bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors relating to the cardiac sequelae of Kawasaki disease one month after initial onset
Authors: Zhang T , Yanagawa H , Oki I , Nakamura Y
Published: August 2010

This study aimed to determine the risk factors related to the presence of cardiac sequelae 1 mo after initial onset and to examine the preventive effect of the early administration of high‐dose gamma‐globulin (GG) on cardiac sequelae in patients with Kawasaki disease. Patients treated with high‐dose GG of 2000 ± 100 mg kg‐1 were selected as subjects from the 15th nation‐wide survey in Japan. Univariate and logistic multiple variable analyses were used to test the effects of background variables such as age and gender, variables relating to laboratory findings such as the percentage of neutrophil leucocytes, and variables relating to the GG treatment on the presence of cardiac sequelae. The odds ratios were significantly higher for males (1.48), those younger than 1 y of age (1.71), recurrent cases (2.42), and those with a low haematocrit (>32.5%) (1.45) and high percentage of neutrophil leucocytes (<68%) (1.63). The odds ratio was low for those who started GG administration in less than 6 d from onset between the patients with and without cardiac sequelae. The odds ratio for the duration of GG treatment was not significantly different between those with and without cardiac sequelae.

Conclusion: Patients who received early administration of GG, less than 6 d from onset of the disease, had a lower risk than those received GG more than 6 d from the onset. The percentage of neutrophil leucocytes and the haematocrit level are useful indicators in predicting the development of cardiac sequelae.
Postnatal urinary conductance measurement in preterm infants
Authors: Rangaraj S , Penney MD , Ferguson SD
Published: August 2010

The aim of this study was to determine whether serial urinary conductance measurements can be used to estimate reliably the end of the transition period of negative sodium balance in preterm infants. The relationship between urine conductance, measured by a conductance meter, and urine sodium concentration was determined in 109 pooled samples of urine obtained from 14 preterm infants during the transitional period of fluid balance. It was shown by linear regression analysis that urine sodium concentration (mmol 1‐1) = 0.78 ± urine conductance – 1.25. Urine sodium concentrations derived from the above formula were concordant with urine sodium measured directly when used to calculate daily sodium balance in all 14 infants.

Conclusion: Urine conductance can be accurately measured at the cotside by neonatal nurses and used to identify the timing of the postnatal transition from negative to positive sodium balance in preterm infants. These findings can help in making decisions on the introduction of postnatal sodium administration to preterm infants.
Breastfeeding, baby friendliness and birth in transition in North Western Russia: a study of women's perceptions of the care they receive when giving birth in six maternity homes in the cities of Archangelsk and Murmansk, 1999
Authors: Helsing E , Chalmers BE , Dinekina TJ , Kondakova NI
Published: August 2010

Women's own views on the quality of the birthing care they received were recorded in a small study in the cities of Archangelsk and Murmansk in February 1999. Six maternity wards took part; one hospital had already been designated as a Baby Friendly Hospital (BFH) according to the strict global criteria of the WHO/UNICEF‐recommended Baby Friendly Hospital Initiative (BFHI). Two of the hospitals had made profound changes in feeding routines and were by their own reckoning close to achieving this distinction, and were included in the BFH group. Three maternity wards were far from being in compliance with the BFHI approach and were grouped as the Non‐Baby‐Friendly Hospitals (NBFH). A total of 180 newly delivered mothers answered a 60‐item questionnaire about their birthing and breastfeeding experiences. The questions were chosen from an existing protocol, the WEB (Women's Experiences of Birth) developed by one of the authors (BC). The study was part of an informal evaluation of five years of BFHI activities in the Barents Region, supported by Norway, and also aimed at recording any positive carry‐over effect of the BFHI into obstetric routines as a whole.

Conclusion: It was found that the project definitely had had an impact; feeding practices at the BFH were markedly closer to the international BFHI recommendations than at the NBFH. BFH mothers, however, reported suffering from breastfeeding problems just as often or more so than NBFH mothers. Possible explanations are discussed; it is concluded that this cross‐sectional study may depict a transitory situation in the BFH. At the two hospitals not yet assessed, although staff felt that they had made profound changes, they may not yet have grasped the full extent and stringency of the changes required. The study shows that, despite good will, some practical details had not yet been worked out, resulting in a mixed outcome for the mothers. There was no noticeable carry‐over of the attitudes and basic ideas of the project into obstetric care, either in the BFH or in the NBFH, so changes in this area may require separate strategies.
Severe sleep problems in infancy associated with subsequent development of attention‐deficit/hyperactivity disorder at 5.5 years of age
Authors: Thunström M
Published: August 2010

The aim of this five‐year prospective study was to follow and compare a group of children with severe sleep problems in infancy with a control group regarding development of symptoms of attention‐deficit/hyperactivity disorder (ADHD). Factors in infancy were sought which were associated with development of ADHD in later childhood. A total community sample of 2518 infants aged 6–18 mo was approached with a questionnaire, and 83% responded. Data from the collection procedure point to a non‐selective dropout. A case group of those children aged 6–12 mo who fulfilled specific criteria for severe and chronic sleep problems (n= 27) was compared with a control group of equal size, matched for age and gender. At the age of 5.5 y, seven of the children in the sleep problem group met the criteria for the diagnosis of ADHD based on an in‐depth assessment by a multidisciplinary team. None of the control children qualified for the diagnosis. This difference is statistically significant. Comparisons between the children with ADHD and the rest of the problem group showed that given severe infant sleep problems, the following characteristics in infancy were associated with subsequent diagnosis of ADHD: psychosocial problems in the family, bedtime struggles and long sleep latency at bedtime. Owing to the small sample size, the results are considered preliminary.

