bluuebunny/crossref_metadata_2025 huggingface dataset:
Leptin levels in breast‐fed and formula‐fed infants
Authors: Savino F , Costamagna M , Prino A , Oggero R , Silvestro L
Published: August 2010

Aim: Leptin, a hormone that regulates food intake and energy metabolism, is present in breast milk and thus may be involved in body composition differences between breastfed and formula‐fed infants. The aim of this study was to evaluate whether diet and gender affect plasma leptin concentration in breastfed and formula‐fed infants during the first months of life. Methods: Anthropometric and bioelectrical impedance measurements [total body water (TBW) calculated with the Fjeld equation] were made and venous blood plasma samples were analysed for leptin concentration in healthy, exclusively breastfed or formula‐fed Italian infants in the first year of life. Infants were subdivided in two ways: three groups (periods) in relation to age, and five groups in relation to weight. Results: The average serum concentration of leptin was 7.35 ng ml‐1. Serum leptin values were higher in breastfed than in formula‐fed infants. Breastfed infants in group 1 had a statistically higher serum leptin concentration (2500–3749 g). There were no significant differences in anthropometric measurements, body mass index or skinfold thickness between breastfed and formula‐fed infants. In the periods I and II, breastfed infants had a significantly higher TBW than formula‐fed infants. Males had a significantly higher TBW than females in periods I and II. Breastfed infants in group 2 (3750–4999 g) had a significantly higher TBW than formula‐fed infants.

Conclusion: The data on TBW, weight and skinfold thickness suggest that the higher leptin concentration observed in breastfed infants in the first months of life may be due not only to adipose tissue production but also to human milk.
Fasting levels of serum glucose, cholesterol and triglyceride at age eleven to twelve years in stunted and non‐stunted Jamaican children
Authors: Bennett FI , Walker SP , Gaskin P , Powell CA
Published: August 2010

Aim: To determine whether fasting serum concentrations of glucose, cholesterol and triglyceride at age 11–12 y (a) differed between children stunted in early childhood and those who were never stunted, (b) were related to birthweight or current anthropometry and (c) were related to stunting after controlling for current size.Methods: Anthropometry, serum glucose and lipid concentrations were measured in 112 children stunted in early childhood and 181 non‐stunted children.Results: Children who were stunted in infancy remained shorter, weighed less and were significantly less fat than non‐stunted children but had a more central distribution of fat. They were also less likely to have entered puberty. Non‐stunted children had higher fasting serum triglyceride concentrations than stunted children (p> 0.05). There were no significant correlations between birthweight and fasting glucose or any measure of serum lipids. The percentage of variance in biochemical measures explained by anthropometry was low: between 2.1 for HDL cholesterol and 14.6 for triglyceride. Nutritional status in early childhood (stunted or non‐stunted) made no additional contribution to the variance.Conclusions: Linear growth retardation in early childhood was not independently related to fasting serum concentrations of glucose, cholesterol and triglyceride at age 11–12 y. However, despite being thinner, stunted children had a more central distribution of fat.
Postnatal adaptation after Caesarean section or vaginal delivery, studied with the static‐charge‐sensitive bed
Authors: Nikkola EM , Kirjavainen TT , Ekblad UU , Kero PO , Salonen MAO
Published: August 2010

Aim: To compare postnatal adaptation between Caesarean and vaginal deliveries, by studying sleep states, oxygenation, heart rate and body movements. Another aim was to follow the adaptation of healthy, term, vaginally born babies. Methods: Ten vaginally born and 12 neonates born by elective Caesarean section were recorded with a movement sensor (SCSB, static‐charge‐sensitive bed), electrocardiogram and oximeter. The recordings started 1.5 h after birth and lasted for 12 h. For the vaginal group, another 12 h recording was performed during the third night postpartum. Results: Delivery mode did not affect sleep state distribution. The vaginal group had more oxyhaemoglobin desaturation episodes >95% than the Caesarean section group (mean ± SD: 59 ± 10% vs 42 ± 22% of epochs, p= 0.03), especially in active sleep, but baseline saturation was similar (96 ± 1% vs 95 ± 3%, p= 0.93). The vaginal group had fewer movements during sleep than the Caesarean section group (movements of 5–10 s: 5 ± 1 h‐1 vs 10 ± 3 h‐1p= 0.0001). During the first 3 d, the amount of sleeping and active sleep increased, whereas wakefulness and quiet sleep decreased. Baseline oxyhaemoglobin saturation and the number of movements of over 5 s increased.

Conclusion: Delivery mode did not affect sleep state distribution but, unexpectedly, the vaginal group had more oxyhaemoglobin desaturation events and fewer body movements than the Caesarean section group. These differences during the first postnatal day remain unexplained, but they may reflect stress and pain during labour. After a few days, changes in sleep organization, and increases in oxyhaemoglobin saturation and frequency of body movements were noted in the vaginal group, which may represent recovery and adaptation to extrauterine life.
Effect of blood transfusions on cerebral haemodynamics in preterm infants
Authors: Dani C , Pezzati M , Martelli E , Prussi C , Bertini G , Rubaltelli FF
Published: August 2010

Aim: To assess the possible cerebral haemodynamic changes occurring in preterm infants after blood transfusions. Methods: Preterm infants who had undergone blood transfusions were prospectively studied using both near infrared spectroscopy and cerebral Doppler ultrasonography. Results: Fourteen infants (mean gestational age 29.6 wk, SD 2.6; mean birthweight 1430 g, SD 332) were studied at the mean age of 29 (SD 14) d. A significant increase in oxygenated haemoglobin (O2Hb), deoxygenated haemoglobin (HHb), mixed cerebral oxygen saturation (SmO2) and change in cerebral blood volume occurred after transfusion. Between ultrasound parameters, we found a decrease in diastolic velocity and an increase in resistance index.

