bluuebunny/crossref_metadata_2025 huggingface dataset:
Sociodemographic risk factors for sudden infant death syndrome: associations with other risk factors
Authors: Daltveit AK , Irgens LM , Øyen N , Skjærven R , Markestad T , Alm B , Wennergren G , Norvenius G , Helweg‐Larsen K
Published: August 2010

The aim of this study was to investigate associations between sudden infant death syndrome (SIDS) and social factors in the Nordic countries. A case‐control study was conducted in Denmark, Norway and Sweden: The Nordic Epidemiological SIDS Study. Parents of 244 SIDS infants and 869 control infants matched on gender, age at death and place of birth filled in questionnaires. The dataset was analysed by conditional logistic regression. In univariate analysis, the following sociodemographic factors were associated with an increased risk of SIDS: low maternal age [odds ratio (OR) 7.8; 2.8‐21.5], high birth order (OR 4.4; 2.5‐7.5), single motherhood (OR 2.9; 1.7‐5.0), low maternal education (OR 4.5; 2.8‐7.1), low paternal education (OR 3.0; 1.9‐4.7), maternal unemployment (OR 2.4; 1.8‐3.4) and paternal unemployment (OR 4.0; 2.7‐5.9). In a multivariate analysis where maternal smoking was also included, only paternal unemployment, young maternal age and high birth order remained significantly associated with SIDS. Housing conditions were not associated with SIDS. However, the risk of SIDS was high if the family had lived in their present home for only a few years (OR 2.3; 1.3–4.1). Sociodemographic differences remain a major concern in SIDS in a low‐incidence situation and even in an affluent population with adequate health services.
Capillary refilling time in newborns–optimal pressing time, sites of testing and normal values
Authors: Strozik KS , Pieper CH , Cools1 F
Published: August 2010

Aspects of capillary refilling time (CRT) in newborns, such as pressing time, sites of testing, normal values and difference between observers were assessed. CRT was measured in 280 term newborns, divided into 7 groups of 40 each, varying pressing time (from 1 to 7 s) was applied. CRT was measured in midpoints of forehead and sternum and plantar surface of heel (defined as head, chest and heel). No statistically significant difference was found between 3 and 7 s pressing time groups. The data points of the CRT of the head and chest approached normality, whilst those of the heel were widely scattered. Normal CRT in newborns is <3 s. No significant difference between two observers in head and chest CRT values was found.
A review of cystic fibrosis children born to single mothers
Authors: Macpherson C , Redmond AOB , Leavy A , McMullan M
Published: August 2010

The purpose of this study was to examine the relationship between single parents and the health of their children with cystic fibrosis. Seventy‐five children aged between 0.8 and 6.0 y were identified from our patient register; 20 of these children came from single parent families. Socioeconomic profiles were collated for each family. Retrospective medical data including, gene mutation analysis, were recorded from the hospital notes of all 75 patients. Maternal health was assessed by means of the General Health Questionnaire (28‐item version). The results show that maternal age of ≤19y and lone parenthood were associated with higher morbidity in CF patients <6y of age. Predicted values of the Shwachman score being lower by 4.1 and 4.3 points, respectively. A declining Shwachman score of 1.1 points/y was associated with increasing patient's age. In addition, analysis showed that the CF children of teenage mothers were 16 times more likely to have admission rates of ≥1/y. Single mothers experienced more stress‐related symptoms than those from the married group. We concluded that the young CF children of single or teenage mothers have a significantly worse clinical progress and consequently have a higher demand for hospital services. Clearly this population requires extra clinical vigilance and social support.
Midline brain lesions in children with hormone insufficiency indicate early prenatal damage
Authors: Hellstrom A , Wiklund L‐M , Svensson E , Stromland K , Albertsson‐Wikland K
Published: August 2010

The relationships between midline brain morphology, anterior visual pathway morphology and hormonal status in children with impaired growth were studied. Intracranial morphology was studied by magnetic resonance imaging in 47 children (14F, 33M), median age 9.7y (range 2.6–18.7y) undergoing growth hormone treatment (GH; 0.1 U/kg/d). They were chosen to represent various birth sizes and a spectrum of hormone insufficiencies. There was a relationship between GH secretion and the morphology of the neurohypophysis, the pituitary stalk and the anterior visual pathways, i.e. the greater the GH insufficiency, the more abnormal were these structures. The children with anterior visual pathway abnormalities had the lowest GH levels and the smallest adenohypophysis. The association between abnormalities of the anterior visual pathways and the hypothalamo‐pituitary structures may reflect a common prenatal neural damage in embryologically and anatomically closely related structures.
Transient focal neurologic deficits associated with hypoglycaemia in children with insulin‐dependent diabetes mellitus
Authors: Pocecco M , Ronfani L ,   the Italian Collaborative Paediatric Diabetologic Group
Published: August 2010

We describe 54 transient focal neurologic deficits (TFND) episodes in 44 children under 18 y observed retrospectively during a 5‐y period (1991–96). Mean age and duration of insulin‐dependent diabetes mellitus (IDDM) were 8.4 and 3.4 y, respectively. None of the children had a history of seizure disorder and only one had a personal history of migraine. Twenty‐nine episodes were characterized by right‐ and 25 by left‐sided hemiparesis. Three of six patients who presented more than one event had alternate episodes of right‐ and left‐sided hemiparesis. On 8 occasions the episode was preceded by a brief convulsion, in 39 it was not witnessed, and in 7 it was certainly absent. Hypoglycaemia (<2.77 mmol/l) was documented on 26 occasions. On 18 of these 26 occasions, the episodes did not resolve promptly after sugar administration. The clinical course was benign, all patients remained neurologically normal and none developed migraine at follow up. Episodes of TFND were associated with hypoglycaemia in the majority of our cases and we do not consider invasive investigations to be mandatory, since the long‐term prognosis was invariably good.
Hunger behaviour contributes to early nutritional homeostasis
Authors: Marchini G , Persson B , Berggren V , Hagenäs L
Published: August 2010