Conclusion: Approximately one in four children with severe sleep problems in infancy will later qualify for the diagnosis of ADHD. Infants with severe sleep problems, especially in combination with behavioural problems, high activity level and psychosocial problems in the family, deserve attention since neurodevelopmental problems seem to be prevalent in this category of children.
Influence of leptin levels and body weight in survival of children with sepsis
Authors: Blanco‐Quirós A , Casado‐Flores J , Arranz E , Garrote JA , Asensio J , Pérez A
Published: August 2010

High levels of serum leptin (LPT) were reported in adult patients with sepsis and a protective role was suggested. LPT was determined in sera from 55 children with severe sepsis at admission (0 h), 6, 24 and 48 h. LPT levels were higher at 0 h than at 24 h (2.80 vs 1.61 ng/ml; p= 0.009) and a negative correlation was found with IL‐13 (p= 0.009), and granulocyte counts (p= 0.035), but not with other factors. Infants younger than 12 mo of age had higher LPT levels than older infants (5.88 vs 2.38 ng/ml; p= 0.0005). The increase in LPT levels was higher in non‐survivor patients than in survivors, with a maximum difference at 24 h (5.30 vs 1.45 ng/ml; p= 0.0042). However, LPT levels were not associated with shock, multiorgan failure or the severity score. Children who died showed higher percentiles of weight than survivors (p= 0.025). A subgroup with higher LPT (<Pc75) included mainly patients with weight <Pc50 (p= 0.0065), low IL‐13 levels (p= 0.007) and low granulocyte counts (p= 0.013), Neisseria meningitidis B being the most frequently isolated germ (p= 0.022).

Conclusion: Using a model of severe infection, mainly meningococcal, in young children (median 3 y 6 mo old), it was not possible to confirm previous results in adults. A general protective role for LPT in sepsis seems unlikely.
Different proinflammatory reactions in fatal and non‐fatal enterovirus 71 infections: implications for early recognition and therapy
Authors: Lin T‐Y , Chang L‐Y , Huang Y‐C , Hsu K‐H , Chiu C‐H , Yang K‐D
Published: August 2010

Aim: The mechanism of pulmonary oedema, a life‐threatening manifestation of enterovirus 71 (EV71) encephalitis, is unclear. Our aim was to assess the relationship of proinflammatory cytokines to EV71‐related pulmonary oedema. Methods: Proinflammatory responses in 33 EV71 patients with various complications and 21 normal healthy children were measured using an enzyme‐linked immunosorbent assay. Results: EV71 patients with both encephalitis and pulmonary oedema were found to have much higher levels of blood interleukin‐6 (IL‐6) (947 ± 1239 vs 4.9 ± 3.1 pg/ml, p= 0.0003), tumour necrosis factor‐α (TNF‐α) (22.4 ± 29.5 vs 5.3 ± 1.0 pg/ml, p= 0.0035), interleukin 1β (IL‐1β) (48.4 ± 85.2 vs 4.9 ± 10.1 pg/ml, p= 0.01), white blood cell count (28.3 ± 7.6 vs 15.5 ± 6.8 109/L, p± 0.0001) and blood glucose (501 ± 186 vs 165 ± 117 mg/dL, p= 0.0009) than patients with EV71 encephalitis alone. In fact, the cytokine levels in patients with encephalitis only or in those without complications were not significantly different from the levels found in normal children. The sensitivity, specificity, positive and negative predictive values of IL‐6 < 70 pg/ml for EV71 encephalitis with pulmonary oedema were all 100%.

Conclusion: Patients with EV71‐related encephalitis combined with pulmonary oedema were found to have significantly elevated levels of proinflammatory cytokines and the best predictor for this complicated condition was found to be the level of serum IL‐6.
Injuries in public and private playgrounds: the relative contribution of structural, equipment and human factors
Authors: Petridou E , Sibert J , Dedoukou X , Skalkidis I , Trichopoulos D
Published: August 2010

The aim of this case‐control study was to identify and quantify risk factors of injuries in playgrounds, where children spend an increasing amount of time in developed countries. The study took place in Greater Athens during 1999. A continuous Emergency Departments Injury Surveillance System (EDISS) of hospitals that cover about 30% of the children's time at risk in Greater Athens identified 777 injuries in public and private playgrounds out of a total of 17 497 injuries. Public playgrounds differ from private ones, because the former generally have more equipment, usually of greater height, with less resilient surfaces, and supervision relies mainly on parents or guardians. Patterns of type of playground use were assessed in a sample of 294 children from the same study base who served as a control group in a hierarchical case‐control design. The annual incidence of playground injuries in Greater Athens was about 7 in 1000 among boys and 4 in 1000 among girls, with a 2.2 times higher risk for an injury in public than in private playgrounds (95% confidence interval 1.61–3.07). Children in public vs private playgrounds had a statistically significant eight times higher odds for concussion and six times higher for open wounds, whereas the odds for long bone fractures were four and for other fractures two; swings, slides and seesaws were the types of equipment most frequently associated with injuries. It was further shown that supervision of children was suboptimal (>60%) in both public and private playgrounds, and children in private playgrounds sustained an unduly high frequency of sprain/ dislocation injuries (odds ratio 1.75) because they were encouraged to play bare‐footed.