Conclusion: Blood transfusions improve cerebral oxygen supply and induce a decrease in cerebral blood volume, probably due to an increase in cerebral vessel resistance.
Hyperphagia, weight gain and neonatal drug withdrawal
Authors: Shephard R , Greenough A , Johnson K , Gerada C
Published: August 2010

Hyperphagia, a classical feature of neonatal drug withdrawal, has been reported not to lead to excessive weight gain, but this is contrary to our clinical experience. The aim of this study was to determine whether infants with neonatal drug withdrawal suffered excessive weight gain because of hyperphagia and, if so, to determine the risk factors. The study population comprised 48 infants consecutively admitted to the neonatal intensive care unit, 11 of whom gained weight by more than 20 g kg‐1 d‐1 for at least 10 d (excessive weight gain). All 11 infants were hyperphagic (>200 ml/kg) for at least part of the excessive weight gain period. During the perinatal period, the 11 infants had a greater fluid intake (p > 0.01) but similar weight gain to gestational‐age‐matched, neonatal drug‐withdrawal infants who did not suffer any excessive weight gain. Compared to the rest of the cohort, the infants with excessive weight gain were more likely to require treatment with morphine/chlorpromzaine (p > 0.05) and had a higher maximum withdrawal score (p > 0.01).

Conclusion: Hyperphagia can lead to excessive weight gain in infants with neonatal drug withdrawal. Our results suggest that hyperphagia occurs in those who require treatment for severe withdrawal.
Final height in psychosocial short stature: is there complete catch‐up?
Authors: Gohlke BC , Stanhope R
Published: August 2010

Aim: To determine whether children with psychosocial short stature attain their genetic height potential. Methods: We report on 18 children (10 girls, 8 boys) diagnosed by a multidisciplinary team as having psychosocial short stature. All the children had had some kind of change in their environment (9 were separated from their families), and increased their mean height velocity standard deviation score (SDS) from −0.7 (1.3) to +3.6 (4.8) (p > 0.005) as well as their height SDS from −3.0 (0.3) to −2.6 (0.9) in the first year after the change. All the patients were post‐pubertal and had reached their near final height (mean age, 20.0 y; range, 16.0–23.3). Results: Only 3 out of 18 had a greater final height than the mid‐parental target height, 14 out of 18 had a near final height within the mid‐parental target range (95% tolerance limits of the mid‐parental height (±2 SD =±10 cm). Nevertheless, mean final height expressed in height SDS for the whole group was significantly shorter with −2.4 SDS compared with the mean of the mid‐parental target height of −1.5 SDS (p > 0.001). Surprisingly, initial catch‐up growth did not correlate with final height attainment.

Conclusion: The majority of patients will attain a stature within the range of mid‐parental target height, although towards the lower limit of this range.
Reversible brain lesions in childhood hypertension
Authors: Singhi P , Subramanian C , Jain V , Singhi S , Ray M
Published: August 2010

Posterior leukoencephalopathy syndrome is characterized by an acute, usually reversible, encephalopathy with transient occipital lobe abnormalities detected on MRI that occur mostly in association with acute hypertension. The clinical presentation includes seizures, headache, altered mental status and blindness. Disturbed autoregulation of cerebral blood flow and endothelial injury are central to the pathogenesis of this disorder. Prompt control of hypertension results in rapid and complete neurological recovery. In this report we discuss the cases of two children with acute onset hypertension of different aetiologies that presented with the characteristic features of posterior leukoencephalopathy syndrome.

Conclusion: Early recognition of this readily treatable condition may obviate the need for extensive and invasive investigations. Despite the alarming lesions on the MRI, prompt control of hypertension carries a uniformly favourable prognosis.
Developmental biology of thrombopoietin in the human fetus and neonate
Authors: Dame C
Published: August 2010

This review focuses on the biology of thrombopoietin (Tpo) during human development. It summarizes the current understanding on molecular biological aspects of Tpo, cellular effects of Tpo on fetal and neonatal megakaryopoiesis, regulation of Tpo production, and circulating Tpo concentrations in human fetuses and neonates. Some important aspects on the developmental biology of Tpo are highlighted. They include the finding of high Tpo gene expression in the bone marrow during the onset of medullary hematopoiesis, higher circulating Tpo concentrations in fetuses and neonates than in children or adults, and a higher sensitivity of neonatal megakaryocyte progenitor cells to Tpo. However, other aspects of the developmental biology of Tpo are incompletely understood.