Objectives and methods: Our goal was to describe nutritional homeostasis in healthy exclusively breastfed infants (n= 175) during their first 5d, by cross‐sectional measurements of body weight, blood glucose, plasma insulin, insulin‐like growth factor‐I (IGF‐I), insulin‐like growth factor binding‐protein‐1 (IGFBP‐1), free fatty acids (FFA), glycerol, ketone (3‐OH‐butyric acid) and lactate. We also investigated whether nutrition affected feeding behaviour by timing the interval between feedings. Results: A progressive loss of body weight, as percentage of birthweight, occurred up to 2 d of age, with a maximal decrease of 5.8 ± 2.1% (mean ± SD); this was accompanied by inhibition of anabolic hormone and metabolic pathways and an increased mobilization of stored fat and ketogenesis. The interval between feedings decreased between d 1 and 2. Weight gain occurred at 3 d and the following re‐feeding phase returned fuel stores to their previous levels and established an anabolic hormonal and metabolic situation. Infants with weight loss exceeding 10% had a further accentuation in their peripheral picture of starvation and a further 7% shortening of the interval between feedings. Conclusions: breastfeeding on demand is accompanied by a balanced nutritional situation and an increased drive to eat when weight reduction is <6%. However, a weight loss of ≥10%, probably elicits hunger sensations in response to decreased fuel availability.
Clinical profiles of subjects with subcortical leukomalacia and border‐zone infarction revealed by MR
Authors: Yokochi K
Published: August 2010

Clinical profiles of 13 children with subcortical leukomalacia and border‐zone infarction revealed by MR were analysed. The causes of brain damage were neonatal asphyxia, hypoglycaemia, circulatory disturbance associated with congenital heart diseases, and other perinatal events in five, three, two and three, respectively. Severe, moderate and mild mental retardation were present in three, five and five, respectively. Of the seven children who could walk alone, six had ataxia and one spastic diplegia; the remaining six manifested truncal instability. The ataxia was deduced to have resulted from cerebral lesions.
Fatty acid composition in colostrum and mature milk from non‐atopic and atopic mothers during the first 6 months of lactation
Authors: Yu G , Duchén K , Björkstén B
Published: August 2010

The fatty acid composition of total lipids was analysed in colostrum and mature human milk samples obtained at 1, 3, 4 and 6 months from 17 non‐atopic and at 1 and 3 months from 17 atopic mothers. The relative levels of linoleic acid and α‐linolenic acid increased up to 3 months after delivery and then declined. In contrast, the levels of their metabolites were higher in colostrum than in mature milk. The levels of dihomo‐γ‐linolenic acid, eicosapentaenoic acid, docosapentaenoic acid and docosahexaenoic acid were all lower in atopic than non‐atopic mothers in milk samples obtained after 1 month of lactation (all p < 0:05). The ratio of total n‐6 to n‐3 long‐chain polyunsaturated fatty acids (LCP) in milk at 1 and 3 months was higher in atopic than non‐atopic mothers (all p < 0:05). Lower levels of the monounsaturated fatty acids (MUFA) were also observed in atopic mothers, as compared to non‐atopic mothers. In the non‐atopic mothers, the levels of individual n‐6 LCP correlated and also correlated with n‐3 LCP in colostrum and early mature milk (r= 0:60‐0.92, all p < 0:01). These correlations within n‐6 and between n‐6 and n‐3 LCP were mostly absent in atopic mothers. The findings suggest that the LCP metabolism in human milk is disturbed in atopic mothers, as indicated by the lower relative levels of some LCP at 1 month, higher ratios of n‐6 to n‐3 LCP and poor correlations between the levels of the various compounds during the first 3 months of lactation.
Vitamin D status of breastfed Pakistani infants
Authors: Atiq M , Suria A , Nizami SQ , Ahmed I
Published: August 2010

This study was conducted to evaluate the vitamin D status of healthy breastfed Pakistani infants and their nursing mothers. Sixty‐two breastfed healthy infants and their nursing mothers belonging to the upper and lower socioeconomic classes were examined. Serum 25‐hydroxy vitamin D [25(OH)D], serum calcium, phosphorus and alkaline phosphatase were measured. The mean serum 25(OH)D in infants was 34.59 ± 26.56 nmol/l. Fifty‐five percent of infants and 45% of mothers had very low serum 25(OH)D levels (<25 nmol/l). Significantly higher levels were found in infants of lower socioeconomic class (p < 0:001) and in those living in mud houses (p= 0:002) and infants > 6 months (p < 0:001). A high prevalence of vitamin D deficiency was found in breastfed infants and nursing mothers, predominantly among those belonging to the upper socioeconomic class. Infants of the lower socioeconomic class had comparatively higher serum 25(OH)D levels, but even these levels were below the normal range for infants (90 ± 27.5 nmol/l).
No resuscitation orders and withdrawal of therapy in French paediatric intensive care units
Authors: Martinot A , Grandbastien B , Leteurtre S , Duhamel A , Leclerc F ,   the Groupe Francophone de Réanimation et ?Urgences Pédiatriques
Published: August 2010