Conclusion: Close to 50% of playground injuries could be prevented by structural and equipment changes, while further reduction could be accomplished through simple measures including closer supervision and encouraging children to wear proper shoes and use protective equipment whenever necessary.
Thymus size at birth is associated with infant mortality: a community study from Guinea‐Bissau
Authors: Aaby P , Marx C , Trautner S , Rudaa D , Hasselbalch H , Jensen H , Lisse I
Published: August 2010

A few studies have suggested that thymus atrophy is associated with severe malnutrition and increased morbidity; however, no study of thymus size has been undertaken in countries with high mortality. This study examined the relation between thymus size at birth and subsequent mortality in an urban West African community. The size of the thymus was assessed by sonography as a volume estimate, the thymus index. A total of 278 children born at the local health centre in Bandim in Bissau, Guinea‐Bissau, was enrolled in the study. Children were followed to the age of 2 y. Thymus size at birth was associated with most strongly weight, as well as with length and arm circumference. Controlling for weight and other risk factors, boys had larger thymus indices than girls [means ratio (MR) = 1.07, 95% confidence interval (95% CI) 1.01–1.14)]. Thymus size was also associated with prematurity, ethnic group, season and investigator, but not with birth order, mother's age, socioeconomic factors or the use of health services. Infant mortality was 117/1000. In a multivariate analysis, excluding premature infants and adjusting for age, gender, ethnic group, season of birth and investigator, higher birthweight (MR = 0.35, 95% CI 0.16–0.74) and larger thymus size (MR = 0.17,95% CI 0.06–0.48) were independently associated with lower infant mortality. When both indices were estimated in the same model, the thymus index was associated with infant mortality (MR = 0.27, 95% CI 0.07–1.00), whereas birthweight had a non‐significant effect (MR = 0.59, 95% CI 0.24–1.47). After 1 y of age neither birthweight nor thymus size at birth was associated with mortality.

Conclusion: As all deaths were due to infectious diseases, thymus size at birth may be an important predictor of immune competence. Future studies should examine the determinants of thymus growth.
Body composition, as assessed by bioelectrical impedance spectroscopy and dual‐energy X‐ray absorptiometry, in a healthy paediatric population
Authors: Fors H , Gelander L , Bjarnason R , Albertsson‐Wikland K , Bosaeus I
Published: August 2010

The aim of this study was to determine the level of agreement between body composition measurements by dual‐energy X‐ray absorptiometry (DXA), single‐frequency bioelectrical impedance analysis (BIA) and multifrequency bioelectrical impedance spectroscopy (BIS). Fat‐free mass (FFM), body fat mass and body fatness (percentage fat) were measured by DXA, BIA and BIS in 61 healthy children (37M, 24F, aged 10.9–13.9 y). Estimates of FFM, body fat mass and body fatness were highly correlated (r= 0.73–0.96, p > 0.0001) between the different methods. However, a Bland‐Altman comparison showed wide limits of agreement between the methods. The mean differences between methods for FFM ranged from 2.31 ± 7.76 kg to 0.48 ± 7.58 kg. Mean differences for body fat mass ranged from 0.16 ± 5.06 kg to 2.95 ± 5.65 kg and for body fatness from 2.3 ± 7.8% to 0.8 ± 9.3%. Calculations of body composition with BIS were not superior to BIA. However, BIA overestimated fat mass in lean subjects and underestimated fat mass in overweight subjects more than BIS, compared with DXA.

Conclusion: The methods used provided estimates of FFM, body fat mass and body fatness that were highly correlated in a population of healthy children. However, the large limits of agreement derived from the Bland‐Altman procedure suggest that the methods should not be used interchangeably.
Health, health‐compromising behaviour, sexuality and involvement in pregnancy among 18‐year‐old Swedish males: a cross‐sectional survey
Authors: Holmberg L , Berg‐Kelly K
Published: August 2010

The aim of this study was to determine whether there are differences regarding well‐being, health habits and health‐compromising behaviour between Swedish young men who had never had sexual intercourse (group I), those who were sexually active but without a pregnancy record (group II), and those who had caused pregnancies (group III). A self‐report questionnaire was used covering questions regarding health, health habits and risk behaviour. Tests of significance for differences between the three groups were performed with χ2‐tests. Differences were found in health, health behaviour and risk‐taking behaviour between the three groups of young men, with an apparent tendency towards riskier lifestyles from group I, through group II, to group III. Two especially striking findings were the more frequent use of anabolic steroids and the reported high rate of sexual offences in group III compared with groups I and II.