Conclusion: More carefully designed studies are needed to provide the necessary background for an optimal treatment of fetal and neonatal thrombocytopenia.
Evaluation and treatment of thrombocytopenia in the neonatal intensive care unit
Authors: Murray NA
Published: August 2010

Phlebotomy‐induced anaemia excepted, thrombocytopenia is the most common haematological abnormality in neonatal intensive care unit (NICU) patients. Roughly one‐quarter of all NICU patients and half of all sick preterm neonates develop thrombocytopenia. Whereas a large number of varied precipitating conditions has been identified, early‐onset thrombocytopenia (>72 h) is most commonly associated with fetomaternal conditions complicated by placental insufficiency and/or fetal hypoxia, e.g. maternal pre‐eclampsia and fetal intrauterine growth restriction. The resulting neonatal thrombocytopenia is usually mild to moderate, resolves spontaneously and requires no specific therapy. Deviation from this pattern of thrombocytopenia suggests the presence of more significant precipitating conditions. The most important of these are the immune thrombocytopenias, and every NICU should develop investigation and treatment protocols to manage these cases promptly and avoid unnecessary risk of haemorrhage. In contrast, late‐onset thrombocytopenia (>72 h) is almost always associated with sepsis or necrotizing enterocolitis and the associated thrombocytopenia is severe, prolonged and often requires treatment by platelet transfusion. Unfortunately, evidence‐based guidelines for platelet transfusion therapy in NICU patients are currently unavailable, making it difficult to define widely accepted thresholds for transfusion and leading to a significant variation in transfusion practice between centres.

Conclusion: While improving this situation remains a pressing need, the growing evidence that impaired megakaryocytopoiesis and platelet production are major contributors to many neonatal thrombocytopenias suggests that recombinant haemopoietic growth factors, including thrombopoietin and interleukin‐11, may be useful future therapies to ameliorate neonatal thrombocytopenia.
Inflammatory mediators in perinatal asphyxia and infection
Authors: Xanthou M , Fotopoulos S , Mouchtouri A , Lipsou N , Zika I , Sarafidou J
Published: August 2010

Aim: To determine serum levels of interleukin‐6 (IL‐6), IL‐1β, tumor necrosis factor‐α (TNF‐α), soluble intercellular adhesion molecule‐1 (sICAM‐1) and C‐reactive protein (CRP) in asphyxiated neonates and compare these inflammatory factors with those found in neonates with perinatal infection. Methods: 88 neonates were studied, of whom 36 were asphyxiated, 18 were infected and the remaining 34 were controls. Peripheral blood samples were obtained on the 1st, 3rd and 5th postnatal days. Results: Cytokines IL‐6 and IL‐1β as well as sICAM‐1 serum levels did not differ between asphyxiated and infected neonates; however, at most time periods, their values were significantly higher than controls. TNF‐α was similar in the three groups of neonates. CRP serum values were significantly higher in the infected neonates than in the asphyxiated or control subjects. Among the 54 asphyxiated and infected neonates, 15 were considered as severe cases and 39 as mild. The severe cases, at most time periods, had significantly higher IL‐6, IL‐1β and sICAM‐1 levels compared with the mild ones. Through receiver operating characteristic curves the cut‐off points, sensitivities, and specificities for distinguishing neonates at risk or at high risk for brain damage were established.

Conclusion: Similar increases in serum levels of IL‐6, IL‐1β and sICAM‐1 were found in perinatally asphyxiated and infected neonates. As these increases correlated with the severity of the perinatal insults, neonates at high risk for brain damage might be detected.
Immune‐mediated neutropenia in the neonate
Authors: Maheshwari A , Christensen RD , Calhoun DA
Published: August 2010

Alloimmune neonatal neutropenia, neonatal autoimmune neutropenia and autoimmune neutropenia of infancy have remained nebulous entities with difficulties in both clinical and laboratory identification. These disorders are reviewed in this article.
Late‐onset neutropenia in very low birthweight infants
Authors: Chirico G , Motta M , Villani P , Cavazza A , Cardone ML
Published: August 2010

Aim: To evaluate the incidence and duration of late‐onset neutropenia (defined as an absolute neutrophil count (ANC) <1500 mm−3 at a postnatal age of >3 wk) in a population of infants with birthweight <2000 g, and to determine whether copper deficiency, a possible cause of both anemia and neutropenia, may be associated with this complication. Methods: Complete blood cell count and differential were assessed in 247 low (LBW) and very low birthweight (VLBW) infants who were discharged after 3 wk of life. In neutropenic infants plasma copper and ceruloplasmin levels were also measured. Results: Late‐onset neutropenia was detected in 11 out of 147 VLBW infants (7.5%) and in 7 out of 127 LBW infants (5.5%). A neutrophil count of <1000 mm−3 was observed in 14 infants (5.1%). A significantly lower gestational age was found in neutropenic infants compared with non‐neutropenic infants. In neutropenic infants ANCs were significantly correlated with hemoglobin and hematocrit. In addition, a significant negative correlation was found between neutrophil and reticulocyte counts. Plasma copper concentration was significantly correlated with birthweight. Oral copper sulfate was administered to infants with plasma copper concentration <50 μg dl−1, and did not seem to affect ANC, hemoglobin, hematocrit or reticulocyte counts.