Objective: To determine the incidence of different modes of death in French paediatric intensive care units and to compare patients’characteristics, including a severity of illness score (Paediatric Risk of Mortality: PRISM score) and prior health status (Paediatric Overall Performance Category scale), according to the mode of death. Design: A 4‐month prospective cohort study. Setting: Nine French multidisciplinary paediatric intensive care units. Patients: All patients who died in PICUs, except premature babies. Main results: Among 712 admissions, 13% patients died. Brain death was declared in 20%, failure of cardiopulmonary resuscitation occurred in 26%, do‐not‐resuscitate status was identified in 27%, and withdrawal of supportive therapy was noted in 27%. The PRISM score and the baseline Paediatric Overall Performance Category were not different between the four groups. Brain‐dead patients were older than those in whom a do‐not‐resuscitate order and withdrawal of therapy were made (median age 81 vs 7 and 4 months). Conclusions: Decisions to limit or to withdraw supportive care were made for a majority of patients dying in French paediatric intensive care units. Chronic health evaluation and severity of illness index are not sufficient to describe dead‐patient populations.
The effect of phototherapy on cerebral blood flow velocity in preterm infants
Authors: Benders MJNL , van Bel F , van de Bor M
Published: August 2010

Cerebral blood flow velocity was studied with two‐dimensional/pulsed Doppler ultrasound before, during and after discontinuation of phototherapy in 22 preterm infants (gestational age ≤ 32 weeks), who were treated for a minimum of 12 h with blue‐light phototherapy for non‐haemolytic hyperbilirubinaemia. Before the cerebral blood flow velocity measurements, patency of the ductus arteriosus was diagnosed by Doppler echocardiography. All infants had normal brain ultrasound scans. Mean cerebral blood flow velocity increased significantly after initiation of phototherapy in all infants. Only in “healthy” (non‐ventilated) infants did cerebral blood flow velocity return to pre‐phototherapy values (baseline) after discontinuation of phototherapy, whereas in “unhealthy” (ventilated) infants cerebral blood flow velocity did not return to baseline. In 10 infants the ductus arteriosus reopened during phototherapy. In those infants, mean cerebral blood flow velocity returned to pre‐phototherapy values after 2 h of phototherapy prior to its discontinuation.
Efficacy of sequential early systemic and inhaled corticosteroid therapy in the prevention of chronic lung disease of prematurity
Authors: Kovács L , Davis GM , Faucher D , Papageorgiou A
Published: August 2010

In order to assess the efficacy of a combination of systemic and nebulized corticosteroids in reducing the incidence and severity of chronic lung disease (CLD) in very low birthweight (VLBW) infants, 60 ventilator‐dependent infants ≤ 1500g were randomly assigned to receive either steroids or placebo as of 7d. The steroid group (n= 30, GA = 25:8 ± 1:6 weeks, BW = 731 ± 147 g) received systemic dexamethasone for 3 d, followed by nebulized budesonide for 18 d. Control infants (n= 30, GA = 25:9 ± 1.8 weeks, BW = 796 ± 199 g) received systemic and inhaled saline. Steroid‐treated infants required less ventilatory support between 9 and 17 d (p < 0:01), and had greater lung compliance at 10 d (p= 0:01), but not subsequently. CLD incidence at 36 weeks was 45.5% vs 56.0% in controls, and fewer steroid‐treated infants required dexamethasone rescue (23.3% vs 56.7%, p= 0:017). Survival to discharge was similar (73.3% vs 83.3%), as were the durations of mechanical ventilation, supplemental oxygen use, and hospitalization. Tracheal effluent elastase/albumin ratios and serum cortisol values did not differ between groups, and no adverse effects were noted. We conclude that early dexamethasone administration was associated with improved pulmonary function, which was not sustained with nebulized budesonide. However, the steroid regimen studied reduced the need for dexamethasone rescue in infants with CLD.
Community‐based survey of paediatric diarrhoeal morbidity and home treatment practices in Finland
Authors: Rautanen T , Halme S , Vesikari T
Published: August 2010

To determine total diarrhoeal morbidity and current home case management practices, a recall study was conducted among 345 mothers whose 406 children under 5 y of age had had diarrhoea in the past 4 months. The seasonally adjusted annual diarrhoea incidence rate was 0.48 episodes/child/y. For home treatment, increased amounts of fluid were given in 93% and oral rehydration solution (ORS) in 37% of cases. However, when given, ORS was diluted with other fluids in 41% of cases. More than half (55%) of the children received increased or normal amounts of food during the diarrhoeal episode, but 7% of the children were kept fasting for at least 1 d. Use of antidiarrhoeal drugs was minimal (0.7%), but products containing lactic acid bacteria were given in 44% of cases. Case management practice in cases of diarrhoea at home have much improved during the last 20 y, but are still not optimal.
Reduced spontaneous growth hormone secretion in patients with Turner's syndrome
Authors: Pirazzoli P , Mazzanti L , Bergamaschi R , Perri A , Scarano E , Nanni S , Zucchini S , Gualandi S , Cicognani A , Cacciari E
Published: August 2010

Pirazzoli P, Mazzanti L, Bergamaschi R, Perri A, Scarano E, Nanni S, Zucchini S, Gualandi S, Cicognani A, Cacciari E. Reduced spontaneous growth hormone secretion in patients with Turner's syndrome. Acta Pædiatr 1999; 88: 610‐3. Stockholm. ISSN 0803‐5253