Conclusion: This study highlights serious health‐compromising behaviours in 18‐y‐old men involved in pregnancies in a medium‐sized Swedish city. This group has been largely ignored both in clinical practice and in scientific studies, in contrast to the huge efforts directed towards pregnant adolescent females. Public health workers, school health programmes and adolescent clinics need to acknowledge this and work accordingly.
Proteinuria and its consequences in renal disease
Authors: Schieppati A , Remuzzi G
Published: August 2010

Chronic renal diseases that involve proteinuria are typically characterized by an inexorable progression to end‐stage renal failure. Many studies suggest that this progression may be the result of factors, such as intraglomerular hypertension and glomerular hypertrophy, that are unrelated to the initial disease. This paper reviews the mechanisms of progression of chronic renal diseases and discusses therapeutic strategies that should prevent or minimize further renal damage and the applicability of these strategies to patients with the rare X‐linked lysosomal storage disorder Fabry disease. Renal involvement is a major feature of Fabry disease, which is characterized by vacuolated epithelial cells in the glomerulus and distal tubules, resulting from lipid inclusions within these cells. Although enzyme replacement therapy is the key strategy to halt the progression of Fabry disease, additional therapeutic options include blood pressure control, reduction of proteinuria, lipid control and inhibition of the renin‐angiotensin system.

Conclusion: A range of therapeutic options, used in conjunction with enzyme replacement therapy, may have beneficial effects on the renal manifestations of Fabry disease.
Inner ear function in children with Fabry disease
Authors: Keilmann A
Published: August 2010

Aim: The prevalence of hearing loss in patients with Fabry disease is still uncertain. This paper examines hearing loss in a group of young patients with Fabry disease.Methods: A clinical ear nose and throat examination, pure‐tone air and bone conduction audiometry, speech audiometry and middle ear testing (tympanometry and acoustic reflex testing) were carried out in four girls and two boys with Fabry disease (age, 7–17 years), receiving enzyme replacement therapy (ERT).Results: None of the patients complained of a hearing disorder or suffered from hearing loss. Three female patients reported tinnitus; however, this was not reported as being a problem. One boy reported tinnitus for the first time during 6 months of ERT.

Conclusion: Based on this small sample of patients, it appears that the hearing disorders associated with Fabry disease develop mainly in adulthood. Tinnitus may be an earlier symptom than previously thought in Fabry disease.
Higher drive for thinness in adolescent males with insulin‐dependent diabetes mellitus compared with healthy controls
Authors: Svensson M , Engström I , Åman J
Published: August 2010

Eating behaviour in adolescent males with insulin‐dependent diabetes mellitus (IDDM) living in central Sweden was compared with that of healthy age‐matched male controls using the Eating Disorder Inventory for Children and an interview. The patients were heavier than controls (p= 0.004) and had higher Drive for Thinness scores (p= 0.002). None was diagnosed as having a current eating disorder.

Conclusion: The results of the study may indicate an increased risk of future eating disorders in males with IDDM.
Adolescent‐friendly services
Authors: Berg‐Kelly K
Published: August 2010

The time has come to discuss adolescent‐friendly services and what these should entail.

Conclusion: The attitudes and skills of the staff are the keys to successful healthcare for the adolescent. Communication skills include providing time without parental presence. Confidentiality in the patient‐provider context is important but rules and practices vary from country to country and have to be learned. The United Nations Convention on the Rights of Children is a generic framework that makes a good starting‐point. Ambiguous cases should be referred to groups of professionals and lay people trained in medical ethics.
The importance of diet on exposure to and effects of persistent organic pollutants on human health in the Arctic
Authors: Odland JØ , Deutch B , Hansen JC , Burkow IC
Published: August 2010

Aim: To describe the importance of diet on exposure to and possible health effects of persistent organic pollutants (POPs) in the Arctic. Methods: The study is based on a literature review. Results: Minor decreases in POPs and minor increases in Hg levels in Arctic populations in Greenland, Eastern Russia, Western Alaska and Eastern Canada are likely to occur by the year 2010 and major decreases in both POPs and Hg levels in these same populations by 2030. Levels of POPs and metals in populations in the Faeroe Islands and the Scandinavian countries are already reasonably low and are only likely to decline marginally by 2030. Estimating the effects on the basis of current knowledge is difficult, but the combination of improved methodology and selection of risk groups will be a progressive step in the process. Any strategies based on traditional food substitution should ensure that the value of the dietary components is sustained.

Conclusions: To improve our understanding of the health effects associated with exposure to contaminants in the Arctic, we recommend that circumpolar epidemiological studies should be implemented on a larger scale. MeHg‐ and POPs‐related effects are still the key issues. However, the role of newly discovered contaminants, such as PBDEs (polybrominated diphenyl ethers) and PCNs (polychlorinated naphthalenes), should be investigated. For exposure assessment, mixtures and nutritional interactions should be considered in epidemiological studies. Epidemiological studies on nutritional benefits of traditional foods should be incorporated in risk‐assessment profiles. We need a more nuanced view on human dietary exposure to xenobiotics. Risk should not be evaluated alone, but seen in relation to benefits from specific diets. It is essential that countries ratify and implement multinational environmental agreements.
Hand strength in juvenile chronic arthritis: a two‐year follow‐up
Authors: Lindehammar H
Published: August 2010