Conclusion: Late‐onset neutropenia appears to be a benign condition that is not associated with any particular complication and does not require specific treatment. Reference ranges after the early neonatal period and during the first few months of life in LBW and VLBW infants should probably be set at lower values.
Aetiology and pathogenesis of hypertrophic cardiomyopathy
Authors: Lombardi R , Betocchi S
Published: August 2010

The term hypertrophic cardiomyopathy is used to describe an autosomal dominant cardiac disorder, characterized by myocyte hypertrophy and disarray, interstitial fibrosis and small vessel disease, with or without macroscopic hypertrophy. More than 100 mutations in ten genes, all encoding sarcomeric proteins, have been identified as responsible for this disease. Mutations in the genes for β‐myosin heavy chain, myosin binding protein‐C, and cardiac troponin T are the most common. Other genes involved are α‐tropomyosin, cardiac troponin‐I, essential and regulatory light chains, α‐cardiac actin, titin, and α‐myosin heavy chain. Some mutations are more frequently associated with a given phenotype, but no particular phenotype is mutation specific; in fact, some mutations exhibit highly variable clinical, electrocardiographic and echocardiographic manifestations. This variability in the phenotypic manifestations is probably due to the influence of environmental factors and/or modifier genes. While the aetiology of hypertrophic cardiomyopathy has been extensively elucidated, its pathogenesis is not completely understood. Mutated proteins are incorporated in the sarcomere and impair myocyte contractility. This probably triggers the compensatory local release of trophic factors, which influence the development of the typical anatomical features of the disease, with a pathway similar to that observed in secondary, pressure overload hypertrophy.

Conclusions: The various pathological cardiac changes seen in hypertrophic cardiomyopathy are probably due to a compensatory response to impaired myocyte function resulting from mutations in the genes encoding sarcomeric proteins.
Pain assessment: the advantages of using pain scales in lysosomal storage diseases
Authors: Cleeland CS
Published: August 2010

Routine and standardized assessment of pain should be conducted in patients with conditions, such as Fabry disease, that are associated with chronic pain. Such pain assessments, using validated and reliable pain scales or questionnaires, should cover the severity, location, temporal pattern and quality of the pain and how the pain impacts on quality of life and normal daily activity. The severity or intensity of pain can be assessed on verbal descriptor scales, visual analogue scales and numerical rating scales, which rate pain on a scale from ‘no pain’ through to ‘excruciating pain’ or ‘pain as bad as you can imagine’. Three pain questionnaires that include such rating scales are short enough to be used repeatedly in a clinical or research setting: the Memorial Pain Assessment Card, the McGill Pain Questionnaire and the Brief Pain Inventory (BPI). The BPI also measures the effect of pain on daily activity and quality of life, defines the location of pain and assesses the effectiveness of previous pain relief medication.

Conclusions: Reliable instruments are available to assess pain in chronic disease. In Fabry disease, these should be used routinely to aid decisions concerning analgesic/pain control medication and to assess the effect of enzyme replacement therapy.
Mucopolysaccharidosis type II – genotype/phenotype aspects
Authors: Froissart R , da Silva I Moreira , Guffon N , Bozon D , Maire I
Published: August 2010

Establishing correlations between a patient's genotype and clinical phenotype is based on the assumption that the same clinical consequences will be observed in individuals with the same residual function of a specific metabolic step. In mucopolysaccharidosis type II (MPS II; Hunter disease), patients present with a wide clinical spectrum. Furthermore, current methods for measuring the activity of the deficient enzyme in MPS II – iduronate‐2‐sulphatase (IDS) – are insufficiently sensitive to differentiate between complete absence of activity and the presence of residual activity. Attempts have therefore been made to establish genotype‐phenotype correlations in order to explain the large degree of heterogeneity and to serve as a better guide to prognosis on which to base genetic counselling and treatment options. Using MPS II as an example, this paper illustrates the difficulties and potential advantages of determining genotype‐phenotype correlations in lysosomal storage diseases. The response of patients with MPS II to allogenic bone marrow transplantation provides some insight into the likely influence of certain genotypes on therapeutic efficacy.

Conclusions: Evaluation of residual activity of IDS in MPS II using gene analysis, expression studies and transcript analysis does not always allow prediction of a patient's phenotype. The variable response to bone marrow transplantation, however, illustrates the potential importance of determining the genotype for selecting the most appropriate therapy for individual patients.
Animal models for mucopolysaccharidoses and their clinical relevance
Authors: Haskins M , Casal M , Ellinwood NM , Melniczek J , Mazrier H , Giger U
Published: August 2010

The mucopolysaccharidoses (MPS) are characterized by the accumulation of glycosaminoglycans (GAG) and result from the impaired function of one of 11 enzymes required for normal GAG degradation. MPS II was the first MPS to be defined clinically in humans and is caused by deficient activity of the enzyme iduronate‐2‐sulphatase. MPS VI was the first MPS recognized in an animal; since then, all but MPS IIIC and IX have been described as naturally occurring in animals or made by knock‐out technology. As in humans, all are inherited as autosomal recessive traits, except for MPS II, which is X‐linked. Most animal colonies have been established from single related heterozygous animals, making the affected offspring homozygous for the same mutant allele. Importantly, these models have disease pathology that is similar to that seen in humans, making the animals extremely valuable for the investigation of disease pathogenesis and the testing of therapies. Large animal homologues are similar to humans in natural genetic diversity, approaches to therapy and care, and the possibility of evaluating long‐term effects of treatment. Therapeutic strategies for MPS include enzyme replacement therapy, heterologous bone marrow transplantation, and somatic cell gene transfer, all of which have been tested in animals with some success.
Comparing suprapubic urine aspiration under real‐time ultrasound guidance with conventional blind aspiration
Authors: Chu RW‐P , Wong Y‐C , Luk S‐H , Wong S‐N
Published: August 2010