We evaluated growth hormone (GH) secretion in 81 patients with Turner's syndrome (TS) (mean age 10.7 ± 3.6 y) with respect to karyotype, auxological characteristics and growth response to GH treatment (1 IU/kg/wk). None of the patients had spontaneous puberty or had started replacement therapy with estrogens. Thirty‐nine patients (48%) had monosomia 45X, 29 (36%) structural abnormalities of the X chromosome and 13 (16%) X mosaicism. Before the start of GH therapy, each patient underwent an evaluation of mean nocturnal GH concentration (MGHC) and 75 patients also underwent 2 pharmacological tests. MGHC of the TS patients did not differ from that of 29 prepubertal GH‐deficient girls (GH peaks < 8 μg/l after pharmacological tests) and both groups were lower(p< 0.0001 andp< 0.0005, respectively) than MGHCs of 27 short normal girls (GH peak > 8 μg/l). MGHC of the patients with TS was negatively correlated(p< 0.001) with bodyweight excess (BWE) at multiple regression analysis. MGHC of the TS patients with BWE < 20% was significantly higher(p< 0.02) than that of the TS patients with BWE > 20%, but again did not differ from that of the GH‐deficient patients and was lower(p< 0.001) than that of the short normal girls. MGHC did not significantly differ between the 3 groups subdivided according to karyotype. Forty‐four percent of the TS patients showed GH responses to pharmacological tests < 8 μg/l. Height velocity SDS at first and second year of therapy was not influenced by MGHC levels, chronological or bone age, target height or BWE. In conclusion, spontaneous secretion in our patients with TS was lower than that of the short normal prepubertal girls and did not differ from that of GH‐deficient subjects, even if we excluded overweight patients. The level of GH secretion was unable to predict GH response to treatment. □Bodyweight excess, growth hormone secretion, growth hormone therapy, Turner's syndrome
Three children with congenital toxoplasmosis: early report from a Swedish prospective screening study
Authors: Malm G , Fahnehjelm K Teäzr , Wiklund S , Engman M‐L , Ivarsson SA , Petersson K , Evengård B
Published: August 2010

Malm G, Teäzr Fahnehjelm K, Wiklund S, Engman M‐L, Ivarsson SA, Petersson K, Evengård B. Three children with congenital toxoplasmosis: early report from a Swedish prospective screening study. Acta Pædiatr 1999; 88: 667‐70. Stockholm. ISSN 0803‐5253

The aim of this prospective study was to define the incidence of congenital toxoplasmosis in Sweden. Blood eluates collected on filter papers, Guthrie cards, from 40 978 newborn babies were analysed for specific immunoglobulin M (IgM) and IgG antitoxoplasma antibodies. This is a preliminary report of three children with congenital toxoplasmosis, defined by the occurrence of antitoxoplasma‐specific IgM antibodies. Two children were asymptomatic at birth. They were both normally developed at the age of 12 and 15 months, respectively. The third child had unidentified but uncomplicated symptoms of infection in the neonatal period. As a result of the screening congenital toxoplasmosis was confirmed and treatment instituted. Microphthalmus and peripheral chorioretinitis were detected in one eye. In spite of the chemotherapeutic treatment he developed hydrocephalus needing neurosurgical intervention at the age of 3 months. His development at 14 months was normal. The incidence in Sweden of congenital toxoplasmosis detected by specific IgM antitoxoplasma antibodies in blood from filter papers is less than 1:10 000. □Congenital toxoplasmosis, Guthrie cards, screening study
Percutaneous endoscopic gastrostomy in children with cancer
Authors: Pedersen A‐M Bisgaard , Kok K , Petersen G , Nielsen OH , Michaelsen KF , Schmiegelow K
Published: August 2010

We reviewed the clinical course of 32 children with cancer who received nutrition through a feeding tube placed percutaneously during gastroscopy (PEG). Their median age was 5.1 y (75%, range: 1.8—13.7 y, min: 3.5 mo) when the PEG was done 0.7—23 mo after diagnosis (median: 1.8 mo, 75%; range: 0.9—8 mo). Five of the children underwent bone marrow transplantation with the gastrostomy in place. There was a significant (p = 0.0001) decrease in the median weight‐for‐age SDS of 0.55 (75%, range: −1.18—0.28) from the time of diagnosis to placement of the gastrostomy. Twenty‐two percent of the children had neutrophils < 0.5 × 109/l at the time of placement. There were no major postoperative complications. Seventy‐two percent of the patients experienced a total of 55 minor and transient complications including leakage of gastric juice (n = 29), superficial wound infections (n= 23), mechanical problems (n= 2), or bleeding (n= 1). There were no documented cases of bacteraemia. Twelve of the wound infections (52%) arose during neutropenic episodes. Two tubes were replaced due to mechanical problems. There was a median increase in weight SDS of 0.3 (75%, range: −0.6—1.1) from the time of placing the gastrostomy to the end of follow‐up (p = 0.054). Nutrition via gastrostomy in children with cancer has several advantages. It is rarely associated with more than minor complications, it is cosmetically more acceptable than the nasogastric tube and it improves nutrition at far lower cost than parenteral nutrition. In selected cases in which bone marrow transplantation or intensive treatment protocols are planned, we suggest that a gastrostomy should be considered before malnutrition develops. □Cancer, child, gastrostomy, nutrition
Postprandial plasma amino acids in preterm infants: influence of the protein source
Authors: Moro G , Minoli I , Boehm G , Georgi G , Jelinek J , Sawatzki G
Published: August 2010