Aim: To describe changes in muscle strength in the hands of children with juvenile chronic arthritis (JCA) and to examine the relationship between muscle strength, presence of local arthritis and disease subtype. Methods: Twenty children (10 girls and 10 boys) with JCA aged 7 to 18 y were followed for two years. Isometric muscle strength in wrist dorsiflexors and handgrip strength were measured repeatedly. The results were compared with reference values for the same methods. Arthritis severity in the hand was scored every third month. Nerve conduction velocities were measured twice. Results: Seven out of 20 patients had initially low or decreasing strength in one or both of the two tests. Five out of 20 children had reduced strength (more than two standard deviations below the mean of the reference group) in at least one test. Four children showed a significant reduction in muscle strength in at least one test during the observation time. The greatest reduction in strength was measured in four children with polyarticular disease. These children also had local arthritis in the hand. A greater proportion of children with polyarthritis had low or decreasing strength compared with children with oligoarthritis. The same was true for children with active arthritis in the hand. Nerve conduction velocities were normal in all cases and did not change.

Conclusion: The majority of children with JCA have normal strength in the hand. Some children, especially those with polyarthritis and hand arthritis, have reduced muscle strength in the hand. Risk factors for low or decreasing strength are polyarthritis and/or active arthritis in the hand.
Total energy expenditure, body composition and weight gain in moderately preterm and full‐term infants at term postconceptional age
Authors: Olhager E , Forsum E
Published: August 2010

Aim: To assess total energy expenditure (TEE) and body composition, i.e. total body water (TBW) and adipose tissue volume (ATV), at term age in 8 healthy preterm infants, born between gestational weeks 30 and 33, and in 9 healthy full‐term newborns. Methods: Total and subcutaneous ATVs were assessed using magnetic resonance imaging, while TEE and TBW were estimated using doubly labelled water. Results: Total ATV was 272 ±21 and 261 ± 56 ml/kg body weight, while subcutaneous ATV was 88.9 ± 1.6 and 89.7 ± 2.0% of total ATV for preterm and full‐term infants, respectively. The corresponding figures for TBW (as percentage of body weight) were 67.4 ± 2.5 and 68.1 ± 4.1, respectively. A significant correlation between ATV/kg body weight and body weight was found for full‐term (p < 0.0001) but not for preterm infants. TEE for preterm infants was 315 ± 20 kJ/kg body weight/24 h, which was significantly higher (p < 0.05) than TEE for full‐term infants (254 ± 45 kJ/kg body weight/24 h). At the time of investigation preterm infants weighed significantly (p < 0.05) less (540 g) than full‐term infants. After the time of investigation, weight gains of preterm and full‐term infants were 38 ± 12 and 24 ± 14 g/24 h, respectively.

Conclusion: When compared to full‐term newborns, predominantly breastfed healthy preterm infants at term postconceptional age were significantly smaller, had a similar average proportion of body fat and showed catch‐up growth. Their higher TEE/kg body weight can be explained by a higher growth rate and possibly also by higher physical activity.
Parental perception of educational, behavioural and general health problems in school‐age survivors of bacterial meningitis
Authors: Koomen I , Grobbee DE , Jennekens‐Schinkel A , Roord JJ , van Furth AM
Published: August 2010

Aim: To determine the occurrence of educational, behavioural and general health problems in Dutch school‐age survivors of bacterial meningitis. Methods: A cohort of 680 school‐age survivors of meningitis caused by the most common Gram‐positive and Gram‐negative bacteria was established approximately 6 y after the children's illness. Children with Haemophilus influenzae type b (Hib) meningitis were excluded because this form of the disease has virtually disappeared. Parents completed questionnaires on educational, behavioural and general health problems. The reference group comprised 304 school‐age siblings and peers. Results: Postmeningitic children were more likely than controls to under achieve at school: 20% vs 5% (odds ratio 5.6; 95% confidence interval 3.0–10.7). The postmeningitic children repeated a year twice as often as the children in the reference group (16% vs 8%, odds ratio: 2.5, 95% confidence interval 1.5–4.2) and were referred to a special‐needs school four times more frequently (8% vs 2%, odds ratio: 5.5; 95% confidence interval 2.0–15.4). Parents also reported more behavioural problems at home. More than half of the postmeningitic children experienced general health problems. The causative pathogen or age at infection had no influence on the relative frequency of educational and behavioural problems, and reduced auditory functioning played only a small part in these problems.

Conclusion: Parents perceive educational, behavioural and general health problems in more than 30% of postmeningitic children. Until it is clear which children are at highest risk of developing these problems, it will be necessary to follow postmeningitic children into their school‐age years.
Stability of longitudinal motor development in very low birthweight infants from 5 months to 5.5 years
Authors: Erikson C , Allert C , Carlberg E Brogren , Katz‐Salamon M
Published: August 2010

Aim: The motor performance of 165 very low birthweight (VLBW) infants was assessed prospectively at 5, 10, 18 mo and 5.5 y. The aim of the study was to evaluate longitudinal stability of motor development and its association with birthweight (BW), gestational age at birth, intraventricular haemorrhage (IVH), periventricular leucomalacia (PVL) and retinopathy of prematurity (ROP). Furthermore, at 5.5 y the motor behaviour of the VLBW population was compared with that of 124 children born at term. Methods: The results of each examination were ranked into four levels and the stability of motor development was evaluated on the basis of this ranking. At 5.5 y, VLBW children and controls were compared according to percentiles in the Movement ABC. Results: Fifty‐three percent of the VLBW infants displayed a stable motor development. Only PVL and BW contributed significantly to the variability in their motor performance. Forty‐seven percent of the infants exhibited an unstable motor development with no association to risk factors. In the entire group only IVH and severe ROP were related to poor motor performance. The majority of the VLBW children performed within the normal range at 5.5 y but their performances were inferior to those of control children.