To determine the optimal method of suprapubic aspiration (SPA), the success rates of real‐time ultrasound‐guided SPA were compared with those of conventional SPA, and factors associated with success were studied. Thirty infants were randomly allocated to group A (for real‐time ultrasound‐guided SPA) and 30 infants to group B (for blind SPA with a prehydration protocol). The results showed that the overall success rates for all attempts were similar (26/30 or 87% in group A vs 24/30 or 80% in group B, p < 0.05). The first attempts in both groups were equally successful (both 18/30 or 60%). In comparison with failed attempts, successful ultrasound SPA attempts were associated with a greater bladder depth (mean ± SD: 28 ± 11 vs 21 ± 5 mm, p > 0.01), length (32 ± 12 vs 23 ± 9 mm, p > 0.05) and volume (17 ± 13 vs 8 ± 6 ml, p > 0.01), but similar width (33 ± 9 vs 29 ± 5 mm, p < 0.05). In blind SPA, successful attempts were associated with the presence of bladder dullness on percussion (odds ratio 29).

Conclusion: This study confirms that ultrasound‐guided SPA has a high success rate. Blind SPA could also be equally successful with appropriate preparation. Ultrasound‐guided SPA is recommended when the bladder depth exceeds 3 cm, or the bladder length exceeds 3.7 cm. If an ultrasound machine is not available, blind SPA may be an alternative, with attention being paid to prehydration and the demonstration of bladder dullness by percussion.
Comorbidity in children with severe developmental language disability
Authors: Westerlund M , Bergkvist L , Lagerberg D , Sundelin C
Published: August 2010

In a cohort of 2359 children, screened for severe developmental language disability (DLD) at 3 y of age, 45 children were identified as true positives. The development, concerning DLD and comorbidity of 41 of these children still living in the municipality of Uppsala was followed up to school start. Criteria for comorbidity were: (a) suspected or diagnosed neuropsychiatric/neuro‐developmental disability according to information from the Child Habilitation Centre and the Child Psychiatric Centre or (b) low performance IQ, signs of activity/distractibility problems according to a psychologist's examination. By school start, 61% of the children with severe DLD were identified with comorbidity.

Conclusion: Severe DLD is often combined with other disabilities within the neuropsychiatric/neurodevelopmental spectra. The comorbidity might not be obvious at 3 y of age—the age at which severe DLD is effectively identified by the 3‐y screening programme. This in turn stresses the necessity of multidisciplinary teamwork both at the referral level and during the therapy work.
Multiple doses of secretin in the treatment of autism: a controlled study
Authors: Sponheim E , Oftedal G , Helverschou SB
Published: August 2010

Dramatic effects on autistic behaviour after repeated injections of the gastrointestinal hormone secretin have been referred in a number of case reports. In the absence of curative and effective treatments for this disabling condition, this information has created new hope among parents. Although controlled studies on the effect of mainly one single dose have not documented any effect, many children still continue to receive secretin. Six children enrolled in a double‐blind, placebo‐controlled crossover study in which each child was its own control. Human synthetic secretin, mean dose 3.4 clinical units, and placebo were administered intravenously in randomized order every 4th wk, on three occasions each. The measurement instruments were the visual analogue scale (VAS) and the aberrant behaviour checklist (ABC). Statistically significant differences were found for placebo in 3 out of 6 children and for secretin in one child, using parental ratings only (VAS scores). Differences were small and lacked clinical significance, which was in accordance with the overall impression of the parents and teachers and visual inspection of graphs.

Conclusion: In this placebo‐controlled study, multiple doses of secretin did not produce any symptomatic improvement.
A longitudinal cohort study on the prevalence of Helicobacter pylori antibodies in Swedish children and adolescents
Authors: Granquist Å , Bredberg A , Sveger T , Axelsson I
Published: August 2010

The aim of this study was to monitor the Helicobacter pylori antibody seroprevalence of an asymptomatic cohort between the ages of 4 and 18 y. The H. pylori antibody titres in a longitudinally followed cohort of 168 native Swedish children (born between 1972 and 1974) were established at 4, 8, 12, 16, and 18 y of age. Seventeen children (10.1%) were found positive on at least one occasion when a paediatric cut‐off was applied. Five children (3.0%) reached levels considered positive in adults. The seroprevalence at 4 y of age was 4.0%, at 8 y 2.5%, at 12 y 4.9%, at 16 y 5.3%, and at 18 y 6.3%. The difference in serological titres between the age groups was not significant. A change from negative to positive after the age of 4 took place in 5 of the cases. Spontaneous seroreversion appeared in 5 cases.

Conclusion: Our findings showed no significant differences among the various age groups. Seventeen of the 168 children (10.1%) had been infected at some time, the prevalence ranging from 2.5% to 6.3%. Seroconversion and seroreversion occurred infrequently between the ages of 4 and 18 y.
Heart rate variations in five‐month‐old children during interactions in a controlled environment
Authors: Montagner H , Deliac P , Bordes JP , Cazenave M , Bensch C
Published: August 2010

This paper reports the first data of a study on heart rate variations of 13 5‐mo‐old infants seated in special chairs. Their electrocardiograms and behaviour were continuously recorded during sessions that were set up with their mother and a mother‐child dyad that they met for the first time when the first session was organized. The protocol comprised two interaction phases between the infants and their mothers and two with one another. The same pairs of mother‐child dyads were studied a second time 1 wk later. During the first session, the infants' heart rate variability increased significantly from the mother‐infant interaction phases to the infant‐infant interaction phases. During the second session, the variability was higher during the mother‐infant phases than in the corresponding phases of the first session. This could be linked to changes in the mothers' behaviour and the infants' idea and excitement of meeting the child from the first session again. However, the variability was significantly lower during the infant‐infant phases than during the mother‐infant phases and the corresponding infant‐infant phases of the first session. This corresponds to the development of affiliative behaviours in the infants.

