully even in neonates with body weights <1500g. According to our experience, balloon dilatation in infants with body weights >2000 g does not differ significantly from standard procedures. In very small infants, however, balloon angioplasty requires special precautions to avoid temperature loss. Arterial access is the major problem in small children, and requires further improvement.

Conclusion: Balloon dilatation is feasible even in neonates < 1500 g. However, special precautions to avoid temperature loss are required and arterial access is the major problem.
Quality of life in childhood asthma: use of the Paediatric Asthma Quality of Life Questionnaire in a Swedish sample of children 7 to 9 years old
Authors: Reichenberg K , Broberg AG
Published: August 2010

Reichenberg K, Broberg AG. Quality of life in childhood asthma: use of the Paediatric Asthma Quality of Life Questionnaire in a Swedish sample of children 7 to 9 years old. Acta Pædiatr 2000; 89: 989‐95. Stockholm. ISSN 0803‐5253

To validate a Swedish translation of the Paediatric Asthma Quality of Life Questionnaire (PAQLQ) and to study determinants of asthmatic children's quality of life, seventy‐one 7‐9‐y‐old children and their families were approached. Sixty‐one children (86%) participated, 36 boys and 25 girls: 11 children with mild, 40 with moderate and 10 with severe asthma. The mean age was 8.7 y. Most commonly restricted activities during the week preceding the investigation were running (74%), gymnastics (30%), walking uphill (26%), playing football (20%) and shouting (13%).

Parental rating of symptoms (Spearman's rho =–0.40,p= 0.001), percentage of expected peak flow rate (PEFR) (rho = 0.30, p= 0.009) and physicians' grading (mild, moderate and severe asthma, p= 0.047) all correlated significantly with PAQLQ scores. Younger children reported more impairment of QoL, as did children of parents not sharing household. Sex or presence of eczema or rhinoconjunctivitis did not significantly affect the scores. Children suffering from food allergy scored less impairment of QoL. The instrument was easy to administer, was well accepted by the children and had acceptable internal consistency.
Systemic activity versus systemic adverse effects of nasal glucocorticoids in the treatment of allergic rhinitis
Authors: Wolthers OD
Published: August 2010

Treatment with nasal glucocorticoids may be associated with systemic activity, which can be detected by sensitive measures of basal adrenal cortisol secretion, bone turnover and short‐term growth (knemometry). The detection of systemic activity, however, does not imply that nasal glucocorticoids cause serious adverse systemic effects, such as an inability of the adrenals to react to physiological stress. Studies assessing the ability of the adrenal cortex to react to stimulation have found this to be intact. Long‐term assessments of bone density and statural height are needed, and the possibility of additive effects of intranasal glucocorticoids in children receiving concomitant treatment with inhaled glucocorticoids has not yet been studied. Children on long‐term treatment with intranasal glucocorticoids should be followed with height measurements every 6 mo.
A regional study of underlying congenital diseases in term neonates with necrotizing enterocolitis
Authors: Bolisetty S , Lui K , Oei J , Wojtulewicz J
Published: August 2010

Aim of the study: The aetiology of necrotizing enterocolitis (NEC) remains poorly understood in infants of all gestation, particularly when it occurs at term. We hypothesize that NEC in term infants is rare but often associated with underlying congenital illnesses. Method: Records of all term infants hospitalized with radiologically or surgically proven NEC in the 10 tertiary centres of two geographical regions of Australia during a 6.5‐y period were reviewed. Regional birth data were obtained and a special care nursery survey was conducted. Results: Twenty‐nine infants had proven NEC giving a population incidence of 0.05 per 1000 live births. Nineteen (66%) of them had underlying congenital diseases. Five (17%) infants had endocrine disorders, which included panhypopituitarism, hypothyroidism, hypoparathyroidism and congenital adrenal hyperplasia. Ten infants had congenital heart disease, eight being cyanotic. Six of them developed NEC prior to any invasive cardiac procedures. Seven of the other nine infants without any congenital diseases had perinatal risk factors associated with NEC. The severity of illness was not different amongst the three groups. All infants, except two, survived.

Conclusion: NEC in term infants is commonly secondary to or preceded by underlying congenital diseases. A considerable proportion of NEC cases had co‐existing endocrine illnesses.
Breathing patterns, oxygen and carbon dioxide levels in sleeping healthy infants during the first nine months after birth
Authors: Horemuzova E , Katz‐Salamon M , Milerad J
Published: August 2010

Data on arterial oxygen saturation (SaO2), transcutaneous pO2, pCO2 (tcpO2, tcpCO2) and breathing patterns in sleeping healthy term infants were obtained during the first 9 mo after birth. Forty‐four healthy infants, mean GA at birth 40 ± 1.0 wk, mean BW 3520 ± 562 g were examined between 2 wk and 9 mo postnatally in a cross‐sectional study. SaO2, tcpO2, tcpCO2, heart rate (HR), rib cage and abdominal respiratory movements were recorded during natural nocturnal sleep, stratified for sleep states (active sleep (AS), indeterminate sleep (IS), quiet sleep (QS)). The data on AS and IS were pooled as in previous studies. The variables were analysed with respect to age. SaO2 in AS + IS and QS was 96.1 ± 1.3%, 96.6 ± 1.4%, respectively. TcpO2 in AS + IS was 10.6 ± 1.1 kPa and 10.7 ± 1.3 kPa in QS, while tcpCO2 in AS + IS was 5.4±0.3kPa and 5.4 ± 0.4kPa in QS. Neither SaO2 nor tcpO2 was influenced by age. TcpCO2 decreased significantly postnatally. Five infants (11.3%) experienced episodes of hypoxaemia with a mean decrease in SaO2 to 86 ± 1.5%. In four infants these hypoxaemic episodes were linked to upper airway obstructions. Episodes of SaO2 < 90% in conjunction with a decrease in HR to <100bpm were detected in one infant only. Periodic breathing (PB) was observed in 38.6% of infants.

Conclusion: Oxygenation and carbon dioxide levels in sleeping healthy term infants were comparable to those reported in older children. Hypoxaemic episodes, if present, are associated with upper airway obstruction. PB, often assumed to be a pathological feature, is a normal breathing pattern in this age group.