Conclusion: VLBW infants with poor early motor performance and/or severe IVH/PVL and ROP should be recruited into individualized follow‐up programmes, whereas regular ongoing monitoring by follow‐up may be sufficient for those with normal early motor performance and normal ultrasound findings.
Factors of significance for mobility in children with myelomeningocele
Authors: Norrlin S , Strinnholm M , Carlsson M , Dahl M
Published: August 2010

Aim: To investigate neurological impairment, hand function and cognitive function in a group of children with myelomeningocele, in order to identify factors of significance for independent mobility and the physical assistance required for mobility in daily activities. Methods: The study material comprised 32 children, aged 6–11 y and without mental retardation. Mobility was assessed with the Pediatric Evaluation of Disability Inventory, scored as caregiver assistance. Statistical differences and correlations between the caregiver assistance scores and the selected variables were analysed. Results: Nine children scored independent mobility. The independent children had better hand coordination (p= 0.004) and walking ability (p= 0.01), lower cele levels (p= 0.011), higher performance IQ (p= 0.027), better visuospatial function (p= 0.029) and executive function (p= 0.037) than the others. The caregiver assistance scores were lower for both the children with early and severe symptoms of brainstem dysfunction and the children with scoliosis. Statistically significant correlations were found between the need for caregiver assistance and reduced walking ability, high cele level, poor hand strength and coordination, visuospatial function, executive function and performance IQ. In the subgroup of children who needed a wheelchair or walking aids, hand strength was the only variable significantly correlated with caregiver assistance (rs= 0.703, p= 0.000).

Conclusion: Most of the children were dependent on others in daily activities. Impaired hand function and cognitive function were significant for mobility, and this has implications for the therapy programme in children with myelomeningocele.
Effects of neonatal intensive care on girls' and boys' language development
Authors: Lacerda F
Published: August 2010

According to Jennische and Sedin, very premature boys are less affected in their speech and language development than a matched group of girls. This is discussed from a general linguistic perspective.

Conclusion: It is speculated that perinatal factors, timing and ambient aspects may impact on boys' advantage over girls.
Secular changes in body height and weight in children and adolescents in Poznan, Poland, between 1880 and 2000
Authors: Krawczynski M , Walkowiak J , Krzyzaniak A
Published: August 2010

Aim: A secular trend in body height and weight is well documented. The first observations concerning this phenomenon in Poland were made at the end of the 19th century. The aim of this study was to assess changes in body height and weight during the 20th century, with special emphasis on the last decade. Methods: The results of body height and weight measurements obtained in eight subsequent surveys (1880–1886, 1922–1927, 1946–1950, 1960–1961, 1970–1971, 1980–1981, 1990–1991 and 1999–2000) were included in the analysis. Mean values were compared and differences between the surveys were analysed. Results: In general, in the 20th century, children grew taller and heavier and reached final body height and weight more rapidly. The biggest differences in body height and weight in the 20th century, observed at growth spurt, were about 17 cm and 11kg, respectively, for boys, and 13 cm and 13 kg for girls. The magnitude of secular changes in body height and weight in the 20th century was not stable. There were periods of increased and decreased intensity of acceleration of physical development (the 1950s and 1970s, and the 1960s and 1980s, respectively), as well as a period of deceleration (the 1940s). In the last decade, the tendency has been towards deceleration in most age groups studied.

Conclusion: The acceleration of physical development in children in Poznan has now ceased.
Treatment of urinary tract infection with gentamicin once or three times daily
Authors: Chong C‐Y , Tan AS‐L , Ng W , Tan‐Kendrick A , Balakrishnan A , Chao S‐M
Published: August 2010

Aim: To examine the safety and efficacy of once‐daily (OD) gentamicin treatment compared with conventional 8‐hourly dosing (TDS) for urinary tract infection (UTI). Methods: This was a prospective, randomized, controlled trial of children 1 mo to 13 y of age with presumed UTI. Children were randomly assigned to OD gentamicin 5 mg kg−1 d−1 or TDS gentamicin 6 mg kg−1 d−1 divided 8 hourly. Microbiological efficacy, nephrotoxicity, ototoxicity and renal scarring were assessed at the end of treatment. Results: 210 patients with presumed UTI were recruited, of whom 172 were analysable (OD 84, TDS 88). The median age was 7 mo, 50% were male and 74% (n= 127) of patients had pyelonephritis. The majority of infections were due to Escherichia coli (n= 153, 89%), of which 9 (5.2%) were bacteraemic. Comparing the two groups, there was no significant difference in age, gender, duration of fever before admission, pyuria, nitrite positivity or initial total white blood cell count. All patients had negative urine cultures after 2–3 d of treatment, demonstrating 100% microbiological efficacy. There was no difference between the two groups in terms of ototoxicity, nephrotoxicity, duration of gentamicin treatment or time to fever defervescence.