Conclusion: When two 5‐mo‐old infants were seated by their mothers in special chairs, significant differences were observed in their heart rate variability when they became familiar with each other, whether they were interacting with their mothers or with one another.
Effect of oral potassium supplementation on QT dispersion in anorexia nervosa
Authors: Franzoni F , Mataloni E , Femia R , Galetta F
Published: August 2010

The aim of this study was to evaluate the degree of QT dispersion in a group of young women with anorexia nervosa and its changes after oral potassium supplementation. Twenty‐eight patients with self‐induced starvation were matched with 20 thin and 20 normal‐weight women (body mass index ≪20). All participants underwent a complete clinical examination, including electrocardiogram (ECG) for QT interval measurements. QT dispersion was defined as the difference between the longest and the shortest QT interval occurring in the 12‐lead ECG. QT dispersion was corrected (QTc) with Bazett's formula. Anorexic patients were later allocated two subgroups of 14 to receive or not to receive potassium aspartate (2 vials K‐Flebo d‐1= 60 mEq d‐1, per os). ECG was repeated in both the subgroups of anorexic patients after 4 wk. QT dispersion was significantly greater in starving patients than in thin or normal‐weight women (QT dispersion = 62.2 ± 12.4 vs 33.4 ± 7.1 or 31.7 ± 6.3 ms; QTc dispersion = 56.5 ± 12 vs 34 ± 9.1 or 33.2 ± 11 ms, p > 0.001). After 4 wk, anorexic women treated with oral potassium aspartate supplementation, compared with untreated patients, showed an increased kalaemia (4.21 ± 0.16 vs 3.91 ± 0.32 mmol 1‐1, p > 0.05) and a significant reduction in the QT interval dispersion (QT dispersion = 44.2 ± 8.1 vs 63.2 ± 9.1 ms, QTc dispersion = 41.3 ± 9.7 vs 57.4 ± 9 ms, p > 0.001).

Conclusion: Patients with anorexia nervosa have greater QT dispersion than constitutionally thin and normal‐weight women, and oral potassium supplementation tends to reduce it. This suggests that the reduction in the pool of potassium may be the critical factor inducing the enhancement of the QT dispersion in anorexia nervosa.
Is coeliac disease prevalent among adolescent psychiatric patients?
Authors: Pynnönen P , Isometsä E , Aalberg V , Verkasalo M , Savilahti E
Published: August 2010

Coeliac disease (CD) occasionally presents solely with neuropsychiatric symptoms and may predispose to mental and behavioural disorders. This study screened new adolescent psychiatric outpatients (n= 140) in the Department of Adolescent Psychiatry of the Hospital for Children and Adolescents, Helsinki, using immunoglobulin A antibody to tissue transglutaminase. The prevalence rate of CD was found to be 1 in 140.

Conclusion: The results do not suggest that undetected CD is markedly overrepresented among adolescent psychiatric outpatients.
Acute and postoperative pain in children: a Swedish nationwide survey
Authors: Karling M , Renström M , Ljungman G
Published: August 2010

Many studies demonstrate inadequate pain treatment in children. The aim of this nationwide survey was to evaluate the prevalence of acute and postoperative pain in children; extent of, and reasons for, inadequate pain therapy; therapy methods; pain‐management structure; and the need for education of healthcare professionals. Questionnaires concerning these points were sent to all departments in Sweden involved in the treatment of children. The response rate was 75% (299/395). Answers from physicians and nurses showed that, despite treatment, moderate to severe pain occurred in 23% of patients with postoperative pain and 31% of patients with pain of other origin. Postoperative pain seemed to be a greater problem in units where children were treated along with adults and in departments where fewer children were treated. According to 45% of physicians and nurses, treatment of pain could often or always be managed more efficiently. Pain assessments were performed regularly in 43% of all departments, but pain measurement was less frequent; 3% of the departments had no formal organization for pain management; and 15% never or infrequently used potent opioids. Educational needs were high. Insufficient pain treatment seemed to be mostly related to organizational aspects, such as inadequate prescriptions. Anxiety in children or parents also contributed to ineffective pain treatment. Swedish treatment practices for the management of pain in children roughly follow the published guidelines, but many improvements are still necessary.

Conclusion: Acute pain in children is still undertreated in Swedish hospitals. This seems to be related mainly to organizational aspects.
Primary ciliary dyskinesia: age at diagnosis and symptom history
Authors: Coren ME , Meeks M , Morrison I , Buchdahl RM , Bush A
Published: August 2010

Age at diagnosis and the symptom history of children with primary ciliary dyskinesia (PCD) are described by reviewing the case notes in the paediatric PCD clinic. Mean age at diagnosis was 4.4 y despite a history of neonatal respiratory distress in 37/55 cases, situs inversus in 38/55 cases and early onset troublesome rhinitis in 42/55.