Preprandial plasma amino acid concentrations have been used extensively as a marker of the nutritional value of dietary proteins in preterm infants. This study investigated the postprandial plasma amino acid profiles of preterm infants fed with different dietary proteins at similar protein intakes during the first weeks of life. In 12 preterm infants, pre‐ and postprandial plasma amino acid concentrations were measured before the removal of an indwelling central venous catheter placed for parenteral nutrition. All infants received breast milk until the time of study. At the start day of the study, infants were randomized to receive a test meal of 10 ml/kg, either of breast milk fortified with breast milk protein to reach a protein content of 2.0 g/dl or of a bovine milk preterm formula with a protein content of 2.0 g/dl (whey/casein ratio 60/40). Five samples of 100 μl blood were obtained immediately before and 15, 30, 45 and 60 min after the test meal. The plasma amino acid analysis was performed by a reversed‐phase high‐performance liquid chromatography based on o‐phthaldialdehyde/2‐mercaptoethanol pre‐column derivatization. In both groups, the plasma amino acid concentrations increased within the first 30 min and the levels did not return to the preprandial baseline during the observation period. Fifteen minutes after the test meal, the plasma levels of all essential amino acids with the exception of histidine were higher in the bovine milk formula fed infants than in the fortified breast milk fed infants. The sum of plasma essential amino acid levels found in the formula fed infants were significantly (p< 0.05) higher than the levels found in the fortified breast milk fed infants at 15, 30 and 45 min. The kinetics of individual amino acids were influenced by the different quality of the protein even when the intakes in the groups were similar, as demonstrated for histidine and phenylalanine. The data indicate that postprandial plasma amino acid concentrations depend significantly on the dietary amino acid source and cannot simply be calculated from the amino acid composition of dietary proteins. Therefore, postprandial plasma amino acid concentrations should be included in the nutritional evaluation of dietary proteins in preterm infants. □Dietary protein, postprandial plasma amino acids, preterm infants
Anthropometry, body composition and body image in dieting and non‐dieting 8‐16‐year‐old Swedish girls
Authors: Edlund B , Sjödén P‐O , Gebre‐Medhin M
Published: August 2010

Anthropometry, body composition and body image were studied in 122 Swedish 8‐16‐y‐old girls and their parents. The subjects participated in a 3‐y prospective longitudinal study and were selected randomly after stratification for grades from those scoring in the upper vs. the lower thirds of the Children's Eating Attitudes Test (ChEAT) score distribution. The ChEAT was completed 6 mo before the present study together with a demographic and dieting questionnaire and a questionnaire for the estimation of body size. In total 43%(n = 52) admitted ever dieting (“Dieters”) and 25%(n = 30) admitted that they were currently trying to lose weight. The anthropometric and body composition data indicated that ChEAT High‐scorers and Dieters were somewhat fatter than Low‐scorers and Non‐dieters, although this pattern was not shown among the 8‐y‐olds or the 14‐y‐olds (High‐scorers). The mothers of the ChEAT High‐scorers were found to be somewhat fatter than the other mothers. A current vs.ideal body shape discrepancy was shown for both High‐scorers and Dieters, with a larger discrepancy for the Dieters. All groups believed that their parents were aspiring for a leaner body. □Anthropometry, body composition, dieting behaviour, schoolgirls
Nosocomial meningitis in children after ventriculoperitoneal shunt insertion
Authors: Filka J , Huttova M , Tuharsky J , Sagat T , Kralinsky K , Krcmery V
Published: August 2010

This study reviews 33 cases of ventriculoperitoneal shunt (VPS) meningitis among 415 children after 540 shunt insertions within 8 y, in 9 paediatric intensive care units from 5 centres in Slovakia. The incidence of VPS meningitis was 6.3% per insertion. The most common organisms isolated from cerebrospinal fluid (CSF) and shunt were coagulase‐negative staphylococci (52.8%), followed by Staphylococcus aureus (13.1%) and Pseudomonas aeruginosa (7.5%). Seven of 15 assessed risk factors were significantly associated with VPS meningitis, compared with non‐VPS meningitis: prior meningitis with hydrocephalus (15.1 vs 1.5%, p< 0.015), perinatal pathology (51.1 vs 1.5%, p< 0.001), very low birthweight (66.6 vs 16.2%, p< 0.001), polymicrobial nosocomial meningitis (30.3 vs 5.9%, p < 0.002), S. aureus (21.2 vs 7.3%, p < 0.05), coagulase‐negative staphylococci (84.8 vs 30.9%, p < 0.001) and P. aeruginosa and Acinetobacter calcoaceticus (30.3 vs 4.5%, p < 0.001) in aetiology. □Ventriculoperitoneal shunt infections
Mental health and psychosocial characteristics in adolescent obesity: a population‐based case‐control study
Authors: Renman C , Engström I , Silfverdal S‐A , Åman J
Published: August 2010

In this population‐based study we compared self‐esteem, social background, social and academic competence, behavioural problems and lifestyle in 58 obese adolescents (BMI ≥ 99.6th percentile or ≥ 30 kg/m2), aged 14—18 y, with 58 sex‐ and age‐matched controls of normal weight. The instruments used were: I Think I Am, Youth Self Report and a lifestyle questionnaire. The obese group was on average, 40 kg heavier than the controls. The obese individuals rated themselves significantly lower in physical characteristics, but in all other aspects of self‐esteem, mental health and social and academic competence there were no differences between the two groups. There were significant socioeconomic differences, with more obese adolescents living with only one parent and with the mothers in the obese group having, in general, lower education than those in the control group. This study confirms previous observations that obesity is associated with special socioeconomic conditions in youth, but that obese adolescents do not differ from their normal‐weight peers in other aspects of mental health. □Adolescents, obesity, self‐esteem, social behaviour
Undescended testicles: an epidemiological review
Authors: Mayr JM , Lawrenz K , Berghold A
Published: August 2010