Conclusion: OD gentamicin is as efficacious as TDS gentamicin in the treatment of UTI in children, with no difference in ototoxicity and nephrotoxicity.
Monitoring breastfeeding rates in Italy: national surveys 1995 and 1999
Authors: Giovannini M , Banderali G , Radaelli G , Carmine V , Riva E , Agostoni C
Published: August 2010

Aim: To assess and compare the rates of initiation and duration of breastfeeding in Italy in 1995 and 1999, and to examine the adherence to the ten steps to successful breastfeeding recommended by WHO. Methods: Two cohorts of mothers who delivered healthy infants in November 1995 (n= 1601) or November 1999 (n= 2450) were interviewed by telephone within 4 wk of delivery and when their infant were 3, 6, 9 and 12 mo of age. Type of breastfeeding was classified according to the WHO definitions. Adherence to the WHO ten steps was evaluated as experienced by the mothers. Results: Initiation and duration of breastfeeding increased during the 1995–1999 period (p < 0.0001). The rate of breastfeeding at birth, at discharge and when the infants were 3, 6, 9 and 12 mo of age was 85%, 83%, 42%, 19%, 10% and 4%, in 1995 and 91%, 89%, 66%, 47%, 25% and 12% in 1999. The rate of exclusive breastfeeding was higher in 1999 than 1995 at birth (39% vs 30%, p < 0.0001) and at discharge (77% vs 70%, p < 0.0001), but overall no longer duration was observed in 1999. At 4 and 6 mo of age the rate of exclusive breastfeeding was 25% and 8% in 1995 and 31% and 5% in 1999. The adherence to each WHO step was higher in 1999 than in 1995 (p < 0.05) but concomitant adherence was low (<3%).

Conclusion: Although an increase in initiation and duration of breastfeeding occurred in Italy during the 1995–1999 period, the duration of breastfeeding and exclusive breastfeeding is currently unsatisfactory, as is adherence to the ten steps specified by WHO. Promotion of breastfeeding and education and improvement in adherence to the WHO recommendations are still needed in Italy.
Extemporaneous (magistral) preparation of oral medicines for children in European hospitals
Authors: Conroy S
Published: August 2010

The lack of availability of licensed paediatric medicines forces pharmacists to compound drugs into a form that children can tolerate. There is a lack of information to support much of this practice and standards tend to vary. Suitable licensed alternatives are often available in other countries but importing restrictions complicate obtaining them.

Conclusion: Regulatory action is needed to simplify licensing and importation processes to facilitate universal access to suitable paediatric medicines.
Concentrations of dioxins and other organochlorines (PCBs, DDTs, HCHs) in human milk from Seveso, Milan and a Lombardian rural area in Italy: a study performed 25 years after the heavy dioxin exposure in Seveso
Authors: Weiss J , Päpke O , Bignert A , Jensen S , Greyerz E , Agostoni C , Besana R , Riva E , Giovannini M , Zetterström R
Published: August 2010

Aim: To investigate whether those who were exposed to high levels of the dioxin TCDD 25 years ago in Seveso, northern Italy still have higher than the expected levels of dioxins in their fat stores, and to investigate the concentrations of dioxins in the breast milk of mothers in Seveso and in two other regions in Italy. The load of vertically transmitted dioxins to the next generation, if being breastfed, was also investigated. Methods: As there may be a synergistic effect of mixtures of organic chlorines, the concentrations of pesticides such as DDTs and PCBs have also been studied in the same human milk samples. Breast milk from 12 mothers from Seveso, Central Milan and a Lombardian village was collected for analysis during the first week and 1 and 3 mo after delivery. Individual samples were used for the analysis of pesticides and PCBs, whereas dioxins were analysed in pooled samples from all 12 mothers on each occasion. Results: In human milk from Seveso, the TCDD concentration in fat calculated on a fresh weight basis was more than twice as high as the level in the other two regions, whereas the concentrations of investigated other toxins were lower in Seveso possible due to induction of the enzyme cytochrome P4501A, which means that the total level of dioxins was the same in all three locations. The congener profile, measured as mean toxic equivalency (TEQ) values, was the same in the Italian samples as previously reported from Stockholm. The calculations are based on the most recent WHO TCDD equivalency factors (TEF). The DDE concentration was higher in the samples from Milan than in the samples from the other two Italian regions, which may be due to the fact that, to a greater extent than in the other regions, Milanese food is imported from countries where DDT is still used as a pesticide.