Conclusion: Diagnosis of PCD is often delayed despite the presence of typical symptoms early in life. The key clinical features of unexplained neonatal respiratory distress, early onset rhinitis, situs inversus and a productive cough are highlighted, which, especially when occurring in combination, makes early referral for specific testing for PCD mandatory.
Swedish population‐based longitudinal reference values from birth to 18 years of age for height, weight and head circumference
Authors: Wikland K Albertsson , Luo ZC , Niklasson A , Karlberg J
Published: August 2010

This study aimed to update growth reference values for height, weight and head circumference in order to reflect the changes in body size in the Swedish population during the past two decades. The data came from a large longitudinal growth study on 3650 full‐term healthy Swedish children who were born between 1973 and 1975. All of these 1801 girls and 1849 boys had longitudinal data for height and weight from birth to final height. Comparison with previous Swedish growth reference values based on children born between 1955 and 1958 revealed that there have been secular changes in body size. For instance, at 18 y of age, the updated height and weight reference values are 180.4 cm for males and 167.7 cm for females, i.e. 1.9 cm taller and 5.7 kg heavier for males and 2.3 cm taller and 3.4kg heavier for females compared with the previous reference values.

Conclusion: These new growth reference values provide current national standards for growth monitoring and evaluation since the year 2000.
Prospective population‐based study on rotavirus disease in Germany
Authors: Ehlken B , Laubereau B , Karmaus W , Petersen G , Rohwedder A , Forster J ,   and the RoMoD Study Group*
Published: August 2010

The aim of this study was to collect representative data on the incidence and clinical characteristics of community‐acquired acute gastroenteritis (AGE) due to rotavirus (RV) in German children up to 4 y of age. In 20 paediatric practices in 5 German regions every child aged 0–4 y presenting with symptoms of AGE from May 1997 to April 1998 was eligible for inclusion into the study. Stool samples were tested for RV antigen by enzyme‐linked immunosorbent assay and polymerase chain reaction was performed for serotyping. The course of the disease, additional diagnoses and treatment regimen were recorded. Incidences adjusted for month and region of observation were calculated by Poisson regression. Of 15 451 children under observation 3980 (26%) presented with AGE. Of 3156 stool samples available 748 (24%) proved RV positive. The incidence of AGE and RV‐positive AGE was 25.2 and 4.0 per 100 children per year, respectively, with a maximum in February/March 1998. RV‐positive cases were more severe than RV‐negative cases (28% vs 12% severe cases, hospitalization rate 6.2% vs 2.0%, p > 0.001). The predominant genotype of RV isolated was Gl/P[8] (77%), followed by G4/P[8] (17%).

Conclusion: Rotavirus accounts for a substantial part of severe cases of AGE in children up to 4y of age. Efficient prevention, including immunization against the circulating serotypes, could save at least 122000 children in Germany from falling ill with RV‐AGE each year.
Antioxidant effect of β‐carotene in cystic fibrosis and bronchiectasis: clinical and laboratory parameters of a pilot study
Authors: Çobanogcarlu N , Özçelik U , Göçmen A , Kiper N , Doǧru D
Published: August 2010

The carotenoids are potent antioxidants with the ability to quench singlet oxygen and other toxic oxygen species. The aim of this pilot study was to investigate the protective effect of β‐carotene on oxidant system in patients with cystic fibrosis (CF) and in patients with bronchiectasis (BE) caused by a reason other than CF. Eighteen children with CF and 15 children with BE followed in the Pediatric Chest Disease Unit of Hacettepe University, and 15 healthy children participated in the study. Compared with the controls, significantly lower plasma levels of β‐carotene were found in the CF group and significantly lower plasma levels of vitamin E in the CF and BE groups. The standardization of carotenoid levels for total cholesterol did not significantly attenuate these differences. In addition, there were significantly higher levels of malondialdehyde (a marker of lipid peroxidation) and tumour necrosis factor‐α (TNF‐α) in children with CF and in children with BE than in normal subjects. After 6 mo of β‐carotene supplementation, the plasma levels of β‐carotene and vitamin E increased and the plasma levels of TNF‐α and malondialdehyde decreased in both groups.

Conclusion: Potent antioxidants, β‐carotene and vitamin E are deficient in patients with CF and in patients with BE, and they are more susceptible to oxidative damage. These patients may benefit from β‐carotene supplementation.
Cardiovascular changes in children with mucopolysaccharide disorders
Authors: Mohan UR , Hay AA , Cleary MA , Wraith JE , Patel RG
Published: August 2010

The aims of this study were to evaluate cardiac involvement, assess risk factors and mortality, and define the outcome of cardiac abnormalities with age in the different types of mucopolysaccharidoses (MPS). The echocardiograms of 99 patients with MPS, aged 1–24 y (median age 10.3 y) were reviewed between 1978 and 2000. Mitral regurgitation (MR) was detected in 29 patients (29%). MR was more frequent in types IH [n= 11 (38%)], II [n= 10 (24%)] and III [n= 4 (20%)]. Sixteen patients (16%) developed aortic regurgitation (AR), seen mostly in types II [n = 9 (56%)] and IV [n= 4 (24%)]. AR and/or MR was detected in 37 patients and 8 had both abnormalities of borderline significance (odds ratio 2.95,95% confidence interval 1.0–8.85, p= 0.05). Of 99 patients, 47 had a normal study on their first echocardiogram, whereas only 7 had a normal study on subsequent echocardiograms. Fifty‐four (54%) had a single echocardiogram. Of these, 27 (50%) were abnormal and 27 normal. Forty‐five patients had more than one echocardiogram, of which 25 (56%) were abnormal and 20 normal. In 13/20 (65%) a cardiac abnormality developed on a subsequent echocardiogram which was statistically significant (p= 0.002). Overall mitral and aortic valve abnormalities showed a positive association with age. Univariate analysis of risk factors showed that increasing age, MPS I and ejection fraction were significant risk factors for death. However, left ventricular hypertrophy, mitral valve abnormalities and type II MPS were not significant risk factors for death, with borderline significance for aortic valve abnormalities.