In a retrospective study the records of 447 boys (median age 5 y, age range 2 wk to 12y) undergoing orchidopexy in a university hospital paediatric surgical department over a 2‐y period were analysed for epidemiological factors related to disturbed testicular descent by comparison with the notes of an equal number of otherwise healthy male trauma patients matched for age. There were higher rates of peripartal asphyxia and intrauterine growth retardation (reflected by lower birthweights in combination with equal gestational age distribution), more complicated deliveries, an increased incidence of congenital malformations and more frequent occurrence of a number of chronic diseases in the families of affected boys. First‐ and second‐born boys were over‐represented in the study group. A cyclical pattern for the month of birth is suggested by the data, but this did not reach statistical significance. Neither was any statistical difference found for premature delivery, the incidence of extra‐uterine fertilization, hormonal treatment of the mother while pregnant, twin pregnancies, threatened or imminent abortions or parental age. The literature dealing with this topic was reviewed. Discrepancies between different studies can be explained, at least in part, by considering different forms of undescended testicles as different nosological entities that should be assessed separately in forthcoming research.
Passive immunity of premature infants against measles during early infancy
Authors: Özbek S , Vural M , Tastan Y , Kahraman I , Perk Y , Ilter Ö
Published: August 2010

The aim of this study was to evaluate the presence of transferred measles antibodies and seronegativity rates during early infancy in premature newborns whose mothers had infection‐induced immunity. The premature group was composed of 22 and 35 newborns of gestational ages ≤ 32 wk and >32 wk, respectively, and the control group consisted of 28 term newborns. Enzyme‐linked immunosorbent assay (ELISA) was used for the qualitative detection of IgG antibodies to measles virus. Mean cord blood relative values were significantly lower in both premature groups, ≤ 32 wk (p < 0.0001) and >32 wk (p < 0.001), when compared with term infants. No seronegative infant was found in the premature group at 2 mo of age. At 4 mo, the seronegativity rate was 27% for premature infants <32 wk and 35% for those >32 wk. At 6 mo, seronegativity increased to 86% and 74% for premature infants born at gestational ages ≤ 32 wk and >32 wk, respectively. Forty‐six percent of the term infants became seronegative at that age. The differences between term infants and those in the two premature groups were statistically significant (p<0.05 and p<0.005). Premature infants, regardless of their prematurity degree, were thought to be more susceptible to measles infection than term ones at the age of 6 mo. Policies for their protection from measles infection are still to be investigated.
Health and health behaviours among Swedish adolescents during a period of social change
Authors: Grufman M , Carlsten C , Krabbe M , Berg‐Kelly K
Published: August 2010

In Sweden there have been cutbacks in the welfare system and increasing unemployment during the 1990s. In what way have these external factors influenced health and behaviour among adolescents? The study describes health profiles and behaviours among students in three schools in Gothenburg, Sweden. Results are based on 2284 self‐reports, representing 88% of available students in 7th and 9th grades with mean ages of 13.5 and 15.5 y, respectively. The study questionnaire was administered four times, in 1990, 1992, 1994 and 1996. The reported health and behaviours showed remarkable stability over the period. When the surveys from 1990 and 1992 were aggregated and compared with the surveys of 1994 and 1996 there was a small increase in psychosomatic symptoms, mental health symptoms and risk‐taking behaviours. Despite the drastic social changes during the 1990s there was only a small change for the worse in reported health and behaviours. It is possible that the external changes had little impact on adolescent networks, or that the period was too short to have had much impact on health and behaviour.
Acute phase proteins as markers of systemic illness in acute diarrhoea
Authors: Darling JC , Filteau SM , Kitundu JA , Kingamkono RR , Msengi AE , Tomkins AM
Published: August 2010

Fifty‐seven Tanzanian children, 6–25 months, hospitalized with acute diarrhoea were grouped according to whether there was clinical evidence of systemic infection (SI) (n= 35) or not (n= 22). Serum acute phase proteins were measured in samples taken within 48 h of admission. Means for C‐reactive protein (CRP) and serum amyloid A (SAA) were significantly higher in children with SI compared to those without (geometric means (95% CI); CRP, mg/l: 22.1 (13.6‐35.5) vs 7.4 (4.4‐12.4); SAA, mg/l: 12.2 (6.8‐22.1) vs 4.9 (2.5‐9.7)). Levels of o1‐acid glycoprotein were similar in both groups (1.16 g/l (0.95‐1.43) vs 1.04 (0.83‐1.29), respectively). CRP ≥ 30 mg/l had a positive predictive value of 95%, and specificity of 96% for correctly identifying SI, but a low sensitivity (51%) and negative predictive value (55%). Clinical outcome of diarrhoea was worse in children with SI: more needed intravenous fluids (23% vs 5%), the duration of diarrhoea was longer (59.4 vs 34.2 h) and mortality was higher (6% vs 0%). APPs were not found to be useful markers of systemic illness in acute diarrhoea in this population.
Antepartum fetal and maternal carboxyhemoglobin and cotinine levels among cigarette smokers
Authors: Hayde M , Bernaschek G , Stevenson DK , Knight GJ , Haddow JE , Widness JA
Published: August 2010

The objective of this study was to examine the association of carboxyhemoglobin (COHb) and plasma cotinine levels among pregnant women who smoke cigarettes and their fetuses. Fifteen pregnant women who smoked and their fetuses undergoing cordocentesis had blood samples analysed simultaneously for COHb and cotinine. Linear regression was used to test for associations among study variables. Significant maternal‐fetal associations were observed both with COHb (r= 0.72, p= 0.003) and with cotinine (r= 0.96, p= 0.003). Maternal cotinine levels were correlated with maternal and fetal COHb levels (r= 0.96, p= 0.003; r= 0.99, p= 0.0003, respectively). Fetal cotinine levels were correlated with COHb in maternal and in fetal blood (r= 0.81, p= 0.0003; r= 0.88, p < 0.0001, respectively). The strong direct associations of maternal and fetal levels of COHb and cotinine indicate that maternal COHb and cotinine measurements may be interpreted as surrogates of fetal COHb levels. However, the specificity, ex vivo stability and ease of measurement of cotinine offer advantages over using COHb in quantifying fetal CO exposure following maternal cigarette smoking.
Automated auditory brainstem response in neonatal hearing screening
Authors: van Straaten HLM
Published: August 2010