Conclusion: Twenty‐five years after the dioxin catastrophe, human milk from mothers in Seveso has concentrations of the highly toxic dioxin congener TCDD that are more than twice as high as those in central Milan and a Lombardian village. This means that breastfed infants in Seveso still store an appreciable amount of TCDD in their body fat. The health consequences of this fact remain to be elucidated. The effect of the high load of DDTs in central Milan also has to be considered
Cost of hospitalization for respiratory syncytial virus chest infection and implications for passive immunization strategies in a developing nation
Authors: Chan PW‐K , Abdel‐Latif ME‐A
Published: August 2010

Respiratory syncytial virus (RSV) chest infection is a common cause of hospitalization in the very young child. The aim of this study was to determine the direct cost of resource utilization in the treatment of children hospitalized with RSV chest infection and the potential cost‐savings with passive immunization for high‐risk infants. An audit of the hospital resource consumption and its costs was performed for 216 children aged <24 mo admitted with RSV chest infection between 1995 and 1997. The cost‐saving potential of passive immunization using monoclonal RSV antibodies during the RSV season was determined by assuming an 0.55 efficacy in hospitalization reduction when administered to “high‐risk” infants according to the guidelines outlined by the American Academy of Pediatrics (AAP). The hospital treatment cost of 1064 bed‐days amounted to USD 64 277.70. Each child occupied a median of 4.0 bed‐days at a median cost of USD 169.99 (IQ1 128.08, IQ3 248.47). Children, who were ex‐premature or with an underlying illness were more likely to have a longer hospital stay, higher treatment costs and need for intensive care. Ten (42%) of 24 ex‐premature infants fulfilled the recommended criteria for passive immunization. Its use resulted in an incremental cost of USD 31.39 to a potential cost saving of USD 0.91 per infant for each hospital day saved.

Conclusion: Ex‐prematurity and the presence of an underlying illness results in escalation of the direct treatment cost of RSV chest infection. Current guidelines for use of passive RSV immunization do not appear to be cost‐effective if adopted for Malaysian infants.
Transferrin receptor in children and its correlation with iron status and types of milk consumption
Authors: Bramhagen A‐C , Virtanen M , Siimes MA , Axelsson I
Published: August 2010

Aim: This study compared transferrin receptor (TfR) concentrations with iron parameters relative to a child's intake of cow's milk and follow‐on formula.Methods: TfR, β‐haemoglobin, serum ferritin and mean corpuscular volume (MCV) of red blood cells were analysed in a study population of 263 children aged 2.5 y. The amounts of cow's milk and follow‐on formula consumed were recorded.Results: There was a significant difference in concentrations of TfR/log ferritin between children whose milk intake was <500 ml and those with a milk intake ≥500 ml (p= 0.003). There were significantly higher values of TfR/log ferritin in children whose MCV of red blood cells was ≤75 fl than in those with >75 fl (p< 0.0001). The TfR concentrations were significantly lower after iron therapy than before treatment.

Conclusion: Higher concentrations of TfR were correlated with lower concentrations of haemoglobin and MCV of red blood cells. Milk consumption increases the risk of a higher ratio of TfR/log ferritin. TfR concentrations were significantly lower after iron therapy.
Development of a conceptual tool for the implementation of kangaroo mother care
Authors: Bergh A‐M , Pattinson RC
Published: August 2010

Aim: To develop a conceptual tool to assist healthcare workers and management in the implementation of a kangaroo mother care programme. Methods: A qualitative research approach was followed and methods included on‐site observations and informal conversational interviews, as well as unstructured, in‐depth interviews with senior managers, doctors and nurses at two large training hospitals in the north of South Africa. A consultative process was used to refine the tool. Results: The patterns that emerged from the data were captured in a diagram, entitled: “Main issues in the establishment of kangaroo mother care”. In addition, a set of core questions was developed to assist in decision‐making at institutional level.

Conclusion: The diagram and questions contain concepts that could be adapted and used by a healthcare facility's multidisciplinary team in planning the implementation of kangaroo mother care and in reviewing the progress made in the implementation and the quality of the kangaroo mother care provided.
Coordination of suck‐swallow and swallow respiration in preterm infants
Authors: Lau C , Smith EO , Schanler RJ
Published: August 2010

Safe oral feeding of infants necessitates the coordination of suck‐swallow‐breathe. Healthy full‐term infants demonstrate such skills at birth. But, preterm infants are known to have difficulty in the transition from tube to oral feeding. Aim: To examine the relationship between suck and swallow and between swallow and breathe. It is hypothesized that greater milk transfer results from an increase in bolus size and/or swallowing frequency, and an improved swallow‐breathe interaction. Methods: Twelve healthy preterm (<30 wk of gestation) and 8 full‐term infants were recruited. Sucking (suction and expression), swallowing, and respiration were recorded simultaneously when the preterm infants began oral feeding (i.e. taking 1–2 oral feedings/d) and at 6–8 oral feedings/d. The full‐term infants were similarly monitored during their first and 2nd to 4th weeks. Rate of milk transfer (ml/min) was used as an index of oral feeding performance. Sucking and swallowing frequencies (#/min), average bolus size (ml), and suction amplitude (mmHg) were measured. Results: The rate of milk transfer in the preterm infants increased over time and was correlated with average bolus size and swallowing frequency. Average bolus size was not correlated with swallowing frequency. Bolus size was correlated with suction amplitude, whereas the frequency of swallowing was correlated with sucking frequency. Preterm infants swallowed preferentially at different phases of respiration than those of their full‐term counterparts.

Conclusion: As feeding performance improved, sucking and swallowing frequency, bolus size, and suction amplitude increased. It is speculated that feeding difficulties in preterm infants are more likely to result from inappropriate swallow‐respiration interfacing than suck‐swallow interaction.