Conclusion: This study demonstrates the evaluation of ventricular function, which is a significant risk factor for death, along with increasing age and MPS I, and outlines the borderline significance of aortic valve abnormalities, which has not been mentioned in previous studies. It also shows that mitral valve lesions, commonly seen in MPS, were not a significant risk factor for death. The results emphasize the importance of performing serial echocardiograms in patients with MPS to assess ventricular function and the progression of cardiac abnormalities with age.
Phenylalanine hydroxylase mutations and phenylalanine‐tyrosine metabolism in heterozygotes for phenylalanine hydroxylase deficiency
Authors: Verduci E , Riva E , Agostoni C , Leviti S , Fiori L , Lammardo AM , Biondi ML , Giovannini M
Published: August 2010

The aim of this study was to determine whether any relationship exists between the severity of mutation of the phenylalanine hydroxylase (PAH) gene and the plasma concentrations of phenylalanine (Phe) and tyrosine (Tyr) under fasting and semifasting conditions among heterozygotes in a matched case‐control study. Parents of patients affected by PAH deficiency (n= 25) detected through the Italian Neonatal Screening Program and referred from January 1994 to June 2000, and parents of healthy children were investigated. In total, 68 subjects without any disease, 34 hyperphenylalaninaemia (HPA) heterozygous parents and 34 age‐ and gender‐matched controls, were recruited. Plasma concentrations of Phe and Tyr in fasting and semifasting (1600 mg Phe oral load) conditions were the main outcome measures. DNA analysis for PAH mutations was performed in all 68 subjects. Compared with controls, heterozygotes showed higher fasting and semifasting Phe concentrations (p > 0.0001), lower semifasting Tyr concentrations (p= 0.015), lower Tyr variations (p= 0.003) and a higher Phe/Tyr ratio (p > 0.0001) in switching from fasting to semifasting conditions. Heterozygotes carrying a severe mutation showed semifasting plasma Tyr concentrations lower than controls (p= 0.019) but not significantly different from Tyr levels found in non‐severe carriers (p= 0.197). The Tyr variations were minor in severe carriers than controls (p > 0.001) and non‐severe carriers too, although with lower significance (p= 0.089). In six carriers of A403V mutation, parents of mild hyperphenylalaninaemics on an unrestricted diet, significant differences in variations from fasting to semifasting conditions were found compared with parents of patients on a diet.

Conclusion: Although the great heterogeneity of PAH mutations limits any general conclusion, the results suggest that monitoring plasma Tyr variations may be more sensitive than plasma Phe in assessing the severity of PAH mutations in HPA heterozygotes.
Perinatal water intoxication due to excessive oral intake during labour
Authors: Johansson S , Lindow S , Kapadia H , Norman M
Published: August 2010

The increased body water in pregnant women and the birth‐related activation of water‐sparing systems contribute to a high risk of perinatal water intoxication if the mother drinks too much water during labour. This study reports on four newborn term infants and one mother presenting with life‐threatening symptoms due to hyponatraemia from excessive oral intake during labour. Awareness of this diagnosis in the delivery unit is very important, because the clinical picture may mimic that of pre‐eclampsia or dehydration.

Conclusion: Guidelines are proposed to prevent and treat perinatal water intoxication due to excessive oral intake during labour.
Attitudes of enuretic children towards their illness
Authors: Wolańczyk T , Banasikowska I , Zlotkowski P , Wińniewski A , Paruszkiewicz G
Published: August 2010

The aim of this study was to establish the attitudes of enuretic children towards their illness and to assess the correlation between children's attitudes and biological and medical variables describing the clinical picture and course of enuresis. Fifty children were included (31M, 19F), aged 8–18 y (mean 12.74 y), all with the diagnosis of enuresis. The reference groups consisted of 60 children with asthma and 40 children with chronic heart disease, aged 8—12 y. The Polish version of the Child Attitude Toward Illness Scale (CATIS) was administered to all the children and structured interviews concerning demographic and medical data were conducted with the parents. There were no significant differences in median CATIS scores between the subgroups divided according to age, type of enuresis and family history of enuresis. There was no significant correlation between the CATIS score and frequency of enuresis and number of therapeutic failures. The girls had significantly lower median CATIS scores than the boys (p= 0.03). The difference in median CATIS scores between genders was significant only for the older group aged 14–18 y. The older girls had the lowest CATIS scores. Enuretic children were found to have statistically significantly more negative attitudes towards their illness than children with asthma (p= 0.006) and children with chronic heart disease (p= 0.067).

Conclusion: Enuretic children had more negative feelings about their illness than children with other chronic conditions. This negative attitude was not related to demographic or clinical data except for gender. The adolescent girls demonstrated the most negative attitude towards enuresis.