Severe congenital hearing impairment is an important handicap affecting 0.1% of apparently healthy liveborn infants and 1‐2% of graduates of neonatal intensive care units. The prognosis for intellectual, emotional, language and speech development in the hearing‐impaired child is improved when the diagnosis is made early and intervention is begun before the age of 6 mo. Universal screening is preferable, since about 50% of infants with hearing loss are not discovered if neonatal hearing screening is restricted to high‐risk groups. The automated auditory brainstem response (AABR) screener is a dedicated hearing screening device which provides information not only about the outer/middle ear and cochlea but also about the auditory pathway up to the brainstem. AABR has an agreement with conventional auditory brainstem response up to 98%. It uses a 35 dB near hearing level click. No operator interpretation is needed and it can be used on the ward and during oxygen therapy without disturbance from ambient noise. Reported referral rates in a hospital‐based screening programme at the time of discharge vary, with an average of 4%. AABR has also been used in a home‐based setting, with the same results. The time necessary for screening varies with the setting, but ranges from 4 to 15min. Initial costs range from $15 to $25 per test, which is similar to neonatal screening for metabolic diseases. In addition to individual healthcare savings, early diagnosis may lead to savings on costs of intensive speech‐language intervention and educational facilities.
Inappropriately high plasma insulin levels in suspected perinatal asphyxia
Authors: Davis DJ , Creery WD , Radziuk J
Published: August 2010

The aim of this study was to determine differences in levels of the major hormones responsible for glucose homeostasis (insulin and glucagon) in babies with acute neonatal encephalopathy secondary to perinatal asphyxia and to correlate these with outcome. In a prospective observational study, plasma insulin, C‐peptide, glucagon and serum glucose levels were determined using standard techniques at specified times in term babies with a diagnosis on admission of perinatal asphyxia or acute neonatal encephalopathy. The setting comprised two university‐affiliated, regional, tertiary level neonatal intensive care units. Thirty‐one babies with a diagnosis of perinatal asphyxia or acute neonatal encephalopathy were entered into the study over 15 months and neurodevelopmental outcomes at 18 months of age for 28 babies were available for analysis. Babies with a poor neurodevelopmental outcome had significantly higher insulin and C‐peptide levels than those who had a good outcome. Glucose delivery, serum glucose and glucagon levels did not differ significantly between the babies with a poor outcome and those with a good outcome. In conclusion, babies with significant foetal or neonatal asphyxia frequently have inappropriately high plasma insulin levels. This, either alone or in combination with other hormonal disturbances, may lead to the hypoglycaemia often associated with severe asphyxia and may predict a poor outcome.
Breastfeeding duration and current neonatal feeding practices in Emilia Romagna, Italy
Authors: Faldella G , Di Comite A , Marchiani E , Govoni M , Salvioli GP
Published: August 2010

A cohort of 1567 infants was studied at birth and at 3 mo of age to elucidate factors possibly affecting feeding policies in the maternity ward and the relationship with subsequent feeding patterns. During their stay in the maternity wards 89.6% of infants were breastfed, with 28.1% receiving formula in addition to mother's milk. Independent predictors of receiving a formula supplement in the maternity wards as a result of multivariate analyses were the separation of the newborn from the mother, a birthweight lower than 3000 g and a gestational age lower than 38 wk. At 3 mo of age, 66.1% infants were still at least partially breastfed and 48.9% were exclusively breastfed. An increased risk of not being breastfed at 3 mo of age was related to supplementary feeding at birth and birthweight. A weak relationship was found between the prevalence of breastfeeding at 3 mo of age and the magnitude of routine formula supplement use in the maternity ward. Given the present trends for early discharge from maternity wards and the National Health System facility for free paediatric assistance after discharge, in Italy paediatricians should be the main actors to support the continuation of breastfeeding.
Vesico‐ureteric reflux: occurrence and long‐term risks
Authors: Jacobson SH , Hansson S , Jakobsson B
Published: August 2010

The prevalence of vesico‐ureteric reflux in the general population is unknown, but it is increased in risk groups, such as children with symptomatic urinary tract infection, schoolgirls with asymptomatic bacteriuria, first‐degree relatives of patients with reflux and children with prenatal dilatation of their upper urinary tract. Children and adults with pyelonephritic renal scarring are at risk of serious long‐term complications, e.g. hypertension and renal failure. Modern paediatric care, with early detection and treatment of urinary tract infections and reflux during childhood and adolescence, may improve long‐term prognosis. In the adult patient with established pyelonephritic renal scarring, careful control of hypertension may retard the rate of progression, and angiotensin converting enzyme inhibitors may have renal protective properties.
Cost‐analysis of management strategies for children with vesico‐ureteric reflux
Authors: Nicklasson L , Höjgård S
Published: August 2010

This study is an economic evaluation of three treatment strategies for vesico‐ureteric reflux in children: neo‐implantation; subureteric injection; and antibacterial prophylaxis. Cost‐analysis was used to compare the strategies, implying that the differences in benefits between them were not measured. Direct and indirect costs are included, taking the analytical viewpoint of the community. For the surgical strategies, data from four different hospitals in Sweden were used, and for the prophylactic strategy, data was gathered through a survey of 31 hospitals. The treatment strategies were ranked in the following order (bilateral reflux in parentheses): (i) subureteric injection SEK 25 000‐28 000 (26 000‐36 000); (ii) antibacterial prophylaxis SEK 16 000‐36 000; and (iii) neo‐implantation SEK 65 000‐90 000 (72 000‐95 000).
Attenuated endothelin‐1 mRNA expression with endothelin‐1 receptor blockade during hypoxaemia and reoxygenation in newborn piglets
Authors: Medbø S , Beisvag V , Tølløfsrud PA , Ellingsen Ø , Wright MS
Published: August 2010

We investigated the cause of decreased plasma endothelin‐1 (ET‐1) during hypoxaemia and reoxygenation in newborn piglets subjected to simultaneous blocking of the ET‐1 receptors. Changes in plasma ET‐1 and prepro‐ET‐1 mRNA expression in the main pulmonary artery and the left lower lobe in the lung were studied in 1‐2‐d‐old piglets. Ten minutes prior to hypoxaemia, the hypoxaemia group (n = 10) was given saline, two groups (both n = 9) were given 1 and 5 mg/kg i.v. SB 217242 (an ET‐1 receptor antagonist). Two groups served as normoxic controls, with and without SB 217242 5 mg/kg i.v. Hypoxaemia was induced by ventilating with 8% O2 until base excess was 20mmol/l or mean arterial blood pressure was < 20mmHg. Reoxygenation was performed for 2h with room air. During hypoxaemia, plasma ET‐1 decreased in the hypoxaemia group, remained unchanged in the 1‐mg group and increased in the 5‐mg group. At the end of reoxygenation, plasma ET‐1 was above baseline in the 1‐mg and 5‐mg groups. In the pulmonary artery, the hypoxaemia group showed 2‐ to 5‐fold higher prepro‐ET‐1 mRNA expression compared to all the other groups (p < 0.05). There were trends for higher prepro‐ET‐1 mRNA expression in pulmonary tissue in the hypoxaemia group compared to the two receptor‐blocking groups (p < 0.07).

Conclusions: We conclude that hypoxaemia and reoxygenation increase prepro‐ET‐1 mRNA expression in the pulmonary artery in newborn piglets. These observations suggest that the half‐life of ET‐1 is decreased during hypoxaemia and reoxygenation in newborn piglets.
Cataracts after autologous bone marrow transplantation in children
Authors: Frisk P , Hagberg H , Mandahl A , Söderberg P , Lönnerholm G
Published: August 2010

We recorded the incidence and degree of posterior subcapsular cataract (PSC) in 29 children who had undergone autologous (n = 28) or syngeneic (n = 1) bone marrow transplantation (BMT) due to haematologic or lymphoid malignancy. Conditioning prior to transplantation consisted either of a combination of chemotherapy and total body irradiation (TBI) (n = 21) or of chemotherapy only (n = 8). TBI was given in one fraction of 7.5 Gy. Nine patients had received previous cranial irradiation. The patients were followed for 4‐10 y (median 8y) after transplantation. Of 29 patients, 22 developed PSC, all within 4 y after BMT. With the exception of one patient who developed unilateral PSC, all had received TBI. Conversely, 100% of those who received TBI developed PSC. In this group (+TBI), eight patients (38%) developed significant PSC, defined as best corrected visual acuity < 0.8 in either eye. Six patients (10 eyes) have since needed surgical repair consisting of extracapsular cataract extraction and intraocular lens implantation. There was no clear relationship between previous cranial irradiation and cataract development, nor any other obvious baseline differences between those in the +TBI group who developed significant PSC and those who did not. Although effects of previous therapy cannot be ruled out, TBI appears to be the main cause of PSC in this group of patients. Twelve patients in the +TBI group had well‐preserved visual acuity throughout the study, reflecting a slow progression of PSC. This compares favourably with previous reports of allogeneic BMT, possibly owing to less need for corticosteroids after autologous BMT.

We conclude that the incidence of PSC was high after autologous BMT where the conditioning regimen included total body irradiation.
Epidemiology of invasive and other pneumococcal disease in children in England and Wales 1996–1998
Authors: Miller E , Waight P , Efstratiou A , Brisson M , Johnson A , George R
Published: August 2010

The results of enhanced national surveillance of pneumococcal disease in children <15y of age in England and Wales are reported for the period 1996–1998. Of the 1985 cases of laboratory‐confirmed invasive disease (annual incidence 6.6 per 100000 overall and 39.7 per 100000 in infants <1 y of age), 485 (24%) were meningitis (annual incidence of 1.6 per 100000 overall and 15.7 per 100000 in infants <1 y of age). Fifty‐nine deaths in children with invasive disease were identified‐3% of the total reports. Thirty‐one different serogroups/types were identified, with organisms in the 7‐valent conjugate vaccine responsible for 69% of the infections in children <5 y of age; this rose to 77% and 82%, respectively, for the 9‐and 11‐valent vaccines. Resistance to penicillin varied from 2.3% to 6.2% in different years, but erythromycin resistance remained constant at 17%. The vast majority of resistant isolates were in vaccine serotype/groups. Computerized hospital admission records for all children <15 y of age with a discharge diagnosis code indicating probable pneumococcal disease were also analysed for 1997. The annual incidence for cases with a code specifically mentioning S. pneumoniae was 9.9 per 100000 compared with 71.2 per 100000 for lobar pneumonia; the mean duration of stay for both was < 1 wk. The incidence of admission for pneumococcal meningitis (1.9 overall and 19.6 for infants < 1 y of age) was similar to that derived from laboratory reports and resulted in an average duration of stay of 2 wk.

Conclusion: This surveillance has confirmed the substantial burden of morbidity attributable to pneumococcal disease in British children and the potential public health benefits that could be achieved by the use of pneumococcal conjugate vaccines.